Bill To Recognize Essential Caregivers Introduced in Congress
Federal law gives nursing home residents the right to “immediate access” to their immediate family and other relatives, 24 hours per day seven days per week and immediate access to others they want to see. Families are critical to the daily operations of nursing homes. They participate in assessment and care planning, help provide care and emotional support to their loved one, and inform staff of issues and problems. The public oversight system also relies on families to talk with state surveyors and to file complaints with the state department of health or federal government, as needed. Many family complaints alert government officials to the most serious problems in nursing facilities.
However, when the public health emergency was announced in March 2020, families were absolutely and completely barred from facilities. Residents were isolated in their rooms. Families and studies reported enormous physical and mental declines in residents as a result of isolation, loneliness, and neglect. Many residents died alone.
Although the Centers for Medicare & Medicaid Services (CMS) lifted the ban a year later, in March 2021, the ban on families continues, in actual practice, in far too many facilities. Many facilities, even now, continue to limit the frequency and duration of visits, telling families that they can visit for 40 minutes once or twice a week and not at all on weekends.
Families organized at the state level and formed a variety of groups, such as the Essential Caregivers Coalition, and successfully supported state laws and executive orders recognizing the principle of essential caregivers – people who perform critical functions for residents and must be allowed to be present, even during a public health emergency.
Federal legislation, the Essential Caregivers Act, H.R. 3733, has now been introduced in Congress. The bipartisan legislation says unequivocally that the government cannot ever again totally ban families. Regardless of any public health emergency, the bill guarantees that all residents can choose up to two people as essential caregivers who can provide them with assistance 12 hours each day and for an unlimited number of hours at the end of a resident’s life.
At a June 30, 2021 press conference, the legislation was introduced by its original sponsors, Congresswoman Claudia Tenney (R-NY) and Congressmen John Larson (D-CT) and John Rutherford (R-FL). Family members spoke movingly about the suffering of their parents and loved ones. Center for Medicare Advocacy’s Senior Policy Attorney Toby S. Edelman participated in the roundtable discussion later on June 30 that continued the discussion.
The Center supports H.R. 3733, the Essential Caregivers Act.
 42 C.F.R. §483.10(f)(4)(ii)
 42 C.F.R. §483.10(f)(4)(iii) provides “immediate access” to “others visiting with the consent of the resident, subject to reasonable clinical and safety restrictions and the resident’s right to deny or withdraw consent at any time.”
 CMS, “Guidance for Infection Control and Prevention of Coronavirus Disease 2019 (COVID-19) in Nursing Homes,” QSO-20-14-NH (Mar. 13, 2020), https://www.cms.gov/files/document/qso-20-14-nh-revised.pdf
 CMS, “Nursing Home Visitation – COVID-19 (REVISED),” QSO-20-39-NH (rev. Mar. 10, 2021), https://www.cms.gov/files/document/qso-20-39-nh-revised.pdf
 The full press conference is available at https://www.youtube.com/watch?v=7LPaOos5e_Q
 The roundtable discussion is available at https://www.youtube.com/watch?v=RjgZxJQTGvQ
 The Center’s statement is available at https://medicareadvocacy.org/wp-content/uploads/2021/07/Nursing-homes-Essential-Caregivers-Roundtable-06.30.2021.pdf
Connecticut Expands Medigap Options for Medicare Beneficiaries Under Age 65
Effective July 1, 2021, Connecticut Medicare beneficiaries who qualify for Medicare by reason of disability will be able to select standardized Medicare Supplement (“Medigap”) plan D, in addition to plans A and B. (Medigap plan C remains available only for those beneficiaries whose Medicare eligibility began before January 1, 2020). The Center for Medicare Advocacy worked with the state legislature to achieve passage of the amended statute to expand Medigap rights.
Connecticut law has strong Medigap protections for all Medicare-eligible residents. Plans are community-rated and have continuous guarantee issue – meaning rates are the same regardless of age and issuance of a policy cannot be denied based on age, pre-existing condition, or how long someone has been on Medicare.
Until 2020, companies selling Medigap plans in Connecticut had been required to offer Medigap plans A, B and C to individuals eligible for Medicare by reason of disability. However, the federal Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) restricted the sale of Medigap plan C (and F, and F high deductible) only to people eligible for Medicare before January 1, 2020. Therefore, anyone who became eligible for Medicare on or after January 1, 2020 may not buy or be sold Medigap plan C.
Both MACRA, and corresponding changes to Connecticut Insurance Regulations, indicate that Medigap plan C was to be re-designated as plan D. However, a corresponding change in the Connecticut General Statutes was needed to ensure that under Connecticut law, companies are required to offer Medigap plan D to individuals who qualify for Medicare by reason of disability.
Adding Medigap plan D for people who are Medicare-qualified by reason of disability allows for Medigap options as similar as possible to beneficiaries who became eligible for Medicare before January 1, 2020. These options in plan D include skilled nursing facility coinsurance and foreign travel emergency coverage.
The Center for Medicare Advocacy applauds the Connecticut state legislature for maintaining one of the United States’ most robust Medigap programs. Having continuous, community-rated Medigap options allows Connecticut Medicare beneficiaries more opportunities to move freely, as needed, between traditional Medicare and a Medicare Advantage plan. We encourage other states to follow suit with their own state laws.
 Connecticut General Statutes Title 38a, Chapter 700c, Section 38a-495c (d)
 Those age 65 or older without prior employer health insurance, MA-PD, or Medigap coverage within 63 days of Medigap enrollment may have a waiting period before pre-existing health conditions are covered by the Medigap policy. All beneficiaries under age 65 may be subject to applicable pre-existing condition waiting periods, regardless of prior coverage. Waiting periods are as long as 6 months for a pre-existing condition.
 Connecticut Insurance Regulations Section 38a -495a-6b (a)(1)
Connecticut Enacts Legislation with Wide-Ranging Impact for Long-Term Care
Over half of the COVID-19-related deaths in Connecticut (54%) occurred in the state’s long-term care facilities. In the 2021 legislative session, which just ended, state lawmakers considered a multitude of bills designed to address significant issues in long-term care that emerged from or were exacerbated by the pandemic.
The Center for Medicare Advocacy monitored the progression of these proposed bills through the state legislature. Below are key pieces of successful legislation that the Center believes will have wide-ranging, long-term care impacts in the state – spanning from resident rights, minimum direct care staffing requirements, technology for virtual visitation and safety monitoring, telehealth, access to home health services, and long-term care insurance. They may also serve as examples for future action nationally or in other states.
|Legislation Title||Bill / Public|
|An Act Strengthening the Bill of|
Rights for Long-Term Care
Residents and Authorizing the Use
of Resident Technology for Virtual
Visitation and Virtual Monitoring
|SB975, Public Act No. 21-55||Affirms that residents of long-term care facilities have the right to treat their living quarters as their homes and have the same rights as all other state residents, including the right to use technology for purposes such as virtual visitation and filing grievances for the violation of their rights.|
|An Act Concerning Access to|
Recordings and Images from
Technology Used by Nursing Home
Residents for Virtual Visitation and
|HB6457, Public Act No. 21-160||An employee of a nursing home facility or employee of a contractor providing services at a nursing home facility who is the subject of proposed disciplinary action by the nursing home facility based upon evidence obtained from technology used by a resident for virtual visitation or virtual monitoring will be given access to the evidence by the nursing home facility for the purposes of defending against such action.|
|An Act Concerning Nursing Homes|
and Dementia Care Units
|SB1030, Public Act No. 21-185||Included in this bill are multiple revisions to long-term care facility statutes, including minimum staffing level requirements in nursing homes. Key provisions: Minimum staffing requirement of 3 hours of direct care per resident per day (increase from current 1.9 hours per resident per day)Enhancing infection control procedures in nursing homes, such as requiring a full-time infection prevention and control specialistImproving emergency planning in nursing homes and other long-term care facilitiesRequiring at least a two-month supply of personal protective equipment for staff, in various sizes.Nursing home administrative heads are required to establish protocols to address resident’s social, emotional, and mental needs.|
|An Act Concerning Physician|
|SB1070, Public Act No. 21-196||This bill allows physician assistants and advanced practice registered nurses to issue home health orders.|
|An Act Concerning Payment|
Recoveries and Incentives Under
Public Assistance Programs
|HB6319, Public Act No. 21-65||This bill includes two main provisions: Requires family members of a be notified in writing when the state is claiming the estate of their deceased “next of kin” for public assistance debt. Makes permanent a pilot incentive program for providers who deliver public assistance for less than the contract amount of payment.|
|An Act Concerning Essential Support|
Persons and a State-wide Visitation
Policy for Residents of Long-Term
|HB6634, Public Act No. 21-71||This legislation will allow long-term care facility residents (or their representatives) to designate two essential support persons who will be allowed to visit in order to attend to the physical, emotional, psychological and socialization needs of the resident despite any potential general visitation restrictions imposed.|
|An Act Strengthening the Voice of|
Residents and Family Councils
|SB973, Public Act No. 21-194||This legislation requires input from resident councils and family councils* at long-term care facilities regarding any state-wide policies affecting living conditions for residents in the facilities. *Resident and family councils in LTC facilities alert management of those facilities about any concerns regarding the living conditions and care of residents.|
|An Act Concerning Telehealth||HB5596, Public Act No. 21-9||This legislation extends the telehealth service provisions initially enacted through the state’s emergency executive order due to the COVID-19 pandemic through June 30, 2023.|
|An Act Concerning Equitable Access|
|HB6442, Public Act No. 21-159||This bill implements the Governor’s budget recommendations to promote broadband build-out throughout Connecticut by: Developing an up-to-date state-wide broadband map with data showing with availability of broadband Internet access services, including download and upload speeds.Establishing a grant program to support the deployment of broadband access services, subject to availability of federal funding.Initiate a process for the construction of underground facilities to provide a conduit for telecommunications and broadband Internet service providers.|
|An Act Concerning Long-Term Care|
|SB1046, Public Act No. 21-150||This legislation includes a variety of consumer protection initiatives imposing measures on insurers that sell long-term care insurance in Connecticut including: Requiring the development of a minimum set of affordable benefit options for long-term care policies. Prohibiting insurers from filing additional rate increases for three years following an increase of 20 percent or more.Prohibiting insurers from offering long-term care insurance policies in the state unless the insurer is also authorized or licensed to sell another type of insurance.|
 KFF. State COVID-19 Data and Policy Actions. Available at: https://www.kff.org/coronavirus-covid-19/issue-brief/state-covid-19-data-and-policy-actions/
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