Sec.17-311-57. Hardship appeals

The commissioner shall consider requests for rate revisions due to hardship for any of the following reasons:

(a) A sale of a facility is contemplated because of the death of the principal owner of a facility, or the principal owner is unable to conduct any business activities due to documented health disability or to advanced age i.e., not less than 65 years. For purposes of these regulations, a principal owner is defined as an individual proprietor or the individual(s) owning the controlling equity in a partnership or corporation.

For those sales which result from the factors mentioned in the preceding paragraph, the property basis used in the application of the fair rental value system, may under certain circumstances be increased as a result of a sale of equity interest in a facility. Sales of partial interests and sales to individuals who are partners or shareholders with the seller in the facility subject to sale or any other long term care facility generally will not provide a basis for property valuation adjustment.

To enable the state to consider a claim for an adjustment in the property basis, the seller must petition the commissioner setting forth all of the pertinent facts of such sale. The commissioner shall examine the transaction and may consider factors such as the following in reaching a decision as to whether and in what amount the property basis may be adjusted.

(1) the reasonableness of the selling price.

(2) the arms-length relationships between the buyer, seller and mortgage lender.

(3) the cost of the property recorded by the seller and the effect thereon of inflationary cost increases as measured by recognized price indices such as the dodge building cost index and the implicit price deflator for the gross national product.

(4) the extent to which depreciation and amortization of the assets covered by the sale needs to be adjusted to reflect the inflationary cost increases determined pursuant to (3) above.

(5) the degree of financing by the seller in relation to the total selling price of the property.

Based on consideration of the foregoing and any other factors as the commissioner deems pertinent, the commissioner may decide that an adjustment in property basis is appropriate, equitable and does not prejudice the interests of the state.

No portion of the purchase price of any facility shall be recognized as purchased goodwill includable in the base for computation of return on equity.

In computing the fair rental value allowance for the revised value of the property, the remaining useful life of the property shall be the greater of:

(1) the remaining useful life of the principal buildings purchased; or

(2) longest term of any mortgage on the property.

Once the sale is effectuated, the commissioner must be notified whether the buyer or seller shall be held financially liable for future assets or the liabilities due to rate adjustments not known at the time of the sale. Failure to submit this information at the time of the sale may result in the commissioner not promulgating an interim rate for the new owner.

(b) A facility is unable to meet its debt service obligations to banks and other recognized financing institutions because of the insufficiency of the property fair rental value allowance included in the per diem reimbursement rate. If an adjustment in the rate is requested on this basis, the provider must petition the commissioner for an adjustment and set forth all the pertinent facts for the commissioner’s consideration. The commissioner shall examine the following and such other factors as he deems appropriate in reaching a decision as to whether and in what amount the per diem rate may be adjusted.

(1) the financial status of the facility must be considered exclusive of any transactions which are not recognized as allowable for rate computation under these regulations.

(2) The mortgage terms and amount must be reasonable in relation to the useful life and carrying amount of the property of the facility used for patient care, provided that the proceeds of refinancing are devoted to patient care.

(3) The mortgage transactions must have been entered into prior to December 20, 1976.

(c) (1) The commissioner receives an affidavit executed by the appropriate official of the facility swearing that the facility had filed for hardship relief pursuant to Emergency Regulation 17-311-82 (e) dated July 6, 1982. In this event the commissioner shall continue the payments authorized pursuant to the Emergency Regulation through June 30, 1983. In the event that the commissioner learns through audit or by notification of the trustees of the pension plan or otherwise that the money so provided has not been used to make the promised contributions to the pension plan the facility agrees to the automatic recoupment of the amount paid out by the commissioner pursuant to this subsection without a hearing; or

(2) The commissioner receives an affidavit executed by the appropriate official of the facility swearing that:

(A) The facility has entered into a legally enforceable agreement with its employees and less than twelve (12) months of the pension costs thereof were reflected in the current medicaid rate.

(B) The terms of the agreement include a provision that the facility must make payments to a qualified pension plan governed by ERISA.

(C) The actual payment of the contribution to the pension plan threatens the economic viability of the facility.

(D) Any funds received as a result of the increase in the rate granted by the commissioner as a result of the operation of this subsection will go exclusively toward the payment of the contribution to the qualified pension plan, and

(E) In the event that the commissioner learns through audit or by notification of the trustees of the pension plan or otherwise that the funds so provided have not been used to make the promised contributions to the pension plan the facility agrees to the automatic recoupment of the amount paid out by the commissioner pursuant to this subsection without a hearing.

(3) Upon examination of the above information and consideration of any other factors which he deems pertinent, the commissioner may grant an increase to the current medicaid rate which is the lesser of:

(A) The projected costs of the actual contribution to the pension plan to be incurred for the current medicaid rate year divided by estimated actual and imputed patient days for the medicaid rate year or,

(B) the dollar amount, for the portion of the current medicaid year for which contribution to the pension plan are made, produced by multiplying the facility’s projected gross wages by the percentage listed in the most recent Chamber of Commerce of the United States study entitled Employee Benefits for "Pension plan premium and pension payments not covered by insurance-type plan (net)" for hospitals in the chart listing "Employee Benefits as Percent of Payroll," divided by estimated actual and imputed patient days for the current medicaid rate year. The commissioner may, if he deems appropriate, increase the percentage listed therein by the Implicit Price Deflator for the Gross National Product for the period since the study. This subsection shall not be construed to authorize any immediate reimbursement of pension costs which are already reimbursed in the facility’s existing medicaid rate.

(C) in the event that the Annual Report of Long Term Care Facility reflects only part of the first year of pension costs, the facility may apply for hardship relief for the unreported portion of said pension costs pursuant to this subsection.

In the event that the Annual Report of Long Term Care Facility reflects twelve (12) months pension costs, the facility shall be ineligible for hardship rate relief pursuant to this subsection.

(4) A facility or a portion of a facility (provided that no portion of a facility will be considered for hardship relief unless it is maintained as a distinct part with fifteen beds or more or unless approved by the Department for 10 to 14 beds under the provisions of subsection (4) (a) (4)) is either providing or proposing to provide care for traumatic brain injury (hereinafter TBI) patients who require extensive care but not acute general hospital care as defined below and seeks a separate TBI rate.

(a) Availability of hardship rate relief for facilities serving traumatically brain injured patients

A chronic and convalescent nursing facility, or a distinct part of a facility, either providing or proposing to provide care for TBI patients who require extensive care but not acute general hospital care may be granted hardship rate relief, at the discretion of the Commissioner of Income Maintenance (provided that no portion of a facility will be considered for hardship relief unless it is maintained as a distinct part with fifteen beds or more or unless approved by the Department for 10 to 14 beds under the provisions of subsection (4) (a) (4)), if such a facility demonstrates that it would suffer financial hardship if not granted rate relief and if the facility meets the requirements for the granting of TBI hardship relief.

For purposes of this Section TBI is any combination of focal and diffuse central nervous system dysfunction, both immediate and delayed, occurring at the brain stem level and above, which results from the interaction of any single or repetitive external force and the body.

In determining whether to grant in whole or part or to deny the request for hardship rate relief for a TBI facility, the Commissioner may consider factors including, but not limited to, the following:

(1) The hardship caused by not having a separate TBI rate calculated for the facility. Each applicant shall file all financial records which the Commissioner, in his discretion, deems necessary to enable the Commissioner to determine if a financial hardship exists or will exist absent the granting of TBI hardship rate relief.

(2) Cost. Each applicant shall file all necessary budgetary data to enable the Commissioner to determine how much the proposed services will cost in excess of the current costs of the facility.

(3) Program Services to be Provided. Each applicant must provide a detailed proposal setting forth specifically what program services will be provided, the quantity of such services, personnel qualifications (specifying the nature of the training and experience of each person providing program services) and the level or levels of TBI patient, using the "Rancho" Scale of Levels of Cognitive Functioning, developed by the Adult Head Trauma Service of Rancho Los Amigos Hospital (hereinafter the "Rancho" scale) for which the services will be appropriate. The proposal must demonstrate that the program requirements set forth in Subsection (c) below will be met and how they will be met.

(4) The Size of the Proposed Unit. Unless granted an exception as provided for below, no unit can be considered for hardship relief unless it is a free standing facility or a distinct part of an existing facility with said distinct part made up of at least fifteen (15) beds. Units with fewer than fifteen (15) beds, but made up of at least ten (10) beds may be approved when it can be shown that the unit will not be more costly than comparable units of fifteen (15) beds or more and that the operation of a larger unit would not be in the best interest of the patients.

(5) Proposed timetable for occupancy of a TBI Unit by TBI patients. Applicant must submit a schedule which details by month, the number of TBI patients and the number of geriatric patients by source of payor that will occupy the distinct part unit. The period of time for which this schedule must be produced is from the date that the first TBI patient is admitted to the date that the unit is fully occupied by TBI patients.

(6) Geographical Location.

(7) The experience of the provider in caring for TBI patients and the experience of the personnel proposed to be utilized in providing the care to the TBI patients.

(8) The number of beds for which TBI hardship relief has already been granted in the same general geographical area.

(9) Any other factors which the Commissioner deems appropriate to consider. In order to permit the Commissioner to consider an application for TBI hardship rate relief, the applicant shall submit an affidavit sworn to under oath which includes:

(A) the items listed in 1 through 6 above and any other information requested by the Commissioner,

(B) a statement that any funds received as a result of the operation of this subsection will be spent exclusively on the TBI patients and

(C) a statement that in the event that the Commissioner learns through audit or otherwise that the funds so provided have not been used on the TBI patients, the facility agrees to the automatic recoupment of the amount paid out by the Commissioner pursuant to this subsection prior to a hearing.

(b) Effect of granting hardship relief

The Commissioner, at his discretion, may grant in whole or in part an application for hardship rate relief upon terms he deems appropriate, equitable and in the best interest of the State or he may deny an application for hardship rate relief. If TBI hardship rate relief is granted, the efficiency limitation set forth in Section 17-311-52 (4), which controls allowable costs at 150 percent of the median of chronic and convalescent nursing facilities, and the inflation cost limitation provided for in Section 17-311-52 (3) shall not apply to the TBI facility or the TBI portion of the facility.

(1) In the event that the Commissioner grants hardship rate relief, an interim TBI rate will be established. In computing the interim rate, the Department will determine the total cost of the TBI unit and deduct the expected revenue from the other patients who will occupy this unit as determined by the cost proposal and the schedule of occupancy required above. The expected revenue to be deducted will be computed by multiplying the number of days in the TBI unit occupied by non-TBI patients by the prevailing Connecticut Medicaid rate. The resultant amount will be divided by the estimated TBI days and the quotient derived therefrom will be the interim TBI rate. The interim rate will be replaced annually or may be replaced at any time by the Commissioner at his discretion when new information is made available to the Department. Revised interim TBI rates will be determined by dividing the reasonable costs of caring for TBI patients as reported in the Annual Report of Long-Term Care Facility by the number of actual TBI days. Interim TBI rates will be replaced by per diem rates computed on the basis of the reasonable costs incurred in caring for TBI patients for the period in which the interim rates were in effect. The Annual Report of Long-Term Care Facility for the appropriate year ending September 30 will be utilized to report the necessary data and must be filed annually by December 31. Proper retroactive adjustments in favor of the provider or the State shall be made to all amounts paid on an interim basis.

After a period of not more than three years from the effective date of these regulations, the Department will analyze the costs incurred in caring for TBI patients and determine what limitations, if any, will be placed on subsequent TBI rates.

(2) For purposes of calculating a separate TBI rate, whether interim or final, a facility that has been granted a special TBI rate for a distinct part shall allocate its costs to the distinct part as if the distinct part were licensed as a separate level of care.

(3) The purpose of granting TBI hardship rate relief is to provide care to TBI patients. Therefore, any funds received as a result of the operation of this subsection must be spent exclusively for care of the TBI patients and in the event that the Commissioner learns through audit or otherwise that the funds so provided have not been used on the TBI patients, the facility agrees to the automatic recoupment of the amount paid out by the Commissioner pursuant to this subsection prior to a hearing.

(c) Availability of hardship TBI rate relief

(1) In order to be considered for hardship TBI rate relief, a chronic and convalescent nursing facility applying for such rate relief must comply with applicable state licensure and federal skilled nursing certification requirements for the provision of nursing home care. In addition, the facility must demonstrate:

(A) that the facility has been granted approval by the Commission on Hospitals and Health Care, pursuant to the provisions of Connecticut General Statutes Section 19a-154, to devote the facility, or distinct part of the facility, to providing services on behalf of traumatically brain injured patients. The extent of any hardship rate relief granted pursuant to this section will be limited to any conditions contained in any ruling of the Commission, including any order limiting the number of beds which may be devoted to the care of traumatically brain injured patients. In order to be considered for hardship rate relief, any distinct part of a facility must contain at least 15 beds devoted to the care of TBI patients, unless approved by the Department for 10 to 14 beds under the provisions of subsection (4) (a) (4).

(B) that the facility has adopted policies, and is prepared to implement its policies, governing the provision of nursing care, related medical care including physician services, and rehabilitative services, which reflect awareness of and provision for meeting the special medical and rehabilitative needs of TBI patients. Where TBI hardship rate relief is requested for a distinct part of the facility, the facility must adopt and implement separate policies for the distinct part serving TBI patients. The medical records of the facility must reflect that patient care is being provided TBI patients in accordance with the facility’s patient care policies.

(C) that the facility’s policies reflect awareness of modern practices of rehabilitative medicine, including the provision of rehabilitative services through an interdisciplinary process. Interdisciplinary teams must be staffed to properly assess and plan for the needs of each individual patient, including at a minimum, a physician, a nurse experienced in providing rehabilitative nursing and skilled nursing services, and a physical therapist, occupational therapist and/or a speech therapist or other professionals depending on the needs of the TBI patient. Notwithstanding the requirement that rehabilitative services be provided through an interdisciplinary process, the facility is obligated to comply with state licensure and federal certification requirements that require that rehabilitative services be provided pursuant to a physician’s order.

(D) that the facility’s policies grant priority for admission wherever practicable to TBI patients who require extensive nursing or rehabilitative services or to TBI patients who are difficult to place in nursing facilities. For purposes of this regulation, the TBI patients requiring extensive nursing or rehabilitative services means patients requiring the provision of at least two skilled nursing or rehabilitative (physical therapy, occupational therapy, speech therapy) services daily. Daily means seven days a week for skilled nursing services and five days a week for rehabilitation services. TBI patients who are difficult to place in nursing facilities include patients in coma, patients on ventilators and patients exhibiting behavioral disturbances. Any admission policy adopted by a facility serving TBI patients must refer to the "Rancho" scale in describing the type of TBI patients who may be admitted to the facility, or distinct part of a facility, granted TBI hardship rate relief.

(E) that the facility adopt and implement policies requiring that TBI patients be provided cognitive remediation service by occupational therapists, speech pathologists or consulting psychologists, as determined by the interdisciplinary team and pursuant to a physician’s order.

(F) that the facility adopt and implement policies requiring that comatose TBI patients receive coma arousal services in conformity with current professional opinion pursuant to a determination of the interdisciplinary team and a physician’s order. The facility must furthermore adopt and implement policies requiring and demonstrating how comatose patients will be protected from harm from others, including behaviorally active clients.

(G) that the facility has adopted and implements discharge policies which provide for the discharge of TBI patients from the facility, or distinct part of the facility, when the TBI patient no longer requires the intensity of skilled nursing or rehabilitative services which required the granting of hardship rate relief to the facility. The required discharge policies may allow for transfer of the patient from a distinct part of the facility (granted hardship rate relief under this section) to a bed in the facility that is not subject to the rate relief granted by this section. Any discharge of a TBI patient must comply with the applicable state licensure and federal certification requirements.

(H) that the facility has adopted and implements policies which require that the TBI patient’s rehabilitative progress be periodically monitored and objectively assessed. The rehabilitation plan must be amended as necessary. The facility’s policies must provide that failure of the TBI patient to make reasonable progress in his rehabilitation plan shall be grounds for his discharge from the facility, or a distinct part of the facility granted hardship rate relief, unless the patient requires intense skilled nursing care or presents major behavioral disturbances which preclude his discharge from the facility. The TBI patient may be readmitted to the facility if he subsequently shows progress in rehabilitation such that the provision of intensive rehabilitative services is indicated.

(I) that the facility has made arrangements with physicians experienced in providing care to TBI patients, e.g., specialists in rehabilitation medicine or physical medicine, to provide for the medical and rehabilitative needs of TBI patients. In addition, the facility must demonstrate that it has arrangements with specialty consulting physicians, depending on the needs of the patients, e.g., neurosurgeons, neurologists, pulmonary disease specialists, urologists and infectious disease specialists.

(J) that the facility has retained sufficient rehabilitative professionals, i.e., physical therapists, occupational therapists, and speech therapists, to meet the rehabilitative needs of the TBI patients. Physical therapists, occupational therapists and speech therapists must have prior experience working with TBI patients or working with patients with similar treatment needs.

(K) that sufficient and appropriate space outside of the patient’s bedroom, is available to conduct rehabilitative services.

(L) that the facility has arranged for the provision of consulting psychological services for TBI patients. As an exception to the Departmental policies that otherwise applies to the provision of psychological services on behalf of skilled and intermediate care facility residents, the psychological services required by this subsection may be provided at the facility; however, the cost of such psychological services must be reported on the facility’s annual cost report and Title XIX reimbursement for the cost of such services must be claimed exclusively through the facility’s per diem rate instead of by a direct charge by the psychologist to the Department for ancillary psychological services.

(2) A chronic and convalescent nursing facility that is dually certified as both a skilled nursing and intermediate care facility may apply for hardship rate relief for TBI patients requiring intermediate care services. In order forrdship rate relief to apply to TBI patients requiring intermediate care services, the facility must demonstrate:

(A) that the facility complies with applicable state licensure and federal intermediate care certification requirements.

(B) that the facility has adopted and implements policies that reflect awareness of any provision for meeting the needs of TBI patients requiring the intermediate care facility level of services through the use of community services, depending on the needs of such patients. Referrals to such providers as the Division of Vocational Rehabilitation of the Department of Education for vocational rehabilitation services, to community sheltered workshops, to community-based rehabilitation clinics or to community-based day treatment programs must be made depending on the patient’s need for such services. The facility must assist the TBI patient in seeking reimbursement for the cost of community services through any available source of payment.

(C) that the facility has adopted and implements admission and discharge policies which provide for the discharge of, or the refusal to admit TBI patients requiring the intermediate care facility level of services unless the TBI intermediate care patient requires the intensity of staff services available as a result of the granting of hardship rate relief to the facility, either because of behavioral disturbances or the need for intense but not skilled rehabilitative services. TBI patients requiring daily rehabilitative services should properly be classified as in need of skilled nursing facility services.

(d) Maintenance of TBI hardship rate relief

(1) As provided in these regulations, the granting of hardship rate relief is discretionary with the Commissioner of Income Maintenance. The Commissioner of Income Maintenance may not exercise his discretion unless the facility, at a minimum, fulfills the requirements of subsection (c) above. Once hardship rate relief is granted, the efficiency limitation of Section 17-311-52 (4) and the inflation cost limitation contained in 17-311-52 (3) shall not apply to the TBI facility or the TBI portion of the facility, provided that the Commissioner does not exercise his discretion by revoking the TBI hardship rate relief granted pursuant to this regulation.

(2) The Commissioner may exercise his discretion and revoke any TBI hardship rate relief for any reason which he deems appropriate, including but not limited to, his finding that the granting of hardship rate relief is not equitable or in the best interests of the State. Noncompliance with applicable state licensure or federal certification requirements shall be cause to revoke TBI hardship rate relief, provided that the facility has had an opportunity to correct said deficiencies and has not done so to the satisfaction of the Commissioner. The retention by the facility of its license or its federal medical certification will not constitute a reason not to revoke hardship rate relief under this section if the Commissioner finds that the facility contains deficiencies which have not been corrected. Noncompliance with the requirements of subsection (c) pertaining to specialized TBI care shall also be cause for the Commissioner to revoke hardship TBI rate relief. Violation of the nondiscrimination provisions set forth in subsection (f) below shall be cause to revoke TBI hardship rate relief. Use of the funds received pursuant to this TBI hardship rate relief provision, other than on the TBI patients shall be cause to revoke TBI hardship rate relief. This list of causes for revocation is not intended to be all inclusive of reasons for revocation.

Any such revocation of hardship relief shall be effective upon whatever date the Commissioner deems appropriate, equitable and in the best interest of the State.

In revoking TBI hardship rate relief, the Commissioner may rely on any information he deems reliable including but not limited to, findings by the health inspection agency pertaining to state licensure or federal certification and findings of the patient review teams of the Department of Income Maintenance.

(3) The Commissioner shall notify the facility of the denial or revocation of TBI hardship rate relief and the effective date of any revocation. If the facility submits a request for a hearing in compliance with section 17-311 (b) of the Connecticut General Statutes, the Department shall afford the facility a hearing as soon as practicable. Said hearing request shall not automatically stay a revocation, and/or any recoupment, which may be stayed in the discretion of the Commissioner.

(4) Given the discretionary nature of both the granting and the revocation of TBI hardship rate relief and the nature of the relief modifying the rate reimbursement system applied to the other long term care facilities throughout the state, the Commissioner’s exercise of discretion modifying, denying or revoking TBI hardship rate relief may be overturned only when the facility has shown by clear and convincing evidence that the Commissioner’s decision is arbitrary, capricious or a clearly unwarranted exercise of discretion.

(e) Prior authorization requirements

(1) Any TBI recipient of medical assistance under Part IV of Chapter 302 of the General Statutes must receive the prior authorization of the Department of Income Maintenance prior to his admission to a facility, or distinct part of a facility, granted hardship rate relief under this section. Any individual who was not eligible for medical assistance at the time of admission to such a facility but who subsequently becomes eligible for medical assistance, must receive the prior authorization for such care before a request is made for payment for the cost of such care. Unless prior authorization has been granted, medical assistance for the cost of care provided by the facility will not be paid by the Department of Income Maintenance.

(2) In order to be granted prior authorization for Title XIX payment for the cost of skilled nursing facility services, the TBI applicant must establish not only that he is eligible for the level of care requested but also establish that he requires the intensity of skilled nursing or rehabilitative services required for facilities granted hardship rate relief under this section.

(3) TBI patients requiring intermediate care facility services generally do not require the intensity of services made available by the granting of TBI hardship rate relief. A TBI recipient of medical assistance requiring intermediate care services, who requests prior authorization for Title XIX payment for the cost of care provided by the facility must demonstrate that the required services could not otherwise be provided to the applicant and that the intensity of nursing (including direct care) or rehabilitative services required by the applicant justifies placement in a facility granted TBI hardship rate relief.

(4) Any prior authorization for the cost of care provided by a facility granted hardship rate relief will be limited to no more than six months. Subsequent prior authorizations may be granted for succeeding six month periods provided that the TBI patient demonstrates that he continues to require the intensity of services provided by the facility granted TBI hardship rate relief under this section and that the TBI patient demonstrates sufficient progress to warrant continued placement in a facility granted TBI hardship rate relief.

(5) Prior authorization may be granted for no more than 30 days for Administratively Necessary Days in accordance with the provisions of subsection (f) below.

(f) Administratively necessary days

Administratively Necessary Days are TBI unit days reimbursed by Medicaid for services to a Title XIX eligible patient and to a patient who will eventually be determined eligible. A patient qualifying for ANDs does not require TBI level-of-care. Instead, the patient requires medical services at the skilled nursing or intermediate level-of-care. The patient is forced to remain in the TBI unit because the appropriate medical level-of-care placement in the skilled nursing or intermediate care facility is not available.

If given prior authorization in accordance with subsection (e) above, TBI ANDs will be paid at the TBI rate for up to a maximum of thirty (30) days when the following procedures and conditions are met:

(1) The Medicaid patient is no longer at the acute care level of service but is at a skilled nursing level-of-care or at an intermediate level-of-care;

(2) Discharge to a skilled nursing or intermediate level-of-care bed is impossible due to the unavailability of a bed;

(3) The patient’s timely discharge and placement to an appropriate skilled nursing or intermediate care bed is planned and arranged by the facility. Clear evidence of this active and continuous transfer or discharge process is documented in the patient’s hospital medical record.

(g) Nondiscrimination

Any facility applying for TBI hardship rate relief or to which TBI hardship rate relief has been granted which receives payments pursuant to the Connecticut Title XIX program must abide by the requirements of Section 19a-533 and 19a-550 of the Connecticut General Statutes and the regulations promulgated thereunder with respect to admission and continuation of stay in the TBI facility or the distinct part of the facility. Violation of said provisions shall be grounds not only for the sanctions imposed therein, but the Commissioner, on this basis alone or in conjunction with other reasons, may modify, deny or revoke TBI hardship relief.

(h) Advisory committee

The Commissioner shall establish an advisory committee of at least a neuropsychiatrist, a rehabilitation nurse with TBI experience, a psychiatrist and a consumer advocate, who shall provide advice and recommendation to the Department in the following areas:

(1) Upon review of the application as specified in this section, the granting or denial of rate relief to the applicant who has applied to the commissioner for rate relief in order to provide services to TBI patients.

(2) The consideration of regulatory or procedural changes which would improve the services provided to TBI patients under this section.

(3) As brought to the committee’s attention by the Department, medical opinion about the appropriateness of admission or continued stay of a TBI patient in a bed which has been granted rate relief under this section.

(i) Other provisions

Except as specifically provided in this hardship provision, all other State and Federal statutes and regulations concerning long term care facilities apply to TBI units and patients.

(Effective March 3, 1987)