AN ACT ESTABLISHING LICENSURE FOR LONG-TERM ACUTE CARE HOSPITALS.

Senate
sSB193 / File No. 29 1

General Assembly File No. 29
February Session, 2026 Substitute Senate Bill No. 193

Senate, March 16, 2026

The Committee on Public Health reported through SEN.
ANWAR of the 3rd Dist., Chairperson of the Committee on the
part of the Senate, that the substitute bill ought to pass.

AN ACT ESTABLISHING LICENSURE FOR LONG-TERM ACUTE
CARE HOSPITALS.
Be it enacted by the Senate and House of Representatives in General
Assembly convened:

Section 1. Section 19a -490 of the general statutes is repealed and the 1
following is substituted in lieu thereof (Effective October 1, 2026): 2
As used in this chapter, unless the context otherwise requires: 3
(a) "Institution" means a hospital, short-term hospital special hospice, 4
hospice inpatient facility, residential care home, nursing home facility, 5
home health care agency, home health aide agency, behavioral health 6
facility, assisted living services agency, substance abuse treatment 7
facility, outpatient surgical facility, outpatient clinic, clinical laboratory, 8
blood collection facility, source plasma donation center, birth center, 9
long-term acute care hospital, an infirmary operated by an educational 10
institution for the care of students enrolled in, and faculty and 11
employees of, such institution; a facility engaged in providing services 12
for the prevention, diagnosis, treatment or care of human health 13
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conditions, including facilities operated and maintained by any state 14
agency; and a residential facility for persons with intellectual disability 15
licensed pursuant to section 17a -227 and certified to participate in the 16
Title XIX Medicaid program as an intermediate care facility for 17
individuals with intellectual disability. "Institution" does not include 18
any facility for the care and treatment of persons with mental illness or 19
substance use disorder operated or maintained by any state agency, 20
except Whiting Forensic Hospital and the hospital and psychiatric 21
residential treatment facility units of the Albert J. Solnit Children's 22
Center; 23
(b) "Hospital" means an establishment for the lodging, care and 24
treatment of persons suffering from disease or other abnormal physical 25
or mental conditions and includes inpatient psychiatric services in 26
general hospitals; 27
(c) "Residential care home" or "rest home" means a community 28
residence that furnishes, in single or multiple facilities, food and shelter 29
to two or more persons unrelated to the proprietor and, in addition, 30
provides services that meet a need beyond the basic provisions of food, 31
shelter and laundry and may qualify as a setting that allows residents to 32
receive home and community -based services funded by state and 33
federal programs; 34
(d) "Home health care agency" means a public or private 35
organization, or a subdivision thereof, engaged in providing 36
professional nursing services and the following services, available 37
twenty-four hours per day, in the patient's home or a substantially 38
equivalent environment: Home health aide services as defined in this 39
section, physical therapy, speech therapy, occupational therapy or 40
medical social services. The agency shall provide professional nursing 41
services and at least one additional service directly and all others 42
directly or through contract. An agency shall be available to enroll new 43
patients seven days a week, twenty-four hours per day; 44
(e) "Home health aide agency" means a public or private 45
organization, except a home health care agency, which provides in the 46
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patient's home or a substantially equivalent environment supportive 47
services which may include, but are not limited to, assistance with 48
personal hygiene, dressing, feeding and incidental household tasks 49
essential to achieving adequate household and family management. 50
Such supportive services shall be provided under the supervision of a 51
registered nurse and, if such nurse determines appropriate, shall be 52
provided by a social worker, physical therapist, speech therapist or 53
occupational therapist. Such supervision may be provided directly or 54
through contract; 55
(f) "Home health aide services" as defined in this section shall not 56
include services provided to assist individuals with activities of daily 57
living when such individuals have a disease or condition that is chronic 58
and stable as determined by a physician licensed in the state; 59
(g) "Behavioral health facility" means any facility that provides 60
mental health services to persons eighteen years of age or older or 61
substance use disorder services to persons of any age in an outpatient 62
treatment or residential setting to ameliorate mental, emotional, 63
behavioral or substance use disorder issues; 64
(h) "Clinical laboratory" means any facility or other area used for 65
microbiological, serological, chemical, hematological, 66
immunohematological, biophysical, cytological, pathological or other 67
examinations of human body fluids, secretions, excretions or excised or 68
exfoliated tissues for the purpose of providing information for the (1) 69
diagnosis, prevention or treatment of any human disease or 70
impairment, (2) assessment of human health, or (3) assessment of the 71
presence of drugs, poisons or other toxicological substances; 72
(i) "Person" means any individual, firm, partnership, corporation, 73
limited liability company or association; 74
(j) "Commissioner" means the Commissioner of Public Health or the 75
commissioner's designee; 76
(k) "Home health agency" means an agency licensed as a home health 77
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care agency or a home health aide agency; 78
(l) "Assisted living services agency" means an agency that provides 79
chronic and stable individuals with services that include, but need not 80
be limited to, nursing services and assistance with activities of daily 81
living and may have a dementia special care unit or program as defined 82
in section 19a-562; 83
(m) "Outpatient clinic" means an organization operated by a 84
municipality or a corporation, other than a hospital, that provides (1) 85
ambulatory medical care, including preventive and health promotion 86
services, (2) dental care, or (3) mental health services in conjunction with 87
medical or dental care for the purpose of diagnosing or treating a health 88
condition that does not require the patient's overnight care; 89
(n) "Multicare institution" means a hospital that provides outpatient 90
behavioral health services or other health care services, psychiatric 91
outpatient clinic for adults, free -standing facility for the care or 92
treatment of substance abusive or dependent persons, hospital for 93
psychiatric disabilities, as defined in section 17a-495, or a general acute 94
care hospital that provides outpatient behavioral health services that (1) 95
is licensed in accordance with this chapter, (2) has more than one facility 96
or one or more satellite units owned and operated by a single licensee, 97
and (3) offers complex patient health care services at each facility or 98
satellite unit. For purposes of this subsection, "satellite unit" means a 99
location where a segregated unit of services is provided by the multicare 100
institution; 101
(o) "Nursing home" or "nursing home facility" means (1) any chronic 102
and convalescent nursing home or any rest home with nursing 103
supervision that provides nursing supervision under a medical director 104
twenty-four hours per day, or (2) any chronic and convalescent nursing 105
home that provides skilled nursing care under medical supervision and 106
direction to carry out nonsurgical treatment and dietary procedures for 107
chronic diseases, convalescent stages, acute diseases or injuries; 108
(p) "Outpatient dialysis unit" means (1) an out-of-hospital out-patient 109
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dialysis unit that is licensed by the department to provide (A) services 110
on an out -patient basis to persons requiring dialysis on a short -term 111
basis or for a chronic condition, or (B) training for home dialysis, or (2) 112
an in-hospital dialysis unit that is a special unit of a licensed hospital 113
designed, equipped and staffed to (A) offer dialysis therapy on an out -114
patient basis, (B) provide training for home dialysis, and (C) perform 115
renal transplantations; 116
(q) "Hospice agency" means a public or private organization that 117
provides home care and hospice services to terminally ill patients; 118
(r) "Psychiatric residential treatment facility" means a nonhospital 119
facility with a provider agreement with the Department of Social 120
Services to provide inpatient services to Medicaid -eligible individuals 121
under the age of twenty-one; 122
(s) "Chronic disease hospital" means a long -term hospital having 123
facilities, medical staff and all necessary personnel for the diagnosis, 124
care and treatment of chronic diseases; 125
(t) "Blood collection facility" means a facility that performs blood 126
component collection activities where blood is removed from a human 127
being for the purpose of administering such blood or any of its 128
components to any human being. "Blood collection facility" does not 129
include a facility that performs blood component collection activities to 130
collect source plasma or perform testing that would require licensure as 131
a clinical laboratory. For the purposes of this subsection, "source 132
plasma" means the liquid portion of human blood collected by 133
plasmapheresis and intended as source material for further 134
manufacturing use and does not include single donor plasma products 135
intended for intravenous use, and "plasmapheresis" means a procedure 136
in which blood is removed from a blood donor, the plasma is separated 137
from the formed elements and at least the red blood cells are returned 138
to the blood donor at the time of the donation; 139
(u) "Source plasma donation center" means a facility where source 140
plasma is collected by plasmapheresis. For the purposes of this 141
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subsection, "source plasma" means the liquid portion of human blood 142
collected by plasmapheresis and intended as source material for further 143
manufacturing use and does not include single donor plasma products 144
intended for intravenous use, and "plasmapheresis" means a procedure 145
in which blood is removed from a blood donor, the plasma is separated 146
from the formed elements and at least the red blood cells are returned 147
to the blood donor at the time of the donation; [and] 148
(v) "Birth center" means a freestanding facility that is licensed by the 149
department (1) to provide perinatal, labor, delivery and postpartum 150
care during and immediately after delivery to persons presenting with 151
a low-risk pregnancy and healthy newborns for a period typically less 152
than twenty-four hours, and (2) that is not a hospital licensed pursuant 153
to the provisions of this chapter, or attached to or located in such a 154
hospital. For the purposes of this subsection, "low -risk pregnancy" 155
means an uncomplicated, singleton pregnancy that has vertex 156
presentation and is at low risk for developing complications during 157
labor and birth, as determined by an evaluation and examination 158
conducted by a licensed health care provider acting within the scope of 159
such provider's practice; and 160
(w) "Long-term acute care hospital" means a hospital that is a long -161
term care hospital, as defined in 42 USC 1395x, as amended from time 162
to time. 163
Sec. 2. Subdivision (4) of subsection (a) of section 19a-491c of the 2026 164
supplement to the general statutes is repealed and the following is 165
substituted in lieu thereof (Effective October 1, 2026): 166
(4) "Long-term care facility" means any facility, agency or provider 167
that is a nursing home, as defined in section 19a -521, a residential care 168
home, as defined in section 19a-521, a home health care agency, hospice 169
agency or home health aide agency, as defined in section 19a -490, as 170
amended by this act , an assisted living services agency, as defined in 171
section 19a-490, as amended by this act, an intermediate care facility for 172
individuals with intellectual disabilities, as defined in 42 USC 1396d(d), 173
except any such facility operated by a Department of Developmental 174
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Services' program subject to background checks pursuant to section 17a-175
227a, a chronic disease hospital, as defined in section 19a -490, as 176
amended by this act , [or] an agency providing hospice care which is 177
licensed to provide such care by the Department of Public Health or 178
certified to provide such care pursuant to 42 USC 1395x or a long-term 179
acute care hospital, as defined in section 19a -490, as amended by this 180
act. 181
This act shall take effect as follows and shall amend the following
sections:

Section 1 October 1, 2026 19a-490
Sec. 2 October 1, 2026 19a-491c(a)(4)

PH Joint Favorable Subst.

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The following Fiscal Impact Statement and Bill Analysis are prepared for the benefit of the members of
the General Assembly, solely for purposes of information, summarization and explanation and do not
represent the intent of the General Assembly or either chamber thereof for any purpose. In general,
fiscal impacts are based upon a variety of informational sources, including the analyst’s professional
knowledge. Whenever applicable, agency data is consulted as part of the analysis, however final
products do not necessarily reflect an assessment from any specific department.

OFA Fiscal Note

State Impact:
Agency Affected Fund-Effect FY 27 $ FY 28 $
Public Health, Dept. GF - Cost Up to
100,000
None
Public Health, Dept. GF - Potential
Revenue Impact
See Below See Below
Note: GF=General Fund

Municipal Impact: None
Explanation
The bill creates a new licensure category for long -term acute care
hospitals (LTACHs), resulting in a one-time General Fund cost of up to
$100,000 in FY 27 and potential annual revenue impacts related to
chronic disease hospitals (CDHs) potentially shifting to the new license.
The Department of Public Health (DPH) requires support from a
Legal Healthcare Consultant to research, draft, and implement
regulations for the LTACH license, resulting in a one -time cost to the
agency of up to $100,000 in FY 27.
Additionally, there is a potential annual revenue change to the
General Fund beginning as early as FY 27, depending on: (1) what, if
any, licensure fees are created for the new category; (2) how these
licensure fees compare to the CDH license fees 1; and (3) the extent
existing CDHs change to the LTACH license. The department currently
licenses four hospitals under the CDH category, but only two are

1 Chronic disease hospitals currently pay the biennial hospital licensure fee of $940 per
site and $7.50 per bed as outlined in CGS Sec. 19a-491.
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certified as LTACHs as required for participation in the federal
Medicare program. It is unclear whether any CDHs would transition to
the new LTACH licensure category once it is created.

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OLR Bill Analysis
sSB 193

AN ACT ESTABLISHING LICENSURE FOR LONG -TERM ACUTE
CARE HOSPITALS.

SUMMARY
This bill creates a specific Department of Public Health licensure
category for long -term acute care hospitals (i.e. those that qualify as
long-term care hospitals under federal Medicare law). The law already
requires them to be licensed (they are currently licensed as chronic
disease hospitals).
Generally, under federal Medicare law, long -term care hospitals are
those that (1) primarily provide inpatient services to Medicare patients
with complex conditions requiring a long hospital stay (with average
stays exceeding 25 days) and (2) meet various criteria on services,
patient screening, staffing, and related matters (42 U.S.C. 1395x).
The bill also makes a conforming change to specify that long -term
acute care hospitals are covered by the law’s long -term care facility
background check requirements (th is law currently cover s them as
chronic disease hospitals).
EFFECTIVE DATE: October 1, 2026
COMMITTEE ACTION
Public Health Committee
Joint Favorable Substitute
Yea 31 Nay 0 (03/02/2026)