Source: https://www.cga.ct.gov/2013/BA/2013HB-06705-R00-BA.htm
Timestamp: 2019-12-09 21:55:46
Document Index: 416559555

Matched Legal Cases: ['§ 1', '§ 32', '§ 22', '§ 2', '§ 2', '§ 157', '§ 17', '§ 71', '§ 75', '§ 76', '§ 79', '§ 83', '§ 83', '§ 85', '§ 86', '§ 102', '§ 103', '§ 104', '§ 105', '§ 106', '§ 107', '§ 108', '§ 109', '§ 110', '§ 111', '§ 112', '§ 113', '§ 114', '§ 115', '§ 116', '§ 117', '§ 118', '§ 121', '§ 122', '§ 123', '§ 124', '§ 125', '§ 126', '§ 127', '§ 128', '§ 132', '§ 132', '§ 133', '§ 133', '§ 133', '§ 133', '§ 133', '§ 134', '§ 135', '§ 19', '§ 137', '§ 136', '§ 139', '§ 140', '§ 141', '§ 141', '§ 142', '§ 143', '§ 145', '§ 146', '§ 147', '§ 148', '§ 149', '§ 150', '§ 152', '§ 153', '§ 154', '§ 156', '§ 157', '§ 17', '§ 17', '§ 17', '§ 17', '§ 17', '§ 17', '§ 17', '§ 17', '§ 17', '§ 17', '§ 17', '§ 17', '§ 16', '§ 26', '§ 78', '§ 82', '§ 83', '§ 105', '§ 127', '§ 128', '§ 128', '§ 128', '§ 148', '§ 148', '§ 46', '§ 153', '§ 153', '§ 1320', '§ 413', '§ 153', '§ 156', '§ 156', '§ 156']

HB 6705
This bill makes changes to laws governing state housing, human services, and public health programs. Concerning housing, PA 12-1, June Special Session, established the Department of Housing (DOH) and made it the lead state agency responsible for all housing matters, including housing and neighborhood policy, development, redevelopment, preservation, maintenance, and improvement. The bill completes DOH's establishment by transferring to it various housing-related responsibilities from the Department of Economic and Community Development (DECD), the Office of Policy and Management (OPM), and the Department of Social Services (DSS).
Concerning human services, the bill makes changes in programs that the departments of social services (DSS) and children and families (DCF) administer. The major revisions include:
1. requiring DSS to reimburse acute care hospitals for providing inpatient, outpatient, and emergency room care based on the severity of the patient's diagnosis;
2. eliminates the ConnPACE program, which currently provides pharmacy assistance to elders and individuals with disabilities who do not qualify for Medicare;
3. repeals the Medicaid for Low-Income Adults program;
4. expands the state's False Claims Act to all state programs, not just DSS medical assistance programs;
5. requires a pilot program to improve the educational outcomes of children in state custody;
6. requires DSS to administer a medication step therapy program for Medicaid recipients; and
7. makes it easier for nursing homes to recover debt and requires these facilities to report certain information to DSS.
Concerning public health, the bill makes changes affecting various health care facilities and professions regulated by the Department of Public Health (DPH), including physicians, surgeons, nurses, nurse-midwives, dentists, home health care agencies, assisted living services agencies, community health centers, nonprofit hospitals, and health care facilities' certificate of need applications.
It also makes changes affecting tattoo artists, DPH technical assistance fees for certain construction projects, the Connecticut Vaccine Program, neonatal intensive care unit transport services, cremation certificate fees, the Tobacco and Health Trust Fund, and the study of high school students' athletic injuries.
Finally, the bill makes several technical and conforming changes.
§§ 1-69 & 157 — DEPARTMENT OF HOUSING
Under the bill, the DOH commissioner generally assumes responsibility for programs concerning:
The bill does not transfer (1) administration of the federal Low-Income Housing Tax Credit program or (2) compliance oversight for properties in the state housing portfolio, both of which remain with the Connecticut Housing Finance Authority (CHFA). Nor does the bill transfer programs providing clinical services to certain populations (e.g., individuals with mental illness), which remain with DSS and the Department of Mental Health and Addiction Services, for example.
The bill specifies that any DOH or DECD orders or regulations in force on January 1, 2013 remain so until amended, repealed, or superseded by law.
§§ 32-33, 43, 51 & 56-57 — Commissioner
1. Building Accessibility Taskforce, beginning July 1, 2013;
2. CHFA's board of directors;
The bill also adds the housing commissioner to the list of officials the Office of Policy and Management (OPM) secretary must consult with to (1) develop recommendations for the state's priority funding areas for growth-related projects and (2) coordinate state and regional transportation planning with other state planning efforts.
§§ 22, 42, 54 – 55, 68 & 69 — Reporting Requirements
The bill generally requires the DOH, rather than the DECD, commissioner to report annually to the governor and the General Assembly on the state's housing and community development activities during the preceding fiscal year. Under the bill, the DOH commissioner must submit the report annually by March 31 and, no more than 30 days later, post it on the department's website.
As under current law, the annual report must cover or include:
8. an analysis of the department's community development portfolio.
Existing law, unchanged by the bill, requires DECD's annual report to also include an analysis of its community development portfolio (i.e., the last reporting requirement listed above) even though, by law, DOH has assumed responsibility for community development activities.
The bill specifies that DOH's annual report to the governor and General Assembly must incorporate any other annual reporting requirements set by statute concerning housing or community development.
State-Assisted Housing Sustainability Fund Report. The bill requires DOH to report to the General Assembly by March 31, rather by February 1 as DECD must do under current law, on the State-Assisted Housing Sustainability Fund's operation during the previous calendar year. By law, the report must include an analysis of fund distribution and performance. It may include recommendations for modifying the program.
Rental Rebate Report. The bill requires DOH, rather than OPM, to report annually to the Finance Committee on the rental rebate program for the elderly and people with total permanent disabilities. Current law requires OPM to submit this report by March 1st each year. The bill does not specify when DOH's first report is due.
Rental Assistance Program Report. By January 1, 2014, and annually thereafter, the bill requires the DOH commissioner to report to the Appropriations, Housing, Human Services, and Public Health committees on (1) the number of departmental clients and (2) of those, the number who have been rental assistance certificate recipients. In submitting the report, the commissioner must consult with the commissioners of social services, children and families, and mental health and addiction services, and developmental services. The report must (1) detail voucher utilization under the rental assistance program (known as RAP) and (2) establish targets to ensure that the program's resources are allocated in accordance with legislative intent.
By law, the council is responsible for advising and assisting the DOH commissioner in planning and starting up the department (see BACKGROUND). The bill adds the following four members to the council, bringing its membership to 18: the (1) commissioners of education, developmental services, and aging and (2) president of the Connecticut chapter of the National Association of Housing and Redevelopment Officials (commonly known as CONN-NAHRO), or their designees.
§§ 2, 7-11, 13-15, 17-31, 34-35, 43-44 & 67 — DECD Transfers
The bill gives DOH authority over state housing and community development programs. Among other things, it transfers to DOH DECD's responsibilities with respect to:
11. grants-in-aid to municipalities financing low- and moderate- income rental housing;
The bill transfers, from DECD to DOH, the authority to designate a Federal HUD Section 202 or Section 236 elderly housing development to provide assisted living services to individuals otherwise eligible to receive these services under the Connecticut Homecare Program for Elders. It also authorizes DOH to designate more than one development.
§§ 2, 36-42 & 55 — OPM Transfers
Various Programs. The bill transfers, from OPM to DOH, responsibility for administering the (1) Main Street Investment Fund; (2) Housing for Economic Growth Program (i.e., incentive housing zone program); and (3) rental rebate program for the elderly and people with total and permanent disabilities.
Rental Rebate Program. For purposes of determining eligibility under the program, the bill specifies that an applicant's spouse's Social Security income cannot be included as qualifying income if the spouse (1) is a resident of a health care or nursing home facility and (2) the facility receives Title XIX Medicaid payments for the spouse. It also authorizes an applicant who is legally separated on the December 31 preceding the application filing date to apply as an unmarried person and be regarded as such for purposes of determining qualifying income.
The bill suspends rental rebate program applications. It does this by specifying that an individual who did not receive a grant for CY 11 is not eligible to apply for another grant. An individual who received a CY 11 grant continues to be eligible to apply. But if such an individual does not receive a grant in any subsequent year, he or she is no longer eligible to apply.
Finally, the bill gives the DOH commissioner 120 days, instead of 90 days as OPM has under current law, to approve payments to municipalities, and forward them to the comptroller under the rental rebate program. By law, the comptroller must draw an order on the treasurer no later than 15 days after receiving the list of approved payments.
EFFECTIVE DATE: July 1, 2013 except the provision (1) removing the rental rebate program from OPM's jurisdiction takes effect July 1, 2013 and applies to assessment years commencing on or after October 1, 2012 and (2) suspending rental rebate applications is effective July 1, 2013 and applicable to applications received on and after April 1, 2013.
3. housing for individuals suffering from AIDS;
The bill also transfers, from DSS to DOH, responsibility for administering (1) the homefinders program to help families who are homeless or in danger of eviction or foreclosure and (2) emergency rental assistance for families living in hotels and motels and eligible for the Temporary Family Assistance program. In administering these programs, DOH must consult with DSS. And DSS remains responsible for seeking relief, in accordance with state and federal law, from income garnishment orders when it is in the best interests of children and families.
Demonstration Project. The bill requires DSS and CHFA to collaborate with DOH, rather than DECD, to operate a demonstration project to provide subsidized assisted living for people residing in affordable housing. The bill makes people age 65 or older eligible for the program if they are also eligible for the home and community-based program for adults with severe and persistent psychiatric disabilities. Under existing law, unchanged by the bill, people are eligible if they are also eligible for the Connecticut homecare program for the elderly are also eligible.
Access to DSS Information. With certain exceptions, the law prohibits DSS from disclosing information concerning individuals who apply for or receive department assistance, or participate in a department program. The bill requires DSS to disclose to the DOH commissioner's authorized representatives information necessary for verifying whether an applicant is a recipient of DSS cash assistance, and the amount of any assistance.
The bill removes the DECD commissioner as the chairperson of CHFA's board, instead requiring the governor to appoint the chair. It also authorizes CRDA to enter into memoranda of understanding as it deems appropriate to carry out its responsibilities.
§ 157 — Repealers
The bill repeals the following housing-related provisions:
5. a pilot project to provide affordable housing and support services to families with children who have ongoing healthcare service needs (CGS § 17a-54a).
Currently, the Department of Rehabilitation Services (DORS) provides up to $6,400 annually to local school districts for the educational needs of each child who is blind or visually impaired. DORS pays for these services from the “educational aid for blind and visually handicapped children” account. The law prioritizes how the funds may be spent, with the top two priorities being the employment of state employee teachers of the visually impaired and providing specialized books, equipment, and materials.
The bill eliminates the $6,400 per student cap. It also eliminates requirements that remaining funds after DORS exhausts spending under the priority categories (1) cover the pro-rated share of the actual cost (including benefits) that school districts use to hire teachers directly instead of using DORS teachers and (2) if there are still funds left, be distributed to school districts on a 2:1 credit ratio of Braille-learning to non-Braille-learning students based on the annual child count data.
§§ 71 & 72 — DCF POST MAJORITY SERVICES
Under current law, DCF is the guardian of a child or youth committed to its care for the duration of the commitment, or until another guardian is legally appointed, (a) until age 18 or (b) by the child's consent, until age 21 if he or she is attending a secondary or technical school, college, or state-accredited job training program full-time. The bill instead allows a youth committed to DCF prior to age 18 to remain in department custody up to age 21 if he or she consents and is:
1. enrolled in a full-time approved secondary education program or an approved program leading to an equivalent credential;
2. enrolled full time in an institution that provides postsecondary or vocational education; or
3. participating full time in a program or activity approved by the DCF commissioner that is designed to promote or remove barriers to employment.
The bill allows the commissioner, in her discretion, to waive the full-time enrollment or participation requirement based on compelling circumstances. It requires DCF, within 120 days after the youth's 18th birthday, to file a motion in juvenile court to determine whether continuation of care is in the youth's best interest and, if so, whether there is an appropriate permanency plan i.e. a plan stating what permanent outcome DCF feels is in the child's best interest and the facts on which DCF bases that position. The bill allows the court, in its discretion, to hold a hearing on the motion.
The law gives the commissioner nine months from the time a child or youth under age 18 is placed to file a motion for the court to review the permanency plan. (There is no deadline for the court to approve the plan.) Once the court approves the plan, the law requires the commissioner to file another motion for review within nine months. A hearing must be held within 90 days after the filing. After the initial hearing, subsequent hearings must be held at least once every 12 months. The bill extends this review process to permanency plans for youths age 18 through 20 in voluntary DCF custody.
The bill provides that residential care homes that are scheduled to receive a lower rate in FYs 14 or 15 (i.e., State Supplement payment from DSS) due to having an interim rate or other agreement with DSS must receive the lower rate. The bill prohibits DSS from considering a facility having its rates rebased when determining rates.
The bill also provides that for the next two fiscal years, DSS may increase an RCH rate (1) if there are available appropriations, (2) up to a limit that the DSS commissioner determines, and (3) only if the RCH has a calculated rate greater than the rate in effect on June 30, 2013. The bill prohibits DSS from issuing a rate to an RCH that is lower than the rate in effect on June 30, 2013, which is contrary to what is stated above
For FY 14, the bill requires DSS to determine nursing home rates based on 2011 cost reports, except (1) a 90% minimum occupancy standard is applied, (2) no facility can receive a rate that is higher than the rate in effect on June 30, 2013, (3) no facility can receive a rate that is 4% or more less than the rate in effect on June 30, 2013, and (4) any facility that would have issued a lower rate effective July 1, 2013 due to interim rate status or some other agreement with DSS, must be issued a lower rate for the 2013-14 rate year.
For FY 15, rates in effect on June 30, 2014 remain the same for the year except that facilities that would have been issued lower rates due to interim rate status or other agreement with DSS must receive the lower rate.
The bill permits the commissioner, within available appropriations, to provide pro rata fair rent increases, including for moveable equipment for facilities that have undergone a material change in circumstances related to fair rent additions or moveable equipment placed in service in the 2012 and 2013 cost reports and not otherwise included in their issued rates.
The bill clarifies that DSS may decrease, as well as increase, nursing home rates regardless of any contrary provision in the nursing home rate setting law, depending on available appropriations.
§ 75 — INTERMEDIATE CARE FACILITIES FOR PEOPLE WITH INTELLECTUAL DISABILTIES (ICF-MR)
The bill limits to FY 13 levels the rates DSS pays ICF-MRs (group homes) in FYs 14 and 15. But it allows for higher rates if (1) a capital improvement is made to the home during either year for the residents' health or safety and the Department of Developmental Services (DDS) approved it, in consultation with DSS and (2) there is funding available to do so. Facilities that would have received lower rates due to their interim rate status or some other agreement with DSS must receive a lower rate.
The bill also extends DSS' authority for the next two years to pay a fair rent increase to an ICF-MR that has (1) undergone a material change in circumstances related to fair rent and (2) an approved certificate of need for the change.
Under current law, the DSS commissioner may increase an ICF-MR's rate if there are available appropriations, regardless of the circumstances. Under the bill, DSS may also decrease rates, but it limits his ability to raise or lower the rate to a reduction in appropriations or determines.
And the bill prohibits the commissioner from considering a facility rebased costs when determining its rate.
§ 76 — HOSPITAL RATES AND COST SHARING FOR NONEMERGENCY USE OF ER
The bill requires DSS, beginning July 1, 2013, to reimburse acute care and children's hospitals for serving Medicaid recipients based on diagnostic-related groups (DRGs) that the DSS commissioner establishes and periodically re-bases. DSS must annually determine the inpatient rates by multiplying DRG relative weights by a base rate. The federal Medicare program uses a DRG-type system when setting the rates it reimburses hospitals for serving Medicare patients. Such a system permits payment to be based on the severity of each patient's illness.
The bill permits the DSS commissioner, within available appropriations, to make additional payments to hospitals based on criteria he establishes.
The bill's provisions replace current law, under which hospitals (including chronic disease hospitals) are reimbursed based on the lower of (1) their reasonable costs or (2) the charge to the general public for ward services or the lowest charge for semiprivate rooms if the hospital has no wards. And it allows these hospitals to receive a higher amount for serving a disproportionate share of indigent patients. In practice, the hospitals receive a flat daily rate per Medicaid patient, along with a payment for serving a disproportionate share of indigent patients.
The bill eliminates a provision requiring DSS to pay hospitals a lower acute care inpatient rate for patients who no longer need an acute level of care. It eliminates obsolete provisions and makes technical changes.
The bill requires DSS, beginning July 1, 2013, to pay hospitals for outpatient and emergency room episodes of care based on prospective rates that the DSS commissioner establishes in accordance with the Medicare Ambulatory Payment Classification (MAPC) system, in conjunction with a state conversion factor. The MAPC system must be modified to provide payment for services that Medicare does not normally cover, including pediatric, obstetric, neonatal, and perinatal services. By law and unchanged by the bill, these rates may not exceed those that the hospital charges to the general public.
The bill retains the requirement that DSS establish a fee schedule from which it pays for outpatient services. Under current law, these services must be paid on the basis of a cost to charges ration. The bill (1) limits this provision to those outpatient services that do not have an MAPC code and (2) allows payments to be based on a fixed fee in effect as of January 1, 2013 as an alternative to the ratio.
The bill also makes a technical, conforming change.
The bill (1) requires the commissioner to determine the fiscal impact of the new DRG and MAPC systems on each hospital and (2) report his results to the Appropriations and Human Services committees within six months of implementing the new rate systems.
Cost Sharing for Nonemergency Use of ER
The bill requires the DSS commissioner, to the extent permitted by federal law, to impose cost sharing requirements on Medicaid recipients who use the ER for nonemergent care. The federal Affordable Care Act permits states to impose cost sharing for nonemergency use of ERs.
By law, DSS can modify the outpatient fee schedule and establish a “blended” inpatient rate if such (1) is needed to ensure that its conversion from a managed care to an administrative services organization (ASO) service delivery model is cost neutral to hospitals in the aggregate and (2) ensures patient access. The bill makes permanent a provision that allows service utilization to be a factor in determining cost neutrality. Under current law, this provision expires on June 30, 2013.
The bill requires DSS to establish, within available appropriations, a supplemental inpatient pool for low-cost hospitals.
The law authorizes the DSS commissioner to annually modify fee schedules for home health care services if doing so (1) is required to ensure that any contract with an ASO is cost neutral to home health care agencies and homemaker-home health aide agencies in the aggregate and (2) ensures patient access (see BACKGROUND). The bill makes permanent a provision, which would have expired on June 30, 2013 under current law, that allows the commissioner to take into account how often a particular service was provided (utilization) when determining cost neutrality.
§ 79 — HOSPITAL MEDICAL SERVICE PROVIDER PAYMENT RATES
The law authorizes the DSS commissioner to establish payment rates for medical service providers if establishing the rates (1) is required to ensure that any contract it maintains with an ASO is cost neutral to hospitals in the aggregate and (2) ensures patient access. The bill makes permanent a provision, which would have expired on June 30, 2013 under current law, that permits the commissioner to take utilization into account when determining cost neutrality.
PA 12-1, December Special Session, imposed a 5% reduction on Medicaid reimbursement rates (from 100% to 95%) for long-term care facility residents receiving only hospice care from January 1, 2013 through June 30, 2013. The bill makes this reimbursement rate reduction permanent.
Currently, DSS must, by July 1, 2013 (1) amend the Medicaid state plan to include foreign language interpreter services as a “covered service” to any LEPs, (2) establish billing codes for interpreter services provided under the Medicaid program, and (3) report semi-annually to the Council on Medical Assistance Program Oversight on the foreign language interpreter services provided under this program. The bill eliminates these requirements.
The Medicaid ASO, Community Health Network of Connecticut, Inc., currently provides foreign language interpreter services for Connecticut Medicaid recipients over the phone and in person upon request. Presumably, it will continue to do so as part of its administrative cost.
PA 12-1, December Special Session, required the DSS commissioner to amend the Medicaid state plan to limit chiropractic coverage only to the extent required by federal law. The bill eliminates this requirement.
Federal law generally requires that children under age 21 be entitled to receive chiropractic coverage under Medicaid's Early and Periodic Screening, Diagnostic, and Treatment (EPSTD) provisions if ordered by a medical professional to treat a condition that a screening reveals. The state reimburses independent chiropractors treating Medicaid-eligible children and provides some limited chiropractic services beyond those required by EPSDT. The bill will enable DSS to continue to provide those services.
The bill eliminates the requirement for DSS, contingent upon federal approval, to reimburse independent pharmacies at a higher rate than chain pharmacies. DSS never implemented this provision.
Current law requires DSS, when determining an individual's eligibility for MSP, to disregard the amount of income that equalizes the program's income limits with the ConnPACE income limits (see BACKGROUND).
The bill instead requires DSS to disregard the amount of income for each MSP sub-group so that a person with an income that is (1) less than 211% of the federal poverty level (FPL) will qualify for Qualified Medicare Beneficiary program coverage, (2) from 211% FPL up to 230% FPL will qualify for the Specified Low-Income Medicare Beneficiary program, and (3) from 231% FPL up to 245% FPL will qualify for the Qualifying Individual program.
The bill does not change the MSP income limits but it does change the mechanism for providing cost of living adjustments.
§ 83 — CONNMAP ELIGIBILITY
Currently, to be eligible for the Connecticut Medicare Assistance Program (ConnMAP) a resident must be enrolled in Medicare Part B with an annual income of up to 165% of the ConnPACE qualifying income level ($43,560 in 2013) or, if married, a combined income of up to 165% of the ConnPACE qualifying income level ($58,740 in 2013) (see BACKGROUND). The bill eliminates the formula for calculating ConnMAP income eligibility and sets the income limits at current levels ($43,560 for an individual income and $58,740 for a combined income). The bill requires the DSS commissioner, starting on January 1, 2014, to annually increase the income limits to the nearest hundred dollars to reflect the annual inflation adjustment in Social Security income. (ConnPACE currently uses the same mechanism to calculate income limit increases).
§§ 83, 84, 88-90, 94-101, & 155 — ELIMINATION OF CONNPACE PROGRAM
The bill eliminates the ConnPACE program and removes all statutory references to it. This program currently provides pharmacy assistance to the elderly and individuals with disabilities who do not qualify for Medicare.
§ 85 — CUSTOMIZED WHEELCHAIRS FOR MEDICAID RECIPIENTS
The bill permits DSS to designate categories of durable medical equipment in addition to customized wheelchairs for which reused equipment, parts, and components are used whenever practicable.
§§ 86-87, 90–93, & 119-120 — CHARTER OAK HEALTH PLAN (COHP) ELIMINATED
§ 102 — LEGISLATIVE OVERSIGHT OF PROPOSED CHANGES RELATIVE TO THE AFFORDABLE CARE ACT – TO CHANGE
Regardless of a provision in law that requires greater oversight, the bill requires the DSS commissioner to submit an eligibility and service plan for the Medicaid Coverage for the Lowest Income Populations program, established pursuant to the federal Affordable Care Act's expansion of the Medicaid program to cover childless adults with income up to 133% of the FPL and in the budget bill (HB 6704), passed by both chambers of the legislature. He must submit the report to the Human Services and Appropriations committees before submitting the plan to the federal government for its approval.
The bill gives the committees 15 days to hold a public hearing or notify the commissioner if they are not planning to hold one. The committees must advise the commissioner of their approval or denial of the plan within 15 days after receiving the plan. The plan is deemed approved if the committees (1) fail to take any action within the time frame or (2) disagree.
§§ 103, 158 — REPEAL OF MEDICAID FOR LOW-INCOME ADULTS
The state's Medicaid for Low-Income Adults program (HUSKY D) provides Medicaid coverage to childless adults between the ages of 19 and 64 with income up to about 60% of the federal poverty level (FPL), or $512.05 per month; there is no asset limit. This program is authorized under the Affordable Care Act, which also requires states to expand their Medicaid programs for this population with income up to 133% of the FPL beginning January 1, 2013. The bill repeals the enabling statutes.
§ 104 — FALSE CLAIMS ACT EXPANSION
Current law prohibits anyone from knowingly filing false or fraudulent claims for payment or approval under any DSS medical assistance program.
The bill expands laws that ban the following to apply to all state programs, rather than just the DSS medical assistance program:
1. having possession, custody or control of property or money used, or to be used, by the state and delivering or causing to be delivered less property than the amount for which the person receives a certificate or receipt, intending to defraud the state or wilfully to conceal the property;
2. being authorized to make or deliver a document certifying receipt of property used, or to be used, by the state and make or deliver such document without completely knowing that the information on the document is true with the intent to defraud the state;
3. knowingly buying, or receiving as a pledge of an obligation or debt, public property from an officer or employee of the state who lawfully may not sell or pledge it;
4. knowingly making, using, or causing to be made or used, a false record or statement material to an obligation to pay or transmit money or property to the state; or
In 2009, the legislature enacted a state False Claims Act applicable to the medical assistance programs DSS administers, which enables the state to keep a greater share of any Medicaid funds the state recovers under it. It creates a civil procedure for pursuing fraud, since the state's criminal laws already provide for prosecuting individuals who commit welfare fraud.
§ 105 — ASO SERVICE AUTHORIZATION
Currently, the ASO must authorize services based solely on the BHP clinical management committee's guidelines. It may make exceptions when a member or the member's legal guardian or service provider requests one and the ASO determines the exception is in the member's best interest. The bill instead (1) requires the ASO to authorize services based solely on “medical necessity,” as defined by statute (see BACKGROUND) and (2) allows it to use the clinical management committee guidelines to inform and guide the authorization decision.
§ 106 & 119 — BEHAVIORAL HEALTH PARTNERSHP
The Behavioral Health Partnership (BHP) is an integrated behavioral health system currently operated by DCF, DMHAS, and DSS. BHP's goal is to provide access to complete, coordinated, and effective community-based behavioral health services and supports. The partnership maintains a contract with an ASO, ValueOptions.
The law requires the DCF, DMHAS and DSS commissioners to implement the BHP for HUSKY Plan A and B members and children enrolled in voluntary DCF services. The bill requires, instead of permits, the commissioners to implement the BHP for all Medicaid recipients, not just those in HUSKY Plan Part A. In practice, the BHP already provides assistance to all Medicaid recipients. The bill also eliminates BHP assistance for Charter Oak Health Plan (COHP) members on January 1, 2014 to conform with the provisions eliminating COHP (see below).
§ 107 — DSS PAYMENTS TO NON-ICF-MR BOARDING HOMES
The bill extends indefinitely the requirement that DSS pay licensed private residential facilities and similar facilities operated by regional educational service centers that provide vocational or functional services for severely handicapped individuals (non-ICF-MR boarding homes) a reduced rate when it has a significant decrease in land and building costs. Under current law, this requirement is imposed for FY 13 only.
The bill allows these facilities to receive higher payments in FYs 14 and 15 (1) if they make a capital improvement in FY 14 or 15; (2) DDS approves it, in consultation with DSS; (3) it is for resident health and safety; and (4) appropriations are available.
§ 108 — STATE OMBUDSMAN PILOT PROGRAM
The bill requires the state ombudsman, beginning July 1, 2015, to personally, or through representatives of her office, implement and administer a pilot program serving home- and community-based care recipients in Hartford County.
§ 109 – DEPARTMENT OF REHABILITATIVE SERVICES
The bill conforms law to practice by authorizing the DORS commissioner, rather than the DSS commissioner, to establish and administer the Assistive Technology Revolving Fund. In practice, BRS administered the fund when it was within DSS and DORS does so currently.
Current law requires using the fund to make loans to people with disabilities to purchase assistive equipment. The bill expands loan eligibility to include senior citizens or the family members of both groups. It eliminates loan use for assistive equipment and instead allows the loans to be used for assistive technology and adaptive equipment and services. It also extends terms of the loan from up to five years to up to ten years and caps the interest at no more than 6%. The bill eliminates the State Bond Commission's authority to set the interest rate and conforms law to practice by allowing the DORS commissioner to set the rate.
DORS currently administers the Connecticut Tech Act Project, which helps clients get the assistive technology they need for greater independence at work, school, or in the community. The bill allows the project to provide available assistive technology evaluation and training services upon request. It allows the project to recoup direct and indirect costs by charging a reasonable fee that the DORS commissioner establishes.
§ 110 — DCF COST ANALYSIS
The bill requires the DCF commissioner, by October 1, 2013, to (1) publish on its website an independent cost analysis of full implementation of the federal Fostering Connections to Success and Increasing Adoption Act of 2008 and (2) report the analysis results to the Children and Human Services committees. The commissioner must analyze costs, federal reimbursements, and off-setting savings for DCF to provide post-majority foster care services to all youth who:
1. are age 18 up to age 21;
2. were in foster care when they turned 18 or exited foster care after turning 18 but wish to reenter; and
3. are (a) completing secondary education or a program leading to an equivalent credential, (b) enrolled in a post secondary or vocational education institution, (c) participating in a program or activity designed to promote employment or remove barriers to employment, (d) employed for at least 80 hours per months, or (e) incapable of participating in any of these activities due to a medical condition.
The analysis must consider all available reimbursements as current costs to other state agencies for serving those foster or former foster youth through age 21.
§ 111 — PILOT MEDICAID DRUG THERAPY PROGRAM
The bill requires the DSS commissioner to begin a pilot drug therapy management program in coordination with the Connecticut Pharmacists Association and a community health center in the greater New Haven area. The program is administered by the health center and must be operated in cooperation with the medication therapy management activities of the ASO.
The bill supersedes the current law's requirement that the DSS commissioner must contract with a patient-centered medical home; a health home; or a pharmacy organization, which can include a school of pharmacy, to provide Medicaid therapy management services.
The law, unchanged by the bill, requires the program to include reviewing patients' prescription histories and developing medication action plans to reduce adverse medication interactions and related health problems.
§ 112 — STRETCHER VANS FOR NONEMERGENCY TRANSPORTATION
PA 12-1, December Special Session, allowed individuals requiring medically necessary, nonemergency transportation to be transported in a stretcher van if they had to be transported in a prone position but did not require medical services during the transport and made related changes. The bill eliminates this requirement.
§ 113 — NURSING HOME NOTIFICATION REQUIREMENT
The law prohibits nursing facilities from admitting anyone, regardless of payment source, who has not undergone a preadmission screening process by which Department of Mental Health and Addiction Services (DMHAS) determines whether the person is mentally ill and, if so, whether he or she requires nursing facility services. The bill allows the DSS commissioner to require a nursing facility to notify DSS within one business day after the admission of a person who is mentally ill and meets the admission requirements.
§ 114 — AUTHORITY OF DSS COMMISSIONER TO PURSUE INITIATIVE RELATED TO THE FEDERAL AFFORDABLE CARE ACT
By law, DSS may purse optional initiatives authorized by the federal Affordable Care Act, as amended. The bill permits him to also pursue policies, and expands the scope of these initiative and policies to include (1) implementing the modified adjusted gross income eligibility (MAGI) rules and (2) coordinating an integrated eligibility system with the Connecticut Health Insurance Exchange.
Under the ACA, states must expand their Medicaid programs to childless adults with incomes up to 133% of the federal poverty guidelines (FPL). The ACA also includes a provision that requires states to disregard an additional 5% of income, bringing the MAGI level to 138% of the FPL.
§ 115 — PILOT TREATMENT PROGRAM
The bill allows the Department of Correction (DOC) to initiate, with support from DMHAS and the Department of Public Health (DPH), a pilot treatment program for methadone maintenance and other drug therapies at facilities including the New Haven Community Correctional Center. The program must be for 18 months and serve 60 to 80 inmates per month. The bill allows DPH to waive public health code regulations that are not applicable to the pilot program's service model.
The bill requires DOC to report the results of the program by October 1, 2014 and April 1, 2015 to the Appropriations, Human Services, and Judiciary committees.
§ 116 — MAXIMIZING PAYMENTS TO HOSPITALS FOR INPATIENT SERVICES
The bill requires the Office of Policy and Management (OPM), subject to federal approval, to determine the amount of revenue that is diverted for purposes of maximizing supplemental payments for inpatient hospital services that the state's acute care hospitals provide to Medicaid patients during FYs 14 and 15.
§ 117 — DISPROPORTIONATE SHARE HOSPITAL PAYMENTS
Under federal and state law, Medicaid provides additional reimbursement to short-term hospitals that serve a disproportionate share (DSH) of low-income patients. (By state law, the Connecticut Children's Medical Center and UConn Health Center are not eligible for such payments.) Under current law, DSS, within available appropriations, can make interim DSH payments on a monthly basis in order to maximize federal Medicaid matching funds. The bill requires that these interim payments be made on a quarterly instead of monthly basis, thus conforming law to current practice.
§ 118 — NURSING HOME ADVANCE PAYMENTS
The bill eliminates a requirement for the DSS commissioner to consult with the OPM secretary before providing advance payments to nursing homes that provide services eligible for payment under the medical assistance program.
§ 121 — CHILDREN'S MENTAL HEALTH TASK FORCE APPOINTMENT
SB 972 of the current session, as amended, establishes a Children's Mental Health Task Force. The bill requires the House majority leader, instead of the Children's Committee House chairperson, to appoint to the task force a complementary and alternative medicine or integrative therapy expert specializing in the treatment of physical, mental, emotional, and behavioral health issues in children.
§ 122 — MONEY FOLLOWS THE PERSON (MFP) “II” – DSS TO IMPLEMENT POLICIES AND PROCEDURES BEFORE REGULATIONS ADOPTED
By law, DSS must develop a plan to establish and administer a program similar to the MFP demonstration program for individuals who are not institutionalized but at risk of such. The bill authorizes the commissioner to implement policies and procedures to implement it while in the process of adopting regulations.
§ 123 — HEALTHY START
The bill (1) establishes in statute the Healthy Start program, which currently (a) is a line item in DSS' budget, (b) is administered by the Children's Trust Fund, (c) serves pregnant women with incomes up to 250% of the FPL, and (d) promotes and supports positive maternal and neonatal health outcomes and (2) requires it to be located within the DSS' Medical Care Administration Division.
The bill requires the DSS commissioner, in consultation with the commissioner of Public Health, to (1) develop a plan to maximize federal Medicaid reimbursement for the program to the extent permitted under federal law and (2) expand services within available state appropriations. The plan must include (1) a venue-based (e.g., health department, hospital clinics, or federally qualified health centers) payment and billing system under the program services provided by “nonlicensed” staff working with a licensed Medicaid provider can receive Medicaid reimbursement and (2) a funding allocation formula that ensures that all eligible women have access to the program's core services. The program already receives federal grant funds through DPH.
The core services include (1) a comprehensive medical and psycho-social risk assessment; (2) development of a care plan; and (2) the delivery of care coordination, such as health education and care management services.
By October 1, 2013 and October 1, 2013, the commissioners, within available funds, must review the effectiveness of the state-funded Healthy Start program. The review must determine if the program (1) should continue to be administered by DSS and (2) should be expanded and how.
§ 124 — RAISE THE GRADE PILOT PROGRAM
The bill requires DCF, in consultation with the State Department of Education (SDE), to establish a two-year, Raise the Grade pilot program in Hartford, Bridgeport, and New Haven to increase the academic achievement of children and youth who are in DCF custody or are being served by the Court Support Services Division (CSSD) of the Judicial Department in these cities.
The program must use full-time coordinators to (1) assist with identifying children or youth who are performing below grade level and are in state custody or under juvenile justice supervision and (2) develop plans, in collaboration with the child's or youth's legal guardian, education surrogate, or advocate to improve the child's academic performance. The coordinators must help facilitate the prompt transfer and review of educational records and report to DCF and the educational surrogate critical educational information, including (1) progress monitoring, (2) absenteeism, and (3) discipline. The coordinators must also help support educational stability for children placed in out of home care by DCF under an emergency order, an order of temporary custody, or a commitment order.
At the end of the pilot, DCF, in coordination with CSSD and SDE , must report to the Achievement Gap Task Force the number and educational profile of children the program serves and the program's impact on their educational performance, including achievement, absenteeism, and adverse disciplinary measures.
§ 125 — ACADEMIC PROGRESS OF CHILDREN IN STATE CUSTODY
The bill requires SDE and DCF to (1) annually track the academic progress of children and youth in state custody from prekindergarten through grade 12 and (2) submit a progress report to the Achievement Gap Task Force. CSSD, in collaboration with SDE, must create an annual aggregate report on the progress of youth in its custody.
For each child or youth in state custody, DCF must include a description of the child's educational status and academic progress in his or her treatment plan. The description must include information regarding the child's current educational performance level, including absenteeism and grade level performance, and the support or services that will or are being provided to improve academic performance.
For children committed to DCF, the educational status information must be included in reports to the Juvenile Court. The court must review the report when making decision regarding the child's well-being in care.
Youth who are in a secure facility run or contracted for by CSSD must have a case plan describing the youth's educational needs and grade-level performance and identifies support and services that are, or will be, provided to support academic performance.
1. the development of effective practices for acquiring and reviewing the student's educational records, including assessment of his or her present level of academic performance;
3. appropriate and ongoing professional development on providing educational and related services to abused, neglected, and juvenile just-involved youth;
5. administrative review of all program that DCF and CSSD run.
§§ 126— RATES PAID TO COMMUNITY HEALTH CENTERS
The bill requires DSS to distribute funding, within available appropriations, to federally qualified health centers based on cost reports they submit to the DSS commissioner until the Human Services and Appropriations committees approve an alternative payment methodology.
§ 127 — MEDICAID STEP THERAPY
§§ 128-131 — NURSING HOME DEBT RECOVERY
The bill changes how the law treats the (1) assets of Medicaid long-term care applicants and beneficiaries and (2) amount of income Medicaid nursing home residents must apply to their care costs (applied income).
During a penalty period, DSS does not make Medicaid payments to the nursing home for the transferor's care. The bill creates a statutory debt, due the nursing home, in an amount equaling the unpaid cost of care the facility provides during the penalty period. The debt amount may not exceed the fair market value of the transferred assets subject to the penalty period at the time they are transferred.
Lawsuits. The bill provides that its provisions do not affect any other rights or remedies the parties may have. It permits a nursing home to sue either the asset's transferor or transferee to collect a debt for the unpaid care if (1) the debt recovery is no more than the transferred asset's fair market value at the time of transfer and (2) the transfer that triggered the penalty period occurred no more than two years before the nursing home resident applied for Medicaid.
The bill allows a court to award actual damages, court costs, and reasonable attorneys' fees to a plaintiff nursing home if it determines, based on clear and convincing evidence, that the defendant caused the debt to the home by (1) willfully transferring assets that are the subject of the penalty period, (2) receiving the assets knowing their purpose, and (3) making a material misrepresentation or omission concerning the assets.
Under the bill, these provisions do not apply to a conservator who transfers income or principal with the probate court's approval (see BACKGROUND).
Definition. In general, nursing home residents determined Medicaid-eligible must spend any income they have, except for a monthly needs allowance, on their nursing home care. This is commonly referred to as “applied income,” which means it is applied to the Medicaid recipient's care costs. If the resident's spouse is living elsewhere, some of the resident's monthly income may go to support that spouse (see below). Under the bill, applied income is also the amount required to be paid to the home for the cost of care and services after the exhaustion of all appeals and in accordance with federal and state law.
Considering Community Spouse's Needs and Notice. The bill requires DSS, when determining the amount of applied income, to take into consideration any modification to the applied income due to (1) revisions in the community spouse's minimum monthly needs allowance (MMNA, see BACKGROUND) and (2) other modifications allowed by state or federal law.
The bill authorizes a nursing home to sue to recover any applied income amount it is owed. But a home may not initiate a suit when a Medicaid recipient has asserted that his or her applied income is needed to increase the recipient's community spouse's MMNA. In this instance, the home must wait until the Medicaid recipient, the community spouse, or their legal representative, exhausts their appeal right before DSS and in court.
The bill allows the home to sue either (1) the Medicaid recipient who owes the money or (2) someone with legal access to the applied income who acted with the intent to deprive the recipient of the income or appropriate it for himself, herself, or a third person.
If, based on clear and convincing evidence, a court finds that a defendant wilfully failed to pay or withheld applied income due and owing to a home for more than 90 days after receiving the notice, it may award the home the amount of debt owed, court costs, and attorneys' fees. The court costs must be awarded as a matter of law to a defendant who successfully defends an action or a counterclaim brought under the bill's provisions. These provisions do not apply to a conservator who transfers income or principal with the probate court's approval (see BACKGROUND).
A nursing home may not sue to recover applied income until 30 days after providing the applied income notice or, if the resident did not receive the notice, 91 days after providing the resident notice of the suit along with the information in the applied income notice.
The bill provides that, to the extent permitted under federal law, institutionalized individuals cannot be determined ineligible for Medicaid solely based on having a life insurance policy with a cash surrender value of less than $10,000, provided (1) the individual is pursuing the policy's surrender and (2) once it is surrendered, the proceeds are used to pay for the individual's long-term care.
Currently, a Medicaid applicant may not have more than $1,600 in liquid assets to qualify for long-term care assistance. (If the applicant is married, this is after the state performs a spousal assessment and gives the community spouse a share of the combined assets.) DSS counts the cash surrender value of any life insurance policy with a face value of more than $1,500 towards the asset limit. DSS also excludes certain transfers of such policies to cover funerals. DSS will not grant eligibility until the policy is surrendered and the money is “spent down” to the asset limit on the individual's care.
§§ 132-140 & 159 — TATTOO TECHNICIAN LICENSE
The bill creates a new license category for tattoo artists (called “tattoo technician”) administered by the Department of Public Health (DPH). DPH must enforce the licensure program within available appropriations and is authorized to adopt implementing regulations.
Starting July 1, 2014, the bill prohibits anyone from engaging in the practice of tattooing unless they are age 18 or older and obtain a Connecticut tattoo technician license or temporary permit.
§ 132 — Definition
§§ 133 & 140 — Licensure Requirements
The bill requires a person who applies for a tattoo technician license on or before July 1, 2014 to provide DPH with satisfactory evidence that he or she:
An applicant seeking licensure after July 1, 2014 must also provide DPH, in a form and manner the commissioner prescribes, documentation that he or she (1) completed at least 2,000 hours of practical training and experience under the personal supervision and instruction of a tattoo technician or (2) practiced tattooing continuously in Connecticut for at least five years prior to July 1, 2014.
The license application fee is $250. Licenses must be renewed biennially for a fee of $200. No license or temporary permit (see below) can be issued if the applicant is facing pending disciplinary action or is the subject of an unresolved complaint in Connecticut or another state or jurisdiction. A person is prohibited from using the title “tattoo technician,” “tattoo artist,” “tattooist,” or similar title unless they have a Connecticut-issued tattoo technician license.
The bill's licensing requirement does not apply to (1) physicians; (2) advanced practice registered nurses (APRNs) working in collaboration with a physician; (3) registered nurses working under the direction of a licensed physician, dentist, or APRN; or (4) physicians assistants working under a physician's supervision, control, or responsibility.
EFFECTIVE DATE: October 1, 2013, except that a conforming change regarding biennial re-licensure takes effect upon passage and applies to registration periods on and after October 1, 2013.
§ 133 — Licensure Requirements for Out-of-State Licensees
§ 133 — Continuing Education
The bill requires tattoo technicians to meet a continuing education requirement to have their licenses renewed. Specifically, it requires licensees to successfully complete a course on preventing disease transmission and blood-borne pathogens that (1) complies with OSHA standards and (2) requires successful completion of a proficiency examination.
§ 133 — Temporary Permits
The bill allows the DPH commissioner to issue a temporary permit to:
1. an applicant who is licensed to practice tattooing in another state and is awaiting DPH approval for his or her license application,
Applicants in Connecticut for the educational and professional purposes specified above must do this at least 45 business days before the event occurs.
§ 133 — Student Tattoo Technicians
The bill allows a student tattoo technician to practice tattooing under the personal supervision of a licensed tattoo technician for up to two years. The student must register with DPH for purposes of completing the practical training and experience required to obtain a tattoo technician license. The student must submit a registration application to DPH on a form the commissioner prescribes that includes:
2. documentation that the student is currently certified in basic first aid training by the American Red Cross of the American Heart Association, and
§ 134 — Title Protection
A person who violates any of these prohibitions is guilty of a class D misdemeanor, which is punishable by a fine of up to $250, imprisonment for up to 30 days, or both.
§ 135 — Disciplinary Action
2. violating the bill's requirements;
5. emotional, mental, physical, or substance use disorders or illnesses; or
6. willfully falsifying client records.
By law, disciplinary actions available to DPH include license revocation or suspension; censure, a letter of reprimand; probation; or a civil penalty (CGS § 19a-17). Under the bill, the department can also order a licensee to undergo a reasonable physical or mental examination if there is an investigation of his or her physical or mental capacity to practice safely.
The bill allows the DPH commissioner to petition the Hartford Superior Court to enforce any disciplinary action it takes. The department must notify the licensee of any contemplated disciplinary action and its cause, the hearing date on the action, and the opportunity for a hearing under the Uniform Administrative Procedure Act.
§ 137 — Inspections of Tattoo Establishments
The bill allows local or health district health directors, or their authorized representatives, to annually inspect the sanitary condition of tattoo establishments within their jurisdictions. It grants the director or authorized representative full power to enter and inspect a tattoo establishment during usual business hours.
The bill specifies, notwithstanding any municipal charter, home rule ordinance, or special act, that any inspection fee collected must be used by the local or district health department for conducting these inspections.
§§ 136 & 138 — Enforcement
§§ 139 & 159 — Repealer
The bill repeals a statute regarding tattooing by specified medical professionals or people acting under a physician's supervision in accordance with DPH regulations and makes a related technical change.
§ 140 — ONLINE LICENSURE RENEWAL AND INCREASED FEES
Starting October 1, 2013, the bill requires, rather than allows, physicians, surgeons, nurses, nurse-midwives, and dentists to renew their licenses using DPH's online license renewal system, with one exception. DPH may allow a licensee to renew his or her license using a paper form and paying the professional service fees by check or money order if the licensee presents extenuating circumstances. This includes submitting to DPH a notarized affidavit indicating that the licensee does not have access to a credit card.
The bill increases the renewal fees for these professionals by $5 (presumably to cover the associated credit card transaction fees). It removes the provision in current law allowing the department to charge a $5 service fee for online license renewals.
It also removes an obsolete DPH reporting requirement regarding the online license renewal system
EFFECTIVE DATE: Upon passage an applicable to registration periods beginning on and after October 1, 2013
§ 141 — LICENSURE FEES FOR HOME HEALTH CARE AGENCIES AND ASSISTED LIVING FACILTIES
The bill establishes a licensing and inspection fee for home health care agencies of $300 per agency and $100 per satellite office. The fee must be paid biennially to DPH, except for Medicare- and Medicaid-certified agencies, which are licensed and inspected triennially.
The bill also establishes a $500 biennial licensing and inspection fee for assisted living services agencies, except those participating in the state's congregate housing pilot program in Norwich.
§ 141 — HEALTH CARE FACILITY TECHNICAL ASSISTANCE FEE
By law, the DPH commissioner may charge a $565 fee for technical assistance the department provides for the design, review, and development of a health care facility's construction, sale, or ownership change. The bill allows the commissioner to also charge this fee for technical assistance provided on a facility's renovation or building alteration.
The bill applies the $565 fee only to projects costing $1 million or less. For projects costing more than this amount, the bill requires the commissioner to charge one-quarter of 1% of the total project cost.
§ 142 — FINANCIAL ASSISTANCE FOR COMMUNITY HEALTH CENTERS
The commissioner must develop a formula to disburse program funds to the centers, which must include (1) the number of uninsured patients the center serves and (2) the types of services it provides.
The bill requires the commissioner to report by October 1, 2013 to the Public Health and Appropriations committees on the disbursement formula. The committees must hold a public hearing on the report within 30 days after receiving it, and then advise the commissioner of their approval or denial of the proposed formula. If the committees fail to do this within 30 days, the formula is deemed approved. The commissioner cannot implement the formula without the committees' approval.
The bill allows the commissioner to establish program participation requirements, provided she gives reasonable notice of the requirements to all community health centers. Centers may only use the funds for commissioner-approved purposes.
The bill defines a “community health center” as a public or private nonprofit medical care facility that (1) meets community health center statutory requirements and (2) is designated by the U.S. Department of Health and Human Services as a federally qualified health center (FQHC) or FQHC look-alike (i.e., is eligible for but does not receive federal Public Health Service Act Section 330 grant funds).
§§ 143 & 144 — CONNECTICUT VACCINE PROGRAM
The bill requires the OPM secretary, in consultation with the DPH commissioner, to determine annually by September 1 the amount of the General Fund appropriation to administer the Connecticut Vaccine Program (CVP) and inform the insurance commissioner of the amount. The law already requires the secretary to annually determine the appropriated amount to purchase, store, and distribute vaccines under the program and inform the insurance commissioner.
By October 1, 2013, the bill requires DPH, in consultation with OPM, to develop and begin annually implementing a reconciliation and expenditure projection process for the state's childhood immunization budget account. This process must include (1) an accounting of the previous year's expenditures, (2) the process and factors to be used in determining each future year's assessment, and (3) the establishment of an appropriate notification process for the entities assessed under the account.
§ 145 — CERTIFICATE OF NEED (CON)
The bill adds to those factors OHCA must consider when evaluating a CON application whether an applicant who failed to provide, or reduced access to, services by Medicaid recipients or indigent people demonstrated good cause for doing so. It specifies that good cause is not demonstrated solely based on differences in reimbursement rates between Medicaid and other health care payers.
By law, OHCA must consider several factors when evaluating a CON application, including the applicant's past and proposed provision of health care services to relevant patient populations and payer mix. The bill specifies that this includes access to services by Medicaid recipients and indigent people.
The law requires OHCA to also consider, among other things, whether the applicant satisfactorily demonstrated how the proposal will improve the quality, accessibility, and cost effectiveness of health care delivery in the region. The bill specifies that this includes the (1) provision of, or change in access to services for Medicaid recipients and indigent people and (2) impact on the cost effectiveness of providing access to Medicaid services.
§ 146 — CREMATION CERTIFICATE FEE
The bill allows the OPM secretary, at the Chief Medical Examiner's request, to waive the $150 cremation certificate fee required for the cremation of a body for which a death certificate has been issued.
§ 147 — UCONN HEALTH CENTER NICU TRANSPORT SERVICES
The bill expressly provides that the University of Connecticut Health Center or a constituent unit, including John Dempsey Hospital (JDH), can discontinue neonatal intensive care unit (NICU) transport services if these services are provided by a qualified transport service.
Existing law established provisions for transferring, from JDH to the Connecticut Children's Medical Center (CCMC), licensure and control of 40 NICU beds after receiving a certificate of need from DPH's Office of Health Care Access. This transfer took place in 2011, and JDH no longer operates a NICU unit. CCMC is scheduled to start NICU transport services in June 2013.
§§ 148-150 — NONPROFIT HOSPITAL REPORTING REQUIREMENTS
The bill requires nonprofit hospitals to submit annually to OHCA (1) a complete copy of the hospital's most recent Internal Revenue Service (IRS) Form 990, including all parts and schedules and (2) data compiled to prepare the hospital's community health needs assessment (see BACKGROUND), in the form and manner OHCA prescribes. But they must not include patient-identifiable information or other individual patient information. They also must not include information that (1) the hospital does not own or control, (2) the hospital is contractually required to keep confidential or is prohibited from disclosing by a data use agreement, or (3) concerns research on human subjects as described in federal Health and Human Services (HHS) regulations (see BACKGROUND).
The bill requires nonprofit hospitals to submit the Form 990 and community health needs assessment data along with information they must already report concerning uncompensated care and related matters. By law, anyone who wilfully fails to file required information with OHCA within the time periods required by law is subject to a civil penalty of up to $ 1,000 for each day the information is missing, incomplete, or inaccurate.
The bill also allows DPH to impose a $ 1,000 daily penalty on health care providers or facilities that wilfully fail to complete the questionnaire required as part of OHCA's statewide health care inventory.
§ 149 — Civil Penalties for Failing to Complete the Inventory Questionnaire
By law, OHCA must conduct a statewide health care facility utilization study, and update its statewide health care facilities and services plan, every two years. As part of this process, OHCA must maintain an inventory of in-state health care facilities, services, and specified equipment. Current law requires health care facilities and providers to complete an OHCA questionnaire to develop the inventory, but exempts them from penalties for failing to complete it.
The bill instead subjects these facilities and providers to the general civil penalties that apply to persons or facilities that fail to file data or information with OHCA as required by law — up to $ 1,000 per day for wilfully failing to comply.
§ 150 — Patient Bills
By law, a hospital must file with OHCA its current pricemaster (detailed schedule of charges). If the billing detail by line item on a patient bill does not agree with the information filed with OHCA, the hospital is subject to a civil penalty of $ 500 per occurrence, subject to the procedures set forth above (e. g. , the hospital has 15 business days to contest the penalty). OHCA can also order the hospital to adjust the bill to be consistent with the charges on file.
The bill specifically requires hospitals to provide detailed patient bills to either DPH or a patient upon request. It also replaces references to “patient bill” with “detailed patient bill” for the purposes of the provisions noted above. It defines a detailed patient bill as a patient billing statement that includes, for each line item, (1) the hospital's current pricemaster code, (2) a description of the charge, and (3) the billed amount.
§ 152 — TOBACCO AND HEALTH TRUST FUND
The bill suspends the operation of the Tobacco and Health Trust Fund's (THTF) board of trustees from July 1, 2015 to June 30, 2016 and makes related technical changes. The suspension period does not affect any trustee's term on the board.
Current law allows the trustees to recommend disbursements of up to half of the previous year's annual disbursement to the THTF from the Tobacco Settlement Fund, up to $ 6 million. It also allows them to recommend disbursements from the THTF's annual net earnings on principal.
For FY 14 and FY 15, the bill instead allows the trustees to recommend disbursement of up to $ 3 million from the THTF annually. (This reflects the FY 14 and FY 15 reduction, from $ 12 million to $ 6 million, in the annual disbursement from the Tobacco Settlement Fund to the THTF in HB 6704 as amended.) Starting in FY 17, the bill restores the current disbursement levels described above.
§ 153 — NURSING HOME REPORTING
The bill requires every (1) for-profit chronic and convalescent nursing home (this appears to mean each for-profit nursing home) that receives state funding to include in its annual cost report to the Department of Social Services (DSS) a profit and loss statement from each related party that receives $10,000 or more a year from the nursing home for goods, “fees,” and services. (Presumably, this means any money the related party receives in fees, not for them.)
The bill also requires all nursing homes, not just for-profit ones, that receive state funding to include detailed information on direct care staff, including (1) regular hours and wages, (2) overtime hours and wages, (3) “benefit” hours and wages (it is not clear what benefit hours are), and (4) employee health and welfare benefits. It requires each direct care and administrative nurse position to be reported as a separate line item.
Cost reports are used to determine the rate DSS pays nursing homes for serving Medicaid-eligible residents.
§ 154 — PILOT PROGRAM STUDYING HIGH SCHOOL ATHLETIC INJURIES
This bill requires the education (SDE) commissioner, in consultation with the DPH commissioner, to establish a pilot program to study the incidence of injuries, particularly concussions, to high school students during interscholastic athletic activities. The commissioner must do this only if federal or private funds are available and the state does not incur a cost.
Under the bill, any school receiving a grant must monitor and report these injuries with the cooperation of the school athletic director, licensed athletic trainers providing services to the school, any physician associated with the school's athletic program, and the Connecticut Interscholastic Athletic Conference.
Within one year of starting the pilot program, the commissioner must report to the Public Health and Education Committees. The report must include (1) a summary of the reports he received from the schools and (2) recommendations for decreasing the number and severity of these injuries.
§ 156 — DCF SCREENINGS FOR DEVELOPMENTAL AND SOCIAL-EMOTIONAL DELAYS
The bill requires DCF to ensure that children age thirty-six months or younger are screened for developmental and social-emotional delays if they are (1) substantiated abuse and neglect victims or (2) receiving DCF differential response program services (see BACKGROUND). The department must do this starting October 1, 2013 for the former and July 1, 2015 for the latter.
The bill requires DCF, within available appropriations, to ensure eligible children age 36 months or younger who are substantiated abuse and neglect victims are screened twice annually, unless the child is found to be eligible for the Birth-to-Three program.
§§ 157-159 — REPEALERS
The bill repeals the following statutes:
1. CGS § 17b-260d—requires the DSS commissioner to apply for a Medicaid home- and community-based services waiver for individuals with AIDS or HIV; DSS never applied for the waiver;
2. CSG § 17b-261n—creates the Medicaid for Low-Income Adults Program
3. CGS § 17b-311—establishes the Charter Oak Health Plan;
4. CGS § 17b-490—creates ConnPACE definitions;
5. CGS § 17b-491—establishes ConnPACE program;
6. CGS § 17b-492—establishes eligibility and other ConnPACE rules;
7. CGS § 17b-493—requires generic substitution for ConnPACE recipients;
8. CGS § 17b-494—requires DSS to adopt regulations for both ConnPACE and prior authorization;
9. CGS § 17b-495—permits DSS to enter into a contract with a fiscal intermediary to administer ConnPACE;
10. CGS § 17b-496—gives individuals aggrieved by any ConnPace administrative action by DSS commissioner the right to a hearing;
11. CGS § 17b-497—imposes penalties on pharmacists and program beneficiaries who defraud or otherwise violate the ConnPACE program and prior authorization laws; and
12. CGS § 17b-498—directs DSS to undertake educational outreach on the ConnPACE program.
§ 16 - Interagency Council on Affordable Housing
PA 12-1, JSS, requires the Interagency Council on Affordable Housing to advise and assist the DOH commissioner in planning and implementing the department. By January 15, 2013 and in consultation with the DOH commissioner, it required the council to report to the governor and the Appropriations, Housing, and Human Services committees with recommendations on:
1. transferring programs to DOH and an implementation timeline,
3. prioritizing housing resources, and
4. enhanced coordination among housing systems.
§ 26 - Department on Aging
The law established a Department on Aging effective January 1, 2013, and transferred to it all functions, powers, duties, and personnel of the DSS Aging Services Division.
§ 78 - Converting Medicaid Program to ASO Model
§ 82 - ConnPACE and MSP
2. Specified Low-Income Medicare Beneficiaries, and
3. Qualified Individuals.
§ 83 - ConnMAP
§ 105 - “Medical Necessity” Definition
The law defines “medical necessity” as those health services required to prevent, identify, diagnose, treat, rehabilitate, or ameliorate a person's medical condition, including mental illness, or its effects, in order to attain or maintain the person's achievable health and independent functioning. The services must be consistent with generally-accepted medical practice standards that are based on (1) credible scientific evidence published in recognized peer-reviewed medical literature, (2) physician-specialty society recommendations, (3) the views of physicians practicing in relevant clinical areas, and (4) any other relevant factors. The services must also be:
3. not more costly than an alternative service or services least likely to produce equivalent therapeutic or diagnostic results for the person's illness, injury, or disease; and
§ 127—Preferred Drug List (PDL)
§§ 128-131—Constructive Trust
§§ 128-131—Community Spouse Allowance and Monthly Needs Allowance
When one spouse is living in a nursing home and the other spouse lives elsewhere, the spouse who is not living in the nursing home (called the community spouse in Connecticut) is allowed by Medicaid to keep a portion of the institutionalized spouse's income. This income, called the community spouse allowance, is determined by subtracting the community spouse's monthly gross income from the MMNA. The MMNA amount will vary from case to case, but for 2013 the minimum is $1,892; the maximum is $2,898. The MMNA takes into account the community spouse's housing costs (e.g., rent, and utilities).
§§ 128-131—Conservators of the Estates of Medicaid Recipients
§ 148 - IRS Form 990 and Community Health Needs Assessment
§ 148 - Research on Human Subjects
HHS regulations set various conditions for research involving human subjects conducted or supported by federal agencies or otherwise subject to federal regulation. Certain types of research are exempt from the HHS policy (such as research involving the (1) use of educational tests in certain circumstances or (2) collection or study of existing data that is publicly available or recorded in a way that subjects cannot be identified) (45 C. F. R. § 46. 101).
§ 153—Nursing Home Cost Reports
4. where (page and line number) on the cost report these costs are shown;
§ 153—Federal Requirements
4. anyone who is an “additional disclosable party” (defined as any person or entity who (a) exercises operational, financial, or managerial control over the facility or a part thereof, provides policies or procedures for any of the operations, or provides financial or case management services to the facility; (b) leases or subleases real property to the facility, or owns a whole or part interest of 5% of more of the total property value of the facility; or (c) provides management or administrative services, management; or clinical consulting, accounting, or financial services to the facility (42 USC § 1320a-3).
4. the charge to the home is in line with the charge in the open market and no more than the entity would charge any others for the same goods and services (42 CFR § 413.17).
§ 153—Nursing Home Licensing Designation
By law, nursing homes must be licensed by the Department of Public Health. The license can be for skilled (also called chronic and convalescent) beds, intermediate care (also called rest home with nursing supervision) beds, or both. The Medicaid reimbursement for the skilled beds is higher than that for the intermediate care
§ 156 - Differential Response Program
§ 156 - Birth-To-Three Program
§ 156 - Children's Trust Fund's Help Me Grow Program
sSB 523 (File 19), which passed the Senate, requires the DSS commissioner, to the extent federal law allows, to reduce the penalty period for certain returned assets.