You asked for a description of:

1. bills affecting seniors that passed in the 2002 regular legislative session;

2. bills affecting seniors that were approved by committees but did not pass, particularly those concerning payments for Medicare-Medicaid dually eligible patients, home care, assisted living, nursing home staffing and nurse shortages, and hospice extensions;

3. portions of the vetoed budget bill (SB 660) that would have affected seniors; and

4. the content and status of the ConnPACE Medicaid waiver, transfer of assets Medicaid waiver, and prior authorization plans.

SUMMARY

In the regular session, the legislature passed 11 bills that affect seniors. These bills:

· exempt Anthem-Blue Cross demutualization payments and stock distributions which many seniors recently received from being counted as income for ConnPACE and other state elderly assistance programs (SB 27);

· require annual flu shots and periodic pneumonia shots for nursing home patients (SB 213);

· require notice and allow public hearings prior to nursing home closures (SB 360);

· requires pharmacies to establish quality assurance programs to detect and prevent prescription errors (SB 504);

· require the Department of Public Health (DPH) to study the need for a pamphlet outlining hospital patients' rights (SB 532);

· add eight new members to the Long-Term Care Advisory Council and require the council to seek recommendations from people with disabilities or people receiving long-term care who reflect the state's socioeconomic diversity (HB 5166);

· require the Office of Policy and Management (OPM) to do a comprehensive assessment of unmet long-term care needs, including a review of the Department of Mental Retardation (DMR) waiting lists, and to project future demand (HB 5169);

· protect more of a bank customer's veterans' or Social Security benefits from being taken by creditors (HB 5514);

· let auto and homeowner's insurance policy holders age 55 and older designate a third party to receive cancellation notices (HB 5641);

· require DPH to establish a quality of care program for health care facilities and require hospitals and outpatient facilities to report adverse events to DPH (HB 5715); and

· allow motor vehicle owners to designate a beneficiary in writing on the registration certificate to assume ownership in case of the current owner's death and require people to honor documents where one adult gives another the right to make certain decisions in health care settings, nursing homes, psychiatric hospitals and other situations (HB 5763).

Below, we describe the most recent versions, including passed amendments, of the above bills under the heading "BILLS THAT PASSED" starting on page 3.

Legislative committees also approved numerous other bills, but the General Assembly did not pass them in the regular session. We describe the most recent version of these bills under the headings "BILLS THAT WERE APPROVED BY COMMITTEES AND SENT TO THE FLOOR BUT DID NOT PASS" starting on page 12 and "BILLS THAT DID NOT REACH THE FLOOR" on page 28. Some may be reconsidered in the upcoming special session. The hospice extension you asked about appears to be a proposed amendment to another bill that did not pass (see below).

Finally, at the end of this report we describe the three plans you asked about:

1. The ConnPACE Medicaid waiver plan, which increases income limits for the program, is still waiting for federal approval before it can go into effect.

2. Last year, the legislature also authorized the Department of Social Services (DSS) to prepare a transfer of assets waiver, which would change the start date of the penalty period for people who transfer certain assets inappropriately in order to become eligible for Medicaid in a nursing home. This spring DSS submitted this waiver plan to the Human Services and Appropriations committees with an additional provision changing the "look back" period for home transfers from three years to five. One committee rejected the plan and the other took no action. DSS recently submitted the plan to the federal Medicaid agency.

3. Two years ago, the legislature directed DSS to establish a prescription drug prior authorization program for the department's drug assistance programs. This year, DSS also submitted this plan (which does not require a federal Medicaid waiver) to the Human Services and Appropriations committees, which expect to take final action on this plan shortly.

BILLS THAT PASSED

SB 27 (SA 02-1)

AN ACT CONCERNING QUALIFYING INCOME FOR PURPOSES OF CERTAIN STATE PROGRAMS

This bill excludes cash payments and the value of stock distributed to individuals in connection with Anthem, Inc. 's conversion to a stockholder-owned company from consideration in determining income eligibility for the following programs:

1. Connecticut Pharmaceutical Assistance Contract to the Elderly and Disabled (ConnPACE),

2. state-reimbursed additional property tax exemption for veterans,

3. elderly property tax freeze,

4. rental rebates for elderly and totally disabled people,

5. property tax credits for elderly and totally disabled homeowners (circuit breaker),

6. local-option additional property tax exemptions for veterans and totally disabled and blind people, and

7. local-option property tax relief for elderly and totally disabled people.

For stock distributions to be excluded, the person receiving the stock must sell it in the tax year during which it is distributed or the two following tax years. The exclusion is limited to the stock's value on the distribution date and does not cover any gains accrued between the distribution date and the sale date.

EFFECTIVE DATE: Upon passage and applicable to property tax assessment years starting on or after October 1, 2001 and taxable years for individuals starting on or after January 1, 2001.

sSB 213

AN ACT CONCERNING THE PREVENTION OF INFLUENZA IN NURSING HOMES

This bill requires the public health commissioner to adopt regulations for the prevention of influenza and pneumococcal disease in nursing homes. The regulations must assure that each nursing home patient is immunized annually against influenza, and against pneumonia according to recommendations of the National Advisory Committee on Immunization. The regulations must also provide appropriate exemptions for patients (1) for whom immunization is medically contraindicated or (2) who object on religious grounds.

EFFECTIVE DATE: October 1, 2002

SB 360

AN ACT CONCERNING NOTICE AND PUBLIC HEARING PRIOR TO A NURSING HOME CLOSURE

This bill establishes notification requirements for nursing homes and other health care facilities undertaking activities that require a certificate of need (CON) from DSS. It requires any nursing home, intermediate care facility for the mentally retarded, rest home, or residential care home submitting a "request for permission" (a CON application) to DSS to concurrently notify the Office of the Long-Term Care Ombudsman.

The bill also requires the facility to notify the ombudsman's office at the same time it submits its CON letter of intent to DSS. Facilities submitting a CON letter of intent to terminate a service or decrease its bed capacity substantially (e. g. , closure of a facility) must also concurrently notify in writing all patients, guardians or conservators, or legally liable relatives or other responsible party, if known. The facility must post a notice in a conspicuous location at the facility.

The bill permits the DSS commissioner to hold a public hearing on such applications and makes hearing procedures for CON applications involving capital expenditures applicable to them. It changes the current law by making hearings in the latter situation permissive, rather than mandatory.

Currently, there is a CON moratorium on new nursing home beds until June 30, 2007, with certain exceptions. This bill permits DSS to approve one CON request for no more than 20 beds for the provision of lifetime nursing home services to residents. The applicant must be a licensed nursing home and cannot participate in the Medicaid or Medicare programs. It must (1) admit residents and provide health care without regard to their income or assets and (2) demonstrate to DSS's satisfaction that it is financially able to provide lifetime care without Medicaid participation.

Under the CON program, DSS reviews a facility's (1) transfer of all or part of its ownership or control prior to licensure; (2) introduction of any additional function or service into its program of care or expansion of an existing function or service; or (3) termination of a service or substantial decrease in its total bed capacity. The facility seeking to do any of these must file a CON application beginning with a letter of intent, using DSS forms and instructions. If the application is approved, the CON is granted.

EFFECTIVE DATE: October 1, 2002

sSB 504 (PA 02-48)

AN ACT CONCERNING THE REPORTING OF PRESCRIPTION ERRORS AND REQUIRING CERTAIN CONTINUING EDUCATION FOR PHARMACISTS

This bill requires the consumer protection commissioner to adopt regulations requiring pharmacies to establish quality assurance programs designed to detect and prevent prescription errors. The bill defines a "prescription error" as an act or omission of clinical significance relating to the dispensing of a drug that results in, or may reasonably be expected to result in, a patient's injury or death. In addition, the bill requires each pharmacy (1) to post signs and include notices on receipts or in prescription packaging informing consumers of a way to report prescription errors and (2) keep records about prescriptions errors.

EFFECTIVE DATE: October 1, 2002

SB 532

AN ACT CONCERNING A PAMPHLET OUTLINING THE RIGHTS OF HOSPITAL PATIENTS

The bill requires DPH to study the need for a pamphlet outlining hospital patients' rights under federal or state law or regulations. The department must list the rights to be included in such a pamphlet and consider the feasibility of requiring all hospitals to provide patients with such a pamphlet. The public health commissioner must report on the study to the Public Health Committee by January 1, 2003. (This will be a Special Act)

EFFECTIVE DATE: Upon passage

sHB 5166

AN ACT CONCERNING THE LONG-TERM CARE ADVISORY COUNCIL

This bill requires the Long-Term Care Advisory Council (LTCAC) to seek recommendations from people with disabilities or people receiving long-term care services who reflect the state's socioeconomic diversity.

It also adds eight new members to the 19-member LTCAC. They are (1) a personal care attendant appointed by the House speaker; (2) the president of the Family Support Council or his designee; (3) someone who, in a home setting, cares for a person with a disability, appointed by the Senate president pro tempore; (4) three people with disabilities, one each appointed by the House and Senate majority leaders and the House minority leader; (5) a legislator who is a member of the Long-Term Care Planning Committee; and (6) a nonunion home health aide appointed by the Senate minority leader.

The bill also makes some minor and technical changes regarding some of the existing council members. It puts the state president of AARP (formerly known as the American Association of Retired Persons) himself or his designee on the council, instead of only his appointee. It also puts the president of the Connecticut chapter of the Connecticut Alzheimer's Association, instead of the executive director of the Connecticut Alzheimer's Association, on the council. And it makes corrections in the names of several entities represented on the council.

The LTCAC, composed of long-term care providers and consumer advocates, advises the interagency Long-Term Care (LTC) Planning Committee which is composed of representatives from executive agencies and legislators. The LTC Planning Committee's charge is to exchange information on long-term care issues, coordinate long-term care policy development, establish a statewide long-term care plan for the elderly and others in need of long-term care and revise it every three years, and study related issues.

EFFECTIVE DATE: October 1, 2002

sHB 5169

AN ACT CONCERNING A COMPREHENSIVE NEEDS ASSESSMENT OF LONG-TERM CARE

The bill requires the OPM to conduct a comprehensive needs assessment of the unmet long-term care needs in the state and project future demand for such services. Such assessment must include a review of DMR's waiting list.

EFFECTIVE DATE: July 1, 2002

sHB 5514

AN ACT CONCERNING BANK ACCOUNT EXECUTIONS (relevant parts only)

By law, a creditor may obtain a court-ordered judgment against someone who owes him money (the debtor) in certain circumstances. The creditor can execute or serve this order on any banking institution (banks, savings and loans, and credit unions; hereafter "bank") where the debtor has an account. This bill increases, from $ 800 to $ 1,000, the amount the bank must leave in the account if the debtor recently received by electronic direct deposit "readily identifiable" exempt federal veterans' or Social Security benefits.

EFFECTIVE DATE: January 1, 2003

Background

Bank and Creditor Obligations. By law, creditors cannot attach or seize exempt funds to satisfy a court judgment. State and federal law exempt such funds as Social Security and federal veterans' benefits, state welfare, child support, pensions, $ 268 per week in wages, and a $ 1,000 "wild card. " Exempt funds retain this status when deposited into a bank.

When a creditor serves an order on the debtor's bank, the bank has to ignore a set amount in the debtor's account (or the entire account balance if less than the set amount) if a readily identifiable exempt federal veterans' or Social Security benefit was directly deposited electronically within the past 30 days. (The bill increases this amount from $ 800 to $ 1,000. ) Banks that exclude this money in good faith or do so by mistake are exempt from liability to creditors, but creditors can ask for a court hearing when they believe that any of the funds a bank withheld are not exempt.

Except as described above, banks served with such orders must remove funds from the account up to the full amount of the judgment and mail the account holder notice and a form he must return to the bank within 15 days if he claims that any of the removed funds were exempt. If the account holder does not return the claim form to the bank within 15 days, the bank pays over the funds to the creditor on request. But if he claims an exemption within the allowable period, the bank must notify the Superior Court and continue to hold the funds for the earlier of 45 days or until a court issues a disposition order for the disputed funds.

sHB 5641 (PA 02-60)

AN ACT ALLOWING SENIOR CITIZENS TO DESIGNATE A THIRD PARTY TO RECEIVE CERTAIN CANCELLATION NOTICES

This bill requires insurers that offer automobile and homeowners insurance to include a conspicuous statement with each policy informing policyholders age 55 and older that they may designate a third party to receive cancellation or nonrenewal notices. The insurance commissioner must approve the statement, which must include a designation form, a mailing address that the policyholder may use to designate a third party, and satisfy other requirements for it to be effective.

The bill adds automobile liability policy third-party designees as recipients of (1) a cancellation notice and (2) the proof of notice required to cancel, nonrenew, or provide reasons for canceling. In the standard fire insurance policy form, the bill adds homeowners' insurance policy third-party designees as recipients of the cancellation notice that insurers must send to cancel the policy. When a designation is made, insurers must give the designee notice for the cancellation or nonrenwal to be effective.

The bill requires automobile and homeowners' insurers that send, deliver, mail, or otherwise provide cancellation or nonrenewal notices to an insured to use the same method to send, deliver, mail or provide a copy of the notice to any third-party designee.

EFFECTIVE DATE: October 1, 2002

sHB 5715

AN ACT CREATING A PROGRAM FOR QUALITY IN HEALTH CARE

This bill requires DPH to establish a quality of care program for health care facilities. DPH must develop a health care quality performance measurement and reporting system initially applicable to the state's hospitals. Other health care facilities come under the quality program as it develops in later years. An advisory committee, chaired by the DPH commissioner, advises the program.

The bill directs DPH to produce a report that compares the state's hospitals based on quality performance measures. The bill requires all hospitals to implement performance improvement plans. These plans must be submitted annually to DPH as a condition of licensure, beginning June 30, 2003.

The bill allows DPH to seek and apply for funding to implement the quality of care program provisions. These provisions must be implemented upon receiving this funding.

The bill requires hospitals and outpatient surgical facilities to report adverse events to DPH. An "adverse event" is an injury caused by or associated with medical management and results in death or measurable disability.

EFFECTIVE DATE: October 1, 2002, except July 1, 2002 for the adverse event reports.

HB 5763

AN ACT CONCERNING A TRANSFER UPON DEATH OPTION IN THE MOTOR VEHICLE REGISTRATION FORM (relevant portions of bill only)

Among other provisions, this bill allows a natural person who is the only owner of a motor vehicle to designate in writing on the registration certificate a beneficiary who will assume ownership on his death.

It also requires people to honor documents executed by one adult designating another adult to make certain decisions on the maker's behalf and giving the designee limited rights or responsibilities. The bill applies to documents used:

1. in psychiatric hospitals, when informed consent for medical treatment is required from someone other than the patient;

2. in nursing homes, when private visitation and room transfer decisions are made;

3. in health care settings, when medical personnel (a) need information about a patient's wishes from people other than the patient or (b) plan to withdraw life support;

4. in the workplace, when an employee receives an emergency telephone call;

5. in court and administrative proceedings involving crime victims; and

6. upon death of the maker, regarding ownership to the maker's motor vehicle.

EFFECTIVE DATE: October 1, 2002, except the provisions concerning motor vehicle transfers are effective January 1, 2003.

Nursing Home Patient's Bill Of Rights

The bill gives nursing home (used generically and includes residential care homes, chronic disease hospitals, and rest homes with nursing supervision) residents the right to have designees (1) receive between 30 and 60 days advance notice of involuntary, non-emergency room transfers, including moving Medicaid patients from private to non-private rooms; (2) included in the consultative process prior to transfer (current law requires notice to, and consultation with, certain relatives, conservators and guardians, or other representatives); (3) visit them in private (current law applies to spouses only); and (4) meet with other patients' families at the facility (current law is limited to family members).

By law, nursing homes must give patients written notice of their rights, which under the bill would include the above. Patients who are injured by a facility's violation of the Nursing Home Patient's Bill of Rights can sue for money damages. They are entitled to punitive damages for a facility's willful or reckless actions.

Life Support and Anatomical Gift Decisions

By law, a physician treating an incapacitated person in a terminal or permanently unconscious condition must consider the patient's wishes concerning the withholding or withdrawal of life support. When the doctor does not have a patient's living will in his possession, he must determine those wishes by asking the patient's health care agent, next of kin, legal guardian or conservator, or anyone else he knows has talked with the patient about his wishes, where this is possible. He must also make reasonable efforts to give advance notice to a person's health care agent, legal guardian, or conservator before withdrawing life support.

The bill adds a patient's designee to the list of people the doctor must consult about a patient's wishes and notify before removing life support. It also requires health care providers to include in a patient's medical record reported communications the patient made to his designee, in addition to the people listed above, about any aspect of his health care preferences, including the withholding or withdrawal of life support.

Finally, the bill gives a deceased person's designee priority in making anatomical gift decisions over his guardian, health care agent, conservator, and all family members except the surviving spouse. As under existing law, no one can override an earlier unrevoked decision the deceased made not to make the gift.

BILLS THAT WERE APPROVED BY COMMITTEES AND SENT TO THE FLOOR BUT DID NOT PASS

SB 36

AN ACT CONCERNING METHODS OF MITIGATING THE EFFECTS OF REVALUATION IN A MUNICIPALITY SUBJECT TO THE PROVISIONS OF SPECIAL ACT 01-1

This bill requires Waterbury to continue, from May 1, 2002 to June 30, 2006, to provide health coverage to its retired employees that is at least equivalent to that provided on the bill's effective date to the majority of the city's unclassified (non-civil service) employees who (1) are not union members and (2) are not employed in grant-funded positions. But the bill allows the city to reduce retiree health coverage if (1) the reduction is consistent with any collective bargaining agreement or contract that applies to a retiree, (2) the retiree or his legal representative agrees, or (3) the change is the result of changes in the state health plan for retired teachers.

From May 1, 2002 through June 30, 2006, the bill also bars Waterbury from changing the health coverage of any retired city employee who as of its effective date is covered by Medicare Part B and the city's fully insured Medicare supplement policy.

EFFECTIVE DATE: Upon passage

SB 96

AN ACT CONCERNING THE TREATMENT OF CERTAIN DISTRIBUTIONS FROM MUTUAL INSURANCE COMPANIES FOR PURPOSES OF THE RENTAL REBATE AND CIRCUIT BREAKER TAX RELIEF PROGRAMS

This bill excludes cash payments and the value of stock distributed to individuals due to a mutual insurance company's conversion to a stockholder-owned company from inclusion as income in determining eligibility for the following programs: (1) rental rebates for elderly and totally disabled people, and (2) property tax credits for elderly and totally disabled homeowners (circuit breaker).

For stock distributions to be excluded the person receiving the stock must sell it in the tax year during which it is distributed or the two following tax years. The exclusion is limited to the stock's value on the distribution date and does not cover any gains accrued between the distribution date and the sale date.

This bill specifically does not cover payments from Anthem, Incorporated, which are exempted by separate parallel legislation that was enacted into law, Special Act 02-1.

EFFECTIVE DATE: Upon passage and applicable to property tax assessment years starting on or after October 1, 2001 and taxable years for individuals starting on or after January 1, 2001.

sSB 130

AN ACT CONCERNING NURSING HOME INSPECTIONS

This bill requires the DPH dual nursing home inspections to be random and unannounced. Current law requires DPH, whenever possible, to conduct both state and federally required inspections at the same time (1) when required for state licensing and for federal Medicaid or Medicare certification and (2) in at least 70% of the facilities. The bill removes this 70% requirement.

EFFECTIVE DATE: Upon passage

Background

Federal Inspection Schedules. To receive federal Medicare or Medicaid reimbursement, nursing homes must become federally certified and periodically undergo federally-mandated inspections (called surveys under federal law). In Connecticut, DPH conducts these surveys for the federal government under a contract with the federal Center for Medicare and Medicaid Services. The surveys must take place, on average, every 12 months, and the time between inspections cannot be more than 15 months. Federal law prohibits advance notice of the survey to the nursing home and imposes civil penalties on anyone giving the homes advance notice. Federal regulations also require that the surveys be unannounced (42 U. S. C. § 1395i-3(g)(2) and 42 C. F. R. §§ 488. 307 and 488. 308).

State Requirements. By law, DPH must renew nursing home licenses every two years after an unscheduled inspection and the nursing home's submission to the commissioner of evidence that it is in compliance with state law, as well as other information the commissioner requires. The law generally prohibits DPH employees, Department of Social Services employees, and regional long-term care ombudsmen from notifying a nursing home that an inspection or other investigation is being considered or about to take place. If they give such notice, they are guilty of a class B misdemeanor and can be dismissed, suspended, or demoted, unless federal or state law specifically requires advance notice. A class B misdemeanor has a penalty of up to six months imprisonment, a fine of up to $ 1,000, or both.

sSB 131

AN ACT CONCERNING FULL DISCLOSURE OF PREPAID FUNERAL SERVICE CONTRACTS

This bill requires:

1. funeral contracts entered into in advance of the furnishing of services and products (i. e. , "pre-need" contracts) to contain specified disclosures to consumers;

2. funeral home owners, before selling the contracts, to post a bond, or series of bonds in varying amounts, depending on the number of homes they own;

3. escrow agents who administer the consumers' funds to notify consumers when homes deposit the funds or other transactions are completed;

4. a contract between the funeral home and the escrow agent and specifies its contents;

5. annual escrow account statements to disclose the amount of all expenses charged to the account and the annual rate of return, in addition to the amount, as required under current law; and

6. that funds remaining in the account after the funeral be turned over to the person responsible for making the funeral arrangements.

EFFECTIVE DATE: October 1, 2002

Background

Pre-Need Funeral Contracts. By law, funeral homes may contract with consumers in advance to provide services and products for a funeral. These contracts can be revocable or, if their value does not exceed $ 5,400, irrevocable. The law already requires funeral homes to place the money the consumer pays on such a contract in an escrow account administered by an escrow agent, which must be a bank, savings and loan association, insurance company, or registered broker-dealer. It also already restricts what the funds can be invested in, requires each party to the contract to receive an annual statement, and sets other procedures for handling the escrow accounts and what to do in case of defaults on either side.

sSB 132

AN ACT REQUIRING CRIMINAL BACKGROUND CHECKS ON CAREGIVERS TO THE ELDERLY

This bill requires nationwide criminal background checks on caregivers and administrators who seek and are offered work in a nursing home or home health care agency (care providers), including people hired through a temporary employment agency. Caregivers include people whose employment or contractual service with a care provider includes physical access to patients or access to patients' finances. Starting October 1, 2002, the bill prohibits providers from hiring such employees without a background check.

The bill establishes procedures for these background checks. It prescribes the duties of the Department of Public Safety (DPS), which conducts the checks, and the Department of Public Health (DPH), which makes the decision to disqualify people from such employment if they are unfit for it and have been convicted, incarcerated, or on probation in the past three years for any of a list of specified crimes. The bill affords the disqualified applicant an opportunity for a hearing and appeal. DPH must keep the background check information confidential.

At the provider's request, DPS, or its designee, must take the applicant's fingerprints. DPS must conduct the background check by submitting the fingerprints to the Federal Bureau of Investigation (FBI). DPS then provides the criminal history record to DPH. DPH must charge the provider the fee for the FBI check (currently $ 24). It must also reimburse DPS for the actual cost of the background check.

The bill authorizes the DPS and DPH commissioners to adopt regulations concerning their respective responsibilities under the program. Although the bill takes effect October 1, 2002, it gives the DPH commissioner the option of establishing a three-year phase-in based on type of provider, by regulation.

Beginning October 1, 2002, providers must keep records showing they have complied with the bill and are subject to fines of up to $ 500 per violation for noncompliance. By October 1, 2002, the DPH commissioner must notify providers of the bill's requirements.

EFFECTIVE DATE: October 1, 2002, but upon passage for the DPH commissioner's notification requirements.

sSB 133

AN ACT CONCERNING THE APPLICABILITY OF MEDICARE SUPPLEMENT INSURANCE RATE INCREASES

This bill prohibits Medicare supplement insurers from increasing rates for at least six months after the initial issue date of a policy. The prohibition applies to Medicare supplement policies first issued on or after October 1, 2002.

A Medicare supplement policy is an individual or group health insurance policy that provides benefits additional to those Medicare provides. Policies sold in Connecticut have been standardized in accordance with federal law (OBRA 90). Insurers must offer a core benefit policy, Plan A, and may offer policies with additional benefits (Plans B through J). Except for Plans H, I, and J, coverage must be offered, and rates must be computed, without regard to the insured's previous claims history or medical condition.

EFFECTIVE DATE: October 1, 2002

sSB 135

AN ACT CONCERNING NURSING HOME STAFFING LEVELS

This bill (1) subjects nursing homes to loss of their license if they do not have enough staff to meet their residents' needs and (2) phases in higher minimum direct care staffing standards over two years. It requires homes that do not meet the standards on any day to report that fact and the surrounding circumstances to DPH every quarter. It allows the DPH commissioner to take certain enforcement actions against homes that fail to submit the reports or have a pattern of noncompliance with the minimum standards.

EFFECTIVE DATE: October 1, 2002

Non-issuance or Withdrawal of License

The bill prohibits DPH from issuing or renewing a nursing home license unless the facility employs sufficient nursing personnel needed for continuous 24-hour nursing care and services to meet each resident's needs.

Direct Care Defined

For purposes of staffing levels, the bill defines "direct care" as care provided to residents that includes face-to-face assessment; administration of medication or treatments; and feeding, bathing, toileting, dressing, and lifting and moving residents. It does not include food preparation, housekeeping, or laundry services, except when these services are required to meet the needs of a resident on an individual or situational basis.

Minimum Direct Care Staffing Level Phase-in

DPH licenses two types of nursing homes: chronic and convalescent care nursing homes (CCNHS), which provide skilled nursing care, and rest homes with nursing supervision (RHNSs), which provide intermediate care. Current regulations set somewhat lesser minimum staffing standards for RHNSs than for CCNHs.

The bill requires both types of nursing homes to maintain identical higher aggregate licensed nurse and nurse's aide staffing levels, over a 24-hour period, in a two-step phase-in. The table below compares the current requirements to the proposed phase-in.

Directors and Assistant Directors of Nurses

Under the bill, a facility with 61 or more beds cannot count its director of nurses in meeting the minimum staffing requirements for direct care from licensed nurses. Current regulations already have this provision.

The bill requires a facility with 121 or more beds to hire a full-time assistant director of nurses, who also cannot be included in meeting the direct care requirements. Current regulations already require facilities with 120 or more beds to hire an assistant director of nurses, but prohibit facilities with 121 or more beds from counting directors and assistant directors of nurses in meeting minimum staff ratios.

Staffing Noncompliance Reports

The bill requires any licensed nursing home that fails to comply with these staffing minimums on any day to submit a report to DPH, on a quarterly basis, that contains (1) the day and shift when the noncompliance occurred and (2) the reasons for and circumstances surrounding the noncompliance.

The bill allows the DPH commissioner to take certain enforcement actions (issuing citations and imposing civil penalties) if (1) the facility fails to submit this report or intentionally misrepresents the information contained in it, or (2) the commissioner determines that there is enough evidence to support a finding that the facility has a pattern of noncompliance.

sSB 140

AN ACT CONCERNING ADMISSIONS TO NURSING HOMES

This bill requires a nursing home medical director to (1) have the results of a patient's mental illness or mental retardation screening before admitting him and (2) notify the Department of Mental Health and Addiction Services (DMHAS) within one week after someone who has undergone a level II preadmission screening mental illness evaluation has been admitted to the home. The bill also requires DMHAS to receive weekly updates of those people who were discharged from DMHAS programs to the nursing homes (presumably the nursing home provides the updates).

EFFECTIVE DATE: October 1, 2002

Mental Illness or Mental Retardation Preadmission Screening

Connecticut law prohibits nursing homes from admitting anyone, irrespective of the payment source, who has not undergone a preadmission screening process for mental illness and mental retardation, based on an independent physical and mental evaluation, that determines whether the person has mental illness or mental retardation (level I) and, if so, whether he requires nursing facility services or specialized services (level II). The law also prohibits nursing homes that violate the preadmission screening requirement from receiving payment from any source for their services to that individual.

Federal regulations also require preadmission screenings for mental illness and mental retardation for anyone entering a Medicaid-certified nursing home (most homes are Medicaid-certified) (42 C. F. R. § 483. 100ff).

sSB 143

AN ACT CONCERNING FOSTER CARE AND OTHER PAYMENTS BY THE DEPARTMENT OF CHILDREN AND FAMILIES

This bill extends the Department of Children and Families' (DCF) subsidized guardianship program to (1) children who were in foster or DCF-certified relative care for between 12 and 18 months before a court appointed their relative as guardian and (2) certain orphans. It establishes a two-tier subsidy level, in which the subsidy for children who were in DCF custody is the same as for foster children while the subsidy for orphans is adjusted for various government payments. But as existing DCF regulations contain an asset test that enables it to adjust subsidies for children formerly in DCF custody to account for government and other payments they receive, it appears that both subsidies for both groups could be treated essentially in the same way.

EFFECTIVE DATE: July 1, 2002

Subsidized Guardianship Eligibility

The bill extends DCF's subsidized guardianship program to children who have been in foster care or DCF-supervised relative care for between 12 and 18 months before a court appoints a relative as their guardian. Under current law, a child must be in foster or relative care for at least 18 months, but the DCF commissioner can create a program to subsidize guardianships for children who have been in her custody for between 12 and 18 months, if funds are available. The bill eliminates this option. (Although both current law and the bill apply to children in "certified" relative care, PA 01-70 requires relatives who care for children for more than 90 days to be licensed as foster parents unless, under certain conditions, they were previously certified as relative caregivers. )

The bill makes orphans who have not been in DCF custody and for whom a court has appointed a relative as guardian eligible for guardianship subsidies as long as the relative's family income is 200% or less of the federal poverty line (200% is currently $ 30,040 for a family of three).

Subsidy Levels

The bill sets the subsidy for children in DCF custody for 12 to 18 months equal to the rate DCF pays foster parents, which is the same level as the current subsidy for children in DCF custody for 18 or more months. For orphans, it sets the subsidy at foster care rate minus (1) Social Security survivors or disability benefits and (2) temporary family assistance (TFA) paid for the child.

The law allows DCF to establish an asset test for program eligibility. DCF regulations governing this asset test, which apply to the current subsidy program, allow it to reduce the subsidy amount to reflect the child's own income from other sources including: Social Security; TFA; child support; life insurance or other death benefits from or through a parent; and all other federal and state assistance and benefit programs.  

Background

Subsidized Guardianship Program. The subsidized guardianship program provides (1) a lump-sum payment for one-time expenses a guardian experiences in assuming the child's care, (2) medical benefits, and (3) a monthly payment. The monthly payment continues until the child turns age 18, unless he is attending high school, technical school, college, or a state-accredited job-training program, in which case it continues until age 21.

The law allows DCF to adopt regulations requiring a home study of the guardian to be filed with the appropriate court within 15 days after the request for a subsidy. Current DCF regulations require it to assess the relative caregiver and others living in the household including their health, intellectual and emotional capacity to care for the child, and criminal record (Conn. Agency Regs. 17a-126-1 to -23).

sSB 277

AN ACT CONCERNING TALKING PRESCRIPTION DRUG BOTTLES

This bill requires private group and individual health insurance policies and the state's Medicaid and ConnPACE programs to cover prescription containers that give recorded audio prescription information, including prescribed dosages, for people with visual impairment. Under the bill, the insurers must cover these "talking" containers only when they are specifically ordered by a licensed prescribing authority for someone with a visual impairment. (For Medicaid and ConnPACE, the bill does not specify that the containers must be prescribed, but these programs appear to require a prescription. )

For insurers, the requirement applies to hospital and medical coverage offered by HMOs and policies that pay for (1) basic hospital expenses, (2) basic medical-surgical expenses, (3) major medical expenses, and (4) hospital or medical services. Coverage applies to policies delivered, issued for delivery, renewed, amended, or continued in the state on or after October 1, 2002.

EFFECTIVE DATE: October 1, 2002

sSB 367

AN ACT ADDRESSING THE SHORTAGE OF NURSES, PHARMACISTS, ALLIED HEALTH PROFESSIONALS, DENTAL HYGIENISTS AND DENTAL ASSISTANTS

This bill establishes incentive grants to encourage students to enter the fields of (1) nursing, (2) pharmacy, (3) allied health, (4) dental hygiene, (5) dental assistance, (6) radiological technology, and (7) laboratory technology. It allows them to qualify for loan reimbursements if they work in certain Connecticut medical facilities after they get their degree or certificate. It requires the higher education commissioner to report to the Education, Public Health, and Workforce Development committees on the programs' status. The bill also requires the state's higher education authorities to expand and improve their dental hygienist, dental assistant, radiological technician, and laboratory technician programs.

EFFECTIVE DATE: Upon passage

Incentive Programs

The bill establishes (1) nursing, pharmacy, and allied health profession; (2) dental hygienist and dental assistant; and (3) radiological and laboratory technology incentive programs, which it requires the Department of Higher Education (DHE) to administer. The bill requires the programs, within available appropriations, to provide grants to students in these programs at colleges and universities the Board of Governors of Higher Education (BOG) approves, or at regional vocational-technical (V-T) schools for the nursing, pharmacy, allied health, and dental programs. The bill prohibits any student from receiving a grant for more than two years, and limits maximum yearly grants to $ 5,000. Students in the nursing, pharmacy, and allied health profession program completing their program requirements as graduate students may also participate, if they received their first grant as an undergraduate. The bill requires DHE to ensure that at least 10% of the grant recipients in each program are minority students, and specifies that those entering the nursing, pharmacy, and allied health profession program be transferring from Connecticut community-technical colleges (CTCs).

sSB 550

AN ACT CONCERNING THE DEVELOPMENT OF A SYSTEM FOR CHECKING ERRORS IN THE DISPENSING OF MEDICATION

This bill directs the consumer protection commissioner to adopt regulations to develop a system for checking for errors made by (1) practitioners prescribing medication and (2) pharmacists dispensing medication.

EFFECTIVE DATE: October 1, 2002

Related Bill

The General Law Committee favorably reported a bill (sSB 504, file 194) that also addresses prescription drug errors and continuing education for pharmacists, which passed (PA 02-48).

sSB 611

AN ACT CONCERNING A TAX AMNESTY PROGRAM, A HOUSING TAX CREDIT AND RELATED HOUSING PROVISIONS, THE CORPORATION BUSINESS TAX AND THE ESTATE TAX (relevant portions of bill only)

Among other provisions, this bill:

1. establishes a tax amnesty between September 1 and November 30, 2002 to forgive penalties and criminal prosecution for taxes owed for any period before March 31, 2002, as long as the taxes and interest are either paid or arrangements for payment are made during the amnesty period; and

2. freezes state generation-skipping transfer and estate taxes at the federal rates that applied, and requires property subject to the taxes to be valued according to federal methods in effect, on January 1, 2001, before enactment of the federal law phasing out the corresponding federal taxes.

EFFECTIVE DATE: The bill takes effect as follows: (1) the amnesty provision is effective on passage; (2) the generation-skipping transfer tax changes are effective July 1, 2002 and apply to transfers occurring on or after that date; and (3) the estate tax changes take effect July 1, 2002 and apply to estates of people who die on or after that date.

SB 634

AN ACT CONCERNING THE REEMPLOYMENT OF RETIRED TEACHERS

The bill lifts the current post retirement earnings limit for up to two years for positions designated by the education commissioner as in subject shortage areas and retains the current earnings limit of 45% of the entry level salary for non critical teaching areas.

Additionally, the bill eliminates any further accrual of benefits to reemployed members and requires that school districts provide health insurance benefits to reemployed retired teachers in the same manner as they do for active teachers.

Under current law, a retired teacher may earn no more than 45% of the entry-level salary for a teacher assigned to the same subject area. If a teacher is approved to exceed the 45% level, retirement benefits are suspended and they have the option to accrue additional benefits by making the required contributions.

Under the bill, a retired teacher employed in a non shortage area may earn no more that than the current limit. Retired teachers employed in subject shortage areas may earn above the limit and receive active teacher health insurance coverage while maintaining their benefits under the Teachers' Retirement System.

EFFECTIVE DATE: July 1, 2002

HB 5106

AN ACT CONCERNING FAIR HOUSING MARKETING PLANS AND ADMISSION TO ELDERLY AND CONGREGATE HOUSING

This bill sets conditions under which housing authorities, nonprofit organizations, and other entities operating state-funded elderly and elderly congregate housing projects can admit applicants based solely on the time and date of their application. An entity can do this only when it opens the waiting list for applications and:

1. gives no preference to people who live in the town where the project is located,

2. allows people to apply by mail,

3. precludes giving geographic preferences by assigning each application an order drawn by a lottery, and

4. complies with its affirmative marketing plan and the Department of Economic and Community Development's regulations.

Current regulations require entities to admit applicants based on a point system or lottery.

The bill also requires the state agencies funding all types of housing projects to periodically give the entities lists of towns with relatively high concentrations of minorities. By law, these entities must use the lists to prepare and implement the affirmative marketing plans required by law. The plans must show how they intend to recruit applicants from towns with relatively high concentrations of minorities.

EFFECTIVE DATE: October 1, 2002

HB 5142

AN ACT CONCERNING AN INCREASE TO THE UNEARNED INCOME DISREGARD FOR STATE SUPPLEMENT RECIPIENTS

This bill requires the Department of Social Service (DSS) commissioner, starting July 1, 2002, to annually increase the amount of unearned income that is excluded (unearned income "disregard") when she determines someone's eligibility for State Supplement benefits. The amount of the increase is equal to the percentage increase in the average consumer price index for urban consumers in the most recent calendar year over the average for the previous calendar year. Currently, she excludes a set amount of unearned income, which varies based on the person's living arrangement. This disregard has not risen since 1988. The maximum State Supplement benefit has likewise been frozen for several years.

EFFECTIVE DATE: July 1, 2002

Background

State Supplement. Needy people who are aged, blind, or disabled can qualify for State Supplement benefits, regardless of whether they are also receiving Supplemental Security Income (SSI) benefits. Eligibility and benefit determination is complex.

In general, DSS looks at the income (both earned and unearned), takes deductions from both types of income, and compares the net amount to a "need" standard. (Gross income cannot exceed 300% of the SSI benefit, which is currently $ 1,635 per month and assets can be no more than $ 1,600 for a single applicant. ) The unearned income disregard varies, depending on the person's living arrangement. For example, someone living alone in the community has $ 183 deducted from his unearned income.

Like the disregard, the need standard varies, depending on the applicant's or recipient's living arrangement. It consists of both the housing costs and a personal needs allowance. Using the above example, someone living in the community has a shelter limit of $ 400 per month and gets a personal needs allowance of $ 164. 10, so his total monthly need would be a maximum of $ 564. 10. (DSS looks at the applicant's actual rent. With regard to needs allowance, people living in licensed boarding facilities have different standards. )

If net income is greater than the need standard, the person is ineligible for assistance. If it is less, the person qualifies and the benefit equals the difference between the two.

Impact of SSI COLAs on State Supplement Benefits. Each year the SSI maximum benefit is adjusted for increases in the cost-of-living (COLA). State Supplement recipients have not been able to deduct these increases since the disregard was frozen. Thus, their state benefit has dropped in proportion to the SSI COLAs.

sHB 5496

AN ACT CONCERNING EARLY CHILDHOOD EDUCATION AND TEACHERS' RETIREMENT (relevant portions of bill only)

This bill:

1. starting July 1, 2004, gradually reduces, from 35 to 32, the number of years a public school teacher must work to retire with the most favorable retirement benefit formula under the Teachers' Retirement System (TRS),

2. liberalizes earning limits for retired teachers who return to the classroom temporarily, and

3. allows retired teachers to earn more than the limit while continuing to collect retirement benefits for up to two years if they are reemployed in shortage areas or other necessary positions identified by the education commissioner.

EFFECTIVE DATE: July 1, 2002, and the retirement service reduction provision takes effect July 1, 2004.

sHB 5555

AN ACT PROVIDING FULL PAYMENT TO PHYSICIANS FOR SERVICES PROVIDED TO DUALLY-ELIGIBLE PATIENTS

The state helps people who are eligible for both Medicare and Medicaid ("dually-eligible") by paying providers a portion of the individual's Medicare cost-sharing (e. g. , premiums) requirements. This bill exempts licensed physicians serving these patients from the law's payment limits. Under current law, the amount the Department of Social Services (DSS) may pay these providers, when combined with the Medicaid payment, cannot exceed the amount that Medicaid alone would pay for the same service. (Providers whose rates the Department of Public Health sets are already exempt from these limits. ) The bill requires physicians to be paid the patient's full deductible and coinsurance.

EFFECTIVE DATE: July 1, 2002

Background

Medicaid-Dually Eligible. The federal Medicaid program establishes a category or coverage group called "dually-eligible," which consists of several subcategories. State Medicaid programs can pay the Medicare Part A and B premiums, deductibles, and co-payments as a means to help certain Medicare beneficiaries avoid needing full Medicaid coverage.

DSS provides assistance with coinsurance and deductibles to qualified medicare beneficiaries (QMB). These individuals cannot have income greater than 100% of the federal poverty level (currently $ 8,860 per year for one person), and their assets cannot exceed more than twice the asset limit in the Supplemental Security Income program (currently $ 4,000 for a single person). For QMBs, Medicaid (which provides most states with a 50% federal match) generally pays the Medicare Part A and B premiums and cost-sharing (deductibles and coinsurance) for Medicare services provided by Medicare providers.

Congress passed the cost-sharing requirement in 1988. The federal State Medicaid Manual, which guides state agencies administering Medicaid, gave states the option to pay Medicare cost-sharing in an amount based either on (1) the full Medicare-approved amount for a particular service or (2) the amount that the state pays for the same service for a Medicaid recipient who was not entitled to Medicare. Connecticut adopted the second option in 1991, but it was not immediately implemented because between 1991 and 1997, courts in some jurisdictions held that states could not limit cost-sharing amounts to those in the Medicaid fee schedule. (Thus, the state's providers during that time, indeed until 1999, continued to be paid the full Medicare co-payment. ) In 1997, Congress made it clear that states had this flexibility. The FY 1999-00 DSS budget included a $ 54 million reduction to reflect the statute's implementation.

Implementation led to providers in many cases no longer getting co-payments. (DSS never stopped paying the $ 100 Medicare deductible. )

Here's an example of what occurred. Before the state began implementing the law in 1999, a provider would bill Medicare $ 120 for a QMB's medical procedure. Medicare determined the "allowable" or approved amount for that procedure ($ 100) and paid the provider 80% of that amount ($ 80). Medicaid then paid the remaining 20% (co-payment) of the approved amount, or $ 20.

With the implementation of the statutory limits on coinsurance, DSS now compares the Medicare payment to the amount that Medicaid pays a provider for the same service. If the Medicaid fee is lower or the same, DSS pays the provider nothing. If it is higher, Medicaid pays the difference. (In most cases, the Medicare-approved amount is higher than the amount in the Medicaid fee schedule. )

sHB 5639

AN ACT CONCERNING LOWER DRUG COSTS FOR CONSUMERS AND THE STATE

This bill:

1. establishes a 21-member Affordable Prescription Drug Board and prescribes its duties, including distributing lists of wholesale and other prices for the 50 most-prescribed drugs in the ConnPACE program;

2. requires the Department of Social Services (DSS) commissioner to submit an annual report to the Affordable Prescription Drug Board and the General Assembly detailing state options and potential strategies for lowering drug prices for the state, businesses, and consumers;

3. requires drug manufacturers whose drugs are sold in the state to file annual reports with the new board disclosing their expenses for advertising and promoting drugs sold in Connecticut; and

4. requires the DSS commissioner, with the board's advice, to coordinate public assistance health plan benefits through use of manufacturers' assistance programs for indigent people and to work with drug manufacturers to facilitate a single application form for such programs.

EFFECTIVE DATE: July 1, 2002

BILLS THAT DID NOT REACH THE FLOOR

Following are brief descriptions of selected bills that seniors had an interest in. Most of these were approved by at least one committee but never reached the floor because the committees sent them to other committees, where they died. A few were never approved by a committee, but are described briefly here because they are of considerable interest to seniors.

SB 6

AN ACT CONCERNING RESIDENTS IN ASSISTED LIVING FACILITIES

The bill allows any individual in a private assisted living facility who exhausts personal assets while living there to continue to live there and required DSS to (1 submit to the federal Centers for Medicaid and Medicare Services a request to include such an option in a Medicaid waiver authorization and (2) adopt regulations to establish additional qualifying requirements.

EFFECTIVE DATE: July 1, 2002

SB 23

AN ACT CONCERNING ASSISTED LIVING

(The governor's bill)

The bill authorizes DSS, within available appropriations, to establish two new pilot programs to pay for assisted living services for a limited number of people living in private assisted living facilities whose assets and income qualify them for the state's home care program.

The first pilot allows up to 50 people to receive these services, provided by a licensed assisted living services agency, under the Medicaid waiver portion of the Connecticut Home Care Program for the Elderly (CHCPE). To be eligible: the individuals must:

1. reside in a managed residential community as defined in Department of Public Health regulations;

2. be ineligible to receive these services under any other assisted living services pilot program established by the General Assembly; and

3. be eligible for services under CHCPE's Medicaid waiver portion.

The bill allows the DSS commissioner to seek a waiver of federal law to strengthen transfer of asset rules for people applying for this pilot program. But it makes the program's implementation not dependent on federal approval of this waiver.

The bill makes statutory procedures for Medicaid waivers also apply to this waiver. (These existing provisions require the DSS commissioner to submit the waiver application to the Appropriations and Human Services committees before submitting it to the federal government and allows the committees, within 30 days of receiving the waiver application, to advise the commissioner of their approval, denial, or modifications. The provisions also require the commissioner, before submitting a waiver application to the General Assembly, to publish a notice in the Connecticut Law Journal and allow 15 days for public comment. )

The second pilot allows up to 25 people to receive these services under the state-funded portion of the CHCPE. To qualify, they must:

1. reside in a managed residential community as defined in Department of Public Health regulations;

2. be ineligible to receive these services under any other assisted living services pilot program established by the General Assembly;

3. have not transferred any assets for less than fair market value, as determined by DSS; and

4. be eligible for services under CHCPE's state-funded portion.

The bill allows both pilots to begin operation on or after January 1, 2003 and requires the social services commissioner to report on the pilot programs by January 1, 2005 to the Public Health, Human Services, and Appropriations committees.

EFFECTIVE DATE: July 1, 2002

SB 97

AAC RENTAL SUBSIDY SUCCESS, RENTAL ASSISTANCE CERTIFICATES FOR CERTAIN DISABLED PERSONS, AND EXPANSION OF THE BEYOND SHELTER INITIATIVE

Among other provisions, the bill (1) provides $ 500,000 specifically for Rental Assistance Program (RAP) certificates for disabled people in local housing authority-owned elderly housing or on the waiting list for such housing and requires DSS to create a separate RAP program for the disabled. The RAP certificates would be administered by the local housing authorities.

EFFECTIVE DATE: July 1, 2002

SB 134

AN ACT CONCERNING DEDICATED WINGS IN NURSING HOMES FOR DEAF RESIDENTS

This bill creates a pilot program in at least one nursing home in the state to (1) dedicate an entire floor, wing or other residential area within the nursing home solely for the care of seniors who are deaf; (2) train nursing home staff in sign language or other interpreting skills needed to communicate with such seniors; and (3) cover other staffing costs directly associated with operating such floor, wing, or other residential area.

EFFECTIVE DATE: October 1, 2002

SB 136

AN ACT CONCERNING HEARING AIDS

The bill requires group and individual insurance policies to cover up to 80% of the cost of hearing aids every three years, but no more than $ 2,000 for each ear. The requirement, however, could not apply to Medicare Supplement policies, whose benefits are regulated by federal law.

EFFECTIVE DATE: October 1, 2002

sSB 137

AN ACT CONCERNING THE HOME CARE PROGRAM

This bill would have required DSS to submit a request to amend the Medicaid home-care program waiver to include services provided by personal care attendants and services provided by non-spousal family members. It also would have required coverage for such personal care services under the purely state-funded portion of the home care program and would have covered such services under this part of the program provided not only by family members, but also spouses.

EFFECTIVE DATE: October 1, 2002

SB 139

AN ACT CONCERNING JOINING THE NORTHEAST PRESCRIPTION DRUG COMPACT

The bill requires the DSS commissioner to consider steps necessary to participate in and consider the recommendations of the Prescription Drug Fair Price Coalition proposed by the Northeast Legislative Association on Prescription Drugs. It would have required the commissioner to establish a pharmacy best practices and cost control program designed to reduce the cost of providing prescription drugs, while maintaining high quality in prescription drug therapies. It would have required the program to include such things as a preferred drug list, utilization review, an education component, and other features.

EFFECTIVE DATE: October 1, 2002

SB 442

AN ACT CONCERNING EXPANSION OF THE ALZHEIMER'S RESPITE CARE SERVICES PROGRAM

The bill appropriates $ 250,000 to further expand the existing Alzheimer's Respite Program.

EFFECTIVE DATE: July 1, 2002

HB 5167

AN ACT CONCERNING A CONNPACE SPEND-DOWN PROVISION

The bill allows ConnPACE applicants to deduct from their annual income verifiable prescription drug expenses incurred during the 12-month period before applying. Any applicant who makes such deduction must submit, at the time of application, documentation of the claimed prescription drug expenses to DSS.

EFFECTIVE DATE: October 1, 2002

HB 5168

AN ACT CONCERNING HOME HEALTH CARE SERVICES

The bill gives a 5% increase in reimbursement to providers of home health care services.

EFFECTIVE DATE: October 1, 2002

HB 5170

AN ACT CONCERNING A LONG-TERM CARE WEBSITE

The bill appropriates $ 100,000 to the Commission on Aging to develop, implement, and maintain a single consumer-oriented Internet website with comprehensive information on long-term care options that are available in Connecticut including, but not limited to: Medicare, Medicaid, ConnPACE, Personal Care Attendant Programs, group homes, congregate living, home and community-based care, assisted living, residential retirement communities, residential care facilities, nursing homes, adult day care, long-term care insurance, tax deductions, tax credits and estate planning. The website must also include direct links and referral information regarding long-term care resources, including private and nonprofit organizations offering advice, counseling and legal services.

EFFECTIVE DATE: July 1, 2002

HB 5173

AN ACT CONCERNING THE FUNDING OF THE SENIOR GAMES

The bill appropriates $ 100,000 annually to the Commission on Aging to fund the Connecticut Senior Games.

EFFECTIVE DATE: July 1, 2002

sHB 5469

AN ACT IMPLEMENTING THE RECOMMENDATIONS OF THE LEGISLATIVE PROGRAM REVIEW AND INVESTIGATIONS COMMITTEE RELATIVE TO MEDICAID RATE SETTING FOR NURSING HOMES

The bill institutes a case-mix system of reimbursement for nursing homes, made OPM responsible for long-term care panning, increased staff for DSS's certificate of need and rate setting unit, increased auditing requirements, and made other changes.

EFFECTIVE DATE: July 1, 2002 for most provisions.

HB 5559

AN ACT INCREASING MEDICAID REIMBURSEMENT FOR HOME HEALTH CARE AND CREATING A DISTRESS FUND FOR HOME HEALTH CARE AGENCIES

The bill gives home health care agencies a 12% Medicaid rate increase and requires them to increase wages for direct care personnel correspondingly.

The bill requires DSS to set up a separate Distress Fund for home health care agencies and homemaker-home health aide agencies experiencing financial distress due to serving a disproportionate share of Medicaid patients. Agencies with at least 15% Medicaid visits could apply to the DSS commissioner for such distress funds.

EFFECTIVE DATE: July 1, 2002

LCO 5521, PROPOSED AMENDMENT TO SB 582

HOSPICE EXTENSION

An amendment filed to a bill not related to seniors is the only item we found that deals with a "hospice extension. " The amendment extends the authority of a qualified hospice to operate a residence for terminally people on a pilot basis from October 1, 2001 to October 1, 2006.

EFFECTIVE DATE: October 1, 2002

VETOED BUDGET BILL (SB 660 - PA 02-38)

The vetoed budget bill contains a number of budgetary changes that would have affected seniors.

According to the Office of Fiscal Analysis, the major changes in funding that would have affected seniors are (from current FY03 appropriation):

The bill also, among other provisions: (1) imposes a temporary surcharge on income over $ 1 million; (2) establishes a tax amnesty program, and (3) defers scheduled decreases in the gift tax and in income taxes for single filers.

These changes are all moot, however, because of the veto.

CONNPACE WAIVER

ConnPACE (Connecticut Pharmaceutical Assistance Contract to the Elderly and Disabled) helps low-income seniors and people with disabilities who do not qualify for Medicaid pay for prescription drugs; participants pay a $ 25 annual enrollment fee and a $ 12 copay per prescription.

In 2001, the legislature increased ConnPACE income limits substantially to $ 20,000 for single seniors and $ 27,100 married couples, beginning April 1, 2002. Further, that legislation required those limits to rise to $ 25,800 and $ 34,800, respectively, effective July 1, 2002, if DSS receives a federal Medicaid waiver for federal funding by then. Existing law, which the act does not change, still requires the commissioner to adjust the income limits each year by the Social Security inflation adjustment (PA 01-2, JSS, § 22, effective July 1, 2001).

In April 2002, DSS submitted the waiver request to the federal Center for Medicare and Medicaid Services. If approved, the waiver would convert ConnPACE from a solely state-funded program to a single benefit, pharmacy-only coverage group in the Medicaid program (which receives 50% federal reimbursement for expenditures).

The waiver plan, which the legislative committees approved this year, contains the following new provisions. Participants with income levels up to 233% of federal poverty level will pay the current $ 12 copay; those with incomes above that will pay a $ 20 copay per prescription in effect, those whose incomes are higher than the $ 20,000 single and $ 27,100 married income limits instituted in April 2002 will be subject to the $ 20 copay. The plan also proposes a voluntary mail order purchasing option as part of the expanded program.

The ConnPACE waiver plan proposes an October 1, 2002 start date for the expanded program if federal approval is received before then, but approval could take longer than expected, which may delay the start date.

TRANSFER OF ASSETS WAIVER

Last year, the General Assembly passed legislation requiring DSS to seek federal approval (i. e. , a Medicaid waiver) to change the way the penalty provisions are implemented when people make "improper" asset transfers within 36 months of applying for long-term care Medicaid. The change was intended to close a perceived loophole in the law that resulted in these penalties expiring before people even applied, or became eligible, for Medicaid.

As required by law, DSS published notice of the intended changes in the Connecticut Law Journal and received public comment. In early 2002, the department submitted its waiver proposal to the Appropriations and Human Services committees. In addition to changing the start-date for the penalty period, the plan included a provision to increase the look-back for home transfers from 36 to 60 months, something the legislature had not directed the agency to do. DSS also proposed the establishment of thresholds, whereby any assets that were transferred with fair market value below the threshold amounts would not be subject to a penalty. Here DSS acknowledged that delaying the start-date of penalties might hurt people who made relatively small transfers.

The committees held a public hearing in March 2002. Most witnesses spoke against the waiver. Most represented elderly people or nursing homes who expressed strong concerns about its "unfairness" and the negative fiscal impact it could have on both. The Human Services Committee rejected the waiver proposal and Appropriations took no action. (The vetoed budget, SB 660, included the savings that would result from the waiver's implementation. ) DSS sent the proposal to Washington and is awaiting its approval.

PRESCRIPTION PRIOR AUTHORIZATION PLAN

Two years ago, the legislature directed DSS to establish a prior authorization (PA) program, whereby pharmacists serving clients in all but one of the department's drug assistance programs, including ConnPACE and Medicaid for the elderly and disabled, must get DSS approval whenever they are asked to fill, for the first time, a brand name drug when a chemically equivalent generic is available. The law also allows DSS to require PA for (1) a prescription costing $ 500 or more per month, or (2) early refills (less than 75% of prescription has been taken).

As required by law, DSS submitted its PA plan to the Human Services and Appropriations committees, (the committees can stop the plan only if they jointly reject it). The latest version of the plan outlines the PA process for each of the three scenarios described above. It includes DSS hiring a contractor to run a clinical call center that will be available around-the-clock, seven days a week.

Here is how it would be expected to work for brand name drug requests. When a prescription comes in requesting a brand name drug, staff at the call center will have to contact the prescriber, who must present his rationale for not prescribing a generic. If he does, and the call center pharmacist agrees that the generic is not appropriate, he must approve the brand name drug and electronically notify the pharmacist. If the call center cannot make its decision within two hours of receiving a PA request, the plan authorizes the pharmacist to dispense a 72 hour supply of the drug (limited to two times per client per month). If the call center disagrees with the prescriber, the generic will be the only option unless the client wishes to pay for the drug out-of-pocket; in these instances, the prescriber and client can appeal. Under current rules, when a prescriber writes "brand medically necessary" on a prescription, the pharmacist must fill it.

The committees are expected to take final action on the plan shortly.

HN: eh