Connecticut Seal

Senate Bill No. 2001

June 30 Special Session, Public Act No. 03-3

AN ACT CONCERNING PUBLIC HEALTH, HUMAN SERVICES AND OTHER MISCELLANEOUS IMPLEMENTER PROVISIONS.

Be it enacted by the Senate and House of Representatives in General Assembly convened:

Section 1. Section 19a-202 of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage):

Upon application to the Department of Public Health any municipal health department shall annually receive from the state an amount equal to [one dollar and thirteen] ninety-four cents per capita, provided such municipality (1) employs a full-time director of health, except that if a vacancy exists in the office of director of health or the office is filled by an acting director for more than three months, such municipality shall not be eligible for funding unless the Commissioner of Public Health waives this requirement; (2) submits a public health program and budget which is approved by the Commissioner of Public Health; and (3) appropriates not less than one dollar per capita, from the annual tax receipts, for health department services. Such municipal department of health is authorized to use additional funds, which the Department of Public Health may secure from federal agencies or any other source and which it may allot to such municipal department of health. The money so received shall be disbursed upon warrants approved by the chief executive officer of such municipality. The Comptroller shall annually in July and upon a voucher of the Commissioner of Public Health, draw the Comptroller's order on the State Treasurer in favor of such municipal department of health for the amount due in accordance with the provisions of this section and under rules prescribed by the commissioner. Any moneys remaining unexpended at the end of a fiscal year shall be included in the budget of such municipal department of health for the ensuing year. This aid shall be rendered from appropriations made from time to time by the General Assembly to the Department of Public Health for this purpose.

Sec. 2. Section 19a-202a of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage):

(a) Upon application to the Department of Public Health, each part-time health department shall annually receive from the state an amount equal to [fifty-nine] forty-nine cents per capita.

(b) Any municipality may designate itself as having a part-time health department if: (1) The municipality has not had a full-time health department or been in a full-time health district prior to January 1, 1998; (2) the municipality has the equivalent of at least one full-time employee, as determined by the Commissioner of Public Health; (3) the municipality annually submits a public health program plan and budget to the commissioner; and (4) the commissioner approves the program plan and budget.

(c) The Commissioner of Public Health shall adopt regulations, in accordance with the provisions of chapter 54, for the development and approval of the program plan and budget required by subdivision (3) of subsection (b) of this section.

Sec. 3. Section 19a-245 of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage):

Upon application to the Department of Public Health, each health district shall annually receive from the state an amount equal to [two dollars and thirty-two] one dollar and ninety-four cents per capita for each town, city and borough of such district which has a population of five thousand or less, and one dollar and [ninety-nine] sixty-six cents per capita for each town, city and borough of such district which has a population of more than five thousand, provided (1) the Commissioner of Public Health approves the public health program and budget of such health district, and (2) the towns, cities and boroughs of such district appropriate for the maintenance of the health district not less than one dollar per capita from the annual tax receipts. Such district departments of health are authorized to use additional funds, which the Department of Public Health may secure from federal agencies or any other source and which it may allot to such district departments of health. The district treasurer shall disburse the money so received upon warrants approved by a majority of the board and signed by its chairman and secretary. The Comptroller shall quarterly, in July, October, January and April, upon such application and upon the voucher of the Commissioner of Public Health, draw the Comptroller's order on the State Treasurer in favor of such district department of health for the amount due in accordance with the provisions of this section and under rules prescribed by the commissioner. Any moneys remaining unexpended at the end of a fiscal year shall be included in the budget of the district for the ensuing year. This aid shall be rendered from appropriations made from time to time by the General Assembly to the Department of Public Health for this purpose.

Sec. 4. (NEW) (Effective from passage) (a) There is established a newborn screening account that shall be a separate nonlapsing account within the General Fund. The account shall contain any moneys required by law to be deposited into the account. Any balance remaining in said account at the end of any fiscal year shall be carried forward in the account for the next fiscal year.

(b) Three hundred forty-five thousand dollars of the amount collected pursuant to section 19a-55 of the general statutes, in each fiscal year, shall be credited to the newborn screening account, and be available for expenditure by the Department of Public Health for the expenses of the testing required by sections 19a-55, as amended by this act, and 19a-59 of the general statutes.

Sec. 5. Section 19a-55 of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage):

(a) The administrative officer or other person in charge of each institution caring for newborn infants shall cause to have administered to every such infant in its care an HIV-related test, as defined in section 19a-581, a test for phenylketonuria and other metabolic diseases, hypothyroidism, galactosemia, sickle cell disease, maple syrup urine disease, homocystinuria, biotinidase deficiency, congenital adrenal hyperplasia and such other tests for inborn errors of metabolism as shall be prescribed by the Department of Public Health. The tests shall be administered as soon after birth as is medically appropriate. If the mother has had an HIV-related test pursuant to section 19a-90 or 19a-593, the person responsible for testing under this section may omit an HIV-related test. The Commissioner of Public Health shall (1) administer the newborn screening program, (2) direct persons identified through the screening program to appropriate specialty centers for treatments, consistent with any applicable confidentiality requirements, and (3) set the fees to be charged to institutions to cover all expenses of the comprehensive screening program including testing, tracking and treatment. The fees to be charged pursuant to subdivision (3) of this section shall be set at a minimum of twenty-eight dollars. The commissioner shall adopt regulations, in accordance with chapter 54, specifying the abnormal conditions to be tested for and the manner of recording and reporting results. On or before January 1, [2003] 2004, such regulations shall include requirements for testing for amino acid disorders, organic acid disorders and fatty acid oxidation disorders, including, but not limited to, long-chain 3-hydroxyacyl CoA dehydrogenase (L-CHAD) and medium-chain acyl-CoA dehydrogenase (MCAD).

(b) The provisions of this section shall not apply to any infant whose parents object to the test or treatment as being in conflict with their religious tenets and practice.

Sec. 6. (NEW) (Effective from passage) (a) Not later than September 1, 2003, and annually thereafter, the Secretary of the Office of Policy and Management, in consultation with the Commissioner of Public Health, shall (1) determine the amount appropriated for the following purposes: (A) To purchase, store and distribute vaccines for routine immunizations included in the schedule for active immunization required by section 19a-7f of the general statutes; (B) to purchase, store and distribute (i) vaccines to prevent hepatitis A and B in persons of all ages, as recommended by the schedule for immunizations published by the National Advisory Committee for Immunization Practices, (ii) antibiotics necessary for the treatment of tuberculosis and biologics and antibiotics necessary for the detection and treatment of tuberculosis infections, and (iii) antibiotics to support treatment of patients in communicable disease control clinics, as defined in section 19a-216a of the general statutes; and (C) to provide services needed to collect up-to-date information on childhood immunizations for all children enrolled in Medicaid who reach two years of age during the year preceding the current fiscal year, to incorporate such information into the childhood immunization registry, as defined in section 19a-7h of the general statutes, and (2) inform the Insurance Commissioner of such amount.

(b) Each domestic insurer or health care center doing life insurance or health insurance business in this state shall annually pay to the Insurance Commissioner, for deposit in the General Fund, a health and welfare fee assessed by the Insurance Commissioner pursuant to this section. Not later than October 1, 2003, the Insurance Commissioner shall determine the fee to be assessed against each such domestic insurer or health care center for the fiscal year ending June 30, 2004. Not later than October 1, 2003, and annually thereafter, the Insurance Commissioner shall determine the fee to be assessed against each such domestic insurer or health care center for the next fiscal year. Such fee shall be a percentage of the total amount appropriated, as identified in subsection (a) of this section, and shall be calculated on the basis of life insurance premiums and health insurance premiums and subscriber charges in the same manner as calculations under section 38a-48 of the general statutes. Not later than November 1, 2003, and annually thereafter, the Insurance Commissioner shall submit a statement to each such insurer and health care center that includes the proposed fee for the insurer or health care center calculated in accordance with this section. As used in this section, "health insurance" means health insurance, as defined in subdivisions (1) to (13), inclusive, of section 38a-469 of the general statutes.

(c) Any domestic insurer or health care center aggrieved by an assessment levied under this section may appeal therefrom in the same manner as provided for appeals under section 38a-52 of the general statutes.

(d) For the fiscal year ending June 30, 2004, the aggregate assessment under this section shall not exceed seven million one hundred thousand dollars. For the fiscal year ending June 30, 2005, the aggregate assessment under this section shall not exceed seven million one hundred thousand dollars.

Sec. 7. Section 38a-490a of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage):

[Every] Each individual health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 delivered, issued for delivery or renewed in this state on or after July 1, 1996, shall provide coverage [for at least five thousand dollars annually] for medically necessary early intervention services provided as part of an individualized family service plan pursuant to section 17a-248e. Such policy shall provide (1) coverage for such services provided by qualified personnel, as defined in section 17a-248, for a child from birth until the child's third birthday, and (2) a maximum benefit of three thousand two hundred dollars per child per year and an aggregate benefit of nine thousand six hundred dollars per child over the total three-year period. No payment made under this [subsection] section shall be applied by the insurer, health care center or plan administrator against any maximum lifetime or annual limits specified in the policy or health benefits plan.

Sec. 8. Section 38a-516a of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage):

[Every] Each group health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 delivered, issued for delivery or renewed in this state on or after July 1, 1996, shall provide coverage [for at least five thousand dollars annually] for medically necessary early intervention services provided as part of an individualized family service plan pursuant to section 17a-248e. Such policy shall provide (1) coverage for such services provided by qualified personnel, as defined in section 17a-248, for a child from birth until the child's third birthday, and (2) a maximum benefit of three thousand two hundred dollars per child per year and an aggregate benefit of nine thousand six hundred dollars per child over the total three-year period. No payment made under this [subsection] section shall be applied by the insurer, health care center or plan administrator against any maximum lifetime or annual limits specified in the policy or health benefits plan.

Sec. 9. Subsection (e) of section 17a-248g of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage):

(e) The commissioner shall establish a schedule of fees based on a sliding scale for early intervention services. The schedule of fees shall consider the cost of such services relative to the financial resources of the parents or legal guardians of eligible children. Fees may be charged to any such parent or guardian, regardless of income, and shall be charged to any such parent or guardian with a gross annual family income of forty-five thousand dollars or more, except that no fee may be charged to the parent or guardian of a child who is eligible for Medicaid. The Department of Mental Retardation may assign its right to collect fees to a designee or provider participating in the early intervention program and providing services to a recipient in order to assist the provider in obtaining payment for such services. The commissioner may implement procedures for the collection of the schedule of fees while in the process of adopting or amending such criteria in regulation, provided the commissioner prints notice of intention to adopt or amend the regulations in the Connecticut Law Journal within twenty days of implementing the policy. Such collection procedures and schedule of fees shall be valid until the time the final regulations or amendments are effective.

Sec. 10. Section 4-28f of the general statutes, as amended by section 3 of public act 03-19, is repealed and the following is substituted in lieu thereof (Effective from passage):

(a) There is created a Tobacco and Health Trust Fund which shall be a separate nonlapsing fund. The purpose of the trust fund shall be to create a continuing significant source of funds to (1) support and encourage development of programs to reduce tobacco abuse through prevention, education and cessation programs, (2) support and encourage development of programs to reduce substance abuse, and (3) develop and implement programs to meet the unmet physical and mental health needs in the state.

(b) The trust fund may accept transfers from the Tobacco Settlement Fund and may apply for and accept gifts, grants or donations from public or private sources to enable the trust fund to carry out its objectives.

(c) The trust fund shall be administered by a board of trustees, [which] except that the board shall suspend its operations from July 1, 2003, to June 30, 2005, inclusive. The board shall consist of seventeen trustees. The appointment of the initial trustees shall be as follows: (1) The Governor shall appoint four trustees, one of whom shall serve for a term of one year from July 1, 2000, two of whom shall serve for a term of two years from July 1, 2000, and one of whom shall serve for a term of three years from July 1, 2000; (2) the speaker of the House of Representatives and the president pro tempore of the Senate each shall appoint two trustees, one of whom shall serve for a term of two years from July 1, 2000, and one of whom shall serve for a term of three years from July 1, 2000; (3) the majority leader of the House of Representatives and the majority leader of the Senate each shall appoint two trustees, one of whom shall serve for a term of one year from July 1, 2000, and one of whom shall serve for a term of three years from July 1, 2000; (4) the minority leader of the House of Representatives and the minority leader of the Senate each shall appoint two trustees, one of whom shall serve for a term of one year from July 1, 2000, and one of whom shall serve for a term of two years from July 1, 2000; and (5) the Secretary of the Office of Policy and Management, or the secretary's designee, shall serve as an ex-officio voting member. Following the expiration of such initial terms, subsequent trustees shall serve for a term of three years. The period of suspension of the board's operations from July 1, 2003, to June 30, 2005, inclusive, shall not be included in the term of any trustee serving on July 1, 2003. The trustees shall serve without compensation except for reimbursement for necessary expenses incurred in performing their duties. The board of trustees shall establish rules of procedure for the conduct of its business which shall include, but not be limited to, criteria, processes and procedures to be used in selecting programs to receive money from the trust fund. The trust fund shall be within the Office of Policy and Management for administrative purposes only. The board of trustees shall meet not less than bimonthly except during the fiscal years ending June 30, 2004, and June 30, 2005, and, not later than January first of each year, except during the fiscal years ending June 30, 2004, and June 30, 2005, shall submit a report of its activities and accomplishments to the joint standing committees of the General Assembly having cognizance of matters relating to public health and appropriations and the budgets of state agencies, in accordance with section 11-4a. Such report shall be approved by each trustee.

(d) (1) During the period commencing July 1, 2000, and ending June 30, [2005] 2003, the board of trustees, by majority vote, may recommend authorization of disbursement from the trust fund for the purposes described in subsection (a) of this section and section 19a-6c, provided the board may not recommend authorization of disbursement of more than fifty per cent of net earnings from the principal of the trust fund for such purposes. For the fiscal year commencing July 1, 2005, and each fiscal year thereafter, the board may recommend authorization of the net earnings from the principal of the trust fund for such purposes. The board's recommendations shall give (A) priority to programs that address tobacco and substance abuse and serve minors, pregnant women and parents of young children, and (B) consideration to the availability of private matching funds. Recommended disbursements from the trust fund shall be in addition to any resources that would otherwise be appropriated by the state for such purposes and programs.

(2) [The] Except during the fiscal years ending June 30, 2004, and June 30, 2005, the board of trustees shall submit such recommendations for the authorization of disbursement from the trust fund to the joint standing committees of the General Assembly having cognizance of matters relating to public health and appropriations and the budgets of state agencies. Not later than thirty days after receipt of such recommendations, said committees shall advise the board of their approval, modifications, if any, or rejection of the board's recommendations. If said joint standing committees do not concur, the speaker of the House of Representatives, the president pro tempore of the Senate, the majority leader of the House of Representatives, the majority leader of the Senate, the minority leader of the House of Representatives and the minority leader of the Senate each shall appoint one member from each of said joint standing committees to serve as a committee on conference. The committee on conference shall submit its report to both committees, which shall vote to accept or reject the report. The report of the committee on conference may not be amended. If a joint standing committee rejects the report of the committee on conference, the board's recommendations shall be deemed approved. If the joint standing committees accept the report of the committee on conference, the joint standing committee having cognizance of matters relating to appropriations and the budgets of state agencies shall advise the board of said joint standing committees' approval or modifications, if any, of the board's recommended disbursement. If said joint standing committees do not act within thirty days after receipt of the board's recommendations for the authorization of disbursement, such recommendations shall be deemed approved. Disbursement from the trust fund shall be in accordance with the board's recommendations as approved or modified by said joint standing committees.

(3) After such recommendations for the authorization of disbursement have been approved or modified pursuant to subdivision (2) of this subsection, any modification in the amount of an authorized disbursement in excess of fifty thousand dollars or ten per cent of the authorized amount, whichever is less, shall be submitted to said joint standing committees and approved, modified or rejected in accordance with the procedure set forth in subdivision (2) of this subsection. Notification of all disbursements from the trust fund made pursuant to this section shall be sent to the joint standing committees of the General Assembly having cognizance of matters relating to public health and appropriations and the budgets of state agencies, through the Office of Fiscal Analysis.

(4) The board of trustees shall, not later than February first of each year, except during the fiscal years ending June 30, 2004, and June 30, 2005, submit a report to the General Assembly, in accordance with the provisions of section 11-4a, that includes all disbursements and other expenditures from the trust fund and an evaluation of the performance and impact of each program receiving funds from the trust fund. Such report shall also include the criteria and application process used to select programs to receive such funds.

Sec. 11. (Effective from passage) The Connecticut Health and Educational Facilities Authority, in conjunction with the Departments of Public Safety, Social Services and Public Health, shall, within available appropriations, develop a strategy for planning and financing the installation of automatic fire sprinkler systems in nursing homes licensed under chapter 368v of the general statutes. On or before February 1, 2004, such strategy shall be submitted, in accordance with section 11-4a of the general statutes, to the Governor and to the joint standing committees of the General Assembly having cognizance of matters relating to public safety, human services and public health.

Sec. 12. (NEW) (Effective from passage) (a) For the purposes of this section, "residence for adult persons with acquired brain injuries" means a community-based residence (1) exclusively serving adult persons with acquired brain injuries, (2) funded or operated by the Department of Mental Health and Addiction Services, and (3) that provides rehabilitation and other support services for persons with acquired brain injuries requiring assistance to live in the community.

(b) Notwithstanding the provisions of chapters 368v and 368z of the general statutes, community-based organizations may operate residences for adult persons with acquired brain injuries on a pilot basis until October 1, 2005. Notwithstanding the provisions of chapter 378 of the general statutes, medication may be administered to persons residing in such residences by trained persons pursuant to the written order of a physician licensed under chapter 370 of the general statutes, a dentist licensed under chapter 379 of the general statutes, an advanced practice registered nurse licensed to prescribe in accordance with section 20-94a of the general statutes, or a physician assistant licensed to prescribe in accordance with section 20-12d of the general statutes. The Commissioner of Public Health, in consultation with the Commissioner of Mental Health and Addiction Services, shall develop standards for the operation of such residences and the training required of persons authorized under this section to administer medications in such residences.

Sec. 13. Subsection (d) of section 54-56d of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage):

(d) If the court finds that the request for an examination is justified and that, in accordance with procedures established by the judges of the Superior Court, there is probable cause to believe that the defendant has committed the crime for which he is charged, the court shall order an examination of the defendant as to his competency. The court [either] may (1) appoint one or more physicians specializing in psychiatry to examine the defendant, or [it may] (2) order the Commissioner of Mental Health and Addiction Services to conduct the examination either (A) by a clinical team consisting of a physician specializing in psychiatry, a clinical psychologist and one of the following: A clinical social worker licensed pursuant to chapter 383b or a psychiatric nurse clinical specialist holding a master's degree in nursing, or (B) by one or more physicians specializing in psychiatry, except that no employee of the Department of Mental Health and Addiction Services who has served as a member of a clinical team in the course of such employment for at least five years prior to October 1, 1995, shall be precluded from being appointed as a member of a clinical team. If the Commissioner of Mental Health and Addiction Services is ordered to conduct the examination, [he] the commissioner shall select the members of the clinical team or the physician or physicians. If the examiners determine that the defendant is not competent, they shall then determine whether there is substantial probability that the defendant, if provided with a course of treatment, will regain competency within the maximum period of any placement order under this section, or whether the defendant appears to be eligible for civil commitment, with monitoring by the Court Support Services Division, pursuant to subdivision (2) of subsection (h) of this section, as amended by this act. The court may authorize a physician specializing in psychiatry, a clinical psychologist, a clinical social worker licensed pursuant to chapter 383b or a psychiatric nurse clinical specialist holding a master's degree in nursing selected by the defendant to observe the examination. Counsel for the defendant may observe the examination. The examination shall be completed within fifteen days from the date it was ordered and the examiner or examiners shall prepare and sign, without notarization, a written report and file [it] such report with the court within twenty-one business days of the date of the order. On receipt of the written report, the clerk of the court shall cause copies to be delivered immediately to the state's attorney and to counsel for the defendant.

Sec. 14. Subsection (h) of section 54-56d of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage):

(h) (1) If, at the hearing, the court finds that there is a substantial probability that the defendant, if provided with a course of treatment, will regain competency within the period of any placement order under this section, the court shall either (A) order placement of the defendant for treatment for the purpose of rendering him competent, or (B) order placement of the defendant at a treatment facility pending civil commitment proceedings pursuant to subdivision (2) of this subsection.

(2) (A) Except as provided in subparagraph (B) of this subdivision, if the court makes a finding pursuant to subdivision (1) of this subsection and does not order placement pursuant to subparagraph (A) of said subdivision, the court shall, on its own motion or on motion of the state or the defendant, order placement of the defendant in the custody of the Commissioner of Mental Health and Addiction Services at a treatment facility pending civil commitment proceedings. The treatment facility shall be determined by the Commissioner of Mental Health and Addiction Services. Such order shall: (i) Include an authorization for the Commissioner of Mental Health and Addiction Services to apply for civil commitment of such defendant pursuant to sections 17a-495 to 17a-528, inclusive; (ii) permit the defendant to agree to participate voluntarily in a treatment plan prepared by the Commissioner of Mental Health and Addiction Services and require that the defendant comply with such treatment plan; and (iii) provide that if the application for civil commitment is denied or not pursued by the Commissioner of Mental Health and Addiction Services, or if, in the case of a defendant who is participating voluntarily in a treatment plan, such defendant ceases to so participate voluntarily, the person in charge of the treatment facility, or such person's designee, shall submit a written progress report to the court pursuant to subsection (j) of this section, as amended by this act, and the defendant shall be returned to the court for a hearing pursuant to subsection (k) of this section. The Court Support Services Division shall monitor the defendant's compliance with any applicable provisions of such order. The period of placement and monitoring under such order shall not exceed the period of the maximum sentence which the defendant could receive on conviction of the charges against such defendant, or eighteen months, whichever is less. If the defendant has complied with such treatment plan and any applicable provisions of such order, at the end of the period of placement and monitoring, the court shall approve the entry of a nolle prosequi to the charges against the defendant or shall dismiss such charges.

(B) This subdivision shall not apply: (i) To any person charged with a class A felony, a class B felony, except a violation of section 53a-122 that does not involve the use, attempted use or threatened use of physical force against another person, or a violation of section 14-227a, subdivision (2) of subsection (a) of section 53-21 or section 53a-56b, 53a-60d, 53a-70, 53a-70a, 53a-70b, 53a-71, 53a-72a or 53a-72b; (ii) to any person charged with a crime or motor vehicle violation who, as a result of the commission of such crime or motor vehicle violation, causes the death of another person; or (iii) unless good cause is shown, to any person charged with a class C felony.

Sec. 15. Subsection (j) of section 54-56d of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage):

(j) The person in charge of the treatment facility, or [his] such person's designee, shall submit a written progress report to the court (1) at least seven days prior to the date of any hearing on the issue of the defendant's competency; (2) whenever he believes that the defendant has attained competency; [or] (3) whenever he believes that there is not a substantial probability that the defendant will attain competency within the period covered by the placement order; or (4) whenever the defendant has been placed for treatment pending civil commitment proceedings pursuant to subdivision (2) of subsection (h) of this section, as amended by this act, and the application for civil commitment of the defendant is denied or not pursued. The progress report shall contain: (A) [the] The clinical findings of the person submitting the report and the facts on which the findings are based; (B) the opinion of the person submitting the report as to whether the defendant has attained competency or as to whether the defendant is making progress, under treatment, toward attaining competency within the period covered by the placement order; and (C) any other information concerning the defendant requested by the court, [such as] including, but not limited to, the method of treatment or the type, dosage and effect of any medication the defendant is receiving.

Sec. 16. Subsection (m) of section 54-56d of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage):

(m) If at any time the court determines that there is not a substantial probability that the defendant will attain competency within the period of treatment allowed by this section, or if at the end of [that] such period the court finds that the defendant is still not competent, the court shall either release the defendant from custody or order the defendant placed in the custody of the Commissioner of Mental Health and Addiction Services, the Commissioner of Children and Families or the Commissioner of Mental Retardation. The commissioner given custody, or [his] the commissioner's designee, shall then apply for civil commitment according to sections 17a-75 to 17a-83, inclusive, 17a-270 to 17a-283, inclusive, and 17a-495 to 17a-528, inclusive. The court shall hear arguments as to whether the defendant should be released or should be placed in the custody of the Commissioner of Mental Health and Addiction Services, the Commissioner of Children and Families or the Commissioner of Mental Retardation. If the court orders the release of a defendant charged with the commission of a crime that resulted in the death or serious physical injury, as defined in section 53a-3, of another person, [it] or orders the placement of such defendant in the custody of the Commissioner of Mental Health and Addiction Services, the court may, on its own motion or on motion of the prosecuting authority, order, as a condition of such release or placement, periodic examinations of the defendant as to his competency. Such an examination shall be conducted in accordance with subsection (d) of this section, as amended by this act. Upon receipt of the written report as provided in [said] subsection (d) of this section, as amended by this act, the court shall, upon the request of either party filed not later than thirty days after the court receives such report, conduct a hearing as provided in subsection (e) of this section. Such hearing shall be held not later than ninety days after the court receives such report. If the court finds that the defendant has attained competency, he shall be returned to the custody of the Commissioner of Correction or released, if he has met the conditions for release, and the court shall continue with the criminal proceedings. Periodic examinations ordered by the court under this subsection shall continue until the court finds that the defendant has attained competency or until the time within which the defendant may be prosecuted for the crime with which he is charged, as provided in section 54-193 or 54-193a, has expired, whichever occurs first. The court shall dismiss, with or without prejudice, any charges for which a nolle prosequi is not entered when the time within which the defendant may be prosecuted for the crime with which he is charged, as provided in section 54-193 or 54-193a, has expired. Notwithstanding the erasure provisions of section 54-142a, police and court records and records of any state's attorney pertaining to a charge which is nolled or dismissed without prejudice while the defendant is not competent shall not be erased until the time for the prosecution of the defendant expires under section 54-193 or 54-193a. A defendant who is not civilly committed as a result of an application made by the Commissioner of Mental Health and Addiction Services, the Commissioner of Children and Families or the Commissioner of Mental Retardation pursuant to this section shall be released. A defendant who is civilly committed pursuant to such an application shall be treated in the same manner as any other civilly committed person.

Sec. 17. Subsection (n) of section 54-56d of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage):

(n) The cost of the examination effected by the Commissioner of Mental Health and Addiction Services and of testimony of persons conducting the examination effected by the commissioner shall be paid by the Department of Mental Health and Addiction Services. The cost of the examination and testimony by physicians appointed by the court shall be paid by the Judicial Department. If the defendant is indigent, the fee of the person selected by the defendant to observe the examination and to testify on his behalf shall be paid by the Public Defender Services Commission. The expense of treating a defendant placed in the custody of the Commissioner of Mental Health and Addiction Services, the Commissioner of Children and Families or the Commissioner of Mental Retardation pursuant to subdivision (2) of subsection (h) of this section, as amended by this act, or subsection (i) of this section shall be computed and paid for in the same manner as is provided for persons committed by a probate court under the provisions of sections 17b-19, 17b-63 to 17b-65, inclusive, 17b-116 to 17b-138, inclusive, 17b-220 to 17b-250, inclusive, 17b-256, 17b-259, 17b-263, 17b-287, 17b-340 to 17b-350, inclusive, 17b-689, 17b-689b and 17b-743 to 17b-747, inclusive.

Sec. 18. Subsection (e) of section 19a-88 of the general statutes is repealed and the following is substituted in lieu thereof (Effective January 1, 2004):

(e) (1) Each person holding a license or certificate issued under section [19a-514,] 20-74s, 20-195cc or 20-206ll and chapters 370 to 373, inclusive, 375, 378 to 381a, inclusive, 383 to [388] 383c, inclusive, 384, 384b, 384d, 385, 393a, 395, [398,] 399 or 400a and section 20-206n or 20-206o shall, annually, during the month of such person's birth, apply for renewal of such license or certificate to the Department of Public Health, giving such person's name in full, such person's residence and business address and such other information as the department requests.

(2) Each person holding a license or certificate issued under section 19a-514 and chapters 384a, 384c, 386, 387, 388 and 398 shall apply for renewal of such license or certificate once every two years, during the month of such person's birth, giving such person's name in full, such person's residence and business address and such other information as the department requests.

(3) Each person holding a license or certificate issued pursuant to section 20-475 or 20-476 shall, annually, during the month of such person's birth, apply for renewal of such license or certificate to the department.

(4) Each entity holding a license issued pursuant to section 20-475 shall, annually, during the anniversary month of initial licensure, apply for renewal of such license or certificate to the department.

Sec. 19. Subsection (e) of section 19a-88 of the general statutes, as amended by section 9 of public act 00-226, is repealed and the following is substituted in lieu thereof (Effective January 1, 2004):

(e) (1) Each person holding a license or certificate issued under section [19a-514,] 20-65k, 20-74s, 20-195cc or 20-206ll and chapters 370 to 373, inclusive, 375, 378 to 381a, inclusive, 383 to [388] 383c, inclusive, 384, 384b, 384d, 385, 393a, 395, [398,] 399 or 400a and section 20-206n or 20-206o shall, annually, during the month of such person's birth, apply for renewal of such license or certificate to the Department of Public Health, giving such person's name in full, such person's residence and business address and such other information as the department requests.

(2) Each person holding a license or certificate issued under section 19a-514 and chapters 384a, 384c, 386, 387, 388 and 398 shall apply for renewal of such license or certificate once every two years, during the month of such person's birth, giving such person's name in full, such person's residence and business address and such other information as the department requests.

(3) Each person holding a license or certificate issued pursuant to section 20-475 or 20-476 shall, annually, during the month of such person's birth, apply for renewal of such license or certificate to the department.

(4) Each entity holding a license issued pursuant to section 20-475 shall, annually, during the anniversary month of initial licensure, apply for renewal of such license or certificate to the department.

Sec. 20. Section 19a-515 of the general statutes, as amended by section 4 of public act 03-118, is repealed and the following is substituted in lieu thereof (Effective January 1, 2004):

(a) Each nursing home administrator's license issued pursuant to the provisions of sections 19a-511 to 19a-520, inclusive, shall be renewed [annually] once every two years, in accordance with section 19a-88, as amended by this act, except for cause, by the Department of Public Health, upon forms to be furnished by said department and upon the payment to said department, by each applicant for license renewal, of the sum of [fifty] one hundred dollars. Each such fee shall be remitted to the Department of Public Health on or before the date prescribed under section 19a-88, as amended by this act. Such renewals shall be granted unless said department finds the applicant has acted or failed to act in such a manner or under such circumstances as would constitute grounds for suspension or revocation of such license.

(b) [On and after October 1, 2004, each] Each licensee shall complete a minimum of [twenty] forty hours of continuing education [during each registration period] every two years. Such two-year period shall commence on the first date of renewal of the licensee's license after October 1, 2004. The continuing education shall be in areas related to the licensee's practice. Qualifying continuing education activities are courses offered or approved by the Connecticut Association of Healthcare Facilities, the Connecticut Association of Not-For-Profit Providers, the Connecticut Chapter of the American College of Health Care Administrators, any accredited college or university, or programs presented or approved by the National Continuing Education Review Service of the National Association of Boards of Examiners of Long Term Care Administrators, or by federal or state departments or agencies. [For purposes of this section, "registration period" means the twelve-month period for which a license has been renewed in accordance with section 19a-88 and is current and valid. ]

(c) Each licensee shall obtain a certificate of completion from the provider of the continuing education for all continuing education hours that are successfully completed and shall retain such certificate for a minimum of three years. [following the license renewal date for which the activity satisfies the continuing education requirements. ] Upon request by the department, the licensee shall submit the certificate to the department. A licensee who fails to comply with the continuing education requirements shall be subject to disciplinary action pursuant to section 19a-517.

(d) The continuing education requirements shall be waived for licensees applying for licensure renewal for the first time. The department may, for a licensee who has a medical disability or illness, grant a waiver of the continuing education requirements for a specific period of time or may grant the licensee an extension of time in which to fulfill the requirements.

Sec. 21. Subsection (b) of section 20-206b of the general statutes is repealed and the following is substituted in lieu thereof (Effective January 1, 2004):

(b) Licenses shall be renewed [annually] once every two years in accordance with the provisions of section 19a-88, as amended by this act. The fee for renewal shall be [one] two hundred dollars. No license shall be issued under this section to any applicant against whom professional disciplinary action is pending or who is the subject of an unresolved complaint in this or any other state or jurisdiction. Any certificate granted by the department prior to June 1, 1993, shall be deemed a valid license permitting continuance of profession subject to the provisions of this chapter.

Sec. 22. Subsection (e) of section 20-206bb of the general statutes is repealed and the following is substituted in lieu thereof (Effective January 1, 2004):

(e) Licenses shall be renewed [annually] once every two years in accordance with the provisions of subsection (e) of section 19a-88, as amended by this act. The fee for renewal shall be [one] two hundred dollars.

Sec. 23. Section 20-239 of the general statutes is repealed and the following is substituted in lieu thereof (Effective January 1, 2004):

All licenses issued to master barbers by the Department of Public Health shall be renewed once every two years, and shall expire in accordance with the provisions of section 19a-88, as amended by this act. No person shall carry on the occupation of master barber after the expiration of his license until he has made application bearing the date of his insignia card to said department, accompanied by a fee of [twenty-five] fifty dollars for the renewal of such license for [one year] two years. Such application shall be in writing, addressed to said department and signed by the person applying for such renewal.

Sec. 24. Section 20-253 of the general statutes is repealed and the following is substituted in lieu thereof (Effective January 1, 2004):

License or examination fees shall be paid to the department at the time of application as follows: (1) For examination as a registered hairdresser and cosmetician, the sum of fifty dollars; and (2) for [annual] renewal of any hairdresser and cosmetician license, the sum of [twenty-five] fifty dollars. Each person engaged in the occupation of registered hairdresser and cosmetician shall, at all times, conspicuously display such person's license within the place where such occupation is being conducted. All hairdresser and cosmetician licenses, except as otherwise provided in this chapter, shall be renewed once every two years and shall expire in accordance with the provisions of section 19a-88, as amended by this act. No person shall carry on the occupation of hairdressing and cosmetology after the expiration of such person's license until such person has made application to the department for the renewal of such license. Such application shall be in writing, addressed to the department and signed by the person applying for such renewal. The department may renew any hairdresser and cosmetician license if application for such renewal is received by the department within ninety days after the expiration of such license.

Sec. 25. Subsection (a) of section 20-275 of the general statutes is repealed and the following is substituted in lieu thereof (Effective January 1, 2004):

(a) Each person licensed under the provisions of this chapter shall [register annually] renew such license once every two years with the department in accordance with the provisions of section 19a-88, as amended by this act, on forms provided by the department. [, such registration to be accompanied by a fee of fifty dollars. ] The renewal fee shall be one hundred dollars.

Sec. 26. Subsection (a) of section 20-398 of the general statutes is repealed and the following is substituted in lieu thereof (Effective January 1, 2004):

(a) No person may engage in the practice of fitting or selling hearing aids, or display a sign or in any other way advertise or claim to be a person who sells or engages in the practice of fitting or selling hearing aids unless such person has obtained a license under this chapter or as an audiologist under chapter 399. No audiologist, other than an audiologist who is a licensed hearing instrument specialist on and after July 1, 1996, shall engage in the practice of fitting or selling hearing aids until such audiologist has presented satisfactory evidence to the commissioner that the audiologist has (1) completed at least six semester hours of coursework regarding the selection and fitting of hearing aids and eighty hours of supervised clinical experience with children and adults in the selection and fitting of hearing aids at an institution of higher education in a program accredited, at the time of the audiologist's completion of coursework and clinical experience, by the American Speech-Language Hearing Association or such successor organization as may be approved by the department, or (2) has satisfactorily passed the written section of the examination required by this section for licensure as a hearing instrument specialist. No person may receive a license, except as provided in subsection (b) of this section, unless such person has submitted proof satisfactory to the department that such person has completed a four-year course at an approved high school or has an equivalent education as determined by the department; has satisfactorily completed a course of study in the fitting and selling of hearing aids or a period of training approved by the department; and has satisfactorily passed a written, oral and practical examination given by the department. Application for the examination shall be on forms prescribed and furnished by the department. Examinations shall be given at least twice yearly. The fee for the examination shall be one hundred dollars; and for the initial license and each renewal thereof shall be [one] two hundred dollars.

Sec. 27. Section 20-402 of the general statutes is repealed and the following is substituted in lieu thereof (Effective January 1, 2004):

Licenses issued under this chapter shall be renewed [annually] once every two years, in accordance with the provisions of section 19a-88, as amended by this act, on payment of the renewal fee of [one] two hundred dollars to the department and on production of evidence of satisfactory completion of continuing education requirements established by the Commissioner of Public Health.

Sec. 28. Section 19a-491 of the general statutes is repealed and the following is substituted in lieu thereof (Effective January 1, 2004):

(a) No person acting individually or jointly with any other person shall establish, conduct, operate or maintain an institution in this state without a license as required by this chapter. Application for such license shall be made to the Department of Public Health upon forms provided by it and shall contain such information as the department requires, which may include affirmative evidence of ability to comply with reasonable standards and regulations prescribed under the provisions of this chapter. The commissioner may require as a condition of licensure that an applicant sign a consent order providing reasonable assurances of compliance with the Public Health Code. The commissioner may issue more than one chronic disease hospital license to a single institution until such time as the state offers a rehabilitation hospital license.

(b) [No] If any person acting individually or jointly with any other person shall own real property or any improvements thereon, upon or within which an institution, as defined in subsection (c) of section 19a-490, is established, conducted, operated or maintained [without a certificate that such real property or improvements are in compliance with those provisions of the Public Health Code relating to] and is not the licensee of the institution, such person shall submit a copy of the lease agreement to the department at the time of any change of ownership and with each license renewal application. The lease agreement shall, at a minimum, identify the person or entity responsible for the maintenance and repair of all buildings and structures within which such an institution is established, conducted or operated. [Such certificate shall be issued by the commissioner after an inspection and investigation. Application for such certificate shall be made biennially to the Department of Public Health upon forms provided by it and shall contain such information as the department requires, which may include affirmative evidence of ability to comply with relevant provisions of the Public Health Code. ] If a violation is found as a result of an inspection or investigation, the commissioner may require the owner to sign a consent order providing assurances that repairs or improvements necessary for compliance with the provisions of the Public Health Code shall be completed within a specified period of time. The provisions of this subsection shall not apply to any property or improvements owned by a person licensed in accordance with the provisions of subsection (a) of this section to establish, conduct, operate or maintain an institution on or within such property or improvements.

[(c) For purposes of this chapter, an institution shall include any person or public or private agency which either advertises, arranges for or provides a homemaker health aide or homemaker-home health aide services in a patient's home or a substantially equivalent environment. ]

[(d)] (c) Notwithstanding any regulation to the contrary, the Commissioner of Public Health shall charge the following fees for the biennial licensing and inspection of the following institutions: (1) Chronic and convalescent nursing homes, per site, three hundred fifty dollars; (2) chronic and convalescent nursing homes, per bed, five dollars; (3) rest homes with nursing supervision, per site, three hundred fifty dollars; (4) rest homes with nursing supervision, per bed, five dollars; [(5) residential care homes, per site, three hundred dollars; (6) residential care homes, per bed, three dollars; (7) ambulatory facilities, except those operated by municipal health departments, health districts, or licensed nonprofit nursing or community health agencies and well-child clinics] (5) outpatient dialysis units and outpatient surgical facilities, five hundred dollars; [(8)] (6) mental health residential facilities, per site, three hundred dollars; [(9)] (7) mental health residential facilities, per bed, five dollars; [(10)] (8) hospitals, per site, seven hundred fifty dollars; [(11)] (9) hospitals, per bed, seven dollars and fifty cents; [(12)] (10) nonstate agency educational institutions, per infirmary, seventy-five dollars; and [(13)] (11) nonstate agency educational institutions, per infirmary bed, twenty-five dollars. [In addition, the Commissioner of Public Health shall charge a fee of four hundred fifty dollars for the technical assistance provided for the design, review and development on an institution's construction, sale or change in ownership. ]

(d) Notwithstanding any regulation, the commissioner shall charge the following fees for the triennial licensing and inspection of the following institutions: (1) Residential care homes, per site, four hundred fifty dollars; and (2) residential care homes, per bed, four dollars and fifty cents.

(e) Notwithstanding any regulation, the commissioner shall charge the following fees for the licensing and inspection every four years of the following institutions: (1) Outpatient clinics that provide either medical or mental health service, and well-child clinics, except those operated by municipal health departments, health districts or licensed nonprofit nursing or community health agencies, one thousand dollars; (2) maternity homes, per site, two hundred dollars; and (3) maternity homes, per bed, ten dollars.

(f) The commissioner shall charge a fee of four hundred fifty dollars for the technical assistance provided for the design, review and development of an institution's construction, sale or change in ownership.

[(e)] (g) The commissioner may require as a condition of the licensure of home health care agencies and homemaker-home health aide agencies that each agency meet minimum service quality standards. In the event the commissioner requires such agencies to meet minimum service quality standards as a condition of their licensure, [he] the commissioner shall adopt regulations in accordance with the provisions of chapter 54 to define such minimum service quality standards, which shall allow for training of homemaker-home health care aides by adult continuing education.

Sec. 29. Subsection (b) of section 19a-77 of the general statutes, as amended by section 22 of public act 03-252, is repealed and the following is substituted in lieu thereof (Effective from passage):

(b) For [registration and] licensing requirement purposes, child day care services shall not include such services which are:

(1) (A) Administered by a public school system, or (B) administered by a municipal agency or department and located in a public school building; [for students enrolled in that school; ]

(2) Administered by a private school which is in compliance with section 10-188 and is approved by the State Board of Education or is accredited by an accrediting agency recognized by the State Board of Education;

(3) Recreation operations such as but not limited to creative art studios for children that offer parent-child recreational programs and classes in music, dance, drama and art that are no longer than two hours in length, library programs, boys' and girls' clubs, church-related activities, scouting, camping or community-youth programs;

(4) Informal arrangements among neighbors or relatives in their own homes, provided the relative is limited to any of the following degrees of kinship by blood or marriage to the child being cared for or to the child's parent: Child, grandchild, sibling, niece, nephew, aunt, uncle or child of one's aunt or uncle;

(5) Drop-in supplementary child care operations for educational or recreational purposes and the child receives such care infrequently where the parents are on the premises;

(6) Drop-in supplementary child care operations in retail establishments where the parents are on the premises for retail shopping, in accordance with section 19a-77a, as amended, provided that the drop-in supplementary child-care operation does not charge a fee and does not refer to itself as a child day care center; or

(7) Religious educational activities administered by a religious institution exclusively for children whose parents or legal guardians are members of such religious institution.

Sec. 30. Section 19a-630 of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage):

As used in this chapter:

(1) "Health care facility or institution" means any facility or institution engaged primarily in providing services for the prevention, diagnosis or treatment of human health conditions, including, but not limited to: Outpatient clinics; free standing outpatient surgical facilities; imaging centers; home health agencies, as defined in section 19a-490, as amended; clinical laboratory or central service facilities serving one or more health care facilities, practitioners or institutions; hospitals; [residential care homes; ] nursing homes; rest homes; nonprofit health centers; diagnostic and treatment facilities; rehabilitation facilities; and mental health facilities. "Health care facility or institution" includes any parent company, subsidiary, affiliate or joint venture, or any combination thereof, of any such facility or institution, but does not include any health care facility operated by a nonprofit educational institution solely for the students, faculty and staff of such institution and their dependents, or any Christian Science sanatorium operated, or listed and certified, by the First Church of Christ, Scientist, Boston, Massachusetts.

(2) "State health care facility or institution" means a hospital or other such facility or institution operated by the state providing services which are eligible for reimbursement under Title XVIII or XIX of the federal Social Security Act, 42 USC Section 301 et seq. , as amended.

(3) "Office" means the Office of Health Care Access.

(4) "Commissioner" means the Commissioner of Health Care Access.

(5) "Person" has the meaning assigned to it in section 4-166.

Sec. 31. Subsection (i) of section 5-259 of the general statutes, as amended by section 1 of public act 03-149, is repealed and the following is substituted in lieu thereof (Effective from passage):

(i) The Comptroller may provide for coverage of employees of municipalities, nonprofit corporations, community action agencies, [and] small employers or members of an association for personal care assistants under the plan or plans procured under subsection (a) of this section, provided: (1) Participation by each municipality, nonprofit corporation, community action agency, [or] small employer or association for personal care assistants shall be on a voluntary basis; (2) where an employee organization represents employees of a municipality, nonprofit corporation, community action agency or small employer, participation in a plan or plans to be procured under subsection (a) of this section shall be by mutual agreement of the municipality, nonprofit corporation, community action agency or small employer and the employee organization only and neither party may submit the issue of participation to binding arbitration except by mutual agreement if such binding arbitration is available; (3) no group of employees shall be refused entry into the plan by reason of past or future health care costs or claim experience; (4) rates paid by the state for its employees under subsection (a) of this section are not adversely affected by this subsection; (5) administrative costs to the plan or plans provided under this subsection shall not be paid by the state; and (6) participation in the plan or plans in an amount determined by the state shall be for the duration of the period of the plan or plans, or for such other period as mutually agreed by the municipality, nonprofit corporation, community action agency, [or] small employer or association for personal care assistants and the Comptroller. The Comptroller may arrange and procure for the employees under this subsection health benefit plans that vary from the plan or plans procured under subsection (a) of this section. Notwithstanding any provision of law the coverage provided under this subsection may be offered to employees on either a fully underwritten or risk-pooled basis at the discretion of the Comptroller, except that coverage offered to small employers shall be fully underwritten in accordance with part V of chapter 700c. For the purposes of this subsection, (A) "municipality" means any town, city, borough, school district, taxing district, fire district, district department of health, probate district, housing authority, regional work force development board established under section 31-3k, flood commission or authority established by special act, regional planning agency, transit district formed under chapter 103a, or the Children's Center established by number 571 of the public acts of 1969; (B) "nonprofit corporation" means a nonprofit corporation organized under 26 USC 501(c)(3) that has a contract with the state; (C) "community action agency" means a community action agency, as defined in section 17b-885; [and] (D) "small employer" means a small employer, as defined in section 38a-564, as amended by this act; and (E) "association for personal care assistants" means an organization composed of personal care attendants who are employed by recipients of service (i) under the home-care program for the elderly under section 17b-342, (ii) under the personal care assistance program under section 17b-605a, (iii) in an independent living center pursuant to sections 17b-613 to 17b-615, inclusive, or (iv) under the program for individuals with acquired brain injury as described in section 17b-260a.

Sec. 32. Subdivision (4) of section 38a-564 of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage):

(4) "Small employer" means any person, firm, corporation, limited liability company, partnership or association actively engaged in business or self-employed for at least three consecutive months who, on at least fifty per cent of its working days during the preceding twelve months, employed no more than fifty eligible employees, the majority of whom were employed within the state of Connecticut. "Small employer" includes a self-employed individual. In determining the number of eligible employees, companies which are affiliated companies, as defined in section 33-840, or which are eligible to file a combined tax return for purposes of taxation under chapter 208 shall be considered one employer. Eligible employees shall not include employees covered through the employer by health insurance plans or insurance arrangements issued to or in accordance with a trust established pursuant to collective bargaining subject to the federal Labor Management Relations Act. Except as otherwise specifically provided, provisions of sections 12-201, 12-211, 12-212a and 38a-564 to 38a-572, inclusive, which apply to a small employer shall continue to apply until the plan anniversary following the date the employer no longer meets the requirements of this definition. "Small employer" does not include (A) a municipality procuring health insurance pursuant to section 5-259, as amended by this act, (B) a private school in this state procuring health insurance through a health insurance plan or an insurance arrangement sponsored by an association of such private schools, [or] (C) a nonprofit organization procuring health insurance pursuant to section 5-259, as amended by this act, unless the Secretary of the Office of Policy and Management and the State Comptroller make a request in writing to the Insurance Commissioner that such nonprofit organization be deemed a small employer for the purposes of this chapter, or (D) an association for personal care assistants procuring health insurance pursuant to section 5-259, as amended by this act.

Sec. 33. Section 19a-342 of the general statutes, as amended by section 1 of public act 03-45, is repealed and the following is substituted in lieu thereof (Effective October 1, 2003):

(a) As used in this section, "smoke" or "smoking" means the lighting or carrying of a lighted cigarette, cigar, pipe or similar device.

(b) (1) Notwithstanding the provisions of section 31-40q, no person shall smoke: (A) In any building or portion of a building owned and operated or leased and operated by the state or any political subdivision thereof; (B) in any area of a health care institution; (C) in any area of a retail food store; (D) in any restaurant; (E) in any area of an establishment with a permit issued for the sale of alcoholic liquor pursuant to section 30-20a, 30-21, 30-21b, 30-22, 30-22c, 30-28, 30-28a, 30-33a, 30-33b, 30-35a, 30-37a, 30-37c, 30-37e or 30-37f, in any area of an establishment with a permit for the sale of alcoholic liquor pursuant to section 30-23 issued after May 1, 2003, and, on and after April 1, 2004, in any area of an establishment with a permit issued for the sale of alcoholic liquor pursuant to section 30-22a or 30-26; (F) within a school building while school is in session or student activities are being conducted; (G) in any passenger elevator, provided no person shall be arrested for violating this subsection unless there is posted in such elevator a sign which indicates that smoking is prohibited by state law; [or] (H) in any dormitory in any public or private institution of higher education; or (I) on and after April 1, 2004, in any area of a dog race track or a facility equipped with screens for the simulcasting of off-track betting race programs or jai alai games. For purposes of this subsection, "restaurant" means space, in a suitable and permanent building, kept, used, maintained, advertised and held out to the public to be a place where meals are regularly served to the public.

(2) This section shall not apply to (A) correctional facilities; (B) designated smoking areas in psychiatric facilities; (C) public housing projects, as defined in subsection (b) of section 21a-278a; (D) classrooms where demonstration smoking is taking place as part of a medical or scientific experiment or lesson; (E) smoking rooms provided by employers for employees, pursuant to section 31-40q, as amended by this act; (F) notwithstanding the provisions of subparagraph (E) of subdivision (1) of this subsection, the outdoor portion of the premises of any permittee listed in subparagraph (E) of subdivision (1) of this subsection, provided, in the case of any seating area maintained for the service of food, at least seventy-five per cent of the outdoor seating capacity is an area in which smoking is prohibited and which is clearly designated with written signage as a nonsmoking area, except that any temporary seating area established for special events and not used on a regular basis shall not be subject to the smoking prohibition or signage requirements of this subparagraph; or (G) any tobacco bar, provided no tobacco bar shall expand in size or change its location from its size or location as of December 31, 2002. For purposes of this subdivision, "outdoor" means an area which has no roof or other ceiling enclosure, "tobacco bar" means an establishment with a permit for the sale of alcoholic liquor to consumers issued pursuant to chapter 545 that, in the calendar year ending December 31, 2002, generated ten per cent or more of its total annual gross income from the on-site sale of tobacco products and the rental of on-site humidors, and "tobacco product" means any substance that contains tobacco, including, but not limited to, cigarettes, cigars, pipe tobacco or chewing tobacco.

(c) The operator of a hotel, motel or similar lodging may allow guests to smoke in not more than twenty-five per cent of the rooms offered as accommodations to guests.

(d) In each room, elevator, area or building in which smoking is prohibited by this section, the person in control of the premises shall post or cause to be posted in a conspicuous place signs stating that smoking is prohibited by state law. Such signs, except in elevators, restaurants, establishments with permits to sell alcoholic liquor to consumers issued pursuant to chapter 545, hotels, motels or similar lodgings, and health care institutions, shall have letters at least four inches high with the principal strokes of letters not less than one-half inch wide.

(e) Any person found guilty of smoking in violation of this section, failure to post signs as required by this section or the unauthorized removal of such signs shall have committed an infraction.

(f) Nothing in this section shall be construed to require any smoking area in any building.

(g) The provisions of this section shall supersede and preempt the provisions of any municipal law or ordinance relative to smoking effective prior to, on or after October 1, 1993.

Sec. 34. Subsection (a) of section 14-41 of the general statutes, as amended by section 6 of public act 03-171, is repealed and the following is substituted in lieu thereof (Effective from passage and applicable as of July 1, 2003):

(a) Except as provided in section 14-41a, each motor vehicle operator's license shall be renewed every six years or every four years on the date of the operator's birthday in accordance with a schedule to be established by the commissioner. On and after July 1, [2003] 2005, the Commissioner of Motor Vehicles shall screen the vision of each motor vehicle operator prior to every other renewal of the operator's license of such operator in accordance with a schedule adopted by the commissioner. Such screening requirement shall apply to every other renewal following the initial screening. In lieu of the vision screening by the commissioner, such operator may submit the results of a vision screening conducted by a licensed health care professional qualified to conduct such screening on a form prescribed by the commissioner during the twelve months preceding such renewal. No motor vehicle operator's license may be renewed unless the operator passes such vision screening. The commissioner shall adopt regulations, in accordance with the provisions of chapter 54, to implement the provisions of this subsection relative to the administration of vision screening.

Sec. 35. Subsection (b) of section 13b-99 of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage):

(b) Each such taxicab shall be inspected, [semiannually, by the Department of Motor Vehicles or] biennially, at the time of renewal of registration of such taxicab, by a repairer or limited repairer licensed and authorized by the Commissioner of Motor Vehicles to perform such inspections. The commissioner shall set a fee for such an inspection.

Sec. 36. Section 14-103 of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage):

(a) The commissioner, [by himself or] an inspector authorized by [him, and] the commissioner, [or] any officer of the Division of State Police within the Department of Public Safety [, and] or any local police officer, may examine any motor vehicle, its number, equipment and identification. Any person who wilfully interferes with or obstructs, or attempts to interfere with or obstruct, any such examination shall be fined not more than fifty dollars or imprisoned not more than thirty days, or both.

(b) The Commissioner of Motor Vehicles may establish and maintain a system of voluntary examination of equipment of motor vehicles registered in this state or being operated on the highways thereof. Such examination may be made by licensed automobile dealers and repair garages, not including limited repairers, which have been approved by said commissioner for such purpose.

(c) All state and local police officers, whenever they see a motor vehicle being operated in apparent violation of any statute relative to the equipment of a motor vehicle, may stop such vehicle and may issue to the operator a warning of defective equipment directing the owner of such vehicle to take it to any inspection station approved by the commissioner and have such vehicle [put in] restored to safe operating condition and officially inspected as soon as possible, and not later than ten days from the date of the issuance of the warning notice. Such warning shall be furnished by the commissioner in such form as [he] the commissioner prescribes and shall be in triplicate, the original of which shall be mailed by the issuing officer to the Department of Motor Vehicles. The duplicate copy shall be given to the motor vehicle operator and shall be presented to the official inspection station at the time the vehicle is submitted for examination. The triplicate copy shall be retained by the issuing officer for [his] such officer's department records. When the inspection station approves such vehicle, its authorized representative shall sign the duplicate copy of the warning of defective equipment and mail it to the Department of Motor Vehicles. If the Department of Motor Vehicles does not receive the duplicate copy, as approved by the inspection station, within twenty days from the date of issuance, the commissioner may assess the owner of the motor vehicle a civil penalty of fifty dollars. If such owner fails to pay such penalty within the time prescribed by the commissioner, the commissioner, after giving notice and an opportunity for a hearing to such motorist, shall suspend the registration of the motor vehicle until such time as the penalty is paid and the vehicle is [put in] restored to safe operating condition.

[(d) The commissioner shall annually inspect each service bus. The fee for the inspection shall be twenty dollars, except that no fee shall be charged for any service bus owned by the state or a municipality, as defined in section 7-245. ]

(d) Each service bus shall be inspected, biennially, at the time of renewal of registration of such service bus, by a repairer or limited repairer licensed and authorized by the Commissioner of Motor Vehicles to perform such inspections. The fee for such inspection shall be forty dollars.

Sec. 37. Section 14-164a of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage):

(a) No person shall operate a motor vehicle in any race, contest or demonstration of speed or skill with a motor vehicle as a public exhibition until a permit for such race or exhibition has been obtained from the Commissioner of Motor Vehicles. Any person desiring to manage, operate or conduct such a motor vehicle race or exhibition shall make application in writing to said commissioner at least ten days prior to the race or exhibition and such application shall set forth in detail the time of such proposed race or exhibition, together with a description of the kind and number of motor vehicles to be used and such further information as said commissioner may require. Such application shall be accompanied by a fee of seventy-five dollars. The Commissioner of Motor Vehicles, upon receipt of such application and fee, shall cause an inquiry to be made concerning the condition of the race track or place of exhibition and all of the appurtenances thereto and, if the commissioner finds no unusual hazard to participants in such race or exhibition or to persons attending such race or exhibition, the commissioner may issue a permit naming a definite date for such race or exhibition, which may be conducted at any reasonable hour of any week day or after twelve o'clock noon on any Sunday. The commissioner, with the approval of the legislative body of the city, borough or town in which the race or exhibition will be held, may issue a permit allowing a start time prior to twelve o'clock noon on any Sunday, provided no such race or exhibition shall take place contrary to the provisions of any city, borough or town ordinances. The commissioner may make regulations as to the conditions under which each such race or exhibition may be conducted, including requirements as to types of tires suitable for safe use, the age and physical condition of the participating operators, the number and qualifications of attending personnel, the provision of first-aid and medical supplies and equipment, including ambulances, and the attendance of doctors or other persons qualified to give emergency medical aid, police and fire protection, and such other requirements as will eliminate any unusual hazard to participants in such race or exhibition or to the spectators. No minor under the age of sixteen years may participate in motor cross racing, except that a minor thirteen years of age or older may participate in such racing with the written permission of the minor's parents or legal guardian. If weather or track conditions are such as to make such race or exhibition unusually hazardous, the commissioner or other person designated by the commissioner may cancel or postpone the same or may require the use of tires of a type approved by the commissioner. No person shall conduct or participate in any motor vehicle race or contest or demonstration of speed or skill in any motor vehicle on the ice of any body of water. The provisions of this section shall not apply to a motor vehicle with a motor of no more than three horsepower or a go-cart type vehicle with a motor of no more than twelve horsepower, when operated on a track of one-eighth of a mile or less in length. Preliminary preparations and practice runs, performed after eleven o'clock in the forenoon, on the date designated in the permit and prior to cancellation or postponement, shall not be construed to constitute a race or exhibition within the meaning of this section. No preliminary preparations or practice runs shall be performed before twelve o'clock noon on Sunday. For the purposes of this subsection, "motor cross racing" means motorcycle racing on a dirt track by participants operating motorcycles designed and manufactured exclusively for off-road use and powered by an engine having a capacity of not more than five hundred cubic centimeters piston displacement.

[(b) The commissioner shall assign an inspector to each such race or exhibition and shall charge the person conducting such race or exhibition a fee for the services of such inspector at a rate of one hundred dollars for four hours or less and two hundred dollars for longer than four hours. ]

[(c)] (b) Any person participating in or conducting any motor vehicle race or exhibition contrary to the provisions of this section shall be fined not more than two hundred dollars or imprisoned not more than six months, or both.

Sec. 38. Subsection (f) of section 13b-59 of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage):

(f) "Motor vehicle receipts" means all fees and other charges required by, or levied pursuant to subsection (c) of section 14-12, section 14-15, subsection (a) of section 14-25a, section 14-28, subsection (b) of section 14-35, subsection (b) of section 14-41, section 14-41a, subsection (b) of section 14-44, sections 14-47 and 14-48b, subsection (a) of section 14-49, subsection (b)(1) of section 14-49, except as provided under subsection (b)(2) of said section, subsections (c), (d), (e), (f), (g), (h), (i), (k), (l), (m), (n), (o), (p), (q), (s), (t), (u), (x), (y) and (aa) of section 14-49, section 14-49a, subsections (a) and (g) of section 14-50, subsections (a)(1), (a)(2), (a)(3), (a)(4), (a)(9), (a)(10) and (a)(14) of section 14-50a, section 14-59, section 14-61, section 14-65, subsection (c) of section 14-66, subsection (e) of section 14-67, subsection (f) of section 14-67a, sections 14-67d, [and] 14-160 [, subsection (b) of section 14-164a, section] and 14-381, subsection (b) of section 14-382 and section 14-383.

Sec. 39. Section 13b-70 of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage):

Each person who pays a motor vehicle related fine, penalty or other charge, as defined in subsection (g) of section 13b-59, shall pay, on and after July 1, 1989, an additional amount equal to fifty per cent of the amount of such fine, penalty or other charge imposed. Any such additional amount shall be rounded off to the next highest dollar. The provisions of this section shall not apply to any fine, penalty or other charge required by or levied pursuant to section 14-64 [,] and section 14-150. [and subsection (b) of section 14-164a. ]

Sec. 40. Section 13a-252 of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage):

The ferries crossing the Connecticut River, known as the Rocky Hill ferry and the Chester and Hadlyme ferry, shall be maintained and operated by the Commissioner of Transportation at the expense of the state. The rates of toll or the charges to be made for travel upon said ferries shall be fixed by the commissioner with the approval of the Secretary of the Office of Policy and Management, except that, after the effective date of this section, the rate of toll or charge shall be (1) for a motor vehicle and operator five dollars, (2) for each additional passenger one dollar and seventy-five cents, and (3) for each walk-on and bicycle one dollar and seventy-five cents. All expense of maintenance, repairs and operation of said ferries shall be paid by the Comptroller on vouchers of the commissioner. The commissioner shall include in his report to the General Assembly a report of the receipts and expenditures incidental to the control and maintenance of said ferries. Said Rocky Hill ferry shall be maintained as a state historic structure and shall be so marked with an appropriate plaque by the commissioner in cooperation with the Connecticut Historical Commission.

Sec. 41. Section 13a-175a of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage):

For each fiscal year there shall be allocated [fourteen million six] twelve million five hundred thousand dollars out of the funds appropriated to the Department of Transportation, or from any other source, not otherwise prohibited by law, to be used by the towns for construction, reconstruction, improvement or maintenance of highways, sections of highways, bridges or structures incidental to highways and bridges or the improvement thereof, including the plowing of snow, the sanding of icy pavements, the trimming and removal of trees, the installation, replacement and maintenance of traffic signs, signals and markings, and for traffic control and vehicular safety programs, traffic and parking planning and administration, and other purposes and programs related to highways, traffic and parking, and for the purposes of providing and operating essential public transportation services and related facilities.

Sec. 42. (NEW) (Effective from passage) (a) Notwithstanding the provisions of sections 17b-7, 17b-111, 17b-111b, 17b-118, 17b-118a, 17b-118b and 17b-221 of the general statutes, the Commissioner of Social Services shall operate a State Administered General Assistance program in accordance with this section and section 44 of this act and sections 17b-78, 17b-119, 17b-131, 17b-257 and 17b-689 of the general statutes, as amended by this act. Notwithstanding any provision of the general statutes, on and after October 1, 2003, no town shall be reimbursed by the state for any general assistance medical benefits incurred after September 30, 2003, and on and after March 1, 2004, no town shall be reimbursed by the state for any general assistance cash benefits or general assistance program administrative costs incurred after February 29, 2004.

(b) No earlier than September 1, 2003, but not later than October 1, 2003, the State Administered General Assistance program pursuant to this section and any general assistance program operated by a town shall provide cash assistance of (1) two hundred dollars per month to a single unemployable person upon determination of such person's unemployability; (2) two hundred dollars per month for a single transitional individual who is required to pay for shelter; and (3) fifty dollars per month for a single transitional individual who is not required to pay for shelter. No earlier than September 1, 2003, but not later than October 1, 2003, eligible families shall receive cash assistance in an amount that is fifty dollars less than the standard of assistance such family would receive under the temporary family assistance program. The standard of assistance paid for individuals residing in rated boarding facilities, shall remain at the level in effect on August 31, 2003. No individual shall be eligible for cash assistance under the program if eligible for cash assistance under any other state or federal cash assistance program.

(c) To be eligible for cash assistance under the program, a person shall (1) be (A) eighteen years of age or older; (B) a minor found by a court to be emancipated pursuant to section 46b-150 of the general statutes; (C) under eighteen years of age and a member of a family eligible for cash or medical assistance under the program; or (D) under eighteen years of age and the commissioner determines good cause for such person's eligibility, and (2) not have assets exceeding two hundred fifty dollars. No person who is a substance abuser and refuses or fails to enter available, appropriate treatment shall be eligible for cash assistance under the program until such person enters treatment. No person whose benefits from the temporary family assistance program have terminated as a result of time-limited benefits or for compliance with a program requirement shall be eligible for cash assistance under the program.

(d) Cash assistance to a transitional individual shall be limited to a twenty-four-month period of eligibility with no more than ten months of assistance in the first twelve months of eligibility and no more than six months of assistance in the second twelve months of eligibility, except that such durational limits shall not apply to a transitional individual not classified as such solely due to mental illness or substance abuse or to a transitional individual who has a dependent child under eighteen years of age. Prior to or upon discontinuance of assistance, a person previously determined to be a transitional individual may petition the commissioner to review the determination of his or her status. In such review, the commissioner shall consider factors, including, but not limited to: (1) Age; (2) education; (3) vocational training; (4) mental and physical health; and (5) employment history and shall make a determination of such person's ability to obtain gainful employment. Upon determination by the commissioner that a transitional individual is not unemployable, the person shall be ineligible to receive cash assistance for one year, unless such person produces medical verification of a substantial deterioration in his or her physical or mental condition or a new condition of such severity and duration that it precludes employment for a period of at least six months.

Sec. 43. Section 17b-257 of the general statutes, as amended by section 18 of public act 03-2, is repealed and the following is substituted in lieu thereof (Effective from passage):

[(a) The Commissioner of Social Services shall implement a state medical assistance program for persons ineligible for Medicaid and on or before April 1, 1997, the commissioner shall implement said program in the towns in which the fourteen regional or district offices of the Department of Social Services are located. The commissioner shall establish a schedule for the transfer of recipients of medical assistance administered by towns under the general assistance program to the state program. To the extent possible, the administration of the state medical assistance program shall parallel that of the Medicaid program as it is administered to recipients of temporary family assistance, including eligibility criteria concerning income and assets. Payment for medical services shall be made only for individuals determined eligible. The rates of payment for medical services shall be those of the Medicaid program. Medical services covered under the program shall be those covered under the Medicaid program, except that nonemergency medical transportation, eye care, optical hardware and optometry care, podiatry, chiropractic, natureopathy, home health care and long-term care and services available pursuant to a home and community-based services waiver under Section 1915 of the Social Security Act shall not be covered. On or after April 1, 1997, the commissioner shall implement a managed care program for medical services provided under this program, except services provided pursuant to section 17a-453a. Notwithstanding the provisions of sections 4a-51 and 4a-57, the commissioner may enter into contracts, including, but not limited to, purchase of service agreements to implement the provisions of this section.

(b) The Commissioner of Social Services shall impose cost sharing requirements on recipients of medical assistance under this section and section 17b-259 as follows: (1) A one dollar copayment for each outpatient medical service delivered by a state medical assistance program provider to a medical assistance recipient, and (2) a one dollar copayment for each drug prescription at the time the prescription is filled, provided the commissioner may make modifications to the prescription cost-sharing requirement for certain individuals who have drugs dispensed in less than a thirty-day supply and may exempt residents in certain institutional settings from such requirement. ]

(a) The Commissioner of Social Services shall implement a state medical assistance component of the State Administered General Assistance program for persons ineligible for Medicaid. Not later than October 1, 2003, each person eligible for State Administered General Assistance shall be entitled to receive medical care through a federally qualified health center or other primary care provider as determined by the commissioner. The Commissioner of Social Services shall determine appropriate service areas and shall, in the commissioner's discretion, contract with community health centers, other similar clinics, and other primary care providers, if necessary, to assure access to primary care services for recipients who live farther than a reasonable distance from a federally qualified health center. The commissioner shall assign and enroll eligible persons in federally qualified health centers and with any other providers contracted for the program because of access needs. Not later than October 1, 2003, each person eligible for State Administered General Assistance shall be entitled to receive hospital services. Medical services under the program shall be limited to the services provided by a federally qualified health center, hospital, or other provider contracted for the program at the commissioner's discretion because of access needs. The commissioner shall ensure that ancillary services and specialty services are provided by a federally qualified health center, hospital, or other providers contracted for the program at the commissioner's discretion. Ancillary services include, but are not limited to, radiology, laboratory, and other diagnostic services not available from a recipient's assigned primary-care provider, and durable medical equipment. Specialty services are services provided by a physician with a specialty that are not included in ancillary services. In no event, shall ancillary or specialty services provided under the program exceed such services provided under the State Administered General Assistance program on July 1, 2003. Eligibility criteria concerning income shall be the same as the medically needy component of the Medicaid program, except that earned monthly gross income of up to one hundred fifty dollars shall be disregarded. Unearned income shall not be disregarded. No person who has family assets exceeding one thousand dollars shall be eligible. No person eligible for Medicaid shall be eligible to receive medical care through the State Administered General Assistance program.

(b) Recipients covered by a general assistance program operated by a town shall be assigned and enrolled in federally qualified health centers and with any other providers in the same manner as recipients of medical assistance under the State Administered General Assistance program pursuant to subsection (a) of this section.

(c) On and after October 1, 2003, pharmacy services shall be provided to recipients of State Administered General Assistance through the federally qualified health center to which they are assigned or through a pharmacy with which the health center contracts. Prior to said date, pharmacy services shall be provided as provided under the Medicaid program. Recipients who are assigned to a community health center or similar clinic or primary care provider other than a federally qualified health center or to a federally qualified health center that does not have a contract for pharmacy services shall receive pharmacy services at pharmacies designated by the commissioner.

(d) Recipients of State Administered General Assistance shall contribute a copayment of one dollar and fifty cents for each prescription.

(e) The Commissioner of Social Services shall contract with federally qualified health centers or other primary care providers as necessary to provide medical services to eligible State Administered General Assistance recipients pursuant to this section. The commissioner shall, within available appropriations, make payments to such centers based on their pro rata share of the cost of services provided or the number of clients served, or both. The Commissioner of Social Services shall, within available appropriations, make payments to other providers based on a methodology determined by the commissioner. The Commissioner of Social Services may reimburse for extraordinary medical services, provided such services are documented to the satisfaction of the commissioner. For purposes of this section, the commissioner may contract with a managed care organization or other entity to perform administrative functions. Provisions of a contract for medical services entered into by the commissioner pursuant to this section shall supersede any inconsistent provision in the regulations of Connecticut state agencies.

(f) Each federally qualified health center participating in the program shall, within thirty days of the effective date of this section, enroll in the federal Office of Pharmacy Affairs Section 340B drug discount program established pursuant to 42 USC 256b to provide pharmacy services to recipients at Federal Supply Schedule costs. Each such health center may establish an on-site pharmacy or contract with a commercial pharmacy to provide such pharmacy services.

(g) The Commissioner of Social Services shall, within available appropriations, make payments to hospitals for inpatient services based on their pro rata share of the cost of services provided or the number of clients served, or both. The Commissioner of Social Services shall, within available appropriations, make payments for any ancillary or specialty services provided to State Administered General Assistance recipients under this section based on a methodology determined by the commissioner.

(h) On or before March 1, 2004, the Commissioner of Social Services shall seek a waiver of federal law under the Health Insurance Flexibility and Accountability demonstration initiative for the purpose of extending health insurance coverage under Medicaid to persons qualifying for medical assistance under the State Administered General Assistance program. The provisions of section 17b-8 shall apply to this section.

Sec. 44. (NEW) (Effective from passage) (a) An applicant for State Administered General Assistance cash or medical benefits aggrieved by a decision of the Commissioner of Social Services under the program operated pursuant to section 42 of this act and section 17b-257, as amended by this act, may request a hearing pursuant to section 17b-60 of the general statutes, but shall not be eligible for State Administered General Assistance cash or medical benefits pending a hearing decision.

(b) A recipient of State Administered General Assistance cash assistance aggrieved by a decision of the Commissioner of Social Services under the program operated pursuant to section 42 of this act, may request a hearing pursuant to section 17b-60 of the general statutes, but shall not be eligible for the continuation of cash assistance pending a hearing decision.

(c) A recipient of State Administered General Assistance medical program benefits aggrieved by a decision of the Commissioner of Social Services under the program operated pursuant to section 17b-257 of the general statutes, as amended by this act, may request a hearing pursuant to section 17b-60 of the general statutes and shall continue to receive medical benefits pending a hearing decision.

Sec. 45. Section 17b-78 of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage):

[(a) The Commissioner of Social Services shall adopt regulations, in accordance with the provisions of chapter 54, establishing mandatory standards for the granting of general assistance financial and medical assistance, including the level of financial assistance to be provided by the state or at the expense of the town in such cases, which, effective no later than August 31, 1997, shall be three hundred fifty dollars per month for a single unemployable person upon determination of his unemployability, two hundred dollars per month for a transitional individual who is required to pay for shelter, and one hundred fifty dollars per month for a transitional individual who is not required to pay for shelter, subject to the provisions of section 17b-89 and subsection (b) of section 17b-104, including the payment of medical bills for persons not receiving general assistance financial aid who are unable to pay such bills over a two-year period, by towns, including standards for investigation and eligibility and extent of need and procedures for record-keeping, including uniform application and billing forms to be used by medical providers as well as towns, and other office practices, and establishing time limits for the determination of eligibility for financial assistance and for the payment of medical bills for persons not receiving general assistance financial aid and for the payment of all medical assistance bills, all with the intent of aiding the towns and any districts established under section 17b-117 in the efficient administration of the laws relating to granting of general assistance financial and medical assistance. Such regulations shall include (1) an earned monthly gross income disregard of up to one hundred fifty dollars, (2) a requirement that each town distribute monthly financial assistance to each recipient at the general assistance office or through a central distribution location, except a town shall mail such assistance to a recipient who is incapacitated or residing outside such town, (3) a requirement for each recipient to present an identification card when receiving such assistance and (4) a prohibition against a town charging a fee for the distribution of such assistance. The commissioner shall inform the towns and such districts of the standards so established and shall advise and assist them in their application thereof. The commissioner may recommend regional areas within which he considers it reasonable for towns to join in the establishment of such districts, and may advise the towns therein of such recommendations and his reasons therefor.

(b) Notwithstanding the provisions of sections 4-230 to 4-236, inclusive, the Commissioner of Social Services shall adopt regulations, in accordance with the provisions of chapter 54, concerning the conduct of audits of all general assistance programs in towns where the commissioner has determined an audit shall be conducted. The regulations shall include a clear statistical methodology for conducting such audits and shall provide that such audits be conducted in accordance with the generally accepted auditing standards recognized by the Comptroller General of the United States and the American Institute of Certified Public Accountants. The audits shall include: (1) A financial review of each town's accounts; (2) a selection and sampling methodology for choosing cases to be reviewed in each town; and (3) a review of such selected cases to determine compliance with significant eligibility, supported work, education and training and program regulations.

(c) The department shall analyze the results of general assistance audits and fair hearings to identify areas of client and agency error and areas which involve program implementation problems.

(d) The Commissioner of Social Services shall adopt regulations, in accordance with the provisions of chapter 54, concerning the recovery of reimbursements made to towns or districts based on audit findings and setting such progressive sanctions as the commissioner deems appropriate for any town or district which is found as a result of an audit not to be in compliance with the standards established pursuant to this section. The regulations shall include a provision allowing the commissioner to take action to withhold reimbursement under section 17b-134 for any such town or district and shall provide for a grace period before a sanction is imposed. A town or district may appeal a decision of the commissioner to withhold reimbursements or to impose a sanction in accordance with the provisions of sections 4-176e, 4-177, 4-177c, 4-180 and 4-183. ]

The Commissioner of Social Services shall adopt regulations, in accordance with the provisions of chapter 54, to implement policies and procedures necessary to carry out the purposes of sections 42 and 44 of this act and sections 17b-119, 17b-131, 17b-257 and 17b-689, all as amended by this act. The Commissioner of Social Services shall implement such policies and procedures while in the process of adopting such policies and procedures as regulations, or amending existing regulations provided notice of intent to adopt or amend the regulations is published in the Connecticut Law Journal within twenty days of implementation, and such policies and procedures shall be valid until the time final regulations are effective. The commissioner shall also amend any regulations in existence on the effective date of this section to conform to the provisions of sections 42 and 44 of this act and sections 17b-78, 17b-119, 17b-131, 17b-257 and 17b-689, all as amended by this act.

Sec. 46. Section 17b-689 of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage):

(a) For the purposes of this section, sections 42 and 44 of this act and sections [17b-63, 17b-78, 17b-118 and 17b-134,] 17b-78, 17b-118, 17b-119, 17b-131 and 17b-257, all as amended by this act, (1) an "employable person" means one [(1)] (A) who is sixteen years of age or older but less than sixty-five years of age; and [(2)] (B) who has no documented physical or mental impairment prohibiting such person from working or participating in an education, training or other work readiness program, or who has such an impairment which is expected to last less than two months, as determined by the commissioner; [, prohibiting him from working or participating in an education, training or other work-readiness program. For the purposes of this section and section 17b-134 an "unemployable person" means one (1) who is under sixteen years of age or sixty-five years of age or older or fifty-five years of age or older with a history of chronic unemployment; (2) who has a physical or mental impairment which is expected to last at least six months, as determined by the commissioner; (3) who is pending receipt of supplemental security income, Social Security income or financial assistance through another program administered by the Department of Social Services; (4) who is needed to care for a child under two years of age or an incapacitated child or spouse; or (5) who is a full-time high school student. For purposes of this section and said section 17b-134, a "transitional individual" means (A) a person who has a documented physical or mental impairment which prevents employment and is expected to last at least two months, but less than six months as defined by the commissioner, and who, unless circumstances precluded participation in the labor force, as determined by the commissioner, has worked in at least three of the most recent five calendar quarters and earned at least five hundred dollars in each quarter or who received or was eligible to receive unemployment compensation within the previous six months; (B) a person whose determination of unemployability or disability, as defined by the commissioner, is pending and who provides medical documentation of a severe physical or mental impairment which is expected to last at least six months; or (C) until such time as the Department of Mental Health and Addiction Services implements its basic needs supplement program in the region in which the person resides, a person with mental illness or a substance abuser in a treatment plan approved by the Commissioner of Mental Health and Addiction Services, or by the local welfare official] (2) an "unemployable person" means a person who (A) is under sixteen years of age or sixty-five years of age or older or fifty-five years of age or older with a history of chronic unemployment; (B) has a physical or mental impairment prohibiting such person from working or participating in an education, training or other work-readiness program, which is expected to last at least six months, as determined by the commissioner; (C) is pending receipt of supplemental security income, Social Security income or financial assistance through another program administered by the Department of Social Services; (D) is needed to care for a child under two years of age or to care for an incapacitated child or spouse; (E) is a full-time high school student in good standing; or (F) is a VISTA volunteer; and (3) a "transitional individual" means a person (A) who has a documented physical or mental impairment which prevents employment and is expected to last at least two months, but less than six months, as determined by the commissioner, and who has a recent connection to the labor market, unless circumstances precluded participation in the labor force, as determined by the commissioner; or (B) whose determination of unemployability or disability, as defined by the commissioner, is pending and who provides medical documentation of a severe physical or mental impairment which is expected to last at least six months. A person who is a substance abuser shall be required to participate in treatment, including counseling, and shall be eligible for assistance while waiting for treatment.

(b) The Commissioner of Social Services, when making determinations concerning disabilities or impairments which are expected to last a period of six months or longer in accordance with subsection (a) of this section, shall make such determinations based on the recommendations made by a medical review team.

Sec. 47. Subsection (a) of section 17a-453a of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage):

(a) The Commissioner of Mental Health and Addiction Services shall operate a behavioral health managed care program, within available appropriations, to: (1) Provide consistent and appropriate treatment to eligible recipients; (2) reduce treatment costs for such recipients; (3) eliminate duplicated services provided to such recipients; and (4) assist such recipients in applying for federally funded programs. Said commissioner shall adopt regulations, in accordance with chapter 54, to implement said program. For purposes of this section "eligible recipient" means an [unemployable, transitional or employable individual, as defined in section 17b-689, who is eligible for state-administered general assistance, as determined by the Department of Social Services, or eligible for general assistance, as determined by the municipality] individual eligible for medical services under the State Administered General Assistance program, pursuant to section 17b-257, as amended by this act, and in need of behavioral health services, as determined by the Department of Mental Health and Addiction Services. Notwithstanding section 17a-476, 17a-676, 17b-257 or any other provision of the general statutes, [to the contrary,] services provided under the behavioral health managed care program established by this section shall not be restricted to services offered under the Medicaid program. The Department of Mental Health and Addiction Services shall be responsible for all services and payments related to the provision of the behavioral health services for eligible recipients and may conduct an audit of all aspects of the program established by this section including, but not limited to, services provided, prior authorizations, payments for services and medical records. The commissioner shall analyze the results of such audits to identify discrepancies and errors with regard to services and payments and areas that involve program implementation and operation problems. The commissioner shall adopt regulations, in accordance with the provisions of chapter 54, concerning the recovery of reimbursements made to providers based on audit findings and setting such progressive sanctions as the commissioner deems appropriate for any providers found, as a result of an audit, not to be in compliance with the standards established pursuant to this section. The regulations shall include a provision allowing the commissioner to take action to withhold reimbursement for any such provider and shall provide for a grace period before a sanction is imposed. A provider may appeal a decision of the commissioner to withhold reimbursements or to impose a sanction in accordance with the provisions of chapter 54.

Sec. 48. Section 17b-131 of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage):

When a person in any town, or sent from such town to any licensed institution or state humane institution, dies or is found dead therein and does not leave sufficient estate or has no legally liable relative able to pay the cost of a proper funeral and burial, [the selectmen, or the public official charged with the administration of general assistance in] the chief executive officer of such town, shall give to such person a proper funeral and burial, and [such selectmen or public official may] shall pay a sum not exceeding twelve hundred dollars as an allowance toward the funeral expenses of such deceased, said sum to be paid, upon submission of a proper bill, to the funeral director, cemetery or crematory, as the case may be. [On and after October 1, 1991, such] The Commissioner of Social Services shall reimburse such town for such burial. Such payment for funeral and burial expenses shall be reduced by (1) the amount in any revocable or irrevocable funeral fund, (2) any prepaid funeral contract, (3) the face value of any life insurance policy owned by the decedent, and (4) contributions in excess of two thousand eight hundred dollars toward such funeral and burial expenses from all other sources including friends, relatives and all other persons, organizations, veterans and other benefit programs and other agencies. [For the purpose of reimbursement from the state, such funeral and burial expense shall be considered a general assistance expenditure within the meaning of section 17b-134. Any person burying or causing to be buried any such person in violation of the provisions of this section shall be fined not less than twenty-five dollars. This section shall not affect the provisions of section 19a-270. ]

Sec. 49. Subsection (a) of section 17b-119 of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage):

[(a) (1) On or before September 30, 1990, for those applicants for or recipients of general assistance who have been denied aid under the federal Supplemental Security Income Program, or who have been notified by the Social Security Administration that their benefits under such program will be terminated, each town, through its selectmen or the public official charged with the administration of general assistance in such town, shall advise the client as to his right of appeal and the availability of local legal counsel. The attorney chosen by the applicant or recipient shall be reimbursed by the state for his reasonable fees, for any case accepted after July 1, 1981, on a contingency basis, limited to the amount approved by the Department of Social Services, and limited to the amount approved by the Social Security Administration when such approval is required by federal regulations for such appeals. Such attorney's fees shall not be recoverable from such applicant or recipient or his estate. The full amount of any interim assistance reimbursement received by the state shall be applied to reduce any obligation owed to the town by such applicant or recipient.

(2) On or after October 1, 1990, for]

(a) For those recipients of [general assistance] State Administered General Assistance who have been denied aid under the federal Supplemental Security Income Program, or who have been notified by the Social Security Administration that their benefits under such program will be terminated, [each town, through its selectmen or the public official charged with the administration of general assistance in such town,] the Commissioner of Social Services shall advise the client as to his right of appeal and the availability of local legal counsel. The attorney chosen by the recipient shall be reimbursed by the state for his reasonable fees, on a contingency basis, limited to the amount approved by the Department of Social Services, and limited to the amount approved by the Social Security Administration when such approval is required by federal regulations for such appeals. Such attorney's fees shall not be recoverable from such recipient or his estate. The full amount of any interim assistance reimbursement received by the state shall be applied to reduce any obligation owed to the town by such recipient.

Sec. 50. Section 17b-340 of the general statutes, as amended by section 17 of public act 03-2 and section 45 of public act 03-19, is repealed and the following is substituted in lieu thereof (Effective from passage):

(a) The rates to be paid by or for persons aided or cared for by the state or any town in this state to licensed chronic and convalescent nursing homes, chronic disease hospitals associated with chronic and convalescent nursing homes, rest homes with nursing supervision and to licensed residential care homes, as defined by section 19a-490, and to residential facilities for the mentally retarded which are licensed pursuant to section 17a-227 and certified to participate in the Title XIX Medicaid program as intermediate care facilities for the mentally retarded, for room, board and services specified in licensing regulations issued by the licensing agency shall be determined annually, except as otherwise provided in this subsection, after a public hearing, by the Commissioner of Social Services, to be effective July first of each year except as otherwise provided in this subsection. Such rates shall be determined on a basis of a reasonable payment for such necessary services, which basis shall take into account as a factor the costs of such services. Cost of such services shall include (1) reasonable costs mandated by collective bargaining agreements with certified collective bargaining agents or other agreements between the employer and employees, provided "employees" shall not include persons employed as managers or chief administrators or required to be licensed as nursing home administrators, and (2) compensation for services rendered by proprietors at prevailing wage rates, as determined by application of principles of accounting as prescribed by said commissioner. Cost of such services shall not include amounts paid by the facilities to employees as salary, or to attorneys or consultants as fees, where the responsibility of the employees, attorneys, or consultants is to persuade or seek to persuade the other employees of the facility to support or oppose unionization. Nothing in this subsection shall prohibit inclusion of amounts paid for legal counsel related to the negotiation of collective bargaining agreements, the settlement of grievances or normal administration of labor relations. The commissioner may, in his discretion, allow the inclusion of extraordinary and unanticipated costs of providing services which were incurred to avoid an immediate negative impact on the health and safety of patients. The commissioner may, in his discretion, based upon review of a facility's costs, direct care staff to patient ratio and any other related information, revise a facility's rate for any increases or decreases to total licensed capacity of more than ten beds or changes to its number of licensed rest home with nursing supervision beds and chronic and convalescent nursing home beds. The commissioner may so revise a facility's rate established for the fiscal year ending June 30, 1993, and thereafter for any bed increases, decreases or changes in licensure effective after October 1, 1989. Effective July 1, 1991, in facilities which have both a chronic and convalescent nursing home and a rest home with nursing supervision, the rate for the rest home with nursing supervision shall not exceed such facility's rate for its chronic and convalescent nursing home. All such facilities for which rates are determined under this subsection shall report on a fiscal year basis ending on the thirtieth day of September. Such report shall be submitted to the commissioner by the thirty-first day of December. The commissioner may reduce the rate in effect for a facility which fails to report on or before such date by an amount not to exceed ten per cent of such rate. The commissioner shall annually, on or before the fifteenth day of February, report the data contained in the reports of such facilities to the joint standing committee of the General Assembly having cognizance of matters relating to appropriations. For the cost reporting year commencing October 1, 1985, and for subsequent cost reporting years, facilities shall report the cost of using the services of any nursing pool employee by separating said cost into two categories, the portion of the cost equal to the salary of the employee for whom the nursing pool employee is substituting shall be considered a nursing cost and any cost in excess of such salary shall be further divided so that seventy-five per cent of the excess cost shall be considered an administrative or general cost and twenty-five per cent of the excess cost shall be considered a nursing cost, provided if the total nursing pool costs of a facility for any cost year are equal to or exceed fifteen per cent of the total nursing expenditures of the facility for such cost year, no portion of nursing pool costs in excess of fifteen per cent shall be classified as administrative or general costs. The commissioner, in determining such rates, shall also take into account the classification of patients or boarders according to special care requirements or classification of the facility according to such factors as facilities and services and such other factors as he deems reasonable, including anticipated fluctuations in the cost of providing such services. The commissioner may establish a separate rate for a facility or a portion of a facility for traumatic brain injury patients who require extensive care but not acute general hospital care. Such separate rate shall reflect the special care requirements of such patients. If changes in federal or state laws, regulations or standards adopted subsequent to June 30, 1985, result in increased costs or expenditures in an amount exceeding one-half of one per cent of allowable costs for the most recent cost reporting year, the commissioner shall adjust rates and provide payment for any such increased reasonable costs or expenditures within a reasonable period of time retroactive to the date of enforcement. Nothing in this section shall be construed to require the Department of Social Services to adjust rates and provide payment for any increases in costs resulting from an inspection of a facility by the Department of Public Health. Such assistance as the commissioner requires from other state agencies or departments in determining rates shall be made available to him at his request. Payment of the rates established hereunder shall be conditioned on the establishment by such facilities of admissions procedures which conform with this section, section 19a-533 and all other applicable provisions of the law and the provision of equality of treatment to all persons in such facilities. The established rates shall be the maximum amount chargeable by such facilities for care of such beneficiaries, and the acceptance by or on behalf of any such facility of any additional compensation for care of any such beneficiary from any other person or source shall constitute the offense of aiding a beneficiary to obtain aid to which he is not entitled and shall be punishable in the same manner as is provided in subsection (b) of section 17b-97. For the fiscal year ending June 30, 1992, rates for licensed residential care homes and intermediate care facilities for the mentally retarded may receive an increase not to exceed the most recent annual increase in the Regional Data Resources Incorporated McGraw-Hill Health Care Costs: Consumer Price Index (all urban)-All Items. Rates for newly certified intermediate care facilities for the mentally retarded shall not exceed one hundred fifty per cent of the median rate of rates in effect on January 31, 1991, for intermediate care facilities for the mentally retarded certified prior to February 1, 1991. Notwithstanding any provision of this section, the Commissioner of Social Services shall not adjust an annual rate for a licensed chronic and convalescent nursing home or a rest home with nursing supervision set for the fiscal years ending June 30, 2004, and June 30, 2005, for any reason other than to: (1) Reflect a percentage increase in subsection (f) of this section; (2) lower a rate; or (3) allow the inclusion of extraordinary and unanticipated costs in accordance with this subsection.

(b) The Commissioner of Social Services shall adopt regulations in accordance with the provisions of chapter 54 to specify other allowable services. For purposes of this section, other allowable services means those services required by any medical assistance beneficiary residing in such home or hospital which are not already covered in the rate set by the commissioner in accordance with the provisions of subsection (a) of this section.

(c) No facility subject to the requirements of this section shall accept payment in excess of the rate set by the commissioner pursuant to subsection (a) of this section for any medical assistance patient from this or any other state. No facility shall accept payment in excess of the reasonable and necessary costs of other allowable services as specified by the commissioner pursuant to the regulations promulgated under subsection (b) of this section for any public assistance patient from this or any other state. Notwithstanding the provisions of this subsection, the commissioner may authorize a facility to accept payment in excess of the rate paid for a medical assistance patient in this state for a patient who receives medical assistance from another state.

(d) In any instance where the Commissioner of Social Services finds that a facility subject to the requirements of this section is accepting payment for a medical assistance beneficiary in violation of subsection (c) of this section, the commissioner shall proceed to recover through the rate set for the facility any sum in excess of the stipulated per diem and other allowable costs, as promulgated in regulations pursuant to subsections (a) and (b) of this section. The commissioner shall make the recovery prospectively at the time of the next annual rate redetermination.

(e) Except as provided in this subsection, the provisions of subsections (c) and (d) of this section shall not apply to any facility subject to the requirements of this section, which on October 1, 1981, (1) was accepting payments from the commissioner in accordance with the provisions of subsection (a) of this section, (2) was accepting medical assistance payments from another state for at least twenty per cent of its patients, and (3) had not notified the commissioner of any intent to terminate its provider agreement, in accordance with section 17b-271, provided no patient residing in any such facility on May 22, 1984, shall be removed from such facility for purposes of meeting the requirements of this subsection. If the commissioner finds that the number of beds available to medical assistance patients from this state in any such facility is less than fifteen per cent the provisions of subsections (c) and (d) of this section shall apply to that number of beds which is less than said percentage.

(f) For the fiscal year ending June 30, 1992, the rates paid by or for persons aided or cared for by the state or any town in this state to facilities for room, board and services specified in licensing regulations issued by the licensing agency, except intermediate care facilities for the mentally retarded and residential care homes, shall be based on the cost year ending September 30, 1989. For the fiscal years ending June 30, 1993, and June 30, 1994, such rates shall be based on the cost year ending September 30, 1990. Such rates shall be determined by the Commissioner of Social Services in accordance with this section and the regulations of Connecticut state agencies promulgated by the commissioner and in effect on April 1, 1991, except that:

(1) Allowable costs shall be divided into the following five cost components: Direct costs, which shall include salaries for nursing personnel, related fringe benefits and nursing pool costs; indirect costs, which shall include professional fees, dietary expenses, housekeeping expenses, laundry expenses, supplies related to patient care, salaries for indirect care personnel and related fringe benefits; fair rent, which shall be defined in accordance with subsection (f) of section 17-311-52 of the regulations of Connecticut state agencies; capital-related costs, which shall include property taxes, insurance expenses, equipment leases and equipment depreciation; and administrative and general costs, which shall include maintenance and operation of plant expenses, salaries for administrative and maintenance personnel and related fringe benefits. The commissioner may provide a rate adjustment for nonemergency transportation services required by nursing facility residents. Such adjustment shall be a fixed amount determined annually by the commissioner based upon a review of costs and other associated information. Allowable costs shall not include costs for ancillary services payable under Part B of the Medicare program.

(2) Two geographic peer groupings of facilities shall be established for each level of care, as defined by the Department of Social Services for the determination of rates, for the purpose of determining allowable direct costs. One peer grouping shall be comprised of those facilities located in Fairfield County. The other peer grouping shall be comprised of facilities located in all other counties.

(3) For the fiscal year ending June 30, 1992, per diem maximum allowable costs for each cost component shall be as follows: For direct costs, the maximum shall be equal to one hundred forty per cent of the median allowable cost of that peer grouping; for indirect costs, the maximum shall be equal to one hundred thirty per cent of the state-wide median allowable cost; for fair rent, the amount shall be calculated utilizing the amount approved by the Office of Health Care Access pursuant to section 19a-638; for capital-related costs, there shall be no maximum; and for administrative and general costs, the maximum shall be equal to one hundred twenty-five per cent of the state-wide median allowable cost. For the fiscal year ending June 30, 1993, per diem maximum allowable costs for each cost component shall be as follows: For direct costs, the maximum shall be equal to one hundred forty per cent of the median allowable cost of that peer grouping; for indirect costs, the maximum shall be equal to one hundred twenty-five per cent of the state-wide median allowable cost; for fair rent, the amount shall be calculated utilizing the amount approved by the Office of Health Care Access pursuant to section 19a-638; for capital-related costs, there shall be no maximum; and for administrative and general costs the maximum shall be equal to one hundred fifteen per cent of the state-wide median allowable cost. For the fiscal year ending June 30, 1994, per diem maximum allowable costs for each cost component shall be as follows: For direct costs, the maximum shall be equal to one hundred thirty-five per cent of the median allowable cost of that peer grouping; for indirect costs, the maximum shall be equal to one hundred twenty per cent of the state-wide median allowable cost; for fair rent, the amount shall be calculated utilizing the amount approved by the Office of Health Care Access pursuant to section 19a-638; for capital-related costs, there shall be no maximum; and for administrative and general costs the maximum shall be equal to one hundred ten per cent of the state-wide median allowable cost. For the fiscal year ending June 30, 1995, per diem maximum allowable costs for each cost component shall be as follows: For direct costs, the maximum shall be equal to one hundred thirty-five per cent of the median allowable cost of that peer grouping; for indirect costs, the maximum shall be equal to one hundred twenty per cent of the state-wide median allowable cost; for fair rent, the amount shall be calculated utilizing the amount approved by the Office of Health Care Access pursuant to section 19a-638; for capital-related costs, there shall be no maximum; and for administrative and general costs the maximum shall be equal to one hundred five per cent of the state-wide median allowable cost. For the fiscal year ending June 30, 1996, and any succeeding fiscal year, except for the fiscal years ending June 30, 2000, and June 30, 2001, for facilities with an interim rate in one or both periods, per diem maximum allowable costs for each cost component shall be as follows: For direct costs, the maximum shall be equal to one hundred thirty-five per cent of the median allowable cost of that peer grouping; for indirect costs, the maximum shall be equal to one hundred fifteen per cent of the state-wide median allowable cost; for fair rent, the amount shall be calculated utilizing the amount approved pursuant to section 19a-638; for capital-related costs, there shall be no maximum; and for administrative and general costs the maximum shall be equal to the state-wide median allowable cost. For the fiscal years ending June 30, 2000, and June 30, 2001, for facilities with an interim rate in one or both periods, per diem maximum allowable costs for each cost component shall be as follows: For direct costs, the maximum shall be equal to one hundred forty-five per cent of the median allowable cost of that peer grouping; for indirect costs, the maximum shall be equal to one hundred twenty-five per cent of the state-wide median allowable cost; for fair rent, the amount shall be calculated utilizing the amount approved pursuant to section 19a-638; for capital-related costs, there shall be no maximum; and for administrative and general costs, the maximum shall be equal to the state-wide median allowable cost and such medians shall be based upon the same cost year used to set rates for facilities with prospective rates. Costs in excess of the maximum amounts established under this subsection shall not be recognized as allowable costs, except that the Commissioner of Social Services (A) may allow costs in excess of maximum amounts for any facility with patient days covered by Medicare, including days requiring coinsurance, in excess of twelve per cent of annual patient days which also has patient days covered by Medicaid in excess of fifty per cent of annual patient days; (B) may establish a pilot program whereby costs in excess of maximum amounts shall be allowed for beds in a nursing home which has a managed care program and is affiliated with a hospital licensed under chapter 368v; and (C) may establish rates whereby allowable costs may exceed such maximum amounts for beds approved on or after July 1, 1991, which are restricted to use by patients with acquired immune deficiency syndrome or traumatic brain injury.

(4) For the fiscal year ending June 30, 1992, (A) no facility shall receive a rate that is less than the rate it received for the rate year ending June 30, 1991; (B) no facility whose rate, if determined pursuant to this subsection, would exceed one hundred twenty per cent of the state-wide median rate, as determined pursuant to this subsection, shall receive a rate which is five and one-half per cent more than the rate it received for the rate year ending June 30, 1991; and (C) no facility whose rate, if determined pursuant to this subsection, would be less than one hundred twenty per cent of the state-wide median rate, as determined pursuant to this subsection, shall receive a rate which is six and one-half per cent more than the rate it received for the rate year ending June 30, 1991. For the fiscal year ending June 30, 1993, no facility shall receive a rate that is less than the rate it received for the rate year ending June 30, 1992, or six per cent more than the rate it received for the rate year ending June 30, 1992. For the fiscal year ending June 30, 1994, no facility shall receive a rate that is less than the rate it received for the rate year ending June 30, 1993, or six per cent more than the rate it received for the rate year ending June 30, 1993. For the fiscal year ending June 30, 1995, no facility shall receive a rate that is more than five per cent less than the rate it received for the rate year ending June 30, 1994, or six per cent more than the rate it received for the rate year ending June 30, 1994. For the fiscal years ending June 30, 1996, and June 30, 1997, no facility shall receive a rate that is more than three per cent more than the rate it received for the prior rate year. For the fiscal year ending June 30, 1998, a facility shall receive a rate increase that is not more than two per cent more than the rate that the facility received in the prior year. For the fiscal year ending June 30, 1999, a facility shall receive a rate increase that is not more than three per cent more than the rate that the facility received in the prior year and that is not less than one per cent more than the rate that the facility received in the prior year, exclusive of rate increases associated with a wage, benefit and staffing enhancement rate adjustment added for the period from April 1, 1999, to June 30, 1999, inclusive. For the fiscal year ending June 30, 2000, each facility, except a facility with an interim rate or replaced interim rate for the fiscal year ending June 30, 1999, and a facility having a certificate of need or other agreement specifying rate adjustments for the fiscal year ending June 30, 2000, shall receive a rate increase equal to one per cent applied to the rate the facility received for the fiscal year ending June 30, 1999, exclusive of the facility's wage, benefit and staffing enhancement rate adjustment. For the fiscal year ending June 30, 2000, no facility with an interim rate, replaced interim rate or scheduled rate adjustment specified in a certificate of need or other agreement for the fiscal year ending June 30, 2000, shall receive a rate increase that is more than one per cent more than the rate the facility received in the fiscal year ending June 30, 1999. For the fiscal year ending June 30, 2001, each facility, except a facility with an interim rate or replaced interim rate for the fiscal year ending June 30, 2000, and a facility having a certificate of need or other agreement specifying rate adjustments for the fiscal year ending June 30, 2001, shall receive a rate increase equal to two per cent applied to the rate the facility received for the fiscal year ending June 30, 2000, subject to verification of wage enhancement adjustments pursuant to subdivision (15) of this subsection. For the fiscal year ending June 30, 2001, no facility with an interim rate, replaced interim rate or scheduled rate adjustment specified in a certificate of need or other agreement for the fiscal year ending June 30, 2001, shall receive a rate increase that is more than two per cent more than the rate the facility received for the fiscal year ending June 30, 2000. For the fiscal year ending June 30, 2002, each facility shall receive a rate that is two and one-half per cent more than the rate the facility received in the prior fiscal year. For the fiscal year ending June 30, 2003, each facility shall receive a rate that is two per cent more than the rate the facility received in the prior fiscal year, except that such increase shall be effective January 1, 2003, and such facility rate in effect for the fiscal year ending June 30, 2002, shall be paid for services provided until December 31, 2002, except any facility that would have been issued a lower rate effective July 1, 2002, than for the fiscal year ending June 30, 2002, due to interim rate status or agreement with the department shall be issued such lower rate effective July 1, 2002, and have such rate increased two per cent effective June 1, 2003. For the fiscal year ending June 30, 2004, rates in effect for the period ending June 30, 2003, shall remain in effect, except any facility that would have been issued a lower rate effective July 1, 2003, than for the fiscal year ending June 30, 2003, due to interim rate status or agreement with the department shall be issued such lower rate effective July 1, 2003. For the fiscal year ending June 30, 2005, rates in effect for the period ending June 30, 2004, shall remain in effect until December 31, 2004, except any facility that would have been issued a lower rate effective July 1, 2004, than for the fiscal year ending June 30, 2004, due to interim rate status or agreement with the department shall be issued such lower rate effective July 1, 2004. Effective January 1, 2005, each facility shall receive a rate that is one per cent greater than the rate in effect December 31, 2004. The Commissioner of Social Services shall add fair rent increases to any other rate increases established pursuant to this subdivision for a facility which has undergone a material change in circumstances related to fair rent.

(5) For the purpose of determining allowable fair rent, a facility with allowable fair rent less than the twenty-fifth percentile of the state-wide allowable fair rent shall be reimbursed as having allowable fair rent equal to the twenty-fifth percentile of the state-wide allowable fair rent, provided for the fiscal years ending June 30, 1996, and June 30, 1997, the reimbursement may not exceed the twenty-fifth percentile of the state-wide allowable fair rent for the fiscal year ending June 30, 1995. On and after July 1, 1998, the Commissioner of Social Services may allow minimum fair rent as the basis upon which reimbursement associated with improvements to real property is added. Beginning with the fiscal year ending June 30, 1996, any facility with a rate of return on real property other than land in excess of eleven per cent shall have such allowance revised to eleven per cent. Any facility or its related realty affiliate which finances or refinances debt through bonds issued by the State of Connecticut Health and Education Facilities Authority shall report the terms and conditions of such financing or refinancing to the Commissioner of Social Services within thirty days of completing such financing or refinancing. The Commissioner of Social Services may revise the facility's fair rent component of its rate to reflect any financial benefit the facility or its related realty affiliate received as a result of such financing or refinancing, including but not limited to, reductions in the amount of debt service payments or period of debt repayment. The commissioner shall allow actual debt service costs for bonds issued by the State of Connecticut Health and Educational Facilities Authority if such costs do not exceed property costs allowed pursuant to subsection (f) of section 17-311-52 of the regulations of Connecticut state agencies, provided the commissioner may allow higher debt service costs for such bonds for good cause. For facilities which first open on or after October 1, 1992, the commissioner shall determine allowable fair rent for real property other than land based on the rate of return for the cost year in which such bonds were issued. The financial benefit resulting from a facility financing or refinancing debt through such bonds shall be shared between the state and the facility to an extent determined by the commissioner on a case-by-case basis and shall be reflected in an adjustment to the facility's allowable fair rent.

(6) A facility shall receive cost efficiency adjustments for indirect costs and for administrative and general costs if such costs are below the state-wide median costs. The cost efficiency adjustments shall equal twenty-five per cent of the difference between allowable reported costs and the applicable median allowable cost established pursuant to this subdivision.

(7) For the fiscal year ending June 30, 1992, allowable operating costs, excluding fair rent, shall be inflated using the Regional Data Resources Incorporated McGraw-Hill Health Care Costs: Consumer Price Index (all urban)-All Items minus one and one-half per cent. For the fiscal year ending June 30, 1993, allowable operating costs, excluding fair rent, shall be inflated using the Regional Data Resources Incorporated McGraw-Hill Health Care Costs: Consumer Price Index (all urban)-All Items minus one and three-quarters per cent. For the fiscal years ending June 30, 1994, and June 30, 1995, allowable operating costs, excluding fair rent, shall be inflated using the Regional Data Resources Incorporated McGraw-Hill Health Care Costs: Consumer Price Index (all urban)-All Items minus two per cent. For the fiscal year ending June 30, 1996, allowable operating costs, excluding fair rent, shall be inflated using the Regional Data Resources Incorporated McGraw-Hill Health Care Costs: Consumer Price Index (all urban)-All Items minus two and one-half per cent. For the fiscal year ending June 30, 1997, allowable operating costs, excluding fair rent, shall be inflated using the Regional Data Resources Incorporated McGraw-Hill Health Care Costs: Consumer Price Index (all urban)-All Items minus three and one-half per cent. For the fiscal year ending June 30, 1992, and any succeeding fiscal year, allowable fair rent shall be those reported in the annual report of long-term care facilities for the cost year ending the immediately preceding September thirtieth. The inflation index to be used pursuant to this subsection shall be computed to reflect inflation between the midpoint of the cost year through the midpoint of the rate year. The Department of Social Services shall study methods of reimbursement for fair rent and shall report its findings and recommendations to the joint standing committee of the General Assembly having cognizance of matters relating to human services on or before January 15, 1993.

(8) On and after July 1, 1994, costs shall be rebased no more frequently than every two years and no less frequently than every four years, as determined by the commissioner. The commissioner shall determine whether and to what extent a change in ownership of a facility shall occasion the rebasing of the facility's costs.

(9) The method of establishing rates for new facilities shall be determined by the commissioner in accordance with the provisions of this subsection.

(10) Rates determined under this section shall comply with federal laws and regulations.

(11) For the fiscal year ending June 30, 1992, and any succeeding fiscal year, one-half of the initial amount payable in June by the state to a facility pursuant to this subsection shall be paid to the facility in June and the balance of such amount shall be paid in July.

(12) Notwithstanding the provisions of this subsection, interim rates issued for facilities on and after July 1, 1991, shall be subject to applicable fiscal year cost component limitations established pursuant to subdivision (3) of this subsection.

(13) A chronic and convalescent nursing home having an ownership affiliation with and operated at the same location as a chronic disease hospital may request that the commissioner approve an exception to applicable rate-setting provisions for chronic and convalescent nursing homes and establish a rate for the fiscal years ending June 30, 1992, and June 30, 1993, in accordance with regulations in effect June 30, 1991. Any such rate shall not exceed one hundred sixty-five per cent of the median rate established for chronic and convalescent nursing homes established under this section for the applicable fiscal year.

(14) For the fiscal year ending June 30, 1994, and any succeeding fiscal year, for purposes of computing minimum allowable patient days, utilization of a facility's certified beds shall be determined at a minimum of ninety-five per cent of capacity, except for new facilities and facilities which are certified for additional beds which may be permitted a lower occupancy rate for the first three months of operation after the effective date of licensure.

(15) The Commissioner of Social Services shall adjust facility rates from April 1, 1999, to June 30, 1999, inclusive, by a per diem amount representing each facility's allocation of funds appropriated for the purpose of wage, benefit and staffing enhancement. A facility's per diem allocation of such funding shall be computed as follows: (A) The facility's direct and indirect component salary, wage, nursing pool and allocated fringe benefit costs as filed for the 1998 cost report period deemed allowable in accordance with this section and applicable regulations without application of cost component maximums specified in subdivision (3) of this subsection shall be totalled; (B) such total shall be multiplied by the facility's Medicaid utilization based on the 1998 cost report; (C) the resulting amount for the facility shall be divided by the sum of the calculations specified in subparagraphs (A) and (B) of this subdivision for all facilities to determine the facility's percentage share of appropriated wage, benefit and staffing enhancement funding; (D) the facility's percentage share shall be multiplied by the amount of appropriated wage, benefit and staffing enhancement funding to determine the facility's allocated amount; and (E) such allocated amount shall be divided by the number of days of care paid for by Medicaid on an annual basis including days for reserved beds specified in the 1998 cost report to determine the per diem wage and benefit rate adjustment amount. The commissioner may adjust a facility's reported 1998 cost and utilization data for the purposes of determining a facility's share of wage, benefit and staffing enhancement funding when reported 1998 information is not substantially representative of estimated cost and utilization data for the fiscal year ending June 30, 2000, due to special circumstances during the 1998 cost report period including change of ownership with a part year cost filing or reductions in facility capacity due to facility renovation projects. Upon completion of the calculation of the allocation of wage, benefit and staffing enhancement funding, the commissioner shall not adjust the allocations due to revisions submitted to previously filed 1998 annual cost reports. In the event that a facility's rate for the fiscal year ending June 30, 1999, is an interim rate or the rate includes an increase adjustment due to a rate request to the commissioner or other reasons, the commissioner may reduce or withhold the per diem wage, benefit and staffing enhancement allocation computed for the facility. Any enhancement allocations not applied to facility rates shall not be reallocated to other facilities and such unallocated amounts shall be available for the costs associated with interim rates and other Medicaid expenditures. The wage, benefit and staffing enhancement per diem adjustment for the period from April 1, 1999, to June 30, 1999, inclusive, shall also be applied to rates for the fiscal years ending June 30, 2000, and June 30, 2001, except that the commissioner may increase or decrease the adjustment to account for changes in facility capacity or operations. Any facility accepting a rate adjustment for wage, benefit and staffing enhancements shall apply payments made as a result of such rate adjustment for increased allowable employee wage rates and benefits and additional direct and indirect component staffing. Adjustment funding shall not be applied to wage and salary increases provided to the administrator, assistant administrator, owners or related party employees. Enhancement payments may be applied to increases in costs associated with staffing purchased from staffing agencies provided such costs are deemed necessary and reasonable by the commissioner. The commissioner shall compare expenditures for wages, benefits and staffing for the 1998 cost report period to such expenditures in the 1999, 2000 and 2001 cost report periods to verify whether a facility has applied additional payments to specified enhancements. In the event that the commissioner determines that a facility did not apply additional payments to specified enhancements, the commissioner shall recover such amounts from the facility through rate adjustments or other means. The commissioner may require facilities to file cost reporting forms, in addition to the annual cost report, as may be necessary, to verify the appropriate application of wage, benefit and staffing enhancement rate adjustment payments. For the purposes of this subdivision, "Medicaid utilization" means the number of days of care paid for by Medicaid on an annual basis including days for reserved beds as a percentage of total resident days.

(16) The interim rate established to become effective upon sale of any licensed chronic and convalescent home or rest home with nursing supervision for which a receivership has been imposed pursuant to sections 19a-541 to 19a-549, inclusive, as amended by this act, shall not exceed the rate in effect for the facility at the time of the imposition of the receivership, subject to any annual increases permitted by this section; provided if such rate is less than the median rate for the facility's peer grouping, as defined in subdivision (2) of this subsection, the Commissioner of Social Services may, in the commissioner's discretion, establish an increased rate for the facility not to exceed such median rate unless the Secretary of the Office of Policy and Management, after review of area nursing facility bed availability and other pertinent factors, authorizes the Commissioner of Social Services to establish a rate higher than the median rate.

(g) For the fiscal year ending June 30, 1993, any intermediate care facility for the mentally retarded with an operating cost component of its rate in excess of one hundred forty per cent of the median of operating cost components of rates in effect January 1, 1992, shall not receive an operating cost component increase. For the fiscal year ending June 30, 1993, any intermediate care facility for the mentally retarded with an operating cost component of its rate that is less than one hundred forty per cent of the median of operating cost components of rates in effect January 1, 1992, shall have an allowance for real wage growth equal to thirty per cent of the increase determined in accordance with subsection (q) of section 17-311-52 of the regulations of Connecticut state agencies, provided such operating cost component shall not exceed one hundred forty per cent of the median of operating cost components in effect January 1, 1992. Any facility with real property other than land placed in service prior to October 1, 1991, shall, for the fiscal year ending June 30, 1995, receive a rate of return on real property equal to the average of the rates of return applied to real property other than land placed in service for the five years preceding October 1, 1993. For the fiscal year ending June 30, 1996, and any succeeding fiscal year, the rate of return on real property for property items shall be revised every five years. The commissioner shall, upon submission of a request, allow actual debt service, comprised of principal and interest, in excess of property costs allowed pursuant to section 17-311-52 of the regulations of Connecticut state agencies, provided such debt service terms and amounts are reasonable in relation to the useful life and the base value of the property. For the fiscal year ending June 30, 1995, and any succeeding fiscal year, the inflation adjustment made in accordance with subsection (p) of section 17-311-52 of the regulations of Connecticut state agencies shall not be applied to real property costs. For the fiscal year ending June 30, 1996, and any succeeding fiscal year, the allowance for real wage growth, as determined in accordance with subsection (q) of section 17-311-52 of the regulations of Connecticut state agencies, shall not be applied. For the fiscal year ending June 30, 1996, and any succeeding fiscal year, no rate shall exceed three hundred seventy-five dollars per day unless the commissioner, in consultation with the Commissioner of Mental Retardation, determines after a review of program and management costs, that a rate in excess of this amount is necessary for care and treatment of facility residents. For the fiscal year ending June 30, 2002, rate period, the Commissioner of Social Services shall increase the inflation adjustment for rates made in accordance with subsection (p) of section 17-311-52 of the regulations of Connecticut state agencies to update allowable fiscal year 2000 costs to include a three and one-half per cent inflation factor. For the fiscal year ending June 30, 2003, rate period, the commissioner shall increase the inflation adjustment for rates made in accordance with subsection (p) of section 17-311-52 of the regulations of Connecticut state agencies to update allowable fiscal year 2001 costs to include a one and one-half per cent inflation factor, except that such increase shall be effective November 1, 2002, and such facility rate in effect for the fiscal year ending June 30, 2002, shall be paid for services provided until October 31, 2002, except any facility that would have been issued a lower rate effective July 1, 2002, than for the fiscal year ending June 30, 2002, due to interim rate status or agreement with the department shall be issued such lower rate effective July 1, 2002, and have such rate updated effective November 1, 2002, in accordance with applicable statutes and regulations. For the fiscal year ending June 30, 2004, rates in effect for the period ending June 30, 2003, shall remain in effect, except any facility that would have been issued a lower rate effective July 1, 2003, than for the fiscal year ending June 30, 2003, due to interim rate status or agreement with the department shall be issued such lower rate effective July 1, 2003. Effective July 1, 2004, each facility shall receive a rate that is three-quarters of one per cent greater than the rate in effect June 30, 2004.

(h) (1) For the fiscal year ending June 30, 1993, any residential care home with an operating cost component of its rate in excess of one hundred thirty per cent of the median of operating cost components of rates in effect January 1, 1992, shall not receive an operating cost component increase. For the fiscal year ending June 30, 1993, any residential care home with an operating cost component of its rate that is less than one hundred thirty per cent of the median of operating cost components of rates in effect January 1, 1992, shall have an allowance for real wage growth equal to sixty-five per cent of the increase determined in accordance with subsection (q) of section 17-311-52 of the regulations of Connecticut state agencies, provided such operating cost component shall not exceed one hundred thirty per cent of the median of operating cost components in effect January 1, 1992. Beginning with the fiscal year ending June 30, 1993, for the purpose of determining allowable fair rent, a residential care home with allowable fair rent less than the twenty-fifth percentile of the state-wide allowable fair rent shall be reimbursed as having allowable fair rent equal to the twenty-fifth percentile of the state-wide allowable fair rent. Beginning with the fiscal year ending June 30, 1997, a residential care home with allowable fair rent less than three dollars and ten cents per day shall be reimbursed as having allowable fair rent equal to three dollars and ten cents per day. Property additions placed in service during the cost year ending September 30, 1996, or any succeeding cost year shall receive a fair rent allowance for such additions as an addition to three dollars and ten cents per day if the fair rent for the facility for property placed in service prior to September 30, 1995, is less than or equal to three dollars and ten cents per day. For the fiscal year ending June 30, 1996, and any succeeding fiscal year, the allowance for real wage growth, as determined in accordance with subsection (q) of section 17-311-52 of the regulations of Connecticut state agencies, shall not be applied. For the fiscal year ending June 30, 1996, and any succeeding fiscal year, the inflation adjustment made in accordance with subsection (p) of section 17-311-52 of the regulations of Connecticut state agencies shall not be applied to real property costs. Beginning with the fiscal year ending June 30, 1997, minimum allowable patient days for rate computation purposes for a residential care home with twenty-five beds or less shall be eighty-five per cent of licensed capacity. Beginning with the fiscal year ending June 30, 2002, for the purposes of determining the allowable salary of an administrator of a residential care home with sixty beds or less the department shall revise the allowable base salary to thirty-seven thousand dollars to be annually inflated thereafter in accordance with section 17-311-52 of the regulations of Connecticut state agencies. The rates for the fiscal year ending June 30, 2002, shall be based upon the increased allowable salary of an administrator, regardless of whether such amount was expended in the 2000 cost report period upon which the rates are based. Beginning with the fiscal year ending June 30, 2000, the inflation adjustment for rates made in accordance with subsection (p) of section 17-311-52 of the regulations of Connecticut state agencies shall be increased by two per cent, and beginning with the fiscal year ending June 30, 2002, the inflation adjustment for rates made in accordance with subsection (c) of said section shall be increased by one per cent. Beginning with the fiscal year ending June 30, 1999, for the purpose of determining the allowable salary of a related party, the department shall revise the maximum salary to twenty-seven thousand eight hundred fifty-six dollars to be annually inflated thereafter in accordance with section 17-311-52 of the regulations of Connecticut state agencies and beginning with the fiscal year ending June 30, 2001, such allowable salary shall be computed on an hourly basis and the maximum number of hours allowed for a related party other than the proprietor shall be increased from forty hours to forty-eight hours per work week.

(2) The commissioner shall, upon determining that a loan to be issued to a residential care home by the Connecticut Housing Finance Authority is reasonable in relation to the useful life and property cost allowance pursuant to section 17-311-52 of the regulations of Connecticut state agencies, allow actual debt service, comprised of principal, interest and a repair and replacement reserve on the loan, in lieu of allowed property costs whether actual debt service is higher or lower than such allowed property costs.

(i) Notwithstanding the provisions of this section, the Commissioner of Social Services shall establish a fee schedule for payments to be made to chronic disease hospitals associated with chronic and convalescent nursing homes to be effective on and after July 1, 1995. The fee schedule may be adjusted annually beginning July 1, 1997, to reflect necessary increases in the cost of services.

Sec. 51. (NEW) (Effective from passage) The Commissioner of Social Services shall design and implement a care enhancement and disease management initiative which initiative shall provide for an integrated and systematic approach for managing the health care needs of high cost Medicaid recipients. Notwithstanding any provision of the general statutes, the commissioner may contract with an entity to effectuate the purposes of this section, provided such entity has an established and demonstrated capability in the design and implementation of a disease management initiative. The commissioner shall report annually on the status of the care enhancement and disease management initiative to the joint standing committees of the General Assembly having cognizance of matters relating to appropriations and the budgets of state agencies and human services.

Sec. 52. Section 17b-280 of the general statutes, as amended by section 11 of public act 03-2, is repealed and the following is substituted in lieu thereof (Effective from passage):

(a) The state shall reimburse for all legend drugs provided under the Medicaid, state-administered general assistance, general assistance, ConnPACE and Connecticut AIDS drug assistance programs at the rate established by the Health Care Finance Administration as the federal acquisition cost, or, if no such rate is established, the commissioner shall establish and periodically revise the estimated acquisition cost in accordance with federal regulations. Effective [March 1, 2003] October 1, 2003, the commissioner shall also establish a professional fee of three dollars and [sixty] thirty cents for each prescription to be paid to licensed pharmacies for dispensing drugs to Medicaid, state-administered general assistance, general assistance, ConnPACE and Connecticut AIDS drug assistance recipients in accordance with federal regulations; and on and after September 4, 1991, payment for legend and nonlegend drugs provided to Medicaid recipients shall be based upon the actual package size dispensed. Effective October 1, 1991, reimbursement for over-the-counter drugs for such recipients shall be limited to those over-the-counter drugs and products published in the Connecticut Formulary, or the cross reference list, issued by the commissioner. The cost of all over-the-counter drugs and products provided to residents of nursing facilities, chronic disease hospitals, and intermediate care facilities for the mentally retarded shall be included in the facilities' per diem rate.

(b) The Department of Social Services may provide an enhanced dispensing fee to a pharmacy enrolled in the federal Office of Pharmacy Affairs Section 340B drug discount program established pursuant to 42 USC 256b or a pharmacy under contract to provide services under said program.

Sec. 53. (NEW) (Effective from passage) The Commissioner of Social Services may modify the state medical assistance durable medical equipment, medical surgical supply, oxygen, orthotic and prosthetic devices and hearing aid fee schedules, applicable regulations, policies and procedures or purchase of service contracts to achieve any expenditure reductions adopted under public act 03-1 of the June 30 special session. In the event that such modifications require revisions to any existing state regulations, the commissioner may make such modifications while in the process of adopting the modifications in regulation form provided the commissioner publishes notice of any modifications of regulations in the Connecticut Law Journal within twenty days of implementation of such modifications. Such modifications may include, but shall not be limited to: (1) A change in the reimbursement to customized manually priced devices to a formula based on a percentage of list or acquisition of costs; (2) a percentage reduction in payments to all other durable medical equipment, medical surgical supply, oxygen, orthotic and prosthetic devices and hearing aid providers; (3) the application of any rental costs for durable medical equipment when the department subsequently purchases the same equipment for a recipient; and (4) the selection of a vendor or vendors to be the providers of durable medical equipment, medical surgical supply, oxygen, orthotic and prosthetic devices and hearing aid services pursuant to a competitive bidding process. In no event shall any modifications to the state medical assistance fee schedules, regulations, policies and procedures or purchase of service contracts implemented by the commissioner pursuant to this section be estimated to achieve expenditure reductions in an amount less than adopted in public act 03-1 of the June 30 special session.

Sec. 54. Subdivision (3) of subsection (a) of section 10-76d of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage):

(3) Beginning with the fiscal year ending [June 30, 2000] June 30, 2004, the Commissioner of Social Services shall make grant payments to local or regional boards of education in amounts representing [sixty] fifty per cent of the federal portion of Medicaid claims processed for Medicaid eligible special education and related services provided to Medicaid eligible students in the school district. Such grant payments shall be made on at least a quarterly basis and may represent estimates of amounts due to local or regional boards of education. Any grant payments made on an estimated basis, including payments made by the Department of Education for the fiscal years prior to the fiscal year ending June 30, 2000, shall be subsequently reconciled to grant amounts due based upon filed and accepted Medicaid claims and Medicaid rates. If, upon review, it is determined that a grant payment or portion of a grant payment was made for ineligible or disallowed Medicaid claims, the local or regional board of education shall reimburse the Department of Social Services for any grant payment amount received based upon ineligible or disallowed Medicaid claims.

Sec. 55. Section 17b-295 of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2003):

(a) The commissioner [may require] shall impose cost sharing requirements including the payment of a premium or copayment in connection with services provided under the HUSKY Plan, Part B, to the extent permitted by federal law, and in accordance with the following limitations:

[(1) Until July 1, 1999, the maximum annual aggregate cost sharing for a family with an income (A) which exceeds one hundred eighty-five per cent of the federal poverty level but does not exceed two hundred thirty-five per cent of the federal poverty level shall not be more than six hundred fifty dollars, and (B) which exceeds two hundred thirty-five per cent of the federal poverty level but does not exceed three hundred per cent of the federal poverty level shall not be more than one thousand two hundred fifty dollars;

(2) On and after July 1, 1999, the commissioner shall submit a schedule for the maximum annual aggregate cost sharing for families with an income specified in subparagraphs (A) and (B) of subdivision (1) of this subsection to the joint standing committees of the General Assembly having cognizance of matters relating to human services, public health, insurance and appropriations and the budgets of state agencies. Within fifteen days of receipt of such schedule, said joint standing committees of the General Assembly may advise the commissioner of their approval, denial or modifications, if any, of the schedule; and]

(1) On and after October 1, 2003, the commissioner may increase the maximum annual aggregate cost sharing requirements provided that such cost sharing requirements shall not exceed five per cent of the family's gross annual income. The commissioner may impose a premium requirement on families, whose income exceeds one hundred eighty-five per cent of the federal poverty level as a component of the family's cost sharing responsibility provided the family's annual combined premiums and copayments do not exceed the maximum annual aggregate cost sharing requirement; and

[(3)] (2) The commissioner shall require each managed care plan to monitor copayments and premiums under the provisions of subdivision (1) of this subsection.

(b) (1) Except as provided in subdivision (2) of this subsection, the commissioner may impose limitations on the amount, duration and scope of benefits under the HUSKY Plan, Part B.

(2) The limitations adopted by the commissioner pursuant to subdivision (1) of this subsection shall not preclude coverage of any item of durable medical equipment or service that is medically necessary.

Sec. 56. Section 17b-292 of the general statutes, as amended by section 7 of public act 03-2, is repealed and the following is substituted in lieu thereof (Effective from passage):

(a) A child who resides in a household with a family income which exceeds one hundred eighty-five per cent of the federal poverty level and does not exceed three hundred per cent of the federal poverty level may be eligible for subsidized benefits under the HUSKY Plan, Part B. The services and cost sharing requirements under the HUSKY Plan, Part B shall be substantially similar to the services and cost sharing requirements of the largest commercially available health plan offered by a managed care organization, as defined in section 38a-478, offered to residents in this state as measured by the number of covered lives reported to the Department of Insurance in the most recent audited annual report.

(b) A child who resides in a household with a family income over three hundred per cent of the federal poverty level may be eligible for unsubsidized benefits under the HUSKY Plan, Part B.

(c) Whenever a court or family support magistrate orders a noncustodial parent to provide health insurance for a child, such parent may provide for coverage under the HUSKY Plan, Part B.

(d) To the extent allowed under federal law, the commissioner shall not pay for services or durable medical equipment under the HUSKY Plan, Part B if the enrollee has other insurance coverage for the services or such equipment.

(e) A newborn child who otherwise meets the eligibility criteria for the HUSKY Plan, Part B shall be eligible for benefits retroactive to his date of birth, provided an application is filed on behalf of the child within thirty days of such date.

[(f) The commissioner shall implement presumptive eligibility for children applying for Medicaid. Such presumptive eligibility determinations shall be in accordance with applicable federal law and regulations. The commissioner shall adopt regulations, in accordance with chapter 54, to establish standards and procedures for the designation of organizations as qualified entities to grant presumptive eligibility. In establishing such regulations, the commissioner shall ensure the representation of state-wide and local organizations that provide services to children of all ages in each region of the state. ]

[(g)] (f) The commissioner shall enter into a contract with an entity to be a single point of entry servicer for applicants and enrollees under the HUSKY Plan, Part A and Part B. The servicer shall jointly market both Part A and Part B together as the HUSKY Plan. Such servicer shall develop and implement public information and outreach activities with community programs. Such servicer shall electronically transmit data with respect to enrollment and disenrollment in the HUSKY Plan, Part B to the commissioner. [who may transmit such data to the Children's Health Council. ]

[(h) To the extent permitted by federal law, the single point of entry servicer may be one of the entities authorized to grant presumptive eligibility under the HUSKY Plan, Part A. ]

[(i)] (g) The single point of entry servicer shall send an application and supporting documents to the commissioner for determination of eligibility of a child who resides in a household with a family income of one hundred eighty-five per cent or less of the federal poverty level. The servicer shall enroll eligible beneficiaries in the applicant's choice of managed care plan.

[(j)] (h) Not more than twelve months after the determination of eligibility for benefits under the HUSKY Plan, Part A and Part B and annually thereafter, the commissioner or the servicer, as the case may be, shall determine if the child continues to be eligible for the plan. The commissioner or the servicer shall mail an application form to each participant in the plan for the purposes of obtaining information to make a determination on eligibility. To the extent permitted by federal law, in determining eligibility for benefits under the HUSKY Plan, Part A and Part B with respect to family income, the commissioner or the servicer shall rely upon information provided in such form by the participant unless the commissioner or the servicer has reason to believe that such information is inaccurate or incomplete. The determination of eligibility shall be coordinated with health plan open enrollment periods.

[(k)] (i) The commissioner shall implement the HUSKY Plan, Part B while in the process of adopting necessary policies and procedures in regulation form in accordance with the provisions of section 17b-10.

[(l)] (j) The commissioner shall adopt regulations, in accordance with chapter 54, to establish residency requirements and income eligibility for participation in the HUSKY Plan, Part B and procedures for a simplified mail-in application process. Notwithstanding the provisions of section 17b-257b, such regulations shall provide that any child adopted from another country by an individual who is a citizen of the United States and a resident of this state shall be eligible for benefits under the HUSKY Plan, Part B upon arrival in this state.

Sec. 57. Subsection (c) of section 17b-297 of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage):

(c) The commissioner shall, within available appropriations, contract with [qualified entities authorized to grant presumptive eligibility,] severe need schools and community-based organizations for purposes of public education, outreach and recruitment of eligible children, including the distribution of applications and information regarding enrollment in the HUSKY Plan, Part A and Part B. In awarding such contracts, the commissioner shall consider the marketing, outreach and recruitment efforts of organizations. For the purposes of this subsection, (1) "community-based organizations" shall include, but not be limited to, day care centers, schools, school-based health clinics, community-based diagnostic and treatment centers and hospitals, and (2) "severe need school" means a school in which forty per cent or more of the lunches served are served to students who are eligible for free or reduced price lunches.

Sec. 58. Subsection (a) of section 17b-492 of the general statutes, as amended by section 15 of public act 03-2, is repealed and the following is substituted in lieu thereof (Effective October 1, 2003):

(a) Eligibility for participation in the program shall be limited to any resident (1) who is sixty-five years of age or older or who is disabled, (2) (A) whose annual income, if unmarried, is less than thirteen thousand eight hundred dollars, except after April 1, 2002, such annual income is less than twenty thousand dollars, or whose annual income, if married, when combined with that of the resident's spouse is less than sixteen thousand six hundred dollars, except after April 1, 2002, such combined annual income is less than twenty-seven thousand one hundred dollars, or (B) in the event the program is granted a waiver to be eligible for federal financial participation, then, after July 1, 2002, whose annual income, if unmarried, is less than twenty-five thousand eight hundred dollars, or whose annual income, if married, when combined with that of the resident's spouse is less than thirty-four thousand eight hundred dollars, (3) who is not insured under a policy which provides full or partial coverage for prescription drugs once a deductible amount is met, [and] (4) whose available assets are below one hundred thousand dollars if unmarried and one hundred twenty-five thousand dollars if married, (A) the asset limit for a married resident shall be determined by combining the value of assets available to both spouses, and (B) for purposes of this section, available assets are those that are considered available in determining eligibility in the Connecticut Home Care Program for the Elderly, and (5) on and after September 15, 1991, who pays an annual thirty-dollar registration fee to the Department of Social Services. Effective January 1, 2002, the commissioner shall commence accepting applications from individuals who will become eligible to participate in the program as of April 1, 2002. On January 1, 1998, and annually thereafter, the commissioner shall increase the income limits established under this subsection over those of the previous fiscal year to reflect the annual inflation adjustment in Social Security income, if any. Each such adjustment shall be determined to the nearest one hundred dollars.

Sec. 59. Section 17b-95 of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage):

(a) [Upon] Subject to the provisions of subsection (b) of this section, upon the death of a parent of a child who has, at any time, been a beneficiary under the program of aid to families with dependent children, the temporary family assistance program or the state-administered general assistance program, or upon the death of any person who has at any time been a beneficiary of aid under the state supplement program, medical assistance program, aid to families with dependent children program, temporary family assistance program or state-administered general assistance program, and, on or after September 1, 2003, the Connecticut Pharmaceutical Assistance Contract to the Elderly and Disabled Program, except as provided in subsection (b) of section 17b-93, the state shall have a claim against such parent's or person's estate for all amounts paid on behalf of each such child or for the support of either parent or such child or such person under the state supplement program, medical assistance program, aid to families with dependent children program, temporary family assistance program or state-administered general assistance program and on or after September 1, 2003, to a beneficiary of aid under the Connecticut Pharmaceutical Assistance Contract to the Elderly and Disabled Program, for which the state has not been reimbursed, to the extent that the amount which the surviving spouse, parent or dependent children of the decedent would otherwise take from such estate is not needed for their support.

(b) In the case of any person dying after October 1, 1959, the claim for medical payments, even though such payments were made prior thereto, shall be restricted to medical disbursements actually made for care of such deceased beneficiary. [Such claims] In the case of any person dying after September 1, 2003, the claim for ConnPACE program benefits shall be restricted to benefits actually received on or after July 1, 2003.

(c) Claims pursuant to this section shall have priority over all unsecured claims against such estate, except (1) expenses of last sickness not to exceed three hundred seventy-five dollars, (2) funeral and burial expenses in accordance with section 17b-84, and (3) administrative expenses, including probate fees and taxes, and including fiduciary fees not exceeding the following commissions on the value of the whole estates accounted for by such fiduciaries: On the first two thousand dollars or portion thereof, five per cent; on the next eight thousand dollars or portion thereof, four per cent; on the excess over ten thousand dollars, three per cent. Upon petition by any fiduciary, the Probate Court, after a hearing thereon, may authorize compensation in excess of the above schedule for extraordinary services. Notice of any such petition and hearing shall be given to the Commissioner of Administrative Services in Hartford at least ten days in advance of such hearing. The allowable funeral and burial payment herein shall be reduced by the amount of any prepaid funeral arrangement. Any amount paid from the estate under this section to any person which exceeds the limits provided herein shall be repaid to the estate by such person, and such amount may be recovered in a civil action with interest at six per cent from the date of demand.

(d) For purposes of this section, all sums due on or after July 1, 2003, to any individual after the death of a public assistance beneficiary pursuant to the terms of an annuity contract purchased at any time with assets of a public assistance beneficiary, shall be deemed to be part of the estate of the deceased beneficiary and shall be payable to the state by the recipient of such annuity payments to the extent necessary to achieve full reimbursement of any public assistance benefits paid to, or on behalf of, the deceased beneficiary irrespective of any provision of law. The recipient of beneficiary payments from any such annuity contract shall be solely liable to the state of Connecticut for reimbursement of public assistance benefits paid to, or on behalf of, the deceased beneficiary to the extent of any payments received by such recipient pursuant to the annuity contract.

Sec. 60. Subsection (b) of section 17b-104 of the general statutes, as amended by section 38 of public act 03-19, is repealed and the following is substituted in lieu thereof (Effective from passage):

(b) On July 1, 1988, and annually thereafter, the commissioner shall increase the payment standards over those of the previous fiscal year under the aid to families with dependent children program, temporary family assistance program, the state-administered general assistance program and for the general assistance program by the percentage increase, if any, in the most recent calendar year average in the consumer price index for urban consumers over the average for the previous calendar year, provided the annual increase, if any, shall not exceed five per cent, except that the payment standards for the fiscal years ending June 30, 1992, June 30, 1993, June 30, 1994, June 30, 1995, June 30, 1996, June 30, 1997, June 30, 1998, June 30, 1999, June 30, 2000, June 30, 2001, June 30, 2002, [and] June 30, 2003, June 30, 2004, and June 30, 2005, shall not be increased. On January 1, 1994, the payment standards shall be equal to the standards of need in effect July 1, 1993.

Sec. 61. Subsection (a) of section 17b-106 of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage):

(a) On July 1, 1985, the Commissioner of Social Services shall increase the adult payment standards for the state supplement to the federal Supplemental Security Income Program by four and three-tenths per cent over the standards for the fiscal year ending June 30, 1985, provided the commissioner shall apply the appropriate disregards. Notwithstanding the provisions of any regulation to the contrary, effective July 1, 1994, the commissioner shall reduce the appropriate unearned income disregard for recipients of the state supplement to the federal Supplemental Security Income Program by seven per cent, provided if sufficient funds are available within accounts in the Department of Social Services and are transferred to the old age assistance account, the aid to the blind account and the aid to the disabled account, the commissioner shall increase the unearned income disregard for recipients of the state supplement to the federal Supplemental Security Income Program to a level not to exceed that in effect on June 30, 1994. On July 1, 1989, and annually thereafter, the Commissioner of Social Services shall increase the adult payment standards over those of the previous fiscal year for the state supplement to the federal Supplemental Security Income Program by the percentage increase, if any, in the most recent calendar year average in the consumer price index for urban consumers over the average for the previous calendar year, provided the annual increase, if any, shall not exceed five per cent, except that the adult payment standards for the fiscal years ending June 30, 1993, June 30, 1994, June 30, 1995, June 30, 1996, June 30, 1997, June 30, 1998, June 30, 1999, June 30, 2000, June 30, 2001, June 30, 2002, [and] June 30, 2003, June 30, 2004, and June 30, 2005, shall not be increased. Effective October 1, 1991, the coverage of excess utility costs for recipients of the state supplement to the federal Supplemental Security Income Program is eliminated. Notwithstanding the provisions of this section, the Commissioner of Social Services may increase the personal needs allowance component of the adult payment standard as necessary to meet federal maintenance of effort requirements.

Sec. 62. Section 17b-261a of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage):

(a) The Commissioner of Social Services shall seek a waiver of federal law for the purpose of establishing that the penalty period during which an applicant for or recipient of assistance for long-term care under the Medicaid program is ineligible for Medicaid-funded services due to a transfer of assets for less than fair market value shall begin in the month the applicant is found otherwise eligible for Medicaid coverage of services rather than in the month of the transfer of assets. This section shall only apply to transfers that occur on or after the effective date of the waiver. The provisions of section 17b-8 shall apply to this section.

(b) Any transfer or assignment of assets resulting in the imposition of a penalty period shall be presumed to be made with the intent, on the part of the transferor or the transferee, to enable the transferor to obtain or maintain eligibility for medical assistance. This presumption may be rebutted only by clear and convincing evidence that the transferor's eligibility or potential eligibility for medical assistance was not a basis for the transfer or assignment.

(c) Any transfer or assignment of assets resulting in the establishment or imposition of a penalty period shall create a debt, as defined in section 36a-645, that shall be due and owing by the transferor or transferee to the Department of Social Services in an amount equal to the amount of the medical assistance provided to or on behalf of the transferor on or after the date of the transfer of assets, but said amount shall not exceed the fair market value of the assets at the time of transfer. The Commissioner of Social Services, the Commissioner of Administrative Services and the Attorney General shall have the power or authority to seek administrative, legal or equitable relief as provided by other statutes or by common law.

(d) The Commissioner of Social Services, upon the request of a nursing facility, may grant financial relief to a nursing facility if the nursing facility establishes that (1) it is experiencing severe financial hardship due to the transfer of asset penalty period beginning in the month the applicant is found otherwise eligible for Medicaid coverage of services rather than in the month of the transfer of assets; and (2) it has made every effort permissible under state and federal law to recover the funds that are due to it for caring for the individual. No request for financial relief may be made by a nursing facility unless the individual who is the subject of the imposition of the penalty period has resided in the nursing facility for at least ninety days with no payment having been made on the individual's behalf during that period. If the department agrees to grant financial relief to the nursing facility in the form of providing Medicaid payment to the facility, the department shall seek recoupment of said payment from the individual and the transferee by pursuing all means available to it under state and federal law.

(e) The Commissioner of Social Services may waive the imposition of a penalty period when the transferor (1) suffers from dementia at the time of application for medical assistance and cannot explain transfers that would otherwise result in the imposition of a penalty period; or (2) suffered from dementia at the time of the transfer; or (3) was exploited into making such a transfer. Waiver of the imposition of a penalty period does not prohibit the establishment of a debt in accordance with subsection (c) of this section.

(f) In reviewing transfers of assets for purposes of determining eligibility for medical assistance, the department shall consider those transfers of assets involving real property that occurred within sixty months preceding the date on which an institutionalized individual has applied for medical assistance under the Medicaid state plan, except transfers of real property that are exempt under department regulations. Transfers of assets that do not involve real property remain subject to the look-back provisions contained in federal law.

(g) The Commissioner of Social Services may establish threshold limits, which shall be the cumulative amount of transfers that may be made within any year of the look-back period without resulting in the imposition of a transfer of assets penalty.

(h) The Commissioner of Social Services, pursuant to section 17b-10, shall implement the policies and procedures necessary to carry out the provisions of this section while in the process of adopting such regulations and procedures in regulation form, provided notice of intent to adopt regulations is published in the Connecticut Law Journal within twenty days after implementation. Such policies and procedures shall be valid until the time final regulations are effective.

Sec. 63. Section 17b-261 of the general statutes, as amended by section 2 of public act 03-2 and section 7 of public act 03-268, is amended by adding subsection (h) as follows (Effective from passage):

(NEW) (h) An institutionalized spouse applying for Medicaid and having a spouse living in the community shall be required, to the maximum extent permitted by law, to divert income to such community spouse in order to raise the community spouse's income to the level of the minimum monthly needs allowance, as described in Section 1924 of the Social Security Act. Such diversion of income shall occur before the community spouse is allowed to retain assets in excess of the community spouse protected amount described in Section 1924 of the Social Security Act. The Commissioner of Social Services, pursuant to section 17b-10, may implement the provisions of this subsection while in the process of adopting regulations, provided the commissioner prints notice of intent to adopt the regulations in the Connecticut Law Journal within twenty days of adopting such policy. Such policy shall be valid until the time final regulations are effective.

Sec. 64. Subsection (c) of section 10-303 of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage):

(c) The Board of Education and Services for the Blind may maintain a nonlapsing account and accrue interest thereon for state and local vending machine income which shall be used for the payment of fringe benefits, training and support to vending facilities operators, [and] to provide entrepreneurial and independent-living training and equipment to children who are blind or visually impaired and adults who are blind and for other vocational rehabilitation programs and services for adults who are blind.

Sec. 65. (Effective from passage) For the fiscal year ending June 30, 2004, the sum of two hundred eighty-three thousand dollars shall be disbursed from the nonlapsing account maintained pursuant to subsection (c) of section 10-303 of the general statutes, as amended by this act, for the purpose of retiring obligations associated with the contract for tee shirts manufactured by the Industries program, and not more than five hundred thousand dollars shall be disbursed from said account for the purpose of funding competitive employment or sheltered employment of blind and visually impaired adults.

Sec. 66. Section 17b-239a of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage):

[For the fiscal year ending June 30, 2002, and the fiscal year ending June 30, 2003, the] The Department of Social Services may, within available funds, make payments to all short-term general hospitals located in distressed municipalities, as defined in section 32-9p, with a population greater than seventy thousand and to all short-term general hospitals located in targeted investment communities with enterprise zones, as defined in section 32-70, with a population greater than one hundred thousand. The payment amount for each hospital shall be determined by the Commissioner of Social Services based upon the ratio that the number of inpatient discharges paid by Medicaid on a fee-for-service basis to the hospital for the most recently filed cost report period bears to the total hospital discharges paid by Medicaid on a fee-for-service basis for all qualifying hospitals. Notwithstanding the provisions of this section, no payment shall be made to a facility licensed as a children's hospital.

Sec. 67. Subsection (d) of section 17b-239 of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage):

(d) The state shall also pay to such hospitals for each outpatient clinic and emergency room visit a reasonable rate to be established annually by the commissioner for each hospital, such rate to be determined by the reasonable cost of such services. The emergency room visit rates in effect June 30, 1991, shall remain in effect through June 30, 1993, except those which would have been decreased effective July 1, 1991, or July 1, 1992, shall be decreased. Nothing contained herein shall authorize a payment by the state for such services to any hospital in excess of the charges made by such hospital for comparable services to the general public. For those outpatient hospital services paid on the basis of a ratio of cost to charges, the ratios in effect June 30, 1991, shall be reduced effective July 1, 1991, by the most recent annual increase in the consumer price index for medical care. For those outpatient hospital services paid on the basis of a ratio of cost to charges, the ratios computed to be effective July 1, 1994, shall be reduced by the most recent annual increase in the consumer price index for medical care. The emergency room visit rates in effect June 30, 1994, shall remain in effect through December 31, 1994. The Commissioner of Social Services shall establish a fee schedule for outpatient hospital services to be effective on and after January 1, 1995. Except with respect to the rate periods beginning July 1, 1999, and July 1, 2000, such fee schedule shall be adjusted annually beginning July 1, 1996, to reflect necessary increases in the cost of services. Notwithstanding the provisions of this subsection, the fee schedule for the rate period beginning July 1, 2000, shall be increased by ten and one-half per cent, effective June 1, 2001. Notwithstanding the provisions of this subsection, outpatient rates in effect as of June 30, 2003, shall remain in effect through June 30, 2005.

Sec. 68. Subsection (g) of section 17b-239 of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage):

(g) Effective June 1, 2001, the commissioner shall establish inpatient hospital rates in accordance with the method specified in regulations adopted pursuant to this section and applied for the rate period beginning October 1, 2000, except that the commissioner shall update each hospital's target amount per discharge to the actual allowable cost per discharge based upon the 1999 cost report filing multiplied by sixty-two and one-half per cent if such amount is higher than the target amount per discharge for the rate period beginning October 1, 2000, as adjusted for the ten per cent incentive identified in Section 4005 of Public Law 101-508. If a hospital's rate is increased pursuant to this subsection, the hospital shall not receive the ten per cent incentive identified in Section 4005 of Public Law 101-508. For rate periods beginning October 1, 2001, [and October 1, 2002] through September 30, 2005, the commissioner shall not apply an annual adjustment factor to the target amount per discharge.

Sec. 69. (NEW) (Effective from passage) (a) Not later than September 30, 2003, the Commissioner of Social Services shall submit an amendment to the Medicaid state plan to allow pharmacies the ability to deny filling Medicaid prescriptions for program beneficiaries who demonstrate a documented and continuous failure to make required copayments, notwithstanding having the financial ability to make such required copayments. Such amendment to the Medicaid state plan shall provide that any person denied prescription drugs pursuant to this section shall, upon payment of all outstanding copayments, be eligible for the filling of prescriptions under the Medicaid program. Such amendment to the Medicaid state plan shall not apply to prescriptions for psychotropic drug therapies.

(b) For purposes of this section, continuous failure to make required copayments means the failure to: (1) Make a required copayment within six months from the date a prescription is filled, or (2) make required copayments on six or more prescriptions when such prescriptions are filled during any six-month period.

Sec. 70. Subsection (c) of section 4 of public act 01-8 of the June special session is repealed and the following is substituted in lieu thereof (Effective from passage):

[(c) Upon completion of the study and report required under subsection (a) of this section, the]

(c) The Commissioner of Social Services shall take such action as may be necessary to amend the Medicaid state plan to provide for coverage of optional adult rehabilitation services supplied by various providers of mental health services, pursuant to a contract with the Department of Mental Health and Addiction Services, for adults with mental health needs who are clients of said department. For the fiscal years ending June 30, [2002] 2004, and June 30, [2003,] 2005, up to three million dollars in each such fiscal year of any moneys received by the state as federal reimbursement for optional Medicaid adult rehabilitation services shall be credited to the Community Mental Health Restoration subaccount within the account established under section 1 of [this act] public act 01-8 of the June special session and shall be available for use for the purposes of the subaccount. The Commissioner of Social Services shall adopt regulations, in accordance with the provisions of chapter 54, to implement optional rehabilitation services under the Medicaid program. The commissioner shall implement policies and procedures to administer such services while in the process of adopting such policies or procedures in regulation form, provided notice of intention to adopt the regulations is printed in the Connecticut Law Journal within forty-five days of implementation, and any such policies or procedures shall be valid until the time final regulations are effective.

Sec. 71. (Effective from passage) Any appropriation or portion thereof, made to The University of Connecticut Health Center under section 1 or 11 of public act 03-1 of the June 30 special session may be transferred by the Secretary of the Office of Policy and Management to the disproportionate share account in the Department of Social Services for purposes of maximizing federal reimbursement.

Sec. 72. (NEW) (Effective October 1, 2003) (a) Notwithstanding any provision of the general statutes or the regulations of Connecticut state agencies, the Commissioner of Social Services, in consultation with the Office of Policy and Management, shall enter into contracts with managed care organizations to provide services for eligible individuals enrolled in a managed care plan under the HUSKY Plan, Part A. The managed care plan shall be substantially similar to the State Employee Non-Gatekeeper POE Plan as of the effective date of this section and shall comply with all Medicaid federal law and regulations. For the fiscal years ending June 30, 2004, and June 30, 2005, the copayment requirements shall not exceed three dollars per medical service and one dollar and fifty cents per prescription drug. The commissioner shall require the managed care organizations to assess a monthly cost sharing requirement for eligible individuals as follows: (1) For a family with an income that is at or above fifty per cent of the federal poverty level but below one hundred per cent of the federal poverty level, an amount of ten dollars per person with a family share not to exceed twenty-five dollars per month; and (2) for a family with an income that is at or above one hundred per cent of the federal poverty level but does not exceed one hundred eighty-five per cent of the federal poverty level, an amount of twenty dollars per person with a family share not to exceed fifty dollars per month.

(b) Individuals participating in HUSKY Plan, Part A, not enrolled in managed care, shall be assessed similar copayments and cost sharing requirements as described under subsection (a) of this section. The commissioner may deny coverage or discontinue eligibility for any recipient who is two months in arrears on premium requirements. Termination shall not occur until thirty days after the recipient is notified.

(c) The commissioner shall amend the state Medicaid plan and seek any federal waivers necessary to implement the provisions of this section.

(d) The commissioner shall implement the changes pursuant to this section while in the process of adopting necessary policies and procedures in regulation form in accordance with the provisions of section 17b-10 of the general statutes.

Sec. 73. Section 17b-290 of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage):

As used in sections 17b-289 to 17b-303, inclusive, section 72 of this act, and section 16 of public act 97-1 of the October 29 special session*:

(1) "Applicant" means an individual over the age of eighteen years who is a natural or adoptive parent or a legal guardian; a caretaker relative, foster parent or stepparent with whom the child resides; or a noncustodial parent under order of a court or family support magistrate to provide health insurance, who applies for coverage under the HUSKY Plan, Part B on behalf of a child and shall include a child who is eighteen years of age or emancipated in accordance with the provisions of sections 46b-150 to 46b-150e, inclusive, and who is applying on his own behalf or on behalf of a minor dependent for coverage under such plan;

(2) "Child" means an individual under nineteen years of age;

(3) "Coinsurance" means the sharing of health care expenses by the insured and an insurer in a specified ratio;

(4) "Commissioner" means the Commissioner of Social Services;

(5) "Copayment" means a payment made on behalf of an enrollee for a specified service under the HUSKY Plan, Part B;

(6) "Cost sharing" means arrangements made on behalf of an enrollee whereby an applicant pays a portion of the cost of health services, sharing costs with the state and includes copayments, premiums, deductibles and coinsurance;

(7) "Deductible" means the amount of out-of-pocket expenses that would be paid for health services on behalf of an enrollee before becoming payable by the insurer;

(8) "Department" means the Department of Social Services;

(9) "Durable medical equipment" means durable medical equipment, as defined in Section 1395x(n) of the Social Security Act;

(10) "Eligible beneficiary" means a child who meets the requirements specified in section 17b-292, except a child excluded under the provisions of Subtitle J of Public Law 105-33 or a child of any municipal employee eligible for employer-sponsored insurance on or after October 30, 1997, provided a child of such a municipal employee may be eligible for coverage under the HUSKY Plan, Part B if dependent coverage was terminated due to an extreme economic hardship on the part of the employee, as determined by the commissioner;

(11) "Enrollee" means an eligible beneficiary who receives services from a managed care plan under the HUSKY Plan, Part B;

(12) "Family" means any combination of the following: (A) An individual; (B) the individual's spouse; (C) any child of the individual or such spouse; or (D) the legal guardian of any such child if the guardian resides with the child;

(13) "HUSKY Plan, Part A" means assistance provided to children pursuant to section 17b-261;

(14) "HUSKY Plan, Part B" means the health insurance plan for children established pursuant to the provisions of sections 17b-289 to 17b-303, inclusive, and section 16 of public act 97-1 of the October 29 special session*;

(15) "HUSKY Plus programs" means two supplemental health insurance programs established pursuant to section 17b-294 for medically eligible enrollees of the HUSKY Plan, Part B whose medical needs cannot be accommodated within the basic benefit package offered to enrollees. One program shall supplement coverage for those medically eligible enrollees with intensive physical health needs and the other program shall supplement coverage for those medically eligible enrollees with intensive behavioral health needs;

(16) "Income" means income as calculated in the same manner as under the Medicaid program pursuant to section 17b-261;

(17) "Managed care plan" means a plan offered by an entity that contracts with the department to provide benefits to enrollees on a prepaid basis;

(18) "Parent" means a natural parent, stepparent, adoptive parent, guardian or custodian of a child;

(19) "Premium" means any required payment made by an individual to offset or pay in full the capitation rate under the HUSKY Plan, Part B;

(20) "Preventive care and services" means: (A) Child preventive care, including periodic and interperiodic well-child visits, routine immunizations, health screenings and routine laboratory tests; (B) prenatal care, including care of all complications of pregnancy; (C) care of newborn infants, including attendance at high-risk deliveries and normal newborn care; (D) WIC evaluations; (E) child abuse assessment required under sections 17a-106a and 46b-129a; (F) preventive dental care for children; and (G) periodicity schedules and reporting based on the standards specified by the American Academy of Pediatrics;

(21) "Primary and preventive health care services" means the services of licensed physicians, optometrists, nurses, nurse practitioners, midwives and other related health care professionals which are provided on an outpatient basis, including routine well-child visits, diagnosis and treatment of illness and injury, laboratory tests, diagnostic x-rays, prescription drugs, radiation therapy, chemotherapy, hemodialysis, emergency room services, and outpatient alcohol and substance abuse services, as defined by the commissioner;

(22) "Qualified entity" means any entity: (A) Eligible for payments under a state plan approved under Medicaid and which provides medical services under the HUSKY Plan, Part A, or (B) that is a qualified entity, as defined in 42 USC 1396r-1a, as amended by Section 708 of Public Law 106-554 and that is determined by the commissioner to be capable of making the determination of eligibility. The commissioner shall provide qualified entities with such forms as are necessary for an application to be made on behalf of a child under the HUSKY Plan, Part A and information on how to assist parents, guardians and other persons in completing and filing such forms;

(23) "WIC" means the federal Special Supplemental Food Program for Women, Infants and Children administered by the Department of Public Health pursuant to section 19a-59c.

Sec. 74. Section 19a-533 of the general statutes is amended by adding subsection (h) as follows (Effective from passage):

(NEW) (h) Notwithstanding the provisions of this section, a nursing home may, without regard to the order of its waiting list, admit an applicant who seeks to transfer from a nursing home that is closing.

Sec. 75. (NEW) (Effective from passage) The Commissioner of Social Services, in accordance with federal law, may implement policy to simplify program administration and increase payment accuracy in the food stamp program, while in the process of adopting such policy as regulation, provided notice of such policy is published in the Connecticut Law Journal within twenty days of implementation.

Sec. 76. Section 19a-547 of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage):

(a) The court may [name] appoint any responsible individual [to act as a receiver, except any state employee or the owner, administrator or any] whose name is proposed by the Commissioner of Public Health and the Commissioner of Social Services to act as a receiver. Such individual shall be a nursing home administrator licensed in the state of Connecticut with substantial experience in operating Connecticut nursing homes. On or before July 1, 2004, the Commissioner of Social Services shall adopt regulations governing qualifications for proposed receivers consistent with this subsection. No state employee or owner, administrator or other person with a financial interest in [such] the facility may serve as a receiver for that facility. No person appointed to act as a receiver shall be permitted to have a current financial interest in the facility; nor shall such person appointed as a receiver be permitted to have a financial interest in the facility for a period of five years from the date the receivership ceases.

(b) The court may remove such receiver in accordance with section 52-513. A nursing home receiver appointed pursuant to this section shall be entitled to a reasonable receiver's fee as determined by the court. The receiver shall be liable only in his official capacity for injury to person and property by reason of the conditions of the nursing home. He shall not be personally liable, except for acts or omissions constituting gross, wilful or wanton negligence.

[(b)] (c) The court, in its discretion, may require a bond of such receiver in accordance with section 52-506.

[(c)] (d) The court may require the Commissioner of Public Health to provide for the payment of any receiver's fees authorized in subsection (a) of this section upon a showing by such receiver to the satisfaction of the court that (1) the assets of the nursing home facility are not sufficient to make such payment, and (2) no other source of payment is available, including the submission of claims in a bankruptcy proceeding. The state shall have a claim for any court-ordered fees and expenses of the receiver which shall have priority over all other claims of secured and unsecured creditors and other persons whether or not the nursing home facility is in bankruptcy, to the extent allowed under state or federal law.

Sec. 77. Section 19a-545 of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage):

(a) A receiver appointed pursuant to the provisions of sections 19a-541 to 19a-549, inclusive, in operating such facility, shall have the same powers as a receiver of a corporation under section 52-507, except as provided in subsection [(b)] (c) of this section and shall exercise such powers to remedy the conditions which constituted grounds for the imposition of receivership, assure adequate health care for the patients and preserve the assets and property of the owner. If a facility is placed in receivership it shall be the duty of the receiver to notify patients and family, except where medically contraindicated. Such receiver may correct or eliminate any deficiency in the structure or furnishings of the facility which endangers the safety or health of the residents while they remain in the facility, provided the total cost of correction does not exceed three thousand dollars. The court may order expenditures for this purpose in excess of three thousand dollars on application from such receiver. If any resident is transferred or discharged such receiver shall provide for: (1) Transportation of the resident and such resident's belongings and medical records to the place where such resident is being transferred or discharged; (2) aid in locating an alternative placement and discharge planning in accordance with section 19a-535; (3) preparation for transfer to mitigate transfer trauma, including but not limited to, participation by the resident or the resident's guardian in the selection of the resident's alternative placement, explanation of alternative placements and orientation concerning the placement chosen by the resident or the resident's guardian; and (4) custodial care of all property or assets of residents which are in the possession of an owner of the facility. The receiver shall preserve all property, assets and records of residents which the receiver has custody of and shall provide for the prompt transfer of the property, assets and records to the alternative placement of any transferred resident. In no event may the receiver transfer all residents and close a facility without a court order and without preparing a discharge plan for each resident in accordance with section 19a-535.

(b) Not later than ninety days after appointment as a receiver, such receiver shall: (1) Determine whether the facility can continue to operate and provide adequate care to residents in substantial compliance with applicable federal and state law within the facility's state payments as established by the Commissioner of Social Services pursuant to subsection (f) of section 17b-340, as amended by this act, together with income from self-pay residents, Medicare payments and other current income and shall report such determination to the court; and (2) seek facility purchase proposals. If the receiver determines that the facility will be unable to continue to operate in compliance with said requirements, the receiver shall request an immediate order of the court to close the facility and make arrangements for the orderly transfer of residents pursuant to subsection (a) of this section; unless the receiver determines that a transfer of the facility to a qualified purchaser is expected within ninety days. If a transfer is not completed within one hundred eighty days of the appointment of the receiver, the receiver shall request an immediate order of the court to close the facility and make arrangements for the orderly transfer of residents pursuant to subsection (a) of this section.

[(b)] (c) The court may limit the powers of a receiver appointed pursuant to the provisions of sections 19a-541 to 19a-549, inclusive, to those necessary to solve a specific problem.

Sec. 78. Subsection (b) of section 17b-352 of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage):

(b) Any facility which intends to (1) transfer all or part of its ownership or control prior to being initially licensed; (2) introduce any additional function or service into its program of care or expand an existing function or service; or (3) terminate a service or decrease substantially its total bed capacity, shall submit a complete request for permission to implement such transfer, addition, expansion, increase, termination or decrease with such information as the department requires to the Department of Social Services, provided no permission or request for permission to close a facility is required when a facility in receivership is closed by order of the Superior Court pursuant to section 19a-545, as amended by this act. The Office of the Long-Term Care Ombudsman pursuant to section 17b-400 shall be notified by the facility of any proposed actions pursuant to this subsection at the same time [as] the request for permission is submitted to the department and when a facility in receivership is closed by order of the Superior Court pursuant to section 19a-545, as amended by this act.

Sec. 79. (NEW) (Effective from passage) (a) The Commissioner of Social Services shall reimburse pathologists, licensed pursuant to chapter 370 of the general statutes, who provide medical services to individuals under programs administered by the department, for the professional component of their service, with no distinction made as to whether such service is provided in a hospital or outpatient setting. In no event shall such rate exceed the prevailing rate paid to physicians for similar physician services.

(b) For the fiscal years ending June 30, 2004, and June 30, 2005, any increase in reimbursement shall not exceed the aggregate sum of one hundred fifty thousand dollars for each fiscal year.

Sec. 80. Subsection (a) of section 17b-112 of the general statutes, as amended by section 1 of public act 03-28 and section 5 of public act 03-268, is repealed and the following is substituted in lieu thereof (Effective from passage):

(a) The Department of Social Services shall administer a temporary family assistance program under which cash assistance shall be provided to eligible families in accordance with the temporary assistance for needy families program, established pursuant to the Personal Responsibility and Work Opportunity Reconciliation Act of 1996. Under the temporary family assistance program, benefits shall be provided to a family for not longer than twenty-one months, except as provided in subsections (b) and (c) of this section. For the purpose of calculating said twenty-one-month time limit, months of assistance received on and after January 1, 1996, pursuant to time limits under the aid to families with dependent children program, shall be included. For purposes of this section, "family" means one or more individuals who apply for or receive assistance together under the temporary family assistance program. If the commissioner determines that federal law allows individuals not otherwise in an eligible covered group for the temporary family assistance program to become covered, such family may also, at the discretion of the commissioner, be composed of (1) a pregnant woman, or (2) a parent, both parents or other caretaker relative and at least one child who is under the age of eighteen, or who is under the age of nineteen and a full-time student in a secondary school or its equivalent. A caretaker relative shall be related to the child or children by blood, marriage or adoption or shall be the legal guardian of such a child or pursuing legal proceedings necessary to achieve guardianship. If the commissioner elects to allow state eligibility consistent with any change in federal law, the commissioner may administratively transfer any qualifying family cases under the cash assistance portion of the State Administered General Assistance Program to the temporary family assistance program without regard to usual eligibility and enrollment procedures. If such families become ineligible coverage group under the federal law, the commissioner shall administratively transfer such families back to the cash assistance portion of the State Administered General Assistance Program without regard to usual eligibility and enrollment procedures to the degree that such families are eligible for the state program.

Sec. 81. Subsection (a) of section 17b-244 of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage):

(a) The room and board component of the rates to be paid by the state to private facilities and facilities operated by regional education service centers which are licensed to provide residential care pursuant to section 17a-227, but not certified to participate in the Title XIX Medicaid program as intermediate care facilities for persons with mental retardation, shall be determined annually by the Commissioner of Social Services, except that rates effective April 30, 1989, shall remain in effect through October 31, 1989. Any facility with real property other than land placed in service prior to July 1, 1991, shall, for the fiscal year ending June 30, 1995, receive a rate of return on real property equal to the average of the rates of return applied to real property other than land placed in service for the five years preceding July 1, 1993. For the fiscal year ending June 30, 1996, and any succeeding fiscal year, the rate of return on real property for property items shall be revised every five years. The commissioner shall, upon submission of a request by such facility, allow actual debt service, comprised of principal and interest, on the loan or loans in lieu of property costs allowed pursuant to section 17-313b-5 of the regulations of Connecticut state agencies, whether actual debt service is higher or lower than such allowed property costs, provided such debt service terms and amounts are reasonable in relation to the useful life and the base value of the property. In the case of facilities financed through the Connecticut Housing Finance Authority, the commissioner shall allow actual debt service, comprised of principal, interest and a reasonable repair and replacement reserve on the loan or loans in lieu of property costs allowed pursuant to section 17-313b-5 of the regulations of Connecticut state agencies, whether actual debt service is higher or lower than such allowed property costs, provided such debt service terms and amounts are determined by the commissioner at the time the loan is entered into to be reasonable in relation to the useful life and base value of the property. The commissioner may allow fees associated with mortgage refinancing provided such refinancing will result in state reimbursement savings, after comparing costs over the terms of the existing proposed loans. For the fiscal year ending June 30, 1992, the inflation factor used to determine rates shall be one-half of the gross national product percentage increase for the period between the midpoint of the cost year through the midpoint of the rate year. For fiscal year ending June 30, 1993, the inflation factor used to determine rates shall be two-thirds of the gross national product percentage increase from the midpoint of the cost year to the midpoint of the rate year. For the fiscal years ending June 30, 1996, and June 30, 1997, no inflation factor shall be applied in determining rates. The Commissioner of Social Services shall prescribe uniform forms on which such facilities shall report their costs. Such rates shall be determined on the basis of a reasonable payment for necessary services. Any increase in grants, gifts, fund-raising or endowment income used for the payment of operating costs by a private facility in the fiscal year ending June 30, 1992, shall be excluded by the commissioner from the income of the facility in determining the rates to be paid to the facility for the fiscal year ending June 30, 1993, provided any operating costs funded by such increase shall not obligate the state to increase expenditures in subsequent fiscal years. Nothing contained in this section shall authorize a payment by the state to any such facility in excess of the charges made by the facility for comparable services to the general public. The service component of the rates to be paid by the state to private facilities and facilities operated by regional education service centers which are licensed to provide residential care pursuant to section 17a-227, but not certified to participate in the Title XIX Medicaid programs as intermediate care facilities for persons with mental retardation, shall be determined annually by the Commissioner of Mental Retardation.

Sec. 82. (NEW) (Effective from passage) A pharmacist, when filling a prescription under the Medicaid, ConnPACE, Connecticut AIDS drug assistance or the State Administered General Assistance programs, shall fill such prescription utilizing the most cost-efficient dosage, consistent with the prescription of a prescribing practitioner as defined in section 20-571 of the general statutes, unless such pharmacist receives permission to do otherwise pursuant to the prior authorization requirements set forth in sections 17b-274, as amended, and 17b-491a of the general statutes.

Sec. 83. Section 17b-274d of the general statutes, as amended by section 19 of public act 03-2 and section 63 of public act 03-278, is repealed and the following is substituted in lieu thereof (Effective from passage):

(a) Pursuant to 42 USC 1396r-8, there is established a Medicaid Pharmaceutical and Therapeutics Committee within the Department of Social Services. Said committee shall convene on or before March 31, 2003.

(b) The Medicaid Pharmaceutical and Therapeutics Committee shall be comprised as specified in 42 USC 1396r-8 and shall consist of [eleven] fourteen members appointed by the Governor. Five members shall be physicians licensed pursuant to chapter 370, [five] including one general practitioner, one pediatrician, one geriatrician, one psychiatrist and one specialist in family planning, four members shall be pharmacists licensed pursuant to chapter 400j, two members shall be visiting nurses, one specializing in adult care and one specializing in psychiatric care, one member shall be a clinician designated by the Commissioner of Mental Health and Addiction Services, one member shall be a representative of pharmaceutical manufacturers and one member shall be a consumer representative. The committee may, on an adhoc basis, seek the participation of other state agencies or other interested parties in its deliberations. The members shall serve for terms of two years from the date of their appointment. Members may be appointed to more than one term. The Commissioner of Social Services, or the commissioner's designee, shall convene the committee following the Governor's designation of appointments. The administrative staff of the Department of Social Services shall serve as staff for said committee and assist with all ministerial duties. The Governor shall ensure that the committee membership includes Medicaid participating physicians and pharmacists, with experience serving all segments of the Medicaid population. [Not less than one of the committee members shall be a representative of the pharmaceutical manufacturers. ]

(c) Committee members shall select a chairperson and vice-chairperson from the committee membership on an annual basis.

(d) The committee shall meet at least quarterly, and may meet at other times at the discretion of the chairperson and committee membership. The committee shall comply with all regulations adopted by the department, including notice of any meeting of the committee, pursuant to the requirements of chapter 54.

(e) On or before July 1, 2003, the Department of Social Services, in consultation with the Medicaid and Pharmaceutical Therapeutics Committee, shall adopt a preferred drug list for use in the Medicaid and ConnPACE programs. To the extent feasible, the department shall review all drugs included in the preferred drug list at least every twelve months, and may recommend additions to, and deletions from, the preferred drug list, to ensure that the preferred drug list provides for medically appropriate drug therapies for Medicaid and ConnPACE patients. For the fiscal year ending June 30, 2004, such drug list shall be limited to three classes of drugs, including proton pump inhibitors and two other classes of drugs determined by the Commissioner of Social Services. The commissioner shall notify the joint standing committees of the General Assembly having cognizance of matters relating to human services and appropriation of the classes of drugs on the list by January 1, 2004.

(f) Except for mental-health-related drugs and antiretroviral drugs, reimbursement for a drug not included in the preferred drug list is subject to prior authorization.

(g) The Department of Social Services shall publish and disseminate the preferred drug list to all Medicaid providers in the state.

(h) The committee shall ensure that the pharmaceutical manufacturers agreeing to provide a supplemental rebate pursuant to 42 USC 1396r-8(c) have an opportunity to present evidence supporting inclusion of a product on the preferred drug list unless a court of competent jurisdiction, in a final decision, determines that the Secretary of Health and Human Services does not have authority to allow such supplemental rebates, provided the inability to utilize supplemental rebates pursuant to this subsection shall not impair the committee's authority to maintain a preferred drug list. Upon timely notice, the department shall ensure that any drug that has been approved or had any of its particular uses approved by the United States Food and Drug Administration under a priority review classification, will be reviewed by the Medicaid Pharmaceutical and Therapeutics Committee at the next regularly scheduled meeting. To the extent feasible, upon notice by a pharmaceutical manufacturer, the department shall also schedule a product review for any new product at the next regularly scheduled meeting of the Medicaid Pharmaceutical and Therapeutics Committee.

(i) Factors considered by the department and the Medicaid Pharmaceutical and Therapeutics Committee in developing the preferred drug list shall include, but not be limited to, clinical efficacy, safety and cost effectiveness of a product.

(j) The Medicaid Pharmaceutical and Therapeutics Committee may also make recommendations to the department regarding the prior authorization of any prescribed drug covered by Medicaid in accordance with the plan developed and implemented pursuant to section 17b-491a.

(k) Medicaid recipients may appeal any department preferred drug list determinations utilizing the Medicaid fair hearing process administered by the Department of Social Services established pursuant to chapter 54.

(l) The provisions of this section shall apply to the State Administered General Assistance program.

Sec. 84. Subsection (c) of section 17b-274 of the general statutes, as amended by section 52 of public act 03-2, is repealed and the following is substituted in lieu thereof (Effective from passage):

(c) The Commissioner of Social Services shall implement a procedure by which a pharmacist shall obtain approval from an independent pharmacy consultant acting on behalf of the Department of Social Services, under an administrative services only contract, whenever the pharmacist dispenses a brand name drug product to a Medicaid, state-administered general assistance, general assistance or ConnPACE recipient and a chemically equivalent generic drug product substitution is available, [at a lower cost,] provided such procedure shall not require approval for other than initial prescriptions for such drug product. In cases where the brand name drug is less costly than the chemically equivalent generic drug when factoring in manufacturers' rebates, the pharmacist shall dispense the brand name drug. If such approval is not granted or denied within two hours of receipt by the commissioner of the request for approval, it shall be deemed granted. Notwithstanding any provision of this section, a pharmacist shall not dispense any initial maintenance drug prescription for which there is a chemically equivalent generic substitution that is for less than fifteen days without the department's granting of prior authorization, provided prior authorization shall not otherwise be required for atypical antipsychotic drugs if the individual is currently taking such drug at the time the pharmacist receives the prescription. The pharmacist may appeal a denial of reimbursement to the department based on the failure of such pharmacist to substitute a generic drug product in accordance with this section.

Sec. 85. (NEW) (Effective from passage) The Commissioner of Social Services shall, consistent with federal law, make changes to the cost-based reimbursement methodology in the Medicaid program for federally qualified health centers. On or before March 1, 2004, the commissioner shall report to the joint standing committees of the General Assembly having cognizance of matters relating to appropriations and the budgets of state agencies and human services on the status of the changes to the cost-based reimbursement methodology.

Sec. 86. Section 17b-349 of the general statutes is amended by adding subsections (h) and (i) as follows (Effective from passage):

(NEW) (h) For the fiscal year ending June 30, 2004, and, any grant awards made to a community health center or its successor for the purpose of supporting the community health center infrastructure services to the uninsured or expansion initiative projects shall be in the same proportion to its grant award made in the fiscal year ending June 30, 2003, as the total appropriation for such grant awards for the fiscal year ending June 30, 2004, is to the total appropriation for such grant awards for the prior fiscal year, provided, if any portion of the amount is not required by a given community health center, the differential shall be distributed among all the other health centers according to their share of total funding.

(NEW) (i) For the fiscal year ending June 30, 2005, and, any grant awards made to a community health center or its successor for the purpose of supporting the community health center infrastructure services to the uninsured or expansion initiative projects shall be in the same proportion to its grant award made in the fiscal year ending June 30, 2004, as the total appropriation for such grant awards for the fiscal year ending June 30, 2005, is to the total appropriation for such grant awards for the prior fiscal year, provided, if any portion of the amount is not required by a given community health center, the differential shall be distributed among all the other health centers according to their share of total funding.

Sec. 87. (Effective from passage) On or before July 1, 2004, the Department of Social Services shall, within the limits of available Medicaid funding, implement a pilot project in Greater Hartford with a chronic disease hospital colocated with a skilled nursing facility and with the facilities, medical staff and all necessary personnel for the diagnosis, care and treatment of chronic or geriatric mental conditions that require prolonged hospital or restorative care. For purposes of this section, "chronic disease hospital" means a long-term hospital with facilities, medical staff and all necessary personnel for the diagnosis, care and treatment of chronic physical and geriatric mental health conditions that require prolonged hospital or restorative care.

Sec. 88. (NEW) (Effective from passage) Notwithstanding any provision of the general statutes and the regulations of Connecticut state agencies, the Commissioner of Social Services may reimburse the Department of Mental Health and Addiction Services for targeted case management services that it provides to its target population, which, for purposes of this section, shall include individuals with severe and persistent psychiatric illness and individuals with persistent substance dependence.

Sec. 89. (Effective from passage) For the fiscal year ending June 30, 2005, the Secretary of the Office of Policy and Management is authorized to transfer funds from the private provider account of the Office of Policy and Management to state agencies to effectuate the rate increase for private providers.

Sec. 90. Subsection (a) of section 19a-639a of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage):

(a) Except as required in subsection (b) of this section, the provisions of section 19a-638, as amended, and subsection (a) of section 19a-639 shall not apply to: (1) An outpatient clinic or program operated exclusively by, or contracted to be operated exclusively for, a municipality or municipal agency, a health district, as defined in section 19a-240, or a board of education; (2) a residential facility for the mentally retarded licensed pursuant to section 17a-227 and certified to participate in the Title XIX Medicaid program as an intermediate care facility for the mentally retarded; (3) an outpatient rehabilitation service agency that was in operation on January 1, 1998, that is operated exclusively on an outpatient basis and that is eligible to receive reimbursement under section 17b-243; (4) a clinical laboratory; (5) an assisted living services agency; (6) an outpatient service offering chronic dialysis; (7) a program of ambulatory services established and conducted by a health maintenance organization; (8) a home health agency; (9) a clinic operated by the Americares Foundation; (10) a nursing home; [(11) a residential care home; or (12)] or (11) a rest home. However, the exemptions provided in this section shall not apply when a nursing home [, residential care home] or rest home is, or will be created, acquired, operated or in any other way related to or affiliated with, or under the complete or partial ownership or control of a facility or institution or affiliate subject to the provisions of section 19a-638, as amended, or subsection (a) of section 19a-639.

Sec. 91. (Effective from passage) The Commissioner of Mental Retardation, in conjunction with the Commissioner of Social Services, shall, within available appropriations, prepare a plan to establish and operate a pilot program to provide residential accommodations with assisted living services to individuals on the Department of Mental Retardation's waiting list for residential placement or support. Such plan shall describe the necessary elements of such a pilot program, including, but not limited to, coordination of staffing issues and applications for federal Department of Health and Human Services Demonstration Grants, and any necessary Medicaid waivers. Not later than January 1, 2004, the Commissioner of Mental Retardation shall submit a report containing such plan, in accordance with section 11-4a of the general statutes, to the joint standing committees of the General Assembly having cognizance of matters relating to public health and human services.

Sec. 92. Section 29-315 of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage):

(a) (1) When any building is to be built having more than four stories and is to be used for human occupancy, such building shall have an automatic fire extinguishing system approved by the State Fire Marshal on each floor.

(2) When any building is (A) to be built as an educational occupancy, (B) eligible for a school building project grant pursuant to chapter 173, and (C) put out to bid on or after July 1, 2004, such building shall have an automatic fire extinguishing system approved by the State Fire Marshal on each floor. "Educational occupancy" shall have the same meaning as in the Fire Safety Code.

(b) Each hotel or motel having six or more guest rooms and providing sleeping accommodations for more than sixteen persons for which a building permit for new occupancy is issued on or after January 1, 1987, shall have an automatic fire extinguishing system installed on each floor in accordance with regulations adopted by the Commissioner of Public Safety.

(c) Not later than October 1, 1992, each hotel or motel having more than four stories shall have an automatic fire extinguishing system approved by the State Fire Marshal on each floor.

(d) (1) Not later than January 1, 1995, each residential building having more than four stories and occupied primarily by elderly persons shall have an automatic fire extinguishing system approved by the State Fire Marshal on each floor. Not later than January 1, 1994, the owner or manager of or agency responsible for such residential building shall submit plans for the installation of such system, signed and sealed by a licensed professional engineer, to the local fire marshal within whose jurisdiction such building is located or to the State Fire Marshal, as the case may be. For the purposes of this subsection, the phrase "occupied primarily by elderly persons" means that on October 1, 1993, or on the date of any inspection, if later, a minimum of eighty per cent of the dwelling units available for human occupancy in a residential building have at least one resident who has attained the age of sixty-five years.

(2) Each residential building having more than twelve living units and occupied primarily by elderly persons, as defined in subdivision (1) of this subsection, or designed to be so occupied, for which a building permit for new occupancy is issued or which is substantially renovated on or after January 1, 1997, shall have an automatic fire extinguishing system approved by the State Fire Marshal on each floor.

(e) No building inspector shall grant a building permit unless a fire extinguishing system as required by subsection (a) or (b) of this section is included in the final, approved building plans and no fire marshal or building inspector shall permit occupancy of such a building unless such fire extinguishing system is installed and operable. The State Fire Marshal may require fire extinguishing systems approved by him to be installed in other occupancies where they are required in the interest of safety because of special occupancy hazards.

(f) Not later than July 1, 2005, each chronic and convalescent nursing home or rest home with nursing supervision licensed pursuant to chapter 368v shall have an automatic fire extinguishing system approved by the State Fire Marshal on each floor. Not later than July 1, 2004, the owner or authorized agent of each such home shall submit plans for the installation of such system, signed and sealed by a licensed professional engineer, to the local fire marshal and building official within whose jurisdiction such home is located or to the State Fire Marshal, as the case may be, and shall apply for a building permit for the installation of such system.

(g) Any person who fails to install an automatic fire extinguishing system in violation of any provision of this section shall be subject to a civil penalty of not more than one thousand dollars for each day such violation continues. The Attorney General, upon request of the State Fire Marshal, shall institute a civil action to recover such penalty.

Sec. 93. Section 20-417d of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2003):

(a) A new home construction contractor shall (1) prior to entering into a contract with a consumer for new home construction, provide to the consumer a copy of the new home construction contractor's certificate of registration and a written notice that (A) discloses that the certificate of registration does not represent in any manner that such contractor's registration constitutes an endorsement of the quality of such person's work or of such contractor's competency by the commissioner, (B) advises the consumer to contact the Department of Consumer Protection to determine (i) if such contractor is registered in this state as a new home construction contractor, (ii) if any complaints have been filed against such contractor, and (iii) the disposition of any such complaints, and (C) advises the consumer to request from such contractor a list of consumers of the last twelve new homes constructed to completion by the contractor during the previous twenty-four months, or if the contractor has not constructed at least twelve new homes to completion during the previous twenty-four months, then a list of all consumers for whom the contractor has constructed a new home to completion during the previous twenty-four months, and to contact several individuals on the list to discuss the quality of such contractor's new home construction work, (2) state in any advertisement, including any advertisement in a telephone directory, the fact that such contractor is registered, and (3) include such contractor's registration number in any such advertisement. The new home construction contractor, or his agent, shall also discuss with the consumer the installation of an automatic fire extinguishing system in a new home.

(b) A new home construction contractor shall include in every contract with a consumer a provision advising the consumer that the consumer may be contacted by such contractor's prospective consumers concerning the quality and timeliness of such contractor's new home construction work, unless the consumer advises such contractor, in writing, at the time the contract is executed, that the consumer prefers not to be contacted.

(c) The written notice required in subsection (a) of this section shall be in capital letters not less than ten-point bold face type, and may include a statement in substantially the following form:

"NEW HOME CONSTRUCTION CONTRACTOR

REGISTRATION NOTICE

A CERTIFICATE OF REGISTRATION AS A NEW HOME CONSTRUCTION CONTRACTOR DOES NOT REPRESENT IN ANY MANNER THAT THE CONNECTICUT DEPARTMENT OF CONSUMER PROTECTION ENDORSES THE QUALITY OF THE CONTRACTOR'S NEW HOME CONSTRUCTION WORK OR THE CONTRACTOR'S COMPETENCY TO ENGAGE IN NEW HOME CONSTRUCTION.

ACCORDINGLY, YOU ARE ADVISED TO:

(1) REQUEST FROM THE CONTRACTOR A LIST OF CONSUMERS OF THE LAST TWELVE NEW HOMES CONSTRUCTED TO COMPLETION BY THE CONTRACTOR DURING THE PREVIOUS TWENTY-FOUR MONTHS, OR IF THE CONTRACTOR HAS NOT CONSTRUCTED AT LEAST TWELVE NEW HOMES TO COMPLETION DURING THE PREVIOUS TWENTY-FOUR MONTHS, THEN A LIST OF ALL CONSUMERS FOR WHOM THE CONTRACTOR HAS CONSTRUCTED A NEW HOME TO COMPLETION DURING THE PREVIOUS TWENTY-FOUR MONTHS,

(2) CONTACT SEVERAL INDIVIDUALS ON THE LIST TO DISCUSS THE QUALITY AND THE TIMELINESS OF THE CONTRACTOR'S NEW HOME CONSTRUCTION WORK, AND

(3) CONTACT THE DEPARTMENT OF CONSUMER PROTECTION TO VERIFY THE REGISTRATION INFORMATION PRESENTED BY THE CONTRACTOR AND TO ASCERTAIN THE CONTRACTOR'S COMPLAINT HISTORY WITH THE DEPARTMENT.

IN ADDITION, YOU ARE ADVISED TO DISCUSS WITH THE NEW HOME CONSTRUCTION CONTRACTOR:

(1) WHETHER THE CONTRACTOR HAS A CUSTOMER SERVICE POLICY AND IF SO, THE IDENTITY OF THE PERSON DESIGNATED TO ASSIST YOU IN RESOLVING ANY COMPLAINT ABOUT THE CONTRACTOR'S WORK, [AND]

(2) WHETHER THE CONTRACTOR WILL HOLD YOU HARMLESS FOR WORK PERFORMED BY ANY SUBCONTRACTOR HIRED BY THE CONTRACTOR, AND

(3) THE INSTALLATION OF AN AUTOMATIC FIRE EXTINGUISHING SYSTEM.

THIS NOTICE DOES NOT CONTAIN AN EXHAUSTIVE LIST OF THE INQUIRIES YOU SHOULD MAKE BEFORE CONTRACTING WITH A NEW HOME CONSTRUCTION CONTRACTOR. ADDITIONAL INFORMATION TO ASSIST YOU IN YOUR SELECTION OF A NEW HOME CONSTRUCTION CONTRACTOR MAY BE OBTAINED BY CONTACTING THE CONNECTICUT DEPARTMENT OF CONSUMER PROTECTION. "

(d) No person shall: (1) Present, or attempt to present as such person's own, the certificate of another; (2) knowingly give false evidence of a material nature to the commissioner for the purpose of procuring a certificate; (3) represent such person falsely as, or impersonate, a registered new home construction contractor; (4) use or attempt to use a certificate which has expired or which has been suspended or revoked; (5) engage in the business of a new home construction contractor or hold himself or herself out as a new home construction contractor without having a current certificate of registration under sections 20-417a to 20-417i, inclusive, as amended, and subsection (b) of section 20-421, as amended; (6) represent in any manner that such person's registration constitutes an endorsement of the quality of such person's work or of such person's competency by the commissioner; or (7) fail to refund a deposit paid to a new home construction contractor not later than ten days after a written request mailed or delivered to the new home construction contractor's last known address, if (A) the consumer has complied with the terms of the written contract up to the time of the request, (B) no substantial portion of the contracted work has been performed at the time of the request, (C) more than thirty days has elapsed since the starting date specified in the written contract or more than thirty days has elapsed since the date of the contract if such contract does not specify a starting date, and (D) the new home construction contractor has failed to provide a reasonable explanation to the consumer concerning such contractor's failure to perform a substantial portion of the contracted work. For purposes of this subdivision, "substantial portion of the contracted work" includes, but is not limited to, work performed by the new home construction contractor to (i) secure permits and approvals, (ii) redraft plans or obtain engineer, architect, surveyor or other approvals for changes requested by the consumer or made necessary by site conditions discovered after the contract is executed, (iii) schedule site work or arrange for other contractors to perform services related to the construction of the consumer's new home, and (iv) do any other work referred to in the contract as a "substantial portion of the contracted work".

Sec. 94. (Effective from passage) Section 16 of public act 03-171 shall take effect January 1, 2004.

Sec. 95. (Effective from passage and applicable as of July 1, 2003) Section 14-12l of the general statutes is repealed.

Sec. 96. (Effective from passage) Sections 17b-259a, 17b-293 and 17b-362a of the general statutes are repealed.

Sec. 97. (Effective March 1, 2004) (a) Sections 17b-19, 17b-62 to 17b-65, inclusive, 17b-111a, 17b-116 to 17b-117, inclusive, 17b-120, 17b-121, 17b-123, 17b-134, 17b-135, 17b-220, 17b-259 and 17b-287 of the general statutes are repealed.

(b) In codifying the provisions of this act, the Legislative Commissioners shall delete the references to sections 17b-19, 17b-62 to 17b-65, inclusive, 17b-111a, 17b-116 to 17b-117, inclusive, 17b-120, 17b-121, 17b-123, 17b-134, 17b-135, 17b-220, 17b-259 and 17b-287 that appear in the following sections of the general statutes: 7-406, 8-358, 10a-194a, 17a-453a, 17a-600, 17b-13, 17b-78, 17b-117, 17b-118, 17b-124, 17b-126 to 17b-129, inclusive, 17b-221, 17b-250, 17b-256d, 18-87, 19a-255, 19a-539, 31-3d, 36a-42, 51-344a, 52-57, as amended by section 116 of public act 03-19, and 54-56d.

Approved August 20, 2003