Connecticut Seal

Substitute Senate Bill No. 1011

Public Act No. 03-268

AN ACT CONCERNING DEPARTMENT OF SOCIAL SERVICES REPORTING REQUIREMENTS TO THE GENERAL ASSEMBLY.

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

Section 1. Section 17b-9 of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2003):

The Commissioner of Social Services shall submit an annual report to the General Assembly no later than January first. The report shall: (1) Outline the department's goals and objectives; and (2) include information indicating the department's degree of compliance with all legislative mandates imposed during the previous year, a timetable for implementation and compliance with those legislative mandates which were partially implemented or not implemented in the previous year and information on the status of legislative mandates until the year succeeding that in which they are fully implemented. [; (3) include financial information on all cost disallowances, financial penalty disallowances, sanctions and fines actually paid during the previous fiscal year and identify for each such disallowance, sanction and fine the circumstances leading to its imposition, and (4) identify all recoveries occurring during the fiscal year for previous years. ]

Sec. 2. Subsection (a) of section 17b-11 of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2003):

(a) The Commissioner of Social Services is authorized and empowered to accept any and all allotments of federal funds, federal funds to match private contributions and commodities, and to manage and dispose of the same in whatever manner is required by federal law, and to take advantage of any amendments and supplements to the federal Social Security Act and of any other federal act relating to public welfare, and to conform to such federal requirements as are conditions precedent to the receipt of federal matching grants and are not prohibited by the general statutes. [The commissioner shall submit an annual report to the joint standing committee of the General Assembly having cognizance of matters relating to appropriations and the budgets of state agencies which sets forth the amount of any federal funds accepted to match private contributions and the purpose for which such funds are accepted and used. ]

Sec. 3. Subsection (b) of section 17b-29 of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2003):

(b) Beginning September 1, 1997, [and monthly thereafter] at meetings scheduled by the council, the Commissioner of Social Services and the Labor Commissioner shall update the council on the implementation of the temporary family assistance program and the employment services program. The council shall submit recommendations to the department regarding, but not limited to, the availability of quality child care and the provision of seamless child care services, procedures for informing parents and teenagers about family planning and pregnancy prevention, client education regarding their rights and responsibilities, the effectiveness of child support enforcement, the effect of reduced exemptions, time limits and increased sanctions, the coordination with Medicaid managed care and health care reform measures and the fiscal impact of these program changes.

Sec. 4. Subsection (g) of section 17b-30 of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2003):

(g) The Commissioner of Social Services shall report to the joint standing committee of the General Assembly having cognizance of matters relating to human services, in accordance with the provisions of section 11-4a, on or before January 1, 1997, and annually thereafter, through January 1, 2004, the following information: (1) The number of recipients participating in said system; (2) the number of recipients whose benefits have been discontinued due to their failure to participate in said system; (3) the cost of implementation and operation of said system; (4) the amount of savings attributed to the establishment and operation of said system; and (5) the compatibility of said system with biometric systems being utilized in surrounding states. The commissioner shall issue a final report on the implementation of a biometric identifier system not later than January 1, 2004.

Sec. 5. Section 17b-112 of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2003):

(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.

(b) The Commissioner of Social Services shall exempt a family from such time-limited benefits for circumstances including, but not limited to: (1) A family with a needy caretaker relative who is incapacitated or of an advanced age, as defined by the commissioner, if there is no other nonexempt caretaker relative in the household; (2) a family with a needy caretaker relative who is needed in the home because of the incapacity of another member of the household, if there is no other nonexempt caretaker relative in the household; (3) a family with a caretaker relative who is not legally responsible for the dependent children in the household if such relative's needs are not considered in calculating the amount of the benefit and there is no other nonexempt caretaker relative in the household; (4) a family with a caretaker relative caring for a child who is under one year of age and who was born not more than ten months after the family's enrollment if there is no other nonexempt caretaker relative in the household; (5) a family with a pregnant or postpartum caretaker relative if a physician has indicated that such relative is unable to work and there is no other nonexempt caretaker relative in the household; (6) a family with a caretaker relative determined by the commissioner to be unemployable and there is no other nonexempt caretaker relative in the household; and (7) minor parents attending and satisfactorily completing high school or high school equivalency programs.

(c) A family who is subject to time-limited benefits may petition the Commissioner of Social Services for six-month extensions of such benefits. The commissioner shall grant not more than three extensions to such family who has made a good faith effort to comply with the requirements of the program and despite such effort has a total family income at a level below the payment standard, or has encountered circumstances preventing employment including, but not limited to: (1) Domestic violence or physical harm to such family's children; or (2) other circumstances beyond such family's control. The commissioner shall disregard ninety dollars of earned income in determining applicable family income. The commissioner may grant a fourth or a subsequent six-month extension if each adult in the family meets one or more of the following criteria: (A) The adult is precluded from engaging in employment activities due to domestic violence or another reason beyond the adult's control; (B) the adult has two or more substantiated barriers to employment including, but not limited to, the lack of available child care, substance abuse or addiction, severe mental or physical health problems, one or more severe learning disabilities, domestic violence or a child who has a serious physical or behavioral health problem; (C) the adult is working thirty-five or more hours per week, is earning at least the minimum wage and continues to earn less than the family's temporary family assistance payment standard; or (D) the adult is employed and works less than thirty-five hours per week due to (i) a documented medical impairment that limits the adult's hours of employment, provided the adult works the maximum number of hours that the medical condition permits, or (ii) the need to care for a disabled member of the adult's household, provided the adult works the maximum number of hours the adult's caregiving responsibilities permit. Families receiving temporary family assistance shall be notified by the department of the right to petition for such extensions. Notwithstanding the provisions of this section, the commissioner shall not provide benefits under the state's temporary family assistance program to a family that is subject to the twenty-one month benefit limit and has received benefits beginning on or after October 1, 1996, if such benefits result in that family's receiving more than sixty months of time-limited benefits unless that family experiences domestic violence, as defined in Section 402(a)(7)(B), P. L. 104-193. For the purpose of calculating said sixty-month limit: (I) A month shall count toward the limit if the family receives assistance for any day of the month, and (II) a month in which a family receives temporary family assistance benefits that are issued from a jurisdiction other than Connecticut shall count toward the limit.

(d) Medicaid eligibility shall be extended for two years to a family who becomes ineligible for cash assistance while employed or a family with an adult who, within six months of becoming ineligible, becomes employed.

(e) Under said program (1) no family shall be eligible that has total gross earnings exceeding the federal poverty level, however, in the calculation of the benefit amount for eligible families and previously eligible families that become ineligible temporarily because of receipt of workers' compensation benefits by a family member who subsequently returns to work immediately after the period of receipt of such benefits, earned income shall be disregarded up to the federal poverty level; (2) the increase in benefits to a family in which an infant is born after the initial ten months of participation in the program shall be limited to an amount equal to fifty per cent of the average incremental difference between the amounts paid per each family size; and (3) a disqualification penalty shall be established for failure to cooperate with the biometric identifier system. Except when determining eligibility for a six-month extension of benefits pursuant to subsection (c) of this section, the commissioner shall disregard the first fifty dollars per month of income attributable to child support that a family receives in determining eligibility and benefit levels for temporary family assistance.

(f) A family receiving assistance under said program shall cooperate with child support enforcement, under title IV-D of the Social Security Act. A family shall be ineligible for benefits for failure to cooperate with child support enforcement.

(g) A family leaving assistance at the end of (1) said twenty-one-month time limit, including a family with income above the payment standard, or (2) the sixty-month limit shall have an interview for the purpose of being informed of services that may continue to be available to such family, including employment services available through the Labor Department. Said interview shall contain a determination of benefits available to said family provided by the Department of Social Services. Said interview shall also include a determination of whether such family is eligible for food stamps or Medicaid. Information and referrals shall be made to such a family for services and benefits including, but not limited to, the earned income tax credit, rental subsidies emergency housing, employment services and energy assistance.

(h) An applicant or recipient of temporary family assistance who is adversely affected by a decision of the Commissioner of Social Services may request and shall be provided a hearing in accordance with section 17b-60.

(i) The commissioner may continue to operate under all or portions of the federal waivers granted under Section 1115 of the Social Security Act for the demonstration entitled "Reach For Jobs First". Notwithstanding continuation of the provisions of said federal waivers, the commissioner shall continue the evaluation of the effectiveness of the temporary family assistance program and may continue to utilize a control group using different program requirements.

[(j) The commissioner shall report, annually on or before November fifteenth, to the joint standing committees of the General Assembly having cognizance of matters relating to human services and appropriations and the budgets of state agencies on the funding requirements necessary to support the programs funded by the temporary assistance for needy families block grant. ]

[(k)] (j) The Commissioner of Social Services shall implement policies and procedures necessary for the purposes of this section while in the process of adopting such policies and procedures in regulation form, provided the commissioner prints notice of intention to adopt the regulations in the Connecticut Law Journal within twenty days of implementing such policies and procedures. Final regulations shall be submitted to the legislative regulation review committee no later than November 15, 1997. Policies and procedures implemented pursuant to this subsection shall be valid until the time final regulations are effective.

Sec. 6. Subsection (n) of section 17b-179 of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2003):

(n) Each year, on or before [January] April first, the IV-D agency, in accordance with section 11-4a, shall submit to the joint standing committees of the General Assembly having cognizance of matters relating to judiciary and human services [a] an assessment report on the [execution] administration and performance of the child support enforcement program [, including the status of compliance with established performance standards,] during the preceding federal fiscal year.

Sec. 7. Section 17b-261 of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2003):

(a) Medical assistance shall be provided for any otherwise eligible person whose income, including any available support from legally liable relatives and the income of the person's spouse or dependent child, is not more than one hundred forty-three per cent, pending approval of a federal waiver applied for pursuant to subsection (d) of this section, of the benefit amount paid to a person with no income under the temporary family assistance program in the appropriate region of residence and if such person is an institutionalized individual as defined in Section 1917(c) of the Social Security Act, 42 USC 1396p(c), and has not made an assignment or transfer or other disposition of property for less than fair market value for the purpose of establishing eligibility for benefits or assistance under this section. Any such disposition shall be treated in accordance with Section 1917(c) of the Social Security Act, 42 USC 1396p(c). Any disposition of property made on behalf of an applicant or recipient or the spouse of an applicant or recipient by a guardian, conservator, person authorized to make such disposition pursuant to a power of attorney or other person so authorized by law shall be attributed to such applicant, recipient or spouse. A disposition of property ordered by a court shall be evaluated in accordance with the standards applied to any other such disposition for the purpose of determining eligibility. The commissioner shall establish the standards for eligibility for medical assistance at one hundred forty-three per cent of the benefit amount paid to a family unit of equal size with no income under the temporary family assistance program in the appropriate region of residence, pending federal approval, except that the medical assistance program shall provide coverage to persons under the age of nineteen up to one hundred eighty-five per cent of the federal poverty level without an asset limit. On and after January 1, 2001, said medical assistance program shall also provide coverage to persons under the age of nineteen and their parents and needy caretaker relatives who qualify for coverage under Section 1931 of the Social Security Act with family income up to one hundred fifty per cent of the federal poverty level without an asset limit, upon the request of such a person or upon a redetermination of eligibility. Such levels shall be based on the regional differences in such benefit amount, if applicable, unless such levels based on regional differences are not in conformance with federal law. Any income in excess of the applicable amounts shall be applied as may be required by said federal law, and assistance shall be granted for the balance of the cost of authorized medical assistance. All contracts entered into on and after July 1, 1997, pursuant to this section shall include provisions for collaboration of managed care organizations with the Healthy Families Connecticut Program established pursuant to section 17a-56. The Commissioner of Social Services shall provide applicants for assistance under this section, at the time of application, with a written statement advising them of the effect of an assignment or transfer or other disposition of property on eligibility for benefits or assistance.

(b) For the purposes of the Medicaid program, the Commissioner of Social Services shall consider parental income and resources as available to a child under eighteen years of age who is living with his or her parents and is blind or disabled for purposes of the Medicaid program, or to any other child under twenty-one years of age who is living with his or her parents.

(c) For the purposes of determining eligibility for the Medicaid program, an available asset is one that is actually available to the applicant or one that the applicant has the legal right, authority or power to obtain or to have applied for the applicant's general or medical support. If the terms of a trust provide for the support of an applicant, the refusal of a trustee to make a distribution from the trust does not render the trust an unavailable asset. Notwithstanding the provisions of this subsection, the availability of funds in a trust or similar instrument funded in whole or in part by the applicant or the applicant's spouse shall be determined pursuant to the Omnibus Budget Reconciliation Act of 1993, 42 USC 1396p. The provisions of this subsection shall not apply to special needs trust, as defined in 42 USC 1396p(d)(4)(A).

(d) The transfer of an asset in exchange for other valuable consideration shall be allowable to the extent the value of the other valuable consideration is equal to or greater than the value of the asset transferred.

[(e) On or before January 15, 1994, and annually thereafter, the Department of Social Services shall submit a report to the General Assembly in accordance with section 11-4a which sets forth the following: The number of children receiving Medicaid services; the number of children receiving medical treatment at any state or municipal health care facility; the number of doctors and dentists participating in state or municipally-funded programs; and the percentage of children treated in medical programs whose family income is less than one hundred thirty-three per cent of the federal poverty level and the number whose family income is greater than one hundred thirty-three per cent but not more than one hundred eighty-five per cent of the federal poverty level. On and after October 1, 1996, the report shall be submitted to the joint standing committee of the General Assembly having cognizance of matters relating to human services and, upon request, to any member of the General Assembly. A summary of the report shall be submitted to each member of the General Assembly if the summary is two pages or less and a notification of the report shall be submitted to each member if the summary is more than two pages. Submission shall be by mailing the report, summary or notification to the legislative address of each member of the committee or the General Assembly, as applicable. ]

[(f)] (e) The Commissioner of Social Services shall seek a waiver from federal law to permit federal financial participation for Medicaid expenditures for families with incomes of one hundred forty-three per cent of the temporary family assistance program payment standard.

Sec. 8. Section 17b-279 of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2003):

The Commissioner of Social Services shall verify the propriety and reasonableness of payments to providers for drugs provided to Medicaid recipients through field audit examinations and other reasonable means to the extent possible within available appropriations. The commissioner shall document financial and utilization statistics as to drugs provided to Medicaid recipients by therapeutic category and shall outline problems encountered in the administration of prescription drug utilization in the Medicaid program, suggested solutions and any recommendations for improvement. [The commissioner shall submit a report, on or before February 15, 1990, and annually thereafter, documenting the results of the verification process, the financial and utilization statistics, the problems encountered, suggested solutions and recommendations to the joint standing committee of the General Assembly having cognizance of matters relating to human services and appropriations. ]

Sec. 9. Subsection (a) of section 17b-341 of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2003):

(a) The Commissioner of Social Services shall determine annually, after a public hearing, the rates to be charged to self-pay patients in any of the following licensed facilities if the facility does not have a provider agreement with the state to provide services to recipients of benefits obtained through Title XIX of the Social Security Amendments of 1965, except a facility that did not have a provider agreement in effect as of January 1, 1991, or had entered into a limited provider agreement before January 1, 1991: Chronic and convalescent nursing homes, chronic disease hospitals associated with chronic and convalescent nursing homes and rest homes with nursing supervision. Each such facility that does have such a provider agreement, each such facility that did not have a provider agreement in effect as of January 1, 1991, or had entered into a limited provider agreement before January 1, 1991, and each residential care home shall determine its own self-pay rates. Rates determined pursuant to this section shall be effective July 1, 1991, and on July first of each year thereafter through June 30, 1993, and shall be determined for each facility individually, on the basis of payment for the reasonable costs of providing all services. All self-pay patients shall be given notice of a rate increase at least thirty days prior to the effective date of such rate increase. In determining rates to be charged to self-pay patients the commissioner shall: (1) Consider the quality of care provided by each facility, based on information which the Department of Public Health shall provide to the commissioner, and any testimony or information received from other interested parties; and (2) take into account the relevant cost considerations set forth in section 17b-340 and in the regulations adopted in accordance with subsection (a) of section 17b-238. Such regulations shall include but not be limited to the establishment of a formula for allowing profit or an operating surplus, and a fair rate of return on invested capital or equity. Nothing in this section shall authorize the commissioner to set a rate lower than the rate set under section 17b-340 for comparable services. As used in this section "self-pay patient" means a patient who is not receiving state or municipal assistance to pay for the cost of care. Each facility determining its own self-pay rates shall report such rates to the commissioner upon determination and upon any modification. The commissioner shall document each rate so reported and each rate determined for a facility by the commissioner pursuant to this section. [and shall report all such rates to the joint standing committee of the General Assembly having cognizance of matters relating to human services on or before December 31, 1992. ] Each facility shall charge any self-pay patient who is insured under a long-term care insurance policy which is precertified pursuant to section 38a-475 a rate which is at least five per cent less than the rate charged other self-pay patients.

Sec. 10. Subsection (d) of section 17b-495 of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2003):

(d) The commissioner shall submit [quarterly reports, within thirty days after the end of each fiscal quarter,] biannual reports, in accordance with section 11-4a, to the Governor and the chairpersons of the joint standing committees of the General Assembly having cognizance of matters relating to appropriations and the budgets of state agencies and public health. The report shall include a copy of the most recent report of the fiscal intermediary, if any, and (1) the number of consumers eligible for the program, (2) the number of consumers utilizing the program, (3) an outline of and a report on the educational outreach program, (4) the number of appeals, (5) an outline of problems encountered in the administration of the program and suggested solutions and any recommendations to enhance the program.

Sec. 11. Section 17b-688h of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2003):

(a) The Labor Department and the Department of Social Services shall enter into a memorandum of understanding, to be effective not later than September 1, 1997, for the purpose of enhancing the effectiveness of the delivery of employment services to recipients of temporary assistance for needy families. The memorandum of understanding shall include, but not be limited to, providing for (1) the identification and reduction of duplicative services; (2) the coordination of contracts for employment services; (3) the maximization of federal funds through the JOB Training Partnership Act which may include seeking any necessary federal waiver; and (4) studying the feasibility of integrating services to provide a one-stop process for recipients seeking services.

(b) Effective July 1, 1998, the Labor Department shall be responsible for the negotiation, establishment, modification, extension, suspension or termination of contracts for employment services. The Labor Department may provide administration and services directly or through the Connecticut Employment and Training Commission or regional workforce development boards.

(c) The Labor Department and the Department of Social Services shall establish a pilot program in each of two regions commencing July 1, 1997, for the purpose of providing employment retention services.

[(d) The Labor Department and the Department of Social Services shall report on the implementation of sections 17b-688b, 17b-688c and this section to the joint standing committees of the General Assembly having cognizance of matters relating to labor and human services, the Office of Policy and Management, the Connecticut Employment and Training Commission and the advisory council established pursuant to section 122 of public act 97-2 of the June 18 special session* on or before February 15, 1998. ]

[(e)] (d) Effective July 1, 1997, the Labor Department shall transfer to the Department of Social Services the sum of nine million dollars. Effective December 1, 1997, the Labor Department shall transfer to the Department of Social Services the sum of eight million five hundred thousand dollars. The five million dollars remaining in the budget of the Labor Department designated for employment services for recipients of temporary family assistance shall be used for the computerized interagency information management system to be developed pursuant to section 17b-688c, and for the pilot programs to be established pursuant to subsection (b) of this section, and for administrative costs associated with such computerized system and such pilot programs.

Sec. 12. Section 17b-362a of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2003):

The Commissioner of Social Services shall establish a pharmacy review panel to serve as advisors in the operation of pharmacy benefit programs administered by the Department of Social Services, including the implementation of any cost-saving initiatives undertaken pursuant to section 17b-362 [,] and subsection (e) of section 17b-491. [and section 17b-363. ] The panel shall be appointed by the commissioner to a three-year term and shall be composed of two representatives of independent pharmacies, two representatives of chain pharmacies, two representatives of pharmacies that serve long-term care facilities, two representatives of pharmaceutical manufacturers, one physician specializing in family practice and one physician specializing in internal medicine or geriatrics. The panel shall meet at least quarterly with the commissioner or said commissioner's designee.

Sec. 13. (Effective October 1, 2003) Sections 17b-17, 17b-18, 17b-286 and 17b-363 of the general statutes are repealed.

Approved July 9, 2003