You asked for a description of major senior issues and the current status of bills addressing them in the 2004 General Assembly session.

SUMMARY

Major issues of concern to seniors include the high cost of prescription drugs, changes in the ConnPACE program, effects of the new Medicare prescription drug program on their state prescription benefits, their long-term care community options when they face having to go into a nursing home or need help with activities of daily living in order to stay in their own homes, how to pay for a nursing home and ensure their safety and quality of care there, how to obtain affordable and safe elderly housing, and health care workforce shortages.

Below we provide more detail on these issues and brief summaries of related bills that have received approval from at least one committee. As it is still early in the session, most of the bills have not been passed by the legislature yet.

The only major bills related to senior issues that have passed both chambers so far are changes needed to wrap ConnPACE benefits around the new Medicare drug discount cards (HB 5041) and changes in the conditions under which nursing homes facing bankruptcy or receivership can receive higher interim rates (HB 5004). The financial effects of repealing the ConnPACE estate recovery and the asset limits have

recently been included in the budget bill (HB 5033) as approved by the Appropriations Committee on March 25, but specific implementing language was not included.

PRESCRIPTION DRUG ISSUES

ConnPACE

The Connecticut Pharmaceutical Assistance Contract to the Elderly and Disabled (ConnPACE) program helps low-income seniors over age 65 and younger disabled people who are not poor enough for Medicaid pay for prescription drugs. It requires participants to pay a $ 16. 25 per-prescription copayment and a $ 30 annual registration fee. To be eligible, applicants must have no other prescription drug insurance or have exhausted their insurance. Their annual incomes must be less than $ 20,800 if they are single or a combined income under $ 28,100 if married. These income limits are adjusted annually for inflation every January. Legislation passed in 2003 also sets an asset limit of $ 100,000 for single people and $ 125,000 for married couples.

Proposals to Repeal Recent Asset Limits. The Department of Social Services (DSS) has begun implementing the asset limit passed last year as of February 1 2004. Starting on that date, all new and renewal applications must show the applicants’ assets, and people over the limit will be denied participation in ConnPACE. The asset limits do not include all the applicants’ assets. Basically, only liquid assets are counted, while the value of a home and certain other property is excluded. The types of assets counted are the same as under the Connecticut Home Care Program for Elders (PA 03-3, § 58, June 30 Special Session). On February 17, the Aging Committee approved SB 9, which would repeal the asset limits, and sent the bill to the Appropriations Committee. The Appropriations Committee reflected funding changes for repeal of the asset limits in the budget bill it approved and sent to the floor on March 25, but it has not yet approved specific implementing language for this change.

Repeal of Estate Recovery in ConnPACE. The same 2003 legislation required DSS to recover from the estates of deceased beneficiaries any ConnPACE benefits received after July 1, 2003. DSS had planned to go forward with recoveries on January 1, 2004, but in November 2003 the governor announced that the administration would not pursue recoveries and that he would propose legislation in the 2004 session to repeal the estate recovery requirement.

In fact, several bills were introduced in the session to make this change. On February 17, the Human Services Committee approved HB 5192 and sent it to the Appropriations Committee. On that same day, the Aging Committee sent SB 15 to the Appropriations Committee. Both bills would repeal the estate recovery provision. The repeal was also included in “the governor’s bill,” HB 5041, § 6, but the Human Services Committee eliminated that provision and a number of others before sending the bill to the Appropriations Committee on March 4.

The Appropriations Committee reflected funding changes for repeal of ConnPACE estate recovery in the budget bill it approved and sent to the floor on March 25, but it has not yet approved specific implementing language for this change.

ConnPACE Copayments. SB 295, reported by the Program Review Committee to the floor on March 3, would, among other provisions, lower the copay for generic drugs to $ 10 and apply the $ 16. 25 copay only to brand name drugs. On March 24, the Senate referred the bill to the Public Health Committee

Federal Medicare Prescription Drug Law

A new federal law establishes a voluntary prescription drug benefit for Medicare beneficiaries (seniors age 65 and over and younger disabled people) in two stages: a drug discount card stating in June 2004 followed by a permanent Medicare Part D prescription drug program in January 2006.

Medicare Drug Discount Card. The temporary drug discount card program will run from June 2004 to January 2006. The discount card may save enrollees between 10% and 25% on their drug costs and will give limited federal assistance of up to $ 600 annually to certain low-income people.

The Human Services Committee on March 4 sent sHB 5041 to the Appropriations Committee, which sent a substitute bill, with minor changes, to the floor on March 16. Subsequently, the House and Senate both passed the bill on March 24 and sent it to the governor, who has as of this date not yet signed it.

sHB 5041 would address the initial phase of the federal legislation by in effect wrapping ConnPACE benefits around the federally approved discount cards. It would allow people who sign up for Medicare discount cards to still be eligible for ConnPACE. It would require pharmacies to make reasonable efforts to determine whether a client is entitled to the $ 600 annual subsidy under the discount card as they must for other types of insurance. While the bill would require the ConnPACE participant to pay the required discount card copays, it would guarantee that the individual would not pay more than the $ 16. 25 required ConnPACE copay amount.

The bill would require an otherwise ConnPACE-eligible resident who is a Medicare beneficiary and has income at or below 135% of the federal poverty level ($ 12,569 for one person and $ 16,862 for two in 2004) to obtain a Medicare discount card approved by the social services commissioner for use in conjunction with ConnPACE as a condition of eligibility for ConnPACE. This is the group that is eligible for the $ 600 annual subsidy. The bill also allows the commissioner, at her discretion, to require the same of people with incomes above that amount if the commissioner determines obtaining the card is cost-effective to the state. In that event, the commissioner may pay for the annual discount card enrollment fees (projected to be $ 35 per person).

Medicare Part D Prescription Drug Program. The permanent program starting in January 2006 allows Medicare beneficiaries to enroll in private, federally subsidized prescription-only plans. (People in a Medicare HMO that covers drugs must receive their new coverage through the HMO. ) The plans must offer at least a standard package with specified premiums, copays, annual deductibles, and coverage thresholds. Under the standard package, there will be no coverage for costs between $ 2,250 and $ 5,100 but there will be “catastrophic coverage” of 95% of costs above $ 5,100. However, the permanent program will give varying levels of extra federal help to enrollees with low incomes and assets and those eligible for both Medicare and Medicaid.

The federal changes will have significant long-term budgetary and program implications for Connecticut. They could bring considerable savings but also some potential extra expenditures depending on how they are implemented, according to the Office of Fiscal Analysis. So far, no bills have been proposed in the General Assembly to address this second phase for 2006, but planning is underway at both state and federal levels. A joint OLR-OFA report on the new federal law and some of the issues it raises is available on the OFA website at http: //www. cga. state. ct. us/ofa/documents/Misc/2004/FederalMedicareReport. pdf

Importation of Canadian Drugs for ConnPACE. A number of states and towns throughout the country are looking at buying cheaper prescription drugs from Canada. Although there is controversy about the legality and safety of such a strategy, proposals have been made in Connecticut’s legislature to take this approach. sSB 8 would require DSS to establish a procedure by regulation so eligible ConnPACE participants can obtain their prescription drugs from Canadian pharmacies and not pay the $ 16. 25 per-prescription copay. It requires the procedure to ensure that:

The Aging Committee approved sSB 8 on February 17 and sent it to the Human Services Committee, which approved it on March 4 and sent it to the Appropriations Committee.

90-day Maintenance Drug Supply for ConnPACE. sSB 13, which the Aging Committee approved and sent to the Appropriations Committee on February 17, would require the DSS commissioner, starting July 1, 2004, to allow any eligible ConnPACE participant to obtain a 90-day supply of a maintenance drug if the doctor authorizes it and the person has previously obtained an initial supply of the drug.

Current law requires the commissioner to adopt regulations that include limits on the maximum quantity per prescription, which cannot exceed a 30-day supply or 120 dosage units, whichever is greater. The bill alternatively would allow a 90-day supply for a maintenance drug and would require DSS regulations to set a maximum of 90 days or 120 units, whichever is greater, for maintenance drug refills.

ConnPACE Replacement Prescriptions. sHB 5008 would allow ConnPACE participants to obtain replacements for lost or stolen prescriptions. In order for ConnPACE to pay for the prescription, the person would have to sign a statement on a form prescribed by the commissioner to the effect that the drug is lost or was stolen or destroyed and he has made a good faith effort to recover it. The bill would limit replacements to twice-a-year and impose penalties for misrepresentations in connection with the replacements. It would exempt replacement prescriptions from the $ 16. 25 copay requirement.

The Aging Committee approved the bill on February 17 and sent it to Human Services, which sent it to Appropriations on March 4.

Medicaid Co-pays

Last year, legislation imposed copays under Medicaid of $ 1. 50 for prescriptions and a maximum of $ 3 for outpatient medical services. (DSS subsequently decided to set the outpatient copay at only $ 2). Medicaid is a state-federal program that provides medical assistance to the very poor aged, blind, and disabled, families on welfare, and children in low-income families (PA 03-1, September 8 Special Session, § 11, effective upon passage).

A number of bills this session propose to rescind the Medicaid copays, which affect seniors poor enough to be on Medicaid. The Human Services Committee approved sSB 457, which would rescind the copays, among other provisions, and sent it to the Appropriations Committee. HB 5033, the budget bill, as approved by the Appropriations Committee on March 25, contains funding that reflects repeal of these copays, but no implementing language has passed so far.

Preferred Drug List

Two bills would make changes in the preferred drug list (PDL), which current law requires DSS to develop in consultation with the Medicaid Pharmaceutical and Therapeutics Committee. SB 295, reported by Program Review to the floor on March 3 (File 82) and referred on March 24 to the Public Health Committee, would require the Department of Social Services (DSS) to make several changes related to the PDL. DSS would have to (1) expand the already required but not yet developed three-drug-class PDL to include all eligible classes of drugs and apply the expanded list to all DSS-administered pharmacy assistance programs in FY 2004-05, (2) make monthly reports to legislative committees until the three-drug class list is adopted, and (3) contract with a pharmacy benefits organization or other entity to negotiate for supplemental prescription rebates once the drug list is established.

sSB 352, approved by the Public Health Committee and sent to the floor on March 16 also would expand the PDL and exempt drugs that people have been using for treatment of a chronic illness before the list is implemented from the law’s requirement that prior authorization (with certain exceptions) will be needed for drugs not on the PDL.

LONG-TERM CARE ISSUES

The Long-Term Care Planning Committee, advised by the Long-Term Care Advisory Council, recently completed its three-year Long-Term Care Plan, which makes numerous recommendations to shift the focus of long-term care from institutions to home and the community and create needed infrastructure. It also recommends balancing public and private resources to meet rising demand over the next two decades. It contains an overall goal of offering people the services and supports they choose in the least restrictive setting. Other recommendations include more support for formal and informal caregivers; expanding personal care assistance and respite programs; and proposals related to Medicaid waivers, workforce shortages, housing, and transportation issues. While the plan does not set priorities, it highlights two legislative recommendations: (1) consider creating in statute a broad philosophical statement that individuals should receive care in the least restrictive setting and (2) allocate adequate resources for a required, but not funded, Connecticut-specific comprehensive long-term care needs assessment.

sHB 5462, approved as a substitute by the Human Services Committee and sent to Appropriations on March 16, is derived from the work of the Planning Committee and Advisory Council. Among other provisions, it would require that the state’s long-term care plan and policy give people with long-term care needs the option to choose and receive this care and support in the least restrictive setting and expands the elderly personal care assistant pilot. The original bill contained $ 100,000 in funding for the comprehensive needs assessment, but the substitute approved in the Human Services Committee removed that provision.

Personal Care Assistants

The Connecticut Home Care Program for Elders (CHCPE) provides care at home to seniors who would otherwise be at risk of going to a nursing home and meet certain financial requirements. Most of this care is provided by home health care agencies. But for several years, the state has run a small state-funded pilot program for seniors who (1) have previously been in the Medicaid Personal Care Assistance Waiver for the Disabled but are no longer eligible for that program because they turned age 65 or (2) cannot otherwise find appropriate health care. Under the pilot, which follows the same rules as the disabled Medicaid waiver, the client functions as the employer and chooses and hires his own personal care assistant (PCA) to provide help with the activities of daily living, negotiates the terms of employment, and trains the employee specifically to meet his own needs. The state provides a fiscal intermediary to handle the payroll functions.

The Aging Committee approved sHB 5007 on March 2 and sent it to the Human Services Committee, which sent it to the Appropriations Committee on March 11. The bill would make personal care assistance a regular service offered by CHCPE starting June 1, 2005 and specify that a family member other than a spouse can be a PCA, which is consistent with Medicaid rules. It further would require the DSS commissioner, when renewing the federal Medicaid waiver for the home care program by June 1, 2005 (when the waiver renewal is due), to include personal care assistance as one of the services in the renewal application. The bill would move the people currently in the purely state-funded elderly PCA pilot to the regular home care program where they can be served with state or federal Medicaid funds depending on their qualifications.

In addition, HB 5462, described above, would expand the elderly PCA pilot program from a maximum of 50 participants to 100.

Conservators’ Placement of Wards in Least Restrictive Setting

sSB 3, approved by the Aging Committee on March 2 and the Judiciary Committee on March 22, would impose more specific responsibilities on the conservator of a person to consider community placement instead of institutionalization in a nursing home if the ward’s physical, mental, and psychosocial needs can be met in a less restrictive and more integrated setting.

If the conservator determines it is necessary to place the ward in a long-term care institution, he would have to file a report with the probate court before the placement, stating the basis for his determination, what community resources have been investigated, and the reasons why the person’s needs cannot be met in a less restrictive and more integrated environment. The bill would provide notice and opportunities for a court hearing. If the court decided that the ward’s physical, mental, and psychosocial needs can be met in a less restrictive and more integrated setting within the limits of his available resources, either through his own estate or through public assistance, the bill would require the court to order that the ward be placed in such a setting.

Nursing Homes

Nursing Home Staffing Requirements. The Aging Committee approved sSB 318 on March 2 and sent it to Human Services, which sent it to the floor on March 18. The substitute bill would phase in higher minimum direct care staffing standards over three years starting October 1, 2005. It also would subject nursing homes to loss of license if they do not have enough direct care staff to provide continuous 24-hour direct care services to meet each resident’s needs. It would require homes to report deficiencies in staffing quarterly to the Department of Public Health (DPH). It would allow the DPH commissioner to take certain enforcement actions against homes that fail to submit the reports or have a pattern of noncompliance with the minimum standards.

Under the bill, required staff-to-patient ratios would be as follows:

Criminal Background Checks. SB 14, which the Aging Committee approved and sent to the Public Health Committee on February 17 would require nursing homes to do state and federal background checks on all direct care staff and volunteers.

Nursing Home Pre-Screening. The General Assembly has for several years considered bills to enhance screening of nursing home patients for high risk behaviors before admission. This session, the Aging Committee approved sHB 5004 and sent it to the Public Health Committee, which reported it to the floor on March 2 (File 33). The bill would have created a task force to study the issue and require a report by January 1, 2005. The task force would have had to recommend policies and procedures for evaluating individuals who (1) may pose a serious risk to others in the absence of specific measures for their supervision and (2) reside in, or seek admission to, a nursing home. Subsequently, the House amended the bill by replacing the task force language with unrelated provisions concerning interim rates for nursing homes facing bankruptcy or receivership. Both chambers passed the amended bill on March 24 and sent it to the governor. Although the task force was not included in the final bill as passed, the concept could potentially surface again as an amendment to other bills.

Medication Technician Pilot. The Public Health Committee on March 4 approved HB 5406, which would create a medication technician pilot program in up to 30 nursing homes and sent it to the floor (File 158).

Respite Care

The Connecticut Statewide Respite Care Program gives families who care for relatives with Alzheimer’s or related disorders at home an occasional break by paying for up to $ 3,500 of respite services per year. The program is run by DSS in partnership with the Area Agencies on Aging. Patients are eligible for this program if they have annual incomes of no more than $ 30,000, assets of no more than $ 80,000, and are not receiving or eligible for Medicaid. Participants can receive the respite care in their home, at an adult day care center, or other out-of-home service (such services other than adult day care are limited to 30 days annually). There is no age requirement for eligibility, but these diseases affect more seniors than non-elderly people.

HB 5388, which the Human Services Committee approved and sent to the Appropriations Committee on March 4, would increase the $ 30,000 annual income limit to $ 35,000 and index it annually to inflation.

Another bill, HB 5391, which the Human Services Committee approved and sent to the Appropriations Committee on March 4, would establish a Lifespan Respite Commission to study how the state can improve respite care for people of all ages and regardless of diagnosis, issue a lifespan respite plan for the state, and make recommendations for needed legislation.

Withdrawal of Transfer of Assets Waiver Request and Legislative Oversight of Waiver Applications

In 2002, the state submitted a request for a Medicaid waiver of certain transfer of asset rules to the federal government. If approved, the pending waiver would change the start date of penalties for people who make inappropriate asset transfers before applying for Medicaid to pay their nursing home costs. The penalty (ineligibility for Medicaid payments for a period of time based on the amount of nursing home services the transferred assets would buy) would begin on the date the person otherwise would have become eligible for Medicaid instead of on the date the transfers occurred, as currently happens. The waiver would also change the look-back period from three years to five years for real estate transfers and exempt small amounts of transfers from the look-back and penalties.

SB 163, approved by the Human Services Committee on February 17 and sent to the Appropriations Committee, would require the DSS commissioner to withdraw the state’s application to the federal government for this waiver. In addition, on February 17 the Human Services Committee approved HB 5193, which would strengthen legislative oversight and approval procedures for all Medicaid waiver applications, and sent it the floor (File 15). On March 3, the House sent it to the Appropriations Committee.

Tax Deductions for Long-Term Care Expenses. Two bills would give people a state income tax exemption for their long-term care insurance premiums (sSB 16) and for the profit on stocks and bonds they have to sell to finance nursing home care or home care (sSB 17). The Aging Committee approved both bills on February 17 and sent them to the Finance, Revenue and Bonding Committee.

WORKFORCE SHORTAGES IN HEALTH CARE

The Higher Education and Employment Advancement Committee on March 9 approved the following bills and sent them to other committees.

sSB 515 went to Public Health, which sent it to the floor on March 18. It would establish a Connecticut nursing faculty incentive program administered by the Office of Workforce Competitiveness. That program, within available appropriations, would provide grants to colleges and universities that work collaboratively with hospitals to (1) establish or expand nursing education programs for registered nurses, or (2) encourage people employed by hospitals or in other industries who are qualified to teach nursing students to serve as full-time or part-time faculty members at these schools. The bill would require the Office, by January 1, 2006, to submit a status report on the incentive program to legislative committees. It also would require the Department of Higher Education to (1) assess the current and future capacity of the state system of higher education to educate and train baccalaureate nursing students or those who want to become licensed practical or registered nurses and (2) submit a report on the assessment’s results to legislative committees by January 5, 2005.

SB 519 went to Public Health, which approved and sent it to the floor on March 18. The bill would establish a Connecticut Allied Health Workforce Policy Board to coordinate with the Connecticut Career Advisory Committee to address the shortage of allied health professionals. The policy board would monitor data and trends in the allied health workforce, including the state’s current and future supply and demand for allied health professionals and the state system of higher education’s capacity to educate and train students in those professions. The bill would also require the board to (1) develop recommendations for the formation and promotion of an economic cluster for allied health professions; (2) identify recruitment and retention strategies for state colleges and universities with allied health programs; (3) develop recommendations for promoting diversity in the allied health workforce and for enhancing the attractiveness of allied health professions; (4) develop recommendations regarding financial and other assistance for students enrolled in or considering enrolling in allied health programs offered at public colleges and universities; (5) identify recruitment and retention strategies for allied health employers; (6) develop recommendations about recruiting and utilizing retired nursing faculty members to teach or train students to become licensed practical or registered nurses; and (7) examine nursing programs at public colleges and universities and develop recommendations about how to streamline the curricula they offer to facilitate timely program completion.

HB 5571 went to Labor, which sent it to the floor on March 16. The bill would (1) establish a Connecticut nursing incentive program, administered by the Department of Higher Education, to provide financial assistance to four community-technical colleges that enter into partnerships with hospitals or other health care institutions to increase the number of faculty qualified to teach students to become registered nurses and (2) require the Office of Workforce Competitiveness to establish a challenge grant program for regional workforce development boards to, among other things, provide training in high growth, workforce shortage areas such as health care.

SENIOR HOUSING ISSUES

A perennial issue concerning senior housing is the extent to which younger disabled people should be allowed to live there. Current law allows them equal access to senior housing with elderly people, but seniors have complained about substance abuse, inappropriate or dangerous behavior, and lifestyle differences. Several proposed bills this session contained provisions to limit the percentage of younger disabled people in elderly housing.

On March 9, the Commerce Committee sent sSB 45 to the floor (File 253). The bill would provide $ 10 million in bonding for supportive housing for people with mental disabilities, which would give them options in addition to elderly housing. SB 47 would have placed a limit on the percentage of disabled people in elderly housing, but was voted down in the committee on March 9.

The Housing Committee approved several bills related to senior housing on March 4 and sent them to the Planning and Development Committee (P & D). HB 5185 would guarantee that all units in elderly housing continue to be available on an equal basis to people with disabilities and prohibits housing authorities from allocating units based on any maximum percentage. P& D took no action on it. HB 5189 would set up a task force to study the laws, regulations and issues surrounding elderly housing and the percentage of elderly versus disabled people living there. sHB 5376 would require collaboration between housing authorities, area agencies on aging, and mental health agencies to provide services to people living in elderly housing. HB 5377 would provide rental assistance certificates for housing in the community with support services for nonelderly disabled people now living in elderly housing or on a waiting list for it. HB 5380 would specify more duties and training for resident services coordinators in elderly housing, particularly in mediation and conflict resolution and in finding needed resources for elderly and disabled people living there. P & D approved HB 5189, HB 5376, and HB 5377 on March 12 and HB 5380 on March 15 and sent them to the floor (no File nos. yet).

MISCELLANEOUS BILLS

Other senior-related bills approved by at least one committee would reestablish the Department on Aging (SB 320), give grandparents and other caretaker relatives appointed by a probate court the same financial assistance as if they were in the Department of Children and Families’ subsidized guardianship program (HB 5003), increase funding for elderly nutrition programs (HB 5005), increase funding for elderly and disabled dial-a-ride programs (HB 5006), clarify the allowed burial plot and funeral-related asset exclusions for eligibility for public assistance programs and require DSS to administer the exclusions uniformly throughout the state (sHB 5364 and HB 5163), require DPH by regulation to establish pain management protocols for nursing homes (SB 319); and enhance disclosures under the patients’ bill of rights in nursing homes (SB 4).

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