You asked for information on the following elderly issues and the status of bills in the legislature addressing them: Alzheimer’s respite care, long term care tax relief, training of nursing home staff, nursing home placements, workforce shortages, and drug formularies (the preferred drug list).

ALZHEIMER’S 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. There are currently no additional funds for Alzheimer’s respite in the budget

bill in the Appropriations Committee, as currently written. Their appropriation is the same $ 1,120,200 as in the original FY05 budget, according to the Office of Fiscal analysis.

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.

LONG TERM CARE TAX RELIEF

Two bills would give people some tax relief for expenses associated with long-term care.

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

NURSING HOME STAFF

Nursing Home Staff Training

HB 5004, as originally raised in the Aging Committee before it was changed (see below) would have, among other provisions, required the Department of Mental Health and Addiction Services, in consultation with the Department of Public Health, to develop a recommended curriculum guide and continued training syllabus for trained staff. “Trained staff” are those trained in behavioral health care risk and risk management appropriate for a nursing home setting.

The Department of Public Health is developing regulations to set training standards for feeding assistants in nursing homes, who have recently been permitted under federal law. No legislation is currently being considered for this, but there has been legislative discussion about the change.

Nursing Home Staffing Requirements

sSB 318, which the Aging Committee approved on March 2 and Public Health approved and sent to the floor on March 18, 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 PLACEMENT ISSUES

Pre-Screening

The General Assembly has for several years considered bills to enhance screening of nursing home patients for high risk behaviors before admission.

As originally raised in the Aging Committee, HB 5004 was similar to last year’s SB 999, which passed the Senate but not the House.

Federal and state laws require preadmission screening for mental illness or mental retardation for people who are about to enter a nursing home. The screening consists of two levels. Level I, administered by the Department of Social Services (DSS), determines whether the individual has one of these conditions. If he does, he must undergo a Level II screening to determine whether he is appropriate for nursing home admission or needs other specialized services (but people diagnosed with Alzheimer’s or related dementia are exempt from the level II screening). Advanced Behavioral Health performs the Level II screening for people coming from the community or a state mental hospital under contract with the Department of Mental Health and Addiction Services (DMHAS) and sends the nursing home a determination letter approving or disapproving the admission. For a private hospital, hospital staff may do the Level II screening.

Raised bill HB 5004 would have required relevant criteria about a patient’s high-risk behavior to be incorporated into the Level II preadmission screening process. (DMHAS already collects this type of information separately for its own clients entering nursing homes) The bill also would have required a nursing home to have a copy of these results and the determination letter before admitting the patient, as well as to determine in writing whether it has adequate space, programming, and trained staff to meet the patient’s needs before admitting the patient. If in the course of admission, including assessment using the federal Centers for Medicare and Medicaid Services’ Minimum Data Set, or afterward in a subsequent review, the nursing home identifies any problem behavior, the bill would have required it to document in the patient’s care plan that it has the appropriate physical environment, staff, and programs to meet the patient’s individual needs.

But on February 17, the Aging Committee eliminated the raised bill’s original provisions and sent a substitute bill it to the Public Health Committee, which reported it to the floor on March 2 (File 33). The substitute bill would, instead, 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.

The House sent the bill to the Human Services and then the Appropriations Committee, which both approved it without change. Then the House and Senate on March 24 deleted the bill’s provisions and replaced them with changes related to nursing home interim rates, passed the bill as amended and sent it to the governor. Although the prescreening task force was not included, it could surface again as an amendment to other bills.

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.

PREFERRED DRUG LIST

A number of states have instituted various kinds of drug formularies in their state pharmaceutical assistance programs. Connecticut, by law, is currently developing a preferred drug list (PDL) that would require prior authorization for (but not entirely prohibit) drugs that are not on the list, with certain exemptions for mental health drugs.

Two bills would make changes in the 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.

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