You asked for a legislative history of the Long-Term Care Planning Committee and the Long-Term Care Advisory Council and highlights of the most significant legislation that was proposed by them or that furthered their recommendations.

SUMMARY

In 1998, the legislature created the Long-Term Care Planning Committee, composed of executive agency representatives and chairmen and ranking members of several legislative committees, as a result of a recommendation in a 1996 Program Review and Investigations Committee study. To advise the Planning Committee, it also created the Long-Term Care Advisory Council, composed of a mix of two independent state agencies (the Commission on Aging and the Long-Term Care Ombudsman's Office) and various long-term care industry, labor, and elderly interest groups. Over the years, both entities have added members, so that now the Planning Committee has 23 members and the Advisory Council 27.

The Planning Committee's original charge was to create a long-term care (LTC) plan for the elderly and study various elderly-related issues, which was later expanded to include all people with disabilities. The plan had to address the three components of the long-term care system: home and community-based services, supportive housing, and nursing facilities. The committee produced a preliminary plan in 1999 and its first formal plan in 2001. The second plan was produced in January 2004. It is available at the Commission on Aging website at http: //www. cga. ct. gov/coa/longtermcare. htm.

This 2004 plan recommended an overall goal for Connecticut's long-term care system of offering people the services and supports of their choice in the least restrictive setting. Its major recommendations included (1) rebalancing the ratio of institutional care in nursing homes and other facilities to home and community care by providing more resources for such care and lessening the traditional institutional bias of Medicaid, (2) balancing the ratio of public and private financial resources, (3) improving the home- and community-based infrastructure to provide more uniformity in Medicaid waivers and maximum flexibility and choice, (4) providing more support and training for informal and formal caregivers, (5) moving more people out of nursing homes to the community, (6) expanding prescreening for entry to nursing homes and other institutions to assure people know about their community options, and (7) further reducing beds in institutions. The plan contained numerous specific recommendations and “action steps” to further these goals.

The Long-Term Care Planning Committee must now issue a long-term care plan every three years. The next one is due in January 2007. By law, the plan is a guide for state agencies' programs serving people who need long-term care.

The Advisory Council, which collaborates with the Planning Committee on developing the LTC plan, made a number of recommendations over time to the Planning Committee and has also proposed its own bills to the legislature. In 2004, it described what it considered key issues from the plan and made recommendations for legislation to address the infrastructures of the long-term care and home- and community-based care systems, workforce shortages, efforts to reduce long-term care demand, education and access, and funding. This document is also on the Commission on Aging website at: http: //www. cga. ct. gov/coa/PDFs/LTCAdvisoryCouncilPlan04keyissues. pdf.

Several of the Advisory Council's main recommendations from the 2004 document and its 2005 and 2006 legislative priorities documents eventually passed the legislature and have been, or are in the process of being, implemented. These include a policy statement of people's rights to choose to be cared for in the least restrictive setting, creation of a comprehensive long-term care website, funding for a comprehensive long-term care needs assessment, transportation for seniors and people with disabilities, expansion of various home care and personal care assistance programs, support for family caregivers, and legislative approval of a lawsuit settlement agreement to reduce the Department of Mental Retardation's (DMR) waiting list for services.

An example of the progress the state has made so far in rebalancing the system is the increase in the proportion of Medicaid LTC clients receiving services in the community from 46% in SFY 2003 to 51% in SFY 2006. One of the 2004 LTC Plan's main recommendations was that by 2025, 75% of Medicaid LTC clients should be receiving services at home or in the community, with only 25% choosing institutional care. To achieve this goal, the Plan recommended a 1% increase each year, which the state has already exceeded over the last three years.

A chronological history of legislation directly affecting the charge and structure of the Planning Committee and Advisory Council, as well as highlights of the most significant legislation derived from their recommendations, or otherwise furthering their goals, follows.

LONG-TERM CARE PLANNING

1998

Long-Term Care Planning Committee. New legislation created an inter-agency Long-Term Care Planning Committee to exchange information on long-term care issues, coordinate policy development, and create a state long-term care plan for the elderly. It required the plan to integrate the three components of a long-term care system (home and community-based services, supportive housing arrangements, and nursing facilities) and to address how changes in one component affect the others. It also required the committee to submit the plan to certain legislative committees every two years beginning January 1, 1999 (later changed to every three years). The initial committee members were the chairmen and ranking members of the legislature's Aging, Human Services, and Public Health committees; the social services commissioner or her designee; and one member each from the Office of Policy and Management, the departments of Social Services, Public Health, Economic and Community Development, and the Office of Health Care Access appointed by their respective agency heads. The act requires committee members to elect their chairman (CGS § 17b-337, PA 98-175, PA 98-239).

Long-Term Care Advisory Council. PA 98-239 also created a Long-Term Care Advisory Council to advise and make recommendations to the Planning Committee. The council consisted of the Commission on Aging director, the state nursing home ombudsman, and representatives of various long-term care industry, labor, and elderly interest groups or in some cases their designees, specifically, the president of the Coalition of Presidents of Resident Councils; the Legal Assistance Resource Center of Connecticut director; one representative of the Connecticut chapter of the American Association of Retired Persons; one representative of a health care employees bargaining unit; and the presidents of the Connecticut Association of Not-for-Profit Providers for the Aging, the Connecticut Association of Health Care Facilities, and the Connecticut Association of Licensed Homes for the Aged (CGS, § 17b-338, PA 98-239).

1999

Home Care Plan Required. Legislation required the Planning Committee to (1) develop a plan to ensure home care availability under the Connecticut Home Care Program for Elders (CHCPE) for seniors who would otherwise qualify for the program except that their income was higher than the established limits, and (2) submit a report on the plan to the Human Services and Aging committees, which the Planning Committee did in February 2000 (PA 99-279, § 39).

Members Added To Planning Committee. PA 99-28 added three new members, one each from the departments of Mental Retardation (DMR), Mental Health and Addiction Services, and Transportation to the Planning Committee (PA 99-28).

2000

Elimination of Home Care Gross Income Test. Based on the Planning Committee's recommendation for the home care plan in February 2000, new legislation made more seniors eligible for the CHCPE by eliminating the program's gross income limit; now, someone can qualify for state-funded home care benefits if he would otherwise qualify for Medicaid in a nursing home. The new law still requires people to contribute toward their care costs and asset limits did not change. But the income cap removal still applies only to the program's state-funded portion because federal approval is still needed for the Medicaid waiver portion (PA 00-2, § 10, June Special Session).

Advisory Council Added Members. New legislation added 10 members (or in some cases their designees) to the Advisory Council, including: the Connecticut Hospital Association president, Connecticut Assisted Living Association executive director, Connecticut Homecare Association executive director, Connecticut Community Care Inc. president, a member of the Connecticut Association of Area Agencies on Aging, Connecticut Alzheimer's Association executive director, a member of the Adult Day Care Association, Connecticut Chapter of the American College of Health Care Administrators president, Connecticut Council for Persons with Disabilities president, and the Connecticut Association of Community Action Agencies president (PA 00-135, § 20).

2001

Planning Committee Change of Mission. PA 01-119 broadened the Planning Committee's scope to include all people in need of long-term care, not just the elderly. The act further required the committee to evaluate long-term care issues in light of the U. S. Supreme Court decision in Olmstead v. L. C. , which required states to place people with disabilities in community settings rather than in institutions when it is appropriate, the individual does not oppose the transfer, and the community placement can be reasonably accommodated.

In addition, the act required:

1. the committee's long-term care plan to serve as a guide for state agencies' programs that serve people in need of long-term care; and

2. any state agency, when developing or modifying any program that, wholly or partially, assists or supports people with long-term care needs to include, to the extent feasible, features that (a) support care-giving by family members and other informal caregivers and (b) promote consumer-directed care.

The act added two new members to the committee: one Department of Children and Families representative and the Office of Protection and Advocacy for Persons with Disabilities executive director or his designee. And it required the committee to issue its long-term care plan every three years instead of every two (PA 01-119).

2002

New Duties for Advisory Council. A new law required the Advisory Council to seek recommendations from people with disabilities or people receiving long-term care services who reflect the state's socioeconomic diversity. It also added eight new members to the 19-member council, for a total of 27. The new members were (1) a personal care attendant appointed by the House speaker; (2) the president of the Family Support Council or his designee; (3) someone caring for a person with a disability in a home setting, appointed by the Senate president pro tempore; (4) three people with disabilities, one each appointed by the House and Senate majority leaders and the House minority leader; (5) a legislator who is a member of the Planning Committee; and (6) a nonunion home health aide appointed by the Senate minority leader. The act also makes some minor and technical changes regarding some of the existing council members (PA 02-100).

Long-Term Care Website. The legislature required the Office of Policy and Management (OPM), within existing budgetary resources, to develop a single, consumer-oriented Internet website that provides comprehensive information on long-term care options in Connecticut. It required that the website include direct links and referral information on long-term care resources, including private and nonprofit organizations offering advice, counseling, and legal services. OPM must consult with the legislature's Aging Committee, the Commission on Aging, and the Advisory Council when developing the site (PA 02-7, § 51, May 9 Special Session). The site was launched in September 2006 and is available at http: //www. ct. gov/longtermcare/site/default. asp.

Comprehensive Needs Assessment. The legislature, on the Advisory Council's recommendation, required OPM to conduct a comprehensive needs assessment of the unmet long-term care needs in the state and project future demand for such services. The assessment must include a review of the DMR's waiting list. The original 1998 legislation had required the Planning Committee to do a needs assessment, but had not provided funding for it. This 2002 legislation also provided no specific funding (SA 02-7). (See 2006 below for related legislation that again moves the responsibility for this assessment and provides funding for it. )

Olmstead Plan. In addition, the Planning Committee, a Community Options Task Force composed of people with disabilities and representatives from the Department of Social Services (DSS), and DSS finished two years of work in March 2002 by publishing Choices Are For Everyone. http: //www. ct. gov/dss/lib/dss/PDFs/CommIntPlan. pdf

This is a plan for how the state can integrate people with disabilities into the community as required by the 1999 federal Olmstead decision instead of placing them in institutions.

2003

In 2003 and subsequent years, the legislature enacted no significant legislation that affected the committee's or council's structure.

However, in 2003 the legislature passed other legislation related to long-term care and health care, most of which furthered the goals of the Planning Committee and Advisory Council.

Sprinklers in Nursing Homes. 2003 legislation required fire sprinklers in nursing homes (PA 03-3, June 30 Special Session).

Transfers from Closed Nursing Homes. Legislation made it easier to transfer from a nursing home that was closing to another one, by allowing such transfers without regard to the order of the new home's waiting list (PA 03-3, June 30 Special Session).

Pilot for Chronic or Geriatric Mental Conditions: Legislation established a pilot project in the Greater Hartford area for chronic or geriatric mental conditions (PA 03-3, June 30 Special Session).

Medicaid Disease Management for High-Cost Clients. Legislation required DSS to design and implement a Medicaid disease management initiative for high-cost Medicaid recipients (PA 03-3, June 30 Special Session – the following year PA 05-209 made the disease management program permissive rather than mandatory and as of 2006 it has not yet been implemented).

Heart Disease and Stroke Prevention. Legislation required the Department of Public Health to create a comprehensive heart disease and stroke prevention plan (SA 03-14).

2004

DMR Funding Increases for Waiting Lists. PA 04-258 and PA 04-216 provided funding to support residential services for 150 people on the DMR waiting list and enhanced DMR family support for another 100 people, consistent with the DMR wait list settlement.

Nursing Facility Transition Project Funding. PA 04-216 provided funding to continue the Nursing Facility Transition Project, whose federal funding ran out in September 2004. The project helps people in nursing homes move to the community.

Personal Care Assistance (PCA) Program. New legislation required DSS to create a state-funded pilot program for up to 100 eligible seniors to receive consumer-directed personal care assistance as an alternative to home care through home health agencies (PA 04-258, funding in PA 04-216).

Home Care Funding Increase. The budget contained a $ 2. 1 million funding increase for the Connecticut Home Care Program for Elders to reflect continued growth in enrollment (PA 04-216).

HUD Assisted Living Pilot Increase. For the assisted living pilot in the three federally financed HUD facilities, the budget appropriated $ 50,000 in additional funds to allow for continued enrollment (PA 04-216).

Private Assisted Living Pilot. For the private assisted living pilot, the legislature combined the 50-person limit on the Medicaid portion and the 25 person limit on the state-funded portion to allow continued enrollment and reduce the likelihood that residents will be turned away from the program.   The program helps pay for assisted living services (but not room and board) for people living in private assisted living facilities who have used up their own financial resources (PA 04-258).

Long-Term Care Workforce Initiatives. The legislature passed several acts aimed at increasing the long-term care workforce in 2004. PA 04-253 established a Connecticut Nursing Incentive Program and required the Office of Workforce Competitiveness to establish a challenge grant program to train low wage, low-skill workers in high growth, workforce shortage areas such as health care. PA 04-220 established a 16-member Connecticut Allied Health Workforce Policy Board, and PA 04-2 provided funds for regional job-training academies that emphasize nursing and health care professions. PA 04-196 established a Connecticut nursing faculty incentive program.

2005

Long-Term Care Policy Statement Law. 2005 legislation, first proposed by the Advisory Council in 2004, required the Long-Term Care Planning Committee's plan and policy to provide that people who need long-term care can choose to receive it in the least restrictive, appropriate setting. This is consistent with the 1999 U. S. Supreme Court Olmstead decision that ruled states cannot discriminate against people with disabilities by offering them long-term care services only in institutions when they could be served in the community, given state resources and other citizens' long-term care needs (PA 05-14).

Conservators' Duties. Another 2005 act required conservators to report to the probate court that appointed them when they determine it is necessary to place a ward in a long-term care institution (a skilled nursing facility or intermediate care facility). The report must state the basis for the conservator's decision, including:

1. what community resources have been considered; and

2. why the ward's physical, mental, and psychosocial needs cannot be met in a less restrictive and more integrated environment.

The act required notice and an opportunity for a hearing within 30 days. If the court decides the ward's needs can be met in a less restrictive and more integrated setting and the ward has sufficient private or public resources, it must order the ward to be placed and maintained in such a setting (PA 05-155).

Temporary Conservators. Another act limited temporary conservators' powers in several ways, particularly their powers to relocate their wards. Under this act, they can place wards in nursing homes when necessary, under generally the same conditions and with the same reporting requirements described above for permanent conservators (PA 05-154).

Commission on Aging Move. Another 2005 act, supported by the Long-Term Care Advisory Council, moved the independent Commission on Aging to the legislative branch for administrative purposes only, added new members, and modified some of the commission's duties (The commission's executive director is co-chairman of the Long-Term Care Advisory Council. ) The commission was previously located in DSS for administrative purposes. The commission advocates for elderly people, conducts public hearings, issues various reports, disseminates information, and makes recommendations on elderly issues. (PA 05-77)

DMR Waiting List Funding. The 2005 budget provided further funding to open up the DMR waiting list (PA 05-251).

DMR Medicaid Waivers. In February 2005 the state received approval for a new Individual and Family Support Medicaid waiver from the federal government, which provides home- and community-based and respite services to families. PA 05-280 required eligible DMR clients to participate in a waiver to continue receiving services. In October 2005, the state also received approval for a Medicaid Comprehensive Support Waiver, which provides residential services and replaced an earlier waiver.

Home Care. 2005 legislation increased asset limits for the state-funded side of the CHCPE program as of April 1, 2007 (PA 05-280).

PCA Pilot Expansion. This act increased, from 100 to 150, the number of seniors who may participate in the state-funded PCA pilot program created in 2004. And it repealed an earlier PCA pilot for seniors either (1) transitioning off the state's Medicaid waiver PCA program for younger adults with disabilities or (2) eligible for CHCPE but unable to access adequate home care services. (The DSS commissioner had administratively expanded that pilot from 50 to 100 people in 2004. ) People in the repealed pilot became part of the new, less restrictive, 150-person pilot.

Under the new pilot, participants still have to be age 65 or older and meet the CHCPE eligibility requirements. But the program is no longer restricted to those aging out of the Medicaid program for younger people with disabilities or otherwise unable to find adequate home care. And family members other than spouses can serve as the PCA (PA 05-209).

Katie Beckett Waiver. The 2005 budget act appropriated enough money to expand the Katie Beckett Waiver slots from 155 to 180. Prior legislation had allowed, but not funded, an expansion up to 200 slots.

DMHAS Supportive Housing Initiative. PA 05-280 required creation of 500 additional supportive housing units as part of the existing Supportive Housing Pilots Initiative.

Funding for Municipal Dial-a-Ride Program. New legislation provided $ 5 million from transportation strategy bonds in both FY 06 and FY 07 to implement the municipal demand responsive (dial-a-ride) matching grant program for those age 60 and over and people with disabilities, which the legislature established in 1999 but never funded. The program allocates matching grants to municipalities based on a formula with two equal factors: the municipality's relative share of the state's elderly population and its size compared to the total area of the state. Municipalities must apply for the grants through a regional planning organization or transit district and must collaborate on service design to determine how to use the funding most effectively. The first such grants were awarded in July 2006 (PA 05-4, JSS).

Seed Money for Elderly Community-Based Regional Transportation. PA 05-280 required DSS, as its budget permits, to provide $ 25,000 grants in FY 06 to up to four towns with populations of at least 25,000 or nonprofit organizations located in them. (See 2006 below for subsequent change in grant amount. ) The grants are seed money for planning and developing financially self-sustaining, community-based regional transportation systems that, through a combination of private donations and user fees, provide rides in passenger cars for seniors who can no longer drive. Before receiving the grant, the town or entity must raise at least $ 25,000 in matching private funds. The town must work cooperatively to develop the system with the regional planning agency to which it belongs. (See 2006 below for subsequent increase in these grants).

2006

LTC Comprehensive Needs Assessment. The legislature transferred the duty to conduct a comprehensive needs assessment of unmet LTC needs and project future demand for such services from the Office of Policy and Management, where 2002 legislation had placed it, to the General Assembly. It required the General Assembly to contract for the assessment after consulting with the Commission on Aging (which is now located in the legislative branch for administrative purposes), the Long-Term Care Advisory Council, and the Long-Term Care Planning Committee. The budget act appropriated money for the assessment. The legislation specified numerous items that the assessment must include, notably projections of people at risk for having unmet LTC needs over the next 30 years, projected costs of meeting these needs, services now available, ways of meeting these future needs, needs of elderly people, and recommendations. (PA 06-188)

Expansion of PCA Programs. PA 06-188 also allowed people participating in the state's Medicaid PCA waiver program for younger people with disabilities to continue after they turned 65 and increased the maximum number of participants from 150 to 250 in the state-funded PCA pilot program for the elderly (age 65 and older).

Home- and Community-Based Services for Younger People with Disabilities. The budget act contained $ 400,000 to begin providing home health care equivalent to the CHCPE (CHCPE serves only people age 65 or older) for younger people with disabilities (specifically multiple sclerosis or AIDS) who need the same services. Previously, these people were eligible for the age 18 to 64 PCA program but not the CHCPE, which provides home health care and other services through home care agencies. (PA 06-186)

Money Follows the Person Pilot Application Authorized. PA 06-188 permits the DSS commissioner to submit an application to the federal government to establish a “Money Follows the Person” demonstration project, as authorized in the federal Deficit Reduction Act of 2005. If the state is selected to participate and DSS elects to do so, the act restricts the project to 100 participants and requires it to include PCA services. The federal demonstration project allows states to compete for grants for projects aimed at (1) increasing home- and community-based, rather than institutional, LTC services; (2) eliminating barriers to the flexible use of Medicaid funds to enable people to receive needed services in the setting they choose; (3) providing service continuity for people moving from an institution to the community; and (4) ensuring and improving service quality.

Adult Day Care Funding. The budget act contained an additional $ 1. 25 million for adult day care centers. (PA 06-186)

Homemaker-Companion Agency Registration. PA 06-187 required homemaker-companion agencies to register annually with the Department of Consumer Protection (DCP). Under the act, these agencies must require new employees hired on or after October 1, 2006 to undergo comprehensive background checks and answer questions in writing about their criminal convictions or certain disciplinary actions against them. They must provide clients with written individualized contracts or service plans that identify the anticipated services' scope, type, frequency, and duration. Agencies that provide such services without registering or make certain misrepresentations face penalties.

Increased Grants for Elderly Community-Based Regional Transportation. PA 06-188 increased the maximum grant authorized by PA 05-280 for the four towns DSS selects to provide community-based regional transportation for the elderly from a one-time $ 25,000 for each in FY 06 to $ 50,000 each during the two-year period covering FY 06 and FY 07. It also permitted DSS to use any grant funds it did not spend in FY 06 during FY 07.

Enhanced Consumer Protections and Training in Special Alzheimer's Units. This act required Alzheimer's special care units or programs to disclose in writing to people who will live in them or to their legal representative or other responsible party information about the unit's philosophy, costs, admission, and discharge procedures; care planning and assessment; staffing; physical environment; residents' activities; and family involvement. Disclosure must begin by January 1, 2007 and be signed by the patient or responsible party. The disclosure must explain what additional care and treatment or specialized program the Alzheimer's unit will provide that is distinct from the care and treatment required by the applicable licensing rules and regulations.

The act requires each special care unit or program to annually provide Alzheimer's- and dementia-specific training to all licensed and registered staff who provide direct patient care in these units or programs. This must include (1) at least eight hours of dementia-specific training, completed within six months after beginning employment, followed by three hours of such training annually and (2) at least two hours a year of training in pain recognition and administration of pain management techniques (PA 06-195).

Autism Spectrum Disorders Pilot. New legislation required DMR, in consultation with DSS and DMHAS, to establish a pilot autism spectrum disorders program for people who do not have mental retardation (PA 06-188).

Medicaid Home Care for Adults with Psychiatric Problems Discharged or Diverted from Nursing Homes. New legislation allowed several state departments jointly to seek either a Medicaid state plan amendment or a Medicaid waiver to implement a Medicaid-financed home- and community-based program for adults with severe and persistent psychiatric disabilities who are discharged or diverted from nursing homes. (PA 06-188)

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