PA 07-2, June 2007 Special Session— HB 8002

Emergency Certification

AN ACT IMPLEMENTING THE PROVISIONS OF THE BUDGET CONCERNING HUMAN SERVICES AND PUBLIC HEALTH

SUMMARY: This act makes changes in the laws governing numerous Department of Social Services (DSS) cash and medical assistance programs, including the Medicaid, HUSKY, Temporary Family Assistance (TFA), and State-Administered General Assistance (SAGA) programs. It:

1. increases benefit levels for TFA and SAGA beneficiaries,

2. freezes cost-of-living increases in the State Supplement Program,

3. limits Medicaid eligibility for “medically needy” individuals and food stamp benefits for legal immigrants,

4. adds new services for SAGA medical assistance beneficiaries,

5. permits more people to participate in the “Money Follows the Person” demonstration program, and

6. eliminates a provision in PA 07-185 that expanded the HUSKY B program to children in families with incomes up to 400% of the federal poverty level (FPL).

It requires DSS to:

1. develop a primary care case management program in the HUSKY A program,

2. ask for federal approval to require employed caretakers of children enrolled in HUSKY A to enroll in employer-sponsored insurance if it is available, with DSS subsidizing their costs,

3. pay for certain nonformulary drugs under its Medicare Part D “wrap-around” program, and

4. establish a state-funded home-care pilot program for younger people with disabilities.

The act ties DSS funding for certain child day care centers to their meeting school readiness requirements.

The act establishes the Charter Oak Health Plan, which provides health insurance and state subsidies to certain state residents who have been uninsured for at least six months. It makes numerous changes in the law governing Medicaid third-party liability to conform to federal law. And it requires school districts to ascertain the health insurance status of students and provide information about publicly funded insurance.

The act increases the amount the state may pay for indigent veterans funeral expenses from $150 to $1,800 and permits the Veterans Affairs' Department to create a health data registry for armed forces members who have completed active service.

It (1) creates a timetable and reporting requirements for testing babies and young children for lead poisoning and assessing their risks, (2) lowers the blood level threshold that triggers local health officials investigations into the sources of a child's lead poisoning, and (3) permits remediation, not just abatement or removal, of lead hazards.

It increases rates hospitals and other institutions receive for their services to DSS medical assistance program participants, increases the state's oversight of assisted living facilities, and changes some provisions governing certain providers.

It authorizes $30 million in hardship grants to hospitals and increases funding for local and district health departments. It permits annual reviews of nursing home residents with mental illness to determine if they continue to need nursing home care or should receive mental health services in another setting.

The act amends several provisions of PA 07-185 concerning the extension of health insurance coverage for unmarried children up to age 26, plans for a network intergrating state-held health information and for a statewide electronic health information system, and funding for school-based health centers. It also repeals serveral provisions of that act.

EFFECTIVE DATE: Various, see below

1 — NURSING HOME PROVIDER TAX CHANGE

Beginning January 1, 2008, this act lowers the maximum nursing home provider tax rate from 6% to 5. 5% of a home's net revenue, consistent with a recent change in federal law. It requires the DSS commissioner, when setting the amount of each home's tax, to use a percentage rate determined by the Office of Policy and Management (OPM) secretary.

The tax is calculated every two years by multiplying each home's anticipated non-Medicare net revenue, including estimated revenue from any increases in Medicaid payments, for the 12-month period ending on June 30th of the succeeding calendar year by the provider tax rate. This product is divided by each nursing home's total anticipated non-Medicare resident days during that same 12-month period. Currently, the tax is $15. 90 per resident day for homes with 230 or fewer beds and $12. 20 a day for those with more than 230 beds or owned by municipalities. Under a federal waiver, the state exempts from the tax nursing homes owned by continuing care retirement communities.

EFFECTIVE DATE: July 1, 2007

2 — INCREASE IN CASH WELFARE BENEFITS

Beginning July 1, 2007, the act requires the DSS commissioner annually to increase the payment standards (benefits) in the TFA and SAGA cash assistance programs by the annual percentage increase, if any, in the consumer price index for urban consumers over the average for the previous year. The act caps these cost of living increases at 5%. TFA benefits (currently $543 for a family of three living in most parts of the state) have been frozen for more than 15 years; SAGA cash assistance (currently $200 per month for a single, unemployable person) benefits were reduced significantly in 2003 and have not risen since.

Increasing the TFA benefit effectively raises the income eligibility limits for SAGA medical assistance and the “medically needy” category under Medicaid. The income limit for participants in both is 143% of the TFA benefit.

EFFECTIVE DATE: July 1, 2007

3 — FREEZE IN STATE SUPPLEMENT BENEFITS

For the next two fiscal years, the act freezes the adult payment standard in the State Supplement program, which provides cash assistance to low-income people who qualify for federal Supplemental Security Income (SSI) benefits. DSS uses this standard to calculate the actual State Supplement benefit, which takes into account both the recipient's need and available income. The law continues to require DSS, when calculating available income, to disregard annual increases in State Supplement recipients' SSI benefit.

EFFECTIVE DATE: July 1, 2007

4 — MEDICARE PART D SUPPLEMENTAL NEEDS FUND

The federal Medicare Part D program helps Medicare beneficiaries pay for certain prescription drugs. The state Medicare Part D Supplemental Needs Fund helps ConnPACE and people dually eligible for Medicaid and Medicare pay for medically necessary drugs that are not on a Medicare Part D plan's formulary (i. e. , “nonformulary” drugs). This act specifies that if DSS, in consultation with the prescribing physician, determines that a nonformulary prescription drug is medically necessary, it must cover the cost of the prescription and any prescribed refills, minus any applicable copayment. (The copayment is up to $16. 25 for ConnPACE recipients and nothing for the dually eligible).

The act requires, rather than allows, DSS to require the beneficiary to establish, to the department's satisfaction, that he or she has made a good faith effort to enroll in a Medicare Part D plan that the DSS commissioner recommends and to use that plan's exception process to obtain the nonformulary drug. It deletes the law's requirement that DSS expeditiously review requests for financial assistance and notify the beneficiary within two hours after receiving the request for assistance.

The act requires that expenditures for each fiscal year cannot exceed the amount appropriated in PA 06-186 ($5 million annually). (PA 07-5, June Special Session, eliminates this limitation.

Prior law required the DSS commissioner to contract with an entity specializing in Medicare appeals and reconsideration for the purpose of having it exhaust remedies for pursuing payment from the Part D plans for the denied nonformulary drugs for which DSS has paid. (This requirement was never implemented and DSS performs this function through its own employees. ) The act eliminates the requirement and instead requires the commissioner to implement a plan for pursuing these payments.

EFFECTIVE DATE: July 1, 2007

5 — MONEY FOLLOWS THE PERSON

The act increases the maximum number of participants in the “Money Follows the Person” demonstration program from 100 to 700. DSS has received funding for this demonstration from a new federal grant program that helps states move back into the community people who have been inappropriately institutionalized in a nursing home or other institution for six months or more. The grant is for five years, and the expansion to 700 participants will apparently occur gradually over that period.

EFFECTIVE DATE: July 1, 2007

6 — MEDICAID ASSIGNMENT OF SPOUSAL SUPPORT RIGHTS

The act changes the conditions under which an institutionalized person or someone in need of institutional care who applies for Medicaid can assign his or her right of support from the community spouse's assets to the DSS commissioner.

Prior state law required such assignment if the Medicaid applicant's spouse was unwilling or unable to provide the information needed to determine the applicant's eligibility for Medicaid. Under federal law, such an assignment permits the person requiring care to qualify for Medicaid without being punished for the spouse's non-cooperation.

The act allows, rather than requires, such assignment under certain somewhat different conditions. Specifically, an applicant may assign the right of spousal support to the DSS commissioner only if (1) the applicant's assets do not exceed the Medicaid asset limit and (2) the applicant cannot locate the community spouse or the spouse is unable to provide information about his or her own assets. If the assignment is made or if the applicant is so physically or mentally impaired that he cannot execute the assignment, the act allows the commissioner to seek recovery of any medical assistance DSS pays on the person's behalf up to the amount of the community spouse's assets that exceed the community spouse protected amount (CSPA) as of the first month of Medicaid eligibility. The CSPA is one-half the couple's countable assets but no more than $101,640 in 2007, set annually by federal Medicaid rules.

This change is in response to a federal court case in Connecticut.

EFFECTIVE DATE: July 1, 2007

7 — REPEAL OF COST SHARING IN HUSKY A AND REFERRALS TO HUSKY B

The act repeals the law requiring the DSS commissioner, to the extent permitted by federal law, to impose premiums and co-payments on HUSKY A caretaker relatives with income between 100% and 185% of the FPL. These have never been implemented. HUSKY A provides Medicaid-funded health insurance to children in families with income up to 185% and their caretaker relatives.

The act requires DSS, when it determines a person is ineligible for HUSKY A, to provide a written notice of ineligibility and a statement advising the person of the availability of HUSKY B. Prior law required DSS to provide the information about HUSKY B when a person applied for HUSKY A.

The act also makes it clear that HUSKY A is provided both to children who live with caretaker relatives, who themselves qualify for benefits, as well as others who do not live with a caretaker relative, including those under age 19 who live independently.

EFFECTIVE DATE: July 1, 2007

8 — PREMIUM ASSISTANCE IN HUSKY A

The act requires the DSS commissioner to seek a federal waiver, if one is required, to encourage HUSKY A caretaker relatives to enroll in employer-sponsored health insurance. The waiver must:

1. as a condition for HUSKY A enrollment, require caretaker relatives to enroll themselves and their dependents in employer-sponsored health plans to the maximum extent available, provided DSS determines doing so is cost-effective;

2. require DSS to reimburse caretaker relatives for all payroll deductions their employer takes to pay for health care insurance; and

3. assure HUSKY A coverage for services that the employer's plan does not cover (“wrap-around”).

Regardless of any state law or contract provision between employers and their health insurance carriers, the act provides that no employee who DSS requires to enroll in employer coverage is subject to open enrollment limitations.

The act permits the DSS commissioner to implement policies and procedures needed to administer these provisions while in the process of adopting them in regulation. He must print a notice of intent to adopt the regulations in the Connecticut Law Journal within 20 days of implementing them. The policies and procedures remain valid until the final regulations are adopted.

EFFECTIVE DATE: July 1, 2007

9 — COVERAGE FOR PREGNANT WOMEN

PA 07-185 required DSS to apply for a federal waiver to increase the income limit for HUSKY A coverage for pregnant women from 185% to 250% of the FPL ($2,852 per month for two-person household). It did not specify a date for doing this. This act repeals that provision and instead requires DSS, by September 30, 2007, to either submit an amendment to the Medicaid state plan, or if the federal government requires, seek a waiver, to cover pregnant women with incomes between 185% and 250% of the FPL who do not “otherwise have creditable coverage,” as defined by federal law. (Federal Medicaid funds match the state's payments for the coverage for pregnant women with incomes under 185% of the FPL. ) If the state plan amendment or a waiver is approved, DSS must implement the change by January 1, 2008.

EFFECTIVE DATE: July 1, 2007

10 — CHILDREN'S PREVENTIVE HEALTH SERVICES PLAN

PA 07-185 requires DSS to develop a children's preventive health services system plan. The act (1) requires it to do this within available appropriations; (2) specifies the plan must include ophthalmologic and optometric services, not vision care; (3) removes the requirement that DSS' tracking of the system's use be done electronically; and (4) requires DSS to report to legislative committes by January 1, 2009 on the plan, not its implementation.

EFFECTIVE DATE: July 1, 2007

11-13 — LONG-TERM CARE INSTITUTION RATE INCREASE

For FY 08, the act increases Medicaid reimbursement rates for nursing homes and intermediate care facilities for the mentally retarded (ICF-MRs) by 2. 9% over FY 07 and freezes the rates at FY 08 levels for FY 09. It increases the rates for private residential facilities serving Department of Mental Retardation clients that are not licensed as ICF-MRs by no more than 2% over FY 07 and no more than another 2% over FY 08 for FY 09.

For all these facilities, the act makes an exception to the increases and the freeze for facilities that have interim rates or agreed to a lower rate. Those facilities that would have received a lower rate on the increase's or freeze's effective date because of their interim rate status or agreement will receive that lower rate.

EFFECTIVE DATE: July 1, 2007

14 — SAGA MEDICAL BENEFITS

Prior law prohibited the SAGA medical program from providing any ancillary or specialty services that exceed the services it provided on July 1, 2003. The act makes an exception to this prohibition, allowing nonemergency medical transportation and vision care services to be provided for a limited duration.

The act also allows the DSS commissioner, when it is cost-effective, to provide or require a contractor to provide home health services or skilled nursing facility coverage for SAGA recipients who are being discharged from a chronic disease hospital.

EFFECTIVE DATE: July 1, 2007

15 — STATE-FUNDED CHILD DAY CARE CENTERS

DSS uses a unit cost reimbursement system for paying state-funded child care centers. Beginning January 1, 2008, the act requires any increase in payments to centers to be based on a requirement that they meet the statutory staffing requirements for school readiness programs. The school readiness law defines “staff qualifications” in a way that currently requires school readiness classrooms to include at least one staff person with certain credentials, such as a college degree or coursework, and imposes stricter credentialing requirements in the future (e. g. , bachelor vs. associate degree).

EFFECTIVE DATE: July 1, 2007

16 — PRIMARY CARE CASE MANAGEMENT (PCCM)

The act requires DSS, no later than November 1, 2007, to develop a plan to implement a pilot PCCM program for at least 1,000 people who are otherwise eligible for HUSKY A benefits. Primary care providers participating in the pilot must provide primary medical care services to enrollees and arrange for specialty care as needed. The act defines PCCM as a system of care in which the health care services for program beneficiaries are coordinated by a primary care provider chosen by or assigned to the enrollee. Currently, all HUSKY A beneficiaries are enrolled in managed care organizations that coordinate care, to some extent, and bear the full medical risk.

The commissioner must submit the plan to the Human Services and Appropriations committees, which within 30 day of receiving the plan must hold a public hearing on it and may advise the commissioner of their approval, denial, or any modifications. DSS must begin enrolling people in the pilot by April 1, 2008.

EFFECTIVE DATE: July 1, 2007

17, 44 — REDUCING INCOME LIMIT FOR HUSKY B

PA 07-185 raised the HUSKY B income eligibility limit from 300% to 400%, of FPL (i. e. , from $41,070 to $54,760 for a two-person family) and provided for premium assistance for families with income above 300% of poverty who did not have access to employer-sponsored coverage. It also required DSS to pay two months of HUSKY B premiums to cover all infants born in Connecticut or bordering states to state residents. The act (1) eliminates the income limit increase for HUSKY B coverage and the premium assistance and (2) increases, from two to four months, the period for which DSS must pay premiums for newborns.

It removes a requirement in PA 07-185 that DSS or its servicer redetermine a family's HUSKY eligibility within 10 months of its original eligibility determination. Instead, it requires DSS or the servicer, within available appropriations, to mail or electronically send the family a new application form within that period and use that information to determine whether to continue eligibility after the initial 12 months. The act also removes a requirement that DSS contract with an entity to provide a single point of entry service for HUSKY applicants and enrollees, instead requiring DSS to provide for such a servicer.

EFFECTIVE DATE: July 1, 2007

18-20 — THIRD PARTY LIABILITY AND MEDICAID COVERAGE

Obligation of Insurers to Provide Information

Federal law requires Connecticut, as a condition of receiving federal Medicaid matching funds, to enact laws requiring health insurers to provide certain information to DSS to enable it to determine whether a person submitting a Medicaid claim is covered by another form of insurance.

By law, DSS must exhaust other payment sources before paying for health care services provided to Medicaid recipients, and individuals are expected to disclose when they have other coverage. The act requires health insurers to provide certain information to the DSS commissioner, when requested, regardless of whether they bear any financial risk for a Medicaid recipient's claims. As used in the act, “health insurer” includes a self-insured plan; group health plan, as defined in federal law; service benefit plan; managed care organization; health care center; pharmacy benefit manager (PBM); dental benefit manager, or other party that is by statute, contract, or agreement legally responsible for paying health care claims.

The act requires health insurers to provide the information in a manner and format the commissioner or his designee prescribes, that identifies, determines, or establishes third-party coverage. This includes information necessary to determine during what period a person, or his or her spouse or dependents, is or was covered by a health insurer and the nature of the coverage provided, including the insurance plan's name, address, and identifying number. The insurer must also provide this information to all third-party administrators, PBMs, dental benefit managers, or other entities with which it arranges to adjudicate health care claims.

Prior law required state-licensed insurance companies to conduct automated data matches to identify this coverage if (1) the DSS commissioner requested it and (2) compatible data elements were available. The law required the commissioner to reimburse the companies for the costs of conducting the matches. The act instead requires health insurers, as more broadly defined by the act, to do these matches at the commissioner's request or allow the commissioner or his designee to conduct them.

Insurers' Obligation to Assist DSS as Condition of Operating in State

With respect to individuals eligible for or receiving Medicaid, the act requires health insurers, as a condition of operating in Connecticut, to:

1. provide the DSS commissioner or his designee, all third-party administrators, PBMs, dental benefits managers, and other entities with which the insurer arranges to adjudicate health care claims any information the commissioner or his designee prescribes that is needed to r determine whether there is available coverage and the coverage plan's name, address, and identifying number;

2. accept the state's right of recovery from the insurer and a person's assignment of benefits to the state for payment of a covered health care service for which Medicaid paid;

3. respond to any inquiry from the commissioner or his designee regarding a health care claim submitted within three years from the date the service was provided; and

4. agree not to deny a claim that the state submits solely based on its submission date, claim form, type or format, or failure to present proper documentation at the “point-of-sale” that is the basis of the claim if (a) the state or its agent submits the claim within the three-year period and (b) the state begins any legal action to enforce its rights with respect to the claim within six years of the claim submission.

Under existing law, no individual or group accident, health, accident or health, medical expense, medical service plan, self-insured plan, or self-funded plan subject to ERISA can contain provisions that have the effect of denying or limiting benefits or excluding coverage because the services are provided to someone who is eligible for or receiving Medicaid. The act applies the prohibition to the act's broadened list of health insurers' plans and extends it to include provisions that limit enrollment in private health care coverage.

DSS Subrogated to Any Right of Recovery for Medicaid Services Rendered

By law, DSS is subrogated (i. e. , entitled) to any right of recovery or indemnification that a Medicaid applicant or recipient, or his or her legally liable relative, has against an insurer for the costs of hospitalization, pharmacy, physician, and nursing services provided, up to the amount DSS spent on such services. The act extends this provision to the broadened list of health insurers and any other legally liable third party. And it adds behavioral health and long-term care services to the list of Medicaid-covered services for which DSS can recover.

Applying for or receiving Medicaid is deemed by law to be a subrogation assignment and an assignment of claims for benefits to DSS. Insurers must pay DSS directly under such an assignment. DSS can further assign its right to payment to a health care provider participating in Medicaid. Currently, providers must notify the “private” insurer of the assignment when rendering health care services. If the provider fails to do this, he or she is ineligible for DSS reimbursement. The act requires notification to a health insurer, as it more broadly defines the term, or other legally liable third party.

Requirement to Pay Claims

The act specifies that claims for recovery or indemnification that DSS or its designee submit to health insurers may not be denied solely based on the submission date, claim form, type or format, or failure to present proper documentation at the “point-of-sale” that is the basis of the claim if (1) the state or its agent submits the claim within three years from the date of service and (2) the state begins any legal action to enforce its rights with respect to the claim within six years of the claim submission.

EFFECTIVE DATE: July 1, 2007

21 — PHARMACY CLAIMS

The act prohibits any pharmacy from claiming payment from DSS under a DSS-administered medical assistance program or the Medicare Part D Supplemental Needs Fund for drugs prescribed to people who have other prescription drug insurance coverage unless the coverage has been exhausted and the person is otherwise eligible for the program or assistance from the Fund. It requires DSS to recoup from the submitting pharmacy any claims it submitted to DSS which DSS paid when other insurance coverage was available.

Under the act, DSS must investigate a pharmacy that consistently submits ineligible payment claims to determine whether the pharmacy is in violation of its medical assistance provider agreement or is committing fraud or abuse in the program. Based on its findings, the act allows DSS to take action against the pharmacy in accordance with state and federal law.

EFFECTIVE DATE: Upon passage

22 — TIMING OF DSS PAYMENTS TO NURSING HOMES

Under prior law, DSS paid half of its initial June payment to a nursing home in June and the other half in July. The act ends this practice and requires DSS to make the full payment in June beginning in 2008.

EFFECTIVE DATE: July 1, 2007

23 — CHARTER OAK HEALTH PLAN

The act establishes a Charter Oak Health Plan for residents who have been uninsured for at least six months and are ineligible for publicly funded health care. In establishing the plan, it authorizes the DSS commissioner to enter into contracts to provide comprehensive health care for this population and allows him to approve an alternative plan to make coverage options available to eligible residents. It requires him to conduct outreach to facilitate enrollment in the plan.

Cost Sharing

The act requires the DSS commissioner to impose cost sharing for plan participants. This may include:

1. monthly premiums;

2. a maximum $1,000 annual deductible;

3. coinsurance of no more than 20%, once the deductible is met;

4. tiered co-payments for prescription drugs, depending on whether the drug is on a formulary, is a brand name, or whether it is mail-ordered;

5. no fees for emergency visits to hospital emergency rooms and a maximum $150 fee for nonemergency visits; and

6. a lifetime benefit up to $1 million.

Premium Assistance

Residents purchasing the insurance pay premiums directly to the insurer and qualify for premium assistance if their income is less than 300% of the FPL. The assistance amounts are shown below.

Income Level Monthly Premium Assistance

Below 150% of FPL $175

150% to 185% of FPL $150

185% to 235% of FPL $75

235% to 300% of FPL $50

Coverage

The act requires the DSS commissioner to determine minimum requirements for the plan's amount, duration, and scope of benefits, which cannot include a pre-existing condition exclusion. Each participating insurer must provide an internal grievance process through which an insured person can request and receive a review of any coverage denial.

Allowable Plans

The act authorizes DSS to contract with any of the following entities to provide coverage:

1. managed care organizations (MCOs),

2. a consortium of federally qualified health centers and other state-funded, community-based health care providers; and

3. other health care provider consortia established to serve plan participants.

The act specifies that these consortia are not subject to the laws governing MCOs, hospital service corporations, and medical service corporations. These laws include annual financial filings with the Department of Insurance (DOI), DOI rate approval, and investment limitations.

The act requires the commissioner to request proposals from the entities based on its cost-sharing and benefit specifications. Before they may participate in the plan, the DSS commissioner must certify them according to criteria he establishes, which must include minimum reserve fund requirements.

Regulations; Exception to Six-Month Crowd Out and Enrollment Restrictions

The act permits the DSS commissioner to implement policies and procedures needed to administer the plan while adopting them as regulations, if notice of intent to adopt the regulations is published in the Connecticut Law Journal within 20 days of implementation. The policies and procedures are valid until the final regulations are adopted.

The policies and regulations may include (1) exceptions to the six-month period of noninsurance and (2) requirements for open enrollment periods and limits on enrollees' ability to change plans between these periods.

EFFECTIVE DATE: July 1, 2008

24 — SCHOOL DISTRICT REPORTING OF STUDENT INSURANCE RATES

The act requires local and regional school boards to require all enrolled students in their jurisdiction to report annually whether they have health insurance. The DSS commissioner, or his designee, must provide information to the boards on state-sponsored health insurance programs for children, including application assistance. The boards must provide this information, and application assistance, to the student's parent or guardian. (PA 07-4, JSS, requires the boards to provider this information only to caretakers of children who are identified as uninsured. )

EFFECTIVE DATE: July 1, 2007

25 — DELAY START OF DEPARTMENT ON AGING

The act postpones the re-establishment date of a Department on Aging by one year, from July 1, 2007 to July 1, 2008.

EFFECTIVE DATE: Upon passage

26 — STATE FOOD STAMP BENEFITS

The act limits benefits for participants in the state-funded food stamps for legal immigrants program to 75% of the amount the individual would receive under the federal food stamp program. In practice, DSS has applied this limit since March 2003 as a result of reduced appropriations. The program serves legal immigrants who do not qualify for the federal program.

EFFECTIVE DATE: July 1, 2007

27 — HOSPITAL RATES

The act requires the DSS commissioner, in consultation with the OPM secretary and within available appropriations, to increase the target amount per discharge used to reimburse hospitals for providing inpatient services to Medicaid recipients to $4,250 from $4,000. The increase applies to the rate period ending September 30, 2007. It permits the commissioner to add an inflation adjustment factor to the discharge amount for those hospitals whose target amounts do not change as a result of the floor being raised.

By October 1, 2008, the DSS commissioner must submit a report to the Public Health, Human Services, and Appropriations committees identifying the increased target amounts or annual adjustment factors applied on or after October 1, 2006 along with the associated costs of these increases.

The act also increases the rates for chronic disease hospitals by 4% in FY 08.

EFFECTIVE DATE: July 1, 2007

28 — HOSPITAL HARDSHIP GRANTS

For FY 08, the act authorizes the DSS commissioner, in consultation with OPM, to spend up to $30 million appropriated for “hospital hardship” for grants to hospitals. The grants must be provided as needed to (1) avoid the substantial deterioration of a hospital's financial condition that may adversely affect patient care and (2) for continued operation of the facility when the DSS commissioner, in consultation with the Department of Public Health (DPH) and Office of Health Care Access commissioners and the Connecticut Health and Educational Facilities Authority executive director determine continuation is necessary.

In determining grant eligibility, DSS must at a minimum consider (1) hospital use by patients eligible for state assistance programs, (2) hospital licensure and certification compliance history, and (3) the reasonableness of actual and projected revenues and expenses. A hospital applying for a grant must submit an application on forms DSS prescribes and a plan describing its operating savings and nongovernmental revenue enhancements. DSS may accept the plan or require modifications. Each hospital (presumably those receiving grants) must file quarterly reports with DSS concerning plan implementation. DSS may stop payments if the hospital fails to report. DSS must provide quarterly written reports to the Human Services and Appropriations committees naming those hospitals requesting a grant, the amount requested, and DSS's action.

EFFECTIVE DATE: July 1, 2007

29 — PILOT HOME CARE PROGRAM FOR PEOPLE WITH DISABILITIES

The act requires the DSS commissioner, within available appropriations, to establish and operate a state-funded pilot program to provide the same home care services to up to 50 people with disabilities ages 18 to 64 as the Connecticut Home Care Program for Elders (CHCPE) state-funded portion provides to people age 65 and older. To qualify, participants must also (1) be inappropriately institutionalized or at risk of being inappropriately institutionalized and (2) have assets that do not exceed the Medicaid community spouse protected amount if single or 150% of that amount if married.

It makes participants, at the DSS commissioner's discretion, potentially eligible to receive services necessary to meet needs attributable to disabilities so they can avoid institutionalization.

The act also:

1. requires program participants with incomes exceeding 200% of the federal poverty level to contribute to the cost of their care in the same way that CHCPE participants do,

2. limits the annualized cost of services provided to an individual under the pilot to 50% of the weighted average cost of nursing home care in the state, and

3. requires the DSS commissioner to establish a waiting list based on applicants' application dates if more than 50 people are eligible for the program or if the pilot's costs exceed available appropriations.

EFFECTIVE DATE: July 1, 2007

30 – 43 — INCREASED OVERSIGHT OF ASSISTED LIVING

By law, DPH licenses assisted living services agencies (ALSAs), which provide nursing services and assistance with activities of daily living to elderly people at assisted living facilities. These facilities are not licensed, but they must meet certain DPH regulatory qualifications to be defined as a “managed residential community” (MRC), which is the only place an ALSA can provide its services.

The act places additional requirements on MRCs. It delineates each MRCs' duties; requires it to provide each resident with a written bill of rights and residency agreement, and specifies what must be in these documents. It requires the ALSA to create a service plan for each resident. It also requires the MRC to comply with applicable state and federal laws and regulations.

It requires DPH to review each MRC every two years and at other times if it has probable cause to believe the MRC has violated the act's requirements. It (1) specifies what these reviews must include; (2) requires DPH to establish administrative procedures for preparing, completing, and transmitting written reports prepared as part of the reviews; (3) requires DPH to notify the MRC of alleged violations of the act; (4) gives the MRC 15 days after receiving the notice to request an administrative hearing; and (5) allows DPH, pending the hearing's outcome, to issue a remedial order, including a civil penalty of up to $5,000 per violation, against the MRC; and (6) authorizes the attorney general, at the DPH commissioner's request, to enforce the orders in Superior Court.

The act exempts from its provisions low- and moderate income state-assisted elderly congregate housing facilities.

It also makes other changes in the MRCs' duties and responsibilities, and makes conforming and technical changes in other statutes.

30 — Definitions

Under the act, “activities of daily living” are activities or tasks essential for a person's healthful and safe existence, including bathing, dressing, grooming, eating, preparing meals, shopping, housekeeping, transferring from a bed to a chair, bowel and bladder care, washing clothes, communicating, self-administering medication, and ambulating.

The act defines:

1. “assisted living services” as nursing services and help with activities of daily living provided to residents in an MRC having supportive services that encourage people primarily age 55 and older to maintain a maximum level of independence;

2. “assisted living services agency” as a DPH- licensed entity that provides, among other things, chronic and stable people with nursing services and help with activities of daily living;

3. “managed residential community” as a for-profit or not-for-profit facility consisting of private residential units that provides a managed group living environment consisting of housing and services for people who are primarily age 55 and over, excluding state-funded congregate housing facilities; and

4. “private residential unit” as a private living environment designed for an MRC resident's use and occupancy that includes a full bathroom and access to facilities and equipment for food preparation and storage.

EFFECTIVE DATE: October 1, 2007

31 — MRC Responsibilities

The act requires all MRCs operating in Connecticut to:

1. provide each resident with a written residency agreement;

2. enable residents to access services provided by an ALSA and in accordance with a service plan, which the act requires;

3. at the resident's request, arrange, in conjunction with the ALSA, for ancillary medical services, including physician, dental, and pharmacy services; restorative physical therapies; podiatry services; hospice care; and home health agency services (the ancillary medical services may not be administered by the MRC's employees unless the resident chooses to receive such services);

4. provide a formal security program to protect residents from intruders;

5. give residents the rights and privileges granted under the state's landlord-tenant laws;

6. comply with provisions currently established in DPH regulations for MRCs (Conn. Agencies Regs. 19-13-D105); and

7. be subject to DPH oversight and regulation.

The act prohibits MRCs from controlling or managing a resident's financial affairs or personal property.

EFFECTIVE DATE: October 1, 2007

32 —Investigaing Complaints

The act requires DPH to receive and investigate any complaint that an MRC is engaging in, or has engaged in activities, practices, or omissions that violate the act's provisions, the regulations DPH adopts under it, or any other regulations that apply to MRCs, including the Public Health Code. It also requires DPH to include in its biennial review of an MRC (see below) a review of the nature and type of any complaints received, as well as DPH's final determination concerning them.

EFFECTIVE DATE: April 1, 2008

33 —Reviews, Administrative Hearings, and Penalties

The act requires DPH to conduct biennial reviews of all MRCs. These biennial reviews must be in addition to, not in lieu of, any inspections by state or local officials to ensure an MRC's compliance with the Public Health Code, State Building or Fire codes, or any local zoning ordinance.

In addition to the biennial review, the act allows DPH to review an MRC at any time it has probable cause to believe it is violating the act's requirements, regulations adopted under it, or any other applicable regulations, including the Public Health Code. The biennial or investigatory review's purpose must be to ensure that an MRC is complying with the act and the regulations.

Under the act, a biennial review must include an inspection of:

1. all of the MRC's common areas, including any common kitchen or meal preparation area and

2. private residential units, but only if the occupants provide prior written consent.

The act allows an inspector, in the course of conducting a biennial or investigatory review, to interview any MRC manager, staff member, or resident. Interviews with residents must be confidential and conducted privately.

Under the act, DPH must establish an administrative procedure for preparing, completing, and transmitting written reports prepared as part of any biennial or investigatory review. If after a review it determines the MRC is violating the act, DPH must provide the MRC written notice of its determination. The notice must advise the MRC of its right to request an administrative hearing to contest the determination in accordance with the Uniform Administrative Procedure Act. The MRC must request a hearing, in writing, within 15 days after it receives DPH's notice of an alleged violation.

The act allows DPH to issue remedial orders it considers necessary to ensure an MRC's compliance with the act's provisions. It specifies that remedial orders available to DPH include imposing a civil penalty of up to $5,000 per violation. But DPH must stay the imposition of any remedial order or civil penalty pending the outcome of the administrative hearing. DPH must maintain and make available for public inspection all completed reports, the MRC's responses, and any remedial orders issued.

If an MRC fails to comply with a DPH remedial order, the attorney general, at the DPH commissioner's request, can apply to Hartford Superior Court to enforce the order. The act gives all such actions precedence in the order of trial over all other civil actions except actions on probate bonds. It allows the court to issue orders necessary to obtain compliance with DPH's order.

EFFECTIVE DATE: April 1, 2008

34 — Bill of Rights

The act requires an MRC to have a written bill of rights that prescribes the rights afforded to its residents. (The ALSA must already have a bill of rights under DPH regulations. ) The MRC must designate a staff person to provide and explain the bill of rights to residents when they enter into a residency agreement. The bill of rights must include each resident's right to:

1. live in a clean, safe, and habitable private residential unit;

2. be treated with consideration, respect, and due recognition of personal dignity, individuality, and the need for privacy;

3. privacy within a private residential unit, subject to the MRC's rules reasonably designed to promote the resident's health, safety, and welfare;

4. keep and use one's own personal property in a private residential unit so as to maintain individuality and personal dignity, provided its use does not infringe on other residents' rights or threaten their health, safety, and welfare;

5. private communications, including receiving and sending unopened correspondence, telephone access, and visiting with people of one's choice;

6. freedom to participate in and benefit from community services and activities so as to achieve the highest possible level of independence, autonomy, and interaction within the community;

7. directly engage or contract with licensed health care professionals and providers of one's choice to obtain necessary health care services in one's private residential unit or in other space made available in the MRC for such purposes;

8. manage one's own financial affairs;

9. exercise civil and religious liberties;

10. present grievances and recommend changes in policy, procedures, and services to the MRC's manager or staff, government officials, and anyone else without restraint, interference, coercion, discrimination, or reprisal from the MRC, including access to DPH or the Office of the Long-Term Care Ombudsman;

11. ask for and receive the name of the service coordinator or anyone else responsible for resident care or coordination of resident care;

12. confidential treatment of all records and communications to the extent required by state and federal law;

13. have reasonable requests responded to promptly and adequately within the MRC's capacity and with due consideration given to other residents' rights;

14. be fully advised of the MRC's relationship with an ALSA, health care facility, or educational institution to the extent that the relationship relates to resident medical care or treatment and to receive an explanation about the relationship;

15. receive a copy of the MRC's rules and regulations;

16. privacy when receiving medical treatment within the MRC's capacity;

17. help plan for his or her care and services and refuse care and treatment, provided refusal may preclude the resident from continuing to live in the MRC; and

18. all rights and privileges afforded tenants under state law.

The act requires an MRC to post the bill of rights in a prominent place in the MRC. The posting must include contact information for DPH and the Office of the Long-Term Care Ombudsman, including names, addresses, and telephone numbers of people in those agencies who handle questions, comments, and complaints about MRCs.

EFFECTIVE DATE: October 1, 2007

35 — Residency Agreement and 24-Hour Skilled Nursing Care

The act prohibits an MRC from entering into a written residency agreement with anyone who requires 24-hour skilled nursing care unless they establish to the MRC's and ALSA's satisfaction that they have, or have arranged for, such 24-hour care and maintain it as a condition of residency if an ALSA determines that such care is necessary.

EFFECTIVE DATE: October 1, 2007

36 — ALSA Individualized Service Plan

The act requires an ALSA, after consulting with the resident and following a registered nurse's assessment, to develop and maintain an individualized service plan for any MRC resident who receives assisted living services. The plan must describe in lay terms the individual's need for such services; the service providers or intended providers; the services' scope, type, and frequency; itemized costs of such services; and other information DPH may require. The service plan and any periodic revisions to it must be confidential and signed by the resident (or the resident's legal representative) and an ALSA representative. It must also be available for inspection by the resident and DPH.

The MRC must maintain written policies and procedures for a resident's initial evaluation and annual reassessment of his or her functional and health status and service requirements.

EFFECTIVE DATE: October 1, 2007

37 — Residency Agreement

The act requires an MRC to enter into a written residency agreement with each resident that clearly sets forth the resident's and the MRC's rights and responsibilities, including rights under PA 06-195, which set requirements for facilities with Alzheimer's special care units or programs. The agreement must be in plain language, at least 14-point type, and signed by the MRC's authorized agent and the resident before the resident takes possession of a private residential unit. It must include, at a minimum:

1. an itemization of assisted living services, transportation services, recreation services, and any other services, goods, lodging, and meals the MRC will provide for the resident;

2. a full and fair disclosure of all charges, fees, expenses, and costs to be borne by the resident, including a payment schedule and disclosure of all late fees or potential penalties;

3. the grievance procedure for enforcing the agreement's terms;

4. the MRC's covenant to (a) comply with all municipal, state, and federal laws and regulations regarding consumer protection and protection from financial exploitation and (b) give residents all rights and privileges afforded them under the state's landlord-tenant laws;

5. the conditions under which either party can terminate the agreement;

6. full disclosure of the MRC's and resident's rights and responsibilities in situations involving the resident's serious health deterioration, hospitalization, or death, including a provision stating that in the event of death, the resident's estate or family will only be responsible for payment to the MRC for up to 15 days following the date of death as long as the unit has been vacated; and

7. any of the MRC's adopted rules reasonably designed to promote residents' health, safety, and welfare.

EFFECTIVE DATE: October 1, 2007

38 — Applicability of Other Laws; Authority To Adopt Regulations

The act requires an MRC to meet the requirements of all applicable federal and state laws and regulations, including the Public Health Code, State Building and Fire Safety codes, and federal and state laws and regulations governing handicapped accessibility.

The act requires the DPH commissioner to adopt regulations to carry out its provisions.

EFFECTIVE DATE: October 1, 2007

39-42 — Conforming Technical Changes

43 — Elderly Congregate Housing Exemption

The act specifies that its provisions do not apply to any state-funded congregate housing facility.

These facilities are regulated by the Department of Economic and Community Development (DECD), allowed to offer assisted living services (15 of the 24 in the state do so), and have been granted DPH waivers from some of the usual assisted living and MRC requirements to enable them to offer the services. Subsidies for the assisted living services in these facilities are available for residents who qualify financially through DECD and DSS' Connecticut Home Care Program for Elders.

EFFECTIVE DATE: October 1, 2007

45 — VETERANS' BURIAL EXPENSES

This act increases the amount that the state may for the funeral expenses of indigent veterans from $150 to $1,800. Claims for such expenses must be made within one year after the veteran dies or his or her remains are returned from abroad and interred here

EFFECTIVE DATE: July 1, 2007

46 — VETERANS' HEALTH REGISTRY

This act allows the Veterans Affairs' Department to establish and maintain a registry of health data on armed forces members who have completed a period of active service. The department may use the data to (1) study the potential short- and long-term effects of environmental hazards on such members and (2) inform, customize, and coordinate the provision of health care services to them. It must accomplish these tasks using available resources.

The act applies to members of the U. S. Army, Navy, Marine Corps, Coast Guard, Air Force, and reserves, including guard members performing under federal law. It allows the Veterans Affairs' Department to develop surveys for members or their health care providers voluntarily to provide registry data during or after their period of active service. The surveys and data must be related to members' illnesses and potential correlations between such illnesses and environmental hazards. These hazards include vaccinations, infections, chemicals, pesticides, microwaves, depleted uranium, pyridostigmine bromide, and chemical and biological warfare agents.

The department must collect and maintain the surveys and data in accordance with the federal Health Insurance Portability and Accountability Act (HIPAA). Except for individually identifiable health data, which may be released only with the member's consent in accordance with HIPAA, the registry database information is disclosable under the Freedom of Information Act.

EFFECTIVE DATE: July 1, 2008.

47 – 60 — LEAD POISONING PREVENTION AND REMEDIATION

47 — Coordinating Lead Poisoning Prevention Efforts

The act makes the DPH the lead state agency for lead poisoning prevention. The commissioner must identify the state and local agencies with responsibilities related to lead poisoning and schedule a meeting with them at least once a year to coordinate their efforts. The act also requires DPH's lead poisoning prevention program to include the screenings it mandates.

EFFECTIVE DATE: October 1, 2007

48 — Lead Screening and Risk Assessments

Screening. The act requires primary care providers (e. g. , physicians and advanced practice registered nurses) other than hospital emergency departments, to screen annually for lead every child between nine and 35 months old. The screenings must follow the Childhood Lead Poisoning Prevention Screening Advisory Committee's recommendations. These recommendations call for blood lead screening (capillary) tests at age 12 months and 24 months with follow-up venous blood tests if the initial screening shows an elevated blood lead level.

These providers must also screen (1) all children between 36 and 72 months old who have never been screened and (2) any child under 72 months if the provider determines it is clinically indicated under the advisory committee's recommendations (which call for screening children who exhibit developmental delays and consideration of blood lead testing for any child who has unexplained seizures, neurologic symptoms, hyperactivity, behavior disorders, growth failure, abdominal pain or other symptoms consistent with elevated lead levels or a recent history of ingesting foreign objects).

Risk Assessments. The act requires primary care providers also to conduct annual lead risk assessments for children ages three to six. Providers can assess younger children if they determine it is needed. Assessments must be conducted according to the Lead Screening Advisory Committee's recommendations. These recommendations call for questioning parents or guardians about the child's housing (age and location) and family history of elevated blood lead levels.

Exemptions. The act exempts children whose parents object to blood tests on religious grounds from these screening requirements.

EFFECTIVE DATE: January 1, 2009

49 — Reporting Elevated Blood Lead Levels

By law, health care institutions and clinical laboratories must notify DPH and appropriate local health officials within 48 hours of receiving or completing a report on a person with a lead level of 10 or more g/dL of blood or other abnormal bodily lead level. The act requires them also to report the results within 48 hours to the health care provider who ordered the test. It requires this provider, within 72 hours of learning the results, to make reasonable efforts to notify the parents or guardians of a child under age three of the results.

Another law (CGS 19a-111b), which this act does not alter, requires the DPH commissioner to establish an early lead diagnosis program that includes routine exams of children under age six. Under this program, exams showing blood levels of 10 or more g/dL must be reported to the child's parents, the local health director, and DPH.

EFFECTIVE DATE: October 1, 2007

50 — Local Health Department Lead Investigations

The act requires the local health director to inform parents about the child's potential eligibility for the state's Birth to Three program, which provides services to families with children with disabilities age three and under. (The current lead threshold for Birth to Three eligibility is 45 g/dL. ) Health directors must already inform parents about lead poisoning dangers, ways to reduce risks, and lead abatement laws.

The act establishes a new lead source investigation and clean-up process that appears to parallel the existing process. Under the act, whenever a local or district health director receives a report that two blood tests (venous) taken at least three months apart confirm a child's blood lead level is between 15 to 20 g/dL, the director must conduct an on-site investigation (presumably of the child's home) to identify the source of lead causing the elevation and order whoever is responsible for the condition to remediate it. The act lowers the threshold for investigations to 10 g/dL if, beginning January 1, 2012, 1% or more of Connecticut children under age six have been reported with blood levels of at least 10 g/dL.

Under existing law (CGS 19a-111), which the act does not change, health directors must conduct, an epidemiological investigation for lead levels of 20 or more g/dL. (An epidemiological investigation is an examination and evaluation to determine the cause of elevated blood lead levels; it is not clear how the new on-site investigation the act requires differs from this). After the epidemiological investigation identifies the lead source, the local health director must take action needed to prevent further lead poisoning. Among other things, the director can order abatement and must try to find temporary housing for residents when the lead hazard cannot be removed from their dwelling within a reasonable time.

EFFECTIVE DATE: January 1, 2009

51 & 52 — Insurance Coverage for Lead Screening

The act requires individual and group health insurance policies to cover the act's lead screening and risk assessments mandates. The requirement applies to Connecticut policies delivered, issued for delivery, amended, renewed, or continued on or after January 1, 2009.

EFFECTIVE DATE: January 1, 2009

53 — Data Collection

The act requires the DPH commissioner, by January 1, 2008, to review the lead poisoning data DPH collects from institutional and private clinical labs performing lead testing and determine if it records it in a format that is compatible with those reports. DPH must adopt regulations if it finds that data should be reported differently.

EFFECTIVE DATE: October 1, 2007

54-56, 60 — Lead Remediation, Abatement, Testing, and Management

In Dwellings Occupied by Children. By law, owners of dwellings with toxic lead levels occupied by children under age six must abate or manage the dangerous materials and follow DPH regulations for doing so. The act permits them to remediate the materials, as well. It defines remediation as the use of interim controls, including paint stabilization, spot point repair, dust control, specialized cleaning, and mulching soil.

The act requires DPH's regulations to establish requirements and procedures for lead testing, remediation, and management of toxic materials; prior law required the regulations to address only removal, which the act eliminates, and abatement. The act also permits DPH to adopt regulations concerning the standards and procedures for these actions in any premises.

The law requires DPH to authorize the use of any encapsulating product that meets national product standards. The act removes the commissioner's ability to disapprove the use of any product that meets these standards. It extends the uses in which these products may be employed to lead remediation.

In Rented Houses, Mobile Homes, and Apartment Houses. The act permits the local or district health director to order the responsible party to correct cracked, chipped, blistered, flaking, peeling, or loose lead-based paint on exposed interior surfaces in rented one- or two-family houses, mobile homes, apartment buildings and boarding houses. The act requires DPH regulations, if they are adopted, to define testing, remediation, abatement, and management of lead paint in these circumstances.

The law subjects anyone who fails to comply with such an order to a fine of up to $200, imprisonment for up to 60 days, or both. If the local health department determines a rented house or mobile home premises is uninhabitable, it can order it vacated for up to 10 days.

Additional Regulations. The act permits DPH to adopt regulations governing paint removal from buildings and structures where removal may be hazardous to nearby buildings. The regulations can set definitions, applicability and exemption criteria, notice procedures, appropriate work practices, and penalties for noncompliance.

The law requires DPH to approve and keep a list of the encapsulation products that can be used in the state to abate toxic lead levels. The act extends these requirements to encapsulation products used for remediation and changes the type of situations in which they are used from those involving toxic lead levels to those involving lead hazards.

Nuisance Abatement. The act permits local health directors to order a property owner to remediate any nuisance they find on the owner's property. Under prior law, they could order only abatement. Nuisances subject to remediation include lead paint, plumbing, sewerage, and ventilation.

The act extends nuisance law provisions to owners or occupants ordered to remediate a nuisance. By law, owners, or in some cases, occupants, who are ordered to correct a nuisance must pay the costs. If the responsible party fails to do this, the town can take corrective action and sue the person to recover damages and expenses. The town can also seek an injunction. The responsible person is subject to a $250 per day civil penalty for each day the nuisance persists.

EFFECTIVE DATE: October 1, 2007

58 — Reporting

The act requires the DPH commissioner to report annually beginning January 1, 2009 to the Public Health and Human Services committees on the status of lead poisoning prevention programs in the state. The report must include the number of children screened and those diagnosed with elevated blood lead levels in the prior calendar year and the amount of lead testing, remediation, abatement, and management done in that year.

EFFECTIVE DATE: October 1, 2007

59 — Financial Aid to Local Health Departments

The act requires DPH, within available appropriations, to establish a financial assistance program to help local health departments pay for their lead-related expenses under the act. It may adopt implementing regulations.

EFFECTIVE DATE: July 1, 2007

60 — Lead Work Standards

The act applies federal Occupational Health and Safety Administration standards for lead-related work, to the extent they apply to employers and employees, to lead abatement, removal, remediation, management, and other activities conducted under the act's provisions.

EFFECTIVE DATE: October 1, 2007

61 & 62 — FUNDING OF LOCAL HEALTH DEPARTMENTS

The act increases funding to local and district health departments as follows: (1) from $. 94 to $1. 18 per capita for full-time municipal health departments, (2) from $1. 94 to $2. 43 per capita for district health departments for each town or borough in the district with a population of 5,000 or less and (3) from $1. 66 to $2. 08 per capita for each town or borough in the district with a population over 5,000.

EFFECTIVE DATE: July 1, 2007

63 — ANNUAL NURSING HOME RESIDENT REVIEWS

The act permits the Department of Mental Health and Addiction Services (DMHAS), within available appropriations, annually to review nursing home residents with mental illness to assesses whether they need (1) nursing home level of service or (2) specialized mental health services. DMHAS does the reviews in consultation with DSS, and the act requires nursing homes to give the agencies access to residents and their medical records for these reviews.

Under the act, if an annual review determines a resident who has continuously lived in a nursing home for at least 30 months needs specialized care but not nursing home care, he or she can opt to stay in the home or receive Medicaid-covered services in another appropriate institutional or noninstitutional setting. The move to the alternative setting must be done according to an alternative disposition plan DSS submits to the federal government and consistent with DMHAS' requirements for specialized services. If the resident has lived in the home fewer than 30 months, the home, in consultation with DMHAS, must arrange for his or her safe discharge. If DMHAS determines the person needs an alternative residential placement, the discharge and transfer must be done according to the DSS disposition plan. But if an alternative placement is not available, the person cannot be transferred.

By law, a nursing home must notify DMHAS when a resident who has mental illness undergoes a significant change in condition that may require specialized services. Upon notice, DMHAS and DSS must evaluate whether the resident requires a nursing home level of care or specialized mental health services.

EFFECTIVE DATE: July 1, 2007

64, 65 & 69 — DEPENDENT CHILDREN COVERAGE EXTENSION

The act amends provisions in PA 07-185 that raise, from age 22 to 26, the age to which group comprehensive and individual health insurance policies that cover unmarried children must do so. That act limited the coverage extension to children who reside in Connecticut; this act specifically extends coverage to full-time students atttending accredited out-of-state colleges and universities and children who live out-of-state with a custodial parent pursuant to a court order.

It makes both the group and individual policy coverage provisions effective January 1, 2009. PA 07-185 made the group provision effective July 1, 2007 and the individual policy provision effective October 1, 2007.

EFFECTIVE DATE: January 1, 2009

66 — CONNECTICUT HEALTH INFORMATION NETWORK PLAN

The act authorizes DPH and the UConn Health Center (UCHC), within available appropriations, to develop a Connecticut Health Information Network (CHIN) plan. The CHIN plan is to integrate state health and social services data within and across the UCHC, the Office of Health Care Access (OHCA), DPH, and the Mental Retardation (DMR) and Children and Families (DCF) departments. Data from other state agencies may be integrated into the network as funding and federal law permit. The CHIN must securely integrate this data consistent with state and federal laws.

The act requires DPH and UCHC's Center for Public Health and Health Policy to collaborate with the Department of Information Technology and DMR, DCF, and OHCA in developing the CHIN plan. The plan must:

1. include research in and describe existing health and human services data;

2. inventory the various health and human services data aggregation initiatives currently underway;

3. include a framework and options for implementing CHIN, including ways to use the network to get aggregate data on the state's key health indicators;

4. identify and comply with confidentiality, security, and privacy standards; and

5. include a detailed cost estimate for implementation and potential funding sources.

The act eliminates provisions of PA 07-185 (. 24-28, 37, 38) that established and funded the CHIN at the UCHC.

EFFECTIVE DATE: July 1, 2007

67 — HEALTHFIRST CONNECTICUT AUTHORITY

The act amends PA 07-185 to add the insurance commissioner and health care advocate or their designees as nonvoting members of this authority, which was created to recommend alternatives for affordable quality health care coverage for un- and underinsured people and cost containment measures and insurance financing mechanisms.

EFFECTIVE DATE: Upon passage

68—STATEWIDE ELECTRONIC HEALTH INFORMATION TECHNOLOGY PLAN

By November 30, 2007, the act requires DPH, in consultation with OHCA and within available appropriations, to contract for the development of a statewide health information technology plan. This must be done through a competitive bid process. The entity awarded the contract must be designated as the state's lead health information exchange organization between December 1, 2007 and June 30, 2009.

The statewide plan must include:

1. general standards and protocols for health information exchange;

2. electronic data standards to facilitate the development of a statewide, integrated electronic health information system for use by state-funded health care providers and institutions funded by the state, including standards:

(a) on security, privacy, data content, structures and format, vocabulary and transmission protocols,

(b) for compatibility with any national data standards in order to allow for interstate interoperability,

(c) permitting the collection of health information in a standard electronic format, and

(d) for compatibility with the requirements for an electronic health information system; and

3. pilot programs for health information exchange and the projected costs and sources of funding.

By December 1, 2008 and annually afterwards, DPH, in consultation with OHCA, must report to the Public Health, Human Services, Government Administration and Elections, and Appropriations committees on the plan's status.

The act defines:

1. “electronic health information system” as computer hardware and software that includes:

(a) a patient electronic health record that can be accessed in real time;

(b) a personal health record through which individuals and their authorized representatives can manage a person's health information;

(c) computerized order entry technology that allows a health care provider to order tests, treatments, and prescriptions;

(d) electronic reminders to health care providers concerning screenings, other preventive measures, and best practices;

(e) error notification procedures; and

(f) tools to collect, analyze, and report adverse event data and quality of care measures;

2. “interoperability” as the ability of separate systems to exchange information including (a) physically connecting to a network, (b) enabling a user who presents appropriate permission to conduct transactions over the network, and (c) enabling such a user to access, transmit, receive, and exchange information with other users; and

3. “standard electronic format” as one using open electronic standards that (a) enables using health information technology to be used for collecting clinically specific information, (b) promoting interoperability across health care settings, including government agencies at all levels, and (c) facilitating clinical decision support.

The act repeals provisions in PA 07-185 that designated eHealth Connecticut as the state's lead health information exchange organization from July 1, 2007 to July 1, 2012 and required the DPH commissioner to contract with eHealth Connecticut to develop a statewide health information technology plan that included standards, protocols, and pilot programs for health information exchange.

EFFECTIVE DATE: July 1, 2007

70 — SCHOOL-BASED HEALTH CENTERS

The act requires DPH, within available funding, to expand school-based health center (SBHC) services in FY 08 for (1) priority school districts and (2) federally designated health professional shortage areas (HPSA), medically underserved areas (MUA), or areas with a medically underserved population. It repeals a provision of PA 07-185 ( 41) that made an appropriation to DPH for the both expansion and operating costs of SBHCs for priority school districts and for areas designated as HPSAs and MUAs.

HRSA develops health workforce shortage designation criteria to help determine whether a geographic area or population group is an HPSA or MUA. HPSAs may have shortages of primary medical care, dental, or mental health providers and may be urban or rural areas, population groups, or medical or other public facilities. MUAs may be a whole county or group of contiguous counties, a group of county or civil divisions, or a group of urban census tracts where residents have a shortage of health services.

EFFECTIVE DATE: July 1, 2007

71 — RYAN WHITE PROGRAM FUNDING

For FY 08, the act authorizes the DPH commissioner, in consultation with the OPM secretary, to (1) make payments to providers to address funding reductions under Parts A and B of the federal Ryan White Program and (2) contract with health departments in the Hartford or New Haven Transitional Grant Areas to address funding reductions under the program.

The Ryan White HIV-AIDS Treatment Modernization Act , Part A, funds urban areas with the highest number of people living with AIDS while also helping mid-size cities and areas with emerging needs. Part B funds states.

EFFECTIVE DATE: July 1, 2007

72 — REPEALER

The act repeals the following provisions of PA 07-185:

1. a premium assistance program for families with incomes between 300% to 400% of FPL who have access to employer-sponsored coverage;

2. a requirement that DSS seek a federal Health Insurance Flexibility and Accountability demonstration waiver to cover pregnant women with incomes between 185% and 250% of the FPL who do not “otherwise have creditable coverage”;

3. the creation of a Connecticut Health Information Network at the UCHC to integrate state and social services data within and across state agencies;

4. the designation of e-Health Connecticut as the state's health information exchange organization

5. a requirement that DSS increase the rates it pays Medicaid providers, including hospitals; and

6. appropriations for:

(a) DSS to establish a child health quality improvement program ($150,000 in FY 08),

(b) DPH to establish electronic health information standards ($250,000 in FY 08),

(c) UCHC to establish a Connecticut Health Information Network ($1 million each in FY 08 and 09),

(d) DPH for the Connecticut HealthFirst Authority ($500,000 in FY 09),

(e) DPH for the Statewide Primary Care Access Authority ($500,000 in FY 09),

(f) for DPH for SBHCs ($2. 5 million in FY 08),

(g) for DPH for patient transportation to community health centers ($500,000 in FY 08), and

(h) for DPH for community health center infrastructure improvement ($2 million in FY 08).

It also repeals a provision of PA 07-252 that required, for FYs 08 and 09, that any balance remaining in the Tobacco and Health Trust Fund, after transfers were made as required by law from the amount disbursed to the fund from the Tobacco Settlement Fund, be allocated to DMHAS. DMHAS was to use such money for grants for tobacco education program to discourage minors from smoking.

EFFECTIVE DATE: July 1, 2007