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

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

Beginning January 1, 2008, this bill (1) lowers the maximum nursing home provider tax from 6% to 5. 5% of the home's net revenue, consistent with a recent change in federal law (PL 109-432) and (2) requires the Department of Social Services commissioner, when setting the amount of the tax every two years, to use a percentage rate as determined by the Office of Policy and Management (OPM) secretary. (The actual tax is currently just under 5. 5%. )

PA 05-251 and PA 05-280 created the nursing home provider tax (also called a “resident user fee”) as a way of providing more state matching funds to increase federal Medicaid funding for nursing homes and certain other providers. Under a federal waiver, the state exempts from the tax nursing homes owned by continuing care retirement communities.

The user fee is calculated by multiplying each home's anticipated non-Medicare net revenue, including estimated revenue from any increases in Medicaid payments, during the 12-month period ending on June 30^th of the succeeding calendar year by the provider tax rate. The product is then divided by the sum of each nursing home's 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. The nursing homes must pay the tax quarterly to the Department of Revenue Services (DRS).

Beginning July 1, 2007, the act requires the DSS commissioner to annually increase the payment standards (benefits) in the Temporary Family Assistance (TFA) and State-Administered General Assistance (SAGA) cash assistance programs by the percentage increase, if any, in the most recent calendar year average in the consumer price index for urban consumers over the average for the previous year, up to 5%. TFA benefits (currently $ 543 for a family of three living in most parts of the state) have been frozen for over 15 years and SAGA cash assistance (currently $ 200 per month for a single, unemployable person) benefits were reduced significantly in 2003 and have not risen since.

By increasing the TFA benefit, the bill also increases the Medicaid medically needy income limit (MNIL). By law, that limit is 143% of the TFA benefit. It also increases the income limit for SAGA medical assistance, which by law is the same as the MNIL.

The bill freezes for the next two fiscal years the adult payment standard in the State Supplement program. This amount is used by DSS to calculate the actual State Supplement benefit, which takes into account both the recipient's need and available income. The law, unchanged by the bill, continues to require DSS, when calculating available income, to disregard annual increases in State Supplement recipients' federal Supplemental Security Income (SSI) benefits.

The federal Medicare Part D program, which began January 1, 2006, helps Medicare beneficiaries pay for certain prescription drugs. State law coordinates benefits under ConnPACE and for full benefit Medicare-Medicaid dually eligible people with the federal benefits. A state Medicare Part D Supplemental Needs Fund helps ConnPACE and dually eligible beneficiaries pay for medically necessary drugs that are not on a Medicare Part D plan's formulary (i. e. , “nonformulary” drugs). This bill 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 original 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 bill 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 as a condition for receiving help paying for the nonformulary drugs. It deletes the law's requirement that DSS expeditiously review requests for assistance and notify the beneficiary within two hours after receiving the request for assistance.

The bill requires that, for each fiscal year the expenditures cannot exceed the amount appropriated in PA 06-186 ($ 5 million annually).

Current law requires 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 is performing this function through its own employees. ) The bill eliminates the requirement and instead requires the commissioner to implement a plan for pursuing these payments.

The bill increases the maximum number of participants in the new “Money Follows the Person“ demonstration program from 100 to 700. The state has received funding for this demonstration from a new federal grant program that helps states move people who have been inappropriately institutionalized in a nursing home or other institution for six months or more back into the community (PL 109-171, § 6071). The federal grant is for five years and the expansion to 700 participants would take place gradually over that five-year period.

The bill 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.

Current state law requires such assignment if the Medicaid applicant's spouse is 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 to qualify for Medicaid without being punished for the spouse's actions. The bill 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 program 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 bill 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 total assets (some assets are exempt) 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 where a wife, who still lived in the community, (1) refused to support her husband in the nursing home with her own assets which exceeded the CSPA and (2) executed an assignment of his support rights to DSS, through the use of a power of attorney he had given her earlier. The couple contended that this made the husband eligible for Medicaid. DSS initially refused the husband's Medicaid application because the couple's combined assets were greater than allowed. The couple sued DSS in federal district court, which decided the husband was eligible for Medicaid under these conditions. The decision was later upheld by a federal appeals court. (Morenz v. Wilson-Coker, 321 F. Supp. 2d 398 (D. Conn. 2004); 415 F. 3d 230, 234 (2d Cir. 2005))

The bill repeals provisions requiring the DSS commissioner, to the extent permitted by federal law, to impose premiums and co-payments on HUSKY A caretaker relatives with income exceeding 100% of the federal poverty level (FPL).

The bill requires DSS to provide individuals who are determined ineligible for HUSKY A to be provided a written statement notifying them of their ineligibility and advising them of the availability of HUSKY B. HUSKY A provides Medicaid-funded health insurance to children in families with income up to 185% and their caretaker relatives. Current law requires DSS, when people initially apply for HUSKY A, to provide them with a written statement that tells them of the availability of HUSKY B for people who are ineligible for assistance at that time or subsequently become ineligible.

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

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

Regardless of any state law or contract provision between employers and their health insurance carriers, the bill provides that no employee who must enroll in employer coverage under the bill can be prohibited from enrolling due to open enrollment limitations.

The bill 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.

PA 07-185 requires DSS 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). The bill 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 who do not “otherwise have creditable coverage,” as defined by federal law, with incomes between 185% and 250% of the FPL. (Federal Medicaid funds match the state's payments for the coverage for pregnant women with incomes under 185% of the FPL. ) Once DSS files the state plan amendment or a waiver is approved, DSS must implement it.

PA 07-185 requires DSS to seek a waiver to make this change. It does not specify an implementation timeframe. The bill repeals this provision and replaces it with the above requirements.

PA 07-185 requires DSS to develop a children's preventive health services system plan. The bill requires it to do this within available appropriations. It specifies the plan must include ophthalmologic and optometric, not vision care, services. And it removes the requirement that DSS' tracking of system service use be done electronically.

For FY 08, the bill increases Medicaid reimbursement rates for (1) 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 and (2) private residential facilities serving Department of Mental Retardation clients which 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. If they would have received a lower rate on the increase's effective date because of their interim rate status, they will receive that lower rate.

Current law provides that ancillary or specialty services provided under the SAGA medical program cannot exceed the services provided under the SAGA program on July 1, 2003. (The program did not provide a number of such services on that date. ) The bill makes an exception to this prohibition, allowing nonemergency medical transportation and vision care services to be provided for a limited duration.

The bill 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 State-Administered General Assistance (SAGA) recipients who are being discharged from a chronic disease hospital.

DSS uses a unit cost reimbursement system for paying state-funded child care centers. Beginning January 1, 2008, the bill requires any increase in payments to centers must 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 requirements in the future (e. g. , bachelor vs. associate degree).

The bill 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. The commissioner must submit the plan to the Human Services and Appropriations committees. Within 30 day of receiving the plan, they 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.

Primary care providers participating in the pilot must provide primary medical care services to enrollees and arrange for specialty care as needed. The bill 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.

PA 07-185 raises the HUSKY B income eligibility limit from 300% to 400%, of FPL and provides for premium assistance for families with the income above 300% of poverty who have access to employer-sponsored coverage. It also requires DSS to pay two months of premium payments HUSKY B premiums to cover all newborns born to state residents born in Connecticut or bordering states. The bill (1) eliminates the increased income limit for subsidized HUSKY B coverage and the premium assistance and (2) increases, from two to four months, the period for which DSS must pay premiums.

It 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. And it removes a requirement that DSS or the servicer redetermine a family's 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 through which it can determine whether to continue eligibility after the initial 12 months.

Federal law requires states, as a condition of receiving federal Medicaid matching funds, to enact laws requiring insurers to provide certain information to DSS. Medicaid is generally the payer of last resort. Thus, DSS must exhaust other payment sources (e. g. , private insurance) before paying for health care services provided to Medicaid recipients. By law, individuals are expected to fully disclose when they have other coverage. The bill 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 bill, “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 bill 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.

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

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

1. provide to 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 necessary for determining whether there is available coverage and the coverage plan's name, address, and identifying number;

2. accept the state's right of recovery and a person's assignment of benefits to the state for payment of a health care service provided 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 current 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 bill instead applies the prohibition to the bill's broadened list of health insurers' plans and extends it to include provisions that limit enrollment in private health care coverage.

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 bill 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 bill requires notification to a health insurer, as it more broadly defines the term or other legally liable third party.

The bill 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 (A) the state or its agent submits the claim within three years from the date of service and (B) any legal action to enforce its rights with respect to the claim the state begins within six years of the claim submission.

§ 21 — PHARMACY CLAIMS FOR BENEFICIARIES WHO HAVE OTHER INSURANCE AND FRAUD UNDER DSS PROGRAMS AND MEDICARE PART D SUPPLEMENTAL NEEDS FUND

The bill 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 is available.

Under the bill, 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 DSS's findings in the investigation, the bill allows it to take action against the pharmacy in accordance with state and federal law.

Under current law, DSS pays half of its initial June payment to a nursing home in June and the other half in July after the new fiscal year begins. The bill ends this practice with FY 07 and consequently requires DSS to make the full payment in June for subsequent years.

The bill 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, the bill authorizes the Department of Social Services (DSS) commissioner to enter into contracts to provide comprehensive health care for the state's uninsured residents. It requires the commissioner to conduct outreach to facilitate enrollment in the plan.

The bill 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 $ 1 million lifetime benefit limit.

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.

The bill 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.

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

The bill specifies that the above 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.

Before these providers may participate in the plan, the DSS commissioner must certify them according to criteria he or she establishes, which must include minimum reserve fund requirements.

The bill requires the commissioner to seek proposals from the entities based on the cost-sharing and benefits (presumably those that the entities offer). It allows the commissioner to approve an alternative plan to make coverage options available to eligible residents.

The bill permits the DSS commissioner to implement policies and procedures for administering the plan while in the process of 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 regulations are adopted.

The bill allows the policies and regulations to include an exception to the six-month period of noninsurance and requirements for open enrollment periods, and limiting enrollees' ability to change plans between these periods.

The bill requires local or regional school boards to require all students in their jurisdiction to report 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. (HB 8005 limits the districts' obligation to offer the information to only those parents and guardians whose children are identified as uninsured. )

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

Connecticut had a Department on Aging from 1969 to 1993, when it was disbanded and most of its functions and personnel merged into the newly created Department of Social Services (DSS) as the Division of Elderly Services.

PA 05-280 re-establishes a Department on Aging as of January 1, 2007, headed by a commissioner appointed by the governor. (Subsequently, PA 06-188 postponed the department's establishment to July 1, 2007. ) The act transfers the functions, powers, duties, and personnel of the DSS Division of Elderly Services to the Department on Aging. (This division was merged into a larger Bureau of Aging, Community, and Social Work Services a few years ago. )

The bill 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 for the program. The program serves legal immigrants who do not qualify for the federal program.

The bill requires the DSS commissioner, in consultation with the OPM commissioner and within available appropriations, to increase the target amount per discharge used to reimburse hospitals for providing inpatient services to Medicaid recipients to $ 4,200 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.

For FY 08, the bill 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 necessary 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 such continuation is determined necessary by the DSS commissioner, in consultation with DPH, OHCA, and the Connecticut Health and Educational Facilities Authority.

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

§ 29 — PILOT HOME CARE PROGRAM FOR PEOPLE WITH DISABILITIES AGED 18 T0 64

The bill 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 disabled people age 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.

1. requires anyone participating in the pilot program who has income 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 designed to serve applicants in the order of their application date if more than 50 people are eligible for the program or if the pilot's cost exceeds available appropriations.

By law, the Department of Public Health (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 (i. e. , managed residential communities). These facilities are not licensed, but they must meet certain DPH regulatory qualifications to be defined as a “managed residential community,” which is the only type of location where an ALSA is allowed to provide its services.

This bill places additional requirements on the managed residential community (MRC). It delineates the 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 bill's requirements. It (1) specifies what these reviews must include, (2) requires DPH to establish administrative procedures for preparation, completion, and transmittal of written reports prepared as part of the reviews; (3) requires DPH notice to the MRC of alleged violations of the bill; (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, on the MRC and (6) authorizes the attorney general, at the DPH commissioner's request, to enforce the orders in Superior Court.

The bill 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.

Under the bill, “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.

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 an entity licensed by DPH that provides, among other things, nursing services and help with activities of daily living to a population that is chronic and stable;

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.

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 bill 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 for the residents' protection and safety that is designed to protect them 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 bill 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 bill'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.

The bill 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 a n 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 bill allows DPH to review an MRC at any time it has probable cause to believe that it is violating the bill'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 bill and the regulations.

The bill 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 bill, 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 bill, 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 bill allows DPH to issue remedial orders it considers necessary to ensure an MRC's compliance with the bill'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 remedial order DPH issues, the attorney general, at the DPH commissioner's request, can apply to Hartford Superior Court to enforce the order. The bill 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.

The bill 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 other residents' 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. refuse care and treatment and participate in the planning for the care and services the resident needs or receives, provided the refusal of care and treatment may preclude the resident from continuing to live in the MRC;

18. all rights and privileges afforded tenants under the state's landlord-tenant law.

The bill 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.

The bill 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.

The bill 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'

*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