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Substitute House Bill No. 5912

Public Act No. 08-29

AN ACT CONCERNING THE REPEAL OF THE EMERGENCY ASSISTANCE PROGRAM ELIMINATED BY THE PERSONAL RESPONSIBILITY AND WORK OPPORTUNITY RECONCILIATION ACT.

Be it enacted by the Senate and House of Representatives in General Assembly convened:

Section 1. Section 19a-659 of the 2008 supplement to the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage):

As used in [sections 19a-659] this section, sections 19a-662, 19a-669 to 19a-670a, inclusive, as amended by this act, 19a-671 of the 2008 supplement to the general statutes, 19a-671a, 19a-672 of the 2008 supplement to the general statutes and 19a-676:

(1) "Office" means the Office of Health Care Access;

(2) "Hospital" means any hospital licensed as a short-term acute care general or children's hospital by the Department of Public Health, including John Dempsey Hospital of The University of Connecticut Health Center;

(3) "Fiscal year" means the hospital fiscal year consisting of a twelve-month period commencing on October first and ending the following September thirtieth;

(4) "Base year" means the fiscal year consisting of a twelve-month period immediately prior to the start of the fiscal year for which a budget is being determined or prepared;

(5) "Affiliate" means a person, entity or organization controlling, controlled by, or under common control with another person, entity or organization;

(6) "Uncompensated care" means the total amount of charity care and bad debts determined by using the hospital's published charges and consistent with the hospital's policies regarding charity care and bad debts which have been approved by, and are on file at, the office;

(7) "Medical assistance" means (A) the programs for medical assistance provided under the state-administered general assistance program or the Medicaid program, including the HUSKY Plan, Part A, or (B) any other state-funded medical assistance program, including the HUSKY Plan, Part B;

(8) "CHAMPUS" or "TriCare" means the federal Civilian Health and Medical Program of the Uniformed Services, as defined in 10 USC Section 1072(4), as from time to time amended;

(9) "Primary payer" means the payer responsible for the highest percentage of the charges for a patient's inpatient or outpatient hospital services;

(10) "Case mix index" means the arithmetic mean of the Medicare diagnosis related group case weights assigned to each inpatient discharge for a specific hospital during a given fiscal year. The case mix index shall be calculated by dividing the hospital's total case mix adjusted discharges by the hospital's actual number of discharges for the fiscal year. The total case mix adjusted discharges shall be calculated by (A) multiplying the number of discharges in each diagnosis-related group by the Medicare weights in effect for that same diagnosis-related group and fiscal year, and (B) then totaling the resulting products for all diagnosis-related groups;

(11) "Contractual allowances" means the difference between hospital published charges and payments generated by negotiated agreements for a different or discounted rate or method of payment;

(12) "Medical assistance underpayment" means the amount calculated by dividing the total net revenue by the total gross revenue, and then multiplying the quotient by the total medical assistance charges, and then subtracting medical assistance payments from the product;

(13) "Other allowances" means the amount of any difference between charges for employee self-insurance and related expenses determined using the hospital's overall relationship of costs to charges;

(14) "Gross revenue" means the total gross patient charges for all patient services provided by a hospital;

(15) "Net revenue" means total gross revenue less contractual allowance, less the difference between government charges and government payments, less uncompensated care and other allowances, plus uncompensated care program disproportionate share hospital payments from the Department of Social Services;

(16) "Emergency assistance to families" means assistance to families with children under the age of twenty-one who do not have the resources to independently provide the assistance needed to avoid the destitution of the child. [and which is authorized by the Department of Social Services pursuant to section 17b-107 and is not otherwise funded. ]

Sec. 2. Section 19a-669 of the 2008 supplement to the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage):

Effective October 1, 1993, and October first of each subsequent year, the Secretary of the Office of Policy and Management shall determine and inform the Office of Health Care Access of the maximum amount of disproportionate share payments and emergency assistance to families eligible for federal matching payments under the [Medical Assistance Program or the Emergency Assistance to Families Program] medical assistance program pursuant to federal statute and regulations and subdivisions (2) and (28) of subsection (a) of section 12-407 of the 2008 supplement to the general statutes, subdivision (1) of section 12-408, subdivision (5) of section 12-412 of the 2008 supplement to the general statutes, section 12-414, section 19a-649 of the 2008 supplement to the general statutes and this section and the actual and anticipated appropriation to the medical assistance disproportionate share-emergency assistance account authorized pursuant to sections 3-114i and 12-263a to 12-263e, inclusive, subdivisions (2) and (29) of subsection (a) of section 12-407 of the 2008 supplement to the general statutes, subdivision (1) of section 12-408, section 12-408a, subdivision (5) of section 12-412 of the 2008 supplement to the general statutes, subdivision (1) of section 12-414 and sections 19a-646 of the 2008 supplement to the general statutes, 19a-659 of the 2008 supplement to the general statutes, as amended by this act, 19a-662, 19a-669 to 19a-670a, inclusive, as amended by this act, 19a-671 of the 2008 supplement to the general statutes, 19a-671a, 19a-672 of the 2008 supplement to the general statutes, 19a-672a, 19a-673 and 19a-676, and the amount of emergency assistance to families' payments to eligible hospitals projected for the year, and the anticipated amount of any increase in payments made pursuant to any resolution of any civil action pending on April 1, 1994, in the United States district court for the district of Connecticut. The Department of Social Services shall inform the office of any amount of uncompensated care which the Department of Social Services determines is due to a failure on the part of the hospital to register patients for emergency assistance to families, or a failure to bill properly for emergency assistance to families' patients. If during the course of a fiscal year the Secretary of the Office of Policy and Management determines that these amounts should be revised, said secretary shall so notify the office and the office may modify its calculation pursuant to section 19a-671 of the 2008 supplement to the general statutes to reflect such revision and its orders as it deems appropriate and the Commissioner of Social Services may modify said commissioner's determination pursuant to section 19a-671 of the 2008 supplement to the general statutes.

Sec. 3. Section 19a-670 of the 2008 supplement to the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage):

(a) Within available appropriations, the Department of Social Services may make semimonthly payments to short-term general hospitals in an amount calculated pursuant to section 19a-671 of the 2008 supplement to the general statutes, provided the total amount of payments made to individual hospitals and to hospitals in the aggregate shall maximize the amount qualifying for federal matching payments under the medical assistance program [and the emergency assistance to families program] as determined by the Department of Social Services in consultation with the Office of Policy and Management. No payments shall be made to any hospital exempt from taxation under chapter 211a. The payments shall be medical assistance disproportionate share payments, including grants provided pursuant to section 19a-168k, to the extent allowable under federal law. [In addition, payments may be made for authorized emergency assistance to needy families with dependent children in accordance with Title IV-A of the Social Security Act to the extent allowable under federal law. ] The payments shall not be part of the routine medical assistance inpatient hospital rate determined pursuant to section 17b-239 of the 2008 supplement to the general statutes. Payments shall be made on an interim basis during each year and a final settlement shall be calculated pursuant to section 19a-671 of the 2008 supplement to the general statutes by the office for each hospital after the year end based on audited data for the hospitals. The Commissioner of Social Services may withhold payment to a hospital which is in arrears in remitting its obligations to the state.

(b) (1) For the hospital fiscal year 1994, and subsequent fiscal years, the commission or its designated representative shall conduct a cash audit of the projected amount of uncompensated care, including emergency assistance to families and underpayments against the actual receipts of the hospital. In addition, the office or its designated intermediary shall conduct an audit of the revenues, deductions from revenue, discharges, days or other measures of patient volume for hospitals for the purposes of termination and final settlement of uncompensated care pool assessments and payments for the period ending March 31, 1994.

(2) For the six-month period ending September 30, 1994, and for each subsequent fiscal year, the office or its designated intermediary shall conduct an audit of the revenues, deductions from revenue, discharges, days or other measures of patient volume for hospitals for the purposes of determining disproportionate share payments. Included in this audit shall be a comparison of projected and actual levels of medical assistance underpayment and uncompensated care.

(3) The total payments from the Department of Social Services medical assistance disproportionate share-emergency assistance account established pursuant to section 38 of public act 94-9* and made in accordance with sections 19a-670 to 19a-672, inclusive, as amended by this act, during the fiscal year less any payments for emergency assistance to families, and less any payments resulting from the resolution of or court order entered in any civil action pending on April 1, 1994, in the United States District Court for the district of Connecticut, shall be reallocated to hospitals based on actual audited levels of medical assistance underpayment, grants pursuant to section 19a-168k and uncompensated care to determine the final payment for the fiscal year.

(4) If the final payment for a hospital for the hospital fiscal year, as determined as a result of this audit, is less than the total payments the hospital received during the same fiscal year excluding any prior year audit adjustment, then the current hospital fiscal year remaining semimonthly payments shall each be reduced by an amount equal to the total excess payment divided by the number of remaining semimonthly payments for the current hospital fiscal year.

(5) If the final payment for a hospital for the hospital fiscal year, as determined as a result of this audit, is greater than the total payments the hospital received during the same fiscal year, then the current hospital fiscal year remaining semimonthly payments shall each be increased by an amount equal to the total excess payment divided by the number of remaining semimonthly payments for the current hospital fiscal year.

(6) The office shall, by June 1, 1995, and June first of each subsequent year, report the results of such audit for the previous hospital fiscal year to the joint standing committee of the General Assembly having cognizance of matters relating to public health. The report shall include information concerning the financial stability of hospitals in a competitive market.

(7) Notwithstanding the provisions of subdivisions (3) to (5), inclusive, of this subsection, no adjustment of disproportionate share payments to hospitals for purposes of final settlement shall be implemented for the hospital fiscal years commencing October 1, 1997, and October 1, 1998, provided every hospital subject to final settlement for said fiscal years submits documentation in writing of its agreement to forego such final settlement to the Commissioner of Social Services in a form acceptable to the commissioner.

(8) Notwithstanding the provisions of subdivisions (3) to (5), inclusive, of this subsection, for the hospital fiscal year commencing October 1, 1999, and for each subsequent fiscal year, no adjustment of disproportionate share payments to hospitals for purposes of final settlement shall be determined or implemented.

(9) For the quarter ending September 30, 2001, no negative adjustment to the disproportionate share payments to hospitals for purposes of implementing the final one-quarter of the disproportionate share final settlement for the hospital fiscal year commencing October 1, 1998, shall be made. Any hospitals with a positive adjustment to the disproportionate share payments for purposes of implementing the remaining one-quarter of the hospital fiscal year 1999 disproportionate share final settlement shall receive payment of the adjustment through funds appropriated for said purpose.

(10) The Department of Social Services may, within available appropriations and with the approval of the Office of Health Care Access and the Office of Policy and Management, make payment of any final settlement amount determined to represent any and all claims arising out of any incorrect payments to Yale-New Haven Hospital for the fiscal quarter ending September 30, 1998, or the hospital fiscal year ending September 30, 1999, or both. If such incorrect payment, whether an overpayment or an underpayment, has occurred as a result of the hospital's reporting incorrect information and statistics to the Office of Health Care Access, the Office of Health Care Access shall recompute the amount of any payments for the indicated time periods, offsetting any underpaid amount by the amount of any overpayment of funds for the indicated time period. Yale-New Haven Hospital shall submit all information and documentation determined necessary by the Office of Health Care Access to make a final determination of the amounts due. Prior to the release of any funds under this section, the hospital shall submit a written release in a form satisfactory to the Secretary of the Office of Policy and Management. The written release shall provide for settlement of any and all claims which have been or could have been brought challenging the amount of payment for the indicated periods. Nothing in this section shall be construed to relieve the hospital from any settlement or adjustments for any periods other than those identified in this section.

(c) The Commissioner of Social Services is authorized to determine exceptions, exemptions and adjustments in accordance with 42 CFR 413. 40.

(d) Nothing in section 3-114i, subdivision (2) or (29) of subsection (a) of section 12-407 of the 2008 supplement to the general statutes, subdivision (1) of section 12-408, section 12-408a, subdivision (5) of section 12-412 of the 2008 supplement to the general statutes, subdivision (1) of section 12-414, or sections 12-263a to 12-263e, inclusive, section 19a-646 of the 2008 supplement to the general statutes, 19a-659 of the 2008 supplement to the general statutes, as amended by this act, 19a-662 or 19a-669 to 19a-670a, inclusive, as amended by this act, 19a-671 of the 2008 supplement to the general statutes, 19a-671a, 19a-672 of the 2008 supplement to the general statutes, 19a-672a, 19a-673 and section 19a-676, or section 1, 2, or 38 of public act 94-9* shall be construed to require the Department of Social Services to pay out more funds than are appropriated pursuant to said sections.

Sec. 4. (Effective from passage) Section 17b-107 of the general statutes is repealed.

Approved April 29, 2008