AN ACT CONCERNING MEDICAID ELIGIBILITY AND REIMBURSEMENT.

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

Section 1. Section 17b-261 of the 2008 supplement to the general statutes is amended by adding subsections (j) and (k) as follows (Effective July 1, 2008):

(NEW) (j) The Commissioner of Social Services shall implement presumptive eligibility for persons applying for Medicaid. Such presumptive eligibility determinations shall be in accordance with applicable federal law and regulations. The commissioner shall adopt regulations, in accordance with chapter 54, to establish standards and procedures for the designation of organizations as qualified entities to grant presumptive eligibility. Qualified entities shall ensure that, at the time a presumptive eligibility determination is made, a completed application for Medicaid is submitted to the department for a full eligibility determination.

(NEW) (k) To the extent permitted by federal law, for purposes of determining Medicaid eligibility for an institutionalized individual, as defined in Section 1917(c) of the Social Security Act, 42 USC 1396p(c), the Department of Social Services shall exclude from consideration an asset owned by that individual if: (1) The individual has an outstanding debt to an institution for care and services that have been provided to the individual that is equal to or more than the value of the asset; (2) the individual demonstrates that he or she is making a bona fide effort to dispose of the asset for fair market value or liquidate such asset and the reason that the asset cannot be disposed of or liquidated is either (A) due to a delay on the part of a financial institution or insurance company; (B) a delay due to the need for the appointment of a conservator for the individual; or (C) a delay due to other circumstances beyond the control of the individual as determined by the commissioner; (3) the amount of the asset does not exceed ten thousand dollars or an amount in excess of ten thousand dollars as approved by the commissioner and does not consist of the corpus of a trust that may be liquidated at the discretion of the trustee; and (4) the individual demonstrates that he or she has agreed to pay the institution that which is necessary to repay such debt upon receipt of the fair market value or liquidation of the asset.

Sec. 2. Section 17b-276 of the general statutes is repealed and the following is substituted in lieu thereof (Effective July 1, 2008):

(a) The Commissioner of Social Services shall identify geographic areas of the state where competitive bidding for nonemergency transportation services provided to medical assistance recipients to access covered medical services would result in cost savings to the state. For the identified areas, the Commissioner of Social Services, in consultation with the Commissioner of Transportation, the Commissioner of Public Health and the Secretary of the Office of Policy and Management, shall purchase such nonemergency transportation services through a competitive bidding process. Any transportation providers awarded a contract or subcontract for the direct provision of such services shall meet state licensure or certification requirements and the nonemergency transportation requirements established by the Department of Social Services, and shall provide the most cost effective transportation service, provided any contractor awarded a contract solely for coordinating such transportation services shall not be required to meet such licensure or certification requirements and provided the first such contracts for the purchase of such services shall not exceed one year. Prior to awarding a contract pursuant to this section, the Commissioner of Social Services shall consider the effect of the contract on the emergency ambulance primary service areas and volunteer ambulance services affected by the contract. The commissioner may limit the geographic areas to be served by a contractor and may limit the amount of services to be performed by a contractor. The commissioner may operate one or more pilot programs prior to state-wide operation of a competitive bidding program for nonemergency transportation services. By enrolling in the Medicaid program or participating in the competitively bid contract for nonemergency transportation services, providers of nonemergency transportation services agree to offer to recipients of medical assistance all types or levels of transportation services for which they are licensed or certified. Effective October 1, 1991, payment for such services shall be made only for services provided to an eligible recipient who is actually transported. A contract entered into pursuant to this section may include services provided by another state agency. Notwithstanding any provision of the general statutes, a contract entered into pursuant to this section shall establish the rates to be paid for the transportation services provided under the contract. A contract entered into pursuant to this section may include services provided by another state agency and shall supersede any conflicting provisions of the regulations of Connecticut state agencies pertaining to medical transportation services. Any contractor awarded a contract solely for coordinating nonemergency transportation services for medical assistance recipients, who also coordinates transportation services for nonmedical assistance recipients, shall disclose to any transportation provider with whom it subcontracts to provide nonemergency transportation services under this section the source of payment at the time the service is requested.

(b) Notwithstanding any other provision of the general statutes, for purposes of administering medical assistance programs, including, but not limited to, the state-administered general assistance program and programs administered pursuant to Title XIX or Title XXI of the Social Security Act, the Department of Social Services shall be the sole state agency that sets emergency and nonemergency medical transportation fees or fee schedules for any transportation services that are reimbursed by the department for said medical assistance programs.

Sec. 3. (NEW) (Effective July 1, 2008) (a) The Commissioner of Social Services shall provide coverage under the Medicaid program for nonemergency transportation by ambulance without prior authorization for a patient who is: (1) Discharged from an acute care hospital, long-term acute care hospital, psychiatric facility or rehabilitation facility, and admitted as a new admission to another facility, including a residential care facility, skilled nursing facility, psychiatric facility, rehabilitation facility or long-term acute care hospital, where prior authorization has been granted for the new admission; (2) discharged from an acute care hospital, long-term acute care hospital, psychiatric facility or rehabilitation facility, and returned to his or her residence in a residential care facility, skilled nursing facility, psychiatric facility, rehabilitation facility or long-term acute care hospital; or (3) transported to a doctor's office, treatment facility or testing facility either free standing or within a hospital, provided one of the following conditions is met: (A) The patient is on oxygen not available to the patient except by ambulance, (B) the patient is unable to sit in a wheelchair or tolerate any other means of transport other than a stretcher due to risk of injury, or (C) the patient's medical condition requires monitoring by trained personnel.

(b) The commissioner shall ensure that personnel are available twenty-four hours a day, seven days a week for purposes of the prior authorization required for the nonemergency transportation by ambulance of patients not described in subsection (a) of this section.

Sec. 4. Section 17b-242 of the general statutes is repealed and the following is substituted in lieu thereof (Effective July 1, 2008):

(a) The Department of Social Services shall determine the rates to be paid to home health care agencies and homemaker-home health aide agencies by the state or any town in the state for persons aided or cared for by the state or any such town. [For the period from February 1, 1991, to January 31, 1992, inclusive, payment for each service to the state shall be based upon the rate for such service as determined by the Office of Health Care Access, except that for those providers whose Medicaid rates for the year ending January 31, 1991, exceed the median rate, no increase shall be allowed. For those providers whose rates for the year ending January 31, 1991, are below the median rate, increases shall not exceed the lower of the prior rate increased by the most recent annual increase in the consumer price index for urban consumers or the median rate. In no case shall any such rate exceed the eightieth percentile of rates in effect January 31, 1991, nor shall any rate exceed the charge to the general public for similar services. Rates effective February 1, 1992, shall be based upon rates as determined by the Office of Health Care Access, except that increases shall not exceed the prior year's rate increased by the most recent annual increase in the consumer price index for urban consumers and rates effective February 1, 1992, shall remain in effect through June 30, 1993. Rates effective July 1, 1993, shall be based upon rates as determined by the Office of Health Care Access except if the Medicaid rates for any service for the period ending June 30, 1993, exceed the median rate for such service, the increase effective July 1, 1993, shall not exceed one per cent. If the Medicaid rate for any service for the period ending June 30, 1993, is below the median rate, the increase effective July 1, 1993, shall not exceed the lower of the prior rate increased by one and one-half times the most recent annual increase in the consumer price index for urban consumers or the median rate plus one per cent.] The Commissioner of Social Services shall establish a fee schedule for home health services. [to be effective on and after July 1, 1994.] The commissioner [may] shall annually increase any fee in the fee schedule based on [an increase in the cost of services. The commissioner shall increase the fee schedule for home health services provided under the Connecticut home-care program for the elderly established under section 17b-342, effective July 1, 2000, by two per cent over the fee schedule for home health services for the previous year] the increase, if any, in the consumer price index for urban consumers. The commissioner may increase any fee payable to a home health care agency or homemaker-home health aide agency upon the application of such an agency evidencing extraordinary costs related to (1) serving persons with AIDS; (2) high-risk maternal and child health care; (3) escort services; or (4) extended hour services. In no case shall any rate or fee exceed the charge to the general public for similar services. A home health care agency or homemaker-home health aide agency which, due to any material change in circumstances, is aggrieved by a rate determined pursuant to this subsection may, [within] not later than ten days [of] after receipt of written notice of such rate from the Commissioner of Social Services, request in writing a hearing on all items of aggrievement. The commissioner shall, upon the receipt of all documentation necessary to evaluate the request, determine whether there has been such a change in circumstances and shall conduct a hearing if appropriate. The Commissioner of Social Services shall adopt regulations, in accordance with chapter 54, to implement the provisions of this subsection. The commissioner, pursuant to section 17b-10, may implement policies and procedures to carry out the provisions of this subsection while in the process of adopting regulations, provided notice of intent to adopt the regulations is published in the Connecticut Law Journal [within] not later than twenty days [of implementing the] after implementation of such policies and procedures. Such policies and procedures shall be valid [for not longer than nine months] until the time final regulations are adopted.

(b) The Department of Social Services shall monitor the rates charged by home health care agencies and homemaker-home health aide agencies. Such agencies shall file annual cost reports and service charge information with the department.

(c) The home health services fee schedule shall include fees for a skilled nursing visit, which shall apply (1) when a patient has one or more active medical conditions requiring the attention of a nurse, or (2) when a patient has been diagnosed with a serious and persistent mental illness that requires the interventions of a psychiatric nurse. A skilled nursing visit shall include, but not be limited to, assessment and monitoring of blood pressure readings, blood glucose checks, pulse rate checks, execution of any medical regimen under the direction of a physician licensed in this state or a state that borders this state and, in the case of any patient with a serious and persistent mental illness, mental status assessment and the teaching of symptom management techniques.

[(c)] (d) The home health services fee schedule shall include a fee for the administration of medication, which shall apply when the purpose of a nurse's visit is limited to the administration of medication. [Administration of medication may include, but is not limited to, blood pressure checks, glucometer readings, pulse rate checks and similar indicators of health status.] The fee for medication administration shall include administration of medications while the nurse is present, the pre-pouring of additional doses that the client will self-administer at a later time and the teaching of self-administration. [The department shall not pay for medication administration in addition to any other nursing service at the same visit. The department may establish prior authorization requirements for this service. Before implementing such change, the Commissioner of Social Services shall consult with the chairpersons of the joint standing committees of the General Assembly having cognizance of matters relating to public health and human services.] When the purpose of a nurse's visit is other than the administration of medication, the visit shall be reimbursed at the skilled nursing visit fee established under subsection (c) of this section.

[(d) The home health services fee schedule established pursuant to subsection (c) of this section shall include rates for psychiatric nurse visits.]

(e) The Department of Social Services, when processing or auditing claims for reimbursement submitted by home health care agencies and homemaker-home health aide agencies shall, in accordance with the provisions of chapter 15, accept electronic records and records bearing the electronic signature of a licensed physician or licensed practitioner of a healthcare profession that has been submitted to the home health care agency or homemaker home-health aide agency.

(f) If the electronic record or signature that has been transmitted to a home health care agency or homemaker-home health aide agency is illegible or the department is unable to determine the validity of such electronic record or signature, the department shall review additional evidence of the accuracy or validity of the record or signature, including, but not limited to, (1) the original of the record or signature, or (2) a written statement, made under penalty of false statement, from (A) the licensed physician or licensed practitioner of a health care profession who signed such record, or (B) if such licensed physician or licensed practitioner of a health care profession is unavailable, the medical director of the agency verifying the accuracy or validity of such record or signature, and the department shall make a determination whether the electronic record or signature is valid.

(g) The Department of Social Services, when auditing claims submitted by home health care agencies and homemaker-home health aide agencies, shall consider any signature from a licensed physician or licensed practitioner of a health care profession that may be required on a plan of care for home health services, to have been provided in timely fashion if (1) the document bearing such signature was signed prior to the time when such agency seeks reimbursement from the department for services provided, and (2) verbal or telephone orders from the licensed physician or licensed practitioner of a health care profession were received prior to the commencement of services covered by the plan of care and such orders were subsequently documented. Nothing in this subsection shall be construed as limiting the powers of the Commissioner of Public Health to enforce the provisions of sections 19-13-D73 and 19-13-D74 of the regulations of Connecticut state agencies and 42 CFR 484.18(c).

(h) Not later than October 1, 2009, the Commissioner of Social Services shall establish a fee schedule and billing codes for the cost of supplies and administration of influenza and pneumoccal polysaccharide vaccines provided by nurses employed by a licensed home health care or homemaker-home health aide agency to persons eligible for benefits under Title XIX of the Social Security Act, and not otherwise eligible for coverage for such vaccines under Title XVIII of the Social Security Act. Such fees and billing requirements shall be identical to those for mass immunizers under Title XVIII of the Social Security Act.

[(h)] (i) For purposes of this section, "licensed practitioner of a healthcare profession" has the same meaning as "licensed practitioner" in section 21a-244a. For purposes of subsections (c), (d) and (h) of this section, "nurse" means an advanced practice nurse, registered nurse or practical nurse licensed under chapter 378.

Sec. 5. (Effective July 1, 2008) For the fiscal year ending on June 30, 2009, the Commissioner of Social Services shall increase the rates paid to home health care agencies and homemaker-home health aide agencies under the Medicaid program for nursing services, extended hourly nursing services, therapy and home health aide services by not less than twenty-nine per cent of the rate paid by the Department of Social Services for such services on June 30, 2008.

Sec. 6. (NEW) (Effective July 1, 2008) (a) On or before January 1, 2009, the Department of Social Services shall establish a two-year pilot program to investigate the feasibility and appropriateness of using telemonitors to manage and treat up to one hundred fifty Medicaid fee-for-service patients in the community with (1) congestive heart failure, (2) diabetes, its indicative conditions, or both, and (3) chronic obstructive pulmonary disease. The Commissioner of Social Services shall contract through a request for proposals process with no fewer than six home health agencies to operate the pilot program in accordance with this section. Each proposal shall include a detailed description of the entity's plan for administering the pilot program and methods and procedures for data collection and reporting.

(b) In selecting patients to participate in the pilot program under this section, each contracted home health agency shall consider the following factors: (1) The nature of the patient's medical condition and whether such medical condition requires health care services of unusually high frequency, urgency or duration, (2) the patient's cognitive ability, (3) whether the patient resides in a medically underserved area, and (4) whether the patient has support from a relative or other caregiver.

(c) Not later than December 31, 2011, the Commissioner of Social Services shall evaluate the pilot program established under this section and shall submit a report, in accordance with section 11-4a of the general statutes, of the commissioner's findings and recommendations to the joint standing committees of the General Assembly having cognizance of matters relating to human services and public health. Such report shall include an evaluation of the data collected with respect to improved chronic disease management and cost savings based on patient outcomes.

Sec. 7. Section 17b-340 of the 2008 supplement to the general statutes is amended by adding subsection (j) as follows (Effective July 1, 2008):

(NEW) (j) For the fiscal year ending June 30, 2009, and each fiscal year thereafter, the Commissioner of Social Services shall increase the rate of reimbursement for rest homes with nursing supervision to a rate that is eighty-five per cent of the rate paid by the department to chronic and convalescent nursing homes, provided such rate shall not exceed the private pay rate for such rest homes with nursing supervision.

Sec. 8. Subdivision (5) of subsection (f) of section 17b-340 of the 2008 supplement to the general statutes is repealed and the following is substituted in lieu thereof (Effective July 1, 2008):

(5) For the purpose of determining allowable fair rent, a facility with allowable fair rent less than the twenty-fifth percentile of the state-wide allowable fair rent shall be reimbursed as having allowable fair rent equal to the twenty-fifth percentile of the state-wide allowable fair rent, provided for the fiscal years ending June 30, 1996, and June 30, 1997, the reimbursement may not exceed the twenty-fifth percentile of the state-wide allowable fair rent for the fiscal year ending June 30, 1995. On and after July 1, [1998] 2008, the Commissioner of Social Services [may] shall allow minimum fair rent as the basis upon which reimbursement associated with improvements to real property is added. Beginning with the fiscal year ending June 30, 1996, any facility with a rate of return on real property other than land in excess of eleven per cent shall have such allowance revised to eleven per cent. Effective July 1, 2008, any chronic and convalescent nursing home and rest home with nursing supervision that has fully amortized (A) the base value of its original real property, other than land, or (B) the base value of its real property, other than land, for property additions associated with an increase in bed capacity in such facility shall have the fair rental allowance for the use of such real property replaced with the lesser of: (i) A value equal to twelve dollars multiplied by the facility's total annual resident days, or (ii) the previous fair rental allowance received for such real property other than land. In no event shall a facility receive allowable fair rent less than the twenty-fifth percentile of the state-wide allowable fair rent. Any facility or its related realty affiliate which finances or refinances debt through bonds issued by the State of Connecticut Health and Education Facilities Authority shall report the terms and conditions of such financing or refinancing to the Commissioner of Social Services within thirty days of completing such financing or refinancing. The Commissioner of Social Services may revise the facility's fair rent component of its rate to reflect any financial benefit the facility or its related realty affiliate received as a result of such financing or refinancing, including, but not limited to, reductions in the amount of debt service payments or period of debt repayment. The commissioner shall allow actual debt service costs for bonds issued by the State of Connecticut Health and Educational Facilities Authority if such costs do not exceed property costs allowed pursuant to subsection (f) of section 17-311-52 of the regulations of Connecticut state agencies, provided the commissioner may allow higher debt service costs for such bonds for good cause. For facilities which first open on or after October 1, 1992, the commissioner shall determine allowable fair rent for real property other than land based on the rate of return for the cost year in which such bonds were issued. The financial benefit resulting from a facility financing or refinancing debt through such bonds shall be shared between the state and the facility to an extent determined by the commissioner on a case-by-case basis and shall be reflected in an adjustment to the facility's allowable fair rent.

Sec. 9. Subdivision (1) of subsection (d) of section 19a-537 of the general statutes is repealed and the following is substituted in lieu thereof (Effective July 1, 2008):

(1) A facility shall be reimbursed for reserving the bed of a resident who is hospitalized for a maximum of seven days including the admission date of hospitalization, if on such date the nursing home documents that (A) it has a vacancy rate of not more than [three] six beds or [three] six per cent of licensed capacity, whichever is greater, and (B) it contacted the hospital and the hospital failed to provide objective information confirming that the person would be unable to return to the nursing home within fifteen days of the date of hospitalization.

Sec. 10. Subsection (a) of section 17b-354 of the 2008 supplement to the general statutes is repealed and the following is substituted in lieu thereof (Effective July 1, 2008):

(a) Except for applications deemed complete as of August 9, 1991, the Department of Social Services shall not accept or approve any requests for additional nursing home beds or modify the capital cost of any prior approval for the period from September 4, 1991, through June 30, 2012, except (1) beds restricted to use by patients with acquired immune deficiency syndrome or traumatic brain injury; (2) beds associated with a continuing care facility which guarantees life care for its residents; (3) Medicaid certified beds to be relocated from one licensed nursing facility to another licensed nursing facility, provided (A) the availability of beds in an area of need will not be adversely affected; (B) no such relocation shall result in an increase in state expenditures; and (C) the relocation results in a reduction in the number of nursing facility beds in the state; (4) a request for no more than twenty beds submitted by a licensed nursing facility that participates in neither the Medicaid program nor the Medicare program, admits residents and provides health care to such residents without regard to their income or assets and demonstrates its financial ability to provide lifetime nursing home services to such residents without participating in the Medicaid program to the satisfaction of the department, provided the department does not accept or approve more than one request pursuant to this subdivision; [and] (5) a request for no more than twenty beds associated with a free standing facility dedicated to providing hospice care services for terminally ill persons operated by an organization previously authorized by the Department of Public Health to provide hospice services in accordance with section 19a-122b of the 2008 supplement to the general statutes; and (6) new or existing Medicaid certified beds to be relocated from a licensed nursing facility in a municipality, with a 2004 estimated population of one hundred twenty-five thousand, to a location within the same municipality provided such Medicaid certified beds do not exceed sixty beds. Notwithstanding the provisions of this subsection, any provision of the general statutes or any decision of the Office of Health Care Access, (i) the date by which construction shall begin for each nursing home certificate of need in effect August 1, 1991, shall be December 31, 1992, (ii) the date by which a nursing home shall be licensed under each such certificate of need shall be October 1, 1995, and (iii) the imposition of such dates shall not require action by the Commissioner of Social Services. Except as provided in subsection (c) of this section, a nursing home certificate of need in effect August 1, 1991, shall expire if construction has not begun or licensure has not been obtained in compliance with the dates set forth in subparagraphs (i) and (ii) of this subsection.

Sec. 11. Subsection (d) of section 17b-99 of the 2008 supplement to the general statutes is repealed and the following is substituted in lieu thereof (Effective July 1, 2008):

(d) The Commissioner of Social Services, or any entity with whom the commissioner contracts, for the purpose of conducting an audit of a service provider that participates as provider of services in a program operated or administered by the department pursuant to this chapter or chapter 319t, 319v, 319y or 319ff, shall conduct any such audit in accordance with the provisions of this subsection. For purposes of this subsection "provider" means a person, public agency, private agency or proprietary agency that is licensed, certified or otherwise approved by the commissioner to supply services authorized by the programs set forth in said chapters.

(1) Not less than thirty days prior to the commencement of any such audit, the commissioner, or any entity with whom the commissioner contracts to conduct an audit of a participating provider, shall provide written notification of the audit to such provider, unless the commissioner, or any entity with whom the commissioner contracts to conduct an audit of a participating provider makes a good faith determination that (A) the health or safety of a recipient of services is at risk; or (B) the provider is engaging in vendor fraud.

(2) Any such audit shall be limited in scope to claims during the period commencing two calendar years prior to the date of the written notice provided pursuant to subdivision (1) of this subsection and ending on the date of such notice and shall not exceed more than two hundred claims for such period of time.

[(2)] (3) Any clerical error, including, but not limited to, recordkeeping, typographical, scrivener's or computer error, discovered in a record or document produced for any such audit, shall not of itself constitute a wilful violation of program rules and shall not be used as the basis for extrapolated projections unless proof of intent to commit fraud or otherwise violate program rules is established.

[(3)] (4) A finding of overpayment or underpayment to a provider in a program operated or administered by the department pursuant to this chapter or chapter 319t, 319v, 319y or 319ff, shall not be based on extrapolated projections unless the rate of payment error exceeds ten per cent and the commissioner makes a written finding that (A) there is a sustained or high level of payment error involving the provider, or (B) documented educational intervention has failed to correct the level of payment error. [, or (C) the value of the claims in aggregate exceeds one hundred fifty thousand dollars on an annual basis.]

[(4)] (5) A provider, in complying with the requirements of any such audit, shall be allowed not less than thirty days to provide documentation in connection with any discrepancy discovered and brought to the attention of such provider in the course of any such audit.

[(5)] (6) The commissioner, or any entity with whom the commissioner contracts, for the purpose of conducting an audit of a provider of any of the programs operated or administered by the department pursuant to this chapter or chapter 319t, 319v, 319y or 319ff, shall produce a preliminary written report concerning any audit conducted pursuant to this subsection, and such preliminary report shall be provided to the provider that was the subject of the audit, not more than sixty days after the conclusion of such audit.

[(6)] (7) The commissioner, or any entity with whom the commissioner contracts, for the purpose of conducting an audit of a provider of any of the programs operated or administered by the department pursuant to this chapter or chapter 319t, 319v, 319y or 319ff, shall, following the issuance of the preliminary report pursuant to subdivision [(5)] (6) of this subsection, hold an exit conference with any provider that was the subject of any audit pursuant to this subsection for the purpose of discussing the preliminary report.

[(7)] (8) The commissioner, or any entity with which the commissioner contracts, for the purpose of conducting an audit of a service provider, shall produce a final written report concerning any audit conducted pursuant to this subsection. Such final written report shall be provided to the provider that was the subject of the audit not more than sixty days after the date of the exit conference conducted pursuant to subdivision [(6)] (7) of this subsection, unless the commissioner, or any entity with which the commissioner contracts, for the purpose of conducting an audit of a service provider, agrees to a later date or there are other referrals or investigations pending concerning the provider.

[(8)] (9) Any provider aggrieved by a decision contained in a final written report issued pursuant to subdivision [(7)] (8) of this subsection, may, not later than thirty days after the receipt of the final report, request, in writing, a review on all items of aggrievement. Such request shall contain a detailed written description of each specific item of aggrievement. The [designee of] person designated by the commissioner [who presides] to preside over the review shall, prior to such review, conduct a hearing on the merits of the provider's request for review. The designee of the commissioner shall be impartial and shall not be an employee of the Department of Social Services Office of Quality Assurance or an employee of an entity with whom the commissioner contracts for the purpose of conducting an audit of a service provider. The designee of the commissioner shall issue a decision not later than thirty days after the conclusion of the hearing. Any provider aggrieved by a decision of the commissioner's designee may appeal such decision to the Superior Court in accordance with the provisions of chapter 54.

[(9)] (10) The provisions of this subsection shall not apply to any audit conducted by the Medicaid Fraud Control Unit established within the Office of the Chief State's Attorney.

(11) The commissioner shall adopt regulations, in accordance with chapter 54, to carry out the provisions of this subsection. The commissioner shall attach a copy of such regulations with the written notification of the audit to the provider under subdivision (1) of this subsection.

Sec. 12. Section 17b-278a of the general statutes is repealed and the following is substituted in lieu thereof (Effective July 1, 2008):

The Commissioner of Social Services shall amend the Medicaid state plan to provide coverage for treatment for smoking cessation ordered by a licensed healthcare professional who possesses valid and current state licensure to prescribe such drugs. [in accordance with a plan developed by the commissioner to provide smoking cessation services. The commissioner shall present such plan to the joint standing committees of the General Assembly having cognizance of matters relating to human services and appropriations by January 1, 2003, and, if such plan is approved by said committees and funding is provided in the budget for the fiscal year ending June 30, 2004, such plan shall be implemented on July 1, 2003.]

Sec. 13. Section 17b-261a of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2008):

(a) [Any] Except as provided in subsection (d) of this section, any transfer or assignment of assets resulting in the imposition of a penalty period shall be presumed to be made with the intent, on the part of the transferor or the transferee, to enable the transferor to obtain or maintain eligibility for medical assistance. This presumption may be rebutted only by clear and convincing evidence that the transferor's eligibility or potential eligibility for medical assistance was not a basis for the transfer or assignment.

(b) Any transfer or assignment of assets resulting in the establishment or imposition of a penalty period shall create a debt, as defined in section 36a-645, that shall be due and owing by the transferor or transferee to the Department of Social Services in an amount equal to the amount of the medical assistance provided to or on behalf of the transferor on or after the date of the transfer of assets, but said amount shall not exceed the fair market value of the assets at the time of transfer. The Commissioner of Social Services, the Commissioner of Administrative Services and the Attorney General shall have the power or authority to seek administrative, legal or equitable relief as provided by other statutes or by common law.

(c) The Commissioner of Social Services may waive the imposition of a penalty period when the transferor (1) in accordance with the provisions of section 3025.25 of the department's Uniform Policy Manual, suffers from dementia at the time of application for medical assistance and cannot explain transfers that would otherwise result in the imposition of a penalty period; or (2) suffered from dementia at the time of the transfer; or (3) was exploited into making such a transfer due to dementia. Waiver of the imposition of a penalty period does not prohibit the establishment of a debt in accordance with subsection (b) of this section.

(d) An uncompensated transfer of assets made by the donation of a conservation easement or conservation restriction that qualifies as a qualified conservation contribution under Section 170(h) of the Internal Revenue Code of 1986, or any subsequent corresponding internal revenue code of the United States, as amended from time to time, shall be presumed not to have been made for the purpose of qualifying for medical assistance. The Commissioner of Social Services may rebut this presumption by clear and convincing evidence that the donation of the qualified conservation contribution was in fact made for such purpose.

[(d)] (e) The Commissioner of Social Services, pursuant to section 17b-10, shall implement the policies and procedures necessary to carry out the provisions of this section while in the process of adopting such policies and procedures in regulation form, provided notice of intent to adopt regulations is published in the Connecticut Law Journal not later than twenty days after implementation. Such policies and procedures shall be valid until the time final regulations are effective.

Sec. 14. (NEW) (Effective July 1, 2008) (a) There is established within the General Fund, a separate, nonlapsing account to be known as the state Medicaid pending pool account. The account shall contain all moneys required by law to be deposited in the account.

(b) Moneys held in the account shall be used by the Department of Social Services to advance payments to nursing home facilities, as defined in section 19a-521 of the general statutes, certified to participate in the Medicaid program, to cover the cost of care provided by such nursing home facilities to residents who have applied for the Medicaid program and are awaiting approval by the Department of Social Services. Upon approval of such application, the Department of Social Services shall make the proper adjustments to the reimbursement methodology for such nursing home facility. The Commissioner of Social Services shall adopt regulations, in accordance with the provisions of chapter 54 of the general statutes, to establish criteria for the disbursement of funds pursuant to this section.

Sec. 15. Section 17b-343 of the general statutes is repealed and the following is substituted in lieu thereof (Effective July 1, 2008):

The Commissioner of Social Services shall establish annually the maximum allowable rate to be paid by said agencies for homemaker services, chore person services, companion services, respite care, meals on wheels, adult day care services, case management and assessment services, transportation, mental health counseling and elderly foster care, except that the maximum allowable rates in effect July 1, 1990, shall remain in effect during the fiscal years ending June 30, 1992, and June 30, 1993. The Commissioner of Social Services shall prescribe uniform forms on which agencies providing such services shall report their costs for such services. Such rates shall be determined on the basis of a reasonable payment for necessary services rendered. The maximum allowable rates established by the Commissioner of Social Services for the Connecticut home-care program for the elderly established under section 17b-342 shall constitute the rates required under this section until revised in accordance with this section. The Commissioner of Social Services shall establish a fee schedule, to be effective on and after July 1, 1994, for homemaker services, chore person services, companion services, respite care, meals on wheels, adult day care services, case management and assessment services, transportation, mental health counseling and elderly foster care. The commissioner may annually increase any fee in the fee schedule based on an increase in the cost of services. The commissioner shall increase the fee schedule effective July 1, 2000, by not less than five per cent, for adult day care services. The commissioner shall increase the fee schedule effective July 1, 2008, by not less than ____ per cent, for transportation services. Nothing contained in this section shall authorize a payment by the state to any agency for such services in excess of the amount charged by such agency for such services to the general public.

Sec. 16. (NEW) (Effective July 1, 2008) The Commissioner of Social Services shall establish and administer a pilot program that shall operate in an identical manner to the Money Follows the Person demonstration project pursuant to section 17b-369 of the 2008 supplement to the general statutes, except that persons need not be institutionalized for at least six months to be eligible for the program. The pilot program shall serve no more than fifty persons. Services available under the pilot program shall include, but not be limited to, personal care assistance services. The commissioner may apply for a Medicaid research and demonstration waiver under Section 1115 of the Social Security Act, if such waiver is necessary to implement the pilot program. The commissioner may, if necessary, modify any existing Medicaid home or community-based waiver if such modification is required to implement the pilot program.

Sec. 17. (Effective July 1, 2008) The sum of ____ dollars is appropriated to the Department of Mental Health and Addiction Services, from the General Fund, for the fiscal year ending June 30, 2009, for the purpose of increasing the rate of reimbursement to hospitals for inpatient and outpatient behavioral health visits under the state-administered general assistance program to equal the rate of reimbursement provided to hospitals for inpatient and outpatient visits under the Medicaid program.

Sec. 18. (Effective July 1, 2008) The sum of ____ dollars is appropriated to the Department of Social Services, from the General Fund, for the fiscal year ending June 30, 2009, for deposit in the state Medicaid pending pool account established pursuant to section 14 of this act.

Statement of Purpose:

To implement changes concerning eligibility and reimbursement for the Medicaid program.

[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline, except that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is not underlined.]