House Bill No. 6721
               House Bill No. 6721

              PUBLIC ACT NO. 97-143


AN  ACT  CONCERNING  A  MANAGED  CARE  PROGRAM FOR
RECIPIENTS OF GENERAL ASSISTANCE.


    Be it enacted  by  the  Senate  and  House  of
Representatives in General Assembly convened:
    Section  1. Section  17b-257  of  the  general
statutes  is  repealed   and   the   following  is
substituted in lieu thereof:
    On and after July 1, 1998, the Commissioner of
Social Services shall  implement  a  state medical
assistance  program  for  persons  ineligible  for
medical  assistance  under   section   17b-107  or
sections 17b-260 to 17b-262, inclusive, 17b-264 to
17b-285,  inclusive,  and   17b-357   to  17b-362,
inclusive, and on  or  before  April  1, 1997, the
commissioner shall implement  said  program in the
towns in which  the  fourteen regional or district
offices of the  Department  of Social Services are
located.  The  commissioner   shall   establish  a
schedule for the transfer of recipients of medical
assistance administered by  towns  under  sections
17b-19, 17b-63 to  17b-65,  inclusive,  17b-115 to
17b-138, inclusive, 17b-220 to 17b-250, inclusive,
17b-256,  17b-259, 17b-263,  17b-287,  17b-340  to
17b-350, inclusive, 17b-689 to 17b-693, inclusive,
and 17b-743 to  17b-747,  inclusive,  to the state
program.    To   the    extent    possible,    the
administration  of the  state  medical  assistance
program  shall  parallel   that  of  the  Medicaid
program as it is administered to recipients of aid
to  families with  dependent  children,  including
eligibility criteria concerning income and assets.
Payment for medical  services  shall  be made only
for individuals determined  eligible. The rates of
payment for medical services shall be those of the
Medicaid program. Medical  services  covered under
the  program shall  be  those  covered  under  the
Medicaid  program,  except   long-term   care  and
services  available  pursuant   to   a   home  and
community-based services waiver under Section 1915
of the Social  Security  Act shall not be covered.
[Effective July 1,  1997,]  ON  OR  AFTER APRIL 1,
1997, the commissioner  shall  implement a managed
care program for  medical  services provided under
this program, except services provided pursuant to
section 17a-453a. NOTWITHSTANDING  THE  PROVISIONS
OF SECTIONS 4a-51  AND 4a-57, THE COMMISSIONER MAY
ENTER INTO CONTRACTS,  INCLUDING  BUT  NOT LIMITED
TO, PURCHASE OF  SERVICE  AGREEMENTS  TO IMPLEMENT
THE PROVISIONS OF THIS SECTION.
    Sec. 2. Subsection  (a)  of section 17b-259 of
the general statutes is repealed and the following
is substituted in lieu thereof:
    (a)   Each  town   shall   provide   medically
necessary  services  by   one  or  more  competent
physicians   for   all   persons   twenty-one   to
sixty-four years of  age who are receiving general
assistance benefits from such town, or eligible to
be supported by  such  town,  or unable to pay for
the same over a two-year period, when such persons
are in need  thereof,  and each town shall furnish
necessary  hospitalization,  in   accordance  with
section 17b-220, for  all  such  persons  if  such
persons have not  made,  within twenty-four months
prior to the  date of application for such aid, an
assignment or transfer  or  other  disposition  of
property for less  than fair market value, for the
purpose of establishing  eligibility  for benefits
or assistance under  sections  17b-19,  17b-63  to
17b-65, inclusive, 17b-115  to 17b-138, inclusive,
17b-220 to 17b-250,  inclusive,  17b-256, 17b-259,
17b-263, 17b-287, 17b-340  to  17b-350, inclusive,
17b-689  to 17b-693,  inclusive,  and  17b-743  to
17b-747, inclusive. Any  such disposition shall be
presumed to have  been  made  for  the  purpose of
establishing   eligibility   for    benefits    or
assistance unless such person furnishes convincing
evidence to establish  that  the  transaction  was
exclusively for some  other purpose. Ineligibility
because of such  disposition  shall  continue only
for either (1)  twenty-four  months after the date
of disposition or (2) that period of time from the
date of disposition  over  which  the  fair market
value of such  property,  less  any  consideration
received in exchange for its disposition, together
with all other income and resources, would furnish
support on a  reasonable  standard  of  health and
decency, whichever period  is shorter, except that
in  any case  where  the  uncompensated  value  of
disposed  of  resources  exceeds  twelve  thousand
dollars, the Commissioner of Social Services shall
provide for a period of ineligibility based on the
uncompensated  value  which   exceeds  twenty-four
months.  The  ability  of  a  person  to  pay  for
medically  necessary  services   over  a  two-year
period shall be determined by a town in accordance
with  regulations adopted  by  the  Department  of
Social Services in  accordance with the provisions
of chapter 54,  provided  income  in excess of the
maximum income levels established pursuant to such
regulations  and  any  assets  in  excess  of  two
hundred  fifty dollars  shall  be  applied  toward
medical bills incurred  during the two-year period
and  assistance shall  be  granted  only  for  the
remaining  balance  of   the   cost  of  medically
necessary  services.  Any  recipient  who  becomes
ineligible  for benefits  under  sections  17b-19,
17b-63 to 17b-65,  inclusive,  17b-115 to 17b-138,
inclusive, 17b-220 to 17b-250, inclusive, 17b-256,
17b-259,  17b-263, 17b-287,  17b-340  to  17b-350,
inclusive,  17b-689  to  17b-693,  inclusive,  and
17b-743 to 17b-747,  inclusive,  due to employment
may continue to  receive medical assistance for up
to three months.  Persons under twenty-one or over
sixty-four years of age who are otherwise eligible
under  this  section  and  who  have  applied  for
Medicaid but have not yet been determined eligible
by the Department  of Social Services, may receive
assistance   under  this   section.   Any   person
receiving  medical  treatment  or  hospitalization
under this section  shall  make  to  the selectmen
full  disclosure of  his  financial  condition  as
provided   in   section   17b-123.   A   completed
application  for  medical  assistance  under  this
section  may  be   filed  by  the  person  seeking
assistance, a member  of  such  person's immediate
family  or  a   medical   provider,   including  a
physician or a  hospital,  within  sixty  days  of
commencement of treatment  or  hospitalization.  A
town shall be  liable  for  medical bills only for
those persons whose  eligibility can be determined
in accordance with  standards established pursuant
to  section  17b-78,   and   those  persons  under
twenty-one or over sixty-four years of age who are
otherwise eligible under this section and who have
applied  for  Medicaid   but  have  not  yet  been
determined eligible by  the  Department  of Social
Services. No applicant  who  may be eligible for a
third-party  payment  to  which  he  is  entitled,
including private insurance,  hospital  or medical
service corporation benefits,  veterans' benefits,
Medicare  and  medical   assistance   pursuant  to
sections 17b-260 to 17b-262, inclusive, 17b-264 to
17b-285,  inclusive,  and   17b-357   to  17b-362,
inclusive,   shall   be   eligible   for   general
assistance medical aid  until he has completed the
application  process for  such  benefits.  On  and
after October 1,  1991, a town shall not be liable
for payment of  the  applicant's  medical bills if
the   applicant  fails   to   provide   sufficient
documentation  to determine  his  eligibility  for
such benefits. Failure  of  a  person or a legally
liable relative of  the person to cooperate in the
general assistance application  process  shall not
prevent payment to a medical provider for services
rendered to the  person if adequate information is
otherwise  available  to  determine  the  person's
eligibility under this  section. ON OR AFTER APRIL
1,  1997,  THE   COMMISSIONER  SHALL  IMPLEMENT  A
MANAGED CARE PROGRAM FOR MEDICAL SERVICES PROVIDED
UNDER  THIS  PROGRAM,   EXCEPT  SERVICES  PROVIDED
PURSUANT TO SECTION  17a-453a. NOTWITHSTANDING THE
PROVISIONS  OF  SECTIONS   4a-51  AND  4a-57,  THE
COMMISSIONER MAY ENTER  INTO  CONTRACTS, INCLUDING
BUT NOT LIMITED TO, PURCHASE OF SERVICE AGREEMENTS
TO IMPLEMENT THE PROVISIONS OF THIS SECTION.
    Sec.  3.  Section   17a-453a  of  the  general
statutes  is  repealed   and   the   following  is
substituted in lieu thereof:
    The   Commissioner  of   Mental   Health   and
Addiction Services shall operate a program to: (1)
Provide consistent and  appropriate treatment to a
general assistance recipient  who is mentally ill,
a substance abuser  or  both; (2) reduce treatment
costs   for   such   recipients;   (3)   eliminate
duplicated services provided  to  such recipients;
and (4) assist  such  recipients  in  applying for
federally funded programs. Said commissioner shall
adopt regulations, in  accordance with chapter 54,
to implement said [pilot] program.
    Sec. 4. This  act  shall  take effect from its
passage.

Approved June 13, 1997