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statutes is repealed and the following is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the general statutes is repealed and the following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