Substitute Senate Bill No. 329
Substitute Senate Bill No. 329
PUBLIC ACT NO. 98-198
AN ACT ESTABLISHING A PILOT PROGRAM OF
ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE).
Be it enacted by the Senate and House of
Representatives in General Assembly convened:
Section 1. (NEW) (a) As used in this section:
(1) "Commissioner" means the Commissioner of
Social Services;
(2) "Eligible individual" means "PACE program
eligible individual", as defined in Subtitle I of
Public Law 105-33, as amended from time to time,
or in a waiver application approved by the United
States Department of Health and Human Services;
(3) "PACE program" means "PACE program", as
defined in Subtitle I of Public Law 105-33, as
amended from time to time, and includes a program
of all-inclusive care for the elderly;
(4) "PACE program agreement" means "PACE
program agreement", as defined in Subtitle I of
Public Law 105-33, as amended from time to time;
(5) "PACE provider" means "PACE provider", as
defined in Subtitle I of Public Law 105-33, as
amended from time to time;
(6) "Secretary" means the Secretary of the
United States Department of Health and Human
Services;
(7) "State administering agency" means "state
administering agency", as defined in Subtitle I of
Public Law 105-33, as amended from time to time.
(b) Not later than July 1, 1998, the
commissioner shall establish a pilot program in
which PACE providers deliver PACE program services
to eligible individuals in this state pursuant to
a PACE program agreement. Under said program, the
commissioner, in consultation with the Insurance
Commissioner, may initially enter into contracts
with integrated service networks which have
successfully completed a feasibility study, in
conjunction with a PACE technical assistance
center, for the provision of PACE program
services.
(c) The Department of Social Services shall be
the state administering agency for the state of
Connecticut responsible for administering PACE
program agreements in this state. The department,
upon request, shall assist the secretary in
establishing procedures for entering into,
extending and terminating PACE program agreements
for the operation of PACE programs by PACE
providers in this state.
(d) The commissioner shall provide medical
assistance under this section for PACE program
services to eligible individuals who are eligible
for medical assistance in this state and enrolled
in a PACE program under a PACE program agreement.
The commissioner shall seek any waiver from
federal law necessary to permit federal
participation for Medicaid expenditures for PACE
programs in this state.
(e) The commissioner may adopt regulations in
accordance with chapter 54 of the general statutes
to implement the provisions of this section.
Sec. 2. Section 113 of public act 97-2 of the
June 18 special session is repealed and the
following is substituted in lieu thereof:
[(a)] The Commissioner of Social Services
[shall] MAY submit an application for a federal
waiver for the purpose of conducting [an 1115
research and demonstration waiver] A PILOT program
BASED ON THE PRINCIPLES OF THE NATIONAL PROGRAM OF
ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE): (1) To
provide comprehensive health care and care
management services for elderly and disabled
Medicaid recipients who may also be eligible for
Medicare; and (2) to simplify eligibility for
Medicaid. The program shall be designed to reduce
costs and increase efficiency in the operation of
the Medicaid program and to improve the
coordination of health care benefits with the
Medicare program. Under said program, the
Commissioner of Social Services, in consultation
with the Insurance Commissioner, may INITIALLY
enter into contracts with integrated service
networks WHICH HAVE SUCCESSFULLY COMPLETED A
FEASIBILITY STUDY, IN CONJUNCTION WITH A PACE
TECHNICAL ASSISTANCE CENTER, for the provision of
comprehensive long-term health care and care
management for participating Medicaid recipients
on a prepayment or per capita basis. THE
COMMISSIONER OF SOCIAL SERVICES MAY MAKE PAYMENTS
ON SUCH BASIS TO DESIGNATED PACE SITES FROM FUNDS
APPROPRIATED TO THE MEDICAID ACCOUNT. THE
COMMISSIONER OF SOCIAL SERVICES, IN SUCH
CONTRACTS, MAY ESTABLISH CONDITIONS NECESSARY TO
OPERATE SUCH PILOT PROGRAM WITHIN AVAILABLE
APPROPRIATIONS, INCLUDING, BUT NOT LIMITED TO,
REQUIRING A NURSING FACILITY TO REDUCE ITS NUMBER
OF BEDS IN A CERTIFICATE OF NEED APPLICATION, TO
USE SPACE FOR RESIDENTIAL CARE HOME BEDS OR
ASSISTED LIVING SERVICES OR TO LIMIT GROWTH IN
SUCH PILOT PROGRAM. Integrated service networks
shall emphasize the utilization of primary and
community-based services to avoid utilization of
institutional care. Eligible Medicaid recipients
shall have a choice of enrolling in an integrated
service network or receiving Medicaid covered
services in a fee-for-service program, and no
copays or a lower level of optional Medicaid state
plan services than currently covered under
fee-for-service Medicaid, shall be used to induce
individuals to transfer into the networks. [Said
program, established pursuant to the waiver, may
include, but not be limited to: The retention of
an independent enrolment broker; quality and
access performance specifications for integrated
service networks; a competitive bidding process
for integrated service networks and enrolment
brokers seeking contracts; a recipient lock-in
policy; and eligibility criteria concerning
assets. Said program, established pursuant to the
waiver, shall: (A) Ensure continuity of care; (B)
establish notice rights, and prompt review and
appeal rights, whenever services are denied,
reduced, suspended, or terminated; (C) provide for
the conducting of quality monitoring of plans and
the publication of regular report cards comparing
plans; (D) set standards for access to health
care; (E) prohibit involuntary terminations of
enrollees from a plan because of their frequent
use of services, their high risk for needing
services, or any other reason not directly related
to furthering their health or safety; (F) the
commissioner shall solicit public response on the
waiver application through a series of public
hearings held at a central location in each of the
department's regions. For the purpose of obtaining
responses from nursing facility residents who may
be unable to attend these hearing, the
commissioner shall also solicit responses from the
resident councils in a sample of the nursing
facilities in each region; and (G) provide
coverage of asymptomatic HIV individuals for drug
therapies connected to the treatment of their
condition to the extent permitted by federal law.
The commissioner, upon approval of said waiver,
shall adopt regulations, in accordance with
chapter 54 of the general statutes, to implement
the eligibility provisions of this section.
(b) The Commissioner of Social Services shall
submit said application for a federal waiver to
the joint standing committees of the General
Assembly having cognizance of matters relating to
human services, public health and appropriations
and the budgets of state agencies prior to the
submission of such application to the federal
government. Within fifteen days of their receipt
of such application, the joint standing committees
may advise the commissioner of their approval,
nonapproval or modifications, if any, of his
application.
(c) Prior to submission of said application
for a waiver from federal law to the General
Assembly under subsection (b) of this section, the
Commissioner of Social Services shall publish a
notice that the commissioner intends to seek such
a waiver in the Connecticut Law Journal, along
with a summary of the provisions of the waiver
application and the manner in which individuals
may submit comments. The commissioner shall allow
fifteen days for written comments on the waiver
application prior to submission of the application
for a waiver to the General Assembly under
subsection (a) of this section and shall include
all written comments with the waiver application
in the submission to the General Assembly.]
Sec. 3. Not later than January 1, 1999, the
Commissioner of Social Services shall submit an
interim report relative to the pilot program
established under section 1 of this act to the
joint standing and select committees of the
General Assembly having cognizance of matters
relating to human services and aging. Not later
than January 1, 2000, said commissioner shall
submit a final report to said committees which
shall analyze the cost-effectiveness of the pilot
program and shall include data on (1) the number
of individuals served by the program, (2) the
number and type of PACE program services offered
under the program, and (3) the monthly cost per
individual under the program.
Sec. 4. This act shall take effect from its
passage.
Approved June 8, 1998