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