House Bill No. 7104

Public Act No. 99-279

An Act Concerning Programs and Modifications Necessary to Implement the Budget Relative to the Department of Social Services.

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

Section 1. (NEW) (a) The Commissioner of Social Services shall implement and administer, within available appropriations, a program of transitionary rental assistance for private housing for persons who are employed at the time they exhaust time-limited benefits under the temporary family assistance program and who have income which exceeds the payment standard under said program. The commissioner may establish a durational limit for the receipt of such assistance which shall not exceed a period of twelve months.

(b) The Commissioner of Social Services shall establish a simplified eligibility determination and application process for transitionary rental assistance. The program shall be designed to allow the provision of such assistance to commence with the first month in which the applicant is no longer receiving benefits under the temporary family assistance program.

(c) The Commissioner of Social Services shall implement the policies and procedures necessary to carry out the provisions of subsections (a) and (b) of this section while in the process of adopting such policies and procedures in regulation form, provided notice of intent to adopt the regulations is published in the Connecticut Law Journal within twenty days after implementation. Such policies and procedures shall be valid until the time final regulations are effective.

Sec. 2. (NEW) Beginning July 1, 1999, and monthly thereafter, the Department of Children and Families shall submit a report to the joint standing committees of the General Assembly having cognizance of matters relating to public health and human services on the number of children and adolescents in the custody of said department who are in subacute care in freestanding psychiatric or general hospitals and who cannot be discharged due to the lack of appropriate placements in the community.

Sec. 3. (NEW) The Commissioner of Social Services may implement a pharmaceutical purchasing initiative by contracting with an established entity for the purchase of maintenance drugs through the lowest pricing available for Medicaid recipients. Any entity with whom the commissioner contracts for the purposes of this section shall have an established pharmaceutical network and a demonstrated capability of processing the prescription volume anticipated for Medicaid recipients. The commissioner may purchase liability insurance as part of the administration of such initiative if necessary to protect the interests of program participants.

Sec. 4. Subsection (a) of section 10-76d of the general statutes is repealed and the following is substituted in lieu thereof:

(a) (1) In accordance with the regulations and procedures established by the [commissioner] Commissioner of Education and approved by the State Board of Education, each local or regional board of education shall provide the professional services requisite to identification of school-age children requiring special education, identify each such child within its jurisdiction, determine the eligibility of such children for special education pursuant to sections 10-76a to 10-76h, inclusive, prescribe suitable educational programs for eligible children, maintain a record thereof and make such reports as the commissioner may require.

[(2) For any town in which the average number of children ages three to twenty-one enrolled in the Medicaid program on October first of each of the previous three years, equals or exceeds five thousand, the]

(2) Any local or regional board of education, through the planning and placement team established in accordance with regulations adopted by the State Board of Education under this section, [shall] may determine [the] a child's Medicaid enrolment status. In determining Medicaid enrolment status, the planning and placement team shall: (A) Inquire of the parents or guardians of each such child whether the child is enrolled in or may be eligible for Medicaid; and (B) if the child may be eligible for Medicaid, request that the parent or guardian of the child apply for Medicaid. [The] For the purpose of determining Medicaid rates for Medicaid eligible special education and related services based on a representative cost sampling method, the board of education shall [submit] make available documentation of the provision and costs of Medicaid eligible special education and related services for [all] any students receiving such services, regardless of an individual student's Medicaid enrolment status, to the Commissioner of [Education] Social Services or to the commissioner's authorized agent at such time and in such manner as [the commissioner prescribes] prescribed. For the purpose of determining Medicaid rates for Medicaid eligible special education and related services based on an actual cost method, the local or regional board of education shall submit documentation of the costs and utilization of Medicaid eligible special education and related services for all students receiving such services to the Commissioner of Social Services or to the commissioner's authorized agent at such time and in such manner as prescribed. The commissioner or such agent may [share] use information received from local or regional boards of education [with the state's Medicaid agent] for the purposes of (i) ascertaining students' Medicaid eligibility status, (ii) submitting Medicaid claims, [and] (iii) complying with state and federal audit requirements and (iv) determining Medicaid rates for Medicaid eligible special education and related services. No child shall be denied special education and related services in the event the parent or guardian refuses to apply for Medicaid.

[(3) Any local or regional board of education which is not required to determine Medicaid enrolment status pursuant to subdivision (2) of this subsection may provide for such determination in accordance with the procedures described in said subdivision (2).

(4) (A) Each local and regional board of education which is required to determine Medicaid enrolment status pursuant to subdivision (2) of this subsection or which chooses to determine such Medicaid enrolment status pursuant to subdivision (3) of this subsection shall (i) continue to make such determination for two consecutive fiscal years following the fiscal year in which it is required or chooses to make such determination, (ii) collect, maintain and submit the documentation required pursuant to subdivision (2) of this subsection for each of such fiscal years and (iii) be eligible to receive a grant as follows: For the fiscal year ending June 30, 1995, and each fiscal year thereafter, (I) eighty per cent of its proportional share of the estimated net Medicaid eligible payments for such fiscal year as determined by the Commissioner of Education plus (II) the difference between its proportional share of actual net Medicaid eligible payments for the prior fiscal year as determined by said commissioner and the estimated grant amount already paid for such year.

(B) Payment shall be made as follows: (i) Twenty-five per cent of the amount determined under subparagraph (A)(iii)(I) in September, (ii) twenty-five per cent of such amount in December, and (iii) any balance due including the amount determined under subparagraph (A)(iii)(II) in April.

(C) If the Commissioner of Education determines that there has been an overpayment in a grant, he shall calculate the amount of such overpayment and shall adjust the amount of the subsequent year's grant accordingly. If the commissioner is unable to make an adjustment for such overpayment or portion thereof, he shall request, in writing, a refund of such overpayment or portion thereof, as appropriate, and upon receipt of such request the local or regional board of education shall submit such refund.

(D) For purposes of this section: (i) "Proportional share" is the amount determined by dividing the amount of Medicaid eligible special education and related services costs of a local or regional board of education by the total amount of such costs of all local and regional boards of education in the state; and (ii) "net Medicaid eligible payments" means sixty per cent of the total Medicaid eligible special education and related services payments received by the state in any year pursuant to this section.]

(3) Beginning with the fiscal year ending June 30, 2000, the Commissioner of Social Services shall make grant payments to local or regional boards of education in amounts representing sixty per cent of the federal portion of Medicaid claims processed for Medicaid eligible special education and related services provided to Medicaid eligible students in the school district. Such grant payments shall be made on at least a quarterly basis and may represent estimates of amounts due to local or regional boards of education. Any grant payments made on an estimated basis, including payments made by the Department of Education for the fiscal years prior to the fiscal year ending June 30, 2000, shall be subsequently reconciled to grant amounts due based upon filed and accepted Medicaid claims and Medicaid rates. If, upon review, it is determined that a grant payment or portion of a grant payment was made for ineligible or disallowed Medicaid claims, the local or regional board of education shall reimburse the Department of Social Services for any grant payment amount received based upon ineligible or disallowed Medicaid claims.

[(5)] (4) Pursuant to federal law, the Commissioner of Social Services, as the state's Medicaid agent, shall determine [, annually,] rates for Medicaid eligible special education and related services pursuant to [subdivisions] subdivision (2) [and (3)] of this subsection. The Commissioner of Social Services [shall] may request and the Commissioner of Education and towns and regional school districts shall provide information [needed] as may be necessary to set such rates. [and such rates shall reflect the reasonable average monthly cost per student of Medicaid eligible special education and related services for the current year pursuant to subdivisions (2) and (3) of this subsection.]

[(6)] (5) Based on school district special education and related services expenditures, the state's Medicaid agent shall report and certify to the federal Medicaid authority the state match required by federal law to obtain Medicaid reimbursement of eligible special education and related services costs.

[(7) If a local or regional board of education fails to create, maintain and submit the documentation required by subdivision (2) of this subsection, such board of education shall reimburse to the state its proportionate share of all disallowed costs resulting from such failure identified in any state or federal audit.]

[(8)] (6) Payments received pursuant to this section shall be paid to the [town or regional school district] local or regional board of education which has incurred such costs [and shall be deemed to be appropriated to the board of education] in addition to the funds appropriated by the town to such board for the current fiscal year.

[(9) The Commissioner of Education shall, by July 30, 1994, and by April first annually thereafter notify each local or regional board of education whether it will be required to comply with the provisions of subdivision (2) of this subsection in the subsequent fiscal year based on the average number of children ages three to twenty-one enrolled in the Medicaid program and residing in such school district on October first of each of the previous three years as reported and certified by the Commissioner of Social Services to the Commissioner of Education by July 15, 1994, and by March first annually thereafter.]

[(10)] (7) An individual plan shall be developed for the transition of a child from school to another program or community setting which shall include a statement of the needed transition services for a child requiring special education. Such plan shall be developed not later than at the annual review of the prescribed educational program next following such child's fifteenth birthday and shall be included as part of such prescribed educational program. Transition services may be included as part of such program prior to the child's fifteenth birthday. Such statement shall identify, where appropriate, interagency responsibilities before the child leaves the school setting. If a participating agency, other than an educational agency, fails to provide agreed upon services, the planning and placement team shall reconvene to revise the individualized education program and identify alternate strategies to meet the transition objectives.

[(11)] (8) Each local and regional board of education shall notify the parent or guardian of a child [requiring] who requires or who may require special education, a pupil if such pupil is an emancipated minor or eighteen years of age or older [requiring] who requires or who may require special education or a surrogate parent appointed pursuant to section 10-94g, in writing, at least five school days before such board proposes to, or refuses to, initiate or change the child's or pupil's identification, evaluation or educational placement or the provision of a free appropriate public education to the child or pupil. Such parent, guardian, pupil or surrogate parent shall be given at least five school [days] days' prior notice of any planning and placement team meeting conducted for such child or pupil and shall have the right to be present at and participate in and to have advisors of [his] such person's own choosing and at [his] such person's own expense to be present at and to participate in all portions of such meeting at which an educational program for such child or pupil is developed, reviewed or revised. Immediately upon the formal identification of any child as a child requiring special education and at each planning and placement team meeting for such child, the responsible local or regional board of education shall inform the parent or guardian of such child or surrogate parent or, in the case of a pupil who is an emancipated minor or eighteen years of age or older, the pupil of the laws relating to special education and the rights of such parent, guardian, surrogate parent or pupil under such laws and the regulations adopted by the State Board of Education relating to special education. If such parent, guardian, surrogate parent or pupil does not attend a planning and placement team meeting, the responsible local or regional board of education shall mail such information to [him] such person. Each board shall have in effect at the beginning of each school year an educational program for each child who has been identified as eligible for special education.

(9) The Commissioner of Social Services shall implement the policies and procedures necessary for the purposes of this subsection while in the process of adopting such policies and procedures in regulation form, provided notice of intent to adopt the regulations is published in the Connecticut Law Journal within twenty days of implementing the policies and procedures. Such policies and procedures shall be valid until the time final regulations are effective.

Sec. 5. Section 17b-93 of the general statutes is amended by adding subsection (d) as follows:

(NEW) (d) Notwithstanding any provision of the general statutes, whenever funds are collected pursuant to this section or section 17b-94, and the person who otherwise would have been entitled to such funds is subject to a court-ordered current or arrearage child support payment obligation in a IV-D support case, such funds shall first be paid to the state for reimbursement of Medicaid funds granted to such person for medical expenses incurred for injuries related to a legal claim by such person which was the subject of the state's lien and such funds shall then be paid to the Bureau of Child Support Enforcement for distribution pursuant to the federally mandated child support distribution system implemented pursuant to subsection (j) of section 17b-179. The remainder, if any, shall be paid to the state for payment of previously provided assistance through the state supplement program, medical assistance program, aid to families with dependent children program, temporary family assistance program or state-administered general assistance program.

Sec. 6. Section 17b-104 of the general statutes is repealed and the following is substituted in lieu thereof:

(a) The Commissioner of Social Services shall administer the program of state supplementation to the Supplemental Security Income Program provided for by the Social Security Act and state law. [He] The commissioner may delegate any [of his] powers and authority to any deputy, assistant, investigator or supervisor, who shall have, within the scope of the power and authority so delegated, all of the power and authority of the Commissioner of Social Services. On and after January 1, 1994, the commissioner shall establish a standard of need based on the cost of living in this state for the temporary family assistance program, the state-administered general assistance program and the general assistance program. [He] The commissioner shall make a reinvestigation, at least every twelve months, of all cases receiving aid from the state, except that such reinvestigation may be conducted every twenty-four months for recipients of assistance to the elderly or disabled with stable circumstances, and [he] shall maintain all case records of the several programs administered by the Department of Social Services so that such records show, at all times, full information with respect to eligibility of the applicant or recipient. In the determination of need under any public assistance program, such income or earnings shall be disregarded as federal law requires, and such income or earnings may be disregarded as federal law permits. The commissioner shall encourage and promulgate such incentive earning programs as are permitted by federal law and regulations.

(b) On July 1, 1988, and annually thereafter, the commissioner shall increase the payment standards over that of the previous fiscal year under the aid to families with dependent children program, temporary family assistance program, the state-administered general assistance program and for the general assistance program by the percentage increase, if any, in the most recent calendar year average in the consumer price index for urban consumers over the average for the previous calendar year, provided the annual increase, if any, shall not exceed five per cent except that the payment standards for the fiscal years ending June 30, 1992, June 30, 1993, June 30, 1994, June 30, 1995, June 30, 1996, June 30, 1997, June 30, 1998, [and] June 30, 1999, June 30, 2000, and June 30, 2001, shall not be increased. On January 1, 1994, the payment standards shall be equal to the standards of need in effect July 1, 1993.

(c) On and after July 1, 1995, the payment standards for families receiving assistance under the temporary family assistance program, the state-administered general assistance program and general assistance program shall be equal to seventy-three per cent of the AFDC standards of need in effect June 30, 1995.

(d) For a family living in subsidized housing, income shall be attributed to such family which shall be eight per cent of the standard of need for such families subject to fill the gap budgeting, and eight per cent of the payment standard for such families not subject to fill the gap budgeting. For purposes of this subsection, "fill the gap budgeting" is a method of calculating benefits under the temporary family assistance program whereby countable income is subtracted from the standard of need and a percentage of the difference is paid to the family.

Sec. 7. Subsection (a) of section 17b-106 of the general statutes is repealed and the following is substituted in lieu thereof:

(a) On July 1, 1985, the Commissioner of Social Services shall increase the adult payment standards for the state supplement to the federal Supplemental Security Income Program by four and three-tenths per cent over the standards for the fiscal year ending June 30, 1985, provided the commissioner shall apply the appropriate disregards. Notwithstanding the provisions of any regulation to the contrary, effective July 1, 1994, the commissioner shall reduce the appropriate unearned income disregard for recipients of the state supplement to the federal Supplemental Security Income Program by seven per cent, provided if sufficient funds are available within accounts in the Department of Social Services and are transferred to the old age assistance account, the aid to the blind account and the aid to the disabled account, the commissioner shall increase the unearned income disregard for recipients of the state supplement to the federal Supplemental Security Income Program to a level not to exceed that in effect on June 30, 1994. On July 1, 1989, and annually thereafter, the Commissioner of Social Services shall increase the adult payment standards over those of the previous fiscal year for the state supplement to the federal Supplemental Security Income Program by the percentage increase, if any, in the most recent calendar year average in the consumer price index for urban consumers over the average for the previous calendar year, provided the annual increase, if any, shall not exceed five per cent, except that the adult payment standards for the fiscal years ending June 30, 1993, June 30, 1994, June 30, 1995, June 30, 1996, June 30, 1997, June 30, 1998, [and] June 30, 1999, June 30, 2000, and June 30, 2001, shall not be increased. Effective October 1, 1991, the coverage of excess utility costs for recipients of the state supplement to the federal Supplemental Security Income Program is eliminated.

Sec. 8. Subsection (e) of section 17b-112 of the general statutes is repealed and the following is substituted in lieu thereof:

(e) Under said program (1) no family shall be eligible [who] that has total gross earnings exceeding the federal poverty level, however, in the calculation of the benefit amount for eligible families and previously eligible families that become ineligible temporarily because of receipt of workers' compensation benefits by a family member who subsequently returns to work immediately after the period of receipt of such benefits, earned income shall be disregarded up to the federal poverty level; (2) the increase in benefits to a family in which an infant is born after the initial ten months of participation in the program shall be limited to an amount equal to fifty per cent of the average incremental difference between the amounts paid per each family size; and (3) a disqualification penalty shall be established for failure to cooperate with the biometric identifier system.

Sec. 9. Subsection (b) of section 17b-112c of the general statutes is repealed and the following is substituted in lieu thereof:

(b) Notwithstanding the provisions of subsection (a) of this section: (1) A qualified alien admitted into the United States on or after August 22, 1996, or other lawfully residing immigrant alien determined eligible for temporary family assistance prior to July 1, 1997, shall remain eligible for such assistance until July 1, [1999] 2001, and (2) a qualified alien or other lawfully residing immigrant alien admitted into the United States on or after August 22, 1996, and not determined eligible prior to July 1, 1997, shall be eligible for such assistance subsequent to six months from establishing residency in this state until July 1, [1999] 2001; except if the individual is otherwise qualified for the purpose of state receipt of federal financial participation under Title IV of Public Law 104-93, such individual shall be eligible for temporary family assistance regardless of the date admitted or the date determined eligible.

Sec. 10. Subsection (e) of section 17b-116 of the general statutes is repealed and the following is substituted in lieu thereof:

(e) Persons domiciled and residing in Connecticut or who have no other residence, and who are United States citizens or who have been admitted as qualified aliens, as defined in Section 431 of Public Law 104-193, into the United States prior to August 22, 1996, shall be eligible for support under the general assistance program. A qualified alien admitted into the United States on or after August 22, 1996, or other lawfully residing immigrant alien determined eligible for general assistance prior to July 1, 1997, shall remain eligible for such assistance until July 1, [1999] 2001. Qualified aliens or other lawfully residing immigrant aliens admitted into the United States on or after August 22, 1996, and not determined eligible for assistance prior to July 1, 1997, shall be eligible for such assistance subsequent to six months from establishing residency in this state until July 1, [1999] 2001. Qualified aliens must pursue citizenship to the maximum extent allowed by law as a condition of eligibility for the general assistance program unless incapable of doing so due to a medical problem, language barrier or other reason as determined by the Commissioner of Social Services. Notwithstanding the provisions of this subsection, any qualified alien or other lawfully residing immigrant alien who is a victim of domestic violence or who has mental retardation shall be eligible for general assistance.

Sec. 11. Section 17b-257b of the general statutes is repealed and the following is substituted in lieu thereof:

Qualified aliens, as defined in section 431 of Public Law 104-193, admitted into the United States on or after August 22, 1996, or other lawfully residing immigrant aliens who have been determined eligible for Medicaid prior to July 1, 1997, may be eligible until July 1, [1999] 2001, for state-funded medical assistance which shall provide coverage to the same extent as the Medicaid program or the HUSKY Plan, Part B. Such qualified aliens or lawfully residing immigrant aliens who have not been determined eligible for Medicaid prior to July 1, 1997, shall be eligible for state-funded assistance or the HUSKY Plan, Part B subsequent to six months from establishing residency in this state until July 1, [1999] 2001. Notwithstanding the provisions of this section, any qualified alien or other lawfully residing immigrant alien who is a victim of domestic violence or who has mental retardation shall be eligible for state-funded assistance or the HUSKY Plan, Part B pursuant to this section. Only individuals who are not eligible for Medicaid shall be eligible for state-funded assistance pursuant to this section.

Sec. 12. Subsection (a) of section 17b-342 of the general statutes is repealed and the following is substituted in lieu thereof:

(a) The Commissioner of Social Services shall administer the Connecticut home-care program for the elderly state-wide in order to prevent the institutionalization of elderly persons (1) who are recipients of medical assistance, (2) who are eligible for such assistance, or (3) who meet the criteria for the state-funded portion of the program under subsection (i) of this section. For purposes of this section, a long-term care facility is a facility which has been federally certified as a skilled nursing facility or intermediate care facility. The commissioner shall make any revisions in the state Medicaid plan required by Title XIX of the Social Security Act prior to implementing the program. The annualized cost of the community-based services provided to such persons under the program shall not exceed sixty per cent of the weighted average cost of care in skilled nursing facilities and intermediate care facilities. The program shall be structured so that the net cost to the state for long-term facility care in combination with the community-based services under the program shall not exceed the net cost the state would have incurred without the program. The commissioner shall investigate the possibility of receiving federal funds for the program and shall apply for any necessary federal waivers. A recipient of services under the program, and the estate and legally liable relatives of the recipient, shall be responsible for reimbursement to the state for such services to the same extent required of a recipient of assistance under the state supplement program, medical assistance program, temporary family assistance program or food stamps program. Only a United States citizen or a noncitizen who meets the citizenship requirements for eligibility under the Medicaid program shall be eligible for home-care services under this section, except a qualified alien, as defined in Section 431 of Public Law 104-193, admitted into the United States on or after August 22, 1996, or other lawfully residing immigrant alien determined eligible for services under this section prior to July 1, 1997, shall remain eligible for such services until July 1, [1999] 2001. Qualified aliens or other lawfully residing immigrant aliens not determined eligible prior to July 1, 1997, shall be eligible for services under this section subsequent to six months from establishing residency until July 1, [1999] 2001. Notwithstanding the provisions of this subsection, any qualified alien or other lawfully residing immigrant alien who is a victim of domestic violence or who has mental retardation shall be eligible for assistance pursuant to this section.

Sec. 13. Subsection (d) of section 17b-239 of the general statutes is repealed and the following is substituted in lieu thereof:

(d) The state shall also pay to such hospitals for each outpatient clinic and emergency room visit a reasonable rate to be established annually by the commissioner for each hospital, such rate to be determined by the reasonable cost of such services, but the established rate for an outpatient clinic visit shall not exceed one hundred sixteen per cent of the combined average fee of the general practitioner and specialist for an office visit according to the fee schedule for practitioners of the healing arts approved under section 4-67c, except that the outpatient clinic rate in effect June 30, 1992, shall increase July 1, 1992, and each July first thereafter by no more than the most recent annual increase in the consumer price index for medical care. The emergency room visit rates in effect June 30, 1991, shall remain in effect through June 30, 1993, except those which would have been decreased effective July 1, 1991, or July 1, 1992, shall be decreased. To the extent that the commissioner receives approval for a disproportionate share exemption pursuant to federal regulations, the commissioner may establish a rate cap for qualifying hospital outpatient clinics up to one hundred seventy-five per cent of the combined average fee of the general practitioner and specialist for an office visit according to the fee schedule for practitioners of the healing arts approved under section 4-67c. Nothing contained herein shall authorize a payment by the state for such services to any hospital in excess of the charges made by such hospital for comparable services to the general public. For those outpatient hospital services paid on the basis of a ratio of cost to charges, the ratios in effect June 30, 1991, shall be reduced effective July 1, 1991, by the most recent annual increase in the consumer price index for medical care. For those outpatient hospital services paid on the basis of a ratio of cost to charges, the ratios computed to be effective July 1, 1994, shall be reduced by the most recent annual increase in the consumer price index for medical care. The emergency room visit rates in effect June 30, 1994, shall remain in effect through December 31, 1994. The Commissioner of Social Services shall establish a fee schedule for outpatient hospital services to be effective on and after January 1, 1995. [Such] Except with respect to the rate periods beginning July 1, 1999 and July 1, 2000, such fee schedule shall be adjusted annually beginning July 1, 1996, to reflect necessary increases in the cost of services.

Sec. 14. Subsection (g) of section 17b-239 of the general statutes is repealed and the following is substituted in lieu thereof:

(g) Effective October 1, 1998, and annually thereafter, the commissioner shall establish hospital inpatient rates in accordance with the method specified in regulations adopted pursuant to this section and applied for the rate period beginning October 1, 1997, except that for the rate period beginning October 1, 1998, the commissioner shall apply a three per cent annual adjustment factor to the target amount per discharge in lieu of the annual adjustment factor, if any, used to determine rates for prospective [payment system-exempt] payment-system-exempt hospitals under the Medicare program, and for succeeding rate periods the commissioner shall not apply an annual adjustment factor.

Sec. 15. Subsection (a) of section 17b-257c of the general statutes is repealed and the following is substituted in lieu thereof:

(a) The Commissioner of Social Services, after consultation with the Commissioner of Mental Health and Addiction Services and the Secretary of the Office of Policy and Management, may provide, within available appropriations, payments to long-term care facilities for the care of certain illegal immigrants. Payments may be made to cover the costs of care, as well as other incidentals as determined by the Commissioner of Social Services, for illegal immigrants who have been admitted to an acute care or psychiatric hospital and for whom services available in a long-term care facility are an appropriate and cost-effective alternative. Such individuals must be otherwise eligible for Medicaid, have resided in this state for at least five years and be unable to return to their country of origin due to medical illness or regulations barring reentry of persons who are ill or disabled or based upon a decision by the Immigration and Naturalization Service not to proceed with deportation.

Sec. 16. Subsection (a) of section 17b-261 of the general statutes is repealed and the following is substituted in lieu thereof:

(a) Medical assistance shall be provided for any otherwise eligible person whose income, including any available support from legally liable relatives and the income of [his] the person's spouse or dependent child, is not more than one hundred forty-three per cent, pending approval of a federal waiver applied for pursuant to subsection (d) of this section, of the benefit amount paid to a person with no income under the temporary family assistance program in the appropriate region of residence and if such person is an institutionalized individual as defined in Section 1917(c) of the Social Security Act, 42 USC 1396p(c), and has not made 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 this section. Any such disposition shall be treated in accordance with Section 1917(c) of the Social Security Act, 42 USC 1396p(c). Any disposition of property made on behalf of an applicant or recipient or [his] the spouse of an applicant or recipient by a guardian, conservator, person authorized to make such disposition pursuant to a power of attorney or other person so authorized by law shall be attributed to such applicant, recipient or spouse. A disposition of property ordered by a court shall be evaluated in accordance with the standards applied to any other such disposition for the purpose of determining eligibility. The commissioner shall establish the standards for eligibility for medical assistance at one hundred forty-three per cent of the benefit amount paid to a family unit of equal size with no income under the temporary family assistance program in the appropriate region of residence, pending federal approval, except that the medical assistance program shall provide coverage to persons under the age of nineteen born after September 30, 1981, up to one hundred eighty-five per cent of the federal poverty level without an asset limit. On and after [January 1, 1998] July 1, 2000, said medical assistance program shall provide coverage to persons under the age of nineteen and their parents and needy caretaker relatives who qualify for coverage under Section 1931 of the Social Security Act with family income up to one hundred eighty-five per cent of the federal poverty level without an asset limit. Such levels shall be based on the regional differences in such benefit amount, if applicable, unless such levels based on regional differences are not in conformance with federal law. Any income in excess of the applicable amounts shall be applied as may be required by said federal law, and assistance shall be granted for the balance of the cost of authorized medical assistance. All contracts entered into on and after July 1, 1997, pursuant to this section shall include provisions for collaboration of managed care organizations with the Healthy Families Connecticut Program established pursuant to section 17a-56. The Commissioner of Social Services shall provide applicants for assistance under this section, at the time of application, with a written statement advising them of the effect of an assignment or transfer or other disposition of property on eligibility for benefits or assistance.

Sec. 17. Subsection (a) of section 17b-265 of the general statutes is repealed and the following is substituted in lieu thereof:

(a) In accordance with 42 USC 1396k, the Department of Social Services shall be subrogated to any right of recovery or indemnification which an applicant or recipient of medical assistance or any legally liable relative has against a private insurer or other third party, as defined in 42 CFR 433.136, for the cost of hospitalization, pharmaceutical services, physician services, nursing services and other medical services, not to exceed the amount expended by the department for such care and treatment of the applicant or recipient. In the case of such a recipient who is an enrollee in a managed care organization under a Medicaid managed care contract with the state or a legally liable relative of such an enrollee, the department shall be subrogated to any right of recovery or indemnification which the enrollee or legally liable relative has against such a private insurer or other third party for the medical costs incurred by the managed care organization on behalf of an enrollee. An applicant or recipient or legally liable relative, by the act of the applicant or recipient receiving medical assistance, shall be deemed to have made a subrogation assignment and an assignment of claim for benefits to the department. The department shall inform an applicant of such assignments at the time of application. Any entitlements from a contractual agreement with an applicant or recipient, legally liable relative or a state or federal program for such medical services, not to exceed the amount expended by the department, shall be so assigned. Such entitlements shall be directly reimbursable to the department by third party payors. The Department of Social Services may assign its right to subrogation or its entitlement to benefits to a designee or a health care provider participating in the Medicaid program and providing services to an applicant or recipient, in order to assist the provider in obtaining payment for such services. A provider that has received an assignment from the department shall notify the private insurer or third party of the assignment upon rendition of services to the applicant or recipient. Failure to so notify the private insurer or third party shall render the provider ineligible for payment from the department. The provider shall notify the department of any request by the applicant or recipient or [his] legally liable relative or representative of such applicant or recipient for billing information. This subsection shall not be construed to affect the right of an applicant or recipient to maintain an independent cause of action against such third party tortfeasor.

Sec. 18. Subdivision (10) of section 17b-290 of the general statutes is repealed and the following is substituted in lieu thereof:

(10) "Eligible beneficiary" means a child who meets the requirements specified in section 17b-292, except a child excluded under the provisions of Subtitle J of Public Law 105-33 or a child of any municipal employee eligible for employer-sponsored insurance on or after October 30, 1997, provided a child of such a municipal employee may be eligible for coverage under the HUSKY Plan, Part B if dependent coverage was terminated due to an extreme economic hardship on the part of the employee, as determined by the commissioner.

Sec. 19. Subdivisions (3) and (4) of subsection (f) of section 17b-340 of the general statutes are repealed and the following is substituted in lieu thereof:

(3) For the fiscal year ending June 30, 1992, per diem maximum allowable costs for each cost component shall be as follows: For direct costs, the maximum shall be equal to one hundred forty per cent of the median allowable cost of that peer grouping; for indirect costs, the maximum shall be equal to one hundred thirty per cent of the state-wide median allowable cost; for fair rent, the amount shall be calculated utilizing the amount approved by the Office of Health Care Access pursuant to section 19a-638; for capital-related costs, there shall be no maximum; and for administrative and general costs, the maximum shall be equal to one hundred twenty-five per cent of the state-wide median allowable cost. For the fiscal year ending June 30, 1993, per diem maximum allowable costs for each cost component shall be as follows: For direct costs, the maximum shall be equal to one hundred forty per cent of the median allowable cost of that peer grouping; for indirect costs, the maximum shall be equal to one hundred twenty-five per cent of the state-wide median allowable cost; for fair rent, the amount shall be calculated utilizing the amount approved by the Office of Health Care Access pursuant to section 19a-638; for capital-related costs, there shall be no maximum; and for administrative and general costs the maximum shall be equal to one hundred fifteen per cent of the state-wide median allowable cost. For the fiscal year ending June 30, 1994, per diem maximum allowable costs for each cost component shall be as follows: For direct costs, the maximum shall be equal to one hundred thirty-five per cent of the median allowable cost of that peer grouping; for indirect costs, the maximum shall be equal to one hundred twenty per cent of the state-wide median allowable cost; for fair rent, the amount shall be calculated utilizing the amount approved by the Office of Health Care Access pursuant to section 19a-638; for capital-related costs, there shall be no maximum; and for administrative and general costs the maximum shall be equal to one hundred ten per cent of the state-wide median allowable cost. For the fiscal year ending June 30, 1995, per diem maximum allowable costs for each cost component shall be as follows: For direct costs, the maximum shall be equal to one hundred thirty-five per cent of the median allowable cost of that peer grouping; for indirect costs, the maximum shall be equal to one hundred twenty per cent of the state-wide median allowable cost; for fair rent, the amount shall be calculated utilizing the amount approved by the Office of Health Care Access pursuant to section 19a-638; for capital-related costs, there shall be no maximum; and for administrative and general costs the maximum shall be equal to one hundred five per cent of the state-wide median allowable cost. For the fiscal year ending June 30, 1996, and any succeeding fiscal year, except for the fiscal years ending June 30, 2000, and June 30, 2001, for facilities with an interim rate in one or both periods, per diem maximum allowable costs for each cost component shall be as follows: For direct costs, the maximum shall be equal to one hundred thirty-five per cent of the median allowable cost of that peer grouping; for indirect costs, the maximum shall be equal to one hundred fifteen per cent of the state-wide median allowable cost; for fair rent, the amount shall be calculated utilizing the amount approved pursuant to section 19a-638; for capital-related costs, there shall be no maximum; and for administrative and general costs the maximum shall be equal to the state-wide median allowable cost. For the fiscal years ending June 30, 2000, and June 30, 2001, for facilities with an interim rate in one or both periods, per diem maximum allowable costs for each cost component shall be as follows: For direct costs, the maximum shall be equal to one hundred forty-five per cent of the median allowable cost of that peer grouping; for indirect costs, the maximum shall be equal to one hundred twenty-five per cent of the state-wide median allowable cost; for fair rent, the amount shall be calculated utilizing the amount approved pursuant to section 19a-638; for capital-related costs, there shall be no maximum; and for administrative and general costs, the maximum shall be equal to the state-wide median allowable cost and such medians shall be based upon the same cost year used to set rates for facilities with prospective rates. Costs in excess of the maximum amounts established under this subsection shall not be recognized as allowable costs, except that the Commissioner of Social Services (A) may allow costs in excess of maximum amounts for any facility with patient days covered by Medicare, including days requiring coinsurance, in excess of twelve per cent of annual patient days which also has patient days covered by Medicaid in excess of fifty per cent of annual patient days; (B) may establish a pilot program whereby costs in excess of maximum amounts shall be allowed for beds in a nursing home which has a managed care program and is affiliated with a hospital licensed under chapter 368v; and (C) may establish rates whereby allowable costs may exceed such maximum amounts for beds approved on or after July 1, 1991, which are restricted to use by patients with acquired immune deficiency syndrome or traumatic brain injury.

(4) For the fiscal year ending June 30, 1992, (A) no facility shall receive a rate that is less than the rate it received for the rate year ending June 30, 1991; (B) no facility whose rate, if determined pursuant to this subsection, would exceed one hundred twenty per cent of the state-wide median rate, as determined pursuant to this subsection, shall receive a rate which is five and one-half per cent more than the rate it received for the rate year ending June 30, 1991; and (C) no facility whose rate, if determined pursuant to this subsection, would be less than one hundred twenty per cent of the state-wide median rate, as determined pursuant to this subsection, shall receive a rate which is six and one-half per cent more than the rate it received for the rate year ending June 30, 1991. For the fiscal year ending June 30, 1993, no facility shall receive a rate that is less than the rate it received for the rate year ending June 30, 1992, or six per cent more than the rate it received for the rate year ending June 30, 1992. For the fiscal year ending June 30, 1994, no facility shall receive a rate that is less than the rate it received for the rate year ending June 30, 1993, or six per cent more than the rate it received for the rate year ending June 30, 1993. For the fiscal year ending June 30, 1995, no facility shall receive a rate that is more than five per cent less than the rate it received for the rate year ending June 30, 1994, or six per cent more than the rate it received for the rate year ending June 30, 1994. For the fiscal years ending June 30, 1996, and June 30, 1997, no facility shall receive a rate that is more than three per cent more than the rate it received for the prior rate year. For the fiscal year ending June 30, 1998, a facility shall receive a rate increase that is not more than two per cent more than the rate that the facility received in the prior year. For the fiscal year ending June 30, 1999, a facility shall receive a rate increase that is not more than three per cent more than the rate that the facility received in the prior year and that is not less than one per cent more than the rate that the facility received in the prior year, exclusive of rate increases associated with a wage, benefit and staffing enhancement rate adjustment added for the period from April 1, 1999, to June 30, 1999, inclusive. For the fiscal year ending June 30, 2000, each facility, except a facility with an interim rate or replaced interim rate for the fiscal year ending June 30, 1999, and a facility having a certificate of need or other agreement specifying rate adjustments for the fiscal year ending June 30, 2000, shall receive a rate increase equal to one per cent applied to the rate the facility received for the fiscal year ending June 30, 1999, exclusive of the facility's wage, benefit and staffing enhancement rate adjustment. For the fiscal year ending June 30, 2000, no facility with an interim rate, replaced interim rate or scheduled rate adjustment specified in a certificate of need or other agreement for the fiscal year ending June 30, 2000, shall receive a rate increase that is more than one per cent more than the rate the facility received in the fiscal year ending June 30, 1999. For the fiscal year ending June 30, 2001, each facility, except a facility with an interim rate or replaced interim rate for the fiscal year ending June 30, 2000, and a facility having a certificate of need or other agreement specifying rate adjustments for the fiscal year ending June 30, 2001, shall receive a rate increase equal to two per cent applied to the rate the facility received for the fiscal year ending June 30, 2000, subject to verification of wage enhancement adjustments pursuant to subdivision (15) of this subsection. For the fiscal year ending June 30, 2001, no facility with an interim rate, replaced interim rate or scheduled rate adjustment specified in a certificate of need or other agreement for the fiscal year ending June 30, 2001, shall receive a rate increase that is more than two per cent more than the rate the facility received for the fiscal year ending June 30, 2000. For the fiscal year ending June 30, [2000] 2002, and any succeeding fiscal year, no facility shall receive a rate that is more than the rate it received in the prior year increased by the annual increase in the Consumer Price Index (all urban) for the most recent calendar year. The Commissioner of Social Services may exclude fair rent from any rate increase maximums established pursuant to this subdivision for a facility which has undergone a material change in circumstances related to fair rent.

Sec. 20. Subsection (f) of section 17b-340 of the general statutes is amended by adding subdivision (15) as follows:

(NEW) (15) The Commissioner of Social Services shall adjust facility rates from April 1, 1999, to June 30, 1999, inclusive, by a per diem amount representing each facility's allocation of funds appropriated for the purpose of wage, benefit and staffing enhancement. A facility's per diem allocation of such funding shall be computed as follows: (A) The facility's direct and indirect component salary, wage, nursing pool and allocated fringe benefit costs as filed for the 1998 cost report period deemed allowable in accordance with this section and applicable regulations without application of cost component maximums specified in subdivision (3) of this subsection shall be totaled; (B) such total shall be multiplied by the facility's Medicaid utilization based on the 1998 cost report; (C) the resulting amount for the facility shall be divided by the sum of the calculations specified in subparagraphs (A) and (B) of this subdivision for all facilities to determine the facility's percentage share of appropriated wage, benefit and staffing enhancement funding; (D) the facility's percentage share shall be multiplied by the amount of appropriated wage, benefit and staffing enhancement funding to determine the facility's allocated amount; and (E) such allocated amount shall be divided by the number of days of care paid for by Medicaid on an annual basis including days for reserved beds specified in the 1998 cost report to determine the per diem wage and benefit rate adjustment amount. The commissioner may adjust a facility's reported 1998 cost and utilization data for the purposes of determining a facility's share of wage, benefit and staffing enhancement funding when reported 1998 information is not substantially representative of estimated cost and utilization data for the fiscal year ending June 30, 2000, due to special circumstances during the 1998 cost report period including change of ownership with a part year cost filing or reductions in facility capacity due to facility renovation projects. Upon completion of the calculation of the allocation of wage, benefit and staffing enhancement funding, the commissioner shall not adjust the allocations due to revisions submitted to previously filed 1998 annual cost reports. In the event that a facility's rate for the fiscal year ending June 30, 1999, is an interim rate or the rate includes an increase adjustment due to a rate request to the commissioner or other reasons, the commissioner may reduce or withhold the per diem wage, benefit and staffing enhancement allocation computed for the facility. Any enhancement allocations not applied to facility rates shall not be reallocated to other facilities and such unallocated amounts shall be available for the costs associated with interim rates and other Medicaid expenditures. The wage, benefit and staffing enhancement per diem adjustment for the period from April 1, 1999, to June 30, 1999, inclusive, shall also be applied to rates for the fiscal years ending June 30, 2000, and June 30, 2001, except that the commissioner may increase or decrease the adjustment to account for changes in facility capacity or operations. Any facility accepting a rate adjustment for wage, benefit and staffing enhancements shall apply payments made as a result of such rate adjustment for increased allowable employee wage rates and benefits and additional direct and indirect component staffing. Adjustment funding shall not be applied to wage and salary increases provided to the administrator, assistant administrator, owners or related party employees. Enhancement payments may be applied to increases in costs associated with staffing purchased from staffing agencies provided such costs are deemed necessary and reasonable by the commissioner. The commissioner shall compare expenditures for wages, benefits and staffing for the 1998 cost report period to such expenditures in the 1999, 2000 and 2001 cost report periods to verify whether a facility has applied additional payments to specified enhancements. In the event that the commissioner determines that a facility did not apply additional payments to specified enhancements, the commissioner shall recover such amounts from the facility through rate adjustments or other means. The commissioner may require facilities to file cost reporting forms, in addition to the annual cost report, as may be necessary, to verify the appropriate application of wage, benefit and staffing enhancement rate adjustment payments. For the purposes of this subdivision, "Medicaid utilization" means the number of days of care paid for by Medicaid on an annual basis including days for reserved beds as a percentage of total resident days.

Sec. 21. Subsection (h) of section 17b-340 of the general statutes is repealed and the following is substituted in lieu thereof:

(h) For the fiscal year ending June 30, 1993, any residential care home with an operating cost component of its rate in excess of one hundred thirty per cent of the median of operating cost components of rates in effect January 1, 1992, shall not receive an operating cost component increase. For the fiscal year ending June 30, 1993, any residential care home with an operating cost component of its rate that is less than one hundred thirty per cent of the median of operating cost components of rates in effect January 1, 1992, shall have an allowance for real wage growth equal to sixty-five per cent of the increase determined in accordance with subsection (q) of section 17-311-52 of the regulations of Connecticut state agencies, provided such operating cost component shall not exceed one hundred thirty per cent of the median of operating cost components in effect January 1, 1992. Beginning with the fiscal year ending June 30, 1993, for the purpose of determining allowable fair rent, a residential care home 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. Beginning with the fiscal year ending June 30, 1997, a residential care home with allowable fair rent less than three dollars and ten cents per day shall be reimbursed as having allowable fair rent equal to three dollars and ten cents per day. Property additions placed in service during the cost year ending September 30, 1996, or any succeeding cost year shall receive a fair rent allowance for such additions as an addition to three dollars and ten cents per day if the fair rent for the facility for property placed in service prior to September 30, 1995, is less than or equal to three dollars and ten cents per day. For the fiscal year ending June 30, 1996, and any succeeding fiscal year, the allowance for real wage growth, as determined in accordance with subsection (q) of section 17-311-52 of the regulations of Connecticut state agencies shall not be applied. For the fiscal year ending June 30, 1996, and any succeeding fiscal year, the inflation adjustment made in accordance with subsection (p) of section 17-311-52 of the regulations of Connecticut state agencies shall not be applied to real property costs. Beginning with the fiscal year ending June 30, 1997, minimum allowable patient days for rate computation purposes for a residential care home with twenty-five beds or less shall be eighty-five per cent of licensed capacity. Beginning with the fiscal year ending June 30, 1998, for the purposes of determining the allowable salary of an administrator of a residential care home with sixty beds or less the department shall revise the allowable base salary to thirty thousand dollars to be annually inflated thereafter in accordance with section 17-311-52 of the regulations of Connecticut state agencies and, beginning with the fiscal year ending June 30, 2000, the inflation adjustment for rates made in accordance with subsection (p) of section 17-311-52 of the regulations of state agencies shall be increased by [one] two per cent. Beginning with the fiscal year ending June 30, 1999, for the purpose of determining the allowable salary of a related party the department shall revise the maximum salary to twenty seven thousand eight hundred fifty six dollars to be annually inflated thereafter in accordance with section 17-311-52 of the regulations of Connecticut state agencies.

Sec. 22. Section 17b-347e of the general statutes is repealed and the following is substituted in lieu thereof:

(a) The Commissioner of Social Services, in collaboration with the Commissioner of Economic and Community Development and the Connecticut Housing Finance Authority, shall establish a demonstration project to provide subsidized assisted living services, as defined in section 19-13-D105 of the regulations of Connecticut state agencies, for persons residing in affordable housing, as defined in section 8-39a. The demonstration project shall be conducted in at least three municipalities to be determined by the Commissioner of Social Services. The demonstration project may accept applications for up to three years from June 8, 1998, and shall be limited to a maximum of three hundred subsidized dwelling units. Applicants for such subsidized assisted living services shall be subject to the same eligibility requirements as the Connecticut home care program for the elderly pursuant to section 17b-342.

(b) Not later than January 1, 1999, the Commissioner of Social Services shall enter into a memorandum of understanding with the Commissioner of Economic and Community Development and the Connecticut Housing Finance Authority. Such memorandum of understanding shall specify that (1) the Department of Social Services apply for a Medicaid waiver to secure federal financial participation to fund assisted living services, establish a process to select nonprofit and for-profit providers and determine the number of dwelling units in the demonstration project, (2) the Department of Economic and Community Development provide rental subsidy certificates pursuant to section 8-402 or rental assistance pursuant to section 8-119kk, and (3) the Connecticut Housing Finance Authority provide second mortgage loans for housing projects for which the authority has provided financial assistance in the form of a loan secured by a first mortgage pursuant to section 8-403 for the demonstration project. Not later than July 1, 1999, the Connecticut Housing Finance Authority shall issue a request for proposals for persons or entities interested in participating in the demonstration project.

(c) Nothing in this section shall be construed to prohibit a combination of unsubsidized dwelling units and subsidized dwelling units under the demonstration project within the same facility. Notwithstanding the provisions of section 8-402, the Department of Economic and Community Development may set the rental subsidy at any percentage of the annual aggregate family income and define aggregate family income and eligibility for subsidies in a manner consistent with such demonstration project.

Sec. 23. Section 17b-349e of the general statutes is amended by adding subsection (e) as follows:

(NEW) (e) The Commissioner of Social Services may allocate any funds appropriated in excess of five hundred thousand dollars for the demonstration program among the five area agencies on aging according to need, as determined by said commissioner.

Sec. 24. Section 17b-364 of the general statutes is repealed and the following is substituted in lieu thereof:

(a) For purposes of this section, "specialized long-term care" means goal-oriented, comprehensive, inpatient care designed for a patient with an acute illness, injury or exacerbation of a disease process. Most patients receiving such care shall not require high-technology monitoring or complex diagnostic procedures. Such care requires a specifically designed program of coordinated services of an interdisciplinary team, including, but not limited to, physicians, nurses and professionals in other relevant disciplines.

(b) Notwithstanding any provision of the general statutes or the regulations of Connecticut state agencies, the Department of Social Services shall establish a demonstration project which shall provide specialized long-term care for chronically disabled and dependent patients with traumatic head, brain or spinal cord injuries, who are ventilator dependent, or suffer severe neurological dysfunction and disorders, including multiple sclerosis, cerebral palsy and such other similar chronic medical conditions as the Commissioner of Social Services deems appropriate.

(c) Said demonstration project shall be conducted in no more than three facilities, involving up to [sixty] seventy-five existing licensed beds, that are specifically equipped and staffed for such purpose. Said demonstration project shall supplement a facility's scope of services and, if necessary, modify its physical environment to improve access for patients with specific chronic medical conditions, provide care that meets such patient's specialized health, social and environmental needs, particularly those of children and young adults, and evaluate the optimum design for such programs.

(d) Said demonstration project shall establish rates based on costs related to patient care. Said demonstration project shall be designed for this specific patient population and shall not necessarily require separate facilities or special units.

(e) Said demonstration project shall address the different needs of (1) a child or young adult with specific chronic medical conditions, and (2) an elderly patient in either a hospital or a skilled nursing home.

(f) Said demonstration project shall restrict direct patient ventilator care to appropriately licensed health care providers.

(g) The commissioner shall issue a request for proposals for acute care hospitals, chronic disease hospitals and skilled nursing homes interested in participating in said demonstration project. Proposals shall identify: (1) The population to be served; (2) the specific services to be provided and budgeted for; (3) the number of existing licensed beds to be designated for said demonstration project; and (4) the evaluation process of said demonstration project. In approving said demonstration project, the commissioner shall consider, to the extent possible, geographic distribution.

(h) The commissioner may increase the number of facilities participating in the demonstration project from three to four on or after January 1, 2000. The commissioner may issue a request for proposals or select from respondents to a request for proposals issued to select the initial three demonstration project facilities.

Sec. 25. Subsection (a) of section 17b-694 of the general statutes is repealed and the following is substituted in lieu thereof:

(a) The Labor Commissioner, in consultation with the Commissioners of Social Services and Mental Health, shall administer a grant program, within available appropriations, to fund employment placement projects for recipients of general assistance [,] or state-administered general assistance [,] cash assistance or medical assistance or recipients of Medicaid who are eighteen to twenty years of age. A grant may be awarded to (1) a municipality or group of towns which form a region based on a project plan providing education, training or other assistance in securing employment, (2) a private substance abuse or mental health services provider based on a project plan incorporating job placement in the treatment process, or (3) a nonprofit organization providing employment services when no municipality or group of towns elect to apply for such a grant for a given geographic area. A plan may include cash incentives as a supplement to wages for recipients who work.

Sec. 26. Subsection (a) of section 19a-507 of the general statutes is repealed and the following is substituted in lieu thereof:

(a) Notwithstanding the provisions of chapter 368z, New Horizons, Inc., a nonprofit, nonsectarian organization, or a subsidiary organization controlled by New Horizons, Inc., is authorized to construct and operate an independent living facility for severely physically disabled adults, in the town of Farmington, provided such facility shall be constructed in accordance with applicable building codes. The Farmington Housing Authority, or any issuer acting on behalf of said authority, subject to the provisions of this section, may issue tax-exempt revenue bonds on a competitive or negotiated basis for the purpose of providing construction and permanent mortgage financing for the facility in accordance with Section 103 of the Internal Revenue Code. Prior to the issuance of such bonds, plans for the construction of the facility shall be submitted to and approved by the Office of Health Care Access. The office shall approve or disapprove such plans within thirty days of receipt thereof. If the plans are disapproved they may be resubmitted. Failure of the office to act on the plans within such thirty-day period shall be deemed approval thereof. The payments to residents of the facility who are eligible for assistance under the state supplement program for room and board and necessary services, shall be determined annually to be effective July first of each year. Such payments shall be determined on a basis of a reasonable payment for necessary services, which basis shall take into account as a factor the costs of providing those services and such other factors as the commissioner deems reasonable, including anticipated fluctuations in the cost of providing services. Such payments shall be calculated in accordance with the manner in which rates are calculated pursuant to section 17b-340, as amended by this act, and the cost related reimbursement system pursuant to said section except that efficiency incentives shall not be granted. The commissioner may adjust such rates to account for the availability of personal care services for residents under the Medicaid program. The commissioner shall, upon submission of a request, allow actual debt service, comprised of principal and interest, in excess of property costs allowed pursuant to section 17-313b-5 of the regulations of Connecticut state agencies, provided such debt service terms and amounts are reasonable in relation to the useful life and the base value of the property. The cost basis for such payment shall be subject to audit, and a recomputation of the rate shall be made based upon such audit. The rate in effect June 30, 1991, shall remain in effect through June 30, 1992, except that if the rate would have been decreased effective July 1, 1991, it shall be decreased. The facility shall report on a fiscal year ending on the thirtieth day of September on forms provided by the commissioner. The required report shall be received by the commissioner no later than December thirty-first of each year. The Department of Social Services may use its existing utilization review procedures to monitor utilization of the facility. If the facility is aggrieved by any decision of the commissioner, the facility may, within ten days, after written notice thereof from the commissioner, obtain by written request to the commissioner, a hearing on all items of aggrievement. If the facility is aggrieved by the decision of the commissioner after such hearing, the facility may appeal to the Superior Court in accordance with the provisions of section 4-183.

Sec. 27. Section 19a-670 of the general statutes is repealed and the following is substituted in lieu thereof:

(a) Within available appropriations, the Department of Social Services may make semimonthly payments to hospitals in an amount calculated pursuant to section 19a-671, provided the total amount of payments made to individual hospitals and to hospitals in the aggregate shall maximize the amount qualifying for federal matching payments under the medical assistance program and the emergency assistance to families program as determined by the Department of Social Services in consultation with the Office of Policy and Management. No payments shall be made to any [children's general] hospital exempt from taxation under chapter 211a. The payments shall be medical assistance disproportionate share payments, including grants provided pursuant to section 19a-168k, to the extent allowable under federal law. In addition payments may be made for authorized emergency assistance to needy families with dependent children in accordance with Title IV-A of the Social Security Act to the extent allowable under federal law. The payments shall not be part of the routine medical assistance inpatient hospital rate determined pursuant to section 17b-239, except to the extent the Commissioner of Social Services determines that increasing those rates would be appropriate to resolve any civil action pending on April 1, 1994, in the United States District Court for the district of Connecticut or the court orders such increase. Payments shall be made on an interim basis during each year and a final settlement shall be calculated pursuant to section 19a-671 by the office for each hospital after the year end based on audited data for the hospitals. The Commissioner of Social Services may withhold payment to a hospital which is in arrears in remitting its obligations to the state.

(b) (1) For the hospital fiscal year 1994, and subsequent fiscal years, the commission or its designated representative shall conduct a cash audit of the projected amount of uncompensated care, including emergency assistance to families and underpayments against the actual receipts of the hospital. In addition, the office or its designated intermediary shall conduct an audit of the revenues, deductions from revenue, discharges, days or other measures of patient volume for hospitals for the purposes of termination and final settlement of uncompensated care pool assessments and payments for the period ending March 31, 1994.

(2) For the six-month period ending September 30, 1994, and for each subsequent fiscal year, the office or its designated intermediary shall conduct an audit of the revenues, deductions from revenue, discharges, days or other measures of patient volume for hospitals for the purposes of [final settlement of] determining disproportionate share payments. Included in this audit shall be a comparison of projected and actual levels of medical assistance underpayment and uncompensated care.

(3) The total payments from the Department of Social Services medical assistance disproportionate share-emergency assistance account established pursuant to section 38 of public act 94-9* and made in accordance with sections 19a-670 to 19a-672, inclusive, during the fiscal year less any payments for emergency assistance to families, and less any payments resulting from the resolution of or court order entered in any civil action pending on April 1, 1994, in the United States District Court for the district of Connecticut, shall be reallocated to hospitals based on actual audited levels of medical assistance underpayment, grants pursuant to section 19a-168k and uncompensated care to determine the final payment for the fiscal year.

(4) If the final payment for a hospital for the hospital fiscal year, as determined as a result of this audit, is less than the total payments the hospital received during the same fiscal year excluding any prior year audit adjustment, then the current hospital fiscal year remaining semimonthly payments shall each be reduced by an amount equal to the total excess payment divided by the number of remaining semimonthly payments for the current hospital fiscal year.

(5) If the final payment for a hospital for the hospital fiscal year, as determined as a result of this audit, is greater than the total payments the hospital received during the same fiscal year, then the current hospital fiscal year remaining semimonthly payments shall each be increased by an amount equal to the total excess payment divided by the number of remaining semimonthly payments for the current hospital fiscal year.

(6) The office shall, by June 1, 1995, and June first of each subsequent year, report the results of such audit for the previous hospital fiscal year to the joint standing committee of the General Assembly having cognizance of matters relating to public health. The report shall include information concerning the financial stability of hospitals in a competitive market.

(7) Notwithstanding the provisions of subdivisions (3) to (5), inclusive, of this subsection, no adjustment of disproportionate share payments to hospitals for purposes of final settlement shall be implemented for the hospital fiscal years commencing October 1, 1997, and October 1, 1998, provided every hospital subject to final settlement for said fiscal years submits documentation in writing of its agreement to forego such final settlement to the Commissioner of Social Services in a form acceptable to the commissioner.

(8) Notwithstanding the provisions of subdivisions (3) to (5), inclusive, of this subsection, for the hospital fiscal year commencing October 1, 1999, and for each subsequent fiscal year, no adjustment of disproportionate share payments to hospitals for purposes of final settlement shall be determined or implemented.

(c) The Commissioner of Social Services is authorized to determine exceptions, exemptions and adjustments in accordance with 42 CFR 413.40.

(d) Nothing in section 3-114i, subdivisions (2) or (29) of section 12-407, subsection (1) of section 12-408, section 12-408a, subdivision (5) of section 12-412, subsection (1) of section 12-414, sections 12-263a to 12-263e, inclusive, sections 19a-646, 19a-659 to 19a-662 or 19a-666 to 19a-680, inclusive, or sections 1, 2, or 38 of public act 94-9** shall be construed to require the Department of Social Services to pay out more funds than are appropriated pursuant to said sections.

Sec. 28. Subsection (a) of section 17b-745 of the general statutes is repealed and the following is substituted in lieu thereof:

(a) (1) The Superior Court or a family support magistrate shall have authority to make and enforce orders for payment of support to the Commissioner of Administrative Services or in IV-D cases, to the state acting by and through the IV-D agency, directed to the husband or wife and, if the patient or person is under twenty-one or, on and after October 1, 1972, under eighteen, any parent of any patient or person being supported by the state, wholly or in part, in a state humane institution, or under any welfare program administered by the state Department of Social Services, as said court finds, in accordance with the provisions of subsection (b) of section 17b-179, or section 17a-90, 17b-81, 17b-223, 46b-129 or 46b-130, to be reasonably commensurate with the financial ability of any such relative. Any court or family support magistrate called upon to make or enforce such an order, including one based upon a determination consented to by the relative, shall insure that such order is reasonable in light of the relative's ability to pay. [In addition, the]

(2) (A) The court or family support magistrate shall include in each support order in a IV-D support case a provision for the health care coverage of the child which provision may include an order for either parent to name any child under eighteen as a beneficiary of any medical or dental insurance or benefit plan carried by such parent or available to such parent on a group basis through an employer or a union. [In such cases,] If such insurance coverage is unavailable at reasonable cost, the provision for health care coverage may include an order for either parent to apply for and maintain coverage on behalf of the child under the HUSKY Plan, Part B. The noncustodial parent shall be ordered to apply for the HUSKY Plan, Part B only if such parent is found to have sufficient ability to pay the appropriate premium. In any IV-D support case in which the noncustodial parent is found to have insufficient ability to provide medical insurance coverage and the custodial party is the HUSKY Plan, Part A or Part B applicant, the provision for health care coverage may include an order for the noncustodial parent to pay such amount as is specified by the court or family support magistrate to the state or the custodial party, as their interests may appear, to offset the cost of any insurance payable under the HUSKY Plan, Part A or Part B. In no event may such order include payment to offset the cost of any such premium if such payment would reduce the amount of current support required under the child support guidelines.

(B) When a parent is ordered to provide insurance coverage in accordance with subparagraph (A) of this subdivision, the court or family support magistrate shall order the employer of such parent to withhold from such employee's compensation the employee's share, if any, of premiums for health coverage, except for certain circumstances under which an employer may withhold less than such employee's share of such premiums, as may be provided by regulation of the Secretary of the United States Department of Health and Human Services and pay such share of premiums to the insurer. The amount withheld shall not exceed the maximum amount permitted to be withheld as set forth in 15 USC 1673(b). Whenever an order of the Superior Court or family support magistrate is issued against a parent to cover the cost of such medical or dental insurance or benefit plan for a child who is eligible for Medicaid benefits, and such parent has received payment from a third party for the costs of such services but such parent has not used such payment to reimburse, as appropriate, either the other parent or guardian or the provider of such services, the Department of Social Services shall have the authority to request the court or family support magistrate to order the employer of such parent to withhold from the wages, salary or other employment income, of such parent to the extent necessary to reimburse the Department of Social Services for expenditures for such costs under the Medicaid program. However, any claims for current or past due child support shall take priority over any such claims for the costs of such services.

(3) Said court or family support magistrate shall also have authority to make and enforce orders directed to the conservator or guardian of any such patient or person, or the payee of Social Security or other benefits to which such patient or person is entitled, to the extent of the income or estate held or received by such fiduciary or payee in any such capacity.

(4) For purposes of this section, the term "father" shall include a person who has acknowledged in writing [his] paternity of a child born out of wedlock, and the court or family support magistrate shall have authority to determine, order and enforce payment of any accumulated sums due under a written agreement to support such child in accordance with the provisions of this section.

(5) (A) Said court or family support magistrate shall also have authority to make and enforce orders for the payment by any person named herein of unpaid support contributions for which any such person is liable in accordance with the provisions of subsection (b) of section 17b-179, or section 17a-90, 17b-81, 17b-223, 46b-129 or 46b-130 or, in IV-D cases, to order such person, provided [he] such person is not incapacitated, to participate in work activities which may include, but shall not be limited to, job search, training, work experience and participation in the job training and retraining program established by the Labor Commissioner pursuant to section 31-3t.

(B) In the determination of support due based on neglect or refusal to furnish support prior to the action, the support due for periods of time prior to the action shall be based upon the obligor's ability to pay during such prior periods. The state shall disclose to the court any information in its possession concerning current and past ability to pay. With respect to such orders entered on or after October 1, 1991, if no information is available to the court concerning past ability to pay, the court may determine the support due for periods of time prior to the action as if past ability to pay is equal to current ability to pay if known or, if not known, based upon assistance rendered to the child.

(C) Any finding as to support due for periods of time prior to the action which is made without information concerning past ability to pay shall be entered subject to adjustment when such information becomes available to the court. Such adjustment may be made upon motion of any party within four months from the date upon which the obligor receives notification of [(1)] (i) the amount of such finding of support due for periods of time prior to the action, and [(2)] (ii) the right within four months of receipt of such notification to present evidence as to [his] such obligor's past ability to pay support for such periods of time prior to the action.

(6) All payments ordered by the court or family support magistrate under this section shall be made to the Commissioner of Administrative Services or, in IV-D cases, to the state acting by and through the IV-D agency, as the court or family support magistrate may determine, for the period during which the supported person is receiving assistance or care from the state, provided, in the case of beneficiaries of any program of public assistance, upon the discontinuance of such assistance, payments shall be distributed to the beneficiary, beginning with the effective date of discontinuance. Any order of payment made under this section may, at any time after being made, be set aside or altered by the court or a family support magistrate.

(7) (A) Proceedings to obtain [such] orders of support under this section shall be commenced by the service on the liable person or persons of a verified petition of the Commissioner of Administrative Services, the Commissioner of Social Services or their designees. The verified petition shall be filed by any of said commissioners or their designees in the judicial district of the court or Family Support Magistrate Division in which the patient, applicant, beneficiary, recipient or the defendant resides. The judge or family support magistrate shall cause a summons, signed by [him] such judge or magistrate, by the clerk of said court, or by a commissioner of the Superior Court to be issued, requiring such liable person or persons to appear before the court or a family support magistrate at a time and place as determined by the clerk but not more than ninety days after the issuance of the summons to show cause, if any, [he has,] why the request for relief in such petition should not be granted. The verified petition, summons and order shall be on forms prescribed by the Office of the Chief Court Administrator.

(B) Service of process issued under this section may be made by a sheriff, any proper officer or any investigator employed by the Department of Social Services or by the Commissioner of Administrative Services. The sheriff, proper officer or investigator shall make due return of process to the court not less than twenty-one days before the date assigned for hearing. Upon proof of the service of the summons to appear before the court or a family support magistrate, at the time and place named for hearing upon such petition, the failure of the defendant to appear shall not prohibit the court or family support magistrate from going forward with the hearing.

(8) Failure of any [such] defendant to obey [any] an order of the court or Family Support Magistrate Division made [hereunder] under this section may be punished as contempt of court. If the summons and order is signed by a commissioner of the Superior Court, upon proof of service of the summons to appear in court or before a family support magistrate and upon the failure of the defendant to appear at the time and place named for hearing upon the petition, request may be made by the petitioner to the court or family support magistrate for an order that a capias mittimus be issued. Except as otherwise provided, upon proof of the service of the summons to appear in court or before a family support magistrate at the time and place named for a hearing upon the failure of the defendant to obey the court order as contempt of court, the court or the family support magistrate may order a capias mittimus to be issued and directed to some proper officer to arrest such defendant and bring [him] such defendant before the Superior Court for the contempt hearing. The costs of commitment of any person imprisoned therefor shall be paid by the state as in criminal cases. When any such defendant is so found in contempt, the court or family support magistrate may award to the petitioner a reasonable attorney's fee and the fees of the officer serving the contempt citation, such sums to be paid by the person found in contempt.

(9) In addition to or in lieu of [such] contempt proceedings, the court or family support magistrate, upon a finding that any person has failed to obey any order made [hereunder] under this section, may issue an order directing that an income withholding order issue against such amount of any debt accruing by reason of personal services due and owing to such person in accordance with section 52-362, or against such lesser amount of such excess as said court or family support magistrate deems equitable, for payment of accrued and unpaid amounts due under such order and all amounts which thereafter become due under such order. On presentation of such income withholding order by the officer to whom delivered for service to the person or persons or corporation from whom such debt accruing by reason of personal services is due and owing, or thereafter becomes due and owing, to the person against whom such support order was issued, such income withholding order shall be a lien and a continuing levy upon such debt to the amount specified therein, which shall be accumulated by the debtor and paid directly to the Commissioner of Administrative Services or, in IV-D cases, to the state acting by and through the IV-D agency, in accordance with section 52-362, until such income withholding order and expenses are fully satisfied and paid, or until such income withholding order is modified.

(10) No entry fee, judgment fee or any other court fee shall be charged by the court to either party in actions under this section.

(11) Written statements from employers as to property, insurance, wages, indebtedness and other information obtained by the Commissioner of Social Services, or the Commissioner of Administrative Services under authority of section 17b-137, shall be admissible in evidence in actions under this section.

Sec. 29. Subsection (f) of section 46b-84 of the general statutes is repealed and the following is substituted in lieu thereof:

(f) After the granting of a decree annulling or dissolving the marriage or ordering a legal separation, and upon complaint or motion with order and summons made to the Superior Court by either parent or by the Commissioner of Administrative Services in any case arising under subsection (a) or (b) of this section, the court shall inquire into the child's need of maintenance and the respective abilities of the parents to supply maintenance. The court shall make and enforce the decree for the maintenance of the child as it considers just, and may direct security to be given therefor, including an order to either party to contract with a third party for periodic payments or payments contingent on a life to the other party. The court shall include in each support order a provision for the health care coverage of the child which provision may include an order for either parent to name any child who is subject to the provisions of subsection (a) or (b) of this section as a beneficiary of any medical or dental insurance or benefit plan carried by such parent or available to such parent on a group basis through an employer or a union. If such insurance coverage is unavailable at reasonable cost, the provision for health care coverage may include an order for either parent to apply for and maintain coverage on behalf of the child under the HUSKY Plan, Part B. The noncustodial parent shall be ordered to apply for the HUSKY Plan, Part B only if such parent is found to have sufficient ability to pay the appropriate premium. In any IV-D support case in which the noncustodial parent is found to have insufficient ability to provide medical insurance coverage and the custodial party is the HUSKY Plan, Part A or Part B applicant, the provision for health care coverage may include an order for the noncustodial parent to pay such amount as is specified by the court or family support magistrate to the state or the custodial party, as their interests may appear, to offset the cost of any insurance payable under the HUSKY Plan, Part A or Part B. In no event may such order include payment to offset the cost of any such premium if such payment would reduce the amount of current support required under the child support guidelines.

Sec. 30. Subsection (a) of section 46b-171 of the general statutes is repealed and the following is substituted in lieu thereof:

(a) (1) If the defendant is found to be the father of the child, the court or family support magistrate shall order [him] the defendant to stand charged with the support and maintenance of such child, with the assistance of the mother if [she] such mother is financially able, as said court finds, in accordance with the provisions of section 17b-81, 17b-223, 17b-745, as amended by this act, subsection (b) of section 17b-179, section 17a-90, 46b-129, 46b-130 or 46b-215, as amended by this act, to be reasonably commensurate with the financial ability of the defendant, and to pay a certain sum periodically until the child attains the age of eighteen years. [; and the] The court or family support magistrate shall order [him] the defendant to pay [the amount thereof] such sum to the complainant, or, if a town or the state has paid such expense, to the town or the state, as the case may be, and shall grant execution for the same and costs of suit taxed as in other civil actions, together with a reasonable attorney's fee; and may require [him] the defendant to become bound with sufficient surety to perform such orders for support and maintenance.

(2) In addition, the court or family support magistrate shall include in each support order in a IV-D support case a provision for the health care coverage of the child which provision may include an order for either parent to name any child under the age of eighteen years as a beneficiary of any medical or dental insurance or benefit plan carried by such parent or available to such parent on a group basis through an employer or union. If such insurance coverage is unavailable at reasonable cost, the provision for health care coverage may include an order for either parent to apply for and maintain coverage on behalf of the child under the HUSKY Plan, Part B. The noncustodial parent shall be ordered to apply for the HUSKY Plan, Part B only if such parent is found to have sufficient ability to pay the appropriate premium. In any IV-D support case in which the noncustodial parent is found to have insufficient ability to provide medical insurance coverage and the custodial party is the HUSKY Plan, Part A or Part B applicant, the provision for health care coverage may include an order for the noncustodial parent to pay such amount as is specified by the court or family support magistrate to the state or the custodial party, as their interests may appear, to offset the cost of any insurance payable under the HUSKY Plan, Part A or Part B. In no event may such order include payment to offset the cost of any such premium if such payment would reduce the amount of current support required under the child support guidelines.

(3) The court or family support magistrate shall also have authority to make and enforce orders for the payment by any person named herein of unpaid support contributions for which the defendant is liable in accordance with the provisions of section 17b-81, 17b-223, subsection (b) of section 17b-179, section 17a-90, 46b-129 or 46b-130 and, in IV-D cases, to order such person, provided [he] such person is not incapacitated, to participate in work activities which may include, but shall not be limited to, job search, training, work experience and participation in the job training and retraining program established by the Labor Commissioner pursuant to section 31-3t.

(4) If [he] the defendant fails to comply with [such] any order made under this section, the court or family support magistrate may commit [him] the defendant to a community correctional center, there to remain until [he] the defendant complies therewith; but, if it appears that the mother does not apply the periodic allowance paid by [him] the defendant toward the support of such child, and that such child is chargeable, or likely to become chargeable, to the town where it belongs, the court, on application, may discontinue such allowance to the mother, and may direct it to be paid to the selectmen of such town, for such support, and may issue execution in their favor for the same. The provisions of section 17b-743 shall apply to this section. The clerk of the court which has rendered judgment for the payment of money for the maintenance of any child under the provisions of this section shall, within twenty-four hours after such judgment has been rendered, notify the selectmen of the town where the child belongs.

(5) Any support order [for the payment of support for any such child] made under this section may at any time thereafter be set aside, altered or modified by any court issuing such order upon a showing of a substantial change in the circumstances of the defendant or the mother of such child or upon a showing that such order substantially deviates from the child support guidelines established pursuant to section 46b-215a, unless there was a specific finding on the record that the application of the guidelines would be inequitable or inappropriate. There shall be a rebuttable presumption that any deviation of less than fifteen per cent from the child support guidelines is not substantial and any deviation of fifteen per cent or more from the guidelines is substantial. Modification may be made of such support order without regard to whether the order was issued before, on or after May 9, 1991. No such support orders may be subject to retroactive modification, except that the court may order modification with respect to any period during which there is a pending motion for a modification of an existing support order from the date of service of the notice of such pending motion upon the opposing party pursuant to section 52-50.

(6) Failure of the defendant to obey any order for support made [hereunder] under this section may be punished as for contempt of court and the costs of commitment of any person imprisoned therefor shall be paid by the state as in criminal cases.

Sec. 31. Subsection (a) of section 46b-215 of the general statutes is repealed and the following is substituted in lieu thereof:

(a) (1) The Superior Court or a family support magistrate shall have authority to make and enforce orders for payment of support against any person who neglects or refuses to furnish necessary support to [his or her] such person's spouse or a child under the age of eighteen, according to [his or her] such person's ability to furnish such support, notwithstanding the provisions of section 46b-37.

(2) Any such support order in a IV-D support case shall include a provision for the health care coverage of the child which provision may include an order for either parent to name any child under eighteen as a beneficiary of any medical or dental insurance or benefit plan carried by such parent or available to such parent on a group basis through an employer or a union. If such insurance coverage is unavailable at reasonable cost, the provision for health care coverage may include an order for either parent to apply for and maintain coverage on behalf of the child under the HUSKY Plan, Part B. The noncustodial parent shall be ordered to apply for the HUSKY Plan, Part B only if such parent is found to have sufficient ability to pay the appropriate premium. In any IV-D support case in which the noncustodial parent is found to have insufficient ability to provide medical insurance coverage and the custodial party is the HUSKY Plan, Part A or Part B applicant, the provision for health care coverage may include an order for the noncustodial parent to pay such amount as is specified by the court or family support magistrate to the state or the custodial party, as their interests may appear, to offset the cost of any insurance payable under the HUSKY Plan, Part A or Part B. In no event may such order include payment to offset the cost of any such premium if such payment would reduce the amount of current support required under the child support guidelines.

(3) Proceedings to obtain [such] orders of support under this section shall be commenced by the service on the liable person or persons of a verified petition with summons and order, in a form prescribed by the Office of the Chief Court Administrator, of the husband or wife, child or any relative or the conservator, guardian or support enforcement officer, town or state, or any selectmen or the public official charged with the administration of public assistance of the town, or in TANF support cases, as defined in subdivision (14) of subsection (b) of section 46b-231, the Commissioner of Social Services. The verified petition, summons and order shall be filed in the judicial district in which the petitioner or respondent resides or does business, or if filed in the Family Support Magistrate Division, in the judicial district in which the petitioner or respondent resides or does business.

(4) For purposes of this section, the term "child" shall include one born out of wedlock whose father has acknowledged in writing [his] paternity of such child or has been adjudged the father by a court of competent jurisdiction, or a child who was born before marriage whose parents afterwards intermarry.

(5) Said court or family support magistrate shall also have authority to make and enforce orders directed to the conservator or guardian of any person, or payee of Social Security or other benefits to which such person is entitled, to the extent of the income or estate held by such fiduciary or payee in any such capacity.

(6) Said court or family support magistrate shall also have authority to determine, order and enforce payment of any sums due under a written agreement to support against the person liable for such support under such agreement.

(7) (A) Said court or family support magistrate shall also have authority to determine, order and enforce payment of any support due because of neglect or refusal to furnish support prior to the action.

(B) In the determination of support due based on neglect or refusal to furnish support prior to the action, the support due for periods of time prior to the action shall be based upon the obligor's ability to pay during such prior periods. The state shall disclose to the court any information in its possession concerning current and past ability to pay. With respect to such orders entered into on or after October 1, 1991, if no information is available to the court concerning past ability to pay, the court may determine the support due for periods of time prior to the action as if past ability to pay is equal to current ability to pay if known or, if not known, based upon assistance rendered to the child.

(C) Any finding as to support due for periods of time prior to the action which is made without information concerning past ability to pay shall be entered subject to adjustment when such information becomes available to the court. Such adjustment may be made upon motion of any party within four months from the date upon which the obligor receives notification of [(1)] (i) the amount of such finding of support due for periods of time prior to the action, and [(2)] (ii) the right within four months of receipt of such notification to present evidence as to [his] past ability to pay support for such periods of time prior to the action.

(8) (A) The judge or family support magistrate shall cause a summons, signed by [him] such judge or magistrate, by the clerk of said court or Family Support Magistrate Division, or by a commissioner of the Superior Court to be issued requiring such liable person or persons to appear in court or before a family support magistrate, at a time and place as determined by the clerk but not more than ninety days after the issuance of the summons. Service may be made by a sheriff, any proper officer or any investigator employed by the Department of Social Services or by the Commissioner of Administrative Services. The sheriff, proper officer or investigator shall make due return of process to the court not less than twenty-one days before the date assigned for hearing. Upon proof of the service of the summons to appear in court or before a family support magistrate at the time and place named for hearing upon such petition, the failure of the defendant or defendants to appear shall not prohibit the court or family support magistrate from going forward with the hearing. If the summons and order is signed by a commissioner of the Superior Court, upon proof of service of the summons to appear in court or before a family support magistrate and upon the failure of the defendant to appear at the time and place named for hearing upon the petition, request may be made by the petitioner to the court or family support magistrate for an order that a capias mittimus be issued.

(B) In the case of a person supported wholly or in part by a town, the welfare authority of the town shall notify the responsible relatives of such person of the amount of assistance given, the beginning date thereof and the amount of support expected from each of them, if any, and if any such relative does not contribute in such expected amount, the superior court for the judicial district in which such town is located or a family support magistrate sitting in the judicial district in which such town is located may order such relative or relatives to contribute to such support, from the time of the beginning date of expense shown on the notice, such sum as said court or family support magistrate deems reasonably within each such relative's ability to support such person.

(C) The court, or any judge thereof, or family support magistrate when said court or family support magistrate is not sitting, may require the defendant or defendants to become bound, with sufficient surety, to the state, town or person bringing the complaint, to abide such judgment as may be rendered on such complaint. Failure of the defendant or defendants to obey any order made [hereunder] under this section, may be punished as contempt of court and the costs of commitment of any person imprisoned therefor shall be paid by the state as in criminal cases. Except as otherwise provided, upon proof of the service of the summons to appear in court or before a family support magistrate at the time and place named for a hearing upon the failure of the defendant or defendants to obey such court order or order of the family support magistrate, the court or family support magistrate may order a capias mittimus be issued, and directed to some proper officer to arrest such defendant or defendants and bring [him or them] such defendant or defendants before the Superior Court for the contempt hearing. When any person is found in contempt under this section, the court or family support magistrate may award to the petitioner a reasonable attorney's fee and the fees of the officer serving the contempt citation, such sums to be paid by the person found in contempt.

(9) In addition to or in lieu of such contempt proceedings, the court or family support magistrate, upon a finding that any person has failed to obey any order made [hereunder, may order] under this section, may: (A) Order a plan for payment of any past-due support owing under such order, or, in IV-D cases, if such obligor is not incapacitated, order such obligor to participate in work activities which may include, but shall not be limited to, job search, training, work experience and participation in the job training and retraining program established by the Labor Commissioner pursuant to section 31-3t; [, and may] (B) suspend any professional, occupational, recreational, commercial driver's or motor vehicle operator's license as provided in subsections (b) to (e), inclusive, of section 46b-220, provided such failure was without good cause; [, may] (C) issue an income withholding order against such amount of any debt accruing by reason of personal services as provided by sections 52-362, 52-362b and 52-362c; [,] and [may further] (D) order executions against any real, personal, or other property of such person which cannot be categorized solely as either, for payment of accrued and unpaid amounts due under such order.

(10) No entry fee, judgment fee or any other court fee shall be charged by the court or the family support magistrate to either party in proceedings under this section.

(11) Any written agreement to support which is filed with the court or the Family Support Magistrate Division shall have the effect of an order of the court or a family support magistrate.

Sec. 32. Section 3 of public act 99-193 is repealed and the following is substituted in lieu thereof:

Notwithstanding the child support guidelines established pursuant to section 46b-215a of the general statutes, [only the earnings of the obligor for the first forty-five hours per week shall be included for the purposes of such guidelines] in cases in which an obligor is an hourly wage earner and has worked less than forty-five hours per week at the time of the establishment of the support order, any additional income earned from working more than forty-five hours per week shall not be considered income for purposes of such guidelines.

Sec. 33. Subsections (a) and (b) of section 8-206e of the general statutes are repealed and the following is substituted in lieu thereof:

(a) The Commissioner of Economic and Community Development shall, within available appropriations, establish a demonstration housing assistance and counseling program to offer advice on matters concerning landlord and tenant relations and the financing of owner-occupied and rental housing purchases, improvements and renovations. The program shall provide: (1) Educational services designed to inform landlords and tenants of their respective rights and responsibilities; (2) dispute mediation services for landlords and tenants; (3) information on securing housing-related financing, including mortgage loans, home improvement loans, energy assistance and weatherization assistance; and (4) such other housing-related counseling and assistance as the commissioner shall provide by regulations.

(b) The Commissioner of Economic and Community Development may, within available appropriations, enter into a contract or contracts to provide financial assistance in the form of grants-in-aid to nonprofit corporations, as defined in section 8-39, to carry out the purposes of subsection (a) of this section.

Sec. 34. Subsection (a) of section 8-119t of the general statutes is repealed and the following is substituted in lieu thereof:

(a) The Commissioner of Economic and Community Development shall encourage the development of independent living opportunities for low and moderate income handicapped and developmentally disabled persons by making grants-in-aid, within available appropriations, to state-wide, private, nonprofit housing development corporations which are organized and operating for the purpose of expanding independent living opportunities for such persons. Such grants-in-aid shall be used to facilitate the development of small, noninstitutionalized living units for such persons, through programs including, but not limited to, preproject development, receipt of federal funds, site acquisition and architectural review. For the purposes of this part, "handicapped and developmentally disabled persons" means any persons who are physically or mentally handicapped, including, but not limited to, mentally retarded, physically disabled, sensory impaired and autistic persons.

Sec. 35. The Commissioner of Social Services shall seek any federal waivers or amend the state Medicaid plan as necessary prior to July 1, 2000, in order to effectuate health insurance coverage for parents and needy caretaker relatives under the provisions of subsection (a) of section 17b-261 of the general statutes, as amended by this act. Not later than March 15, 2000, said commissioner shall submit a report on said commissioner's progress in the implementation of such coverage to the joint standing committees of the General Assembly having cognizance of matters relating to human services and appropriations and the budgets of state agencies.

Sec. 36. The Department of Social Services, in consultation with the Departments of Children and Families, Mental Health and Addiction Services, Mental Retardation and Education, shall conduct a study of the behavioral health services available to children enrolled in the HUSKY Plan, Part A and Part B. The study shall include a review of the service utilization and expenditures for behavioral health services by such departments. The Department of Social Services shall (1) coordinate the development of an inventory of services that shall include the expenditures associated with identified services for all Medicaid eligible children under twenty-one years of age who are enrolled in a managed care plan and are receiving services from the Department of Social Services, Children and Families, Mental Health and Addiction Services, Mental Retardation or Education, and (2) review funding sources and apply for grants and awards as may be required to cover the expenses associated with the study. Not later than February 1, 2000, said department shall submit a report on its findings and recommendations to the joint standing committees of the General Assembly having cognizance of matters relating to human services and public health and to the select committee of the General Assembly having cognizance of matters relating to children. The report may include, but not be limited to, (A) an aggregate patient profile that includes demographics, status of children with respect to the Department of Children and Families, payer source, diagnosis, acuity level, acute and subacute care placement, timeliness of service access and length of stay or number of visits for behavioral health services, (B) administrative or medical necessity reinsurance utilization for acute, subacute and residential placement in the HUSKY Plan, (C) the average time from referral to the start of outpatient treatment and the percentage of children who receive care compared to the percentage referred, (D) recommendations concerning the provision of individualized education plans that include mental health services for committed and noncommitted children and the payer source for such services, (E) the utilization of substance abuse services, (F) an overall assessment of changing utilization patterns of behavioral health services, (G) an identification of unmet behavioral health service needs, (H) recommendations to improve access to, and the delivery and quality of, behavioral health services for children, and (I) recommendations to improve the integration of such services across such departments.

Sec. 37. (a) On and after the effective date of this section, the Commissioner of Social Services shall establish a state-funded pilot program to allow not more than ten persons to receive services under the Connecticut home-care program for the elderly established under section 17b-342 of the general statutes (1) provided such persons would be eligible for the Medicaid-funded portion of the Connecticut home-care program for the elderly except that their monthly income exceeds the amount allowed under said program by not more than one hundred dollars and formerly received services under said program, and (2) only after an evaluation and a determination by said commissioner that such persons would require care in a long-term care facility if such persons did not receive services under said program. Services provided and contributions required under the pilot program shall be equivalent to those under the Medicaid-funded portion of the Connecticut home-care program for the elderly. Said pilot program shall terminate on June 30, 2000.

(b) The commissioner may require any person who participates in the pilot program to contribute the portion of income that exceeds the income eligibility limit established in section 17b-342 of the general statutes toward the cost of services in such manner as the commissioner prescribes.

(c) Not later than October 1, 2000, the commissioner shall submit a report to the joint standing committees of the General Assembly having cognizance of matters relating to human services and appropriations and the budgets of state agencies and to the select committee of the General Assembly having cognizance of matters relating to aging, in such detail, depth and scope as said committees require to evaluate the effect of the pilot program on the state and pilot program participants. The report shall include information on (1) the number of persons screened for the pilot program, (2) the number of persons served by the pilot program, (3) the average cost per person in the pilot program, (4) the amount by which the income of each person served by the pilot program exceeds the income limits under the Connecticut home-care program for the elderly, (5) the cost of administering the pilot program, and (6) the estimated savings generated by the pilot program.

Sec. 38. On and after the effective date of this section, and until June 30, 2000, the Commissioner of Social Services shall provide medical services other than the services provided under the Connecticut home-care program for the elderly equivalent to the services provided under the Medicaid program to persons who participate in the pilot program established under section 37 of this act.

Sec. 39. Not later than February 1, 2000, the Long-Term Care Planning Committee established under section 17b-337 of the general statutes shall (1) develop a plan to ensure the availability of home care services for elderly persons under the Connecticut home-care program for the elderly established pursuant to the provisions of section 17b-342 of the general statutes who would qualify for said program except for income in excess of the established limits, and (2) submit a report on such plan to the joint standing committee of the General Assembly having cognizance of matters relating to human services and the select committee of the General Assembly having cognizance of matters relating to aging.

Sec. 40. Not later than June 30, 2001, and to the extent permitted by federal law, the Department of Social Services shall restructure the Medicaid program to ensure that the state receives the most favorable rates for selected medical services covered under said program for eligible individuals who are living in the community and who are not covered for such selected services under a managed care plan. The department shall restructure the medical assistance program under the state-administered general assistance program in a similar manner.

Sec. 41. The Nursing Home Financial Advisory Committee established pursuant to section 17b-339 of the general statutes shall study the current payment system for nursing facilities and develop recommendations concerning the feasibility of changing to a per diem prospective payment system covering all costs related to services furnished to Medicaid recipients. The prospective payment system shall be determined using the following factors: (1) Historic allowable costs; (2) case-mix adjusted per diem payments using a resident classification system based on data from nursing facility resident assessments; (3) geographic adjustments based on rent and wage rates; and (4) annual inflationary updates. Such study shall include the feasibility of a phase-in of the prospective payment system beginning July 1, 2001, to June 30, 2003. The results of such study shall be submitted to the joint standing committees of the General Assembly having cognizance of matters relating to appropriations and the budgets of state agencies and human services, in accordance with the provisions of section 11-4a of the general statutes, not later than February 1, 2000.

Sec. 42. From July 1, 1999, to June 30, 2001, inclusive, in the event of the sale of a nursing facility, no such facility shall receive an increase in its per diem rate which exceeds the rate such facility was receiving on the date of such sale by twenty per cent, except as otherwise provided by section 17b-340 of the general statutes.

Sec. 43. At least thirty days prior to entering into any contract to modify, or at least thirty days prior to the implementation of any modifications to, the pharmacy benefit or financial structure of the Connecticut Pharmaceutical Assistance Contract to the Elderly and the Disabled Program established pursuant to section 17b-491 of the general statutes, the medical assistance program under the state-administered general assistance program established pursuant to section 17b-257 of the general statutes, or the Medicaid program, the Commissioner of Social Services shall submit a report to the joint standing committees of the General Assembly having cognizance of matters relating to human services and appropriations and the budgets of state agencies, and the select committee of the General Assembly having cognizance of matters relating to aging. The report shall include (1) financial information and savings projections, (2) information concerning the source of the savings, (3) the financial effect on the program of the loss of the pharmaceutical manufacturers' rebates, (4) the potential effect on the program of pharmacies ceasing to participate in the program due to the loss of revenue from dispensing fees, and (5) other information as may be requested by the chairpersons and ranking members of said committees on or before July 15, 1999.

Sec. 44. The unexpended balance of funds appropriated to the Commission on Children in section 11 of special act 97-21, as amended by section 1 of special act 98-6, for Personal Services, Other Expenses and Equipment shall not lapse on June 30, 1999, and such funds shall be available for expenditure for the purpose of funding the Parent Leadership Training Institute during the fiscal year ending June 30, 2000.

Sec. 45. This act shall take effect from its passage, except that sections 1 to 4, inclusive, 6, 7, 9 to 14, inclusive, 17 to 31, inclusive, and 33 to 44, inclusive, shall take effect July 1, 1999, sections 5 and 8 shall take effect October 1, 1999, and section 16 shall take effect July 1, 2000.

Approved June 29, 1999

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