June Special Session, Public Act No. 01-2
AN ACT CONCERNING THE EXPENDITURES OF THE DEPARTMENT OF SOCIAL SERVICES.
Be it enacted by the Senate and House of Representatives in General Assembly convened:
Section 1. (NEW) For the fiscal year ending June 30, 2003, the Commissioner of Social Services may, within available appropriations, provide rate relief to enhance the staffing of chronic and convalescent nursing homes and rest homes with nursing supervision. Priority in the use of such available funding shall be given to those facilities with staffing levels below two hours per patient per day for nurses' aides, three-quarters of an hour per patient per day for registered and licensed nurses, and two and three-quarters hours per patient per day total.
Sec. 2. (NEW) For the fiscal year ending June 30, 2004, the Commissioner of Social Services may, within available appropriations, provide rate relief to enhance the staffing of chronic and convalescent nursing homes and rest homes with nursing supervision. Priority in the use of such available funding shall be given to those facilities with staffing levels below two hours per patient per day for nurses' aides, one hour per patient per day for registered and licensed nurses, and three hours per patient per day total.
Sec. 3. Section 17b-261 of the general statutes is repealed and the following is substituted in lieu thereof: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 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 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 up to one hundred eighty-five per cent of the federal poverty level without an asset limit. On and after January 1, 2001, said medical assistance program shall also 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 fifty per cent of the federal poverty level without an asset limit, upon the request of such a person or upon a redetermination of eligibility. 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.
(b) For the purposes of the Medicaid program, the Commissioner of Social Services shall consider parental income and resources as available to a child under eighteen years of age who is living with his or her parents and is blind or disabled for purposes of the Medicaid program, or to any other child under twenty-one years of age who is living with his or her parents.
(c) For the purposes of determining eligibility for the Medicaid program, an available asset is one that is actually available to the applicant or one that the applicant has the legal right, authority or power to obtain or to have applied for the applicant's general or medical support. If the terms of a trust provide for the support of an applicant, the refusal of a trustee to make a distribution from the trust does not render the trust an unavailable asset. Notwithstanding the provisions of this subsection, the availability of funds in a trust or similar instrument funded in whole or in part by the applicant or the applicant's spouse shall be determined pursuant to the Omnibus Budget Reconciliation Act of 1993, 42 USC 1396p. The provisions of this subsection shall not apply to special needs trust, as defined in 42 USC 1396p(d)(4)(A).
(d) The transfer of an asset in exchange for other valuable consideration shall be allowable to the extent the value of the other valuable consideration is equal to or greater than the value of the asset transferred.
[(c)] (e) On or before January 15, 1994, and annually thereafter, the Department of Social Services shall submit a report to the General Assembly in accordance with section 11-4a which sets forth the following: The number of children receiving Medicaid services; the number of children receiving medical treatment at any state or municipal health care facility; the number of doctors and dentists participating in state or municipally-funded programs; and the percentage of children treated in medical programs whose family income is less than one hundred thirty-three per cent of the federal poverty level and the number whose family income is greater than one hundred thirty-three per cent but not more than one hundred eighty-five per cent of the federal poverty level. On and after October 1, 1996, the report shall be submitted to the joint standing committee of the General Assembly having cognizance of matters relating to human services and, upon request, to any member of the General Assembly. A summary of the report shall be submitted to each member of the General Assembly if the summary is two pages or less and a notification of the report shall be submitted to each member if the summary is more than two pages. Submission shall be by mailing the report, summary or notification to the legislative address of each member of the committee or the General Assembly, as applicable.
[(d)] (f) The Commissioner of Social Services shall seek a waiver from federal law to permit federal financial participation for Medicaid expenditures for families with incomes of one hundred forty-three per cent of the temporary family assistance program payment standard.
Sec. 4. (NEW) The Commissioner of Social Services shall seek a waiver of federal law for the purpose of establishing that the penalty period during which an applicant for or recipient of assistance for long-term care under the Medicaid program is ineligible for Medicaid-funded services due to a transfer of assets for less than fair market value shall begin in the month the applicant is found otherwise eligible for Medicaid coverage of services rather than in the month of the transfer of assets. This section shall only apply to transfers that occur on or after the effective date of the waiver. The provisions of section 17b-8 of the general statutes shall apply to this section.
Sec. 5. (NEW) (a) The Department of Social Services shall be the sole agency to determine eligibility for assistance and services under programs operated and administered by said department.
(b) Any person filing an application with a probate court for spousal support, in accordance with section 45a-655 of the general statutes, shall certify to that court that a copy of the application and accompanying attachments have been sent by regular mail, postage prepaid, to the Commissioner of Social Services. The probate court shall provide a notice of hearing to the commissioner at least fifteen business days prior to the hearing. The commissioner or a designee shall have the right to appear at such hearing and may present the commissioner's position as to the application in person or in writing. Any final order by the court on such application for spousal support shall be sent to the commissioner within seven business days of the order.
(c) No probate court shall approve an application for spousal support of a community spouse unless (1) notice is provided in accordance with subsection (b) of this section, and (2) the order is consistent with state and federal law.
Sec. 6. Subsection (d) of section 45a-655 of the general statutes is repealed and the following is substituted in lieu thereof:
(d) In the case of any person receiving public assistance, state-administered general assistance or Medicaid, the conservator of the estate shall apply toward the cost of care of such person any assets exceeding limits on assets set by statute or regulations adopted by the Commissioner of Social Services. Notwithstanding the provisions of subsections (a) and (b) of this section, in the case of an institutionalized person who has applied for or is receiving such medical assistance, no conservator shall apply and no court shall approve the application of (1) the net income of the ward to the support of the ward's spouse in an amount that exceeds the monthly income allowed a community spouse as determined by the Department of Social Services pursuant to 42 USC 1396r-5(d)(2)-(4), or (2) any portion of the property of the ward to the support, maintenance and medical treatment of the ward's spouse in an amount that exceeds the amount determined allowable by the department pursuant to 42 USC 1396r-5(f)(1) and (2), notwithstanding the provisions of 42 USC 1396r-5(f)(2)(A)(iv), unless [(A)] such limitations on income [or property] would result in significant financial duress. [or (B) an amount exceeding such limitations is necessary to generate income.]
Sec. 7. Section 17b-278b of the general statutes is repealed and the following is substituted in lieu thereof:
(a) [To the extent authorized by federal law, the] The Commissioner of Social Services [may] shall provide coverage under the Medicaid program in accordance with Public Law 106-354 to women diagnosed with breast or cervical cancer. The commissioner shall seek any federal waivers or amend the state Medicaid plan as necessary in order to secure federal reimbursement for the costs [to such plan] of providing [treatment and other medical services to women diagnosed with breast or cervical cancer under the breast and cervical cancer early detection and treatment referral program established under section 19a-266] coverage under the Medicaid program to such women. Such coverage shall not be dependent on the available income or assets of an applicant.
(b) To qualify for medical assistance under this section, a woman shall: (1) Have been screened for breast or cervical cancer under the Centers for Disease Control and Prevention's National Breast and Cervical Cancer Early Detection Program and found to be in need of treatment for breast or cervical cancer, including a precancerous condition of the breast or cervix; (2) not otherwise have creditable coverage, as defined in 42 USC 300gg(c); (3) not have attained the age of sixty-five years; (4) not be eligible under any mandatory Medicaid eligibility group; and (5) be a resident of this state and a United States citizen or a qualified alien, as defined in Section 431 of Public Law 104-193.
(c) The commissioner shall deem an applicant who has been determined eligible for medical assistance under this section as having been eligible for up to three months prior to the month in which an application was filed if the requirements in subsection (b) of this section were met during such three-month period. An individual determined eligible for medical assistance under this section shall remain eligible until the individual's course of treatment is completed or until eligibility criteria set forth in subsection (b) of this section are no longer met. The commissioner shall establish procedures for the granting of presumptive eligibility in order to ensure prompt access to services for applicants.
(d) The Commissioner of Social Services shall implement policies and procedures necessary to carry out the provisions of this section while in the process of adopting such policies and procedures in regulation form in accordance with chapter 54, provided notice of intention to adopt the regulations is published in the Connecticut Law Journal within twenty days of implementation of such policies and procedures. Such policies and procedures shall be valid until the time final regulations are effective.
Sec. 8. (NEW) The Commissioner of Social Services shall seek a waiver from federal law to provide coverage for used durable medical equipment under the Medicaid program.
Sec. 9. For the fiscal year ending June 30, 2002, the Department of Social Services shall pay the Medicare Part B premiums for eligible Medicaid recipients, from expenditures deposited in a nonlapsing account from revenue received from the United States Department of Health and Human Services for the portion designated for such Medicare Part B premiums. The department shall continue such payments until such time the department contracts with the federal government to administer the Medicare Part B Buy-in Program.
Sec. 10. For the fiscal year ending June 30, 2002, and each fiscal year thereafter, with the approval of the Office of Policy and Management, the Department of Social Services may credit to a nonlapsing account in the General Fund, and expend from such nonlapsing account, the amounts necessary for payment of the federal share of recoveries or overpayments established under the Aid to Families with Dependent Children program.
Sec. 11. Subsection (a) of section 17b-239 of the general statutes is repealed and the following is substituted in lieu thereof:
(a) The rate to be paid by the state to hospitals receiving appropriations granted by the General Assembly and to freestanding chronic disease hospitals, providing services to persons aided or cared for by the state for routine services furnished to state patients, shall be based upon reasonable cost to such hospital, or the charge to the general public for ward services or the lowest charge for semiprivate services if the hospital has no ward facilities, imposed by such hospital, whichever is lowest, except to the extent, if any, that the commissioner [in his discretion] determines that a greater amount is appropriate in the case of hospitals serving a disproportionate share of indigent patients. Such rate shall be promulgated annually by the Commissioner of Social Services. Nothing contained herein shall authorize a payment by the state for such services to any such hospital in excess of the charges made by such hospital for comparable services to the general public. Notwithstanding the provisions of this section, for the rate period beginning July 1, 2000, rates paid to freestanding chronic disease hospitals and freestanding psychiatric hospitals shall be increased by three per cent. [For the rate period beginning July 1, 2001, and each succeeding rate period, rates paid to freestanding chronic disease hospitals and freestanding psychiatric hospitals shall be equal to but not exceed rates for the preceding rate period, plus an inflation factor equal to the Medicare market basket inflation rate as published in the previous September Federal Register of each year with the wage portion of such market basket adjusted for the Hartford metropolitan statistical area.] For the rate period beginning July 1, 2001, a freestanding chronic disease hospital or freestanding psychiatric hospital shall receive a rate that is two and one-half per cent more than the rate it received in the prior fiscal year. For the rate period beginning July 1, 2002, a freestanding chronic disease hospital or freestanding psychiatric hospital shall receive a rate that is two per cent more than the rate it received in the prior fiscal year.
Sec. 12. Subsection (c) of section 17b-112 of the general statutes is repealed and the following is substituted in lieu thereof:
(c) A family who is subject to time-limited benefits may petition the Commissioner of Social Services for six-month extensions of such benefits. The commissioner shall grant [such an extension to a] not more than three extensions to such family who has made a good faith effort to comply with the requirements of the program and despite such effort has a total family income at a level below the payment standard, or has encountered circumstances preventing employment including, but not limited to: (1) Domestic violence or physical harm to such family's children; or (2) other circumstances beyond such family's control. [Earned income counting towards total family income shall have ninety dollars disregarded. Such family] The commissioner shall disregard ninety dollars of earned income in determining applicable family income. The commissioner may grant a fourth or a subsequent six-month extension if each adult in the family meets one or more of the following criteria: (A) The adult is precluded from engaging in employment activities due to domestic violence or another reason beyond the adult's control; (B) the adult has two or more substantiated barriers to employment including, but not limited to, the lack of available child care, substance abuse or addiction, severe mental or physical health problems, one or more severe learning disabilities, domestic violence or a child who has a serious physical or behavioral health problem; (C) the adult is working thirty-five or more hours per work, is earning at least the minimum wage and continues to earn less than the family's temporary family assistance payment standard; or (D) the adult is employed and works less than thirty-five hours per week due to (i) a documented medical impairment that limits the adult's hours of employment, provided the adult works the maximum number of hours that the medical condition permits, or (ii) the need to care for a disabled member of the adult's household, provided the adult works the maximum number of hours the adult's caregiving responsibilities permit. Families receiving temporary family assistance shall be notified by the department of the right to petition for such extensions. Notwithstanding the provisions of this section, the commissioner shall not provide benefits under the state's temporary family assistance program to a family that is subject to the twenty-one month benefit limit and has received benefits beginning on or after October 1, 1996, if such benefits result in that family's receiving more than sixty months of time-limited benefits unless that family experiences domestic violence, as defined in Section 402(a)(7)(B), P.L. 104-193. For the purpose of calculating said sixty-month limit: (I) A month shall count toward the limit if the family receives assistance for any day of the month, and (II) a month in which a family receives temporary family assistance benefits that are issued from a state other than Connecticut shall count toward the limit.
Sec. 13. (NEW) A minor parent who is without a high school diploma, is not married and has a child who is at least twelve weeks of age, who is in such parent's care, shall be ineligible for temporary family assistance unless such parent is participating in educational activities directed toward the attainment of a high school diploma or its equivalent.
Sec. 14. Section 17b-688c of the general statutes is repealed and the following is substituted in lieu thereof:
(a) The Department of Social Services shall administer, in accordance with sections 17b-688d and 17b-688e, an employment services program for the purpose of providing employment services to recipients of benefits under the temporary assistance for needy families program pursuant to Title IV-A of the Social Security Act. Said program shall include the provision of employment services to recipients of temporary family assistance that will enable them to become employed and independent of cash assistance within twenty-one months of receipt of temporary family assistance.
(b) The Department of Social Services shall reduce the benefits awarded to a family under the temporary family assistance program when a member of the family who is required to participate in employment services fails to comply with an employment services requirement without good cause. The first instance of noncompliance with an employment services requirement shall result in a twenty-five per cent reduction of such benefits for three consecutive months. The second instance of noncompliance with such requirement shall result in a thirty-five per cent reduction of such benefits for three consecutive months. A third or subsequent instance of noncompliance with such requirement shall result in the termination of such benefits for three consecutive months. If only one member of a family is eligible for temporary family assistance and such member fails to comply with an employment services requirement, the department shall terminate all benefits of such family for three consecutive months. Notwithstanding the provisions of this subsection, the department shall terminate the benefits awarded to a family under the temporary family assistance program if a member of the family who is not exempt from the twenty-one-month time limit specified in subsection (a) of section 17b-112, as amended by this act, fails, without good cause, to: (1) Attend any scheduled assessment appointment or interview relating to the establishment of an employment services plan, except that such individual's benefits shall be reinstated if the individual attends a subsequently scheduled appointment or interview within thirty days of the date on which the department has issued notification to the individual that benefits have been terminated, or (2) comply with an employment services requirement during a six-month extension of benefits. Any individual who fails to comply with the provisions of subdivision (1) of this subsection may submit a new application for such benefits at any time after termination of benefits.
(c) The Department of Social Services shall not enter into or renew any contractual obligations for the employment services program that extend beyond June 30, 1998. Within fifteen days after execution of such contractual obligations, the Department of Social Services shall send to the Labor Department a copy of such contracts for the information of the Labor Department.
(d) The Commissioner of Social Services shall implement policies and procedures necessary to carry out the purposes of this section while in the process of adopting such policies and procedures in regulation form, provided notice is published in the Connecticut Law Journal within twenty days of implementation of such policies and procedures. [Final regulations shall be submitted to the legislative regulation review committee no later than November 15, 1997.] Policies and procedures implemented pursuant to this section shall be valid until the time final regulations are effective.
Sec. 15. 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 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. Except when determining eligibility for a six-month extension of benefits pursuant to subsection (c) of this section, the commissioner shall disregard the first fifty dollars per month of income attributable to child support that a family receives in determining eligibility and benefit levels for temporary family assistance.
Sec. 16. Section 17b-112g of the general statutes is repealed and the following is substituted in lieu thereof:
(a) The Commissioner of Social Services shall offer immediate diversion assistance designed to prevent certain families who are applying for monthly temporary family assistance from needing such assistance. Diversion assistance shall be offered to families that (1) upon initial assessment are determined eligible for temporary family assistance, (2) demonstrate a short-term need that cannot be met with current or anticipated family resources, and (3) with the provision of a service or short-term benefit, would be prevented from needing monthly temporary family assistance.
(b) The Commissioner of Social Services shall establish (1) a simplified eligibility determination process for diversion assistance, and (2) an expedited procedure to deliver benefits pursuant to this section. Diversion assistance shall be provided not later than fifteen calendar days from the date the applicant signs a request for diversion assistance. An application for temporary family assistance shall be withdrawn if the Commissioner of Social Services and the applicant agree that diversion assistance would prevent the family from needing temporary family assistance and such diversion assistance is provided. In no event shall the amount of diversion assistance be greater than the cash assistance equivalent of three months of temporary family assistance for such family.
(c) Diversion assistance may include, but not be limited to, employment services, child care assistance, transportation assistance, housing assistance, utilities assistance, clothing assistance and assistance with purchasing or maintaining tools necessary for employment.
(d) A family receiving diversion assistance shall be ineligible to receive monthly temporary family assistance payments for a period of three months from the date of application for temporary family assistance, except that such family shall be eligible to receive temporary family assistance payments within such period if the Commissioner of Social Services, or [his] the commissioner's designee, in [his] the commissioner's sole discretion, determines that the family has experienced undue hardship. A family that is subject to the twenty-one-month benefit limit under temporary family assistance shall have diversion assistance count as three months toward such limit. Nothing in this [subsection] section shall prohibit a family receiving diversion assistance that later qualifies for temporary family assistance from qualifying for a six-month extension available to recipients of temporary family assistance who did not receive diversion assistance.
(e) Notwithstanding the provisions of section 17b-77 and to the extent permitted by federal law, families shall not be required to assign their right to receive child support payments to the state while receiving diversion assistance.
(f) The Commissioner of Social Services shall inform each applicant of the specific benefits and services the family will receive through diversion assistance and the benefits available to such family under temporary family assistance. If the applicant consents to diversion assistance, [he] the applicant may rescind [his] the request for such assistance within three business days of the request for diversion assistance.
(g) Nothing in this section shall prohibit a family receiving diversion assistance from being eligible for other social service programs administered by the Department of Social Services including, but not limited to, food stamps, child care assistance, medical assistance and transitional child care and medical assistance benefits.
(h) The Commissioner of Social Services shall implement the policies and procedures necessary to carry out the provisions 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. 17. Subsection (a) of section 17b-112c of the general statutes is repealed and the following is substituted in lieu thereof:
(a) Qualified aliens, as defined in Section 431 of Public Law 104-193, who do not qualify for federally-funded cash assistance, other lawfully residing immigrant aliens or aliens who formerly held the status of permanently residing under color of law shall be eligible for solely state-funded temporary family assistance [, assistance under the federal waiver for the demonstration program entitled "Reach for Jobs First"] or cash assistance under the state-administered general assistance program, provided other conditions of eligibility are met. An individual who is granted assistance under this section must pursue citizenship to the maximum extent allowed by law as a condition of eligibility 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 section, any qualified alien or other lawfully residing immigrant alien or alien who formerly held the status of permanently residing under color of law who is a victim of domestic violence or who has mental retardation shall be eligible for assistance under this section. The commissioner shall not accept new applications for assistance under this subsection as of the effective date of this section.
Sec. 18. Subsection (a) of section 17b-790a of the general statutes is repealed and the following is substituted in lieu thereof:
(a) The Commissioner of Social Services, within available appropriations, shall establish a food assistance program for individuals entering the United States prior to April 1, 1998, whose immigrant status meets the eligibility requirements of the federal Food Stamp Act of 1977, as amended, but who are no longer eligible for food stamps solely due to their immigrant status under Public Law 104-193. The commissioner shall not accept new applications for assistance under this section after June 30, 2002. Individuals who enter the United States after April 1, 1998, must have resided in the state for six months prior to becoming eligible for the state program. The commissioner may administer such program in accordance with the provisions of the federal food stamp program, except those pertaining to the determination of immigrant status under Public Law 104-193.
Sec. 19. 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 or cash assistance under the state-administered general assistance program prior to July 1, 1997, or other lawfully residing immigrant alien or alien who formerly held the status of permanently residing under color of law, shall remain eligible, [for such assistance until July 1, 2001,] and (2) a qualified alien, other lawfully residing immigrant alien admitted into the United States on or after August 22, 1996, other lawfully residing immigrant alien or an alien who formerly held the status of permanently residing under color of law 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, 2001, except if the individual is otherwise qualified for the purpose of state receipt of federal financial participation.]
Sec. 20. (NEW) Notwithstanding any provision of chapter 319v of the general statutes, the Commissioner of Social Services may implement a mandatory program of primary care case management to provide medical assistance to beneficiaries eligible under sections 17b-257 and 17b-259 of the general statutes, as amended by this act. The Department of Social Services may enter into contracts for medical services and program management to implement the provisions of this section.
Sec. 21. Subsection (a) of section 20-126l of the general statutes is repealed and the following is substituted in lieu thereof:
(a) As used in this section:
(1) "General supervision of a licensed dentist" means supervision that authorizes dental hygiene procedures to be performed with the knowledge of said licensed dentist, whether or not the dentist is on the premises when such procedures are being performed;
(2) "Public health facility" means an institution, as defined in section 19a-490, a community health center, a group home, [or] a school, a preschool operated by a local or regional board of education or a head start program; and
(3) The "practice of dental hygiene" means the performance of educational, preventive and therapeutic services including: Complete prophylaxis; the removal of calcerous deposits, accretions and stains from the supragingival and subgingival surfaces of the teeth by scaling, root planing and polishing; the application of pit and fissure sealants and topical solutions to exposed portions of the teeth; dental hygiene examinations and the charting of oral conditions; dental hygiene assessment, treatment planning and evaluation; and collaboration in the implementation of the oral health care regimen.
Sec. 22. Section 17b-492 of the general statutes is repealed and the following is substituted in lieu thereof:
(a) Eligibility for participation in the program shall be limited to any resident (1) who is sixty-five years of age or older or who is disabled, (2) (A) whose annual income, if unmarried, is less than thirteen thousand eight hundred dollars, except after April 1, 2002, such annual income is less than twenty thousand dollars, or whose annual income, if married, when combined with that of [his] the resident's spouse is less than sixteen thousand six hundred dollars, except after April 1, 2002, such combined annual income is less than twenty-seven thousand one hundred dollars, or (B) in the event the program is granted a waiver to be eligible for federal financial participation, then, after July 1, 2002, whose annual income, if unmarried, is less than twenty-five thousand eight hundred dollars, or whose annual income, if married, when combined with that of the resident's spouse is less than thirty-four thousand eight hundred dollars, (3) who is not insured under a policy which provides full or partial coverage for prescription drugs once a deductible amount is met, and (4) on and after September 15, 1991, who pays an annual twenty-five-dollar registration fee to the Department of Social Services. Effective January 1, 2002, the commissioner shall commence accepting applications from individuals who will become eligible to participate in the program as of April 1, 2002. On January 1, 1998, and annually thereafter, the commissioner shall, by the adoption of regulations in accordance with chapter 54, increase the income limits established under this subsection over those of the previous fiscal year to reflect the annual inflation adjustment in Social Security income, if any. Each such adjustment shall be determined to the nearest one hundred dollars.
(b) Payment for a prescription under the program shall be made only if no other plan of insurance or assistance is available to an eligible person for such prescription at the time of dispensing. The pharmacy shall make reasonable efforts to ascertain the existence of other insurance or assistance.
(c) Any eligible resident who (1) is insured under a policy which provides full or partial coverage for prescription drugs, and (2) expects to exhaust such coverage, may apply to participate in the program prior to the exhaustion of such coverage. Such application shall be valid for the applicable income year. To be included in the program, on or after the date the applicant exhausts such coverage, [he or his] the applicant or the applicant's designee shall notify the department that such coverage is exhausted and, if required by the department, shall submit evidence of exhaustion of coverage. Not later than ten days after an eligible resident submits such evidence, [he] such resident shall be included in the program. The program shall (A) cover prescriptions that are not covered by any other plan of insurance or assistance available to the eligible resident and that meet the requirements of this chapter, and (B) retroactively cover such prescriptions filled after or concurrently with the exhaustion of such coverage. Nothing in this subsection shall be construed to prevent a resident from applying to participate in the program as otherwise permitted by this chapter and regulations adopted pursuant to this chapter.
(d) The Commissioner of Social Services may adopt regulations in accordance with the provisions of chapter 54 to implement the provisions of subsection (c) of this section. Such regulations may provide for the electronic transmission of relevant coverage information between a pharmacist and the department or between an insurer and the department in order to expedite applications and notice.
Sec. 23. Section 17b-296 of the general statutes is repealed and the following is substituted in lieu thereof:
(a) Each managed care plan shall include sufficient numbers of appropriately trained and certified clinicians of pediatric care, including primary, medical subspecialty and surgical specialty physicians, as well as providers of necessary related services such as dental services, mental health services, social work services, developmental evaluation services, occupational therapy services, physical therapy services, speech therapy and language services, school-linked clinic services and other public health services to assure enrollees the option of obtaining benefits through such providers.
(b) Each managed care organization that on or after the effective date of this section, enters into a contract with the department to provide comprehensive services under the HUSKY Plan, Part A or the HUSKY Plan, Part B, or both, shall have primary responsibility for ensuring that its behavioral health and dental subcontractors adhere to the contract between the department and the managed care organization, including the provision of timely payments to providers and interest payments in accordance with subdivision (15) of section 38a-816. The managed care organization shall submit to the department a claims aging inventory report including all data on all services paid by subcontractors in accordance with the terms of the contract with the department.
(c) Upon the initial contract or the renewal of a contract between a managed care organization and a behavioral health or dental subcontractor, the department shall require that the managed care organizations impose a performance bond, letter of credit, statement of financial reserves or payment withhold for behavioral health and dental subcontractors that provide services under the HUSKY Plan, Part A or the HUSKY Plan, Part B, or both. Any such performance bond, letter of credit, statement of financial reserves or payment withhold that may be required by the department pursuant to a contract with a managed care organization shall be in an amount sufficient to assure the settlement of provider claims in the event that the contract between the managed care organization and the behavioral health or dental subcontractor is terminated. Upon the initial contract or the renewal of a contract between a managed care organization and a behavioral health or dental subcontractor, the managed care organization shall negotiate and enter into a contract termination agreement with its behavioral health and dental subcontractors that shall include, but not be limited to, provisions concerning financial responsibility for the final settlement of provider claims and data reporting to the department. The managed care organization shall submit reports to the department, at such times as the department shall determine, concerning any payments made from such performance bond or any payment withholds, the timeliness of claim payments to providers and the payment of any interest to providers.
(d) Prior to the approval by the department of a contract between a managed care organization and a behavioral health and dental subcontractor for services provided under the HUSKY Plan, Part A or the HUSKY Plan, Part B, or both, the managed care organization shall submit a plan to the department for the resolution of any outstanding claims submitted by providers to a previous behavioral health or dental subcontractor of the managed care organization for services provided to members enrolled in the HUSKY Plan, Part A or the HUSKY Plan, Part B, or both. Such plan for the resolution of outstanding claims shall include a claims aging inventory report and shall comply with the terms of the contract between the department and the managed care organization.
Sec. 24. Section 46a-33a of the general statutes is repealed and the following is substituted in lieu thereof:
(a) For the purposes of this section:
(1) "Interpreting" means the translating or transliterating of English concepts to specialized vocabulary used by a person who is deaf or hard of hearing or means the translating of a deaf or hard of hearing person's specialized vocabulary to English concepts. Specialized vocabulary concepts include, but are not limited to, the use of American sign language, English-based sign language, cued speech, oral transliterating and information received tactually;
(2) "Legal setting" means any criminal or civil action involving the Superior Court or its agents, any investigation conducted by a duly authorized law enforcement agency, employment related hearings and appointments requiring the presence of an attorney; [and]
(3) "Medical setting" means medical related situations including mental health treatment, psychological evaluations, substance abuse treatment, crisis intervention and appointments or treatment requiring the presence of a doctor or nurse; and
(4) "Educational setting" means a school or other educational institution, including elementary, high school and post-graduation schools where interpretive services are provided to a student.
(b) Commencing October 1, 1998, and annually thereafter, all persons providing interpreting services shall register with the Commission on the Deaf and Hearing Impaired. Such registration shall be on a form prescribed or furnished by the commission and shall include the registrant's name, address, phone number, place of employment as interpreter and interpreter certification or credentials. Commencing July 1, 2001, and annually thereafter, the commission shall issue identification cards for those who register in accordance with this section.
(c) On and after July 1, 2001, no person shall provide interpreting services unless such person is registered with the commission according to the provisions of this section and (1) has passed the National Registry of Interpreters for the Deaf written generalist test and holds a level three certification provided by the National Association of the Deaf and documents the achievement of two continuing education units per year for a maximum of five years of commission approved training, (2) has passed the National Registry of Interpreters for the Deaf written generalist test and is a graduate of an accredited interpreter training program and documents the achievement of two continuing education units per year for a maximum of five years of commission approved training, (3) holds a level four certification or higher from the National Association of the Deaf, (4) holds certification by the National Registry of Interpreters for the Deaf, (5) for situations requiring an oral interpreter only, holds oral certification from the National Registry of Interpreters for the Deaf, (6) for situations requiring a cued speech transliterator only, holds certification from the National Training, Evaluation and Certification Unit and has passed the National Registry of Interpreters for the Deaf written generalist test, or (7) holds a reverse skills certificate or is a certified deaf interpreter under the National Registry of Interpreters of the Deaf.
(d) On and after July 1, 2001, no person shall provide interpreting services in a medical setting unless such person is registered with the commission according to the provisions of this section and holds (1) a comprehensive skills certificate from the National Registry of Interpreters for the Deaf, (2) a certificate of interpretation or a certificate of transliteration from the National Registry of Interpreters for the Deaf, (3) a level [five] four certification from the National Association of the Deaf, (4) a reverse skills certificate or is a certified deaf interpreter under the National Registry of Interpreters of the Deaf, (5) for situations requiring an oral interpreter only, oral certification from the National Registry of Interpreters for the Deaf, or (6) for situations requiring a cued speech transliterator only, certification from the National Training, Evaluation and Certification Unit and has passed the National Registry of Interpreters for the Deaf written generalist test.
(e) No person shall provide interpreting services in a legal setting unless such person is registered with the commission according to the provisions of this section and holds (1) a comprehensive skills certificate from the National Registry of Interpreters for the Deaf, (2) a certificate of interpretation and a certificate of transliteration from the National Registry of Interpreters for the Deaf, (3) a level five certification from the National Association of the Deaf, (4) a reverse skills certificate or is a certified deaf interpreter under the National Registry of Interpreters of the Deaf, (5) for situations requiring an oral interpreter only, oral certification from the National Registry of Interpreters for the Deaf, or (6) for situations requiring a cued speech transliterator only, certification from the National Training, Evaluation and Certification Unit and has passed the National Registry of Interpreters for the Deaf written generalist test.
(f) The requirements of this section shall apply to persons who receive compensation for the provision of interpreting services and include those who provide interpreting services as part of their job duties.
(g) The provisions of subsection (c) of this section shall not apply to any person providing interpreting services in an educational setting until July 1, 2003.
Sec. 25. (NEW) Any state agency that places a child, as defined in section 17a-93 of the general statutes, in a residential facility shall enter into a written agreement with the facility at the time of the placement. Such written agreement shall establish clear standards for the child's care and treatment, including, but not limited to, requirements for monthly written reports concerning the child's care and treatment, addressed to the case worker overseeing the child's placement. The monthly written reports shall set forth child-specific goals and expectations for treatment and progress. The written agreement shall require the facility to report promptly to the placing agency any allegation that the child is abused or neglected, as defined in section 46b-120 of the general statutes, or any incident of abuse or neglect of an individual placed in the facility. The placing agency shall ensure that a discharge plan is initiated within two weeks of the child's placement in the facility.
Sec. 26. (a) The Commissioner of Social Services, in collaboration with the Office of Health Care Access and the Office of Policy and Management, shall prepare a plan for the purchase of employer-sponsored health insurance for adults or children. The plan may include, but shall not be limited to, recommendations on the following: (1) A sliding scale of copremium subsidies for employees, their spouses or children with a family income of up to three hundred per cent of the federal poverty level; (2) minimum benefit standards for participating employer-sponsored health plans; (3) the fiscal impact on state spending, including anticipated reductions in other health-related expenditures; (4) maximization of federal Title XXI allocations and Medicaid reimbursement; (5) review of potential for appropriate copremium subsidy during periods of unemployment; (6) strategies to address the service wraparound for eligible recipients; (7) infrastructure and resource requirements of implementation; (8) assessment of the impact of applying the copremium subsidy plan to enrollees of the HUSKY Plan, Part A and Part B; and (9) a timeline to achieve implementation beginning January 1, 2003.
(b) Not later than March 1, 2002, the commissioner shall submit such plan to the joint standing committees of the General Assembly having cognizance of matters relating to human services, public health, insurance and appropriations and the budgets of state agencies.
Sec. 27. Subsections (e) and (f) of section 52-362 of the general statutes are repealed and the following is substituted in lieu thereof:
(e) A withholding order shall issue in the amount necessary to enforce a support order against only such nonexempt income of the obligor as exceeds the greater of (1) eighty-five per cent of the first one hundred forty-five dollars per week of disposable income, or (2) the amount exempt under Section 1673 of Title 15 of the United States Code, or against any lesser amount which the court or family support magistrate deems equitable. The withholding order shall secure payment of past and future amounts due under the support order and an additional amount computed in accordance with the child support guidelines established in accordance with section 46b-215a, to be applied toward liquidation of any arrearage accrued under such order, unless contested by the obligor after a notice has been served pursuant to subsection (c) of this section, in which case the court or family support magistrate may determine the amount to be applied toward the liquidation of the arrearage found to have accrued under prior order of the court or family support magistrate. In no event shall such additional amount be applied if there is an existing arrearage order from the court or family support magistrate in a IV-D support case, as defined in subdivision (13) of subsection (b) of section 46b-231. Any investigator or other authorized employee of the Bureau of Child Support Enforcement within the Department of Social Services, or any officer of [the] Support Enforcement [Division] Services of the Superior Court, shall issue a withholding order pursuant to this subsection when the obligor becomes subject to withholding under subsection (c) of this section. On service of the order of withholding on an existing or any future employer or other payer of income, and until the support order is fully satisfied or modified, the order of withholding is a continuing lien and levy on the obligor's income as it becomes due.
(f) Commencing no later than the first pay period in the case of an employer, or the date of periodic payment in the case of a payer of income other than an employer, that occurs after fourteen days following the date of service of an order for withholding and within seven business days of the date the obligor is paid thereafter, an employer or other payer of income shall pay sums withheld pursuant to the withholding order to the state disbursement unit, as required by subsection (p) of this section. [When orders for withholding are payable on behalf of a dependent in a IV-D support case, as defined in subdivision (14) of subsection (b) of section 46b-231, the] The employer or other payer of income (1) shall specify the dates on which each withholding occurred and the amount withheld for each obligor on each such date, and (2) may combine all withheld amounts into a single payment to the state disbursement unit with the portion thereof which is attributable to each individual obligor being separately designated. If an employer or other payer of income fails to withhold from income due an obligor pursuant to an order for withholding or fails to make those payments, such employer or other payer of income is liable to such person for the full amount of income not withheld since receipt of proper notice in an action therefor, and the amount secured in the action shall be applied by such person toward the arrearage owed by the obligor. Such employer or other payer of income shall be subject to a finding of contempt by the court or family support magistrate for failure to honor such order for withholding, provided service of the order is made in accordance with section 52-57 or by certified mail, return receipt requested.
Sec. 28. Subsection (h) of section 52-362 of the general statutes is repealed and the following is substituted in lieu thereof:
(h) Service of any process under this section, including any notice, may be made in accordance with section 52-57, or by certified mail, return receipt requested. If service is made on behalf of the state, it may be made by an authorized employee of [the] Support Enforcement [Division of the court] Services, or by an investigator or other officer of the Bureau of Child Support Enforcement within the Department of Social Services or by an investigator of the Department of Administrative Services or by the Attorney General. Service of income withholding orders by Support Enforcement Services or by an investigator or other officer of said bureau upon an employer under this section may be made in accordance with section 52-57, by certified mail, return receipt requested, or by first class mail.
Sec. 29. (NEW) (a) As used in this section: (1) "Underemployed" means an individual: (A) Working part time but seeking full-time work; or (B) working full-time but receiving wages below the poverty level determined in accordance with criteria established by the Labor Commissioner, in cooperation with the Commissioner of Social Services; (2) "unemployed" means an individual who is without a job, is available for work and is seeking full-time work; (3) "economically disadvantaged" means an individual who meets the criteria established by the Labor Commissioner; and (4) "comprehensive job training and related services" means recruitment, counseling remediation, motivational prejob training, vocational training, job development, job placement and other appropriate services enabling individuals to secure and retain employment at their maximum capacity.
(b) The Labor Commissioner shall establish a program of grants for: (1) Comprehensive job training and related services or job opportunities programs for economically disadvantaged, unemployed and underemployed individuals, including persons of limited English-speaking ability, through opportunities industrialization centers and other community-based organizations; and (2) the establishment and operation in the state of these centers and organizations.
(c) The Labor Commissioner shall adopt regulations, in accordance with the provisions of chapter 54 of the general statutes, establishing criteria for the distribution of funds under this section and shall adopt regulations, in accordance with chapter 54 of the general statutes, to further implement the purposes of this section. The criteria shall include requirements that: (1) The program receiving state assistance: (A) Involves the Commissioner of Social Services in the planning of the program; (B) involves residents in the region to be served by the program in the planning and operation of the program; (C) involves the business community in the region to be served by the program in its development and operation; and (D) gives priority to persons who receive general assistance or state-administered general assistance benefits; and (2) a program receiving financial assistance has adequate internal administrative controls, accounting procedures, personnel standards, evaluation procedures, availability of in-service training and technical assistance programs and other policies as are necessary to promote the effective use of funds received under said programs.
Sec. 30. Subsection (b) of section 17b-78 of the general statutes is repealed and the following is substituted in lieu thereof:
(b) Notwithstanding the provisions of sections 4-230 to 4-236, inclusive, the Commissioner of Social Services shall adopt regulations, in accordance with the provisions of chapter 54, concerning the conduct of audits of all general assistance programs in towns where the commissioner has determined an audit shall be conducted. The regulations shall include a clear statistical methodology for conducting such audits and shall provide that such audits be conducted in accordance with the generally accepted auditing standards recognized by the Comptroller General of the United States and the American Institute of Certified Public Accountants. The audits shall include: (1) A financial review of each town's accounts; (2) a selection and sampling methodology for choosing cases to be reviewed in each town; [,] and (3) a review of such selected cases to determine compliance with significant eligibility, supported work, education and training and program regulations.
Sec. 31. Subsection (a) of section 37 of public act 99-279, as amended by section 11 of public act 00-2 of the June special session, is amended to read as follows:
(a) On and after the effective date of section 37 of public act 99-279, 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 the date on which such services are covered under the Medicaid-funded portioned of the Connecticut home-care for the elderly. [or July 1, 2001, whichever is sooner.] Such persons who participate in the pilot program may continue to receive services under said program provided all other conditions of eligibility are met.
Sec. 32. Section 17b-802 of the general statutes is repealed and the following is substituted in lieu thereof:
(a) The Commissioner of Social Services shall establish, within available appropriations, and administer a security deposit guarantee program for persons who are recipients of temporary family assistance, aid under the state supplement program, state-administered general assistance or general assistance and to persons who have a documented showing of financial need and are residing in emergency shelters or other emergency housing or who cannot remain in permanent housing due to any reason specified in subsection (a) of section 17b-808 or is served a notice to quit in a summary process action instituted pursuant to chapter 832, for use by such persons in lieu of a security deposit on a rental dwelling unit. Eligible persons may receive a security deposit guarantee in an amount not to exceed the equivalent of [one month's] two months' rent on such rental unit. [, except that upon a documented showing of financial need, the commissioner may approve a security deposit guarantee in an amount not to exceed the equivalent of two month's rent.] No person may apply for and receive a security deposit guarantee more than once in any eighteen-month period without the express authorization of the Commissioner of Social Services, except as provided in subsection (b) of this section.
(b) In the case of any person who qualifies for a guarantee, the Commissioner of Social Services, or any emergency shelter under contract with the Department of Social Services to assist in the administration of the security deposit guarantee program established pursuant to subsection (a) of this section, may execute a written agreement to pay the landlord for any damages suffered by the landlord due to the tenant's failure to comply with such tenant's obligations as defined in section 47a-21, provided the amount of any such payment shall not exceed the amount of the requested security deposit. [If] Notwithstanding the provisions of subsection (a) of this section, if a person who has previously received a grant for a security deposit or a security deposit guarantee becomes eligible for a subsequent security deposit guarantee [, the] within eighteen months after a claim has been paid on a prior security deposit guarantee, such person may receive a security deposit guarantee. The amount of the subsequent security deposit guarantee for which such person would otherwise have been eligible shall be reduced by (1) any amount of a previous grant which has not been returned to the department pursuant to section 47a-21, or (2) the amount of any payment made to the landlord for damages pursuant to this subsection.
(c) Any payment made pursuant to this section to any person receiving temporary family assistance, aid under the state supplement program, general assistance or state-administered general assistance shall not be deducted from the amount of assistance to which the recipient would otherwise be entitled.
(d) On and after July 1, 2000, no special need or special benefit payments shall be made by the commissioner for security deposits from the temporary family assistance, state supplement, state-administered general assistance or general assistance programs.
(e) The Commissioner of Social Services may, within available appropriations, [from funds appropriated to the safety net account,] on a case-by-case basis, provide a security deposit grant to a person residing in an emergency shelter or other emergency housing or to a person who cannot remain in permanent housing due to any reason specified in subsection (a) of section 17b-808 or is served of a notice to quit in a summary process action instituted pursuant to chapter 832, in an amount not to exceed the equivalent of one month's rent on such rental unit provided the commissioner determines that emergency circumstances exist which threaten the health, safety or welfare of a child who resides with such person. Such person shall not be eligible for more than one such grant without the authorization of said commissioner. Nothing in this section shall preclude the approval of such one-month security deposit grant in conjunction with a one-month security deposit guarantee.
(f) The Commissioner of Social Services may provide a security deposit grant to a person receiving such grant through any emergency shelter under an existing contract with the Department of Social Services to assist in the administration of the security deposit program, but in no event shall a payment be authorized after October 1, 2000. Nothing in this section shall preclude the commissioner from entering into a contract with one or more emergency shelters for the purpose of issuing security deposit guarantees.
(g) The Commissioner of Social Services shall adopt regulations, in accordance with the provisions of chapter 54, to administer the program established pursuant to this section and to set eligibility criteria for the program, but may implement the program until January 1, 2002, while in the process of adopting such regulations provided notice of intent to adopt the regulations is published in the Connecticut Law Journal within twenty days after implementation.
Sec. 33. Subsection (k) of section 46b-129 of the general statutes is amended by adding subdivision (4) as follows:
(NEW) (4) If the court approves the permanency plan of adoption: (A) The Commissioner of Children and Families may conduct a thorough adoption assessment and child-specific recruitment; and (B) the court may order that the child be photo-listed within thirty days if the court determines that such photo-listing is in the best interest of the child. As used in this subdivision, "thorough adoption assessment" means conducting and documenting face-to-face interviews with the child, foster care providers, and other significant parties and "child specific recruitment" means recruiting an adoptive placement targeted to meet the individual needs of the specific child, including, but not limited to, use of the media, use of photo-listing services and any other in-state or out-of-state resources that may be used to meet the specific needs of the child, unless there are extenuating circumstances that indicate that these efforts are not in the best interest of the child.
Sec. 34. Section 46b-141 of the general statutes is repealed and the following is substituted in lieu thereof:
(a) Except as otherwise limited by subsection (i) of section 46b-140, commitment of children convicted as delinquent by the Superior Court to the Department of Children and Families shall be for (1) an indeterminate time up to a maximum of eighteen months, or (2) when so convicted for a serious juvenile offense, up to a maximum of four years at the discretion of the court, unless extended as hereinafter provided.
(b) The Commissioner of Children and Families may [petition the court] file a motion for an extension of the commitment as provided in subdivision (1) of subsection (a) beyond the eighteen-month period on the grounds that such extension is for the best interest of the child or the community. The court shall give notice to the parent or guardian and to the child at least fourteen days prior to the hearing upon such [petition] motion. The court may, after hearing and upon finding that such extension is in the best interest of the child or the community, continue the commitment for an additional period of not more than eighteen months. Not later than twelve months after a child is committed to the Department of Children and Families in accordance with subdivision (1) of subsection (a) of this section the court shall hold a permanency hearing in accordance with subsection (d) of this section. After the initial permanency hearing, subsequent permanency hearings shall be held not less frequently than every twelve months while the child remains committed to the Department of Children and Families.
(c) The [Commissioner of Children and Families shall obtain judicial review of] court shall hold a permanency hearing in accordance with subsection (d) of this section for each child convicted as delinquent for a serious juvenile offense as provided in subdivision (2) of subsection (a) of this section within [eighteen] twelve months of commitment to the Department of Children and Families and every [eighteen] twelve months thereafter if the child remains committed to the Department of Children and Families. Such [judicial review] hearing may include the submission of a [petition] motion to the court by the commissioner to either (1) modify such commitment, or (2) extend the commitment beyond such four-year period on the grounds that such extension is for the best interest of the child or the community. The court shall give notice to the parent or guardian and to the child at least fourteen days prior to the hearing upon such [petition] motion. The court, after hearing, may modify such commitment or, upon finding that such extension is in the best interest of the child or the community, continue the commitment for an additional period of not more than eighteen months.
(d) At least sixty days prior to each permanency hearing required pursuant to subsection (b) or (c) of this section, the Commissioner of Children and Families shall file a permanency plan with the court. At each permanency hearing, the court shall review and approve a permanency plan that is in the best interest of the child and takes into consideration the child's need for permanency. Such permanency plan may include the goal of: (1) Revocation of commitment and placement of the child with the parent or guardian, (2) transfer of guardianship, (3) permanent placement with a relative, (4) adoption, or (5) such other planned permanent living arrangement ordered by the court, provided the Commissioner of Children and Families has documented a compelling reason why it would not be in the best interest of the child for the permanency plan to include the goals in subdivisions (1) to (4), inclusive, of this subsection. Such other planned permanent living arrangement may include, but not be limited to, placement of the child in an independent living program. At any such permanency hearing, the court shall also determine whether the Commissioner of Children and Families has made reasonable efforts to achieve the permanency plan.
[(d)] (e) All other commitments of delinquent, mentally deficient or mentally ill children by the court pursuant to the provisions of section 46b-140, may be for an indeterminate time. Commitments may be reopened and terminated at any time by said court, provided the Commissioner of Children and Families shall be given notice of such proposed reopening and a reasonable opportunity to present [his] the commissioner's views thereon. The parents or guardian of such child may apply not more than twice in any calendar year for such reopening and termination of commitment. Any order of the court made under the provisions of this section shall be deemed a final order for purposes of appeal, except that no bond shall be required nor costs taxed on such appeal.
Sec. 35. Section 17a-151 of the general statutes, as amended by section 10 of public act 01-175, is repealed and the following is substituted in lieu thereof:
(a) The Commissioner of Children and Families shall investigate the conditions stated in each application made under the provisions of section 17a-145 and shall require any person [applying] identified on the application under said section to submit to state and national criminal history records checks. The commissioner shall investigate the conditions in each application under the provisions of section 17a-149 and, if the commissioner finds such conditions suitable for the proper care of children, or for the placing out of children, under such standards for the promotion of the health, safety, morality and well-being of such children as the commissioner prescribes, shall issue such license as is required as promptly as possible, without expense to the licensee. If, after such investigation, the commissioner finds that the applicant, notwithstanding good faith efforts, is not able to fully comply with all the requirements the commissioner prescribes, but compliance can be achieved with minimal efforts, the commissioner may issue a provisional license for a period not to exceed sixty days. The provisional license may be renewed for additional sixty-day periods, but in no event shall the total of such periods be for longer than one year. Before issuing any license, the commissioner shall give to the selectmen of the town wherein such licensee proposes to carry on the licensed activity ten days' notice in writing that the issuance of such license is proposed, but such notice shall not be required in case of intention to issue such license to any corporation incorporated for the purpose of caring for or placing such children. Each license so issued shall specify whether it is granted for child-caring or child-placing purposes, shall state the number of children who may be cared for, shall be in force twenty-four months from date of issue, and shall be renewed for the ensuing twenty-four months, if conditions continue to be satisfactory to the commissioner. The commissioner shall also provide such periodical inspections and review as shall safeguard the well-being, health and morality of all children cared for or placed under a license issued by the commissioner under this section and shall visit and consult with each such child and with the licensee as often as the commissioner deems necessary but at intervals of not more than ninety days. Each licensee under the provisions of this section shall file annually with the commissioner a report containing such information concerning its functions, services and operation, including financial data, as the commissioner requires. Any license issued under this section may be revoked, suspended or limited by the commissioner for cause, after notice given to the person or entity concerned and after opportunity for a hearing thereon. Any party whose application is denied or whose license is revoked, suspended or limited by the commissioner may appeal from such adverse decision in accordance with the provisions of section 4-183. Appeals under this section shall be privileged in respect to the order of trial assignment.
(b) The criminal history records checks required pursuant to subsection (a) of this section shall be conducted in accordance with section 31 of public act 01-175.
(c) The commissioner shall adopt regulations, in accordance with chapter 54, to establish a staggered schedule for the renewal of licenses issued pursuant to sections 17a-145 and 17a-149.
Sec. 36. Section 8-206e of the general statutes is 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.
(c) The Commissioner of Economic and Community Development shall adopt regulations in accordance with the provisions of chapter 54 to carry out the purposes of subsections (a) and (b) of this section.
(d) The Commissioner of Economic and Community Development shall establish a demonstration program in [one] up to four United States Department of Housing and Urban Development, Section 202 [, elderly housing development and one United States Department of Housing and Urban Development,] or Section 236 [,] elderly housing [development] developments to provide assisted living services. [for persons who are residents of the state.]
(e) The Commissioner of Economic and Community Development shall establish criteria for making disbursements under the provisions of subsection (d) of this section which shall include, but are not limited to: (1) Size of the United States Department of Housing and Urban Development, Section 202 and Section 236 [,] elderly housing developments; (2) geographic locations in which the developments are located; (3) anticipated social and health value to the resident population; (4) each Section 202 and Section 236 housing development's designation as a managed residential community, as defined in section 19-13-D105 of the regulations of Connecticut state agencies; and (5) the potential community development benefit to the relevant municipality. Such criteria may specify who may apply for grants, the geographic locations determined to be eligible for grants, and the eligible costs for which a grant may be made. For the purposes of the demonstration program, multiple properties with overlapping board membership or ownership may be considered a single applicant.
(f) The Commissioner of Economic and Community Development may adopt regulations, in accordance with the provisions of chapter 54, to implement the provisions of subsections (d) and (e) of this section.
Sec. 37. Subsection (a) of 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.
Sec. 38. 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] 2002, 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] thirty-seven thousand dollars to be annually inflated thereafter in accordance with section 17-311-52 of the regulations of Connecticut state agencies. [and, beginning] The rates for the fiscal year ending June 30, 2002, shall be based upon the increased allowable salary of an administrator, regardless of whether such amount was expended in the 2000 cost report period upon which the rates are based. 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 two per cent, and beginning with the fiscal year ending June 30, 2002, the inflation adjustment for rates made in accordance with subsection (c) of said section shall be increased by one 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 and beginning with the fiscal year ending June 30, 2001, such allowable salary shall be computed on an hourly basis and the maximum number of hours allowed for a related party other than the proprietor shall be increased from forty hours to forty-eight hours per work week.
Sec. 39. Section 17a-50 of the general statutes is repealed and the following is substituted in lieu thereof:
(a) There is established a Children's Trust Fund the resources of which shall be used by the council established pursuant to subsection (b) of this section, to fund programs aimed at preventing child abuse and neglect and family resource programs. Said fund is intended to be in addition to those resources that would otherwise be appropriated by the state for programs aimed at preventing child abuse and neglect and family resource programs. The Children's Trust Fund Council may apply for and accept any federal funds which are available for a Children's Trust Fund and shall administer such funds in the manner required by federal law. The fund shall receive money from grants and gifts made pursuant to section 17a-18. The Children's Trust Fund Council shall adopt regulations, in accordance with the provisions of chapter 54, to administer the fund and to set eligibility requirements for programs seeking funding. Youth service bureaus may receive funds from the Children's Trust Fund. The Parent Trust Fund, established pursuant to subsection (c) of this section, may receive funds directed to it through the Children's Trust Fund.
(b) There shall be established, within existing resources, a Children's Trust Fund Council which shall be within the Department of Children and Families for administrative purposes only. The council shall be composed of sixteen members as follows: (1) The Commissioners of the Departments of Social Services, Education, Children and Families and Public Health, or their designees; (2) a representative of the business community with experience in fund-raising, appointed by the president pro tempore of the Senate; (3) a representative of the business community with experience in fund-raising, appointed by the speaker of the House of Representatives; (4) a representative of the business community with experience in fund-raising, appointed by the minority leader of the House of Representatives; (5) a representative of the business community with experience in fund-raising, appointed by the minority leader of the Senate; (6) a parent, appointed by the majority leader of the House of Representatives; (7) a parent, appointed by the majority leader of the Senate; (8) a parent, appointed by the president pro tempore of the Senate; (9) a person with expertise in child abuse prevention, appointed by the speaker of the House of Representatives; (10) a person with expertise in child abuse prevention, appointed by the minority leader of the House of Representatives; (11) a staff member of a child abuse prevention program, appointed by the minority leader of the Senate; (12) a staff member of a child abuse prevention program, appointed by the majority leader of the House of Representatives; and (13) a pediatrician, appointed by the majority leader of the Senate. The council shall solicit and accept funds, on behalf of the Children's Trust Fund, to be used for the prevention of child abuse and neglect and family resource programs, or on behalf of the Parent Trust Fund, to be used for parent community involvement to improve the health, safety and education of children, and shall make grants to programs pursuant to [subsection (a)] subsections (a) and (c) of this section.
(c) There is established a Parent Trust Fund which shall be used to fund programs aimed at improving the health, safety and education of children by training parents in civic leadership skills and supporting increased, sustained, quality parental engagement in community affairs. The fund shall receive federal or private money from grants and gifts made pursuant to section 17a-18, as amended by this act.
[(c)] (d) On or before July 1, 1997, and annually thereafter, the Children's Trust Fund Council shall report to the joint standing committees of the General Assembly having cognizance of matters relating to human services, public health and education concerning the source and amount of funds received by the Children's Trust Fund and the Parent Trust Fund, and the manner in which such funds were administered and disbursed.
Sec. 40. Section 17a-18 of the general statutes is repealed and the following is substituted in lieu thereof:
The Commissioner of Children and Families may accept and receive on behalf of the department or any institution or facility thereof, or on behalf of the Children's Trust Fund or the Parent Trust Fund established pursuant to section 17a-50, subject to section 4b-22, any bequest, devise or grant made to the department or to any institution or facility thereof, or to such Children's Trust Fund or Parent Trust Fund, and may hold and use such property for the purpose specified in such bequest, devise or gift.
Sec. 41. (a) There is established an Eastern Connecticut Transportation Access Project to provide, within available appropriations, transportation to jobs in Eastern Connecticut for persons residing in the following uniform regional service areas, as designated by the Office of Policy and Management under sections 17b-6 and 16a-4a of the general statutes: (1) The North Central Service Area (Greater Hartford); (2) the South Central Service Area (Greater New Haven); and (3) the Eastern Connecticut Service Area.
(b) Funding for the Eastern Connecticut Transportation Access Project shall be expended through the Transportation Employment Independence Program and its collaborative planning and oversight process. The funding shall be contingent upon receipt of matching funds or in-kind services from private employers.
(c) Funding for the Eastern Connecticut Transportation Access Project shall be divided in the following manner: (1) At least forty per cent but not more than fifty per cent shall be directed to the North Central Service Area; (2) at least twenty per cent but not more than thirty per cent shall be directed to the South Central Service Area; and (3) at least twenty per cent but not more than thirty per cent shall be directed to the Eastern Service Area. The facilitators of the three service areas shall jointly prioritize funding levels of this subsection above the minimum up to the maximum.
Sec. 42. Section 17a-1 of the general statutes is repealed and the following is substituted in lieu thereof:
As used in sections 17a-1 to 17a-26, inclusive, as amended by this act, 17a-28 to 17a-49, inclusive, 17a-127, as amended by this act, and 46b-120:
(1) "Commissioner" means the Commissioner of Children and Families;
(2) "Council" means the State Advisory Council on Children and Families;
(3) "Advisory committee" means the Children's Behavioral Health Advisory Committee to the council;
[(3)] (4) "Department" means the Department of Children and Families;
[(4)] (5) "Child" means any person under sixteen years of age;
[(5)] (6) "Youth" means any person at least sixteen [to eighteen] years of age and under nineteen years of age;
[(6)] (7) "Delinquent child" shall have the meaning ascribed thereto in section 46b-120;
[(7)] (8) "Child or youth with [mental illness] behavioral health needs" means a child or youth who is suffering from one or more mental disorders as defined in the most recent edition of the American Psychiatric Association's "Diagnostic and Statistical Manual of Mental Disorders";
[(8) "Child or youth with emotional disturbance" means a child or youth who has a clinically significant emotional or behavioral disorder, as determined by a trained mental health professional, that disrupts the academic or developmental progress, family or interpersonal relationships of such child or youth or is associated with present distress or disability or a risk of suffering death, pain or disability;]
(9) "Individual [system of care] service plan" means a written plan [developed by the Commissioner of Children and Families] to access specialized, coordinated and integrated care for a child or youth [who is mentally ill, emotionally disturbed or seriously emotionally disturbed or who is at placement risk which shall be developed when such child or youth needs services from at least two public agencies and] with complex behavioral health service needs which shall be designed to meet the needs of the child or youth and his or her family and may include, when appropriate (A) an assessment of the individual needs of the child or youth, (B) an identification of service needs, (C) an identification of services which are currently being provided, (D) an identification of opportunities for full participation by parents or emancipated minors, (E) include a reintegration plan when an out-of-home placement is made or recommended, (F) an identification of criteria for evaluating the effectiveness and appropriateness of such plan, and (G) coordination of the individual service plan with any educational services provided to the child or youth. The plan shall be subject to review at least every six months or upon reasonable request by the parent based on a changed circumstance, and be approved, in writing, by the parents, guardian of a child or youth and emancipated minors;
(10) "Family" means a child or youth [who is mentally ill, emotionally disturbed or seriously emotionally disturbed or who is at placement risk] with behavioral health needs together with (A) one or more biological or adoptive parents, except for a [biological] parent whose parental rights have been terminated, (B) one or more persons to whom legal custody or guardianship has been given, or (C) one or more [adult family members] adults who have a primary responsibility for providing continuous care to such child or youth;
[(11) "Child or youth at placement risk" means a mentally ill, emotionally disturbed or seriously emotionally disturbed child or youth who is at risk of placement out of his home or is in placement out of his home for the primary purpose of receiving mental health treatment;]
[(12)] (11) "Parent" means a biological or adoptive parent, except a [biological] parent whose parental rights have been terminated;
[(13)] (12) "Guardian" means a person who has a judicially created relationship between a child or youth and such person which is intended to be permanent and self-sustaining as evidenced by the transfer to such person of the following parental rights with respect to the child or youth: (A) The obligation of care and control; (B) the authority to make major decisions affecting the child's or youth's welfare, including, but not limited to, consent determinations regarding marriage, enlistment in the armed forces and major medical, psychiatric or surgical treatment; (C) the obligation of protection of the child or youth; (D) the obligation to provide access to education; and (E) custody of the child or youth; [and]
[(14)] (13) "Serious emotional disturbance" and "seriously emotionally disturbed" means, with regard to a child or youth, that the child or youth (A) has a range of diagnosable mental, behavioral or emotional disorders of sufficient duration to meet diagnostic criteria specified in the most recent edition of the American Psychiatric Association's "Diagnostic and Statistical Manual of Mental Disorders", and (B) exhibits behaviors that substantially interfere with or limit the child's or youth's ability to function in the family, school or community and are not a temporary response to a stressful situation;
(14) "Child or youth with complex behavioral health service needs" means a child or youth with behavioral health needs who needs specialized, coordinated behavioral health services;
(15) "Transition services" means services in the areas of education, employment, housing and community living designed to assist a youth with a serious emotional disturbance who is transitioning into adulthood; and
(16) "Community collaborative" means a local consortium of public and private health care providers, parents and guardians of children with behavioral health needs and service and education agencies that have organized to develop coordinated comprehensive community resources for children or youth with complex behavioral health service needs and their families in accordance with principles and goals of Connecticut Community KidCare.
Sec. 43. Section 17a-22a of the general statutes is repealed and the following is substituted in lieu thereof:
(a) The Commissioner of Social Services and the Commissioner of Children and Families shall, within available appropriations, develop and administer an integrated behavioral health service delivery system [for children and youth with serious emotional disturbances who meet the criteria established in accordance with subdivision (1) of subsection (a) of section 5 of public act 00-2 of the June special session* and who are eligible to receive services from the HUSKY Plan, Part A or Part B, the HUSKY Plus program for intensive behavioral health needs or voluntary services provided through the Department of Children and Families] to be known as Connecticut Community KidCare. Said system shall provide services to children and youth with behavioral health needs who are in the custody of the Department of Children and Families, who are eligible to receive services from the HUSKY Plan, Part A or the federally subsidized portion of Part B, or receive services under the voluntary services program operated by the Department of Children and Families. All necessary changes to the IV-E, Title XIX and Title XXI state plans shall be made to maximize federal financial participation. The Commissioner of Social Services may amend the state Medicaid plan to facilitate the claiming of federal reimbursement for private nonmedical institutions as defined in the Social Security Act. The Commissioner of Social Services may implement policies and procedures necessary to provide reimbursement for the services provided by private nonmedical institutions, as defined in 42 CFR Part 434, while in the process of adopting such policies and procedures in regulation form, provided the commissioner prints notice of intention to adopt the regulations in the Connecticut Law Journal within twenty days of implementing such policies and procedures. Policies and procedures implemented pursuant to this subsection, shall be valid until the time such regulations are effective.
[(b) Not later than October 1, 2000, said]
(b) Connecticut Community KidCare shall, within available appropriations, provide a comprehensive benefit package of behavioral health specialty services. The HUSKY Plan shall continue to provide primary behavioral health services and may provide additional behavioral health services to be determined by the Department of Social Services and shall assure an integration of such services with the behavioral health services provided by Connecticut Community KidCare.
(c) Connecticut Community KidCare shall include: (1) A system of care model in which service planning is based on the needs and preferences of the child or youth and his or her family and that places an emphasis on early identification, prevention and treatment; (2) a comprehensive behavioral health program with a flexible benefit package that shall include clinically necessary and appropriate home and community-based treatment services and comprehensive support services in the least restrictive setting; (3) community-based care planning and service delivery, including services and supports for children from birth through early childhood that link Connecticut Community KidCare to the early childhood community and promote emotional wellness; (4) comprehensive children and youth behavioral health training for agency and system staff and interested parents and guardians; (5) an efficient balance of local participation and state-wide administration; (6) integration of agency funding to support the benefit package; (7) a performance measurement system for monitoring quality and access; (8) accountability for quality, access and cost; (9) elimination of the major gaps in services and barriers to access services; (10) a system of care that is family-focused with respect for the legal rights of the child or youth and his or her parents and provides training, support and family advocacy services; (11) assurances of timely payment of service claims; (12) assurances that no child or youth shall be disenrolled or inappropriately discharged due to behavioral health care needs; and (13) identification of youths in need of transition services to adult systems.
(d) Said commissioners shall enter into a memorandum of understanding for the purpose of the joint administration of [an integrated behavioral health service delivery system] Connecticut Community KidCare. Such memorandum of understanding shall establish mechanisms to administer [combined] funding, establish standards for, and monitor implementation of, [the integrated behavioral health service delivery system] Connecticut Community KidCare and specify that (1) the Department of Social Services, which is the agency designated as the single state agency for the administration of the Medicaid program pursuant to Title XIX of the Social Security Act and is the agency responsible for the administration of HUSKY Plan, Part B under Title XXI of the Social Security Act, manage all Medicaid and HUSKY Plan modifications, waiver amendments, federal reporting and claims processing and provide financial management, and (2) the Department of Children and Families, which is the state agency responsible for administering and evaluating a comprehensive and integrated state-wide program of services for children and youth [who are seriously emotionally disturbed] with behavioral health needs, define the services to be included in the continuum of care and develop state-wide training programs [on the systems of care approach] for providers, families and other persons.
[(c) Not later than October 1, 2000, said commissioners shall complete the memorandum of understanding, establish fiscal and programmatic eligibility guidelines, develop fiscal and programmatic outcome measures and develop a plan to evaluate the administration of behavioral health services.
(d) Said commissioners may commence a project of limited scope and duration in the state fiscal year commencing July 1, 2000, to implement the provisions of this section in those locations where the commissioners determine that services are well-developed and a high degree of cooperation exists among providers.]
(e) Said commissioners shall consult with the Commissioner of Mental Health and Addiction Services, [and] the Commissioner of Mental Retardation, the Commissioner of Public Health and the Commissioner of Education during the development of [the integrated behavioral health service delivery system] Connecticut Community KidCare in order to (1) ensure coordination of a delivery system of behavioral health services across the life span of children, youth and adults with behavioral health needs, (2) maximize federal reimbursement and revenue, and (3) ensure the coordination of care and funding among agencies.
(f) The Commissioner of Social Services and the Commissioner of Children and Families may apply for any federal waivers or waiver amendments necessary to implement the provisions of this section.
Sec. 44. Section 17a-22b of the general statutes is repealed and the following is substituted in lieu thereof:
[Not later than January 1, 2001, and annually thereafter, each local system of care]
(a) Each community collaborative shall, within available appropriations, (1) complete a local needs assessment which shall include objectives and [outcome] performance measures, (2) specify the number of children and youth requiring behavioral health services, (3) specify the number of children and youth actually receiving community-based and residential services and the type and frequency of such services, and (4) complete an annual self-evaluation process and a review of discharge summaries. Each [local system of care] community collaborative shall submit its local needs assessment to the Commissioner of Children and Families and the Commissioner of Social Services. [For the purposes of this section, "local system of care" means community-based organizations that work in teams to deliver behavioral health services in a manner that assists children and youth with behavioral health problems and provides their families with access to the full range of services tailored to the physical, emotional, social and educational needs of each individual in or near the communities in which they reside.]
(b) The regional offices of the Department of Children and Families shall contract with lead service agencies, within available appropriations, to coordinate the care of all children and youth enrolled in Connecticut Community KidCare residing within their designated catchment areas, including children and youth with complex behavioral health service needs. The lead service agencies shall employ or subcontract for the employment of care coordinators to assist families in establishing and implementing individual service plans for children and youth with complex behavioral health service needs and to improve clinical outcomes and cost effectiveness. Parents shall be afforded a choice of contracted providers for authorized services.
(c) Each community collaborative may establish the number of members and the type of representatives to ensure that the membership of such collaborative is appropriately balanced. The chief elected officers of municipalities served by a community collaborative may designate a member to serve as a representative of the chief elected officials. A community collaborative, at a minimum, shall consist of representatives from the local or regional board of education, special education program, youth services bureau, local departments of social services and public health, representatives from private organizations serving children and youth and a substantial number of parents of children and youth with behavioral health needs. A community collaborative shall participate in the regional advisory councils established under section 17a-30, provide outreach to community resources, coordinate behavioral health services by forming, with the consent of the family, child specific teams for children and youth with complex behavioral health service needs, conduct community need assessments to identify service gaps and service barriers, identify priority investment areas for the state and lead service agencies and provide public education and support. A community collaborative shall establish a governance structure, determine membership and identify or establish a fiscal agent.
(d) The Commissioner of Children and Families and the Commissioner of Social Services shall, within available appropriations, provide or arrange for the administrative services necessary to operate Connecticut Community KidCare.
Sec. 45. Section 17a-127 of the general statutes is repealed and the following is substituted in lieu thereof:
(a) The following shall be established for the purposes of developing and implementing an individual [system of care] service plan:
[(1)] Within available appropriations, a child specific team may be developed by the family of a child or [adolescent at placement risk and] youth with complex behavioral health service needs which shall provide for family participation in all aspects of assessment, planning and implementation of services and may include, but need not be limited to, family members, the child or adolescent if appropriate, clergy, school personnel, representatives of local or regional agencies providing programs and services for children and youth, a family advocate, and other community or family representatives. The team shall designate one member to be the team coordinator. The team coordinator shall, with the consent of the parent, guardian, youth or emancipated minor, compile the results of all assessments and evaluations completed prior to the preparation of an individual service plan that document the service needs of the child or youth, make decisions affecting the implementation of an individual [system of care] service plan, [with the consent of the team, except as otherwise provided by law. If a case manager, other than the case manager from the Department of Children and Families, has been assigned to the child and is not designated as the team coordinator, such case manager] and make referrals to community agencies and resources in accordance with an individual service plan. The care coordinator shall not make decisions affecting the implementation of the individual [system of care] service plan without the consent of the [team] parent, guardian, youth or emancipated minor, except as otherwise provided by law.
[(2) Within available appropriations, case review committees may be developed by each regional office of the Department of Children and Families and shall be comprised of at least three parents of children or adolescents with mental illness, emotional disturbance or serious emotional disturbance and representatives of local or regional agencies and service providers including, but not limited to, the regional administrator of the office of the Department of Children and Families or his designee, a superintendent of schools or his designee, a director of a local children's mental health agency or his designee, the district director of the district office of the Department of Social Services or his designee, representatives from the Departments of Mental Retardation and Mental Health and Addiction Services who are knowledgeable of the needs of a child or adolescent at placement risk, a representative from a local housing authority and a representative from the court system. The functions of the case review committees shall include, but not be limited to: (A) The determination of whether or not a child or adolescent meets the definition of a child or adolescent at placement risk; (B) assisting children or families without a child specific team in the formation of such a team; and (C) resolution of the development or implementation of an individual system of care plan not developed, implemented or agreed upon by a child specific team. Such functions shall be completed in one hundred twenty days or less from the date of referral to the case review committee. In the event of the need for an individual system of care plan for a child or adolescent with no identifiable community, a representative of the child or adolescent shall make a referral to the state coordinated care committee, established pursuant to subdivision (3) of this subsection, which shall designate responsibility for the development of an individual system of care plan to a case review committee. The case review committee shall also monitor the implementation of an individual system of care plan when appropriate. The Department of Children and Families may assign a system coordinator to each case review committee. The duties of the system coordinator shall include, but not be limited to, assistance and consultation to child specific teams and assistance with the development of case review committees and child specific teams.
(3) A coordinated care committee shall be developed by the Commissioner of Children and Families and shall be comprised of a parent of a child or adolescent with mental illness, emotional disturbance or serious emotional disturbance who is currently serving or has served on a case review committee, a person who is now or has been a recipient of services for a child or adolescent at placement risk, representatives of the Departments of Children and Families, Education, Mental Health and Addiction Services, Social Services and Mental Retardation who are knowledgeable of the needs of a child or adolescent at placement risk, and a representative of the Office of Protection and Advocacy for Persons with Disabilities who is knowledgeable of the needs of a child or adolescent at placement risk.
(b) The commissioner, in consultation with the coordinated care committee, shall submit a report on the findings and recommendations of programs for children and youth at placement risk, including recommendations for budget options or programmatic changes necessary to enhance the system of care for such child or youth and his family, to the joint standing committee and the select committee of the General Assembly having cognizance of matters relating to children, on or before January 1, 1998, and annually thereafter.]
[(c)] (b) The provisions of this section shall not be construed to grant an entitlement to any child or youth [at placement risk] with behavioral health needs to receive particular services under this section in an individual [system of care] service plan if such child or youth is not otherwise eligible to receive such services from any state agency or to receive such services pursuant to any other provision of law.
[(d)] (c) The Commissioner of Children and Families, in consultation with the Commissioner of Social Services, may adopt regulations in accordance with chapter 54 for the purpose of implementing the provisions of this section.
Sec. 46. (NEW) (a) The Commissioner of Children and Families and the Commissioner of Social Services shall establish performance measures in the areas of finance, administration, utilization, client satisfaction, quality and access for Connecticut Community KidCare.
(b) The Commissioner of Children and Families shall develop and implement, within available appropriations, culturally appropriate and competency-based curricula including best practices for the care of children and youth with, or at risk of, behavioral health needs and offer training to all willing persons involved in Connecticut Community KidCare, including, but not limited to, employees in education and child care and appropriate employees within the judicial system.
(c) The Commissioners of Children and Families and Social Services shall, within available appropriations, design and conduct a five-year independent longitudinal evaluation with evaluation goals and methods utilizing an independent evaluator. The evaluation shall assess changes in outcomes for individual children, youth and families, evaluate the effectiveness of the overall initiative in the early phases to guide future expansion of Connecticut Community KidCare and examine benefits, costs and cost avoidance achieved by it. Such evaluation may include, but is not limited to, the following: (1) Utilization of out-of-home placements; (2) adherence to system of care principles; (3) school attendance; (4) delinquency recidivism rates; (5) satisfaction of families and children and youth with Connecticut Community KidCare as assessed through client satisfaction surveys; (6) coordination of Connecticut Community KidCare with the juvenile justice, child protection, adult behavioral health and education systems; and (7) the quality of transition services.
Sec. 47. (NEW) The Commissioner of Children and Families may, within available appropriations, provide financial assistance for the establishment of an organization, with local chapters in each region served by the Department of Children and Families, that shall provide family-to-family support and family advocates for children, youth and their families, and when requested by the family, assist the family with the individual service plan process and otherwise encourage active family participation in treatment and Connecticut Community KidCare planning. Such organization shall assure that families have input into the development and implementation of their individual service plans including those established pursuant to section 17a-127 of the general statutes, as amended by this act, policy and planning for, and the implementation and evaluation of, Connecticut Community KidCare.
Sec. 48. (NEW) On and after October 1, 2002, the Commissioners of Children and Families and Social Services shall submit quarterly reports concerning the implementation of Connecticut Community KidCare to the joint standing committees of the General Assembly having cognizance of matters relating to human services, public health and education. Not later than January 1, 2004, and annually thereafter, the commissioners shall submit a report to said joint standing committees concerning (1) the number, ages, sex and race of children and youth in out-of-state residential facilities, (2) the number, ages, sex and race of children and youth in in-state residential facilities, (3) the number, ages, sex and race of children and youth in nonresidential treatment, (4) annual public funds expended for out-of-state placements, the sources of such funds and the average cost per child and youth of such out-of-state placement, (5) annual public funds expended for in-state residential placements, the sources of such funds and the average cost per child and youth of such in-state residential placement, (6) annual public funds expended for nonresidential treatment by type of service provided, the sources of such funds and the average cost per child and youth of such nonresidential treatment, (7) the average length of stay in out-of-state and in-state placements, (8) the number, ages, sex and race of children and youth placed in out-of-home treatment compared to the total number of children and youth in each region of the state, and (9) expenditures made during each reporting period.
Sec. 49. Not later than March 1, 2002, the Commissioners of Social Services and Children and Families shall submit a report to the joint standing committees of the General Assembly having cognizance of matters relating to appropriations and the budgets of state agencies, human services, education and public health: (1) Concerning the status of the implementation of Connecticut Community KidCare; (2) that recommends the appropriate number of lead service agencies; (3) concerning procedures for access to and protection of confidential medical records; (4) that evaluates a hold harmless provision for funding child guidance clinics; (5) that establishes mechanisms for the continuous evaluation and quality improvement of the integrated behavioral health service delivery system, including periodic evaluation of behavioral health programs and services and research on child and youth outcomes and that specifies performance measures in the areas of finance, administration, clinical process and clinical outcome; (6) that reports on the implementation of a program for training staff and providers; (7) that recommends, in consultation with the Department of Mental Health and Addiction Services, appropriate transition services and mechanisms to achieve this transition; (8) that establishes procedures for compiling of baseline data and conducting needs assessments and the design and cost of a longitudinal evaluation; (9) that determines the nature of support for development and financing of an independent family-operated organization to provide family-to-family support; (10) concerning what resources identified by the Department of Public Health, the Department of Education and the judicial branch that could be committed to the integrated funding for Connecticut Community KidCare; (11) on the establishment of an integrated grievance process for all children enrolled in Connecticut Community KidCare regardless of whether such children and youth were originally enrolled in the HUSKY Plan, Part A or Part B or the voluntary services program; (12) that recommends a mechanism for handling conflict resolution among the various responsible agencies; and (13) that recommends a process for adopting a five-year plan which shall include public input and a timeline for the full implementation of the Connecticut Community KidCare by July 1, 2003.
Sec. 50. Section 17a-4 of the general statutes is repealed and the following is substituted in lieu thereof:
(a) There shall be a State Advisory Council on Children and Families which shall consist of [fifteen] seventeen members appointed by the Governor, including at least five persons who are child care professionals, one child psychiatrist licensed to practice medicine in this state and at least one attorney. The balance of the advisory council shall be representative of young persons, parents and others interested in the delivery of services to children and youth. No less than fifty per cent of the council's members shall be parents or family members of children who have received, or are receiving, behavioral health, child welfare services or juvenile services and no more than half the members of the council shall be persons who receive income from a private practice or any public or private agency that delivers mental health, substance abuse, child abuse prevention and treatment, child welfare services or juvenile services. Members of the council shall serve without compensation, except for necessary expenses incurred in the performance of their duties. [No person] Members shall serve on the council for terms of two years each and no member shall serve for more than two consecutive terms. The commissioner shall be an ex-officio member of the council without vote and shall attend its meetings. Any member who fails to attend three consecutive meetings or fifty per cent of all meetings during any calendar year shall be deemed to have resigned. The council shall elect a chairperson and vice-chairperson to act in the chairperson's absence.
(b) The council shall meet quarterly, and more often upon the call of the chair or a majority of the members. A majority of the members in office, but not less than six members, shall constitute a quorum. The council shall have complete access to all records of the institutions and facilities of the department in furtherance of its duties, while at all times protecting the right of privacy of all individuals involved, as provided in section 17a-28.
(c) The duties of the council shall be to: (1) Recommend to the commissioner programs, legislation or other matters which will improve services for children and youth; (2) annually review and advise the commissioner regarding [his] the proposed budget; (3) interpret to the community at large the policies, duties and programs of the department; and (4) issue any reports it deems necessary to the Governor and the Commissioner of Children and Families.
Sec. 51. Section 17a-4a of the general statutes is repealed and the following is substituted in lieu thereof:
(a) There is established a Children's Behavioral Health Advisory Committee to the State Advisory Council on Children and Families which shall promote and enhance the provision of behavioral health services for all children in this state.
(b) The Children's Behavioral Health Advisory Committee shall be composed of the following ex officio voting members: (1) The Commissioner of Children and Families or the commissioner's designee; (2) the Commissioner of Social Services or the commissioner's designee; (3) the Executive Director of the Children's Health Council or said director's designee; (4) the Chief Court Administrator or said administrator's designee; (5) the Commissioner of Education or the commissioner's designee; (6) the Commissioner of Mental Health and Addiction Services or the commissioner's designee; and (7) the Commissioner of Mental Retardation or the commissioner's designee; and the following public members: [(8) two] (A) Two members appointed by the Governor, one member who shall be a parent of a child who receives behavioral health services and the other a provider of behavioral health services; [(9)] (B) one member each shall be appointed by the president pro tempore of the Senate, the speaker of the House of Representatives, the majority leader of the Senate, the majority leader of the House of Representatives, the minority leader of the Senate and the minority leader of the House of Representatives, all of whom shall be knowledgeable on issues relative to children in need of behavioral health services and family supports; and [(10)] (C) sixteen members appointed by the chairperson of the State Advisory Council on Children and Families. The membership of the advisory committee shall fairly and adequately represent parents of children who have a serious emotional disturbance. At least [fifty] fifty-one per cent of the members of the advisory committee shall be persons who are parents or relatives of a child who has or had a serious emotional disturbance or persons who had a serious emotional disturbance as a child and no more than half the members of the committee shall be persons who receive income from a private practice or any public or private agency that delivers behavioral health services.
(c) All appointments to the advisory committee shall be made no later than sixty days after July 1, 2000. Any vacancy shall be filled by the appointing authority. Members shall serve two-year terms and no public member shall serve for more than two consecutive terms.
(d) The advisory committee shall elect two cochairpersons from among its members, one of whom shall be the parent of a child with a serious emotional disturbance. The advisory committee shall meet at least bimonthly. Members of the advisory committee shall serve without compensation, except for necessary expenses incurred in the performance of their duties.
(e) Not later than October first of each year, the advisory committee shall submit a status report on local systems of care and practice standards for state-funded behavioral health programs to the State Advisory Council on Children and Families.
(f) Not later than October first of each odd-numbered year, the advisory committee shall submit recommendations concerning the provision of behavioral health services for all children in the state to the State Advisory Council on Children and Families. The recommendations shall address, but shall not be limited to, the following: (1) The target population for children with behavioral health needs, and assessment and benefit options for children with such needs; (2) the appropriateness and quality of care for children with behavioral health needs; (3) the coordination of behavioral health services provided under the HUSKY Plan with services provided by other publicly-funded programs; (4) performance standards for preventive services, family supports and emergency service training programs; (5) assessments of community-based and residential care programs; (6) outcome measurements by reviewing provider practice; and (7) a medication protocol and standards for the monitoring of medication and after-care programs.
Sec. 52. Subdivision (4) of subsection (f) of section 17b-340 of the general statutes is repealed and the following is substituted in lieu thereof:
(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, 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.] For the fiscal year ending June 30, 2002, each facility shall receive a rate increase that is two and on-half per cent more than the rate the facility received in the prior fiscal year. For the fiscal year ending June 30, 2003, each facility shall receive a rate increase that is two per cent more than the rate the facility received in the prior fiscal year. The Commissioner of Social Services [may exclude fair rent from any rate increase maximums] shall add fair rent increases to any other rate increases established pursuant to this subdivision for a facility which has undergone a material change in circumstances related to fair rent.
Sec. 53. Subsection (a) of section 17b-354 of the general statutes is repealed and the following is substituted in lieu thereof:
(a) Except for applications deemed complete as of August 9, 1991, the Department of Social Services shall not accept or approve any requests for additional nursing home beds or modify the capital cost of any prior approval for the period from September 4, 1991, through June 30, [2002] 2007, except (1) beds restricted to use by patients with acquired immune deficiency syndrome or traumatic brain injury; (2) beds associated with a continuing care facility which guarantees life care for its residents; and (3) Medicaid certified beds to be relocated from one licensed nursing facility to another licensed nursing facility, provided (A) the availability of beds in an area of need will not be adversely affected; (B) no such relocation shall result in an increase in state expenditures; and (C) the relocation results in a reduction in the number of nursing facility beds in the state. Notwithstanding the provisions of this subsection, any provision of the general statutes or any decision of the Office of Health Care Access, (i) the date by which construction shall begin for each nursing home certificate of need in effect August 1, 1991, shall be December 31, 1992, (ii) the date by which a nursing home shall be licensed under each such certificate of need shall be October 1, 1995, and (iii) the imposition of such dates shall not require action by the Commissioner of Social Services. Except as provided in subsection (c) of this section, a nursing home certificate of need in effect August 1, 1991, shall expire if construction has not begun or licensure has not been obtained in compliance with the dates set forth in subparagraphs (i) and (ii) of this subsection.
Sec. 54. (NEW) (a) Except for applications filed on or before May 1, 2001, which shall not be subject to the restrictions set forth in this section, for the period from July 1, 2001, to June 30, 2007, rest homes with nursing supervision beds under common ownership with chronic and convalescent nursing home beds in the same or an immediately adjacent building may be converted to chronic and convalescent nursing home beds in accordance with the provisions of section 17b-352 of the general statutes, provided that such conversion shall not result in an increase in cost to the state of more than twelve per cent of the amount previously paid to the facility annually for both levels of care. This limitation shall apply only to conversion of rest homes with nursing supervision beds under common ownership with chronic and convalescent nursing home beds or in the same or an immediately adjacent building. Rest homes with nursing supervision beds in freestanding facilities and rest homes with nursing supervision beds transferred to another licensed and Medicaid-certified nursing home may be converted to chronic and convalescent nursing home beds pursuant to section 17b-352 and subsection (a) of section 17b-354 of the general statutes as applicable.
(b) No later than December 31, 2001, the commissioner shall publish proposed regulations pursuant to subsections (a) to (e), inclusive, of section 4-168 of the general statutes implementing this section.
Sec. 55. Subsection (b) of section 17b-104 of the general statutes is repealed and the following is substituted in lieu thereof:
(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, June 30, 1999, June 30, 2000, [and] June 30, 2001, June 30, 2002, and June 30, 2003, shall not be increased. On January 1, 1994, the payment standards shall be equal to the standards of need in effect July 1, 1993.
Sec. 56. 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, June 30, 1999, June 30, 2000, [and] June 30, 2001, June 30, 2002, and June 30, 2003, 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. 57. Section 17b-112e of the general statutes is repealed and the following is substituted in lieu thereof:
(a) The Department of Social Services shall provide safety net services for certain families no longer receiving benefits or who are at risk of losing benefits under the temporary family assistance program. Such families include those who are not eligible for six-month extensions of benefits due to: (1) The receipt of two sanctions from the department during the first twenty months of the twenty-one-month time limit of said temporary family assistance program; or (2) the determination by the department that such a family has not made a good-faith effort to seek and maintain employment.
(b) Said safety net shall consist of services provided through the existing community service delivery network with additional resources provided by the Department of Social Services. Services shall be provided in-kind or through vendor or voucher payment. Services may include the following: (1) Food, shelter, clothing and employment assistance; (2) eviction prevention; (3) intensive case management; (4) continuous monitoring for child abuse or neglect; and (5) for families at risk of losing benefits under the temporary family assistance program, individual performance contracts, [requiring] that shall be administered by the Labor Department and that require job training, job searching, volunteer work, participation in parenting programs or counseling or any other requirements deemed necessary by the Labor Commissioner. [of Social Services.]
(c) Families successfully meeting the program requirements established by the individual performance contracts in subdivision (5) of subsection (b) of this section prior to the end of the twenty-one-month time limit shall be considered to have made a good faith effort to comply with the requirements of the program for the purposes of qualifying for a six-month extension, provided they have made a good faith effort to comply with the individual performance contract or have not incurred a sanction subsequent to completing the individual performance contract.
(d) The Commissioner of Social Services shall implement policies and procedures necessary for the purposes of this section while in the process of adopting such policies and procedures in regulation form, provided the commissioner prints notice of intention to adopt the regulations in the Connecticut Law Journal within twenty days of implementing such policies and procedures. [Final regulations shall be submitted to the legislative regulation review committee no later than November 15, 1997.] Policies and procedures implemented pursuant to this subsection shall be valid until the time final regulations are effective.
Sec. 58. Subsection (d) of section 17b-104 of the general statutes is repealed and the following is substituted in lieu thereof:
(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. 59. Section 17b-257 of the general statutes is repealed and the following is substituted in lieu thereof:
On and after July 1, 1998, the Commissioner of Social Services shall implement a state medical assistance program for persons ineligible for Medicaid and on or before April 1, 1997, the commissioner shall implement said program in the towns in which the fourteen regional or district offices of the Department of Social Services are located. The commissioner shall establish a schedule for the transfer of recipients of medical assistance administered by towns under the general assistance program to the state program. To the extent possible, the administration of the state medical assistance program shall parallel that of the Medicaid program as it is administered to recipients of temporary family assistance, including eligibility criteria concerning income and assets. Payment for medical services shall be made only for individuals determined eligible. The rates of payment for medical services shall be those of the Medicaid program. Medical services covered under the program shall be those covered under the Medicaid program, except that nonemergency medical transportation and long-term care and services available pursuant to a home and community-based services waiver under Section 1915 of the Social Security Act shall not be covered. On or after April 1, 1997, the commissioner shall implement a managed care program for medical services provided under this program, except services provided pursuant to section 17a-453a. Notwithstanding the provisions of sections 4a-51 and 4a-57, the commissioner may enter into contracts, including but not limited to, purchase of service agreements to implement the provisions of this section.
Sec. 60. Section 17b-259 of the general statutes is repealed and the following is substituted in lieu thereof:
(a) Each town shall provide medically necessary services by one or more competent physicians for all persons twenty-one to sixty-four years of age who are receiving general assistance benefits from such town, or eligible to be supported by such town, or unable to pay for the same over a two-year period, when such persons are in need thereof, and each town shall furnish necessary hospitalization, in accordance with section 17b-220, for all such persons if such persons have not made, within twenty-four months prior to the date of application for such aid, an assignment or transfer or other disposition of property for less than fair market value, for the purpose of establishing eligibility for benefits or assistance under the general assistance program. Any such disposition shall be presumed to have been made for the purpose of establishing eligibility for benefits or assistance unless such person furnishes convincing evidence to establish that the transaction was exclusively for some other purpose. Ineligibility because of such disposition shall continue only for either (1) twenty-four months after the date of disposition, or (2) that period of time from the date of disposition over which the fair market value of such property, less any consideration received in exchange for its disposition, together with all other income and resources, would furnish support on a reasonable standard of health and decency, whichever period is shorter, except that in any case where the uncompensated value of disposed of resources exceeds twelve thousand dollars, the Commissioner of Social Services shall provide for a period of ineligibility based on the uncompensated value which exceeds twenty-four months. The ability of a person to pay for medically necessary services over a two-year period shall be determined by a town in accordance with regulations adopted by the Department of Social Services in accordance with the provisions of chapter 54, provided income in excess of the maximum income levels established pursuant to such regulations and any assets in excess of two hundred fifty dollars shall be applied toward medical bills incurred during the two-year period and assistance shall be granted only for the remaining balance of the cost of medically necessary services. Any recipient who becomes ineligible for benefits under the general assistance program due to employment may continue to receive medical assistance for up to three months. Persons under twenty-one or over sixty-four years of age who are otherwise eligible under this section and who have applied for Medicaid but have not yet been determined eligible by the Department of Social Services, may receive assistance under this section. Any person receiving medical treatment or hospitalization under this section shall make to the selectmen full disclosure of his or her financial condition as provided in section 17b-123. A completed application for medical assistance under this section may be filed by the person seeking assistance, a member of such person's immediate family or a medical provider, including a physician or a hospital, within sixty days of commencement of treatment or hospitalization. A town shall be liable for medical bills only for those persons whose eligibility can be determined in accordance with standards established pursuant to section 17b-78, and those persons under twenty-one or over sixty-four years of age who are otherwise eligible under this section and who have applied for Medicaid but have not yet been determined eligible by the Department of Social Services. No applicant who may be eligible for a third-party payment to which [he] such applicant is entitled, including private insurance, hospital or medical service corporation benefits, veterans' benefits, Medicare and Medicaid shall be eligible for general assistance medical aid until [he] such applicant has completed the application process for such benefits. On and after October 1, 1991, a town shall not be liable for payment of the applicant's medical bills if the applicant fails to provide sufficient documentation to determine [his] eligibility for such benefits. Failure of a person or a legally liable relative of the person to cooperate in the general assistance application process shall not prevent payment to a medical provider for services rendered to the person if adequate information is otherwise available to determine the person's eligibility under this section. On or after April 1, 1997, the commissioner shall implement a managed care program for medical services provided under this program, except services provided pursuant to section 17a-453a. Notwithstanding the provisions of sections 4a-51 and 4a-57, the commissioner may enter into contracts, including but not limited to, purchase of service agreements to implement the provisions of this section.
(b) The medical services for which a town shall be liable under this section and for which a town shall be reimbursed by the state shall be limited to the following medically necessary services provided such services are covered under the Medicaid program: (1) Physician services, (2) hospital services, on an inpatient basis subject to the provisions of section 17b-220 and outpatient care, (3) community clinic services, (4) prescription drugs, excluding over-the-counter drugs, [(5) glasses, (6)] (5) hearing aids, [(7)] (6) laboratory and x-ray services, [(8)] (7) emergency dental services, [(9)] (8) emergency medical transportation, and [(10)] (9) examinations (A) needed to determine unemployability, or (B) requested by an attorney to establish the eligibility of a person receiving general assistance benefits for federal supplementary security income benefits pursuant to section 17b-119. Services not covered under this program include, but are not limited to, nonemergency medical transportation. In lieu of providing medical services, in accordance with this section, a town or group of towns may submit a plan to the Department of Social Services for approval to provide medical services in some other manner. The department shall approve the plan only if the persons served under it receive at least the services listed in this subsection and the plan offers the possibility of improved medical care or cost savings. The department shall encourage a town or group of towns to contract for the management of such medically necessary services.
Sec. 61. Subsection (g) of section 17b-112 of the general statutes is repealed and the following is substituted in lieu thereof:
(g) A family leaving assistance at the end of (1) said twenty-one-month time limit, including a family with income above the payment standard, or (2) the sixty-month limit shall have an interview for the purpose of being informed of services that may continue to be available to such family, including employment services available through the Labor Department. Said interview shall contain a determination of benefits available to said family provided by the Department of Social Services. Said interview shall also include a determination of whether such family is eligible for food stamps or Medicaid. Information and referrals shall be made to such a family for services and benefits including, but not limited to, the earned income tax credit, rental subsidies emergency housing, employment services and energy assistance.
Sec. 62. Subsection (g) of section 17b-340 of the general statutes is repealed and the following is substituted in lieu thereof:
(g) For the fiscal year ending June 30, 1993, any intermediate care facility for the mentally retarded with an operating cost component of its rate in excess of one hundred forty 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 intermediate care facility for the mentally retarded with an operating cost component of its rate that is less than one hundred forty 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 thirty 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 forty per cent of the median of operating cost components in effect January 1, 1992. Any facility with real property other than land placed in service prior to October 1, 1991, shall, for the fiscal year ending June 30, 1995, receive a rate of return on real property equal to the average of the rates of return applied to real property other than land placed in service for the five years preceding October 1, 1993. For the fiscal year ending June 30, 1996, and any succeeding fiscal year, the rate of return on real property for property items shall be revised every five years. 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 17-311-52 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. For the fiscal year ending June 30, 1995, 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. 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, no rate shall exceed three hundred seventy-five dollars per day unless the commissioner, in consultation with the Commissioner of Mental Retardation, determines after a review of program and management costs, that a rate in excess of this amount is necessary for care and treatment of facility residents. For the fiscal year ending June 30, 2002, rate period, the Commissioner of Social Services shall increase the inflation adjustment for rates made in accordance with subsection (p) of section 17-311-52 of the Regulations of State Agencies to update allowable fiscal year 2000 costs to include a three and one-half per cent inflation factor. For the fiscal year ending June 30, 2003, rate period, the commissioner shall increase the inflation adjustment for rates made in accordance with subsection (p) of section 17-311-52 of the Regulations of State Agencies to update allowable fiscal year 2001 costs to include a one and one-half per cent inflation factor.
Sec. 63. Section 17b-355 of the general statutes is repealed and the following is substituted in lieu thereof:
In determining whether a request submitted pursuant to sections 17b-352 to 17b-354, inclusive, will be granted, modified or denied, the Commissioner of Social Services shall consider the following: The relationship of the request to the state health plan, the financial feasibility of the request and its impact on the applicant's rates and financial condition, the contribution of the request to the quality, accessibility and cost-effectiveness of health care delivery in the region, whether there is clear public need for the request, the relationship of any proposed change to the applicant's current utilization statistics, the business interests of all owners, partners, associates, incorporators, directors, sponsors, stockholders and operators and the personal background of such persons, and any other factor which the department deems relevant. Whenever the granting, modification or denial of a request is inconsistent with the state health plan, a written explanation of the reasons for the inconsistency shall be included in the decision. [The] In considering whether there is clear public need for any request for additional nursing home beds associated with a continuing care facility submitted pursuant to section 17b-354, the commissioner shall only consider the need for beds for current and prospective residents of the continuing care facility. In considering whether there is clear public need for any request for the relocation of beds, the commissioner shall [not grant a request for additional nursing facility beds unless] consider whether there is a demonstrated bed need in the towns within [twenty miles] a fifteen mile radius of the town in which the beds are proposed to be located. [, including the town of the proposed location, as listed in the March 1, 1974, Official Mileage Table of the Public Utilities Commission.] Bed need shall be based on the recent occupancy percentage of area nursing facilities and the projected bed need for no more than five years into the future at ninety-seven and one-half per cent occupancy using the latest official population projections by town and age as published by the Office of Policy and Management and the latest available state-wide nursing facility utilization statistics by age cohort from the Department of Public Health. The commissioner may also consider area specific utilization and reductions in utilization rates to account for the increased use of less institutional alternatives.
Sec. 64. Section 19a-537 of the general statutes is repealed and the following is substituted in lieu thereof:
(a) As used in this section and section 19a-537a:
(1) "Vacancy" means a bed that is available for an admission;
(2) "Nursing home" means any chronic and convalescent facility or any rest home with nursing supervision, as defined in section 19a-521;
[(3) "Level of care" means the level of care that the person was assigned in the nursing home at the time of discharge to the hospital;]
[(4)] (3) "Hospital" means a general short-term hospital licensed by the Department of Public Health or a hospital for mental illness, as defined in section 17a-495, or a chronic disease hospital, as defined in section 19-13-D1(a) of the Public Health Code.
(b) A nursing home shall:
(1) Reserve the bed of a self-pay resident of such facility who is absent from the facility due to hospitalization whenever payment is available to reserve the bed;
(2) Inform the self-pay resident and [his] such resident's relatives or other responsible persons, upon admission of a person to the facility and upon transfer of a resident to a hospital, that the bed of a resident will be reserved as long as payment is available to the facility to reserve the bed and that if payment is not made, the resident will be admitted to the next available bed;
(3) Reserve the bed of a resident who is a recipient of medical assistance when the resident is absent from the facility for home leave days authorized under the Medicaid program;
(4) Inform the resident who is a recipient of medical assistance and [his] such resident's relatives or other responsible persons, upon admission of a person to the nursing home and upon transfer of a resident to a hospital of the conditions under which the Department of Social Services requires the nursing home to reserve the bed of a resident and that if the home is not required to reserve the bed, the resident will be admitted to the next available bed; and
(5) Not make the bed reserved for a hospitalized resident available for use by any other person unless the nursing home records in such resident's medical record the medical reasons justifying the change in such resident's bed, and the necessity of making the change before the resident's return to the facility, provided no resident's bed shall be changed if (A) such a change is medically contraindicated as defined in subsection (a) of section 19a-550; or (B) if the resident does not consent to the change, except when the change is made (i) to protect the resident or others from physical harm; (ii) to control the spread of an infectious disease; or (iii) to respond to a physical plant or environmental emergency that threatens the resident's health or safety. In the case of such an involuntary change of a resident's bed, disruption of residents shall be minimized, notice shall be provided to the resident or representative within twenty-four hours after the change and, if practicable, the resident, if he or she wishes, shall be returned to his or her room when the threat to health or safety which prompted the transfer has been eliminated. When a resident's bed is changed without his or her consent to protect the resident or others from physical harm, a consultative process shall be established on the first business day following the resident's return to the facility. The consultative process shall include the participation of the attending physician, a registered nurse with responsibility for the resident, other appropriate staff in disciplines as determined by the resident's needs and the participation of the resident, [his] such resident's family or other representative. The consultative process shall determine what caused the change in bed, whether the cause can be removed and, if not, whether the facility has attempted alternatives to the change. The resident shall be informed of the risks and benefits of the change in bed and of any alternatives.
(c) A nursing home shall reserve, for at least fifteen days, the bed of a resident who is a recipient of medical assistance and who is absent from such home due to hospitalization unless the nursing home documents that it has objective information from the hospital confirming that the patient will not return to the nursing home [at the same level of care] within fifteen days of the hospital admission including the day of hospitalization.
(d) The Department of Social Services shall reimburse a nursing home at the per diem Medicaid rate of the facility for each day that the facility reserves the bed of a resident who is a recipient of medical assistance in accordance with the following conditions:
(1) A facility shall be reimbursed for reserving the bed of a resident who is hospitalized for a maximum of seven days including the admission date of hospitalization, if on such date the nursing home documents that (A) it has a vacancy rate of not more than three beds or three per cent of licensed capacity, whichever is greater, [at the same level of care as the hospitalized person,] and (B) it contacted the hospital and the hospital failed to provide objective information confirming that the person would be unable to return to the nursing home [at the same level of care] within fifteen days of the date of hospitalization.
(2) The nursing home shall be reimbursed for a maximum of eight additional days provided:
(A) On the seventh day of the person's hospital stay, the nursing home has a vacancy rate that is not more than three beds or three per cent of licensed capacity, whichever is greater; [, at the same level of care as the hospitalized person,] and
(B) Within seven days of the hospitalization of a resident who is a recipient of medical assistance, the nursing home has contacted the hospital for an update on the person's status and the nursing home documents such contact in the person's file and that the information obtained through the contact does not indicate that the person will be unable to return to the nursing home [at the same level of care] within fifteen days of hospitalization.
(3) A facility shall be reimbursed for reserving the bed of a resident who is absent for up to twenty-one days of home leave as authorized under the Medicaid program if on the day of such an absence the facility documents that it has a vacancy rate of not more than four beds or four per cent of licensed capacity, whichever is greater. [, at the same level of care as the resident so absent.] No facility shall require or request a resident who is a recipient of medical assistance to provide payment for such authorized home leave days, whether or not such payment is available from the department.
(e) If a resident's hospitalization exceeds the period of time that a nursing home is required to reserve the resident's bed or the nursing home is not required to reserve the resident's bed under this section, the nursing home:
(1) Shall provide the resident with the first bed available at the time the nursing home receives notice of the resident's discharge from the hospital;
(2) Shall grant the resident priority of admission over applicants for first admission to the nursing home;
(3) May charge a fee to reserve the bed, not exceeding the facility's self-pay rate for the unit in which that resident resided, or not exceeding the per diem Medicaid rate for recipients of medical assistance, whichever charge is applicable, for the number of days which the resident is absent from the facility.
Sec. 65. Section 19a-537a of the general statutes is repealed and the following is substituted in lieu thereof:
Compliance with section 19a-537 shall be monitored by the department on a postaudit basis or whenever a complaint is received and its provisions shall be enforced as follows:
(1) The Department of Social Services is authorized to impose a penalty not greater than eight thousand five hundred dollars for each violation of said section 19a-537.
(2) The department shall recoup payments made to a nursing home for reserve-bed days when it is determined that: The nursing home made the bed assigned to a hospitalized resident available to another person; [,] or the nursing home was reimbursed for reserve bed days after it had objective information indicating that the hospitalized person would not return to the nursing home; [at the same level of care;] or the nursing home failed to provide a resident with the first available bed or grant a resident priority of admission as required by subsection (e) of said section 19a-537; or the nursing home failed to document the appropriate vacancy rate or hospital contact. If the payments have already been made, the department may set off the amount of the payments against any other payments due to the nursing home.
(3) The department may impose a penalty upon a facility pursuant to subdivision (1) of this section or recoup any payments from a facility pursuant to subdivision (2) of this section, regardless of whether a change in ownership of the facility has taken place since the time of the violation, provided the department has issued notice of the alleged violation and the accompanying penalty or recoupment prior to the effective date of the change in ownership and record of such notice is readily available in a central registry maintained by the department.
(4) Prior to imposing any penalty pursuant to subdivision (1) of this section or recouping any payments pursuant to subdivision (2) of this section, the Department of Social Services shall notify the nursing home of the alleged violation and the accompanying penalty or recoupment, and shall permit such facility to request an administrative hearing, in accordance with sections 4-177 to 4-181, inclusive. A facility shall request such hearing within fifteen days of receipt of the notice of violation from the Department of Social Services. The department shall stay the imposition of any penalty or recoupment pending the outcome of the administrative hearing.
Sec. 66. Subsection (a) of section 17b-239 of the general statutes is repealed and the following is substituted in lieu thereof:
(a) The rate to be paid by the state to hospitals receiving appropriations granted by the General Assembly and to freestanding chronic disease hospitals, providing services to persons aided or cared for by the state for routine services furnished to state patients, shall be based upon reasonable cost to such hospital, or the charge to the general public for ward services or the lowest charge for semiprivate services if the hospital has no ward facilities, imposed by such hospital, whichever is lowest, except to the extent, if any, that the commissioner in [his] the commissioner's discretion determines that a greater amount is appropriate in the case of hospitals serving a disproportionate share of indigent patients. Such rate shall be promulgated annually by the Commissioner of Social Services. Nothing contained herein shall authorize a payment by the state for such services to any such hospital in excess of the charges made by such hospital for comparable services to the general public. Notwithstanding the provisions of this section, for the rate period beginning July 1, 2000, rates paid to freestanding chronic disease hospitals and freestanding psychiatric hospitals shall be increased by three per cent. For the rate period beginning July 1, 2001, and each succeeding rate period, rates paid to freestanding chronic disease hospitals and freestanding psychiatric hospitals shall be equal to but not exceed rates for the preceding rate period, plus an inflation factor equal to the Medicare market basket inflation rate as published in the previous September Federal Register of each year with the wage portion of such market basket adjusted for the Hartford metropolitan statistical area. Notwithstanding the provisions of this subsection, the commissioner shall use the rate of the highest-paid freestanding chronic disease hospital for any freestanding chronic disease hospital having more than an average of fifteen per cent of its inpatient days utilized as long-term ventilator patient days paid for by the Department of Social Services beginning for the rate period ending in 2001, in lieu of the rate paid for the period when determining the rates to be paid on and after July 1, 2001. For purposes of this subsection, "long-term ventilator patient" means any patient at a freestanding chronic disease hospital on a ventilator for a total of sixty days or more in any consecutive twelve-month period.
Sec. 67. Sections 19a-670b and 19a-671b of the general statutes are repealed.
Sec. 68. Sections 17b-695, 17b-696, 17b-697 and 17b-698a of the general statutes are repealed.
Sec. 69. This act shall take effect from its passage, except that sections 3 to 6, inclusive, 13, 20 to 22, inclusive, 24, 25, 27 to 31, inclusive, 36 to 38, inclusive, 42 to 66, inclusive, and 68 shall take effect July 1, 2001, and sections 1, 2, 12, 14 to 16, inclusive, 23, 32 to 35, inclusive, 39 and 40 shall take effect October 1, 2001.
Approved July 2, 2001