PA 08-180—sSB 561

Human Services Committee

Appropriations Committee

AN ACT CONCERNING THE MONEY FOLLOWS THE PERSON PROJECT AND OTHER LONG-TERM CARE INITIATIVES

SUMMARY: This act increases, from 700 to 5,000, the number of individuals who can be served under the state's plan for participating in the federal Money Follows the Person (MFP) demonstration program. MFP is a five-year program that permits states to move individuals out of nursing homes or other institutional settings and into less-restrictive, community-based settings and not jeopardize federal funding. The act requires, instead of allows, the Department of Social Services (DSS) commissioner to submit an application to the federal government. DSS has developed a protocol for the demonstration, which needs federal approval before it can be implemented.

The act also requires the DSS commissioner to develop a plan to establish and administer a similar home- and community-based services (HCBS) project for adults who may not meet the MFP institutionalization requirement.

And it establishes a separate, nonlapsing General Fund account to hold the enhanced federal matching funds the state receives for MFP. It specifies the uses of funds in the account and requires a report on expenditures from it.

EFFECTIVE DATE: July 1, 2008, except the changes in the MFP demonstration are effective upon passage.

DEMONSTRATION HCBS PROJECT

Plan

The DSS commissioner must develop a plan to establish and administer a demonstration project to provide home- and community-based long-term care services to individuals who are 18 and older who (1) are institutionalized or at risk of institutionalization and (2) meet the financial and level of care eligibility criteria established in the Connecticut Home Care Program for Elders (CHCPE) regulations.

The plan must detail the project's structure, people served, services, and service provision. It must also include a timetable for implementing the project beginning July 1, 2009.

The plan must further identify (1) any federal Medicaid waivers or state plan amendments necessary to implement the demonstration and (2) any costs or savings it creates. In developing the plan, the commissioner must consider consolidating existing waivers, demonstration projects, and state-funded programs to promote efficiencies.

Services

The services the project must provide must be modeled after those provided by the MFP demonstration. Project participants must receive a level of care and services necessary to maintain them in their home or community.

The plan must ensure that the project provides, at a minimum, the following Medicaid-covered services, which would be authorized through a Medicaid state plan amendment, a new Medicaid waiver, or modification to an existing Medicaid waiver:

1. personal care assistance,

2. 24-hour care,

3. occupational therapy,

4. homemaker and companion services,

5. meals on wheels,

6. adult day care,

7. transportation,

8. mental health counseling,

9. care management,

10. elderly foster care,

11. minor home modifications,

12. assistive technology, and

13. assisted living.

Report

By January 1, 2009, the act requires the DSS commissioner to submit the plan to the Human Services and Appropriations committees, along with recommended legislation and funding to implement it. The committees have 60 days to advise the commissioner whether they approve, deny, or modify the plan. If it is approved, it must be implemented on or after July 1, 2009, subject to available appropriations.

LONG-TERM CARE REINVESTMENT ACCOUNT

The account must hold any money the law requires it to. Any enhanced federal Medicaid matching funds the state receives from implementing MFP must be deposited into it.

The act requires the DSS commissioner, in consultation with the Office of Policy and Management (OPM) secretary, to develop and implement a written plan for allocating funds in the account, which must include application procedures and eligibility criteria and requirements for fund recipients. The commissioner must submit a copy of the plan to the Human Services and Appropriations committees.

The DSS commissioner must also consult with the OPM secretary when actually spending account funds, which can go towards:

1. programs and services that provide cost-effective home- and community-based alternatives to nursing home care;

2. rate increases for home health agencies and other home care providers above and beyond those authorized by law and increased wages for MFP transition coordinators;

3. developing, improving, and increasing the long-term care services workforce, including training, education, and other incentives;

4. improving information technology and systems to track costs and savings associated with using home- and community-based care and improve access to long-term care services information;

5. encouraging the purchase of precertified long-term care insurance through the Connecticut Partnership for Long-Term Care by paying for six months of premiums;

6. paying to relocate nursing home residents to other facilities if needed to protect their health and safety, maintaining and operating facilities pending deficiency corrections or closures, and reimbursing residents for lost personal needs fund accounts;

7. grants promoting the adoption of building design and principles of alternative nursing homes; and

8. grants to existing nursing homes for improvements and modifications to support HCBS and programs.

Report

The act requires the DSS commissioner to submit annual reports on the fund, starting by January 1, 2009, to the governor and the Human Services and Appropriations committees. The report must include such information as the number, amount, and type of fund expenditures during the prior calendar year and estimates of the account's impact on present and future Medicaid expenditures.

BACKGROUND

MFP

In 2005, Congress, as part of the Deficit Reduction Act, enacted the MFP provisions as a way to encourage states to rebalance their long-term care spending by moving individuals from nursing homes or other institutions into less-restrictive, community-based settings. The law requires that program participants (1) reside in the nursing home for at least six months and (2) need a nursing home level of care once they leave.

States that run the demonstration projects are eligible for an enhanced federal match (75% instead of 50%) of state expenditures for the first year of Medicaid-eligible services. States must commit to provide some of these services once the year is up through some other authority (e. g. , federal home- and community-based services waiver). Federal matching funds of 50% are also available to support services not allowed by Medicaid that the state will provide during the demonstration, such as housing coordinators.

Other federal law allows states to provide Medicaid–funded community-based services to the elderly and disabled, and Connecticut currently runs several waiver programs that offer these services. These programs generally have enrollment caps. State law allows the DSS commissioner to modify the existing Medicaid waivers if necessary to carry out the demonstration.

Connecticut Home Care Program for Elders (CHCPE)

This program provides home- and community-based services for individuals aged 65 and older who are institutionalized or at risk of institutionalization. It includes both Medicaid waiver- and state-funded components.

The program has three categories of services, depending on the participant's care needs and his or her financial circumstances. Table 1 illustrates these.

Table 1: CHCPE Care Levels, Eligibility, and Service Limitations

Category

Care Level Eligibility

Income Eligibility/Service Limits

1

Might not immediately enter hospital or nursing home in absence of services

No income limit but client contribution once income reaches 200% of the federal poverty level ($20,800 for single person in 2008); assets limited to $31,320 and $41,760, for single and married participants, respectively.

Services authorized for up to 25% of weighted average nursing home cost

2

Individuals would require institutionalization in absence of services

Same financial criteria as Category 1.

Services authorized for up to 50% of weighted average

3

Same as Category 2 and meet Medicaid's eligibility criteria under federal waiver

300% of Supplemental Security Income maximum benefit ($1,911 per month in 2008 for single person); assets up to $1,600 for single person.

Services authorized for up to 100% of average nursing home cost

OLR Tracking: RC: JR: PF: ts