OLR Research Report

March 5, 2008




By: Robin K. Cohen, Principal Analyst

You asked for an analysis of SB 34. The entire bill is effective on July 1, 2008.

1—Medicaid Coverage for Interpreter Services for People with Limited English Proficiency

The bill repeals a 2007 law that requires the Department of Social Services (DSS) to amend the Medicaid state plan to cover interpreter services for people with limited English proficiency. Federal law obliges states to offer interpreter services to these individuals. They can either offer it as a “covered service,” which would be listed separately in a state's Medicaid state plan (which must get federal approval), or they can do it administratively, for which no federal approval is needed. DSS currently does the latter, offering interpreters through staffed, off-site telephone services.

States choosing to provide direct reimbursement to medical providers essentially pay these providers a higher rate than they pay just for the medical services. Like the telephone service, this higher service rate is eligible for a 50% federal match.

2—Definition of Medical Necessity

The bill requires DSS, by January 1, 2009, to amend the definition of “medically necessary” services in the medical assistance program (presumably Medicaid) so that it is the same as the regulatory definition that applies to the State-Administered General Assistance (SAGA) medical assistance program. Medicaid generally pays only for those services considered to be medically necessary.

Currently, the Medicaid definition of medically necessary is “health care provided to: correct or diminish the adverse effect of a medical condition or mental illness; assist an individual in attaining or maintaining an optimal level of health; or diagnose a condition or prevent a medical condition from occurring.”

SAGA regulations define medically necessary as “those health services required to prevent, identify, diagnose, treat, rehabilitate, or ameliorate a health problem or its effects; or to maintain health and functioning. But the services must be:

1. consistent with generally accepted standards of medical practice;

2. clinically appropriate in terms of type, frequency, timing, site, and duration;

3. demonstrated through scientific evidence to be safe and effective and the least costly among similarly effective alternatives, where adequate scientific evidence exists; and

4. efficient in regard to the avoidance of waste and refraining from provision of services that, on the basis of the best available scientific evidence, are not likely to produce benefit.”

The bill permits the DSS commissioner to implement policies and procedures necessary to carry out this provision while in the process of adopting them as regulations. He must publish notice of intent to adopt in the Connecticut Law Journal within 20 days of implementation. These policies and procedures are valid until the regulations are adopted.

3—Residential Care Homes (RCH) Rates

The bill limits the amount that RCHs can receive in State Supplement payments for FY 09. It prohibits them from receiving a rate that is more than 2% higher than the rate in effect on June 30, 2008. But RCHs that

would have received lower rates as of July 1, 2008 because they are on interim rate status (i.e., negotiate a rate outside the regular formula) must receive the lower rate.

4—RCH Administration of Medication

Under current law, the Department of Public Health must adopt regulations to allow unlicensed personnel working in RCHs to be certified to administer drugs to residents. The bill instead requires the regulations to (1) require each RCH to designate an appropriate number of unlicensed personnel to be certified (2) establish criteria for determining this number, and (3) set training requirements for certification.

The bill requires each RCH to ensure that it has personnel certified by January 1, 2009, and it authorizes these individuals to administer the medications.

The bill provides that administering drugs does not include injected drugs, except for injected drugs in pre-measured, commercially prepared syringes provided to residents with diagnosed medical conditions that may require emergency treatment.

5—Child Support Disregard in Temporary Family Assistance (TFA) Program

The bill increases, from $50 to $100, the amount of monthly child support that DSS must disregard when determining income eligibility and benefit levels in the TFA program. Raising this limit allows families to keep more child support income without affecting their TFA benefits. If DSS collects more than the disregard limit, the excess counts towards eligibility but not the benefit amount and is considered reimbursement for TFA benefits. But when the current support collected exceeds the family's monthly TFA benefit plus the limit, the child support is paid directly to the family and is counted for purposes of determining the TFA benefit.

The current monthly TFA benefit for a family of three living in most parts of the state is $560. To initially qualify for TFA, a family's income can be no higher than the TFA benefit for that family's size, plus $90 (from earnings). Once receiving TFA, families can have income up to the federal poverty level without losing eligibility.

6—Hospice Benefit in Medicaid

The bill requires DSS to consult with the Office of Policy and Management to determine the cost effectiveness of amending the Medicaid State Plan to include hospice services. The DSS commissioner must amend the state plan to include the services by February 1, 2009 if it is determined to be cost effective to do so.

Currently, Medicaid pays for certain home health care services but not the full panoply of hospice benefits, such as bereavement counseling.

7 & 8—Behavioral Health Partnership

The bill allows the Behavioral Health Partnership to provide integrated behavioral health services to children, adolescents, and families served by the Court Support Services Division (CSSD) of the Judicial Department. By law, these services must be offered to HUSKY A and B enrollees and children enrolled in the Department of Children and Families' (DCF) voluntary services program. At DSS' and DCF's discretion, the program can also serve other children, adolescents, and families.

As a corollary, the bill also adds a nonvoting, ex-officio member representing the CSSD to the partnership's oversight council. The chief court administrator appoints this member.

9—Trusts for State Supplement Recipients Residing in Residential Care Homes and New Horizons, Inc.

In general, State Supplement applicants who transfer assets within 24 months before applying for assistance are presumed to have done so to qualify. Such transfers generally render the transferor ineligible for State Supplement for a period of time based on the value of the asset. But if the applicant can provide convincing evidence that the transfer was made for another reason, eligibility is not affected.

The bill adds a second exception by allowing transfers to “special needs trusts” by individuals who (1) are living in residential care homes or New Horizons, Inc. (a facility for people with severe physical disabilities, located in Farmington) and (2) have available income that is more than 300% of the maximum federal Supplemental Security Income (SSI) program benefit for an individual ($1,911 per month in 2008) and below the private rate that the RCH or New Horizons charges. Currently, an individual cannot qualify for State Supplement benefits if his or her income exceeds 300% of the SSI benefit.

The bill requires the trust to be funded solely with the individual's excess income. The trust must provide that once the individual dies, the state will receive all amounts remaining in it after the Medicaid program is reimbursed for Medicaid-funded services the individual received, up to an amount equaling the amount of State Supplement provided. The type of trust someone may establish is the same that federal law allows for purposes of Medicaid eligibility (42 USC 1396p(d)(4)).

The bill does not explicitly provide that individuals with such trusts can have the excess income they deposit into them disregarded for purposes of State Supplement eligibility. DSS offered substitute language at the public hearing to make this change.

State Supplement is a state-funded program offering cash assistance to aged, blind, and disabled residents, most of whom receive SSI. To qualify, an individual may not have income above 300% of the maximum SSI benefit and assets cannot exceed $1,600 for a single person. The amount of the State Supplement benefit is based on the individual's living arrangement, with individuals living in institutional settings receiving higher amounts than individuals residing in the community.