OLR Bill Analysis
AN ACT IMPLEMENTING THE PROVISIONS OF THE BUDGET CONCERNING HUMAN SERVICES AND MAKING CHANGES TO VARIOUS SOCIAL SERVICES STATUTES.
This bill implements provisions of the budget pertaining to human services.
EFFECTIVE DATE: Upon passage
§§ 1-17 — FALSE CLAIMS ACT FOR DSS PROGRAMS
The bill creates a Connecticut False Claims Act (FCA) applicable to the medical assistance programs that the Department of Social Services (DSS) administers, including Medicaid, State-Administered General Assistance (SAGA), HUSKY B, and Charter Oak. The 2005 federal Deficit Reduction Act permits states that adopt their own act to keep a greater share of any Medicaid funds that they recover under it.
§ 2 — Violations
With respect to goods and services rendered through all DSS medical assistance programs, including Medicaid, the bill prohibits anyone from:
1. knowingly presenting, or causing to be presented to a state employee or officer, a false or fraudulent claim for payment or approval;
2. knowingly making, using, or causing to be made or used, a false record or statement to secure payment or approval of a false or fraudulent claim under these programs;
3. conspiring to defraud the state by securing the allowance or payment of a false or fraudulent claim;
4. having possession, custody, or control of property or money used, or to be used, by the state relative to these programs, and, with intent to defraud the state or willfully conceal the property, deliver or cause to be delivered less property than the amount for which the person receives a receipt or certificate;
5. being authorized to make or deliver a document certifying receipt of property used, or to be used, by the state relative to these programs. and, with intent to defraud the state, make or deliver the document without completely knowing that the information on it is true;
6. knowingly buying, or receiving as a pledge of an obligation or debt, public property from a state employee or officer who may not legally sell or pledge the property; and
7. knowingly making, using, or causing to be made or used, a false record or statement to conceal, avoid, or decrease an obligation to pay or transmit money or property to the state.
Anyone who violates any of the above provisions is liable for:
1. a civil penalty between $ 5,000 and $ 10,000;
2. three times the amount of damages to the state due to the violation; and
3. the costs of investigating and prosecuting the violation.
The liability is joint and several for any violation committed by two or more people.
An individual faces a smaller penalty for damages (#2, above) if a court finds that (1) the person committing the violation provided state investigators with all information he or she knew about it within 30 days after first obtaining that information; (2) the person fully cooperated with state investigators; and (3) when he or she provides the state the information, (a) no criminal, civil, or administrative actions have begun (see below) and (b) the person had no knowledge of an investigation. The court in these instances can assess a penalty of not less than twice the amount of damages. The bill exempts any information a person provider under these circumstances from disclosure under the Freedom of Information Act (FOIA).
§ 3 — Attorney General- Initiated Civil Actions
The bill authorizes the attorney general to investigate any alleged violations. Information obtained during the investigations is exempt from disclosure under the state Freedom of Information Act. If the attorney general finds that a violation has occurred or is occurring, he can bring a civil action in Hartford Superior Court.
§ 4 — Other Civil Actions
The bill also authorizes any other person to bring a civil action against a violator in the person's and the state's behalf. These actions subsequently can be withdrawn only if the court and the attorney general give written consent and their reasons for doing so. In these actions or actions under the federal False Claims Act, only the state can intervene or bring a related action based on the facts underlying the pending action.
The person bringing the action must provide a copy of the complaint and written disclosure of substantially all material evidence and information he or she possesses by serving the attorney general in the same way civil actions are brought against the state. Among other things, this includes leaving a true and attested copy of the process, including the declaration or complaint, at the Attorney General's Office in Hartford.
The complaint must be filed in camera (in private), remain sealed for at least 60 days, and cannot be served on the defendant until a court orders it. The motion can be supported by in camera affidavits or other submissions. The court, upon the attorney general's motion, can, for good cause, extend the time during which the complaint is sealed. Before the sealed period ends, the attorney general must (1) proceed with the action, which he must conduct or (2) notify the court that he has declined to take over the action, in which case the person can proceed to bring the action.
If the court orders that the complaint be unsealed and served, the Superior Court must issue an appropriate order requiring the same notice that is ordinarily required to bring a civil action. The defendant cannot be required to respond to any complaint until 30 days after he or she is served.
§ 5 — Attorney General Proceeds With or Withdraws From Action
If the attorney general decides to proceed with the action, he has the primary responsibility for prosecuting it and is not bound by any act of the person bringing it. But the person bringing the action has the right to continue as a party to it, subject to limits described below.
The bill authorizes the attorney general to withdraw the action regardless of any objections the person bringing it has if the attorney general notifies the person of his motion (presumably to withdraw) and the court provides the person the opportunity for a hearing on it. Likewise, the attorney general can settle with the defendant even if the person bringing the action objects if the court, after a hearing, determines that the proposed settlement is fair, adequate, and reasonable under all the circumstances. These hearings can be held in camera for good cause.
§ 13, 14 — Proving Essential Elements Through Preponderance of Evidence
Under the bill, whoever brings the FCA action must prove all its essential elements, including damages, by a preponderance of the evidence.
The bill also specifies that regardless of any other contrary state law, a final judgment for the state's favor against a defendant in any criminal proceeding charging fraud or false statements, whether after a trial or plea of guilty or no contest, prevents the defendant from denying the essential elements of the offense in a civil action that involves the same transaction as the criminal proceeding.
§ 5(d) — Court Limits on Person's Participation in Action
The bill gives the court discretion to limit participation by the person bringing the action when either the attorney general or defendant can show cause. Specifically, the attorney general must show that unrestricted participation would (1) interfere with or unduly delay his prosecution of the case or (2) be repetitious, irrelevant, or for harassment. The defendant must show that unrestricted participation would be for harassment or would cause him or her undue burden or unnecessary expense. The court can limit (1) the number of witnesses the person can call, (2) the length of their testimony, (3) cross-examination, and (4) their participation in other ways it chooses.
§ 5(e)(f) — Rewards for Person Bringing Actions
The bill provides that if (1) the court awards civil penalties or damages to the state or (2) the attorney general settles and receives civil penalties or damages, the person bringing the action must receive between 15% and 25 % of the proceeds, based on the extent to which he or she substantially contributed to the prosecution.
The court can award the person less than 15% in certain cases. When it finds that the action is based primarily on disclosures or specific information relating to allegations or transactions (1) in a criminal, civil, or administrative hearing; (2) in a report, hearing, audit, or investigation conducted by the General Assembly or one of its committees, the state auditors, or a state agency or quasi-public agency; or (3) from the news media, the court may award the person an amount it deems appropriate, but no more than 10% of the proceeds, taking into account the significance of the information and the person's role in advancing the case to litigation.
In either instance, the person must also receive an amount for the reasonable expenses that the court finds he or she incurred necessarily, plus reasonable attorney fees and costs. The defendant must pay all of these expenses, fees, and costs.
§ 6 — When Attorney General Declines to Proceed
The bill empowers the person bringing the action to conduct it when the attorney general declines to proceed. If the attorney general makes this decision and asks, the court must order that copies of all pleadings filed in the action and of any deposition transcripts be provided to the state. When the person proceeds with the action, the court, without limiting the person's status or rights, can permit the attorney general to intervene at a later date if he can show good cause.
When Individual Prevails. The bill provides rewards for people bringing or settling these actions that the court decides are reasonable. The award is between 25% and 30% of the proceeds. As with the actions the attorney general brings, the person must also be reimbursed for expenses and legal fees and costs.
When Defendant Prevails. Under the bill, if the defendant prevails in these actions and the court finds that the claim was clearly frivolous or vexatious or brought primarily to harass, the court can require the person bringing the action to pay the defendant's attorney fees and expenses.
Stays of Discovery. The bill provides that whether or not the attorney general proceeds with an action, if he requests and can show that certain motions or requests for discovery by the person bringing the action would interfere with the state's investigation or prosecution of a criminal or civil matter arising from the same facts, the court can stay the discovery for up to 60 days. This showing must be done in camera. The court can extend the stay for an additional 60 days upon further in camera showing that the state has pursued its investigation or proceedings with reasonable diligence and any proposed discovery in the individual's civil action will interfere with the state's case. The bill allows the chief state's attorney or state's attorney for the appropriate judicial district to explain to the court the potential impact of the discovery on a pending criminal investigation or prosecution.
§ 7 — Alternate Means to Pursue State's Claim
The bill authorizes the attorney general to pursue the state's claim through any alternate remedy available to the state, including an administrative proceeding to determine a civil penalty. If he pursues an alternate remedy, the person bringing the action has the same rights as he or she would have had if the action had continued in court. Any fact finding or conclusion of law made in an alternate proceeding that has become final is conclusive on all parties to court actions. A finding or conclusion is final if it has been finally determined on appeal to the appropriate state court, if the time for filing an appeal has expired, or if it is not subject to judicial review.
§ 8 — When the Person Bringing the Action Planned or Initiated the Violation
The bill provides that if the court finds that the action was brought by someone who planned and initiated the violation upon which the action is brought, the court can reduce the share of the proceeds the person would otherwise receive (10-30%), taking into account the person's role in advancing the case to litigation and any relevant circumstances relating to the violation.
If the person bringing the action is convicted of criminal conduct arising from his or her role in the violation, he or she must be dismissed from the civil action and may not receive any share of the proceeds. A dismissal does not prejudice the attorney general's right to continue the action.
§ 9 — Court Jurisdiction Limited
Unless the attorney general brings the action or the person bringing it is an original source of the information, the bill provides that the court does not have jurisdiction over an action:
1. against a member of the General Assembly or the judiciary, an elected state officer or a state department head if the action is based on evidence or information known to the state when the action was brought;
2. that is based on allegations or transactions that are the subject of a civil suit or an administrative civil penalty proceeding in which the state is already a party; or
3. that is based on the public disclosure of allegations or transactions (a) in a criminal, civil, or administrative hearing; (b) in a report, hearing, audit, or investigation conducted by the General Assembly or one of its committees, the state auditors, a state agency, or quasi-public agency; or (c) from the news media An “original source” means an individual who has direct and independent knowledge of the information on which the allegations are based and has voluntarily provided it to the state before filing the action based on the information.
The court likewise has no jurisdiction over actions brought by a person who knew or had reason to know that the attorney general or another state law enforcement official knew of the allegations or transactions before the person filed the action or disclosed the material evidence to the attorney general.
§ 10 — No State Liability for Expenses Incurred by Individuals Bringing Actions
The bill provides that the state is not liable for expenses that a person bringing an action incurs.
§ 11 — Whistle-Blower Protections
The bill provides that any employee who is discharged, demoted, suspended, threatened, harassed, or in any other manner discriminated against by his or her employer because the employee lawfully acts on his, her, or others' behalf in furthering one of the bill's actions, including investigating, initiating, or testifying or assisting in, an action filed or to be filed under the bill is entitled to all relief necessary to make the employee whole.
This relief, which the employee can request through Superior Court, must include (1) reinstatement with the same seniority status that the employee would have had except for the discrimination and (2) twice the amount of any back pay, plus interest on it, and compensation for any special damages that the discrimination caused, including litigation costs and reasonable attorneys' fees.
§ 12 — Statute of Limitations
The bill specifies that any FCA action it permits cannot be brought (1) more than six years after the date the violation occurs or (2) more than three years after the date when material facts are known or reasonably should have been known by the state official charged with acting on them, whichever occurs later, but in no event can an action be brought more than 10 years after the date the violation is committed.
§ 15 — Non-Exclusivity of Remedies
The bill provides that its FCA provisions and the state Whistleblower law are not exclusive and that the remedies it provides are in addition to any others provided in state, federal, or common law.
§ 17 — Authority for Attorney General to Act; Confidentiality of Records
By law, the attorney general has the power to summon witnesses and take other steps when investigating complaints brought to the state auditors against state or quasi-public agencies or involving large state contracts. The bill extends this authority to enable him to begin investigating suspected FCA violations until he files a civil action under the bill.
The bill also provides that neither the state auditors nor the attorney general may disclose the identity of the person who provided information under these FCA provisions without his or her consent unless the auditors or attorney general determine that disclosure is unavoidable. By law they may withhold records of the investigation while it is occurring.
The bill also exempts from disclosure under the Freedom of Information Act records of an investigation or the name of an employee providing information under the FCA.
§ 18 — False Claims Report
The bill requires the attorney general to submit a report to the General Assembly and the governor beginning on the 30th day after the bill's passage and annually thereafter that provides:
1. the number of civil actions he and private individuals filed under the FCA during the previous calendar year;
2. with respect to civil actions filed by private individuals during that period, the number that remain under seal, the number of action filed by court location, the state agency or program involved in the action, and the number of actions filed by people who previously filed actions under the federal FCA or another state's act;
3. any known amount the state recovered from these actions in settlements, damages, penalties, and litigation costs; and
4. for all recoveries, the case number and parties; a breakdown of damages, penalties, and litigation costs; and the amount and per cent paid by the state to the person who brought the civil action.
The bill requires the attorney general to include in his first report information on false claim actions brought under the FCA that the bill establishes during this past. However, the FCA provisions are effective upon passage and were not in existence during the previous year; thus, it does not appear that the attorney general can provide any information in the first report.
§ 19 — DELAY START OF DEPARTMENT ON AGING
The bill postpones the reestablishment of a state Department on Aging by two years, from July 1, 2008 to July 1, 2010.
Connecticut disbanded its Department on Aging in 1993 and merged most of its functions and personnel into DSS as the Division of Elderly Services. (This division was renamed the Aging Services Division several years ago. ) In 2005, the legislature reestablished the department effective January 1, 2007, but PA 07-2, JSS postponed the reestablishment date to July 1, 2008.
§ 20, 55, 64, 78 — MEDICAL ASSISTANCE FOR QUALIFIED ALIENS
Termination of Medical Benefits
The bill eliminates most state-funded medical assistance coverage for legal immigrants and certain others who have lived in the U. S. for less than five years. (Once here for five years they generally qualify for federally funded assistance. )
Specifically, it eliminates coverage under the state-funded medical assistance (State-Funded Medical Assistance for Non-Citizens, SMANC) and HUSKY B programs established in 1997 to assist legal immigrants and certain other residents who are ineligible for Medicaid and the federal State Children's Health Insurance Program (SCHIP, HUSKY B in Connecticut) because they have lived in the U. S. for less than five years.
But those immigrants who were receiving home care services or nursing home care under the SMANC program on September 8, 2009 continue to receive coverage for these services as long as they meet Medicaid eligibility criteria except for their immigrant status. Likewise, assistance continues for individuals who are receiving nursing home care, have applied for SMANC before September 8, 2009, and would otherwise be eligible for it. For these individuals, the assistance continues for as long as the individual meets Medicaid eligibility requirements for nursing home care except for his or her immigrant status.
Likewise, the bill requires children and pregnant women who have been admitted legally less than five years before the date they receive services must continue to receive coverage until such time as the state plan amendment concerning federal funding to cover them is approved (see below).
The bill allows the DSS commissioner to implement policies and procedures needed to carry out these provisions while in the process of adopting them in regulation. He must print notice of intent to publish the regulations in the Connecticut Law Journal within 20 days of implementing them. The policies and procedures are valid until final regulations are adopted.
At least 10 days before terminating the assistance, the commissioner must provide notice of the intended action. The notice must include (1) the reason for the termination and (2) information concerning the person's eligibility for other state or federal medical assistance program, including instructions on applying for them.
Continued Assistance for Children and Pregnant Women
The bill requires the DSS commissioner, by January 1, 2010, to seek federal funds to provide medical assistance to qualified alien children and pregnant women who were admitted into the U. S. less than five years before the date services are provided. To date, DSS has not yet received federal approval to cover these individuals but it expects to do so.
The recently passed federal Children's Health Insurance Program Reauthorization Act (CHIPRA, PL 111-3) permits states to claim federal Medicaid (HUSKY A in Connecticut) and State Children's Health Insurance Program (SCHIP, HUSKY B) funds to provide health care coverage to pregnant women and children who are recent (within five years) immigrants.
The 1996 federal welfare reform law generally bars legal immigrants who have been in the U. S. for fewer than five years from receiving federally funded assistance. States can provide this assistance with state-only funds, which Connecticut has done since 1997.
SAGA Ban for Immigrants Losing Coverage
The bill apparently also prevents people losing their eligibility for the state-funded program from moving into the State-Administered General Assistance (SAGA) medical assistance program. Currently, people ineligible for Medicaid can qualify for SAGA medical assistance if they meet the program's financial eligibility criteria, regardless of their country of origin. Under the bill, only those individuals who do not qualify for Medicaid because they do not meet the federal program's categorically eligibility requirements (e. g. , aged, blind, child under age 19) can receive SAGA.
A 2004 attorney general opinion stated that the state could not deny a state-funded program to one group of otherwise eligible individuals and not another. To do so would violate the equal protection clause of the U. S. Constitution. He asserted that denying the other programs (e. g. , SMANC) would not be a violation as they serve only legal immigrants. It is not clear whether the bill's provisions would pass constitutional muster.
§§ 21-29 — CHILDREN'S TRUST FUND
The bill moves the Children's Trust Fund and its council from the Department of Children and Families (DCF), where it currently exists for administrative purposes, to the Department of Social Services (DSS). It provides that any Children's Trust Fund order, regulation, or contract in force on September 1, 2009 remains in force as a DSS order, regulation, or contract until it is amended, repealed, or superseded.
The bill makes DSS the lead state agency, in collaboration with the Children's Trust Fund Council, for community-based, prevention-focused programs and activities to strengthen and support families to prevent child abuse and neglect. Its responsibilities include:
1. initiating programs to support families at risk of child abuse or neglect,
2. helping organizations to recognize abuse and neglect,
3. encouraging community safety,
4. increasing broad-based efforts to prevent abuse and neglect,
5. creating a network of agencies to advance abuse and neglect prevention, and
6. increasing public awareness of abuse and neglect issues.
In carrying out these responsibilities, DSS must, with the guidance of the Trust Fund Council, collaborate with state agencies, hospitals, clinics, schools, and community service organizations.
The bill requires DSS to report to Human Services and Appropriations committees within 60 days of the bill's passage on how it is integrating these duties into the department. The commissioner and council must file annual reports with various legislative committees and the governor.
With the advice of the Children's Trust Fund Council, the bill authorizes the DSS commissioner to fund programs aimed at preventing child abuse and neglect and family resource programs. It removes the council's authority to hire an executive director and any necessary staff. It requires DSS to ensure that the Nurturing Families Network (NFN) is implemented statewide. Currently, NFN is composed of several pilot programs operating in different areas of the state.
Under the bill, the DSS commissioner may apply for and accept private and federal funds on behalf of the department and Trust Fund that are used for the prevention of child abuse and neglect and family resource programs. Currently, this can only be done by the Children's Trust Fund.
The bill substitutes the DSS commissioner for the DCF commissioner as the state official who can accept gifts on behalf of the Children's Trust Fund. The bill revises the duties of the Nurturing Families Network Advisory Commission, which monitors the Trust Fund Council's NFN.
Along with the Children's Trust Fund, the bill adds DSS as an administrator of the Kinship Fund and the Grandparents and Relatives Respite Fund. Someone who is appointed guardian of a child or children through Superior Court and who does not receive foster care payments or subsidized guardianship benefits from DCF, can apply for grants from these funds through the probate court.
§§ 30, 31, 33, 47, 89 — MEDICARE PART D—ENROLLMENT IN BENCHMARK PLANS, CO-PAYS, AND ENROLLMENT PERIOD, INCOME LIMIT COLA
Connecticut's Medicare Part D recipients can choose one of 47 prescription drug plans to pay for their drugs. Currently, people who are eligible for both Medicare and Medicaid (dually eligible) can get help paying for their premiums and co-payments from the federal Low-Income Subsidy (LIS) Program. The annual federal premium payment is limited--it only covers premiums for a “benchmark” prescription plan ($ 31. 74 per month in 2009). If the dually eligible person picks a plan with a more expensive premium, DSS pays the difference between the federal benchmark payment and the actual premium cost. The bill requires all full-benefit dually eligible (those for whom DSS provides coverage for services that Medicare does not) individuals to enroll only in one of the benchmark plans (currently 12). A benchmark plan is one that offers basic Part D coverage with premiums equal to or lower than the regional low-income premium subsidy amount calculated annually.
The law makes the DSS commissioner representative to enroll dually eligible individuals in a Part D plan. Under the bill, he can enroll people in a benchmark plan.
Under current law, in addition to paying the premiums for the fully dually eligible, DSS also pays all their Part D prescription co-payments. The bill requires these individuals to pay up to $ 15 per month in co-payments, with DSS paying anything above that. These co-pays range from $ 1. 10 to $ 6 per prescription in 2009 and are subsidized by the LIS program.
The bill also requires ConnPACE applicants and recipients eligible for Medicare Part D to enroll in these benchmark plans. Like it does for the fully dually eligible, the bill authorizes the DSS commissioner to enroll ConnPACE recipients in these plans.
ConnPACE—COLA Freeze, Increased Annual Fee, and Enrollment Period
The bill freezes the income limit in the ConnPACE program (currently $ 25,100 annually for a single person and $ 33,800 for married couples) until January 1, 2012 (these are tied to increases in Social Security benefits, which take effect on January 1). It also increases the ConnPACE annual registration fee from $ 30 to $ 45.
And beginning October 1, 2009, it limits new applications for ConnPACE to the period between November 15 and December 30 of each year. This is the same enrollment period that the Medicare Part D program uses. But people can apply at other times of the year, provided it is within 31 days of either (1) turning age 65 or (2) becoming eligible for federal Social Security Disability Income (SSDI) or Supplemental Security Income (SSI) benefits.
The bill repeals a provision establishing a council to advise on the implementation of Medicare Part D.
§§ 32, 40 — NURSING HOME AND ICF-MR RATE FREEZES
The bill freezes at FY 09 levels, the Medicaid rates the state pays in FY 10 and FY 11 to nursing homes and intermediate care facilities for people with mental retardation (ICF-MR). But facilities that would have received a lower rate on July 1, 2009 because of their interim rate status or agreement with DSS will receive that lower rate.
The bill also eliminates fair rent increases to nursing home rates in FY 10 and FY 11 except for homes that have an approved certificate of need (CON). Current law requires DSS to add a fair rent increase to nursing home rates for homes that have undergone a material change in circumstances related to fair rent.
Nursing homes must apply for a CON to establish new, additional, expanded or replacement facilities, services, or functions; bed expansion, reduction, relocation, or conversion; certain capital expenditures; or to close the facility.
§§ 34, 38 — PRIOR AUTHORIZATION FOR DRUGS DISPENSED IN DSS PHARMACY PROGRAMS; PREFERRED DRUG LIST
By law, the DSS commissioner can require prior authorization (PA) for any prescription for a drug covered by the Medicaid, SAGA, and ConnPACE programs. The bill codifies current practice by (1) specifying that this applies to drugs prescribed under any medical assistance programs DSS administers, which could also include the HUSKY B, Charter Oak Health Plan, and the Connecticut AIDS Drug Assistance Program and (2) applying the PA authority to over-the counter drugs. It makes a parallel change in the law related to maximum oral dosages of drugs dispensed for program clients.
The bill also requires pharmacists to provide a one-time 14-day supply of drugs requiring prior authorization (PA) when a pharmacist is unable to obtain the prescribing physician's authorization at the time the prescription is presented for filling. In current practice, when a DSS drug assistance program client goes to the pharmacy with a prescription requiring PA, the pharmacist can immediately dispense a 30-day supply pending receipt of PA. This provision applies both to nonpreferred drugs in the classes of drugs included in DSS' preferred drug list (PDL) and drugs in classes not in the PDL.
The bill also permits DSS to require PA for (1) high-cost prescription individual drugs or drug classes, at the commissioner's discretion, effective July 1, 2009 and (2) “off –label” drugs prescribed for children under the age of 18, beginning July 1, 2010. The bill defines “off-label” as a drug that is approved for a clinical use other than the one for which it is prescribed.
In general, pharmacists serving DSS pharmacy program clients must obtain PA whenever they dispense a brand-name drug when a chemically equivalent generic is available. If PA is not granted or denied within two hours of PA being requested from DSS, it is deemed approved.
The bill also eliminates mental health-related drugs' blanket exemption from the PDL. Instead, it specifies that PA is not required for these drugs when they have been filled or refilled, in any dosage, at least once in the one-year period before the client presents a prescription for it at the pharmacy.
The bill also removes obsolete language related to pharmacy suppliers.
§ 36 — BENEFIT LEVEL FREEZES IN TFA AND SAGA
The bill freezes at FY 09 levels, the benefit levels in the TFA and SAGA cash assistance programs in FY 10 and FY 11.
§ 37 — STATE SUPPLEMENT PROGRAM BENEFIT LEVEL FREEZE
The bill freezes the need standards in the State Supplement Program (SSP) at FY 09 levels for FY 10 and FY 11. The SSP provides supplemental cash assistance to aged, blind, and disabled people receiving Social Security or Supplemental Security Income benefits.
Current law allows for increases in SSP benefits in two ways. First, it requires DSS to index the unearned income disregard for Social Security cost of living adjustments, if any. This allows any increases in a recipient's SSI benefits, which are considered unearned income, to be passed along and not affect the SSP benefit level. Second, it requires DSS to annually increase, up to 5%, the need standards based on the percentage increase in the Consumer Price Index for Urban Consumers. The need standards have been statutorily frozen since 1993.
§ 39 — DEFERRAL OF JUNE MEDICAID PAYMENTS TO NURSING HOMES
Beginning in FY 11, the bill requires DSS to pay nursing homes half of their June Medicaid payment in July. Current law required this arrangement for fiscal years 1992 through 2007.
§§ 35, 41, 42 — RATE FREEZES FOR RESIDENTIAL CARE HOMES AND FACILITIES AND NEW HORIZONS, INC.
The bill freezes at FY 09 levels, the rate the state pays in FY 10 and FY 11 to residential care homes, private residential facilities, and New Horizons, Inc. (a state-subsidized, independent living facility for people with severe physical disabilities located in Farmington) at FY 09 levels in FY 10 and FY 11. But facilities that would have received a lower rate on July 1, 2009 because of their interim rate status or agreement with DSS will receive that lower rate. The bill allows the commissioner to increase a facility's rate for reasonable costs associated with the facility's compliance with the provisions in Section 44 of the bill regarding medication administration by unlicensed personnel. Current law requires DSS to determine rates for these facilities annually.
§ 43 — SMALL HOUSE NURSING HOMES
The bill prohibits the DSS commissioner from approving more than one project under the Small House Nursing Home pilot program through June 30, 2011 and limits the project to 280 beds. Current law requires the DSS commissioner to establish a pilot program, within existing appropriations, to help develop up to 10 small house nursing homes in the state.
The bill requires the commissioner, before approving proposals, to consult with and receive approval from the OPM secretary. Currently, he must consult only with the Long-Term Care Planning Committee. The bill also allows, rather than requires, him to approve up to 10 proposals. And it removes the requirement that two of the 10 proposals selected must develop a small house nursing home in a distressed municipality with more than 100,000 people. It instead allows the commissioner to give preference to such proposals.
§ 44 — MEDICATION ADMINISTRATION BY UNLICENSED PERSONNEL IN RESIDENTIAL CARE HOMES
The bill requires the DPH commissioner to revise regulations governing medication administration by unlicensed personnel in RCHs that admit residents requiring medication administration assistance to include the following:
1. the requirement that each RCH designate unlicensed personnel to obtain certification and ensure that they do;
2. criteria homes must use to determine the appropriate number of unlicensed personnel who will obtain certification; and
3. required training in identifying the types of medication that unlicensed personnel can administer.
It also requires that by January 1, 2010, each RCH ensure that the number of unlicensed personnel it determined appropriate actually obtain certification to administer medication. Once certified, they can administer medication, except by injection, to RCH residents unless a resident's physician specifies that a medication be administered only by licensed personnel.
The bill permits the DPH commissioner to implement policies and procedures to administer the provisions of this section while in the process of adopting them in regulation, provided notice is published in the Connecticut Law Journal no later than 20 days after they are implemented. The policies and procedures are valid until final regulations are adopted.
Current law requires the commissioner to establish regulations allowing unlicensed personnel in RCHs to obtain certification to administer medication. The regulations must establish on-going training requirements, including initial orientation, residents' rights, behavioral management, personal care, nutrition and food safety, and general health and safety.
§§ 45, 46 — CAPIAS OFFICERS FOR CHILD SUPPORT ENFORCEMENT
The bill increases, from four to six, the number of capias officers the commissioner of public safety may appoint as special policemen in the DSS Bureau of Child Support Enforcement to bring people into court in child support matters.
PA 09-3 requires the DSS commissioner to forward to a state marshal for service any subpoena, summons, warrant, or court order related to proceedings that he initiated, provided none of these documents has had action taken on it within the past 14 days and the underlying proceedings remain unresolved. The bill eliminates this requirement.
To reduce any backlog, PA 09-3 also requires the commissioner, beginning October 1, 2009 and monthly thereafter, to forward to the marshals no more than 150 of these legal documents when no action has been taken within 30 days. The bill (1) increases the time frame to 60 days and (2) requires the marshals to return the documents to DSS within two business days.
The bill also makes a technical change.
§§ 48, 49 — PRIOR AUTHORIZATION FOR NONEMERGENCY DENTAL SERVICES FOR DSS CLIENTS
The bill subjects most nonemergency dental services provided under DSS' dental program to prior authorization. It also requires the DSS commissioner, at least quarterly, to retrospectively review payments for emergency dental services and restoration procedures for appropriateness of payment, and allows him to recoup payments for services determined not to be for an emergency condition or otherwise exceeding what is medically necessary.
The bill defines an “emergency condition” as a dental condition that manifests itself in acute symptoms, including severe pain, that leads a prudent layperson with an average knowledge of health and medicine to reasonably expect that not getting immediate dental attention would result in (1) placing the health of the individual, or the health of a pregnant woman's unborn fetus, in serious jeopardy; (2) cause serious impairment to body functions; or (3) cause serious dysfunction of any body organ or part.
The bill removes a provision requiring the DSS commissioner to review eliminating prior authorization for basic and routine dental services before implementing a statewide dental plan. Instead, it specifies that nonemergency services, including diagnostic, prevention, basic restoration, and nonsurgical extractions that are consistent with standard and reasonable dental practices must be exempt from PA.
The bill allows the DSS commissioner to implement policies and procedures needed to carry out these provisions while in the process of adopting them in regulation. He must print notice of intent to publish the regulations in the Connecticut Law Journal within 20 days of implementing them. The policies and procedures are valid until final regulations are adopted.
Since late 2008, all DSS-funded dental services have been provided through the new Connecticut Dental Health Partnership. Previously, dental services were provided either on a fee-for-service basis or through the HUSKY managed care contracts.
§ 50 — LEGISLATIVE OVERSIGHT OF MEDICAID STATE PLAN AMENDMENTS
The bill requires the DSS commissioner to submit notice of any proposed amendment to the Medicaid state plan to the Human Services and Appropriations committees before submitting it to the federal government.
§ 51 — CARE 4 KIDS PROGRAM REPORTING REQUIREMENTS
The bill requires the DSS commissioner to submit a copy of the Child Care and Development Fund Plan to the Human Services and Appropriations committees. The commissioner is required to submit this plan to the federal Administration for Children and Families (ACF) and must provide a copy to the committees within 30 days after submission to ACF.
§§ 52-54 — DSS FALL PREVENTION PROGRAM ESTABLISHED
The bill requires DSS, within available appropriations, to establish a fall prevention program targeted at older adults. The program must promote and support fall prevention research; oversee research and demonstration projects; and establish, in consultation with the public health commissioner, a professional education program on fall prevention for healthcare providers.
Research Promotion and Support
The fall prevention program must promote and support research to:
1. improve the identification, diagnosis, treatment and rehabilitation of older adults and others with a high risk of falling;
2. improve data collection and analysis to identify fall risk factors and factors that reduce the likelihood of falls;
3. design, implement, and evaluate the most effective fall prevention interventions;
4. improve intervention strategies proven effective in reducing falls by tailoring them to specific older adult populations;
5. maximize the dissemination of proven, effective fall prevention interventions;
6. assess the fall risk in various settings;
7. identify barriers to adopting proven fall prevention interventions;
8. develop, implement, and evaluate the most effective approaches to reducing falls among higher-risk older adults living in communities and long-term care and assisted living facilities;
9. evaluate the effectiveness of community fall prevention programs.
Research and Demonstration Projects
Under the fall prevention program, DSS must oversee and support research and demonstration projects carried out by qualified organizations, institutions, or consortia of such entities in the following areas:
1. targeted fall risk screening and referral programs;
2. programs designed for older adults living in the community that use fall intervention approaches including physical activity, medication assessment, medication reduction when possible, vision enhancement, and home-modification strategies;
3. programs targeting new fall victims at risk for second falls and designed to maximize independence and quality of life for older adults, especially those with functional limitations; and
4. private sector and public-private partnerships to develop technology to prevent falls among older adults and prevent or reduce injuries after falls.
Grants, Contracts, and Cooperative Agreements
Under the bill, DSS must award grants, contracts, or cooperative agreements to qualified organizations, institutions, or consortia of qualified entities to design, implement, and evaluate fall prevention programs using proven intervention strategies in residential and institutional settings.
Professional Education Program
The bill requires DSS, in consultation with the DPH commissioner, to establish an education program in fall prevention, evaluation, and management for physicians, allied health professionals, and other healthcare providers serving the elderly. The DSS commissioner may contract to establish the program through (1) a request for proposal process, (2) a competitive grant program, or (3) cooperative agreements with qualified entities.
Connecticut insurance companies and hospital and medical service corporations annually pay the insurance commissioner the actual expenditures, including fringe benefits and capital equipment purchases, of the Insurance Department and the Office of Health Care Advocate. The commissioner deposits payments received in the Insurance Fund.
The bill requires the Insurance Fund to pay for the DSS fall prevention program and adds the program's appropriation to the annual operating assessment these insurers pay. It requires the insurance commissioner and the Office of Health Care Advocate to include the program's appropriation in the annual written statement of the fund's assessments and expenditures they provide to insurers.
If the fall prevention program's expenditures are less than the amount allocated, the DSS commissioner must notify the insurance commissioner and the healthcare advocate. By law, these officials must annually recalculate their assessment after the close of the fiscal year and send each insurer a written statement by July 31st showing the difference between the recalculated amount and what the insurer already paid. By August 31st the commissioner and healthcare advocate must make any necessary adjustments and render an adjusted assessment to the affected insurers.
§ 55 — MEDICAID COVERAGE FOR STATE-ADMINISTERED GENERAL ASSISTANCE (SAGA) AND CHARTER OAK HEALTH PLAN; FEDERALLY QUALIFIED HEALTH CENTERS (FQHC) SERVICE DELIVERY
By law, DSS was supposed to apply for a federal waiver, by January 1, 2008, to get Medicaid to pay for the state-funded SAGA medical assistance program. It never did.
Under the bill, if the commissioner fails to submit the waiver application to the Human Services and Appropriations Committees by February 1, 2010, he must submit a written report to the committees by February 2, 2010 that includes (1) an explanation why the waiver has not been sought and (2) an estimate of the fiscal impact in one calendar year that would result from getting the waiver approved.
In the SAGA medical assistance program, health care is generally provided by the state's network of federally qualified health centers (FQHC) with which DSS contacts. The bill specifies that once the waiver is approved, the DSS commissioner may provide, or may require a contractor, FQHC, or other provider to provide, home care services, school-based services, or other outpatient community-based services when the commissioner has determined that such services are cost effective.
The commissioner must contract with FQHCs or other primary care providers as needed to provide these services to SAGA recipients. The bill further provides that DSS, within available appropriations, must pay FQHCs for these services when the FQHC provides them.
The bill also eliminates a provision that would have extended SAGA medical assistance eligibility to anyone with income up to 100% of the federal poverty level (FPL) if the waiver was granted. Currently, income eligibility is just under 60% of the FPL but when a disregard of income is included, that number rises to a little over 70% of the FPL.
§ 56 — INTERPRETER SERVICES UNDER MEDICAID
The bill establishes a February 1, 2011 deadline for the DSS commissioner to amend the
Medicaid state plan to include foreign language interpreter services provided to any beneficiary with limited English proficiency as a “covered service” under the Medicaid program (See BACKGROUND). PA 07-185 directed the commissioner to amend the state plan. PA 08-1 required him to expedite amending the plan by June 30, 2009. The commissioner has not amended the state plan.
The bill also requires the commissioner, by February 1, 2011, to develop and implement the use of medical billing codes for foreign language interpreter services for the HUSKY Part A and B and fee-for-service Medicaid programs. It requires each managed care organization that contracts with DSS to provide interpreter services under HUSKY Part A to submit semiannual reports to DSS (by June 1st and December 31st) on the interpreter services provided to these beneficiaries. Within 30 days of receiving the report, DSS must submit a copy to the Medicaid Managed Care Council.
§§ 57, 58 — HUSKY PERFORMANCE; MEDICAID MANAGED CARE COUNCIL
The bill requires the DSS commissioner, within available appropriations and in collaboration with the Medicaid Managed Care Council, to annually prepare a report about “health care choices” under the HUSKY A program. The report, at a minimum, must compare performance of each managed care organization (presumably those serving HUSKY A clients), the primary care case management pilot program and other service delivery choices. The commissioner must provide a copy of each to part to all HUSKY A recipients.
The bill also requires the Council to make recommendations regarding the HUSKY A primary care case management pilot program, in addition to its existing charge.
It allows the commissioner or the council, in consultation with an educational institution, to apply for available funding, including federal funds, to support Medicaid managed care programs.
And it changes the council's composition. Currently, two community providers of health care appointed by the Senate President Pro Tempore appoints sit on the council. Under the bill, a representative of each HUSKY managed care organization (MCO) must be on the council. Currently, three MCOs serve HUSKY recipients. And it adds a representative of a primary care case management provider to the council.
§ 59 — SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM (SNAP) EMPLOYMENT AND TRAINING PROGRAM
The bill allows any regional community-technical college participating in the SNAP (formerly known as Food Stamps) Employment and Training program through a memorandum of understanding (MOU) with DSS prior to October 1, 2008 to retain all federal matching funds provided for in the MOU until it expires.
By law, DSS may use part of the optional federal matching funds it receives through the program to pay for its operational and administrative costs. The remaining funds must be used for poverty reduction strategies and distributed as follows:
1. 75%, on a pro rata basis, to SNAP Employment and Training providers whose expenditures generated the funds; and
2. 25% to SNAP Employment and Training community collaboratives (local consortiums of public and private providers to implement poverty reduction strategies).
The federal SNAP Employment and Training program provides employment and training activities, support services, and other programs and services to food stamp participants. It has two components: (1) 100% federal administrative grants and (2) optional 50% federal matching funds.
§ 60 — ADMINISTRATIVE SERVICES FOR MEDICAID RECIPIENTS WHO HAVE DISABILITIES OR ARE ELDERLY
The bill requires the DSS commissioner to contract with one or more entities, either on a at-risk or non-risk basis, to provide administrative services to elderly Medicaid recipients and those who have disabilities, including those (1) dually-eligible for Medicare and (2) enrolled in dually eligible special needs plans. The services the entities may provide include care coordination, utilization management, disease management, provider network management, quality management, and customer service.
The bill allows the DSS commissioner to implement policies and procedures needed to carry out these provisions while in the process of adopting them in regulation. He must print notice of intent to publish the regulations in the Connecticut Law Journal within 20 days of implementing them. The policies and procedures are valid until final regulations are adopted.
The bill requires the commissioner to submit a report to the Medicaid Managed Care Council within 30 days of making any policy change with respect to this section.
§ 61 — SCHOOL-BASED CHILD HEALTH PROGRAM
Federal law requires local education agencies (LEA) to identify all children with disabilities who are in need of special education and “related” services. Although the LEAs must provide the services, federal Medicaid law provides federal reimbursement (DSS, through the School-Based Child Health Program, bills Medicaid for 100% of what the LEA spends, keeps one half of the reimbursement, and passes the other half to the participating LEAs) for related services.
The bill requires the DSS commissioner, beginning with FY 09, to exclude any enhanced federal medical assistance percentages (FMAP) in calculating the federal portion of the Medicaid claims for this program. Before the federal stimulus legislation passed, the federal match or FMAP was 50%, which meant for every $ 1 the state spent on the Medicaid program the federal government would reimburse it $ . 50. The stimulus temporarily increased the FMAP by 12%, which raised Connecticut's match from 50% to 62%.
§ 62 — FAMILY PLANNING MEDICAID WAIVER
PA 05-120 directed the DSS commissioner to apply for a family planning waiver for adults in households with income up to 185% of the FPL who are not otherwise eligible for Medicaid. The bill requires the commissioner, if he does not apply by February 1, 2010 to submit a written report to the Human Services and Appropriations committees by February 2, 2010 (1) explaining why he did not seek the waiver and (2) estimating the fiscal impact that would result from the waiver approval in one calendar year.
§ 63 — HIV AND AIDS MEDICAID WAIVER
The bill requires the DSS commissioner, by February 1, 2010, to apply for a 1915(c) home and community-based services Medicaid waiver to develop and implement a program providing home and community-based services to up to 100 Medicaid beneficiaries who (1) have tested positive for human immunodeficiency virus (HIV) or have immune deficiency syndrome (AIDS) and (2) would remain Medicaid-eligible if admitted to a hospital, nursing home, or ICF-MR or would require Medicaid-covered care in these facilities without the waiver services. The bill provides that an individual who meets these requirements is eligible to receive services deemed necessary by the commissioner to meet his or her needs in order to avoid institutionalization.
If the commissioner does not apply by the deadline, he must submit a written report to the Human Services and Appropriations committees by February 2, 2010 (1) explaining why he did not seek the waiver and (2) estimating the fiscal impact resulting from the waiver approval in one calendar year.
§ 65 — DEFERRAL OF JUNE PAYMENTS HUSKY MCOS
The bill allows the DSS commissioner to pay certain managed care plan Medicaid bills due in June 2011 no later than July 31, 2011.
§ 66 — COST SHARING UNDER CHCPE
Current law requires a participant in the state-funded portion of the Connecticut Homecare Program for Elders (CHCPE) to contribute to the cost of care if his or her income exceeds 200% FPL. Cost-sharing amounts are determined individually based on a DSS methodology established in its Uniform Policy Manual. Generally, DSS considers a participant's income, medical insurance premiums paid, and other allowable deductions; any remaining income must be paid toward the cost of care.
The bill requires any participant in the state-funded portion of the program with income up to 200% of the FPL to contribute 15% of the cost of his or her care. A participant whose income exceeds 200% FPL must contribute 15% of the cost of care in addition to the applied income contributed under DSS's existing methodology.
The bill exempts from these cost-sharing requirements certain people living in affordable housing under the state's assisted living demonstration program. For these people, cost-sharing is required only if the participant's income exceeds 200% FPL. Cost-sharing amounts are determined by DSS's existing cost-sharing methodology for medical assistance recipients.
Under the bill, any participant in the state-funded portion of the program who is required to contribute to the cost of care and does not do so is ineligible to receive services. For participants living in affordable housing, this provision applies only to those whose income exceeds 200% FPL. It further provides that, notwithstanding any other state law, DSS is not required to provide an administrative hearing to a person determined ineligible for services because of failure to contribute to the cost of care.
CHCPE is a Medicaid waiver and state-funded program that provides home and community-based services for qualifying individuals age 65 and older who are institutionalized or at risk of institutionalization.
§ 67 — BACKGROUND CHECKS FOR DISABILITY DETERMINATION SERVICES NEW HIRES
The bill requires the DSS commissioner to inquire into the criminal history of any applicant (except someone currently employed by DSS) for a position with its Disability Determination Services unit. The inquiry process must adhere to the state law restricting an employer's right to ask an applicant to disclose information about erased criminal records.
Under the bill, the commissioner must require each applicant to state (1) whether he or she has ever been convicted of a crime, (2) if there are any pending criminal charges against the applicant at the time of application, and (3) if applicable, to identify any such charges and the court in which they are pending. If the applicant is offered a position in the unit, he or she must submit to fingerprinting and a state and national criminal history records check through the State Police Bureau of Identification.
In October 2008, the federal Social Security Administration amended its Program Operations Manual System (POMS) to include the minimum requirement that states conduct a statewide criminal background check for new hires in Disability Determination Services units.
§ 68 — EMERGENCY PLACEMENT BACKGROUND CHECKS
The bill conforms law to current practice by giving DCF the authority to request an instant federal name-based criminal history search from a criminal justice agency for any person living in the home where a child has been placed as a result of the sudden unavailability of his or her primary caretaker. These emergency placements include private homes of the child's neighbors, friends, or relatives.
Within 15 calendar days after the name-based search is performed, DCF must request that the State Police Bureau of Identification perform a state and national criminal history records check of anyone living in the home. If a person refuses to provide fingerprints or other identifying information, DCF must immediately remove the child from the home.
If DCF denies emergency placement or removes a child from a home based on the results of the federal name-based criminal history search, the subject has the right to contest the denial or removal by requesting a full criminal history records check. It is unclear if there is a deadline for the subject to contest the department's action.
§ 69 — SUBSIDIZED GUARDIANSHIP PROGRAM
The bill gives DCF greater flexibility to alter its subsidized relative guardianship program by eliminating most statutory requirements and generalizing the department's authority to issue and modify regulations. This change streamlines the process for changing program requirements by regulation rather than by statutory amendment when federal reimbursement requirements change. Under the bill, the department's regulations must include all federal requirements necessary to maximize federal reimbursement available to the state.
1. in determining whether taking care of a related child qualifies the caretaker for subsidies, requires the DCF commissioner to consider the child's suitability for adoption, rather than only that reunification with his or her parent is not a viable option; alters how long a relative must care for a child before becoming eligible for subsidies, changes how subsidy amounts and benefit levels are set; and
2. establishes a method for transferring subsidies to another relative when the original caretaker dies or becomes too infirm to continue taking care of the child.
The bill also makes conforming and technical changes.
Currently, DCF regulations must set criteria for (1) qualifying relative caregivers for subsidies on behalf of children who are not related to them but are siblings, half-siblings, or stepbrothers and –sisters of a child on behalf of whom they are receiving subsidies; (2) home studies and subsidy amounts and types, and (3) appeal procedures. Under the bill, they must, instead, cover (1) program eligibility criteria, (2) the maximum age at which a child is no longer eligible for subsidies and for claiming federal reimbursement, and (3) a procedure for determining subsidy types and amounts.
Currently, DCF has two different guardianship programs – one for those who have taken care of a related child for at least 18 months, and one that, within appropriations, is for those who have taken care of a related child for between six and 18 months. The bill eliminates the second program and modifies the first by requiring that care be given for at least six consecutive months and that the guardian be a licensed foster parent.
By law, DCF provides three types of subsidies for relatives taking care of children who otherwise would be in non-relative foster homes: (1) lump sum payments for one-time expenses resulting from the assumption of care for children whose medical conditions, ages, or other characteristics make them unlikely to be adopted; (2) medical subsidies comparable to the subsidy provided to adoptive parents of uninsured children who had been in DCF's care, and (3) monthly subsidies equivalent to the prevailing foster care rate.
The bill (1) caps lump sum payments at $ 2,000 and (2) requires that the amount of the monthly subsidy be based on the caregiver's circumstances and the child's needs. Nothing in the bill prohibits the commission from continuing to pay guardianship subsidies to caregivers according to the terms of existing written subsidy agreements.
The bill also eliminates the department's authority to offset the child's assets (such as Social Security Disability benefits) to reduce subsidy payments. It requires that, at a minimum, those qualified for subsidies remain eligible until they turn age 18 (or age 21 if they are full-time students). The latter change allows DCF to continue subsidy payments beyond those ages.
When a relative caregiver who is receiving a guardianship subsidy dies or becomes too infirm to continue taking care of a child, the bill permits the DCF commissioner to transfer the subsidy to a new relative caregiver. The new caregiver must meet the department's foster care safety requirements and be the child's court-appointed legal guardian. It is unclear whether the new caregiver must obtain a foster care license or meet other program requirements.
§ 70 — MEDICARE SAVINGS PROGRAM, CONNPACE, AND MEDICARE PART D LOW-INCOME SUBSIDY
PA 09-2 enables more individuals to qualify for the Medicare Part D low-income subsidy (LIS) by loosening the financial eligibility criteria for the Medicare Savings Program MSP. MSP eligibility automatically makes someone eligible for the LIS. It essentially makes the eligibility criteria the same as for the ConnPACE program.
The bill explicitly provides that there is no asset test for the MSP (ConnPACE has none). And it delays the start of the change from July 1, 2008 to the fiscal year ending October 1, 2009. (The state fiscal year ends on June 30. )
§§ 71, 72 — PHARMACY REIMBURSEMENTS AND DISPENSING FEES
The bill reduces, from $ 3. 15 to $ 2. 65, the dispensing fee DSS pays pharmacies for filling prescriptions for Medicaid, ConnPACE, and Connecticut AIDS Drug Assistance Program clients. It adds SAGA to the list of state medical assistance programs this dispensing fee covers. (Starting February 1, 2008, DSS “carved out” pharmacy benefits from the SAGA medical assistance program. The federally qualified health centers and other providers with which DSS contracted to run these programs had previously negotiated the pharmacy dispensing fee in a separate contract. )
The bill also requires DSS, in consultation with the Connecticut Pharmacists Association, to review the impact of potential or actual changes in the methodologies used in calculating the AWP for brand name and generic drugs. This review must include the financial impact of any required changes in DSS pharmacy reimbursement payments. DSS must report on the results of this review no later than January 1, 2010 (the bill does not direct the report to a specific body).
Based on the outcome of the review, starting January 1, 2010 DSS may, in FY 10, with approval from OPM, (1) adjust pharmacy dispensing fees for generic and brand named drugs and (2) within available appropriations, increase pharmacy dispensing fees or reimbursements in order to help participating pharmacies experiencing financial hardship due to the changes in the methodologies used to calculate AWP.
§ 73 — PENDING MEDICAID ELIGIBILITY FOR NURSING HOME CARE
The bill requires DSS to allocate $ 300,000 to process pending eligibility applications for Medicaid recipients residing in nursing homes and requires the department to submit a report on these applications to the public health and human services committees by January 1, 2011.
§ 74 — PER DIEM RATES FOR ICF-MRS IN GENERAL HOSPITALS
The bill allows DSS to amend the Medicaid state plan to create a per diem rate for intermediate care beds for mentally ill patients in general hospitals.
§ 75 — EASY BREATHING MODEL IN HUSKY
The bill allows the Department of Social Services (DSS) commissioner to require use of the Easy Breathing model in the HUSKY program. It appears that this model is one that helps primary care physicians diagnose asthma and prescribe treatment based on the severity of the patient's condition. The model is believed to reduce hospitalizations and urgent care visits.
§ 76 — PILOT PROGRAM OF MANAGED CARE FOR OAK HILL CLIENTS
The bill permits DSS, to the extent federal law allows, to amend the state Medicaid plan to establish a voluntary pilot program to serve up to 500 people served by Oak Hill-The Connecticut Institute for the Blind, Inc. who are also eligible for Medicare (dually eligible). The pilot must be designed to demonstrate the feasibility and cost effectiveness of delivering comprehensive health care coverage in a managed care setting. (Currently, these individuals receive their Medicaid services on a fee-for-service basis. ) The bill allows the commissioner to (1) include optional Medicaid services that the state is not covering on the date the bill passes and (2) make other modifications to the Medicaid program to encourage participation in the pilot.
§ 77 — ADULT DAY CENTERS
Effective July 1, 2009, the bill requires DSS, subject to available appropriations, to increase the reimbursement rate paid to providers of adult date care services under the CHCPE by an annualized rate equal to $ 700,000.
§ 79 — TECHNICAL CHANGES
The bill revises the budget adopted in PA 09-3, JSS by appropriating the following amounts to DSS:
§§ 80-81 — LOW-INCOME ENERGY ADVISORY BOARD
By law, DSS must submit an annual plan and two annual reports regarding the federal Low-Income Home Energy Assistance Program block grant to the Appropriations, Energy and Technology, and Human Services committees by specified deadlines. The bill requires DSS to submit these documents to the Low-Income Energy Advisory Board at least 7 days before submitting them to the committees. The plan sets eligibility criteria for energy and weatherization assistance and describes program outreach efforts, among other things. The reports describe such things as (1) the number of households who apply for and receive assistance, (2) expenditures by type of assistance, and (3) the types of weatherization provided.
The bill expands the board's responsibilities to include making recommendations to the legislature on the administration of the block grant program.
§ 82 — ENERGY ASSISTANCE
PA 09-3 carries forward funds appropriated to OPM in 2008 to provide money to Operation Fuel, Incorporated to expand its emergency energy assistance program. Under that act, Operation Fuel must use the money during FY 10 to help households with incomes between 150% and 200% of the federal poverty level that cannot pay their electric, gas, or deliverable fuels (e. g. , heating oil) bills on time. This bill specifies that this assistance can be provided regardless of whether these are the household's primary or secondary energy sources, e. g. , the assistance can be used to help pay electric bills for a household that uses electric space heaters to supplement its oil or gas furnace.
§ 83 — MEDICARE PART D REFERRAL PROCESS FOR DUALLY ELIGIBLES
The bill requires DSS, within available appropriations, to contract with (1) the Center for Medicare Advocacy (CMA) to provide assistance with Medicare Part D Plan appeals relating to medically necessary prescription denials, and (2) a pharmacy association or pharmacist to help clients choose a Medicare Part D Plan that best meets their needs.
Current law requires the DSS commissioner to report, by December 1, 2009, to the Appropriations and Human Services committees on its nonformulary exception review and appeal process for dually eligible clients (Medicaid and Medicare Part D). The report must include an explanation of (1) the department's revised process for determining the medical necessity of a nonformulary drug before it pays for it, (2) the conditions under which DSS pursues an appeal with private plans and (3) the criteria for making a referral to CMA for further appeals.
Instead of submitting this report, the bill requires the commissioner, to provide these committees with a plan concerning its referral process for dually eligible clients. The plan, which must also be submitted by December 1, 2009, must include providing information to clients about appeal rights and available assistance from CMA.
§ 84, 85 — LONG-TERM CARE REINVESTMENT ACCOUNT
To the extent permitted by federal law, the bill postpones, from July 1, 2009 until July 1, 2011, the establishment of a nonlapsing long-term care reinvestment General Fund account to hold the enhanced federal matching funds the state receives for the federal Money Follows the Person (MFP) demonstration program. Consequently, MFP funds will go into the General Fund for use without restriction.
The bill also postpones, from January 1, 2010 to January 1, 2012, the date by which the DSS commissioner must begin reporting annually on expenditures from the MFP account to the Human Services and Appropriations committees.
§ 86 — NURSING HOME FINANCIAL ADVISORY COMMITTEE
The bill removes the director of the Office of Fiscal Analysis from the Nursing Home Financial Advisory Committee's membership. It also designates as the representative of the nonprofit and for profit nursing home industries: the executive director of the Connecticut Association of Not-for-Profit Providers for the Aging and the executive director of the Connecticut Association of Health Care Facilities or their designees. The DSS and DPH commissioners, the secretary of OPM, and the executive director of the Connecticut Health and Educational Facilities Authority (CHEFA) or their designees remain committee members. The bill also removes the current requirement that vacancies be filled by the appointing authority.
The bill requires the committee to recommend appropriate action to the DPH commissioner, as it must currently do for the DSS commissioner, when it receives a report relating to nursing homes' financial solvency and quality of care. It requires the DSS commissioner to submit quarterly reports to the committee concerning any nursing home's pending interim rate request. These reports must (without identifying a facility by name) list (1) the amount of each requested increase, the reason for the request, and the resulting rate if the request is granted.
Starting January 1, 2010, the bill requires the committee to report annually on its activities to the Appropriations Committee, as well as the Human Services, Public Health, and Aging committees. And starting January 1, 2010, the committee must also meet quarterly with the chairpersons and ranking members of the Appropriations, Human Services, and Public Health Committees and the long-term care ombudsman to discuss its activities.
§ 87 — MONEY FOLLOWS THE PERSON
The bill postpones, from January 1, 2009 to January 1, 2012 the date by which the DSS commissioner must submit a plan to implement the Money Follows the Person (MFP) II demonstration program to the Human Services and Appropriations committees. The bill also delays the implementation date of the program from July 1, 2009 to July 1, 2012.
The federal MFP demonstration program is a five-year program that permits states to move individuals out of nursing homes and other institutional settings and into less-restrictive, community-based settings. PA 08-180 required DSS to develop and implement a demonstration program similar to MFP. This program, referred to as “MFP II,” must provide home- and community-based long-term care services to adults (age 18 and older) who (1) are institutionalized or at risk of institutionalization and (2) meet CHCPE's financial and level of care eligibility criteria established in regulations. MFP II was created to allow adults who do not meet MFP's federally mandated six-month institutionalization requirement to receive similar services.
§ 88 — ASSISTED LIVING SERVICES
By law, the commissioner of the Department of Economic and Community Development (DECD) established an assisted living demonstration program for low- and moderate-income seniors living in government subsidized elderly housing in four locations.
Notwithstanding this program, the bill allows the DECD commissioner, in consultation with the DSS commissioner and the OPM secretary, to designate a Federal Department of Housing and Urban Development Section 202 or Section 236 elderly housing development to provide assisted living services to individuals otherwise eligible to receive these services under the CHCPE.
Children's Trust Fund
The Children's Trust Fund is an independent agency established to prevent child abuse by identifying at-risk parents and providing them with prevention services. The Children's Trust Fund Council is made up of 16 members, including the commissioners of DSS, DCF, and the departments of Education and Public Health and 12 members appointed by various legislators, including parents, child-abuse prevention experts and a pediatrician. It makes recommendations to the DCF commissioner concerning grants to programs.
State Advisory Council
The primary duties of the Council are to: review policies; recommend programs, legislation or other matters that will improve services for children, youth and families; review and advise the DCF commissioner on the proposed agency budget; perform public outreach to educate the community regarding policies, duties and programs of DCF and issue any reports it deems necessary to the governor and the commissioner.
Nurturing Families Network
NFN is a no-cost, voluntary program that provides information, guidance and assistance to first-time parents through home visits; parenting groups; and connections between parents, volunteers, and others in the community.
Medicaid Coverage of Interpreter Services
Federal Medicaid law allows states to get federal matching funds for limited English proficiency (LEP) interpreters either by designating them as (1) a covered state plan service or (2) an administrative cost. In Connecticut, the matching rate would be 50% of the state's cost for providing the interpreters.
As a covered service, it would be reimbursed as part of another service provided. For example, if a physician bills for a service and also provides interpreter services, the state would reimburse him or her more than if just the medical service had been provided.
And the federal government would reimburse the state for half of these costs. As an administrative expense, the state could either pay translators directly or contract with medical providers and bill the federal government for the match along with any other administrative costs for which it would normally bill.
Currently, DSS does not pay for medical interpreter services for Medicaid fee-for-service clients. Managed care plans serving HUSKY clients have a contractual obligation (based on federal requirements) to provide interpreters and their capitation payments include the costs of doing so. DSS receives a 50% federal match for the capitation payments but the interpreter services are not separated.
Making interpreters a state plan service would entitle any Medicaid recipient to it if it were deemed necessary, as with any other service DSS includes in its Medicaid state plan.