PA 09-3, September 2009 Special Session—SB 2051

Emergency Certification

AN ACT IMPLEMENTING THE PROVISIONS OF THE BUDGET CONCERNING PUBLIC HEALTH AND MAKING CHANGES TO VARIOUS HEALTH STATUTES

SUMMARY: This act merges Office of Health Care Access into the Department of Public Health and makes numerous changes to public health, developmental disabilities, and mental health and addiction services programs. The changes are described section-by-section below.

EFFECTIVE DATE: Upon passage, except as noted below.

1-38 — MERGER OF OHCA WITH DPH

The act makes a number of changes, primarily technical, to merge the existing Office of Health Care Access (OHCA) with the Department of Public Health (DPH). It establishes an OHCA division, in DPH and under the direction of the DPH commissioner, as a successor to the former, independent OHCA. OHCA will no longer have its own commissioner.

The act establishes a deputy commissioner position to oversee the new OHCA division. The act specifies that the commissioner of the former OHCA serves as this new deputy commissioner and exercises independent decision-making authority over all certificate of need (CON)–related matters, including CON determinations, orders, decisions, and agreed settlements. She can designate an executive assistant. By January 1, 2010, this deputy commissioner, in consultation with the DPH commissioner, must report to the governor and the Public Health Committee on recommendations for CON reform.

The act specifies that any order, decision, agreed settlement, or regulation of OHCA in force as of the act's passage, continues in force and effect as a DPH order or regulation until amended, repealed, or superseded by law.

Hospitals are currently assessed to fund OHCA. Under the act, hospitals must make these payments to DPH instead of OHCA. By law, they are deposited in the General Fund.

OHCA's current responsibilities, including health care facility utilization and planning, CON review, hospital charges and payments, data filings, and adoption of regulations, continue under the act.

39-41 — LOCAL HEALTH DEPARTMENT FUNDING

The act changes the requirements that municipal and district departments of health must meet in order to receive state funding. It eliminates funding for part-time health departments, reduces funding for district health departments, and maintains funding ($1. 18 per capita) for full-time municipal health departments.

The act adds a requirement that a municipality with a full-time health department have a population of at least 50,000 in order to receive annual funding from the state. Existing requirements for municipal health departments, unchanged by the act, require the municipality to (1) employ a full-time health director, (2) have a public health program and budget approved by DPH, and (3) appropriate at least $1 per capita from annual tax receipts for health department services.

Under prior law, district health departments received annual state funding of (1) $2. 43 per capita for each city, town, and borough in the district with a population of 5,000 or less and (2) $2. 08 per capita for each such jurisdiction with a population over 5,000. The act requires a health district to have a total population of at least 50,000 or serve three or more municipalities regardless of their combined total population in order to receive state funding. It reduces district funding to $1. 85 per capita. As with municipal departments, districts must have DPH-approved programs and budgets and receive at least $1 per capita in members' tax revenue.

EFFECTIVE DATE: July 1, 2009

42, 61 — MANAGED RESIDENTIAL COMMUNITIES

The act eliminates (1) the requirement that managed residential communities (MRCs) be subject to DPH oversight and regulation and (2) DPH's responsibility to investigate complaints about MRC violations of the law and review every MRC's operations every two years. But it retains DPH's authority to adopt regulations governing MRCs and the requirement that MRCs comply with them. MRCs are facilities that provide housing and services for people over age 55, including access to assisted living services.

43, 59 — SUSTINET

Board Membership

The act increases membership on the SustiNet Health Partnership board of directors from nine to 11 by adding (1) an individual with expertise in either the reduction of racial, ethnic, cultural, and linguistic inequities in health care or multi-cultural competency in the health care workforce, appointed by the healthcare advocate, and (2) an individual appointed by the comptroller. These appointments must be made within 30 days of the act's passage. The initial term for these new board members is five years. The act also increases the number of board members necessary for a quorum from five to six.

Funding Sources

Under existing law, the board must offer recommendations to the General Assembly on the structure of the entity best suited to oversee and implement the SustiNet Plan. These recommendations can include the creation of a public authority authorized, among other things, to raise funds from private and public sources outside of the state budget to contribute toward support of its mission and operations. The act specifies that this includes applying for and receiving federal funds.

44-46 — BIRTH-TO-THREE FEE AND INSURANCE INCREASES

The act increases the fee certain families must pay to participate in the Birth-to-Three Program and eliminates the two months of free service that, by regulation, are provided following enrollment It requires the Department of Developmental Services (DDS) to increase the fees by 60%. It also requires DDS to base the fees on the state's, as well as parents', financial resources and periodically to revise its fee schedule.

The law requires DDS to charge a fee for families with gross incomes over $45,000 and permits it to charge parents with lower incomes. But DDS may not charge any family whose child is eligible for Medicaid. DDS maintains two sliding scale fee schedules, one for families with health insurance and one for uninsured families, based on income and family size. Fees currently range from $15 a month for a family with three or fewer children and no insurance to $310 a month for a family with six or more children and insurance whose income is over $175,000. DDS regulations require the State Interagency Birth to Three Coordinating Council to review and make recommendations to DDS about the fee schedule at least every three years.

The law requires group and individual health insurance policies to cover birth-to-three services. The act doubles the maximum annual coverage to $6,400 per child and the aggregate, three-year benefit to $19,200. It applies to individual and group health insurance policies delivered, issued, renewed, amended, or continued in Connecticut that cover (1) basic hospital expenses; (2) basic medical-surgical expenses; (3) major medical expenses; and (4) hospital or medical services, including coverage under an HMO plan. Due to federal law (ERISA), state insurance benefit mandates do not apply to self-insured benefit plans.

47-49 — SEXUAL ASSAULT FORENSIC EXAMINERS

Sexual Assault Forensic Examiners Program

The act authorizes the Office of Victim Services (OVS) to establish a program to train sexual assault forensic examiners (SAFE) and make them available to adult and adolescent sexual assault victims at participating hospitals. It allows OVS to apply for and use funds from federal, state, and private sources for the program.

The act requires a SAFE to be a physician or a registered or advanced practice registered nurse. Under the act, a SAFE may provide immediate care and treatment to a sexual assault victim in a hospital and collect evidence. In doing so, the SAFE must follow (1) existing state sexual assault evidence collection protocols and (2) the hospital's policies, accreditation standards, and written participation agreement with OVS and DPH.

The act specifies that it is not to be construed to alter the scope of nursing practice established in statute.

Sexual Assault Forensic Examiners Advisory Committee

The act creates a 12-member committee to advise OVS on establishing and implementing the program.

Responsibilities. The committee must make recommendations to OVS on:

1. recruiting nurses and physicians and developing a specialized training course for them;

2. developing agreements between Judicial Branch, DPH, and participating hospitals on the program's scope of services and hospital standards for providing the services;

3. mechanisms for tracking individual cases;

4. using medically accepted best practices; and

5. developing quality assurance mechanisms.

Membership. The committee consists of:

1. the chief court administrator, chief state's attorney, victim advocate, and DPH commissioner, or their designees;

2. one representative each of the Public Safety Department's Scientific Services and State Police divisions, appointed by the public safety commissioner;

3. the presidents of the Connecticut Hospital Association and Connecticut College of Emergency Physicians, or their designees;

4. a person appointed by the directors of Connecticut Sexual Assault Crisis Services, Inc. ; and

5. one appointee each from the Connecticut Chapter of the International Association of Forensic Nurses, the Connecticut Police Chiefs Association, and the Connecticut Emergency Nurses Association.

The committee terminates on June 30, 2012.

50 — BUDGET TRANSFERS

The act revises three DDS appropriations for FYs 10 and 11 adopted in PA 09-3, JSS, as shown in the following table.

 

FY 10

FY 11

Purpose

PA 09-3, JSS

Act

PA 09-3, JSS

Act

Personal Services

$305,242,900

$304,742,900

$305,072,458

$304,572,458

Voluntary Services

33,692,416

32,692,416

33,692,416

32,692,416

Community Residential Services

377,947,857

379,447,857

388,998,055

390,498,055

51-52 — PAYMENT FOR TUBERCULOSIS TREATMENT

By law, individuals with tuberculosis (TB) who require medical care provided by a (1) state chronic disease hospital, (2) private hospital or clinic, or (3) physician or other provider, must be seen without regard to the patient's financial condition. The cost of the care and treatment of such patients is computed based on a number of statutory provisions. The state pays these costs if DPH deems them appropriate for TB treatment.

The act specifically authorizes the DPH commissioner to consider available third-party sources for payment of TB treatment when determining whether to pay for it. By law, if the patient is (1) a veteran and the TB or suspected TB for which the veteran has been hospitalized or treated is a service-connected disability entitling him to medical benefits or (2) eligible for medical benefits under workers' compensation or under any private or public medical insurance or payment plan, then the patient or the patient's obligor is liable for the costs of the care to the extent of such available benefits. The costs of such care must be determined according to the existing statutory process by which the comptroller annually determines the per capita per diem cost for the support of people in humane institutions.

The act authorizes DPH and the Department of Social Services (DSS) to exchange patient information they hold to determine if any patient needing or receiving TB treatment is eligible for Medicaid benefits.

53 — DMHAS ACTING FOR MEDICARE PART D

The act permits the DMHAS commissioner, after consulting with the administrative services commissioner, to (1) bill directly for prescriptions under Medicare Part D or contract with a private entity to do so and (2) enter into agreements and contracts, including negotiated reimbursement rates, for Medicare Part D plans for DMHAS clients. It supersedes existing law that makes the administrative services commissioner responsible for acting and collecting money due to the state for public assistance cases. The law authorizes the DMHAS commissioner or the commissioner's designee to represent a DMHAS client or assistance beneficiary for purposes of (1) enrolling him or her in the Medicare Part D prescription drug program, (2) selecting a Part D drug plan if the person does not select one within a reasonable time after being informed of the opportunity to do so, and (3) applying for the low-income subsidy available under the Medicare drug program.

54-55 — PRETRIAL ALCOHOL AND DRUG PROGRAMS

The act increases fees for both the pretrial alcohol and drug education programs and makes them more uniform. These programs are available to certain people charged with driving a motor vehicle or operating a boat under the influence of alcohol or possessing drugs or drug paraphernalia. If a person wants to take advantage of the programs, the court seals the case files to the public and refers the individual for assessment and placement in an intervention or treatment program.

Alcohol Education

The act renames the pretrial alcohol education system as the pretrial alcohol education program. It increases the program application fee from $50 to $100. It retains the $100 nonrefundable evaluation fee and requires crediting it to the pretrial account. It requires anyone approved for participation to begin within 90 days after the court orders it, unless the court grants a delay. By law, the court can order a person to participate in either a 10- or 15-session intervention program. The act raises the fee for the 10-session program to $350 from $325 and retains the $500 fee for the 15-session program.

The act establishes procedures for the court to follow when dealing with a person who does not successfully complete an intervention program or is found no longer amenable to treatment. Under prior law, if the program provider certified either of these circumstances, the court unsealed the court record, entered a not guilty plea for the individual, and scheduled a trial; in practice, the court reinstated people in intervention programs. Under the act, if the program provider certifies either of these circumstances it must, to the extent practicable, (1) recommend to the court whether a 10- or 15-session intervention or placement in a state-licensed alcohol treatment program would best serve the person's needs and (2) indicate whether the person had been in an initial program or had been reinstated. If the person does not pursue reinstatement or if the court denies it, the court must proceed to trial as under prior law.

The act imposes a nonrefundable $175 dollar reinstatement fee for a 10-session intervention program and $250 for 15 sessions. It limits a person to two reinstatements; the fees apparently apply for each reinstatement. The act allows the court to waive the fee for good cause, otherwise the person must pay it. The reinstatement fee must be credited to the pretrial account. The act requires the Court Services Support Division (CSSD) to confirm that the person is eligible for reinstatement and the court to order reinstatement. A person reinstated in a treatment program is responsible for paying any costs associated with reinstatement.

The act increases, from seven years to 10, the time the Motor Vehicle and Environmental Protection departments must keep records of people's participation in the program. It retains the seven-year retention requirement for CSSD.

Drug Education Program

The act creates three program options: 10- and 15-hour intervention programs and a drug treatment program. Previously, the program ran for 12 hours over eight sessions. Under the act, once the court allows a person to participate in the program, it must refer him or her to DMHAS for evaluation (presumably to determine which of the three options is most appropriate).

The act establishes a $100 application fee and a $100 evaluation fee. It establishes a $500 fee for the 15-session program; the 10-session fee remains $350. All fees must be credited to the pretrial account. The act makes people ordered into substance abuse treatment responsible for paying program costs. As under prior law, (1) indigent people cannot be excluded from any program and (2) program fees are not refundable if a person is later found ineligible to participate or fails to complete a program.

The act extends to all components of the drug education program the prohibition against participation for anyone who previously participated in it or the community service labor program.

It requires people placed in the drug education program to receive appropriate intervention or treatment services as recommended in their evaluation. Placement cannot exceed one year. Treatment services must be provided only at a state-licensed facility that complies with all state standards governing its operations.

Under the act, program participants must agree to (1) complete whichever option the court orders and (2) begin participating within 90 days after the order is entered; the law already requires them to agree to accept placement in a treatment program after completing the education program if a DMHAS provider recommends this. The act increases the time people participating in the drug education program must also participate in the community service labor program. Prior law required them to participate for four days. The act requires those in the 10-session intervention program or the treatment program participate in community service labor for at least five days while those in the 15-session program must participate for at least 10 days.

The act creates the same reinstatement procedures and fees for the substance abuse education program as it does for the alcohol education program (see above). It increases, from seven years to 10, the time CSSD must keep records of people's participation in the program.

EFFECTIVE DATE: January 1, 2010

56 — DMHAS/DSS MEMORANDUM OF UNDERSTANDING

The act requires DMHAS and DSS to enter into a memorandum of understanding under which DMHAS will continue to manage the State Administered General Assistance behavioral health program.

57 — DDS PROVIDER REIMBURSEMENT STUDY

The act establishes a 29-member advisory committee to study the effect of switching the way DDS pays private providers for support services. Currently, DDS enters into a fixed-sum, master contract with each provider; the act contemplates moving to an attendance-based, fee-for-service reimbursement system. The study must include:

1. ways to ensure that providers continue to receive reimbursement under the master contract system while the new system is studied;

2. participation by a large and diverse group of providers based on their reimbursement and attendance rates;

3. a review of the appropriateness of a level-of-need tool and reimbursement rates, the process for completing such tools, ways to link levels of need to funding, and level-of-need scores and ways to appeal them;

4. the identification of the costs of raising low-wage providers to a standard wage rate while holding high-wage providers harmless;

5. an analysis of attendance factors based on clients' health and staff vacation, holidays, and personal and paid time off;

6. the identification of a reasonable attendance factor that would keep providers whole and maintain normalization and integration philosophies;

7. a determination of appropriate models for reimbursing providers for transporting clients;

8. a review of acting and documentation systems to identify information technology and related costs;

9. the identification of ways to maintain cash flow to providers and systematically increase rates to keep pace with increases in service costs; and

10. examination of efficiencies in the service delivery system.

The committee is composed of:

1. the chairpersons and ranking members of the Appropriations, Human Services, and Public Health committees;

2. the chairpersons and ranking members of the Appropriations Committee's Health Subcommittee;

3. a member the governor designates;

4. the DDS commissioner or his designee;

5. a member of the Office of Policy and Management, appointed by the secretary;

6. a member of DSS's Medicaid unit who has oversight of DDS reimbursements, appointed by the DSS commissioner;

7. the Connecticut Community Providers Association's chief executive officer or his or her designee;

8. The Connecticut Association of Nonprofits' executive director, or the director's designee;

9. a chief financial officer of a community provider organization appointed by the community providers association's executive director;

10. an information technology officer of a community provider organization appointed by the Connecticut Association of Nonprofits' executive director;

11. a member appointed by the president of the labor organization that represents the majority of the workers who perform the services in these programs; and

12. three DDS employees, one each in operations, information technology, and audits.

All appointments to the committee must be made within 30 days after the act's passage. The House speaker and Senate president pro tempore select the committee's chairpersons who must schedule its first meeting with 60 days after the act's passage. The appointing authority fills any vacancies. DDS staff serves as the committee's administrative staff.

The committee must report its finding and recommendations by January 1, 2011 to the Appropriations, Human Services, and Public Health committees. It terminates on that date or the date it submits its report, whichever is earlier.

58 — HEALTH CARE PROVIDER PEER REVIEW CONFIDENTIALITY

The act specifies that materials or information produced for peer review purposes, in any format or media, are not subject to disclosure under the Freedom of Information Act (FOIA). By law, “peer review” means the procedure for health care professionals to evaluate the quality and effectiveness of services ordered or performed by other health care professionals. This includes practice analysis, inpatient hospital and extended care facility utilization review, medical audit, ambulatory care review, and claims review.

The act specifies that it does not preclude DPH from accessing peer review materials and information in connection with any department review or investigation of a provider's license. But DPH may not disclose the information to anyone outside of the agency, except as necessary to take disciplinary action against the provider, and the information cannot be disclosed under FOIA. The act also specifies that it does not limit other protections on peer review provided by law.

Background

The Connecticut Supreme Court recently held that records of a public hospital that would be privileged from discovery under Connecticut's peer review statute are subject to disclosure pursuant to proceedings before the state's Freedom of Information Commission (Director of Health Affairs Policy Planning, University of Connecticut Health Center v. Freedom of Information Commission, Conn. , No. SC 18286, August 25, 2009).

60 — UCONN HEALTH CENTER MALPRACTICE FUND

The UConn Health Center Finance Corporation was created to allow the John Dempsey Hospital and the UConn medical and dental schools to operate with greater flexibility by acquiring and disposing of equipment and real property and entering into contracts and joint ventures on their behalf. By law, the corporation administers a separate insurance fund through which it insures the hospital and itself against malpractice claims and associated expenses. It may self-insure and purchase insurance to cover claims and expenses.

Prior law required the UConn Board of Trustees to determine actuarially the amount of funds needed to protect the hospital and which must be transferred to the insurance fund from the hospital's revolving fund. The act eliminates the requirement that the funding determination be actuarially based.

It also eliminates the requirement that any self-insurance program paid from the insurance fund be operated on an actuarially sound basis. It continues to require the hospital to provide additional money that the corporation determines is needed to meet the fund's self-insurance obligations. The act gives the UConn Board of Trustees sole authority to determine and approve the funding level needed, rather than have this amount determined on an actuarial basis as under prior law.

61 — REPEALED SECTIONS

The act repeals obsolete OHCA statutes, a section on TB treatment payment for consistency with new language in the act, and provisions related to DPH responsibilities concerning managed residential care communities. PA 09-7, September Special Session, reinstates one of the repealed OHCA statutes, which requires that payments to hospitals based on DSS-established inpatient hospital rates include any inpatient service days provided in a new long-term acute care hospital or satellite facility established as a demonstration project (CGS 19a-617c).

OLR Tracking: SS/JK: JK/SS/CR: ts