General Assembly Committee Bill No. 297
January Session, 2011 LCO No. 3887
*03887SB00297HS_*
Referred to Committee on Human Services
Introduced by:
(HS)
General Assembly
Committee Bill No. 297
January Session, 2011
LCO No. 3887
*03887SB00297HS_*
Referred to Committee on Human Services
Introduced by:
(HS)
AN ACT CONCERNING AN AMENDMENT TO THE MEDICAID STATE PLAN UNDER SECTION 1915(i) OF THE SOCIAL SECURITY ACT TO PROVIDE HOME CARE SERVICES.
Be it enacted by the Senate and House of Representatives in General Assembly convened:
Section 1. (NEW) (Effective from passage) (a) The Commissioner of Social Services shall seek to amend the Medicaid state plan pursuant to Section 1915(i) of the Social Security Act to improve access to home and community-based services by using needs-based eligibility criteria. The commissioner may amend a previously submitted waiver application submitted under Section 1915(c) of the Social Security Act if necessary to implement the provisions of this section.
(b) A person shall be financially eligible for coverage of home and community-based services under the Section 1915(i) Medicaid state plan amendment if the person meets the categorical eligibility special income requirements established by the commissioner and described in section 2540.92 of the department's uniform policy manual.
(c) Except for a person having mental retardation, as defined in section 1-1g of the general statutes, a person shall be functionally eligible for coverage of home and community-based services under the Section 1915(i) Medicaid state plan amendment if the person is assessed as having a functional limitation that is expected to last for a continuous period of more than ninety days and that is characterized by: (1) An inability, without substantial assistance, substantial supervision or substantial cueing, to perform two or more (A) activities of daily living, that shall include, but not be limited to, eating, toileting, transferring from one place to another, bathing, dressing and continence; or (B) instrumental activities of daily living, that shall include, but not be limited to, housework, meal preparation, administering medications, managing money, shopping and communicating by telephone or other means; or (2) a serious and persistent mental health condition.
(d) A person who is otherwise eligible to receive services under this section shall, as a condition of participation in the program (1) apply for benefits under a state medical assistance program at the request of the Department of Social Services, and (2) if determined eligible for state medical assistance benefits, accept such benefits.
(e) A person whose income exceeds two hundred per cent of the federal poverty level shall contribute to the person's cost of care in accordance with the methodology established for recipients of medical assistance pursuant to sections 5035.20 and 5035.25 of the department's uniform policy manual.
(f) Except for a person with acquired brain injury, who is eligible for Medicaid-financed home and community-based services pursuant to section 17b-260a of the general statutes, a person who is determined to be financially and functionally eligible for home and community-based services under this section shall qualify for payment of such services in an amount not to exceed a monthly care plan cost cap equal to one hundred per cent of the weighted average cost of the state's monthly payment for services in a skilled nursing facility or intermediate care facility.
(g) The community-based services covered under the Section 1915(i) Medicaid state plan amendment shall include, but not be limited to, home and community-based services that have been approved for Medicaid waivers under Section 1915(c) of the Social Security Act and described in sections 17b-260a, 17b-283, 17b-342, 17b-283, 17b-602a and 17b-605a of the general statutes, to the extent that such services are not otherwise available under the Medicaid state plan.
Sec. 2. (NEW) (Effective from passage) The Commissioner of Social Services shall submit an application in accordance with the State Balancing Incentive Payment Program, established pursuant to the Patient Protection and Affordable Care Act, P.L. 111-148, to the Centers for Medicare and Medicaid Services to increase the state's federal matching assistance payments for Medicaid home and community-based services. The commissioner shall make the administrative changes required in accordance with the terms of said program including, but not limited to: (1) The establishment of a "no-wrong door single entry point system" to enable consumers to gain access to information on services available, including referral services, and to receive an assessment to determine eligibility for various programs; (2) the provision of "conflict free" case management to develop individual service plans and to arrange for and conduct ongoing monitoring of services; and (3) the utilization of a core standardized assessment instrument to determine eligibility and appropriate services.
Sec. 3. Subsections (a) and (b) of section 17b-371 of the general statutes are repealed and the following is substituted in lieu thereof (Effective from passage):
(a) On July 1, 2011, to the extent permitted by federal law, there shall be established within the General Fund, a separate, nonlapsing account which shall be known as the "Long-Term Care Reinvestment account". The account shall contain any moneys required by law and this section to be deposited in the account. Any funds (1) resulting from the enhanced federal medical assistance percentage received by the state under the Money Follows the Person demonstration project pursuant to Section 6071 of the Deficit Reduction Act of 2005, or (2) received by the state under the Patient Protection and Affordable Care Act, P.L. 111-148 and related to home and community-based services shall be deposited in the account.
(b) Money held in the account shall be expended by the Commissioner of Social Services, in consultation with the Secretary of the Office of Policy and Management, in accordance with this subsection and the plan developed pursuant to subsection (c) of this section, to:
(1) Provide funds [for programs and services that provide cost-effective home and community-based alternatives to institutional care in nursing home facilities, including, but not limited to, occupational therapy, homemaker services, companion services, meals on wheels, adult day care, personal care services, transportation, mental health counseling, care management, elderly foster care, minor home modifications and assisted living services] for supplemental services available under the Medicaid state plan amendment submitted by the commissioner pursuant to Section 1915(i) of the Social Security Act;
(2) Provide funds for rate increases (A) for home health agencies and other providers of home care services that are in addition to any rate increases authorized pursuant to sections 17b-242 and 17b-343 to meet the actual costs of care, and (B) for increased wages for transition coordinators under the Money Follows the Person demonstration project;
(3) Provide funds to develop, improve and increase the long-term care services workforce, including, but not limited to, training, education and other incentives;
(4) Provide funds to improve information technology and systems used to track costs and savings associated with the provision of home and community-based services and to improve access to information on long-term care programs and services for the elderly and disabled;
(5) Encourage the purchase of precertified long-term care insurance through the Connecticut Partnership for Long-Term Care by covering the costs of the premiums of individuals for six months;
(6) Pay the cost of relocating nursing home residents to other facilities if necessary to protect the health and safety of such residents, maintaining and operating a facility pending correction of deficiencies or closure, and reimbursing residents for the loss of funds in personal fund accounts pursuant to subsection (b) of section 17b-106;
(7) Provide grants to existing nursing home facilities to make facility changes, improvements and modifications to support home and community-based services and programs; or
(8) Provide grants to promote the adoption of building designs and principles of alternative nursing homes, such as Eden Alternative, Green House or Small House nursing homes, to improve the quality of life for long-term care facility residents.
This act shall take effect as follows and shall amend the following sections:
Section 1 from passage New section
Sec. 2 from passage New section
Sec. 3 from passage 17b-371(a) and (b)
This act shall take effect as follows and shall amend the following sections:
Section 1
from passage
New section
Sec. 2
from passage
New section
Sec. 3
from passage
17b-371(a) and (b)
Statement of Purpose:
To require the Commissioner of Social Services to amend the Medicaid state plan under Section 1915(i) of the Social Security Act.
[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline, except that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is not underlined.]
Co-Sponsors: SEN. MUSTO, 22nd Dist.
Co-Sponsors:
SEN. MUSTO, 22nd Dist.
S.B. 297