General Assembly Substitute Bill No. 297
January Session, 2011 *_____SB00297HS____032311____*
General Assembly
Substitute Bill No. 297
January Session, 2011
*_____SB00297HS____032311____*
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 of Social Services 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-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 Section 10202 of 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 services 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.
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
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
Statement of Legislative Commissioners:
In section 2, "pursuant to the Patient Protection and Affordable Care Act" was changed to "pursuant to Section 10202 of the Patient Protection and Affordable Care Act" for clarity. In section 2 (2), "conflict free case management" was changed to "conflict-free case management services" for conformity with the reference in the federal act.
HS Joint Favorable Subst.
HS
Joint Favorable Subst.