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General Assembly Substitute Bill No. 5296
February Session, 2024
AN ACT EXPANDING THE CONNECTICUT HOME -CARE PROGRAM
FOR THE ELDERLY.
Be it enacted by the Senate and House of Representatives in General
Assembly convened:
Section 1. Section 17b-342 of the general statutes is repealed and the 1
following is substituted in lieu thereof (Effective July 1, 2024): 2
(a) The Commissioner of Social Services shall administer the 3
Connecticut home-care program for the elderly state-wide in order to 4
prevent the institutionalization of elderly persons (1) who are recipients 5
of medical assistance, (2) who are eligible for such assistance, (3) who 6
would be eligible for medical assistance if residing in a nursing facility, 7
or (4) who meet the criteria for the state-funded portion of the program 8
under subsection (i) of this section. For purposes of this section, a long-9
term care facility is a facility that has been federally certified as a skilled 10
nursing facility or intermediate care facility. The commissioner shall 11
make any revisions in the state Medicaid plan required by Title XIX of 12
the Social Security Act prior to implementing the program. The program 13
shall be structured so that the net cost to the state for long-term facility 14
care in combination with the services under the program shall not 15
exceed the net cost the state would have incurred without the program. 16
The commissioner shall investigate the possibility of receiving federal 17
funds for the program and shall apply for any necessary federal 18 Substitute Bill No. 5296
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waivers. A recipient of services under the program, and the estate and 19
legally liable relatives of the recipient, shall be responsible for 20
reimbursement to the state for such services to the same extent required 21
of a recipient of assistance under the state supplement program, medical 22
assistance program, temporary family assistance program or 23
supplemental nutrition assistance program. Only a United States citizen 24
or a noncitizen who meets the citizenship requirements for eligibility 25
under the Medicaid program shall be eligible for home-care services 26
under this section, except a qualified alien, as defined in Section 431 of 27
Public Law 104-193, admitted into the United States on or after August 28
22, 1996, or other lawfully residing immigrant alien determined eligible 29
for services under this section prior to July 1, 1997, shall remain eligible 30
for such services. Qualified aliens or other lawfully residing immigrant 31
aliens not determined eligible prior to July 1, 1997, shall be eligible for 32
services under this section subsequent to six months from establishing 33
residency. Notwithstanding the provisions of this subsection, any 34
qualified alien or other lawfully residing immigrant alien or alien who 35
formerly held the status of permanently residing under color of law who 36
is a victim of domestic violence or who has intellectual disability shall 37
be eligible for assistance pursuant to this section. Qualified aliens, as 38
defined in Section 431 of Public Law 104-193, or other lawfully residing 39
immigrant aliens or aliens who formerly held the status of permanently 40
residing under color of law shall be eligible for services under this 41
section provided other conditions of eligibility are met. 42
(b) The commissioner shall solicit bids through a competitive process 43
and shall contract with an access agency, approved by the Office of 44
Policy and Management and the Department of Social Services as 45
meeting the requirements for such agency as defined by regulations 46
adopted pursuant to subsection (e) of this section, that submits 47
proposals which meet or exceed the minimum bid requirements. In 48
addition to such contracts, the commissioner may use department staff 49
to provide screening, coordination, assessment and monitoring 50
functions for the program. 51 Substitute Bill No. 5296
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(c) The community-based services covered under the program shall 52
include, but not be limited to, the following services to the extent that 53
they are not available under the state Medicaid plan, occupational 54
therapy, homemaker services, companion services, meals on wheels, 55
adult day care, transportation, mental health counseling, care 56
management, [elderly foster care] adult family living, minor home 57
modifications and assisted living services provided in state-funded 58
congregate housing and in other assisted living pilot or demonstration 59
projects established under state law. Personal care assistance services 60
shall be covered under the program to the extent that (1) such services 61
are not available under the Medicaid state plan and are more cost 62
effective on an individual client basis than existing services covered 63
under such plan, and (2) the provision of such services is approved by 64
the federal government. A family caregiver, including, but not limited 65
to, a spouse, who provides personal care assistance services to an 66
individual enrolled in the program shall be compensated to the extent 67
permissible under federal law. Recipients of state-funded services and 68
persons who are determined to be functionally eligible for community-69
based services who have an application for medical assistance pending 70
shall have the cost of home health and community-based services 71
covered by the program, provided they comply with all medical 72
assistance application requirements. Access agencies shall not use 73
department funds to purchase community-based services or home 74
health services from themselves or any related parties. 75
(d) Physicians, hospitals, long-term care facilities and other licensed 76
health care facilities may disclose, and, as a condition of eligibility for 77
the program, elderly persons, their guardians, and relatives shall 78
disclose, upon request from the Department of Social Services, such 79
financial, social and medical information as may be necessary to enable 80
the department or any agency administering the program on behalf of 81
the department to provide services under the program. Long-term care 82
facilities shall supply the Department of Social Services with the names 83
and addresses of all applicants for admission. Any information 84
provided pursuant to this subsection shall be confidential and shall not 85 Substitute Bill No. 5296
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be disclosed by the department or administering agency. 86
(e) The commissioner shall adopt regulations, in accordance with the 87
provisions of chapter 54, to define "access agency", to implement and 88
administer the program, to establish uniform state-wide standards for 89
the program and a uniform assessment tool for use in the screening 90
process and to specify conditions of eligibility. 91
(f) The commissioner may require long-term care facilities to inform 92
applicants for admission of the program established under this section 93
and to distribute such forms as the commissioner prescribes for the 94
program. Such forms shall be supplied by and be returnable to the 95
department. 96
(g) The commissioner shall report annually, by June first, to the joint 97
standing committee of the General Assembly having cognizance of 98
matters relating to human services on the program in such detail, depth 99
and scope as said committee requires to evaluate the effect of the 100
program on the state and program participants. Such report shall 101
include information on (1) the number of persons diverted from 102
placement in a long-term care facility as a result of the program, (2) the 103
number of persons screened, (3) the average cost per person in the 104
program, (4) the administration costs, (5) the estimated savings, [and] 105
(6) a comparison between costs under the different contracts, and (7) for 106
adult family living services provided under the program, (A) the 107
participation rate of individuals receiving services pursuant to this 108
section, (B) the number of home care agencies that administer adult 109
family living services, (C) the primary languages spoken by individuals 110
receiving adult family living services, and (D) the estimated savings for 111
the state by deferred institutionalization of individuals receiving adult 112
family living services. 113
(h) An individual who is otherwise eligible for services pursuant to 114
this section shall, as a condition of participation in the program, apply 115
for medical assistance benefits pursuant to section 17b-260 when 116
requested to do so by the department and shall accept such benefits if 117 Substitute Bill No. 5296
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determined eligible. 118
(i) (1) The Commissioner of Social Services shall, within available 119
appropriations, administer a state-funded portion of the program for 120
persons (A) who are sixty-five years of age and older; (B) who are 121
inappropriately institutionalized or at risk of inappropriate 122
institutionalization; (C) whose income is less than or equal to the 123
amount allowed under subdivision (3) of subsection (a) of this section; 124
and (D) whose assets, if single, do not exceed one hundred fifty per cent 125
of the federal minimum community spouse protected amount pursuant 126
to 42 USC 1396r-5(f)(2) or, if married, the couple's assets do not exceed 127
two hundred per cent of said community spouse protected amount. For 128
program applications received by the Department of Social Services for 129
the fiscal years ending June 30, 2016, and June 30, 2017, only persons 130
who require the level of care provided in a nursing home shall be 131
eligible for the state-funded portion of the program, except for persons 132
residing in affordable housing under the assisted living demonstration 133
project established pursuant to section 17b-347e who are otherwise 134
eligible in accordance with this section. 135
(2) Except for persons residing in affordable housing under the 136
assisted living demonstration project established pursuant to section 137
17b-347e, as provided in subdivision (3) of this subsection, any person 138
whose income is at or below two hundred per cent of the federal poverty 139
level and who is ineligible for Medicaid shall contribute three per cent 140
of the cost of his or her care. Any person whose income exceeds two 141
hundred per cent of the federal poverty level shall contribute three per 142
cent of the cost of his or her care in addition to the amount of applied 143
income determined in accordance with the methodology established by 144
the Department of Social Services for recipients of medical assistance. 145
Any person who does not contribute to the cost of care in accordance 146
with this subdivision shall be ineligible to receive services under this 147
subsection. Notwithstanding any provision of sections 17b-60 and 17b-148
61, the department shall not be required to provide an administrative 149
hearing to a person found ineligible for services under this subsection 150 Substitute Bill No. 5296
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because of a failure to contribute to the cost of care. 151
(3) Any person who resides in affordable housing under the assisted 152
living demonstration project established pursuant to section 17b-347e 153
and whose income is at or below two hundred per cent of the federal 154
poverty level, shall not be required to contribute to the cost of care. Any 155
person who resides in affordable housing under the assisted living 156
demonstration project established pursuant to section 17b-347e and 157
whose income exceeds two hundred per cent of the federal poverty 158
level, shall contribute to the applied income amount determined in 159
accordance with the methodology established by the Department of 160
Social Services for recipients of medical assistance. Any person whose 161
income exceeds two hundred per cent of the federal poverty level and 162
who does not contribute to the cost of care in accordance with this 163
subdivision shall be ineligible to receive services under this subsection. 164
Notwithstanding any provision of sections 17b-60 and 17b-61, the 165
department shall not be required to provide an administrative hearing 166
to a person found ineligible for services under this subsection because 167
of a failure to contribute to the cost of care. 168
(4) The annualized cost of services provided to an individual under 169
the state-funded portion of the program shall not exceed fifty per cent 170
of the weighted average cost of care in nursing homes in the state, except 171
an individual who received services costing in excess of such amount 172
under the Department of Social Services in the fiscal year ending June 173
30, 1992, may continue to receive such services, provided the annualized 174
cost of such services does not exceed eighty per cent of the weighted 175
average cost of such nursing home care. The commissioner may allow 176
the cost of services provided to an individual to exceed the maximum 177
cost established pursuant to this subdivision in a case of extreme 178
hardship, as determined by the commissioner, provided in no case shall 179
such cost exceed that of the weighted cost of such nursing home care. 180
(5) A family caregiver, including, but not limited to, a spouse, shall 181
be compensated for any personal care assistance services provided to an 182
individual enrolled in the program. 183 Substitute Bill No. 5296
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(j) The Commissioner of Social Services shall collect data on services 184
provided under the program, including, but not limited to, the: (1) 185
Number of participants before and after copayments are reduced 186
pursuant to subsection (i) of this section, (2) average hours of care 187
provided under the program per participant, and (3) estimated cost 188
savings to the state by providing home care to participants who may 189
otherwise receive care in a nursing home facility. The commissioner 190
shall, in accordance with the provisions of section 11-4a, report on the 191
results of the data collection to the joint standing committees of the 192
General Assembly having cognizance of matters relating to aging, 193
appropriations and the budgets of state agencies and human services 194
not later than July 1, 2022. The commissioner may implement revised 195
criteria for the operation of the program while in the process of adopting 196
such criteria in regulation form, provided the commissioner publishes 197
notice of intention to adopt the regulations in accordance with section 198
17b-10. Such criteria shall be valid until the time final regulations are 199
effective. 200
(k) The commissioner shall notify any access agency or area agency 201
on aging that administers the program when the department sends a 202
redetermination of eligibility form to an individual who is a client of 203
such agency. 204
(l) In determining eligibility for the program described in this section, 205
the commissioner shall not consider as income (1) Aid and Attendance 206
pension benefits granted to a veteran, as defined in section 27-103, or the 207
surviving spouse of such veteran, and (2) any tax refund or advance 208
payment with respect to a refundable credit to the same extent such 209
refund or advance payment would be disregarded under 26 USC 6409 210
in any federal program or state or local program financed in whole or in 211
part with federal funds. 212
(m) Not later than January 1, 2025, the Commissioner of Social 213
Services shall develop and implement a multilingual public awareness 214
campaign to promote adult family living services offered under the 215
program. Any materials developed for the public awareness campaign 216 Substitute Bill No. 5296
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shall be translated into the fifteen most commonly spoken languages in 217
the state, as determined by the commissioner. The commissioner shall 218
(1) make paper copies of such materials available to the public at various 219
times and at various locations throughout the state, as determined by 220
the commissioner, and (2) post a link to such materials on the 221
department's Internet web site. 222
Sec. 2. Section 17b-343 of the general statutes is repealed and the 223
following is substituted in lieu thereof (Effective July 1, 2024): 224
The Commissioner of Social Services shall establish annually the 225
maximum allowable rate to be paid by agencies for homemaker 226
services, chore person services, companion services, respite care, meals 227
on wheels, adult day care services, case management and assessment 228
services, transportation, mental health counseling and [elderly foster 229
care] adult family living. The Commissioner of Social Services shall 230
prescribe uniform forms on which agencies providing such services 231
shall report their costs for such services. Such rates shall be determined 232
on the basis of a reasonable payment for necessary services rendered. 233
The maximum allowable rates established by the Commissioner of 234
Social Services for the Connecticut home-care program for the elderly 235
established under section 17b-342, as amended by this act, shall 236
constitute the rates required under this section until revised in 237
accordance with this section. The Commissioner of Social Services shall 238
establish a fee schedule, to be effective on and after July 1, 1994, for 239
homemaker services, chore person services, companion services, respite 240
care, meals on wheels, adult day care services, case management and 241
assessment services, transportation, mental health counseling and 242
[elderly foster care] adult family living. The commissioner may annually 243
increase the fee schedule based on an increase in the cost of services. The 244
commissioner shall increase the fee schedule effective July 1, 2000, by 245
not less than five per cent, for adult day care services. The commissioner 246
shall increase the fee schedule effective July 1, 2011, by four dollars per 247
person, per day for adult day care services. The commissioner shall 248
increase the fee schedule effective July 1, 2019, for meals on wheels by 249 Substitute Bill No. 5296
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ten per cent over the fee schedule for meals on wheels for the previous 250
fiscal year. Effective July 1, 2020, and annually thereafter, the 251
commissioner may increase the fee schedule for meals on wheels 252
providers serving participants in the Connecticut home-care program 253
for the elderly by, at a minimum, the cost-of-living adjustment as 254
measured by the consumer price index. The commissioner may increase 255
any fee payable to a meals on wheels provider upon the application of 256
such provider evidencing extraordinary costs related to delivery of 257
meals on wheels in sparsely populated rural regions of the state. 258
Nothing contained in this section shall authorize a payment by the state 259
to any agency for such services in excess of the amount charged by such 260
agency for such services to the general public. 261
Sec. 3. Subsection (b) of section 17b-370 of the general statutes is 262
repealed and the following is substituted in lieu thereof (Effective July 1, 263
2024): 264
(b) The plan developed pursuant to subsection (a) of this section shall 265
detail the structure of the demonstration project, persons served, 266
services to be provided and how they will be provided. The plan shall 267
include a timetable for implementation of the demonstration project on 268
or after July 1, 2009. The plan shall ensure that the demonstration project 269
includes, but is not limited to, the provision of the following services 270
through a Medicaid state plan amendment, a new Medicaid waiver or 271
modification of an existing home and community-based Medicaid 272
waiver: Personal care assistance services, twenty-four-hour care, 273
occupational therapy, homemaker services, companion services, meals 274
on wheels, adult day care, transportation, mental health counseling, care 275
management, [elderly foster care] adult family living, minor home 276
modifications, assistive technology and assisted living services. The 277
plan shall ensure that a person participating in the demonstration 278
project receives the level of care and services appropriate to maintain 279
such person in such person's home or community. 280 Substitute Bill No. 5296
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This act shall take effect as follows and shall amend the following
sections:
Section 1 July 1, 2024 17b-342
Sec. 2 July 1, 2024 17b-343
Sec. 3 July 1, 2024 17b-370(b)
AGE Joint Favorable Subst.