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General Assembly Raised Bill No. 311
February Session, 2024
LCO No. 2153
Referred to Committee on HUMAN SERVICES
Introduced by:
(HS)
AN ACT CONCERNING 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 Section 17b-342 of the general statutes is repealed and the 1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 who (1) [who] are 5
recipients of medical assistance, (2) [who] are eligible for such 6
assistance, (3) [who] would be eligible for medical assistance if residing 7
in a nursing facility, or (4) [who] meet the criteria for the state-funded 8
portion of the program under subsection [(i)] (j) of this section. For 9
purposes of this section, [a long-term care facility is] "long-term care 10
facility" means a facility that has been federally certified as a skilled 11
nursing facility or intermediate care facility. The commissioner shall 12
make any revisions in the state Medicaid plan required by Title XIX of 13
the Social Security Act prior to implementing the program. The program 14
shall be structured so that the net cost to the state for long-term facility 15 Raised Bill No. 311
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care in combination with the services under the program shall not 16
exceed the net cost the state would have incurred without the program. 17
The commissioner shall investigate the possibility of receiving federal 18
funds for the program and shall apply for any necessary federal 19
waivers. A recipient of services under the program, and the estate and 20
legally liable relatives of the recipient, shall be responsible for 21
reimbursement to the state for such services to the same extent required 22
of a recipient of assistance under the state supplement program, medical 23
assistance program, temporary family assistance program or 24
supplemental nutrition assistance program. Only a United States citizen 25
or a noncitizen who meets the citizenship requirements for eligibility 26
under the Medicaid program shall be eligible for home-care services 27
under this section, except a qualified alien, as defined in Section 431 of 28
Public Law 104-193, admitted into the United States on or after August 29
22, 1996, or other lawfully residing immigrant alien determined eligible 30
for services under this section prior to July 1, 1997, shall remain eligible 31
for such services. Qualified aliens or other lawfully residing immigrant 32
aliens not determined eligible prior to July 1, 1997, shall be eligible for 33
services under this section subsequent to six months from establishing 34
residency. Notwithstanding the provisions of this subsection, any 35
qualified alien or other lawfully residing immigrant alien or alien who 36
formerly held the status of permanently residing under color of law who 37
is a victim of domestic violence or who has intellectual disability shall 38
be eligible for assistance pursuant to this section. Qualified aliens, as 39
defined in Section 431 of Public Law 104-193, or other lawfully residing 40
immigrant aliens or aliens who formerly held the status of permanently 41
residing under color of law shall be eligible for services under this 42
section provided other conditions of eligibility are met. 43
(b) The commissioner shall solicit bids through a competitive process 44
and shall contract with an access agency, approved by the Office of 45
Policy and Management and the Department of Social Services as 46
meeting the requirements for such agency as defined by regulations 47
adopted pursuant to subsection [(e)] (n) of this section, that submits 48
proposals [which] that meet or exceed the minimum bid requirements. 49 Raised Bill No. 311
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In addition to such contracts, the commissioner may use department 50
staff to provide screening, coordination, assessment and monitoring 51
functions for the program. 52
(c) The community-based services covered under the program shall 53
include, but not be limited to, [the following services to the extent that 54
they are not] services not otherwise available under the state Medicaid 55
plan: [, occupational] (1) Occupational therapy, (2) homemaker services, 56
(3) companion services, (4) meals on wheels, (5) adult day care, (6) 57
transportation, (7) mental health counseling, (8) care management, 58
[elderly foster care,] (9) adult family living, (10) minor home 59
modifications, and (11) assisted living services provided in state-funded 60
congregate housing and in other assisted living pilot or demonstration 61
projects established under state law. Personal care assistance services 62
shall be covered under the program to the extent that [(1)] (A) such 63
services are not available under the Medicaid state plan and are more 64
cost effective on an individual client basis than existing services covered 65
under such plan, and [(2)] (B) the provision of such services is approved 66
by the federal government. A family caregiver, including, but not 67
limited to, a spouse, may be compensated for personal care assistance 68
provided to an individual in the program to the extent such 69
compensation is permissible under federal law, provided such caregiver 70
meets training and documentation requirements prescribed by the 71
Commissioner of Social Services. Recipients of state-funded services, 72
pursuant to subsection (j) of this section, and persons who are 73
determined to be functionally eligible for community-based services 74
who have an application for medical assistance pending, or are 75
determined to be presumptively eligible for Medicaid pursuant to 76
subsection (e) of this section, shall have the cost of home health and 77
community-based services covered by the program, provided they 78
comply with all medical assistance application requirements. Access 79
agencies shall not use department funds to purchase community-based 80
services or home health services from themselves or any related parties. 81
(d) Physicians, hospitals, long-term care facilities and other licensed 82
health care facilities may disclose, and, as a condition of eligibility for 83 Raised Bill No. 311
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the program, elderly persons, their guardians, and relatives shall 84
disclose, upon request from the Department of Social Services, such 85
financial, social and medical information as may be necessary to enable 86
the department or any agency administering the program on behalf of 87
the department to provide services under the program. Long-term care 88
facilities shall supply the Department of Social Services with the names 89
and addresses of all applicants for admission. Any information 90
provided pursuant to this subsection shall be confidential and shall not 91
be disclosed by the department or administering agency. 92
[(e) The commissioner shall adopt regulations, in accordance with the 93
provisions of chapter 54, to define "access agency", to implement and 94
administer the program, to establish uniform state-wide standards for 95
the program and a uniform assessment tool for use in the screening 96
process and to specify conditions of eligibility.] 97
(e) Not later than October 1, 2024, the Commissioner of Social 98
Services shall establish a presumptive Medicaid eligibility system under 99
which the state shall fund services under the Connecticut home-care 100
program for the elderly for a period of not longer than ninety days for 101
applicants who require a skilled level of nursing care and who are 102
determined to be presumptively eligible for Medicaid coverage. The 103
system shall include, but need not be limited to: (1) The development of 104
a preliminary screening tool by the Department of Social Services to be 105
used by representatives of the access agency selected pursuant to 106
subsection (b) of this section to determine whether an applicant is 107
functionally able to live at home or in a community setting and is likely 108
to be financially eligible for Medicaid; (2) a requirement that the 109
applicant complete a Medicaid application on the date such applicant is 110
preliminarily screened for functional eligibility or not later than ten days 111
after such screening; (3) a determination of presumptive eligibility for 112
an eligible applicant by the department and initiation of home-care 113
services not later than ten days after an applicant is successfully 114
screened for eligibility; and (4) a written agreement to be signed by the 115
applicant attesting to the accuracy of financial and other information 116
such applicant provides and acknowledging that the state shall solely 117 Raised Bill No. 311
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fund services not longer than ninety days after the date on which home-118
care services begin. The department shall make a final determination as 119
to Medicaid eligibility for an applicant determined to be presumptively 120
eligible for Medicaid coverage not later than forty-five days after the 121
date of receipt of a completed Medicaid application from such applicant, 122
provided the department may make such determination not later than 123
ninety days after receipt of the application if the applicant has 124
disabilities. 125
(f) The Commissioner of Social Services shall retroactively provide 126
Medicaid reimbursement for eligible expenses for a period not to exceed 127
ninety days prior to a Medicaid application in accordance with 42 CFR 128
435.915. 129
[(f)] (g) The commissioner may require long-term care facilities to 130
inform applicants for admission of the Connecticut home-care program 131
for the elderly established under this section and to distribute such 132
forms as the commissioner prescribes for the program. Such forms shall 133
be supplied by and be returnable to the department. 134
[(g)] (h) The commissioner shall report annually, by June first, in 135
accordance with the provisions of section 11-4a, to the joint standing 136
committee of the General Assembly having cognizance of matters 137
relating to human services on the Connecticut home-care program for 138
the elderly in such detail, depth and scope as said committee requires to 139
evaluate the effect of the program on the state and program participants. 140
Such report shall include information on (1) the number of persons 141
diverted from placement in a long-term care facility as a result of the 142
program, (2) the number of persons screened [, (3)] for the program, (3) 143
the number of persons determined presumptively eligible for Medicaid, 144
(4) savings for the state based on institutional care costs that were 145
averted for persons determined to be presumptively eligible for 146
Medicaid who later were determined to be eligible for Medicaid, (5) the 147
number of persons determined presumptively eligible for Medicaid 148
who later were determined not to be eligible for Medicaid and costs to 149
the state to provide such persons with home-care services before the 150 Raised Bill No. 311
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final Medicaid eligibility determination, (6) the average cost per person 151
in the program, [(4)] (7) the administration costs, [(5)] (8) the estimated 152
savings to provide home care versus institutional care for all persons in 153
the program, and [(6)] (9) a comparison between costs under the 154
different contracts for program services. 155
[(h)] (i) An individual who is otherwise eligible for services pursuant 156
to this section shall, as a condition of participation in the program, apply 157
for medical assistance benefits [pursuant to section 17b-260] when 158
requested to do so by the department and shall accept such benefits if 159
determined eligible. 160
[(i)] (j) (1) The Commissioner of Social Services shall, within available 161
appropriations, administer a state-funded portion of the Connecticut 162
home-care program for the elderly for persons (A) who are sixty-five 163
years of age and older and are not eligible for Medicaid; (B) who are 164
inappropriately institutionalized or at risk of inappropriate 165
institutionalization; (C) whose income is less than or equal to the 166
amount allowed [under subdivision (3) of subsection (a) of this section] 167
for a person who would be eligible for medical assistance if residing in 168
a nursing facility; and (D) whose assets, if single, do not exceed [one 169
hundred fifty per cent of the federal minimum community spouse 170
protected amount pursuant to 42 USC 1396r-5(f)(2)] fifty-five thousand 171
dollars or, if married, the couple's assets do not exceed [two hundred 172
per cent of said community spouse protected amount] seventy thousand 173
dollars. For program applications received by the Department of Social 174
Services for the fiscal years ending June 30, 2016, and June 30, 2017, only 175
persons who require the level of care provided in a nursing home shall 176
be eligible for the state-funded portion of the program, except for 177
persons residing in affordable housing under the assisted living 178
demonstration project established pursuant to section 17b-347e who are 179
otherwise eligible in accordance with this section. For program 180
applications received by the department on and after July 1, 2024, the 181
following categories shall also be eligible: (i) Persons at risk of 182
hospitalization or nursing facility placement if preventive home-care 183
services are not provided and who need assistance with not more than 184 Raised Bill No. 311
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two critical needs, and (ii) persons with three or more critical needs who 185
would require nursing facility care but are either not actively 186
considering it or have resources which would prohibit them from 187
qualifying for Medicaid upon admission to a nursing facility. For 188
purposes of this subdivision, "critical needs" means activities of daily 189
living that are hands-on activities or tasks that are essential for a 190
person's health and safety, including, but not limited to, bathing, 191
dressing, transferring from a seated position to an upright position or 192
from an upright position to a seated position, toileting, feeding, meal 193
preparation, administration of medication or ambulation. 194
(2) Except for persons residing in affordable housing under the 195
assisted living demonstration project established pursuant to section 196
17b-347e, as provided in subdivision (3) of this subsection, any person 197
whose income is at or below two hundred per cent of the federal poverty 198
level and who is ineligible for Medicaid shall contribute [three] two per 199
cent of the cost of his or her care. Any person whose income exceeds two 200
hundred per cent of the federal poverty level shall contribute [three] two 201
per cent of the cost of his or her care in addition to the amount of applied 202
income determined in accordance with the methodology established by 203
the Department of Social Services for recipients of medical assistance. 204
Any person who does not contribute to the cost of care in accordance 205
with this subdivision shall be ineligible to receive services under this 206
subsection. Notwithstanding any provision of sections 17b-60 and 17b-207
61, the department shall not be required to provide an administrative 208
hearing to a person found ineligible for services under this subsection 209
because of a failure to contribute to the cost of care. 210
(3) Any person who resides in affordable housing under the assisted 211
living demonstration project established pursuant to section 17b-347e 212
and whose income is at or below two hundred per cent of the federal 213
poverty level, shall not be required to contribute to the cost of care. Any 214
person who resides in affordable housing under the assisted living 215
demonstration project established pursuant to section 17b-347e and 216
whose income exceeds two hundred per cent of the federal poverty 217
level, shall contribute to the applied income amount determined in 218 Raised Bill No. 311
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accordance with the methodology established by the Department of 219
Social Services for recipients of medical assistance. Any person whose 220
income exceeds two hundred per cent of the federal poverty level and 221
who does not contribute to the cost of care in accordance with this 222
subdivision shall be ineligible to receive services under this subsection. 223
Notwithstanding any provision of sections 17b-60 and 17b-61, the 224
department shall not be required to provide an administrative hearing 225
to a person found ineligible for services under this subsection because 226
of a failure to contribute to the cost of care. 227
(4) The annualized cost of services provided to an individual under 228
the state-funded portion of the program shall not exceed fifty per cent 229
of the weighted average cost of care in nursing homes in the state, except 230
an individual who received services costing in excess of such amount 231
under the Department of Social Services in the fiscal year ending June 232
30, 1992, may continue to receive such services, provided the annualized 233
cost of such services does not exceed eighty per cent of the weighted 234
average cost of such nursing home care. The commissioner may allow 235
the cost of services provided to an individual to exceed the maximum 236
cost established pursuant to this subdivision in a case of extreme 237
hardship, as determined by the commissioner, provided in no case shall 238
such cost exceed that of the weighted cost of such nursing home care. 239
(5) A family caregiver, including, but not limited to, a spouse, may be 240
compensated for personal care assistance provided to an individual in 241
the program provided such caregiver meets training and 242
documentation requirements prescribed by the Commissioner of Social 243
Services. 244
[(j)] (k) The Commissioner of Social Services shall collect data on 245
services provided under the program, including, but not limited to, the: 246
(1) Number of participants before and after copayments are reduced 247
pursuant to subsection [(i)] (j) of this section, (2) average hours of care 248
provided under the program per participant, and (3) estimated cost 249
savings to the state by providing home care to participants who may 250
otherwise receive care in a nursing home facility. The commissioner 251 Raised Bill No. 311
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shall, in accordance with the provisions of section 11-4a, report on the 252
results of the data collection to the joint standing committees of the 253
General Assembly having cognizance of matters relating to aging, 254
appropriations and the budgets of state agencies and human services 255
not later than July 1, 2022. The commissioner may implement revised 256
criteria for the operation of the program while in the process of adopting 257
such criteria in regulation form, provided the commissioner publishes 258
notice of intention to adopt the regulations in accordance with section 259
17b-10. Such criteria shall be valid until the time final regulations are 260
effective. 261
[(k)] (l) The commissioner shall notify any access agency or area 262
agency on aging that administers the program when the department 263
sends a redetermination of eligibility form to an individual who is a 264
client of such agency. 265
[(l)] (m) In determining eligibility for the program described in this 266
section, the commissioner shall not consider as income (1) Aid and 267
Attendance pension benefits granted to a veteran, as defined in section 268
27-103, or the surviving spouse of such veteran, and (2) any tax refund 269
or advance payment with respect to a refundable credit to the same 270
extent such refund or advance payment would be disregarded under 26 271
USC 6409 in any federal program or state or local program financed in 272
whole or in part with federal funds. 273
(n) The commissioner shall adopt regulations, in accordance with the 274
provisions of chapter 54, to (1) define "access agency", (2) implement and 275
administer the Connecticut home-care program for the elderly, (3) 276
implement and administer the presumptive Medicaid eligibility system 277
described in subsection (e) of this section, (4) establish uniform state-278
wide standards for the program and uniform assessment tools for use 279
in the screening process for the program and the prescreening for 280
presumptive Medicaid eligibility, and (5) specify conditions of 281
eligibility. 282
Sec. 2. Subsection (a) of section 17b-253 of the general statutes is 283 Raised Bill No. 311
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repealed and the following is substituted in lieu thereof (Effective July 1, 284
2024): 285
(a) The Department of Social Services shall seek appropriate 286
amendments to its Medicaid regulations and state plan to allow 287
protection of resources and income pursuant to section 17b-252. Such 288
protection shall be provided, to the extent approved by the federal 289
Centers for Medicare and Medicaid Services, for any purchaser of a 290
precertified long-term care policy and shall last for the life of the 291
purchaser. Such protection shall be provided under the Medicaid 292
program or its successor program. Any purchaser of a precertified long-293
term care policy shall be guaranteed coverage under the Medicaid 294
program or its successor program, to the extent the individual meets all 295
applicable eligibility requirements for the Medicaid program or its 296
successor program. Until such time as eligibility requirements are 297
prescribed for Medicaid's successor program, for the purposes of this 298
subsection, the applicable eligibility requirements shall be the Medicaid 299
program's requirements as of the date its successor program was 300
enacted. The Department of Social Services shall count insurance benefit 301
payments toward resource exclusion to the extent such payments (1) are 302
for services paid for by a precertified long-term care policy; (2) are for 303
the lower of the actual charge and the amount paid by the insurance 304
company; (3) are for nursing home care, or formal services delivered to 305
insureds in the community as part of a care plan approved by an access 306
agency approved by the Office of Policy and Management and the 307
Department of Social Services as meeting the requirements for such 308
agency as defined in regulations adopted pursuant to [subsection (e) of] 309
section 17b-342, as amended by this act; and (4) are for services provided 310
after the individual meets the coverage requirements for long-term care 311
benefits established by the Department of Social Services for this 312
program. The Commissioner of Social Services shall adopt regulations, 313
in accordance with chapter 54, to implement the provisions of this 314
subsection and sections 17b-252, 17b-254 and 38a-475, as amended by 315
this act, relating to determining eligibility of applicants for Medicaid, or 316
its successor program, and the coverage requirements for long-term care 317 Raised Bill No. 311
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benefits. 318
Sec. 3. Subdivision (1) of subsection (e) of section 17b-354 of the 319
general statutes is repealed and the following is substituted in lieu 320
thereof (Effective July 1, 2024): 321
(e) (1) A continuing care facility, as described in section 17b-520, (A) 322
shall arrange for a medical assessment to be conducted by an 323
independent physician or an access agency approved by the Office of 324
Policy and Management and the Department of Social Services as 325
meeting the requirements for such agency as defined by regulations 326
adopted pursuant to [subsection (e) of] section 17b-342, as amended by 327
this act, prior to the admission of any resident to the nursing facility and 328
shall document such assessment in the resident's medical file and (B) 329
may transfer or discharge a resident who has intentionally transferred 330
assets in a sum which will render the resident unable to pay the cost of 331
nursing facility care in accordance with the contract between the 332
resident and the facility. 333
Sec. 4. Subsection (a) of section 17b-617 of the general statutes is 334
repealed and the following is substituted in lieu thereof (Effective July 1, 335
2024): 336
(a) The Commissioner of Social Services shall, within available 337
appropriations, establish and operate a state-funded pilot program to 338
allow not more than one hundred persons with disabilities (1) who are 339
age eighteen to sixty-four, inclusive, (2) who are inappropriately 340
institutionalized or at risk of inappropriate institutionalization, (3) 341
whose assets do not exceed the asset limits of the state-funded home 342
care program for the elderly, established pursuant to subsection [(i)] (j) 343
of section 17b-342, as amended by this act, and (4) who are not eligible 344
for medical assistance under section 17b-261 or a Medicaid waiver 345
pursuant to 42 USC 1396n, to be eligible to receive the same services that 346
are provided under the state-funded home care program for the elderly. 347
At the discretion of the Commissioner of Social Services, such persons 348
may also be eligible to receive services that are necessary to meet needs 349 Raised Bill No. 311
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attributable to disabilities in order to allow such persons to avoid 350
institutionalization. 351
Sec. 5. Section 38a-475 of the general statutes is repealed and the 352
following is substituted in lieu thereof (Effective July 1, 2024): 353
The Insurance Department shall only precertify long-term care 354
insurance policies that (1) alert the purchaser to the availability of 355
consumer information and public education provided by the 356
Department of Aging and Disability Services pursuant to section 17a-357
861; (2) offer the option of home and community-based services in 358
addition to nursing home care; (3) in all home care plans, include case 359
management services delivered by an access agency approved by the 360
Office of Policy and Management and the Department of Social Services 361
as meeting the requirements for such agency as defined in regulations 362
adopted pursuant to [subsection (e) of] section 17b-342, as amended by 363
this act, which services shall include, but need not be limited to, the 364
development of a comprehensive individualized assessment and care 365
plan and, as needed, the coordination of appropriate services and the 366
monitoring of the delivery of such services; (4) provide inflation 367
protection; (5) provide for the keeping of records and an explanation of 368
benefit reports on insurance payments which count toward Medicaid 369
resource exclusion; and (6) provide the management information and 370
reports necessary to document the extent of Medicaid resource 371
protection offered and to evaluate the Connecticut Partnership for 372
Long-Term Care. No policy shall be precertified if it requires prior 373
hospitalization or a prior stay in a nursing home as a condition of 374
providing benefits. The commissioner may adopt regulations, in 375
accordance with chapter 54, to carry out the precertification provisions 376
of this section. 377
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-253(a)
Sec. 3 July 1, 2024 17b-354(e)(1) Raised Bill No. 311
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Sec. 4 July 1, 2024 17b-617(a)
Sec. 5 July 1, 2024 38a-475
Statement of Purpose:
To expand access to the Connecticut home-care program for the elderly
by establishing presumptive eligibility for Medicaid-funded services,
reducing copayments, increasing asset limits, and expanding categories
of persons who may be covered under the state-funded program and to
authorize compensation for family caregivers.
[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.]