Publications

Table of Contents

I. INTRODUCTION

II. BILLS PASSED AND SIGNED INTO LAW

1. AN ACT CONCERNING THE MEMBERSHIP OF THE LONG-TERM PLANNING COMMITTEE

Public Act No. 99-28, effective May 27, 1999

2. AN ACT CONCERNING PETS IN ELDERLY HOUSING

Public Act No. 99-50, effective October 1, 1999

3. AN ACT CONCERNING CHARITABLE GIFT ANNUITIES

Public Act No. 99-52, effective October 1, 1999

4. AN ACT CONCERNING APPORTIONMENT OF LIABILITY BETWEEN NEGLIGENT AND INTENTIONAL TORTFEASORS

Public Act No. 99-69. The Act takes effect May 27, 1999, and is also applicable to any civil action pending or filed on or after August 11, 1998

5. AN ACT CONCERNING ADMINISTRATION OF MEDICATION IN RESIDENTIAL CARE HOMES

Public Act No. 99-80, effective October 1, 1999

6. AN ACT CONCERNING UTILITY CHARGES FOR NUSING HOME RESIDENTS

Public Act No. 99-87, effective July 1, 1999

7. AN ACT MANDATING PSYCHOLOGISTS TO REPORT CASES OF ABUSE, NEGLECT AND EXPLOITATION OF THE ELDERLY

Public Act No. 99-101, effective October 1, 1999

8. AN ACT CONCERNING HOME HEALTH CARE RATES

Public Act No. 99-130, effective October 1, 1999

9. AN ACT CONCERNING THE ELIGIBILITY OF ELDERLY AND TOTALLY DISABLED RENTERS WHO RECEIVE CASH ASSISTANCE FROM THE DEPARTMENT OF SOCIAL SERVICES FOR A PARTIAL REBATE OF RENT AND UTILITY EXPENSES

Public Act No. 99-134, effective January 1, 2000

10. AN ACT INCREASING UNEMPLOYMENT COMPENSATION DEPENDENCY ALLOWANCES

Public Act No. 99-154, effective October 1, 1999

11. AN ACT CONCERNING THE ALZHEIMER’S RESPITE CARE DEMONSTRATION PROGRAM

Public Act No. 99-162, effective July 1, 1999

12. AN ACT CONCERNING ADVANCED PRACTICE NURSING

Public Act No. 99-168, effective October 1, 1999

13. AN ACT CONCERNING PHYSICAL RESTRAINT OF PERSONS WITH DISABILITIES

Public Act No. 99-210. Effective June 29, 1999 for the ban on using life-threatening physical restraints. Other provisions are effective October 1, 1999

14. AN ACT ADJUSTING THE CAP ON WORKERS’ COMPENSATION ASSESSMENTS FOR ADMINISTRATIVE COSTS

Public Act No. 99-214, effective July 1, 1999

15. AN ACT CONFORMING THE STATE NURSING HOME OMBUDSMAN OFFICE WITH THE FEDERAL OLDER AMERICANS ACT

Public Act No. 99-176, effective July 1, 1999

16. AN ACT CREATING A MEDICARE CONSUMERS’ GUIDE

Public Act No. 99-177, effective July 1, 1999

17. AN ACT CONCERNING ORGAN DONATION

Public Act No. 99-120, effective October 1, 1999

18. AN ACT IMPROVING OVERSIGHT OF MEDICAID MANAGED CARE PLANS

Public Act No. 99-167, effective October 1, 1999

19. AN ACT CONCERNING MANAGED CARE ACCOUNTABILITY

Public Act No. 99-284.

Effective October 1, 1999, except that (1) the public education and outreach provision and the DPH study on adding additional providers to the profile program took effect June 7, 1999; (2) the mental health parity sections of the various insurance requirements take effect January 1, 2000; and (3) the medical records sections take effect July 1, 2000.

20. AN ACT CONCERNING INCOME LIMITS FOR CONTINUED OCCUPANCY IN CONGREGATE HOUSING

Public Act No. 99-244, effective October 1, 1999

21. AN ACT CONCERNING ELDERLY TRANSPORTATION SERVICES

Public Act No. 99-265, effective October 1, 1999

22. AN ACT CONCERNING REQUIREMENTS UNDER THE AFFORDABLE HOUSING APPEALS PROCEDURE AND JURISDICTION OVER AFFORDABLE HOUSING APPEALS

Public Act No. 99-261.

Effective June 29,1999, except section 2 (regarding the assignment of judges) is effective October 1, 1999

23. AN ACT CONCERNING CONTINUING CARE FACILITIES

Public Act No. 99-282, effective October 1, 1999

24. AN ACT CONCERNING PROGRAMS AND MODIFICATIONS NECESSARY TO IMPLEMENT THE BUDGET RELATIVE TO THE DEPARTMENT OF SOCIAL SERVICES

Public Act No. 99-279.

Effective June 29, 1999 unless otherwise indicated

25. AN ACT CONCERNING PUBLIC HEALTH EXPENDITURES; DEPARTMENT OF MENTAL HEALTH AND ADDICTION SERVICES TRANSPORTATION COSTS, CENTERS, VENDOR PAYMENTS AND INFORMATION ON ARRESTED PERSONS; TOBACCO SETTLEMENT FUNDS; DENTAL CLINICS; COMMUNITY HEALTH CENTERS; ACCESS TO AGENCY DATA; NAIL TECHNICIAN AND OTHER LICENSURE REQUIREMENTS; STUDIES OF PROSTATE, BREAST AND CERVICAL CANCER; SCHOOL COACHES; BODY PIERCING; NEEDLE EXCHANGE; WATER SUPPLY, DAY CARE WORKERS; A MEDICAL INSURANCE STUDY; AN AIDS DRUG PROGRAM; LOAN FUNDS FOR HOSPITALS; THE OFFICE OF CHILD ADVOCATE; THE CHILD FATALITY REVIEW PANEL; STATE EMPLOYEE DEATH BENEFITS; LOTTER SALES; SEXUAL OFENDERS; PHARMACY COMPUTER PROBLEMS; HIV TESTING; NOTIFICATION OF MEDICAL TEST RESULTS; AND TECHNICAL CHANGES

June Special Session, Public Act No. 99-2 (Sections 15, 29 and 42).

Effective June 29, 1999, unless otherwise indicated

III. OTHER LEGISLATIVE INITIATIVES SUPPORTED BY THE GENERAL ASSEMBLY

1. MEDICARE CO-PAYMENTS AND DEDUCTIBLES

1999 LEGISLATIVE SUMMARY

I. INTRODUCTION

The 1999 General Assembly closed out its regular session on June 9, 1999. A Special Session was held on June 14, 1999 to enact technical corrections to the General Statutes and to consider certain Public and Special Acts.

This year the General Assembly considered numerous bills that have implications for the long-term care industry. Although many of these initiatives did not become law, the General Assembly did take action in some areas. The following is a brief summary of legislation enacted in the 1999 Session that relates to providers of services to the elderly.

If you require additional information on any law summarized in this report, or on any other legislation, we encourage you to contact Maureen Weaver at (860) 297-3706 or (203) 498-4384 or PMW@WIGGIN.COM; Catherine P. Baatz at (860) 297-3748 or CPB@WIGGIN.COM; or Ted Kennedy at (203) 498-4371 or EMK@WIGGIN.COM.

II. BILLS PASSED AND SIGNED INTO LAW

1. AN ACT CONCERNING THE MEMBERSHIP OF THE LONG-TERM PLANNING COMMITTEE,

Public Act No. 99-28, effective May 27, 1999.

This law expands the membership of the Long-Term Care Planning Committee, to include three new members: one member from the Department of Mental Retardation (to be appointed by the Commissioner of Mental Retardation), one member from the Department of Mental Health and Addiction Services (to be appointed by the Commissioner of Mental Health and Addiction Services), and one member from the Department of Transportation (to be appointed by the Commissioner of Transportation). It amends C.G.S. §17b-337.

2. AN ACT CONCERNING PETS IN ELDERLY HOUSING,

Public Act No. 99-50, effective October 1, 1999.

The purpose of this law is to allow an applicant for admission to an elderly housing project to have a pet if the project allowed pets when the individual applied for admission but later voted to prohibit pets. It amends C.G.S. § 8-116b, which addresses pets in elderly housing.

3. AN ACT CONCERNING CHARITABLE GIFT ANNUITIES,

Public Act No. 99-52, effective October 1, 1999.

This Act provides that charitable organizations issuing “qualified charitable gift annuities” are not engaging in the business of insurance in the state.
A charitable gift annuity provides periodic cash payments over one or two lives. In exchange for the annuity, a donor transfers cash or other property to the charitable organization that issued the annuity. The actuarial value of the annuity is less than the value of the cash or property transferred, and the difference in value constitutes a charitable deduction for federal tax purposes. A “qualified charitable gift annuity” is a charitable gift annuity described in certain sections of the Internal Revenue Code that is issued by a charitable organization that on the date of the annuity agreement: (a) has a minimum of $300,000 in unrestricted cash, cash equivalents or publicly traded securities, exclusive of assets funding the annuity agreement and (b) has been in continuous operation for at least three years or is a successor or affiliate of a charitable organization that has been in continuous operation for at least three years.

When a charitable organization enters into qualified charitable gift annuity agreement, it must disclose to the donor in writing that the annuity is not (1) insurance under state law, (2) subject to regulation by the insurance commissioner, or (3) protected by state guaranty funds.

Charitable organizations must notify the Insurance Commissioner in writing about their status and status of any annuities they issue by the later of January 1, 2000 or the date that they enter into their first gift annuity agreement. The notice must (a) be signed by an officer or director of the organization; (b) identify the organization and (c) certify that the organization is a charitable organization and that the annuities issued by the organization are qualified charitable annuities.

The law provides that any charitable gift annuity issued prior to the effective date of the Act (October 1, 1999) constitutes a “qualified charitable gift annuity” and issuance of that annuity shall not constitute engaging in the business of insurance in this State. The Act specifies that the failure to comply with the disclosure or notice requirement will not prevent an annuity from constituting a qualified charitable gift annuity if it satisfies the Act’s requirements in all other respects. However, if the charitable organization fails to follow the notice requirement, then the Commissioner may fine the organization up to $1,000 per agreement issued until in compliance.

4. AN ACT CONCERNING APPORTIONMENT OF LIABILITY BETWEEN NEGLIGENT AND INTENTIONAL TORTFEASORS,

Public Act No. 99-69.

The Act takes effect May 27, 1999, and is also applicable to any civil action pending or filed on or after August 11, 1998.

The purpose of this Act was to legislatively overrule the Connecticut Supreme Court’s decision in Bhinder v. Sun Co., 246 Conn. 223 (August 11, 1998), and to prohibit apportionment of liability or damages, with certain exceptions, between parties liable for negligence and parties liable on any other basis other than negligence, such as intentional tortfeasors.

The Bhinder court considered the question of whether the owner of a convenience store, sued by the estate of an employee killed during a robbery, could cite in the criminal assailant as an apportionment defendant. The court held that liability could be apportioned under such circumstances between a negligent defendant and a defendant whose willful, wanton, or reckless conduct also caused the injuries or death. The court concluded that although Connecticut’s comparative negligence statute, C.G.S. § 52-572h, does not authorize such apportionment, Connecticut common (judge-made) law should be expanded to allow it.
In passing the law, the General Assembly sought (1) to clarify its legislative intentions when enacting C.G.S. §§ 52-102b and 52-572h which it felt disallowed such apportionment; (2) to restate its desire to eliminate common law joint and several liability, and (3) to reestablish G.G.S. §§ 52-102b and 52-572h as the sole means of apportioning damages between parties in any civil action.

5. AN ACT CONCERNING ADMINISTRATION OF MEDICATION IN RESIDENTIAL CARE HOMES,

Public Act No. 99-80, effective October 1, 1999.

The purpose of this Act is to modernize the regulations on administration of medications in residential care homes and to clarify the type of required training needed for those who administer medications in residential care home environments.
The Act directs the Commissioner of Public Health to adopt regulations on or before July 1, 2000 specifically permitting unlicensed personnel to administer medications in residential care homes, provided that they obtain certain training and certification. The future regulations must establish ongoing training requirements, including initial orientation, resident rights, behavioral management, personal care, nutrition and food safety, and general health and safety.

6. AN ACT CONCERNING UTILITY CHARGES FOR NUSING HOME RESIDENTS,

Public Act No. 99-87, effective July 1, 1999.

The purpose of this Act is to prevent nursing homes from charging patients for telephone, cable television or other telecommunication services, any amounts that exceed the amounts paid by the nursing home for the service. Nursing homes may no longer charge a surcharge or administrative fee for providing such services.

7. AN ACT MANDATING PSYCHOLOGISTS TO REPORT CASES OF ABUSE, NEGLECT AND EXPLOITATION OF THE ELDERLY,

Public Act No. 99-101, effective October 1, 1999.

The purpose of this Act is to include psychologists in the list of professionals with a statutory duty to report suspected abuse, neglect or exploitation of the elderly. It amends C.G.S. § 17b-451(a).

8. AN ACT CONCERNING HOME HEALTH CARE RATES,

Public Act No. 99-130, effective October 1, 1999.

This Act eliminates the Connecticut Department of Social Services’ (DSS) authority to set the maximum rates that home health agencies and homemaker-home health aide agencies can charge the public for their services. Connecticut was the last state to regulate such payments. It amends C.G.S. § 17b-242.

Under the prior law, DSS set the maximum rate that could be charged, fearing price gouging of senior citizens, especially in Connecticut’s rural areas with little or no competition from other home health providers. Ever since the enactment of the Balanced Budget Act of 1997, however, utilization rates in the home care industry have declined dramatically, and the costs to provide home care have often exceeded the maximum allowable reimbursement rates. The potential lack of competition was no longer viewed as a significant issue.
Under the new law, all home health agencies and homemaker-home health aide agencies must file annual cost reports and service charge information with DSS. DSS will continue to evaluate the reimbursement rates.

9. AN ACT CONCERNING THE ELIGIBILITY OF ELDERLY AND TOTALLY DISABLED RENTERS WHO RECEIVE CASH ASSISTANCE FROM THE DEPARTMENT OF SOCIAL SERVICES FOR A PARTIAL REBATE OF RENT AND UTILITY EXPENSES,

Public Act No. 99-134, effective January 1, 2000.

This Act simplifies the process for the Office of Policy and Management (OPM) to give tax rebates up to $400 to some low-income elderly and disabled renters. It requires that any cash assistance received from DSS by a person in a year prior to a year in which the person files an application for a grant for a partial rebate of rent and utility expenses shall be automatically deducted from the amount of the grant in instances where the difference is equal to or greater than $10. Under the prior law, otherwise eligible renters who had received cash benefits from DSS in the previous year had to repay DSS before OPM would give them their rebate. This Act amends C.G.S. § 12-170d(a).

10. AN ACT INCREASING UNEMPLOYMENT COMPENSATION DEPENDENCY ALLOWANCES,

Public Act No. 99-154, effective October 1, 1999.

The purpose of this Act is to increase, from $10 to $15, the weekly allowance an unemployment compensation claimant can receive for each dependent. It eliminates the dependency allowance cap of 50% of the claimants total weekly benefit rate but retains the five-dependent limit, making the maximum allowance $75 per week. Dependents include the claimant’s non-working spouse who lives with the claimant and the children (and stepchildren) that the claimant supports. It amends C.G.S. § 31-234.

11. AN ACT CONCERNING THE ALZHEIMER’S RESPITE CARE DEMONSTRATION PROGRAM,

Public Act No. 99-162, effective July 1, 1999.

This Act increases, from 21 to 30, the number of days that certain individuals with Alzheimer’s disease are eligible to receive an out-of-home respite care services benefit. This out-of-home respite care services benefit is part of a demonstration program that the General Assembly established in 1998 to provide short-term relief to caretakers of individuals with Alzheimer’s disease. The Act specifies that adult day care services are not subject to the 30-day maximum for out-of-home respite care services. It amends C.G.S. § 17b-349e.

The demonstration program provides up to $3,500 a year in respite benefits to caretakers needing help caring for someone with Alzheimer’s disease. To be eligible, the Alzheimer’s patient may have no more than $30,000 in annual income or $80,000 in liquid assets. In addition, the patient may not be covered by Medicaid.

The Act also requires that JCAHO-accredited service providers be given preference in contracting with the state for the provision of respite care services under the demonstration program.

12. AN ACT CONCERNING ADVANCED PRACTICE NURSING,

Public Act No. 99-168, effective October 1, 1999.

The purpose of this Act is to remove the physician direction requirements on advanced practice registered nurses (APRNs).

A. Collaboration vs. Direction

The most significant change in the operative words of the new amendments to the relevant statute, C.G.S. § 20-87a, is that APRNs shall now “collaborate with a physician” instead of having to treat patients “under the direction of a physician.”
“Collaborate” is defined by the new law as “a mutually agreed upon relationship” between an APRN and a physician. The Act states that the collaboration should address such issues as the level of consultation and referral; coverage for the patient in the absence of the APRN; a method to review patient outcomes, and a method of disclosure of the relationship to the patient.

The law requires that a description of the relationship and roles of the physician and APRN be in writing.

B. Prescriptive Authority

The Act also addresses prescriptive authority of APRNs to reflect the collaborative approach. The Act states that the collaboration plan between APRNs and physicians regarding prescriptive authority must be in writing and must “address the level of schedule II and III controlled substances that the [APRN] may prescribe [,] and provide a method to review patient outcomes, including, but not limited to, the review of medical therapeutics, corrective measures, laboratory tests and other diagnostic procedures that the [APRN] may prescribe, dispense and administer.” An APRN prescribing, administering, or dispensing controlled substances must get a certificate of registration from the Department of Consumer Protection (DCP). The prescription form used by the APRN must contain the name of the collaborating physician.

Prior to the Act, APRNs, under the direction of a state-licensed physician, and according to written protocols, could prescribe, dispense, and administer “medical therapeutics and corrective measures” if practicing in (1) health care institutions (defined by law as: hospitals, nursing homes, residential care homes, health care facilities for the handicapped, rest homes, mental health facilities, substance abuse treatment facilities, infirmaries at educational facilities, or state facilities providing prevention, treatment and diagnostic services), (2) licensed industrial health facilities serving at 2,000 employees, (3) clinics operated by the state, municipalities or private nonprofit corporation, and (4) clinics operated by educational institutions. In all other settings, APRNs could prescribe and administer but could not dispense drug samples.

Under the new law, as under existing law, APRNs prescribing and administering medical therapeutics during surgery may do so only if the physician medically directing the prescriptive activity is physically present in the institution where the surgery takes place. In addition, the Act does not alter the restriction that APRNs working outside institutional settings can only dispense professional samples.

C. Malpractice Insurance Requirement

The new law also requires that all APRNs providing direct patient care services have professional liability insurance of at least $500,000 per person per occurrence with an aggregate of at least $1.5 million.

13. AN ACT CONCERNING PHYSICAL RESTRAINT OF PERSONS WITH DISABILITIES,

Public Act No. 99-210.

Effective June 29, 1999 for the ban on using life-threatening physical restraints. Other provisions are effective October 1, 1999.

The purpose of this Act is to prohibit the use of “life-threatening restraints” on children and other “persons at risk.” The Act applies to persons in institutions licensed by or under contract with Departments of Public Health (DPH), Mental Retardation (DMR), Children and Families (DCF) and Mental Health and Addiction Services (DMHAS), but excludes patients in nursing homes that are subject to federal regulations governing the use of restraints. The law does apply to chronic disease hospitals and general hospitals.

“Life-threatening physical restraint” means any physical restraint or hold of a person that restricts the flow of air into the person’s lungs, whether by chest compression or any other means. The terms does not include the practice of briefly holding the person down in order to calm or comfort the person, restraining a person for patient transport, or providing protective gear, such as helmets, mitts, and other devices in trying to prevent self-injury whenever such devices are part of a treatment plan.

Under the new law, no provider of care, educator, or supervisor may involuntarily restrain a person, place a person in seclusion, or medicate a person without consent. An exception exists for emergency interventions to prevent immediate or imminent harm to the patient or others, and in situations when the nature of the restraint, seclusion or medication are therapeutically appropriate and not a substitute for other appropriate treatment.

Any use of physical restraints or seclusion shall be documented in the person’s medical or educational record. Injuries resulting from their use must be reported to the state agency overseeing the institution, which in turn must report them to state protective agencies.

The Act also requires each affected institution to develop policies and procedures for training staff in restraint use and its alternatives, for monitoring, and for internal reporting.

14. AN ACT ADJUSTING THE CAP ON WORKERS’ COMPENSATION ASSESSMENTS FOR ADMINISTRATIVE COSTS,

Public Act No. 99-214, effective July 1, 1999.

This Act increases the Workers’ Compensation Commission (WCC) employer assessment cap for the fiscal years ending June 30, 2000 and June 30, 2001 from the current 4% to 5% of the employer’s workers’ compensation expenses for the prior year. For the fiscal years ending on or after June 30, 2002, such assessment cap will return to 4% of the employer’s workers’ compensation expenses for the prior year. This law also requires the chairman of the Workers’ Compensation Commission to include the cost of funding occupation health clinics created in accordance with Connecticut statutes in determining the amount needed to meet the Commission’s annual expenses.

15. AN ACT CONFORMING THE STATE NURSING HOME OMBUDSMAN OFFICE WITH THE FEDERAL OLDER AMERICANS ACT,

Public Act No. 99-176, effective July 1, 1999.

The purpose of this Act is to make Connecticut’s nursing home ombudsman law more consistent with the federal Older Americans Act of 1965 (OAA). The OAA requires states to have a long-term care ombudsman program in order to receive federal elderly funding.

The Act also changes the name of the “Nursing Home Ombudsman Office” to the “Office of the Long-Term Care Ombudsman,” and substitutes the terms “long-term care facility” for “nursing home” and “residents” for “patients” throughout the statute, C.G.S. § 17b-400. The definition of “long term care facility” includes chronic and convalescent nursing homes, rest homes with nursing supervision and residential care homes.

The new law makes the State Ombudsman more independent, but keeps the office within DSS’ Division of Elderly Services. Although the Act retains the DSS Commissioner’s authority to appoint the State Ombudsman, it authorizes the Ombudsman to appoint assistant regional ombudsmen and residents’ advocates. The new law states that the State Ombudsman shall be a full-time position.

The Act makes other changes in the current statute in order to comply with the OAA in the following ways: (1) it removes the regional ombudsmen and residents’ advocates as mandated reporters of elder abuse, (2) it requires the State Ombudsman to monitor and comment on laws, regulations and government policies pertaining to the elderly, and authorizes him/her to provide recommendations to the General Assembly, and to ensure that state laws comply with the federal Older Americans Act of 1965, and (3) it provides the State Ombudsman with greater latitude in identifying problems affecting residents, advocating for the health, safety and welfare of residents, resolving resident complaints.

The new Act extends the authority of the State Ombudsman beyond that mandated by the OAA in that it allows the Ombudsman to investigate complaints from applicants for admission into long-term care facilities. The OAA is limited to long term care facilities.
The Act requires the State Ombudsman to promulgate regulations to carry out the Act, including its provisions regarding the responsibilities and training of regional ombudsmen and residents’ advocates.

16. AN ACT CREATING A MEDICARE CONSUMERS’ GUIDE,

Public Act No. 99-177, effective July 1, 1999.

This Act requires DSS, through its CHOICES program, to develop and distribute a Connecticut Medicare consumers guide so beneficiaries can compare plans. CHOICES is a federally recognized health insurance counseling and assistance program managed and operated by DSS in cooperation with the area agencies on aging and the Center for Medicare Advocacy. The Act permits the insurance commissioner, in cooperation with or on behalf of the DSS commissioner, to require Medicare plans (1) to annually submit data, reports or information relevant to beneficiaries, and (2) whenever changes occur, to submit information concerning current benefits, services and costs. The goal is to allow beneficiaries to compare and analyze their options for Medicare services.

17. AN ACT CONCERNING ORGAN DONATION,

Public Act No. 99-120, effective October 1, 1999.

This Act adds “any person legally authorized to make health care decisions for the decedent prior to death,” and conservators of the person, to the list of persons (in order of priority) who can make an anatomical gift of all or part of the deceased’s body. The Act includes “health care agents” as “any person legally authorized to make health care decisions for the decedent prior to death.” In doing so, the Act conflicts with Connecticut law governing health care agents, which authorizes the health care agent only to convey the patient’s wishes, not to make decisions on his or her behalf.

The Act also eliminates provisions of existing law that (1) required a designated hospital staff person to ask patients if they are organ donors on or before their admission to the hospital or as soon as possible thereafter, and (2) specified the next steps that a person must take depending on the answer.

18. AN ACT IMPROVING OVERSIGHT OF MEDICAID MANAGED CARE PLANS,

Public Act No. 99-167, effective October 1, 1999.

This Act requires the Medicaid Managed Care Council to make recommendations to DSS on the need for program quality studies in the areas subject to its review, and for DSS to apply for available grant funds to conduct these studies. The council is charged with making recommendations in these or other areas and must report to the legislature quarterly on its activities and progress.

19. AN ACT CONCERNING MANAGED CARE ACCOUNTABILITY,

Public Act No. 99-284.

Effective October 1, 1999, with certain exceptions for the provisions concerning the expansion of coverage for specified conditions and the mental health parity sections of the various insurance requirements to begin on January 1, 2000, and for the medical records sections to take effect July 1, 2000.

A. Physician profiles to be posted on the Internet

The Act requires DPH, in conjunction with the Connecticut State Medical Society and the State Medical Examining Board, to develop profiles of each state-licensed physician, and make them available to the public in the Internet. The profile must contain information about the physician’s education: practice specialty and certifications; medical malpractice judgments; arbitration awards and settlements (but not actual amounts paid by physicians); disciplinary actions; criminal convictions; hospital privileges; and other information.

B. New requirements of managed care organizations (MCOs)

This Act makes a number of changes concerning the operations, procedures and regulations of MCOs and other health insurers and entities. The Act (1) establishes the Office of Managed Care Ombudsman; (2) extends to MCOs certain insurance law provisions on unfair methods of competition or unfair or deceptive acts or practices; (3) requires benefits for the diagnosis and treatment of mental or nervous condition [expands the requirement for mental health parity in mental health contracts]; (4) requires health insurers to define the extent to which they cover experimental treatments and requires coverage of experimental treatments under certain conditions; (5) requires MCOs to promptly pay claims; (6) requires MCOs to complete coverage determinations within 45 days of after a request for determination and notify the insured and provider in the care of a denial; (7) extends the law establishing standards for the collection, care and disclosure of insurance information to medical record information collected by MCOs and other entities; (8) prohibits a variety of insurance and health-related entities and professionals from selling individually identifiable health information, or marketing such information without consent; (9) requires insurance-related entities to develop and implement written standards and procedures for management, transfer and security of medical information that they collect; (10) requires MCOs to resolve enrollee complaints and grievances within 60 days; (11) requires the Insurance Department to develop a public education and outreach program about appeals procedures; (12) requires MCOs to allow continued use of prescribed drugs that the insurer later determines are not covered for patients with a chronic illness under certain conditions; (13) requires, rather than allows, employers to keep medical records separate from and not a part of a personnel file; (14) requires health insurance coverage for outpatient self-management training for the treatment of certain types of diabetes; (15) requires coverage of prostate cancer screenings for certain men; (16) requires health insurers to cover Lyme disease treatment under specified conditions; and (17) requires health insurers and Medicaid to cover general anesthesia, nursing, and related hospital services in conjunction with dental services under certain conditions.

20. AN ACT CONCERNING INCOME LIMITS FOR CONTINUED OCCUPANCY IN CONGREGATE HOUSING,

Public Act No. 99-244, effective October 1, 1999.

This bill eliminates the following requirements for elderly housing:

1. Establishment of maximum income and asset limits for continued occupancy, subject to the approval of the Commissioner of Economic and Community Development (“the Commissioner”).

2. The annual submission to the Commissioner of standards of continued occupancy.

21. AN ACT CONCERNING ELDERLY TRANSPORTATION SERVICES,

Public Act No. 99-265, effective October 1, 1999.

This law requires the Commissioner of Transportation to establish state-wide objectives for providing special transportation services, including services for people with disabilities, the elderly, and people receiving Medicaid and services required under the federal Americans with Disabilities Act.

The commissioner must establish a state matching grant program for municipalities to provide “elderly and disabled demand responsive transportation programs” (e.g. dial-a-ride) for persons age 60 or older. In addition, the law requires the Commissioner to make biannual reports to the Transportation Committee of the General Assembly.

Finally, the law requires that the Connecticut Public Transportation Commission include one person who is 60 older.

22. AN ACT CONCERNING REQUIREMENTS UNDER THE AFFORDABLE HOUSING APPEALS PROCEDURE AND JURISDICTION OVER AFFORDABLE HOUSING APPEALS,

Public Act No. 99-261.

Effective June 29,1999, except section 2 (regarding the assignment of judges) is effective October 1, 1999.

This Act establishes more stringent criteria that developers must satisfy to be eligible to use the affordable housing appeals procedure to challenge municipal development decisions. Developers using private financing must make at least 25% of the units available as affordable housing for at least thirty years after the initial occupation of the proposed development. Furthermore, the law creates a two-tier system dividing affordable housing among two eligible income groups. At least 10 percent of the dwelling units must be sold or rented to people with very-low income (earnings less than 60% of the area’s or the state’s median income, whichever is less). The remaining units needed to meet the 25% set-aside requirement must be affordable to people with low and moderate incomes (earnings of 80% or less of the area’s or the state’s median income, whichever is less).

The law requires the Chief Court Administrator to make efforts to he extent practicable to assign cases regarding affordable housing appeals, including pretrial motions, to a small number of judges who sit in geographically diverse parts of the state. Furthermore, each assigned judge must hear appeals in the judicial district in which the judge sits.

23. AN ACT CONCERNING CONTINUING CARE FACILITIES,

Public Act No. 99-282, effective October 1, 1999.

This law requires a continuing care facility to provide a revised and up-to-date disclosure statement to a prospective resident or that person’s legal representative not more than 60 or less than 10 days before a person occupies the continuing care facility. If there have been no changes to the original disclosure statement previously provided to the prospective resident when he or she executed the continuing care contract (as required under the current law), then the facility must provide a statement that no revisions have been made.

Under the Act, each facility must provide annual notification to each resident of the right to view financial and actuarial information that the facility files annually with the Department of Social Services and the right to receive a copy of the most recent filing upon request from the facility.

The Act authorizes the Commissioner of Social Services to adopt regulations to prescribe financial and actuarial information to be filed.

The law requires a provider operating a continuing care facility to notify the commissioner, in writing, prior to refinancing any existing indebtedness or making any material change in its business or corporate structure. The commissioner also may require a provider operating or constructing a continuing care facility to submit information upon request if the commissioner has reason to believe that the facility, if currently operating, is in financial distress or, if under construction, is at risk of being in financial distress. “Financial distress” means the issuance of a negative going concern opinion, or failure to meet debt service payments, or drawing down on debt service reserve. The commissioner is also given the authority to adopt regulations to prescribe additional conditions that constitute financial distress.

Finally, the law allows the commissioner to request the Attorney General to seek restitution or damages and other appropriate relief on behalf of a person injured by violations of statutes governing management of continuing care facilities.

24. AN ACT CONCERNING PROGRAMS AND MODIFICATIONS NECESSARY TO IMPLEMENT THE BUDGET RELATIVE TO THE DEPARTMENT OF SOCIAL SERVICES,

Public Act No. 99-279.

Effective June 29, 1999 unless otherwise indicated.

A. Pharmaceutical Purchasing Initiative (Section 3), effective July 1, 1999

The purpose of this section is to enable the DSS Commissioner to implement a pharmaceutical purchasing initiative by contracting with an established entity for the purchase of maintenance drugs through the lowest pricing available for Medicaid recipients. The contracting entity must have an established pharmaceutical network and a demonstrated ability to process the prescription volume for Medicaid recipients.

B. Adjustments to State Supplement to Social Security Income (Section 7), effective July 1, 1999

This section extends the moratorium on any increase in the adult payment standards for the state supplement to federal SSI payments through the fiscal years ending June 30, 2000 and June 30, 2001.

C. Eligibility of Legal Aliens for State-Funded Medical Assistance, Home Care for the Elderly, and General Assistance Benefits (Sections 10, 11, and 12), effective July 1, 1999

This section extends the eligibility of certain qualified aliens or other lawfully residing immigrant aliens for state-funded medical assistance (similar to Medicaid coverage), Home Care Program for the Elderly and General Assistance benefits to July 1, 2001.

D. Payment for Long-Term Care Provided to Certain Illegal Aliens (Section 15)

This section enables the DSS Commissioner to include the costs of “other incidentals” in the payment made to long-term care facilities for the costs of care of certain illegal aliens who had been admitted to an acute care or psychiatric hospital and for whom services available in a long-term care facility had been determined to be an appropriate and cost-effective alternative.

E. Wage and Salary Enhancements (Sections 19 and 20), effective July 1, 1999

These sections amend Conn. Gen Stat. § 17b-340, which governs nursing home Medicaid rates.

1. The law requires that the Commissioner of Social Services adjust facility rates for the period from April 1, 1999 to June 30, 1999, and for the fiscal years ending June 30, 2000 and June 30, 2001, by a per diem amount representing the facility’s allocation of funds appropriated for wage, benefit and staffing enhancement.

• The law sets forth the methodology that the Department must follow to determine the per diem enhancement amount.

• The methodology involves computation of (A) a facility’s allowable (prior to application of cost caps) direct and indirect component salary, wage, nursing pool and allocated fringe benefit costs for the 1998 cost report period multiplied by (B) the facility’s 1998 Medicaid utilization. The facility’s percentage share is then calculated by dividing the totals of (A) and (B) for all facilities. The facility’s percentage share is then multiplied by the amount appropriated for wage, benefit and staffing enhancement funding to determine the facility’s allocated amount. To derive the per diem rate enhancement, this allocated amount is then divided by the number of days of care paid for by Medicaid on an annual basis, including days for reserved beds specified in the 1998 cost report.

• If a facility’s reported 1998 information is not representative of estimated cost and utilization data for the fiscal year ending June 30, 2000 due to special circumstances during the 1998 cost report period (e.g. change of ownership with a partial year cost filing or reductions in capacity due to renovations), then the Commissioner may adjust the facility’s reported 1998 cost and utilization data.
• For facilities on interim rates or facilities that received rate increases during the fiscal year ending June 30, 1999, the Commissioner may withhold or reduce the per diem enhancement .
• If a facility accepts the rate adjustment for wage, benefit and staffing enhancements, it must apply resulting payments to increased allowable employee wage rates and benefits and additional direct and indirect component staffing. The law specifically prohibits facilities from using the rate adjustment amounts for wage and salary increases provided to the administrator, assistant administrator, owners or related party employees.
• Facilities may apply enhancement payments to cost increases associated with staffing purchased from staffing agencies (e.g. nursing pool agencies) provided the Commissioner deems those cost increases “necessary and reasonable.”
• The law requires the Commissioner to compare expenditures for wages, benefits and staffing for the 1998 cost report period to those expenditures for the 1999, 2000 and 20001 cost report periods to verify whether a facility applied the additional payments to specified wage, benefit and staffing cost enhancements. If the Commissioner determines that the facility did not apply additional payments to specified enhancements, the Commissioner must recover those amounts from the facility “through rate adjustments or other means.”

2. The law also provides for a one percent rate increase for the fiscal year ending June 30, 2000 and a two percent rate increase for the fiscal year ending June 30, 2001. These increases do not apply to facilities with interim or replaced rates during the prior rate period. For interim rate and replaced rate facilities and facilities that received scheduled rate adjustments in a certificate of need or other agreement, rates for fiscal years ending June 30, 2000 and June 30, 2001 respectively are limited to no more than one percent and two percent of the prior year’s rate. The one and two percent increases are exclusive of increases associated with wage, benefit and staffing enhancements.

3. The law establishes cost component caps for facilities on interim rates during one or both of fiscal years ending June 30, 2000 and June 30, 2001. These caps are as follows: for direct costs, 145% of median allowable cost for the applicable peer grouping; for indirect costs, 125% of state-wide median allowable cost; for administrative and general costs, the state-wide median allowable cost. These cost maximums must be based on the same cost year used to set rates for prospective rate facilities.

F. Reimbursement for Residential Care Homes (Section 21), effective July 1, 1999

This section provides for an increase of two percent, beginning with the fiscal year ending June 30, 2000, in the calculation of the inflation adjustment made to account for the time lag between the cost period and the rate period.

G. Demonstration Project for Subsidized Assisted Living Services in Affordable Housing (Section 22), effective July 1, 1999

This section allows the DSS Commissioner to expand the demonstration project to provide subsidized assisted living services for persons living in affordable housing beyond the initial minimum of three municipalities to “at least” three municipalities. The law also clarifies that the demonstration project is limited to a maximum of three hundred subsidized dwelling units. However, the law further provides that there is no prohibition on a combination of unsubsidized and subsidized dwelling units under the demonstration project within the same facility. The law also permits the Department of Economic and Community Development to set the rental subsidy at any percentage of the annual aggregate family income and to define aggregate family income and eligibility for subsidies in a manner consistent with the demonstration project.

H. Demonstration Project for Provision of Respite Care Services for Caretakers of Alzheimer’s Patients (Section 23), effective date July 1, 1999

This section allows the DSS Commissioner to allocate funds appropriated in excess of five hundred thousand dollars for the respite care demonstration project among the five area agencies on aging according to need as determined by the Commissioner.

I. Demonstration Project for the Provision of Specialized Long-Term Care (Section 24), effective July 1, 1999

This section provides for an increase in the number of existing licensed beds that may be utilized for this demonstration project from “up to sixty” to “up to seventy-five” in no more than three facilities. The law also allows for an increase in the number of facilities participating in the project from three to four on or after January 1, 2000. Finally, the Act gives the commissioner the authority to issue a request for proposals or select the participating facilities from the respondents to a request for proposals.

J. Home Care Program for the Elderly (Sections 37, 38, and 39), effective July 1, 1999

This section requires the DSS Commissioner to establish a state-funded pilot program to allow ten persons to receive services under the home-care program for the elderly. Such persons must have formerly received such services under the program, must be eligible for the Medicaid-funded portion of the program except income exceeds eligibility limit by no more than $100.00 and must be determined to otherwise require care in a long-term care facility, if home-care services were not available. The person’s income exceeding the income eligibility limit may be used to contribute toward the cost of services provided. Such persons shall receive medical services equivalent to such services provided under the Medicaid program. The pilot program terminates on June 30, 2000. The DSS Commissioner must submit a report to the Human Services, the Aging, and the Budget Committees of the General Assembly by October 1, 2000.

In addition, the law requires the Long-Term Care Planning Committee to develop a plan to ensure the availability of home care services for elderly persons under the home-care program who would otherwise qualify except for exceeding the income eligibility limits. The Committee must submit a report to the Human Services and the Aging Committees of the General Assembly by February 1, 2000.

K. Study of Medicaid Per Diem Prospective Payment System (Section 41), effective July 1, 1999

This section requires the Nursing Home Financial Advisory Committee to study the current payment system for nursing facilities and develop recommendations regarding a per diem prospective payment system covering costs for services provided to Medicaid recipients. The following factors will be considered: (1) Historic allowable costs; (2) case-mix adjusted per diem payment using a resident classification system based on data from nursing facility resident assessments; (3) geographic adjustments based on rent and wage rates; and (4) annual inflationary updates. The Committee must also consider the feasibility of a phase-in of the per diem prospective payment system beginning July 1, 2001 to June 30, 2003 and submit a report to the Budget and the Human Services Committees of the General Assembly by February 1, 2000.

L. Sale of Nursing Home and Per Diem Rate (Section 42), effective July 1, 1999

This section provides that in the event of a sale of a nursing home between July 1, 1999 and June 30, 2001, any increase in the per diem rate received by the nursing home must not exceed 20 percent of the rate such facility was receiving on the date of sale, unless provided otherwise under Connecticut law.

M. Modifications to Pharmacy Benefits of CONNPace, Medicaid, or State-Funded Medical Assistance (Section 43), effective July 1, 1999

This law required the DSS Commissioner to submit financial reports to certain committees of the General Assembly at least 30 days prior to entering into a contract to modify, or prior to the implementation of any modifications to the pharmacy benefit or financial structure of the CONNPace, the medical assistance program under the state-administered general assistance program, or the Medicaid program.

25. AN ACT CONCERNING PUBLIC HEALTH EXPENDITURES; DEPARTMENT OF MENTAL HEALTH AND ADDICTION SERVICES TRANSPORTATION COSTS, CENTERS, VENDOR PAYMENTS AND INFORMATION ON ARRESTED PERSONS; TOBACCO SETTLEMENT FUNDS; DENTAL CLINICS; COMMUNITY HEALTH CENTERS; ACCESS TO AGENCY DATA; NAIL TECHNICIAN AND OTHER LICENSURE REQUIREMENTS; STUDIES OF PROSTATE, BREAST AND CERVICAL CANCER; SCHOOL COACHES; BODY PIERCING; NEEDLE EXCHANGE; WATER SUPPLY, DAY CARE WORKERS; A MEDICAL INSURANCE STUDY; AN AIDS DRUG PROGRAM; LOAN FUNDS FOR HOSPITALS; THE OFFICE OF CHILD ADVOCATE; THE CHILD FATALITY REVIEW PANEL; STATE EMPLOYEE DEATH BENEFITS; LOTTER SALES; SEXUAL OFENDERS; PHARMACY COMPUTER PROBLEMS; HIV TESTING; NOTIFICATION OF MEDICAL TEST RESULTS; AND TECHNICAL CHANGES,

June Special Session, Public Act No. 99-2 (Sections 15, 29 and 42). Effective June 29, 1999, unless otherwise indicated.

A. Nursing Home Change of Ownership (Section 15)

The law expands the list of persons deemed to be “a person related by blood or marriage” for purposes of determining whether a change of ownership (“CHOW”) of a nursing home is subject to the prior approval of the Department of Public Health (“DPH”). In addition, the law expressly provides that a change in the legal form of the ownership entity shall not be considered a CHOW if the beneficial ownership is unchanged and the owner provides information regarding the change required by DPH to identify the current status of ownership and beneficial ownership of the facility.

B. Nursing Home License Renewal (Section 39)

This section requires that a person seeking to renew a nursing home license furnish the Department of Public Health with satisfactory written proof that the owner of the facility consents to such renewal if the owner is different than the person seeking renewal.

C. Long-Term Prescription Coverage (Section 42), effective July 1, 1999

This section requires each managed care organization (“MCO”) the ConnPACE program, and the state Medicaid program to develop a plan by October 1, 1999 to address the availability and payment of coverage for long-term prescription medication in the event that:

1. A year 2000 computer problem would make prescription refills problematic due to restrictions on amounts of medication available at any one time; or

2. January 1, 2000 is the termination date of the MCO contract and failure to refill or guarantee reimbursement for the prescription might result in an interruption of a therapeutic regimen or create patient suffering.

III. OTHER LEGISLATIVE INITIATIVES SUPPORTED BY THE GENERAL ASSEMBLY

1. MEDICARE CO-PAYMENTS AND DEDUCTIBLES

The State has authorized the implementation of an existing law that discontinues payment of Medicare co-pays and deductibles for dual eligibles. The law, C.G.S. § 17b-256(b) requires the Commissioner of DSS to “limit reimbursement to medical assistance providers [for dual eligible clients] for coinsurance and deductible payments under the Medicare program to assure that the combined Medicare and Medicaid payment to the provider shall not exceed the maximum allowable under the Medicaid program fee schedules.” The State has indicated that it will only eliminate payment of co-pay and deductibles under Medicare Part B. The State will continue to reimburse providers for co-pays and deductibles under Medicare Part A. Since the state pays the Medicare premiums for these recipients, the state was also paying the copayment to providers. The implementation of this provision limits payments to the Medicaid schedule rate and not the Medicare rate plus the copayment. Providers are required to accept the Medicaid rate and cannot bill the recipient for the copayment.

The implementation of this state provision is in accordance with related amendments to federal law. Since 1989, federal law required state Medicaid programs to pay cost-sharing amounts, including premiums, deductibles and copayments that the federal government does not reimburse for qualified Medicare beneficiaries (“QMBs”). QMBs are elderly or disabled persons who qualify for Medicare and who, in addition, either qualify by reason of their poverty for Medicaid as well (i.e., “dual eligibles”) or though not poor enough to qualify for Medicaid, cannot afford to pay the Medicare Part B premiums, deductible and copayments. The federal law was ambiguous, however, about the level of payment a State would be required to make to satisfy its Medicare cost-sharing obligations, i.e., the full Medicare-approved amount or the State’s Medicaid rate. The federal law was amended by the Balanced Budget Act of 1997 to clarify the ambiguity expressly stating that a State is not required to provide any payment to expenses incurred relating to payments for deductibles, coinsurance, or copayments for QMBs to the extent that payment under Medicare for the service would exceed the amount that would be paid under the Medicaid State plan if the service were provided to an eligible recipient who is not a Medicare beneficiary.

THIS MEMORANDUM IS INTENEDED TO SUMMARIZE LEGISLATION ONLY; IT IS NOT INTENDED TO PROVIDE LEGAL ADVICE. ANYONE CONCERNED ABOUT THE APPLICATION OF A LAW TO PARTICULAR CIRCUMSTANCES SHOULD NOT RELY ON THIS MEMORANDUM, BUT INSTEAD CONSULT LEGAL COUNSEL.