CANPFA Capitol Line
June 10, 2011
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Legislative Session Ends
The State Legislature completed their session Wednesday night at midnight and for the most part, the work of this session is done. The budget and implementers have been passed and several other bills made their way to a final vote by midnight. The one issue remaining is whether or not the state employee unions will ratify the concessions that are included in the state budget. The results of the union votes will not be known before June 24 and if the unions reject the concessions, the Governor, in conjunction with the Legislature, will need to revisit the budget and make additional cuts before the fiscal year begins on July 1. Keep this in mind as you consider the provisions included in the budget at this time.
CANPFA had a very good session, working with legislators, state agencies, and other interest groups to raise our policy issues and to address issues raised by others. Our lobbying team of Robinson & Cole was extremely effective in getting our concerns heard and our issues advanced and we were very pleased with the collaborative spirit of the state agencies that helped to move several issues forward in a manner that was acceptable to all interest parties. And once again our legal team at Wiggin and Dana provided expert guidance throughout the session as they reviewed proposed legislation, drafted language and assisted our advocacy efforts on a full range of issues.
We have included in this edition of Capitol Line a summary of the outcome of the session. A complete review of the 2011 Legislative Session will be produced by Wiggin and Dana and provided to the membership. There will also be a discussion of the session results at the Board and Membership meeting on May 14. In the meantime, if you should have any questions regarding any of the legislation from the session, please contact Mag Morelli at CANPFA.
To access a copy of any of the legislation referenced in this report, go to www.cga.ct.gov and use the “quick search” tool at the top of the page.
State Budget
The state budget document was passed as Senate Bill 1239, now Public Act No. 11-6, AN ACT CONCERNING THE BUDGET FOR THE BIENNIUM ENDING JUNE 30, 2013, AND OTHER PROVISIONS RELATING TO REVENUE.
The bills that implement that budget and provide much of the detail behind the numbers are:
SB 1240, now Public Act No. 11-44, AN ACT CONCERNING THE BUREAU OF REHABILITATIVE SERVICES AND IMPLEMENTATION OF PROVISIONS OF THE BUDGET CONCERNING HUMAN SERVICES AND PUBLIC HEALTH
Bill Analysis
HB 6652, AN ACT IMPLEMENTING THE REVENUE ITEMS IN THE BUDGET AND MAKING BUDGET ADJUSTMENTS, DEFICIENCY APPROPRIATIONS, CERTAIN REVISIONS TO BILLS OF THE CURRENT SESSION AND MISCELLANEOUS CHANGES TO THE GENERAL STATUTES, as amended by Amendment A
HB 6652 [pdf]
Adopted Amendment A to HB 9952
Bill Analysis
SB 1127, AN ACT CONCERNING EXPENDITURES OF APPROPRIATED FUNDS OTHER THAN THE GENERAL FUND, as amended by Amendments A & B
Adopted "Strike All" Amendment A to SB 1127
Adopted Amendment B to SB 1127
SB-1242, AN ACT AUTHORIZING BONDS OF THE STATE FOR CAPITAL IMPROVEMENTS AUTHORIZING SPECIAL TAX OBLIGATION BONDS OF THE STATE FOR TRANSPORTATION PURPOSES AND AUTHORIZING STATE GRANT COMMITMENTS FOR SCHOOL BUILDING PROJECTS
Bill Analysis
Issues relevant to our members that are contained in these budget documents include:
Nursing home rate increase of approximately 3.7% on July 1, 2011 and an additional .33% on July 1, 2012. This is in conjunction with an increase in the nursing home user fee.
Estimated User FeesCurrent / 7-1-11 / 10-1-11
Facilities Under 230 Beds / $15.90 / $18.76 / $20.35
Municipal and 230+ Beds / $12.20 / $14.40 / $15.62
Full June nursing home payment starting this month.
Personal needs allowance reduction from $69 to $60 beginning July 1st.
Adult day center rate increase of $4 a day.
Authorization of the establishment of an Administrative Service Organization (ASO) structure for the Medicaid program with the utilization of a medical home concept.
To facility the ASO model, the Commissioner of DSS is authorized to modify the home health care fee schedule in a cost neutral way to ensure patient access.
Increase in the co-pay for the state funded portion of the Connecticut Home Care Program for Elders from 6% to 7%.
Medicaid payment for eyeglasses limited to one pair every other year, although medically necessary exceptions to this limit were passed in HB-6652.
The maximum capacity for the individual units of the one small house project is increased from 10 to 14 beds.
The maximum asset level for of the community spouse for the purpose of Medicaid eligibility is reduced back to one half of the couple’s assets or the maximum limit, whichever is less. It previously had been raised to just the maximum limit.
The asset transfer rules were clarified to state that under certain conditions, a resident can be penalized for an asset transfer even if the entire amount is returned and that the partial return of a transferred asset will not reduce an imposed penalty period. (The specifics of these provisions will be sent out at a later date.)
The Department of Aging is postponed until 2013.
The Long Term Care Reinvestment Account is repealed.
Permission for the Department of Corrections, DSS, and DMHAS to establish or contract to establish a nursing home on state-owned or private property for persons who require nursing home level of care and are transitioning from prison into the community or are DMHAS clients.
Bond funding for senior housing development - $25 million in each year of the budget.
One Solution at a Time Bill & Statewide Strategic Planning Initiative
CANPFA began the session presenting our public policy position called “One Solution at a Time.” This policy called for the state to provide the regulatory environment we felt was needed to encourage and allow long term care providers to implement strategic plans for their own organizations that could include downsizing or diversifying services. Our concepts were raised by the Public Health Committee in Senate Bill 1185. In the meantime, the state received a $21 million federal rebalancing grant through the Money Follows the Person program to go towards several initiatives including the development of a statewide rebalancing strategic plan. This new dynamic, the fact that the state will actually develop a statewide strategic plan determining the need for long term care services throughout the state, changed the political dynamic surrounding SB 1185.
After much negotiation and discussion with the various state agencies and other associations, new language was developed outlining the state’s strategic planning initiative and incorporating a certain level of regulatory flexibility that had been included in SB 1185. A major difference in the new language from our original concept is that the state now will be looking for nursing homes to collaborate their own organizational planning with the overall statewide strategic plan. In addition, the state will be proactively seeking bed reductions if the strategic plan indicates that is needed. This new language is included as Sections 547 and 548 of the amended HB 6618, An Act Concerning Various Revisions to Public Health Related Statutes, which was passed by the House and Senate and awaits the Governor’s signature. Amendment to 6618
The state is moving quickly to develop the statewide strategic plan and is determined to have a plan in place by the end of September. Mercier has been hired as the consultant on the project and they have already begun work on the data collection and analysis. A large stakeholder meeting will be held in July to actually develop the initial draft of the plan. CANPFA will have representatives invited to that stakeholder meeting.
New Language in Sections 547 and 548 of HB 6618 as amended
Sec. 547. Section 17b-369 of the general statutes is amended by adding subsections (c) to (e), inclusive, as follows (Effective July1, 2011):
(NEW) (c) The Commissioner of Social Services shall develop a strategic plan, consistent with the long-term care plan established pursuant to section 17b-337, to rebalance Medicaid long-term care supports and services, including, but not limited to, those supports and services provided in home, community-based settings and institutional settings. The commissioner shall include home, community-based and institutional providers in the development of the strategic plan. In developing the strategic plan the commissioner shall consider topics that include, but are not limited to: (1) Regional trends concerning the state's aging population; (2) trends in the demand for home, community-based and institutional services; (3) gaps in the provision of home and community-based services which prevent community placements; (4) gaps in the provision of institutional care; (5) the quality of care provided by home, community-based and institutional providers; (6) the condition of institutional buildings; (7) the state's regional supply of institutional beds; (8) the current rate structure applicable to home, community-based and institutional services; (9) the methods of implementing adjustments to the bed capacity of individual nursing facilities; and (10)a review of the provisions of subsection (a) of section 17b-354, as amended by this act.
(NEW) (d) The Commissioner of Social Services may contract with nursing facilities, as defined in section 17b-357, and home and community-based providers for the purpose of carrying out the strategic plan. In addition, the commissioner may revise a rate paid to a nursing facility pursuant to section 17b-340 in order to effectuate the strategic plan. The commissioner may fund strategic plan initiatives with federal grant-in-aid resources available to the state pursuant to the Money Follows the Person demonstration project pursuant to Section 6071 of the Deficit Reduction Act, P. L. 109-171, and the State Balancing Incentive Payments Program under the Patient Protection and Affordable Care Act, P. L. 111-148.
(NEW) (e) The Commissioner of Public Health, or the commissioner's designee, may waive the requirements of sections19-13-D8t, 19-13-D6 and 19-13-D105 of the regulations of Connecticut state agencies, if a provider requires such a waiver for purposes of effectuating the strategic plan developed pursuant to subsection (c) of this section and the commissioner, or the commissioner's designee, determines that such waiver will not endanger the health and safety of the provider's residents or clients. The commissioner, or the commissioner's designee, may impose conditions on the granting of any waiver which are necessary to ensure the health and safety of the provider's residents or clients. The commissioner, or the commissioner's designee, may revoke any waiver granted pursuant to this subsection upon a finding that the health or safety of a resident or client of a provider has been jeopardized.
Sec. 548. Subsection (a) of section 17b-354 of the general statutes is repealed and the following is substituted in lieu thereof (Effective July1, 2011) – Note: Only the underlined text is new, the other text is existing language in the nursing home moratorium statute:
(a) Except for applications deemed complete as of August 9, 1991, the Department of Social Services shall not accept or approve any requests for additional nursing home beds or modify the capital cost of any prior approval for the period from September 4, 1991, through June 30, 2012, except (1) beds restricted to use by patients with acquired immune deficiency syndrome or traumatic brain injury; (2) beds associated with a continuing care facility which guarantees life care for its residents; (3) Medicaid certified beds to be relocated from one licensed nursing facility to another licensed nursing facility, to a new facility to meet a priority need identified in the strategic plan developed pursuant to subsection (c) of section 17b-369, as amended by this act, or to a small house nursing home, as defined in section 17b-372, provided (A) the availability of beds in an area of need will not be adversely affected; (B) no such relocation shall result in an increase in state expenditures; and (C) the relocation results in a reduction in the number of nursing facility beds in the state; (4) a request for no more than twenty beds submitted by a licensed nursing facility that participates in neither the Medicaid program nor the Medicare program, admits residents and provides health care to such residents without regard to their income or assets and demonstrates its financial ability to provide lifetime nursing home services to such residents without participating in the Medicaid program to the satisfaction of the department, provided the department does not accept or approve more than one request pursuant to this subdivision; (5) a request for no more than twenty beds associated with a free standing facility dedicated to providing hospice care services for terminally ill persons operated by an organization previously authorized by the Department of Public Health to provide hospice services in accordance with section 19a-122b; and (6) new or existing Medicaid certified beds to be relocated from a licensed nursing facility in a municipality with a 2004 estimated population of one hundred twenty-five thousand to a location within the same municipality provided such Medicaid certified beds do not exceed sixty beds. Notwithstanding the provisions of this subsection, any provision of the general statutes or any decision of the Office of Health Care Access, (i) the date by which construction shall begin for each nursing home certificate of need in effect August 1, 1991, shall be December 31, 1992, (ii) the date by which a nursing home shall be licensed under each such certificate of need shall be October 1, 1995, and (iii) the imposition of such dates shall not require action by the Commissioner of Social Services. Except as provided in subsection (c) of this section, a nursing home certificate of need in effect August 1, 1991, shall expire if construction has not begun or licensure has not been obtained in compliance with the dates set forth in subparagraphs (i) and (ii) of this subsection.
Centralized Background Checks for Long Term Care
The Department of Public Health is the recipient of a $1.9 million federal grant to establish a centralized state and federal background check system for long term care employees. Senate Bill 3, An Act Concerning a Criminal History and Patient Abuse Background Search Program, was the legislation proposed by the Department of Public Health to authorize the centralized system and implement the grant, but at the end of the session the language was incorporated into in Sections 554-559 of the amendment to HB 6618, An Act Concerning Various Revisions to Public Health Related Statutes, Amendment to 6618, which was passed by the House and Senate and awaits the Governor’s signature. A stakeholder advisory group will work with DPH to develop a plan for the centralized background check system to be submitted the legislature and implemented by July 1, 2012, although the implementation process will be incremental as provider groups are phased into the system over time.