Sec. 17b-342. (Formerly Sec. 17-314b). Connecticut home-care program for the elderly.
Sec. 17b-342. (Formerly Sec. 17-314b). Connecticut home-care program for
the elderly. (a) The Commissioner of Social Services shall administer the Connecticut
home-care program for the elderly state-wide in order to prevent the institutionalization
of elderly persons (1) who are recipients of medical assistance, (2) who are eligible for
such assistance, (3) who would be eligible for medical assistance if residing in a nursing
facility, or (4) who meet the criteria for the state-funded portion of the program under
subsection (i) of this section. For purposes of this section, a long-term care facility is a
facility which has been federally certified as a skilled nursing facility or intermediate
care facility. The commissioner shall make any revisions in the state Medicaid plan
required by Title XIX of the Social Security Act prior to implementing the program.
The annualized cost of the community-based services provided to such persons under
the program shall not exceed sixty per cent of the weighted average cost of care in skilled
nursing facilities and intermediate care facilities. The program shall be structured so
that the net cost to the state for long-term facility care in combination with the community-based services under the program shall not exceed the net cost the state would have
incurred without the program. The commissioner shall investigate the possibility of
receiving federal funds for the program and shall apply for any necessary federal waivers. A recipient of services under the program, and the estate and legally liable relatives
of the recipient, shall be responsible for reimbursement to the state for such services to
the same extent required of a recipient of assistance under the state supplement program,
medical assistance program, temporary family assistance program or food stamps program. Only a United States citizen or a noncitizen who meets the citizenship requirements for eligibility under the Medicaid program shall be eligible for home-care services
under this section, except a qualified alien, as defined in Section 431 of Public Law
104-193, admitted into the United States on or after August 22, 1996, or other lawfully
residing immigrant alien determined eligible for services under this section prior to
July 1, 1997, shall remain eligible for such services. Qualified aliens or other lawfully
residing immigrant aliens not determined eligible prior to July 1, 1997, shall be eligible
for services under this section subsequent to six months from establishing residency.
Notwithstanding the provisions of this subsection, any qualified alien or other lawfully
residing immigrant alien or alien who formerly held the status of permanently residing
under color of law who is a victim of domestic violence or who has mental retardation
shall be eligible for assistance pursuant to this section. Qualified aliens, as defined in
Section 431 of Public Law 104-193, or other lawfully residing immigrant aliens or aliens
who formerly held the status of permanently residing under color of law shall be eligible
for services under this section provided other conditions of eligibility are met.
(b) The commissioner shall solicit bids through a competitive process and shall
contract with an access agency, approved by the Office of Policy and Management and
the Department of Social Services as meeting the requirements for such agency as defined by regulations adopted pursuant to subsection (e) of this section, that submits
proposals which meet or exceed the minimum bid requirements. In addition to such
contracts, the commissioner may use department staff to provide screening, coordination, assessment and monitoring functions for the program.
(c) The community-based services covered under the program shall include, but
not be limited to, the following services to the extent that they are not available under the
state Medicaid plan, occupational therapy, homemaker services, companion services,
meals on wheels, adult day care, transportation, mental health counseling, care management, elderly foster care, minor home modifications and assisted living services provided in state-funded congregate housing and in other assisted living pilot or demonstration projects established under state law. Recipients of state-funded services and persons
who are determined to be functionally eligible for community-based services who have
an application for medical assistance pending shall have the cost of home health and
community-based services covered by the program, provided they comply with all medical assistance application requirements. Access agencies shall not use department funds
to purchase community-based services or home health services from themselves or any
related parties.
(d) Physicians, hospitals, long-term care facilities and other licensed health care
facilities may disclose, and, as a condition of eligibility for the program, elderly persons,
their guardians, and relatives shall disclose, upon request from the Department of Social
Services, such financial, social and medical information as may be necessary to enable
the department or any agency administering the program on behalf of the department
to provide services under the program. Long-term care facilities shall supply the Department of Social Services with the names and addresses of all applicants for admission.
Any information provided pursuant to this subsection shall be confidential and shall not
be disclosed by the department or administering agency.
(e) The commissioner shall adopt regulations, in accordance with the provisions of
chapter 54, to define "access agency", to implement and administer the program, to
establish uniform state-wide standards for the program and a uniform assessment tool
for use in the screening process and to specify conditions of eligibility.
(f) The commissioner may require long-term care facilities to inform applicants for
admission of the program established under this section and to distribute such forms as
the commissioner prescribes for the program. Such forms shall be supplied by and be
returnable to the department.
(g) The commissioner shall report annually, by June first, to the joint standing committee of the General Assembly having cognizance of matters relating to human services
on the program in such detail, depth and scope as said committee requires to evaluate
the effect of the program on the state and program participants. Such report shall include
information on (1) the number of persons diverted from placement in a long-term care
facility as a result of the program, (2) the number of persons screened, (3) the average
cost per person in the program, (4) the administration costs, (5) the estimated savings,
and (6) a comparison between costs under the different contracts.
(h) An individual who is otherwise eligible for services pursuant to this section
shall, as a condition of participation in the program, apply for medical assistance benefits
pursuant to section 17b-260 when requested to do so by the department and shall accept
such benefits if determined eligible.
(i) (1) On and after July 1, 1992, the Commissioner of Social Services shall, within
available appropriations, administer a state-funded portion of the program for persons
(A) who are sixty-five years of age and older; (B) who are inappropriately institutionalized or at risk of inappropriate institutionalization; (C) whose income is less than or
equal to the amount allowed under subdivision (3) of subsection (a) of this section; and
(D) whose assets, if single, do not exceed the minimum community spouse protected
amount pursuant to Section 4022.05 of the department's uniform policy manual or, if
married, the couple's assets do not exceed one hundred fifty per cent of said community
spouse protected amount and on and after April 1, 2007, whose assets, if single, do not
exceed one hundred fifty per cent of the minimum community spouse protected amount
pursuant to Section 4022.05 of the department's uniform policy manual or, if married,
the couple's assets do not exceed two hundred per cent of said community spouse protected amount.
(2) Any person whose income exceeds two hundred per cent of the federal poverty
level shall contribute to the cost of care in accordance with the methodology established
for recipients of medical assistance pursuant to Sections 5035.20 and 5035.25 of the
department's uniform policy manual.
(3) On and after June 30, 1992, the program shall serve persons receiving state-funded home and community-based services from the department, persons receiving
services under the promotion of independent living for the elderly program operated by
the Department of Social Services, regardless of age, and persons receiving services on
June 19, 1992, under the home care demonstration project operated by the Department
of Social Services. Such persons receiving state-funded services whose income and
assets exceed the limits established pursuant to subdivision (1) of this subsection may
continue to participate in the program, but shall be required to pay the total cost of care,
including case management costs.
(4) Services shall not be increased for persons who received services under the
promotion of independent living for the elderly program over the limits in effect under
said program in the fiscal year ending June 30, 1992, unless a person's needs increase
and the person is eligible for Medicaid.
(5) The annualized cost of services provided to an individual under the state-funded
portion of the program shall not exceed fifty per cent of the weighted average cost of
care in nursing homes in the state, except an individual who received services costing
in excess of such amount under the Department of Social Services in the fiscal year
ending June 30, 1992, may continue to receive such services, provided the annualized
cost of such services does not exceed eighty per cent of the weighted average cost of
such nursing home care. The commissioner may allow the cost of services provided to
an individual to exceed the maximum cost established pursuant to this subdivision in a
case of extreme hardship, as determined by the commissioner, provided in no case shall
such cost exceed that of the weighted cost of such nursing home care.
(j) The Commissioner of Social Services may implement revised criteria for the
operation of the program while in the process of adopting such criteria in regulation
form, provided the commissioner prints notice of intention to adopt the regulations in
the Connecticut Law Journal within twenty days of implementing the policy. Such criteria shall be valid until the time final regulations are effective.
(P.A. 85-556, S. 1, 2; P.A. 86-374, S. 4, 6; P.A. 87-363, S. 1, 2; P.A. 89-296, S. 7, 9; P.A. 90-182, S. 1, 3; P.A. 91-176;
May Sp. Sess. P.A. 92-16, S. 37, 89; P.A. 93-262, S. 1, 87; 93-418, S. 27, 41; P.A. 95-160, S. 7, 69; P.A. 96-139, S. 12,
13; June 18 Sp. Sess. P.A. 97-2, S. 76, 165; P.A. 99-279, S. 12, 45; P.A. 00-83, S. 4, 5; June Sp. Sess. P.A. 00-2, S. 10;
June Sp. Sess. P.A. 01-9, S. 110, 131; May 9 Sp. Sess. P.A. 02-7, S. 23; P.A. 04-258, S. 17; P.A. 05-280, S. 10.)
History: P.A. 86-374 rephrased provision in Subsec. (b) re solicitation of bids and contracting processes, expanded
community-based services in Subsec. (c), and inserted new Subsec. (g) re commencement of preadmission screening and
community-based services program, relettering former Subsec. (g) as (h); P.A. 87-363 amended Subsec. (b) to eliminate
the requirement that the commissioner contract with "at least three different" coordination, assessment and monitoring
agencies and Subsec. (g) to remove language specifying that the program start on January 1, 1987, if the department has
approval and added the language providing for implementation when the department has approval and has arranged for
the provision of coordination, assessment and monitoring functions state-wide and added language on operation within
available appropriations; P.A. 89-296 added Subsec. (i) re application for medical assistance benefits under Sec. 17-134a
as condition of participation in program; P.A. 90-182 amended program eligibility criteria in Subsec. (a) to exclude persons
who would become eligible for medical assistance within 180 days if they were placed in a long-term care facility, and to
delete reference to sliding fee schedule for such persons, and to include persons receiving state-funded program services
on June 30, 1990, and persons who apply for such services by June 30, 1990, and are determined eligible; amended Subsec.
(c) to exclude persons who are ineligible for medical assistance from eligibility for home health services and to provide
that persons determined to be functionally eligible for community-based services who have applied for medical assistance
are eligible for home health and community-based services; amended Subsec. (f) to delete provision that long-term care
facilities shall not be required to determine if applicants for admission who are not medical assistance recipients would
become eligible for such assistance within 180 days following admission, and to delete provision that no long-term care
facility shall be subject to penalty or denied reimbursement due to failure of an applicant for admission who is not a medical
assistance recipient to apply for program established under section or to comply with program requirements; deleted
obsolete provisions of Subsec. (g) re implementation of program and renumbered remaining Subsecs; P.A. 91-176 amended
Subsec. (a) to require that the estate and legally liable relatives of a recipient of services under the program be responsible
for reimbursement to the state for such services; May Sp. Sess. P.A. 92-16 changed the name of the program to the
Connecticut home-care program for the elderly, added Subsec. (i) establishing a state-funded portion of the program and
made technical changes for consistency; P.A. 93-262 authorized substitution of commissioner and department of social
services for commissioner and department of income maintenance and commissioner and department on aging, effective
July 1, 1993; P.A. 93-418 amended Subsec. (i) to include persons whose gross income is less than or equal to the amount
allowed under the federally funded portion of the program and changed the provisions of the asset test to reflect whether
a person is single or married, effective July 1, 1993; Sec. 17-314b transferred to Sec. 17b-342 in 1995; P.A. 95-160 replaced
coordination, assessment and monitoring agency with access agency, amended Subsec. (e) to require the commissioner to
adopt regulations defining "access agency", amended Subsec. (g) to change the reporting date from January first to June
first, amended Subsec. (j) to allow the commissioner to implement revised criteria for the operation of the entire program,
instead of the state-funded portion of the program, effective July 1, 1995; P.A. 96-139 changed effective date of P.A. 95-160 but without affecting this section; June 18 Sp. Sess. P.A. 97-2 amended Subsec. (a) by allowing only citizens or
noncitizens who meet eligibility requirements under Medicaid to qualify for services under this section, by allowing certain
qualified aliens to be eligible for services under this section, by allowing any qualified alien or lawfully residing immigrant
alien who is a victim of domestic violence or who has mental retardation to be eligible for services under this section and
by making technical changes, effective July 1, 1997; P.A. 99-279 amended Subsec. (a) to extend from July 1, 1999, to
July 1, 2001, the eligibility of certain qualified aliens or other lawfully residing immigrant aliens for services under this
section, effective July 1, 1999; P.A. 00-83 amended Subsec. (a) to provide that alien who formerly held status of permanently
residing under color of law who is a domestic violence victim or who has mental retardation shall be eligible for assistance
under this section and to provide that qualified aliens or other lawfully residing immigrant aliens who formerly held such
status shall be eligible for services under this section if other eligibility conditions are met, effective July 1, 2000; June
Sp. Sess. P.A. 00-2 amended Subsec. (a) to add new Subdiv. (3) re eligibility for elderly persons who would be eligible
for medical assistance if residing in a nursing facility and to designate former Subdiv. (3) as Subdiv. (4), amended Subsec.
(c) to expand community-based services covered under the program to include "care", in lieu of "case", management,
minor home modifications and assisted living services provided in state-funded congregate housing and other assisted
living pilot or demonstration projects, amended Subsec. (f) to make a technical change, amended Subsec. (i)(1)(C) to
change income requirements from amount allowed under federally funded portion of program to amount allowed under
Subsec. (a)(3), deleted former Subsec. (i)(2) re sliding scale formula for required contributions for program participants,
and added new Subsec. (i)(2) requiring that persons whose income exceeds 200% of federal poverty level contribute to
cost of care in accordance with methodology established for medical assistance recipients; June Sp. Sess. P.A. 01-9 amended
Subsec. (a) to extend deadline for acceptance of applications by certain aliens to June 30, 2002, effective July 1, 2001;
May 9 Sp. Sess. P.A. 02-7 amended Subsec. (a) to extend the deadline for certain aliens to apply for assistance until June
30, 2003, effective August 15, 2002; P.A. 04-258 amended Subsec. (a) by deleting provision that prohibited Commissioner
of Social Services from accepting applications for assistance pursuant to section from a qualified alien or other lawfully
residing immigrant alien after June 30, 2003, effective July 1, 2004; P.A. 05-280 amended Subsec. (i)(1) to provide that,
on and after April 1, 2007, the applicable asset limit used in determining eligibility for the state-funded portion of the
program, for a single person, is assets not to exceed 150% of the community spouse protected amount and, for married
individuals, is couple's assets not to exceed 200% of the community spouse protected amount, effective July 1, 2005.