§ 17b-342 — (Formerly Sec. 17-314b). Connecticut home-care program for the elderly.

Connecticut § 17b-342

• Jurisdiction: Connecticut
• Title 17b: Social Services
• Ch. 319y: Long-Term Care

Text

(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 who (1) are recipients of medical assistance, (2) are eligible for such assistance, (3) would be eligible for medical assistance if residing in a nursing facility, or (4) meet the criteria for the state-funded portion of the program under subsection (j) of this section. For purposes of this section, “long-term care facility” means a facility that 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 program shall be structured so that the net cost to the state for long-term facility care in combination with the 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 supplemental nutrition assistance 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 intellectual disability 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 (m) of this section, that submits proposals that 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, services not otherwise available under the state Medicaid plan: (1) Occupational therapy, (2) homemaker services, (3) companion services, (4) meals on wheels, (5) adult day care, (6) transportation, (7) mental health counseling, (8) care management, (9) elderly foster care, (10) minor home modifications, and (11) assisted living services provided in state-funded congregate housing and in other assisted living pilot or demonstration projects established under state law. Personal care assistance services shall be covered under the program to the extent that (A) such services are not available under the Medicaid state plan and are more cost effective on an individual client basis than existing services covered under such plan, and (B) the provision of such services is approved by the federal government. Recipients of state-funded services, pursuant to subsection (i) of this section, and persons who are determined to be functionally eligible for community-based services who have an application for medical assistance pending, or are determined to be presumptively eligible for Medicaid pursuant to subsection (e) of this section, 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) (1) The Commissioner of Social Services shall, subject to the provisions of subdivisions (2) and (3) of this subsection, establish a presumptive Medicaid eligibility system under which the state shall fund services under the Connecticut home-care program for the elderly for a period of not longer than ninety days for applicants who require a skilled level of nursing care and who are determined to be presumptively eligible for Medicaid coverage. The system shall include, but need not be limited to: (A) The development of a preliminary screening tool by the Department of Social Services to be used by representatives of the access agency selected pursuant to subsection (b) of this section to determine whether an applicant is functionally able to live at home or in a community setting and is likely to be financially eligible for Medicaid; (B) a requirement that the applicant complete a Medicaid application on the date such applicant is preliminarily screened for functional eligibility or not later than ten days after such screening; (C) a determination of presumptive eligibility for eligible applicants by the department and approval of a care plan authorizing home care services not later than ten days after an applicant is successfully screened for eligibility; and (D) a written agreement to be signed by the applicant (i) attesting to the accuracy of financial and other information such applicant provides, (ii) acknowledging that the state shall solely fund services not longer than ninety days after the date on which home care services begin, and (iii) waiving any right to receive continued coverage while awaiting a hearing that is requested in response to the department's determination during or at the end of the presumptive period of eligibility that (I) the applicant is not eligible for Medicaid or (II) the applicant failed to provide information necessary to allow the department to make an eligibility determination. The department shall make a final determination as to Medicaid eligibility for applicants determined to be presumptively eligible for Medicaid coverage not later than the end of the ninety-day period of presumptive eligibility. The department may make such determination prior to the end of such ninety-day period if it receives information indicating that the applicant is not eligible for Medicaid. (2) To the extent permitted by federal law, the commissioner shall seek any federal waiver or amend the Medicaid state plan as necessary to attempt to secure federal reimbursement for the costs of providing coverage to persons determined to be presumptively eligible for Medicaid coverage. The provisions of this subsection and any other provision of this section relating to the establishment of a presumptive Medicaid eligibility system, including, but not limited to, such provisions located in subsections (c), (g) and (m), shall not be effective until the commissioner secures such federal reimbursement through a federal waiver or Medicaid state plan amendment. (3) Not less than two years after the date of the establishment of a presumptive Medicaid eligibility system pursuant to the provisions of this subsection, the commissioner may, in the commissioner's discretion, discontinue the system if the commissioner determines that the system is not cost effective. (f) The commissioner may require long-term care facilities to inform applicants for admission of the Connecticut home-care program for the elderly 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, in accordance with the provisions of section 11-4a , to the joint standing committee of the General Assembly having cognizance of matters relating to human services on the Connecticut home-care program for the elderly 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 for the program, (3) the number of persons determined presumptively eligible for Medicaid, (4) savings for the state based on institutional care costs that were averted for persons determined to be presumptively eligible for Medicaid who later were determined to be eligible for Medicaid, (5) the number of persons determined presumptively eligible for Medicaid who later were determined not to be eligible for Medicaid and costs to the state to provide such persons with home care services before the final Medicaid eligibility determination, (6) the average cost per person in the program, (7) the administration costs, (8) the estimated savings to provide home care versus institutional care for all persons in the program, and (9) a comparison between costs under the different contracts for program services. (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 when requested to do so by the department and shall accept such benefits if determined eligible. (i) (1) The Commissioner of Social Services shall, within available appropriations, administer a state-funded portion of the Connecticut home-care program for the elderly for persons (A) who are sixty-five years of age and older and are not eligible for Medicaid; (B) who are inappropriately institutionalized or at risk of inappropriate institutionalization; (C) whose income is less than or equal to the amount allowed for a person who would be eligible for medical assistance if residing in a nursing facility; and (D) whose assets, if single, do not exceed one hundred fifty per cent of the federal minimum community spouse protected amount pursuant to 42 USC 1396r-5(f)(2) or, if married, the couple's assets do not exceed two hundred per cent of said community spouse protected amount. For program applications received by the Department of Social Services for the fiscal years ending June 30, 2016, and June 30, 2017, only persons who require the level of care provided in a nursing home shall be eligible for the state-funded portion of the program, except for persons residing in affordable housing under the assisted living demonstration project established pursuant to section 17b-347e who are otherwise eligible in accordance with this section. (2) Except for persons residing in affordable housing under the assisted living demonstration project established pursuant to section 17b-347e , as provided in subdivision (3) of this subsection, any person whose income is at or below two hundred per cent of the federal poverty level and who is ineligible for Medicaid shall contribute three per cent of the cost of his or her care. Any person whose income exceeds two hundred per cent of the federal poverty level shall contribute three per cent of the cost of his or her care in addition to the amount of applied income determined in accordance with the methodology established by the Department of Social Services for recipients of medical assistance. Any person who does not contribute to the cost of care in accordance with this subdivision shall be ineligible to receive services under this subsection. Notwithstanding any provision of sections 17b-60 and 17b-61 , the department shall not be required to provide an administrative hearing to a person found ineligible for services under this subsection because of a failure to contribute to the cost of care. (3) Any person who resides in affordable housing under the assisted living demonstration project established pursuant to section 17b-347e and whose income is at or below two hundred per cent of the federal poverty level, shall not be required to contribute to the cost of care. Any person who resides in affordable housing under the assisted living demonstration project established pursuant to section 17b-347e and whose income exceeds two hundred per cent of the federal poverty level, shall contribute to the applied income amount determined in accordance with the methodology established by the Department of Social Services for recipients of medical assistance. Any person whose income exceeds two hundred per cent of the federal poverty level and who does not contribute to the cost of care in accordance with this subdivision shall be ineligible to receive services under this subsection. Notwithstanding any provision of sections 17b-60 and 17b-61 , the department shall not be required to provide an administrative hearing to a person found ineligible for services under this subsection because of a failure to contribute to the cost of care. (4) 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 shall collect data on services provided under the program, including, but not limited to, the: (1) Number of participants before and after any adjustment in copayments, (2) average hours of care provided under the program per participant, and (3) estimated cost savings to the state by providing home care to participants who may otherwise receive care in a nursing home facility. The commissioner shall, in accordance with the provisions of section 11-4a , report on the results of the data collection to the joint standing committees of the General Assembly having cognizance of matters relating to aging, appropriations and the budgets of state agencies and human services not later than July 1, 2022. The commissioner may implement revised criteria for the operation of the program while in the process of adopting such criteria in regulation form, provided the commissioner publishes notice of intention to adopt the regulations in accordance with section 17b-10 . Such criteria shall be valid until the time final regulations are effective. (k) The commissioner shall notify any access agency or area agency on aging that administers the program when the department sends a redetermination of eligibility form to an individual who is a client of such agency. (l) In determining eligibility for the program described in this section, the commissioner shall not consider as income (1) Aid and Attendance pension benefits granted to a veteran, as defined in section 27-103 , or the surviving spouse of such veteran, and (2) any tax refund or advance payment with respect to a refundable credit to the same extent such refund or advance payment would be disregarded under 26 USC 6409 in any federal program or state or local program financed in whole or in part with federal funds. (m) The commissioner shall adopt regulations, in accordance with the provisions of chapter 54, to (1) define “access agency”, (2) implement and administer the program, (3) implement and administer the presumptive Medicaid eligibility system described in subsection (e) of this section, (4) establish uniform state-wide standards for the program and uniform assessment tools for use in the screening process for the program and the prescreening for presumptive Medicaid eligibility, and (5) specify conditions of eligibility.

Legislative History

(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; P.A. 09-9, S. 27; 09-64, S. 1; Sept. Sp. Sess. P.A. 09-5, S. 66; P.A. 10-126, S. 1; 10-179, S. 21; P.A. 11-25, S. 14; 11-44, S. 86; P.A. 12-208, S. 7; P.A. 13-139, S. 24; P.A. 14-142, S. 1; June Sp. Sess. P.A. 15-5, S. 383; June Sp. Sess. P.A. 21-2, S. 326, 330; P.A. 22-118, S. 234; P.A. 24-39, S. 10; 24-81, S. 105.) 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. 17a-405 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; P.A. 09-9 amended Subsec. (a) by replacing “food stamps” with “supplemental nutrition assistance”, effective May 4, 2009; P.A. 09-64 amended Subsec. (c) by adding provision re coverage for personal care assistance services, effective April 1, 2010; Sept. Sp. Sess. P.A. 09-5 amended Subsec. (i), in Subdiv. (2), by adding exception re persons residing in affordable housing under assisted living demonstration project, replacing “exceeds” with “is at or below”, inserting “and who is ineligible for Medicaid” and “fifteen per cent”, and replacing provision re contributions in accordance with methodology established in uniform policy manual with provisions re contributions to cost of care based on income level, re persons ineligible for services and re hearing not required for such ineligible persons, in Subdiv. (3), by replacing former provisions with provisions re contributions to cost of care based on income level by persons residing in affordable housing under assisted living demonstration project, re persons ineligible for services and re hearing not required for such ineligible persons, by deleting former Subdiv. (4) re increase in certain services and by redesignating existing Subdiv. (5) as Subdiv. (4), effective October 5, 2009; P.A. 10-126 added Subsec. (k) re notification to access agencies and area agencies on aging when department sends redetermination of eligibility forms to clients, effective July 1, 2010; P.A. 10-179 amended Subsec. (i)(2) by changing the Medicaid contribution from 15% of cost of care to 6% of cost of care, effective July 1, 2010; P.A. 11-25 made a technical change in Subsec. (i)(2); P.A. 11-44 amended Subsec. (i)(2) by increasing contribution to cost of care from 6% to 7%, effective July 1, 2011; P.A. 12-208 added Subsec. (l) re income disregard for veterans' Aid and Attendance pension benefits, effective July 1, 2012; P.A. 13-139 amended Subsec. (a) by substituting “intellectual disability” for “mental retardation” and making a technical change; P.A. 14-142 amended Subsec. (a) to delete provision re limitation on annualized cost of community-based services and delete “community-based” re services under program, effective July 1, 2014; June Sp. Sess. P.A. 15-5 amended Subsec. (i) to delete provisions re asset limits prior to April 1, 2007, add “federal” re minimum community spouse protected amount, replace “Section 4022.05 of the department's uniform policy manual” with “42 USC 1396r-5(f)(2)”, add provision re program applications received for fiscal years ending June 30, 2016, and June 30, 2017, and make a technical change in Subdiv. (1), to increase individual contribution from 7 per cent to 9 per cent in Subdiv. (2), and to replace “the general statutes” with “sections 17b-60 and 17b-61” in Subdivs. (2) and (3), effective July 1, 2015; June Sp. Sess. P.A. 21-2 amended Subsec. (i)(2) by reducing copayments from 9 to 4.5 per cent and amended Subsec. (j) by adding data collection and report requirements and changing requirement regulation intention be printed in Connecticut Law Journal to requirement regulation intention be published in accordance with section 17b-10 and amended Subsec. (l) by adding Subdiv. (2) re disregard of certain tax refunds or advance payments and redesignating existing provision as Subdiv. (1), effective July 1, 2021; P.A. 22-118 amended Subsec. (i)(2) by decreasing from 4.5 to 3 per cent the cost contribution of certain persons, effective May 7, 2022; P.A. 24-39 amended Subsec. (c) by designating existing provisions as Subdivs. (1) to (11), redesignating existing Subdivs. (1) and (2) as Subdiv. (11)(A) and (B), adding reference to Subsec. (i) and adding provision re presumptive eligibility, deleted existing Subsec. (e) re authority to adopt regulations, added new Subsec. (e) re establishment of presumptive Medicaid eligibility system, amended Subsec. (g) by adding new Subdivs. (3) to (5) re information on presumptive Medicaid eligibility system, redesignating existing Subdivs. (3) to (6) as Subdivs. (6) to (9) and adding provision re home care versus institutional care comparison in Subdiv. (8), amended Subsec. (i)(1) by adding “and are not eligible for Medicaid” in Subpara. (A) and replacing reference to Subsec. (a)(3) with “for a person who would be eligible for medical assistance if residing in a nursing facility” in Subpara. (C), amended Subsec. (j)(1) by replacing “copayments are reduced pursuant to subsection (i) of this section” with “any adjustment in copayments”, added Subsec. (m) re authority to adopt regulations and made technical and conforming changes, effective July 1, 2024; P.A. 24-81 amended Subsec. (e)(1)(C) by replacing “initiation of home care services” with “approval of a care plan authorizing home care services”, and amended Subsec. (e)(1)(D) by designating existing provisions clauses (i) and (ii), adding clause (iii) re waiving right to receive continued coverage, deleting provision re 45 day and, for persons with disabilities, 90-day deadlines for final determination of Medicaid eligibility, and adding provisions re deadline for final determination of Medicaid eligibility at end of 90-day period of presumptive eligibility or earlier if department receives information re ineligibility, and making conforming changes, effective July 1, 2024.