SB 2001 - PUBLIC ACT 03-3 - JUNE 30 SPECIAL SESSION 2003
DSS "IMPLEMENTER BILL"
AN ACT CONCERNING PUBLIC HEALTH, HUMAN SERVICES AND OTHER MISCELLANEOUS IMPLEMENTER PROVISIONS.
Passed by both House and Senate August 16, 2003 - most provisions eff. 8/16/2003 (see Effective Dates below)
Click for COMPLETE TEXT - excerpts are below

Sec. 12 - Pilot project for ABI residences operated by community-based organizations.
Sec. 58 - ConnPACE asset test
Sec. 59 - Estate recovery: (1) includes ConnPACE; (2) includes annuities
Sec. 61 - State Supplement (AUTHORIZES but does not require adjustment of personal needs allowance; continues practice of offsetting benefit by amount of SSI COLA increases)
Sec. 62 - Authorization of the 1115 Waiver; TRANSFEREE LIABILITY; Etc.
Sec. 63 - "Income-First" required in order to protect community spouse MMNA
Sec. 91 - Pilot Program for assisted living services for mentally retarded on waiting lists for group homes
Sec. 92 - Sprinkler Systems required in nursing homes

Sec. 12. (NEW) (Effective from passage) (a) For the purposes of this section, "residence for adult persons with acquired brain injuries" means a community-based residence (1) exclusively serving adult persons with acquired brain injuries, (2) funded or operated by the Department of Mental Health and Addiction Services, and (3) that provides rehabilitation and other support services for persons with acquired brain injuries requiring assistance to live in the community.

(b) Notwithstanding the provisions of chapters 368v and 368z of the general statutes, community-based organizations may operate residences for adult persons with acquired brain injuries on a pilot basis until October 1, 2005. Notwithstanding the provisions of chapter 378 of the general statutes, medication may be administered to persons residing in such residences by trained persons pursuant to the written order of a physician licensed under chapter 370 of the general statutes, a dentist licensed under chapter 379 of the general statutes, an advanced practice registered nurse licensed to prescribe in accordance with section 20-94a of the general statutes, or a physician assistant licensed to prescribe in accordance with section 20-12d of the general statutes. The Commissioner of Public Health, in consultation with the Commissioner of Mental Health and Addiction Services, shall develop standards for the operation of such residences and the training required of persons authorized under this section to administer medications in such residences.

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Sec. 58. Subsection (a) of section 17b-492 of the general statutes, as amended by section 15 of public act 03-2, is repealed and the following is substituted in lieu thereof (Effective October 1, 2003):

(a) Eligibility for participation in the program shall be limited to any resident (1) who is sixty-five years of age or older or who is disabled, (2) (A) whose annual income, if unmarried, is less than thirteen thousand eight hundred dollars, except after April 1, 2002, such annual income is less than twenty thousand dollars, or whose annual income, if married, when combined with that of the resident's spouse is less than sixteen thousand six hundred dollars, except after April 1, 2002, such combined annual income is less than twenty-seven thousand one hundred dollars, or (B) in the event the program is granted a waiver to be eligible for federal financial participation, then, after July 1, 2002, whose annual income, if unmarried, is less than twenty-five thousand eight hundred dollars, or whose annual income, if married, when combined with that of the resident's spouse is less than thirty-four thousand eight hundred dollars, (3) who is not insured under a policy which provides full or partial coverage for prescription drugs once a deductible amount is met, [and] (4) whose available assets are below one hundred thousand dollars if unmarried and one hundred twenty-five thousand dollars if married, (A) the asset limit for a married resident shall be determined by combining the value of assets available to both spouses, and (B) for purposes of this section, available assets are those that are considered available in determining eligibility in the Connecticut Home Care Program for the Elderly, and (5) on and after September 15, 1991, who pays an annual thirty-dollar registration fee to the Department of Social Services. Effective January 1, 2002, the commissioner shall commence accepting applications from individuals who will become eligible to participate in the program as of April 1, 2002. On January 1, 1998, and annually thereafter, the commissioner shall increase the income limits established under this subsection over those of the previous fiscal year to reflect the annual inflation adjustment in Social Security income, if any. Each such adjustment shall be determined to the nearest one hundred dollars.

Sec. 59. Section 17b-95 of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage):

(a) [Upon] Subject to the provisions of subsection (b) of this section, upon the death of a parent of a child who has, at any time, been a beneficiary under the program of aid to families with dependent children, the temporary family assistance program or the state-administered general assistance program, or upon the death of any person who has at any time been a beneficiary of aid under the state supplement program, medical assistance program, aid to families with dependent children program, temporary family assistance program or state-administered general assistance program, and, on or after September 1, 2003, the Connecticut Pharmaceutical Assistance Contract to the Elderly and Disabled Program, except as provided in subsection (b) of section 17b-93, the state shall have a claim against such parent's or person's estate for all amounts paid on behalf of each such child or for the support of either parent or such child or such person under the state supplement program, medical assistance program, aid to families with dependent children program, temporary family assistance program or state-administered general assistance program and on or after September 1, 2003, to a beneficiary of aid under the Connecticut Pharmaceutical Assistance Contract to the Elderly and Disabled Program, for which the state has not been reimbursed, to the extent that the amount which the surviving spouse, parent or dependent children of the decedent would otherwise take from such estate is not needed for their support.

(b) In the case of any person dying after October 1, 1959, the claim for medical payments, even though such payments were made prior thereto, shall be restricted to medical disbursements actually made for care of such deceased beneficiary. [Such claims] In the case of any person dying after September 1, 2003, the claim for ConnPACE program benefits shall be restricted to benefits actually received on or after July 1, 2003.

(c) Claims pursuant to this section shall have priority over all unsecured claims against such estate, except (1) expenses of last sickness not to exceed three hundred seventy-five dollars, (2) funeral and burial expenses in accordance with section 17b-84, and (3) administrative expenses, including probate fees and taxes, and including fiduciary fees not exceeding the following commissions on the value of the whole estates accounted for by such fiduciaries: On the first two thousand dollars or portion thereof, five per cent; on the next eight thousand dollars or portion thereof, four per cent; on the excess over ten thousand dollars, three per cent. Upon petition by any fiduciary, the Probate Court, after a hearing thereon, may authorize compensation in excess of the above schedule for extraordinary services. Notice of any such petition and hearing shall be given to the Commissioner of Administrative Services in Hartford at least ten days in advance of such hearing. The allowable funeral and burial payment herein shall be reduced by the amount of any prepaid funeral arrangement. Any amount paid from the estate under this section to any person which exceeds the limits provided herein shall be repaid to the estate by such person, and such amount may be recovered in a civil action with interest at six per cent from the date of demand.

(d) For purposes of this section, all sums due on or after July 1, 2003, to any individual after the death of a public assistance beneficiary pursuant to the terms of an annuity contract purchased at any time with assets of a public assistance beneficiary, shall be deemed to be part of the estate of the deceased beneficiary and shall be payable to the state by the recipient of such annuity payments to the extent necessary to achieve full reimbursement of any public assistance benefits paid to, or on behalf of, the deceased beneficiary irrespective of any provision of law. The recipient of beneficiary payments from any such annuity contract shall be solely liable to the state of Connecticut for reimbursement of public assistance benefits paid to, or on behalf of, the deceased beneficiary to the extent of any payments received by such recipient pursuant to the annuity contract.

Sec. 61. Subsection (a) of section 17b-106 of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage):

(a) On July 1, 1985, the Commissioner of Social Services shall increase the adult payment standards for the state supplement to the federal Supplemental Security Income Program by four and three-tenths per cent over the standards for the fiscal year ending June 30, 1985, provided the commissioner shall apply the appropriate disregards. Notwithstanding the provisions of any regulation to the contrary, effective July 1, 1994, the commissioner shall reduce the appropriate unearned income disregard for recipients of the state supplement to the federal Supplemental Security Income Program by seven per cent, provided if sufficient funds are available within accounts in the Department of Social Services and are transferred to the old age assistance account, the aid to the blind account and the aid to the disabled account, the commissioner shall increase the unearned income disregard for recipients of the state supplement to the federal Supplemental Security Income Program to a level not to exceed that in effect on June 30, 1994. On July 1, 1989, and annually thereafter, the Commissioner of Social Services shall increase the adult payment standards over those of the previous fiscal year for the state supplement to the federal Supplemental Security Income Program by the percentage increase, if any, in the most recent calendar year average in the consumer price index for urban consumers over the average for the previous calendar year, provided the annual increase, if any, shall not exceed five per cent, except that the adult payment standards for the fiscal years ending June 30, 1993, June 30, 1994, June 30, 1995, June 30, 1996, June 30, 1997, June 30, 1998, June 30, 1999, June 30, 2000, June 30, 2001, June 30, 2002, [and] June 30, 2003, June 30, 2004, and June 30, 2005, shall not be increased. Effective October 1, 1991, the coverage of excess utility costs for recipients of the state supplement to the federal Supplemental Security Income Program is eliminated. Notwithstanding the provisions of this section, the Commissioner of Social Services may increase the personal needs allowance component of the adult payment standard as necessary to meet federal maintenance of effort requirements.

Sec. 62. Section 17b-261a of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage):

(a) The Commissioner of Social Services shall seek a waiver of federal law for the purpose of establishing that the penalty period during which an applicant for or recipient of assistance for long-term care under the Medicaid program is ineligible for Medicaid-funded services due to a transfer of assets for less than fair market value shall begin in the month the applicant is found otherwise eligible for Medicaid coverage of services rather than in the month of the transfer of assets. This section shall only apply to transfers that occur on or after the effective date of the waiver. The provisions of section 17b-8 shall apply to this section.

(b) Any transfer or assignment of assets resulting in the imposition of a penalty period shall be presumed to be made with the intent, on the part of the transferor or the transferee, to enable the transferor to obtain or maintain eligibility for medical assistance. This presumption may be rebutted only by clear and convincing evidence that the transferor's eligibility or potential eligibility for medical assistance was not a basis for the transfer or assignment.

(c) Any transfer or assignment of assets resulting in the establishment or imposition of a penalty period shall create a debt, as defined in section 36a-645, that shall be due and owing by the transferor or transferee to the Department of Social Services in an amount equal to the amount of the medical assistance provided to or on behalf of the transferor on or after the date of the transfer of assets, but said amount shall not exceed the fair market value of the assets at the time of transfer. The Commissioner of Social Services, the Commissioner of Administrative Services and the Attorney General shall have the power or authority to seek administrative, legal or equitable relief as provided by other statutes or by common law.

(d) The Commissioner of Social Services, upon the request of a nursing facility, may grant financial relief to a nursing facility if the nursing facility establishes that (1) it is experiencing severe financial hardship due to the transfer of asset penalty period beginning in the month the applicant is found otherwise eligible for Medicaid coverage of services rather than in the month of the transfer of assets; and (2) it has made every effort permissible under state and federal law to recover the funds that are due to it for caring for the individual. No request for financial relief may be made by a nursing facility unless the individual who is the subject of the imposition of the penalty period has resided in the nursing facility for at least ninety days with no payment having been made on the individual's behalf during that period. If the department agrees to grant financial relief to the nursing facility in the form of providing Medicaid payment to the facility, the department shall seek recoupment of said payment from the individual and the transferee by pursuing all means available to it under state and federal law.

(e) The Commissioner of Social Services may waive the imposition of a penalty period when the transferor (1) suffers from dementia at the time of application for medical assistance and cannot explain transfers that would otherwise result in the imposition of a penalty period; or (2) suffered from dementia at the time of the transfer; or (3) was exploited into making such a transfer. Waiver of the imposition of a penalty period does not prohibit the establishment of a debt in accordance with subsection (c) of this section.

(f) In reviewing transfers of assets for purposes of determining eligibility for medical assistance, the department shall consider those transfers of assets involving real property that occurred within sixty months preceding the date on which an institutionalized individual has applied for medical assistance under the Medicaid state plan, except transfers of real property that are exempt under department regulations. Transfers of assets that do not involve real property remain subject to the look-back provisions contained in federal law.

(g) The Commissioner of Social Services may establish threshold limits, which shall be the cumulative amount of transfers that may be made within any year of the look-back period without resulting in the imposition of a transfer of assets penalty.

(h) The Commissioner of Social Services, pursuant to section 17b-10, shall implement the policies and procedures necessary to carry out the provisions of this section while in the process of adopting such regulations and procedures in regulation form, provided notice of intent to adopt regulations is published in the Connecticut Law Journal within twenty days after implementation. Such policies and procedures shall be valid until the time final regulations are effective.

Sec. 63. Section 17b-261 of the general statutes, as amended by section 2 of public act 03-2 and section 7 of public act 03-268, is amended by adding subsection (h) as follows (Effective from passage):

(NEW) (h) An institutionalized spouse applying for Medicaid and having a spouse living in the community shall be required, to the maximum extent permitted by law, to divert income to such community spouse in order to raise the community spouse's income to the level of the minimum monthly needs allowance, as described in Section 1924 of the Social Security Act. Such diversion of income shall occur before the community spouse is allowed to retain assets in excess of the community spouse protected amount described in Section 1924 of the Social Security Act. The Commissioner of Social Services, pursuant to section 17b-10, may implement the provisions of this subsection while in the process of adopting regulations, provided the commissioner prints notice of intent to adopt the regulations in the Connecticut Law Journal within twenty days of adopting such policy. Such policy shall be valid until the time final regulations are effective.

Sec. 91. (Effective from passage) The Commissioner of Mental Retardation, in conjunction with the Commissioner of Social Services, shall, within available appropriations, prepare a plan to establish and operate a pilot program to provide residential accommodations with assisted living services to individuals on the Department of Mental Retardation's waiting list for residential placement or support. Such plan shall describe the necessary elements of such a pilot program, including, but not limited to, coordination of staffing issues and applications for federal Department of Health and Human Services Demonstration Grants, and any necessary Medicaid waivers. Not later than January 1, 2004, the Commissioner of Mental Retardation shall submit a report containing such plan, in accordance with section 11-4a of the general statutes, to the joint standing committees of the General Assembly having cognizance of matters relating to public health and human services.

Sec. 92. Section 29-315 of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage):

(a) (1) When any building is to be built having more than four stories and is to be used for human occupancy, such building shall have an automatic fire extinguishing system approved by the State Fire Marshal on each floor.

(2) When any building is (A) to be built as an educational occupancy, (B) eligible for a school building project grant pursuant to chapter 173, and (C) put out to bid on or after July 1, 2004, such building shall have an automatic fire extinguishing system approved by the State Fire Marshal on each floor. "Educational occupancy" shall have the same meaning as in the Fire Safety Code.

(b) Each hotel or motel having six or more guest rooms and providing sleeping accommodations for more than sixteen persons for which a building permit for new occupancy is issued on or after January 1, 1987, shall have an automatic fire extinguishing system installed on each floor in accordance with regulations adopted by the Commissioner of Public Safety.

(c) Not later than October 1, 1992, each hotel or motel having more than four stories shall have an automatic fire extinguishing system approved by the State Fire Marshal on each floor.

(d) (1) Not later than January 1, 1995, each residential building having more than four stories and occupied primarily by elderly persons shall have an automatic fire extinguishing system approved by the State Fire Marshal on each floor. Not later than January 1, 1994, the owner or manager of or agency responsible for such residential building shall submit plans for the installation of such system, signed and sealed by a licensed professional engineer, to the local fire marshal within whose jurisdiction such building is located or to the State Fire Marshal, as the case may be. For the purposes of this subsection, the phrase "occupied primarily by elderly persons" means that on October 1, 1993, or on the date of any inspection, if later, a minimum of eighty per cent of the dwelling units available for human occupancy in a residential building have at least one resident who has attained the age of sixty-five years.

(2) Each residential building having more than twelve living units and occupied primarily by elderly persons, as defined in subdivision (1) of this subsection, or designed to be so occupied, for which a building permit for new occupancy is issued or which is substantially renovated on or after January 1, 1997, shall have an automatic fire extinguishing system approved by the State Fire Marshal on each floor.

(e) No building inspector shall grant a building permit unless a fire extinguishing system as required by subsection (a) or (b) of this section is included in the final, approved building plans and no fire marshal or building inspector shall permit occupancy of such a building unless such fire extinguishing system is installed and operable. The State Fire Marshal may require fire extinguishing systems approved by him to be installed in other occupancies where they are required in the interest of safety because of special occupancy hazards.

(f) Not later than July 1, 2005, each chronic and convalescent nursing home or rest home with nursing supervision licensed pursuant to chapter 368v shall have an automatic fire extinguishing system approved by the State Fire Marshal on each floor. Not later than July 1, 2004, the owner or authorized agent of each such home shall submit plans for the installation of such system, signed and sealed by a licensed professional engineer, to the local fire marshal and building official within whose jurisdiction such home is located or to the State Fire Marshal, as the case may be, and shall apply for a building permit for the installation of such system.

(g) Any person who fails to install an automatic fire extinguishing system in violation of any provision of this section shall be subject to a civil penalty of not more than one thousand dollars for each day such violation continues. The Attorney General, upon request of the State Fire Marshal, shall institute a civil action to recover such penalty.