LeadingAge Connecticut
2012 Legislative Review
September 11, 2012
Presented by:
Maureen Weaver
Elisabeth A. Pimentel
Wiggin and Dana, LLP
© 2012 Wiggin and Dana
Nursing Homes
Public Act 12-1(SS) The Implementer
• § 16 Nursing Home Reimbursement
Effective January 1, 2013
– DSS may provide pro rata fair rent increases in FY
2013 for facilities that undergo material changes in
circumstances related to fair rent additions placed in
service in the cost report years ending September 30,
2008 through September 30, 2011
– For FY 2013, DSS must add fair rent increases
associated with an approved CON
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Nursing Homes
Public Act 12-1(SS) The Implementer (cont’d)
• § 26 Waiver for Medicaid Low-Income Adults
Effective July 1, 2012
– DSS must apply for a Medicaid waiver to modify
eligibility and coverage for low-income adults by:
(i) establishing an asset limit of $10K
(ii) include income and assets of parent(s) of an
applicant
(iii) limiting coverage of nursing facility care to
ninety days
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Nursing Homes
Public Act 12-1(SS) The Implementer (continued)
• § 104 Inmates Released to Nursing Homes
Effective July 1, 2012
– Under certain conditions DOC may release inmates to
nursing homes for palliative and end-of-life care
– Released to licensed nursing home under contract with the
state
– Inmates convicted of a capital felony or murder with special
circumstances are not eligible for release under this program
– State has issued an RFP soliciting proposals from nursing
homes
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Nursing Homes
Public 12-104 Strategic Plan for Nursing Home
Rightsizing and Long-Term Care Rebalancing
Effective July 1, 2012
• Adjustments to the budget and bond package made to further the
rebalancing efforts
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Nursing Homes
Public Act 12-189 Act Adjusting Bonds of the State
• §§ 8, 9, 14 &15 Grants-in-Aid to Nursing Home
Effective June 15, 2012
– $10 million in grants-in-aid to nursing homes for alterations,
renovations, and improvements for conversion to other uses
in support of right-sizing
• If the premises ceases to be used in the manner anticipated by
the grant within 10 years of the grant, a prorated portion of the
grant money must be repaid to the state
– Also, $3 million to Money Follows the Person
– Administered by DECD
– State will issue RFP
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Nursing Homes
Public Act 12-118 Moratorium on Long-Term Care Beds
Effective June 15, 2012
– Extends the current moratorium by prohibiting DSS from
accepting or approving requests for additional nursing homes
beds or modifying the capital cost of prior approvals until June
30, 2016
– Moratorium exemptions still intact, including ability to transfer
Medicaid beds from one facility to another
– New moratorium: DPH may not issue or renew a license for any
hospital as a Medicare long-term care hospital
(unless the hospital was certified as such
as of January 1, 2012) until June 30, 2017.
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Residential Care Homes
Public Act 12-1 (SS)
• §§ 7 & 15 DSS Payments to Residential Care Homes
Effective July 1, 2012
– § 7 provides for FY 2012 RCH rates to remain in effect until June 30,
2013
– But § 15 removes the rate freeze placed on residential care homes in
2011 permitting DSS to provide a rate increase within appropriations
for FY 2013
– If a facility receives a lower rate due to its interim rate status, it must
keep that lower rate
– Removal of rate freeze allows DSS to rebase all rates using the cost
reports ending September 30, 2011
– RCHs can appeal new rates if they feel a
reduction is unwarranted
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Housing
Public Act 12-1 (SS)
• §§ 112 & 113 Department of Housing
Effective June 15, 2012
– Department of Housing established within DECD
• Responsible for developing strategies to encourage provision of
housing for very low, low, and moderate income families
• Must review the organization and delivery of state housing
programs and submit a report to the General Assembly by January
15, 2013
– Interagency Council on Affordable Housing established to
advised DOH Commissioner
• Members: Commissioner of DSS, DMHAS, DCF, DOC, and
DECD; Secretary of OPM; executive directors of CT Housing
Coalition, CT Coalition to End Homelessness, CHFA; two
members receiving state housing assistance and a state resident
eligible for housing assistance
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Housing
Interagency Council on Affordable Housing (cont’d)
– Council must develop strategies and recommendations for the
organization and mission of DOH – July 15, 2012
– By January 15, 2013 must report to Governor and General
Assembly recommendations on:
• Programs to be transferred to DOH and timeline for
implementation
• Effective changes to the state’s housing delivery systems
• Prioritization of housing resources
• Enhanced coordination across housing systems
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Housing
Public Act 12-189 Act Authorizing and Adjusting
Bonds of the State
• §§ 29 & 30 Funding for Housing Redevelopment and
Rehabilitation
Effective June 15, 2012
– Maximum of $87.5 million in state bonds to DECD for housing
development
– Not more than $12.5 million for congregate
housing
– Not more than $1 million for grants-in-aid
for accessibility modifications for persons
transitioning from institutions to homes
under Money Follows the Person
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Housing
Special Act 12-6 Task Force to Study Aging in Place
Effective June 15, 2012
– Task force will study:
1.
2.
3.
4.
5.
6.
7.
infrastructure and transportation improvements
Zoning changes to facilitate home care
Enhanced nutrition programs and delivery options
Improved fraud and abuse protections
Expansion of home medical care options
Tax incentives
Incentives for private insurance
– Task force report due to General Assembly by January 1, 2013
at which time the task force will terminate
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Housing
Public Act 12-41 Equal Treatment of Renters with
Mental Disabilities
Effective October 1, 2012
– Certain protections provided to physically disabled tenants
> 62 years are expanded to encompass family members who
permanently reside with such tenants
Public Act 12-157 Property Tax Assessments
by Municipalities
Effective October 1, 2012
– Municipalities may assess property taxes on
structures partially completed or under construction
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Housing
Public Act 12-184 Smoke and CO Detectors
and Alarms in Residential Dwellings
Effective October 1, 2012
– Any one or two-family dwellings undergoing interior
alterations or additions under a building permit must have
smoke detectors temporarily installed
– CO detectors are required if the same structure has a fuel
burning appliance, fireplace or attached garage
– May have both detectors in a single device
– Public awareness campaign to be established to promote
installation of smoke and CO detectors in all residences and
educate about dangers of failure to install
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Housing
Public Act 12-24 Deposits of Senior Citizens and
Those with Disabilities in Public Housing
Effective October 1, 2012
– Entities receiving state financial assistance and providing
housing for senior citizens and disabled persons must pay
interest on security deposits at a rate indexed to commercial
bank deposit rates
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Home and Community Based Services
Public Act 12-1 (SS) The Implementer
Effective July 1, 2012
• §§ 9 & 10 Expansion of Private Assisted Living Services Pilot
– DSS assisted living pilot programs enroll 50 additional
individuals for a total of 125 participants
• § 11 Medication Administration by Unlicensed Personnel
– RN may delegate the administration of non-injectable
medications to homemaker home health aides who are certified
for medication administration (unless prescriber says only RN
administration)
– Home health care agencies must adopt policies and ensure
delegation of nursing care tasks in home care settings
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Home and Community Based Services
• § 11 Medication Administration by Unlicensed Personnel
(cont’d)
– RN is protected from disciplinary or civil action for properly
delegating medication administration
– No person may coerce an RN into delegating medication
administration if RN’s assessment is that RN should administer
• § 12 Personal Care Assistants Permitted to Administer
Medication
– A PCA, if employed by a registered homemaker-companion
agency, is not prohibited from administering medication to a
competent adult who directs his or her own care and makes his
or her own decisions
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Home and Community Based Services
Public Act 12-91 Life-Support Care at Home
Effective October 1, 2012
• DSS must create and operate a 2 year pilot program for up to 10
ventilator-dependent Medicaid recipients receiving medical care
at home and living in Fairfield County
– Participants may directly hire RNs or LPNs
– DSS annual assessment of participants
– DSS must report to Appropriations and Human Services
Committees by January 15, 2015 on program’s costeffectiveness and care continuity
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Home and Community Based Services
Public Act 12-119 Social Services Programs
Effective June 15, 2012
• § 1 Community Choices Program
– DSS must develop and administer a statewide
Community Choices program that will act as
the state’s Aging and Disability Resource Center
– Serves individuals: 62 years and older or older than 17 years
old with disabilities, and their caretakers
• § 3 Municipal Agents for the Elderly
– If local ordinance calls for appointment of a municipal agent
for the elderly, must appoint.
– No longer required to submit annual reports to state and local
government.
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Home and Community Based Services
Public Act 12-140 Hospice Care Regulations
Effective June 15, 2012
• Licensed hospices have authority to operate a hospital facility,
including specialized hospice residences that provide inpatient
hospice and hospice home care services.
• Hospice no longer required to be Medicaid certified to operate
hospice facilities or use titles, “hospice” or “hospice care
program”
• DPH has promulgated hospice regulations: Conn. Agencies
Regs. §§ 19a-495-5a–b; 19a-495-6a to 19a-495-6m (2012).
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Physician Extenders
Public Act 12-37 Physician Assistants
Effective October 1, 2012
– Permits more flexible supervision of PA by physician; review
on a “regular basis” instead of weekly at any location
– Supervision must still be described in a written delegation
agreement
– Supervising physician may now document his or her approval of
PA’s Schedule II or III prescription in the
patient’s chart in compliance with delegation
agreement, instead of within one day of
prescription issuance
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Physician Extenders
Public Act 12-197 Public Health Statute Revisions
Effective October 1, 2012
• §§ 33–41 In certain instances, APRNs can now provide written
documentation or certification that previously only could be completed by
physicians.
– Health Certification for handicapped and disabled veterans seeking to work in
a variety of settings
– Individuals seeking to limit their availability to work to part-time employment
– Certification of qualifying event for accelerated benefits under life insurance
policy
– Statement that a terminally or chronically ill owner of an
insurance policy is of sound mind and under no constraint
or undue influence to enter into a life settlement contract
– Completing a standard Health Care Financing
Administration 1500 (health insurance claim form)
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Physician Extenders
§ 48 Licensing Requirements for APRN
– Expands options to fulfill education requirements necessary
to obtain APRN license
• Under prior law one of the four requirements necessitated that
an APRN hold a graduate degree in nursing
• Now that requirement may be fulfilled if:
(i) prior to December 31, 2004 the applicant completed an
APRN program certified by a national certifying body;
and
(ii) the applicant holds a current APRN license in another
state that requires a master’s degree in nursing
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Employment Issues
Public Act 12-33 Collective Bargaining for Child Care
Providers and Personal Care Attendants
Effective July 1, 2012
– Permits collective bargaining with the state as an employee
organization over state reimbursement rates, benefits,
payment procedures, contract grievance arbitration, training
professional development, and other
requirements and opportunities
– May not bargain over state employee pension
or health care benefits
– May not strike
– May not file grievances against parents,
consumers or surrogates
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Employment Issues
Public Act 12-33 Collective Bargaining (cont’d)
– PCA Workforce Council established
• 13 members: state officials and population representatives
served by PCAs
• Tasked with studying PCA recruitment, retention, and
adequacy, and with developing a plan to improve PCA quality,
stability, and availability
• After July 1, 2013 DSS and DDS must review Council’s plan
and if they approve it, must include requests for funding to
implement the plan in any budgetary requests submitted to
OPM
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Employment Issues
Public Act 12-125 Hearings Before the Administrator
and Employment Security Appeals Division
Effective October 1, 2012
– Telephone or other electronic means are the default methods
for hearing an appeal of an unemployment eligibility
determination
– If either party requests an in-person hearing, there must be an
in-person hearing at a location designated by the executive
head of Employment Security Appeals Division
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Probate
Public Act 12-25 Appointment of Guardian ad litem for
Conserved Persons with Psychiatric Disabilities
Effective October 1, 2012
– This pertains to individuals with psychiatric disabilities only
• Forced medication cases: no GAL until there is a finding that patient
is incapable of giving informed consent
• Court may not appoint conservator until patient’s mental status is
judged to meet legal standard for conservatorship
• For mentally conserved person, no GAL until court makes specific
finding that:
– Court needs GAL for specific purpose or to answer specific question; or
– Conserved person’s attorney cannot ascertain client’s preferences
– Any appointment of GAL shall be limited in scope and duration,
give specific direction to GAL, and shall terminate with GAL’s
report to the court.
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Probate
Public Act 12-22 Connecticut Uniform Adult
Protective Proceedings Jurisdiction Act
Effective October 1, 2012
– This Act aligns Connecticut law with nationwide uniform
procedures to resolve interstate jurisdiction controversies in
conservatorship proceedings involving individuals who have
connection with more than one state.
– Facilitates transfer of cases between jurisdictions and
provides for recognition and enforcement of guardianship or
protective orders across jurisdictions.
– Adopted in 29 states and D.C.
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Probate
Public Act 12-66 Probate Court Operations
Varying effective dates
– Changes nomenclature from “temporary administrators” to
“estate examiners”
– Eliminates the requirement that the attorney for an
intellectually disabled person under guardianship submit a
report on the status of the guardianship; court now to receive
copies of reports submitted to DDS
– Allows service of process on a non-resident
Fiduciary to be accomplished by leaving
an attested copy of process with probate
court that appointed fiduciary
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Miscellaneous
Public Act 12-55 Palliative Use of Marijuana
Effective May 31, 2012 and October 1, 2012
– Licensed physician may prescribe marijuana if determines
patient has a debilitating condition, including:
• Cancer, HIV/AIDS, Parkinson’s Disease
– Removes criminal and civil penalties for patients,
caregivers, doctors, dispensaries, and producers for
specific actions relating to use, prescription or supply of
marijuana
• Also, above parties may not be denied rights or privileges from
professional organization or licensing body
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Miscellaneous
Public Act 12-55 Palliative Use of Marijuana (cont’d)
– Patient must have certification of endorsement from
physician, in writing on a DCP form
• Valid for one year; all product must be destroyed within 10
days of certification’s expiration
– Patients and caregivers must register with DCP
– Pharmacists seeking to dispense have special licensing
requirements from DCP
• DCP will promulgate regulations
– Producers must be registered with DCP
• DCP will promulgate regulations
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Miscellaneous
Public Act 12-55 Palliative Use of Marijuana (cont’d)
– Penalties for patients, physicians, and producers if they do
not adhere to regulations
– *Importantly* this Act permits use of medical marijuana in
CT, but this does not change federal laws which still prohibit
and criminalize the use of marijuana for any reason
– DOJ states it will not go after individuals in compliance with
state laws, but compliance with state laws is
not a defense to a violation of federal law
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Miscellaneous
Public Act 12-197 LeadingAge Name Change
Effective October 1, 2012
Public Act 12-119 Investigating Medicaid Participants
for Dual Coverage
Effective June 15, 2012
– Now requires third-party administrators to supply certain
information on health insurance coverage policy holders who
apply for aid or other support from DSS
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Miscellaneous
Public Act 12-1 (SS) The Implementer
• § 8 Veterans Required to Apply for Federal Aid Benefits
Effective July 1, 2012
– Veterans applying for or receiving assistance under the Medicaid
program must also apply for benefits through the VA or DoD
• § 21 Report on Medicaid Fraud
Effective July 1, 2012
– New requirement that Chief State’s Attorney provide annual report to
Appropriations Committee detailing the money recovered from DSS
fraud investigations: October 1, 2013
• § 130 Disclosing Security Breaches of Computerized Data
Effective October 1, 2012
– Any business that owns, licenses or maintain computerized data that
includes personal information must disclose any breach
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Miscellaneous
Public Act 12-57 Permanent Absentee Ballot
Status for Permanently Disabled
Effective January 1, 2013
– Eligible for status if permanently physically disabled and unable to
appear in-person at designated polling place
– Now registrar of voters must send absentee ballots for each election,
primary or referendum in which voter may vote
– Annual notice in January to these voters to update status, if not returned
in 30 days, voter will be removed from permanent absentee ballot rolls.
Public Act 12-92 Agency Regulations Go Online
Effective July 1, 2013
– Regulations and proposed rules must be published on website of
agency and Secretary of State
– Regs become effective when published online
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Miscellaneous
Public Act 12-148 Enhancing Emergency Preparedness
and Response
Effective July 1, 2012
• § 7 Electric Services for Critical Facilities
– DEEP must establish a microgrid grant and loan pilot program
to support local distributed energy generation for “critical
facilities” which include hospitals so that they may operate in
grid-connected or island mode in the event of
a service outage
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Looking Forward:
2013 Legislative Session
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Questions and Discussion
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