HB 5001 — AN ACT SUPPORTING CONNECTICUT SENIORS AND THE IMPROVEMENT OF NURSING AND HOME-BASED CARE.

628 living services provided in state-funded congregate housing and in other assisted living pilot or demonstration projects established under state law.

(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,Public socialAct andNo. 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.

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5001 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.

[(e)The commissioner shalladopt regulations,inaccordance withthe 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.] sHB5001(e) /(1) FileThe No.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.

628 sHB5001 File No.

628 (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.

and (D) a written agreement to be signed by the applicant attestingPublic toAct theNo. accuracy of financial and other information such applicant provides and acknowledging that the state shall solely fund services not longer than ninety days after the date on which home care services begin.

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5001 attesting to the accuracy of financial and other information such applicant provides and acknowledging that the state shall solely fund services not longer than ninety days after the date on which home care services begin.

The provisions of this subsection and any other sHB5001provision /of Filethis No.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.

628 sHB5001 File No.

628 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.

(g)Public TheAct commissionerNo. 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 theeffect ofthe programonthestateandprogramparticipants.

Such24-39 report11 shall include information on (1) the number of persons31 divertedSubstitute fromHouse placementBill 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 personsdetermined presumptively eligiblefor Medicaidwho 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, [(4)] (7) the administration costs, [(5)] (8) the estimated savings to sHB5001 / File No.

6285001 sHB5001(g) FileThe No.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 theeffect ofthe programonthestateandprogramparticipants.

628Such 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 personsdetermined presumptively eligiblefor Medicaidwho 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, [(4)] (7) the administration costs, [(5)] (8) the estimated savings to provide home care versus institutional care for all persons in the program, and [(6)] (9) a comparison between costs under the different contracts for program services.

(B) who are inappropriately institutionalized or at risk of inappropriate institutionalization;Public Act No.

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5001 institutionalization;

Any person whose income exceeds two sHB5001hundred /per Filecent No.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.

628 sHB5001 File No.

628 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.

(3) Any person who resides in affordable housing under the assisted livingPublic demonstrationAct projectNo. 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.

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5001 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.

(4) The annualized cost of services provided to an individual under the state-funded portion of the program shall not exceed fifty per cent oftheweightedaveragecostofcareinnursing homesinthestate,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 continuetoreceive suchservices,providedtheannualized cost of such services does not exceed eighty per cent of the weighted sHB5001average /cost Fileof No.such nursing home care.

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628 average cost of such nursing home care.

(1) Number of participants before and after [copayments are reduced pursuantPublic toAct subsectionNo. (i)ofthissection]any adjustment incopayments, (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.

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5001 pursuant to subsection (i)ofthissection]any adjustment incopayments, (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.

(l) In determining eligibility for the programdescribed in this section, the commissioner shall not consider as income (1) Aid and Attendance pensionbenefitsgrantedto aveteran,asdefinedinsection27-103,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 sHB5001part /with Filefederal No.funds.

628(m)Thecommissioner sHB5001shalladoptregulations,inaccordancewiththe Fileprovisionsofchapter54,to(1)define"accessagency",(2)implementand administer the program, (3) implement and administer the presumptive Medicaideligibility systemdescribedin subsection(e)ofthissection,(4) establish uniform state-wide standards for the program and uniform Public Act No.

62824-39 part15 withof federal31 funds.Substitute House Bill No.

(m)Thecommissioner5001 shalladoptregulations,inaccordancewiththe provisionsofchapter54,to(1)define"accessagency",(2)implementand administer the program, (3) implement and administer the presumptive Medicaideligibility systemdescribedin subsection(e)ofthissection,(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.

TheTheDepartment Department ofSocialServicesshallcount insurance benefit payments toward resource exclusion to the extent such payments (1) are for services paid for by a precertified long-term care policy;

(3) are for nursing home care, or formal services delivered to insureds in the community as part of a care plan approved by an access sHB5001agency /approved Fileby No.the Office of Policy and Management and the Department of Social Services as meeting the requirements for such agency as defined in regulations adopted pursuant to subsection [(e)] (m) of section 17b-342, as amended by this act;

628and sHB5001(4) Fileare for services Public Act No.

62824-39 agency16 approved by the Office of Policy31 andSubstitute ManagementHouse andBill theNo. Department of Social Services as meeting the requirements for such agency as defined in regulations adopted pursuant to subsection [(e)] (m) of section 17b-342, as amended by this act;

and5001 (4) are for services provided after the individual meets the coverage requirements for long- term care benefits established by the Department of Social Services for this program.

The Insurance Department shall only precertify long-term care insurance policies that (1) alert the purchaser to the availability of consumer information and public education provided by the sHB5001Department /of FileAging No.and Disability Services pursuant to section 17a- 861;

628(2) sHB5001offer Filethe option of home and community-based services in Public Act No.

62824-39 Department17 of Aging31 andSubstitute DisabilityHouse ServicesBill pursuantNo. to section 17a- 861;

(2)5001 offer the option of home and community-based services in addition to nursing home care;

Not later than January 1, 2025, the commissioner shall report, in accordance with the provisions of section 11-4a of the general statutes, to the joint standing committees of the General Assembly having cognizance of matters sHB5001Public /Act File No.

62824-39 sHB500118 Fileof 31 Substitute House Bill No.

6285001 relating to aging and human services regarding such study.

(3) support and educational services to parents, nonparent caretaker relatives and legal guardians whose children are participants of the childPublic careAct servicesNo. of the program and who are interested in obtaining a high school diploma or its equivalent.

Parents24-39 and19 theirof preschool31 ageSubstitute childrenHouse andBill nonparent caretaker relatives, legal guardians and sHB5001 / File No.

6285001 sHB5001child Filecare No.services of the program and who are interested in obtaining a high school diploma or its equivalent.

628Parents and their preschool age children and nonparent caretaker relatives, legal guardians and preschool age children in their care may attend classes in parenting and child learning skills together so as to promote the mutual pursuit of education and enhance parent-child interaction;

Section 17a-54 of the general statutes is repealed and the followingPublic isAct substitutedNo. in lieu thereof (Effective October 1, 2024):

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5001 following is substituted in lieu thereof (Effective October 1, 2024):

The goal of each center shall be to improve parenting and enhance family functioning in order to provide sHB5001children /and Fileyouths No.increased opportunities for positive development.

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628 children and youths increased opportunities for positive development.

(2) assisting elderly persons [to apply] in applying for federal and [other benefits]Public stateAct benefits,No. and accessing community resources, available to such persons;

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5001 benefits] state benefits, and accessing community resources, available to such persons;

For the purposes of this subsection, "community resources" means resources that assist elderly persons in gaining access to housing opportunities, including, but not limited to, information regarding access to waitlists sHB5001for /housing Filedesignated No.for elderly persons, applications and consumer reports.

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628 for housing designated for elderly persons, applications and consumer reports.

ThePublic commissionerAct shallNo. post a link to the directory on the Department of Aging and Disability Services' Internet web site.

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5001 The commissioner shall post a link to the directory on the Department of Aging and Disability Services' Internet web site.

(NEW) (Effective October 1, 2024) Each managed residential sHB5001community /shall Fileprovide No.not less than thirty days' notice to its residents and residents' legal representatives before (1) the operator of the managed residential community changes from one business entity to another, or (2) the assisted living services agency providing services at the managed residential community changes from one agency to another.

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628 community shall provide not less than thirty days' notice to its residents and residents' legal representatives before (1) the operator of the managed residential community changes from one business entity to another, or (2) the assisted living services agency providing services at the managed residential community changes from one agency to another.

ThePublic regionalAct ombudsmenNo. shall, in accordance with the policies and procedures established by the Office of the Long-Term Care Ombudsman:

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5001 The regional ombudsmen shall, in accordance with the policies and procedures established by the Office of the Long-Term Care Ombudsman:

(3) Identify, investigate and resolve complaints made by or on behalf of residents that relate to action, inaction or decisions that may sHB5001adversely /affect Filethe No.health, safety, welfare or rights of the residents or by, or on behalf of, applicants in relation to issues concerning applications to long-term care facilities;

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628 adversely affect the health, safety, welfare or rights of the residents or by, or on behalf of, applicants in relation to issues concerning applications to long-term care facilities;

Sec.Public Act No.

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5001 Sec.

(B) (i) the complainant or resident gives consent orally, sHB5001visually /or Filethrough No.the use of auxiliary aids and services;

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628 visually or through the use of auxiliary aids and services;

and (4) "long-term services and supports"Public meansAct (A)No. health, health-related, personal care and social services provided to persons with physical, cognitive or mental health conditions or disabilities to facilitate optimal functioning and quality of life, or (B) hospice care providedto personswho may benearing the end of their lives.

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5001 supports" means (A) health, health-related, personal care and social services provided to persons with physical, cognitive or mental health conditions or disabilities to facilitate optimal functioning and quality of life, or (B) hospice care providedto personswho may benearing the end of their lives.

Not later than October 1, 2022, the State Ombudsman appointed pursuant to said section shall, within available appropriations, appoint a Community Ombudsman who shall have access to data pertaining to long-term services and supports provided by a home care provider to a client, including, but not limited to, medical, social and other data relating to such client, provided (1) such client or such client's authorized representative provides written consent to such access, [or] (2) if such client is incapable of providing such consent due to a physical, cognitive or mental health condition or sHB5001disability, /the Fileclient No.communicates consent orally, visually or through the use of auxiliary aids and services, or (3) if such client is incapable of providing such consent as described in subdivision (2) of this subsection, and has no authorized representative, the Community Ombudsmandeterminesthedataisnecessary toinvestigateacomplaint concerning such client's care.

628 sHB5001 File No.

628 disability, the client communicates consent orally, visually or through the use of auxiliary aids and services, or (3) if such client is incapable of providing such consent as described in subdivision (2) of this subsection, and has no authorized representative, the Community Ombudsmandeterminesthedataisnecessary toinvestigateacomplaint concerning such client's care.

(5)Public CoachAct individualsNo. in self advocacy;

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5001 (5) Coach individuals in self advocacy;

(4) Providing information to public and private agencies, elected and sHB5001appointedofficials,themediaandotherpersonsregardingtheproblems /andconcernsofolderadultsandpeoplewithdisabilitiesreceivinghome Filecare; No.

628 sHB5001 File No.

628 appointedofficials,themediaandotherpersonsregardingtheproblems andconcernsofolderadultsandpeoplewithdisabilitiesreceivinghome care;

(e) Not later than December 1, 2023, and annually thereafter, theState Ombudsman shall submit a report, in accordance with the provisions of section 11-4a, to the joint standing committees of the General Assembly having cognizance of matters relating to aging, human services and publicPublic healthAct onNo. (1) implementation of the public awareness strategy relating to the Community Ombudsman program, (2) the number of persons served in the program, (3) the number of complaints regarding homecarefiledwiththeprogram,(4)thedispositionofsuchcomplaints, and (5) any gaps in services and resources needed to address such gaps.

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5001 public health on (1) implementation of the public awareness strategy relating to the Community Ombudsman program, (2) the number of persons served in the program, (3) the number of complaints regarding homecarefiledwiththeprogram,(4)thedispositionofsuchcomplaints, and (5) any gaps in services and resources needed to address such gaps.

(Effective from passage) The Commissioner of Social Services shall conduct a study on the feasibility of pursuing a family caregiver support benefit through a Medicaid demonstration waiver under Section 1115 of the Social Security Act that would provide respite services and support to residents of the state who are not otherwise sHB5001eligible /for Filesuch No.services under Medicaid.

628 sHB5001 File No.

628 eligible for such services under Medicaid.

Sec.Public Act No.

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5001 Sec.

(F) the Secretary of the Office sHB5001of /Policy Fileand No.Management, or the secretary's designee;

628 sHB5001 File No.

628 of Policy and Management, or the secretary's designee;

(3)Public identifyAct aNo. pathway through application, inspection or other means by which a nursing home may be designated as a Center of Excellence;

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5001 (3) identify a pathway through application, inspection or other means by which a nursing home may be designated as a Center of Excellence;

The commissioner shall develop the incentives in a time frame and manner to ensure that such incentives do not duplicate other applicable federal sHB5001or /state Filefunding. No.

628 sHB5001 File No.

628 or state funding.

(NEW) (Effective July 1, 2024) The Department of Public Health, in consultation with the Office of the Long-Term Care Ombudsman and the Long-Term Care Advisory Council, shall establish an online nursing home consumer dashboard, within available appropriations,Public thatAct provides:No.

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5001 appropriations, that provides:

ThisApproved actMay shall21, take2024 effectPublic asAct followsNo. and shall amend the following sections:

October24-39 1,31 2024of Section31 1 New section Sec.

2 October 1, 2024 New section Sec.

3 October 1, 2024 New section Sec.

4 October 1, 2024 New section Sec.

5 October 1, 2024 New section Sec.

6 from passage New section Sec.

7 October 1, 2024 New section October 1, 2024 Sec.

8 New section Sec.

9 October 1, 2024 20-675 Sec.

10 July 1, 2024 17b-342 Sec.

11 July 1, 2024 17b-253(a) Sec.

12 July 1, 2024 17b-354(e)(1) Sec.

13 July 1, 2024 38a-475 Sec.

14 from passage New section Sec.

15 October 1, 2024 10-4o(a) Sec.

16 October 1, 2024 17a-54 Sec.

17 October 1, 2024 7-127b Sec.

18 October 1, 2024 New section Sec.

19 October 1, 2024 New section Sec.

20 from passage New section Sec.

21 October 1, 2024 17a-875 Sec.

22 October 1, 2024 17a-882 Sec.

23 October 1, 2024 17a-886 Sec.

24 from passage New section sHB5001 / File No.

628 sHB5001 File No.

628 Sec.

25 July 1, 2024 New section Sec.

26 July 1, 2024 New section sHB5001 / File No.

628 30 sHB5001 File No.

628 The following Fiscal Impact Statement and Bill Analysis are prepared for the benefit of the members of the General Assembly, solely for purposes of information, summarization and explanation and do not represent the intent of the General Assembly or either chamber thereof for any purpose.

In general, fiscal impacts are based upon a variety of informational sources, including the analyst’s professional knowledge.

Whenever applicable, agency data is consulted as part of the analysis, however final products do not necessarily reflect an assessment from any specific department.

OFA Fiscal Note State Impact:

See Below Municipal Impact:

See Below OFA Fiscal Note The bill results in a fiscal impact to various state agencies associated with changes to long term services and supports for elderly adults including home care, and related monitoring and investigations.

Various municipalities may experience a revenue gain related to the expansion of fingerprinting locations.

Section 1 results in a cost associated with requiring the Department of Social Services (DSS) to develop and maintain a home care provider registry and data processing system to promote awareness and access to qualified home care providers.

The development and management of the registry/system is anticipated to cost at least $200,000 in FY 25 and $100,000 in FY 26.

The state may experience a related federal grants revenue gain to the extent system expenditures are funded through Other Expenses and approved for federal reimbursement.

Section 1 also results in a potential cost to the Department of Consumer Protection (DCP) to the extent additional complaints are received and investigations are required.

If there is a significant increase in the number of complaints DCP will have to hire a special 1DCP regulates and investigates complaints regarding homemaker companion agencies which are included in the new registry.

sHB5001 / File No.

628 31 sHB5001 File No.

628 investigator for a salary and other expenses cost of $57,000 in FY 25 and $73,000 in FY 26, along with corresponding fringe benefits costs of $22,000 in FY 25 and $29,000 in FY 26.

Section 2, which requires each home health care, home health aide, andhospice providerto submit specifiedinformationto theDepartment of Public Health (DPH) so that DPH can forward that information on to DSS for inclusion in a new registry, is anticipated to result in an annual cost to DPH of approximately $30,000 for a half-time Processing Technician.

The cost to the State Comptroller for fringe benefits for this position are estimated at approximately $12,375 annually.

Section 6 requires the Department of Emergency Services and Public Protection (DESPP) to develop and implement a plan to expand fingerprinting locations throughout the state for persons requiring criminal history records checks for employment or licensing purposes, resulting in a potential revenue loss to the Applicant Fingerprint Card Submission Account and a potential revenue gain to various municipal police departments to the extent that applicants shift from using state police fingerprinting locations to other fingerprinting locations.

Section 10 results in a cost to DSS associated with presumptive eligibility for the Medicaid portion of the Connecticut Home Care Program for the Elderly (CHCPE).

The bill requires DSS to establish a presumptive eligibility system and adopt regulations to establish uniform state-wide standards and uniform assessment tools for use in the screening process for the program and the prescreening for presumptive Medicaid eligibility.

This results in administrative costs to the agency of approximately $500,000 in FY 25 to support eligibility specialists and related costs to meet the requirements of the new presumptive eligibility process.

2FY 25 costs reflect 9 months of salary due to the bill's October 1, 2024 effective date.

3DESPP conducts fingerprinting for a fee of $15 fee per person paid to the Applicant Fingerprint Card Submission Account, a non-lapsing account used for IT support and maintenance for the fingerprinting systems.

sHB5001 / File No.

628 32 sHB5001 File No.

628 Additionally, presumptive eligibilityforCHCPEcouldenablecertain individuals to achieve Medicaid eligibility sooner than they otherwise would have, resulting in a shift in associated costs.

The state may also incur costs to the extent that individuals are enrolled and then determined ineligible.

The actual cost to the state will depend on the presumptive eligibility process developed, the number of applicable individuals who enroll earlier, and the number of individuals who are found ineligible and their associated costs.

For context, the average monthly gross cost per enrollee is approximately $3,400.

Under the bill, DSS can fund services up to ninety days after the date on which home care services begin.

The fiscal impact to DSS under this section is based on the approval for such process and payments by the Centers for Medicare and Medicaid Services (CMS).

Section 13 requires the Department of Aging and Disability Services (ADS) to study and report to the Aging and Human Services Committees, by January 1, 2025 on:

(1) reimbursement rate options for families receiving TFA benefits in which the head of household is a nonparent caretaker relative and legal guardian of a child, (2) methods to means test these families to target those with the greatest need, and (3) the number of nonparent caretaker relatives who may be eligible under the bill’s provisions.

These topics are outside of the agency’s expertise, as the TFA program is not administered by ADS and relevant data necessary to complete the analysis is not housed within the agency.

It is estimated this will result in a cost of $100,000 in FY 25 to hire a consultant to assist with meeting the study and reporting requirements within this timeframe.

Sections21-23isanticipatedto result inacost to ADS of upto $400,00 to support upto fournewregionalombudsmen.These ombudsmen will stafftheOfficeoftheLong-TermCareOmbudsmanandtheCommunity Ombudsman program within that office and will assist in better managing their respective offices’ responsibilities.

sHB5001 / File No.

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628 Section 25 requires DPH to design a statewide Centers of Excellence Program to provide incentives to licensed nursing homes that deliver services consistent with evidence-based best practices, which is anticipated to cost $250,000 in FY 25.

Section 26, which requires DPH to establish an online nursing home consumer report card dashboard, is anticipated to cost $500,000 in FY 25.

The bill makes various technical, conforming, and other changes that have no fiscal impact.

House “A” strikes the language in the underlying bill and the associated impact and results in the fiscal impact described above.

The Out Years The annualized ongoing fiscal impact identified above would continue into the future subject to inflation.

sHB5001 / File No.

628 34 sHB5001 File No.

628 OLR Bill Analysis sHB 5001 (as amended by House "A")* AN ACT SUPPORTING CONNECTICUT SENIORS AND THE IMPROVEMENT OF NURSING AND HOME-BASED CARE.

TABLE OF CONTENTS:

SUMMARY Requires the DSS commissioner, starting January 1, 2025, to develop and maintain a home care provider registry and data processing system for people receiving Medicaid home-and community-based services;

allows the commissioner to apply to the federal Centers for Medicare and Medicaid Services for enhanced federal financial participation related to the registry’s development, maintenance, and ongoing operation RequirestheDPHandDSScommissionerstoprominentlypostontheirdepartmentwebsites a link to the Medicare Nursing Home Care Compare website Requires the DESPP commissioner to develop and implement a plan to expand fingerprinting locations in the state and report on the plan to the Aging, Public Health, and Public Safety committees by January 1, 2025 §§ 7-9 — HOME CARE EMPLOYEE BADGES AND PHOTOGRAPHS Requires home health care, home health aide, homemaker-companion, and hospice agencies to require their employees to wear an identification badge with their name and photograph during client appointments;

subjects agencies to disciplinary action for violating the requirements Requires the DSS commissioner to establish a presumptive Medicaid eligibility system for people applying to the Medicaid-funded portion of CHCPE;

requires the state to pay for up to 90 days of home care applicants determined to be presumptively Medicaid eligible;

expands DSS annual CHCPE reporting requirements to include data on the presumptive Medicaid eligibility system Requires the ADS commissioner to study reimbursement rate options for nonparent caretaker relatives (e.g., grandparents) receiving DSS Temporary Family Assistance benefits and report on the study to the Aging and Human Services committees by January 1, 2025 §§ 15 & 16 — FAMILY RESOURCE CENTERS AND PARENT EDUCATION AND SUPPORT CENTERS Expands the scope of SDE family resource centers and DCF parent education and support centers to include resources, programs, and services for nonparent caretaker relatives and legal guardians;

requires the centers to make referrals to certain community programs Makes the duties of municipalagents for the elderly mandatory and expands themto include helping seniors access housing assistance resources;

requires the ADS commissioner to create a directory with these agents’ contact information and post it on the department’s website sHB5001 / File No.

628 sHB5001 File No.

628 § 18 — LONG-TERM CARE OMBUDSMAN NOTIFICATION OF ALSA LICENSURE Requires the DPH commissioner to notify the Long-Term Care Ombudsman within 30 days after granting a license to an ALSA that operates an MRC or provides services at an MRC Requires MRCs to give residents and their legal representatives at least 30 days’ notice before changing the facility’s operator or ALSA that provides facility services Requires the Long-Term Care Ombudsman, in consultation with the public health commissioner, to develop an MRC consumer guide and post it on specified agency websites by January 1, 2025 Expands the duties of regional long-term care ombudsmen to include activities related to the Community Ombudsman program, which supports adults receiving DSS-administered home- and community-based services Allows nursing home residents or complainants to give consent visually or by using auxiliary aids for the Office of the Long-Term Care Ombudsman to disclose their files or records;

requires an office representative to document the consent in writing Allows recipients of home- andcommunity-based services with specified medical conditions or disabilities to give consent visually or by using auxiliary aids for the Community Ombudsman to disclose their files or records;

specifies that this data includes medical, social, or other client-related data;

allows the Long-Term Care Ombudsman to assign a community regional ombudsman the duties of a long-term care regional ombudsman Requires the DSS commissioner to (1) study the feasibility of providing a family caregiver support benefit through a Medicaid Section 1115 waiver and (2) report the study results to the Aging and Human Services committees by January 1, 2025 Requires the public health commissioner to design a Center of Excellence Program for licensed nursing homes to provide incentives for those that meet certain criteria Requires DPH to establish an online nursing home consumer dashboard, within available appropriations SUMMARY Thisbillevaluatesand expandssupportsandservicesforolderadults as described in the section-by-section analysis below.

*House Amendment “A” replaces the underlying bill (File 607) and adds provisions on (1) the Department of Social Services (DSS) home care provider registry and data processing system, (2) presumptive eligibility system for Medicaid home- and community-based services, (3) DSS study on family caregiver support benefits, (4) Department of Aging and Disability Services (ADS) study on reimbursement for nonparent caretaker relatives, (5) expansion of regional long-term care ombudsmen’s duties, (6) disclosure of records and files under the Community Ombudsman Program, (7) nursing home Center of Excellence Program, and (8) Department of Public Health (DPH) online nursing home dashboard.

It also eliminates provisions on (1) training sHB5001 / File No.

628 36 sHB5001 File No.

628 for personal care attendants (PCAs) and homecare worker training on consumer harassment, abuse, and discrimination;

(2) training for family caregivers providing PCA services;

(3) managed residencial community (MRC) residency agreements and fees;

(4) assisted living services agency (ALSA) fees;

(5) bonds to expand the Aging in Place Safely Program;

and (6) various ADS and DPH General Fund appropriations.

EFFECTIVE DATE:

October 1, 2024, unless otherwise noted below.

§§ 1-3 — DSS HOME CARE PROVIDER REGISTRY AND DATA PROCESSING SYSTEM Requires the DSS commissioner, starting January 1, 2025, to develop and maintain a home care provider registry and data processing system for people receiving Medicaid home- and community-based services;

allows the commissioner to apply to the federal Centers for Medicare and Medicaid Services for enhanced federal financial participation related to the registry’s development, maintenance, and ongoing operation Starting January 1, 2025, the bill requires the Department of Social Services (DSS) commissioner to develop and maintain a home care provider registry and data processing system that (1) promotes awareness of and access to qualified home care providers for recipients of Medicaid home- and community-based services (HCBS) and (2) may support the recruitment, retention, and oversight of qualified home care providers.

The commissioner must do this in consultation with the Department of Consumer Protection (DCP) and Department of Public Health (DPH) commissioners and post a link to the registry on the DSS website.

It also permits the DSS commissioner to adopt regulations to implement the registry.

Registry Contents Under the bill, the registry must include home care providers who (1) either (a) offer home care or long-term services and supports (e.g., health, personal care, and social services or hospice care) and are not licensed by DPH (e.g., personal care attendants) or (b) are employed by an entity that provides these services, such as a home health agency, hospice agency, or homemaker-companion agency, and (2) are not sHB5001 / File No.

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628 PCAs or family caregivers who provide adult family living services under DSS or Department of Developmental Services Medicaid waiver programs.

The bill requires the registry to include the following information about these providers:

1.

their first and last name, job title, and date of hire;

2.

their employer’s legal name;

and 3.

a list of training programs their employer offers and the dates providers completed trainings.

Registry Exemptions Under the bill, providers may exempt themselves from the registry if they (1) are a victim of domestic violence or sexual assault;

(2) have a court-issued protective order, restraining order, standing criminal protective order, or foreign protective order (i.e., order issued by another state or U.S.

territory);

or (3) assert that extraordinary personal circumstances require an exemption to protect their health, safety, or welfare.

Providers must assert their exemption directly to their employer as the DSS commissioner prescribes.

Providers who do so are not required to submit proof that they qualify for the exemption.

Registry Submissions The bill requires the DSS commissioner to consult with the DCP and DPH commissioners to develop procedures for collecting and maintaining registry information, including how often they will collect the information and how they will update or remove inaccurate or outdated information.

It correspondingly requires the following agencies to submit the required provider information listed above to the (1) DPH commissioner, for home health aide, home health care, and hospice sHB5001 / File No.

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628 agencies, and (2) DCP commissioner, for homemaker-companion agencies.

The DCP and DPH commissioners must then give the information to the DSS commissioner to include in the registry.

The bill prohibits agencies from submitting provider information on any employees who assert an exemption from the registry.

Registry Functionalities The registry may include functionalities that (1) connect people seeking HCBS with qualified home care providers, (2) support recruiting and retaining qualified home care providers, and (3) support state oversight of these providers.

Connecting Providers and Service Recipients.

Under the bill, the registry may connect people seeking HCBS with qualified home care providers by doing the following:

1.

helping them identify and match with qualified home care providers by sorting providers based on characteristics (e.g., language proficiency, certifications, prior experience, and special skills) and 2.

helping individuals and their families navigate the state’s home- and community-based services system.

Provider Recruitment and Retention.

Under the bill, the registry may support recruiting and retaining qualified home care providers by doing the following:

1.

helping them become and stay enrolled as Medicaid HCBS providers, 2.

actively recruiting these providers through job advertisements and job fairs, 3.

connecting providers to training benefits and professional development opportunities, 4.

facilitating provider access to health insurance coverage and sHB5001 / File No.

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628 other benefits, and 5.

facilitating communication with providers during public health and other emergencies.

Provider Oversight.

The bill authorizes the registry to support state oversight of these HCBS providers by facilitating background checks, verifying their qualifications and special skills, and facilitating communication with providers during a public health or other emergency.

Registry Funding The bill authorizes the DSS commissioner to submit an advanced planning document to the federal Centers for Medicare and Medicaid Services (CMS) for enhanced federal financial participation related to developing and maintaining the registry or its ongoing operations.

§§ 4 & 5 — MEDICARE NURSING HOME CARE COMPARE WEBSITE LINK Requires the DPH and DSS commissioners to prominently post on their department websites a link to the Medicare Nursing Home Care Compare website The bill requires the DSS and DPH commissioners to post, in a prominent location on their respective department websites, a link to the Medicare Nursing Home Care Compare website.

This online reporting tool uses a five-star rating system that allows the public to compare nursing homes by quality of care, health inspections, and staffing.

§ 6 — EXPANDING FINGERPRINTING LOCATIONS Requires the DESPP commissioner to develop and implement a plan to expand fingerprinting locations in the state and report on the plan to the Aging, Public Health, and Public Safety committees by January 1, 2025 The bill requires the Department of Emergency Services and Public Protection (DESPP) commissioner, in consultation with the DPH commissioner, to develop and implement a plan to expand fingerprinting locations in the state to facilitate more access to these locations for people required to complete state and national criminal sHB5001 / File No.

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628 history records checks for employment or licensing purposes.

The commissioner must report to the Aging, Public Health, and Public Safety committees on the plan by January 1, 2025.

EFFECTIVE DATE:

Upon passage §§ 7-9 — HOME CARE EMPLOYEE BADGES AND PHOTOGRAPHS Requires home health care, home health aide, homemaker-companion, and hospice agencies to require their employees to wear an identification badge with their name and photograph during client appointments;

subjects agencies to disciplinary action for violating the requirements The bill requires each home health care, home health aide, homemaker-companion, and hospice agency to requires employees to wear an identification badge that includes his or her name and photograph during each client appointment.

The requirement takes effect July 1, 2025, for homemaker-companion agency employees and October 1, 2024, for all other agency employees.

Underthebill,violatorsmaybesubjecttovariousdisciplinaryactions (e.g., license suspension or revocation or probation) by the (1) Department of Consumer Protection, for homemaker-companion agencies and (2) DPH, for all other agencies.

The bill also makes a related conforming change.

§§ 10-13 — PRESUMPTIVE MEDICAID ELIGIBILITY FOR HOMECARE Requires the DSS commissioner to establish a presumptive Medicaid eligibility system for people applying to the Medicaid-funded portion of CHCPE;

requires the state to pay for up to 90 days of home care applicants determined to be presumptively Medicaid eligible;

expands DSS annual CHCPE reporting requirements to include data on the presumptive Medicaid eligibility system The bill requires the DSS commissioner to establish a presumptive Medicaid eligibility system for people applying to the Medicaid-funded portion of the Connecticut Home Care Program for Elders (CHCPE).

It requires the commissioner to adopt regulations to implement and administer the system.

sHB5001 / File No.

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628 A presumptive eligibility determination deems an applicant immediately eligible for CHCPE services prior to a full Medicaid- eligibility determination.

Under the bill, the state will pay for up to 90 days of care for applicants who (1) require a skilled level of nursing care and (2) are determined presumptively eligible for Medicaid.

The bill requires the commissioner, to the extent federal law allows, to seek a federal Medicaid waiver or state plan amendment needed to try to get federal reimbursement for the costs of providing coverage to those determined presumptively eligible for Medicaid.

Under the bill, the presumptive eligibility system does not take effect until the commissioner gets the federal reimbursement.

The bill allows the commissioner, in her discretion, to discontinue the system if (1) it has been operational for at least two years and (2) she determines it is not cost effective.

Thebillalsomakesrelatedminor,technical,andconformingchanges.

EFFECTIVE DATE:

July 1, 2024 Eligibility Determinations By law, DSS contracts with “access” agencies to determine CHCPE participants’ service needs and develop individualized care plans.

The bill requires the commissioner to develop a screening tool for these agencies to use to determine if a presumptive eligibility applicant is (1) functionally able to live in a home or community setting (“functionally eligible”) and (2) likely to be financially eligible for Medicaid.

Under the bill, applicants must complete a Medicaid application on the day they are screened for functional eligibility or within 10 days after.

If the applicant meets the two criteria, DSS must make a presumptive eligibility determination and initiate home care services within 10 days.

The bill requires DSS to make a final Medicaid-eligibility determination within 45 days after receiving an applicant’s completed Medicaid sHB5001 / File No.

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628 application, or within 90 days for an applicant with disabilities.

For a person determined presumptively eligible for Medicaid, the commissioner must, in keeping with federal law, determine the person retroactively eligible for Medicaid for up to 90 days before the date of his or her Medicaid application.

Written Agreement The bill requires applicants to sign a written agreement attesting to the accuracy of the information they provide.

The agreement must also acknowledge that applicants will receive state-funded services up to 90 days after the home care services begin.

Reporting Requirements By law, the commissioner must annually report certain CHCPE information to the Human Services Committee.

The bill adds the following to this required information:

1.

the number of people determined presumptively eligible for Medicaid, 2.

state savings based on institutional care costs that were averted by correctly determining people presumptively eligible, and 3.

the number of people incorrectly determined presumptively eligibleandthecoststoprovidethemwiththehomecare services before the final eligibility determination.

§ 14 — ADS STUDY ON FINANCIAL ASSISTANCE FOR NONPARENT CARETAKER RELATIVES Requires the ADS commissioner to study reimbursement rate options for nonparent caretaker relatives (e.g., grandparents) receiving DSS Temporary Family Assistance benefits and report on the study to the Aging and Human Services committees by January 1, 2025 The bill requires the ADS to study financial assistance for nonrelative caretakers, including:

1.

reimbursement rate options for families receiving DSS sHB5001 / File No.

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628 Temporary Family Assistance (TFA) benefits where the head of household is a nonparent caretaker relative and the legal guardian of a child, 2.

ways to means test these families to target reimbursement to those with the greatest need, and 3.

the number of nonparent caretaker relatives who may be eligible for TFA reimbursement after applying a means-testing method the department examines.

Under thebill, the ADS commissioner must report onthe study to the Aging and Human Services committees by January 1, 2025.

EFFECTIVE DATE:

Upon passage §§ 15 & 16 — FAMILY RESOURCE CENTERS AND PARENT EDUCATION AND SUPPORT CENTERS Expands the scope of SDE family resource centers and DCF parent education and support centers to include resources, programs, and services for nonparent caretaker relatives and legal guardians;

requires the centers to make referrals to certain community programs Thebillexpandsthescopeof(1)StateDepartmentofEducation(SDE) family resource centers and (2) Department of Children and Families (DCF) parent education and support centers to include resources, programs, and services for nonparent caretaker relatives and legal guardians (see Background).

It also requires these centers to make referrals for parents, nonparent caretaker relatives, and legal guardians to community programs on childhood development and positive parenting practices.

Background — SDE Family Resource Centers By law, SDE and DSS must coordinate family resource centers together.

These centers are generally located in public elementary schools and provide comprehensive child care services, remedial educational and literary services, families-in-training programs, and supportive services to parents who receive Temporary Family Assistance and other parents who need services.

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628 Background — DCF Parent Education and Support Centers DCF operates, within available appropriations, community-based, multiservice parent education and support centers.

The goal of each center is to improve parenting and family functioning to give children and youths more opportunities for positive development.

Centers provide (1) education, training, and support services;

(2) information on, and coordination of, other community services;

(3) consultation services;

and (4) coordination of child care and transportation services to facilitate participation in the center’s programs.

§ 17 — MUNICIPAL AGENTS FOR THE ELDERLY Makes the duties of municipal agents for the elderly mandatory and expands them to include helping seniors access housing assistance resources;

requires the ADS commissioner to create a directory with these agents’ contact information and post it on the department’s website By law, municipalities must appoint a municipal agent for the elderly to help seniors learn about community resources and file for benefits.

The bill makes the agents’ duties mandatory, rather than permissive as undercurrentlaw.Italsoexpandstheirdutiestoincludehelpingseniors access resources on housing opportunities, including information on accessing elderly housing waiting lists, applications, and consumer reports.

The bill also requires the ADS commissioner, by January 1, 2025, to create a directory of these municipal agents that includes their names and titles, phone numbers, and email and mailing addresses.

The commissioner must post a link to the directory on the ADS website.

§ 18 — LONG-TERM CARE OMBUDSMAN NOTIFICATION OF ALSA LICENSURE Requires the DPH commissioner to notify the Long-Term Care Ombudsman within 30 days after granting a license to an ALSA that operates an MRC or provides services at an MRC The bill requires the DPH commissioner to notify the Long-Term Care Ombudsman within 30 days after granting a license to an assisted living services agency (ALSA) that operates a managed residential community (MRC) or provides services at an MRC.

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628 Background — ALSA Licensure Under existing law, the state does not license assisted living facilities.

Instead, it licenses and regulates ALSAs that provide assisted living services.

ALSAs can only provide these services at an MRC.

MRCs that wish to provide assisted living services must obtain a DPH license as an ALSA or arrange for the services with a licensed ALSA.

§ 19 — MANAGED RESIDENTIAL COMMUNITY RESIDENT NOTIFICATION Requires MRCs to give residents and their legal representatives at least 30 days’ notice before changing the facility’s operator or ALSA that provides facility services The bill requires MRCs to give residents and their legal representatives at least 30 days’ notice before changing the facility’s operator or ALSA that provides services at the facility.

§ 20 — MANAGED RESIDENTIAL COMMUNITY CONSUMER GUIDE Requires the Long-Term Care Ombudsman, in consultation with the public health commissioner, to develop an MRC consumer guide and post it on specified agency websites by January 1, 2025 The bill requires the Long-Term Care Ombudsman, in consultation with the public health commissioner, to develop an MRC consumer guide that includes information on (1) resident protections;

(2) housing protections, including those related to evictions;

(3) MRC fees;

and (4) any other information the ombudsman deems relevant.

By January 1, 2025, the ombudsman and commissioner must post the consumer guide on their respective agency websites, and the DSS commissioner must post it on the MyPlaceCT website.

EFFECTIVE DATE:

Upon passage § 21 — REGIONAL LONG-TERM CARE OMBUDSMEN DUTIES Expands the duties of regional long-term care ombudsmen to include activities related to the Community Ombudsman program, which supports adults receiving DSS- administered home- and community-based services By law, the Long-Term Care Ombudsman must appoint regional ombudsmen to help her perform certain duties, such as investigating and resolving nursing home resident complaints, representing sHB5001 / File No.

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628 residents’ and applicants’ interests before government agencies, and supporting the development of resident and family councils.

Under current law, regional ombudsmen must also carry out other activities the state ombudsman decides are appropriate.

The bill specifies that this includes activities related to the Community Ombudsman program, which supports adults receiving DSS- administered home- and community-based services.

§ 22 — OFFICE OF THE LONG-TERM CARE OMBUDSMAN CLIENT RECORDS DISCLOSURE Allows nursing home residents or complainants to give consent visually or by using auxiliary aids for the Office of the Long-Term Care Ombudsman to disclose their files or records;

requires an office representative to document the consent in writing Existing law authorizes the Office of the Long-Term Care Ombudsman to disclose its files and records only at the discretion of the ombudsman or her designee.

The office cannot identify the associated complainant or resident without the person’s consent, or the consent of the person’s legal representative, unless a court orders the disclosure.

Under existing law, a resident or complainant, or their legal representative, may give consent in writing or orally.

The bill also allows them to give consent visually or by using auxiliary aids and services.

As under existing law, a representative of the office must document the consent in writing.

§ 23 — COMMUNITY OMBUDSMAN PROGRAM Allows recipients of home- and community-based services with specified medical conditions or disabilities to give consent visually or by using auxiliary aids for the Community Ombudsman to disclose their files or records;

specifies that this data includes medical, social, or other client-related data;

allows the Long-Term Care Ombudsman to assign a community regional ombudsman the duties of a long-term care regional ombudsman Existing law establishes a Community Ombudsman program within the Office of the Long Term Care Ombudsman to, among other things, respond to complaints about long-term services and supports provided to adults in home- and community-based programs administered by DSS.

Current law grants the Community Ombudsman access to data on sHB5001 / File No.

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628 long-term services and supports given by a home care provider to a client if the client, or his or her authorized representative, generally consents in writing.

Under the bill, if the client has a physical, cognitive, or mental health condition or disability, he or she may instead give informed consent orally, visually, or using auxiliary aids and services.

If the client is unable to do so and does not have an authorized representative, the Community Ombudsman must determine the data is necessary to investigate a complaint about the client’s care, as under current law.

The bill also specifies that the datathe Community Ombudsman may access includes medical, social, or other data related to the client.

Lastly, the bill allows the Long Term Care Ombudsman to assign a regional community ombudsman the duties and responsibilities of a regional long-term care ombudsman, as deemed necessary by the Long Term Care Ombudsman.

§ 24 — STUDY ON MEDICAID FAMILY CAREGIVER SUPPORT BENEFITS Requires the DSS commissioner to (1) study the feasibility of providing a family caregiver support benefit through a Medicaid Section 1115 waiver and (2) report the study results to the Aging and Human Services committees by January 1, 2025 The bill requires the DSS commissioner to study the feasibility of pursuing a family caregiver support benefit through a Section 1115 Medicaid waver that would provide respite services and support to residents not otherwise eligible for these services under Medicaid.

The study must examine (1) Oregon’s Project Independence and Family Caregiver Assistance Program, which is operated under this type of Medicaid waiver;

(2) other options to expand eligibility for respite services for those not Medicaid-eligible;

and (3) potential state-funded long-term care services that could be used to offset the costs of a family caregiver support benefit.

Under the bill, the commissioner must report the study results to the Aging and Human Services committees by January 1, 2025.

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628 EFFECTIVE DATE:

Upon passage § 25 — NURSING HOME CENTER OF EXCELLENCE PROGRAM Requires the public health commissioner to design a Center of Excellence Program for licensed nursing homes to provide incentives for those that meet certain criteria The bill requires the DPH commissioner to design a Center of Excellence Program to provide incentives for qualifying nursing homes.

A “Center of Excellence” is a nursing home that serves residents in a manner consistent with evidence-based best practices for person- centered care.

While designing the program, the commissioner must study (1) how much a Center of Excellence Program could improve the quality of care at nursing homes and (2) what other states with similar programs consider to be best practices for nursing homes.

Under the bill, the commissioner must also consult:

1.

nursing home owners and operators, 2.

hospitals, 3.

nursing home residents and their advocates, 4.

the Office of the Long-Term Care Ombudsman, 5.

the DSS commissioner or her designee, 6.

the Office of Policy and Management (OPM) secretary or his designee, and 7.

other relevant stakeholders as the DPH commissioner considers necessary.

The bill requires the program’s design to do at least the following:

1.

identify evidence-based qualitative and quantitative standards for care delivery that a nursing home must meet to be designated as a Center of Excellence, and the measures that must be met for sHB5001 / File No.

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628 each standard;

2.

identify a pathway for nursing homes to achieve this designation (by applying, an inspection, or other means), and create a way to designate them;

3.

determine potential incentives for nursing homes that meet these standards;

and 4.

identify ways to maximize the use of available federal funding to support the program.

Under the bill, the program is voluntary and nursing homes will not be penalized if they do not participate.

The commissioner can engage with a consultant, within available appropriations, to identify best practices and design the program.

After completing the program’s design or no later than January 1, 2026, the commissioner must report to the OPM secretary on the plan developed.

The bill authorizes the DSS commissioner to seek a Medicaid state planamendment, or a waiver fromfederallaw,to provideincentivesfor the program participants.

The commissioner must develop incentives that do not duplicate other federal or state funding.

EFFECTIVE DATE:

July 1, 2024 § 26 — ONLINE NURSING HOME CONSUMER DASHBOARD Requires DPH to establish an online nursing home consumer dashboard, within available appropriations The bill requires DPH, in consultation with the Office of the Long- Term Care Ombudsman and the Long-Term Care Advisory Council, to establish an online nursing home consumer dashboard, within available appropriations, that includes:

1.

comprehensive information on the quality of care for people in need of nursing home care and their families and sHB5001 / File No.

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628 2.

industry leading practices.

DPH must include a link to the dashboard in a prominent place on the department’s website.

EFFECTIVE DATE:

July 1, 2024 COMMITTEE ACTION Aging Committee Joint Favorable Substitute Yea 15 Nay 0 (03/12/2024) Appropriations Committee Joint Favorable Substitute Yea 52 Nay 0 (04/15/2024) sHB5001 / File No.

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