LeadingAge Connecticut 2012 Legislative Review September 11, 2012

1. LeadingAge Connecticut2012 Legislative ReviewSeptember 11, 2012 Presented by: Maureen Weaver Elisabeth A. Pimentel Wiggin and Dana, LLP

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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.

8. Residential Care Homes Public Act 12-1 (SS) • §§ 7 & 15 DSS Payments to Residential Care Homes Effective July 1, 2012 • § 7 provides forFY 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

9. 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

10. 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

11. 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

12. Housing Special Act 12-6 Task Force to Study Aging in Place Effective June 15, 2012 • Task force will study: • 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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 cost-effectiveness and care continuity

19. 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.

20. 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). 20

21. 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

22. 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)

23. 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

24. 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

25. 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 25

26. 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

27. 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.

28. 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. 28

29. 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

30. 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

31. 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

32. 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 32

33. 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

34. 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

35. 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

36. 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

37. Looking Forward: 2013 Legislative Session

38. Questions and Discussion #2753801v2