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2013 End-of-Session Summary

This session, the CT Association for Healthcare at Home made terrific advances in getting a "seat at the table,” and helping to influence and support State policy-making. Through the combined efforts of staff, members, and our lobbyists, we saw many of the bills important to home care and hospice pass in both chambers and be signed into law. Our Association was invited to multiple meetings with state officials, asked to participate on many task forces and advisory councils, and given the opportunity to provide testimony on several bills which helped to further the healthcare at home initiative. Below, you’ll find a summary of this 2013 Legislative Session, including important meetings, bills, and opportunities for the future of healthcare at home.


Meeting with DSS & Commissioner Roderick Bremby:

On June 17th, Association Executive Committee members Richard Corcoran, VNA Community Healthcare, and Kimberly Nystrom, NE Homecare, along with Mark Chudwick of VNSCT and Association staff Deb Hoyt and Tracy Wodatch, outlined the value of home- and community-based care in a senior-level meeting at the CT Department of Social Services.

They discussed the value as well as the challenges home care and hospice agencies are facing as the state of CT transitions from a fee-for-service to shared-savings model. Rate and regulatory burden issues were brought up, as well as opportunities that home care will have in the new dually-eligible (MME) initiative and State Innovation Model (SIM).Kate McEvoy and Deputy Commissioner Kathleen Brennan both expressed the need for the Association and member agencies to review and provide feedback on home care's role in these models positioned to go into effect within the next six months. Commissioner Bremby provided a status report on DSS' modernization, including its call centers and process improvement accomplishments.

In an effort to increase ease-of-access for the public and providers, DSS has begun the ConneCT with DSS initiative, where all Medicaid documentation will be electronic and beneficiaries can now access their benefits and account status at www.connect.ct.gov (here is an English and a Spanish version of the ConneCT wth DSS pamphlet).

John McCormick requested a meeting for July 3 to learn more about the TPL burden on healthcare at home. Also, Commissioner Bremby requested that the Association and its leadership meet with him more frequently as we "share common Medicaid customers," and home and community-based care is vital to the success of the State's long-term services and support plan.

CT 2013 State Budget Impact:

The State budget was successfully passed during the regular session, and spared the home care and hospice industry for the larger part. The State legislature did allocate a great deal in the budget to

potentially-recovered Medicare and Medicard funds through fraud and abuse detection and prevention. What impact this will have on the already substantial regulatory scrutiny for CT home care and hospice agencies is unknown, but the open dialogue between the Association and DSS should foster further understanding, and hopefully prevent costly regulatory burdens for the industry.

In a recent statement, Office of Policy and Management Secretary Ben Barnes predicted that the state will end the fiscal year with a $236.6 million surplus. About $220.8 million of the surplus will be used to balance the 2014-15 year budget and the remaining funds will be transferred to the Rainy Day fund.

State Comptroller Kevin Lembo will certify the budget numbers on July 1. Lembo’s projection of the surplus was $212.3 million — a slightly more conservative number than the one reported by Barnes.


Below is a brief summary of several of the bills of interest to healthcare at home which were passed in both chambers.

For the full summary, click here.

SB 991 - AN ACT CONCERNING AN ADVISORY COUNCIL ON PALLIATIVE CARE

This bill establishes a 13-member Palliative Care Advisory Council within the Department of Public Health (DPH). The council must analyze the current state of palliative care in Connecticut and advise DPH on matters related to improving palliative care and the quality of life for people with serious or chronic illnesses. The Association has nominated ten people from within the Healthcare at Home membership and provider care continuum to represent the interest of home care and hospice at the State capitol.

SB 1026 - AN ACT CONCERNING AN ADEQUATE PROVIDER NETWORK TO ENSURE POSITIVE HEALTH OUTCOMES FOR LOW-INCOME RESIDENTS

The Council on Medical Assistance Program Oversight will study obstacles to achieving an adequate health care provider network for Medicaid recipients and recommend strategies to improve access to such providers, and health outcomes for such recipients across racial and ethnic lines.

The study will include an analysis of: Administrative burdens faced by providers, the extent and benefits of provider education concerning provision of care to Medicaid recipients, and the effect of Medicaid rates of reimbursement on achieving an adequate provider network.

The study will identify strategies to improve access to Medicaid providers by Medicaid recipients, improve health outcomes of all Medicaid recipients, reduce spending rates, particularly for the provision of care to Medicaid recipients with the costliest health needs, and reduce racial and ethnic disparities in health outcomes.

HB 5345 - AN ACT CONCERNING HOMEMAKER-COMPANION AGENCIES AND CONSUMER PROTECTION

This bill expands several notice requirements for homemaker-companion agencies. It also adds certain consumer protections to agency contracts, including specifying when contracts are enforceable and can be cancelled and payment obligations, including allowing agencies to recover payment for work
performed. Two amendments added important requirements to Homemaker-Companion Agency operation:

*House Amendment "A” requires agencies to notify clients that a background check was performed before sending an employee to a client's home rather than providing the check's results and adds the payment recovery provision.

*Senate Amendment "A” adds to the notice requirement that upon the client's request, the agency must provide written notice that a background check was performed and eliminates the prior notice background check provision added by House "A.”

HB 6514 - AN ACT IMPLEMENTING THE RECOMMENDATIONS OF THE PROGRAM REVIEW AND INVESTIGATIONS COMMITTEE CONCERNING MEDICAID PAYMENT INTEGRITY

Starting January 1, 2015, this bill requires the Department of Social Services (DSS), in coordination with the chief state's attorney and attorney general, to annually submit a joint report to the General Assembly on the state's efforts in the previous fiscal year to prevent and control Medicaid fraud, abuse, and errors and recover Medicaid overpayments.

The bill also requires DSS to assess the feasibility of expanding its Medicaid audit program and report its findings to the Human Services and Appropriations committees by January 1, 2014.

HB 6644 - AN ACT CONCERNING VARIOUS REVISIONS TO THE PUBLIC HEALTH STATUTES

This bill makes numerous substantive and minor changes to Department of Public Health (DPH)-related statutes and programs. For example, the bill requires licensed health care institutions to submit to DPH corrective action plans after the department finds the institution to be noncompliant with state laws or regulations.

The bill limits required background checks for long-term care facility volunteers with direct patient access to only those volunteers reasonably expected to regularly perform duties substantially similar to those of employees with direct patient access. It eliminates the Connecticut Homeopathic Medical Examining Board, transferring responsibility for disciplining homeopathic physicians from the board to DPH.

The bill makes changes affecting several health care professions and institutions, including master social workers, physician assistants, marital and family therapists, nuclear medicine technologists, optometrists, dental hygienists, hospice and nursing home facilities, residential care homes (RCHs), outpatient clinics, family day care homes, and hospitals.

The bill also makes changes affecting the disclosure of patient information by certain health care providers, statutory definitions related to addiction services, the state's electronic prescription drug monitoring program, the Alzheimer's Disease and Dementia Task Force, and the PANDAS/PANS advisory council.

*House Amendment "A” removes the provisions allowing DPH and professional regulatory boards to take disciplinary actions against specified health professionals for failing to conform to accepted professional standards. It also adds the provisions regarding the statutory definition of RCHs; nursing home and RCH citations for violations of the state's long-term care criminal history and patient abuse background search program; disclosure of patient information by DPH-licensed health care professionals; the Alzheimer's Disease and Dementia Task Force; nuclear medicine technologists; hospital coronary angioplasty reporting requirements; DPH's PANDAS/PANS advisory council; the electronic prescription drug monitoring program; outpatient clinics; and technical corrections to the public health statutes.

HB 6610 - AN ACT CONCERNING FEDERAL MEDICAID WAIVERS

Section 1. (Effective July 1, 2013) Not later than July 1, 2014, the Department of Social Services shall conduct a cost benefit analysis of providing home care versus institutional care for Medicaid and HUSKY Plan Part B recipients age eighteen years of age and under, and make recommendations to the joint standing committee of the General Assembly having cognizance of matters relating to human services on other Medicaid waiver programs or state plan options the state may apply for or utilize in order to provide home care services to Medicaid recipients age eighteen years of age and under.

SB 466 - AN ACT CONCERNING CONTINUING EDUCATION COURSES FOR PHYSICIANS

This bill reduces the frequency with which physicians must take mandatory topics for continuing medical education (CME), and adds behavioral health to the list of such topics. The mandatory topics currently include infectious diseases, risk management, sexual assault, domestic violence, and cultural competency.

SB 886 - AN ACT CONCERNING AGING IN PLACE

This bill makes changes in several statutes to help senior citizens remain in their own homes and communities as they age. Specifically, it:

1. Requires the Department of Social Services (DSS) to incorporate into its existing efforts coordinated outreach to increase the use of the supplemental nutrition assistance program (SNAP) by seniors, among others;

2. Requires local plans of conservation and development (C&D) to consider allowing seniors and individuals with disabilities to remain in their homes and communities;

3. Specifies that the exemption from obtaining a State Building Code variance or exemption for constructing homes with visitable features includes certain building ramps allowing wheelchair access;

4. Adds anyone paid by an institution, organization, agency, or facility to care for seniors to the list of mandated elder abuse reporters and establishes a related training requirement for their employers;

5. Requires DSS, by July 1, 2014, to begin annually reporting to the legislature on elder abuse and neglect complaints it received in the previous calendar year; and

6. Requires the Department of Consumer Protection (DCP), in collaboration with the aging and social services departments, to conduct a public awareness campaign, within available funding, to educate seniors and caregivers on ways to resist aggressive marketing tactics and scams.

*Senate Amendment "A” requires DSS to incorporate into its existing efforts outreach to increase SNAP program utilization, instead of creating a new coordinated outreach program; permits, rather than requires, local plans of C&D to include planning that allows seniors and individuals with disabilities to age in place; and requires DCP to collaborate with DSS, in addition to the Aging Department, when conducting its public awareness campaign on aggressive marketing tactics and scams.

It removes provisions regarding state dial-a-ride grant program funds, state personal income tax deductions for long-term care premiums, dependent care state income tax credits, and a new DCP voluntary elder financial abuse training and reporting system. It also makes minor changes to the provision on mandated elder abuse reporters.

*Senate Amendment "B” requires DSS to implement the SNAP outreach provision only within available appropriations, specifies that wheelchair access ramps eligible for certain state building code exemptions must comply with the code's International Residential Code portion, removes provisions establishing a uniform recording system for elder abuse and neglect complaints; and makes minor changes to the provision regarding mandated elder abuse reporters.

SB 387 - AN ACT INCREASING THE MINIMUM FAIR WAGE

This bill increases the hourly minimum wage from its current $ 8.25 to $ 8.70 on January 1, 2014 and from $ 8.70 to $ 9.00 on January 1, 2015. The law, allows learners, beginners, and people under age 18 to be paid 85% of the minimum wage for the first 200 hours of their employment. In effect, the bill's minimum wage increases raise this wage from its current $ 7.01 to $ 7.39 in 2014 and $ 7.65 in 2015.

SB 1060 - AN ACT CONCERNING THE MAINTENANCE OF PROFESSIONAL LIABILITY INSURANCE BY NURSING HOMES, HOME HEALTH CARE AGENCIES AND HOMEMAKER-HOME HEALTH AIDE AGENCIES

This bill requires anyone who individually or jointly establishes, conducts, operates, or maintains a nursing home, home health care agency, or homemaker-home health aide agency to maintain professional liability insurance or other indemnity against liability for professional malpractice. The insurance must cover malpractice claims for injury or death of at least $1 million for one person, per occurrence, with an aggregate (i.e., the total for all claims within the coverage period) of at least $3 million.

The bill explicitly exempts residential care homes from this requirement.

SB 1070 - AN ACT CONCERNING A SCHOOL NURSE ADVISORY COUNCIL AND AN ADVISORY COUNCIL ON PEDIATRIC AUTOIMMUNE NEUROPSYCHIATRIC DISORDER ASSOCIATED WITH STREPTOCOCCAL INFECTIONS

This bill requires the State Department of Education (SDE) commissioner to create a School Nurse Advisory Council. The council must advise the SDE and Department of Public Health (DPH) commissioners on matters affecting school nurses, including their professional development, staffing levels, and delivery of health care services. The bill requires the advisory council to annually report to the SDE and DPH commissioners and the Public Health and Education committees, with the first report due February 1, 2014.

The bill also establishes an advisory council on pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections (PANDAS) and pediatric acute neuropsychiatric syndrome (PANS) (see BACKGROUND). This council must advise the DPH commissioner on research, diagnosis, treatment, and education relating to these conditions.

 

 

Throughout this entire 2013 session, the Association has sought to become the driving force for change in the health care continuum. Through the actions of everyone involved, we have become an influential part of the legislative process, and have made a great deal of significant new relationships in the legislature. The home care and hospice industry is rapidly becoming known as a solution to the state’s health care and fiscal problems, and through our continued effort, we will see that solution realized.

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