House Bill No. 6002

June Special Session, Public Act No. 00-2

An Act Concerning Programs And Modifications Necessary To Implement The Budget Relative To The Department Of Social Services.

Be it enacted by the Senate and House of Representatives in General Assembly convened:

Section 1. (NEW) (a) The Commissioner of Social Services shall, within available appropriations, establish a pilot program to provide additional financial benefits for persons with severe physical disabilities (1) who are unable to transfer independently in the event of an emergency, (2) who apply for or receive aid under the state supplement program, and (3) who reside with individuals who provide transfer assistance to such persons. Benefits shall be provided under the program only if the individual providing such transfer assistance is not related to the person with a severe physical disability. Under the program, payments shall be made in an amount equal to the amount of the increased benefit the person would receive under the state supplement program if the individual providing such transfer assistance were not living with the person with a severe physical disability. For the purposes of this section, "transfer assistance" means help provided to a person with a severe physical disability by an individual who physically lifts such person or utilizes a hoyer lift, transfer board or other device in order to move such person between surfaces or to or from a bed, chair or wheelchair within such person's residence.

(b) The Commissioner of Social Services shall adopt regulations, in accordance with the provisions of chapter 54 of the general statutes, to administer the program established under subsection (a) of this section. Said commissioner may implement the program until January 1, 2002, while in the process of adopting such regulations, provided notice of intent to adopt the regulations is published in the Connecticut Law Journal within twenty days after implementation.

Sec. 2. (NEW) The Commissioner of Public Health, the Commissioner of Social Services and the chief executive officer of The University of Connecticut Health Center, shall establish a pilot program for the delivery of dental services to children of low-income families in two regions of the state. Such program shall provide for the design and implementation of a model integrated system of children's dental care in such regions, including dental disease prevention and service intervention components, and shall provide for measurable outcomes.

Sec. 3. (NEW) (a) The Commissioner of Social Services and the Commissioner of Children and Families shall develop and administer an integrated behavioral health service delivery system for children and youth with serious emotional disturbances who meet the criteria established in accordance with subdivision (1) of subsection (a) of section 5 of this act and who are eligible to receive services from the HUSKY Plan, Part A or Part B, the HUSKY Plus program for intensive behavioral health needs or voluntary services provided through the Department of Children and Families. All necessary changes to the IV-E, Title XIX and Title XXI state plans shall be made to maximize federal financial participation.

(b) Not later than October 1, 2000, said commissioners shall enter into a memorandum of understanding for the purpose of the joint administration of an integrated behavioral health service delivery system. Such memorandum of understanding shall establish mechanisms to administer combined funding, establish standards for, and monitor implementation of, the integrated behavioral health service delivery system and specify that (1) the Department of Social Services, which is the agency designated as the single state agency for the administration of the Medicaid program pursuant to Title XIX of the Social Security Act, manage all Medicaid and HUSKY Plan modifications, waiver amendments, federal reporting and claims processing and provide financial management, and (2) the Department of Children and Families, which is the state agency responsible for administering and evaluating a comprehensive and integrated state-wide program of services for children and youth who are seriously emotionally disturbed, define the services to be included in the continuum of care and develop state-wide training programs on the systems of care approach for providers, families and other persons.

(c) Not later than October 1, 2000, said commissioners shall complete the memorandum of understanding, establish fiscal and programmatic eligibility guidelines, develop fiscal and programmatic outcome measures and develop a plan to evaluate the administration of behavioral health services.

(d) Said commissioners may commence a project of limited scope and duration in the state fiscal year commencing July 1, 2000, to implement the provisions of this section in those locations where the commissioners determine that services are well-developed and a high degree of cooperation exists among providers.

(e) Said commissioners shall consult with the Commissioner of Mental Health and Addiction Services and the Commissioner of Mental Retardation during the development of the integrated behavioral health service delivery system in order to ensure coordination of a delivery system of behavioral health services across the life span of children, youth and adults with behavioral health needs.

(f) The Commissioner of Social Services and the Commissioner of Children and Families may apply for any federal waivers necessary to implement the provisions of this section.

Sec. 4. (NEW) Not later than January 1, 2001, and annually thereafter, each local system of care shall, within available appropriations, (1) complete a local needs assessment which shall include objectives and outcome measures, (2) specify the number of children requiring behavioral health services, (3) specify the number of children actually receiving community-based and residential services and the type and frequency of such services, and (4) complete an annual self-evaluation process and a review of discharge summaries. Each local system of care shall submit its local needs assessment to the Commissioner of Children and Families and the Commissioner of Social Services. For the purposes of this section, "local system of care" means community-based organizations that work in teams to deliver behavioral health services in a manner that assists children and youth with behavioral health problems and provides their families with access to the full range of services tailored to the physical, emotional, social and educational needs of each individual in or near the communities in which they reside.

Sec. 5. (a) Not later than October 1, 2000, the Commissioner of Social Services and the Commissioner of Children and Families shall submit a report to the joint standing committees of the General Assembly having cognizance of matters relating to appropriations and the budgets of state agencies, human services and public health that specifies a behavioral health program plan to: (1) Determine the clinical and functional criteria that will be used to identify those children and youth in the target population specified in subsection (a) of section 3 of this act who will receive services from the integrated behavioral health service delivery system; (2) estimate state and federal funds for behavioral health services under the HUSKY Plan, Part A and Part B and Title IV-E according to the criteria to be developed under subdivision (1) of this subsection; (3) enhance the local systems of care established under section 17a-127 of the general statutes as the primary providers of services under the integrated behavioral health service delivery system; (4) define and establish lead service agencies to coordinate the local systems of care; (5) contract with an administrative services organization or other organizations to provide data and fiduciary management for the lead service agencies; (6) deliver high quality care in the least restrictive environment; (7) determine the feasibility of allowing for a hardship exemption under the provisions of section 17b-299 of the general statutes for eligible children who meet the criteria to be developed under subdivision (1) of this subsection; (8) determine the feasibility of allowing eligible children whose parents have a household income which exceeds three hundred per cent of the federal poverty level to purchase health insurance coverage under the HUSKY Plan, Part B; (9) develop a strategy for enhancing home and community-based services in order to allow children and youth in out-of-home placements to return to their families and communities; (10) establish mechanisms for the continuous evaluation and quality improvement of the integrated behavioral health service delivery system, including periodic evaluation of behavioral health programs and services and research on child outcomes; (11) establish a program for training staff and providers regarding the changes in the system of care principles and structures and in all aspects of the delivery of care under the integrated behavioral health service delivery system; and (12) establish procedures for compiling all data and conducting all needs assessments as are necessary for planning an integrated behavioral health service delivery system.

(b) Not later than October 1, 2000, the Commissioner of Children and Families shall submit a report to the joint standing committee of the General Assembly having cognizance of matters relating to human services on the feasibility of establishing a Bureau of Behavioral Health within the Department of Children and Families.

Sec. 6. Section 17a-1 of the general statutes is repealed and the following is substituted in lieu thereof:

As used in sections 17a-1 to 17a-26, inclusive, as amended, 17a-28 to 17a-49, inclusive, as amended, 17a-127, as amended by this act, and 46b-120:

(1) "Commissioner" means the Commissioner of Children and Families;

(2) "Council" means the State Advisory Council on Children and Families;

(3) "Department" means the Department of Children and Families;

(4) "Child" means any person under sixteen years of age;

(5) "Youth" means any person sixteen to eighteen years of age;

(6) "Delinquent child" shall have the meaning ascribed thereto in section 46b-120;

(7) "Child or youth with mental illness" means a child or youth who is suffering from one or more mental disorders as defined in the most recent edition of the American Psychiatric Association's "Diagnostic and Statistical Manual of Mental Disorders";

(8) "Child or youth with emotional disturbance" means a child or youth who has a clinically significant emotional or behavioral disorder, as determined by a trained mental health professional, that disrupts the academic or developmental progress, family or interpersonal relationships of such child or youth or is associated with present distress or disability or a risk of suffering death, pain or disability;

(9) "Individual system of care plan" means a written plan developed by the Commissioner of Children and Families for a child or youth who is mentally ill, [or] emotionally disturbed or seriously emotionally disturbed or who is at placement risk which shall be developed when such child or youth needs services from at least two public agencies and which shall be designed to meet the needs of the child or youth and his family;

(10) "Family" means a child or youth who is mentally ill, [or] emotionally disturbed or seriously emotionally disturbed or who is at placement risk together with (A) one or more biological or adoptive parents, except for a biological parent whose parental rights have been terminated, (B) one or more persons to whom legal custody or guardianship has been given, or (C) one or more adult family members who have a primary responsibility for providing continuous care to such child or youth;

(11) "Child or youth at placement risk" means a mentally ill, [or] emotionally disturbed or seriously emotionally disturbed child or youth who is at risk of placement out of his home or is in placement out of his home for the primary purpose of receiving mental health treatment;

(12) "Parent" means a biological or adoptive parent, except a biological parent whose parental rights have been terminated; [and]

(13) "Guardian" means a person who has a judicially created relationship between a child and such person which is intended to be permanent and self-sustaining as evidenced by the transfer to such person of the following parental rights with respect to the child: (A) The obligation of care and control; (B) the authority to make major decisions affecting the child's welfare, including, but not limited to, consent determinations regarding marriage, enlistment in the armed forces and major medical, psychiatric or surgical treatment; (C) the obligation of protection of the child; (D) the obligation to provide access to education; and (E) custody of the child; and

(14) "Serious emotional disturbance" and "seriously emotionally disturbed" means, with regard to a child or youth, that the child or youth (A) has a range of diagnosable mental, behavioral or emotional disorders of sufficient duration to meet diagnostic criteria specified in the most recent edition of the American Psychiatric Association's "Diagnostic and Statistical Manual of Mental Disorders" and (B) exhibits behaviors that substantially interfere with or limit the child's or youth's ability to function in the family, school or community and are not a temporary response to a stressful situation.

Sec. 7. Section 17a-127 of the general statutes is repealed and the following is substituted in lieu thereof:

(a) The following shall be established for the purposes of developing and implementing an individual system of care plan:

(1) Within available appropriations, a child specific team may be developed by the family of a child or adolescent at placement risk and include, but not be limited to, family members, the child or adolescent if appropriate, clergy, school personnel, representatives of local or regional agencies providing programs and services for children and youth, a family advocate, and other community or family representatives. The team shall designate one member to be the team coordinator. The team coordinator shall make decisions affecting the implementation of an individual system of care plan with the consent of the team, except as otherwise provided by law. If a case manager, other than the case manager from the Department of Children and Families, has been assigned to the child and is not designated as the team coordinator, such case manager shall not make decisions affecting the implementation of the individual system of care plan without the consent of the team, except as otherwise provided by law;

(2) Within available appropriations, case review committees may be developed by each regional office of the Department of Children and Families and shall be comprised of at least three parents of children or adolescents with mental illness, emotional disturbance or serious emotional disturbance and representatives of local or regional agencies and service providers including, but not limited to, the regional administrator of the office of the Department of Children and Families or his designee, a superintendent of schools or his designee, a director of a local children's mental health agency or his designee, the district director of the district office of the Department of Social Services or his designee, representatives from the Departments of Mental Retardation and Mental Health and Addiction Services who are knowledgeable of the needs of a child or adolescent at placement risk, a representative from a local housing authority and a representative from the court system. The functions of the case review committees shall include, but not be limited to: (A) The determination of whether or not a child or adolescent meets the definition of a child or adolescent at placement risk; (B) assisting children or families without a child specific team in the formation of such a team; and (C) resolution of the development or implementation of an individual system of care plan not developed, implemented or agreed upon by a child specific team. Such functions shall be completed in one hundred twenty days or less from the date of referral to the case review committee. In the event of the need for an individual system of care plan for a child or adolescent with no identifiable community, a representative of the child or adolescent shall make a referral to the state coordinated care committee, established pursuant to subdivision (3) of this subsection, which shall designate responsibility for the development of an individual system of care plan to a case review committee. The case review committee shall also monitor the implementation of an individual system of care plan when appropriate. The Department of Children and Families may assign a system coordinator to each case review committee. The duties of the system coordinator shall include, but not be limited to, assistance and consultation to child specific teams and assistance with the development of case review committees and child specific teams.

(3) A coordinated care committee shall be developed by the Commissioner of Children and Families and shall be comprised of a parent of a child or adolescent with [serious] mental illness, emotional disturbance or serious emotional disturbance who is currently serving or has served on a case review committee, a person who is now or has been a recipient of services for a child or adolescent at placement risk, representatives of the Departments of Children and Families, Education, Mental Health and Addiction Services, Social Services and Mental Retardation who are knowledgeable of the needs of a child or adolescent at placement risk, and a representative of the Office of Protection and Advocacy for Persons with Disabilities who is knowledgeable of the needs of a child or adolescent at placement risk.

(b) The commissioner, in consultation with the coordinated care committee, shall submit a report on the findings and recommendations of programs for children and youth at placement risk, including recommendations for budget options or programmatic changes necessary to enhance the system of care for such child or youth and his family, to the joint standing committee and the select committee of the General Assembly having cognizance of matters relating to children, on or before January 1, 1998, and annually thereafter.

(c) The provisions of this section shall not be construed to grant an entitlement to any child or youth at placement risk to receive particular services under this section in an individual system of care plan if such child or youth is not otherwise eligible to receive such services from any state agency or to receive such services pursuant to any other provision of law.

(d) The Commissioner of Children and Families may adopt regulations in accordance with chapter 54 for the purpose of implementing the provisions of this section.

Sec. 8. (NEW) (a) The Commissioner of Public Health shall allow state-funded congregate housing facilities to provide assisted living services through licensed assisted living services agencies, as defined in section 19a-490 of the general statutes.

(b) In order to facilitate the development of assisted living services in state-funded congregate housing facilities, the Commissioner of Public Health may waive any provision of the regulations for assisted living services agencies, as defined in section 19a-490 of the general statutes, which provide services in state-funded congregate housing facilities. No waiver of such regulations shall be made if the commissioner determines that the waiver would: (1) Endanger the life, safety or health of any resident receiving assisted living services in a state-funded congregate housing facility; (2) impact the quality or provision of services provided to a resident in a state-funded congregate housing facility; (3) revise or eliminate the requirements for an assisted living services agency's quality assurance program; (4) revise or eliminate the requirements for an assisted living services agency's grievance and appeals process; or (5) revise or eliminate the assisted living services agency's requirements relative to a client's bill of rights and responsibilities. The commissioner, upon the granting of a waiver of any provision of such regulations, may impose conditions which assure the health, safety and welfare of residents receiving assisted living services in a state-funded congregate housing facility. The commissioner may revoke such a waiver upon a finding (A) that the health, safety or welfare of any such resident is jeopardized, or (B) that such facility has failed to comply with such conditions as the commissioner may impose pursuant to this subsection.

(c) The Commissioner of Public Health may adopt regulations, in accordance with the provisions of chapter 54 of the general statutes, to implement the provisions of this section. Said commissioner may implement the waiver of provisions as specified in subsection (b) of this section until January 1, 2002, while in the process of adopting criteria for the waiver process in regulation form, provided notice of intent to adopt the regulations is published in the Connecticut Law Journal within twenty days after implementation.

Sec. 9. Section 8-206e of the general statutes, as amended by section 33 of public act 99-279, is repealed and the following is substituted in lieu thereof:

(a) The Commissioner of Economic and Community Development shall, within available appropriations, establish a demonstration housing assistance and counseling program to offer advice on matters concerning landlord and tenant relations and the financing of owner-occupied and rental housing purchases, improvements and renovations. The program shall provide: (1) Educational services designed to inform landlords and tenants of their respective rights and responsibilities; (2) dispute mediation services for landlords and tenants; (3) information on securing housing-related financing, including mortgage loans, home improvement loans, energy assistance and weatherization assistance; and (4) such other housing-related counseling and assistance as the commissioner shall provide by regulations.

(b) The Commissioner of Economic and Community Development may, within available appropriations, enter into a contract or contracts to provide financial assistance in the form of grants-in-aid to nonprofit corporations, as defined in section 8-39, to carry out the purposes of subsection (a) of this section.

(c) The Commissioner of Economic and Community Development shall adopt regulations in accordance with the provisions of chapter 54 to carry out the purposes of subsections (a) and (b) of this section.

[(d) Not later than January 1, 1989, the Commissioner of Economic and Community Development shall submit to the General Assembly a report containing an evaluation of the operation and effectiveness of the demonstration program authorized under this section.]

(d) The Commissioner of Economic and Community Development shall establish a demonstration program in one United States Department of Housing and Urban Development, Section 202, elderly housing development and one United States Department of Housing and Urban Development, Section 236, elderly housing development to provide assisted living services for persons who are residents of the state.

(e) The Commissioner of Economic and Community Development shall establish criteria for making disbursements under the provisions of subsection (d) of this section which shall include, but are not limited to: (1) Size of the United States Department of Housing and Urban Development, Section 202 and Section 236, elderly housing developments; (2) geographic locations in which the developments are located; (3) anticipated social and health value to the resident population; (4) each Section 202 and Section 236 housing development's designation as a managed residential community, as defined in section 19-13-D105 of the regulations of Connecticut state agencies; and (5) the potential community development benefit to the relevant municipality. Such criteria may specify who may apply for grants, the geographic locations determined to be eligible for grants, and the eligible costs for which a grant may be made.

(f) The Commissioner of Economic and Community Development may adopt regulations, in accordance with the provisions of chapter 54, to implement the provisions of subsections (d) and (e) of this section.

Sec. 10. Section 17b-342 of the general statutes, as amended by section 12 of public act 99-279 and section 4 of public act 00-83, is repealed and the following is substituted in lieu thereof:

(a) The Commissioner of Social Services shall administer the Connecticut home-care program for the elderly state-wide in order to prevent the institutionalization of elderly persons (1) who are recipients of medical assistance, (2) who are eligible for such assistance, [or] (3) who would be eligible for medical assistance if residing in a nursing facility, or (4) who meet the criteria for the state-funded portion of the program under subsection (i) of this section. For purposes of this section, a long-term care facility is a facility which has been federally certified as a skilled nursing facility or intermediate care facility. The commissioner shall make any revisions in the state Medicaid plan required by Title XIX of the Social Security Act prior to implementing the program. The annualized cost of the community-based services provided to such persons under the program shall not exceed sixty per cent of the weighted average cost of care in skilled nursing facilities and intermediate care facilities. The program shall be structured so that the net cost to the state for long-term facility care in combination with the community-based services under the program shall not exceed the net cost the state would have incurred without the program. The commissioner shall investigate the possibility of receiving federal funds for the program and shall apply for any necessary federal waivers. A recipient of services under the program, and the estate and legally liable relatives of the recipient, shall be responsible for reimbursement to the state for such services to the same extent required of a recipient of assistance under the state supplement program, medical assistance program, temporary family assistance program or food stamps program. Only a United States citizen or a noncitizen who meets the citizenship requirements for eligibility under the Medicaid program shall be eligible for home-care services under this section, except a qualified alien, as defined in Section 431 of Public Law 104-193, admitted into the United States on or after August 22, 1996, or other lawfully residing immigrant alien determined eligible for services under this section prior to July 1, 1997, shall remain eligible for such services until July 1, 2001. Qualified aliens or other lawfully residing immigrant aliens not determined eligible prior to July 1, 1997, shall be eligible for services under this section subsequent to six months from establishing residency until July 1, 2001. Notwithstanding the provisions of this subsection, any qualified alien or other lawfully residing immigrant alien or alien who formerly held the status of permanently residing under color of law who is a victim of domestic violence or who has mental retardation shall be eligible for assistance pursuant to this section. Qualified aliens, as defined in Section 431 of Public Law 104-193, or other lawfully residing immigrant aliens or aliens who formerly held the status of permanently residing under color of law shall be eligible for services under this section provided other conditions of eligibility are met.

(b) The commissioner shall solicit bids through a competitive process and shall contract with an access agency, approved by the Office of Policy and Management and the Department of Social Services as meeting the requirements for such agency as defined by regulations adopted pursuant to subsection (e) of this section, that submits proposals which meet or exceed the minimum bid requirements. In addition to such contracts, the commissioner may use department staff to provide screening, coordination, assessment and monitoring functions for the program.

(c) The community-based services covered under the program shall include, but not be limited to, the following services to the extent that they are not available under the state Medicaid plan, occupational therapy, homemaker services, companion services, meals on wheels, adult day care, transportation, mental health counseling, [case] care management, [and] elderly foster care, minor home modifications and assisted living services provided in state-funded congregate housing and in other assisted living pilot or demonstration projects established under state law. Recipients of state-funded services and persons who are determined to be functionally eligible for community-based services who have an application for medical assistance pending shall have the cost of home health and community-based services covered by the program, provided they comply with all medical assistance application requirements. Access agencies shall not use department funds to purchase community-based services or home health services from themselves or any related parties.

(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, 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. Long-term care facilities shall supply the Department of Social Services with the names and addresses of all applicants for admission. Any information provided pursuant to this subsection shall be confidential and shall not be disclosed by the department or administering agency.

(e) The commissioner shall adopt regulations, in accordance with the 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.

(f) The commissioner may require long-term care facilities to inform applicants for admission of the program established under this section and to distribute such forms as [he] the commissioner prescribes for the program. Such forms shall be supplied by and be returnable to the department.

(g) The commissioner shall report annually, by June first, to the joint standing committee of the General Assembly having cognizance of matters relating to human services on the program in such detail, depth and scope as said committee requires to evaluate the effect of the program on the state and program participants. Such 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, (3) the average cost per person in the program, (4) the administration costs, (5) the estimated savings, and (6) a comparison between costs under the different contracts.

(h) An individual who is otherwise eligible for services pursuant to this section shall, as a condition of participation in the program, apply for medical assistance benefits pursuant to section 17b-260 when requested to do so by the department and shall accept such benefits if determined eligible.

(i) (1) On and after July 1, 1992, the Commissioner of Social Services shall, within available appropriations, administer a state-funded portion of the program for persons (A) who are sixty-five years of age and older; (B) who are inappropriately institutionalized or at risk of inappropriate institutionalization; (C) whose income is less than or equal to the amount allowed under [the federally funded portion of the program established pursuant to] subdivision (3) of subsection (a) of this section; and (D) whose assets, if single, do not exceed the minimum community spouse protected amount pursuant to Section 4022.05 of the department's uniform policy manual or, if married, the couple's assets do not exceed one hundred fifty per cent of said community spouse protected amount.

[(2) The commissioner shall establish a sliding fee scale for required contributions to the cost of services provided under the program for program participants whose income is equal to or greater than one hundred fifty per cent of the federal poverty level. The sliding fee scale shall be based on a formula which establishes the midpoint of each twenty-five per cent income increase over the poverty level and assesses a fee based on a percentage of the midpoint for all eligible persons whose income is within that range. The percentage of the midpoint shall start at eleven per cent and shall increase by one per cent for each income range.]

(2) Any person whose income exceeds two hundred per cent of the federal poverty level shall contribute to the cost of care in accordance with the methodology established for recipients of medical assistance pursuant to Sections 5035.20 and 5035.25 of the department's uniform policy manual.

(3) On and after June 30, 1992, the program shall serve persons receiving state-funded home and community-based services from the department, persons receiving services under the promotion of independent living for the elderly program operated by the Department of Social Services, regardless of age, and persons receiving services on June 19, 1992, under the home care demonstration project operated by the Department of Social Services. Such persons receiving state-funded services whose income and assets exceed the limits established pursuant to subdivision (1) of this subsection may continue to participate in the program, but shall be required to pay the total cost of care, including case management costs.

(4) Services shall not be increased for persons who received services under the promotion of independent living for the elderly program over the limits in effect under said program in the fiscal year ending June 30, 1992, unless a person's needs increase and the person is eligible for Medicaid.

(5) The annualized cost of services provided to an individual under the state-funded portion of the program shall not exceed fifty per cent of the weighted average cost of care in nursing homes in the state, 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 continue to receive such services, provided the annualized cost of such services does not exceed eighty per cent of the weighted average cost of such nursing home care. The commissioner may allow the cost of services provided to an individual to exceed the maximum cost established pursuant to this subdivision in a case of extreme hardship, as determined by the commissioner, provided in no case shall such cost exceed that of the weighted cost of such nursing home care.

(j) The Commissioner of Social Services may implement revised criteria for the operation of the program while in the process of adopting such criteria in regulation form, provided the commissioner prints notice of intention to adopt the regulations in the Connecticut Law Journal within twenty days of implementing the policy. Such criteria shall be valid until the time final regulations are effective.

Sec. 11. Subsection (a) of section 37 of public act 99-279 is amended to read as follows:

(a) On and after the effective date of [this section] section 37 of public act 99-279, the Commissioner of Social Services shall establish a state-funded pilot program to allow not more than ten persons to receive services under the Connecticut home-care program for the elderly established under section 17b-342 of the general statutes (1) provided such persons would be eligible for the Medicaid-funded portion of the Connecticut home-care program for the elderly except that their monthly income exceeds the amount allowed under said program by not more than one hundred dollars and formerly received services under said program, and (2) only after an evaluation and a determination by said commissioner that such persons would require care in a long-term care facility if such persons did not receive services under said program. Services provided and contributions required under the pilot program shall be equivalent to those under the Medicaid-funded portion of the Connecticut home-care program for the elderly. Said pilot program shall terminate on [June 30, 2000] the date on which such services are covered under the Medicaid-funded portion of the Connecticut home-care program for the elderly or July 1, 2001, whichever is sooner. Such persons who participate in the pilot program may continue to receive services under said program provided all other conditions of eligibility are met.

Sec. 12. Section 38 of public act 99-279 is amended to read as follows:

On and after the effective date of [this section] section 38 of public act 99-279, [and until June 30, 2000,] the Commissioner of Social Services shall provide medical services other than the services provided under the Connecticut home-care program for the elderly equivalent to the services provided under the Medicaid program to persons who participate in the pilot program established under section 37 of [this act] public act 99-279, as amended by this act.

Sec. 13. Subsection (a) of section 17b-8 of the general statutes is repealed and the following is substituted in lieu thereof:

(a) The Commissioner of Social Services shall submit an application for a federal waiver of any assistance program requirements, except such application pertaining to routine operational issues, to the joint standing committee of the General Assembly having cognizance of matters relating to appropriations and the budgets of state agencies and to the joint standing committee of the General Assembly having cognizance of matters relating to human services prior to the submission of such application to the federal government. Within [fifteen] thirty days of their receipt of such application, the joint standing committees may advise the commissioner of their approval, denial or modifications, if any, of his application.

Sec. 14. Subsection (h) of section 21a-70 of the general statutes is repealed and the following is substituted in lieu thereof:

(h) No manufacturer or wholesaler shall sell any drugs except to the state or any political subdivision thereof, to another manufacturer or wholesaler, to any hospital recognized by the state as a general or specialty hospital, to any institution having a full-time pharmacist who is actively engaged in the practice of pharmacy in such institution not less than thirty-five hours a week, to a chronic and convalescent nursing home having a pharmacist actively engaged in the practice of pharmacy based upon the ratio of one-tenth of one hour per patient per week but not less than twelve hours per week, to a practicing physician, podiatrist, dentist, optometrist or veterinarian or to a licensed pharmacy or a store to which a permit to sell nonlegend drugs has been issued as provided in section 20-624, as amended. The commissioner may adopt such regulations as are necessary to administer and enforce the provisions of this section.

Sec. 15. Subsection (a) of section 17b-239 of the general statutes is repealed and the following is substituted in lieu thereof:

(a) The rate to be paid by the state to hospitals receiving appropriations granted by the General Assembly and to freestanding chronic disease hospitals, providing services to persons aided or cared for by the state for routine services furnished to state patients, shall be based upon reasonable cost to such hospital, or the charge to the general public for ward services or the lowest charge for semiprivate services if the hospital has no ward facilities, imposed by such hospital, whichever is lowest, except to the extent, if any, that the commissioner in his discretion determines that a greater amount is appropriate in the case of hospitals serving a disproportionate share of indigent patients. Such rate shall be promulgated annually by the Commissioner of Social Services. Nothing contained herein shall authorize a payment by the state for such services to any such hospital in excess of the charges made by such hospital for comparable services to the general public. [Notwithstanding the provisions of this section, on and after July 1, 1995, rates paid to freestanding chronic disease hospitals shall not exceed rates paid in rate periods ending in 1995 plus the inflation factor annually applied in determining acute care inpatient hospital rates under the Medicaid program. A freestanding chronic disease hospital having more than an average of fifty per cent of its inpatient days paid for by the department may request that the commissioner use the actual charge based on utilized service for the rate period ending in 1995 in lieu of the rate paid for the period when determining the rates to be paid on and after July 1, 1995.] Notwithstanding the provisions of this section, for the rate period beginning July 1, 2000, rates paid to freestanding chronic disease hospitals and freestanding psychiatric hospitals shall be increased by three per cent. For the rate period beginning July 1, 2001, and each succeeding rate period, rates paid to freestanding chronic disease hospitals and freestanding psychiatric hospitals shall be equal to but not exceed rates for the preceding rate period, plus an inflation factor equal to the Medicare market basket inflation rate as published in the previous September federal register of each year with the wage portion of such market basket adjusted for the Hartford metropolitan statistical area.

Sec. 16. Section 17b-242 of the general statutes, as amended by public act 99-130, is repealed and the following is substituted in lieu thereof:

(a) The Department of Social Services shall determine the rates to be paid to home health care agencies and homemaker-home health aide agencies by the state or any town in the state for persons aided or cared for by the state or any such town. For the period from February 1, 1991, to January 31, 1992, inclusive, payment for each service to the state shall be based upon the rate for such service as determined by the Office of Health Care Access, except that for those providers whose Medicaid rates for the year ending January 31, 1991, exceed the median rate, no increase shall be allowed. For those providers whose rates for the year ending January 31, 1991, are below the median rate, increases shall not exceed the lower of the prior rate increased by the most recent annual increase in the consumer price index for urban consumers or the median rate. In no case shall any such rate exceed the eightieth percentile of rates in effect January 31, 1991, nor shall any rate exceed the charge to the general public for similar services. Rates effective February 1, 1992, shall be based upon rates as determined by the Office of Health Care Access, except that increases shall not exceed the prior year's rate increased by the most recent annual increase in the consumer price index for urban consumers and rates effective February 1, 1992, shall remain in effect through June 30, 1993. Rates effective July 1, 1993, shall be based upon rates as determined by the Office of Health Care Access pursuant to the provisions of subsection (b) of section 19a-635, except if the Medicaid rates for any service for the period ending June 30, 1993, exceed the median rate for such service, the increase effective July 1, 1993, shall not exceed one per cent. If the Medicaid rate for any service for the period ending June 30, 1993, is below the median rate, the increase effective July 1, 1993, shall not exceed the lower of the prior rate increased by one and one-half times the most recent annual increase in the consumer price index for urban consumers or the median rate plus one per cent. The Commissioner of Social Services shall establish a fee schedule for home health services to be effective on and after July 1, 1994. The commissioner may annually increase any fee in the fee schedule based on an increase in the cost of services. [The fee schedule may be phased in over a two-year period during which no agency shall be paid for a service in an amount which varies by more than ten per cent from the payment made for the service in the preceding fiscal year.] The commissioner shall increase the fee schedule for home health services provided under the Connecticut home-care program for the elderly established under section 17b-342, as amended, effective July 1, 2000, by two per cent over the fee schedule for home health services for the previous year. The commissioner may increase any fee payable to a home health care agency or homemaker-home health aide agency upon the application of such an agency evidencing extraordinary costs related to (1) serving persons with AIDS; (2) high-risk maternal and child health care; (3) escort services; or (4) extended hour services. In no case shall any rate or fee exceed the charge to the general public for similar services. A home health care agency or homemaker-home health aide agency which, due to any material change in circumstances, is aggrieved by a rate determined pursuant to this subsection may, within ten days of receipt of written notice of such rate from the Commissioner of Social Services, request in writing a hearing on all items of aggrievement. The commissioner shall, upon the receipt of all documentation necessary to evaluate the request, determine whether there has been such a change in circumstances and shall conduct a hearing if appropriate. The Commissioner of Social Services shall adopt regulations, in accordance with chapter 54, to implement the provisions of this subsection. The commissioner may implement policies and procedures to carry out the provisions of this subsection while in the process of adopting regulations, provided notice of intent to adopt the regulations is published in the Connecticut Law Journal within twenty days of implementing the policies and procedures. Such policies and procedures shall be valid for not longer than nine months.

(b) The Department of Social Services shall monitor the rates charged by home health care agencies and homemaker-home health aide agencies. Such agencies shall file annual cost reports and service charge information with the department.

Sec. 17. Section 17b-343 of the general statutes is repealed and the following is substituted in lieu thereof:

The Commissioner of Social Services shall establish annually the maximum allowable rate to be paid by said agencies for homemaker services, chore person services, companion services, respite care, meals on wheels, adult day care services, case management and assessment services, transportation, mental health counseling and elderly foster care, except that the maximum allowable rates in effect July 1, 1990, shall remain in effect during the fiscal years ending June 30, 1992, and June 30, 1993. The Commissioner of Social Services shall prescribe uniform forms on which agencies providing such services shall report their costs for such services. Such rates shall be determined on the basis of a reasonable payment for necessary services rendered. The maximum allowable rates established by the Commissioner of Social Services for the Connecticut home-care program for the elderly established under section 17b-342, as amended, shall constitute the rates required under this section until revised in accordance with this section. The Commissioner of Social Services shall establish a fee schedule, to be effective on and after July 1, 1994, for homemaker services, chore person services, companion services, respite care, meals on wheels, adult day care services, case management and assessment services, transportation, mental health counseling and elderly foster care. The commissioner may annually increase any fee in the fee schedule based on an increase in the cost of services. The commissioner shall increase the fee schedule effective July 1, 2000, by not less than five per cent, for adult day care services. Nothing contained in this section shall authorize a payment by the state to any agency for such services in excess of the amount charged by such agency for such services to the general public.

Sec. 18. Subsection (a) of section 17b-261 of the general statutes, as amended by section 16 of public act 99-279, is repealed and the following is substituted in lieu thereof:

(a) Medical assistance shall be provided for any otherwise eligible person whose income, including any available support from legally liable relatives and the income of the person's spouse or dependent child, is not more than one hundred forty-three per cent, pending approval of a federal waiver applied for pursuant to subsection (d) of this section, of the benefit amount paid to a person with no income under the temporary family assistance program in the appropriate region of residence and if such person is an institutionalized individual as defined in Section 1917(c) of the Social Security Act, 42 USC 1396p(c), and has not made an assignment or transfer or other disposition of property for less than fair market value for the purpose of establishing eligibility for benefits or assistance under this section. Any such disposition shall be treated in accordance with Section 1917(c) of the Social Security Act, 42 USC 1396p(c). Any disposition of property made on behalf of an applicant or recipient or the spouse of an applicant or recipient by a guardian, conservator, person authorized to make such disposition pursuant to a power of attorney or other person so authorized by law shall be attributed to such applicant, recipient or spouse. A disposition of property ordered by a court shall be evaluated in accordance with the standards applied to any other such disposition for the purpose of determining eligibility. The commissioner shall establish the standards for eligibility for medical assistance at one hundred forty-three per cent of the benefit amount paid to a family unit of equal size with no income under the temporary family assistance program in the appropriate region of residence, pending federal approval, except that the medical assistance program shall provide coverage to persons under the age of nineteen [born after September 30, 1981,] up to one hundred eighty-five per cent of the federal poverty level without an asset limit. On and after [July 1, 2000] January 1, 2001, said medical assistance program shall also provide coverage to persons under the age of nineteen and their parents and needy caretaker relatives who qualify for coverage under Section 1931 of the Social Security Act with family income up to one hundred [eighty-five] fifty per cent of the federal poverty level without an asset limit, upon the request of such a person or upon a redetermination of eligibility. Such levels shall be based on the regional differences in such benefit amount, if applicable, unless such levels based on regional differences are not in conformance with federal law. Any income in excess of the applicable amounts shall be applied as may be required by said federal law, and assistance shall be granted for the balance of the cost of authorized medical assistance. All contracts entered into on and after July 1, 1997, pursuant to this section shall include provisions for collaboration of managed care organizations with the Healthy Families Connecticut Program established pursuant to section 17a-56. The Commissioner of Social Services shall provide applicants for assistance under this section, at the time of application, with a written statement advising them of the effect of an assignment or transfer or other disposition of property on eligibility for benefits or assistance.

Sec. 19. Section 17b-266 of the general statutes is amended by adding subsection (e) as follows:

(NEW) (e) On or after May 1, 2000, the payment to the Commissioner of Social Services of (1) any monetary sanction imposed by the commissioner on a managed care organization under the provisions of a contract between the commissioner and such organization entered into pursuant to this section or sections 17b-289 to 17b-304, inclusive, or (2) any sum agreed upon by the commissioner and such an organization as settlement of a claim brought by the commissioner or the state against such an organization for failure to comply with the terms of a contract with the commissioner or fraud affecting the Department of Social Services shall be deposited in an account designated for use by the department for expenditures for children's health programs and services.

Sec. 20. Section 17b-291 of the general statutes is repealed and the following is substituted in lieu thereof:

The commissioner shall submit a state children's health insurance plan to implement the provisions of sections 17b-289 to 17b-303, inclusive, and section 16 of public act 97-1 of the October 29 special session* to the Health Care Financing Administration in accordance with the provisions of Subtitle J of Public Law 105-33. Such plan and any revisions thereto shall be submitted to the joint standing committees of the General Assembly having cognizance of matters relating to human services, public health, insurance and appropriations and the budgets of state agencies. Within [fifteen] thirty days of receipt of such plan or revisions thereto, said joint standing committees of the General Assembly may advise the commissioner of their approval, denial or modifications, if any, of the plan or any revisions thereto. If the joint standing committees do not concur, the committee chairmen shall appoint a committee on conference which shall be comprised of three members from each joint standing committee. At least one member appointed from each committee shall be a member of the minority party. The report of the committee on conference shall be made to each committee, which shall vote to accept or reject the report. The report of the committee on conference may not be amended. If a joint standing committee rejects the report of the committee on conference, the plan or revisions thereto shall be deemed approved. If the joint standing committees accept the report, the committee having cognizance of matters relating to appropriations and the budgets of state agencies shall advise the commissioner of their approval or modifications, if any, of the plan or revisions thereto, provided if the committees do not act within [fifteen] thirty days, the plan or revisions thereto shall be deemed approved.

Sec. 21. Subsection (h) of section 17b-340 of the general statutes, as amended by section 21 of public act 99-279, is repealed and the following is substituted in lieu thereof:

(h) For the fiscal year ending June 30, 1993, any residential care home with an operating cost component of its rate in excess of one hundred thirty per cent of the median of operating cost components of rates in effect January 1, 1992, shall not receive an operating cost component increase. For the fiscal year ending June 30, 1993, any residential care home with an operating cost component of its rate that is less than one hundred thirty per cent of the median of operating cost components of rates in effect January 1, 1992, shall have an allowance for real wage growth equal to sixty-five per cent of the increase determined in accordance with subsection (q) of section 17-311-52 of the regulations of Connecticut state agencies, provided such operating cost component shall not exceed one hundred thirty per cent of the median of operating cost components in effect January 1, 1992. Beginning with the fiscal year ending June 30, 1993, for the purpose of determining allowable fair rent, a residential care home with allowable fair rent less than the twenty-fifth percentile of the state-wide allowable fair rent shall be reimbursed as having allowable fair rent equal to the twenty-fifth percentile of the state-wide allowable fair rent. Beginning with the fiscal year ending June 30, 1997, a residential care home with allowable fair rent less than three dollars and ten cents per day shall be reimbursed as having allowable fair rent equal to three dollars and ten cents per day. Property additions placed in service during the cost year ending September 30, 1996, or any succeeding cost year shall receive a fair rent allowance for such additions as an addition to three dollars and ten cents per day if the fair rent for the facility for property placed in service prior to September 30, 1995, is less than or equal to three dollars and ten cents per day. For the fiscal year ending June 30, 1996, and any succeeding fiscal year, the allowance for real wage growth, as determined in accordance with subsection (q) of section 17-311-52 of the regulations of Connecticut state agencies shall not be applied. For the fiscal year ending June 30, 1996, and any succeeding fiscal year, the inflation adjustment made in accordance with subsection (p) of section 17-311-52 of the regulations of Connecticut state agencies shall not be applied to real property costs. Beginning with the fiscal year ending June 30, 1997, minimum allowable patient days for rate computation purposes for a residential care home with twenty-five beds or less shall be eighty-five per cent of licensed capacity. Beginning with the fiscal year ending June 30, 1998, for the purposes of determining the allowable salary of an administrator of a residential care home with sixty beds or less the department shall revise the allowable base salary to thirty thousand dollars to be annually inflated thereafter in accordance with section 17-311-52 of the regulations of Connecticut state agencies and, beginning with the fiscal year ending June 30, 2000, the inflation adjustment for rates made in accordance with subsection (p) of section 17-311-52 of the regulations of state agencies shall be increased by two per cent. Beginning with the fiscal year ending June 30, 1999, for the purpose of determining the allowable salary of a related party, the department shall revise the maximum salary to twenty seven thousand eight hundred fifty-six dollars to be annually inflated thereafter in accordance with section 17-311-52 of the regulations of Connecticut state agencies and beginning with the fiscal year ending June 30, 2001, such allowable salary shall be computed on an hourly basis and the maximum number of hours allowed for a related party other than the proprietor shall be increased from forty hours to forty-eight hours per work week.

Sec. 22. Section 17b-99 of the general statutes is repealed and the following is substituted in lieu thereof:

(a) Any vendor found guilty of vendor fraud under sections 53a-290 to 53a-296, inclusive, shall be subject to forfeiture or suspension of any franchise or license held by [him] such vendor from the state in accordance with this subsection, after hearing in the manner provided for in sections 4-176e to 4-180a, inclusive, and 4-181a. Any vendor convicted of vendor fraud under sections 53a-290 to 53a-296, inclusive, shall have such license or franchise revoked. Nothing in this subsection shall preclude any board or commission established under chapters 369 to 376, inclusive, 378 to 381, inclusive, and 383 to 388, inclusive, and the Department of Public Health with respect to professions under its jurisdiction which have no board or commission from taking any action authorized in section 19a-17. Any vendor who is convicted in any state or federal court of a crime involving fraud in the Medicare program or Medicaid program or aid to families with dependent children program or state-administered general assistance program or temporary family assistance program or state supplement to the federal Supplemental Security Income Program or any federal or state energy assistance program or general assistance program or state-funded child care program or the refugee program shall be terminated from such programs, effective upon conviction, except that the Commissioner of Social Services may delay termination for a period he deems sufficient to protect the health and well-being of beneficiaries receiving services from such vendor. A vendor who is ineligible for federal financial participation shall be ineligible for participation in such programs. No vendor shall be eligible for reimbursement for any goods provided or services performed by a person convicted of a crime involving fraud in such programs. The convicted person may request a hearing concerning such ineligibility for reimbursement pursuant to sections 4-176e to 4-180a, inclusive, and 4-181a provided such request is filed in writing with the Commissioner of Social Services within ten days of the date of written notice by the commissioner to the person of such ineligibility. The commissioner shall give notice of such ineligibility to such vendors by means of publication in the Connecticut Law Journal following the expiration of said ten-day hearing request period, if no timely request has been filed, or following the decision on the hearing. The Commissioner of Social Services may take such steps as [he considers] necessary to inform the public of the conviction and ineligibility for reimbursement. No vendor or person so terminated or denied reimbursement shall be readmitted to or be eligible for reimbursement in such programs. Any sums paid as a result of vendor fraud under sections 53a-290 to 53a-296, inclusive, may be recovered in an action brought by the state against such person.

(b) For the purpose of determining compliance with subsection (a), all vendors shall notify the commissioner within thirty days after the date of employment or conviction, whichever is later, of the identity, interest and extent of services performed by any person convicted of a crime involving fraud in the Medicare program or Medicaid program or aid to families with dependent children program or state-administered general assistance program or temporary family assistance program or state supplement to the federal Supplemental Security Income Program or any federal or state energy assistance program or general assistance program or state-funded child care program or the refugee program. Prior to the commissioner's acceptance of a provider agreement or at any time upon written request by the commissioner, the vendor shall furnish the commissioner with the identity of any person convicted of a crime involving fraud in such programs who has an ownership or control interest in the vendor or who is an agent or managing employee. The commissioner shall terminate, refuse to enter into or renew an agreement with a vendor, except a vendor providing room and board and services pursuant to section 17b-340, if such convicted person has such interest or is such agent or employee. In the case of a vendor providing room and board and services pursuant to said section 17b-340, the commissioner may terminate, refuse to enter into or renew an agreement after consideration of any adverse impact on beneficiaries of such termination or refusal.

(c) The Department of Social Services shall distribute to all vendors who are providers in the medical assistance program a copy of the rules, regulations, standards and laws governing the program. The Commissioner of Social Services shall adopt by regulation in the manner provided for in sections 4-166 to 4-176, inclusive, administrative sanctions against providers in the Medicare program or Medicaid program or aid to families with dependent children program or state-funded child care program or state-administered general assistance program or temporary family assistance program or state supplement to the federal Supplemental Security Income Program including suspension from the program, for any violations of the rules, regulations, standards or law. The commissioner may adopt regulations in accordance with the provisions of chapter 54 to provide for the withholding of payments currently due in order to offset money previously obtained as the result of error or fraud. The department shall notify the proper professional society and licensing agency of any violations of this section.

Sec. 23. Section 17b-737 of the general statutes is repealed and the following is substituted in lieu thereof:

The Commissioner of Social Services shall establish a program, within available appropriations, to provide grants to municipalities, boards of education and child care providers to encourage the use of school facilities for the provision of child day care services before and after school. In order to qualify for a grant, a municipality, board of education or child care provider shall guarantee the availability of a school site which meets the standards set by the Department of Public Health in regulations adopted under sections 19a-77, 19a-79, 19a-80 and 19a-82 to 19a-87a, inclusive, and shall agree to provide liability insurance coverage for the program. Grant funds shall be used by the municipality, board of education or child care provider for the maintenance and utility costs directly attributable to the use of the school facility for the day care program, for related transportation costs and for the portion of the municipality, board of education or child care provider liability insurance cost and other operational costs directly attributable to the day care program. The municipality or board of education may contract with a child day care provider for the program. [The contract shall limit the amount the provider may charge under the program to the provider's base cost per capita plus a percentage of the base cost.] The Commissioner of Social Services may adopt regulations, in accordance with the provisions of chapter 54, for purposes of this section. The commissioner may utilize available child care subsidies to implement the provisions of this section and encourage association and cooperation with the Head Start program established pursuant to section 10-16n.

Sec. 24. Section 17b-802 of the general statutes is repealed and the following is substituted in lieu thereof:

(a) The Commissioner of Social Services shall establish, within available appropriations, and administer a security deposit guarantee program [of grants to] for persons [residing in emergency shelters or other emergency housing] who are recipients of [public assistance] temporary family assistance, aid under the state supplement program, state-administered general assistance or general assistance and to persons who have a documented showing of financial need and are residing in emergency shelters or other emergency housing or who cannot remain in permanent housing due to any reason specified in subsection (a) of section 17b-808, for use by such persons [as] in lieu of a security deposit on a rental dwelling unit. Eligible persons may receive a [grant] security deposit guarantee in an amount not to exceed the equivalent of one month's rent on such rental unit, except that upon a documented showing of financial need, the commissioner may approve a [grant] security deposit guarantee in an amount not to exceed the equivalent of two month's rent. No person may apply for and receive a [grant for use as a] security deposit guarantee more than once without the express authorization of the Commissioner of Social Services, except as provided in subsection (b) of this section.

(b) In the case of any person who qualifies for a [grant] guarantee, the Commissioner of Social Services, or any emergency shelter under contract with the Department of Social Services to assist in the administration of the security deposit guarantee program established pursuant to subsection (a) of this section, may [, in accordance with the landlord's preference, either pay the security deposit directly to the landlord or] execute a written agreement to pay the landlord for any damages suffered by the landlord due to the tenant's failure to comply with such tenant's obligations as defined in section 47a-21, provided the amount of any such payment shall not exceed the amount of the requested security deposit. [Payment of a security deposit directly to the landlord shall be conditional upon the execution by the landlord of a written agreement providing that if the tenant for whom such payment is made vacates the housing unit, any return of the security deposit and of accrued interest to which the tenant would be entitled, shall be paid directly to the Department of Social Services. Such refund shall be made in accordance with the requirements of section 47a-21, and, if the landlord claims the right to withhold all or most of the security deposit, he shall comply with all of the applicable provisions of said section except that any notices required shall also be sent to the Department of Social Services. The rights of such a tenant to the return of a security deposit shall be subrogated to the state of Connecticut and if suit is necessary to collect the deposit, the defendant shall pay all costs and shall be subject to double damages as provided in section 47a-21.] If a person who has previously received a grant for a security deposit or a security deposit guarantee becomes eligible for a subsequent [grant] security deposit guarantee, the amount of the subsequent [grant] security deposit guarantee for which such person would otherwise have been eligible shall be reduced by (1) any amount of [the] a previous grant which has not been returned to the department pursuant to section 47a-21 or (2) the amount of any payment made to the landlord for damages pursuant to this subsection. [In any fiscal year, the total amount of security deposits granted and written agreements executed for the payment of damages pursuant to this section shall not exceed the amount available for the program for that fiscal year.]

(c) Any payment made pursuant to this section to any person receiving temporary family assistance, aid under the state supplement program, general assistance or state-administered general assistance shall not be deducted from the amount of assistance to which the recipient would otherwise be entitled.

(d) On and after July 1, 2000, no special need or special benefit payments shall be made by the commissioner for security deposits from the temporary family assistance, state supplement, state-administered general assistance or general assistance programs.

(e) The Commissioner of Social Services may, within available appropriations, from funds appropriated to the safety net account, on a case-by-case basis, provide a security deposit grant to a person residing in an emergency shelter or other emergency housing or to a person who cannot remain in permanent housing due to any reason specified in subsection (a) of section 17b-808, in an amount not to exceed the equivalent of one month's rent on such rental unit provided the commissioner determines that emergency circumstances exist which threaten the health, safety or welfare of a child who resides with such person. Such person shall not be eligible for more than one such grant without the authorization of said commissioner.

(f) The Commissioner of Social Services may provide a security deposit grant to a person receiving such grant through any emergency shelter under an existing contract with the Department of Social Services to assist in the administration of the security deposit program, but in no event shall a payment be authorized after October 1, 2000.

[(d)] (g) The Commissioner of Social Services shall adopt regulations, in accordance with the provisions of chapter 54, to administer the program established pursuant to this section and to set eligibility criteria for [grants under] the program, but may implement the program until January 1, 2002, while in the process of adopting such regulations provided notice of intent to adopt the regulations is published in the Connecticut Law Journal within twenty days after implementation.

Sec. 25. Section 53a-290 of the general statutes is repealed and the following is substituted in lieu thereof:

A person commits vendor fraud when, with intent to defraud and acting on [his own] such person's own behalf or on behalf of an entity, [he] such person provides goods or services to a beneficiary under sections 17b-22, 17b-75 to 17b-77, inclusive, 17b-79 to 17b-103, inclusive, [17b-114,] 17b-180a, 17b-183, 17b-260 to 17b-262, inclusive, 17b-264 to 17b-285, inclusive, 17b-357 to 17b-362, inclusive, 17b-600 to 17b-604, inclusive, 17b-749, as amended, 17b-807 and 17b-808 or provides services to a recipient under Title XIX of the Social Security Act, as amended, and, (1) presents for payment any false claim for goods or services performed; (2) accepts payment for goods or services performed, which exceeds either the amounts due for goods or services performed, or the amounts authorized by law for the cost of such goods or services; (3) solicits to perform services for or sell goods to any such beneficiary, knowing that such beneficiary is not in need of such goods or services; (4) sells goods to or performs services for any such beneficiary without prior authorization by the Department of Social Services, when prior authorization is required by said department for the buying of such goods or the performance of any service; or (5) accepts from any person or source other than the state an additional compensation in excess of the amount authorized by law.

Sec. 26. Section 19a-671 of the general statutes is repealed and the following is substituted in lieu thereof:

The Commissioner of Social Services is authorized to determine the amount of payments pursuant to sections 19a-670 to 19a-672, inclusive, as amended, for each hospital. The commissioner's determination shall be based on the advice of the office and the application of the calculation in this section. For each hospital the Office of Health Care Access shall calculate the amount of payments to be made pursuant to sections 19a-670 to 19a-672, inclusive, as amended, as follows:

(1) For the period April 1, 1994, to June 30, 1994, inclusive, and for the period July 1, 1994, to September 30, 1994, inclusive, the office shall calculate and advise the Commissioner of Social Services of the amount of payments to be made to each hospital as follows:

(A) Determine the amount of pool payments for the hospital, including grants approved pursuant to section 19a-168k, in the previously authorized budget authorization for the fiscal year commencing October 1, 1993.

(B) Calculate the sum of the result of subparagraph (A) of this subdivision for all hospitals.

(C) Divide the result of subparagraph (A) of this subdivision by the result of subparagraph (B) of this subdivision.

(D) From the anticipated appropriation to the medical assistance disproportionate share-emergency assistance account made pursuant to sections 3-114i and 12-263a to 12-263e, inclusive, subdivisions (2) and (29) of section 12-407, subsection (1) of section 12-408, section 12-408a, subdivision (5) of section 12-412, subsection (1) of section 12-414 and sections 19a-646, 19a-659 to 19a-662, inclusive, and 19a-666 to 19a-680, inclusive, for the quarter subtract the amount of any additional medical assistance payments made to hospitals pursuant to any resolution of or court order entered in any civil action pending on April 1, 1994, in the United States District Court for the district of Connecticut, and also subtract the amount of any emergency assistance to families payments projected by the office to be made to hospitals in the quarter.

(E) The disproportionate share payment shall be the result of subparagraph (D) of this subdivision multiplied by the result of subparagraph (C) of this subdivision.

(2) For the fiscal year commencing October 1, 1994, and subsequent fiscal years, the interim payment shall be calculated as follows for each hospital:

(A) For each hospital determine the amount of the medical assistance underpayment determined pursuant to section 19a-659, plus the [authorized] actual amount of uncompensated care including emergency assistance to families determined pursuant to section 19a-659, less any amount of uncompensated care determined by the Department of Social Services to be due to a failure of the hospital to enroll patients for emergency assistance to families, plus the amount of any grants authorized pursuant to the authority of section 19a-168k.

(B) Calculate the sum of the result of subparagraph (A) of this subdivision for all hospitals.

(C) Divide the result of subparagraph (A) of this subdivision by the result of subparagraph (B) of this subdivision.

(D) From the anticipated appropriation made to the medical assistance disproportionate share-emergency assistance account pursuant to sections 3-114i and 12-263a to 12-263e, inclusive, as amended, subdivisions (2) and (29) of section 12-407, as amended, subsection (1) of section 12-408, as amended, section 12-408a, subdivision (5) of section 12-412, subsection (1) of section 12-414 and sections 19a-646, 19a-659 to 19a-662, inclusive, and 19a-666 to 19a-680, inclusive, as amended, for the fiscal year, subtract the amount of any additional medical assistance payments made to hospitals pursuant to any resolution of or court order entered in any civil action pending on April 1, 1994, in the United States District Court for the district of Connecticut, and also subtract any emergency assistance to families payments projected by the office to be made to the hospitals for the year.

(E) The disproportionate share payment shall be the result of subparagraph (D) of this subdivision multiplied by the result of subparagraph (C) of this subdivision.

Sec. 27. Section 31-261 of the general statutes is repealed and the following is substituted in lieu thereof:

(a) There is created in the State Treasury a special segregated fund to be known as the Unemployment Compensation Fund. Said fund shall consist of all contributions and moneys paid into or received by it for the payment of unemployment compensation benefits, of any property or securities acquired from the use of moneys belonging to the fund, all interest earned thereon, all money credited to this state's account in the Unemployment Trust Fund established by Section 904 of the Social Security Act pursuant to Section 903 of the Social Security Act, as amended, and all money received for the fund from any other source. All moneys in said fund shall be expended solely for the payment of benefits and refunds provided for by this chapter, exclusive of the expenses of administration, except that money credited to the account of this state in the Unemployment Trust Fund by the Secretary of the Treasury of the United States pursuant to Section 903 of the Social Security Act, as amended, may be requisitioned and used for the payment of expenses incurred for the administration of this chapter pursuant to a specific appropriation by the General Assembly, provided the expenses are incurred and the money is requisitioned after the enactment of an appropriation act which [(a)] (1) specifies the purposes for which such money is appropriated and the amounts appropriated therefor, [(b)] (2) limits the period within which such money may be obligated to a period ending not more than two years after the date of the enactment of such act, and [(c)] (3) limits the amount which may be used during a twelve-month period beginning on July first and ending on the next June thirtieth to an amount which does not exceed the amount by which [(1)] (A) the aggregate of the amounts credited to the account of this state pursuant to Section 903 of the Social Security Act, as amended, during the same twelve-month period and the twenty-four preceding twelve-month periods exceeds [(2)] (B) the aggregate of the amounts used pursuant to this [subsection] subdivision and charged against the amounts credited to the account of this state during any of such twenty-five twelve-month periods. For the purposes of this [subsection] subdivision, amounts used during any such twelve-month period shall be charged against equivalent amounts which were first credited and which are not already so charged, except that no amount used for administration during any such twelve-month period may be charged against any amount credited during such a twelve-month period earlier than the twenty-fourth preceding such period. Money credited to the account of this state pursuant to Section 903 of the Social Security Act, as amended, may not be withdrawn or used except for the payment of benefits and for the payment of expenses for the administration of this chapter and of public employment offices pursuant to this [section] subsection. Money requisitioned for the payment of expense of administration pursuant to this [section] subsection shall be deposited in the Employment Security Administration Fund, but, until expended, shall remain a part of the Unemployment Compensation Fund. The administrator shall maintain a separate record of the deposit, obligation, expenditure and return of funds so deposited. If any money so deposited is, for any reason, not to be obligated for the purpose for which it was appropriated, or if it remains unobligated at the end of the period specified by the law appropriating such money, or if any money which has been obligated within the period will not be expended, it shall be withdrawn and returned to the Secretary of the Treasury of the United States for credit to this state's account in the Unemployment Trust Fund. The State Treasurer shall be liable on his official bond for the faithful performance of his duties in connection with the Unemployment Compensation Fund. All sums recovered on any surety bond for losses sustained by the Unemployment Compensation Fund shall be deposited in said fund.

(b) Notwithstanding the provisions of subsection (a) of this section, money credited to the account of this state pursuant to Section 903 of the Social Security Act, as amended, with respect to the federal fiscal years 1999, 2000 and 2001, shall be used solely for the payment of expenses incurred for the administration of this chapter, and such money shall not otherwise be subject to the provisions of subsection (a) of this section.

Sec. 28. Section 40 of public act 99-2 of the June special session is repealed and the following is substituted in lieu thereof:

(a) The [Office of Health Care Access, in consultation with the] Office of Policy and Management, may provide [loans to] grants, technical assistance or consultation services, or any combination thereof, to one or more nongovernmental acute care general hospitals as permitted by this section. Such grants, technical assistance or consultation services shall be consistent with applicable federal disproportionate share regulations, as from time to time amended.

(b) [Loans] Grants, technical assistance or consultation services, or any combination thereof, provided under [the provisions of] this section may be made to assist [an] a nongovernmental acute care general hospital to develop and implement a plan to achieve financial stability and assure the delivery of appropriate health care services in the service area of [the hospital seeking a loan under this program. The maximum term of any loan authorized pursuant to this section shall not exceed five years] such hospital, or to assist a nongovernmental acute care general hospital in determining strategies, goals and plans to ensure its financial viability or stability. Any such hospital seeking such [loan] grants, technical assistance or consultation services shall prepare and submit to the Office of Policy and Management and the Office of Health Care Access a plan that includes at least the following: (1) A statement of the [facility's] hospital's current projections of its finances for the [term of the proposed loan] current and the next three fiscal years; (2) identification of the major financial issues which effect the financial stability of the hospital; (3) the steps proposed to study or improve the financial status of the hospital and eliminate ongoing operating losses; (4) plans to study or change the mix of services provided by the hospital, which may include transition to an alternative licensure category; and (5) other related elements as determined by the Office of [Health Care Access] Policy and Management. Such plan shall clearly identify the amount, value or type of the [loan] grant, technical assistance or consultation services, or combination thereof, requested. Any [loans originated by the state pursuant to this act shall bear interest at a rate agreed to] grants, technical assistance or consultation services, or any combination thereof, provided under this section shall be determined by the Secretary of the Office of Policy and Management [and which will] not to jeopardize the federal matching payments under the medical assistance program and the emergency assistance to families program as determined by the Office of Health Care Access or the Department of Social Services in consultation with the Office of Policy and Management. [The hospital's proposed financial plan must include a plan to repay the loan with interest within five years of initiation.]

(c) There is established a [non-lapsing] nonlapsing account, from which [loans] grants, purchases of services of any type or reimbursement of state costs for services deemed necessary by the Office of Policy and Management to assist one or more nongovernmental acute care general hospitals under this section shall be made. [Upon receipt of repayment of some or all of said loans, such funds shall be deposited in the General Fund.]

(d) The submission of [the] a proposed plan by the hospital under subsection (b) of this section may be considered a letter of intent for the purposes of any certificate of need which may be required to change the [facility's] hospital's service offering.

(e) Upon review and approval of the [financial viability] probable significant benefit of a hospital's submitted plan, the Office of [Health Care Access] Policy and Management may recommend that a [loan] grant be awarded and issue such [loan] grant, or contract with one or more consultants to provide technical or other assistance or consultation services, or may provide any combination of such grant and assistance that the office deems necessary or advisable.

Sec. 29. (a) The Commissioner of Social Services shall develop a plan to modify the Connecticut Pharmaceutical Assistance Contract to the Elderly and Disabled program, otherwise known as "ConnPACE", by establishing a component to be known as "ConnPACE Part B", to meet the prescription drug assistance needs of elderly and disabled residents who are ineligible for ConnPACE due to income exceeding ConnPACE income standards and who have no means of paying the full or partial cost of their prescription drug needs through private insurance or other means.

(b) (1) The plan developed by the Commissioner of Social Services under subsection (a) of this section may include, but shall not be limited to, the following: (A) A reasonable application fee for applicants of the program; (B) a prescription drug benefit where recipients may receive prescription drugs at a reduced cost which to the extent possible is at or below the current Medicaid rate; (C) a manufacturers' drug rebate agreement which equals the rebates established under the Medicaid program and which may require a manufacturer participating in the ConnPACE program to participate in the ConnPACE Part B program; (D) a provision establishing a dispensing fee and additional subsidies paid to a pharmacist participating in the program; (E) an eligibility income limitation based on a percentage of the federal poverty level; and (F) an eligibility provision whereby income spent on catastrophic costs of prescription drugs would not be counted in a determination of eligibility.

(2) Such plan shall include a fiscal impact analysis which specifies (A) the overall program and administrative costs, including projections of costs associated with any fees or subsidies provided to a pharmacist participating in the program, any costs associated with the eligibility determination and claims processing requirements of a ConnPACE part B program and any potential program start-up costs, and (B) projections of revenues, including anticipated manufacturer participation and rebates and revenues associated with an application fee. Program expenditures and administrative costs under such plan shall not exceed estimated revenues from such program.

(c) Not later than January 1, 2001, the Commissioner of Social Services shall submit such plan to the joint standing committees of the General Assembly having cognizance of matters relating to public health, human services and appropriations and the budgets of state agencies. Within thirty days of the receipt of the plan, said committees shall make a finding to the speaker of the House of Representatives, the president pro tempore of the Senate, the majority leader of the House of Representatives, the majority leader of the Senate, the minority leader of the House of Representatives, the minority leader of the Senate and the Commissioner of Social Services, that such plan meets, or fails to meet, the requirements that program expenditures and administrative costs do not exceed estimated revenues. In the event that the committees find that program expenditures and administrative costs do not exceed estimated revenues, such plan shall be implemented by the commissioner as soon as is practicable, but not later than July 1, 2001.

(d) There shall be established a separate, nonlapsing ConnPACE Part B account, into which ConnPACE Part B manufacturers' rebates and other revenues may be deposited and from which payments for program expenditures and administrative costs may be made.

(e) The Commissioner of Social Services may negotiate the contractual terms of participation of any pharmaceutical manufacturer, pharmacist and eligibility and claims processing agent participating in the ConnPACE Part B program.

Sec. 30. Not later than February 1, 2001, the Commissioner of Social Services shall study the impact of the security deposit guarantee program on access to affordable housing for recipients of benefits under such program and report any findings and recommendations to the joint standing committees of the General Assembly having cognizance of matters relating to human services and appropriations and the budgets of state agencies, in accordance with the provisions of section 11-4a of the general statutes.

Sec. 31. (a) The Commissioner of Social Services shall study methods of operating the Medicaid managed care program including primary care case management, fee for service and the current system. The study shall compare probable costs and quality under each system, including provider participation, client participation, client access to care parameters, ease of access, preventive care, treatment referrals, outreach, any disincentives to providing care, public ownership of program information and data and the administrative burden on providers, clients and the state. The commissioner shall rely on the experiences of other states and input from current and potential providers and clients of such program.

(b) Not later than March 1, 2001, the Commissioner of Social Services shall submit a report of any findings and recommendations to the joint standing committees of the General Assembly having cognizance of matters relating to public health, human services and appropriations and the budgets of state agencies, in accordance with the provisions of section 11-4a of the general statutes.

Sec. 32. (a) There is established a Dental Advisory Council consisting of the following members: (1) The Commissioner of Social Services, or the commissioner's designee; (2) the Commissioner of Public Health, or the commissioner's designee; (3) the dean of The University of Connecticut School of Dentistry, or the dean's designee; and (4) seven persons, one of whom shall be a representative of a mobile dental clinic appointed by the Governor, one of whom shall be a representative of the Connecticut State Dental Association appointed by the speaker of the House of Representatives, one of whom shall be a representative of a managed care organization appointed by the president pro tempore of the Senate, one of whom shall be a representative of a community health center or a school-based health center appointed by the majority leader of the House of Representatives, one of whom shall be a representative of the Connecticut Dental Hygiene Association appointed by the majority leader of the Senate, one of whom shall be a representative of the Connecticut Children's Health Council appointed by the minority leader of the House Of Representatives, and one of whom shall be a faculty member or an administrator of a dental hygiene school located in the state appointed by the minority leader of the Senate.

(b) The Dental Advisory Council shall: (1) Review fees for dental services paid by the Department of Social Services under the Medicaid dental program to determine the adequacy of such fees and make recommendations for adjustments or modifications to such fees based on experience and access to dental services and dental utilization as reflected in annual Health Care Financing Administration utilization reports; (2) monitor the effects of fee increases under the Medicaid dental program on the number of persons eligible under the program who obtain dental services and the number of dental care providers who participate in the program; (3) make recommendations on dental services capacity assessment; (4) identify private foundation support for public or nonprofit health care entities providing dental services; (5) evaluate dental care pilot programs; (6) enhance public and medical community awareness of dental access issues; and (7) make recommendations concerning the expansion of access to dental care and the increase of dental services utilization in the state including, but not limited to, recommendations for state utilization goals.

(c) Not later than April 15, 2001, the Dental Advisory Council shall submit an interim report of its analysis and recommendations under subsection (b) of this section to the joint standing committees of the General Assembly having cognizance of matters relating to public health and human services, in accordance with the provisions of section 11-4a of the general statutes. The Dental Advisory Council shall submit its final report under this subsection to said committees not later than January 1, 2002.

Sec. 33. Not later than January 1, 2001, the Commissioner of Children and Families shall submit a report to the joint standing committees of the General Assembly having cognizance of matters relating to human services and appropriations and the budgets of state agencies which shall specify a methodology said commissioner will use to indicate in said agency's estimate of expenditure requirements transmitted pursuant to subsection (a) of section 4-77 of the general statutes, expenditure requirements classified to indicate expenditures estimated for the following: (1) Child protective services; (2) juvenile justice; (3) children's mental health and substance abuse services; (4) prevention; and (5) administration.

Sec. 34. (NEW) The expenditure report relative to the temporary assistance for needy families block grant required to be submitted by the Commissioner of Social Services to the federal Department of Health and Human Services shall be transmitted to the joint standing committees of the General Assembly having cognizance of matters relating to human services and appropriations and the budgets of state agencies within forty-five days of the date of such submission. Such report for the last quarter of the fiscal year shall include the identification of unliquidated obligations either identified in previous quarterly reports for the same fiscal year and claimed before the prior quarterly report or those not yet claimed by the commissioner for the purposes of receiving federal reimbursement. In the event that such report identifies any unliquidated obligations, the commissioner shall notify said committees of the commissioner's intention concerning the disposition of such unliquidated obligations, which may include, establishing or contributing to a reserve account to meet future needs in the temporary family assistance program.

Sec. 35. (NEW) The maximum allowable cost paid for Factor VIII pharmaceuticals under the Medicaid, state-administered general assistance, general assistance and ConnPACE programs shall be the actual acquisition cost plus eight per cent. The Commissioner of Social Services may designate specific suppliers of Factor VIII pharmaceuticals from which a dispensing pharmacy shall order the prescription to be delivered to the pharmacy and billed by the supplier to the Department of Social Services. If the commissioner so designates specific suppliers of Factor VIII pharmaceuticals, the department shall pay the dispensing pharmacy a handling fee equal to eight per cent of the actual acquisition cost for such prescription.

Sec. 36. (NEW) (a) The Commissioner of Social Services may establish a plan for the prior authorization of (1) any initial prescription for a drug covered under the Medicaid, state-administered general assistance, general assistance or ConnPACE program that costs five hundred dollars or more for a thirty-day supply or (2) any early refill of a prescription drug covered under any of said programs. The Commissioner of Social Services shall establish a procedure by which prior authorization under this subsection shall be obtained from an independent pharmacy consultant acting on behalf of the Department of Social Services, under an administrative services only contract. If prior authorization is not granted or denied within two hours of receipt by the commissioner of the request for prior authorization, it shall be deemed granted.

(b) The Commissioner of Social Services shall, to increase cost-efficiency or enhance access to a particular prescription drug, establish a plan under which the commissioner may designate specific suppliers of a prescription drug from which a dispensing pharmacy shall order the prescription to be delivered to the pharmacy and billed by the supplier to the department. For each prescription dispensed through designated suppliers, the department shall pay the dispensing pharmacy a handling fee not to exceed four hundred per cent of the dispensing fee established pursuant to section 17b-280 of the general statutes. In no event shall the provisions of this subsection be construed to allow the commissioner to purchase all prescription drugs covered under the Medicaid, state-administered general assistance, general assistance and ConnPACE programs under one contract.

(c) Notwithstanding the provisions of section 17b-262 of the general statutes and any regulation adopted thereunder, on or after July 1, 2000, the Commissioner of Social Services may establish a schedule of maximum quantities of oral dosage units permitted to be dispensed at one time for prescriptions covered under the Medicaid, state-administered general assistance and general assistance programs based on a review of utilization patterns.

(d) A plan or schedule established pursuant to subsection (a), (b) or (c) of this section and any revisions thereto shall be submitted to the joint standing committees of the General Assembly having cognizance of matters relating to public health, human services and appropriations and the budgets of state agencies. Within sixty days of receipt of such a plan or schedule or revisions thereto, said joint standing committees of the General Assembly shall approve or deny the plan or schedule or any revisions thereto and advise the commissioner of their approval or denial of the plan or schedule or any revisions thereto. The plan or schedule or any revisions thereto shall be deemed approved unless all committees vote to reject such plan or schedule or revisions thereto within sixty days of receipt of such plan or schedule or revisions thereto.

Sec. 37. (NEW) (a) Each long-term care facility shall return to the vendor pharmacy which shall accept, for repackaging and reimbursement to the Department of Social Services, drug products that were dispensed to a patient and not used if such drug products are (1) prescription drug products that are not controlled substances, (2) sealed in individually packaged units, (3) returned to the vendor pharmacy within the recommended period of shelf life for the purpose of redispensing such drug products, (4) determined to be of acceptable integrity by a licensed pharmacist, and (5) oral and parenteral medication in single-dose sealed containers approved by the federal Food and Drug Administration, topical or inhalant drug products in units of use containers approved by the federal Food and Drug Administration or parenteral medications in multiple-dose sealed containers approved by the federal Food and Drug Administration from which no doses have been withdrawn.

(b) Notwithstanding the provisions of subsection (a) of this section:

(1) If such drug products are packaged in manufacturer's unit-dose packages, such drug products shall be returned to the vendor pharmacy for redispensing and reimbursement to the Department of Social Services if such drugs may be redispensed for use before the expiration date, if any, indicated on the package.

(2) If such drug products are repackaged in manufacturer's unit-dose or multiple-dose blister packs, such drug products shall be returned to the vendor pharmacy for redispensing and reimbursement to the Department of Social Services if (A) the date on which such drug product was repackaged, such drug product's lot number and expiration date are indicated clearly on the package of such repackaged drug; (B) ninety days or fewer have elapsed from the date of repackaging of such drug product; and (C) a repackaging log is maintained by the pharmacy in the case of drug products repackaged in advance of immediate needs.

(3) No drug products dispensed in a bulk dispensing container may be returned to the vendor pharmacy.

(c) Each long-term care facility shall establish procedures for the return of unused drug products to the vendor pharmacy from which such drug products were purchased.

(d) The Department of Social Services (1) shall reimburse to the vendor pharmacy the reasonable cost of services incurred in the operation of this section, as determined by the commissioner, and (2) may establish procedures, if feasible, for reimbursement to nonMedicaid payors for drug products returned pursuant to this section.

(e) The Department of Consumer Protection, in consultation with the Department of Social Services, shall adopt regulations, in accordance with the provisions of chapter 54 of the general statutes, which shall govern the repackaging and labeling of drug products returned pursuant to subsections (a) and (b) of this section. The Department of Consumer Protection shall implement the policies and procedures necessary to carry out the provisions of this section until January 1, 2002, while in the process of adopting such policies and procedures in regulation form, provided notice of intent to adopt the regulations is published in the Connecticut Law Journal within twenty days after implementation.

Sec. 38. Section 17b-274 of the general statutes is repealed and the following is substituted in lieu thereof:

(a) The Commissioner of Social Services shall pay a pharmacist a professional dispensing fee of fifty cents per prescription, in addition to any other dispensing fee, for substituting a generically equivalent drug product, in accordance with section 20-619, as amended by this act, for the drug prescribed by the licensed practitioner for a Medicaid recipient, provided the substitution is not required by federal law or regulation.

(b) The Division of Criminal Justice shall periodically investigate pharmacies to ensure that the state is not billed for a brand name drug product when a less expensive generic substitute drug product is dispensed to a Medicaid recipient. The Commissioner of Social Services shall cooperate and provide information as requested by such division.

(c) A licensed medical practitioner may specify in writing or by a telephonic or electronic communication that there shall be no substitution for the specified brand name drug product in any prescription for a Medicaid, state-administered general assistance, general assistance or ConnPACE recipient, provided (1) the practitioner specifies the basis on which the brand name drug product and dosage form is medically necessary in comparison to a chemically equivalent generic drug product substitution, and (2) the phrase "brand medically necessary" shall be in the practitioner's handwriting on the prescription form or, if the prohibition was communicated by telephonic communication, in the pharmacist's handwriting on such form, and shall not be preprinted or stamped or initialed on such form. If the practitioner specifies by telephonic communication that there shall be no substitution for the specified brand name drug product in any prescription for a Medicaid, state-administered general assistance, general assistance or ConnPACE recipient, written certification in the practitioner's handwriting bearing the phrase "brand medically necessary" shall be sent to the dispensing pharmacy within ten days. A pharmacist shall dispense a generically equivalent drug product for any drug listed in accordance with the Code of Federal Regulations Title 42 Part 447.332 for a drug prescribed for a Medicaid, state-administered general assistance, general assistance or ConnPACE recipient unless the phrase "brand medically necessary" is ordered in accordance with this subsection and such pharmacist has received approval to dispense the brand name drug product in accordance with subsection (d) of this section.

(d) The Commissioner of Social Services shall establish a procedure by which a pharmacist shall obtain approval from an independent pharmacy consultant acting on behalf of the Department of Social Services, under an administrative services only contract, whenever the pharmacist dispenses a brand name drug product to a Medicaid, state-administered general assistance, general assistance or ConnPACE recipient and a chemically equivalent generic drug product substitution is available, provided such procedure shall not require approval for other than initial prescriptions for such drug product. If such approval is not granted or denied within two hours of receipt by the commissioner of the request for approval, it shall be deemed granted. The pharmacist may appeal a denial of reimbursement to the department based on the failure of such pharmacist to substitute a generic drug product in accordance with this section.

(e) A licensed medical practitioner shall disclose to the Department of Social Services or such consultant, upon request, the basis on which the brand name drug product and dosage form is medically necessary in comparison to a chemically equivalent generic drug product substitution. The Commissioner of Social Services shall establish a procedure by which such a practitioner may appeal a determination that a chemically equivalent generic drug product substitution is required for a Medicaid, state-administered general assistance, general assistance or ConnPACE recipient.

Sec. 39. Section 17b-362a of the general statutes is repealed and the following is substituted in lieu thereof:

The Commissioner of Social Services shall establish a pharmacy review panel to serve as advisors in the operation of pharmacy benefit programs administered by the Department of Social Services, including the implementation of any cost-saving initiatives undertaken pursuant to section 17b-362, subsection (e) of section 17b-491 and section 17b-363. The panel shall be appointed by the commissioner to a three-year term and shall be composed of two representatives of independent pharmacies, two representatives of chain pharmacies, two representatives of pharmacies that serve long-term care facilities, two representatives of pharmaceutical manufacturers, one physician specializing in family practice and one physician specializing in internal medicine or geriatrics. The panel shall meet at least quarterly with the commissioner or [his] said commissioner's designee.

Sec. 40. Subsection (e) of section 17b-491 of the general statutes is repealed and the following is substituted in lieu thereof:

(e) All prescription drugs of a pharmaceutical manufacturer that participates in the program pursuant to subsection (d) of this section shall be subject to prospective drug utilization review. [, but not prior authorization.] Any prescription drug of a manufacturer that does not participate in the program shall not be reimbursable, unless the department determines the prescription drug is essential to program participants.

Sec. 41. Section 17b-493 of the general statutes is repealed and the following is substituted in lieu thereof:

A pharmacist shall, except as limited by subsection (c) of section 20-619, as amended by this act, and section 17b-274, as amended by this act, substitute a therapeutically and chemically equivalent generic drug product for a prescribed drug product when filling a prescription for an eligible person under the program.

Sec. 42. Subsection (c) of section 20-619 of the general statutes, as amended by section 39 of public act 99-175, is repealed and the following is substituted in lieu thereof:

(c) A prescribing practitioner may specify in writing or by a telephonic or other electronic communication that there shall be no substitution for the specified brand name drug product in any prescription, provided (1) in any prescription for a Medicaid, state-administered general assistance, general assistance or ConnPACE recipient, such practitioner specifies the basis on which the brand name drug product and dosage form is medically necessary in comparison to a chemically equivalent generic drug product substitution, and (2) the phrase ["NO SUBSTITUTION" or, for prescriptions covered by medical assistance in accordance with the Code of Federal Regulations, Title 42, Part 447.332, the phrase] "BRAND MEDICALLY NECESSARY", shall be in the practitioner's handwriting on the prescription form or on an electronically-produced copy of the prescription form or, if the prohibition was communicated by telephonic or other electronic communication that did not reproduce the practitioner's handwriting, a statement to that effect appears on the form. The phrase ["NO SUBSTITUTION" or] "BRAND MEDICALLY NECESSARY" shall not be preprinted or stamped or initialed on the form. If the practitioner specifies by telephonic or other electronic communication that did not reproduce the practitioner's handwriting that there shall be no substitution for the specified brand name drug product in any prescription for a Medicaid, state-administered general assistance, general assistance or ConnPACE recipient, written certification in the practitioner's handwriting bearing the phrase "BRAND MEDICALLY NECESSARY" shall be sent to the dispensing pharmacy within ten days.

Sec. 43. Subsection (b) of section 17b-134 of the general statutes is repealed and the following is substituted in lieu thereof:

(b) At the end of each quarter, one of the selectmen or the public official charged with the administration of general assistance in each town shall send to the Commissioner of Social Services, in the form prescribed by said commissioner, a statement of the cost to such town of general assistance during such quarter, which report shall be signed and sworn to by such selectman or public official. Such report form shall be uniform throughout the state and shall include, but not be limited to, the following information: (1) The approved budget of each town for general assistance, (2) the number of applications received, (3) compilation of data required under section 17b-123, (4) the extent to which recipients participated in work relief programs, if any, (5) the amount of the support and medical aid furnished, (6) the amount of the town's share of the cost for inpatient hospital and other medical services paid by the Department of Social Services pursuant to section 17b-220, and (7) such other information the commissioner deems necessary for the proper administration and oversight of the general assistance program. "Cost", as used herein, means the actual relief expenditure made by such town for persons therein or sent from such town to such licensed institutions, including expenses, except attorneys' fees, incurred in an appeal of a denial of Supplemental Security Income Assistance as provided in section 17b-119, but not including administrative costs, provided the expenditures for medical care shall not exceed the amounts set forth in the various fee schedules promulgated by the Commissioner of Social Services for medical, dental and allied services and supplies or the charges made for comparable services and supplies to the general public, whichever is less. Upon state processing and payment of medical claims pursuant to this chapter, pharmaceutical manufacturers shall be liable for rebates on pharmaceutical products. Rebate amounts for brand name pharmaceutical products shall be equal to those under the Medicaid program. Rebate amounts for generic pharmaceutical products shall be [equal to] established by the commissioner, provided such amounts may not be less than those under the Medicaid program. The process for computing and collecting such rebates shall parallel such process in the Medicaid program. Failure or refusal of a manufacturer to pay rebate amounts billed may result in elimination of coverage under general assistance for all or some products of the manufacturer. Any hospital receiving state aid shall charge a uniform rate for paupers receiving medical treatment or being supported or cared for in such hospital under the provisions of this section, not in excess of the rate established under the provisions of section 17b-238 for room, board, ordinary nursing care and routine medications and not in excess of the daily average cost rate for special professional services as established under the provisions of subsection (b) of section 17b-239. The commissioner, if satisfied that the statements are substantially true and if the town has complied with the reporting requirements of this section, shall certify them to the Comptroller, who shall pay within sixty days of receipt of such certification, subject to subsequent audits, to the town for general assistance expenditures, subject to section 17b-220, ninety per cent for expenditures made prior to July 1, 1992, and notwithstanding the provisions of section 2-32a, eighty-five per cent for expenditures made on and after July 1, 1992, eighty per cent for expenditures made on and after July 1, 1993, ninety per cent for expenditures made on and after April 1, 1996, and one hundred per cent for expenditures made on and after April 1, 1997. The commissioner may reduce by twenty-five per cent the amount otherwise payable to the town in accordance with this section for any statement which is submitted more than three months after the close of the quarter for which the statement was prepared. Effective August 31, 1997, towns shall not be reimbursed for assistance paid to employable persons. If not satisfied, the commissioner may reject such claim and shall notify the selectmen or other public official submitting the report of his decision. Notwithstanding any other provision of this section, the state shall charge the town for ten per cent of the inpatient hospital expenses paid prior to July 1, 1992, of a person who is hospitalized and is eligible for or is receiving general assistance benefits in the form of an adjustment to the quarterly statement submitted by the town pursuant to this section. Notwithstanding the provisions of section 2-32a, (A) the state shall charge the town for fifteen per cent of the inpatient hospital and other medical expenses paid on and after July 1, 1992, on behalf of any such person in such form and (B) the state shall charge the town for twenty per cent of the inpatient hospital and other medical expenses paid on or after July 1, 1993, ten per cent for such expenses paid on or after April 1, 1996, and the state shall not charge for such expenses on or after April 1, 1997, on behalf of any person in such form. Any town aggrieved by the action of the commissioner may, within thirty days after receipt of such notice, request a hearing before the commissioner. The commissioner shall fix a time and place for the hearing, which shall be not more than thirty days after the receipt of such request and notify the town of the time and place not later than fifteen days before the date of the hearing. The hearing shall be conducted in accordance with the procedures established under sections 4-176e, 4-177, 4-177c and 4-180 for contested cases. The commissioner or the person authorized by him to conduct the hearing shall render a decision within thirty days after the hearing and notify the town by mailing a copy of the decision to the selectmen or the public official charged with the administration of general assistance. If the town is aggrieved by the decision, it may appeal to the Superior Court in accordance with the provisions of section 4-183.

Sec. 44. Subsection (d) of section 17b-491 of the general statutes is repealed and the following is substituted in lieu thereof:

(d) The commissioner shall establish an application form whereby a pharmaceutical manufacturer may apply to participate in the program. Upon receipt of a completed application, the department shall issue a certificate of participation to the manufacturer. Participation by a pharmaceutical manufacturer shall require that the department shall receive a rebate from the pharmaceutical manufacturer. [equal to the rebate supplied by the manufacturer under Section 1927 of Title XIX of the Social Security Act for every prescription drug dispensed under the program.] Rebate amounts for brand name prescription drugs shall be equal to those under the Medicaid program. Rebate amounts for generic prescription drugs shall be established by the commissioner, provided such amounts may not be less than those under the Medicaid program. A participating pharmaceutical manufacturer shall make quarterly rebate payments to the department [equal to the rebate supplied by the manufacturer under Section 1927 of Title XIX of the Social Security Act] for the total number of dosage units of each form and strength of a prescription drug which the department reports as reimbursed to providers of prescription drugs, provided such payments shall not be due until thirty days following the manufacturer's receipt of utilization data from the department including the number of dosage units reimbursed to providers of prescription drugs during the quarter for which payment is due.

Sec. 45. (a) The Commissioner of Social Services, in consultation with the pharmacy review panel established pursuant to section 17b-362a of the general statutes, as amended by this act, shall study the feasibility of implementation of additional pharmacy efficiencies in the Medicaid, state-administered general assistance, general assistance and ConnPACE programs, including, but not limited to, (1) enhanced use of cognitive services by pharmacists in the use of medicines for chronic disease; (2) enhancement of services to address adverse drug reactions experienced by recipients of such programs; and (3) pursuit of fraudulent use or other misuse of prescriptive authority by licensed medical practitioners.

(b) Not later than May 1, 2001, the Commissioner of Social Services shall submit a report of any findings and recommendations to the joint standing committees of the General Assembly having cognizance of matters relating to public health, human services and appropriations and the budgets of state agencies, in accordance with the provisions of section 11-4a of the general statutes.

Sec. 46. In the event that prescription drug and pharmacy savings initiatives undertaken by the Department of Social Services pursuant to sections 35 to 37, inclusive, of this act, sections 17b-274 and section 17b-362a of the general statutes, as amended by this act, subsections (d) and (e) of section 17b-491 of the general statutes, as amended by this act, section 17b-493 of the general statutes, as amended by this act, subsection (c) of section 20-619 of the general statutes, as amended by this act, subsection (b) of section 17b-134 of the general statutes, as amended by this act, and section 45 of this act, for the fiscal year ending June 30, 2001, result in greater savings than anticipated, the Commissioner of Social Services shall develop a plan for the disbursement to participating pharmacies of any such excess savings and shall report such savings and such plan to the joint standing committees of the General Assembly having cognizance of matters relating to public health, human services and appropriations and the budgets of state agencies not later than May 15, 2001.

Sec. 47. (a) The Commissioner of Social Services shall, within available appropriations, establish and operate a state-funded pilot program to allow not more than fifty persons who are sixty-five years of age or older and (1) who had received services under the personal care assistance program established under section 17b-605a of the general statutes, as amended, at any time within the twelve-month period preceding such person's sixty-fifth birthday, or (2) who are eligible for services under the Connecticut home-care program for the elderly established under section 17b-342 of the general statutes, as amended by this act, provided the commissioner determines that such persons are unable to access adequate home care services, to receive personal care assistance in order to avoid institutionalization.

(b) The Commissioner of Social Services shall evaluate the cost effectiveness of providing personal care assistance under the provisions of subsection (a) of this section.

(c) The Commissioner of Social Services may, within available appropriations, increase the number of persons participating in the pilot program to no more than one hundred provided such personal care assistance has been demonstrated to be cost-effective.

(d) Not later than January 1, 2002, the Commissioner of Social Services shall submit a report to the joint standing committees of the General Assembly having cognizance of matters relating to public health, human services and appropriations and the budgets of state agencies on the pilot program established under subsection (a) of this section.

Sec. 48. (NEW) No person shall, except for purposes directly connected with the administration of programs of the social service department of a municipality, solicit, disclose, receive or make use of, knowingly permit, participate in or acquiesce in the use of, any list of the names of, or any personally identifiable social, financial, employment, medical health, mental health, substance abuse treatment or case history information pertaining to individuals receiving assistance from or participating in any program administered by the social services department of a municipality, directly or indirectly derived from the records, papers, files or communications of such municipal department, or acquired in the course of the performance of official duties.

Sec. 49. (a) The Commissioner of Social Services shall conduct a comprehensive needs assessment detailing the continuum of care needs of children and young adults with specific chronic medical conditions.

(b) Not later than February 1, 2001, the commissioner shall submit a report of any findings and recommendations to the joint standing committees of the General Assembly having cognizance of matters relating to human services, public health, insurance and appropriations and the budgets of state agencies, in accordance with the provisions of section 11-4a of the general statutes.

Sec. 50. Section 17b-283 of the general statutes is repealed and the following is substituted in lieu thereof:

[(a)] The Commissioner of Social Services shall amend the state's model 2176 Medicaid waiver to allow one hundred twenty-five disabled persons to participate under the waiver. The commissioner may, within available appropriations, amend such waiver to increase the number of persons eligible to participate under the waiver to not more than two hundred disabled persons.

[(b) The Commissioner of Social Services may study the feasibility of and costs associated with providing Medicaid coverage for outpatient substance abuse treatment services. The commissioner shall report his findings and recommendations to the joint standing committees of the General Assembly having cognizance of matters relating to human services and appropriations and the budgets of state agencies by January 1, 1991.]

Sec. 51. The unexpended balance of funds appropriated to the Office of Health Care Access under special act 99-10 for the purposes of a distressed hospitals loan program shall be transferred to the hospital grant and assistance program in the Office of Policy and Management established pursuant to section 40 of public act 99-2 of the June special session, as amended by this act.

Sec. 52. Section 3 of public act 99-279 and section 27 of public act 00-216 are repealed.

Sec. 53. This act shall take effect from its passage, except that sections 1 to 7, inclusive, 13 to 18, inclusive, 20 to 47, inclusive, and 49 to 52, inclusive, shall take effect July 1, 2000, and sections 8 to 10, inclusive, shall take effect October 1, 2000.