OLR Bill Analysis

sHB 5476

AN ACT EXPANDING CONSUMER CHOICE FOR LIFE SUPPORT CARE AT HOME.

SUMMARY:

This bill requires the Department of Social Services (DSS) commissioner, within available appropriations, to establish and operate a two-year, state-funded pilot program for up to 10 ventilator-dependent Medicaid recipients who live in Fairfield County and receive medical care at home. Under the pilot, the participants can hire their own licensed registered nurses (RN) and respiratory therapists directly. (Medicaid rules generally require these professionals to be hired by home health care agencies, which send them out to Medicaid recipients' homes. )

The bill requires DSS to set a maximum amount it reimburses the nurses and therapists for pilot services. The rate DSS pays for the nurses' care must be at least 80% of the prevailing rate DSS pays home health agencies to provide comparable care. Currently, DSS pays home health care agencies the following amounts for RN services provided: $ 94. 26 for any part of the first hour, $ 23. 56 for each 15-minute increment of the second hour, and $ 43. 07 for any part of an hour after the first hour for visits lasting more than two hours.

The bill requires nurses and therapists participating in the pilot to (1) submit to criminal history background checks (the bill does not specify who pays for the check) and (2) certify, in writing, that they will not terminate a patient's care unless they provide at least two weeks written notice, except in an emergency. It requires DSS to annually screen pilot participants to determine whether they are able to manage their care.

The bill requires the commissioner to report to the Appropriations and Human Services committees on the pilot, including its cost-effectiveness and care continuity, by January 1, 2015.

The bill also requires the DSS commissioner to survey Medicaid recipients who are receiving continuous skilled care at home and report by January 1, 2014 on the survey results to the Human Services Committee.

EFFECTIVE DATE: October 1, 2012

PILOT PROGRAM FOR VENTILATOR-DEPENDENT MEDICAID RECIPIENTS

Under the bill, DSS must, at least annually, screen each Medicaid recipient participating in the pilot to determine whether he or she can manage his or her care.

Participants must certify in writing that they, or their authorized representatives, assume responsibility for their plan of care. These plans must (1) be directed by a physician, (2) approved by DSS, and (3) include a protocol for ensuring that care is provided when the caregiver the recipient has hired is unavailable.

SURVEY OF MEDICAID RECIPIENTS RECEIVING CONTINUOUS SKILLED NURSING CARE AT HOME

The survey DSS conducts must determine:

1. the number of recipients receiving continuous skilled care at home,

2. the number of times each recipient's care has been terminated by a licensed home health care agency over the two years preceding the survey and the reasons, and

3. consumer satisfaction with the quality of care the agencies provided.

COMMITTEE ACTION

Human Services Committee

Joint Favorable Substitute

Yea

16

Nay

0

(03/22/2012)