PA 13-234 — HB 6705

Emergency Certification


SUMMARY: This act makes changes in laws governing state housing ( 1-69, 150 & 155), human services ( 70-130 & 153-156), and public health programs (131-150, 151-152 & 157).

Concerning housing, PA 12-1, June Special Session, established the Department of Housing (DOH) and made it the lead state agency responsible for all housing matters, including housing and neighborhood policy, development, redevelopment, preservation, maintenance, and improvement. The act completes DOH's establishment by transferring to it various housing-related responsibilities from the Department of Economic and Community Development (DECD), Office of Policy and Management (OPM), and Department of Social Services (DSS).

Concerning human services, the act makes changes in programs mostly administered by DSS and the Department of Children and Families (DCF). The major revisions include (1) creating a new, acuity-based Medicaid rate setting system for hospital care; (2) eliminating the ConnPACE and Charter Oak Health Plan programs; (3) requiring DCF, in conjunction with the State Department of Education (SDE) to take steps to improve the academic achievement of children and youth in DCF or Judicial Branch custody; and (4) enabling nursing homes to recover debt by changing how the law treats resident income and assets.

Concerning public health, the act makes changes affecting various health care facilities and professions regulated by the Department of Public Health (DPH), including physicians, surgeons, nurses, nurse-midwives, dentists, home health care agencies, assisted living services agencies, community health centers, nonprofit hospitals, and health care facilities' certificate of need applications.

It also makes changes affecting tattoo artists, DPH technical assistance fees for certain construction projects, the Connecticut Vaccine Program (CVP), neonatal intensive care unit transport services, cremation certificate fees, the Tobacco and Health Trust Fund, and the study of high school students' athletic injuries.

Finally, the act makes several technical and conforming changes.

EFFECTIVE DATE: July 1, 2013, unless otherwise specified.

1-69, 150, & 155 — DEPARTMENT OF HOUSING

Under the act, the DOH commissioner generally assumes responsibility for programs concerning:

1. affordable housing development and financing,

2. individual and group housing,

3. rent subsidies,

4. eviction and foreclosure prevention,

5. shelter provision and transitional living, and

6. homeownership.

The act does not transfer (1) administration of the federal Low-Income Housing Tax Credit program or (2) compliance oversight for properties in the state housing portfolio, both of which remain with the Connecticut Housing Finance Authority (CHFA). Nor does the act transfer programs providing clinical services to certain populations (e. g. , individuals with mental illness), which remain with DSS and the Department of Mental Health and Addiction Services (DMHAS), for example.

The act specifies that any DOH or DECD orders or regulations in force on January 1, 2013 remain so until amended, repealed, or superseded by law.

32-33, 43, 51, & 56-57 — Commissioner

By law, the DOH commissioner is responsible for developing policies and strategies to encourage housing provision in the state, including for very low-, low-, and moderate-income families. The act adds the commissioner, or his or her designee, to the following entities, increasing their membership by one:

1. Building Accessibility Task Force,

2. CHFA's board of directors,

3. Capital Region Development Authority's (CRDA) board of directors, and

4. Interagency Council for Ending the Achievement Gap.

The act also adds the housing commissioner to the list of officials the OPM secretary must consult with to (1) develop recommendations for the state's priority funding areas for growth-related projects and (2) coordinate state and regional transportation planning with other state planning efforts.

EFFECTIVE DATE: July 1, 2013, except the provision adding the commissioner to CHFA's board of directors takes effect upon passage.

1 — Deputy Commissioner

The act authorizes the commissioner to appoint a deputy commissioner, who is exempt from classified service. The appointee must be qualified by training and expertise and assume the commissioner's powers and duties if he or she is unable to perform them, or is disqualified from doing so.

22, 42, 54-55, 68, & 69 — Reporting Requirements

The act generally requires the DOH, rather than the DECD, commissioner to report annually to the governor and the General Assembly on the state's housing and community development activities during the preceding fiscal year. Under the act, the DOH commissioner must submit the report annually by March 31 and, no more than 30 days later, post it on the department's website.

As under prior law, the annual report must cover or include:

1. the department's housing development functions and activities,

2. the state-funded housing development portfolio,

3. an economic impact analysis of the department's housing development efforts and activities,

4. the Housing Trust Fund and Housing Trust Fund Program,

5. the Energy Conservation Loan Program,

6. a summary of the total social and economic impact of the department's community and housing development efforts and activities,

7. an assessment of the department's performance in meeting its stated goals and objectives,

8. the rental rebate program for the elderly and people with total and permanent disabilities, and

9. an analysis of the department's community development portfolio.

Existing law, unchanged by the act, requires DECD's annual report to also include an analysis of its community development portfolio (i. e. , the last reporting requirement listed above) even though, by law, DOH has assumed responsibility for community development activities.

The act specifies that DOH's annual report to the governor and General Assembly must incorporate any other annual reporting requirements set by statute concerning housing or community development.

State-Assisted Housing Sustainability Fund Report ( 22). The act requires DOH to report to the General Assembly by each March 31, rather than by February 1 as DECD had to do under prior law, on the State-Assisted Housing Sustainability Fund's operation during the previous calendar year. By law, the report must include an analysis of fund distribution and performance. It may include recommendations for modifying the program.

Rental Assistance Program (RAP) Report ( 69). By January 1, 2014, and annually thereafter, the act requires the DOH commissioner to report to the Appropriations, Housing, Human Services, and Public Health committees on the number of departmental clients and of those, the number who have been RAP recipients. In submitting the report, the commissioner must consult with the commissioners of children and families, developmental services, mental health and addiction services, and social services. The report must (1) detail voucher utilization under the RAP program and (2) establish targets to ensure that the program's resources are allocated in accordance with legislative intent.

16 — Interagency Council on Affordable Housing

By law, this council is responsible for advising and helping the DOH commissioner plan and implement the department (see BACKGROUND). The act expands its membership to 18 by adding the following four members: the (1) commissioners of education, developmental services, and aging and (2) president of the Connecticut chapter of the National Association of Housing and Redevelopment Officials (commonly known as CONN-NAHRO), or their designees.

2, 7-11, 13-15, 17-31, 34-35, 43-44, 67, & 150 — DECD Transfers

The act gives DOH authority over state housing and community development programs. Among other things, it transfers to DOH DECD's responsibilities with respect to:

1. working with and providing financial assistance to CHFA to achieve the state's housing and community development goals;

1. the state supplier diversity program (formerly called the set-aside program);

2. the affordable housing land use appeals procedure, including maintenance of the assisted housing inventory;

3. the state's consolidated plan for housing and community development;

4. the State-Assisted Housing Sustainability Fund;

5. congregate housing for the elderly;

6. independent living for low- and moderate-income individuals with disabilities;

7. rental assistance for elderly people residing in state-assisted rental housing (known as ERAP);

8. the community housing land bank and land trust program;

9. housing development zones;

10. the homeownership loan program;

11. grants-in-aid to municipalities financing low- and moderate-income rental housing;

12. the Energy Conservation Loan Fund;

13. condominium conversion compliance; and

14. the Common Interest Ownership Act.

The act transfers, from DECD to DOH, the authority to designate a federal HUD Section 202 or Section 236 elderly housing development to provide assisted living services to individuals otherwise eligible to receive these services under the Connecticut Homecare Program for Elders. It also authorizes DOH to designate more than one development.

The act requires DOH to consult with the newly established Department on Aging, rather than DSS as DECD previously did, in providing services to people with disabilities under the congregate housing program (see BACKGROUND).

The law requires DECD to give preference in its grant and loan programs to energy efficient projects. The act extends this requirement to DOH.

2, 36-42, & 55 — OPM Transfers

Various Programs. The act transfers, from OPM to DOH, responsibility for administering the (1) Main Street Investment Fund; (2) Housing for Economic Growth Program (i. e. , incentive housing zone program); and (3) rental rebate program for the elderly and people with total and permanent disabilities.

OPM remains responsible for administering the Homeowners' Tax Relief Program for the elderly and people with disabilities (known as the circuit breaker program).

Rental Rebate Program for the Elderly. The act limits rental rebate program eligibility by specifying that an individual who did not receive a rebate for calendar year 2011 is not eligible to apply for another rebate. An individual who received a calendar year 2011 grant continues to be eligible to apply. But if such an individual does not receive a rebate in any subsequent year, he or she is no longer eligible to apply.

Finally, the act gives the DOH commissioner 120 days, instead of 90 days as OPM had under prior law, to approve payments to municipalities, and forward them to the comptroller under the rental rebate program. By law, the comptroller must draw an order on the treasurer no later than 15 days after receiving the list of approved payments.

EFFECTIVE DATE: The provision (1) removing the rental rebate program from OPM's jurisdiction takes effect July 1, 2013 and applies to assessment years commencing on or after October 1, 2012 and (2) suspending rental rebate applications takes effect July 1, 2013 and applies to applications received on and after April 1, 2013.

2, 12, & 45-50 — DSS Transfers

The act transfers, from DSS to DOH, responsibility for administering:

1. the federal Housing Choice Voucher and Section 8 programs;

1. RAP, including the transitionary and emergency rental assistance programs;

2. homelessness prevention programs, including emergency shelter services, transitional housing services, and on-site social services;

3. housing for individuals with AIDS;

4. the rent bank program;

5. the assessment and mediation program for certain families at risk of becoming homeless or in imminent danger of eviction or foreclosure; and

6. the security deposit guarantee program.

The act also transfers, from DSS to DOH, responsibility for administering (1) the homefinders program to help families who are homeless or in danger of eviction or foreclosure and (2) emergency rental assistance for families living in hotels and motels and eligible for the Temporary Family Assistance program. In administering these programs, DOH must consult with DSS. And DSS remains responsible for seeking relief, in accordance with state and federal law, from income garnishment orders when it is in the best interests of children and families.

Assisted Living Demonstration Project. The act requires DSS and CHFA to collaborate with DOH, rather than DECD, to operate a demonstration project to provide subsidized assisted living services to seniors residing in affordable housing. The act expands eligibility to seniors age 65 or older who are also eligible for DMHAS' home and community-based program for adults with severe and persistent psychiatric disabilities. Prior law limited eligibility to only those seniors who qualified for the Connecticut Homecare Program for elders.

Access to DSS Information. With certain exceptions, the law prohibits DSS from disclosing information about individuals who apply for or receive department assistance, or participate in a department program. The act requires DSS to disclose to the DOH commissioner's authorized representatives information necessary for verifying whether an applicant is a recipient of DSS cash assistance, and the amount of any assistance.

33 & 52 — Miscellaneous

The act removes the DECD commissioner as the chairperson of CHFA's board, instead requiring the governor to appoint the chairperson. It also authorizes CRDA to enter into memoranda of understanding as it deems appropriate to carry out its responsibilities.


The Department of Rehabilitative Services (DORS) uses funds from its Educational Aid for Blind and Visually Handicapped Children account to provide and pay for educational services to blind and visually impaired children. The act eliminates the $6,400 per child annual spending limit.

Prior law required DORS to spend funds from the account in the following order: (1) pay for specialized books, equipment, and material; (2) pay for teaching services that school districts request directly from the department; and (3) reimburse local school districts that directly hire teachers instead of using those employed by DORS. Under the act, DORS no longer provides the school district reimbursements. The act also eliminates the requirement that DORS give any remaining funds to local school districts on a pro rata basis, with a two-to-one credit ratio for Braille-learning students to non-Braille-learning students.


Under prior law, DCF was the guardian of a child or youth committed to its care for the duration of the commitment, or until another guardian was legally appointed, (a) until age 18 or (b) by the child's consent, until age 21 if he or she was attending a secondary or technical school, college, or state-accredited job training program full-time. The act instead allows a youth committed to DCF prior to age 18 to remain in department custody up to age 21 if he or she consents and is:

1. enrolled in a full-time approved secondary education program or an approved program leading to an equivalent credential,

2. enrolled full-time in an institution providing postsecondary or vocational education, or

3. participating full-time in a DCF-approved program or activity designed to promote or remove employment barriers.

The act allows the commissioner, in her discretion, to waive the full-time enrollment or participation requirement based on compelling circumstances. It requires DCF, within 120 days after the youth's 18th birthday, to file a motion in juvenile court to determine whether continuation of DCF custody is in the youth's best interest and, if so, whether there is an appropriate permanency plan (i. e. , a plan stating what permanent outcome DCF feels is in the child's best interest and the facts on which the decision is based). The court may hold a hearing on the motion.

Permanency Plans

The law gives the commissioner nine months from the time a child or youth under age 18 is placed in DCF custody to file a motion for the court to review the permanency plan. Once the court approves the plan (there is no deadline), the law requires the commissioner to file another motion to review the plan within nine months. A hearing must be held within 90 days after the filing. After the initial hearing, subsequent hearings must be held at least once every 12 months. The act applies this review process to permanency plans for youths age 18 through 20 in voluntary DCF custody.

EFFECTIVE DATE: October 1, 2013


The act provides that residential care homes (RCH) scheduled to receive a lower rate (i. e. , State Supplement payment from DSS) in FYs 14 or 15 due to having an interim rate or other agreement with DSS must receive the lower rate. The act prohibits DSS in FYs 14 and 15 from considering if a facility has had its rates rebased when determining rates. (PA 13-247, 89, eliminates the prohibition. )

The act also provides that for the next two fiscal years, DSS may increase an RCH rate (1) within available appropriations, (2) up to a limit that the DSS commissioner determines, and (3) only if the RCH has a calculated rate greater than the rate in effect on June 30, 2013. The act prohibits DSS from issuing a lower rate to an RCH than the rate in effect on June 30, 2013, which is contrary to the rate reduction required above (PA 13-247, 89, removes DSS' authority to issue a lower rate than what is in effect on June 30, 2013. )


For FY 14, the act requires DSS to determine nursing home rates based on 2011 cost reports, except:

1. it must apply a 90% minimum occupancy standard (the law generally requires a minimum 95% occupancy unless the home is new);

2. no facility can receive a rate higher than the rate in effect on June 30, 2013;

3. no facility can receive a rate that is 4% less than the rate in effect on June 30, 2013; and

4. any facility that would have been issued a lower rate effective July 1, 2013 due to interim rate status or some other agreement with DSS must be issued a lower rate for the 2013-14 rate year. (PA 13-247, 90, provides that DSS may reduce a home's rate by up to 4%. )

For FY 15, rates in effect on June 30, 2014 remain the same for the year except that facilities that would have been issued lower rates due to an interim rate status or other agreement with DSS must receive the lower rate.

For FYs 14 and 15, the act permits the commissioner, within available appropriations, to provide pro rata fair rent increases, including for moveable equipment, for facilities that have undergone a material change in circumstances related to fair rent additions or moveable equipment placed in service in the 2012 and 2013 cost report years and not otherwise included in their issued rates.

The act specifies that DSS may decrease, as well as increase, nursing home rates regardless of any contrary provision in the nursing home rate setting law, depending on available appropriations.


The act limits to FY 13 levels the rates DSS pays ICF-IDs (group homes) in FYs 14 and 15. But it allows for higher rates if (1) a capital improvement is made to the home during either year for the residents' health or safety and the Department of Developmental Services (DDS) approved it, in consultation with DSS, and (2) funding is available. Homes that would have received lower rates in FYs 14 and 15 due to their interim rate status or some other agreement with DSS must receive a lower rate. (PA 13-139 changes the phrase “mentally retarded” to “intellectual disability” throughout the statutes, including changing the designation of these homes from “intermediate care facilities for people with mental retardation (ICF-MR)” to ICF-IDs).

The act also extends DSS' authority (1) indefinitely, to pay a reduced rate to an ICF-ID that has a significant decrease in land and building costs and (2) for the next two years, to pay a fair rent increase to an ICF-ID that has (a) undergone a material change in circumstances related to fair rent and (b) an approved certificate of need for the change.

Under prior law, the DSS commissioner could increase a facility's rate if there were available appropriations, regardless of the circumstances. Under the act, the commissioner may also decrease rates, but the act limits his ability to raise or lower the rate to reflect a reduction in appropriations.

Finally, the act prohibits the commissioner, in FYs 14 and 15, from considering if an ICF-ID rebased costs when determining its rate.


Inpatient Rates – Diagnostic Related Groups

The act requires DSS, beginning July 1, 2013, to reimburse acute care and children's hospitals for serving Medicaid recipients based on diagnostic-related groups (DRGs) that the DSS commissioner establishes and periodically rebases. DSS must annually determine the inpatient rates by multiplying DRG relative weights by a base rate. The federal Medicare program uses a DRG-type system when setting the rates it reimburses hospitals for serving Medicare patients. Such a system permits payment based on the severity of each patient's illness.

The act permits the DSS commissioner, within available appropriations, to make additional payments to hospitals based on criteria he establishes.

The act's provisions replace prior law, under which hospitals (including chronic disease hospitals) (1) were reimbursed based on the lower of (a) their reasonable costs or (b) the charge to the general public for ward services or the lowest charge for semiprivate rooms if the hospital had no wards and (2) received a higher amount for serving a disproportionate share of indigent patients. In practice, the hospitals receive a flat daily rate per Medicaid patient, along with a separate payment for serving a disproportionate share of indigent patients (see 116).

The act eliminates a provision requiring DSS to pay hospitals a lower acute care inpatient rate for patients who no longer need an acute level of care. It also eliminates obsolete provisions and makes technical changes.

By law, the reimbursement rates may not exceed those that the hospital charges to the general public.

The act does not address rates paid to chronic disease hospitals. (PA 13-247, 91, requires DSS to continue to establish rates for these hospitals. )

Medicare Ambulatory Payment Classification - Outpatient and Emergency Room Rates

The act requires DSS, beginning July 1, 2013, to pay hospitals for outpatient and emergency room “episodes of” care based on prospective rates that the DSS commissioner establishes in accordance with the Medicare Ambulatory Payment Classification (MAPC) system, in conjunction with a state conversion factor. The MAPC system must be modified to provide payment for services that Medicare does not normally cover, including pediatric, obstetric, neonatal, and perinatal services. By law and unchanged by the act, these rates may not exceed those that the hospital charges to the general public.

The act requires DSS to pay hospitals that do not have an MAPC code either on a cost-to-charges ratio or a fixed fee in effect as of January 1, 2013. The act retains the requirement that DSS establish a fee schedule.

Fiscal Impact Report

The act (1) requires the commissioner to determine the fiscal impact of the new DRG and MAPC systems on each hospital and (2) report his results to the Appropriations and Human Services committees no later than six months after implementing the new rate systems.

Cost Sharing for Nonemergency Use of Emergency Room

The act requires the DSS commissioner, to the extent permitted by federal law, to impose cost sharing requirements on Medicaid recipients who use the emergency room for nonemergency care. The federal Affordable Care Act permits states to impose cost sharing for nonemergency use of emergency rooms.

Utilization and Cost Neutrality

By law, DSS can modify the outpatient fee schedule and establish a “blended” inpatient rate if it (1) is needed to ensure that its conversion from a managed care to an administrative services organization (ASO) service delivery model is cost neutral to hospitals in the aggregate and (2) ensures patient access. The act makes permanent a provision that allows service utilization to be a factor in determining cost neutrality. Under prior law, this provision would have expired on June 30, 2013.

DSS Authorization to Implement Before Regulations Finalized

The act permits the DSS commissioner to implement policies and procedures necessary to carry out the above hospital-related provisions while in the process of adopting them in regulation, provided he publishes notice of intent to adopt regulations in the Connecticut Law Journal no more than 20 days after implementation.


The act requires DSS to establish, within available appropriations, a supplemental inpatient pool for low-cost hospitals.


The law authorizes the DSS commissioner to annually modify fee schedules for home health care services the department provides under Medicaid if doing so (1) is required to ensure that any contract with an ASO is cost neutral to home health care agencies and homemaker-home health aide agencies in the aggregate and (2) ensures patient access (see BACKGROUND). The act makes permanent a provision, which would have expired on June 30, 2013 under prior law, that allows the commissioner to take utilization into account when determining cost neutrality.


The law authorizes the DSS commissioner to establish payment rates for medical service providers if establishing the rates (1) is required to ensure that any contract it maintains with an ASO is cost neutral to providers in the aggregate and (2) ensures patient access. The act makes permanent a provision, which would have expired on June 30, 2013 under prior law, that permits the commissioner to take utilization into account when determining cost neutrality.


PA 12-1, December Special Session, imposed a 5% reduction on Medicaid reimbursement rates (from 100% to 95% of the facility's per diem rate) for long-term care facility residents receiving only hospice care from January 1, 2013 through June 30, 2013. The act makes this reimbursement rate reduction permanent.

Some long-term care facility and hospice agency services provided to residents who have chosen hospice care overlap. In this situation, federal Medicaid law allows state programs to set a facility's per diem rates at 95% of what it would otherwise have been.


Chiropractic Services

PA 12-1, December Special Session, required the DSS commissioner to amend the Medicaid state plan to limit chiropractic coverage to what is required by federal law. The act eliminates this requirement.

Federal law designates chiropractic coverage as an optional service for adult Medicaid recipients and the state does not currently cover this for adults if the service is provided by an independent chiropractor.

Federal law generally requires that children under age 21 be entitled to receive chiropractic coverage under Medicaid's Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) provisions if ordered by a medical professional to treat a condition that a screening reveals. The state reimburses independent chiropractors treating Medicaid-eligible children and provides some limited chiropractic services beyond those required by EPSDT. The act enables DSS to continue to provide those services.

Interpreter Services

Federal Medicaid law requires states to provide foreign language interpreter services to individuals with limited English proficiency (LEP). It allows states to receive federal matching funds for LEP interpreters, either by designating them as a covered state plan service or an administrative cost.

The act eliminates the requirements that DSS, by July 1, 2013, (1) amend the Medicaid state plan to include foreign language interpreter services as a covered service to any LEPs, (2) establish billing codes for interpreter services provided under the Medicaid program, and (3) report semi-annually to the Council on Medical Assistance Program Oversight on the foreign language interpreter services provided under this program.

The Medicaid ASO, Community Health Network of Connecticut, Inc. , currently provides foreign language interpreter services for Medicaid recipients over the phone and in person upon request.


The act eliminates the requirement for DSS, contingent upon federal approval, to reimburse independent pharmacies at a higher rate than chain pharmacies. DSS never implemented this provision.


The act changes the way DSS determines a person's eligibility for MSP, which provides Medicaid-funded assistance with Medicare Part A and Part B cost-sharing. It requires DSS to disregard the amount of income for each MSP subgroup so that a person with an income that is (1) less than 211% of the federal poverty level (FPL) will qualify for the Qualified Medicare Beneficiary Program; (2) from 211% of the FPL up to 230% of the FPL will qualify for the Specified Low-Income Medicare Beneficiary program; and (3) from 231% of the FPL up to 245% of the FPL will qualify for the Qualified Individuals program.

Prior law required DSS to disregard the amount of income that equalized the program's income limits with ConnPACE income limits. (The act eliminates the ConnPACE program, see below. ) (See BACKGROUND. )

EFFECTIVE DATE: January 1, 2014

82-84, 88-90, 94-101, & 156 — ELIMINATION OF CONNPACE PROGRAM

The act eliminates the ConnPACE program and removes statutory references to it. This program provides pharmacy assistance to the elderly and individuals with disabilities who do not qualify for Medicare.

EFFECTIVE DATE: January 1, 2014


Previously, to qualify for CONNMAP, a resident had to be enrolled in Medicare Part B with an annual income of up to 165% of the ConnPACE qualifying income level ($43,560 in 2013) or, if married, a combined income of up to 165% of the ConnPACE qualifying income level ($58,740 in 2013). The act eliminates the income eligibility formula and sets the income limits at the 2013 levels. The act requires the DSS commissioner, starting on January 1, 2014, to annually increase the income limits to the nearest hundred dollars to reflect the annual inflation adjustment in Social Security income. (ConnPACE, which the act eliminates, currently uses the same mechanism to calculate income limit increases. )

EFFECTIVE DATE: January 1, 2014


The law provides that customized wheelchairs must be covered under Medicaid only when a standard wheelchair will not meet an individual's needs, as DSS determines. DSS regulations permit vendors or nursing homes to perform assessments to determine this need. The act removes a requirement that any assessments performed be done only when DSS requests them. The act permits DSS to designate categories of durable medical equipment in addition to customized wheelchairs for which reused equipment, parts, and components are used whenever practicable.

EFFECTIVE DATE: Upon passage

86, 87, 90–93, 118, 119, & 156 — CHARTER OAK HEALTH PLAN (COHP) ELIMINATED

The act eliminates COHP, effective January 1, 2014. COHP provides health insurance coverage to residents who have been uninsured for at least six months, including those with pre-existing medical conditions. Some individuals currently insured through COHP will be able to enroll in health insurance plans through the Connecticut Health Insurance Exchange, starting in October 2013. Others will qualify for Medicaid under the new federal income eligibility limits, effective January 1, 2014.

EFFECTIVE DATE: January 1, 2014


Regardless of a provision in law that requires greater oversight (see BACKGROUND), the act requires the DSS commissioner to submit an eligibility and service plan for the Medicaid Coverage for the Lowest Income Populations program, established under the federal Affordable Care Act's expansion of the Medicaid program to cover childless adults with income up to 133% of the FPL and PA 13-184 (the budget act). He must submit the plan to the Human Services and Appropriations committees before submitting it for federal approval.

The act gives the committees 15 days after receiving the plan to hold a public hearing or notify the commissioner if they are not planning to hold one. The committees must advise the commissioner of their approval or denial of the plan within the same time frame. The plan is deemed approved if the committees (1) fail to take any action within the time frame or (2) disagree.


The state's Medicaid for Low-Income Adults (LIA) program (HUSKY D) provides Medicaid coverage to childless adults between ages 19 and 64 with income up to about 60% of the FPL, or $512. 05 per month; there is no asset limit. This program is authorized under the federal Affordable Care Act, which also requires states to expand their Medicaid programs for this population with income under 133% of the FPL beginning January 1, 2014. The act repeals the LIA program's enabling statutes. (PA 13-184 also eliminates the LIA program and establishes the new coverage group described above in 102. )

EFFECTIVE DATE: January 1, 2014


ASO Service Authorization

Previously, the ASO had to authorize services based solely on the BHP clinical management committee's guidelines. It could make exceptions when a member or the member's legal guardian or service provider requested one and the ASO determined the exception was in the member's best interest. The act instead (1) requires the ASO to authorize services based solely on “medical necessity,” as defined by statute (see BACKGROUND) and (2) allows it to use the clinical management committee's guidelines to inform and guide its authorization decision.

Program Expansion

The BHP is an integrated behavioral health system currently operated by DCF, DMHAS, and DSS. BHP's goal is to provide access to complete, coordinated, and effective community-based behavioral health services and supports. The partnership maintains a contract with an ASO, Value Options.

The law requires the DCF, DMHAS, and DSS commissioners to implement the BHP for HUSKY Plan A (Medicaid) and B (S-CHIP) members and children enrolled in DCF voluntary services. The act requires, instead of permits, the commissioners to implement the BHP for all Medicaid recipients, not just those in HUSKY Plan A. In practice, the BHP already provides assistance to all Medicaid recipients. The act also eliminates BHP eligibility for COHP members on January 1, 2014 to conform to the provisions eliminating COHP (see above).

EFFECTIVE DATE: July 1, 2013 for the provision requiring the commissioner to implement the BHP for all Medicaid recipients and January 1, 2014 for the provision eliminating BHP assistance for COHP members.


The act extends indefinitely the requirement that DSS pay licensed private residential facilities and similar facilities operated by regional educational service centers that provide vocational or functional services for severely handicapped individuals (non-ICF-ID boarding homes) a reduced rate when it has a significant decrease in land and building costs. Under prior law, this requirement was imposed for FY 13 only.

The act allows these facilities to receive higher payments in FYs 14 and 15 if (1) they make a capital improvement in those years for resident health and safety; (2) Department of Developmental Services approves it, in consultation with DSS; and (3) appropriations are available.


The act requires the state ombudsman, beginning July 1, 2014, to personally, or through representatives of her office, implement and administer a pilot program serving home- and community-based care recipients in Hartford County.


PA 11-44 created a new Bureau of Rehabilitative Services (renamed DORS in 2012) to provide services to individuals who are blind and visually impaired and deaf and hearing impaired. DORS assumed all of DSS' Bureau of Rehabilitation Services (BRS) functions.

Assistive Technology Revolving Fund

The act conforms law to practice by authorizing the DORS, rather than the DSS, commissioner to (1) establish and administer the Assistive Technology Revolving Fund and (2) make loans to people with disabilities for certain equipment and services. The act:

1. expands loan eligibility to include senior citizens and the family members of either group;

2. allows the loans to be used for assistive technology and adaptive equipment and services instead of just assistive equipment;

3. extends, from five to 10 years, the maximum loan term and caps the interest at a fixed rate of up to 6%; and

4. removes obsolete language allowing the State Bond Commission to set the interest rate. (In practice, DORS sets the interest rate; the Bond Commission has not done so for years. )

The act also requires the DORS commissioner to adopt regulations to implement these changes.

Connecticut Tech Act Project

DORS administers the Connecticut Tech Act Project, which helps clients get the assistive technology they need for greater independence at work, school, or in the community. The act allows the project to provide available assistive technology evaluation and training services upon request. It allows the project to recoup direct and indirect costs by charging a reasonable fee that the DORS commissioner establishes.


The act requires the DCF commissioner, by October 1, 2013, to (1) publish on its website an independent cost analysis of full implementation of the 2008 federal Fostering Connections to Success and Increasing Adoption Act and (2) report the analysis results to the Children's and Human Services committees. The commissioner must analyze costs, federal reimbursements, and off-setting savings for DCF to provide post-majority foster care services to all youths:

1. ages 18 to 21;

2. who were in foster care when they turned age 18 or exited foster care after turning age 18 but wish to reenter; and

3. (a) completing secondary education or a program leading to an equivalent credential, (b) enrolled in a post secondary or vocational education institution, (c) participating in a program or activity designed to promote employment or remove employment barriers, (d) employed for at least 80 hours per month, or (e) incapable of participating in any of these activities due to a medical condition.

The analysis must consider all available reimbursements as well as current costs to other state agencies for serving those foster or former foster youths through age 21.

EFFECTIVE DATE: Upon passage


The act requires the DSS commissioner to begin a pilot drug therapy management program in coordination with the Connecticut Pharmacists Association and a community health center in the greater New Haven area. The program must be (1) administered by the health center and (2) operated in cooperation with the medication therapy management activities of “the administrative services organization” (ASO) (presumably Community Health Network, Inc. , the ASO with which DSS contracts to help administer the HUSKY program).

The act replaces prior law's requirement that the DSS commissioner contract with a patient-centered medical home; health home; or pharmacy organization, which could include a school of pharmacy, to provide Medicaid therapy management services.

The law, unchanged by the act, requires the program to include reviewing patients' prescription histories and developing medication action plans to reduce adverse medication interactions and related health problems.


The act eliminates provisions in PA 12-1, December Special Session, which allowed Medicaid recipients requiring medically necessary, nonemergency transportation to be transported in a stretcher van if they had to be transported in a prone position but did not require medical services during the transport and made related changes.


The law prohibits nursing facilities from admitting anyone, regardless of payment source, who has not undergone a preadmission screening process by which the Department of Mental Health and Addiction Services (DMHAS) determines whether the person is mentally ill and, if so, whether he or she requires nursing facility services. The act allows the DSS commissioner to require a nursing facility to notify DSS within one business day after admitting a person who is mentally ill and meets the admission requirements.

EFFECTIVE DATE: Upon passage


By law, the DSS commissioner may implement policies and procedures necessary to pursue optional initiatives authorized by the federal ACA, as amended, while in the process of adopting them in regulation form. The act permits him to also pursue policies, and expands the scope of these initiatives and policies to include, among other things, (1) implementing the modified adjusted gross income eligibility (MAGI) rules and (2) coordinating an integrated eligibility system with the Connecticut Health Insurance Exchange.

Under the ACA, states must expand their Medicaid programs to childless adults under age 65 with income under 133% of the federal poverty level (FPL). The ACA also requires states to disregard an additional 5% of income, bringing the MAGI level to 138% of the FPL.


The act allows the Department of Correction (DOC) to initiate, by October 1, 2013, with support from DMHAS and the Department of Public Health (DPH), a pilot treatment program for methadone maintenance and other drug therapies at facilities including the New Haven Community Correctional Center. The program must be for 18 months and serve 60 to 80 inmates per month. The act allows DPH to waive public health code regulations that are not applicable to the pilot program's service model.

It requires DOC to report the program results, by October 1, 2014 and April 1, 2015, to the Appropriations, Human Services, and Judiciary committees.


The act requires OPM, subject to federal approval, to determine the amount of revenue diverted for purposes of maximizing supplemental payments in FYs 14 and 15 for inpatient hospital services that the state's acute care hospitals provide to Medicaid patients.

EFFECTIVE DATE: January 1, 2014


Under federal and state law, Medicaid provides additional reimbursement to short-term hospitals that serve a disproportionate share (DSH) of low-income patients. (By state law, the Connecticut Children's Medical Center and UConn Health Center are not eligible for such payments. ) By law, DSS, within available appropriations, can make interim DSH payments in order to maximize federal Medicaid matching funds. In practice, DSS makes these payments on a quarterly basis. Prior law required monthly payments. The act conforms law to practice.


The act eliminates a requirement for the DSS commissioner to consult with the OPM secretary before providing advance payments to nursing facilities that provide services eligible for payment under Medicaid.

EFFECTIVE DATE: Upon passage


PA 13-178 establishes a Children's Mental Health Task Force. This act requires the House majority leader, instead of the Children's Committee House chairperson, to appoint to the task force a complementary and alternative medicine or integrative therapy expert specializing in the treatment of physical, mental, emotional, and behavioral health issues in children.


By law, DSS must develop a plan to establish and administer a program similar to the MFP demonstration program for individuals who are not institutionalized but at risk of such. The act authorizes the commissioner to implement policies and procedures to implement the program while in the process of adopting regulations, provided he publishes notice of intent to adopt regulations in the Connecticut Law Journal no more than 20 days after implementation.


The act codifies the Healthy Start program, which (1) is a line item in DSS' budget, (2) is administered by the Children's Trust Fund, (3) serves pregnant women with incomes up to 250% of the FPL, and (4) promotes and supports positive maternal and neonatal health outcomes. It requires the program to be located within DSS' Medical Care Administration Division.

The act requires the DSS commissioner, in consultation with the DPH commissioner, to (1) develop a plan to maximize federal Medicaid reimbursement for the program to the extent permitted under federal law and (2) expand services within available state appropriations. The plan must include (1) a venue-based (e. g. , health departments, hospital clinics, or federally qualified health centers) payment and billing system under which the program services provided by “nonlicensed” staff working with a licensed Medicaid provider can receive Medicaid reimbursement and (2) a funding allocation formula that ensures that all eligible women have access to the program's core services. The program already receives federal grant funds through DPH. (PA 13-247, 92, eliminates the specifics of the plan. )

The core services include (1) a comprehensive medical and psycho-social risk assessment; (2) development of a care plan; and (3) delivery of care coordination, such as health education and care management services.

By October 1, 2013 and October 1, 2014, the commissioners, within available funds, must review the effectiveness of the state-funded Healthy Start program to determine if the program should (1) continue to be administered by DSS and (2) be expanded and how.

The commissioners must report their study results to the Human Services, Public Health, and Appropriations committees.


The act requires DCF, in consultation with the State Department of Education (SDE), to establish a two-year, “Raise the Grade” pilot program in Bridgeport, Hartford, and New Haven to increase the academic achievement of children and youth in DCF custody or being served by the Court Support Services Division (CSSD) of the Judicial Department in these cities.

The program must use full-time coordinators to (1) help identify children or youth performing below grade level and in state custody or under juvenile justice supervision and (2) develop plans, in collaboration with the child's or youth's legal guardian, education surrogate, or advocate to improve the child's academic performance. The coordinators must help facilitate the prompt transfer and review of educational records and report to DCF and the educational surrogate critical educational information, including (1) progress monitoring, (2) absenteeism, and (3) discipline. The coordinators must also help support educational stability for children DCF placed in out-of-home care under emergency temporary custody or commitment orders.

At the end of the pilot, DCF, in coordination with CSSD and SDE, must report to the Achievement Gap Task Force on the number and educational profile of children the program serves and its impact on their educational performance, including achievement, absenteeism, and adverse disciplinary measures.


The act requires SDE and DCF to (1) annually track the academic progress of children and youth in state custody from prekindergarten through grade 12 and (2) submit a progress report to the Achievement Gap Task Force. CSSD, in collaboration with SDE, must create an annual aggregate report on the progress of youth in its custody.

For each child or youth in state custody for child protection purposes, DCF must include a description of the child's educational status and academic progress in his or her treatment plan. The description must include information on the child's current educational performance level, including absenteeism and grade level performance, and the support or services that will be, or are being, provided to improve his or her academic performance.

For children committed to DCF, the educational status information must be included in reports to the Juvenile Court. The court must review the report when making decisions about the child's well-being in care.

Youths who are in a secure facility run or contracted for by CSSD must have a case plan describing the youths' educational needs and grade-level performance and identifying support and services that are, or will be, provided to support academic performance.

DCF and CSSD must develop a plan to ensure that all facilities and school programs they run or they contract for can meet the academic and related service needs of enrolled children and youth. The plan must ensure the ability to provide:

1. the development of effective practices for acquiring and reviewing a student's educational records, including assessment of his or her present level of academic performance;

2. the youth's identified educational and related service needs;

3. appropriate and ongoing professional development on providing educational and related services to abused, neglected, and juvenile justice involved youth;

4. research-based instruction and standards-based core curriculum for all enrolled youth; and

5. administrative review of all programs that DCF and CSSD run, including those under contract with the agencies.

The plan must be finalized by July 1, 2014 and submitted to the Achievement Gap Task Force.


The act requires DSS to distribute funding, within available appropriations, to federally qualified health centers based on cost reports they submit to the DSS commissioner until the Human Services and Appropriations committees approve an alternative payment methodology.


The act authorizes the DSS commissioner to establish a “step therapy” program for prescription drugs dispensed to Medicaid recipients. (The act does not define step therapy. ) Under the program, DSS may condition Medicaid payments to pharmacies on a patient first trying a drug (for 30 days) that is on DSS' preferred drug list (PDL). Under the act, the step therapy program must:

1. require that the patient try and fail on only one drug on the PDL before another one can be prescribed and be eligible for DSS payment,

2. not apply to any mental health-related drugs, and

3. give the prescriber access to a clear and convenient process to expeditiously request DSS to override the step therapy drug under certain circumstances.

The act requires DSS to expeditiously grant an override of the step therapy restriction if the prescriber demonstrates that the step therapy drug:

1. has been ineffective in treating the patient's medical condition in the past (presumably the same medical condition) or is expected to be ineffective based on the (a) patient's known relevant physical or mental characteristics and (b) drug regimen's known characteristics,

2. will cause or will likely cause an adverse reaction or other physical harm to the patient, or

3. is not in the patient's best interest to provide the recommended drug regimen based on medical necessity.

It (1) permits the prescriber to deem the treatment clinically ineffective after the 30 days and (2) requires Medicaid to pay for the drug the prescriber prescribes and recommends instead when this occurs.

It appears that the state's prior authorization law would require a pharmacist to dispense, and DSS to reimburse, a 14-day supply of a non-preferred drug when a prescriber has requested an override of the step therapy drug but a decision to grant has not been made by the time the patient is ready to leave the pharmacy (see BACKGROUND).


The act changes how the law treats the (1) assets of Medicaid long-term care applicants and beneficiaries and (2) amount of income Medicaid nursing home residents must apply to their care costs (applied income).

By law, Medicaid long-term care applicants who transfer assets for less than fair market value within five years of applying for coverage are presumed to have done so solely to qualify for Medicaid. People who cannot successfully rebut this presumption face a “penalty period” (period of Medicaid ineligibility).

Medicaid Long-Term Care Asset Transfers

Transfers that Create a Debt. By law, when an asset transfer results in a penalty period, such transfer creates a debt owed to DSS by the person transferring the asset or the transferee. The amount of the debt equals the amount of Medicaid services provided to the transferor beginning on the date the assets are transferred (CGS 17b-261a).

During a penalty period, DSS does not make Medicaid payments to the nursing home for the transferor's care. The act creates a statutory debt, due the nursing home, in an amount equaling the unpaid cost of care the facility provides during the penalty period. The debt amount may not exceed the fair market value of the transferred assets subject to the penalty period at the time they are transferred.

Lawsuits. The act provides that its provisions do not affect any other rights or remedies the parties may have. It permits a nursing home to sue either the asset's transferor or transferee to collect a debt for the unpaid care if the (1) debt recovery is no more than the transferred asset's fair market value at the time of transfer and (2) transfer that triggered the penalty period occurred no more than two years before the nursing home resident applied for Medicaid.

The act allows a court to award actual damages, court costs, and reasonable attorneys' fees to a plaintiff nursing home if it determines, based on clear and convincing evidence, that the defendant caused the debt to the home by (1) willfully transferring assets that are the subject of the penalty period, (2) receiving the assets knowing their purpose, and (3) materially misrepresenting or omitting the assets.

The court costs and attorneys' fee must be awarded as a matter of law to a defendant who successfully defends an action or a counterclaim that is brought.

By law, the DSS and administrative services commissioners and the attorney general may seek administrative, legal, or equitable relief.

The act further allows the court, including a probate court, to also order the assets or proceeds from the transfer to be held in constructive trust to satisfy the debt.

Under the act, these provisions do not apply to a conservator who transfers income or principal with the probate court's approval (see BACKGROUND).

Applied Income

Definition. In general, nursing home residents determined Medicaid-eligible must spend any income they have, except for a monthly needs allowance, on their nursing home care (i. e. , the applied income). If the resident's spouse is living elsewhere, some of the resident's monthly income may go to support that spouse (see below). Under the act, applied income is the amount required to be paid to the home for the cost of care and services after the exhaustion of all appeals and in accordance with federal and state law.

Considering Community Spouse's Needs and Notice. The act requires DSS, when determining the amount of applied income, to take into consideration any modification to the applied income due to (1) revisions in the community spouse's minimum monthly needs allowance (MMNA, see BACKGROUND) and (2) other modifications allowed by state or federal law.

Under the act, nursing homes must provide written notice to Medicaid recipients and anyone the law authorizes to control the recipient's applied income. The notice must indicate (1) the amount of applied income due the home and the recipient's legal obligation to pay it and (2) that the recipient's failure to pay it within 90 days of receiving the notice may result in a lawsuit.

Lawsuits. The act authorizes a nursing home to sue to recover any applied income amount it is owed. But a home may not initiate a suit when a Medicaid recipient has asserted that his or her applied income is needed to increase the recipient's community spouse's MMNA. In this instance, the home must wait until the Medicaid recipient, the community spouse, or their legal representative, exhausts their appeal right before DSS and in court.

The act allows the home to sue either (1) the Medicaid recipient who owes the money or (2) someone with legal access to the applied income who acted with the intent to deprive the recipient of the income or appropriate it for himself, herself, or a third person.

If, based on clear and convincing evidence, a court finds that a defendant willfully failed to pay or withheld applied income due and owing to a home for more than 90 days after receiving the notice, it may award the home the amount of debt owed, court costs, and attorneys' fees. The court costs must be awarded as a matter of law to a defendant who successfully defends an action or a counterclaim brought under the act's provisions. These provisions do not apply to a conservator who transfers income or principal with the probate court's approval (see BACKGROUND).

A nursing home may not sue to recover applied income until (1) 30 days after providing the applied income notice or, (2) if the resident did not receive the notice, 91 days after providing the resident notice of the suit along with the information in the applied income notice.

Copies of Complaints and Court Document

The act requires nursing homes, when filing an applied income or improper asset transfer suit, and after a court issues a related judgment or decree, to mail copies of the complaint and court documents to the attorney general and DSS commissioner.

Life Insurance Policies

The act provides that, to the extent permitted under federal law, institutionalized individuals cannot be determined ineligible for Medicaid solely based on having a life insurance policy with a cash surrender value of less than $10,000, provided (1) the individual is pursuing the policy's surrender and (2) once it is surrendered, the proceeds are used to pay for the individual's long-term care.

Currently, a Medicaid applicant may not have more than $1,600 in liquid assets to qualify for long-term care assistance. (If the applicant is married, this is after the state performs a spousal assessment and gives the community spouse a share of the combined assets. ) DSS previously counted the cash surrender value of any life insurance policy with a face value of more than $1,500 towards the asset limit.

DSS also excludes certain transfers of such policies to cover funerals. DSS will not grant eligibility until the policy is surrendered and the money is “spent down” to the asset limit on the individual's care.

EFFECTIVE DATE: October 1, 2013


The act creates a new license category for tattoo artists (called “tattoo technician”) administered by DPH. DPH must enforce the licensure program within available appropriations and is authorized to adopt implementing regulations.

Starting July 1, 2014, the act prohibits anyone from engaging in the practice of tattooing unless he or she is age 18 or older and obtains a Connecticut tattoo technician license or temporary permit. A person engages in tattooing if he or she marks or colors anyone's skin by pricking in coloring matter or by producing scars.

EFFECTIVE DATE: October 1, 2013, except that the (1) conforming change regarding biennial re-licensure takes effect upon passage and applies to registration periods on and after October 1, 2013 and (2) repealer provision takes effect July 1, 2014.

132 & 139 — Licensure Requirements

The act's licensure requirements vary depending on when a person applies for a license. It requires a person who applies for a tattoo technician license on or before July 1, 2014 to provide DPH with satisfactory evidence that he or she:

1. is age 18 or older;

2. successfully completed, within three years preceding the application date, a course on preventing disease transmission and blood-borne pathogens that (a) complies with federal Occupational Safety and Health Administration (OSHA) standards and (b) requires successful completion of a proficiency examination; and

3. is currently certified in basic first aid training by the American Red Cross or the American Heart Association.

In addition to meeting these requirements, an applicant seeking licensure after July 1, 2014 must provide DPH, in a form and manner the commissioner prescribes, documentation that he or she (1) completed at least 2,000 hours of practical training and experience under the personal supervision and instruction of a tattoo technician or (2) practiced tattooing continuously in Connecticut for at least five years prior to July 1, 2014.

The license application fee is $250. Licenses must be renewed biennially for a fee of $200. No license or temporary permit (see below) can be issued if the applicant is facing pending disciplinary action or is the subject of an unresolved complaint in Connecticut or another state or jurisdiction. A person is prohibited from using the title “tattoo technician,” “tattoo artist,” “tattooist,” or similar title unless he or she has a Connecticut-issued tattoo technician license.

The act's licensing requirement does not apply to (1) physicians; (2) advanced practice registered nurses (APRNs) working in collaboration with a physician; (3) registered nurses working under the direction of a licensed physician, dentist, or APRN; or (4) physicians assistants working under a physician's supervision, control, or responsibility.

132 — Licensure Requirements for Out-of-State Licensees

Notwithstanding the above licensure requirements, the act allows DPH to issue a license to an applicant licensed as a tattoo technician or to perform similar services in another state or jurisdiction who submits to DPH satisfactory evidence that he or she:

1. is currently licensed in good standing to practice tattooing in another state or jurisdiction,

2. has documentation of licensed practice in another state or jurisdiction for at least two years immediately preceding the application date,

3. successfully completed a course on preventing disease transmission and blood-borne pathogens that complies with OSHA standards, and

4. is currently certified in basic first-aid training by the American Red Cross or the American Heart Association.

132 — Continuing Education

The act requires tattoo technicians to meet a continuing education requirement to have their licenses renewed. Specifically, it requires licensees to successfully complete a course on preventing disease transmission and blood-borne pathogens that (1) complies with OSHA standards and (2) requires successful completion of a proficiency examination.

Each licensee must sign a statement attesting that he or she successfully completed the course within six months before the license expires. He or she must obtain a certificate of completion from the continuing education provider and retain it for at least four years after the year of completing the course. The licensee must submit the certificate to DPH within 45 days after the department requests it.

132 — Temporary Permits

The act allows the DPH commissioner to issue a temporary permit to:

1. an applicant licensed to practice tattooing in another state and awaiting DPH approval for his or her license application,

2. an applicant previously licensed in Connecticut whose license is void, or

3. a person licensed or certified to practice tattooing in another state who is in Connecticut to attend an educational event or trade show or to participate in a product demonstration.

Applicants for a temporary permit must submit to DPH a:

1. completed application form;

2. copy of a current license or certification to practice tattooing from another state or jurisdiction;

3. notarized affidavit attesting that the license or certification is valid and belongs to the applicant; and

4. $100 fee, except for out-of-state licensees awaiting Connecticut licensure approval, who must submit a $250 fee.

Applicants in Connecticut for the educational and professional purposes specified above must submit the documentation and fee at least 45 business days before the event occurs.

The temporary permit, which is not renewable, authorizes the holder to work as a tattoo technician for up to 120 calendar days except that such permits issued to people licensed in another state who are in Connecticut for educational and professional purposes are valid for up to 14 consecutive calendar days and can be issued once each year.

132 — Student Tattoo Technicians

The act allows a student tattoo technician to practice tattooing under the personal supervision of a licensed tattoo technician for up to two years. The student must register with DPH for purposes of completing the practical training and experience required to obtain a tattoo technician license. The student must submit a registration application to DPH on a form the commissioner prescribes that includes:

1. documentation of the student's successful completion of a course on preventing disease transmission and blood-borne pathogens that (a) complies with OSHA standards and (b) requires successful completion of a proficiency examination,

2. documentation that the student is currently certified in basic first aid training by the American Red Cross or the American Heart Association, and

3. a notarized statement signed by a licensed tattoo technician acknowledging that he or she is personally responsible for supervising the student's practical training and experience.

133 — Title Protection

Starting July 1, 2014, the act prohibits anyone from:

1. buying, selling, or fraudulently obtaining or furnishing any diploma, certificate, license, record, or registration showing that a person is qualified or authorized to practice tattooing or participating in such activity;

2. practicing or attempting or offering to practice tattooing under (a) the cover of any of the above documents or (b) a name other than his or her own;

3. aiding or abetting tattooing by a person not licensed in Connecticut or whose license is suspended or revoked;

4. advertising services under the description of tattooing or using the word “tattoo” or “tattooing” without a Connecticut tattoo technician license;

5. practicing tattooing on an unemancipated minor under age 18 without permission of the minor's parent or guardian; or

6. during a period of license suspension or revocation, (a) practicing or attempting, offering, or advertising to practice tattooing or (b) working for or assisting a licensed tattoo technician.

A person who violates any of these prohibitions is guilty of a class D misdemeanor (see Table on Penalties).

134 — Disciplinary Action

The act allows DPH to take disciplinary action against a licensed tattoo technician for:

1. failing to conform to accepted professional standards;

2. violating the act;

3. fraudulent or deceptive tattooing practices;

4. negligent, incompetent, or wrongful conduct in professional activities;

5. emotional disorders or mental illnesses;

6. physical illnesses or impairments;

7. abuse or excessive use of drugs and alcohol; or

8. willfully falsifying client records.

By law, disciplinary actions available to DPH include (1) revoking or suspending a license, (2) issuing a letter of reprimand, (3) placing the violator on probation, or (4) imposing a civil penalty (CGS 19a-17). Under the act, the department can also order a licensee to undergo a reasonable physical or mental examination if there is an investigation of his or her physical or mental capacity to practice safely.

The act allows the DPH commissioner to petition Hartford Superior Court to enforce any disciplinary action it takes. The department must notify the licensee of any contemplated disciplinary action and its cause, the hearing date on the action, and the opportunity for a hearing under the Uniform Administrative Procedure Act.

136 — Inspections of Tattoo Establishments

The act allows local or health district health directors, or their authorized representatives, to annually inspect the sanitary condition of tattoo establishments within their jurisdictions. It grants the director or authorized representative full power to enter and inspect a tattoo establishment during usual business hours.

It allows the health director to collect an inspection fee of up to $100 from the establishment's owner. If the establishment is found to be unsanitary, the health director must issue a written order that the establishment be placed in sanitary condition.

The act specifies, notwithstanding any municipal charter, home rule ordinance, or special act, that any inspection fee collected must be used by the local or district health department for conducting these inspections.

135 & 137 — Enforcement

The act specifies that (1) the DPH commissioner must enforce the act within available appropriations and (2) no new regulatory board is established for tattoo technicians.

138 & 157 — Repealer

The act repeals a statute regarding tattooing by specified medical professionals or people acting under a physician's supervision in accordance with DPH regulations and makes a related technical change.


Starting October 1, 2013, the act requires, rather than allows, physicians, surgeons, nurses, nurse-midwives, and dentists to renew their licenses using DPH's online license renewal system, except in extenuating circumstances, in which case the licensee can renew his or her license using a paper form and paying the professional service fees by check or money order. Such circumstances include not having access to a credit card, which the licensee must document by submitting a notarized affidavit to DPH to that effect.

The act increases the renewal fees for these professionals by $5 (presumably to cover the associated credit card transaction fees). It removes the provision in prior law allowing the department to charge a $5 service fee for online license renewals.

It also removes an obsolete DPH reporting requirement regarding the online license renewal system.

EFFECTIVE DATE: Upon passage and applicable to registration periods beginning on and after October 1, 2013.


The act establishes a licensing and inspection fee for home health care agencies of $300 per agency and $100 per satellite office. The fee must be paid biennially to DPH, except for Medicare- and Medicaid-certified agencies, which are licensed and inspected every three years.

The act also establishes a $500 biennial licensing and inspection fee for assisted living services agencies, except those participating in the state's congregate housing pilot program in Norwich.


By law, the DPH commissioner may charge a $565 fee for technical assistance the department provides for the design, review, and development of a health care facility's construction, sale, or ownership change. The act allows the commissioner to also charge this fee for technical assistance provided on a facility's renovation or building alteration.

The act limits the $565 fee to projects costing $1 million or less. For projects costing more than this amount, the act requires the commissioner to charge one-quarter of 1% of the total project cost.

The act specifies that the fee includes all DPH reviews and on-site inspections and does not apply to state-owned facilities.


The act requires the DPH commissioner, within available appropriations, to establish and administer a financial assistance program for community health centers.

The commissioner must develop a formula to disburse program funds to the centers, which must include the number of uninsured patients the center serves and types of services it provides.

The act requires the commissioner to report by October 1, 2013 to the Public Health and Appropriations committees on the disbursement formula. The committees must hold a public hearing on the report within 30 days after receiving it, and then advise the commissioner of their approval or denial of the proposed formula. If the committees fail to do this within 30 days, the formula is deemed approved. The commissioner cannot implement the formula without the committees' expressed or tacit approval.

The act allows the commissioner to establish program participation requirements, provided she gives reasonable notice of the requirements to all community health centers. The act limits participation to public or private nonprofit medical care facilities that (1) meet community health center statutory requirements and (2) are designated by the U. S. Department of Health and Human Services as a federally qualified health center (FQHC) or FQHC look-alike (i. e. , is eligible for but does not receive federal Public Health Service Act Section 330 grant funds). Centers may only use the funds for commissioner-approved purposes.


The act requires the OPM secretary, in consultation with the DPH commissioner, to determine annually by September 1 the amount of the General Fund appropriation to administer the CVP and inform the insurance commissioner of the amount. The law already requires the secretary to annually determine the appropriated amount to purchase, store, and distribute vaccines under the program and inform the insurance commissioner.

By October 1, 2013, the act requires DPH, in consultation with OPM, to develop and begin annually implementing a reconciliation and expenditure projection process for the state's childhood immunization budget account. This process must include (1) an accounting of the previous year's expenditures, (2) the process and factors to be used in determining each future year's assessment, and (3) the establishment of an appropriate notification process for the entities assessed under the account.

The CVP is a state- and federally-funded program that provides certain childhood vaccinations at no cost to health care providers. The state-funded component is funded by an assessment on certain health insurers and third-party administrators.


The act adds to those factors the Office of Health Care Access (OHCA) must consider when evaluating a CON application whether an applicant who failed to provide, or reduced access to, services by Medicaid recipients or indigent people demonstrated good cause for doing so. It specifies that good cause is not demonstrated solely based on differences in reimbursement rates between Medicaid and other health care payers.

By law, OHCA must consider several factors when evaluating a CON application, including the applicant's past and proposed provision of health care services to relevant patient populations and payer mix. The act specifies that this includes access to services by Medicaid recipients and indigent people.

The law requires OHCA to also consider, among other things, whether the applicant satisfactorily demonstrated how the proposal will improve the quality, accessibility, and cost effectiveness of health care delivery in the region. The act specifies that this includes the (1) provision of, or change in access to services for Medicaid recipients and indigent people and (2) impact on the cost effectiveness of providing access to Medicaid services.

EFFECTIVE DATE: October 1, 2013


The act allows the OPM secretary, at the Chief Medical Examiner's request, to waive the $150 cremation certificate fee required for the cremation of a body for which a death certificate has been issued.


The act expressly provides that the University of Connecticut Health Center or a constituent unit, including John Dempsey Hospital (JDH), can discontinue neonatal intensive care unit (NICU) transport services if these services are provided by a qualified transport service.

Existing law established provisions for transferring, from JDH to the Connecticut Children's Medical Center (CCMC), licensure and control of 40 NICU beds after receiving a CON from DPH's OHCA. This transfer took place in 2011, and JDH no longer operates a NICU unit. CCMC is scheduled to start NICU transport services in June 2013.

EFFECTIVE DATE: October 1, 2013


147 — IRS Form 990 and Community Health Needs Assessment Data

The act requires nonprofit hospitals to submit annually to OHCA (1) a complete copy of the hospital's most recent Internal Revenue Service (IRS) Form 990, including all parts and schedules and (2) data compiled to prepare the hospital's community health needs assessment (see BACKGROUND), in the form and manner OHCA prescribes. But they must not include patient-identifiable information or other individual patient information. They also must not include information that (1) the hospital does not own or control, (2) the hospital is contractually required to keep confidential or is prohibited from disclosing by a data use agreement, or (3) concerns research on human subjects as described in federal Health and Human Services (HHS) regulations (see BACKGROUND).

The act requires nonprofit hospitals to submit the Form 990 and community health needs assessment data along with information they must already report on uncompensated care and related matters. By law, anyone who wilfully fails to file required information with OHCA within the time periods required by law is subject to a civil penalty of up to $1,000 for each day the information is missing, incomplete, or inaccurate.

EFFECTIVE DATE: October 1, 2013

148 — Civil Penalties for Failing to Complete the Inventory Questionnaire

By law, OHCA must conduct a statewide health care facility utilization study, and update its statewide health care facilities and services plan, every two years. As part of this process, OHCA must maintain an inventory of in-state health care facilities, services, and specified equipment. Prior law required health care facilities and providers to complete an OHCA questionnaire to develop the inventory, but exempted them from penalties for failing to complete it.

The act instead subjects these facilities and providers to the general civil penalties that apply to persons or facilities that fail to file data or information with OHCA as required by law — up to $1,000 per day for wilfully failing to comply.

By law, before DPH can impose such civil penalties, it must notify the party by first class mail or personal service of the violation. The person or entity has 15 business days from the mailing date to apply in writing for a (1) hearing to contest the penalty or (2) time extension to file the data. A final order assessing the civil penalty can be appealed to New Britain Superior Court.

EFFECTIVE DATE: October 1, 2013

149 — Patient Bills

By law, a hospital must file with OHCA its current pricemaster (detailed schedule of charges). If the billing detail by line item on a patient bill does not agree with the information filed with OHCA, the hospital is subject to a civil penalty of $500 per occurrence, subject to the procedures set forth above (e g. , the hospital has 15 business days to contest the penalty). OHCA can also order the hospital to adjust the bill to be consistent with the charges on file.

The act specifically requires hospitals to provide detailed patient bills to either DPH or a patient upon request. It also replaces references to “patient bill” with “detailed patient bill” for the purposes of the provisions noted above. It defines a detailed patient bill as a patient billing statement that includes, for each line item, (1) the hospital's current pricemaster code, (2) a description of the charge, and (3) the billed amount.

EFFECTIVE DATE: October 1, 2013


The act suspends the operation of the Tobacco and Health Trust Fund's (THTF) board of trustees, from July 1, 2015 to June 30, 2016, and makes related technical changes. The suspension period does not affect any trustee's term on the board.

Prior law allowed the trustees to recommend disbursements of up to half of the previous year's annual disbursement to the THTF from the Tobacco Settlement Fund, up to $6 million. It also allowed them to recommend disbursements from the THTF's annual net earnings on principal.

For FY 14 and FY 15, the act instead allows the trustees to recommend disbursements of up to $3 million from the THTF annually. (This reflects the FY 14 and FY 15 reduction, from $12 million to $6 million, in the annual disbursement from the Tobacco Settlement Fund to the THTF in PA 13-184. ) Starting in FY 17, the act restores the prior disbursement levels described above.

EFFECTIVE DATE: Upon passage


The act requires the SDE commissioner, in consultation with the DPH commissioner, to establish a pilot program to study the incidence of injuries, particularly concussions, to high school students during interscholastic athletic activities. The commissioner must do this only if federal or private funds are available and the state does not incur a cost.

The SDE commissioner must make grants to 20 high schools to (1) monitor these injuries for two years and (2) report the occurrence of these injuries to the SDE commissioner in a manner he prescribes. The commissioner may accept private and federal funds to make these grants.

Under the act, any school receiving a grant must monitor and report these injuries with the cooperation of the school athletic director, licensed athletic trainers providing services to the school, any physician associated with the school's athletic program, and the Connecticut Interscholastic Athletic Conference.

Within one year of starting the pilot program, the SDE commissioner must report to the Public Health and Education committees. The report must include (1) a summary of the reports he received from the schools and (2) recommendations for decreasing the number and severity of these injuries.

EFFECTIVE DATE: Upon passage


The act makes a technical change to a provision on nursing home facility protocols for a prescription drug formulary system.


The act requires DCF to ensure that children age 36 months or younger are screened for developmental and social-emotional delays if they are (1) substantiated abuse and neglect victims or (2) receiving DCF differential response program services (see BACKGROUND). The department must do this starting October 1, 2013 for the former and July 1, 2015 for the latter.

The department must refer any child found, through the screening, to exhibit such delays to (1) the Birth-to-Three Program (see BACKGROUND) or if ineligible for this program (2) the Children's Trust Fund's Help Me Grow prevention program (see BACKGROUND) or a similar program.

Starting by July 1, 2014, the act requires DCF to begin submitting annual reports on the screenings and referrals to the Children's Committee for inclusion in the committee's annual report card on state policies and programs affecting children.

EFFECTIVE DATE: October 1, 2013


The act requires DCF, within available appropriations, to ensure eligible children age 36 months or younger who are substantiated abuse and neglect victims are screened twice annually, unless the child is found to be eligible for the Birth-to-Three program.

It also requires DCF to ensure eligible children receiving DCF differential response program services are screened, unless the child is found to be eligible for the Birth-to-Three program. But, it does not specify how often these screenings must occur.

The act requires all screenings to be conducted using validated assessment tools, such as the Ages and Stages and the Ages and Stages-Social/Emotional Questionnaires, or their equivalents.


Starting July 1, 2014, DCF must annually report, for the preceding 12 months, the number of Connecticut children age three or younger who (1) were substantiated abuse and neglect victims or (2) received differential response program services. Of these children, DCF must also report the number who:

1. were screened for developmental and social-emotional delays by DCF or a contracted provider;

2. were (a) referred to the Birth-to-Three program for evaluation, (b) actually evaluated by the program, (c) found eligible for program services and the types of services for which they were eligible; and

3. received evidence-based developmental support services through the Birth-to-Three program or a DCF-contracted provider.


The act repeals the following housing-related provisions:

1. the sale of rental property by a housing authority between October 1, and November 30, 2003 (CGS 8-45b);

1. a pilot program requiring that certain multifamily housing projects be adaptable for use and occupancy by people with disabilities (CGS 8-81a);

2. the Housing Advisory Committee (CGS 8-385);

3. a homeowner loan program that terminated on June 1, 1991 (CGS 8-415 to 8-419);

4. the Home Heating System Loan Fund, which the state treasurer terminated on July 15, 1985 (CGS 16a-40k); and

5. a pilot project to provide affordable housing and support services to families with children who have ongoing health care service needs (CGS 17a-54a).

The act also repeals the following human services-related provisions:

1. CGS 17a-220 — creates definitions for a Department of Developmental Disabilities Community Residential Facility Revolving Loan Fund (PA 13-247, 93, restores this) and

2. CGS 17b-260d — requires the DSS commissioner to apply for a Medicaid home- and community-based services waiver for individuals with AIDS or HIV; DSS never applied for the waiver.


78 — Converting the Medicaid Program to an ASO Model

The law authorizes DSS to contract with one or more ASOs (currently, the Community Health Network of Connecticut, Inc. ) to provide a variety of nonmedical services for Medicaid and HUSKY B enrollees. DSS previously contracted with managed care organizations to perform most of these services, which they did as part of a risk-sharing capitation payment that covered medical services. The ASO performs the services for a set fee and does not share any risk for providing medical services.

82 — ConnPACE and MSP

For over 25 years, the ConnPACE program subsidized prescription drug costs for eligible low-income seniors. In 2009, the legislature equalized MSP eligibility with ConnPACE eligibility, essentially making all Medicare-eligible ConnPACE recipients eligible for MSP, which reduced client medical costs and state ConnPACE costs. In 2011, ConnPACE was eliminated for all Medicare-eligible seniors, since they could receive prescription drug assistance through MSP.

MSP provides Medicaid-funded assistance with Medicare Part A and B cost sharing. Additionally, people who qualify for MSP automatically qualify for the federally funded Medicare Part D Low-Income Subsidy, which provides significant prescription drug subsidies.

104 — Medical Necessity Definition

The law defines “medical necessity” as those health services required to prevent, identify, diagnose, treat, rehabilitate, or ameliorate a person's medical condition, including mental illness, or its effects, in order to attain or maintain the person's achievable health and independent functioning. The services must be consistent with generally accepted medical practice standards based on (1) credible scientific evidence published in recognized peer-reviewed medical literature, (2) physician-specialty society recommendations, (3) the views of physicians practicing in relevant clinical areas, and (4) any other relevant factors. The services must also be:

1. clinically appropriate in terms of type, frequency, timing, extent, and duration and considered effective for the person's illness, injury, or disease;

2. not primarily for the convenience of the person, the person's health care provider, or other health care providers;

3. no more costly than an alternative service or services at least as likely to produce equivalent therapeutic or diagnostic results for the person's illness, injury, or disease; and

4. based on an assessment of the person and his or her medical condition (CGS 17b-259b).

127 — Preferred Drug List (PDL)

By law, DSS maintains a PDL, which is a list of drugs for which DSS will reimburse pharmacists when they dispense the drugs to Medicaid recipients. By law, if a practitioner prescribes a drug that is not on the PDL, the pharmacist must receive prior authorization from DSS before it can be paid for dispensing the drug. Prior authorization is not required for any mental health-related drug that has been filled or refilled, in any dosage, at least once in the previous year. When prior authorization is granted, it is valid for one year from when the drug is filled. (By law, drugs used to treat AIDS and AIDS-related illness may not be on the PDL (CGS 17b-274d(f)).

If prior authorization is required and the pharmacist is unable to obtain the prescriber's authorization at the time the prescription is presented, the law requires the pharmacist to dispense a one-time 14-day supply. By law, DSS issues a flier to pharmacies to distribute to Medicaid recipients, letting them know that they need to contact the prescriber to get the full amount of the non-preferred drug (CGS 17b-491a).

128-131 — Constructive Trust

A court can order a constructive trust against someone who, through wrongdoing, fraud, or other unconscionable act, obtains or holds legal property rights to which he or she is not entitled. It is often used to prevent undue enrichment. It can be used to order the person who would otherwise be unjustly enriched to transfer the property to the intended party.

128-131 — Community Spouse Allowance and Monthly Needs Allowance

When one spouse is living in a nursing home and the other spouse lives elsewhere, the spouse who is not living in the nursing home (called the community spouse in Connecticut) is allowed by Medicaid to keep a portion of the institutionalized spouse's income. This income, called the community spouse allowance, is determined by subtracting the community spouse's monthly gross income from the MMNA. The MMNA amount will vary from case to case, but for 2013 the minimum is $1,892; the maximum is $2,898. The MMNA takes into account the community spouse's housing costs (e. g. , rent, and utilities).

The minimum and maximum are set by federal law and the state must update the amounts each year. The maximum may be exceeded only if a DSS fair hearing orders it.

128-131 — Conservators of the Estates of Medicaid Recipients

The law requires conservators of the estates of individuals receiving Medicaid to apply towards the recipient's cost of care any assets exceeding the limits set in law. Similarly, the law prohibits conservators from applying, and courts from approving, net income of the conserved person to support a community spouse in excess of the federal MMNA, unless such limits would result in significant financial distress.

The law further permits the probate court to authorize a conservator to make gifts or other transfers of income and principal from the conserved person's estate to certain trusts (CGS 45a-655 (d) and (e)).

147 — IRS Form 990 and Community Health Needs Assessment

The IRS Form 990 is the “Return of Organization Exempt From Income Tax” form. In practice, OHCA currently collects this form from nonprofit hospitals on a voluntary basis.

The federal Patient Protection and Affordable Care Act requires nonprofit hospitals to conduct community health needs assessments at least once every three years, and make the assessments widely available to the public. It also requires such hospitals to include a description of how they are meeting the law's community health needs assessment requirements in their IRS Form 990 filing.

147 — Research on Human Subjects

HHS regulations set various conditions for research involving human subjects conducted or supported by federal agencies or otherwise subject to federal regulation. Certain types of research are exempt from the HHS policy (such as research involving the (1) use of educational tests in certain circumstances or (2) collection or study of existing data that is publicly available or recorded in a way that subjects cannot be identified) (45 CFR 46. 101).

154 — Differential Response Program

Through the differential response program, DCF can refer families to appropriate community providers for assessment and services (1) at any time during an investigation in an abuse or neglect case or (2) when DCF decides not to investigate such a case that it classifies as presenting a lower risk. These referrals can occur only when there has been an initial safety assessment of the family's circumstances and criminal background checks have been performed on all adults involved in the report.

154 — Birth-To-Three Program

The Birth-to-Three program is designed to strengthen families' capacities to meet the developmental and health-related needs of their infants and toddlers who have developmental delays or disabilities. Eligible families work with service providers to develop Individualized Family Services Plans, with services starting within 45 days of the plan's completion. The plans are reviewed at least once every six months and rewritten at least annually.

DDS is the state's lead agency for the Birth-to-Three program, but families may get referrals from it to other state agencies' programs, depending on the number and type of disabilities a child has.

154 — Children's Trust Fund's Help Me Grow Program

The Children's Trust Fund is a division of DSS. Its Help Me Grow program helps parents and child health and service providers access community-based early identification, prevention, and intervention services for child developmental or behavioral problems through a toll-free number.

Related Act

PA 13-7 ( 3) makes the same changes to the Assistive Technology Revolving Fund as 108 of this act.

KS: ND: VR: ts