Human Services Committee

JOINT FAVORABLE REPORT

Bill No.:

SB-410

Title:

AN ACT CONCERNING ADMINISTRATIVE HEARINGS CONDUCTED BY THE DEPARTMENT OF SOCIAL SERVICES.

Vote Date:

3/20/2014

Vote Action:

Joint Favorable Substitute

PH Date:

3/11/2014

File No.:

SPONSORS OF BILL:

Human Services Committee

REASONS FOR BILL:

To update the Department of Social Services' administrative hearing procedure to comply with provisions of federal law and to eliminate obsolete language.

The original DSS bill changed the time DSS has to set grievance hearings from 30 to 45 days, limited continuances to three and disallowed grievances by providers based on anything other than DSS decisions involving payments.

Substitute language merges elements of another fair hearing bill, including a requirement that DSS set up independent administrator office to hear grievances and that no ex parte communications be allowed between administrator and DSS staff without notice to adverse party. Substitute also deletes provision limiting provider appeals to payment matters.

RESPONSE FROM ADMINISTRATION/AGENCY:

RODERICK L. BREMBY, Commissioner of the State of Connecticut Department of Social Services (DSS), testified in support of this bill. In his testimony he stated, “This bill updates DSS fair hearings procedures for clarity, efficiency, and consistency with federal law. Moreover, several of the changes being proposed will ease the burden on clients by allowing additional methods by which they may request hearings and greater flexibility in when they are required to attend.

Specifically the bill proposes the following:

Section 1 expands the ways that client hearings may be requested to include by mail, phone or other electronic means as contemplated under the Affordable Care Act (ACA). It specifies who may request a hearing on behalf of a client. Under current law, a request for a hearing must be mailed to the Commissioner within sixty days after the date of the decision being contested. In order to accommodate an anticipated change in our eligibility management system without affecting clients, this proposal provides that a hearing request must be received by the Department within sixty-five days of the date of the decision. This proposal increases the number of days within which DSS must schedule a hearing from 30 to 45 and limits to three the number of continuances that may be granted. The proposal also provides that a client need not be present if represented by legal counsel and if not needed to testify. Lastly, the proposal allows testimony by phone in the hearing officer's discretion.

Section 2 makes clarifications that are not substantive changes to practice.

Section 3 specifies that the decisions that may be contested under the section are those that involve the issuance of a payment rate to a provider and deletes some obsolete language.”

NATURE AND SOURCES OF SUPPORT:

MAG MORELLI, President of LeadingAge Connecticut, submitted testimony on this bill. Her testimony stated, “LeadingAge Connecticut objects to Section 3 of this bill which proposes changes to 17b-238 governing provider appeals (lines 215-216). The current law permits appeals of 'any decision by the Commissioners.' The proposed language is more limiting, authorizing only appeals of 'a payment rate issued by the Commissioner'.”

“There are many changes underway regarding the method that DSS is and will be paying providers. These new reimbursement systems may include acuity ratings, performance standards and other means of calculating reimbursement values. Our concern is that limiting the language in this statute to just the “payment rate” issued will take away the opportunity for a class of provider to challenge decisions regarding new reimbursement systems and/or methodologies as well as an individual provider's right to challenge decisions regarding outcome measures, supporting documentation or other claims issues not specific to the payment rate.”

“Nursing home providers are particularly concerned because they are currently carved out of the audit statute for appeals rights because their appeals rights are found in this specific rate statute that DSS is now proposing to limit.”

NATURE AND SOURCES OF OPPOSITION:

CONNECTICUT HOPSITAL ASSOCIATION (CHA), submitted testimony opposing this bill. “While CHA has no objections to the procedural changes set forth in Sections 1 and 2 of the bill, we have grave concerns about the potential adverse impact of Section 3 on hospitals.”

“Section 3 of the bill will unduly limit the right of a hospital to request an administrative hearing to only those decisions pertaining to a payment rate, rather than to any decision issued by the Commissioner, which has been a right available to hospitals for decades. CHA strenuously objects to this proposed change, since it will eliminate judicial review of decisions that are injurious to the hospital.”

“Limiting the scope of aggrievement in this manner will jeopardize the due process rights of hospitals. It will summarily eliminate a hospital's right to seek administrative redress for other legitimate items of aggrievement. For example, in the past year hospitals appealed a proposed change in payment methodology for ambulatory surgery services. The proposed change would have reduced funding by about $60 million per year. Upon receipt of the appeals, the Department decided to withdraw the proposal. Hospitals also appealed the Department's failure to update and issue inpatient rates. The current inpatient rates expired on 9/30/12. On October 1, 2013, the hospitals filed appeals asking for the rates to be issued and updated for inflation as required. Hospitals also often have to appeal audit findings. Arbitrarily eliminating an administrative remedy that has been available for decades removes a significant backstop to decisions which otherwise would proceed regardless of the consequences.”

Reported by: Dionne Abrams

Date: March 27, 2014