Sec. 17b-221a. Revenue from Riverview Hospital to be used to pay Medicaid
claims. For the fiscal year ending June 30, 2002, and each fiscal year thereafter, revenue
received by the Department of Administrative Services-Financial Services Center/Collections from Medicaid managed care plans for services performed at Riverview Hospital shall be deposited in the General Fund and credited to a nonlapsing account in the
Department of Social Services and shall be available for expenditure by the Department
of Social Services for the payment of Medicaid claims.
(June Sp. Sess. P.A. 01-6, S. 12, 85.)
History: June Sp. Sess. P.A. 01-6 effective July 1, 2001.
Sec. 17b-221b. Federal matching funds for special education-related services.
Portion to be used for Medicaid claims. For the fiscal year ending June 30, 2002, and
each fiscal year thereafter, all federal matching funds received by the Department of
Social Services for special education-related services rendered in schools pursuant to
section 10-76d shall be deposited in the General Fund and credited to a nonlapsing
account in the Department of Social Services. Sixty per cent of such funds shall be
expended by the Department of Social Services for payment of grants to towns pursuant
to subdivision (3) of subsection (a) of section 10-76d and the remaining funds shall
be available for expenditure by the Department of Social Services for the payment of
Medicaid claims.
(June Sp. Sess. P.A. 01-6, S. 13, 85.)
History: June Sp. Sess. P.A. 01-6 effective July 1, 2001.
As used in sections 17b-223, 17b-228, 17b-229 and 17b-748, "state humane institution" or "humane institution" means and includes state mental hospitals, community
mental health centers, treatment facilities for children and adolescents, or any other
facility or program administered by the Departments of Mental Health and Addiction
Services, Mental Retardation, or Children and Families. The person in charge of each
state humane institution shall furnish the Commissioner of Administrative Services with
a daily report of changes in the patient roster and the date of formal commitment of each
patient.
(1955, S. 1488d; 1957, P.A. 586, S. 7; 1959, P.A. 201; 1967, P.A. 314, S. 16; 839, S. 1; 1971, P.A. 530, S. 1; P.A. 75-
603, S. 12, 15; P.A. 77-614, S. 70, 610; P.A. 87-421, S. 6, 13; P.A. 93-91, S. 1, 2; 93-381, S. 9, 39; P.A. 95-257, S. 30, 58.)
History: 1959 act required that welfare commissioner be supplied with daily report of changes in patient roster and
dates of formal commitment of patients; 1967 acts deleted "tuberculosis facilities in chronic disease hospitals" from the
definition and provided that the commissioner of finance and control rather than the welfare commissioner receive the
reports of patient rosters; 1971 act included community mental health centers, treatment facilities for children and adolescents and other facilities and programs administered by mental health department in definition of "humane institution";
P.A. 75-603 included reference to programs and facilities administered by children and youth services department; P.A.
77-614 replaced commissioner of finance and control with commissioner of administrative services; P.A. 87-421 included
facilities or programs administered by the Connecticut state alcohol and drug abuse commission and by the department of
mental retardation in the definition of state human institution and excluded state training schools for mentally retarded
persons from the definition; P.A. 93-91 substituted commissioner and department of children and families for commissioner
and department of children and youth services, effective July 1, 1993; P.A. 93-381 replaced Connecticut alcohol and drug
abuse commission with department of public health and addiction services, effective July 1, 1993; Sec. 17-294 transferred
to Sec. 17b-222 in 1995; P.A. 95-257 replaced Department of Mental Health with Department of Mental Health and
Addiction Services and deleted reference to the Department of Public Health and Addiction Services, effective July 1, 1995.
Annotations to former section 17-294:
Cited. 183 C. 330, 332—334, 336.
Cited. 30 CS 118.
(a) The
Comptroller shall at least annually determine the cost per capita per diem for the support
of persons in state humane institutions and furnish such itemized per capita cost to the
Commissioner of Administrative Services. Such cost for the care of persons in facilities
operated by the Department of Mental Health and Addiction Services shall be determined by the Comptroller, in consultation with the Commissioner of Mental Health and
Addiction Services, on a facility-wide, ward-wide or unit-wide basis. The provisions
of this section shall not apply to cases eligible for medical assistance or public assistance
under Title XVIII or Title XIX of the Social Security Act, and such cases shall be
administered as medical or public assistance cases and shall be subject to federal and
state law, rules and procedures governing the same.
(b) The maximum rate to be charged for the support of each patient for the ensuing
year shall be the per capita cost. The commissioner shall, upon the admission of each
patient to a humane institution, and may, upon any subsequent readmission of such
patient, cause an investigation to be made of the financial circumstances of each liable
person and the estate of each patient and, if any such person or estate is found unable
to pay the per capita cost, shall bill such liable person or estate from the date of admission
at a rate which he finds such person or estate able to pay, provided the total billing to
all persons responsible for the support of any patient, including the patient or patient's
estate, shall be based on actual days of attendance at the facility involved and shall not
exceed the per capita cost. A complete disclosure for the amount and terms of such
monthly billing and continuing liability for costs associated with services provided by
the state shall be provided to such liable person or patient prior to admission or if the
immediate need or admission precludes such notification, at the earliest possibility thereafter.
(c) Each patient, the husband or wife of such patient and the father and mother of
a patient under the age of eighteen years each shall be legally liable from the date of
admission for the support of such patient in such institution in accordance with his ability
to pay; except that the maximum liability of legally liable relatives as such for a patient
in a state humane institution shall be determined by the commissioner in accordance
with section 4a-12 and subsection (b) of this section. The guardian, conservator and
payee of Social Security or other benefits on behalf of any such patient shall be similarly
responsible for the support of such patient, but shall be liable in such capacity only in
accordance with the amount of the patient's estate or the benefits received, or both, as
the case may be. Said commissioner may bill and accept payment from any other person
or agency willing to assume any portion of the cost of support of a person in a state
humane institution at such rate as such person or agency is willing to pay. The relatives
of any such patient who is a veteran shall not be liable as such for any part of the cost
of his care in such institution.
(d) Wherever a rate of billing has been established as the result of a fraud of the
patient or a liable person, or where assets of the patient or relative have been concealed
so as not to be available to civil process, such patient or liable person, as the case may
be, shall be liable for the difference between the amounts actually billed and paid and
the amount which would have been billed against such patient or liable person except
for such fraud or concealment, which difference may be recovered in a civil action in
the same manner as is provided in section 17b-228, together with interest at the rate of
twelve per cent from the date of such billing, and no statute of limitations shall apply
to such right of action.
(1949 Rev., S. 2661; 1953, 1955, S. 1489d; November, 1955, S. N169; 1959, P.A. 470; 671, S. 1; 1961, P.A. 590;
February, 1965, P.A. 539, S. 1; 594, S. 1, 2; 1967, P.A. 314, S. 16; 364, S. 1, 3; 746, S. 3; 759, S. 2, 3; 825; 1969, P.A.
730, S. 12; 1972, P.A. 127, S. 27; P.A. 74-243, S. 1—3; P.A. 76-435, S. 19, 82; P.A. 77-614, S. 70, 610; P.A. 78-302, S.
9, 11; 78-343, S. 1, 2; P.A. 79-376, S. 20; 79-443, S. 1, 2; P.A. 80-389, S. 1, 3; P.A. 84-246, S. 1, 2; P.A. 86-169; P.A. 87-
421, S. 7, 13; P.A. 88-285, S. 30, 35; P.A. 95-257, S. 11, 58; P.A. 96-135; P.A. 97-312, S. 3.)
History: 1959 acts added, in Subsec. (b), proviso re maximum rate and exception for patients eligible for medical and
hospital benefits; added, in Subsec. (c), provision re cessation of liability and limitation on responsibility of guardian,
conservator and payee of social security and requirement for investigating each patient's estate; added Subsec. (d); limited
application of Subsec. (e) to liable relatives or the patient and substituted, in Subsec. (f), "liable persons" for "legally liable
relatives"; 1961 act placed limitation, in Subsec. (b), on maximum rate, provided for payment by more than one relative
in the same period in Subsec. (c) and eliminated, in Subsec. (d), deferral of finding re financial responsibility pending
commission's finding, referring determination directly to commissioner; 1965 acts added a Subsec. (h) establishing maximum rates predicated on taxable income where patient was mentally retarded, and allowed exclusion of four hundred
dollars from available assets of mentally retarded patients returning from outside training in determination of ability to
pay in Subsec. (e); 1967 acts removed items of cost provisions from Subsec. (a) and added sentence re social security act,
changed basis of rate in Subsec. (b) to per capita cost, specified the maximum rate "per week" and deleted exceptions,
changed relatives liable in Subsec. (c) to parents of children under twenty-one and children of parents under sixty-five,
repealed Subsec. (h), substituting Sec. 17-295a, and substituted commissioner of finance and control for welfare commissioner; 1969 act deleted from exception regarding liability statement that children be only equally liable and that liability
waived if child's gross income is $15,000 or less in Subsec. (c); 1972 act changed reference to patients under twenty-one
to refer to those under eighteen in Subsec. (c), reflecting changed age of majority; P.A. 74-243 made maximum rate charged
relatives applicable after first one hundred twenty days of treatment and added provisions re investigation and adjustments
in charge if liable person or estate cannot bear the charge in Subsec. (b), deleted from liability in Subsec. (c) children of
patient under sixty-five and deleted provisions re investigation and adjustment to charges now in Subsec. (b) and rephrased
use of measurement standard in Subsec. (e) for clarification; P.A. 76-435 deleted Subsec. (g) which had allowed commissioner to recover balance of charges billed despite receipt of lesser rate; P.A. 77-614 replaced commissioner of finance
and control with commissioner of administrative services; P.A. 78-302 required annual determinations of cost under Subsec.
(a); P.A. 78-343 extended exception to allow charge of maximum rate for patients committed to High Meadows from
date of admission or commitment under Subsec. (b); P.A. 79-376 substituted "workers' compensation" for "workmen's
compensation" in Subsec. (e); P.A. 79-443 made cost determination on per diem rather than per week basis and added
provision re determination of costs in facilities operated by mental health department in Subsec. (a); P.A. 80-389 increased
maximum rate for legally liable relatives from $26.95 to $53.90 per week and increased interest rate in Subsec. (f) from
six to twelve per cent; P.A. 84-246 eliminated mandatory investigation upon readmission of patients, deleted requirement
that investigation be made prior to rendering of bill and provided a monetary limit on liability of legally liable relatives;
P.A. 86-169 deleted provision setting maximum rate charged to legally liable relatives of patients at High Meadows; P.A.
87-421 (1) amended Subsec. (b) to delete a maximum dollar amount per week which could be charged liable relatives after
the first one hundred twenty days of care, (2) amended Subsec. (c) to remove a cap on liability based on sixteen years of
care and to substitute a cap determined in accordance with Sec. 4-68a and Subsec. (b) of this section and (3) removed
Subsec. (e) on the considerations for determining ability of liable relatives to contribute to the cost of care and relettered
the remaining subsection; P.A. 88-285 amended Subsec. (d) to replace veterans' home and hospital commission with
commissioner of veterans' affairs; Sec. 17-295 transferred to Sec. 17b-223 in 1995; P.A. 95-257 replaced Commissioner
and Department of Mental Health with Commissioner and Department of Mental Health and Addiction Services, effective
July 1, 1995; P.A. 96-135 repealed provisions of former Subsec. (d) re review by Commissioner of Veterans Affairs of
determination of financial responsibility for certain veterans admitted to state humane institutions, consolidated remaining
provisions of former Subsec. (d) into Subsec. (c) and relettered former Subsec. (e) as Subsec. (d); P.A. 97-312 amended
Subsec. (b) by requiring full disclosure of monthly billing and continuing liability to the liable person, prior to admission
or at the earliest possibility thereafter.
See Sec. 17a-278 re recall of residents placed in private boarding home for examination.
See Sec. 17a-461 re charges for care in Connecticut Mental Health Center.
See Sec. 19a-257 re support of patients with chronic illness excluding tuberculosis.
Annotations to former statute:
Cited. 139 C. 472; 142 C. 329.
Cited. 14 CS 33.
Social security payments made to parent as "representative payee" for dependent child are property of child and may
be billed against for child's hospitalization. 4 Conn. Cir. Ct. 63, 66. Estate of veteran with service- connected disability
liable for maximum rate under subsection (b). Id., 75. Commissioner may make a retroactive change in patient's billing upon
discovery of new circumstances. Id., 81. Burden of proof commissioner acted illegally or so arbitrarily and unreasonably as
to abuse his discretion is on plaintiff. Id., 138. Cited. Id., 402. During confinement of social security recipient for mental
illness under order of criminal court, defendant, representative payee of recipient, must apply such funds for support of
beneficiary at institution of commitment. 5 Conn. Cir. Ct. 542.
Annotations to former section 17-295:
Cited. 152 C. 55. Cited. 183 C. 330, 332—336. Cited. 192 C. 520, 522. State not precluded by federal supremacy clause
from using legal process to compel payment of institutional support charges. 205 C. 104—108, 115.
Cited. 30 CS 118. Cited. 34 CS 518, 520, 521.
Subsec. (b):
Cited. 183 C. 330, 333, 336.
Subsec. (c):
Cited. 183 C. 330, 333.
Sec. 17b-224. (Formerly Sec. 17-295b). Liability of patient for per capita cost
of care. A patient who is receiving or has received care in a state humane institution,
his estate or both shall be liable to reimburse the state for any unpaid portion of per
capita cost to the same extent as the liability of a public assistance beneficiary under
sections 17b-93 and 17b-95, subject to the same protection of a surviving spouse or
dependent child as is therein provided.
(1969, P.A. 730, S. 13.)
History: Sec. 17-295b transferred to Sec. 17b-224 in 1995.
Annotations to former section 17-295b:
Cited. 192 C. 520, 522, 525.
State's claim against estate of deceased recipient or patient depends upon amount due at time of death of such recipient
or patient. Upon date of death, estate's liability to reimburse state is fixed and cannot be expanded or contracted by
subsequent enactments. 34 CS 518—520, 522, 523.
Sec. 17b-225. (Formerly Sec. 17-295c). Availability of patient information to
certain agencies. (a) The Department of Public Safety, the Department of Social Services and the United States Department of Health and Human Services shall be entitled
to receive only such information concerning patients in institutions, hospitals and facilities of the Departments of Public Health, Mental Retardation and Mental Health and
Addiction Services as is required to obtain support and payments for the care of such
patients, including submissions of such information to probate courts, agencies and
corporations dispensing benefits, or only such information concerning such patients as
is required for the purpose of claiming federal reimbursement, or only such information
concerning such patients as is required for the review and audit of federally funded
programs. Any such information received by said Department of Public Safety, Department of Social Services and United States Department of Health and Human Services
shall be confidential and shall be used for the purposes of obtaining support and payments
for the care of said patients or for the purpose of claiming federal reimbursement or for
the review and audit of federally funded programs.
(b) The Department of Administrative Services shall be entitled to receive only
such information concerning patients in institutions, hospitals and facilities of the Departments of Public Health, Mental Health and Addiction Services and Mental Retardation, and state humane institutions, as defined in section 17b-222, as is required to obtain
support and payments for the care of such patients, including submissions of such information to probate courts, agencies and corporations dispensing benefits. Any such information received by said Department of Administrative Services shall be confidential
and shall be used only for the purposes specified in this subsection.
(1971, P.A. 263; P.A. 73-248, S. 1, 2; P.A. 74-215, S. 1, 3; P.A. 75-420, S. 4, 6; 75-638, S. 21, 23; P.A. 77-614, S. 71,
323, 587, 608, 610; P.A. 78-303, S. 85, 127, 136; P.A. 79-383; P.A. 93-262, S. 1, 87; 93-381, S. 9, 39; P.A. 95-257, S. 11,
12, 21, 58.)
History: P.A. 73-248 entitled welfare department and U.S. Department of Health, Education and Welfare to receive
information and included information relevant to claims for federal reimbursement or to review or audit of federally-
funded programs; P.A. 74-215 added word "only" with reference to information re federal reimbursement and federal
reviews and audits; P.A. 75-420 replaced welfare department with department of social services; P.A. 75-638 included
information on patients in facilities of mental retardation department; P.A. 77-614 replaced central collections division of
department of finance and control with department of administrative services and, effective January 1, 1979, replaced
department of health with department of health services and department of social services with department of income
maintenance; P.A. 78-303 entitled department of public safety to information; P.A. 79-383 added Subsec. (b) containing
special provisions re information to which administrative services department entitled and removed references to said
department in previous provisions, now Subsec. (a); P.A. 93-262 authorized substitution of commissioner and department
of social services for commissioner and department of income maintenance, effective July 1, 1993; P.A. 93-381 replaced
department of health services with department of public health and addiction services, effective July 1, 1993; Sec. 17-295c
transferred to Sec. 17b-225 in 1995; P.A. 95-257 replaced Commissioner and Department of Public Health and Addiction
Services with Commissioner and Department of Public Health and replaced Commissioner and Department of Mental
Health with Commissioner and Department of Mental Health and Addiction Services, effective July 1, 1995.
Sec. 17b-226. (Formerly Sec. 17-295d). Consideration of the costs mandated
by collective bargaining agreements. The state shall take into consideration the costs
mandated by collective bargaining agreements with certified collective bargaining
agents or other agreements between employers and employees when making grants to
or entering into contracts for services with the following: (1) Nonprofit organizations
for mental health services pursuant to section 17a-476; (2) nonprofit organizations concerning services for drug-dependent and alcohol-dependent persons pursuant to section
17a-676; (3) residential and educational services pursuant to subsections (a) and (b) of
section 17a-17; (4) psychiatric clinics and community mental health facilities pursuant
to section 17a-20; (5) day treatment centers pursuant to section 17a-22; (6) youth service
bureaus pursuant to subsection (a) of section 10-19n; (7) programs for the treatment
and prevention of child abuse and neglect and for juvenile diversion pursuant to section
17a-49; (8) community-based service programs pursuant to sections 18-101i and 18-
101k; (9) programs for mentally retarded children and adults pursuant to section 17a-
217; (10) community-based residential facilities for mentally retarded persons pursuant
to section 17a-218; and (11) vocational training programs for mentally retarded adults
pursuant to section 17a-226.
(P.A. 87-497, S. 2, 3; P.A. 90-209, S. 22; P.A. 91-406, S. 3, 29; P.A. 93-381, S. 13, 39.)
History: P.A. 90-209 in Subdiv. (2) substituted "alcohol-dependent" for "alcoholic" and Sec. 17-155gg for repealed
Sec. 17-226d and made a technical change; P.A. 91-406 deleted former Subdiv. (11) re diagnostic clinics for mentally
retarded persons, renumbering former Subsec. (12) accordingly; P.A. 93-381 made technical changes, effective July 1,
1993; Sec. 17-295d transferred to Sec. 17b-226 in 1995.
All bills for support of inmates in state hospitals for mental illness shall be paid to the
Commissioner of Administrative Services, who shall keep an account of the same and
turn over the amount received in payment thereof to the State Treasurer.
(1949 Rev., S. 2662; 1951, S. 1497d; 1967, P.A. 314, S. 16; P.A. 77-614, S. 70, 610.)
History: 1967 act substituted commissioner of finance and control for welfare commissioner; P.A. 77-614 replaced
commissioner of finance and control with commissioner of administrative services; Sec. 17-297 transferred to Sec. 17b-
227 in 1995.
Sec. 17b-228. (Formerly Sec. 17-298). Court action by state to recover unpaid
portion of charges. When any person has been supported, wholly or in part, by the state
in a humane institution, whether such person was admitted thereto as a pauper or indigent
or otherwise, and any portion of the charges for which such person or his liable relatives
were liable under the provisions of section 17b-223 remains unpaid, such person or such
relatives, as the case may be, or the estate of any such person or such relatives, shall be
liable to the state therefor, and the Commissioner of Administrative Services may, in
the name of the state, bring a complaint therefor, against any liable person or persons,
in any court having jurisdiction thereof in the county in which such liable person or the
conservator or guardian of such patient resides, or, if several are liable, in the county
in which any of them resides, and any other person who might, under the provisions
hereof, have been made a defendant in such action may be cited in as a party defendant
on motion of either party thereto. Said court may render judgment against the defendant,
or each or any of the several defendants, in favor of the state for the balance of the
charges remaining unpaid for which such defendants are liable, and payment of such
judgment may be secured by attachment and execution issued thereon. The limitation
of action provided in section 52-576 shall apply only to any such claim against a relative
as such, and any claim by the state for reimbursement of the balance of the billed charges
remaining unpaid from the estate of any deceased person shall be presented to the executor or administrator thereof within the time limited for the presentation of other claims
against such estate.
(1949 Rev., S. 2663; 1953, 1955, S. 1498d; 1959, P.A. 404; 1961, P.A. 62; 1967, P.A. 314, S. 16; 653, S. 1; 1969, P.A.
453, S. 4; P.A. 77-614, S. 70, 610.)
History: 1959 act specified Sec. 52-276 apply only to claims against a relative as such, raised amount of personal estate
limit from one to two thousand dollars, and reduced waiting time from ninety to thirty days; 1961 act deleted provision
for municipality to take estate proceedings, added expenses for last illness and burial and authorized banks, etc., having
control to pay sums to commissioner and deleted alternatives for paying same; 1967 acts substituted commissioner of
finance and control for welfare commissioner and raised personal estate limit from two thousand to thirty-five hundred
dollars; 1969 act deleted provisions re taking of estates not exceeding thirty-five thousand dollars by state; P.A. 77-614
replaced commissioner of finance and control with commissioner of administrative services; Sec. 17-298 transferred to
Sec. 17b-228 in 1995.
See Sec. 17b-222 for definition of "humane institution".
See Sec. 17b-745 re issuance of court order for support of persons supported by state and wage executions.
Annotations to former section 17-298:
Applies to a past expenditure. 93 C. 573. By bringing action, state subjects itself to the procedure established for its
final disposition. 119 C. 220. Trustee's agreement to pay for support furnished prior to death of testator held invalid. 119
C. 508. In action by city against same trustee, held no duty on trustee of discretionary trust to use fund for support of
inmate. 133 C. 31. Essential for recovery against an estate that decedent was able to reimburse the state during his lifetime.
140 C. 21, 26. Cited. 127 C. 58; 137 C. 319; 139 C. 472; 140 C. 214; 142 C. 329; 152 C. 55. Cited. 189 C. 726, 727.
Finding by probate court that a person was a pauper not conclusive because fact is a jurisdictional one. 4 CS 286. Statute
retrospective in operation because it does not originate a new cause of action but extends one which previously existed in
the state to the towns and cities. 11 CS 295. Not applicable to a person, certified insane after having been committed to
jail on a binding over process, and then transferred to a state hospital until the time of his trial. 14 CS 33. Cited. 15 CS
177. An action under this provision should not be entered on the jury docket. Id., 369. Claim for reimbursement for care
of tubercular patient allowed. 16 CS 118. Creates absolute liability on recipient of town aid for support and care in a humane
institution. 18 CS 337.
Commissioner may proceed under this section or section 17-324 to obtain support for a patient in a state humane
institution. 4 Conn. Cir. Ct. 81. Cited. 4 Conn. Cir. Ct. 548.
(a) No relative of a patient in a state humane institution, nor the estate of such relative, shall be
liable for any portion of the cost of support of any such patient in such institution for any
period prior to July 1, 1955, except unpaid charges billed by the Welfare Commissioner.
(b) The provisions of sections 17a-278, 17a-502, 17b-222, 17b-223, 17b-228, 17b-
232, 17b-748, 46b-215 and 53-304 shall not affect or impair the responsibility of any
patient or patient's estate for his care in a state humane institution prior to July 1, 1955,
and the same may be enforced by any action by which such responsibility would have
been enforceable prior to July 1, 1955, but only to the extent of that portion of such
estate as is not needed for the support of the spouse, parents and dependent children of
such patient.
(1955, S. 1499d; 1957, P.A. 330, S. 1, 2; February, 1965, P.A. 574, S. 25; P.A. 76-139, S. 11; P.A. 77-614, S. 587, 608,
610; P.A. 78-303, S. 85, 136; P.A. 91-406, S. 4, 29.)
History: 1965 act deleted references to Secs. 17-159, 17-168 and 17-323 and added reference to Sec. 17-174a; P.A.
76-139 deleted reference to Secs. 19-122, 19-123 and 19-124 repealed by same act; P.A. 77-614 and P.A. 78-303 would
have replaced welfare commissioner with commissioner of income maintenance but for qualifying date reference; P.A. 91-
406 made technical changes in Subsec. (b), deleting references to Secs. 17-174a, 17-296 and 17-320 and adding references to
Secs. 17a-278 and 46b-215; Sec. 17-299 transferred to Sec. 17b-229 in 1995.
Sec. 17b-230. (Formerly Sec. 17-300). Claim of state on death of institution
patient. Upon the death of a patient or of a person who has, at any time, been a patient
in a state humane institution, the state shall have a claim against his estate for reimbursement for institutional support according to the provisions of sections 17b-223, 17b-
224 and 17b-229 to the extent that the amount which the surviving spouse, parent or
dependent children of the decedent would otherwise take from such estate is not needed
for their support. Such claims shall have priority over all unsecured claims against such
estate, except (1) expenses of last sickness not to exceed three hundred seventy-five
dollars, (2) funeral and burial expenses in accordance with section 17b-84, (3) such
unpaid fees and expenses of the conservator of such patient, if any, as are authorized
by law and (4) administrative expenses, including probate fees and taxes, and including
fiduciary fees not exceeding the following commissions on the value of the whole estates
accounted for by such fiduciaries: On the first two thousand dollars or portion thereof,
five per cent; on the next eight thousand dollars or portion thereof, four per cent; on the
excess over ten thousand dollars, three per cent. Upon petition by any fiduciary, the
Probate Court, after hearing thereon, may authorize compensation in excess of the above
schedule for extraordinary services. Notice of any such petition and hearing shall be
given to the Commissioner of Administrative Services in Hartford at least ten days in
advance of such hearing. The allowable funeral and burial payment herein shall be
reduced by the amount of any prepaid funeral arrangement. Any amount paid from the
estate under this section to any person which exceeds the limits provided herein shall
be repaid to the estate by such person, and such amount may be recovered in a civil
action with interest at six per cent from the date of demand.
(1957, P.A. 500; 1959, P.A. 395, S. 3; 1961, P.A. 426, S. 3; 1963, P.A. 438, S. 9; February, 1965, P.A. 625, S. 8; 1967,
P.A. 151, S. 8; 314, S. 16; 1969, P.A. 730, S. 39; 1972, P.A. 294, S. 16; P.A. 77-614, S. 70, 610; P.A. 78-337, S. 10, 11;
P.A. 88-364, S. 27, 123.)
History: 1959 act amended Subdiv. (2) to raise total funeral and burial expenses from three hundred to six hundred
dollars and added Subdiv. (3) and provisions re reductions for prepaid funeral arrangements and recovery or repayment
of amounts paid in excess of limits; 1961 act clarified language re restrictions placed on application of Secs. 17-295 and
17-299; 1963 act reduced funeral and burial expense priority amount from six hundred to four hundred dollars; 1965 act
increased funeral and burial expense priority amount to four hundred fifty dollars; 1967 acts raised funeral and burial
expense ceiling to five hundred dollars and substituted commissioner of finance and control for welfare commissioner;
1969 act increased limit on funeral and burial expenses to six hundred dollars; 1972 act added reference to Sec. 17-295b;
P.A. 77-614 replaced commissioner of finance and control with commissioner of administrative services; P.A. 78-337
replaced specific dollar limit on funeral and burial expenses with reference to amounts allowed under Sec. 17-82q; P.A.
88-364 made technical change in section; Sec. 17-300 transferred to Sec. 17b-230 in 1995.
Annotations to former section 17-300:
Cited. 34 CS 518, 522, 523.
Sec. 17b-231. (Formerly Sec. 17-301). Refund for support of persons in state
institutions. Claim for any sum due from the state as a refund for the support of any
person in a state institution may be made by the person entitled thereto to the Commissioner of Administrative Services, in writing, on forms furnished by said commissioner,
who shall decide as to the amount due and, if satisfied that the claimant is entitled to
any refund, shall certify the amount due to the comptroller, who shall pay the same.
(1949 Rev., S. 2619; 1967, P.A. 314, S. 16; P.A. 77-614, S. 70, 610.)
History: 1967 act substituted commissioner of finance and control for welfare commissioner; P.A. 77-614 replaced
commissioner of finance and control with commissioner of administrative services; Sec. 17-301 transferred to Sec. 17b-
231 in 1995.
Annotations to former section 17-301:
Cited. 30 CS 118.
Sec. 17b-232. (Formerly Sec. 17-306). Payment for board and care in boarding
home, group home, convalescent hospital or other residential facility. The state,
through the agency of the state-operated facility, as defined in subsection (b) of section
17a-458, authorizing the transfer of a resident to a private boarding home for mental
patients, group home, chronic and convalescent hospital or other residential facility as
provided by section 17a-509, shall pay the cost of the board and care of such mentally
ill person, provided such cost shall not be in excess of the rates established under section
17b-340 for such facilities.
(1949 Rev., S. 2685; 1953, 1955, S. 1513d; 1957, P.A. 19; 1959, P.A. 543; P.A. 80-3; June Sp. Sess. P.A. 83-39, S. 3, 18.)
History: 1959 act deleted provision that state pay costs in addition to those paid in accordance with Sec. 17-295, added
that payment is not to exceed rates under Sec. 17-314 and substituted term "mentally retarded" for "mentally deficient";
P.A. 80-3 deleted state hospital reference, included state- operated facilities, regional centers or other facilities for care
and training of the mentally retarded and group homes or other residential facilities and updated section reference to reflect
transfer of Sec. 17-174 to Sec. 19-569h; June Sp. Sess. P.A. 83-39 deleted reference to state training schools, regional
centers or other facilities for the care and training of the mentally retarded and reference to Sec. 19a-451; Sec. 17-306
transferred to Sec. 17b-232 in 1995.
Sec. 17b-233. (Formerly Sec. 17-307). Care of handicapped and other children
at Newington Children's Hospital. Children with drug-related conditions not to
be admitted. Newington Children's Hospital may admit any child who is handicapped
or afflicted with any pediatric illness upon application of the selectmen of any town, or
the guardian or any relative of such child, or any public health agency or physician,
provided, no person shall be admitted primarily for the treatment of any drug-related
condition. Said hospital shall admit such child to said hospital if such child is pronounced
by the physicians on the staff of said hospital, after examination, to be suitable for
admission, and said hospital shall keep and support such child for such length of time
as it deems proper. Said hospital shall not be required to admit any such child unless it
can conveniently receive and care for such child at the time application is made and
said hospital may return to the town in which such child resides any child so taken who
is pronounced by the physicians on the staff of said hospital, after examination, to be
unsuitable for retention or who, by reason of improvement in his condition or completion
of his treatment or training, ought not to be further retained. The hospital may refuse
to admit any child pronounced by the physicians on the staff of said hospital, after
examination, to be unsuitable for admission and may refuse to admit any such child
when the facilities at the hospital will not, in the judgment of said physicians, permit
the hospital to care for such child adequately and properly.
(1949 Rev., S. 2609; June, 1949, 1955, S. 1440d; 1959, P.A. 610, S. 1; P.A. 80-293, S. 1, 2.)
History: 1959 act changed name of hospital, substituted affliction with "noncontagious pediatric illness or handicapping
physical condition" for "poliomyelitis or cerebral palsy or any uncontagious crippling disease," deleted statement that
child or relatives must be unable to pay and required that child be "suitable" rather than "fit" for admission; P.A. 80-293
changed admission requirement, substituting "handicapped" child for one "of sound mind who is a cripple", allowing
admission for any pediatric illness rather than for "noncontagious" illnesses alone and deleting reference to "handicapping
physical condition", and added proviso prohibiting admission "primarily for the treatment of any drug-related condition";
Sec. 17-307 transferred to Sec. 17b-233 in 1995.
Annotations to former section 17-307:
In tort action no recovery allowed for value of services rendered gratuitously by state-supported or other public charity.
129 C. 207.
The Department of Social Services shall
notify the Newington Children's Hospital of each referral for whom said department
can apply for federal matching grants. Newington Children's Hospital shall charge the
Department of Social Services for said eligible referrals only and shall retain all such
payments received from the department. Such payments by the state shall be in lieu of
all other payments to said hospital by the state or any town in this state except payments
by the Department of Social Services as provided in this section, the State Board of
Education or the Department of Public Health. Such payments shall not prevent payments to said hospital from private sources for the care and support of any child in said
hospital or for the balance of such operating expense. The Office of Health Care Access,
in establishing rates to be charged by the Newington Children's Hospital, shall not
include the grant made to said hospital pursuant to this section. In order to be eligible
for the grant authorized by this section, the Newington Children's Hospital shall cooperate with The University of Connecticut Health Center in order to provide consolidated
and coordinated pediatric services.
(June, 1949, 1951, 1953, S. 1441d; November, 1955, S. N167, N168; 1957, P.A. 550, S. 1; 1959, P.A. 610, S. 2; 1961,
P.A. 460, S. 1; P.A. 73-117, S. 20; 73-273, S. 1, 3; P.A. 74-182, S. 2, 3; P.A. 75-420, S. 4, 6; P.A. 77-614, S. 323, 608,
610; P.A. 79-560, S. 24, 39; P.A. 81-430, S. 1, 3; P.A. 82-91, S. 31, 38; June Sp. Sess. P.A. 83-32, S. 5, 8; P.A. 84-442,
S. 1, 2; P.A. 88-281, S. 1, 4; P.A. 93-262, S. 1, 87; 93-381, S. 9, 39; P.A. 95-257, S. 12, 21, 39, 58; June 18 Sp. Sess. P.A.
97-8, S. 20, 88.)
History: 1959 act changed name of hospital, increased per cent of operating expenses paid from twenty-five to twenty-
six per cent and added provision re per capita operating expense for preceding year; 1961 act increased portion of operating
expense paid to twenty-eight per cent and deleted exclusion, when calculating operating expense, for expense of operation
of farm; P.A. 73-117 replaced hospital cost commission with committee established under Sec. 17-311; P.A. 73-273
reduced state payment by amount paid by welfare department for services to children for whom said department receives
federal matching grants and added provisions re notice to hospital of eligible referrals and charges pertaining in such cases;
P.A. 74-182 changed payments' basis from year ending June thirtieth to year ending September thirtieth as of July 1, 1974,
and required determination of payment amount on or before July 1, 1974, adding provisions for making determination and
adjustments; P.A. 75-420 replaced welfare department with department of social services; P.A. 77-614 replaced department
of health with department of health services and replaced department of social services with department of income maintenance, effective January 1, 1979; P.A. 79-560 replaced references to committee established under Sec. 17-311 with references to commissioner of income maintenance; P.A. 81-430 lowered state's payment for support of children admitted to
the hospital from twenty-eight to twenty-four per cent of the hospital's operating cost; P.A. 82-91 added Subsec. (a) which
provided that (1) for fiscal years 82-83 and 83-84, the state grant to Newington Children's Hospital shall be the lesser of
$1,000,000 or the amount by which 24% of the hospital's operating expense exceeds payments to it by the department of
income maintenance, (2) the hospital shall retain all payments from said department, (3) the state grant shall be in lieu of
all other payments by the state or any town, except payments by said department or the state board of education and (4)
commission on hospitals and health care shall not include grant in establishing rates and specified that, in order to be
eligible for state grant the hospital shall cooperate with The University of Connecticut health center in order to provide
consolidated, coordinated pediatric services; June Sp. Sess. P.A. 83-32 amended Subsec. (a) which reduced the grant to
the Newington Children's Hospital from one million dollars to seven hundred fifty thousand dollars and excepted payments
by the department of health services from the provision that the state grant shall be in lieu of all other payments; P.A. 84-
442 deleted Subsec. (b) which would, effective July 1, 1984, establish the state's payment to the hospital at twenty-four
per cent of the hospital's operating expenses, and applied provisions formerly designated as Subsec. (a) to fiscal year
commencing July 1, 1984, and each year thereafter; P.A. 88-281 changed the amount of the annual grant, on behalf of the
department of health services, to the hospital from "the lesser of (1) seven hundred fifty thousand dollars or (2) the amount
by which twenty-four per cent of the operating expense of said hospital exceeds payments to said hospital by the department
of income maintenance for services to children for whom said department receives federal matching grants" to "the amount
appropriated to the department for the purposes of such grant" and repealed method for determination of "operating
expense"; P.A. 93-262 authorized substitution of commissioner and department of social services for commissioner and
department of income maintenance, effective July 1, 1993; P.A. 93-381 replaced department of health services with department of public health and addiction services, effective July 1, 1993; Sec. 17-308 transferred to Sec. 17b-234 in 1995;
P.A. 95-257 replaced Commissioner and Department of Public Health and Addiction Services with Commissioner and
Department of Public Health and replaced Commission on Hospitals and Health Care with Office of Health Care Access,
effective July 1, 1995; June 18 Sp. Sess. P.A. 97-8 deleted obsolete provision re grants to Newington Children's Hospital,
effective July 1, 1997.
Annotation to former section 17-308:
Cited. 33 CA 673, 693.
Nothing
in section 17b-234 shall preclude the state from paying retroactive claims to Newington
Children's Hospital for the purpose of claiming federal reimbursement.
(P.A. 73-273, S. 2, 3.)
History: Sec. 17-308a transferred to Sec. 17b-235 in 1995.
When there is found in any town in this state any
child of sound mind who is physically disabled or who is afflicted with poliomyelitis
or rheumatic fever, or any uncontagious disabling disease, and who is unable to pay and
whose relatives who are legally liable for his support are unable to pay the full cost of
treating such disease, if such child and one of such relatives reside in this state, the
selectmen of such town, or the guardian or any relative of such child, or any public
health agency or physician in this state, may make application to The Children's Center,
located at Hamden, for the admission of such child to said center. Said center shall admit
such child if such child is pronounced by the physicians on the staff of said center, after
examination, to be fit for admission, and said center shall keep and support such child
for such length of time as it deems proper. Said center shall not be required to admit
any such child unless it can conveniently receive and care for him at the time such
application is made, and said center may return to the town in which such child resides
any child so taken who is pronounced by the physicians on the staff of said center, after
examination, to be unfit for retention, or who, by reason of improvement in his condition
or completion of his treatment or training, ought not to be further retained. The center
may refuse to admit any child who is pronounced by the physicians on the staff of said
center, after examination, to be unfit for admission, and may refuse to admit any such
child when the facilities at the center will not, in the judgment of said physicians, permit
the center to care for such child adequately and properly.
(1955, S. 1442d; 1969, P.A. 571, S. 7, 9.)
History: 1969 act changed name of New Haven Orphan Asylum to the Children's Center; Sec. 17-309 transferred to
Sec. 17b-236 in 1995.
Sec. 17b-237. (Formerly Sec. 17-310). State aid toward support of children at
center. The state shall pay annually toward the support of children who have been
admitted to the center in accordance with the provisions of section 17b-236 twenty-five
per cent of the operating expense of the convalescent hospital for the preceding year
ended June thirtieth. Such amount shall be determined annually by the Commissioner
of Social Services. Upon the determination by said commissioner of such amount, said
commissioner shall notify the Comptroller thereof, and the Comptroller shall pay
monthly during the ensuing fiscal year one-twelfth of the amount so determined. Such
payments by the state shall not abrogate any responsibility for payments by the state or
any town or any person for care in said center, except that for care in said convalescent
hospital of any child directly supported by the state the charge for such care to the state
shall not exceed seventy-five per cent of the daily average cost rate for the preceding
year ended June thirtieth as such rate shall be determined by said commissioner.
(1955, S. 1443d; 1957, P.A. 541, S. 1; P.A. 73-117, S. 21, 31; P.A. 79-560, S. 25, 39; P.A. 93-262, S. 1, 87.)
History: P.A. 73-117 replaced hospital cost commission with "the committee established under ... section 17-311";
P.A. 79-560 replaced references to committee and incorrect references to its predecessor, the commission, with references
to commissioner of income maintenance; P.A. 93-262 authorized substitution of commissioner and department of social
services for commissioner and department of income maintenance, effective July 1, 1993; Sec. 17-310 transferred to Sec.
17b-237 in 1995.
(a) The
Commissioner of Social Services shall establish annually the cost of services for which
payment is to be made under the provisions of section 17b-239. All hospitals receiving
state aid shall submit their cost data under oath on forms approved by the commissioner.
The commissioner may adopt, in accordance with the provisions of chapter 54, regulations concerning the submission of data by institutions and agencies to which payments
are to be made under sections 17b-239, 17b-243, 17b-244, 17b-340, 17b-341 and section
17b-343, and the defining of policies utilized by the commissioner in establishing rates
under said sections, which data and policies are necessary for the efficient administration
of said sections. The commissioner shall provide, upon request, a statement of interpretation of the Medicaid cost-related reimbursement system regulations for long-term care
facilities reimbursed under section 17b-340 concerning allowable and unallowable costs
or expenditures. Such statement of interpretation shall not be construed to constitute a
regulation violative of chapter 54. Failure of such statement of interpretation to address
a specific unallowable cost or expenditure fact pattern shall in no way prevent the commissioner from enforcing all applicable laws and regulations.
(b) Any institution or agency to which payments are to be made under sections 17b-
239 to 17b-246, inclusive, and sections 17b-340 and 17b-343 which is aggrieved by
any decision of said commissioner may, within ten days after written notice thereof
from the commissioner, obtain, by written request to the commissioner, a rehearing on
all items of aggrievement. On and after July 1, 1996, a rehearing shall be held by the
commissioner or his designee, provided a detailed written description of all such items
is filed within ninety days of written notice of the commissioner's decision. The rehearing shall be held within thirty days of the filing of the detailed written description of
each specific item of aggrievement. The commissioner shall issue a final decision within
sixty days of the close of evidence or the date on which final briefs are filed, whichever
occurs later. Any designee of the commissioner who presides over such rehearing shall
be impartial and shall not be employed within the Department of Social Services office
of certificate of need and rate setting. Any such items not resolved at such rehearing to
the satisfaction of either such institution or agency or said commissioner shall be submitted to binding arbitration to an arbitration board consisting of one member appointed by
the institution or agency, one member appointed by the commissioner and one member
appointed by the Chief Court Administrator from among the retired judges of the Superior Court, which retired judge shall be compensated for his services on such board in
the same manner as a state referee is compensated for his services under section 52-
434. The proceedings of the arbitration board and any decisions rendered by such board
shall be conducted in accordance with the provisions of the Social Security Act, 49 Stat.
620 (1935), 42 USC 1396, as amended from time to time, and chapter 54.
(c) The submission of any false or misleading fiscal information or data to said
commissioner shall be grounds for suspension of payments by the state under sections
17b-239 to 17b-246, inclusive, and sections 17b-340 and 17b-343 in accordance with
regulations adopted by said commissioner. In addition, any person, including any corporation, who knowingly makes or causes to be made any false or misleading statement
or who knowingly submits false or misleading fiscal information or data on the forms
approved by the commissioner shall be guilty of a class D felony.
(d) Said commissioner, or any agent authorized by the commissioner to conduct
any inquiry, investigation or hearing under the provisions of this section, shall have
power to administer oaths and take testimony under oath relative to the matter of inquiry
or investigation. At any hearing ordered by the commissioner, the commissioner or such
agent having authority by law to issue such process may subpoena witnesses and require
the production of records, papers and documents pertinent to such inquiry. If any person
disobeys such process or, having appeared in obedience thereto, refuses to answer any
pertinent question put to him by the commissioner or his authorized agent or to produce
any records and papers pursuant thereto, the commissioner or his agent may apply to
the superior court for the judicial district of Hartford or for the judicial district wherein
the person resides or wherein the business has been conducted, or to any judge of said
court if the same is not in session, setting forth such disobedience to process or refusal
to answer, and said court or such judge shall cite such person to appear before said court
or such judge to answer such question or to produce such records and papers.
(1949, 1953, S. 1585d; 1961, P.A. 474, S. 1; February, 1965, P.A. 146; 1969, P.A. 506; 642, S. 1; 1971, P.A. 300; P.A.
73-117, S. 22, 31; P.A. 75-420, S. 4, 6; 75-562, S. 5, 8; P.A. 76-244; 76-436, S. 10a, 592, 681; P.A. 77-574, S. 3, 6; 77-
593, S. 3, 4; 77-614, S. 19, 344, 587, 610; P.A. 78-264, S. 1, 4; 78-280, S. 1, 5, 127; 78-303, S. 85, 136; P.A. 79-182, S.
2, 4; P.A. 80-196, S. 1, 2; P.A. 81-249; P.A. 83-73; P.A. 86-319, S. 2; P.A. 88-156, S. 18; 88-230, S. 1, 12; 88-317, S. 74,
107; P.A. 90-98, S. 1, 2; P.A. 93-142, S. 4, 7, 8; 93-262, S. 1, 87; P.A. 95-220, S. 4—6; 95-351, S. 24, 30.)
History: 1961 act added commissioners of finance and control and mental health, deleted requirement that commission
prescribe and provide uniform forms and provided that commission approve cost data forms; 1965 act added Subsec. (b);
1969 acts replaced hospital cost analyst with executive director of commission in Subsec. (a) and replaced appeal provisions
in Subsec. (b) with provisions for rehearing and required aggrieved hospital to file within ten days after receiving notice
rather than within thirty days; 1971 act replaced state budget director with commissioner of finance and control in Subsec.
(a) and added commission's power to make regulations and define policies used in establishing rates; P.A. 73-117 replaced
commission with committee, removed commissioner of health as member and added chairman and vice chairman of
commission on hospitals and health care and replaced provision concerning executive director with statement that necessary
staff will be made available by commission on hospitals and health care; P.A. 75-420 replaced welfare commissioner with
commissioner of social services; P.A. 75-562 made department of health responsible for supplying necessary staff; P.A.
76-244 added Subsec. (c) re power to administer oaths, take testimony, issue subpoenas, etc.; P.A. 76-436 replaced chief
judge with chief court administrator in Subsec. (b), effective July 1, 1978; P.A. 77-574 replaced "hospital" with "institution
or agency ..." in Subsec. (b); P.A. 77-593 inserted new Subsec. (c) re submission of false or misleading fiscal information
and relettered former Subsec. (c) as Subsec. (d); P.A. 77-614 and P.A. 78-303 replaced commissioner of finance and control
with secretary of the office of policy and management as committee member but later provision replaced committee with
commissioner of income maintenance and removed reference to staff supplied by health department, effective January 1,
1979; P.A. 78-264 repealed amendments to Subsec. (a) made by P.A. 77-614; P.A. 78-280 replaced "county" with "judicial
district" and "Hartford courts", with "judicial district of Hartford-New Britain"; P.A. 79-182 added reference to Sec. 17-
314a in Subsec. (a); P.A. 80-196 required that proceedings of arbitration board be conducted in accordance with Social
Security and Uniform Administrative Procedure Act; P.A. 81-249 amended Subsec. (c) to provide that any person, including
any corporation, who knowingly makes or causes to be made any false or misleading statement or who knowingly submits
false or misleading fiscal information shall be guilty of a class D felony; P.A. 83-73 amended Subsec. (a) to provide for a
statement of interpretation of the medicaid cost related reimbursement system regulations; P.A. 86-319 added references
to Sec. 17-314c; P.A. 88-156 made a technical correction in Subsec. (b); P.A. 88-230 replaced "judicial district of Hartford-
New Britain" with "judicial district of Hartford", effective September 1, 1991; P.A. 88-317 amended Subsec. (b) by
substituting "chapter 54" for "the Uniform Administrative Procedure Act, sections 4-166 to 4-189", effective July 1, 1989,
and applicable to all agency proceedings commencing on or after that date; P.A. 90-98 changed the effective date of P.A.
88-230 from September 1, 1991, to September 1, 1993; P.A. 93-142 changed the effective date of P.A. 88-230 from
September 1, 1993, to September 1, 1996, effective June 14, 1993; P.A. 93-262 authorized substitution of commissioner
and department of social services for commissioner and department of income maintenance, effective July 1, 1993; Sec.
17-311 transferred to Sec. 17b-238 in 1995; P.A. 95-220 changed the effective date of P.A. 88-230 from September 1,
1996, to September 1, 1998, effective July 1, 1995; P.A. 95-351 amended Subsec. (b) by adding provisions for a rehearing,
effective July 1, 1995.
See Sec. 19a-630 for applicable definitions.
Annotations to former section 17-311:
Subsec. (b):
Cited. 42 CS 348, 349, 351, 352, 354. Cited. Id., 558—561.
Subsec. (c):
Cited. 242 C. 345.
Annotations to present section:
Subsec. (a):
Cited. 242 C. 345.
Subsec. (c):
Cited. 242 C. 345.
(a)
The rate to be paid by the state to hospitals receiving appropriations granted by the
General Assembly and to freestanding chronic disease hospitals, providing services to
persons aided or cared for by the state for routine services furnished to state patients,
shall be based upon reasonable cost to such hospital, or the charge to the general public
for ward services or the lowest charge for semiprivate services if the hospital has no
ward facilities, imposed by such hospital, whichever is lowest, except to the extent, if
any, that the commissioner determines that a greater amount is appropriate in the case
of hospitals serving a disproportionate share of indigent patients. Such rate shall be
promulgated annually by the Commissioner of Social Services. Nothing contained
herein shall authorize a payment by the state for such services to any such hospital in
excess of the charges made by such hospital for comparable services to the general
public. Notwithstanding the provisions of this section, for the rate period beginning July
1, 2000, rates paid to freestanding chronic disease hospitals and freestanding psychiatric
hospitals shall be increased by three per cent. For the rate period beginning July 1, 2001,
a freestanding chronic disease hospital or freestanding psychiatric hospital shall receive
a rate that is two and one-half per cent more than the rate it received in the prior fiscal
year and such rate shall remain effective until December 31, 2002. Effective January
1, 2003, a freestanding chronic disease hospital or freestanding psychiatric hospital shall
receive a rate that is two per cent more than the rate it received in the prior fiscal year.
Notwithstanding the provisions of this subsection, for the period commencing July 1,
2001, and ending June 30, 2003, the commissioner may pay an additional total of no
more than three hundred thousand dollars annually for services provided to long-term
ventilator patients. For purposes of this subsection, "long-term ventilator patient" means
any patient at a freestanding chronic disease hospital on a ventilator for a total of sixty
days or more in any consecutive twelve-month period.
(b) Effective October 1, 1991, the rate to be paid by the state for the cost of special
services rendered by such hospitals shall be established annually by the commissioner
for each such hospital based on the reasonable cost to each hospital of such services
furnished to state patients. Nothing contained herein shall authorize a payment by the
state for such services to any such hospital in excess of the charges made by such hospital
for comparable services to the general public.
(c) The term "reasonable cost" as used in this section means the cost of care furnished such patients by an efficient and economically operated facility, computed in
accordance with accepted principles of hospital cost reimbursement. The commissioner
may adjust the rate of payment established under the provisions of this section for the
year during which services are furnished to reflect fluctuations in hospital costs. Such
adjustment may be made prospectively to cover anticipated fluctuations or may be made
retroactive to any date subsequent to the date of the initial rate determination for such
year or in such other manner as may be determined by the commissioner. In determining
"reasonable cost" the commissioner may give due consideration to allowances for fully
or partially unpaid bills, reasonable costs mandated by collective bargaining agreements
with certified collective bargaining agents or other agreements between the employer
and employees, provided "employees" shall not include persons employed as managers
or chief administrators, requirements for working capital and cost of development of
new services, including additions to and replacement of facilities and equipment. The
commissioner shall not give consideration to amounts paid by the facilities to employees
as salary, or to attorneys or consultants as fees, where the responsibility of the employees,
attorneys or consultants is to persuade or seek to persuade the other employees of the
facility to support or oppose unionization. Nothing in this subsection shall prohibit the
commissioner from considering amounts paid for legal counsel related to the negotiation
of collective bargaining agreements, the settlement of grievances or normal administration of labor relations.
(d) The state shall also pay to such hospitals for each outpatient clinic and emergency
room visit a reasonable rate to be established annually by the commissioner for each
hospital, such rate to be determined by the reasonable cost of such services. The emergency room visit rates in effect June 30, 1991, shall remain in effect through June 30,
1993, except those which would have been decreased effective July 1, 1991, or July 1,
1992, shall be decreased. Nothing contained herein shall authorize a payment by the
state for such services to any hospital in excess of the charges made by such hospital
for comparable services to the general public. For those outpatient hospital services paid
on the basis of a ratio of cost to charges, the ratios in effect June 30, 1991, shall be
reduced effective July 1, 1991, by the most recent annual increase in the consumer price
index for medical care. For those outpatient hospital services paid on the basis of a ratio
of cost to charges, the ratios computed to be effective July 1, 1994, shall be reduced
by the most recent annual increase in the consumer price index for medical care. The
emergency room visit rates in effect June 30, 1994, shall remain in effect through December 31, 1994. The Commissioner of Social Services shall establish a fee schedule for
outpatient hospital services to be effective on and after January 1, 1995. Except with
respect to the rate periods beginning July 1, 1999, and July 1, 2000, such fee schedule
shall be adjusted annually beginning July 1, 1996, to reflect necessary increases in the
cost of services. Notwithstanding the provisions of this subsection, the fee schedule for
the rate period beginning July 1, 2000, shall be increased by ten and one-half per cent,
effective June 1, 2001.
(e) The commissioner shall adopt regulations, in accordance with the provisions of
chapter 54, establishing criteria for defining emergency and nonemergency visits to
hospital emergency rooms. All nonemergency visits to hospital emergency rooms shall
be paid at the hospital's outpatient clinic services rate. Nothing contained in this subsection or the regulations adopted hereunder shall authorize a payment by the state for such
services to any hospital in excess of the charges made by such hospital for comparable
services to the general public.
(f) On and after October 1, 1984, the state shall pay to an acute care general hospital
for the inpatient care of a patient who no longer requires acute care a rate determined
by the following schedule: For the first seven days following certification that the patient
no longer requires acute care the state shall pay the hospital at a rate of fifty per cent of
the hospital's actual cost; for the second seven-day period following certification that
the patient no longer requires acute care the state shall pay seventy-five per cent of the
hospital's actual cost; for the third seven-day period following certification that the
patient no longer requires acute care and for any period of time thereafter, the state shall
pay the hospital at a rate of one hundred per cent of the hospital's actual cost. On and
after July 1, 1995, no payment shall be made by the state to an acute care general hospital
for the inpatient care of a patient who no longer requires acute care and is eligible for
Medicare unless the hospital does not obtain reimbursement from Medicare for that stay.
(g) Effective June 1, 2001, the commissioner shall establish inpatient hospital rates
in accordance with the method specified in regulations adopted pursuant to this section
and applied for the rate period beginning October 1, 2000, except that the commissioner
shall update each hospital's target amount per discharge to the actual allowable cost per
discharge based upon the 1999 cost report filing multiplied by sixty-two and one-half
per cent if such amount is higher than the target amount per discharge for the rate period
beginning October 1, 2000, as adjusted for the ten per cent incentive identified in Section
4005 of Public Law 101-508. If a hospital's rate is increased pursuant to this subsection,
the hospital shall not receive the ten per cent incentive identified in Section 4005 of
Public Law 101-508. For rate periods beginning October 1, 2001, and October 1, 2002,
the commissioner shall not apply an annual adjustment factor to the target amount per
discharge.
(1949, 1953, S. 1586d; 1961, P.A. 474, S. 2; 1967, P.A. 726, S. 1; 1969, P.A. 339, S. 1; P.A. 73-117, S. 23, 31; P.A.
77-574, S. 4, 6; P.A. 79-560, S. 26, 39; P.A. 81-472, S. 111, 159; P.A. 84-367, S. 1, 3; P.A. 85-482, S. 1, 2; P.A. 87-27,
S. 1; 87-516, S. 1, 5; P.A. 88-156, S. 19; P.A. 89-296, S. 6, 9; June Sp. Sess. P.A. 91-8, S. 13, 43, 63; May Sp. Sess. P.A.
92-16, S. 25, 89; P.A. 93-262, S. 1, 87; May Sp. Sess. P.A. 94-5, S. 2, 30; P.A. 95-160, S. 25, 69; 95-306, S. 1, 7; 95-351,
S. 28, 30; P.A. 96-139, S. 12, 13; P.A. 98-131, S. 1, 2; P.A. 99-279, S. 13, 14, 45; June Sp. Sess. P.A. 00-2, S. 15, 53; June
Sp. Sess. P.A. 01-2, S. 11, 66, 69; June Sp. Sess. P.A. 01-3, S. 1, 2, 6; June Sp. Sess. P.A. 01-9, S. 119, 120, 121, 129, 131;
May 9 Sp. Sess. P.A. 02-7, S. 57.)
History: 1961 act changed technical language, added standard of comparable charges to Subsec. (a), deleted requirement
of Subsec. (b) that special services be professional and added Subsec. (c); 1967 act changed term "welfare" to "state"
patients, restricted standard of comparable charges in Subsec. (a), made allowances for unpaid bills, working capital
requirements and services development costs in determination of "actual cost" in Subsec. (c) and added Subsec. (d); 1969
act allowed alternative rates in Subsec. (a) based on charges for ward or semiprivate facilities and placed limit on rate for
outpatient clinic visit in Subsec. (d); P.A. 73-117 replaced hospital cost commission with committee established in accordance with Sec. 17-311; P.A. 77-574 included allowances for costs associated with collective bargaining agreements in
Subsec. (c); P.A. 79-560 replaced committee with commissioner of income maintenance; P.A. 81-472 made technical
changes; P.A. 84-367 changed the basis of the rate from "actual" to "reasonable" cost and added Subsec. (e) setting rates
for the inpatient care of patients who no longer require acute care; P.A. 85-482 amended Subsec. (d) by substituting "one
hundred sixteen" per cent for "one hundred fifty" per cent of combined average fee of general practitioner and specialist
for office visit as maximum rate for an outpatient clinic visit; P.A. 87-27 amended Subsec. (c) to exclude from "reasonable
cost" amounts paid to employees, attorneys or consultants due to unionization disputes; P.A. 87-516 allowed the commissioner to establish a rate cap if he receives approval for a disproportionate share exemption pursuant to federal regulations;
P.A. 88-156 added freestanding chronic disease hospitals providing services to persons aided or cared for by the state for
routine services furnished to state patients and gave the commissioner the discretion to set a higher rate for hospitals serving
a disproportionate share of indigent patients; P.A. 89-296 amended Subsec. (d) to prohibit the state from paying a hospital
for services in excess of the charges made by the hospital for comparable services to the public, added a new Subsec. (e)
requiring the commissioner to adopt regulations establishing criteria for defining emergency and nonemergency visits to
hospital emergency rooms and relettered former Subsec. (e) as Subsec. (f); June Sp. Sess. P.A. 91-8 amended Subsec. (b)
to add a provision re payment by the state of charges in excess of charges made when comparable service is rendered to
the general public and amended Subsec. (d) re rates paid by the state for outpatient clinic, services, emergency room visits
and outpatient hospital services paid on the basis of a ratio of cost to charges; May Sp. Sess. P.A. 92-16 amended Subsec.
(d) by providing that emergency room visit rates in effect on June 30, 1991, shall remain in effect through June 30, 1993,
except that those which would decrease on July 1, 1992, shall decrease; P.A. 93-262 authorized substitution of commissioner
and department of social services for commissioner and department of income maintenance, effective July 1, 1993; May
Sp. Sess. P.A. 94-5 amended Subsec. (d) to add a formula concerning outpatient hospital services paid on the basis of a
ratio of cost to charges and required the commissioner to establish a fee schedule for outpatient hospital services, effective
July 1, 1994; Sec. 17-312 transferred to Sec. 17b-239 in 1995; P.A. 95-160 amended Subsec. (a) by adding a provision
for rates to be paid to freestanding chronic disease hospitals, effective July 1, 1995; P.A. 95-306 amended Subsec. (f) by
prohibiting payment to an acute care general hospital for inpatient care of a patient if such patient is no longer in need of
such care and is eligible for Medicare, unless Medicare reimbursement is not received for such care, effective July 1, 1995;
P.A. 95-351 amended Subsec. (a) by providing that the commissioner use the "actual charge based on utilized service"
instead of the "cost of service" when determining rates paid to freestanding chronic disease hospitals, effective July 1,
1995; P.A. 96-139 changed effective date of P.A. 95-160 but without affecting this section; P.A. 98-131 added new Subsec.
(g) requiring commissioner to establish hospital inpatient rates, effective July 1, 1998; P.A. 99-279 amended Subsec. (d)
to eliminate annual increases in the fee schedule for outpatient hospital services for the rate periods beginning July 1, 1999,
and July 1, 2000, and amended Subsec. (g) to provide an exception for the rate period beginning October 1, 1998, from
the application of the three per cent annual adjustment factor to the target amount per discharge, to prohibit the commissioner
from applying an annual adjustment factor for succeeding rate periods, and to make a technical change, effective July 1,
1999; June Sp. Sess. P.A. 00-2 amended Subsec. (a) by deleting provisions re rates paid to freestanding chronic disease
hospitals on and after July 1, 1995, and inserting provisions re rates paid to freestanding chronic disease hospitals and
freestanding psychiatric hospitals, beginning July 1, 2000, and thereafter, effective July 1, 2000; June Sp. Sess. P.A. 01-
2 amended Subsec. (a) to make a technical change for the purpose of gender neutrality, to require commissioner to use the
rate of the highest-paid freestanding chronic disease hospital for any freestanding chronic disease hospital having more
than an average of fifteen per cent of its inpatient days utilized as long-term ventilator patient days beginning for the rate
period ending in 2001, in lieu of rate paid for period when determining rates paid on and after July 1, 2001, notwithstanding
provisions of subsection, and to define term "long-term ventilator patient", effective July 1, 2001, and further amended
Subsec. (a) to remove discretion of commissioner re determination of appropriate amount in the case of hospitals serving
a disproportionate number share of indigent patients and to replace provisions re rates paid to freestanding chronic disease
hospitals and freestanding psychiatric hospitals for rate period beginning July 1, 2001, effective July 2, 2001; June Sp.
Sess. P.A. 01-3 amended Subsec. (d) by deleting provisions re rate for outpatient clinic visit and rate cap for outpatient
clinics upon approval of disproportionate share exemption and adding provision re increase of fee schedule for rate period
beginning July 1, 2001, and amended Subsec. (g) by deleting former provisions and adding provisions re establishment
of inpatient hospital rates, effective July 1, 2001; June Sp. Sess. P.A. 01-9 amended Subsec. (d) to make ten and one-half
per cent increase applicable to rate period beginning July 1, 2000, and effective June 1, 2001, and amended Subsec. (g) to
make June 1, 2001, the date by which the commissioner is to establish inpatient hospital rates, effective July 1, 2001, and
revised effective date of June Sp. Sess. P.A. 01-2 but without affecting this section; May 9 Sp. Sess. P.A. 02-7 amended
Subsec. (a) by delaying from July 1, 2002, to January 1, 2003, a two per cent rate increase to a free standing chronic disease
hospital and a free standing psychiatric hospital and maintaining effectiveness of existing rate until December 31, 2002,
effective August 15, 2002.
Annotations to former section 17-312:
Cited. 175 C. 49, 60, 65. Cited. 181 C. 130—132, 135.
Subsec. (a):
Cited. 175 C. 49, 60. Cited. 181 C. 130, 133, 135.
For the fiscal year ending June 30, 2002, and the fiscal year
ending June 30, 2003, the Department of Social Services may, within available funds,
make payments to all short-term general hospitals located in distressed municipalities, as
defined in section 32-9p, with a population greater than seventy thousand. The payment
amount for each hospital shall be determined by the Commissioner of Social Services
based upon the ratio that the number of inpatient discharges paid by Medicaid on a fee-
for-service basis to the hospital for the most recently filed cost report period bears to
the total hospital discharges paid by Medicaid on a fee-for-service basis for all qualifying
hospitals. Notwithstanding the provisions of this section, no payment shall be made to
a facility licensed as a children's hospital.
(June Sp. Sess. P.A. 01-3, S. 4, 6.)
History: June Sp. Sess. P.A. 01-3 effective July 1, 2001.
Sec. 17b-240. (Formerly Sec. 17-312a). Payments to hospitals by the Office of
Health Care Access. Notwithstanding the provisions of section 17b-239, the rate to be
paid by the state to a hospital receiving appropriations granted by the General Assembly
shall be established annually by the Office of Health Care Access pursuant to the provisions of chapter 368z, provided said office receives a waiver of Medicare principles of
reimbursement from the Department of Health and Human Services pursuant to Section
222 of Public Law 92-603. This section shall be effective only for such period as said
waiver remains in effect.
(P.A. 78-250, S. 1, 2; P.A. 95-257, S. 39, 58.)
History: Sec. 17-312a transferred to Sec. 17b-240 in 1995; P.A. 95-257 replaced Commission on Hospitals and Health
Care with Office of Health Care Access, effective July 1, 1995.
Annotations to former section 17-312a:
Cited. 181 C. 130, 135.
(a) Any
rates established by the Commissioner of Social Services in effect February 1, 1991,
for mental health and substance abuse residential facilities shall remain in effect through
June 30, 1992, except those which would have been decreased effective July 1, 1991,
shall be decreased. Any rate increases made during the fiscal year ending June 30, 1993,
shall not exceed the most recent annual increase in the consumer price index for urban
consumers.
(b) Any rates established by the Commissioner of Social Services in effect February
1, 1991, for free-standing detoxification centers shall remain in effect through June 30,
1992, except those which would have been decreased effective July 1, 1991, shall be
decreased. Any rate increases made during the fiscal years ending June 30, 1993, June
30, 1994, and June 30, 1995, shall not exceed the most recent annual increase in the
consumer price index for urban consumers. Any free-standing detoxification center
which has an established rate below the average and, due to a material change in circumstances resulting in financial hardship, is aggrieved by a rate determined pursuant to
this subsection may, within ten days of receipt of written notice of such rate from the
commissioner, request in writing a hearing on such rate. The commissioner shall, upon
the receipt of all documentation necessary to evaluate the request, determine whether
there has been such a change in circumstances and shall conduct a hearing if appropriate.
(June Sp. Sess. P.A. 91-8, S. 16, 63; May Sp. Sess. P.A. 92-16, S. 33, 89; P.A. 93-262, S. 1, 87; 93-418, S. 23, 41.)
History: May Sp. Sess. P.A. 92-16 amended Subsecs. (a) and (b) by adding provision to each requiring that any rate
increases made during the fiscal year ending June 30, 1993, shall not exceed the most recent annual increase in the consumer
price index for urban consumers; P.A. 93-262 authorized substitution of commissioner and department of social services
for commissioner and department of income maintenance, effective July 1, 1993; P.A. 93-418 amended Subsec. (b) to
make provisions applicable to the fiscal years ending June 30, 1994, and June 30, 1995 and added provision regarding
free-standing detoxification centers' request for hearing on a rate established by the commissioner, effective July 1, 1993;
Sec. 17-312b transferred to Sec. 17b-241 in 1995.
Sec. 17b-242. (Formerly Sec. 17-313). Payments to home health care agencies
and homemaker-home health aide agencies. Appeals. Hearings. Regulations. (a)
The Department of Social Services shall determine the rates to be paid to home health
care agencies and homemaker-home health aide agencies by the state or any town in
the state for persons aided or cared for by the state or any such town. For the period
from February 1, 1991, to January 31, 1992, inclusive, payment for each service to the
state shall be based upon the rate for such service as determined by the Office of Health
Care Access, except that for those providers whose Medicaid rates for the year ending
January 31, 1991, exceed the median rate, no increase shall be allowed. For those providers whose rates for the year ending January 31, 1991, are below the median rate, increases
shall not exceed the lower of the prior rate increased by the most recent annual increase
in the consumer price index for urban consumers or the median rate. In no case shall
any such rate exceed the eightieth percentile of rates in effect January 31, 1991, nor
shall any rate exceed the charge to the general public for similar services. Rates effective
February 1, 1992, shall be based upon rates as determined by the Office of Health Care
Access, except that increases shall not exceed the prior year's rate increased by the
most recent annual increase in the consumer price index for urban consumers and rates
effective February 1, 1992, shall remain in effect through June 30, 1993. Rates effective
July 1, 1993, shall be based upon rates as determined by the Office of Health Care
Access except if the Medicaid rates for any service for the period ending June 30, 1993,
exceed the median rate for such service, the increase effective July 1, 1993, shall not
exceed one per cent. If the Medicaid rate for any service for the period ending June 30,
1993, is below the median rate, the increase effective July 1, 1993, shall not exceed the
lower of the prior rate increased by one and one-half times the most recent annual increase in the consumer price index for urban consumers or the median rate plus one per
cent. The Commissioner of Social Services shall establish a fee schedule for home health
services to be effective on and after July 1, 1994. The commissioner may annually
increase any fee in the fee schedule based on an increase in the cost of services. The
commissioner shall increase the fee schedule for home health services provided under
the Connecticut home-care program for the elderly established under section 17b-342,
effective July 1, 2000, by two per cent over the fee schedule for home health services
for the previous year. The commissioner may increase any fee payable to a home health
care agency or homemaker-home health aide agency upon the application of such an
agency evidencing extraordinary costs related to (1) serving persons with AIDS; (2)
high-risk maternal and child health care; (3) escort services; or (4) extended hour services. In no case shall any rate or fee exceed the charge to the general public for similar
services. A home health care agency or homemaker-home health aide agency which,
due to any material change in circumstances, is aggrieved by a rate determined pursuant
to this subsection may, within ten days of receipt of written notice of such rate from the
Commissioner of Social Services, request in writing a hearing on all items of aggrievement. The commissioner shall, upon the receipt of all documentation necessary
to evaluate the request, determine whether there has been such a change in circumstances
and shall conduct a hearing if appropriate. The Commissioner of Social Services shall
adopt regulations, in accordance with chapter 54, to implement the provisions of this
subsection. The commissioner may implement policies and procedures to carry out the
provisions of this subsection while in the process of adopting regulations, provided
notice of intent to adopt the regulations is published in the Connecticut Law Journal
within twenty days of implementing the policies and procedures. Such policies and
procedures shall be valid for not longer than nine months.
(b) The Department of Social Services shall monitor the rates charged by home
health care agencies and homemaker-home health aide agencies. Such agencies shall
file annual cost reports and service charge information with the department.
(1957, P.A. 539; P.A. 73-117, S. 24, 31; P.A. 78-264, S. 2, 4; P.A. 91-406, S. 5, 29; June Sp. Sess. P.A. 91-8, S. 20,
63; May Sp. Sess. P.A. 92-16, S. 26, 89; P.A. 93-262, S. 1, 20, 87; 93-418, S. 24, 41; 93-435, S. 59, 95; May Sp. Sess.
P.A. 94-5, S. 22, 30; P.A. 95-257, S. 39, 58; 95-351, S. 14, 30; P.A. 96-268, S. 5, 34; P.A. 99-130; June Sp. Sess. P.A. 00-
2, S. 16, 53; P.A. 02-101, S. 13.)
History: P.A. 73-117 replaced hospital cost commission with committee established under Sec. 17-311; P.A. 78-264
replaced public health nursing agencies with home health care and homemaker-home health aide agencies and replaced
previous rate provisions with statement that rate to be determined by commission on hospitals and health care; P.A. 91-
406 corrected an internal reference; June Sp. Sess. P.A. 91-8 amended the section by replacing "state" with the specific
departments, by specifying the rates paid by the state to home health care agencies and homemaker-home health aide
agencies and by adding provisions re the appeal of a rate determination; May Sp. Sess. P.A. 92-16 provided that rates in
effect on February 1, 1992, shall remain in effect through June 30, 1993; P.A. 93-262 removed the references to departments
of income maintenance, human resources and aging and provided that the department of social services shall determine
rates to be charged home health care agencies and homemaker-home health aide agencies, made technical changes and
added provisions requiring commissioner to adopt regulations, effective July 1, 1993; P.A. 93-418 added provisions regarding rates effective July 1, 1993, which are determined by the commission on hospitals and health care and authorizing
income maintenance commissioner to establish fee schedule on and after July 1, 1994, effective July 1, 1993; P.A. 93-435
authorized the Revisors to substitute social services commissioner for income maintenance commissioner in P.A. 93-418,
effective June 28, 1993; May Sp. Sess. P.A. 94-5 allowed the fee schedule to be phased in over a two-year period and
allowed the commissioner to increase any fee payable to a home health care agency or homemaker-home health aide
agency if there are extraordinary costs, effective July 1, 1994; Sec. 17-313 transferred to Sec. 17b-242 in 1995; P.A. 95-
257 replaced Commission on Hospitals and Health Care with Office of Health Care Access, effective July 1, 1995; P.A.
95-351 added Subdiv. (4) allowing the commissioner to increase any fee payable for extraordinary costs relating to extended
hour services, effective July 1, 1995 (Revisor's note: In the first sentence the phrase "rates to be charged by home health
care agencies and the rates to be paid" was changed editorially by the Revisors to read "rates to be charged by home health
care agencies and homemaker-home health aide agencies and the rates to be paid" to correct a clerical error in the preparation
of the 1995 General Statutes); P.A. 96-268 added reference to homemaker-home health aide agencies, effective July 1,
1996; P.A. 99-130 designated existing language as Subsec. (a), eliminating the responsibility of the department to determine
rates to be charged by home health care agencies and homemaker-home health aide agencies and added Subsec. (b) requiring
the department to monitor the rates charged by such agencies, requiring such agencies to file annual cost reports and service
charge information with the department, and made technical changes; June Sp. Sess. P.A. 00-2 amended Subsec. (a) by
deleting provision re phasing in the fee schedule over a two-year period and inserting provision requiring the commissioner
to increase by two per cent the fee schedule for home health care services provided under the Connecticut home-care
program for the elderly, effective July 1, 2000; P.A. 02-101 amended Subsec. (a) to make a technical change, effective
July 1, 2002.
(a)
The rate to be paid by the state to rehabilitation centers, including but not limited to,
centers affiliated with the Easter Seal Society of Connecticut, Inc., for services to patients
referred by any state agency, except employment opportunities and day services, as
defined in section 17a-246, shall be determined annually by the Commissioner of Social
Services who shall prescribe uniform forms on which such rehabilitation centers shall
report their costs, except that rates effective April 30, 1989, shall remain in effect through
May 31, 1990, and rates in effect February 1, 1991, shall remain in effect through December 31, 1992, except those which would be decreased effective January 1, 1992, shall
be decreased. For the rate years beginning January 1, 1993, through December 31, 1995,
any rate increase shall not exceed the most recent annual increase in the consumer price
index for urban consumers. Such rates shall be determined on the basis of a reasonable
payment for necessary services rendered. Nothing contained herein shall authorize a
payment by the state to any such rehabilitation center in excess of the charges made by
such center for comparable services to the general public. The Commissioner of Social
Services shall establish a fee schedule for rehabilitation services to be effective on and
after January 1, 1996. The fee schedule may be adjusted annually beginning July 1,
1997, to reflect necessary increases in the cost of services.
(b) The amount to be paid by the state to rehabilitation centers including but not
limited to centers affiliated with the Easter Seal Society of Connecticut, Inc., for employment opportunities and day services to patients referred by any state agency shall be
determined annually using a uniform payment system in accordance with the provisions
of subsection (a) of section 17a-246.
(1969, P.A. 346, S. 1; P.A. 73-117, S. 25, 31; P.A. 79-560, S. 27, 39; P.A. 80-483, S. 174, 186; P.A. 89-325, S. 13, 26;
June Sp. Sess. P.A. 91-8, S. 14, 63; May Sp. Sess. P.A. 92-16, S. 27, 89; P.A. 93-262, S. 1, 87; 93-418, S. 25, 41; P.A. 95-
160, S. 66, 69; P.A. 96-139, S. 12, 13.)
History: P.A. 73-117 replaced hospital cost commission with committee established under Sec. 17-311; P.A. 79-560
replaced the committee with commissioner of income maintenance; P.A. 80-483 deleted "for Crippled Children and Adults"
in Easter Seal Society name; P.A. 89-325 amended Subsec. (a) to exclude centers that provide employment opportunities
and day services from the rate setting in this section, it also allows rates effective April 30, 1989, to remain in effect through
May 31, 1990, and added a new Subsec. (b) re rates for centers providing employment opportunities and day services;
June Sp. Sess. P.A. 91-8 amended Subsec. (a) re rates paid by the state for rehabilitation centers; May Sp. Sess. P.A. 92-
16 amended Subsec. (a) by providing that for the rate year beginning January 1, 1993, any rate increase shall not exceed
the most recent annual increase in the consumer price index for urban consumers. P.A. 93-262 authorized substitution of
commissioner and department of social services for commissioner and department of income maintenance, effective July
1, 1993; P.A. 93-418 amended Subsec. (a) concerning rate increases and the consumer price index to specify applicability
for any succeeding rate year after January 1, 1993, effective July 1, 1993; Sec. 17-313a transferred to Sec. 17b-243 in
1995; P.A. 95-160 amended Subsec. (a) by replacing "any succeeding year" with "December 31, 1995" for the period of
time after January 1, 1993, which shall not have a rate increase exceeding the most recent annual increase in the consumer
price index for urban consumers and by adding a provision requiring the commissioner to establish a fee schedule for
rehabilitation services to be effective on and after January 1, 1996, effective June 1, 1995; P.A. 96-139 changed effective
date of P.A. 95-160 but without affecting this section.
(a) The room and
board component of the rates to be paid by the state to private facilities and facilities
operated by regional education service centers which are licensed to provide residential
care pursuant to section 17a-227, but not certified to participate in the Title XIX Medicaid program as intermediate care facilities for persons with mental retardation, shall be
determined annually by the Commissioner of Social Services, except that rates effective
April 30, 1989, shall remain in effect through October 31, 1989. Any facility with real
property other than land placed in service prior to July 1, 1991, shall, for the fiscal year
ending June 30, 1995, receive a rate of return on real property equal to the average of
the rates of return applied to real property other than land placed in service for the five
years preceding July 1, 1993. For the fiscal year ending June 30, 1996, and any succeeding fiscal year, the rate of return on real property for property items shall be revised
every five years. The commissioner shall, upon submission of a request by such facility,
allow actual debt service, comprised of principal and interest, on the loan or loans in lieu
of property costs allowed pursuant to section 17-313b-5 of the regulations of Connecticut
state agencies, whether actual debt service is higher or lower than such allowed property
costs, provided such debt service terms and amounts are reasonable in relation to the
useful life and the base value of the property. In the case of facilities financed through
the Connecticut Housing Finance Authority, the commissioner shall allow actual debt
service, comprised of principal, interest and a reasonable repair and replacement reserve
on the loan or loans in lieu of property costs allowed pursuant to section 17-313b-5 of
the regulations of Connecticut state agencies, whether actual debt service is higher or
lower than such allowed property costs, provided such debt service terms and amounts
are determined by the commissioner at the time the loan is entered into to be reasonable
in relation to the useful life and base value of the property. For the fiscal year ending
June 30, 1992, the inflation factor used to determine rates shall be one-half of the gross
national product percentage increase for the period between the midpoint of the cost
year through the midpoint of the rate year. For fiscal year ending June 30, 1993, the
inflation factor used to determine rates shall be two-thirds of the gross national product
percentage increase from the midpoint of the cost year to the midpoint of the rate year.
For the fiscal years ending June 30, 1996, and June 30, 1997, no inflation factor shall
be applied in determining rates. The Commissioner of Social Services shall prescribe
uniform forms on which such facilities shall report their costs. Such rates shall be determined on the basis of a reasonable payment for necessary services. Any increase in
grants, gifts, fund-raising or endowment income used for the payment of operating costs
by a private facility in the fiscal year ending June 30, 1992, shall be excluded by the
commissioner from the income of the facility in determining the rates to be paid to the
facility for the fiscal year ending June 30, 1993, provided any operating costs funded
by such increase shall not obligate the state to increase expenditures in subsequent fiscal
years. Nothing contained in this section shall authorize a payment by the state to any
such facility in excess of the charges made by the facility for comparable services to
the general public. The service component of the rates to be paid by the state to private
facilities and facilities operated by regional education service centers which are licensed
to provide residential care pursuant to section 17a-227, but not certified to participate
in the Title XIX Medicaid programs as intermediate care facilities for persons with
mental retardation, shall be determined annually by the Commissioner of Mental Retardation.
(b) The Commissioner of Social Services and the Commissioner of Mental Retardation shall adopt regulations in accordance with the provisions of chapter 54 to implement
the provisions of this section.
(1971, P.A. 560, S. 1; P.A. 73-117, S. 26, 31; P.A. 79-227; 79-560, S. 28, 39; June Sp. Sess. P.A. 83-39, S. 1, 2, 18;
P.A. 84-546, S. 54, 173; P.A. 88-71; P.A. 89-325, S. 14, 26; June Sp. Sess. P.A. 91-8, S. 15, 63; June Sp. Sess. P.A. 91-
11, S. 11, 25; May Sp. Sess. P.A. 92-16, S. 28, 89; P.A. 93-262, S. 1, 87; May Sp. Sess. P.A. 94-5, S. 11, 30; P.A. 95-160,
S. 65, 69; P.A. 96-139, S. 12, 13; 96-188, S. 1, 2.)
History: P.A. 73-117 replaced hospital cost commission with committee established under Sec. 17-311; P.A. 79-227
replaced committee with commissioner of income maintenance, included payments to community residences and changed
Association for Retarded Children to Association for Retarded Citizens; P.A. 79-560 deleted reference to Sec. 17-311;
June Sp. Sess. P.A. 83-39 provided for payment to private nonprofit facilities providing functional and vocational services
for severely handicapped persons and to private facilities operated by regional education service centers providing residential care and added Subsec. (b) re establishment of separate rate (Revisor's note: Subsec. (c) was added editorially by the
Revisors); P.A. 84-546 confirmed Revisors' action in editorially adding Subsec. (c) re adoption of regulations; P.A. 88-
71 substantially rewrote section to empower commissioner of mental retardation to establish service component of rates
where previously commissioner of income maintenance had set all rates and commissioner of mental retardation had
performed a consultative role; P.A. 89-325 allowed rates in effect April 30, 1989, to remain in effect through October 31,
1989, and also deleted language re rates to be paid to private nonprofit facilities in Subsec. (a); June Sp. Sess. P.A. 91-8
amended Subsec. (a) re rates paid by the state to private facilities providing functional or vocational services for severely
handicapped persons and clients of residential care facilities; June Sp. Sess. P.A. 91-11 amended Subsec. (a) to prohibit
the department of income maintenance from considering any grants, gifts, fund-raising or endowment income used during
the preceding year for payment of operating costs by a private facility in determining the facility's rates for fiscal year
1992-93; May Sp. Sess. P.A. 92-16 amended Subsec. (a) by providing that for the fiscal year ending June 30, 1993, the
inflation factor used to determine rates shall be two-thirds of the gross national product percentage increase from the
midpoint of the cost year to the midpoint of the rate year (Revisor's note: In Subsec. (a) in the sentence beginning "For
the fiscal year ending June 30, 1992," the words "period between the" were inserted before the word "midpoint" and the
words "cost year through the midpoint of the" were inserted before the words "rate year" editorially by the Revisors
to reinstate existing language omitted through clerical error); P.A. 93-262 authorized substitution of commissioner and
department of social services for commissioner and department of income maintenance, effective July 1, 1993; May Sp.
Sess. P.A. 94-5 amended Subsec. (a) to establish a formula for rates of return for real property for facilities with real
property other than land placed in service prior to July 1, 1991, effective July 1, 1994; Sec. 17-313b transferred to Sec.
17b-244 in 1995; P.A. 95-160 amended Subsec. (a) by adding a provision that for fiscal years ending June 30, 1996, and
June 30, 1997, no inflation factor shall be applied in determining rates, effective June 1, 1995; P.A. 96-139 changed
effective date of P.A. 95-160 but without affecting this section; P.A. 96-188 provided that the commissioner shall allow,
upon request of a facility, actual debt service whether higher or lower than allowed property costs, provided that, in the
case of facilities financed through the Connecticut Housing Finance Authority, the commissioner shall allow actual debt
service whether higher or lower than allowed property costs, provided such debt service terms and amounts are determined
by the commissioner at the time the loan is entered into to be reasonable in relation to the useful life and base value of the
property and made a technical change, effective May 31, 1996.
Sec. 17b-245. (Formerly Sec. 17-313c). Payments to day care and vocational
training programs sponsored by certain associations. (a) The rates to be paid by the
state to the day care and vocational training programs sponsored by the associations
affiliated with United Cerebral Palsy of Connecticut, Inc., Epilepsy Foundation of
America, Inc., Goodwill Industries of America, Inc. and to any private, nonprofit agency
providing such programs for autistic or neurologically impaired persons, for services
to clients referred by any state agency, except employment opportunities and day services, as defined in section 17a-246, shall be determined annually by the Commissioner
of Social Services who shall prescribe uniform forms on which such day care and vocational training programs shall report their costs, except that rates effective April 30,
1989, shall remain in effect through May 31, 1990. Such rates shall be determined on
the basis of a reasonable payment for necessary services rendered. Nothing contained
herein shall authorize a payment by the state to any such day care or vocational training
program in excess of the charges made by such programs for comparable services to
the general public.
(b) The amount to be paid by the state to the day care and vocational training programs sponsored by the associations affiliated with United Cerebral Palsy of Connecticut, Inc., Epilepsy Foundation of America, Inc., Goodwill Industries of America, Inc.
and to any private, nonprofit agency providing such programs for autistic or neurologically impaired or severely handicapped persons, for employment opportunities and day
services to clients referred by any state agency shall be determined annually using a
uniform payment system in accordance with the provisions of subsection (a) of section
17a-246.
(P.A. 77-371; P.A. 79-560, S. 29, 39; P.A. 89-325, S. 15, 26; P.A. 93-262, S. 1, 87.)
History: P.A. 79-560 replaced committee established under Sec. 17-311 with commissioner of income maintenance;
P.A. 89-325 added reference to employment opportunities and day services in Sec. 19a-483d and allowed rates effective
April 30, 1989, to remain in effect through May 31, 1990, in Subsec. (a) and added a new Subsec. (b) re rates to day care
and vocational training programs; P.A. 93-262 authorized substitution of commissioner and department of social services
for commissioner and department of income maintenance, effective July 1, 1993; Sec. 17-313c transferred to Sec. 17b-
245 in 1995.
On and after
April 1, 1996, in the determination of rates for federally qualified health centers, the
Commissioner of Social Services shall apply Medicare productivity standards and a
maximum allowable per visit cost of one hundred fifteen per cent of the median cost
per visit.
(P.A. 95-160, S. 67, 69; P.A. 96-139, S. 12, 13.)
History: P.A. 95-160, S. 67 effective June 1, 1995; P.A. 96-139 changed effective date of P.A. 95-160 but without
affecting this section.
Sec. 17b-246. (Formerly Sec. 17-313d). Rates to include reimbursement for
reasonable costs mandated by collective bargaining agreements. For purposes of
establishing rates to be paid by the state (1) to private facilities which provide functional,
vocational services or residential services for severely handicapped persons pursuant to
section 17b-244, and (2) to associations which provide day care and vocational training
programs pursuant to section 17b-245, the state shall include reimbursement for reasonable costs, within available appropriations, mandated by collective bargaining
agreements with certified collective bargaining agents or other agreements between any
such facility or association and its employees.
(P.A. 87-497, S. 1, 3.)
History: Sec. 17-313d transferred to Sec. 17b-246 in 1995.
The Commissioner of Social
Services shall, where feasible and cost effective, enter into contracts with suppliers of
stock and standard durable medical equipment, medical surgical supplies, oxygen and
laboratory services for such services provided to recipients of medical assistance excluding those services provided by hospitals or routinely provided by nursing homes as part
of their rate. In the case of laboratory services billed through a hospital outpatient clinic,
payment shall be made at the lower of the provider's charges to the general public or
the contracted rate. Except for hospital based laboratory work and those laboratory tests
specifically exempted by the commissioner, no payment shall be made for laboratory
services except under contract, where feasible. Except for those facilities specifically
exempted by the commissioner, all oxygen services for residents of nursing facilities
and chronic disease hospitals shall be supplied through such a contract.
(June Sp. Sess. P.A. 91-8, S. 11, 63; P.A. 93-262, S. 1, 87.)
History: P.A. 93-262 authorized substitution of commissioner and department of social services for commissioner and
department of income maintenance, effective July 1, 1993; Sec. 17-314l transferred to Sec. 17b-247 in 1995.
Sec. 17b-248. (Formerly Sec. 17-316). Liability of home or institution having
life care contract. No home or institution having a life care contract with any person
therein shall be liable for the support of such person in a state humane institution if such
home or institution is financially unable to continue performance of the life care contract,
as set forth in section 17b-602, provided such home or institution shall be liable to the
extent of its ability as determined by the Commissioner of Social Services under the
provisions of said section.
(1957, P.A. 184; P.A. 75-420, S. 4, 6; P.A. 77-614, S. 608, 610; P.A. 93-262, S. 1, 87.)
History: P.A. 75-420 replaced welfare commissioner with commissioner of social services; P.A. 77-614 replaced commissioner of social services with commissioner of income maintenance, effective January 1, 1979; P.A. 93-262 authorized
substitution of commissioner and department of social services for commissioner and department of income maintenance,
effective July 1, 1993; Sec. 17-316 transferred to Sec. 17b-248 in 1995.
Sec. 17b-249. (Formerly Sec. 17-317). Support of mentally ill persons accused
of crime. When any person, charged with any offense punishable by fine or imprisonment or both, has been found not guilty because of mental illness and, by reason of
such mental illness, has been committed for confinement or treatment to any institution
supported in whole or in part by the state, the expense for the support and treatment of
such person while so committed shall be charged to the state.
(1949 Rev., S. 2664; 1953, S. 1501d; March, 1958, P.A. 27, S. 6; P.A. 85-506, S. 27, 32.)
History: P.A. 85-506 required that support and treatment expenses be charged to state rather than "computed and paid
for in the same manner as is provided in this chapter for patients committed by courts of probate"; Sec. 17-317 transferred
to Sec. 17b-249 in 1995.
Annotations to former section 17-317:
Held in violation of equal protection provisions of federal and state constitutions. 192 C. 520—522, 525, 526, 530—
532. Held unconstitutional. Id., 532, 534. Cited. 225 C. 528, 541, 542. Cited. 230 C. 400, 417.
Does not pertain if accused never stood trial. 14 CS 33.
Sec. 17b-250. (Formerly Sec. 17-318). Payment of hospital expense of inmate
transferred from correctional institution. When any person has been transferred from
the Connecticut Correctional Institution, Somers, the Connecticut Correctional Institution, Niantic, or its maximum security division, the John R. Manson Youth Institution,
Cheshire, or a community correctional center to a state hospital, such person's hospital
expense prior to the termination of his sentence shall be charged to the state. If any
person, transferred from a correctional institution or community correction center is
committed to or otherwise remains in a state hospital after the expiration of his sentence,
such person's hospital expense shall be paid to the state in the manner provided for
payment in sections 17b-19, 17b-63 to 17b-65, inclusive, 17b-116 to 17b-138, inclusive,
17b-220 to 17b-250, inclusive, 17b-256, 17b-259, 17b-263, 17b-287, 17b-340 to 17b-
350, inclusive, 17b-689, 17b-689b and 17b-743 to 17b-747, inclusive.
(1949 Rev., S. 2670; 1953, S. 1504d; 1959, P.A. 165; 1969, P.A. 297; P.A. 75-416, S. 1, 3; P.A. 86-186, S. 7.)
History: 1959 act deleted requirement for payment to state of other necessary costs of commitment when person is
committed to state hospital after expiration of his sentence; 1969 act substituted "community correctional center" for "jail";
P.A. 75-416 provided that state bear cost when person transferred to state hospital from community correctional centers,
previously person's estate bore cost if there was an estate; P.A. 86-186 changed the name of the Connecticut Correctional
Institution, Cheshire to the John R. Manson Youth Institution, Cheshire; Sec. 17-318 transferred to Sec. 17b-250 in 1995;
(Revisor's note: In 1999 the references to "17b-115 to 17b-138" and "17b-689 to 17b-693, inclusive," were changed
editorially by the Revisors to "17b-116 to 17b-138" and "17b-689, 17b-689b", respectively, to reflect the repeal of certain
sections by section 164 of June 18 Sp. Sess. P.A. 97-2).
Annotations to former section 17-318:
Cited. 192 C. 520, 524—526, 530—532. Cited. 230 C. 400, 417.
Cited. 30 CS 118.
Sec. 17b-251. (Formerly Sec. 17a-307). Connecticut Partnership for Long-
Term Care: Outreach program established. The Department of Social Services shall
establish an outreach program to educate consumers as to: (1) The need for long-term
care; (2) mechanisms for financing such care; (3) the availability of long-term care
insurance; and (4) the asset protection provided under sections 17b-252 to 17b-254,
inclusive, and 38a-475. The Department of Social Services shall provide public information to assist individuals in choosing appropriate insurance coverage.
(P.A. 89-352, S. 4, 6; P.A. 93-262, S. 1, 87.)
History: P.A. 93-262 authorized substitution of commissioner and department of social services for commissioner and
department on aging, effective July 1, 1993; Sec. 17a-307 transferred to Sec. 17b-251 in 1995.
See Sec. 17b-252 re overview of program.
See Sec. 17b-253 re amendments to Medicaid regulations and state plan, and regulations re determining eligibility of
applicants for Medicaid and coverage requirements for long-term care benefits.
See Sec. 17b-254 re foundation funds and federal approval and report to General Assembly.
See Sec. 38a-475 re precertification of long-term care insurance policies.
Sec. 17b-252. (Formerly Sec. 17-12q). Connecticut Partnership for Long-
Term Care. The Office of Policy and Management shall coordinate a program entitled
the Connecticut Partnership for Long-Term Care whereby private insurance and Medicaid, or its successor program, funds shall be combined to finance long-term care. Under
such program, an individual may purchase a precertified long-term care insurance policy
in an amount commensurate with his assets. Notwithstanding any provision of the general statutes, the resources of such an individual, to the extent such resources are equal
to the amount of long-term care insurance benefit payments as provided in section 17b-
253, shall not be considered by the Department of Social Services in a determination
of his eligibility for Medicaid, or its successor program, or in any subsequent recovery
by the state of a payment for medical services.
(P.A. 89-352, S. 1, 6; P.A. 91-187, S. 1, 4; P.A. 93-262, S. 1, 87; P.A. 94-167, S. 1, 4; P.A. 96-131, S. 1, 3.)
History: P.A. 91-187 changed closing date of program from July 1, 1995, to July 1, 1997, and deleted provision providing
that resources protected under the program not be considered in determining the amount of any Medicaid payment; P.A.
93-262 authorized substitution of commissioner and department of social services for commissioner and department of
income maintenance, effective July 1, 1993; P.A. 94-167 deleted dates for program beginning and end and the word pilot
before program, effective June 7, 1994; Sec. 17-12q transferred to Sec. 17b-252 in 1995; P.A. 96-131 inserted references
to Medicaid's "successor program", effective May 29, 1996.
See Sec. 17b-251 re outreach program.
See Sec. 17b-253 re amendments to Medicaid regulations and state plan, and regulations re determining eligibility of
applicants for Medicaid and coverage requirements for long-term care benefits.
See Sec. 17b-254 re foundation funds and federal approval and report to General Assembly.
See Sec. 38a-475 re precertification of long-term care insurance policies.
Sec. 17b-253. (Formerly Sec. 17-12r). Connecticut Partnership for Long-
Term Care: Amendments to Medicaid regulations and state plan. Regulations. (a)
The Department of Social Services shall seek appropriate amendments to its Medicaid
regulations and state plan to allow protection of resources and income pursuant to section
17b-252. Such protection shall be provided, to the extent approved by the federal Health
Care Financing Administration, for any purchaser of a precertified long-term care policy
and shall last for the life of the purchaser. Such protection shall be provided under the
Medicaid program or its successor program. Any purchaser of a precertified long-term
care policy shall be guaranteed coverage under the Medicaid program or its successor
program, to the extent the individual meets all applicable eligibility requirements for
the Medicaid program or its successor program. Until such time as eligibility requirements are prescribed for Medicaid's successor program, for the purposes of this subsection, the applicable eligibility requirements shall be the Medicaid program's requirements as of the date its successor program was enacted. The Department of Social
Services shall count insurance benefit payments toward resource exclusion to the extent
such payments (1) are for services paid for by a precertified long-term care policy; (2)
are for the lower of the actual charge and the amount paid by the insurance company;
(3) are for nursing home care, or formal services delivered to insureds in the community
as part of a care plan approved by an access agency approved by the Office of Policy
and Management and the Department of Social Services as meeting the requirements
for such agency as defined in regulations adopted pursuant to subsection (e) of section
17b-342; and (4) are for services provided after the individual meets the coverage requirements for long-term care benefits established by the Department of Social Services
for this program. The Commissioner of Social Services shall adopt regulations, in accordance with chapter 54, to implement the provisions of this subsection and sections
17b-251, 17b-252, 17b-254 and 38a-475 relating to determining eligibility of applicants
for Medicaid, or its successor program, and the coverage requirements for long-term
care benefits.
(b) The Commissioner of Social Services, after consultation with the Secretary of
the Office of Policy and Management, may enter into reciprocal agreements with other
states to extend the resource exclusions under section 17b-252 and subsection (a) of
this section to purchasers of qualified long-term care insurance policies issued in states
entering into such reciprocal agreements if such purchasers apply to the Medicaid program or its successor program. Such reciprocal agreements shall also allow purchasers
of precertified policies under section 38a-475 to receive a Medicaid resource exclusion
in states entering into such reciprocal agreements. The provisions of such reciprocal
agreements shall be effective for the life of a purchaser of a precertified policy. For the
purposes of this subsection, "qualified long-term care insurance policy" means a long-
term care insurance policy approved through a program in another state that provides
a Medicaid resource exclusion or asset disregard substantially similar to the Medicaid
resource exclusion included in precertified policies and includes benefits substantially
similar to those included in a precertified policy.
(P.A. 89-352, S. 2, 6; P.A. 91-187, S. 2, 4; P.A. 93-262, S. 1, 87; P.A. 94-167, S. 2, 4; P.A. 95-160, S. 6, 69; P.A. 96-
131, S. 2, 3; 96-139, S. 12, 13; P.A. 98-239, S. 21, 35.)
History: P.A. 91-187 changed deadline for purchasing policy providing protection under the program from December
31, 1994, to December 31, 1996; P.A. 93-262 authorized substitution of commissioner and department of social services
for commissioner and department of income maintenance, effective July 1, 1993; P.A. 94-167 removed deadline for
purchasing policy, effective June 7, 1994; Sec. 17-12r transferred to Sec. 17b-253 in 1995; P.A. 95-160 replaced a reference
to a coordination, assessment and monitoring agency with access agency, effective July 1, 1995; P.A. 96-131 inserted
references to Medicaid's "successor program", required such successor program to provide protection of resources and
income provided by Medicaid, guaranteed coverage under the Medicaid program or its successor program for any purchaser
of a precertified long-term care policy, with certain eligibility requirements, amended Subdiv. (1) to replace "Medicaid
approves or covers for its recipients" with "paid for by a precertified long-term care policy", effective May 29, 1996; P.A.
96-139 changed effective date of P.A. 95-160 but without affecting this section; P.A. 98-239 made technical changes in
existing section, designated as Subsec. (a), and added Subsec. (b) allowing commissioner, after consulting with the Secretary
of the Office of Policy and Management, to enter into reciprocal agreements with other states to extend the resource
exclusions under the program to purchasers of qualified long-term care insurance policies issued in those states if such
purchasers apply to the Medicaid program, providing that such reciprocal agreements shall allow purchasers of precertified
policies under Sec. 38a-475 to receive a Medicaid resource exclusion in states which enter into such agreements and
defining "qualified long-term care insurance policy", effective June 8, 1998.
See Sec. 17b-251 re outreach program.
See Sec. 17b-252 re overview of program.
See Sec. 17b-254 re foundation funds and federal approval and report to General Assembly.
See Sec. 38a-475 re precertification of long-term care insurance policies.
Sec. 17b-254. (Formerly Sec. 17-12s). Connecticut Partnership for Long-
Term Care: Foundation funds and federal approval. Report. The Office of Policy
and Management shall seek the foundation funds and federal approvals necessary to
carry out the purposes of this section and sections 17b-251 to 17b-253, inclusive, and
38a-475. Each year, on January first, the Secretary of the Office of Policy and Management shall report to the General Assembly on the progress of the program. Such report
shall include: (1) The success in implementing the public and private partnership; (2)
the number of policies precertified; (3) the number, age and financial circumstances
of individuals purchasing precertified policies; (4) the number of individuals seeking
consumer information services; (5) the extent and type of benefits paid under precertified
policies that could count toward Medicaid resource protection; (6) estimates of impact
on present and future Medicaid expenditures; (7) the cost effectiveness of the program;
and (8) a determination regarding the appropriateness of continuing the program.
(P.A. 89-352, S. 5, 6.)
History: Sec. 17-12s transferred to Sec. 17b-254 in 1995.
See Sec. 17b-251 re outreach program.
See Sec. 17b-252 re overview of program.
See Sec. 17b-253 re amendments to Medicaid program regulations and state plan, and regulations re determining
eligibility of applicants for Medicaid and coverage requirements for long-term care benefits.
See Sec. 38a-475 re precertification of long-term care insurance policies.
Sec. 17b-255. (Formerly Sec. 17-12gg). Insurance assistance for people with
AIDS. Managed care insurance program for persons with AIDS. (a) There is established, in the Department of Social Services, a program to provide insurance assistance
for people with AIDS. Under the program the state shall pay insurance premiums for
persons with AIDS-related disease who, without such assistance, would be unable to
obtain health insurance coverage through an employer. To qualify for assistance a person
shall have a family income less than two hundred per cent of the federal poverty level,
shall have less than ten thousand dollars in cash assets and shall have health insurance
which may be continued upon termination of employment of the applicant, the applicant's spouse or the applicant's parent. Insurance premiums and medical expenses for
which the applicant has no coverage, which are incurred in the month of application,
shall be deducted from gross income for the purpose of determining income eligibility for
the program. Eligibility shall be periodically redetermined and any uncovered medical
expenses incurred in the month of redetermination shall be deducted from gross income
in determining continued eligibility for the program. An applicant for assistance shall
document the risk of losing health insurance and submit a physician's statement that
the applicant has an AIDS-related disease.
(b) The Commissioner of Social Services shall adopt regulations, in accordance
with chapter 54, to implement the provisions of this section, which shall include the
establishment of (1) higher income eligibility limits for applicants with dependents; (2)
an application process for the program, including application forms; and (3) a procedure
by which the insurance premiums of participants in the program shall be paid.
(c) Except as otherwise specified in this section, the insurance assistance for people
with AIDS program shall be operated in a manner consistent with the Medicaid program.
(d) The Department of Social Services shall investigate the purchasing of a managed
care insurance program in lieu of the issuance of individual policies.
(P.A. 90-318; June Sp. Sess. P.A. 91-8, S. 5, 63; P.A. 93-262, S. 1, 87; P.A. 95-269, S. 1.)
History: June Sp. Sess. P.A. 91-8 added a new Subsec. (c) requiring that AIDS pilot program be operated in a manner
consistent with the Medicaid program; P.A. 93-262 authorized substitution of commissioner and department of social
services for commissioner and department of income maintenance, effective July 1, 1993; Sec. 17-12gg transferred to Sec.
17b-255 in 1995; P.A. 95-269 amended Subsec. (a) to make "pilot" program permanent, to replace reference to persons
"unable to continue working" who may lose health insurance with persons "who, without such assistance, would be unable
to obtain health insurance coverage through an employer", to broaden the eligibility and income requirements and to make
certain technical corrections for accuracy, deleted reference to "pilot" program in Subsec. (c) and added a new Subsec.
(d) re purchase of managed care insurance program in lieu of the issuance of individual policies.
The Commissioner of Social Services may administer, within available appropriations, a program providing payment for the cost of drugs
prescribed by a physician for the prevention or treatment of acquired immunodeficiency
syndrome (AIDS) or human immunodeficiency virus (HIV infection). The commissioner shall determine specific drugs to be covered and may implement a pharmacy
lock-in procedure for the program. The commissioner shall adopt regulations, in accordance with the provisions of chapter 54, to carry out the purposes of this section. The
commissioner may implement the program while in the process of adopting regulations,
provided notice of intent to adopt the regulations is published in the Connecticut Law
Journal within twenty days of implementation. The regulations may include eligibility
for all persons with AIDS or HIV infection whose income is below four hundred per cent
of the federal poverty level. The commissioner shall, within available federal resources,
purchase and maintain insurance policies for eligible clients, including, but not limited
to, coverage of costs associated with such policies, that provide a full range of HIV
treatments and access to comprehensive primary care services as determined by the
commissioner and as provided by federal law, and may provide payment, determined
by the commissioner, for (1) drugs and nutritional supplements prescribed by a physician
that prevent or treat opportunistic diseases and conditions associated with AIDS or HIV
infection; (2) ancillary supplies related to the administration of such drugs; and (3)
laboratory tests ordered by a physician.
(June Sp. Sess. P.A. 91-8, S. 44, 63; P.A. 93-262, S. 1, 87; 93-418, S. 14, 41; P.A. 96-238, S. 16, 25; June Sp. Sess.
P.A. 99-2, S. 6, 72; June Sp. Sess. P.A. 01-4, S. 9, 58; May 9 Sp. Sess. P.A. 02-7, S. 49.)
History: P.A. 93-262 authorized substitution of commissioner and department of social services for commissioner and
department of income maintenance, effective July 1, 1993; P.A. 93-418 made the program subject to available appropriations, expanded the program to include prescription drugs for the prevention and treatment of AIDS, ARC or HIV, deleting
specific reference to AZT and requiring the commissioner to specify the drugs to be covered, required the commissioner
to adopt regulations and allowed the commissioner to implement the program while in the process of adopting regulations,
effective July 1, 1993; Sec. 17-314m transferred to Sec. 17b-256 in 1995; P.A. 96-238 authorized payment for drugs,
nutritional supplements and ancillary supplies and laboratory tests prescribed or ordered by a physician for the prevention
or treatment of opportunistic diseases and conditions associated with AIDS or HIV infection, effective July 1, 1996; June
Sp. Sess. P.A. 99-2 added provisions allowing regulations to include eligibility for persons with income below four hundred
per cent of the federal poverty level and allowing commissioner to purchase and maintain insurance policies with specified
coverage, effective July 1, 1999; June Sp. Sess. P.A. 01-4 deleted provision re AIDS-related complex (ARC) and made
a technical change, effective July 1, 2001; May 9 Sp. Sess. P.A. 02-7 changed "commissioner may, within available
appropriations, purchase and maintain insurance polices for eligible clients," to "commissioner shall, within available
federal resources, purchase and maintain insurance policies for eligible clients," effective August 15, 2002.
Reserved for future use.
Sec. 17b-256d. State medical assistance program. Use of federally-qualified
community health centers. Notwithstanding any provision of this chapter, the Commissioner of Social Services may enter into a contract with a consortium of federally-
qualified community health centers to provide medical assistance to beneficiaries eligible under sections 17b-257 and 17b-259.
(June Sp. Sess. P.A. 01-2, S. 20, 69; June Sp. Sess. P.A. 01-9, S. 129, 131; May 9 Sp. Sess. P.A. 02-7, S. 62.)
History: June Sp. Sess. P.A. 01-2 effective July 1, 2001; June Sp. Sess. P.A. 01-9 revised effective date of June Sp.
Sess. P.A. 01-2 but without affecting this section; May 9 Sp. Sess. P.A. 02-7 authorized Commissioner of Social Services
to contract with consortium of federally-qualified community health centers to provide medical assistance to eligible
beneficiaries, deleted provision re implementation of "mandatory program of primary case management" and deleted
provision re contracts for medical services and program management, effective August 15, 2002.
On
and after July 1, 1998, the Commissioner of Social Services shall implement a state
medical assistance program for persons ineligible for Medicaid and on or before April
1, 1997, the commissioner shall implement said program in the towns in which the
fourteen regional or district offices of the Department of Social Services are located.
The commissioner shall establish a schedule for the transfer of recipients of medical
assistance administered by towns under the general assistance program to the state program. To the extent possible, the administration of the state medical assistance program
shall parallel that of the Medicaid program as it is administered to recipients of temporary
family assistance, including eligibility criteria concerning income and assets. Payment
for medical services shall be made only for individuals determined eligible. The rates of
payment for medical services shall be those of the Medicaid program. Medical services
covered under the program shall be those covered under the Medicaid program, except
that nonemergency medical transportation, eye care, optical hardware and optometry
care, podiatry, chiropractic, natureopathy, home health care and long-term care and
services available pursuant to a home and community-based services waiver under Section 1915 of the Social Security Act shall not be covered. On or after April 1, 1997, the
commissioner shall implement a managed care program for medical services provided
under this program, except services provided pursuant to section 17a-453a. Notwithstanding the provisions of sections 4a-51 and 4a-57, the commissioner may enter into
contracts, including, but not limited to, purchase of service agreements to implement
the provisions of this section.
(May Sp. Sess. P.A. 92-16, S. 21, 89; P.A. 93-262, S. 1, 87; P.A. 93-418, S. 7, 41; P.A. 95-351, S. 8, 30; P.A. 96-268,
S. 23, 34; P.A. 97-143, S. 1, 4; June 18 Sp. Sess. P.A. 97-2, S. 68, 165; June Sp. Sess. P.A. 01-2, S. 59, 69; June Sp. Sess.
P.A. 01-9, S. 129, 131; May 9 Sp. Sess. P.A. 02-7, S. 19.)
History: P.A. 93-262 authorized substitution of commissioner and department of social services for commissioner and
department of income maintenance, effective July 1, 1993; P.A. 93-418 changed the date for implementing program from
July 1, 1994, to July 1, 1996, effective July 1, 1993; Sec. 17-12ii transferred to Sec. 17b-257 in 1995; P.A. 95-351 changed
the implementation date for the state medical program from July 1, 1996, to July 1, 1998, and provided that such program
shall be implemented in the towns in which the fourteen regional or district offices of the Department of Social Services
are located on or before April 1, 1997, effective July 1, 1995; P.A. 96-268 added a provision requiring the commissioner,
effective July 1, 1997, to implement a managed care program for medical services for the state medical assistance program,
except for services provided pursuant to Sec. 17a-453a, effective July 1, 1996; P.A. 97-143 changed the implementation
date for the managed care program from July 1, 1997, to on or after April 1, 1997, and added a provision allowing the
commissioner to enter into contracts including purchase of service agreements, effective June 13, 1997; June 18 Sp. Sess.
P.A. 97-2 replaced a reference to aid to families with dependent children with temporary family assistance and made
technical changes, effective July 1, 1997; June Sp. Sess. P.A. 01-2 added exception for nonemergency medical transportation, effective July 1, 2001; June Sp. Sess. P.A. 01-9 changed effective date of June Sp. Sess. P.A. 01-2 from July 1, 2001,
to August 1, 2001; May 9 Sp. Sess. P.A. 02-7 added eye care, optical hardware and optometry care, podiatry, chiropractic,
natureopathy and home health care as exceptions to services covered under the state medical assistance program, effective
August 15, 2002.
Qualified aliens, as defined in section 431 of Public Law 104-193, admitted into the United States prior to
August 22, 1996, shall be eligible for Medicaid provided other conditions of eligibility
are met. Qualified aliens admitted into the United States on or after August 22, 1996,
shall be eligible for Medicaid subsequent to five years from the date admitted, except
if the individual is otherwise qualified for the purposes of state receipt of federal financial
participation under Title IV of Public Law 104-193, such individual shall be eligible
for Medicaid regardless of the date admitted.
(June 18 Sp. Sess. P.A. 97-2, S. 145, 165.)
History: June 18 Sp. Sess. P.A. 97-2 effective July 1, 1997.
Qualified aliens, as
defined in Section 431 of Public Law 104-193, admitted into the United States on or
after August 22, 1996, other lawfully residing immigrant aliens or aliens who formerly
held the status of permanently residing under color of law who have been determined
eligible for Medicaid or for state-administered general assistance medical aid prior to
July 1, 1997, may be eligible for state-funded medical assistance which shall provide
coverage to the same extent as the Medicaid program, state-administered general assistance medical aid or the HUSKY Plan, Part B provided other conditions of eligibility
are met. Such qualified aliens or lawfully residing immigrant aliens or aliens who formerly held the status of permanently residing under color of law who have not been
determined eligible for Medicaid or for state-administered general assistance medical
aid prior to July 1, 1997, shall be eligible for state-funded assistance or the HUSKY
Plan, Part B subsequent to six months from establishing residency in this state. The
Commissioner of Social Services shall not accept applications for assistance pursuant
to this section on or after June 30, 2003. Notwithstanding the provisions of this section,
any qualified alien or other lawfully residing immigrant alien or alien who formerly
held the status of permanently residing under color of law who is a victim of domestic
violence or who has mental retardation shall be eligible for state-funded assistance or
the HUSKY Plan, Part B pursuant to this section. Only individuals who are not eligible
for Medicaid shall be eligible for state-funded assistance pursuant to this section.
(June 18 Sp. Sess. P.A. 97-2, S. 146, 165; October 29 Sp. Sess. P.A. 97-1, S. 17, 23; P.A. 99-279, S. 11, 45; P.A. 00-
83, S. 3, 5; June Sp. Sess. P.A. 01-9, S. 109, 131; May 9 Sp. Sess. P.A. 02-7, S. 22.)
History: June 18 Sp. Sess. P.A. 97-2 effective July 1, 1997; Oct. 29 Sp. Sess. P.A. 97-1 made qualified aliens eligible
for benefits under the HUSKY Plan, Part B, effective October 30, 1997; P.A. 99-279 extended the eligibility of certain
qualified aliens or other lawfully residing immigrant aliens for state-funded medical assistance from July 1, 1999, to July 1,
2001, effective July 1, 1999; P.A. 00-83 extended provisions of section to aliens who formerly held the status of permanently
residing under color of law, added references to "state-administered general assistance medical aid", and provided that
alien who formerly held such status who is a domestic violence victim or who has mental retardation shall be eligible for
state-funded assistance or the HUSKY Plan, Part B, effective July 1, 2000; June Sp. Sess. P.A. 01-9 extended the deadline
for certain aliens to apply for assistance until June 30, 2002, effective July 1, 2001; May 9 Sp. Sess. P.A. 02-7 extended
the deadline for certain aliens to apply for assistance until June 30, 2003, effective August 15, 2002.
(a)
The Commissioner of Social Services, after consultation with the Commissioner of
Mental Health and Addiction Services and the Secretary of the Office of Policy and
Management, may provide, within available appropriations, payments to long-term care
facilities for the care of certain illegal immigrants. Payments may be made to cover the
costs of care, as well as other incidentals as determined by the Commissioner of Social
Services, for illegal immigrants who have been admitted to an acute care or psychiatric
hospital and for whom services available in a long-term care facility are an appropriate
and cost-effective alternative. Such individuals must be otherwise eligible for Medicaid,
have resided in this state for at least five years and be unable to return to their country
of origin due to medical illness or regulations barring reentry of persons who are ill or
disabled or based upon a decision by the Immigration and Naturalization Service not
to proceed with deportation.
(b) The Commissioner of Social Services shall implement the policies and procedures necessary to carry out the provisions of subsection (a) of this section while in the
process of adopting such policies and procedures in regulation form, provided notice
of intent to adopt the regulations is published in the Connecticut Law Journal within
twenty days after implementation. Such policies and procedures shall be valid until the
time final regulations are effective.
(P.A. 98-239, S. 7, 35; P.A. 99-279, S. 15, 45.)
History: P.A. 98-239 effective July 1, 1998; P.A. 99-279 amended Subsec. (a) to provide that payments may cover the
costs of other incidentals as determined by the Commissioner of Social Services for illegal immigrants, effective June
29, 1999.
(a) The Commissioner of Social Services may establish a two-year
pilot program to provide health insurance assistance for unemployed persons. Under
the program the state shall pay health insurance premiums or a portion thereof for persons
who are unemployed and eligible to continue insurance coverage provided through a
former employer. To qualify for assistance, the family income of a person shall be less
than two hundred per cent of the federal poverty level and the cash assets of the person
shall be less than ten thousand dollars. Insurance premiums and medical expenses for
which the applicant has no coverage, which are incurred in the month of application,
shall be deducted from gross income for the purpose of determining income eligibility for
the program. Eligibility shall be periodically redetermined and any uncovered medical
expenses incurred in the month of redetermination shall be deducted from gross income
in determining continued eligibility for the program.
(b) The Commissioner of Social Services shall adopt regulations, in accordance
with chapter 54, to implement the provisions of this section, which shall include the
establishment of (1) a sliding scale for copayment requirements; (2) an application process for the program, including application forms; and (3) a procedure by which the
insurance premiums of participants in the program shall be paid.
(May Sp. Sess. P.A. 92-16, S. 43, 89; P.A. 93-262, S. 1, 87.)
History: P.A. 93-262 authorized substitution of commissioner and department of social services for commissioner and
department of income maintenance, effective July 1, 1993; Sec. 17-12jj transferred to Sec. 17b-258 in 1995.
(a) Each
town shall provide medically necessary services by one or more competent physicians
for all persons twenty-one to sixty-four years of age who are receiving general assistance
benefits from such town, or eligible to be supported by such town, or unable to pay for
the same over a two-year period, when such persons are in need thereof, and each town
shall furnish necessary hospitalization, in accordance with section 17b-220, for all such
persons if such persons have not made, within twenty-four months prior to the date of
application for such aid, an assignment or transfer or other disposition of property for
less than fair market value, for the purpose of establishing eligibility for benefits or
assistance under the general assistance program. Any such disposition shall be presumed
to have been made for the purpose of establishing eligibility for benefits or assistance
unless such person furnishes convincing evidence to establish that the transaction was
exclusively for some other purpose. Ineligibility because of such disposition shall continue only for either (1) twenty-four months after the date of disposition, or (2) that
period of time from the date of disposition over which the fair market value of such
property, less any consideration received in exchange for its disposition, together with
all other income and resources, would furnish support on a reasonable standard of health
and decency, whichever period is shorter, except that in any case where the uncompensated value of disposed of resources exceeds twelve thousand dollars, the Commissioner
of Social Services shall provide for a period of ineligibility based on the uncompensated
value which exceeds twenty-four months. The ability of a person to pay for medically
necessary services over a two-year period shall be determined by a town in accordance
with regulations adopted by the Department of Social Services in accordance with the
provisions of chapter 54, provided income in excess of the maximum income levels
established pursuant to such regulations and any assets in excess of two hundred fifty
dollars shall be applied toward medical bills incurred during the two-year period and
assistance shall be granted only for the remaining balance of the cost of medically necessary services. Any recipient who becomes ineligible for benefits under the general assistance program due to employment may continue to receive medical assistance for up to
three months. Persons under twenty-one or over sixty-four years of age who are otherwise eligible under this section and who have applied for Medicaid but have not yet
been determined eligible by the Department of Social Services, may receive assistance
under this section. Any person receiving medical treatment or hospitalization under this
section shall make to the selectmen full disclosure of his or her financial condition as
provided in section 17b-123. A completed application for medical assistance under
this section may be filed by the person seeking assistance, a member of such person's
immediate family or a medical provider, including a physician or a hospital, within
sixty days of commencement of treatment or hospitalization. A town shall be liable for
medical bills only for those persons whose eligibility can be determined in accordance
with standards established pursuant to section 17b-78, and those persons under twenty-
one or over sixty-four years of age who are otherwise eligible under this section and
who have applied for Medicaid but have not yet been determined eligible by the Department of Social Services. No applicant who may be eligible for a third-party payment to
which such applicant is entitled, including private insurance, hospital or medical service
corporation benefits, veterans' benefits, Medicare and Medicaid shall be eligible for
general assistance medical aid until such applicant has completed the application process
for such benefits. On and after October 1, 1991, a town shall not be liable for payment
of the applicant's medical bills if the applicant fails to provide sufficient documentation
to determine eligibility for such benefits. Failure of a person or a legally liable relative
of the person to cooperate in the general assistance application process shall not prevent
payment to a medical provider for services rendered to the person if adequate information
is otherwise available to determine the person's eligibility under this section. On or after
April 1, 1997, the commissioner shall implement a managed care program for medical
services provided under this program, except services provided pursuant to section 17a-
453a. Notwithstanding the provisions of sections 4a-51 and 4a-57, the commissioner
may enter into contracts, including but not limited to, purchase of service agreements
to implement the provisions of this section.
(b) The medical services for which a town shall be liable under this section and for
which a town shall be reimbursed by the state shall be limited to the following medically
necessary services provided such services are covered under the Medicaid program: (1)
Physician services, (2) hospital services, on an inpatient basis subject to the provisions
of section 17b-220 and outpatient care, (3) community clinic services, (4) prescription
drugs, excluding over-the-counter drugs, (5) hearing aids, (6) laboratory and x-ray services, (7) emergency dental services, (8) emergency medical transportation, and (9)
examinations (A) needed to determine unemployability, or (B) requested by an attorney
to establish the eligibility of a person receiving general assistance benefits for federal
supplementary security income benefits pursuant to section 17b-119. Services not covered under this program include, but are not limited to, nonemergency medical transportation, eye care, optical hardware and optometry care, podiatry, chiropractic, natureopathy and home health care. In lieu of providing medical services, in accordance with this
section, a town or group of towns may submit a plan to the Department of Social Services
for approval to provide medical services in some other manner. The department shall
approve the plan only if the persons served under it receive at least the services listed
in this subsection and the plan offers the possibility of improved medical care or cost
savings. The department shall encourage a town or group of towns to contract for the
management of such medically necessary services.
(1949 Rev., S. 2586; 1959, P.A. 572, S. 1; February, 1965, P.A. 96; 1971, P.A. 187; P.A. 77-131; P.A. 81-214, S. 4;
P.A. 83-575, S. 2, 10; P.A. 84-168, S. 3; P.A. 86-415, S. 6; P.A. 88-156, S. 15; P.A. 89-239, S. 2; P.A. 90-80, S. 2; June
Sp. Sess. P.A. 91-8, S. 37, 63; May Sp. Sess. P.A. 92-16, S. 8, 89; P.A. 93-262, S. 1, 87; 93-395, S. 1; P.A. 95-194, S. 13,
33; 95-265, S. 4, 7; P.A. 97-143, S. 2, 4; June 18 Sp. Sess. P.A. 97-2, S. 69, 165; June Sp. Sess. P.A. 01-2, S. 60, 69; June
Sp. Sess. P.A. 01-9, S. 107, 129, 131; May 9 Sp. Sess. P.A. 02-7, S. 20.)
History: 1959 act added provisions re hospitalization, required disclosure of financial condition by person needing care
or verification of financial condition through other sources and added provision re notice by hospital and effect of notice
requirement on date town's obligation begins; 1965 act added provision enumerating information required in notice and
raised grace period for notice from three business days; 1971 act added word "made" with reference to available information
to verify financial condition of person seeking assistance, thus relieving town of burden of verification; P.A. 77-131 changed
notice period from five to seven days; P.A. 81-214 added provisions re effect of transfer of property on eligibility for
medical assistance from towns; P.A. 83-575 changed the requirement for towns to provide medical treatment to persons
"liable" to be supported by such town and hospitalization for such persons and persons unable to pay for the same "over
a reasonable period to time" to a requirement that medical treatment and hospitalization be provided to persons receiving
general assistance, eligible for general assistance or unable to pay for the same over "a two year period", changed the
application requirements and added Subsec. (b) specifying the required medical services and Subsec. (c) re administrative
or judicial action requiring town medical assistance, effective April 1, 1984; P.A. 84-168 amended Subsec. (a) by changing
the time limit for applying for medical assistance from within ninety to within sixty days of commencement of treatment
or hospitalization; P.A. 86-415 added references to Sec. 17-292g; P.A. 88-156 moved provision re liability of town for
medical bills of persons whose eligibility established; P.A. 89-239 changed the term "medical treatment" to "medically
necessary services" in Subsec. (a) and in Subsec. (b) included in the list of medically necessary services examinations
required by a prospective employer but not paid for by the employer; P.A. 90-80 amended Subsec. (a) clarifying how a town
is to determine a person's ability to pay for medically necessary services and amended Subsec. (c) limiting reimbursement of
a town required to grant medical assistance by administrative or judicial action to cases where the town has followed
general assistance program requirements; June Sp. Sess. P.A. 91-8 amended Subsec. (a) re eligibility for general assistance
medical aid and appropriate application and qualification documentation and deleted coverage for natureopaths, podiatrists
and chiropractors in Subsec. (b); May Sp. Sess. P.A. 92-16 amended Subsec. (a) by limiting eligibility for medical assistance
to persons twenty-one to sixty-four years of age, providing that medical assistance may be continued for three months for
recipients who become ineligible for general assistance due to employment, providing that a recipient employed under the
department of labor subsidized employment program may continue to receive medical assistance, providing that persons
under twenty-one or over sixty-four years of age who are otherwise eligible under this section and have applied for Medicaid
but have not yet been determined eligible by the department may receive medical assistance under this section, requiring
specific information be included in an application for medical assistance, deleting provision which required a town to
accept an incomplete application, amended Subsec. (b) by providing that only medically necessary services covered under
chapter 302 shall be covered under this chapter, eliminating coverage for convalescent home services for recipients for
whom such services were covered prior to January 1, 1983, and restoring coverage for services provided by a natureopath,
podiatrist or chiropractor, and deleted Subsec. (c) re reimbursement to towns for medical assistance granted pursuant to
administrative or judicial action; P.A. 93-262 authorized substitution of commissioner and department of social services
for commissioner and department of income maintenance, effective July 1, 1993; P.A. 93-395 removed the requirement
that application for assistance contain applicant's age, address, sex, place of birth, citizenship, social security number,
profession, marital status and immediate past employer; Sec. 17-274 transferred to Sec. 17b-259 in 1995; P.A. 95-194
amended Subsec. (b) by adding a provision requiring the department to encourage a town or group of towns to contract
for the management of medically necessary services, effective July 1, 1995; P.A. 95-265 amended Subsec. (a) to delete
provision which had authorized recipients employed under the Labor Department's subsidized employment program to
continue receiving medical assistance, effective July 1, 1995; P.A. 97-143 amended Subsec. (a) by adding a provision
allowing the commissioner to implement a managed care program and a provision allowing the commissioner to enter into
contracts including purchase of service agreements, effective June 13, 1997; June 18 Sp. Sess. P.A. 97-2 made technical
and conforming changes, effective July 1, 1997; June Sp. Sess. P.A. 01-2 amended Subsec. (a) to make technical changes
and amended Subsec. (b) to delete former Subdiv. (5) re glasses, to redesignate existing Subdivs. (6) to (10) as Subdivs.
(5) to (9), and to provide that services not covered under program include, but are not limited to, nonemergency medical
transportation, effective July 1, 2001; June Sp. Sess. P.A. 01-9 reincorporated glasses as new Subdiv. (9) and redesignated
former Subdiv. (9) as Subdiv. (10), effective July 1, 2001, and changed effective date of June Sp. Sess. P.A. 01-2 from
July 1, 2001, to August 1, 2001; May 9 Sp. Sess. P.A. 02-7 amended Subsec. (b) to delete former Subdiv. (9) re glasses,
redesignate existing Subdiv. (10) as Subdiv. (9) and add eye care, optical hardware and optometry care, podiatry, chiropractic, natureopathy and home health care as exceptions to services defined as medically necessary under the state medical
assistance program, effective August 15, 2002.
See Sec. 17b-121 for regulations re medical treatment and hospitalization services.
Annotations to former statute:
Town held liable for hospital bills even though person failed to disclose her financial condition. 146 C. 686.
Annotations to former section 17-274:
Statute does not impose liability if necessary eligibility cannot be determined. 206 C. 1, 2, 4, 5.
Cited. 33 CA 247, 250.
Cited. 32 CS 272. Each town is obliged to provide medical treatment and hospitalization to those persons liable to be
supported on condition that such town be given certain information by the patient and the institution rendering services.
33 CS 762—767.
Subsec. (a):
Cited. 33 CA 247, 250.
The Commissioner of Social Services may impose cost sharing requirements on recipients of medical assistance, including a deductible, coinsurance, copayment, or similar charge up to the maximum permitted under 42 CFR 447.54,
except that no copayment may be imposed for prescription drugs. Such cost sharing
requirements shall be implemented in accordance with the conditions specified in federal
regulations.
(P.A. 95-351, S. 15, 30; P.A. 98-239, S. 22, 35.)
History: P.A. 95-351, S. 15 effective July 1, 1995; P.A. 98-239 made commissioner's imposition of cost sharing
requirements on recipients of medical assistance discretionary rather than mandatory and prohibited the imposition of a
copayment for prescription drugs, effective July 1, 1998.
The Commissioner of Social Services is authorized to take advantage
of the medical assistance programs provided in Title XIX, entitled "Grants to States for
Medical Assistance Programs", contained in the Social Security Amendments of 1965
and may administer the same in accordance with the requirements provided therein,
including the waiving, with respect to the amount paid for medical care, of provisions
concerning recovery from beneficiaries or their estates, charges and recoveries against
legally liable relatives, and liens against property of beneficiaries.
(February, 1965, P.A. 357, S. 1; 1967, P.A. 2, S. 1; 759, S. 1(a); P.A. 75-420, S. 4, 6; P.A. 77-614, S. 608, 610; P.A.
93-262, S. 1, 87.)
History: 1967 acts deleted exclusion of patients in institutions for tuberculosis and mental diseases; P.A. 75-420 replaced
welfare commissioner with commissioner of social services; P.A. 77-614 replaced commissioner of social services with
commissioner of income maintenance, effective January 1, 1979; P.A. 93-262 authorized substitution of commissioner
and department of social services for commissioner and department of income maintenance, effective July 1, 1993; Sec.
17-134a transferred to Sec. 17b-260 in 1995.
Annotations to former section 17-134a:
Cited. 168 C. 336. Cited. 179 C. 83, 85; id., 463, 464, 469. Cited. 191 C. 384, 389, 391, 405. Cited. 192 C. 310, 318.
Cited. 204 C. 17, 19, 20. Cited. 209 C. 390, 396. Cited. 216 C. 85—87, 90. Cited. 226 C. 818, 824. Cited. 237 C. 550.
Cited. 5 Conn. Cir. Ct. 506.
Annotations to present section:
Cited as "17b-260 et seq. (providing for supplemental medical assistance)". 233 C. 557, 565. Cited. 237 C. 550. Cited.
240 C. 141. Cited. 242 C. 345.
Distribution of trust assets upon death of spouse served to disqualify plaintiff from receiving benefits. 49 CA 432.
Sec. 17b-260a. Medicaid-financed home and community-based program for
individuals with acquired brain injury. The Commissioner of Social Services shall
seek a waiver from federal law to establish a Medicaid-financed, home and community-
based program for individuals with acquired brain injury. Such waiver shall be submitted
no later than October 1, 1995.
(P.A. 95-209.)
(a) Medical assistance shall be provided for any otherwise eligible person whose income, including any available support from legally liable relatives and the income of the person's
spouse or dependent child, is not more than one hundred forty-three per cent, pending
approval of a federal waiver applied for pursuant to subsection (d) of this section, of
the benefit amount paid to a person with no income under the temporary family assistance
program in the appropriate region of residence and if such person is an institutionalized
individual as defined in Section 1917(c) of the Social Security Act, 42 USC 1396p(c),
and has not made an assignment or transfer or other disposition of property for less than
fair market value for the purpose of establishing eligibility for benefits or assistance
under this section. Any such disposition shall be treated in accordance with Section
1917(c) of the Social Security Act, 42 USC 1396p(c). Any disposition of property made
on behalf of an applicant or recipient or the spouse of an applicant or recipient by a
guardian, conservator, person authorized to make such disposition pursuant to a power
of attorney or other person so authorized by law shall be attributed to such applicant,
recipient or spouse. A disposition of property ordered by a court shall be evaluated in
accordance with the standards applied to any other such disposition for the purpose of
determining eligibility. The commissioner shall establish the standards for eligibility
for medical assistance at one hundred forty-three per cent of the benefit amount paid to
a family unit of equal size with no income under the temporary family assistance program
in the appropriate region of residence, pending federal approval, except that the medical
assistance program shall provide coverage to persons under the age of nineteen up to
one hundred eighty-five per cent of the federal poverty level without an asset limit. On
and after January 1, 2001, said medical assistance program shall also provide coverage
to persons under the age of nineteen and their parents and needy caretaker relatives who
qualify for coverage under Section 1931 of the Social Security Act with family income
up to one hundred fifty per cent of the federal poverty level without an asset limit, upon
the request of such a person or upon a redetermination of eligibility. Such levels shall
be based on the regional differences in such benefit amount, if applicable, unless such
levels based on regional differences are not in conformance with federal law. Any income in excess of the applicable amounts shall be applied as may be required by said
federal law, and assistance shall be granted for the balance of the cost of authorized
medical assistance. All contracts entered into on and after July 1, 1997, pursuant to this
section shall include provisions for collaboration of managed care organizations with
the Healthy Families Connecticut Program established pursuant to section 17a-56. The
Commissioner of Social Services shall provide applicants for assistance under this section, at the time of application, with a written statement advising them of the effect of
an assignment or transfer or other disposition of property on eligibility for benefits or
assistance.
(b) For the purposes of the Medicaid program, the Commissioner of Social Services
shall consider parental income and resources as available to a child under eighteen years
of age who is living with his or her parents and is blind or disabled for purposes of the
Medicaid program, or to any other child under twenty-one years of age who is living
with his or her parents.
(c) For the purposes of determining eligibility for the Medicaid program, an available asset is one that is actually available to the applicant or one that the applicant has
the legal right, authority or power to obtain or to have applied for the applicant's general
or medical support. If the terms of a trust provide for the support of an applicant, the
refusal of a trustee to make a distribution from the trust does not render the trust an
unavailable asset. Notwithstanding the provisions of this subsection, the availability of
funds in a trust or similar instrument funded in whole or in part by the applicant or the
applicant's spouse shall be determined pursuant to the Omnibus Budget Reconciliation
Act of 1993, 42 USC 1396p. The provisions of this subsection shall not apply to special
needs trust, as defined in 42 USC 1396p(d)(4)(A).
(d) The transfer of an asset in exchange for other valuable consideration shall be
allowable to the extent the value of the other valuable consideration is equal to or greater
than the value of the asset transferred.
(e) On or before January 15, 1994, and annually thereafter, the Department of Social
Services shall submit a report to the General Assembly in accordance with section 11-
4a which sets forth the following: The number of children receiving Medicaid services;
the number of children receiving medical treatment at any state or municipal health care
facility; the number of doctors and dentists participating in state or municipally-funded
programs; and the percentage of children treated in medical programs whose family
income is less than one hundred thirty-three per cent of the federal poverty level and
the number whose family income is greater than one hundred thirty-three per cent but
not more than one hundred eighty-five per cent of the federal poverty level. On and after
October 1, 1996, the report shall be submitted to the joint standing committee of the
General Assembly having cognizance of matters relating to human services and, upon
request, to any member of the General Assembly. A summary of the report shall be
submitted to each member of the General Assembly if the summary is two pages or less
and a notification of the report shall be submitted to each member if the summary is
more than two pages. Submission shall be by mailing the report, summary or notification
to the legislative address of each member of the committee or the General Assembly,
as applicable.
(f) The Commissioner of Social Services shall seek a waiver from federal law to
permit federal financial participation for Medicaid expenditures for families with incomes of one hundred forty-three per cent of the temporary family assistance program
payment standard.
(1967, P.A. 759, S. 1(b); 1969, P.A. 730, S. 8; P.A. 78-192, S. 4, 7; P.A. 80-50; P.A. 81-214, S. 6; P.A. 85-505, S. 14,
21; 85-527; P.A. 86-363, S. 3; P.A. 87-390, S. 1, 4; P.A. 89-317, S. 1, 2; P.A. 92-233, S. 1; P.A. 93-262, S. 1, 87; 93-289,
S. 1—3; 93-435, S. 59, 95; May Sp. Sess. P.A. 94-5, S. 16, 30; P.A. 95-194, S. 30, 33; 95-351, S. 22, 30; P.A. 96-251, S.
9; P.A. 97-288, S. 3, 6; June 18 Sp. Sess. P.A. 97-2, S. 70, 165; October 29 Sp. Sess. P.A. 97-1, S. 19, 23; P.A. 99-279, S.
16, 45; June Sp. Sess. P.A. 00-2, S. 18, 53; June Sp. Sess. P.A. 01-2, S. 3, 69; June Sp. Sess. P.A. 01-9, S. 129, 131.)
History: 1969 act deleted varying income limits and exclusions dependent upon marital status and number of dependents,
referring instead to income limits under federal law; P.A. 78-192 added provisions re increases in eligibility standards;
P.A. 80-50 added Subsec. (b); P.A. 81-214 added provisions re effect of transfer of property on eligibility for benefits in
Subsec. (a); P.A. 85-505 amended Subsec. (a) to allow the extension of benefits for six months for former recipients; P.A.
85-527 amended Subsec. (a) by replacing "the minimum income permissible under federal law" with "one hundred twenty
per cent of the standard of need"; P.A. 86-363 included children under eighteen years of age who are living with their
parents and are blind or disabled in group for which parental income shall be considered under Subsec. (b); P.A. 87-390
changed the limit from one hundred "twenty" to one hundred "thirty-three", added language on division of property and
transfer of the interest in a house between spouses, and added requirement for a written statement advising applicants of
the effect of an assignment, transfer or other disposition of property on eligibility; P.A. 89-317 amended Subsec. (a) to
require that a person be institutionalized, as defined in the Social Security Act, to be eligible for medical assistance, changed
the time from which a transfer of assets will be permitted from "twenty-four" months to "thirty" months prior to the date
of application and "thirty" months prior to the date of institutionalization and to require treatment of any disposition of
assets in accordance with Section 1917 (c) of the Social Security Act, 42 U.S.C. 1396p (c); P.A. 92-233 amended Subsec.
(a) by adding provisions re attribution of property disposed of on behalf of an applicant or his spouse by a guardian,
conservator or authorized representative and disposition of property ordered by a court; P.A. 93-262 and 93-435 authorized
substitution of commissioner and department of social services for commissioner and department of income maintenance,
effective July 1, 1993; P.A. 93-289, S. 1 required that the medical assistance program provide coverage to persons under
the age of six and S. 2 was added editorially by the Revisors as Subsec. (c) requiring the department of income maintenance
to submit a report, effective July 1, 1993; May Sp. Sess. P.A. 94-5 removed the time limit on transfers of assets and extended
coverage to children under the age of nineteen born after September 30, 1983, rather than children under six, effective July
1, 1994; Sec. 17-134b transferred to Sec. 17b-261 in 1995; P.A. 95-194 amended Subsec. (a) by changing the eligibility
for medical assistance from an income which is not more than one hundred thirty-three per cent of the standard of need
established pursuant to section 17b-104 to an income which is not more than one hundred forty-two per cent of the benefit
amount paid to a person with no income under the AFDC program in the appropriate region of residence and by requiring
the commissioner to establish the standards for eligibility for medical assistance at one hundred thirty-three per cent of
the benefit amount paid to a family unit of equal size with no income under the AFDC program in the appropriate region
of residence, added Subdiv. (d) requiring the commissioner to seek a waiver to permit federal financial participation for
Medicaid expenditures and made technical changes, effective July 1, 1995; P.A. 95-351 replaced "one hundred forty-two"
with "one hundred forty-three" as the highest allowable percentage of income for the provision of medical assistance and
made a technical change, effective July 1, 1995; P.A. 96-251 amended Subsec. (c) by requiring that on and after October
1, 1996, reports be submitted to the legislative committee on human services and to legislators upon request and by adding
provisions re submission of report summaries to legislators; P.A. 97-288 amended Subsec. (a) to require that contracts
entered into after July 1, 1997, include provisions for collaboration of managed care organizations with the program
established under Sec. 17a-56, effective July 1, 1997; June 18 Sp. Sess. P.A. 97-2 amended Subsec. (a) by extending
Medicaid coverage, on and after July 1, 1998, from persons under the age of nineteen born after September 30, 1983, to
persons under the age of nineteen born after September 30, 1981, or if possible, within available appropriations, born after
June 30, 1980, with family income up to one hundred eighty-five per cent of the federal poverty level without an asset
limit, replaced references to aid to families with dependent children with temporary family assistance, and made technical
and conforming changes, effective July 1, 1997; Oct. 29 Sp. Sess. P.A. 97-1 amended Subsec. (a) to provide that on and
after January 1, 1998, the medical assistance program shall provide coverage to persons under the age of nineteen and
deleted reference to "born after June 30, 1981, or if possible within available appropriations, born after June 30, 1980",
effective October 30, 1997; P.A. 99-279 amended Subsec. (a) to require extension of coverage under the medical assistance
program to parents of children enrolled in the HUSKY Plan, Part A and to their needy caretaker relatives who qualify for
coverage under Section 1931 of the Social Security Act and made technical changes, effective July 1, 2000; June Sp. Sess.
P.A. 00-2 amended Subsec. (a) by deleting "born after September 30, 1981," changing "July 1, 2000," to "January 1,
2001," changing the family income level for eligibility for medical assistance from one hundred eighty-five to one hundred
fifty per cent of federal poverty level, and adding provision re providing coverage upon the request of a person or upon a
redetermination of eligibility, effective July 1, 2000; June Sp. Sess. P.A. 01-2 made technical changes for purposes of
gender neutrality in Subsec. (b), added new Subsecs. (c) and (d) re availability and transfer of assets, and redesignated
existing Subsecs. (c) and (d) as Subsecs. (e) and (f), effective July 1, 2001; June Sp. Sess. P.A. 01-9 revised effective date
of June Sp. Sess. P.A. 01-2 but without affecting this section.
Annotations to former section 17-134b:
Cited. 168 C. 336. Since disclaimer is invalid state may reassess eligibility for assistance. 179 C. 463, 464, 469, 470.
Cited. 199 C. 524, 535. Cited. 204 C. 17, 19, 20. Cited. Id., 672, 676, 681. Cited. 216 C. 85—87, 90.
Welfare commissioner is obligated to provide medical assistance for any otherwise eligible person whose income is
not more than minimum income permissible under federal law for such eligibility. 34 CS 525, 526. State regulation on
Medicaid abortion funding is contrary to statutory provision. 40 CS 394, 411—416, 432.
Subsec. (a):
Cited. 204 C. 672, 676.
Annotations to present section:
Cited as "17b-260 et seq. (providing for supplemental medical assistance)". 233 C. 557, 565.
Sec. 17b-261a. Long-term care under Medicaid program; federal waiver re
period of ineligibility for. The Commissioner of Social Services shall seek a waiver
of federal law for the purpose of establishing that the penalty period during which an
applicant for or recipient of assistance for long-term care under the Medicaid program
is ineligible for Medicaid-funded services due to a transfer of assets for less than fair
market value shall begin in the month the applicant is found otherwise eligible for Medicaid coverage of services rather than in the month of the transfer of assets. This section
shall only apply to transfers that occur on or after the effective date of the waiver. The
provisions of section 17b-8 shall apply to this section.
(June Sp. Sess. P.A. 01-2, S. 4, 69; June Sp. Sess. P.A. 01-9, S. 129, 131.)
History: June Sp. Sess. P.A. 01-2 effective July 1, 2001; June Sp. Sess. P.A. 01-9 revised effective date of June Sp.
Sess. P.A. 01-2 but without affecting this section.
(a) The Department of Social Services shall be the sole agency to determine eligibility for assistance and services under programs operated and administered by said
department.
(b) Any person filing an application with a probate court for spousal support, in
accordance with section 45a-655, shall certify to that court that a copy of the application
and accompanying attachments have been sent by regular mail, postage prepaid, to the
Commissioner of Social Services. The probate court shall provide a notice of hearing
to the commissioner at least fifteen business days prior to the hearing. The commissioner
or a designee shall have the right to appear at such hearing and may present the commissioner's position as to the application in person or in writing. Any final order by the
court on such application for spousal support shall be sent to the commissioner within
seven business days of the order.
(c) No probate court shall approve an application for spousal support of a community spouse unless (1) notice is provided in accordance with subsection (b) of this section,
and (2) the order is consistent with state and federal law.
(June Sp. Sess. P.A. 01-2, S. 5, 69; June Sp. Sess. P.A. 01-9, S. 129, 131.)
History: June Sp. Sess. P.A. 01-2 effective July 1, 2001; June Sp. Sess. P.A. 01-9 revised effective date of June Sp.
Sess. P.A. 01-2 but without affecting this section.
Sec. 17b-262. (Formerly Sec. 17-134d). Regulations. Admissions to nursing
home facilities. The Commissioner of Social Services may make such regulations as are
necessary to administer the medical assistance program. Such regulations shall include
provisions requiring the Department of Social Services (1) to monitor admissions to
nursing home facilities, as defined in section 19a-521, and (2) to prohibit the admission
by such facilities of persons with primary psychiatric diagnoses if such admission would
jeopardize federal reimbursements.
(1967, P.A. 759, S. 1(d); P.A. 75-420, S. 4, 6; P.A. 77-614, S. 608, 610; P.A. 87-113; P.A. 93-262, S. 1, 87.)
History: P.A. 75-420 replaced welfare commissioner with commissioner of social services; P.A. 77-614 replaced commissioner of social services with commissioner of income maintenance, effective January 1, 1979; P.A. 87-113 added
requirements for the regulations in Subdivs. (1) and (2); P.A. 93-262 authorized substitution of commissioner and department of social services for commissioner and department of income maintenance, effective July 1, 1993; Sec. 17-134d
transferred to Sec. 17b-262 in 1995.
Annotations to former section 17-134d:
Cited. 168 C. 336. Since disclaimer is invalid, state may reassess eligibility for assistance. 179 C. 463, 470. Cited. 191
C. 384, 405. Cited. 204 C. 17, 19, 20. Cited. 216 C. 85—87, 90. Cited. 226 C. 818, 824.
Cited. 40 CS 394, 415.
Cited. 5 Conn. Cir. Ct. 567.
Annotations to present section:
Cited as "17b-260 et seq. (providing for supplemental medical assistance)". 233 C. 557, 565.
Sec. 17b-263. (Formerly Sec. 17-274b). Utilization of outpatient mental health
services. Contract for services. Rates. (a) The Commissioner of Social Services shall
extend the provisions of section 17-134d-11 of the regulations of Connecticut state
agencies to monitor and control Medicaid recipient utilization of outpatient mental
health services. The commissioner shall contract, through a competitive bidding process,
for recipient surveillance and review services. Such contract shall authorize the imposition of utilization controls, including but not limited to, prior authorization requirements
based on medical appropriateness and cost effectiveness.
(b) The rate paid for hospital outpatient mental health therapy services, except for
partial hospitalization and other comprehensive services as defined by the commissioner, shall be that established in subsection (d) of section 17b-239 for an outpatient
clinic visit. Payment for partial hospitalization services shall be considered payment in
full for all outpatient mental health services.
(June Sp. Sess. P.A. 91-8, S. 10, 63; P.A. 93-262, S. 1, 87.)
History: P.A. 93-262 authorized substitution of commissioner and department of social services for commissioner and
department of income maintenance, effective July 1, 1993; Sec. 17-274b transferred to Sec. 17b-263 in 1995.
Cited as "17b-260 et seq. (providing for supplemental medical assistance)". 233 C. 557, 565.
Sec. 17b-264. (Formerly Sec. 17-134e). Extension of other public assistance
provisions. All of the provisions of sections 17b-22, 17b-75 to 17b-77, inclusive, 17b-
79 to 17b-103, inclusive, and 17b-600 to 17b-604, inclusive, are extended to the medical
assistance program except such provisions as are inconsistent with federal law and regulations governing Title XIX of the Social Security Amendments of 1965 and sections
17b-260 to 17b-262, inclusive, 17b-264 to 17b-285, inclusive, and 17b-357 to 17b-362,
inclusive.
(1967, P.A. 759, S. 1(e); June 18 Sp. Ses. P.A. 97-2, S. 71, 165.)
History: Sec. 17-134e transferred to Sec. 17b-264 in 1995; June 18 Sp. Sess. P.A. 97-2 made technical changes, effective
July 1, 1997.
Annotations to former section 17-134e:
Cited. 168 C. 336. Cited. 172 C. 292. Since disclaimer is invalid, state may reassess eligibility for assistance. 179 C.
463, 465, 470. Cited. 204 C. 17, 19, 20. Cited. 209 C. 390, 396. Cited. 216 C. 85—87, 90. Cited. 225 C. 314, 338.
Cited. 44 CA 143.
This section extends the provisions of chapter 302 to the medical assistance program except such provisions which are
inconsistent with federal law and part IV of chapter 302. 32 CS 523, 526.
Annotations to present section:
Cited as "17b-260 et seq. (providing for supplemental medical assistance)". 233 C. 557, 565. Cited. 237 C. 550. Cited.
240 C. 141.
Cited. 44 CA 143.
Sec. 17b-265. (Formerly Sec. 17-134f). Department subrogated to right of recovery of applicant or recipient. Utilization of personal health insurance. Insurance
coverage of medical assistance recipients. Limitations. (a) In accordance with 42
USC 1396k, the Department of Social Services shall be subrogated to any right of recovery or indemnification which an applicant or recipient of medical assistance or any
legally liable relative has against a private insurer or other third party, as defined in 42
CFR 433.136, for the cost of hospitalization, pharmaceutical services, physician services, nursing services and other medical services, not to exceed the amount expended
by the department for such care and treatment of the applicant or recipient. In the case
of such a recipient who is an enrollee in a managed care organization under a Medicaid
managed care contract with the state or a legally liable relative of such an enrollee, the
department shall be subrogated to any right of recovery or indemnification which the
enrollee or legally liable relative has against such a private insurer or other third party
for the medical costs incurred by the managed care organization on behalf of an enrollee.
An applicant or recipient or legally liable relative, by the act of the applicant or recipient
receiving medical assistance, shall be deemed to have made a subrogation assignment
and an assignment of claim for benefits to the department. The department shall inform
an applicant of such assignments at the time of application. Any entitlements from a
contractual agreement with an applicant or recipient, legally liable relative or a state or
federal program for such medical services, not to exceed the amount expended by the
department, shall be so assigned. Such entitlements shall be directly reimbursable to
the department by third party payors. The Department of Social Services may assign
its right to subrogation or its entitlement to benefits to a designee or a health care provider
participating in the Medicaid program and providing services to an applicant or recipient,
in order to assist the provider in obtaining payment for such services. A provider that
has received an assignment from the department shall notify the private insurer or third
party of the assignment upon rendition of services to the applicant or recipient. Failure
to so notify the private insurer or third party shall render the provider ineligible for
payment from the department. The provider shall notify the department of any request
by the applicant or recipient or legally liable relative or representative of such applicant
or recipient for billing information. This subsection shall not be construed to affect the
right of an applicant or recipient to maintain an independent cause of action against
such third party tortfeasor.
(b) When a recipient of medical assistance has personal health insurance in force
covering care or other benefits provided under such program, payment or part-payment
of the premium for such insurance may be made when deemed appropriate by the Commissioner of Social Services. Effective January 1, 1992, the commissioner shall limit
reimbursement to medical assistance providers, except those providers whose rates are
established by the Commissioner of Public Health pursuant to chapter 368d, for coinsurance and deductible payments under Title XVIII of the Social Security Act to assure
that the combined Medicare and Medicaid payment to the provider shall not exceed the
maximum allowable under the Medicaid program fee schedules.
(c) Notwithstanding the provisions of subsection (c) of section 38a-553, no (1) individual or group accident, health or accident and health policy or medical expense policy
or medical service plan contract, delivered, issued for delivery or renewed in this state
on or after July 1, 1984, or (2) self-insured or self-funded plan subject to the provisions
of the Employee Retirement Income Security Act of 1974 shall contain any provision
which has the effect of denying or limiting benefits or excluding coverage because
services are rendered to an insured or beneficiary who is eligible for or who received
medical assistance under this chapter. No insurer, as defined in section 38a-497a, shall
impose requirements on the state Medicaid agency, which has been assigned the rights
of an individual eligible for Medicaid and covered for health benefits from an insurer,
that differ from requirements applicable to an agent or assignee of another individual
so covered.
(d) The Commissioner of Social Services shall not pay for any services provided
under this chapter if the individual eligible for medical assistance has coverage for the
services under an accident or health insurance policy.
(1967, P.A. 759, S. 1(f); P.A. 75-420, S. 4, 6; P.A. 77-614, S. 608, 610; P.A. 83-145; P.A. 84-367, S. 2, 3; P.A. 90-
283, S. 1; June Sp. Sess. P.A. 91-8, S. 6, 63; P.A. 93-262, S. 1, 87; 93-381, S. 9, 39; 93-418, S. 32, 41; May Sp. Sess. P.A.
94-5, S. 6, 30; P.A. 95-257, S. 12, 21, 58; 95-305, S. 3, 6; P.A. 99-279, S. 17, 45.)
History: P.A. 75-420 replaced welfare commissioner with commissioner of social services; P.A. 77-614 replaced commissioner of social services with commissioner of income maintenance, effective January 1, 1979; P.A. 83-145 made the
existing section Subsec. (b) and added Subsec. (a) dealing with subrogation to any right of recovery, assignment of claim
for benefits and entitlements and right of action against third party tortfeasors; P.A. 84-367 added Subsec. (c) prohibiting
a provision denying or limiting insurance benefits because services are rendered to an insured who is eligible for or received
medical assistance and added Subsec. (d) prohibiting the commissioner from paying for services if the individual has
coverage under an accident or health insurance policy; P.A. 90-283 in Subsec. (a) subrogated the department to any right
of recovery of a legally liable relative of an applicant or recipient of medical assistance and added provisions whereby the
department may assign its right of subrogation; June Sp. Sess. P.A. 91-8 amended Subsec. (b) to require a limitation on
reimbursement to medical assistance providers for coinsurance and deductible payments to not exceed the maximum
allowable under the Medicaid fee schedules, except for those providers licensed by the department of health services; P.A.
93-262 authorized substitution of commissioner and department of social services for commissioner and department of
income maintenance, effective July 1, 1993; P.A. 93-381 replaced commissioner of health services with commissioner of
public health and addiction services, effective July 1, 1993; P.A. 93-418 changed reference to insurer to a private insurer
or third party and made other technical changes, effective July 1, 1993; May Sp. Sess. P.A. 94-5 amended Subsec. (c) to
prevent insurers from imposing requirements on the department of social services which deny or limit benefits which have
been assigned pursuant to this section, effective July 1, 1994; Sec. 17-134f transferred to Sec. 17b-265 in 1995; P.A. 95-
257 replaced Commissioner and Department of Public Health and Addiction Services with Commissioner and Department
of Public Health, effective July 1, 1995; P.A. 95-305 amended Subsec. (c) by deleting a provision that an insurer, health
care center or issuer of any service plan contract for hospital or medical expense coverage shall not impose requirements
on the Department of Social Services which limit or deny benefits and adding a provision prohibiting an insurer from
imposing certain requirements on the state Medicaid agency, effective July 1, 1995; P.A. 99-279 amended Subsec. (a) to
provide that the department shall be subrogated to any right of recovery or indemnification which an enrollee in a managed
care organization under a Medicaid managed care contract or legally liable relative has against a private insurer or other
third party for the medical costs incurred by the managed care organization on behalf of an enrollee and made technical
changes, effective July 1, 1999.
See Sec. 17b-265a re physicians providing services to dually eligible Medicaid and Medicare clients.
Annotations to former section 17-134f:
Cited. 168 C. 336. Cited. 204 C. 17, 19, 20. Cited. 216 C. 85—87, 90.
Annotations to present section:
Cited as "17b-260 et seq. (providing for supplemental medical assistance)". 233 C. 557, 565.
Sec. 17b-265a. Physicians providing services to dually eligible Medicaid and
Medicare clients. Rates. Effective April 1, 2003, the Commissioner of Social Services
shall, within available Medicaid appropriations, grant a rate increase to physicians who
provide services to clients who are eligible under both Medicaid and Medicare.
(May 9 Sp. Sess. P.A. 02-7, S. 54.)
History: May 9 Sp. Sess. P.A. 02-7 effective August 15, 2002.
See Sec. 17b-265 re insurance coverage of medical assistance recipients and limitations.
Sec. 17b-266. (Formerly Sec. 17-134g). Purchase of insurance. Contracts for
comprehensive health care on a prepayment or per capita basis. Certification of
providers by commissioner. Exception of deadline for payment of capitation
claims. Deposit of funds for expenditures for children's health programs and services. (a) The Commissioner of Social Services may, when he finds it to be in the public
interest, fund part or all of the cost of benefits to any recipient under sections 17b-260
to 17b-262, inclusive, 17b-264 to 17b-285, inclusive, 17b-357 to 17b-362, inclusive,
17b-289 to 17b-303, inclusive, and section 16 of public act 97-1 of the October 29
special session*, through the purchase of insurance from any organization authorized
to do a health insurance business in this state or from any organization specified in
subsection (b) of this section.
(b) The Commissioner of Social Services may require recipients of Medicaid or
other public assistance to receive medical care on a prepayment or per capita basis, in
accordance with federal law and regulations, if such prepayment is anticipated to result
in lower medical assistance costs to the state. The commissioner may enter into contracts
for the provision of comprehensive health care on a prepayment or per capita basis in
accordance with federal law and regulations, with the following: (1) A health care center
subject to the provisions of chapter 698a; (2) a consortium of federally-qualified community health centers and other community-based providers of health services which are
funded by the state; (3) other consortia of providers of health care services established
for the purposes of this subsection; or (4) an integrated service network providing care
management and comprehensive health care on a prepayment or per capita basis to
elderly and disabled recipients of Medicaid who may also be eligible for Medicare.
(c) Providers of comprehensive health care services as described in subdivisions
(2), (3) and (4) of subsection (b) of this section shall not be subject to the provisions of
chapter 698a or, in the case of an integrated service network, sections 17b-239 to 17b-
245, inclusive, 17b-281, 17b-340 or 17b-342 to 17b-343, inclusive. Any such provider
shall be certified by the Commissioner of Social Services in accordance with criteria
established by the commissioner, including, but not limited to, minimum reserve fund
requirements.
(d) The commissioner shall pay all capitation claims which would otherwise be
reimbursed to the health plans described in subsection (b) of this section in June, 1997,
no later than July 31, 1997.
(e) On or after May 1, 2000, the payment to the Commissioner of Social Services of
(1) any monetary sanction imposed by the commissioner on a managed care organization
under the provisions of a contract between the commissioner and such organization
entered into pursuant to this section or sections 17b-289 to 17b-304, inclusive, or (2)
any sum agreed upon by the commissioner and such an organization as settlement of a
claim brought by the commissioner or the state against such an organization for failure
to comply with the terms of a contract with the commissioner or fraud affecting the
Department of Social Services shall be deposited in an account designated for use by
the department for expenditures for children's health programs and services.
(1967, P.A. 759, S. 1(g); P.A. 75-420, S. 4, 6; P.A. 77-614, S. 608, 610; P.A. 83-51; P.A. 93-262, S. 1, 87; May Sp.
Sess. P.A. 94-5, S. 27, 30; P.A. 95-160, S. 26, 69; P.A. 96-139, S. 12, 13; June 18 Sp. Sess. P.A. 97-2, S. 112, 165; P.A.
98-239, S. 23, 35; June Sp. Sess. P.A. 00-2, S. 19, 53; P.A. 02-89, S. 31.)
*Note: Section 16 of public act 97-1 of the October special session is special in nature and therefore has not been
codified but remains in full force and effect according to its terms.
History: P.A. 75-420 replaced welfare commissioner with commissioner of social services; P.A. 77-614 replaced commissioner of social services with commissioner of income maintenance, effective January 1, 1979; P.A. 83-51 added
Subsec. (b) allowing the commissioner to enter into contracts for comprehensive health care on a prepayment or per capita
basis and allowing recipients to receive medical care on such basis; P.A. 93-262 authorized substitution of commissioner
and department of social services for commissioner and department of income maintenance, effective July 1, 1993; May
Sp. Sess. P.A. 94-5 specified with whom the commissioner may contract for the provision of comprehensive health care,
allowed comprehensive health care providers not to be subject to chapter 698a and required the health care providers to
be certified by the commissioner, effective July 1, 1994; Sec. 17-134g transferred to Sec. 17b-266 in 1995; P.A. 95-160
added Subsec. (d) requiring the commissioner to pay all capitation claims to be reimbursed to health plans in June, 1997,
no later than July 31, 1997, effective July 1, 1995; P.A. 96-139 changed effective date of P.A. 95-160 but without affecting
this section; June 18 Sp. Sess. P.A. 97-2 authorized the commissioner to enter into comprehensive health care contracts
with integrated service networks and exempted such networks from the provisions of chapter 698a or sections 17b-239 to
17b-245, inclusive, 17b-281, 17b-340 or 17b-342 to 17b-344, inclusive, effective July 1, 1997; (Revisor's note: New
Subsec. (e) added by vetoed P.A. 97-240 and reprinted in Sec. 112 of June 18 Sp. Sess. P.A. 97-2 is void and was therefore
not codified); P.A. 98-239 amended Subsec. (a) to allow the Commissioner of Social Services to fund part or all of the
health care insurance costs for recipients of the HUSKY Plan, Part B through the purchase of insurance from any organization authorized to conduct a health insurance business in this state or from any organization specified in Subsec. (b),
effective June 8, 1998; June Sp. Sess. P.A. 00-2 added Subsec. (e) re payments made to the commissioner of certain
monetary sanctions or settlements deposited in account designated for use for expenditures for children's health programs
and services, effective June 21, 2000; P.A. 02-89 amended Subsec. (c) to replace reference to Sec. 17b-344 with reference
to Sec. 17b-343, reflecting the repeal of Sec. 17b-344 by the same public act.
Annotations to former section 17-134g:
Cited. 168 C. 336. Cited. 204 C. 17, 19, 20. Cited. 216 C. 85—87, 90.
Annotations to present section:
Cited as "17b-260 et seq. (providing for supplemental medical assistance)". 233 C. 557, 565.
(a) If any group or association of providers of medical
assistance services wishes to have payments as provided for under sections 17b-260 to
17b-262, inclusive, 17b-264 to 17b-285, inclusive, and 17b-357 to 17b-362, inclusive,
to such providers made through a national, state or other public or private agency or
organization and nominates such agency or organization for this purpose, the Commissioner of Social Services is authorized to enter into an agreement with such agency or
organization providing for the determination by such agency or organization, subject
to such review by the Commissioner of Social Services as may be provided for by the
agreement, of the payments required to be made to such providers at the rates set by the
hospital cost commission, and for the making of such payments by such agency or
organization to such providers. Such agreement may also include provision for the
agency or organization to do all or any part of the following: With respect to the providers
of services which are to receive payments through it, (1) to serve as a center for, and
to communicate to providers, any information or instructions furnished to it by the
Commissioner of Social Services, and to serve as a channel of communication from
providers to the Commissioner of Social Services; (2) to make such audits of the records
of providers as may be necessary to insure that proper payments are made under this
section; and (3) to perform such other functions as are necessary to carry out the provisions of sections 17b-267 to 17b-271, inclusive.
(b) The Commissioner of Social Services shall not enter into an agreement with
any agency or organization under subsection (a) unless (1) he finds (A) that to do so
is consistent with the effective and efficient administration of the medical assistance
program, and (B) that such agency or organization is willing and able to assist the providers to which payments are made through it in the application of safeguards against
unnecessary utilization of services furnished by them to individuals entitled to hospital
insurance benefits under section 17b-261 and the agreement provides for such assistance, and (2) such agency or organization agrees to furnish to the Commissioner of
Social Services such of the information acquired by it in carrying out its agreement
under sections 17b-267 to 17b-271, inclusive, as the Commissioner of Social Services
may find necessary in performing his functions under said sections.
(c) An agreement with any agency or organization under subsection (a) may contain
such terms and conditions as the Commissioner of Social Services finds necessary or
appropriate, may provide for advances of funds to the agency or organization for the
making of payments by it under said subsection (a), and shall provide for payment by
the Commissioner of Social Services of so much of the cost of administration of the
agency or organization as is determined by said Commissioner of Social Services to be
necessary and proper for carrying out the functions covered by the agreement.
(1971, P.A. 431, S. 1; P.A. 75-420, S. 4, 6; P.A. 77-614, S. 608, 610; P.A. 93-262, S. 1, 87.)
History: P.A. 75-420 replaced welfare commissioner with commissioner of social services; P.A. 77-614 replaced commissioner of social services with commissioner of income maintenance, effective January 1, 1979; P.A. 93-262 authorized
substitution of commissioner and department of social services for commissioner and department of income maintenance,
effective July 1, 1993; Sec. 17-134h transferred to Sec. 17b-267 in 1995.
Annotations to former section 17-134h:
Cited. 168 C. 336. Cited. 204 C. 17, 19, 20. Cited. 216 C. 85—87, 90.
Annotations to present section:
Cited as "17b-260 et seq. (providing for supplemental medical assistance)". 233 C. 557, 565.
If the nomination of an agency or organization as provided in section
17b-267 is made by a group or association of providers of services, it shall not be binding
on members of the group or association which notify the Commissioner of Social Services of their election not to be included in such nomination. Any provider may, upon
such notice as may be specified in the agreement under section 17b-267, withdraw its
nomination to receive payments through such agency or organization. Any provider
which has withdrawn its nomination, and any group or association of providers which
has not made a nomination, may elect to receive payments from any agency or organization which has entered into an agreement with the Commissioner of Social Services
under section 17b-267 if the Commissioner of Social Services and such agency or organization agree to it.
(1971, P.A. 431, S. 2; P.A. 75-420, S. 4, 6; P.A. 77-614, S. 608, 610; P.A. 93-262, S. 1, 87.)
History: P.A. 75-420 replaced welfare commissioner with commissioner of social services; P.A. 77-614 replaced commissioner of social services with commissioner of of income maintenance, effective January 1, 1979; P.A. 93-262 authorized
substitution of commissioner and department of social services for commissioner and department of income maintenance,
effective July 1, 1993; Sec. 17-134i transferred to Sec. 17b-268 in 1995.
Annotations to former section 17-134i:
Cited. 168 C. 336. Cited. 204 C. 17, 19, 20. Cited. 216 C. 85—87, 90.
Annotations to present section:
Cited as "17b-260 et seq. (providing for supplemental medical assistance)". 233 C. 557, 565.
An
agreement with an agency or organization under section 17b-267 may require any of
its officers or employees certifying payments or disbursing funds pursuant to the
agreement, or otherwise participating in carrying out the agreement, to give surety bond
to the state in such amount as the Commissioner of Social Services may deem appropriate.
(1971, P.A. 431, S. 4; P.A. 75-420, S. 4, 6; P.A. 77-614, S. 608, 610; P.A. 93-262, S. 1, 87.)
History: P.A. 75-420 replaced welfare commissioner with commissioner of social services; P.A. 77-614 replaced commissioner of social services with commissioner of income maintenance, effective January 1, 1979; P.A. 93-262 authorized
substitution of commissioner and department of social services for commissioner and department of income maintenance,
effective July 1, 1993; Sec. 17-134j transferred to Sec. 17b-269 in 1995.
Annotations to former section 17-134j:
Cited. 168 C. 336. Cited. 204 C. 17, 19, 20. Cited. 216 C. 85—87, 90.
Annotations to present section:
Cited as "17b-260 et seq. (providing for supplemental medical assistance)". 233 C. 557, 565.
(a)
No individual designated pursuant to an agreement under section 17b-267 as a certifying
officer shall, in the absence of gross negligence or intent to defraud the state, be liable
with respect to any payments certified by him under section 17b-267.
(b) No disbursing officer shall, in the absence of gross negligence or intent to defraud the state, be liable with respect to any payment by him under section 17b-267 if
it was based upon a voucher signed by a certifying officer designated as provided in
subsection (a) of this section.
(c) No such agency or organization shall be liable to the state for any payments
referred to in subsection (a) or (b) of this section.
(1971, P.A. 431, S. 5.)
History: Sec. 17-134k transferred to Sec. 17b-270 in 1995.
Annotations to former section 17-134k:
Cited. 168 C. 336. Cited. 204 C. 17, 19, 20. Cited. 216 C. 85—87, 90.
Annotations to present section:
Cited as "17b-260 et seq. (providing for supplemental medical assistance)". 233 C. 557, 565.
An
agreement with the Commissioner of Social Services under section 17b-267 may be
terminated: (1) By the agency or organization which entered into such agreement at
such time and upon such notice to the Commissioner of Social Services, to the public,
and to the providers as may be provided in regulations of the Commissioner of Social
Services, or (2) by the Commissioner of Social Services at such time and upon such
notice to the agency or organization, to the group or association of providers which have
nominated it for purposes of section 17b-267, and to the public, as may be provided in
said regulations, but only if he finds, after reasonable notice and opportunity for hearing
to the agency or organization, that (A) the agency or organization has failed substantially
to carry out the agreement, or (B) the continuation of some or all of the functions provided
for in the agreement with the agency or organization is disadvantageous or is inconsistent
with the efficient administration of the medical assistance program.
(1971, P.A. 431, S. 3; P.A. 75-420, S. 4, 6; P.A. 77-614, S. 608, 610; P.A. 93-262, S. 1, 87.)
History: P.A. 75-420 replaced welfare commissioner with commissioner of social services; P.A. 77-614 replaced commissioner of social services with commissioner of income maintenance, effective January 1, 1979; P.A. 93-262 authorized
substitution of commissioner and department of social services for commissioner and department of income maintenance,
effective July 1, 1993; Sec. 17-134l transferred to Sec. 17b-271 in 1995.
Annotations to former section 17-134l:
Cited. 168 C. 336. Cited. 204 C. 17, 19, 20. Cited. 216 C. 85—87, 90.
Annotations to present section:
Cited as "17b-260 et seq. (providing for supplemental medical assistance)". 233 C. 557, 565.
Effective
July 1, 1998, the Commissioner of Social Services shall permit patients residing in
nursing homes, chronic disease hospitals and state humane institutions who are medical
assistance recipients under sections 17b-260 to 17b-262, inclusive, 17b-264 to 17b-285,
inclusive, and 17b-357 to 17b-362, inclusive, to have a monthly personal fund allowance
of fifty dollars. Effective July 1, 1999, the commissioner shall increase such allowance
annually to reflect the annual inflation adjustment in Social Security income, if any.
(P.A. 81-320; P.A. 84-354, S. 1, 2; P.A. 85-367, S. 1; P.A. 87-367, S. 1, 2; June Sp. Sess. P.A. 91-8, S. 7, 63; P.A. 93-
262, S. 1, 87; June 18 Sp. Sess. P.A. 97-2, S. 151, 165; P.A. 98-239, S. 3, 35.)
History: P.A. 84-354 increased the allowance from twenty-eight to thirty dollars; P.A. 85-367 increased the allowance
from thirty to thirty-five dollars; P.A. 87-367 increased the allowance from "thirty-five" to "forty" dollars and added the
language re adjustments beginning July 1, 1988; June Sp. Sess. P.A. 91-8 reduced the allowance to an amount equal to
the minimum permitted under Title XIX, beginning October 1, 1991, and deleted the previous forty dollar allowance and
the language re adjustments; P.A. 93-262 authorized substitution of commissioner and department of social services for
commissioner and department of income maintenance, effective July 1, 1993; Sec. 17-134m transferred to Sec. 17b-272
in 1995; June 18 Sp. Sess. P.A. 97-2 added a provision effective July 1, 1998, requiring the commissioner to increase
personal fund allowance annually to reflect any annual inflation adjustment in Social Security income, effective July 1,
1997; P.A. 98-239 substituted "July 1, 1998" for "October 1, 1991" as applicable date and increased the allowance to fifty
dollars, deleting reference to "a level equal to the minimum permitted under Title XIX of the Social Security Act" and
substituted "July 1, 1999" for "July 1, 1998" as applicable date for annual increases, effective July 1, 1998.
Cited as "17b-260 et seq. (providing for supplemental medical assistance)". 233 C. 557, 565.
On and after April 1, 1983, the Commissioner of Social Services shall increase the payment rate for ambulance rides eligible
under the state medical assistance program.
(P.A. 82-350, S. 1, 4; P.A. 93-262, S. 1, 87.)
History: P.A. 93-262 authorized substitution of commissioner and department of social services for commissioner and
department of income maintenance, effective July 1, 1993; Sec. 17-134o transferred to Sec. 17b-273 in 1995.
Cited as "17b-260 et seq. (providing for supplemental medical assistance)". 233 C. 557, 565.
Sec. 17b-274. (Formerly Sec. 17-134q). Periodic investigations of pharmacies
by Division of Criminal Justice. Brand medically necessary. Procedure for prior
approval to dispense brand name drug. Disclosure. (a) The Division of Criminal
Justice shall periodically investigate pharmacies to ensure that the state is not billed for
a brand name drug product when a less expensive generic substitute drug product is
dispensed to a Medicaid recipient. The Commissioner of Social Services shall cooperate
and provide information as requested by such division.
(b) A licensed medical practitioner may specify in writing or by a telephonic or
electronic communication that there shall be no substitution for the specified brand name
drug product in any prescription for a Medicaid, state-administered general assistance,
general assistance or ConnPACE recipient, provided (1) the practitioner specifies the
basis on which the brand name drug product and dosage form is medically necessary
in comparison to a chemically equivalent generic drug product substitution, and (2) the
phrase "brand medically necessary" shall be in the practitioner's handwriting on the
prescription form or, if the prohibition was communicated by telephonic communication, in the pharmacist's handwriting on such form, and shall not be preprinted or
stamped or initialed on such form. If the practitioner specifies by telephonic communication that there shall be no substitution for the specified brand name drug product in any
prescription for a Medicaid, state-administered general assistance, general assistance
or ConnPACE recipient, written certification in the practitioner's handwriting bearing
the phrase "brand medically necessary" shall be sent to the dispensing pharmacy within
ten days. A pharmacist shall dispense a generically equivalent drug product for any drug
listed in accordance with the Code of Federal Regulations Title 42 Part 447.332 for a
drug prescribed for a Medicaid, state-administered general assistance, general assistance
or ConnPACE recipient unless the phrase "brand medically necessary" is ordered in
accordance with this subsection and such pharmacist has received approval to dispense
the brand name drug product in accordance with subsection (c) of this section.
(c) The Commissioner of Social Services shall implement a procedure by which a
pharmacist shall obtain approval from an independent pharmacy consultant acting on
behalf of the Department of Social Services, under an administrative services only contract, whenever the pharmacist dispenses a brand name drug product to a Medicaid,
state-administered general assistance, general assistance or ConnPACE recipient and
a chemically equivalent generic drug product substitution is available, provided such
procedure shall not require approval for other than initial prescriptions for such drug
product. If such approval is not granted or denied within two hours of receipt by the
commissioner of the request for approval, it shall be deemed granted. Notwithstanding
any provision of this section, a pharmacist shall not dispense any initial maintenance
drug prescription for which there is a chemically equivalent generic substitution that is
for less than fifteen days without the department's granting of prior authorization, provided prior authorization shall not otherwise be required for atypical antipsychotic drugs
if the individual is currently taking such drug at the time the pharmacist receives the
prescription. The pharmacist may appeal a denial of reimbursement to the department
based on the failure of such pharmacist to substitute a generic drug product in accordance
with this section.
(d) A licensed medical practitioner shall disclose to the Department of Social Services or such consultant, upon request, the basis on which the brand name drug product
and dosage form is medically necessary in comparison to a chemically equivalent generic drug product substitution. The Commissioner of Social Services shall establish a
procedure by which such a practitioner may appeal a determination that a chemically
equivalent generic drug product substitution is required for a Medicaid, state-administered general assistance, general assistance or ConnPACE recipient.
(P.A. 83-52, S. 1, 2, 4; P.A. 84-217, S. 1, 2; P.A. 89-111, S. 1; P.A. 93-262, S. 1, 87; P.A. 95-264, S. 46; P.A. 96-169,
S. 13; June Sp. Sess. P.A. 00-2, S. 38, 53; May 9 Sp. Sess. P.A. 02-7, S. 50.)
History: P.A. 84-217 removed language that limited payment of fee to the period from July 1, 1983, to June 30, 1984,
and increased fee from twenty-five to fifty cents; P.A. 89-111 added a new Subsec. (c) containing provisions for when
there is to be no substitute for the specified brand name drug product; P.A. 93-262 authorized substitution of commissioner
and department of social services for commissioner and department of income maintenance, effective July 1, 1993; Sec.
17-134q transferred to Sec. 17b-274 in 1995; P.A. 95-264 made technical changes; P.A. 96-169 amended Subsec. (b) to
require the Commissioner of Social Services to cooperate and provide information as requested by the Division of Criminal
Justice; June Sp. Sess. P.A. 00-2 amended Subsec. (c) to apply provisions to state-administered general assistance, general
assistance and ConnPACE recipients, to require specification of the basis of medical necessity and to add provision re
approval to dispense, added new Subsec. (d) requiring the Commissioner of Social Services to establish a procedure for
approval of dispensing brand name drug products and added new Subsec. (e) re disclosure of the basis of medical necessity,
effective July 1, 2000; May 9 Sp. Sess. P.A. 02-7 deleted former Subsec. (a) re fifty cent per prescription dispensing fee,
redesignated existing Subsecs. (b) to (e) as Subsecs. (a) to (d) and amended Subsec. (c) by changing "shall establish a
procedure" to "shall implement a procedure" and adding requirement that pharmacist not dispense any initial maintenance
drug prescription for less than fifteen days for which there is a chemically equivalent generic substitution without obtaining
prior authorization from the department, such prior authorization not required for atypical antipsychotic drugs currently
used by individuals at the time pharmacist receives prescription, effective August 15, 2002.
Cited as "17b-260 et seq. (providing for supplemental medical assistance)". 233 C. 557, 565.
The Commissioner of Social Services
may establish maximum allowable costs to be paid under the Medicaid, state-administered general assistance, general assistance, ConnPACE and Connecticut AIDS drug
assistance programs for generic prescription drugs based on, but not limited to, actual
acquisition costs. The department shall implement and maintain a procedure to review
and update the maximum allowable cost list at least annually, and shall report annually
to the joint standing committee of the General Assembly having cognizance of matters
relating to appropriations and the budgets of state agencies on its activities pursuant to
this section.
(May 9 Sp. Sess. P.A. 02-1, S. 118; May 9 Sp. Sess. P.A. 02-7, S. 53.)
History: May 9 Sp. Sess. P.A. 02-1 effective July 1, 2002; May 9 Sp. Sess. P.A. 02-7 required department to implement
and maintain a procedure to review and update the maximum allowable cost list at least annually and to report annually
to the General Assembly, effective August 15, 2002.
See Sec. 17b-491a re increasing cost efficiency of prescription drug programs.
The
Commissioner of Social Services may implement a pharmaceutical purchasing initiative
by contracting with an established entity for the purchase of drugs through the lowest
pricing available notwithstanding the provisions of section 17b-280 for Medicaid, state-
administered general assistance, general assistance, ConnPACE and Connecticut AIDS
drug assistance recipients. Any entity with whom the commissioner contracts for the
purposes of this section shall have an established pharmaceutical network and a demonstrated capability of processing the prescription volume anticipated for Medicaid, state-
administered general assistance, general assistance, ConnPACE and Connecticut AIDS
drug assistance recipients. The department shall report annually on the status of the
pharmaceutical purchasing initiative to the joint standing committee of the General
Assembly having cognizance of matters relating to appropriations and the budgets of
state agencies.
(May 9 Sp. Sess. P.A. 02-1, S. 123; May 9 Sp. Sess. P.A. 02-7, S. 56.)
History: May 9 Sp. Sess. P.A. 02-1 effective July 1, 2002; May 9 Sp. Sess. P.A. 02-7 required department to report
annually to the General Assembly, effective August 15, 2002.
See Sec. 17b-491a re increasing cost efficiency of prescription drug programs.
Sec. 17b-274c. Voluntary mail order option for maintenance prescription
drugs. The Commissioner of Social Services may establish a voluntary mail order option
for any maintenance prescription drug covered under the Medicaid, state-administered
general assistance, general assistance, ConnPACE or Connecticut AIDS drug assistance
programs.
(May 9 Sp. Sess. P.A. 02-1, S. 120.)
History: May 9 Sp. Sess. P.A. 02-1 effective July 1, 2002.
Sec. 17b-274d. Medicaid Pharmaceutical and Therapeutics Committee.
Membership. Duties. Preferred drug list. (a) Pursuant to 42 USC 1396r-8, there is
established a Medicaid Pharmaceutical and Therapeutics Committee within the Department of Social Services.
(b) The Medicaid Pharmaceutical and Therapeutics Committee shall be comprised
as specified in 42 USC 1396r-8 and shall consist of eleven members appointed by the
Governor. Five members shall be physicians licensed pursuant to chapter 370, five
members shall be pharmacists licensed pursuant to chapter 400j, and one member shall
be a consumer representative. The members shall serve for terms of two years from the
date of their appointment. Members may be appointed to more than one term. The
administrative staff of the Department of Social Services shall serve as staff for said
committee and assist with all ministerial duties. The Governor shall ensure that the
committee membership includes Medicaid participating physicians and pharmacists,
with experience serving all segments of the Medicaid population. Not less than one of
the committee members shall be a representative of the pharmaceutical manufacturers.
(c) Committee members shall select a chairperson and vice-chairperson from the
committee membership on an annual basis.
(d) The committee shall meet at least quarterly, and may meet at other times at the
discretion of the chairperson and committee membership. The committee shall comply
with all regulations adopted by the department, including notice of any meeting of the
committee, pursuant to the requirements of chapter 54.
(e) Upon recommendation of the Medicaid Pharmaceutical and Therapeutics Committee, the Department of Social Services shall adopt a preferred drug list. To the extent
feasible, the committee shall review all drugs included in the preferred drug list at least
every twelve months, and may recommend additions to, and deletions from, the preferred
drug list, to ensure that the preferred drug list provides for medically appropriate drug
therapies for Medicaid patients.
(f) Except for mental-health-related drugs and antiretroviral drugs, reimbursement
for a drug not included in the preferred drug list is subject to prior authorization.
(g) The Department of Social Services shall publish and disseminate the preferred
drug list to all Medicaid providers in the state.
(h) The committee shall ensure that the pharmaceutical manufacturers agreeing to
provide a supplemental rebate pursuant to 42 USC 1396r-8(c) have an opportunity to
present evidence supporting inclusion of a product on the preferred drug list unless a
court of competent jurisdiction, in a final decision, determines that the Secretary of
Health and Human Services does not have authority to allow such supplemental rebates;
provided the inability to utilize supplemental rebates pursuant to this subsection shall
not impair the committee's authority to maintain a preferred drug list. Upon timely
notice, the department shall ensure that any drug that has been approved or had any of
its particular uses approved by the United States Food and Drug Administration under
a priority review classification, will be reviewed by the Medicaid Pharmaceutical and
Therapeutics Committee at the next regularly scheduled meeting. To the extent feasible,
upon notice by a pharmaceutical manufacturer, the department shall also schedule a
product review for any new product at the next regularly scheduled meeting of the
Medicaid Pharmaceutical and Therapeutics Committee.
(i) Factors considered by the Medicaid Pharmaceutical and Therapeutics Committee in developing the preferred drug list shall include, but not be limited to, clinical
efficacy, safety and cost effectiveness of a product.
(j) The Medicaid Pharmaceutical and Therapeutics Committee may also make recommendations to the department regarding the prior authorization of any prescribed
drug covered by Medicaid.
(k) Medicaid recipients may appeal any department preferred drug list determinations utilizing the Medicaid fair hearing process administered by the Department of
Social Services established pursuant to chapter 54.
(May 9 Sp. Sess. P.A. 02-1, S. 121; May 9 Sp. Sess. P.A. 02-7, S. 52.)
History: May 9 Sp. Sess. P.A. 02-1 effective July 1, 2002; May 9 Sp. Sess. P.A. 02-7 amended Subsec. (h) by adding
provision re implementation of supplemental rebate program subject to determination by a court of competent jurisdiction
re federal authority to allow such rebates, effective August 15, 2002.
See Secs. 17b-274, 17b-491a re required prior authorization for brand name prescriptions.
The Commissioner of Social Services shall implement, not later than October
1, 1984, a physician and pharmacy lock-in procedure to restrict the use of the health
care delivery system by medical assistance recipients who are determined by the commissioner to have utilized medical services or items at a frequency or amount that is not
medically necessary. The commissioner shall establish criteria and a case review system
in order to make such determination. The commissioner shall require such recipients
for a reasonable period of time to obtain medical services or items only from designated
providers provided (1) the department gives the recipient notice and an opportunity for
a hearing, in accordance with procedures established by the department, before such
restrictions are imposed and (2) the department assures that the recipient has reasonable
access, taking into account geographic location and reasonable travel time, to medical
services of adequate quality.
(P.A. 84-352, S. 1, 4; P.A. 93-262, S. 1, 87.)
History: P.A. 93-262 authorized substitution of commissioner and department of social services for commissioner and
department of income maintenance, effective July 1, 1993; Sec. 17-134r transferred to Sec. 17b-275 in 1995.
Cited as "17b-260 et seq. (providing for supplemental medical assistance)". 233 C. 557, 565.
(a) The Commissioner of Social
Services shall identify geographic areas of the state where competitive bidding for nonemergency transportation services provided to medical assistance recipients to access
covered medical services would result in cost savings to the state. For the identified
areas the Commissioner of Social Services, in consultation with the Commissioner of
Transportation, the Commissioner of Public Health, and the Secretary of the Office of
Policy and Management, shall purchase such nonemergency transportation services
through a competitive bidding process. Any transportation providers awarded a contract
or subcontract for the direct provision of such services shall meet state licensure or
certification requirements and the nonemergency transportation requirements established by the Department of Social Services, and shall provide the most cost effective
transportation service, provided any contractor awarded a contract solely for coordinating such transportation services shall not be required to meet such licensure or certification requirements and provided the first such contracts for the purchase of such services
shall not exceed one year. Prior to awarding a contract pursuant to this section, the
Commissioner of Social Services shall consider the effect of the contract on the emergency ambulance primary service areas and volunteer ambulance services affected by
the contract. The commissioner may limit the geographic areas to be served by a contractor and may limit the amount of services to be performed by a contractor. The commissioner may operate one or more pilot programs prior to state-wide operation of a competitive bidding program for nonemergency transportation services. By enrolling in the
Medicaid program or participating in the competitively bid contract for nonemergency
transportation services, providers of nonemergency transportation services agree to offer to recipients of medical assistance all types or levels of transportation services for
which they are licensed or certified. Effective October 1, 1991, payment for such services
shall be made only for services provided to an eligible recipient who is actually transported. A contract entered into pursuant to this section may include services provided
by another state agency. Notwithstanding any provision of the general statutes, a contract
entered into pursuant to this section shall establish the rates to be paid for the transportation services provided under the contract. A contract entered into pursuant to this section
may include services provided by another state agency and shall supercede any conflicting provisions of the regulations of Connecticut state agencies pertaining to medical
transportation services.
(b) Notwithstanding any other provision of the general statutes, for purposes of
administering medical assistance programs, including, but not limited to, the state-administered general assistance program and programs administered pursuant to Title XIX
or Title XXI of the Social Security Act, the Department of Social Services shall be the
sole state agency that sets emergency and nonemergency medical transportation fees
or fee schedules for any transportation services that are reimbursed by the department
for said medical assistance programs.
(P.A. 85-505, S. 12, 21; P.A. 86-403, S. 37, 132; June Sp. Sess. P.A. 91-8, S. 8, 63; P.A. 93-262, S. 1, 87; P.A. 96-268,
S. 15, 34; May 9 Sp. Sess. P.A. 02-7, S. 61.)
History: P.A. 86-403 made technical changes; June Sp. Sess. P.A. 91-8 required that medical transportation service
providers offer medical assistance recipients all types and levels of service which are provided, and that payment of services
shall only be rendered to providers who transport eligible recipients; P.A. 93-262 authorized substitution of commissioner
and department of social services for commissioner and department of income maintenance, effective July 1, 1993; Sec.
17-134s transferred to Sec. 17b-276 in 1995; P.A. 96-268 replaced "medical transportation services" with "nonemergency
transportation services", required consultation with Commissioners of Transportation and Public Health and the Secretary
of the Office of Policy and Management, required transportation providers to meet licensure or certification requirements,
required commissioner to consider the effect of a contract on the emergency ambulance primary service areas, required
transportation providers to agree to offer Medicaid recipients all types of services provided, allowed contracts to include
services provided by other state agencies and required contracts to establish rates to be paid for services, effective July 1,
1996; May 9 Sp. Sess. P.A. 02-7 designated existing provisions as Subsec. (a) and amended same by adding provisions
re contract may include services provided by another state agency and supersedes any conflicting provisions of medical
transportation services regulations, and added Subsec. (b) re exclusive authority of Department of Social Services in setting
emergency and nonemergency medical transportation fees for medical assistance programs, effective August 15, 2002.
See Sec. 17b-276a re amendment to Medicaid state plan to reduce expenditures for nonemergency medical transportation.
Cited as "17b-260 et seq. (providing for supplemental medical assistance)". 233 C. 557, 565.
Sec. 17b-276a. Amendment to Medicaid state plan to reduce expenditures for
Medicaid nonemergency medical transportation. Limitations. Notwithstanding any
provision of the general statutes, on or before June 30, 2003, the Commissioner of Social
Services, in consultation with the Secretary of the Office of Policy and Management,
may submit an amendment to the Medicaid state plan or implement changes necessary
to reduce expenditures for Medicaid nonemergency medical transportation, provided
in implementing such efficiencies or reduction of services no category of eligible need
shall be eliminated other than the reimbursement for personal vehicle use.
(May 9 Sp. Sess. P.A. 02-7, S. 60.)
History: May 9 Sp. Sess. P.A. 02-7 effective August 15, 2002.
See Sec. 17b-276 re competitive bidding process for nonemergency transportation services.
Sec. 17b-277. (Formerly Sec. 17-134u). Medical assistance for needy pregnant
women and children. Presumptive eligibility. (a) The Commissioner of Social Services shall provide, in accordance with federal law and regulations, medical assistance
under the Medicaid program to needy pregnant women and children up to one year of
age whose families have an income up to one hundred eighty-five per cent of the federal
poverty level.
(b) The commissioner shall implement presumptive eligibility for appropriate applicants for the Medicaid program with an emphasis on pregnant women. Such presumptive eligibility determinations shall be in accordance with applicable federal law and
regulations. The commissioner shall provide such presumptive eligibility determinations on a pilot basis, in one district office, beginning June 1, 1991, and shall provide
them state-wide effective September 1, 1991.
(P.A. 88-217, S. 1, 2; P.A. 90-134, S. 4, 28; P.A. 93-262, S. 1, 87; June 18 Sp. Sess. P.A. 97-2, S. 72, 165.)
History: P.A. 90-134 added Subsec. (b) re presumptive eligibility; P.A. 93-262 authorized substitution of commissioner
and department of social services for commissioner and department of income maintenance, effective July 1, 1993; Sec.
17-134u transferred to Sec. 17b-277 in 1995; June 18 Sp. Sess. P.A. 97-2 made technical changes, effective July 1, 1997.
Cited as "17b-260 et seq. (providing for supplemental medical assistance)". 233 C. 557, 565.
The Commissioner of Social Services shall amend the state's
Medicaid plan to increase to thirty-six days per year the number of home leave absences
allowed for a resident of an intermediate care facility for the mentally retarded who is
receiving medical assistance.
(P.A. 91-21; P.A. 93-262, S. 1, 87.)
History: P.A. 93-262 authorized substitution of commissioner and department of social services for commissioner and
department of income maintenance, effective July 1, 1993; Sec. 17-134z transferred to Sec. 17b-278 in 1995.
Cited as "17b-260 et seq. (providing for supplemental medical assistance)". 233 C. 557, 565.
The Commissioner of Social Services shall amend the Medicaid state plan to provide coverage for
treatment for smoking cessation ordered by a licensed healthcare professional who possesses valid and current state licensure to prescribe such drugs in accordance with a
plan developed by the commissioner to provide smoking cessation services. The commissioner shall present such plan to the joint standing committees of the General Assembly having cognizance of matters relating to human services and appropriations by January 1, 2003, and, if such plan is approved by said committees and funding is provided
in the budget for the fiscal year ending June 30, 2004, such plan shall be implemented
on July 1, 2003.
(P.A. 99-250, S. 1; P.A. 02-4, S. 19.)
History: P.A. 02-4 mandated provision of coverage for treatment ordered by licensed healthcare professional in accordance with plan approved by General Assembly committees, deleting provisions re treatment ordered by licensed physician
to extent permitted by federal law and re coverage limited to maximum of four hundred dollars per person per year, effective
July 1, 2002.
(a) The Commissioner of Social Services shall provide coverage under the Medicaid program in
accordance with Public Law 106-354 to women diagnosed with breast or cervical cancer.
The commissioner shall seek any federal waivers or amend the state Medicaid plan as
necessary in order to secure federal reimbursement for the costs of providing coverage
under the Medicaid program to such women. Such coverage shall not be dependent on
the available income or assets of an applicant.
(b) To qualify for medical assistance under this section, a woman shall: (1) Have
been screened for breast or cervical cancer under the Centers for Disease Control and
Prevention's National Breast and Cervical Cancer Early Detection Program and found
to be in need of treatment for breast or cervical cancer, including a precancerous condition of the breast or cervix; (2) not otherwise have creditable coverage, as defined in 42
USC 300gg(c); (3) not have attained the age of sixty-five years; (4) not be eligible under
any mandatory Medicaid eligibility group; and (5) be a resident of this state and a United
States citizen or a qualified alien, as defined in Section 431 of Public Law 104-193.
(c) The commissioner shall deem an applicant who has been determined eligible
for medical assistance under this section as having been eligible for up to three months
prior to the month in which an application was filed if the requirements in subsection
(b) of this section were met during such three-month period. An individual determined
eligible for medical assistance under this section shall remain eligible until the individual's course of treatment is completed or until eligibility criteria set forth in subsection
(b) of this section are no longer met. The commissioner shall establish procedures for
the granting of presumptive eligibility in order to ensure prompt access to services for
applicants.
(d) The Commissioner of Social Services shall implement policies and procedures
necessary to carry out the provisions of this section while in the process of adopting
such policies and procedures in regulation form in accordance with chapter 54, provided
notice of intention to adopt the regulations is published in the Connecticut Law Journal
within twenty days of implementation of such policies and procedures. Such policies
and procedures shall be valid until the time final regulations are effective.
(P.A. 00-216, S. 5, 28; June Sp. Sess. P.A. 01-2, S. 7, 69; June Sp. Sess. P.A. 01-9, S. 129, 131.)
History: P.A. 00-216 effective July 1, 2000; June Sp. Sess. P.A. 01-2 designated existing provisions as Subsec. (a),
replaced provisions therein authorizing commissioner to seek federal reimbursement for costs of providing treatment and
other medical services under Sec. 19a-266 to women diagnosed with breast or cervical cancer with provisions directing
commissioner to provide coverage under the Medicaid program to such women, and added new Subsecs. (b) to (d) re
medical assistance under section, effective July 2, 2001; June Sp. Sess. P.A. 01-9 revised effective date of June Sp. Sess.
P.A. 01-2 but without affecting this section.
Sec. 17b-278c. Amendment to state Medicaid plan to provide mammogram
examinations to certain women. The Commissioner of Social Services, to the extent
permitted by federal law, shall amend the Medicaid state plan to provide coverage for
mammographic examinations for any woman eligible for Medicaid that is at least equal
to the following minimum requirements: (1) A baseline mammogram for any such
woman who is thirty-five to thirty-nine years of age, inclusive; and (2) a mammogram
every year for any such woman who is forty years of age or older.
(P.A. 01-171, S. 24, 25.)
Sec. 17b-279. (Formerly Sec. 17-134aa). Prescription drug utilization review.
Report. The Commissioner of Social Services shall verify the propriety and reasonableness of payments to providers for drugs provided to Medicaid recipients through field
audit examinations and other reasonable means to the extent possible within available
appropriations. The commissioner shall document financial and utilization statistics
as to drugs provided to Medicaid recipients by therapeutic category and shall outline
problems encountered in the administration of prescription drug utilization in the Medicaid program, suggested solutions and any recommendations for improvement. The commissioner shall submit a report, on or before February 15, 1990, and annually thereafter,
documenting the results of the verification process, the financial and utilization statistics,
the problems encountered, suggested solutions and recommendations to the joint standing committee of the General Assembly having cognizance of matters relating to human
services and appropriations.
(P.A. 89-296, S. 1, 9; P.A. 91-190, S. 1, 9; P.A. 93-262, S. 1, 87; May 9 Sp. Sess. P.A. 02-7, S. 88.)
History: P.A. 91-190 amended Subsec. (a) to eliminate advisory panel to review prescription drug utilization in the
Medicaid program and repealed Subsec. (b) requiring commissioner to study feasibility of (1) implementing a limited
formulary of high volume drugs for medical assistance recipients and (2) a rebate to the state from a pharmaceutical
manufacturer or direct distributor of a percentage of total sales to the state, and to report results to general assembly
committees by February 15, 1990; P.A. 93-262 authorized substitution of commissioner and department of social services
for commissioner and department of income maintenance, effective July 1, 1993; Sec. 17-134aa transferred to Sec. 17b-
279 in 1995; May 9 Sp. Sess. P.A. 02-7 deleted ", including the generic incentive dispensing fee", effective September
1, 2002.
Cited as "17b-260 et seq. (providing for supplemental medical assistance)". 233 C. 557, 565.
Notwithstanding any provision of the regulations of Connecticut state agencies concerning payment for drugs provided to Medicaid recipients (1) effective July 1, 1989, the state
shall reimburse for all legend drugs provided under the Medicaid, state-administered
general assistance, general assistance, ConnPACE and Connecticut AIDS drug assistance programs at the rate established by the Health Care Finance Administration as the
federal acquisition cost, or, if no such rate is established, the commissioner shall establish
and periodically revise the estimated acquisition cost in accordance with federal regulations. Effective September 1, 2002, the commissioner shall also establish a professional
fee of three dollars and eighty-five cents for each prescription to be paid to licensed
pharmacies for dispensing drugs to Medicaid, state-administered general assistance,
general assistance, ConnPACE and Connecticut AIDS drug assistance recipients in
accordance with federal regulations; and (2) on and after September 4, 1991, payment
for legend and nonlegend drugs provided to Medicaid recipients shall be based upon
the actual package size dispensed. Effective October 1, 1991, reimbursement for over-
the-counter drugs for such recipients shall be limited to those over-the-counter drugs
and products published in the Connecticut Formulary, or the cross reference list, issued
by the commissioner. The cost of all over-the-counter drugs and products provided to
residents of nursing facilities, chronic disease hospitals, and intermediate care facilities
for the mentally retarded shall be included in the facilities' per diem rate.
(P.A. 89-296, S. 2, 9; June Sp. Sess. P.A. 91-8, S. 9, 63; May 9 Sp. Sess. P.A. 02-1, S. 122.)
History: June Sp. Sess. P.A. 91-8 divided the subsection into Subdivs., substituted "Medicaid" for "medical aid" and
added a new Subdiv. (2) re payment for legend and nonlegend drugs and basing the payment on the actual package size
dispensed, limitation on the reimbursement of over-the-counter drugs as of October 1, 1991, and the inclusion in the rate
of the cost of over-the-counter drugs for nursing facilities, chronic disease hospitals and the intermediate care facilities
for the mentally retarded; Sec. 17-134bb transferred to Sec. 17b-280 in 1995; May 9 Sp. Sess. P.A. 02-1 amended Subdiv.
(1) to provide that reimbursement for legend drugs applies to the Medicaid, state-administered general assistance, general
assistance, ConnPACE and Connecticut AIDS drug assistance programs and that, effective September 1, 2002, the dispensing fee paid to licensed pharmacists is three dollars and eighty-five cents per prescription, effective July 1, 2002.
Cited as "17b-260 et seq. (providing for supplemental medical assistance)". 233 C. 557, 565.
Notwithstanding any provision of the regulations of Connecticut state agencies, effective July 1, 1989, the state shall pay for oxygen
products and services for Medicaid recipients when such recipients meet the medical
criteria for coverage under the Medicare program, except that payment for oxygen products and services via oxygen concentrators in rest homes with nursing supervision and
in chronic and convalescent homes shall be included in the per diem reimbursement
rate established by the Commissioner of Social Services. Reimbursement for alternative
oxygen products and services in such facilities may be made if substantiated by medical
necessity.
(P.A. 89-296, S. 3, 9; P.A. 93-262, S. 1, 87.)
History: P.A. 93-262 authorized substitution of commissioner and department of social services for commissioner and
department of income maintenance, effective July 1, 1993; Sec. 17-134cc transferred to Sec. 17b-281 in 1995.
Cited as "17b-260 et seq. (providing for supplemental medical assistance)". 233 C. 557, 565.
(a) The Commissioner of Social Services shall extend the
procedure in effect on October 1, 1998, for the preauthorization of the purchase or rental
of new durable medical equipment and modification or repair of existing equipment to
include services provided to Medicaid recipients who are also recipients of Medicare.
The commissioner may enter into any necessary agreements with the Health Care Financing Administration to ensure the coordination of authorization and payment for
durable medical equipment for such recipients.
(b) Access to such procedure shall not be denied to a recipient on the basis that a
Medicare coverage determination has not been made prior to the submission of a request
for preauthorization to the commissioner. The commissioner shall not make payment
for an item to a supplier of durable medical equipment on behalf of a Medicare recipient
until the commissioner has received documentation establishing that a claim has been
filed with, and a coverage and reimbursement decision has been rendered under, the
Medicare program.
(P.A. 98-239, S. 6.)
The Commissioner of Social Services may authorize payment for used durable
medical equipment to a vendor or supplier of durable medical equipment enrolled as a
medical equipment, devices and supplies provider under the Medicaid program.
(June Sp. Sess. P.A. 01-2, S. 8, 69; June Sp. Sess. P.A. 01-9, S. 129, 131; May 9 Sp. Sess. P.A. 02-7, S. 48.)
History: June Sp. Sess. P.A. 01-2 effective July 2, 2001; June Sp. Sess. P.A. 01-9 revised effective date of June Sp.
Sess. P.A. 01-2 but without affecting this section; May 9 Sp. Sess. P.A. 02-7 amended section to permit commissioner to
authorize payment to a vendor or supplier of used durable medical equipment provided under the Medicaid program and
eliminated requirement that commissioner seek federal waiver to provide coverage for such equipment, effective August
15, 2002.
On and after January 1, 1991, the Commissioner of Social Services may provide, in accordance with federal law and regulations
and within available appropriations, medical assistance under the Medicaid program to
(1) children over five and under nine years of age whose families have an income below
one hundred per cent of the federal poverty level and (2) elderly and disabled persons
who would be eligible to receive supplemental security income benefits except for income and who have incomes below one hundred per cent of the federal poverty level.
(P.A. 90-134, S. 3, 28; P.A. 93-262, S. 1, 87; June 18 Sp. Sess. P.A. 97-2, S. 73, 165.)
History: P.A. 93-262 authorized substitution of commissioner and department of social services for commissioner and
department of income maintenance, effective July 1, 1993; Sec. 17-134dd transferred to Sec. 17b-282 in 1995; June 18
Sp. Sess. P.A. 97-2 made technical changes, effective July 1, 1997.
Cited as "17b-260 et seq. (providing for supplemental medical assistance)". 233 C. 557, 565.
The Commissioner of Social
Services, to the extent permitted by federal law, shall amend the Medicaid state plan to
provide coverage for general anesthesia, nursing and related hospital services provided
in conjunction with dental services, provided such anesthesia, nursing and related hospital services are provided in conjunction with in-patient dental services if the following
conditions are met:
(1) The anesthesia, nursing and related hospital services are deemed medically necessary by the treating dentist or oral surgeon and the patient's primary care physician
in accordance with the department's requirements for prior authorization of services, if
required; and
(2) The patient is either (A) a child under the age of four who is determined by a
licensed dentist, in conjunction with a licensed physician who specializes in primary
care, to have a dental condition of significant dental complexity that it requires certain
dental procedures to be performed in a hospital, or (B) a person who has a developmental
disability, as determined by a licensed physician who specializes in primary care, that
places the person at serious risk. The expense of such anesthesia, nursing and related
hospital services shall be deemed a medical expense under such health insurance policy
and shall not be subject to any limits on dental benefits under such policy.
(P.A. 99-284, S. 42, 60.)
History: P.A. 99-284 effective January 1, 2000.
The
Commissioner of Social Services shall amend the state's model 2176 Medicaid waiver
to allow one hundred twenty-five disabled persons to participate under the waiver. The
commissioner may, within available appropriations, amend such waiver to increase the
number of persons eligible to participate under the waiver to not more than two hundred
disabled persons.
(P.A. 90-134, S. 5, 28; P.A. 93-262, S. 1, 87; June 18 Sp. Sess. P.A. 97-2, S. 74, 165; June Sp. Sess. P.A. 00-2, S. 50, 53.)
History: P.A. 93-262 authorized substitution of commissioner and department of social services for commissioner and
department of income maintenance, effective July 1, 1993; Sec. 17-134ee transferred to Sec. 17b-283 in 1995; June 18
Sp. Sess. P.A. 97-2 made a technical and conforming change in Subsec. (b), effective July 1, 1997; June Sp. Sess. P.A.
00-2 deleted former Subsec. (b) re feasibility study concerning Medicaid coverage for outpatient substance abuse treatment,
removed Subsec. (a) designator and added language re amendment of waiver to increase number of eligible persons,
effective July 1, 2000.
Cited as "17b-260 et seq. (providing for supplemental medical assistance)". 233 C. 557, 565.
(a) The Commissioner of Social Services may continue, within available appropriations, to provide Medicaid to employed persons who have conditions
which prevent them from obtaining health insurance under an employer's group health
insurance plan and who would otherwise be eligible for such medical assistance.
(b) The commissioner may pay under the Medicaid program, within available appropriations, the employee's share of health insurance under an employer's group health
insurance plan for employees who would otherwise be eligible for medical assistance.
(c) The commissioner may pay under the Medicaid program, within available appropriations, the premiums for continued health insurance coverage under an employer's
group health insurance plan, pursuant to the federal Consolidated Omnibus Budget Reconciliation Act of 1985, as amended, for chronically ill and disabled persons who are
no longer employed and would otherwise be eligible for Medicaid.
(P.A. 90-134, S. 6, 28; P.A. 93-262, S. 1, 87; June 18 Sp. Sess. P.A. 97-2, S. 75, 165.)
History: P.A. 93-262 authorized substitution of commissioner and department of social services for commissioner and
department of income maintenance, effective July 1, 1993; Sec. 17-134ff transferred to Sec. 17b-284 in 1995; June 18 Sp.
Sess. P.A. 97-2 made technical changes, effective July 1, 1997.
Cited as "17b-260 et seq. (providing for supplemental medical assistance)". 233 C. 557, 565.
Sec. 17b-285. (Formerly Sec. 17-134gg). Assignment of spousal support of an
institutionalized person or person in need of institutional care. An institutionalized
person or person in need of institutional care who applies for Medicaid shall assign to
the Commissioner of Social Services the right of support derived from the assets of the
spouse of such person, provided the spouse of such person is unwilling or unable to
provide the information necessary to determine eligibility for Medicaid. If such applicant
lacks the ability to execute an assignment due to physical or mental impairment, the
commissioner may bring a support proceeding against such applicant's spouse without
such assignment.
(P.A. 91-396; P.A. 93-262, S. 1.)
History: P.A. 93-262 authorized substitution of commissioner and department of social services for commissioner and
department of income maintenance, effective July 1, 1993; Sec. 17-134gg transferred to Sec. 17b-285 in 1995.
Cited as "17b-260 et seq. (providing for supplemental medical assistance)". 233 C. 557, 565.
The Department of Social Services, in conjunction with the Office of Policy and Management
and the Office of Fiscal Analysis, shall review the proposed reports to be generated by
the revised Medicaid management information system and the executive information
system to ensure that proper administration reporting is available to monitor and forecast
the programs and services administered through these systems. The Department of Social Services, the Office of Fiscal Analysis and the Office of Policy and Management
shall issue a report to the joint standing committee on appropriations detailing their
findings regarding the revised reporting structures by January 1, 1994, and quarterly
thereafter until the projects are completed and the proposed reporting structures are in
place.
(P.A. 93-262, S. 1, 87; 93-418, S. 35, 41; 93-435, S. 59, 95.)
History: P.A. 93-418 effective July 1, 1993 (Revisor's note: P.A. 93-262 and 93-435 authorized substitution of commissioner and department of social services for commissioner and department of income maintenance, effective July 1, 1993).
Cited as "17b-260 et seq. (providing for supplemental medical assistance)". 233 C. 557, 565.
When a person in medical need is determined by the Commissioner of Social Services not to be a resident of any town but to
be eligible for general assistance and to need hospitalization, the state shall pay the
hospital directly, in accordance with the provisions of section 17b-220 and subsection
(b) of section 17b-134, the cost of such hospitalization.
(1959, P.A. 536; P.A. 83-575, S. 7, 10; P.A. 86-415, S. 8; May Sp. Sess. P.A. 92-16, S. 15, 89; P.A. 93-262, S. 1, 87.)
History: P.A. 83-575 entirely replaced previous section concerning a pauper not having a residence in the state who is
involved in a motor vehicle accident with new provisions, effective April 1, 1984; P.A. 86-415 added Subsec. (b) re
direct payment of hospitalization costs by state; May Sp. Sess. P.A. 92-16 deleted Subsec. (a) re assignment of assistance
responsibility for person who is a resident of no town to town in which the person became in medical need; P.A. 93-262
authorized substitution of commissioner and department of social services for commissioner and department of income
maintenance, effective July 1, 1993; Sec. 17-292a transferred to Sec. 17b-287 in 1995.
Annotations to former section 17-292a:
Cited. 229 C. 664, 672.
Annotations to present section:
Cited as "17b-260 et seq. (providing for supplemental medical assistance)". 233 C. 557, 565.
There is established an
organ transplant account which shall be a separate, nonlapsing account within the General Fund. Any moneys collected under the contribution system established under section 12-743 shall be deposited by the Commissioner of Revenue Services into the account. This account may also receive moneys from public and private sources or from
the federal government. All moneys deposited in the account shall be used by the Department of Social Services or persons acting under a contract with the department, (1) to
assist residents of the state in paying all or part of any costs associated with a medically
required organ transplant or (2) the promotion of the income tax contribution system
and the organ transplant account. Expenditures from the account in any fiscal year for
the promotion of the contribution system or the account shall not exceed ten per cent
of the amount of moneys raised during the previous fiscal year provided such limitation
shall not apply to an expenditure of not more than fifteen thousand dollars from the
account on or before July 1, 1994, to reimburse expenditures made on or before said
date, with prior written authorization of the Commissioner of Public Health, by private
organizations to promote the contribution system and the organ transplant account.
(b) The Commissioner of Social Services shall adopt regulations, in accordance
with the provisions of chapter 54, to provide for the distribution of funds available
pursuant to this section and section 12-743.
(P.A. 93-233, S. 2; 93-381, S. 9, 39; 93-435, S. 59, 95; P.A. 94-175, S. 15, 32; 94-210, S. 25, 30; May Sp. Sess. P.A.
94-4, S. 80, 85; P.A. 95-160, S. 64, 69; 95-257, S. 12, 21, 58.)
History: P.A. 93-381 and P.A. 93-435 authorized substitution of commissioner and department of public health and
addiction services for commissioner and department of health services, effective July 1, 1993; P.A. 94-175 in Subsec. (a)
changed account name from "organ transplant fund account" to "organ transplant account", effective June 2, 1994; P.A.
94-210 transferred responsibility for the program from the department of public health and addiction services to the department of social services, effective July 1, 1994; May Sp. Sess. P.A. 94-4 and P.A. 95-160 revised effective date of P.A. 94-
175 but without affecting this section; P.A. 95-257 replaced Commissioner and Department of Public Health and Addiction
Services with Commissioner and Department of Public Health, effective July 1, 1995.
(a) Sections 17b-289
to 17b-303, inclusive, and section 16 of public act 97-1 of the October 29 special session*
shall be known as the "HUSKY and HUSKY Plus Act".
(b) Children receiving assistance under section 17b-261 shall be participants in the
HUSKY Plan, Part A and children receiving assistance under sections 17b-289 to 17b-
303, inclusive, and section 16 of public act 97-1 of the October 29 special session* shall
be participants in the HUSKY Plan, Part B. For purposes of marketing and outreach,
both parts shall be known as the HUSKY Plan.
(October 29 Sp. Sess. P.A. 97-1, S. 1, 23.)
*Note: Section 16 of public act 97-1 of the October 29 special session is special in nature and therefore has not been
codified but remains in full force and effect according to its terms.
History: Oct. 29 Sp. Sess. P.A. 97-1 effective October 30, 1997.
As used in sections 17b-289 to 17b-303, inclusive, and
section 16 of public act 97-1 of the October 29 special session*:
(1) "Applicant" means an individual over the age of eighteen years who is a natural
or adoptive parent or a legal guardian; a caretaker relative, foster parent or stepparent
with whom the child resides; or a noncustodial parent under order of a court or family
support magistrate to provide health insurance, who applies for coverage under the
HUSKY Plan, Part B on behalf of a child and shall include a child who is eighteen years
of age or emancipated in accordance with the provisions of sections 46b-150 to 46b-
150e, inclusive, and who is applying on his own behalf or on behalf of a minor dependent
for coverage under such plan;
(2) "Child" means an individual under nineteen years of age;
(3) "Coinsurance" means the sharing of health care expenses by the insured and an
insurer in a specified ratio;
(4) "Commissioner" means the Commissioner of Social Services;
(5) "Copayment" means a payment made on behalf of an enrollee for a specified
service under the HUSKY Plan, Part B;
(6) "Cost sharing" means arrangements made on behalf of an enrollee whereby an
applicant pays a portion of the cost of health services, sharing costs with the state and
includes copayments, premiums, deductibles and coinsurance;
(7) "Deductible" means the amount of out-of-pocket expenses that would be paid
for health services on behalf of an enrollee before becoming payable by the insurer;
(8) "Department" means the Department of Social Services;
(9) "Durable medical equipment" means durable medical equipment, as defined in
Section 1395x(n) of the Social Security Act;
(10) "Eligible beneficiary" means a child who meets the requirements specified in
section 17b-292, except a child excluded under the provisions of Subtitle J of Public
Law 105-33 or a child of any municipal employee eligible for employer-sponsored
insurance on or after October 30, 1997, provided a child of such a municipal employee
may be eligible for coverage under the HUSKY Plan, Part B if dependent coverage
was terminated due to an extreme economic hardship on the part of the employee, as
determined by the commissioner;
(11) "Enrollee" means an eligible beneficiary who receives services from a managed care plan under the HUSKY Plan, Part B;
(12) "Family" means any combination of the following: (A) An individual; (B) the
individual's spouse; (C) any child of the individual or such spouse; or (D) the legal
guardian of any such child if the guardian resides with the child;
(13) "HUSKY Plan, Part A" means assistance provided to children pursuant to
section 17b-261;
(14) "HUSKY Plan, Part B" means the health insurance plan for children established
pursuant to the provisions of sections 17b-289 to 17b-303, inclusive, and section 16 of
public act 97-1 of the October 29 special session*;
(15) "HUSKY Plus programs" means two supplemental health insurance programs
established pursuant to section 17b-294 for medically eligible enrollees of the HUSKY
Plan, Part B whose medical needs cannot be accommodated within the basic benefit
package offered to enrollees. One program shall supplement coverage for those medically eligible enrollees with intensive physical health needs and the other program shall
supplement coverage for those medically eligible enrollees with intensive behavioral
health needs;
(16) "Income" means income as calculated in the same manner as under the Medicaid program pursuant to section 17b-261;
(17) "Managed care plan" means a plan offered by an entity that contracts with the
department to provide benefits to enrollees on a prepaid basis;
(18) "Parent" means a natural parent, stepparent, adoptive parent, guardian or custodian of a child;
(19) "Premium" means any required payment made by an individual to offset or
pay in full the capitation rate under the HUSKY Plan, Part B;
(20) "Preventive care and services" means: (A) Child preventive care, including
periodic and interperiodic well-child visits, routine immunizations, health screenings
and routine laboratory tests; (B) prenatal care, including care of all complications of
pregnancy; (C) care of newborn infants, including attendance at high-risk deliveries and
normal newborn care; (D) WIC evaluations; (E) child abuse assessment required under
sections 17a-106a and 46b-129a; (F) preventive dental care for children; and (G) periodicity schedules and reporting based on the standards specified by the American Academy
of Pediatrics;
(21) "Primary and preventive health care services" means the services of licensed
physicians, optometrists, nurses, nurse practitioners, midwives and other related health
care professionals which are provided on an outpatient basis, including routine well-
child visits, diagnosis and treatment of illness and injury, laboratory tests, diagnostic
x-rays, prescription drugs, radiation therapy, chemotherapy, hemodialysis, emergency
room services, and outpatient alcohol and substance abuse services, as defined by the
commissioner;
(22) "Qualified entity" means any entity: (A) Eligible for payments under a state
plan approved under Medicaid and which provides medical services under the HUSKY
Plan, Part A, or (B) that is a qualified entity, as defined in 42 USC 1396r-1a, as amended
by Section 708 of Public Law 106-554 and that is determined by the commissioner to
be capable of making the determination of eligibility. The commissioner shall provide
qualified entities with such forms as are necessary for an application to be made on
behalf of a child under the HUSKY Plan, Part A and information on how to assist parents,
guardians and other persons in completing and filing such forms;
(23) "WIC" means the federal Special Supplemental Food Program for Women,
Infants and Children administered by the Department of Public Health pursuant to section 19a-59c.
(October 29 Sp. Sess. P.A. 97-1, S. 2, 23; P.A. 99-279, S. 18, 45; P.A. 00-196, S. 53; P.A. 01-137, S. 2, 9.)
*Note: Section 16 of public act 97-1 of the October 29 special session is special in nature and therefore has not been
codified but remains in full force and effect according to its terms.
History: Oct. 29 Sp. Sess. P.A. 97-1 effective October 30, 1997; P.A. 99-279 amended Subdiv. (10) to provide that a
child of a municipal employee may be eligible for coverage under the HUSKY Plan, Part B if dependent coverage was
terminated due to an extreme economic hardship on the part of the employee, as determined by the commissioner, effective
July 1, 1999; P.A. 00-196 made technical changes in Subdivs. (21) and (22); P.A. 01-137 amended Subdiv. (22) to redefine
"qualified entity" by deleting language contained in the federal definition of term and adding reference to such federal
definition, effective July 1, 2001 (Revisor's note: In Subdiv. (22), the word "that" was inserted editorially by the Revisors
after "(B)" for proper form).
The commissioner shall submit
a state children's health insurance plan to implement the provisions of sections 17b-
289 to 17b-303, inclusive, and section 16 of public act 97-1 of the October 29 special
session* to the Health Care Financing Administration in accordance with the provisions
of Subtitle J of Public Law 105-33. Such plan and any revisions thereto shall be submitted
to the joint standing committees of the General Assembly having cognizance of matters
relating to human services, public health, insurance and appropriations and the budgets
of state agencies. Within thirty days of receipt of such plan or revisions thereto, said
joint standing committees of the General Assembly may advise the commissioner of
their approval, denial or modifications, if any, of the plan or any revisions thereto. If
the joint standing committees do not concur, the committee chairmen shall appoint a
committee on conference which shall be comprised of three members from each joint
standing committee. At least one member appointed from each committee shall be a
member of the minority party. The report of the committee on conference shall be made
to each committee, which shall vote to accept or reject the report. The report of the
committee on conference may not be amended. If a joint standing committee rejects the
report of the committee on conference, the plan or revisions thereto shall be deemed
approved. If the joint standing committees accept the report, the committee having cognizance of matters relating to appropriations and the budgets of state agencies shall
advise the commissioner of their approval or modifications, if any, of the plan or revisions thereto, provided if the committees do not act within thirty days, the plan or revisions thereto shall be deemed approved.
(October 29 Sp. Sess. P.A. 97-1, S. 3, 23; June Sp. Sess. P.A. 00-2, S. 20, 53.)
*Note: Section 16 of public act 97-1 of the October 29 special session is special in nature and therefore has not been
codified but remains in full force and effect according to its terms.
History: Oct. 29 Sp. Sess. P.A. 97-1 effective October 30, 1997; June Sp. Sess. P.A. 00-2 increased the time period for
action by the joint standing legislative committees from fifteen to thirty days, effective July 1, 2000.
(a) A child who resides in a household with a family income which
exceeds one hundred eighty-five per cent of the federal poverty level and does not exceed
three hundred per cent of the federal poverty level may be eligible for subsidized benefits
under the HUSKY Plan, Part B.
(b) A child who resides in a household with a family income over three hundred
per cent of the federal poverty level may be eligible for unsubsidized benefits under the
HUSKY Plan, Part B.
(c) Whenever a court or family support magistrate orders a noncustodial parent to
provide health insurance for a child, such parent may provide for coverage under the
HUSKY Plan, Part B.
(d) A child who has been determined to be eligible for benefits under either the
HUSKY Plan, Part A or Part B shall remain eligible for said plan for a period of twelve
months from such child's determination of eligibility unless the child attains the age of
nineteen years or is no longer a resident of the state.
(e) To the extent allowed under federal law, the commissioner shall not pay for
services or durable medical equipment under the HUSKY Plan, Part B if the enrollee
has other insurance coverage for the services or such equipment.
(f) A newborn child who otherwise meets the eligibility criteria for the HUSKY
Plan, Part B shall be eligible for benefits retroactive to his date of birth, provided an
application is filed on behalf of the child within thirty days of such date.
(g) The commissioner shall implement presumptive eligibility for children applying
for Medicaid. Such presumptive eligibility determinations shall be in accordance with
applicable federal law and regulations. The commissioner shall adopt regulations, in
accordance with chapter 54, to establish standards and procedures for the designation
of organizations as qualified entities to grant presumptive eligibility. In establishing
such regulations, the commissioner shall ensure the representation of state-wide and
local organizations that provide services to children of all ages in each region of the state.
(h) The commissioner shall enter into a contract with an entity to be a single point
of entry servicer for applicants and enrollees under the HUSKY Plan, Part A and Part
B. The servicer shall jointly market both Part A and Part B together as the HUSKY
Plan. Such servicer shall develop and implement public information and outreach activities with community programs. Such servicer shall electronically transmit data with
respect to enrollment and disenrollment in the HUSKY Plan, Part B to the commissioner
who may transmit such data to the Children's Health Council.
(i) To the extent permitted by federal law, the single point of entry servicer may be
one of the entities authorized to grant presumptive eligibility under the HUSKY Plan,
Part A.
(j) The single point of entry servicer shall send an application and supporting documents to the commissioner for determination of eligibility of a child who resides in a
household with a family income of one hundred eighty-five per cent or less of the federal
poverty level. The servicer shall enroll eligible beneficiaries in the applicant's choice
of managed care plan.
(k) Not more than twelve months after the determination of eligibility for benefits
under the HUSKY Plan, Part A and Part B and annually thereafter, the commissioner
or the servicer, as the case may be, shall determine if the child continues to be eligible
for the plan. The commissioner or the servicer shall mail an application form to each
participant in the plan for the purposes of obtaining information to make a determination
on eligibility. To the extent permitted by federal law, in determining eligibility for benefits under the HUSKY Plan, Part A and Part B with respect to family income, the commissioner or the servicer shall rely upon information provided in such form by the participant
unless the commissioner or the servicer has reason to believe that such information is
inaccurate or incomplete. The determination of eligibility shall be coordinated with
health plan open enrollment periods.
(l) The commissioner shall implement the HUSKY Plan, Part B while in the process
of adopting necessary policies and procedures in regulation form in accordance with
the provisions of section 17b-10.
(m) The commissioner shall adopt regulations, in accordance with chapter 54, to
establish residency requirements and income eligibility for participation in the HUSKY
Plan, Part B and procedures for a simplified mail-in application process. Notwithstanding the provisions of section 17b-257b, such regulations shall provide that any child
adopted from another country by an individual who is a citizen of the United States and
a resident of this state shall be eligible for benefits under the HUSKY Plan, Part B upon
arrival in this state.
(October 29 Sp. Sess. P.A. 97-1, S. 4, 23; P.A. 01-137, S. 1, 3, 4, 9.)
History: Oct. 29 Sp. Sess. P.A. 97-1 effective October 30, 1997; P.A. 01-137 amended Subsec. (h) to require servicer
to electronically transmit enrollment and disenrollment data re HUSKY Plan, Part B to commissioner who may transmit
such data to Children's Health Council and amended Subsec. (k) to require the commissioner or servicer, as the case may
be, to determine if a child continues to be eligible for benefits under the HUSKY Plan, Part A or Part B, to mail an application
form to each participant in the plan and to rely upon information provided in the application form by the participant in
determining eligibility for benefits under the plan with respect to family income unless the commissioner or servicer has
reason to believe that such information is inaccurate or incomplete, effective July 1, 2001, and amended Subsec. (m) to
require regulations providing that any child adopted from another country by a U.S. citizen and state resident shall be
eligible for benefits under the HUSKY Plan, Part B upon arrival in this state, effective June 28, 2001.
The Commissioner of Social Services, in determining if an individual continues to be eligible for the HUSKY Plan, Part A or Part B, shall determine
whether such individual is a recipient of a child care subsidy under section 17b-749,
food stamps under the food stamp program pursuant to the Food Stamp Act of 1977 or
benefits under any other program administered by the Department of Social Services
for the purpose of ascertaining whether the department has information necessary for
the redetermination of eligibility under the HUSKY Plan. In the event such information
is available, the commissioner shall use such information in such redetermination.
(P.A. 01-137, S. 8, 9.)
History: P.A. 01-137 effective July 1, 2001.
(a) The
HUSKY Plan, Part B shall provide the following minimum benefit coverage:
(1) No copayments for preventive care and services;
(2) No copayments for inpatient physician and hospital, outpatient surgical, ambulance and for emergency medical conditions, skilled nursing, home health, hospice and
short-term rehabilitation and physical therapy, occupational and speech therapies, lab
and x-ray, preadmission testing, prosthetics, durable medical equipment other than powered wheelchairs, dental exams every six months, x-rays, fillings, fluoride treatments
and oral surgery. For purposes of this subdivision, in accordance with the National
Committee for Quality Assurance, an emergency medical condition is a condition such
that a prudent lay-person, acting reasonably, would have believed that emergency medical treatment is needed;
(3) Outpatient physician visits, hearing examinations, nurse midwives, nurse practitioners, podiatrists, chiropractors and natureopaths;
(4) Prescription drugs;
(5) Eye care and optical hardware;
(6) Orthodontia;
(7) Mental health inpatient maximum of sixty days with allowable substitution of
alternative levels of care and outpatient maximum of thirty visits with supplemental
coverage available under a HUSKY Plus program for medically eligible enrollees, provided coverage under the HUSKY Plan, Part B and HUSKY Plus programs shall be
consistent with the provisions of the Mental Health Parity Act, Public Law 104-204,
sections 38a-488a, 38a-514 and 38a-533;
(8) Substance abuse, detoxification and inpatient for drugs sixty days and alcohol
forty-five days and outpatient sixty visits per calendar year maximum with supplemental
coverage available under a HUSKY Plus program for medically eligible enrollees;
(9) Under the HUSKY Plan, Part B no deductibles shall be charged; no preexisting
condition exclusion shall be applied and there shall be no annual or lifetime benefit
maximums and no coinsurance.
(b) The commissioner may establish a schedule of reasonable copayments for coverage provided under subdivisions (3) to (8), inclusive, of subsection (a) of this section.
(October 29 Sp. Sess. P.A. 97-1, S. 5, 23; P.A. 99-284, S. 50, 60.)
History: Oct. 29 Sp. Sess. P.A. 97-1 effective October 30, 1997; P.A. 99-284 replaced reference to Sec. 38a-514a with
Secs. 38a-488a, 38a-514 and 38a-533, effective January 1, 2000.
(a) The commissioner shall, within available appropriations, establish two supplemental health insurance programs, to be known
as HUSKY Plus programs, for enrollees of the subsidized portion of the HUSKY Plan,
Part B with family incomes which do not exceed three hundred per cent of the federal
poverty level, whose medical needs cannot be accommodated within the basic benefit
package offered enrollees. One program shall supplement coverage for those medically
eligible enrollees with intensive physical health needs and one shall supplement coverage for those medically eligible enrollees with intensive behavioral health needs.
(b) Within available appropriations, the commissioner shall contract with entities
to administer and operate the HUSKY Plus program for medically eligible enrollees
with intensive physical health needs. Such entities shall be the same entities that the
Department of Public Health contracts with to administer and operate the program under
Title V of the Social Security Act. The advisory committee established by the Department of Public Health for Title V of the Social Security Act shall be the steering committee for such program, except that such committee shall include representatives of the
Departments of Social Services and Children and Families.
(c) Within available appropriations, the commissioner shall contract with one or
more entities to operate the HUSKY Plus program for medically eligible enrollees with
intensive behavioral health needs. The steering committee for such program shall be
established by the commissioner, in consultation with the Commissioner of Children
and Families. The steering committee shall include representatives of the Departments
of Social Services and Children and Families.
(d) The acuity standards or diagnostic eligibility criteria, or both, the service benefits
package and the provider network for the HUSKY Plus program for intensive physical
health needs shall be consistent with that of Title V of the Social Security Act. Such
service benefit package shall include powered wheelchairs.
(e) The steering committee for intensive behavioral health needs shall submit recommendations to the commissioner for acuity standards or diagnostic eligibility criteria,
or both, for admission to the program for intensive behavioral health needs as well as a
service benefits package. The criteria shall reflect the severity of psychiatric or substance
abuse symptoms, the level of functional impairment secondary to symptoms and the
intensity of service needs. The network of community-based providers in the program
shall include the services generally provided by child guidance clinics, family service
agencies, youth service bureaus and other community-based organizations.
(f) The commissioner shall adopt regulations, in accordance with chapter 54, to
establish a procedure for the appeal of a denial of coverage under any of the HUSKY
Plus programs. Such regulations shall provide that (1) an appeal of a denial of coverage
for a medically eligible enrollee with intensive physical health needs shall be taken to
the steering committee for intensive physical health needs, (2) an appeal of a denial of
coverage for a medically eligible enrollee with intensive behavioral health needs shall be
taken to the steering committee for intensive behavioral health needs, and (3) a medically
eligible enrollee with intensive physical or behavioral health needs may appeal the decision of any such steering committee to the commissioner.
(g) The commissioner shall contract for an external quality review of the HUSKY
Plus programs. Not later than January 1, 1999, and annually thereafter, the commissioner
shall submit a report to the Governor and the General Assembly on the HUSKY Plus
programs which shall include an evaluation of the health outcomes and access to care
for medically eligible enrollees in the HUSKY Plus programs.
(h) On and after the date on which any medically eligible enrollee begins receiving
benefits under the HUSKY Plus programs, such enrollee shall not be eligible for services
under Title V of the Social Security Act.
(i) Not later than December 1, 1997, or not less than fifteen days before submission
of the state children's health insurance plan to the joint standing committees of the
General Assembly having cognizance of matters relating to human services, public
health, insurance and appropriations and the budgets of state agencies, whichever is
sooner, the commissioner shall submit to said joint standing committees of the General
Assembly any part of the state children's health insurance plan that refers to the HUSKY
Plus programs. Such submission shall address acuity standards and diagnostic eligibility
criteria, the service benefit package and coordination between the HUSKY Plan, Part
B and the HUSKY Plus programs and coordination with other state agencies. Within
fifteen days of receipt of such submission, said joint standing committees of the General
Assembly may advise the commissioner of their approval, denial or modifications, if
any, of the submission. If the joint standing committees do not concur, the committee
chairmen shall appoint a committee on conference which shall be comprised of three
members from each joint standing committee. At least one member appointed from each
committee shall be a member of the minority party. The report of the committee on
conference shall be made to each committee, which shall vote to accept or reject the
report. The report of the committee on conference may not be amended. If a joint standing
committee rejects the report of the committee on conference, the submission shall be
deemed approved. If the joint standing committees accept the report, the committee
having cognizance of matters relating to appropriations and the budgets of state agencies
shall advise the commissioner of their approval or modifications, if any, of the submission, provided if the committees do not act within fifteen days, the submission shall be
deemed approved.
(j) The commissioner shall adopt regulations, in accordance with the provisions of
chapter 54, to establish criteria and specify services for the HUSKY Plus programs.
Such regulations shall state that the HUSKY Plus programs shall give priority in such
programs to enrollees with family incomes at or below two hundred thirty-five per cent
of the federal poverty level.
(k) As used in this section, "medically eligible enrollee" means any enrollee with
special needs related to either physical or behavioral health who meets the acuity standards or diagnostic eligibility criteria adopted by the commissioner regarding the acuity,
diagnosis, functional impairment and intensive service needs of the enrollee.
(October 29 Sp. Sess. P.A. 97-1, S. 6, 23; P.A. 98-8, S. 1, 5.)
History: Oct. 29 Sp. Sess. P.A. 97-1 effective October 30, 1997; P.A. 98-8 amended Subsec. (a) to limit benefits under
the HUSKY Plus portion of the HUSKY Plan, Part B to children in families with incomes at or below three hundred per
cent of the federal poverty level, effective April 7, 1998.
Sec. 17b-295. Premium or copayment for services under HUSKY Plan, Part
B. (a) The commissioner may require the payment of a premium or copayment in connection with services provided under the HUSKY Plan, Part B in accordance with the
following limitations:
(1) Until July 1, 1999, the maximum annual aggregate cost sharing for a family
with an income (A) which exceeds one hundred eighty-five per cent of the federal poverty level but does not exceed two hundred thirty-five per cent of the federal poverty
level shall not be more than six hundred fifty dollars, and (B) which exceeds two hundred
thirty-five per cent of the federal poverty level but does not exceed three hundred per
cent of the federal poverty level shall not be more than one thousand two hundred fifty
dollars;
(2) On and after July 1, 1999, the commissioner shall submit a schedule for the
maximum annual aggregate cost sharing for families with an income specified in subparagraphs (A) and (B) of subdivision (1) of this subsection to the joint standing committees of the General Assembly having cognizance of matters relating to human services,
public health, insurance and appropriations and the budgets of state agencies. Within
fifteen days of receipt of such schedule, said joint standing committees of the General
Assembly may advise the commissioner of their approval, denial or modifications, if
any, of the schedule; and
(3) The commissioner shall require each managed care plan to monitor copayments
and premiums under the provisions of subdivision (1) of this subsection.
(b) (1) Except as provided in subdivision (2) of this subsection, the commissioner
may impose limitations on the amount, duration and scope of benefits under the HUSKY
Plan, Part B.
(2) The limitations adopted by the commissioner pursuant to subdivision (1) of this
subsection shall not preclude coverage of any item of durable medical equipment or
service that is medically necessary.
(October 29 Sp. Sess. P.A. 97-1, S. 7, 23; P.A. 98-8, S. 2, 5.)
History: Oct. 29 Sp. Sess. P.A. 97-1 effective October 30, 1997; P.A. 98-8 amended Subdiv. (3) of Subsec. (a) to require
each managed care plan, rather than its health care providers, to monitor copayments and premiums, effective April 7, 1998.
Sec. 17b-296. Provision for clinicians in managed care plans. Provision by
managed care organizations of services under HUSKY Plan. (a) Each managed care
plan shall include sufficient numbers of appropriately trained and certified clinicians
of pediatric care, including primary, medical subspecialty and surgical specialty physicians, as well as providers of necessary related services such as dental services, mental
health services, social work services, developmental evaluation services, occupational
therapy services, physical therapy services, speech therapy and language services,
school-linked clinic services and other public health services to assure enrollees the
option of obtaining benefits through such providers.
(b) Each managed care organization that on or after October 1, 2001, enters into a
contract with the department to provide comprehensive services under the HUSKY
Plan, Part A or the HUSKY Plan, Part B, or both, shall have primary responsibility
for ensuring that its behavioral health and dental subcontractors adhere to the contract
between the department and the managed care organization, including the provision of
timely payments to providers and interest payments in accordance with subdivision (15)
of section 38a-816. The managed care organization shall submit to the department a
claims aging inventory report including all data on all services paid by subcontractors
in accordance with the terms of the contract with the department.
(c) Upon the initial contract or the renewal of a contract between a managed care
organization and a behavioral health or dental subcontractor, the department shall require that the managed care organizations impose a performance bond, letter of credit,
statement of financial reserves or payment withhold for behavioral health and dental
subcontractors that provide services under the HUSKY Plan, Part A or the HUSKY
Plan, Part B, or both. Any such performance bond, letter of credit, statement of financial
reserves or payment withhold that may be required by the department pursuant to a
contract with a managed care organization shall be in an amount sufficient to assure the
settlement of provider claims in the event that the contract between the managed care
organization and the behavioral health or dental subcontractor is terminated. Upon the
initial contract or the renewal of a contract between a managed care organization and
a behavioral health or dental subcontractor, the managed care organization shall negotiate and enter into a contract termination agreement with its behavioral health and dental
subcontractors that shall include, but not be limited to, provisions concerning financial
responsibility for the final settlement of provider claims and data reporting to the department. The managed care organization shall submit reports to the department, at such
times as the department shall determine, concerning any payments made from such
performance bond or any payment withholds, the timeliness of claim payments to providers and the payment of any interest to providers.
(d) Prior to the approval by the department of a contract between a managed care
organization and a behavioral health and dental subcontractor for services provided
under the HUSKY Plan, Part A or the HUSKY Plan, Part B, or both, the managed care
organization shall submit a plan to the department for the resolution of any outstanding
claims submitted by providers to a previous behavioral health or dental subcontractor
of the managed care organization for services provided to members enrolled in the
HUSKY Plan, Part A or the HUSKY Plan, Part B, or both. Such plan for the resolution
of outstanding claims shall include a claims aging inventory report and shall comply with
the terms of the contract between the department and the managed care organization.
(October 29 Sp. Sess. P.A. 97-1, S. 8, 23; June Sp. Sess. P.A. 01-2, S. 23; June Sp. Sess. P.A. 01-9, S. 129, 131.)
History: Oct. 29 Sp. Sess. P.A. 97-1 effective October 30, 1997; June Sp. Sess. P.A. 01-2 designated existing provisions
as Subsec. (a) and added Subsecs. (b) to (d) re subcontractor services under the HUSKY Plan; June Sp. Sess. P.A. 01-9
revised effective date of June Sp. Sess. P.A. 01-2 but without affecting this section.
(a)
The commissioner, in consultation with the Children's Health Council, the Medicaid
Managed Care Council and Infoline of Connecticut, shall develop mechanisms for outreach for the HUSKY Plan, Part A and Part B, including, but not limited to, development
of mail-in applications and appropriate outreach materials through the Department of
Revenue Services, the Labor Department, the Department of Social Services, the Department of Public Health, the Department of Children and Families and the Office of Protection and Advocacy for Persons with Disabilities.
(b) The commissioner shall include in such outreach efforts information on the
Medicaid program for the purpose of maximizing enrollment of eligible children and
the use of federal funds.
(c) The commissioner shall, within available appropriations, contract with qualified
entities authorized to grant presumptive eligibility, severe need schools and community-
based organizations for purposes of public education, outreach and recruitment of eligible children, including the distribution of applications and information regarding enrollment in the HUSKY Plan, Part A and Part B. In awarding such contracts, the commissioner shall consider the marketing, outreach and recruitment efforts of organizations.
For the purposes of this subsection, (1) "community-based organizations" shall include,
but not be limited to, day care centers, schools, school-based health clinics, community-
based diagnostic and treatment centers and hospitals, and (2) "severe need school" means
a school in which forty per cent or more of the lunches served are served to students
who are eligible for free or reduced price lunches.
(d) All outreach materials shall be approved by the commissioner pursuant to Subtitle J of Public Law 105-33.
(e) Not later than January 1, 1999, and annually thereafter, the commissioner shall
submit a report to the Governor and the General Assembly on the implementation of
and the results of the community-based outreach program specified in subsections (a)
to (c), inclusive, of this section.
(October 29 Sp. Sess. P.A. 97-1, S. 9, 23.)
History: Oct. 29 Sp. Sess. P.A. 97-1 effective October 30, 1997.
The Commissioner of Social Services may seek a waiver, if required, under Title XXI of the Social Security Act to
authorize the use of funds received under said title to promote the enrollment of children
in the HUSKY Plan who are eligible for benefits under other income-based assistance
programs including, but not limited to, free or reduced school lunch programs.
(P.A. 01-137, S. 6, 9.)
History: P.A. 01-137 effective July 1, 2001.
Sec. 17b-297b. Procedures for sharing information in applications for school
lunch program for purpose of determining eligibility under HUSKY Plan. Procedure for application for HUSKY Plan. (a) To the extent permitted by federal law, the
Commissioners of Social Services and Education shall jointly establish procedures for
the sharing of information contained in applications for free and reduced price meals
under the National School Lunch Program for the purpose of determining whether children participating in such program are eligible for coverage under the HUSKY Plan,
Part A and Part B. The Commissioner of Social Services shall take all actions necessary
to ensure that children identified as eligible for the HUSKY Plan are able to enroll in
such plan.
(b) The Commissioner of Education shall establish procedures whereby an individual may apply for the HUSKY Plan, Part A or Part B, at the same time such individual
applies for the National School Lunch Program.
(P.A. 01-137, S. 7, 9.)
History: P.A. 01-137 effective July 1, 2001.
Sec. 17b-298. Regulations re quality of care under HUSKY Plan. Outcome
criteria. Sanctions. Reports re HUSKY Plans to General Assembly. (a) The commissioner shall adopt regulations, in accordance with chapter 54, to establish appropriate
contract standards to oversee and ensure the quality of care provided under the HUSKY
Plan, Part B. Such regulations shall require the establishment of an internal quality
assurance plan by each managed care plan which shall be in writing and available to
the public.
(b) The commissioner shall develop criteria for assessing the outcomes of health
care provided to children under the HUSKY Plan, Part B.
(c) The commissioner shall contract for the external quality review of the HUSKY
Plan, Part B. Such review shall include, but not be limited to, an evaluation of access
to care, medical record standards, provider credentialing and individual case review.
(d) The commissioner may impose the following sanctions on any managed care
plan which does not meet the quality of care required by standards adopted pursuant to
subsection (a) of this section or the standards developed for external quality review by
a contract under the provisions of subsection (c) of this section:
(1) Require the managed care plan to submit and implement a plan of correction;
(2) Limit new enrollment during any period of noncompliance;
(3) Withhold state payments that may become due until the deficiencies are corrected; and
(4) Prohibit the managed care plan from renewing or entering into new contracts
to serve enrollees.
(e) Not later than January 1, 1999, and annually thereafter, the commissioner shall
submit a report to the Governor and the General Assembly which shall outline the overall
effect of the HUSKY Plan, Part B on access to, utilization and quality of primary and
preventive health care services for children and the impact of such plan on the health
status of enrollees.
(f) Not later than July 1, 1998, or the close of the calendar quarter following federal
approval of the state children's health insurance plan, and quarterly thereafter, the commissioner shall submit a report to the Governor and the General Assembly which shall
analyze enrollment levels in the HUSKY Plan, Part B in relation to the availability of
state and federal funds for such plan and, if necessary, establish priorities for access
under the HUSKY Plan, Part B to health insurance for eligible beneficiaries in families
with income of less than two hundred thirty-five per cent of the federal poverty level.
(October 29 Sp. Sess. P.A. 97-1, S. 10, 23.)
History: Oct. 29 Sp. Sess. P.A. 97-1 effective October 30, 1997.
(a) The commissioner or, at the commissioner's discretion, the single point of entry servicer shall review applications for eligibility to determine whether applicants or employers of applicants have discontinued
employer-sponsored dependent coverage for the purpose of participation in the HUSKY
Plan, Part B.
(b) An application may be disapproved if it is determined that a child to be covered
under the HUSKY Plan, Part B was covered by an employer-sponsored insurance within
the last two months. If the commissioner determines that the time period specified in
this subsection is insufficient to effectively deter applicants or employers of applicants
from discontinuing employer-sponsored dependent coverage for the purpose of participation in the HUSKY Plan, Part B, the commissioner may extend such period for a
maximum of an additional two months.
(c) An application may be approved in cases where prior employer-sponsored coverage ended less than two months prior to the determination of eligibility for reasons
unrelated to the availability of the HUSKY Plan, Part B, including, but not limited to:
(1) Loss of employment due to factors other than voluntary termination;
(2) Death of a parent;
(3) Change to a new employer that does not provide an option for dependent coverage;
(4) Change of address so that no employer-sponsored coverage is available;
(5) Discontinuation of health benefits to all employees of the applicant's employer;
(6) Expiration of the coverage periods established by the Consolidated Omnibus
Budget Reconciliation Act of 1985, (P.L. 99-272) as amended from time to time,
(COBRA);
(7) Self-employment;
(8) Termination of health benefits due to a long-term disability;
(9) Termination of dependent coverage due to an extreme economic hardship on
the part of either the employee or the employer, as determined by the commissioner; or
(10) Substantial reduction in either lifetime medical benefits or benefit category
available to an employee and dependents under an employer's health care plan.
(October 29 Sp. Sess. P.A. 97-1, S. 11, 23; P.A. 01-137, S. 5, 9.)
History: Oct. 29 Sp. Sess. P.A. 97-1 effective October 1, 1997; P.A. 01-137 amended Subsecs. (b) and (c) to substitute
"two" months for "six" months, effective July 1, 2001.
The applicant
for an enrollee shall notify the enrollee's managed care plan of any change in circumstance that could affect the enrollee's continued eligibility for coverage under the
HUSKY Plan, Part B within thirty days of such change. An enrollee shall be disenrolled
if the commissioner determines the enrollee is no longer eligible for participation in
such plan for reasons including, but not limited to, those specified in section 17b-301
and the nonpayment of premiums.
(October 29 Sp. Sess. P.A. 97-1, S. 12, 23.)
History: Oct. 29 Sp. Sess. P.A. 97-1 effective October 30, 1997.
Sec. 17b-301. Recovery of payment for false statement, misrepresentation or
concealment. Any payment made by the state on behalf of an enrollee as a result of
any false statement, misrepresentation or concealment of or failure to disclose income
or health insurance coverage by an applicant responsible for maintaining insurance may
be recovered by the state.
(October 29 Sp. Sess. P.A. 97-1, S. 13, 23.)
History: Oct. 29 Sp. Sess. P.A. 97-1 effective October 30, 1997.
Sec. 17b-302. Public involvement in design and implementation of HUSKY
Plan, Part B. Submission of plan for public involvement to General Assembly. (a)
The commissioner shall develop a program to involve the public in the design and
implementation of the HUSKY Plan, Part B and to ensure ongoing public involvement.
Such program shall include the opportunity to submit written comments and broad distribution of information and opportunities to the public and to consumers, consumer advocacy groups, medical providers and other organizations involved in children's health.
Information available to the public shall include one or more preliminary documents
identifying the state's options as well as the HUSKY Plan, Part B and a summary of
the plan. Public notices and HUSKY Plan, Part B materials shall be available to persons
with disabilities and to those who do not speak English.
(b) The commissioner shall submit a plan for such program and any revisions thereto
to the joint standing committees of the General Assembly having cognizance of matters
relating to human services, public health, insurance and appropriations and the budgets
of state agencies. Within fifteen days of receipt of the plan, said joint standing committees of the General Assembly may advise the commissioner of their approval, denial or
modifications, if any, of the plan.
(October 29 Sp. Sess. P.A. 97-1, S. 14, 23.)
History: Oct. 29 Sp. Sess. P.A. 97-1 effective October 30, 1997.
(a) For purposes of determining eligibility for the HUSKY Plan, Part B and to the extent permitted
by federal law and to the extent federal financial participation is available, the commissioner may disregard family income. Such disregard of family income shall allow subsidized coverage for an eligible beneficiary who resides in a household with a family
income of not more than three hundred per cent of the federal poverty level. No such
income disregard shall have the effect of granting eligibility for a child under the HUSKY
Plan, Part A.
(b) The commissioner may submit an application for a waiver under Section 1115
of the Social Security Act (1) to authorize the use of funds received under Title XXI of
the Social Security Act to establish a non-Medicaid health insurance program for eligible
beneficiaries who reside in a household with a family income of more than two hundred
thirty-five per cent of the federal poverty level but less than three hundred per cent of
the federal poverty level, and (2) to allow families under Section 2105(c)(3) of Title
XXI of the Social Security Act to purchase health insurance under the HUSKY Plan,
Part B with a sliding fee scale for families with an income up to three hundred per cent
of the federal poverty level and at full premium for those uninsured families with an
income of over three hundred per cent of the federal poverty level. The commissioner
may submit an application for a waiver of allowable expenditures in excess of ten per
cent under the provisions of Section 2105(c)(2) of Subtitle J of Public Law 105-33.
(c) The commissioner shall submit any application for a federal waiver or proposed
modification of any such waiver in connection with the HUSKY Plan, Part A and Part
B, except the initial waivers specified under subsection (b) of this section, to the joint
standing committees of the General Assembly having cognizance of matters relating to
human services, public health, insurance and appropriations and the budgets of state
agencies prior to the submission of such application or proposed modification to the
federal government in accordance with the provisions of section 17b-8.
(d) If the waiver specified in subdivision (1) of subsection (b) of this section is
denied and the income disregard under subsection (a) of this section is not available,
uninsured children who reside in a household with a family income of more than two
hundred thirty-five per cent of the federal poverty level but less than three hundred per
cent of the federal poverty level shall be eligible for unsubsidized benefits under the
provisions of subsection (b) of section 17b-292.
(October 29 Sp. Sess. P.A. 97-1, S. 15, 23; P.A. 98-8, S. 3, 5.)
History: Oct. 29 Sp. Sess. P.A. 97-1 effective October 30, 1997; P.A. 98-8 amended Subsec. (a) re family income
disregard to eliminate phrase "up to sixty-five per cent of the federal poverty level for the size of the family" and to establish
that such income disregard shall not make a child eligible under the HUSKY Plan, Part A (Medicaid), effective April 7, 1998.
The commissioner shall implement the policies and
procedures necessary to carry out the provisions of sections 17b-292 to 17b-303, inclusive, 17b-257b, 17b-261 and section 16 of public act 97-1 of the October 29 special
session* while in the process of adopting such policies and procedures in regulation
form, provided notice of intent to adopt the regulations is published in the Connecticut
Law Journal within twenty days after implementation. Such policies and procedures
shall be valid until the time final regulations are effective.
(October 29 Sp. Sess. P.A. 97-1, S. 20, 23.)
*Note: Section 16 of public act 97-1 of the October 29 special session is special in nature and therefore has not been
codified but remains in full force and effect according to its terms.
History: Oct. 29 Sp. Sess. P.A. 97-1 effective October 30, 1997.
Reserved for future use.
Note: Chapters 319w and 319x are also reserved for future use.
