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Substitute Senate Bill No. 75

PUBLIC ACT NO. 96-131

AN ACT CONCERNING LONG-TERM CARE.

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

Section 1. Section 17b-252 of the general statutes is repealed and the following is substituted in lieu thereof:

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 pre-certified 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, AS AMENDED BY SECTION 2 OF THIS ACT 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.

Sec. 2. Section 17b-253 of the general statutes, as amended by section 6 of public act 95-160, is repealed and the following is substituted in lieu thereof:

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 AS AMENDED BY SECTION 1 OF THIS ACT. Such protection shall be provided, to the extent approved by the federal Health Care Financing Administration, for any purchaser of a pre-certified 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 SECTION, 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 [Medicaid approves or covers for its recipients] 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 AS AMENDED 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 section and sections 17b-251, 17b-252, AS AMENDED BY SECTION 1 OF THIS ACT, 17b-254 and 38a-475, AS AMENDED 95-160, relating to determining eligibility of applicants for Medicaid, OR ITS SUCCESSOR PROGRAM, and the coverage requirements for long-term care benefits.

Sec. 3. This act shall take effect from its passage.

Approved May 29, 1996. Effective May 29, 1996.

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