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Senate Bill No. 72

PUBLIC ACT NO. 96-238

AN ACT CONCERNING PUBLIC HEALTH BUDGET IMPLEMENTATION, AIDS, COGUARDIANS, A HOSPITAL DEMONSTRATION PROJECT AND BREAST CANCER SCREENING.

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

Section 1. Section 19a-170c of the general statutes, as amended by section 59 of public act 95-160, is repealed and the following is substituted in lieu thereof:

[(a)] For the fiscal year commencing October 1, 1992, and subsequent fiscal years, each hospital shall submit to the office, in the form and manner prescribed by the office, the data specified in section 19a-167g-91 of the regulations of Connecticut state agencies, as from time to time amended, the audit required under section 19a-167f and any other data required by the office [to implement this section. For the period January 1, 1995, through September 30, 1995, and for subsequent fiscal years, if a hospital exceeds its authorized net revenue limit, adjusted for changes in equivalent discharges and for unbundling of services, an amount equal to the excess revenue for the year prior to the base year as determined in subdivision (3) of subsection (b) of this section shall be (1) deducted from the subsequent fiscal year's net revenue limit; (2) paid by the hospital to the office in four equal instalments commencing October first of the year two years following the year for which the compliance is being determined and deposited into the General Fund; or (3) deducted from payments to hospitals from the Medicaid account, as determined by the Department of Social Services, in consultation with the Office of Policy and Management.

(b) For the period January 1, 1995, through September 30, 1995, and for subsequent fiscal years, the excess revenue for the fiscal year shall be calculated as provided in subdivisions (1) to (3), inclusive, of this subsection, except that for the fiscal year commencing October 1, 1994, only, the compliance amount shall be calculated at a rate of 0.75 times the computed compliance amount for the period from October 1, 1994, to September 30, 1995, inclusive. (1) The office shall adjust the compliance adjusted authorized net revenue of the hospital for the difference between the equivalent discharges used in determining authorized net revenue and the equivalent discharges experienced by the hospital in the budget year using a fifty per cent variable cost factor. The result shall be the volume adjusted net revenue. (2) The office shall adjust the actual net revenue of the hospital, including net payments from the uncompensated care pool and payments from the Department of Social Services, then adjusting for any unbundling of services. If the actual uncompensated care rate experienced by the hospital exceeds the authorized uncompensated care rate, the difference times the total actual charges shall be added to the actual net revenue plus unbundling adjustments. The result shall be the adjusted actual net revenue. (3) The net revenue compliance adjustment shall be the adjusted net revenue calculated in subdivision (2) of this subsection minus the adjusted authorized net revenue calculated in subdivision (1) of this subsection. If this compliance adjustment is positive, that is, if the hospital collected more revenue than authorized, the amount shall be increased by the percentage increase in the authorized net revenue per equivalent discharge between the year for which the compliance adjustment is being calculated and the year in which the adjustment is being applied. This amount is called the inflation adjusted net revenue compliance adjustment. This amount shall be (A) deducted from the subsequent fiscal year's net revenue limit; (B) paid by the hospital to the office in four equal instalments commencing October first of the year two years following the year for which the compliance is being determined and deposited into the General Fund; or deducted from payments to hospitals from the Medicaid account, as determined by the Department of Social Services, in consultation with the Office of Policy and Management.

(c) By April thirtieth of each year each hospital shall calculate its compliance adjustment based on the data for the first six months of the hospital fiscal year and report this calculation to the office in the form and manner prescribed by the office. If such data shows that the hospital is not in compliance, the hospital shall implement and provide to the office by April thirtieth of the same year a plan of correction in order to comply with the authorized net revenue limit.

(d) Any compliance calculated pursuant to this section shall not be affected by the termination of the hospital budget review pursuant to sections 19a-167 to 19a-167d, inclusive, of the general statutes, revision of 1958, revised to 1993, as amended, and the repeal of said sections shall not affect any liability or obligation imposed pursuant to this section.]

Sec. 2. Subsection (b) of section 19a-170c of the general statutes, as amended by section 59 of public act 95-160, is repealed and the following is substituted in lieu thereof:

(b) For the period January 1, 1995, through September 30, 1995, and for subsequent fiscal years, the excess revenue for the fiscal year shall be calculated as provided in subdivisions (1) to (3), inclusive, of this subsection, except that for the fiscal year commencing October 1, 1994, only, the compliance amount shall be calculated at a rate of 0.75 times the computed compliance amount for the period from October 1, 1994, to September 30, 1995, inclusive. (1) The office shall adjust the compliance adjusted authorized net revenue of the hospital for the difference between the equivalent discharges used in determining authorized net revenue and the equivalent discharges experienced by the hospital in the budget year using a fifty per cent variable cost factor. The result shall be the volume adjusted net revenue. (2) The office shall adjust the actual net revenue of the hospital, including net payments from the uncompensated care pool and payments from the Department of Social Services, then adjusting for any unbundling of services. If the actual uncompensated care rate experienced by the hospital exceeds the authorized uncompensated care rate, the difference times the total actual charges shall be added to the actual net revenue plus unbundling adjustments. The result shall be the adjusted actual net revenue. (3) The net revenue compliance adjustment shall be the adjusted net revenue calculated in subdivision (2) of this subsection minus the adjusted authorized net revenue calculated in subdivision (1) of this subsection. If this compliance adjustment is positive, that is, if the hospital collected more revenue than authorized, the amount shall be increased by the percentage increase in the authorized net revenue per equivalent discharge between the year for which the compliance adjustment is being calculated and the year in which the adjustment is being applied. This amount is called the inflation adjusted net revenue compliance adjustment. This amount shall be (A) deducted from the subsequent fiscal year's net revenue limit; (B) paid by the hospital to the office in four equal instalments commencing October first of the year two years following the year for which the compliance is being determined and deposited into the General Fund; or deducted from payments to hospitals from the Medicaid account, as determined by the Department of Social Services, in consultation with the Office of Policy and Management. NOTWITHSTANDING THE REQUIREMENTS OF THIS SUBSECTION, FOR THE FISCAL YEAR COMMENCING OCTOBER 1, 1995, COMPLIANCE PAYMENTS SHALL NOT BE REQUIRED TO BE MADE ON AN EQUAL QUARTERLY BASIS.

Sec. 3. Section 61 of public act 95-160 is repealed and the following is substituted in lieu thereof:

As to any service rendered by a hospital during the period from November 1, 1994, through June 1, 1995, [as to which the hospital rendered a bill prior to June 1, 1995,] the hospital shall not issue a bill for, or attempt to collect, ON A PRIOR BILL OR OTHERWISE any [additional] amount for or relating to such service [, regardless] IN ADDITION TO THE SUMS, IF ANY, COLLECTED PRIOR TO JUNE 1, 1995 whether or not the [additional] amount is called a tax, if either (1) the total amount billed or attempted to be collected FOR OR RELATING TO SUCH SERVICE is greater than [the rate for such service included on] WOULD HAVE BEEN DUE UNDER the pricemaster in effect on October 31, 1994, or (2) [the original] ANY PRIOR amount billed AND COLLECTED FOR OR RELATING TO SUCH SERVICE included an amount for sales [or] AND gross earnings [tax] TAXES. Nothing in this section shall be construed to alter, impair or interfere with any existing contract between any hospital and any payer. In any civil action involving collection of an [additional] amount [for] IN ADDITION TO THE SUMS, IF ANY, COLLECTED PRIOR TO JUNE 1, 1995, FOR OR RELATING TO a service rendered [on or after] DURING THE PERIOD FROM November 1, 1994, [which was previously billed,] the hospital shall have the burden of proof in establishing by clear and convincing evidence that it has complied with this section. Violation of the provisions of this section shall be deemed an unfair or deceptive act or practice as defined by section 42-110b.

Sec. 4. (NEW) For purposes of this act: (1) "Breast cancer treatment services" means a procedure intended to treat cancer of the human breast, including, but not limited to, surgery, radiation therapy, chemotherapy, hormonal therapy and related medical follow-up services. (2) "Cervical cancer treatment services" means a procedure intended to treat cancer of the human cervix, including, but not limited to, surgery, radiation therapy, cryotherapy, electrocoagulation and related medical follow-up services. (3) "Unserved or underserved populations" means women who are: (A) At or below two-hundred per cent of the federal poverty level for individuals; (B) without health insurance that covers breast cancer screening mammography or cervical cancer screening services; and (C) forty to sixty-four years of age.

Sec. 5. (NEW) (a) There is established, within existing appropriations, a breast and cervical cancer early detection and treatment referral program, within the Department of Public Health, to promote screening detection and treatment of breast cancer and cervical cancer among unserved or underserved populations, to educate the public regarding breast cancer and cervical cancer and the benefits of early detection and to provide counseling and referral services for treatment.

(b) The program shall include, but not be limited to: (1) Establishment of a public education and outreach initiative to publicize breast cancer and cervical cancer early detection services and the extent of coverage for such services by health insurance, the medical assistance program and other public and private programs and the benefits of early detection of cervical cancer and the recommended frequency of pap tests; (2) Development of professional education programs, including the benefits of early detection of breast cancer and the recommended frequency of mammography and the benefits of early detection of cervical cancer and the recommended frequency of pap tests; (3) Establishment of a system for the purpose of tracking and follow-up of all women screened for breast cancer and cervical cancer in the program. The system shall include, but not be limited to, follow-up of abnormal screening tests and referral to treatment when needed and tracking women to be screened at recommended screening intervals; (4) Ensurance that all participating providers of breast cancer and cervical cancer screening are in compliance with national and state quality assurance legislative mandates.

Sec. 6. (NEW) The Department of Public Health shall provide, within existing appropriations and through contracts with health care providers: (a) One mammogram every two years for unserved or underserved populations under the age of fifty; (b) one mammogram every year for unserved or underserved populations over the age of fifty; and (c) one pap test for cervical cancer per year for unserved and underserved populations.

Sec. 7. (NEW) The Department of Public Health may apply for and receive money from public and private sources and from the federal government for the purposes of a program for breast cancer and cervical cancer early detection and treatment referral.

Sec. 8. (NEW) The Commissioner of Public Health shall report annually to the joint standing committee of the General Assembly having cognizance of matters relating to public health. The report shall include, but not be limited to, a description of the rate of breast cancer and cervical cancer morbidity and mortality in this state and the extent of participation in breast cancer and cervical cancer screening.

Sec. 9. (NEW) Four million of the dollars appropriated to the Private Providers Account in the Office of Policy and Management for fiscal year 1997 in section 11 of special act 95-12, as amended by section 1 of special act 96-8, as amended, shall be distributed by the Office of Policy and Management to the Departments of Mental Retardation, Mental Health and Addiction Services, Social Services and Children and Families, and shall be used by these departments for supplementary payments to private providers receiving funds for wage-related costs from the private providers account, as follows: (1) One and one-half million dollars to reimburse, within available appropriations, all otherwise unreimbursed costs of collective bargaining agreements incurred in fiscal years 1996 and 1997 by unionized agencies that settle wage and benefit reopeners in connection with existing collective bargaining agreements for fiscal year 1997 between May 1, 1996, and June 1, 1996, and proportional cost increases for these agencies' nonunionized employees; (2) two and one-half million dollars to reimburse other such private providers for increases in personnel costs for employees to be designated by the Secretary of the Office of Policy and Management as "low wage employees". The use of funds distributed to the Department of Social Services shall be limited to intermediate care facilities for the mentally retarded.

Sec. 10. (NEW) The term of any contingency reserve loan agreement, or modification thereof, between the Municipal Liability Trust Fund Committee established pursuant to section 19 of public act 86-350, and an interlocal risk management agency, which agreement was made in accordance with public act 86-350, shall be extended for two years, notwithstanding the provision of any such agreement regarding repayment of such loan.

Sec. 11. Section 1 of special act 95-14 is amended to read as follows:

The unexpended balance of the funds appropriated to the department of public health [and addiction services] in section 1 of public act 93-80, as amended by section 1 of public act 94-4 of the May special session, for the fiscal year ending June 30, [1995] 1996, for community health services, shall not lapse on June 30, [1995] 1996, and such funds shall continue to be available for expenditure by newly developing and existing community health centers to which funds for the fiscal year ending June 30, [1995] 1996, were committed or promised or for the establishment of community health centers in Danbury, Torrington and Bristol during the fiscal year ending June 30, [1996] 1997.

Sec. 12. (NEW) The unexpended balance of funds appropriated to the Department of Mental Retardation for workers' compensation claims for the fiscal year ending June 30, 1996, shall not lapse on June 30, 1996, and shall continue to be available for expenditure during the fiscal year ending June 30, 1997, for program enhancement.

Sec. 13. (NEW) The Birth-to-Three Program established pursuant to public act 96-185 shall not be considered a humane institution, as defined in section 17b-222 of the general statutes, as amended.

Sec. 14. Subsection (a) of section 17a-219b of the general statutes is repealed and the following is substituted in lieu thereof:

(a) Except as provided in sections [10-91a to 10-91d, inclusive,] 10-94f and 10-94g [and section 5 of public act 93-383,] the Department of Mental Retardation shall be responsible for the coordination of family support services for children with disabilities. The department shall, within available appropriations, promote state-wide availability of family support services.

Sec. 15. Section 17a-3 of the general statutes, as amended by section 1 of public act 95-250 and section 5 of public act 95-257, is repealed and the following is substituted in lieu thereof:

The department shall plan, create, develop, operate or arrange for, administer and evaluate a comprehensive and integrated state-wide program of services, including preventive services, for children and youth whose behavior does not conform to the law or to acceptable community standards, or who are mentally ill, INCLUDING DEAF AND HEARING IMPAIRED CHILDREN AND YOUTH WHO ARE MENTALLY ILL emotionally disturbed, substance abusers, delinquent, abused, neglected or uncared for, including all children and youth who are or may be committed to it by any court, and all children and youth voluntarily admitted to the department for services of any kind. Services shall not be denied to any such child or youth solely because of other complicating or multiple disabilities. The department shall work in cooperation with other child-serving agencies and organizations to provide or arrange for preventive programs, including but not limited to teenage pregnancy and youth suicide prevention, for children and youth and their families. In furtherance of this purpose, the department shall: (a) Maintain Long Lane School and other appropriate facilities exclusively for delinquents; (b) develop a comprehensive program for prevention of problems of children and youth and provide a flexible, innovative and effective program for the placement, care and treatment of children and youth committed by any court to the department, transferred to the department by other departments, or voluntarily admitted to the department; (c) provide appropriate services to families of children and youth as needed to achieve the purposes of sections 17a-1 to 17a-26, inclusive, AS AMENDED and 17a-28 to 17a-49, inclusive AS AMENDED and 17a-51; (d) establish incentive paid work programs for children and youth under the care of the department, the rates to be paid such children and youth for work done in such programs and may provide allowances to children and youth in his custody; (e) be responsible to collect, interpret and publish statistics relating to children and youth within the department; (f) conduct studies of any program, service or facility developed, operated, contracted for or supported by the department in order to evaluate its effectiveness; (g) establish staff development and other training and educational programs designed to improve the quality of departmental services and programs, provided no social worker trainee shall be assigned a case load prior to completing training, and may establish educational or training programs for children, youth, parents or other interested persons on any matter related to the promotion of the well being of children, or the prevention of mental illness, emotional disturbance, delinquency and other disabilities in children and youth; (h) develop and implement aftercare and follow-up services appropriate to the needs of any child or youth under his care; (i) establish a case audit unit to monitor each region's compliance with regulations and procedures; (j) develop and maintain a data base listing available community service programs funded by the department; (k) provide outreach and assistance to persons caring for children whose parents are unable to do so by informing such persons of programs and benefits for which they may be eligible; (l) collect data sufficient to identify the housing needs of children served by the department and share such data with the Department of Economic and Community Development; (m) prepare and submit biennially to the General Assembly a five-year master plan. The master plan shall include, but not be limited to: (1) The long range goals and the current level of attainment of such goals of the department; (2) a detailed description of the types and amounts of services presently provided to the department's clients; (3) a detailed forecast of the service needs of current and projected target populations; (4) detailed cost projections for alternate means of meeting projected needs; (5) funding priorities for each of the five years included in the plan and specific plans indicating how the funds are to be used; (6) a written plan for the prevention of child abuse and neglect; (7) a comprehensive mental health plan for children and adolescents INCLUDING CHILDREN WITH COMPLICATING OR MULTIPLE DISABILITIES; (8) a comprehensive plan for children and youth who are substance abusers, developed in conjunction with the Department of Mental Health and Addiction Services pursuant to the provisions of sections 19a-2a AS AMENDEDand 19a-7 AS AMENDED; and (9) an overall assessment of the adequacy of children's services in Connecticut. The plan shall be prepared within existing funds appropriated to the department.

Sec. 16. Section 17b-256 of the general statutes is repealed and the following is substituted in lieu thereof:

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), AIDS-related complex (ARC) 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 COMMISSIONER MAY, WITHIN AVAILABLE APPROPRIATIONS, PROVIDE PAYMENT, DETERMINED BY SAID 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.

Sec. 17. Section 45a-616 of the general statutes is repealed and the following is substituted in lieu thereof:

(a) If any minor has no parent or guardian of his or her person, the court of probate for the district in which the minor resides may, on its own motion, appoint a guardian or coguardians of the person of the minor, taking into consideration the standards provided in section 45a-617, AS AMENDED BY SECTION 17 OF THIS ACT. Such court shall take of such guardian or coguardians a written acceptance of guardianship and, if the court deems it necessary for the protection of the minor, a probate bond.

(b) [When appointing a guardian or coguardians under this section, the court shall take into consideration the minor's wishes, if he or she is over the age of twelve.] IF ANY MINOR HAS A PARENT OR GUARDIAN, WHO IS THE SOLE GUARDIAN OF THE PERSON OF THE CHILD, THE COURT OF PROBATE FOR THE DISTRICT IN WHICH THE MINOR RESIDES MAY, ON THE APPLICATION OF THE PARENT OR GUARDIAN OF SUCH CHILD OR OF THE COMMISSIONER OF CHILDREN AND FAMILIES WITH THE CONSENT OF SUCH PARENT OR GUARDIAN AND WITH REGARD TO A CHILD WITHIN THE CARE OF THE COMMISSIONER, APPOINT ONE OR MORE PERSONS TO SERVE AS COGUARDIANS OF THE CHILD. WHEN APPOINTING A GUARDIAN OR GUARDIANS UNDER THIS SUBSECTION, THE COURT SHALL TAKE INTO CONSIDERATION THE STANDARDS PROVIDED IN SECTION 45a-617, AS AMENDED BY SECTION 17 OF THIS ACT. THE COURT MAY ORDER THAT THE APPOINTMENT OF A GUARDIAN OR GUARDIANS UNDER THIS SUBSECTION TAKE EFFECT IMMEDIATELY OR, UPON REQUEST OF THE PARENT OR GUARDIAN, UPON THE OCCURRENCE OF A SPECIFIED CONTINGENCY, INCLUDING, BUT NOT LIMITED TO, THE MENTAL INCAPACITY, PHYSICAL DEBILITATION OR DEATH OF THAT PARENT OR GUARDIAN. UPON THE OCCURRENCE OF SUCH CONTINGENCY AND NOTICE THEREOF BY WRITTEN AFFIDAVIT TO THE PROBATE COURT BY THE APPOINTED GUARDIAN OR GUARDIANS, SUCH APPOINTMENT SHALL THEN TAKE EFFECT AND CONTINUE UNTIL THE FURTHER ORDER OF THE COURT, PROVIDED THE COURT MAY HOLD A HEARING TO VERIFY THE OCCURRENCE OF SUCH CONTINGENCY. THE COURT SHALL TAKE OF SUCH GUARDIAN OR COGUARDIANS A WRITTEN ACCEPTANCE OF GUARDIANSHIP, AND IF THE COURT DEEMS IT NECESSARY FOR THE PROTECTION OF THE MINOR, A PROBATE BOND.

(c) UPON RECEIPT BY THE COURT OF AN APPLICATION PURSUANT TO THIS SECTION, THE COURT SHALL SET A TIME AND PLACE FOR A HEARING TO BE HELD WITHIN THIRTY DAYS OF THE APPLICATION, UNLESS THE COURT REQUESTS AN INVESTIGATION IN ACCORDANCE WITH THE PROVISIONS OF SECTION 45a-619, IN WHICH CASE THE COURT SHALL SET A DAY FOR HEARING NOT MORE THAN THIRTY DAYS FOLLOWING RECEIPT OF THE RESULTS OF THE INVESTIGATION. THE COURT SHALL ORDER NOTICE OF THE HEARING TO BE GIVEN TO THE MINOR, IF OVER TWELVE YEARS OF AGE, BY CERTIFIED MAIL, RETURN RECEIPT REQUESTED, DELIVERABLE TO THE ADDRESSEE ONLY, AT LEAST TEN DAYS PRIOR TO THE DATE OF THE HEARING. IN ADDITION, NOTICE BY REGULAR MAIL SHALL BE GIVEN TO THE PETITIONER AND ALL OTHER PARTIES IN INTEREST KNOWN BY THE COURT.

[(c)] (d) [The guardian or coguardians shall have the same right to custody and control which the sole surviving parent of a minor has.] THE RIGHTS AND OBLIGATIONS OF THE GUARDIAN OR COGUARDIANS SHALL BE THOSE DESCRIBED IN SUBDIVISIONS (5) AND (6) OF SECTION 45a-604, AND SHALL BE SHARED WITH THE PARENT OR PREVIOUSLY APPOINTED GUARDIAN OF THE PERSON OF THE MINOR. THE RIGHTS AND OBLIGATIONS OF GUARDIANSHIP MAY BE EXERCISED INDEPENDENTLY BY THOSE WHO HAVE SUCH RIGHTS AND OBLIGATIONS. IN THE EVENT OF A DISPUTE BETWEEN GUARDIANS OR BETWEEN A COGUARDIAN AND A PARENT, THE MATTER MAY BE SUBMITTED TO THE COURT OF PROBATE WHICH APPOINTED THE GUARDIAN OR COGUARDIAN.

(e) UPON THE DEATH OF THE PARENT OR GUARDIAN, ANY APPOINTED GUARDIANS OF THE PERSON OF A MINOR CHILD SHALL BECOME THE SOLE GUARDIANS OR COGUARDIANS OF THE PERSON OF THAT MINOR CHILD.

Sec. 18. Section 45a-617 of the general statutes is repealed and the following is substituted in lieu thereof:

When appointing a guardian OR COGUARDIANS of the person of a minor, the court shall take into consideration the following factors: (1) The ability of the prospective guardian OR COGUARDIANS to meet, on a continuing day to day basis, the physical, emotional, moral and educational needs of the minor; (2) the minor's wishes, if he or she IS OVER THE AGE OF TWELVE OR is of sufficient maturity and capable of forming an intelligent preference; [and] (3) the existence or nonexistence of an established relationship between the minor and the prospective guardian OR COGUARDIANS; AND (4) THE BEST INTERESTS OF THE CHILD.

Sec. 19. (a) The sum of $25,000 appropriated to the Department of Mental Retardation, for the fiscal year ending June 30, 1997, for dental services, shall be transferred to the Department of Social Services for a grant to the Epilepsy Foundation of Connecticut.

(b) The sum of $50,000 appropriated to the Department of Mental Retardation, for the fiscal year ending June 30, 1997, for dental services, shall be transferred to the Department of Public Health for a grant to the Sickle Cell Disease Association of America/Connecticut Chapter, Inc.

(c) During the fiscal year ending June 30, 1997, $220,000 received by the Department of Mental Health and Addiction Services, as fees for the licensure of alcohol and drug counselors, shall, upon deposit in the General Fund, be credited to the appropriation to the Department of Mental Health and Addiction Services for the purposes of said licensure program.

Sec. 20. Funds in the amount agreed to by the Office and Policy and Management, the Department of Public Health and the Department of Social Services may be transferred by the finance advisory committee from the appropriation to the Department of Public Health in section 1 of special act 96-8 for the healthy start program, to the appropriation to the Department of Social Services in said section 1 to effect the transfer of responsibility for Medicaid healthy start clients from the Department of Public Health to the Department of Social Services.

Sec. 21. The sum of two hundred seventy thousand and twelve dollars is appropriated from the General Fund for the fiscal year ending June 30, 1997, to the Department of Public Health for the State Toxicology Laboratory for the following purposes:

Personal Services $151,862

Equipment 106,490

Other Expenses 11,660

Sec. 22. (NEW) (a) The Department of Public Health and the Office of Health Care Access, in consultation with the Department of Social Services, shall establish a five-year demonstration project to improve access to health care in an area of the state in which the viability of traditional acute-care hospitals is in question. The Department of Public Health, the Office of Health Care Access and the Department of Social Services jointly shall select not more than one hospital that is willing to terminate its certificate of need as an acute-care hospital pursuant to sections 19a-154 and 19a-155, of the general statutes, and its licensure as an in-patient hospital pursuant to chapter 368v of the general statutes. Such entity shall provide: (1) An emergency room, provided the emergency room is affiliated with a hospital and that the emergency room makes use of paramedics, or (2) an ambulatory surgery center. Such entity may also provide services that include but are not limited to (A) nursing facility beds, provided such beds represent a portion of beds currently licensed and occupied as of the effective date of this act, and provided further that such nursing facility beds are relocated from an existing Medicaid certified nursing facility and such relocation does not result in an increase in state expenditure and does not result in an increase in the number of nursing facility beds in the state; and (B) assisted living under a continuing care facility that guarantees life care for its residents, as defined in section 17b-354 of the general statutes.

(b) Notwithstanding any provision of the general statutes or the regulations of Connecticut state agencies, the Office of Health Care Access, with the approval of the Department of Social Services, in consultation with the Department of Public Health, shall waive certificate of need requirements and the Department of Social Services, with the approval of the Department of Public Health, in consultation with the Office of Health Care Access, shall waive the licensure requirements otherwise required for the provision of the services enumerated in subsection (a) of this section and any other services deemed necessary for the demonstration project, provided the Office of Health Care Access, in consultation with the Department of Public Health and the Department of Social Services, determines that the entity providing such services otherwise meets the requirements for such certificate of need or licensure.

(c) The Office of Health Care Access and the Department of Public Health shall reach a determination of an application for waiver under subsection (b) of this section within ninety days of submittal of the complete application.

(d) On or before January 1, 2001, the Department of Public Health, the Department of Social Services and the Office of Health Care Access shall report to the joint standing committees of the General Assembly having cognizance of matters relating to public health and human services on the effect on access to health care in the area of the state selected.

Sec. 23. (NEW) Any municipality may, upon approval by its legislative body or in any town in which the legislative body is a town meeting, by the board of selectmen, abate the property taxes due for any tax year or the interest on delinquent taxes with respect to any demonstration project established pursuant to section 22 of this act.

Sec. 24. (NEW) (a) The Commissioner of Public Health shall establish and administer a program of services for children and youth who experience the illness or death of one or more family members to HIV disease. The commissioner shall, within available appropriations, annually provide funds for pilot projects, for purposes of the program, with local providers of child mental health services and AIDS services in the four areas of greatest AIDS prevalence in the state to establish and provide culturally-appropriate therapeutic support groups and outpatient and in-home mental health services, and to provide transportation to such services for children and youth. Contracts with such providers shall require collaboration between child mental health service providers and local AIDS service providers in the design and delivery of services to AIDS-affected children and their families. Eligibility for such services shall be limited to children who lack private, third-party insurance that covers such services and whose family income is equal to or less than two hundred fifty per cent of the federal poverty level, as well as to children eligible for Medicaid to the extent that Medicaid does not wholly cover the services provided through this program.

(b) The commissioner shall, within available appropriations, conduct a training and outreach program designed to educate professionals in education, health, probate and juvenile law, and juvenile justice with regard to the program, the needs of children affected by AIDS, and the importance of family-centered, culturally-appropriate services. Such training shall include information about the psychological impacts of parental illness and death from AIDS on children and youth, the epidemiology and clinical course of the disease, legal options available to families to assure permanency in placement for affected children, and the services that are available within the state to children affected by AIDS.

Sec. 25. This act shall take effect from its passage except sections 2 to 20, inclusive, shall take effect July 1, 1996 and section 1 shall take effect October 1, 1997.

Approved June 4, 1996. Effective as provided in section 25.

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