Ceao Appendices

COMMISSION ON ENHANCING
AGENCY OUTCOMES
APPENDICES
Appendix A
Commission on
Enhancing Agency Outcomes
Initial Report to
the Governor, President Pro Tempore of the
Senate, and the Speaker of the House
State of Connecticut
Pursuant to Public Act 09-7
September Special Session
February 1, 2010
▪▪▪
Commission on Enhancing Agency Outcomes A-1 Dec. 15, 2010 Final Report
Commission on Enhancing Agency Outcomes
Members
By Virtue of Office
Senator Gayle Slossberg, Co-Chair Representative James Spallone, Co-

Government Administration and Elections Chair
Committee Chair Government Administration and Elections
Committee Chair
Senator Michael McLachlan

Government Administration and Elections Committee Ranking Member
Representative John Hetherington
Government Administration and Elections Ranking Member
Senator Toni Harp
Appropriations Committee Chair (or designee)
Representative John Geragosian
Appropriations Committee Chair (or designee)
Senator Dan Debicella
Appropriations Committee Ranking Member (or designee)
Representative Craig Miner
Appropriations Committee Ranking Member (or designee)
Senator John Kissel
Program Review and Investigations Committee Chair (or designee)
Representative Mary Mushinsky
Program Review and Investigations Committee Chair (or designee)
Secretary Robert Genuario
Secretary of the Office of Policy and Management (or secretary’s designee)
By Virtue of Appointment
Representative Robert Megna
Speaker of the House Appointee
Representative Russell Morin
Speaker of the House Appointee
Senator Bob Duff
Senate President Pro Tem Appointee
Senator Gary LeBeau
Senate President Pro Tem Appointee
Chancellor Emeritus William Cibes
House Majority Leader Appointee
Shelley Geballe
Senate Majority Leader Appointee
Representative Vince Candelora
House Minority Leader Appointee
William Aniskovich
Senate Minority Leader Appointee
SECTION I
Introduction
The Commission on Enhancing Agency Outcomes was first established in

February 2009 via legislation enacted to mitigate the FY09 state budget deficit (P.A. 09-
2). Its legislative goal from the beginning has been to reduce state costs and enhance the
quality and accessibility of state services. Its membership and certain responsibilities,
however, have changed through subsequent legislation. It is currently composed of a 19-
member panel of legislators, legislative appointees, and the secretary of the Office of
Policy and Management (or designee).
This initial report, required by public act, identifies subjects for further study; it
may be viewed as the commission’s work plan for the year. Although the members of
the commission believe all of the recommendations are worthy of consideration, probably
no member endorses every concept. The commission is required to submit a full report on
its findings and recommendations no later than December 31, 2010.
Background
After its original enactment in February 2009, the commission’s authority and
responsibilities have been amended twice – in the FYs 2010-2011 biennial budget bill
passed on August 31, 2009, and effective September 9, 2009, and in one subsequent
budget implementer, passed on October 2, 2009.
Original enactment: February 2009

P.A. 09-2 (Sec. 9) 1
As first enacted, the commission was, and still is, directed to:
• identify functional overlaps and other redundancies among state agencies;

and
• promote efficiency and accountability in state government by:
o identifying ways to eliminate such overlaps and redundancies,
and
o making such other recommendations as the commission deems
appropriate.
These activities are to be done with the goal of reducing costs to the state and enhancing
the quality and accessibility of state services.
Originally, the commission also was directed to consider the merger of state
agencies to further the goals of the commission. Two specific mergers were suggested
1
P.A. 09-2 An Act Concerning Deficit Mitigation Measures for the Fiscal Year Ending June 30, 2009
for consideration in the legislation: 1) the Departments of Mental Health and Addiction
Services and Social Services; and 2) the Connecticut Commission on Tourism and
Culture, portions of the Office of Workforce Competitiveness, and the Department of
Economic and Community Development.
The commission’s original 17 members included: the chairs and ranking members
of the Government Administration and Elections Committee (GAE), the chairs and
ranking members of the Appropriations Committee, the secretary of the Office of Policy
and Management (OPM), and eight legislative appointees. The GAE chairs are the chairs
of the commission.
GAE administrative staff and nonpartisan legislative staff were to serve as

administrative staff to the commission. The commission was to report on its findings and
recommendations no later that July 1, 2009, to the governor, the house speaker, and the
senate president, and terminate on July 1, 2009, or upon receiving the report, whichever
was later.
First amendment: August 2009

P.A. 09-3 June Special Session (Sec. 56)2
Two actions in the biennial budget bill passed in August 2009 affected the
commission. First, the reporting requirements and the termination date of the
commission were changed. The commission was to submit an initial report, still no later
than July 1, 2009, on its findings and recommendations, but also periodically submit
additional reports. The commission’s termination date was set at June 30, 2010.
Second, under the August 2009 biennial budget act, general fund lapses in both
FY10 and FY11 were attributed to “Enhancing Agency Outcomes”-- $3 million in FY10
and $50 million in FY11.3 The apparent intent is that the commission is expected to
achieve at least those amounts in savings as a result of its work.
Second amendment: October 2009

P.A. 09-7 September Special Session (Sec. 49)4
In a bill implementing the biennial budget passed in October 2009, the

commission’s responsibilities, membership, reporting requirements, and duration were
further amended.
In terms of the directives to the commission related to agency mergers, the

references to specific agencies for possible merger were deleted. The commission is still
required to consider the merging of state agencies generally, as well as streamlining state
operations to further the goals of the commission.
2
P.A. 09-3 June Sp. Sess. An Act Concerning Expenditures and Revenue for the Biennium Ending June
30, 2011
3
The total lapse amount for FY10 was $473,293,794, and for FY11, $530,363,090.
4
PA 09-7 Sept. Sp. Sess. An Act Implementing the Provisions of the Budget Concerning General
Government and Making Changes to Various Programs
The act also added the co-chairs of the Legislative Program Review and
Investigations (PRI) Committee to the commission, increasing its total membership to 19.
The PRI Committee is required to assist the commission, within existing budgetary
resources, as determined by the PRI Committee. This provision refers to the PRI
Committee making available some of its full-time permanent, nonpartisan professional
staff resources to assist in carrying out the commission duties.
The commission’s required reports now include this initial one, due by February
1, 2010, to identify subjects for further study; and a full report on the commission’s
findings and recommendations due no later than December 31, 2010. The commission’s
termination date was extended to December 31, 2011.
Activities to Date
During its initial work phase, from March through May 2009, the commission
sought and collected ideas for reducing state costs and streamlining government from
many quarters. The commission’s first meeting was held on March 18, 2009.
An IBM representative and a consultant connected with IBM presented

information to the commission on April 24, 2009, about electronic approaches to state
government infrastructure, cost savings, and efficiency improvements, as well as to
enhancing human services efficiency and effectiveness. On May 27, 2009, the Office of
Child Advocate made a presentation entitled Lessons From Across the Country:
Improving Human Services Delivery, which included a case study of the Allegheny
County (PA) Department of Human Services. The commission held two evening public
hearings in April, one in New Haven and one in Danbury. The commission requested by
letter certain information from state agencies including whether they conducted
administrative hearings; how contracts were negotiated; and if they issued permits or
licenses. Related data was also requested. Inquiries about state printing facilities,
interagency or outsourced printing, and agency mailing activities also were made.
Responses were received from a number of agencies.
After the long biennial budget process for FYs 2010 and 2011 finally concluded,
on November 30, 2009, the newly constituted commission met. Commission members
received a document called Proposed Areas of Focus, which was a preliminary list of all
the ideas gathered by the commission to date, requiring further review. On December 14,
2009, the commission held a public hearing in Hartford to seek both feedback on its
preliminary list and additional ideas for savings and service improvements.
The commission met on January 22, 2010, to review the preliminary Proposed
Areas of Focus list, re-organized by topic area to facilitate the review. That list combined
with ideas from the December 14 hearing is the basis for this initial report identifying
subjects for further study. The approach the commission took to evaluate the list is
explained below.
Approach Used to Identify Subjects for Further Study
At the commission’s January 22, 2010, meeting, each Proposed Area of Focus
was assessed as to how soon a proposed idea (or part of it) might be implemented, using
the following timeframes:
• Immediately (during the 2010 legislative session)

• Short-term (by 18 months)
• Long-term (three to five years)
No areas of focus were eliminated from the list.
Section II contains the results of this review process, organized by these topic
areas:
• Personnel/Agency or Function Consolidations or Mergers

• Regulatory and Procedural
• Contracting and Purchasing
• Administrative
• Revenue Maximization: Federal and State
• Information Technology/Automation
• Medicaid and Other Large Budget Areas
In addition to the estimated implementation timeframe for each item under the
topic area, information about support and opposition voiced during the December 14
public hearing is provided. Appendix A contains a full listing of all persons and
organizations that testified or submitted written testimony to the commission at all three
of its public hearings.
The tasks the commission anticipates would have to be completed and/or the
additional information necessary to move forward on implementing the proposals also are
presented for each topic area. Cost savings are noted for some of the proposed areas of
focus, but the basis for most of these cost-savings is unclear. Therefore, except in the
few cases where the cost information source is identified, no specific savings are attached
yet to any proposals. It is anticipated that potential savings will be determined as
proposals are further explored and refined. It is expected that the nonpartisan staff
offices—Program Review and Investigations (PRI), Office of Legislative Research
(OLR), and Office of Fiscal Analysis (OFA)—would develop more accurate savings
estimates collaboratively.
The commission expressed interest at the January 22 meeting in following up with

the agencies that did not testify at or submit testimony to the December 14, 2009, public
hearing, which might further refine proposals.
Next Steps
The commission understands this initial report encompasses many ideas to
achieve its overall goal of reducing state costs and enhancing the quality and accessibility
of state services. At its January 27, 2010, meeting, the commission acknowledged that
this effort needs to go beyond generating ideas and issuing proposals, to actual
implementation. Without an overall strategy to achieve implementation, the commission
is concerned that the report will just “gather dust”.
Thus, in order to accomplish its savings goal and meet its final report deadline,
the commission after submitting this report on February 1, 2010, will take the following
next steps.
• The commission co-chairs shall review the tasks outlined in each area and
assign those tasks in accordance within its authority.
• The commission co-chairs shall meet with the General Assembly majority and
minority leaders, and representatives of the executive branch, to determine
which immediate and short-term ideas will be included as legislation in the
2010 General Assembly session. The co-chairs shall report back to the full
commission on or before February 17, 2010, with which ideas will be
submitted to the relevant committees as legislation.
• The commission co-chairs shall lay out a work plan for fully exploring each
short- term and long-term idea no later than February 26, 2010. The co-chairs
shall review these work plans with the commission and update the
commission on the status of the short-term legislation no later than March 5,
2010.
• The commission shall create a specific plan to save $3 million in FY 2010 and
$50 million in FY 2011 as specified by the adopted biennium budget. The
commission shall approve a specific plan for FY 2010 savings no later than
February 26, 2010, and for FY 2011 savings, no later than April 16, 2010.
In addition, it was also suggested that the legislative members of the commission work
with their leaders to support and assist the commission’s efforts.
Intentionally blank
SECTION II
This section outlines an ambitious work plan for the Commission on Enhancing
Agency Outcomes to be carried out over the next several months. As described in the
previous section, the work plan is organized into seven broad categories with all the
proposals under consideration by the commission contained under the relevant category.
The work plan also contains the anticipated time frame for the proposal to be
implemented, and a brief explanation regarding the time frame designation. The work
plan also highlights support or opposition for the proposal based on testimony (oral or
written) submitted at the commission’s December 14, 2009, public hearing. Finally the
work plan summarizes the tasks that will be necessary to research and structure the
proposal for implementation, if that is what the commission determines. The work plan
also recognizes that more definitive cost-savings estimates will be developed at the stage
when proposals are more formalized.
The seven categories contained in the work plan are: I) Personnel/Agency or

Function Consolidations or Mergers; II) Regulatory and Procedural; III) Administrative;
IV) Contracting and Purchasing; V) Information Technology and Automation; VI)
Revenue Maximization: Federal and State; and VII) Medicaid and Other Large Budget
Areas.
I. PERSONNEL/AGENCY OR FUNCTION CONSOLIDATIONS OR MERGERS
IMMEDIATE TO SHORT-TERM
Proposal #1:
Streamline economic development agencies, processes and functions for simpler access,
greater focus and reportable outcomes, and explore other opportunities for
consolidations such as the merger of Cedarcrest and Connecticut Valley Hospital,
and the consolidation of 23 agencies into six state agencies (See Appendix B for
Senator Debicella’s and Senator McLachlan’s proposals).
Proposal #2:
Move additional state agencies to DAS SMART Unit for administrative functions
Explanation. Proposal #1 could be done this legislative session; the governor’s

budget called for a merger during the 2009 session. The 2009 program review study on
economic competitiveness recommends a merger of the Connecticut Development
Authority and the Connecticut Innovations Inc., and a transfer of some business
development functions from the Department of Economic and Community Development
to the merged authority. Savings potential short-term from rents and other expenses about
$1 million; longer-term from not refilling positions. Most of these savings are not from
state budget, since these are quasi-public but savings could translate to more funding to
businesses, and less to agency operations.
Proposal #2 could also be done on an immediate to short-term basis, as the Department of
Administrative Services is open to the idea (per its December 14, 2009 testimony).
SHORT-TERM
Proposal #3:
Review delivery of state human services focusing on being more consumer-driven,
efficient, accountable and transparent.
a) Consolidate administrative functions including fiscal operations, human

resources, payroll, central office legal, information technology,
communications, public relations, quality management, rate setting and rate
enhancement and may include other areas.
b) Programmatic changes (see Long-term below)
c) Enhance internal operations
• consolidate training – maximize federal funding
• online applications systems (see broader recommendations in Category
V)
• consolidate contracting
Proposal #4: Consolidate and execute the “steering” function5 – across existing state
agency lines – for: (A) health care; (B) services to persons with disabilities; (C)
education and job training; (D) integrating institutionalized persons back into the
community; (E) supporting innovation and entrepreneurs and other economic
development; (F) housing; (G) sustainable resource management; (H)
transportation and infrastructure; and (I) public safety, corrections, and homeland
security. A “steering function” in each area could use funding streams to provide
services from the most effective and efficient providers. It could also facilitate
the consolidation of “back-office” administrative functions such as
personnel/human resources, payroll, affirmative action, fiscal/budget/accounting,
and contract management form the relevant agencies.
Alternative ways for consolidating and executing a “steering” function include,

but are not limited to:
• Add a “Deputy Chief of Staff” for each function in the Governor’s

Office, or a “Secretary” of each function, above the Commissioner level,
or a divisional head at OPM in charge of each function. Such positions
5
The idea is from Osborne and Hutchinson, The Price of Government, Chapter 5, “Consolidation.” In their
view, “steering” – setting policy and direction – focuses on doing the right thing. “Rowing” – service
delivery and compliance operations – focuses on doing things right. The best option, according to Osborne
and Hutchinson, is to consolidate funding streams and steering authority, but not the organizations that do
the actual rowing. Using consolidated funding streams, steering organizations can purchase results from
any rowing organization (provider) they consider best equipped to provide them. The benefits: more
effective steering and more competitive service delivery.
would be supported by a Cabinet composed of Commissioners of relevant
agencies.
• Review the role and function of the Office of Policy and Management
(OPM), addressing this responsibility for coordinating policy, planning
and implementation throughout state government, perhaps realigning state
employee positions to better equip OPM to perform these functions.
• Require the creation of Interagency Steering Committees (similar to one

created by Executive Order 15 in 2007) made up of Commissioners of
relevant areas (sub-groups of A through I above) to meet at least quarterly
to report to the governor and/or the secretary of OPM on how these
“steering functions” are being implemented. Commissioners would be
required to attend.
• Meetings of the Interagency Steering Committees would be public and,

as much as possible, televised on Connecticut Network (CT-N).
(Washington State does this as a way of making government more
transparent, elevating the planning/coordination function to a high level,
and adding a substantial degree of accountability). If obstacles exist, like
funding streams, commissioners should have authority to come to
resolution.
Explanation. The commission discussed how the steering function might be

implemented at it January 27, 2010, meeting, and concern was expressed that introducing
cabinet level or secretary positions may be perceived as adding another layer of
bureaucracy and that other ways of achieving the coordination by functional area should
be explored. Alternative approaches are listed above and are considered short-term as
much could be accomplished through executive directives to consolidate such functions.
In fact, the interagency steering council for responsible growth areas has already been
created by executive order but needs to be reactivated; a similar approach is
recommended for education and workforce development in the state economic strategic
plan (issued September 2009).
Savings from a back-office consolidation among agencies serving persons with

disabilities were estimated by the Program Review and Investigations staff in 2003 at $8
million annually, based on analysis of savings of 10 percent of the administrative costs
then. Current analysis would be applied to current administrative costs in agencies to
estimate savings now, but analysis should include an assessment of reductions that may
have occurred in these areas since 2003. Also, any reorganization that calls for reductions
in staff will have to consider both the current “no layoff” agreement in place, and
restrictions in the current SEBAC agreement with state employees.
LONG-TERM
Proposal #5: Programmatic changes required under agency consolidations of human
services agencies (or others)
Proposal #6: Explore modifying state employee pension plans and other state employee
post-employment benefits (OPEB), like retiree health care costs. 6
Proposal #7: Apply cost-benefit analysis to the delivery of state services by state
agencies and private providers and utilize the principles of results-based
accountability (RBA) for both state agencies and state-contracted service
providers and vendors. (RBA means the method of planning, budgeting, and
performance measurement for state programs that focuses on the quality of life
results the state desires for its citizens and that identifies program performance
measures and indicators of the progress the state makes in achieving such quality
of life results in addition to the programs and partners that make a significant
contribution to such quality of life results.)
Public Hearing Testimony on Agency or Function Mergers and Consolidations
Support for Proposal #3 from Connecticut Business and Industry Association.

Connecticut Non Profit Human Services Cabinet support for aspects of Proposals #3 and
#4 consolidating administrative functions like contracting and data collection, and using
clear and consistent guidelines, but skeptical of creating a behemoth agency. “Keep The
Promise Coalition” (Amdur) suggests making human services more “population
focused”, but cautions against a mega-agency. The Connecticut Community Providers
Association supports Proposal #4 but suggests community providers be involved.
Community Health Resources (Gates) suggests separating administrative and

support functions from regulatory functions before consolidating or reorganizing.
Senator Debicella (Sen. District 21) testified that additional consolidations and
mergers are possible—suggests 23 agencies can be merged into 6 new agencies, and
Cedarcrest and Connecticut Valley Hospital can be merged, and suggests no more than
three layers (in agency organizations) exist between Commissioners and line staff.
The Department of Public Health opposes Proposal #3 consolidation of

(backoffice) administrative functions, especially accounting and contracting, but thinks
there may be value in cross-training. Department of Administrative Services is open to
Proposal #2 – additional agencies under SMART program.
Tasks To Develop and Refine Proposals
6
See, especially, the analysis by the Pew Center on the States, Promises with a Price: Public Sector
Retirement Benefits, 2007, at http://www.pewcenteronthestates.org/uploadedFiles/Promises%20with
%20a%20Price.pdf
• Need to determine refill rates, types of positions approved/not approved – should
there be approval only of line or direct service and not on administrative or
managerial?
• Need to determine number of retire/rehires
• Related longer term – examine need to build in an incentive for managers to keep
personnel (and other costs) down – no incentive for that now
• Need to determine the number and percent of state employees in hazardous duty
positions – additional benefits—how do percent and benefits—compare with
other states?
• Examine state employee pension plans, health care benefits, and unfunded
liability. How do benefits compare with other public pension and health care
plans? What actions have other states taken to address?
• Consider other potential proposals: other consolidation opportunities – and
consolidation of administrative functions (not just for human services agencies)
and other similar functions.
• Review SEBAC agreement and other collective bargaining agreements to better
determine restrictions, as well as determine barriers that exist because of
information technology and databases.
• Determine cost-savings estimates for refined proposals.
II. REGULATORY AND PROCEDURAL
Proposal #8: Implement lean processes in all executive branch agencies
Explanation. This was considered immediate, at least for some state agencies,
since this has already been implemented at the Department of Labor and some areas of
the Department of Environmental Protection. It could be done without legislative action,
and there are state employees already trained in the concept and application of the
processes.
SHORT-TERM TO LONG-TERM
Proposal #9: Streamline licensing and permitting processes

a. business to state government including but not limited to DOT, DRS and DEP
(e.g., water permits, human service providers)
b. general commercial activity
c. consumers
Proposal #10: Overhaul DMV functions focusing on consumer needs (esp. reducing
lines at DMV) that would improve efficiency, accountability, and transparency
Proposal #11: Expand online applications statewide (also recommended in Information

Technology/Automation section) and expand satellite locations where residents
and businesses may obtain licenses, permits, and apply for assistance. Provide
clear instructions on agency websites as to what information and documentation
will be needed no matter how the application is made.
Explanation. Proposal #10 and aspects of Proposal #9 were identified as short-

term as the most problematic processes and functions would first need to be identified;
then ways to streamline and expedite the processes would need to be implemented,
including determining alternative locations for processing state transactions. The
commission members also discussed that one of the problems that could be addressed
immediately is more predictability about state processes, which can be provided by
clearly informing people about what the requirements are and what documentation and
information they will need to produce online and/or in person to successfully complete
the transaction.
However, commission members discussed that any approaches to application or

issuance of state licenses, permits, or assistance must consider the confidentiality and
protection of information and records. Further, any regulatory streamlining must be done
without imposing additional risk on public health or safety or the environment (i.e., the
underlying need and criteria for license or permit), which may be more long-term.
Public Hearing Testimony on Regulatory and Procedural Issues
DEP indicates streamlining licensing and permitting (Proposal #9) is important,

and DPH has had success with on-line licensing and is working on one behavioral health
license. The Connecticut Community Providers Association supports establishing one
overarching licensing protocol for community providers. The Connecticut Business and
Industry Association supports any streamlining that will help promote business
development and thereby enhance state revenues.
CBIA supports LEAN processes (Proposal #8), as does DEP. TTT

Transformations LLC, a private consulting firm, also testified in support of LEAN and
other quality improvement processes.
• Require each agency to identify its one most problematic regulatory process.
• Identify one or two main processes at DMV that impact the most state residents to
target for improvements and/or cost savings, including exploring opportunities to
expand services to outside agencies.
• Work with business groups to identify most problematic regulatory processes
impacting economic development in the state.
• Analyze processes to determine where bottlenecks or duplication are occurring,
and develop structured proposals for streamlining, including better local/state
coordination.
• Work with Blue Ribbon Commission on Municipal Opportunities and Regional
Efficiencies (MORE) to assess what proposals it is implementing that will
streamline regulatory processes and improve efficiencies.
• Determine time and cost savings to customers (e.g., businesses, providers,
individuals).
III. ADMINISTRATIVE
Proposal #12: Require “direct deposit” of all state payroll checks, unemployment
compensation checks, and workers’ compensation checks, to eliminate printing
and mailing costs. Confirming information can be available online through
CORE-CT.
Proposal #13: Require a centralized, uniform electronic process for recording and
transmitting state employee time records throughout state agencies
SHORT-TERM
Proposal #14: Consolidate administrative hearings and/or use judge trial referees to
provide administrative hearings for all agencies, as is recommended for CHRO.
A pilot program might be established where certain administrative areas would
be consolidated with hearing officers assigned with expertise in that area,
addressing the concern that such hearing officers have knowledge in that area.
Proposal #15: Printing within state agencies

a. consolidate printing centers
b. introduce and expand paperless processes
Explanation. These proposals were identified as short-term, with the commission

suggesting that an immediate pilot program to consolidate hearings might be undertaken.
While requiring “direct deposit” appears more immediate, it would require notice to both
employees and the public of the change. Also, there may be issues because some banks
charge a fee for electronic deposit, while some individuals may not have accounts where
direct deposits can be made.
Public Hearing Testimony on Administrative Issues
The Commission on Human Rights and Opportunities supports Recommendation

14, while the Departments of Public Health and Environmental Protection oppose it,
stating that hearing officers need expertise in the specific area. CBIA supports
Recommendation #12, and suggests immediate implementation, while State Comptroller
Wyman opposes it, indicating it might cost more money than it saves.
Pitney Bowes testified that using better software and implementing better
document management for both printing and mailing would be beneficial.
• Determine the agencies and personnel involved in conducting administrative

hearings now.
• Determine the subject matter areas of the administrative hearings and decisions,
and current workloads.
• Determine the vacancies in these areas, and the number of refilled (or rehired
retirees) positions.
• Determine where and how a pilot program to consolidate administrative hearing
might be most feasible and effective, as well as the feasibility for longer-term
implementation.
• Identify all various processes for recording of time and attendance and obstacles
to making uniform, consistent, electronic process, and costs/savings estimates
(personnel and other) from one process.
• Determine the costs (printing and personnel) throughout state government of
paper checks, and statements.
• Determine the costs and obstacles to direct electronic deposit, and confirm that
there would be savings (printing, personnel, etc.)
• Determine the printing needs, including reporting, of state agencies, and where
and how that is done, and explore areas where that can be reduced or done
electronically. Estimate cost savings from refined administrative proposals.
IV. CONTRACTING AND PURCHASING
IMMEDIATE
Proposal #16: Enforce use of p-cards (review audit findings)
Proposal #17: Expand the use of reverse auctions for purchasing, and also use for
services.
Explanation. These were determined to be immediate as they could be

implemented administratively within the executive branch agencies without legislation or
other mandates, except that legislation would be required to extend reverse auction
use to services. The reverse auction proposal (#17) was not among the list of
preliminary proposals but was discussed at the January 22 and 27, 2010, commission
meetings, and proposed its expanded use among agencies, towns, as well as for services
and products. The practice is already used in some state agencies, including at the Office
of Policy and Management for the purchase of energy used by the state.
SHORT-TERM
Proposal #18: Mandate “managed competition” – among both internal state
government and external providers – for most services (excluding functions
involving state-sanctioned violence (e.g., prisons and police), those which protect
due process rights, those which handle sensitive security and privacy issues, and
those that require absolutely fair and equal treatment (courts).7
Proposal #19: Cooperative Purchasing Opportunities – create and/or join cooperative

purchasing venture to allow certain eligible entities to purchase goods, certain
services and utilities from state/multistate contracts. Greater volume allows for
better price. (see Minnesota)
o Requires legislation to define joint powers/governmental entities that may

join program. Includes municipalities, school districts as well as other
entities – certain tax exempt, non profits and charitable organizations
o And/or join multistate cooperative purchasing organization – see for

example www.USCommunities.org; other cooperatives allow
participating government entities to avoid the time-consuming competitive
bid process that involves formulating and issuing requests for proposal,
evaluating vendors, and negotiating contracts. Each participating
government entity adds an addendum to the original contract, slightly
altering the contract's terms and conditions to meet its own purchasing
requirements. Since all purchasers are working off one contract, instead
of the contractor having to maintain thousands of contracts across the
country, they only have to maintain one. By us streamlining our side,
[vendors] can provide the products and prices at a much lower cost than
they could otherwise.
o Enforce bulk purchasing rules for higher education (see audit)
Proposal #20: Join Multistate Contracting Alliance for Pharmacy purchases – (see
Minnesota Multistate Contracting Alliance for Pharmacy (MMCAP), created in
1985, a voluntary cooperative purchasing group that combines the purchasing
power of its members to receive the best prices available for pharmaceuticals,
hospital supplies, and related products. MMCAP contracts with over 160
pharmaceutical manufacturers, and also has contracts for distributors (to support
the pharmaceutical contracts), hospital supplies, returned goods processing, flu
vaccine, and vials and containers. MMCAP’s niche is to provide, through volume
contracting and careful contract management, the best value in pharmaceuticals
and related products to its members - eligible governmental health care facilities.
Currently, MMCAP has membership agreements with 45 states and the Cities of
Chicago and Los Angeles - 43 Participating Entities and over 5,000 eligible
facilities.
7
See David Osborne and Peter Hutchinson, The Price of Government, Chapter 7, “Buying Services
Competitively.”
Proposal #21: Effectively utilize Eastern States Contracting Alliance modeled on
Western state alliance (WSCA) created in 1998 by the State of New Mexico. The
WSCA are four contracts with PC manufacturers to provide, through volume
contracting and careful contract management, the best value in PCs to the
participating entities in 41 states that currently use these contracts. In January
2004, administration and management of these contracts was transferred to the
Materials Management Division. Sixteen contracts, based on solicitations issued
by Minnesota since February 2004, have become effective at various times since
September 2004.
Proposal #22: Share services/purchasing with neighboring states (see Minnesota and
Wisconsin-savings identified $10m each state); see for example backing up each
other's databases, investing together in communications systems for law
enforcement and purchasing products from each other.
Explanation. Proposals #18 through 22 were all determined to be short-term,

although the commission determined some aspects of Proposal #18 have the potential for
being more long-term. The commission determined that all could be implemented by
executive branch agencies and would not require statutory changes. In the case of the
purchasing agreements, the Department of Administrative Services indicates (December
14, 2009, public hearing) that it already engages in several purchasing alliances for the
state (and some municipalities).
The Department of Administrative Services indicates it already belongs to the

Eastern States Contracting Alliance, which is part of the larger National Association of
State Procurement Officials (NASPO), but DAS states it need a legislative change
granting it authority to purchase off an already existing contract, as DAS needs to be part
of the group that develops the specifics for each procurement contract.
LONG-TERM
Proposal #23: Master contracting

o business to state government
o internal within state government
o intergovernmental
o consumers to state government
o municipalities
Explanation. The master contracting and all the subcategories listed in Proposal
#23 were determined to be a long-term initiative. This would entail clarifying the
definition of what a master contract actually means, what agencies and areas might be
subject to it, and what the obstacles would be. Further, some aspects of Proposal #18 in
mandating managed competition for some services could be longer-term if they have
implications on personnel issues with SEBAC or other collective bargaining contracts.
Public Hearing Testimony on Contracting and Purchasing
The Department of Administrative Services indicated it would need further
clarification on “master contracting”; in some cases DAS indicates it already does this.
TTT Transformations LLC, supports a standard contracting process, and the Commission
on Children supports master contracting, if it is implemented by “issue”. AFSCME
Council 4 suggested implementing a contract services budget, and convening of the
Contracting Standards Board.
CBIA supports Proposals #19-22, on group and cooperative purchasing and the
Comptroller indicated that in some cases these cooperative arrangements work and in
other cases they are not as successful. UCONN and the State University system indicated
they are already doing cooperative purchasing, but UCONN indicated it should retain its
purchasing authority because of unique higher education needs.
DAS stated it would need further clarification on the use of the p-cards
(Proposal #16), and the Comptroller supported their use, with scrutiny.
Re: Contract Types and Aggregate Expenditures

• Identify all major types of state contracts and categorize:
o Purchase of service agreements
o Personal service agreements
o Procurement Contracts
o Other
• Identify which agencies oversee contracts
• Determine total dollar amounts
• Status of budget provision calling for reduction in contracts
Re: Individual Contractors and Contracts

• Identify individual contractors and non-profits
• Determine contracted amounts and services provided
• Determine continued need for contract
• Identify administrative expenses of contractors/non-profits
• Determine status and impact of budget provision calling for reduction of $95
million in state contracts in each of FYs 10 and 11
• Determine the status of the State Contracting Standards Board
o Determine potential obstacles to “managed competition”, including
collective bargaining provisions
• Determine what other states have done to address contracting in current fiscal
environment, and current best practices
Re: Purchasing
• Determine aspects noted above for all state purchasing activity, including the
status of Buy Smart-Buy Together, a joint purchasing effort undertaken by the
state a few years ago
• Inquire of Auditors the use of p-cards in state agencies, and review any audit
findings.
• Determine states’ best practices for purchasing, and potential cost-savings if
best practices are implemented
• Determine current status (extent and areas) of Connecticut’s involvement in
multi-state alliance contracts, and potential for wider use and savings
potential.
• Review plan for prescription drug purchasing by state agencies required by
P.A. 09-206.
Re: Regionalization
• Determine what opportunities exist for regionalizing contracting, purchasing,
and other services in the state, and what obstacles exist, and what is needed to
eliminate obstacles.
• Identify ways of using state financial incentives or reductions to encourage
implementation of regional contracting and purchasing.
V. INFORMATION TECHNOLOGY/AUTOMATION
Proposal #24: On-line applications system statewide (example, Department of Motor

Vehicles drivers’ licenses, and is also listed in Regulatory/Procedural Section)).
Other agencies should include Departments of Higher Education, Social Services
and Transportation. Clients should be able to file an application for any social
service with any social service agency.
Proposal #25: Use the Internet to allow residents to determine the time and place of
receiving services from state agencies (self-service) including applications for
licenses and permits –and using the generated data to make services data to make
services more responsive.8
Proposal #26: Use the Internet to make processes more predictable by informing
residents and businesses of information, documentation needed to complete
transaction or process.
Proposal #27: Leverage the existing statewide state fiber network to provide training to
state agency personnel (such as DCF, DMHAS, DSS, DDS, affirmative action,
8
See Osborne and Hutchinson, The Price of Government, chapter 9, “Smarter Customer Service: Putting
Customers in the Driver’s Seat.”
etc.) by interactive video, rather than by travel to multiple locations with multiple
presentations.
Proposal #28: Make regulations for all state agencies accessible online and other
relevant information such as rules, policy guidelines.
Explanation. These proposals were determined to be achieved in the short term

since Internet capabilities would allow for these to be accomplished without creation of
new systems, and some online applications, webinars etc. are already available and
should be able to be expanded relatively quickly.
Proposal #29: Consolidate data centers
Proposal #30: Use managed competition for certain information technology services,
such as email, file sharing, and database applications, and forms automation and
processing, and explore use of open source software and enhancing
interoperability.
Explanation. These proposals were determined to need further exploration before

clear designation of a time frame for implementation, as it is not clear where all data
centers reside, and what computer systems and data are compatible. It is possible that
certain aspects might be accomplished in the short-term, but longer-term implementation
is more realistic.
LONG-TERM
Proposal #31: Designate a lead state agency to modernize statewide communication

platform
Proposal #32: Facilitate the creation and use of statewide, interoperable electronics
systems for state records, including an electronic health records system (EHR)
to reduce health care costs and improve quality of service.
Explanation. Proposals #29, 30 and 31, and aspects of #32 above will require
significant research on what the current state systems provide, and what the obstacles are
to modernizing platforms and making systems interoperable. Creating and accessing
electronic health records statewide should be more short-term. Although such an EHR is
available free of charge from the federal Veterans Health Administration,9 potential state
users of an EHR state that the VA system does not meet their needs. However, the
Connecticut Health and Educational Facilities Authority (CHEFA) is writing a federal
grant proposal that will be submitted through the Department of Public Health to access
$200 million in federal stimulus funds under Section 3014 of the American Recovery and
9
See David Osborne, “Memo to the New President: Reinventing Health Care,” January 15, 2009, on page
12 of the printed version, available at the website of the Public Strategies Group, specifically at:
http://www.ppionline.org/print.cfm?contentid=254877
Reinvestment Act (ARRA) to be combined with $50 million in tax-exempt bonds to be
issued pursuant to Section 10a-186a of the Connecticut General Statutes, for the purpose
of creating interoperable EHR systems for Connecticut providers. Moreover, a
collaboration is under way to secure up to $43 million in federal Medicaid funding (100
percent of state Medicaid expenditures for this purpose), under Section 4201 of the
ARRA, to support the adoption, implementation or upgrade of certified EHR technology
by eligible hospitals in Connecticut. Both of these efforts should be supported by the
General Assembly. Potential out-year savings in Medicaid costs: considerable.
Public Hearing Testimony on Information Technology and Automation
The Commission on Children supports online application (#24) for benefits with
common applications. The Department of Information Technology supports data center
consolidation, expanding statewide application processes, including licensing, but does
not support the managed competition approach to information technology.
There was support for developing electronic health records (EHR) (#32) systems
from various parties, including the Connecticut Community Providers Association,
UCONN (which indicates it is already implementing), and the Department of Public
Health, which supports the concept but not the VA system, indicating it does not
encompass needs of all providers. The Connecticut Hospital Association supports the
EHR proposal, but indicates the state would need to put up some state dollars in order to
get a federal match.
CBIA supports modernizing systems, consolidating data centers, and managed

competition in the information technology area. The Comptroller supports consolidation
as well as virtualization of servers per CORE-CT, the state’s automated business system
for personnel, payments etc. DPH is concerned about confidentiality of client data if data
centers are consolidated.
• Require the Department of Information Technology (DOIT) to provide

description of current information technology systems, what is provided by DOIT,
and what state agencies perform.
• Determine what resources (staff, equipment, and other) are currently expended on
information technology and automation currently.
• Determine best practices (e.g., Digital Government) for state information
technology and other processes, and what implementation would cost or save.
• To the extent possible, (and within available resources) work with outside
consultant services (with no product or service to sell) to assess current systems
and alternatives.
VI. REVENUE MAXIMIZATION: FEDERAL AND STATE
FEDERAL
Proposal #33: Pursue a Section 1115 Medicaid waiver for the SAGA program, while
increasing reimbursements to providers. This action is already required by Section
17b-192(g) of the Connecticut General Statutes, but has not yet been
implemented.
Proposal #34: Seek new federal revenue for existing Department of Mental Health and
Addiction Services (DMHAS) (ACT, Supervised Housing services, Supported
Housing services, Mobile Crisis) as Medicaid rehabilitation services.
Proposal #35: Maximize federal revenue by billing Medicaid, to the fullest extent
allowed, for outpatient services by DMHAS state operated and contracted
providers
Proposal #36: Take advantage of federal assistance to veterans, by requiring all state
agencies to ask clients seeking assistance “Have you served in the military?” and
forwarding name and addresses of veterans to the Dept of Veterans’ Affairs,
which can then seek out all forms of assistance to veterans.
Proposal #37: Maximize emergency TANF (temporary assistance) and Supplemental

Nutrition Assistance Program-Employment and Training Reimbursement
Program funding (SNAP E&T, formerly FSET (Food Stamp Employment and
Training))
Proposal #38: Designate a person in each state agency for maximizing federal funds
and grants.
STATE
Proposal #39: Confer with the Department of Revenue Services (DRS) about what the
agency needs to promote full tax collections, and consider whether adding auditor
positions would increase tax collection.
Proposal #40: Impose a $75 fee for filing discrimination complaints at the Commission
of Human Rights and Opportunities (CHRO) to discourage the filing of frivolous
complaints, and allow for a waiver if indigency is shown.
Explanation. The Commission on Enhancing Agency Outcomes concluded at its

January 22, 2010, meeting that certain aspects of federal revenue maximization could be
achieved immediately if a more aggressive approach was taken by executive branch
agencies to seek out, research eligibility criteria, and apply for federal (and other)
funding. The commission also believed that inquiring about veteran status could be
implemented immediately if required of all executive branch agencies, although DMHAS
testified that the information cannot be shared unless permission is granted. Other
aspects of the proposals would be short-term but not immediate, as waiver applications or
expansions would have to be explored, and some might require additional state money
before Medicaid funds would reimburse.
The commission also determined that state collections could also be maximized,
and in particular thought that DRS processes/resources could be reviewed for increasing
collection of taxes owed. Using an idea brought forward at the December 14, 2009,
public hearing, the commission thinks establishing a fee for CHRO complaint filings, as
long as there is a indigency waiver, would be beneficial.
Public Hearing Testimony on Federal and State Revenue Maximization
The Connecticut Nonprofit Human Services Cabinet supports greater efforts at

Medicaid reimbursement (#33) (and other funds); CBIA supports waiver for the SAGA
program, as does the Connecticut Hospital Association, and the Connecticut Community
Providers Association, but with “carve outs” for some services.
The proposals for seeking Medicaid funding for additional Department of Mental
Health and Addiction Services (DMHAS) (#34) and other outpatient services (#35) were
supported by various testifiers including the Connecticut Community Providers
Association, the National Alliance on Mental Illness (NAMI-CT), and the Department of
Mental Health and Addiction Services (although DMHAS noted that many services are
not federally reimbursable). The “Keep the Promise” Coalition also supported #35.
Other revenue maximization proposals suggested at the public hearing were:
• adding auditor positions at Department of Revenue Services to garner taxes

owed
• eliminate some tax expenditures (tax credits) that do not provide a public
benefit
• impose a filing fee at CHRO, with a waiver for the indigent
• TANF and FSET funding (commission January 22, 2010 meeting)
• Determine total federal dollars received in Connecticut, and how (and in what
agencies) the state applies for federal dollars and/or federal Medicaid waivers.
• Identify human services that are currently 100 percent state-funded, and analyze
whether there is potential for Medicaid (or other) federal funding.
• Determine how other states are organized for obtaining federal revenues (and
what incentives are provide to agencies for seeking and obtaining), and whether
consolidation or contracting out of this function makes sense.
• Discuss with National Conference of State Legislatures, Council of State
Governments, and National Governors Association.
• Determine maintenance of effort issues around Medicaid, waivers, and state
funding.
• Research whether state agencies should be allowed discretion to negotiate with
persons to settle outstanding accounts for money owed to the state at lesser
amounts than owed.
• Research number of DRS auditors/tax collection return amounts; find out if any
other point in DRS process could be enhanced to increase collection of taxes
owed.
VII. MEDICAID & OTHER LARGE BUDGET AREAS
MEDICAID
IMMEDIATE to SHORT-TERM
Proposal #41: Fully implement drug recycling programs
LONG-TERM
Proposal #42: Control long-term health care costs
Proposal #43: State needs to invest in appropriate planning capacity to address issue of
long-term health care costs.
Explanation. The commission determined there are many aspects to this broad
proposal (Proposal #42), and therefore not much could be done immediately to control
long-term health care costs. Many suggestions were proposed at the December 14, 2009
public hearing – from rebalancing the care system to provide more community-based care
and expanding newer community initiatives like “Money Follows the Person”, to
expanding waivers for current home care services and community-based services for the
young mentally ill, and transferring more clients from state-run programs to community
providers. However, one commission member cautioned at the January 22, 2010, meeting
that the state, in its efforts to control costs, must be careful not to create two parallel,
expensive entitlement programs.
Public Hearing Testimony on Controlling Long-term Health Care Costs
The Commission on Aging suggests rebalancing the system more towards home
care, streamlining the home and community-based waiver systems and supports the
“Money Follows the Person” initiative. CBIA also supports more care in the community
and by community providers rather than state agencies and suggests a cost analysis of
Southbury Training School. Senator Debicella also supports greater services by
community providers rather than state agencies.
Other suggestions for controlling long-term health care costs were more
administrative and may well lend themselves to the review of contracting and
administrative segments of the work plan, for example, to develop a single application
process for most social services, standardize data and reporting systems, and increase
collaboration among nonprofits to offer and coordinate more back office services. Some
efforts at controlling costs might be able to begin immediately, like full implementation
of drug recycling programs (#41), and fall prevention programs for the elderly.

• Explore whether federal restrictions exist on state reducing optional Medicaid
services.
• Determine capacity and occupancy rates of nursing homes, administrative costs of
nursing homes, and potential ways of reducing the number of beds and/or homes.
• Explore obstacles to transferring additional services to community providers from
state agencies (e.g., SEBAC and other collective bargaining agreements).
CORRECTIONS
SHORT-TERM
Proposal #44: Provide community services to approximately 1,400 persons in prison

with moderate to serious mental illness who are incarcerated ONLY for low-level,
non-violent offenses. If community services cost $20,000 per person, vs. $32,000
per incarcerated person, savings would be $17 million annually. Medicaid
reimbursement for community services could provide additional federal revenue
of $10 million or more.
Proposal #45: The state should carefully review the potential for saving money and
improving public safety by enhancing its programs for community corrections as
alternatives to incarceration for lower-risk-level, non-violent offenders, including
in the weeks and months prior to release from prison – using proven risk-
assessment methods and evidence-based supervision programs. Such programs
have proved effective in states like Texas and Arizona, they cost far less than
incarceration, and they improve outcomes (including protecting public safety,
improving offenders’ reintegration into the community, and decreasing the rate of
recidivism).10
Proposal #46: Innovation and prevention, state corrections
Explanation. The commission determined proposals # 44 and 45 could be

implemented in the short-term because it believes there are evidence-based models out
there that could be fairly easily replicated that have demonstrated to reduce recidivism
10
See the analyses by the Pew Center on the States, including One in 31 (2009), and “Right-Sizing Prisons:
Business Leaders Make the Case for Corrections Reform” (January 2010), both available at
www.pewcenteronthestates.org
and save money. One obstacle discussed was local opposition to siting community-based
residential facilities.
CORRECTIONS
LONG-TERM
Proposal #47: Explore the privatization of Inmate Medical Services in DOC

Public Hearing Testimony on Corrections
The Connecticut Business and Industry Association supports programs that cut
the rate of recidivism like “character-based” prison models, alternatives to incarceration
for non-violent offenders, and enhanced community re-entry services. The Capital
Workforce Partners also supports prevention programs such as better alignment of
employment and training services with client needs, and developing programs for high
school dropouts and ex-offenders.
The Department of Mental Health and Addiction Services, NAMI-CT, and

CCPA, and CNPHSC, the nonprofit human services cabinet, all support enhanced
community services in the corrections area, but indicate that they must adequately
address needs (like mental health) and cover costs.
MHM Correctional Services, a private firm in the area of correctional consulting

and services supports privatizing some correctional services, and public/private
partnerships in implementing other correctional programs.
• Determine how Department of Corrections provides services (including medical)

now, and what evidence-based models exist for these services to be privatized
and/or provided in community.
• Explore obstacles that might exist to privatizing services, (e.g., security issues like
locked units).
• Review Pew Center on the States Report entitled One in 31 cited in footnote 10.
DEPARTMENT OF CHILDREN AND FAMILIES

SHORT-TERM
Proposal #48: Enhance community prevention and intervention efforts by DCF, to

support and preserve families, keeping children at home when safe, and using
foster care, rather than congregate care, when children must be removed from
their families. Short-term savings result because foster care board and care
payments should be less than per child costs for congregate care. And there
should be longer-term savings because kids are far more likely to get adopted out
of foster homes than congregate care.
Explanation. The commission determined that this proposal could be
implemented in the short term, recognizing that many of these programs already exist in
the state have been demonstrated to be less expensive and in many cases more effective.
The use of these less costly alternatives could be expanded within the executive branch.
Public Hearing Testimony on Department of Children and Families
The Commission on Children supports prevention programs for children
• Determine how DCF provides child welfare and prevention services now,
what are the determining factors and what evidence-based models exist for
these services to be privatized and/or provided in community?
EDUCATION COSTS
Proposal #49: Promote regionalization of elementary and secondary education to

more efficiently use state education funding.
• Work with Blue Ribbon Commission on Municipal Opportunities and

Regional Efficiencies (MORE) to assess what proposals it is exploring that
would promote regionalization of elementary and secondary education.
STATE OWNED MENTAL HEALTH FACILITY

IMMEDIATE
Proposal #50: Use City of Middletown to provide water service to Connecticut Valley
Hospital (CVH)
• Discuss idea with the Department of Mental Health and Addiction Services to
understand DMHAS concerns.
SOCIAL SERVICES DELIVERY

LONG-TERM
Proposal #51: Undertake rigorous cost/benefit analysis of transferring most or all

social services clients from state institutions to not-for-profit private providers
and closing state institutions. Agencies including the Department of
Developmental Services and the Department of Mental Health and Addiction
Services will be reviewed to determine the timetable and savings from
transferring clients to the private providers.
Miscellaneous (Suggestions from December 14, 2009 Public Hearing)

• Do not rebid contracts with nonprofits; already providing services at less than
state services
• Accept suggestions from SEBAC members on providing more effective and
efficient services
• Eliminate the Connecticut Resources Recovery Authority
Intentionally blank
Appendix A
Persons/Organizations That Testified or Submitted Testimony at
Commission on Enhancing Agency Outcomes Public Hearings
April 27, 2009 New Haven
Cynthia Clair
Fritz Jellinghaus and Ann Scheffer
Helen Higgins
John Herzan
Larry Bingaman
Nancy Ahern
Rachel Gibson
Robert Dunne
Ryan Odinak
April 30, 2009 Danbury
Jeffry Muthersbaugh
T.H. Martland
Tom Nelson
December 14, 2009 Hartford
Alicia Woodsby, NAMI-CT
Alyssa Goduti, Community Providers Association
Barry Kasdan, Bridges in Milford
Brian Ellsworth, Connecticut Association for Hospice & Homecare
Chancellor David G. Carter, Connecticut State University System
CIO Diane Wallace, Department of Information Technology
Commissioner Amey Marrella, Department of Environmental Protection
Commissioner Patricia Rehmer, Department of Mental Health & Addiction Services
Commissioner Robert Galvin, Department of Public Health
Comptroller Nancy Wyman
Connecticut Hospital Association
Connecticut Nonprofit Human Services Cabinet
Department of Administrative Services
Elaine Zimmerman, Commission on Children
Hal Smith, MHM Correctional Services, Inc
Heather Gates, President & CEO of Community Health Resources
Jon P. FitzGerald, Office of Public Hearings, Commission on Human Rights & Opportunities
Julia Evans Starr, Commission on Aging
Leigh Walton, Pitney Bowes
Peter Gioia, Chief Economist, Connecticut Business & Industry Association
Ron Cretaro, Connecticut Association of Nonprofits
Sal Luciano, AFSCME Council 4
Senator Dan Debicella, 21st District
Shelia Amdur, Keep the Promise Coalition
Thomas Gullotta
Thomas Nelson, TTT Transformations, LLC
Thomas Phillips, Capital Workforce Partners
VP & CIO Barry Feldman, University of Connecticut
Brian Anderson
Intentionally blank
Appendix B
Senator Debicella Proposals (12/11/09 Letter)
Senator McLachlan Proposals (4/23/09 Letter)
Appendix B
Commission on Enhancing Agency Outcomes: Key Events
February 2009: Commission on Enhancing Agency Outcomes established via P.A. 09-
2, Sec. 9, An Act Concerning Deficit Mitigation Measures for the Fiscal Year Ending
June 30, 2009.
■ findings and recommendations report due by July 1, 2009, to legislative
leaders and the governor
■ terminate on the date report submitted or July 1, 2009, whichever is later.
March 18, 2009: Commission meeting: Organizational
April 24, 2009: Commission meeting: IBM representative and consultant connected to
IBM presented information about electronic approaches to state government
infrastructure, cost savings, and efficiency improvements, as well as to enhancing human
services efficiency and effectiveness.
April 27, 2009: Commission public hearing in New Haven (7:00 p.m., New Haven City
Hall check)
April 30, 2009: Commission public hearing in Danbury (7:00 p.m., Danbury City Hall)
May 27, 2009: Commission meeting: Office of Child Advocate made presentation
entitled Lessons From Across the Country: Improving Human Services Delivery (with
case study of the Allegheny County (PA) Department of Human Services.
August 2009: Biennial budget for FYs 2010-2011 enacted, with provisions: 1) changing
the CEAO reporting requirements and termination date (to June 30, 2010); and 2) making
CEAO responsible for budget lapses in each FY (FY 10-$3 million; FY 11--$50 million)
(P.A. 09-3 June Special Session, (Section 56), An Act Concerning Expenditures and
Revenue for the Biennium Ending June 30, 2011)
October 2009: Implementer bill for biennial budget enacted, with provisions: 1)
changing CEAO responsibilities, membership, reporting requirements, and duration
■ agency specific merger references deleted and changed to general
consideration of agency mergers and streamlining state operations
■ added Legislative Program Review and Investigations Committee (PRI) co-
chairs to CEAO membership, and required PRI to assist the commission,
within existing budgetary resources, as determine by PRI (i.e., loan PRI staff)
■ Initial report to identify subjects for further review due by February 1, 2010
■ Full report in findings and recommendations due no later than December 31,
2010.
■ CEAO termination date December 31, 2011.
Commission on Enhancing Agency Outcomes B-1 Dec. 15, 2010 Final Report
November 30, 2009: Commission meeting: Members received a document called
Proposed Areas of Focus, which was a preliminary list of all the ideas gathered by the
commission to date, requiring further review.
December 14, 2009: Commission public hearing in Hartford to seek feedback on the
CEAO preliminary list and receive additional ideas for savings and service
improvements.
December 17, 2009: PRI committee votes to direct PRI director to assign [at least four]
some PRI staff upon the completion of the 2009 PRI projects to assist CEAO in
developing the initial report required no later than February 1, 2010.
January 22, 2010: Commission meeting - Reviewed the preliminary Proposed Areas
of Focus list, re-organized by topic area, along with ideas from December 14 public
hearing.
January 27, 2010: Commission meeting - Reviewed draft initial report and made
changes
February 1, 2010: CEAO Initial Report identifying subjects for further review delivered
to legislative leaders and the governor.
March 18, 2010: Commission meeting—Staff presented summaries on ideas about:

implementing the LEAN process; the City of Middletown providing water to Connecticut
Valley Hospital; longevity payments to state employees; and moving additional state
agencies to the DAS SmART unit. Information was also provided on the attrition rate for
state employees, along with a comparison of 2010 bills to consolidate economic
development agencies. General discussion on what commission wanted to focus on and
get more information about, based on Initial Report.
April 7, 2010: Commission meeting – Staff presented summaries on ideas about:

requiring direct deposit of all state payroll checks; pursuing a Section 1115 Medicaid
Waiver for SAGA; and fully implementing the state’s drug recycling program.
Information was also provided about state employee compensation compared to private
sector compensation, along with an inventory of all Connecticut permits and licenses.
General discussion on what commission wanted to focus on and get more information
about, based on Initial Report.
June 21, 2010: Commission meeting – Staff presented a summary about the proposal to
close Cedar Ridge Hospital, and provided further information on direct deposit, discussed
at the previous meeting. Also, staff provided material from the gubernatorially-
established State Post-Employment Benefits Commission, which staff was monitoring for
CEAO (the PEB Commission was created XXX and was operating the same time as was
CEAO. PRI scopes. General discussion on what commission wanted to focus on and get
more information about, based on Initial Report.
July 28, 2010: Commission meeting – Staff presented further information about possible
expansion of the DAS SmART Unit, direct deposit, including costs and legal concerns
about mandating direct deposit, and Cedar Ridge closure
August 11, 2010: Commission meeting -The Commission on Aging and the Connecticut
Business and Industry Association presented information on the state’s long-term care
situation based on the State’s Long Term Care Plan and a report by the Regional Institute
for the 21st Century. The commission agreed to send a letter to the governor asking for
priority action on long-term care solutions.
September 15, 2010: Commission meeting – Staff presented: a summary on increasing

Medicaid generic drug use and cost reduction; description and analysis of selected state
personnel statistics, based on staff use of CORE-CT; information about CREC
administrative costs (OLR report); and further information about expanding the drug
recycling program. The commission also received a letter from DAS containing its
analysis of further SmART unit expansion, as requested by the commission.
November 22, 2010: Commission meeting – Based on commission work to date and the
February 1, 2010, initial report, staff presented a draft list containing: thirty-two
proposals to achieve potential savings, fifteen additional proposals to enhance outcomes
but not necessarily save money, and four areas for further exploration.
Also, staff provided additional reports, most pertinent to proposals on the draft list:
Long-term health care costs; selected state expense areas (e.g., contracting and
purchasing (based on CORE-CT information)); Department of Revenue Services audits,
collections, and enforcement of tax obligations; personnel statistics for human services
agencies; Temporary Assistance for Needy Families (TANF) emergency fund update;
Department of Motor Vehicles Function Overhaul; corrections and community-based
services; selected Department of Children and Families (DCF) family intervention
programs; posting state agency regulations on line; streamlining charitable gaming within
Division of Special Revenue; economic competitiveness in Connecticut; energy
efficiency in state buildings; federal assistance for veterans; inpatient inmate medical
services payment; and state employee retirement statistics. A report on the prescription
drug purchasing program by the Department of Social Services was also provided to the
commission.
November 29, 2010: Commission meeting – Commission discussed and took action on
the draft proposal list presented at the last meeting. The commission accepted many of
the proposals as written, amended some, and chose to not vote on some. Prior to the
next meeting scheduled for December 15, 2010, the commission will receive a draft final
report.
December 15, 2010: TBD
December 31, 2010: TBD
Appendix D
COMMISSION ON ENHANCING AGENCY OUTCOMES
SUMMARY SHEET
SmART Unit Analysis (Small Agency Resource Team)
Background
The “Small Agency Resource Team” or SmART, is a unit within the Department of Administrative
Services that provides certain state agencies with consolidated business office functions and personnel, payroll,
and affirmative action services (i.e., equal employment opportunity (EEO)).
The DAS SmART unit was established on July 1, 2005, under Section 60(c) of P.A. 05-251, which
required the Commissioner of Administrative Services, in consultation with the Secretary of the Office of
Policy and Management, to determine which state agencies would merge and consolidate their personnel,
payroll, affirmative action and business office functions with the DAS Unit.
Agencies Served By SmART Unit
Currently, 23 small agencies, commissions or offices are served by the DAS SmART Unit (Table 1).
Combined, there are an estimated 1,048 full time state employees within these 23 agencies.
Table 1. State Agencies/Commissions/Offices Served by DAS SmART Unit as of July 23, 2010a
State Agency/Commission/Office
c
Board of Accountancy (5) Department of Public Works (169)
Board of Education and Services for the Blind (121) Governor’s Office (29)
Board of Firearms Permit Examiners (1) Judicial Selection Commission (1)
Commission on Culture and Tourism (47) Lieutenant Governor’s Office (5)
Commission on the Deaf and Hearing Impaired (38) Office of Child Advocate (8)
Commission on Fire Prevention and Control (72) Office of Consumer Counsel (14)
Commission on Human Rights and Opportunities (74) Office of Protection and Advocacy for Persons
with Disabilities (45)
c
Connecticut Siting Council (9) Office of the Victim Advocate (4)
Department of Agriculture (62) Office of Workforce Competitiveness (3)
Department of Consumer Protection (156) Police Officers Standards and Training Council
(22)
b
Department of Emergency Management and Homeland State Contracting Standards Board (0)
Security (48)
c
Department of Public Utility Control (115)
a
Number of full time employees in a state agency, commission or office (shown in parentheses) determined by PRI staff
using CORE-CT data. For this summary sheet, PRI staff defines full time state employees as those who work more than
49% of whatever is considered fulltime for their positions (thus eligible for pension); and have the status of active, on
leave, or suspended, as long as they were paid within the last 365 days. The definition excludes students, national guard
personnel, prisoner/client workers, and temporary/seasonal workers.
b
The SmART Unit will perform these functions when the board has employees.
c
Business office functions covered by home agency.
Source of Data: PRI staff analysis of CORE-CT, Office of Legislative Research (Report # 2010-R-0044)
Small Agencies For Possible Coverage by SmART Unit
Nineteen additional small agencies (150 employees or fewer) could potentially be covered by the
SmART Unit. Table 2 shows the human resources staff (HR, Payroll, Affirmative Action (AA)) currently in
these small agencies. Note that some of the positions may also perform other functions besides HR, payroll
and/or AA, which would need to be explored further prior to any considered merger with the SmART Unit.
Commission on Enhancing Agency Outcomes D-1 Dec. 15, 2010 Final Report
Table 2. Small Agencies/Commissions/Offices Not Covered by SmART as of July 23, 2010a
# of State Agency HR, Payroll, and Affirmative Action Employees:
Emplyees1 Position(s) Salariesa
20 Freedom of Information • FOIC Program Manager (Fiscal/Administrative) $104,954 $250,570
Commission • Associate Fiscal Administrative Officer $84,522
• Fiscal Administrative Assistant $61,094
• Note: Affirmative Action performed by Staff Attorney 3
61 Office of the Chief Medical • HR Specialist $73,516
Examiner
101 Connecticut State Library • Principal HR Specialist $97,032 $170,688
• Fiscal Administrative Officer $73,656
116 Department of Bankingb • Principal HR Specialist $91,951 $250,605
• HR Assistant $50,947
• HR Associate $58,254
110 Division of Special Revenue • Principal HR Specialist $97,032 $313,817
• HR Specialist $85,436
• Payroll Officer 1 $69,036
• Admin Assist $62,313
117 Department of Economic and • Principal HR Specialist $89,708 $163,364
Community Development • Fiscal Administrative Officer $73,656
• Note: Affirmative Action handled by SmART Unit
140 Department of Insuranceb • Principal HR Specialist $84,736 $229,272
• HR Assistant $59,015
• Payroll Clerk $41,217
• Office Assistant $44,304
• Note: Affirmative Action handled by OSC employee
83 Agriculture Experiment • Chief of Fiscal Services AES $130,900 $278,056
Station • Vice Director – AES $147,156
9 Office of the Health Care No HR titles (Administratively under the Department of Insurance)
Advocate
2 Judicial Review Council No HR titles (Administratively under OSC)
107 Military Department • HumResManager $104,954 $180,659
• PayrollOfficer2 $75,705
131 Office of Policy and • Human Resources Associate $73,803 $252,560
Management • HumResManager $104,954
• Fiscal Admin Officer $73,803
• Note: Affirmative Action performed by Dir. of Staff Dev.
85 Office of the Secretary of the • Fiscal Administrative Manager 1 $107,007 $241,749
State • Human Resources Specialist $72,429
• Administrative Assistant $62,313
• Note: Affirmative Action performed by OSC employee
9 Soldrs’ Sailors’ Marines’ Fndb • Fiscal Administrative Officer $73,803 $73,803
49 State Elections Enfrcmt Com • Fiscal Administrative Supervisor $95,084 $95,084
18 Office of State Ethics • Fiscal Administrative Officer $69,698 $119,152
• Note: Affirmative Action performed by Staff Attorney 3
142 Office of the State Treasurer • HumanResourcesAssociate $59,384 $274,262
• PayrollClerk $44,190
• PrincipalHRSpecialist $97,032
24 Teacher’s Retirement Board • TRB Assistant Administrator $109,159 $161,904
116 Worker’s Compensation • PrincipalHRSpecialist $97,032 $318,991
Commissionb • Processing Technician $54,546
• Office Assistant $44,304
1
Number of full time employees in a state agency, commission or office (shown in parentheses) determined by PRI staff using
CORE-CT data. For this summary sheet, PRI staff defines full time state employees as those who work more than 49% of whatever
is considered fulltime for their positions (thus eligible for pension); and have the status of active, on leave, or suspended, as long as
they were paid within the last 365 days. The definition excludes students, national guard personnel, prisoner/client workers, and
temporary/seasonal workers.
a
Base salary, excluding longevity, overtime, and fringe.
b
Salaries paid for by monies outside of the General Fund.
Source of Data: CORE-CT, DAS, Office of Legislative Research (Report # 2010-R-0044)
SmART Unit in Transition
The DAS SmART Unit is currently undergoing a transition -- the previously separate DAS human
resources department is now merged with the SmART Unit, the affirmative action staff have been transferred to
the commissioner’s office, and a new SmART Unit director has been appointed as the previous director retired
in July. The structure as of August has 16 human resources and payroll positions in the SmART Unit. The four
Affirmative Action positions are now under the direction of the DAS staff counsel and legislative liaison within
the commissioner’s office.
Opportunities for Possible Savings by Increasing Agencies Covered by the SmART Unit
InCommissione
Table 3 summarizes the ratio of HR staff to employees for the current SmART Unit, as well as for the
non-SmART small agencies listed in Table 2.
Lega
Table 3. Ratio of HR Staff to CT State Employees: SmART Unit and Other Small Agencies
Agency # of State HR, Payroll, and Ratio of employees to hr staff
Employees Affirmative Action # of employees # of HR staff per
Employees covered per HR 100 employees
staff person
SmART Unit 1,048 16-20 52-66 1.5-1.9
Other small agencies 1,440 45 32 3.1
Source of Data: PRI staff analysis of Core CT data
These figures are only one piece of information needed for the analysis required to plan further
expansion of the SmART Unit, and should not be dispositive. Finally, DAS estimates that three to six
months are needed to move personnel, systems and processes.
Commission recommendation to move additional state agencies to DAS SmART Unit
The commission recommended that the five agencies shown in Table 4 be moved under the SmART Unit,
with estimated savings based on a 50 percent resource transfer to DAS.
Table 4. Agencies’ HR/Payroll/EEO Positions

Agency Positions Annual Salaries
Office of the Chief Medical Fiscal Admin. Manager $320,861
Examiner Assoc. Fiscal Admin Officer
Fiscal Administrative Asst. (2)
HR Specialist
Connecticut State Library Principal HR Specialist $170,688
Fiscal Administrative Officer
Division of Special Revenue Principal HR Specialist $311,643
HR Specialist
Administrative Assistant
Payroll Officer 1
Department of Economic and Principal HR Specialist $163,364
Community Development Fiscal Administrative Officer
EEO already handled by SmART
Military Department HR Manager $180,659
Payroll Officer
Total Annualized Personal Services $1,147,215
Estimated 50% resource transfer to DAS $573,608
Net consolidation savings (573,608)
Source: Office of Fiscal Analysis Preliminary Draft Fiscal Impact 8/9/10, LCO 5907.
Ratio Of Human Resources Workers11 To Number Of State Employees
Other States and Industry Standards
• Georgia has one human resources staff person for every 115 state employees, except for Georgia’s
smaller state agencies, which have one human resources staff person for every 88 state employees.12
• New Jersey has one human resources staff person for every 63 state employees, with a range from one
for every 48 state employees in the Human Services department, to one for every 140 state employees in
the Public Defender department.13
• A general rule in the HR field is one human resources staff person for every 100 employees.14
• A study by the Society of Human Resource Management15 reported the average HR staff to employee
ratio by organization size to be:
No. of Employees Average HR Staff to

Employee Ratio
Fewer than 100 2.70
100 to 249 1.26
250 to 499 1.07
500 to 999 0.82
1,000 to 2,499 0.79
2,500 to 7,499 0.53
7,500 or more 0.42
These ratios may vary depending on such factors as degree of centralization of the HR function, geographic
distribution of employees, degree of outsourcing, and level of regulatory oversight, among others.
11
Human Resources workers are often responsible for managing personnel recruitment and selection, compensation, job classification,
and administering employee benefits and insurance. Definitions of the human resources function vary, and the ratios described above
may or may not include payroll, affirmative action/EEO, and/or training positions.
12
Georgia State Senate Budget Task Force Final Report, March 16, 2010.
13
Human Resource Management in New Jersey State Government, Report prepared for the State of New Jersey Department of
Personnel by John J. Heldrich Center for Workforce Development, Rutgers University, April 2006.
14
Russell, R., & Harrop, D. (2009). Staffing the Human Resources Function. (http://mcgladreypullen.com/Issues/hrstaffing.html)
15
Society for Human Resource Management Capital Benchmarking Study, March 2000.
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Appendix F
SUMMARY SHEET
Closure of State Institutions: Cedar Ridge Hospital Case Study
I. Background
Context: The closure of state-run institutions as a cost-saving measure has been suggested for a number of
years. The Commission on Enhancing Agency Outcomes chose to use the recent closure of Cedar Ridge
Hospital as a case study of such initiatives. By examining the process and resulting client, staff and
financial impact, the experience could inform consideration of future closures. It should be noted that a
retirement incentive program coincided with the hospital closure and was a complicating factor impacting
staffing needs.
Description of Cedar Ridge Hospital: Cedar Ridge Hospital (CR) was the psychiatric division of
Cedarcrest Hospital.16 A 103 bed inpatient facility, CR was located in Newington and operated by the
Connecticut Department of Mental Health and Addiction Services (DMHAS). 17 The hospital served
persons with severe and persistent psychiatric and/or substance abuse disorders, who had experienced
prior hospitalizations and/or support and treatment in the community for an extended period of time. The
majority of clients were admitted from general hospital psychiatric units or emergency departments. In
addition to 72 general psychiatry beds and 15 Young Adult Program beds, 18 there were also 16 residential
step-down, transitional beds.19
During SFYs 2007 through 2009, the average daily census for the general psychiatric beds was 87, and
the average length of stay 300 days (10 months). (The average length of stay for the 16 individuals in
residential step-down beds was 338 days (11 months)).
The annual cost to operate Cedar Ridge Hospital was $29.9 million ($290,291 per patient)
annually, 87 percent of which was for salaries ($25.9 million). Other costs included medication ($1.4
million), contracted professional medical services ($600,000), and food, heat, clothing, etc. ($2 million).
Closure of Cedar Ridge Hospital: On December 14, 2009, DMHAS filed a certificate of need application
with the Office of Health Care Access (OHCA) to terminate acute care psychiatric and residential step-
down services at Cedar Ridge Hospital. Following a public hearing in January, OHCA issued an agreed
settlement regarding the closure of Cedar Ridge by June 30, 2010, requiring DMHAS to establish
sufficient resources to accommodate individuals being discharged from psychiatric hospitals into the
community. While the facility continues to officially remain open until all community resources have
been established, there are currently no patients at Cedar Ridge.
What were the Advantages and Drawbacks of the Closure?
Advantages: more resources available at Connecticut Valley Hospital (CVH) (e.g., physical therapists,
speech pathologists, monolingual specialty services) * facility in better physical condition * frees up
16
There is also a substance abuse division, Blue Hills, which is located in Hartford, and provides detoxification and
rehabilitation services.
17
DMHAS currently operates four other inpatient facilities: Connecticut Valley Hospital (Middletown); Greater
Bridgeport Mental Health Center; Connecticut Mental Health Center (New Haven); and Capitol Region Mental
Health Center (Hartford).
18
Provided age-specific psychiatric treatment services to 18 to 25 year olds previously committed to DCF, with an
average of 7-10 out-of-home placements.
19
Was an unlocked unit that provided community reintegration skills for persons waiting for community placement
and/or facing barriers to community re-entry.
Commission on Enhancing Agency Outcomes F-1 Dec. 15, 2010 Final Report
resources to move more clients from inpatient hospitalization to lower levels of care (i.e., more group
homes, enhanced crisis supports, 1-1 supervision, homemakers)
Drawbacks: insufficient community resources for an increasing client population leading to re-
institutionalization in prisons and nursing homes * concern about feasibility of new community services
being implemented and available prior to the proposed termination date of June 30, 2010 * some think
DMHAS lacks a system to monitor, measure need, and systematically plan for increased community-
based services
II. What Happened to the Cedar Ridge Hospital Clients?
Where the Cedar Ridge Clients Went: In March 2010, there were 83 clients residing at CR. As the chart
below shows, over two-thirds of Cedar Ridge clients (57 individuals) had a clinical need for continued
inpatient services, and were transferred to CVH. A sizeable number went into the community (24
individuals). Community living services and supports include specialized residential support programs,
supervised apartments, and other residential supports.20
As described by DMHAS, the importance of continuity of care for individuals transitioning from
Cedar Ridge to other DMHAS inpatient facilities or to the community was shown in the following ways:
• Each client was engaged in an individualized transition plan that took into account clinical and
programming needs, in addition to personal preference
• Staff from the DMHAS inpatient service system and community Local Mental Health Authority
system worked collaboratively with clients and service providers to ensure the best match between
the individual and DMHAS inpatient/community resources
• DMHAS staff and/or community provider staff took steps to establish relationships with clients
including:
o Scheduling day trips and overnight stays six to eight weeks prior to actual discharge for
clients with community discharges
o arranging transportation to CVH as needed, so that individuals and families could visit
the hospital prior to transfer (for clients with discharges to CVH)
 having CVH staff develop and share a “Welcome Video” for individuals and
families who could not visit CVH prior to patient transfer
57toCVH
The agency noted that the planned and routine discharge of individuals throughout DMHAS’
inpatient service system has and will continue according to their specific plans of treatment. These
community transitions, along with the prior discharges from the DMHAS inpatient service system, have
been carefully developed and taken into account individuals’ preference, clinical and programming needs.
20
Additionally, 31 clients from other DMHAS facilities were also discharged to the community during that same
time period, for a total of 55 individuals.
Commission on Enhancing Agency Outcomes Young F-2 Dec. 15, 2010 Final Report
Adu
ltUnit
How Monitoring of Quality of Care for the Clients Transferred from Cedar Ridge Occurs: DMHAS
described a system for client monitoring that includes:
• Overall: Weekly discharge planning and progress meetings designed to assess that the services
received by an individual are at the most appropriate level of care. This weekly process also monitors
the quality of care and the treatment process for clients in DMHAS inpatient facilities.
o Issues arising for clients transitioning from Cedar Ridge hospital are brought to the
attention of the DMHAS CEO, who then determines whether to bring it to the
commissioner.
• For Inpatient Care: Regularly scheduled treatment team meetings include psychiatrists, social
workers, psychologists, nurses, the client, and others involved in the day to day care of the individuals
at CVH.
o The two clients at the DMHAS Greater Bridgeport Mental Health Center are in a
specialized inpatient program addressing co-occurring mental health and substance use
disorders, and are also monitored by the treatment team at that facility.
o Both facilities also have ongoing contact with the DMHAS Medical Director should any
concerns about the care of clients arise.
• For Community Discharges: Monitoring occurs through the DMHAS Local Mental Health
Authorities (LMHAs) system.21 When a client is first placed into a community setting, there is daily
contact, with the frequency of contact lessening over time based on clinical need.
• Through the DMHAS Health Care System (HCS) and Evaluation, Quality Management and
Improvement (EQMI) Divisions, DMHAS regularly monitors the quality of care and outcomes of
clients in the community (e.g., reviews critical incident reports, and client outcome statistics).
Preliminary Information on Outcomes of Clients Transferred from Cedar Ridge: The DMHAS
commissioner’s office, through its Evaluation, Quality Management and Improvement (EQMI) division,
tracks client outcomes. Using National Outcome Measures (NOMs), clients are assessed every six months
in such areas as employment, housing, social connectedness, and other quality of life indicators.
Because six months have not passed since the 24 clients were transferred from Cedar Ridge to the
community, this follow-up assessment has not yet occurred. As of July 22, 2010, of the 55 total
individuals discharged to the community, including the 24 from Cedar Ridge (see footnote 5) one client
was re-admitted to DMHAS’ inpatient service system. In this case, DMHAS staff worked closely with the
respective LMHA to ensure that the client had access to services that were clinically indicated.
III. What Happened to Cedar Ridge Hospital Staff?
Staff Remaining at Cedar Ridge: Following the departure of the last remaining Cedar Ridge patients, all
but 27 employees had left the facility by the beginning of June. Most of these staff (n=22) left at various
points during the month of June as computers and medical records were moved, quality assurance
paperwork completed, and transfer of facility maintenance to DPW occurred.
As of July 15, 2010, there were five DMHAS employees at Cedar Ridge Hospital: telephone
operator, administrative supervisor, maintenance person, medical director, and clinical manager (acting as
CEO). (The Medical Director and the Clinical Manager currently spend approximately 40 percent of their
time at Cedar Ridge,22 and 60 percent of their time at CVH).
21
Includes seven DMHAS-operated LMHAs and eight DMHAS-funded LMHAs operated by private non-profit
providers. The LMHAs offer care coordination and an array of services and supports to individuals within their
respective service areas.
22
Including closing out the Medical Records Department, overseeing plant closure activities, and following state
guidelines regarding disposition of nursing, pharmacy, staff education, physician, hr, and other records/files.
Once the state’s application for intermediate short-term beds in general hospitals is approved by
the federal government Centers for Medicare and Medicaid Services (CMS), then DMHAS should
receive written acknowledgment from OHCA regarding the Department's full compliance with the
applicable provisions of the CON agreement, and formally close the facility.
Where the Cedar Ridge Staff Went/Will Go: Table 1 shows where all Cedar Ridge employees will have
transferred to/upon formal closure of the hospital.
Table 1. Where Did Cedar Ridge Employees Go?

Agency/Division # of Staff who are:
Total Direct Care Non-Direct Care
DMHAS:
CVH 214a 182 32
Blue Hills Hospital 6 2 4

Community Mental Health Center (New Haven) 1 1
Capitol Region Mental Health Center 24 19 5
Western CT Mental Health Network 6 5 1
River Valley Services (Middletown) 8 8
Commissioner’s Office 1 1
Subtotal: 260 217 43
Other Agencies:
DPW 2 2
DPH 1 1
Subtotal: 3 0 3
TOTAL 263 217 46
Transferred to Other State Agency in fall 2009 16 16
Left State Government 12 9 3
Adjusted Total 291 226 65
a
154 of these 214 staff continue to be involved in the care of the 57 former Cedar Ridge clients who transferred to
CVH.
Source of Data: DMHAS
Note, of the 263 staff at Cedar Ridge in spring 2010 and currently in state government:
• All the direct care staff (n=217) remained within DMHAS
o The largest number (182) transferred to CVH (84 percent)
• Over two-thirds (69 percent) of the non-direct care staff remained within DMHAS (43 of 62)
• Of the 214 staff who transferred to CVH, approximately 72 percent (n=154) continue to be involved
in the care of the 57 former Cedar Ridge patients who had transferred to CVH
Retirement Incentive Program (RIP): Coinciding with the closure of Cedar Ridge Hospital, Connecticut
offered a retirement incentive program (RIP) in 2009 as a strategy to reduce the size of state government.
Over 3,800 employees took advantage of the program, including 311 DMHAS employees. As shown in
Table 2, there were 150 direct care staff who took the RIP, over half of whom (89) were direct care staff
at inpatient DMHAS facilities. A total of 83 positions were authorized to be refilled.
Table 2. DMHAS Retirement Incentive Program Participants and Refills
Type of Staff # of Retirement RIP refills approved % RIP positions

Incentive Program approved for refill
Participants:
Direct Care Staff 150 (48%) 58 39%
Non-Direct Care Staff 161 (52%) 25 16%
Total 311 (100%) 83 27%
Source of Data: OPM Excel Spreadsheet of Final DMHAS RIP Plan
RIP Refills: In conversations with staff at OPM and DMHAS, they report that the refill rate for RIP
positions was lower than would have otherwise occurred because the transfer of former Cedar Ridge
employees into vacant positions was factored into the equation. Had Cedar Ridge remained open, there
would have likely been significantly more than 83 RIP refills authorized. This factor is not apparent when
calculating financial savings realized solely by the closure of CR. Consider the following:
• There were 53 former Cedar Ridge Young Adult Services Unit staff who transferred with the unit
intact to CVH, and an additional 101 CR staff who continued to be involved in the care of former CR
patients who had transferred to CVH.
• There were also 60 former CR staff who transferred to CVH and filled existing vacancies.23 Beyond
CVH, as detailed in Table 1, there were 46 additional staff who transferred into vacancies at other
DMHAS facilities or locations (total of 106 staff).
• When the 106 non-CR-patient-related filled positions are added to the 83 officially authorized RIP
refills, DMHAS was actually authorized to fill 189 vacant positions, and should include this factor
in the calculations of savings due to the RIP.24
• Looked at from another perspective, the staffing required to care for the 83 former CR clients
should be less costly, now that 24 of the clients are living in the community. While specific costs
for the care of the 24 clients in the community is not available, community care is generally estimated
to be less than half the cost of inpatient hospital care.
IV. What Will Happen to the Cedar Ridge Facility?
Oversight/Responsibility for the Facility: On July 1, 2010, the Cedar Ridge facility/property reverted to
the Department of Public Works (DPW). Although DPW has responsibility for the daily operations of the
physical plant of Cedar Ridge, DMHAS continues to maintain capacity to provide services at Cedar
Ridge Hospital until written acknowledgment to terminate services is received from OHCA.
23
Staff went to fill opportunities (vacancies) designated in accordance with the 2009 SEBAC Agreement.
24
Note, that as of July 15, 2010, 37 RIP Refill positions were filled, 22 of them with current DMHAS
employees, which resulted in recruitment for 22 backfill positions. Additionally, 13 of the RIP Refills
were filled by employees impacted by closures at the Department of Children and Families (High
Meadows) and the State Department of Education (LPN program at the technical high schools).
Condition of the Facility: The 75-acre Cedar Ridge campus contains 16 buildings totaling over 272,000
square feet, including the hospital main building (113,120 sq. ft.), and the Division of Revenue Services
building (46,000 sq. ft.).
In its facilities evaluation, DPW reported that the “building conditions range from very good,
good, fair to deteriorating.”25 Heating occurs via a central boiler plant (requiring two state employee
Boiler Tenders and four contracted boiler tenders), and all but the DRS building receive electricity from a
distribution system owned and maintained by the state. None of the occupied buildings have sprinkler
systems, although they do have fire alarm systems. Each building has its own air conditioning/ventilation
system, and sewer/water is handled by MDC. The roads are in fair condition and no environmental issues
were reported.
Including contracted security guards, property manager, general trades worker, and contracted
and state employee boiler tenders, DPW projected a total operating budget of $1.3 million to maintain the
Cedar Ridge facility:
Boiler Plant Staffing $475,000

Utilities $275,490
Life Safety Maintenance $43,000
Property Preservation $510,000
Total $1,303,490
Plans for the Facility: Possible future plans for the campus reported by DPW include:
• Construction of new data center for the Department of Information Technology (DoIT) to
replace existing data center located in leased spaced in East Hartford (which currently has
insufficient power and cooling)
o Status: General Assembly approved $2.5 million in design funds; however,
no bonding has been approved for building construction (estimated to cost
approximately $21 million)
• Renovation of hospital building to house DoIT staff offices
o General Assembly would need to approve $8 million in bonding
• Determination of whether residential homes on campus could be converted into office space
V. Were there Savings Generated by the Closure of Cedar Ridge Hospital?
As this case study demonstrates, it is difficult to look at the closure of a state facility in isolation. The
closure of Cedar Ridge, for example, coincided with a statewide retirement incentive program, leading to
many direct care vacancies within the Department of Mental Health and Addiction Services. Table 3
shows expenses pre- and post- CR closing.
There are approximately $2 million in estimated non-personnel savings from prorating expenses due
to the reduction in patients from 83 to 53 in the following non salary areas:
• Professional services - savings in contractual fees for doctors and nurses

• Medication volume – savings due to decrease in inpatient clients from 83 to 53
• Medication costs - by prescribing generics/increasing individuals to Medicaid where possible
• Other fixed expenses, such as food, heat, clothing reduced
25
Department of Public Works Facilities Evaluation of Cedarcrest Hospital Campus (Received Via email on
7/23/10).
Personnel were the primary cost driver associated with CR. The answer to whether there were
savings generated by the closure of CR will depend on the context in which the question is posed:
• Looking at personnel expenses for CR alone, the number of staff needed to care for CR clients
decreased by approximately 41 percent, with 106 fewer staff needed to care for former CR clients.
• When examined within the framework of the Retirement Incentive Program, savings were
realized by having fewer RIP refills requested, knowing that CR personnel would be available for
vacant positions.
• Considering the overall state budget, because of the no layoff clause, all 263 staff went to fill
opportunities (vacancies) designated in accordance with the 2009 SEBAC Agreement, and thus no
personnel savings could be realized. The overall state budget also increased by $5.8 million to
develop more community resources needed for the clients leaving inpatient care.
• Considering the cost of inpatient vs. community care, it is less costly to treat clients in the
community than in an inpatient psychiatric hospital. The Office of the State Comptroller estimates
one day of hospitalization at CVH to be $1,236 per patient (vs. estimates of $397 per day in the
community). Anticipating 40 new community slots at a savings of $839 per day, there could
potentially be a net savings of $6,449,400. ($12,249,400 less the $5,800,000 in cost to provide
community services).
Table 3. Expenses Pre- and Post-Cedar Ridge Closure

Expense: Cost (in millions)
Pre-Cedar Ridge Closure Post-Cedar Ridge Closure
Personnel1 $25.9 $25.9
Non Salary Expenses
Professional Services $0.6 $0.4
Medications $1.4 $0.9
Other $2.0 $0.7
Additional Community Resources $5.8
Maintenance of vacant campus $0.35
Total $29.9 $34.05
1
Expense for all 263 personnel remains as SEBAC agreement does not permit layoffs through FY 11.
Source: DMHAS Cedar Ridge Closure Expenditure Flow Chart
Summary: This case study shows the complexity of closing a state-run institution. Client and staffing
considerations, and the context in which the closure occurs, all intersect to make it difficult to calculate
net savings. From a statewide, bottom-line perspective, it is difficult to argue that the closure of CR saved
Connecticut money, at least in the short-term. However, the expansion of community services will benefit
both former CR residents as well as other future clients served by DMHAS, and help to shift the balance
from institutional care to the more home-like, and less costly, community care. This shift away from
institutional care will save DMHAS and the state money over the long-term if there is a proportionate
decrease in inpatient staffing levels as the number of inpatient clients declines.
Appendix G
SUMMARY SHEET
Proposal to Streamline the Division of Special Revenue –

Reduce and/or Consolidate the Charitable Games Unit
Overview of Division of Special Revenue. The Division of Special Revenue (DSR) is the state
agency responsible for regulating legal gaming. Founded in 1971 as the Commission on Special
Revenue (P.A. 865), Connecticut first began regulating gaming such as the state lottery, off-track
betting, and horse racing. Division responsibilities expanded in 1987 with the transfer of
responsibility for charitable gaming from the state police to DSR, and in 1992 with the
assumption of responsibility for casino gambling (Responsibility for the state lottery was
separated into the quasi-public Connecticut Lottery Corporation in 1996).
The figure below shows the current organization of the Division of Special Revenue as of July
2010. Apart from the administrative hearings and back office functions, there are four units—
including the Charitable Games Unit (CGU).
Description of Charitable Games Unit. Under C.G.S. Ch 98, the charitable gaming activities of
bingo, sealed ticket sales, bazaars, and raffles conducted by nonprofit organizations, are subject
to registration, permit, and other regulatory requirements of the CGU. Specifically, the unit is
responsible for:
• administration of required registrations and permits;
• review of the financial statements/audits of the sponsoring organizations; and
• field oversight of authorized activities.
The cost to regulate charitable games in Connecticut is covered by revenues from CGU. A recent
study of gambling in Connecticut26 found revenues had decreased to the point that the amount
transferred to the General Fund in 2007 did not cover the state’s costs to regulate charitable
26
See p. 168, The Impacts of Gambling in Connecticut, Spectrum Gaming Group (prepared for the Division of
Special Revenue), June 22, 2009.
Commission on Enhancing Agency Outcomes G-1 Dec. 15, 2010 Final Report
Administration
Appendix G
SUMMARY SHEET
games. According to the division director, however, that has not occurred since, due both to the
slight growth in charitable games revenues and the streamlining of CGU.
Streamlining of CGU. The CGU budget for FY 09 was $1.6 million, most of which (73 percent)
was expended on costs for 20 staff positions. Effective July 1, 2010, under legislation enacted
during the 2010 regular session, all six field operations positions (responsible for inspections and
education/support) were eliminated, saving approximately $375,000 annually. Consequently,
CGU will now have limited training and educational services for permittees, and conduct on-site
inspections only when there are complaints.
Consolidation of CGU into other DSR Units. The DSR could further streamline operations by
folding CGU Licensing and Applications into DSR’s Security Unit, and CGU back office
functions into the DSR Administration Section (see figure below). This will create potential
annual savings by eliminating the currently vacant “Charitable Games Unit Head” position
(annual base salary range: $88,505-$113,525, median=$101,015).
Possible Consolidation of CGU into DSR

Currently in CGU Potential Consolidation:
• 1 Lic&ApplicsSupv Move to Security Unit and name “Charitable Games
• 1 SpecRevnGmblRegSupv Licensing”
• 4 Office Assistants
• 1 Administrative Assistant
• 2 Processing Technicians
• Fscl/AdminAsst Move to Fiscal Admin Office of Purchasing/General
• Storekeeper Services/Custodial (part of Administration Section)
Further consolidation. In 1990, DSR was organized, for administrative purposes only, as a part
of the Department of Revenue Services (DRS). A Thomas Commission report produced at that
time noted that DSR did not rely on DRS for administrative or operations support, and the
Executive Director of DSR served at the pleasure of the Governor, reporting directly to the
governor. The Thomas Commission recommended that DSR be given department status, which
would be consistent with its reporting responsibilities.
In an effort to reduce the number of state agencies or independent divisions, Connecticut could
return to the previous consolidation of DSR into DRS. CGU administrative hearings, for
example, could be folded into the DRS Legal Division, and the Charitable Games Unit into DRS
Taxpayer Services.
Alternatively, the charitable gaming portion of DSR could become the responsibility of the CT
state police, as was the case in CT from 1965 to 1987 (Charitable gaming is a responsibility of
state police in other states, including Rhode Island and Maine).
Commission on Enhancing Agency Outcomes G-2 Dec. 15, 2010 Final Report
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Appendix I
COMPARISON OF BILLS TO CONSOLIDATE ECONOMIC DEVELOPMENT AGENCIES
sSB 308 Aspects of Consolidation Profiles of Agencies Involved
PRI BILL Original bill consolidated CII and CDA • Agency. DECD is a state agency. Its mission is
into one quasi-public, the Connecticut to promote and attract businesses and jobs, revitalize
Economic Innovations Authority and neighborhoods and communities, and ensure quality
would transfer responsibility for direct housing and foster appropriate development.
financial assistance for businesses from
• Established. 1995 (As currently structured)
DECD to this new entity
• Executive. Commissioner and a Deputy
Commissioner.
Public Hearing. March 1, 2010.
Committee received testimony form DECD • Staff. Pre-RIP DECD had 139; now 116
indicating that this would fragment economic positions, many are in collective bargaining. Almost
development further, and that a broader all are General Fund positions.
approach with a single point of entry might • Board. DECD currently has no oversight
be preferable. DECD suggested reviewing advisory board. SB 308 would create a
the proposal in SB 160. Competitiveness Council to do that.
Status: At PRI JF meeting on March 11, • Agency. Connecticut Housing Finance

2010 voted to draft substitute language that Authority (CHFA) is a quasi-public agency, which
would broaden the consolidation to a full provides low-interest loans to first-time homebuyers,
merger of DECD, CDA, CII and CHFA. issues bonds to finance development of affordable
This would be a new Connecticut Economic housing in the state, and manage state housing assets.
Development Authority. • Established. 1969
• Executive. CHFA has one Executive Director.
 JFS to Floor.
• Staff. CHFA has 129 staff, not covered by
collective bargaining. CHFA staff are paid through
CHFA funds, not in state budget.
Purpose: Create one agency where • Board. CHFA has a 15-member board of
businesses could go for any economic and directors.
community development assistance. There
should be some though to a broker/case-
manager approach at the front end to ensure • Agency. Connecticut Development Authority
that businesses receive actual service, and are (CDA) is a quasi-public agency that provides
not just referred to another part of the financing to help businesses, sometimes in
authority. combination with private lenders but often when
business cannot obtain financing in the private
Benefits: Single service, one point-of entry sector.
Businesses could receive more • Established. 1973
individualized service if broker model is • Executive. CDA has a President and an
implemented. Executive Director.
Economies of scale in a merged agency. • Staff. CDA has 26 employees. All staff at CDA
Should not be the need for the same number are funded though CDA funding not through the
of executive, administrative and managerial state budget.
staff. • Board. CDA has an 11-member board.
Commission on Enhancing Agency Outcomes I-1 Dec. 15, 2010 Final Report
• Agency. Connecticut Innovations Inc. (CII) is

a quasi-public agency that provides financing and
other assistance to high-tech, innovative businesses,
especially in the early start-up phase.
• Established. 1989
• Executive. CII has one Executive Director.
Staff. CII has 25 employees, paid through CII funds
(state Bonds funds, and return on investments.)
• Board. CII has a 15-member board.
• Agency. CT Clean Energy Fund (CCEF) is to

increase installed renewable energy capacity;
promote clean energy technologies; and enhance
public awareness about renewable energy. Exists
under the umbrella organization of CII.
• Established. 1998
• Executive. CCEF has an Executive Director.
• Staff. CCEF has 19 staff. Funding for programs
and staff comes from a customer surcharge on
electricity bills.
• Board. CCEF has a 15-member board.
SB 160 –
 Commerce (Franz) SB 160
Proposed Bill
• Bill proposes one quasi-public that

combines DECD, CDA, CII, and CHFA.
• The bill has not been drafted.
 Commerce RSB 327

Commerce
RSB 327 This bill implements the same Involves some of the same agencies discussed
consolidation as the original PRI bill above, but not all.
SB 308, which would have merged
CDA and CII and transferred the
business development functions
from DECD to the new authority, the
Connecticut Economic Innovations
Authority.
Status: Public Hearing held March 2, 2010.

Still in Commerce Committee.
Proposed Bill 79
Introducers: Senators Roraback, Fasano and Profile of Agencies Involved
McKinney
DECD described above
 This bill proposes a broad,
comprehensive consolidation of many state Department of Labor (DOL). To assist both
agencies. One of those mergers would be workers and employers to become more competitive
DECD and the Department of Labor. in a global economy. Assistance to workers through
 Status: Bill has not been drafted; income support between jobs, protection on the job,
referred to GAE on 2/9/10. No hearing training and job search assistance. For employers,
access to workplace data and labor market
information, worker recruitment and training
assistance.
Established: 1873
Executive: Commissioner and one Deputy
Commissioners (currently deputy is Acting
Commissioner)
Staff: Pre-RIP was 783; now 715. Many of these are
in collective bargaining, and many are funded
through federal Employment Security
Administration Fund (administering unemployment)
Appendix J
Longevity Payments to State Employees
All state employees who have been with the state 10 years or more are statutorily required to
receive “longevity payments” twice a year. In 2009, about 35,000 unionized employees and
managers received such payments, although the number is likely smaller since the RIP. The
payments are required to be made on the last regular pay day of April and October. For state
employees who are in collective bargaining unions, the payments are also required in current
contract language.
For managers, the longevity payments are calculated as a percent of salary and are made twice a
year. The table below shows the payment percentages for the four different lengths of time an
employee has been employed with the state.
Longevity Payments for Managers – Twice a year

Years Percent of salary Range of payments
10-14 2% $413-$1,408
15-19 2.5% $826-$2,817
20-25 3% $1,238-$4,225
25+ 3.5% $1,651-$5,633
Source: Management Pay Plan: Longevity Schedule
For unionized employees, the amounts are flat amounts (not a percent of salary), and vary
depending on number of classes and salary groups in the bargaining unit, but the longevity
groupings by years are the same as for managers. Some typical payments are shown in table 2
below.
Longevity Payments for Unionized Employees – Twice a year

Years Range of Payments
10-14 $75- $499
15-19 $150-$533
20-25 $225-$1,497
25+ $300-$1,938
Source: Longevity Schedules from 3 Collective Bargaining Contracts
According to Office of State Comptroller information, the breakout of total payment in October
2009 (post-RIP) was:
Employee Status Number Total $ Amount

Bargaining unit employees 26,792 $11,841,885
Non-Bargaining 3,447 $6,494,067
Total 30,239 $18,335,952
Source: Office of State Comptroller Information
Thus, total costs annually for longevity are about $36.6 million. Payments for managers could be
terminated or suspended by statute, while it appears changes would have to be made to contracts
for unionized employees. Attached is a listing of the 13 collective bargaining contracts with their
expiration dates. Changes to the April 2010 longevity payments would have to be made by April
1, 2010.
Commission on Enhancing Agency Outcomes J-1 Dec. 15, 2010 Final Report
Calculation of Longevity into Retirement: Statutorily (Sec 5-154 (h)) longevity payments are
calculated into an employee’s “base salary” for retirement purposes.
Attachment
13 Current collective bargaining agreements and contract dates:
State Police – 2007-2010

Maintenance Workers – 2005-2008
Administrative and Clerical –2006-2009
Corrections Officers 2008-2011
Protective Services 2008-2011
Paraprofessional – Health- 2005-2009
Correctional Supervisors – 2205 2008
Professional Healthcare 2005-2009
Social and Human Services -2006-2009
Educational Administrators 2005-2009
Educational Professionals 2005-2009
Engineering, Scientific and Technical 2005-2009
Administrative and Residual -2007-2011
Source: Department of Administrative Services website.
Commission on Enhancing Agency Outcomes J-2 Dec. 15, 2010 Final Report
Appendix K
State Employee Compensation Compared to the Private Sector
Examined this in two parts: 1) overall average difference in compensation; and 2) difference in
monetary compensation in several selected positions.
PART ONE: OVERALL COMPARISON INCLUDING BENEFITS
State Compensation. First, in overall terms, the average state employee salary for 2008 was
$65,74627, which is a gross average using all payroll for all active SERS employees divided by
the number of active SERS employees, which covers most state personnel. The benefit package
value is costed-out below.28 In using 2008 as the year for calculations, it assumes an annual
payroll including payment of merit pay, all cost of living increases, etc., and prior to SEBAC
agreement imposing furlough days, pay freezes, etc.
Table 1. Average State Employee Compensation

Amount % of Salary
All monetary compensation -- Salary, longevity, overtime, merit $65,746
bonuses
Medical/Health Insurance -- Employer’s Share (89%) for subscriber + $12,173 18.52%
1 (POE) (Employee contribution $1,517 (11%)
FICA – Social Security $4,076 6.2%
FICA –Medicare $960 1.45%
Unemployment $190 0.29%
SERS – Retirement $22,353 33.99%
Value of benefits29 (and % of salary) $39,752 60.5%
Total Compensation Package for Average State Employee $105,498
Private Sector Compensation. In the private sector, staff used average private sector wage for
Connecticut in 2008 (CT DOL) and applied the same percentages for FICA (required by federal
law). Staff used the premiums for health care for employee plus one for CT. from Kaiser Family
Foundation30. Retirement benefits are based on results from CBIA 2008 survey of member
employers. Since most of the respondent businesses31 indicated they had a 401k, (defined
contribution plan) and the typical employer contribution was 85 percent of the first 6.2% of
salary, that is what is used for this analysis.
Table 2. Average Private Sector Employee Compensation

Amount % of Salary
All monetary compensation -- salary, overtime, merit bonuses $59,313
27
This is the average salary used in the FY 08 SERS valuation report, prepared by Milliman Actuarial Consulting.
28
This analysis does not place a value on more intangible benefits like number of vacation days, number of personal
days, number of sick days, or the ability to carry them over from year to year, or in cash-out value when state
employment terminates. Typically, for state employees, cash-out value would be the value of all unused vacation time
(up to a 120-day maximum) any time an employee terminates and 25 percent of all unused sick time (capped at 60
days), paid only at time of retirement, not other termination. The analysis does not place a cash value on severance
packages, more common at termination in the private sector.
29
The value of benefit package will be less for newer state employees who will be assessed a 3% of salary contribution
for retiree health care until they reach 10 years of employment (refundable if leave state service prior to 10 years)
Commission on Enhancing Agency Outcomes K-1 Dec. 15, 2010 Final Report
Medical/Health Insurance -- Employer’s Share (79%) for subscriber + $6,925 11.7%
1 employee’s contribution is $2,380 (21%)
FICA – Social Security $3,677 6.2%
FICA –Medicare $860 1.45%
Unemployment $409 0.69%
Retirement $2,990 5.0%
Value of benefits (and % of salary) $14,861 25%
Total Compensation Package for Average Private Sector $74,174
Employee
Difference in the two sectors. Therefore, the difference in average monetary compensation
between state employees and the private sector is not that great -- $6,433 – about 10 percent
higher for state employees. However, it is the difference in the cost of the benefit package
between the state and private employment that is substantial -- $14,861 in the private sector (or
about 25% of the average wage) versus $39,752 in state employment (or about 60% of the
average wage). The dollar value difference of the benefit packages in the two sectors then is
about $24,891 (or about 167% higher for state employees).
PART TWO: COMPARISON FOR SELECTED POSITIONS
Earnings comparison between state government and the private sector are from the Connecticut
Department of Labor 2009 wage data for 383 occupational titles. The data identify base wage
rates by occupation, including such things as cost-of-living allowances, guaranteed pay,
hazardous-duty pay, incentive pay including commissions and production bonuses, tips, and on-
call pay. Excluded are jury duty pay, overtime pay, severance pay, shift differentials,
nonproduction bonuses, employer cost of supplementary benefits, and tuition reimbursements.
CT DOL analysis of the data for the 383 occupational codes at five levels is shown in Figure 1
Figure 1. Comparison of Wages for 383 Occupations at
Various Percentiles Between State and Private Sector
400
300
State Wages
200
Private Sector
100
0
10th 25th Median 75th 90th
As the figure indicates, state wages were higher for more occupations at all levels, but at the 75 th
and especially at the 90th percentile, that tended to level out. Complicating this analysis, however,
is the fact that nonproduction bonuses are not reflected in compensation, and these types of
bonuses are more typically provided to higher salaried private sector workers. Similarly, overtime
pay is also not included which could have an impact on wages in both sectors, but more likely at
the lower levels.
30
These premium amounts and % contribution would be for all plans – both public and private -- and
therefore may be somewhat higher than for private sector plans alone. Supporting that is the information from a 2007
CBIA benefit survey indicating that the employer % of premiums covered was 62%
31
41% of CBIA respondents indicated they had a 401K plan, but only about 75% match employee contribution, which
is not reflected in the $2,990 figure.
Several occupations that would be used in both sectors were selected for wage comparison. They
are listed below. The median annual salary from the CT DOL compensation data were used,
except as noted in the table below. In general, with the exception of the information and
technology area, state salaries tend to be higher than those in the private sector.
Table 3. Compensation Comparison of Selected Positions Between State Employment and Private
Sector –2009
Private Sector State Employment
Health Care/Social Services
Registered Nurse $70,623 $70,263 ↔
Nurse Aide $26,863 $40,945 ↑
Child/Family Social Worker $47,709 $69,571 ↑
Information Technology32
Computer Systems Manager/Director $125,008 $127,822 ↔
Information Technology Operations Manager $111,877 $105,055 ↓
Computer Software Engineer $88,819 $76,770 ↓
Computer Database Analyst (senior 7-9 years) $90,654 $83,828 ↓
Clerical/Administrative
Executive Secretary/Admin Asst $45,905 $59,127 ↑
Payroll Clerk $41,152 $45,370 ↑
Paralegal $48,738 $56,485 ↑
Engineering
Civil engineer $75,364 $79.906 ↑
Plant Facilities Engineer (non-manager)33 $88,824 $90,932 ↔
Plant Facilities Engineer (manager) $89,824 $101,015 ↑
Director/Chief Engineering $116,375 $127,822 ↑
Business/Financial/Administrative
Accountant $66,320 $71,785 ↑
Fiscal/Administrative Manager $101,602 $105,724 ↑
Human Resources Manager $100,630 $100,712 ↔
Purchasing Agent $62,638 $76,676 ↑
Management Analyst $77,594 $75,217 ↔
Administrative Services Manager $75,669 $96,454 ↑
Education Administrator –Postsecondary $84,920 $122,670 ↑
32
For most of the occupations in the information technology and engineering areas (exceptions are the computer
software engineer, and civil engineer), staff used compensation data from the state compensation plans compared to
Economic Research Institute (ERI) data for similar job descriptions, as the CT DOL data was more generic and
contained no specific job descriptions.
33
7 Similarly, the plant facilities engineering positions and director of engineering data were taken from the state current
compensation plans and Connecticut Business and Industry Association survey and ERI data, and not CT DOL data.
The positions are for more specific classes than the DOL data offers.
Appendix L
Connecticut Retirement and Pension Summary
Benefit payments. Annual retirement benefit payments currently total more than $1.2 billion annually. (These do
not include cost-of-living adjustments – two since FY 08).
Table 1. Current retirees: When retired, Average Salary and Total Benefit Payments and COLA Adj.
When Retired Number Average Total $ COLA on Pension: Annual wage
6/30/08 Retirement Annually adjust. on all retirement wage
Salary (000) FY 08
Pre-1980 2,750 $15,710 $43,202 5%
1980-1997 20,480 $26,855 $549,998 3%
1997 and after 14,863 $30,564 $454,278 Choice of 3% or formula below,
except after June 30, 1999 formula
below
2009 (RIP) 3,898 $45,700 $168,861 Formula -- 2.5%-6% depending on
(FY 09) CPI
Total 41,991 $28,966 $1,216,339
Sources: FY 2008 SERS Actuarial Report and the Office of State Comptroller for 2009 RIP Data
Overall, Connecticut’s state retiree benefits are generous. Comparison Nationally 200834: Private Sector -- $13,222
Public Sector --$24,147
When Hired # of Current Average Salary Employee Age to Retire

Employees (June 2008) Tier Contribution (Generally)
(Pre-tax)
Pre-1984 353 $98,028 Tier I – 4% to Social
Hazardous Security Any -20 years
Duty Taxable Wage of service
Base plus 5%
earnings above
Pre -1984 6,512 $84,987 Tier 1 (plan B 2% to 5% of 55
or C) earnings
depending on
Social Security
participation
1984-1997 5,400 $80,282 Tier II 4% Any (20 years
Hazardous of service)
1984 -1997 16,924 $71,670 Tier II 0% 60
1997 and 5,692 $59,516 Tier II –A 5%
after Hazardous Any -20 years
of service
1997 and 18,315 $50,623 Tier II-A 2% 62

after
Not date- 9,800 Unknown Alternative 5%
driven; Retirement
primarily in Plan
higher
education
Sources: 2008 Milliman Actuarial Report of SERS and other Office of State Comptroller Information
34
Employee Benefits Research Institute. Figure 5 Mean Annual Income from Pensions and Annuities in Constant 2008 Dollars
for Population Over 50. May 2010 Notes, Vol. 31. No 5., p. 17
Commission on Enhancing Agency Outcomes L-1 Dec. 15, 2010 Final Report
Retiree Health Care Costs. In FY 09, actual expenditures for retiree health care costs totaled almost $435 million,
and estimated to be more than $542 million in FY 10. The table below outlines the monthly premiums for
current retiree health care benefits. The retiree health plans have the same coverage, co-pays and benefit structure as
those for active employees. By comparison, monthly premiums for active employees are generally between $105
and $220 for subscriber+1, depending on plan chosen. (Approximated since payments are made each pay period;
most expensive plan which is about $500 a month, closed after 2009 SEBAC agreement).
Table II – CT Retiree Health Insurance Benefits

When Retired Post-retirement healthcare premiums (monthly)
Pre-1980 $0
1980-1997 $0
1997-1999 $0 for most plans
1999 and after Depends on plan -- $0 for many plans –others vary
typically about $30 a month for 2 not on Medicare
Until 2009, all payments for retiree health care were made on a pay-as-you go basis. However, as part of
the 2009 SEBAC agreement, employees with less than five years of state service must pay 3 percent of
their salaries for 10 years into a fund for their post-retirement health care (refundable if the employee
leaves state service before 10 years.)
Comparison on Contributions to Pension: Only 7 states have required employee contributions equal to
Connecticut’s current 2% or below; five of those states require no contributions from employees.
ISSUES
Unfunded liability or legacy costs: The employer contribution rate for SERS is currently 24.96% of
state payroll, or $944 million. However, of that, 15.96% of payroll ($603m) is funding the unfunded
portion of current retirees (because of prior unfunded or underfunding pension payments), while about
9% of payroll ($341m) is funding for current employees. This does not include payments for retiree
health care benefits, which are currently on a pay-as-you-go basis, and in FY 10 is about $542 million
annually for current retirees and their dependents. Also, this does not include funding for employees in
the alternative retirement system – which includes approximately 9,800 employees – and in FY 10 the
state’s contribution was $33.4 million.
It is important to note that only about 1/3 of the current annual retirement contribution (ARC) is for
current employees, while 2/3 of the ARC goes for retirees. However, the unfunded liability may continue
to grow if underestimating the payments required to pay for future retirees occurs. This may be likely for
a few reasons:
 Connecticut’s actuarial estimates of investment income are among the highest of any state’s
pension plan – 8.25%. Only six other states had the same estimate; only three had higher (8.5%)
compared to about 7-7.5% nationwide35; without investment returns that closely match estimates,
the unfunded liability will grow.
 Connecticut’s 2008 funding ratio36 was slightly less than 52%, meaning that only a little more
than half of estimated obligations (at present value) were being funded – only Illinois was less at
35
Wisconsin Legislative Council. 2008 Comparative Study of Major Public Employee Retirement Systems.
36
Funding ratio is ratio of two numbers – the value of benefits earned compared to the value of assets to support the
benefits
46%; Since the economic downturn, the actuarial assessment of the funding ratio is now in the
mid-40% range;
 Assumptions on wage inflation (4%) may be too low. According to the June 2008 actuarial
valuation report, the compensation for active SERS had increased from $3,107.9 billion in FY 06
to $3,497.4 billion in FY 08, an increase of 12.5% in two years alone. If state employee wage
inflation is looked at over a longer period, (between FY 00 and FY 10) state payroll has grown at
a greater rate than 4 percent (compounded) a year. Given the payroll amounts, even a small
fraction of a percent difference can be important.
 The contribution levels from current employees cited above, the relatively optimistic interest rate
assumptions, and low wage inflation assumptions raise questions as to whether the state
retirement system is chronically underfunded, not just because of prior liability but also because
current funding does not adequately cover the current and future benefit obligations.
The commission consulted reports such as the Pew Center on the States’ report entitled State Pensions
and Retiree Health Benefits: The Trillion Dollar Gap, (February 2010), which cites Connecticut as being
one of eight states with more than one-third of total pension liability unfunded. It seems clear based on
the PEW study and other reports that Connecticut’s pension fund and its future financial stability
is a matter of great concern.
SPECIFIC CONCERNS WITH CONNECTICUT’S SERS PENSION PLAN
A great number of current employees (about 14,000 TIER II post-RIP) make no contributions to
their pension plan. While Tier II-A employees do contribute, the 2% is also low compared to other
states. Based on estimated payroll data of about $1 billion for Tier II, $10 million could be generated for
every 1% of employee contributions (prior to investment returns).
There is no cap on the retirement salary a retiree can be paid -- either by amount or by percentage of
final average salary. (CT Teachers’ Retirement has a cap of 75% of FAS). Connecticut does have a cap
in the calculation of the FAS, which is no one year of the three-year calculation can be more than 130%
of either of the other two. The two factors may contribute to retirement salaries increasing.
The average retirement salary for the 2009 RIP is over $45,000 as shown in Table 1. This is more than
$15,000 greater than the average of those retiring after 1997 but before June 2008 (date of last actuarial
valuation).
The COLA adjustments are generous compared to other states. Connecticut’s COLA adjustment is a
minimum of 2.5% (or 60% of CPI up to a cap of 6%) of total retirement salary annually. Since 2000, the
2.5% threshold has always been greater than 60% of CPI, and in 2010, the CPI actually decreased (- 0.4).
Most states do not have a minimum % COLA, but rather use CPI with a max. Massachusetts, Rhode
Island, and New York also cap the amount of retirement income the COLA applies to (e.g. the first
$15,000) rather than the total amount. Other states have a waiting period before a retiree begins receiving
a COLA adjustment; Connecticut does not. On the other hand, some states (e.g., MA and NY) exempt
retirement benefits from state income tax, while Connecticut does not.
While COLA adjustments of 1% above or below CPI may not seem considerable, on annual retirement
payouts of $1.2 billion, 1% is $12 million. Further, when there is a minimum COLA, in a year like 2010
when CPI actually declined, the COLA payments of $30 million are adding to the base payout – in the
payout year and for years to come -- but for non-existent inflation. Further, Social Security recipients
have not received a COLA increase in two years. Most active Connecticut state employees did not receive
a COLA adjustment in FY 09 and many did not for either FY 09 or FY 10.
The percent of active members in hazardous duty is increasing. Overall the percent of employees in
hazardous duty employment as of June 2008 was 11,445, which was 21.5% of SERS active membership.
This is in contrast with 3,306 hazardous duty retirees, which is only 13.7% of retirees. This may have
implications for future retirement costs and liability: longer time in retirement; COLAs over a longer
period, and more difficult final average salary to predict because of overtime.
Further, the average annual benefit paid in FY 08 to regular SERS retirees ages 60 to 64 was $36,467,
while the average benefit paid to those hazardous duty retirees in the same age category, the average
annual benefit was $47,273, a more than $10,000 difference.37 The difference in annual average benefits
between the two groups is even greater at younger ages, and the average annual retirement payment
difference between the two groups overall was more than $15,000.
Other than increasing employee contributions, actual retirement provisions for hazardous duty employees
have not changed over time: 20 years to retire at half the FAS which is the final average salary38; method
of calculating the FAS which includes overtime39. Studies and reports have found that the use of overtime
can be a salary “spiking” issue.
EFFORTS AT REFORM
Pursuant to Executive Order 38, a Commission on State Post-Employment Benefits was established in
February 2010. The commission completed its work, issuing a final report on October 28, 2010. The
Executive Summary of the report is attached. The full report can be accessed at
www.ct.gov./opm/lib/opm/secretary/opeb
37
Summary Statistics (p.47) from FY 2008 SERS Valuation Report
38
Final average salary for SERS is 3 highest-paid years, including overtime and longevity
39
New York Times, July 7, 2010. Cuomo Finds Pattern of Workers’ Inflating Pensions
Appendix M
Direct Deposit/Electronic Pay/Advice Statements
Connecticut state government issues payments to: state of Connecticut employees and retirees, the
unemployed (through unemployment insurance payments), and state workers injured on the job
(worker’s compensation payments). The CT Department of Labor processes unemployment
insurance, and a third party administrator processes workers’ compensation payments; each of the
latter processes issue paper checks only and electronic deposit payments are currently not an option.
Current Usage of Direct Deposit: The number of persons getting paid in one of 152 distinct state
departments ranges from one (e.g., Board of Firearms and Permits) to 12,779 (e.g., University of
Connecticut). Although 81 percent of all CT state employees use direct deposit, the percent varies
widely across individual departments, agencies or commissions, from a low of 47 percent (Military
Department) to a high of 100 percent (e.g., State Elections Enforcement Commission, CT Siting
Council).
CT State Employees: Direct Deposit vs. Paper
Checks
Paper Check
14,213
(19%)
Direct Deposit
62,386 (81%)
Below are the highest and lowest direct deposit participation rates for employees in larger
agencies/departments:
Percent at Larger Agencies/Departments Using Direct Deposit
Department or Agency Total # Paid % Direct Deposit
Southern CT State University 2,599 68%
Bureau of Highway Operations 1,464 70%
Dept of Children and Families 3,560 90%
Department of Social Services 1,929 91%
Source: Office of State Comptroller
Paperless Systems. Regardless of whether the person is paid through direct deposit or paper
check, CGS Sec. 31-13a requires that each employee must be furnished with a written record of
hours worked with each wage payment (i.e., payroll remittance advice or payroll warrant report).
The Commission on Enhancing Agency Outcomes is considering a change to all electronic/direct
deposit for current state employees, with the choice to “Opt Out” and request a paper
check/paper advice. The commission is also considering a change to all electronic/direct deposit
for retirees, with a similar choice given to “Opt Out” and request a paper check/paper advice.
Examples of states or organizations that have chosen a paperless payroll system and eliminated
paper checks and/or paper payroll remittance advice reports include:
Commission on Enhancing Agency Outcomes M-1 Dec. 15, 2010 Final Report
• Ohio State University uses a paperless system for all paychecks and pay stub information.
All faculty, staff and student employees receive their pay stub information online or via
touch-tone telephone using an interactive voice response (IVR) system.
• Wal-Mart estimates the cost of producing paper checks to be 70-79 percent more expensive
than direct deposit or payroll cards. Wal-Mart recently shifted to a paperless payroll system.
• Massachusetts gives state employees the option of suppressing the printing of payroll
remittance advices. As of February 2010, a total of 95 percent of 88,268 employees across
151 departments chose direct deposit, with 36 percent of direct depositors (30,127
employees) opting to suppress pay advices, a figure which has been increasing since the
option was initially introduced at several state agencies (see graph below) (Employee’s pay
advice information is available a full day earlier than paper and can be accessed at any time
through the internet).
100%
90%
80%
70%
60%
50%
40%
36%
30%
20%
10% 7%
0%
Nov '07 Nov '08 Nov '09 Feb '10
Costs Associated With Direct Deposit/Electronic Advice Statements
Table 1 shows the estimated costs associated with the different forms of payment (paper or direct deposit)
and advice statements (paper or electronic).
The figures apply cost estimates from the Connecticut Department of Labor for the distribution of
Unemployment Insurance (UI) payments to the payments provided to current employees and retirees.
[Note that within the next few months, the current UI paper check processing system will be converted to
an electronic payment system.]
Table 1. Costs Associated with Form of Payment and Advice Statements

Activity/Expense Estimated Cost Per Type of Payment
Paper Check/ Direct Deposit/ Direct Deposit/
Paper Advice Paper Advice Electronic Advice
Bank Cost Per:
Check 9¢ 9¢
Direct Deposit 3.3¢ 3.3¢ 3.3¢
Postage 37.5¢ 37.5¢ 37.5¢
Printing/inserting costs 4.3¢ 4.3¢ 4.3¢
Check/envelope stock costs 3.9¢ 3.9¢ 3.9¢
Total Cost If Mailed 54.7¢ 49¢ N/A
Total Cost If NOT Mailed 17.2¢ 11.5¢ 3.3¢
Source of Data: CT DOL
The Office of the State Comptroller did not have a figure on the additional expense to change to an all-
electronic pay/advice system. However, there are anticipated initial costs to implement the relevant
CORE-CT module, e-Pay, make system modifications, and provide accessibility and training for all
employees.
Possible Scenarios
According to the Office of the State Comptroller, there are approximately 76,699 state employees (82
percent of them are on direct deposit) and 36,000 state retirees (80 percent of them are on direct deposit).
No employees or retirees receive advice statements electronically.
Based on the costs described in Table 1 and the participation levels experienced by Massachusetts,
possible savings associated with a greater participation level in direct deposit and introduction of
electronic advice statements are shown in Table 2. If 95 percent of employees and retirees received direct
deposit, and 20 percent received advice statements electronically, there would be an annual savings of
$180,257 based on banking, postage, and printing cost reductions alone; savings from reduction of
positions determined unnecessary by this change is currently unknown.
Table 2. Possible Direct Deposit and Electronic Advice Scenarios

Scenario Annual Cost Annual Savings from
Current
A. Possible Scenarios for Employee Payment/Advice (N=76,699)
Currently: 18% Paper Check/100% Paper Advice $249,790
Potentially: 5% Paper Check/100% Paper Advice $235,013 $14,777
B. Possible Scenarios for Retiree Payment/Advice (N=36,000)
Currently: 20% Paper Check/100% Paper Advice $216,605
a
Per Office of the State Comptroller 3/12/2010.
Note: Assumes 26 bi-weekly payments for employees and 12 monthly payments for retirees.
Note that the Office of the State Comptroller is looking to put together a project team to implement
mandatory direct deposit for retirees, including the elimination of advice (or sending advice only when
there is a change).
Reponses to questions posed by the commission are found on the next page.
Question: Answer: Possible Actions:
1) Does the federal government No. There is no federal requirement • Eliminate requirement from
require employers to furnish that employees receive written Connecticut statute (Sec. 31-
employees with written records statements of earnings with each 13a)
of hours worked (i.e., Payroll wage payment (see Fair Labor
Remittance Advice Reports)? Standards Act)
• Provide Advice/ earnings
statements electronically
2) Does SEBAC agreement Yes. Although there is no reference • Negotiate with SEBAC for
require direct deposit to be to direct deposit in the SEBAC mandatory direct deposit
optional? agreements, a change to requiring
• Make direct deposit
direct deposit would have to be
negotiated, as it is considered a
mandatory for all new hires
change in working conditions. (does NOT require
negotiation)
3) From what system are Retirees are paid through the • Make direct deposit/pay
retirees paid? Are all retirees on Retirement Payroll System in the cards mandatory for all
direct deposit? Office of the State Comptroller current retirees
Retirement Division.
(Note: Retirees are not
• Make direct deposit/pay
represented by SEBAC, and a Retirees are given a choice of cards mandatory for all new
change to mandatory direct either direct deposit or paper retirees
deposit would not require checks for their payments (77-80
negotiation with unions) percent are on direct deposit)
4) Are students who are Yes. Approximately 55 percent are • Make direct deposit/pay
attending one of CT’s public currently on direct deposit; cards mandatory for all
colleges offered direct deposit? however, the figure varies from students
college to college (e.g., 40% at
• Initial college administrator
WCSU vs. 70% at CCSU)
response very positive
5) How is Unemployment • By paper check • 10-yr contract signed April
Insurance paid? • DoIT prints all checks 2010 with JP Morgan Chase
• Vendor folds and stuffs to implement direct deposit
envelopes and debit cards for U.I. by
• “Advice” only provided on line August 2010
• CTDOL currently • Projected savings of $3.6
implementing direct deposit million annually from
for U.I. postage alone
6) Can fees be waived for state No. According to state Banking
employees using direct deposit? Dept. this would unlikely be
enforceable: would interfere with
regular commerce of banking;
would not apply to any non-state
chartered financial institution; and
if placed as a requirement on
bank(s) the state draws its checks
on, could not require a state
employee to bank there.
APPENDIX N
SUMMARY SHEET
State Employee Time and Attendance Records
The Office of the State Comptroller (OSC) is responsible for maintaining time and attendance
records for state employees in most state agencies. The exempt agencies are the University of
Connecticut, the UConn Health Center, the Office of Legislative Management, and the Judicial Branch.
The OSC uses CORE-CT as its automated time and attendance record system and ultimately all
employee records for the included agencies are inputted into the system for payroll. However, there are
three methods by which individual agencies enter, record, and maintain their employees’ records before
they are entered and maintained in the CORE-CT system. Those three methods are:
 Electronic – Using a module available in CORE-CT, an agency employee electronically

enters his/her time and attendance data, a supervisor approves it electronically, and it is then
submitted to CORE-CT.
 Interface – Time and attendance records are collected and entered into a system, known as a
Time Collection Device (TCD), which ultimately interfaces electronically with the CORE-CT
system. The Time Collection Device system can either be a homegrown one developed by
the agency or a commercial product (Atlas software is an example).
 Timekeeper – Typically, the employees in agencies using this method are recording their
time and attendance on paper time sheets that are then approved by the supervisor and entered
into a file or CORE-CT by a clerical or data entry staff person.
At this point, there is no compiled information on which agencies are using which method; even
within one agency, staff may not all be entering their time and attendance the same way. Thus,
commission staff has not yet determined the extent that paper records are still being used in state
agencies, but will continue to develop information in this area. One obstacle cited to moving away from
paper records is that not all agency staff has access to computers to electronically enter time.
Commission staff contacted the Connecticut Community Providers Association (CCPA), whose
member agencies provide services at many locations in the community, similar to state agencies that have
24/7 shift coverage, like the Department of Developmental Disabilities and the Department of Mental
Health and Addiction Services. CCPA officials indicated that they do not believe any of CCPA members
maintain paper time and attendance records, but instead use a variety of electronic ways to record time,
including:
 a finger swipe method where data from the finger swipe goes directly into the agency payroll
system;
 a card swipe system, where each site or program has a swipe machine that the employee swipes
when they begin and end work; or
 an automated telephone system at the site or program that the employee calls in using a password
and the information is logged into the agency’s payroll system.
Commission on Enhancing Agency Outcomes N-1 Dec. 15, 2010 Final Report
Information will continue to be developed on the number of staff in agencies devoted to payroll and
time record keeping, differences among agencies using different methods, and the potential for savings if
all agencies used electronic recording and maintenance of time and attendance.
APPENDIX N
SUMMARY SHEET
State Employee Time and Attendance Records
The Office of the State Comptroller (OSC) is responsible for maintaining time and attendance
records for state employees in most state agencies. The exempt agencies are the University of
Connecticut, the UConn Health Center, the Office of Legislative Management, and the Judicial Branch.
The OSC uses CORE-CT as its automated time and attendance record system and ultimately all
employee records for the included agencies are inputted into the system for payroll. However, there are
three methods by which individual agencies enter, record, and maintain their employees’ records before
they are entered and maintained in the CORE-CT system. Those three methods are:
 Electronic – Using a module available in CORE-CT, an agency employee electronically

enters his/her time and attendance data, a supervisor approves it electronically, and it is then
submitted to CORE-CT.
 Interface – Time and attendance records are collected and entered into a system, known as a
Time Collection Device (TCD), which ultimately interfaces electronically with the CORE-CT
system. The Time Collection Device system can either be a homegrown one developed by
the agency or a commercial product (Atlas software is an example).
 Timekeeper – Typically, the employees in agencies using this method are recording their
time and attendance on paper time sheets that are then approved by the supervisor and entered
into a file or CORE-CT by a clerical or data entry staff person.
At this point, there is no compiled information on which agencies are using which method; even
within one agency, staff may not all be entering their time and attendance the same way. Thus,
commission staff has not yet determined the extent that paper records are still being used in state
agencies, but will continue to develop information in this area. One obstacle cited to moving away from
paper records is that not all agency staff has access to computers to electronically enter time.
Commission staff contacted the Connecticut Community Providers Association (CCPA), whose
member agencies provide services at many locations in the community, similar to state agencies that have
24/7 shift coverage, like the Department of Developmental Disabilities and the Department of Mental
Health and Addiction Services. CCPA officials indicated that they do not believe any of CCPA members
maintain paper time and attendance records, but instead use a variety of electronic ways to record time,
including:
 a finger swipe method where data from the finger swipe goes directly into the agency payroll
system;
 a card swipe system, where each site or program has a swipe machine that the employee swipes
when they begin and end work; or
 an automated telephone system at the site or program that the employee calls in using a password
and the information is logged into the agency’s payroll system.
Information will continue to be developed on the number of staff in agencies devoted to payroll and
time record keeping, differences among agencies using different methods, and the potential for savings if
all agencies used electronic recording and maintenance of time and attendance.
APPENDIX O
SUMMARY SHEET
Reduction In Printing
Business Entity Filings
The Secretary of State (SOS) is responsible for maintaining the commercial records and annual
reporting of all business entities, including domestic and out-of-state stock and non-stock corporations,
limited partnerships, limited liability companies, and limited partnerships. There are currently 365,000
such entities that are required to file and annually report to the Secretary of State. This process for the
most part is all done by hard copy and regular mail.
File 634 of the 2010 session40 (HB 5427 as amended,) would have:
 allowed the SOS to establish a timeline for when the annual reports are due (rather than using the
anniversary date of the original filing); and
 changed the annual report filing from a paper process, where the SOS sends a paper copy of the
most recent information with space for any changes, to a process that is almost entirely
electronic.
In the first year of the transition the SOS would send postcards alerting businesses that the annual
report filings were due, with future notices sent via e-mail. Entities would then file their reports
electronically. A hardship exception might be granted for small businesses that might not have the
capability of filing electronically. It is anticipated that about 15,000 of the total business entities might
not file electronically.
The Secretary of State’s Office estimates the change would save the state about $140,000 in the first
year of implementation and up to $240,000 annually thereafter. This is for hard costs alone – paper,
envelopes, and postage, and does not include the costs of staff time in stuffing envelopes, and entering
the data in the system once the hard copies are returned. According to the SOS, it also does not include
the costs of returning incomplete hard copies to the entity. The system’s planned design would not allow
the electronic submission unless it was complete, which would also add savings.
Other Printing Requirements
File 634 also would have eliminated other printing (and certification) requirements through:
 eliminating the requirement for the Secretary of State to distribute specific numbers of favorably
reported bills to certain entities (bills are available online);
 removing the requirement that the SOS send by certified mail notices to legislators of special and
reconvened sessions of the General Assembly;
 eliminating the requirement that the SOS distribute to towns and Superior Court clerks, printed
copies of each public act; and
 removing the requirement to certify to the Treasurer and Comptroller the amount and purpose of
each legislative appropriation.
OFA estimated the savings to the Office of Legislative Management would be $48,000 annually and to
the Secretary of State’s office, $7,000 annually, or a total annual savings of $55,000. In testimony on the
bill, the SOS estimated a total savings of $100,000 annually.
40
File 634 passed the House on 4/21/10, but was not acted on in the Senate before the end of the 2010 session.
Commission on Enhancing Agency Outcomes O-1 Dec. 15, 2010 Final Report
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Appendix Q
SUMMARY SHEET
State Agency Regulations Online
Background
State statutes often require or authorize state agencies to adopt regulations to provide
further detail about how the pertinent statutory program or policy is to be actually implemented.
Once approved in accordance with Connecticut’s Uniform Administrative Procedures Act
(UAPA), state agency regulations have the force of law, like statutes. Connecticut state statutes
have been available on line at no cost to the public on the state legislature website for several
years. However, the state agency regulations that interpret and flesh out these statutes are not
publicly available on line.
Per the UAPA, the Secretary of the State (SOS) is the official repository of state agency
regulations—the office is to keep a “permanent register” of the regulations open to public
inspection. An agency with approved regulations41 must submit two certified copies of the
regulations to the Secretary of the State’s office, in the form intended for publication. The
Secretary of the State’s Office is not responsible for publishing, printing, or distributing the
regulations, though. By statute, after receiving the approved regulations, the SOS sends one
copy for publication and distribution to the Commission on Official Legal Publications (COLP),
which is within the Judicial Branch.
The vast majority of what COLP produces is court-related documents (e.g., court
decisions and court rules of practice). In addition, COLP is required to publish a number of
different items related to state agency regulations, as submitted to it from both state agencies and
the SOS.
■ Notices of intent: COLP publishes the notices of intent to promulgate regulations

that agencies are required to submit directly to it, in order to give the public and other
interested parties a chance to comment. These are published in the Connecticut Law
Journal (CLJ), which is a statutorily mandated official journal of notice and record
issued weekly (that also prints state court decisions, among other items).
■ Text of approved regulations: COLP is also required to publish in the CLJ at least
monthly the text of the approved regulations submitted to it by the Secretary of the
State during the preceding month.
■ Compilation of all state agency regulations: COLP publishes and distributes a
compilation of all effective state agency regulations—this publication may be a
supplement to or a revision of the most current compilation, at least semi-annually.
Official state agency regulations are contained in 18 binders, arranged by the order of
the statutes.
Judicial Branch information indicates that these regulation publication functions cost
$34,112 in FY 2010 (see table below). COLP charges for copies of the final regulations. A
complete set of regulations in 18 binders currently costs $714.00, and an annual subscription to
keep the binders up to date is $87.00.
41
Proposed agency regulations must be submitted to the Attorney General’s Office for a legal sufficiency review
and the Connecticut General Assembly’s Regulations Review Committee for approval.
Commission on Enhancing Agency Outcomes Q-1 Dec. 15, 2010 Final Report
Appendix Q
SUMMARY SHEET
Connecticut State Regulation Availability: Accessibility and Transparency Problem
The concern about the lack of public availability of state agency regulations online is not
based on cost-savings, but rather on government accessibility and transparency. Relatively
speaking, Connecticut state government is not spending a lot of money publishing its regulations,
as indicated by the table below. (The cost of the process prior to publication, both direct and
indirect, is a different matter for exploration). Most other states have their regulations publicly
available on line, either in PDF or HTML. A major impediment in Connecticut is that COLP
uses a typesetting system that is apparently not easily convertible to language need to put the
regulations on line with search capabilities. It should be noted that some people can currently
access Connecticut state regulations online, if they subscribe to a commercial legal database. (A
commercial publisher can now purchase very basic electronic regulation files from COLP, which
a publisher may use to create a searchable, online database that is packaged with numerous other
legal databases.)
Attempts have been made to establish a publicly available online regulation database or
at minimum require agencies to publish their regulations on their websites. Most recently, in
2008, proposed legislation called for the Department of Information Technology, in consultation
with COLP, to develop a computer program that would enable each state agency to post
regulations on its website. Envisioning this would involve creating an on-line searchable
database of state agency regulations, the fiscal note estimated a one-time cost of between
$100,000 and $250,000, with an ongoing annual cost to DOIT of $50,000. These proposals
failed.
In some states, publicly accessible online regulations are provided without cost by a
commercial publisher that is otherwise producing some other legal publications for the states.
Since 2005 in New Jersey, for example, a commercial publisher, LexisNexis, puts the state
agency regulations online in a publicly accessible way at no cost as part of its contract with New
Jersey to publish the official state agency code for which LexisNexis charges. The contract
between LexisNexis and New Jersey requires LexisNexis to pay for licensing and royalty fees to
the state. (From 1976 to 1995, the New Jersey Office of Administrative Law published the state
regulations and register in house.)
The lack of easily accessible state agency regulations in Connecticut may be symptomatic
of a larger issue of how the state regulation-making process works in general and who is or
should be responsible for the process, questions that would require more review. For example,
although the UAPA requires agencies to submit approved regulations to the SOS “in the form
intended for publication”, more than one person connected to the process commented that many
“final” regulations needed more work to get them prepared for publication. Also, much of the
regulation review process still involves paper copies. Finally, all regulations are not alike in
terms of complexity, and development and drafting many regulations is not an easy task. Some
agencies may struggle more with regulation drafting than others.
Recommendation
Appendix Q
SUMMARY SHEET
1. Transfer the responsibility of publishing state agency regulations from COLP to the
Secretary of the State’s Office (notice of intent and final approved). The Connecticut Law
Journal may still be used for notices of intent through an agreement between SOS and the
Judicial Branch.
2. Seek RFPs from commercial publishers to handle the publication of regulations for
subscription sales and include requirement that a searchable online data base be made
available.
3. Conduct further review of the state agency regulation development and approval
process.
In FY10, the Judicial Branch spent $34, 122.19: 1) to publish proposed and final regulations
for mandatory notice purposes in the CT Law Journal, and 2) to produce and distribute final
supplements for the regulation binder sets.
Law Journal Costs (for 720 pages) (5.21 % of all Law Journal Pages (13, 812)
Element Cost Detail
Typesetting $5,141.76* (208 hours per year)
Editorial $8,827.00* (260 hours per year)
Other Production $4,788.60 Supplies (ink, plates, sheets)
Labor
TOTAL $18,757.36
Supplements for Regulation Cumulative Costs (avg. 1100 pages per years)
Element Cost Detail
Typesetting $3,955.20* (160 hours per year)
Editorial $7,265.60* (160 hours per year)
Other Production
For Supp. #84 $689.01 Supplies (ink, plates, sheets)
Labor
For supp. #85 $1,466.02 Supplies (ink, plates, sheets)
Labor
Subscription Mailing $1,989 188 subscriptions at $11.00 each
TOTAL 15,364.83
GRAND TOTAL $34,122.19
* average
Source of Date: Judicial Branch
Appendix R
Reverse Auctions (#17)
Background. A reverse auction is a purchasing tool with which a buyer seeks the lowest price
for what is being bought through an online bidding process. In contrast to a paper-based bid, in
which the bidder makes a best-guess offer that is static throughout the competitive bidding
process, in online, real-time reverse auctions, a supplier can re-evaluate and adjust its bid in
response to offerings from other bidders.
With access to real-time information, suppliers can quickly respond to competition and submit a
lower bid. Bidder identity is shielded, which ensures sealed-bid integrity is maintained
throughout the event. The auction itself typically takes 30-60 minutes. Once the procurement
event is completed, the buyer:
• evaluates the bids, weighs other variables to be considered; and

• either makes the best value award or declines to make an award.
Connecticut experience. Towns had not participated in reverse auctions before 2008
legislation (P.A. 08-141) authorized it. Since May 2009, approximately five reverse auctions
have been held for a number of towns (one reverse auction was for 40 towns through
Connecticut Conference of Municipalities) for items such as laptop computers and street-
sweepers.
Orbis Online was selected by CCM through competitive bidding process as the vendor to
operate reverse auctions, as it has the experience and the necessary online systems. The reverse
auction vendor is paid by the seller (successful bidder) – through a fee contained in the bid; the
purchaser does not pay the online vendor.
According to staff at CCM, reverse auctions work best for standard items where current pricing
can be obtained upon which to judge the auction bids. Experience with reverse auctions
indicates that savings of 25 percent off typical pricing (of standard items) can be realized.
This level of savings was also confirmed to CEAO staff by the Connecticut Association of
Purchasing Management, which represents 600 professionals involved in procurement in
Connecticut and promotes more efficient ways of purchasing.
State agency use of reverse auctions has been very limited. CEAO staff has determined that to
date only OPM/DAS (combined) have used the reverse auction process to purchase electricity
and natural gas for the state. The vendor (i.e., reverse auction operator) is World Energy. This
vendor is also paid by the successful seller, so the state incurs no costs for that. Reverse auctions
for purchase of electricity are run about every 18 months and once a year for natural gas. In
discussions with OPM, the agency believes reverse auction for energy has saved the state about
20 percent in energy costs. However, because energy costs keep rising (and there has been
little done to reduce state energy use) the state still spends about $200 million for energy. (See
Energy Efficiency proposal).
Commission on Enhancing Agency Outcomes R-1 Dec. 15, 2010 Final Report
APPENDIX S
Commission on Enhancing Agency Outcomes S-1 Dec. 15, 2010 Final Report
Commission on Enhancing Agency Outcomes -
S-2 Dec. 15, 2010 Final Report
S-13
Commission on Enhancing Agency Outcomes T-13 - Dec. 15, 2010 Final Report
S-14
S-15
Appendix T
Fully Implement Drug Recycling Programs
What is the Drug Recycling Program? Implemented initially as a pilot program in January 1998 (P.A. 97-
2), and subsequently as a mandatory program (P.A. 00-2), the drug recycling program requires long term
care facilities (and correctional facilities) to return unused non-controlled medications to vendor
pharmacies, with the CT Medical Assistance Program then receiving credit for the returned medication.
Medications must be sealed in individually packaged units and be least three months away from their
expiration dates. The pharmacy that dispensed the prescription receives a $5.00 return fee.
What efforts have been made to encourage participation in the drug recycling program?
• DSS reports extensive outreach to nonparticipants including meeting in 2003 with provider
associations to clarify policies and program procedures and address any issues.
• Any nursing home not participating in the drug return program may be fined up to $30,000 for non-
compliance (CGS Sec. 17b-363a(f)). To date, no nursing home has been fined.
Who is not yet participating in the drug recycling program?
• DSS tracks program participation monthly (reports unavailable to PRI due to DSS concerns with
inconsistencies in the data provided by Medicaid MIS contractor Electronic Data Systems (EDS)).
• On 10/1/09, DSS reported that 70 of the 238 nursing homes were not participating in the drug
recycling program (29 percent) (Source: DSS Provider Bulletin 2009-48). However, according to
DSS, these figures were based on incorrect information provided by EDS. (DSS has directed EDS to
revise their reporting system).
• On 3/19/10, DSS reported that corrected information showed just five nursing homes not participating
in the drug recycling program (2 percent): 1) Whitney Center (Hamden); 2) Seabury Retirement
(Bloomfield); 3) Noble Horizons (Salisbury); 4) Chestnut Point Care (Warehouse Point); and 5)
Haven Healthcare (Cromwell).
Actual Savings Generated: The program actually saved $1,273,755 in FY 09 (see chart below); however,
it was budgeted that the program would save $1.5 million annually (shortfall of $226,245). Further, the
quarterly decrease in savings over time reflects both the adoption of Medicare Part D and the increasing
shift toward a federal payor, and the continued closing of CT nursing homes. Based on the latest quarter
of savings reported, the drug recycling program as currently implemented would save just $602,300, as
opposed to the budgeted $1.5 million annually.
Actual Savings from Nursing Home Drug Recycling Program

$600,000 $503,671
$407,991
$400,000
$211,538
$150,575
$200,000
$0
3Q08 4Q08 1Q09 2Q09
Source: DSS Commissioner, 10/8/09, Long Term Care Financial Managers Association
Meeting
Expansion of Drug Recycling Program to Prescriptions Paid for Through Medicare Part D. In
June 2010, DSS reported that department attorneys had sought guidance from CMS regarding
drugs paid for through Medicare and their inclusion in CT’s drug recycling program. CMS
advised that there is no federal prohibition against including Medicaid Part D recipients in the
drug recycling program as long as the beneficiary (e.g., nursing home resident) signed a form
permitting this. The recycling program was also supposed to be expanded to include Medical
clients in residential settings other than nursing homes. An update from the department as
recently as September 14, 2010, found that this change had not yet occurred. The commission
recommends that DSS fully implement the drug recycling program (with participation of
Medicare Part D recipients) at an additional potential annual savings of $2.4 million.
Appendix U
Proposal to Privatize Inmate Medical Services in Department of Corrections
Background. The Department of Correction (DOC) had 18,320 inmates (and an additional 4,789
persons under community supervision) on November 1, 2010. Adequate medical treatment for
inmates is a federal constitutional requirement. In Connecticut, medical care for inmates occurs
through contract with the University of Connecticut Health Center. The budgeted amount for
inmate medical services in FY 10 was approximately $100 million, and approximately $98.6
million in FY 11.
Privatization of Inmate Medical Services. The Commission on Enhancing Agency Outcomes

was asked to explore the privatization of inmate medical services in DOC, and what obstacles
might exist to privatizing services. Some states have experienced difficulties following the
privatization of inmate medical services:
• Florida outsourced inmate health care services in one region beginning in 2003, and
experienced increased expenses and substandard inmate health care in some facilities due to
repeated noncompliance with contract requirements, and inadequate contract management
and medical oversight during the subsequent five years42
• California awarded 1,149 contracts with private medical service providers between 2001-
2003 (most not competitively bid), and a state audit report found prisons may be overpaying
inappropriate and invalid medical claims (due to inadequate contracting processes and
oversight)43
• Due to poor fiscal monitoring, weak contract enforcement, inadequate inmate medical care,
and increased costs, New Jersey recently cancelled an $85 million contract with a private
vendor, and is now using the services of the state university medical and dental school
(although privatization opportunities for inmate medical health services may be explored
under the current governor)44
• Vermont’s Department of Corrections has undergone multiple changes in private medical
care vendors for inmates, and a state audit of the inmate medical services contract found
ineffective financial oversight, insufficient quality assurance, and questionable procedures
for contract bidding, amendment and assignments45
Based on the experiences of other states, privatization of inmate medical services would require
careful contract management and oversight. States have also looked to reduce inmate medical
costs through the use of Medicaid for inmate inpatient services.
Use of Medicaid for Inmate Inpatient Services. Generally, the federal government, via the
Centers for Medicare and Medicaid Services (CMS) does not reimburse states for inmate
42
Steps to Control Prison Inmate Health Care Costs Have Begun to Show Savings (January 2009), Florida Office of
Program Policy Analysis & Government Accountability (Report No. 09-07).
43
California Department of Corrections: It Needs to Ensure That All Medical Service Contracts It Enters Are in the
State’s Best Interest and All Medical Claims It Pays Are Valid (Report 2003-117 Summary – April 2004).
44
The New Jersey Privatization Task Force Report to Governor Chris Christie, May 31, 2010.
45
Keys to Success: Improving Accountability, Contract Management & Fiscal Oversight at the Department of
Corrections, Vermont Office of the State Auditor, May 26, 2004.
Commission on Enhancing Agency Outcomes U-1 Dec. 15, 2010 Final Report
medical care under the Medicaid program. An exception, however, is permitted when inmates
are treated in a hospital not under the control of the state’s correction system. When that occurs,
the individual has “inpatient status” and is not considered an inmate of a public institution. 46 In
FY 10, $8.5 of the approximately $100 million Department of Correction inmate medical care
budget was used for inpatient care.
The North Carolina Office of the State Auditor recently evaluated whether that state’s inmate
health care costs could be reduced by requiring hospitals and other medical service providers to
bill Medicaid for inpatient hospital and professional services for individuals who would
otherwise be eligible for Medicaid. The auditor’s office concluded that approximately $11.5
million could be saved annually by this change from the current system of the state Department
of Correction paying for inmate health care.
The North Carolina state audit included a letter (dated May 4, 2010) received from CMS
clarifying the Medicaid coverage policy for inmates of a public institution in any state.
Specifically:
• “Eligibility must be determined for each inmate in accordance with the standard eligibility
determination process used by [the state] Medicaid [system]”
• “Once determined Medicaid eligible, the inmates remain eligible and their cases should be
placed in a suspension status during their incarceration”
• “While incarcerated, Medicaid payment is only available when the inmate is an inpatient in a
medical institution not under the control of the corrections system. Such institutions include a
hospital, nursing facility, juvenile psychiatric facility, or intermediate care facility.”
In a four-state review of Medicaid payments for incarcerated beneficiaries, the Department of

Health and Human Services Office of Inspector General (June 2004 A-04-02-06002) reported
Medicaid claims paid on behalf of incarcerated beneficiaries in Florida, Massachusetts, Missouri,
and North Carolina totaled over $130 million during a three-year period (October 1, 1998
through September 30, 2001).
Current Provision of Medical Services for Connecticut Inmates. Connecticut provides

medical, dental, and mental health services for inmates through a contract with the University of
Connecticut Health Center, which established the University of Connecticut Correctional
Managed Health Care program.
Inmates who require inpatient care are usually admitted to a secured unit at the UConn Health
Center John Dempsey Hospital (JDH) located in Farmington.47 In emergency situations, inmates
are admitted to the nearest hospital and subsequently transferred to JDH. Special arrangements
have been made with Lawrence and Memorial Hospital for care of pregnant women at the
46
Section 1905, 42 U.S.C. 1396d (Title XIX of the Social Security Act) states that Federal Financial Participation
(FFP) is not available for services provided to inmates except when the inmate is not in a prison setting and becomes
an inpatient in a medical institution.
47
In 1995, a 12-bed correctional inpatient unit was opened at JDH. Recently reduced to a 10-bed unit,
approximately six inmates are hospitalized at any one time at JDH (Source: University of Connecticut Health
Center Correctional Managed Health Care Annual Report, July 2008-June 2009; Department of Correction
Responses to Questions from CEAO staff, April 1, 2010.)
Niantic Prison. Currently, JDH does not apply for Medicaid reimbursement for these inpatient
services.
Suspension of Medicaid Enrollment for Prisoners. In its response to North Carolina and
elsewhere, CMS recommends suspension rather than termination of Medicaid benefits. CMS
considers suspension of Medicaid enrollment for prisoners a best practice for reentry planning, as
it particularly benefits prisoners who have mental illness and substance abuse problems or who
are otherwise at risk of homelessness when released.48
In 2008, Florida law was amended (Fla. Stat. § 409.9025) to provide for suspension (rather than
termination) of Medicaid while recipients are incarcerated, with Medicaid reimbursement sought
for inpatient hospital services furnished to an inmate at a hospital outside of the inmate facility.
In Connecticut, DOC sends DSS a list of inmates who have been sentenced within the past 30
days. DSS then searches for matches with its database of Medicaid recipients, and terminates
Medicaid at that time. Medicaid for eligible inmates imprisoned two years or less is reinstated
prior to re-entry by DSS eligibility workers (funded by DOC for this re-entry work) who
complete a shorter eligibility form.
Medicaid Reimbursement for Hospitalization of CT Inmates Outside of a Department of

Correction Facility. As noted, in FY 10, $8.5 of the approximately $100 million budget was
used for inpatient hospitalization.49 The majority of the inpatient costs occurred at JDH ($8
million) with the remainder ($500,000) spread across all other state hospitals (CMHC pays the
state hospitals at current Medicaid rates). A request was made to DSS for information on the
percent of inmates who were Medicaid beneficiaries at time of incarceration, but to date, that
information has not been received. If all JDH inpatient expenses were covered by Medicaid, the
50 percent match would result in as much as $4 million in savings.
48
Returning Home: Access to Health Care After Prison, National Conference of State Legislatures, July 2009.
49
Conference call with Gail Duncan of CMHC on October 7, 2010.
Appendix V
Proposal to Take Advantage of Federal Assistance to Veterans
Current Federal Health Care System for Veterans. Connecticut has over 277,000 veterans.50 The federal
Department of Veterans Affairs, through the Veterans Health Administration, operates a system
that includes 153 medical centers, 882 ambulatory care and community-based outpatient clinics,
207 Vet Centers,51 136 nursing homes, 45 residential rehabilitation treatment programs, and 92
comprehensive home-based care programs. Health care assistance for veterans includes inpatient
hospital care, outpatient care, laboratory services, pharmaceutical dispensing, and mental health
counseling. In addition to VA-run nursing homes, the VA also operates a community nursing
home program, which allows some level of patient choice in selecting a nursing home close to
the veteran’s home and family, and quality assurance through regular visits by VA health care
facility staff.
Connecticut’s federally supported VA system has an inpatient facility and ambulatory care center
(West Haven), an ambulatory care center (Newington), six primary care community based
outpatient clinics (Danbury, New London, Stamford, Waterbury, Windham, and Winsted), and
four Vet Centers (Danbury, Norwich, Rocky Hill, and West Haven). A Veterans Benefits
Administration regional office is located in Newington, and intake sites are at the US Naval
Submarine Base New London at Groton, and at the New London Coast Guard Academy.
The Veterans’ Health Care Eligibility Reform Act of 1996 expanded the population of veterans
eligible for VA hospital care and medical services. Historically a health care system covering only
veterans with service-connected disabilities, under current VA rules, the VA Medical Benefits package is
now open to all veterans who served honorably for two years in a branch of the military. To receive VA
health care benefits, a veteran must enroll in the VA health care system (using VA Form 10-10EZ).
Veterans are then categorized into one of eight priority groups (see Appendix A for a description of the
priority groups). Priority Group 5, for example, includes any veteran (and spouse) who is eligible for
Medicaid.
VA health benefits are established by federal law and regulations, and are funded through
appropriations; they are not considered an entitlement. Although dependent upon how much Congress
approves for VA benefits in a given year, priority group 5 veterans have never lost their benefits.52
How Many Veterans are Receiving Medical Benefits from VA? There are 7.9 million veterans nationwide
currently receiving VA benefits. There are an additional approximately 5.8 million veterans who meet
eligibility requirements in priority groups 1-7 for medical care from the VA health system who are not
enrolled. Based on these figures, just 58 percent of eligible veterans are actually enrolled in the VA
health system.
50
Testimony provided by Commissioner of Department of Veteran’s Affairs at 3/2/10 public hearing of VA
Committee. The U.S. Census Bureau 2006-2008 American Community Survey 3-Year Estimates identified 246,572
civilian veterans in Connecticut.
51
Vet Centers provide counseling and other services to help veterans and their families make a successful post-war
adjustment in their community.
52
According to 10/13/10 telephone conversation with aide in Senator Lieberman’s office.
Commission on Enhancing Agency Outcomes V-1 Dec. 15, 2010 Final Report
In Connecticut, there are 52,000 veterans receiving medical benefits from the VA, and 27,000 of them
have service-connected disabilities.53
Potential barriers to receipt of medical benefits from VA include:
• challenges in the process for transitioning active duty service members from TRICARE (health
care system operated by the Department of Defense) into the VA health care system (operated by
the Department of Veterans Affairs),
• inconvenient distance to VA health care sites, and
• lack of awareness that such benefits are available to the veteran.
Veterans Receiving Medicaid Benefits. Prompted by challenging financial times, at least 20 states are
examining whether veterans currently receiving state-funded Medicaid, may also qualify for federally-
funded veterans benefits. Many states have reported that veterans did not realize they qualified for federal
veterans benefits, which could provide them with less expensive co-pays for prescription drugs and other
health care advantages.
The California Legislative Analyst’s Office recently conducted a study of military veterans in California 54
and concluded that there were approximately 144,000 veterans and their family members receiving state-
funded Medicaid (Medi-Cal) who could be receiving comprehensive federally-funded medical benefits
from the VA. In comparing Medi-Cal with the federal veterans medical benefits, the analysts concluded
that VA medical benefits were often better than those provided by Medi-Cal because:
• there is greater access to mental health counseling and treatment for alcohol and substance abuse;
• the VA does not place a cap on the cost of dental services;
• the VA does not limit the number of days per year a patient can be hospitalized;
• unlike Medi-Cal, the VA system does not require a beneficiary to pay down assets to become
“medically needy” before covering the costs of long-term care; and
• the VA has greatly improved accessibility and wait time (e.g., waiting time for cardiovascular
procedures was significantly shorter through the VA than through Medicaid (and Medicare)).
Veterans May Receive Health Care from Multiple Sources. In a report issued by the Congressional
Budget Office,55 it was noted that veterans may receive medical services from the VA and/or other
sources such as Medicare, Medicaid, private health insurance, the military system, or public hospitals.
The report further noted that reliance on VA for medical needs varied across the veteran priority groups.
For example, low-income veterans in priority group 5 (i.e., Medicaid-eligible) receive approximately 43
percent of their medical care from the VA.
Because enrollment in other health coverage does not preclude receipt of VA health benefits, the veteran
may belong to multiple health plans, and have the flexibility to use services from an array of sources.
Further, under federal law, Medicaid is intended to be the payor of last resort, meaning that other
available sources such as the VA must be exhausted before Medicaid can provide services.
Identification of Veterans Receiving Medicaid. The CT DSS eligibility determination form requires
applicants to self-report information about household members who are veterans, including receipt of
veterans benefits. The number of Medicaid recipients who had self-reported veteran status during the
application process is unknown by DSS at this time.
53
Telephone conversation with DVA Commissioner Schwartz
54
Data Match Increases Veterans’ Access to Benefits and Reduces State Costs, California Legislative Analyst’s
Office, Analysis of the 2007-08 Budget Bill.
55
The Health Care System for Veterans: An Interim Report, December 2007, Congressional Budget Office.
In addition to self-reporting of veteran status during the DSS eligibility application process, a 17-year-old
federal computer data matching system (originally developed to prevent welfare recipients from drawing
benefits in more than one state at a time), the Public Assistance Reporting Information System
(PARIS), allows states to identify people who are simultaneously enrolled in state and federal health and
social services programs. States may then shift medical care for veterans to the federal government
thereby eliminating the state match required for Medicaid. Use of the PARIS system had been optional.
However, in October 2009, in an effort to reduce Medicaid fraud, Congress required Connecticut and
other states to use PARIS as a requirement for their receipt of CMS funding for automated data systems.
Connecticut’s Department of Social Services (DSS) Fraud & Recoveries area has used the PARIS match
information to identify individuals receiving both Medicaid and veterans benefits, resulting in reductions
or closure of Medicaid benefits. Since 2004, PARIS matches have identified 2,627 cases in Connecticut
with discrepancies in information reported by DSS beneficiaries who were also receiving veterans
benefits. Subsequent investigation by the DSS Fraud & Recoveries area led to reductions or elimination
of $407,766 in all DSS benefits (not just Medicaid) for 638 cases (24 percent).
DMHAS has indicated informally to DVA Commissioner Schwartz that DMHAS provides services for
over 7,000 veterans. However, due to confidentiality issues, DMHAS will not share this information with
DVA.56
A Memorandum of Agreement entered into spring 2009 between CT DVA and DSS:
1. allows DSS, on a quarterly basis, to send electronic reports to CT DVA containing lists of DSS
clients deemed by DSS to either receive or be eligible for benefits from DSS and the federal
Department of Veterans Affairs;
2. specifies that CT DVA shall further research eligibility, and apply for federal benefits for the
veteran and his/her dependents as appropriate; and
3. specifies that CT DVA is to report back monthly to DSS on the status of benefits.
In May 2009, DSS produced an initial file for DVA containing information on 2,508 individuals receiving
both veterans and DSS benefits. (DSS has not yet provided DVA with information on DSS recipients who
identify themselves as veterans during the DSS benefit application process, but who were not receiving
veterans benefits.)
DVA reported that nothing has been done with this initial list. DSS reported that it has been discussing
the mechanics of the data-sharing with DVA as recently as November 1, 2010; however, no further
progress has been made to use the information provided by the PARIS match and names of DSS
beneficiaries not currently receiving veterans benefits.
Examples of Savings Other States Experienced. Several states have begun using the PARIS match
information to transfer veterans to VA or Department of Defense benefits. Some examples are:
• Montana (101,584 veterans)57 saved $1 million in fiscal year 2008 and anticipated a savings of $1.9
million in fiscal year 2009 by transferring veterans from Medicaid to the military’s TRICARE health
system.
• Washington state, with an estimated 618,086 veterans8 has transferred over 3,500 veterans and their
families, many in long-term care, from Medicaid to either Department of Defense or VA healthcare
coverage, saving $20 million since 2006, including $4.9 million in the most recent fiscal year
56
PRI interview with Commissioner Schwartz on October 5, 2010.
57
U.S. Census Bureau 2006-2008 American Community Survey 3-Year Estimates.
• California, with an estimated 2,086,560 veterans8 identified 144,000 state Medicaid recipients in 2007
who were veterans, and eligible for benefits from the Veterans Health Administration; annual savings
of $250 million from a voluntary shift of veterans from Medicaid to VA healthcare were estimated
• Colorado began using the PARIS match information and identified 1,600 VA-benefit eligible
individuals or families, estimated to potentially save $8 million annually
Washington State. When the PARIS match was originally launched in 2003 in Washington State,
just three percent of long-term care patients were identified as veterans, even though data showed the
figure should have been over 40 percent (The Washington Department of Veterans Affairs estimated that
50 percent of all males 65 years of age and older are veterans). The lower percentage was due primarily
to: 1) reliance on self-identification or identification by the veteran’s family, 2) confusion about what
benefits the VA actually provided, and 3) lack of clarity regarding who qualified for VA benefits.
Washington state now sends their DVA—on a weekly basis--a list of Medicaid recipients who were
recently approved for long-term care, and 42-43 percent are consistently found to be veterans (and thus
eligible for federal VA benefits). Washington State also:
• used the PARIS database to identify veterans receiving no benefits ($0), often due to the veteran
failing to turn in an eligibility review form, with the benefits subsequently cancelled by the VA.
Washington State now reaches out to these $0 cases and helps veterans file the necessary forms;
• began using the PARIS database to identify veterans receiving $90 per month from the VA. This
dollar amount was a flag that the veteran had been receiving a VA pension (as high as $1,700 per
month), which was then reduced to $90 upon entry into a nursing home. However, for veterans
who left nursing home care to return to the community and receive in-home care, the higher VA
pension should have been reinstated, allowing the veteran to contribute to their state-funded care;
and
• stopped paying prescription drug claims for 200 Medicaid clients living in two veteran nursing
facilities, shifting veterans to the VA prescription drug plan, and saving approximately $1 million
annually.
Investment in Identification and Receipt of Federal VA Benefits for Veterans. As noted, the state of
Washington is the originator of the effort to identify and transfer eligible veterans from Medicaid to
federal VA medical benefits. Since 2006, that state’s efforts in identifying and transferring veterans from
Medicaid to federal VA coverage have resulted in a savings of $20 million. The resources required for
this effort were two staff to identify the veterans using PARIS match information, and two to three
state Department of Veterans Affairs staff to help the veterans apply for and transition to the federal
VA program.
California researched the experience of other states, including New York and Pennsylvania, and estimated
it would require approximately $200,000 for two additional staff members and related operating
support to implement a program similar to that of Washington state.
Due in part to inadequate resources to reach potential beneficiaries, Kansas estimates just 14 percent of its
10,400 veterans (1,500) eligible for benefits currently receive them. Kansas further estimates that its
proposed veterans’ benefit enhancement program (based on PARIS match information) will cost
approximately $225,000.
Connecticut resources. Based on the experiences of other states, approximately two DSS
staff would be needed to review the PARIS match and analyze the results to identify veterans potentially
eligible for VA benefits. Current DSS efforts pertaining to the PARIS match occur in the Fraud and
Recoveries area, with a focus on identifying whether income from the VA was accurately reported by
DSS beneficiaries. Instead of identifying fraud, Washington State, for example, focuses on the matches as
an opportunity to offer additional, better services, and at the same time, save the state money.
Additionally, there are veterans who receive Medicaid and are not receiving any veterans benefits, and
thus will not appear on the PARIS match. Efforts to identify these veterans and shift some or all of their
benefits to the federal VA program, would save Connecticut the money spent on the 50 percent match
required by the state Medicaid program.
Interviews with the Connecticut DVA have highlighted significant resource limitations, particularly
following the RIP retirements (although the manager of veteran advocacy and assistance position was
recommended and approved for refill (which occurred July 2010)). The CT DVA reports vacancies in the
Office of Assistance and Advocacy for three veterans services officer positions. In the Bridgeport region
alone, for example, there are two veterans services officer vacancies, leaving just one veterans service
officer to do outreach for the entire Bridgeport region. The CT DVA would most likely need one to two
additional staff dedicated to outreach and assistance in linking veterans with eligible benefits from the
federal VA. Some states subcontract with veterans groups, such as the VFW, to assist in outreach to
veterans, an option Connecticut might also wish to consider.
Communication between DSS and DVA is critical to the success of such an initiative. As a result of the
RIP, both agencies lost key staff most familiar with the PARIS match and the agencies need to:
• develop a better understanding of the purpose and frequency of the PARIS match,
• what the resulting information means,
• the filtering and identification of particular veterans, and
• provision of the information in a format that is usable by DVA.
Not only will these efforts result in financial savings to Connecticut, but veterans will gain additional
support beyond what they currently receive.
If Connecticut was to have an experience similar to that of Washington state and Montana, then, with a
minimal investment of $200,000-$250,000 in adequate staffing, the state could expect to save
approximately $2 million in the first year, and more in subsequent years.
Finally, better sharing of veteran’s information among all agencies who potentially could be serving
veterans is needed. The Department of Mental Health and Addiction Services, for example, purportedly
provides services to over 7,000 veterans; however, there has been a reluctance to share this information
with DVA due to confidentiality issues.58 Just as there is a memorandum of agreement between DSS and
DVA to share information, a similar agreement between DVA and DMHAS (and perhaps DVA and other
agencies serving veterans) would further efforts to help veterans gain additional benefits to which they are
entitled, and result in financial savings to Connecticut’s budget.
58
PRI interview with Commissioner Schwartz on October 5, 2010.
APPENDIX A
Eligibility Requirements for VA Medical Benefits Priority Groups

Priority Group Eligibility Requirements
1 • Veterans with service-connected disabilities rated 50% or more disabling
• Veterans determined by VA to be unemployable due to VA service-connected
conditions
2 • Veterans with service-connected disabilities rated 30% or 40% disabling
3 • Veterans who are former prisoners of war
• Veterans awarded the Purple Heart Medal
• Veterans whose discharge was for a disability that was incurred or aggravated in the
line of duty
• Veterans with VA service-connected disabilities rated 10% to 20% disabling
• Veterans disabled by treatment or vocational rehabilitation provided by the VA
4 • Veterans who are receiving aid and attendance benefits (cash payments from VA to
eligible individuals who need assistance with daily activities because of a disability)
or are housebound
• Veterans who have been determined by VA to be catastrophically disabled
5 • 0% disabled veterans whose annual income and net worth are below the established
VA Means Test thresholds
• Veterans receiving VA pension benefits
• Veterans who are eligible for Medicaid benefits
6 • World War I or Mexican Border War veterans
• Veterans seeking care solely for disorders associated with exposure in the line of
duty to chemical, nuclear, or biological agents (e.g., Agent Orange)
• Compensable 0% service-connected Veterans
• Combat veterans who are within the two-year special eligibility period
7 • Non-disabled veterans who have income and/or net worth above VA’s means-test
thresholds and below a geographic index defined by the Department of Housing and
Urban Development
8 • Non-disabled veterans who have income and/or net worth above VA’s means-test
thresholds and above a geographic index defined by the Department of Housing and
Urban Development
• (Enrollment in this priority group has been frozen since January 2003; however,
recent combat veterans may enroll during a two-year special eligibility period
regardless of disability or income status)
Source: United States Department of Veterans Affairs
(http://www4.va.gov/healtheligibility/library/pubs/healthcareoverview/)
Appendix W
SUMMARY SHEET
Control Long-Term Care Costs
Background on Long-Term Care
Long-term care (LTC) refers to both institutional and community-based care for persons who
need assistance due to a physical, cognitive, or mental disability or condition. The goal of LTC is
to allow a person to attain and maintain the highest level of functioning and independent living
reasonably possible. Medicaid is the primary payor of long-term care nationally and in
Connecticut (other sources include Medicare, private insurance, out-of-pocket pay by
individuals, and other public sources).59
Because nursing home beds were available, a higher percentage of Connecticut’s elderly
population is receiving nursing home than the national average – 5.5% of 65+ in Connecticut
compared to 3.7% of the elderly nationally. What this also means is that in Connecticut a less
frail population is served in nursing homes than is the case nationally. The most common
measure used to determine level of care needed is the ability to accomplish activities of daily
living (ADLs), like dressing, bathing, and feeding.60 The lower the score, the less assistance
needed. In Connecticut, the average ADL score was 3.7 while the national average was 4.0.; only
two states had a lower score, and only four other states had a 3.7 ADL average score.
Long-term care Medicaid expenditures are expected to more than double by 2025 if no action is
taken.61 Currently, Connecticut long-term care Medicaid expenditures are:
• 13 percent of the overall state budget;
• 49 percent of the entire DSS budget; and
• 53 percent of the state’s Medicaid budget.
Perhaps one of the major reasons that Connecticut spends so much of its Medicaid long-term
care dollars on nursing facilities is that when this was the only type of care for which Medicaid
would reimburse a state, Connecticut responded by having an ample supply of nursing homes
and beds for its residents. While a moratorium on new nursing homes has been in effect since
1991, Connecticut still has many more nursing home beds for its elderly population (65+) than
the national average. In 2008, Connecticut had 1 bed for every 16.5 people 65 and over, while
the national average was 1 nursing home bed for every 22 people 65 and over.62
Based on surveys for Connecticut’s long-term care needs assessment, almost 80 percent of CT’s
residents would like to continue living in their homes with home health or homemaker services
59
Medicaid can only be accessed after individuals have spent their savings and become impoverished.
60
Average ADL Dependence – Based on data obtained from CMS OSCAR Nursing Facility database as of December 2008.
Average ADL dependence is defined as the sum of residents that are somewhat or fully dependent on staff for the five ADLs
(i.e., dressing, bathing, transferring, toileting, and eating) divided by the total number of residents.
61
CT Commission on Aging presentation to the Commission on Enhancing Agency Outcomes, August 11, 2010.
62
The State Long-Term Health Care Sector, Characteristics, Utilization, and Government Funding: 2009 Update (calculations by
CEAO staff).
Commission on Enhancing Agency Outcomes W-1 Dec. 15, 2010 Final Report
provided at home.63 It is also about two to three times less expensive to live in the community as
opposed to living in institutional care. In FY 06, for example, the average cost for institutional
care in CT was $74,637 and the average cost for home and community based care was $32,902.64
Traditionally, however, Medicaid has made institutional care65 easier to access than home and
community-based care. Medicaid has historically only paid for long-term care in institutional
settings and a waiver has been required to obtain reimbursement for long-term care in the
community.
In Connecticut, approximately 35 percent of long-term care Medicaid dollars are spent on home
and community based-services (HCBS), ranking Connecticut 34th in HCBS spending in FY 07.
Connecticut continued to spend 35 percent ($873.9 million) of its Medicaid long-term care
expenditures ($2.4 billion) on Medicaid HCBS in FY 09. (In September 2010, the CEAO sent a
letter to Governor Rell requesting that she more aggressively make long-term care and its costs a
priority.) There are several strategies under consideration to control long-term health care costs.
Re-Balancing Strategy
Currently, at least six states spend more than half of their long-term care dollars on alternatives
to nursing facilities, including Alaska, California, Minnesota, New Mexico, Oregon and
Washington State (Colorado, Idaho, North Carolina, Texas and Vermont are moving in the same
direction).66
On March 23, 2010, the federal Patient Protection and Affordable Care Act (PPACA) became
law. The PPACA contains financial incentives for states currently spending less than 50 percent
of their Medicaid long-term care dollars on health and community based services, to spend at
least 50 percent of their long-term care dollars on non-institutional services, by offering a grant
for each individual who leaves a nursing home to receive services in the community.
Referred to as the “State Balancing Incentive Payment Program,” it runs from October 1, 2011
through September 30, 2015, and offers temporary financial incentives to states that in FY 09
had spent less than 50 percent of their Medicaid long-term care dollars on HCBS to increase its
spending in that area. Participating states spending between 25-50 percent will receive a two
percent increase in their federal matching funds for HCBS services; states spending less than 25
percent will receive a five percent increase in HCBS reimbursement. In FY 09, Connecticut
spent 35 percent on Medicaid HCBS.67
A condition of the increased match is that, within six months of applying, states must implement
administrative changes designed to increase Medicaid HCBS utilization including:
1. “No wrong door single point of entry system” enabling consumers to access long-term
care information, referrals, and financial and functional eligibility assessments through a
single access point;
63
CT Commission on Aging presentation to the Commission on Enhancing Agency Outcomes, August 11, 2010
64
University of Connecticut Health Center’s Center on Aging. Long Term Care Needs Assessment Legislative
Briefing—Follow-up to Questions Asked, January 16, 2008.
65
Institutional care includes nursing homes, intermediate care facilities for people with developmental disabilities,
psychiatric hospitals, and chronic disease hospitals (Source: CT Long-Term Care Planning Committee Long-Term
Care Plan, January 2010)
66
Tennessee’s Bold Leap in Care for the Aged and Disabled, by Christine Vestal, Stateline.org, October 12, 2010
67
Backgrounder: Federal Health Care Reform: Long-Term Care Provisions, OLR Research Report (2010-R-0304),
September 10, 2010
2. “conflict free” case management to develop individual service plans and arrange for and
conduct ongoing service monitoring; and
3. core standardized assessment tools used statewide to determine eligibility and services.
Participating states are expected to increase their Medicaid HCBS spending to a target
percentage by September 30, 2015. States whose Medicaid HCBS spending was less than 25
percent in 2009 must increase it to 25 percent. All other states must increase such spending to 50
percent.
The CT Long Term Care Planning Committee recommends increasing the ratio of home and
community-based and institutional care to 75 percent HCBS by 2025. This would occur through
a one percent increase in the percentage of persons in Medicaid long-term care in the community
each year. Thus, from 2010 to 2015, there would be an increase from 53 percent to 58 percent of
long-term care provided in the community.
However, in order for Connecticut to take full advantage of PPACA, the rebalancing would have
to occur at a quicker rate, reaching 67 percent by 2015 (see figure below).
Figure 1. Percent of LTC Clients in Community
80%
70%
67%
Percent
60% 58%
50%
53%
40%
2010 2011 2012 2013 2014 2015
LTC Plan PPACA
Table 1 shows the potential difference in savings by rebalancing at a faster rate.
Table 1. Savings (in millions) Due to Rebalancing LTC Ratio of Institutional Care: HCBS
Savings 2011 2012 2013 2014 2015 Total
No Rebalance $0 $0 $0 $0 $0 $0
LTC Plan Rebalance $16.6 $34.2 $51.9 $69.6 $87.2 $259.5
PPACA Rebalance $34.2 $87.2 $140.1 $193 $246 $700.5
Assumes no change in the overall number of LTC clients (N=40,097), and annual cost of HCBS is $43,999 less than
annual cost of Institutional Care.
The figures in Table 1 do not include the value of the increased federal match for HCBS care under the PPACA. At
the increased percentage level (52% vs. 50%), and based on currently HCBS spending of $874 million, the increased
federal reimbursement would be $17.5 million.
Money Follows the Person Program
Another strategy to control long-term health care costs is the Money Follows the Person (MFP)
program, a recent Connecticut initiative designed to promote personal independence and achieve
fiscal efficiencies. MFP is a five-year federal demonstration program that helps states move
people from institutional care such as nursing homes, into less restrictive, community-based
settings. (As indicated previously, the population being served in Connecticut’s nursing homes is
less frail than the national average, so the target population for this program is there). MFP
increases the federal Medicaid match up to 75 percent for the first year that program participants
are living in community-based settings.
Connecticut estimated the actual cost of care for persons in the MFP program to be $3,676 per
month, with a net cost to Connecticut (after the $2,713 federal match) of $963 per match. This
compares favorably with the cost of institutional care, which is estimated to be $6,658 per
month, with a net cost to Connecticut (after the $4,008 federal match) of $2,651.68
CT DSS began implementing MFP in December 2008 and has a target of moving 700 people
into the community. The legislature also directed DSS to plan for a program to extend MFP
services to adults who do not meet the federal six-month institutionalization requirement (PA 08-
180). However, implementation of this directive was subsequently postponed until 2012 (PA 09-
5, September 2009 Special Session).
PPACA also extends the federal Money Follows the Person demonstration program until 2016
and decreases the institutional residency requirement by half (from six months to 90 days).
Single Waiver Strategy
There are a number of Medicaid waivers operating in Connecticut to permit Medicaid payment
for other than institutional care, each managed and implemented separately, and created for
individuals with very specific types of disabilities. Waivers include:69,70
• Home Care Program for Elders (DSS Medicaid waiver for individuals age 65 and over who
would otherwise be in nursing homes)
• Personal Care Assistance (DSS Medicaid waiver for individuals age 16-64 with physical
disabilities, who would otherwise require institutionalization)
• Acquired Brain Injury (DSS Medicaid waiver for individuals age 18-64 with brain injuries)
• Katie Beckett Waiver (DSS Medicaid waiver primarily for children with severe physical
disabilities, who would otherwise require institutionalization)
• Comprehensive Supports (DDS Medicaid waiver for persons age 18 and over with
developmental disabilities living in group homes, organized day programs, or living in their
own homes, who would otherwise require institutionalization)
• Individuals with Serious Mental Illness (DMHAS Medicaid waiver for persons age 18-64
currently in nursing facilities or at risk for this level of care, that allow participants to live in
the community and avoid institutional care)
There are at least 31 states that have gone to using a single Medicaid 1915(c) waiver to provide
home and community-based services to both their elderly as well as their disabled, young adult
68
Source of data: CT DSS, Money Follows the Person Rebalancing Demonstration Legislative Status Update,
October 2009.
69
CT Commission on Aging, “Break Down the Silos” chart, 12/9/09
70
More information on the waivers is found in the CEAO Summary Sheet on Section 1115 Medicaid Waiver for
SAGA
population, including Maine, Rhode Island, New Hampshire, New York and New Jersey.71 In its
September 2, 2010 letter to Governor Rell, the Commission on Enhancing Agency Outcomes
encouraged simplification and streamlining of federal waivers and related programs and pilots.
Consolidation and Integration of CT’s Long-Term Care Functions
Connecticut provides publicly-financed long-term care services and supports to older adults and
persons with disabilities through a somewhat fractured governance structure consisting of a vast
array of departments and programs that often operate in silos serving narrowly-defined segments
of the population.72
There are many state agencies that must coordinate long-term care, with the four major agencies
responsible for aspects of long-term care being:
• Department of Social Services
• Department of Developmental Services
• Department of Mental Health and Addiction Services
• Department of Public Health
Consolidation and integration of Connecticut’s long-term care functions has been recommended
by the Connecticut Regional Institute for the 21st Century, and the CT Long Term Care Planning
Committee. The potential proposal to consolidate back office functions for these state agencies
will help promote the consolidation and integration of these long-term care functions as
interaction across agencies is increased. The single waiver strategy as well as a single point of
entry may also help to consolidate and integrate Connecticut’s long-term care functions.
Single Point of Entry
The Connecticut Regional Institute for the 21st Century and the Connecticut Long Term Care
Planning Committee recommended that Connecticut create a statewide single-point of entry for
long-term care information and referral across all ages and disabilities. This change would
address the difficulties reported by CT residents who need long-term care to obtain basic
information about available services. Additionally, a single point of entry would satisfy the
PPACA requirement of “No wrong door single point of entry system.” Further, the September 2,
2010 letter to Governor Rell from the Commission on Enhancing Agency Outcomes considered
creation of a workable statewide single point of entry that is customer-friendly to be a key first
step in Connecticut’s long-term care reform.
Caveats
Control of long-term health care costs is a complex issue and, with any of the strategies
proposed, there are several caveats that bear mentioning.
71
OLR Research Report (2008-R-0122) States with Single Medicaid Waivers for Home and Community-Based
Services, February 27, 2008.
72
CT Long-Term Care Planning Committee Long-Term Care Plan, January 2010
Woodwork effect. There is concern that offering more home-based services will lead to people
who had not previously considered entering a nursing home to “come out of the woodwork” and
apply for Medicaid. There have been surveys that show that for each patient in a nursing facility,
there are two more with similar disabilities making do at home. 73 One potential strategy to
prepare for such an effect would be to start opening up community-based services by phasing in
certain age groups. For example, individuals age 90 and above might be the initial group offered
HCBS.
Assistance to nursing homes. Nursing homes are already struggling financial institutions, and are
likely to oppose rebalancing efforts that reallocate resources from their facilities to community
services. A key strategy outlined in the September 2, 2010 CEAO letter to Governor Rell was to
assist nursing homes in diversifying their business models. The number of nursing home beds
has declined by about 2,230 since FY 01. However, in comparison to the national ratio of 1
nursing home bed for every 22 elderly people (1:22)—Connecticut’s ratio is 1:16.5. Connecticut
still has about 7,000 more nursing home beds than is the norm. Recognizing that bed surplus,
policymakers must take a hard line in granting rate relief to financially troubled homes74 or in
helping homes out of bankruptcy, when it might be better to relocate residents to other homes or
the community. In Minnesota, grants are offered for nursing homes to voluntarily “turn-in” or
close beds. According to a recent report, Minnesota is now closing approximately 1,000 beds a
year.75 The same report indicates that in Vermont, the reimbursement model is changing in some
areas of the state, projecting bed demand and then issuing an RFP to select the facilities with
which it would contract for the needed bed days.
Whatever method is used, it seems clear that enhancing a community-based long-term care
system without reducing the number of nursing home beds and facilities will not save money, but
indeed might prompt a parallel, very expensive system. Therefore, any plan that is developed
should set a goal of funding the national ratio of nursing home bed (1:22 elderly) by 2017, and
closing 7,000 nursing home beds by that date (closure rate similar to Minnesota).
Champion of long-term care. Because the long-term care system is complicated, with multiple
types and levels of care needs, diverse funding, competing long-term care providers with
significant investments, and a structure that needs to meet personal choice and court-mandated
policy goals, there is a need for someone from the governor’s administration to be responsible
and accountable for quickly developing a strategy to implement a plan for Connecticut’s long-
term care.
Summary
With long-term care Medicaid expenditures expected to more than double by 2025 if no action is
taken, an aggressive re-balancing strategy is needed to increase the proportion of long-term
care provided in homes and communities rather than in institutions. Beyond helping to control
long-term health care costs, it is the preference of many of CT’s residents to continue living in
73
Tennessee’s Bold Leap in Care for the Aged and Disabled, by Christine Vestal, Stateline.org, October 12, 2010
74
In FY 08 16 facilities requested $11.2 million, and received $4.6 million, and in FY 09, 27 facilities requested $19.8 million
and received $7.9 million. Another 15 facilities had pending requests for $6.7 million in FY 10. DSS presentation 2009.
75
Topics in Rebalancing the State of Long-Term Care Systems, Kane, Priester, and Kane. A CMS-funded project, May 2008.
their own homes with assistance. Use of a single Medicaid 1915(c) waiver to provide home and
community based services to both the elderly as well as the disabled, young adult population,
would facilitate re-balancing, as would a single point of entry for long-term care information
and referral, and consolidation and integration of long-term care functions spread across
multiple agencies. Further, a plan must be developed that avoids establishing a parallel long-term
care system, which will mean a reduction of nursing home beds.
To achieve this, the new administration should quickly designate a champion of long-term care
who would provide responsibility and accountability for implementing a plan for Connecticut’s
long-term care. As shown in Table 1, potential savings in a single year could be as much as $16-
$34 million.
APPENDIX X
Commission on Enhancing Agency Outcomes X-1 Dec. 15, 2010 Final Report
X-17
APPENDIX Y
Commission on Enhancing Agency Outcomes Y-1 Dec. 15, 2010 Final Report
Room 2200 Legislative Office Building
Hartford, CT 06106
September 2, 2010
The Honorable M. Jodi Rell

Governor
State of Connecticut
State Capitol
Hartford, CT 06106
Dear Governor Rell:
As members of the bipartisan Commission on Enhancing Agency Outcomes, we

respectfully and urgently request that you use the power of your leadership to more
aggressively make long-term care and its costs a priority76. The commission recently
received and concurs with the following priority action items from the Commission on
Aging, the Connecticut Regional Institute for the 21st Century, the Connecticut Long-
Term Care Planning Committee, and the Connecticut Business and Industry Association
as logical starting points to more aggressively move forward on long-term care reform:
■ Charge someone in your administration to be responsible and accountable for

developing quickly a strategy based on Connecticut’s 2010 Long-Term Care Plan,
to determine what to do first, by whom, and by when, and then execute that
strategy with reasonable speed and comprehensiveness
■ Key first steps in the strategy should be:

o develop the outline of a comprehensive system of home and
community-based care, analogous to that pertaining to persons with
developmental disabilities, as a viable alternative to nursing home care
o Create a workable statewide single point of entry that is customer-
friendly
o Simplify and streamline federal waivers and related programs and
pilots
o Assist nursing homes in diversifying their business models
o Learn from other states
Commendably, the state has taken a purposeful approach in this area to identify
problems, obstacles, and solutions related to long-term care. Statewide planning has been
required since 1998, with the most recent comprehensive plan completed in January
2010, based on a 2007 statewide needs assessment. As you know, the plan’s central
conclusion is that Connecticut’s long-term care system is out of balance, with a current
over-emphasis on institutional care and public resources. This imbalance may thwart
76
Long-term care in Connecticut is among the areas identified for potential cost savings by the
Commission on Enhancing Agency Outcomes. As you know, long-term care costs represent a substantial
part of the state budget; looking only at those expenditures covered by Medicaid, long-term care expenses
were $2.4 billion, or 13 percent of the state’s FY 2009 budget.
Hartford, CT 06106
personal choice and optimum care level, and cost Connecticut taxpayers more. The plan
includes a number of specific steps recommended to reach a new balance favoring home
and community-based care.
We recognize and appreciate all the work done by your administration, in particular by
the Long-Term Care Planning Committee, charged with the statewide planning task, and
chaired and staffed by the Office of Policy and Management. The latest long-term care
plan dated January 2010 includes a very informative status report on state long-term care
activities since the last plan in 2007, and touches on the key steps identified above. No
doubt the work to date provides an invaluable base from which to proceed. However, we
look at our progress in light of the state’s fiscal situation, and conclude that more focused
and urgent action needs to be taken, given the potential savings to the state. Thus we
make the request above.
Clearly, the long-term care system is complicated, with multiple types and levels of care
needs, diverse funding, competing long-term care providers with significant investments,
and a structure that needs to meet personal choice and court-mandated policy goals. We
also understand that in the process of rebalancing, we must be careful not to create two
parallel, expensive entitlement programs. However, given the state’s fiscal situation and
soaring aging population, a more urgent timetable is needed now to rapidly change
Connecticut’s long-term care system to favor home and community-based care and
promote greater use of private resources. The current system is unsustainable.
We appreciate your assistance in achieving these measures and look forward to working
with you on this crucial issue.
Sincerely,
_____________________________ ___________________________
Senator Gayle Slossberg, Co-Chair Representative James Spallone, Co-Chair
Government Administration and Elections Government Administration and Elections
Committee Chair Committee Chair
____________________________
Representative Mary Mushinsky, Member
Legislative Program Review and
Investigations Committee Chair
Appendix Z
Proposal to Enhance Community Prevention and Intervention Efforts by DCF
Background. In recent years, the Department of Children and Families (DCF) has made a
priority of keeping children with their families whenever safely possible. Available data
reviewed by PRI staff in the RBA Pilot Project77 indicated a shift away from out-of-home
placement toward in-home care for DCF-involved children.
Effective family preservation and support programs can prevent removals from home or
minimize the time at-risk children spend in out-of-home placements, reduce repeat
maltreatment, and improve child and family functioning. Such programs may be less
expensive than out-of-home care, and evidence exists that such programs are more
effective for the children and families.78 During FY 09, DCF contracted with private
providers to make available over 20 different preservation and support services to its
client families.
Potential cost savings are now examined for two community prevention and intervention
programs with the goal of preserving families and maintaining children in the home: the
Intensive Family Preservation program (IFP), and the Intensive In-Home Child &
Adolescent Psychiatric Service (IICAPS) program.
Intensive Family Preservation program (IFP). The purpose of IFP is to reduce immediate
safety threats to prevent child out-of-home placement and promote successful
reunification for those children who have already been removed. Through contracts with
private providers, IFP workers make in-home visits to families with an open DCF
abuse/neglect case that are at high risk of child out-of-home placement, that were just
reunified, or with upcoming reunification plans.
The length of IFP service is expected to last up to 12 weeks, but can last as long as six
months. Beyond CT’s IFP program duration standard being long compared to other
states’ IFP programs, there is a resulting decreased capacity to serve more families.
Nearly half the 13 DCF offices, for example, have waitlists all or most of the time, from
three weeks to two months. There were 660 families who completed IFP in FY 09.79
Statistics on the number of CT DCF families who were preserved and avoided placement
of child(ren) in foster care is unknown. Similarly, the number of children who returned
home from out-of-home care is unknown. However, anecdotal evidence and statistics
from other states suggests a reduction in out-of-home placements of anywhere from 23
percent to 57 percent for IFP program participants.
77
RBA Pilot Project Study of Selected Human Services Programs (P.A. 09-166), January 12, 2010.
78
RBA Pilot Project Study of Selected Human Services Programs (P.A. 09-166), January 12, 2010.
79
RBA Report Card in PRI RBA Pilot Study of Selected Human Services Programs (P.A. 09-166), January
12, 2010.
Commission on Enhancing Agency Outcomes Z-1 Dec. 15, 2010 Final Report
Apart from the question of total number of families helped, consider the following:
• families purportedly qualify for Intensive Family Preservation services because

they are at imminent risk of disruption, resulting in out-of-home placement of
their child(ren);
• IFP costs approximately $8,788 per family80;
• foster care costs approximately $47.33 per day, or $54,720 for 3.2 years; and
• for every family that avoids placement of a child in foster care due to IFP, there is
an estimated net savings of approximately $45,932 per family.
Further, there were approximately 1,200 IFP slots funded by DCF in FY 09. More
families could be served without increasing funding. If 100 more families were helped
to reunite or avoid foster care, savings of approximately $4,593,200 could be realized.
Intensive In-Home Child & Adolescent Psychiatric Service (IICAPS). IICAPS is an
evidence-based practice that provides an intensive, home-based intervention for children
and adolescents with serious emotional disturbances who are at risk for psychiatric
institutional-based treatment, are unable to be discharged from psychiatric institutional-
based treatment due to lack of community and home resources, or are unresponsive to
clinic-based services. During FY 10, DCF contracted with 19 private providers (114
teams) to offer IICAPS. Children receiving these intensive in-home behavioral health
services are expected to have reduced use of very expensive institutional care, and both
children and their families to experience improved functioning.
The funding for IICAPS is complex. Considering the $1.2 million spent on IICAPS
contracts directly from DCF’s budget and the $1.8 million that was transferred from DCF
to DSS (for a combined total of $3 million), IICAPS averaged $2,437 per case in FY09.
There were 1,231 children in Connecticut who completed the IICAPS program in FY 10
(Figure 1).
Figure 1. Service Usage Prior and During Receipt of IICAPS
610
600 538
449
Children
331
400
# of
200 48 19
0
Psychiatric Inpatient Emergency Residential
Admissions Department Visits Treatment
Admissions
6 months prior to IICAPS During receipt of IICAPS
Figure 1 shows the 1,231 children had81:

• 38% fewer psychiatric inpatient admissions;
80
Based on $5.8 million budget and 660 families served.
• 26% fewer Emergency Department visits; and
• 60% fewer residential treatment admissions.
For the 1,231 children, the total number of days spent in psychiatric inpatient care during
receipt of IICAPS (5,396 days) was 40 percent less than during the six-month period
prior to receipt of IICAPS (9,075 days). While the IICAPS waitlist is currently
undergoing a careful review and the figure will most likely be updated in December,
there may be as many as 177 children and families waiting for IICAPS.
Table 1. Cost Comparison for Six-Month Period With and Without IICAPS
Types of Expenses Without IICAPS With IICAPS Savings
Inpatient hospitalization (9,075 days) (5,396 days) $5,286,723
($1,437 per day)a $13,040,775 $7,754,052
Emergency Room Visits (610 visits) (449 visits) $161,000
($1,000 per visit) $610,000 $449,000
Residential Treatment (48 admissions) (19 admissions) $1,070,831
(avg LOS 117)b $1,772,410 $701,579
($315.60 per day)c
Cost of IICAPS program $0 $3,000,000 ($3,000,000)
($2,437)c
Total $15,423,185 $11,904,631 $3,518,554
a
2009 Riverview Hospital Annual Report (on DCF website).
b
February 19, 2010 meeting notes of the Behavioral Health Partnership Oversight Council Quality
Management, Access & Safety Subcommittee.
c
Office of Fiscal Analysis.
Summary. Potential cost savings for two of DCF’s community prevention and
intervention programs were estimated. With regard to IFP, additional savings could occur
by increasing the number of families served, which is currently significantly below
contract requirements. If 100 more families were helped to reunite or avoid foster care,
savings of approximately $4,593,200 could be realized.
Additionally, there are some modest savings that could be realized through expansion of
the IICAPS program. With an average savings of $2,858 per child ($3,518,554/1,231
children), approximately $285,800 could be saved by expanding capacity and
reducing the wait list by 100 children.
81
4th Quarter Fiscal Year 2009-2010 IICAPS Network Quarterly Report, Yale Child Study Center, Yale
University, New Haven, CT
APPENDIX AA
SUMMARY SHEET
Reduction of Medicaid Prescription Drug Costs

(within CEAO major area VII)
 Connecticut’s Medicaid expenditures for prescription drugs for FFY 09 were more than $445 million,
almost 12 percent of the $3.8 billion FY 09 Medicaid budget in Connecticut.
 While Medicaid pharmacy costs nationwide decreased from $24.2 billion in FFY 08 to $22.9 billion
in FFY 09, in Connecticut Medicaid prescription expenses increased by $22 million – from $423.6 to
$445.8 million -- or 5 percent.
Table I shows some key information on Medicaid prescription utilization and expenditures in Connecticut
compared to surrounding states and nationwide.
Table I. Medicaid Drug Utilization and Expenditures: CT and Other States FFY 09
State Medicaid % Total Rx Rx Expenditures Avg. $ Generic Generic
Enroll # 65+ (000) Per (000) Overall % of Avg. $
(000) client per Rx scripts
CT 553.8 12.4 5,095 9.2 $445,784 $87 63% $26
MA 1,402.5 11.3 7,808 5.6 $464,636 $59 76% $16
ME 350.1 15.8 2,890 8.2 $190,535 $66 64% $12
PA 2,090.2 11.2 7,385 3.5 $495,511 $67 70% $14
NY 4,954.6 11.2 37,795 7.6 $3,197,809 $84 62% $19
VT 157.6 12.6 1,332 8.4 $108,543 $81 63% $19
US 58,106 10.2 295,599 5.1 $22,972,896 $77 67% $21
Sources: Medicaid population data from Kaiser Family Foundation, Prescription data from Generic Pharmaceutical
Association82 using data from CMS.
 Connecticut appears to have higher overall prescription utilization per Medicaid enrollee
than other states – about 9 per client compared to the national average of 5.
 Connecticut has a higher average cost overall for Medicaid prescriptions -- $87 per
prescription on average compared to the national average of $77.
 Contributing to those higher overall cost is the fact that Connecticut has a lower utilization
(63%) of generic prescriptions than nationally (67%) and other comparative states -- NY (62%)
and VT (63%) are exceptions.
 Connecticut has a higher average cost for generic prescriptions.83 Connecticut’s average
generic prescription cost of $26 was $5 higher than the national average of $21; and $10 higher
than Massachusetts’ average generic cost of $16.
Recommendation to bring Medicaid prescription costs down:
82
Generic Pharmaceutical Association, National Brand and Generic Prescription Medicaid Drug Utilization and Expenditures by State in
2009Q1-Q4. (table using CMS data)
83
While these data do not identify the types of drugs being prescribed, one assumes that for the states’ Medicaid populations overall, the types
would be similar, and especially in the Northeast states, where a similar percentage of the Medicaid population is elderly;
Commission on Enhancing Agency Outcomes AA-1 Dec. 15, 2010 Final Report
APPENDIX AA
SUMMARY SHEET
Mandate that pharmacists dispense the FDA-approved generic equivalent when available for
Medicaid prescriptions, with implementation of rigorous prior authorization for brand name
drugs.
Expedite reduced pricing mechanisms for generic drugs.
Efforts at Increasing Utilization of Generic Prescriptions and Lowering Costs
 Thirteen states84, including Massachusetts, New York and Pennsylvania mandate generic
substitution, generally for all patients and all payers.
 If Connecticut’s Medicaid program could increase its generic prescription use by 5 percent,
it is estimated the state could save $21.8 million, and the federal government another $21.8
million, as the federal Medicaid reimbursement rate for Connecticut is 50%. These savings
assume the current generic average price of $26.
 If Connecticut could pay a lower price for generic drugs – to the national average of $21, for
example – this would save an additional $17.4 million -- $8.7 million for CT and $8.7 million
for the federal government.
 If Connecticut cannot negotiate such price reductions for generics (and other drugs) on its own,
it should join one of the four multi-state pools currently in existence for purchasing Medicaid
drugs. Thirty states and D.C. currently belong to one of these pools; Connecticut does not. New
York documented savings of $80.5 million in 2007 due to multi-state negotiated rebates.85
 The legislature mandated the development of such a purchasing plan cooperative in 2009, which
was to be submitted to the legislature in December 2009. To date no plan has been developed.
The CEAO recently sent a letter to the DSS commissioner requesting information on the status of
the required plan.
 Public Act 10-3 (section 24) mandates that a Medicaid provider (including pharmacies) bill
DSS the lowest amount for the good or service that the provider routinely accepts from any
other payer. In other words, if a pharmacy chain store’s lowest price for a particular prescription
to a private payer or an insurer is $10 that is now what that provider must bill Medicaid. This
new provision should help to lower Connecticut’s Medicaid prescriptions costs.
 Massachusetts, which does not belong to a multi-state pool, and does not rely heavily on
negotiated rebates to develop a MassHealth drug list, employs a number of other components to
manage its drug program and contain costs. (As Table 1 indicates, Massachusetts has a high
utilization of generic drugs and lower cost than national averages). Massachusetts employs
Generics First, a step therapy that requires that a generic drug be tried first, before a brand
name may be used. Massachusetts also has a “lowest provider price” provision like the one in
Connecticut passed in P.A. 10-3.
ESTIMATED SAVINGS TO CONNECTICUT: $30.5 million

84
NCSL Brief on Use of Generic Prescription Drugs and Brand-Name Discounts, June 2010. The 13 states are Florida, Hawaii, Kentucky,
Massachusetts, Minnesota, Mississippi, Nevada, New Jersey, New York, Pennsylvania, Rhode Island, Washington, and West Virginia.
85
NCSL Brief on Prescription Drug Agreements and Volume Purchasing, June 2010. Cites New York and other states’ experiences in
reducing Medicaid prescription costs.
Commission on Enhancing Agency Outcomes AA-2 Dec. 15, 2010 Final Report
Appendix BB
SUMMARY SHEET
TANF Emergency Fund Update (Proposal # 37)
The CEAO received a brief update on this proposal at its September 10, 2010 meeting, and there
was an interest then in exploring the issue further.
Overall Allocations: Early in 2009, the Temporary Assistance for Needy Families (TANF)
Emergency Contingency Fund was appropriated $5 billion nationwide in federal stimulus
monies. Connecticut was eligible to receive emergency funds of approximately $133 million.
Eligible Programs: There were three categories of expenses that were eligible for funding:
 caseload increases and increased expenditures on basic assistance;

 increased expenditures related to non-recurrent, short-term benefits, such as emergency
help to pay rent, short-term food assistance, domestic violence services, vehicle repair,
and back-to-school allowances; and
 increased expenditures for subsidized employment.86
Application Process: The federal agency administering the program is the Administration for
Children and Families (ACF) in the Department of Health and Human Services (HHS). The
application for funding had to be made by the state, but could have included expenditures by
towns or other agencies if they were allowable expenditures in the state’s application.
The law required that, in order to be reimbursable, the expenditures must have been incurred
prior to September 30, 2010.
Status: As of August 2010, Connecticut had applied for $56.3 million87 of the $133 million
maximum allocation ($76.7 million less).
Issues:
Connecticut (DSS as the applicant) did not submit an application for the latter two
categories until May 2010, leaving only a few months until the September expenditure
deadline.
86
According to federal guidance material, states were allowed broad leeway in interpreting subsidized employment. It
could be for employment in the private sector, in non-profits and cover all or part of the wages of the subsidized employee.
The expenditures could be for a newly created job or to prevent a layoff of in an existing job, so long as the state ensures
that it complies with requirements against displacing other workers, and ensures that it is providing a job to a needy parent
or youth who would not otherwise be employed. Training costs were allowed to be counted as reimbursable expenses.
87
Application material received from DSS indicates $56 million; the ACF website indicates Connecticut has applied for
$38 million.
Commission on Enhancing Agency Outcomes BB-1 Dec. 15, 2010 Final Report
It also appears that Connecticut (DSS as the applicant) interpreted eligibility, expenses,
and reporting requirements too narrowly. For example, CEAO staff contacted one of
Connecticut’s largest food banks to ask why the organization was not included in the DSS
application. Staff was told that, as the program was explained to that agency, accounting for
increased activity and expenses would be required by family or assistance unit, and that the
agency would not have been able to comply. However, material on the ACF website states that
exceptions and estimating are allowed in determining eligible expenses.
Connecticut’s neighboring states of New York, Massachusetts, and New Jersey all
successfully submitted applications for the full amounts allocated to that state. CEAO staff
asked DSS why those states would have been eligible for the full allocations, as they would have
had to meet the same eligibility, expense, and reporting requirements. DSS has not responded.
It seemed somewhat unclear to CEAO staff as to what revisions the state might make to its initial
applications (due and filed by September 1, 2010.), so CEAO staff made an informal inquiry to
the ACF Region I Office. Staff was told that the applications submitted to date cannot be revised
to garner more funding, and the total amounts already allocated to each state are the caps. It
therefore appears that Connecticut has missed an opportunity to maximize federal revenue
(a potential loss of $76 million) in this program. However, since there is such a large
amount of funding at stake, Connecticut should seek an official interpretation. If
Connecticut is allowed to revise its applications, DSS should:
 ensure that as broad an interpretation as allowed under federal guidelines for

eligibility, eligible expenses, and reporting is used;
 work with all agencies that were part of the application to ensure they submit
expenses using the broadest interpretation.
In the longer-term, DSS should immediately designate a high-level staff person as federal
revenue ombudsman to ensure that the state does not miss future federal funding
opportunities.
Commission on Enhancing Agency Outcomes BB-2 Dec. 15, 2010 Final Report
Appendix CC
Hartford, CT 06106
November 24, 2010
The Honorable Michael P. Starkowski,

Commissioner
Department of Social Services
25 Sigourney St.
Hartford, CT 06106
Dear Commissioner Starkowski:
The Commission on Enhancing Agency Outcomes met on Monday, November 22, 2010, and, as
part of its agenda received your October 6, 2010 letter to leadership of the public health and
human services committees along with the Prescription Drug Purchasing Program report
(required by P.A. 09-206). The commission is scheduled to vote on the proposals in that report
along with many others at its next meeting, on Monday November 29, 2010.
Also, the commission voted to request action of your department regarding two other
commission proposals. The first concerns the drug recycling program. The commission would
like written assurances that the department is fully implementing the drug recycling program,
including full participation by Medicare Part D recipients, and Medicaid clients who are being
cared for in residential settings other than nursing homes.
The second matter concerns the Department of Social Services applications for the TANF
Emergency Contingency Fund, administered under the federal Department of Health and Human
Services (DHHS). As you know, the state was eligible for approximately $133 million in federal
stimulus funds under this program. Information your department provided to CEAO showed that
as of August, 2010, DSS had applied for funding in the three separate categories totaling $56.3
million, far short of the $133 million the state was eligible to receive. DSS indicated that
program and eligible expense rules, as well as reporting requirements, limited the amounts for
which the state could be approved. However, DHHS information indicates that many states,
including three of Connecticut’s neighboring states, have had applications approved for the full
amounts for which they were eligible. The commission staff asked DSS, via e-mail, why this
may have occurred, as one assumes the same eligibility rules would have applied in those states.
Commission staff did not receive a response.
Given the amount of federal revenue “left on the table” ($76.7 million), the commission is
requesting the Department of Social Services seek an official interpretation from the federal
Administration of Children and Families (ACF) of DHHS regarding whether the state may revise
already-submitted applications to include additional programs and costs under the short-term
recurring expense and the subsidized employment categories. If the state is allowed to amend its
Commission on Enhancing Agency Outcomes CC-1 Dec. 15, 2010 Final Report
Appendix CC
Hartford, CT 06106
applications, the department should take immediate action to ensure the broadest interpretation
of program and expense eligibility and auditing and reporting requirements are used to capture
all the funds for which the state is eligible.
Please provide the commission with your department’s response by December 6, 2010. Thank
you for your attention to these matters.
Sincerely,
_____________________________ ___________________________
Senator Gayle Slossberg, Co-Chair Representative James Spallone, Co-Chair
Government Administration and Elections Government Administration and Elections
Committee Chair Committee Chair
_____________________________
Representative Mary Mushinsky, Member
Legislative Program Review and Investigations
Committee Chair
Commission on Enhancing Agency Outcomes CC-2 Dec. 15, 2010 Final Report
APPENDIX DD
Commission on Enhancing Agency Outcomes DD-1 Dec. 15, 2010 Final Report
APPENDIX DD
APPENDIX DD
APPENDIX DD
APPENDIX DD
Appendix EE
SUMMARY SHEET
Energy Efficiency in State Buildings
Background: The State of Connecticut owns and occupies more than 1,140 facilities88 for which it pays
utilities. In FY 10, the state, excluding all of higher education, paid almost $109 million in energy costs –
almost $72.5 million in electricity alone. If higher education facility energy costs were included,
estimated costs would more than double—and total more than $200 million. In FY 07, the total cost
estimates were about $123 million, an increase of more than 60 percent in three years.
In early 2005, a task force established by the governor proposed a number of recommendations for
reducing electricity use in state buildings including assigning responsibility for energy use to each state
agency and establishing an energy reduction goal – 10% in 2005, and an additional reduction of 5%
in 2006. The recommendations were not implemented and the goals were not achieved.
Many state buildings are very energy inefficient. Beginning in 2005 through 2008, the Institute for
Sustainable Energy89 engaged in a number of separate projects in which 110 facilities were assessed for
energy use and “benchmarked” using the U.S. EPA’s Energy Portfolio Manager (which can be used at no
charge and scores buildings compared to similar facilities). The table below shows the agencies, the
facilities, and other pertinent information from those benchmarking projects. Facilities receiving a 75 or
above are very energy efficient and are eligible for Energy Star recognition; the lower the rating the less
energy efficient.
There is no single agency, department or area that is responsible for energy use or costs in state
facilities, energy ratings, or projects slated for upgrades or projects completed. To assess the results
of the benchmarking project alone, CEAO had to obtain the information from three different areas of state
government.
Table 1. Results of State Facilities Energy Benchmarking

Agency Year # # at 75+ # at 50- # 26-49 # at 25 or
Facilities 75 below
Various State Bldgs 2005 6 3 3 0 0
Judicial Courthouses 2005 23 11 9 1 2
SCSU Residences 2005 11 8 2 1 0
Reg. Voc/Tech Schools 2005 19 1 0 4 14
DMV 2006 6 0 2 0 4
DPS 2006 22 0 0 1 21
DPW (DPH lab and 2006 2 0 0 0 2
DEP)
Ag. Exp. Station 2006 4 0 0 1 3
Dept. of Correction 2008 15 0 0 2 13
Total 108 23 16 10 59
Source: Reports Conducted for OPM by Institute for Sustainable Energy
88
The state owns more than 3,600 buildings and facilities, but many of those are maintenance and storage facilities. To better
analyze buildings where energy is being used and utilities paid, CEAO staff used only facilities where building value was $1
million or more.
89
Institute for Sustainable Energy, located at Eastern Connecticut State University is to “identify, develop, and implement the
means for achieving a sustainable energy future.” ISE website. ISE is funded by the Connecticut Energy Efficiency Fund.
Commission on Enhancing Agency Outcomes EE-1 Dec. 15, 2010 Final Report
Of the 108 facilities benchmarked, more than half (59) had energy ratings of 25 or below. These
buildings would appear to be extremely energy inefficient, and would provide prime targets for facility
improvements to reduce energy consumption and costs. It is unclear what buildings have been targeted
for energy upgrades, which ones are underway or even completed, since that information does not
reside in any one place.
Potential funding sources: There are currently five major ways to fund measure es or projects to
improve energy efficiency in state facilities. One or a combination of sources can be used.
 General Fund monies or bond funds. Because of the budget situation, these funds have been
virtually nonexistent recently.
 Connecticut ratepayer funds -- Ct Energy Efficiency Fund (CEEF) and CT Clean Energy
Fund. In 2001, $12 million was diverted from the fund just for improving energy efficiency in
state buildings. From July 2010 DPW reports, it appears 20 projects have been completed, but it
seems clear not all of the $12 million has been spent. Incentives (in addition to the $12 million
are also allowed if projects meet criteria and funding capacity of CEEF.) The state has not
tapped into the Clean Energy Fund.
 Demand response funds have been available since 2005 from Independent System Operator
New England ISO (the region’s electric grid operator) for facilities that lower demand (or have
alternative supply) during periods of peak electric demand. Thirteen state agencies (54
facilities) have participated since 2005 and generated $6.4 million in payments to the state. These
funds are then distributed back to the agencies for improving facilities’ energy efficiency.
Potential Savings: The Department of Correction has been a primary

participant in this program. Over the past four years, DOC has completed
several projects at its facilities costing $2.7 million, using almost $2.4
million from ISO in demand response funding. According to DOC, the
actual saving thus far have been almost $1.28 million, a payback of
almost 50 percent, often in less than three years. (For other projects,
DOC estimates another $861,267 in potential savings)
 Federal stimulus funds. There is approximately $15 million in federal stimulus money
allocated solely for energy efficiency projects for state agencies:
o $5 million in ARRA90 through federal Department of Energy funds. DPW reports
indicate 12 projects completed using $1.3 million of the ARRA monies, indicating there
is a considerable amount left. Part of that stimulus funding is also being used to support
the Building Operators Certificate (BOC) program, a nationally recognized program that
trains and certifies facility employees in operating energy efficient buildings. Since 2006,
OPM indicates 142 of the 334 employees receiving level one training, and 55 of the 177
at level two, have been from state agencies.
o Another $10 million (of a Connecticut allocation of approximately $36 million) in
ARRA funding under the Qualified Energy Conservation Bond Program reserved for
state agencies. No state agency has even applied for any of the $10 million.
90
Connecticut was awarded $38 million in energy federal stimulus funds, $5 million of that was targeted at state facilities.
Another $65 million was targeted at weatherizing housing for low-income and elderly, some of which was to be used in state-
owned or financed housing. As of October 2010, 2,368 units had been weatherized. 233 of those were state- financed.
o The Clean Energy Fund also received about $19 million in separate federal stimulus
money to fund alternative energy projects in four different categories (e.g., fuel cells,
geothermal, etc). No state agency has yet applied for any of those funds.
 Energy performance contracting. Another method of funding energy upgrades is to use

performance contracting (see Attachment A for a full description) whereby a private company,
typically known as a energy services company (ESCO) assesses what measures will need to be
taken to reduce energy and save costs. The ESCO typically pays for the costs of the project and is
paid back (with financing added) with the energy savings. The provisions for this are written in
the contract. The Office of Policy and Management has been statutorily mandated since 2003
to implement a pilot program using energy performance contracting. To date the state has
not engaged in this type of energy performance contracting.
In summary:
 State energy costs continue to rise substantially, 60 percent over the past four years, and now
total more than $200 million.
 The state has done little to reduce energy costs through making its facilities more energy
efficient.
 The state has not taken advantage of ARRA funding, and has not followed a statutory mandate to
engage in performance contracting.
 The lack of initiative is due to a set of factors: no financial incentives for agencies bring energy
costs down; no managerial accountability for energy costs in agency budgets; and diffused
responsibility for energy projects (and facility management in general) in state government.
 There has been no clear direction or leadership for energy consumption reduction in state
facilities. In Massachusetts, Governor Patrick in 2007 issued an executive order calling for
reducing state government energy consumption by 20 percent by 2010 (off 2004 levels) and by
35 percent by 2030. No similar order has been issued in Connecticut.
 Savings could be significant: even if conservative estimates of 10 percent savings are used, (and
the DOC experience has been that savings are much greater) this could mean a savings of $20
million a year for the state.
To achieve these savings, state agencies will need to reduce energy costs by 10 percent by the
end of FY 12. State agency commissioners should be responsible for ensuring that reduction
by whatever means they choose, including training facility management in BOC, using the
Connecticut Energy Efficiency Fund, the Connecticut Clean Energy Fund, and energy
performance contracting.
Attachment A
Energy Performance Contracting
Energy performance contracting (EPC) is a concept that has several variations but basically whoever the
contracted vendor is will be paid back with all (or a portion) of the savings that result from reduction in
energy expenses. In some cases, the contractor will obtain the financing for any facility improvements. In
other cases, the purchaser obtains the financing, and contracts for the facility improvement measures
(FIMs) that the contractor will install. In either case, the contractor is paid through the savings in energy
costs.
While the state has been statutorily mandated since 2003 (P.A. 03-132) to establish a pilot program for an
energy performance contract in a state facility, and cited in a 2008 PRI study for not having done so, the
state still has not engaged in performance contracting for state facilities.
OPM staff in the energy division indicate that since financing through bonding can be obtained at less
expense, it does not make sense to engage in performance contracting. However, this assumes that bond
funding is available for this purpose, which has not been the case recently.
Public Sector is Using Energy Performance Contracting
East Hartford. The town of East Hartford engaged Johnston Controls Inc. (JCI) about two years ago to
retrofit and install FMIs in several town facilities. East Hartford borrowed $5 million through Bank of
America over a 12-year repayment period. JCI indicated the FIMs would save the town about 30 percent
on energy costs in those buildings. East Hartford hired an independent energy consultant to verify JCI’s
estimates and calculations. To date, East Hartford states it is saving at least 30 percent on its energy
costs.
East Hartford is embarking on a second phase of energy performance contracting for $7.3 million, and
has again engaged JCI to do the work in many of the town’s schools and education facilities. The town
has coupled the energy performance contracting with qualified energy conservation bond funding
(discussed on page 1 of summary) to finance the second phase.
Massachusetts. Massachusetts is using energy performance contracting extensively. More than 180 state
projects are currently underway, typically using combination of EPC with other financing, like federal
stimulus money, rebates or ratepayer funds. Further, Massachusetts has developed model contracting
language around energy performance contracting. Other model language has been developed by the
Building Owners and Management Association (BOMA) and the Energy Services Coalition. Links to the
websites are below:
www.mass.gov/Eoaf/docs/dcam/energy/model_comprehensive_esa_rec10_06.pdf
www.energystar.gov/index.cfm?c=comm_real_estate.bus_comm_real_estate.boma
www.energyservicescoalition.org/espc/tools/practices02/Model_EPC_Legislation.pdf
Appendix FF
Update on Proposal #50 to Have the City of Middletown Provide Water to CVH
How Does CVH Currently Receive Water? Connecticut Valley Hospital, located in Middletown,
receives water from its own reservoirs and water treatment plant. CVH’s six reservoirs also
provide water to the Connecticut Juvenile Training Center, Riverview Hospital, Shepherd Home,
Connection, Inc and several other neighboring facilities.
Current Expenses of the CVH Water Treatment Facility:
The cost to provide water at CVH and its neighbors is approximately $280,000-$300,000.
Current Expenses of CVH Water Treatment Facility

Expense Category Description Estimated Cost
Personal Service (staffing) 2 employees including 1 plant facility $140,000-$150,000
(not including fringe) engineer
Operating Expenses Chemicals, equipment, etc. $140,000-$150,000
Total $280,000-$300,000
Source: CVH Director of Physical Services and Plant Operations
Current Condition of the CVH Water Treatment Facility:

Siemens Water Technologies, Corporation, Shrewsbury, MA, inspected the CVH water
treatment plant and prepared a report dated January 29, 2010, describing the condition of
the filtration system as “very good.” Some “minor attention [is needed] to maintain the
high quality water it currently produces” (referring to minor rust and painting).
Current Proposal by the City of Middletown to Provide Water to CVH:
• Annual fee to CVH: $346,935 (high-end estimate), based on 94,641,800 gallons used
• There would also be an applicable meter charge to CVH depending on the size of the
meter required
• Ownership of water assets would be required to pass to the City of Middletown (six
reservoirs, watershed land, storage facilities, and production facilities). The City does
not have enough water to supply CVH without assuming these assets.
Summary:
The Department of Mental Health and Addiction Services, and CVH are concerned about
loss of control over the water for their patients. The City of Middletown has not inspected the
CVH plant in 12-15 years and questioned whether costly repairs might be needed. Because
current cost is not tied to the quantity of water used, CVH water expense is not impacted by an
increase in the client population, as is expected to occur with the closure of Cedar Ridge
Hospital.
Based on the City of Middletown projected water fee ($346,935) and the current cost of
water at CVH ($300,000), there would be an additional expense of $46,935 to have the City
of Middletown provide water to CVH. DMHAS/CVH may want to explore opportunities to
capitalize on this asset and distribute water more broadly, either independently or in partnership
with the City of Middletown.
Commission on Enhancing Agency Outcomes FF-1 Dec. 15, 2010 Final Report
APPENDIX GG
SUMMARY SHEET
Update on Proposal #8 to Implement LEAN Processes
What is LEAN? A process improvement approach used to reduce waste and focus on value to
the customer.
Examples of Waste
Document errors Completing work Waiting for the Searching for Backlogs
not needed next step information
Source: CT DOL
Originating in manufacturing, LEAN techniques are increasingly being used to identify and
eliminate redundancies, decrease the number of steps and processing time, and otherwise
improve efficiency in government service and administrative processes.
What LEAN efforts have occurred in CT government?

• CT DOL established Center for LEAN Government in May 2004 * 19 LEAN projects at
DOL to date * estimate saved $1,199,929 in worker hours
• CT DEP undertook 19 LEAN projects * reduced processing time for loan applications for
municipal wastewater treatment projects from 294 days to 113 days
• DAS awarded a contract for procurement of professional services to facilitate LEAN
government methodologies and services (Estimated to have a total value of $1.6 million,
seven companies are named in the award; however, use of the consultant companies is
dependent on agencies having funding available for this expense from their individual
budgets.)
• Bill to require state agencies to implement LEAN techniques to improve
current processes was introduced by GAE this year (SB 467: AAC LEAN
Government)
Examples of LEAN Projects at State Agencies

LEAN Project $aved
DOL - Streamline process to recoup Unemployment Insurance overpayments $13,200
• Eliminated or re-engineered 18 steps
• Eliminated 10,000 duplicate forms sent to employers annually
DEP - Streamline Inland Water Resources Division Permit Sufficiency Review $57,000
• Shortened response time to regulated community
• Reduced # of copies CT DOT has to make for processing the permits
BESB – Streamline process to deliver low-vision aids $54,000
• Reduced time to deliver low-vision aids to Adult Services Division clients
• Changed from individual to bulk ordering, with blanket purchase order approved by
state comptroller's office
Also: Cost per large print calendar (produced for clients) reduced from $15 (using private $10,300
vendor) to $4.70 (using DAS print shop)
Source: CT DOL Report on Cost Savings Through LEAN, 3/16/2010; BESB personal communication.
Commission on Enhancing Agency Outcomes GG-1 Dec. 15, 2010 Final Report
APPENDIX GG
SUMMARY SHEET
Summary: The total cost savings that can be attributed to LEAN is currently unavailable; the
above individual project savings range from $10,300 to $57,000; however, some LEAN
projects may result in efficiencies and better customer service, but not financial savings.
Commission on Enhancing Agency Outcomes GG-2 Dec. 15, 2010 Final Report
APPENDIX HH
Back Office Functions and Manager/Supervisor Positions in CT State Government
Agency* Total # of # of HR # of Payroll # of EEO # of Fiscal # of I.T. # of Managerial # of Non- # of
Employees Positions Positions
# of Positions Positions Positions Employees
# of Managerial
# of Non- Supervisors
Total # of # of HR # of EEO # of Fiscal # of I.T. Employees # of
Agency* Payroll Managerial Managerial
Board of Firearms and Permits Employees1 Positions
0 Positions0 Positions 0 Positions0 Supervisors 0
Positions0 Employees 0Employees 1
Comm Human Right and Ops 74 0 0 0 0 1 4 70 1
General Government
Office of Healthcare Advocate 9 5 00
Board of Accountancy 00 00 00 0
0 1 2 4 7 10
Military Department 107 1
Dept of Administrative Services 331 50 41 40 13
45 241 35 4 296 103 3513
Office of Child Advocate 8 01
Div Crim Justice 495 10 10 50 0
4 9 3 486 5 0
Protect/Advocacy Prsns Disab 45 00
Department of Public Works 169 10 00 160 0
3 19 2 150 43 19 5
Office of Victim
Department ofAdvocate
Revenue 4 0 0 0 0 0 0 4 0
Police Officer Stnds/Training
Services 22710 05 50 20 440 521 54 7 656 15 54 0
Department
DepartmentofofPublic Utility
Special Revenue 124110 01 10 00 166 8
4 4 9 106115 47
Workers
Dept of Comp Comm
Veterans Affairs 116338 13 10 10 118 4
3 11 2 327114 11 6
TOTAL Enforcement Comm
Elections 434649 300 0
14 05 12
145 1127 9238 40
4108 9
438
Conservation
Ethics Command 18 0 0 0 3 1 3 15 3
Development
Freedom of Information Comm 20 0 2 0 1 1 7 13 7
Agricultural Exp Station 83 00
Governor's Office 29 00 00 03 0
0 0 8 29 75 01
Arts Tourism Culture History 47 05
Dept of Information Technology 231 00 00 210 1840 61 3 170 44 61 1
Film
JudicialEnvironmental
Council Selection CommQuality 2 1 00 00 00 00 0
0 1 1 0 1 10
Lt. Governor's
Dept Office
Environmental Protection 946 5 100 04 02 0
41 220 0 50 5896 0
118
Off of Attorney
Economic General Dev
and Community 117328 11 10 00 6
17 3
3 217 15 111102 217 6
HH-2
Office of Policy and

TOTAL 1195 112
Management 131 04 02 61
44 254 56 77 1118
75 126
56
Health and Hospitals
Office of State Comptroller 264 3 9 1 64 67 44 220 44
Office of Chief Medical 61 11
Office of State Treasurer 142 00 00 364 2
7 28 3 114 58 28 1
Examiner
Off of Workforce
Dept of Developmental 4355 3 270 20
Competitiveness 0 03 56
0 17
0 2105 4250
1 332
2
HH-1
Services
Secretary
Dept of State
of Public Health 80985 81 03 01 5
30 5
20 4 42 81767 470
DeptTOTAL
of Mental Hlth & Addctn 3464
3490 73
43 25
16 96 329
56 374
41 565232 2899
3258 556
183
Svcs
Psychiatric
Regulation SecandReview Board
Protection 4 0 0 0 0 0 0 4 0
TOTAL
Dept of Agriculture 871962 790 39
0 10
0 146
0 80
0 5382 8337
57 586
3
Transportation
Office of Consumer Council 14 0 0 0 0 0 0 14 1
Deptof
Dept ofConsumer
Transportation
Protection 3078
156 230 00 08 173
4 39
2 8127 2951
148 288
21
HumanSvcs
Department of Motor Vehicles 750 7 3 2 28 29 42 708 46
Dept
DeptofofSocial Services
Banking 1921
116 143 02 01 87
28 51
3 15 77 1844
101 159
26
Soldiers
Department of Marine
Sailors Fund
Insurance 9
140 02 10 00 61 0
5 20 0 120 9 10 0
TOTAL
Department of Labor 1930
800 145 22 11 88
29 51
40 40 77 1853
760 159
85
Department of Public Safety 1678 11 7 2 14 17 67 1611 210
Emergency & Homeland Security 48 0 0 0 8 3 6 42 2
Fire Prevention 72 0 0 0 1 3 2 70 2
APPENDIX HH
Back Office Functions and Manager/Supervisor Positions in CT State Government
# of # of Non-
Total # of # of HR # of Payroll # of EEO # of Fiscal # of I.T. Managerial Managerial # of
Agency* Employees Positions Positions Positions Positions Positions Employees Employees Supervisors
Corrections
DCF 3518 39 10 4 62 36 221 3,297 484
DOC 6252 46 24 5 98 23 148 6,104 604
TOTAL 9770 85 34 9 160 59 369 9,401 1088
Education
Bd State Acdmc Awds (Charter Oak) 79 0 0 0 0 0 0 79 0
CCCS (provided by CCCS Chancellor
Herzog) 2,322 33 33 1 106 147 116 2,206
Comm Deaf Hearing Impaired 38 0 0 0 0 0 3 35 0
CT State Library 101 1 0 0 5 3 6 95 11
CSUS 3,489 37** 12 85 15 737 80* 3,325
DHE 44 0 0 0 0 0 44 0
BESB 121 0 0 0 4 4 1 120 5
SDE 2001 8 2 1 79 18 35 1,966 35
Teachers Rtrmnt Bd 24 0 0 0 11 3 3 21 1
UCHC (provided by UCHC)**** 4,715 39 13 4 58 134 149 4,566
HH-3
UCONN (provided by UConn)**** 4,559*** 39 23 7 86 172 105 4,454

TOTAL EDUCATION 17,493 157 82 13 364 1218 498 16911
Judicial****
Child Protection Commission 9 0 0 0 0 0 0 9
Judicial Branch (provided by Judge
Quinn) 4,362 25 9 2 19 185 187 4,175
Public Defender Services Comm 402 0 1 0 0 0 0 402
TOTAL JUDICIAL 4773 25 10 2 19 185 187 4586
* Provided by CSUS
** Based on location description
*** OPM reported 4,925 and PRI found 5,621 full time/>.49FTE employees
**** Agency not asked for # of supervisors
Appendix II
P-Card Program and Electronic Invoices
OVERVIEW
The State’s Purchasing Card (P-Card) Program is designed to offer State

agencies an alternative to the existing State procurement processes. It
allows agencies to quickly and conveniently purchase approved items
directly from a vendor that accepts credit cards. The State Comptroller, in
conjunction with the Department of Administrative Services, issues the State
of Connecticut Agency Purchasing Card Coordinator Manual, which sets forth
the State’s guidelines and procedures on the use of the purchasing cards by
State agencies.
The Comptroller may allow budgeted executive branch agencies to use

purchasing cards for purchases of $10,000 or less (4-98(c)). The Comptroller
can also establish specific limits for use of the purchasing card within the
limits established by the statute.
The following guidelines are included in the State of Connecticut Agency

Purchasing Card Coordinator Manual:
 State agencies are required to pay the full amount of the P-Card invoice
by the due date so no interest is accrued on the account. After the bill has
been paid, the Department should review the amounts charged to the P-
Card to determine whether they were appropriate State purchases and
whether there is adequate documentation on hand to support the
purchase.
 If the product or service being ordered is available from a State contract
supplier, the order must be placed with the State contract supplier.
 No personal expenses such as meals, personal telephone charges and
movie rentals should be charged to the P-Card.
 Travel expenses that are charged to the P-Card should be purchased
through the State contracted travel agent and should be for State
business only.
COST OF PURCHASE ORDER VS. PURCHASING CARD (From the

Comptroller’s Office)
Fiscal Year 2008
During Fiscal Year 2008, the total number of purchase orders issued was
124,883. Of these purchase orders, 75,133 were issued for purchases less
than $1,000. Using the industry standard cost of $89.21 per transaction, the
total annual cost for processing these transactions using a purchase order is
Commission on Enhancing Agency Outcomes II-1 Dec. 15, 2010 Final Report
estimated to be $6,702,615. If these purchases had been made using the
purchasing card, using the industry standard of $21.83 per transaction, the
annual cost would have been $1,640,153.
Of the 124,883 purchase orders issued during Fiscal Year 2008, 93,036 were
issued for purchases less then $2,500. Using the industry standard of $89.21
per transaction, the total annual cost for processing these transactions using a
purchase order is estimated to be $8,299,742. If these purchases had been
made using the purchasing card, using the industry standard of $21.83 per
transaction, the annual cost would have been $2,030,976.
Fiscal Year 2009
During Fiscal Year 2009, the total number of purchase orders issued was 99,471.
Of these purchase orders, 60,432 were issued for purchases less than $1,000.
Using the industry standard cost of $89.21 per transaction, the total annual cost
for processing these transactions using a purchase order is estimated to be
$5,391,139. If these purchases had been made using the purchasing card,
using the industry standard of $21.83 per transaction, the annual cost would
have been $1,319,231.
Of the 99,471 purchase orders issued during Fiscal Year 2009, 75,099 were
issued for purchases less than $2,500. Using the industry standard of $89.21
per transaction, the total annual cost for processing these transactions using a
purchase order is estimated to be $6,699,582. If these purchases had been
made on the purchasing card, using the industry standard of $21.83 per
transaction, the annual cost would have been $1,639,411.
REBATE (source: Comptroller’s Office)
Each year the State of Connecticut receives a rebate check from the
purchasing card vendor based on the annual charge volume generated with
the state Purchasing Card Program. For calendar years 2008 and 2009, the
state received a total of $315,000, which was deposited in the State’s general
fund.
POTENTIAL SAVINGS (source: Comptroller’s Office)
Statewide
The potential savings for the State of Connecticut for Fiscal Year 2008 could have
been $5,062,462 if state agencies had used the purchasing card for all
transactions less than $1,000. If the parameters were expanded to include all
purchases up to $2,500, the potential savings would have increased to
$6,268.766.
The potential savings for the State of Connecticut for Fiscal Year 2009 could have
been $4,071,908 if state agencies had used the purchasing card for all
transactions less than $1,000. If the parameters were expanded to include all
purchases up to $2,500, the potential savings would have increased to
$5,060,171.
The total estimated savings for FY 2008 and FY 2009, if state agencies had
utilized the purchasing card program instead of using a purchase order for
transactions less than $1,000, would have been $9,134,370. If purchases up
to $2,500 were included, the total estimated savings for FY 2008 and FY 2009
would have increased to $11,328,936. (Exhibit C)
Office of the State Comptroller
The State Comptrollers Office would benefit from an additional savings in the
operating budget in the costs associated with check stock, envelopes and
postage.
Best Practices:
Using the purchasing card provides an option that will reduce an agency’s
workload and reduce the costs to produce payments to vendors. In addition,
controls over purchasing are increased by allowing administrators to set dollar
limits per transaction and to restrict types of purchases made. Efficiencies are
achieved because the number of transactions to pay vendors is reduced by
requiring one purchase order for all transactions monthly and one monthly
payment. This provides staff the time to focus on more value added activities.
In accordance with Federal Acquisition Regulation 13.201 (b), the government-
wide commercial purchase card is the preferred method to purchase and to pay
for purchases $2,500 or less by the federal government.
The State of Connecticut purchasing policy prior to the implementation of

Core-CT in 2003 did not require a purchase order for purchases less than
$1,000. The purchasing authority used was “reservation 7,” which allowed an
agency to make a purchase without having to issue a purchase order. This
reduced the number of purchase orders issued. Prior to the implementation of
Core-CT, the State of Connecticut recognized this as a best practice. With the
implementation of Core-CT, all transactions now require a purchase order.
When using the purchasing card, all of the individual transactions are on one
purchase order in Core-CT.
AUDITING P-CARD PROGRAMS
During an agency audit, the Auditors of Public Accounts examine P-Card

Program usage and compliance. The auditors told us that they have not
encountered major program abuses. Below are the Auditors’ findings
concerning the P-Card Program in two agencies: the Department of Public
Safety and Office of Protection and Advocacy for Persons with Disabilities.
These findings seem to be consistent with those in other agencies.
DEPARTMENT OF PUBLIC SAFETY

FOR THE FISCAL YEARS ENDED JUNE 30, 2005 AND 2006
We reviewed monthly P-Card activity in the fiscal year ended June 30, 2006.
This testing disclosed the following:
• Numerous instances in which required documentation (either the P-Card log

(Form CO-501) or the Statement of Account) was either not completed, did not
contain the required supervisory approval, or was not submitted by the 20th of
the month.
• One instance in which a restricted, personal charge was made on a P-Card.
• One instance in which no supporting documentation was submitted as

required.
• Two instances in which both the employee and their supervisor did not sign
the Statement of Account.
DEPARTMENT OF PUBLIC SAFETY

FOR THE FISCAL YEARS ENDED JUNE 30, 2005 AND 2006
 We reviewed ten purchasing card invoices during the audited period;

three from the fiscal year ended June 30, 2005, and seven from the fiscal year
ended June 30, 2006. During our review, we noted the following:
 Five instances in which the purchasing card logs detailing purchases

made by two employees were not signed by respective supervisors, indicating
their approval.
 One instance in which it appeared that a single purchase was split into
multiple purchases, which by-passed the $1,000 single purchase limit
established by the Comptroller’s Purchasing Card Cardholder Work Rules
Manual.
 One instance in which a purchasing card was used to purchase meals

during a State business trip, which is prohibited by the State Comptroller’s
Purchasing Card Cardholder Work Rules Manual.

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COMMISSION ON ENHANCING

Senator Gayle Slossberg, Co-Chair Representative James Spallone, Co-

Senator Michael McLachlan

The Commission on Enhancing Agency Outcomes was first established in

Original enactment: February 2009

• identify functional overlaps and other redundancies among state agencies;

GAE administrative staff and nonpartisan legislative staff were to serve as

First amendment: August 2009

Second amendment: October 2009

In a bill implementing the biennial budget passed in October 2009, the

In terms of the directives to the commission related to agency mergers, the

An IBM representative and a consultant connected with IBM presented

• Immediately (during the 2010 legislative session)

No areas of focus were eliminated from the list.

• Personnel/Agency or Function Consolidations or Mergers

The commission expressed interest at the January 22 meeting in following up with

The seven categories contained in the work plan are: I) Personnel/Agency or

I. PERSONNEL/AGENCY OR FUNCTION CONSOLIDATIONS OR MERGERS

Explanation. Proposal #1 could be done this legislative session; the governor’s

a) Consolidate administrative functions including fiscal operations, human

Alternative ways for consolidating and executing a “steering” function include,

• Add a “Deputy Chief of Staff” for each function in the Governor’s

• Require the creation of Interagency Steering Committees (similar to one

• Meetings of the Interagency Steering Committees would be public and,

Explanation. The commission discussed how the steering function might be

Savings from a back-office consolidation among agencies serving persons with

Public Hearing Testimony on Agency or Function Mergers and Consolidations

Support for Proposal #3 from Connecticut Business and Industry Association.

Community Health Resources (Gates) suggests separating administrative and

The Department of Public Health opposes Proposal #3 consolidation of

Tasks To Develop and Refine Proposals

II. REGULATORY AND PROCEDURAL

Proposal #8: Implement lean processes in all executive branch agencies

Proposal #9: Streamline licensing and permitting processes

Proposal #11: Expand online applications statewide (also recommended in Information

Explanation. Proposal #10 and aspects of Proposal #9 were identified as short-

However, commission members discussed that any approaches to application or

Public Hearing Testimony on Regulatory and Procedural Issues

DEP indicates streamlining licensing and permitting (Proposal #9) is important,

CBIA supports LEAN processes (Proposal #8), as does DEP. TTT

Tasks To Develop and Refine Proposals

Proposal #15: Printing within state agencies

Explanation. These proposals were identified as short-term, with the commission

Public Hearing Testimony on Administrative Issues

The Commission on Human Rights and Opportunities supports Recommendation

Tasks To Develop and Refine Proposals

• Determine the agencies and personnel involved in conducting administrative

IV. CONTRACTING AND PURCHASING

Proposal #16: Enforce use of p-cards (review audit findings)

Explanation. These were determined to be immediate as they could be

Proposal #19: Cooperative Purchasing Opportunities – create and/or join cooperative

o Requires legislation to define joint powers/governmental entities that may

o And/or join multistate cooperative purchasing organization – see for

o Enforce bulk purchasing rules for higher education (see audit)

Explanation. Proposals #18 through 22 were all determined to be short-term,

The Department of Administrative Services indicates it already belongs to the

Proposal #23: Master contracting

Public Hearing Testimony on Contracting and Purchasing

Tasks To Develop and Refine Proposals

Re: Contract Types and Aggregate Expenditures

Re: Individual Contractors and Contracts

Proposal #24: On-line applications system statewide (example, Department of Motor

Explanation. These proposals were determined to be achieved in the short term