Connecticut Provider Legislative Update

Shipman is pleased to share with our Connecticut friends and clients the following summary of relevant legislative developments.  Should you need any clarification, we are ready to help.

General:

• Telehealth Expansion--New laws extend last year’s telehealth provisions until June 30, 2023. The laws also (1) expand the types of health professionals authorized to provide telehealth services, (2) expand allowable service delivery of audio-only services, (3) establish requirements for telehealth providers seeking payment from underinsured and uninsured patients, and (4) expand requirements for insurance and Medicaid coverage of telehealth services. (PA 21-9, as amended by PA 12-133, §§ 3 and 4, effective upon passage July 7, 2021)
• Outpatient Mental Health Treatment--A new law allows minors to request and receive (without parental consent) as many outpatient mental health treatment sessions as necessary from a psychiatrist, psychologist, independent social worker, or marital and family therapist (whereas prior law generally limited this to six sessions). The new law also allows a provider to notify a parent or guardian of treatment provided without the minor’s consent or notification if the notification or disclosure is necessary for the minor’s well-being, the treatment is solely for mental health and not for a substance use disorder, the minor is given an opportunity to express objection, and the provider discloses only a limited subset of information. (PA 21-46, § 10, effective July 1, 2021)
• Immunization Requirements--A new law eliminated the state’s religious exemption from immunization requirements for individuals attending public and private schools, which includes higher education institutions, and child care centers and group and family day care homes. Certain students’ religious exemptions are grandfathered in under the new law. (PA 21-6, effective April 28, 2021)
• Cannabis Legalization/Medical Marijuana--The state’s new cannabis legalization law permits hospitals to restrict patients’ cannabis use and the medical marijuana law was amended to broaden the types of entities in which physicians or APRNs may not have a financial interest if they certify patients for medical marijuana use, to require licensed pharmacists working in dispensary facilities or hybrid retailer employees to transmit dispensing information on any cannabis sold to a qualifying patient or caregiver in a manner the DCP commissioner prescribes, and to allow the DCP commissioner to add to the list of medical conditions that qualify for medical use without adopting regulations. (PA 21-1, §§ 65, 66-82, 94, 104, 146, with various effective dates from July 1, 2021 to January 1, 2022)
• Nonprofit Savings Incentive Program--New laws expand and make permanent a pilot incentive program for nonprofit human services providers that realize savings in the state-contracted services they deliver, which must allow providers to retain any savings realized and must not reduce future contracted amounts solely to reflect such savings. Eligible providers include nonprofit providers of services to persons with intellectual, physical or mental disabilities or autism spectrum disorder, who, upon retaining savings under the incentive program, must submit a report to the OPM secretary on how excess funds were reinvested. (PA 21-65, § 2, and PA 21-2, § 339, effective July 1, 2021)
• Primary Care Direct Services Program and Loan Repayment--A new law requires, rather than allows, DPH to establish a program providing three-year grants to community-based primary care providers to expand access to care for the uninsured. Existing law permits program grants to be used for providing loan repayment to primary care clinicians and registered nurses, and another new law requires DPH in FY 22 to implement the state loan repayment program for community-based health care providers in primary care settings. (PA 21-2, § 28, and PA 21-35, § 21, effective June 14, 2021 and July 1, 2021)
• Clinical Laboratories--A new law requires licensed clinical laboratories to report to DPH the name and address of each blood collection facility they own and operate, both before obtaining or renewing their license and whenever opening or closing a blood collection facility. (PA 21-121, § 39, effective July 1, 2021)
• Post-Traumatic Stress Injuries Related to COVID-19--A new law makes certain health care providers eligible to receive workers’ comp benefits for post-traumatic stress injuries (PTSI) if a PTSI is diagnosed by a mental health professional as a direct result of a “qualifying event” in the line of duty, which is defined to include 4 events in the context of a provider engaging in activities substantially dedicated to mitigating or responding to COVID-19. (PA 21-107, effective June 30, 2021)

Hospitals:

• DPH Access to Certain Electronic Hospital Records--A new law requires hospitals to provide DPH access, including remote access, to the entirety of certain electronic medical records: (1) concerning reportable diseases and emergency illness and health conditions; (2) to perform case finding or other quality improvement audits deemed necessary by DPH to ensure completeness of reporting and data accuracy in the Connecticut Tumor Registry; (3) to review case information as DPH deems necessary related to a maternal death case under review by the Maternal Mortality Review Program, as DPH deems necessary; and (4) to perform quality improvement audits, as DPH deems necessary, to ensure completeness of reporting and data accuracy of births, fetal deaths, and death occurrences. Hospitals must grant DPH this access by October 1, 2022 if technically feasible. (PA 21-121, §§ 78-81, effective October 1, 2021)
• Hospital Patients and Family Caregivers--A new law requires hospital personnel, when admitting a patient, to promptly ask the patient if they want the hospital to notify a family member, caregiver, or support person of the admission (whereas prior law required that hospital personnel ask only about physicians the patient wished to be notified). If the patient desires, hospital personnel must make reasonable efforts to contact such person as soon as practicable, but within 24 hours of the patient’s request. (PA 21-26, § 4, effective October 1, 2021)
• Implicit Bias Training--A new law requires hospitals, staring October 1, 2021, to include training in implicit bias as part of their regular training for staff members who provide direct care to women who are pregnant or in the postpartum period. (PA 21-35, § 13, effective June 14, 2021)
• Restrictions on Hospital Billing & Collection Efforts and Facility Fees--A new law makes several changes to Connecticut’s laws regarding restrictions on hospital billing and collection efforts, including, but not limited to, the following: (1) expanding the application of billing and collection restrictions beyond hospitals by also including entities that are “owned by” or “affiliated with” hospitals (both of these terms are defined by statute); and (2) adding provisions prohibiting hospitals, entities that are “owned by” or “affiliated with” hospitals, or collection agents that receive a referral from a hospital or entity “owned by” or affiliated with” hospitals from: (a) reporting an individual patient to a credit rating agency for a period of 1 year beginning on the date that such patient first receives a bill for health care provided; (b) initiating an action to foreclose a lien on a patient’s primary residence if the lien was filed to secure payment for health care provided; or (c) applying to a court for an execution against a patient’s wages or otherwise seeking to garnish such patient’s wages, to collect payment for health care provided, if such patient is eligible for the hospital bed fund.
  
  A new law also makes several changes to Connecticut’s laws regarding facility fees, including, but not limited to, the following: (1) requiring that, not later than October 15, 2022, and annually thereafter, hospitals, health systems, and hospital-based facilities submit to the Health Planning Unit of the Office of Health Strategy (“OHS”) a sample of their billing statements that illustrate compliance with legal requirements concerning facility fee billing; (2) adding a requirement to the existing hospital-based facility fee notice requirement that the written notice include tag lines in at least the top 15 languages spoken in the state indicating that the notice is available in each of those languages and that, not later than October 1, 2022, and annually thereafter, each hospital-based facility submit a copy of the notice to the OHS Health Planning Unit; and (3) requiring that each hospital-based facility that was the subject of a transaction during the preceding calendar year report to the OHS Health Planning Unit the number of patients served by such hospital-based facility in the preceding 3 years. (PA 21-129, effective October 1, 2022)

Insurance:

• Health Insurance/Participating Provider Contracts--A new law makes changes to contracts between health carriers and participating providers, including requiring carriers to provide 90 days’ notice before making changes to certain provisions or documents incorporated by reference into the contract, including provider manuals and policies, that result in a material change to the contract or procedures that a participating provider must follow pursuant to the contract. The new law also grants providers the right to appeal those changes. Applies to contracts entered into, renewed, or amended on or after July 1, 2022. (PA 21-2, § 83, effective October 1, 2021)
• Third Party Liability for Medical Assistance Payments--A new law establishes deadlines for insurers to act on claims DSS submits to it for covered health care items and services by paying the claim, requesting information necessary to determine its legal obligation to pay, or denying the claim. If the insurer does not act within 180 days of receipt of the claim, then it creates an uncontestable obligation to pay the claim. The new law also requires insurers to request refunds from DSS when they determine that they are not liable for a claim for which they reimbursed DSS within 12 months from the date of its reimbursement to DSS. (PA 21-2, § 334, effective July 1, 2021)

Medicaid:

• Medicaid Expanded Coverage--New laws expanded eligibility for Medicaid and other forms of medical assistance, including (1) starting April 1, 2022, extending coverage under Medicaid and CHIP for women for 12 months after giving birth (PA 21-2, §§ 335 & 336, effective June 32, 2001); (2) starting April 1, 2023, providing state-funded medical assistance for postpartum care for women who do not qualify for Medicaid due to immigration status (PA 21-176, § 2, effective October 1, 2021); (3) starting in 2023, providing state-funded medical assistance for children under 9, regardless of immigration status, who live in households with certain income requirements (PA 21-176, §§ 1 & 3, effective October 1, 2021); and (4) starting April 1, 2022, providing CHIP coverage for pregnant women under an option that allows the state to consider the unborn child a low-income child eligible for CHIP coverage (PA 21-176, § 4, and PA 21-2, § 344, effective October 1, 2021).
• Provider Rate Increases--Several provider rate increases were included in the budget implementer act (PA 21-2), including:
  • allocating $4.625 million appropriated to DSS from the General Fund in FYs 22 and 23 to fund an increase in the Medicaid reimbursement rate for certain Medicaid-funded home and community-based waiver programs services and home health care (§ 338, effective July 1, 2021);
  • allocating $375,000 appropriated to DSS from the General Fund in FYs 22 and 23 to increase the reimbursement rate for the state-funded portion of the Connecticut Home Care Program for the Elderly (§ 338, effective July 1, 2021);
  • requiring DSS to increase the per diem rate for chronic disease hospitals by 4% (§ 342, effective July 1, 2021);
  • increasing Medicaid reimbursement rates by 10% for emergency and nonemergency ambulance services and by $3 for transports beginning in FY 22 (§ 340, effective July 1, 2021);
  • requiring OPM to allocate available funds for FY 22 and 23 to increase rates to state-contracted providers for wage enhancements and related payroll taxes, workers’ comp, and unemployment insurance expenses for employees who provide services to individuals with intellectual disability who receive supports and services through DDS (§ 341, effective July 1, 2021); and
  • requiring DSS to provide an inpatient Medicaid rate of $975 per day to Natchaug Hospital for FY 22 (§ 343, effective June 23, 2021).
• Various Provider Rates/Policies--Several other changes to laws concerning Medicaid providers include:
  • Allowing APRNs and PAs to order home health care services covered by DSS (PA 21-133, § 1, effective July 7, 2021);
  • Allowing DSS commissioner to waive or suspend prior authorization or other utilization review criteria for Medicaid and CHIP (PA 21-133, § 5, effective July 7, 2021);
  • Requiring DSS to cover services provided by acupuncturists and chiropractors under Medicaid (PA 21-2, § 331, effective June 23, 2021);
  • Eliminating a provision under prior law that required Medicaid payments for methadone maintenance to be contingent on providers meeting certain performance measures (PA 21-2, § 332, effective July 1, 2021);
  • Requiring DSS to reimburse licensed nurse-midwives at the same rates as OB/GYNs for performing the same services or procedures (PA 21-2, § 333, effective June 23, 2021); and
  • Requiring DSS to reimburse licensed podiatrists at the same rates as licensed physicians for performing the same services or procedures (PA 21-2, § 333, effective June 23, 2021).

Provider Scope of Practice:

• Physician Assistants--A new law allows PAs to certify, sign, or otherwise document medical information in several situations that previously required a physician’s or APRN’s signature, certification, or documentation. Some examples include (1) certifying a disability or illness for continuing education waivers or extensions for various health professions and (2) documenting that a patient’s nursing home room transfer would be medically contraindicated. (PA 21-196, effective October 1, 2021)
• Home Health Orders--A new law allows PAs and APRNs licensed in Connecticut to order home health care agency services, hospice agency services, and home health aide agency services, and allows PAs and APRNs in bordering states to order home health care agency services. Only physicians could issue these orders under prior law. (PA 21-121, § 52, effective July 1, 2021)
• Out-of-State Practitioners During Public Health Emergencies--A new law expands the type of out-of-state-practitioners for which DPH may temporarily suspend licensing, certification, and registration requirements during a declared public health emergency, to include alcohol and drug counselors; art and music therapists; behavior analysts; dietician-nutritionists; dentists and dental hygienists; genetic counselors; OTs; radiographers, radiologic technologists; radiologist assistants, and nuclear medicine technologists; and SLPs. (PA 21-121, § 43, effective July 6, 2021)
• Doula Scope of Practice--A new law requires the DPH commissioner to conduct a scope of practice review, according to existing scope of practice review processes, to determine whether DPH should establish a state certification process for doulas. (PA 21-35, § 15, effective June 14, 2021)

Assisted Living:

• Assisted Living Services Agencies’ Licensure--A new law requires a managed residential community (MRC) that wishes to provide assisted living services to obtain a DPH license as an assisted living services agency (ALSA) or arrange for such services with a licensed ALSA, for which the MRC must apply to DPH to arrange for those services. (PA 21-121, §§ 45, 56, effective July 1, 2021; and §§ 91 & 92, effective July 6, 2021)
• ALSAs Operating as Dementia Special Care Units--A new law prohibits ALSAs from providing services as dementia special care units or programs unless they obtain DPH approval. (PA 21-121, § 56, effective July 1, 2021)

Pharmacists/Prescription Drug Management:

• Collaborative Drug Therapy Management Agreements--A new law specifies that when certain pharmacists have entered into written, protocol-based collaborative drug therapy agreements with physicians or APRNs to manage a patient’s drug therapy, then (1) a pharmacist is also authorized to continue or de-prescribe a drug therapy, and (2) such agreements may include guideline-directed management, rather than be patient-specific. (PA 21-192, §§ 1 & 4, effective July 13, 2021)
• Pharmacist-Prescribed Epinephrine Auto Injectors--A new law permits a pharmacist, once a year per patient and in his or her professional discretion, to issue and fill a prescription for up to 2 epinephrine auto injectors, under certain conditions. (PA 21-37, § 45, effective June 4, 2021)
• Reporting Opioid Agonists--A new law requires, under certain conditions, that opioid agonists for treatment of a substance use disorder (e.g. methadone) be uploaded into the electronic Prescription Drug Monitoring Program’s database by previously exempt substance abuse treatment-related opioid antagonist dispensers and administrators. (PA 21-192, § 5, effective July 1, 2022)

DPH/State Action:

• Commission on Racial Equity in Public Health--A new law declares that racism is a public health crisis in Connecticut and will continue to be a crisis until the state meets the goal of reducing, by at least 70%, racial disparities in specified indicators in education, health care utilization and outcomes, criminal justice, and economic matters. The act also establishes a Commission on Racial Equity in Public Health. (PA 21-35, §§ 1-4, effective June 14, 2021) 
• Demographic Data Collection--Starting January 1, 2022, the new law establishes requirements for state agencies or state entities that collet demographic data related to health care or public health, including by (1) expanding race and ethnicity categories to include subgroup identities as specified by OHS’ Community and Clinical Integration Program, and (2) allowing people to select one or more ethnic or racial designations or refuse to identify such designations. (PA 21-35, § 11, effective June 14, 2021)
• Physician Practices and Merger Oversight Study--A new law requires OHS to (1) study certain matters regarding physician practices and oversight of practice mergers and acquisitions, and (2) develop legislative recommendations to improve reporting and oversight of these transactions. (PA 21-129, § 5, effective July 7, 2021)
• Provider Payment Parity Study--A new law requires the DSS commissioner in collaboration with the DMHAS and Housing commissioners to study whether state-contracted human services providers, including physical and behavioral health services providers, receive disparate payment rates under programs they administer in different regions of the state. DSS Commissioner must report on the study and any rate adjustment recommendations to the Appropriations, Housing, Human Services, and Public Health Committees. (PA 21-148, § 11, effective July 7, 2021)