Connecticut Provider Legislative Update – Food, Drugs, Healthcare, Life Sciences – United States – Mondaq News Alerts

United States: Connecticut Provider Legislative Update

13 September 2021

Shipman & Goodwin LLP

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 (which we wrote about here) 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 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 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” of “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 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) staring 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, 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 identifies 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)

The content of this article is intended to provide a general
guide to the subject matter. Specialist advice should be sought
about your specific circumstances.

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