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United States: Connecticut Provider Legislative Update

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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.


  • 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,
  • 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,
  • 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,
  • Primary Care Direct Services Program and Loan
    –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,
  • Post-Traumatic Stress Injuries Related to
    –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)


  • DPH Access to Certain Electronic Hospital
    –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,
  • 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,
  • 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
  • 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)


  • Health Insurance/Participating Provider
    –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,
  • Third Party Liability for Medical Assistance
    –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,


  • 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,
  • 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,
  • 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,
    • 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,
    • Requiring DSS to cover services provided by acupuncturists and
      chiropractors under Medicaid (PA 21-2, § 331, effective June 23,
    • 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,
    • 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);
    • 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,

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,
  • Out-of-State Practitioners During Public Health
    –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,
  • 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,

Assisted Living:

  • Assisted Living Services Agencies’
    –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
    –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,

Pharmacists/Prescription Drug Management:

  • Collaborative Drug Therapy Management
    –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
    –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,
  • 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,

DPH/State Action:

  • Commission on Racial Equity in Public
    –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,
  • 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,
  • Physician Practices and Merger Oversight
    –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,
  • 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,

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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