CT HEALTH LAW LEGISLATIVE UPDATE
The Following Public Acts Are Effective From Passage:
Special Act 14-1: An Act Concerning a Study of the Renewal Times for Occupational Licenses.
This legislation requires the Department of Public Health (DPH) and the Department of Consumer Protection (DCP) to review the occupational license renewal times for health care and pharmacy professionals under current licensure laws. By July 1, 2015, DPH and DCP must jointly report to the applicable joint standing committees of the General Assembly their recommendations for extending such renewal periods without jeopardizing the public’s health or safety while achieving cost savings for such professionals. Special Act 14-5: An Act Concerning DPH's Recommendations Regarding Medical Orders for Life-Sustaining Treatment. This new legislation allows DPH to establish a pilot program in one or more geographic areas of the state for the use of medical orders for life-sustaining treatment (Medical Orders), which are written orders by a physician, advanced practice registered nurse (APRN) or physician assistant (PA) to carry out a patient’s request for life-sustaining treatment when a physician determines that a patient is nearing the end stages of a serious illness or is in an advanced condition of frailty. Under this legislation, DPH must adopt policies and procedures for the pilot program to ensure that (1) the Medical Orders are transferrable among and recognized by different types of health care institutions; (2) the patient or the patient’s authorized representative signs the medical order and the patient’s authorized representative is given a copy of the Medical Order; (3) there is documentary evidence that the patient’s physician, APRN or PA discussed the patient’s treatment goals, benefits and risks of treatment, and methods of end-of-life procedures with the patient or the patient’s representative, and (4) physicians, APRNs and PAs receive training on communicating to patients endof-life issues and medical orders. Participation in the pilot program is voluntary, and the pilot program will end no later than October 1, 2016. Public Act 14-157: An Act Concerning Coverage Under State Medical Assistance Programs for Certain Over-the-Counter Drugs. Generally, under current Connecticut law, the Department of Social Services (DSS) provides no payment through its medical assistance programs for over-the-counter drugs, except for drugs paid for through the Connecticut AIDS Drug Assistance Program, insulin, nutritional supplements for individuals who are tube fed and smoking cessation drugs. This new legislation expands this list to include over-the-counter drugs required to be covered under the Affordable Care Act, which includes drugs rated as “A” or “B” by the U.S. Preventative Services Task Force, such as vitamin supplements for certain populations. (Public Act No. 14-217 contains identical language to Public Act No. 14- 157).Page 2 of 23 CT HEALTH LAW LEGISLATIVE UPDATE Public Act 14-167: An Act Concerning Workers’ Compensation and Liability for Hospital and Ambulatory Surgical Center Services. Connecticut’s Workers’ Compensation Act (Act) requires employers to reimburse hospitals and ambulatory surgical centers at the prevailing rates in the community for treatment provided to injured workers covered under the Act. This legislation seeks to set predetermined rates for employer liability for such costs by requiring the Workers’ Compensation Commission (Commission) to establish Medicare-based formulas for reimbursement of hospital and ambulatory surgical center services covered by Medicare. The Commission is required to publish the new reimbursement rates by January 1, 2015, and update them annually thereafter. Commencing 90 days following publication of such rates, employer liability for hospital or ambulatory surgical center services shall be limited to (1) such published rates for services covered by Medicare or (2) reimbursement rates determined by the Commission for services not covered by Medicare. In setting the new reimbursement rates required by this legislation, the Commission is required to consult with employers and their insurance carriers, self-insured employers, hospitals, ambulatory surgical centers, third-party reimbursement organizations and other entities. The new reimbursement rates will not apply to employers that independently negotiated separate rate agreements with hospitals or ambulatory surgical centers. Public Act 14-206: An Act Concerning Medicaid Cost Savings. Currently, the Council on Medical Assistance Program Oversight (CMAPO) advises DSS on planning and implementing the HUSKY Plan, Parts A and B and the Medicaid program. This legislation adds six members to the CMAPO to serve on a subcommittee that will make recommendations on Medicaid cost savings through the use of evidence-based best practices. The new members will be appointed by the House speaker, the senate president pro tempore, the majority leaders of the House and Senate and the minority leaders of the House and Senate. The additional CMAPO members will represent the following industries: the Connecticut Hospitals Association, the business community, the for-profit and not-for-profit nursing home industry and physicians who serve Medicaid patients. The Following Public Acts Are Effective July 1, 2014: Public Act 14-30: An Act Concerning Capital Expenditures at Residential Care Homes. This legislation revises a current law that governs rates of payment to residential care homes by requiring that any costs less than $10,000 that are reported to DSS in connection with DSS’ rate-setting processes and are incurred by a residential care home associated with land, buildings or nonmovable equipment repair or improvement must be capitalized within five years. Public Act 14-95: An Act Concerning the Expansion of a Small House Nursing Home Pilot Program. Under current law, DSS administers a pilot program that supports the development of one “small house nursing home” to improve quality of life for nursing home residents and to support the goal of providing nursing home care in a more home-like setting. A “small house nursing home” is defined as a facility designed to simulate a private residence that enables an increased role for support staff in the care of residents and incorporates a philosophy of individualized care while being licensed as a nursing home. This legislation enables DSS to expand the pilot program Page 3 of 23 CT HEALTH LAW LEGISLATIVE UPDATE to develop additional small house nursing homes in the state. This legislation also removes the current law’s limit of 280 beds as the maximum allowable number of beds for involvement in the pilot program. Public Act 14-115: An Act Connecting the Public to Behavioral Health Care Services. This legislation directs the Office of the Healthcare Advocate (OHA) to establish a service for Connecticut residents and providers to receive information on, referrals to and access to behavioral health care providers by January 1, 2015. Also by January 1, 2015, the OHA must develop a process to track referrals to providers, patient wait times and the number of providers who accept or reject patient requests for services based on health care coverage. Public Act 14-150: An Act Concerning Waivers for Medicaid-Financed, Home and Community-Based Programs for Individuals with Acquired Brain Injury. Currently, pursuant to a Medicaid waiver, DSS offers home- and community-based services to adults with acquired brain injuries (ABI) who are under age 65. This legislation requires DSS to continue the current waiver and prohibits DSS from phasing out services under the waiver or institutionalizing individuals to meet federal cost neutrality requirements. This legislation also authorizes DSS to seek a second Medicaid waiver for the provision of additional home- and community-based ABI services. Public Act 14-158: An Act Concerning Brand Name Drug Prescriptions for State Medical Assistance Recipients. Current law allows licensed medical practitioners to prescribe brand-name drugs to Medicaid recipients when a generic alternative is available, provided that the practitioner states the reason for the brand-name drug and, in handwriting, states “brand medically necessary.” The practitioner may transmit the handwritten prescription electronically or by phone, and if communicated to the pharmacist by phone, the pharmacist must handwrite the phrase “brand medically necessary” on the prescription form. This new legislation allows a practitioner, when electronically submitting a prescription, to select a code to indicate that a generic drug may not be substituted for the brand-name drug prescribed. This new legislation applies to prescriptions written for individuals who receive “medical assistance.” Medical assistance recipients include Medicaid recipients and those receiving benefits under the State Children’s Health Insurance Program, known as HUSKY B. Unless a practitioner specifies that a generic substitute shall not be made, pharmacists are required to dispense a generic equivalent drug to a medical assistance recipient. Public Act 14-160: An Act Concerning Medicaid Reimbursement for Emergency Department Physicians. Beginning on January 1, 2015, concurrent with the implementation of diagnosis-related group payment to hospitals, an emergency department physician may separately enroll as a Medicaid provider and receive direct reimbursement for professional services provided to Medicaid recipients in a hospital emergency department. The reimbursement may include payment for services provided on the same day a Medicaid recipient is admitted to the hospital. Physicians who elect to separately enroll will be paid under the Medicaid physician fee schedule. However, if DSS determines that such rates will increase cost to the state, DSS will work with the Connecticut Hospital Association and the Connecticut College of Emergency Physicians to adjust the payment rates.Page 4 of 23 CT HEALTH LAW LEGISLATIVE UPDATE Public Act 14-162: An Act Concerning Provider Audits Under the Medicaid Program. This legislation revises the processes by which DSS audits (1) Medicaid service providers (providers), including hospitals, durable medical equipment suppliers, physicians, federally qualified health centers, home health agencies and pharmaceutical service providers and (2) long-term care facilities (facilities) that receive Medicaid or other state payments, including nursing homes, chronic disease hospitals associated with a nursing home, residential care homes and residential facilities for intellectually disabled people. DSS may now consider a provider’s or facility’s history of compliance in determining which providers and facilities shall be audited. Current law allows DSS to find an overpayment or underpayment based on extrapolated projections (1) if there has been a high rate of error, (2) where education has not corrected the error level or (3) where the aggregate value of the claims is over $150,000 annually. This new legislation revises the aggregate value of claims to over $200,000. This legislation defines extrapolation as “the determination of an unknown value by projecting the results of the review of a sample to the universe from which the sample was drawn.” A “universe” is “a defined population of claims submitted by a provider [or facility] during a specific time period.” This legislation also requires DSS and its audit contractors (audit contractors) to consult, on an as-needed basis, with licensed health professionals who are experienced in the type of treatment, billing and coding procedures that are used by the provider or facility being audited. Current law states that DSS or an audit contractor must hold an exit conference with the provider or facility that was audited to discuss the preliminary audit report. This legislation allows a provider or facility to present evidence at the exit conference that refutes the auditor’s findings. This legislation requires DSS to provide free training to providers and facilities on avoiding claims errors and preparing cost reports. DSS must also establish and publish audit protocols to improve compliance with state and federal Medicaid regulations for specific providers or facilities, including, but not limited to, (1) home health agencies, (2) hospital outpatient service, (3) durable medical equipment, (4) physician and nursing services, (5) pharmaceutical services, (6) chronic and convalescent nursing homes, (7) residential care homes, (8) chronic disease hospitals associated with a nursing home, (9) residential facilities for intellectually disabled people and (10) rest homes with nursing supervision. Lastly, this legislation adds a requirement that DSS must submit a report by February 15, 2015, to the General Assembly’s Human Services Committee on the audit protocols and procedures it established for providers and facilities. By February 15, 2016, DSS must report back to the Human Services Committee on the implementation of such audit protocols and procedures. The provisions of this legislation do not apply to provider audits conducted by the Medicaid Fraud Control Unit of the Office of the Chief State’s Attorney. Public Act 14-197: An Act Concerning Pharmacy Rewards Programs and Protected Health Information. This new legislation requires a pharmacy to provide consumers with a written summary, in plain language, of the terms and conditions of its pharmacy rewards program prior to enrollment in such a program. A “pharmacy rewards program” is a promotional arrangement that provides a consumer with discounts or other benefits in exchange for Page 5 of 23 CT HEALTH LAW LEGISLATIVE UPDATE filling prescriptions through the pharmacy or its affiliates. If a pharmacy requires the consumer to sign an authorization form under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) to participate in the program, the pharmacy must provide the consumer with detailed information about the permissible uses and disclosures of the consumer’s protected health information (PHI) by the pharmacy’s rewards program. Specifically, the authorization must (1) describe the specific uses and disclosures of PHI allowed by the authorization; (2) state whether the pharmacy will disclose PHI to third parties and, if so, that such information may not be protected by HIPAA or other privacy laws; (3) if applicable, state which third parties will have access to the consumer’s PHI; (4) describe how the consumers may revoke their authorization and (5) state that the consumer is entitled to a signed copy of the authorization. In addition, a pharmacy must define the terms “HIPAA,” “Health Insurance Portability and Accountability Act of 1996,” “HIPAA authorization,” “protected health information,” and “marketing” if any of those terms are used by the pharmacy in promotional materials, in the plain language summary and adjacent to the signature line on the HIPAA authorization form. Violation of this new law shall be deemed an unfair or deceptive act or practice under Connecticut’s Unfair Trade Practices Act. Public Act 14-224: An Act Concerning the Pharmacy Practice Act and Counterfeit Drugs or Devices. This legislation makes a number of changes to Connecticut’s Pharmacy Practice Act and also implements a prohibition on the sale and delivery of counterfeit drugs or devices. Under current law, a pharmacist may substitute a generic drug for a prescription drug in certain circumstances, except where the prescribing practitioner specifies in writing or by telephonic or electronic order that there shall be no substitution. Current law contains specific requirements for Medicaid prescriptions that a practitioner must meet for prescription drugs that cannot be substituted. This legislation eliminates these Medicaid-specific requirements from the Pharmacy Practice Act, thereby enabling Public Act 14-158, which implements revisions to the process for prescribing brand-name drugs to individuals who receive medical assistance as described above. This legislation requires prescribing practitioners to indicate “brand medically necessary” or “no substitution” on a prescription form. This legislation also eliminates a previous requirement that a practitioner who specified no substitution by a telephonic or electronic communication, where the communication did not reproduce the practitioner’s handwriting, submit a written certification to that effect within 10 days to the dispensing pharmacy. For prescriptions transmitted telephonically, this legislation requires pharmacists to specify “brand medically necessary” or “no substitution” on the prescription form in the pharmacist’s handwriting, along with the time the pharmacist received the telephonic authorization and the name of the authorizing practitioner. For prescriptions transmitted electronically, this legislation requires the practitioner to select the “dispense as written” code on the certified electronic prescription form to indicate that a substitution is not allowed. This legislation prohibits prescription forms, whether transmitted in writing, telephonically, or electronically, from defaulting to “brand medically necessary” or “no substitution.” This legislation also introduces compliance requirements for sterile compounding pharmacies. A “sterile compounding pharmacy” is a domestic or nonresident pharmacy that dispenses or compounds sterile pharmaceuticals, which are defined as any dosage form of a drug. In certain instances, the new requirements also apply to institutional pharmacies operating within hospitals or other facilities that compound sterile pharmaceuticals. This legislation includes new registration, inspection and reporting requirements for both resident and non-resident sterile compounding pharmacies. This legislation requires sterile compounding pharmacies to notify DCP within 24 hours of any recall, to report any action taken by a regulatory or accreditation agency and to report known violations of sample Page 6 of 23 CT HEALTH LAW LEGISLATIVE UPDATE testing. In addition, this legislation requires practitioners, hospitals and other health care facilities to notify DCP of any dispensing errors or suspected adulteration of sterile pharmaceuticals. Finally, this legislation implements an enhanced prohibition on the sale or delivery of a counterfeit drug or device and repeals a previous law prohibiting the purchase, sale or transfer of a counterfeit substance. This legislation enables DCP to conduct investigations and hearings regarding the illegal sale or delivery of counterfeit drugs or devices. DCP is authorized to suspend or restrict a license, to impose civil penalties of up to $1,000 per violation and to take other action as it deems necessary against violators of this legislation. Violators may also be subject to fines of up to $10,000, imprisonment for up to one year, or both for each violation. The Following Public Acts Are Effective October 1, 2014 Public Act 14-6: An Act Concerning Captive Insurance Companies. This legislation makes several changes to Connecticut’s captive insurance laws, including the following: Current law restricts the operation of branch captive insurance companies in the state to only writing insurance or reinsurance of the employee benefit business of its parent and affiliated companies. This legislation removes that restriction, enabling branch captive insurance companies to write other types of coverage as well. Current law requires branch captive insurance companies to maintain a principal place of business in Connecticut to conduct insurance business in the state. This legislation modifies that requirement so that a branch captive insurance company is only required to maintain one of its principal places of branch operations in Connecticut. This legislation permits a captive insurance company organized under the laws of another state to become a domestic captive insurance company in Connecticut. To become a domestic captive insurance company, the organization must comply with Connecticut organizational and licensure requirements and must designate its principle place of business in Connecticut. Current law limits the insurance statutes with which captive insurance companies must comply. This legislation expands the application of certain insurance statutes to captive insurance companies. For example, this legislation requires captive insurance companies to adopt conflict of interest policies and procedures, and it empowers the Connecticut Insurance Department to impose additional statutory compliance requirements on captive insurance companies that meet certain controlling interest thresholds. A compliance requirement may subsequently be rescinded where the captive insurance company demonstrates that the conditions that triggered imposition of the compliance requirement are no longer present and that no other triggering conditions exist. Public Act 14-61: An Act Providing Immunity to a Person Who Administers an Opioid Antagonist to Another Person Experiencing an Opioid-Related Drug Overdose. Current law grants civil and criminal immunity to licensed health care professionals who prescribe, dispense or administer an opioid antagonist (e.g., naloxone hydrochloride) to treat or prevent a drug overdose, provided that the Page 7 of 23 CT HEALTH LAW LEGISLATIVE UPDATE professional acts with reasonable care. This legislation provides immunity to any person who, in good faith, believes that another person is experiencing an opioid overdose and with reasonable care administers an opioid antagonist to that person. However, a licensed health care professional acting in the ordinary course of employment is not eligible for immunity under this new legislation. Public Act 14-119: An Act Concerning DPH's Recommendations Concerning Medical Spas. This new legislation establishes certain requirements for medical spas, which are establishments where cosmetic medical procedures are performed. A “cosmetic medical procedure” is any medical procedure performed to improve an individual’s appearance that does not prevent or treat illness or disease in a meaningful way. Laser hair removal, laser skin resurfacing, hair transplants, intense pulsed light and cosmetic injections are all examples of cosmetic medical procedures. Every medical spa must employ or contract with a physician, physician assistant or advanced practice registered nurse who has training and experience to perform cosmetic medical procedures (each a Medical Spa Provider). A Medical Spa Provider must assess each person prior to such person receiving a cosmetic medical procedure. Only a Medical Spa Provider or a registered nurse may perform cosmetic medical procedures at a medical spa. This legislation requires a medical spa to post the names and specialties of Medical Spa Providers performing procedures in a conspicuous place accessible to customers and on any website maintained by the medical spa. This information must also be included in a written notice to each individual prior to undergoing a cosmetic medical procedure at a medical spa and in any advertisement by the medical spa, except that an advertisement may state that the information is available on the medical spa’s website. Public Act 14-121: An Act Concerning the Appointment of a Conservator for a Person with Intellectual Disability. Connecticut law permits a probate court to appoint a conservator of the estate for someone who is unable to manage his or her affairs or is unable to care for himself or herself. The court generally requires that a licensed physician introduce medical evidence that the person is unable to manage his or her affairs or take care of himself or herself. This legislation permits a licensed psychologist to introduce psychological evidence in lieu of a physician’s medical evidence if the involuntary conservatorship hearing involves a person with an intellectual disability. The requirements for the introduction of psychological evidence mirror those related to medical evidence. For example, the psychologist must have examined the individual within 45 days of the hearing, the evidence must describe the individual’s condition and how it affects the individual’s ability to care for himself or herself, and the court must generally keep such information confidential. This legislation maintains the requirement that an involuntary conservatorship be reviewed by the court one year after the original conservatorship order and every three years thereafter. This legislation, however, allows a psychologist to submit a report on an individual’s condition if a conservator is appointed due to an intellectual disability. Public Act 14-138: An Act Concerning Various Revisions to the Department of Mental Health and Addiction Services’ Statutes. This legislation, as amended by Public Act 14-231, codifies several revisions to current laws governing the activities of the Department of Mental Health and Addiction Services (DMHAS), including, but not limited to, the following:Page 8 of 23 CT HEALTH LAW LEGISLATIVE UPDATE Current law enables persons receiving DMHAS services who also require supervised living arrangements to be eligible to receive subsidies. This legislation removes the supervised living requirement and provides a clarification that DMHAS can provide housing subsidies to individuals receiving DMHAS services if they qualify for supportive housing. Individuals that qualify for supportive housing include (1) persons or families who are homeless or at risk of homelessness or are affected by psychiatric disabilities or substance abuse disorders, (2) families eligible under the temporary assistance for needy families program, (3) adults 18 to 23 years of age who are homeless or at risk of homelessness due to transfer from foster care or other residential programs and (4) persons with serious mental health needs who are community-supervised offenders supervised by the executive or judicial branch. This legislation allows any amounts undistributed by the agency responsible for allocating housing subsidies to qualifying individuals receiving DMHAS services at the end of a fiscal year to be allocated towards the same purpose in the subsequent year. Current law divides Connecticut into a series of mental health regions to provide regionalized services for care and treatment of persons with mental health diseases and disorders. This legislation adds a provision to the current law that allows a person to receive DMHAS services outside of the mental health region in which the person resides. Public Act 14-141: An Act Concerning the Admission of Veterans to Hospitals and the Application of Military Occupational Training to State Licensure Requirements. Under current law, a veteran in need of medical, surgical or mental health care who has no adequate means of support may be admitted to any hospital in Connecticut to receive necessary food, clothing, care and treatment therein at the expense of the state, unless other funds or means of payment are available. This legislation requires all hospitals in the state to ask whether a patient is a veteran upon admission and to take sufficient steps to determine that no other funds or means of payment are available to cover the cost of services rendered to a veteran prior to submitting a bill to the state for such services. This legislation requires the Department of Veteran Affairs to provide a list of payment options and benefits available to cover veterans’ hospital costs to all hospitals in the state. Public Act 14-145: An Act Concerning Fees Charged for Services Provided at HospitalBased Facilities. This new legislation requires a hospital or health system that charges patients a facility fee to provide patients with written notice of such fee. This legislation defines a facility fee as any fee charged or billed by a hospital or health system for outpatient hospital services provided in a hospital-based facility that is separate and distinct from the professional fee and is intended to compensate the hospital or health system for its operational expenses. This legislation defines a “hospital-based facility” as a facility where hospital or professional medical services are provided that is owned or operated, in whole or in part, by a hospital or health system. This new legislation requires the patient notice to be in writing, in plain language and in a form that may be reasonably understood by patients without special knowledge of facility fees. The notice must include the following information: (1) the facility is part of a hospital or health system that charges a facility fee in addition to and separate from the professional fee charged by the provider, (2) the amount of the patient’s actual financial liability depends on the medical services actually provided and (3) an explanation that the patient’s financial liability for services received Page 9 of 23 CT HEALTH LAW LEGISLATIVE UPDATE at the hospital-based facility may be greater than if the services were not provided in a hospital-based facility. If the facility fee is based on current procedural terminology evaluation and management codes and is expected to be charged in addition to a professional fee for outpatient services at a hospital-based facility, the patient notice must also include the amount of the patient’s potential financial liability, including any facility fee likely to be charged and either the professional fees to be charged by an affiliated provider, or, if not known, the estimated amount of the patient’s liability based on customary charges or visits to the facility (including the facility fee). For purposes of this law, an “affiliated provider” is an individual or entity employed by or under arrangement with the hospital or health system that permits the hospital or health system to bill on the provider’s behalf. For nonemergency care appointments scheduled 10 or more days in the future, notice must be sent to the patient by U.S. mail, encrypted e-mail or a secure internet portal within three days after the appointment is made. For appointments scheduled to take place within ten days and for visits without an appointment, notice must be handdelivered to the patient upon arrival at the facility. For emergency care, such notice must be provided to the patient as soon as practicable after the patient is stabilized or is determined not to have an emergency medical condition and before the patient leaves the hospital-based facility. The patient notice requirements described above do not apply to Medicare or Medicaid patients or patients with workers’ compensation coverage provided under Connecticut’s Workers’ Compensation Act. This new legislation also requires a hospital-based facility to clearly hold itself out to the public and payors as hospital based by stating the name of the hospital or health system in its signage, marketing materials, web sites and stationery. A hospital-based facility must prominently display notice, in readily accessible locations, that the hospitalbased facility is part of a hospital or health system and, if the hospital-based facility charges a facility fee, that the patient may incur increased financial liability that would not be incurred if the facility was not hospital-based. Public Act 14-148: An Act Concerning Care Coordination for Chronic Disease. This new legislation requires DPH to develop a plan (Plan) to reduce the incidence of and improve care coordination and clinical outcomes for conditions related to chronic disease. DPH’s plan must be consistent with Connecticut’s 2020 health improvement plan and Connecticut’s state health care innovation plan. Beginning on January 15, 2015, DPH is required to report biennially to the Public Health Committee on the progress of the Plan. DPH must post each report on its website within 30 days of submission to the Public Health Committee. Public Act 14-165: An Act Concerning Mandatory Reporting of Abuse and Neglect of Individuals with Autism Spectrum Disorder, the Definition of Abuse, and the Department of Developmental Services Abuse and Neglect Registry Under current law, the Office of Protection and Advocacy for Persons with Disabilities (OPA), the Department of Children and Families (DCF) and DSS investigate allegations of abuse; however, investigations of abuse of individuals with autism spectrum disorder are not specified in the law. This new legislation authorizes the Department of Developmental Services (DDS) to investigate allegations that a DDS employee (or an employee of an agency or organization, or an individual licensed or funded by DDS) abused or neglected an individual between 18 and 60 years old who receives funding or services from DDS’s Division of Autism Spectrum Disorder (Division). This new legislation expands the definition of “abuse” as it applies to individuals who receive DDS funding or services to include financial exploitation and sexual, psychological and verbal abuse. All state, local and private agencies must Page 10 of 23 CT HEALTH LAW LEGISLATIVE UPDATE cooperate with the investigation and release records related to the individual allegedly abused. DDS must keep the investigation and all related documentation confidential. Current law requires individuals in certain professional roles to report suspected abuse of an intellectually disabled person within three days of reasonably suspecting such abuse. For example, physicians, nurses, psychologists and physician assistants, among many others, are mandated reporters under the law. This new legislation expands the reporting requirements to include suspected abuse of individuals who receive services from the Division. Public Act 14-180: An Act Concerning Notice of a Patient's Observation Status. This new law requires hospitals to provide both oral and written notice to patients placed in observation status, informing patients of such status. The notice must include (1) a statement that the patient is under observation status and has not been admitted to the hospital; (2) a statement that the patient’s observation status may affect the patient’s Medicare, Medicaid or private insurance coverage for hospital services (including medications and pharmaceutical supplies) or home, community-based or skilled nursing facility care when the patient is discharged and (3) a recommendation that the patient contact his or her health insurance company or the Office of Healthcare Advocate with any questions. The patient receiving the notice or that patient’s guardian, conservator or other authorized legal representative must sign and date the notice. Notice must be provided to the patient within 24 hours of the patient’s placement on observation status, except that the notice requirement does not apply if the patient has been discharged or has left the hospital before the 24-hour period ended. Public Act 14-193: An Act Concerning Pharmacy Audits and Electronic Funds Transfer Payments to Pharmacies. This legislation revises current law governing the activities of pharmacy benefits managers to require, upon request, payment of all claims to pharmacies by electronic funds transfer. This legislation also establishes a new procedure for conducting pharmacy audits in Connecticut. A pharmacy audit is defined as an audit, conducted on-site or remotely by or on behalf of a pharmacy benefits manager or plan sponsor of pharmacy records for prescription drugs or prescription devices dispensed by such pharmacy to beneficiaries of a health benefit plan. This legislation specifies certain prohibitions and requirements for the auditing entity and allows an audited pharmacy to review and formally respond to an audit report before a final audit report is issued. Importantly, this legislation limits the scope of a pharmacy audit to (1) a period of 24 months after a claim is submitted, unless otherwise required by law or (2) 250 prescriptions. In addition, this legislation prohibits an auditing entity from using extrapolation methods to calculate penalties or charges to be recouped unless otherwise required by federal requirements or federal plans. This legislation does not apply to audits of pharmacy records where fraud or intentional willful misrepresentation is indicated by physical review of claims data or statements or where other investigative methods suggest criminal wrongdoing, fraud or other intentional or willful misrepresentation on the part of the pharmacy. Public Act 14-203: An Act Concerning Hepatitis C Testing. This new law requires primary care providers to offer hepatitis C testing to all patients born between 1945 and 1965. For purposes of this law, “primary care providers” include physicians, advanced practice registered nurses and physician assistants who provide primary care services, which include services associated with the medical fields of Page 11 of 23 CT HEALTH LAW LEGISLATIVE UPDATE family medicine, general pediatrics, primary care, internal medicine, primary care obstetrics and primary care gynecology. In general, the hepatitis C test must be offered at the time that primary care services are provided and must be either a screening test, which detects the presence of hepatitis C virus antibodies or a diagnostic test, which detects the presence of the hepatitis C virus and provides confirmation on whether the patient is infected. A provider is not required to offer hepatitis C testing in an emergency if the patient has already been offered or has already received such testing or if the patient lacks the capacity to consent to such testing. Public Act 14-211: An Act Concerning the Provision of Behavioral Health and Substance Use Treatment Services by Multi-Care Institutions. Under current law, DPH may issue a license to an institution only for the premises and persons named in the license application. This legislation exempts multi-care institutions from this requirement. A “multi-care institution” is defined as a hospital, adult psychiatric outpatient clinic, free-standing substance abuse treatment facility, hospital for psychiatric disabilities or a general acute care hospital that is licensed, has more than one facility or satellite unit that is operated by a single licensee and that offers complex patient health care services at each location. The term “complex patient health care services” is not defined. This legislation permits multi-care institutions to provide behavioral health or substance abuse treatment services at more than one facility under the terms of its existing license. A multi-care institution that wants to offer services at satellite units or other locations must apply to DPH for approval. Current law states that DPH may issue a license to a home health care agency or homemaker-home health aide agency only if such organizations are not otherwise required to be licensed by the state. This legislation expands this provision to apply to all institutions so that DPH may only issue a license to an institution that is not otherwise required to be licensed by the state of Connecticut. The Following Public Acts Are Effective January 1, 2015: Public Act 14-97: An Act Concerning Copayments for Breast Ultrasound Screenings and Occupational Therapy Services. Current law requires certain individual and group health insurance policies to provide coverage for comprehensive breast ultrasound screenings to women where a mammographic examination reveals symptoms associated with increased risks of breast cancer. This legislation imposes a maximum copayment amount of $20 for the breast ultrasound screening provided to a woman under such clinically indicated circumstances. This legislation also limits the maximum copayment for in-network occupational therapy services rendered by a licensed occupational therapist to $30. Public Act 14-118: An Act Concerning Requirements for Insurers’ Use of Step Therapy. Current laws prohibit individual and group health insurance policies issued by an insurance company, a hospital service corporation, a medical service corporation or a health care center from requiring any person insured under such a policy to obtain prescription drugs from a mail order pharmacy as a condition of obtaining coverage for such drugs. This legislation expands these prohibitions to apply, in addition to the above entities, to any other entity delivering, issuing for delivery, renewing, amending or continuing an individual health insurance policy or contract that Page 12 of 23 CT HEALTH LAW LEGISLATIVE UPDATE provides coverage for prescription drugs (all such entities described above are collectively referred to as Insurers in the following text). This legislation limits Insurers’ ability to require step therapy treatment of covered persons by prohibiting policies mandating the use of step therapy for any prescribed drug by covered persons for longer than 60 days and implementing new processes by which a covered person’s provider may request an override the use of any step therapy drug regimen under certain clinically indicated circumstances. For purposes of this legislation, step therapy is defined as a protocol or program that establishes the specific sequence in which prescription drugs for a specified medical condition are to be prescribed. After 60 days in a step therapy program, a covered person’s provider must review the clinical effectiveness of the treatment, and where a provider determines step therapy to be clinically ineffective, an Insurer must authorize dispensation of alternate prescription drugs available under the covered person’s policy. Insurers must also disclose a process by which a health care provider may, at any time, conveniently and expeditiously request an override of a step therapy drug regimen where the required drug regimen (1) has been ineffective in the past, (2) is expected to be ineffective, (3) is likely to cause an adverse reaction or (4) is not in the best interest of the covered person. Where an override request has been granted, an Insurer must authorize dispensation of alternate prescription drugs available under the covered person’s policy. This legislation does not affect a provider’s or a covered person’s right to request review of a claims denial or affect Connecticut’s law mandating coverage of pain management treatments. Public Act 14-159: An Act Concerning Employers and Home Care Workers. This legislation conforms Connecticut law to upcoming changes to the federal Fair Labor Standards Act, scheduled to take effect on January 1, 2015. This legislation allows companionship services employees who are employed by third-party providers (such as home care agencies) and who must remain on the work site for 24 hours to agree to exclude up to eight hours of sleep time from overtime pay calculations. To exclude such time, the employer must satisfy certain requirements, such as providing on-site sleeping facilities to the companionship services employee. The Following Public Acts Have Various Effective Dates: Public Act 14-12: An Act Concerning the Governor’s Recommendations to Improve Access to Health Care. THE FOLLOWING PROVISION OF PUBLIC ACT 14-12 IS EFFECTIVE AS OF JULY 1, 2014: Under current law, an advanced practice registered nurse (APRN) is required to practice in collaboration with a physician licensed in Connecticut. This legislation, as amended by Public Act 14-231, permits an APRN to practice independently after three years of continuous licensure, three years of active collaboration with a physician in the state and at least two thousand hours of collaborative practice. An APRN seeking to practice independently must submit a written notice to DPH to that effect. An APRN must retain documentation demonstrating satisfaction of these requirements for at least three years following completion of the above requirements and must make such documentation available within 45 days of a DPH request. As a result of this legislation, an APRN that satisfies the three year and two thousand hour collaboration requirement may thereafter diagnose and treat patients and Page 13 of 23 CT HEALTH LAW LEGISLATIVE UPDATE prescribe, dispense and administer certain drugs and medical supplies to patients independent of a physician collaborator. THE FOLLOWING PROVISION OF PUBLIC ACT 14-12 IS EFFECTIVE FROM PASSAGE: This legislation, as amended by Public Act 14-231, requires an APRN applying for licensure renewal to earn a minimum of fifty contact hours of continuing education within the preceding twenty-four-month period, including at least five contact hours of training and education in pharmacotherapeutics and at least one contact hour of training in infectious diseases, risk management, sexual assault, domestic violence, cultural competency and substance abuse. This legislation defines a “contact hour” as at least 50 minutes of education and activities. Licensees must submit an attestation of their compliance with this requirement to DPH during the licensure process and maintain records of their continuing education activities for at least three years following such activities. APRNs applying for a license renewal for the first time are exempt from the continuing education requirements. APRNs not engaged in active practice during the registration period may obtain an exemption from the continuing education requirements by submitting a notarized application for exemption. APRNs who are exempt from the continuing education provisions for less than 2 years and who wish to return to practice must complete 25 hours of continuing education within the twelve months preceding their return to practice. DPH may grant waivers or extensions to the APRN continuing education requirements, such as waivers for health reasons or for service on a nursing board or commission. THE FOLLOWING PROVISION OF PUBLIC ACT 14-12 IS EFFECTIVE AS OF OCTOBER 1, 2014: This legislation, as amended by Public Act 14-217, requires manufacturers of a drug, device, biological or medical supply payable under Medicare or Medicaid to file quarterly reports with DCP on payments or other transfers of value to an APRN. The first report must be filed by July 1, 2015, and must provide the same information as required by the federal Physician Payment Sunshine Act, including, but not limited to, the amount, date, form and description of the payment or value conferred to the APRN. DCP may publish any information contained in such a report on its website. Each unreported payment or transfer of value by a manufacturer is punishable by civil penalties ranging from one thousand dollars to four thousand dollars. Public Act 14-55: An Act Improving Transparency of Nursing Home Operations. THE FOLLOWING PROVISION OF PUBLIC ACT 14-55 IS EFFECTIVE FROM PASSAGE: The Nursing Home Financial Advisory Committee (NHFAC) is responsible for examining the financial solvency of nursing homes on an ongoing basis and for supporting DSS and DPH in their mission to provide oversight to the nursing home industry on issues concerning financial solvency of and quality of care provided by nursing homes. This legislation revises the membership of the NHFAC and orders it to convene by August 1, 2014, to evaluate information related to quality of care and staffing at nursing homes and to recommend action to further the State’s long-term strategy plan to rebalance Medicaid long-term care support and services. The NHFAC is now required to submit annual reports and to meet quarterly with legislators to discuss budgetary issues and matters related to the financial solvency of and quality of care provided by nursing homes. THE FOLLOWING PROVISION OF PUBLIC ACT 14-55 IS EFFECTIVE AS OF JULY 1, 2014: Under current law, chronic and convalescent homes that provide care to Medicaid patients are required to provide yearly cost reports to DSS in connection with DSS’s annual rate-setting process. This legislation requires a for-profit chronic and convalescent home that receives state funding to include with such annual cost report a profit and loss Page 14 of 23 CT HEALTH LAW LEGISLATIVE UPDATE statement from each related party that receives $50,000 or more per year for goods, fees and services from the chronic and convalescent home. This legislation defines “related party” to include any company related to the chronic and convalescent home through a family association (i.e. a relationship by birth, marriage or domestic partnership) or common ownership, control or business association with any of the owners, operators or officials of the chronic and convalescent home. Public Act 14-164: An Act Concerning Direct Payment of Residential Care Facilities. THE FOLLOWING PROVISIONS OF PUBLIC ACT 14-164 ARE EFFECTIVE FROM PASSAGE: Current law states that DSS must generally make temporary family assistance or state supplement program (SSP) payments directly to the individual applicant or another person entitled to receive such payment. This legislation allows DSS to make payments directly to licensed residential care homes (RCH) or a rated housing facility where an eligible individual resides. This legislation defines rated housing facilities as boarding facilities or homes licensed by one of the following: DDS, DMHAS, DCF, and the New Horizons, Inc. facility, a state-subsidized independent living facility for severely physically handicapped individuals. This legislation also requires DSS to adopt regulations authorizing a method for such payments, including procedures for necessary adjustments of payment rates. Under current law, RCHs are required to submit annually a cost report to DSS, and DSS is authorized to reduce the payment rate to any RCH that does not timely submit a cost report. This legislation requires that DSS notify an RCH that it has not submitted a complete and accurate cost report. DSS may withhold payment rate increases only if the RCH has not submitted a complete and accurate cost report within 30 days from DSS’s notice. THE FOLLOWING PROVISIONS OF PUBLIC ACT 14-164 ARE EFFECTIVE AS OF JULY 1, 2014: Beginning with the fiscal year ending June 30, 2014, and for each year thereafter, this legislation provides that RCHs will receive rate increases for capital improvements made during the fiscal year that improve the health and safety of its residents. DSS must have approved such capital improvements, and the rate increases must be within available DSS appropriations. Public Act 14-168: An Act Concerning Notice of Acquisitions, Joint Ventures, Affiliations of Group Medical Practices and Hospital Admissions, Medical Foundations and Certificates of Need. Signed into law on June 3, 2014, this legislation makes changes to a number of Connecticut laws associated with hospital conversions, organization and operation of medical foundations and certificate of need (CON) requirements, and the promulgation of new physician practice acquisition reporting requirements and a new personal physician notification requirement. Robinson+Cole’s summary of Public Act 14-168 is available here. Public Act 14-194: An Act Concerning the Alzheimer’s Disease and Dementia Task Force’s Recommendations on Training. This legislation makes changes to a number of current state statutes and implements mandatory training, education and awareness programs on Alzheimer’s disease and dementia for personnel statewide who, by virtue of their position, interact with or supervise interactions with persons particularly susceptible to Alzheimer’s disease or dementia.Page 15 of 23 CT HEALTH LAW LEGISLATIVE UPDATE THE FOLLOWING PROVISIONS OF PUBLIC ACT 14-194 ARE EFFECTIVE AS OF OCTOBER 1, 2014: This legislation expands current in-service training requirements for staff at chronic and convalescent nursing homes or rest homes with nursing supervision to require that all such facility staff receive training upon employment and annually thereafter in Alzheimer’s disease and dementia symptoms and care and also requires a designated individual at such facilities to review current procedures and make recommendations addressing the needs of patients with dementia and staff training programs. This legislation introduces mandatory training and education on Alzheimer’s disease and dementia upon employment and annually thereafter for staff who provide direct patient care for home health agencies, residential care homes, assisted living services agencies and licensed hospice care organizations. This legislation expands the regulatory scope of DDS to require that residential facilities serving persons above 50 years of age with Down syndrome provide training to at least one staff member on Alzheimer’s disease and dementia. This legislation revises training requirements for licensed and direct care staff and nurse’s aides who provide direct care working in Alzheimer’s special care units or programs in nursing home facilities to require that any such staff hired after October 1, 2014, receive initial training on Alzheimer’s disease and dementia within 120 days of employment. This legislation mandates training in Alzheimer’s disease and dementia as part of a nursing home administrator’s continuing education requirements and directs DPH to include Alzheimer’s disease and dementia requirements in regulations governing nursing home administrator education and training programs. This legislation also directs DSS to ensure that all employees assigned to DSS’s protective services for the elderly program receive annual training in Alzheimer’s disease and dementia if they directly interact with elderly persons. This legislation also expands the scope of refresher training requirements pursuant to recertification of emergency medical technicians to include required training in Alzheimer’s disease and dementia. THE FOLLOWING PROVISION OF PUBLIC ACT 14-194 IS EFFECTIVE AS OF NOVEMBER 1, 2014: This legislation also revises the criteria that applicants for licensure as a nursing home administrator are required to satisfy prior to granting of a license: For applicants seeking licensure as a nursing home administrator by examination, this legislation adds training in Alzheimer’s disease and dementia as a prerequisite to licensure. For applicants seeking licensure as a nursing home administrator by endorsement, this legislation mandates training or education in Alzheimer’s disease and dementia prior to licensure or within 120 days following a grant of license.Page 16 of 23 CT HEALTH LAW LEGISLATIVE UPDATE Public Act 14-214: An Act Concerning a Task Force to Study Stroke and Reporting on Health Care-Associated Infections. THE FOLLOWING PROVISION OF PUBLIC ACT 14-214 IS EFFECTIVE FROM PASSAGE: This new legislation creates a task force to study strokes. The task force will include representatives from the American Academy of Neurology, the Stroke Coordinators of Connecticut, the Connecticut College of Emergency Physicians, the American Heart Association, and the Connecticut Hospital Association as well as the Commissioner of Public Health (DPH Commissioner) or designee, a member from the Emergency Medical Services Advisory Board and two additional members appointed by the DPH Commissioner. The task force will study (1) whether it is feasible to adopt a national stroke assessment tool; (2) the care protocols for assessment, treatment and transportation of stroke victims; (3) a plan for continuous quality improvement for stroke-related care and (4) whether it is feasible to create a statewide hospital stroke designation program that would be administered by DPH. The task force must report its findings to the General Assembly’s Public Health Committee by January 15, 2016. THE FOLLOWING PROVISION OF PUBLIC ACT 14-214 IS EFFECTIVE AS OF OCTOBER 1, 2014: Under current law, DPH must submit a report to the Public Health Committee of the General Assembly on the infections reported by health care facilities to DPH during each year. This legislation expands the scope of infections to be reported to the Public Health Committee to include central-line, catheter-associated urinary tract, surgical site, methicillin-resistant staphylococcus aureus and Clostridium difficile infections. DPH must post information on health care-associated infections on its website as well as links to the reported information and the Medicare Hospital Compare Internet website, which contains information about the rate of infections at facilities in the state. Public Act No. 14-217: An Act Implementing Provisions of the State Budget for the Fiscal Year Ending June 30, 2015. THE FOLLOWING PROVISIONS OF PUBLIC ACT NO. 14-217 ARE EFFECTIVE FROM PASSAGE: Currently, the Connecticut False Claims Act (CFCA) prohibits the filing of false or fraudulent claims where payment is to be made under a medical assistance program administered by DSS. The CFCA also prohibits related acts such as using false documentation, making false statements and concealing obligations to pay a DSS medical assistance program. Penalties for violations include fines, treble damages and the repayment of the costs of investigation and prosecution of the violation. This legislation replaces the current CFCA with substantially similar language and expands the scope of the CFCA. Under this legislation, the prohibitions and penalties of the CFCA apply to false claims submitted to any state-administered health or human services program. Included in the revised scope of the CFCA are programs administered by the Departments of Aging, Children and Families, Developmental Services, Mental Health and Addition Services, Public Health, Rehabilitative Services, Administrative Services and the Office of Early Childhood. The revised CFCA also applies to state employee, retiree and health programs administered by the Office of the State Comptroller. This new legislation requires a primary area service responder (PSAR) to notify DPH and the chief elected official of the municipality to which the PSAR is assigned, at least 60 days prior to the sale or transfer of more than half of its ownership interest or its assets. The intended buyer of the PSAR’s interests or assets must apply to DPH for approval of the transaction. DPH must approve or reject the application within 45 Page 17 of 23 CT HEALTH LAW LEGISLATIVE UPDATE days and will consider the buyer’s history of performance and its financial ability to perform PSAR services. This legislation also permits DPH to hold a hearing on the buyer’s application to purchase the PSAR’s interests or assets. This legislation requires the State Comptroller (the Comptroller) to report to the General Assembly on the impact that facility fees and total hospital or health system fees for outpatient hospital services have on State employee health insurance plans. “Facility fees” are outpatient services fees charged by a hospital or health system for services performed in a hospital-based facility that are meant to compensate the hospital or health system for its operational expenses. Facility fees do not include professional medical services fees. The Comptroller must analyze at least five service types or categories for which (1) facilities fees are charged by at least two hospitals or health systems or (2) total facility fees charged by a hospital or health system exceed the facility fees charged by comparable providers. By March 1, 2015, the Comptroller must determine the amount of facility fees and total fees charged by hospitals or health systems to State employee health insurance plans for the chosen service types, on an aggregate and per-hospital or health system basis. This legislation also requires the Comptroller to determine the reasonableness of such fees by using criteria that includes (1) a comparison of facility fees charged in proportion to professional fees charged by typical providers, (2) a comparison of total fees charged by a provider when identified as “hospital based” versus when unaffiliated with a hospital or health system and (3) the extent to which facility fees or an increase in total fees is related to improved services or outcomes. The Comptroller will, by July 1, 2015, conclude whether it is feasible to remove reimbursement for such fees that the Comptroller determines to be unreasonable. Under this legislation, the Comptroller is required to submit a report by October 1, 2015, on the above analysis of the facility fees to the governor, the General Assembly and the Health Care Cost Containment Committee, which is a state labor and management committee under the State Employees Bargaining Agent Coalition. Under current law, Connecticut’s Health Insurance Exchange (HIX) is authorized to charge an assessment or user fee to health insurers able to offer Affordable Care Act-certified health plans through the HIX. This new legislation requires the chief executive officer of the HIX to inform the Connecticut Insurance Commissioner (the Commissioner) of all health insurers that do not pay the required assessment or user fee to the HIX. The Commissioner is permitted to use any legal means of enforcing the payment of the HIX fee, including assessing fines and suspending or revoking insurance licenses. Health insurers adversely affected by the Commissioner’s actions may appeal to the New Britain Superior Court. This new legislation requires that DSS submit a report by January 1, 2015, to the General Assembly on the impact of certain issues related to complex rehabilitative technology (CRT). Medicare has classified CRT products as “durable medical equipment” that is individually customizable and medically necessary for the basic functions of daily living, including items such as wheelchairs, adaptive seating devices and gait trainers. DSS must report on the impact of (1) using the Healthcare Common Procedure Coding System designation of certain products and services as CRT; (2) creating minimum standards for qualifying as a CRT supplier eligible for Medicaid reimbursement; (3) continuing to allow CRT to be billed and paid for as a purchase, which allows a single payment for CRT devices needed for at least one year and (4) requiring Page 18 of 23 CT HEALTH LAW LEGISLATIVE UPDATE Medicaid recipients to receive an evaluation by a qualified health care professional or qualified CRT professional before qualifying for reimbursement of a wheelchair or seating component. This new legislation requires DSS to submit to the Centers for Medicare & Medicaid Services an amendment to the Medicaid state plan for increasing the Medicaid rate for private psychiatric residential treatment facilities. The increased Medicaid rate must be within available appropriations. A “private psychiatric treatment facility” is a nonhospital facility that provides inpatient services to individuals under the age of 21 who are eligible to receive Medicaid. Under this new legislation, beginning on or before July 1, 2014, DSS must accept electronically transmitted claims for reimbursement under the medical assistance program for certain durable medical equipment (DME). A licensed health care provider who has authority to write prescriptions for such DME must electronically sign such claims. THE FOLLOWING PROVISIONS OF PUBLIC ACT NO. 14-217 ARE EFFECTIVE JULY 1, 2014: Currently, Connecticut Home Care Program for Adults with Disabilities (Program), a state-funded pilot program, allows up to 50 disabled adults between the ages of 18 and 64 to receive home and communitybased services to avoid inappropriate institutionalization of such individuals. This legislation increases participation in the Program to 100 individuals. The Health Information Technology Exchange of Connecticut (HITE-CT) is a quasi-public agency responsible for developing a statewide health information exchange and providing grants to advance health information exchange and technology. This legislation repeals the statutes that established HITE-CT and transfers most of its responsibilities to DSS. Following the effective date of this legislation, DSS will work with DPH and DMHAS to implement and revise the statewide health information technology plan and to establish electronic data standards to be used by state-funded health care providers, institutions and state agencies including DPH and DMHAS. Under current law, on January 1 of each year, each federally qualified health center (FQHC) must file the following with DSS: its previous year’s Medicaid cost report, audited financial statements and any additional information required by DSS. This legislation allows FQHCs that do not use the state fiscal year to file such information within six months following the end of their actual fiscal year. This legislation requires DSS to evaluate payments for all hospital services, including services provided in pediatric psychiatric inpatient units and gives DSS discretion to implement a pay-for-performance program for pediatric psychiatric inpatient care, provided that sufficient appropriations are available. This new legislation requires DSS, by October 1, 2014, to expand the state Medicaid plan to include coverage for behavioral health services provided to Medicaid recipients age 21 or older by psychologists, clinical social workers, alcohol and drug counselors, professional counselors and marital and family therapists licensed by the state. This legislation also requires DSS to directly reimburse the above clinicians who are enrolled in Medicaid and who treat Medicaid recipients in an independent setting.Page 19 of 23 CT HEALTH LAW LEGISLATIVE UPDATE THE FOLLOWING PROVISIONS OF PUBLIC ACT NO. 14-217 ARE EFFECTIVE OCTOBER 1, 2014: This legislation requires DPH to review a primary service area responder’s (PSAR) provision of services to a municipality under the municipality’s emergency medical services plan once every five years. DPH will assign a performance rating to the PSAR, and if the PSAR does not meet performance standards, it may be further reviewed or removed as the municipality’s PSAR. This legislation creates new definitions for the terms “performance crisis” and “unsatisfactory performance” as they relate to a primary service area responder’s (PSAR) provision of services in a municipality. A municipality may petition DPH for removal of the PSAR if the municipality alleges that the PSAR’s conduct resulted in a performance crisis. In such case, DPH may designate a temporary PSAR for a municipality. If, after a hearing, DPH determines that (1) a performance crisis exists, (2) the PSAR has demonstrated unsatisfactory performance or (3) it is in the best interest of patient care, DPH may revoke the PSAR from providing services in the assigned area. DPH may also remove a PSAR on its own, provided that a hearing is held, if the PSAR has failed to correct poor performance. This new legislation provides a process by which a municipality can request DPH to change the municipality’s primary service area responder (PSAR) due to the PSAR’s poor performance or a change in the municipality’s emergency medical services plan. DPH will conduct a hearing on the proposed removal of a municipality’s PSAR to determine whether to approve the municipality’s request for the PSAR’s removal. In making its decision, DPH will consider a number of factors, including the impact on patient care; the impact on the local, regional and the statewide emergency medical services system; the recommendation of the PSAR’s sponsor hospital and the financial impact on the municipality. Under current law, DPH collects certain information from physicians, advance practice registered nurses (APRNs), dentists, optometrists, podiatrists, chiropractors, naturopaths, dental hygienists and physical therapists. The information includes the health care providers’ demographics, publications, organizational affiliations and disciplinary actions. DPH uses the information to create individual profiles of health care providers and publishes this information to the public. Currently, DPH may collect the above information and create profiles to the extent that such activities are within available appropriations. This new legislation removes the “within available appropriations” restriction with regard to collecting information from physicians and APRNs. This legislation also requires DPH to collect from all health care providers whether each provides primary care services. APRNs must also indicate whether they practice independently or in collaboration with a physician. This legislation requires an acute care hospital located on a state-owned campus to be designated as that campus’s PSAR. This legislation creates a new subset of business corporations in Connecticut called “benefit corporations.” In addition to the requirement to increase shareholder value that is imposed on traditional business corporations, benefit corporations are legally required to create a general public benefit. Under the Connecticut Benefit Corporation Act (CBCA), a general public benefit means that the benefit corporation has a material positive impact on society and the environment. A benefit corporation may also provide a specific Page 20 of 23 CT HEALTH LAW LEGISLATIVE UPDATE public benefit, such as improving health, promoting education or increasing the capital of other benefit corporations or similar organizations whose purpose is to benefit society or the environment. The general public benefit and specific public benefit, if any, that the benefit corporation chooses to create must be stated in its certificate of incorporation. Except as modified by the CBCA, the Connecticut Business Corporation Act, which apples to traditional business corporations, also applies to benefit corporations. The CBCA imposes certain governance requirements on benefit corporations. For example, in discharging its duties to a benefit corporation, the board of directors must consider the effect that the benefit corporation’s actions will have on a variety of persons and interests, including the benefit corporation’s customers and shareholders, employees of the benefit corporation and its subsidiaries and suppliers, the short- and long-term interests of the benefit corporation, the local and global environment, societal and community factors (including those of each community where the benefit corporation, its subsidiaries and suppliers have an office or facility) and the benefit corporation’s ability to achieve its general and specific public benefits, if any. Benefit corporations are also subject to certain accountability requirements. For example, the CBCA requires benefit corporations to select a third-party standard against which the corporation’s pursuit of general and specific benefits will be measured. The CBCA also requires a benefit corporation to provide annually a benefit report on its performance and operations to both its shareholders and the general public. Public Act 14-231: An Act Concerning DPH’s Recommendations Regarding Various Revisions to the Public Health Statutes. This public act makes a number of substantive and technical changes to public health statutes. THE FOLLOWING PROVISIONS OF PUBLIC ACT 14-231 ARE EFFECTIVE AS OF OCTOBER 1, 2014: This legislation requires outpatient surgical facilities to, on a biennial basis, respond to an Office of Health Care Access (OHCA) inventory questionnaire. In responding to the questionnaire, each outpatient surgical facility must provide its name, location, hours of operation, facility type, type of services provided and the total number of clients, treatments, visits and procedures and scans performed during a year. Beginning July 1, 2015, OHCA may require outpatient surgical facilities to report additional outpatient data. This legislation changes the name of DPH’s Office of Multicultural Health to the Office of Health Equity (OHE) and states that population groups served by the OHE may be classified by race, ethnicity, age, gender, socioeconomic position, immigrant status, sexual minority status, language, disability, homelessness, mental illness or geographic area of residence. Under this legislation, if a person or entity providing nursing facility management services fails to substantially comply with the requirements and regulations applicable to it, DPH may require the service provider and the nursing facility to submit a plan of correction. This legislation allows a nursing home facility to use electronic signatures for patient medical records. The nursing home facility must have written policies to protect the privacy and security of the electronic signatures. Page 21 of 23 CT HEALTH LAW LEGISLATIVE UPDATE This legislation requires chronic and convalescent nursing homes and rest homes with nursing supervision to perform a complete medical history and examination of each patient when that patient is admitted and then annually thereafter. This legislation requires DPH to specify what tests and procedures must be provided; however, it specifically states that a urinalysis is not required for postadmission tests. Under current law, DPH can issue a summary order that revokes or suspends a home health care agency’s or homemaker-home health aide agency’s (collectively, Home Health Agency) license if DPH determines that the welfare of a Home Health Agency’s patients is in danger. This legislation allows DPH to issue such summary revocation or suspension order to any health care “institution,” including hospitals, outpatient facilities, residential care homes, nursing homes, Home Health Agencies, substance abuse treatment facilities, rest homes and mental health facilities (collectively referred to as an Institution). This legislation requires DPH, prior to issuing a summary order to a hospital, to work with the hospital and one or more area health care providers to plan the relocation of the hospital’s inpatients and to find similar services for its outpatients. Currently, DPH may waive provisions of regulations affecting the physical plant requirements of residential nursing homes. This legislation allows DPH to waive regulatory provisions affecting an Institution, provided that such waiver does not endanger any patients. This legislation makes several changes to the emergency medical services statutes, including the following: o This legislation requires paramedic intercept services organizations to be licensed by DPH. Paramedic intercept services are paramedic treatment services provided by an entity other than the one providing ambulance transportation. In general, licensing requirements for paramedic intercept services are similar to those imposed on ambulance services. o This legislation requires each emergency medical service organization (EMSO) to ensure that all of its medical personnel hold proper licenses and certificates from DPH, whether such personnel are employed by the EMSO or contract with the EMSO through an employment agency or personnel pool. This legislation also requires the EMSO to ensure that any company that provides personnel to the EMSO has the minimum required general and professional liability insurance that covers all people working or volunteering for the EMSO. An EMSO is defined as any organization that offers transportation or treatment services to patients primarily under emergency conditions. o This legislation allows DPH to issue certifications to emergency medical responder and emergency medical services instructor applicants who meet the requisite licensure and training requirements and have no pending disciplinary actions or complaints. o Current law allows DPH to issue a temporary emergency medical technician (EMT) certificate to applicants who provide evidence that they were a certified EMT before becoming a paramedic and that their EMT certificate and paramedic license have expired for failure to renew. This legislation permits DPH to issue a temporary EMT certificate if only one of the above requirements is met. o Presently, the scope of practice of emergency medical technicians and paramedics can include treatments not specified in the state regulations as long as such treatments are approved by the Page 22 of 23 CT HEALTH LAW LEGISLATIVE UPDATE Connecticut Emergency Medical Services Medical Advisory Committee and administered under the direction or oversight of a sponsor hospital. This legislation expands the applicability of the above provisions to emergency medical responders and emergency medical services instructors. o This legislation allows a general or children’s general hospital to use an ambulance service other than the primary service area responder (PSAR) to transport patients to another facility when the level of care required is beyond the PSAR’s authorization, the PSAR does not have the necessary equipment or the transport would take the PSAR outside of its service area for more than two hours and an ambulance with the proper authorization level and equipment is available. Under this legislation, the patient’s attending physician determines whether to use the PSAR or another ambulance for transport. o Current law requires Institutions to file a strike contingency plan with DPH when a labor organization notifies the Institution of its intent to strike. Under this legislation, licensed or certified emergency medical services organizations (EMS organizations) are subject to the same requirement. EMS organizations must file a contingency plan at least five days before the scheduled strike. This legislation requires nursing homes to provide direct-care staff and nursing aides with one hour of oral health and hygiene training within one year of the date of hire and annually thereafter. Currently, hospitals, home health care agencies, and homemaker-home health aide agencies may only administer polysaccharide forms of influenza and pneumococcal vaccines to patients. This legislation allows hospitals, home health care agencies and homemaker-home health aide agencies to administer nonpolysaccharide forms of influenza and pneumococcal vaccines to patients, provided that the patient has no contraindications and the administration is done in accordance with hospital policy. Current law requires hospitals, clinical laboratories and health care providers to report to DPH every occurrence of a reportable tumor treated in the state. DPH maintains information on reported tumors in the Connecticut Tumor Registry. This legislation limits the health care providers who have to report tumors to doctors, chiropractors, naturopaths, podiatrists, nurses, dentists and emergency medical service providers. This legislation expands the amount of information that must be reported to DPH to include the patient’s occupation and the type of business to which the occupation relates. Hospitals, laboratories and health care providers must annually update the reported information during the patient’s lifetime. This legislation clarifies that a technologist who is certified by the International Society for Clinical Densitometry or the America Registry of Radiologic Technologists, who operates a bone densitometry system and who is supervised by a physician, does not have to be licensed as a radiographer. This legislation requires licensed psychologists to complete at least ten hours of continuing education during every 12-month license renewal period. Psychologists applying for their first license renewal will be exempt from the continuing education requirements. DPH has discretion to waive the continuing education requirements or to grant extensions of time for completion.Page 23 of 23 CT HEALTH LAW LEGISLATIVE UPDATE Current law requires a clinical laboratory, upon request by a provider, to provide a patient’s medical test results to that provider for purposes of the patient’s medical care. This legislation also requires a clinical laboratory to provide such information to the patient if the patient requests such information. This legislation expands the definition of naturopathy to include ordering diagnostic tests related to mechanical and material healing sciences, ordering medical devices and durable medical equipment, and removing ear wax as well as spirometry, tuberculosis testing and venipuncture related to blood testing. This legislation removes the requirement that physician assistant orders must be signed by the physician assistant and be accompanied by the printed name of the supervising physician and removes the current requirement that prescription forms used by physician assistants identify the supervising physician. This legislation does not revise the requirement that, with respect to any schedule II or III controlled substance prescribed by a physician assistant, the supervising physician document his or her approval in the patient’s medical record. THE FOLLOWING PROVISION OF PUBLIC ACT 14-231 IS EFFECTIVE JULY 1, 2014: Under this legislation, nuclear technologists working under the supervision of a physician do not need a medical license. THE FOLLOWING PROVISION OF PUBLIC ACT 14-231 IS EFFECTIVE JANUARY 1, 2015: This legislation permits physicians assistants to provide students with a certificate of exception from receiving a meningococcal conjugate vaccine, as required by state law for students enrolling in public or private colleges or universities in Connecticut. Under current law, only physicians and advanced practice registered nurses are authorized to issue a certificate of exemption.