Connecticut Health Law

The 2015 legislative session of the Connecticut General Assembly was a particularly busy one—dozens of important new statutes were enacted that will impact hospitals and other health care providers in a big way. We’ve highlighted below what we consider some of the most significant health care legislation scheduled to take effect on October 1, 2015 (or, where noted, January 1, 2016). Given how many Public Acts will become effective within the next few months, we did not include new laws that will be implemented after January 1, 2016, nor have we addressed 2015 Public Acts that are already in effect.

The purpose of this Alert is to summarize key areas of the law only; please refer to the full Public Acts for complete information.

Patient Notification:

• Referrals to Affiliates: Health care providers must notify patients in writing when they refer them to an affiliated provider who is not a member of the same partnership, professional corporation or LLC formed to render professional services. Among other things, the notice must state that the patient has a right to seek care from a provider of his/her choice, and provide the patient with the website and toll-free number of his/her insurer to obtain information regarding in-network providers and estimated out-of-pocket costs for the referred services.

The term “health care provider” is not defined in the statute, though it would appear to apply only to individual licensees and not facilities. The term “affiliated” means “a relationship between two or more health care providers that permits the health care providers to negotiate jointly or as a member of the same group of health care providers with third parties over rates for professional medical services.”

(PA 15-146, Section 15)

• Charges: Beginning January 1, 2016, each health care provider must, prior to any scheduled service for nonemergency care, determine whether the patient is covered under a health insurance policy, and, for those patients without coverage or whose coverage is out-of-network, the provider must notify the patient in writing about the charges for the service, unforeseen services that may arise and any out-of-network rates that may apply. The notice must be written in language understandable to the average reader. (The term “health care provider” is not defined, so it is unclear whether it pertains to licensed facilities only, or to both licensed facilities and individual practitioners.) (PA 15-146, Section 3)

Facility Fees: New restrictions on facility fees were enacted this year, which, beginning January 1, 2016:

• Require hospitals to include notice of the facility fee in their billing statements;
• Prohibit health insurers from charging a separate copayment for facility fees; and
• Add new notice and reporting requirements for group practices that engage in certain transactions resulting in a hospital-based facility at which a facility fee will be charged. Importantly, a violation of this latter provision will constitute an “unfair trade practice” under Connecticut law.

(PA 15-146, Sections 13 and 14)

Electronic Health Records: Hospitals are required to maximize the functionality of their electronic health records and must ensure that, to the fullest extent practicable, EHRs follow the patient; are made accessible to the patient; and are shared with the patient’s health care provider (i.e., either a licensed individual or facility) in a timely manner.

The Act also introduces the term “health information blocking,” which is defined as knowingly (1) interfering with, or engaging in conduct reasonably likely to interfere with, the ability of patients, health care providers (i.e., either a licensed individual or facility), or other authorized persons to access, exchange, or use EHRs; or (2) using an EHR system both to steer patient referrals to affiliated providers and to interfere with referrals to non-affiliated providers.

The term “affiliated provider” is defined as ‘a health care provider that is: (A) employed by a hospital or health system, (B) under a professional services agreement with a hospital or health system that permits such hospital or health system to bill on behalf of such health care provider, or (C) a clinical faculty member of a medical school, as defined in section 33-182aa of the general statutes, that is affiliated with a hospital or health system in a manner that permits such hospital or health system to bill on behalf of such clinical faculty member.’

Health information blocking is an unfair trade practice.

(PA 15-146, Sections 20 and 24)

Telehealth: New requirements are established for health care providers (i.e., licensed individuals, including physicians, PAs, APRNs, OTs and PTs) who provide medical services through the use of telehealth. Among other things, a telehealth provider must obtain a patient's informed consent to provide telehealth services at the first telehealth interaction. Effective January 1, 2016, certain health insurance policies must cover medical services provided through telehealth to the extent that they cover the services through in-person visits. (PA 15-88)

Clinical Practice:

• New Obligations on Agencies that Treat Psychiatric Disabilities or Substance Abuse: These agencies must begin collecting the statistical information that DMHAS was responsible for collecting in the past, and report the information to DMHAS on request. DMHAS will report to DPH any agency that fails to do so. (PA 15-120)
• Continuing Ed Requirements: Physicians, APRNs, PAs, and dentists must take courses in pain management and prescribing controlled substances as part of their continuing ed programs. (PA 15-198) In addition, beginning January 1, 2016, the continuing ed courses that physicians, APRNs, LADCs, social workers and other specified practitioners are required to take must include training in the mental health conditions common to veterans and their families. (PA 15-242, Sections 60-67)
• Electronic Prescription Drug Monitoring Program: A prescribing practitioner must, before prescribing more than a 72-hour supply of any controlled substance, review the patient’s records in the state electronic prescription drug monitoring program. If a controlled substance is prescribed for a prolonged period, the prescribing practitioner must review, not less than once every 90 days, the patient’s records in the prescription drug monitoring program. (PA 15-198)
• Patient-Centered Caregivers: The standards for discharge planning are amended to require that, whenever an inpatient is discharged from a hospital to his/her home, the hospital must allow the patient to designate a caregiver, and the hospital must make reasonable attempts to notify the caregiver of the patient’s discharge, and must provide the caregiver with post-discharge training. (PA 15-32)
• Interpreter Services: Hospitals must ensure the availability of interpreter services to patients whose primary language is spoken by a group constituting not less than 5% of the population residing in the geographic area served by the hospital. (PA 15-34)
• Newborns: At the time a newborn infant is discharged from the hospital, the hospital must provide the parent/legal guardian with written informational materials containing the American Academy of Pediatrics’ recommendations for safe sleep practices. (PA 15-39)
• Elder Care: Training in the symptoms of dementia must be provided to hospital staff members who provide direct patient care. (PA 15-129) In addition, the definition of elderly “neglect” is broadened to include individuals who do not live alone (PA 15-233), and licensed/certified EMS providers are required to be mandatory reporters of elder abuse. (PA 15-242, Section 9).

Health Care Providers and Health Insurers:

• Limitations on Contracts with Health Insurers: Beginning January 1, 2016, contracts entered into or renewed between a health care provider and a health carrier must not prohibit disclosure of: (1) billed or allowed amounts, reimbursement rates or out-of-pocket costs; or (2) any data to the All-Payer Claims Database. (While not defined, the term “health care provider” presumably applies to all licensees, including facilities.) (PA 15-146, Section 4)

• Notice When Provider Stops Accepting an Insurer: Not later than 30 days after a health care provider stops accepting patients who are enrolled in an insurance plan, the provider must notify the applicable health carrier in writing, and the carrier must update its health care provider directory at least monthly. (The term “health care provider” is not defined in the statute.) (PA 15-146, Section 6)

New Reporting Requirements for Hospitals, Health Care Employers and Health Care Professionals:

• Reports of Nurse Staffing Levels: Hospitals are responsible for reporting their prospective nursing plans to DPH, and, for nursing plans developed after January 1, 2016, new information must be included in the plans. (PA 15-91, Section 1)

• Workplace Violence: Not later than January 1, 2016 and annually thereafter, health care employers, including hospitals, must report to DPH on the number of workplace violence incidents occurring on the premises during the preceding calendar year. (PA 15-91, Section 2)

• Reporting Impaired Health Care Professionals: Hospitals and other health care professionals (including physicians, PAs, nurses, social workers, PTs and others) are required to file a petition with DPH if they have information that appears to show that a health care professional is or may be unable to practice with reasonable skill and safety. In addition, these professionals are required to report their own arrests due to possession, use, prescription for use or distribution of a controlled substance, prescription drug or alcohol, or their own diagnosis of mental illness or behavioral/emotional disorder. (PA 15-5, Section 480)

Certificates of Need:

Changes to the CON Process for Hospital Transfers on and after December 1, 2015 include:

• New submission requirements for hospitals involved in a transfer of ownership, and two new factors that DPH must take into account when reviewing the CON.

• A requirement that OHCA deny the CON unless it finds that the affected community would be assured of continued access to high quality affordable health care.

• A new requirement for a Cost and Market Impact Review for hospital transfers where the purchaser has net patient revenue greater than $1.5 billion or is organized for profit.

(PA 15-146, Section 28 et seq.)

Taxes:

• Ambulatory Surgical Centers: For each calendar quarter beginning on and after October 1, 2015, ASCs will be taxed at the rate of 6% of gross receipts. However, no tax is imposed on the first $1 million of gross receipts of the ASC in the applicable fiscal year, and on the net patient revenue of a hospital that is subject to the hospitals tax. The law also specifies that nothing prohibits an ASC from seeking remuneration for this tax. (PA 15-5, Section 130)

• Real Property: Beginning with assessments on and after October 1, 2015, a property tax is imposed on real property acquired by a health system on or after October 1 that is subject to taxation at the time of acquisition, if the acquiring health system had net patient revenues from facilities located in Connecticut of $1.5 billion or more for the FY ending September 30, 2013. Personal property incident to the rendering of health care services at such real property is also taxable. Exceptions apply. (PA 15-5, Sections 238-239)

Other Laws Affecting Health Care Facilities:

• Prohibition on Advance Notice of Investigations: DPH, DSS and regional ombudsmen are prohibited from giving advance notice to any health care institution that an investigation or inspection (other than an initial licensure inspection) is under consideration, or from giving any information regarding any complaint regarding a report of suspected elder abuse prior to an on-the-scene investigation, unless required by federal or state law. (PA 15-242, Section 18)

• Hospital Contact Person: Hospitals are required to designate one employee to act as the “hospital contact person” to notify “designated officers” (e.g., ambulance workers, fire department, police) of cases where persons have possibly been exposed to airborne infectious disease, and to respond to requests for information from designated officers. Hospitals must notify DPH of its hospital contact person by January 1, 2016, and DPH will make a list of these individuals available on its website. (PA 15-242, Section 51)

• New Notice Requirements on Parties to Certain Transactions: For transactions that result in an affiliation between hospitals and hospital systems, notice must be submitted to the state Attorney General 30 days prior to the effective date of the affiliation, and a report describing each such affiliation must be submitted to the AG and DPH annually, with the first report due December 31, 2015. For transactions that result in a material change to a group practice, the parties must notify DPH 30 days after the transaction takes place. DPH will post a link to this notice on its website. (PA 146, Section 27)