Connecticut Health Care Laws Effective January 1, 2025

Several new statutory provisions affecting health care providers are scheduled to take effect on January 1, 2025. We have highlighted below some of the more notable pieces of legislation.

1. Emergency Department Crowding (PA 24-4)

Not later than January 1, 2025, and annually thereafter until January 1, 2029, each hospital in the state with an emergency department must (and each hospital operated exclusively by the state may), directly or in consultation with a hospital association in Connecticut, analyze the following data from the previous calendar year concerning its emergency department:

• The number of patients who received treatment in the emergency department;
• The number of emergency department patients who were admitted to the hospital;
• For patients admitted to the hospital after presenting to the emergency department, the average length of time from the patient's first presentation to the emergency department until the patient's admission to the hospital; and
• The percentage of patients who were admitted to the hospital after presenting to the emergency department but were transferred to an available bed located in a physical location other than the emergency department more than four hours after an admitting order for the patient was completed.

Hospitals must utilize the analysis with the goals of developing policies or procedures to reduce wait times for admission after a patient presents to the emergency department, as well as informing potential methods to improve admission efficiencies and examining root causes for delays in admission times.

Not later than March 1, 2025, and annually thereafter until March 1, 2029, each hospital that conducts the analysis must submit a report to the Public Health Committee of the General Assembly regarding its findings and any recommendations for achieving its goals.

2. Cybersecurity Audits (PA 24-19, Section 20)

Each hospital in Connecticut (other than a hospital operated exclusively by the state) must, not later than January 1, 2025 and annually thereafter: (1) submit its plans to respond to a cybersecurity disruption to an audit by an independent, certified cybersecurity auditor or credentialed cybersecurity expert to determine the adequacy of its plans and to identify any necessary improvements to these plans; and (2) make available for inspection on a confidential basis to the Department of Public Health (DPH), the Department of Administrative Services and the Department of Emergency Services and Public Protection (Division of Emergency Management and Homeland Security) information regarding whether its plans have been determined to be adequate pursuant to the audit and the steps the hospital is taking to implement any improvements recommended by the auditor.

Recipients of the information submitted or made available are required to maintain the maximum level of confidentiality allowed under law and may not disclose the information except as expressly required by law. The information will also be exempt from disclosure under the Connecticut Freedom of Information Act.

3. Standards for Patient Accessibility (PA 24-113)

Effective July 1, 2024, Public Act 24-113 expanded the types of health care providers who must take into consideration the federal standards for accessibility for persons with disabilities when purchasing medical diagnostic equipment to include not only “facilities” (that is, hospitals, outpatient clinics, long-term care facilities, and hospices), but also “practice locations” (that is, the office of a practice of nine (9) or more physicians or advanced practice registered nurses, or a combination thereof).

Beginning January 1, 2025, both facilities and practice locations will also have new responsibilities related to patient accessibility, including: (1) training staff with direct patient care responsibilities regarding policies and procedures for addressing patients' access to care; (2) providing the steps patients may take to contact the facility or practice location (including a phone number) for assistance with patient access needs and making such information readily available to the public; and (3) taking and documenting an inventory of all medical diagnostic equipment that meets, and does not meet, the standards for accessibility, including an action plan for addressing gaps (and making this documentation available to DPH upon request). Facilities and practice locations must also identify and document the steps necessary to comply with the requirements set forth in the following paragraph and make such documentation available to DPH upon request.

Beginning January 1, 2026, health care facilities and practice locations with three or more examination rooms will be required to: (1) independently verify or obtain assurances from a seller of medical equipment that the equipment complies with the federal standards for accessibility and maintain documentation of such verification; and (2) have available an accessible examination table or chair in at least one examination room and an accessible weight scale (if it uses a weight scale). The law includes exceptions, such as when a facility or practice location is unable to obtain medical diagnostic equipment that is commercially available at a commercially reasonable price. These requirements will be in place until federal regulations governing accessibility of medical diagnostic equipment become mandatory.

4. Toxicology Screenings following Nonfatal Opioid Overdose (PA 24-120)

For the period beginning January 1, 2025, until August 31, 2028, a new law requires hospitals that treat patients for a nonfatal overdose of an opioid drug to administer, with the patient's consent, a toxicology screening of the patient, if medically appropriate. The screening must include, but need not be limited to, screening for opiates, opioids, benzodiazepines, cannabinoids, methadone, cocaine, gabapentin, xylazine and any other substance DPH deems appropriate. A hospital that administers a toxicology screening is required to report the screening results to DPH.

On or before January 1, 2026, and annually thereafter, until January 1, 2029, DPH must report to the Public Health Committee of the General Assembly regarding these toxicology screening results, including the identification and analysis of any trends identified; the identification of any benefits experienced by patients as a result of the toxicology screening results; and a recommendation regarding whether toxicology screening reporting should continue after August 31, 2028.

5. Prior Authorizations (PA 24-19, Section 40)

On and after January 1, 2025, each hospital, outpatient surgical facility and group practice of two (2) or more physicians may record and maintain data regarding the amount of time spent when an employee requests prior authorization for or precertification of an admission, service, medication, procedure or extension of stay from a health carrier for a patient. This includes, but is not limited to: (1) speaking directly with the health carrier; (2) physician peer-to-peer conversations regarding the prior authorization or precertification; and (3) writing appeals of a denial of any request for a prior authorization or precertification.

The new law provides that these providers may use preauthorization and precertification codes generated by a hospital association in Connecticut to record the data uniformly. They may also make the data available to Public Health Committee of the General Assembly upon request.

6. Specialty Certification for Health and Professional Liability Insurance Not Required (PA 24-19, Sections 12-13)

A new law effective January 1 prohibits certain health insurers from: (1) refusing to reimburse a health care provider; or (2) preventing a health care provider from participating in any provider network, in either case based solely on the provider's decision not to maintain a specialty certification, including, but not limited to, through participation in a maintenance of certification program, so long as the provider does not hold himself or herself out to be a specialist under the specialty certification.

Similarly, professional liability insurers may not: (1) deny coverage of a health care provider based solely on the provider's decision not to maintain a specialty certification, including, but not limited to, through participation in a maintenance of certification program; or (2) require evidence of maintenance of a specialty certification as a prerequisite for professional liability insurance or other indemnity against liability for professional malpractice, so long as the provider does not hold himself or herself out to be a specialist under the specialty certification.

7. Coverage for Coronary Calcium Scans (PA 24-19, Sections 18 and 19)

Group and individual health insurance policies delivered, issued for delivery, renewed, amended or continued in Connecticut on or after January 1, 2025 generally must cover coronary calcium scans.

The new law will also apply to high deductible health plans (HDHPs) to the maximum extent permitted by federal law. With respect to HDHPs used to establish a medical savings account, an Archer MSA or a health savings account, the new law applies to the maximum extent permitted by federal law and to the extent that the coverage does not disqualify the account for preferred tax treatment.

8. Home Care Provider Registry (PA 24-39, Sections 1-4)

On and after January 1, 2025, the Department of Social Services (DSS), in consultation with DPH and the Department of Consumer Protection, is required to develop and maintain a home care provider registry and data processing system that: (1) promotes awareness of and access to qualified home care providers for persons who receive Medicaid-covered home and community-based services; and (2) may support recruitment and retention of qualified home care providers and support oversight of home care providers. These agencies are responsible for developing procedures for collecting and maintaining the information including, but not limited to, procedures relating to the frequency of collection and methods for updating or removing inaccurate or outdated information.

DSS may apply for enhanced federal financial participation relating to developing and maintaining the registry or ongoing operations relating to the registry.

DSS must post a link to the registry on its web site.

9. Coverage for Ambulance Services (PA 24-19, Sections 34-35)

Current law prohibits certain individual and group health insurance plans from directing or requiring an enrollee to obtain approval prior to calling a 9-1-1 local prehospital EMS system whenever such enrollee is confronted with a life or limb threatening emergency. (CGS §38a-498a).

Effective January 1, 2025, those plans delivered, issued for delivery or renewed on or after January 1, 2025 may not: (1) require an enrollee to obtain approval from the insurer prior to transporting the enrollee when medically necessary by ambulance to a hospital; or (2) deny payment to any ambulance provider responding to a 9-1-1 local prehospital emergency medical service system call on the basis that the enrollee did not obtain approval from the insurer prior to calling the EMS system or prior to transporting the enrollee when medically necessary by ambulance to a hospital.

10. Clinical Peers (PA 24-19, Sections 32-33)

Under current law (CGS §38a-591d), health insurers must use clinical peers who, using clinical review criteria, evaluate the clinical appropriateness of adverse determinations. Clinical peers are health care professionals who hold a nonrestricted license in any state in the same or similar specialty as typically manages the medical condition, procedure, or treatment under review. Following an initial adverse determination that was based, in whole or in part, on medical necessity, Connecticut law requires the insurer to offer a covered person's health care professional the opportunity to confer, at the request of the covered person's health care professional, with a clinical peer. Effective January 1, 2025, the statute governing clinical peers is amended to authorize clinical peers to reverse initial adverse determinations that were based on medical necessity.

Effective January 1, 2026, the definition of “clinical peer” will be amended to require a clinical peer to have the same specialty as the treating health care provider who is managing the medical condition, procedure or treatment under review.

And a Look Ahead…

Nurse Licensure Compact (PA 24-83)

Connecticut has enacted the Nurse Licensure Compact for the period October 1, 2025 through January 1, 2028. The Compact creates a process for registered nurses, licensed practical nurses and vocational nurses to get a multistate license, allowing them to practice in any member state (including by telehealth).

If you have any questions or would like more information about these new laws, please contact a Pullman & Comley Health Care attorney.