P.A. 22-47 AAC Children's Mental Health (H.B. 5001)
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Click here to read The Alliance’s testimony on the bill.
Public Act 22-47 (H.B. 5001) is the most comprehensive of three major bills passed in 2022 addressing the children’s mental health crisis in Connecticut. It contains a significant number of policy changes, detailed below.
Information about select sections is below. To read a detailed analysis of each section of the bill from the Office of Legislative Research, please click here.
§ 1 — DPH Plan for Waiver of Licensure Requirements for Certain Providers
This bill requires the Department of Public Health (DPH) commissioner, in consultation with the Department of Children and Families (DCF) commissioner, to develop and implement a plan to waive licensure requirements for mental or behavioral health care providers licensed or certified (or otherwise entitled to provide these services under a different designation) in other states. The DPH commissioner must prioritize providers licensed or certified (or otherwise entitled) to provide these services to children.
§ 2 — Expedited Licensure for Health Care Providers
The bill expands an existing law on expedited licensure for health care providers licensed in other states by eliminating current provisions limiting it only to state residents or spouses of active-duty military members stationed in Connecticut.
§ 3 — Social Work Licensure Examination Accommodations
The bill requires the DPH commissioner to notify every clinical and master social worker licensure applicant that he or she may be eligible for testing accommodations under the federal Americans with Disabilities Act or other accommodations determined by the Association of Social Work Boards, or its successor organization. Under the bill, these accommodations may include (1) using a dictionary while taking the licensure examination or (2) additional time to complete the examination.
§ 4 — Master Social Work License Temporary Permits
The bill extends, until June 30, 2024, the duration of temporary master social worker permits
from 120 days to one year after attaining a master’s degree and specifies that they are not
void solely because the applicant fails the examination.
§ 5 — Telehealth Services by Out-Of-State Social Workers
The bill allows out-of-state social workers, under certain conditions, to provide telehealth services to residents of other states while the residents are in Connecticut, until July 1, 2024.
P.A. 22-81 (S.B. 2) extends P.A. 21-9’s temporary expanded telehealth requirements by one year until June 30, 2024.
§ 6 — Need-Based Assistance for Mental and Behavioral Health Care Licensure Applicants
The bill requires DPH, within available appropriations, to establish a need-based program that waives application and licensure fees for certain applicants who will provide children’s mental or behavioral health services.
§ 7 — Children’s Mental Health Advisory Board
The bill changes the composition of the Children’s Mental, Emotional, and Behavioral Health Plan Implementation Advisory Board by adding 11 new members and specifying the required credentials of the DCF commissioner’s appointees.
§ 8 — Mobile Psychiatric Services Data Repository
The bill requires DCF to establish and administer a mobile psychiatric services data repository for personnel to share best practices and experiences and collect data on patient outcomes.
P.A. 22-81 (S.B. 2) requires DCF to make mobile crisis response services available to the public 24 hours a day, seven days a week.
§ 9 — Waterbury FQHC Pilot Program for Adolescents with Mental or Behavioral Health Issues
The bill establishes a pilot program in Waterbury, administered by DCF in consultation with DSS, allowing a federally qualified health center (FQHC) to administer intensive outpatient services for adolescents with mental or behavioral health issues. The bill requires the FQHC to administer these services, which must include an extended day treatment program, to at least 144 adolescents annually for no less than five years.
§ 10 — DCF Regional Behavioral Health Consultation and Care Coordination Program
Current law requires DCF’s regional behavioral health consultation and care coordination program to provide certain services to primary care providers who serve children. The bill expands the program to include mental health consultation and coordination and to provide these services to the provider’s pediatric patients. Specifically, the bill incorporates the program expansion to require that it give providers (1) timely access to a consultation team, including a child psychiatrist, social worker, and care coordinator; (2) patient care coordination and transitional services for mental or behavioral health care; and (3) training and education on patient access to mental and behavioral health services.
The bill also requires the program to refer a provider’s pediatric patients for up to three follow-up telehealth or in-person appointments with a mental or behavioral health care provider (1) if the provider determines it to be medically necessary and (2) after the primary care provider has used the program on the patient’s behalf and the patient has been prescribed medication to treat a mental or behavioral health condition. The program must cover the appointment costs, within available appropriations.
The bill requires the providers to refer the patients to a care coordinator who contracts with DCF, but is not participating in the program, to provide short-term assistance to the patients in getting mental or behavioral health care from a non-participating mental or behavioral health care provider. Under the bill, DCF must request reimbursement from a health carrier for services provided under the program before paying for the services with appropriated funds.
§ 11 — Office of Healthcare Advocate Employee
The bill requires the healthcare advocate to designate an employee to be responsible for Office of Healthcare Advocate services that are specific to minors.
§ 12 — Student Mental Health Specialist Employment Survey
The bill requires SDE to annually survey boards of education about their employment of student mental health specialists and calculate student-to-specialist ratios for districts and schools
§ 13 — Grant for Student Mental Health Specialist Hiring
The bill requires the State Department of Education (SDE) to administer a program to provide grants in FYs 23-25 to local and regional boards of education for hiring student mental health specialists.
§ 14 — Grant for Delivery of Student Mental Health Services
The bill requires SDE to administer a program to provide grants in FYs 23-25 to boards of education, youth camps, and other summer program operators for delivery of student mental health services.
§ 15 — Grant for College and University Delivery of Student Mental Health Services
The bill requires the Office of Higher Education (OHE) to administer a program to provide grants in FYs 23-25 to public and private higher education institutions to deliver student mental health services on campus.
§§ 16 & 21 — Student Truancy and Behavioral Health Interventions
The bill requires each school district to adopt and implement three new policies or procedures related to truant students; requires SDE to develop a truancy intervention model that accounts for mental and behavioral health; requires SDE, along with DCF, to issue guidance to school districts regarding best practices for behavioral health interventions and when to call the 2-1-1 Infoline program or use alternative interventions
§§ 17 & 18 — Regional Student Trauma Coordinators
The bill requires each of the state’s six regional educational service centers (RESCs) to hire a regional trauma coordinator to, among other things, develop and implement a trauma- informed care training program; requires coordinators to train specialists at the local level to train teachers, administrators, and other staff; requires progress report and a final report to be submitted to the Children’s and Education committees.
§ 19 — Behavior Intervention Meetings
Beginning in the 2022-23 school year, the bill allows any classroom teacher to request a behavior intervention meeting with the school’s crisis intervention team for any student whose behavior has caused (1) a serious disruption to other students’ instruction or (2) self-harm or physical harm to the teacher, another student, or staff in the teacher’s classroom. By law, the school’s crisis intervention team responds to incidents where physical restraint or seclusion may be necessary to prevent immediate or imminent injury to a student or others. The school principal designates the team members, consisting of a teacher, administrator, and school paraprofessional or other school employee who has direct contact with students (CGS § 10-236b(o)(2)).
The crisis intervention team must hold the meeting, and its participants must identify resources and supports to address the social, emotional, and instructional needs of the student of concern.
§ 20 — Student Trauma Assessment Added to the Strategic School Profile
The bill adds a needs assessment that identifies resources needed to address the level of student trauma to the existing list of items included in every school’s strategic school profile.
§§ 22-24 — Statewide Emergency Service Telecommunications
The bill specifies that the statewide emergency service telecommunications plan must address residents who need mental health, behavioral health, or substance use disorder services. It also adds the DPH, DMHAS and DCF commissioners to the E 9-1-1 Commission and adds the DMHAS and DCF Commissioners to the DESPP Coordinating Advisory Board.
§§ 25-30 — 9-8-8 Suicide Prevention and Mental Health Crisis Lifeline
9-8-8 Fund (§25)
A 2020 federal law (P.L. 116-172) designated 9-8-8 as the national suicide prevention and mental health crisis hotline, scheduled to be operational on July 16, 2022.
The bill establishes the “9-8-8 Suicide Prevention and Mental Health Crisis Lifeline Fund” as a separate, non-lapsing General Fund account. Although the funding is unspecified by the bill, DMHAS must only use the account’s funds for (1) ensuring the efficient and effective routing of in-state calls made to 9-8-8 to an appropriate crisis center and (2) personnel and the provision of acute mental health, crisis outreach, and stabilization services by directly responding to 9-8-8.
The bill requires that the following be deposited or transferred into the fund: (1) any General Fund appropriation to DMHAS directed to the fund; (2) any grants or gifts intended for the fund; and (3) fund interest, premiums, gains, or other earnings. It also prohibits any money in the fund from being transferred or otherwise diverted to other purposes.
The bill requires the DMHAS commissioner to annually report on the fund’s deposits and expenditures beginning by January 1, 2024, to the Appropriations, Public Health, Human Services, and Children’s committees.
Public Safety Answering Points (PSAP) Procedures for 9-1-1 Calls (§ 26)
The bill requires the Department of Emergency Services and Public Protection (DESPP), in collaboration with DMHAS, DCF, and DPH, to develop a plan for incorporating mental and behavioral health and substance use disorder diversion into the procedures public safety answering points (PSAPs) use to dispatch emergency response services in response to 9-1-1 calls. The plan must include recommendations for the following:
- staffing PSAPs with licensed mental and behavioral health and substance abuse disorder service providers to (a) provide crisis counseling to 9-1-1 callers who immediately require these services, (b) assess their need for ongoing services, and (c) if needed, refer them to service providers;
- transferring callers who require these services to responders, other than law enforcement (e.g., community organizations, mobile crisis teams, local organizations, or networks), who provide telephone support or referral services for people with mental or behavioral health needs or a substance use disorder, and asking whether these callers are veterans to better target the necessary services;
- requiring PSAPs to coordinate with DMHAS during the state’s transition of mental health crisis and suicide response from the United Way’s 2-1-1 Infoline program to the National Suicide Prevention Lifeline’s 9-8-8 program;
- developing protocols for transferring 9-1-1 calls to the 9-8-8 line when it is operational;
- setting standards for training telecommunicators (i.e., 9-1-1 emergency dispatchers) to respond to 9-1-1 callers who may require mental or behavioral health or substance use disorder services;
- collecting data to evaluate the effectiveness of procedures used to divert 9-1-1 callers who may need these services to the appropriate crisis hotline or services provider; and
- evaluating how other states or jurisdictions implemented these procedures.
Tracking of Services in Response to 9-8-8 Calls (§ 27)
The bill requires DMHAS to develop and report on a mechanism to track services provided in response to 9-8-8 calls.
9-8-8 on Student IDs (§§ 28-30)
The bill requires school districts and colleges & universities to include the 9-8-8 Suicide Prevention Lifeline on all student identification cards issued to students in grades 6-12 and in college.
§ 31 — Certificate of Need for Mental Health Facilities
Generally, existing law requires health care facilities to apply for and receive a certificate of need (CON) from the Office of Health Strategy’s (OHS) Health Systems Planning Unit when proposing to (1) establish a new facility or provide new services, (2) change ownership, (3) purchase or acquire certain equipment, or (4) terminate certain services. Nonprofit facilities that contract with state agencies are exempt from needing to acquire a Certificate of Need. Thus, the bill applies to for-profit facilities or nonprofit facilities not otherwise exempt by current law.
Under certain conditions, the bill exempts from CON requirements increases in the licensed bed capacity of mental health facilities, through June 30, 2026.
To be eligible for the bill’s temporary CON exemption, a mental health facility must demonstrate to the Health Systems Planning Unit, in a form the unit prescribes, that it accepts reimbursement for any covered benefit to covered individuals under certain types of private or public insurance plans. Specifically, this applies to:
- individual or group health insurance policies that cover (a) basic hospital expenses; (b) basic medical-surgical expenses; (c) major medical expenses; or (d) hospital or medical services, including those provided under an HMO plan;
- self-insured plans under the federal Employee Retirement Income Security Act (ERISA); and
- HUSKY Health (i.e., Medicaid and the state children’s health insurance program).
The exemption ends if the mental health facility does not accept or stops accepting reimbursement for any covered benefit under these policies, plans, or programs.
§ 32 — DCF Grant Program for Certain Mental and Behavioral Health Treatment Costs
The bill establishes a Mental and Behavioral Health Treatment Fund, with funds the DCF commissioner must use to assist families with the costs of obtaining prescribed drugs or treatments and intensive services for children with mental and behavioral health conditions if insurance or Medicaid does not cover them.
Under the bill, the intensive services include intensive evidence- based services or other intensive services to treat mental and behavioral health conditions in children and adolescents, including intensive in- home child and adolescent psychiatric services and services provided by an intensive outpatient program.
§ 33 — Pediatric Mental Health Screening Tool
The bill requires DPH to develop or procure a screening tool to help pediatricians and emergency room doctors diagnose mental health, behavioral health, or substance use disorders in children.
By January 1, 2023, the bill requires DPH, in collaboration with DCF and DMHAS, to make the screening tool available to all pediatricians and emergency department physicians in the state, free of charge, and make recommendations to pediatricians and emergency department physicians for its effective use. It requires pediatricians and emergency department physicians to use the screening tool as a supplement to the existing methods used to diagnose a mental or behavioral health condition or a substance use disorder.
Under the bill, pediatricians must provide the screening tool to each patient annually, and emergency department physicians must (1) provide the screening tool to each emergency department patient under age 18 and at least the minimum department-determined age, or the parents or guardian, before the child’s discharge from the emergency department and (2) send a copy of it to the child’s pediatrician or primary care provider to the extent possible and as soon as practicable.
§§ 34-36 — Peer-To-Peer Mental Health Support Program
The bill requires DCF, in collaboration with SDE, to develop a peer-to-peer mental health support program for students in grades 6 through 12 and authorizes local and regional boards of education and certain other entities to administer the program in grades 6 through 12 beginning with the 2023-2024 school year.
§ 37 — DCF In-Home Respite Care Services Program
The bill requires the DCF commissioner to set up an in-home respite care services program to help parents and guardians of children with behavioral health needs and creates a General Fund account dedicated to the program.
§ 38 — Child and Adolescent Psychiatrist Grant Program
The bill requires DPH to establish a child and adolescent psychiatrist grant program, providing incentive grants to employers for recruiting, hiring, and retaining these psychiatrists.
§ 39 — DMHAS Advertising Campaign
The bill requires DMHAS, in collaboration with DCF, to (1) plan and implement a statewide advertising campaign on the availability of mental or behavioral health and substance use disorder services in the state and (2) set up a comprehensive website with related information.
§ 40 — Peer-To-Peer Support Program for Caregivers
Requires the DCF-contracted peer-to-peer support program for parents and caregivers of children with behavioral health needs to use allocated state funds to provide services to those who are not covered for these services under HUSKY Health or a health insurance policy
The bill requires the peer-to-peer support program that provides services to parents and caregivers of children with mental and behavioral health issues to use state funds allocated for the program to provide services to those who are not covered for these services under (1) HUSKY Health or (2) an individual or group health insurance policy. The bill allows the program, which is operated by an administrative services organization that contracts with DCF, to continue to provide services to parents and caregivers of children covered under HUSKY Health if the program exhausts allocated state funds.
§§ 41 & 42 — Mental Health Wellness Exams
The bill requires fully insured individual and group health insurance policies to cover two mental health wellness examinations per year conducted by a licensed mental health professional or primary care provider. The examinations must be provided with no patient cost-sharing (i.e., no coinsurance, copay, or deductible) or prior authorization requirements.
§§ 43 & 44 — Health Insurance Coverage for Intensive Services for Mental Conditions
The bill requires fully insured individual and group health insurance policies to cover intensive or evidence-based services to treat a child’s mental or nervous condition, instead of intensive home-based services as current law requires. The bill also expands this coverage to include adolescents, rather than only children as under current law.
§ 45 — Psychology Doctoral Student Clerkship Program
The bill requires DPH to establish an incentive program to allow two-year license renewal, rather than annual, for four years for psychology doctoral students completing a clerkship at certain DCF-licensed or -operated facilities.
§ 46 — Protocols for EMS Transport
The bill requires the Office of Emergency Medical Services to develop protocols for EMS organizations or providers to transport pediatric patients with mental or behavioral health needs by ambulance to DCF-licensed urgent crisis centers.
§§ 47 & 48 — Health Insurance Coverage for Collaborative Care Model Services
The bill requires fully insured individual and group health insurance policies to cover health care services that a primary care provider provides to an insured under the Collaborative Care Model. Under the bill, the “Collaborative Care Model” is the integrated delivery of behavioral health and primary care services by a primary care team that includes a primary care provider, behavioral care manager, and psychiatric consultant. It must also include a database the behavioral care manager uses to track patient progress.
Under the bill, this coverage must include services with the following Current Procedural Terminology (CPT) or Healthcare Common Procedure Coding System (HCPCS) codes, including any subsequent corresponding codes:
- HCPCS G2214, an initial or subsequent psychiatric collaborative care management, in consultation with other collaborative care team professionals (i.e., tracking or following up on patient progress);
- CPT 99484, clinical staff time for behavioral health care management conditions;
- CPT 99492, an initial psychiatric collaborative care management;
- CPT 99493, subsequent psychiatric collaborative care management; and
- CPT 99494, additional initial or subsequent psychiatric collaborative care management.
§§ 49-54 — Expanded Health Insurance Coverage for Certain Emergency Services qnd DCF-Licensed Urgent Crisis Centers
Prior Authorization, Cost Sharing, and Maximum Billable Amounts (§ 49)
The bill prohibits health carriers from (1) requiring prior authorization for urgent crisis center services or (2) imposing a cost- sharing level for out-of-network services provided at these urgent crisis centers that is greater than the in-network level. Under the bill, an “urgent crisis center” is a DCF-licensed center dedicated to treating children’s urgent mental or behavioral health needs, and “urgent crisis center services” are pediatric mental and behavioral health services provided at one of these centers.
The bill also establishes the maximum allowable billable and reimbursable amounts for out-of-network services provided at an urgent crisis center. For these services, a provider may bill the carrier directly, and a carrier must reimburse the center or insured, for the in- network rate as payment in full. As with existing law for out-of-network emergency services, a provider and carrier may agree to a different rate.
Prohibits Balance Billing (§§ 50 & 51)
The bill makes it a Connecticut Unfair Trade Practices Act (CUTPA) violation for a health care provider to “balance bill” an insured for covered out-of-network service provided at a DCF-licensed urgent crisis center (i.e., bill more than the collectable cost-sharing under the policy).
The bill also prohibits any health care center (i.e., HMO) provider, agent, trustee, or assignee from requesting any payment from an enrollee for covered out-of-network services provided at one of these crisis centers, presumably excluding allowable cost sharing. It additionally requires all HMO contracts with providers to disclose that doing so is a CUTPA violation.
Applicability (§ 49)
The provisions described above (i.e., prior authorization, cost sharing, billable amounts, and balance billing) apply to individual and group health insurance policies. However, for plans that are high deductible health plans (HDHPs), it applies only to the maximum extent permitted by federal law.
Full Week, 24-Hour Access to Services (§ 52)
By law, health carriers must provide covered people with access to emergency services 24 hours per day, seven days per week. The bill requires carriers to also ensure that covered people have the same access to DCF-licensed urgent crisis center services, to the extent urgent crisis center services are available.
Expanded Treatment Coverage for Mental or Nervous Conditions (§§ 53 & 54)
By law and with the exception of emergency services or certain referrals, HMOs are not required to cover state-mandated treatments for mental or nervous conditions at unaffiliated facilities. By also excluding services rendered at a DCF-licensed urgent crisis center, the bill requires HMOs to cover these services even when provided at unaffiliated facilities.
§§ 55 & 56 — Prohibiting Prior Authorization for Certain Emergency Acute Inpatient Psychiatric Services
The bill prohibits individual and group health insurance policies that cover acute inpatient psychiatric services from requiring prior authorization if these services are provided (1) after a hospital emergency department admission; (2) under a referral from the insured’s treating physician, psychologist, or APRN if the insured poses an imminent danger to himself or others; or (3) at an urgent crisis center. The bill specifies that it does not preclude a health carrier from using other forms of utilization review, including concurrent and retrospective review.
§ 57 — Office of Health Strategy Reimbursement Rate Study
The bill requires the Office of Health Strategy (OHS) to study the rates at which health carriers (e.g., insurers and HMOs) and third-party administrators (TPAs) in the state reimburse health care providers for covered physical, mental, and behavioral health benefits under individual and group health insurance policies.
§ 58 — OHS Payment Parity Study
The bill requires OHS, in consultation with the insurance and DSS commissioners, to study whether payment parity exists between the following:
- providers of behavioral and mental health services and providers of other medical services in the private insurance market;
- these providers within the HUSKY Health program (i.e., Medicaid and the state children’s health insurance program); and
- behavioral and mental health providers within the HUSKY Health program and the private insurance market.
The study must also include (1) what rate increases may be needed to encourage more private providers to offer behavioral and mental health services to HUSKY Health members, (2) an estimate of how much these increases would cost the state annually, and (3) potential state savings on other health care costs annually if HUSKY Health members were to have expanded access to these providers.
§ 59 — Medicaid Reimbursement System to Encourage Collaboration
The bill requires the DSS commissioner to implement a Medicaid reimbursement system, to the extent federal law allows, that encourages collaboration between primary care providers and behavioral and mental health care providers and recognizes that multiple providers may be involved in providing care. The bill allows the commissioner to consider the potential impact on federal reimbursement when implementing the system.
The bill allows the DSS commissioner to adopt the Collaborative Care Model to expand access to behavioral and mental health services for HUSKY Health program members. Under the bill, this model is the integrated delivery of behavioral health and primary care services by a primary care team that includes a primary care provider, a psychiatric consultant, and a behavioral care manager who uses a database to track patient progress. The bill also allows DSS to use the billing system developed by the federal Centers for Medicare and Medicaid Services (CMS) that provides Medicaid rates for services provided under this model.
§§ 60 & 61 — Youth Service Corps (YSC) Program and Grants
The bill establishes a YSC grant program to provide grants to municipalities with priority school districts (PSD) to establish programs that provide paid, community-based service learning and academic and workforce development programs to eligible Connecticut youth and young adults (i.e., local YSC programs).
§§ 62-64 — Information on Children’s Mental Health and Domestic Violence
The bill sets new distribution requirements for the (1) DCF children’s behavioral and mental health resources document and (2) judicial branch’s Office of Victim Services (OVS) domestic violence victim resources document, including providing both documents in multiple languages and available electronically, and requires first responders carry the document in their vehicles and provide it to victims of domestic violence.
§§ 65 & 66 — Victim Compensation Program Expansion
The bill expands the Victim Compensation Program by extending eligibility to victims of child abuse substantiated by DCF and victims of certain other crimes against minors.
§ 67 — Special Education Disability Terminology
The bill requires SDE and boards of education to use “emotional disability” instead of “emotional disturbance” for special education purposes.
§ 68 — Child and Adolescent Psychiatry Working Group
The bill creates a working group to develop a plan to increase the number of psychiatry residency and child and adolescent psychiatry fellowship placements in the state.
§ 69 — DPH Grant To Children’s Hospital
The bill allows DPH, within available resources, to award a $150,000 grant in FY 23 to an in-state children’s hospital for coordinating a mental and behavioral health training and consultation program, and requires the hospital to report on the program.
§ 70 — Behavioral and Mental Health Policy and Oversight Committee
The bill establishes, within the Legislative Department, a Behavioral and Mental Health Policy and Oversight Committee. The committee’s charge is to (1) evaluate the availability and efficacy of prevention, early intervention, and mental health treatment services and options for children (birth to age 18) and (2) make recommendations to the legislature and executive agencies on the governance and administration of the mental health care system for children.
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