P.A. 22-81 AA Expanding Preschool and Mental and Behavioral Services for Children. (S.B. 2)
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Public Act 22-81 (S.B. 2) is one 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 — Department of Mental Health Services (DMHAS) Mobile Crisis Response Services
The bill requires, for FY 23 and each year after, DMHAS to make mobile crisis response services available to the public 24 hours a day, seven days a week.
§ 2 — Social Determinants of Mental Health Fund
Establishes a “Social Determinants of Mental Health Fund” and requires the DCF commissioner to use the funds to help families with the costs of mental health services and treatment for their children.
§§ 3 & 4 — Mental Health Plan for Student Athletes
Requires SDE to establish, and boards of education to implement, a mental health plan for student athletes to raise awareness about available resources.
§ 5 — Pipeline for Connecticut’s Future Program
Current law allows local or regional boards of education to set up a “Pipeline for Connecticut’s Future” program with local business to create onsite student training opportunities for course credit. The bill instead requires SDE, in collaboration with The Department of Labor (DOL), to administer this program. Under the bill, SDE must help boards of education enhance existing partnerships or make new ones with child care providers and early childhood education programs, as well as partnerships with more fields, such as manufacturing, computer programming, or culinary arts, and one or more local businesses, to offer a pathways program.
§ 8 — Family Care Coordinators
The bill requires each local and regional board of education to hire or designate an existing employee to serve as the district’s family care coordinator. The family care coordinator must work with school social workers, school psychologists, and school counselors under the board’s jurisdiction and serve as the school system’s liaison with mental health service providers to (1) provide students with access to mental health resources in the community and (2) bring mental health services to students in school.
§§ 10 & 11 — Children’s Mental Health Day
Requires (1) the governor to proclaim May twenty-sixth of each year to be “Get Outside and Play for Children’s Mental Health Day” and (2) SDE to provide annual notice about the day to school boards starting with the 2022-2023 school year.
§ 12 — Payment to Early Intervention Services Providers
The bill requires the OEC commissioner, for FYs 23-24, to make a $200 general administrative payment to early intervention service providers for each child (1) with an individualized family service plan on the first day of the billing month and (2) whose plan accounts for less than nine service hours during the billing month, as long as the provider provides at least one service during the month.
§§ 14 & 15 — OEC Regulations on Parental Notification
The bill requires the OEC commissioner to adopt regulations requiring child care facilities to notify parents about certain incidents resulting in a child’s injury or illness.
§ 16 — DCF Cost Offset and Benefit Payment Policy
The bill prohibits DCF from using a child’s Social Security disability benefits to offset the cost of their care while in DCF care and custody, and requires the DCF commissioner to establish a policy to manage these benefits.
§ 17 — DPH Pilot Program Expanding Behavioral Health Care for Children by Pediatric Care Providers
The bill requires the DPH commissioner, in consultation with the DSS commissioner, to establish a pilot grant program to expand behavioral health care offered to children by pediatric care providers in private practices.
Under the bill, the DPH commissioner, must within available appropriations, establish a grant program to provide the pediatric care providers a 50% match for the cost associated with paying the salaries of licensed social workers providing counseling and other services to children receiving primary health care from the providers.
§ 23 — Out-Of-Pocket Medical Costs for Child Care Facility Employees
The bill requires the DSS commissioner, in consultation with the state comptroller, to study ways the state can provide financial assistance to child care facility employees for out-of-pocket medical costs.
§ 24 — Task Force to Study Children’s Needs
The bill reconvenes a 25-member task force to continue to study the (1) comprehensive needs of children in the state and (2) extent to which educators, community members, and local and state agencies are meeting them.
§ 25 — Medicaid State Plan Expansion
The bill requires the DSS commissioner, by October 1, 2022, to provide Medicaid payments to an enrolled independent licensed behavioral health clinician in private practice for covered services performed by an associate licensed behavioral health clinician under the independent clinician’s supervision if the:
- associate clinician is working within his or her scope of practice and
- independent clinician (a) is authorized under state law to supervise the associate clinician and complies with any supervision and documentation requirements required by law.
Under this provision an “independent licensed behavioral health clinician” is a licensed psychologist, marital and family therapist, clinical social worker, or professional counselor. An “associate licensed behavioral health clinician” is a licensed marital and family therapy associate, master social worker, or professional counselor associate.
“Private practice” means a practice setting that does not require a facility or institutional license and includes both solo and group practices of independent licensed behavioral health clinicians.
The bill specifies that its provisions must not be construed to alter any requirements regarding these services, including scope of practice, supervision, and documentation requirements.
§ 26 — Licensure by Reciprocity or Endorsement for Speech and Language Pathologists and Occupational Therapists
The bill requires DPH, in consultation with OEC, to develop and implement a plan to establish licensure by reciprocity or endorsement for speech and language pathologists or occupational therapists licensed elsewhere and who intend to provide services under the Birth-to-Three program
§ 27 — Connecticut Alcohol and Drug Policy Council
The bill the child advocate, or her designee, to the Connecticut Alcohol and Drug Policy Council.
§ 28 — DPH Primary Care Direct Services Program
Existing law requires the DPH commissioner to establish, within available resources, a program to provide three-year grants to community-based primary care services providers to expand access to health care for the uninsured. The grants may be used for, among other things, (1) funding for direct services; (2) providing loan repayment to primary care clinicians (e.g., family practice physicians); and (3) capital expenditures.
Current law requires the community-based primary care providers under the direct service program to provide, or arrange access, to certain health services (e.g., primary and preventive services). The bill requires them to also provide, or arrange access to, behavioral health services.
The bill makes psychiatrists, psychologists, licensed clinical social workers, licensed marriage and family therapists, and licensed professional counselors eligible for the state loan repayment program. It does so by broadening the definition of “primary care clinicians” to include these professional designations. Under current law, “primary care clinicians” are family practice physicians, general practice osteopaths, obstetricians and gynecologists, internal medicine physicians, pediatricians, dentists, certified nurse midwives, advanced practice registered nurses, physician assistants, and dental hygienists.
Under the bill, for FY23, DPH must expend at least $1.6 million of the funds appropriated for the state loan repayment program for repayments for physicians. Any remaining funds may be expended for other health care providers.
§§ 30-41 —Telehealth
The bill extends PA 21-9’s temporary expanded telehealth requirements for the delivery of
telehealth services by one year to June 30, 2024, including audio-only services, and applies them to all authorized telehealth providers, instead of only in-network and CMAP telehealth providers. It also makes a number of other changes and expansions to telebehavioral health in Connecticut.
P.A. 22-47 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.
Out-Of-State Telehealth Providers (§§ 30, 32 & 33)
The bill extends PA 21-9’s provisions allowing certain out-of-state telehealth providers to provide telehealth services in Connecticut to June 30, 2024.
Starting July 1, 2024, the bill permanently authorizes out-of-state mental or behavioral health service providers to practice telehealth in Connecticut if the provider:
- is appropriately licensed, certified, or registered in another U.S. state or territory, or the District of Columbia, as a physician, naturopath, registered nurse, advanced practice registered nurse, physician assistant, psychologist, marital and family therapist, clinical or master social worker, alcohol and drug counselor, professional counselor, dietician-nutritionist, nurse-midwife, behavior analyst, or music or art therapist;
- provides telehealth services under a relevant Department of Public Health (DPH) order (see below);
- provides mental or behavioral health services within his or her professional scope of practice and professional standards of care; and
- maintains professional liability insurance or other indemnity against professional malpractice liability in an amount equal to or greater than what is required in Connecticut for these providers.
The bill correspondingly permits the DPH commissioner to issue an order authorizing out-of-state telehealth providers to practice in Connecticut that may do the following:
- limit the duration of this practice or the types of authorized telehealth providers allowed to do so and
- impose conditions, including requiring out-of-state telehealth providers to submit an application for licensure, certification, or registration, as applicable.
Under the bill, the commissioner may suspend or revoke an out-of- state telehealth provider’s authorization to practice in Connecticut if he or she violates any condition the commissioner imposes or any applicable statutory requirements.
Hospital Facility Fees for Telehealth Services (§ 31)
The bill prohibits hospitals from charging facility fees for telehealth services, whether those services are provided on or off the hospital campus. (Existing law prohibits telehealth providers from charging facility fees.)
Temporary Expansion of Telehealth Service Delivery Requirements (§§ 32, 34 & 38)
Existing law generally sets requirements for the provision of telehealth services by authorized providers. PA 21-9 temporarily replaces these requirements with similar, but more expansive, requirements for authorized providers who are (1) in-network providers for fully insured health plans or (2) Connecticut Medical Assistance Program (“CMAP,” i.e., Medicaid and HUSKY B) providers until June 30, 2023. The bill extends the more expansive requirements described below by one year until June 30, 2024, and applies them to all authorized telehealth providers, instead of only in-network and CMAP telehealth providers.
The bill also extends by one year until June 30, 2024, a provision in PA 21-9 that permits physicians and advanced practice registered nurses to certify a qualifying patient’s use of medical marijuana and provide follow-up care using telehealth if they comply with other statutory certification and recordkeeping requirements. As under current law, they may do so despite existing laws, regulations, policies, or procedures on medical marijuana certifications.
The bill allows authorized telehealth providers to provide telehealth services via audio-only telephone until June 30, 2024.
By law, a telehealth provider can provide telehealth services to a patient only when the provider has met certain requirements, such as (1) having access to, or knowledge of, the patient’s medical history and health record and (2) conforming to his or her professional standard of care expected for in-person care appropriate for the patient’s age and presenting condition.
The bill requires, until June 30, 2024, that the provider also determine whether the (1) patient has health coverage that is fully insured, not fully insured, or provided through CMAP and (2) coverage includes telehealth services. It also allows telehealth providers to provide telehealth services from any location, regardless of any state licensing standards and subject to compliance with applicable federal requirements.
Existing law requires a provider, at the first telehealth interaction with a patient, to document in the patient’s medical record that he or she obtained the patient’s consent after giving information about telehealth methods and limitations. Until June 30, 2024, the bill requires this to include information on the limited duration of the bill’s provisions. A patient’s revocation of consent must also be documented in their medical record.
The bill modifies the requirement that telehealth services and health records comply with the Health Insurance Portability and Accountability Act (HIPAA) by allowing telehealth providers to use more information and communication technologies in accordance with HIPAA requirements for remote communication as directed by the federal Department of Health and Human Services’ Office of Civil Rights (e.g., certain third-party video communication applications, such as Apple FaceTime, Skype, or Facebook Messenger). The bill allows the use of these additional information and communication technologies until June 30, 2024.
Temporary Insurance Coverage for Telehealth Services (§§ 35-37)
As in existing law and PA 21-9, the bill requires commercial health insurance policies to cover medical advice, diagnosis, care, or treatment provided through telehealth to the extent that they cover those services when provided in person. It generally subjects telehealth coverage to the same terms and conditions that apply to other benefits under a health policy. Insurers, HMOs, and related entities may conduct utilization reviews for telehealth services in the same way they do for in-person services, including using the same clinical review criteria. (The bill clarifies that telehealth excludes audio- only telephone for policies that use a provider network and the telehealth provider is out-of-network.)
Under the bill, as under PA 21-9, health insurance policies cannot exclude coverage (1) just because a service is provided through telehealth, so long as telehealth is appropriate, or (2) for a telehealth platform that a telehealth provider selects. Also, telehealth providers who receive reimbursement for providing a telehealth service may not seek any payment from the insured patient except for cost sharing (e.g., copay, coinsurance, deductible) and must accept the amount as payment in full. Lastly, the bill prohibits health carriers (e.g., insurers and HMOs), until June 30, 2024, from reducing the amount of reimbursement they pay to telehealth providers for covered services appropriately provided through telehealth instead of in person.
Permanent Insurance Coverage for Telehealth Services (§§ 39 & 40)
Beginning July 1, 2024, following the sunset of the temporary insurance coverage provisions noted above (Sections 35-37), the bill permanently requires fully insured individual and group health insurance policies to cover medical advice, diagnosis, care, or treatment provided through telehealth to the same extent that they cover those services when provided in person by a health care provider licensed in Connecticut. Current law requires the coverage to the extent the service is covered in person by any provider.
Telehealth Study (§ 41)
The bill requires the OHS executive director to study the provision of, and coverage for, telehealth services in the state. The study must include (1) the feasibility and impact of expanding access to telehealth
services, telehealth providers, and coverage for telehealth services in the state beginning July 1, 2024, and (2) any means available to reduce or eliminate obstacles to such services, including, but not limited to, reducing patient costs.
§ 42 — Psychology Interjurisdictional Compact
The bill enters Connecticut into the Psychology Interjurisdictional Compact, which provides a process authorizing psychologists to practice by (1) telehealth and (2) temporary in- person, face-to-face services across state boundaries, without requiring psychologist licensure in each state.
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