CMGMA Board members Sandra Coppola, Peter Verlezza, Bill Wollman and Jed Beaulier attending Physician’s Day at the Capitol on March 16, 2017

CMGMA Board members Sandra Coppola, Peter Verlezza, Bill Wollman and Jed Beaulier attending Physician’s Day at the Capitol on March 16, 2017. They spent the day speaking to legislators and networking with physicians throughout the state.

2017 Legislative Session

 5 Healthcare Stories to Watch in the 2017 Legislative Session


The 2017 legislative session is currently in full swing with committee meetings and hearings.  Most committees will soon meet their committee deadlines to report bills to the floor of the House or the Senate.  Dominating the session this year is the projected $1.5 billion deficit that the state is currently facing.  Many health care related services may face significant cuts.  Health care advocates are strongly encouraging the state to increase taxes on cigarettes and other tobacco products in order to raise revenue (and to discourage the use of tobacco products).  In addition to possible budget cuts, the legislature may have to alter the healthcare exchange depending on what comes down from the federal government’s possible repeal of Obama Care.  The legislature must also continue to look for ways to decrease health care costs for consumers, combat opioid abuse, consider scope of practice bills, determine possible expansion of health care coverage, and a possible altering of the certificate of need process.  CMGMA will continue to monitor and advocate on all legislation that will impact patients and the practice of medicine.


2016 Legislative Recap

May 11, 2016

The 2016 regular legislative session ended on May 4.  Throughout the session, staff read through each piece of introduced legislation, identified those of importance to medicine and then monitored and advocated on them.  Following is a list of bills and their final status that were of priority to medicine during the session. 

Senate Bill 67 – An Act Concerning the Authority and Responsibilities of Advanced Practice Registered Nurses was passed despite opposition from medicine.  The bill allows advanced practice registered nurses (APRNs) to certify, sign, or otherwise document medical information in several situations that currently require a physician's signature, certification, or documentation.  For example, an APRN may now certify a patient for medical marijuana use (except for glaucoma), issue “do not resuscitate” orders, certify a disability to cancel a health club contract, and  certify a disability or illness for continuing education waivers or extensions for various health professions.  The bill also extends an APRNs authority or responsibility where written documentation is not required that currently applies only to physicians (e.g., notification to specified people before removal of life support).  In addition, the bill extends certain reporting requirements to APRNs regarding specified types of patients or conditions (e.g., reporting to the Department of Rehabilitation Services (DORS) when a blind person comes under the APRN's care).

The bill allows optometrists and APRNs to document an individual's blindness or other vision-related information in a few situations that currently require a physician's documentation.

House Bill 5129 – An Act Concerning the Administration of Vaccines by Pharmacists and Medical Assistants and the Listing of Certified Medical Assistants would have expanded the authority of licensed pharmacists to administer vaccines, by allowing them to administer the flu vaccine to minors age 12 and older, under the same conditions as currently apply when they administer vaccines to adults.  It would have also allowed medical assistants meeting specified education, national certification, and supervision requirements to administer the flu vaccine in certain settings.  The bill died on the House calendar.

House Bill 5053 – An Act Increasing Access to Overdose Reversal Drugs includes several provisions on opioid abuse prevention and treatment and related issues and was passed by both the House and the Senate.  The bill awaits the Governor’s signature.  Specifically, the bill: 

 1. prohibits, with certain exceptions, a prescribing practitioner authorized to prescribe an opioid drug from issuing a prescription for more than a seven-day supply to (a) an adult for the first time for outpatient use or (b) a minor (§ 7);

2. makes various changes to the electronic prescription drug monitoring program, such as (a) expanding who may serve as a prescriber's authorized agent, (b) modifying reporting deadlines, and (c) decreasing prescriber reviews for prolonged treatment of schedule V nonnarcotic drugs (§§ 8 & 9);

3. allows any licensed health care professional to administer an opioid antagonist (e.g., Narcan) to treat or prevent a drug overdose without civil or criminal liability (§ 1);

4. requires municipalities, by October 1, 2016, to amend their local emergency medical services (EMS) plans to ensure that specified first responders are equipped with an opioid antagonist and trained in administering it (§ 1);

5. prohibits certain health insurance policies that provide prescription drug coverage for opioid antagonists from requiring prior authorization for these drugs (§§ 2 & 3); and

6. requires the Public Health Committee chairpersons to establish a working group on the issuance of opioid drug prescriptions by prescribing practitioners. (OLR Bill Analysis)

Senate Bill 433 – An Act Concerning Standards and Requirements for Health Carriers’ Provider Networks and Contracts between Health Carriers and Participating Providers.  This bill requires health carriers (e.g., insurers and HMOs) to establish and maintain adequate provider networks to assure that all covered benefits are accessible to covered individuals without unreasonable travel or delay. Carriers must ensure that emergency services are available at all times. Additionally, it requires a carrier to provide benefits at the in-network level of coverage when a nonparticipating provider performs covered services for a covered individual if a participating provider is not available in the network.  The bill passed the House and the Senate and now awaits the Governor’s signature. 

Senate Bill 351 - An Act Concerning Matters Affecting Physicians and Hospitals was passed by the House and Senate and now awaits the Governor’s signature.  The bill makes several changes that impact physicians and their practices.  Specifically, the bill:

1. sets specific limits on physician non-compete agreements, such as (a) restricting them to no more than one year and a 20-mile radius from the physician's primary practice site and (b) prohibiting hospitals from restricting a physician's ability to leave for private practice;

2. expands which entities may employ physicians by allowing independent practice associations and certain other entities not owned by a hospital to establish for-profit or nonprofit medical foundations, and makes other changes concerning medical foundations;

3. expands an existing definition of “captive professional entity,” that applies to the medical foundation provisions and existing notice requirements for material changes to physician group practices;

4. requires hospital bills to include the hospital's cost-to-charge ratio;

5. changes the required information providers must give to patients when referring them to certain affiliated providers; and

6. allows the Health Care Cabinet to study and report on the possible licensure of urgent care and limited service health clinics. (OLR Bill Analysis)

Senate Bill 373 – An Act Limiting Changes to Health Insurers’ Prescription Drug Formularies.  This bill prohibits insurers and HMOs from removing a drug from a formulary (i.e., a list of covered prescription drugs) or reclassifying any covered drug into a higher cost sharing tier during a health insurance policy's term, unless the drug is seemed unsafe.  The bill was passed by the Insurance and Real Estate Committee but died in the Appropriations Committee.

House Bill 5517 –An Act Concerning Cost-Sharing for Prescription Drugs.  This bill attempted to limit coinsurance, copayments, deductibles or other out-of-pocket expenses imposed on insureds for prescription drugs but was not voted on by the Insurance and Real Estate Committee by its committee deadline. 

Senate Bill 372 – An Act Concerning Clinical Review Criteria for Utilization Review and Adverse Determination Notices.  This bill expands the clinical review criteria that health carriers (e.g., insurers and HMOs) may use for utilization reviews. Under the bill, these may include criteria intended to address technological or treatment advances not covered in certain professional medical society treatment criteria publications. The bill also repeals a health carrier's disclosure requirement specific to clinical review criteria for (1) substance use disorders, (2) child or adolescent mental disorders, and (3) adult mental disorders. It replaces these specific requirements with a general disclosure applicable to all clinical review criteria. The bill passed the Senate and the House and now awaits the Governor’s signature.


 Legislative Update

March 2015
The 2015 legislative session is underway at the state Capitol. Over the past few months, several bills of interest to the medical community have been introduced and have been heard in various committee. Committees have recently begun voting on bills and will soon reach their deadlines to act on bills. Below are some of the many bills that are currently being considered by the legislature. 
Extension of Health Insurance Coverage
Bills extending health insurance coverage to telemedicine services, hearing aids, orally and intravenously administered medications, abuse deterrent opioids, and the treatment of mental and nervous disorders have all been heard at the Capitol. While medicine has always taken the position that insurance coverage should be provided for what a physician deems as medically necessary, there are some concerns with how the above bills are written. Medicine will continue to support these initiatives but will make sure that the bills are written in a way that protects patients and physicians.
Managed Care Related Issues
Once again a bill that would establish cooperative health care arrangements has been introduced and is being supported by medicine. In addition, a bill concerning healthcare provider network adequacy has also been introduced. This bill would require health care insurers to make sure that an adequate number of physicians are available to provide network enrollees complete and efficient access to health care services. Medicine is supporting this bill.

Medical Malpractice
Medicine continues to advocate for medical malpractice reforms such as supporting legislation that addresses expert witness certification and advocating for immunity for physicians who provide volunteer services. While advocating for some reforms, medicine is also opposing others such as a bill that would extend the statute of limitations for negligence actions brought by a minor. Medicine continues to advocate that tort laws need to be strengthened not weakened. 

Definition of Surgery
The word “surgery” is used throughout the Connecticut State Statutes, however the term is not defined. Medicine is currently working with the state legislature to establish a definition of surgery that would protect physicians and patients by making sure that only those qualified to perform surgery are actually able to do so.  
Acquisition of Physician Practices
A bill requiring that physician practices receive approval from the Commissioner of the Department of Public Health and the Attorney General prior to entering into an agreement to transfer assets or operation or change of control of the practice to an insurer has been introduced. While medicine supports the spirit behind the bill which is to ensure that certain such transfers of practice are in the best interest of those receiving care and not simply seen as a financial transaction for the benefit of a for profit insurance entity, there are concerns with the bill. Medicine testified that it cannot identify ANY situation in which any portion of ownership of a physicians practice by an insurer is appropriate, advocating that even with certain approval by the state, the ability for insurers to purchase and own physician practices will only strengthen their ability to dictate care and could in a way add a monopoly power as well. 

Medicaid Provider Audits
Medicine is currently working on a bill that attempts to make changes to the Medicaid provider audit process. The intent of the bill is to (1) establish clear parameters governing the use of extrapolation, (2) set standards for statistical sampling, (3) establish a process for physicians and other network providers to challenge findings and (4) increase transparency, outreach and education. While the intent of the bill is a good start, medicine continues to advocate that the language of the bill be drafted in a way to ensure inherent fairness and transparency throughout the process and that to help retain physician participation in Medicaid. 

Other Bills
·      Definition of Urgent Care Clinic – This bill would establish a definition of urgent care clinics so that patients know what type of medical services are provided. Medicine is advocating that any clinic that may call itself urgent care must be able to actually provide the types of services that a patient would consider urgent. Medicine supports the definition but continues to work with the legislature to work out the details.
·      Practice of Homeopathy - Medicine is opposing a bill that would recognize nationally-certified classical homeopaths and allow those persons to practice homeopathy. Medicine is opposed to allowing a group to practice health care without licensure and normal DPH oversight. 
·      Nutrition Advisory Council – Medicine is supporting the creation of a nutrition advisory council.
·      Off Label Prescription Drug Coverage – Medicine is advocating that any state legislation concerning off label prescription drug coverage be consistent with AMA standards.
·      E-Cigarettes – Medicine is supporting a bill that would prohibit the use of E-Cigarettes at school and requesting that the bill be expanded to prohibit the use of E-Cigarettes wherever the use of tobacco is prohibited.
·      Medical Assistants – A bill that would create a pilot program to allow medical assistants to administer medications is being considered by a Public Health Committee.