May 7, 2010

Memorandum via Email

To:            Connecticut Counseling Association

From:        Ken Przybysz and Liz Gemski

Subject:      2010 Legislative Wrap-up

Wednesday night at midnight, the Connecticut General Assembly concluded its business for the 2010 legislative session, passing a flurry of bills in the late hours of the evening and a Deficit Mitigation Plan to bring the Fiscal Year (FY) 2011 budget, which begins on July 1, into balance.  Throughout the 2010 legislative session the state budget deficit and declining state revenues, a result of the economic crisis, dominated the work of General Assembly, hampering the passage of legislation until days and hours before the end of the legislative session.  Rumors of special sessions and partisan bickering circulated the halls of the Legislative Office Building and Capitol for the past five months.  Yet in the final days of the session an agreement was reached between Democratic leadership and the Governor’s office to permit the appointment of judges to the judicial branch and the passage of an $18.93 billion revised budget.

Throughout the legislative session, our focus for the Connecticut Counseling Association (CCA) has been to pass legislation clarifying the professional statute for Licensed Professional Counselors (LPCs) by adding the word “diagnose” to the statute.  Prior to introducing legislation, we held regular conference calls with the Executive Board to strategize on our approach to pass legislation and researched other laws relating to payment to ensure our arguments were sound.  Based on these discussions we developed a one-page document to hand out to legislators on our issue. 

We also met with other related professional organizations prior to the start of session, including social workers, psychologists, and marriage and family therapists to discuss our legislative intent for the session and weed-out any potential opposition.  We worked to have the change included in legislation, the Department of Public Health’s technical bill, Senate Bill 428. 

Once the legislative process began, we worked to provide written testimony in support of the legislation during the public hearing process and had Dr. Michael Gilles on hand to testify if any issues arose during the hearing.  We advocated for the successful advancement of the legislation throughout the process, providing strategic legislative and grassroots advice when to pass the final piece of legislation, Senate Bill 428 out of both chambers.  The legislation now awaits action by the Governor.

In addition to the clarification of the LPC professional statute, Senate Bill 428 also includes some sections that pertain to LPCs as a result of the definition of health care provider that we wanted to make you aware of.  Senate Bill 428 has amended current law as it related to providing patients with copies of their health records and the creation of a Health Information Technology Exchange.  Attached to this memo is the specific language that relates to these two areas for your review.

At the beginning of the legislative session, we also met with related professional organizations including social workers, psychologists, and marriage and family therapists to discuss the Social Workers classification bill to determine their legislative intent and whether or not LPCs should also be considered for additional professional classification.  After the meeting it was determined that we would not pursue the legislation for LPCs this year, however the Association was going to review the issue to determine if it is an area it would like to pursue legislatively in the future.

Finally, we monitored the progress of legislation that could apply to LPCs because of the health care provider definition.  Below is a status update along with a brief summary of legislation we have tracked on behalf of the CCA for the FY 2010 legislative session. 

House Bill 5244, Emergency Certificates
Concerns the issuance of emergency certificates by certain staff of the Emergency Mobile Psychiatric Services Program; permits designated professionals operating within the Department of Children and Families' Emergency Mobile Psychiatric Services program the authority to issue emergency certificates directing that a child with psychiatric disabilities be hospitalized for an evaluation. LPCs were included in the list of professions authorized in the legislation.  This bill was passed in both chambers and is awaiting action by the Governor.

House Bill 5258, Program Review and Investigation
Implements the recommendations of the Program Review and Investigations Committee concerning scope of practice determinations for health care professions; implements the recommendation of the Legislative Program Review and Investigations Committee concerning scope of practice determinations for health care professionals. This bill was referred to the House calendar but was never voted on and as a result died.

House Bill 5286, Licensure of Master and Clinical Social Workers
Concerns licensure of master and clinical social workers; establishes Department of Public Health licensure for master social workers. This bill has become law, Public Act 10-38.

House Bill 5452, Provision of Volunteer Health Care Services
Relates to health care practitioners licensed in another state; provides for volunteer health care services on a temporary basis; encourages the provision of charitable medical care at free clinics, the Special Olympics and other similar athletic events held throughout the state; requires liability insurance against professional malpractice. This Bill has become law, Public Act 10-23.

House Bill 5531, Admissibility of Medical Bills in Civil Actions
Concerns the admissibility of medical bills in civil actions; provides that evidence that a health care provider accepted a reduced amount of payment shall not be admissible for determining economic damages in civil actions. This bill died in Committee.

House Bill 5537, Merit
Concerns certificates of merit; revises provisions concerning certificates of merit and opinions and testimony of health care providers in medical malpractice actions. This bill was scheduled for consideration by the House but was never considered and as a result died.

House Bill 5539, Judicial Branch Powers and Procedures
Concerns judicial branch powers and procedures and the criminal justice information system; makes certain revisions concerning the powers and procedures of the Judicial Branch, including appellate procedures, emergency powers of the Chief Justice and Chief Court Administrator, probation violations, diversionary programs, juvenile matters, victim services and courthouses; makes certain revisions concerning the duties and responsibilities of the Criminal Justice Information System Governing Board. The bill allows any licensed health care provider, instead of just licensed physicians, to send the jury administrator a letter stating that someone summoned for jury duty has a disability that prevents him or her from satisfactorily performing jury service.  This bill has become law, Public-Act 10-43.

Senate Bill 222, Complaints Pending
Concerns complaints pending in the department of public health against physicians and certain other health care providers and establishing a mediation program for medical malpractice actions; permits a person who files a complaint with the Department of Public Health alleging incompetence, negligence, fraud or deceit by a health care provider to obtain information about the status of the complaint. This bill died in Committee.

Senate Bill 246, Issuance of Emergency Certificates
Concerns issuance of emergency certificates and the safety of patients and staff at facilities operated by the department of mental health and addiction services; allows licensed clinical social workers and advanced practice registered nurses who have completed specialized training in conducting direct evaluations through community support programs certified by the Department of Mental Health and Addiction Services (DHMAS); relates to discharge of clients into the adjacent community. This bill passed both chambers and is awaiting action by the Governor.

A member of CCA contacted the Executive Board about this bill asking us to help amend the bill to include LPC in the DMHAS statute to issue an emergency certificate to have a person assessed at an emergency room.  We approached DMHAS about the issue and learned that they were adamantly against adding LPCs to the list of professions authorized in the bill because advocates for persons with mental illness do not want more professions issuing these orders.  We will need to discuss this issue more thoroughly and determine if we want to work more on this issue with DHMAS next session.

Senate Bill 258, Health Insurance Benefits Denials
Concerns appeals of health insurance benefits denials; specifies a presumption of medical necessity for appeals reviewed by review entities on behalf of the Insurance Commissioner pursuant to section 38a-478n of the general statutes, to require managed care companies, health insurers and utilization review companies to provide to providers of record and enrollees after a final determination not to certify an admission. This bill passed the Senate but was never considered by the House so it died.

Senate Bill 393, Standards in Health Care Provider Contracts
Concerns standards in health care provider contracts; establishes certain standards for contracts between health care providers and insurers. This bill passed the Senate but was never considered by the House so it died.

Senate Bill 404, Task Force
Concerns the establishment of a task force to review the oversight role of professional examining boards regulating health care professions; establishes a task force that shall examine the current level of oversight provided by professional examining boards regulating the state's health care professions. This bill died in Committee.

Senate Bill 429, Most Favored Nation Clauses in Health Care Contracts
Concerns most-favored-nation clauses in health care contracts; prohibits the use of most-favored-nation clauses in contracts between insurers and medical providers or hospitals. This bill died in Committee.

As always, please feel free to contact us if you have any questions.

Sections of Senate Bill 428 that Apply to LPC’s

Sec. 5. Section 20-7c of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2010):

(a) For purposes of this section, "provider" has the same meaning as provided in section 20-7b.

(b) (1) A provider, except as provided in section 4-194, shall supply to a patient upon request complete and current information possessed by that provider concerning any diagnosis, treatment and prognosis of the patient. (2) A provider shall notify a patient of any test results in the provider's possession or requested by the provider for the purposes of diagnosis, treatment or prognosis of such patient.

(c) Upon a written request of a patient, a patient's attorney or authorized representative, or pursuant to a written authorization, a provider, except as provided in section 4-194, shall furnish to the person making such request a copy of the patient's health record, including but not limited to, bills, x-rays and copies of laboratory reports, contact lens specifications based on examinations and final contact lens fittings given within the preceding three months or such longer period of time as determined by the provider but no longer than six months, records of prescriptions and other technical information used in assessing the patient's health condition. No provider shall refuse to return to a patient original records or copies of records that the patient has brought to the provider from another provider. When returning records to a patient, a provider may retain copies of such records for the provider's file, provided such provider does not charge the patient for the costs incurred in copying such records. No provider shall charge more than sixty-five cents per page, including any research fees, handling fees or related costs, and the cost of first class postage, if applicable, for furnishing a health record pursuant to this subsection, except such provider may charge a patient the amount necessary to cover the cost of materials for furnishing a copy of an x-ray, provided no such charge shall be made for furnishing a health record or part thereof to a patient, a patient's attorney or authorized representative if the record or part thereof is necessary for the purpose of supporting a claim or appeal under any provision of the Social Security Act and the request is accompanied by documentation of the claim or appeal. A provider shall furnish a health record requested pursuant to this section within thirty days of the request. No health care provider, who has purchased or assumed the practice of a provider who is retiring or deceased, may refuse to return original records or copied records to a patient who decides not to seek care from the successor provider. When returning records to a patient who has decided not to seek care from a successor provider, such provider may not charge a patient for costs incurred in copying the records of the retired or deceased provider.

(d) If a provider reasonably determines that the information is detrimental to the physical or mental health of the patient, or is likely to cause the patient to harm himself or another, the provider may withhold the information from the patient. The information may be supplied to an appropriate third party or to another provider who may release the information to the patient. If disclosure of information is refused by a provider under this subsection, any person aggrieved thereby may, within thirty days of such refusal, petition the superior court for the judicial district in which such person resides for an order requiring the provider to disclose the information. Such a proceeding shall be privileged with respect to assignment for trial. The court, after hearing and an in camera review of the information in question, shall issue the order requested unless it determines that such disclosure would be detrimental to the physical or mental health of the person or is likely to cause the person to harm himself or another.

(e) The provisions of this section shall not apply to any information relative to any psychiatric or psychological problems or conditions.

(f) In the event that a provider abandons his or her practice, the Commissioner of Public Health may appoint a licensed health care provider to be the keeper of the records, who shall be responsible for disbursing the original records to the provider's patients, upon the request of any such patient.

Sec. 82. (NEW) (Effective from passage) (a) There is hereby created as a body politic and corporate, constituting a public instrumentality and political subdivision of the state created for the performance of an essential public and governmental function, the Health Information Technology Exchange of Connecticut, which is empowered to carry out the purposes of the authority, as defined in subsection (b) of this section, which are hereby determined to be public purposes for which public funds may be expended. The Health Information Technology Exchange of Connecticut shall not be construed to be a department, institution or agency of the state.

(b) For purposes of this section, sections 83 to 85, inclusive, of this act and section 19a-25g of the general statutes, as amended by this act, "authority" means the Health Information Technology Exchange of Connecticut and "purposes of the authority" means the purposes of the authority expressed in and pursuant to this section, including the promoting, planning and designing, developing, assisting, acquiring, constructing, maintaining and equipping, reconstructing and improving of health care information technology. The powers enumerated in this section shall be interpreted broadly to effectuate the purposes of the authority and shall not be construed as a limitation of powers. The authority shall have the power to:

(1) Establish an office in the state;

(2) Employ such assistants, agents and other employees as may be necessary or desirable, which employees shall be exempt from the classified service and shall not be employees, as defined in subsection (b) of section 5-270 of the general statutes;

(3) Establish all necessary or appropriate personnel practices and policies, including those relating to hiring, promotion, compensation, retirement and collective bargaining, which need not be in accordance with chapter 68 of the general statutes, and the authority shall not be an employer, as defined in subsection (a) of section 5-270 of the general statutes;

(4) Engage consultants, attorneys and other experts as may be necessary or desirable to carry out the purposes of the authority;

(5) Acquire, lease, purchase, own, manage, hold and dispose of personal property, and lease, convey or deal in or enter into agreements with respect to such property on any terms necessary or incidental to the carrying out of these purposes;

(6) Procure insurance against loss in connection with its property and other assets in such amounts and from such insurers as it deems desirable;

(7) Make and enter into any contract or agreement necessary or incidental to the performance of its duties and execution of its powers. The contracts entered into by the authority shall not be subject to the approval of any other state department, office or agency. However, copies of all contracts of the authority shall be maintained by the authority as public records, subject to the proprietary rights of any party to the contract;

(8) To the extent permitted under its contract with other persons, consent to any termination, modification, forgiveness or other change of any term of any contractual right, payment, royalty, contract or agreement of any kind to which the authority is a party;

(9) Receive and accept, from any source, aid or contributions, including money, property, labor and other things of value;

(10) Invest any funds not needed for immediate use or disbursement in obligations issued or guaranteed by the United States of America or the state and in obligations that are legal investments for savings banks in this state;

(11) Account for and audit funds of the authority and funds of any recipients of funds from the authority;

(12) Sue and be sued, plead and be impleaded, adopt a seal and alter the same at pleasure;

(13) Adopt regular procedures for exercising the power of the authority not in conflict with other provisions of the general statutes; and

(14) Do all acts and things necessary and convenient to carry out the purposes of the authority.

(c) (1) The Health Information Technology Exchange of Connecticut shall be managed by a board of directors. The board shall consist of the following members: The Lieutenant Governor, or his or her designee; the Commissioners of Public Health, Social Services and Consumer Protection, or their designees; the Chief Information Officer of the Department of Information Technology, or his or her designee; three appointed by the Governor, one of whom shall be a representative of a medical research organization, one of whom shall be an insurer or representative of a health plan and one of whom shall be an attorney with background and experience in the field of privacy, health data security or patient rights; three appointed by the president pro tempore of the Senate, one of whom shall have background and experience with a private sector health information exchange or health information technology entity, one of whom shall have expertise in public health and one of whom shall be a physician licensed under chapter 370 of the general statutes who works in a practice of not more than ten physicians and who is not employed by a hospital, health network, health plan, health system, academic institution or university; three appointed by the speaker of the House of Representatives, one of whom shall be a representative of hospitals, an integrated delivery network or a hospital association, one of whom who shall have expertise with federally qualified health centers and one of whom shall be a consumer or consumer advocate; one appointed by the majority leader of the Senate, who shall be a primary care physician whose practice utilizes electronic health records; one appointed by the majority leader of the House of Representatives, who shall be a consumer or consumer advocate; one appointed by the minority leader of the Senate, who shall be a pharmacist or a health care provider utilizing electronic health information exchange; and one appointed by the minority leader of the House of Representatives, who shall be a large employer or a representative of a business group. The Secretary of the Office of Policy and Management and the Healthcare Advocate, or their designees, shall be ex-officio, nonvoting members of the board. The Commissioner of Public Health, or his or her designee, shall serve as the chairperson of the board.

(2) All initial appointments to the board shall be made on or before October 1, 2010. The initial term for the board members appointed by the Governor shall be for four years. The initial term for board members appointed by the speaker of the House of Representatives and the majority leader of the House of Representatives shall be for three years. The initial term for board members appointed by the minority leader of the House of Representatives and the minority leader of the Senate shall be for two years. The initial term for the board members appointed by the president pro tempore of the Senate and the majority leader of the Senate shall be for one year. Terms shall expire on September thirtieth of each year in accordance with the provisions of this subsection. Any vacancy shall be filled by the appointing authority for the balance of the unexpired term. Other than an initial term, a board member shall serve for a term of four years. No board member, including initial board members, may serve for more than two terms. Any member of the board may be removed by the appropriate appointing authority for misfeasance, malfeasance or wilful neglect of duty.

(3) The chairperson shall schedule the first meeting of the board, which shall be held not later than November 1, 2010.

(4) Any member appointed to the board who fails to attend three consecutive meetings or who fails to attend fifty per cent of all meetings held during any calendar year shall be deemed to have resigned from the board.

(5) Notwithstanding any provision of the general statutes, it shall not constitute a conflict of interest for a trustee, director, partner, officer, stockholder, proprietor, counsel or employee of any person, firm or corporation to serve as a board member, provided such trustee, director, partner, officer, stockholder, proprietor, counsel or employee shall abstain from deliberation, action or vote by the board in specific respect to such person, firm or corporation. All members shall be deemed public officials and shall adhere to the code of ethics for public officials set forth in chapter 10 of the general statutes.

(6) Board members shall receive no compensation for their services, but shall receive actual and necessary expenses incurred in the performance of their official duties.

(d) The board shall select and appoint a chief executive officer who shall be responsible for administering the authority's programs and activities in accordance with policies and objectives established by the board. The chief executive officer shall serve at the pleasure of the board and shall receive such compensation as shall be determined by the board. The chief executive officer (1) may employ such other employees as shall be designated by the board of directors; and (2) shall attend all meetings of the board, keep a record of all proceedings and maintain and be custodian of all books, documents and papers filed with the authority and of the minute book of the authority.

(e) The board shall direct the authority regarding: (1) Implementation and periodic revisions of the health information technology plan submitted in accordance with the provisions of section 74 of public act 09-232, including the implementation of an integrated state-wide electronic health information infrastructure for the sharing of electronic health information among health care facilities, health care professionals, public and private payors, state and federal agencies and patients; (2) appropriate protocols for health information exchange; and (3) electronic data standards to facilitate the development of a state-wide integrated electronic health information system, as defined in subsection (a) of section 19a-25d of the general statutes, for use by health care providers and institutions that receive state funding. Such electronic data standards shall: (A) Include provisions relating to security, privacy, data content, structures and format, vocabulary and transmission protocols; (B) limit the use and dissemination of an individual's Social Security number and require the encryption of any Social Security number provided by an individual; (C) require privacy standards no less stringent than the "Standards for Privacy of Individually Identifiable Health Information" established under the Health Insurance Portability and Accountability Act of 1996, P. L. 104-191, as amended from time to time, and contained in 45 CFR 160, 164; (D) require that individually identifiable health information be secure and that access to such information be traceable by an electronic audit trail; (E) be compatible with any national data standards in order to allow for interstate interoperability, as defined in subsection (a) of section 19a-25d of the general statutes; (F) permit the collection of health information in a standard electronic format, as defined in subsection (a) of section 19a-25d of the general statutes; and (G) be compatible with the requirements for an electronic health information system, as defined in subsection (a) of section 19a-25d of the general statutes.

(f) Applications for grants from the authority shall be made on a form prescribed by the board. The board shall review applications and decide whether to award a grant. The board may consider, as a condition for awarding a grant, the potential grantee's financial participation and any other factors it deems relevant.

(g) The board may consult with such parties, public or private, as it deems desirable in exercising its duties under this section.

(h) Not later than February 1, 2011, and annually thereafter until February 1, 2016, the chief executive officer of the authority shall report, in accordance with section 11-4a of the general statutes, to the Governor and the General Assembly on (1) any private or federal funds received during the preceding year and, if applicable, how such funds were expended, (2) the amount and recipients of grants awarded, and (3) the current status of health information exchange and health information technology in the state.