CPA’s Legislative Committee strives to be a resource on many issues facing our State today, including:
· Improved access to services for those patients seeking behavioral health and psychiatric services and treatment.
· Issues and initiatives that support parity for behavioral health and psychiatric services.
· Practices that promote fair and equal access to quality forensic evaluation, court-based assessments and treatment provided by qualified psychologists.
· Support and access to care for our Veterans.
· Maintaining the integrity and value of the training Psychologists receive as a practitioner and scientist.
· The understanding and integration of available scientific research with regard to issues of patient care, brain development, childhood development, and geriatrics.
· Treatment and care of our vulnerable citizens including children, those with behavioral health and developmental disabilities, victims of crime and violence, and the disadvantaged.
If you are interested in joining our committee or lend some advocacy on some of these very important issues, please contact Dr. Marcy Kane at firstname.lastname@example.org.
Let us know what you would like us to advocate for in 2020!
2019 CPA's Legislative Committee Wrap-up:
Connecticut Psychological Association (CPA) 2019 Legislative Summary
Prepared by Anita Schepker, Esq., Josh Hughes, Esq., and Mike Dugan Capitol Consulting LLC June 19, 2019
The General Assembly adjourned the 2019 legislative session on Wednesday, June 5th, at midnight, its constitutionally mandated adjournment date. The November election resulted in a state government trifecta, with Democratic Governor Ned Lamont taking the helm proclaiming a fresh approach to governing and no state political experience. Additionally, a record number of Democrats won seats in traditionally Republican-held districts in both the House and the Senate, giving them a handy majority, although neither chamber has veto override capability without the help of the Republicans. The State Senate stands at 22 Democrats to 14 Republicans. The Democrats control the 151-member State House with 91 members to the Republicans 60.
During the last few days of the General Assembly Session, Connecticut legislators approved a two-year, $43 billion state budget. While the budget was approved only by Democrats, there were 5 Democrats in the House and two in the Senate who voted against the package. The 567-page budget will close a projected deficit of $3.7 billion. It increases spending by 1.7 percent in the first year and 3.4 percent in the second year, which are lower spending increase than in past years. The Rainy Day Fund, currently $1.2 billion, could grow to $2.65 billion in the fall.
The budget includes no reduction in state aid to cities and towns. And, the budget contains very few tax increases as compared to previous years—--while not increasing the sales tax rate or changing the income tax, there is an expansion of sales taxes onto certain services previously exempt from the tax such as parking, dry cleaning, laundry and interior design services.
Governor Lamont issued a statement and commented that he was proud of the overall budget, and that it was a fair and balanced document. Yet he also noted that the state still had much more work to do as he alluded to the fact that a Special Session may be necessary. The Republicans countered with a statement that the budget “lacked a long- term, strategic vision to help small businesses, create jobs and kick-start the state’s slow- growth economy”.
The Governor’s comments concerning “more work to do” became quite clear; the day after the session was over, he told the press that he intended to call the General Assembly into Special Session to address the issue of the implementation of tolls in Connecticut, and potentially to review gaming issues in the state. Shortly before the close of the Regular session, the General Assembly also called themselves into Special Session, as they did not have time to vote on bonding or school construction items. It is expected that the Special Sessions will be held in July. Capitol Consulting will keep you informed of all of the activities post-session, including meetings and any Special Sessions that take place.
For CPA, Capitol Consulting tracked and/or lobbied over 100 bills that had either an impact or potential impact on the practice of psychology, psychologists and the people that they serve. It is clear that most legislators have a keen interest in behavioral health issues, but budget constraints and insurance reimbursement issues remain.
Legislation of Interest to CPA which FAILED
SB 966 AN ACT CONCERNING THE PRESCRIPTIVE AUTHORITY OF PSYCHOLOGISTS.
This bill would have allowed licensed psychologists (doctoral level psychologists) to apply for certification from the Department of Public Health to prescribe, administer and dispense drugs and controlled substances after the completion of a rigorous Master’s degree program in psychopharmacology above and beyond their doctoral degree, including the passage of a nationally certified test and a certain level of supervision under a psychiatrist or M.D.
CPA did an outstanding job of getting this bill raised in the Committee for a public hearing and fell short by one vote of getting it out of committee. CPA is putting together a strategy for the Board on this issue and will present such to the Board sometime in July.
HB 6401 AN ACT RECOGNIZING PARENTAL ALIENATION SYNDROME AS A FORM OF EMOTIONAL CHILD ABUSE
Along with bills such as HB 5877 restricting the use of Guardians ad Litem in highly contested family court cases, these bills all failed despite the public forum on parental
alienation held at the state Legislative Office Building early on during the session. The drafted bills were highly controversial and ultimately did not even get a public hearing.
HB 5915 AN ACT CONCERNING THE GRANTING OF LIMITED PRESCRIPTIVE AUTHORITY TO NATUROPATHIC PHYSICIANS TO IMPROVE PATIENT ACCESS TO CARE.
Along with HB 6544 and HB 5902, this bill would have allowed the Department of Public Health, in concert with the Naturopaths and the Connecticut State Medical Society to agree on a formulary that was appropriated and general amended the law to authorize limited prescriptive authority to naturopathic physicians to improve patient access to care. This bill was opposed by the DPH, which takes the position that once a scope of practice review has been undertaken by the Department, the legislature must make changes and not give the task of governing (or setting formularies in this case) back to DPH.
HB 7140 would have required, among other things that motor cycle operators and their passengers be required to wear helmets. CA testified in favor of this portion of the bill, but ultimately this bill did not pass.
PSYPACT While the PsyPact bill did not pass as legislation, there is a commitment by the Department of Public Health to study this issue and bring back a recommendation to the Public Health Committee next year and compare it with the expansion of telehealth services in Connecticut. CPA will be involved heavily on this issue.
Legislation of Interest to CPA which PASSED
HB 7125 AN ACT CONCERNING MENTAL HEALTH AND SUBSTANCE USE DISORDER BENEFITS. (PARITY)
This bill, several years in the making and with a great coalition of patient groups such as the Mental Health Association, CT NAMI, CPA and the CT Psychiatrists, finally passed. The bill requires:
• that each health carrier annually report to the insurance commissioner about mental health and substance use disorder benefits and nonquantitative treatment limitations. The report must include: (a) the process used to develop and select criteria to assess the medical necessity of mental health and substance use disorder benefits and medical and surgical benefits and (b) all nonquantitative treatment limitations applied to mental health, substance use disorder, and medical and surgical benefits.
• that “mental health and substance use disorder benefits” are defined as all benefits used to treat a mental health condition or substance use disorder that is listed as a mental disorder in the International Classification of Diseases or a mental disorder as defined by the American Psychiatric Association.
• that the report by carriers contain an analysis of the process, strategies, evidentiary standards used to develop and apply the medical necessity criteria and nonquantitative treatment limitations. The analyses must disclose information that sufficiently demonstrates that the carrier applied nonquantitative treatment limitations comparably, and not more stringently, to mental health and substance use disorder benefits and medical and surgical benefits consistent with the federal Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act and applied nonquantitative treatment limitations equally across mental health, substance use, and medical and surgical benefits.
• that the carrier demonstrate that it complied with state mental and nervous conditions coverage, prescription drug coverage, step therapy laws, and federal mental health parity laws.
• that the carrier analysis must disclose each factor considered, regardless of whether it was accepted or rejected, in designing and determining whether to apply nonquantitative treatment limitations; disclose all evidentiary standards, whether quantitative or qualitative, or provide a clear description of the factor if no evidentiary standard was used; provide the comparative analyses that show that the written processes and strategies used to design and apply nonquantitative treatment limitations to mental health and substance use disorder benefits are comparable to, and applied no more stringently than, those used to design and apply nonquantitative treatment limitations to medical and surgical benefits; and provide the comparative analyses that show the processes and strategies used to apply nonquantitative treatment limitations to mental health and substance use disorder benefits are comparable to, and applied no more stringently than, those used to apply nonquantitative treatment limitations to medical and surgical benefits.
• that beginning in 2021, the Insurance Commissioner issue an Annual Report to the Insurance and Real Estate Committee as well as the Attorney General, Healthcare Advocate, and the Office of Health Strategy’s executive director. The health carrier’s names and identities, including the names and identities of entities they contract with, are confidential, and the commissioner is prohibited from making them public. The commissioner is also prohibited from disclosing the results of the analysis in a manner likely to compromise their financial, competitive, or proprietary nature. The bill specifies that it does not require any disclosure in violation of federal confidentiality laws.
• that the Insurance and Real Estate Committee may hold a public hearing on the reports. The insurance commissioner or his designee must attend and inform the committee whether, in his opinion, each health carrier submitted the required
reports; applied nonquantitative treatment limitations equally across mental health, substance use, and medical and surgical benefits; and complied with certain state mental and nervous conditions coverage, prescription drug coverage, step therapy laws, and federal mental health parity laws.
HB 7424 AN ACT CONCERNING THE STATE BUDGET FOR THE BIENNIUM ENDING JUNE THIRTIETH, 2021, AND MAKING APPROPRIATIONS THEREFOR, AND IMPLEMENTING PROVISIONS OF THE BUDGET. (The budget)
This bill made several last- minute changes to the Licensed Professional Counselor (PC) and Marital and Family Therapist (MFT) statutes to allow for Associate Licensure. For several years, both the PCs and the MFTs have been looking to have an associate licensure category for those LPCs and MFTs practicing under professional supervision while pursuing full licensure.
• § 162-175 of the bill clarifies that qualify for an associate license, the applicant must meet certain educational and clinical training requirements. The bill also prohibits anyone who is unlicensed from using the title (1) “licensed professional counselor associate” or “professional counselor” or any title, words, letters, or abbreviations that may reasonably be confused with licensure or (2) “licensed marital and family therapist associate.” Existing law similarly prohibits unlicensed people from using a title that indicates that they are fully licensed LPCs and MFTs. The bill allows DPH to take disciplinary actions against associate LPC and MFT licensees under the same grounds for which she may take actions against other LPC and MFT licensees (e.g., fraud or deceit in obtaining the license).
• §§ 176-182 of the bill creates a licensure program for art therapists and generally prohibits unlicensed individuals from using the “art therapist” title. To receive a license, an applicant must (1) hold a graduate degree and be credentialed or certified by the Art Therapy Credentials Board or (2) qualify for licensure by endorsement. The bill also provides for nonrenewable temporary permits authorizing the holder to work under a licensed person’s supervision. This has been a proposed bill for six years and has finally passed also with severe restrictions.
HB 7159 AN ACT ADDRESSING OPIOID USE
This bill updates and adds to existing laws with respect to providers and prescribers of opioids. The bill:
• requires pharmacists to offer consultations to all patients when dispensing a prescription, not just Medicaid patients as under current law, and allows pharmacists to designate a trained pharmacy technician to access the state’s Connecticut Prescription Monitoring and Reporting System (CPMRP);
• specifies that prescribing practitioners or their agents are not prohibited from disclosing CPMRS information about pharmacy or veterinarian-dispensed prescriptions to the Department of Social Services (DSS) to administer Medicaid;
• requires drug manufacturers and wholesalers to report to the Department of Consumer Protection (DCP) decisions to terminate or refuse an order from a pharmacy or prescribing practitioner for schedule II to V controlled substances;
• prohibits life insurance and annuity policies or contracts from excluding coverage solely based on an individual having received a prescription for naloxone;
• requires prescribing practitioners who prescribe an opioid drug with more than a 12-week supply to establish a treatment agreement with the patient or discuss a care plan for chronic opioid drug use;
• requires higher education institutions to develop and implement a policy on the availability and use of opioid antagonists by students and employees;
• requires the Department of Mental Health and Addiction Services (DMHAS) to review and report on literature about the efficacy of providing home-based treatment and recovery services for opioid use disorder to certain Medicaid beneficiaries;
• requires treatment programs under DHMAS to educate patients with opioid use disorder and family members on opioid antagonists and how to administer them;
• makes various changes to credentialing of certain emergency medical services (EMS) personnel;
• requires hospitals to administer a mental health screening or assessment on patients treated for a nonfatal opioid drug overdoses if it is medically appropriate to do so; and
• requires DMHAS to study and report on the protocol for police detention of someone suspected of overdosing on an opioid drug and the implications of involuntarily transporting such a person to an emergency department.
SB164 AN ACT CONCERNING WORKERS' COMPENSATION BENEFITS FOR CERTAIN MENTAL OR EMOTIONAL IMPAIRMENTS, MENTAL HEALTH CARE FOR POLICE OFFICERS AND WELLNESS TRAINING FOR POLICE OFFICERS, PAROLE OFFICERS AND FIREFIGHTERS.
• establishes the eligibility requirements for these officers and firefighters to receive PTSD benefits;
• limits the benefits’ (a) duration to 52 weeks and (b) availability to within four years after the qualifying event;
• reduces the amount of weekly PTSD benefits an officer or firefighter may receive by the amount of other benefits he or she receives (e.g., from a pension, Social
Security, or disability insurance), if the total benefits exceed the officer’s or firefighter’s average weekly wage; and
• establishes a process for employers to contest PTSD claims.
The bill prohibits a law enforcement unit from disciplining police officers solely because they seek or receive mental health care services or surrender their work weapons or ammunition. The diagnosis and treatment of a police officer or firefighter may be conducted by a board-certified psychiatrist or a licensed psychologist specializing in the treatment of PTSD. It also requires law enforcement units to request that officers seek a mental health examination before returning their weapons or ammunition.
HB 7198 AN ACT CONCERNING SOCIAL WORKERS
This bill, which CPA supported, prohibits anyone from using the title “social worker,” or any associated initials, or advertising services as a social worker unless he or she (1) has a bachelor’s or master’s degree in social work from a program accredited by the Council on Social Work Education (CSWE); a doctorate in social work; if educated outside of the U.S. or its territories, completed an education program that CSWE deems equivalent. The bill exempts state employees with the title social worker and municipal employees with this title hired before July 1, 2019. Existing law already allows any person employed by the state before October 1, 1996, with the title in the social work series of the classified service to have such a title to describe or perform his or her duties, but as of October 1, 2019, the bill requires the state, on any posting for a job in the social work series of classified service that does not require a social work license, to specify that the preferred qualification is a bachelor’s or master’s degree in social work from a CSWE accredited program or a doctorate in social work.
OTHER BILLS OF INTEREST
In addition to these bills, legislation passed on juvenile justice, gun storage, gun safety, school climate and unrestricted play for children in schools as well as a bill that allows a child charged with a delinquency offense involving an “act of fire starting” to file a motion with the court for an evaluation to determine if he or she would benefit from participating in a fire-starting behavior treatment program.
In addition to the legislative issues, CPA met with the Department of Social Services and was successful in correcting neuropsychological testing code errors and implementation of new insurance codes.
2018 CPA’s Legislative Committee Wrap-up:
A bill was not introduced this year to allow for prescription privileges for psychologists; it will likely be introduced in the 2019 Legislative Session. Of particular concern from the opposition (largely psychiatrists, doctors and APRNs) on that issue is the amount of time and duration of supervision and potentially the formulary under which a psychologist could prescribe. Here are the other bills that were of interest to CPA during the Legislative Session:
1. HB 5149- An Act Concerning Sober Living Homes- this bill passed and allows sober home s to voluntarily registered as certified sober homes in order that consumers can choose quality outpatient care.
2. HB 5212- An Act Concerning a Grandparent’s Right to Visitation with his or her Grandchild-did not pass for the third year in a row.
3. Sexual Assault Bills HB 5246, SB 238, -bills lifting the current statute of limitations on sexual assault cases did not pass.
4. SB 479- An Act Concerning Immunity From Civil or Criminal Liability for Persons providing Medical Assistance or Intervention in a Child Abuse or Neglect Case- This bill provides immunity from civil and criminal liability to any person, institution, or agency that, in good faith, provides professional medical intervention or assistance in any proceeding involving child abuse or neglect. The bill's immunity applies to liability that might otherwise arise from or is related to actions such as: 1. causing a photograph, x-ray, or physical custody examination to be made; 2. causing a child to be taken into emergency protective custody 3. disclosing a medical record or other information pertinent to the proceeding; or 4. performing a medically relevant test. The bill also eliminates current immunity from civil or criminal liability for any person, institution, or agency that, in good faith, does not report suspected child abuse or neglect or alleged sexual assault of a student to the DCF or law enforcement as required or permitted by law. The bill retains immunity for a person, institution, or agency that, in good faith, makes such a report and applies the immunity to civil or criminal liability that might otherwise arise from, or is related to, making the report. Currently, this immunity applies to civil or criminal liability that might otherwise be incurred or imposed.
5. HB 5575- An Act Concerning the Appointment of a Qualified, Licensed Health Care Professional to Provide Treatment of an Evaluation in Connection with a Family Relations Matter.This bill establishes a process for selecting qualified, licensed health care providers in family relations matters involving court-ordered treatment or evaluation of parents and children. The bill requires the court to permit the parent to select the treatment provider for him or herself and allow the parent or legal guardian to do so for the child. When the child's parents do not agree on a provider within a specific timeframe, the bill requires the court to select the provider. In doing so, the court must consider the parents' insurance coverage and financial resources. When the parties agree or the court orders that a parent or child undergo an evaluation from a qualified, licensed healthcare provider, the court must first find that the parties can afford to pay the provider. The bill establishes the (1) components of the court order and (2) deadline by which the provider must file a report containing the results of the evaluation with the court. The parties must have a reasonable time to examine the report before the case is heard and the court must seal the report
6. HB 5163- An Act Concerning the Department of Public Health's Recommendations Regarding Various Revisions to the Public Health Statutes.Students who graduate with advanced degrees in marital and family therapy, professional counseling, or psychology may practice without a license in order to complete the supervised work experience required for licensure, but only if supervised by a person licensed in their respective profession. This bill permits these graduates to practice in this unlicensed capacity for up to two yearsafter completing the supervised work experience, if they failed the respective licensing examination. Under current law, professional counseling and psychology students may practice in this manner until they are notified that they failed the respective licensing examination, or one year after completing the supervised work experience, whichever occurs first. For marital and family therapist students, current law does not specify that the licensure exemption ends on the earlier of these two dates.
7. SB 384 Mental Health Parity- This data bill passed the Senate but not the House. This Insurance Companies were opposed to the bill.
8. SB 302- Telehealth- this bill allows for the ability to prescribe medications under certain circumstances; itallows telehealth providers to prescribe non-opioid Schedule II or III controlled substances using telehealth to treat a psychiatric disability or substance use disorder, if certain conditions are met; modifies requirements for telehealth providers to obtain and document patient consent to provide telehealth services and disclose related records; and adds registered nurses and pharmacists to the list of health care providers authorized to provide telehealth services. The bill specifies that its provisions do not prevent a licensed or certified health care provider from using telehealth to order medication or treatment for hospital inpatients in accordance with the federal law.
9. HB 5294- An Act Concerning Naturopaths- this bill did not pass and would have allowed the Department of Public Health to set up a formulary for medications that could be prescribed by naturopaths.
10. SB -244-An Act Requiring Behavior Analysts to be Mandated Reporters of Suspected Child Abuse and Neglect-this bill passed and is self-explanatory.
11. SB 315-An Act Concerning Minor Revisions to the Statutes of the Department of Children and Families and Establishing a Pilot Program to Permit Electronic Reporting by Mandated Reporters -passed and is self-explanatory as CPA was watching the electronic reporting section.