SB 314 — AN ACT CONCERNING EMERGENCY MEDICAID COVERAGE FOR TREATMENT OF EMERGENCY MEDICAL CONDITIONS.

Senate General Assembly RaisedFile Bill No.

314338 February Session, 2024 LCOSubstitute Senate Bill No.

2090314 ReferredSenate, toApril 8, 2024 The Committee on HUMANHuman SERVICESServices Introducedreported by:through SEN.

(HS)LESSER ANof ACTthe CONCERNING9th EMERGENCYDist., MEDICAIDChairperson COVERAGEof FORthe TREATMENTCommittee OFon EMERGENCYthe MEDICALpart CONDITIONS.of the Senate, that the substitute bill ought to pass.

AN ACT CONCERNING EMERGENCY MEDICAID COVERAGE FOR TREATMENT OF EMERGENCY MEDICAL CONDITIONS.

(b) The Commissioner of Social Services shall expand emergency Medicaid coverage consistent with federal law for treatment of emergency medical conditions, including, but not limited to, emergency medical conditions related to (1) a high-risk pregnancy, (2) diabetes Type 1 in persons under theage oftwenty-one, (3) diabetic emergencies, including,sSB314 but/ notFile limited to, diabetic ketoacidosis, (4) renal failure LCO No.

2090338 1 ofsSB314 2File RaisedNo. Bill No.314 requiring ongoing dialysis, (5) fracture of a bone in the skull, arm, neck, leg, spine or pelvis occurring in the two-month period prior to a request for emergency Medicaid coverage, (6) hypertensive emergencies involving persons presenting with signs or symptoms of end organ damage or systolic blood pressure equaling or exceeding one hundred eighty or diastolic blood pressure equaling or exceeding one hundred twenty, (7) unstable seizure disorder characterized by at least five minutes of uncontrollable seizures or at least two discrete seizures between which the person does not regain consciousness, (8) active treatment for cancer related to a current diagnosis, (9) ventilator dependency,(10)laboranddelivery,and(11)acuteinpatientpsychiatric hospitalization.

(c)338 Notincluding, laterbut thannot Octoberlimited 1,to, 2024,diabetic theketoacidosis, commissioner(4) shallrenal establishfailure anrequiring administrativeongoing systemdialysis, for(5) personsfracture toof applya bone in advancethe skull, arm, neck, leg, spine or pelvis occurring in the two-month period prior to a request for emergency Medicaid coveragecoverage, for(6) emergencyhypertensive medicalemergencies conditionsinvolving thatpersons canpresenting bewith treatedsigns inor outpatientsymptoms settingsof ratherend thanorgan indamage hospitaland emergencysystolic departments.blood pressure equaling or exceeding one hundred eighty or diastolic blood pressure equaling or exceeding one hundred twenty, (7) unstable seizure disorder characterized by at least five minutes of uncontrollable seizures or at least two discrete seizures between which the person does not regain consciousness, (8) active treatment for cancer related to a current diagnosis, (9) ventilator dependency,(10)laboranddelivery,and(11)acuteinpatientpsychiatric hospitalization.

(c) Not later than July 1, 2025, the commissioner shall establish an administrative system for persons to apply in advance for emergency Medicaid coverage for emergency medical conditions that can be treated in outpatient settings rather than in hospital emergency departments.

Section 1 from passage New section Statement of Purpose:Legislative Commissioners:

ToIn requireSubsec. the Commissioner of Social Services to upgrade policies to provide Medicaid coverage for more outpatient treatment of emergency medical conditions.

[Proposed(b)(6), deletions"damage areor" enclosedwas inchanged brackets.to "damage and" for accuracy.

ProposedHS additionsJoint areFavorable indicatedSubst. by underline, except underlined.]e entire text of a bill or resolution or a section of a bill or resolution is new, it is not LCO No.

2090sSB314 2/ ofFile 2No.

338 2 sSB314 File No.

338 The following Fiscal Impact Statement and Bill Analysis are prepared for the benefit of the members of the General Assembly, solely for purposes of information, summarization and explanation and do not represent the intent of the General Assembly or either chamber thereof for any purpose.

In general, fiscal impacts are based upon a variety of informational sources, including the analyst’s professional knowledge.

Whenever applicable, agency data is consulted as part of the analysis, however final products do not necessarily reflect an assessment from any specific department.

OFA Fiscal Note State Impact:

Agency Affected Fund-Effect FY 25 $ FY 26 $ Social Services, Dept.

GF - Cost Potential Potential Significant Significant Note:

GF=General Fund Municipal Impact:

None Explanation The bill results in a cost to the Department of Social Services (DSS) by expanding coverage for emergency Medicaid services.

The state would incur costs associated with (1) an administrative system used to apply, in advance, for emergency Medicaid coverage for emergency medical conditions that can be treated in outpatient settings, and (2) expanded services under emergency Medicaid.

DSS is anticipated to incur costs of at least $250,000 to support system modifications.

For context, the average gross cost for existing emergency Medicaid services is approximately $34 million annually.

The extent of the increased costs for emergency Medicaid under the bill is dependent on the utilization of services that would not otherwise be covered.

The Out Years The annualized ongoing fiscal impact identified above would continue into the future subject to the utilization and coverage of services under emergency Medicaid.

sSB314 / File No.

338 3 sSB314 File No.

338 OLR Bill Analysis sSB 314 AN ACT CONCERNING EMERGENCY MEDICAID COVERAGE FOR TREATMENT OF EMERGENCY MEDICAL CONDITIONS.

SUMMARY This bill requires the Department of Social Services (DSS) commissioner to expand,ina way consistent withfederallaw,Medicaid coverage for treating emergency medical conditions (i.e., emergency Medicaid, see “BACKGROUND”).

Under the bill, an “emergency medical condition” is a medical condition, including emergency labor and delivery, with acute symptoms severe enough that it can be expected to result in the following without treatment:

1.

placing the patient’s health in serious jeopardy, 2.

serious impairment to bodily functions, or 3.

serious dysfunction of an organ or body part.

The bill lists several conditions that must qualify for emergency Medicaid coverage under the expansion.

The bill also requires the DSS commissioner, by July 1, 2025, to create an administrative system for people to apply in advance for emergency Medicaid coverage for outpatient treatment for emergency medical conditions.

The commissioner must include (1) a link to the application and list of covered emergency medical conditions on the DSS website and (2) information about advance applications for emergency Medicaid and a list of covered conditions in DSS forms and policy manuals.