HB 6470 — AN ACT CONCERNING HOME HEALTH, TELEHEALTH AND UTILIZATION REVIEW.

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5 from passage New section sHB6470 / File No.

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772 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:

See Below Municipal Impact:

None Explanation The bill (1) specifies conditions under which audio-only telehealth services can be provided under Medicaid and HUSKY B, and (2) requires Medicaid reimbursement for telehealth services to be the same as if the service was provided in person, to the extent allowed under federal law.

DSS currently reimburses for telehealth services (including audio-only under certain conditions) at the in-person rate.

While this codifies current practice under the public health emergency, it could preclude future savings to the extent telehealth services would otherwise be provided at lower rates than those established for equivalent in-person services.

The bill makes other technical and conforming changes, which have no fiscal impact.

House "A" strikes the language in the underlying bill and the associated fiscal impact and results in the impact described above.

The Out Years The annualized ongoing fiscal impact identified above would continue into the future subject to inflation.

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772 OLR Bill Analysis sHB 6470 (as amended by House "A")* AN ACT CONCERNING HOME HEALTH, TELEHEALTH AND UTILIZATION REVIEW.

SUMMARY This bill requires the Department of Social Services (DSS) commissioner, to the extent permissible under federal law, to provide Medicaid reimbursement for telehealth services to the same extent as services provided in person.

Existing law requires DSS to provide Medicaid coverage for categories of telehealth services if the DSS commissioner determines they are (1) clinically appropriate to be providedthroughtelehealth, (2) cost effective for the state, and (3) likely to expand access in certain circumstances (CGS § 17b-245e).

Current law allows the DSS commissioner, at her discretion, to cover audio-only telehealth services under the state’s medical assistance programs (e.g., Medicaid) until June 30, 2023.

The bill instead requires her to do so, without a sunset date, when (1) she determines doing so is clinically appropriate;

(2) providing comparable covered audiovisual telehealth services is not possible;

and (3) audio-only services are providedto peoplewho are unableto use oraccess comparable,covered audiovisual services.

Both the authorization under current law and the requirement under the bill are applicable to the extent permissible under federal law.

Thebillalsoexpandsthetypesofhealthcareproviderswhocanorder home health care services to include advanced practice registered nurses (APRNs) and physician assistants.

It also allows DSS to waive or suspend prior authorization requirements and other utilization review criteria and procedures for sHB6470 / File No.

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772 Medicaid and the Children’s Health Insurance Program (CHIP).

The bill makes a minor change to a provision allowing telehealth providerstoprovideservicesfromanylocation.Italsoremovesobsolete provisions and makes conforming changes.

*House Amendment “A” (1) eliminates provisions in the underlying bill allowing licensed nurse midwives and behavior analysts to provide telehealthservices,and (2)makesminorchangestoprovisionsonorders for home health care services and telehealth providers providing services from any location.

EFFECTIVE DATE:

Upon passage §§ 1 & 2 — ORDERS FOR HOME HEALTH CARE SERVICES Current Department of Public Health (DPH) regulations generally require physicians to sign patient care plans that include a needs assessment for home health services (Conn.

Agencies Regs.

§ 19-13- D73).

The bill supersedes this and any other state regulation and allows APRNs and physician assistants, as well as physicians, to order home health care agency, hospice home health care agency, and home health aide agency services.

(An April 27, 2020, DPH order enacted a similar policy for the duration of the COVID-19 public health and civil preparedness emergencies;

the authorizing executive order (Executive Order 7K) has since expired.) The bill also allows APRNs and physician assistants in states that border Connecticut to order home health care agency services, in addition to physicians in bordering states under current law.

The bill expands this provision to also explicitly apply to hospice home health care agency services and home health aide agency services.

The bill extends any DPH regulation, policy, or procedure that applies to a physician ordering home health services to also apply to APRNs and physician assistants.

This includes provisions on reviewing and approving care plans for these services.

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772 The bill similarly allows APRNs and physician assistants to order home health care services covered by DSS (i.e., under medical assistance programs, suchasMedicaid).Under thebill, any DSSregulation,policy, or procedure that applies to physicians ordering home health care services also applies to APRNs and physician assistants, including related provisions on care plan review and approval.

§ 3 — TELEHEALTH PROVIDER LOCATION PA 21-9 establishes requirements for the delivery of telehealth services and insurance coverage of these services until June 30, 2023.

Among other things, the law allows telehealth providers, regardless of any contrary state laws, to providetelehealthservicesfromany location.

Under the bill, this provision applies (1) subject to compliance with all applicable federal requirements and (2) regardless of any state licensing standards.

§ 5 — PRIOR AUTHORIZATION AND UTILIZATION REVIEW The bill allows the DSS commissioner to waive or suspend, in whole orinpart,anypriorauthorizationorotherutilizationreviewcriteriaand procedures for Medicaid and CHIP.

The bill requires her to include notice of any waiver or suspension in a provider bulletin sent to affected providers and posted on the Connecticut Medical Assistance Program website at least 14 days before implementing it.

(An executive order issued during the COVID-19 pandemic contained similar provisions (Executive Order 7EE,§ 4, issued April 23, 2020);

the order was repealed on May 20, 2021.) BACKGROUND Related Bill sHB 6666 (§ 52), as amended by House Amendment “A” and passed by the House, similarly allows licensed APRNs and physician assistants to order home health care agency,hospice agency,andhomehealth aide agency services.

COMMITTEE ACTION Human Services Committee sHB6470 / File No.

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772 Joint Favorable Substitute Yea 19 Nay 0 (03/18/2021) sHB6470 / File No.

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