Matt Lesser

Senate Democrats Announce “A Healthier CT” Agenda

Addresses issues of children’s mental health care, health care access, and Medicaid access and services

HARTFORD, CT — Today, the Senate Democratic Majority of the Connecticut General Assembly announced the third of its legislative priorities for the 2023 session, A Healthier CT. The proposals address issues of children’s mental health care, health care access, and Medicaid access and services.

Today’s announcement marks the third of four successive days of public policy statements from Senate Democrats on a wide variety of issues confronting Connecticut and its residents: improved personal safety, strengthening education and Connecticut’s workforce, improving mental and physical health, and lowering costs for consumers.

“Health care coverage and access is a perpetual issue that we will focus on this legislative session,” said Senate President Martin M. Looney (D-New Haven). “Everyone in Connecticut, regardless of income, deserves quality health care and this year we will continue our vigilant work to protect consumers.”

“The pandemic’s impact on our children has been immeasurable. The increase of anxiety, depression, and other mental health issues in Connecticut’s youth is very real and concerning,” said Senate Majority Leader Bob Duff (D-Norwalk). “Senate Democrats will build upon our success over the past two years and continue to work to improve the quality and availability of mental health care services for children in Connecticut.”

Today’s announcement focuses on specific public policy areas, including:

Children’s Health

SB 2: AN ACT CONCERNING THE MENTAL, PHYSICAL AND EMOTIONAL WELLNESS OF CHILDREN, to improve access to mental, physical and emotional health services for children and provide a continuum of care in the delivery of such services.

Amid the demand for children’s mental health services, unfortunately in many cases there is a shortage of staff to administer services, and an ever-growing number of children experiencing mental health issues provoked by stress, anxiety, worry, nervousness, etc. In Connecticut, children are experiencing emotional hardship but are being placed on waitlists to receive the help and care they need. There is a shortage in mental health services. For providers, there are too many patients and not enough funding to treat them.

Children’s mental health concerns have increased since the coronavirus pandemic. Children had to navigate through an unprecedented change in their lives at home, through school, and the lack of activities.

Even before the COVID-19 pandemic, as many as one in six children in the United States experienced mental health disorders. That rate has only increased in recent years; in 2021, the Connecticut Mirror reported that as many as 47 children per day experiencing mental health crises waited in the emergency department of Connecticut Children’s Hospital, which experts said was a significant escalation from prior years; at Yale New Haven Children’s Hospital, the rate of children experiencing mental health crises more than doubled from March to May 2021, and the rate of hours of care provided to children experiencing mental health crises more than doubled as the pandemic progressed.

In 2021, the Comprehensive Needs of Children in the State Task Force was created to take a harder look at the underlying issues of children’s health. In 2022, the task force was extended. In 2022, legislation was passed that worked to support, expand, and create preventative programs to reduce conditions conducive to children developing mental health disorders. Currently, the task force is supposed to study the comprehensive needs of children in the state and the extent to which such needs are being met by educators, community members and local and state agencies. They are set to provide recommendations to meet the demand for infant and toddler care in the state by increasing access to and enrollment in child care centers, group child care homes and family child care homes, and identify resources to assist such centers and homes in meeting such demand. The task force is also responsible for studying the feasibility of adjusting school start times to improve students’ mental and physical well-being.

Senate Bill 2 will:

• Implement recommendations from last year’s Comprehensive Needs of Children in the State Task Force
• Expand and improve existing mental and physical health programs
• Provide additional funding to school-based health centers
• Ensure all children, no matter what gender, have equitable and safe access to school, support systems, and healthcare
• Collaborate with state and local agencies to provide access to healthy food in our schools
• Evaluate pathways for creating sanctuary libraries
• Provide resources to help appropriately identify and diagnose both children in need of assistance due to the fallout of the pandemic and children in need of increased help and intervention more broadly

Connecticut is not the only state to address children’s mental health. According to the National Academy For State Health Policy, States have pursued a range of approaches including 26 states allocating federal and state funding to increase school-based mental health services, 12 states supporting strategic planning to improve school mental health systems, 24 states providing education and resources for school staff and students, and 10 states guiding school mental health policies.

In Arkansas, legislators did something similar to Connecticut and implemented a strategic planning tool to improve school mental health systems. Lawmakers established a study be done on Mental Health and Behavioral Health and worked to study and develop a report on mental health screening and suicide prevention policies for children in schools.

In Florida, legislators also passed a law similar to Connecticut that helps guide school mental health policies. This law in Florida requires that school health services plans indicate that school and law enforcement staff must attempt to contact a mental health professional for a student in crisis, and that behavioral health providers and school resource officers must attempt to verbally de-escalate crises.

“We often hear about mental health issues of children caused by the COVID-19 pandemic, certainly the instability of the pandemic created issues for some that they did not previously have, but children have needed support for mental health challenges even before COVID-19 closed schools and brought about uncertainty”, said Sen. Ceci Maher (D-Wilton). “As Senate Chair of the Children’s Committee, I am confident we are on the right track with Senate Bill 2, as we look to broaden and expand access for every child that needs it. Nationwide we are seeing states taking children’s mental health more seriously, putting dollars and resources towards helping our young people deal with very serious challenges, such as anxiety and depression, challenges that left uncared for can be catastrophic. Connecticut has always positioned itself as a leader, and I believe we can build off the momentum set forth in previous legislative sessions to pass a good bill that addresses children’s mental health needs appropriately and comprehensively.”

Health Care Protections

SB 6: AN ACT CONCERNING PRESCRIPTION DRUG AFFORDABILITY AND PROTECTIONS FOR CONNECTICUT’S HEALTH CARE CONSUMERS, to provide for more affordable and accessible prescription drugs and allow for increased and more transparent access to health care.

Senate Bill 6 will

• Join the ArrayRX program to standardize and lower prescription drug costs
• Make prescription drugs more affordable for all of Connecticut’s residents
• Improve step therapy practices
• Create a ‘Gold Card’ for prior authorization. This means insurers cannot require prior authorization for a drug or service when such requests by a doctor have been approved 90+% of the time in the past six months. So if a doctor obtains gold card status for a particular drug or service, prior authorization could not be required for that particular drug or service
• In 2019, West Virginia adopted a version of the Gold Card Law. In 2021, the Texas legislature passed the Gold Card Law, and adopted a version more favorable to patients and doctors. Connecticut’s proposal will be modeled after Texas. Currently, Vermont has a pilot program for Medicaid and private insurers
• Shrink the current 15-day deadline for non-urgent care and the 72 hour deadline for urgent care
• Require staffing on weekends by insurers of prior authorization staff
• Require 24/7 staffing to respond to prior authorization
• Require insurance to accept prior authorization requests electronically
• Ensure insurance coverage of hormones prescribed to women for developmental or other issues is equal to coverage for men
• Extend the period within which the insured person must notify the health carrier about the birth of a child from 61 days after birth to 121 days after birth or the hospital discharge date

“On top of being very costly, our health care system can be cumbersome, inefficient and flat out fail people in need of, and deserving of, good care,” said Sen. Jorge Cabrera (D-Hamden). “Prior authorization is just another way a system that is supposed to be helping people, instead creates headaches and delays care. We have some of the best health care physicians in our state and prior authorization gets in their way as well. With Senate Bill 6, we are dealing with this problem directly and removing this roadblock as we continue to identify ways to make care more accessible, affordable, and less burdensome. As Senate Chair of the Insurance and Real Estate Committee, I am optimistic we will pass a bill that really helps people and serves as a model for addressing issues caused by prior authorization, as many states across the country look for ways to deal with this problem as well.”

“SB6 is about the Senate Democrats saying to the people, the patients in Connecticut as well as the physicians and all care providers, we hear you,” said Senator Saud Anwar (D-South Windsor). “We will help you continue to provide excellent care and for the people you will receive quality care and we will reduce the various barriers to care. We will help reduce the cost of medicines.”

Prior Authorization

Right now, there is an administrative hurdle created by the health insurance industry to commonly delay access to care for patients and serve as an imposition into the patient/physician relationship and decision-making process. This being, Prior Authorization. Prior authorization processes can harm patient outcomes and create a tremendous obstacle to treatment decisions deemed most appropriate by physicians. Prior authorization requirements (even for services that are ultimately approved) invariably delay care and keep physicians on the phone with health plans, detracting from time that could be spent on patient care. It also contributes to consolidation of providers.

Currently in Connecticut, for emergency medical care, insurers cannot require prior authorization. For urgent medical care, insurers must respond to requests within 48 hours, or 72 hours if such 48 hour period overlaps with part of the weekend. (If it is a substance abuse urgent matter, then the deadline is 24 hours). For non-urgent medical care, insurers must respond within 15 days, with the possibility of a 15-day extension.

Also, in Connecticut under current law, the state has tried to address some specific issues, with specific laws applying to chronic disease, brand medically necessary drugs, how a prior authorization can be repealed by an insurer, etc.

In a 2021 survey of physicians conducted by the American Medical Association (AMA):

• 93% of respondents reported that prior authorization requirements created delays in accessing necessary care
• 82% of physicians reported that prior authorization can lead to patients abandoning a recommended course of treatment
• 34% of respondents reported that prior authorization requirements have led to a serious adverse medical event for a patient with nearly one quarter reporting that prior authorization delays have led to a patient’s hospitalization

In a 2022 survey of physicians conducted by CSMS of its membership:

• 70% of respondents said they spent at least 9 hours per week dealing with health insurer prior authorizations; 11% spent at least 26 hours and 19% spent more than 35 hours per week
• 42% of respondents indicated that prior authorizations requests are ultimately approved more than 90% of the time and 30% of respondents indicated that prior authorization requests are ultimately approved between 70 and 90% of the time
• 63% of respondents submitted at least 11 prior authorization requests per week; 14% submit at least 31 requests per week and 19% greater than 40 prior authorization requests per week on average

Newborn Insurance

SB6 will also expand time to enroll newborns onto insurance, meaning it would extend the period for which a parent would need to provide notice of the birth of a newborn and pay any required premium or subscription fee to continue the newborns coverage.

Currently, certain health insurance policies that cover family members must cover newborns from birth for a set period before requiring payment to continue the coverage. Infants in the Hartford NICU often stay for weeks and months at a time as they receive highly specialized care. In Fiscal Year 2021, Connecticut Children’s treated 850 patients across the NICU; 206 of which stayed greater than 30 days. The average length of stay for these patients was 77 days. As it relates to this bill, CT Children’s has supported an extended period of time to notify insurers as navigating the complexities of enrollment is often the last thing on a parent’s mind when their newborn is receiving care in a NICU.

Modernizing Health Care Services

SB 10: AN ACT MODERNIZING SUPPORT SERVICES FOR VULNERABLE POPULATIONS, to ensure all vulnerable persons in the state receive the maximum amount of Medicaid care and support services available in a modernized delivery system

Connecticut Medicaid, which is administered by the Department of Social Services, is a major health plan that covers over 800,000 Connecticut citizens, which is 22% of the state population. In 2011, Connecticut ended contracts it had with Aetna, UnitedHealthcare’s AmeriChoice division, and a nonprofit insurer, Community Health Network of Connecticut (CHNCT). Connecticut assumed risk of 529,000 people in the state’s Husky Health program, a group that included adults and family members covered by Medicaid and children in the Children’s Health Insurance Program (CHIP). Connecticut adopted a self-insured system similar to what large employers use and contracted with three companies to provide administrative services under administrative services only (ASO) contracts and approve payments for hospitals, physicians and other providers serving Medicaid and CHIP members,

HUSKY provides health coverage to 3.5 million people, meaning 1 in 4 CT residents are covered by Husky. Medicaid offers home care and long-term services, support, and health care coverage to people with limited income and resources. It expands health coverage for low-income adults and individuals and those living with disabilities. CHIP, the Children’s Health Insurance Program, covers uninsured children in families with incomes that are modest but too high to qualify for Medicaid. These two major health coverage programs are a major source of health care coverage that provides medical, behavioral health, dental, pharmacy, long-term services and supports LTSS, and non-emergency medical transportation.

Medicaid covers a wide range of services, within federal guidelines. Examples of mandatory services include inpatient hospital, outpatient hospital, nursing facilities, family planning, medical transportation, and early and periodic screening. Medicaid can also provide optional services, which Connecticut has elected to cover a broad range of them. Examples include, prescription drugs, dental services, hospice, personal care, care management, and home and community-based services.

Healthcare is a human right that too many Connecticut residents struggle to afford. It becomes problematic when a family is trying to afford their every-day life necessities while paying for coverage of prescription drugs they cannot afford. Nearly 200,000 residents lack health insurance altogether. Americans pay much more for pharmaceuticals than other people in other countries. Three in ten Americans report cutting pills in half, skipping doses, or substituting drugs because of the high cost of prescription drugs.

Senate Bill 10 will work to:

• Increase access to Medicaid to those in need
• Increase access to essential services for those using Medicaid
• Provide more services to low-income individuals who require health insurance

“I am excited that under the leadership of Senator Looney and Senator Duff, 2023 is going to be a banner year for health reform,” said Senator Matt Lesser (D-Middletown). “We have a historic opportunity to expand Medicaid and our new CoveredConnecticut Program, helping kids, the poor, the elderly and people with disabilities get access to health care. And after 15 years of treading water we can finally take steps to ensure that specialists and health centers and front line providers are compensated fairly. The benefits of Medicaid don’t just extend to the poor – this is going to be a banner year for prescription drug reform as well, and we can leverage the state’s HUSKY program to bring down hospital and drug prices for everyone, tackling health care monopolies head on and bringing real relief to Connecticut residents.”

“We know our state’s population is aging and that vulnerable people need supports – ones they too often don’t get,” said Senator Martha Marx (D-New London). “Our medical systems have not fully caught up with technology advances and improvements in care delivery efficiency. We can, and should, change that. By maximizing the value of Medicaid and modernizing how we deliver these vital services, we can ensure our older residents remain cared for now and for years to come, meeting needs they have today.”

“Too many of our residents need healthcare services they cannot afford,” said Sen. Jan Hochadel (D-Meriden). “As Chair of the Aging Committee I am dedicated to finding solutions that enable affordable and accessible healthcare for our seniors. Expanding Medicaid services allows for improved quality of care to those over 65 with limited income.”