Human Services Committee
JOINT FAVORABLE REPORT
Bill No.: SB-764
Title: AN ACT CONCERNING MEDICAID PROVIDERS.
Vote Date: 3/9/2021
Vote Action: Joint Favorable
PH Date: 2/16/2021
File No.:
Disclaimer: The following JOINT FAVORABLE Report is prepared for the benefit of the
members of the General Assembly, solely for purposes of information, summarization and
explanation and does not represent the intent of the General Assembly or either chamber
thereof for any purpose.
SPONSORS OF BILL:
Human Services Committee
REASONS FOR BILL:
To add acupuncture and chiropractor services to those covered under Medicaid, adjust the
Medicaid payment methodology for methadone maintenance providers, achieve Medicaid
payment parity for nurse-midwives and podiatrists performing the same services as physicians,
and provide Medicaid reimbursement to peer support specialists. This will improve access to
needed services for Medicaid recipients, and services that, based upon experience, reduces the
use of powerful medications in treatment, and results in improved outcomes without the risk of
narcotic dependency.
RESPONSE FROM ADMINISTRATION/AGENCY:
Deidre Gifford, Commissioner, Connecticut Department of Social Services
Section 1: There is clinical evidence that acupuncture services are effective in addressing
pain and other clinical conditions. There is clinical evidence that chiropractic services are
effective in addressing acute and chronic back and spinal pain. Both services may be used
as an alternative method of treatment to pain medications, including opioids. Therefore, the
Department appreciates the concept of additional Medicaid coverage for services provided by
licensed acupuncturists and chiropractors in independent practice and other applicable
covered settings. As with all Medicaid covered services, the Department would approve
coverage only for services that are medically necessary.
Section 2: This section proposes to delete language in the existing statute specifically related
to provider rates decreasing if they do not meet the minimum performance level on
established performance measures. DSS is instead considering a more graduated approach
to adoption of value-based payment strategies under its proposed substance use disorder
1115 research and demonstration waiver.
Section 3: This section seeks parity for nurse-midwives with physicians. The Department of
Social Services believes any fee increase should be tied to improvements in clinical outcome.
The Department of Social Services believes the original disparity is linked to the difference in
education and in the average debt incurred. Despite the differences in training, experience
and debt between physicians and nurse midwives, the Department also recognizes
numerous studies that show, when compared head to head, the outcomes of women and
infants served by a nurse midwife are as good as if not superior to those served by an
obstetrician. The Department of Social Services believes that equalizing fees paid to
midwives and obstetricians is an idea whose time, clinically, has come. The financial impact
of this legislation, however, would be substantial. In place of an immediate rate increase,
however, DSS proposes to review this issue in context of designing an expanded Medicaid
maternity bundle under which it will seek to address and remedy disparities of access,
utilization and outcomes for pregnant women served by HUSKY Health, with an emphasis on
women of color..
Section 4: This section would include peer support specialists within care teams. While DSS
strongly supports the concept and practice of including peer support specialists within care
teams, it must respectfully oppose Section 4 of this bill as drafted. The Governors budget
does not provide funding for such services under the Medicaid State Plan.
NATURE AND SOURCES OF SUPPORT:
The Advocacy Committee for Womens Health Connecticut
WHC feels that it is reasonable and fair for CNMs to receive the same reimbursement as an
obstetrician-gynecologist for providing the same services. Further, they may play a role in
reducing the cost of maternal care overall for our state. In recent years, Connecticut midwives
have attended in approximately 10-15% of the vaginal births annually and studies have
shown them to be instrumental in helping to lower cesarean deliveries, the rate of induction
and the use of anesthesia.
Polly Moran, CNM, MSN
Less health disparities, better health outcomes, and less costly interventions in women's
health saves women at the same time it saves Connecticut money. I urge your support.
Matthew Maneggia, Licensed Acupuncturist
Acceptance of acupuncture has grown by leaps and bounds - not only by the public but by
the medical community. Reports of increased referrals suggest improved demand for, and
access to, this important service. Doctor referrals have become especially common since the
realization of the profound dangers of prescription narcotic pain medication. Currently, most
private health insurers offer coverage for acupuncture - likely due to their realization of
tremendous cost savings when people choose relatively inexpensive treatments like
acupuncture over high-cost treatments like prescription pain medications, surgeries, and
other invasive procedures. In my opinion, it is far past due that we offer these relatively
inexpensive, low-risk healthcare options to the most vulnerable among us.
Page 2 of 4 SB-764
Amy Romano, MBA, MSN, CNM, FACNM
Payment parity for midwives is long overdue, and Connecticut stands apart from other states
in the region and around the country in its outdated approach to midwifery reimbursement.
There are decades of research demonstrating positive outcomes and cost savings with
midwifery care and midwife-led models such as the birth center model. Organizations that
have endorsed expansion of midwifery services to improve outcomes, access, and equity
include the American College of Obstetricians and Gynecologists; the Institute for Medicaid
Innovation; the Office of the Surgeon General; the March of Dimes; the Center for Medicare
and Medicaid Innovation; The National Academies of Science, Engineering, and Medicine;
and the National Partnership for Women and Families; We are in a maternal health crisis that
is only exacerbated by the pandemic. The situation is urgent, especially for Black,
Indigenous, and other people of color who suffer much higher rates of maternal mortality and
serious morbidity compared with non-Hispanic white women. Midwifery is a key strategy for
addressing health inequities and training more midwives of color is the fastest way to
diversify the obstetric and womens primary care workforce to provide culturally aligned and
appropriate care and reduce disparities.
Dr. Mathew DiMond, a Doctor of Chiropractic, Assistant Professor and Clinician at the
University of Bridgeport
Lack of adequate coverage can restrict care delivery options driving patients in their time of
need to pursue guideline discordant care. What does that mean? Research shows that for
numerous musculoskeletal pain conditions, such as chronic low back pain, treatment first
provided by non-pharmacologic approaches yields - improved outcomes, reduced
hospitalizations, improved patient satisfaction, and overall decreased healthcare costs. For
example, a 2012 article in the journal Spine showed that the likelihood of surgery for a patient
who first saw a surgeon was 42.7%, while the likelihood of surgery for a patient who first saw
a chiropractor was a mere 1.5%. Even in the wave of the current opioid epidemic, multiple
studies have shown that excessive opioid medications are routinely prescribed for all types of
injuries and surgical procedures, even when the evidence supports non-pharmacologic
approaches first.
As a matter of cost, as a matter of science, as a matter of equity, our ask is that chiropractic
be restored to the optional services covered under Medicaid.
Additional Sources of Support include:
Steven Zuckerman, President and CEO, Root Center for Advanced Recovery
Ben Shaiken, Manager of Advocacy and Public Policy, The Alliance
Gretchen Raffa, Senior Director for Public Policy, Advocacy and Organizing, Planned
Parenthood.
NATURE AND SOURCES OF OPPOSITION:
None expressed
Reported by David Rackliffe Date: March 22, 2021
Page 3 of 4 SB-764
Page 4 of 4 SB-764


Statutes affected:
Raised Bill:
HS Joint Favorable:
File No. 109:
APP Joint Favorable: