Human Services Committee
JOINT FAVORABLE REPORT
Bill No.: HB-6470
AN ACT CONCERNING HOME HEALTH, TELEHEALTH AND UTILIZATION
Title: REVIEW.
Vote Date: 3/18/2021
Vote Action: Joint Favorable Substitute
PH Date: 2/23/2021
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 make permanent certain Medicaid and Childrens Health Insurance Program (CHIP) home
health, telehealth, and utilization review policy changes that were temporarily implemented
under the Governors executive orders during the COVID-19 public health emergency. This
bill seeks to make health care more accessible by allowing permanent access to video
telehealth services, allowing nurse practitioners and physician assistants to issue orders for
individuals to receive home health services. In addition, audio-only services would be
covered when clinically appropriate, to the extent permissible under federal law. It would
allow the Commissioner of Social Services to relax utilization review criteria and procedures
for the Connecticut medical assistance program, and add behavior analysts and nurse-
midwives to the list of approved telehealth providers. All of these provisions seek to improve
health care access for people in Connecticut.
RESPONSE FROM ADMINISTRATION/AGENCY:
Deidre Gifford, Commissioner, Department of Social Services, supports this bill for many
reasons. Commissioner Gifford notes that federal Medicaid regulations recently changed to
allow nurse practitioners and physician assistants to issue orders for individuals to receive
health home services. DSS is in favor of implementing this permanently because it will
improve access to home health services efficiently. Commissioner Gifford is in support of
retaining the ability to choose to cover certain audio-only telephone services in Section 3
because it is a necessary step to improve access and equity to care. The Department is in
support of section 5 because the authority to relax specific utilization review criteria is
important to efficiently adapt the program to changing clinical practices and program
structure, ensure sufficient access to services, and safeguard quality of services provided.
NATURE AND SOURCES OF SUPPORT:
50 Licensed Behavior Analysts submitted testimony in support of the bill. All of these testifiers
support this bill as it adds Licensed Behavior Analysts to the list of approved telehealth
providers. They support this addition because, throughout the pandemic, telehealth has
become a standard method of service delivery and continues to be a widely applied modality
within the behavior analytic community.
A majority of the testifiers support this bill because telehealth expands access to impactful,
evidence-based, quality services, for a wide range of clients and their families. Telehealth has
improved access to medically necessary services which may not otherwise be available due
to location, transportation, health, or other variables. Some people included that telehealth
has empowered caregivers because of increased participation and training. Others added
that it allows providers to observe and analyze behaviors that may only be displayed at
home. Others pointed out that telehealth allows for continued care, which is critical to
continued progress. Without a telehealth option, many children would have a lapse in
services which can be very damaging and even cause regression in abilities and behavior.
Other supporting arguments included: telehealth allows for LBAs to take on an increased
number of clients without compromising quality of care, and it provides flexibility in timing to
meet individual family needs.
27 additional individuals submitted testimony in support of the bill. They all support this bill
because telehealth services increase access to care, and there is growing evidence
demonstrating the efficacy of telehealth. Many testifiers mentioned the importance of audio-
only sessions, as they allow providers to reach parents and children who do not have the
technical capacity to connect via video, or simply are uncomfortable doing so. Many testifiers
also commented that this bill is a vital step toward addressing the current crisis regarding
mental health and addiction care in the state. To meet the increased need for mental health
services, people must have access to flexible, high-quality telehealth. Others emphasize the
importance of audio-only telephone communication as an option, as it ensures more
equitable access to care. Many patients do not have access to the internet or audio-visual
devices; without an audio-only option, a large portion of patients would be disenfranchised. A
few testifiers mention that this bill addresses health disparities by removing barriers to care,
through the ability of PAs and APRNs to order home health care. A handful of testifiers
mentioned that telehealth contains costs for healthcare systems.
A collection of 20 groups and providers submitted testimony in support of the bill. They
support this bill because telehealth increases access to care by connecting patients to a wide
variety of vital services; it helps ensure that options are available for patients to receive the
right care, at the right place, at the right time. Though the pandemic underscored the value
of telehealth, it also demonstrated that it should remain an essential method for delivering
healthcare services.
Michael Aronow, President, Connecticut Orthopaedic Society, requests language clarification
to Section 1 (h) (i) and Section 2 (a) (b). The Society requests that the language is amended
Page 2 of 3 HB-6470
to clarify that physician assistants would be authorized, under the supervision and direction of
a physician to order home health services. They also request that language is amended to
clarify that for the first three years after having been issued a license pursuant to section 20-
94a, an advanced practice registered nurse ordering home health services would need to
collaborate with a physician licensed to practice medicine in this state. Lastly, they request
language is amended to clarify that physician assistants and advanced practice registered
nurses licensed in a state which borders Connecticut would be held to the same
requirements as physician assistants and advanced practice registered nurses licensed in
Connecticut.
Lynn Evans supports this bill because telehealth has provided her life-saving services
through this pandemic.
Sharri and Wyatt Lungarini, support this bill because of their personal experience witnessing
the critical support their son received throughout the pandemic through telehealth.
Brunilda Ferraj, Director of Policy Research and Organizational Initiatives, CT Community
Nonprofit Alliance supports the intent of the bill but believes it does not adequately protect
and ensure continuity in care. First, The Alliance requests that language in Section 4 is
amended to require the DSS Commissioner to allow for audio-only service provision as long
as it is permissible by federal law. Second, they request the language from H.B 6272
regarding rate parity for telehealth and in-person services be added to this bill.
Kelly McConney Moore, Senior Policy Counsel, American Civil Liberties Union of
Connecticut, supports this bill because access to telehealth during a global pandemic is both
a matter of racial equity and reproductive freedom. Reducing spread, through limited
contact, directly improves health outcomes for communities of color, who have been
disproportionately impacted by COVID-19. Access to reproductive healthcare through
telehealth ensures that time-sensitive and essential services are provided.
Pareesa Charmchi Goodwin, Executive Director, CT Oral Health Initiative, supports the bill
and recommends adding licensed dentists and registered dental hygienists to the list of
telehealth providers. Teledentistry is critical to assess urgent needs, which prevents
unnecessary emergency room visits. It also brings care to difficult to reach populations.
NATURE AND SOURCES OF OPPOSITION:
None expressed
Reported by: Gianna Vollano Date: March 30, 2021
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Statutes affected:
Raised Bill:
HS Joint Favorable Substitute:
File No. 265:
File No. 772:
Public Act No. 21-133: