Public Health Committee
JOINT FAVORABLE REPORT
Bill No.: SB-331
AN ACT CONCERNING THE PROVISION OF DEVELOPMENTAL SERVICES
Title: AND MENTAL AND BEHAVIORAL HEALTH SERVICES.
Vote Date: 3/16/2022
Vote Action: Joint Favorable
PH Date: 3/14/2022
File No.: 185
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:
The Public Health Committee
REASONS FOR BILL:
To address long-standing concerns of the Department of Developmental Services (DDS), this
bill changes several statutes. It should be noted that this bill is a work-in-progress and will
continue to receive input on several key points as it progresses.
The current language of the bill provides for the following:
Requires the commissioner of DDS to develop a plan to reduce wait times for services
provided by the department, and to notify recipients before their eligibility to receive
such services ends.
Allow the DSS Commissioner to contract with hospitals and nonprofits to provide
frequent users of hospital services with social services and referrals.
Requires the Secretary of the Office of Policy and Management (OPM) to consult with
relevant stakeholders before closing a DDS facility.
Establishes a task force to study the DDS Level of Need (LON) system.
Requires providers to conduct a mental health examination during an annual physical,
and prohibits insurers from requiring step therapy for behavioral health conditions.
Specifies that substance use disorder is a disease (Sec. 8).
RESPONSE FROM ADMINISTRATION/AGENCY:
Peter Mason, Deputy Commissioner, Department of Developmental Services, (DDS):
On the requirement for a plan to reduce wait times in Sec. 1, DDS notes that previous
initiatives to reduce wait time have been accompanied by additional funding. That funding will
be necessary to take the necessary measures to reduce their waiting list. Regarding Sec. 2,
when DDS closes facilities, it works with individuals and their families, employees, unions,
and advocates, to ensure the successful transition of individuals to new locations and will
continue to do so. On Sec. 4 of the bill, Level of Need (LON) is a system used to assess the
individual's needs in a variety of key areas to determine how DDS can best provide services
to them. DDS is currently moving towards adopting a universal system for this function which
would be shared with DSS and based on their model. They recommend that any such study
be focused on the current DSS model.
Department of Social Services (DSS):
DSS contends that Sec. 5 of this bill is unnecessary, as there is no current impediment to the
Department aligning any of its current contractual agreements with providers of social
services to coordinate health services for people served by HUSKY Health. They currently
have in place multiple mechanisms and initiatives to address those needs. These practices
have significantly decreased the inappropriate use of the emergency department and
inpatient hospital admissions and readmissions.
Denise Drummond, African American Legislative Policy Analyst, (CWCSEO):
The provision in Sec. 1 of this bill to reduce DDS wait times is vital to the more than 2,100
adults in Connecticut with intellectual disabilities most of whom live at home with their families
and are waiting for placement in a group home or private setting. As the parents age, or the
individual's behavior regresses, an out-of-home placement, or qualifying for more in-home
support, becomes critically important. While CWCSEO urges passage, the commission also
recommends a more comprehensive approach to reducing wait times for assistance from
DDS.
NATURE AND SOURCES OF SUPPORT:
Ben Shaiken, Director of Government Relations, CT Community Nonprofit Alliance:
The Alliance requests that the Sec. 4 mandate that providers, family members and people
with I/DD be a part of the decision-making process in changing the Level of Need (LON)
system. As it currently stands, LON scores are directly tied to the rates that providers are
paid for treatment, which leads to an inherent conflict between appropriate funding and an
individuals assessed need. They are very supportive of Sec. 7-8. When insurance
companies put forth fail first policies, required by step-therapy, patients are not allowed to
get their recommended prescriptions until they have failed to improve with a series of
cheaper medications. This practice violates the patient-provider relationship, and
compromises effective treatment.
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Howard Sovronsky, Chief Behavioral Health Officer, Connecticut Childrens:
Sec. 1 of this bill will help address the needs of children with developmental and intellectual
disabilities. While many of those children can be successfully treated in the home setting,
there remains a need for expanding residential care for those requiring more intensive on-
going care and treatment. They also support Sec. 6 of the bill but suggest that, in addition to
screening, adding the need to strengthen primary care providers abilities to confidently
recognize and care for a child with behavioral health challenges.
Sheldon Toubman, Litigation Attorney, Disability Rights Connecticut:
They are very supportive of limiting the practice of step-therapy, which is particularly harmful
to patients with mental health disabilities. Some behavioral health drugs can cause serious
and permanent side effects which persist after use is ended. Subjecting patients to this
experimentation for the insurers financial benefit may reasonably cause some of these
individuals to give up on any medication therapy entirely, even though it might be beneficial.
CT DDS Families First Leadership:
Sec. 1 of this bill is overdue, as the most recent waiting list initiative was in 2014. Regarding
Sec. 2, there have been cases where guardians are not consulted prior to a closure decision.
CT DDS believes that no closure should be scheduled until adequate appropriate placement
and transition is complete. They support Sec. 3 but note that a minimum notice period of at
least 30 days should be specified. Finally, in Sec. 4, they believe that there must be broad
representation of different needs in evaluating any change to the Level of Need or other
assessment system.
Jordan Fairchild, Coordinator, Keep The Promise Coalition:
They support limiting step-therapy. Prescribing the wrong medication can result in the
worsening of a persons mental health and puts patients lives at risk. Research has shown
that restricting access to medication has resulted in increased and prolonged hospitalizations,
and more emergency room visits, especially for patients seeking mental health treatment.
NATURE AND SOURCES OF OPPOSITION:
Wyatt Bosworth, Assistant Counsel, Connecticut Business & Industry Association:
Research studies show that step therapy has demonstrated savings of more than 10% in
targeted categories of drugs. Step therapy is already heavily regulated by the state to ensure
consumer protection. For example, it is limited to only sixty days of use. Step therapy is an
important tool that employers, health plans, and Pharmacy Benefit Managers (PBMs) utilize
to ensure patients receive clinically appropriate and cost-effective drug therapies.
Connecticut Association of Health Plans:
Step therapy helps advance the use of clinical "best" practice protocols while at the same
time considering the costs associated with various treatments. Step therapy has helped in the
fight against the opioid epidemic and evidence-based clinical research has shown a reduction
in the overprescribing of opioid medications for pain management. Removing the use of step
therapy adds an administrative burden as well, as these new mandates add appreciable
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volatility to the landscape that is not conducive to an efficient, stable, and predictable
insurance market.
Sam Hallemeier, State Affairs Director, Pharmaceutical Care Management Association:
Step therapy is a useful tool to ensure that patients receive clinically appropriate and cost-
effective drug therapies. The industry already effectively self-regulates to prevent step-
therapy from becoming too restrictive, as every plan has an established exceptions process
to cover non-first-line drugs if a physician provides documented medical reason.
Reported by: Dallas Emerle Date: 4/4/2022
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