Senator Needleman Joins Senate Democrats’ Passage of Priority Legislation Improving Children’s Health and Protecting Literary Freedom

HARTFORD, CT – Today, Senate Democrats passed Senate Bill 2 “An Act Concerning the Mental, Physical and Emotional Wellness of Children,” priority legislation for the caucus that, among other important factors, aims to protect libraries from the onslaught of book bans by conservatives that have been prevalent across the nation. The bill also contains several provisions crucial to fostering positive health and wellness for Connecticut children.

“We need to do all we can to support mental health treatment in our state, as reports continue to indicate our residents are experiencing issues. I’m proud to vote for legislation bolstering mental health for both youth and adults,” said State Senator Norm Needleman (D-Essex), who voted in support of the bill. “This bill seeks to provide new and beneficial aid to workers and teens experiencing crisis. It also counters a concerning trend around the country, providing additional resources to libraries properly serving constituents. I am looking forward to seeing it become law.”

SB 2 is a comprehensive bill that protects against politically fueled book bans, commonly by conservatives, which has remained an issue over the past year. The American Library Association (ALA) recently reported last year there were 1,269 attempts to ban books across the country, a sizable increase from the 729 in 2021. Last year, Texas banned 801 books from July 1, 2021-June 30, 2022 according to Statista. Florida banned 560 books and Pennsylvania banned 457 last year as well. According to PEN America, Between August and November, Missouri banned nearly 300 books in at least 11 school districts. These bans are targeted specifically at books regarding the LGBTQ community and communities of color. According to PEN America, “more than 40% of the banned titles address lesbian, gay, bisexual, transgender and queer themes or have prominent queer characters.” Per Statista, “40 percent of banned titles featured protagonists or other key characters of color.”

Rewarding Libraries that Protect Literary Freedom

SB 2 enables libraries that prioritize and protect literary freedom by establishing a system to review books that have been challenged via a policy set by their governing board to have access to a state grant which could provide a library with approximately $1,300 to $3,000 per library.

Per the legislation, ” no principal public library shall be eligible to receive a state grant, if such principal public library does not maintain and adhere to collection development, collection management, and collection reconsideration policies which are approved by their governing body. The collection reconsideration policy shall offer residents a clear process to request a reconsideration of library materials. In the instance of a book challenge, these policies shall govern.”

Addressing Birth to 3

Per the bill language, “the bill makes permanent the $200 general administrative payment the Office of Early Childhood commissioner must make to certain Birth to Three early intervention service providers that will sunset under current law on June 30, 2024.” This will go into effect July 1, 2023, if signed into law. Under the bill and current law, the commissioner must make these payments to providers for each child: with an individualized family service plan on the first day of the billing month; whose plan accounts for less than nine service hours during the billing month, as long as the provider delivers at least one service during the month

Creating Mental Wellness Days

SB 2 requires employers to allow service workers to use accrued paid sick leave for a “mental health wellness day” to attend to their emotional or psychological well-being. Currently, existing law allows service workers to use paid sick leave for their, or their spouse’s or child’s (1) illness, injury or health condition; (2) medical diagnosis, care, or treatment of a physical or mental illness, injury, or health condition; or (3) preventive care. Per bill language, the legislation applies to specified service worker occupations covered by existing law, they are as follows: certain food service industry jobs; health care; hospitality; retail; sanitation industry workers

The legislation also covers certain, specific scenarios in which a worker would need to use a mental health wellness day. They are as follows: where a service worker is a victim of family violence or sexual assault, or the parent or guardian of a child who is a victim of family violence or sexual assault, provided such service worker is not the perpetrator or alleged perpetrator of such family violence or sexual assault; for medical care or psychological or other counseling for physical or psychological injury or disability, to obtain or obtaining services from a victim services organization; to relocate or while relocating due to such family violence or sexual assault; to participate or while participating in any civil or criminal proceedings related to or resulting from such family violence or sexual assault

If signed into law, this will go into effect on October 1, 2023.

Help for At-Risk Teenagers

SB 2 makes it optional for the State Department of Education (SDE) to hire one full-time employee responsible for awarding a grant to, and collaborating with, a nonprofit organization specializing in identifying and providing services for at-risk teenage students with depression, anxiety, substance abuse struggles, and trauma and conflict-related stresses, per the bill language. The bill continues: the organization must use the grant to train school behavioral health providers to provide them services. The bill allocates $15,000, for the 2024 fiscal year, to SDE from the federal funds the state received under the American Rescue Plan Act of 2021 to fund the awarding of a grant to a nonprofit organization to train school behavioral health providers to identify and provide services for these students. This will go into effect July 1, 2023, if signed into law.

Due to the clear need for this bill, SB 2 received support during the public hearing period of the legislative session. Nicole Chen of Yale Dems spoke in favor of SB 2, saying, “this bill would allocate further resources towards improving children’s access to mental, physical, and emotional health services.” Chen added “this shortage of mental health services for children in Connecticut demands a solution. We should prioritize this issue, increasing funding along with access to professional services and training, in order to ensure children the chance at help.”

The bill heads to the state House of Representative for further debate and action. It previously passed the Committee on Children by a 13-6 tally before landing in the state Senate.

SENATE DEMOCRATS LEAD PASSAGE OF LEGISLATION TO REMOVE UNNECESSARY ROADBLOCKS TO CARE

HARTFORD, CT – Today, Senate Democrats led passage of legislation that will eliminate certain delays and inefficiencies to care. Senate Bill 6: “An Act Concerning Utilization Review and Health Care Contracts, Health Insurance Coverage for Newborns and Step Therapy,” advanced out of the state Senate and heads to the state House of Representatives for further debate and action.

“We need health care that meets patients where they are, not health care that makes patients jump through hoops to even receive services,” said State Senator Norm Needleman (D-Essex), who voted for the bill. “This bill helps ensure that is indeed the case. By reducing use of prior authorization, we reduce delays and administrative issues that could delay and hamper care. Reducing use of step therapy provides easier, more direct access to the care people need. And helping young families get more time with their newborns and less time worrying about paperwork is a real-world benefit across our state. I’m proud to support this bill and hope it becomes law.”

SB 6 implements several changes to make more efficient the currently cumbersome and lengthy administrative process of prior authorization, which frequently delays care for patients and unnecessarily occupies health care workers seeking to obtain required approval from insurance companies to fill prescriptions and/or treat patients. The legislation also broadens prohibitions on step therapy, a cost-cutting practice by insurers which also delays care. As patients gradually progress through less costly medications, and as they fail, they are then provided access to the medication the patient originally required.

Regarding newborns, Senate Bill 6 will lengthen the deadline for parents of newborns to enroll the child in their insurance to 91 days. Currently, parents must do so 61 days after the baby is born, a deadline which can pass parents by as they acclimate to parenthood and, in some instances, comes before the baby leaves the hospital to go home with their family. Per the bill, SB 6 will do the following:

Prior Authorization

To address the unnecessary pain and suffering of patients, and the frustration of medical professionals, S.B. 6 makes the following changes to prior authorization: “One-and-Done” – Section 2 prevents insurers from requiring prior authorization for a prescription that addresses cancer, autoimmune diseases, and multiple sclerosis, if the insurer already approved the prescription for a patient in the past. With chronic illnesses, a provider and patient should not have to seek approval every month, 6 months or otherwise; shorter Timelines – Connecticut requires insurers to approve or disapprove a request for health care coverage within fifteen-day deadline, which can be extended by another fifteen days under circumstances beyond the insurer’s control. Section 3 changes it to a 7-day deadline, with a possible 5 day extension. A survey by the American Medical Association identified the deadlines for 35 states, and most of those states had deadlines of 5 days or less, and a good mix of 13 red and blue states have a deadline of 72 hours. If the health condition of the patient is urgent, current law provides a 72 hour deadline, and the bill would shorten the time frame to 24 hours, a deadline that at least 14 states already require.

Enrolling Newborns

Sections 5 and 6 would protect families from missing important enrollment deadlines after a baby is born. Insurers must provide coverage to newborns, but that can be denied if the parent, who is the member, does not notify the insurer within 61 days of birth. The total denial of coverage is a heavy-handed way to force compliance with a mostly arbitrary deadline. In our FY 2021, the average length of stay for babies in the NICU greater than 30 days, was 77 days and in FY 2022 it was 63 days. These parents have exponential stress on top of the regular challenges of a newborn that can keep them occupied from completing insurance forms in a timely manner. This bill would extend to 91 days the time parents have to enroll their newborn onto their insurance.

Step-Therapy

Like prior authorization, insurers use step-therapy as a cost-cutting mechanism, which unfortunately leads to the same consequences of pain and suffering for patients and frustration and burnout for health care providers. When a doctor prescribes a drug, the insurer will use the process of step-therapy to deny coverage of the doctor preferred drug until the patient tests cheaper alternatives, each which must fail to help the patient before the insurer agrees to cover the costs of the drug preferred to be used by the patient’s doctor. The General Assembly has pushed back, first with the passage of PA 14-118 that capped step-therapy to 60 days, and then with PA 17-228 that prohibits step-therapy for stage IV metastatic cancer. But there are far too many scenarios where 60 days forces unnecessary suffering of the patient. In January, the Washington Post ran an article highlighting the suffering of a three-year-old boy who was forced in and out of the emergency room with debilitating arthritis, fevers, and rash because the insurer required step-therapy.
Sections 7 and 8 would change the 60-day cap on step therapy to 30 days, which is the current cap for Medicaid/HUSKY. In addition, for a three year period from January 1, 2024 to January 1, 2027, the bill will exempt from step therapy the treatment of schizophrenia, major depressive disorder and bipolar disorder.

Background on Existing Prior Authorization Law and its Impact

Currently in Connecticut, for emergency medical care, insurers cannot require prior authorization.

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 the Connecticut State Medical Society 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.

Currently in Connecticut, for emergency medical care, insurers cannot require prior authorization. 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 the Connecticut State Medical Society 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

Background on Current Step Therapy State Law

Public Act 14-118 capped step-therapy to 60 days; Public Act 17-228 prohibits step-therapy for stage IV metastatic cancer