SB 7, An Act Concerning Protections For Access To Health Care And The Equitable Delivery Of Health Care Services In The State

TESTIMONY OF THE CONNECTICUT HOSPITAL ASSOCIATION
SUBMITTED TO THE PUBLIC HEALTH COMMITTEE

Monday, March 24, 2025

The Connecticut Hospital Association (CHA) appreciates this opportunity to submit testimony concerning SB 7, An Act Concerning Protections For Access To Health Care And The Equitable Delivery Of Health Care Services In The State. CHA opposes Sections 3, 4, 14, 15-18, and 28-32. CHA also opposes Sections 5-13 as written.

Connecticut hospitals and health systems care for patients, strengthen the state’s economy, and support vulnerable communities across the state. Every day, they work to improve healthcare access, affordability, and health equity. Even as they face ongoing challenges, hospitals provide world-class care to everyone who walks through their doors, regardless of their ability to pay. Hospitals also support an exemplary workforce as the largest collective employer in the state, contribute significantly to the state’s economy, and invest in their communities addressing social drivers of health.

Off-Campus Infusion Services (Section 3)

Section 3 of this bill focuses on injection and infusion services provided by hospitals in off-campus settings. The majority of this care supports cancer treatment, which typically involves frequent infusion of chemotherapy or other drugs by nurses or other hospital staff pursuant to a physician order and plan of care. This bill would introduce an outright prohibition on commercial reimbursement for these services in off-campus settings. Stated another way, hospitals and the clinical staff who support these services would receive no commercial payment whatsoever for providing these services, other than for the cost of the drug. This would likely result in a loss of access to these services. It would also introduce the needless loss of tens of millions in hospital revenue at a time when hospitals across the state are experiencing extraordinary financial challenges.

Low-income patients on Medicaid rely on the access provided by hospitals — access that they may not otherwise be afforded in community practice settings. In addition, hospitals often serve patients with more severe or complex conditions than can be effectively managed in non-hospital settings. There is no public health rationale for making it illegal for hospitals to collect commercial reimbursement for these services, which would result in the elimination of these care settings entirely and access for all patients who rely on this care, regardless of payer.

State Shield Law (Section 4)

Section 4 seeks to permit licensed healthcare providers to share information with or provide certain types of care to patients if the provider in good faith believes the information is accurate and appropriate even if such information or care is inconsistent with the requirements of their job, policies of the facility, or violates care protocols of their facility.

This is language that was considered in prior legislative sessions, but no action was taken because it would not accomplish its intended goals and could create significant hazards. The bill would allow individual providers to substitute their judgment (and point of view) above everything else, bypassing protocols, policies, departmental structure, or leadership.

Federal-level changes (actual and impending) have demonstrated that the “standard of care” is not as settled as perhaps was thought just a year or two ago. Case law informs us that the standard of care is not a local issue — it is based on national standards.

Examples of why it is now unclear what a court would say is the standard of care:

    • Significant personnel and policy changes at the Department of Health and Human Services (HHS)
    • A U.S. Supreme Court case pending that will decide whether Colorado’s ban on conversion therapy is constitutional (a law very similar to Connecticut’s law on conversion therapy)
    • An Increasing threat regarding providing gender-affirming care at all, and certainly to minors, from an executive order of the White House

Section 4 of SB 7 does not fill the gaps or threats created by these federal-level developments.

Instead, it creates a foothold for those who may place their own views and ideology above everything else, including patient choice.

We urge the legislature to reject Section 4.

State Emergency Medical Treatment and Labor Act EMTALA (Section 5-13)

Sections 5-13 of the bill would create a state Emergency Medical Treatment and Labor Act (EMTALA) law in parallel to the fully operational federal EMTALA law. This duplication is both unnecessary and problematic.

The federal EMTALA law, and its corresponding regulations and extensive guidance, have not been changed. There has been an unfortunate movement by states that have banned abortion or placed significant restrictions on abortion and other reproductive healthcare to deny care to patients, arguing that EMTALA cannot preempt their restrictive state laws.

None of that affects Connecticut. Connecticut laws on reproductive healthcare and other areas of care are not restrictive. We again urge the legislature not to pass unnecessary laws that could prompt hostile litigation and additional federal scrutiny. That approach would actually be harmful, not helpful, to healthcare access because it creates confusion, expends scarce healthcare dollars for administrative burden, and opens questions about the precise meaning of the state law versus the federal law.

However unlikely legally, to the extent a gap in EMTALA enforcement might result from federal preemption lawsuits in other states, we urge that the following language be used as a substitute for Sections 5-13 of SB 7:

(NEW) (a) It is declared to be the policy of the state of Connecticut that in cases in which there is a serious risk to a patient’s life or health, reproductive healthcare services related to complications of pregnancy, including, but not limited to, services related to miscarriage management and treatment for ectopic pregnancies, shall be part of the care required by emergency departments at licensed hospitals.
(b) The care described in subsection (a), shall be carried out in a manner consistent with the legal requirements of the federal Emergency Medical Treatment and Labor Act, 42 USC 1395dd, as amended from time to time, including without limitation regulations governing transfer, capabilities, and on-call professional staff.
(c) Nothing in this section shall be interpreted to require healthcare services that violate the accepted standard of care.

Health Care Cabinet Review of Stop-Loss Policies (Section 14)

We acknowledge that there are a number of provisions included in proposed bills that would impact the use of stop-loss policies in coordination with self-funded health plans. As large employers, hospitals and health systems use self-funded health plans to offer health insurance benefits to their employees. These self-funded plans are supported by stop-loss policies that protect the hospital from significant, unexpected costs related to covered services. These policies are very important to keeping health insurance costs affordable to both the hospital and employees.

We oppose action that would undermine the use of stop-loss policies and ask the committee to consider the potential increased costs related to additional legislative and regulatory action in this space.

Repeal of Favorable Presumption for Transfer of Ownership for Large Group Practice (Sections 15-18)

We oppose the repeal of current statutory language that requires the Office of Health Strategy (OHS) to apply a presumption in favor of approving the certificate of need (CON) application for a transfer of ownership of a large group practice when an offer was made in response to a request for proposal or similar voluntary offer for sale.

It is important to note that the presumption is limited to CON applications for a transfer of ownership that are in response to a large group practice seeking a new financial arrangement. The current statutory framework helps ensure that access to physicians is preserved. As physicians reach retirement age and it becomes more difficult to operate a financially viable group practice, physicians often look for new owners to help secure the continued viability of their practice, which in turn retains access to providers for their patients. Repealing the current statutory language could have a detrimental impact on healthcare access, and this change should be rejected.

Licensure of Healthcare Executives (Sections 28-32)

Sections 28-32 provide for the licensure of healthcare executives by the Department of Public Health (DPH).

CHA opposes these sections and notes that the entirety of hospital-related healthcare would come to a screeching halt upon implementation because the proposal imposes unworkable pre-conditions for hundreds if not thousands of disparate hospital-based professionals who currently serve in managerial roles with a level of oversight for clinical staff at every hospital in the state.

Sections 28-32 of the bill seek to create a wide-reaching licensure category overseen by DPH for “health care administrators” that would apply to every professional employed by a hospital who is “a nonclinical hospital manager with direct supervisory authority over clinical health care providers” if that “manager” is responsible for any of the following:

    • Hiring, scheduling, evaluating, and providing direct supervision of clinical healthcare providers
    • Monitoring hospital activities for compliance with state or federal regulatory requirements
    • Developing fiscal reports for clinical units of the hospital or the hospital as a whole

Those categories touch on almost every aspect of hospital operations. Implementation of the bill would disrupt hundreds if not thousands of positions at hospitals while we wait for DPH to create and validate a licensure system that includes a “test” of unknown specificity. This seems impracticable, if not impossible, given the breadth of distinct positions involved.

We should not enact a law that implies that all non-clinical professionals are less skilled than all clinical professionals —– even when the job involved is non-clinical in nature (e.g., compliance, monitoring and oversight, scheduling, or fiscal oversight, including reimbursement and the law of tax-exempt organizations). Yet that is the unmistakable conclusion one must draw from these sections.

A non-exhaustive list of positions that may have supervisory roles involving oversight that impacts clinical staff roles includes: epidemiologists, compliance officers, patient safety experts, engineers, attorneys, accountants, supply chain experts, master’s in public health, doctoral-level public health experts, doctoral-level researchers, master’s and doctoral-level HIT experts, population health experts, human resources professionals, quality experts, genetics experts, and healthcare finance administration experts.

Engineers know more about medical gas delivery systems than most respiratory therapists. Attorneys know more about the federal Conditions of Participation than most physicians. Accountants know more about financial sustainability than most nurses. Compliance officers know more about compliance than everybody else. The list is endless.

The Connecticut Public Health Regulations 19-13-D3(b)(1) already requires each hospital in Connecticut to be managed by a governing board. That board, among other legal duties, is required to appoint a “competent hospital administrator.” This person is the president or CEO of a hospital, who is required by the Public Health Code to have the following qualifications, at a minimum: either completion of a master’s or doctoral-level degree and at least three years of experience in hospital management or administration; or at least five years in hospital management or administration.

The Public Health Code goes on to indicate that the hospital administrator “shall be responsible to the governing board for the management and operation of the hospital and for the employment of personnel. The administrator may attend meetings of the governing board and meetings of the medical staff.” There are also myriad expectations for the role of hospital chief executive in both the CMS Conditions of Participation and The Joint Commission accreditation requirements.

Passage of these sections will, however, substantially increase operating costs, create a workforce crisis that will threaten to halt hospital operations statewide, and place significant added burdens on DPH to administer.

We urge you to reject Sections 28-32.

Thank you for your consideration of our position. For additional information, contact CHA Government Relations at (203) 294-7301.