Cristin McCarthy Vahey

Over the course of the next few weeks, I will share information about some of the legislation we passed this session, starting today with Public Health.

Public Health continues to make the news with heat advisories, measles cases reported in 38 states and the District of Columbia, and concerns about hantavirus and now ebola. We continue to learn more about outbreaks, how they are being handled, and what this means for us in the United States and even closer to home here in Connecticut. Often the work of public health is invisible, so I’d like to share more about what we passed this year in the legislature.

This year the Public Health Committee successfully passed three priority bills, one on vaccines, a second on the state’s certificate of need process, and the third to limit private equity control of hospital main campuses. We passed many other bills on a variety of topics. Below is more detailed information on these three priority bills, with a little more detail on the vaccine legislation so that you have accurate information about what the bill does and does not do.

The law does NOT create any new vaccine mandates. Here is what the law does:

• Requires the Department of Public Health (DPH) Commissioner to establish the standards of care for immunization for both adults and children, taking into consideration Advisory Committee for Immunization Practices of the Center for Disease Control (ACIP / CDC), American Academy of Pediatrics, American College of Obstetrics & Gynecology and American Academy of Family Physicians. This is not a list of mandated vaccines, but recommendations.
• Allows the DPH to purchase vaccines included in the CT standard of care rather than just those recommended by the ACIP. Currently, Connecticut may purchase vaccines for the Connecticut Vaccine Program from the CDC only IF they are recommended by ACIP.
• Allows the DPH Commissioner to adopt regulations for nursing homes regarding respiratory viral disease. Currently, nursing home residency requires the pneumonia and flu vaccines, with both medical and religious exemptions available.
• The mandatory School Vaccination schedule requires the Commissioner to go through the Regulations Review Committee process. No temporary permissions are available to change these requirements, and there are no new vaccines mandated. Medical exemptions to the school vaccine schedule are permitted if granted by a licensed medical provider, but religious exemptions are not. Religious exemptions were eliminated in 2021.
• During a declared public health emergency, the Governor may allow the Commissioner to issue a standing order to allow medical interventions, including vaccines. The bill has specific language that says this "does not require any individual to receive or utilize such medical intervention."
• Establishes an adult vaccine program for uninsured and underinsured adults through free clinics or municipal health authorities. Again, there is no mandate, but increased access for adults to afford the vaccinations they choose.
• Requires both group and individual insurance policies cover vaccines recommended within the DPH standard of care, and not simply the CDC / ACIP standard of care.
• Continues to allow pharmacists to prescribe and administer vaccines to adults age 18 and older and to youth 12-17 with parental permission. Clarifies that they may administer all vaccinations within the DPH standards of care.
• Provides that the state Religious Freedom Restoration Act does not apply to the school immunization requirements for public and private schools, including higher education, and family and group childcare centers. This effectively retains the elimination of the religious exemption passed by the legislature in 2021.

After three years of active negotiations with the Connecticut Hospital Association, the Governor’s office, the Attorney General, the Office of Health Strategy, and the Department of Public Health, we were able to reach a compromise and pass a bill this year that:

• Creates a new Certificate of Need (CON) program overseen by a panel under the Department of Public Health
• Streamlines the Certificate of Need review process for health care facility determinations
• Requires the creation of an expedited review process for certain applicants
• Specifies that change of ownership control of more than 25% of an entity’s assets, equity or voting share requires a CON
• Requires notice of certain large group practice transactions, allowing the state to collect data on who is purchasing these practices

This bill, referred to as the private equity bill, was also one negotiated for years and had previously failed to gain passage. It is an important step forward, though we expect we will continue to discuss private equity’s role in healthcare in future sessions. The bill:

• Prohibits hospital main campuses from entering into a sale-leaseback agreement like those that helped bankrupt the Prospect hospitals
• Requires hospitals to attest that private equity does not have a controlling interest or governing control of a hospital’s main campus
• Assures that hospital provider’s clinical judgment and clinical decisions are not directed by private equity

As always, please feel free to reach out directly with your ideas, questions, or concerns. You can reach me by phone at (860) 240-8585 or (203) 522-3037.

Take care,

Cristin McCarthy Vahey