October 7, 2009
WOMEN'S HEALTH-RELATED LEGISLATION
By: John Kasprak, Senior Attorney
You asked for recent legislation enacted in Connecticut on women's health-related issues.
Recent legislation affecting women's health has addressed cancer, in particular breast and cervical cancer; domestic violence; health equity; health insurance coverage; Medicaid eligibility; nurse-midwife services; sexual assault; trafficking in persons; ultrasounds; and umbilical cord blood.
BREAST AND CERVICAL CANCER
Breast and Cervical Cancer Programs, Comprehensive Cancer Plan (PA 06-195, §§ 5, 6, 52)
The act expands the breast cancer program's existing public education and outreach initiative to include publicizing the benefits of early detection and the recommended frequency of screening services, including clinical breast examinations and mammography.
The act requires the Department of Public Health (DPH) to provide clinical breast examinations, screening mammograms, and pap tests as recommended in the most current breast and cervical cancer screening guidelines of the U. S. Preventive Services Task Force, for the woman's age and medical history. It retains the 60-day pap test follow-up for sexual assault victims and the every six-month test for HIV-positive women.
The act requires DPH, within available appropriations, to establish a comprehensive state cancer plan. The plan must provide for (1) a statewide smoking cessation program that targets Medicaid recipients; (2) development and implementation of (a) a program that encourages people to get colorectal screenings and (b) a statewide clinical trials network; (3) identification of services for, and provision of services to, cancer survivors; and (4) identification and provision of services to organizations offering hospice or palliative care education.
Health Insurance Coverage for Breast Cancer Screening (PA 06-38)
The act changes when health insurance policies must provide coverage for a comprehensive ultrasound screening of a woman's entire breast or breasts. Under prior law, a policy had to provide coverage if a physician recommended the screening for a woman classified as category 2, 3, 4, or 5 on the American College of Radiology's Breast Imaging Reporting and Database System (BI-RADS) mammogram reading scale. The act instead requires coverage if (1) a mammogram shows heterogeneous or dense breast tissue based on BIRADS or (2) a woman is considered at an increased breast cancer risk because of family history, her own prior breast cancer history, positive genetic testing, or other indications determined by her physician or advanced practice registered nurse. By law coverage for breast ultrasound screening is subject to any policy provisions applicable to other covered services and is in addition to coverage required for mammograms.
The act applies to individual and group health insurance policies that cover (1) basic hospital expenses; (2) basic medical-surgical expenses; (3) major medical expenses; and (4) hospital or medical services, including those provided by HMOs. The act also applies to individual policies that cover (1) accidents only and (2) limited benefits.
Mammographic Breast Density Information (PA 09-41)
This act requires all mammography reports (i.e., written results of a mammogram) given to a patient on and after October 1, 2009 to include information about breast density based on BIRADS. When applicable, the report must include the following notice:
“If your mammogram demonstrates that you have dense breast tissue, which could hide small abnormalities, you might benefit from supplementary screening tests, which can include a breast ultrasound screening or a breast MRI examination, or both, depending on your individual risk factors. A report of your mammography results, which
contains information about your breast density, has been sent to your physician's office and you should contact your physician if you have any questions or concerns about this report.”
COMMISSION ON HEALTH EQUITY (PAs 08-171, 09-232)
PA 08-171 establishes a 32-member Commission on Health Equity within the Office of the Health Care Advocate for administrative purposes. The commission must work to (1) eliminate disparities in health status based on race, ethnicity, and linguistic ability and (2) improve the quality of health for all state residents.
The act repeals the Advisory Commission on Multicultural Health. That commission's mission was the elimination of disparities in health status among the state's cultural and ethnic communities and the overall improvement of state residents' health.
PA 09-232, (§ 9) adds eliminating gender-related health disparities to the Commission on Health Equity's charge and requires at least one of its eight public members to represent women. The top four legislative leaders each appoint two public members.
An Act Concerning Certain State Programs and the American Recovery and Reinvestment Act of 2009 (09-3)
This act makes an employee eligible for unemployment compensation if he or she voluntarily leaves a job to protect his or her child, regardless of where the child lives, from becoming or remaining a victim of family violence. It also makes the employee eligible for unemployment compensation if he or she quits to protect his or her spouse or parent from such violence. By law, the employee must make a reasonable effort to preserve the employment.
An Act Concerning the Protection of Family Violence Victims In Family Relations Matters (PA 08-67)
The act authorizes the Superior Court, in any family relations matter, to order that the testimony of a party or a child who is a subject of the proceeding be taken outside the physical presence of any other party if (1) a protective order, restraining order, or standing criminal restraining order has been issued on behalf of the party or child and (2) the other party is subject to the protective order or restraining order. The court may do so, within available resources, upon the motion of the attorney for any party.
An Act Concerning Domestic Violence (PA 07-123)
1. expands the circumstances under which a court may issue a standing criminal restraining order,
2. establishes release procedures for police officers to follow when someone is arrested for committing a family violence crime,
3. absolves police officers of liability in any civil action for personal or property injuries resulting from the release conditions,
4. makes people arrested for family violence guilty of a crime if they intentionally violate a nonfinancial condition of release set by a police officer, and
5. allows law enforcement officers to seize any electronic defense weapon that is in plain view or possessed by the arrested person at a family violence crime site.
For more detailed information on this issue, see OLR Report 2009-R-0349.
MEDICAID PRESUMPTIVE ELIGIBILITY FOR PREGNANT WOMEN (PA 06-68)
The act replaced the existing expedited Medicaid eligibility process for pregnant women with a presumptive eligibility process. Presumptive eligibility allows states to grant immediate health care coverage to these women without a full Medicaid eligibility determination. The act requires the Department of Social Services (DSS) commissioner to designate “qualified entities” to receive and determine presumptive eligibility in accordance with federal laws and regulations.
Under prior law, the commissioner performed expedited eligibility for pregnant women with income up to 250% of the federal poverty level ($35,000 for a family of two). In emergencies, this required DSS to process applications no later than 24 hours after receiving all required minimum information from the applicant. For nonemergency applicants, DSS could take up to five days. Within 30 days of applying, an applicant had to submit required information, including proof of identity, pregnancy, residency, citizenship status, and income.
NURSE-MIDWIVES (PA 06-195, §§ 36-39)
The act revises nurse-midwives' scope of practice and their relationship with physicians. It expands the scope to include all women's health care needs; previously their scope was limited to gynecology, pregnancy, childbirth, and post-partum care of mothers and newborns. It removes the restriction that nurse-midwives care only for essentially normal newborns and women and only under an obstetrician-gynecologist's (OB-GYN) direction (which does not require the physician to be present). And it specifies that (1) their scope includes family planning and (2) they practice in collaboration with qualified ob-gyns.
The act eliminates the requirement that the clinical relationship between a nurse-midwife and a physician be based on written protocols and guidelines that contain a list of the drugs, devices, and lab tests a nurse-midwife can prescribe, administer, or dispense. Instead, it requires them to practice within a health care system and have a clinical relationship with ob-gyns that provide for consultation, collaborative management, or referral as indicated by the patient's health status. It requires each nurse-midwife to provide (1) care consistent with standards the American College of Nurse Midwives establishes and (2) information about, or referral to, other providers or services, if the patient asks or requires care that is not in the nurse-midwife's scope of practice.
Emergency Contraception (PA 07-24)
This act establishes standard-of-care requirements for licensed health care facilities providing emergency treatment to female sexual assault victims. Each facility must promptly:
1. provide a victim with medically and factually accurate and objective information about emergency contraception;
2. inform her of emergency contraception's availability, use, and efficacy; and
3. provide her emergency contraception at the facility at her request, unless she is determined pregnant based on a U. S. Food and Drug Administration (FDA)-approved pregnancy test.
The act prohibits a facility from determining its protocol for standard-of-care compliance on any basis other than an FDA-approved pregnancy test.
The act allows a facility to contract with one or more independent providers to (1) ensure compliance at the facility with the standard-of-care requirements and (2) conduct forensic exams of victims at the facility. These exams must be conducted in accordance with the State of Connecticut Technical Guidelines for Health Care Response to Victims of Sexual Assault, published by the Commission on the Standardization of the Collection of Evidence in Sexual Assault Investigations.
Under the act, “emergency contraception” means one or more prescription drugs used separately or in combination and administered to or self-administered by a patient to prevent pregnancy. It must be administered within a medically recommended time frame after intercourse; dispensed for that purpose, consistent with professional standards of practice; and determined safe by the FDA.
Sexual Assault Forensic Examiners (2009 “Public Health Implementer,” SB 2051)
The act authorizes the Office of Victim Services (OVS) to establish a program to train sexual assault forensic examiners (SAFE) and make them available to adult and adolescent sexual assault victims at participating hospitals. It allows OVS to apply for and use funds from federal, state, and private sources for the program.
The act requires a SAFE to be a physician or a registered or advanced practice registered nurse. Under the act, a SAFE may provide immediate care and treatment to a sexual assault victim in a hospital and collect evidence. In doing so, the SAFE must follow (1) existing state sexual assault evidence collection protocols, (2) the hospital's policies and accreditation standards, and (3) the hospital's written agreement with OVS and DPH concerning its participation in the SAFE program.
The act creates a 12-member committee to advise OVS on establishing and implementing the program. The committee must make recommendations to OVS on:
1. recruiting participants and developing a specialized training course for them;
2. developing agreements between Judicial Branch, the Public Health Department (DPH), and participating hospitals on the program's scope of services and hospital standards for providing the services;
3. mechanisms for tracking individual cases;
4. using medically accepted best practices; and
5. developing quality assurance mechanisms.
The committee consists of:
1. the chief court administrator, chief state's attorney, victim advocate, and DPH commissioner, or their designees;
2. one representative each of the Public Safety Department's Scientific Services and State Police divisions, appointed by the public safety commissioner;
3. the presidents of the Connecticut Hospital Association and Connecticut College of Emergency Physicians, or their designees;
4. a person appointed by the directors of Connecticut Sexual Assault Crisis Services, Inc. ;
5. one appointee each from the Connecticut Chapter of the International Association of Forensic Nurses, the Connecticut Police Chiefs Association, and the Connecticut Emergency Nurses Association.
The committee terminates on June 30, 2012.
TRAFFICKING IN PERSONS COUNCIL (PA 07-107)
This act creates a 26-member Trafficking in Persons Council to:
1. consult with government and non-government organizations in developing recommendations to strengthen state and local efforts to prevent trafficking, protect and assist victims, and prosecute traffickers;
2. identify criteria for providing services to adult trafficking victims and their children; and
3. hold meetings to provide updates and progress reports.
The council can request information from state and local agencies to carry out its duties.
The act requires the council to meet at least three times per year, and annually report to the General Assembly on its activities and recommended legislation, beginning January 1, 2008.
The act places the council in the Permanent Commission on the Status of Women (PCSW) for administrative purposes only.
ULTRASOUNDS (PA 09-125)
The act prohibits anyone from performing an obstetrical ultrasound procedure unless it is (1) for a medical or diagnostic purpose and (2) ordered by a licensed health care provider acting within the scope of his or her practice.
UMBILICAL CORD BLOOD (PA 09-232, § 21)
The act requires doctors and other health care providers who provide pregnancy-related care for women during their third trimester to provide the women with timely, relevant, and appropriate information about umbilical cord blood and cord blood banks. The information must be sufficient to allow women to make informed choices about banking or donating their child's cord blood.