In anticipation of a healthcare workforce shortage resulting from the COVID-19 pandemic, on March 23rd, the Connecticut Department of Public Health (“DPH”) issued an Order allowing professionals licensed in other states to work in Connecticut for up to 60 days without obtaining a Connecticut license, certification, or registration. This Order applies to the following professions, among others: physicians, physician assistants, nurses, nurses’ aides, pharmacists, respiratory care practitioners, emergency medical services personnel, physical therapists, psychologists, marital and family therapists, social workers, and professional counselors.[i]
The Order requires that Connecticut hospitals and other facilities utilizing out-of-state providers to supplement their workforce take the following steps:
- Verify the provider’s credentials in the state in which he or she is licensed, certified, or registered;
- Ensure that the provider is in good standing in the state in which he or she is licensed; and
- Confirm that the provider has and maintains any required malpractice or other liability insurance in the form and amount that would be required if the provider were licensed in Connecticut.
In addition, out-of-state providers must maintain compliance with the reimbursement restrictions imposed by the Order. In particular, those enrolled in Medicaid or a fully insured commercial plan must accept the Medicaid or in-network reimbursement as payment in full for their services. For all other patients, prior to providing services, the provider must determine whether the patient is covered by a health plan that provides coverage for the proposed services. If the provider receives payment under such a plan, the provider is prohibited from billing the patient for any additional charges. If payment is not available under such plan or the patient is uninsured, the provider must accept the amount that Medicare reimburses as payment in full for their services[ii] and must offer financial assistance to the patient if otherwise required to do so under state or federal law. And, finally, these out-of-state providers may not prescribe controlled substances. (This prohibition is being considered by the State).
In addition to state regulation, Medicare and Medicaid reimbursement is also subject to federal governance. Fortunately, CMS recently “Temporarily waive[d] requirements that out-of-state providers be licensed in the state where they are providing services when they are licensed in another state”. CMS Blanket Waiver. In order to ensure proper reimbursement, we recommend that any facility planning to utilize out-of-state providers first notify the CMS Regional Office.
[i] The requirements for licensure, certification or registration of professions subject to the following chapters of the Connecticut General Statutes are temporarily suspended: 368d (Emergency Medical Services), 370 (Medicine and Surgery), 376 (Physical Therapists), 378 (Nursing), 378a (Nurse’s Aide), 381a (Respiratory Care Practitioners), 383 (Psychologists), 383a (Marital and Family Therapists), 383b (Clinical Social Workers and Master Social Workers), 383c (Professional Counselors), 384d (Emergency Medical Services Personnel), and 400j (Pharmacy). These providers must practice only within their scope of practice, as defined by Connecticut law.
[ii] If the provider determines that the patient is uninsured or otherwise unable to pay for such services, the provider must offer financial assistance if required to do so under state or federal law.
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