LEGISLATION; JUVENILES; HEALTH (GENERAL);
JUVENILES - LEGISLATION;
May 9, 2003
CHILDREN'S HEALTH ISSUES IN 2003 LEGISLATIVE SESSION
By: Saul Spigel, Chief Analyst
You asked for a brief summary of the children’s health issues before the General Assembly this year.
This session, the General Assembly is considering many proposals affecting children’s health. They include (1) increasing the costs of participating in the HUSKY B program, (2) reinstating some HUSKY benefits cut earlier in the year, (3) requiring private insurance coverage for certain dental services associated with facial surgery and for medically necessary foods and formulas to treat cystic fibrosis, (4) broadening the scope of medication administration in schools, (5) restricting the availability of junk foods in schools while requiring more time for physical activity, (6) improving air quality in schools, (7) restricting teens’ access to indoor tanning salons, and (8) expanding the mandate for child restraint seats in cars and trucks.
The legislation requiring insurers to cover dental services associated with facial surgery has been enacted as PA 03-37; all the other bills discussed in this report are still being considered by the legislature.
The governor’s budget called for increasing premiums for participating in HUSKY B (the non-Medicaid portion of the HUSKY program of children’s health insurance). He proposed imposing monthly premiums of $ 30 per child, up to $ 50 for a household earning up to 235% of the federal poverty level ($ 40,067 for a family of four) and increasing, to $ 50 per child and $ 75 per household, the premium for families with incomes up to 300% of poverty ($ 51,150). This latter group currently pays $ 30 per child and $ 50 per household. The governor also proposed suspending further enrollment in HUSKY B and redesigning its benefits to more closely resemble commercial insurance packages.
The biennial budget reported by the Appropriations Committee (sHB 6548) does not incorporate the governor’s HUSKY proposals.
PA 03-02 eliminated the continuous eligibility policy for HUSKY A and B. Under this policy, a child who is determined to be eligible for benefits remains eligible for twelve months, even if there is a change in status that would otherwise make the child ineligible. This means that families must now report whenever a change occurs in their income or other eligibility factors, and the Department of Social Services (DSS) must determine whether they remain eligible for services. This elimination is being challenged in court, and a Human Services Committee bill (sHB 5474) restores the continuous eligibility policy.
Another Human Services bill, SB 1010, indefinitely continues eligibility for solely state-funded public assistance, including HUSKY B, for legal immigrants barred from federally funded programs. Current law generally prohibits acceptance of new applicants after June 30, 2003. The bill also removes the current six-month residency requirement for new applicants who did not become eligible for the programs before July 1, 1997.
DSS is in the process of “carving out” the administration of dental services in the state’s Medicaid program (HUSKY A) from the administration of other Medicaid medical services. A Human Services Committee bill, sSB 521, requires DSS, before implementing this plan, to submit a copy of it to the Public Health, Human Services, and Appropriations committees. It requires the committees to hold a hearing on the plan and within 30 days to advise the commissioner of their approval, denial, plan modifications, or plan revisions. And it contains a procedure for reconciling differences among the committees.
OTHER INSURANCE COVERAGE
SB 1, reported by the Insurance Committee, requires certain individual and group health insurance policies to cover medically necessary orthodontic processes and appliances for treatment of craniofacial disorders for children up to age 18. A craniofacial team recognized by the American Cleft-Palate-Craniofacial Association must prescribe these processes and appliances. Coverage is not required for cosmetic surgery. This bill has passed both chambers (PA 03-37).
Another Insurance Committee bill, sSB 41, extends coverage under certain individual and group health insurance policies for certain food preparations and formulas to treat cystic fibrosis by adding it to the definition of “inherited metabolic disease. ” The bill also requires policies to cover these food preparations and formulas used to treat all such diseases the same way they cover outpatient prescription drugs.
MEDICATION AND HEALTH CARE IN SCHOOLS
Two bills this year address issues involving the administration of medication in schools. sHB 6689, from the Education Committee:
1. requires school boards to let diabetic students test their own glucose levels in school if a physician's written order states the student needs to self-test and is capable of doing so;
2. expands the types of school personnel who can administer medication to students under certain circumstances;
3. specifies the school personnel who can recommend medical evaluations for students, requires school board policies to address procedures for recommending such evaluations, and clarifies and expands the provisions of the law requiring school boards to adopt policies prohibiting school personnel from recommending psychotropic drugs for a child; and
4. requires school boards to honor advanced practice registered nurses’ orders restricting a student’s physical activity in school.
HB 5931, from the Public Health Committee, allows a school paraprofessional to administer epinephrine in automatic, prefilled cartridge injectors (commonly called “EpiPens”) if a parent or guardian authorizes this in writing, the student has a prescription for the medication, and the paraprofessional administers it under the general supervision of the school nurse. It applies to school grounds, school buses, and school trips.
And sSB 1149, also from the Public Health Committee, prohibits a coach from giving, selling, delivering, exchanging, or in any way providing dietary supplements or related literature to a student enrolled in a public school where he works or any school under the jurisdiction of the school board that employs him. A coach who violates this prohibition is subject to a fine of up to $ 500, six months in prison, or both.
Several bills were introduced this year to address what many experts say is an alarming increase in childhood obesity. Two are still working their way through the legislature. sHB 6664 (Education Committee) prohibits school boards from allowing certain foods and beverages to be sold to students on school premises until after regular school hours. These products are chewing gum and candy; soda water; water ice; coffee and tea; juice products containing less than 10% full-strength juice by volume; and any item containing more than eight grams of fat, except nuts, peanut butter, cheese, ice cream, butter, margarine, and salad dressing.
The bill also requires school boards to ensure that each child (1) in a district has an opportunity for a lunch break of at least 20 minutes every day and (2) in grades kindergarten through five has an opportunity for physical activity for at least 20 minutes per day or 100 minutes per week. It allows a special education student’s planning and placement team to develop a different recess schedule for that student, if appropriate.
sSB 1074, from the Children’s Committee, requires the Education Department to establish school nutrition pilot programs in three districts that agree to limit the sales of candy, soda, high fat, and other food items, similar to those in sHB 6664. The programs are to operate during the 2003-04 school year, and a report on them must be submitted to legislative committees by October 1, 2004.
The bill also creates a task force to adopt a state nutrition policy and assist in reducing and preventing obesity and non-insulin-using (Type II) diabetes in children. The task force must report to the Children's, Education, and Public Health committees by January 1, 2005.
INDOOR AIR QUALITY IN SCHOOLS
Two bills this year address the air students breathe in schools. sHB 6503, from the Environment Committee, requires that, by January 1, 2008, and every five years thereafter, school boards inspect and evaluate the indoor air quality of school buildings built, renovated, or replaced after January 1, 2003. It requires school boards to create indoor environmental quality committees for each school building. Such committees must use Tools for Schools to increase staff and student awareness of indoor environmental factors affecting their health, such as air quality, water quality, and the presence of radon.
sHB 6426 (Education Committee) makes several changes to the school construction and school board statutes to improve and protect the indoor air quality in Connecticut schools. These changes include requiring districts to: (1) conduct Phase I environmental site assessments of proposed school construction sites; (2) operate and maintain heating, ventilating, and air conditioning systems in accordance with prevailing standards; and (3) implement a preventative program, such as the U. S. Environmental Protection Agency’s (EPA) Tools for Schools.
A Public Health Committee bill, sSB 833, prohibits a tanning facility operator from knowingly allowing a person under age 16 to use a tanning device and subjects operators who violate this prohibition to a fine of up to $ 100.
CHILD CAR SEATS
A Transportation Committee bill (SB 704) requires children from age four to age eight who weigh less than 80 pounds to be secured while riding in a motor vehicle in a booster seat approved by the Department of Motor Vehicles anchored by a seat safety belt that includes a shoulder belt. A child under age eight and weighing 80 pounds or more must be
transported in either an approved booster seat anchored by a safety belt or in a safety belt alone. By law, children under age four already must be transported in an approved child restraint system. Under the bill, a person may restrain a child in a booster seat only when the vehicle's seat safety belt equipment includes a shoulder belt.