LEGISLATION; MEDICAL PERSONNEL;

MEDICAL PERSONNEL;

OLR Research Report


HEALTH PROFESSIONS

By:

John Kasprak, Senior Attorney

2003-R-0677

September 24, 2003

NOTICE TO READERS

TABLE OF CONTENTS

PA 03-240 requires the Department of Public Health (DPH) to license as an acupuncturist any applicant who (1) passed the National Commission for the Certification of Acupuncturists’ written examination by test or credentials review, (2) successfully completed the commission’s practical examination of point location skills, and (3) successfully completed the clean-needle technique course offered by the Council of Colleges of Acupuncture and Oriental Medicine.

The act takes effect October 1, 2003.

(see also “Occupational Licensing and Fees”, page 13).

PA 03-8 specifies that registered nurses can implement medical orders for a patient under the direction of an advanced practice registered nurse, as well as of a physician or dentist. This act takes effect October 1, 2003.

(see also “Student Health Care,” page 19).

Under PA 03-118 and beginning October 1, 2004, licensed or certified alcohol and drug counselors must complete a minimum 20 hours of continuing education annually. Continuing education must be in areas related to the individual’s practice and include educational offerings sponsored by a hospital or other licensed health care institution or courses offered by (1) regionally accredited higher education institutions or (2) individuals or organizations on a list of approved continuing education providers maintained by the Connecticut Certification Board, Inc.

A licensee must get a certificate of completion from the continuing education provider for all successfully completed continuing education hours. He must keep the certificate for at least three years following the license renewal date. The licensee must provide DPH with the certificate if requested.

Failure to meet the act’s continuing education requirements can result in disciplinary action, including the refusal, revocation, or suspension of a license.

DPH must waive the continuing education requirements for licensees applying for their first license renewal. It can waive the requirement for a specific period or give a licensee an extension to meet the requirements because he has a medical disability or illness. This act takes effect October 1, 2003.

PA 03-195 exempts from the law requiring licensure of Department of Correction (DOC) alcohol and drug counselors (substance abuse counselors) employees counseling DOC clients in order to satisfy the license and certification law’s supervised, paid work experience requirement. Prior law exempted only supervised student trainees and interns.

By law, substance abuse counselors must (1) complete an accredited master’s degree program or be certified clinical supervisors and (2) be certified by DPH. One of the criteria for DPH certification is completion of three years of supervised, paid work experience or acceptable unpaid internships. This act takes effect October 1, 2003.

DPH sets the maximum allowable rates for ambulance services. PA 03-46 removes a requirement that ambulance services file with DPH an audited financial statement or an accountant’s review report for the most recently completed fiscal year if they (1) do not apply for a rate increase in excess of the Medical Care Services Consumer Price Index for the prior year or (2) accept the maximum allowable rates in a voluntary statewide rate schedule established by DPH. This act takes effect October 1, 2003.

PA 03-87 establishes fees for certifying asbestos abatement workers and site supervisors, as well as for approval of asbestos-related training and refresher training programs. It also allows for Connecticut certification by endorsement for certain out-of-state workers and supervisors.

By law, asbestos abatement workers and site supervisors must complete a DPH-approved training program and be certified by DPH. The act establishes initial and annual renewal license fees of $ 25 for an asbestos worker certificate and $ 50 for a site supervisor certificate. It allows DPH to certify a person licensed or certified in another state with standards substantially similar to Connecticut’s and who is not facing any unresolved complaints or pending disciplinary actions.

The act establishes a $ 500 fee for each application or reapplication to DPH for approval of training programs for asbestos abatement workers, asbestos abatement site supervisors, and asbestos consultants. It also establishes a $ 250 application fee for DPH’s approval or reapproval of refresher training programs. This act takes effect October 1, 2003.

PA 03-203 (1) requires the Department of Mental Retardation (DMR) to conduct state criminal background checks on everyone applying for a job in a DMR program that provides direct care to clients, (2) allows DMR to require private providers that it licenses for direct services to conduct such checks on certain prospective employees, and (3) requires DMR to study issues involved with requiring national criminal history checks for DMR’s and private providers’ direct care staff.

PA 03-124 establishes a reduced annual license fee of $ 100 for dentists who practice for no fee and for at least 100 hours per year at a public health facility, but do not otherwise practice dentistry. The regular annual license fee for a practicing dentist is $ 450.

“Public health facilities” include community health centers, group homes, and schools and preschools operated by a local board of education or a Head Start program. They also include facilities such as hospitals, rest homes, health care facilities for the handicapped, nursing homes, residential care homes, mental health facilities, home health care agencies, homemaker-home health aide agencies, substance abuse treatment agencies, infirmaries operated by educational institutions, and intermediate care facilities for people with mental retardation. This act takes effect October 1, 2003.

PA 03-159 allows those licensed health care practitioners who can prescribe an opioid antagonist to prescribe, dispense, or administer it to a drug user in need of intervention without being civilly or criminally liable. Under the act, an “opioid antagonist” is naloxone hydrochloride or any other similarly acting and equally safe drug approved by the federal Food and Drug Administration for treating a drug overdose. By law, physicians and surgeons, physician assistants, dentists, advanced practice registered nurses, and podiatrists may prescribe them.

The act requires DPH to publish a report on the causes and rates of statewide fatal and nonfatal drug overdoses for at least the past three years. The report must include (1) trends in drug overdose death rates and (2) suggested data collection improvements. DPH must report by January 1, 2004 to the governor and the Public Health Committee.

PA 03-187 prohibits anyone from requiring an employee assistance professional or employee to disclose any information or records concerning or confirming the employee’s voluntary participation in an employee assistance program (EAP) sponsored or authorized by the employer. Existing law prohibits anyone from requiring state employees to disclose information or records about their participation in an EAP sponsored or authorized by the state.

The act defines an “EAP” as one sponsored or authorized by an employer to help employees identify and resolve personal concerns, including health, marital, family, financial, alcohol, drug, gambling, legal, emotional, stress, or other personal issues that may affect job performance. “Employee assistance professional” is a person required by job description or employment contract to provide services through an EAP.

The act prohibits an EAP, including its agents and representatives, from disclosing any information or records about an employee’s voluntary participation in a program without the person’s prior written consent, unless disclosure is necessary to prevent harm to the employee or others. Records of state employees, who already have this written consent protection, also are subject to disclosure when necessary to prevent harm under the act. This takes effect October 1, 2003.

PA 03-118 requires licensed funeral directors and embalmers to complete at least six hours of continuing education annually in order to renew their license. The continuing education must be in areas such as bereavement care; business management and administration; funeral-related religious customs and traditions; pre-need, cremation, and cemetery services; natural sciences; restorative arts and embalming; federal and state laws; counseling; funeral service merchandising; sanitation and infection control; organ donation; and hospice care.

Continuing education must be in courses offered or approved by the Academy of Professional Funeral Service Practice, educational offerings sponsored by a hospital or other licensed health care institution, or courses offered by a regionally accredited higher education institution.

A licensee must get a certificate of completion from the continuing education provider for all successfully completed continuing education hours. He must keep the certificate for at least three years following the license renewal date. The licensee must provide DPH with the certificate if requested.

Failure to meet the act’s continuing education requirements can result in disciplinary action against the licensee, including the refusal, revocation, or suspension of a license.

DPH must waive the continuing education requirements for licensees applying for their first license renewal. It can waive the requirement for a specific period or give a licensee an extension to meet the requirements because he has a medical disability or illness. This act takes effect October 1, 2003.

PA 03-32 allows currently practicing hairdressers and cosmeticians licensed in any U. S. commonwealth (e. g. , Puerto Rico) or territory (e. g. , Virgin Islands and Guam) to obtain a Connecticut license without taking the state’s licensing exam if the commonwealth or territory (1) has licensing requirements at least equivalent to Connecticut’s and (2) provides reciprocal privileges to Connecticut licensees. This act takes effect October 1, 2003.

PA 03-240 requires DPH to issue a hairdresser and cosmetician license to an applicant who (1) has at least two years of relevant professional experience; (2) is licensed by any other state, the District of Columbia, or a U. S. commonwealth or territory; and (3) is not facing any pending professional disciplinary action or unresolved professional complaints. The initial license application fee is $ 50; the annual renewal fee is $ 25. This takes effect October 1, 2003.

(see also “Occupational Licensing and Fees”, page 13).

PA 03-272 provides protections against discriminatory treatment of, or retaliation against, health care facility employees who submit a complaint, or initiate or cooperate in a government investigation or proceeding, related to conditions, care, or service issues at that facility. The act defines “discriminatory treatment” as discharge, demotion, suspension, or any other detrimental changes in employment terms or conditions, or the threat of any such actions. A “health care facility” is any facility or institution primarily providing services for the prevention, diagnosis, or treatment of human health conditions.

It requires a health care facility that discriminates or retaliates against an employee to reinstate him and reimburse him for lost wages, lost work benefits, and any reasonable legal costs he incurs. The act’s provisions and remedies are in addition to others available in statute or common law.

It also requires employers to notify employees of potential risks from a health emergency, disease cluster, or imminent hazard and recommended measures to reduce those risks.

Finally, the act requires DPH to adopt recommendations on minimum and maximum temperatures for areas in nursing homes and rest homes. They may be based on standards set by national public or private entities after research into appropriate temperature settings to ensure residents’ health and safety. DPH must make these recommendations available to nursing homes, rest homes, and the public, and post them on its website. This takes effect October 1, 2003.

PA 03-240 requires DPH to license as a hearing instrument specialist any applicant who (1) received a license to practice medicine in the state on or before October 4, 1971; (2) has a certification from the American Board of Otolaryngology originally issued on or before November 4, 1971; and (3) has been on the faculty of a Connecticut medical school for 10 years, with at least one year within the two years preceding the application. This takes effect October 1, 2003.

PA 03-3 (June Special Session) raises the initial licensing fee for a hearing instrument specialist from $ 100 to $ 200.

(see also “Occupational Licensing and Fees”, page 13).

Under PA 03-252 act, a homeopathic physician must be licensed to practice medicine and surgery and successfully complete at least 120 hours of post-graduate medical training in homeopathy in an approved institution or 120 hours of post-graduate medical training under the direct supervision of a licensed homeopathic physician. The latter training must include 30 hours of theory and 90 hours of clinical practice. The existing Homeopathic Medical Examining Board must approve the training done under a licensed homeopathic physician. Homeopathy is a system of medicine that attempts to stimulate the body to recover itself. It is based on the “law of similars” which looks for the one substance that, if administered in minute doses to a sick person, would produce similar symptoms in a healthy person if administered in large doses. This takes effect October 1, 2003.

PA 03-266 makes a number of changes to the laws governing hospital bed funds; hospital debt collection practices; and hospital services to, and payment for, uninsured patients. This act takes effect October 1, 2003.

PA 03-252 gives a person aggrieved by an order of a local health director three business days after receiving the order, instead of 48 hours after the order is issued, to appeal to DPH. This takes effect October 1, 2003.

PA 03-3 (June Special Session) reduces funding to local and district health departments as follows.

Department Type

Current Per Capita Funding

Proposed Per Capita Funding

Health District

• Town over 5,000 pop.

• Town under 5,000 pop.

$ 1. 99

$ 2. 32

$ 1. 66

$ 1. 94

Full-time Local Health Dept.

$ 1. 13

$ 0. 94

Part-time Local Health Dept.

$ 0. 59

$ 0. 49

This takes effect upon passage.

(see also “Public Health Emergencies,” page 18).

Both PAs 03-118 and 03-252 clarify that DPH has disciplinary authority over marital and family therapists who violate licensure laws and regulations. This act takes effect October 1, 2003.

PA 03-64 requires the administrative services commissioner to establish a job classification series for state-licensed marital and family therapists and professional counselors. This takes effect October 1, 2003.

PA 03-252 authorizes DPH, during October 2003, to issue a marital and family therapist license to any applicant who (1) earned a master’s degree in guidance and personnel services before 1992; (2) has current clinical membership in the American Association of Marital and Family Therapists originally issued before 1992; and (3) has provided counseling services for at least 10 years within the 15-year-period immediately before applying for licensure. This takes effect October 1, 2003.

PA 03-274 requires certain outpatient surgical facilities using specified levels of sedation or anesthesia to obtain a license from DPH. The licensure requirement applies to outpatient surgical facilities (1) established, operated, or maintained by an entity, individual, firm, partnership, corporation, limited liability company, or association, but not one operated by a hospital (hospital-based outpatient surgical facilities are already subject to DPH and Office of Health Care Access (OHCA) requirements) and (2) providing surgical services for human health conditions that include the use of moderate or deep sedation or analgesia or general anesthesia, as these levels are defined by the American Society of Anesthesiologists or other entity recognized by DPH.

The act provides initial exceptions from licensure based on certain OHCA determinations, but facilities initially receiving an exception must become licensed by March 30, 2007. No facility can be established between July 1, 2003, and July 1, 2004, unless it satisfies one of these exceptions.

The act specifies that outpatient surgical facilities that have received anesthesia accreditation continue to be subject to such accreditation requirements. The act’s provisions do not apply to licensed dentists and licensed outpatient clinics.

Also the act establishes an advisory committee to address various outpatient surgical facility issues.

PA 03-164 adds pharmacists working in nursing homes to those pharmacists who can establish collaborative agreements with physicians to manage patients’ drug therapy. Existing law allows physicians and hospital pharmacists to enter into collaborative agreements to manage the drug therapy of individuals receiving inpatient hospital services. The agreements must be based on written protocols and approved by the hospital. They can authorize a pharmacist to implement, modify, or discontinue a drug therapy the physician prescribes. The pharmacist can also order associated lab tests and administer drugs. All treatments must be based on a written protocol specific to each patient.

The act expands this by also allowing pharmacists employed by or under contract with a nursing home to enter into such collaboratives with physicians. The agreements must be based on written protocols for purposes of managing the drug therapy of individual patients in nursing homes and are subject to the nursing home’s approval. Each patient’s collaborative drug therapy management must be based on a written protocol specific to that patient and developed by the treating physician in consultation with the pharmacist. The protocol must be reviewed and approved by the nursing home’s active, organized medical staff.

Under the act, the nursing home that employs the pharmacist must determine that he is competent to participate in each collaborative agreement, just as hospitals must do now for hospital pharmacists participating in collaborative agreements with physicians. The nursing home, as a hospital must currently do, must file a copy of the criteria it uses to judge competence with the Pharmacy Commission.

The act specifies that records collected or maintained under the prescription drug error reporting program do not have to be disclosed for six months from the date the records were created. Also, these records are not subject to subpoena, discovery, or introduction into evidence in any judicial proceeding except as otherwise specifically provided by law. This takes effect October 1, 2003.

PA 03-166 establishes a revolving loan program to provide loans to federally qualified health centers (FQHCs) to establish pharmacies or contract pharmacy arrangements with community pharmacies or other pharmacy contractors. The Connecticut Health and Educational Facilities Authority (CHEFA) must administer the program and may capitalize it with up to $ 500,000. Loans cannot be made after June 30, 2008. CHEFA must submit an annual report to the Public Health Committee on the program, and the Department of Social Services (DSS) must assist FQHCs applying for loans and report on the program to various legislative committees.

FQHCs are community health centers that receive federal funding and meet specific federal criteria, including those governing the services they provide. Federal law allows certain entities, such as FQHCs, to purchase drugs at discounted prices by creating an in-house pharmacy or contracting with a retail pharmacy. This takes effect October 1, 2003.

For other acts affecting pharmacists and pharmacies, please see OLR’s “Acts Affecting Seniors”.

PA 03-209 adds “wellness care” to physical therapists’ scope of practice and allows them and their assistants to provide such care to anyone without symptoms of illness or injury, with or without a referral from a physician, podiatrist, natureopath, chiropractor, dentist, advanced practice nurse, or physician assistant. By law, except for this exception for wellness care, physical therapists and their assistants can only treat a patient referred by one of these licensed providers.

The act defines wellness care as services related to conditioning and fitness, strength training, workplace ergonomics, or injury prevention. It specifies that it does not prohibit or limit other licensed or certified providers from giving such care within the scope of their practice. The act states that it does not require an employer or insurer to pay for wellness care provided by a physical therapist.

The act also requires physical therapists to complete 20 hours annually of continuing education in order to renew their licenses. The continuing education must be in areas related to their practice. Therapists must obtain certificates of completion from continuing education providers and submit them to DPH at its request. They must keep the certificates for three years after the license renewal to which the certificates apply. DPH can discipline a therapist who fails to comply with these requirements.

The act (1) waives the continuing education requirement for an individual’s first license renewal and (2) allows DPH to waive the requirements for a specific period for a therapist who has a medical disability or illness or grant him more time to fulfill them.

PA 03-252 limits to 30 consecutive days the time a physician living and licensed in another state who is employed in this state by an individual to treat his ailment, injury, or disease can practice in the state without a Connecticut license.

It also allows a physician licensed in another state who is board-certified in pediatrics or family medicine to practice as a youth camp physician in Connecticut without a Connecticut license for up to nine weeks, even if the other state’s licensure standards are not equivalent to Connecticut’s.

PA 03-236 strengthens the governor’s, the DPH commissioner’s, and local health directors’ powers to respond to public health emergencies. It:

1. authorizes the governor, subject to disapproval by legislative leaders, to declare a public health emergency and order the DPH commissioner to take certain actions;

3. allows people to refuse vaccination for any reason, including on medical, religious, or conscientious grounds, and allows those who do so to be quarantined or isolated;

8. allows DPH to suspend temporarily license requirements for out-of-state health professionals who work in Connecticut during a public health emergency; and

PA 03-240 requires DPH to issue a radiographer’s license to any applicant who (1) has practiced as a radiographer for at least 10 years, one of which was no earlier than two years before the application date; (2) has a current registration as a radiation therapy technologist originally issued by the American Registry of Radiological Technologists before January 2, 1984; and (3) has a radiographer’s license from another state originally issued before January 2, 1984. DPH may not license an applicant who has been disciplined or is the subject of an unresolved complaint.

Pa 03-252 specifies that a licensed clinical social worker holding a professional educator certificate with a school social worker endorsement issued by the State Board of Education can meet continuing education requirements for social workers by completing continuing education activities required for the educator certificate. The number of continuing education hours for maintaining the educator certificate must equal that required for social worker continuing education over a one-year period. This takes effect October 1, 2003.