File No. 400

House of Representatives, April 3, 2008

The Committee on Public Health reported through REP. SAYERS, P. of the 60th Dist., Chairperson of the Committee on the part of the House, that the substitute bill ought to pass.

AN ACT CONCERNING REVISIONS TO STATUTES PERTAINING TO THE DEPARTMENT OF PUBLIC HEALTH.

Be it enacted by the Senate and House of Representatives in General Assembly convened:

Section 1. Section 7-48a of the 2008 supplement to the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2008):

On and after January 1, 2002, each birth certificate shall be filed with the name of the birth mother recorded. [The] If the birth is subject to a gestational agreement, the Department of Public Health shall create a replacement certificate in accordance with an order from a court of competent jurisdiction not later than forty-five days after receipt of such order or forty-five days after the birth of the child, whichever is later. Such replacement certificate shall include all information required to be included in a certificate of birth of this state as of the date of the birth. When a certified copy of such certificate of birth is requested by an eligible party, as provided in section 7-51, a copy of the replacement certificate shall be provided. The department shall seal the original certificate of birth in accordance with the provisions of subsection (c) of section 19a-42. Immediately after a replacement certificate has been prepared, the department shall transmit an exact copy of such certificate to the registrar of vital statistics of the town of birth and to any other registrar as the department deems appropriate. The town shall proceed in accordance with the provisions of section 19a-42.

Sec. 2. Subsection (a) of section 7-72 of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2008):

(a) Each sexton having charge of any burial place shall, during the first week of each month, return a list of all interments, disinterments and removals made by such sexton during the preceding month [next preceding, with the dates thereof,] to the registrar of the town. [and also, within said time, file with the registrar permits received by such sexton by virtue of which a body has been brought into the town from another town or state for burial, with such sexton's endorsement thereon showing when and in what cemeteries the interments took place.] The list shall be in a format prescribed by the Commissioner of Public Health. The sexton shall also file during the first week of each month, completed burial permits received by such sexton in the preceding month. The registrar shall inscribe upon each certificate and each permit [so] received the date of its reception and record such lists and permits in [books to be furnished by the Department of Public Health] a log. When a permit has been given for the disinterment and removal of a body, the registrar shall make a memorandum on the registrar's records of such removal and the place to which such body was removed.

Sec. 3. Subsection (b) of section 19a-215 of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2008):

(b) [Each] A health care provider shall report [in writing or by telephone] each case occurring in [his] such provider's practice, of any disease on the commissioner's list of reportable diseases and laboratory findings to the director of health of the town, city or borough in which such case resides and to the Department of Public Health,[ within] no later than twelve hours after [his] such provider's recognition of the disease. Such reports shall be in writing, by telephone or in an electronic format approved by the commissioner. Such reports of disease shall be confidential and not open to public inspection except as provided in subsection (d) of this section.

Sec. 4. Section 19a-209c of the 2008 supplement to the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2008):

(a) Any person who applies to the Department of Public Health for [authorization relating to] an exception to the separating distance requirements for the repair or new construction of a subsurface sewage disposal system [that involves the waiver of the proximity requirement of a subsurface sewage disposal system in relation to a private residential] relative to a water supply well, shall notify all owners of [abutting] properties with water supply wells affected by the exception request of such application by certified mail, return receipt requested. The notice shall include a copy of the application. [A decision by the Department of Public Health concerning such application shall constitute a final decision for purposes of section 4-183.]

(b) A decision approving such an application shall not be an affirmative defense for the owner of the subsurface sewage disposal system to any claim of liability for damages relating to contamination caused by the proximity of a subsurface sewage disposal system to a [private residential] water supply well.

Sec. 5. Subsection (a) of section 19a-36 of the 2008 supplement to the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2008):

(a) The Commissioner of Public Health shall establish a Public Health Code and, from time to time, amend the same. The Public Health Code may provide for the preservation and improvement of the public health.

(1) Said code may include regulations pertaining to retail food establishments, including, but not limited to, food service establishments, catering food service establishments and itinerant food vending establishments and the permitting required from local health departments or districts to operate said establishments.

(2) Drainage and toilet systems to be installed in any house or building arranged or designed for human habitation, or field sanitation provided for agricultural workers or migratory farm laborers, shall conform to minimum requirements prescribed in said code.

(3) Said code may include regulations requiring toilets and handwashing facilities in large stores, as defined in such regulations, in shopping centers and in places dispensing food or drink for consumption on the premises, for the use of patrons of such establishments, except that the provisions of such regulations shall not apply to such establishments constructed or altered pursuant to plans and specifications approved or building permits issued prior to October 1, 1977.

(4) The provisions of such regulations (A) with respect to the requirement of employing a qualified food operator and any reporting requirements relative to such operator, shall not apply to an owner or operator of a soup kitchen who relies exclusively on services provided by volunteers, and (B) shall not prohibit the sale of food at a noncommercial function such as an educational, religious, political or charitable organization's bake sale or pot luck supper provided the seller maintains such food under the temperature, pH level and water activity level conditions that will inhibit the rapid and progressive growth of infectious or toxigenic microorganisms. For the purposes of this section, a "noncommercial function" means a function where food is sold by a person not regularly engaged in the business of selling such food.

(5) The provisions of such regulations with respect to qualified food operators shall require that the contents of the test administered to qualified food operators include elements testing the qualified food operator's knowledge of food allergies.

(6) Each regulation adopted by the Commissioner of Public Health shall state the date on which it shall take effect, and a copy of the regulation, signed by the Commissioner of Public Health, shall be filed in the office of the Secretary of the State and a copy sent by said commissioner to each director of health, and such regulation shall be published in such manner as the Commissioner of Public Health may determine.

(7) Any person who violates any provision of the Public Health Code shall be fined not more than one hundred dollars or imprisoned not more than three months, or both.

Sec. 6. Section 19a-494a of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2008):

If the Commissioner of Public Health finds that the health, safety or welfare of any patient or patients served by an institution, as defined in [subsections (d) and (e) of] section 19a-490 of the 2008 supplement to the general statutes, imperatively requires emergency action and [he] incorporates a finding to that effect in [his] the order, [he] the commissioner may issue a summary order to the holder of a license issued pursuant to section 19a-493 pending completion of any proceedings conducted pursuant to section 19a-494. These proceedings shall be promptly instituted and determined. The orders which the commissioner may issue shall include, but not be limited to: (1) Revoking or suspending the license; (2) prohibiting such institution from contracting with new patients or terminating its relationship with current patients; (3) limiting the license of such institution in any respect, including reducing the patient capacity or services which may be provided by such institution; and (4) compelling compliance with the applicable statutes or regulations of the department.

Sec. 7. Section 19a-70 of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2008):

If the Department of Public Health finds that there is an epidemic of any disease within the state and that antitoxin or other biologic product is in short supply, the commissioner shall notify the Governor, who may proclaim that an emergency exists. On such declaration, the Governor shall appoint an advisory committee, consisting of the Commissioner of Public Health and such five other persons as the Governor deems advisable. The committee shall recommend to the Department of Public Health the priority of the supply, distribution and use of such biologic products in the interest of the health, welfare and safety of the people of the state. The Department of Public Health, after receiving the recommendations of the committee, is authorized to make regulations determining the priority of supply, distribution and use of such biologic product. Violation of any such regulation on the part of any physician or pharmacist shall be cause for the revocation, suspension or annulment of a license or certificate of registration or other disciplinary action in accordance with sections 20-13a to [20-13i] 20-13e, inclusive, as amended by this act, or section 20-45, 20-576 or 20-579.

Sec. 8. Section 20-13a of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2008):

As used in sections 20-13a to [20-13i] 20-13e, inclusive, as amended by this act, unless the context otherwise requires:

(1) "Board" means the Connecticut Medical Examining Board, as provided for in section 20-8a of the 2008 supplement to the general statutes;

(2) "Commissioner" means the Commissioner of Public Health;

(3) "County society" means a county medical association affiliated with the Connecticut State Medical Society;

(4) "Department" means the Department of Public Health;

(5) "License" means any license or permit issued pursuant to section 20-10, 20-11a or 20-12;

(6) "Physician" means a person holding a license issued pursuant to this chapter, except a homeopathic physician; and

(7) "State society" means the Connecticut State Medical Society or the Connecticut Osteopathic Medical Society.

Sec. 9. Section 20-13b of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2008):

The Commissioner of Public Health, with advice and assistance from the board, shall establish guidelines as may be necessary to carry out the provisions of sections 20-13a to [20-13i] 20-13e, inclusive, as amended by this act. Not later than January 1, 2006, such guidelines shall include, but need not be limited to: (1) Guidelines for screening complaints received to determine which complaints will be investigated; (2) guidelines to provide a basis for prioritizing the order in which complaints will be investigated; (3) a system for conducting investigations to ensure prompt action when it appears necessary; (4) guidelines to determine when an investigation should be broadened beyond the scope of the initial complaint to include, but not be limited to, sampling patient records to identify patterns of care, reviewing office practices and procedures, and reviewing performance and discharge data from hospitals; and (5) guidelines to protect and ensure the confidentiality of patient and provider identifiable information when an investigation is broadened beyond the scope of the initial complaint. Such guidelines shall not be considered regulations, as defined in section 4-166.

Sec. 10. Section 22-6r of the 2008 supplement to the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage):

(a) For purposes of this section:

(1) "Farmers' market" means a cooperative or nonprofit enterprise or association that consistently occupies a given site throughout the season, which operates principally as a common marketplace for a group of farmers, at least two of whom are selling Connecticut-grown fresh produce, to sell Connecticut-grown farm products [directly to consumers and to sell fresh produce to food service establishments, as defined in section 19-13-B42 of the regulations of Connecticut state agencies,] in conformance with the applicable regulations of Connecticut state agencies and where the farm products sold are produced by the participating farmers with the sole intent and purpose of generating a portion of household income;

(2) "Fresh produce" means fruits and vegetables that have not been processed in any manner;

(3) "Certified farmers' market" means a farmers' market that is authorized by the commissioner to operate;

(4) "Farmer's kiosk" means a structure or area located within a certified farmers' market used by a farm business to conduct sales of Connecticut-grown farm products;

(5) "Connecticut-grown" means produce and other farm products that have a traceable point of origin within Connecticut;

(6) "Farm" has the meaning ascribed to it in subsection (q) of section 1-1;

(7) "Farm products" means any fresh fruits, vegetables, mushrooms, nuts, shell eggs, honey or other bee products, maple syrup or maple sugar, flowers, nursery stock and other horticultural commodities, livestock food products, including meat, milk, cheese and other dairy products, food products of "aquaculture", as defined in subsection (q) of section 1-1, including fish, oysters, clams, mussels and other molluscan shellfish taken from the waters of the state or tidal wetlands, products from any tree, vine or plant and their flowers, or any of the products listed in this subdivision that have been processed by the participating farmer, including, but not limited to, baked goods made with farm products.

(b) A farmer's kiosk at a certified farmers' market shall be considered an extension of the farmer's business and regulations of Connecticut state agencies relating to the sale of farm products on a farm shall govern the sale of farm products at a farmer's kiosk.

(c) [(1)] A farmer offering farm products for sale at a certified farmers' market shall obtain and maintain any license required to sell such products.

[(2)] (d) A food service establishment, as defined in section 19-13-B42 of the regulations of Connecticut state agencies, [shall request and obtain] may purchase farm products that have been produced and are sold in conformance with the applicable regulations of Connecticut state agencies at a farmers' market, provided such establishment requests and obtains an invoice from the farmer or person selling [fresh produce] farm products. The farmer or person selling [fresh produce] farm products shall provide to the food service establishment an invoice that indicates the source and date of purchase of the [fresh produce] farm products at the time of the sale.

[(d)] (e) Section 22-6g or this section shall not supersede the provisions of any state or local health and safety laws, regulations or ordinances.

Sec. 11. Section 19a-492d of the 2008 supplement to the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2008):

On and after October 1, 2007, a nurse who is employed by an agency licensed by the Department of Public Health as a home health care agency or a homemaker-home health aide agency may administer influenza and pneumococcal polysaccharide vaccines to [patients] persons in their homes, after an assessment for contraindications, without a physician's order in accordance with a physician-approved agency policy that includes an anaphylaxis protocol. In the event of an adverse reaction to the vaccine, such nurse may also administer epinephrine or other anaphylaxis medication without a physician's order in accordance with the physician-approved agency policy. For purposes of this section, "nurse" means an advanced practice registered nurse, registered nurse or practical nurse licensed under chapter 378.

Sec. 12. Subsection (c) of section 19a-7h of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2008):

(c) Except as specified in subsections (a) and (b) of this section, all personal information including vaccination status and dates of vaccination of individuals shall be confidential pursuant to section 19a-25 and shall not be further disclosed without the authorization of the child or the child's legal guardian. [After consultation with the state Childhood Immunization Advisory Council established under section 19a-7g, the] The commissioner shall adopt regulations, pursuant to chapter 54, to specify how information on vaccinations or exemptions from vaccination will be reported in a timely manner to the registry, how information on the registry will be made available to health care providers, parents or guardians, and directors of health, how parents or guardians may decline their child's enrollment in the registry, and to otherwise implement the provisions of this section.

Sec. 13. (NEW) (Effective October 1, 2008) (a) As used in this section:

(1) "Commissioner" means the Commissioner of Public Health;

(2) "Contact hour" means a minimum of fifty minutes of continuing education activity;

(3) "Department" means the Department of Public Health;

(4) "Licensee" means any person who receives a license from the department pursuant to chapter 373 of the general statutes; and

(5) "Registration period" means the one-year period for which a license renewed in accordance with section 19a-88 of the 2008 supplement to the general statutes is current and valid.

(b) Except as otherwise provided in this section, for registration periods beginning on and after October 1, 2009, a licensee applying for license renewal shall earn a minimum of fifteen contact hours of continuing education within the preceding registration period. Such continuing education shall (1) be directly related to the practice of natureopathy; and (2) reflect the professional needs of the licensee in order to meet the health care needs of the public. Qualifying continuing education activities include, but are not limited to, courses, including on-line courses, offered or approved by the Association of Accredited Naturopathic Medical Colleges, regionally accredited institutions of higher education or a state or local health department.

(c) Each licensee applying for license renewal pursuant to section 19a-88 of the 2008 supplement to the general statutes shall sign a statement attesting that he or she has satisfied the continuing education requirements of subsection (b) of this section on a form prescribed by the department. Each licensee shall retain records of attendance or certificates of completion that demonstrate compliance with the continuing education requirements of said subsection (b) for a minimum of five years following the year in which the continuing education activities were completed and shall submit such records to the department for inspection not later than forty-five days after a request by the department for such records.

(d) A licensee applying for the first time for license renewal pursuant to section 19a-88 of the 2008 supplement to the general statutes is exempt from the continuing education requirements of this section.

(e) In individual cases involving medical disability or illness, the commissioner may, in the commissioner's discretion, grant a waiver of the continuing education requirements or an extension of time within which to fulfill the continuing education requirements of this section to any licensee, provided the licensee submits to the department an application for waiver or extension of time on a form prescribed by the department, along with a certification by a licensed physician of the disability or illness and such other documentation as may be required by the commissioner. The commissioner may grant a waiver or extension for a period not to exceed one registration period, except that the commissioner may grant additional waivers or extensions if the medical disability or illness upon which a waiver or extension is granted continues beyond the period of the waiver or extension and the licensee applies for an additional waiver or extension.

(f) Any licensee whose license has become void pursuant to section 19a-88 of the 2008 supplement to the general statutes and who applies to the department for reinstatement of such license pursuant to section 19a-14 of the general statutes shall submit evidence documenting successful completion of fifteen contact hours of continuing education within the one-year period immediately preceding application for reinstatement.

Sec. 14. Subsection (a) of section 20-12d of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2008):

(a) A physician assistant who has complied with the provisions of sections 20-12b of the 2008 supplement to the general statutes and 20-12c of the 2008 supplement to the general statutes may perform medical functions delegated by a supervising physician when: (1) The supervising physician is satisfied as to the ability and competency of the physician assistant; (2) such delegation is consistent with the health and welfare of the patient and in keeping with sound medical practice; and (3) such functions are performed under the oversight, control and direction of the supervising physician. The functions that may be performed under such delegation are those that are within the scope of the supervising physician's license, within the scope of such physician's competence as evidenced by such physician's postgraduate education, training and experience and within the normal scope of such physician's actual practice. Delegated functions shall be implemented in accordance with written protocols established by the supervising physician. All orders written by physician assistants shall be followed by the signature of the physician assistant and the printed name of the supervising physician. A physician assistant may, as delegated by the supervising physician within the scope of such physician's license, (A) prescribe and administer drugs, including controlled substances in schedule IV or V in all settings, (B) renew prescriptions for controlled substances in schedule II, III, IV or V in all settings, [and] (C) prescribe and administer controlled substances in schedule II or III in all settings, provided in all cases where the physician assistant prescribes a controlled substance in schedule II or III, the physician under whose supervision the physician assistant is prescribing shall document such physician's approval of the order in the patient's medical record not later than one calendar day thereafter, and (D) prescribe and approve the use of durable medical equipment. The physician assistant may, as delegated by the supervising physician within the scope of such physician's license, request, sign for, receive and dispense drugs to patients, in the form of professional samples, as defined in section 20-14c, or when dispensing in an outpatient clinic as defined in the regulations of Connecticut state agencies and licensed pursuant to subsection (a) of section 19a-491 that operates on a not-for-profit basis, or when dispensing in a clinic operated by a state agency or municipality. Nothing in this subsection shall be construed to allow the physician assistant to request, sign for, receive or dispense any drug the physician assistant is not authorized under this subsection to prescribe.

Sec. 15. Subsection (b) of section 14-253a of the 2008 supplement to the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2008):

(b) The Commissioner of Motor Vehicles shall accept applications and renewal applications for special license plates and removable windshield placards from (1) any person who is blind, as defined in section 1-1f; (2) any person with disabilities which limit or impair the ability to walk, as defined in 23 CFR Part 1235.2; (3) any parent or guardian of any blind person or person with disabilities who is under eighteen years of age at the time of application; and (4) any organization which meets criteria established by the commissioner and which certifies to the commissioner's satisfaction that the vehicle for which a plate or placard is requested is primarily used to transport blind persons or persons with disabilities which limit or impair their ability to walk. Such applications shall be on a form prescribed by the commissioner and shall include certification of disability from a licensed physician, physician's assistant or advanced practice registered nurse, licensed in accordance with the provisions of chapter 378, or of blindness from an ophthalmologist or an optometrist. In the case of persons with disabilities which limit or impair the ability to walk, the application shall also include certification from a licensed physician, an advanced practice registered nurse, licensed in accordance with the provisions of chapter 378, or a member of the handicapped driver training unit established pursuant to section 14-11b that the applicant meets the definition of persons with disabilities which limit or impair the ability to walk, as defined in 23 CFR Section 1235.2. The commissioner, in said commissioner's discretion, may accept the discharge papers of a disabled veteran, as defined in section 14-254, in lieu of such certification. The commissioner may require additional certification at the time of the original application or at any time thereafter. If a person who has been requested to submit additional certification fails to do so within thirty days of the request, or if such additional certification is deemed by the commissioner to be unfavorable to the applicant, the commissioner may refuse to issue or, if already issued, suspend or revoke such special license plate or removable windshield placard. The commissioner shall not be required to issue more than one removable windshield placard per applicant. The fee for the issuance of a temporary removable windshield placard shall be five dollars. Any person whose application has been denied or whose special license plate or removable windshield placard has been suspended or revoked shall be afforded an opportunity for a hearing in accordance with the provisions of chapter 54.

Sec. 16. Subsection (a) of section 20-128 of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2008):

(a) There shall be within the Department of Public Health a Connecticut Board of Examiners for Optometrists. Said board shall consist of seven members appointed by the Governor, subject to the provisions of section 4-9a, as follows: Four practicing licensed optometrists in good professional standing who reside in this state and three public members. The optometrists appointed for terms beginning on and after January 1, 1997, shall be optometrists authorized under this chapter to practice at the highest level of their profession, except that any optometrist serving on the board on October 1, 1996, shall be eligible for reappointment on or after January 1, 1997, whether or not such optometrist is authorized to practice at the highest level of his profession. The Governor shall appoint a chairman from among such members. No member appointed on or after January 1, 1991, shall serve on the board for more than [eight] twelve years.

Sec. 17. Subsection (b) of section 19a-515 of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2008):

(b) Each licensee shall complete a minimum of forty hours of continuing education every two years. Such two-year period shall commence on the first date of renewal of the licensee's license after January 1, 2004. The continuing education shall be in areas related to the licensee's practice. Qualifying continuing education activities are courses offered or approved by the Connecticut Association of Healthcare Facilities, the Connecticut Association of Not-For-Profit Providers for the Aging, the Connecticut Alliance for Long Term Care, the Connecticut Chapter of the American College of Health Care Administrators, the Association For Long Term Care Financial Managers or any accredited college or university, or programs presented or approved by the National Continuing Education Review Service of the National Association of Boards of Examiners of Long Term Care Administrators, or by federal or state departments or agencies.

Sec. 18. (NEW) (Effective October 1, 2008) On and after October 1, 2008, no agreement, lease or other contract entered into, renewed or extended between an optometrist and any other person shall contain any provision that: (1) Impedes an optometrist's ability to gain access to his or her professional office or patient records; or (2) limits, inhibits or prevents an optometrist's ability to communicate with his or her patients at any time.

Sec. 19. Subsection (a) of section 19a-6g of the 2008 supplement to the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage):

(a) There is established a HealthFirst Connecticut Authority composed of the following members: Two appointed by the speaker of the House of Representatives, one of whom is a health care provider and one of whom represents businesses with fifty or more employees; two appointed by the president pro tempore of the Senate, one of whom has experience in community-based health care and one of whom represents businesses with fewer than fifty employees; one appointed by the majority leader of the House of Representatives who represents consumers; one appointed by the majority leader of the Senate who represents the interests of labor; one appointed by the minority leader of the House of Representatives who represents health insurance companies; one appointed by the minority leader of the Senate who represents hospitals; and two appointed by the Governor, one of whom advocates for health care quality or patient safety and one with experience in information technology. The Insurance Commissioner and the Commissioners of Public Health and Social Services or their designees, the Healthcare Advocate or the Healthcare Advocate's designee, the executive director of the Permanent Commission on the Status of Women or the executive director's designee, the executive director of the African-American Affairs Commission or the executive director's designee, the executive director of the Latino and Puerto Rican Affairs Commission or the executive director's designee and the Comptroller or Comptroller's designee shall be ex-officio, nonvoting members.

Sec. 20. Subsection (a) of section 19a-6h of the 2008 supplement to the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage):

(a) There is established a State-wide Primary Care Access Authority. The authority shall consist of the Commissioners of Public Health and Social Services, the Comptroller, the chairpersons of the HealthFirst Connecticut Authority established under section 19a-6g of the 2008 supplement to the general statutes, as amended by this act, and the following members: One each appointed by the Connecticut Primary Care Association, the Connecticut State Medical Society, the Connecticut Chapter of the American Academy of Pediatrics, the Connecticut Nurses Association, the Connecticut Association of School-Based Health Centers, the Connecticut State Dental Association, the Connecticut Community Providers Association and the Weitzman Center for Innovation In Community Health and Primary Care. Members shall serve for a term of four years commencing on August 1, 2007. All initial appointments to the committee shall be made by July 15, 2007. Any vacancy shall be filled by the appointing authority.

Sec. 21. Subsection (b) of section 17a-271 of the 2008 supplement to the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2008):

(b) The board of trustees shall recommend to the council such matters as it deems necessary, [;] shall advise the director of the institution on general policies concerning the operation and administration of the institution [;] and shall inspect such institution annually.

Sec. 22. Subsection (e) of section 17a-451 of the 2008 supplement to the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2008):

(e) The commissioner shall collaborate and cooperate with other state agencies providing services for mentally disordered children and adults with psychiatric disabilities or persons with substance use disorders, or [persons with] both, [disabilities,] and shall coordinate the activities of the Department of Mental Health and Addiction Services with the activities of said agencies.

Sec. 23. Subsection (c) of section 17a-458 of the 2008 supplement to the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2008):

(c) "State-operated facilities" means those hospitals or other facilities providing treatment for persons with psychiatric disabilities or for persons with substance use disorders, or both, which are operated in whole or in part by the Department of Mental Health and Addiction Services. Such facilities include, but are not limited to, the Capitol Region Mental Health Center, the Connecticut Valley Hospital, including the Acute Care Division of Connecticut Valley Hospital, the Connecticut Mental Health Center, the Franklin S. DuBois Center, the Greater Bridgeport Community Mental Health Center and River Valley Services.

Sec. 24. Subsection (e) of section 19a-12a of the 2008 supplement to the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2008):

(e) Any health care professional participating in the assistance program shall immediately notify the assistance program upon (1) being made aware of the filing of any disciplinary charges or the taking of any disciplinary action against such health care professional by a professional licensing or disciplinary body, or (2) being charged with or convicted of a felony under the laws of this state, or of an offense that, if committed within this state, would constitute a felony. The assistance program shall regularly review available sources to determine if disciplinary charges have been filed, or disciplinary action has been taken, or felony charges have been filed or substantiated against any health care professional who has been admitted to the assistance program. Upon such notification, the assistance program shall refer such health care professional to the department and shall submit to the department all records and files maintained by the assistance program concerning such health care professional. Upon such referral, the department shall determine if the health care professional is eligible to continue participating in the assistance program and whether such participation should be treated as confidential in accordance with subsection (h) of this section. The department may seek the advice of professional health care societies or organizations and the assistance program in determining what intervention, referral assistance, rehabilitation or support services are appropriate for such health care professional. If the department determines that the health care professional is an appropriate candidate for confidential participation in the assistance program, the entire record of the referral and investigation of the health care professional shall be confidential and shall not be disclosed, except at the request of the health care professional, for the duration of the health care professional's participation in and upon successful completion of the program, provided such participation is in accordance with terms agreed upon by the department, the health care professional and the assistance program.

Sec. 25. Subsection (c) of section 19a-37 of the 2008 supplement to the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2008):

(c) The Commissioner of Public Health shall adopt regulations, in accordance with chapter 54, to clarify the criteria under which a well permit exception may be granted and describe the terms and conditions that shall be imposed when a well is allowed at a [premise] premises (1) that is connected to a public water supply system, or (2) whose boundary is located within two hundred feet of an approved community water supply system, measured along a street, alley or easement. Such regulations shall (A) provide for notification of the permit to the public water supplier, (B) address the quality of the water supplied from the well, the means and extent to which the well shall not be interconnected with the public water supply, the need for a physical separation, and the installation of a reduced pressure device for backflow prevention, the inspection and testing requirements of any such reduced pressure device, and (C) identify the extent and frequency of water quality testing required for the well supply.

Sec. 26. Subdivisions (2) and (3) of subsection (a) of section 19a-77 of the 2008 supplement to the general statutes are repealed and the following is substituted in lieu thereof (Effective October 1, 2008):

(2) A "group day care home" which offers or provides a program of supplementary care (A) to not less than seven [nor] or more than twelve related or unrelated children on a regular basis, or (B) that meets the definition of a family day care home except that it operates in a facility other than a private family home.

(3) A "family day care home" which consists of a private family home caring for not more than six children, including the provider's own children not in school full time, where the children are cared for not less than three [nor] or more than twelve hours during a twenty-four-hour period and where care is given on a regularly recurring basis except that care may be provided in excess of twelve hours but not more than seventy-two consecutive hours to accommodate a need for extended care or intermittent short-term overnight care. During the regular school year, a maximum of three additional children who are in school full time, including the provider's own children, shall be permitted, except that if the provider has more than three children who are in school full time, all of the provider's children shall be permitted.

Sec. 27. Subsection (b) of section 19a-535b of the 2008 supplement to the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2008):

(b) A facility shall not transfer or discharge a patient from the facility except for medical reasons, or for the patient's welfare or the welfare of other patients, as documented in the patient's medical record; or, in the case of a self pay patient, for nonpayment or arrearage of more than fifteen days of the per diem chronic disease hospital room rates for the patient's stay, except as prohibited by the Social Security Act. In the case of an involuntary transfer or discharge, the patient and, if known, the patient's legally liable relative, guardian or conservator and the patient's personal physician, if the discharge plan is prepared by the medical director of the chronic disease hospital, shall be given at least thirty [days] days' written notice of the proposed action to ensure orderly transfer or discharge.

Sec. 28. Subdivision (1) of section 19a-693 of the 2008 supplement to the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2008):

(1) "Activities of daily living" means activities or tasks [,] that are essential for a person's healthful and safe existence, including, but not limited to, bathing, dressing, grooming, eating, meal preparation, shopping, housekeeping, transfers, bowel and bladder care, laundry, communication, self-administration of medication and ambulation.

Sec. 29. Section 19a-695 of the 2008 supplement to the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2008):

The Department of Public Health shall receive and investigate any complaint alleging that a managed residential community is engaging in, or has engaged in activities, practices or omissions that would constitute a violation of sections 19a-694 to 19a-701, inclusive, the regulations adopted pursuant to section 19a-701 of the 2008 supplement to the general statutes, or any other regulation applicable to managed residential communities, including the Public Health Code. The department shall include in its biennial review of a managed residential community, conducted in accordance with section 19a-696 of the 2008 supplement to the general statutes, a review of the nature and type of any complaint received concerning the managed residential community, as well as the department's final determination made with respect to such complaint.

Sec. 30. Subsection (b) of section 20-609 of the 2008 supplement to the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2008):

(b) Any person owning, managing or conducting any store, shop or place of business not being a pharmacy who exhibits within or upon the outside of such store, shop or place of business, or includes in any advertisement the words "drug store", "pharmacy", "apothecary", "drug", "drugs", "medicine shop", or any combination of such terms or any other words, displays or symbols indicating that such store, shop or place of business is a pharmacy shall be fined not more than two hundred dollars or imprisoned not more than thirty days or both. The provisions of this subsection shall not apply to any person [who] that provides pharmacy-related services directly to pharmacies or practitioners and does not offer such services and drugs or medical services directly to the public.

Sec. 31. (Effective October 1, 2008) Sections 19a-7g, 19a-127k, 19a-181e, 19a-197, 20-13i and 25-39a of the general statutes are repealed.

The following fiscal impact statement and bill analysis are prepared for the benefit of members of the General Assembly, solely for the purpose of information, summarization, and explanation, and do not represent the intent of the General Assembly or either chamber thereof for any purpose:

OFA Fiscal Note

State Impact:

Note: GF=General Fund

Municipal Impact: None

Explanation

Section 1 clarifies law regarding the issuance of replacement birth certificates for births subject to a gestational agreement. This results in no fiscal impact.

Section 2 makes changes to and deletes obsolete provisions regarding the filing of burial information by sextons. These changes result in no fiscal impact.

Section 3 authorizes health care providers to electronically submit reports of reportable diseases. This results in no fiscal impact.

Section 4 modifies law concerning notification requirements that must be met by a party requesting an exception to the separating distance requirements for a septic system as it relates to water supply wells. These changes result in no fiscal impact.

Section 5 authorizes the Commissioner of Public Health to establish requirements for the permitting of retail food establishments by local health authorities. Currently, licensing/permitting is conducted only by local ordinance. Fewer than ten municipalities will have to enact ordinances establishing a permitting/licensure process (inspections are currently performed). This is not anticipated to result in any cost to these municipalities.

Section 6 grants authority to the Commissioner of Public Health to issue emergency summary orders in health care facilities other than nursing homes, home health care agencies and homemaker-home health agencies. This change results in no fiscal impact.

Sections 7 – 9 make technical changes that have no associated fiscal impact.

Section 10 expands the products that may be sold to food service establishments at a farmers' market. This change results in no fiscal impact.

Section 11 allows a nurse employed by a home health care or homemaker home health care agency, subsequent to administering flu or pneumonia vaccines, to administer epinephrine or other anaphylaxis medication. This results in no fiscal impact.

Section 12 makes a conforming change, consistent with the repeal of Section 19a-7g CGS within Section 31.

Section 13 establishes continuing education requirements for naturopaths. The Department of Public Health (DPH) will be required to make available forms for use by a naturopath when attesting to completion of the continuing education requirement, as well as process requests for waivers or extensions. It is anticipated that the DPH can accommodate these changes without requiring additional resources.

Section 14 expands the scope of practice of a physician assistant to include prescribing and approving the use of durable medical equipment. This results in no fiscal impact.

Section 15 expands the list of professionals who may certify disability for purposes of windshield placards issued by the Department of Motor Vehicles. No fiscal impact is associated with this change.

Section 16 increases the maximum term of members of the Board of Examiners for Optometrists. This change has no associated fiscal impact.

Section 17 expands the list of qualified continuing education programs for nursing home administrators. This change results in no fiscal impact.

Section 18 requires certain provisions to be included in agreements, leases, or contracts between any optometrist and other parties, on and after 10/1/08. These changes have no associated fiscal impact.

Section 19 adds the executive directors of the Permanent Commission on the Status of Women, the African-American Affairs Commission, and the Latino and Puerto Rican Affairs Commission to the membership of the HealthFirst Connecticut Authority. No additional expenses are anticipated for the Office of Legislative Management (OLM).

Section 20 adds two members to the State-wide Primary Care Access Authority. No additional expenses are anticipated for the OLM.

Sections 21 - 30 make technical changes that have no associated fiscal impact.

Section 31 eliminates:

1. A Childhood Immunization Advisory Council. No fiscal impact is anticipated - members are not entitled to compensation or expense reimbursement.

2. The mandatory reporting of community benefits programs to the DPH by hospitals and managed care organizations. The department will experience a workload reduction.

3. A pilot program for municipal selection of emergency medical services providers. No fiscal impact is associated with this change.

4. The DPH's registry of automatic external defibrillators (AEDs) and a requirement that persons report the location of AEDs. The department will experience a workload decrease.

5. A requirement that DPH produce an annual report on investigations of and disciplinary actions taken against physicians. A minor savings will result from averted printing costs.

6. A requirement that DPH produce an annual report regarding carcinogens in public water supplies and the mandatory reporting of the organic chemical content of water supplies by public water companies. A minimal savings will result from averted printing costs.

The Out Years

The annualized ongoing fiscal impact identified above would continue into the future subject to inflation.

OLR Bill Analysis

sHB 5701

AN ACT CONCERNING REVISIONS TO STATUTES PERTAINING TO THE DEPARTMENT OF PUBLIC HEALTH.

SUMMARY:

This bill makes a number of substantive and technical changes to Department of Public Health (DPH) and other related statutes concerning health care practitioner licensing and regulation, vital records, sextons, reportable diseases, subsurface sewage disposal, food establishments, farmers' markets, vaccine administration, health care institution regulation, childhood immunization, and membership on health care authorities. It also repeals certain DPH reporting requirements.

EFFECTIVE DATE: October 1, 2008 except as noted below.

§ 1 — BIRTH CERTIFICATES-GESTATIONAL AGREEMENTS

Existing law requires that each birth certificate contain the birth mother's name. It directs DPH to create a replacement certificate, within 45 days after receiving a court order or 45 days after the child's birth, whichever is later. It must include all information required for the birth certificate as of the date of the birth. The bill appears to limit the replacement certificate requirement to births that are subject to a gestational agreement.

§ 2 — SEXTONS

By law, a sexton in charge of any burial place must provide a monthly list of all interments, disinterments, and removal of bodies to the registrar of the town. The sexton must also file with the registrar permits he received when a body was brought into the town from another town or state for burial.

The bill specifies that the list must be in a DPH-prescribed format and requires the sexton to also file, during the first week of each month, completed burial permits he or she receives in the preceding month. It eliminates the permit filing requirement and deletes an obsolete provision concerning books furnished by DPH.

§ 3 — REPORTABLE DISEASES

The bill amends existing law concerning mechanisms to report diseases on the DPH commissioner's list of reportable diseases and laboratory findings. By law, health care providers must make these reports to the department and to the local health director where the subject resides. In addition to the current filing by writing or telephone, the bill allows electronic reporting in a format specified by DPH.

§ 4 — SUBSURFACE SEWAGE DISPOSAL SYSTEMS

Current law requires any person applying to DPH for authorization to repair or newly construct a subsurface sewage disposal system involving a waiver of the proximity requirement as it relates to a private residential well to notify in writing all abutting property owners. (The law does not further explain “proximity requirement.”) A DPH decision on the application constitutes a final decision for purposes of appeal to Superior Court.

The bill: (1) replaces the term “private residential well“ with “water supply well,” thus broadening applicability to also include non-residential wells and public water supply wells; (2) requires written notification to all property owners with water supply wells affected by the exception request, not just abutting property owners; and (3) eliminates the language on a final decision for appeal to court.

§ 5 — FOOD ESTABLISHMENT PERMITS

By law, the DPH commissioner can establish and amend a Public Health Code (i.e., DPH regulations). Currently, the code can address regulations concerning retail food establishments, including food establishments, catering food service establishments, and itinerant food vending establishments.

The bill also allows the code to include regulations concerning permitting required from local health departments or districts for the operation of such establishments.

§ 6 — SUMMARY ORDERS AGAINST HEALTH CARE INSTITUTIONS

The bill expands the DPH commissioner's authority by allowing him to issue summary orders to all health care institutions under his jurisdiction. Currently, the commissioner can issue a summary order against a home health care agency or homemaker-home health care agency when the health, safety, or welfare of any patient served requires emergency action. Such orders can include (1) revoking or suspending the institution's license; (2) prohibiting the institution from contracting with new patients or terminating its relationship with current patients; (3) limiting the institution's license, including reducing the institution's patient services or capacity; and (4) compelling compliance with applicable statutes and regulations.

Under the bill, this summary order authority also applies to hospitals; residential care homes; nursing homes; health care facilities for the handicapped; rest homes; mental health facilities; substance abuse treatment facilities; outpatient surgical facilities; infirmaries operated by educational institutions; facilities providing services for the prevention, diagnosis, and treatment of human health conditions; residential care facilities for persons with mental retardation certified to participate in Medicaid as an intermediate care facility for the mentally retarded; and assisted living services agencies (CGS § 19a-490).

§ 10 — FARMER'S MARKET

The bill allows food service establishments to purchase Connecticut-grown farm products, instead of just fresh produce, that have been produced and are sold according to applicable state regulations at a farmer's market. Under current law, food service establishments can request and obtain fresh produce at a farmer's market. “Farm products,” as defined under current law, includes fresh fruits and vegetables; nuts; shell eggs; honey; maple syrup; nursery stock and other horticultural products; livestock food products such as meat, milk, cheese, and other dairy products; sugar; flowers; aquaculture products; products from trees, vines, or plants; and products processed by the farmer, such as baked goods made with farm products.

EFFECTIVE DATE: Upon passage

§ 11 — ADMINISTRATION OF VACCINES BY CERTAIN NURSES

Current law allows nurses working for home health care or homemaker home health care agencies to administer flu and pneumonia vaccines to persons in their homes without a physician's order after an assessment for contraindications and according to a physician-approved agency policy.

The bill requires the policy to include an anaphylaxis protocol. In the case of an adverse reaction to a vaccine, the bill authorizes the nurse to also administer epinephrine or other anaphylaxis medication without a physician's order according to the approved agency policy.

§§ 12, 31 — CHILDHOOD IMMUNIZATION ADVISORY COUNCIL

The bill deletes a reference to the Childhood Immunization Advisory Council in the existing childhood immunization registry law because the council is eliminated under the bill.

DPH has formed an advisory group with a broad spectrum of vaccine providers to address current vaccine issues.

§ 13 — CONTINUING EDUCATION FOR NATUREOPATHS

The bill establishes continuing education requirements for natureopaths. For registration periods beginning on and after October 1, 2009, a natureopath applying for license renewal must earn a minimum of 15 contact hours of continuing education within the preceding registration period. “Registration period” means the one-year period for which a renewed license is current and valid. “Contact hour” means a minimum of 50 minutes of continuing education activity.

The continuing education must be directly related to natureopathy practice and reflect the professional needs of the licensee in meeting the public's health care needs. Qualifying continuing education include courses, including on-line ones, offered or approved by the American Association of Naturopathic Medical Colleges, regionally accredited higher education institutions, or state or local health departments.

A license renewal applicant must sign a statement attesting that he or she has met the continuing education requirements on a DPH-prescribed form. The licensee must retain attendance records or certificates of completion that demonstrate compliance with the continuing education requirements. Such records and certificates must be kept for at least five years after the continuing education was completed. The licensee must provide these records to DPH for inspection within 45 days of such a request.

A first-time license applicant is exempt from the continuing education requirements. The bill gives the DPH commissioner the discretion to waive the continuing education requirements or grant a time extension in cases of medical disability or illness if the licensee submits an application for the waiver or extension on a DPH-prescribed form. Also, the person must provide a certification by a licensed physician of the disability or illness and other documentation the commissioner may require. The commissioner can grant a waiver or time extension for up to one registration period; he may grant additional waivers or extensions if the disability or illness continues beyond that period and the person files for the additional waiver or extension.

A person whose license becomes void for failure to renew and who applies for reinstatement must provide evidence documenting completion of 15 contact hours of continuing education within the one-year period immediately preceding his or her reinstatement application.

§§ 14, 15 — PHYSICIAN ASSISTANTS

The bill authorizes physician assistants, as delegated by a supervising physician within the scope of the physician's license, to prescribe and approve the use of durable medical equipment.

It also allows physician assistants to provide a certification of disability for purposes of applications to the Department of Motor Vehicles for special license plates and removable windshield placards.

§§ 16, 18 — OPTOMETRISTS

The bill extends from eight to 12 years the maximum time a person can serve on the Connecticut Board of Examiners for Optometrists.

On and after October 1, 2008, the bill bars any agreement, lease, or other contract entered into, renewed, or extended between an optometrist and another from (1) impeding an optometrist's ability to gain access to his or her professional office or patient records or (2) limiting, inhibiting, or preventing an optometrist's ability to communicate with his or her patients at any time.

§ 17 — NURSING HOME ADMINISTRATORS

The bill adds courses offered or approved by the Connecticut Alliance for Long Term Care to those acceptable for meeting continuing education requirements for nursing home administrator licensure.

§ 19 — HEALTHFIRST CONNECTICUT AUTHORITY MEMBERSHIP

The bill adds the executive directors, or their designees, of the Permanent Commission on the Status of Women, the African-American Affairs Commission, and the Latino and Puerto Rican Affairs Commission to the HealthFirst Connecticut Authority.

The HealthFirst Connecticut Authority, created by PA 07-185, must recommend alternatives for affordable quality health care coverage for un- and under-insured people, cost containment measures, and insurance financing mechanisms.

EFFECTIVE DATE: Upon passage

§ 20 — STATE-WIDE PRIMARY CARE ACCESS AUTHORITY

The bill adds two members to the State-wide Primary Care Access Authority, one appointed by the Connecticut State Dental Association and one appointed by the Connecticut Community Providers Association.

This authority, created by PA 07-185, must develop a universal system for providing primary care services to all Connecticut residents.

EFFECTIVE DATE: Upon passage

§ 31 — REPEALED SECTIONS

The bill repeals (1) the Childhood Immunization Advisory Council (see § 12), (2) the DPH community benefits program, (3) an outdated pilot program concerning municipal selection of emergency medical service providers, (4) an automatic external defibrillator (AED) notice and registry requirement, (5) a DPH annual report concerning the activities of the Connecticut Medical Examining Board, and (6) a DPH reporting requirement concerning the monitoring of public water supplies for organic chemicals.

State law, repealed by the bill, requires each hospital and managed care organization (MCO) to submit a biennial report to DPH on whether it has a community benefits program. “Community benefits” means a voluntary program to promote preventive care and improve the health status of working families and populations at risk in the communities within the geographic areas of the hospital or MCO. By law, DPH must summarize and analyze the required reports biennially and make summaries available to the public. It can impose a civil penalty of up to $50 for late reports.

Current law requires any person possessing an AED to notify the Office of Emergency Medical Services (OEMS) of its location. OEMS is required to establish an AED registry and a procedure for the use of the enhanced 9-1-1 service for the location of AEDs nearest to the caller. The bill repeals these provisions.

The law requires each water company to monitor, according to DPH regulations, the organic chemical content of all public water supplies to determine what potentially harmful carcinogens are in the water supply and report this to DPH. DPH must rank the carcinogens in order of potential danger and estimate the cost of removal of the more dangerous ones. DPH must report on this annually to the governor and General Assembly. The bill eliminates these requirements.

BACKGROUND

Related Bill

HB 5812, An Act Concerning the Availability of Automatic Defibrillators for Public Use, was reported by the Public Health Committee to the Appropriations Committee on March 17.

COMMITTEE ACTION

Public Health Committee

Joint Favorable Substitute