OLR Bill Analysis
AN ACT CONCERNING VARIOUS REVISIONS TO THE PUBLIC HEALTH STATUTES.
This bill makes numerous substantive, minor, and technical changes to Department of Public Health (DPH)-related statutes and programs. For example, the bill allows out-of-state registered nurses and licensed practical nurses to temporarily care for a patient in Connecticut for up to 72 hours without obtaining a DPH permit.
The bill prohibits regional long-term care ombudsmen and DPH and Department of Social Services (DSS) employees from providing any health care institution, instead of only nursing or residential care homes, (1) advance notice of an investigation or inspection or (2) information about a complaint filed by a mandated reporter of elder abuse unless they are specifically required to do so by state or federal regulations.
It makes changes affecting several health care professions and institutions, including physician assistants, massage therapists, primary service area responders, mandated elder abuse reporters, emergency medical services providers, clinical and environmental laboratories, physical therapists, medical spas, acupuncturists, opticians, hairdressers and cosmeticians, nuclear medicine technologists, and certified dietician-nutritionists.
The bill also makes changes affecting technical assistance fees for certain health care institution construction projects, stem cell research, release of patient data by the Office of Health Care Access, disciplinary action against licensed health care practitioners, voluntary license surrender by health care practitioners, the Commission on Medicolegal Investigations, the PANS/PANDAS advisory council, and the certificate of need (CON) process for health care institutions.
EFFECTIVE DATE: October 1, 2015, except that the provision on optician training programs takes effect upon passage.
§ 1 – TECHNICAL ASSISTANCE FEE
By law, DPH charges a fee for technical assistance the department provides for the design, review, and development of a health care institution's construction, renovation, sale, or ownership change. For projects costing more than $ 1 million, the current fee is one-quarter of 1% of the total project cost. The bill specifies that the fee is based on total construction costs rather than project costs. (Neither current law nor the bill define either term.)
§ 2 – PHYSICIAN ASSISTANT ORDERS
The bill requires all orders written by a physician assistant to include his or her signature and printed name. (The signature requirement was inadvertently removed by PA 14-231.)
§ 3 – STEM CELL RESEARCH
The bill eliminates DPH's authority to (1) enforce specified laws concerning stem cell research and (2) adopt implementing regulations. Among other things, these laws establish conditions under which someone may conduct research involving embryonic stem cells. By law, this research must continue to be overseen by an embryonic stem cell research oversight committee established under national guidelines.
The bill also eliminates the requirement for a researcher to provide documentation to the department before someone may perform this research, verifying the voluntary nature of the donation of the stem cells and related materials or adherence to national guidelines for embryonic stem cells derived from out of state.
§ 4 – NURSES FROM OTHER STATES
Currently, a qualified registered nurse or licensed practical nurse from another state may temporarily care for a patient in Connecticut if he or she receives a temporary DPH permit. The bill allows such temporary care for up to 72 hours without a permit. A permit is still required for temporary care beyond 72 hours.
As under current law, the nurse must not represent himself or herself as licensed in Connecticut.
§ 5 – MASSAGE THERAPISTS
The bill specifically allows DPH to take disciplinary action against a licensed massage therapist for fraud or deceit in obtaining the license.
§ 6 – PRIMARY SERVICE AREA RESPONDERS
The bill allows certain primary service area responders (PSARs) to apply, on a short form application, to change the address of their principal or branch locations within the primary service area, without necessarily going through the standard hearing process. This applies to licensed or certified volunteer, hospital-based, or municipal ambulance services that are PSARs. By law, a primary service area is a specific geographic area to which DPH assigns a designated emergency medical services provider for each category of emergency medical response services. These providers are termed PSARs
Under the bill, applicants must notify in writing all other PSARs in the municipality or adjacent municipalities. The application is deemed approved 30 days after filing, unless one of the notified PSARs objects in writing to the commissioner and requests a hearing within 15 days after receiving notice. At the hearing, the applicant must demonstrate the need to change its address, following existing procedures requiring a public hearing when an emergency medical services (EMS) organization requests approval of permits for new or expanded emergency medical services.
The bill requires the commissioner to develop the short form application. The application must at least require the applicant to provide (1) the applicant's name, current address, and new address, (2) an explanation for moving the principal or branch location, and (3) a list of the providers to whom it sent notice and proof of notification.
§ 7 – MANDATED REPORTERS OF ELDER ABUSE
The bill adds licensed or certified EMS providers to the list of mandated elder abuse reporters.
Under the elder abuse mandated reporter law, various professionals must notify DSS when they reasonably suspect an elderly person (1) has been abused, neglected, abandoned, or exploited or (2) needs protective services.
§ 8 – EMS CALL VOLUME REPORTS
By law, DPH must establish EMS rates and adopt regulations that establish rate-setting methods. Currently, the regulations must specify that ambulance or paramedic intercept services that do not apply for a rate increase in a given year beyond the medical care services consumer price index (published by the U.S. Department of Labor), or that accept the maximum allowable rates in the voluntary statewide rate schedule, must file certain information by July 15. The bill extends this deadline to the last business day of August.
By law, this filing must include (1) a statement of call volume and (2) if the service is not applying for an increase, a written declaration that it will not change its current maximum rates during the rate year.
§§ 9 & 10 – EMS VEHICLE INSPECTIONS
PA 14-231 made various changes concerning required biennial inspections of EMS vehicles, including (1) allowing the inspections to be performed by state or municipal employees, or Department of Motor Vehicles-licensed motor vehicle repairers or dealers, qualified under federal regulations and (2) requiring the inspections to be conducted in accordance with federal regulations. Under the bill, these provisions only apply to ambulances and invalid coaches, but not to intercept vehicles staffed by advanced emergency technicians or paramedics. (Generally, these intercepts provide advanced life support.)
The bill requires all such ambulances, invalid coaches, and intercept vehicles to be inspected by DPH. (It is unclear how this provision interacts with the existing provision on who can conduct inspections, noted above.) The bill also allows the DPH commissioner to inspect any rescue vehicle used by an EMS organization, for compliance with minimum equipment standards. (The bill does not define rescue vehicle.)
The bill also updates terminology and makes minor and technical changes.
§ 11 – OHCA RELEASE OF DATA
The bill makes technical changes to clarify that DPH's Office of Health Care Access (OHCA) may release patient-identifiable data for medical and scientific research purposes, in accordance with existing regulations.
Regulations establish conditions for the department's release of identifiable health data. Among other requirements, the (1) requestor must apply to the department and (2) department must determine that the data will be used solely for bona fide medical and scientific research and the disclosure is necessary for the proposed research (Conn. Agency Regs. § 19a-25-3).
§ 12 – STUDENT ATHLETE CONCUSSIONS
The bill adds licensed physical therapists to the list of providers who may clear a student to return to sport activities after being diagnosed with a concussion or showing signs of having suffered a concussion.
It also specifies that a licensed athletic trainer may clear a student in this situation only when acting under the consent and direction of a licensed physician, chiropractor, podiatrist, or naturopath.
§§ 13 & 14 – CLINICAL LABORATORIES
The bill makes various changes concerning DPH's disciplinary authority over clinical laboratories.
By law, DPH may impose $100 to $300 fines on clinical laboratories for violations of certain laws. The bill specifies that each day a laboratory is out of compliance with the law or regulations is a separate violation for this purpose.
Under current law, DPH may suspend or revoke a clinical laboratory's license if the laboratory commits fraud, engages in fee-splitting inducements or bribes, violates the laws on reporting of medical errors, or violates other provisions of the licensing law. The bill allows DPH to impose its standard range of disciplinary actions, not just license suspension or revocation. These other disciplinary actions may include censure, a letter of reprimand, probation, or a civil penalty.
The bill also allows DPH to take disciplinary action for violations of regulations adopted pursuant to the licensing law.
It grants to the department similar investigative authority over clinical laboratories as it already has over licensed health care institutions. Thus, the bill allows the commissioner or an authorized agent to conduct any inquiry, investigation, or hearing needed to enforce the laws and regulations on clinical laboratory licensure. She or her agent may issue subpoenas; order the production of books, records or documents; administer oaths; and take testimony under oath. If a person disobeys a subpoena or refuses to answer a pertinent question or produce a requested document, the commissioner or agent may apply to Superior Court (in Hartford or the district where the person lives or the business is conducted) to order compliance.
§ 15 – DISCIPLINARY ACTION
The bill allows DPH and its professional licensing boards and commissions to take disciplinary action against a practitioner's license or permit as a result of the practitioner being subject to disciplinary action by a federal agency. Existing law grants this authority as to practitioners subject to disciplinary action by other states, the District of Columbia, U.S. possessions or territories, or foreign jurisdictions.
As under existing law regarding these other jurisdictions, the bill allows DPH or the board or commission to rely upon the federal agency's findings and conclusions when imposing this discipline.
§ 16 – VOLUNTARY SURRENDER OF A LICENSE
The bill specifies that DPH may deny an application for license reinstatement by a person who voluntarily surrendered or agreed not to renew or reinstate his or her license if the applicant:
1. failed to comply with state laws or regulations;
2. was found guilty or convicted of a felony;
3. is the subject of pending or final disciplinary action or an unresolved complaint in another jurisdiction;
4. was subject to disciplinary action in another jurisdiction, including a federal agency;
5. committed an act which, if he or she were licensed, would not conform to accepted professional standards of practice; or
6. has a condition that would interfere with his or her professional practice, such as a physical or mental illness.
Existing law already allows DPH to deny, for the above reasons, applicants for (1) permits; (2) licensure by examination, endorsement, or reciprocity; or (3) license reinstatement.
§ 17 – ADVANCE NOTICE OF HEALTH CARE INSTITUTION INSPECTIONS AND INVESTIGATIONS
The law prohibits regional long-term care ombudsmen and DPH and DSS employees from providing nursing or residential care homes (1) advance notice of an investigation or inspection or (2) information about a complaint filed by a mandated reporter of elder abuse unless they are specifically required to do so by state or federal regulations. The bill extends the prohibition to cover all licensed health care institutions and specifies that it does not apply to inspections related to an institution's initial licensure.
Under the bill and current law, violators are guilty of a class B misdemeanor, punishable by a fine of up $1,000, up to six months in prison, or both. They may also be dismissed, suspended, or demoted from their positions.
§ 18 – MEDICAL SPAS
The bill specifies that the statutory definition of a medical spa does not include hospitals or other licensed health care facilities. The law defines a medical spa as an establishment where cosmetic medical procedures are performed.
By law, a medical-spa-employed- or contracted- physician, physician assistant, or advanced practice registered nurse must perform an initial physical assessment of a person before he or she can undergo a cosmetic medical procedure at the spa. The bill requires the assessment to be performed in person.
§ 19 – COMMISSION ON MEDICOLEGAL INVESTIGATIONS
The bill allows the DPH commissioner to designate an employee to represent her on the Commission on Medicolegal Investigations. The nine-member commission supervises and controls the Office of the Chief Medical Examiner.
§ 20 – ENVIRONMENTAL LABORATORIES
By law, DPH approves and certifies private, municipal, and state-operated environmental laboratories that test drinking water, sewage, soil, and other environmental samples for contaminants.
The bill excludes two types of facilities from the definition of “environmental laboratory”:
1. publicly owned treatment works that only perform physical, residue, microbiological, and biological oxygen demand tests for their own facilities and
2. pollution abatement facilities that test for pH, turbidity, conductivity, salinity, oxidation-reduction potential, and residual chlorine for their own facilities.
The exclusion applies only if the test results are submitted to the Department of Energy and Environmental Protection (DEEP) to comply with water discharge permits or emergency authorizations. For pollution abatement facilities, it also applies if the testing is required by DEEP for such compliance purposes.
§§ 21-22 – PROFESSIONAL LIABILITY INSURANCE FOR ACUPUNCTURISTS
Starting October 1, 2015, the bill requires an acupuncturist applying for or renewing a license to maintain professional liability insurance or other indemnity against liability for professional malpractice in an amount the DPH commissioner determines.
§ 23 – PANDAS/PANS ADVISORY COUNCIL
The bill adds the insurance commissioner, or her designee, to the 14-member Advisory Council on Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infections (PANDAS) and Pediatric Acute Neuropsychiatric Syndrome (PANS).
The council advises the DPH commissioner on research, diagnosis, treatment, and education relating to these conditions and must report annually to the Public Health Committee.
§ 24 – OPTICAL SALES PERMITS
By law, a licensed optician or an establishment with an optical department must obtain a DPH permit to sell retail optical glasses and instruments. The bill exempts from the permit requirement a regionally accredited college or university that operates an optical establishment to provide practical training to students enrolled in its optician training program.
The law allows students enrolled in these optician training programs to produce, mount, and fit ophthalmic lenses under the direct supervision of a licensed optician and to perform work that is incidental to their course of study (CGS § 20-147a).
§§ 25-26 – CERTIFICATE OF NEED
Generally, the law requires a health care facility to apply for a certificate of need (CON) from DPH's Office of Health Care Access (OHCA) when it proposes to (1) establish a new facility or provide new services, (2) change ownership, (3) purchase or acquire certain equipment, or (4) terminate certain services. The bill (1) specifies when facilities must file a CON before terminating services and (2) defines several terms used in the OHCA statutes.
Termination of Services by Health Care Facilities
By law, if a health care facility proposes to terminate all of its services and those services were originally authorized by a CON, it must (1) notify OHCA at least 60 days before and (2) surrender its CON within 30 days after, taking such action.
Additionally, existing law requires a facility that proposes to stop operating or providing a service for which a CON was not originally obtained to notify OHCA at least 60 days before taking such action.
The bill specifies that a health care facility must comply with the above requirements only if it is not otherwise required to file a CON application. By law, a CON is required if:
1. a hospital seeks to terminate any inpatient or outpatient services;
2. with certain exceptions, termination of surgical services is proposed by (a) an outpatient surgical facility or (b) a facility providing outpatient surgical services as part of the outpatient department of a short-term acute care hospital;
3. a short-term acute care hospital seeks to terminate an emergency department; or
4. a state-operated health care facility or institution that serves Medicare or Medicaid beneficiaries seeks to terminate any inpatient or outpatient services.
The bill defines several terms used in the statutes pertaining to OHCA, and that primarily affect the CON process. Under the bill:
1. “access” means the availability of services to a person who needs care and the person's ability to obtain the services based on (1) the services' location, (2) available transportation, (3) the location's hours of operation, and (4) any language or cultural considerations;
2. “clear public need” means the necessity for the proposed health care facilities, services, or equipment that results from deficiencies in their access or availability based on (a) population demographics, (b) service utilization patterns, and (c) epidemiological information regarding diseases or health conditions of members of the public;
3. “health care services” means medical, surgical, diagnostic, or therapeutic services integral to the clinical management of illness, disease, disability, or injury;
4. “population served” means the residents of an applicant's primary service area;
5. “primary service area” means an area consisting of the smallest number of zip codes from which the applicant draws at least 75% of its patients;
6. “quality” means the degree to which health care services increase the likelihood of desired health care outcomes and are consistent with established professional knowledge, standards, and guidelines;
7. “relocation” means moving a health care facility from its current location to a new location when the payer mix and population served do not substantially change; and
8. “termination” occurs when a health care facility stops operating or eliminates a health care service, excluding the facility's affiliates. It does not include suspending a service for six months or less.
§ 27 – NUCLEAR MEDICINE TECHNOLOGISTS
Current law specifies that a radiographer license is not required for a nuclear medicine technologist certified by the International Society for Clinical Densitometry or the American Registry of Radiologic Technologists (ARRT) if the technologist is operating a bone densitometry system under a licensed physician's supervision, control, and responsibility. The bill extends this provision to technologists certified by the Nuclear Medicine Technology Certification Board (NMTCB).
The law also specifies that the radiographer licensure statutes do not prohibit a nuclear medicine technologist from fully operating a CT or magnetic resonance imaging (MRI) portion of a hybrid-fusion imaging system, including diagnostic imaging, in conjunction with a (1) positron emission tomography or (2) single-photon emission CT imaging system. The technologist must (1) have successfully completed the individual certification exam for CT or MRI administered by the ARRT and (2) hold and maintain in good standing CT or MRI certification. The bill allows technologists to also obtain the certification from the NMCTB, instead of just the ARRT.
§ 28 – HAIRDRESSER AND COSMETICIAN LICENSURE WITHOUT EXAMINATION
The bill removes the requirement that applicants currently licensed as hairdressers and cosmeticians in another state have successfully passed a written examination in that state in order to obtain a Connecticut license without examination. It continues to require these applicants to (1) have successfully completed a hairdresser and cosmetician education and training program and (2) pay a $50 fee. By law, applicants must not have any pending disciplinary actions or unresolved complaints against them.
§ 29 – CERTIFIED DIETICIAN-NUTRITIONISTS
The bill allows certified dietician-nutritionists (CDNs) to directly order diet or nutritional support, including therapeutic diets, for patients in health care institutions. Current law only allows CDNs to convey a physician's verbal order.
Under the bill, the CDN must document the order in the patient's medical record and a physician must countersign it within 24 hours unless state or federal law requires otherwise.
Any order a CDN conveys can be acted on by the institution's nurses and physician assistants with the same authority as if the order was received directly from a physician.
The bill continues to allow physicians to convey verbal orders to CDNs for such diet or nutritional support but eliminates the requirement that CDNs document these orders in the patient's medical record.
sSB 706, favorably reported by the Aging Committee, adds certain EMS providers to the list of mandated elder abuse reporters.
sSB 1005, favorably reported by the Aging Committee, makes certain EMS providers and financial institution officers and employees mandated elder abuse reporters and limits which patient advocates are mandated reporters.
Public Health Committee
Joint Favorable Substitute