PA 15-242—sHB 6987

Public Health Committee

AN ACT CONCERNING VARIOUS REVISIONS TO THE PUBLIC HEALTH STATUTES

SUMMARY: This act makes numerous substantive, minor, and technical changes to Department of Public Health (DPH)-related statutes and programs. These changes affect several health care professions and institutions, including acupuncturists, certified behavior analysts, clinical and environmental laboratories, certified dietician-nutritionists, emergency medical services providers, hairdressers and cosmeticians, hospitals, mandated elder abuse reporters, massage therapists, medical spas, nuclear medicine technologists, nurses, opticians, and physician assistants.

The act also contains provisions relating to, among other things, technical assistance fees for certain health care institution construction projects; stem cell research; release of patient data by DPH's Office of Health Care Access (OHCA); advanced notice of licensed health care facility investigations or inspections; the Commission on Medicolegal Investigations; advisory councils on PANS/PANDAS and health information technology; the Behavioral Health Partnership Oversight Council; food-borne disease outbreaks; task forces on childhood nutrition, rare diseases, and food allergies; Department of Mental Health and Addiction Services' (DMHAS) contracts and settlements; youth suicide prevention training; cottage food regulations; the Connecticut Health Insurance Exchange's consumer health information website; and childhood immunization requirements.

EFFECTIVE DATE: October 1, 2015, unless otherwise noted below.

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 change in ownership. For projects costing more than $1 million, the act provides that the fee (one-quarter of 1%) is based on total construction costs rather than total project costs.

2 – HOSPITAL RECORDS

The act requires chronic disease hospitals to maintain their medical records on-site in an accessible manner. It also requires this for children's hospitals, except for nurses' notes.

It requires both chronic disease and children's hospitals to keep a patient's medical records on-site for at least 10 years after the patient's discharge, except they may destroy the original records sooner if they preserve a copy through a process consistent with current hospital standards. Each such hospital must provide DPH with a list of the processes it uses to preserve copies in this manner. Existing regulations generally require health care providers to maintain medical records for seven years (Conn. Agency Regs. 19a-14-42).

The act also requires chronic disease hospitals to complete a patient's medical records within 30 days after the person's discharge, except in unusual circumstances as specified in the hospital's medical staff rules and regulations.

The act allows DPH to adopt implementing regulations.

3 – PHYSICIAN ASSISTANT ORDERS

The act requires all orders written by a physician assistant to include his or her signature and printed name. (This signature requirement was inadvertently removed by PA 14-231. )

4 & 5 – STEM CELL RESEARCH

The act eliminates DPH's authority to (1) enforce specified laws concerning stem cell research and related topics and (2) adopt implementing regulations. Among other things, these laws establish conditions in 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 act eliminates the requirement for a researcher to provide documentation to DPH 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. The underlying requirement continues to apply (i. e. , that the donation be voluntary).

Under the act, the Regenerative Medicine Research Advisory Committee also must require research grant applicants to submit a form attesting to compliance with the law's requirements for embryonic stem cell research and related topics, if the research involves these cells.

6 – NURSES FROM OTHER STATES

Prior law allowed a qualified registered nurse or licensed practical nurse from another state to temporarily care for a patient in Connecticut only if the nurse received a temporary DPH permit. The act 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 prior law, the nurse must not represent himself or herself as licensed in Connecticut.

7 – MASSAGE THERAPISTS

The act specifically allows DPH to take disciplinary action against a licensed massage therapist for fraud or deceit in obtaining the license.

8 – PRIMARY SERVICE AREA RESPONDERS

The act allows certain primary service area responders (PSARs) to apply to DPH, 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 (EMS) provider for each category of emergency medical response services. These providers are termed PSARs.

Under the act, 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 EMS organization requests approval of permits for new or expanded emergency medical services.

The act 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.

9 – MANDATED REPORTERS OF ELDER ABUSE

The law requires certain professionals (mandated reporters) to notify the Department of Social Services (DSS) when they reasonably suspect an elderly person (1) has been abused, neglected, abandoned, or exploited or (2) needs protective services. The act adds as mandated reporters the following licensed or certified EMS providers: paramedics; emergency medical responders, technicians, and advanced technicians; service instructors; and any of these professionals who are members of a municipal fire department.

Failure to make a report is punishable by a fine of up to $500. An intentional failure to report is a class C misdemeanor for a first offense and a class A misdemeanor for a subsequent offense (see Table on Penalties).

Training

The act expands the training that institutions, organizations, agencies, and facilities employing individuals to care for someone age 60 or older must provide their employees. The act requires this training to cover detecting elderly exploitation and abandonment, in addition to the existing topics of detecting abuse and neglect and informing employees of their reporting responsibilities.

10 – EMS CALL VOLUME REPORTS

By law, DPH must establish EMS rates and adopt regulations that establish rate-setting methods. 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, or that accept the maximum allowable rates in a voluntary statewide rate schedule, must file certain information. The act extends the filing deadline from July 15 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 approved maximum rates during the rate year.

11 & 12 – 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 act, 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. )

In addition to this inspection, the act specifies that all such ambulances, invalid coaches, and intercept vehicles must also be inspected by DPH, to verify their compliance with minimum standards for vehicle design and equipment. The act also allows the DPH commissioner to inspect any rescue vehicle used by an EMS organization, for compliance with minimum equipment standards.

The act also updates terminology and makes minor and technical changes.  

13 – OHCA RELEASE OF DATA

The act makes technical changes to clarify that OHCA may release patient-identifiable data for medical and research purposes, in accordance with existing regulations.

Regulations establish conditions for DPH's release of identifiable health data for medical or scientific research. Among other requirements, (1) the requestor must apply to DPH and agree not to permit disclosure without DPH's prior approval and (2) DPH 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).

14 & 15 – CLINICAL LABORATORIES

The act 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 the licensure law and related provisions. Under the act, each day a laboratory is out of compliance with the law or regulations is a separate violation for this purpose.

Under existing 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 medical errors, or violates other provisions of the licensing law. The act 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 act also allows DPH to take disciplinary action for violations of regulations adopted pursuant to the licensing law.

It grants to the department investigative authority over clinical laboratories similar to that which it already has over licensed health care institutions. Thus, the act 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 other 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 judicial district where the person lives or the business is conducted) to order compliance. The court, in turn, must cite the person to appear in court to answer the question or produce the document.

16 – DISCIPLINARY ACTION AGAINST PRACTITIONERS

The act 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 against 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 act allows DPH or the board or commission to rely upon the federal agency's findings and conclusions when imposing the disciplinary action.  

17 – VOLUNTARY SURRENDER OF A LICENSE

The act 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 disciplinary action or an unresolved complaint in another jurisdiction;

4. was subject to disciplinary action in another jurisdiction, including by 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.

18 – ADVANCED NOTICE OF HEALTH CARE INSTUTITION INSPECTIONS AND INVESTIGATIONS

The law prohibits regional long-term care ombudsmen and DPH and DSS employees from providing nursing or residential care homes (1) advanced 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 act 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 act and existing law, violators are guilty of a class B misdemeanor (see Table on Penalties). They may also be dismissed, suspended, or demoted.  

19 – MEDICAL SPAS

The act 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 the person can undergo a cosmetic medical procedure at the spa. The act requires the assessment to be performed in-person.

20 – COMMISSION ON MEDICOLEGAL INVESTIGATIONS

The act allows the DPH commissioner to designate someone else to represent her on the Commission on Medicolegal Investigations. The nine-member commission supervises and controls the Office of the Chief Medical Examiner.  

21 – 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 act excludes the following 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 required by or submitted to the Department of Energy and Environmental Protection (DEEP) to comply with water discharge permits or emergency authorizations.

22-24 – PROFESSIONAL LIABILITY INSURANCE FOR ACUPUNCTURISTS

Starting October 1, 2015, the act requires an acupuncturist applying for an initial or renewal license to maintain professional liability insurance or other indemnity against liability for professional malpractice that is at least $250,000 per person, per occurrence, with an aggregate of at least $1 million. The applicant must do this before providing direct patient care services.

The act allows DPH to take disciplinary action against a licensee who fails to comply with these insurance requirements. Existing law already allows DPH to take such action against a licensee for various reasons, such as (1) failing to conform to accepted professional standards; (2) a felony conviction; or (3) negligent, incompetent, or wrongful conduct in professional activities.

By law, disciplinary actions available to DPH include license revocation or suspension, censure, a letter of reprimand, probation, or a civil penalty.

25 – PANDAS/PANS ADVISORY COUNCIL

The act adds the Insurance Committee chairs, or their designees, to the Advisory Council on Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infections (PANDAS) and Pediatric Acute Neuropsychiatric Syndrome (PANS), thus increasing the membership from 14 to 16.

The council advises the DPH commissioner on research, diagnosis, treatment, and education relating to these conditions and must annually report to the Public Health Committee.  

26 – OPTICAL SELLING 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 act 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).

EFFECTIVE DATE: Upon passage

27 – CERTIFICATE OF NEED

Generally, the law requires a health care facility to apply for a certificate of need (CON) from 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.

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 act 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.

28 – NUCLEAR MEDICINE TECHNOLOGISTS

Existing law 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 American Registry of Radiologic Technologists (ARRT) and (2) hold and maintain in good standing CT or MRI certification. The act allows technologists to obtain the certification from the Nuclear Medicine Technology Certification Board, instead of just the ARRT.

29 – HAIRDRESSER AND COSMETICIAN LICENSURE WITHOUT EXAMINATION

By law, an applicant currently licensed as a hairdresser and cosmetician in another state who has successfully passed a written examination in that state may obtain a Connecticut license without examination.

The act additionally waives the examination requirement for an applicant from a state that did not require an examination as a condition of licensure, if the applicant (1) legally practiced cosmetology for at least five years in another state and (2) submits to the DPH commissioner satisfactory evidence of his or her education and experience, including:

1. an original certification from the other state's licensing agency demonstrating at least five years of licensure;

2. correspondence from the applicant's former employers, coworkers, or clients describing the applicant's work experience for at least five years; and

3. a copy of tax returns indicating cosmetology as the applicant's occupation.

Under the act and existing law, applicants for licensure without examination must also (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.

30 – BEHAVIORAL HEALTH PARTNERSHIP OVERSIGHT COUNCIL

The act adds two nonvoting, ex-officio members to the Behavioral Health Partnership Oversight Council: one each appointed by the DPH commissioner and health care advocate, to represent their department or office respectively. Currently, the Council has eight nonvoting members and approximately 30 voting members.

By law, the council advises the children and families, social services, and mental health and addiction services commissioners on the planning and implementation of the Behavioral Health Partnership (BHP), which these departments administer. BHP is an integrated behavioral health system for Medicaid patients.

31 – BAN ON LATEX GLOVES AT RETAIL FOOD ESTABLISHMENTS

The act prohibits the use, or requiring the use, of disposable, natural rubber latex gloves at retail food establishments, including food service, catering, or itinerant (temporary or mobile) food vending establishments. It subjects violators to fines of between $250 and $500.

EFFECTIVE DATE: July 1, 2016

32 – CERTIFIED BEHAVIORAL ANALYSTS

The act requires the education commissioner, in consultation with the public health commissioner, to study the:

1. potential advantages of licensing board certified behavior analysts and assistant behavior analysts who are credentialed by the Behavior Analyst Certification Board and

2. inclusion of board certified behavior analysts and assistant behavior analysts in school special education planning and placement teams (PPT) (see BACKGROUND).

The act requires the education commissioner, by January 1, 2016, to report to the Public Health and Education committees on these studies, including:

1. any new licensure or certification categories relating to behavior analysis,

2. adding board certified behavior analysts or assistant behavior analysts on special education PPTs, and

3. incentives for people to enter the behavior analysis field.

EFFECTIVE DATE: Upon passage

33 – FOOD-BORNE DISEASE OUTBREAK STUDY

The act requires DPH to study food-borne disease outbreaks originating in public eating places, including the type of information communicated to the public after confirmed outbreaks and how it is communicated. By July 1, 2016, the commissioner must report on the study to the Public Health Committee.

The act defines a “food-borne disease outbreak” as an incident in which at least two people experience a similar illness from ingesting a food or beverage that originated from a common source and was contaminated with chemicals or infectious agents.

34 – CHILDHOOD NUTRITION TASK FORCE

The act establishes an 12-member task force to study childhood nutrition, including (1) promoting healthier eating habits and promoting and providing healthier school meals and (2) developing a nutrition education program for local and regional school districts to adopt and integrate into their physical education curriculum.

The task force must report its findings and recommendations to the Public Health Committee by January 1, 2016, and terminates on that date or when it submits the report, whichever is later.  

Membership

Under the act, the task force includes the following eight appointed members:

1. two appointed by the House speaker, one of whom must be a certified dietitian-nutritionist practicing in Connecticut who serves children;

2. two appointed by the Senate president pro tempore, one of whom must be a licensed pediatrician practicing in the state;

3. one medical researcher with experience in research on the effects of childhood nutrition on overall health, appointed by the House majority leader;

4. one school nurse licensed and practicing in Connecticut, appointed by the Senate majority leader;

5. one psychiatrist licensed and practicing in the state with experience treating children with nutrition-related issues, appointed by the House minority leader; and

6. one licensed clinical social worker with experience serving children with nutrition-related issues, appointed by the Senate minority leader.

Additional task force members include the Public Health Committee chairpersons and ranking members or their designees.

Appointing authorities must (1) make their appointments by July 30, 2015 and (2) fill any vacancies. An appointee may be a legislator.

Operations

The Senate president pro tempore and House speaker must select the task force chairperson from among its members. The chairperson must schedule the task force's first meeting, which must be held within 60 days after the act takes effect.  

EFFECTIVE DATE: Upon passage

35 – RARE DISEASE TASK FORCE

The act establishes a 16-member task force to study rare diseases. The task force must (1) examine rare disease research, diagnoses, treatment, and education and (2) make recommendations for the establishment of a permanent group of experts to advise DPH on rare diseases.

The act incorporates a definition of “rare disease” from federal law. Under that law, rare diseases are those that (1) affect fewer than 200,000 people in the United States or (2) affect more than 200,000 people but there is no reasonable expectation that the cost to develop and make a drug for the disease available in the United States will be recovered from its domestic sales (21 USC 360bb).

Membership and Procedure

The task force includes 16 appointed members as shown in Table 1. All designated physician appointees must be licensed and practicing in Connecticut and must have experience researching, diagnosing, or treating rare diseases. Any member may be a legislator.

Table 1: Members – Rare Disease Task Force

Appointing Authority

Member Qualifications

House speaker

- two physicians, one representing neurology or neurological surgery and the other representing pediatrics

- an administrator of a hospital in Connecticut

- a medical researcher with experience researching rare diseases

Senate president pro tempore

- two physicians, one representing cardiology or cardiovascular surgery and the other representing pulmonology

- a representative of a hospital in Connecticut

- a registered nurse or advanced practice registered nurse licensed and practicing in the state with experience treating rare diseases

House majority leader

- a physician representing orthopedics or orthopedic surgery

- a rare disease survivor over age 18

Senate majority leader

- a physician representing internal medicine

- a caregiver of a pediatric rare disease survivor

House minority leader

- a physician representing emergency medicine

- a representative of the National Organization for Rare Disorders

Senate minority leader

- a representative of the biopharmaceutical industry in the state with experience in research and development relating to rare diseases

- a representative of a hospital in the state with such experience

Task force appointments must be made no later than 30 days after the act's passage. The appropriate appointing authority fills any vacancy.

The House speaker and Senate president must select chairpersons from among the task force members. The chairpersons must schedule the first task force meeting, which must be held within 60 days after the act's passage.

Reporting Requirement

The act requires the task force to report its findings and recommendations to the Public Health Committee by January 1, 2016. The task force terminates on the date it submits the report or January 1, 2016, whichever is later.

EFFECTIVE DATE: Upon passage

36-48 — LCO TECHNICAL REVISIONS

The act makes a minor change to the statute pertaining to death certificate fees. Specifically, it restores a provision in prior law that requires death certificate fees received by DPH to be deposited in the state's neglected cemetery account. (Under PA 14-133, this provision was eliminated as of July 1, 2015. )

The act also makes technical and conforming changes to various public health statutes.

EFFECTIVE DATE: October 1, 2015, except that the provisions regarding (1) death certificate fees and (2) certain Department of Children and Families (DCF) statutes take effect July 1, 2015.

49 – CYTOMEGALOVIRUS

The act makes a technical correction to PA 15-10, which requires all health care institutions caring for newborn infants to test those who fail a newborn hearing screening for cytomegalovirus, starting January 1, 2016.

EFFECTIVE DATE: Upon passage

50 – DMHAS CONTRACTS, AGREEMENTS, AND SETTLEMENTS

The act changes the effective date, from October 1, 2015 to upon passage, of a statutory provision amended by PA 15-120. This provision authorizes the DMHAS commissioner to designate any employee, instead of only a deputy commissioner, to sign a contract, agreement, or settlement on the department's behalf.

EFFECTIVE DATE: Upon passage

51 – INFECTIOUS DISEASE NOTIFICATION TO EMS RESPONDERS

Existing law requires hospitals to notify EMS responders, through designated officers (see BACKGROUND), that may have been exposed to infectious pulmonary tuberculosis when treating, assisting, or transporting a victim of an emergency, including victims who die at or en route to the hospital. This act expands the notification requirement to include possible exposure to airborne infectious diseases that are:

1. specified as such on the U. S. Department of Health and Human Services' (HHS) infectious disease list developed pursuant to the federal Ryan White Notification law (see BACKGROUND) and

2. designated by the DPH commissioner through regulation.

Existing law also allows an EMS responder to initiate an inquiry about infectious disease exposure based on a potential exposure incident (e. g. , contact with body fluids or a needlestick injury). The act specifies that an inquiry may be made for possible exposure to any DPH- or HHS-designated infectious disease.

Additionally, the act (1) requires hospitals to designate a hospital contact person to communicate with designated officers; (2) requires DPH to maintain and make publicly available a list of hospital contact persons and designated officers; and (3) allows DPH to take specified disciplinary actions against hospitals, hospital contact persons, or designated officers who fail to comply with the notification law.   

The act also makes technical and conforming changes.

Infectious and Airborne Infectious Diseases

The act expands the diseases considered infectious for the purposes of the notification law. Prior law limited this to 12 diseases, such as HIV and AIDS; Hepatitis A, B, and C; and plague. Under the act, infectious diseases are those:

1. on the HHS infectious disease list developed pursuant to the Ryan White Notification Law (see BACKGROUND)(HHS delegated this responsibility to the Centers for Disease Control and Prevention (CDC)) and

2. designated by the public health commissioner through regulation.

The act specifies that airborne infectious diseases are a subset of infectious diseases specifically designated as such by HHS and the DPH commissioner.

The act requires the DPH commissioner to designate an infectious or airborne infectious disease, as defined by the act, by adopting regulations. It allows her to implement these designations while in the process of adopting them in regulation, if she publishes notice of intent to adopt the regulations on the department's website and the eRegulations System within 20 days of implementation. The designations are valid until the regulations take effect.

Infectious Disease Exposure     

The act broadens the circumstances under which someone is considered exposed to an infectious disease. Under the act, “exposed” means to be in circumstances where there is a recognized risk of infectious disease transmission:

1. from a human source to an EMS member or

2. if HHS designates the disease as a select agent, from a surface or environment contaminated by the agent to an EMS member.

Previously, “exposure” meant when a person's percutaneous or mucous membrane was exposed to another person's (1) blood, semen, or vaginal secretions or (2) spinal, synovial, pleural, peritoneal, pericardial, or amniotic fluid.  

Routine Notification Requirements For Hospitals

The act requires a hospital that diagnoses a patient as having an airborne infectious disease, instead of only infectious pulmonary tuberculosis, to notify the designated officer of the EMS organization that treated, assisted, or transported the patient (1) verbally, within 48 hours after the diagnosis and (2) in writing, within 72 hours after the diagnosis. If a hospital determines a patient who died at or en route to the facility had an airborne infectious disease, it must notify the designated officer within 48 hours of this determination.

Designated Officers and Hospital Contact Persons

Hospital Contact Persons. The act requires each hospital to designate one employee to act as its contact person to:

1. notify designated officers of cases where people may have been exposed to airborne infectious disease and

2. receive and respond to designated officers' requests for information on patients' infectious disease test results.

A hospital contact person may designate another hospital employee to serve as a designee if he or she is unavailable.  

DPH Notification and Listing Requirements. By January 1, 2016, the act requires each EMS organization and hospital to notify the DPH commissioner or her designee of the name and contact information for their designated officer and hospital contact person, respectively. They must also promptly notify the commissioner of any changes to this information.

The act requires the commissioner, or her designee, to help designated officers and hospital contact persons answer questions about their responsibilities. Starting January 1, 2016, the commissioner must maintain and update a list of the names and contact information of designated officers and hospital contact persons and post the list on the department's website.

Disciplinary Action

The act extends to hospital contact persons the law's protections for hospitals and designated officers against a cause of action for damages or civil penalty for failing to comply with the notification law. But the act allows the DPH commissioner to take certain disciplinary actions against these individuals and entities for such noncompliance, including (1) license or permit revocation or suspension, (2) letter of reprimand, (3) censure, or (4) placement on probation.

For hospitals, the act authorizes the commissioner to also (1) restrict their ability to acquire other facilities, (2) issue a compliance order, or (3) impose a corrective action plan.

52 – YOUTH SUICIDE PREVENTION TRAINING

The act requires DCF's Youth Suicide Advisory Board, within available appropriations, to periodically offer youth suicide prevention training for health care providers, school employees, and others who provide services to children, young adults, and families.

The board's existing duties include, among other things, (1) increasing public awareness of youth suicide and ways to prevent it and (2) recommending ways to develop statewide training in youth suicide prevention and implement suicide prevention procedures in schools.

53 – FOOD ALLERGY TASK FORCE STAFF

The act changes, from the Public Health to the Education Committee staff, who must serve as the administrative staff of the food allergy task force.

EFFECTIVE DATE: Upon passage

54-56 – CERTIFIED DIETICIAN-NUTRITIONISTS

The act allows certified dietician-nutritionists (CDNs) to directly order diet or nutritional support, including therapeutic diets, for patients in health care institutions. Prior law allowed CDNs to only convey a physician's verbal order.

Under the act, the CDN must document the order in the patient's medical record and a physician must countersign it within 72 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 as if the order were received directly from a physician.

The act 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.

The act also makes related technical and conforming changes.

57 – COTTAGE FOOD

PA 15-76 allows food to be prepared in private residences for sale if the preparation is done according to regulations that the DPH commissioner adopts after consulting with the consumer protection (DCP) commissioner.

This act instead requires the DCP commissioner to adopt the regulations after consulting with the DPH commissioner.

58 – CONSUMER HEALTH WEBSITE

PA 15-146 requires the Connecticut Health Insurance Exchange, starting July 1, 2016 and within available resources, to establish and maintain a consumer health information website. It establishes related data submission and reporting requirements, and requires the exchange to post all such information on the consumer website.

This act instead requires this posting to occur on the website in a manner and timeframe that is organizationally and financially reasonable, in the exchange's sole discretion. It also removes the requirement that the website contain information on patient decision aids.

59 – HEALTH INFORMATION TECHNOLOGY ADVISORY COUNCIL

PA 15-146 establishes a State Health Information Technology Advisory Council. One of the governor's appointees must be an employee or trustee of an employee benefit plan established under federal law.

Under the act, the appointee may be a current or former employee or trustee.

EFFECTIVE DATE: July 1, 2015

60-67 – CONTINUING EDUCATION ON VETERANS' MENTAL HEALTH CONDITIONS

The act requires certain health care professionals, starting January 1, 2016, to take at least two contact hours of training or education on mental health conditions common to veterans and their family members, during the first renewal period in which continuing education (CE) is required and once every six years thereafter. This includes (1) determining whether a patient is a veteran or a veteran's family member; (2) screening for conditions such as post-traumatic stress disorder, risk of suicide, depression, and grief; and (3) suicide prevention training.

The act requires such CE for the following professions:

1. advanced practice registered nurses (APRNs),

2. alcohol and drug counselors,

3. chiropractors,

4. marital and family therapists,

5. professional counselors,

6. psychologists, and

7. social workers.

Under the act, the DPH commissioner must adopt regulations on such training or education for chiropractors, marital and family therapists, and professional counselors.

The act also allows, but does not require, physicians to take such training.

68 & 71 – CHILDHOOD IMMUNIZATIONS

PA 15-174 exempts children from school immunization requirements if the child presents a statement from his or her parents or guardians that the immunization would be contrary to the parents' or guardians' religious beliefs. (Existing law already allows such an exemption if the immunization would be contrary to the child's religious beliefs. ) It requires any such statement to be officially acknowledged by a notary public, Connecticut-licensed attorney, judge, family support magistrate, court clerk or deputy clerk, town clerk, or justice of the peace. The act also allows school nurses to officially acknowledge the statement.

The act also eliminates the requirement in PA 15-174 that parents or guardians submit the religious exemption statement annually in order for the child to remain enrolled in a public or private school, child day care center, or group or family day care home. It instead requires submission of the statement (1) once for children attending child day care centers or group or family day care homes and (2) before a public or private school student enrolls in seventh grade, in addition to when he or she initially enrolls in school, as existing law requires.

EFFECTIVE DATE: July 1, 2015

69 – HOMELESS SHELTERS

By January 1, 2016, the act requires the Department of Housing (DOH), in collaboration with DMHAS and the Department of Education, to make available information on trauma-informed care and related services for homeless children and youths to homeless shelter providers that receive DOH financial assistance.

The providers must, to the extent feasible, (1) refer homeless children or youth to these services as necessary and (2) attempt to ensure that they have access to these services.

70 – HEALTH SYSTEM ANNUAL REPORTING

Existing law requires hospitals to file their audited financial statements with OHCA annually by February 28. The act allows a health system to submit one report with the audited financial statements for all of its hospitals. For this purpose, a health system is (1) a parent corporation of one or more hospitals and any entity affiliated with that corporation through ownership, governance, membership, or other means, or (2) a hospital and any entity affiliated with the hospital through any such means.

PA 15-146, 40, contains a similar provision that applies to health systems operating certain hospitals.

EFFECTIVE DATE: July 1, 2015

BACKGROUND

32 – Planning and Placement Team (PPT)

A PPT is a group consisting of a student's parents, teachers, and educational specialists who meet to develop and periodically review the student's individualized education program, which lists special education services to which the student is entitled.

51 - Designated Officer

A designated officer is an employee or volunteer of an EMS organization responsible for (1) receiving notice of cases of possible exposure to infectious disease, (2) investigating the cases, (3) maintaining hospital contact information, (4) requesting additional information from hospitals, and (5) maintaining any records required by law. By law, each EMS organization must identify one designated officer (CGS 19a-904).

51 - EMS Organization

By law, EMS organizations include (1) the State Police, (2) local police departments, (3) municipal constabularies, (4) paid or volunteer fire departments, (5) ambulance companies, or (6) other organizations that transport or treat patients in emergencies (CGS 19a-904).  

51 - Ryan White Notification Law

Part G of the 2009 Ryan White HIV/AIDS Treatment Extension Act (P. L. 111-87) establishes a process for medical facilities to inform emergency responders that they may have been exposed to certain infectious diseases, so that they can make informed decisions about subsequent diagnosis, prevention, or treatment.

Notification occurs by either (1) an inquiry initiated by an EMS responder or (2) routine notification by a medical facility that determines that the victim of an emergency has a federal HHS-listed infectious disease (see below).

This requirement does not apply to states with existing notification laws that are substantially similar to the federal law.

51 - HHS Infectious Disease List

The Ryan White Notification Law required HHS to develop a list of potentially life-threatening infectious diseases. The current list includes:

1. cutaneous anthrax;

2. diphtheria;

3. Hepatitis B and C;

4. HIV and AIDS;

5. measles, mumps, and rubella;

6. meningitis;

7. novel influenza A and certain other influenza strains;

8. pertussis;

9. pneumonic plague;

10. rabies;

11. severe acute respiratory syndrome (SARS);

12. smallpox;

13. tuberculosis;

14. vaccinia virus;

15. varicella zoster virus (chickenpox); and

16. viral hemorrhagic fevers.

Related Acts

PA 15-236 contains similar provisions as 9 of this act on mandated reporters of elder abuse.

OLR Tracking: ND: KD: PF: cmg