OLR Bill Analysis

sHB 5537

AN ACT CONCERNING VARIOUS REVISIONS TO THE PUBLIC HEALTH STATUTES.

SUMMARY:

This bill makes numerous substantive, minor, and technical changes to Department of Public Health (DPH)-related statutes and programs.

For example, the bill requires dentists and dental hygienists to take continuing education in infection control and makes other changes concerning dental professionals. It allows nursing home patients to receive methadone treatment for opioid addiction at the nursing home. It recognizes in statute a category of psychology technicians and allows them to provide services related to psychological testing.

Among other things, the bill also makes changes affecting various licensed institutions, including hospitals, nursing homes, and residential care homes; tattoo technicians; various licensed health care professionals; the medical orders for life sustaining treatment pilot program; wells for semipublic use; marriages (including those performed at tribal reservations); and newborn screening.

A section-by-section summary appears below.

EFFECTIVE DATE: October 1, 2016, except as otherwise noted.

1 — TECHNICAL CHANGE

This section makes a technical change, correcting an inaccurate statutory reference.

EFFECTIVE DATE: Upon passage

2 — TATTOOING WITHOUT A LICENSE

Existing law generally requires an individual to have a license or temporary permit to engage in the practice of tattooing. The bill provides that engaging in tattooing without a license or temporary permit is a class D misdemeanor (punishable by up to thirty days in prison, a fine of up to $250, or both).

3 — REPORTING OF IMPAIRED HEALTH PROFESSIONALS

By law, physicians must notify DPH if they are aware that a physician or physician assistant (PA) may be unable to practice with skill and safety because he or she is impaired, and PAs must similarly notify DPH if another PA may be so impaired (CGS 20-12e and 20-13d). PA 15-5, June Special Session, created a parallel reporting requirement covering other licensed or permitted health care professionals.

The bill includes physicians and PAs within the new reporting requirement covering other licensed or permitted health professionals, thus specifying that all health professionals are obligated to report other such professionals who may be so impaired.

4 — METHADONE FOR OPIOID ADDICTION IN NURSING HOMES

The bill allows licensed substance abuse treatment facilities providing medication assisted treatment for opioid addiction to provide methadone and related substance abuse treatment services to patients in licensed nursing home facilities. Substance abuse treatment facilities seeking to do this must request permission from the DPH commissioner, in a form and manner he prescribes. He may grant the request if he determines that it would not endanger the health, safety, or welfare of any patient. Current law generally requires nursing home patients receiving methadone treatment for opioid addiction to receive that treatment at the substance abuse treatment facility rather than in the nursing home.

If the commissioner approves the request, he may impose conditions to ensure patients' health, safety, or welfare. He may revoke the approval if he finds that any patient's health, safety, or welfare has been jeopardized.

5-7 & 33 — INSTITUTIONAL LICENSING DEFINITIONS

The bill amends certain definitions related to the licensing of health care institutions.

Behavioral Health Facility

The bill renames a “mental health facility” as a “behavioral health facility.” It defines “behavioral health facility” as any facility providing mental health services to individuals age 18 or older, or substance use disorder services to individuals of any age, in an outpatient or residential setting to ameliorate mental, emotional, behavioral, or substance use disorder issues. Current law defines “mental health facility” as any facility providing care or treatment for individuals with mental illness or emotional disturbance, or any mental health outpatient treatment facility providing treatment to individuals age 16 or older who are receiving services from the Department of Mental Health and Addiction Services, but not including family care homes for the mentally ill.

Nursing Homes, Residential Care Homes, and Rest Homes

For institutional licensing purposes, current law defines a residential care home (RCH), nursing home, or rest home as an establishment that (1) furnishes, in single or multiple facilities, food and shelter to at least two unrelated people and to the proprietor and (2) provides services beyond the basic needs of providing food, shelter, and laundry.

The bill amends this definition and applies it to RCHs and rest homes, but not nursing homes. It specifies that an RCH or rest home is a community residence that provides these services. It also provides that an RCH or rest home may qualify as a setting that allows residents to receive home- and community-based services funded by state and federal programs.

The bill removes “rest home” from the list of DPH-licensed institutions. In practice, rest homes are not licensed as their own category, but either as RCHs or as a subset of nursing home facilities (rest homes with nursing supervision).

The bill creates a separate definition for “nursing home facility” for institutional licensing purposes, defining it the same way as statutes related to nursing home oversight. Under this definition, a nursing home facility is a (1) chronic and convalescent nursing home (CCNH) or rest home with nursing supervision that provides 24-hour nursing supervision under a medical director or (2) CCNH that provides skilled nursing care under medical supervision and direction to carry out nonsurgical treatment and dietary procedures for chronic or acute diseases, convalescent stages, or injuries.

The bill also makes related technical and conforming changes.

8 — MOLST PILOT PROGRAM

The bill extends the end date for DPH's medical orders for life sustaining treatment (MOLST) pilot program, from October 1, 2016 to October 2, 2017.

EFFECTIVE DATE: Upon passage

9 — DENTAL ANESTHESIA

The bill allows the DPH commissioner to deny or revoke a dental permit for moderate sedation, deep sedation, or general anesthesia based on state dental commission disciplinary action against the dentist.

10-13 — INFECTION CONTROL IN DENTAL SETTINGS

Continuing Education

The bill requires dentists and dental hygienists to complete at least one contact hour (i.e., 50 minutes) every two years of training or education in infection control in a dental setting, as part of existing continuing education requirements.

The bill makes a corresponding change by providing that dentists' other continuing education must include at least one contact hour in any three, rather than four, of the 10 mandatory topics prescribed by the DPH commissioner.

By law, starting with their second license renewal, (1) dentists generally must complete 25 contact hours of continuing education every two years and (2) dental hygienists generally must complete 16 contact hours every two years.

Dental Commission Disciplinary Action

The bill allows the dental commission to take disciplinary action against a dentist for failure to adhere to the most recent version of the National Centers for Disease Control and Prevention's guidelines for infection control in dental settings.

Dental Assistants

Existing law allows dentists to delegate certain procedures to dental assistants. Starting on January 1, 2018, the bill prohibits dentists from delegating any dental procedures to a dental assistant who has not provided the dentist a record documenting that he or she passed the Dental Assisting National Board's infection control examination. The bill also requires dentists delegating procedures to an assistant to keep these records for inspection on DPH's request.

14 — SOCIAL WORK

The bill repeals an obsolete provision allowing an unlicensed person with a master's or doctoral degree to satisfy the work experience requirement for social work licensure by gaining social work experience under professional supervision.

Last year, DPH implemented a licensure program for master social workers as a separate license from clinical social workers. Master social workers must have a master's or doctoral degree and work under professional supervision while gaining the work experience needed for the clinical social worker license.

15-19 — NURSE-MIDWIFERY CERTIFYING AND ACCREDITING ORGANIZATIONS

The bill updates the names of the certification and accreditation bodies for nurse-midwives. It refers to the “Accreditation Midwifery Certification Board” and “Accreditation Commission for Midwifery Education,” rather than to the “American College of Nurse-Midwives.”

20 — FEE FOR HAIRDRESSER LICENSE WITHOUT EXAMINATION

The bill increases, from $50 to $100, the fee for a hairdresser's license without examination (which is available to certain applicants licensed in other jurisdictions). The existing fee for licensure by examination is $100.

21 — WELLS FOR SEMIPUBLIC USE

The bill extends several existing provisions concerning private residential wells to “wells for semipublic use,” which the bill does not define. This includes laws:

1. requiring the DPH commissioner to adopt regulations for testing well water quality;

2. requiring the testing company to report the results to the local health authority and DPH if a test was conducted within six months of the property's sale;

3. prohibiting regulations from requiring a test as a consequence or condition of a property sale, transfer, or rental;

4. allowing local health directors to require wells to be tested for certain contaminants if there are reasonable grounds to suspect that contaminants are present in the groundwater; and

5. specifying who may collect samples to determine water quality in the wells.

Existing law allows the DPH commissioner to adopt regulations on the protection and location of new water supply wells for public or semipublic use.

22 — MARRIAGE

The bill specifies that a couple currently married to each other in any jurisdiction are not eligible to marry each other in Connecticut.

23 — NEWBORN SCREENING

The bill specifies that adrenoleukodystrophy (ALD) is part of the required newborn screening tests. It repeals an obsolete provision requiring the DPH commissioner, by October 1, 2015, to execute an agreement with the New York State Department of Health to (1) conduct a newborn screening test for ALD using dried blood spots and (2) develop a quality assurance testing method for the screening test.

It also makes a technical change.

24 — HOSPITAL RECORD STORAGE

The bill allows chronic disease hospitals and children's hospitals to maintain their medical records at an off-site location as long as they can retrieve them within 24 hours of a request for them. Current law requires the records to be kept on-site.

Under existing law and the bill, these provisions do not apply to nurses' notes at children's hospitals.

25 — DELIVERY OF UNCLAIMED DECEASED BODY

The bill gives acute care hospitals seven days to notify DPH and deliver an unclaimed dead body in its possession to a listed higher education institution for use in medical study. Current law requires hospitals to do so within 24 hours.

26 — DIET ORDERS FROM A DIETITIAN-NUTRITIONIST

Existing law allows certified dietitian-nutritionists (CDNs) to directly order diets for patients, including therapeutic diets for patients in health care institutions. Under current law, a physician must countersign the order within 72 hours unless state or federal law provides otherwise. The bill eliminates this requirement.

By law, physicians may convey verbal orders to CDNs for such diets. The bill requires these orders to be reduced to writing and countersigned by a physician within 72 hours unless state or federal law provides otherwise.

27 — PLACENTA REMOVAL FROM HOSPITALS

Under specified conditions, the bill permits a hospital to allow a woman who has given birth in the hospital, or her spouse if she is incapacitated or deceased, to take possession of the placenta and remove it from the hospital.

The woman who gave birth must test negative for infectious diseases. Also, the woman (or her spouse) taking possession of the placenta must:

1. do so for personal use and not for resale and

2. provide a written acknowledgment that (a) she (or her spouse) received from the hospital educational information on the spread of blood-borne diseases from a placenta, the danger of ingesting formalin, and the proper handling of a placenta, and (b) the placenta is for personal use.

The hospital must retain the signed acknowledgment with the woman's medical records.

The bill specifies that these provisions do not (1) prohibit a pathological examination of the delivered placenta ordered by a physician or required by hospital policy or (2) authorize a woman or her spouse to interfere with such an examination. The bill does not allow a woman or her spouse to take possession of the portion of a placenta needed for such an examination.

Under the bill, a hospital that allows someone to possess and remove a placenta under these provisions:

1. is not required to dispose of the placenta as biomedical waste and

2. is immune from liability in a civil action, criminal prosecution, or administrative proceeding for allowing this.

28 — PSYCHOLOGY TECHNICIANS

The bill allows psychology technicians with specified education and training to provide certain services related to psychological testing.

Under the bill, a “psychology technician” has a bachelor's or graduate degree in psychology or another mental health field and completed at least 80 hours of training by a licensed psychologist, including at least:

1. 16 hours of studying and mastering information from psychological and neuropsychological testing manuals;

2. 20 hours of directly observing the psychologist administering and scoring objective psychological and neuropsychological tests;

3. 40 hours of administering and scoring such tests in the psychologist's presence; and

4. four hours of education in professional ethics and best practices for administering and scoring such tests, including (a) the American Psychological Association (APA) Ethical Principles of Psychologists and Code of Conduct and (b) legal obligations on patient confidentiality and reporting any suspicion of patient abuse or neglect.

Under the bill, a technician's services may include administering and scoring such tests with specific, predetermined, and manualized administrative procedures. A technician's responsibilities may include observing and describing the patient's behavior and test responses, but not evaluating, interpreting, or making other judgments concerning the patient or the patient's test responses.

The bill allows these technicians to provide objective psychological and neuropsychological testing services under a psychologist's supervision and direction, as long as (1) the psychologist is satisfied as to the technician's ability and competency, (2) the services are consistent with the patient's health and welfare and with the practice of psychology, and (3) the psychologist oversees, controls, and directs the services.

The bill prohibits such a technician from:

1. selecting tests;

2. conducting intake assessments;

3. conducting clinical interviews, including interviews of the patient, the patient's relatives or friends, or other professionals associated with the patient;

4. interpreting patient data;

5. communicating test results or treatment recommendations to patients; or

6. administering tests in educational institutions.

These provisions do not apply to the activities and services of a person enrolled in a psychology technician educational program acceptable to the APA, if the activities and services are incidental to the course of study.

29 — PHYSICIAN CONTINUING EDUCATION

The bill adds the Connecticut Osteopathic Medical Society to the list of qualifying continuing education providers for physicians. It also updates the name of another such qualifying organization, from “American Osteopathic Medical Association” to “American Osteopathic Association.”

EFFECTIVE DATE: Upon passage

30-32 — MARRIAGES AT TRIBAL RESERVATIONS

Existing law requires recognition of marriages (or relationships that provide substantially the same rights, benefits, and responsibilities) between two people entered into in other jurisdictions and recognized as valid in that jurisdiction, unless the relationship is expressly prohibited by Connecticut law. The bill:

1. specifies that this includes recognition of marriages entered into at the Mashantucket Pequot and Mohegan reservations;

2. exempts such marriages from requirements that generally apply to Connecticut marriages regarding marriage licenses and related matters; and

3. recognizes as valid any marriages celebrated before the bill's passage under a tribal marriage license at the Mashantucket Pequot and Mohegan reservations, as long as the marriage was recognized under the applicable tribal law and is not otherwise expressly prohibited by state law.

EFFECTIVE DATE: Upon passage

34 — REPEALER

The bill repeals laws:

1. establishing within DPH a birth defects surveillance program, within available funds, and specifying the confidentiality of information collected by the program (CGS 19a-56a and -56b);

2. allowing DPH to provide loans for the purchase of in-home hemodialysis machines (CGS 19a-57); and

3. requiring DPH to appoint an advisory panel on the regulation of nurse-midwives (CGS 20-86d).

COMMITTEE ACTION

Public Health Committee

Joint Favorable Substitute

Yea

27

Nay

1

(03/21/2016)