OLR Bill Analysis

sHB 5537 (as amended by House "A")*

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, it:

1. makes changes affecting local health departments, such as establishing a process to address alleged impropriety by local health directors or their employees;

2. creates a new designation of dental assistant and requires dental professionals to take continuing education in infection control;

3. allows nursing home patients to receive methadone treatment for opioid addiction at the nursing home;

4. recognizes in statute a category of psychology technicians and allows them to provide services related to psychological testing;

5. as of July 1, 2017, eliminates the Office of Protection and Advocacy for Persons with Disabilities and requires the governor to designate a nonprofit entity to serve this function;

6. creates a diabetes advisory council in DPH, within available appropriations; and

7. creates a nail salon working group and a medical records task force.

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); newborn screening; medication administration by unlicensed personnel; music or art therapists; hospice care residences; medical assistants; Medicaid overpayment audits; and funeral directors and embalmers.

A section-by-section summary appears below.

*House Amendment “A” adds provisions on  (1) medication administration by unlicensed personnel, (2) music and art therapists, (3) hospice zoning regulations, (4) dental assistants and expanded function dental assistants, (5) local health departments, (6) certified medical assistants, (7) a nail salon working group, (8) Medicaid overpayment audits, (9) a medical records task force, (10) the Office of Protection and Advocacy for Persons with Disabilities, (11) a diabetes advisory council, and (12) funeral directors and embalmers.

It also makes changes to the bill's underlying provisions, such as (1) adding to the list of providers who must report on other impaired providers and (2) several minor and clarifying changes.

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 (JSS), created a parallel reporting requirement covering most other licensed or permitted health care professionals.

The bill includes the following within the reporting requirement created by PA 15-5, JSS: physicians, PAs, nursing home administrators, perfusionists, electrologists, and audiologists.

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 & 32 — 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.

10-12 — INFECTION CONTROL IN DENTAL SETTINGS

Continuing Education for Dentists and Dental Hygienists

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 requirement applies to registration periods beginning on and after October 1, 2016.

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.

13 — 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.

14-18 — 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.”

19 — 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.

20 — 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.

21 — MARRIAGE

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

22 — 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.

23 — HOSPITAL RECORD STORAGE

The bill allows chronic disease hospitals and children's hospitals to maintain their medical records off-site as long as they can retrieve them by the end of the next business day after a request for them. Current law requires the records to be kept on-site.

For children's hospitals, current law exempts nurses' notes from the requirement to keep records on-site. The bill removes this exemption and applies the same rule as described above.

24 — 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.

25 — 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 also allows advance practice registered nurses (APRNs) to do so. It requires these orders to be reduced to writing and countersigned by a physician or APRN within 72 hours unless state or federal law provides otherwise.

The bill requires nurses and PAs to act upon such CDN orders as if they were received directly by a physician or APRN, not just a physician as under current law.

26 — 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.

27 — 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 has 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.

28 — 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

29-31 — 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

33 & 34 — MEDICATION ADMINISTRATION BY UNLICENSED PERSONNEL

Existing law permits a registered nurse to delegate the administration of medications that are not injected into patients to homemaker-home health aides who obtain certification for medication administration. It also allows residential care homes (RCH) that admit residents requiring medication administration assistance to employ a sufficient number of certified, unlicensed personnel to perform this function in accordance with DPH regulations.

The bill requires these homemaker-home health aides and RCH unlicensed personnel to obtain recertification every three years to continue to administer medication. It also makes conforming changes in requirements for DPH regulations on medication administration.

35 & 36 — MUSIC AND ART THERAPISTS

The bill generally makes it a class D felony to represent oneself as a music therapist or art therapist unless meeting certain certification and education requirements. Class D felonies are punishable by up to five years in prison, a fine of up to $5,000, or both.

Specifically, the bill prohibits someone not certified as a music therapist (as defined below) from using (1) the title “music therapist” or “certified music therapist” or (2) any title, words, letters, abbreviations, or insignia indicating or implying that he or she is a certified music therapist. It similarly prohibits someone not certified as an art therapist (as defined below) from using the title “art therapist” or “certified art therapist” or similar terms indicating or implying such certification. Each contact or consultation with an individual in violation of these provisions is a separate offense.

For both professions, the bill provides exemptions from this prohibition, such as for other licensed individuals providing music or art therapy under specified conditions.

Definitions

The bill defines “music therapy” as the clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed a music therapy program approved by the American Music Therapy Association or any successor association. It defines a “music therapist” as someone who (1) has a bachelor's or graduate degree in music therapy or a related field from an accredited higher education institution and (2) is certified as a music therapist by the Certification Board for Music Therapists or any successor board.

The bill defines “art therapy” as the clinical and evidence-based use of art, including art media, the creative process, and the resulting artwork, to accomplish individualized goals within a therapeutic relationship, by a credentialed professional who has completed an art therapy program approved by the American Art Therapy Association or any successor association. It defines an “art therapist” as someone who (1) has a bachelor's or graduate degree in art therapy or a related field from an accredited higher education institution and (2) is certified as an art therapist by the Art Therapy Credentials Board or any successor board.

Exemptions

For music therapists, the bill's restrictions do not apply to:

1. individuals (a) licensed, certified, or regulated under state law in another profession or occupation, such as occupational or physical therapy, speech and language pathology, audiology, or counseling or (b) supervised by such a licensed, certified, or regulated individual, and who use music in their practice and incidental to it, as long as they do not hold themselves out as music therapists;

2. other professionals whose training and national certification demonstrate their ability to practice their certified occupation or profession, and whose use of music is incidental to this other practice, as long as they do not hold themselves out as music therapists; and

3. students enrolled in a music therapy or graduate music therapy educational program approved by the American Music Therapy Association or any successor association, in which music therapy is an integral part of the course of study, if performing such therapy under a music therapist's direct supervision.

For art therapists, the bill's restrictions do not apply to:

1. individuals providing art therapy while acting within the scope of practice of their license and training, as long as they do not hold themselves out as art therapists and

2. students enrolled in an art therapy or graduate art therapy educational program approved by the American Art Therapy Association or any successor association, in which art therapy is an integral part of the course of study, if performing such therapy under an art therapist's direct supervision.

37 — HOSPICE FACILITIES AND ZONING

Current law requires local zoning regulations to treat as single-family homes certain DPH-licensed inpatient hospice facilities serving up to six people.

The bill instead requires local zoning regulations to treat as single-family homes certain residences that provide licensed hospice care for up to six people, presumably on an inpatient or outpatient basis. It specifies that this requirement only applies if the residence was built in compliance with the applicable building code for occupancy by six or fewer people who are not capable of self-preservation.

Under existing law, unchanged by the bill, this zoning requirement applies only to such residences that are:

1. managed by a tax-exempt nonprofit organization,

2. served by public sewer and water, and

3. located in a city with more than 100,000 residents within a zone allowing development on one or more acres.

38 — DENTAL ASSISTANTS

The bill establishes a new designation of dental assistant called expanded function dental assistants (“EFDAs”). It changes some of the procedures a dentist can delegate to other dental assistants, allows a dentist to delegate more procedures if the assistant is an EFDA, and specifies the level of supervision required for both types of assistants.

The bill places a number of requirements on EFDAs and the dentists that hire them. It requires dental assistants to receive training in infection control, starting in 2018. It also allows the DPH commissioner to adopt implementing regulations.

Dental Assistant Definitions

The bill defines dental assistants and EFDAs as follows.

“Dental assistant” means a person who has met any requirements the DPH commissioner establishes through regulations and has completed one of the following: (1) on-the-job training in dental assisting under direct supervision, as defined below, or (2) a dental assistant education program (a) accredited by the American Dental Association's (ADA) Commission on Dental Accreditation or (b) accredited or recognized by the New England Association of Schools and Colleges.

“Expanded function dental assistant” means a dental assistant who has passed the Dental Assisting National Board's (DANB) certified dental assistant or certified orthodontic assistant examination, and then successfully completed:

1. an EFDA program at a higher education institution accredited by the ADA's Commission on Dental Accreditation and

2. a DANB-administered comprehensive written examination on certified preventive and restorative functions.

An EFDA's education program must have included:

1. courses on didactic and laboratory preclinical objectives for skills used by EFDAs, with required demonstration of these skills before advancing to clinical practice;

2. at least four hours of education on the ethics and professional standards for dental professionals; and

3. a comprehensive clinical examination at the program's conclusion.

Supervision Requirement

Current law allows dentists to delegate certain dental procedures to dental assistants, and provides that any such procedures must be performed under the dentist's supervision and control.

Under the bill, if a dental assistant is not an EFDA, any such procedures must be performed under a dentist's direct supervision. Procedures by EFDAs must be performed under a dentist's direct or indirect supervision.

“Direct supervision” means a dentist has authorized a dental assistant or EFDA to perform certain procedures with the dentist remaining on-site in the office or facility while the procedures are performed and, before the patient leaves, the dentist reviews and approves the assistant's treatment.

“Indirect supervision” means a dentist has personally diagnosed the condition, planned the treatment, authorized the procedures to be performed, remains in the dental office or facility while the assistant or EFDA performs the procedures, and evaluates the assistant's or EFDA's performance.

As under existing law for other dental assistants, the bill requires a dentist supervising an EFDA to assume responsibility for the EFDA's procedures.

Permissible and Impermissible Delegated Functions

The bill makes various changes to the list of procedures that dentists may delegate to assistants.

The bill permits dental assistants to take impressions of a patient's teeth for study models. It prohibits dental assistants from taking final impressions of the teeth or jaws for purposes of fabricating an appliance or prosthesis (current law prohibits them from taking any such impressions, not just final ones).

Current law permits dental assistants to take dental x-rays if the assistant has successfully completed the dental radiography portion of a DANB-prescribed examination. The bill changes this to a DANB-administered dental radiation health and safety exam.

Under current law, dental assistants may not place, finish, or adjust temporary or final restorations, capping materials, and cement bases. The bill allows EFDAs to perform these functions, except it refers to “long-term individual fillings” rather than “final restorations.”

The bill also allows dentists to delegate the following to EFDAs:

1. coronal polishing, as long as the procedure is not represented or billed as prophylaxis;

2. oral health education for patients; and

3. dental sealants.

EFDA Requirements

Under the bill, an EFDA must:

1. maintain dental assistant or orthodontic assistant certification from DANB;

2. conspicuously display the certificate in the place of employment or place where he or she provides EFDA services;

3. maintain professional liability insurance or other indemnity against liability for professional malpractice of at least $500,000 for one person, per occurrence, with an aggregate liability of at least $1.5 million;

4. limit his or her practice to providing services under the indirect or direct supervision of a licensed dentist; and

5. meet any requirements the DPH commissioner establishes through regulations (see below).

Dentist Requirements

Under the bill, each dentist employing an EFDA or otherwise engaging an EFDA's services must:

1. beforehand, verify that the EFDA meets the bill's education, examination, certification, and liability insurance requirements;

2. maintain, on the premises where the EFDA works, documentation of the EFDA having met these requirements;

3. make the documentation available to DPH upon request; and

4. provide direct or indirect supervision to no more than (a) two EFDAs providing services at one time or (b) four EFDAs providing services at one time if the dentist's practice is limited to orthodontics.

Infection Control

The bill establishes requirements for dental assistants to receive training in infection control. These requirements apply to regular assistants and EFDAs.

Starting on January 1, 2018, the bill:

1. generally 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 DANB's infection control examination (but the bill allows EFDAs to perform certain functions even if they do not receive this training);

2. allows an assistant to receive up to nine months' of on-the-job training by the dentist to prepare the assistant for the examination; and

3. requires dentists delegating procedures to an assistant to keep the records documenting passage of the examination for inspection on DPH's request.

Starting on January 1, 2018, the bill also requires dental assistants, after successfully completing DANB's infection control examination, to complete at least one hour of training or education every two years in infection control in a dental setting. This may include courses (including on-line courses) offered or approved by a dental school or another higher education institution that is accredited or recognized by the Commission on Dental Accreditation; a regional accrediting organization; the ADA; or a state, district, or local dental association or society affiliated with the ADA or the American Dental Assistants Association.

Regulations

The bill authorizes the DPH commissioner, in consultation with the State Dental Commission, to adopt implementing regulations. If the commissioner adopts regulations, they must identify the:

1. types of procedures that a dental assistant and EFDA can perform, consistent with the bill;

2. appropriate number of didactic, preclinical, and clinical hours or number of procedures to be evaluated for clinical competency for each skill an EFDA can employ; and

3. level of supervision required for each procedure an EFDA can perform.

39-42 — LOCAL HEALTH DEPARTMENTS

Serving in a Full-Time Capacity

The bill requires district health directors to serve in a full-time capacity, instead of devoting their “entire time” to performing the duties of the position, as is required under current law. Existing law requires this of certain municipal health directors (see BACKGROUND).

Additionally, it prohibits (1) district health directors and (2) municipal health directors in towns with a population of at least 40,000 for five consecutive years from having a financial interest or engaging in a job, transaction, or professional activity that substantially conflicts with the director's duties.

By law, a municipal or district health director generally must (1) be a licensed physician and hold a public health degree from an accredited school, college, university, or institution or (2) hold a graduate public health degree from an accredited school, college, or institution.

EFFECTIVE DATE: July 1, 2016

Impropriety on Behalf of Local Health Department Directors or Employees

The bill requires the DPH commissioner to take certain action if he reasonably suspects impropriety on the part of a municipal or district health director or the director's employee related to the performance of their duties. Specifically, the commissioner must notify the municipal or district health department's governing authority and provide any evidence of such impropriety for the purposes of reviewing and assessing the director's or employee's compliance with their duties.

The governing authority must report its findings to the commissioner within 90 days after completing the review and assessment.

Under the bill, a director's employee includes (1) an employee of, (2) a consultant employed or retained by, or (3) an independent contractor retained by, a municipal or district health department or a director.  

Review of Local Health Department Statutes

The bill requires the DPH commissioner to review the statutes related to local health departments to determine if they need revising. He must submit his determination to the Public Health Committee by January 1, 2017.

43 — LIST OF CERTIFIED MEDICAL ASSISTANTS

By law, the DPH commissioner must annually obtain from the American Association of Medical Assistants a list of all state residents on the organization's registry of certified medical assistants. DPH must make the list available to the public. The bill extends this requirement to also include a comparable list from the National Healthcareer Association.

EFFECTIVE DATE: Upon passage

44 — NAIL SALON WORKING GROUP

The bill establishes an eight-member working group to consider matters relating to nail salons and nail technicians' services. These matters may include, among other things:

1. standards for nail salons to protect customers' health and safety;

2. licensure or certification standards for nail technicians, including educational and training requirements;

3. nail technicians' working conditions;

4. fair and equitable business practices; and

5. developing informational publications, in multiple languages as appropriate, to advise nail salon owners and managers of applicable state laws and regulations.

The working group must report its findings and recommendations to the Public Health Committee by January 1, 2017. The group terminates on the date it submits the report or January 1, 2017, whichever is later.

Membership and Procedure

Under the bill, the working group's membership includes the Public Health committee chairs or their designees and one member appointed by each of the six legislative leaders, as follows.

Table 1: Legislative Leaders' Appointments to Nail Salon Working Group

Appointing Authority

Member Qualifications

House speaker

Owner of two or more nail salons in Connecticut

Senate president pro tempore

Individual with at least two years' work experience as a nail technician

House majority leader

Representative of the Nail and Spa Association of Connecticut

Senate majority leader

Qualifications unspecified

House minority leader

Owner of one nail salon employing fewer than five people

Senate minority leader

Individual with experience working as a nail technician

Appointments must be made no later than 30 days after the bill's passage. Any member of the working group may be a legislator. The appropriate appointing authority fills any vacancy.

The House speaker and Senate president pro tempore must select a chairperson from among the group members. The chairperson must schedule the first working group meeting, which must be held within 60 days after the bill's passage.

EFFECTIVE DATE: Upon passage

45 — MEDICAID OVERPAYMENT AUDITS

The bill allows the Department of Social Services (DSS), in consultation with the Office of Policy and Management (OPM) secretary, to waive recoupment of an audit finding of a Medicaid overpayment made to a hospital that was under prior ownership during part of the audit period.

EFFECTIVE DATE: Upon passage

46 — MEDICAL RECORDS TASK FORCE

The bill establishes a 10-member task force to study the furnishing of medical records by health care providers and institutions. The study must examine the (1) time frame for health care providers or institutions to respond to a request for medical records, (2) cost for research and copies in response to such requests, and (3) requirements of HIPAA regulations concerning individuals' access to their own protected health information.

By January 1, 2017, the task force must report its findings and recommendations to the Public Health Committee. The task force terminates on the date that it submits its report or January 1, 2017, whichever is later.

The task force must include the appointees designated in Table 1. Any of the appointees may be a legislator.

Table 1: Appointed Task Force Members

Appointing Authority

Number of Appointees

Qualifications

House speaker

2

One must be a representative of a business that provides health information management services

One must be a member of the Public Health Committee

Senate president pro tempore

2

one must be a representative of the Connecticut Trial Lawyers Association

one must be a member of the Public Health Committee

House majority leader

1

None specified

Senate majority leader

1

A patient advocate

House minority leader

2

One must be a representative of the Connecticut State Medical Society

One must be a member of the Public Health Committee

Senate minority leader

2

One must be a representative of the Connecticut Hospital Association

One must be a member of the Public Health Committee

The House speaker and the Senate president pro tempore select the chairperson from among the task force members. All appointments must be made and the chairperson must schedule and hold the first meeting within 30 and 60 days, respectively, after the bill's passage. Appointing authorities must fill any vacancies.

EFFECTIVE DATE: Upon passage

47-50 — OFFICE OF PROTECTION AND ADVOCACY FOR PERSONS WITH DISABILITIES AND THE BOARD OF ADVOCACY AND PROTECTION FOR PERSONS WITH DISABILITIES

Effective July 1, 2017, the bill eliminates the Office of Protection and Advocacy for Persons with Disabilities (OPA) and the Board of Advocacy and Protection for Persons with Disabilities (“the board”). OPA currently (1) provides protection, advocacy, and client assistance functions to people with disabilities and (2) investigates alleged abuse of individuals with intellectual disabilities or receiving services from the Department of Developmental Services' Division of Autism Spectrum Disorder Services. The board currently advises the OPA executive director on matters relating to advocacy policy, client service priorities, and issues affecting persons with disabilities.

The bill also establishes the Connecticut protection and advocacy system (“the system”), which is a nonprofit entity designated by the governor to serve as the state's protection and advocacy system and client assistance program. Under the bill, the system must provide (1) protection and advocacy services for people with disabilities, as provided by federal law and (2) a client assistance program for people with disabilities as provided by federal law. (Certain federal funding is contingent on the state having such a program in place.) Former OPA employees and board members may serve on the system's board or work as a system employee, provided they are not employed by the system while employed by the state.

The bill requires (1) OPM, by October 1, 2016, to issue a request for information from nonprofit entities regarding their ability to serve as the system and (2) the governor to designate an entity to serve as the system by July 1, 2017. For the governor's designation, the bill waives certain state contracting requirements, including those related to privatization contracts and personal service contracts.

It transfers OPA's (1) investigatory responsibilities to the Department of Rehabilitation Services effective July 1, 2017 and (2) protection and advocacy and client assistance functions to the system, though it allows OPA, prior to its elimination and with OPM approval, to contract out any of its non-investigatory services to one or more non-state entities. For this purpose, the bill waives requirements related to state contracting and privatization of state services.

The bill requires OPA, by November 1, 2016 and in consultation with the board, to submit a plan to the OPM secretary that (1) is consistent with state and federal law, (2) provides for the effective transfer, by July 1, 2017, of OPA's protection, advocacy and client assistance program functions to a nonprofit entity, and (3) includes any proposed legislative changes. Any work in progress, other than investigations, on July 1, 2017, must be completed by the system in accordance with federal regulations and in the same manner and with the same effect as if OPA completed it prior to its elimination.

EFFECTIVE DATE: Upon passage, except for the provision that eliminates OPA and the board, which is effective July 1, 2017.

51 — DIABETES ADVISORY COUNCIL

The bill establishes, within available appropriations, a Diabetes Advisory Council within DPH. The council must (1) analyze the current state of diabetes prevention, control, and treatment in Connecticut and (2) advise DPH on methods to achieve the federal Centers for Disease Control and Prevention's goal in granting funds to the state for diabetes prevention. It consists of state officials and appointees.

Duties

The bill requires the council to make recommendations to enhance and support diabetes prevention, control and treatment programs. To do this, the council must review the following:

1. strategies to identify and enroll individuals at risk of diabetes in prevention programs;

2. strategies to identify and refer individuals with diabetes for enrollment in formal education classes and management programs;

3. the status of health care organizations reporting on clinical quality measures related to diabetes control;

4. existing state programs that address prevention, control, and treatment; and

5. evidence that supports the need for such programs.

Additionally, the bill permits the council to study the (1) effectiveness of existing state diabetes programs; (2) financial impact of diabetes on the state, including disease prevalence and the cost for administering related programs; and (3) coordination of state agency programs and other efforts to prevent, control, and treat diabetes.

The council may also develop an action plan with steps to reduce diabetes impact on the state, including expected outcomes for each step toward prevention, control, and treatment.

Lastly, the bill requires the council, by January 1, 2017, to submit a progress report on its findings and recommendations to the Public Health Committee. It must then report final findings and recommendations to the committee by May 1, 2017. The council terminates on the date it submits the final report or January 1, 2018, whichever is later.

Membership

The state officials on the council are the social services commissioner, comptroller, executive directors of the Latino and Puerto Rican Affairs and African-American Affairs Commissions, and Public Health Committee co-chairs, or their designees. Under the bill, one of the Public Health Committee co-chairs' designees may be a legislator.

The bill requires the DPH commissioner to appoint the following council members within 90 days after the bill's passage:

1. two DPH representatives;

2. one member of the Connecticut Alliance of Diabetes Educators;

3. one diabetes prevention advocate;

4. one representative each from two locations of the Young Men's Christian Association in the state that provide a diabetes prevention program;

5. one representative of an insurance carrier that covers Connecticut residents;

6. one representative each from two federally qualified health centers;

7. one representative of the Connecticut State Medical Society;

8. one representative of an accountable care organization;

9. one primary health care provider who is not employed by a hospital, federally qualified health center, or accountable care organization;

10. two representatives of a research and bioscience manufacturer with expertise in metabolic diseases; and

11. any additional member the commissioner determines would be beneficial to serve on the council.

The members must elect a chairperson from among its membership. A majority of council members constitutes a quorum and any action the council takes requires a majority vote of those present.

Council members are not compensated, but are reimbursed for necessary expenses incurred in performing their duties.

EFFECTIVE DATE: Upon passage

52 — FUNERAL DIRECTORS AND EMBALMERS

Under existing law, DPH may take disciplinary action against a funeral director or embalmer for various reasons, including fraud or deceit in obtaining or attempting to obtain a license, registration, or inspection certificate.

Notwithstanding these provisions, the bill prohibits DPH from revoking or suspending the license of a funeral director or embalmer for the reason noted above before April 1, 2017 if the individual completed an examination as part of a program in funeral directing and embalming at a higher education institution that lost its accreditation within 24 months of the bill's passage.

EFFECTIVE DATE: Upon passage

53 — 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).

BACKGROUND

Local Health Departments

Connecticut has 73 local health departments, of which 53 are full-time departments and 20 are part-time. The full-time departments include 33 individual municipal health departments and 20 health district departments (multi-town departments serving from two to 20 towns).

Municipal Health Directors

By law, a municipal health director in a town with a population of at least 40,000 for five consecutive years must serve in a full-time capacity. But the director may serve part-time if the town also designates him or her as the chief medical advisor for its public schools.

COMMITTEE ACTION

Public Health Committee

Joint Favorable Substitute

Yea

27

Nay

1

(03/21/2016)