PA 16-66—sHB 5537

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.

For example, it does the following:

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 dental assistant designation 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 under certain conditions;

4. recognizes in statute a category of psychology technicians and allows them to provide certain psychological testing services if acting under a psychologist's supervision;

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 act 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 on 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.

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

The act makes engaging in the practice of tattooing without a license or temporary permit a class D misdemeanor (see Table on Penalties).

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). A 2015 law created a parallel reporting requirement covering most other licensed or permitted health care professionals.

The act subjects physicians and PAs to this parallel reporting requirement as well as nursing home administrators, perfusionists, electrologists, and audiologists.

4 — METHADONE FOR OPIOID ADDICTION IN NURSING HOMES

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

Prior law generally required 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.

5-7 & 32 — INSTITUTIONAL LICENSING DEFINITIONS

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

Behavioral Health Facility

The act renames a “mental health facility” as a “behavioral health facility,” which it defines 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. Prior law defined “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, not including family care homes for the mentally ill.

Nursing Homes, Residential Care Homes, and Rest Homes

For institutional licensing purposes, prior law defined 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) delivers services beyond the basic needs of providing food, shelter, and laundry.

The act amends this definition by designating RCHs and rest homes, but not nursing homes, as community residences and specifies that these facilities are the ones that provide the services listed above. 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 act eliminates “rest home” as a separate category of facilities requiring a DPH license. In practice, rest homes are not licensed as their own category but either as RCHs or a subset of nursing home facilities (i. e. , rest homes with nursing supervision).

The act 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 providing 24-hour nursing supervision under a medical director or (2) CCNH providing 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 act also makes related technical and conforming changes.

8 — MEDICAL ORDERS FOR LIFE SUSTAINING TREATMENT (MOLST) PILOT PROGRAM

The act extends the end date for DPH's MOLST pilot program from October 1, 2016 to October 2, 2017.

EFFECTIVE DATE: Upon passage

9 — DENTAL ANESTHESIA

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

10-12 — INFECTION CONTROL IN DENTAL SETTINGS

Continuing Education for Dentists and Dental Hygienists

The act requires dentists and dental hygienists to complete at least one contact hour 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 act 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 act allows the dental commission to take disciplinary action against a dentist for failure to adhere to the National Centers for Disease Control and Prevention's guidelines for infection control in dental settings.

13 — SOCIAL WORK

The act repeals an obsolete provision that allowed an unlicensed person with a master's or doctoral degree to satisfy the work experience requirement for clinical social worker licensure by gaining social work experience under professional supervision. The provision became obsolete in 2014 after 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 act 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 act increases, from $50 to $100, the fee for a hairdresser's license without examination (which is available to certain applicants already licensed outside of Connecticut). The existing fee for licensure by examination is $100.

20 — WELLS FOR SEMIPUBLIC USE

The act extends several existing provisions concerning the regulation of private residential wells to “wells for semipublic use. ” This includes laws that do the following:

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

2. require the testing company to report the results to the local health authority and DPH under certain circumstances;

3. prohibit regulations from requiring well testing as a consequence or condition of a property sale, transfer, or rental;

4. allow 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. specify 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 act specifies that a couple already married to each other in Connecticut or another jurisdiction are not eligible to marry each other in Connecticut.

22 — NEWBORN SCREENING

The act specifies that adrenoleukodystrophy (ALD) is part of the required newborn screening tests. It repeals an obsolete provision which required 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 act gives chronic disease hospitals and children's hospitals the option to (1) keep their medical records on-site in an accessible manner or (2) maintain them off-site as long as they can retrieve them by the end of the next business day after a request for them. Prior law required the records to be kept on-site.

The act establishes the same options for children's hospitals regarding nurses' notes. Prior law exempted children's hospital nurses' notes from the requirement to keep records on-site.

24 — DELIVERY OF UNCLAIMED DECEASED BODY

The act gives acute care hospitals up to seven days to notify DPH and deliver an unclaimed dead body in its possession to one of certain higher education institutions listed in statute for use in medical study, if the hospital had notice that a listed school needs bodies for this purpose. Prior law required them to complete these tasks 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 prior law, a physician had to countersign the order within 72 hours unless state or federal law provided otherwise. The act eliminates this requirement.

By law, physicians may convey verbal orders to CDNs for such diets. The act also allows advance practice registered nurses (APRNs) to do so. It requires these orders from physicians or APRNs to be reduced to writing and countersigned by a physician or APRN within 72 hours unless state or federal law provides otherwise.

The act 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 prior law.

26 — PLACENTA REMOVAL FROM HOSPITALS

Under specified conditions, the act 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 sale 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 (a preservative), and the proper handling of a placenta and (b) the placenta is for personal use.

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

The act 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 act does not allow a woman or her spouse to take possession of the portion of a placenta needed for such an examination.

Under the act, a hospital that allows someone to possess and remove a placenta under these provisions is not required to dispose of the placenta as biomedical waste. Also, such a hospital is immune from liability in a civil action, criminal prosecution, or administrative proceeding for allowing this removal.

27 — PSYCHOLOGY TECHNICIANS

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

Under the act, 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 act, a technician's services 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 act 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 act prohibits such a technician from performing the following tasks:

1. selecting tests;

2. conducting intake assessments;

3. conducting clinical interviews, including interviews of the patient or collateral interviews of 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 act 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 ON 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 act:

1. specifies that this includes recognition of marriages entered into on 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 act's passage under a tribal marriage license on the Mashantucket Pequot or Mohegan reservations, as long as the marriage is 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 act 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 act generally makes it a class D felony (see Table on Penalties) to represent oneself as a music therapist or an art therapist unless meeting certain certification and education requirements.

Specifically, the act 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 act provides exemptions from this prohibition, such as for other licensed individuals providing music or art therapy under specified conditions.

Definitions

The act 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 act 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 act's restrictions do not apply to the following people:

1. individuals who use music in their practice incidentally, do not represent themselves to the public as music therapists, and are either (a) licensed, certified, or regulated under state law in another profession or occupation, including occupational or physical therapy, speech and language pathology, audiology, or counseling or (b) supervised by such a licensed, certified, or regulated individual;

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 represent themselves to the public 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 act's restrictions do not apply to the following people:

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

The act changes some of the criteria under which a zoning commission's regulations must treat a facility providing hospice care for up to six people the same as a single-family home. Under prior law, the regulations had to treat a facility the same as a single-family home if DPH licensed the facility as an inpatient hospice facility. The act instead requires the regulations to treat a residence as a single-family home if (1) it provides licensed hospice care for up to six people, presumably on an inpatient or outpatient basis, and (2) it was built in compliance with the building codes that apply to structures housing six or fewer people incapable of self-preservation.

Under the act, the structure must still meet existing law's other requirements to be treated as a single-family home. Specifically, the facility must be (1) managed by a tax-exempt 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 act establishes a new designation of dental assistants 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 act 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 act distinguishes between two types of dental assistants.

A “dental assistant” is someone 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.

An “expanded function dental assistant” is someone who has passed the Dental Assisting National Board's (DANB) certified dental assistant or certified orthodontic assistant examination and then 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 include the following:

1. courses on didactic and laboratory preclinical objectives for skills used by EFDAs that require 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

Under the act, the extent to which a dentist must supervise an assistant's work depends on whether the assistant is a dental assistant or EFDA. The dentist (1) must directly supervise any procedure he or she delegates to a dental assistant who is not an EFDA, and (2) must directly or indirectly supervise any procedure he or she delegates to an EFDA. Prior law required that any procedures delegated to dental assistants be performed under the dentist's supervision and control.

“Direct supervision” occurs when the dentist authorizes 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 or EFDA's treatment.

“Indirect supervision” occurs when the dentist personally diagnoses the condition, plans the treatment, authorizes 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 act requires a dentist supervising an EFDA to assume responsibility for the EFDA's procedures.

Permissible and Impermissible Delegated Functions

The act makes various changes to the list of procedures that dentists may delegate to assistants. It allows them to delegate to dental assistants the taking of impressions of a patient's teeth for study models, but not the taking of final impressions of the teeth or jaws for purposes of fabricating an appliance or prosthesis. (Prior law prohibited them from taking any such impressions, not just final ones. )

The act allows dentists to delegate the taking of dental x-rays if the assistant has passed a DANB-administered dental radiation health and safety exam. Prior law instead referred to the dental radiography portion of a DANB-prescribed examination.

Prior law prohibited dentists from delegating to dental assistants the placing, finishing, or adjusting of temporary or final restorations, capping materials, and cement bases. The act allows EFDAs to perform these functions, except it refers to “long-term individual fillings” rather than “final restorations.

The act 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 act, an EFDA must do the following:

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 act, each dentist employing an EFDA or otherwise engaging an EFDA's services must do the following:

1. beforehand, verify that the EFDA meets the act'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 act requires dental assistants and EFDAs to receive training in infection control. Starting on January 1, 2018, the act:

1. generally prohibits dentists from delegating any dental procedures to a dental assistant or EFDA who has not provided the dentist a record documenting that he or she passed DANB's infection control examination (while allowing EFDAs to perform certain functions even if they do not receive this training);

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

3. requires dentists who delegate procedures to a dental assistant to keep the records documenting the assistant's exam passage for DPH's inspection upon request.

Starting on January 1, 2018, the act also requires dental assistants or EFDAs, 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 online 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 act 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 act; (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 act 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 was required under prior 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.

Local Health Department Director or Employee Impropriety

The act requires the DPH commissioner to take certain actions 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 his or her duties.

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

Under the act, a director's employee includes an employee of, a consultant employed or retained by, or an independent contractor retained by a municipal or district health department or director.  

Review of Local Health Department Statutes

The act 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.

EFFECTIVE DATE: July 1, 2016, except the provisions requiring the DPH commissioner to act on potential health district improprieties take effect October 1, 2016

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. Under the act, starting January 1, 2017, DPH must obtain a comparable list from the National Healthcareer Association and make it available to the public.

EFFECTIVE DATE: Upon passage

44 — NAIL SALON WORKING GROUP

The act 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. development of 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 act, 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 in Table 1.

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 act'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 May 27, 2016.

EFFECTIVE DATE: Upon passage

45 — MEDICAID OVERPAYMENT AUDITS

The act allows the Department of Social Services (DSS) commissioner, 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 act 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 of research and copies in response to such requests, and (3) federal regulation requirements 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 includes the appointees designated in Table 2. Any of the appointees may be a legislator.

Table 2: Medical Records Task Force Members

Appointing Authority

Number of Appointees

Qualifications

House speaker

2

Representative of a business that provides health information management services

Member of the Public Health Committee

Senate president pro tempore

2

Representative of the Connecticut Trial Lawyers Association

Member of the Public Health Committee

House majority leader

1

None specified

Senate majority leader

1

Patient advocate

House minority leader

2

Representative of the Connecticut State Medical Society

Member of the Public Health Committee

Senate minority leader

2

Representative of the Connecticut Hospital Association

Member of the Public Health Committee

Under the act, 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 May 27, 2016. 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 act 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' (DDS) Division of Autism Spectrum Disorder Services (PA 16-3, May Special Session transferred this division from DDS to DSS). The board currently advises the OPA executive director on matters relating to advocacy policy, client service priorities, and issues affecting persons with disabilities.

The act 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 act, 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 act 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 act waives certain state contracting requirements, including those related to privatization contracts and personal service contracts.

The act 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 act waives requirements related to state contracting and privatization of state services.

The act 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 act 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 act 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 act 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 of 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 act 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; the Public Health Committee co-chairs, or their designees; and the executive directors of the Latino and Puerto Rican Affairs and African-American Affairs commissions. (PA 16-3, May Special Session, 127 creates the Commission on Equity and Opportunity and deems it a successor agency to the Latino and Puerto Rican Affairs and African-American Affairs commissions, which that act eliminates. ) Under the act, one of the Public Health Committee co-chairs' designees may be a legislator.

The act requires the DPH commissioner to appoint the following council members within 90 days after the act'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 the council's 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 act prohibits DPH from revoking or suspending the license of a funeral director or embalmer before April 1, 2017 for the reason noted above 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 May 27, 2016.

EFFECTIVE DATE: Upon passage

53 — REPEALER

The act repeals laws that did the following:

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

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

3. required 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 (i. e. , 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.

OLR Tracking: JO/ ND; JR, MS; bs