OLR Bill Analysis
AN ACT CONCERNING THE DEPARTMENT OF PUBLIC HEALTH'S VARIOUS REVISIONS TO THE PUBLIC HEALTH STATUTES.
This bill makes various substantive, minor, and technical changes to Department of Public Health (DPH)-related statutes and programs. For example, it does the following:
1. allows DPH to extend the 60-day limit under which a long-term care facility may conditionally employ a job applicant if the department needs additional time to review the applicant's request to waive a disqualifying offense on his or her background check;
2. allows DPH and its professional licensing boards and commissions to take summary disciplinary action against a practitioner's license or permit if the practitioner is subject to disciplinary action by the federal government; and
3. requires licensed health care institutions to report to DPH any major systems failure (e.g., loss of water or heat) or incident that causes the institution to activate its emergency preparedness plan.
Among other things, the bill also makes changes affecting the following:
1. various licensed institutions, including microbiological and biomedical biosafety labs, and outpatient dialysis units;
2. various licensed health care professionals, including dentists, dental hygienists, marriage and family therapists, occupational therapy assistants, professional counselors, and psychologists;
3. school board reports on asthma;
4. semipublic and private residential wells;
5. birth defect surveillance;
6. newborn screening;
7. “do not resuscitate” orders;
8. equipment purchases for children with disabilities;
10. Quality of Care Advisory Committee;
11. Public Health Preparedness Advisory Committee;
12. Women, Infants, and Children Advisory Council;
13. Interagency and Partnership Advisory Panel on Lupus; and
14. PANDAS/PANS Advisory Council.
A section-by-section summary appears below.
EFFECTIVE DATE: October 1, 2017, except a provision on siting of crematories (§ 18) is effective July 1, 2017.
§ 1 — HEALTH CARE FACILITY LICENSURE APPLICATION FEES
The bill requires applicants for health care facility licensure to submit the required fee to DPH along with their licensure application.
Under existing law, health care facilities licensed by DPH must pay fees for licensure and inspection. The fee amount and inspection frequency vary based on the type of institution.
§ 2 — OUTPATIENT DIALYSIS UNITS
Under existing law, outpatient dialysis units are licensed by DPH. The bill adds a statutory definition of this term, generally codifying the definition in existing regulations (Conn. Agencies Regs., § 19-13-D55a). Thus, it defines an outpatient dialysis unit as:
1. an out-of-hospital out-patient dialysis unit licensed by DPH to provide (a) out-patient services to persons requiring dialysis on a short-term basis or for a chronic condition or (b) training for home dialysis, or
2. an in-hospital dialysis unit that is a special unit of a licensed hospital designed, equipped, and staffed to (a) offer dialysis therapy on an out-patient basis, (b) provide training for home dialysis, and (c) perform renal transplantations.
§§ 3 & 4 — DENTAL HYGIENIST CONTINUING EDUCATION
The bill requires dental hygienists, every two years, to complete at least one contact hour of training or education in cultural competency, as part of existing continuing education requirements. The requirement applies to registration periods beginning on and after October 1, 2017.
Under current law, starting with their second license renewal, dental hygienists generally must complete 16 hours of continuing education every two years. The bill specifies that they must complete 16 “contact hours” and defines a contact hour as a minimum of 50 minutes of continuing education activity.
§ 5 — SCHOOL BOARD REPORTS ON ASTHMA
The bill reduces, from annually to every three years, the frequency with which local and regional boards of education must report to the local health department and DPH on the number of pupils per school and in the district that have been diagnosed with asthma. As under existing law, the boards must report this number for students having this diagnosis (1) upon enrollment, (2) in grade six or seven, and (3) in grade 10 or 11.
Under the bill, the next such report is due October 1, 2017.
§ 6 — DO NOT RESUSCITATE ORDERS
The bill adds a statutory definition of “do not resuscitate” or “DNR” orders. It defines these terms as an order written by a licensed physician or advanced practice registered nurse for a particular patient to withhold (1) cardiopulmonary resuscitation (CPR), including chest compressions, defibrillation, or breathing, or (2) ventilation by any assistive or mechanical means, such as mouth-to-mouth, bag-valve mask, endotracheal tube, or ventilator.
Existing law requires DPH to adopt regulations to provide for a system governing the recognition and transfer of DNR orders.
§ 7 — REPORTS OF MAJOR SYSTEM FAILURES
The bill requires licensed health care institutions to report to DPH any major systems failure, including loss of water, heat, or electricity, or incident that causes the institution to activate its emergency preparedness plan.
Under the bill, if the institution fails to report within four hours after discovering such an event, DPH may impose a fine of up to $100 per day, beginning with the date of the failure or incident until the institution reports it.
§ 8 — SUMMARY DISCIPLINARY ACTION
The bill allows DPH and its professional licensing boards and commissions to take summary disciplinary action against the license or permit of a practitioner who is subject to disciplinary action by the federal government.
As with other cases of summary action under existing law, DPH or the board or commission must promptly notify the practitioner of the action and bring formal revocation proceedings within 90 days of that notification.
§ 9 — DENTIST LICENSURE WITHOUT EXAMINATION
Current law allows DPH to issue a license without examination to a dentist licensed and board certified in another state or territory with licensure requirements similar to or higher than those of Connecticut.
The bill instead allows DPH to issue such a license to a currently practicing, competent dentist in another state or territory who:
1. holds a current, valid license in good professional standing issued after examination by another state or territory with licensure standards commensurate with Connecticut's, except for the practical examination, and
2. has worked continuously as a licensed dentist in an academic or clinical setting in another state or territory for at least five years immediately before applying for licensure.
As under current law, the applicant must pay a $650 license fee.
§ 10 — SUPERVISION OF OCCUPATIONAL THERAPY ASSISTANTS
By law, an occupational therapy assistant must work under the supervision of, or in consultation with, a licensed occupational therapist. The bill defines “supervision” as an occupational therapist's oversight of, or participation in, the work of an occupational therapist assistant, including:
1. continuous availability of direct communication between the assistant and the therapist;
2. availability of the therapist on a regularly scheduled basis to review the assistant's practice and support the assistant in the performance of his or her services; and
3. a plan for emergency situations, including designating an alternate licensed occupational therapist to oversee or participate in the assistant's work in the regular therapist's absence.
The bill also makes technical changes to the definition of “occupational therapy.”
§§ 11-13 — MARRIAGE AND FAMILY THERAPISTS, PROFESSIONAL COUNSELORS, AND PSYCHOLOGY STUDENTS
By law, students enrolled in marital and family therapy (MFT), professional counseling, and psychology degree programs may generally practice without a license under the supervision of a person licensed in their respective professions.
The bill specifies that students may do this only if the licensure exemption ends when the student is notified that he or she failed the licensing examination or six months after completing the supervised work experience, whichever occurs first.
The bill also extends to professional counseling students, the current requirement for MFT and psychology students, that such unlicensed practice must be necessary to satisfy the supervised work experience requirement for licensure.
Existing law requires these students to complete the following supervised work hours:
1. for MFTs, (a) 1,000 hours of direct client contact after being awarded a master's degree or doctorate or after the year of postgraduate training and (b) 100 hours of postgraduate clinical supervision by a licensed MFT;
2. for professional counselors, 3,000 hours of postgraduate supervised experience performed over at least one year, including 100 hours of direct supervision by specified licensed health care providers (e.g., psychiatrists, psychologists, MFTs); and
3. for psychologists, supervised work experience of at least (a) 35 hours per week for 46 weeks within 12 consecutive months or (b) 1,800 hours within 24 consecutive months.
§ 14 — DPH EQUIPMENT PURCHASES FOR CHILDREN WITH DISABILITIES
Current law allows DPH to purchase, within available appropriations, wheelchairs and placement equipment for children with disabilities without going through the Department of Administrative Services' normal purchasing procedures, provided (1) the cost of an individual item does not exceed $6,500 and (2) purchases are made on the open market and, when possible, through competitive bidding.
The bill instead allows DPH, or the department's contractor, to purchase medically necessary and appropriate durable medical equipment and other DPH-approved goods and services. Services must be identical to those goods and services covered under the state's Medicaid and HUSKY programs and payment cannot exceed the current Medicaid payment rate for these goods and services.
§ 15 — DPH BIRTH DEFECT SURVEILLANCE PROGRAM
The bill modifies DPH's birth defect surveillance program. Under current law, specified licensed health care providers must report to DPH within 48 hours after learning that a child has a birth defect. The bill limits what must be reported to information pertaining to children under age one born in Connecticut, instead of all children under age five.
It also limits the reporting requirement to physicians, physician assistants (PA), advanced practice registered nurses (APRN), registered nurses (RN), or nurse midwives (hereafter referred to as “licensed health care providers”). Current law also requires chiropractors, naturopaths, and podiatrists to report this information.
Birth Defect Screening
The bill requires each child born in Connecticut to have a birth defects screening by a licensed health care provider before being discharged from the hospital. The hospital's administrator must enter the screening results into DPH's birth defects registry in a manner the DPH commissioner prescribes. This registry is located in the department's newborn screening system for genetic and metabolic disorders.
As under current law, licensed health care providers must report to DPH the nature of the child's birth defect and any other information the department reasonably requires. The bill also requires DPH to post the notification form on its website and, as under current law, keep the notification for at least six years after receiving it.
The bill removes the requirement that DPH provide a copy of the notification to the State Board of Education within 10 days.
Access to Hospital Records
The bill grants the DPH commissioner access, upon his request, to hospital discharge records for newborn infants born in Connecticut, including their identifying information. But the commissioner may only use the identifying information for the purposes of the birth defects surveillance program.
Hospitals must also make available to DPH, upon request, the medical records of patients diagnosed with a birth defect or other adverse reproductive outcomes for purposes of research and data verification.
Confidentiality of Information
The bill specifies that all information collected from hospitals or licensed health care providers pertaining to the birth defect surveillance program, including personally identifiable information, is confidential. Access to the information is limited to DPH and people the commissioner determines have valid scientific interest and qualifications if they:
1. are engaged in demographic, epidemiologic, or other similar health-related studies and
2. agree in writing to maintain the confidentiality of the information.
Newborn Screening System Records
The bill requires the DPH commissioner to maintain an accurate record of people given access to information in its newborn screening system. The record must be publicly available during DPH's normal operating hours and include the (1) name, title, and organizational affiliation of people given access to the system; (2) dates of such access; and (3) specific purpose for which the information is used.
Routine Analysis and Statistics
The bill requires the DPH commissioner to use information collected under the birth defect surveillance program and information available from other sources to conduct routine analyses to determine if there were any preventable causes of the birth defects reported to DPH.
The bill also allows the DPH commissioner to publish statistical compilations related to birth defects or other adverse reproductive outcomes that do not identify individual cases or individual information sources.
The bill requires the DPH commissioner to review and approve all proposed research that will (1) use personally identifiable information in DPH's newborn screening system or (2) require contact with affected individuals.
§ 16 — NEWBORN SCREENING FOR CRITICAL CONGENITAL HEART DISEASE
By law, all health care institutions caring for newborn infants must test them for critical congenital heart disease, unless their parents object on religious grounds. Starting January 1, 2018, the bill requires the institution's administrator to enter the screening test results into DPH's newborn screening system for genetic and metabolic disorders.
§ 17 — SEMIPUBLIC AND PRIVATE RESIDENTIAL WELLS
Testing Wells in Connection to Home Sales
The bill requires an environmental laboratory that tests the water quality of a semipublic or private residential well in connection with a home's sale to report the results to DPH and the local health department within 30 days after completing the test. Current law requires the reports only if the well was tested by the seller or purchaser within six months of the home's sale.
By law, local health districts and departments oversee semipublic and private residential wells and owners are responsible for maintaining the well and testing the quality of their own drinking water. State regulation requires water quality tests for newly constructed wells, but neither state law nor regulation requires an existing well to be tested as a condition of selling a home.
Bulk Water Transport
The bill allows only a licensed bulk water hauler to transport bulk water that will be used for drinking or domestic purposes to a premises currently supplied by a semipublic or private residential well. The water hauler must first notify the owner of the premises before making such a delivery.
The bill allows such a delivery only as a temporary measure to alleviate a water supply shortage.
§ 18 — CREMATORY LOCATION
Starting July 1, 2017, the bill prohibits crematories anywhere within 500 feet of residential property unless the crematory's owner also owns the property. Current law allows crematories anywhere within an established cemetery with at least 20 acres if it has been operating for at least five years. It also allows them in other locations approved by a town's zoning commission, chief elected official, or legislative body.
§ 19 — QUALITY OF CARE ADVISORY COMMITTEE
The bill eliminates the requirement for the Quality of Care Advisory Committee to meet on a semiannual basis. Instead, it allows the committee to meet at the DPH commissioner's discretion.
By law, the committee advises the commissioner on various issues within DPH's quality of care program, such as selecting patient satisfaction survey measures and identifying ways to reduce medical error.
§ 20 — PUBLIC HEALTH PREPAREDNESS ADVISORY COMMITTEE
By law, the DPH commissioner must establish a Public Health Preparedness Advisory Committee. The bill specifies that the committee's purpose is to advise DPH on emergency responses to public health emergencies.
The bill removes an obsolete provision requiring the advisory committee to annually report to the Public Health and Public Safety committees on the status of its public health emergency preparedness plan and the resources needed to implement it. It instead allows the advisory committee to meet, at the DPH commissioner's request, to review the plan and other matters the commissioner deems necessary.
By law, the advisory committee consists of the DPH and emergency services and public protection commissioners; six top legislative leaders; the chairs and ranking members of the Public Health, Public Safety, and Judiciary committees; representatives of municipal and district health directors appointed by the DPH commissioner; and any other organizations or individuals the DPH commissioner deems relevant to the effort.
§ 21 — BACKGROUND CHECKS FOR LONG-TERM CARE FACILITY WORKERS
By law, long-term care facilities must require people who will have direct access, or provide direct service, to patients or residents to undergo a federal and state criminal history records check (“background check”). Facilities are generally prohibited from hiring or contracting with these individuals (1) before receiving the DPH notice of the background check results or (2) if a search reveals a disqualifying offense (e.g., conviction or substantiated finding of abuse or neglect), unless DPH grants a waiver.
But the law allows a facility to offer conditional, supervised employment for up to 60 days while waiting to receive DPH notification. The bill allows DPH to extend the 60-day period to give the department time to review an individual's written request to waive a disqualifying offense.
Existing law, unchanged by the bill, allows an individual to submit a waiver request to DPH within 30 days after being notified that he or she has a disqualifying offense. DPH has 15 days to mail a written determination, unless the individual challenges the accuracy of the information obtained from the background search. In this case, the 15-day deadline does not apply.
§ 22 — MICROBIOLOGICAL AND BIOMEDICAL BIOSAFETY LABS
The bill establishes a $400 biennial registration fee for microbiological and biomedical biosafety laboratories and exempts state and federally operated laboratories from the fee. DPH currently registers and inspects these laboratories every two years but does not charge an associated fee.
The bill also updates statutory definitions related to microbiological and biomedical biosafety laboratories to reflect current federal Centers for Disease Control and Prevention and National Institutes of Health guidelines by:
1. updating the definition of “biolevel-three laboratory” and renaming it “biolevel three microbiological and biomedical biosafety laboratory” and
2. adding definitions for “microbiological and biomedical safety laboratory” and “biolevel two microbiological and biomedical biosafety laboratory.”
The bill defines a “microbiological and biomedical biosafety laboratory” as one that (1) utilizes any living agent capable of causing a human infection or reportable human disease or (2) is used to secure evidence of the presence or absence of such a living agent for purposes of teaching, research, or quality control of the disease or infection.
Under current law, a biolevel-three laboratory is one that is (1) designed and equipped as such under federal guidelines and (2) operated by a higher education institution. The bill expands the definition to also include such a laboratory operated by another research entity. It also specifies that such laboratories must handle agents that (1) have a known potential for aerosol transmission, (2) may cause serious and potentially lethal human infections or diseases, and (3) are either indigenous or exotic in origin.
Additionally, the bill defines a “biolevel 2 microbiological and biomedical biosafety laboratory” as one that presents a modern hazard to personnel of exposure to an infection or disease that utilizes agents associated with human infection or disease.
§ 23 — WOMEN, INFANTS AND CHILDREN (WIC) ADVISORY COUNCIL
The bill eliminates the WIC Advisory Council. Current law requires the council to advise DPH on issues concerning increased participation in and access to WIC supplemental food services. (It appears that the council is now defunct.)
§ 24 — DPH INTERAGENCY AND PARTNERSHIP ADVISORY PANEL ON LUPUS AND PANDAS/PANS ADVISORY COUNCIL
The bill eliminates DPH's 13-member Interagency and Partnership Advisory Panel on Lupus, which has completed its charge. The panel was charged with developing and implementing a comprehensive lupus education and awareness plan after evaluating and analyzing existing educational materials and resources.
The bill also eliminates the department's 16-member Advisory Council on Pediatric Autoimmune Neuropsychiatric Disorder Associated With Streptococcal Infections and Pediatric Neuropsychiatric Syndrome (PANDAS/PANS). The council is charged with advising the commissioner on research, diagnosis, treatment, and education relating to these conditions and must annually report to the Public Health Committee. (It appears to be defunct.)
sSB 796, reported favorably by the Public Health Committee contains the same provisions regarding supervision of occupational therapists and DPH equipment purchases for children with disabilities.
Public Health Committee