OLR Bill Analysis

sHB-7222 (as amended by House "B")*

AN ACT CONCERNING THE DEPARTMENT OF PUBLIC HEALTH'S VARIOUS REVISIONS TO THE PUBLIC HEALTH STATUTES.

SUMMARY

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 an applicant's request to waive a disqualifying offense on his or her background check and

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.

Among other things, the bill also makes changes affecting various licensed (1) institutions, including certified stroke hospitals, microbiological and biomedical biosafety labs, and outpatient dialysis units and (2) health care professionals, including alcohol and drug counselors, dentists, dental assistants, dental hygienists, embalmers and funeral directors, lead abatement and asbestos professionals, marital and family therapists, occupational therapy assistants, professional counselors, and psychologists.

The bill also makes changes concerning birth defect surveillance; newborn screening; crematories; DPH's lead poisoning prevention report; “do not resuscitate” orders; equipment purchases for children with disabilities; the Head Start Collaboration Office; medication administration by certain unlicensed personnel; school board reports on asthma; semipublic and private residential wells; household and small commercial subsurface sewage disposal systems; and smoking and electronic cigarette regulation.

Finally, the bill makes changes to various boards, committees, councils, and task forces, including the Advisory Board for Persons Who Are Deaf and Hard of Hearing; Interagency and Partnership Advisory Panel on Lupus; PANDAS/PANS Advisory Council; Psychiatry Workforce Task Force; Public Health Preparedness Advisory Committee; Quality of Care Advisory Committee; Medical Records Task Force; Rare Disease Task Force; Mobile Integrated Health Care Program Working Group; School-Based Health Care Center Advisory Committee; and Women, Infants, and Children Advisory Council

A section-by-section summary appears below.

*House Amendment “B” replaces the underlying bill (File 594) and removes the provision requiring health care institutions to report to DPH any major systems failure. It also adds the provisions on alcohol and drug counselors, rare disease task force, embalmers and funeral directors, Advisory Board for Persons Who are Deaf and Hard of Hearing, Lead Poisoning Prevention Report, School-Based Health Center Advisory Committee, sewage disposal systems, medication administration by unlicensed personnel, lead abatement and asbestos professionals, smoking and e-cigarette restrictions, certified stroke hospitals, dental assistants and infection control, medical records task force, mobile integrated health care program working group, Psychiatry Workforce Task Force, a technical change to PA 17-6, and the Head Start Collaboration Office.

EFFECTIVE DATE: October 1, 2017, except as otherwise noted below.

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 creates a statutory definition of this term, codifying the definition in existing regulations with technical changes (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 once 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 diagnosed with asthma and certain related demographic information. The bill also changes the due date of the report, from February 1 to October 1 annually. As under existing law, the boards must report this number for students with this diagnosis (1) upon enrollment, (2) in grade six or seven, and (3) in grade 10 or 11.

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 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.

8 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;

1. 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

2. 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.”

9-11 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, as part of their studies, 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 they failed the licensing examination or one year after completing their supervised work experience, whichever occurs first.

The bill also extends to professional counseling students the current requirement for MFT and psychology students that any 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, over at least 12 months, (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;

1. 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

2. for psychologists, supervised work experience of (a) at least 35 hours per week for 46 weeks within 12 consecutive months or (b) at least 1,800 hours within 24 consecutive months.

12 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 its contractors, to purchase, within available appropriations, medically necessary and appropriate durable medical equipment and other DPH-approved goods and services. Such goods and 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.

13 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 the population for which this information must be reported 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), and nurse midwives (hereafter referred to as “licensed health care professionals”). 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 professional 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.

Notification Requirements

As under current law, licensed health care professionals 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, to 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 and may only be used for the program's purposes. 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 of which the DPH was notified.

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.

Proposed Research

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.

14 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 health care institution's administrator to enter the screening test results into DPH's newborn screening system for genetic and metabolic disorders.

15 SEMI-PUBLIC AND PRIVATE RESIDENTIAL WELLS

Testing Wells in Connection with 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 laboratory to report the information 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 licensed bulk water hauler cannot make such a delivery without first notifying the owner of the premises.

The bill allows such a delivery only as a temporary measure to alleviate a water supply shortage.

16 CREMATORY LOCATION

Starting July 1, 2017, the bill prohibits locating a new crematory within 500 feet of residential structures or 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.

EFFECTIVE DATE: July 1, 2017

17 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 ways to reduce medical error.

18 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 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 Department of 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.

19 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 allow 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.

20 MICROBIOLOGICAL AND BIOMEDICAL BIOSAFETY LABS

Registration Fee

The bill establishes a $400 biennial registration fee for microbiological and biomedical biosafety laboratories and exempts federally and state-operated laboratories from the fee. DPH currently registers and inspects these laboratories every two years, but does not charge a fee for doing so.

Definitions

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

1. 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 moderate hazard to personnel of exposure to an infection or disease that utilizes agents associated with human infection or disease.

21 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 currently defunct.)

22 — ALCOHOL AND DRUG COUNSELORS

The bill specifies that a licensed alcohol and drug counselor may provide counseling services to a person diagnosed with a co-occurring mental health condition other than alcohol and drug dependency if such counseling is within the licensee's scope of practice.

EFFECTIVE DATE: Upon passage

23 — RARE DISEASE TASK FORCE

PA 15-242 ( 35) created a 16-member task force to study rare disease research, diagnoses, treatment, and education and make recommendations for establishing a permanent group of experts to advise DPH on rare diseases.

The bill adds the Public Health Committee chairpersons, or their designees, to the task force. It also extends the task force reporting deadline from January 1, 2016 until January 1, 2018.

EFFECTIVE DATE: Upon passage

24 — EMBALMERS AND FUNERAL DIRECTORS

Under certain conditions, the bill prohibits DPH and the Connecticut Board of Examiners of Embalmers and Funeral Directors from taking disciplinary action against a licensee notified on or before October 1, 2017 that his or her score on the national board examination was invalidated. The prohibition applies only (1) to discipline based on the invalidation of the exam score and (2) if the licensee retakes and passes the exam no later than October 1, 2018.

Under the bill, if a licensee is subject to the above provisions and fails to retake and pass the exam by October 1, 2018, his or her license is annulled, subject to the Uniform Administrative Procedure Act.

25-27 — ADVISORY BOARD FOR PERSONS WHO ARE DEAF OR HARD OF HEARING

PA 17-30 renamed the Commission on the Deaf and Hearing Impaired as the “Advisory Board for Persons Who are Deaf or Hard of Hearing.” It also changed the board's membership from 21 members (including three non-voting and seven state agency heads) to 15 members, all of whom are voting members and appointed by the governor.

The bill increases the membership from 15 to 16 by adding the director of the Connecticut Chapter of We the Deaf People. It also makes technical and conforming changes.

EFFECTIVE DATE: Upon passage

28 — LEAD POISONING PREVENTION REPORT

The bill changes current law's deadline for DPH's annual report to the Public Health and Human Services committees on lead poisoning prevention efforts, making it due each October 1 rather than January 1.

Consequently, the bill shortens, by three months, the time for DPH to submit its next report, as it is due October 1, 2017 and not January 1, 2018.

EFFECTIVE DATE: Upon passage

29 — SCHOOL-BASED HEALTH CENTER ADVISORY COMMITTEE

By law, the School-Based Health Center Advisory Committee must advise the DPH commissioner on (1) statutory and regulatory changes to improve health care access through school-based health centers and expended school health sites and (2) minimum standards for providing services at these centers and sites to ensure delivery of high quality health care services. The bill also requires the committe to advise the commissioner on other relevant topics the commissioner requests.

EFFECTIVE DATE: Upon passage

30 — HOUSEHOLD AND SMALL COMMERCIAL SUBSURFACE SEWAGE DISPOSAL SYSTEMS

The bill increases the size of subsurface disposal systems (generally, septic systems) over which DPH, rather than the Department of Energy and Environmental Protection (DEEP), has jurisdiction, from a capacity of up to 5,000 gallons per day to up to 7,500 gallons per day.

Under existing law, DEEP delegates to the DPH commissioner authority to issue permits and approvals for household and small commercial subsurface disposal systems. DPH must establish minimum requirements for such systems in regulations and procedures for local health directors or sanitarians to issue permits or other approvals. The bill provides that the regulations in effect as of July 1, 2017 apply to household and small commercial subsurface sewage disposal systems with a daily capacity of up to 7,500 gallons.

EFFECTIVE DATE: July 1, 2017

31 & 32 — MEDICATION ADMINISTRATION BY UNLICENSED PERSONNEL

Existing law generally permits a registered nurse to delegate the administration of non-injected medications to homemaker-home health aides who obtain certification for medication administration and renew their certification every three years. It also requires 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 who were certified by June 30, 2015 to be recertified by July 1, 2018 to continue to administer medication.

EFFECTIVE DATE: Upon passage

33 & 34 — LEAD ABATEMENT AND ASBESTOS PROFESSIONALS

The bill removes provisions from SB 937 as amended (which passed both chambers) that permit DPH to adopt regulations to implement the certification of certain lead abatement and asbestos professionals. Existing law already requires DPH to adopt regulations on similar topics (CGS 20-440 and 20-478).

EFFECTIVE DATE: July 1, 2017

35-39 — RESTRICTIONS ON SMOKING AND E-CIGARETTES

The bill makes various changes affecting the regulations of smoking and e-cigarettes (i.e., electronic nicotine delivery systems and vapor products) in certain establishments and public areas. It also makes related technical and conforming changes.

Prohibited Locations

Existing law prohibits smoking and e-cigarette use in various locations, such as restaurants, health care institutions, and state buildings. The bill exempts from the prohibition medical research sites where smoking and e-cigarette use is integral to the research being conducted.

Existing law, unchanged by the bill, also exempts various locations from the prohibition, such as correctional facilities and public housing projects.

Posting Signs in Buildings

The law requires the person in control of any building in which smoking and e-cigarette use are prohibited by state law to post or have a sign posted stating the prohibition. The bill specifies that signs are not required to be in each room of a building, provided they are posted in conspicuous places.

Definition of Vapor Products

The bill exempts from the statutory definition of “vapor product” a medicinal or therapeutic product used by a (1) licensed health care provider to treat a patient in a health care setting or (2) patient in any setting, as prescribed or directed by a licensed health care provider.

Under existing law, a vapor product uses a heating element; power source; electronic circuit; or other electronic, chemical, or mechanical means, regardless of shape or size, to produce a vapor the user inhales. The vapor may or may not include nicotine.

Penalties

The bill exempts from fines a person who sells, gives, or delivers tobacco or e-cigarettes to a person under age 18 who delivers or accepts delivery as part of a scientific study (1) conducted by an organization for medical research purposes to further efforts in tobacco and e-cigarette use prevention and cessation and (2) approved by the organization's institutional review board. The law already exempts anyone who sells, gives, or delivers tobacco or e-cigarettes to a person under age 18 who receives or delivers it as an employee.

Under current law and the bill, anyone who violates the above provision is subject to a maximum fine of $200 for a first offense. The bill retains the maximum fines under current law for second and subsequent offense, $350 and $500 respectively, but applies the fines to those offenses committed within a 24 month, rather than 18 month, period.

40 & 41 — CERTIFIED STROKE CENTERS AND STROKE-READY HOSPITALS

Certification Reporting Requirements

Starting by October 1, 2017, the bill requires certain stroke-certified hospitals to annually report to DPH, in a form and manner the commissioner prescribes, an attestation of the certification. The requirement applies to any hospital certified as a comprehensive stroke center, primary stroke center, or acute stroke-ready hospital by the (1) American Heart Association, (2) Joint Commission (an independent nonprofit organization that accredits and certifies hospitals and other health care organizations and programs), or (3) any other nationally recognized certifying organization.

EFFECTIVE DATE: Upon passage

Certification List

Starting by October 15, 2017, DPH must annually post a list of these stroked-certified hospitals on its website. The department must also, starting by January 1, 2018, annually send the list to the medical director of each EMS provider in Connecticut. DPH must also maintain a copy of the list in its Office of Emergency Medical Services.

Under the bill, DPH may remove a hospital from the list if (1) the hospital requests it; (2) DPH has been informed by the certifying organization that the hospital's certification is expired, suspended, or revoked; or (3) the hospital does not provide DPH with attestation of the certification by October 1.

EFFECTIVE DATE: October 1, 2017, except the requirement to post the list on the DPH website is effective upon passage.

Reporting Complaints

The bill requires DPH to report to the national certifying organization any complaint it receives about a hospital's certification. If the complainant intends to pursue a complaint with that organization, DPH must also provide the complainant with the organization's name and contact information (presumably, upon the complainant's request).

EFFECTIVE DATE: Upon passage

Stroke Triage Assessment Tool

The bill requires the Connecticut EMS Advisory Board, by January 1, 2018, to recommend to DPH for adoption, (1) a nationally recognized, standardized stroke triage assessment tool and (2) pre-hospital care protocols for assessing, treating, and transporting stroke patients. Within 30 days after receiving these recommendations, DPH must adopt the tool and post it and protocols on the department's website.

The bill permits the DPH commissioner to modify the assessment tool as he deems necessary. DPH must provide a copy of the tool and pre-hospital care protocols to each EMS provider, who must then develop plans to implement them.

42 — TECHNICAL CHANGE

The bill makes a technical change to PA 17-6, correcting an inaccurate statutory citation.

EFFECTIVE DATE: July 1, 2017

43 DENTAL ASSISTANTS AND INFECTION CONTROL

The bill delays by six months, from January 1, 2018 to July 1, 2018, the start date for certain provisions enacted in PA 16-66 on dental assistants and infection control.

Specifically, these provisions:

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

1. allow 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

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

EFFECTIVE DATE: Upon passage

44 MEDICAL RECORDS TASK FORCE

PA 16-66 created a task force to study the furnishing of medical records by health care providers and institutions. The bill extends by one year the task force reporting deadline, to January 1, 2018.

EFFECTIVE DATE: Upon passage

45 MOBILE INTEGRATED HEALTH CARE PROGRAM WORKING GROUP

The bill requires DPH, within available appropriations and in consultation with the Insurance and Social Services departments, to convene a working group to implement a mobile integrated health care program. The program must allow a paramedic to provide community-based health care (i.e., using patient-centered, mobile resources outside the hospital) within his or her scope of practice and make recommendations regarding non-emergency transportation by emergency medical services (EMS) providers.

Under the bill, the DPH commissioner must report the working group's findings and recommendations to the Human Services, Insurance, and Public Health committees by January 1, 2019.

EFFECTIVE DATE: Upon passage

Membership

The working group consists of the following members, each of whom must be appointed by the DPH commissioner within 60 days after the bill's passage:

1. one representative of the Connecticut Hospital Association, or his or her designee;

1. one chairperson of the Connecticut EMS Medical Advisory Committee, or his or her designee;

2. one licensed advanced practice registered nurse;

3. one licensed behavioral health professional;

4. one representative of the Community Health Care Association of Connecticut;

5. one representative from a primary care provider that self-identifies as an urgent care facility;

6. one representative of the Connecticut commercial health insurance industry;

7. one representative of a fire department-based EMS provider;

8. three representatives of EMS providers, one each who must (a) be a designee of the Association of Connecticut Ambulance Providers and have a background in providing ambulance services in a rural area of the state, (b) have a background in providing ambulance services in an urban area of the state, and (c) be a designee of the Connecticut EMS Chiefs' Association;

9. one representative of the Connecticut Association for Healthcare at Home;

10. one representative of a state-licensed or federally certified hospice care agency;

11. one representative of the Connecticut Nurses Association; and

12. one representative of the Connecticut College of Emergency Physicians.

Additional non-appointed working group members include the following, or their designees:

1. director of DPH's Office of Emergency Medical Services;

2. chair of the EMS Advisory Board;

3. insurance, public health, and social services commissioners;

4. Office of Policy and Management secretary; and

5. chairpersons, vice-chairpersons, and ranking members of the Public Health Committee.

Tasks

The working group must identify:

1. areas in Connecticut that would benefit from a mobile integrated health care program due to gaps in the availability of health care services;

1. any scope-of-practice patient care interventions that a paramedic may provide;

2. any additional education or training paramedics may need to provide community-based health care;

3. any potential savings or additional costs associated with providing community health care that may be incurred by an insured or the Medicaid program;

4. any potential reimbursement issues related to health care coverage for community-based health care by a paramedic;

5. minimum criteria for implementing the mobile integrated health care program and any statute or regulation that may be impacted by the program's implementation; and

6. any successful models for such a program out of state.

Recommendations

The bill requires the working group, in collaboration with the EMS Advisory Board and its Medical Advisory Committee, to make recommendations on

1. the ability of an EMS provider to transport a patient to an alternative destination other than a hospital emergency department for health care services when established protocols dictate that the emergency department is not the most appropriate destination and

2. whether an EMS provider requires additional training for purposes of determining whether to transport a patient to an alternative destination.

46 — PSYCHIATRY WORKFORCE TASK FORCE

The bill establishes a 12–member task force to study the projected shortage in Connecticut's psychiatry workforce, including examining the causes of and potential solutions to avoid or reduce the projected shortage.

By July 1, 2018, 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 July 1, 2018, whichever is later.

Under the bill, the six legislative leaders each appoint two members to the task force, as shown in Table 1. Any of the appointees may be a legislator.

Table 1: Task Force Members

Appointing Authority

Qualifications of Appointees

House speaker

A child and adolescent psychiatrist

A psychologist

Senate president pro tempore

A psychiatrist

An individual with expertise in workforce shortages and development

House majority leader

An individual with expertise in social work and counseling

A primary care provider who consults with psychiatrists

Senate majority leader

An individual with expertise in recovery support

A representative of an institution that employs psychiatrists, including an inpatient psychiatric hospital, outpatient clinic, or emergency department in the state

House minority leader

A physician assistant for a psychiatrist

An emergency medicine physician

Senate minority leader

A psychiatric nurse practitioner

A faculty member from a department of psychiatry at a Connecticut medical school

Under the bill, all task force appointments must be made no later than 30 days after the bill's passage. The appointing authority fills any vacancy.

The bill requires the House speaker and Senate president pro tempore to select the task force chairpersons from among its members. The chairpersons must schedule the first meeting of the task force, to be held no later than 30 days after the bill's passage.

The bill requires the Public Health Committee's administrative staff to serve in that capacity for the task force.

EFFECTIVE DATE: Upon passage

47 — HEAD START STATE COLLABORATION OFFICE

The bill conforms to existing practice by placing the Connecticut Head Start State Collaboration Office within the Office of Early Childhood.

EFFECTIVE DATE: Upon passage

48 — 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. The panel has completed its charge to develop and implement 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). (It appears that the council is now defunct in practice.) The council advises the commissioner on research, diagnosis, treatment, and education relating to these conditions and must annually report to the Public Health Committee.

COMMITTEE ACTION

Public Health Committee

Joint Favorable

Yea

26

Nay

0

(03/27/2017)