PA 17-146—sHB 7222

Public Health Committee

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

SUMMARY: This act makes various changes in Department of Public Health (DPH)-related statutes and programs. For example, it:

1. allows DPH to extend the 60-day period for 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. requires (a) certain stroke-certified hospitals to annually report to DPH an attestation of their certification and (b) DPH to annually post a list of these hospitals on its website, send the list to the medical director of each Connecticut emergency medical services (EMS) provider, and adopt a nationally recognized stroke triage assessment tool and pre-hospital care stroke protocols.

The act also changes laws affecting various licensed (1) institutions, including 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.

And it 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 act makes changes in 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; Medical Records Task Force; Rare Disease Task Force; Mobile Integrated Health Care Program Working Group; PANDAS/PANS Advisory Council; Psychiatry Workforce Task Force; Public Health Preparedness Advisory Committee; Quality of Care Advisory Committee; School-Based Health Center Advisory Committee; and Women, Infants, and Children Advisory Council.

A section-by-section summary appears below.

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

1 — HEALTH CARE FACILITY LICENSURE APPLICATION FEES

The act requires applicants for health care facility licensure to submit the required fee to DPH along with their license application.

Under existing law, health care facilities licensed by DPH must pay fees for licensure and inspection. The fee amount and inspection frequency depend on the type of institution.

2 — OUTPATIENT DIALYSIS UNITS

Under existing law and regulations, DPH licenses outpatient dialysis units. The act defines this term in statute, codifying a similar definition found in existing regulations (Conn. Agencies Regs., 19-13-D55a). Thus, it defines an outpatient dialysis unit as an:

1. out-of-hospital outpatient dialysis unit licensed by DPH to provide (a) outpatient services to persons requiring dialysis on a short-term basis or for a chronic condition or (b) training for home dialysis, or

2. in-hospital dialysis unit that is a special unit of a licensed hospital designed, equipped, and staffed to (a) offer dialysis therapy on an outpatient basis, (b) provide training for home dialysis, and (c) perform renal transplantations.

3 & 4 DENTAL HYGIENIST CONTINUING EDUCATION

The act requires dental hygienists to complete at least one contact hour of training or education in cultural competency every two years as part of existing continuing education requirements. The requirement applies to registration periods beginning on and after October 1, 2017.

Under existing law, starting with their second license renewal, dental hygienists generally must complete 16 hours of continuing education every two years. The act specifies that they must complete 16 “contact hours,” with a contact hour consisting of at least 50 minutes of continuing education activity.

5 SCHOOL BOARD REPORTS ON ASTHMA

The act 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 and certain demographic characteristics of pupils per school and in the district diagnosed with asthma. It also changes the due date of the report, from February 1 to October 1. By law, the boards must report this number for students with this diagnosis (1) on enrollment, (2) in grade six or seven, and (3) in grade 10 or 11.

6 DO NOT RESUSCITATE ORDERS

The act adds a statutory definition of “do not resuscitate” (DNR) orders. It defines this term 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 act 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 after the 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 act 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 act also makes technical changes to the definition of “occupational therapy.”

9-11 MARRIAGE AND FAMILY THERAPISTS, PROFESSIONAL COUNSELORS, AND PSYCHOLOGY STUDENTS

By law, students who graduate with advanced degrees in marital and family therapy (MFT) or psychology may practice without a license in order to complete the supervised work experience required for licensure, but only if supervised by a person licensed in their respective profession. The act extends this exemption to graduates pursuing professional counseling licensure.

The act also limits the length of time in which the graduates in these professions may practice in this unlicensed capacity. For professional counselors and psychologists, they may only do so until they are notified that they failed the respective licensing examination or one year after completing the supervised work experience, whichever occurs first. For marital and family therapists, the act does not specify that the exemption ends on the earlier of these two dates.

12 DPH EQUIPMENT PURCHASES FOR CHILDREN WITH DISABILITIES

Prior law allowed 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 the (1) cost of an individual item did not exceed $6,500 and (2) purchases were made on the open market and, when possible, through competitive bidding.

The act instead allows DPH and 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 covered under the state's Medicaid and HUSKY programs and payment cannot exceed the state Medicaid payment rate for the goods and services.

13 BIRTH DEFECT SURVEILLANCE PROGRAM

The act modifies DPH's birth defect surveillance program. By law, specified licensed health care providers must report to DPH within 48 hours after learning that a child has a birth defect. The act 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 (“licensed health care professionals”). Prior law also required chiropractors, naturopaths, and podiatrists to report this information.

Birth Defect Screening

The act 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 in DPH's birth defects registry as directed by the DPH commissioner. This registry is located in the department's newborn screening system for genetic and metabolic disorders.

Notification Requirements

As under existing 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 act also requires DPH to post the notification form on its website and, as under existing law, to keep each notification for at least six years after receiving it.

The act 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 act grants the DPH commissioner access, on 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, on request, the medical records of patients diagnosed with a birth defect or other adverse reproductive outcomes for research and data verification purposes.

Confidentiality of Information

The act 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 act 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; (2) dates of such access; and (3) specific purpose for which they used the information.

Routine Analysis and Statistics

The act requires the DPH commissioner to use information collected from the birth defect surveillance program and information available from other sources to determine if there were any preventable causes of the birth defects of which DPH was notified.

It also allows the commissioner to publish statistical compilations of birth defects or other adverse reproductive outcomes that do not identify individual cases or individual information sources.

Proposed Research

The act 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 the infant's parents object on religious grounds. Starting January 1, 2018, the act 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 act 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. Prior law required 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 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 act allows only a licensed bulk water hauler to transport water that will be used for drinking or domestic purposes to a premises currently supplied by a semipublic or private well. It prohibits a bulk water hauler from making such a delivery without first notifying the owner of the premises. And it only allows such a delivery as a temporary measure to alleviate a water supply shortage.

16 CREMATORY LOCATION

Starting July 1, 2017, the act prohibits locating a new crematory within 500 feet of residential structures or land unless the crematory's owner also owns the property. Existing law allows crematories on 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 act 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 act specifies that the committee's purpose is to advise DPH on responses to public health emergencies.

The act removes an obsolete provision that required the advisory committee to develop a public health emergency response plan and annually report to the Public Health and Public Safety committees on its status and the resources needed to implement it. The act 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; the 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 federal and state criminal history records checks (“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 for DPH's notification. The act 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 act, 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 then has 15 days to mail a written determination, unless the individual challenges the accuracy of the background search information. In that case, the 15-day deadline does not apply.

20 MICROBIOLOGICAL AND BIOMEDICAL BIOSAFETY LABS

Registration Fee

The act establishes a $400 biennial registration fee for microbiological and biomedical biosafety laboratories and exempts federally and state-operated laboratories from the fee. Previously, DPH registered and inspected these laboratories every two years, but did not charge a fee to do so.

Definitions

The act 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. adding definitions for “microbiological and biomedical safety laboratory” and “biolevel-two microbiological and biomedical biosafety laboratory” and

2. updating the definition of “biolevel-three laboratory” and renaming it “biolevel-three microbiological and biomedical biosafety laboratory.”

The act 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.

Prior law defined a biolevel-three laboratory as one (1) designed and equipped as such under federal guidelines and (2) operated by a higher education institution. The act expands the definition to also include such a laboratory operated by another research entity. It also specifies that these 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 act defines a “biolevel-two microbiological and biomedical biosafety laboratory” as one that presents a moderate hazard to personnel of exposure to an infection or disease and utilizes agents associated with human infection or disease.

21 WOMEN, INFANTS, AND CHILDREN (WIC) ADVISORY COUNCIL

The act eliminates the WIC Advisory Council. Prior law required the council to advise DPH on issues concerning increased participation in and access to WIC supplemental food services. (In practice, the council was already defunct.)

22 — ALCOHOL AND DRUG COUNSELORS

The act 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 created a 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 act 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 act 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 by October 1, 2018.

Under the act, if a licensee is subject to the above provisions and fails to timely retake and pass the exam, 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 members and seven state agency heads) to 15 members, all of whom are voting members appointed by the governor.

The act increases the membership from 15 to 16 by adding the director of the Connecticut chapter of We the Deaf People. It also increases, from eight to nine, the number of voting members needed for a quorum and makes technical and conforming changes.

EFFECTIVE DATE: Upon passage

28 — LEAD POISONING PREVENTION REPORT

The act changes, from January 1 to October 1, the deadline for DPH's annual report to the Public Health and Human Services committees on lead poisoning prevention efforts.

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 expanded 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 act also requires the committee to advise the commissioner on other topics the commissioner deems relevant.

EFFECTIVE DATE: Upon passage

30 — HOUSEHOLD AND SMALL COMMERCIAL SUBSURFACE SEWAGE DISPOSAL SYSTEMS

The act increases the size of subsurface disposal systems (generally, septic systems) over which DPH and local health departments, rather than the Department of Energy and Environmental Protection (DEEP), have jurisdiction, from a maximum capacity of 5,000 gallons per day to a maximum of 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 act provides that, notwithstanding any other laws or regulations, 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 act 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 act removes provisions from PA 17-66 that permitted DPH to adopt regulations to implement the certification of certain lead abatement and asbestos professionals. Other laws already require 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 act 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 act 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 act, 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 is prohibited by state law to post or have a sign posted stating the prohibition. The act 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 act 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 act 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 existing law and the act, anyone who violates the above provision is subject to a maximum fine of $200 for a first offense. The act retains the maximum fines under prior law for second and subsequent offenses, $350 and $500 respectively, but applies the fines to those offenses committed within 24 months of each other, rather than 18 months.

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

Certification Reporting Requirements

Starting by October 1, 2017, the act 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 (1) the American Heart Association, (2) the 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 stroke-certified hospitals on its website. And by January 1, 2018, it must begin annually sending 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 act, DPH may remove a hospital from the list if (1) the hospital requests it; (2) the certifying organization has informed DPH 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 act 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 act 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 the protocols on the department's website.

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

42 — TECHNICAL CHANGE

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

EFFECTIVE DATE: July 1, 2017

43 DENTAL ASSISTANTS AND INFECTION CONTROL

The act 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 provide such documentation),

2. allow a dental assistant to receive up to nine months of on-the-job training to prepare for the examination, and

3. require dentists who delegate procedures to a dental assistant to keep the records documenting the assistant's passing exam grade 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 act 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 act 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 transport by EMS providers.

Under the act, 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 by August 29, 2017:

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

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

3. one licensed advanced practice registered nurse;

4. one licensed behavioral health professional;

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

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

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

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

9. 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;

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

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

12. one representative of the Connecticut Nurses Association; and

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

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

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

2. the chair of the EMS Advisory Board;

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

4. the Office of Policy and Management secretary; and

5. the 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 because of gaps in the availability of health care services;

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

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

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

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

6. 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

7. any successful models for such a program in another state.

Recommendations

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

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 act, 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 act, all task force appointments must be made no later than July 30, 2017. The appointing authority fills any vacancy.

The act requires the House speaker and Senate president 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 July 30, 2017.

The act 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 act conforms the law 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 act eliminates DPH's Interagency and Partnership Advisory Panel on Lupus. The panel has completed its charge to develop and implement a comprehensive lupus education and awareness plan. The act also eliminates the department's Advisory Council on Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infections and Pediatric Neuropsychiatric Syndrome (PANDAS/PANS). (It appears that the council is defunct.) Under prior law, the council advised the commissioner on research, diagnosis, treatment, and education relating to these conditions and had to annually report to the Public Health Committee.

BACKGROUND

Related Acts

PA 17-202 contains identical provisions on (1) DPH equipment purchases for children with disabilities and (2) supervising occupational therapist assistants.