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

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

Prohibits DPH from disclosing personnel records it receives during an investigation

Allows dental hygienists with at least two years' experience to practice without a dentist's general supervision at senior centers, managed residential communities, or child care centers.

Expands access to data on a death certificate except for the decedent's social security number

Consolidates certain DPH reporting requirements related to asthma screening and makes related changes

Specifies that school social workers with the appropriate credentials may use that title, even if not licensed by DPH

Gives a health care institution more time to submit a correction plan after receiving a notice of noncompliance

Expands the scope of DPH's mandatory reporting system for health care associated infections, adds to the membership of the advisory committee on such matters, and makes related changes

Eliminates the requirement for the DPH commissioner to annually report on the department's quality of care program

Eliminates a requirement that DPH report on certain matters related to donated property

Eliminates a requirement for DPH to annually publish a report on nursing homes and residential care homes and instead requires the department to post certain related information online

Requires the DPH commissioner to adopt specified national standards for trauma data collection and provides that an existing reporting requirement applies annually starting by December 1, 2018

Allows DPH to issue a dentist license without examination to a dentist licensed in another state who has worked as such for the past five years, even if the other state does not require a practical examination for licensure

Specifies that lead training providers and asbestos training providers must apply to renew their certificates during the anniversary month of their initial certification

Exempts certain residential care homes from the food code's requirements and modifies the definition of a class 1 food establishment to, among other things, prohibit such an establishment from selling commercially prepackaged food that is not time or temperature controlled

Replaces statutory references to “venereal disease” with references to “sexually transmitted disease”

Updates terminology related to funeral home licensure and decreases the required frequency of DPH inspections of funeral homes

Adds APRNs into the laws on living wills and other advance directives, authorizing them to perform certain functions that currently may be performed only by a physician

Prohibits DPH from requiring that a health care institution licensure application be notarized

Modifies the length of time during which marriage and family therapist, professional counselor, and psychology students may practice without a license in order to complete the supervised work experience required for licensure

Extends until January 1, 2019, the date by which DPH must adopt and administer the FDA Model Food Code as the state's food code for regulating food establishments; requires food establishments to designate an alternate person to be in charge when their certified food protection manager is absent.

Expands eligibility criteria to qualify as the director of DPH's Office of Oral Public Health

Exempts records and information from DPH's long-term care facility background search program from disclosure under the Freedom of Information Act; exempts from the program's requirements certain intermediate care facilities for individuals with intellectual disabilities; and makes technical changes

Subjects DDS job applicants who will provide direct care services to fingerprint and national criminal background checks, in addition to state background checks; permits DDS to require state criminal background checks for DDS-licensed or –funded private providers; allows DDS and private providers to conditionally employ applicants while waiting for required background check results

Modifies the certification examination requirements for nuclear medicine technologists to operate certain CT or magnetic resonance imaging equipment

Removes the authority for a PA to order an APRN to administer a controlled substance

Modifies the definition of “alcohol and drug counseling” to distinguish between licensed and certified counselors; makes other minor and technical changes to licensure requirements

Requires the Tobacco and Health Trust Fund Board to report to the legislature only following a fiscal year when it receives a deposit from the Tobacco Settlement Fund, instead of annually; eliminates the requirement that the board meet at least biannually

Allows the legal guardian of a person who is the subject of an acknowledgment of paternity to obtain a certified copy of the form

Expressly permits a health district to join an existing health district; makes technical changes to statutes on municipal and district health departments

Requires small community water systems to submit to DPH a fiscal and asset management plan for all their capital assets; requires the DPH commissioner to publish a schedule of civil penalties imposed against water companies, instead of adopting them in regulations and; establishes related notification and public hearing requirements

Staring October 1, 2019, modifies the education and training requirements for massage therapist licensure; establishes minimum professional liability insurance requirements; and generally allows out-of-state massage therapists to provide voluntary services at the invitation of the emergency division of the American Massage Therapy Association Connecticut Chapter's Community Service Massage Team

Prohibits anyone without the proper credentials from referring to himself or herself as a “Doctor of Physical Therapy” or “D.P.T.”

Requires DPH, by January 1, 2019, to develop and post on its website educational materials for health care professionals on the signs and symptoms of amniotic fluid embolism and distribute them to specified health care entities by July 1, 2019

Changes the process and qualifications for licensed podiatrists seeking to engage in independent ankle surgery and qualifications to engage in supervised ankle surgery and makes related changes

Permits DPH to administer the Connecticut Aids Drug Assistance Program and Connecticut Insurance Premium Assistance Program; requires all program rebates and refunds to be paid to DPH; and permits DPH to implement policies and procedures to administer the programs while adopting them in regulations

Requires DPH, by January 1, 2019, to develop a system for nursing homes to electronically report “reportable events” to the department, after which nursing homes must report such events using the electronic system

Increases the minimum education requirement for art therapists by requiring them to obtain a graduate degree, instead of a bachelor's degree, in art therapy of a related field

Expands and updates the scope of practice of respiratory therapists; makes minor changes to update licensure requirements; and increases annual continuing education requirements from six to 10 hours

Requires local and regional boards of education to request that students have an oral health assessment prior to public school enrollment, in grade 6 or 7, and in grade 9 or 10; establishes related requirements on, among other things, parental notification and consent, assessment forms, and records access

Allows dental assistants to provide fluoride varnish treatments, if the dentist directly supervises the assistant in providing the treatment

This bill makes various substantive, minor, and technical changes to Department of Public Health (DPH)-related statutes and programs.

*House Amendment “A” makes minor and technical changes to the underlying bill. It also adds the provisions on (1) alcohol and drug counselors; art therapists; dental assistants; marital and family therapy, professional counselor, and psychology students; massage therapists; nuclear medicine technologists; physical therapists; physician assistant orders and supervision; and respiratory care therapists; (2) extending the Food Code implementation date and designating alternate certified food protection managers; (3) long-term care facility and DDS facility background check programs; (4) DPH's Office of Oral Health; (5) the Tobacco and Health Trust Fund; (6) acknowledgements of paternity; (7) municipal and district health departments; (8) public water systems; (9) amniotic fluid embolism education; (10) podiatric ankle surgery; (11) the Connecticut Aids Drug Assistance and Connecticut Insurance Premium Assistance Programs; (12) nursing home reportable events; and (13) school oral health assessments. It also expands provisions on dental hygienist practice without supervision.

The bill makes a technical correction in a statutory citation in the tumor registry statute.

Prohibits DPH from disclosing personnel records it receives during an investigation

The bill prohibits DPH, unless required by federal law, from disclosing personnel records it receives during an investigation of a person DPH licenses, certifies, or regulates. It provides that such records are not subject to disclosure under the Freedom of Information Act (FOIA). These provisions already apply to patient medical records DPH receives during an investigation or disciplinary proceeding of such a person.

Allows dental hygienists with at least two years' experience to practice without a dentist's general supervision at senior centers, managed residential communities, or child care centers.

The bill permits dental hygienists with two years of experience to practice without a dentist's general supervision at senior centers, managed residential communities, or licensed child care centers. Hygienists with two years of experience can already practice without such supervision at DPH-licensed health care institutions; community health centers; group homes; schools; preschools operated by local school boards; Head Start programs; and programs offered or sponsored by the Women, Infants, and Children (WIC) program (collectively, “public health facilities”).

As is already the case for such practice at other public health facilities, the bill requires hygienists practicing at senior centers, managed residential communities, or licensed child care centers to refer to a dentist any patients with needs outside of the hygienist's scope of practice (CGS § 20-126l(f)).

Under existing law, a dental hygienist may substitute eight hours of volunteer practice at a public health facility for one hour of continuing education, up to a maximum of five hours in a two-year period (CGS § 20-126l(g)). This applies under the bill to volunteer practice at senior centers or managed residential communities.

Under existing law and the bill, managed residential communities are facilities consisting of private residential units that provide a managed group living environment for persons who are primarily 55 years old or older. The term does not include state-funded congregate housing facilities.

EFFECTIVE DATE: October 1, 2018, except that the provision on child care centers takes effect July 1, 2018.

The bill adds three members to the SBHC Advisory Committee, increasing its membership to 20.

The bill adds to the committee the Department of Children and Families commissioner or her designee. It also adds two members, appointed by the DPH commissioner, from municipalities that operate SBHCs — one from a municipality with a population of at least 50,000 but under 100,000 people, and the other from a municipality with a population of at least 100,000. (Under existing law, the commissioner also appoints a third member who represents an SBHC sponsored by a local health department.)

By law, the committee advises the DPH commissioner on minimum service standards and other matters concerning SBHCs and expanded school health sites.

Expands access to data on a death certificate except for the decedent's social security number

The bill allows any adult to access all data listed on a death certificate, except it continues to restrict access to the social security number to only certain parties, as under current law. Under the bill, for deaths occurring on or after July 1, 1997, the administrative purposes section of a death certificate includes only the decedent's social security number, and only the following parties can access the full death certificate with that section:

1. the parties listed on the certificate (e.g., the funeral director, physician, and town clerk), for purposes of processing it; and

2. the surviving spouse, next of kin, and state and federal agencies authorized by federal law.

The bill requires DPH to remove or redact the social security number when providing a death certificate to any other individual, researcher, or state or federal agency.

Under current law, the administrative purposes section also includes the decedent's occupation, business or industry, race, Hispanic origin if applicable, and educational level, if known. (Presumably, such information will still be included on death certificates.) Current law allows (1) only the parties listed above to access the full information in the administrative purposes section and (2) researchers to access such information, other than the social security number.

Consolidates certain DPH reporting requirements related to asthma screening and makes related changes

Current law requires DPH to (1) maintain an asthma monitoring system, and annually report on the status and results of the system and statewide asthma plan and (2) report every three years on the asthma screening information provided to DPH by school districts (i.e., the total number of students per school and per district with asthma upon enrollment and in specified grades). The bill eliminates the annual report and instead incorporates, into the triennial report, information on the activities of the asthma monitoring system.

It extends the due date for the next triennial report from October 1, 2019 to October 1, 2021. It requires DPH, starting by that date and every three years after that, to post on its website the activities of the asthma monitoring system, including the information the department collects from school districts.

The bill removes certain specific requirements for the asthma monitoring system, such as that (1) it include reports of asthma visits and the number of people with asthma, as voluntarily reported by health care providers and (2) the commissioner use the system to estimate the annual incidence and distribution of asthma in the state, including based on certain demographic criteria.

The bill also removes certain obsolete provisions and makes other technical changes.

Specifies that school social workers with the appropriate credentials may use that title, even if not licensed by DPH

The bill specifies that if someone holds a professional educator certificate with a school social worker endorsement, the person may use the title “school social worker” to describe his or her activities while working at a public or private school, even if the person is not licensed as a social worker by DPH.

Gives a health care institution more time to submit a correction plan after receiving a notice of noncompliance

Under existing law, a licensed health care institution must submit a correction plan to DPH if the department, after an inspection, issues a notice that the institution was out of compliance with applicable laws or regulations. The bill requires the institution to submit the plan within 10 business days after receiving the notice of noncompliance, rather than 10 calendar days as under current law.

Expands the scope of DPH's mandatory reporting system for health care associated infections, adds to the membership of the advisory committee on such matters, and makes related changes

The bill expands the scope of DPH's mandatory reporting system for health care associated infections to also include antimicrobial resistance. It specifies that the system must be based on nationally recognized and recommended standards.

In practice, under the current program, DPH collects data on health care associated infections at acute care and long-term acute care hospitals, inpatient rehabilitation facilities, and outpatient dialysis facilities. The bill expands the program to include other health care facilities.

Current law requires DPH to (1) annually report to the Public Health Committee on the information collected through the system, (2) make such reports available online, and (3) post online information on health care associated infections to help the public learn about them and compare infection rates at Connecticut facilities. The bill eliminates the annual reporting requirement, and instead requires DPH to annually post online the information it collects through the mandatory reporting system. It requires such information to include:

1. the number and type of health care associated infections and antimicrobial resistance reported by each health care facility (current law requires the report to include the number and type of such infections, including certain specific types);

2. links to the National Centers for Disease Control and Prevention's health care associated infection data reports and the federal Centers for Medicare and Medicaid Services' (CMS) quality improvement program website (current law requires DPH's website to include a link to CMS's hospital compare website); and

3. information to help the public learn about health care associated infections and antimicrobial resistance and how to prevent such infections and resistance.

Under current law, an advisory committee advises DPH on the health care associated infection monitoring program. To correspond with the expanded scope of the program, the bill renames the committee as the “advisory committee on health care associated infections and antimicrobial resistance.” It also adds the following 10 members to the committee, to be appointed by the DPH commissioner:

Current law requires the committee to meet at unspecified intervals. The bill instead specifies that the committee may meet upon the commissioner's request. It modifies the purposes for which the committee may meet to include identifying, evaluating, and recommending reporting measures and processes designed to prevent antimicrobial resistance, not just health care associated infections as under current law.

The bill eliminates from the committee's purview recommending appropriate methods to increase public awareness about how to reduce the spread of infections.

Eliminates the requirement for the DPH commissioner to annually report on the department's quality of care program

The bill eliminates the requirement for the DPH commissioner to annually report on DPH's quality of care program to the governor and Public Health Committee. It also removes certain obsolete provisions on one-time reporting requirements.

Eliminates a requirement that DPH report on certain matters related to donated property

The bill eliminates the requirement that DPH annually report on certain matters related to real estate or other property donated to the department, such as the donors' names and how the property is being used.

Eliminates a requirement for DPH to annually publish a report on nursing homes and residential care homes and instead requires the department to post certain related information online

The bill eliminates a requirement for DPH to annually publish a report that lists and classifies all nursing homes and residential care homes in the state, and instead requires the department to post the information on its website.

It requires the posted information to include the number and effective date of the license and the address for each such facility. It does not require other information currently required for the published report, such as the total number of beds; number of private and semiprivate rooms; religious affiliation, and religious services offered, if any, in the facility; and per diem cost for private patients.

Requires the DPH commissioner to adopt specified national standards for trauma data collection and provides that an existing reporting requirement applies annually starting by December 1, 2018

Existing law requires the DPH commissioner to report to the Emergency Medical Services Advisory Board on specified EMS call data categorized by municipality, such as the total number of calls by each ambulance or paramedic intercept service, the EMS level required for each call, and response times. The bill requires the commissioner to report the data annually, starting by December 31, 2018.

It also requires the commissioner, with the board's recommendation, to adopt for use in trauma data collection the most recent version of the National Trauma Data Bank's National Trauma Data Standards and Data Dictionary and nationally recognized guidelines for field triage of injured patients.

Under current law, DPH may issue a license, without examination, to a dentist licensed in another state or territory, provided the other jurisdiction's licensure requirements are similar or higher to Connecticut's. The bill instead allows DPH to issue a license without examination to a dentist licensed and practicing in another state or territory if he or she:

1. holds a license issued after examination by another state with licensing standards that, except for the practical examination, are commensurate with Connecticut's standards, 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 preceding the application for licensure without examination.

Specifies that lead training providers and asbestos training providers must apply to renew their certificates during the anniversary month of their initial certification

By law, lead training providers and asbestos training providers must be certified by DPH, subject to annual renewal. The bill specifies that they must apply for renewal during the month of their initial certification.

PA 17-93 required DPH, by July 1, 2018, to adopt the Food and Drug Administration's Food Code as the state's food code for regulating food establishments. As noted below, the bill extends the deadline to January 1, 2019 (see §§ 505-507).

The bill exempts certain residential care homes from the food code's requirements. Specifically, it exempts such a home with 30 or fewer beds, as long as the home's administrator or his or her designee has passed a test as part of a food protection manager certification program approved by an accrediting agency recognized by the Conference for Food Protection as conforming to its accreditation standards. The exemption does not apply to such a home that (1) enters into a service contract with a food establishment or (2) lends, rents, or leases any area of its facility to any person or entity for the purpose of preparing or selling food.

Under current law, there are four classifications of food establishments in the food code. The bill amends the definition of a class 1 establishment to prohibit these establishments from serving a population that is highly susceptible to foodborne illnesses. The bill specifies that if such an establishment offers for sale commercially prepackaged, precooked food that is time or temperature controlled and heated, it must be served within four hours after heating.

The bill makes additional minor changes to the definitions of a class 1 and 3 establishment and makes other minor and technical changes to certain provisions related to the food code.

Replaces statutory references to “venereal disease” with references to “sexually transmitted disease”

The bill makes technical changes by replacing several statutory references to “venereal disease” with “sexually transmitted disease.”

Updates terminology related to funeral home licensure and decreases the required frequency of DPH inspections of funeral homes

Under current law, a funeral service business may not operate unless it receives a DPH-issued inspection certificate. The bill replaces the term “inspection certificate” with “funeral home license.”

It also decreases the required frequency of DPH inspections of funeral homes, from annually to at least once every three years.

§§ 34-39 — ADVANCED PRACTICE REGISTERED NURSES (APRNS) AND ADVANCE DIRECTIVES

Adds APRNs into the laws on living wills and other advance directives, authorizing them to perform certain functions that currently may be performed only by a physician

The bill incorporates APRNs into the laws on living wills and other advance directives. In doing so, it extends to APRNs the authority to perform certain functions that currently may be performed only by a physician or, in some cases, other specified providers.

For example, current law provides that a living will or appointment of a health care representative becomes operative when the document is given to the attending physician and the physician determines the person to be incapacitated. The bill provides that such a document also takes effect when given to a patient's APRN who determines the person to be incapacitated.

The bill makes several corresponding and conforming changes. For example, it adds references to APRNs into the law's standard forms for advance directives (e.g., form language stating that the patient's APRN, not just physician as under current law, may rely on the document's health care instructions and decisions made by the patient's health care representative).

It provides in the forms that an APRN, not just a physician, may make the determination that a patient is suffering from a terminal condition. It makes a corresponding change to the existing definition of “terminal condition” for these purposes (see § 34).

Current law provides that, if a resident of a facility operated or licensed by the Department of Mental Health and Addiction Services or Department of Developmental Services seeks to execute a document appointing a health care representative, at least one witness must be a physician or clinical psychologist with specialized training in treating mental illness or developmental disabilities, respectively. In both situations, the bill adds APRNs to the list of eligible witnesses (§ 37).

Prohibits DPH from requiring that a health care institution licensure application be notarized

The bill prohibits DPH from requiring that a health care institution licensure application be notarized.

1. DPH and the Department of Social Services to create a media campaign to reduce teen pregnancy (CGS § 19a-59e),

2. a DPH permit for public exhibitions of still or motion pictures relating to sexually transmitted diseases (CGS § 21-7), and

3. the Office of Health Care Access to adopt regulations on specified matters concerning state professional standard review organizations (CGS § 38a-558).

The bill also repeals a law on public laundries that, among other things, (1) classifies a public laundry as a manufacturing establishment (thus setting limits on hours for certain workers at such establishments) and (2) prohibits public laundry employers from allowing employees to work if they have certain communicable diseases (CGS § 31-43).

§§ 501-504 — MARRIAGE AND FAMILY THERAPISTS, PROFESSIONAL COUNSELORS, AND PSYCHOLOGY STUDENTS

By law, students who graduate with advanced degrees in marital and family therapy (MFT), professional counseling, 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 bill permits these graduates to practice in this unlicensed capacity for up to two years after completing the supervised work experience, if they failed the respective licensing examination.

Under current law, professional counseling and psychology students may practice in this manner 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 therapist students, current law does not specify that the licensure exemption ends on the earlier of these two dates.

The bill extends by six months, from July 1, 2018 to January 1, 2019, the date by which DPH must adopt and administer the federal Food and Drug Administration's (FDA) Food Code, and any published supplements, as the state's food code for regulating food establishments. Under current law, DPH regulates these establishments under the Public Health Code.

1. requiring food inspectors to obtain certification from DPH after meeting specified education and training requirements and

2. allowing food establishments to request from DPH a variance from Public Health Code requirements in order to use the sous vide cooking technique or acidify sushi rice, as an alternative to temperature control.

By law, Class 2, Class 3, and Class 4 food establishments must employ a “certified food protection manager.” To be designated as such, the person must pass an exam that is part of a certification program evaluated and approved by an accrediting agency recognized by the Conference for Food Protection.

The bill requires a food establishment's owner or manager to designate an alternate person to be in charge whenever the certified food protection manager is absent. The alternate person must ensure that:

1. all employees comply with the bill's provisions,

2. foods are safely prepared in accordance with the Model Food Code's requirements,

3. emergencies are properly managed,

4. a food inspector is admitted to the establishment upon request, and

5. he or she receives and signs inspection reports.

Expands eligibility criteria to qualify as the director of DPH's Office of Oral Public Health

Under current law, the director of DPH's Office of Oral Public Health must be a licensed dentist or dental hygienist with public health experience. The bill also allows someone with the following qualifications to serve as the director:

1. a person with a Doctor of Medicine or Doctor of Osteopathy degree from an accredited higher education institution or

2. a public health professional with a graduate degree in public health.

By law, DPH administers a comprehensive criminal history and patient abuse background search program that facilitates the performance, processing, and analysis of background searches on people who have direct access to long-term care facility residents (i.e., employees and volunteers).

Under current law, long-term care facilities subject to the program's requirements include home health agencies, assisted living agencies, chronic disease hospitals, DPH-licensed or federally certified agencies providing hospice care, nursing homes, and intermediate care facilities for individuals with intellectual disabilities (ICF-IIDs). The bill exempts ICF-IIDs operated by a Department of Developmental Services' (DDS) program already subject to background checks under current law (see § 511).

Additionally, the bill exempts DPH background search program records and information from disclosure under the Freedom of Information Act.

The bill also makes technical changes, including eliminating obsolete provisions requiring DPH to develop a plan to implement the program.

Existing law requires DDS to conduct state criminal background checks on any job applicant that will provide direct services to people with intellectual disability. The bill also subjects these job applicants to fingerprint and national criminal background checks.

Current law allows, but does not require, DDS to subject private subcontractors to state criminal background checks. The bill instead permits DDS to subject private providers licensed or funded by the department to such background checks.

Current law prohibits DDS and private providers from hiring an applicant until the results of a required background check are available. The bill instead allows DDS and private providers to employ such applicants on a conditional basis until they receive and review the background check results.

Modifies the certification examination requirements for nuclear medicine technologists to operate certain CT or magnetic resonance imaging equipment

Existing law specifies that the radiographer licensure statutes do not prohibit a nuclear medicine technologist from fully operating a CT or magnetic resonance imaging (MRI) portion of a hybrid-fusion imaging system, including diagnostic imaging, in conjunction with a (1) positron emission tomography or (2) single-photon emission CT imaging system.

To do this, the technologist must (1) hold and maintain in good standing CT or MRI certification from the American Registry of Radiologic Technologists (ARRT) or the Nuclear Medicine Technology Certification Board (NMTCB) and (2) have successfully completed the individual certification exam for CT or MRI. The bill allows technologists to complete the certification exam administered by the NMCTB, instead of just the ARRT.

Removes the authority for a PA to order an APRN to administer a controlled substance

The bill specifies that a PA does not have the authority to order an APRN to administer a controlled substance.

Modifies the definition of “alcohol and drug counseling” to distinguish between licensed and certified counselors; makes other minor and technical changes to licensure requirements

The bill makes various changes, mostly minor and technical, to update statutory definitions and licensure requirements for alcohol and drug counselors.

The bill modifies the definition of “alcohol and drug counseling” to distinguish between the scope of practice of alcohol and drug counselors who are licensed and those who are certified. It permits licensed alcohol and drug counselors to, among other things:

1. clinically evaluate substance use and co-occurring disorders (i.e., a psychiatric or medical disorder combined with a substance use disorder) and

2. as under current law, conduct substance use disorder screenings and risk assessments, and develop related treatment plans and referrals.

Under the bill, certified alcohol and drug counselors may apply methods to assist an individual or group to develop an understanding of alcohol and drug dependency problems, define goals, and plan action reflecting the individual's or group's interests, abilities, and needs.

Under current law, to become a certified or licensed alcohol or drug counselor, an individual must, among other requirements, have completed (1) 300 hours of supervised practical training in alcohol and drug counseling and (2) three years of supervised paid work experience or unpaid internship that involved direct client work (a master's degree may be substituted for one year of such experience). The bill specifies that the supervisor must be a licensed alcohol and drug counselor or other licensed mental health professional whose scope of practice includes the screening, assessment, diagnosis, and treatment of substance use disorders and co-occurring disorders.

Current law requires the Tobacco and Health Trust Fund Board to report (1) its activities and accomplishments to the Appropriations and Public Health committees by January 1^st annually and (2) all disbursements and expenditures and an evaluation of fund recipients' performance and impact to the legislature by February 1^st annually. The bill instead requires the board to submit these reports only following a fiscal year in which the trust fund receives a deposit from the Tobacco Settlement Fund.

The bill also eliminates the requirement under current law that the 17-member board meet at least biannually.

Allows the legal guardian of a person who is the subject of an acknowledgment of paternity to obtain a certified copy of the form

The bill allows the legal guardian of a person whose birth is the subject of an acknowledgment of paternity to obtain a certified copy of the acknowledgment.

Existing law restricts access to the acknowledgment to certain parties, including the parents named on the form, the person whose birth is acknowledged if an adult, attorneys representing the person or parent named on the form, and authorized government agencies. By law, the Department of Public Health must maintain a paternity registry, which includes such voluntary acknowledgements and court-ordered adjudications of paternity (CGS § 19a-42a(a)).

Expressly permits a health district to join an existing health district; makes technical changes to statutes on municipal and district health departments

The bill expands a health district's powers to include the ability to join an existing health district. Existing law already allows municipalities to join or form a district health department.

The bill also makes numerous technical changes to statutes on municipal and district health departments.

The bill makes various changes affecting public water systems and the oversight of small community water systems (i.e., those regularly serving between 25 and 1,000 year-round residents). Among other things, it requires (1) small community water systems to submit to DPH a fiscal and asset management plan for all their capital assets and (2) the DPH commissioner to publish a schedule of civil penalties imposed against water companies under the safe drinking water statutes, instead of adopting them in regulations as under current law.

Under the bill, as under existing law, “water company” means any individual, municipality, or entity that owns, maintains, operates, manages, controls, or employs any pond, lake, reservoir, well, stream, or distributing plant or system that supplies water to two or more consumers or to 25 or more people on a regular basis.

The bill requires each small community water system to prepare a fiscal and asset management plan for all of the system's capital assets. The fiscal and asset management plan must include:

1. a list of all of the system's capital assets;

2. the assets' (a) useful life, based on their current condition, (b) maintenance and service history, and (c) manufacturer's recommendation;

3. the small community water system's plan for reconditioning, refurbishing, or replacing the assets; and

4. information on (a) whether the small community water system has any unaccounted for water loss (i.e. water supplied to its distribution system that never reached consumers), (b) the amount and cause of such unaccounted water loss, and (c) measures the system is taking to reduce it.

The bill requires the water system to begin creating the plan by assessing its hydropneumatic pressure tanks as its initial priority.

Under the bill, the “useful life” of a water system's capital asset means the manufacturer's recommended life or the estimated lifespan, taking into consideration the asset's service history and condition when the fiscal and asset management plan is prepared.

Deadline. The bill requires small community water systems to complete the fiscal and asset management plan by January 1, 2021. But they must first complete an assessment review of their hydropneumatic pressure tanks by May 2, 2019, on a form DPH prepares.

The bill also requires small community water systems to update the fiscal and asset management plan annually and make it available to DPH upon request.

Exceptions. The plan requirement does not apply to a small community water system that is (1) regulated by the Public Utilities Regulatory Authority (i.e., investor-owned water companies), (2) required to submit a water supply plan to DPH (e.g., generally those serving 1,000 or more people or 250 or more customers), or (3) a state agency.

The bill deems the report requirement to relate to the purity and adequacy of water supplies for the purpose of imposing a penalty for violating statutory or regulatory requirements regarding public water supply purity, adequacy, or testing described further below.

Regulations. The bill authorizes the DPH commissioner to adopt regulations to implement the fiscal and asset management plan requirement.

Publishing Civil Penalty Schedule. Current law requires the DPH commissioner to adopt regulations establishing a schedule of civil penalties that may be imposed against water companies that violate state laws and regulations regarding the purity, adequacy, and testing of public water supplies.

The bill instead requires the commissioner to publish the civil penalty schedule on the department's website if the penalty for a violation has not been established by statute. The commissioner must do this annually, or when he deems it necessary in response to any guidelines or rules issued by the federal Environmental Protection Agency.

Notwithstanding the Uniform Administrative Procedure Act (UAPA), the bill does not require the commissioner to adopt or revise any regulations for imposing these civil penalties.

Within six months before publishing the civil penalty schedule on the DPH website, the commissioner must publish a notice in the Connecticut Law Journal of his intention to do so. The notice must include (1) the civil penalty schedule, (2) the date the commissioner intends to hold a public hearing on the matter, and (3) when the commissioner will receive public comments on the schedule. He must hold the hearing and receive public comments on the civil penalty schedule within 30 days after publishing the notice.

The bill requires the commissioner to consider the public comments he receives when establishing the civil penalty schedule and publish his response to these comments on the department's website at least one month before publishing the schedule.

Notice of Violations. By law, the DPH commissioner must notify a water company before imposing a civil penalty for failing to correct a violation within a specified date. He may do this by certified mail, return receipt requested, or personal service. The bill specifies that for the latter, the notification must be served to the address the water company filed with the department, or if the water company failed to do so, the company's last known address on file.

If the civil penalty is imposed for a continuing violation, the bill requires the notice to include the initial date the penalty is imposed. For an isolated violation, the notice must include the date for which it is imposed. By law, the notice must include additional information, such as a statement of the violation and the water company's right to a hearing.

Administrative Appeal. By law, a water company can contest the penalty by applying to the DPH commissioner for an administrative hearing under the UAPA within 20 days after receiving notice of the penalty. The bill requires the application to include a detailed statement of all the grounds for contesting the penalty.

Existing law, unchanged by the bill, requires the water company to send a copy of the application to the health director of the municipalities in which the violation occurred or that use the water that was the subject of the violation. A water company aggrieved by a DPH order may appeal to Superior Court.

The bill makes various changes affecting massage therapists, including (1) modifying education and training licensure requirements; (2) establishing minimum professional liability insurance requirements; and (3) generally allowing out-of-state massage therapists to provide voluntary, supervised services at the invitation of the emergency division of the American Massage Therapy Association (AMTA) Connecticut Chapter's Community Service Massage Team.

EFFECTIVE DATE: October 1, 2019, except that the provision on voluntary services by out-of-state massage therapists takes effect October 1, 2018.

Starting October 1, 2019, the bill increases, from 500 to 750, the number of classroom hours an applicant for an initial license or a license by endorsement (i.e., a person licensed by another state) must complete upon graduating from an accredited massage therapy school.

It also requires such applicants to complete at least 60 hours of unpaid, supervised clinical or internship experience.

Existing law, unchanged by the bill, also requires licensure applicants to (1) pass a national examination prescribed by DPH and (2) pay a $375 application fee.

The bill requires licensed massage therapists who provide direct patient care to maintain professional liability insurance of at least $500,000 per person per occurrence, and $1 million aggregate.

Starting January 1, 2019, insurers who provide such policies must annually report to DPH the names and addresses of massage therapists who, in the prior year, cancel or refuse to renew their professional liability insurance policies as well as their reasons for doing so. The bill also requires such insurers to provide similar information to the Department of Insurance by March 1 annually.

The bill allows massage therapists licensed in other states to provide voluntary, supervised massage therapy services if they:

1. are (a) licensed or certified in another state whose standards are equivalent or greater than Connecticut's or (b) if the state does not require such licensure or certification, AMTA members in good standing;

2. are invited by the emergency division of the AMTA Connecticut Chapter's Community Service Massage Team; and

3. do not hold themselves out to be licensed in Connecticut.

Current law already allows out-of-state massage therapists to provide such services to participants in the Special Olympics or other athletic competition for individuals with disabilities. The bill limits such services only to the individuals with disabilities at these events.

Prohibits anyone without the proper credentials from referring to himself or herself as a “Doctor of Physical Therapy” or “D.P.T.”

The bill prohibits anyone from using the term “Doctor of Physical Therapy” or the letters “D.P.T.” unless the person is licensed as a physical therapist and has a Doctor of Physical Therapy degree from an accredited higher education institution. A violation is a class D felony, punishable by up to five years in prison, a fine of up to $5,000, or both (CGS § 20-73(c)).

The bill requires DPH to develop and post on its website, materials to educate health care professionals on the signs and symptoms of amniotic fluid embolism (AFE) (see BACKGROUND). The department must do this by January 1, 2019, and in consultation with (1) the AFE Foundation and (2) a licensed physician specializing in obstetrics and gynecology who is recommended by the Connecticut State Medical Society.

Under the bill, DPH must distribute the educational materials by July 1, 2019, to the following entities to distribute to their members and post on their websites: the Connecticut State Medical Society, American College of Nurse-Midwives' Connecticut Affiliate, Connecticut Advanced Practice Registered Nurse Society, Connecticut Nurses Association, and Connecticut Hospital Association. DPH must also provide the materials to each Connecticut medical school for dissemination to its students.

The bill also requires DPH to provide the educational materials to the Public Health Committee by July 1, 2019.

Finally, the bill provides that its provisions cannot be construed to override professional medical judgement or restrict the use of other educational or instructional materials.

AFE is a pregnancy complication that is unpreventable and often fatal. It occurs when the mother or baby experiences an allergic-like reaction to amniotic fluid entering the mother's circulatory system. Among other things, the condition may cause rapid respiratory failure, cardiac arrest, and hemorrhaging at the site of the placental attachment or cesarean incision.

Changes the process and qualifications for licensed podiatrists seeking to engage in independent ankle surgery and qualifications to engage in supervised ankle surgery and makes related changes

1. modifies the process and qualifications for podiatrists seeking to independently engage in ankle surgery;

2. modifies the qualifications for podiatrists seeking to engage in supervised ankle surgery;

3. specifies that a podiatrist's privileges and scope of practice for foot surgery are not impacted by his or her privileges and scope of practice for ankle surgery; and

4. makes related minor, technical, and conforming changes, such as updating the names of national certification boards.

EFFECTIVE DATE: October 1, 2018, except a conforming change is effective July 1, 2018.

Under current law, a licensed podiatrist cannot independently engage in ankle surgery unless he or she meets specified qualifications and receives a separate permit from DPH. The qualifications differ for a permit to independently perform standard or advanced ankle surgery.

The bill eliminates the requirement for a separate DPH permit. It correspondingly eliminates requirements that the DPH commissioner (1) appoint an advisory committee to assist him in evaluating permit applications and (2) adopt regulations identifying the number and types of procedures needed to qualify for a permit.

The bill instead allows a licensed podiatrist to independently engage in ankle surgery if he or she provides documentation to DPH of having met specified qualifications (see below). It requires DPH to implement a mechanism for (1) a podiatrist to provide the required documentation as part of the initial licensure application and (2) credentialing boards and the public to access the names of podiatrists who submitted the documentation. The bill provides that any podiatrist who holds a standard ankle surgery permit on October 1, 2018 is deemed to have met the bill's documentation requirements.

Qualifications. The bill allows podiatrists to independently perform ankle surgery if they submit documentation that they:

1. graduated from a podiatric residency program meeting the criteria below and

2. hold current board certification or qualification in reconstructive rearfoot ankle surgery by the American Board of Foot and Ankle Surgery or its successor.

The residency program must have been accredited by the Council on Podiatric Medical Education, or its successor, at the time of graduation. The program must have been at least (1) two years in length if the person graduated before June 1, 2006, or (2) three years for graduates after that.

These qualifications are generally similar to the current qualifications for the permit, except under current law:

1. podiatrists who graduated before June 1, 2006 must hold current board certification, not qualification; and

2. for the advanced permit, and in some situations for the standard permit, podiatrists must submit additional documentation of acceptable training and experience.

As under current law, the bill establishes qualifications for podiatrists to engage in ankle surgery while being directly supervised by a (1) podiatrist qualified to independently perform surgery or (2) physician with hospital privileges to perform such procedures.

The bill requires such podiatrists to be board certified in foot and ankle surgery. It eliminates current provisions that allow podiatrists to perform ankle surgery under supervision if they are board certified or qualified in reconstructive rearfoot ankle surgery. It also eliminates the current requirement that such a podiatrist have completed a two-year residency.

§ 531 — CONNECTICUT AIDS DRUG ASSISTANCE PROGRAM AND CONNECTICUT INSURANCE PREMIUM ASSISTANCE PROGRAM

Notwithstanding certain state medical assistance laws, the bill permits DPH, within available resources, to administer the Connecticut Aids Drug Assistance Program and Connecticut Insurance Premium Assistance Program. It requires all rebates and refunds from the programs to be paid to DPH.

Under the bill, DPH may implement policies and procedures to administer the programs while adopting them in regulations. The department may do this only if it posts the policies and procedures on the state eRegulations system before adopting them. The policies and procedures are valid until regulations are adopted.

The bill requires DPH to develop a system for nursing homes to electronically report “reportable events” to the department. It must do this by January 1, 2019, after which nursing homes must report the events using the electronic system.

Under the bill, “reportable events” are events occurring at a nursing home that the department deems to require immediate notification.

Increases the minimum education requirement for art therapists by requiring them to obtain a graduate degree, instead of a bachelor's degree, in art therapy of a related field

The bill increases the minimum education requirement for art therapists by requiring them to obtain a graduate degree, instead of a bachelor's degree, in art therapy or a related field from an accredited higher education institution.

Connecticut does not license art therapists, but the law generally makes it a class D felony to represent oneself as an art therapist without (1) meeting the education requirement and (2) maintaining national certification by the Art Therapy Credentials Board or any successor board. The law does not apply to:

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

2. students enrolled in certain approved art therapy or graduate art therapy educational programs, if performing the therapy under an art therapist's direct supervision.

By law, a class D felony is punishable by up to five years imprisonment, up to a $5,000 fine, or both.

The bill makes various changes affecting respiratory care therapists, including (1) expanding and updating their scope of practice, (2) making minor changes to update licensure requirements, and (3) increasing annual continuing education requirements from six to 10 hours.

The bill expands the scope of practice of respiratory care practitioners to include:

1. inserting, monitoring, and maintaining arterial catheters;

2. monitoring and maintaining other cardiovascular indwelling catheters, including central venous and pulmonary artery catheters;

3. inserting intravenous and intraosseous (i.e., bone marrow) catheters in appropriately identified health care settings (e.g., medical evaluation and transport vehicles and outpatient bronchoscopy, long-term care, and rehabilitation facilities) if the practitioner completed a competency-based training and education program to do so;

4. inserting nasogastric tubes, including those used to sense diaphragmatic movements; and

5. monitoring and maintaining extracorporeal life support, including extracorporeal membrane oxygenation (ECMO) and extracorporeal carbon dioxide removal in appropriately identified health care settings (e.g., adult, pediatric, and neonatal intensive care units), if the practitioner meets specified standards (see below).

A respiratory care therapist may only perform the functions related to extracorporeal life support if he or she:

1. is a registered respiratory therapist by the National Board for Respiratory Care and successfully completed the examination necessary to obtain such certification;

2. has neonatal, pediatric, or adult critical care clinical experience;

3. completed education and training to practice as an ECMO specialist in accordance with the Extracorporeal Life Support Organization's training and continuing education guidelines;

4. practices as an ECMO specialist under the direction and supervision of a licensed physician trained in ECMO;

5. does not participate in ECMO procedures that occur in an operating room, except in the case of a life-threatening emergency requiring the immediate resuscitation of a patient; and

6. if performing these functions in a hospital setting, is approved by the hospital's critical care committee.

The bill makes minor and technical changes to update licensure requirements for respiratory care practitioners. It allows applicants to complete educational programs accredited by the Commission on the Accreditation for Respiratory Care, instead of only those programs:

1. accredited by the Committee on Allied Health Education and Accreditation or the Commissioner on Accreditation of Allied Health Education Programs, in cooperation with the Joint Review Committee for Respiratory Therapy Education or

2. recognized by the Joint Review Committee for Respiratory Therapy Education.

The bill increases the annual continuing education requirement for respiratory care practitioners from six to 10 hours. At least five hours must include real-time education with opportunities for live interaction, such as in-person phone conferences and real-time webinars. As under current law, continuing education must be directly related to respiratory therapy and reflect the practitioner's professional needs in order to meet the public's health care needs.

Under the bill, the requirements apply to license registration periods starting January 1, 2019.

The bill removes the current limitation that a physician may serve as the supervising physician for no more than six full-time PAs or the part-time equivalent.

The bill requires local and regional boards of education to request that students have an oral health assessment prior to public school enrollment, in grade 6 or 7, and in grade 9 or 10. It establishes related requirements on providers authorized to perform the assessments, parental consent, assessment forms, notification, and records access.

1. a dentist or dental hygienist or

2. a physician, physician assistant (PA), or an advanced practice registered nurse (APRN), if he or she is trained in conducting such assessments as part of a DPH-approved training program.

If a dentist conducts the assessment, it must include a dental examination. If another such provider conducts the assessment, it must include a visual screening and risk assessment.

The bill prohibits an oral health assessment as described above from being performed unless (1) the child's parent or guardian consents and (2) the assessment is made in the presence of the parent or guardian or another school employee. The parent or guardian must receive prior written notice and have a reasonable opportunity to opt his or her child out of the assessment, be present at the assessment, or provide for the assessment himself or herself.

The bill prohibits a school board from denying a child's public school enrollment or continued attendance for not receiving such an oral health assessment.

Under the bill, a school board must provide prior notice to the parents or guardians of a school's students if the board hosts a free oral health assessment event at which a qualified provider performs such oral health assessments.

The parents and guardians must have the opportunity to opt their children out of the assessment event. If the parent or guardian does not do so, the child must receive an assessment free of charge.

The bill prohibits the child from receiving any dental treatment as part of the assessment event without the parent's or guardian's informed consent.

Under the bill, the results of an oral health assessment must be recorded on forms supplied by the State Board of Education. The form must include a check box for the provider to indicate any low, moderate, or high risk factors associated with any dental or orthodontic appliance, saliva, gingival condition, visible plaque, tooth demineralization, carious lesions, restorations, pain, swelling, or trauma.

The provider performing the assessment must completely fill out and sign the form. If the provider has any recommendations, they must be in writing. For any child who receives an oral health assessment, the results must be included in the child's cumulative health record and kept on file in the school.

The bill requires appropriate school health personnel to review the assessment results. When, in the health personnel's judgment, a child needs further testing or treatment, the school superintendent must give written notice to the child's parent or guardian and make reasonable efforts to ensure that further testing or treatment is provided. These efforts must including determining whether the parent or guardian obtained the necessary testing or treatment for the child and, if not, advising the parent or guardian on how to do so.

The results of the further testing or treatment must be recorded on the assessment forms and reviewed by school health personnel.

As under existing law regarding school health assessments, the bill provides the following for oral health assessments:

1. no records of any such assessment may be open to public inspection; and

2. each provider who conducts an assessment for a child seeking to enroll in a public school must provide the assessment results to the school district's designated representative and a representative of the child.

Allows dental assistants to provide fluoride varnish treatments, if the dentist directly supervises the assistant in providing the treatment

The bill allows dentists to delegate to dental assistants the provision of fluoride varnish treatments. The bill defines such treatments as the application of a highly concentrated form of fluoride on the surface of the teeth.

As with other procedures that a dentist delegates to a dental assistant, the treatments must be performed under direct supervision and the supervising dentist must assume responsibility for the procedure.

Yea

Nay

(03/23/2018)