SB 921

Version: File+No.+594+R000594+FC
Author: Public Health Committee

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AN ACT CONCERNING THE SCOPE OF PRACTICE OF ADVANCED PRACTICE REGISTERED NURSES.

Be it enacted by the Senate and House of Representatives in General Assembly convened:

1 Section 1. Subsection (a) of section 17a-81 of the general statutes is 2 repealed and the following is substituted in lieu thereof (Effective

3October 1, 2019):

4(a) Parental consent shall be necessary for treatment. In the event

5such consent is withheld or immediately unavailable and the physician

6or advanced practice registered nurse certified as a psychiatric mental

7 health provider by the American Nurses Credentialing Center

8concludes that treatment is necessary to prevent serious harm to the

9child, such emergency treatment may be administered pending receipt

10of parental consent.

11Sec. 2. Subparagraph (B) of subdivision (16) of section 31-275 of the

12general statutes is repealed and the following is substituted in lieu

13thereof (Effective October 1, 2019):

14(B) "Personal injury" or "injury" shall not be construed to include:

15(i) An injury to an employee that results from the employee's

16voluntary participation in any activity the major purpose of which is

17social or recreational, including, but not limited to, athletic events,

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18parties and picnics, whether or not the employer pays some or all of

19the cost of such activity;

20(ii) A mental or emotional impairment, unless such impairment (I)

21arises from a physical injury or occupational disease, (II) in the case of

22a police officer, arises from such police officer's use of deadly force or

23subjection to deadly force in the line of duty, regardless of whether

24such police officer is physically injured, provided such police officer is

25the subject of an attempt by another person to cause such police officer

26serious physical injury or death through the use of deadly force, and

27such police officer reasonably believes such police officer to be the

28subject of such an attempt, or (III) in the case of a firefighter, is

29diagnosed as post-traumatic stress disorder by a licensed and board

30certified mental health professional or a licensed advanced practice

31registered nurse who is certified as a psychiatric mental health

32provider by the American Nurses Credentialing Center, determined by

33 such professional or advanced practice registered nurse to be

34originating from the firefighter witnessing the death of another

35firefighter while engaged in the line of duty and not subject to any

36other exclusion in this section. As used in this clause, "police officer"

37means a member of the Division of State Police within the Department

38of Emergency Services and Public Protection, an organized local police

39 department or a municipal constabulary, "firefighter" means a

40uniformed member of a municipal paid or volunteer fire department,

41and "in the line of duty" means any action that a police officer or

42firefighter is obligated or authorized by law, rule, regulation or written

43condition of employment service to perform, or for which the police

44officer or firefighter is compensated by the public entity such officer

45serves;

46(iii) A mental or emotional impairment that results from a personnel

47action, including, but not limited to, a transfer, promotion, demotion

48or termination; or

49(iv) Notwithstanding the provisions of subparagraph (B)(i) of this

50subdivision, "personal injury" or "injury" includes injuries to

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51employees of local or regional boards of education resulting from

52participation in a school-sponsored activity but does not include any

53injury incurred while going to or from such activity. As used in this

54clause, "school-sponsored activity" means any activity sponsored,

55recognized or authorized by a board of education and includes

56activities conducted on or off school property and "participation"

57means acting as a chaperone, advisor, supervisor or instructor at the

58request of an administrator with supervisory authority over the

59employee.

60Sec. 3. Subsections (a) to (c), inclusive, of section 31-294d of the

61general statutes are repealed and the following is substituted in lieu

62thereof (Effective October 1, 2019):

63(a) (1) The employer, as soon as the employer has knowledge of an

64injury, shall provide a competent physician, [or] surgeon or advanced

65practice registered nurse to attend the injured employee and, in

66addition, shall furnish any medical and surgical aid or hospital and

70employer, any insurer acting on behalf of the employer, or any other

71entity acting on behalf of the employer or insurer shall be responsible

72for paying the cost of such prescription drugs directly to the provider.

73If the employer utilizes an approved providers list, when an employee

74 reports a work-related injury or condition to the employer the

75employer shall provide the employee with such approved providers

76list within two business days of such reporting.

77(2) If the injured employee is a local or state police officer, state

78marshal, judicial marshal, correction officer, emergency medical

79technician, paramedic, ambulance driver, firefighter, or active member

80of a volunteer fire company or fire department engaged in volunteer

81duties, who has been exposed in the line of duty to blood or bodily

82fluids that may carry blood-borne disease, the medical and surgical aid

83or hospital and nursing service provided by the employer shall include

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84any relevant diagnostic and prophylactic procedure for and treatment

85of any blood-borne disease.

88physicians, [and] surgeons and advanced practice registered nurses

89prepared by the chairman of the Workers' Compensation Commission.

90If the employee is unable to make the selection, the employer shall do

91so, subject to ratification by the employee or his next of kin. If the

92 employer has a full-time staff physician or advanced practice

93registered nurse or if a physician or advanced practice registered nurse

94 is available on call, the initial treatment required immediately

95following the injury may be rendered by that physician or advanced

96practice registered nurse, but the employee may thereafter select his

97own physician or advanced practice registered nurse as provided by

98this chapter for any further treatment without prior approval of the

99commissioner.

100(c) The commissioner may, without hearing, at the request of the

101employer or the injured employee, when good reason exists, or on his

102own motion, authorize or direct a change of physician, [or] surgeon or

103advanced practice registered nurse or hospital or nursing service

104provided pursuant to subsection (a) of this section.

105Sec. 4. Subsection (f) of section 31-294d of the general statutes is

106repealed and the following is substituted in lieu thereof (Effective

107October 1, 2019):

108(f) If the employer fails to promptly provide a physician, [or]

109surgeon or advanced practice registered nurse or any medical and

110surgical aid or hospital and nursing service as required by this section,

111the injured employee may obtain a physician, [or] surgeon or

112advanced practice registered nurse, selected from the approved list

113prepared by the chairman, or such medical and surgical aid or hospital

114and nursing service at the expense of the employer.

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115Sec. 5. Section 31-294i of the general statutes is repealed and the

116following is substituted in lieu thereof (Effective October 1, 2019):

117For the purpose of adjudication of claims for payment of benefits

118under the provisions of this chapter to a uniformed member of a paid

119municipal fire department or a regular member of a paid municipal

120police department or constable who began such employment on or

121after July 1, 1996, any condition or impairment of health caused by a

122cardiac emergency occurring to such member on or after July 1, 2009,

123while such member is in training for or engaged in fire duty at the site

124of an accident or fire, or other public safety operation within the scope

125of such member's employment for such member's municipal employer

126that results in death or temporary or permanent total or partial

127disability, shall be presumed to have been suffered in the line of duty

128and within the scope of such member's employment, unless the

129contrary is shown by a preponderance of the evidence, provided such

130member successfully passed a physical examination on entry into

131service conducted by a licensed physician or advanced practice

132registered nurse designated by such department which examination

133failed to reveal any evidence of such condition. For the purposes of

134this section, "cardiac emergency" means cardiac arrest or myocardial

135infarction, and "constable" means any municipal law enforcement

136officer who is authorized to make arrests and has completed Police

137Officer Standards and Training Council certification pursuant to

138section 7-294a.

139Sec. 6. Subsection (c) of section 31-296 of the general statutes is

140repealed and the following is substituted in lieu thereof (Effective

141October 1, 2019):

142(c) The employer's or insurer's notice of intention to discontinue or

143reduce payments shall (1) identify the claimant, the claimant's attorney

144or other representative, the employer, the insurer, and the injury,

145including the date of the injury, the city or town in which the injury

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148reduction of payments, and (B) identifies the claimant's attending

149physician or advanced practice registered nurse, and (3) be in

150substantially the following form:

154YOU ARE HEREBY NOTIFIED THAT THE EMPLOYER OR INSURER

155INTENDS TO REDUCE OR DISCONTINUE YOUR COMPENSATION

156PAYMENTS ON .... (date) FOR THE FOLLOWING REASONS:

157If you object to the reduction or discontinuance of benefits as stated

158in this notice, YOU MUST REQUEST A HEARING NOT LATER

159THAN 15 DAYS after your receipt of this notice, or this notice will

160automatically be approved.

161To request an Informal Hearing, call the Workers' Compensation

162Commission District Office in which your case is pending.

163Be prepared to provide medical and other documentation to

164support your objection. For your protection, note the date when you

165received this notice.

166Sec. 7. Section 38a-472a of the general statutes is repealed and the

167following is substituted in lieu thereof (Effective October 1, 2019):

168No contract between a managed care company, other organization

169or insurer authorized to do business in this state and a medical

170provider practicing in this state for the provision of services may

171require that the medical provider indemnify the managed care

172company, other organization or insurer for any expenses and liabilities

173including, without limitation, judgments, settlements, attorneys' fees,

174court costs and any associated charges incurred in connection with any

175claim or action brought against a managed care company, other

176organization or insurer on the basis of its determination of medical

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177necessity or appropriateness of health care services if the information

178provided by such medical provider used in making the determination

179was accurate and appropriate at the time it was given. As used in this

180section and section 38a-472b, "medical provider" means any person

181licensed pursuant to chapters 370 to 373, inclusive, or chapter 375, 378,

182379, 380 or 383.

183Sec. 8. Subsections (d) to (h), inclusive, of section 38a-488a of the

184general statutes are repealed and the following is substituted in lieu

185thereof (Effective October 1, 2019):

186(d) In the case of benefits payable for the services of a licensed

187physician, such benefits shall be payable for the same services when

188such services are lawfully rendered by a psychologist licensed under

189the provisions of chapter 383 or by such a licensed psychologist in a

190licensed hospital or clinic or an advanced practice registered nurse

191licensed under the provisions of chapter 378.

192(e) In the case of benefits payable for the services of a licensed

193physician or psychologist, such benefits shall be payable for the same

194services when such services are rendered by:

195(1) A clinical social worker who is licensed under the provisions of

196chapter 383b and who has passed the clinical examination of the

197American Association of State Social Work Boards and has completed

198at least two thousand hours of post-master's social work experience in

199a nonprofit agency qualifying as a tax-exempt organization under

200Section 501(c) of the Internal Revenue Code of 1986 or any subsequent

201corresponding internal revenue code of the United States, as from time

202to time amended, in a municipal, state or federal agency or in an

203institution licensed by the Department of Public Health under section

20419a-490;

205(2) A social worker who was certified as an independent social

206worker under the provisions of chapter 383b prior to October 1, 1990;

207(3) A licensed marital and family therapist who has completed at

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208least two thousand hours of post-master's marriage and family therapy

209work experience in a nonprofit agency qualifying as a tax-exempt

210organization under Section 501(c) of the Internal Revenue Code of 1986

211or any subsequent corresponding internal revenue code of the United

212States, as from time to time amended, in a municipal, state or federal

213agency or in an institution licensed by the Department of Public Health

214under section 19a-490;

215(4) A marital and family therapist who was certified under the

216provisions of chapter 383a prior to October 1, 1992;

217(5) A licensed alcohol and drug counselor, as defined in section 20-

21874s, or a certified alcohol and drug counselor, as defined in section 20-

21974s;

220(6) A licensed professional counselor; or

221(7) An advanced practice registered nurse licensed under the

222provisions of chapter 378.

223(f) (1) In the case of benefits payable for the services of a licensed

224physician, such benefits shall be payable for (A) services rendered in a

225child guidance clinic or residential treatment facility by a person with a

226master's degree in social work or by a person with a master's degree in

227marriage and family therapy under the supervision of a psychiatrist,

228physician, licensed marital and family therapist, or licensed clinical

229social worker who is eligible for reimbursement under subdivisions (1)

230to (4), inclusive, of subsection (e) of this section; (B) services rendered

231in a residential treatment facility by a licensed or certified alcohol and

232drug counselor who is eligible for reimbursement under subdivision

233(5) of subsection (e) of this section; [or] (C) services rendered in a

234residential treatment facility by a licensed professional counselor who

235is eligible for reimbursement under subdivision (6) of subsection (e) of

236this section; or (D) services rendered in a residential treatment facility

237by a licensed advanced practice registered nurse who is eligible for

238reimbursement under subdivision (7) of subsection (e) of this section.

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239(2) In the case of benefits payable for the services of a licensed

240psychologist under subsection (e) of this section, such benefits shall be

241payable for (A) services rendered in a child guidance clinic or

242residential treatment facility by a person with a master's degree in

243social work or by a person with a master's degree in marriage and

244family therapy under the supervision of such licensed psychologist,

245licensed marital and family therapist, or licensed clinical social worker

246who is eligible for reimbursement under subdivisions (1) to (4),

247inclusive, of subsection (e) of this section; (B) services rendered in a

248residential treatment facility by a licensed or certified alcohol and drug

249counselor who is eligible for reimbursement under subdivision (5) of

250subsection (e) of this section; [or] (C) services rendered in a residential

251treatment facility by a licensed professional counselor who is eligible

252for reimbursement under subdivision (6) of subsection (e) of this

253section; or (D) services rendered in a residential treatment facility by a

254licensed advanced practice registered nurse who is eligible for

255reimbursement under subdivision (7) of subsection (e) of this section.

256(g) In the case of benefits payable for the service of a licensed

257physician practicing as a psychiatrist or a licensed psychologist, under

258subsection (e) of this section, such benefits shall be payable for

259outpatient services rendered (1) in a nonprofit community mental

260health center, as defined by the Department of Mental Health and

261Addiction Services, in a nonprofit licensed adult psychiatric clinic

262operated by an accredited hospital or in a residential treatment facility;

263(2) under the supervision of a licensed physician practicing as a

264psychiatrist, a licensed psychologist, a licensed marital and family

265therapist, a licensed clinical social worker, a licensed or certified

266alcohol and drug counselor, [or] a licensed professional counselor or a

267licensed advanced practice registered nurse who is eligible for

268reimbursement under subdivisions (1) to [(6)] (7), inclusive, of

269subsection (e) of this section; and (3) within the scope of the license

270issued to the center or clinic by the Department of Public Health or to

271the residential treatment facility by the Department of Children and

272Families.

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273(h) Except in the case of emergency services or in the case of services

274for which an individual has been referred by a physician or an

275advanced practice registered nurse affiliated with a health care center,

276nothing in this section shall be construed to require a health care center

277to provide benefits under this section through facilities that are not

278affiliated with the health care center.

279Sec. 9. Subsection (b) of section 38a-492e of the general statutes is

280repealed and the following is substituted in lieu thereof (Effective

281October 1, 2019):

282(b) Benefits shall cover: (1) Initial training visits provided to an

283individual after the individual is initially diagnosed with diabetes that

284is medically necessary for the care and management of diabetes,

285including, but not limited to, counseling in nutrition and the proper

286use of equipment and supplies for the treatment of diabetes, totaling a

287maximum of ten hours; (2) training and education that is medically

288necessary as a result of a subsequent diagnosis by a physician or an

289advanced practice registered nurse of a significant change in the

290individual's symptoms or condition which requires modification of the

291individual's program of self-management of diabetes, totaling a

292maximum of four hours; and (3) training and education that is

293medically necessary because of the development of new techniques

294and treatment for diabetes totaling a maximum of four hours.

295Sec. 10. Section 38a-499 of the general statutes is repealed and the

296following is substituted in lieu thereof (Effective October 1, 2019):

297(a) For the purposes of this section:

298(1) ["Certified nurse practitioner"] "Advanced practice registered

299nurse" means any advanced practice registered nurse licensed under

300 the provisions of chapter 378; [who has completed a formal

301educational nurse practitioner program and is certified by the

302American Nurses' Association, the National Board of Pediatric Nurse

303Practitioners and Associates or the Nurses' Association of the

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304American College of Obstetricians and Gynecologists;]

305(2) ["Certified psychiatric-mental health clinical nurse specialist"]

306"Certified psychiatric-mental health advanced practice registered

307nurse" means any advanced practice registered nurse licensed under

308chapter 378 who [has completed a formal educational program as a

309psychiatric-mental health clinical nurse specialist and is certified by the

310American Nurses' Association] is board certified as a psychiatric-

311mental health provider by the American Nurses Credentialing Center;

312(3) "Certified nurse-midwife" means any individual certified as

313nurse-midwife pursuant to sections 20-86a to 20-86e, inclusive;

314(4) "Physician assistant" means an individual licensed pursuant to

315section 20-12b.

316(b) Each individual health insurance policy providing coverage of

317the type specified in subdivisions (1), (2), (4), (6), (10), (11) and (12) of

318section 38a-469 delivered, issued for delivery, renewed, amended or

319continued in this state shall provide coverage for the services of

320physician assistants, [certified nurse practitioners] advanced practice

321registered nurses, certified psychiatric-mental health [clinical nurse

322specialists] advanced practice registered nurses and certified nurse-

323 midwives if such services are within the individual's area of

324professional competence as established by education and licensure or

325certification and are currently reimbursed when rendered by any other

326licensed health care provider. Subject to the provisions of chapter 378

327and sections 20-86a to 20-86e, inclusive, no insurer, hospital service

328corporation, medical service corporation or health care center may

329require signature, referral or employment by any other health care

330provider as a condition of reimbursement, provided no insurer,

331hospital service corporation, medical service corporation or health care

332center may be required to pay for duplicative services actually

333rendered by both a physician assistant or [a certified registered nurse]

334an advanced practice registered nurse and any other health care

335provider. The payment of such benefits shall be subject to any policy

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336 provisions which apply to other licensed health practitioners

337providing the same services. Nothing in this section may be construed

338as permitting (1) any registered nurse to perform or provide services

339beyond the scope of practice permitted in chapter 378 and sections 20-

34086a to 20-86e, inclusive, or (2) any physician assistant to perform or

341provide services beyond the scope of practice permitted in chapter 370.

342Sec. 11. Subsection (d) of section 38a-503 of the general statutes is

343repealed and the following is substituted in lieu thereof (Effective

344October 1, 2019):

345(d) Each mammography report provided to a patient shall include

346information about breast density, based on the Breast Imaging

347Reporting and Data System established by the American College of

348Radiology. Where applicable, such report shall include the following

349notice: "If your mammogram demonstrates that you have dense breast

350tissue, which could hide small abnormalities, you might benefit from

351supplementary screening tests, which can include a breast ultrasound

352screening or a breast MRI examination, or both, depending on your

353individual risk factors. A report of your mammography results, which

354contains information about your breast density, has been sent to your

355physician's or advanced practice registered nurse's office and you

356should contact your physician or advanced practice registered nurse if

357you have any questions or concerns about this report.".

358Sec. 12. Subsection (b) of section 38a-518e of the general statutes is

359repealed and the following is substituted in lieu thereof (Effective

360October 1, 2019):

361(b) Benefits shall cover: (1) Initial training visits provided to an

362individual after the individual is initially diagnosed with diabetes that

363is medically necessary for the care and management of diabetes,

364including, but not limited to, counseling in nutrition and the proper

365use of equipment and supplies for the treatment of diabetes, totaling a

366maximum of ten hours; (2) training and education that is medically

367necessary as a result of a subsequent diagnosis by a physician or

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368advanced practice registered nurse of a significant change in the

369individual's symptoms or condition which requires modification of the

370individual's program of self-management of diabetes, totaling a

371maximum of four hours; and (3) training and education that is

372medically necessary because of the development of new techniques

373and treatment for diabetes totaling a maximum of four hours.

374Sec. 13. Subsection (d) of section 38a-530 of the general statutes is

375repealed and the following is substituted in lieu thereof (Effective

376October 1, 2019):

377(d) Each mammography report provided to a patient shall include

378information about breast density, based on the Breast Imaging

379Reporting and Data System established by the American College of

380Radiology. Where applicable, such report shall include the following

381notice: "If your mammogram demonstrates that you have dense breast

382tissue, which could hide small abnormalities, you might benefit from

383supplementary screening tests, which can include a breast ultrasound

384screening or a breast MRI examination, or both, depending on your

385individual risk factors. A report of your mammography results, which

386contains information about your breast density, has been sent to your

387physician's or advanced practice registered nurse's office and you

388should contact your physician or advanced practice registered nurse if

389you have any questions or concerns about this report.".

390Sec. 14. Section 4-105 of the general statutes is repealed and the

391following is substituted in lieu thereof (Effective October 1, 2019):

392If any patient who has received treatment in any such hospital, after

393[his] discharge from such hospital, has made written application to

394such hospital, hospital society or corporation for permission to

395examine his or her record as such patient in such hospital and has been

396refused permission to examine or copy the same, such patient may file

397a written motion addressed to any judge of the Superior Court,

398praying for a disclosure of the contents of such hospital record relating

399to such patient and for a production of the same before such judge.

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400Upon such application being filed, the judge to whom the same has

401been presented shall cause reasonable notice to be given to such

402hospital, hospital society or corporation of the time when and place

403where such petition will be heard, and such judge, after due hearing

404and notice, may order the officer authorized to act in the capacity of

405manager of such hospital to produce before [him] the court and deliver

406into [his] the custody of the court the history, bedside notes, charts,

407pictures and plates of such patient for the purpose of being examined

408or copied by such patient [,] or his or her physician, advanced practice

409registered nurse or authorized attorney. Each officer of any hospital

410having custody of the history, bedside notes, charts, pictures or plates

411of any patient therein, who refuses to produce such record before such

412[judge] court, pursuant to the provisions of this section, shall be fined

413not more than one hundred dollars or imprisoned not more than six

414months or both.

415Sec. 15. Subsection (c) of section 7-51a of the general statutes is

416repealed and the following is substituted in lieu thereof (Effective

417October 1, 2019):

418(c) For deaths occurring on or after July 1, 1997, the Social Security

419number of the deceased person shall be recorded in the "administrative

420purposes" section of the death certificate. Such administrative

421purposes section, and the Social Security number contained therein,

422shall be restricted and disclosed only to the following eligible parties:

423(1) All parties specified on the death certificate, including the

424informant, licensed funeral director, licensed embalmer, conservator,

425surviving spouse, physician or advanced practice registered nurse and

426town clerk, for the purpose of processing the certificate, (2) the

427surviving spouse, (3) the next of kin, or (4) any state and federal

428agencies authorized by federal law. The department shall provide any

429other individual, researcher or state or federal agency requesting a

430certified or uncertified death certificate, or the information contained

431within such certificate, for a death occurring on or after July 1, 1997,

432such certificate or information. The decedent's Social Security number

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433shall be removed or redacted from such certificate or information or

434the administrative purposes section shall be omitted from such

435certificate.

436Sec. 16. Section 17b-233 of the general statutes is repealed and the

437following is substituted in lieu thereof (Effective October 1, 2019):

438Newington Children's Hospital may admit any child who is

439handicapped or afflicted with any pediatric illness upon application of

440the selectmen of any town, or the guardian or any relative of such

441child, or any public health agency, [or] physician or advanced practice

442registered nurse, provided, no person shall be admitted primarily for

443the treatment of any drug-related condition. Said hospital shall admit

444such child to said hospital if such child is pronounced by [the

445physicians] a physician or advanced practice registered nurse on the

446staff of said hospital, after examination, to be suitable for admission,

447and said hospital shall keep and support such child for such length of

448time as it deems proper. Said hospital shall not be required to admit

449any such child unless it can conveniently receive and care for such

450child at the time application is made and said hospital may return to

451the town in which such child resides any child so taken who is

452pronounced by [the physicians] a physician or advanced practice

453registered nurse on the staff of said hospital, after examination, to be

454unsuitable for retention or who, by reason of improvement in his

455condition or completion of his treatment or training, ought not to be

456further retained. The hospital may refuse to admit any child

457pronounced by [the physicians] a physician or advanced practice

458registered nurse on the staff of said hospital, after examination, to be

459unsuitable for admission and may refuse to admit any such child when

460 the facilities at the hospital will not, in the judgment of said

461[physicians] physician or advanced practice registered nurse, permit

462the hospital to care for such child adequately and properly.

463Sec. 17. Section 17b-236 of the general statutes is repealed and the

464following is substituted in lieu thereof (Effective October 1, 2019):

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465When there is found in any town in this state any child of sound

466mind who is physically disabled or who is afflicted with poliomyelitis

467or rheumatic fever, or any uncontagious disabling disease, and who is

468unable to pay and whose relatives who are legally liable for his

469support are unable to pay the full cost of treating such disease, if such

470child and one of such relatives reside in this state, the selectmen of

471such town, or the guardian or any relative of such child, or any public

472health agency, [or] physician or advanced practice registered nurse in

473this state, may make application to The Children's Center, located at

474Hamden, for the admission of such child to said center. Said center

475shall admit such child if such child is pronounced by [the physicians] a

476physician or advanced practice registered nurse on the staff of said

477center, after examination, to be fit for admission, and said center shall

478keep and support such child for such length of time as it deems

479proper. Said center shall not be required to admit any such child unless

480it can conveniently receive and care for him at the time such

481application is made, and said center may return to the town in which

482such child resides any child so taken who is pronounced by [the

483physicians] a physician or advanced practice registered nurse on the

484staff of said center, after examination, to be unfit for retention, or who,

485by reason of improvement in his condition or completion of his

486treatment or training, ought not to be further retained. The center may

487refuse to admit any child who is pronounced by [the physicians] a

488physician or advanced practice registered nurse on the staff of said

489center, after examination, to be unfit for admission, and may refuse to

490admit any such child when the facilities at the center will not, in the

491judgment of said [physicians] physician or advanced practice

492registered nurse, permit the center to care for such child adequately

493and properly.

494Sec. 18. Section 17b-278d of the general statutes is repealed and the

495following is substituted in lieu thereof (Effective October 1, 2019):

496The Commissioner of Social Services, to the extent permitted by

497federal law, shall take such action as may be necessary to amend the

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498Medicaid state plan and the state children's health insurance plan to

499provide coverage without prior authorization for each child diagnosed

500with cancer on or after January 1, 2000, who is covered under the

501HUSKY Health program, for neuropsychological testing ordered by a

502licensed physician or licensed advanced practice registered nurse, to

503assess the extent of any cognitive or developmental delays in such

504child due to chemotherapy or radiation treatment.

505Sec. 19. Section 19a-2a of the general statutes is repealed and the

506following is substituted in lieu thereof (Effective October 1, 2019):

507The Commissioner of Public Health shall employ the most efficient

508and practical means for the prevention and suppression of disease and

509shall administer all laws under the jurisdiction of the Department of

510Public Health and the Public Health Code. The commissioner shall

511have responsibility for the overall operation and administration of the

512Department of Public Health. The commissioner shall have the power

513and duty to: (1) Administer, coordinate and direct the operation of the

514department; (2) adopt and enforce regulations, in accordance with

515chapter 54, as are necessary to carry out the purposes of the

516department as established by statute; (3) establish rules for the internal

517operation and administration of the department; (4) establish and

518develop programs and administer services to achieve the purposes of

519the department as established by statute; (5) enter into a contract,

520including, but not limited to, a contract with another state, for facilities,

521services and programs to implement the purposes of the department

522as established by statute; (6) designate a deputy commissioner or other

523employee of the department to sign any license, certificate or permit

524issued by said department; (7) conduct a hearing, issue subpoenas,

525administer oaths, compel testimony and render a final decision in any

526case when a hearing is required or authorized under the provisions of

527any statute dealing with the Department of Public Health; (8) with the

528health authorities of this and other states, secure information and data

529concerning the prevention and control of epidemics and conditions

530affecting or endangering the public health, and compile such

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531information and statistics and shall disseminate among health

532authorities and the people of the state such information as may be of

533value to them; (9) annually issue a list of reportable diseases,

534emergency illnesses and health conditions and a list of reportable

535laboratory findings and amend such lists as the commissioner deems

536necessary and distribute such lists as well as any necessary forms to

537each licensed physician, licensed advanced practice registered nurse

538and clinical laboratory in this state. The commissioner shall prepare

539printed forms for reports and returns, with such instructions as may be

540necessary, for the use of directors of health, boards of health and

541registrars of vital statistics; and (10) specify uniform methods of

542keeping statistical information by public and private agencies,

543organizations and individuals, including a client identifier system, and

544collect and make available relevant statistical information, including

545 the number of persons treated, frequency of admission and

546readmission, and frequency and duration of treatment. The client

547identifier system shall be subject to the confidentiality requirements set

548forth in section 17a-688 and regulations adopted thereunder. The

549commissioner may designate any person to perform any of the duties

550listed in subdivision (7) of this section. The commissioner shall have

551authority over directors of health and may, for cause, remove any such

552director; but any person claiming to be aggrieved by such removal

553may appeal to the Superior Court which may affirm or reverse the

554action of the commissioner as the public interest requires. The

555commissioner shall assist and advise local directors of health and

556district directors of health in the performance of their duties, and may

557require the enforcement of any law, regulation or ordinance relating to

558public health. In the event the commissioner reasonably suspects

559impropriety on the part of a local director of health or district director

560of health, or employee of such director, in the performance of his or

561her duties, the commissioner shall provide notification and any

562evidence of such impropriety to the appropriate governing authority

563of the municipal health authority, established pursuant to section 19a-

564200, or the district department of health, established pursuant to

565section 19a-244, for purposes of reviewing and assessing a director's or

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566an employee's compliance with such duties. Such governing authority

567shall provide a written report of its findings from the review and

568assessment to the commissioner not later than ninety days after such

569review and assessment. When requested by local directors of health or

570district directors of health, the commissioner shall consult with them

571and investigate and advise concerning any condition affecting public

572health within their jurisdiction. The commissioner shall investigate

573nuisances and conditions affecting, or that he or she has reason to

574suspect may affect, the security of life and health in any locality and,

575for that purpose, the commissioner, or any person authorized by the

576commissioner, may enter and examine any ground, vehicle, apartment,

577building or place, and any person designated by the commissioner

578shall have the authority conferred by law upon constables. Whenever

579the commissioner determines that any provision of the general statutes

580or regulation of the Public Health Code is not being enforced

581effectively by a local health department or health district, he or she

582shall forthwith take such measures, including the performance of any

583act required of the local health department or health district, to ensure

584enforcement of such statute or regulation and shall inform the local

585health department or health district of such measures. In September of

586each year the commissioner shall certify to the Secretary of the Office

587of Policy and Management the population of each municipality. The

588commissioner may solicit and accept for use any gift of money or

589property made by will or otherwise, and any grant of or contract for

590money, services or property from the federal government, the state,

591any political subdivision thereof, any other state or any private source,

592and do all things necessary to cooperate with the federal government

593or any of its agencies in making an application for any grant or

594contract. The commissioner may establish state-wide and regional

595advisory councils. For purposes of this section, "employee of such

596director" means an employee of, a consultant employed or retained by

597or an independent contractor retained by a local director of health, a

598district director of health, a local health department or a health district.

599Sec. 20. Subsection (a) of section 19a-26 of the general statutes is

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600repealed and the following is substituted in lieu thereof (Effective

601October 1, 2019):

602(a) The Department of Public Health may establish, maintain and

603control state laboratories to perform examinations of supposed morbid

604tissues, other laboratory tests for the diagnosis and control of

605preventable diseases, and laboratory work in the field of sanitation,

606environmental and occupational testing and research studies for the

607protection and preservation of the public health. Such laboratory

608 services shall be performed upon the application of licensed

609physicians, other laboratories, licensed dentists, licensed podiatrists,

610licensed advanced practice registered nurses, local directors of health,

611 public utilities or state departments or institutions, subject to

612regulations prescribed by the Commissioner of Public Health, and

613upon payment of any applicable fee as provided in this subsection. For

614such purposes the department may provide necessary buildings and

615 apparatus, employ, subject to the provisions of chapter 67,

616administrative and scientific personnel and assistants and do all things

617necessary for the conduct of such laboratories. The Commissioner of

618Public Health may establish a schedule of fees, provided the

619commissioner waives the fees for local directors of health and local law

620enforcement agencies. If the commissioner establishes a schedule of

621fees, the commissioner may waive (1) the fees, in full or in part, for

622others if the commissioner determines that the public health requires a

623waiver, and (2) fees for chlamydia and gonorrhea testing for nonprofit

624organizations and institutions of higher education if the organization

625or institution provides combination chlamydia and gonorrhea test kits.

626The commissioner shall also establish a fair handling fee which a client

627of a state laboratory may charge a person or third party payer for

628arranging for the services of the laboratory. Such client shall not charge

629an amount in excess of such handling fee.

630Sec. 21. Subsection (a) of section 19a-490b of the general statutes is

631repealed and the following is substituted in lieu thereof (Effective

632October 1, 2019):

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633(a) Upon the written request of a patient or the patient's attorney or

634authorized representative, or pursuant to a written authorization, an

635institution licensed pursuant to this chapter shall furnish to the person

636making such request a copy of the patient's health record, including

637but not limited to, copies of bills, laboratory reports, prescriptions and

638other technical information used in assessing the patient's health

639condition. In addition, an institution shall provide the patient or the

640 patient's designated health care provider with a reasonable

641opportunity to examine retained tissue slides and retained pathology

642tissue blocks. Upon the written request of the patient, the patient's

643attorney or the patient's designated health care provider, an institution

644shall send the original retained tissue slide or original retained tissue

645 block directly to the patient's designated licensed institution,

646laboratory or physician. If the original slide or block is not available or

647if a new section cut of the original slide or block is a fair representation

648of the original slide or block, then the institution may send the new

649section cut, which is clearly labeled as a new section cut, to the

650patient's designated health care provider. Any patient or the patient's

651attorney or authorized representative who is provided with an original

652retained slide, tissue block or a new section under the provisions of

653this subsection shall be solely responsible for safeguarding and

654returning the slide, block or new section to the institution. Any

655institution or laboratory that has released an original slide, an original

656tissue block or new section pursuant to the provisions of this

657subsection shall not be subject to any liability arising out of releasing

658or not retaining the slide, block or new section and no cause of action

659for damages shall arise against any such institution for releasing or not

660retaining the slide, block or new section. No such institution shall

661charge more than sixty-five cents per page, including any research

662fees, clerical fees, handling fees or related costs, and the cost of first

663class postage, if applicable, for furnishing or providing access to a

664health record pursuant to this subsection, except such an institution

665may charge the amount necessary to cover its cost of materials for

666furnishing a copy of an x-ray or for furnishing an original retained

667slide, an original tissue block or a new section cut from a retained

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668pathology tissue block. For purposes of this subsection, "health care

669provider" means an institution or laboratory licensed under this

670chapter or licensed in the state where located, [or] a physician licensed

671under chapter 370 or licensed in the state where located or an

672advanced practice registered nurse licensed under chapter 378 or

673licensed in the state where located.

674Sec. 22. Subsections (a) and (b) of section 20-631 of the general

675statutes are repealed and the following is substituted in lieu thereof

676(Effective October 1, 2019):

677(a) Except as provided in section 20-631b, one or more pharmacists

678licensed under this chapter who are determined competent in

679accordance with regulations adopted pursuant to subsection (d) of this

680section may enter into a written protocol-based collaborative drug

681therapy management agreement with one or more physicians licensed

682under chapter 370 or advanced practice registered nurses licensed

683under chapter 378 to manage the drug therapy of individual patients.

684In order to enter into a written protocol-based collaborative drug

685therapy management agreement, such physician or advanced practice

686registered nurse shall have established a [physician-patient] provider-

687patient relationship with the patient who will receive collaborative

688drug therapy. Each patient's collaborative drug therapy management

689shall be governed by a written protocol specific to that patient

690established by the treating physician or advanced practice registered

691nurse in consultation with the pharmacist. For purposes of this

692subsection, a ["physician-patient relationship"] "provider-patient

693relationship" is a relationship based on (1) the patient making a

694medical complaint, (2) the patient providing a medical history, (3) the

695patient receiving a physical examination, and (4) a logical connection

696existing between the medical complaint, the medical history, the

697physical examination and any drug prescribed for the patient.

698(b) A collaborative drug therapy management agreement may

699authorize a pharmacist to implement, modify or discontinue a drug

700therapy that has been prescribed for a patient, order associated

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701laboratory tests and administer drugs, all in accordance with a patient-

702specific written protocol. In instances where drug therapy is

703discontinued, the pharmacist shall notify the treating physician or

704advanced practice registered nurse of such discontinuance no later

705than twenty-four hours from the time of such discontinuance. Each

706protocol developed, pursuant to the collaborative drug therapy

707management agreement, shall contain detailed direction concerning

708the actions that the pharmacist may perform for that patient. The

709protocol shall include, but need not be limited to, (1) the specific drug

710or drugs to be managed by the pharmacist, (2) the terms and

711conditions under which drug therapy may be implemented, modified

712or discontinued, (3) the conditions and events upon which the

713pharmacist is required to notify the physician or advanced practice

714registered nurse, and (4) the laboratory tests that may be ordered. All

715activities performed by the pharmacist in conjunction with the

716protocol shall be documented in the patient's medical record. The

717pharmacist shall report at least every thirty days to the physician or

718advanced practice registered nurse regarding the patient's drug

719therapy management. The collaborative drug therapy management

720agreement and protocols shall be available for inspection by the

721Departments of Public Health and Consumer Protection. A copy of the

722protocol shall be filed in the patient's medical record.

723Sec. 23. Subsections (a) and (b) of section 20-631a of the general

724statutes are repealed and the following is substituted in lieu thereof

725(Effective October 1, 2019):

726(a) Not later than January 1, 2006, the Commissioner of Consumer

727Protection, in consultation with the Commission of Pharmacy, shall

728establish and operate a two-year pilot program to allow not more than

729ten pharmacists licensed under this chapter who are determined

730eligible in accordance with subsection (c) of this section and employed

731by or under contract with a licensed community pharmacy, to enter

732into a written protocol-based collaborative drug therapy management

733agreement with one or more physicians licensed under chapter 370 or

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734advanced practice registered nurses licensed under chapter 378, to

735manage the drug therapy of individual patients receiving drug therapy

736for diabetes, asthma, hypertension, hyperlipidemia, osteoporosis,

737congestive heart failure or smoking cessation, including patients who

738qualify as targeted beneficiaries under the provisions of Section 1860D-

7394(c)(2)(A)(ii) of the federal Social Security Act, in accordance with

740subsections (b) to (d), inclusive, of this section and subject to the

741approval of the licensed community pharmacy. Each patient's

742collaborative drug therapy management shall be governed by a

743written protocol specific to that patient established by the treating

744physician or advanced practice registered nurse in consultation with

745the pharmacist.

746(b) A collaborative drug therapy management agreement may

747authorize a pharmacist to implement, modify or discontinue a drug

748therapy that has been prescribed for a patient, order associated

749laboratory tests and administer drugs, all in accordance with a patient-

750specific written protocol. Each protocol developed, pursuant to the

751collaborative drug therapy management agreement, shall contain

752detailed direction concerning the actions that the pharmacist may

753perform for that patient. The protocol shall include, but need not be

754limited to, (1) the specific drug or drugs to be managed by the

755pharmacist, (2) the terms and conditions under which drug therapy

756may be implemented, modified or discontinued, (3) the conditions and

757events upon which the pharmacist is required to notify the physician

758or advanced practice registered nurse, and (4) the laboratory tests that

759may be ordered. All activities performed by the pharmacist in

760conjunction with the protocol shall be documented in the patient's

761medical record. The pharmacist shall report to the physician or

762advanced practice registered nurse through oral, written or electronic

763manner regarding the implementation, administration, modification or

764discontinuation of a drug therapy that has been prescribed for a

765patient not later than twenty-four hours after such implementation,

766administration, modification or discontinuation. The collaborative

767drug therapy management agreement and protocols shall be available

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768for inspection by the Departments of Public Health and Consumer

769Protection. A copy of the protocol shall be filed in the patient's medical

770record.

771Sec. 24. Section 52-146d of the general statutes is repealed and the

772following is substituted in lieu thereof (Effective October 1, 2019):

773As used in sections 52-146d to 52-146i, inclusive:

774(1) "Authorized representative" means (A) a person empowered by

775a patient to assert the confidentiality of communications or records

776which are privileged under sections 52-146c to 52-146i, inclusive, or (B)

777if a patient is deceased, his or her personal representative or next of

778kin, or (C) if a patient is incompetent to assert or waive his privileges

779hereunder, (i) a guardian or conservator who has been or is appointed

780 to act for the patient, or (ii) for the purpose of maintaining

781confidentiality until a guardian or conservator is appointed, the

782patient's nearest relative;

783(2) "Communications and records" means all oral and written

784communications and records thereof relating to diagnosis or treatment

785of a patient's mental condition between the patient and a [psychiatrist]

786psychiatric mental health provider, or between a member of the

787patient's family and a [psychiatrist] psychiatric mental health provider,

788or between any of such persons and a person participating under the

789supervision of a [psychiatrist] psychiatric mental health provider in the

790accomplishment of the objectives of diagnosis and treatment, wherever

791made, including communications and records which occur in or are

792prepared at a mental health facility;

793(3) "Consent" means consent given in writing by the patient or his

794authorized representative;

795(4) "Identifiable" and "identify a patient" refer to communications

796and records which contain (A) names or other descriptive data from

797which a person acquainted with the patient might reasonably

798recognize the patient as the person referred to, or (B) codes or numbers

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799which are in general use outside of the mental health facility which

800prepared the communications and records;

801(5) "Mental health facility" includes any hospital, clinic, ward,

802[psychiatrist's] psychiatric mental health provider's office or other

803facility, public or private, which provides inpatient or outpatient

804service, in whole or in part, relating to the diagnosis or treatment of a

805patient's mental condition;

806(6) "Patient" means a person who communicates with or is treated

807by a [psychiatrist] psychiatric mental health provider in diagnosis or

808treatment;

809(7) ["Psychiatrist"] "Psychiatric mental health provider" means a

810physician specializing in psychiatry and licensed under the provisions

811of sections 20-9 to 20-12, inclusive, an advanced practice registered

812nurse licensed under chapter 378 who is board certified as a

813 psychiatric mental health provider by the American Nurses

814Credentialing Center, a person licensed to practice medicine who

815devotes a substantial portion of his or her time to the practice of

816psychiatry [,] or a person reasonably believed by the patient to be so

817qualified.

818Sec. 25. Subdivisions (1) to (5), inclusive, of section 52-146f of the

819general statutes are repealed and the following is substituted in lieu

820thereof (Effective October 1, 2019):

821(1) Communications or records may be disclosed to other persons

822engaged in the diagnosis or treatment of the patient or may be

823transmitted to another mental health facility to which the patient is

824admitted for diagnosis or treatment if the [psychiatrist] psychiatric

825mental health provider in possession of the communications or records

826determines that the disclosure or transmission is needed to accomplish

827the objectives of diagnosis or treatment. The patient shall be informed

828that the communications or records will be so disclosed or transmitted.

829For purposes of this subsection, persons in professional training are to

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830be considered as engaged in the diagnosis or treatment of the patients.

831(2) Communications or records may be disclosed when the

832[psychiatrist] psychiatric mental health provider determines that there

833is substantial risk of imminent physical injury by the patient to himself

834or others or when a [psychiatrist] psychiatric mental health provider,

835in the course of diagnosis or treatment of the patient, finds it necessary

836to disclose the communications or records for the purpose of placing

837the patient in a mental health facility, by certification, commitment or

838otherwise, provided the provisions of sections 52-146d to 52-146j,

839inclusive, as amended by this act, shall continue in effect after the

840patient is in the facility.

841(3) Except as provided in section 17b-225, the name, address and

842 fees for psychiatric services to a patient may be disclosed to

843individuals or agencies involved in the collection of fees for such

844services. In cases where a dispute arises over the fees or claims or

845where additional information is needed to substantiate the fee or

846claim, the disclosure of further information shall be limited to the

847following: (A) That the person was in fact a patient; (B) the diagnosis;

848(C) the dates and duration of treatment; and (D) a general description

849of the treatment, which shall include evidence that a treatment plan

850exists and has been carried out and evidence to substantiate the

851necessity for admission and length of stay in a health care institution

852or facility. If further information is required, the party seeking the

853information shall proceed in the same manner provided for hospital

854patients in section 4-105, as amended by this act.

855(4) Communications made to or records made by a [psychiatrist]

856psychiatric mental health provider in the course of a psychiatric

857examination ordered by a court or made in connection with the

858application for the appointment of a conservator by the Probate Court

859for good cause shown may be disclosed at judicial or administrative

860proceedings in which the patient is a party, or in which the question of

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863 patient has been informed before making the communications that any 864 communications will not be confidential and provided the

865communications shall be admissible only on issues involving the

866patient's mental condition.

867(5) Communications or records may be disclosed in a civil

868proceeding in which the patient introduces his mental condition as an

869element of his claim or defense, or, after the patient's death, when his

870condition is introduced by a party claiming or defending through or as

871a beneficiary of the patient and the court or judge finds that it is more

872important to the interests of justice that the communications be

873disclosed than that the relationship between patient and [psychiatrist]

874psychiatric mental health provider be protected.

875Sec. 26. Section 52-584 of the general statutes is repealed and the

876following is substituted in lieu thereof (Effective October 1, 2019):

877No action to recover damages for injury to the person, or to real or

878personal property, caused by negligence, or by reckless or wanton

879misconduct, or by malpractice of a physician, surgeon, dentist,

880podiatrist, chiropractor, advanced practice registered nurse, hospital or

881sanatorium, shall be brought but within two years from the date when

882the injury is first sustained or discovered or in the exercise of

883reasonable care should have been discovered, and except that no such

884action may be brought more than three years from the date of the act

885or omission complained of, except that a counterclaim may be

886interposed in any such action any time before the pleadings in such

887action are finally closed.

This act shall take effect as follows and shall amend the following sections:

Statement of Legislative Commissioners:

In Section 3, Subsec. (a) of section 31-294d was added and amended to include "advanced practice registered nurse" for clarity and accuracy.

PH Joint Favorable Subst.

SB 921

Version: File+No.+594+R000594+FC
Author: Public Health Committee

Created by BCL easyConverter SDK 5 (HTML Version)

AN ACT CONCERNING THE SCOPE OF PRACTICE OF ADVANCED PRACTICE REGISTERED NURSES.

Be it enacted by the Senate and House of Representatives in General Assembly convened:

1 Section 1. Subsection (a) of section 17a-81 of the general statutes is 2 repealed and the following is substituted in lieu thereof (Effective

3October 1, 2019):

4(a) Parental consent shall be necessary for treatment. In the event

5such consent is withheld or immediately unavailable and the physician

6or advanced practice registered nurse certified as a psychiatric mental

7 health provider by the American Nurses Credentialing Center

8concludes that treatment is necessary to prevent serious harm to the

9child, such emergency treatment may be administered pending receipt

10of parental consent.

11Sec. 2. Subparagraph (B) of subdivision (16) of section 31-275 of the

12general statutes is repealed and the following is substituted in lieu

13thereof (Effective October 1, 2019):

14(B) "Personal injury" or "injury" shall not be construed to include:

15(i) An injury to an employee that results from the employee's

16voluntary participation in any activity the major purpose of which is

17social or recreational, including, but not limited to, athletic events,

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18parties and picnics, whether or not the employer pays some or all of

19the cost of such activity;

20(ii) A mental or emotional impairment, unless such impairment (I)

21arises from a physical injury or occupational disease, (II) in the case of

22a police officer, arises from such police officer's use of deadly force or

23subjection to deadly force in the line of duty, regardless of whether

24such police officer is physically injured, provided such police officer is

25the subject of an attempt by another person to cause such police officer

26serious physical injury or death through the use of deadly force, and

27such police officer reasonably believes such police officer to be the

28subject of such an attempt, or (III) in the case of a firefighter, is

29diagnosed as post-traumatic stress disorder by a licensed and board

30certified mental health professional or a licensed advanced practice

31registered nurse who is certified as a psychiatric mental health

32provider by the American Nurses Credentialing Center, determined by

33 such professional or advanced practice registered nurse to be

34originating from the firefighter witnessing the death of another

35firefighter while engaged in the line of duty and not subject to any

36other exclusion in this section. As used in this clause, "police officer"

37means a member of the Division of State Police within the Department

38of Emergency Services and Public Protection, an organized local police

39 department or a municipal constabulary, "firefighter" means a

40uniformed member of a municipal paid or volunteer fire department,

41and "in the line of duty" means any action that a police officer or

42firefighter is obligated or authorized by law, rule, regulation or written

43condition of employment service to perform, or for which the police

44officer or firefighter is compensated by the public entity such officer

45serves;

46(iii) A mental or emotional impairment that results from a personnel

47action, including, but not limited to, a transfer, promotion, demotion

48or termination; or

49(iv) Notwithstanding the provisions of subparagraph (B)(i) of this

50subdivision, "personal injury" or "injury" includes injuries to

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51employees of local or regional boards of education resulting from

52participation in a school-sponsored activity but does not include any

53injury incurred while going to or from such activity. As used in this

54clause, "school-sponsored activity" means any activity sponsored,

55recognized or authorized by a board of education and includes

56activities conducted on or off school property and "participation"

57means acting as a chaperone, advisor, supervisor or instructor at the

58request of an administrator with supervisory authority over the

59employee.

60Sec. 3. Subsections (a) to (c), inclusive, of section 31-294d of the

61general statutes are repealed and the following is substituted in lieu

62thereof (Effective October 1, 2019):

63(a) (1) The employer, as soon as the employer has knowledge of an

64injury, shall provide a competent physician, [or] surgeon or advanced

65practice registered nurse to attend the injured employee and, in

66addition, shall furnish any medical and surgical aid or hospital and

70employer, any insurer acting on behalf of the employer, or any other

71entity acting on behalf of the employer or insurer shall be responsible

72for paying the cost of such prescription drugs directly to the provider.

73If the employer utilizes an approved providers list, when an employee

74 reports a work-related injury or condition to the employer the

75employer shall provide the employee with such approved providers

76list within two business days of such reporting.

77(2) If the injured employee is a local or state police officer, state

78marshal, judicial marshal, correction officer, emergency medical

79technician, paramedic, ambulance driver, firefighter, or active member

80of a volunteer fire company or fire department engaged in volunteer

81duties, who has been exposed in the line of duty to blood or bodily

82fluids that may carry blood-borne disease, the medical and surgical aid

83or hospital and nursing service provided by the employer shall include

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84any relevant diagnostic and prophylactic procedure for and treatment

85of any blood-borne disease.

88physicians, [and] surgeons and advanced practice registered nurses

89prepared by the chairman of the Workers' Compensation Commission.

90If the employee is unable to make the selection, the employer shall do

91so, subject to ratification by the employee or his next of kin. If the

92 employer has a full-time staff physician or advanced practice

93registered nurse or if a physician or advanced practice registered nurse

94 is available on call, the initial treatment required immediately

95following the injury may be rendered by that physician or advanced

96practice registered nurse, but the employee may thereafter select his

97own physician or advanced practice registered nurse as provided by

98this chapter for any further treatment without prior approval of the

99commissioner.

100(c) The commissioner may, without hearing, at the request of the

101employer or the injured employee, when good reason exists, or on his

102own motion, authorize or direct a change of physician, [or] surgeon or

103advanced practice registered nurse or hospital or nursing service

104provided pursuant to subsection (a) of this section.

105Sec. 4. Subsection (f) of section 31-294d of the general statutes is

106repealed and the following is substituted in lieu thereof (Effective

107October 1, 2019):

108(f) If the employer fails to promptly provide a physician, [or]

109surgeon or advanced practice registered nurse or any medical and

110surgical aid or hospital and nursing service as required by this section,

111the injured employee may obtain a physician, [or] surgeon or

112advanced practice registered nurse, selected from the approved list

113prepared by the chairman, or such medical and surgical aid or hospital

114and nursing service at the expense of the employer.

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115Sec. 5. Section 31-294i of the general statutes is repealed and the

116following is substituted in lieu thereof (Effective October 1, 2019):

117For the purpose of adjudication of claims for payment of benefits

118under the provisions of this chapter to a uniformed member of a paid

119municipal fire department or a regular member of a paid municipal

120police department or constable who began such employment on or

121after July 1, 1996, any condition or impairment of health caused by a

122cardiac emergency occurring to such member on or after July 1, 2009,

123while such member is in training for or engaged in fire duty at the site

124of an accident or fire, or other public safety operation within the scope

125of such member's employment for such member's municipal employer

126that results in death or temporary or permanent total or partial

127disability, shall be presumed to have been suffered in the line of duty

128and within the scope of such member's employment, unless the

129contrary is shown by a preponderance of the evidence, provided such

130member successfully passed a physical examination on entry into

131service conducted by a licensed physician or advanced practice

132registered nurse designated by such department which examination

133failed to reveal any evidence of such condition. For the purposes of

134this section, "cardiac emergency" means cardiac arrest or myocardial

135infarction, and "constable" means any municipal law enforcement

136officer who is authorized to make arrests and has completed Police

137Officer Standards and Training Council certification pursuant to

138section 7-294a.

139Sec. 6. Subsection (c) of section 31-296 of the general statutes is

140repealed and the following is substituted in lieu thereof (Effective

141October 1, 2019):

142(c) The employer's or insurer's notice of intention to discontinue or

143reduce payments shall (1) identify the claimant, the claimant's attorney

144or other representative, the employer, the insurer, and the injury,

145including the date of the injury, the city or town in which the injury

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148reduction of payments, and (B) identifies the claimant's attending

149physician or advanced practice registered nurse, and (3) be in

150substantially the following form:

154YOU ARE HEREBY NOTIFIED THAT THE EMPLOYER OR INSURER

155INTENDS TO REDUCE OR DISCONTINUE YOUR COMPENSATION

156PAYMENTS ON .... (date) FOR THE FOLLOWING REASONS:

157If you object to the reduction or discontinuance of benefits as stated

158in this notice, YOU MUST REQUEST A HEARING NOT LATER

159THAN 15 DAYS after your receipt of this notice, or this notice will

160automatically be approved.

161To request an Informal Hearing, call the Workers' Compensation

162Commission District Office in which your case is pending.

163Be prepared to provide medical and other documentation to

164support your objection. For your protection, note the date when you

165received this notice.

166Sec. 7. Section 38a-472a of the general statutes is repealed and the

167following is substituted in lieu thereof (Effective October 1, 2019):

168No contract between a managed care company, other organization

169or insurer authorized to do business in this state and a medical

170provider practicing in this state for the provision of services may

171require that the medical provider indemnify the managed care

172company, other organization or insurer for any expenses and liabilities

173including, without limitation, judgments, settlements, attorneys' fees,

174court costs and any associated charges incurred in connection with any

175claim or action brought against a managed care company, other

176organization or insurer on the basis of its determination of medical

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177necessity or appropriateness of health care services if the information

178provided by such medical provider used in making the determination

179was accurate and appropriate at the time it was given. As used in this

180section and section 38a-472b, "medical provider" means any person

181licensed pursuant to chapters 370 to 373, inclusive, or chapter 375, 378,

182379, 380 or 383.

183Sec. 8. Subsections (d) to (h), inclusive, of section 38a-488a of the

184general statutes are repealed and the following is substituted in lieu

185thereof (Effective October 1, 2019):

186(d) In the case of benefits payable for the services of a licensed

187physician, such benefits shall be payable for the same services when

188such services are lawfully rendered by a psychologist licensed under

189the provisions of chapter 383 or by such a licensed psychologist in a

190licensed hospital or clinic or an advanced practice registered nurse

191licensed under the provisions of chapter 378.

192(e) In the case of benefits payable for the services of a licensed

193physician or psychologist, such benefits shall be payable for the same

194services when such services are rendered by:

195(1) A clinical social worker who is licensed under the provisions of

196chapter 383b and who has passed the clinical examination of the

197American Association of State Social Work Boards and has completed

198at least two thousand hours of post-master's social work experience in

199a nonprofit agency qualifying as a tax-exempt organization under

200Section 501(c) of the Internal Revenue Code of 1986 or any subsequent

201corresponding internal revenue code of the United States, as from time

202to time amended, in a municipal, state or federal agency or in an

203institution licensed by the Department of Public Health under section

20419a-490;

205(2) A social worker who was certified as an independent social

206worker under the provisions of chapter 383b prior to October 1, 1990;

207(3) A licensed marital and family therapist who has completed at

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208least two thousand hours of post-master's marriage and family therapy

209work experience in a nonprofit agency qualifying as a tax-exempt

210organization under Section 501(c) of the Internal Revenue Code of 1986

211or any subsequent corresponding internal revenue code of the United

212States, as from time to time amended, in a municipal, state or federal

213agency or in an institution licensed by the Department of Public Health

214under section 19a-490;

215(4) A marital and family therapist who was certified under the

216provisions of chapter 383a prior to October 1, 1992;

217(5) A licensed alcohol and drug counselor, as defined in section 20-

21874s, or a certified alcohol and drug counselor, as defined in section 20-

21974s;

220(6) A licensed professional counselor; or

221(7) An advanced practice registered nurse licensed under the

222provisions of chapter 378.

223(f) (1) In the case of benefits payable for the services of a licensed

224physician, such benefits shall be payable for (A) services rendered in a

225child guidance clinic or residential treatment facility by a person with a

226master's degree in social work or by a person with a master's degree in

227marriage and family therapy under the supervision of a psychiatrist,

228physician, licensed marital and family therapist, or licensed clinical

229social worker who is eligible for reimbursement under subdivisions (1)

230to (4), inclusive, of subsection (e) of this section; (B) services rendered

231in a residential treatment facility by a licensed or certified alcohol and

232drug counselor who is eligible for reimbursement under subdivision

233(5) of subsection (e) of this section; [or] (C) services rendered in a

234residential treatment facility by a licensed professional counselor who

235is eligible for reimbursement under subdivision (6) of subsection (e) of

236this section; or (D) services rendered in a residential treatment facility

237by a licensed advanced practice registered nurse who is eligible for

238reimbursement under subdivision (7) of subsection (e) of this section.

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239(2) In the case of benefits payable for the services of a licensed

240psychologist under subsection (e) of this section, such benefits shall be

241payable for (A) services rendered in a child guidance clinic or

242residential treatment facility by a person with a master's degree in

243social work or by a person with a master's degree in marriage and

244family therapy under the supervision of such licensed psychologist,

245licensed marital and family therapist, or licensed clinical social worker

246who is eligible for reimbursement under subdivisions (1) to (4),

247inclusive, of subsection (e) of this section; (B) services rendered in a

248residential treatment facility by a licensed or certified alcohol and drug

249counselor who is eligible for reimbursement under subdivision (5) of

250subsection (e) of this section; [or] (C) services rendered in a residential

251treatment facility by a licensed professional counselor who is eligible

252for reimbursement under subdivision (6) of subsection (e) of this

253section; or (D) services rendered in a residential treatment facility by a

254licensed advanced practice registered nurse who is eligible for

255reimbursement under subdivision (7) of subsection (e) of this section.

256(g) In the case of benefits payable for the service of a licensed

257physician practicing as a psychiatrist or a licensed psychologist, under

258subsection (e) of this section, such benefits shall be payable for

259outpatient services rendered (1) in a nonprofit community mental

260health center, as defined by the Department of Mental Health and

261Addiction Services, in a nonprofit licensed adult psychiatric clinic

262operated by an accredited hospital or in a residential treatment facility;

263(2) under the supervision of a licensed physician practicing as a

264psychiatrist, a licensed psychologist, a licensed marital and family

265therapist, a licensed clinical social worker, a licensed or certified

266alcohol and drug counselor, [or] a licensed professional counselor or a

267licensed advanced practice registered nurse who is eligible for

268reimbursement under subdivisions (1) to [(6)] (7), inclusive, of

269subsection (e) of this section; and (3) within the scope of the license

270issued to the center or clinic by the Department of Public Health or to

271the residential treatment facility by the Department of Children and

272Families.

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273(h) Except in the case of emergency services or in the case of services

274for which an individual has been referred by a physician or an

275advanced practice registered nurse affiliated with a health care center,

276nothing in this section shall be construed to require a health care center

277to provide benefits under this section through facilities that are not

278affiliated with the health care center.

279Sec. 9. Subsection (b) of section 38a-492e of the general statutes is

280repealed and the following is substituted in lieu thereof (Effective

281October 1, 2019):

282(b) Benefits shall cover: (1) Initial training visits provided to an

283individual after the individual is initially diagnosed with diabetes that

284is medically necessary for the care and management of diabetes,

285including, but not limited to, counseling in nutrition and the proper

286use of equipment and supplies for the treatment of diabetes, totaling a

287maximum of ten hours; (2) training and education that is medically

288necessary as a result of a subsequent diagnosis by a physician or an

289advanced practice registered nurse of a significant change in the

290individual's symptoms or condition which requires modification of the

291individual's program of self-management of diabetes, totaling a

292maximum of four hours; and (3) training and education that is

293medically necessary because of the development of new techniques

294and treatment for diabetes totaling a maximum of four hours.

295Sec. 10. Section 38a-499 of the general statutes is repealed and the

296following is substituted in lieu thereof (Effective October 1, 2019):

297(a) For the purposes of this section:

298(1) ["Certified nurse practitioner"] "Advanced practice registered

299nurse" means any advanced practice registered nurse licensed under

300 the provisions of chapter 378; [who has completed a formal

301educational nurse practitioner program and is certified by the

302American Nurses' Association, the National Board of Pediatric Nurse

303Practitioners and Associates or the Nurses' Association of the

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304American College of Obstetricians and Gynecologists;]

305(2) ["Certified psychiatric-mental health clinical nurse specialist"]

306"Certified psychiatric-mental health advanced practice registered

307nurse" means any advanced practice registered nurse licensed under

308chapter 378 who [has completed a formal educational program as a

309psychiatric-mental health clinical nurse specialist and is certified by the

310American Nurses' Association] is board certified as a psychiatric-

311mental health provider by the American Nurses Credentialing Center;

312(3) "Certified nurse-midwife" means any individual certified as

313nurse-midwife pursuant to sections 20-86a to 20-86e, inclusive;

314(4) "Physician assistant" means an individual licensed pursuant to

315section 20-12b.

316(b) Each individual health insurance policy providing coverage of

317the type specified in subdivisions (1), (2), (4), (6), (10), (11) and (12) of

318section 38a-469 delivered, issued for delivery, renewed, amended or

319continued in this state shall provide coverage for the services of

320physician assistants, [certified nurse practitioners] advanced practice

321registered nurses, certified psychiatric-mental health [clinical nurse

322specialists] advanced practice registered nurses and certified nurse-

323 midwives if such services are within the individual's area of

324professional competence as established by education and licensure or

325certification and are currently reimbursed when rendered by any other

326licensed health care provider. Subject to the provisions of chapter 378

327and sections 20-86a to 20-86e, inclusive, no insurer, hospital service

328corporation, medical service corporation or health care center may

329require signature, referral or employment by any other health care

330provider as a condition of reimbursement, provided no insurer,

331hospital service corporation, medical service corporation or health care

332center may be required to pay for duplicative services actually

333rendered by both a physician assistant or [a certified registered nurse]

334an advanced practice registered nurse and any other health care

335provider. The payment of such benefits shall be subject to any policy

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336 provisions which apply to other licensed health practitioners

337providing the same services. Nothing in this section may be construed

338as permitting (1) any registered nurse to perform or provide services

339beyond the scope of practice permitted in chapter 378 and sections 20-

34086a to 20-86e, inclusive, or (2) any physician assistant to perform or

341provide services beyond the scope of practice permitted in chapter 370.

342Sec. 11. Subsection (d) of section 38a-503 of the general statutes is

343repealed and the following is substituted in lieu thereof (Effective

344October 1, 2019):

345(d) Each mammography report provided to a patient shall include

346information about breast density, based on the Breast Imaging

347Reporting and Data System established by the American College of

348Radiology. Where applicable, such report shall include the following

349notice: "If your mammogram demonstrates that you have dense breast

350tissue, which could hide small abnormalities, you might benefit from

351supplementary screening tests, which can include a breast ultrasound

352screening or a breast MRI examination, or both, depending on your

353individual risk factors. A report of your mammography results, which

354contains information about your breast density, has been sent to your

355physician's or advanced practice registered nurse's office and you

356should contact your physician or advanced practice registered nurse if

357you have any questions or concerns about this report.".

358Sec. 12. Subsection (b) of section 38a-518e of the general statutes is

359repealed and the following is substituted in lieu thereof (Effective

360October 1, 2019):

361(b) Benefits shall cover: (1) Initial training visits provided to an

362individual after the individual is initially diagnosed with diabetes that

363is medically necessary for the care and management of diabetes,

364including, but not limited to, counseling in nutrition and the proper

365use of equipment and supplies for the treatment of diabetes, totaling a

366maximum of ten hours; (2) training and education that is medically

367necessary as a result of a subsequent diagnosis by a physician or

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368advanced practice registered nurse of a significant change in the

369individual's symptoms or condition which requires modification of the

370individual's program of self-management of diabetes, totaling a

371maximum of four hours; and (3) training and education that is

372medically necessary because of the development of new techniques

373and treatment for diabetes totaling a maximum of four hours.

374Sec. 13. Subsection (d) of section 38a-530 of the general statutes is

375repealed and the following is substituted in lieu thereof (Effective

376October 1, 2019):

377(d) Each mammography report provided to a patient shall include

378information about breast density, based on the Breast Imaging

379Reporting and Data System established by the American College of

380Radiology. Where applicable, such report shall include the following

381notice: "If your mammogram demonstrates that you have dense breast

382tissue, which could hide small abnormalities, you might benefit from

383supplementary screening tests, which can include a breast ultrasound

384screening or a breast MRI examination, or both, depending on your

385individual risk factors. A report of your mammography results, which

386contains information about your breast density, has been sent to your

387physician's or advanced practice registered nurse's office and you

388should contact your physician or advanced practice registered nurse if

389you have any questions or concerns about this report.".

390Sec. 14. Section 4-105 of the general statutes is repealed and the

391following is substituted in lieu thereof (Effective October 1, 2019):

392If any patient who has received treatment in any such hospital, after

393[his] discharge from such hospital, has made written application to

394such hospital, hospital society or corporation for permission to

395examine his or her record as such patient in such hospital and has been

396refused permission to examine or copy the same, such patient may file

397a written motion addressed to any judge of the Superior Court,

398praying for a disclosure of the contents of such hospital record relating

399to such patient and for a production of the same before such judge.

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400Upon such application being filed, the judge to whom the same has

401been presented shall cause reasonable notice to be given to such

402hospital, hospital society or corporation of the time when and place

403where such petition will be heard, and such judge, after due hearing

404and notice, may order the officer authorized to act in the capacity of

405manager of such hospital to produce before [him] the court and deliver

406into [his] the custody of the court the history, bedside notes, charts,

407pictures and plates of such patient for the purpose of being examined

408or copied by such patient [,] or his or her physician, advanced practice

409registered nurse or authorized attorney. Each officer of any hospital

410having custody of the history, bedside notes, charts, pictures or plates

411of any patient therein, who refuses to produce such record before such

412[judge] court, pursuant to the provisions of this section, shall be fined

413not more than one hundred dollars or imprisoned not more than six

414months or both.

415Sec. 15. Subsection (c) of section 7-51a of the general statutes is

416repealed and the following is substituted in lieu thereof (Effective

417October 1, 2019):

418(c) For deaths occurring on or after July 1, 1997, the Social Security

419number of the deceased person shall be recorded in the "administrative

420purposes" section of the death certificate. Such administrative

421purposes section, and the Social Security number contained therein,

422shall be restricted and disclosed only to the following eligible parties:

423(1) All parties specified on the death certificate, including the

424informant, licensed funeral director, licensed embalmer, conservator,

425surviving spouse, physician or advanced practice registered nurse and

426town clerk, for the purpose of processing the certificate, (2) the

427surviving spouse, (3) the next of kin, or (4) any state and federal

428agencies authorized by federal law. The department shall provide any

429other individual, researcher or state or federal agency requesting a

430certified or uncertified death certificate, or the information contained

431within such certificate, for a death occurring on or after July 1, 1997,

432such certificate or information. The decedent's Social Security number

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433shall be removed or redacted from such certificate or information or

434the administrative purposes section shall be omitted from such

435certificate.

436Sec. 16. Section 17b-233 of the general statutes is repealed and the

437following is substituted in lieu thereof (Effective October 1, 2019):

438Newington Children's Hospital may admit any child who is

439handicapped or afflicted with any pediatric illness upon application of

440the selectmen of any town, or the guardian or any relative of such

441child, or any public health agency, [or] physician or advanced practice

442registered nurse, provided, no person shall be admitted primarily for

443the treatment of any drug-related condition. Said hospital shall admit

444such child to said hospital if such child is pronounced by [the

445physicians] a physician or advanced practice registered nurse on the

446staff of said hospital, after examination, to be suitable for admission,

447and said hospital shall keep and support such child for such length of

448time as it deems proper. Said hospital shall not be required to admit

449any such child unless it can conveniently receive and care for such

450child at the time application is made and said hospital may return to

451the town in which such child resides any child so taken who is

452pronounced by [the physicians] a physician or advanced practice

453registered nurse on the staff of said hospital, after examination, to be

454unsuitable for retention or who, by reason of improvement in his

455condition or completion of his treatment or training, ought not to be

456further retained. The hospital may refuse to admit any child

457pronounced by [the physicians] a physician or advanced practice

458registered nurse on the staff of said hospital, after examination, to be

459unsuitable for admission and may refuse to admit any such child when

460 the facilities at the hospital will not, in the judgment of said

461[physicians] physician or advanced practice registered nurse, permit

462the hospital to care for such child adequately and properly.

463Sec. 17. Section 17b-236 of the general statutes is repealed and the

464following is substituted in lieu thereof (Effective October 1, 2019):

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465When there is found in any town in this state any child of sound

466mind who is physically disabled or who is afflicted with poliomyelitis

467or rheumatic fever, or any uncontagious disabling disease, and who is

468unable to pay and whose relatives who are legally liable for his

469support are unable to pay the full cost of treating such disease, if such

470child and one of such relatives reside in this state, the selectmen of

471such town, or the guardian or any relative of such child, or any public

472health agency, [or] physician or advanced practice registered nurse in

473this state, may make application to The Children's Center, located at

474Hamden, for the admission of such child to said center. Said center

475shall admit such child if such child is pronounced by [the physicians] a

476physician or advanced practice registered nurse on the staff of said

477center, after examination, to be fit for admission, and said center shall

478keep and support such child for such length of time as it deems

479proper. Said center shall not be required to admit any such child unless

480it can conveniently receive and care for him at the time such

481application is made, and said center may return to the town in which

482such child resides any child so taken who is pronounced by [the

483physicians] a physician or advanced practice registered nurse on the

484staff of said center, after examination, to be unfit for retention, or who,

485by reason of improvement in his condition or completion of his

486treatment or training, ought not to be further retained. The center may

487refuse to admit any child who is pronounced by [the physicians] a

488physician or advanced practice registered nurse on the staff of said

489center, after examination, to be unfit for admission, and may refuse to

490admit any such child when the facilities at the center will not, in the

491judgment of said [physicians] physician or advanced practice

492registered nurse, permit the center to care for such child adequately

493and properly.

494Sec. 18. Section 17b-278d of the general statutes is repealed and the

495following is substituted in lieu thereof (Effective October 1, 2019):

496The Commissioner of Social Services, to the extent permitted by

497federal law, shall take such action as may be necessary to amend the

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498Medicaid state plan and the state children's health insurance plan to

499provide coverage without prior authorization for each child diagnosed

500with cancer on or after January 1, 2000, who is covered under the

501HUSKY Health program, for neuropsychological testing ordered by a

502licensed physician or licensed advanced practice registered nurse, to

503assess the extent of any cognitive or developmental delays in such

504child due to chemotherapy or radiation treatment.

505Sec. 19. Section 19a-2a of the general statutes is repealed and the

506following is substituted in lieu thereof (Effective October 1, 2019):

507The Commissioner of Public Health shall employ the most efficient

508and practical means for the prevention and suppression of disease and

509shall administer all laws under the jurisdiction of the Department of

510Public Health and the Public Health Code. The commissioner shall

511have responsibility for the overall operation and administration of the

512Department of Public Health. The commissioner shall have the power

513and duty to: (1) Administer, coordinate and direct the operation of the

514department; (2) adopt and enforce regulations, in accordance with

515chapter 54, as are necessary to carry out the purposes of the

516department as established by statute; (3) establish rules for the internal

517operation and administration of the department; (4) establish and

518develop programs and administer services to achieve the purposes of

519the department as established by statute; (5) enter into a contract,

520including, but not limited to, a contract with another state, for facilities,

521services and programs to implement the purposes of the department

522as established by statute; (6) designate a deputy commissioner or other

523employee of the department to sign any license, certificate or permit

524issued by said department; (7) conduct a hearing, issue subpoenas,

525administer oaths, compel testimony and render a final decision in any

526case when a hearing is required or authorized under the provisions of

527any statute dealing with the Department of Public Health; (8) with the

528health authorities of this and other states, secure information and data

529concerning the prevention and control of epidemics and conditions

530affecting or endangering the public health, and compile such

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531information and statistics and shall disseminate among health

532authorities and the people of the state such information as may be of

533value to them; (9) annually issue a list of reportable diseases,

534emergency illnesses and health conditions and a list of reportable

535laboratory findings and amend such lists as the commissioner deems

536necessary and distribute such lists as well as any necessary forms to

537each licensed physician, licensed advanced practice registered nurse

538and clinical laboratory in this state. The commissioner shall prepare

539printed forms for reports and returns, with such instructions as may be

540necessary, for the use of directors of health, boards of health and

541registrars of vital statistics; and (10) specify uniform methods of

542keeping statistical information by public and private agencies,

543organizations and individuals, including a client identifier system, and

544collect and make available relevant statistical information, including

545 the number of persons treated, frequency of admission and

546readmission, and frequency and duration of treatment. The client

547identifier system shall be subject to the confidentiality requirements set

548forth in section 17a-688 and regulations adopted thereunder. The

549commissioner may designate any person to perform any of the duties

550listed in subdivision (7) of this section. The commissioner shall have

551authority over directors of health and may, for cause, remove any such

552director; but any person claiming to be aggrieved by such removal

553may appeal to the Superior Court which may affirm or reverse the

554action of the commissioner as the public interest requires. The

555commissioner shall assist and advise local directors of health and

556district directors of health in the performance of their duties, and may

557require the enforcement of any law, regulation or ordinance relating to

558public health. In the event the commissioner reasonably suspects

559impropriety on the part of a local director of health or district director

560of health, or employee of such director, in the performance of his or

561her duties, the commissioner shall provide notification and any

562evidence of such impropriety to the appropriate governing authority

563of the municipal health authority, established pursuant to section 19a-

564200, or the district department of health, established pursuant to

565section 19a-244, for purposes of reviewing and assessing a director's or

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566an employee's compliance with such duties. Such governing authority

567shall provide a written report of its findings from the review and

568assessment to the commissioner not later than ninety days after such

569review and assessment. When requested by local directors of health or

570district directors of health, the commissioner shall consult with them

571and investigate and advise concerning any condition affecting public

572health within their jurisdiction. The commissioner shall investigate

573nuisances and conditions affecting, or that he or she has reason to

574suspect may affect, the security of life and health in any locality and,

575for that purpose, the commissioner, or any person authorized by the

576commissioner, may enter and examine any ground, vehicle, apartment,

577building or place, and any person designated by the commissioner

578shall have the authority conferred by law upon constables. Whenever

579the commissioner determines that any provision of the general statutes

580or regulation of the Public Health Code is not being enforced

581effectively by a local health department or health district, he or she

582shall forthwith take such measures, including the performance of any

583act required of the local health department or health district, to ensure

584enforcement of such statute or regulation and shall inform the local

585health department or health district of such measures. In September of

586each year the commissioner shall certify to the Secretary of the Office

587of Policy and Management the population of each municipality. The

588commissioner may solicit and accept for use any gift of money or

589property made by will or otherwise, and any grant of or contract for

590money, services or property from the federal government, the state,

591any political subdivision thereof, any other state or any private source,

592and do all things necessary to cooperate with the federal government

593or any of its agencies in making an application for any grant or

594contract. The commissioner may establish state-wide and regional

595advisory councils. For purposes of this section, "employee of such

596director" means an employee of, a consultant employed or retained by

597or an independent contractor retained by a local director of health, a

598district director of health, a local health department or a health district.

599Sec. 20. Subsection (a) of section 19a-26 of the general statutes is

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600repealed and the following is substituted in lieu thereof (Effective

601October 1, 2019):

602(a) The Department of Public Health may establish, maintain and

603control state laboratories to perform examinations of supposed morbid

604tissues, other laboratory tests for the diagnosis and control of

605preventable diseases, and laboratory work in the field of sanitation,

606environmental and occupational testing and research studies for the

607protection and preservation of the public health. Such laboratory

608 services shall be performed upon the application of licensed

609physicians, other laboratories, licensed dentists, licensed podiatrists,

610licensed advanced practice registered nurses, local directors of health,

611 public utilities or state departments or institutions, subject to

612regulations prescribed by the Commissioner of Public Health, and

613upon payment of any applicable fee as provided in this subsection. For

614such purposes the department may provide necessary buildings and

615 apparatus, employ, subject to the provisions of chapter 67,

616administrative and scientific personnel and assistants and do all things

617necessary for the conduct of such laboratories. The Commissioner of

618Public Health may establish a schedule of fees, provided the

619commissioner waives the fees for local directors of health and local law

620enforcement agencies. If the commissioner establishes a schedule of

621fees, the commissioner may waive (1) the fees, in full or in part, for

622others if the commissioner determines that the public health requires a

623waiver, and (2) fees for chlamydia and gonorrhea testing for nonprofit

624organizations and institutions of higher education if the organization

625or institution provides combination chlamydia and gonorrhea test kits.

626The commissioner shall also establish a fair handling fee which a client

627of a state laboratory may charge a person or third party payer for

628arranging for the services of the laboratory. Such client shall not charge

629an amount in excess of such handling fee.

630Sec. 21. Subsection (a) of section 19a-490b of the general statutes is

631repealed and the following is substituted in lieu thereof (Effective

632October 1, 2019):

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633(a) Upon the written request of a patient or the patient's attorney or

634authorized representative, or pursuant to a written authorization, an

635institution licensed pursuant to this chapter shall furnish to the person

636making such request a copy of the patient's health record, including

637but not limited to, copies of bills, laboratory reports, prescriptions and

638other technical information used in assessing the patient's health

639condition. In addition, an institution shall provide the patient or the

640 patient's designated health care provider with a reasonable

641opportunity to examine retained tissue slides and retained pathology

642tissue blocks. Upon the written request of the patient, the patient's

643attorney or the patient's designated health care provider, an institution

644shall send the original retained tissue slide or original retained tissue

645 block directly to the patient's designated licensed institution,

646laboratory or physician. If the original slide or block is not available or

647if a new section cut of the original slide or block is a fair representation

648of the original slide or block, then the institution may send the new

649section cut, which is clearly labeled as a new section cut, to the

650patient's designated health care provider. Any patient or the patient's

651attorney or authorized representative who is provided with an original

652retained slide, tissue block or a new section under the provisions of

653this subsection shall be solely responsible for safeguarding and

654returning the slide, block or new section to the institution. Any

655institution or laboratory that has released an original slide, an original

656tissue block or new section pursuant to the provisions of this

657subsection shall not be subject to any liability arising out of releasing

658or not retaining the slide, block or new section and no cause of action

659for damages shall arise against any such institution for releasing or not

660retaining the slide, block or new section. No such institution shall

661charge more than sixty-five cents per page, including any research

662fees, clerical fees, handling fees or related costs, and the cost of first

663class postage, if applicable, for furnishing or providing access to a

664health record pursuant to this subsection, except such an institution

665may charge the amount necessary to cover its cost of materials for

666furnishing a copy of an x-ray or for furnishing an original retained

667slide, an original tissue block or a new section cut from a retained

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668pathology tissue block. For purposes of this subsection, "health care

669provider" means an institution or laboratory licensed under this

670chapter or licensed in the state where located, [or] a physician licensed

671under chapter 370 or licensed in the state where located or an

672advanced practice registered nurse licensed under chapter 378 or

673licensed in the state where located.

674Sec. 22. Subsections (a) and (b) of section 20-631 of the general

675statutes are repealed and the following is substituted in lieu thereof

676(Effective October 1, 2019):

677(a) Except as provided in section 20-631b, one or more pharmacists

678licensed under this chapter who are determined competent in

679accordance with regulations adopted pursuant to subsection (d) of this

680section may enter into a written protocol-based collaborative drug

681therapy management agreement with one or more physicians licensed

682under chapter 370 or advanced practice registered nurses licensed

683under chapter 378 to manage the drug therapy of individual patients.

684In order to enter into a written protocol-based collaborative drug

685therapy management agreement, such physician or advanced practice

686registered nurse shall have established a [physician-patient] provider-

687patient relationship with the patient who will receive collaborative

688drug therapy. Each patient's collaborative drug therapy management

689shall be governed by a written protocol specific to that patient

690established by the treating physician or advanced practice registered

691nurse in consultation with the pharmacist. For purposes of this

692subsection, a ["physician-patient relationship"] "provider-patient

693relationship" is a relationship based on (1) the patient making a

694medical complaint, (2) the patient providing a medical history, (3) the

695patient receiving a physical examination, and (4) a logical connection

696existing between the medical complaint, the medical history, the

697physical examination and any drug prescribed for the patient.

698(b) A collaborative drug therapy management agreement may

699authorize a pharmacist to implement, modify or discontinue a drug

700therapy that has been prescribed for a patient, order associated

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701laboratory tests and administer drugs, all in accordance with a patient-

702specific written protocol. In instances where drug therapy is

703discontinued, the pharmacist shall notify the treating physician or

704advanced practice registered nurse of such discontinuance no later

705than twenty-four hours from the time of such discontinuance. Each

706protocol developed, pursuant to the collaborative drug therapy

707management agreement, shall contain detailed direction concerning

708the actions that the pharmacist may perform for that patient. The

709protocol shall include, but need not be limited to, (1) the specific drug

710or drugs to be managed by the pharmacist, (2) the terms and

711conditions under which drug therapy may be implemented, modified

712or discontinued, (3) the conditions and events upon which the

713pharmacist is required to notify the physician or advanced practice

714registered nurse, and (4) the laboratory tests that may be ordered. All

715activities performed by the pharmacist in conjunction with the

716protocol shall be documented in the patient's medical record. The

717pharmacist shall report at least every thirty days to the physician or

718advanced practice registered nurse regarding the patient's drug

719therapy management. The collaborative drug therapy management

720agreement and protocols shall be available for inspection by the

721Departments of Public Health and Consumer Protection. A copy of the

722protocol shall be filed in the patient's medical record.

723Sec. 23. Subsections (a) and (b) of section 20-631a of the general

724statutes are repealed and the following is substituted in lieu thereof

725(Effective October 1, 2019):

726(a) Not later than January 1, 2006, the Commissioner of Consumer

727Protection, in consultation with the Commission of Pharmacy, shall

728establish and operate a two-year pilot program to allow not more than

729ten pharmacists licensed under this chapter who are determined

730eligible in accordance with subsection (c) of this section and employed

731by or under contract with a licensed community pharmacy, to enter

732into a written protocol-based collaborative drug therapy management

733agreement with one or more physicians licensed under chapter 370 or

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734advanced practice registered nurses licensed under chapter 378, to

735manage the drug therapy of individual patients receiving drug therapy

736for diabetes, asthma, hypertension, hyperlipidemia, osteoporosis,

737congestive heart failure or smoking cessation, including patients who

738qualify as targeted beneficiaries under the provisions of Section 1860D-

7394(c)(2)(A)(ii) of the federal Social Security Act, in accordance with

740subsections (b) to (d), inclusive, of this section and subject to the

741approval of the licensed community pharmacy. Each patient's

742collaborative drug therapy management shall be governed by a

743written protocol specific to that patient established by the treating

744physician or advanced practice registered nurse in consultation with

745the pharmacist.

746(b) A collaborative drug therapy management agreement may

747authorize a pharmacist to implement, modify or discontinue a drug

748therapy that has been prescribed for a patient, order associated

749laboratory tests and administer drugs, all in accordance with a patient-

750specific written protocol. Each protocol developed, pursuant to the

751collaborative drug therapy management agreement, shall contain

752detailed direction concerning the actions that the pharmacist may

753perform for that patient. The protocol shall include, but need not be

754limited to, (1) the specific drug or drugs to be managed by the

755pharmacist, (2) the terms and conditions under which drug therapy

756may be implemented, modified or discontinued, (3) the conditions and

757events upon which the pharmacist is required to notify the physician

758or advanced practice registered nurse, and (4) the laboratory tests that

759may be ordered. All activities performed by the pharmacist in

760conjunction with the protocol shall be documented in the patient's

761medical record. The pharmacist shall report to the physician or

762advanced practice registered nurse through oral, written or electronic

763manner regarding the implementation, administration, modification or

764discontinuation of a drug therapy that has been prescribed for a

765patient not later than twenty-four hours after such implementation,

766administration, modification or discontinuation. The collaborative

767drug therapy management agreement and protocols shall be available

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768for inspection by the Departments of Public Health and Consumer

769Protection. A copy of the protocol shall be filed in the patient's medical

770record.

771Sec. 24. Section 52-146d of the general statutes is repealed and the

772following is substituted in lieu thereof (Effective October 1, 2019):

773As used in sections 52-146d to 52-146i, inclusive:

774(1) "Authorized representative" means (A) a person empowered by

775a patient to assert the confidentiality of communications or records

776which are privileged under sections 52-146c to 52-146i, inclusive, or (B)

777if a patient is deceased, his or her personal representative or next of

778kin, or (C) if a patient is incompetent to assert or waive his privileges

779hereunder, (i) a guardian or conservator who has been or is appointed

780 to act for the patient, or (ii) for the purpose of maintaining

781confidentiality until a guardian or conservator is appointed, the

782patient's nearest relative;

783(2) "Communications and records" means all oral and written

784communications and records thereof relating to diagnosis or treatment

785of a patient's mental condition between the patient and a [psychiatrist]

786psychiatric mental health provider, or between a member of the

787patient's family and a [psychiatrist] psychiatric mental health provider,

788or between any of such persons and a person participating under the

789supervision of a [psychiatrist] psychiatric mental health provider in the

790accomplishment of the objectives of diagnosis and treatment, wherever

791made, including communications and records which occur in or are

792prepared at a mental health facility;

793(3) "Consent" means consent given in writing by the patient or his

794authorized representative;

795(4) "Identifiable" and "identify a patient" refer to communications

796and records which contain (A) names or other descriptive data from

797which a person acquainted with the patient might reasonably

798recognize the patient as the person referred to, or (B) codes or numbers

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799which are in general use outside of the mental health facility which

800prepared the communications and records;

801(5) "Mental health facility" includes any hospital, clinic, ward,

802[psychiatrist's] psychiatric mental health provider's office or other

803facility, public or private, which provides inpatient or outpatient

804service, in whole or in part, relating to the diagnosis or treatment of a

805patient's mental condition;

806(6) "Patient" means a person who communicates with or is treated

807by a [psychiatrist] psychiatric mental health provider in diagnosis or

808treatment;

809(7) ["Psychiatrist"] "Psychiatric mental health provider" means a

810physician specializing in psychiatry and licensed under the provisions

811of sections 20-9 to 20-12, inclusive, an advanced practice registered

812nurse licensed under chapter 378 who is board certified as a

813 psychiatric mental health provider by the American Nurses

814Credentialing Center, a person licensed to practice medicine who

815devotes a substantial portion of his or her time to the practice of

816psychiatry [,] or a person reasonably believed by the patient to be so

817qualified.

818Sec. 25. Subdivisions (1) to (5), inclusive, of section 52-146f of the

819general statutes are repealed and the following is substituted in lieu

820thereof (Effective October 1, 2019):

821(1) Communications or records may be disclosed to other persons

822engaged in the diagnosis or treatment of the patient or may be

823transmitted to another mental health facility to which the patient is

824admitted for diagnosis or treatment if the [psychiatrist] psychiatric

825mental health provider in possession of the communications or records

826determines that the disclosure or transmission is needed to accomplish

827the objectives of diagnosis or treatment. The patient shall be informed

828that the communications or records will be so disclosed or transmitted.

829For purposes of this subsection, persons in professional training are to

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830be considered as engaged in the diagnosis or treatment of the patients.

831(2) Communications or records may be disclosed when the

832[psychiatrist] psychiatric mental health provider determines that there

833is substantial risk of imminent physical injury by the patient to himself

834or others or when a [psychiatrist] psychiatric mental health provider,

835in the course of diagnosis or treatment of the patient, finds it necessary

836to disclose the communications or records for the purpose of placing

837the patient in a mental health facility, by certification, commitment or

838otherwise, provided the provisions of sections 52-146d to 52-146j,

839inclusive, as amended by this act, shall continue in effect after the

840patient is in the facility.

841(3) Except as provided in section 17b-225, the name, address and

842 fees for psychiatric services to a patient may be disclosed to

843individuals or agencies involved in the collection of fees for such

844services. In cases where a dispute arises over the fees or claims or

845where additional information is needed to substantiate the fee or

846claim, the disclosure of further information shall be limited to the

847following: (A) That the person was in fact a patient; (B) the diagnosis;

848(C) the dates and duration of treatment; and (D) a general description

849of the treatment, which shall include evidence that a treatment plan

850exists and has been carried out and evidence to substantiate the

851necessity for admission and length of stay in a health care institution

852or facility. If further information is required, the party seeking the

853information shall proceed in the same manner provided for hospital

854patients in section 4-105, as amended by this act.

855(4) Communications made to or records made by a [psychiatrist]

856psychiatric mental health provider in the course of a psychiatric

857examination ordered by a court or made in connection with the

858application for the appointment of a conservator by the Probate Court

859for good cause shown may be disclosed at judicial or administrative

860proceedings in which the patient is a party, or in which the question of

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863 patient has been informed before making the communications that any 864 communications will not be confidential and provided the

865communications shall be admissible only on issues involving the

866patient's mental condition.

867(5) Communications or records may be disclosed in a civil

868proceeding in which the patient introduces his mental condition as an

869element of his claim or defense, or, after the patient's death, when his

870condition is introduced by a party claiming or defending through or as

871a beneficiary of the patient and the court or judge finds that it is more

872important to the interests of justice that the communications be

873disclosed than that the relationship between patient and [psychiatrist]

874psychiatric mental health provider be protected.

875Sec. 26. Section 52-584 of the general statutes is repealed and the

876following is substituted in lieu thereof (Effective October 1, 2019):

877No action to recover damages for injury to the person, or to real or

878personal property, caused by negligence, or by reckless or wanton

879misconduct, or by malpractice of a physician, surgeon, dentist,

880podiatrist, chiropractor, advanced practice registered nurse, hospital or

881sanatorium, shall be brought but within two years from the date when

882the injury is first sustained or discovered or in the exercise of

883reasonable care should have been discovered, and except that no such

884action may be brought more than three years from the date of the act

885or omission complained of, except that a counterclaim may be

886interposed in any such action any time before the pleadings in such

887action are finally closed.

This act shall take effect as follows and shall amend the following sections:

Statement of Legislative Commissioners:

In Section 3, Subsec. (a) of section 31-294d was added and amended to include "advanced practice registered nurse" for clarity and accuracy.

PH Joint Favorable Subst.