Connecticut 2019 Regular Session

Connecticut Senate Bill SB00919 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
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	7	+	General Assembly Raised Bill No. 919
	8	+	January Session, 2019
	9	+	LCO No. 4096
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	11	+
	12	+	Referred to Committee on PUBLIC HEALTH
	13	+
	14	+
	15	+	Introduced by:
	16	+	(PH)
1	17
2	18
3	19
4		-	Senate Bill No. 919
5		-
6		-	Public Act No. 19-97
7		-
8		-
9		-	AN ACT REMOVING THE TERM "HOMEMAKER" IN REFERENCE
10		-	TO HOME HEALTH AIDE AGENCIES AND SERVICE S.
	20	+	AN ACT REMOVING THE TER M "HOMEMAKER" IN REF ERENCE TO
	21	+	HOME HEALTH AIDE AGE NCIES AND SERVICES.
11	22		Be it enacted by the Senate and House of Representatives in General
12	23		Assembly convened:
13	24
14		-	Section 1. Section 17b-242 of the general statutes is repealed and the
15		-	following is substituted in lieu thereof (Effective July 1, 2019):
16		-	(a) The Department of Social Services shall determine the rates to be
17		-	paid to home health care agencies and [homemaker-home] home
18		-	health aide agencies by the state or any town in the state for persons
19		-	aided or cared for by the state or any such town. For the period from
20		-	February 1, 1991, to January 31, 1992, inclusive, payment for each
21		-	service to the state shall be based upon the rate for such service as
22		-	determined by the Office of Health Care Access, except that for those
23		-	providers whose Medicaid rates for the year ending January 31, 1991,
24		-	exceed the median rate, no increase shall be allowed. For those
25		-	providers whose rates for the year ending January 31, 1991, are below
26		-	the median rate, increases shall not exceed the lower of the prior rate
27		-	increased by the most recent annual increase in the consumer price
28		-	index for urban consumers or the median rate. In no case shall any
29		-	such rate exceed the eightieth percentile of rates in effect January 31,
30		-	1991, nor shall any rate exceed the charge to the general public for
31		-	similar services. Rates effective February 1, 1992, shall be based upon Senate Bill No. 919
	25	+	Section 1. Section 17b-242 of the general statutes is repealed and the 1
	26	+	following is substituted in lieu thereof (Effective July 1, 2019): 2
	27	+	(a) The Department of Social Services shall determine the rates to be 3
	28	+	paid to home health care agencies and [homemaker-home] home 4
	29	+	health aide agencies by the state or any town in the state for persons 5
	30	+	aided or cared for by the state or any such town. For the period from 6
	31	+	February 1, 1991, to January 31, 1992, inclusive, payment for each 7
	32	+	service to the state shall be based upon the rate for such service as 8
	33	+	determined by the Office of Health Care Access, except that for those 9
	34	+	providers whose Medicaid rates for the year ending January 31, 1991, 10
	35	+	exceed the median rate, no increase shall be allowed. For those 11
	36	+	providers whose rates for the year ending January 31, 1991, are below 12
	37	+	the median rate, increases shall not exceed the lower of the prior rate 13
	38	+	increased by the most recent annual increase in the consumer price 14
	39	+	index for urban consumers or the median rate. In no case shall any 15
	40	+	such rate exceed the eightieth percentile of rates in effect January 31, 16 Raised Bill No. 919
32	41
33		-	Public Act No. 19-97 2 of 13
34	42
35		-	rates as determined by the Office of Health Care Access, except that
36		-	increases shall not exceed the prior year's rate increased by the most
37		-	recent annual increase in the consumer price index for urban
38		-	consumers and rates effective February 1, 1992, shall remain in effect
39		-	through June 30, 1993. Rates effective July 1, 1993, shall be based upon
40		-	rates as determined by the Office of Health Care Access except if the
41		-	Medicaid rates for any service for the period ending June 30, 1993,
42		-	exceed the median rate for such service, the increase effective July 1,
43		-	1993, shall not exceed one per cent. If the Medicaid rate for any service
44		-	for the period ending June 30, 1993, is below the median rate, the
45		-	increase effective July 1, 1993, shall not exceed the lower of the prior
46		-	rate increased by one and one-half times the most recent annual
47		-	increase in the consumer price index for urban consumers or the
48		-	median rate plus one per cent. The Commissioner of Social Services
49		-	shall establish a fee schedule for home health services to be effective on
50		-	and after July 1, 1994. The commissioner may annually modify such
51		-	fee schedule if such modification is needed to ensure that the
52		-	conversion to an administrative services organization is cost neutral to
53		-	home health care agencies and [homemaker-home] home health aide
54		-	agencies in the aggregate and ensures patient access. Utilization may
55		-	be a factor in determining cost neutrality. The commissioner shall
56		-	increase the fee schedule for home health services provided under the
57		-	Connecticut home-care program for the elderly established under
58		-	section 17b-342, effective July 1, 2000, by two per cent over the fee
59		-	schedule for home health services for the previous year. The
60		-	commissioner may increase any fee payable to a home health care
61		-	agency or [homemaker-home] home health aide agency upon the
62		-	application of such an agency evidencing extraordinary costs related to
63		-	(1) serving persons with AIDS; (2) high-risk maternal and child health
64		-	care; (3) escort services; or (4) extended hour services. In no case shall
65		-	any rate or fee exceed the charge to the general public for similar
66		-	services. A home health care agency or [homemaker-home] home
67		-	health aide agency which, due to any material change in Senate Bill No. 919
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68	46
69		-	Public Act No. 19-97 3 of 13
	47	+	1991, nor shall any rate exceed the charge to the general public for 17
	48	+	similar services. Rates effective February 1, 1992, shall be based upon 18
	49	+	rates as determined by the Office of Health Care Access, except that 19
	50	+	increases shall not exceed the prior year's rate increased by the most 20
	51	+	recent annual increase in the consumer price index for urban 21
	52	+	consumers and rates effective February 1, 1992, shall remain in effect 22
	53	+	through June 30, 1993. Rates effective July 1, 1993, shall be based upon 23
	54	+	rates as determined by the Office of Health Care Access except if the 24
	55	+	Medicaid rates for any service for the period ending June 30, 1993, 25
	56	+	exceed the median rate for such service, the increase effective July 1, 26
	57	+	1993, shall not exceed one per cent. If the Medicaid rate for any service 27
	58	+	for the period ending June 30, 1993, is below the median rate, the 28
	59	+	increase effective July 1, 1993, shall not exceed the lower of the prior 29
	60	+	rate increased by one and one-half times the most recent annual 30
	61	+	increase in the consumer price index for urban consumers or the 31
	62	+	median rate plus one per cent. The Commissioner of Social Services 32
	63	+	shall establish a fee schedule for home health services to be effective on 33
	64	+	and after July 1, 1994. The commissioner may annually modify such 34
	65	+	fee schedule if such modification is needed to ensure that the 35
	66	+	conversion to an administrative services organization is cost neutral to 36
	67	+	home health care agencies and [homemaker-home] home health aide 37
	68	+	agencies in the aggregate and ensures patient access. Utilization may 38
	69	+	be a factor in determining cost neutrality. The commissioner shall 39
	70	+	increase the fee schedule for home health services provided under the 40
	71	+	Connecticut home-care program for the elderly established under 41
	72	+	section 17b-342, effective July 1, 2000, by two per cent over the fee 42
	73	+	schedule for home health services for the previous year. The 43
	74	+	commissioner may increase any fee payable to a home health care 44
	75	+	agency or [homemaker-home] home health aide agency upon the 45
	76	+	application of such an agency evidencing extraordinary costs related to 46
	77	+	(1) serving persons with AIDS; (2) high-risk maternal and child health 47
	78	+	care; (3) escort services; or (4) extended hour services. In no case shall 48
	79	+	any rate or fee exceed the charge to the general public for similar 49
	80	+	services. A home health care agency or [homemaker-home] home 50
	81	+	health aide agency which, due to any material change in 51 Raised Bill No. 919
70	82
71		-	circumstances, is aggrieved by a rate determined pursuant to this
72		-	subsection may, within ten days of receipt of written notice of such
73		-	rate from the Commissioner of Social Services, request in writing a
74		-	hearing on all items of aggrievement. The commissioner shall, upon
75		-	the receipt of all documentation necessary to evaluate the request,
76		-	determine whether there has been such a change in circumstances and
77		-	shall conduct a hearing if appropriate. The Commissioner of Social
78		-	Services shall adopt regulations, in accordance with chapter 54, to
79		-	implement the provisions of this subsection. The commissioner may
80		-	implement policies and procedures to carry out the provisions of this
81		-	subsection while in the process of adopting regulations, provided
82		-	notice of intent to adopt the regulations is published in the Connecticut
83		-	Law Journal not later than twenty days after the date of implementing
84		-	the policies and procedures. Such policies and procedures shall be
85		-	valid for not longer than nine months.
86		-	(b) The Department of Social Services shall monitor the rates
87		-	charged by home health care agencies and [homemaker-home] home
88		-	health aide agencies. Such agencies shall file annual cost reports and
89		-	service charge information with the department.
90		-	(c) The home health services fee schedule shall include a fee for the
91		-	administration of medication, which shall apply when the purpose of a
92		-	nurse's visit is limited to the administration of medication.
93		-	Administration of medication may include, but is not limited to, blood
94		-	pressure checks, glucometer readings, pulse rate checks and similar
95		-	indicators of health status. The fee for medication administration shall
96		-	include administration of medications while the nurse is present, the
97		-	pre-pouring of additional doses that the client will self-administer at a
98		-	later time and the teaching of self-administration. The department
99		-	shall not pay for medication administration in addition to any other
100		-	nursing service at the same visit. The department may establish prior
101		-	authorization requirements for this service. Before implementing such Senate Bill No. 919
102	83
103		-	Public Act No. 19-97 4 of 13
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104	87
105		-	change, the Commissioner of Social Services shall consult with the
106		-	chairpersons of the joint standing committees of the General Assembly
107		-	having cognizance of matters relating to public health and human
108		-	services. The commissioner shall monitor Medicaid home health care
109		-	savings achieved through the implementation of nurse delegation of
110		-	medication administration pursuant to section 19a-492e, as amended
111		-	by this act. If, by January 1, 2016, the commissioner determines that the
112		-	rate of savings is not adequate to meet the annualized savings
113		-	assumed in the budget for the biennium ending June 30, 2017, the
114		-	department may reduce rates for medication administration as
115		-	necessary to achieve the savings assumed in the budget. Prior to any
116		-	rate reduction, the department shall report to the joint standing
117		-	committees of the General Assembly having cognizance of matters
118		-	relating to appropriations and the budgets of state agencies and
119		-	human services provider specific cost and utilization trend data for
120		-	those patients receiving medication administration. Should the
121		-	department determine it necessary to reduce medication
122		-	administration rates under this section, it shall examine the possibility
123		-	of establishing a separate Medicaid supplemental rate or a pay-for-
124		-	performance program for those providers, as determined by the
125		-	commissioner, who have established successful nurse delegation
126		-	programs.
127		-	(d) The home health services fee schedule established pursuant to
128		-	subsection (c) of this section shall include rates for psychiatric nurse
129		-	visits.
130		-	(e) The Department of Social Services, when processing or auditing
131		-	claims for reimbursement submitted by home health care agencies and
132		-	[homemaker-home] home health aide agencies shall, in accordance
133		-	with the provisions of chapter 15, accept electronic records and records
134		-	bearing the electronic signature of a licensed physician or licensed
135		-	practitioner of a healthcare profession that has been submitted to the Senate Bill No. 919
	88	+	circumstances, is aggrieved by a rate determined pursuant to this 52
	89	+	subsection may, within ten days of receipt of written notice of such 53
	90	+	rate from the Commissioner of Social Services, request in writing a 54
	91	+	hearing on all items of aggrievement. The commissioner shall, upon 55
	92	+	the receipt of all documentation necessary to evaluate the request, 56
	93	+	determine whether there has been such a change in circumstances and 57
	94	+	shall conduct a hearing if appropriate. The Commissioner of Social 58
	95	+	Services shall adopt regulations, in accordance with chapter 54, to 59
	96	+	implement the provisions of this subsection. The commissioner may 60
	97	+	implement policies and procedures to carry out the provisions of this 61
	98	+	subsection while in the process of adopting regulations, provided 62
	99	+	notice of intent to adopt the regulations is published in the Connecticut 63
	100	+	Law Journal not later than twenty days after the date of implementing 64
	101	+	the policies and procedures. Such policies and procedures shall be 65
	102	+	valid for not longer than nine months. 66
	103	+	(b) The Department of Social Services shall monitor the rates 67
	104	+	charged by home health care agencies and [homemaker-home] home 68
	105	+	health aide agencies. Such agencies shall file annual cost reports and 69
	106	+	service charge information with the department. 70
	107	+	(c) The home health services fee schedule shall include a fee for the 71
	108	+	administration of medication, which shall apply when the purpose of a 72
	109	+	nurse's visit is limited to the administration of medication. 73
	110	+	Administration of medication may include, but is not limited to, blood 74
	111	+	pressure checks, glucometer readings, pulse rate checks and similar 75
	112	+	indicators of health status. The fee for medication administration shall 76
	113	+	include administration of medications while the nurse is present, the 77
	114	+	pre-pouring of additional doses that the client will self-administer at a 78
	115	+	later time and the teaching of self-administration. The department 79
	116	+	shall not pay for medication administration in addition to any other 80
	117	+	nursing service at the same visit. The department may establish prior 81
	118	+	authorization requirements for this service. Before implementing such 82
	119	+	change, the Commissioner of Social Services shall consult with the 83
	120	+	chairpersons of the joint standing committees of the General Assembly 84 Raised Bill No. 919
136	121
137		-	Public Act No. 19-97 5 of 13
138	122
139		-	home health care agency or [homemaker home-health] home health
140		-	aide agency.
141		-	(f) If the electronic record or signature that has been transmitted to a
142		-	home health care agency or [homemaker-home] home health aide
143		-	agency is illegible or the department is unable to determine the
144		-	validity of such electronic record or signature, the department shall
145		-	review additional evidence of the accuracy or validity of the record or
146		-	signature, including, but not limited to, (1) the original of the record or
147		-	signature, or (2) a written statement, made under penalty of false
148		-	statement, from (A) the licensed physician or licensed practitioner of a
149		-	health care profession who signed such record, or (B) if such licensed
150		-	physician or licensed practitioner of a health care profession is
151		-	unavailable, the medical director of the agency verifying the accuracy
152		-	or validity of such record or signature, and the department shall make
153		-	a determination whether the electronic record or signature is valid.
154		-	(g) The Department of Social Services, when auditing claims
155		-	submitted by home health care agencies and [homemaker-home] home
156		-	health aide agencies, shall consider any signature from a licensed
157		-	physician or licensed practitioner of a health care profession that may
158		-	be required on a plan of care for home health services, to have been
159		-	provided in timely fashion if (1) the document bearing such signature
160		-	was signed prior to the time when such agency seeks reimbursement
161		-	from the department for services provided, and (2) verbal or telephone
162		-	orders from the licensed physician or licensed practitioner of a health
163		-	care profession were received prior to the commencement of services
164		-	covered by the plan of care and such orders were subsequently
165		-	documented. Nothing in this subsection shall be construed as limiting
166		-	the powers of the Commissioner of Public Health to enforce the
167		-	provisions of sections 19-13-D73 and 19-13-D74 of the regulations of
168		-	Connecticut state agencies and 42 CFR 484.18(c).
169		-	(h) For purposes of this section, "licensed practitioner of a healthcare Senate Bill No. 919
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170	126
171		-	Public Act No. 19-97 6 of 13
	127	+	having cognizance of matters relating to public health and human 85
	128	+	services. The commissioner shall monitor Medicaid home health care 86
	129	+	savings achieved through the implementation of nurse delegation of 87
	130	+	medication administration pursuant to section 19a-492e, as amended 88
	131	+	by this act. If, by January 1, 2016, the commissioner determines that the 89
	132	+	rate of savings is not adequate to meet the annualized savings 90
	133	+	assumed in the budget for the biennium ending June 30, 2017, the 91
	134	+	department may reduce rates for medication administration as 92
	135	+	necessary to achieve the savings assumed in the budget. Prior to any 93
	136	+	rate reduction, the department shall report to the joint standing 94
	137	+	committees of the General Assembly having cognizance of matters 95
	138	+	relating to appropriations and the budgets of state agencies and 96
	139	+	human services provider specific cost and utilization trend data for 97
	140	+	those patients receiving medication administration. Should the 98
	141	+	department determine it necessary to reduce medication 99
	142	+	administration rates under this section, it shall examine the possibility 100
	143	+	of establishing a separate Medicaid supplemental rate or a pay-for-101
	144	+	performance program for those providers, as determined by the 102
	145	+	commissioner, who have established successful nurse delegation 103
	146	+	programs. 104
	147	+	(d) The home health services fee schedule established pursuant to 105
	148	+	subsection (c) of this section shall include rates for psychiatric nurse 106
	149	+	visits. 107
	150	+	(e) The Department of Social Services, when processing or auditing 108
	151	+	claims for reimbursement submitted by home health care agencies and 109
	152	+	[homemaker-home] home health aide agencies shall, in accordance 110
	153	+	with the provisions of chapter 15, accept electronic records and records 111
	154	+	bearing the electronic signature of a licensed physician or licensed 112
	155	+	practitioner of a healthcare profession that has been submitted to the 113
	156	+	home health care agency or [homemaker home-health] home health 114
	157	+	aide agency. 115
	158	+	(f) If the electronic record or signature that has been transmitted to a 116
	159	+	home health care agency or [homemaker-home] home health aide 117 Raised Bill No. 919
172	160
173		-	profession" has the same meaning as "licensed practitioner" in section
174		-	21a-244a.
175		-	Sec. 2. Subsection (a) of section 19a-490 of the general statutes is
176		-	repealed and the following is substituted in lieu thereof (Effective July
177		-	1, 2019):
178		-	(a) "Institution" means a hospital, short-term hospital special
179		-	hospice, hospice inpatient facility, residential care home, nursing home
180		-	facility, home health care agency, [homemaker-home] home health
181		-	aide agency, behavioral health facility, assisted living services agency,
182		-	substance abuse treatment facility, outpatient surgical facility,
183		-	outpatient clinic, an infirmary operated by an educational institution
184		-	for the care of students enrolled in, and faculty and employees of, such
185		-	institution; a facility engaged in providing services for the prevention,
186		-	diagnosis, treatment or care of human health conditions, including
187		-	facilities operated and maintained by any state agency; and a
188		-	residential facility for persons with intellectual disability licensed
189		-	pursuant to section 17a-227 and certified to participate in the Title XIX
190		-	Medicaid program as an intermediate care facility for individuals with
191		-	intellectual disability. "Institution" does not include any facility for the
192		-	care and treatment of persons with mental illness or substance use
193		-	disorder operated or maintained by any state agency, except Whiting
194		-	Forensic Hospital;
195		-	Sec. 3. Subsections (d) to (f), inclusive, of section 19a-490 of the
196		-	general statutes are repealed and the following is substituted in lieu
197		-	thereof (Effective July 1, 2019):
198		-	(d) "Home health care agency" means a public or private
199		-	organization, or a subdivision thereof, engaged in providing
200		-	professional nursing services and the following services, available
201		-	twenty-four hours per day, in the patient's home or a substantially
202		-	equivalent environment: [Homemaker-home] Home health aide Senate Bill No. 919
203	161
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206		-	services as defined in this section, physical therapy, speech therapy,
207		-	occupational therapy or medical social services. The agency shall
208		-	provide professional nursing services and at least one additional
209		-	service directly and all others directly or through contract. An agency
210		-	shall be available to enroll new patients seven days a week, twenty-
211		-	four hours per day;
212		-	(e) ["Homemaker-home health aide agency"] "Home health aide
213		-	agency" means a public or private organization, except a home health
214		-	care agency, which provides in the patient's home or a substantially
215		-	equivalent environment supportive services which may include, but
216		-	are not limited to, assistance with personal hygiene, dressing, feeding
217		-	and incidental household tasks essential to achieving adequate
218		-	household and family management. Such supportive services shall be
219		-	provided under the supervision of a registered nurse and, if such
220		-	nurse determines appropriate, shall be provided by a social worker,
221		-	physical therapist, speech therapist or occupational therapist. Such
222		-	supervision may be provided directly or through contract;
223		-	(f) ["Homemaker-home health aide services"] "Home health aide
224		-	services" as defined in this section shall not include services provided
225		-	to assist individuals with activities of daily living when such
226		-	individuals have a disease or condition that is chronic and stable as
227		-	determined by a physician licensed in the state; [of Connecticut;]
228		-	Sec. 4. Subsection (k) of section 19a-490 of the general statutes is
229		-	repealed and the following is substituted in lieu thereof (Effective July
230		-	1, 2019):
231		-	(k) "Home health agency" means an agency licensed as a home
232		-	health care agency or a [homemaker-home] home health aide agency;
233		-	Sec. 5. Section 19a-490g of the general statutes is repealed and the
234		-	following is substituted in lieu thereof (Effective July 1, 2019): Senate Bill No. 919
	166	+	agency is illegible or the department is unable to determine the 118
	167	+	validity of such electronic record or signature, the department shall 119
	168	+	review additional evidence of the accuracy or validity of the record or 120
	169	+	signature, including, but not limited to, (1) the original of the record or 121
	170	+	signature, or (2) a written statement, made under penalty of false 122
	171	+	statement, from (A) the licensed physician or licensed practitioner of a 123
	172	+	health care profession who signed such record, or (B) if such licensed 124
	173	+	physician or licensed practitioner of a health care profession is 125
	174	+	unavailable, the medical director of the agency verifying the accuracy 126
	175	+	or validity of such record or signature, and the department shall make 127
	176	+	a determination whether the electronic record or signature is valid. 128
	177	+	(g) The Department of Social Services, when auditing claims 129
	178	+	submitted by home health care agencies and [homemaker-home] home 130
	179	+	health aide agencies, shall consider any signature from a licensed 131
	180	+	physician or licensed practitioner of a health care profession that may 132
	181	+	be required on a plan of care for home health services, to have been 133
	182	+	provided in timely fashion if (1) the document bearing such signature 134
	183	+	was signed prior to the time when such agency seeks reimbursement 135
	184	+	from the department for services provided, and (2) verbal or telephone 136
	185	+	orders from the licensed physician or licensed practitioner of a health 137
	186	+	care profession were received prior to the commencement of services 138
	187	+	covered by the plan of care and such orders were subsequently 139
	188	+	documented. Nothing in this subsection shall be construed as limiting 140
	189	+	the powers of the Commissioner of Public Health to enforce the 141
	190	+	provisions of sections 19-13-D73 and 19-13-D74 of the regulations of 142
	191	+	Connecticut state agencies and 42 CFR 484.18(c). 143
	192	+	(h) For purposes of this section, "licensed practitioner of a healthcare 144
	193	+	profession" has the same meaning as "licensed practitioner" in section 145
	194	+	21a-244a. 146
	195	+	Sec. 2. Subsection (a) of section 19a-490 of the general statutes is 147
	196	+	repealed and the following is substituted in lieu thereof (Effective July 148
	197	+	1, 2019): 149 Raised Bill No. 919
235	198
236		-	Public Act No. 19-97 8 of 13
237	199
238		-	The Department of Public Health shall develop and produce a
239		-	consumer guide of bilingual information on home health care agencies
240		-	and [homemaker-home] home health aide agencies.
241		-	Sec. 6. Subsections (h) and (i) of section 19a-491 of the general
242		-	statutes are repealed and the following is substituted in lieu thereof
243		-	(Effective July 1, 2019):
244		-	(h) The commissioner may require as a condition of the licensure of
245		-	home health care agencies and [homemaker-home] home health aide
246		-	agencies that each agency meet minimum service quality standards. In
247		-	the event the commissioner requires such agencies to meet minimum
248		-	service quality standards as a condition of their licensure, the
249		-	commissioner shall adopt regulations, in accordance with the
250		-	provisions of chapter 54, to define such minimum service quality
251		-	standards, which shall (1) allow for training of [homemaker-home]
252		-	home health aides by adult continuing education, (2) require a
253		-	registered nurse to visit and assess each patient receiving [homemaker-
254		-	home] home health aide services as often as necessary based on the
255		-	patient's condition, but not less than once every sixty days, and (3)
256		-	require the assessment prescribed by subdivision (2) of this subsection
257		-	to be completed while the [homemaker-home] home health aide is
258		-	providing services in the patient's home.
259		-	(i) No person acting individually or jointly with any other person
260		-	shall establish, conduct, operate or maintain a home health care agency
261		-	or [homemaker-home] home health aide agency without maintaining
262		-	professional liability insurance or other indemnity against liability for
263		-	professional malpractice. The amount of insurance which such person
264		-	shall maintain as insurance or indemnity against claims for injury or
265		-	death for professional malpractice shall be not less than one million
266		-	dollars for one person, per occurrence, with an aggregate of not less
267		-	than three million dollars. Senate Bill No. 919
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268	203
269		-	Public Act No. 19-97 9 of 13
	204	+	(a) "Institution" means a hospital, short-term hospital special 150
	205	+	hospice, hospice inpatient facility, residential care home, nursing home 151
	206	+	facility, home health care agency, [homemaker-home] home health 152
	207	+	aide agency, behavioral health facility, assisted living services agency, 153
	208	+	substance abuse treatment facility, outpatient surgical facility, 154
	209	+	outpatient clinic, an infirmary operated by an educational institution 155
	210	+	for the care of students enrolled in, and faculty and employees of, such 156
	211	+	institution; a facility engaged in providing services for the prevention, 157
	212	+	diagnosis, treatment or care of human health conditions, including 158
	213	+	facilities operated and maintained by any state agency; and a 159
	214	+	residential facility for persons with intellectual disability licensed 160
	215	+	pursuant to section 17a-227 and certified to participate in the Title XIX 161
	216	+	Medicaid program as an intermediate care facility for individuals with 162
	217	+	intellectual disability. "Institution" does not include any facility for the 163
	218	+	care and treatment of persons with mental illness or substance use 164
	219	+	disorder operated or maintained by any state agency, except Whiting 165
	220	+	Forensic Hospital; 166
	221	+	Sec. 3. Subsections (d) to (f), inclusive, of section 19a-490 of the 167
	222	+	general statutes are repealed and the following is substituted in lieu 168
	223	+	thereof (Effective July 1, 2019): 169
	224	+	(d) "Home health care agency" means a public or private 170
	225	+	organization, or a subdivision thereof, engaged in providing 171
	226	+	professional nursing services and the following services, available 172
	227	+	twenty-four hours per day, in the patient's home or a substantially 173
	228	+	equivalent environment: [Homemaker-home] Home health aide 174
	229	+	services as defined in this section, physical therapy, speech therapy, 175
	230	+	occupational therapy or medical social services. The agency shall 176
	231	+	provide professional nursing services and at least one additional 177
	232	+	service directly and all others directly or through contract. An agency 178
	233	+	shall be available to enroll new patients seven days a week, twenty-179
	234	+	four hours per day; 180
	235	+	(e) ["Homemaker-home health aide agency"] "Home health aide 181
	236	+	agency" means a public or private organization, except a home health 182 Raised Bill No. 919
270	237
271		-	Sec. 7. Section 19a-492d of the general statutes is repealed and the
272		-	following is substituted in lieu thereof (Effective July 1, 2019):
273		-	On and after October 1, 2007, a nurse who is employed by an agency
274		-	licensed by the Department of Public Health as a home health care
275		-	agency or a [homemaker-home] home health aide agency may
276		-	administer influenza and pneumococcal vaccines to persons in their
277		-	homes, after an assessment for contraindications, without a physician's
278		-	order in accordance with a physician-approved agency policy that
279		-	includes an anaphylaxis protocol. In the event of an adverse reaction to
280		-	the vaccine, such nurse may also administer epinephrine or other
281		-	anaphylaxis medication without a physician's order in accordance with
282		-	the physician-approved agency policy. For purposes of this section,
283		-	"nurse" means an advanced practice registered nurse, registered nurse
284		-	or practical nurse licensed under chapter 378.
285		-	Sec. 8. Section 19a-492e of the general statutes is repealed and the
286		-	following is substituted in lieu thereof (Effective July 1, 2019):
287		-	(a) For purposes of this section "home health care agency" has the
288		-	same meaning as provided in section 19a-490, as amended by this act.
289		-	Notwithstanding the provisions of chapter 378, a registered nurse may
290		-	delegate the administration of medications that are not administered
291		-	by injection to [homemaker-home] home health aides who have
292		-	obtained certification and recertification every three years thereafter
293		-	for medication administration in accordance with regulations adopted
294		-	pursuant to subsection (b) of this section, unless the prescribing
295		-	practitioner specifies that a medication shall only be administered by a
296		-	licensed nurse. Any [homemaker-home] home health aide who
297		-	obtained certification in the administration of medications on or before
298		-	June 30, 2015, shall obtain recertification on or before July 1, 2018.
299		-	(b) (1) The Commissioner of Public Health shall adopt regulations,
300		-	in accordance with the provisions of chapter 54, to carry out the Senate Bill No. 919
301	238
302		-	Public Act No. 19-97 10 of 13
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303	242
304		-	provisions of this section. Such regulations shall require each home
305		-	health care agency that serves clients requiring assistance with
306		-	medication administration to (A) adopt practices that increase and
307		-	encourage client choice, dignity and independence; (B) establish
308		-	policies and procedures to ensure that a registered nurse may delegate
309		-	allowed tasks of nursing care, to include medication administration, to
310		-	[homemaker-home] home health aides when the registered nurse
311		-	determines that it is in the best interest of the client and the
312		-	[homemaker-home] home health aide has been deemed competent to
313		-	perform the task; (C) designate [homemaker-home] home health aides
314		-	to obtain certification and recertification for the administration of
315		-	medication; and (D) ensure that such [homemaker-home] home health
316		-	aides receive such certification and recertification.
317		-	(2) The regulations shall establish certification and recertification
318		-	requirements for medication administration and the criteria to be used
319		-	by home health care agencies that provide services for clients requiring
320		-	assistance with medication administration in determining (A) which
321		-	[homemaker-home] home health aides shall obtain such certification
322		-	and recertification, and (B) education and skill training requirements,
323		-	including ongoing training requirements for such certification and
324		-	recertification.
325		-	(3) Education and skill training requirements for initial certification
326		-	and recertification shall include, but not be limited to, initial
327		-	orientation, training in client rights and identification of the types of
328		-	medication that may be administered by unlicensed personnel,
329		-	behavioral management, personal care, nutrition and food safety, and
330		-	health and safety in general.
331		-	(c) Each home health care agency shall ensure that, on or before
332		-	January 1, 2013, delegation of nursing care tasks in the home care
333		-	setting is allowed within such agency and that policies are adopted to
334		-	employ [homemaker-home] home health aides for the purposes of Senate Bill No. 919
	243	+	care agency, which provides in the patient's home or a substantially 183
	244	+	equivalent environment supportive services which may include, but 184
	245	+	are not limited to, assistance with personal hygiene, dressing, feeding 185
	246	+	and incidental household tasks essential to achieving adequate 186
	247	+	household and family management. Such supportive services shall be 187
	248	+	provided under the supervision of a registered nurse and, if such 188
	249	+	nurse determines appropriate, shall be provided by a social worker, 189
	250	+	physical therapist, speech therapist or occupational therapist. Such 190
	251	+	supervision may be provided directly or through contract; 191
	252	+	(f) ["Homemaker-home health aide services"] "Home health aide 192
	253	+	services" as defined in this section shall not include services provided 193
	254	+	to assist individuals with activities of daily living when such 194
	255	+	individuals have a disease or condition that is chronic and stable as 195
	256	+	determined by a physician licensed in the state; [of Connecticut;] 196
	257	+	Sec. 4. Subsection (k) of section 19a-490 of the general statutes is 197
	258	+	repealed and the following is substituted in lieu thereof (Effective July 198
	259	+	1, 2019): 199
	260	+	(k) "Home health agency" means an agency licensed as a home 200
	261	+	health care agency or a [homemaker-home] home health aide agency; 201
	262	+	Sec. 5. Section 19a-490g of the general statutes is repealed and the 202
	263	+	following is substituted in lieu thereof (Effective July 1, 2019): 203
	264	+	The Department of Public Health shall develop and produce a 204
	265	+	consumer guide of bilingual information on home health care agencies 205
	266	+	and [homemaker-home] home health aide agencies. 206
	267	+	Sec. 6. Subsections (h) and (i) of section 19a-491 of the general 207
	268	+	statutes are repealed and the following is substituted in lieu thereof 208
	269	+	(Effective July 1, 2019): 209
	270	+	(h) The commissioner may require as a condition of the licensure of 210
	271	+	home health care agencies and [homemaker-home] home health aide 211
	272	+	agencies that each agency meet minimum service quality standards. In 212 Raised Bill No. 919
335	273
336		-	Public Act No. 19-97 11 of 13
337	274
338		-	allowing nurses to delegate such tasks.
339		-	(d) A registered nurse licensed pursuant to the provisions of chapter
340		-	378 who delegates the task of medication administration to a
341		-	[homemaker-home] home health aide pursuant to this section shall not
342		-	be subject to disciplinary action based on the performance of the
343		-	[homemaker-home] home health aide to whom tasks are delegated,
344		-	unless the [homemaker-home] home health aide is acting pursuant to
345		-	specific instructions from the registered nurse or the registered nurse
346		-	fails to leave instructions when the nurse should have done so,
347		-	provided the registered nurse: (1) Documented in the patient's care
348		-	plan that the medication administration could be properly and safely
349		-	performed by the [homemaker-home] home health aide to whom it is
350		-	delegated, (2) provided initial direction to the [homemaker-home]
351		-	home health aide, and (3) provided ongoing supervision of the
352		-	[homemaker-home] home health aide, including the periodic
353		-	assessment and evaluation of the patient's health and safety related to
354		-	medication administration.
355		-	(e) A registered nurse who delegates the provision of nursing care
356		-	to another person pursuant to this section shall not be subject to an
357		-	action for civil damages for the performance of the person to whom
358		-	nursing care is delegated unless the person is acting pursuant to
359		-	specific instructions from the nurse or the nurse fails to leave
360		-	instructions when the nurse should have done so.
361		-	(f) No person may coerce a registered nurse into compromising
362		-	patient safety by requiring the nurse to delegate the administration of
363		-	medication if the nurse's assessment of the patient documents a need
364		-	for a nurse to administer medication and identifies why the need
365		-	cannot be safely met through utilization of assistive technology or
366		-	administration of medication by certified [homemaker-home] home
367		-	health aides. No registered nurse who has made a reasonable
368		-	determination based on such assessment that delegation may Senate Bill No. 919
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369	278
370		-	Public Act No. 19-97 12 of 13
	279	+	the event the commissioner requires such agencies to meet minimum 213
	280	+	service quality standards as a condition of their licensure, the 214
	281	+	commissioner shall adopt regulations, in accordance with the 215
	282	+	provisions of chapter 54, to define such minimum service quality 216
	283	+	standards, which shall (1) allow for training of [homemaker-home] 217
	284	+	home health aides by adult continuing education, (2) require a 218
	285	+	registered nurse to visit and assess each patient receiving [homemaker-219
	286	+	home] home health aide services as often as necessary based on the 220
	287	+	patient's condition, but not less than once every sixty days, and (3) 221
	288	+	require the assessment prescribed by subdivision (2) of this subsection 222
	289	+	to be completed while the [homemaker-home] home health aide is 223
	290	+	providing services in the patient's home. 224
	291	+	(i) No person acting individually or jointly with any other person 225
	292	+	shall establish, conduct, operate or maintain a home health care agency 226
	293	+	or [homemaker-home] home health aide agency without maintaining 227
	294	+	professional liability insurance or other indemnity against liability for 228
	295	+	professional malpractice. The amount of insurance which such person 229
	296	+	shall maintain as insurance or indemnity against claims for injury or 230
	297	+	death for professional malpractice shall be not less than one million 231
	298	+	dollars for one person, per occurrence, with an aggregate of not less 232
	299	+	than three million dollars. 233
	300	+	Sec. 7. Section 19a-492d of the general statutes is repealed and the 234
	301	+	following is substituted in lieu thereof (Effective July 1, 2019): 235
	302	+	On and after October 1, 2007, a nurse who is employed by an agency 236
	303	+	licensed by the Department of Public Health as a home health care 237
	304	+	agency or a [homemaker-home] home health aide agency may 238
	305	+	administer influenza and pneumococcal vaccines to persons in their 239
	306	+	homes, after an assessment for contraindications, without a physician's 240
	307	+	order in accordance with a physician-approved agency policy that 241
	308	+	includes an anaphylaxis protocol. In the event of an adverse reaction to 242
	309	+	the vaccine, such nurse may also administer epinephrine or other 243
	310	+	anaphylaxis medication without a physician's order in accordance with 244
	311	+	the physician-approved agency policy. For purposes of this section, 245 Raised Bill No. 919
371	312
372		-	compromise patient safety shall be subject to any employer reprisal or
373		-	disciplinary action pursuant to chapter 378 for refusing to delegate or
374		-	refusing to provide the required training for such delegation. The
375		-	Department of Social Services, in consultation with the Department of
376		-	Public Health and home health care agencies, shall develop protocols
377		-	for documentation pursuant to the requirements of this subsection.
378		-	The Department of Social Services shall notify all licensed home health
379		-	care agencies of such protocols prior to the implementation of this
380		-	section.
381		-	(g) The Commissioner of Public Health may implement policies and
382		-	procedures necessary to administer the provisions of this section while
383		-	in the process of adopting such policies and procedures as regulations,
384		-	provided notice of intent to adopt regulations is published in the
385		-	Connecticut Law Journal not later than twenty days after the date of
386		-	implementation. Policies and procedures implemented pursuant to
387		-	this section shall be valid until the time final regulations are adopted.
388		-	Sec. 9. Subsection (a) of section 19a-495 of the general statutes is
389		-	repealed and the following is substituted in lieu thereof (Effective July
390		-	1, 2019):
391		-	(a) The Department of Public Health shall, after consultation with
392		-	the appropriate public and voluntary hospital planning agencies,
393		-	establish classifications of institutions. The department shall, in the
394		-	Public Health Code, adopt, amend, promulgate and enforce such
395		-	regulations based upon reasonable standards of health, safety and
396		-	comfort of patients and demonstrable need for such institutions, with
397		-	respect to each classification of institutions to be licensed under
398		-	sections 19a-490 to 19a-503, inclusive, as amended by this act,
399		-	including their special facilities, as will further the accomplishment of
400		-	the purposes of said sections in promoting safe, humane and adequate
401		-	care and treatment of individuals in institutions. The department shall
402		-	adopt such regulations, in accordance with chapter 54, concerning Senate Bill No. 919
403	313
404		-	Public Act No. 19-97 13 of 13
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405	317
406		-	home health care agencies and [homemaker-home] home health aide
407		-	agencies.
408		-	Sec. 10. Subdivision (2) of subsection (a) of section 19a-905 of the
409		-	general statutes is repealed and the following is substituted in lieu
410		-	thereof (Effective July 1, 2019):
411		-	(2) "Health care facility or institution" means a hospital, nursing
412		-	home, rest home, home health care agency, [homemaker-home] home
413		-	health aide agency, emergency medical services organization, assisted
414		-	living services agency, outpatient surgical facility and an infirmary
415		-	operated by an educational institution for the care of students enrolled
416		-	in, and faculty and employees of, such institution.
417		-	Sec. 11. Subdivision (7) of section 20-670 of the general statutes is
418		-	repealed and the following is substituted in lieu thereof (Effective July
419		-	1, 2019):
420		-	(7) "Homemaker-companion agency" means (A) any public or
421		-	private organization that employs one or more persons and is engaged
422		-	in the business of providing companion services or homemaker
423		-	services, or (B) any registry. "Homemaker-companion agency" shall
424		-	not include a home health care agency, as defined in subsection (d) of
425		-	section 19a-490, as amended by this act, or a [homemaker-home] home
426		-	health aide agency, as defined in subsection (e) of section 19a-490.
	318	+	"nurse" means an advanced practice registered nurse, registered nurse 246
	319	+	or practical nurse licensed under chapter 378. 247
	320	+	Sec. 8. Section 19a-492e of the general statutes is repealed and the 248
	321	+	following is substituted in lieu thereof (Effective July 1, 2019): 249
	322	+	(a) For purposes of this section "home health care agency" has the 250
	323	+	same meaning as provided in section 19a-490, as amended by this act. 251
	324	+	Notwithstanding the provisions of chapter 378, a registered nurse may 252
	325	+	delegate the administration of medications that are not administered 253
	326	+	by injection to [homemaker-home] home health aides who have 254
	327	+	obtained certification and recertification every three years thereafter 255
	328	+	for medication administration in accordance with regulations adopted 256
	329	+	pursuant to subsection (b) of this section, unless the prescribing 257
	330	+	practitioner specifies that a medication shall only be administered by a 258
	331	+	licensed nurse. Any [homemaker-home] home health aide who 259
	332	+	obtained certification in the administration of medications on or before 260
	333	+	June 30, 2015, shall obtain recertification on or before July 1, 2018. 261
	334	+	(b) (1) The Commissioner of Public Health shall adopt regulations, 262
	335	+	in accordance with the provisions of chapter 54, to carry out the 263
	336	+	provisions of this section. Such regulations shall require each home 264
	337	+	health care agency that serves clients requiring assistance with 265
	338	+	medication administration to (A) adopt practices that increase and 266
	339	+	encourage client choice, dignity and independence; (B) establish 267
	340	+	policies and procedures to ensure that a registered nurse may delegate 268
	341	+	allowed tasks of nursing care, to include medication administration, to 269
	342	+	[homemaker-home] home health aides when the registered nurse 270
	343	+	determines that it is in the best interest of the client and the 271
	344	+	[homemaker-home] home health aide has been deemed competent to 272
	345	+	perform the task; (C) designate [homemaker-home] home health aides 273
	346	+	to obtain certification and recertification for the administration of 274
	347	+	medication; and (D) ensure that such [homemaker-home] home health 275
	348	+	aides receive such certification and recertification. 276
	349	+	(2) The regulations shall establish certification and recertification 277 Raised Bill No. 919
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	355	+
	356	+	requirements for medication administration and the criteria to be used 278
	357	+	by home health care agencies that provide services for clients requiring 279
	358	+	assistance with medication administration in determining (A) which 280
	359	+	[homemaker-home] home health aides shall obtain such certification 281
	360	+	and recertification, and (B) education and skill training requirements, 282
	361	+	including ongoing training requirements for such certification and 283
	362	+	recertification. 284
	363	+	(3) Education and skill training requirements for initial certification 285
	364	+	and recertification shall include, but not be limited to, initial 286
	365	+	orientation, training in client rights and identification of the types of 287
	366	+	medication that may be administered by unlicensed personnel, 288
	367	+	behavioral management, personal care, nutrition and food safety, and 289
	368	+	health and safety in general. 290
	369	+	(c) Each home health care agency shall ensure that, on or before 291
	370	+	January 1, 2013, delegation of nursing care tasks in the home care 292
	371	+	setting is allowed within such agency and that policies are adopted to 293
	372	+	employ [homemaker-home] home health aides for the purposes of 294
	373	+	allowing nurses to delegate such tasks. 295
	374	+	(d) A registered nurse licensed pursuant to the provisions of chapter 296
	375	+	378 who delegates the task of medication administration to a 297
	376	+	[homemaker-home] home health aide pursuant to this section shall not 298
	377	+	be subject to disciplinary action based on the performance of the 299
	378	+	[homemaker-home] home health aide to whom tasks are delegated, 300
	379	+	unless the [homemaker-home] home health aide is acting pursuant to 301
	380	+	specific instructions from the registered nurse or the registered nurse 302
	381	+	fails to leave instructions when the nurse should have done so, 303
	382	+	provided the registered nurse: (1) Documented in the patient's care 304
	383	+	plan that the medication administration could be properly and safely 305
	384	+	performed by the [homemaker-home] home health aide to whom it is 306
	385	+	delegated, (2) provided initial direction to the [homemaker-home] 307
	386	+	home health aide, and (3) provided ongoing supervision of the 308
	387	+	[homemaker-home] home health aide, including the periodic 309
	388	+	assessment and evaluation of the patient's health and safety related to 310 Raised Bill No. 919
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	394	+
	395	+	medication administration. 311
	396	+	(e) A registered nurse who delegates the provision of nursing care 312
	397	+	to another person pursuant to this section shall not be subject to an 313
	398	+	action for civil damages for the performance of the person to whom 314
	399	+	nursing care is delegated unless the person is acting pursuant to 315
	400	+	specific instructions from the nurse or the nurse fails to leave 316
	401	+	instructions when the nurse should have done so. 317
	402	+	(f) No person may coerce a registered nurse into compromising 318
	403	+	patient safety by requiring the nurse to delegate the administration of 319
	404	+	medication if the nurse's assessment of the patient documents a need 320
	405	+	for a nurse to administer medication and identifies why the need 321
	406	+	cannot be safely met through utilization of assistive technology or 322
	407	+	administration of medication by certified [homemaker-home] home 323
	408	+	health aides. No registered nurse who has made a reasonable 324
	409	+	determination based on such assessment that delegation may 325
	410	+	compromise patient safety shall be subject to any employer reprisal or 326
	411	+	disciplinary action pursuant to chapter 378 for refusing to delegate or 327
	412	+	refusing to provide the required training for such delegation. The 328
	413	+	Department of Social Services, in consultation with the Department of 329
	414	+	Public Health and home health care agencies, shall develop protocols 330
	415	+	for documentation pursuant to the requirements of this subsection. 331
	416	+	The Department of Social Services shall notify all licensed home health 332
	417	+	care agencies of such protocols prior to the implementation of this 333
	418	+	section. 334
	419	+	(g) The Commissioner of Public Health may implement policies and 335
	420	+	procedures necessary to administer the provisions of this section while 336
	421	+	in the process of adopting such policies and procedures as regulations, 337
	422	+	provided notice of intent to adopt regulations is published in the 338
	423	+	Connecticut Law Journal not later than twenty days after the date of 339
	424	+	implementation. Policies and procedures implemented pursuant to 340
	425	+	this section shall be valid until the time final regulations are adopted. 341
	426	+	Sec. 9. Subsection (a) of section 19a-495 of the general statutes is 342 Raised Bill No. 919
	427	+
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	432	+
	433	+	repealed and the following is substituted in lieu thereof (Effective July 343
	434	+	1, 2019): 344
	435	+	(a) The Department of Public Health shall, after consultation with 345
	436	+	the appropriate public and voluntary hospital planning agencies, 346
	437	+	establish classifications of institutions. The department shall, in the 347
	438	+	Public Health Code, adopt, amend, promulgate and enforce such 348
	439	+	regulations based upon reasonable standards of health, safety and 349
	440	+	comfort of patients and demonstrable need for such institutions, with 350
	441	+	respect to each classification of institutions to be licensed under 351
	442	+	sections 19a-490 to 19a-503, inclusive, as amended by this act, 352
	443	+	including their special facilities, as will further the accomplishment of 353
	444	+	the purposes of said sections in promoting safe, humane and adequate 354
	445	+	care and treatment of individuals in institutions. The department shall 355
	446	+	adopt such regulations, in accordance with chapter 54, concerning 356
	447	+	home health care agencies and [homemaker-home] home health aide 357
	448	+	agencies. 358
	449	+	Sec. 10. Subdivision (2) of subsection (a) of section 19a-905 of the 359
	450	+	general statutes is repealed and the following is substituted in lieu 360
	451	+	thereof (Effective July 1, 2019): 361
	452	+	(2) "Health care facility or institution" means a hospital, nursing 362
	453	+	home, rest home, home health care agency, [homemaker-home] home 363
	454	+	health aide agency, emergency medical services organization, assisted 364
	455	+	living services agency, outpatient surgical facility and an infirmary 365
	456	+	operated by an educational institution for the care of students enrolled 366
	457	+	in, and faculty and employees of, such institution. 367
	458	+	Sec. 11. Subdivision (7) of section 20-670 of the general statutes is 368
	459	+	repealed and the following is substituted in lieu thereof (Effective July 369
	460	+	1, 2019): 370
	461	+	(7) "Homemaker-companion agency" means (A) any public or 371
	462	+	private organization that employs one or more persons and is engaged 372
	463	+	in the business of providing companion services or homemaker 373 Raised Bill No. 919
	464	+
	465	+
	466	+	LCO 4096 {\\PRDFS1\SCOUSERS\FORZANOF\WS\2019SB-00919-
	467	+	R01-SB.docx }
	468	+	13 of 13
	469	+
	470	+	services, or (B) any registry. "Homemaker-companion agency" shall 374
	471	+	not include a home health care agency, as defined in subsection (d) of 375
	472	+	section 19a-490, as amended by this act, or a [homemaker-home] home 376
	473	+	health aide agency, as defined in subsection (e) of section 19a-490. 377
	474	+	This act shall take effect as follows and shall amend the following
	475	+	sections:
	476	+
	477	+	Section 1 July 1, 2019 17b-242
	478	+	Sec. 2 July 1, 2019 19a-490(a)
	479	+	Sec. 3 July 1, 2019 19a-490(d) to (f)
	480	+	Sec. 4 July 1, 2019 19a-490(k)
	481	+	Sec. 5 July 1, 2019 19a-490g
	482	+	Sec. 6 July 1, 2019 19a-491(h) and (i)
	483	+	Sec. 7 July 1, 2019 19a-492d
	484	+	Sec. 8 July 1, 2019 19a-492e
	485	+	Sec. 9 July 1, 2019 19a-495(a)
	486	+	Sec. 10 July 1, 2019 19a-905(a)(2)
	487	+	Sec. 11 July 1, 2019 20-670(7)
	488	+
	489	+	PH Joint Favorable
427	490