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General Assembly Raised Bill No. 921
January Session, 2019
LCO No. 4478
Referred to Committee on PUBLIC HEALTH
Introduced by:
(PH)
AN ACT CONCERNING TH E SCOPE OF PRACTICE OF ADVANCED
PRACTICE REGISTERED NURSES.
Be it enacted by the Senate and House of Representatives in General
Assembly convened:
Section 1. Subsection (a) of section 17a-78 of the general statutes is 1
repealed and the following is substituted in lieu thereof (Effective 2
October 1, 2019): 3
(a) If a physician or an advanced practice registered nurse 4
determines that a child is in need of immediate hospitalization for 5
evaluation or treatment of a mental disorder, the child may be 6
hospitalized under an emergency or diagnostic certificate as provided 7
in this section for not more than fifteen days without order of any 8
court, unless a written application for commitment of such child has 9
been filed in the Court of Probate prior to the expiration of the fifteen 10
days, in which event such hospitalization shall be continued under the 11
emergency certificate for an additional fifteen days or twenty-five days 12
if the matter has been transferred to the Superior Court, or until the 13
completion of court proceedings, whichever occurs first. At the time of 14
delivery of such child to such hospital, there shall be left, with the 15 Raised Bill No. 921
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persons in charge of such hospital, a certificate, signed by a physician 16
licensed to practice medicine or surgery in [Connecticut] under chapter 17
370 or an advanced practice registered nurse licensed under chapter 18
378, and dated not more than three days prior to its delivery to the 19
person in charge of the hospital. Such certificate shall state the findings 20
of the physician or advanced practice registered nurse and the date of 21
personal examination of the child to be hospitalized, which shall be not 22
more than three days prior to the date of the signature of the 23
certificate. 24
Sec. 2. Subsection (f) of section 17a-78 of the general statutes is 25
repealed and the following is substituted in lieu thereof (Effective 26
October 1, 2019): 27
(f) Any clinical social worker licensed under chapter 383b[, 28
advanced practice registered nurse licensed under chapter 378] or 29
professional counselor licensed under chapter 383c who has (1) 30
received a minimum of eight hours of specialized training in the 31
conduct of direct evaluations as a member of any emergency mobile 32
psychiatric services team under contract with the Department of 33
Children and Families, and (2) reasonable cause to believe, based on a 34
direct evaluation of a child, that such child (A) has psychiatric 35
disabilities, (B) is dangerous to himself or others or gravely disabled, 36
and (C) is in need of immediate care and treatment may issue an 37
emergency certificate that requires the hospitalization of such child for 38
a psychiatric and medical evaluation. Such child shall be evaluated not 39
later than twenty-four hours after the issuance of the emergency 40
certificate and shall not be held for more than seventy-two hours 41
pursuant to such certificate unless committed pursuant to section 17a-42
77. The Commissioner of Children and Families shall collect and 43
maintain statistical and demographic information pertaining to 44
emergency certificates issued under this subsection. 45
Sec. 3. Subsection (a) of section 17a-81 of the general statutes is 46
repealed and the following is substituted in lieu thereof (Effective 47
October 1, 2019): 48 Raised Bill No. 921
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(a) Parental consent shall be necessary for treatment. In the event 49
such consent is withheld or immediately unavailable and the physician 50
or advanced practice registered nurse concludes that treatment is 51
necessary to prevent serious harm to the child, such emergency 52
treatment may be administered pending receipt of parental consent. 53
Sec. 4. Subparagraph (B) of subdivision (16) of section 31-275 of the 54
general statutes is repealed and the following is substituted in lieu 55
thereof (Effective October 1, 2019): 56
(B) "Personal injury" or "injury" shall not be construed to include: 57
(i) An injury to an employee that results from the employee's 58
voluntary participation in any activity the major purpose of which is 59
social or recreational, including, but not limited to, athletic events, 60
parties and picnics, whether or not the employer pays some or all of 61
the cost of such activity; 62
(ii) A mental or emotional impairment, unless such impairment (I) 63
arises from a physical injury or occupational disease, (II) in the case of 64
a police officer, arises from such police officer's use of deadly force or 65
subjection to deadly force in the line of duty, regardless of whether 66
such police officer is physically injured, provided such police officer is 67
the subject of an attempt by another person to cause such police officer 68
serious physical injury or death through the use of deadly force, and 69
such police officer reasonably believes such police officer to be the 70
subject of such an attempt, or (III) in the case of a firefighter, is 71
diagnosed as post-traumatic stress disorder by a licensed and board 72
certified mental health professional or a licensed advanced practice 73
registered nurse who is certified as a psychiatric mental health 74
provider by the American Nurses Credentialing Center, determined by 75
such professional or advanced practice registered nurse to be 76
originating from the firefighter witnessing the death of another 77
firefighter while engaged in the line of duty and not subject to any 78
other exclusion in this section. As used in this clause, "police officer" 79
means a member of the Division of State Police within the Department 80 Raised Bill No. 921
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of Emergency Services and Public Protection, an organized local police 81
department or a municipal constabulary, "firefighter" means a 82
uniformed member of a municipal paid or volunteer fire department, 83
and "in the line of duty" means any action that a police officer or 84
firefighter is obligated or authorized by law, rule, regulation or written 85
condition of employment service to perform, or for which the police 86
officer or firefighter is compensated by the public entity such officer 87
serves; 88
(iii) A mental or emotional impairment that results from a personnel 89
action, including, but not limited to, a transfer, promotion, demotion 90
or termination; or 91
(iv) Notwithstanding the provisions of subparagraph (B)(i) of this 92
subdivision, "personal injury" or "injury" includes injuries to 93
employees of local or regional boards of education resulting from 94
participation in a school-sponsored activity but does not include any 95
injury incurred while going to or from such activity. As used in this 96
clause, "school-sponsored activity" means any activity sponsored, 97
recognized or authorized by a board of education and includes 98
activities conducted on or off school property and "participation" 99
means acting as a chaperone, advisor, supervisor or instructor at the 100
request of an administrator with supervisory authority over the 101
employee. 102
Sec. 5. Subsections (b) and (c) of section 31-294d of the general 103
statutes are repealed and the following is substituted in lieu thereof 104
(Effective October 1, 2019): 105
(b) The employee shall select the physician, [or] surgeon or 106
advanced practice registered nurse from an approved list of 107
physicians, [and] surgeons and advanced practice registered nurses 108
prepared by the chairman of the Workers' Compensation Commission. 109
If the employee is unable to make the selection, the employer shall do 110
so, subject to ratification by the employee or his next of kin. If the 111
employer has a full-time staff physician or advanced practice 112 Raised Bill No. 921
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registered nurse or if a physician or advanced practice registered nurse 113
is available on call, the initial treatment required immediately 114
following the injury may be rendered by that physician or advanced 115
practice registered nurse, but the employee may thereafter select his 116
own physician or advanced practice registered nurse as provided by 117
this chapter for any further treatment without prior approval of the 118
commissioner. 119
(c) The commissioner may, without hearing, at the request of the 120
employer or the injured employee, when good reason exists, or on his 121
own motion, authorize or direct a change of physician, [or] surgeon or 122
advanced practice registered nurse or hospital or nursing service 123
provided pursuant to subsection (a) of this section. 124
Sec. 6. Subsection (f) of section 31-294d of the general statutes is 125
repealed and the following is substituted in lieu thereof (Effective 126
October 1, 2019): 127
(f) If the employer fails to promptly provide a physician, [or] 128
surgeon or advanced practice registered nurse or any medical and 129
surgical aid or hospital and nursing service as required by this section, 130
the injured employee may obtain a physician, [or] surgeon or 131
advanced practice registered nurse, selected from the approved list 132
prepared by the chairman, or such medical and surgical aid or hospital 133
and nursing service at the expense of the employer. 134
Sec. 7. Section 31-294i of the general statutes is repealed and the 135
following is substituted in lieu thereof (Effective October 1, 2019): 136
For the purpose of adjudication of claims for payment of benefits 137
under the provisions of this chapter to a uniformed member of a paid 138
municipal fire department or a regular member of a paid municipal 139
police department or constable who began such employment on or 140
after July 1, 1996, any condition or impairment of health caused by a 141
cardiac emergency occurring to such member on or after July 1, 2009, 142
while such member is in training for or engaged in fire duty at the site 143
of an accident or fire, or other public safety operation within the scope 144 Raised Bill No. 921
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of such member's employment for such member's municipal employer 145
that results in death or temporary or permanent total or partial 146
disability, shall be presumed to have been suffered in the line of duty 147
and within the scope of such member's employment, unless the 148
contrary is shown by a preponderance of the evidence, provided such 149
member successfully passed a physical examination on entry into 150
service conducted by a licensed physician or advanced practice 151
registered nurse designated by such department which examination 152
failed to reveal any evidence of such condition. For the purposes of 153
this section, "cardiac emergency" means cardiac arrest or myocardial 154
infarction, and "constable" means any municipal law enforcement 155
officer who is authorized to make arrests and has completed Police 156
Officer Standards and Training Council certification pursuant to 157
section 7-294a. 158
Sec. 8. Subsection (c) of section 31-296 of the general statutes is 159
repealed and the following is substituted in lieu thereof (Effective 160
October 1, 2019): 161
(c) The employer's or insurer's notice of intention to discontinue or 162
reduce payments shall (1) identify the claimant, the claimant's attorney 163
or other representative, the employer, the insurer, and the injury, 164
including the date of the injury, the city or town in which the injury 165
occurred and the nature of the injury, (2) include medical 166
documentation that (A) establishes the basis for the discontinuance or 167
reduction of payments, and (B) identifies the claimant's attending 168
physician or advanced practice registered nurse, and (3) be in 169
substantially the following form: 170
IMPORTANT 171
STATE OF CONNECTICUT WORKERS' COMPENSATION 172
COMMISSION 173
YOU ARE HEREBY NOTIFIED THAT THE EMPLOYER OR INSURER 174
INTENDS TO REDUCE OR DISCONTINUE YOUR COMPENSATION 175
PAYMENTS ON .... (date) FOR THE FOLLOWING REASONS: 176 Raised Bill No. 921
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If you object to the reduction or discontinuance of benefits as stated 177
in this notice, YOU MUST REQUEST A HEARING NOT LATER 178
THAN 15 DAYS after your receipt of this notice, or this notice will 179
automatically be approved. 180
To request an Informal Hearing, call the Workers' Compensation 181
Commission District Office in which your case is pending. 182
Be prepared to provide medical and other documentation to 183
support your objection. For your protection, note the date when you 184
received this notice. 185
Sec. 9. Section 38a-472a of the general statutes is repealed and the 186
following is substituted in lieu thereof (Effective October 1, 2019): 187
No contract between a managed care company, other organization 188
or insurer authorized to do business in this state and a medical 189
provider practicing in this state for the provision of services may 190
require that the medical provider indemnify the managed care 191
company, other organization or insurer for any expenses and liabilities 192
including, without limitation, judgments, settlements, attorneys' fees, 193
court costs and any associated charges incurred in connection with any 194
claim or action brought against a managed care company, other 195
organization or insurer on the basis of its determination of medical 196
necessity or appropriateness of health care services if the information 197
provided by such medical provider used in making the determination 198
was accurate and appropriate at the time it was given. As used in this 199
section and section 38a-472b, "medical provider" means any person 200
licensed pursuant to chapters 370 to 373, inclusive, or chapter 375, 378, 201
379, 380 or 383. 202
Sec. 10. Subsections (d) to (h), inclusive, of section 38a-488a of the 203
general statutes are repealed and the following is substituted in lieu 204
thereof (Effective October 1, 2019): 205
(d) In the case of benefits payable for the services of a licensed 206
physician, such benefits shall be payable for the same services when 207 Raised Bill No. 921
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such services are lawfully rendered by a psychologist licensed under 208
the provisions of chapter 383 or by such a licensed psychologist in a 209
licensed hospital or clinic or an advanced practice registered nurse 210
licensed under the provisions of chapter 378. 211
(e) In the case of benefits payable for the services of a licensed 212
physician or psychologist, such benefits shall be payable for the same 213
services when such services are rendered by: 214
(1) A clinical social worker who is licensed under the provisions of 215
chapter 383b and who has passed the clinical examination of the 216
American Association of State Social Work Boards and has completed 217
at least two thousand hours of post-master's social work experience in 218
a nonprofit agency qualifying as a tax-exempt organization under 219
Section 501(c) of the Internal Revenue Code of 1986 or any subsequent 220
corresponding internal revenue code of the United States, as from time 221
to time amended, in a municipal, state or federal agency or in an 222
institution licensed by the Department of Public Health under section 223
19a-490; 224
(2) A social worker who was certified as an independent social 225
worker under the provisions of chapter 383b prior to October 1, 1990; 226
(3) A licensed marital and family therapist who has completed at 227
least two thousand hours of post-master's marriage and family therapy 228
work experience in a nonprofit agency qualifying as a tax-exempt 229
organization under Section 501(c) of the Internal Revenue Code of 1986 230
or any subsequent corresponding internal revenue code of the United 231
States, as from time to time amended, in a municipal, state or federal 232
agency or in an institution licensed by the Department of Public Health 233
under section 19a-490; 234
(4) A marital and family therapist who was certified under the 235
provisions of chapter 383a prior to October 1, 1992; 236
(5) A licensed alcohol and drug counselor, as defined in section 20-237
74s, or a certified alcohol and drug counselor, as defined in section 20-238 Raised Bill No. 921
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74s; 239
(6) A licensed professional counselor; or 240
(7) An advanced practice registered nurse licensed under the 241
provisions of chapter 378. 242
(f) (1) In the case of benefits payable for the services of a licensed 243
physician, such benefits shall be payable for (A) services rendered in a 244
child guidance clinic or residential treatment facility by a person with a 245
master's degree in social work or by a person with a master's degree in 246
marriage and family therapy under the supervision of a psychiatrist, 247
physician, licensed marital and family therapist, or licensed clinical 248
social worker who is eligible for reimbursement under subdivisions (1) 249
to (4), inclusive, of subsection (e) of this section; (B) services rendered 250
in a residential treatment facility by a licensed or certified alcohol and 251
drug counselor who is eligible for reimbursement under subdivision 252
(5) of subsection (e) of this section; [or] (C) services rendered in a 253
residential treatment facility by a licensed professional counselor who 254
is eligible for reimbursement under subdivision (6) of subsection (e) of 255
this section; or (D) services rendered in a residential treatment facility 256
by a licensed advanced practice registered nurse who is eligible for 257
reimbursement under subdivision (7) of subsection (e) of this section. 258
(2) In the case of benefits payable for the services of a licensed 259
psychologist under subsection (e) of this section, such benefits shall be 260
payable for (A) services rendered in a child guidance clinic or 261
residential treatment facility by a person with a master's degree in 262
social work or by a person with a master's degree in marriage and 263
family therapy under the supervision of such licensed psychologist, 264
licensed marital and family therapist, or licensed clinical social worker 265
who is eligible for reimbursement under subdivisions (1) to (4), 266
inclusive, of subsection (e) of this section; (B) services rendered in a 267
residential treatment facility by a licensed or certified alcohol and drug 268
counselor who is eligible for reimbursement under subdivision (5) of 269
subsection (e) of this section; [or] (C) services rendered in a residential 270 Raised Bill No. 921
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treatment facility by a licensed professional counselor who is eligible 271
for reimbursement under subdivision (6) of subsection (e) of this 272
section; or (D) services rendered in a residential treatment facility by a 273
licensed advanced practice registered nurse who is eligible for 274
reimbursement under subdivision (7) of subsection (e) of this section. 275
(g) In the case of benefits payable for the service of a licensed 276
physician practicing as a psychiatrist or a licensed psychologist, under 277
subsection (e) of this section, such benefits shall be payable for 278
outpatient services rendered (1) in a nonprofit community mental 279
health center, as defined by the Department of Mental Health and 280
Addiction Services, in a nonprofit licensed adult psychiatric clinic 281
operated by an accredited hospital or in a residential treatment facility; 282
(2) under the supervision of a licensed physician practicing as a 283
psychiatrist, a licensed psychologist, a licensed marital and family 284
therapist, a licensed clinical social worker, a licensed or certified 285
alcohol and drug counselor, [or] a licensed professional counselor or a 286
licensed advanced practice registered nurse who is eligible for 287
reimbursement under subdivisions (1) to [(6)] (7), inclusive, of 288
subsection (e) of this section; and (3) within the scope of the license 289
issued to the center or clinic by the Department of Public Health or to 290
the residential treatment facility by the Department of Children and 291
Families. 292
(h) Except in the case of emergency services or in the case of services 293
for which an individual has been referred by a physician or an 294
advanced practice registered nurse affiliated with a health care center, 295
nothing in this section shall be construed to require a health care center 296
to provide benefits under this section through facilities that are not 297
affiliated with the health care center. 298
Sec. 11. Subsection (b) of section 38a-492e of the general statutes is 299
repealed and the following is substituted in lieu thereof (Effective 300
October 1, 2019): 301
(b) Benefits shall cover: (1) Initial training visits provided to an 302 Raised Bill No. 921
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individual after the individual is initially diagnosed with diabetes that 303
is medically necessary for the care and management of diabetes, 304
including, but not limited to, counseling in nutrition and the proper 305
use of equipment and supplies for the treatment of diabetes, totaling a 306
maximum of ten hours; (2) training and education that is medically 307
necessary as a result of a subsequent diagnosis by a physician or an 308
advanced practice registered nurse of a significant change in the 309
individual's symptoms or condition which requires modification of the 310
individual's program of self-management of diabetes, totaling a 311
maximum of four hours; and (3) training and education that is 312
medically necessary because of the development of new techniques 313
and treatment for diabetes totaling a maximum of four hours. 314
Sec. 12. Section 38a-499 of the general statutes is repealed and the 315
following is substituted in lieu thereof (Effective October 1, 2019): 316
(a) For the purposes of this section: 317
(1) ["Certified nurse practitioner"] "Advanced practice registered 318
nurse" means any advanced practice registered nurse licensed under 319
the provisions of chapter 378; [who has completed a formal 320
educational nurse practitioner program and is certified by the 321
American Nurses' Association, the National Board of Pediatric Nurse 322
Practitioners and Associates or the Nurses' Association of the 323
American College of Obstetricians and Gynecologists;] 324
(2) ["Certified psychiatric-mental health clinical nurse specialist"] 325
"Certified psychiatric-mental health advanced practice registered 326
nurse" means any advanced practice registered nurse licensed under 327
chapter 378 who [has completed a formal educational program as a 328
psychiatric-mental health clinical nurse specialist and is certified by the 329
American Nurses' Association] is board certified as a psychiatric- 330
mental health provider by the American Nurses Credentialing Center; 331
(3) "Certified nurse-midwife" means any individual certified as 332
nurse-midwife pursuant to sections 20-86a to 20-86e, inclusive; 333 Raised Bill No. 921
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(4) "Physician assistant" means an individual licensed pursuant to 334
section 20-12b. 335
(b) Each individual health insurance policy providing coverage of 336
the type specified in subdivisions (1), (2), (4), (6), (10), (11) and (12) of 337
section 38a-469 delivered, issued for delivery, renewed, amended or 338
continued in this state shall provide coverage for the services of 339
physician assistants, [certified nurse practitioners] advanced practice 340
registered nurses, certified psychiatric-mental health [clinical nurse 341
specialists] advanced practice registered nurses and certified nurse-342
midwives if such services are within the individual's area of 343
professional competence as established by education and licensure or 344
certification and are currently reimbursed when rendered by any other 345
licensed health care provider. Subject to the provisions of chapter 378 346
and sections 20-86a to 20-86e, inclusive, no insurer, hospital service 347
corporation, medical service corporation or health care center may 348
require signature, referral or employment by any other health care 349
provider as a condition of reimbursement, provided no insurer, 350
hospital service corporation, medical service corporation or health care 351
center may be required to pay for duplicative services actually 352
rendered by both a physician assistant or [a certified registered nurse] 353
an advanced practice registered nurse and any other health care 354
provider. The payment of such benefits shall be subject to any policy 355
provisions which apply to other licensed health practitioners 356
providing the same services. Nothing in this section may be construed 357
as permitting (1) any registered nurse to perform or provide services 358
beyond the scope of practice permitted in chapter 378 and sections 20-359
86a to 20-86e, inclusive, or (2) any physician assistant to perform or 360
provide services beyond the scope of practice permitted in chapter 370. 361
Sec. 13. Subsection (d) of section 38a-503 of the general statutes is 362
repealed and the following is substituted in lieu thereof (Effective 363
October 1, 2019): 364
(d) Each mammography report provided to a patient shall include 365
information about breast density, based on the Breast Imaging 366 Raised Bill No. 921
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Reporting and Data System established by the American College of 367
Radiology. Where applicable, such report shall include the following 368
notice: "If your mammogram demonstrates that you have dense breast 369
tissue, which could hide small abnormalities, you might benefit from 370
supplementary screening tests, which can include a breast ultrasound 371
screening or a breast MRI examination, or both, depending on your 372
individual risk factors. A report of your mammography results, which 373
contains information about your breast density, has been sent to your 374
physician's or advanced practice registered nurse's office and you 375
should contact your physician or advanced practice registered nurse if 376
you have any questions or concerns about this report.". 377
Sec. 14. Subdivision (5) of subsection (a) of section 38a-514b of the 378
general statutes is repealed and the following is substituted in lieu 379
thereof (Effective October 1, 2019): 380
(5) "Diagnosis" means the medically necessary assessment, 381
evaluation or testing performed by a licensed physician, licensed 382
psychologist, [or] licensed clinical social worker or licensed advanced 383
practice registered nurse to determine if an individual has autism 384
spectrum disorder. 385
Sec. 15. Subsection (c) of section 38a-514b of the general statutes is 386
repealed and the following is substituted in lieu thereof (Effective 387
October 1, 2019): 388
(c) Such policy shall provide coverage for the following treatments, 389
provided such treatments are (1) medically necessary, and (2) 390
identified and ordered by a licensed physician, licensed psychologist, 391
[or] licensed clinical social worker or licensed advanced practice 392
registered nurse for an insured who is diagnosed with autism 393
spectrum disorder, in accordance with a treatment plan developed by 394
a licensed behavior analyst, licensed physician, licensed psychologist 395
or licensed clinical social worker, pursuant to a comprehensive 396
evaluation or reevaluation of the insured: 397
(A) Behavioral therapy; 398 Raised Bill No. 921
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(B) Prescription drugs, to the extent prescription drugs are a 399
covered benefit for other diseases and conditions under such policy, 400
prescribed by a licensed physician, a licensed physician assistant or an 401
advanced practice registered nurse for the treatment of symptoms and 402
comorbidities of autism spectrum disorder; 403
(C) Direct psychiatric or consultative services provided by a 404
licensed psychiatrist; 405
(D) Direct psychological or consultative services provided by a 406
licensed psychologist; 407
(E) Physical therapy provided by a licensed physical therapist; 408
(F) Speech and language pathology services provided by a licensed 409
speech and language pathologist; and 410
(G) Occupational therapy provided by a licensed occupational 411
therapist. 412
Sec. 16. Subsection (e) of section 38a-514b of the general statutes is 413
repealed and the following is substituted in lieu thereof (Effective 414
October 1, 2019): 415
(e) (1) Except for treatments and services received by an insured in 416
an inpatient setting, an insurer, health care center, hospital service 417
corporation, medical service corporation or fraternal benefit society 418
may review a treatment plan developed as set forth in subsection (c) of 419
this section for such insured, in accordance with its utilization review 420
requirements, not more than once every six months unless such 421
insured's licensed physician, licensed psychologist, [or] licensed 422
clinical social worker or licensed advanced practice registered nurse 423
agrees that a more frequent review is necessary or changes such 424
insured's treatment plan. 425
(2) For the purposes of this section, the results of a diagnosis shall be 426
valid for a period of not less than twelve months, unless such insured's 427
licensed physician, licensed psychologist, [or] licensed clinical social 428 Raised Bill No. 921
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worker or licensed advanced practice registered nurse determines a 429
shorter period is appropriate or changes the results of such insured's 430
diagnosis. 431
Sec. 17. Subsection (b) of section 38a-518e of the general statutes is 432
repealed and the following is substituted in lieu thereof (Effective 433
October 1, 2019): 434
(b) Benefits shall cover: (1) Initial training visits provided to an 435
individual after the individual is initially diagnosed with diabetes that 436
is medically necessary for the care and management of diabetes, 437
including, but not limited to, counseling in nutrition and the proper 438
use of equipment and supplies for the treatment of diabetes, totaling a 439
maximum of ten hours; (2) training and education that is medically 440
necessary as a result of a subsequent diagnosis by a physician or 441
advanced practice registered nurse of a significant change in the 442
individual's symptoms or condition which requires modification of the 443
individual's program of self-management of diabetes, totaling a 444
maximum of four hours; and (3) training and education that is 445
medically necessary because of the development of new techniques 446
and treatment for diabetes totaling a maximum of four hours. 447
Sec. 18. Subsection (d) of section 38a-530 of the general statutes is 448
repealed and the following is substituted in lieu thereof (Effective 449
October 1, 2019): 450
(d) Each mammography report provided to a patient shall include 451
information about breast density, based on the Breast Imaging 452
Reporting and Data System established by the American College of 453
Radiology. Where applicable, such report shall include the following 454
notice: "If your mammogram demonstrates that you have dense breast 455
tissue, which could hide small abnormalities, you might benefit from 456
supplementary screening tests, which can include a breast ultrasound 457
screening or a breast MRI examination, or both, depending on your 458
individual risk factors. A report of your mammography results, which 459
contains information about your breast density, has been sent to your 460 Raised Bill No. 921
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physician's or advanced practice registered nurse's office and you 461
should contact your physician or advanced practice registered nurse if 462
you have any questions or concerns about this report.". 463
Sec. 19. Section 4-105 of the general statutes is repealed and the 464
following is substituted in lieu thereof (Effective October 1, 2019): 465
If any patient who has received treatment in any such hospital, after 466
[his] discharge from such hospital, has made written application to 467
such hospital, hospital society or corporation for permission to 468
examine his or her record as such patient in such hospital and has been 469
refused permission to examine or copy the same, such patient may file 470
a written motion addressed to any judge of the Superior Court, 471
praying for a disclosure of the contents of such hospital record relating 472
to such patient and for a production of the same before such judge. 473
Upon such application being filed, the judge to whom the same has 474
been presented shall cause reasonable notice to be given to such 475
hospital, hospital society or corporation of the time when and place 476
where such petition will be heard, and such judge, after due hearing 477
and notice, may order the officer authorized to act in the capacity of 478
manager of such hospital to produce before [him] the court and deliver 479
into [his] the custody of the court the history, bedside notes, charts, 480
pictures and plates of such patient for the purpose of being examined 481
or copied by such patient [,] or his or her physician, advanced practice 482
registered nurse or authorized attorney. Each officer of any hospital 483
having custody of the history, bedside notes, charts, pictures or plates 484
of any patient therein, who refuses to produce such record before such 485
[judge] court, pursuant to the provisions of this section, shall be fined 486
not more than one hundred dollars or imprisoned not more than six 487
months or both. 488
Sec. 20. Subsection (c) of section 7-51a of the general statutes is 489
repealed and the following is substituted in lieu thereof (Effective 490
October 1, 2019): 491
(c) For deaths occurring on or after July 1, 1997, the Social Security 492 Raised Bill No. 921
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number of the deceased person shall be recorded in the "administrative 493
purposes" section of the death certificate. Such administrative 494
purposes section, and the Social Security number contained therein, 495
shall be restricted and disclosed only to the following eligible parties: 496
(1) All parties specified on the death certificate, including the 497
informant, licensed funeral director, licensed embalmer, conservator, 498
surviving spouse, physician or advanced practice registered nurse and 499
town clerk, for the purpose of processing the certificate, (2) the 500
surviving spouse, (3) the next of kin, or (4) any state and federal 501
agencies authorized by federal law. The department shall provide any 502
other individual, researcher or state or federal agency requesting a 503
certified or uncertified death certificate, or the information contained 504
within such certificate, for a death occurring on or after July 1, 1997, 505
such certificate or information. The decedent's Social Security number 506
shall be removed or redacted from such certificate or information or 507
the administrative purposes section shall be omitted from such 508
certificate. 509
Sec. 21. Section 17b-233 of the general statutes is repealed and the 510
following is substituted in lieu thereof (Effective October 1, 2019): 511
Newington Children's Hospital may admit any child who is 512
handicapped or afflicted with any pediatric illness upon application of 513
the selectmen of any town, or the guardian or any relative of such 514
child, or any public health agency, [or] physician or advanced practice 515
registered nurse, provided, no person shall be admitted primarily for 516
the treatment of any drug-related condition. Said hospital shall admit 517
such child to said hospital if such child is pronounced by [the 518
physicians] a physician or advanced practice registered nurse on the 519
staff of said hospital, after examination, to be suitable for admission, 520
and said hospital shall keep and support such child for such length of 521
time as it deems proper. Said hospital shall not be required to admit 522
any such child unless it can conveniently receive and care for such 523
child at the time application is made and said hospital may return to 524
the town in which such child resides any child so taken who is 525
pronounced by [the physicians] a physician or advanced practice 526 Raised Bill No. 921
LCO No. 4478 18 of 33
registered nurse on the staff of said hospital, after examination, to be 527
unsuitable for retention or who, by reason of improvement in his 528
condition or completion of his treatment or training, ought not to be 529
further retained. The hospital may refuse to admit any child 530
pronounced by [the physicians] a physician or advanced practice 531
registered nurse on the staff of said hospital, after examination, to be 532
unsuitable for admission and may refuse to admit any such child when 533
the facilities at the hospital will not, in the judgment of said 534
[physicians] physician or advanced practice registered nurse, permit 535
the hospital to care for such child adequately and properly. 536
Sec. 22. Section 17b-236 of the general statutes is repealed and the 537
following is substituted in lieu thereof (Effective October 1, 2019): 538
When there is found in any town in this state any child of sound 539
mind who is physically disabled or who is afflicted with poliomyelitis 540
or rheumatic fever, or any uncontagious disabling disease, and who is 541
unable to pay and whose relatives who are legally liable for his 542
support are unable to pay the full cost of treating such disease, if such 543
child and one of such relatives reside in this state, the selectmen of 544
such town, or the guardian or any relative of such child, or any public 545
health agency, [or] physician or advanced practice registered nurse in 546
this state, may make application to The Children's Center, located at 547
Hamden, for the admission of such child to said center. Said center 548
shall admit such child if such child is pronounced by [the physicians] a 549
physician or advanced practice registered nurse on the staff of said 550
center, after examination, to be fit for admission, and said center shall 551
keep and support such child for such length of time as it deems 552
proper. Said center shall not be required to admit any such child unless 553
it can conveniently receive and care for him at the time such 554
application is made, and said center may return to the town in which 555
such child resides any child so taken who is pronounced by [the 556
physicians] a physician or advanced practice registered nurse on the 557
staff of said center, after examination, to be unfit for retention, or who, 558
by reason of improvement in his condition or completion of his 559
treatment or training, ought not to be further retained. The center may 560 Raised Bill No. 921
LCO No. 4478 19 of 33
refuse to admit any child who is pronounced by [the physicians] a 561
physician or advanced practice registered nurse on the staff of said 562
center, after examination, to be unfit for admission, and may refuse to 563
admit any such child when the facilities at the center will not, in the 564
judgment of said [physicians] physician or advanced practice 565
registered nurse, permit the center to care for such child adequately 566
and properly. 567
Sec. 23. Section 17b-278d of the general statutes is repealed and the 568
following is substituted in lieu thereof (Effective October 1, 2019): 569
The Commissioner of Social Services, to the extent permitted by 570
federal law, shall take such action as may be necessary to amend the 571
Medicaid state plan and the state children's health insurance plan to 572
provide coverage without prior authorization for each child diagnosed 573
with cancer on or after January 1, 2000, who is covered under the 574
HUSKY Health program, for neuropsychological testing ordered by a 575
licensed physician or licensed advanced practice registered nurse, to 576
assess the extent of any cognitive or developmental delays in such 577
child due to chemotherapy or radiation treatment. 578
Sec. 24. Section 19a-2a of the general statutes is repealed and the 579
following is substituted in lieu thereof (Effective October 1, 2019): 580
The Commissioner of Public Health shall employ the most efficient 581
and practical means for the prevention and suppression of disease and 582
shall administer all laws under the jurisdiction of the Department of 583
Public Health and the Public Health Code. The commissioner shall 584
have responsibility for the overall operation and administration of the 585
Department of Public Health. The commissioner shall have the power 586
and duty to: (1) Administer, coordinate and direct the operation of the 587
department; (2) adopt and enforce regulations, in accordance with 588
chapter 54, as are necessary to carry out the purposes of the 589
department as established by statute; (3) establish rules for the internal 590
operation and administration of the department; (4) establish and 591
develop programs and administer services to achieve the purposes of 592 Raised Bill No. 921
LCO No. 4478 20 of 33
the department as established by statute; (5) enter into a contract, 593
including, but not limited to, a contract with another state, for facilities, 594
services and programs to implement the purposes of the department 595
as established by statute; (6) designate a deputy commissioner or other 596
employee of the department to sign any license, certificate or permit 597
issued by said department; (7) conduct a hearing, issue subpoenas, 598
administer oaths, compel testimony and render a final decision in any 599
case when a hearing is required or authorized under the provisions of 600
any statute dealing with the Department of Public Health; (8) with the 601
health authorities of this and other states, secure information and data 602
concerning the prevention and control of epidemics and conditions 603
affecting or endangering the public health, and compile such 604
information and statistics and shall disseminate among health 605
authorities and the people of the state such information as may be of 606
value to them; (9) annually issue a list of reportable diseases, 607
emergency illnesses and health conditions and a list of reportable 608
laboratory findings and amend such lists as the commissioner deems 609
necessary and distribute such lists as well as any necessary forms to 610
each licensed physician, licensed advanced practice registered nurse 611
and clinical laboratory in this state. The commissioner shall prepare 612
printed forms for reports and returns, with such instructions as may be 613
necessary, for the use of directors of health, boards of health and 614
registrars of vital statistics; and (10) specify uniform methods of 615
keeping statistical information by public and private agencies, 616
organizations and individuals, including a client identifier system, and 617
collect and make available relevant statistical information, including 618
the number of persons treated, frequency of admission and 619
readmission, and frequency and duration of treatment. The client 620
identifier system shall be subject to the confidentiality requirements set 621
forth in section 17a-688 and regulations adopted thereunder. The 622
commissioner may designate any person to perform any of the duties 623
listed in subdivision (7) of this section. The commissioner shall have 624
authority over directors of health and may, for cause, remove any such 625
director; but any person claiming to be aggrieved by such removal 626
may appeal to the Superior Court which may affirm or reverse the 627 Raised Bill No. 921
LCO No. 4478 21 of 33
action of the commissioner as the public interest requires. The 628
commissioner shall assist and advise local directors of health and 629
district directors of health in the performance of their duties, and may 630
require the enforcement of any law, regulation or ordinance relating to 631
public health. In the event the commissioner reasonably suspects 632
impropriety on the part of a local director of health or district director 633
of health, or employee of such director, in the performance of his or 634
her duties, the commissioner shall provide notification and any 635
evidence of such impropriety to the appropriate governing authority 636
of the municipal health authority, established pursuant to section 19a-637
200, or the district department of health, established pursuant to 638
section 19a-244, for purposes of reviewing and assessing a director's or 639
an employee's compliance with such duties. Such governing authority 640
shall provide a written report of its findings from the review and 641
assessment to the commissioner not later than ninety days after such 642
review and assessment. When requested by local directors of health or 643
district directors of health, the commissioner shall consult with them 644
and investigate and advise concerning any condition affecting public 645
health within their jurisdiction. The commissioner shall investigate 646
nuisances and conditions affecting, or that he or she has reason to 647
suspect may affect, the security of life and health in any locality and, 648
for that purpose, the commissioner, or any person authorized by the 649
commissioner, may enter and examine any ground, vehicle, apartment, 650
building or place, and any person designated by the commissioner 651
shall have the authority conferred by law upon constables. Whenever 652
the commissioner determines that any provision of the general statutes 653
or regulation of the Public Health Code is not being enforced 654
effectively by a local health department or health district, he or she 655
shall forthwith take such measures, including the performance of any 656
act required of the local health department or health district, to ensure 657
enforcement of such statute or regulation and shall inform the local 658
health department or health district of such measures. In September of 659
each year the commissioner shall certify to the Secretary of the Office 660
of Policy and Management the population of each municipality. The 661
commissioner may solicit and accept for use any gift of money or 662 Raised Bill No. 921
LCO No. 4478 22 of 33
property made by will or otherwise, and any grant of or contract for 663
money, services or property from the federal government, the state, 664
any political subdivision thereof, any other state or any private source, 665
and do all things necessary to cooperate with the federal government 666
or any of its agencies in making an application for any grant or 667
contract. The commissioner may establish state-wide and regional 668
advisory councils. For purposes of this section, "employee of such 669
director" means an employee of, a consultant employed or retained by 670
or an independent contractor retained by a local director of health, a 671
district director of health, a local health department or a health district. 672
Sec. 25. Subsection (a) of section 19a-26 of the general statutes is 673
repealed and the following is substituted in lieu thereof (Effective 674
October 1, 2019): 675
(a) The Department of Public Health may establish, maintain and 676
control state laboratories to perform examinations of supposed morbid 677
tissues, other laboratory tests for the diagnosis and control of 678
preventable diseases, and laboratory work in the field of sanitation, 679
environmental and occupational testing and research studies for the 680
protection and preservation of the public health. Such laboratory 681
services shall be performed upon the application of licensed 682
physicians, other laboratories, licensed dentists, licensed podiatrists, 683
licensed advanced practice registered nurses, local directors of health, 684
public utilities or state departments or institutions, subject to 685
regulations prescribed by the Commissioner of Public Health, and 686
upon payment of any applicable fee as provided in this subsection. For 687
such purposes the department may provide necessary buildings and 688
apparatus, employ, subject to the provisions of chapter 67, 689
administrative and scientific personnel and assistants and do all things 690
necessary for the conduct of such laboratories. The Commissioner of 691
Public Health may establish a schedule of fees, provided the 692
commissioner waives the fees for local directors of health and local law 693
enforcement agencies. If the commissioner establishes a schedule of 694
fees, the commissioner may waive (1) the fees, in full or in part, for 695
others if the commissioner determines that the public health requires a 696 Raised Bill No. 921
LCO No. 4478 23 of 33
waiver, and (2) fees for chlamydia and gonorrhea testing for nonprofit 697
organizations and institutions of higher education if the organization 698
or institution provides combination chlamydia and gonorrhea test kits. 699
The commissioner shall also establish a fair handling fee which a client 700
of a state laboratory may charge a person or third party payer for 701
arranging for the services of the laboratory. Such client shall not charge 702
an amount in excess of such handling fee. 703
Sec. 26. Subsection (a) of section 19a-490b of the general statutes is 704
repealed and the following is substituted in lieu thereof (Effective 705
October 1, 2019): 706
(a) Upon the written request of a patient or the patient's attorney or 707
authorized representative, or pursuant to a written authorization, an 708
institution licensed pursuant to this chapter shall furnish to the person 709
making such request a copy of the patient's health record, including 710
but not limited to, copies of bills, laboratory reports, prescriptions and 711
other technical information used in assessing the patient's health 712
condition. In addition, an institution shall provide the patient or the 713
patient's designated health care provider with a reasonable 714
opportunity to examine retained tissue slides and retained pathology 715
tissue blocks. Upon the written request of the patient, the patient's 716
attorney or the patient's designated health care provider, an institution 717
shall send the original retained tissue slide or original retained tissue 718
block directly to the patient's designated licensed institution, 719
laboratory or physician. If the original slide or block is not available or 720
if a new section cut of the original slide or block is a fair representation 721
of the original slide or block, then the institution may send the new 722
section cut, which is clearly labeled as a new section cut, to the 723
patient's designated health care provider. Any patient or the patient's 724
attorney or authorized representative who is provided with an original 725
retained slide, tissue block or a new section under the provisions of 726
this subsection shall be solely responsible for safeguarding and 727
returning the slide, block or new section to the institution. Any 728
institution or laboratory that has released an original slide, an original 729
tissue block or new section pursuant to the provisions of this 730 Raised Bill No. 921
LCO No. 4478 24 of 33
subsection shall not be subject to any liability arising out of releasing 731
or not retaining the slide, block or new section and no cause of action 732
for damages shall arise against any such institution for releasing or not 733
retaining the slide, block or new section. No such institution shall 734
charge more than sixty-five cents per page, including any research 735
fees, clerical fees, handling fees or related costs, and the cost of first 736
class postage, if applicable, for furnishing or providing access to a 737
health record pursuant to this subsection, except such an institution 738
may charge the amount necessary to cover its cost of materials for 739
furnishing a copy of an x-ray or for furnishing an original retained 740
slide, an original tissue block or a new section cut from a retained 741
pathology tissue block. For purposes of this subsection, "health care 742
provider" means an institution or laboratory licensed under this 743
chapter or licensed in the state where located, [or] a physician licensed 744
under chapter 370 or licensed in the state where located or an 745
advanced practice registered nurse licensed under chapter 378 or 746
licensed in the state where located. 747
Sec. 27. Section 19a-551 of the general statutes is repealed and the 748
following is substituted in lieu thereof (Effective October 1, 2019): 749
Each nursing home facility and residential care home shall: (1) On 750
or before the admission of each resident provide such resident or such 751
resident's legally liable relative, guardian or conservator with a written 752
statement explaining such resident's rights regarding the resident's 753
personal funds and listing the charges that may be deducted from such 754
funds. Such statement shall explain that the nursing home facility or 755
residential care home shall on and after October 1, 1992, pay interest at 756
a rate not less than four per cent per annum and on and after October 757
1, 1994, pay interest at a rate not less than five and one-half per cent 758
per annum on any security deposit or other advance payment required 759
of such resident prior to admission to the nursing home facility or 760
residential care home. In the case of residents receiving benefits under 761
Title XVIII or XIX of the federal Social Security Act the statement shall 762
include a list of charges not covered by said titles and not covered by 763
the basic per diem rate provided by said titles. Upon delivery of such 764 Raised Bill No. 921
LCO No. 4478 25 of 33
statement the person in charge of the nursing home facility or 765
residential care home shall obtain a signed receipt acknowledging such 766
delivery; (2) upon written consent or request of the resident or the 767
resident's legally liable relative, guardian or conservator, manage such 768
resident's personal funds, provided such consent by a resident shall 769
not be effective unless cosigned by the resident's legally liable relative 770
or guardian if such resident has been determined by a physician or 771
advanced practice registered nurse to be mentally incapable of 772
understanding and no conservator has been appointed. As manager of 773
such personal funds the nursing home facility or residential care home 774
shall: (A) Either maintain separate accounts for each resident or 775
maintain an aggregate trust account for residents' funds to prevent 776
commingling the personal funds of residents with the funds of such 777
facility or residential care home. Such facility or residential care home 778
shall notify in writing each resident receiving Medicaid assistance or 779
such resident's legally liable relative, guardian or conservator when 780
the amount in the resident's account reaches two hundred dollars less 781
than the dollar amount determined under the Medicaid program as 782
the maximum for eligibility under the program and advise the resident 783
or such resident's legally liable relative, guardian or conservator that if 784
the amount in the account plus the value of the resident's other 785
nonexempt resources reaches the maximum the resident may lose his 786
or her Medicaid eligibility; (B) obtain signed receipts for each 787
expenditure from each resident's personal funds; (C) maintain an 788
individual itemized record of income and expenditures for each 789
resident, including quarterly accountings; and (D) permit the resident 790
or the resident's legally liable relative, guardian or conservator, and 791
the regional long-term care ombudsman, and representatives from the 792
Departments of Social Services and Public Health, access to such 793
record; and (3) (A) refund any overpayment or deposit from a former 794
resident or such resident's legally liable relative, guardian or 795
conservator not later than thirty days after the resident's discharge and 796
(B) refund any deposit from an individual planning to be admitted to 797
such facility or residential care home not later than thirty days after 798
receipt of written notification that the individual is no longer planning 799 Raised Bill No. 921
LCO No. 4478 26 of 33
to be admitted. A refund issued after thirty days shall include interest 800
at a rate of ten per cent per annum. For the purposes of this section 801
"deposit" shall include liquidated damages under any contract for 802
pending admission. 803
Sec. 28. Subsections (a) and (b) of section 20-631 of the general 804
statutes are repealed and the following is substituted in lieu thereof 805
(Effective October 1, 2019): 806
(a) Except as provided in section 20-631b, one or more pharmacists 807
licensed under this chapter who are determined competent in 808
accordance with regulations adopted pursuant to subsection (d) of this 809
section may enter into a written protocol-based collaborative drug 810
therapy management agreement with one or more physicians licensed 811
under chapter 370 or advanced practice registered nurses licensed 812
under chapter 378 to manage the drug therapy of individual patients. 813
In order to enter into a written protocol-based collaborative drug 814
therapy management agreement, such physician or advanced practice 815
registered nurse shall have established a [physician-patient] provider-816
patient relationship with the patient who will receive collaborative 817
drug therapy. Each patient's collaborative drug therapy management 818
shall be governed by a written protocol specific to that patient 819
established by the treating physician or advanced practice registered 820
nurse in consultation with the pharmacist. For purposes of this 821
subsection, a ["physician-patient relationship"] "provider-patient 822
relationship" is a relationship based on (1) the patient making a 823
medical complaint, (2) the patient providing a medical history, (3) the 824
patient receiving a physical examination, and (4) a logical connection 825
existing between the medical complaint, the medical history, the 826
physical examination and any drug prescribed for the patient. 827
(b) A collaborative drug therapy management agreement may 828
authorize a pharmacist to implement, modify or discontinue a drug 829
therapy that has been prescribed for a patient, order associated 830
laboratory tests and administer drugs, all in accordance with a patient-831
specific written protocol. In instances where drug therapy is 832 Raised Bill No. 921
LCO No. 4478 27 of 33
discontinued, the pharmacist shall notify the treating physician or 833
advanced practice registered nurse of such discontinuance no later 834
than twenty-four hours from the time of such discontinuance. Each 835
protocol developed, pursuant to the collaborative drug therapy 836
management agreement, shall contain detailed direction concerning 837
the actions that the pharmacist may perform for that patient. The 838
protocol shall include, but need not be limited to, (1) the specific drug 839
or drugs to be managed by the pharmacist, (2) the terms and 840
conditions under which drug therapy may be implemented, modified 841
or discontinued, (3) the conditions and events upon which the 842
pharmacist is required to notify the physician or advanced practice 843
registered nurse, and (4) the laboratory tests that may be ordered. All 844
activities performed by the pharmacist in conjunction with the 845
protocol shall be documented in the patient's medical record. The 846
pharmacist shall report at least every thirty days to the physician or 847
advanced practice registered nurse regarding the patient's drug 848
therapy management. The collaborative drug therapy management 849
agreement and protocols shall be available for inspection by the 850
Departments of Public Health and Consumer Protection. A copy of the 851
protocol shall be filed in the patient's medical record. 852
Sec. 29. Subsections (a) and (b) of section 20-631a of the general 853
statutes are repealed and the following is substituted in lieu thereof 854
(Effective October 1, 2019): 855
(a) Not later than January 1, 2006, the Commissioner of Consumer 856
Protection, in consultation with the Commission of Pharmacy, shall 857
establish and operate a two-year pilot program to allow not more than 858
ten pharmacists licensed under this chapter who are determined 859
eligible in accordance with subsection (c) of this section and employed 860
by or under contract with a licensed community pharmacy, to enter 861
into a written protocol-based collaborative drug therapy management 862
agreement with one or more physicians licensed under chapter 370 or 863
advanced practice registered nurses licensed under chapter 378, to 864
manage the drug therapy of individual patients receiving drug therapy 865
for diabetes, asthma, hypertension, hyperlipidemia, osteoporosis, 866 Raised Bill No. 921
LCO No. 4478 28 of 33
congestive heart failure or smoking cessation, including patients who 867
qualify as targeted beneficiaries under the provisions of Section 1860D-868
4(c)(2)(A)(ii) of the federal Social Security Act, in accordance with 869
subsections (b) to (d), inclusive, of this section and subject to the 870
approval of the licensed community pharmacy. Each patient's 871
collaborative drug therapy management shall be governed by a 872
written protocol specific to that patient established by the treating 873
physician or advanced practice registered nurse in consultation with 874
the pharmacist. 875
(b) A collaborative drug therapy management agreement may 876
authorize a pharmacist to implement, modify or discontinue a drug 877
therapy that has been prescribed for a patient, order associated 878
laboratory tests and administer drugs, all in accordance with a patient-879
specific written protocol. Each protocol developed, pursuant to the 880
collaborative drug therapy management agreement, shall contain 881
detailed direction concerning the actions that the pharmacist may 882
perform for that patient. The protocol shall include, but need not be 883
limited to, (1) the specific drug or drugs to be managed by the 884
pharmacist, (2) the terms and conditions under which drug therapy 885
may be implemented, modified or discontinued, (3) the conditions and 886
events upon which the pharmacist is required to notify the physician 887
or advanced practice registered nurse, and (4) the laboratory tests that 888
may be ordered. All activities performed by the pharmacist in 889
conjunction with the protocol shall be documented in the patient's 890
medical record. The pharmacist shall report to the physician or 891
advanced practice registered nurse through oral, written or electronic 892
manner regarding the implementation, administration, modification or 893
discontinuation of a drug therapy that has been prescribed for a 894
patient not later than twenty-four hours after such implementation, 895
administration, modification or discontinuation. The collaborative 896
drug therapy management agreement and protocols shall be available 897
for inspection by the Departments of Public Health and Consumer 898
Protection. A copy of the protocol shall be filed in the patient's medical 899
record. 900 Raised Bill No. 921
LCO No. 4478 29 of 33
Sec. 30. Section 52-146d of the general statutes is repealed and the 901
following is substituted in lieu thereof (Effective October 1, 2019): 902
As used in sections 52-146d to 52-146i, inclusive: 903
(1) "Authorized representative" means (A) a person empowered by 904
a patient to assert the confidentiality of communications or records 905
which are privileged under sections 52-146c to 52-146i, inclusive, or (B) 906
if a patient is deceased, his or her personal representative or next of 907
kin, or (C) if a patient is incompetent to assert or waive his privileges 908
hereunder, (i) a guardian or conservator who has been or is appointed 909
to act for the patient, or (ii) for the purpose of maintaining 910
confidentiality until a guardian or conservator is appointed, the 911
patient's nearest relative; 912
(2) "Communications and records" means all oral and written 913
communications and records thereof relating to diagnosis or treatment 914
of a patient's mental condition between the patient and a [psychiatrist] 915
psychiatric mental health provider, or between a member of the 916
patient's family and a [psychiatrist] psychiatric mental health provider, 917
or between any of such persons and a person participating under the 918
supervision of a [psychiatrist] psychiatric mental health provider in the 919
accomplishment of the objectives of diagnosis and treatment, wherever 920
made, including communications and records which occur in or are 921
prepared at a mental health facility; 922
(3) "Consent" means consent given in writing by the patient or his 923
authorized representative; 924
(4) "Identifiable" and "identify a patient" refer to communications 925
and records which contain (A) names or other descriptive data from 926
which a person acquainted with the patient might reasonably 927
recognize the patient as the person referred to, or (B) codes or numbers 928
which are in general use outside of the mental health facility which 929
prepared the communications and records; 930
(5) "Mental health facility" includes any hospital, clinic, ward, 931 Raised Bill No. 921
LCO No. 4478 30 of 33
[psychiatrist's] psychiatric mental health provider's office or other 932
facility, public or private, which provides inpatient or outpatient 933
service, in whole or in part, relating to the diagnosis or treatment of a 934
patient's mental condition; 935
(6) "Patient" means a person who communicates with or is treated 936
by a [psychiatrist] psychiatric mental health provider in diagnosis or 937
treatment; 938
(7) ["Psychiatrist"] "Psychiatric mental health provider" means a 939
physician specializing in psychiatry and licensed under the provisions 940
of sections 20-9 to 20-12, inclusive, an advanced practice registered 941
nurse licensed under chapter 378 who is board certified as a 942
psychiatric mental health provider by the American Nurses 943
Credentialing Center, a person licensed to practice medicine who 944
devotes a substantial portion of his or her time to the practice of 945
psychiatry [,] or a person reasonably believed by the patient to be so 946
qualified. 947
Sec. 31. Subdivisions (1) to (5), inclusive, of section 52-146f of the 948
general statutes are repealed and the following is substituted in lieu 949
thereof (Effective October 1, 2019): 950
(1) Communications or records may be disclosed to other persons 951
engaged in the diagnosis or treatment of the patient or may be 952
transmitted to another mental health facility to which the patient is 953
admitted for diagnosis or treatment if the [psychiatrist] psychiatric 954
mental health provider in possession of the communications or records 955
determines that the disclosure or transmission is needed to accomplish 956
the objectives of diagnosis or treatment. The patient shall be informed 957
that the communications or records will be so disclosed or transmitted. 958
For purposes of this subsection, persons in professional training are to 959
be considered as engaged in the diagnosis or treatment of the patients. 960
(2) Communications or records may be disclosed when the 961
[psychiatrist] psychiatric mental health provider determines that there 962
is substantial risk of imminent physical injury by the patient to himself 963 Raised Bill No. 921
LCO No. 4478 31 of 33
or others or when a [psychiatrist] psychiatric mental health provider, 964
in the course of diagnosis or treatment of the patient, finds it necessary 965
to disclose the communications or records for the purpose of placing 966
the patient in a mental health facility, by certification, commitment or 967
otherwise, provided the provisions of sections 52-146d to 52-146j, 968
inclusive, as amended by this act, shall continue in effect after the 969
patient is in the facility. 970
(3) Except as provided in section 17b-225, the name, address and 971
fees for psychiatric services to a patient may be disclosed to 972
individuals or agencies involved in the collection of fees for such 973
services. In cases where a dispute arises over the fees or claims or 974
where additional information is needed to substantiate the fee or 975
claim, the disclosure of further information shall be limited to the 976
following: (A) That the person was in fact a patient; (B) the diagnosis; 977
(C) the dates and duration of treatment; and (D) a general description 978
of the treatment, which shall include evidence that a treatment plan 979
exists and has been carried out and evidence to substantiate the 980
necessity for admission and length of stay in a health care institution 981
or facility. If further information is required, the party seeking the 982
information shall proceed in the same manner provided for hospital 983
patients in section 4-105, as amended by this act. 984
(4) Communications made to or records made by a [psychiatrist] 985
psychiatric mental health provider in the course of a psychiatric 986
examination ordered by a court or made in connection with the 987
application for the appointment of a conservator by the Probate Court 988
for good cause shown may be disclosed at judicial or administrative 989
proceedings in which the patient is a party, or in which the question of 990
his incompetence because of mental illness is an issue, or in 991
appropriate pretrial proceedings, provided the court finds that the 992
patient has been informed before making the communications that any 993
communications will not be confidential and provided the 994
communications shall be admissible only on issues involving the 995
patient's mental condition. 996 Raised Bill No. 921
LCO No. 4478 32 of 33
(5) Communications or records may be disclosed in a civil 997
proceeding in which the patient introduces his mental condition as an 998
element of his claim or defense, or, after the patient's death, when his 999
condition is introduced by a party claiming or defending through or as 1000
a beneficiary of the patient and the court or judge finds that it is more 1001
important to the interests of justice that the communications be 1002
disclosed than that the relationship between patient and [psychiatrist] 1003
psychiatric mental health provider be protected. 1004
Sec. 32. Section 52-584 of the general statutes is repealed and the 1005
following is substituted in lieu thereof (Effective October 1, 2019): 1006
No action to recover damages for injury to the person, or to real or 1007
personal property, caused by negligence, or by reckless or wanton 1008
misconduct, or by malpractice of a physician, surgeon, dentist, 1009
podiatrist, chiropractor, advanced practice registered nurse, hospital or 1010
sanatorium, shall be brought but within two years from the date when 1011
the injury is first sustained or discovered or in the exercise of 1012
reasonable care should have been discovered, and except that no such 1013
action may be brought more than three years from the date of the act 1014
or omission complained of, except that a counterclaim may be 1015
interposed in any such action any time before the pleadings in such 1016
action are finally closed. 1017
This act shall take effect as follows and shall amend the following
sections:
Section 1 October 1, 2019 17a-78(a)
Sec. 2 October 1, 2019 17a-78(f)
Sec. 3 October 1, 2019 17a-81(a)
Sec. 4 October 1, 2019 31-275(16)(B)
Sec. 5 October 1, 2019 31-294d(b) and (c)
Sec. 6 October 1, 2019 31-294d(f)
Sec. 7 October 1, 2019 31-294i
Sec. 8 October 1, 2019 31-296(c)
Sec. 9 October 1, 2019 38a-472a
Sec. 10 October 1, 2019 38a-488a(d) to (h)
Sec. 11 October 1, 2019 38a-492e(b) Raised Bill No. 921
LCO No. 4478 33 of 33
Sec. 12 October 1, 2019 38a-499
Sec. 13 October 1, 2019 38a-503(d)
Sec. 14 October 1, 2019 38a-514b(a)(5)
Sec. 15 October 1, 2019 38a-514b(c)
Sec. 16 October 1, 2019 38a-514b(e)
Sec. 17 October 1, 2019 38a-518e(b)
Sec. 18 October 1, 2019 38a-530(d)
Sec. 19 October 1, 2019 4-105
Sec. 20 October 1, 2019 7-51a(c)
Sec. 21 October 1, 2019 17b-233
Sec. 22 October 1, 2019 17b-236
Sec. 23 October 1, 2019 17b-278d
Sec. 24 October 1, 2019 19a-2a
Sec. 25 October 1, 2019 19a-26(a)
Sec. 26 October 1, 2019 19a-490b(a)
Sec. 27 October 1, 2019 19a-551
Sec. 28 October 1, 2019 20-631(a) and (b)
Sec. 29 October 1, 2019 20-631a(a) and (b)
Sec. 30 October 1, 2019 52-146d
Sec. 31 October 1, 2019 52-146f(1) to (5)
Sec. 32 October 1, 2019 52-584
Statement of Purpose:
To update the general statutes to reflect the current scope of practice of
advanced practice registered nurses.
[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline,
except that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is
not underlined.]