Substitute Senate Bill No. 9
Public Act No. 23-97
AN ACT CONCERNING HEALTH AND WELLNESS FOR
CONNECTICUT RESIDENTS.
Be it enacted by the Senate and House of Representatives in General
Assembly convened:
Section 1. (NEW) (Effective from passage) (a) As used in this section, (1)
"assisted reproductive technology" has the same meaning as provided
in 42 USC 263a-7, as amended from time to time, and (2) "assisted
reproduction" has the same meaning as provided in section 46b-451 of
the general statutes.
(b) No person or entity may prohibit or unreasonably limit any
person from (1) accessing assisted reproductive technology or assisted
reproduction, (2) continuing or completing an ongoing assisted
reproductive technology treatment or procedure or an ongoing assisted
reproduction treatment or procedure pursuant to a written plan or
agreement with a health care provider, or (3) retaining all rights
regarding the use of reproductive genetic materials, including, but not
limited to, gametes.
(c) No person or entity may prohibit or unreasonably limit a health
care provider who is licensed, certified or otherwise authorized to
perform assisted reproductive technology treatments or procedures or
assisted reproduction treatments or procedures from (1) performing any Substitute Senate Bill No. 9
Public Act No. 23-97 2 of 80
such treatment or procedure, or (2) providing evidence-based
information related to assisted reproductive technology or assisted
reproduction.
Sec. 2. (Effective July 1, 2023) The Commissioner of Social Services
shall adjust Medicaid reimbursement criteria to provide funding for
same-day access to long-acting reversible contraceptives at federally
qualified health centers. As used in this section, "long-acting reversible
contraceptive" means any method of contraception that does not have
to be used or applied more than once a menstrual cycle or once a month.
Sec. 3. (Effective from passage) (a) As used in this section:
(1) "Harm reduction center" means a medical facility where a person
with a substance use disorder may (A) receive substance use disorder
and other mental health counseling, (B) use a test strip to test a substance
for traces of fentanyl or xylazine, or traces of any other substance
recognized by the Commissioner of Mental Health and Addiction
Services as having a high risk of causing an overdose, (C) receive
educational information regarding opioid antagonists, as defined in
section 17a-714a of the general statutes, and the risks of contracting
diseases from sharing hypodermic needles, (D) receive referrals to
substance use disorder treatment services, and (E) receive access to basic
support services, including, but not limited to, laundry machines, a
bathroom, a shower and a place to rest; and
(2) "Test strip" means a product that a person may use to test any
substance prior to injection, inhalation or ingestion of the substance to
prevent accidental overdose by injection, inhalation or ingestion of the
substance.
(b) Not later than July 1, 2027, the Department of Mental Health and
Addiction Services, in consultation with the Department of Public
Health, shall establish a pilot program to prevent drug overdoses Substitute Senate Bill No. 9
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through the establishment of harm reduction centers in three
municipalities in the state selected by the Commissioner of Mental
Health and Addiction Services, subject to the approval of the chief
elected officials of each municipality selected by said commissioner. No
harm reduction center established pursuant to this subsection shall be
subject to regulation by the Department of Public Health until the
termination of the pilot program.
(c) Each harm reduction center established pursuant to subsection (b)
of this section shall (1) employ persons, including, but not limited to,
licensed health care providers with experience treating persons with
substance use disorders to provide substance use disorder or other
mental health counseling and monitor persons utilizing the harm
reduction center for the purpose of providing medical treatment to any
person who experiences symptoms of an overdose, in a number
determined sufficient by the Commissioner of Mental Health and
Addiction Services, (2) provide persons with test strips at the request of
such persons, and (3) provide referrals for substance use disorder or
other mental health counseling or other mental health or medical
treatment services that may be appropriate for persons utilizing the
harm reduction center. A licensed health care provider's participation in
the pilot program shall not be grounds for disciplinary action by the
Department of Public Health pursuant to section 19a-17 of the general
statutes or by any board or commission listed in subsection (b) of section
19a-14 of the general statutes.
(d) The Commissioner of Mental Health and Addiction Services may
request a disbursement of funds from the Opioid Settlement Fund
established pursuant to section 17a-674c of the general statutes to fund,
in whole or in part, the establishment and administration of the pilot
program.
Sec. 4. Subsection (b) of section 19a-638 of the general statutes is
repealed and the following is substituted in lieu thereof (Effective from Substitute Senate Bill No. 9
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passage):
(b) A certificate of need shall not be required for:
(1) Health care facilities owned and operated by the federal
government;
(2) The establishment of offices by a licensed private practitioner,
whether for individual or group practice, except when a certificate of
need is required in accordance with the requirements of section 19a-
493b or subdivision (3), (10) or (11) of subsection (a) of this section;
(3) A health care facility operated by a religious group that
exclusively relies upon spiritual means through prayer for healing;
(4) Residential care homes, as defined in subsection (c) of section 19a-
490, and nursing homes and rest homes, as defined in subsection (o) of
section 19a-490;
(5) An assisted living services agency, as defined in section 19a-490;
(6) Home health agencies, as defined in section 19a-490;
(7) Hospice services, as described in section 19a-122b;
(8) Outpatient rehabilitation facilities;
(9) Outpatient chronic dialysis services;
(10) Transplant services;
(11) Free clinics, as defined in section 19a-630;
(12) School-based health centers and expanded school health sites, as
such terms are defined in section 19a-6r, community health centers, as
defined in section 19a-490a, not-for-profit outpatient clinics licensed in
accordance with the provisions of chapter 368v and federally qualified Substitute Senate Bill No. 9
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health centers;
(13) A program licensed or funded by the Department of Children
and Families, provided such program is not a psychiatric residential
treatment facility;
(14) Any nonprofit facility, institution or provider that has a contract
with, or is certified or licensed to provide a service for, a state agency or
department for a service that would otherwise require a certificate of
need. The provisions of this subdivision shall not apply to a short-term
acute care general hospital or children's hospital, or a hospital or other
facility or institution operated by the state that provides services that are
eligible for reimbursement under Title XVIII or XIX of the federal Social
Security Act, 42 USC 301, as amended;
(15) A health care facility operated by a nonprofit educational
institution exclusively for students, faculty and staff of such institution
and their dependents;
(16) An outpatient clinic or program operated exclusively by or
contracted to be operated exclusively by a municipality, municipal
agency, municipal board of education or a health district, as described
in section 19a-241;
(17) A residential facility for persons with intellectual disability
licensed pursuant to section 17a-227 and certified to participate in the
Title XIX Medicaid program as an intermediate care facility for
individuals with intellectual disabilities;
(18) Replacement of existing imaging equipment if such equipment
was acquired through certificate of need approval or a certificate of need
determination, provided a health care facility, provider, physician or
person notifies the unit of the date on which the equipment is replaced
and the disposition of the replaced equipment; Substitute Senate Bill No. 9
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(19) Acquisition of cone-beam dental imaging equipment that is to be
used exclusively by a dentist licensed pursuant to chapter 379;
(20) The partial or total elimination of services provided by an
outpatient surgical facility, as defined in section 19a-493b, except as
provided in subdivision (6) of subsection (a) of this section and section
19a-639e;
(21) The termination of services for which the Department of Public
Health has requested the facility to relinquish its license;
(22) Acquisition of any equipment by any person that is to be used
exclusively for scientific research that is not conducted on humans; [or]
(23) On or before June 30, 2026, an increase in the licensed bed
capacity of a mental health facility, provided (A) the mental health
facility demonstrates to the unit, in a form and manner prescribed by
the unit, that it accepts reimbursement for any covered benefit provided
to a covered individual under: (i) An individual or group health
insurance policy providing coverage of the type specified in
subdivisions (1), (2), (4), (11) and (12) of section 38a-469; (ii) a self-
insured employee welfare benefit plan established pursuant to the
federal Employee Retirement Income Security Act of 1974, as amended
from time to time; or (iii) HUSKY Health, as defined in section 17b-290,
and (B) if the mental health facility does not accept or stops accepting
reimbursement for any covered benefit provided to a covered
individual under a policy, plan or program described in clause (i), (ii) or
(iii) of subparagraph (A) of this subdivision, a certificate of need for such
increase in the licensed bed capacity shall be required; or
(24) The establishment of harm reduction centers through the pilot
program established pursuant to section 3 of this act.
Sec. 5. (NEW) (Effective October 1, 2023) (a) As used in this section: Substitute Senate Bill No. 9
Public Act No. 23-97 7 of 80
(1) "Eligible entity" means (A) a municipality, (B) a local or regional
board of education, (C) a similar body governing one or more nonpublic
schools, (D) a district department of health, (E) a municipal health
department, (F) a law enforcement agency, or (G) an emergency medical
services organization;
(2) "Emergency medical services personnel" has the same meaning as
provided in section 19a-175 of the general statutes;
(3) "Opioid antagonist" means naloxone hydrochloride or any other
similarly acting and equally safe drug approved by the federal Food and
Drug Administration for the treatment of a drug overdose;
(4) "Opioid drug" has the same meaning as provided in 42 CFR 8.2,
as amended from time to time;
(5) "Opioid use disorder" means a medical condition characterized by
a problematic pattern of opioid use and misuse leading to clinically
significant impairment or distress;
(6) "Pharmacist" has the same meaning as provided in section 20-609a
of the general statutes; and
(7) "Wholesaler" or "distributor" has the same meaning as provided
in section 21a-70 of the general statutes.
(b) There is established an Opioid Antagonist Bulk Purchase Fund
which shall be a separate nonlapsing account within the General Fund.
The account shall contain any (1) amounts appropriated or otherwise
made available by the state for the purposes of this section, (2) moneys
required by law to be deposited in the account, and (3) gifts, grants,
donations or bequests made for the purposes of this section. Investment
earnings credited to the assets of the account shall become part of the
assets of the account. Any balance remaining in the account at the end
of any fiscal year shall be carried forward in the account for the fiscal Substitute Senate Bill No. 9
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year next succeeding. The State Treasurer shall administer the account.
All moneys deposited in the account shall be used by the Department of
Mental Health and Addiction Services for the purposes of this section.
The department may deduct and retain from the moneys in the account
an amount equal to the costs incurred by the department in
administering the provisions of this section, except that said amount
shall not exceed two per cent of the moneys deposited in the account in
any fiscal year.
(c) Not later than January 1, 2024 the Department of Mental Health
and Addiction Services, in collaboration with the Department of Public
Health, shall use the Opioid Antagonist Bulk Purchase Fund for the
provision of opioid antagonists to eligible entities and by emergency
medical services personnel to certain members of the public. Emergency
medical services personnel shall distribute an opioid antagonist kit
containing a personal supply of opioid antagonists and the one-page
fact sheet developed by the Connecticut Alcohol and Drug Policy
Council pursuant to section 17a-667a of the general statutes regarding
the risks of taking an opioid drug, symptoms of opioid use disorder and
services available in the state for persons who experience symptoms of
or are otherwise affected by opioid use disorder to a patient who (1) is
treated by such personnel for an overdose of an opioid drug, (2) displays
symptoms to such personnel of opioid use disorder, or (3) is treated at a
location where such personnel observes evidence of illicit use of an
opioid drug, or to such patient's family member, caregiver or friend who
is present at the location. Emergency medical services personnel shall
refer the patient or such patient's family member, caregiver or friend to
the written instructions regarding the administration of such opioid
antagonist, as deemed appropriate by such personnel.
(d) The Department of Mental Health and Addiction Services may,
within available appropriations, contract with a wholesaler or
distributor for the purchasing and distribution of opioid antagonists in Substitute Senate Bill No. 9
Public Act No. 23-97 9 of 80
bulk to eligible entities pursuant to subsection (c) of this section. Each
eligible entity shall make such bulk-purchased opioid antagonists
available at no charge to a family member, caregiver or friend of a
person who has experienced an overdose of an opioid drug or displays
symptoms of opioid use disorder.
(e) Emergency medical services organizations may obtain opioid
antagonists for dissemination pursuant to subsection (c) of this section
from a pharmacist pursuant to section 20-633c, 20-633d or 21a-286 of the
general statutes.
(f) Emergency medical services personnel shall document the
number of opioid antagonist kits distributed pursuant to subsection (c)
of this section, including, but not limited to, the number of doses of an
opioid antagonist included in each kit.
(g) Not later than January 1, 2025, and annually thereafter, the
executive director of the Office of Emergency Medical Services shall
report to the Department of Mental Health and Addiction Services
regarding the implementation of the provisions of subsections (c), (e)
and (f) of this section, including, but not limited to, any information
required under subsection (h) of this section for inclusion in the state
substance use disorder plan developed pursuant to subsection (j) of
section 17a-451 of the general statutes known to the executive director.
(h) The Commissioner of Mental Health and Addiction Services shall
include in the state substance use disorder plan developed pursuant to
subsection (j) of section 17a-451 of the general statutes the following
information: (1) The amount of funds used to purchase and distribute
opioid antagonists, (2) the number of eligible entities that received
opioid antagonists under this section, (3) the amount of opioid
antagonists purchased under this section, (4) the use of the opioid
antagonists purchased by each such eligible entity, if known by the
commissioner, and (5) any recommendations regarding the Opioid Substitute Senate Bill No. 9
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Antagonist Bulk Purchase Fund, including any proposed legislation to
facilitate the purposes of this section.
Sec. 6. Section 20-14o of the general statutes is repealed and the
following is substituted in lieu thereof (Effective October 1, 2023):
(a) As used in this section:
(1) "Opioid drug" has the same meaning as provided in 42 CFR 8.2,
as amended from time to time;
(2) "Adult" means a person who is at least eighteen years of age;
(3) "Prescribing practitioner" has the same meaning as provided in
section 20-14c;
(4) "Minor" means a person who is under eighteen years of age;
(5) "Opioid agonist" means a medication that binds to the opiate
receptors and provides relief to individuals in treatment for abuse of or
dependence on an opioid drug;
(6) "Opiate receptor" means a specific site on a cell surface that
interacts in a highly selective fashion with an opioid drug;
(7) "Palliative care" means specialized medical care to improve the
quality of life of patients and their families facing the problems
associated with a life-threatening illness; and
(8) "Opioid antagonist" has the same meaning as provided in section
17a-714a.
(b) When issuing a prescription for an opioid drug to an adult patient
for the first time for outpatient use, a prescribing practitioner who is
authorized to prescribe an opioid drug shall not issue a prescription for
more than a seven-day supply of such drug, as recommended in the Substitute Senate Bill No. 9
Public Act No. 23-97 11 of 80
National Centers for Disease Control and Prevention's Guideline for
Prescribing Opioids for Chronic Pain.
(c) A prescribing practitioner shall not issue a prescription for an
opioid drug to a minor for more than a five-day supply of such drug.
(d) Notwithstanding the provisions of subsections (b) and (c) of this
section, if, in the professional medical judgment of a prescribing
practitioner, more than a seven-day supply of an opioid drug is required
to treat an adult patient's acute medical condition, or more than a five-
day supply of an opioid drug is required to treat a minor patient's acute
medical condition, as determined by the prescribing practitioner, or is
necessary for the treatment of chronic pain, pain associated with a
cancer diagnosis or for palliative care, then the prescribing practitioner
may issue a prescription for the quantity needed to treat the acute
medical condition, chronic pain, pain associated with a cancer diagnosis
or pain experienced while the patient is in palliative care. The condition
triggering the prescription of an opioid drug for more than a seven-day
supply for an adult patient or more than a five-day supply for a minor
patient shall be documented in the patient's medical record and the
practitioner shall indicate that an alternative to the opioid drug was not
appropriate to address the medical condition.
(e) The provisions of subsections (b), (c) and (d) of this section shall
not apply to medications designed for the treatment of abuse of or
dependence on an opioid drug, including, but not limited to, opioid
agonists and opioid antagonists.
(f) When issuing a prescription for an opioid drug to an adult or
minor patient, the prescribing practitioner shall (1) discuss with the
patient the risks associated with the use of such opioid drug, including,
but not limited to, the risks of addiction and overdose associated with
opioid drugs and the dangers of taking opioid drugs with alcohol,
benzodiazepines and other central nervous system depressants, and the Substitute Senate Bill No. 9
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reasons the prescription is necessary, and, if applicable, with the
custodial parent, guardian or other person having legal custody of the
minor patient if such parent, guardian or other person is present at the
time of issuance of the prescription, and (2) encourage the patient and,
if applicable, the custodial parent, guardian or other person having legal
custody of the minor patient if such parent, guardian or other person is
present at the time of issuance of the prescription, to obtain an opioid
antagonist.
Sec. 7. (NEW) (Effective July 1, 2023) (a) The Commissioner of
Education shall, in collaboration with the Chief Workforce Officer,
utilize the plan required of the Office of Workforce Strategy pursuant to
section 2 of special act 22-9 in (1) the promotion of the health care
professions as career options to students in middle and high school,
including, but not limited to, through career day presentations
regarding health care career opportunities in the state, the development
of partnerships with health care career education programs in the state
and the creation of counseling programs directed to high school
students to inform such students about, and recruit them to, the health
care professions, and (2) job shadowing and internship experiences in
health care fields for high school students.
(b) Not later than September 1, 2023, the Commissioner of Education
shall provide each local and regional board of education with the plan
described in subsection (a) of this section, and through the Governor's
Workforce Council Education Committee, support implementation of
such plan.
Sec. 8. (Effective from passage) (a) The Office of Workforce Strategy
shall convene a working group to develop recommendations for
expanding the health care workforce in the state. The working group
shall evaluate the following: (1) The quality of the nursing and nurse's
aides education programs in the state; (2) the quality of the clinical
training programs for nurses and nurse's aides in the state; (3) the Substitute Senate Bill No. 9
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potential for increasing the number of clinical training sites for nurses
and nurse's aides; (4) the expansion of clinical training facilities in the
state for nurses and nurse's aides; (5) barriers to recruitment and
retention of health care providers, including, but not limited to, nurses
and nurse's aides; (6) the impact of the state health care staffing shortage
on the provision of health care services, the public's access to health care
services and wait times for health care services; and (7) the impact of
federal and state reimbursement for the costs of health care services on
the public's access to such services.
(b) The working group shall consist of the following members:
(1) Two representatives of a labor organization representing acute
care hospital workers in the state;
(2) Two representatives of a labor organization representing nurses
and nurse's aides employed by the state of Connecticut or a hospital or
long-term care facility in the state;
(3) Two representatives of a labor organization representing faculty
and professional staff at the regional community-technical colleges;
(4) The chairperson of the Board of Regents for Higher Education, or
the chairperson's designee;
(5) The president of the Connecticut State Colleges and Universities,
or the president's designee;
(6) The president of The University of Connecticut, or the president's
designee;
(7) One member of the administration of The University of
Connecticut Health Center;
(8) Two representatives of the Connecticut Conference of
Independent Colleges; Substitute Senate Bill No. 9
Public Act No. 23-97 14 of 80
(9) The Commissioner of Public Health, or the commissioner's
designee;
(10) The Commissioner of Social Services, or the commissioner's
designee;
(11) The Commissioner of Administrative Services, or the
commissioner's designee;
(12) The Secretary of the Office of Policy and Management, or the
secretary's designee;
(13) A representative of the State Board of Examiners for Nursing;
(14) A representative of the State Employees Bargaining Agent
Coalition;
(15) The chairpersons and ranking members of the joint standing
committee of the General Assembly having cognizance of matters
relating to public health, or the chairpersons' and ranking members'
designees; and
(16) The chairpersons and ranking members of the joint standing
committee of the General Assembly having cognizance of matters
relating to higher education and employment advancement, or the
chairpersons' and ranking members' designees.
(c) The cochairpersons of the working group shall be the
Commissioner of Public Health, or the commissioner's designee, and the
chairperson of the Board of Regents for Higher Education, or the
president's designee. The cochairpersons shall schedule the first
meeting of the working group, which shall be held not later than sixty
days after the effective date of this section.
(d) Not later than January 1, 2024, the working group shall submit a
report, in accordance with the provisions of section 11-4a of the general Substitute Senate Bill No. 9
Public Act No. 23-97 15 of 80
statutes, to the joint standing committees of the General Assembly
having cognizance of matters relating to public health and higher
education and employment advancement on its findings and any
recommendations for improving the recruitment and retention of health
care providers in the state, including, but not limited to, a five-year plan
and a ten-year plan for increasing the health care workforce in the state.
The working group shall terminate on the date that it submits such
report or January 1, 2024, whichever is later.
Sec. 9. (NEW) (Effective July 1, 2023) On and after January 1, 2024,
notwithstanding any provision of title 10a of the general statutes, each
public institution of higher education shall consider any licensed health
care provider who (1) has not less than ten years of clinical health care
experience in a field in which such provider is licensed, and (2) applies
for a position as an adjunct faculty member at such institution of higher
education in a health care related field in which such provider has such
experience, to be a qualified applicant for such position and give such
provider the same consideration as any other qualified applicant for
such position. As used in this section, "public institution of higher
education" means those constituent units identified in subdivisions (1)
and (2) of section 10a-1 of the general statutes.
Sec. 10. (NEW) (Effective July 1, 2023) (a) On or before January 1, 2024,
the Office of Higher Education shall establish and administer, within
available appropriations, an adjunct professor incentive grant program.
The program shall provide an incentive grant in an amount of twenty
thousand dollars to each licensed health care provider who (1) accepts a
position as an adjunct professor at a public institution of higher
education that was offered to such provider after being considered as an
applicant for such position pursuant to section 9 of this act, and (2)
remains in such position for not less than one academic year. Each
licensed health care provider who receives a grant under this subsection
shall be eligible for an additional grant in an amount of twenty thousand Substitute Senate Bill No. 9
Public Act No. 23-97 16 of 80
dollars if the provider remains in such position for not less than two
academic years. The executive director of the Office of Higher Education
shall establish the application process for the grant program.
(b) Not later than January 1, 2025, and annually thereafter, the
executive director of the Office of Higher Education shall report, in
accordance with the provisions of section 11-4a of the general statutes,
to the joint standing committee of the General Assembly having
cognizance of matters relating to public health regarding the number
and demographics of the adjunct professors who applied for and
received incentive grants from the adjunct professor grant program
established under subsection (a) of this section, the number and types
of classes taught by such adjunct professors, the institutions of higher
education employing such adjunct professors and any other
information deemed pertinent by the executive director.
Sec. 11. (NEW) (Effective July 1, 2023) (a) As used in this section,
"personal care attendant", "consumer" and "personal care assistance"
have the same meanings as provided in section 17b-706 of the general
statutes.
(b) Not later than January 1, 2024, the Department of Social Services
shall establish and administer a personal care attendants career
pathways program to improve the quality of care offered by personal
care attendants and incentivize the recruitment and retention of
personal care attendants in the state. A personal care attendant who is
not employed by a consumer, but who is eligible for employment by a
consumer, may participate in the program following the completion of
a program orientation developed by the Commissioner of Social
Services.
(c) The career pathways program shall include, but need not be
limited to, the following objectives: Substitute Senate Bill No. 9
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(1) Increase in employment retention and recruitment of personal
care attendants to maintain a stable workforce for consumers, including,
but not limited to, through the creation of career pathways for such
attendants that improve skill and knowledge and increase wages;
(2) Dignity in providing and receiving care through meaningful
collaboration between consumers and personal care attendants;
(3) Improvement in the quality of personal care assistance and the
overall quality of life of the consumer;
(4) Advancement of equity in the provision of personal care
assistance;
(5) Promotion of a culturally and linguistically competent workforce
of personal attendants to serve the growing racial, ethnic and linguistic
diversity of an aging population of consumers; and
(6) Promotion of self-determination principles by personal care
attendants.
(d) The Commissioner of Social Services shall offer the following
career pathways as part of the career pathways program:
(1) The basic skills career pathways, including (A) general health and
safety, and (B) adult education topics; and
(2) The specialized skills career pathways, including (A) cognitive
impairments and behavioral health, (B) complex physical care needs,
and (C) transitioning to home and community-based living from out-of-
home care or homelessness.
(e) The Commissioner of Social Services shall develop or identify, in
consultation with a labor management committee at a hospital or health
care organization, the training curriculum for each career pathway of
the career pathways program. Substitute Senate Bill No. 9
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(f) Not later than January 1, 2025, the Commissioner of Social Services
shall report in accordance with the provisions of section 11-4a of the
general statutes, to the joint standing committees of the General
Assembly having cognizance of matters relating to human services and
public health, on the following information concerning the career
pathways program:
(1) The number of personal care attendants who enrolled in the
program and types of career pathways chosen by each attendant;
(2) The number of personal care attendants who successfully
completed a career pathway and the types of career pathways
completed by each attendant;
(3) The effectiveness of the program, as determined by surveys, focus
groups and interviews of personal care attendants, and whether the
successful completion of a career pathway resulted in a related license
or certificate for each personal care attendant or the retention of
employment as a personal care attendant;
(4) The number of personal care attendants who were employed by a
consumer with specialized care needs after completing a specialized
career pathway and who were retained in employment by such
consumer for a period of not less than six months; and
(5) The number of personal care attendants who were employed by a
consumer with specialized care needs after completing a specialized
career pathway and were retained in employment by such consumer for
a period of at least twelve months.
Sec. 12. (NEW) (Effective October 1, 2023) (a) As used in this section,
(1) "board eligible" means eligible to take a qualifying examination
administered by a medical specialty board after having graduated from
a medical school, completed a residency program and trained under
supervision in a specialty fellowship program, (2) "board certified" Substitute Senate Bill No. 9
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means having passed the qualifying examination administered by a
medical specialty board to become board certified in a particular
specialty, and (3) "board recertification" means recertification in a
particular specialty after a predetermined time period prescribed by a
medical specialty board after having passed the qualifying examination
administered by the medical specialty board to become board certified
in a particular specialty.
(b) No hospital, or medical review committee of a hospital, shall
require, as part of its credentialing requirements (1) for a board eligible
physician to acquire privileges to practice in the hospital, that the
physician provide credentials of board certification in a particular
specialty until five years after the date on which the physician became
board eligible in such specialty, or (2) for a board certified physician to
acquire or retain privileges to practice in the hospital, that the physician
provide credentials of board recertification.
Sec. 13. Section 20-14p of the general statutes is repealed and the
following is substituted in lieu thereof (Effective July 1, 2023):
(a) For purposes of this section: (1) "Covenant not to compete" means
any provision of an employment or other contract or agreement that
creates or establishes a professional relationship with a physician and
restricts the right of a physician to practice medicine in any geographic
area of the state for any period of time after the termination or cessation
of such partnership, employment or other professional relationship; (2)
"physician" means an individual licensed to practice medicine under
this chapter; and (3) "primary site where such physician practices"
means [(A) the office, facility or location where a majority of the revenue
derived from such physician's services is generated, or (B) any other]
any single office, facility or location where such physician practices,
[and] as mutually agreed to by the parties and [identified] defined in the
covenant not to compete. Substitute Senate Bill No. 9
Public Act No. 23-97 20 of 80
(b) (1) A covenant not to compete is valid and enforceable only if it is:
(A) Necessary to protect a legitimate business interest; (B) reasonably
limited in time, geographic scope and practice restrictions as necessary
to protect such business interest; and (C) otherwise consistent with the
law and public policy. The party seeking to enforce a covenant not to
compete shall have the burden of proof in any proceeding.
(2) A covenant not to compete that is entered into, amended,
extended or renewed on or after July 1, 2016, shall not: (A) Restrict the
physician's competitive activities (i) for a period of more than one year,
and (ii) in a geographic region of more than fifteen miles from the
primary site where such physician practices; or (B) be enforceable
against a physician if (i) such employment contract or agreement was
not made in anticipation of, or as part of, a partnership or ownership
agreement and such contract or agreement expires and is not renewed,
unless, prior to such expiration, the employer makes a bona fide offer to
renew the contract on the same or similar terms and conditions, or (ii)
the employment or contractual relationship is terminated by the
employer, unless such employment or contractual relationship is
terminated for cause.
(3) A covenant not to compete that is entered into, amended,
extended or renewed on or after October 1, 2023, shall not be enforceable
if (A) the physician who is a party to the employment or other contract
or agreement does not agree to a proposed material change to the
compensation terms of such contract or agreement prior to or at the time
of the extension or renewal of such contract or agreement, and (B) the
contract or agreement expires and is not renewed by the employer or
the employment or contractual relationship is terminated by the
employer, unless such employment or contractual relationship is
terminated by the employer for cause. The provisions of this subdivision
shall not apply to a covenant not to compete that is entered into between
a physician and a group practice, as defined in section 19a-486i, of not Substitute Senate Bill No. 9
Public Act No. 23-97 21 of 80
more than thirty-five physicians the majority ownership of which is
comprised of physicians.
[(3)] (4) Each covenant not to compete entered into, amended or
renewed on and after July 1, 2016, shall be separately and individually
signed by the physician.
(c) The remaining provisions of any contract or agreement that
includes a covenant not to compete that is rendered void and
unenforceable, in whole or in part, under the provisions of this section
shall remain in full force and effect, including provisions that require
the payment of damages resulting from any injury suffered by reason of
termination of such contract or agreement.
Sec. 14. (NEW) (Effective July 1, 2023) (a) For purposes of this section:
(1) "Covenant not to compete" means any provision of an employment
or other contract or agreement that creates or establishes a professional
relationship with an advanced practice registered nurse and restricts the
right of an advanced practice registered nurse to practice as an
advanced practice registered nurse in any geographic area of the state
for any period of time after the termination or cessation of such
partnership, employment or other professional relationship; (2)
"advanced practice registered nurse" means an individual licensed as an
advanced practice registered nurse pursuant to chapter 378 of the
general statutes; and (3) "primary site where such advanced practice
registered nurse practices" means any single office, facility or location
where such advanced practice registered nurse practices, as mutually
agreed to by the parties and defined in the covenant not to compete.
(b) (1) A covenant not to compete that is entered into, amended,
extended or renewed on or after October 1, 2023, shall be valid and
enforceable only if it is: (A) Necessary to protect a legitimate business
interest; (B) reasonably limited in time, geographic scope and practice
restrictions as necessary to protect such business interest; and (C) Substitute Senate Bill No. 9
Public Act No. 23-97 22 of 80
otherwise consistent with the law and public policy. The party seeking
to enforce a covenant not to compete shall have the burden of proof in
any proceeding.
(2) A covenant not to compete that is entered into, amended,
extended or renewed on or after October 1, 2023, shall not: (A) Restrict
the advanced practice registered nurse's competitive activities (i) for a
period of more than one year, and (ii) in a geographic region of more
than fifteen miles from the primary site where such advanced practice
registered nurse practices; or (B) be enforceable against an advanced
practice registered nurse if (i) such employment contract or agreement
was not made in anticipation of, or as part of, a partnership or
ownership agreement and such contract or agreement expires and is not
renewed, unless, prior to such expiration, the employer makes a bona
fide offer to renew the contract on the same or similar terms and
conditions, or (ii) the employment or contractual relationship is
terminated by the employer, unless such employment or contractual
relationship is terminated for cause.
(3) A covenant not to compete that is entered into, amended,
extended or renewed on or after October 1, 2023, shall not be enforceable
if (A) the advanced practice registered nurse who is a party to the
employment or other contract or agreement does not agree to a
proposed material change to the compensation terms of such contract or
agreement prior to or at the time of the extension or renewal of such
contract or agreement; and (B) the contract or agreement expires and is
not renewed by the employer or the employment or contractual
relationship is terminated by the employer, unless such employment or
contractual relationship is terminated for cause.
(4) Each covenant not to compete entered into, amended or renewed
on or after October 1, 2023, shall be separately and individually signed
by the advanced practice registered nurse. Substitute Senate Bill No. 9
Public Act No. 23-97 23 of 80
(c) The remaining provisions of any contract or agreement that
includes a covenant not to compete that is rendered void and
unenforceable, in whole or in part, under the provisions of this section
shall remain in full force and effect, including provisions that require
the payment of damages resulting from any injury suffered by reason of
termination of such contract or agreement.
Sec. 15. (NEW) (Effective July 1, 2023) (a) For purposes of this section:
(1) "Covenant not to compete" means any provision of an employment
or other contract or agreement that creates or establishes a professional
relationship with a physician assistant and restricts the right of a
physician assistant to practice as a physician assistant in any geographic
area of the state for any period of time after the termination or cessation
of such partnership, employment or other professional relationship; (2)
"physician assistant" means an individual licensed as a physician
assistant pursuant to chapter 370 of the general statutes; and (3)
"primary site where such physician assistant practices" means any single
office, facility or location where such physician assistant practices, as
mutually agreed to by the parties and defined in the covenant not to
compete.
(b) (1) A covenant not to compete that is entered into, amended,
extended or renewed on or after October 1, 2023, shall be valid and
enforceable only if it is: (A) Necessary to protect a legitimate business
interest; (B) reasonably limited in time, geographic scope and practice
restrictions as necessary to protect such business interest; and (C)
otherwise consistent with the law and public policy. The party seeking
to enforce a covenant not to compete shall have the burden of proof in
any proceeding.
(2) A covenant not to compete that is entered into, amended,
extended or renewed on or after October 1, 2023, shall not: (A) Restrict
the physician assistant's competitive activities (i) for a period of more
than one year, and (ii) in a geographic region of more than fifteen miles Substitute Senate Bill No. 9
Public Act No. 23-97 24 of 80
from the primary site where such physician assistant practices; or (B) be
enforceable against a physician assistant if (i) such employment contract
or agreement was not made in anticipation of, or as part of, a
partnership or ownership agreement and such contract or agreement
expires and is not renewed, unless, prior to such expiration, the
employer makes a bona fide offer to renew the contract on the same or
similar terms and conditions, or (ii) the employment or contractual
relationship is terminated by the employer, unless such employment or
contractual relationship is terminated for cause.
(3) A covenant not to compete that is entered into, amended,
extended or renewed on or after October 1, 2023, shall not be enforceable
if (A) the physician assistant who is a party to the employment or other
contract or agreement does not agree to a proposed material change to
the compensation terms of such contract or agreement prior to or at the
time of the extension or renewal of such contract or agreement; and (B)
the contract or agreement expires and is not renewed by the employer
or the employment or contractual relationship is terminated by the
employer, unless such employment or contractual relationship is
terminated for cause.
(4) Each covenant not to compete entered into, amended or renewed
on or after October 1, 2023, shall be separately and individually signed
by the physician assistant.
(c) The remaining provisions of any contract or agreement that
includes a covenant not to compete that is rendered void and
unenforceable, in whole or in part, under the provisions of this section
shall remain in full force and effect, including provisions that require
the payment of damages resulting from any injury suffered by reason of
termination of such contract or agreement.
Sec. 16. (NEW) (Effective July 1, 2023) The Physical Therapy Licensure
Compact is hereby enacted into law and entered into by the state of Substitute Senate Bill No. 9
Public Act No. 23-97 25 of 80
Connecticut with any and all jurisdictions legally joining therein in
accordance with its terms. The compact is substantially as follows:
"PHYSICAL THERAPY LICENSURE COMPACT
SECTION 1. PURPOSE
The purpose of the compact is to facilitate interstate practice of
physical therapy with the goal of improving public access to physical
therapy services. The practice of physical therapy occurs in the state
where the patient is located at the time of the patient encounter. The
compact preserves the regulatory authority of states to protect public
health and safety through the current system of state licensure.
The compact is designed to achieve the following objectives:
(1) Increase public access to physical therapy services by providing
for the mutual recognition of other member state licenses;
(2) Enhance the states' ability to protect the public's health and safety;
(3) Encourage the cooperation of member states in regulating multi-
state physical therapy practice;
(4) Support spouses of relocating military members;
(5) Enhance the exchange of licensure, investigative and disciplinary
information between member states; and
(6) Allow a remote state to hold a provider of services with a compact
privilege in such state accountable to such state's practice standards.
SECTION 2. DEFINITIONS
As used in section 1, this section and sections 3 to 12, inclusive, of the
compact, and except as otherwise provided: Substitute Senate Bill No. 9
Public Act No. 23-97 26 of 80
(1) "Active duty military" means full-time duty status in the active
uniformed service of the United States, including members of the
National Guard and Reserve on active duty orders pursuant to 10 USC
1209 and 1211, as amended from time to time;
(2) "Adverse action" means disciplinary action taken by a physical
therapy licensing board based upon misconduct, unacceptable
performance or a combination of both;
(3) "Alternative program" means a nondisciplinary monitoring or
practice remediation process approved by a physical therapy licensing
board, including, but not limited to, substance abuse issues;
(4) "Compact privilege" means the authorization granted by a remote
state to allow a licensee from another member state to practice as a
physical therapist or work as a physical therapist assistant in the remote
state under its laws and rules. The practice of physical therapy occurs in
the member state where the patient or client is located at the time of the
patient or client encounter;
(5) "Continuing competence" means a requirement, as a condition of
license renewal, to provide evidence of participation in, or completion
of, educational and professional activities relevant to practice or area of
work;
(6) "Data system" means a repository of information about licensees,
including examination, licensure, investigative, compact privilege and
adverse action;
(7) "Encumbered license" means a license that a physical therapy
licensing board has limited in any way;
(8) "Executive board" means a group of directors elected or appointed
to act on behalf of, and within the powers granted to them, by the
commission; Substitute Senate Bill No. 9
Public Act No. 23-97 27 of 80
(9) "Home state" means the member state that is the licensee's
primary state of residence;
(10) "Investigative information" means information, records and
documents received or generated by a physical therapy licensing board
pursuant to an investigation;
(11) "Jurisprudence requirement" means the assessment of an
individual's knowledge of the laws and rules governing the practice of
physical therapy in a state;
(12) "Licensee" means an individual who currently holds an
authorization from the state to practice as a physical therapist or to work
as a physical therapist assistant;
(13) "Member state" means a state that has enacted the compact;
(14) "Party state" means any member state in which a licensee holds
a current license or compact privilege or is applying for a license or
compact privilege;
(15) "Physical therapist" means an individual who is licensed by a
state to practice physical therapy;
(16) "Physical therapist assistant" means an individual who is
licensed or certified by a state and who assists the physical therapist in
selected components of physical therapy;
(17) "Physical therapy", "physical therapy practice" and "the practice
of physical therapy" mean the care and services provided by or under
the direction and supervision of a licensed physical therapist;
(18) "Physical Therapy Compact Commission" or "commission"
means the national administrative body whose membership consists of
all states that have enacted the compact; Substitute Senate Bill No. 9
Public Act No. 23-97 28 of 80
(19) "Physical therapy licensing board" or "licensing board" means the
agency of a state that is responsible for the licensing and regulation of
physical therapists and physical therapist assistants;
(20) "Remote state" means a member state other than the home state,
where a licensee is exercising or seeking to exercise the compact
privilege;
(21) "Rule" means a regulation, principle, or directive promulgated
by the commission that has the force of law; and
(22) "State" means any state, commonwealth, district or territory of
the United States of America that regulates the practice of physical
therapy.
SECTION 3. STATE PARTICIPATION IN THE COMPACT
(a) To participate in the compact, a state shall:
(1) Participate fully in the commission's data system, including using
the commission's unique identifier as defined in rules;
(2) Have a mechanism in place for receiving and investigating
complaints about licensees;
(3) Notify the commission, in compliance with the terms of the
compact and rules, of any adverse action or of the availability of
investigative information regarding a licensee;
(4) Fully implement a criminal background check requirement,
within a time frame established by rule, by receiving the results of the
Federal Bureau of Investigation record search on criminal background
checks and use the results in making licensure decisions in accordance
with subsection (b) of this section;
(5) Comply with the rules of the commission; Substitute Senate Bill No. 9
Public Act No. 23-97 29 of 80
(6) Utilize a recognized national examination as a requirement for
licensure pursuant to the rules of the commission; and
(7) Have continuing competence requirements as a condition for
license renewal.
(b) Upon adoption of the compact, the member state shall have the
authority to obtain biometric-based information from each physical
therapy licensure applicant and shall submit such information to the
Federal Bureau of Investigation for a criminal background check in
accordance with 28 USC 534 and 42 USC 14616, as amended from time
to time.
(c) A member state shall grant the compact privilege to a licensee
holding a valid unencumbered license in another member state in
accordance with the terms of the compact and rules.
(d) Member states may charge a fee for granting a compact privilege.
SECTION 4. COMPACT PRIVILEGE
(a) To exercise the compact privilege under the terms and provisions
of the compact, the licensee shall:
(1) Hold a license in the home state;
(2) Have no encumbrance on any state license;
(3) Be eligible for a compact privilege in any member state in
accordance with subsections (d), (g) and (h) of this section;
(4) Have not had any adverse action against any license or compact
privilege within the previous two years;
(5) Notify the commission that the licensee is seeking the compact
privilege within a remote state or remote states; Substitute Senate Bill No. 9
Public Act No. 23-97 30 of 80
(6) Pay any applicable fees, including any state fee, for the compact
privilege;
(7) Meet any jurisprudence requirements established by the remote
state or states in which the licensee is seeking a compact privilege; and
(8) Report to the commission adverse action taken by any
nonmember state not later than thirty days after the date the adverse
action is taken.
(b) The compact privilege is valid until the expiration date of the
home license. The licensee shall comply with the requirements of
subsection (a) of this section of the compact to maintain the compact
privilege in the remote state.
(c) A licensee providing physical therapy in a remote state under the
compact privilege shall function within the laws and regulations of the
remote state.
(d) A licensee providing physical therapy in a remote state is subject
to such state's regulatory authority. A remote state may, in accordance
with due process and such state's laws, remove a licensee's compact
privilege in the remote state for a specific period of time, impose fines
and take any other necessary action to protect the health and safety of
its citizens. The licensee is not eligible for a compact privilege in any
state until the specific time for removal has passed and all fines are paid.
(e) If a home state license is encumbered, the licensee shall lose the
compact privilege in any remote state until the following occur:
(1) The home state license is no longer encumbered; and
(2) Two years have elapsed from the date of the adverse action.
(f) Once an encumbered license in the home state is restored to good
standing, the licensee shall meet the requirements of subsection (a) of Substitute Senate Bill No. 9
Public Act No. 23-97 31 of 80
this section of the compact to obtain a compact privilege in any remote
state.
(g) If a licensee's compact privilege in any remote state is removed,
the individual shall lose the compact privilege in any remote state until
the following occur:
(1) The specific period of time for which the compact privilege was
removed has ended;
(2) All fines have been paid; and
(3) Two years have elapsed from the date of the adverse action.
(h) Once the requirements of subsection (g) of this section of the
compact have been met, the licensee shall meet the requirements set
forth in subsection (a) of this section of the compact to obtain a compact
privilege in a remote state.
SECTION 5. ACTIVE DUTY MILITARY PERSONNEL OR THEIR
SPOUSES
A licensee who is active duty military or is the spouse of an
individual who is active duty military may designate one of the
following as the home state:
(1) Home of record;
(2) Permanent change of station (PCS); or
(3) State of current residence if such state is different from the PCS
state or home of record.
SECTION 6. ADVERSE ACTIONS
(a) A home state shall have exclusive power to impose adverse action
against a license issued by the home state. Substitute Senate Bill No. 9
Public Act No. 23-97 32 of 80
(b) A home state may take adverse action based on the investigative
information of a remote state, so long as the home state follows its own
procedures for imposing adverse action.
(c) Nothing in the compact shall override a member state's decision
that participation in an alternative program may be used in lieu of
adverse action and that such participation shall remain nonpublic if
required by the member state's laws. Member states shall require
licensees who enter any alternative programs in lieu of discipline to
agree not to practice in any other member state during the term of the
alternative program without prior authorization from such other
member state.
(d) Any member state may investigate actual or alleged violations of
the statutes and rules authorizing the practice of physical therapy in any
other member state in which a physical therapist or physical therapist
assistant holds a license or compact privilege.
(e) A remote state shall have the authority to:
(1) Take adverse actions as set forth in subsection (d) of section 4 of
the compact against a licensee's compact privilege in the state;
(2) Issue subpoenas for both hearings and investigations that require
the attendance and testimony of witnesses and the production of
evidence. Subpoenas issued by a physical therapy licensing board in a
party state for the attendance and testimony of witnesses or the
production of evidence from another party state shall be enforced in
such other party state by any court of competent jurisdiction, according
to the practice and procedure of such court applicable to subpoenas
issued in proceedings pending before such court. The issuing authority
shall pay any witness fees, travel expenses, mileage and other fees
required by the service statutes of the state where the witnesses or
evidence are located; and Substitute Senate Bill No. 9
Public Act No. 23-97 33 of 80
(3) If otherwise permitted by state law, recover from the licensee the
costs of investigations and disposition of cases resulting from any
adverse action taken against such licensee.
(f) Joint Investigations
(1) In addition to the authority granted to a member state by its
respective physical therapy practice act or other applicable state law, a
member state may participate with other member states in joint
investigations of licensees.
(2) Member states shall share any investigative, litigation or
compliance materials in furtherance of any joint or individual
investigation initiated under the compact.
SECTION 7. ESTABLISHMENT OF THE PHYSICAL THERAPY
COMPACT COMMISSION
(a) The compact member states hereby create and establish a joint
public agency known as the Physical Therapy Compact Commission.
(1) The commission is an instrumentality of the compact states.
(2) Venue is proper and judicial proceedings by or against the
commission shall be brought solely and exclusively in a court of
competent jurisdiction where the principal office of the commission is
located. The commission may waive venue and jurisdictional defenses
to the extent that it adopts or consents to participate in alternative
dispute resolution proceedings.
(3) Nothing in the compact shall be construed to be a waiver of
sovereign immunity.
(b) Membership, Voting and Meetings
(1) Each member state shall have and be limited to one delegate Substitute Senate Bill No. 9
Public Act No. 23-97 34 of 80
selected by such member state's licensing board.
(2) The delegate shall be a current member of the licensing board who
is a physical therapist, a physical therapist assistant, a public member or
the board administrator.
(3) Any delegate may be removed or suspended from office as
provided by the law of the state from which the delegate is appointed.
(4) The member state board shall fill any vacancy occurring in the
commission.
(5) Each delegate shall be entitled to one vote with regard to the
promulgation of rules and creation of bylaws and shall otherwise have
an opportunity to participate in the business and affairs of the
commission.
(6) A delegate shall vote in person or by such other means as
provided in the bylaws. The bylaws may provide for delegates'
participation in meetings by telephone or other means of
communication.
(7) The commission shall meet at least once during each calendar
year. Additional meetings shall be held as set forth in the bylaws.
(c) The commission shall have the following powers and duties:
(1) Establish the fiscal year of the commission;
(2) Establish bylaws;
(3) Maintain its financial records in accordance with the bylaws;
(4) Meet and take such actions as are consistent with the provisions
of the compact and the bylaws;
(5) Promulgate uniform rules to facilitate and coordinate Substitute Senate Bill No. 9
Public Act No. 23-97 35 of 80
implementation and administration of the compact. The rules shall have
the force and effect of law and shall be binding in all member states;
(6) Bring and prosecute legal proceedings or actions in the name of
the commission, provided the standing of any state physical therapy
licensing board to sue or be sued under applicable law shall not be
affected;
(7) Purchase and maintain insurance and bonds;
(8) Borrow, accept or contract for services of personnel, including, but
not limited to, employees of a member state;
(9) Hire employees, elect or appoint officers, fix compensation, define
duties and grant such individuals appropriate authority to carry out the
purposes of the compact and establish the commission's personnel
policies and programs relating to conflicts of interest, qualifications of
personnel and other related personnel matters;
(10) Accept any and all appropriate donations and grants of money,
equipment, supplies, materials and services and receive, utilize and
dispose of such money, equipment, supplies, materials and services,
provided at all times the commission shall avoid any appearance of
impropriety or conflict of interest;
(11) Lease, purchase, accept appropriate gifts or donations of, or
otherwise own, hold, improve or use any property, real, personal or
mixed, provided at all times the commission shall avoid any appearance
of impropriety;
(12) Sell, convey, mortgage, pledge, lease, exchange, abandon or
otherwise dispose of any real, personal or mixed property;
(13) Establish a budget and make expenditures;
(14) Borrow money; Substitute Senate Bill No. 9
Public Act No. 23-97 36 of 80
(15) Appoint committees, including standing committees composed
of members, state regulators, state legislators or their representatives,
and consumer representatives and such other interested persons as may
be designated in the compact and the bylaws;
(16) Provide and receive information from, and cooperate with, law-
enforcement agencies;
(17) Establish and elect an executive board; and
(18) Perform such other functions as may be necessary or appropriate
to achieve the purposes of the compact consistent with the state
regulation of physical therapy licensure and practice.
(d) The Executive Board
The executive board shall have the power to act on behalf of the
commission according to the terms of the compact.
(1) The executive board shall be composed of nine members as
follows:
(A) Seven voting members who are elected by the commission from
the current membership of the commission;
(B) One ex-officio, nonvoting member from the recognized national
physical therapy professional association; and
(C) One ex-officio, nonvoting member from the recognized
membership organization of the physical therapy licensing boards.
(2) The ex-officio members shall be selected by their respective
organizations.
(3) The commission may remove any member of the executive board
as provided in bylaws. Substitute Senate Bill No. 9
Public Act No. 23-97 37 of 80
(4) The executive board shall meet at least annually.
(5) The executive board shall have the following duties and
responsibilities:
(A) Recommend to the entire commission changes to the rules or
bylaws, changes to the compact legislation, fees paid by compact
member states, including annual dues, and any commission compact fee
charged to licensees for the compact privilege;
(B) Ensure compact administration services are appropriately
provided, contractual or otherwise;
(C) Prepare and recommend the budget;
(D) Maintain financial records on behalf of the commission;
(E) Monitor compact compliance of member states and provide
compliance reports to the commission;
(F) Establish additional committees as necessary; and
(G) Perform other duties as provided in rules or bylaws.
(e) Meetings of the Commission
(1) All meetings shall be open to the public, and public notice of
meetings shall be given in the same manner as required under the
rulemaking provisions of section 9 of the compact.
(2) The commission or the executive board or other committees of the
commission may convene in a closed, nonpublic meeting if the
commission or executive board or other committees of the commission
shall discuss:
(A) Noncompliance of a member state with its obligations under the
compact; Substitute Senate Bill No. 9
Public Act No. 23-97 38 of 80
(B) The employment, compensation, discipline or other matters,
practices or procedures related to specific employees or other matters
related to the commission's internal personnel practices and procedures;
(C) Current, threatened or reasonably anticipated litigation;
(D) Negotiation of contracts for the purchase, lease or sale of goods,
services or real estate;
(E) Accusing any person of a crime or formally censuring any person;
(F) Disclosure of trade secrets or commercial or financial information
that is privileged or confidential;
(G) Disclosure of information of a personal nature where disclosure
would constitute a clearly unwarranted invasion of personal privacy;
(H) Disclosure of investigative records compiled for law-enforcement
purposes;
(I) Disclosure of information related to any investigative reports
prepared by or on behalf of or for use of the commission or other
committee charged with responsibility of investigation or determination
of compliance issues pursuant to the compact; or
(J) Matters specifically exempted from disclosure by federal or
member state statute.
(3) If a meeting or portion of a meeting is closed pursuant to this
provision, the commission's legal counsel or designee shall certify that
the meeting may be closed and shall reference each relevant exempting
provision.
(4) The commission shall keep minutes that fully and clearly describe
all matters discussed in a meeting and shall provide a full and accurate
summary of actions taken and the reasons therefor, including a Substitute Senate Bill No. 9
Public Act No. 23-97 39 of 80
description of the views expressed. All documents considered in
connection with an action shall be identified in such minutes. All
minutes and documents of a closed meeting shall remain under seal,
subject to release by a majority vote of the commission or order of a
court of competent jurisdiction.
(f) Financing of the Commission
(1) The commission shall pay or provide for the payment of the
reasonable expenses of its establishment, organization and ongoing
activities.
(2) The commission may accept any and all appropriate revenue
sources, donations and grants of money, equipment, supplies, materials
and services.
(3) The commission may levy on and collect an annual assessment
from each member state or impose fees on other parties to cover the cost
of the operations and activities of the commission and its staff, which
shall be in a total amount sufficient to cover its annual budget as
approved each year for which revenue is not provided by other sources.
The aggregate annual assessment amount shall be allocated based upon
a formula to be determined by the commission, which shall promulgate
a rule binding upon all member states.
(4) The commission shall not incur obligations of any kind prior to
securing the funds adequate to meet such obligations, or pledge the
credit of any of the member states, except by and with the authority of
the member state.
(5) The commission shall keep accurate accounts of all receipts and
disbursements. The receipts and disbursements of the commission shall
be subject to the audit and accounting procedures established under its
bylaws. All receipts and disbursements of funds handled by the
commission shall be audited annually by a certified or licensed public Substitute Senate Bill No. 9
Public Act No. 23-97 40 of 80
accountant and the report of the audit shall be included in and become
part of the annual report of the commission.
(g) Qualified Immunity, Defense and Indemnification
(1) The members, officers, executive director, employees and
representatives of the commission shall be immune from suit and
liability, either personally or in their official capacity, for any claim for
damage to or loss of property or personal injury or other civil liability
caused by or arising out of any actual or alleged act, error or omission
that occurred or that the person against whom the claim is made had a
reasonable basis for believing occurred within the scope of commission
employment, duties or responsibilities, provided nothing in this
subdivision shall be construed to protect any such person from suit or
liability for any damage, loss, injury or liability caused by the intentional
or wilful or wanton misconduct of such person.
(2) The commission shall defend any member, officer, executive
director, employee or representative of the commission in any civil
action seeking to impose liability arising out of any actual or alleged act,
error or omission that occurred within the scope of commission
employment, duties or responsibilities or that the person against whom
the claim is made had a reasonable basis for believing occurred within
the scope of commission employment, duties or responsibilities,
provided (A) nothing in this subdivision shall be construed to prohibit
such person from retaining his or her own counsel, and (B) the actual or
alleged act, error or omission did not result from such person's
intentional or wilful or wanton misconduct.
(3) The commission shall indemnify and hold harmless any member,
officer, executive director, employee or representative of the
commission for the amount of any settlement or judgment obtained
against such person arising out of any actual or alleged act, error or
omission that occurred within the scope of commission employment, Substitute Senate Bill No. 9
Public Act No. 23-97 41 of 80
duties or responsibilities or that such person had a reasonable basis for
believing occurred within the scope of commission employment, duties
or responsibilities, provided the actual or alleged act, error or omission
did not result from the intentional or wilful or wanton misconduct of
such person.
SECTION 8. DATA SYSTEM
(a) The commission shall provide for the development, maintenance
and utilization of a coordinated database and reporting system
containing licensure, adverse action and investigative information on all
licensed individuals in member states.
(b) Notwithstanding any other provision of state law to the contrary,
a member state shall submit a uniform data set to the data system on all
individuals to whom the compact is applicable as required by the rules
of the commission, including:
(1) Identifying information;
(2) Licensure data;
(3) Adverse actions against a license or compact privilege;
(4) Nonconfidential information related to alternative program
participation;
(5) Any denial of application for licensure, and the reason for such
denial; and
(6) Other information that may facilitate the administration of the
compact, as determined by the rules of the commission.
(c) Investigative information pertaining to a licensee in any member
state shall only be available to other party states. Substitute Senate Bill No. 9
Public Act No. 23-97 42 of 80
(d) The commission shall promptly notify all member states of any
adverse action taken against a licensee or an individual applying for a
license. Adverse action information pertaining to a licensee in any
member state shall be available to any other member state.
(e) Member states contributing information to the data system may
designate information that may not be shared with the public without
the express permission of the contributing state.
(f) Any information submitted to the data system that is subsequently
required to be expunged by the laws of the member state contributing
the information shall be removed from the data system.
SECTION 9. RULEMAKING
(a) The commission shall exercise its rulemaking powers pursuant to
the criteria set forth in this section and the rules adopted thereunder.
Rules and amendments shall become binding as of the date specified in
each rule or amendment.
(b) If a majority of the legislatures of the member states rejects a rule,
by enactment of a statute or resolution in the same manner used to adopt
the compact not later than four years after the date of adoption of the
rule, such rule shall have no further force and effect in any member
state.
(c) Rules or amendments to the rules shall be adopted at a regular or
special meeting of the commission.
(d) Prior to promulgation and adoption of a final rule or rules by the
commission, and at least thirty days in advance of the meeting at which
the rule will be considered and voted upon, the commission shall file a
notice of proposed rulemaking:
(1) On the Internet web site of the commission or other publicly Substitute Senate Bill No. 9
Public Act No. 23-97 43 of 80
accessible platform; and
(2) On the Internet web site of each member state physical therapy
licensing board or other publicly accessible platform or the publication
in which each state would otherwise publish proposed rules.
(e) The notice of proposed rulemaking shall include:
(1) The proposed time, date and location of the meeting in which the
rule will be considered and voted upon;
(2) The text of the proposed rule or amendment and the reason for
the proposed rule;
(3) A request for comments on the proposed rule from any interested
person; and
(4) The manner in which interested persons may submit notice to the
commission of their intention to attend the public hearing and any
written comments.
(f) Prior to adoption of a proposed rule, the commission shall allow
persons to submit written data, facts, opinions and arguments, which
shall be made available to the public.
(g) The commission shall grant an opportunity for a public hearing
before it adopts a rule or amendment if a hearing is requested by:
(1) At least twenty-five persons;
(2) A state or federal governmental subdivision or agency; or
(3) An association having at least twenty-five members.
(h) If a hearing is held on the proposed rule or amendment, the
commission shall publish the place, time and date of the scheduled
public hearing. If the hearing is held via electronic means, the Substitute Senate Bill No. 9
Public Act No. 23-97 44 of 80
commission shall publish the mechanism for access to the electronic
hearing.
(1) All persons wishing to be heard at the hearing shall notify the
executive director of the commission or other designated member in
writing of their desire to appear and testify at the hearing not less than
five business days before the scheduled date of the hearing.
(2) Hearings shall be conducted in a manner providing each person
who wishes to comment a fair and reasonable opportunity to comment
orally or in writing.
(3) All hearings shall be recorded. A copy of the recording shall be
made available on request.
(4) Nothing in this section shall be construed as requiring a separate
hearing on each rule. Rules may be grouped for the convenience of the
commission at hearings required by this section.
(i) Following the scheduled hearing date, or by the close of business
on the scheduled hearing date if the hearing was not held, the
commission shall consider all written and oral comments received.
(j) If no written notice of intent to attend the public hearing by
interested parties is received, the commission may proceed with
promulgation of the proposed rule without a public hearing.
(k) The commission shall, by majority vote of all members, take final
action on the proposed rule and shall determine the effective date of the
rule, if any, based on the rulemaking record and the full text of the rule.
(l) Upon determination that an emergency exists, the commission
may consider and adopt an emergency rule without prior notice,
opportunity for comment or hearing, provided the usual rulemaking
procedures provided in the compact and in this section shall be Substitute Senate Bill No. 9
Public Act No. 23-97 45 of 80
retroactively applied to the rule as soon as reasonably possible, but in
no event later than ninety days after the effective date of the rule. For
the purposes of this subsection, an emergency rule shall be adopted
immediately to:
(1) Meet an imminent threat to public health, safety or welfare;
(2) Prevent a loss of commission or member state funds;
(3) Meet a deadline for the promulgation of an administrative rule
that is established by federal law or rule; or
(4) Protect public health and safety.
(m) The commission or an authorized committee of the commission
may direct revisions to a previously adopted rule or amendment for
purposes of correcting typographical errors, errors in format, errors in
consistency or grammatical errors. Public notice of any revisions shall
be posted on the Internet web site of the commission. The revision shall
be subject to challenge by any person for a period of thirty days after
posting. The revision may be challenged only on grounds that the
revision results in a material change to a rule. A challenge shall be made
in writing and delivered to the chair of the commission prior to the end
of the notice period. If no challenge is made, the revision shall take effect
without further action. If the revision is challenged, the revision may not
take effect without the approval of the commission.
SECTION 10. OVERSIGHT, DISPUTE RESOLUTION AND
ENFORCEMENT
(a) Oversight
(1) The executive, legislative and judicial branches of state
government in each member state shall enforce the compact and take all
actions necessary and appropriate to effectuate the compact's purposes Substitute Senate Bill No. 9
Public Act No. 23-97 46 of 80
and intent. The provisions of the compact and the rules promulgated
under the compact shall have standing as statutory law.
(2) All courts shall take judicial notice of the compact and the rules in
any judicial or administrative proceeding in a member state pertaining
to the subject matter of the compact which may affect the powers,
responsibilities or actions of the commission.
(3) The commission shall be entitled to receive service of process in
any such proceeding and shall have standing to intervene in such a
proceeding for all purposes. Failure to provide service of process to the
commission shall render a judgment or order void as to the commission,
the compact or promulgated rules.
(b) Default, Technical Assistance and Termination
(1) If the commission determines that a member state has defaulted
in the performance of its obligations or responsibilities under the
compact or the promulgated rules, the commission shall:
(A) Provide written notice to the defaulting state and other member
states of the nature of the default, the proposed means of curing the
default, and or any other action to be taken by the commission; and
(B) Provide remedial training and specific technical assistance
regarding the default.
(2) If a state in default fails to cure the default, the defaulting state
may be terminated from the compact upon an affirmative vote of a
majority of the member states, and all rights, privileges and benefits
conferred by the compact may be terminated on the effective date of
termination. A cure of the default shall not relieve the offending state of
obligations or liabilities incurred during the period of default.
(3) Termination of membership in the compact shall be imposed only Substitute Senate Bill No. 9
Public Act No. 23-97 47 of 80
after all other means of securing compliance have been exhausted.
Notice of intent to suspend or terminate shall be given by the
commission to the governor, the majority and minority leaders of the
defaulting state's legislature and each of the member states.
(4) A state that has been terminated is responsible for all assessments,
obligations and liabilities incurred through the effective date of
termination, including obligations that extend beyond the effective date
of termination.
(5) The commission shall not bear any costs related to a state that is
found to be in default or that has been terminated from the compact,
unless agreed upon in writing between the commission and the
defaulting state.
(6) The defaulting state may appeal the action of the commission by
petitioning the United States District Court for the District of Columbia
or the federal district where the commission has its principal offices. The
prevailing member shall be awarded all costs of such litigation,
including reasonable attorney's fees.
(c) Dispute Resolution
(1) Upon request by a member state, the commission shall attempt to
resolve disputes related to the compact that arise among member states
and between member and nonmember states.
(2) The commission shall promulgate a rule providing for both
mediation and binding dispute resolution for disputes as appropriate.
(d) Enforcement
(1) The commission, in the reasonable exercise of its discretion, shall
enforce the provisions and rules of the compact.
(2) By majority vote, the commission may initiate legal action in the Substitute Senate Bill No. 9
Public Act No. 23-97 48 of 80
United States District Court for the District of Columbia or the federal
district where the commission has its principal offices against a member
state in default to enforce compliance with the provisions of the compact
and its promulgated rules and bylaws. The relief sought may include
both injunctive relief and damages. In the event judicial enforcement is
necessary, the prevailing member shall be awarded all costs of such
litigation, including reasonable attorney's fees.
(3) The remedies herein shall not be the exclusive remedies of the
commission. The commission may pursue any other remedies available
under federal or state law.
SECTION 11. DATE OF IMPLEMENTATION OF THE INTERSTATE
COMMISSION FOR PHYSICAL THERAPY PRACTICE AND
ASSOCIATED RULES, WITHDRAWAL AND AMENDMENT
(a) The compact shall come into effect on the date on which the
compact statute is enacted into law in the tenth member state. The
provisions, which become effective at such time, shall be limited to the
powers granted to the commission relating to assembly and the
promulgation of rules. Thereafter, the commission shall meet and
exercise rulemaking powers necessary to the implementation and
administration of the compact.
(b) Any state that joins the compact subsequent to the commission's
initial adoption of the rules shall be subject to the rules as they exist on
the date on which the compact becomes law in such state. Any rule that
has been previously adopted by the commission shall have the full force
and effect of law on the day the compact becomes law in such state.
(c) Any member state may withdraw from the compact by enacting a
statute repealing the same.
(1) A member state's withdrawal shall not take effect until six months
after enactment of the repealing statute. Substitute Senate Bill No. 9
Public Act No. 23-97 49 of 80
(2) Withdrawal shall not affect the continuing requirement of the
withdrawing state's physical therapy licensing board to comply with the
investigative and adverse action reporting requirements of the compact
prior to the effective date of withdrawal.
(d) Nothing contained in the compact shall be construed to invalidate
or prevent any physical therapy licensure agreement or other
cooperative arrangement between a member state and a nonmember
state that does not conflict with the provisions of the compact.
(e) The compact may be amended by the member states. No
amendment to the compact shall become effective and binding upon
any member state until it is enacted into the laws of all member states.
SECTION 12. CONSTRUCTION AND SEVERABILITY
The compact shall be liberally construed so as to effectuate the
purposes thereof. The provisions of the compact shall be severable, and
if any phrase, clause, sentence or provision of the compact is declared to
be contrary to the constitution of any party state or the Constitution of
the United States, or the applicability thereof to any government,
agency, person or circumstance is held invalid, the validity of the
remainder of the compact and the applicability thereof to any
government, agency, person or circumstance shall not be affected
thereby. If the compact shall be held contrary to the constitution of any
party state, the compact shall remain in full force and effect as to the
remaining party states and in full force and effect as to the party state
affected as to all severable matters."
Sec. 17. (NEW) (Effective July 1, 2023) The Commissioner of Public
Health shall require each person applying for licensure as a physical
therapist or physical therapist assistant to submit to a state and national
fingerprint-based criminal history records check pursuant to section 29-
17a of the general statutes. For the purposes of this section, "physical Substitute Senate Bill No. 9
Public Act No. 23-97 50 of 80
therapist" means an individual licensed for the independent practice of
physical therapy, "physical therapist assistant" means an individual
licensed to assist in the practice of physical therapy in this state under
the supervision of a physical therapist and "licensure" means
authorization by a state physical therapy regulatory authority to engage
in the independent practice of physical therapy, the practice of which
would be unlawful without such authorization.
Sec. 18. (Effective July 1, 2023) (a) The Commissioner of Public Health
shall establish a podiatric scope of practice working group to advise the
Department of Public Health and any relevant scope of practice review
committee established pursuant to section 19a-16e of the general
statutes regarding the scope of practice of podiatrists as it relates to
surgical procedures. The working group shall consist of not less than
three podiatrists licensed pursuant to chapter 375 of the general statutes
and not less than three orthopedic surgeons licensed pursuant to
chapter 370 of the general statutes appointed by the commissioner. Not
later than January 1, 2024, the working group shall report to the
commissioner and any such scope of practice review committee
regarding its findings and recommendations.
(b) Not later than February 1, 2024, the Commissioner of Public
Health shall report, in accordance with the provisions of section 11-4a
of the general statutes, to the joint standing committee of the General
Assembly having cognizance of matters relating to public health on the
findings and recommendations of the working group and whether the
Department of Public Health and any relevant scope of practice review
committee is in agreement with such findings and recommendations.
Sec. 19. Section 20-94a of the general statutes is repealed and the
following is substituted in lieu thereof (Effective October 1, 2023):
(a) The Department of Public Health may issue an advanced practice
registered nurse license to a person seeking to perform the activities Substitute Senate Bill No. 9
Public Act No. 23-97 51 of 80
described in subsection (b) of section 20-87a, as amended by this act,
upon receipt of a fee of two hundred dollars, to an applicant who: (1)
Maintains a license as a registered nurse in this state, as provided by
section 20-93 or 20-94; (2) holds and maintains current certification as a
nurse practitioner, a clinical nurse specialist or a nurse anesthetist from
one of the following national certifying bodies that certify nurses in
advanced practice: The American Nurses' Association, the Nurses'
Association of the American College of Obstetricians and Gynecologists
Certification Corporation, the National Board of Pediatric Nurse
Practitioners and Associates or the American Association of Nurse
Anesthetists, their successors or other appropriate national certifying
bodies approved by the Board of Examiners for Nursing; (3) has
completed thirty hours of education in pharmacology for advanced
nursing practice; and (4) (A) holds a graduate degree in nursing or in a
related field recognized for certification as either a nurse practitioner, a
clinical nurse specialist, or a nurse anesthetist by one of the foregoing
certifying bodies, or (B) (i) on or before December 31, 2004, completed
an advanced nurse practitioner program that a national certifying body
identified in subdivision (2) of subsection (a) of this section recognized
for certification of a nurse practitioner, clinical nurse specialist, or nurse
anesthetist, and (ii) at the time of application, holds a current license as
an advanced practice registered nurse in another state that requires a
master's degree in nursing or a related field for such licensure. No
license shall be issued under this section to any applicant against whom
professional disciplinary action is pending or who is the subject of an
unresolved complaint.
(b) During the period commencing January 1, 1990, and ending
January 1, 1992, the Department of Public Health may in its discretion
allow a registered nurse, who has been practicing as an advanced
practice registered nurse in a nurse practitioner role and who is unable
to obtain certification as a nurse practitioner by one of the national
certifying bodies specified in subsection (a) of this section, to be licensed Substitute Senate Bill No. 9
Public Act No. 23-97 52 of 80
as an advanced practice registered nurse provided the individual:
(1) Holds a current Connecticut license as a registered nurse pursuant
to this chapter;
(2) Presents the department with documentation of the reasons one
of such national certifying bodies will not certify him as a nurse
practitioner;
(3) Has been in active practice as a nurse practitioner for at least five
years in a facility licensed pursuant to section 19a-491;
(4) Provides the department with documentation of his preparation
as a nurse practitioner;
(5) Provides the department with evidence of at least seventy-five
contact hours, or its equivalent, of continuing education related to his
nurse practitioner specialty in the preceding five calendar years;
(6) Has completed thirty hours of education in pharmacology for
advanced nursing practice;
(7) Has his employer provide the department with a description of
his practice setting, job description, and a plan for supervision by a
licensed physician; and
(8) Notifies the department of each change of employment to a new
setting where he will function as an advanced practice registered nurse
and will be exercising prescriptive and dispensing privileges.
(c) Any person who obtains a license pursuant to subsection (b) of
this section shall be eligible to renew such license annually provided he
presents the department with evidence that he received at least fifteen
contact hours, or its equivalent, eight hours of which shall be in
pharmacology, of continuing education related to his nurse practitioner
specialty in the preceding licensure year. If an individual licensed Substitute Senate Bill No. 9
Public Act No. 23-97 53 of 80
pursuant to subsection (b) of this subsection becomes eligible at any
time for certification as a nurse practitioner by one of the national
certifying bodies specified in subsection (a) of this section, the
individual shall apply for certification, and upon certification so notify
the department, and apply to be licensed as an advanced practice
registered nurse in accordance with subsection (a) of this section.
(d) On and after October 1, 2023, a person, who is not eligible for
licensure under subsection (a) of this section, may apply for licensure by
endorsement as an advanced practice registered nurse. Such applicant
shall (1) present evidence satisfactory to the Commissioner of Public
Health that the applicant has acquired three years of experience as an
advanced practice registered nurse, or as a person entitled to perform
similar services under a different designation, in another state or
jurisdiction that has requirements for practicing in such capacity that are
substantially similar to, or higher than, those of this state and that there
are no disciplinary actions or unresolved complaints pending against
such person, and (2) pay a fee of two hundred dollars to the
commissioner.
[(d)] (e) A person who has received a license pursuant to this section
shall be known as an "Advanced Practice Registered Nurse" and no
other person shall assume such title or use the letters or figures which
indicate that the person using the same is a licensed advanced practice
registered nurse.
Sec. 20. Subsection (b) of section 20-87a of the general statutes is
repealed and the following is substituted in lieu thereof (Effective October
1, 2023):
(b) (1) Advanced nursing practice is defined as the performance of
advanced level nursing practice activities that, by virtue of post-basic
specialized education and experience, are appropriate to and may be
performed by an advanced practice registered nurse. The advanced Substitute Senate Bill No. 9
Public Act No. 23-97 54 of 80
practice registered nurse performs acts of diagnosis and treatment of
alterations in health status, as described in subsection (a) of this section.
(2) (A) An advanced practice registered nurse having been issued a
license pursuant to section 20-94a, as amended by this act, shall, for the
first three years after having been issued such license, collaborate with
a physician licensed to practice medicine in this state. In all settings,
such advanced practice registered nurse may, in collaboration with a
physician licensed to practice medicine in this state, prescribe, dispense
and administer medical therapeutics and corrective measures and may
request, sign for, receive and dispense drugs in the form of professional
samples in accordance with sections 20-14c to 20-14e, inclusive, except
such advanced practice registered nurse licensed pursuant to section 20-
94a, as amended by this act, and maintaining current certification from
the American Association of Nurse Anesthetists who is prescribing and
administrating medical therapeutics during surgery may only do so if
the physician who is medically directing the prescriptive activity is
physically present in the institution, clinic or other setting where the
surgery is being performed. For purposes of this subdivision,
"collaboration" means a mutually agreed upon relationship between
such advanced practice registered nurse and a physician who is
educated, trained or has relevant experience that is related to the work
of such advanced practice registered nurse. The collaboration shall
address a reasonable and appropriate level of consultation and referral,
coverage for the patient in the absence of such advanced practice
registered nurse, a method to review patient outcomes and a method of
disclosure of the relationship to the patient. Relative to the exercise of
prescriptive authority, the collaboration between such advanced
practice registered nurse and a physician shall be in writing and shall
address the level of schedule II and III controlled substances that such
advanced practice registered nurse may prescribe and provide a method
to review patient outcomes, including, but not limited to, the review of
medical therapeutics, corrective measures, laboratory tests and other Substitute Senate Bill No. 9
Public Act No. 23-97 55 of 80
diagnostic procedures that such advanced practice registered nurse may
prescribe, dispense and administer.
(B) An advanced practice registered nurse having been issued a
license pursuant to subsection (d) of section 20-94a, as amended by this
act, who collaborated, prior to the issuance of such license, with a
physician licensed to practice medicine in another state may count the
time of such collaboration toward the three-year requirement set forth
in subparagraph (A) of this subsection, provided such collaboration
otherwise satisfies the requirements set forth in said subparagraph.
(3) An advanced practice registered nurse having (A) been issued a
license pursuant to section 20-94a, as amended by this act, (B)
maintained such license, or, for an advanced practice registered nurse
having been issued a license pursuant to subsection (d) of said section,
such license or a license to practice in another state as an advanced
practice registered nurse or as a person entitled to perform similar
services under a different designation, for a period of not less than three
years, and (C) engaged in the performance of advanced practice level
nursing activities in collaboration with a physician for a period of not
less than three years and not less than two thousand hours in accordance
with the provisions of subdivision (2) of this subsection, may, thereafter,
alone or in collaboration with a physician or another health care
provider licensed to practice in this state: (i) Perform the acts of
diagnosis and treatment of alterations in health status, as described in
subsection (a) of this section; and (ii) prescribe, dispense and administer
medical therapeutics and corrective measures and dispense drugs in the
form of professional samples as described in subdivision (2) of this
subsection in all settings. Any advanced practice registered nurse
electing to practice not in collaboration with a physician in accordance
with the provisions of this subdivision shall maintain documentation of
having engaged in the performance of advanced practice level nursing
activities in collaboration with a physician for a period of not less than Substitute Senate Bill No. 9
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three years and not less than two thousand hours. Such advanced
practice registered nurse shall maintain such documentation for a
period of not less than three years after completing such requirements
and shall submit such documentation to the Department of Public
Health for inspection not later than forty-five days after a request made
by the department for such documentation. Any such advanced practice
registered nurse shall submit written notice to the Commissioner of
Public Health of his or her intention to practice without collaboration
with a physician after completing the requirements described in this
subdivision and prior to beginning such practice. Not later than
December first, annually, the Commissioner of Public Health shall
publish on the department's Internet web site a list of such advanced
practice registered nurses who are authorized to practice not in
collaboration with a physician.
(4) An advanced practice registered nurse licensed under the
provisions of this chapter may make the determination and
pronouncement of death of a patient, provided the advanced practice
registered nurse attests to such pronouncement on the certificate of
death and signs the certificate of death not later than twenty-four hours
after the pronouncement.
Sec. 21. (NEW) (Effective July 1, 2023) Not later than January 1, 2024,
the owner or operator of each splash pad and spray park where water
is recirculated shall post a sign in a conspicuous location at or near the
entryway to the splash pad or spray park stating that the water is
recirculated and warning that there is a potential health risk to persons
ingesting the water.
Sec. 22. (NEW) (Effective from passage) (a) Notwithstanding the
provisions of chapter 378 of the general statutes, a public or independent
institution of higher education that (1) is accredited as a degree-granting
institution in good standing by a regional accrediting association
recognized by the Secretary of the United States Department of Substitute Senate Bill No. 9
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Education and maintains such accreditation status; and (2) offers, or is
seeking state approval to offer, a nursing program pursuant to section
10a-34 of the general statutes, may apply to the Connecticut State Board
of Examiners for Nursing to establish a pilot program that offers
licensed practical nursing education and training on or before January
30, 2024. As used in this subsection, "public institution of higher
education" and "independent institution of higher education" have the
same meanings as described in section 10a-173 of the general statutes.
(b) An institution of higher education that applies to the Connecticut
State Board of Examiners for Nursing to establish a pilot program
pursuant to subsection (a) of this section shall provide to said board the
following information, in writing, not later than sixty days prior to the
date on which it seeks to establish the pilot program:
(1) Identifying information regarding the pilot program, including,
but not limited to, the name of the program, address where such
program will be administered, responsible party for the program and
contact information for the program;
(2) A description of the pilot program, including accreditation status,
any clinical partner and anticipated enrollment by academic term;
(3) An identification of resources that support the program;
(4) Graduation rates and National Council Licensure Examination
licensure and certification pass rates for the past three years for any
existing nursing programs offered by the institution of higher
education;
(5) A plan for employing qualified faculty and administrators and
clinical experiences; and
(6) Other information as requested by the Connecticut State Board of
Examiners for Nursing. Substitute Senate Bill No. 9
Public Act No. 23-97 58 of 80
(c) The Connecticut State Board of Examiners for Nursing shall
review and consider an application made by an institution of higher
education described in subsection (a) of this section to establish a pilot
program pursuant to said subsection if the institution of higher
education provides the information required pursuant to subsection (b)
of this section. The Connecticut State Board of Examiners for Nursing
may hold a public hearing on such application.
(d) The pilot program established pursuant to this section shall
comply with the relevant provisions of chapter 378 of the general
statutes and sections 20-90-45 to 20-90-59, inclusive, of the regulations
of Connecticut state agencies. Notwithstanding the provisions of section
10a-34 of the general statutes, if such pilot program complies with such
provisions for not less than two years, and provides evidence that the
program is meeting its educational outcomes, as defined in section 20-
90-47 of the regulations of Connecticut state agencies, such pilot
program shall be deemed fully approved by the Connecticut State Board
of Examiners for Nursing.
Sec. 23. (NEW) (Effective from passage) The Office of Higher Education
may enter into a reciprocity agreement with one or more neighboring
states that permits such neighboring state to allow a student attending
an institution of higher education in such neighboring state to train in a
clinical rotation for credit in Connecticut, provided such neighboring
state allows a student attending a Connecticut institution of higher
education to train in a clinical rotation for credit in such neighboring
state.
Sec. 24. Subsection (f) of section 19a-112j of the general statutes is
repealed and the following is substituted in lieu thereof (Effective July 1,
2023):
(f) A majority of the membership of the commission shall constitute
a quorum for the transaction of any business and any decision shall be Substitute Senate Bill No. 9
Public Act No. 23-97 59 of 80
by a majority vote of those present at a meeting, except the commission
may establish such subcommissions, advisory groups or other entities
as it deems necessary to further the purposes of the commission,
including, but not limited to, a subcommission, advisory group or other
entity to evaluate the challenges associated with the provision of home
health care to victims of gun violence and methods to foster a system
that unites community service providers with adults and juveniles
needing supports and services in order to address trauma suffered as a
result of gun violence.
Sec. 25. (Effective from passage) The Department of Public Health, in
consultation with the Department of Mental Health and Addiction
Services, and organizations representing health care facilities and
licensed health care professionals, shall develop a maternal mental
health toolkit to provide information and resources regarding maternal
mental health to licensed health care professionals and new parents in
the state. Such toolkit shall include, but need not be limited to, (1)
information about perinatal mood and anxiety disorders, including, but
not limited to, the symptoms of such disorders, potential impact of such
disorders on families and treatment options for a person with a perinatal
mood or anxiety disorder; and (2) a list of licensed health care
professionals, peer support networks and nonprofit organizations in the
state that treat perinatal mood and anxiety disorders or provide support
for persons with a perinatal mood or anxiety disorder and the family
members of such persons. Not later than October 1, 2023, the
Department of Public Health shall make such toolkit available on its
Internet web site.
Sec. 26. Section 19a-490u of the general statutes is repealed and the
following is substituted in lieu thereof (Effective October 1, 2023):
(a) Each hospital, as defined in section 19a-490, shall include training
in the symptoms of dementia as part of such hospital's regularly
provided training to staff members who provide direct care to patients. Substitute Senate Bill No. 9
Public Act No. 23-97 60 of 80
(b) On and after October 1, 2021, each hospital shall include training
in implicit bias as part of such hospital's regularly provided training to
staff members who provide direct care to women who are pregnant or
in the postpartum period. As used in this subsection, "implicit bias"
means an attitude or internalized stereotype that affects a person's
perceptions, actions and decisions in an unconscious manner and often
contributes to unequal treatment of a person based on such person's
race, ethnicity, gender identity, sexual orientation, age, disability or
other characteristic.
(c) On and after October 1, 2023, each hospital shall include training
in perinatal mood and anxiety disorders as part of such hospital's
regularly provided training to staff members who provide direct care to
women who are pregnant or in the postpartum period.
Sec. 27. (Effective from passage) (a) On or before July 1, 2023, the
Commissioner of Public Health shall convene a working group to advise
the commissioner regarding methods to alleviate emergency
department crowding and the lack of available emergency department
beds in the state, including, but not limited to, the following:
(1) The establishment of a quality measure for the timeliness of the
transfer of an emergency department patient, who will be admitted to
the hospital, out of the hospital's emergency department;
(2) The establishment of emergency department discharge units to
expedite the discharge of patients from the emergency department;
(3) (A) An evaluation of the percentage of emergency department
patients who are held in the emergency department after being
admitted to the hospital and while waiting for an inpatient bed to
become available, and (B) the development of a plan to decrease such
percentage; and
(4) The reduction in liability for hospitals and their emergency Substitute Senate Bill No. 9
Public Act No. 23-97 61 of 80
physicians when patient crowding of a hospital's emergency
department has reached the point of causing significant wait times for
patients seeking emergency department services.
(b) The working group convened pursuant to subsection (a) of this
section may include, but need not be limited to, the following members:
(1) Two emergency physicians licensed pursuant to chapter 370 of the
general statutes representing the Connecticut chapter of a national
college of emergency physicians; (2) two emergency physicians licensed
pursuant to chapter 370 of the general statutes, one of whom shall be the
director of the emergency department of a larger hospital system in the
state, and one of whom shall be the director of the emergency
department of an independent community hospital; (3) one primary
care physician licensed pursuant to chapter 370 of the general statutes
representing the Connecticut chapter of a national college of physicians;
(4) two representatives of a hospital association in the state; (5) one
representative of a medical society in the state; (6) one representative of
the Connecticut chapter of a national organization of emergency nurses;
(7) one representative of the Connecticut chapter of a national
organization of pediatric physicians; (8) one representative of the
Connecticut chapter of a national association of psychiatrists; (9) one
representative of an association of nurses in the state; (10) two nurses
licensed pursuant to chapter 378 of the general statutes, one of whom
shall be the nurse director of the emergency department in a larger
hospital system, and one of whom shall be the nurse director of the
emergency department in an independent community hospital; (11) two
patient care navigators, one of whom shall be employed by a larger
hospital system, and one of whom shall be employed by an independent
community hospital; (12) one representative of hospital patients in the
state; (13) one provider of emergency medical transportation services in
the state; (14) one representative of a national association of retired
persons; (15) the Healthcare Advocate, or the Healthcare Advocate's
designee; (16) the Commissioner of Mental Health and Addiction Substitute Senate Bill No. 9
Public Act No. 23-97 62 of 80
Services, or the commissioner's designee; (17) the Commissioner of
Children and Families, or the commissioner's designee; (18) one
representative from the Department of Public Health's Office of
Emergency Medical Services; (19) one representative from the
Department of Public Health's facilities licensing and investigations
section; (20) one representative of the Office of the Long-Term Care
Ombudsman; (21) the Child Advocate, or the Child Advocate's
designee; (22) one representative of a nonprofit nursing home in the
state; (23) one representative from a for-profit nursing home in the state;
(24) one representative from the insurance industry in the state; and (25)
one member of an association of trial lawyers in the state. The
chairpersons of the working group shall be one of the emergency
physicians representing the Connecticut chapter of a national college of
emergency physicians and one of the representatives of a hospital
association in the state, who shall be selected by the Commissioner of
Public Health. Once selected, the chairpersons of the working group
may convene the first meeting of the working group whether or not any
other members of the working group identified in subdivisions (1) to
(25), inclusive, of this subsection have been selected by the
Commissioner of Public Health. If said commissioner has not selected
any member of the working group described in said subdivisions on or
before August 1, 2023, the cochairpersons may jointly select such
member. The first meeting of the working group shall be held not later
than December 1, 2023. The working group shall meet biannually and
at other times upon the call of the cochairpersons.
(c) On or before January 1, 2024, and annually thereafter until January
1, 2025, the working group shall report its findings and
recommendations to the Commissioner of Public Health and, in
accordance with the provisions of section 11-4a of the general statutes,
to the joint standing committee of the General Assembly having
cognizance of matters relating to public health. Substitute Senate Bill No. 9
Public Act No. 23-97 63 of 80
Sec. 28. (Effective from passage) (a) There is established a task force to
study childhood and adult psychosis. Such study shall include, but need
not be limited to, an examination of (1) the establishment of, in
collaboration with the Departments of Children and Families and
Mental Health and Addiction Services, clinics staffed by mental health
care providers in various fields who provide comprehensive care for
children and adults who are experiencing symptoms of early or first
episode psychosis to prevent symptoms from becoming disabling, (2)
early evaluation of children and adults with symptoms of a psychosis
and management of such symptoms, including, but not limited to,
initiating treatment and making any necessary referrals for additional
treatment or services, (3) creating (A) care pathways that include
specialty teams that treat children and adults who are experiencing
early or first episode psychosis, (B) a state-wide model for coordinating
specialty care for children and adults experiencing psychosis, as
recommended by the National Institute of Mental Health, and (C)
services for such children and adults, including, but not limited to,
collaboration on psychotherapy and pharmacotherapy, family support,
education, coordination with community support services and
collaboration with employers and education systems, and (4)
strengthening existing clinical networks that treat children and adults
experiencing psychosis with a focus on collaborative research and
outcomes. As used in this subsection, "psychosis" means a severe mental
condition in which disruptions to a person's thoughts and perceptions
make it difficult for the person to recognize what is real and what is not
real and are often experienced as seeing, hearing and believing things
that are not real or having strange, persistent thoughts, behaviors and
emotions, including, but not limited to, hallucinations and delusions.
(b) The task force shall consist of the following members:
(1) Two appointed by the speaker of the House of Representatives,
one of whom shall be a child and adolescent psychiatrist with Substitute Senate Bill No. 9
Public Act No. 23-97 64 of 80
experience treating patients with psychosis and one of whom shall be a
clinical researcher in the field of psychosis;
(2) Two appointed by the president pro tempore of the Senate, one of
whom shall be a psychiatrist with experience treating adults with
psychosis and one of whom shall be a clinical researcher in the field of
psychosis;
(3) One appointed by the majority leader of the House of
Representatives, who shall be the parent or guardian of a child or
adolescent who has been treated for psychosis;
(4) One appointed by the majority leader of the Senate, who shall be
an adult who has been treated for psychosis;
(5) One appointed by the minority leader of the House of
Representatives, who shall be a licensed mental health care provider
who has treated children or adolescents with psychosis;
(6) One appointed by the minority leader of the Senate, who shall be
a licensed mental health care provider who has treated adults with
psychosis;
(7) The Commissioner of Mental Health and Addiction Services, or
the commissioner's designee; and
(8) The Commissioner of Children and Families, or the
commissioner's designee.
(c) Any member of the task force appointed under subdivision (1),
(2), (3), (4), (5) or (6) of subsection (b) of this section may be a member
of the General Assembly.
(d) All initial appointments to the task force shall be made not later
than thirty days after the effective date of this section. Any vacancy shall
be filled by the appointing authority. Substitute Senate Bill No. 9
Public Act No. 23-97 65 of 80
(e) The speaker of the House of Representatives and the president pro
tempore of the Senate shall select the chairpersons of the task force from
among the members of the task force. Such chairpersons shall schedule
the first meeting of the task force, which shall be held not later than sixty
days after the effective date of this section.
(f) The administrative staff of the joint standing committee of the
General Assembly having cognizance of matters relating to public
health shall serve as administrative staff of the task force.
(g) Not later than January 1, 2024, the task force shall submit a report
on its findings and recommendations to the joint standing committee of
the General Assembly having cognizance of matters relating to public
health, in accordance with the provisions of section 11-4a of the general
statutes. The task force shall terminate on the date that it submits such
report or January 1, 2024, whichever is later.
Sec. 29. (Effective from passage) (a) The Departments of Mental Health
and Addiction Services, Social Services and Children and Families shall,
in consultation with direct service providers and individuals with lived
experience, evaluate existing programs for persons with substance use
disorder who are caregivers of children and the barriers to treatment of
such persons and develop a plan for the establishment and
implementation of programs for the treatment of such persons and their
children. Such programs shall include, but need not be limited to, the
following:
(1) Same-day access, in all geographical areas, to family-centered
medication-assisted treatment that includes prenatal and perinatal care
and access to supports that provide a bridge to such treatment;
(2) Intensive in-home treatment supports;
(3) Gender-specific programming; Substitute Senate Bill No. 9
Public Act No. 23-97 66 of 80
(4) Expanded access to residential programs for pregnant and
parenting persons, including residential programs for parents who have
more than one child or who have children over the age of seven; and
(5) Access to recovery support specialists and peer support to provide
care coordination.
(b) Not later than January 1, 2024, the Commissioners of Mental
Health and Addiction Services, Social Services and Children and
Families shall jointly report, in accordance with the provisions of section
11-4a of the general statutes, to the joint standing committees of the
General Assembly having cognizance of matters relating to public
health, human services and children regarding such plan and
recommendations for legislative changes necessary to implement the
programs described in subsection (a) of this section.
Sec. 30. (Effective from passage) The Departments of Mental Health and
Addiction Services and Social Services shall, in collaboration with the
Office of Early Childhood, establish a plan to permit parents who are in
treatment for substance use disorder to be eligible for child care
supports and subsidies. Not later than January 1, 2024, the
Commissioners of Mental Health and Addiction Services and Social
Services shall jointly report, in accordance with the provisions of section
11-4a of the general statutes, to the joint standing committees of the
General Assembly having cognizance of matters relating to public
health and human services regarding such plan.
Sec. 31. (Effective from passage) Not later than January 1, 2024, the
Commissioner of Mental Health and Addiction Services shall report, in
accordance with the provisions of section 11-4a of the general statutes,
to the joint standing committees of the General Assembly having
cognizance of matters relating to public health, human services and
housing regarding access in the state to supportive housing for pregnant
and parenting persons with a substance use disorder. Substitute Senate Bill No. 9
Public Act No. 23-97 67 of 80
Sec. 32. (Effective from passage) Not later than January 1, 2024, the
Commissioners of Mental Health and Addiction Services, Social
Services and Children and Families shall jointly report, in accordance
with the provisions of section 11-4a of the general statutes, to the joint
standing committees of the General Assembly having cognizance of
matters relating to public health, human services and children regarding
access for parents with a substance use disorder whose children are
receiving services from the Department of Children and Families to
appropriate treatment for substance use disorder in the state to prevent
removal of children from their parents where possible and to support
reunification when removal is necessary, including, but not limited to,
consideration of in-home parenting and child care services to assist with
safety planning during initial stages of treatment and recovery.
Sec. 33. (Effective from passage) Not later than January 1, 2024, the
Commissioners of Mental Health and Addiction Services, Children and
Families and Social Services shall jointly report, in accordance with the
provisions of section 11-4a of the general statutes, to the joint standing
committees of the General Assembly having cognizance of matters
relating to public health regarding existing substance use disorder
treatment services for pregnant and parenting persons, utilization of
such services and areas where additional substance use disorder
treatment services for such persons are necessary.
Sec. 34. (Effective from passage) Not later than January 1, 2024, the
Commissioner of Children and Families shall report, in accordance with
the provisions of section 11-4a of the general statutes, to the joint
standing committees of the General Assembly having cognizance of
matters relating to public health and children regarding efforts of the
Department of Children and Families to mitigate child safety concerns
in the home when the child is living with a caregiver with a substance
use disorder.
Sec. 35. Subsection (b) of section 17a-674d of the general statutes is Substitute Senate Bill No. 9
Public Act No. 23-97 68 of 80
repealed and the following is substituted in lieu thereof (Effective July 1,
2023):
(b) The committee shall consist of the following members:
(1) The Secretary of the Office of Policy and Management, or the
secretary's designee;
(2) The Attorney General, or the Attorney General's designee;
(3) The Commissioners of Children and Families, Mental Health and
Addiction Services and Public Health, or said commissioners' designees,
who shall serve as ex-officio members;
(4) The president pro tempore of the Senate, the speaker of the House
of Representatives, the majority leaders of the Senate and House of
Representatives, the minority leaders of the Senate and House of
Representatives, the Senate and House chairpersons of the joint
standing [committee] committees of the General Assembly having
cognizance of matters relating to appropriations and the budgets of state
agencies and public health, or their designees, provided such persons
have experience living with a substance [or] use disorder or are the
family member of a person who has experience living with a substance
use disorder;
(5) [Seventeen] Twenty-one individuals representing municipalities,
who shall be appointed by the Governor;
(6) The executive director of the Commission on Racial Equity in
Public Health, or a representative of the commission designated by the
executive director; and
(7) [Six] Eight individuals appointed by the commissioner as follows:
(A) A provider of community-based substance use treatment services
for adults, who shall be a nonvoting member; (B) a provider of Substitute Senate Bill No. 9
Public Act No. 23-97 69 of 80
community-based substance use treatment services for adolescents,
who shall be a nonvoting member; (C) an addiction medicine licensed
health care professional with prescribing ability, who shall be a
nonvoting member; [and] (D) three individuals with experience living
with a substance use disorder or family members of an individual with
experience living with a substance use disorder; and (E) two individuals
with experience supporting infants and children affected by the opioid
crisis.
Sec. 36. Subdivision (8) of section 19a-177 of the general statutes is
repealed and the following is substituted in lieu thereof (Effective October
1, 2023):
(8) (A) Develop an emergency medical services data collection
system. Each emergency medical service organization licensed or
certified pursuant to this chapter shall submit data to the commissioner,
on a quarterly basis, from each licensed ambulance service, certified
ambulance service or paramedic intercept service that provides
emergency medical services. Such submitted data shall include, but not
be limited to: (i) The total number of and reasons for calls for emergency
medical services received by such licensed ambulance service, certified
ambulance service or paramedic intercept service through the 9-1-1
system during the reporting period; (ii) each level of emergency medical
services, as defined in regulations adopted pursuant to section 19a-179,
required for each such call; (iii) the response time for each licensed
ambulance service, certified ambulance service or paramedic intercept
service during the reporting period; (iv) the number of passed calls,
cancelled calls and mutual aid calls, both made and received, during the
reporting period; and (v) for the reporting period, the prehospital data
for the nonscheduled transport of patients required by regulations
adopted pursuant to subdivision (6) of this section. The data required
under this subdivision may be submitted in any electronic form selected
by such licensed ambulance service, certified ambulance service or Substitute Senate Bill No. 9
Public Act No. 23-97 70 of 80
paramedic intercept service and approved by the commissioner,
provided the commissioner shall take into consideration the needs of
such licensed ambulance service, certified ambulance service or
paramedic intercept service in approving such electronic form. The
commissioner may conduct an audit of any such licensed ambulance
service, certified ambulance service or paramedic intercept service as
the commissioner deems necessary in order to verify the accuracy of
such reported data.
(B) On or before June 1, 2023, and annually thereafter, the
commissioner shall prepare a report to the Emergency Medical Services
Advisory Board, established pursuant to section 19a-178a, that shall
include, but not be limited to, the following data: (i) The total number
of calls for emergency medical services received during the reporting
year by each licensed ambulance service, certified ambulance service or
paramedic intercept service; (ii) the level of emergency medical services
required for each such call; (iii) the name of the emergency medical
service organization that provided each such level of emergency
medical services furnished during the reporting year; (iv) the response
time, by time ranges or fractile response times, for each licensed
ambulance service, certified ambulance service or paramedic intercept
service, using a common definition of response time, as provided in
regulations adopted pursuant to section 19a-179; [and] (v) the number
of passed calls, cancelled calls and mutual aid calls during the reporting
year; and (vi) any shortage of emergency medical services personnel in
the state. The commissioner shall prepare such report in a format that
categorizes such data for each municipality in which the emergency
medical services were provided, with each such municipality grouped
according to urban, suburban and rural classifications.
(C) If any licensed ambulance service, certified ambulance service or
paramedic intercept service does not submit the data required under
subparagraph (A) of this subdivision for a period of six consecutive Substitute Senate Bill No. 9
Public Act No. 23-97 71 of 80
months, or if the commissioner believes that such licensed ambulance
service, certified ambulance service or paramedic intercept service
knowingly or intentionally submitted incomplete or false data, the
commissioner shall issue a written order directing such licensed
ambulance service, certified ambulance service or paramedic intercept
service to comply with the provisions of subparagraph (A) of this
subdivision and submit all missing data or such corrected data as the
commissioner may require. If such licensed ambulance service, certified
ambulance service or paramedic intercept service fails to fully comply
with such order not later than three months from the date such order is
issued, the commissioner (i) shall conduct a hearing, in accordance with
chapter 54, at which such licensed ambulance service, certified
ambulance service or paramedic intercept service shall be required to
show cause why the primary service area assignment of such licensed
ambulance service, certified ambulance service or paramedic intercept
service should not be revoked, and (ii) may take such disciplinary action
under section 19a-17 as the commissioner deems appropriate.
(D) The commissioner shall collect the data required by
subparagraph (A) of this subdivision, in the manner provided in said
subparagraph, from each emergency medical service organization
licensed or certified pursuant to this chapter. Any such emergency
medical service organization that fails to comply with the provisions of
this section shall be liable for a civil penalty not to exceed one hundred
dollars per day for each failure to report the required data regarding
emergency medical services provided to a patient, as determined by the
commissioner. The civil penalties set forth in this subparagraph shall be
assessed only after the department provides a written notice of
deficiency and the organization is afforded the opportunity to respond
to such notice. An organization shall have not more than fifteen business
days after the date of receiving such notice to provide a written response
to the department. The commissioner may adopt regulations, in
accordance with chapter 54, concerning the development, Substitute Senate Bill No. 9
Public Act No. 23-97 72 of 80
implementation, monitoring and collection of emergency medical
service system data. All state agencies licensed or certified as emergency
medical service organizations shall be exempt from the civil penalties
set forth in this subparagraph.
(E) The commissioner shall, with the recommendation of the
Connecticut Emergency Medical Services Advisory Board established
pursuant to section 19a-178a, adopt for use in trauma data collection the
most recent version of the National Trauma Data Bank's National
Trauma Data Standards and Data Dictionary and nationally recognized
guidelines for field triage of injured patients.
(F) On or before June 1, 2024, and annually thereafter, the
commissioner shall submit the report described in subparagraph (B) of
this subdivision, in accordance with the provisions of section 11-4a, to
the joint standing committee of the General Assembly having
cognizance of matters relating to public health;
Sec. 37. (Effective from passage) (a) There is established a task force to
study issues concerning rural health. Such study shall include, but need
not be limited to, an examination of resources and services available to
promote rural health and support health care providers in rural areas
throughout the state and methods for coordinating and streamlining
such resources and services.
(b) The task force shall consist of the following members:
(1) One appointed by the speaker of the House of Representatives;
(2) One appointed by the president pro tempore of the Senate;
(3) One appointed by the majority leader of the House of
Representatives;
(4) One appointed by the majority leader of the Senate; Substitute Senate Bill No. 9
Public Act No. 23-97 73 of 80
(5) One appointed by the minority leader of the House of
Representatives;
(6) One appointed by the minority leader of the Senate;
(7) One each appointed by the chairpersons of the joint standing
committee of the General Assembly having cognizance of matters
relating to public health;
(8) One each appointed by the ranking members of the joint standing
committee of the General Assembly having cognizance of matters
relating to public health;
(9) The Commissioner of Public Health, or the commissioner's
designee;
(10) The Commissioner of Mental Health and Addiction Services, or
the commissioner's designee;
(11) The Attorney General, or the Attorney General's designee;
(12) The State Comptroller, or the State Comptroller's designee; and
(13) The executive director of the Office of Health Strategy, or the
executive director's designee.
(c) Any member of the task force appointed under subdivision (1),
(2), (3), (4), (5), (6), (7) or (8) of subsection (b) of this section may be a
member of the General Assembly.
(d) All initial appointments to the task force shall be made not later
than thirty days after the effective date of this section. Any vacancy shall
be filled by the appointing authority.
(e) The speaker of the House of Representatives and the president pro
tempore of the Senate shall select the chairpersons of the task force from Substitute Senate Bill No. 9
Public Act No. 23-97 74 of 80
among the members of the task force. Such chairpersons shall schedule
the first meeting of the task force, which shall be held not later than sixty
days after the effective date of this section.
(f) The administrative staff of the joint standing committee of the
General Assembly having cognizance of matters relating to public
health shall serve as administrative staff of the task force.
(g) Not later than January 1, 2024, the task force shall submit a report
on its findings and recommendations to the joint standing committee of
the General Assembly having cognizance of matters relating to public
health, in accordance with the provisions of section 11-4a of the general
statutes. The task force shall terminate on the date that it submits such
report or January 1, 2024, whichever is later.
Sec. 38. (Effective from passage) The Commissioner of Education, in
consultation with the Labor Commissioner and Commissioner of Public
Health, shall study the feasibility of establishing an interdistrict magnet
school program that provides education and training to students
interested in health care professions. The program shall provide
pathways for a student to (1) graduate with a certification, license or
registration that enables such student to practice in a health care field
upon graduation from the program, and (2) complete a curriculum
designed to prepare such student for higher education in premedicine
or nursing. Not later than February 1, 2024, the Commissioner of
Education shall report, in accordance with the provisions of section 11-
4a of the general statutes, to the joint standing committee of the General
Assembly having cognizance of matters relating to public health
regarding the results of such study.
Sec. 39. (Effective from passage) The Commissioner of Aging and
Disability Services, in consultation with the Advisory Board for Persons
Who are Deaf, Hard of Hearing or Deafblind, shall conduct a study to
evaluate gaps in communication access for deaf, hard of hearing or Substitute Senate Bill No. 9
Public Act No. 23-97 75 of 80
deafblind persons to medical providers and develop recommendations
for improved access, including, but not limited to, interpreting through
American Sign Language for such persons and through Spanish Sign
Language for such persons whose primary language is Spanish. Not
later than October 1, 2023, the commissioner shall report, in accordance
with the provisions of section 11-4a of the general statutes, to the joint
standing committees of the General Assembly having cognizance of
matters relating to aging, human services and public health on such
study.
Sec. 40. Subdivision (1) of subsection (c) of section 20-112a of the
general statutes is repealed and the following is substituted in lieu
thereof (Effective October 1, 2023):
(c) (1) A licensed dentist may delegate to dental assistants such dental
procedures as the dentist may deem advisable, including: (A) The taking
of dental x-rays if the dental assistant can demonstrate successful
completion of the dental radiation health and safety examination
administered by the Dental Assisting National Board or a radiation
health and safety competency assessment administered by a dental
education program in the state that is accredited by the American Dental
Association's Commission on Dental Accreditation; (B) the taking of
impressions of teeth for study models; and (C) the provision of fluoride
varnish treatments. Such procedures shall be performed under the
direct supervision of a licensed dentist and the dentist providing direct
supervision shall assume responsibility for such procedures.
Sec. 41. (Effective from passage) On or before January 1, 2025, The
University of Connecticut School of Dental Medicine shall develop a
radiation health and safety competency assessment for dental assistants
that reflects current industry practices regarding the taking of dental x-
rays. Such assessment shall be a suitable competency evaluation, the
successful completion of which would allow a dental assistant to take
dental x-rays under the direct supervision of a licensed dentist pursuant Substitute Senate Bill No. 9
Public Act No. 23-97 76 of 80
to the provisions of subdivision (1) of subsection (c) of section 20-112a
of the general statutes, as amended by this act. Not later than January 1,
2025, The University of Connecticut School of Dental Medicine shall
report, in accordance with the provisions of section 11-4a of the general
statutes, to the joint standing committee of the General Assembly
having cognizance of matters relating to public health regarding the
development of such assessment.
Sec. 42. Section 19a-197a of the general statutes is repealed and the
following is substituted in lieu thereof (Effective October 1, 2023):
(a) As used in this section, ["emergency medical technician"]
"emergency medical services personnel" means (1) any class of
emergency medical technician certified [under regulations adopted
pursuant to section 20-206oo] pursuant to sections 20-206ll and 20-
206mm, including, but not limited to, any advanced emergency medical
technician, [and] (2) any paramedic licensed pursuant to [section]
sections 20-206ll and 20-206mm, and (3) any emergency medical
responder certified pursuant to sections 20-206ll and 20-206mm.
(b) Any emergency medical [technician] services personnel who has
been trained, in accordance with national standards recognized by the
Commissioner of Public Health, in the administration of epinephrine
using automatic prefilled cartridge injectors, [or] similar automatic
injectable equipment or by prefilled vial and syringe and who functions
in accordance with written protocols and the standing orders of a
licensed physician serving as an emergency department director [may]
shall administer epinephrine using such injectors, [or] equipment or
prefilled vial and syringe when the use of epinephrine is deemed
necessary by the emergency medical services personnel for the
treatment of a patient. All emergency medical [technicians] services
personnel shall receive such training from an organization designated
by the commissioner. All licensed or certified ambulances shall be
equipped with epinephrine in such injectors, [or] equipment [which Substitute Senate Bill No. 9
Public Act No. 23-97 77 of 80
may be administered] or prefilled vials and syringes that the emergency
medical services personnel shall administer in accordance with written
protocols and standing orders of a licensed physician serving as an
emergency department director.
Sec. 43. (NEW) (Effective January 1, 2024) (a) Each institution, as
defined in section 19a-490 of the general statutes, except a facility
operated by the Department of Mental Health and Addiction Services
and the hospital and psychiatric residential treatment facility units of
the Albert J. Solnit Children's Center, shall, upon receipt of a medical
records request directed by the patient or the patient's representative,
provide an electronic copy of such patient's medical records to another
such institution (1) as soon as feasible, but not later than six days after
such request is received by the institution, if such request is urgent, or
(2) not later than seven business days after such request is received, if
such request is not urgent. Notwithstanding any other provision of the
general statutes, an institution providing an electronic copy of a
patient's medical records pursuant to the provisions of this section shall
not be required to obtain specific written consent from such patient
before providing such electronic copy.
(b) The provisions of subsection (a) of this section shall not be
construed to require an institution to provide records (1) in violation of
the Health Insurance Portability and Accountability Act of 1996, P.L.
104-191, as amended from time to time, or 45 CFR 160.101 to 45 CFR
164.534, inclusive, as amended from time to time, (2) in response to a
direct request from another health care provider, unless such provider
can validate that such provider has a health provider relationship with
the patient whose records are being requested, or (3) in response to a
third-party request.
Sec. 44. (Effective from passage) (a) There is established a task force to
study methods to address the shortage of radiologic technologists,
nuclear medicine technologists and respiratory care practitioners in the Substitute Senate Bill No. 9
Public Act No. 23-97 78 of 80
state and develop a plan to address such shortage.
(b) The task force shall consist of the following members:
(1) One appointed by the speaker of the House of Representatives,
who has expertise in the radiologic technologist profession and is a
representative of a state-wide association of radiologic technologists;
(2) One appointed by the president pro tempore of the Senate, who
has expertise in the nuclear medicine technologists profession and is a
representative of a state-wide association of nuclear medicine
technologists;
(3) One appointed by the majority leader of the House of
Representatives, who has expertise in the respiratory care practitioners
profession and is a representative of a state-wide association of
respiratory care practitioners;
(4) One appointed by the majority leader of the Senate, who is a
representative of an association of hospitals in the state;
(5) One appointed by the minority leader of the House of
Representatives, who is a representative of a society of radiologists in
the state;
(6) One appointed by the minority leader of the Senate, who has
expertise in pulmonary issues and is a representative of a medical
society in the state; and
(7) The chairpersons and ranking members of the joint standing
committee of the General Assembly having cognizance of matters
relating to public health, or the chairpersons' and ranking members'
designees.
(c) Any member of the task force appointed under subsection (b) of
this section may be a member of the General Assembly. Substitute Senate Bill No. 9
Public Act No. 23-97 79 of 80
(d) All initial appointments to the task force shall be made not later
than thirty days after the effective date of this section. Any vacancy shall
be filled by the appointing authority.
(e) The speaker of the House of Representatives and the president pro
tempore of the Senate shall select the chairpersons of the task force from
among the members of the task force. Such chairpersons shall schedule
the first meeting of the task force, which shall be held not later than sixty
days after the effective date of this section.
(f) The administrative staff of the joint standing committee of the
General Assembly having cognizance of matters relating to public
health shall serve as administrative staff of the task force.
(g) Not later than January 1, 2024, the task force shall submit a report
on its findings and recommendations to the joint standing committee of
the General Assembly having cognizance of matters relating to public
health, in accordance with the provisions of section 11-4a of the general
statutes. The task force shall terminate on the date that it submits such
report or January 1, 2024, whichever is later.
Sec. 45. (NEW) (Effective July 1, 2023) The Commissioner of Public
Health shall require each person applying for licensure as a physician
under section 20-13 of the general statutes, who indicates an intention
to apply for a license in one or more other states not later than one year
after the date of such person's application for licensure, to submit to a
state and national fingerprint-based criminal history records check by
the Department of Emergency Services and Public Protection. The
Commissioner of Emergency Services and Public Protection shall report
the results of each such criminal history records check to the
Commissioner of Public Health pursuant to the provisions of section 29-
17a of the general statutes.
Sec. 46. (NEW) (Effective July 1, 2023) The Commissioner of Public Substitute Senate Bill No. 9
Public Act No. 23-97 80 of 80
Health shall require each person applying for licensure as a psychologist
to submit to a state and national fingerprint-based criminal history
records check pursuant to section 29-17a of the general statutes. For the
purposes of this section, "psychologist" means an individual licensed for
the independent practice of psychology and "licensure" means
authorization by a state psychology regulatory authority to engage in
the independent practice of psychology, the practice of which would be
unlawful without such authorization.