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OLR Bill Analysis
sSB 9
AN ACT CONCERNING HEALTH AND WELLNESS FOR
CONNECTICUT RESIDENTS.
TABLE OF CONTENTS:
§ 1 — ASSISTED REPRODUCTIVE TECHNOLOGY
Prohibits anyone from barring or unreasonably limiting (1) anyone from accessing ART
or (2) authorized providers from performing these procedures, and makes related changes
§ 2 — MEDICAID FUNDING FOR LONG-ACTING REVERSIBLE
CONTRACEPTIVES
Conforms to existing DSS policy by requiring Medicaid coverage for same-day access to
long-acting reversible contraceptives at federally qualified health centers
§§ 3 & 4 — DRUG USE HARM REDUCTION CENTE RS
Requires DMHAS to create a pilot program establishing harm reduction centers where
people with substance use disorder (1) can access counseling and various other services
and (2) in a separate location, safely use drugs under health care provider observation;
creates an advisory committee to advise DMHAS on various issues concerning the pilot
program
§ 5 — OPIOID ANTAGONIST BULK PURCHASE FUND
Creates an Opioid Antagonist Bulk Purchase Fund, which DMHAS must use to give
grants to municipalities or other eligible entities to buy opioid antagonists in large
quantities at discounted prices
§ 6 — OPIOID ANTAGONIST PRESCRIPTIONS
Requires prescribing practitioners, when prescribing an opioid, to also give certain
patients a prescription for an opioid antagonist
§§ 7 & 8 — EMS PROVIDING OPIOID ANTAGONIST KITS
Requires DPH’s Office of Emergency Medical Services to develop a program for EMS
personnel to provide kits with opioid antagonists and an opioid-related fact sheet to certain
patients, such as those showing symptoms of opioid use disorder; allows prescribers and
pharmacies to enter into related standing orders
§ 9 — HEALTH CARE CAREER ADVISORY COUNCIL
Requires the education commissioner to establish a Health Care Career Advisory Council
to advise on developing a health career program that promotes these career options and
provides shadowing and internship opportunities for students
§ 10 — NURSING WORKFORCE WORKING GROUP
Requires DPH to convene a working group to develop recommendations to expand the
nursing workforce in the state 2023SB-00009-R000507-BA.DOCX
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§§ 11 & 12 — HEALTH CARE PROVIDERS SERVING AS ADJUNCT
FACULTY
Requires public higher education institutions to consider any licensed health care provider
with at least 10 years of clinical experience to be qualified for an adjunct faculty position;
correspondingly requires the Office of Higher Education to establish a program providing
incentive grants to these providers who become adjunct professors, with the grants
covering the difference between their most recent clinical salary and adjunct salary
§ 13 — NURSE’S AIDE COMPETENCY EVA LUATIONS
Requires DPH to offer nurse’s aide competency tests in both English and Spanish
§ 14 — PERSONAL CARE ATTENDANT CAREER PA THWAYS
PROGRAM
Requires DSS to establish a PCA career pathways program, including both a basic skills
and specialized skills pathway, to improve their quality of care and incentivize their
recruitment and retention in the state
§ 15 — HOSPITAL PRIVILEGES
Prohibits hospitals, for purposes of granting practice privileges, from requiring (1) board
eligible physicians to become board-certified until five years after becoming board eligible,
or (2) board certified physicians to provide evidence of board recertification
§§ 16 & 17 — BAN ON PHYSICIAN OR APRN NON-COMPETE
CLAUSES
Prohibits physician or APRN non-compete clauses that are entered into, amended,
extended, or renewed starting on July 1, 2023
§ 18 — MEDICAL MALPRACTICE REFORM TASK FORCE
Creates a task force to study medical malpractice reform to incentivize physicians and
other providers to practice in the state
§ 19 — PHYSICAL THERAPY LICENSURE COMPAC T
Enters Connecticut into the Physical Therapy Licensure Compact, which provides a
process authorizing physical therapists or physical therapy assistants properly
credentialed in one member state to practice across state boundaries, without requiring
licensure in each state
§ 20 — BACKGROUND CH ECKS FOR PT LICENSURE
Requires PT licensure applicants to complete a fingerprint-based criminal background
check
§ 21 — PODIATRIC SCOPE OF PRACTICE WORKING GROUP
Requires DPH to establish a working group to advise the department and any relevant
scope of practice review committee on podiatrists’ scope of practice relating to surgical
procedures
§ 22 — APRN LICENSURE BY ENDORSEMENT
Allows for licensure by endorsement for APRNs who have (1) practiced for at least three
years in another state with practice requirements that are substantially similar to, or
higher, than Connecticut’s and (2) no disciplinary history or unresolved complaints
pending
§ 23 — HEALTH CARE PROVIDER LOAN REIMBUR SEMENT 2023SB-00009-R000507-BA.DOCX
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For purposes of a health care provider loan reimbursement program, requires OHE to
award at least 10% of grants to providers working full-time in rural communities
§ 24 — SPLASH PAD AND SPRAY PARK WARNING SIGNS
Requires splash pad and spray park owners or operators to post warning signs about the
potential health risk of ingesting recirculated water
COMMENT
§ 1 — ASSISTED REPRODUCTIVE TECHNOL OGY
Prohibits anyone from barring or unreasonably limiting (1) anyone from accessing ART
or (2) authorized providers from performing these procedures, and makes related changes
This bill prohibits any person or entity from prohibiting or
unreasonably limiting someone from:
1. accessing assisted reproductive technology (ART);
2. continuing or completing an ongoing ART treatment or
procedure under a written plan or agreement with a health care
provider; or
3. retaining all rights on the use of reproductive genetic materials,
such as gametes and embryos.
The bill also prohibits anyone from prohibiting or unreasonably
limiting a health care provider who is licensed, certified, or otherwise
authorized to perform ART treatments or procedures from (1) doing so
or (2) providing evidence-based information related to ART.
Under the bill, “assisted reproductive technology” includes all
treatments or procedures in which human oocytes (i.e., cells that
develop into eggs) or embryos are handled, such as (1) in vitro
fertilization and (2) gamete or zygote intrafallopian transfer (see 42
U.S.C. § 263a-7).
EFFECTIVE DATE: Upon passage
§ 2 — MEDICAID FUNDING FOR LONG -ACTING REVERSIBLE
CONTRACEPTIVES
Conforms to existing DSS policy by requiring Medicaid coverage for same-day access to
long-acting reversible contraceptives at federally qualified health centers 2023SB-00009-R000507-BA.DOCX
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The bill requires the Department of Social Services (DSS)
commissioner to adjust Medicaid reimbursement criteria to cover same-
day access to long-acting reversible contraceptives at federally qualified
health centers. In doing so, the bill conforms to current DSS policy.
The bill defines this type of contraceptive as any contraception
method that does not have to be used more than once per menstrual
cycle or per month.
EFFECTIVE DATE: July 1, 2023
§§ 3 & 4 — DRUG USE HARM REDUCTION CENTE RS
Requires DMHAS to create a pilot program establishing harm reduction centers where
people with substance use disorder (1) can access counseling and various other services
and (2) in a separate location, safely use drugs under health care provider observation;
creates an advisory committee to advise DMHAS on various issues concerning the pilot
program
The bill requires the Department of Mental Health and Addiction
Services (DMHAS), in consultation with the Department of Public
Health (DPH), to create a pilot program consisting of harm reduction
centers to prevent drug overdoses. Under the bill, these centers must be
established in three municipalities the commissioner chooses, subject to
their chief elected officials’ approval.
For this purpose, “harm reduction centers” are medical facilities
where a person with a substance use disorder may (1) receive various
services, such as counseling, treatment referrals, and basic support
services (see below) and (2) in a separate location, safely consume
controlled substances under the observation of licensed health care
providers who are present to provide necessary medical treatment in
the event of an overdose (see COMMENT section below).
Under the bill, these centers must employ licensed providers with
experience treating people with substance use disorders. The DMHAS
commissioner determines the staffing level. The bill specifies that a
health care provider’s participation in the pilot program is not grounds
for DPH disciplinary action.
The bill requires the DMHAS commissioner to adopt regulations 2023SB-00009-R000507-BA.DOCX
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implementing the pilot program. It allows her to request Opioid
Settlement Fund disbursements to fund the program fully or partially.
The bill creates a Harm Reduction Center Pilot Program Advisory
Committee to advise DMHAS on issues concerning the program’s
establishment.
It also requires the DMHAS commissioner to report annually to the
Public Health Committee, starting by January 1, 2024, and until the
program ends. She must report on the advisory committee’s
recommendations (see below) and the program’s outcomes.
EFFECTIVE DATE: Upon passage
Harm Reduction Center Services and Providers
The bill requires harm reduction centers under the pilot program to
offer the following services to people with a substance use disorder:
1. substance use disorder and other mental health counseling;
2. educational information about opioid antagonists and the risks
of contracting diseases from sharing hypodermic needles;
3. referrals to substance use disorder treatment services; and
4. access to basic support services, including laundry machines, a
bathroom, a shower, and a place to rest.
The bill requires the centers to employ licensed providers with
experience treating people with substance use disorders, to (1) provide
these counseling services and (2) monitor people using the center and
provide treatment to those experiencing overdose symptoms. The
centers must provide referrals for (1) substance use disorder or mental
health counseling or (2) other mental health or medical treatment
services that may be appropriate.
Pilot Program Advisory Committee (§ 4)
Charge. The bill requires the advisory committee to meet at the
DMHAS commissioner’s discretion and make recommendations to her 2023SB-00009-R000507-BA.DOCX
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on the following:
1. maximizing the centers’ potential public health and safety
benefits;
2. the proper disposal of hypodermic needles and syringes;
3. the recovery of people using the centers;
4. federal, state, and local laws impacting the centers’ creation and
operation;
5. appropriate guidance to relevant professional licensing boards
on the impact of health care providers’ participation on the
program’s effectiveness;
6. potentially integrating the program with other public health
efforts;
7. consideration of other beneficial factors to promote public health
and safety in the program’s operation; and
8. how to protect property owners and staff, volunteers, and
program participants from criminal or civil liability resulting
from the program.
Membership and Procedures. Under the bill, the advisory
committee includes the following people or their designees:
1. the DMHAS commissioner;
2. the DPH commissioner;
3. the Connecticut Conference of Municipalities’ president; and
4. one of the Opioid Settlement Advisory Committee’s co-
chairpersons (specifically, the one appointed by the House
speaker and Senate president pro tempore).
The advisory committee also includes 11 appointed members, as 2023SB-00009-R000507-BA.DOCX
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shown in the table below. The appointing authority fills any vacancy.
Table: Harm Reduction Center Pilot Program Advisory Committee Appointed
Members
Appointing Authority Appointee Qualifications
In-state medical society (1) Organization representative
In-state hospital society (1) Organization representative
Connecticut chapter of a national
society of addiction medicine (1)
Organization representative
House speaker (2) One person with a substance use disorder
One administrator of a harm reduction center
in another state
Senate president pro tempore (2) One health care provider with experience
treating people with substance use disorders
and overdose prevention
One administrator of a harm reduction center
in another state
House majority leader (1) Current or former law enforcement official
Senate majority leader (1) Family member of someone who suffered a
fatal drug overdose
House minority leader (1) Licensed mental health care provider
experienced in treating people with opioid use
disorder
Senate minority leader (1) Licensed health care provider experienced in
treating people who have experienced a drug
overdose
Under the bill, the DMHAS commissioner or her designee serves as
the advisory committee’s chairperson. The chairperson, with a majority
vote of members present, may appoint ex-officio nonvoting members in
specialties not represented among voting members.
The chairperson may also designate one or more working groups to
address specific issues and must appoint members to these groups. Each
working group must report its findings and recommendations to the full
committee.
§ 5 — OPIOID ANTAGONIST BULK PURCHASE FU ND 2023SB-00009-R000507-BA.DOCX
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Creates an Opioid Antagonist Bulk Purchase Fund, which DMHAS must use to give
grants to municipalities or other eligible entities to buy opioid antagonists in large
quantities at discounted prices
The bill creates an Opioid Antagonist Bulk Purchase Fund as a
separate, nonlapsing General Fund account. DMHAS must use the
account’s funds to give grants to eligible entities to buy opioid
antagonists in large quantities at discounted prices.
The program is open to (1) municipalities, (2) local and regional
boards of education, (3) similar bodies governing nonpublic schools, (4)
district and municipal health departments, and (5) law enforcement
agencies. The DMHAS commissioner (1) must create an application
process, and (2) may contract with a prescription drug wholesaler to
purchase and distribute opioid antagonists through the program.
As under existing law, an opioid antagonist is naloxone
hydrochloride (e.g., Narcan) or any other similarly acting and equally
safe drug that the Food and Drug Administration (FDA) has approved
for treating a drug overdose.
The bill requires DMHAS to adopt implementing regulations but
allows it to implement policies and procedures while in the process of
adopting regulations. It also requires DMHAS to annually report on the
program, starting by January 1, 2025.
EFFECTIVE DATE: October 1, 2023
Opioid Antagonist Bulk Purchase Fund (§ 5(b))
The bill requires the state treasurer to administer the Bulk Purchase
Fund account. The account must contain (1) any state appropriations or
other state money made available for the fund’s purposes; (2) moneys
required by law to be deposited into the account; (3) gifts, grants,
donations, or bequests directed to it; and (4) the account’s investment
earnings. Any balance remaining at the end of a fiscal year must be
carried forward.
DMHAS must use the funds for the grant program, except the
department may use up to 2% of the account in any fiscal year for related 2023SB-00009-R000507-BA.DOCX
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administrative expenses.
Regulations and Related Policies and Procedures (§ 5(d))
The bill requires DMHAS to adopt regulations to implement this bulk
purchasing program. But during the regulation adoption process,
DMHAS may implement the policies and procedures in the regulations,
as long as the department posts notice of intent to adopt regulations on
its website and the state’s eRegulations System within 20 days after
implementing them. The policies and procedures are valid until
regulations are adopted, but no longer than one year after publishing
this notice.
Reporting Requirement
The bill requires DMHAS, starting by January 1, 2025, to annually
report on the program to the Public Health and Appropriations
committees. The reports must include the following information for the
prior calendar year:
1. the number of grant applications received;
2. the number of entities receiving grants and the amount each
received;
3. the number of opioid antagonists purchased by each grant
recipient, and if known by DMHAS, how the recipient used
them; and
4. any recommendations for the program, including proposed
legislation to facilitate the bill’s purposes.
§ 6 — OPIOID ANTAGONIST PRESCRIPTIONS
Requires prescribing practitioners, when prescribing an opioid, to also give certain
patients a prescription for an opioid antagonist
Under certain conditions, the bill requires prescribing practitioners,
when prescribing for an opioid (whether to an adult or minor patient),
to also prescribe an opioid antagonist for the patient. They must do so
when any of the following risk factors are present:
1. the patient has a history of a substance use disorder, 2023SB-00009-R000507-BA.DOCX
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2. the prescription was for a high-dose opioid drug that results in
90 morphine milligram equivalents or more per day, or
3. the patient is taking opioids as well as a benzodiazepine or
nonbenzodiazepine sedative hypnotic.
EFFECTIVE DATE: October 1, 2023
§§ 7 & 8 — EMS PROVIDING OPIOID ANTAGONIST KITS
Requires DPH’s Office of Emergency Medical Services to develop a program for EMS
personnel to provide kits with opioid antagonists and an opioid-related fact sheet to certain
patients, such as those showing symptoms of opioid use disorder; allows prescribers and
pharmacies to enter into related standing orders
The bill requires DPH’s Office of Emergency Medical Services
(OEMS) to develop a program for emergency medical services (EMS)
personnel to give kits with opioid antagonists and related information
(in a one-page fact sheet) to certain members of the public. OEMS must
develop the program by January 1, 2024, and consult with DMHAS and
the Department of Consumer Protection (DCP) in doing so.
For these purposes, EMS personnel include emergency medical
responders, emergency medical technicians (EMTs), advanced EMTs,
EMS instructors, and paramedics. The bill requires them to document
the number of kits they distribute through the program, including the
number of doses of opioid antagonists in each kit.
The bill allows EMS organizations to obtain opioid antagonists from
pharmacists to distribute through the program. It correspondingly
allows prescribers and pharmacies to enter into standing orders
allowing the pharmacy to dispense opioid antagonists to EMS
organizations for this purpose. (The bill does not specify who pays for
the kits.)
The bill allows DPH to adopt implementing regulations.
Starting by January 1, 2025, it also requires the OEMS executive
director to annually report to the Public Health Committee. The reports
must address the program’s implementation, including the information
the EMS personnel must document on the number of kits and doses they 2023SB-00009-R000507-BA.DOCX
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distributed.
EFFECTIVE DATE: July 1, 2023
EMS-Provided Opioid Antagonist Kits (§ 7(b))
Under the program, EMS personnel must distribute opioid
antagonist kits with a personal supply of this medication and a one-page
fact sheet to patients who (1) they are treating for an opioid overdose,
(2) show symptoms of opioid use disorder, or (3) are treated at a location
where the personnel observe evidence of illicit use of opioids. The
personnel must give the kits to the patients themselves or their family
members, caregivers, or friends who are at the location.
The fact sheet must be the one that existing law requires the state’s
Alcohol and Drug Policy Council to develop, with information on the
risks of taking an opioid drug, symptoms of opioid use disorder, and
available in-state services for people who experience symptoms of, or
are otherwise affected by, opioid use disorder.
The bill requires the EMS personnel, as they find appropriate, to refer
the patient (or their family member, caregiver, or friend) to the written
instructions on administering the opioid antagonist.
Standing Orders (§ 8)
Under the bill, prescribing practitioners authorized to prescribe
opioid antagonists may issue a standing order (i.e., non-patient specific
prescription) to a pharmacy, for the purpose of allowing pharmacists to
dispense opioid antagonists to EMS personnel under this new program.
Under the bill, as under existing law for similar standing orders in
other contexts, these orders are subject to several requirements,
including that:
1. the medication must be FDA-approved and administered nasally
or by auto-injection;
2. the pharmacist must have completed a DCP-approved training
and certification program; 2023SB-00009-R000507-BA.DOCX
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3. when dispensing the medication, the pharmacist must train the
person on how to administer it and keep a record of the
dispensing and training under the law’s recordkeeping
requirements;
4. the pharmacist must send a copy of the dispensing record to the
prescribing practitioner who entered into the standing order;
5. the pharmacy must give DCP a copy of each standing order; and
6. the pharmacists who dispense opioid antagonists under these
provisions are deemed not to have violated their standard of care.
§ 9 — HEALTH CARE CAREER ADVISORY COUNCI L
Requires the education commissioner to establish a Health Care Career Advisory Council
to advise on developing a health career program that promotes these career options and
provides shadowing and internship opportunities for students
The bill requires the education commissioner to establish a Health
Care Career Advisory Council to advise her on developing a program
that (1) promotes health care professions as career options to middle and
high school students and (2) provides health care job shadowing and
internship experiences for high school students.
The program would promote these professions through (1) career
day presentations; (2) developing partnerships with in-state health care
career education programs; and (3) creating counseling programs to
inform high school students about, and recruit them for, health care
professions.
EFFECTIVE DATE: July 1, 2023
Council Membership and Procedures
Under the bill, the council consists of representatives from the
following entities:
1. a Connecticut hospital association,
2. a Connecticut medical society,
3. the state chapter of a national association of nurse practitioners, 2023SB-00009-R000507-BA.DOCX
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4. a Connecticut nurses’ association,
5. a Connecticut physician assistants’ association,
6. the state chapter of a national association of social workers,
7. the state chapter of a national association of psychologists, and
8. a Connecticut pharmacists’ association.
Under the bill, members are not paid but are reimbursed for
necessary expenses. The council members must elect a chairperson from
among themselves.
The education commissioner must schedule the first meeting, to be
held by September 1, 2023. The council must meet upon t he
chairperson’s call or upon a request from the majority of members. A
majority of members constitutes a quorum, and a majority vote of a
quorum is needed for any official action.
Reporting Requirement
The bill requires the council, starting by January 1, 2024, to annually
report on its recommendations to the education commissioner and the
Education and Public Health Committees. Within 30 days after
receiving the report, the commissioner must notify local and regional
boards of education about the council’s recommendations.
Background — Related Bill
sSB 1228 (File 471, § 1), reported favorably by the Public Health
Committee, requires the education commissioner, in consultation with
the labor and DPH commissioners, to study the feasibility of
establishing an interdistrict magnet school program focused on training
students for health care professions.
§ 10 — NURSING WORKF ORCE WORKING GROUP
Requires DPH to convene a working group to develop recommendations to expand the
nursing workforce in the state
The bill requires the DPH commissioner to convene a working group
to develop recommendations for expanding the nursing workforce in 2023SB-00009-R000507-BA.DOCX
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the state. The group must evaluate:
1. the quality of in-state education and clinical training programs
for nurses and nurse’s aides,
2. the potential for increasing the number of these clinical training
sites,
3. the expansion of these clinical training facilities, and
4. any barriers to recruit and retain nurses and nurse’s aides.
EFFECTIVE DATE: Upon passage
Working Group Membership and Procedures
Under the bill, the nursing workforce working group consists 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 or an in-state hospital or
long-term care facility;
3. two representatives of a labor organization representing faculty
and professional staff at the regional community-technical
colleges;
4. the presidents of the Board of Regents for Higher Education
(BOR), the Connecticut State Colleges and Universities, and
UConn, or their designees;
5. one member of the UConn Health Center’s administration;
6. two representatives of the Connecticut Conference of
Independent Colleges;
7. the DPH, DSS, and Department of Administrative Services
commissioners, or their designees; 2023SB-00009-R000507-BA.DOCX
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8. the Office of Policy and Management secretary, or his designee;
9. a representative of the State Board of Examiners for Nursing; and
10. the chairpersons and ranking members of Public Health and
Higher Education and Employment Advancement committees,
or their designees.
The bill requires the DPH commissioner and BOR president, or their
designees, to serve as the working group’s chairpersons. They must
schedule the first meeting, to be held within 60 days after the bill’s
passage.
Reporting Requirement
The bill requires the working group to report to the Public Health and
Higher Education and Employment Advancement committees by
January 1, 2024. The group must report its findings and any
recommendations to improve recruiting and retaining nurses and
nurse’s aides in the state, including a five-year and 10-year plan to
increase the nursing workforce in the state.
The group terminates when it submits its report or January 1, 2024,
whichever is later.
§§ 11 & 12 — HEALTH CARE PROVIDERS SERVI NG AS ADJUNCT
FACULTY
Requires public higher education institutions to consider any licensed health care provider
with at least 10 years of clinical experience to be qualified for an adjunct faculty position;
correspondingly requires the Office of Higher Education to establish a program providing
incentive grants to these providers who become adjunct professors, with the grants
covering the difference between their most recent clinical salary and adjunct salary
Beginning January 1, 2024, the bill requires public higher education
institutions to consider any licensed health care provider applying for
an adjunct faculty position in their field to be qualified if the provider
has at least 10 years of clinical experience. Under the bill, the institutions
must give them the same consideration as other qualified applicants
(presumably, as it relates to experience). If a provider is hired under this
provision, they are eligible for grants equal to the difference between
their clinical salary and adjunct salary (see below). 2023SB-00009-R000507-BA.DOCX
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These provisions apply to UConn, the Connecticut State Universities,
the regional community-technical colleges, and Charter Oak State
College, and regardless of existing higher education statutes.
EFFECTIVE DATE: July 1, 2023
Supplemental Grant Program
The bill requires the Office of Higher Education (OHE), by January 1,
2024, to establish and administer a program giving incentive grants to
licensed health care providers accepting adjunct professor positions
under the provisions described above.
The grant must make up the difference between the provider’s (1)
most recent annual salary as a clinical provider and (2) salary as an
adjunct professor at one of these institutions. (The bill does not require
a provider to work as an adjunct full-time. It is unclear how the grant
functions for part-time adjuncts who retain clinical positions.)
OHE must give grants for as long as the provider remains employed
in this role at the institution. OHE’s executive director must establish
the application process.
The bill requires the executive director, starting by January 1, 2025, to
annually report on the program to the Public Health Committee. He
must report on:
1. the number and demographics of the adjunct professors who
applied for and received program grants,
2. which institutions employed them and the number and types of
classes they taught, and
3. any other information he considers pertinent.
§ 13 — NURSE’S AIDE COMPETENCY EVALUATIO NS
Requires DPH to offer nurse’s aide competency tests in both English and Spanish
Starting January 1, 2024, the bill requires DPH to offer any required
competency evaluations for nurse’s aides in both English and Spanish. 2023SB-00009-R000507-BA.DOCX
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EFFECTIVE DATE: July 1, 2023
§ 14 — PERSONAL CARE ATTENDANT CAREER PATHWAYS
PROGRAM
Requires DSS to establish a PCA career pathways program, including both a basic skills
and specialized skills pathway, to improve their quality of care and incentivize their
recruitment and retention in the state
The bill requires DSS, by January 1, 2024, to establish and administer
a career pathways program for personal care attendants (PCAs). The
program’s purpose is to improve PCAs’ quality of care and incentivize
their recruitment and retention in the state.
PCAs provide in-home and community-based personal care
assistance and other non-professional services to the elderly and people
with disabilities. The bill allows PCAs who are not employed by a
consumer (i.e., a person receiving services under a state-funded
program), but eligible for this employment, to participate in the
program after completing a DSS-developed orientation program.
EFFECTIVE DATE: July 1, 2023
Program Objectives
The bill requires the program to include at least the following
objectives:
1. increasing PCAs’ retention and recruitment to maintain a stable
workforce for consumers, including by creating career pathways
that improve PCAs’ skill and knowledge and increase their
wages;
2. dignity in how PCAs provide care, and how consumers receive
it, through meaningful collaboration between them;
3. improving the quality of personal care assistance and the
consumers’ overall quality of life;
4. advancing equity in personal care assistance;
5. promoting a culturally and linguistically competent PCA
workforce to serve the growing racial, ethnic, and linguistic 2023SB-00009-R000507-BA.DOCX
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diversity of an aging consumer population; and
6. promoting self-determination principles for PCAs.
Program Components
Under the bill, the DSS commissioner must offer the following
pathways under the program:
1. the basic skills career pathways, including general health and
safety and adult education topics; and
2. the specialized skills career pathways, including cognitive
impairments and behavioral health, complex physical care needs,
and transitioning to home and community-based living from out-
of-home care or homelessness.
The commissioner must develop or identify the training curriculum
for each pathway. In doing so, she must consult with a hospital’s or
health care organization’s labor management committee.
Reporting Requirement
By January 1, 2025, the bill requires the commissioner to report to the
Human Services and Public Health committees on the following
program information:
1. the number of enrolled PCAs and the pathways they choose;
2. the number of PCAs who completed a career pathway, by
pathway type;
3. the program’s effectiveness, as determined by surveys, focus
groups, and interviews of PCAs, and whether completing the
program led to (a) a related license or certificate or (b) continued
employment for each PCA; and
4. the number of PCAs employed by consumers with specialized
care needs after completing a specialized career pathway and
whom the consumer kept employed for at least (a) six months
and (b) 12 months. 2023SB-00009-R000507-BA.DOCX
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§ 15 — HOSPITAL PRIVILEGES
Prohibits hospitals, for purposes of granting practice privileges, from requiring (1) board
eligible physicians to become board-certified until five years after becoming board eligible,
or (2) board certified physicians to provide evidence of board recertification
The bill prohibits hospitals (and their medical review committees),
for purposes of granting practice privileges, from requiring (1) board
eligible physicians to become board-certified until five years after
becoming board eligible, or (2) board certified physicians to provide
evidence of board recertification.
Under the bill, a physician is “board eligible” after passing the
written portion of a medical specialty board’s examination to become
certified in a particular specialty. A physician is “board certified” after
passing the written and oral portions of the exam.
EFFECTIVE DATE: October 1, 2023
§§ 16 & 17 — BAN ON PHYSICIAN OR APRN NO N-COMPETE
CLAUSES
Prohibits physician or APRN non-compete clauses that are entered into, amended,
extended, or renewed starting on July 1, 2023
The bill prohibits physician or advanced practice registered nurse
(APRN) non-compete agreements (“covenants not to compete”) entered
into, amended, or renewed on or after July 1, 2023, and renders them
void and unenforceable. It applies to non-compete agreements that are
part of physician or APRN employment, partnership, or ownership
contracts or agreements.
The bill allows an aggrieved physician or APRN to sue the employer
or other appropriate entity in Superior Court to recover damages, along
with court costs and reasonable attorney’s fees, and for injunctive and
equitable relief as the court deems appropriate.
If a covenant is rendered void and unenforceable under the bill’s
provisions, the contract’s remaining provisions remain in effect,
including provisions requiring the payment of damages for injuries
suffered due to the contract’s termination. (This already applies to
covenants for physicians that are rendered void and unenforceable
under current law’s limitations for physician covenants (see below); the 2023SB-00009-R000507-BA.DOCX
Researcher: JO Page 20 4/12/23
bill similarly applies the provision to APRN covenants.)
EFFECTIVE DATE: July 1, 2023
Physician Non-Compete Agreements
Current law sets limits on, but does not prohibit, physician non-
compete agreements, including that they (1) may extend for no more
than one year and a 15-mile radius from the physician’s primary
practice site and (2) are allowed only if necessary to protect a legitimate
business interest. Under the bill, these restrictions continue to apply to
physician non-compete agreements entered into, amended, extended,
or renewed before July 1, 2023. The bill prohibits these non-compete
agreements entered into, amended, extended, or renewed on or after
that date.
APRN Non-Compete Agreements
Current law does not specifically limit APRN non-compete
agreements. In practice, courts generally consider certain factors when
assessing whether a particular non-compete agreement is reasonable,
such as its duration and geographical scope.
The bill prohibits these non-compete agreements entered into,
amended, extended, or renewed on or after July 1, 2023.
The bill defines “covenant not to compete” for APRNs in a way that
is substantially similar to the definition in existing law that applies to
physicians. Under the bill, an APRN “covenant not to compete” is any
provision of an employment or other contract or agreement that
establishes a professional relationship with an APRN and restricts their
right to provide health care services in any area of the state for any
period after the end of the partnership, employment, or other
professional relationship.
§ 18 — MEDICAL MALPRACTICE REFORM TASK F ORCE
Creates a task force to study medical malpractice reform to incentivize physicians and
other providers to practice in the state
The bill creates a task force to study medical malpractice reform to
incentivize physicians and other licensed health care providers to 2023SB-00009-R000507-BA.DOCX
Researcher: JO Page 21 4/12/23
practice in Connecticut.
EFFECTIVE DATE: Upon passage
Membership and Administration
Under the bill, the task force includes the DPH commissioner or her
designee and eight appointed members, as shown below.
Table: Medical Malpractice Task Force Appointed Members
Appointing Authority Appointee Qualifications
House speaker (2) Medical malpractice law expert
Tort reform expert
Senate president pro
tempore (2)
Representative of an in-state medical society
Representative of an in-state hospital association
House majority leader (1) Representative of an in-state nurses’ association
Senate majority leader (1) Member of the judiciary
House minority leader (1) Member of an in-state trial lawyers’ association
Senate minority leader (1) Health care advocate in the state
Under the bill, legislative appointees may be legislators. Initial
appointments must be made within 30 days after the bill’s passage.
Appointing authorities fill any vacancy.
The House speaker and Senate president pro tempore select the task
force chairpersons from among its members. The chairpersons must
schedule the first meeting, to be held within 60 days after the bill’s
passage.
The Public Health Committee’s administrative staff serves in that
capacity for the task force.
Reporting Requirement
The bill requires the task force to report its findings and
recommendations to the Public Health Committee by January 1, 2024.
The task force terminates when it submits the report or on January 1,
2024, whichever is later. 2023SB-00009-R000507-BA.DOCX
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§ 19 — PHYSICAL THERAPY LICENSURE COMPAC T
Enters Connecticut into the Physical Therapy Licensure Compact, which provides a
process authorizing physical therapists or physical therapy assistants properly
credentialed in one member state to practice across state boundaries, without requiring
licensure in each state
The bill enters Connecticut into the Physical Therapy Licensure
Compact (hereinafter, PT Compact or compact). The compact creates a
process authorizing physical therapists (PTs) and PT assistants who are
licensed or certified (as appropriate) in one member state, to practice
across state boundaries without requiring licensure or certification in
each state. Member states must grant the “compact privilege” (i.e., the
authority to practice in the state) to people holding a valid,
unencumbered license who otherwise meet the compact’s eligibility
requirements. The compact is administered by the PT Compact
Commission, which Connecticut would join under the bill.
Among various other provisions, the compact:
1. sets eligibility criteria for states to join the compact and for PTs
or PT assistants to practice under it;
2. addresses several matters related to disciplinary actions for
licensees practicing under the compact, such as information
sharing among member states and removal of compact
privileges;
3. provides that amendments to the compact only take effect if all
member states adopt them into law; and
4. has a process for states to withdraw from the compact.
A broad overview of the compact appears below.
EFFECTIVE DATE: July 1, 2023
Compact Overview
The PT Compact creates a process authorizing PTs and PT assistants
to work in multiple states if they are licensed (for PTs) or licensed or
certified (for assistants) in one member state. A “licensee” is someone 2023SB-00009-R000507-BA.DOCX
Researcher: JO Page 23 4/12/23
currently authorized by a state to practice as a PT or PT assistant.
Under the compact, a “state” is a U.S. state, commonwealth, district,
or territory that regulates physical therapy. A “member state” is a state
that has joined the compact.
A “home state” is the member state that is the licensee’s primary state
of residence. A “remote state” is a member state, other than the home
state, where a licensee is exercising or seeking to exercise the compact
privilege.
The compact allows active-duty military personnel, or their spouses,
to designate as their home state their (1) home of record, (2) permanent
change of station, or (3) state of current residence if different from either
of those.
“Compact privilege” is a remote state’s authorization to allow a
licensee from another member state to practice in the remote state under
its laws and rules. The compact specifies that PT practice occurs in the
member state where the patient or client is located.
State Eligibility (§ 19(3))
To participate in the compact, a state must do the following:
1. participate fully in the commission’s licensee data system,
including using the commission’s unique identifier;
2. have a mechanism to receive and investigate complaints about
licensees;
3. notify the commission, in compliance with the compact’s terms
and rules, about any adverse action (i.e., board disciplinary
action for misconduct or unacceptable performance) or the
availability of investigative information about a licensee;
4. fully implement a criminal background check requirement,
within deadlines set by rule, by receiving FBI search results and
using that information in making licensure decisions (see below
and § 20); 2023SB-00009-R000507-BA.DOCX
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5. comply with the commission’s rules;
6. require passage of a recognized national examination for
licensure, under the commission’s rules; and
7. require continuing competence (e.g., continuing education) for
license renewal.
Upon joining the compact, member states must have the authority to
get biometric-based information from each PT licensure applicant and
submit it to the FBI for a criminal record check.
Individual Compact Privilege (§ 19(3) & (4))
The compact requires member states to grant the compact privilege
to a licensee holding a valid, unencumbered license in another member
state, under the compact’s terms and rules. Member states may charge
a fee for granting the privilege.
To exercise the compact privilege, a licensee must meet the following
requirements:
1. be licensed in the home state;
2. have no encumbrance on any state license;
3. be eligible for a compact privilege in any member state, under the
compact’s provisions on remote states’ authority to remove that
privilege (see next subheading);
4. have no adverse action against any license or compact privilege
within the prior two years;
5. notify the commission that the licensee is seeking the compact
privilege in one or more remote states;
6. pay any state fees or other applicable fees for the compact
privilege;
7. meet any applicable remote states’ jurisprudence requirements
(i.e., assessment of knowledge as to PT practice laws and rules 2023SB-00009-R000507-BA.DOCX
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for that state); and
8. report to the commission within 30 days after being subject to
adverse action by any non-member state.
Under the compact, the privilege is valid until the home license
expires. The licensee must comply with the above requirements to
maintain the privilege in the remote state.
Respective States’ Authority, Adverse Actions, and Data System
(§ 19(4), (6) & (8))
The compact addresses several matters related to states’ authority to
investigate and discipline licensees practicing under its procedures.
Broadly, the compact maintains the home state authority to regulate the
home state license and grants the remote state the authority to regulate
the compact privilege in that state, each according to its own regulatory
structure. Additionally, a home state may take action against a licensee
based on investigative information from a remote state.
The following are examples of the regulatory structure under the
compact:
1. a home state has exclusive authority to impose adverse action
against a home state license, but a remote state may remove a
licensee’s compact privilege, investigate and issue subpoenas,
impose fines, and take other necessary action;
2. if allowed by their law, remote states may recover from the
licensee any investigation and disposition costs for cases leading
to adverse actions;
3. if a licensee’s home state license is encumbered or remote state
privilege is removed, he or she cannot regain the compact
privilege in any remote state until (a) the encumbrance is lifted
or removal period passes; (b) two years have passed since the
adverse action; (c) for remote state removals, any fines have been
paid; and (d) the licensee otherwise meets the compact’s
eligibility requirements; 2023SB-00009-R000507-BA.DOCX
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4. member states may allow licensees to participate in an alternative
program (e.g., for substance abuse) rather than imposing an
adverse action, but the state must require the licensee to get prior
authorization from other member states before practicing there
during this period; and
5. any member state may investigate actual or alleged violations in
other member states where a licensee holds a license or compact
privilege.
Member states must submit the same information on licensees for
inclusion in a database the compact creates, and the commission must
promptly notify all member states about any adverse action against
licensees or licensure applicants. Investigation information about a
licensee is available only to states in which a licensee holds, or is
applying for, a license or compact privilege.
PT Compact Commission (§ 19(7) & (9))
The compact is administered by the PT Compact Commission, which
consists of one voting member appointed by each member state’s PT
licensing board. The compact sets forth several powers, duties, and
procedures for the commission. For example, the commission:
1. may make rules to facilitate and coordinate the compact’s
implementation and administration (a rule has no effect if a
majority of the member states’ legislatures reject it within four
years of the rule’s adoption),
2. may levy and collect an annual assessment from each member
state and impose fees on other parties to cover the costs of its
operations, and
3. must have its receipts and disbursements audited yearly and the
audit report included in the commission’s annual report.
The compact addresses several other matters regarding the
commission and its operations, such as setting conditions under which
its officers and employees are immune from civil liability. By virtue of 2023SB-00009-R000507-BA.DOCX
Researcher: JO Page 27 4/12/23
adopting the compact, Connecticut joins the commission.
Compact Oversight, Enforcement, Member Withdrawal, and
Related Matters (§ 19(10)-(12))
Among other related provisions, the compact provides the following:
1. each member state’s executive, legislative, and judicial branches
must enforce the compact and take necessary steps to carry out
its purposes;
2. the commission must take specified steps if a member state
defaults on its obligations under the compact, and after all other
means of securing compliance have been exhausted, a defaulting
state is terminated from the compact upon a majority vote of the
member states;
3. upon a member state’s request, the commission must attempt to
resolve a compact-related dispute among member states or
between member and non-member states;
4. the commission must enforce the compact and rules and may
bring legal action against a member state in default upon a
majority vote (the case may be brought in the U.S. District Court
for the District of Columbia or the federal district where the
commission’s principal offices are located);
5. a member state may withdraw from the compact by repealing
that state’s enabling legislation, but withdrawal does not take
effect until six months after the repealing statute’s enactment;
6. the member states may amend the compact, but no amendment
takes effect until all member states enact it into law; and
7. the compact’s provisions are severable and its provisions must be
liberally construed to carry out its purposes, and if the compact
is held to violate a member state’s constitution, it remains in
effect in the remaining member states.
§ 20 — BACKGROUND CHECKS FO R PT LICENSURE 2023SB-00009-R000507-BA.DOCX
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Requires PT licensure applicants to complete a fingerprint-based criminal background
check
Under the bill, the DPH commissioner must require anyone applying
for PT licensure to submit to a state and national fingerprint-based
criminal history records check.
EFFECTIVE DATE: July 1, 2023
§ 21 — PODIATRIC SCOPE OF PRACTICE WORKI NG GROUP
Requires DPH to establish a working group to advise the department and any relevant
scope of practice review committee on podiatrists’ scope of practice relating to surgical
procedures
The bill requires the DPH commissioner to establish a working group
to advise DPH and any relevant scope of practice review committee (see
below) on podiatrists’ scope of practice relating to surgical procedures.
The commissioner appoints the working group’s members, which must
include at least three podiatrists and three orthopedic surgeons.
By January 1, 2024, the working group must report its findings and
recommendations to the commissioner and any such scope of practice
review committee. By February 1, 2024, the commissioner must report
to the Public Health Committee on (1) the group’s findings and
recommendations and (2) whether DPH and any relevant scope of
practice review committee agrees with them.
Existing law establishes a process for DPH to review requests from
representatives of health care professions seeking to establish or revise
a scope of practice before consideration by the legislature. DPH selects
the requests it will act upon and, within available appropriations,
appoints members to scope of practice review committees, whose
members include representatives from the profession making the
request and other professions directly impacted by it (CGS § 19a-16e).
EFFECTIVE DATE: July 1, 2023
§ 22 — APRN LICENSURE BY ENDORSEMENT
Allows for licensure by endorsement for APRNs who have (1) practiced for at least three
years in another state with practice requirements that are substantially similar to, or
higher, than Connecticut’s and (2) no disciplinary history or unresolved complaints
pending 2023SB-00009-R000507-BA.DOCX
Researcher: JO Page 29 4/12/23
The bill allows APRNs with certain experience who are not otherwise
eligible to apply for licensure in Connecticut to apply for licensure by
endorsement. To be eligible, the applicant must give DPH satisfactory
evidence that he or she has (1) practiced for at least three years as an
APRN (or similar services under a different designation) in another state
or jurisdiction and (2) no disciplinary actions or unresolved complaints
pending. The other jurisdiction must have requirements for practicing
that are substantially similar to, or higher than, Connecticut’s.
The bill requires these applicants to pay a $200 fee, the same as for
other APRN licensure applicants under existing law.
EFFECTIVE DATE: October 1, 2023
§ 23 — HEALTH CARE PROVIDER LOAN REIMBUR SEMENT
For purposes of a health care provider loan reimbursement program, requires OHE to
award at least 10% of grants to providers working full-time in rural communities
A 2022 law requires OHE to establish a program giving loan
reimbursement grants to DPH-licensed health care providers employed
full-time in the state. The bill requires at least 10% of the grants to be
awarded to people working full-time in rural communities. (To date,
this program has not yet been funded.)
Under existing law, (1) at least 20% of the grants must be awarded to
regional community-technical college graduates and (2) the OHE
executive director must consider health care workforce shortage areas
when developing the program’s eligibility requirements.
EFFECTIVE DATE: July 1, 2023
§ 24 — SPLASH PAD AND SPRAY PARK WARNING SIGNS
Requires splash pad and spray park owners or operators to post warning signs about the
potential health risk of ingesting recirculated water
The bill requires owners or operators of splash pads and spray parks
where water is recirculated to post a sign stating that the water is
recirculated and warning of the potential health risk to people ingesting
it. They must post the sign by January 1, 2024, and in a conspicuous
location at or near the entrance. 2023SB-00009-R000507-BA.DOCX
Researcher: JO Page 30 4/12/23
EFFECTIVE DATE: July 1, 2023
COMMENT
Harm Reduction Centers and Federal Law
Under the bill’s harm reduction center pilot program (§ 3), these
centers are defined as medical facilities where, among other services,
people with substance use disorder, “in a separate location,” may safely
consume controlled substances under observation by licensed
providers.
While the bill does not specify how these separate locations would be
operated, it appears that this provision may conflict with federal law.
Federal law prohibits managing or controlling any place (as an owner,
lessee, agent, employee, occupant, or mortgagee) and knowingly and
intentionally making it available for the purpose of unlawfully using
controlled substances (21 U.S.C. § 856).
COMMITTEE ACTION
Public Health Committee
Joint Favorable Substitute
Yea 27 Nay 10 (03/27/2023)