Connecticut 2023 Regular Session

Connecticut Senate Bill SB00009 Compare Versions

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	7	+	General Assembly Substitute Bill No. 9
	8	+	January Session, 2023
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4		-	Substitute Senate Bill No. 9
5		-
6		-	Public Act No. 23-97
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9	14		AN ACT CONCERNING HEALTH AND WELLNESS FOR
10	15		CONNECTICUT RESIDENTS.
11	16		Be it enacted by the Senate and House of Representatives in General
12	17		Assembly convened:
13	18
14		-	Section 1. (NEW) (Effective from passage) (a) As used in this section, (1)
15		-	"assisted reproductive technology" has the same meaning as provided
16		-	in 42 USC 263a-7, as amended from time to time~~, and (2) "assisted~~
17		-	~~reproduction" has the same meaning as provided in section 46b-451~~ of
18		-	~~the general statutes.~~
19		-	~~(b) No person~~ or ~~entity may prohibit or unreasonably limit any~~
20		-	~~person from (1) accessing assisted reproductive technology~~ or ~~assisted~~
21		-	~~reproduction~~, ~~(2) continuing~~ or ~~completing an ongoing assisted~~
22		-	reproductive ~~technology treatment or procedure or an ongoing assisted~~
23		-	~~reproduction treatment or procedure pursuant to a written plan or~~
24		-	~~agreement with~~ a health ~~care provider, or (3) retaining all rights~~
25		-	~~regarding the use of reproductive genetic materials~~, ~~including, but not~~
26		-	~~limited to,~~ ~~gametes.~~
27		-	(c) ~~No person~~ or ~~entity may prohibit~~ or ~~unreasonably limit a health~~
28		-	~~care provider who is licensed, certified or otherwise authorized~~ to
29		-	~~perform assisted reproductive technology treatments or procedures or~~
30		-	~~assisted reproduction treatments or procedures from~~ (1) ~~performing any~~ Substitute ~~Senate~~ Bill No. 9
	19	+	Section 1. (NEW) (Effective from passage) (a) As used in this section, 1
	20	+	"assisted reproductive technology" has the same meaning as provided 2
	21	+	in 42 USC 263a-7, as amended from time to time. 3
	22	+	(b) No person or entity may prohibit or unreasonably limit any 4
	23	+	person from (1) accessing assisted reproductive technology, (2) 5
	24	+	continuing or completing an ongoing assisted reproductive technology 6
	25	+	treatment or procedure pursuant to a written plan or agreement with a 7
	26	+	health care provider, or (3) retaining all rights regarding the use of 8
	27	+	reproductive genetic materials, including, but not limited to, gametes 9
	28	+	and embryos. 10
	29	+	(c) No person or entity may prohibit or unreasonably limit a health 11
	30	+	care provider who is licensed, certified or otherwise authorized to 12
	31	+	perform assisted reproductive technology treatments or procedures 13
	32	+	from (1) performing any such treatment or procedure, or (2) providing 14
	33	+	evidence-based information related to assisted reproductive 15
	34	+	technology. 16
	35	+	Sec. 2. (Effective July 1, 2023) The Commissioner of Social Services 17 Substitute Bill No. 9
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32		-	Public Act No. 23-97 2 of 80
33	37
34		-	such treatment or procedure, or (2) providing evidence-based
35		-	information related to assisted reproductive technology or assisted
36		-	reproduction.
37		-	Sec. 2. (Effective July 1, 2023) The Commissioner of Social Services
38		-	shall adjust Medicaid reimbursement criteria to provide funding for
39		-	same-day access to long-acting reversible contraceptives at federally
40		-	qualified health centers. As used in this section, "long-acting reversible
41		-	contraceptive" means any method of contraception that does not have
42		-	to be used or applied more than once a menstrual cycle or once a month.
43		-	Sec. 3. (Effective from passage) (a) As used in this section:
44		-	(1) "Harm reduction center" means a medical facility where a person
45		-	with a substance use disorder may (A) receive substance use disorder
46		-	and other mental health counseling, (B) use a test strip to test a substance
47		-	for traces of fentanyl or xylazine, or traces of any other substance
48		-	recognized by the Commissioner of Mental Health and Addiction
49		-	Services as having a high risk of causing an overdose, (C) receive
50		-	educational information regarding opioid antagonists, as defined in
51		-	section 17a-714a of the general statutes, and the risks of contracting
52		-	diseases from sharing hypodermic needles, (D) receive referrals to
53		-	substance use disorder treatment services, and (E) receive access to basic
54		-	support services, including, but not limited to, laundry machines, a
55		-	bathroom, a shower and a place to rest; and
56		-	(2) "Test strip" means a product that a person may use to test any
57		-	substance prior to injection, inhalation or ingestion of the substance to
58		-	prevent accidental overdose by injection, inhalation or ingestion of the
59		-	substance.
60		-	(b) Not later than July 1, 2027, the Department of Mental Health and
61		-	Addiction Services, in consultation with the Department of Public
62		-	Health, shall establish a pilot program to prevent drug overdoses Substitute Senate Bill No. 9
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	42	+	shall adjust Medicaid reimbursement criteria to provide funding for 18
	43	+	same-day access to long-acting reversible contraceptives at federally 19
	44	+	qualified health centers. As used in this section, "long-acting reversible 20
	45	+	contraceptive" means any method of contraception that does not have 21
	46	+	to be used or applied more than once a menstrual cycle or once a month. 22
	47	+	Sec. 3. (Effective from passage) (a) As used in this section and section 4 23
	48	+	of this act, "harm reduction center" means a medical facility where a 24
	49	+	person with a substance use disorder may (1) receive (A) substance use 25
	50	+	disorder and other mental health counseling, (B) educational 26
	51	+	information regarding opioid antagonists, as defined in section 17a-714a 27
	52	+	of the general statutes, and the risks of contracting diseases from sharing 28
	53	+	hypodermic needles, (C) referrals to substance use disorder treatment 29
	54	+	services, and (D) access to basic support services, including, but not 30
	55	+	limited to, laundry machines, a bathroom, a shower and a place to rest, 31
	56	+	and (2) in a separate location, safely consume controlled substances 32
	57	+	under the observation of licensed health care providers who are present 33
	58	+	to provide necessary medical treatment in the event of an overdose of a 34
	59	+	controlled substance. 35
	60	+	(b) The Department of Mental Health and Addiction Services, in 36
	61	+	consultation with the Department of Public Health, shall establish a 37
	62	+	pilot program to prevent drug overdoses through the establishment of 38
	63	+	harm reduction centers in three municipalities in the state selected by 39
	64	+	the Commissioner of Mental Health and Addiction Services, subject to 40
	65	+	the approval of the chief elected officials of each municipality selected 41
	66	+	by said commissioner. 42
	67	+	(c) Each harm reduction center established pursuant to subsection (b) 43
	68	+	of this section shall (1) employ licensed health care providers with 44
	69	+	experience treating persons with substance use disorders to provide 45
	70	+	substance use disorder or other mental health counseling and monitor 46
	71	+	persons utilizing the harm reduction center for the purpose of providing 47
	72	+	medical treatment to any person who experiences symptoms of an 48
	73	+	overdose, in a number determined sufficient by the Commissioner of 49
	74	+	Mental Health and Addiction Services, and (2) provide referrals for 50 Substitute Bill No. 9
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66		-	through the establishment of harm reduction centers in three
67		-	municipalities in the state selected by the Commissioner of Mental
68		-	Health and Addiction Services, subject to the approval of the chief
69		-	elected officials of each municipality selected by said commissioner. No
70		-	harm reduction center established pursuant to this subsection shall be
71		-	subject to regulation by the Department of Public Health until the
72		-	termination of the pilot program.
73		-	(c) Each harm reduction center established pursuant to subsection (b)
74		-	of this section shall (1) employ persons, including, but not limited to,
75		-	licensed health care providers with experience treating persons with
76		-	substance use disorders to provide substance use disorder or other
77		-	mental health counseling and monitor persons utilizing the harm
78		-	reduction center for the purpose of providing medical treatment to any
79		-	person who experiences symptoms of an overdose, in a number
80		-	determined sufficient by the Commissioner of Mental Health and
81		-	Addiction Services, (2) provide persons with test strips at the request of
82		-	such persons, and (3) provide referrals for substance use disorder or
83		-	other mental health counseling or other mental health or medical
84		-	treatment services that may be appropriate for persons utilizing the
85		-	harm reduction center. A licensed health care provider's participation in
86		-	the pilot program shall not be grounds for disciplinary action by the
87		-	Department of Public Health pursuant to section 19a-17 of the general
88		-	statutes or by any board or commission listed in subsection (b) of section
89		-	19a-14 of the general statutes.
90		-	(d) The Commissioner of Mental Health and Addiction Services may
91		-	request a disbursement of funds from the Opioid Settlement Fund
92		-	established pursuant to section 17a-674c of the general statutes to fund,
93		-	in whole or in part, the establishment and administration of the pilot
94		-	program.
95		-	Sec. 4. Subsection (b) of section 19a-638 of the general statutes is
96		-	repealed and the following is substituted in lieu thereof (Effective from Substitute Senate Bill No. 9
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100		-	passage):
101		-	(b) A certificate of need shall not be required for:
102		-	(1) Health care facilities owned and operated by the federal
103		-	government;
104		-	(2) The establishment of offices by a licensed private practitioner,
105		-	whether for individual or group practice, except when a certificate of
106		-	need is required in accordance with the requirements of section 19a-
107		-	493b or subdivision (3), (10) or (11) of subsection (a) of this section;
108		-	(3) A health care facility operated by a religious group that
109		-	exclusively relies upon spiritual means through prayer for healing;
110		-	(4) Residential care homes, as defined in subsection (c) of section 19a-
111		-	490, and nursing homes and rest homes, as defined in subsection (o) of
112		-	section 19a-490;
113		-	(5) An assisted living services agency, as defined in section 19a-490;
114		-	(6) Home health agencies, as defined in section 19a-490;
115		-	(7) Hospice services, as described in section 19a-122b;
116		-	(8) Outpatient rehabilitation facilities;
117		-	(9) Outpatient chronic dialysis services;
118		-	(10) Transplant services;
119		-	(11) Free clinics, as defined in section 19a-630;
120		-	(12) School-based health centers and expanded school health sites, as
121		-	such terms are defined in section 19a-6r, community health centers, as
122		-	defined in section 19a-490a, not-for-profit outpatient clinics licensed in
123		-	accordance with the provisions of chapter 368v and federally qualified Substitute Senate Bill No. 9
	81	+	substance use disorder or other mental health counseling or other 51
	82	+	mental health or medical treatment services that may be appropriate for 52
	83	+	persons utilizing the harm reduction center. A licensed health care 53
	84	+	provider's participation in the pilot program shall not be grounds for 54
	85	+	disciplinary action by the Department of Public Health pursuant to 55
	86	+	section 19a-17 of the general statutes. 56
	87	+	(d) The Commissioner of Mental Health and Addiction Services may 57
	88	+	request a disbursement of funds from the Opioid Settlement Fund 58
	89	+	established pursuant to section 17a-674c of the general statutes to fund, 59
	90	+	in whole or in part, the establishment and administration of the pilot 60
	91	+	program. 61
	92	+	(e) The Commissioner of Mental Health and Addiction Services shall 62
	93	+	adopt regulations, in accordance with the provisions of chapter 54 of the 63
	94	+	general statutes, to implement the provisions of this section. 64
	95	+	Sec. 4. (Effective from passage) (a) There is established a Harm 65
	96	+	Reduction Center Pilot Program Advisory Committee that shall advise 66
	97	+	the Department of Mental Health and Addiction Services on issues 67
	98	+	concerning the establishment of the harm reduction center pilot 68
	99	+	program pursuant to section 3 of this act. The advisory committee shall 69
	100	+	meet at the discretion of the Commissioner of Mental Health and 70
	101	+	Addiction Services and shall make recommendations to the 71
	102	+	commissioner regarding the following: 72
	103	+	(1) Maximizing the potential public health and safety benefits of the 73
	104	+	harm reduction centers; 74
	105	+	(2) The proper disposal of hypodermic needles; 75
	106	+	(3) The recovery of persons utilizing the harm reduction centers; 76
	107	+	(4) Federal, state and local laws impacting the creation and operation 77
	108	+	of the harm reduction centers; 78
	109	+	(5) Appropriate guidance to relevant professional licensing boards 79 Substitute Bill No. 9
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127		-	health centers;
128		-	(13) A program licensed or funded by the Department of Children
129		-	and Families, provided such program is not a psychiatric residential
130		-	treatment facility;
131		-	(14) Any nonprofit facility, institution or provider that has a contract
132		-	with, or is certified or licensed to provide a service for, a state agency or
133		-	department for a service that would otherwise require a certificate of
134		-	need. The provisions of this subdivision shall not apply to a short-term
135		-	acute care general hospital or children's hospital, or a hospital or other
136		-	facility or institution operated by the state that provides services that are
137		-	eligible for reimbursement under Title XVIII or XIX of the federal Social
138		-	Security Act, 42 USC 301, as amended;
139		-	(15) A health care facility operated by a nonprofit educational
140		-	institution exclusively for students, faculty and staff of such institution
141		-	and their dependents;
142		-	(16) An outpatient clinic or program operated exclusively by or
143		-	contracted to be operated exclusively by a municipality, municipal
144		-	agency, municipal board of education or a health district, as described
145		-	in section 19a-241;
146		-	(17) A residential facility for persons with intellectual disability
147		-	licensed pursuant to section 17a-227 and certified to participate in the
148		-	Title XIX Medicaid program as an intermediate care facility for
149		-	individuals with intellectual disabilities;
150		-	(18) Replacement of existing imaging equipment if such equipment
151		-	was acquired through certificate of need approval or a certificate of need
152		-	determination, provided a health care facility, provider, physician or
153		-	person notifies the unit of the date on which the equipment is replaced
154		-	and the disposition of the replaced equipment; Substitute Senate Bill No. 9
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	116	+	concerning the impact of health care providers participating in the harm 80
	117	+	reduction center pilot program on the effectiveness of the pilot program; 81
	118	+	(6) Potential integration of the harm reduction center pilot program 82
	119	+	with other public health efforts; 83
	120	+	(7) Consideration of any other factors beneficial to promoting the 84
	121	+	public health and safety in the operation of the harm reduction center 85
	122	+	pilot program; and 86
	123	+	(8) Liability protection for property owners and staff, volunteers and 87
	124	+	participants in the harm reduction center pilot program, from criminal 88
	125	+	or civil liability resulting from the operation of a harm reduction center. 89
	126	+	(b) The advisory committee shall consist of the following members: 90
	127	+	(1) The Commissioners of Mental Health and Addiction Services and 91
	128	+	Public Health, or the commissioners' designee; 92
	129	+	(2) The president of the Connecticut Conference of Municipalities, or 93
	130	+	the president's designee; 94
	131	+	(3) The cochairperson of the Opioid Settlement Advisory Committee 95
	132	+	appointed by the speaker of the House of Representatives and the 96
	133	+	president pro tempore of the Senate pursuant to subsection (c) of section 97
	134	+	17a-674d of the general statutes, or the cochairperson's designee; 98
	135	+	(4) One member who represents and shall be appointed by a medical 99
	136	+	society in the state; 100
	137	+	(5) One member who represents and shall be appointed by a hospital 101
	138	+	society in the state; 102
	139	+	(6) One member who represents and shall be appointed by the 103
	140	+	Connecticut chapter of a national society of addiction medicine; 104
	141	+	(7) Two members appointed by the speaker of the House of 105
	142	+	Representatives, one of whom shall be a person with a substance use 106 Substitute Bill No. 9
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158		-	(19) Acquisition of cone-beam dental imaging equipment that is to be
159		-	used exclusively by a dentist licensed pursuant to chapter 379;
160		-	(20) The partial or total elimination of services provided by an
161		-	outpatient surgical facility, as defined in section 19a-493b, except as
162		-	provided in subdivision (6) of subsection (a) of this section and section
163		-	19a-639e;
164		-	(21) The termination of services for which the Department of Public
165		-	Health has requested the facility to relinquish its license;
166		-	(22) Acquisition of any equipment by any person that is to be used
167		-	exclusively for scientific research that is not conducted on humans; [or]
168		-	(23) On or before June 30, 2026, an increase in the licensed bed
169		-	capacity of a mental health facility, provided (A) the mental health
170		-	facility demonstrates to the unit, in a form and manner prescribed by
171		-	the unit, that it accepts reimbursement for any covered benefit provided
172		-	to a covered individual under: (i) An individual or group health
173		-	insurance policy providing coverage of the type specified in
174		-	subdivisions (1), (2), (4), (11) and (12) of section 38a-469; (ii) a self-
175		-	insured employee welfare benefit plan established pursuant to the
176		-	federal Employee Retirement Income Security Act of 1974, as amended
177		-	from time to time; or (iii) HUSKY Health, as defined in section 17b-290,
178		-	and (B) if the mental health facility does not accept or stops accepting
179		-	reimbursement for any covered benefit provided to a covered
180		-	individual under a policy, plan or program described in clause (i), (ii) or
181		-	(iii) of subparagraph (A) of this subdivision, a certificate of need for such
182		-	increase in the licensed bed capacity shall be required; or
183		-	(24) The establishment of harm reduction centers through the pilot
184		-	program established pursuant to section 3 of this act.
185		-	Sec. 5. (NEW) (Effective October 1, 2023) (a) As used in this section: Substitute Senate Bill No. 9
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189		-	(1) "Eligible entity" means (A) a municipality, (B) a local or regional
190		-	board of education, (C) a similar body governing one or more nonpublic
191		-	schools, (D) a district department of health, (E) a municipal health
192		-	department, (F) a law enforcement agency, or (G) an emergency medical
193		-	services organization;
194		-	(2) "Emergency medical services personnel" has the same meaning as
195		-	provided in section 19a-175 of the general statutes;
196		-	(3) "Opioid antagonist" means naloxone hydrochloride or any other
197		-	similarly acting and equally safe drug approved by the federal Food and
198		-	Drug Administration for the treatment of a drug overdose;
199		-	(4) "Opioid drug" has the same meaning as provided in 42 CFR 8.2,
200		-	as amended from time to time;
201		-	(5) "Opioid use disorder" means a medical condition characterized by
202		-	a problematic pattern of opioid use and misuse leading to clinically
203		-	significant impairment or distress;
204		-	(6) "Pharmacist" has the same meaning as provided in section 20-609a
205		-	of the general statutes; and
206		-	(7) "Wholesaler" or "distributor" has the same meaning as provided
207		-	in section 21a-70 of the general statutes.
208		-	(b) There is established an Opioid Antagonist Bulk Purchase Fund
209		-	which shall be a separate nonlapsing account within the General Fund.
210		-	The account shall contain any (1) amounts appropriated or otherwise
211		-	made available by the state for the purposes of this section, (2) moneys
212		-	required by law to be deposited in the account, and (3) gifts, grants,
213		-	donations or bequests made for the purposes of this section. Investment
214		-	earnings credited to the assets of the account shall become part of the
215		-	assets of the account. Any balance remaining in the account at the end
216		-	of any fiscal year shall be carried forward in the account for the fiscal Substitute Senate Bill No. 9
	149	+	disorder, and one of whom shall be an administrator of a harm 107
	150	+	reduction center operating in another state; 108
	151	+	(8) Two members appointed by the president pro tempore of the 109
	152	+	Senate, one of whom shall be a health care provider experienced in 110
	153	+	treating persons with substance use disorders and overdose prevention, 111
	154	+	and one of whom shall be an administrator of a harm reduction center 112
	155	+	operating in another state; 113
	156	+	(9) One member appointed by the majority leader of the House of 114
	157	+	Representatives, who shall be a current or former law enforcement 115
	158	+	official; 116
	159	+	(10) One member appointed by the majority leader of the Senate, who 117
	160	+	shall be a family member of a person who suffered a fatal drug 118
	161	+	overdose; 119
	162	+	(11) One member appointed by the minority leader of the House of 120
	163	+	Representatives, who shall be a licensed mental health care provider 121
	164	+	with experience treating persons with opioid use disorder; and 122
	165	+	(12) One member appointed by the minority leader of the Senate, who 123
	166	+	shall be a licensed health care provider with experience treating persons 124
	167	+	who have experienced a drug overdose. 125
	168	+	(c) The Commissioner of Mental Health and Addiction Services, or 126
	169	+	said commissioner's designee, shall be the chairperson of the committee. 127
	170	+	The chairperson of the committee, with a vote of the majority of the 128
	171	+	members present, may appoint ex-officio nonvoting members in 129
	172	+	specialties not represented among voting members. Any vacancy shall 130
	173	+	be filled by the appointing authority. 131
	174	+	(d) The chairperson of the advisory committee may designate one or 132
	175	+	more working groups to address specific issues and shall appoint the 133
	176	+	members of each working group. Each working group shall report its 134
	177	+	findings and recommendations to the full advisory committee. 135 Substitute Bill No. 9
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220		-	year next succeeding. The State Treasurer shall administer the account.
221		-	All moneys deposited in the account shall be used by the Department of
222		-	Mental Health and Addiction Services for the purposes of this section.
223		-	The department may deduct and retain from the moneys in the account
224		-	an amount equal to the costs incurred by the department in
225		-	administering the provisions of this section, except that said amount
226		-	shall not exceed two per cent of the moneys deposited in the account in
227		-	any fiscal year.
228		-	(c) Not later than January 1, 2024 the Department of Mental Health
229		-	and Addiction Services, in collaboration with the Department of Public
230		-	Health, shall use the Opioid Antagonist Bulk Purchase Fund for the
231		-	provision of opioid antagonists to eligible entities and by emergency
232		-	medical services personnel to certain members of the public. Emergency
233		-	medical services personnel shall distribute an opioid antagonist kit
234		-	containing a personal supply of opioid antagonists and the one-page
235		-	fact sheet developed by the Connecticut Alcohol and Drug Policy
236		-	Council pursuant to section 17a-667a of the general statutes regarding
237		-	the risks of taking an opioid drug, symptoms of opioid use disorder and
238		-	services available in the state for persons who experience symptoms of
239		-	or are otherwise affected by opioid use disorder to a patient who (1) is
240		-	treated by such personnel for an overdose of an opioid drug, (2) displays
241		-	symptoms to such personnel of opioid use disorder, or (3) is treated at a
242		-	location where such personnel observes evidence of illicit use of an
243		-	opioid drug, or to such patient's family member, caregiver or friend who
244		-	is present at the location. Emergency medical services personnel shall
245		-	refer the patient or such patient's family member, caregiver or friend to
246		-	the written instructions regarding the administration of such opioid
247		-	antagonist, as deemed appropriate by such personnel.
248		-	(d) The Department of Mental Health and Addiction Services may,
249		-	within available appropriations, contract with a wholesaler or
250		-	distributor for the purchasing and distribution of opioid antagonists in Substitute Senate Bill No. 9
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	184	+	(e) Not later than January 1, 2024, and annually thereafter until the 136
	185	+	termination of the pilot program, the Commissioner of Mental Health 137
	186	+	and Addiction Services shall report, in accordance with the provisions 138
	187	+	of section 11-4a of the general statutes, to the joint standing committee 139
	188	+	of the General Assembly having cognizance of matters relating to public 140
	189	+	health regarding the recommendations of the advisory committee and 141
	190	+	the outcome of the harm reduction center pilot program established 142
	191	+	pursuant to section 3 of this act. 143
	192	+	Sec. 5. (NEW) (Effective October 1, 2023) (a) As used in this section, (1) 144
	193	+	"eligible entity" means a (A) municipality, (B) local or regional board of 145
	194	+	education, (C) similar body governing one or more nonpublic school, 146
	195	+	(D) district department of health, (E) municipal health department, or 147
	196	+	(F) law enforcement agency, and (2) "opioid antagonist" means naloxone 148
	197	+	hydrochloride or any other similarly acting and equally safe drug 149
	198	+	approved by the federal Food and Drug Administration for the 150
	199	+	treatment of a drug overdose. 151
	200	+	(b) There is established an Opioid Antagonist Bulk Purchase Fund 152
	201	+	which shall be a separate nonlapsing account within the General Fund. 153
	202	+	The account shall contain any (1) amounts appropriated or otherwise 154
	203	+	made available by the state for the purposes of this section, (2) moneys 155
	204	+	required by law to be deposited in the account, and (3) gifts, grants, 156
	205	+	donations or bequests made for the purposes of this section. Investment 157
	206	+	earnings credited to the assets of the account shall become part of the 158
	207	+	assets of the account. Any balance remaining in the account at the end 159
	208	+	of any fiscal year shall be carried forward in the account for the fiscal 160
	209	+	year next succeeding. The State Treasurer shall administer the account. 161
	210	+	All moneys deposited in the account shall be used by the Department of 162
	211	+	Mental Health and Addiction Services for the purposes of this section. 163
	212	+	The department may deduct and retain from the moneys in the account 164
	213	+	an amount equal to the costs incurred by the department in 165
	214	+	administering the provisions of this section, except that said amount 166
	215	+	shall not exceed two per cent of the moneys deposited in the account in 167
	216	+	any fiscal year. 168 Substitute Bill No. 9
253	217
254		-	bulk to eligible entities pursuant to subsection (c) of this section. Each
255		-	eligible entity shall make such bulk-purchased opioid antagonists
256		-	available at no charge to a family member, caregiver or friend of a
257		-	person who has experienced an overdose of an opioid drug or displays
258		-	symptoms of opioid use disorder.
259		-	(e) Emergency medical services organizations may obtain opioid
260		-	antagonists for dissemination pursuant to subsection (c) of this section
261		-	from a pharmacist pursuant to section 20-633c, 20-633d or 21a-286 of the
262		-	general statutes.
263		-	(f) Emergency medical services personnel shall document the
264		-	number of opioid antagonist kits distributed pursuant to subsection (c)
265		-	of this section, including, but not limited to, the number of doses of an
266		-	opioid antagonist included in each kit.
267		-	(g) Not later than January 1, 2025, and annually thereafter, the
268		-	executive director of the Office of Emergency Medical Services shall
269		-	report to the Department of Mental Health and Addiction Services
270		-	regarding the implementation of the provisions of subsections (c), (e)
271		-	and (f) of this section, including, but not limited to, any information
272		-	required under subsection (h) of this section for inclusion in the state
273		-	substance use disorder plan developed pursuant to subsection (j) of
274		-	section 17a-451 of the general statutes known to the executive director.
275		-	(h) The Commissioner of Mental Health and Addiction Services shall
276		-	include in the state substance use disorder plan developed pursuant to
277		-	subsection (j) of section 17a-451 of the general statutes the following
278		-	information: (1) The amount of funds used to purchase and distribute
279		-	opioid antagonists, (2) the number of eligible entities that received
280		-	opioid antagonists under this section, (3) the amount of opioid
281		-	antagonists purchased under this section, (4) the use of the opioid
282		-	antagonists purchased by each such eligible entity, if known by the
283		-	commissioner, and (5) any recommendations regarding the Opioid Substitute Senate Bill No. 9
284	218
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286	222
287		-	Antagonist Bulk Purchase Fund, including any proposed legislation to
288		-	facilitate the purposes of this section.
289		-	Sec. 6. Section 20-14o of the general statutes is repealed and the
290		-	following is substituted in lieu thereof (Effective October 1, 2023):
291		-	(a) As used in this section:
292		-	(1) "Opioid drug" has the same meaning as provided in 42 CFR 8.2,
293		-	as amended from time to time;
294		-	(2) "Adult" means a person who is at least eighteen years of age;
295		-	(3) "Prescribing practitioner" has the same meaning as provided in
296		-	section 20-14c;
297		-	(4) "Minor" means a person who is under eighteen years of age;
298		-	(5) "Opioid agonist" means a medication that binds to the opiate
299		-	receptors and provides relief to individuals in treatment for abuse of or
300		-	dependence on an opioid drug;
301		-	(6) "Opiate receptor" means a specific site on a cell surface that
302		-	interacts in a highly selective fashion with an opioid drug;
303		-	(7) "Palliative care" means specialized medical care to improve the
304		-	quality of life of patients and their families facing the problems
305		-	associated with a life-threatening illness; and
306		-	(8) "Opioid antagonist" has the same meaning as provided in section
307		-	17a-714a.
308		-	(b) When issuing a prescription for an opioid drug to an adult patient
309		-	for the first time for outpatient use, a prescribing practitioner who is
310		-	authorized to prescribe an opioid drug shall not issue a prescription for
311		-	more than a seven-day supply of such drug, as recommended in the Substitute Senate Bill No. 9
	223	+	(c) The Department of Mental Health and Addiction Services shall 169
	224	+	use the Opioid Antagonist Bulk Purchase Fund to make grants to 170
	225	+	eligible entities for the purchase of large quantities of opioid antagonists 171
	226	+	in bulk at a discounted price. The department may contract with a 172
	227	+	wholesaler of prescription drugs for the purchasing and distribution of 173
	228	+	opioid antagonists in bulk. The Commissioner of Mental Health and 174
	229	+	Addiction Services shall establish an application process for eligible 175
	230	+	entities to apply for a grant under this subsection. 176
	231	+	(d) The Department of Mental Health and Addiction Services shall 177
	232	+	adopt regulations implementing the provisions of this section, in 178
	233	+	accordance with the provisions of chapter 54 of the general statutes. The 179
	234	+	department may implement the policies and procedures contained in 180
	235	+	such proposed regulations while in the process of adopting such 181
	236	+	proposed regulations, provided the department publishes notice of 182
	237	+	intention to adopt the regulations on the department's Internet web site 183
	238	+	and on the eRegulations System not later than twenty days after 184
	239	+	implementing such policies and procedures. Policies and procedures 185
	240	+	implemented pursuant to this subsection shall be valid until the earlier 186
	241	+	of the date on which such regulations are effective or one year after the 187
	242	+	publication of such notice of intention. 188
	243	+	(e) Not later than January 1, 2025, and annually thereafter, the 189
	244	+	Commissioner of Mental Health and Addiction Services shall report, in 190
	245	+	accordance with the provisions of section 11-4a of the general statutes, 191
	246	+	to the joint standing committees of the General Assembly having 192
	247	+	cognizance of matters relating to public health and appropriations and 193
	248	+	the budgets of state agencies regarding the following information for 194
	249	+	the preceding calendar year: (1) The number of grants applications 195
	250	+	received, (2) the number of eligible entities that received grants under 196
	251	+	this section, (3) the amount in grants made to each such eligible entity, 197
	252	+	(4) the amount of opioid antagonists purchased by each such eligible 198
	253	+	entity, (5) the use of the opioid antagonists purchased with such grants 199
	254	+	by each such eligible entity, if known by the commissioner, and (6) any 200
	255	+	recommendations regarding the Opioid Antagonist Bulk Purchase 201 Substitute Bill No. 9
312	256
313		-	Public Act No. 23-97 11 of 80
314	257
315		-	National Centers for Disease Control and Prevention's Guideline for
316		-	Prescribing Opioids for Chronic Pain.
317		-	(c) A prescribing practitioner shall not issue a prescription for an
318		-	opioid drug to a minor for more than a five-day supply of such drug.
319		-	(d) Notwithstanding the provisions of subsections (b) and (c) of this
320		-	section, if, in the professional medical judgment of a prescribing
321		-	practitioner, more than a seven-day supply of an opioid drug is required
322		-	to treat an adult patient's acute medical condition, or more than a five-
323		-	day supply of an opioid drug is required to treat a minor patient's acute
324		-	medical condition, as determined by the prescribing practitioner, or is
325		-	necessary for the treatment of chronic pain, pain associated with a
326		-	cancer diagnosis or for palliative care, then the prescribing practitioner
327		-	may issue a prescription for the quantity needed to treat the acute
328		-	medical condition, chronic pain, pain associated with a cancer diagnosis
329		-	or pain experienced while the patient is in palliative care. The condition
330		-	triggering the prescription of an opioid drug for more than a seven-day
331		-	supply for an adult patient or more than a five-day supply for a minor
332		-	patient shall be documented in the patient's medical record and the
333		-	practitioner shall indicate that an alternative to the opioid drug was not
334		-	appropriate to address the medical condition.
335		-	(e) The provisions of subsections (b), (c) and (d) of this section shall
336		-	not apply to medications designed for the treatment of abuse of or
337		-	dependence on an opioid drug, including, but not limited to, opioid
338		-	agonists and opioid antagonists.
339		-	(f) When issuing a prescription for an opioid drug to an adult or
340		-	minor patient, the prescribing practitioner shall (1) discuss with the
341		-	patient the risks associated with the use of such opioid drug, including,
342		-	but not limited to, the risks of addiction and overdose associated with
343		-	opioid drugs and the dangers of taking opioid drugs with alcohol,
344		-	benzodiazepines and other central nervous system depressants, and the Substitute Senate Bill No. 9
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346		-	Public Act No. 23-97 12 of 80
	262	+	Fund, including any proposed legislation to facilitate the purposes of 202
	263	+	this section. 203
	264	+	Sec. 6. Section 20-14o of the general statutes is repealed and the 204
	265	+	following is substituted in lieu thereof (Effective October 1, 2023): 205
	266	+	(a) As used in this section: 206
	267	+	(1) "Opioid drug" has the same meaning as provided in 42 CFR 8.2, 207
	268	+	as amended from time to time; 208
	269	+	(2) "Adult" means a person who is at least eighteen years of age; 209
	270	+	(3) "Prescribing practitioner" has the same meaning as provided in 210
	271	+	section 20-14c; 211
	272	+	(4) "Minor" means a person who is under eighteen years of age; 212
	273	+	(5) "Opioid agonist" means a medication that binds to the opiate 213
	274	+	receptors and provides relief to individuals in treatment for abuse of or 214
	275	+	dependence on an opioid drug; 215
	276	+	(6) "Opiate receptor" means a specific site on a cell surface that 216
	277	+	interacts in a highly selective fashion with an opioid drug; 217
	278	+	(7) "Palliative care" means specialized medical care to improve the 218
	279	+	quality of life of patients and their families facing the problems 219
	280	+	associated with a life-threatening illness; and 220
	281	+	(8) "Opioid antagonist" has the same meaning as provided in section 221
	282	+	17a-714a. 222
	283	+	(b) When issuing a prescription for an opioid drug to an adult patient 223
	284	+	for the first time for outpatient use, a prescribing practitioner who is 224
	285	+	authorized to prescribe an opioid drug shall not issue a prescription for 225
	286	+	more than a seven-day supply of such drug, as recommended in the 226
	287	+	National Centers for Disease Control and Prevention's Guideline for 227
	288	+	Prescribing Opioids for Chronic Pain. 228 Substitute Bill No. 9
347	289
348		-	reasons the prescription is necessary, and, if applicable, with the
349		-	custodial parent, guardian or other person having legal custody of the
350		-	minor patient if such parent, guardian or other person is present at the
351		-	time of issuance of the prescription, and (2) encourage the patient and,
352		-	if applicable, the custodial parent, guardian or other person having legal
353		-	custody of the minor patient if such parent, guardian or other person is
354		-	present at the time of issuance of the prescription, to obtain an opioid
355		-	antagonist.
356		-	Sec. 7. (NEW) (Effective July 1, 2023) (a) The Commissioner of
357		-	Education shall, in collaboration with the Chief Workforce Officer,
358		-	utilize the plan required of the Office of Workforce Strategy pursuant to
359		-	section 2 of special act 22-9 in (1) the promotion of the health care
360		-	professions as career options to students in middle and high school,
361		-	including, but not limited to, through career day presentations
362		-	regarding health care career opportunities in the state, the development
363		-	of partnerships with health care career education programs in the state
364		-	and the creation of counseling programs directed to high school
365		-	students to inform such students about, and recruit them to, the health
366		-	care professions, and (2) job shadowing and internship experiences in
367		-	health care fields for high school students.
368		-	(b) Not later than September 1, 2023, the Commissioner of Education
369		-	shall provide each local and regional board of education with the plan
370		-	described in subsection (a) of this section, and through the Governor's
371		-	Workforce Council Education Committee, support implementation of
372		-	such plan.
373		-	Sec. 8. (Effective from passage) (a) The Office of Workforce Strategy
374		-	shall convene a working group to develop recommendations for
375		-	expanding the health care workforce in the state. The working group
376		-	shall evaluate the following: (1) The quality of the nursing and nurse's
377		-	aides education programs in the state; (2) the quality of the clinical
378		-	training programs for nurses and nurse's aides in the state; (3) the Substitute Senate Bill No. 9
379	290
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382		-	potential for increasing the number of clinical training sites for nurses
383		-	and nurse's aides; (4) the expansion of clinical training facilities in the
384		-	state for nurses and nurse's aides; (5) barriers to recruitment and
385		-	retention of health care providers, including, but not limited to, nurses
386		-	and nurse's aides; (6) the impact of the state health care staffing shortage
387		-	on the provision of health care services, the public's access to health care
388		-	services and wait times for health care services; and (7) the impact of
389		-	federal and state reimbursement for the costs of health care services on
390		-	the public's access to such services.
391		-	(b) The working group shall consist of the following members:
392		-	(1) Two representatives of a labor organization representing acute
393		-	care hospital workers in the state;
394		-	(2) Two representatives of a labor organization representing nurses
395		-	and nurse's aides employed by the state of Connecticut or a hospital or
396		-	long-term care facility in the state;
397		-	(3) Two representatives of a labor organization representing faculty
398		-	and professional staff at the regional community-technical colleges;
399		-	(4) The chairperson of the Board of Regents for Higher Education, or
400		-	the chairperson's designee;
401		-	(5) The president of the Connecticut State Colleges and Universities,
402		-	or the president's designee;
403		-	(6) The president of The University of Connecticut, or the president's
404		-	designee;
405		-	(7) One member of the administration of The University of
406		-	Connecticut Health Center;
407		-	(8) Two representatives of the Connecticut Conference of
408		-	Independent Colleges; Substitute Senate Bill No. 9
	295	+	(c) A prescribing practitioner shall not issue a prescription for an 229
	296	+	opioid drug to a minor for more than a five-day supply of such drug. 230
	297	+	(d) Notwithstanding the provisions of subsections (b) and (c) of this 231
	298	+	section, if, in the professional medical judgment of a prescribing 232
	299	+	practitioner, more than a seven-day supply of an opioid drug is required 233
	300	+	to treat an adult patient's acute medical condition, or more than a five-234
	301	+	day supply of an opioid drug is required to treat a minor patient's acute 235
	302	+	medical condition, as determined by the prescribing practitioner, or is 236
	303	+	necessary for the treatment of chronic pain, pain associated with a 237
	304	+	cancer diagnosis or for palliative care, then the prescribing practitioner 238
	305	+	may issue a prescription for the quantity needed to treat the acute 239
	306	+	medical condition, chronic pain, pain associated with a cancer diagnosis 240
	307	+	or pain experienced while the patient is in palliative care. The condition 241
	308	+	triggering the prescription of an opioid drug for more than a seven-day 242
	309	+	supply for an adult patient or more than a five-day supply for a minor 243
	310	+	patient shall be documented in the patient's medical record and the 244
	311	+	practitioner shall indicate that an alternative to the opioid drug was not 245
	312	+	appropriate to address the medical condition. 246
	313	+	(e) The provisions of subsections (b), (c) and (d) of this section shall 247
	314	+	not apply to medications designed for the treatment of abuse of or 248
	315	+	dependence on an opioid drug, including, but not limited to, opioid 249
	316	+	agonists and opioid antagonists. 250
	317	+	(f) When issuing a prescription for an opioid drug to an adult or 251
	318	+	minor patient, the prescribing practitioner shall discuss with the patient 252
	319	+	the risks associated with the use of such opioid drug, including, but not 253
	320	+	limited to, the risks of addiction and overdose associated with opioid 254
	321	+	drugs and the dangers of taking opioid drugs with alcohol, 255
	322	+	benzodiazepines and other central nervous system depressants, and the 256
	323	+	reasons the prescription is necessary, and, if applicable, with the 257
	324	+	custodial parent, guardian or other person having legal custody of the 258
	325	+	minor if such parent, guardian or other person is present at the time of 259
	326	+	issuance of the prescription. 260 Substitute Bill No. 9
409	327
410		-	Public Act No. 23-97 14 of 80
411	328
412		-	(9) The Commissioner of Public Health, or the commissioner's
413		-	designee;
414		-	(10) The Commissioner of Social Services, or the commissioner's
415		-	designee;
416		-	(11) The Commissioner of Administrative Services, or the
417		-	commissioner's designee;
418		-	(12) The Secretary of the Office of Policy and Management, or the
419		-	secretary's designee;
420		-	(13) A representative of the State Board of Examiners for Nursing;
421		-	(14) A representative of the State Employees Bargaining Agent
422		-	Coalition;
423		-	(15) The chairpersons and ranking members of the joint standing
424		-	committee of the General Assembly having cognizance of matters
425		-	relating to public health, or the chairpersons' and ranking members'
426		-	designees; and
427		-	(16) The chairpersons and ranking members of the joint standing
428		-	committee of the General Assembly having cognizance of matters
429		-	relating to higher education and employment advancement, or the
430		-	chairpersons' and ranking members' designees.
431		-	(c) The cochairpersons of the working group shall be the
432		-	Commissioner of Public Health, or the commissioner's designee, and the
433		-	chairperson of the Board of Regents for Higher Education, or the
434		-	president's designee. The cochairpersons shall schedule the first
435		-	meeting of the working group, which shall be held not later than sixty
436		-	days after the effective date of this section.
437		-	(d) Not later than January 1, 2024, the working group shall submit a
438		-	report, in accordance with the provisions of section 11-4a of the general Substitute Senate Bill No. 9
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440		-	Public Act No. 23-97 15 of 80
	333	+	(g) When issuing a prescription for an opioid drug to an adult or 261
	334	+	minor patient, the prescribing practitioner shall also issue a prescription 262
	335	+	for an opioid antagonist to the patient when the following risk factors 263
	336	+	are present: (1) The patient has a history of a substance use disorder; (2) 264
	337	+	the prescribing practitioner issued a prescription for a high-dose opioid 265
	338	+	drug that results in ninety morphine milligram equivalents or higher 266
	339	+	per day; or (3) concurrent use by the patient of an opioid drug and a 267
	340	+	benzodiazepine or nonbenzodiazepine sedative hypnotic. 268
	341	+	Sec. 7. (NEW) (Effective July 1, 2023) (a) As used in this section: 269
	342	+	(1) "Emergency medical services personnel" has the same meaning as 270
	343	+	provided in section 19a-175 of the general statutes; 271
	344	+	(2) "Opioid antagonist" means naloxone hydrochloride or any other 272
	345	+	similarly acting and equally safe drug approved by the federal Food and 273
	346	+	Drug Administration for the treatment of a drug overdose; 274
	347	+	(3) "Opioid use disorder" means a medical condition characterized by 275
	348	+	a problematic pattern of opioid use and misuse leading to clinically 276
	349	+	significant impairment or distress; 277
	350	+	(4) "Opioid drug" has the same meaning as provided in 42 CFR 8.2, 278
	351	+	as amended from time to time; and 279
	352	+	(5) "Pharmacist" has the same meaning as provided in section 20-609a 280
	353	+	of the general statutes. 281
	354	+	(b) Not later than January 1, 2024, the Office of Emergency Medical 282
	355	+	Services, in collaboration with the Departments of Mental Health and 283
	356	+	Addiction Services and Consumer Protection, shall develop a program 284
	357	+	for the provision of opioid antagonists and related information by 285
	358	+	emergency medical services personnel to certain members of the public. 286
	359	+	Emergency medical services personnel shall distribute an opioid 287
	360	+	antagonist kit containing a personal supply of opioid antagonists and 288
	361	+	the one-page fact sheet developed by the Connecticut Alcohol and Drug 289
	362	+	Policy Council pursuant to section 17a-667a of the general statutes 290 Substitute Bill No. 9
441	363
442		-	statutes, to the joint standing committees of the General Assembly
443		-	having cognizance of matters relating to public health and higher
444		-	education and employment advancement on its findings and any
445		-	recommendations for improving the recruitment and retention of health
446		-	care providers in the state, including, but not limited to, a five-year plan
447		-	and a ten-year plan for increasing the health care workforce in the state.
448		-	The working group shall terminate on the date that it submits such
449		-	report or January 1, 2024, whichever is later.
450		-	Sec. 9. (NEW) (Effective July 1, 2023) On and after January 1, 2024,
451		-	notwithstanding any provision of title 10a of the general statutes, each
452		-	public institution of higher education shall consider any licensed health
453		-	care provider who (1) has not less than ten years of clinical health care
454		-	experience in a field in which such provider is licensed, and (2) applies
455		-	for a position as an adjunct faculty member at such institution of higher
456		-	education in a health care related field in which such provider has such
457		-	experience, to be a qualified applicant for such position and give such
458		-	provider the same consideration as any other qualified applicant for
459		-	such position. As used in this section, "public institution of higher
460		-	education" means those constituent units identified in subdivisions (1)
461		-	and (2) of section 10a-1 of the general statutes.
462		-	Sec. 10. (NEW) (Effective July 1, 2023) (a) On or before January 1, 2024,
463		-	the Office of Higher Education shall establish and administer, within
464		-	available appropriations, an adjunct professor incentive grant program.
465		-	The program shall provide an incentive grant in an amount of twenty
466		-	thousand dollars to each licensed health care provider who (1) accepts a
467		-	position as an adjunct professor at a public institution of higher
468		-	education that was offered to such provider after being considered as an
469		-	applicant for such position pursuant to section 9 of this act, and (2)
470		-	remains in such position for not less than one academic year. Each
471		-	licensed health care provider who receives a grant under this subsection
472		-	shall be eligible for an additional grant in an amount of twenty thousand Substitute Senate Bill No. 9
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476		-	dollars if the provider remains in such position for not less than two
477		-	academic years. The executive director of the Office of Higher Education
478		-	shall establish the application process for the grant program.
479		-	(b) Not later than January 1, 2025, and annually thereafter, the
480		-	executive director of the Office of Higher Education shall report, in
481		-	accordance with the provisions of section 11-4a of the general statutes,
482		-	to the joint standing committee of the General Assembly having
483		-	cognizance of matters relating to public health regarding the number
484		-	and demographics of the adjunct professors who applied for and
485		-	received incentive grants from the adjunct professor grant program
486		-	established under subsection (a) of this section, the number and types
487		-	of classes taught by such adjunct professors, the institutions of higher
488		-	education employing such adjunct professors and any other
489		-	information deemed pertinent by the executive director.
490		-	Sec. 11. (NEW) (Effective July 1, 2023) (a) As used in this section,
491		-	"personal care attendant", "consumer" and "personal care assistance"
492		-	have the same meanings as provided in section 17b-706 of the general
493		-	statutes.
494		-	(b) Not later than January 1, 2024, the Department of Social Services
495		-	shall establish and administer a personal care attendants career
496		-	pathways program to improve the quality of care offered by personal
497		-	care attendants and incentivize the recruitment and retention of
498		-	personal care attendants in the state. A personal care attendant who is
499		-	not employed by a consumer, but who is eligible for employment by a
500		-	consumer, may participate in the program following the completion of
501		-	a program orientation developed by the Commissioner of Social
502		-	Services.
503		-	(c) The career pathways program shall include, but need not be
504		-	limited to, the following objectives: Substitute Senate Bill No. 9
	369	+	regarding the risks of taking an opioid drug, symptoms of opioid use 291
	370	+	disorder and services available in the state for persons who experience 292
	371	+	symptoms of or are otherwise affected by opioid use disorder to a 293
	372	+	patient who (1) is treated by such personnel for an overdose of an opioid 294
	373	+	drug, (2) displays symptoms to such personnel of opioid use disorder, 295
	374	+	or (3) is treated at a location where such personnel observes evidence of 296
	375	+	illicit use of an opioid drug, or to such patient's family member, 297
	376	+	caregiver or friend who is present at the location. Emergency medical 298
	377	+	services personnel shall refer the patient or such patient's family 299
	378	+	member, caregiver or friend to the written instructions regarding the 300
	379	+	administration of such opioid antagonist, as deemed appropriate by 301
	380	+	such personnel. 302
	381	+	(c) Emergency medical services organizations may obtain opioid 303
	382	+	antagonists for dissemination through the program developed pursuant 304
	383	+	to subsection (b) of this section from a pharmacist pursuant to section 305
	384	+	20-633c, 20-633d, as amended by this act, or 21a-286 of the general 306
	385	+	statutes. 307
	386	+	(d) Emergency medical services personnel shall document the 308
	387	+	number of opioid antagonist kits distributed pursuant to subsection (b) 309
	388	+	of this section, including, but not limited to, the number of doses of an 310
	389	+	opioid antagonist included in each kit. 311
	390	+	(e) Not later than January 1, 2025, and annually thereafter, the 312
	391	+	executive director of the Office of Emergency Medical Services shall 313
	392	+	report, in accordance with the provisions of section 11-4a of the general 314
	393	+	statutes, to the joint standing committee of the General Assembly 315
	394	+	having cognizance of matters relating to public health regarding the 316
	395	+	implementation of the program developed pursuant to subsection (b) of 317
	396	+	this section, including, but not limited to, information contained in the 318
	397	+	documentation prepared pursuant to subsection (d) of this section. 319
	398	+	(f) The Department of Public Health may adopt regulations, in 320
	399	+	accordance with the provisions of chapter 54 of the general statutes, to 321
	400	+	implement the provisions of this section. 322 Substitute Bill No. 9
505	401
506		-	Public Act No. 23-97 17 of 80
507	402
508		-	(1) Increase in employment retention and recruitment of personal
509		-	care attendants to maintain a stable workforce for consumers, including,
510		-	but not limited to, through the creation of career pathways for such
511		-	attendants that improve skill and knowledge and increase wages;
512		-	(2) Dignity in providing and receiving care through meaningful
513		-	collaboration between consumers and personal care attendants;
514		-	(3) Improvement in the quality of personal care assistance and the
515		-	overall quality of life of the consumer;
516		-	(4) Advancement of equity in the provision of personal care
517		-	assistance;
518		-	(5) Promotion of a culturally and linguistically competent workforce
519		-	of personal attendants to serve the growing racial, ethnic and linguistic
520		-	diversity of an aging population of consumers; and
521		-	(6) Promotion of self-determination principles by personal care
522		-	attendants.
523		-	(d) The Commissioner of Social Services shall offer the following
524		-	career pathways as part of the career pathways program:
525		-	(1) The basic skills career pathways, including (A) general health and
526		-	safety, and (B) adult education topics; and
527		-	(2) The specialized skills career pathways, including (A) cognitive
528		-	impairments and behavioral health, (B) complex physical care needs,
529		-	and (C) transitioning to home and community-based living from out-of-
530		-	home care or homelessness.
531		-	(e) The Commissioner of Social Services shall develop or identify, in
532		-	consultation with a labor management committee at a hospital or health
533		-	care organization, the training curriculum for each career pathway of
534		-	the career pathways program. Substitute Senate Bill No. 9
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535	406
536		-	Public Act No. 23-97 18 of 80
	407	+	Sec. 8. Subsection (a) of section 20-633d of the general statutes is 323
	408	+	repealed and the following is substituted in lieu thereof (Effective July 1, 324
	409	+	2023): 325
	410	+	(a) A prescribing practitioner, as defined in section 20-14c, who is 326
	411	+	authorized to prescribe an opioid antagonist, as defined in section 17a-327
	412	+	714a, and a pharmacy may enter into an agreement for a medical 328
	413	+	protocol standing order at such pharmacy allowing a pharmacist 329
	414	+	licensed under part II of this chapter to dispense an opioid antagonist 330
	415	+	that is [(1)] administered by an intranasal application delivery system or 331
	416	+	an auto-injection delivery system [, (2)] and approved by the federal 332
	417	+	Food and Drug Administration [, and (3) dispensed to] to (1) any person 333
	418	+	at risk of experiencing an overdose of an opioid drug, as defined in 42 334
	419	+	CFR 8.2, [or to] (2) a family member, friend or other person in a position 335
	420	+	to assist a person at risk of experiencing an overdose of an opioid drug, 336
	421	+	or (3) an emergency medical services organization for purposes of 337
	422	+	section 7 of this act. 338
	423	+	Sec. 9. (NEW) (Effective July 1, 2023) (a) The Commissioner of 339
	424	+	Education shall establish a Health Care Career Advisory Council 340
	425	+	consisting of the following members: 341
	426	+	(1) A representative of an association of hospitals in the state; 342
	427	+	(2) A representative of a medical society in the state; 343
	428	+	(3) A representative of the Connecticut chapter of a national 344
	429	+	association of nurse practitioners; 345
	430	+	(4) A representative of an association of nurses in the state; 346
	431	+	(5) A representative of an association of physician assistants in the 347
	432	+	state; 348
	433	+	(6) A representative of the Connecticut chapter of a national 349
	434	+	association of social workers; 350 Substitute Bill No. 9
537	435
538		-	(f) Not later than January 1, 2025, the Commissioner of Social Services
539		-	shall report in accordance with the provisions of section 11-4a of the
540		-	general statutes, to the joint standing committees of the General
541		-	Assembly having cognizance of matters relating to human services and
542		-	public health, on the following information concerning the career
543		-	pathways program:
544		-	(1) The number of personal care attendants who enrolled in the
545		-	program and types of career pathways chosen by each attendant;
546		-	(2) The number of personal care attendants who successfully
547		-	completed a career pathway and the types of career pathways
548		-	completed by each attendant;
549		-	(3) The effectiveness of the program, as determined by surveys, focus
550		-	groups and interviews of personal care attendants, and whether the
551		-	successful completion of a career pathway resulted in a related license
552		-	or certificate for each personal care attendant or the retention of
553		-	employment as a personal care attendant;
554		-	(4) The number of personal care attendants who were employed by a
555		-	consumer with specialized care needs after completing a specialized
556		-	career pathway and who were retained in employment by such
557		-	consumer for a period of not less than six months; and
558		-	(5) The number of personal care attendants who were employed by a
559		-	consumer with specialized care needs after completing a specialized
560		-	career pathway and were retained in employment by such consumer for
561		-	a period of at least twelve months.
562		-	Sec. 12. (NEW) (Effective October 1, 2023) (a) As used in this section,
563		-	(1) "board eligible" means eligible to take a qualifying examination
564		-	administered by a medical specialty board after having graduated from
565		-	a medical school, completed a residency program and trained under
566		-	supervision in a specialty fellowship program, (2) "board certified" Substitute Senate Bill No. 9
567	436
568		-	Public Act No. 23-97 19 of 80
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569	440
570		-	means having passed the qualifying examination administered by a
571		-	medical specialty board to become board certified in a particular
572		-	specialty, and (3) "board recertification" means recertification in a
573		-	particular specialty after a predetermined time period prescribed by a
574		-	medical specialty board after having passed the qualifying examination
575		-	administered by the medical specialty board to become board certified
576		-	in a particular specialty.
577		-	(b) No hospital, or medical review committee of a hospital, shall
578		-	require, as part of its credentialing requirements (1) for a board eligible
579		-	physician to acquire privileges to practice in the hospital, that the
580		-	physician provide credentials of board certification in a particular
581		-	specialty until five years after the date on which the physician became
582		-	board eligible in such specialty, or (2) for a board certified physician to
583		-	acquire or retain privileges to practice in the hospital, that the physician
584		-	provide credentials of board recertification.
585		-	Sec. 13. Section 20-14p of the general statutes is repealed and the
586		-	following is substituted in lieu thereof (Effective July 1, 2023):
587		-	(a) For purposes of this section: (1) "Covenant not to compete" means
588		-	any provision of an employment or other contract or agreement that
589		-	creates or establishes a professional relationship with a physician and
590		-	restricts the right of a physician to practice medicine in any geographic
591		-	area of the state for any period of time after the termination or cessation
592		-	of such partnership, employment or other professional relationship; (2)
593		-	"physician" means an individual licensed to practice medicine under
594		-	this chapter; and (3) "primary site where such physician practices"
595		-	means [(A) the office, facility or location where a majority of the revenue
596		-	derived from such physician's services is generated, or (B) any other]
597		-	any single office, facility or location where such physician practices,
598		-	[and] as mutually agreed to by the parties and [identified] defined in the
599		-	covenant not to compete. Substitute Senate Bill No. 9
	441	+	(7) A representative of the Connecticut chapter of a national 351
	442	+	association of psychologists in the state; and 352
	443	+	(8) A representative of an association of pharmacists in the state. 353
	444	+	(b) The advisory council shall advise the Commissioner of Education 354
	445	+	concerning the development of a health care career program consisting 355
	446	+	of (1) the promotion of the health care professions as career options to 356
	447	+	students in middle and high school, including, but not limited to, 357
	448	+	through career day presentations regarding health care career 358
	449	+	opportunities in the state, the development of partnerships with health 359
	450	+	care career education programs in the state and the creation of 360
	451	+	counseling programs directed to high school students in order to inform 361
	452	+	them about and recruit them to the health care professions, and (2) job 362
	453	+	shadowing and internship experiences in health care fields for high 363
	454	+	school students. 364
	455	+	(c) Members shall receive no compensation except for reimbursement 365
	456	+	for necessary expenses incurred in performing their duties. 366
	457	+	(d) The Commissioner of Education shall schedule the first meeting 367
	458	+	of the advisory council, which shall be held not later than September 1, 368
	459	+	2023. The members shall elect the chairperson of the advisory council 369
	460	+	from among the members of the council. A majority of the council 370
	461	+	members shall constitute a quorum. A majority vote of a quorum shall 371
	462	+	be required for any official action of the advisory council. The advisory 372
	463	+	council shall meet upon the call of the chairperson or upon the majority 373
	464	+	request of the council members. 374
	465	+	(e) Not later than January 1, 2024, and not less than annually 375
	466	+	thereafter, the advisory council shall submit a report, in accordance with 376
	467	+	the provisions of section 11-4a of the general statutes, on its 377
	468	+	recommendations to the Commissioner of Education and to the joint 378
	469	+	standing committees of the General Assembly having cognizance of 379
	470	+	matters relating to education and public health. 380
	471	+	(f) The Commissioner of Education shall notify each local and 381 Substitute Bill No. 9
600	472
601		-	Public Act No. 23-97 20 of 80
602	473
603		-	(b) (1) A covenant not to compete is valid and enforceable only if it is:
604		-	(A) Necessary to protect a legitimate business interest; (B) reasonably
605		-	limited in time, geographic scope and practice restrictions as necessary
606		-	to protect such business interest; and (C) otherwise consistent with the
607		-	law and public policy. The party seeking to enforce a covenant not to
608		-	compete shall have the burden of proof in any proceeding.
609		-	(2) A covenant not to compete that is entered into, amended,
610		-	extended or renewed on or after July 1, 2016, shall not: (A) Restrict the
611		-	physician's competitive activities (i) for a period of more than one year,
612		-	and (ii) in a geographic region of more than fifteen miles from the
613		-	primary site where such physician practices; or (B) be enforceable
614		-	against a physician if (i) such employment contract or agreement was
615		-	not made in anticipation of, or as part of, a partnership or ownership
616		-	agreement and such contract or agreement expires and is not renewed,
617		-	unless, prior to such expiration, the employer makes a bona fide offer to
618		-	renew the contract on the same or similar terms and conditions, or (ii)
619		-	the employment or contractual relationship is terminated by the
620		-	employer, unless such employment or contractual relationship is
621		-	terminated for cause.
622		-	(3) A covenant not to compete that is entered into, amended,
623		-	extended or renewed on or after October 1, 2023, shall not be enforceable
624		-	if (A) the physician who is a party to the employment or other contract
625		-	or agreement does not agree to a proposed material change to the
626		-	compensation terms of such contract or agreement prior to or at the time
627		-	of the extension or renewal of such contract or agreement, and (B) the
628		-	contract or agreement expires and is not renewed by the employer or
629		-	the employment or contractual relationship is terminated by the
630		-	employer, unless such employment or contractual relationship is
631		-	terminated by the employer for cause. The provisions of this subdivision
632		-	shall not apply to a covenant not to compete that is entered into between
633		-	a physician and a group practice, as defined in section 19a-486i, of not Substitute Senate Bill No. 9
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634	477
635		-	Public Act No. 23-97 21 of 80
	478	+	regional board of education of the advisory council's recommendations 382
	479	+	not later than thirty days after the commissioner's receipt of the advisory 383
	480	+	council's report containing such recommendations. 384
	481	+	Sec. 10. (Effective from passage) (a) The Commissioner of Public Health 385
	482	+	shall convene a working group to develop recommendations for 386
	483	+	expanding the nursing workforce in the state. The working group shall 387
	484	+	evaluate the following: (1) The quality of the nursing and nurse's aides 388
	485	+	education programs in the state; (2) the quality of the clinical training 389
	486	+	programs for nurses and nurse's aides in the state; (3) the potential for 390
	487	+	increasing the number of clinical training sites for nurses and nurse's 391
	488	+	aides; (4) the expansion of clinical training facilities in the state for 392
	489	+	nurses and nurse's aides; and (5) barriers to recruitment and retention 393
	490	+	of nurses and nurse's aides. 394
	491	+	(b) The working group shall consist of the following members: 395
	492	+	(1) Two representatives of a labor organization representing acute 396
	493	+	care hospital workers in the state; 397
	494	+	(2) Two representatives of a labor organization representing nurses 398
	495	+	and nurse's aides employed by the state of Connecticut or a hospital or 399
	496	+	long-term care facility in the state; 400
	497	+	(3) Two representatives of a labor organization representing faculty 401
	498	+	and professional staff at the regional community-technical colleges; 402
	499	+	(4) The president of the Board of Regents for Higher Education, or the 403
	500	+	president's designee; 404
	501	+	(5) The president of the Connecticut State Colleges and Universities, 405
	502	+	or the president's designee; 406
	503	+	(6) The president of The University of Connecticut, or the president's 407
	504	+	designee; 408
	505	+	(7) One member of the administration of The University of 409 Substitute Bill No. 9
636	506
637		-	more than thirty-five physicians the majority ownership of which is
638		-	comprised of physicians.
639		-	[(3)] (4) Each covenant not to compete entered into, amended or
640		-	renewed on and after July 1, 2016, shall be separately and individually
641		-	signed by the physician.
642		-	(c) The remaining provisions of any contract or agreement that
643		-	includes a covenant not to compete that is rendered void and
644		-	unenforceable, in whole or in part, under the provisions of this section
645		-	shall remain in full force and effect, including provisions that require
646		-	the payment of damages resulting from any injury suffered by reason of
647		-	termination of such contract or agreement.
648		-	Sec. 14. (NEW) (Effective July 1, 2023) (a) For purposes of this section:
649		-	(1) "Covenant not to compete" means any provision of an employment
650		-	or other contract or agreement that creates or establishes a professional
651		-	relationship with an advanced practice registered nurse and restricts the
652		-	right of an advanced practice registered nurse to practice as an
653		-	advanced practice registered nurse in any geographic area of the state
654		-	for any period of time after the termination or cessation of such
655		-	partnership, employment or other professional relationship; (2)
656		-	"advanced practice registered nurse" means an individual licensed as an
657		-	advanced practice registered nurse pursuant to chapter 378 of the
658		-	general statutes; and (3) "primary site where such advanced practice
659		-	registered nurse practices" means any single office, facility or location
660		-	where such advanced practice registered nurse practices, as mutually
661		-	agreed to by the parties and defined in the covenant not to compete.
662		-	(b) (1) A covenant not to compete that is entered into, amended,
663		-	extended or renewed on or after October 1, 2023, shall be valid and
664		-	enforceable only if it is: (A) Necessary to protect a legitimate business
665		-	interest; (B) reasonably limited in time, geographic scope and practice
666		-	restrictions as necessary to protect such business interest; and (C) Substitute Senate Bill No. 9
667	507
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669	511
670		-	otherwise consistent with the law and public policy. The party seeking
671		-	to enforce a covenant not to compete shall have the burden of proof in
672		-	any proceeding.
673		-	(2) A covenant not to compete that is entered into, amended,
674		-	extended or renewed on or after October 1, 2023, shall not: (A) Restrict
675		-	the advanced practice registered nurse's competitive activities (i) for a
676		-	period of more than one year, and (ii) in a geographic region of more
677		-	than fifteen miles from the primary site where such advanced practice
678		-	registered nurse practices; or (B) be enforceable against an advanced
679		-	practice registered nurse if (i) such employment contract or agreement
680		-	was not made in anticipation of, or as part of, a partnership or
681		-	ownership agreement and such contract or agreement expires and is not
682		-	renewed, unless, prior to such expiration, the employer makes a bona
683		-	fide offer to renew the contract on the same or similar terms and
684		-	conditions, or (ii) the employment or contractual relationship is
685		-	terminated by the employer, unless such employment or contractual
686		-	relationship is terminated for cause.
687		-	(3) A covenant not to compete that is entered into, amended,
688		-	extended or renewed on or after October 1, 2023, shall not be enforceable
689		-	if (A) the advanced practice registered nurse who is a party to the
690		-	employment or other contract or agreement does not agree to a
691		-	proposed material change to the compensation terms of such contract or
692		-	agreement prior to or at the time of the extension or renewal of such
693		-	contract or agreement; and (B) the contract or agreement expires and is
694		-	not renewed by the employer or the employment or contractual
695		-	relationship is terminated by the employer, unless such employment or
696		-	contractual relationship is terminated for cause.
697		-	(4) Each covenant not to compete entered into, amended or renewed
698		-	on or after October 1, 2023, shall be separately and individually signed
699		-	by the advanced practice registered nurse. Substitute Senate Bill No. 9
	512	+	Connecticut Health Center; 410
	513	+	(8) Two representatives of the Connecticut Conference of 411
	514	+	Independent Colleges; 412
	515	+	(9) The Commissioner of Public Health, or the commissioner's 413
	516	+	designee; 414
	517	+	(10) The Commissioner of Social Services, or the commissioner's 415
	518	+	designee; 416
	519	+	(11) The Commissioner of Administrative Services, or the 417
	520	+	commissioner's designee; 418
	521	+	(12) The Secretary of the Office of Policy and Management, or the 419
	522	+	secretary's designee; 420
	523	+	(13) A representative of the State Board of Examiners for Nursing; 421
	524	+	(14) The chairpersons and ranking members of the joint standing 422
	525	+	committee of the General Assembly having cognizance of matters 423
	526	+	relating to public health, or the chairpersons' and ranking members' 424
	527	+	designees; and 425
	528	+	(15) The chairpersons and ranking members of the joint standing 426
	529	+	committee of the General Assembly having cognizance of matters 427
	530	+	relating to higher education and employment advancement, or the 428
	531	+	chairpersons' and ranking members' designees. 429
	532	+	(c) The cochairpersons of the working group shall be the 430
	533	+	Commissioner of Public Health, or the commissioner's designee, and the 431
	534	+	president of the Board of Regents for Higher Education, or the 432
	535	+	president's designee. The cochairpersons shall schedule the first 433
	536	+	meeting of the working group, which shall be held not later than sixty 434
	537	+	days after the effective date of this section. 435
	538	+	(d) Not later than January 1, 2024, the working group shall submit a 436
	539	+	report, in accordance with the provisions of section 11-4a of the general 437 Substitute Bill No. 9
700	540
701		-	Public Act No. 23-97 23 of 80
702	541
703		-	(c) The remaining provisions of any contract or agreement that
704		-	includes a covenant not to compete that is rendered void and
705		-	unenforceable, in whole or in part, under the provisions of this section
706		-	shall remain in full force and effect, including provisions that require
707		-	the payment of damages resulting from any injury suffered by reason of
708		-	termination of such contract or agreement.
709		-	Sec. 15. (NEW) (Effective July 1, 2023) (a) For purposes of this section:
710		-	(1) "Covenant not to compete" means any provision of an employment
711		-	or other contract or agreement that creates or establishes a professional
712		-	relationship with a physician assistant and restricts the right of a
713		-	physician assistant to practice as a physician assistant in any geographic
714		-	area of the state for any period of time after the termination or cessation
715		-	of such partnership, employment or other professional relationship; (2)
716		-	"physician assistant" means an individual licensed as a physician
717		-	assistant pursuant to chapter 370 of the general statutes; and (3)
718		-	"primary site where such physician assistant practices" means any single
719		-	office, facility or location where such physician assistant practices, as
720		-	mutually agreed to by the parties and defined in the covenant not to
721		-	compete.
722		-	(b) (1) A covenant not to compete that is entered into, amended,
723		-	extended or renewed on or after October 1, 2023, shall be valid and
724		-	enforceable only if it is: (A) Necessary to protect a legitimate business
725		-	interest; (B) reasonably limited in time, geographic scope and practice
726		-	restrictions as necessary to protect such business interest; and (C)
727		-	otherwise consistent with the law and public policy. The party seeking
728		-	to enforce a covenant not to compete shall have the burden of proof in
729		-	any proceeding.
730		-	(2) A covenant not to compete that is entered into, amended,
731		-	extended or renewed on or after October 1, 2023, shall not: (A) Restrict
732		-	the physician assistant's competitive activities (i) for a period of more
733		-	than one year, and (ii) in a geographic region of more than fifteen miles Substitute Senate Bill No. 9
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735		-	Public Act No. 23-97 24 of 80
	546	+	statutes, to the joint standing committees of the General Assembly 438
	547	+	having cognizance of matters relating to public health and higher 439
	548	+	education and employment advancement on its findings and any 440
	549	+	recommendations for improving the recruitment and retention of 441
	550	+	nurses and nurse's aides in the state, including, but not limited to, a five-442
	551	+	year plan and a ten-year plan for increasing the nursing workforce in 443
	552	+	the state. The working group shall terminate on the date that it submits 444
	553	+	such report or January 1, 2024, whichever is later. 445
	554	+	Sec. 11. (NEW) (Effective July 1, 2023) On and after January 1, 2024, 446
	555	+	notwithstanding any provision of title 10a of the general statutes, each 447
	556	+	public institution of higher education shall consider any licensed health 448
	557	+	care provider who (1) has not less than ten years of clinical health care 449
	558	+	experience in a field in which such provider is licensed, and (2) applies 450
	559	+	for a position as an adjunct faculty member at such institution of higher 451
	560	+	education in a health care related field in which such provider has such 452
	561	+	experience, to be a qualified applicant for such position and give such 453
	562	+	provider the same consideration as any other qualified applicant for 454
	563	+	such position. As used in this section, "public institution of higher 455
	564	+	education" means those constituent units identified in subdivisions (1) 456
	565	+	and (2) of section 10a-1 of the general statutes. 457
	566	+	Sec. 12. (NEW) (Effective July 1, 2023) (a) On or before January 1, 2024, 458
	567	+	the Office of Higher Education shall establish and administer an adjunct 459
	568	+	professor incentive grant program. The program shall provide incentive 460
	569	+	grants to each licensed health care provider who accepts a position as 461
	570	+	an adjunct professor at a public institution of higher education that was 462
	571	+	offered to such provider after being considered as an applicant for such 463
	572	+	position pursuant to section 11 of this act. Such grants shall be in an 464
	573	+	annual amount that represents the difference between the provider's 465
	574	+	most recent annual salary as a licensed health care provider in the 466
	575	+	clinical setting and the provider's salary as an adjunct professor at such 467
	576	+	institution of higher education, for as long as such provider remains 468
	577	+	employed as an adjunct professor in a health care related field at such 469
	578	+	institution of higher education. The executive director of the Office of 470 Substitute Bill No. 9
736	579
737		-	from the primary site where such physician assistant practices; or (B) be
738		-	enforceable against a physician assistant if (i) such employment contract
739		-	or agreement was not made in anticipation of, or as part of, a
740		-	partnership or ownership agreement and such contract or agreement
741		-	expires and is not renewed, unless, prior to such expiration, the
742		-	employer makes a bona fide offer to renew the contract on the same or
743		-	similar terms and conditions, or (ii) the employment or contractual
744		-	relationship is terminated by the employer, unless such employment or
745		-	contractual relationship is terminated for cause.
746		-	(3) A covenant not to compete that is entered into, amended,
747		-	extended or renewed on or after October 1, 2023, shall not be enforceable
748		-	if (A) the physician assistant who is a party to the employment or other
749		-	contract or agreement does not agree to a proposed material change to
750		-	the compensation terms of such contract or agreement prior to or at the
751		-	time of the extension or renewal of such contract or agreement; and (B)
752		-	the contract or agreement expires and is not renewed by the employer
753		-	or the employment or contractual relationship is terminated by the
754		-	employer, unless such employment or contractual relationship is
755		-	terminated for cause.
756		-	(4) Each covenant not to compete entered into, amended or renewed
757		-	on or after October 1, 2023, shall be separately and individually signed
758		-	by the physician assistant.
759		-	(c) The remaining provisions of any contract or agreement that
760		-	includes a covenant not to compete that is rendered void and
761		-	unenforceable, in whole or in part, under the provisions of this section
762		-	shall remain in full force and effect, including provisions that require
763		-	the payment of damages resulting from any injury suffered by reason of
764		-	termination of such contract or agreement.
765		-	Sec. 16. (NEW) (Effective July 1, 2023) The Physical Therapy Licensure
766		-	Compact is hereby enacted into law and entered into by the state of Substitute Senate Bill No. 9
767	580
768		-	Public Act No. 23-97 25 of 80
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769	584
770		-	Connecticut with any and all jurisdictions legally joining therein in
771		-	accordance with its terms. The compact is substantially as follows:
772		-	"PHYSICAL THERAPY LICENSURE COMPACT
773		-	SECTION 1. PURPOSE
774		-	The purpose of the compact is to facilitate interstate practice of
775		-	physical therapy with the goal of improving public access to physical
776		-	therapy services. The practice of physical therapy occurs in the state
777		-	where the patient is located at the time of the patient encounter. The
778		-	compact preserves the regulatory authority of states to protect public
779		-	health and safety through the current system of state licensure.
780		-	The compact is designed to achieve the following objectives:
781		-	(1) Increase public access to physical therapy services by providing
782		-	for the mutual recognition of other member state licenses;
783		-	(2) Enhance the states' ability to protect the public's health and safety;
784		-	(3) Encourage the cooperation of member states in regulating multi-
785		-	state physical therapy practice;
786		-	(4) Support spouses of relocating military members;
787		-	(5) Enhance the exchange of licensure, investigative and disciplinary
788		-	information between member states; and
789		-	(6) Allow a remote state to hold a provider of services with a compact
790		-	privilege in such state accountable to such state's practice standards.
791		-	SECTION 2. DEFINITIONS
792		-	As used in section 1, this section and sections 3 to 12, inclusive, of the
793		-	compact, and except as otherwise provided: Substitute Senate Bill No. 9
	585	+	Higher Education shall establish the application process for the grant 471
	586	+	program. 472
	587	+	(b) Not later than January 1, 2025, and annually thereafter, the 473
	588	+	executive director of the Office of Higher Education shall report, in 474
	589	+	accordance with the provisions of section 11-4a of the general statutes, 475
	590	+	to the joint standing committee of the General Assembly having 476
	591	+	cognizance of matters relating to public health regarding the number 477
	592	+	and demographics of the adjunct professors who applied for and 478
	593	+	received incentive grants from the adjunct professor grant program 479
	594	+	established under subsection (a) of this section, the number and types 480
	595	+	of classes taught by such adjunct professors, the institutions of higher 481
	596	+	education employing such adjunct professors and any other 482
	597	+	information deemed pertinent by the executive director. 483
	598	+	Sec. 13. (NEW) (Effective July 1, 2023) On and after January 1, 2024, the 484
	599	+	Department of Public Health shall offer any competency evaluations 485
	600	+	prescribed by the Commissioner of Public Health for nurse's aides, as 486
	601	+	defined in section 20-102aa of the general statutes, in both English and 487
	602	+	Spanish. 488
	603	+	Sec. 14. (NEW) (Effective July 1, 2023) (a) As used in this section, 489
	604	+	"personal care attendant", "consumer" and "personal care assistance" 490
	605	+	have the same meanings as provided in section 17b-706 of the general 491
	606	+	statutes. 492
	607	+	(b) Not later than January 1, 2024, the Department of Social Services 493
	608	+	shall establish and administer a personal care attendants career 494
	609	+	pathways program to improve the quality of care offered by personal 495
	610	+	care attendants and incentivize the recruitment and retention of 496
	611	+	personal care attendants in the state. A personal care attendant who is 497
	612	+	not employed by a consumer, but who is eligible for employment by a 498
	613	+	consumer, may participate in the program following the completion of 499
	614	+	a program orientation developed by the Commissioner of Social 500
	615	+	Services. 501 Substitute Bill No. 9
794	616
795		-	Public Act No. 23-97 26 of 80
796	617
797		-	(1) "Active duty military" means full-time duty status in the active
798		-	uniformed service of the United States, including members of the
799		-	National Guard and Reserve on active duty orders pursuant to 10 USC
800		-	1209 and 1211, as amended from time to time;
801		-	(2) "Adverse action" means disciplinary action taken by a physical
802		-	therapy licensing board based upon misconduct, unacceptable
803		-	performance or a combination of both;
804		-	(3) "Alternative program" means a nondisciplinary monitoring or
805		-	practice remediation process approved by a physical therapy licensing
806		-	board, including, but not limited to, substance abuse issues;
807		-	(4) "Compact privilege" means the authorization granted by a remote
808		-	state to allow a licensee from another member state to practice as a
809		-	physical therapist or work as a physical therapist assistant in the remote
810		-	state under its laws and rules. The practice of physical therapy occurs in
811		-	the member state where the patient or client is located at the time of the
812		-	patient or client encounter;
813		-	(5) "Continuing competence" means a requirement, as a condition of
814		-	license renewal, to provide evidence of participation in, or completion
815		-	of, educational and professional activities relevant to practice or area of
816		-	work;
817		-	(6) "Data system" means a repository of information about licensees,
818		-	including examination, licensure, investigative, compact privilege and
819		-	adverse action;
820		-	(7) "Encumbered license" means a license that a physical therapy
821		-	licensing board has limited in any way;
822		-	(8) "Executive board" means a group of directors elected or appointed
823		-	to act on behalf of, and within the powers granted to them, by the
824		-	commission; Substitute Senate Bill No. 9
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826		-	Public Act No. 23-97 27 of 80
	622	+	(c) The career pathways program shall include, but need not be 502
	623	+	limited to, the following objectives: 503
	624	+	(1) Increase in employment retention and recruitment of personal 504
	625	+	care attendants to maintain a stable workforce for consumers, including, 505
	626	+	but not limited to, through the creation of career pathways for such 506
	627	+	attendants that improve skill and knowledge and increase wages; 507
	628	+	(2) Dignity in providing and receiving care through meaningful 508
	629	+	collaboration between consumers and personal care attendants; 509
	630	+	(3) Improvement in the quality of personal care assistance and the 510
	631	+	overall quality of life of the consumer; 511
	632	+	(4) Advancement of equity in the provision of personal care 512
	633	+	assistance; 513
	634	+	(5) Promotion of a culturally and linguistically competent workforce 514
	635	+	of personal attendants to serve the growing racial, ethnic and linguistic 515
	636	+	diversity of an aging population of consumers; and 516
	637	+	(6) Promotion of self-determination principles by personal care 517
	638	+	attendants. 518
	639	+	(d) The Commissioner of Social Services shall offer the following 519
	640	+	career pathways as part of the career pathways program: 520
	641	+	(1) The basic skills career pathways, including (A) general health and 521
	642	+	safety, and (B) adult education topics; and 522
	643	+	(2) The specialized skills career pathways, including (A) cognitive 523
	644	+	impairments and behavioral health, (B) complex physical care needs, 524
	645	+	and (C) transitioning to home and community-based living from out-of-525
	646	+	home care or homelessness. 526
	647	+	(e) The Commissioner of Social Services shall develop or identify, in 527
	648	+	consultation with a labor management committee at a hospital or health 528
	649	+	care organization, the training curriculum for each career pathway of 529 Substitute Bill No. 9
827	650
828		-	(9) "Home state" means the member state that is the licensee's
829		-	primary state of residence;
830		-	(10) "Investigative information" means information, records and
831		-	documents received or generated by a physical therapy licensing board
832		-	pursuant to an investigation;
833		-	(11) "Jurisprudence requirement" means the assessment of an
834		-	individual's knowledge of the laws and rules governing the practice of
835		-	physical therapy in a state;
836		-	(12) "Licensee" means an individual who currently holds an
837		-	authorization from the state to practice as a physical therapist or to work
838		-	as a physical therapist assistant;
839		-	(13) "Member state" means a state that has enacted the compact;
840		-	(14) "Party state" means any member state in which a licensee holds
841		-	a current license or compact privilege or is applying for a license or
842		-	compact privilege;
843		-	(15) "Physical therapist" means an individual who is licensed by a
844		-	state to practice physical therapy;
845		-	(16) "Physical therapist assistant" means an individual who is
846		-	licensed or certified by a state and who assists the physical therapist in
847		-	selected components of physical therapy;
848		-	(17) "Physical therapy", "physical therapy practice" and "the practice
849		-	of physical therapy" mean the care and services provided by or under
850		-	the direction and supervision of a licensed physical therapist;
851		-	(18) "Physical Therapy Compact Commission" or "commission"
852		-	means the national administrative body whose membership consists of
853		-	all states that have enacted the compact; Substitute Senate Bill No. 9
854	651
855		-	Public Act No. 23-97 28 of 80
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856	655
857		-	(19) "Physical therapy licensing board" or "licensing board" means the
858		-	agency of a state that is responsible for the licensing and regulation of
859		-	physical therapists and physical therapist assistants;
860		-	(20) "Remote state" means a member state other than the home state,
861		-	where a licensee is exercising or seeking to exercise the compact
862		-	privilege;
863		-	(21) "Rule" means a regulation, principle, or directive promulgated
864		-	by the commission that has the force of law; and
865		-	(22) "State" means any state, commonwealth, district or territory of
866		-	the United States of America that regulates the practice of physical
867		-	therapy.
868		-	SECTION 3. STATE PARTICIPATION IN THE COMPACT
869		-	(a) To participate in the compact, a state shall:
870		-	(1) Participate fully in the commission's data system, including using
871		-	the commission's unique identifier as defined in rules;
872		-	(2) Have a mechanism in place for receiving and investigating
873		-	complaints about licensees;
874		-	(3) Notify the commission, in compliance with the terms of the
875		-	compact and rules, of any adverse action or of the availability of
876		-	investigative information regarding a licensee;
877		-	(4) Fully implement a criminal background check requirement,
878		-	within a time frame established by rule, by receiving the results of the
879		-	Federal Bureau of Investigation record search on criminal background
880		-	checks and use the results in making licensure decisions in accordance
881		-	with subsection (b) of this section;
882		-	(5) Comply with the rules of the commission; Substitute Senate Bill No. 9
	656	+	the career pathways program. 530
	657	+	(f) Not later than January 1, 2025, the Commissioner of Social Services 531
	658	+	shall report in accordance with the provisions of section 11-4a of the 532
	659	+	general statutes, to the joint standing committees of the General 533
	660	+	Assembly having cognizance of matters relating to human services and 534
	661	+	public health, on the following information concerning the career 535
	662	+	pathways program: 536
	663	+	(1) The number of personal care attendants who enrolled in the 537
	664	+	program and types of career pathways chosen by each attendant; 538
	665	+	(2) The number of personal care attendants who successfully 539
	666	+	completed a career pathway and the types of career pathways 540
	667	+	completed by each attendant; 541
	668	+	(3) The effectiveness of the program, as determined by surveys, focus 542
	669	+	groups and interviews of personal care attendants, and whether the 543
	670	+	successful completion of a career pathway resulted in a related license 544
	671	+	or certificate for each personal care attendant or the retention of 545
	672	+	employment as a personal care attendant; 546
	673	+	(4) The number of personal care attendants who were employed by a 547
	674	+	consumer with specialized care needs after completing a specialized 548
	675	+	career pathway and who were retained in employment by such 549
	676	+	consumer for a period of not less than six months; and 550
	677	+	(5) The number of personal care attendants who were employed by a 551
	678	+	consumer with specialized care needs after completing a specialized 552
	679	+	career pathway and were retained in employment by such consumer for 553
	680	+	a period of at least twelve months. 554
	681	+	Sec. 15. (NEW) (Effective October 1, 2023) (a) As used in this section, 555
	682	+	(1) "board eligible" means a physician has passed the written portion of 556
	683	+	the examination administered by a medical specialty board to become 557
	684	+	certified in a particular specialty, and (2) "board certified" means a 558
	685	+	physician has passed the written and oral portions of the examination 559 Substitute Bill No. 9
883	686
884		-	Public Act No. 23-97 29 of 80
885	687
886		-	(6) Utilize a recognized national examination as a requirement for
887		-	licensure pursuant to the rules of the commission; and
888		-	(7) Have continuing competence requirements as a condition for
889		-	license renewal.
890		-	(b) Upon adoption of the compact, the member state shall have the
891		-	authority to obtain biometric-based information from each physical
892		-	therapy licensure applicant and shall submit such information to the
893		-	Federal Bureau of Investigation for a criminal background check in
894		-	accordance with 28 USC 534 and 42 USC 14616, as amended from time
895		-	to time.
896		-	(c) A member state shall grant the compact privilege to a licensee
897		-	holding a valid unencumbered license in another member state in
898		-	accordance with the terms of the compact and rules.
899		-	(d) Member states may charge a fee for granting a compact privilege.
900		-	SECTION 4. COMPACT PRIVILEGE
901		-	(a) To exercise the compact privilege under the terms and provisions
902		-	of the compact, the licensee shall:
903		-	(1) Hold a license in the home state;
904		-	(2) Have no encumbrance on any state license;
905		-	(3) Be eligible for a compact privilege in any member state in
906		-	accordance with subsections (d), (g) and (h) of this section;
907		-	(4) Have not had any adverse action against any license or compact
908		-	privilege within the previous two years;
909		-	(5) Notify the commission that the licensee is seeking the compact
910		-	privilege within a remote state or remote states; Substitute Senate Bill No. 9
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911	691
912		-	Public Act No. 23-97 30 of 80
	692	+	administered by a medical specialty board to become board certified in 560
	693	+	a particular specialty. 561
	694	+	(b) No hospital, or medical review committee of a hospital, shall 562
	695	+	require, as part of its credentialing requirements for a (1) board eligible 563
	696	+	physician to be granted privileges to practice in the hospital, that the 564
	697	+	physician provide credentials of board certification in a particular 565
	698	+	specialty until five years after the date on which the physician became 566
	699	+	board eligible in such specialty, or (2) board certified physician to be 567
	700	+	granted privileges to practice in the hospital, that the physician provide 568
	701	+	credentials of board recertification. 569
	702	+	Sec. 16. Section 20-14p of the general statutes is repealed and the 570
	703	+	following is substituted in lieu thereof (Effective July 1, 2023): 571
	704	+	(a) For purposes of this section: (1) "Covenant not to compete" means 572
	705	+	any provision of an employment or other contract or agreement that 573
	706	+	creates or establishes a professional relationship with a physician and 574
	707	+	restricts the right of a physician to practice medicine in any geographic 575
	708	+	area of the state for any period of time after the termination or cessation 576
	709	+	of such partnership, employment or other professional relationship; (2) 577
	710	+	"physician" means an individual licensed to practice medicine under 578
	711	+	this chapter; and (3) "primary site where such physician practices" 579
	712	+	means (A) the office, facility or location where a majority of the revenue 580
	713	+	derived from such physician's services is generated, or (B) any other 581
	714	+	office, facility or location where such physician practices and mutually 582
	715	+	agreed to by the parties and identified in the covenant not to compete. 583
	716	+	(b) (1) A covenant not to compete that is entered into, amended, 584
	717	+	extended or renewed prior to July 1, 2023, is valid and enforceable only 585
	718	+	if it is: (A) Necessary to protect a legitimate business interest; (B) 586
	719	+	reasonably limited in time, geographic scope and practice restrictions as 587
	720	+	necessary to protect such business interest; and (C) otherwise consistent 588
	721	+	with the law and public policy. The party seeking to enforce a covenant 589
	722	+	not to compete shall have the burden of proof in any proceeding. 590 Substitute Bill No. 9
913	723
914		-	(6) Pay any applicable fees, including any state fee, for the compact
915		-	privilege;
916		-	(7) Meet any jurisprudence requirements established by the remote
917		-	state or states in which the licensee is seeking a compact privilege; and
918		-	(8) Report to the commission adverse action taken by any
919		-	nonmember state not later than thirty days after the date the adverse
920		-	action is taken.
921		-	(b) The compact privilege is valid until the expiration date of the
922		-	home license. The licensee shall comply with the requirements of
923		-	subsection (a) of this section of the compact to maintain the compact
924		-	privilege in the remote state.
925		-	(c) A licensee providing physical therapy in a remote state under the
926		-	compact privilege shall function within the laws and regulations of the
927		-	remote state.
928		-	(d) A licensee providing physical therapy in a remote state is subject
929		-	to such state's regulatory authority. A remote state may, in accordance
930		-	with due process and such state's laws, remove a licensee's compact
931		-	privilege in the remote state for a specific period of time, impose fines
932		-	and take any other necessary action to protect the health and safety of
933		-	its citizens. The licensee is not eligible for a compact privilege in any
934		-	state until the specific time for removal has passed and all fines are paid.
935		-	(e) If a home state license is encumbered, the licensee shall lose the
936		-	compact privilege in any remote state until the following occur:
937		-	(1) The home state license is no longer encumbered; and
938		-	(2) Two years have elapsed from the date of the adverse action.
939		-	(f) Once an encumbered license in the home state is restored to good
940		-	standing, the licensee shall meet the requirements of subsection (a) of Substitute Senate Bill No. 9
941	724
942		-	Public Act No. 23-97 31 of 80
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943	728
944		-	this section of the compact to obtain a compact privilege in any remote
945		-	state.
946		-	(g) If a licensee's compact privilege in any remote state is removed,
947		-	the individual shall lose the compact privilege in any remote state until
948		-	the following occur:
949		-	(1) The specific period of time for which the compact privilege was
950		-	removed has ended;
951		-	(2) All fines have been paid; and
952		-	(3) Two years have elapsed from the date of the adverse action.
953		-	(h) Once the requirements of subsection (g) of this section of the
954		-	compact have been met, the licensee shall meet the requirements set
955		-	forth in subsection (a) of this section of the compact to obtain a compact
956		-	privilege in a remote state.
957		-	SECTION 5. ACTIVE DUTY MILITARY PERSONNEL OR THEIR
958		-	SPOUSES
959		-	A licensee who is active duty military or is the spouse of an
960		-	individual who is active duty military may designate one of the
961		-	following as the home state:
962		-	(1) Home of record;
963		-	(2) Permanent change of station (PCS); or
964		-	(3) State of current residence if such state is different from the PCS
965		-	state or home of record.
966		-	SECTION 6. ADVERSE ACTIONS
967		-	(a) A home state shall have exclusive power to impose adverse action
968		-	against a license issued by the home state. Substitute Senate Bill No. 9
	729	+	(2) A covenant not to compete that is entered into, amended, 591
	730	+	extended or renewed on or after July 1, 2016, but before June 30, 2023, 592
	731	+	shall not: (A) Restrict the physician's competitive activities (i) for a 593
	732	+	period of more than one year, and (ii) in a geographic region of more 594
	733	+	than fifteen miles from the primary site where such physician practices; 595
	734	+	or (B) be enforceable against a physician if (i) such employment contract 596
	735	+	or agreement was not made in anticipation of, or as part of, a 597
	736	+	partnership or ownership agreement and such contract or agreement 598
	737	+	expires and is not renewed, unless, prior to such expiration, the 599
	738	+	employer makes a bona fide offer to renew the contract on the same or 600
	739	+	similar terms and conditions, or (ii) the employment or contractual 601
	740	+	relationship is terminated by the employer, unless such employment or 602
	741	+	contractual relationship is terminated for cause. 603
	742	+	(3) Each covenant not to compete entered into, amended or renewed 604
	743	+	on and after July 1, 2016, until June 30, 2023, shall be separately and 605
	744	+	individually signed by the physician. 606
	745	+	(4) On and after July 1, 2023, no employment, partnership or 607
	746	+	ownership contract or agreement entered into, amended or renewed 608
	747	+	shall contain a covenant not to compete and each covenant not to 609
	748	+	compete entered into, amended or renewed on and after said date shall 610
	749	+	be void and unenforceable. Any physician who is aggrieved by a 611
	750	+	violation of this subdivision may bring a civil action in the Superior 612
	751	+	Court to recover damages, together with court costs and reasonable 613
	752	+	attorney's fees, and for such injunctive and equitable relief as the court 614
	753	+	deems appropriate. 615
	754	+	(c) The remaining provisions of any contract or agreement that 616
	755	+	includes a covenant not to compete that is rendered void and 617
	756	+	unenforceable, in whole or in part, under the provisions of this section 618
	757	+	shall remain in full force and effect, including provisions that require 619
	758	+	the payment of damages resulting from any injury suffered by reason of 620
	759	+	termination of such contract or agreement. 621
	760	+	Sec. 17. (NEW) (Effective July 1, 2023) (a) For purposes of this section: 622 Substitute Bill No. 9
969	761
970		-	Public Act No. 23-97 32 of 80
971	762
972		-	(b) A home state may take adverse action based on the investigative
973		-	information of a remote state, so long as the home state follows its own
974		-	procedures for imposing adverse action.
975		-	(c) Nothing in the compact shall override a member state's decision
976		-	that participation in an alternative program may be used in lieu of
977		-	adverse action and that such participation shall remain nonpublic if
978		-	required by the member state's laws. Member states shall require
979		-	licensees who enter any alternative programs in lieu of discipline to
980		-	agree not to practice in any other member state during the term of the
981		-	alternative program without prior authorization from such other
982		-	member state.
983		-	(d) Any member state may investigate actual or alleged violations of
984		-	the statutes and rules authorizing the practice of physical therapy in any
985		-	other member state in which a physical therapist or physical therapist
986		-	assistant holds a license or compact privilege.
987		-	(e) A remote state shall have the authority to:
988		-	(1) Take adverse actions as set forth in subsection (d) of section 4 of
989		-	the compact against a licensee's compact privilege in the state;
990		-	(2) Issue subpoenas for both hearings and investigations that require
991		-	the attendance and testimony of witnesses and the production of
992		-	evidence. Subpoenas issued by a physical therapy licensing board in a
993		-	party state for the attendance and testimony of witnesses or the
994		-	production of evidence from another party state shall be enforced in
995		-	such other party state by any court of competent jurisdiction, according
996		-	to the practice and procedure of such court applicable to subpoenas
997		-	issued in proceedings pending before such court. The issuing authority
998		-	shall pay any witness fees, travel expenses, mileage and other fees
999		-	required by the service statutes of the state where the witnesses or
1000		-	evidence are located; and Substitute Senate Bill No. 9
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1001	766
1002		-	Public Act No. 23-97 33 of 80
	767	+	(1) "Covenant not to compete" means any provision of an employment 623
	768	+	or other contract or agreement that creates or establishes a professional 624
	769	+	relationship with an advanced practice registered nurse and restricts the 625
	770	+	right of an advanced practice registered nurse to provide health care 626
	771	+	services as an advanced practice registered nurse in any geographic area 627
	772	+	of the state for any period of time after the termination or cessation of 628
	773	+	such partnership, employment or other professional relationship; and 629
	774	+	(2) "advanced practice registered nurse" means an individual licensed 630
	775	+	as an advanced practice registered nurse pursuant to chapter 378 of the 631
	776	+	general statutes. 632
	777	+	(b) On and after July 1, 2023, no employment, partnership or 633
	778	+	ownership contract or agreement entered into, amended or renewed 634
	779	+	shall contain a covenant not to compete and each covenant not to 635
	780	+	compete entered into, amended or renewed on and after said date shall 636
	781	+	be void and unenforceable. Any advanced practice registered nurse 637
	782	+	who is aggrieved by a violation of this subsection may bring a civil 638
	783	+	action in the Superior Court to recover damages, together with court 639
	784	+	costs and reasonable attorney's fees, and for such injunctive and 640
	785	+	equitable relief as the court deems appropriate. 641
	786	+	(c) The remaining provisions of any contract or agreement that 642
	787	+	includes a covenant not to compete that is rendered void and 643
	788	+	unenforceable, in whole or in part, under the provisions of this section 644
	789	+	shall remain in full force and effect, including provisions that require 645
	790	+	the payment of damages resulting from any injury suffered by reason of 646
	791	+	termination of such contract or agreement. 647
	792	+	Sec. 18. (Effective from passage) (a) There is established a task force to 648
	793	+	study medical malpractice reform to incentivize physicians and other 649
	794	+	licensed health care providers to practice in the state. 650
	795	+	(b) The task force shall consist of the following members: 651
	796	+	(1) Two appointed by the speaker of the House of Representatives, 652
	797	+	one of whom has expertise in medical malpractice laws and one of 653 Substitute Bill No. 9
1003	798
1004		-	(3) If otherwise permitted by state law, recover from the licensee the
1005		-	costs of investigations and disposition of cases resulting from any
1006		-	adverse action taken against such licensee.
1007		-	(f) Joint Investigations
1008		-	(1) In addition to the authority granted to a member state by its
1009		-	respective physical therapy practice act or other applicable state law, a
1010		-	member state may participate with other member states in joint
1011		-	investigations of licensees.
1012		-	(2) Member states shall share any investigative, litigation or
1013		-	compliance materials in furtherance of any joint or individual
1014		-	investigation initiated under the compact.
1015		-	SECTION 7. ESTABLISHMENT OF THE PHYSICAL THERAPY
1016		-	COMPACT COMMISSION
1017		-	(a) The compact member states hereby create and establish a joint
1018		-	public agency known as the Physical Therapy Compact Commission.
1019		-	(1) The commission is an instrumentality of the compact states.
1020		-	(2) Venue is proper and judicial proceedings by or against the
1021		-	commission shall be brought solely and exclusively in a court of
1022		-	competent jurisdiction where the principal office of the commission is
1023		-	located. The commission may waive venue and jurisdictional defenses
1024		-	to the extent that it adopts or consents to participate in alternative
1025		-	dispute resolution proceedings.
1026		-	(3) Nothing in the compact shall be construed to be a waiver of
1027		-	sovereign immunity.
1028		-	(b) Membership, Voting and Meetings
1029		-	(1) Each member state shall have and be limited to one delegate Substitute Senate Bill No. 9
1030	799
1031		-	Public Act No. 23-97 34 of 80
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1032	803
1033		-	selected by such member state's licensing board.
1034		-	(2) The delegate shall be a current member of the licensing board who
1035		-	is a physical therapist, a physical therapist assistant, a public member or
1036		-	the board administrator.
1037		-	(3) Any delegate may be removed or suspended from office as
1038		-	provided by the law of the state from which the delegate is appointed.
1039		-	(4) The member state board shall fill any vacancy occurring in the
1040		-	commission.
1041		-	(5) Each delegate shall be entitled to one vote with regard to the
1042		-	promulgation of rules and creation of bylaws and shall otherwise have
1043		-	an opportunity to participate in the business and affairs of the
1044		-	commission.
1045		-	(6) A delegate shall vote in person or by such other means as
1046		-	provided in the bylaws. The bylaws may provide for delegates'
1047		-	participation in meetings by telephone or other means of
1048		-	communication.
1049		-	(7) The commission shall meet at least once during each calendar
1050		-	year. Additional meetings shall be held as set forth in the bylaws.
1051		-	(c) The commission shall have the following powers and duties:
1052		-	(1) Establish the fiscal year of the commission;
1053		-	(2) Establish bylaws;
1054		-	(3) Maintain its financial records in accordance with the bylaws;
1055		-	(4) Meet and take such actions as are consistent with the provisions
1056		-	of the compact and the bylaws;
1057		-	(5) Promulgate uniform rules to facilitate and coordinate Substitute Senate Bill No. 9
	804	+	whom has expertise in tort reform; 654
	805	+	(2) Two appointed by the president pro tempore of the Senate, one of 655
	806	+	whom shall be a representative of a medical society in the state and one 656
	807	+	of whom shall be a representative of a hospital association in the state; 657
	808	+	(3) One appointed by the majority leader of the House of 658
	809	+	Representatives, who shall be a representative of a nurse's association 659
	810	+	in the state; 660
	811	+	(4) One appointed by the majority leader of the Senate, who shall be 661
	812	+	a member of the judiciary; 662
	813	+	(5) One appointed by the minority leader of the House of 663
	814	+	Representatives, who shall be a member of an association of trial 664
	815	+	lawyers in the state; 665
	816	+	(6) One appointed by the minority leader of the Senate, who shall be 666
	817	+	a health care advocate in the state; and 667
	818	+	(7) The Commissioner of Public Health, or the commissioner's 668
	819	+	designee. 669
	820	+	(c) Any member of the task force appointed under subdivision (1), 670
	821	+	(2), (3), (4), (5) or (6) of subsection (b) of this section may be a member 671
	822	+	of the General Assembly. 672
	823	+	(d) All initial appointments to the task force shall be made not later 673
	824	+	than thirty days after the effective date of this section. Any vacancy shall 674
	825	+	be filled by the appointing authority. 675
	826	+	(e) The speaker of the House of Representatives and the president pro 676
	827	+	tempore of the Senate shall select the chairpersons of the task force from 677
	828	+	among the members of the task force. Such chairpersons shall schedule 678
	829	+	the first meeting of the task force, which shall be held not later than sixty 679
	830	+	days after the effective date of this section. 680
	831	+	(f) The administrative staff of the joint standing committee of the 681 Substitute Bill No. 9
1058	832
1059		-	Public Act No. 23-97 35 of 80
1060	833
1061		-	implementation and administration of the compact. The rules shall have
1062		-	the force and effect of law and shall be binding in all member states;
1063		-	(6) Bring and prosecute legal proceedings or actions in the name of
1064		-	the commission, provided the standing of any state physical therapy
1065		-	licensing board to sue or be sued under applicable law shall not be
1066		-	affected;
1067		-	(7) Purchase and maintain insurance and bonds;
1068		-	(8) Borrow, accept or contract for services of personnel, including, but
1069		-	not limited to, employees of a member state;
1070		-	(9) Hire employees, elect or appoint officers, fix compensation, define
1071		-	duties and grant such individuals appropriate authority to carry out the
1072		-	purposes of the compact and establish the commission's personnel
1073		-	policies and programs relating to conflicts of interest, qualifications of
1074		-	personnel and other related personnel matters;
1075		-	(10) Accept any and all appropriate donations and grants of money,
1076		-	equipment, supplies, materials and services and receive, utilize and
1077		-	dispose of such money, equipment, supplies, materials and services,
1078		-	provided at all times the commission shall avoid any appearance of
1079		-	impropriety or conflict of interest;
1080		-	(11) Lease, purchase, accept appropriate gifts or donations of, or
1081		-	otherwise own, hold, improve or use any property, real, personal or
1082		-	mixed, provided at all times the commission shall avoid any appearance
1083		-	of impropriety;
1084		-	(12) Sell, convey, mortgage, pledge, lease, exchange, abandon or
1085		-	otherwise dispose of any real, personal or mixed property;
1086		-	(13) Establish a budget and make expenditures;
1087		-	(14) Borrow money; Substitute Senate Bill No. 9
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1088	837
1089		-	Public Act No. 23-97 36 of 80
	838	+	General Assembly having cognizance of matters relating to public 682
	839	+	health shall serve as administrative staff of the task force. 683
	840	+	(g) Not later than January 1, 2024, the task force shall submit a report 684
	841	+	on its findings and recommendations to the joint standing committee of 685
	842	+	the General Assembly having cognizance of matters relating to public 686
	843	+	health, in accordance with the provisions of section 11-4a of the general 687
	844	+	statutes. The task force shall terminate on the date that it submits such 688
	845	+	report or January 1, 2024, whichever is later. 689
	846	+	Sec. 19. (NEW) (Effective July 1, 2023) The Physical Therapy Licensure 690
	847	+	Compact is hereby enacted into law and entered into by the state of 691
	848	+	Connecticut with any and all jurisdictions legally joining therein in 692
	849	+	accordance with its terms. The compact is substantially as follows: 693
	850	+	"PHYSICAL THERAPY LICENSURE COMPACT 694
	851	+	SECTION 1. PURPOSE 695
	852	+	The purpose of the compact is to facilitate interstate practice of 696
	853	+	physical therapy with the goal of improving public access to physical 697
	854	+	therapy services. The practice of physical therapy occurs in the state 698
	855	+	where the patient is located at the time of the patient encounter. The 699
	856	+	compact preserves the regulatory authority of states to protect public 700
	857	+	health and safety through the current system of state licensure. 701
	858	+	The compact is designed to achieve the following objectives: 702
	859	+	(1) Increase public access to physical therapy services by providing 703
	860	+	for the mutual recognition of other member state licenses; 704
	861	+	(2) Enhance the states' ability to protect the public's health and safety; 705
	862	+	(3) Encourage the cooperation of member states in regulating multi-706
	863	+	state physical therapy practice; 707
	864	+	(4) Support spouses of relocating military members; 708 Substitute Bill No. 9
1090	865
1091		-	(15) Appoint committees, including standing committees composed
1092		-	of members, state regulators, state legislators or their representatives,
1093		-	and consumer representatives and such other interested persons as may
1094		-	be designated in the compact and the bylaws;
1095		-	(16) Provide and receive information from, and cooperate with, law-
1096		-	enforcement agencies;
1097		-	(17) Establish and elect an executive board; and
1098		-	(18) Perform such other functions as may be necessary or appropriate
1099		-	to achieve the purposes of the compact consistent with the state
1100		-	regulation of physical therapy licensure and practice.
1101		-	(d) The Executive Board
1102		-	The executive board shall have the power to act on behalf of the
1103		-	commission according to the terms of the compact.
1104		-	(1) The executive board shall be composed of nine members as
1105		-	follows:
1106		-	(A) Seven voting members who are elected by the commission from
1107		-	the current membership of the commission;
1108		-	(B) One ex-officio, nonvoting member from the recognized national
1109		-	physical therapy professional association; and
1110		-	(C) One ex-officio, nonvoting member from the recognized
1111		-	membership organization of the physical therapy licensing boards.
1112		-	(2) The ex-officio members shall be selected by their respective
1113		-	organizations.
1114		-	(3) The commission may remove any member of the executive board
1115		-	as provided in bylaws. Substitute Senate Bill No. 9
1116	866
1117		-	Public Act No. 23-97 37 of 80
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1118	870
1119		-	(4) The executive board shall meet at least annually.
1120		-	(5) The executive board shall have the following duties and
1121		-	responsibilities:
1122		-	(A) Recommend to the entire commission changes to the rules or
1123		-	bylaws, changes to the compact legislation, fees paid by compact
1124		-	member states, including annual dues, and any commission compact fee
1125		-	charged to licensees for the compact privilege;
1126		-	(B) Ensure compact administration services are appropriately
1127		-	provided, contractual or otherwise;
1128		-	(C) Prepare and recommend the budget;
1129		-	(D) Maintain financial records on behalf of the commission;
1130		-	(E) Monitor compact compliance of member states and provide
1131		-	compliance reports to the commission;
1132		-	(F) Establish additional committees as necessary; and
1133		-	(G) Perform other duties as provided in rules or bylaws.
1134		-	(e) Meetings of the Commission
1135		-	(1) All meetings shall be open to the public, and public notice of
1136		-	meetings shall be given in the same manner as required under the
1137		-	rulemaking provisions of section 9 of the compact.
1138		-	(2) The commission or the executive board or other committees of the
1139		-	commission may convene in a closed, nonpublic meeting if the
1140		-	commission or executive board or other committees of the commission
1141		-	shall discuss:
1142		-	(A) Noncompliance of a member state with its obligations under the
1143		-	compact; Substitute Senate Bill No. 9
	871	+	(5) Enhance the exchange of licensure, investigative and disciplinary 709
	872	+	information between member states; and 710
	873	+	(6) Allow a remote state to hold a provider of services with a compact 711
	874	+	privilege in such state accountable to such state's practice standards. 712
	875	+	SECTION 2. DEFINITIONS 713
	876	+	As used in section 1, this section and sections 3 to 12, inclusive, of the 714
	877	+	compact, and except as otherwise provided: 715
	878	+	(1) "Active duty military" means full-time duty status in the active 716
	879	+	uniformed service of the United States, including members of the 717
	880	+	National Guard and Reserve on active duty orders pursuant to 10 USC 718
	881	+	1209 and 1211, as amended from time to time; 719
	882	+	(2) "Adverse action" means disciplinary action taken by a physical 720
	883	+	therapy licensing board based upon misconduct, unacceptable 721
	884	+	performance or a combination of both; 722
	885	+	(3) "Alternative program" means a nondisciplinary monitoring or 723
	886	+	practice remediation process approved by a physical therapy licensing 724
	887	+	board, including, but not limited to, substance abuse issues; 725
	888	+	(4) "Compact privilege" means the authorization granted by a remote 726
	889	+	state to allow a licensee from another member state to practice as a 727
	890	+	physical therapist or work as a physical therapist assistant in the remote 728
	891	+	state under its laws and rules. The practice of physical therapy occurs in 729
	892	+	the member state where the patient or client is located at the time of the 730
	893	+	patient or client encounter; 731
	894	+	(5) "Continuing competence" means a requirement, as a condition of 732
	895	+	license renewal, to provide evidence of participation in, or completion 733
	896	+	of, educational and professional activities relevant to practice or area of 734
	897	+	work; 735
	898	+	(6) "Data system" means a repository of information about licensees, 736 Substitute Bill No. 9
1144	899
1145		-	Public Act No. 23-97 38 of 80
1146	900
1147		-	(B) The employment, compensation, discipline or other matters,
1148		-	practices or procedures related to specific employees or other matters
1149		-	related to the commission's internal personnel practices and procedures;
1150		-	(C) Current, threatened or reasonably anticipated litigation;
1151		-	(D) Negotiation of contracts for the purchase, lease or sale of goods,
1152		-	services or real estate;
1153		-	(E) Accusing any person of a crime or formally censuring any person;
1154		-	(F) Disclosure of trade secrets or commercial or financial information
1155		-	that is privileged or confidential;
1156		-	(G) Disclosure of information of a personal nature where disclosure
1157		-	would constitute a clearly unwarranted invasion of personal privacy;
1158		-	(H) Disclosure of investigative records compiled for law-enforcement
1159		-	purposes;
1160		-	(I) Disclosure of information related to any investigative reports
1161		-	prepared by or on behalf of or for use of the commission or other
1162		-	committee charged with responsibility of investigation or determination
1163		-	of compliance issues pursuant to the compact; or
1164		-	(J) Matters specifically exempted from disclosure by federal or
1165		-	member state statute.
1166		-	(3) If a meeting or portion of a meeting is closed pursuant to this
1167		-	provision, the commission's legal counsel or designee shall certify that
1168		-	the meeting may be closed and shall reference each relevant exempting
1169		-	provision.
1170		-	(4) The commission shall keep minutes that fully and clearly describe
1171		-	all matters discussed in a meeting and shall provide a full and accurate
1172		-	summary of actions taken and the reasons therefor, including a Substitute Senate Bill No. 9
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1173	904
1174		-	Public Act No. 23-97 39 of 80
	905	+	including examination, licensure, investigative, compact privilege and 737
	906	+	adverse action; 738
	907	+	(7) "Encumbered license" means a license that a physical therapy 739
	908	+	licensing board has limited in any way; 740
	909	+	(8) "Executive board" means a group of directors elected or appointed 741
	910	+	to act on behalf of, and within the powers granted to them, by the 742
	911	+	commission; 743
	912	+	(9) "Home state" means the member state that is the licensee's 744
	913	+	primary state of residence; 745
	914	+	(10) "Investigative information" means information, records and 746
	915	+	documents received or generated by a physical therapy licensing board 747
	916	+	pursuant to an investigation; 748
	917	+	(11) "Jurisprudence requirement" means the assessment of an 749
	918	+	individual's knowledge of the laws and rules governing the practice of 750
	919	+	physical therapy in a state; 751
	920	+	(12) "Licensee" means an individual who currently holds an 752
	921	+	authorization from the state to practice as a physical therapist or to work 753
	922	+	as a physical therapist assistant; 754
	923	+	(13) "Member state" means a state that has enacted the compact; 755
	924	+	(14) "Party state" means any member state in which a licensee holds 756
	925	+	a current license or compact privilege or is applying for a license or 757
	926	+	compact privilege; 758
	927	+	(15) "Physical therapist" means an individual who is licensed by a 759
	928	+	state to practice physical therapy; 760
	929	+	(16) "Physical therapist assistant" means an individual who is 761
	930	+	licensed or certified by a state and who assists the physical therapist in 762
	931	+	selected components of physical therapy; 763 Substitute Bill No. 9
1175	932
1176		-	description of the views expressed. All documents considered in
1177		-	connection with an action shall be identified in such minutes. All
1178		-	minutes and documents of a closed meeting shall remain under seal,
1179		-	subject to release by a majority vote of the commission or order of a
1180		-	court of competent jurisdiction.
1181		-	(f) Financing of the Commission
1182		-	(1) The commission shall pay or provide for the payment of the
1183		-	reasonable expenses of its establishment, organization and ongoing
1184		-	activities.
1185		-	(2) The commission may accept any and all appropriate revenue
1186		-	sources, donations and grants of money, equipment, supplies, materials
1187		-	and services.
1188		-	(3) The commission may levy on and collect an annual assessment
1189		-	from each member state or impose fees on other parties to cover the cost
1190		-	of the operations and activities of the commission and its staff, which
1191		-	shall be in a total amount sufficient to cover its annual budget as
1192		-	approved each year for which revenue is not provided by other sources.
1193		-	The aggregate annual assessment amount shall be allocated based upon
1194		-	a formula to be determined by the commission, which shall promulgate
1195		-	a rule binding upon all member states.
1196		-	(4) The commission shall not incur obligations of any kind prior to
1197		-	securing the funds adequate to meet such obligations, or pledge the
1198		-	credit of any of the member states, except by and with the authority of
1199		-	the member state.
1200		-	(5) The commission shall keep accurate accounts of all receipts and
1201		-	disbursements. The receipts and disbursements of the commission shall
1202		-	be subject to the audit and accounting procedures established under its
1203		-	bylaws. All receipts and disbursements of funds handled by the
1204		-	commission shall be audited annually by a certified or licensed public Substitute Senate Bill No. 9
1205	933
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1207	937
1208		-	accountant and the report of the audit shall be included in and become
1209		-	part of the annual report of the commission.
1210		-	(g) Qualified Immunity, Defense and Indemnification
1211		-	(1) The members, officers, executive director, employees and
1212		-	representatives of the commission shall be immune from suit and
1213		-	liability, either personally or in their official capacity, for any claim for
1214		-	damage to or loss of property or personal injury or other civil liability
1215		-	caused by or arising out of any actual or alleged act, error or omission
1216		-	that occurred or that the person against whom the claim is made had a
1217		-	reasonable basis for believing occurred within the scope of commission
1218		-	employment, duties or responsibilities, provided nothing in this
1219		-	subdivision shall be construed to protect any such person from suit or
1220		-	liability for any damage, loss, injury or liability caused by the intentional
1221		-	or wilful or wanton misconduct of such person.
1222		-	(2) The commission shall defend any member, officer, executive
1223		-	director, employee or representative of the commission in any civil
1224		-	action seeking to impose liability arising out of any actual or alleged act,
1225		-	error or omission that occurred within the scope of commission
1226		-	employment, duties or responsibilities or that the person against whom
1227		-	the claim is made had a reasonable basis for believing occurred within
1228		-	the scope of commission employment, duties or responsibilities,
1229		-	provided (A) nothing in this subdivision shall be construed to prohibit
1230		-	such person from retaining his or her own counsel, and (B) the actual or
1231		-	alleged act, error or omission did not result from such person's
1232		-	intentional or wilful or wanton misconduct.
1233		-	(3) The commission shall indemnify and hold harmless any member,
1234		-	officer, executive director, employee or representative of the
1235		-	commission for the amount of any settlement or judgment obtained
1236		-	against such person arising out of any actual or alleged act, error or
1237		-	omission that occurred within the scope of commission employment, Substitute Senate Bill No. 9
	938	+	(17) "Physical therapy", "physical therapy practice" and "the practice 764
	939	+	of physical therapy" mean the care and services provided by or under 765
	940	+	the direction and supervision of a licensed physical therapist; 766
	941	+	(18) "Physical Therapy Compact Commission" or "commission" 767
	942	+	means the national administrative body whose membership consists of 768
	943	+	all states that have enacted the compact; 769
	944	+	(19) "Physical therapy licensing board" or "licensing board" means the 770
	945	+	agency of a state that is responsible for the licensing and regulation of 771
	946	+	physical therapists and physical therapist assistants; 772
	947	+	(20) "Remote state" means a member state other than the home state, 773
	948	+	where a licensee is exercising or seeking to exercise the compact 774
	949	+	privilege; 775
	950	+	(21) "Rule" means a regulation, principle, or directive promulgated 776
	951	+	by the commission that has the force of law; and 777
	952	+	(22) "State" means any state, commonwealth, district or territory of 778
	953	+	the United States of America that regulates the practice of physical 779
	954	+	therapy. 780
	955	+	SECTION 3. STATE PARTICIPATION IN THE COMPACT 781
	956	+	(a) To participate in the compact, a state shall: 782
	957	+	(1) Participate fully in the commission's data system, including using 783
	958	+	the commission's unique identifier as defined in rules; 784
	959	+	(2) Have a mechanism in place for receiving and investigating 785
	960	+	complaints about licensees; 786
	961	+	(3) Notify the commission, in compliance with the terms of the 787
	962	+	compact and rules, of any adverse action or of the availability of 788
	963	+	investigative information regarding a licensee; 789
	964	+	(4) Fully implement a criminal background check requirement, 790 Substitute Bill No. 9
1238	965
1239		-	Public Act No. 23-97 41 of 80
1240	966
1241		-	duties or responsibilities or that such person had a reasonable basis for
1242		-	believing occurred within the scope of commission employment, duties
1243		-	or responsibilities, provided the actual or alleged act, error or omission
1244		-	did not result from the intentional or wilful or wanton misconduct of
1245		-	such person.
1246		-	SECTION 8. DATA SYSTEM
1247		-	(a) The commission shall provide for the development, maintenance
1248		-	and utilization of a coordinated database and reporting system
1249		-	containing licensure, adverse action and investigative information on all
1250		-	licensed individuals in member states.
1251		-	(b) Notwithstanding any other provision of state law to the contrary,
1252		-	a member state shall submit a uniform data set to the data system on all
1253		-	individuals to whom the compact is applicable as required by the rules
1254		-	of the commission, including:
1255		-	(1) Identifying information;
1256		-	(2) Licensure data;
1257		-	(3) Adverse actions against a license or compact privilege;
1258		-	(4) Nonconfidential information related to alternative program
1259		-	participation;
1260		-	(5) Any denial of application for licensure, and the reason for such
1261		-	denial; and
1262		-	(6) Other information that may facilitate the administration of the
1263		-	compact, as determined by the rules of the commission.
1264		-	(c) Investigative information pertaining to a licensee in any member
1265		-	state shall only be available to other party states. Substitute Senate Bill No. 9
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1266	970
1267		-	Public Act No. 23-97 42 of 80
	971	+	within a time frame established by rule, by receiving the results of the 791
	972	+	Federal Bureau of Investigation record search on criminal background 792
	973	+	checks and use the results in making licensure decisions in accordance 793
	974	+	with subsection (b) of this section; 794
	975	+	(5) Comply with the rules of the commission; 795
	976	+	(6) Utilize a recognized national examination as a requirement for 796
	977	+	licensure pursuant to the rules of the commission; and 797
	978	+	(7) Have continuing competence requirements as a condition for 798
	979	+	license renewal. 799
	980	+	(b) Upon adoption of the compact, the member state shall have the 800
	981	+	authority to obtain biometric-based information from each physical 801
	982	+	therapy licensure applicant and shall submit such information to the 802
	983	+	Federal Bureau of Investigation for a criminal background check in 803
	984	+	accordance with 28 USC 534 and 42 USC 14616, as amended from time 804
	985	+	to time. 805
	986	+	(c) A member state shall grant the compact privilege to a licensee 806
	987	+	holding a valid unencumbered license in another member state in 807
	988	+	accordance with the terms of the compact and rules. 808
	989	+	(d) Member states may charge a fee for granting a compact privilege. 809
	990	+	SECTION 4. COMPACT PRIVILEGE 810
	991	+	(a) To exercise the compact privilege under the terms and provisions 811
	992	+	of the compact, the licensee shall: 812
	993	+	(1) Hold a license in the home state; 813
	994	+	(2) Have no encumbrance on any state license; 814
	995	+	(3) Be eligible for a compact privilege in any member state in 815
	996	+	accordance with subsections (d), (g) and (h) of this section; 816 Substitute Bill No. 9
1268	997
1269		-	(d) The commission shall promptly notify all member states of any
1270		-	adverse action taken against a licensee or an individual applying for a
1271		-	license. Adverse action information pertaining to a licensee in any
1272		-	member state shall be available to any other member state.
1273		-	(e) Member states contributing information to the data system may
1274		-	designate information that may not be shared with the public without
1275		-	the express permission of the contributing state.
1276		-	(f) Any information submitted to the data system that is subsequently
1277		-	required to be expunged by the laws of the member state contributing
1278		-	the information shall be removed from the data system.
1279		-	SECTION 9. RULEMAKING
1280		-	(a) The commission shall exercise its rulemaking powers pursuant to
1281		-	the criteria set forth in this section and the rules adopted thereunder.
1282		-	Rules and amendments shall become binding as of the date specified in
1283		-	each rule or amendment.
1284		-	(b) If a majority of the legislatures of the member states rejects a rule,
1285		-	by enactment of a statute or resolution in the same manner used to adopt
1286		-	the compact not later than four years after the date of adoption of the
1287		-	rule, such rule shall have no further force and effect in any member
1288		-	state.
1289		-	(c) Rules or amendments to the rules shall be adopted at a regular or
1290		-	special meeting of the commission.
1291		-	(d) Prior to promulgation and adoption of a final rule or rules by the
1292		-	commission, and at least thirty days in advance of the meeting at which
1293		-	the rule will be considered and voted upon, the commission shall file a
1294		-	notice of proposed rulemaking:
1295		-	(1) On the Internet web site of the commission or other publicly Substitute Senate Bill No. 9
1296	998
1297		-	Public Act No. 23-97 43 of 80
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1298	1002
1299		-	accessible platform; and
1300		-	(2) On the Internet web site of each member state physical therapy
1301		-	licensing board or other publicly accessible platform or the publication
1302		-	in which each state would otherwise publish proposed rules.
1303		-	(e) The notice of proposed rulemaking shall include:
1304		-	(1) The proposed time, date and location of the meeting in which the
1305		-	rule will be considered and voted upon;
1306		-	(2) The text of the proposed rule or amendment and the reason for
1307		-	the proposed rule;
1308		-	(3) A request for comments on the proposed rule from any interested
1309		-	person; and
1310		-	(4) The manner in which interested persons may submit notice to the
1311		-	commission of their intention to attend the public hearing and any
1312		-	written comments.
1313		-	(f) Prior to adoption of a proposed rule, the commission shall allow
1314		-	persons to submit written data, facts, opinions and arguments, which
1315		-	shall be made available to the public.
1316		-	(g) The commission shall grant an opportunity for a public hearing
1317		-	before it adopts a rule or amendment if a hearing is requested by:
1318		-	(1) At least twenty-five persons;
1319		-	(2) A state or federal governmental subdivision or agency; or
1320		-	(3) An association having at least twenty-five members.
1321		-	(h) If a hearing is held on the proposed rule or amendment, the
1322		-	commission shall publish the place, time and date of the scheduled
1323		-	public hearing. If the hearing is held via electronic means, the Substitute Senate Bill No. 9
	1003	+	(4) Have not had any adverse action against any license or compact 817
	1004	+	privilege within the previous two years; 818
	1005	+	(5) Notify the commission that the licensee is seeking the compact 819
	1006	+	privilege within a remote state or remote states; 820
	1007	+	(6) Pay any applicable fees, including any state fee, for the compact 821
	1008	+	privilege; 822
	1009	+	(7) Meet any jurisprudence requirements established by the remote 823
	1010	+	state or states in which the licensee is seeking a compact privilege; and 824
	1011	+	(8) Report to the commission adverse action taken by any 825
	1012	+	nonmember state not later than thirty days after the date the adverse 826
	1013	+	action is taken. 827
	1014	+	(b) The compact privilege is valid until the expiration date of the 828
	1015	+	home license. The licensee shall comply with the requirements of 829
	1016	+	subsection (a) of this section of the compact to maintain the compact 830
	1017	+	privilege in the remote state. 831
	1018	+	(c) A licensee providing physical therapy in a remote state under the 832
	1019	+	compact privilege shall function within the laws and regulations of the 833
	1020	+	remote state. 834
	1021	+	(d) A licensee providing physical therapy in a remote state is subject 835
	1022	+	to such state's regulatory authority. A remote state may, in accordance 836
	1023	+	with due process and such state's laws, remove a licensee's compact 837
	1024	+	privilege in the remote state for a specific period of time, impose fines 838
	1025	+	and take any other necessary action to protect the health and safety of 839
	1026	+	its citizens. The licensee is not eligible for a compact privilege in any 840
	1027	+	state until the specific time for removal has passed and all fines are paid. 841
	1028	+	(e) If a home state license is encumbered, the licensee shall lose the 842
	1029	+	compact privilege in any remote state until the following occur: 843
	1030	+	(1) The home state license is no longer encumbered; and 844 Substitute Bill No. 9
1324	1031
1325		-	Public Act No. 23-97 44 of 80
1326	1032
1327		-	commission shall publish the mechanism for access to the electronic
1328		-	hearing.
1329		-	(1) All persons wishing to be heard at the hearing shall notify the
1330		-	executive director of the commission or other designated member in
1331		-	writing of their desire to appear and testify at the hearing not less than
1332		-	five business days before the scheduled date of the hearing.
1333		-	(2) Hearings shall be conducted in a manner providing each person
1334		-	who wishes to comment a fair and reasonable opportunity to comment
1335		-	orally or in writing.
1336		-	(3) All hearings shall be recorded. A copy of the recording shall be
1337		-	made available on request.
1338		-	(4) Nothing in this section shall be construed as requiring a separate
1339		-	hearing on each rule. Rules may be grouped for the convenience of the
1340		-	commission at hearings required by this section.
1341		-	(i) Following the scheduled hearing date, or by the close of business
1342		-	on the scheduled hearing date if the hearing was not held, the
1343		-	commission shall consider all written and oral comments received.
1344		-	(j) If no written notice of intent to attend the public hearing by
1345		-	interested parties is received, the commission may proceed with
1346		-	promulgation of the proposed rule without a public hearing.
1347		-	(k) The commission shall, by majority vote of all members, take final
1348		-	action on the proposed rule and shall determine the effective date of the
1349		-	rule, if any, based on the rulemaking record and the full text of the rule.
1350		-	(l) Upon determination that an emergency exists, the commission
1351		-	may consider and adopt an emergency rule without prior notice,
1352		-	opportunity for comment or hearing, provided the usual rulemaking
1353		-	procedures provided in the compact and in this section shall be Substitute Senate Bill No. 9
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1354	1036
1355		-	Public Act No. 23-97 45 of 80
	1037	+	(2) Two years have elapsed from the date of the adverse action. 845
	1038	+	(f) Once an encumbered license in the home state is restored to good 846
	1039	+	standing, the licensee shall meet the requirements of subsection (a) of 847
	1040	+	this section of the compact to obtain a compact privilege in any remote 848
	1041	+	state. 849
	1042	+	(g) If a licensee's compact privilege in any remote state is removed, 850
	1043	+	the individual shall lose the compact privilege in any remote state until 851
	1044	+	the following occur: 852
	1045	+	(1) The specific period of time for which the compact privilege was 853
	1046	+	removed has ended; 854
	1047	+	(2) All fines have been paid; and 855
	1048	+	(3) Two years have elapsed from the date of the adverse action. 856
	1049	+	(h) Once the requirements of subsection (g) of this section of the 857
	1050	+	compact have been met, the licensee shall meet the requirements set 858
	1051	+	forth in subsection (a) of this section of the compact to obtain a compact 859
	1052	+	privilege in a remote state. 860
	1053	+	SECTION 5. ACTIVE DUTY MILITARY PERSONNEL OR THEIR 861
	1054	+	SPOUSES 862
	1055	+	A licensee who is active duty military or is the spouse of an 863
	1056	+	individual who is active duty military may designate one of the 864
	1057	+	following as the home state: 865
	1058	+	(1) Home of record; 866
	1059	+	(2) Permanent change of station (PCS); or 867
	1060	+	(3) State of current residence if such state is different from the PCS 868
	1061	+	state or home of record. 869
	1062	+	SECTION 6. ADVERSE ACTIONS 870 Substitute Bill No. 9
1356	1063
1357		-	retroactively applied to the rule as soon as reasonably possible, but in
1358		-	no event later than ninety days after the effective date of the rule. For
1359		-	the purposes of this subsection, an emergency rule shall be adopted
1360		-	immediately to:
1361		-	(1) Meet an imminent threat to public health, safety or welfare;
1362		-	(2) Prevent a loss of commission or member state funds;
1363		-	(3) Meet a deadline for the promulgation of an administrative rule
1364		-	that is established by federal law or rule; or
1365		-	(4) Protect public health and safety.
1366		-	(m) The commission or an authorized committee of the commission
1367		-	may direct revisions to a previously adopted rule or amendment for
1368		-	purposes of correcting typographical errors, errors in format, errors in
1369		-	consistency or grammatical errors. Public notice of any revisions shall
1370		-	be posted on the Internet web site of the commission. The revision shall
1371		-	be subject to challenge by any person for a period of thirty days after
1372		-	posting. The revision may be challenged only on grounds that the
1373		-	revision results in a material change to a rule. A challenge shall be made
1374		-	in writing and delivered to the chair of the commission prior to the end
1375		-	of the notice period. If no challenge is made, the revision shall take effect
1376		-	without further action. If the revision is challenged, the revision may not
1377		-	take effect without the approval of the commission.
1378		-	SECTION 10. OVERSIGHT, DISPUTE RESOLUTION AND
1379		-	ENFORCEMENT
1380		-	(a) Oversight
1381		-	(1) The executive, legislative and judicial branches of state
1382		-	government in each member state shall enforce the compact and take all
1383		-	actions necessary and appropriate to effectuate the compact's purposes Substitute Senate Bill No. 9
1384	1064
1385		-	Public Act No. 23-97 46 of 80
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1386	1068
1387		-	and intent. The provisions of the compact and the rules promulgated
1388		-	under the compact shall have standing as statutory law.
1389		-	(2) All courts shall take judicial notice of the compact and the rules in
1390		-	any judicial or administrative proceeding in a member state pertaining
1391		-	to the subject matter of the compact which may affect the powers,
1392		-	responsibilities or actions of the commission.
1393		-	(3) The commission shall be entitled to receive service of process in
1394		-	any such proceeding and shall have standing to intervene in such a
1395		-	proceeding for all purposes. Failure to provide service of process to the
1396		-	commission shall render a judgment or order void as to the commission,
1397		-	the compact or promulgated rules.
1398		-	(b) Default, Technical Assistance and Termination
1399		-	(1) If the commission determines that a member state has defaulted
1400		-	in the performance of its obligations or responsibilities under the
1401		-	compact or the promulgated rules, the commission shall:
1402		-	(A) Provide written notice to the defaulting state and other member
1403		-	states of the nature of the default, the proposed means of curing the
1404		-	default, and or any other action to be taken by the commission; and
1405		-	(B) Provide remedial training and specific technical assistance
1406		-	regarding the default.
1407		-	(2) If a state in default fails to cure the default, the defaulting state
1408		-	may be terminated from the compact upon an affirmative vote of a
1409		-	majority of the member states, and all rights, privileges and benefits
1410		-	conferred by the compact may be terminated on the effective date of
1411		-	termination. A cure of the default shall not relieve the offending state of
1412		-	obligations or liabilities incurred during the period of default.
1413		-	(3) Termination of membership in the compact shall be imposed only Substitute Senate Bill No. 9
	1069	+	(a) A home state shall have exclusive power to impose adverse action 871
	1070	+	against a license issued by the home state. 872
	1071	+	(b) A home state may take adverse action based on the investigative 873
	1072	+	information of a remote state, so long as the home state follows its own 874
	1073	+	procedures for imposing adverse action. 875
	1074	+	(c) Nothing in the compact shall override a member state's decision 876
	1075	+	that participation in an alternative program may be used in lieu of 877
	1076	+	adverse action and that such participation shall remain nonpublic if 878
	1077	+	required by the member state's laws. Member states shall require 879
	1078	+	licensees who enter any alternative programs in lieu of discipline to 880
	1079	+	agree not to practice in any other member state during the term of the 881
	1080	+	alternative program without prior authorization from such other 882
	1081	+	member state. 883
	1082	+	(d) Any member state may investigate actual or alleged violations of 884
	1083	+	the statutes and rules authorizing the practice of physical therapy in any 885
	1084	+	other member state in which a physical therapist or physical therapist 886
	1085	+	assistant holds a license or compact privilege. 887
	1086	+	(e) A remote state shall have the authority to: 888
	1087	+	(1) Take adverse actions as set forth in subsection (d) of section 4 of 889
	1088	+	the compact against a licensee's compact privilege in the state; 890
	1089	+	(2) Issue subpoenas for both hearings and investigations that require 891
	1090	+	the attendance and testimony of witnesses and the production of 892
	1091	+	evidence. Subpoenas issued by a physical therapy licensing board in a 893
	1092	+	party state for the attendance and testimony of witnesses or the 894
	1093	+	production of evidence from another party state shall be enforced in 895
	1094	+	such other party state by any court of competent jurisdiction, according 896
	1095	+	to the practice and procedure of such court applicable to subpoenas 897
	1096	+	issued in proceedings pending before such court. The issuing authority 898
	1097	+	shall pay any witness fees, travel expenses, mileage and other fees 899
	1098	+	required by the service statutes of the state where the witnesses or 900
	1099	+	evidence are located; and 901 Substitute Bill No. 9
1414	1100
1415		-	Public Act No. 23-97 47 of 80
1416	1101
1417		-	after all other means of securing compliance have been exhausted.
1418		-	Notice of intent to suspend or terminate shall be given by the
1419		-	commission to the governor, the majority and minority leaders of the
1420		-	defaulting state's legislature and each of the member states.
1421		-	(4) A state that has been terminated is responsible for all assessments,
1422		-	obligations and liabilities incurred through the effective date of
1423		-	termination, including obligations that extend beyond the effective date
1424		-	of termination.
1425		-	(5) The commission shall not bear any costs related to a state that is
1426		-	found to be in default or that has been terminated from the compact,
1427		-	unless agreed upon in writing between the commission and the
1428		-	defaulting state.
1429		-	(6) The defaulting state may appeal the action of the commission by
1430		-	petitioning the United States District Court for the District of Columbia
1431		-	or the federal district where the commission has its principal offices. The
1432		-	prevailing member shall be awarded all costs of such litigation,
1433		-	including reasonable attorney's fees.
1434		-	(c) Dispute Resolution
1435		-	(1) Upon request by a member state, the commission shall attempt to
1436		-	resolve disputes related to the compact that arise among member states
1437		-	and between member and nonmember states.
1438		-	(2) The commission shall promulgate a rule providing for both
1439		-	mediation and binding dispute resolution for disputes as appropriate.
1440		-	(d) Enforcement
1441		-	(1) The commission, in the reasonable exercise of its discretion, shall
1442		-	enforce the provisions and rules of the compact.
1443		-	(2) By majority vote, the commission may initiate legal action in the Substitute Senate Bill No. 9
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1444	1105
1445		-	Public Act No. 23-97 48 of 80
	1106	+	(3) If otherwise permitted by state law, recover from the licensee the 902
	1107	+	costs of investigations and disposition of cases resulting from any 903
	1108	+	adverse action taken against such licensee. 904
	1109	+	(f) Joint Investigations 905
	1110	+	(1) In addition to the authority granted to a member state by its 906
	1111	+	respective physical therapy practice act or other applicable state law, a 907
	1112	+	member state may participate with other member states in joint 908
	1113	+	investigations of licensees. 909
	1114	+	(2) Member states shall share any investigative, litigation or 910
	1115	+	compliance materials in furtherance of any joint or individual 911
	1116	+	investigation initiated under the compact. 912
	1117	+	SECTION 7. ESTABLISHMENT OF THE PHYSICAL THERAPY 913
	1118	+	COMPACT COMMISSION 914
	1119	+	(a) The compact member states hereby create and establish a joint 915
	1120	+	public agency known as the Physical Therapy Compact Commission. 916
	1121	+	(1) The commission is an instrumentality of the compact states. 917
	1122	+	(2) Venue is proper and judicial proceedings by or against the 918
	1123	+	commission shall be brought solely and exclusively in a court of 919
	1124	+	competent jurisdiction where the principal office of the commission is 920
	1125	+	located. The commission may waive venue and jurisdictional defenses 921
	1126	+	to the extent that it adopts or consents to participate in alternative 922
	1127	+	dispute resolution proceedings. 923
	1128	+	(3) Nothing in the compact shall be construed to be a waiver of 924
	1129	+	sovereign immunity. 925
	1130	+	(b) Membership, Voting and Meetings 926
	1131	+	(1) Each member state shall have and be limited to one delegate 927
	1132	+	selected by such member state's licensing board. 928 Substitute Bill No. 9
1446	1133
1447		-	United States District Court for the District of Columbia or the federal
1448		-	district where the commission has its principal offices against a member
1449		-	state in default to enforce compliance with the provisions of the compact
1450		-	and its promulgated rules and bylaws. The relief sought may include
1451		-	both injunctive relief and damages. In the event judicial enforcement is
1452		-	necessary, the prevailing member shall be awarded all costs of such
1453		-	litigation, including reasonable attorney's fees.
1454		-	(3) The remedies herein shall not be the exclusive remedies of the
1455		-	commission. The commission may pursue any other remedies available
1456		-	under federal or state law.
1457		-	SECTION 11. DATE OF IMPLEMENTATION OF THE INTERSTATE
1458		-	COMMISSION FOR PHYSICAL THERAPY PRACTICE AND
1459		-	ASSOCIATED RULES, WITHDRAWAL AND AMENDMENT
1460		-	(a) The compact shall come into effect on the date on which the
1461		-	compact statute is enacted into law in the tenth member state. The
1462		-	provisions, which become effective at such time, shall be limited to the
1463		-	powers granted to the commission relating to assembly and the
1464		-	promulgation of rules. Thereafter, the commission shall meet and
1465		-	exercise rulemaking powers necessary to the implementation and
1466		-	administration of the compact.
1467		-	(b) Any state that joins the compact subsequent to the commission's
1468		-	initial adoption of the rules shall be subject to the rules as they exist on
1469		-	the date on which the compact becomes law in such state. Any rule that
1470		-	has been previously adopted by the commission shall have the full force
1471		-	and effect of law on the day the compact becomes law in such state.
1472		-	(c) Any member state may withdraw from the compact by enacting a
1473		-	statute repealing the same.
1474		-	(1) A member state's withdrawal shall not take effect until six months
1475		-	after enactment of the repealing statute. Substitute Senate Bill No. 9
1476	1134
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1478	1138
1479		-	(2) Withdrawal shall not affect the continuing requirement of the
1480		-	withdrawing state's physical therapy licensing board to comply with the
1481		-	investigative and adverse action reporting requirements of the compact
1482		-	prior to the effective date of withdrawal.
1483		-	(d) Nothing contained in the compact shall be construed to invalidate
1484		-	or prevent any physical therapy licensure agreement or other
1485		-	cooperative arrangement between a member state and a nonmember
1486		-	state that does not conflict with the provisions of the compact.
1487		-	(e) The compact may be amended by the member states. No
1488		-	amendment to the compact shall become effective and binding upon
1489		-	any member state until it is enacted into the laws of all member states.
1490		-	SECTION 12. CONSTRUCTION AND SEVERABILITY
1491		-	The compact shall be liberally construed so as to effectuate the
1492		-	purposes thereof. The provisions of the compact shall be severable, and
1493		-	if any phrase, clause, sentence or provision of the compact is declared to
1494		-	be contrary to the constitution of any party state or the Constitution of
1495		-	the United States, or the applicability thereof to any government,
1496		-	agency, person or circumstance is held invalid, the validity of the
1497		-	remainder of the compact and the applicability thereof to any
1498		-	government, agency, person or circumstance shall not be affected
1499		-	thereby. If the compact shall be held contrary to the constitution of any
1500		-	party state, the compact shall remain in full force and effect as to the
1501		-	remaining party states and in full force and effect as to the party state
1502		-	affected as to all severable matters."
1503		-	Sec. 17. (NEW) (Effective July 1, 2023) The Commissioner of Public
1504		-	Health shall require each person applying for licensure as a physical
1505		-	therapist or physical therapist assistant to submit to a state and national
1506		-	fingerprint-based criminal history records check pursuant to section 29-
1507		-	17a of the general statutes. For the purposes of this section, "physical Substitute Senate Bill No. 9
	1139	+	(2) The delegate shall be a current member of the licensing board who 929
	1140	+	is a physical therapist, a physical therapist assistant, a public member or 930
	1141	+	the board administrator. 931
	1142	+	(3) Any delegate may be removed or suspended from office as 932
	1143	+	provided by the law of the state from which the delegate is appointed. 933
	1144	+	(4) The member state board shall fill any vacancy occurring in the 934
	1145	+	commission. 935
	1146	+	(5) Each delegate shall be entitled to one vote with regard to the 936
	1147	+	promulgation of rules and creation of bylaws and shall otherwise have 937
	1148	+	an opportunity to participate in the business and affairs of the 938
	1149	+	commission. 939
	1150	+	(6) A delegate shall vote in person or by such other means as 940
	1151	+	provided in the bylaws. The bylaws may provide for delegates' 941
	1152	+	participation in meetings by telephone or other means of 942
	1153	+	communication. 943
	1154	+	(7) The commission shall meet at least once during each calendar 944
	1155	+	year. Additional meetings shall be held as set forth in the bylaws. 945
	1156	+	(c) The commission shall have the following powers and duties: 946
	1157	+	(1) Establish the fiscal year of the commission; 947
	1158	+	(2) Establish bylaws; 948
	1159	+	(3) Maintain its financial records in accordance with the bylaws; 949
	1160	+	(4) Meet and take such actions as are consistent with the provisions 950
	1161	+	of the compact and the bylaws; 951
	1162	+	(5) Promulgate uniform rules to facilitate and coordinate 952
	1163	+	implementation and administration of the compact. The rules shall have 953
	1164	+	the force and effect of law and shall be binding in all member states; 954 Substitute Bill No. 9
1508	1165
1509		-	Public Act No. 23-97 50 of 80
1510	1166
1511		-	therapist" means an individual licensed for the independent practice of
1512		-	physical therapy, "physical therapist assistant" means an individual
1513		-	licensed to assist in the practice of physical therapy in this state under
1514		-	the supervision of a physical therapist and "licensure" means
1515		-	authorization by a state physical therapy regulatory authority to engage
1516		-	in the independent practice of physical therapy, the practice of which
1517		-	would be unlawful without such authorization.
1518		-	Sec. 18. (Effective July 1, 2023) (a) The Commissioner of Public Health
1519		-	shall establish a podiatric scope of practice working group to advise the
1520		-	Department of Public Health and any relevant scope of practice review
1521		-	committee established pursuant to section 19a-16e of the general
1522		-	statutes regarding the scope of practice of podiatrists as it relates to
1523		-	surgical procedures. The working group shall consist of not less than
1524		-	three podiatrists licensed pursuant to chapter 375 of the general statutes
1525		-	and not less than three orthopedic surgeons licensed pursuant to
1526		-	chapter 370 of the general statutes appointed by the commissioner. Not
1527		-	later than January 1, 2024, the working group shall report to the
1528		-	commissioner and any such scope of practice review committee
1529		-	regarding its findings and recommendations.
1530		-	(b) Not later than February 1, 2024, the Commissioner of Public
1531		-	Health shall report, in accordance with the provisions of section 11-4a
1532		-	of the general statutes, to the joint standing committee of the General
1533		-	Assembly having cognizance of matters relating to public health on the
1534		-	findings and recommendations of the working group and whether the
1535		-	Department of Public Health and any relevant scope of practice review
1536		-	committee is in agreement with such findings and recommendations.
1537		-	Sec. 19. Section 20-94a of the general statutes is repealed and the
1538		-	following is substituted in lieu thereof (Effective October 1, 2023):
1539		-	(a) The Department of Public Health may issue an advanced practice
1540		-	registered nurse license to a person seeking to perform the activities Substitute Senate Bill No. 9
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1541	1170
1542		-	Public Act No. 23-97 51 of 80
	1171	+	(6) Bring and prosecute legal proceedings or actions in the name of 955
	1172	+	the commission, provided the standing of any state physical therapy 956
	1173	+	licensing board to sue or be sued under applicable law shall not be 957
	1174	+	affected; 958
	1175	+	(7) Purchase and maintain insurance and bonds; 959
	1176	+	(8) Borrow, accept or contract for services of personnel, including, but 960
	1177	+	not limited to, employees of a member state; 961
	1178	+	(9) Hire employees, elect or appoint officers, fix compensation, define 962
	1179	+	duties and grant such individuals appropriate authority to carry out the 963
	1180	+	purposes of the compact and establish the commission's personnel 964
	1181	+	policies and programs relating to conflicts of interest, qualifications of 965
	1182	+	personnel and other related personnel matters; 966
	1183	+	(10) Accept any and all appropriate donations and grants of money, 967
	1184	+	equipment, supplies, materials and services and receive, utilize and 968
	1185	+	dispose of such money, equipment, supplies, materials and services, 969
	1186	+	provided at all times the commission shall avoid any appearance of 970
	1187	+	impropriety or conflict of interest; 971
	1188	+	(11) Lease, purchase, accept appropriate gifts or donations of, or 972
	1189	+	otherwise own, hold, improve or use any property, real, personal or 973
	1190	+	mixed, provided at all times the commission shall avoid any appearance 974
	1191	+	of impropriety; 975
	1192	+	(12) Sell, convey, mortgage, pledge, lease, exchange, abandon or 976
	1193	+	otherwise dispose of any real, personal or mixed property; 977
	1194	+	(13) Establish a budget and make expenditures; 978
	1195	+	(14) Borrow money; 979
	1196	+	(15) Appoint committees, including standing committees composed 980
	1197	+	of members, state regulators, state legislators or their representatives, 981
	1198	+	and consumer representatives and such other interested persons as may 982 Substitute Bill No. 9
1543	1199
1544		-	described in subsection (b) of section 20-87a, as amended by this act,
1545		-	upon receipt of a fee of two hundred dollars, to an applicant who: (1)
1546		-	Maintains a license as a registered nurse in this state, as provided by
1547		-	section 20-93 or 20-94; (2) holds and maintains current certification as a
1548		-	nurse practitioner, a clinical nurse specialist or a nurse anesthetist from
1549		-	one of the following national certifying bodies that certify nurses in
1550		-	advanced practice: The American Nurses' Association, the Nurses'
1551		-	Association of the American College of Obstetricians and Gynecologists
1552		-	Certification Corporation, the National Board of Pediatric Nurse
1553		-	Practitioners and Associates or the American Association of Nurse
1554		-	Anesthetists, their successors or other appropriate national certifying
1555		-	bodies approved by the Board of Examiners for Nursing; (3) has
1556		-	completed thirty hours of education in pharmacology for advanced
1557		-	nursing practice; and (4) (A) holds a graduate degree in nursing or in a
1558		-	related field recognized for certification as either a nurse practitioner, a
1559		-	clinical nurse specialist, or a nurse anesthetist by one of the foregoing
1560		-	certifying bodies, or (B) (i) on or before December 31, 2004, completed
1561		-	an advanced nurse practitioner program that a national certifying body
1562		-	identified in subdivision (2) of subsection (a) of this section recognized
1563		-	for certification of a nurse practitioner, clinical nurse specialist, or nurse
1564		-	anesthetist, and (ii) at the time of application, holds a current license as
1565		-	an advanced practice registered nurse in another state that requires a
1566		-	master's degree in nursing or a related field for such licensure. No
1567		-	license shall be issued under this section to any applicant against whom
1568		-	professional disciplinary action is pending or who is the subject of an
1569		-	unresolved complaint.
1570		-	(b) During the period commencing January 1, 1990, and ending
1571		-	January 1, 1992, the Department of Public Health may in its discretion
1572		-	allow a registered nurse, who has been practicing as an advanced
1573		-	practice registered nurse in a nurse practitioner role and who is unable
1574		-	to obtain certification as a nurse practitioner by one of the national
1575		-	certifying bodies specified in subsection (a) of this section, to be licensed Substitute Senate Bill No. 9
1576	1200
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1578	1204
1579		-	as an advanced practice registered nurse provided the individual:
1580		-	(1) Holds a current Connecticut license as a registered nurse pursuant
1581		-	to this chapter;
1582		-	(2) Presents the department with documentation of the reasons one
1583		-	of such national certifying bodies will not certify him as a nurse
1584		-	practitioner;
1585		-	(3) Has been in active practice as a nurse practitioner for at least five
1586		-	years in a facility licensed pursuant to section 19a-491;
1587		-	(4) Provides the department with documentation of his preparation
1588		-	as a nurse practitioner;
1589		-	(5) Provides the department with evidence of at least seventy-five
1590		-	contact hours, or its equivalent, of continuing education related to his
1591		-	nurse practitioner specialty in the preceding five calendar years;
1592		-	(6) Has completed thirty hours of education in pharmacology for
1593		-	advanced nursing practice;
1594		-	(7) Has his employer provide the department with a description of
1595		-	his practice setting, job description, and a plan for supervision by a
1596		-	licensed physician; and
1597		-	(8) Notifies the department of each change of employment to a new
1598		-	setting where he will function as an advanced practice registered nurse
1599		-	and will be exercising prescriptive and dispensing privileges.
1600		-	(c) Any person who obtains a license pursuant to subsection (b) of
1601		-	this section shall be eligible to renew such license annually provided he
1602		-	presents the department with evidence that he received at least fifteen
1603		-	contact hours, or its equivalent, eight hours of which shall be in
1604		-	pharmacology, of continuing education related to his nurse practitioner
1605		-	specialty in the preceding licensure year. If an individual licensed Substitute Senate Bill No. 9
	1205	+	be designated in the compact and the bylaws; 983
	1206	+	(16) Provide and receive information from, and cooperate with, law-984
	1207	+	enforcement agencies; 985
	1208	+	(17) Establish and elect an executive board; and 986
	1209	+	(18) Perform such other functions as may be necessary or appropriate 987
	1210	+	to achieve the purposes of the compact consistent with the state 988
	1211	+	regulation of physical therapy licensure and practice. 989
	1212	+	(d) The Executive Board 990
	1213	+	The executive board shall have the power to act on behalf of the 991
	1214	+	commission according to the terms of the compact. 992
	1215	+	(1) The executive board shall be composed of nine members as 993
	1216	+	follows: 994
	1217	+	(A) Seven voting members who are elected by the commission from 995
	1218	+	the current membership of the commission; 996
	1219	+	(B) One ex-officio, nonvoting member from the recognized national 997
	1220	+	physical therapy professional association; and 998
	1221	+	(C) One ex-officio, nonvoting member from the recognized 999
	1222	+	membership organization of the physical therapy licensing boards. 1000
	1223	+	(2) The ex-officio members shall be selected by their respective 1001
	1224	+	organizations. 1002
	1225	+	(3) The commission may remove any member of the executive board 1003
	1226	+	as provided in bylaws. 1004
	1227	+	(4) The executive board shall meet at least annually. 1005
	1228	+	(5) The executive board shall have the following duties and 1006
	1229	+	responsibilities: 1007 Substitute Bill No. 9
1606	1230
1607		-	Public Act No. 23-97 53 of 80
1608	1231
1609		-	pursuant to subsection (b) of this subsection becomes eligible at any
1610		-	time for certification as a nurse practitioner by one of the national
1611		-	certifying bodies specified in subsection (a) of this section, the
1612		-	individual shall apply for certification, and upon certification so notify
1613		-	the department, and apply to be licensed as an advanced practice
1614		-	registered nurse in accordance with subsection (a) of this section.
1615		-	(d) On and after October 1, 2023, a person, who is not eligible for
1616		-	licensure under subsection (a) of this section, may apply for licensure by
1617		-	endorsement as an advanced practice registered nurse. Such applicant
1618		-	shall (1) present evidence satisfactory to the Commissioner of Public
1619		-	Health that the applicant has acquired three years of experience as an
1620		-	advanced practice registered nurse, or as a person entitled to perform
1621		-	similar services under a different designation, in another state or
1622		-	jurisdiction that has requirements for practicing in such capacity that are
1623		-	substantially similar to, or higher than, those of this state and that there
1624		-	are no disciplinary actions or unresolved complaints pending against
1625		-	such person, and (2) pay a fee of two hundred dollars to the
1626		-	commissioner.
1627		-	[(d)] (e) A person who has received a license pursuant to this section
1628		-	shall be known as an "Advanced Practice Registered Nurse" and no
1629		-	other person shall assume such title or use the letters or figures which
1630		-	indicate that the person using the same is a licensed advanced practice
1631		-	registered nurse.
1632		-	Sec. 20. Subsection (b) of section 20-87a of the general statutes is
1633		-	repealed and the following is substituted in lieu thereof (Effective October
1634		-	1, 2023):
1635		-	(b) (1) Advanced nursing practice is defined as the performance of
1636		-	advanced level nursing practice activities that, by virtue of post-basic
1637		-	specialized education and experience, are appropriate to and may be
1638		-	performed by an advanced practice registered nurse. The advanced Substitute Senate Bill No. 9
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1639	1235
1640		-	Public Act No. 23-97 54 of 80
	1236	+	(A) Recommend to the entire commission changes to the rules or 1008
	1237	+	bylaws, changes to the compact legislation, fees paid by compact 1009
	1238	+	member states, including annual dues, and any commission compact fee 1010
	1239	+	charged to licensees for the compact privilege; 1011
	1240	+	(B) Ensure compact administration services are appropriately 1012
	1241	+	provided, contractual or otherwise; 1013
	1242	+	(C) Prepare and recommend the budget; 1014
	1243	+	(D) Maintain financial records on behalf of the commission; 1015
	1244	+	(E) Monitor compact compliance of member states and provide 1016
	1245	+	compliance reports to the commission; 1017
	1246	+	(F) Establish additional committees as necessary; and 1018
	1247	+	(G) Perform other duties as provided in rules or bylaws. 1019
	1248	+	(e) Meetings of the Commission 1020
	1249	+	(1) All meetings shall be open to the public, and public notice of 1021
	1250	+	meetings shall be given in the same manner as required under the 1022
	1251	+	rulemaking provisions of section 9 of the compact. 1023
	1252	+	(2) The commission or the executive board or other committees of the 1024
	1253	+	commission may convene in a closed, nonpublic meeting if the 1025
	1254	+	commission or executive board or other committees of the commission 1026
	1255	+	shall discuss: 1027
	1256	+	(A) Noncompliance of a member state with its obligations under the 1028
	1257	+	compact; 1029
	1258	+	(B) The employment, compensation, discipline or other matters, 1030
	1259	+	practices or procedures related to specific employees or other matters 1031
	1260	+	related to the commission's internal personnel practices and procedures; 1032
	1261	+	(C) Current, threatened or reasonably anticipated litigation; 1033 Substitute Bill No. 9
1641	1262
1642		-	practice registered nurse performs acts of diagnosis and treatment of
1643		-	alterations in health status, as described in subsection (a) of this section.
1644		-	(2) (A) An advanced practice registered nurse having been issued a
1645		-	license pursuant to section 20-94a, as amended by this act, shall, for the
1646		-	first three years after having been issued such license, collaborate with
1647		-	a physician licensed to practice medicine in this state. In all settings,
1648		-	such advanced practice registered nurse may, in collaboration with a
1649		-	physician licensed to practice medicine in this state, prescribe, dispense
1650		-	and administer medical therapeutics and corrective measures and may
1651		-	request, sign for, receive and dispense drugs in the form of professional
1652		-	samples in accordance with sections 20-14c to 20-14e, inclusive, except
1653		-	such advanced practice registered nurse licensed pursuant to section 20-
1654		-	94a, as amended by this act, and maintaining current certification from
1655		-	the American Association of Nurse Anesthetists who is prescribing and
1656		-	administrating medical therapeutics during surgery may only do so if
1657		-	the physician who is medically directing the prescriptive activity is
1658		-	physically present in the institution, clinic or other setting where the
1659		-	surgery is being performed. For purposes of this subdivision,
1660		-	"collaboration" means a mutually agreed upon relationship between
1661		-	such advanced practice registered nurse and a physician who is
1662		-	educated, trained or has relevant experience that is related to the work
1663		-	of such advanced practice registered nurse. The collaboration shall
1664		-	address a reasonable and appropriate level of consultation and referral,
1665		-	coverage for the patient in the absence of such advanced practice
1666		-	registered nurse, a method to review patient outcomes and a method of
1667		-	disclosure of the relationship to the patient. Relative to the exercise of
1668		-	prescriptive authority, the collaboration between such advanced
1669		-	practice registered nurse and a physician shall be in writing and shall
1670		-	address the level of schedule II and III controlled substances that such
1671		-	advanced practice registered nurse may prescribe and provide a method
1672		-	to review patient outcomes, including, but not limited to, the review of
1673		-	medical therapeutics, corrective measures, laboratory tests and other Substitute Senate Bill No. 9
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1676	1267
1677		-	diagnostic procedures that such advanced practice registered nurse may
1678		-	prescribe, dispense and administer.
1679		-	(B) An advanced practice registered nurse having been issued a
1680		-	license pursuant to subsection (d) of section 20-94a, as amended by this
1681		-	act, who collaborated, prior to the issuance of such license, with a
1682		-	physician licensed to practice medicine in another state may count the
1683		-	time of such collaboration toward the three-year requirement set forth
1684		-	in subparagraph (A) of this subsection, provided such collaboration
1685		-	otherwise satisfies the requirements set forth in said subparagraph.
1686		-	(3) An advanced practice registered nurse having (A) been issued a
1687		-	license pursuant to section 20-94a, as amended by this act, (B)
1688		-	maintained such license, or, for an advanced practice registered nurse
1689		-	having been issued a license pursuant to subsection (d) of said section,
1690		-	such license or a license to practice in another state as an advanced
1691		-	practice registered nurse or as a person entitled to perform similar
1692		-	services under a different designation, for a period of not less than three
1693		-	years, and (C) engaged in the performance of advanced practice level
1694		-	nursing activities in collaboration with a physician for a period of not
1695		-	less than three years and not less than two thousand hours in accordance
1696		-	with the provisions of subdivision (2) of this subsection, may, thereafter,
1697		-	alone or in collaboration with a physician or another health care
1698		-	provider licensed to practice in this state: (i) Perform the acts of
1699		-	diagnosis and treatment of alterations in health status, as described in
1700		-	subsection (a) of this section; and (ii) prescribe, dispense and administer
1701		-	medical therapeutics and corrective measures and dispense drugs in the
1702		-	form of professional samples as described in subdivision (2) of this
1703		-	subsection in all settings. Any advanced practice registered nurse
1704		-	electing to practice not in collaboration with a physician in accordance
1705		-	with the provisions of this subdivision shall maintain documentation of
1706		-	having engaged in the performance of advanced practice level nursing
1707		-	activities in collaboration with a physician for a period of not less than Substitute Senate Bill No. 9
	1268	+	(D) Negotiation of contracts for the purchase, lease or sale of goods, 1034
	1269	+	services or real estate; 1035
	1270	+	(E) Accusing any person of a crime or formally censuring any person; 1036
	1271	+	(F) Disclosure of trade secrets or commercial or financial information 1037
	1272	+	that is privileged or confidential; 1038
	1273	+	(G) Disclosure of information of a personal nature where disclosure 1039
	1274	+	would constitute a clearly unwarranted invasion of personal privacy; 1040
	1275	+	(H) Disclosure of investigative records compiled for law-enforcement 1041
	1276	+	purposes; 1042
	1277	+	(I) Disclosure of information related to any investigative reports 1043
	1278	+	prepared by or on behalf of or for use of the commission or other 1044
	1279	+	committee charged with responsibility of investigation or determination 1045
	1280	+	of compliance issues pursuant to the compact; or 1046
	1281	+	(J) Matters specifically exempted from disclosure by federal or 1047
	1282	+	member state statute. 1048
	1283	+	(3) If a meeting or portion of a meeting is closed pursuant to this 1049
	1284	+	provision, the commission's legal counsel or designee shall certify that 1050
	1285	+	the meeting may be closed and shall reference each relevant exempting 1051
	1286	+	provision. 1052
	1287	+	(4) The commission shall keep minutes that fully and clearly describe 1053
	1288	+	all matters discussed in a meeting and shall provide a full and accurate 1054
	1289	+	summary of actions taken and the reasons therefor, including a 1055
	1290	+	description of the views expressed. All documents considered in 1056
	1291	+	connection with an action shall be identified in such minutes. All 1057
	1292	+	minutes and documents of a closed meeting shall remain under seal, 1058
	1293	+	subject to release by a majority vote of the commission or order of a 1059
	1294	+	court of competent jurisdiction. 1060
	1295	+	(f) Financing of the Commission 1061 Substitute Bill No. 9
1708	1296
1709		-	Public Act No. 23-97 56 of 80
1710	1297
1711		-	three years and not less than two thousand hours. Such advanced
1712		-	practice registered nurse shall maintain such documentation for a
1713		-	period of not less than three years after completing such requirements
1714		-	and shall submit such documentation to the Department of Public
1715		-	Health for inspection not later than forty-five days after a request made
1716		-	by the department for such documentation. Any such advanced practice
1717		-	registered nurse shall submit written notice to the Commissioner of
1718		-	Public Health of his or her intention to practice without collaboration
1719		-	with a physician after completing the requirements described in this
1720		-	subdivision and prior to beginning such practice. Not later than
1721		-	December first, annually, the Commissioner of Public Health shall
1722		-	publish on the department's Internet web site a list of such advanced
1723		-	practice registered nurses who are authorized to practice not in
1724		-	collaboration with a physician.
1725		-	(4) An advanced practice registered nurse licensed under the
1726		-	provisions of this chapter may make the determination and
1727		-	pronouncement of death of a patient, provided the advanced practice
1728		-	registered nurse attests to such pronouncement on the certificate of
1729		-	death and signs the certificate of death not later than twenty-four hours
1730		-	after the pronouncement.
1731		-	Sec. 21. (NEW) (Effective July 1, 2023) Not later than January 1, 2024,
1732		-	the owner or operator of each splash pad and spray park where water
1733		-	is recirculated shall post a sign in a conspicuous location at or near the
1734		-	entryway to the splash pad or spray park stating that the water is
1735		-	recirculated and warning that there is a potential health risk to persons
1736		-	ingesting the water.
1737		-	Sec. 22. (NEW) (Effective from passage) (a) Notwithstanding the
1738		-	provisions of chapter 378 of the general statutes, a public or independent
1739		-	institution of higher education that (1) is accredited as a degree-granting
1740		-	institution in good standing by a regional accrediting association
1741		-	recognized by the Secretary of the United States Department of Substitute Senate Bill No. 9
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1742	1301
1743		-	Public Act No. 23-97 57 of 80
	1302	+	(1) The commission shall pay or provide for the payment of the 1062
	1303	+	reasonable expenses of its establishment, organization and ongoing 1063
	1304	+	activities. 1064
	1305	+	(2) The commission may accept any and all appropriate revenue 1065
	1306	+	sources, donations and grants of money, equipment, supplies, materials 1066
	1307	+	and services. 1067
	1308	+	(3) The commission may levy on and collect an annual assessment 1068
	1309	+	from each member state or impose fees on other parties to cover the cost 1069
	1310	+	of the operations and activities of the commission and its staff, which 1070
	1311	+	shall be in a total amount sufficient to cover its annual budget as 1071
	1312	+	approved each year for which revenue is not provided by other sources. 1072
	1313	+	The aggregate annual assessment amount shall be allocated based upon 1073
	1314	+	a formula to be determined by the commission, which shall promulgate 1074
	1315	+	a rule binding upon all member states. 1075
	1316	+	(4) The commission shall not incur obligations of any kind prior to 1076
	1317	+	securing the funds adequate to meet such obligations, or pledge the 1077
	1318	+	credit of any of the member states, except by and with the authority of 1078
	1319	+	the member state. 1079
	1320	+	(5) The commission shall keep accurate accounts of all receipts and 1080
	1321	+	disbursements. The receipts and disbursements of the commission shall 1081
	1322	+	be subject to the audit and accounting procedures established under its 1082
	1323	+	bylaws. All receipts and disbursements of funds handled by the 1083
	1324	+	commission shall be audited annually by a certified or licensed public 1084
	1325	+	accountant and the report of the audit shall be included in and become 1085
	1326	+	part of the annual report of the commission. 1086
	1327	+	(g) Qualified Immunity, Defense and Indemnification 1087
	1328	+	(1) The members, officers, executive director, employees and 1088
	1329	+	representatives of the commission shall be immune from suit and 1089
	1330	+	liability, either personally or in their official capacity, for any claim for 1090
	1331	+	damage to or loss of property or personal injury or other civil liability 1091
	1332	+	caused by or arising out of any actual or alleged act, error or omission 1092 Substitute Bill No. 9
1744	1333
1745		-	Education and maintains such accreditation status; and (2) offers, or is
1746		-	seeking state approval to offer, a nursing program pursuant to section
1747		-	10a-34 of the general statutes, may apply to the Connecticut State Board
1748		-	of Examiners for Nursing to establish a pilot program that offers
1749		-	licensed practical nursing education and training on or before January
1750		-	30, 2024. As used in this subsection, "public institution of higher
1751		-	education" and "independent institution of higher education" have the
1752		-	same meanings as described in section 10a-173 of the general statutes.
1753		-	(b) An institution of higher education that applies to the Connecticut
1754		-	State Board of Examiners for Nursing to establish a pilot program
1755		-	pursuant to subsection (a) of this section shall provide to said board the
1756		-	following information, in writing, not later than sixty days prior to the
1757		-	date on which it seeks to establish the pilot program:
1758		-	(1) Identifying information regarding the pilot program, including,
1759		-	but not limited to, the name of the program, address where such
1760		-	program will be administered, responsible party for the program and
1761		-	contact information for the program;
1762		-	(2) A description of the pilot program, including accreditation status,
1763		-	any clinical partner and anticipated enrollment by academic term;
1764		-	(3) An identification of resources that support the program;
1765		-	(4) Graduation rates and National Council Licensure Examination
1766		-	licensure and certification pass rates for the past three years for any
1767		-	existing nursing programs offered by the institution of higher
1768		-	education;
1769		-	(5) A plan for employing qualified faculty and administrators and
1770		-	clinical experiences; and
1771		-	(6) Other information as requested by the Connecticut State Board of
1772		-	Examiners for Nursing. Substitute Senate Bill No. 9
1773	1334
1774		-	Public Act No. 23-97 58 of 80
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1775	1338
1776		-	(c) The Connecticut State Board of Examiners for Nursing shall
1777		-	review and consider an application made by an institution of higher
1778		-	education described in subsection (a) of this section to establish a pilot
1779		-	program pursuant to said subsection if the institution of higher
1780		-	education provides the information required pursuant to subsection (b)
1781		-	of this section. The Connecticut State Board of Examiners for Nursing
1782		-	may hold a public hearing on such application.
1783		-	(d) The pilot program established pursuant to this section shall
1784		-	comply with the relevant provisions of chapter 378 of the general
1785		-	statutes and sections 20-90-45 to 20-90-59, inclusive, of the regulations
1786		-	of Connecticut state agencies. Notwithstanding the provisions of section
1787		-	10a-34 of the general statutes, if such pilot program complies with such
1788		-	provisions for not less than two years, and provides evidence that the
1789		-	program is meeting its educational outcomes, as defined in section 20-
1790		-	90-47 of the regulations of Connecticut state agencies, such pilot
1791		-	program shall be deemed fully approved by the Connecticut State Board
1792		-	of Examiners for Nursing.
1793		-	Sec. 23. (NEW) (Effective from passage) The Office of Higher Education
1794		-	may enter into a reciprocity agreement with one or more neighboring
1795		-	states that permits such neighboring state to allow a student attending
1796		-	an institution of higher education in such neighboring state to train in a
1797		-	clinical rotation for credit in Connecticut, provided such neighboring
1798		-	state allows a student attending a Connecticut institution of higher
1799		-	education to train in a clinical rotation for credit in such neighboring
1800		-	state.
1801		-	Sec. 24. Subsection (f) of section 19a-112j of the general statutes is
1802		-	repealed and the following is substituted in lieu thereof (Effective July 1,
1803		-	2023):
1804		-	(f) A majority of the membership of the commission shall constitute
1805		-	a quorum for the transaction of any business and any decision shall be Substitute Senate Bill No. 9
	1339	+	that occurred or that the person against whom the claim is made had a 1093
	1340	+	reasonable basis for believing occurred within the scope of commission 1094
	1341	+	employment, duties or responsibilities, provided nothing in this 1095
	1342	+	subdivision shall be construed to protect any such person from suit or 1096
	1343	+	liability for any damage, loss, injury or liability caused by the intentional 1097
	1344	+	or wilful or wanton misconduct of such person. 1098
	1345	+	(2) The commission shall defend any member, officer, executive 1099
	1346	+	director, employee or representative of the commission in any civil 1100
	1347	+	action seeking to impose liability arising out of any actual or alleged act, 1101
	1348	+	error or omission that occurred within the scope of commission 1102
	1349	+	employment, duties or responsibilities or that the person against whom 1103
	1350	+	the claim is made had a reasonable basis for believing occurred within 1104
	1351	+	the scope of commission employment, duties or responsibilities, 1105
	1352	+	provided (A) nothing in this subdivision shall be construed to prohibit 1106
	1353	+	such person from retaining his or her own counsel, and (B) the actual or 1107
	1354	+	alleged act, error or omission did not result from such person's 1108
	1355	+	intentional or wilful or wanton misconduct. 1109
	1356	+	(3) The commission shall indemnify and hold harmless any member, 1110
	1357	+	officer, executive director, employee or representative of the 1111
	1358	+	commission for the amount of any settlement or judgment obtained 1112
	1359	+	against such person arising out of any actual or alleged act, error or 1113
	1360	+	omission that occurred within the scope of commission employment, 1114
	1361	+	duties or responsibilities or that such person had a reasonable basis for 1115
	1362	+	believing occurred within the scope of commission employment, duties 1116
	1363	+	or responsibilities, provided the actual or alleged act, error or omission 1117
	1364	+	did not result from the intentional or wilful or wanton misconduct of 1118
	1365	+	such person. 1119
	1366	+	SECTION 8. DATA SYSTEM 1120
	1367	+	(a) The commission shall provide for the development, maintenance 1121
	1368	+	and utilization of a coordinated database and reporting system 1122
	1369	+	containing licensure, adverse action and investigative information on all 1123
	1370	+	licensed individuals in member states. 1124 Substitute Bill No. 9
1806	1371
1807		-	Public Act No. 23-97 59 of 80
1808	1372
1809		-	by a majority vote of those present at a meeting, except the commission
1810		-	may establish such subcommissions, advisory groups or other entities
1811		-	as it deems necessary to further the purposes of the commission,
1812		-	including, but not limited to, a subcommission, advisory group or other
1813		-	entity to evaluate the challenges associated with the provision of home
1814		-	health care to victims of gun violence and methods to foster a system
1815		-	that unites community service providers with adults and juveniles
1816		-	needing supports and services in order to address trauma suffered as a
1817		-	result of gun violence.
1818		-	Sec. 25. (Effective from passage) The Department of Public Health, in
1819		-	consultation with the Department of Mental Health and Addiction
1820		-	Services, and organizations representing health care facilities and
1821		-	licensed health care professionals, shall develop a maternal mental
1822		-	health toolkit to provide information and resources regarding maternal
1823		-	mental health to licensed health care professionals and new parents in
1824		-	the state. Such toolkit shall include, but need not be limited to, (1)
1825		-	information about perinatal mood and anxiety disorders, including, but
1826		-	not limited to, the symptoms of such disorders, potential impact of such
1827		-	disorders on families and treatment options for a person with a perinatal
1828		-	mood or anxiety disorder; and (2) a list of licensed health care
1829		-	professionals, peer support networks and nonprofit organizations in the
1830		-	state that treat perinatal mood and anxiety disorders or provide support
1831		-	for persons with a perinatal mood or anxiety disorder and the family
1832		-	members of such persons. Not later than October 1, 2023, the
1833		-	Department of Public Health shall make such toolkit available on its
1834		-	Internet web site.
1835		-	Sec. 26. Section 19a-490u of the general statutes is repealed and the
1836		-	following is substituted in lieu thereof (Effective October 1, 2023):
1837		-	(a) Each hospital, as defined in section 19a-490, shall include training
1838		-	in the symptoms of dementia as part of such hospital's regularly
1839		-	provided training to staff members who provide direct care to patients. Substitute Senate Bill No. 9
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1840	1376
1841		-	Public Act No. 23-97 60 of 80
	1377	+	(b) Notwithstanding any other provision of state law to the contrary, 1125
	1378	+	a member state shall submit a uniform data set to the data system on all 1126
	1379	+	individuals to whom the compact is applicable as required by the rules 1127
	1380	+	of the commission, including: 1128
	1381	+	(1) Identifying information; 1129
	1382	+	(2) Licensure data; 1130
	1383	+	(3) Adverse actions against a license or compact privilege; 1131
	1384	+	(4) Nonconfidential information related to alternative program 1132
	1385	+	participation; 1133
	1386	+	(5) Any denial of application for licensure, and the reason for such 1134
	1387	+	denial; and 1135
	1388	+	(6) Other information that may facilitate the administration of the 1136
	1389	+	compact, as determined by the rules of the commission. 1137
	1390	+	(c) Investigative information pertaining to a licensee in any member 1138
	1391	+	state shall only be available to other party states. 1139
	1392	+	(d) The commission shall promptly notify all member states of any 1140
	1393	+	adverse action taken against a licensee or an individual applying for a 1141
	1394	+	license. Adverse action information pertaining to a licensee in any 1142
	1395	+	member state shall be available to any other member state. 1143
	1396	+	(e) Member states contributing information to the data system may 1144
	1397	+	designate information that may not be shared with the public without 1145
	1398	+	the express permission of the contributing state. 1146
	1399	+	(f) Any information submitted to the data system that is subsequently 1147
	1400	+	required to be expunged by the laws of the member state contributing 1148
	1401	+	the information shall be removed from the data system. 1149
	1402	+	SECTION 9. RULEMAKING 1150 Substitute Bill No. 9
1842	1403
1843		-	(b) On and after October 1, 2021, each hospital shall include training
1844		-	in implicit bias as part of such hospital's regularly provided training to
1845		-	staff members who provide direct care to women who are pregnant or
1846		-	in the postpartum period. As used in this subsection, "implicit bias"
1847		-	means an attitude or internalized stereotype that affects a person's
1848		-	perceptions, actions and decisions in an unconscious manner and often
1849		-	contributes to unequal treatment of a person based on such person's
1850		-	race, ethnicity, gender identity, sexual orientation, age, disability or
1851		-	other characteristic.
1852		-	(c) On and after October 1, 2023, each hospital shall include training
1853		-	in perinatal mood and anxiety disorders as part of such hospital's
1854		-	regularly provided training to staff members who provide direct care to
1855		-	women who are pregnant or in the postpartum period.
1856		-	Sec. 27. (Effective from passage) (a) On or before July 1, 2023, the
1857		-	Commissioner of Public Health shall convene a working group to advise
1858		-	the commissioner regarding methods to alleviate emergency
1859		-	department crowding and the lack of available emergency department
1860		-	beds in the state, including, but not limited to, the following:
1861		-	(1) The establishment of a quality measure for the timeliness of the
1862		-	transfer of an emergency department patient, who will be admitted to
1863		-	the hospital, out of the hospital's emergency department;
1864		-	(2) The establishment of emergency department discharge units to
1865		-	expedite the discharge of patients from the emergency department;
1866		-	(3) (A) An evaluation of the percentage of emergency department
1867		-	patients who are held in the emergency department after being
1868		-	admitted to the hospital and while waiting for an inpatient bed to
1869		-	become available, and (B) the development of a plan to decrease such
1870		-	percentage; and
1871		-	(4) The reduction in liability for hospitals and their emergency Substitute Senate Bill No. 9
1872	1404
1873		-	Public Act No. 23-97 61 of 80
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1874	1408
1875		-	physicians when patient crowding of a hospital's emergency
1876		-	department has reached the point of causing significant wait times for
1877		-	patients seeking emergency department services.
1878		-	(b) The working group convened pursuant to subsection (a) of this
1879		-	section may include, but need not be limited to, the following members:
1880		-	(1) Two emergency physicians licensed pursuant to chapter 370 of the
1881		-	general statutes representing the Connecticut chapter of a national
1882		-	college of emergency physicians; (2) two emergency physicians licensed
1883		-	pursuant to chapter 370 of the general statutes, one of whom shall be the
1884		-	director of the emergency department of a larger hospital system in the
1885		-	state, and one of whom shall be the director of the emergency
1886		-	department of an independent community hospital; (3) one primary
1887		-	care physician licensed pursuant to chapter 370 of the general statutes
1888		-	representing the Connecticut chapter of a national college of physicians;
1889		-	(4) two representatives of a hospital association in the state; (5) one
1890		-	representative of a medical society in the state; (6) one representative of
1891		-	the Connecticut chapter of a national organization of emergency nurses;
1892		-	(7) one representative of the Connecticut chapter of a national
1893		-	organization of pediatric physicians; (8) one representative of the
1894		-	Connecticut chapter of a national association of psychiatrists; (9) one
1895		-	representative of an association of nurses in the state; (10) two nurses
1896		-	licensed pursuant to chapter 378 of the general statutes, one of whom
1897		-	shall be the nurse director of the emergency department in a larger
1898		-	hospital system, and one of whom shall be the nurse director of the
1899		-	emergency department in an independent community hospital; (11) two
1900		-	patient care navigators, one of whom shall be employed by a larger
1901		-	hospital system, and one of whom shall be employed by an independent
1902		-	community hospital; (12) one representative of hospital patients in the
1903		-	state; (13) one provider of emergency medical transportation services in
1904		-	the state; (14) one representative of a national association of retired
1905		-	persons; (15) the Healthcare Advocate, or the Healthcare Advocate's
1906		-	designee; (16) the Commissioner of Mental Health and Addiction Substitute Senate Bill No. 9
	1409	+	(a) The commission shall exercise its rulemaking powers pursuant to 1151
	1410	+	the criteria set forth in this section and the rules adopted thereunder. 1152
	1411	+	Rules and amendments shall become binding as of the date specified in 1153
	1412	+	each rule or amendment. 1154
	1413	+	(b) If a majority of the legislatures of the member states rejects a rule, 1155
	1414	+	by enactment of a statute or resolution in the same manner used to adopt 1156
	1415	+	the compact not later than four years after the date of adoption of the 1157
	1416	+	rule, such rule shall have no further force and effect in any member 1158
	1417	+	state. 1159
	1418	+	(c) Rules or amendments to the rules shall be adopted at a regular or 1160
	1419	+	special meeting of the commission. 1161
	1420	+	(d) Prior to promulgation and adoption of a final rule or rules by the 1162
	1421	+	commission, and at least thirty days in advance of the meeting at which 1163
	1422	+	the rule will be considered and voted upon, the commission shall file a 1164
	1423	+	notice of proposed rulemaking: 1165
	1424	+	(1) On the Internet web site of the commission or other publicly 1166
	1425	+	accessible platform; and 1167
	1426	+	(2) On the Internet web site of each member state physical therapy 1168
	1427	+	licensing board or other publicly accessible platform or the publication 1169
	1428	+	in which each state would otherwise publish proposed rules. 1170
	1429	+	(e) The notice of proposed rulemaking shall include: 1171
	1430	+	(1) The proposed time, date and location of the meeting in which the 1172
	1431	+	rule will be considered and voted upon; 1173
	1432	+	(2) The text of the proposed rule or amendment and the reason for 1174
	1433	+	the proposed rule; 1175
	1434	+	(3) A request for comments on the proposed rule from any interested 1176
	1435	+	person; and 1177
	1436	+	(4) The manner in which interested persons may submit notice to the 1178 Substitute Bill No. 9
1907	1437
1908		-	Public Act No. 23-97 62 of 80
1909	1438
1910		-	Services, or the commissioner's designee; (17) the Commissioner of
1911		-	Children and Families, or the commissioner's designee; (18) one
1912		-	representative from the Department of Public Health's Office of
1913		-	Emergency Medical Services; (19) one representative from the
1914		-	Department of Public Health's facilities licensing and investigations
1915		-	section; (20) one representative of the Office of the Long-Term Care
1916		-	Ombudsman; (21) the Child Advocate, or the Child Advocate's
1917		-	designee; (22) one representative of a nonprofit nursing home in the
1918		-	state; (23) one representative from a for-profit nursing home in the state;
1919		-	(24) one representative from the insurance industry in the state; and (25)
1920		-	one member of an association of trial lawyers in the state. The
1921		-	chairpersons of the working group shall be one of the emergency
1922		-	physicians representing the Connecticut chapter of a national college of
1923		-	emergency physicians and one of the representatives of a hospital
1924		-	association in the state, who shall be selected by the Commissioner of
1925		-	Public Health. Once selected, the chairpersons of the working group
1926		-	may convene the first meeting of the working group whether or not any
1927		-	other members of the working group identified in subdivisions (1) to
1928		-	(25), inclusive, of this subsection have been selected by the
1929		-	Commissioner of Public Health. If said commissioner has not selected
1930		-	any member of the working group described in said subdivisions on or
1931		-	before August 1, 2023, the cochairpersons may jointly select such
1932		-	member. The first meeting of the working group shall be held not later
1933		-	than December 1, 2023. The working group shall meet biannually and
1934		-	at other times upon the call of the cochairpersons.
1935		-	(c) On or before January 1, 2024, and annually thereafter until January
1936		-	1, 2025, the working group shall report its findings and
1937		-	recommendations to the Commissioner of Public Health and, in
1938		-	accordance with the provisions of section 11-4a of the general statutes,
1939		-	to the joint standing committee of the General Assembly having
1940		-	cognizance of matters relating to public health. Substitute Senate Bill No. 9
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1941	1442
1942		-	Public Act No. 23-97 63 of 80
	1443	+	commission of their intention to attend the public hearing and any 1179
	1444	+	written comments. 1180
	1445	+	(f) Prior to adoption of a proposed rule, the commission shall allow 1181
	1446	+	persons to submit written data, facts, opinions and arguments, which 1182
	1447	+	shall be made available to the public. 1183
	1448	+	(g) The commission shall grant an opportunity for a public hearing 1184
	1449	+	before it adopts a rule or amendment if a hearing is requested by: 1185
	1450	+	(1) At least twenty-five persons; 1186
	1451	+	(2) A state or federal governmental subdivision or agency; or 1187
	1452	+	(3) An association having at least twenty-five members. 1188
	1453	+	(h) If a hearing is held on the proposed rule or amendment, the 1189
	1454	+	commission shall publish the place, time and date of the scheduled 1190
	1455	+	public hearing. If the hearing is held via electronic means, the 1191
	1456	+	commission shall publish the mechanism for access to the electronic 1192
	1457	+	hearing. 1193
	1458	+	(1) All persons wishing to be heard at the hearing shall notify the 1194
	1459	+	executive director of the commission or other designated member in 1195
	1460	+	writing of their desire to appear and testify at the hearing not less than 1196
	1461	+	five business days before the scheduled date of the hearing. 1197
	1462	+	(2) Hearings shall be conducted in a manner providing each person 1198
	1463	+	who wishes to comment a fair and reasonable opportunity to comment 1199
	1464	+	orally or in writing. 1200
	1465	+	(3) All hearings shall be recorded. A copy of the recording shall be 1201
	1466	+	made available on request. 1202
	1467	+	(4) Nothing in this section shall be construed as requiring a separate 1203
	1468	+	hearing on each rule. Rules may be grouped for the convenience of the 1204
	1469	+	commission at hearings required by this section. 1205 Substitute Bill No. 9
1943	1470
1944		-	Sec. 28. (Effective from passage) (a) There is established a task force to
1945		-	study childhood and adult psychosis. Such study shall include, but need
1946		-	not be limited to, an examination of (1) the establishment of, in
1947		-	collaboration with the Departments of Children and Families and
1948		-	Mental Health and Addiction Services, clinics staffed by mental health
1949		-	care providers in various fields who provide comprehensive care for
1950		-	children and adults who are experiencing symptoms of early or first
1951		-	episode psychosis to prevent symptoms from becoming disabling, (2)
1952		-	early evaluation of children and adults with symptoms of a psychosis
1953		-	and management of such symptoms, including, but not limited to,
1954		-	initiating treatment and making any necessary referrals for additional
1955		-	treatment or services, (3) creating (A) care pathways that include
1956		-	specialty teams that treat children and adults who are experiencing
1957		-	early or first episode psychosis, (B) a state-wide model for coordinating
1958		-	specialty care for children and adults experiencing psychosis, as
1959		-	recommended by the National Institute of Mental Health, and (C)
1960		-	services for such children and adults, including, but not limited to,
1961		-	collaboration on psychotherapy and pharmacotherapy, family support,
1962		-	education, coordination with community support services and
1963		-	collaboration with employers and education systems, and (4)
1964		-	strengthening existing clinical networks that treat children and adults
1965		-	experiencing psychosis with a focus on collaborative research and
1966		-	outcomes. As used in this subsection, "psychosis" means a severe mental
1967		-	condition in which disruptions to a person's thoughts and perceptions
1968		-	make it difficult for the person to recognize what is real and what is not
1969		-	real and are often experienced as seeing, hearing and believing things
1970		-	that are not real or having strange, persistent thoughts, behaviors and
1971		-	emotions, including, but not limited to, hallucinations and delusions.
1972		-	(b) The task force shall consist of the following members:
1973		-	(1) Two appointed by the speaker of the House of Representatives,
1974		-	one of whom shall be a child and adolescent psychiatrist with Substitute Senate Bill No. 9
1975	1471
1976		-	Public Act No. 23-97 64 of 80
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	1474	+	43 of 53
1977	1475
1978		-	experience treating patients with psychosis and one of whom shall be a
1979		-	clinical researcher in the field of psychosis;
1980		-	(2) Two appointed by the president pro tempore of the Senate, one of
1981		-	whom shall be a psychiatrist with experience treating adults with
1982		-	psychosis and one of whom shall be a clinical researcher in the field of
1983		-	psychosis;
1984		-	(3) One appointed by the majority leader of the House of
1985		-	Representatives, who shall be the parent or guardian of a child or
1986		-	adolescent who has been treated for psychosis;
1987		-	(4) One appointed by the majority leader of the Senate, who shall be
1988		-	an adult who has been treated for psychosis;
1989		-	(5) One appointed by the minority leader of the House of
1990		-	Representatives, who shall be a licensed mental health care provider
1991		-	who has treated children or adolescents with psychosis;
1992		-	(6) One appointed by the minority leader of the Senate, who shall be
1993		-	a licensed mental health care provider who has treated adults with
1994		-	psychosis;
1995		-	(7) The Commissioner of Mental Health and Addiction Services, or
1996		-	the commissioner's designee; and
1997		-	(8) The Commissioner of Children and Families, or the
1998		-	commissioner's designee.
1999		-	(c) Any member of the task force appointed under subdivision (1),
2000		-	(2), (3), (4), (5) or (6) of subsection (b) of this section may be a member
2001		-	of the General Assembly.
2002		-	(d) All initial appointments to the task force shall be made not later
2003		-	than thirty days after the effective date of this section. Any vacancy shall
2004		-	be filled by the appointing authority. Substitute Senate Bill No. 9
	1476	+	(i) Following the scheduled hearing date, or by the close of business 1206
	1477	+	on the scheduled hearing date if the hearing was not held, the 1207
	1478	+	commission shall consider all written and oral comments received. 1208
	1479	+	(j) If no written notice of intent to attend the public hearing by 1209
	1480	+	interested parties is received, the commission may proceed with 1210
	1481	+	promulgation of the proposed rule without a public hearing. 1211
	1482	+	(k) The commission shall, by majority vote of all members, take final 1212
	1483	+	action on the proposed rule and shall determine the effective date of the 1213
	1484	+	rule, if any, based on the rulemaking record and the full text of the rule. 1214
	1485	+	(l) Upon determination that an emergency exists, the commission 1215
	1486	+	may consider and adopt an emergency rule without prior notice, 1216
	1487	+	opportunity for comment or hearing, provided the usual rulemaking 1217
	1488	+	procedures provided in the compact and in this section shall be 1218
	1489	+	retroactively applied to the rule as soon as reasonably possible, but in 1219
	1490	+	no event later than ninety days after the effective date of the rule. For 1220
	1491	+	the purposes of this subsection, an emergency rule shall be adopted 1221
	1492	+	immediately to: 1222
	1493	+	(1) Meet an imminent threat to public health, safety or welfare; 1223
	1494	+	(2) Prevent a loss of commission or member state funds; 1224
	1495	+	(3) Meet a deadline for the promulgation of an administrative rule 1225
	1496	+	that is established by federal law or rule; or 1226
	1497	+	(4) Protect public health and safety. 1227
	1498	+	(m) The commission or an authorized committee of the commission 1228
	1499	+	may direct revisions to a previously adopted rule or amendment for 1229
	1500	+	purposes of correcting typographical errors, errors in format, errors in 1230
	1501	+	consistency or grammatical errors. Public notice of any revisions shall 1231
	1502	+	be posted on the Internet web site of the commission. The revision shall 1232
	1503	+	be subject to challenge by any person for a period of thirty days after 1233
	1504	+	posting. The revision may be challenged only on grounds that the 1234 Substitute Bill No. 9
2005	1505
2006		-	Public Act No. 23-97 65 of 80
2007	1506
2008		-	(e) The speaker of the House of Representatives and the president pro
2009		-	tempore of the Senate shall select the chairpersons of the task force from
2010		-	among the members of the task force. Such chairpersons shall schedule
2011		-	the first meeting of the task force, which shall be held not later than sixty
2012		-	days after the effective date of this section.
2013		-	(f) The administrative staff of the joint standing committee of the
2014		-	General Assembly having cognizance of matters relating to public
2015		-	health shall serve as administrative staff of the task force.
2016		-	(g) Not later than January 1, 2024, the task force shall submit a report
2017		-	on its findings and recommendations to the joint standing committee of
2018		-	the General Assembly having cognizance of matters relating to public
2019		-	health, in accordance with the provisions of section 11-4a of the general
2020		-	statutes. The task force shall terminate on the date that it submits such
2021		-	report or January 1, 2024, whichever is later.
2022		-	Sec. 29. (Effective from passage) (a) The Departments of Mental Health
2023		-	and Addiction Services, Social Services and Children and Families shall,
2024		-	in consultation with direct service providers and individuals with lived
2025		-	experience, evaluate existing programs for persons with substance use
2026		-	disorder who are caregivers of children and the barriers to treatment of
2027		-	such persons and develop a plan for the establishment and
2028		-	implementation of programs for the treatment of such persons and their
2029		-	children. Such programs shall include, but need not be limited to, the
2030		-	following:
2031		-	(1) Same-day access, in all geographical areas, to family-centered
2032		-	medication-assisted treatment that includes prenatal and perinatal care
2033		-	and access to supports that provide a bridge to such treatment;
2034		-	(2) Intensive in-home treatment supports;
2035		-	(3) Gender-specific programming; Substitute Senate Bill No. 9
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2036	1510
2037		-	Public Act No. 23-97 66 of 80
	1511	+	revision results in a material change to a rule. A challenge shall be made 1235
	1512	+	in writing and delivered to the chair of the commission prior to the end 1236
	1513	+	of the notice period. If no challenge is made, the revision shall take effect 1237
	1514	+	without further action. If the revision is challenged, the revision may not 1238
	1515	+	take effect without the approval of the commission. 1239
	1516	+	SECTION 10. OVERSIGHT, DISPUTE RESOLUTION AND 1240
	1517	+	ENFORCEMENT 1241
	1518	+	(a) Oversight 1242
	1519	+	(1) The executive, legislative and judicial branches of state 1243
	1520	+	government in each member state shall enforce the compact and take all 1244
	1521	+	actions necessary and appropriate to effectuate the compact's purposes 1245
	1522	+	and intent. The provisions of the compact and the rules promulgated 1246
	1523	+	under the compact shall have standing as statutory law. 1247
	1524	+	(2) All courts shall take judicial notice of the compact and the rules in 1248
	1525	+	any judicial or administrative proceeding in a member state pertaining 1249
	1526	+	to the subject matter of the compact which may affect the powers, 1250
	1527	+	responsibilities or actions of the commission. 1251
	1528	+	(3) The commission shall be entitled to receive service of process in 1252
	1529	+	any such proceeding and shall have standing to intervene in such a 1253
	1530	+	proceeding for all purposes. Failure to provide service of process to the 1254
	1531	+	commission shall render a judgment or order void as to the commission, 1255
	1532	+	the compact or promulgated rules. 1256
	1533	+	(b) Default, Technical Assistance and Termination 1257
	1534	+	(1) If the commission determines that a member state has defaulted 1258
	1535	+	in the performance of its obligations or responsibilities under the 1259
	1536	+	compact or the promulgated rules, the commission shall: 1260
	1537	+	(A) Provide written notice to the defaulting state and other member 1261
	1538	+	states of the nature of the default, the proposed means of curing the 1262
	1539	+	default, and or any other action to be taken by the commission; and 1263 Substitute Bill No. 9
2038	1540
2039		-	(4) Expanded access to residential programs for pregnant and
2040		-	parenting persons, including residential programs for parents who have
2041		-	more than one child or who have children over the age of seven; and
2042		-	(5) Access to recovery support specialists and peer support to provide
2043		-	care coordination.
2044		-	(b) Not later than January 1, 2024, the Commissioners of Mental
2045		-	Health and Addiction Services, Social Services and Children and
2046		-	Families shall jointly report, in accordance with the provisions of section
2047		-	11-4a of the general statutes, to the joint standing committees of the
2048		-	General Assembly having cognizance of matters relating to public
2049		-	health, human services and children regarding such plan and
2050		-	recommendations for legislative changes necessary to implement the
2051		-	programs described in subsection (a) of this section.
2052		-	Sec. 30. (Effective from passage) The Departments of Mental Health and
2053		-	Addiction Services and Social Services shall, in collaboration with the
2054		-	Office of Early Childhood, establish a plan to permit parents who are in
2055		-	treatment for substance use disorder to be eligible for child care
2056		-	supports and subsidies. Not later than January 1, 2024, the
2057		-	Commissioners of Mental Health and Addiction Services and Social
2058		-	Services shall jointly report, in accordance with the provisions of section
2059		-	11-4a of the general statutes, to the joint standing committees of the
2060		-	General Assembly having cognizance of matters relating to public
2061		-	health and human services regarding such plan.
2062		-	Sec. 31. (Effective from passage) Not later than January 1, 2024, the
2063		-	Commissioner of Mental Health and Addiction Services shall report, in
2064		-	accordance with the provisions of section 11-4a of the general statutes,
2065		-	to the joint standing committees of the General Assembly having
2066		-	cognizance of matters relating to public health, human services and
2067		-	housing regarding access in the state to supportive housing for pregnant
2068		-	and parenting persons with a substance use disorder. Substitute Senate Bill No. 9
2069	1541
2070		-	Public Act No. 23-97 67 of 80
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2071	1545
2072		-	Sec. 32. (Effective from passage) Not later than January 1, 2024, the
2073		-	Commissioners of Mental Health and Addiction Services, Social
2074		-	Services and Children and Families shall jointly report, in accordance
2075		-	with the provisions of section 11-4a of the general statutes, to the joint
2076		-	standing committees of the General Assembly having cognizance of
2077		-	matters relating to public health, human services and children regarding
2078		-	access for parents with a substance use disorder whose children are
2079		-	receiving services from the Department of Children and Families to
2080		-	appropriate treatment for substance use disorder in the state to prevent
2081		-	removal of children from their parents where possible and to support
2082		-	reunification when removal is necessary, including, but not limited to,
2083		-	consideration of in-home parenting and child care services to assist with
2084		-	safety planning during initial stages of treatment and recovery.
2085		-	Sec. 33. (Effective from passage) Not later than January 1, 2024, the
2086		-	Commissioners of Mental Health and Addiction Services, Children and
2087		-	Families and Social Services shall jointly report, in accordance with the
2088		-	provisions of section 11-4a of the general statutes, to the joint standing
2089		-	committees of the General Assembly having cognizance of matters
2090		-	relating to public health regarding existing substance use disorder
2091		-	treatment services for pregnant and parenting persons, utilization of
2092		-	such services and areas where additional substance use disorder
2093		-	treatment services for such persons are necessary.
2094		-	Sec. 34. (Effective from passage) Not later than January 1, 2024, the
2095		-	Commissioner of Children and Families shall report, in accordance with
2096		-	the provisions of section 11-4a of the general statutes, to the joint
2097		-	standing committees of the General Assembly having cognizance of
2098		-	matters relating to public health and children regarding efforts of the
2099		-	Department of Children and Families to mitigate child safety concerns
2100		-	in the home when the child is living with a caregiver with a substance
2101		-	use disorder.
2102		-	Sec. 35. Subsection (b) of section 17a-674d of the general statutes is Substitute Senate Bill No. 9
	1546	+	(B) Provide remedial training and specific technical assistance 1264
	1547	+	regarding the default. 1265
	1548	+	(2) If a state in default fails to cure the default, the defaulting state 1266
	1549	+	may be terminated from the compact upon an affirmative vote of a 1267
	1550	+	majority of the member states, and all rights, privileges and benefits 1268
	1551	+	conferred by the compact may be terminated on the effective date of 1269
	1552	+	termination. A cure of the default shall not relieve the offending state of 1270
	1553	+	obligations or liabilities incurred during the period of default. 1271
	1554	+	(3) Termination of membership in the compact shall be imposed only 1272
	1555	+	after all other means of securing compliance have been exhausted. 1273
	1556	+	Notice of intent to suspend or terminate shall be given by the 1274
	1557	+	commission to the governor, the majority and minority leaders of the 1275
	1558	+	defaulting state's legislature and each of the member states. 1276
	1559	+	(4) A state that has been terminated is responsible for all assessments, 1277
	1560	+	obligations and liabilities incurred through the effective date of 1278
	1561	+	termination, including obligations that extend beyond the effective date 1279
	1562	+	of termination. 1280
	1563	+	(5) The commission shall not bear any costs related to a state that is 1281
	1564	+	found to be in default or that has been terminated from the compact, 1282
	1565	+	unless agreed upon in writing between the commission and the 1283
	1566	+	defaulting state. 1284
	1567	+	(6) The defaulting state may appeal the action of the commission by 1285
	1568	+	petitioning the United States District Court for the District of Columbia 1286
	1569	+	or the federal district where the commission has its principal offices. The 1287
	1570	+	prevailing member shall be awarded all costs of such litigation, 1288
	1571	+	including reasonable attorney's fees. 1289
	1572	+	(c) Dispute Resolution 1290
	1573	+	(1) Upon request by a member state, the commission shall attempt to 1291
	1574	+	resolve disputes related to the compact that arise among member states 1292
	1575	+	and between member and nonmember states. 1293 Substitute Bill No. 9
2103	1576
2104		-	Public Act No. 23-97 68 of 80
2105	1577
2106		-	repealed and the following is substituted in lieu thereof (Effective July 1,
2107		-	2023):
2108		-	(b) The committee shall consist of the following members:
2109		-	(1) The Secretary of the Office of Policy and Management, or the
2110		-	secretary's designee;
2111		-	(2) The Attorney General, or the Attorney General's designee;
2112		-	(3) The Commissioners of Children and Families, Mental Health and
2113		-	Addiction Services and Public Health, or said commissioners' designees,
2114		-	who shall serve as ex-officio members;
2115		-	(4) The president pro tempore of the Senate, the speaker of the House
2116		-	of Representatives, the majority leaders of the Senate and House of
2117		-	Representatives, the minority leaders of the Senate and House of
2118		-	Representatives, the Senate and House chairpersons of the joint
2119		-	standing [committee] committees of the General Assembly having
2120		-	cognizance of matters relating to appropriations and the budgets of state
2121		-	agencies and public health, or their designees, provided such persons
2122		-	have experience living with a substance [or] use disorder or are the
2123		-	family member of a person who has experience living with a substance
2124		-	use disorder;
2125		-	(5) [Seventeen] Twenty-one individuals representing municipalities,
2126		-	who shall be appointed by the Governor;
2127		-	(6) The executive director of the Commission on Racial Equity in
2128		-	Public Health, or a representative of the commission designated by the
2129		-	executive director; and
2130		-	(7) [Six] Eight individuals appointed by the commissioner as follows:
2131		-	(A) A provider of community-based substance use treatment services
2132		-	for adults, who shall be a nonvoting member; (B) a provider of Substitute Senate Bill No. 9
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2133	1581
2134		-	Public Act No. 23-97 69 of 80
	1582	+	(2) The commission shall promulgate a rule providing for both 1294
	1583	+	mediation and binding dispute resolution for disputes as appropriate. 1295
	1584	+	(d) Enforcement 1296
	1585	+	(1) The commission, in the reasonable exercise of its discretion, shall 1297
	1586	+	enforce the provisions and rules of the compact. 1298
	1587	+	(2) By majority vote, the commission may initiate legal action in the 1299
	1588	+	United States District Court for the District of Columbia or the federal 1300
	1589	+	district where the commission has its principal offices against a member 1301
	1590	+	state in default to enforce compliance with the provisions of the compact 1302
	1591	+	and its promulgated rules and bylaws. The relief sought may include 1303
	1592	+	both injunctive relief and damages. In the event judicial enforcement is 1304
	1593	+	necessary, the prevailing member shall be awarded all costs of such 1305
	1594	+	litigation, including reasonable attorney's fees. 1306
	1595	+	(3) The remedies herein shall not be the exclusive remedies of the 1307
	1596	+	commission. The commission may pursue any other remedies available 1308
	1597	+	under federal or state law. 1309
	1598	+	SECTION 11. DATE OF IMPLEMENTATION OF T HE INTERSTATE 1310
	1599	+	COMMISSION FOR PHYSICAL THERAPY PRACTICE AND 1311
	1600	+	ASSOCIATED RULES, WITHDRAWAL AND AMENDMENT 1312
	1601	+	(a) The compact shall come into effect on the date on which the 1313
	1602	+	compact statute is enacted into law in the tenth member state. The 1314
	1603	+	provisions, which become effective at such time, shall be limited to the 1315
	1604	+	powers granted to the commission relating to assembly and the 1316
	1605	+	promulgation of rules. Thereafter, the commission shall meet and 1317
	1606	+	exercise rulemaking powers necessary to the implementation and 1318
	1607	+	administration of the compact. 1319
	1608	+	(b) Any state that joins the compact subsequent to the commission's 1320
	1609	+	initial adoption of the rules shall be subject to the rules as they exist on 1321
	1610	+	the date on which the compact becomes law in such state. Any rule that 1322
	1611	+	has been previously adopted by the commission shall have the full force 1323 Substitute Bill No. 9
2135	1612
2136		-	community-based substance use treatment services for adolescents,
2137		-	who shall be a nonvoting member; (C) an addiction medicine licensed
2138		-	health care professional with prescribing ability, who shall be a
2139		-	nonvoting member; [and] (D) three individuals with experience living
2140		-	with a substance use disorder or family members of an individual with
2141		-	experience living with a substance use disorder; and (E) two individuals
2142		-	with experience supporting infants and children affected by the opioid
2143		-	crisis.
2144		-	Sec. 36. Subdivision (8) of section 19a-177 of the general statutes is
2145		-	repealed and the following is substituted in lieu thereof (Effective October
2146		-	1, 2023):
2147		-	(8) (A) Develop an emergency medical services data collection
2148		-	system. Each emergency medical service organization licensed or
2149		-	certified pursuant to this chapter shall submit data to the commissioner,
2150		-	on a quarterly basis, from each licensed ambulance service, certified
2151		-	ambulance service or paramedic intercept service that provides
2152		-	emergency medical services. Such submitted data shall include, but not
2153		-	be limited to: (i) The total number of and reasons for calls for emergency
2154		-	medical services received by such licensed ambulance service, certified
2155		-	ambulance service or paramedic intercept service through the 9-1-1
2156		-	system during the reporting period; (ii) each level of emergency medical
2157		-	services, as defined in regulations adopted pursuant to section 19a-179,
2158		-	required for each such call; (iii) the response time for each licensed
2159		-	ambulance service, certified ambulance service or paramedic intercept
2160		-	service during the reporting period; (iv) the number of passed calls,
2161		-	cancelled calls and mutual aid calls, both made and received, during the
2162		-	reporting period; and (v) for the reporting period, the prehospital data
2163		-	for the nonscheduled transport of patients required by regulations
2164		-	adopted pursuant to subdivision (6) of this section. The data required
2165		-	under this subdivision may be submitted in any electronic form selected
2166		-	by such licensed ambulance service, certified ambulance service or Substitute Senate Bill No. 9
2167	1613
2168		-	Public Act No. 23-97 70 of 80
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	1616	+	47 of 53
2169	1617
2170		-	paramedic intercept service and approved by the commissioner,
2171		-	provided the commissioner shall take into consideration the needs of
2172		-	such licensed ambulance service, certified ambulance service or
2173		-	paramedic intercept service in approving such electronic form. The
2174		-	commissioner may conduct an audit of any such licensed ambulance
2175		-	service, certified ambulance service or paramedic intercept service as
2176		-	the commissioner deems necessary in order to verify the accuracy of
2177		-	such reported data.
2178		-	(B) On or before June 1, 2023, and annually thereafter, the
2179		-	commissioner shall prepare a report to the Emergency Medical Services
2180		-	Advisory Board, established pursuant to section 19a-178a, that shall
2181		-	include, but not be limited to, the following data: (i) The total number
2182		-	of calls for emergency medical services received during the reporting
2183		-	year by each licensed ambulance service, certified ambulance service or
2184		-	paramedic intercept service; (ii) the level of emergency medical services
2185		-	required for each such call; (iii) the name of the emergency medical
2186		-	service organization that provided each such level of emergency
2187		-	medical services furnished during the reporting year; (iv) the response
2188		-	time, by time ranges or fractile response times, for each licensed
2189		-	ambulance service, certified ambulance service or paramedic intercept
2190		-	service, using a common definition of response time, as provided in
2191		-	regulations adopted pursuant to section 19a-179; [and] (v) the number
2192		-	of passed calls, cancelled calls and mutual aid calls during the reporting
2193		-	year; and (vi) any shortage of emergency medical services personnel in
2194		-	the state. The commissioner shall prepare such report in a format that
2195		-	categorizes such data for each municipality in which the emergency
2196		-	medical services were provided, with each such municipality grouped
2197		-	according to urban, suburban and rural classifications.
2198		-	(C) If any licensed ambulance service, certified ambulance service or
2199		-	paramedic intercept service does not submit the data required under
2200		-	subparagraph (A) of this subdivision for a period of six consecutive Substitute Senate Bill No. 9
	1618	+	and effect of law on the day the compact becomes law in such state. 1324
	1619	+	(c) Any member state may withdraw from the compact by enacting a 1325
	1620	+	statute repealing the same. 1326
	1621	+	(1) A member state's withdrawal shall not take effect until six months 1327
	1622	+	after enactment of the repealing statute. 1328
	1623	+	(2) Withdrawal shall not affect the continuing requirement of the 1329
	1624	+	withdrawing state's physical therapy licensing board to comply with the 1330
	1625	+	investigative and adverse action reporting requirements of the compact 1331
	1626	+	prior to the effective date of withdrawal. 1332
	1627	+	(d) Nothing contained in the compact shall be construed to invalidate 1333
	1628	+	or prevent any physical therapy licensure agreement or other 1334
	1629	+	cooperative arrangement between a member state and a nonmember 1335
	1630	+	state that does not conflict with the provisions of the compact. 1336
	1631	+	(e) The compact may be amended by the member states. No 1337
	1632	+	amendment to the compact shall become effective and binding upon 1338
	1633	+	any member state until it is enacted into the laws of all member states. 1339
	1634	+	SECTION 12. CONSTRUCTION AND SEVERABILITY 1340
	1635	+	The compact shall be liberally construed so as to effectuate the 1341
	1636	+	purposes thereof. The provisions of the compact shall be severable, and 1342
	1637	+	if any phrase, clause, sentence or provision of the compact is declared to 1343
	1638	+	be contrary to the constitution of any party state or the Constitution of 1344
	1639	+	the United States, or the applicability thereof to any government, 1345
	1640	+	agency, person or circumstance is held invalid, the validity of the 1346
	1641	+	remainder of the compact and the applicability thereof to any 1347
	1642	+	government, agency, person or circumstance shall not be affected 1348
	1643	+	thereby. If the compact shall be held contrary to the constitution of any 1349
	1644	+	party state, the compact shall remain in full force and effect as to the 1350
	1645	+	remaining party states and in full force and effect as to the party state 1351
	1646	+	affected as to all severable matters." 1352 Substitute Bill No. 9
2201	1647
2202		-	Public Act No. 23-97 71 of 80
2203	1648
2204		-	months, or if the commissioner believes that such licensed ambulance
2205		-	service, certified ambulance service or paramedic intercept service
2206		-	knowingly or intentionally submitted incomplete or false data, the
2207		-	commissioner shall issue a written order directing such licensed
2208		-	ambulance service, certified ambulance service or paramedic intercept
2209		-	service to comply with the provisions of subparagraph (A) of this
2210		-	subdivision and submit all missing data or such corrected data as the
2211		-	commissioner may require. If such licensed ambulance service, certified
2212		-	ambulance service or paramedic intercept service fails to fully comply
2213		-	with such order not later than three months from the date such order is
2214		-	issued, the commissioner (i) shall conduct a hearing, in accordance with
2215		-	chapter 54, at which such licensed ambulance service, certified
2216		-	ambulance service or paramedic intercept service shall be required to
2217		-	show cause why the primary service area assignment of such licensed
2218		-	ambulance service, certified ambulance service or paramedic intercept
2219		-	service should not be revoked, and (ii) may take such disciplinary action
2220		-	under section 19a-17 as the commissioner deems appropriate.
2221		-	(D) The commissioner shall collect the data required by
2222		-	subparagraph (A) of this subdivision, in the manner provided in said
2223		-	subparagraph, from each emergency medical service organization
2224		-	licensed or certified pursuant to this chapter. Any such emergency
2225		-	medical service organization that fails to comply with the provisions of
2226		-	this section shall be liable for a civil penalty not to exceed one hundred
2227		-	dollars per day for each failure to report the required data regarding
2228		-	emergency medical services provided to a patient, as determined by the
2229		-	commissioner. The civil penalties set forth in this subparagraph shall be
2230		-	assessed only after the department provides a written notice of
2231		-	deficiency and the organization is afforded the opportunity to respond
2232		-	to such notice. An organization shall have not more than fifteen business
2233		-	days after the date of receiving such notice to provide a written response
2234		-	to the department. The commissioner may adopt regulations, in
2235		-	accordance with chapter 54, concerning the development, Substitute Senate Bill No. 9
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2236	1652
2237		-	Public Act No. 23-97 72 of 80
	1653	+	Sec. 20. (NEW) (Effective July 1, 2023) The Commissioner of Public 1353
	1654	+	Health shall require each person applying for licensure as a physical 1354
	1655	+	therapist to submit to a state and national fingerprint-based criminal 1355
	1656	+	history records check pursuant to section 29-17a of the general statutes. 1356
	1657	+	For the purposes of this section, "physical therapist" means an 1357
	1658	+	individual licensed for the independent practice of physical therapy, 1358
	1659	+	and "licensure" means authorization by a state physical therapy 1359
	1660	+	regulatory authority to engage in the independent practice of physical 1360
	1661	+	therapy, the practice of which would be unlawful without such 1361
	1662	+	authorization. 1362
	1663	+	Sec. 21. (Effective July 1, 2023) (a) The Commissioner of Public Health 1363
	1664	+	shall establish a podiatric scope of practice working group to advise the 1364
	1665	+	Department of Public Health and any relevant scope of practice review 1365
	1666	+	committee established pursuant to section 19a-16e of the general 1366
	1667	+	statutes regarding the scope of practice of podiatrists as it relates to 1367
	1668	+	surgical procedures. The working group shall consist of not less than 1368
	1669	+	three podiatrists licensed pursuant to chapter 375 of the general statutes 1369
	1670	+	and not less than three orthopedic surgeons licensed pursuant to 1370
	1671	+	chapter 370 of the general statutes appointed by the commissioner. Not 1371
	1672	+	later than January 1, 2024, the working group shall report to the 1372
	1673	+	commissioner and any such scope of practice review committee 1373
	1674	+	regarding its findings and recommendations. 1374
	1675	+	(b) Not later than February 1, 2024, the Commissioner of Public 1375
	1676	+	Health shall report, in accordance with the provisions of section 11-4a 1376
	1677	+	of the general statutes, to the joint standing committee of the General 1377
	1678	+	Assembly having cognizance of matters relating to public health on the 1378
	1679	+	findings and recommendations of the working group and whether the 1379
	1680	+	Department of Public Health and any relevant scope of practice review 1380
	1681	+	committee is in agreement with such findings and recommendations. 1381
	1682	+	Sec. 22. Section 20-94a of the general statutes is repealed and the 1382
	1683	+	following is substituted in lieu thereof (Effective October 1, 2023): 1383
	1684	+	(a) The Department of Public Health may issue an advanced practice 1384 Substitute Bill No. 9
2238	1685
2239		-	implementation, monitoring and collection of emergency medical
2240		-	service system data. All state agencies licensed or certified as emergency
2241		-	medical service organizations shall be exempt from the civil penalties
2242		-	set forth in this subparagraph.
2243		-	(E) The commissioner shall, with the recommendation of the
2244		-	Connecticut Emergency Medical Services Advisory Board established
2245		-	pursuant to section 19a-178a, adopt for use in trauma data collection the
2246		-	most recent version of the National Trauma Data Bank's National
2247		-	Trauma Data Standards and Data Dictionary and nationally recognized
2248		-	guidelines for field triage of injured patients.
2249		-	(F) On or before June 1, 2024, and annually thereafter, the
2250		-	commissioner shall submit the report described in subparagraph (B) of
2251		-	this subdivision, in accordance with the provisions of section 11-4a, to
2252		-	the joint standing committee of the General Assembly having
2253		-	cognizance of matters relating to public health;
2254		-	Sec. 37. (Effective from passage) (a) There is established a task force to
2255		-	study issues concerning rural health. Such study shall include, but need
2256		-	not be limited to, an examination of resources and services available to
2257		-	promote rural health and support health care providers in rural areas
2258		-	throughout the state and methods for coordinating and streamlining
2259		-	such resources and services.
2260		-	(b) The task force shall consist of the following members:
2261		-	(1) One appointed by the speaker of the House of Representatives;
2262		-	(2) One appointed by the president pro tempore of the Senate;
2263		-	(3) One appointed by the majority leader of the House of
2264		-	Representatives;
2265		-	(4) One appointed by the majority leader of the Senate; Substitute Senate Bill No. 9
2266	1686
2267		-	Public Act No. 23-97 73 of 80
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2268	1690
2269		-	(5) One appointed by the minority leader of the House of
2270		-	Representatives;
2271		-	(6) One appointed by the minority leader of the Senate;
2272		-	(7) One each appointed by the chairpersons of the joint standing
2273		-	committee of the General Assembly having cognizance of matters
2274		-	relating to public health;
2275		-	(8) One each appointed by the ranking members of the joint standing
2276		-	committee of the General Assembly having cognizance of matters
2277		-	relating to public health;
2278		-	(9) The Commissioner of Public Health, or the commissioner's
2279		-	designee;
2280		-	(10) The Commissioner of Mental Health and Addiction Services, or
2281		-	the commissioner's designee;
2282		-	(11) The Attorney General, or the Attorney General's designee;
2283		-	(12) The State Comptroller, or the State Comptroller's designee; and
2284		-	(13) The executive director of the Office of Health Strategy, or the
2285		-	executive director's designee.
2286		-	(c) Any member of the task force appointed under subdivision (1),
2287		-	(2), (3), (4), (5), (6), (7) or (8) of subsection (b) of this section may be a
2288		-	member of the General Assembly.
2289		-	(d) All initial appointments to the task force shall be made not later
2290		-	than thirty days after the effective date of this section. Any vacancy shall
2291		-	be filled by the appointing authority.
2292		-	(e) The speaker of the House of Representatives and the president pro
2293		-	tempore of the Senate shall select the chairpersons of the task force from Substitute Senate Bill No. 9
	1691	+	registered nurse license to a person seeking to perform the activities 1385
	1692	+	described in subsection (b) of section 20-87a, upon receipt of a fee of two 1386
	1693	+	hundred dollars, to an applicant who: (1) Maintains a license as a 1387
	1694	+	registered nurse in this state, as provided by section 20-93 or 20-94; (2) 1388
	1695	+	holds and maintains current certification as a nurse practitioner, a 1389
	1696	+	clinical nurse specialist or a nurse anesthetist from one of the following 1390
	1697	+	national certifying bodies that certify nurses in advanced practice: The 1391
	1698	+	American Nurses' Association, the Nurses' Association of the American 1392
	1699	+	College of Obstetricians and Gynecologists Certification Corporation, 1393
	1700	+	the National Board of Pediatric Nurse Practitioners and Associates or 1394
	1701	+	the American Association of Nurse Anesthetists, their successors or 1395
	1702	+	other appropriate national certifying bodies approved by the Board of 1396
	1703	+	Examiners for Nursing; (3) has completed thirty hours of education in 1397
	1704	+	pharmacology for advanced nursing practice; and (4) (A) holds a 1398
	1705	+	graduate degree in nursing or in a related field recognized for 1399
	1706	+	certification as either a nurse practitioner, a clinical nurse specialist, or a 1400
	1707	+	nurse anesthetist by one of the foregoing certifying bodies, or (B) (i) on 1401
	1708	+	or before December 31, 2004, completed an advanced nurse practitioner 1402
	1709	+	program that a national certifying body identified in subdivision (2) of 1403
	1710	+	subsection (a) of this section recognized for certification of a nurse 1404
	1711	+	practitioner, clinical nurse specialist, or nurse anesthetist, and (ii) at the 1405
	1712	+	time of application, holds a current license as an advanced practice 1406
	1713	+	registered nurse in another state that requires a master's degree in 1407
	1714	+	nursing or a related field for such licensure. No license shall be issued 1408
	1715	+	under this section to any applicant against whom professional 1409
	1716	+	disciplinary action is pending or who is the subject of an unresolved 1410
	1717	+	complaint. 1411
	1718	+	(b) During the period commencing January 1, 1990, and ending 1412
	1719	+	January 1, 1992, the Department of Public Health may in its discretion 1413
	1720	+	allow a registered nurse, who has been practicing as an advanced 1414
	1721	+	practice registered nurse in a nurse practitioner role and who is unable 1415
	1722	+	to obtain certification as a nurse practitioner by one of the national 1416
	1723	+	certifying bodies specified in subsection (a) of this section, to be licensed 1417
	1724	+	as an advanced practice registered nurse provided the individual: 1418 Substitute Bill No. 9
2294	1725
2295		-	Public Act No. 23-97 74 of 80
2296	1726
2297		-	among the members of the task force. Such chairpersons shall schedule
2298		-	the first meeting of the task force, which shall be held not later than sixty
2299		-	days after the effective date of this section.
2300		-	(f) The administrative staff of the joint standing committee of the
2301		-	General Assembly having cognizance of matters relating to public
2302		-	health shall serve as administrative staff of the task force.
2303		-	(g) Not later than January 1, 2024, the task force shall submit a report
2304		-	on its findings and recommendations to the joint standing committee of
2305		-	the General Assembly having cognizance of matters relating to public
2306		-	health, in accordance with the provisions of section 11-4a of the general
2307		-	statutes. The task force shall terminate on the date that it submits such
2308		-	report or January 1, 2024, whichever is later.
2309		-	Sec. 38. (Effective from passage) The Commissioner of Education, in
2310		-	consultation with the Labor Commissioner and Commissioner of Public
2311		-	Health, shall study the feasibility of establishing an interdistrict magnet
2312		-	school program that provides education and training to students
2313		-	interested in health care professions. The program shall provide
2314		-	pathways for a student to (1) graduate with a certification, license or
2315		-	registration that enables such student to practice in a health care field
2316		-	upon graduation from the program, and (2) complete a curriculum
2317		-	designed to prepare such student for higher education in premedicine
2318		-	or nursing. Not later than February 1, 2024, the Commissioner of
2319		-	Education shall report, in accordance with the provisions of section 11-
2320		-	4a of the general statutes, to the joint standing committee of the General
2321		-	Assembly having cognizance of matters relating to public health
2322		-	regarding the results of such study.
2323		-	Sec. 39. (Effective from passage) The Commissioner of Aging and
2324		-	Disability Services, in consultation with the Advisory Board for Persons
2325		-	Who are Deaf, Hard of Hearing or Deafblind, shall conduct a study to
2326		-	evaluate gaps in communication access for deaf, hard of hearing or Substitute Senate Bill No. 9
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2327	1730
2328		-	Public Act No. 23-97 75 of 80
	1731	+	(1) Holds a current Connecticut license as a registered nurse pursuant 1419
	1732	+	to this chapter; 1420
	1733	+	(2) Presents the department with documentation of the reasons one 1421
	1734	+	of such national certifying bodies will not certify him as a nurse 1422
	1735	+	practitioner; 1423
	1736	+	(3) Has been in active practice as a nurse practitioner for at least five 1424
	1737	+	years in a facility licensed pursuant to section 19a-491; 1425
	1738	+	(4) Provides the department with documentation of his preparation 1426
	1739	+	as a nurse practitioner; 1427
	1740	+	(5) Provides the department with evidence of at least seventy-five 1428
	1741	+	contact hours, or its equivalent, of continuing education related to his 1429
	1742	+	nurse practitioner specialty in the preceding five calendar years; 1430
	1743	+	(6) Has completed thirty hours of education in pharmacology for 1431
	1744	+	advanced nursing practice; 1432
	1745	+	(7) Has his employer provide the department with a description of 1433
	1746	+	his practice setting, job description, and a plan for supervision by a 1434
	1747	+	licensed physician; 1435
	1748	+	(8) Notifies the department of each change of employment to a new 1436
	1749	+	setting where he will function as an advanced practice registered nurse 1437
	1750	+	and will be exercising prescriptive and dispensing privileges. 1438
	1751	+	(c) Any person who obtains a license pursuant to subsection (b) of 1439
	1752	+	this section shall be eligible to renew such license annually provided he 1440
	1753	+	presents the department with evidence that he received at least fifteen 1441
	1754	+	contact hours, or its equivalent, eight hours of which shall be in 1442
	1755	+	pharmacology, of continuing education related to his nurse practitioner 1443
	1756	+	specialty in the preceding licensure year. If an individual licensed 1444
	1757	+	pursuant to subsection (b) of this subsection becomes eligible at any 1445
	1758	+	time for certification as a nurse practitioner by one of the national 1446
	1759	+	certifying bodies specified in subsection (a) of this section, the 1447 Substitute Bill No. 9
2329	1760
2330		-	deafblind persons to medical providers and develop recommendations
2331		-	for improved access, including, but not limited to, interpreting through
2332		-	American Sign Language for such persons and through Spanish Sign
2333		-	Language for such persons whose primary language is Spanish. Not
2334		-	later than October 1, 2023, the commissioner shall report, in accordance
2335		-	with the provisions of section 11-4a of the general statutes, to the joint
2336		-	standing committees of the General Assembly having cognizance of
2337		-	matters relating to aging, human services and public health on such
2338		-	study.
2339		-	Sec. 40. Subdivision (1) of subsection (c) of section 20-112a of the
2340		-	general statutes is repealed and the following is substituted in lieu
2341		-	thereof (Effective October 1, 2023):
2342		-	(c) (1) A licensed dentist may delegate to dental assistants such dental
2343		-	procedures as the dentist may deem advisable, including: (A) The taking
2344		-	of dental x-rays if the dental assistant can demonstrate successful
2345		-	completion of the dental radiation health and safety examination
2346		-	administered by the Dental Assisting National Board or a radiation
2347		-	health and safety competency assessment administered by a dental
2348		-	education program in the state that is accredited by the American Dental
2349		-	Association's Commission on Dental Accreditation; (B) the taking of
2350		-	impressions of teeth for study models; and (C) the provision of fluoride
2351		-	varnish treatments. Such procedures shall be performed under the
2352		-	direct supervision of a licensed dentist and the dentist providing direct
2353		-	supervision shall assume responsibility for such procedures.
2354		-	Sec. 41. (Effective from passage) On or before January 1, 2025, The
2355		-	University of Connecticut School of Dental Medicine shall develop a
2356		-	radiation health and safety competency assessment for dental assistants
2357		-	that reflects current industry practices regarding the taking of dental x-
2358		-	rays. Such assessment shall be a suitable competency evaluation, the
2359		-	successful completion of which would allow a dental assistant to take
2360		-	dental x-rays under the direct supervision of a licensed dentist pursuant Substitute Senate Bill No. 9
2361	1761
2362		-	Public Act No. 23-97 76 of 80
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2363	1765
2364		-	~~to the provisions of subdivision (1) of subsection (c) of section 20-112a~~
2365		-	of the ~~general statutes,~~ as ~~amended by this act.~~ ~~Not later than January 1,~~
2366		-	~~2025, The University~~ of ~~Connecticut School of Dental Medicine shall~~
2367		-	~~report~~, ~~in accordance with the provisions of section 11-4a~~ ~~of the general~~
2368		-	~~statutes, to the joint standing committee~~ of ~~the General Assembly~~
2369		-	~~having cognizance of matters relating to public health regarding the~~
2370		-	~~development~~ of ~~such assessment.~~
2371		-	~~Sec. 42.~~ ~~Section 19a-197a~~ of ~~the general statutes is repealed and the~~
2372		-	~~following is substituted in lieu thereof (Effective October 1~~, ~~2023):~~
2373		-	(a~~) As used~~ in ~~this section,~~ ~~["emergency medical technician"]~~
2374		-	~~"emergency medical services personnel"~~ ~~means (1) any class of~~
2375		-	~~emergency medical technician certified [under~~ ~~regulations adopted~~
2376		-	~~pursuant to section 20-206oo] pursuant to sections 20-206ll~~ ~~and 20-~~
2377		-	~~206mm~~, ~~including, but not limited~~ to~~, any advanced emergency medical~~
2378		-	~~technician, [and] (2) any paramedic licensed pursuant to [section]~~
2379		-	~~sections 20-206ll and 20-206mm, and~~ (3) ~~any emergency medical~~
2380		-	~~responder certified pursuant to sections 20-206ll~~ and ~~20-206mm.~~
2381		-	~~(b) Any emergency medical [technician] services personnel who has~~
2382		-	~~been trained, in accordance with national standards recognized by~~ the
2383		-	~~Commissioner of Public Health,~~ ~~in the administration of epinephrine~~
2384		-	~~using automatic prefilled cartridge injectors,~~ ~~[or] similar automatic~~
2385		-	~~injectable equipment or by prefilled vial and syringe and who functions~~
2386		-	~~in accordance with written protocols and~~ the ~~standing orders~~ of a
2387		-	~~licensed physician serving as an emergency department director [may]~~
2388		-	shall ~~administer epinephrine using such injectors, [or] equipment or~~
2389		-	~~prefilled vial and syringe when~~ the ~~use of epinephrine is deemed~~
2390		-	~~necessary by the emergency medical services personnel for the~~
2391		-	~~treatment of a patient~~. ~~All emergency medical [technicians] services~~
2392		-	~~personnel~~ shall ~~receive such training from an organization designated~~
2393		-	by the ~~commissioner. All licensed or certified ambulances shall be~~
2394		-	~~equipped with epinephrine in~~ such ~~injectors, [or] equipment [which~~ Substitute ~~Senate~~ Bill No. 9
	1766	+	individual shall apply for certification, and upon certification so notify 1448
	1767	+	the department, and apply to be licensed as an advanced practice 1449
	1768	+	registered nurse in accordance with subsection (a) of this section. 1450
	1769	+	(d) On and after October 1, 2023, a person, who is not eligible for 1451
	1770	+	licensure under subsection (a) of this section, may apply for licensure by 1452
	1771	+	endorsement as an advanced practice registered nurse. Such applicant 1453
	1772	+	shall (1) present evidence satisfactory to the Commissioner of Public 1454
	1773	+	Health that the applicant has acquired three years of experience as an 1455
	1774	+	advanced practice registered nurse, or as a person entitled to perform 1456
	1775	+	similar services under a different designation, in another state or 1457
	1776	+	jurisdiction that has requirements for practicing in such capacity that are 1458
	1777	+	substantially similar to, or higher than, those of this state and that there 1459
	1778	+	are no disciplinary actions or unresolved complaints pending against 1460
	1779	+	such person, and (2) pay a fee of two hundred dollars to the 1461
	1780	+	commissioner. 1462
	1781	+	[(d)] (e) A person who has received a license pursuant to this section 1463
	1782	+	shall be known as an "Advanced Practice Registered Nurse" and no 1464
	1783	+	other person shall assume such title or use the letters or figures which 1465
	1784	+	indicate that the person using the same is a licensed advanced practice 1466
	1785	+	registered nurse. 1467
	1786	+	Sec. 23. Section 10a-19l of the general statutes is repealed and the 1468
	1787	+	following is substituted in lieu thereof (Effective July 1, 2023): 1469
	1788	+	(a) Not later than January 1, 2023, the Office of Higher Education shall 1470
	1789	+	establish a health care provider loan reimbursement program. The 1471
	1790	+	health care provider loan reimbursement program shall provide loan 1472
	1791	+	reimbursement grants to health care providers licensed by the 1473
	1792	+	Department of Public Health who are employed full-time as a health 1474
	1793	+	care provider in the state. 1475
	1794	+	(b) The executive director of the Office of Higher Education shall (1) 1476
	1795	+	develop, in consultation with the Department of Public Health, 1477
	1796	+	eligibility requirements for recipients of such loan reimbursement 1478 Substitute Bill No. 9
2395	1797
2396		-	Public Act No. 23-97 77 of 80
2397	1798
2398		-	may be administered] or prefilled vials and syringes that the emergency
2399		-	medical services personnel shall administer in accordance with written
2400		-	protocols and standing orders of a licensed physician serving as an
2401		-	emergency department director.
2402		-	Sec. 43. (NEW) (Effective January 1, 2024) (a) Each institution, as
2403		-	defined in section 19a-490 of the general statutes, except a facility
2404		-	operated by the Department of Mental Health and Addiction Services
2405		-	and the hospital and psychiatric residential treatment facility units of
2406		-	the Albert J. Solnit Children's Center, shall, upon receipt of a medical
2407		-	records request directed by the patient or the patient's representative,
2408		-	provide an electronic copy of such patient's medical records to another
2409		-	such institution (1) as soon as feasible, but not later than six days after
2410		-	such request is received by the institution, if such request is urgent, or
2411		-	(2) not later than seven business days after such request is received, if
2412		-	such request is not urgent. Notwithstanding any other provision of the
2413		-	general statutes, an institution providing an electronic copy of a
2414		-	patient's medical records pursuant to the provisions of this section shall
2415		-	not be required to obtain specific written consent from such patient
2416		-	before providing such electronic copy.
2417		-	(b) The provisions of subsection (a) of this section shall not be
2418		-	construed to require an institution to provide records (1) in violation of
2419		-	the Health Insurance Portability and Accountability Act of 1996, P.L.
2420		-	104-191, as amended from time to time, or 45 CFR 160.101 to 45 CFR
2421		-	164.534, inclusive, as amended from time to time, (2) in response to a
2422		-	direct request from another health care provider, unless such provider
2423		-	can validate that such provider has a health provider relationship with
2424		-	the patient whose records are being requested, or (3) in response to a
2425		-	third-party request.
2426		-	Sec. 44. (Effective from passage) (a) There is established a task force to
2427		-	study methods to address the shortage of radiologic technologists,
2428		-	nuclear medicine technologists and respiratory care practitioners in the Substitute Senate Bill No. 9
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2429	1802
2430		-	Public Act No. 23-97 78 of 80
	1803	+	grants, which requirements may include, but need not be limited to, 1479
	1804	+	income guidelines, [and] (2) award at least twenty per cent of such loan 1480
	1805	+	reimbursement grants to graduates of a regional community-technical 1481
	1806	+	college, and (3) award at least ten per cent of such loan reimbursement 1482
	1807	+	grants to persons employed full-time as health care providers in a rural 1483
	1808	+	community in the state. The executive director shall consider health care 1484
	1809	+	workforce shortage areas when developing such eligibility 1485
	1810	+	requirements. A person who qualifies for a loan reimbursement grant 1486
	1811	+	shall be reimbursed on an annual basis for qualifying student loan 1487
	1812	+	payments in amounts determined by the executive director. A health 1488
	1813	+	care provider shall only be reimbursed for loan payments made while 1489
	1814	+	such person is employed full-time in the state as a health care provider. 1490
	1815	+	Persons may apply for loan reimbursement grants to the Office of 1491
	1816	+	Higher Education at such time and in such manner as the executive 1492
	1817	+	director prescribes. 1493
	1818	+	(c) The Office of Higher Education may accept gifts, grants and 1494
	1819	+	donations, from any source, public or private, for the health care 1495
	1820	+	provider loan reimbursement program. 1496
	1821	+	Sec. 24. (NEW) (Effective July 1, 2023) Not later than January 1, 2024, 1497
	1822	+	the owner or operator of each splash pad and spray park where water 1498
	1823	+	is recirculated shall post a sign in a conspicuous location at or near the 1499
	1824	+	entryway to the splash pad or spray park stating that the water is 1500
	1825	+	recirculated and warning that there is a potential health risk to persons 1501
	1826	+	ingesting the water. 1502
	1827	+	This act shall take effect as follows and shall amend the following
	1828	+	sections:
2431	1829
2432		-	state and develop a plan to address such shortage.
2433		-	(b) The task force shall consist of the following members:
2434		-	(1) One appointed by the speaker of the House of Representatives,
2435		-	who has expertise in the radiologic technologist profession and is a
2436		-	representative of a state-wide association of radiologic technologists;
2437		-	(2) One appointed by the president pro tempore of the Senate, who
2438		-	has expertise in the nuclear medicine technologists profession and is a
2439		-	representative of a state-wide association of nuclear medicine
2440		-	technologists;
2441		-	(3) One appointed by the majority leader of the House of
2442		-	Representatives, who has expertise in the respiratory care practitioners
2443		-	profession and is a representative of a state-wide association of
2444		-	respiratory care practitioners;
2445		-	(4) One appointed by the majority leader of the Senate, who is a
2446		-	representative of an association of hospitals in the state;
2447		-	(5) One appointed by the minority leader of the House of
2448		-	Representatives, who is a representative of a society of radiologists in
2449		-	the state;
2450		-	(6) One appointed by the minority leader of the Senate, who has
2451		-	expertise in pulmonary issues and is a representative of a medical
2452		-	society in the state; and
2453		-	(7) The chairpersons and ranking members of the joint standing
2454		-	committee of the General Assembly having cognizance of matters
2455		-	relating to public health, or the chairpersons' and ranking members'
2456		-	designees.
2457		-	(c) Any member of the task force appointed under subsection (b) of
2458		-	this section may be a member of the General Assembly. Substitute Senate Bill No. 9
	1830	+	Section 1 from passage New section
	1831	+	Sec. 2 July 1, 2023 New section
	1832	+	Sec. 3 from passage New section
	1833	+	Sec. 4 from passage New section
	1834	+	Sec. 5 October 1, 2023 New section
	1835	+	Sec. 6 October 1, 2023 20-14o
	1836	+	Sec. 7 July 1, 2023 New section Substitute Bill No. 9
2459	1837
2460		-	Public Act No. 23-97 79 of 80
2461	1838
2462		-	(d) All initial appointments to the task force shall be made not later
2463		-	than thirty days after the effective date of this section. Any vacancy shall
2464		-	be filled by the appointing authority.
2465		-	(e) The speaker of the House of Representatives and the president pro
2466		-	tempore of the Senate shall select the chairpersons of the task force from
2467		-	among the members of the task force. Such chairpersons shall schedule
2468		-	the first meeting of the task force, which shall be held not later than sixty
2469		-	days after the effective date of this section.
2470		-	(f) The administrative staff of the joint standing committee of the
2471		-	General Assembly having cognizance of matters relating to public
2472		-	health shall serve as administrative staff of the task force.
2473		-	(g) Not later than January 1, 2024, the task force shall submit a report
2474		-	on its findings and recommendations to the joint standing committee of
2475		-	the General Assembly having cognizance of matters relating to public
2476		-	health, in accordance with the provisions of section 11-4a of the general
2477		-	statutes. The task force shall terminate on the date that it submits such
2478		-	report or January 1, 2024, whichever is later.
2479		-	Sec. 45. (NEW) (Effective July 1, 2023) The Commissioner of Public
2480		-	Health shall require each person applying for licensure as a physician
2481		-	under section 20-13 of the general statutes, who indicates an intention
2482		-	to apply for a license in one or more other states not later than one year
2483		-	after the date of such person's application for licensure, to submit to a
2484		-	state and national fingerprint-based criminal history records check by
2485		-	the Department of Emergency Services and Public Protection. The
2486		-	Commissioner of Emergency Services and Public Protection shall report
2487		-	the results of each such criminal history records check to the
2488		-	Commissioner of Public Health pursuant to the provisions of section 29-
2489		-	17a of the general statutes.
2490		-	Sec. 46. (NEW) (Effective July 1, 2023) The Commissioner of Public Substitute Senate Bill No. 9
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2491	1842
2492		-	Public Act No. 23-97 80 of 80
	1843	+	Sec. 8 July 1, 2023 20-633d(a)
	1844	+	Sec. 9 July 1, 2023 New section
	1845	+	Sec. 10 from passage New section
	1846	+	Sec. 11 July 1, 2023 New section
	1847	+	Sec. 12 July 1, 2023 New section
	1848	+	Sec. 13 July 1, 2023 New section
	1849	+	Sec. 14 July 1, 2023 New section
	1850	+	Sec. 15 October 1, 2023 New section
	1851	+	Sec. 16 July 1, 2023 20-14p
	1852	+	Sec. 17 July 1, 2023 New section
	1853	+	Sec. 18 from passage New section
	1854	+	Sec. 19 July 1, 2023 New section
	1855	+	Sec. 20 July 1, 2023 New section
	1856	+	Sec. 21 July 1, 2023 New section
	1857	+	Sec. 22 October 1, 2023 20-94a
	1858	+	Sec. 23 July 1, 2023 10a-19l
	1859	+	Sec. 24 July 1, 2023 New section
2493	1860
2494		-	Health shall require each person applying for licensure as a psychologist
2495		-	to submit to a state and national fingerprint-based criminal history
2496		-	records check pursuant to section 29-17a of the general statutes. For the
2497		-	purposes of this section, "psychologist" means an individual licensed for
2498		-	the independent practice of psychology and "licensure" means
2499		-	authorization by a state psychology regulatory authority to engage in
2500		-	the independent practice of psychology, the practice of which would be
2501		-	unlawful without such authorization.
	1861	+
	1862	+	PH Joint Favorable Subst.
	1863	+	APP Joint Favorable
2502	1864