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General Assembly Substitute Bill No. 986
January Session, 2023
AN ACT PROTECTING MATERNAL HEALTH.
Be it enacted by the Senate and House of Representatives in General
Assembly convened:
Section 1. Section 19a-490 of the general statutes is repealed and the 1
following is substituted in lieu thereof (Effective January 1, 2024): 2
As used in this chapter, unless the context otherwise requires: 3
(a) "Institution" means a hospital, short-term hospital special hospice, 4
hospice inpatient facility, residential care home, nursing home facility, 5
home health care agency, home health aide agency, behavioral health 6
facility, assisted living services agency, substance abuse treatment 7
facility, outpatient surgical facility, outpatient clinic, clinical laboratory, 8
birth center, an infirmary operated by an educational institution for the 9
care of students enrolled in, and faculty and employees of, such 10
institution; a facility engaged in providing services for the prevention, 11
diagnosis, treatment or care of human health conditions, including 12
facilities operated and maintained by any state agency; and a residential 13
facility for persons with intellectual disability licensed pursuant to 14
section 17a-227 and certified to participate in the Title XIX Medicaid 15
program as an intermediate care facility for individuals with intellectual 16
disability. "Institution" does not include any facility for the care and 17
treatment of persons with mental illness or substance use disorder 18 Substitute Bill No. 986
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operated or maintained by any state agency, except Whiting Forensic 19
Hospital and the hospital and psychiatric residential treatment facility 20
units of the Albert J. Solnit Children's Center; 21
(b) "Hospital" means an establishment for the lodging, care and 22
treatment of persons suffering from disease or other abnormal physical 23
or mental conditions and includes inpatient psychiatric services in 24
general hospitals; 25
(c) "Residential care home" or "rest home" means a community 26
residence that furnishes, in single or multiple facilities, food and shelter 27
to two or more persons unrelated to the proprietor and, in addition, 28
provides services that meet a need beyond the basic provisions of food, 29
shelter and laundry and may qualify as a setting that allows residents to 30
receive home and community-based services funded by state and 31
federal programs; 32
(d) "Home health care agency" means a public or private 33
organization, or a subdivision thereof, engaged in providing 34
professional nursing services and the following services, available 35
twenty-four hours per day, in the patient's home or a substantially 36
equivalent environment: Home health aide services as defined in this 37
section, physical therapy, speech therapy, occupational therapy or 38
medical social services. The agency shall provide professional nursing 39
services and at least one additional service directly and all others 40
directly or through contract. An agency shall be available to enroll new 41
patients seven days a week, twenty-four hours per day; 42
(e) "Home health aide agency" means a public or private 43
organization, except a home health care agency, which provides in the 44
patient's home or a substantially equivalent environment supportive 45
services which may include, but are not limited to, assistance with 46
personal hygiene, dressing, feeding and incidental household tasks 47
essential to achieving adequate household and family management. 48
Such supportive services shall be provided under the supervision of a 49
registered nurse and, if such nurse determines appropriate, shall be 50 Substitute Bill No. 986
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provided by a social worker, physical therapist, speech therapist or 51
occupational therapist. Such supervision may be provided directly or 52
through contract; 53
(f) "Home health aide services" as defined in this section shall not 54
include services provided to assist individuals with activities of daily 55
living when such individuals have a disease or condition that is chronic 56
and stable as determined by a physician licensed in the state; 57
(g) "Behavioral health facility" means any facility that provides 58
mental health services to persons eighteen years of age or older or 59
substance use disorder services to persons of any age in an outpatient 60
treatment or residential setting to ameliorate mental, emotional, 61
behavioral or substance use disorder issues; 62
(h) "Clinical laboratory" means any facility or other area used for 63
microbiological, serological, chemical, hematological, 64
immunohematological, biophysical, cytological, pathological or other 65
examinations of human body fluids, secretions, excretions or excised or 66
exfoliated tissues for the purpose of providing information for the (1) 67
diagnosis, prevention or treatment of any human disease or 68
impairment, (2) assessment of human health, or (3) assessment of the 69
presence of drugs, poisons or other toxicological substances; 70
(i) "Person" means any individual, firm, partnership, corporation, 71
limited liability company or association; 72
(j) "Commissioner" means the Commissioner of Public Health or the 73
commissioner's designee; 74
(k) "Home health agency" means an agency licensed as a home health 75
care agency or a home health aide agency; 76
(l) "Assisted living services agency" means an agency that provides, 77
among other things, nursing services and assistance with activities of 78
daily living to a population that is chronic and stable and may have a 79
dementia special care unit or program as defined in section 19a-562; 80 Substitute Bill No. 986
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(m) "Outpatient clinic" means an organization operated by a 81
municipality or a corporation, other than a hospital, that provides (1) 82
ambulatory medical care, including preventive and health promotion 83
services, (2) dental care, or (3) mental health services in conjunction with 84
medical or dental care for the purpose of diagnosing or treating a health 85
condition that does not require the patient's overnight care; 86
(n) "Multicare institution" means a hospital that provides outpatient 87
behavioral health services or other health care services, psychiatric 88
outpatient clinic for adults, free-standing facility for the care or 89
treatment of substance abusive or dependent persons, hospital for 90
psychiatric disabilities, as defined in section 17a-495, or a general acute 91
care hospital that provides outpatient behavioral health services that (1) 92
is licensed in accordance with this chapter, (2) has more than one facility 93
or one or more satellite units owned and operated by a single licensee, 94
and (3) offers complex patient health care services at each facility or 95
satellite unit. For purposes of this subsection, "satellite unit" means a 96
location where a segregated unit of services is provided by the multicare 97
institution; 98
(o) "Nursing home" or "nursing home facility" means (1) any chronic 99
and convalescent nursing home or any rest home with nursing 100
supervision that provides nursing supervision under a medical director 101
twenty-four hours per day, or (2) any chronic and convalescent nursing 102
home that provides skilled nursing care under medical supervision and 103
direction to carry out nonsurgical treatment and dietary procedures for 104
chronic diseases, convalescent stages, acute diseases or injuries; 105
(p) "Outpatient dialysis unit" means (1) an out-of-hospital out-patient 106
dialysis unit that is licensed by the department to provide (A) services 107
on an out-patient basis to persons requiring dialysis on a short-term 108
basis or for a chronic condition, or (B) training for home dialysis, or (2) 109
an in-hospital dialysis unit that is a special unit of a licensed hospital 110
designed, equipped and staffed to (A) offer dialysis therapy on an out-111
patient basis, (B) provide training for home dialysis, and (C) perform 112
renal transplantations; 113 Substitute Bill No. 986
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(q) "Hospice agency" means a public or private organization that 114
provides home care and hospice services to terminally ill patients; 115
(r) "Psychiatric residential treatment facility" means a nonhospital 116
facility with a provider agreement with the Department of Social 117
Services to provide inpatient services to Medicaid-eligible individuals 118
under the age of twenty-one; [and] 119
(s) "Chronic disease hospital" means a long-term hospital having 120
facilities, medical staff and all necessary personnel for the diagnosis, 121
care and treatment of chronic diseases; and 122
(t) "Birth center" means a freestanding facility that is licensed by the 123
department (1) to provide prenatal, labor, delivery and postpartum care 124
during and immediately after delivery to persons presenting with a low-125
risk pregnancy and healthy newborns for a period typically less than 126
twenty-four hours, and (2) that is not a hospital licensed pursuant to the 127
provisions of this chapter, or attached to or located in such a hospital. 128
For the purposes of this subsection, "low-risk pregnancy" means an 129
uncomplicated, singleton pregnancy that has vertex presentation and is 130
at low risk for developing complications during labor and birth, as 131
determined by an evaluation and examination conducted by a licensed 132
physician or other licensed practitioner acting within the scope of such 133
practitioner's practice. 134
Sec. 2. (NEW) (Effective October 1, 2023) (a) On and after January 1, 135
2024, no person, entity, firm, partnership, corporation, limited liability 136
company or association shall establish, conduct, operate or maintain a 137
birth center, as defined in section 19a-490 of the general statutes, as 138
amended by this act, in this state without obtaining a license in 139
accordance with the provisions of chapter 368v of the general statutes. 140
An outpatient clinic shall not provide any birth center services without 141
being licensed as a birth center pursuant to the provisions of chapter 142
368v of the general statutes. For the purposes of this subsection, "birth 143
center services" means prenatal, labor, delivery and postpartum care 144
during and immediately after delivery to persons presenting with a low-145 Substitute Bill No. 986
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risk pregnancy and healthy newborns for a period typically less than 146
twenty-four hours and "low-risk pregnancy" has the same meaning as 147
provided in subsection (t) of section 19a-490 of the general statutes, as 148
amended by this act. 149
(b) Each applicant for licensure as a birth center shall be accredited 150
by the Commission for the Accreditation of Birth Centers at the time it 151
submits an application for licensure to the Department of Public Health 152
and maintain such accreditation during the time it is licensed. If a birth 153
center loses its accreditation, the birth center shall immediately notify 154
the Commissioner of Public Health and cease providing birth center 155
services to patients until authorized by the commissioner to reinstate 156
such services. 157
(c) Each birth center shall have a written plan to obtain services from 158
a hospital, licensed pursuant to chapter 368v of the general statutes, to 159
provide obstetrical, pediatric and neonatal services in the event of an 160
emergency or other conditions that pose a risk to the health of a patient 161
that require transfer of the patient to a hospital. No hospital shall refuse 162
to enter into or terminate an agreement with a birth center for the 163
implementation of such plan without the commissioner's approval. 164
(d) The commissioner may adopt regulations, in accordance with the 165
provisions of chapter 54 of the general statutes, to implement the 166
provisions of this section and section 19a-495 of the general statutes. 167
Such regulations may include, but need not be limited to, provisions 168
regarding the administration of the facility, staffing requirements, 169
infection control protocols, physical plant requirements, 170
accommodation of the participation of support persons of the patient's 171
choice, limitations on the provision of anesthesia and surgical 172
procedures, operating procedures for determining risk status of patients 173
at admission and during labor, reportable events, medical records, 174
pharmaceutical services, laundry services and emergency planning. The 175
commissioner may implement policies and procedures necessary to 176
administer the provisions of this section while in the process of adopting 177
such policies and procedures as regulations, provided notice of intent to 178 Substitute Bill No. 986
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adopt regulations is published on the eRegulations System not later than 179
twenty days after the date of implementation. Policies and procedures 180
implemented pursuant to this subsection shall be valid until the date on 181
which final regulations are adopted. 182
Sec. 3. Subsection (c) of section 19a-491 of the general statutes is 183
repealed and the following is substituted in lieu thereof (Effective January 184
1, 2024): 185
(c) [Notwithstanding any regulation, the] The Commissioner of 186
Public Health shall charge the following fees for the biennial licensing 187
and inspection of the following institutions: (1) Chronic and 188
convalescent nursing homes, per site, four hundred forty dollars; (2) 189
chronic and convalescent nursing homes, per bed, five dollars; (3) rest 190
homes with nursing supervision, per site, four hundred forty dollars; (4) 191
rest homes with nursing supervision, per bed, five dollars; (5) outpatient 192
dialysis units and outpatient surgical facilities, six hundred twenty-five 193
dollars; (6) mental health residential facilities, per site, three hundred 194
seventy-five dollars; (7) mental health residential facilities, per bed, five 195
dollars; (8) hospitals, per site, nine hundred forty dollars; (9) hospitals, 196
per bed, seven dollars and fifty cents; (10) nonstate agency educational 197
institutions, per infirmary, one hundred fifty dollars; (11) nonstate 198
agency educational institutions, per infirmary bed, twenty-five dollars; 199
(12) home health care agencies, except certified home health care 200
agencies described in subsection (d) of this section, per agency, three 201
hundred dollars; (13) home health care agencies, hospice agencies or 202
home health aide agencies, except certified home health care agencies, 203
hospice agencies or home health aide agencies described in subsection 204
(d) of this section, per satellite patient service office, one hundred 205
dollars; (14) assisted living services agencies, except such agencies 206
participating in the congregate housing facility pilot program described 207
in section 8-119n, per site, five hundred dollars; (15) short-term hospitals 208
special hospice, per site, nine hundred forty dollars; (16) short-term 209
hospitals special hospice, per bed, seven dollars and fifty cents; (17) 210
hospice inpatient facility, per site, four hundred forty dollars; [and] (18) 211 Substitute Bill No. 986
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hospice inpatient facility, per bed, five dollars; and (19) birth centers, per 212
site, nine hundred forty dollars and, per bed, seven dollars and fifty 213
cents. 214
Sec. 4. Section 20-86b of the general statutes is repealed and the 215
following is substituted in lieu thereof (Effective January 1, 2024): 216
Nurse-midwives shall practice within a health care system or birth 217
center and have clinical relationships with obstetrician-gynecologists 218
that provide for consultation, collaborative management or referral, as 219
indicated by the health status of the patient. Nurse-midwifery care shall 220
be consistent with the standards of care established by the Accreditation 221
Commission for Midwifery Education. Each nurse-midwife shall 222
provide each patient with information regarding, or referral to, other 223
providers and services upon request of the patient or when the care 224
required by the patient is not within the midwife's scope of practice. 225
Each nurse-midwife shall sign the birth certificate of each infant 226
delivered by the nurse-midwife. If an infant is born alive and then dies 227
within the twenty-four-hour period after birth, the nurse-midwife may 228
make the actual determination and pronouncement of death provided: 229
(1) The death is an anticipated death; (2) the nurse-midwife attests to 230
such pronouncement on the certificate of death; and (3) the nurse-231
midwife or a physician licensed pursuant to chapter 370 certifies the 232
certificate of death not later than twenty-four hours after such 233
pronouncement. In a case of fetal death, as described in section 7-60, the 234
nurse-midwife who delivered the fetus may make the actual 235
determination of fetal death and certify the date of delivery and that the 236
fetus was born dead. 237
Sec. 5. Section 19a-505 of the general statutes is repealed and the 238
following is substituted in lieu thereof (Effective October 1, 2023): 239
(a) No person shall keep a maternity hospital or lying-in place unless 240
such person has previously obtained a license therefor, issued by the 241
Department of Public Health. Each such license shall be valid for a term 242
of two years and may be revoked by the Department of Public Health 243 Substitute Bill No. 986
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upon proof that the institution for which such license was issued is 244
being improperly conducted or for the violation of any of the provisions 245
of this section or of the Public Health Code, or on the basis of lack of 246
demonstrable need, provided the licensee shall be given a reasonable 247
opportunity to be heard in reference to such proposed revocation. 248
(b) Within six hours after the departure, removal or withdrawal of 249
any child born at such maternity hospital or lying-in place, the keeper 250
thereof shall make a record of such departure, removal or withdrawal 251
of such child, the names and residences of the persons who took such 252
child or its body and the place to which it was taken and where it was 253
left, which record shall be produced by the keeper or licensee of such 254
hospital or lying-in place, for inspection by and upon the demand of any 255
person authorized to make such inspection by the Department of Public 256
Health or the council. Each keeper of any such hospital or lying-in place, 257
and his servants and agents, shall permit any person so authorized to 258
enter such hospital or lying-in place and inspect such hospital or lying-259
in place and all of its appurtenances, for the purpose of detecting any 260
improper treatment of any child or any improper management or 261
conduct in such hospital or lying-in place or its appurtenances. Each 262
person so authorized may remove any article which he may think 263
presents evidence of any crime being committed therein and deliver the 264
same to the appropriate law enforcement official to be disposed of 265
according to law. Any person who violates any provision of this section 266
shall be fined not more than two hundred dollars or imprisoned not 267
more than six months or both. 268
(c) On and after January 1, 2024, the Commissioner of Public Health 269
shall not grant or renew a maternity hospital license pursuant to this 270
section. 271
Sec. 6. Subsection (b) of section 19a-638 of the general statutes is 272
repealed and the following is substituted in lieu thereof (Effective January 273
1, 2024): 274
(b) A certificate of need shall not be required for: 275 Substitute Bill No. 986
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(1) Health care facilities owned and operated by the federal 276
government; 277
(2) The establishment of offices by a licensed private practitioner, 278
whether for individual or group practice, except when a certificate of 279
need is required in accordance with the requirements of section 19a-280
493b or subdivision (3), (10) or (11) of subsection (a) of this section; 281
(3) A health care facility operated by a religious group that 282
exclusively relies upon spiritual means through prayer for healing; 283
(4) Residential care homes, as defined in subsection (c) of section 19a-284
490, as amended by this act, and nursing homes and rest homes, as 285
defined in subsection (o) of section 19a-490, as amended by this act; 286
(5) An assisted living services agency, as defined in section 19a-490, 287
as amended by this act; 288
(6) Home health agencies, as defined in section 19a-490, as amended 289
by this act; 290
(7) Hospice services, as described in section 19a-122b; 291
(8) Outpatient rehabilitation facilities; 292
(9) Outpatient chronic dialysis services; 293
(10) Transplant services; 294
(11) Free clinics, as defined in section 19a-630; 295
(12) School-based health centers and expanded school health sites, as 296
such terms are defined in section 19a-6r, community health centers, as 297
defined in section 19a-490a, not-for-profit outpatient clinics licensed in 298
accordance with the provisions of chapter 368v and federally qualified 299
health centers; 300
(13) A program licensed or funded by the Department of Children 301 Substitute Bill No. 986
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and Families, provided such program is not a psychiatric residential 302
treatment facility; 303
(14) Any nonprofit facility, institution or provider that has a contract 304
with, or is certified or licensed to provide a service for, a state agency or 305
department for a service that would otherwise require a certificate of 306
need. The provisions of this subdivision shall not apply to a short-term 307
acute care general hospital or children's hospital, or a hospital or other 308
facility or institution operated by the state that provides services that are 309
eligible for reimbursement under Title XVIII or XIX of the federal Social 310
Security Act, 42 USC 301, as amended; 311
(15) A health care facility operated by a nonprofit educational 312
institution exclusively for students, faculty and staff of such institution 313
and their dependents; 314
(16) An outpatient clinic or program operated exclusively by or 315
contracted to be operated exclusively by a municipality, municipal 316
agency, municipal board of education or a health district, as described 317
in section 19a-241; 318
(17) A residential facility for persons with intellectual disability 319
licensed pursuant to section 17a-227 and certified to participate in the 320
Title XIX Medicaid program as an intermediate care facility for 321
individuals with intellectual disabilities; 322
(18) Replacement of existing imaging equipment if such equipment 323
was acquired through certificate of need approval or a certificate of need 324
determination, provided a health care facility, provider, physician or 325
person notifies the unit of the date on which the equipment is replaced 326
and the disposition of the replaced equipment; 327
(19) Acquisition of cone-beam dental imaging equipment that is to be 328
used exclusively by a dentist licensed pursuant to chapter 379; 329
(20) The partial or total elimination of services provided by an 330
outpatient surgical facility, as defined in section 19a-493b, except as 331 Substitute Bill No. 986
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provided in subdivision (6) of subsection (a) of this section and section 332
19a-639e; 333
(21) The termination of services for which the Department of Public 334
Health has requested the facility to relinquish its license; 335
(22) Acquisition of any equipment by any person that is to be used 336
exclusively for scientific research that is not conducted on humans; [or] 337
(23) On or before June 30, 2026, an increase in the licensed bed 338
capacity of a mental health facility, provided (A) the mental health 339
facility demonstrates to the unit, in a form and manner prescribed by 340
the unit, that it accepts reimbursement for any covered benefit provided 341
to a covered individual under: (i) An individual or group health 342
insurance policy providing coverage of the type specified in 343
subdivisions (1), (2), (4), (11) and (12) of section 38a-469; (ii) a self-344
insured employee welfare benefit plan established pursuant to the 345
federal Employee Retirement Income Security Act of 1974, as amended 346
from time to time; or (iii) HUSKY Health, as defined in section 17b-290, 347
and (B) if the mental health facility does not accept or stops accepting 348
reimbursement for any covered benefit provided to a covered 349
individual under a policy, plan or program described in clause (i), (ii) or 350
(iii) of subparagraph (A) of this subdivision, a certificate of need for such 351
increase in the licensed bed capacity shall be required; or 352
(24) A birth center, as defined in section 19a-490, as amended by this 353
act. 354
Sec. 7. (NEW) (Effective October 1, 2023) (a) As used in this section and 355
section 8 of this act, "infant death" means the death of a child that occurs 356
between birth and one year of age. 357
(b) There is established, within the Department of Public Health, an 358
infant mortality review program. The purpose of the program shall be 359
to review medical records and other relevant data related to infant 360
deaths, including, but not limited to, information collected from death 361
and birth records, and medical records from health care providers and 362 Substitute Bill No. 986
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health care facilities for the purposes of making recommendations to 363
reduce health care disparities and identify gaps in or problems with the 364
delivery of care or services to reduce infant deaths. 365
(c) All health care providers, health care facilities and pharmacies 366
shall provide the Commissioner of Public Health, or the commissioner's 367
designee, with access to all medical and other records associated with 368
an infant death case under review by the program, including, but not 369
limited to, prenatal care records, upon the request of the commissioner. 370
(d) A person who completes a death certificate pursuant to section 7-371
62b or section 19a-409 of the general statutes for an infant death shall 372
report such death to the department in a form and manner prescribed 373
by the commissioner. 374
(e) Notwithstanding any provision of the general statutes, the 375
commissioner shall notify the child fatality review panel, established 376
pursuant to section 46a-13l of the general statutes, of an infant death if, 377
pursuant to a review performed by the infant mortality review program, 378
the commissioner determines that such infant death occurred in out-of-379
home care or was due to unexpected or unexplained causes. 380
(f) All information obtained by the commissioner, or the 381
commissioner's designee, for the infant mortality review program shall 382
be confidential pursuant to section 19a-25 of the general statutes, as 383
amended by this act. 384
(g) Notwithstanding any provision of the general statutes, the 385
commissioner, or the commissioner's designee may provide the infant 386
mortality review committee, established pursuant to section 8 of this act, 387
with information as is necessary, in the commissioner's discretion, for 388
the committee to make recommendations regarding the prevention of 389
infant deaths. 390
(h) The provisions of this section and section 8 of this act shall not be 391
construed to limit or alter the authority of the Office of the Child 392
Advocate or the child fatality review panel, established pursuant to 393 Substitute Bill No. 986
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section 46a-13l of the general statutes, to investigate or make 394
recommendations regarding a child's death pursuant to the provisions 395
of said section. 396
Sec. 8. (NEW) (Effective October 1, 2023) (a) There is established an 397
infant mortality review committee within the department to conduct a 398
comprehensive, multidisciplinary review of infant deaths for purposes 399
of reducing health care disparities, identifying factors associated with 400
infant deaths and making recommendations to reduce infant deaths. 401
(b) The cochairpersons of the infant mortality review committee shall 402
be the Commissioner of Public Health, or the commissioner's designee, 403
and a representative designated by the Connecticut chapter of the 404
American Academy of Pediatrics. The cochairpersons shall convene a 405
meeting of the infant mortality review committee upon the request of 406
the Commissioner of Public Health. 407
(c) The infant mortality review committee may include, but need not 408
be limited to, any of the following members, as needed, depending on 409
the infant death case being reviewed: 410
(1) A physician licensed pursuant to chapter 370 of the general 411
statutes, who specializes in obstetrics and gynecology, designated by 412
the Connecticut Chapter of the American College of Obstetrics and 413
Gynecology; 414
(2) A community health worker, designated by the Commission on 415
Women, Children, Seniors, Equity and Opportunity; 416
(3) A pediatric nurse licensed pursuant to chapter 378 of the general 417
statutes, designated by the Connecticut Nurses Association; 418
(4) A clinical social worker licensed pursuant to chapter 383b of the 419
general statutes, designated by the Connecticut Chapter of the National 420
Association of Social Workers; 421
(5) The Chief Medical Examiner, or the Chief Medical Examiner's 422 Substitute Bill No. 986
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designee; 423
(6) A member of the Connecticut Hospital Association representing a 424
pediatric facility; 425
(7) A representative of The University of Connecticut-sponsored 426
Health Disparities Institute; 427
(8) A physician licensed pursuant to chapter 370 of the general 428
statutes, who practices neonatology, designated by the Connecticut 429
Medical Society; 430
(9) A physician assistant licensed pursuant to chapter 370 of the 431
general statutes or advanced practice registered nurse licensed pursuant 432
to chapter 378 of the general statutes, designated by an association 433
representing physician assistants or advanced practice registered nurses 434
in the state; 435
(10) The Child Advocate, or the Child Advocate's designee; 436
(11) The Commissioner of Social Services, or the commissioner's 437
designee; 438
(12) The Commissioner of Children and Families, or the 439
commissioner's designee; 440
(13) The Commissioner of Early Childhood, or the commissioner's 441
designee; 442
(14) The Commissioner of Mental Health and Addiction Services, or 443
the commissioner's designee; and 444
(15) Any additional member the cochairpersons determine would be 445
beneficial to serve as a member of the committee. 446
(d) For any infant mortality review, the committee may consult with 447
relevant experts to evaluate the information and findings obtained from 448
the department pursuant to section 7 of this act and make 449 Substitute Bill No. 986
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recommendations regarding the prevention of infant deaths. 450
(e) The infant mortality review committee shall include available 451
infant death reports and recommendations produced by the child 452
fatality review panel, established pursuant to section 46a-13l of the 453
general statutes, in its review of infant deaths for the purposes of 454
making recommendations to reduce health care disparities and identify 455
gaps in or problems with the delivery of care or services to reduce infant 456
deaths. 457
(f) Not later than ninety days after completing an infant mortality 458
review, the committee shall, in consultation with the Office of the Child 459
Advocate, report to the Commissioner of Public Health the 460
recommendations and findings of the committee in a manner that 461
complies with section 19a-25 of the general statutes, as amended by this 462
act. 463
(g) All information provided by the department to the infant 464
mortality review committee or provided to any expert consulted by the 465
committee shall be subject to the provisions of section 19a-25 of the 466
general statutes, as amended by this act. 467
Sec. 9. Subsection (a) of section 19a-25 of the general statutes is 468
repealed and the following is substituted in lieu thereof (Effective October 469
1, 2023): 470
(a) All information, records of interviews, written reports, statements, 471
notes, memoranda or other data, including personal data as defined in 472
subdivision (9) of section 4-190, procured by: (1) The Department of 473
Public Health, by staff committees of facilities accredited by the 474
Department of Public Health, [or] the maternity mortality review 475
committee, established pursuant to section 19a-59i, or the infant 476
mortality review committee, established pursuant to section 8 of this act, 477
in connection with studies of morbidity and mortality conducted by the 478
Department of Public Health, such staff committees, [or] the maternal 479
mortality review committee or the infant mortality review committee, 480 Substitute Bill No. 986
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or carried on by said department, such staff committees or the maternal 481
mortality review committee jointly with other persons, agencies or 482
organizations, (2) the directors of health of towns, cities or boroughs or 483
the Department of Public Health pursuant to section 19a-215, or (3) the 484
Department of Public Health or such other persons, agencies or 485
organizations, for the purpose of reducing the morbidity or mortality 486
from any cause or condition, shall be confidential and shall be used 487
solely for the purposes of medical or scientific research and, for 488
information obtained pursuant to section 19a-215, disease prevention 489
and control by the local director of health and the Department of Public 490
Health and reducing the morbidity or mortality from any cause or 491
condition. Such information, records, reports, statements, notes, 492
memoranda or other data shall not be admissible as evidence in any 493
action of any kind in any court or before any other tribunal, board, 494
agency or person, nor shall it be exhibited or its contents disclosed in 495
any way, in whole or in part, by any officer or representative of the 496
Department of Public Health or of any such facility, by any person 497
participating in such a research project or by any other person, except 498
as may be necessary for the purpose of furthering the research project 499
or public health use to which it relates. 500
Sec. 10. (NEW) (Effective July 1, 2023) (a) As used in this section, (1) 501
"certified doula" means a doula who is certified by the Department of 502
Public Health, and (2) "doula" means a trained, nonmedical professional 503
who provides physical, emotional and informational support, virtually 504
or in person, to a pregnant person and any family or friends supporting 505
such person before, during and after birth. 506
(b) The Doula Advisory Committee, established pursuant to section 507
40 of public act 22-58, shall advise the Commissioner of Public Health, 508
or the commissioner's designee, on matters relating to doula services, 509
including, but not limited to, (1) access and promotion of education and 510
resources for pregnant persons, and any family and friends supporting 511
such person; (2) recommendations to improve access to doula care; and 512
(3) furthering interagency efforts to address maternal health disparities. 513 Substitute Bill No. 986
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The committee shall decide to renew or disband the committee on an 514
annual basis in a manner determined by the commissioner or the 515
commissioner's designee. 516
(c) The Doula Training Program Review Committee, established 517
pursuant to section 40 of public act 22-58, shall (1) conduct an ongoing 518
review of doula education and training programs; (2) provide the 519
commissioner, or the commissioner's designee, with a list of approved 520
doula education and training programs, which shall include training in 521
core doula competencies; and (3) recommend certified doula continuing 522
education requirements to the commissioner. 523
(d) On and after October 1, 2023, no person shall use the title "certified 524
doula" unless such person is certified pursuant to this section. 525
(e) Each person seeking certification to practice as a certified doula 526
shall apply to the Department of Public Health, on forms prescribed by 527
the commissioner, and pay an application fee of one hundred dollars. 528
Such application shall include: (1) Proof that the applicant is eighteen 529
years of age or older; (2) two reference letters from families or 530
professionals with direct knowledge of the applicant's experience as a 531
doula verifying the applicant's training or experience; and (3) (A) 532
demonstration of the applicant's completion of a doula training 533
program or a combination of such programs approved pursuant to 534
subsection (c) of this section, or (B) an attestation by the applicant that 535
such applicant has provided doula services to at least three families 536
during the five years preceding the date of the application. 537
(f) The commissioner may grant certification by endorsement to a 538
doula who presents evidence satisfactory to the commissioner that the 539
applicant is certified as a doula in another state or jurisdiction whose 540
requirements for certification are substantially similar to those of this 541
state. No certification shall be issued under this section to any applicant 542
against whom professional disciplinary action is pending or who is the 543
subject of an unresolved complaint. 544 Substitute Bill No. 986
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(g) The commissioner shall adopt continuing education requirements 545
for certified doulas provided by the Doula Training Program Review 546
Committee pursuant to subsection (c) of this section. 547
(h) Certification issued under this section may be renewed every 548
three years. The certification shall be renewed in accordance with the 549
provisions for renewal under section 19a-88 of the general statutes for a 550
fee of one hundred dollars. Each certified doula applying for renewal 551
shall provide to the commissioner evidence of completion of the 552
continuing education requirements adopted pursuant to subsection (g) 553
of this section. 554
(i) The commissioner may take any disciplinary action set forth in 555
section 19a-17 of the general statutes against a certified doula for failure 556
to conform to the accepted standards of the profession including, but 557
not limited to, any of the following reasons: (1) Fraud or deceit in 558
obtaining or seeking reinstatement of a certification to practice as a 559
certified doula; (2) engaging in fraud or material deception in the course 560
of professional services or activities; (3) negligent, incompetent or 561
wrongful conduct in professional activities; (4) aiding or abetting the use 562
of the title "certified doula" by an individual who is not certified; (5) 563
physical, mental or emotional illness or disorder resulting in an inability 564
to conform to the accepted standards of the profession; or (6) abuse or 565
excessive use of drugs, including alcohol, narcotics or chemicals. The 566
commissioner may order a certified doula to submit to a reasonable 567
physical or mental examination if such certified doula's physical or 568
mental capacity to practice safely is the subject of an investigation. The 569
commissioner may petition the superior court for the judicial district of 570
Hartford to enforce such order or any action taken pursuant to section 571
19a-17 of the general statutes. The commissioner shall give notice and 572
an opportunity to be heard on any contemplated action under section 573
19a-17 of the general statutes. 574
Sec. 11. (NEW) (Effective July 1, 2023) (a) As used in this section: 575
(1) "Certified midwife" means any individual who completes a 576 Substitute Bill No. 986
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graduate degree in midwifery and passes a national certification 577
examination administered by the American Midwifery Certification 578
Board to receive the professional designation of certified midwife; 579
(2) "Community birth" means a planned home birth or a birth 580
occurring at a birth center; 581
(3) "Direct entry midwife" means any individual trained in planned 582
out-of-hospital births other than a nurse-midwife, which may include 583
certified midwives, certified professional midwives, community 584
midwives and traditional midwives; and 585
(4) "Licensed nurse-midwife" means any individual licensed as a 586
nurse-midwife pursuant to chapter 377 of the general statutes. 587
(b) The Commissioner of Public Health shall establish a midwifery 588
working group. The working group shall study and make 589
recommendations concerning the advancement of choices in care for 590
community birth and the role of community midwives in addressing 591
maternal and infant health disparities. Such study shall include, but 592
need not be limited to: 593
(1) Improvements in birthing care quality and safety, including 594
improvements addressing racial disparities in maternal and infant 595
health outcomes; 596
(2) Regulation, licensure or certification of direct entry midwives not 597
otherwise licensed to practice midwifery in the state; 598
(3) Regulation, licensure or certification of certified midwives not 599
otherwise licensed to practice midwifery in the state; and 600
(4) Advancements of interprofessional coordination of birthing care, 601
including community birth. 602
(c) The Commissioner of Public Health shall appoint members of the 603
working group. Such members shall include, but need not be limited to, 604 Substitute Bill No. 986
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the commissioner's designee, at least six direct-entry midwives 605
practicing in the state, a certified nurse-midwife with experience 606
working with direct entry midwives, a certified midwife representing 607
an entity that certifies midwives, a doula serving communities of color, 608
a representative of families or a community-based organization with an 609
interest in maternity care, a representative of a community organization 610
furthering health equity, representatives of associated maternity care 611
professions, a representative of the state hospital association and a 612
representative of the Department of Social Services. 613
(d) Not later than February 1, 2024, and annually thereafter, the 614
midwifery working group shall report to the Commissioner of Public 615
Health and, in accordance with the provisions of section 11-4a of the 616
general statutes, to the joint standing committee of the General 617
Assembly having cognizance of matters relating to public health on its 618
findings and recommendations. 619
(e) The midwifery working group shall select to renew or disband the 620
group on an annual basis in a manner determined by the commissioner 621
or the commissioner's designee. 622
Sec. 12. (NEW) (Effective July 1, 2023) (a) As used in this section, 623
"universal newborn nurse home visiting" means an evidence-based 624
nurse home visiting model in which a registered nurse, licensed 625
pursuant to chapter 378 of the general statutes, with specialized training 626
provides services in the home to families with newborns in accordance 627
with the provisions of this section. 628
(b) The Commissioner of Early Childhood, in collaboration with the 629
Commissioners of Social Services and Public Health and the Executive 630
Director of the Office of Health Strategy, shall, within available 631
appropriations, develop and implement a state-wide program to offer 632
universal newborn nurse home visiting services to all families with 633
newborns residing in the state to support parental health, healthy child 634
development and strengthen families. 635 Substitute Bill No. 986
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(c) When developing the program, said commissioners and executive 636
director, shall (1) consult with insurers that offer health benefit plans in 637
the state, hospitals, local public health authorities, existing early 638
childhood home visiting programs, community-based organizations 639
and social service providers; and (2) maximize the use of available 640
federal funding. 641
(d) The program shall provide universal newborn nurse home 642
visiting services that are (1) evidence-based, and (2) designed to 643
improve outcomes in one or more of the following areas: (A) Child 644
safety; (B) child health and development; (C) family economic self-645
sufficiency; (D) maternal and parental health; (E) positive parenting; (F) 646
reducing child mistreatment; (G) reducing family violence; (H) parent-647
infant bonding; and (I) any other appropriate area established, in 648
writing, by the Commissioners of Early Childhood, Social Services and 649
Public Health and the Executive Director of the Office of Health 650
Strategy. 651
(e) The universal newborn nurse home visiting services provided 652
pursuant to the program shall: (1) Be voluntary and carry no negative 653
consequences for a family that declines to participate; (2) be offered in 654
every community in the state; (3) include an evidence-based assessment 655
of the physical, social and emotional factors affecting a family receiving 656
such services; (4) be offered to all families with newborns based on the 657
full extent of available provider capacity; (5) include at least one visit 658
during a newborn's first three months of life or other timeframe as 659
deemed appropriate by said commissioners and executive director; (6) 660
allow families to choose up to a certain number of additional visits 661
consistent with an evidence-based model; (7) include a follow-up visit 662
no later than three months or other time frame established by such 663
model after the last visit; and (8) provide information and referrals to 664
address each family's identified needs. 665
(f) The Commissioner of Social Services may seek approval of an 666
amendment to the state Medicaid plan or a waiver from federal law to 667
provide coverage for universal newborn nurse home visiting services 668 Substitute Bill No. 986
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provided pursuant to this section and in a time frame and manner to 669
ensure that such coverage does not duplicate other applicable federal 670
funding. 671
(g) The Commissioner of Early Childhood, in collaboration with the 672
Commissioners of Social Services and Public Health and the executive 673
director of the Office of Health Strategy, shall collect and analyze data 674
generated by the program to assess the effectiveness of the program in 675
meeting the goals described in subsection (d) of this section and 676
collaborate with other state agencies to develop protocols for sharing 677
such data, including the timely sharing of data with primary care 678
providers that provide care to families with newborns receiving 679
universal newborn nurse home visiting services pursuant to the 680
provisions of this section. 681
Sec. 13. Section 19a-505 of the general statutes is repealed. (Effective 682
July 1, 2025) 683
This act shall take effect as follows and shall amend the following
sections:
Section 1 January 1, 2024 19a-490
Sec. 2 October 1, 2023 New section
Sec. 3 January 1, 2024 19a-491(c)
Sec. 4 January 1, 2024 20-86b
Sec. 5 October 1, 2023 19a-505
Sec. 6 January 1, 2024 19a-638(b)
Sec. 7 October 1, 2023 New section
Sec. 8 October 1, 2023 New section
Sec. 9 October 1, 2023 19a-25(a)
Sec. 10 July 1, 2023 New section
Sec. 11 July 1, 2023 New section
Sec. 12 July 1, 2023 New section
Sec. 13 July 1, 2025 Repealer section
PH Joint Favorable Subst.
APP Joint Favorable Substitute Bill No. 986
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