CT
Connecticut Senate Bill SB00986

Connecticut 2023 Regular Session

Connecticut Senate Bill SB00986 Compare Versions

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7+General Assembly Substitute Bill No. 986
8+January Session, 2023
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4-Substitute Senate Bill No. 986
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6-Public Act No. 23-147
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914 AN ACT PROTECTING MATERNAL HEALTH.
1015 Be it enacted by the Senate and House of Representatives in General
1116 Assembly convened:
1217
13-Section 1. Section 19a-490 of the general statutes is repealed and the
14-following is substituted in lieu thereof (Effective January 1, 2024):
15-As used in this chapter, unless the context otherwise requires:
16-(a) "Institution" means a hospital, short-term hospital special hospice,
17-hospice inpatient facility, residential care home, nursing home facility,
18-home health care agency, home health aide agency, behavioral health
19-facility, assisted living services agency, substance abuse treatment
20-facility, outpatient surgical facility, outpatient clinic, clinical laboratory,
21-birth center, an infirmary operated by an educational institution for the
22-care of students enrolled in, and faculty and employees of, such
23-institution; a facility engaged in providing services for the prevention,
24-diagnosis, treatment or care of human health conditions, including
25-facilities operated and maintained by any state agency; and a residential
26-facility for persons with intellectual disability licensed pursuant to
27-section 17a-227 and certified to participate in the Title XIX Medicaid
28-program as an intermediate care facility for individuals with intellectual
29-disability. "Institution" does not include any facility for the care and
30-treatment of persons with mental illness or substance use disorder Substitute Senate Bill No. 986
18+Section 1. Section 19a-490 of the general statutes is repealed and the 1
19+following is substituted in lieu thereof (Effective January 1, 2024): 2
20+As used in this chapter, unless the context otherwise requires: 3
21+(a) "Institution" means a hospital, short-term hospital special hospice, 4
22+hospice inpatient facility, residential care home, nursing home facility, 5
23+home health care agency, home health aide agency, behavioral health 6
24+facility, assisted living services agency, substance abuse treatment 7
25+facility, outpatient surgical facility, outpatient clinic, clinical laboratory, 8
26+birth center, an infirmary operated by an educational institution for the 9
27+care of students enrolled in, and faculty and employees of, such 10
28+institution; a facility engaged in providing services for the prevention, 11
29+diagnosis, treatment or care of human health conditions, including 12
30+facilities operated and maintained by any state agency; and a residential 13
31+facility for persons with intellectual disability licensed pursuant to 14
32+section 17a-227 and certified to participate in the Title XIX Medicaid 15
33+program as an intermediate care facility for individuals with intellectual 16
34+disability. "Institution" does not include any facility for the care and 17
35+treatment of persons with mental illness or substance use disorder 18 Substitute Bill No. 986
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34-operated or maintained by any state agency, except Whiting Forensic
35-Hospital and the hospital and psychiatric residential treatment facility
36-units of the Albert J. Solnit Children's Center;
37-(b) "Hospital" means an establishment for the lodging, care and
38-treatment of persons suffering from disease or other abnormal physical
39-or mental conditions and includes inpatient psychiatric services in
40-general hospitals;
41-(c) "Residential care home" or "rest home" means a community
42-residence that furnishes, in single or multiple facilities, food and shelter
43-to two or more persons unrelated to the proprietor and, in addition,
44-provides services that meet a need beyond the basic provisions of food,
45-shelter and laundry and may qualify as a setting that allows residents to
46-receive home and community-based services funded by state and
47-federal programs;
48-(d) "Home health care agency" means a public or private
49-organization, or a subdivision thereof, engaged in providing
50-professional nursing services and the following services, available
51-twenty-four hours per day, in the patient's home or a substantially
52-equivalent environment: Home health aide services as defined in this
53-section, physical therapy, speech therapy, occupational therapy or
54-medical social services. The agency shall provide professional nursing
55-services and at least one additional service directly and all others
56-directly or through contract. An agency shall be available to enroll new
57-patients seven days a week, twenty-four hours per day;
58-(e) "Home health aide agency" means a public or private
59-organization, except a home health care agency, which provides in the
60-patient's home or a substantially equivalent environment supportive
61-services which may include, but are not limited to, assistance with
62-personal hygiene, dressing, feeding and incidental household tasks
63-essential to achieving adequate household and family management. Substitute Senate Bill No. 986
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42+operated or maintained by any state agency, except Whiting Forensic 19
43+Hospital and the hospital and psychiatric residential treatment facility 20
44+units of the Albert J. Solnit Children's Center; 21
45+(b) "Hospital" means an establishment for the lodging, care and 22
46+treatment of persons suffering from disease or other abnormal physical 23
47+or mental conditions and includes inpatient psychiatric services in 24
48+general hospitals; 25
49+(c) "Residential care home" or "rest home" means a community 26
50+residence that furnishes, in single or multiple facilities, food and shelter 27
51+to two or more persons unrelated to the proprietor and, in addition, 28
52+provides services that meet a need beyond the basic provisions of food, 29
53+shelter and laundry and may qualify as a setting that allows residents to 30
54+receive home and community-based services funded by state and 31
55+federal programs; 32
56+(d) "Home health care agency" means a public or private 33
57+organization, or a subdivision thereof, engaged in providing 34
58+professional nursing services and the following services, available 35
59+twenty-four hours per day, in the patient's home or a substantially 36
60+equivalent environment: Home health aide services as defined in this 37
61+section, physical therapy, speech therapy, occupational therapy or 38
62+medical social services. The agency shall provide professional nursing 39
63+services and at least one additional service directly and all others 40
64+directly or through contract. An agency shall be available to enroll new 41
65+patients seven days a week, twenty-four hours per day; 42
66+(e) "Home health aide agency" means a public or private 43
67+organization, except a home health care agency, which provides in the 44
68+patient's home or a substantially equivalent environment supportive 45
69+services which may include, but are not limited to, assistance with 46
70+personal hygiene, dressing, feeding and incidental household tasks 47
71+essential to achieving adequate household and family management. 48
72+Such supportive services shall be provided under the supervision of a 49
73+registered nurse and, if such nurse determines appropriate, shall be 50 Substitute Bill No. 986
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67-Such supportive services shall be provided under the supervision of a
68-registered nurse and, if such nurse determines appropriate, shall be
69-provided by a social worker, physical therapist, speech therapist or
70-occupational therapist. Such supervision may be provided directly or
71-through contract;
72-(f) "Home health aide services" as defined in this section shall not
73-include services provided to assist individuals with activities of daily
74-living when such individuals have a disease or condition that is chronic
75-and stable as determined by a physician licensed in the state;
76-(g) "Behavioral health facility" means any facility that provides
77-mental health services to persons eighteen years of age or older or
78-substance use disorder services to persons of any age in an outpatient
79-treatment or residential setting to ameliorate mental, emotional,
80-behavioral or substance use disorder issues;
81-(h) "Clinical laboratory" means any facility or other area used for
82-microbiological, serological, chemical, hema tological,
83-immunohematological, biophysical, cytological, pathological or other
84-examinations of human body fluids, secretions, excretions or excised or
85-exfoliated tissues for the purpose of providing information for the (1)
86-diagnosis, prevention or treatment of any human disease or
87-impairment, (2) assessment of human health, or (3) assessment of the
88-presence of drugs, poisons or other toxicological substances;
89-(i) "Person" means any individual, firm, partnership, corporation,
90-limited liability company or association;
91-(j) "Commissioner" means the Commissioner of Public Health or the
92-commissioner's designee;
93-(k) "Home health agency" means an agency licensed as a home health
94-care agency or a home health aide agency; Substitute Senate Bill No. 986
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98-(l) "Assisted living services agency" means an agency that provides,
99-among other things, nursing services and assistance with activities of
100-daily living to a population that is chronic and stable and may have a
101-dementia special care unit or program as defined in section 19a-562;
102-(m) "Outpatient clinic" means an organization operated by a
103-municipality or a corporation, other than a hospital, that provides (1)
104-ambulatory medical care, including preventive and health promotion
105-services, (2) dental care, or (3) mental health services in conjunction with
106-medical or dental care for the purpose of diagnosing or treating a health
107-condition that does not require the patient's overnight care;
108-(n) "Multicare institution" means a hospital that provides outpatient
109-behavioral health services or other health care services, psychiatric
110-outpatient clinic for adults, free-standing facility for the care or
111-treatment of substance abusive or dependent persons, hospital for
112-psychiatric disabilities, as defined in section 17a-495, or a general acute
113-care hospital that provides outpatient behavioral health services that (1)
114-is licensed in accordance with this chapter, (2) has more than one facility
115-or one or more satellite units owned and operated by a single licensee,
116-and (3) offers complex patient health care services at each facility or
117-satellite unit. For purposes of this subsection, "satellite unit" means a
118-location where a segregated unit of services is provided by the multicare
119-institution;
120-(o) "Nursing home" or "nursing home facility" means (1) any chronic
121-and convalescent nursing home or any rest home with nursing
122-supervision that provides nursing supervision under a medical director
123-twenty-four hours per day, or (2) any chronic and convalescent nursing
124-home that provides skilled nursing care under medical supervision and
125-direction to carry out nonsurgical treatment and dietary procedures for
126-chronic diseases, convalescent stages, acute diseases or injuries;
127-(p) "Outpatient dialysis unit" means (1) an out-of-hospital out-patient Substitute Senate Bill No. 986
80+provided by a social worker, physical therapist, speech therapist or 51
81+occupational therapist. Such supervision may be provided directly or 52
82+through contract; 53
83+(f) "Home health aide services" as defined in this section shall not 54
84+include services provided to assist individuals with activities of daily 55
85+living when such individuals have a disease or condition that is chronic 56
86+and stable as determined by a physician licensed in the state; 57
87+(g) "Behavioral health facility" means any facility that provides 58
88+mental health services to persons eighteen years of age or older or 59
89+substance use disorder services to persons of any age in an outpatient 60
90+treatment or residential setting to ameliorate mental, emotional, 61
91+behavioral or substance use disorder issues; 62
92+(h) "Clinical laboratory" means any facility or other area used for 63
93+microbiological, serological, chemical, hematological, 64
94+immunohematological, biophysical, cytological, pathological or other 65
95+examinations of human body fluids, secretions, excretions or excised or 66
96+exfoliated tissues for the purpose of providing information for the (1) 67
97+diagnosis, prevention or treatment of any human disease or 68
98+impairment, (2) assessment of human health, or (3) assessment of the 69
99+presence of drugs, poisons or other toxicological substances; 70
100+(i) "Person" means any individual, firm, partnership, corporation, 71
101+limited liability company or association; 72
102+(j) "Commissioner" means the Commissioner of Public Health or the 73
103+commissioner's designee; 74
104+(k) "Home health agency" means an agency licensed as a home health 75
105+care agency or a home health aide agency; 76
106+(l) "Assisted living services agency" means an agency that provides, 77
107+among other things, nursing services and assistance with activities of 78
108+daily living to a population that is chronic and stable and may have a 79
109+dementia special care unit or program as defined in section 19a-562; 80 Substitute Bill No. 986
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131-dialysis unit that is licensed by the department to provide (A) services
132-on an out-patient basis to persons requiring dialysis on a short-term
133-basis or for a chronic condition, or (B) training for home dialysis, or (2)
134-an in-hospital dialysis unit that is a special unit of a licensed hospital
135-designed, equipped and staffed to (A) offer dialysis therapy on an out-
136-patient basis, (B) provide training for home dialysis, and (C) perform
137-renal transplantations;
138-(q) "Hospice agency" means a public or private organization that
139-provides home care and hospice services to terminally ill patients;
140-(r) "Psychiatric residential treatment facility" means a nonhospital
141-facility with a provider agreement with the Department of Social
142-Services to provide inpatient services to Medicaid-eligible individuals
143-under the age of twenty-one; [and]
144-(s) "Chronic disease hospital" means a long-term hospital having
145-facilities, medical staff and all necessary personnel for the diagnosis,
146-care and treatment of chronic diseases; and
147-(t) "Birth center" means a freestanding facility that is licensed by the
148-department (1) to provide perinatal, labor, delivery and postpartum
149-care during and immediately after delivery to persons presenting with
150-a low-risk pregnancy and healthy newborns for a period typically less
151-than twenty-four hours, and (2) that is not a hospital licensed pursuant
152-to the provisions of this chapter, or attached to or located in such a
153-hospital. For the purposes of this subsection, "low-risk pregnancy"
154-means an uncomplicated, singleton pregnancy that has vertex
155-presentation and is at low risk for developing complications during
156-labor and birth, as determined by an evaluation and examination
157-conducted by a licensed health care provider acting within the scope of
158-such provider's practice.
159-Sec. 2. (NEW) (Effective October 1, 2023) (a) On and after January 1, Substitute Senate Bill No. 986
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116+(m) "Outpatient clinic" means an organization operated by a 81
117+municipality or a corporation, other than a hospital, that provides (1) 82
118+ambulatory medical care, including preventive and health promotion 83
119+services, (2) dental care, or (3) mental health services in conjunction with 84
120+medical or dental care for the purpose of diagnosing or treating a health 85
121+condition that does not require the patient's overnight care; 86
122+(n) "Multicare institution" means a hospital that provides outpatient 87
123+behavioral health services or other health care services, psychiatric 88
124+outpatient clinic for adults, free-standing facility for the care or 89
125+treatment of substance abusive or dependent persons, hospital for 90
126+psychiatric disabilities, as defined in section 17a-495, or a general acute 91
127+care hospital that provides outpatient behavioral health services that (1) 92
128+is licensed in accordance with this chapter, (2) has more than one facility 93
129+or one or more satellite units owned and operated by a single licensee, 94
130+and (3) offers complex patient health care services at each facility or 95
131+satellite unit. For purposes of this subsection, "satellite unit" means a 96
132+location where a segregated unit of services is provided by the multicare 97
133+institution; 98
134+(o) "Nursing home" or "nursing home facility" means (1) any chronic 99
135+and convalescent nursing home or any rest home with nursing 100
136+supervision that provides nursing supervision under a medical director 101
137+twenty-four hours per day, or (2) any chronic and convalescent nursing 102
138+home that provides skilled nursing care under medical supervision and 103
139+direction to carry out nonsurgical treatment and dietary procedures for 104
140+chronic diseases, convalescent stages, acute diseases or injuries; 105
141+(p) "Outpatient dialysis unit" means (1) an out-of-hospital out-patient 106
142+dialysis unit that is licensed by the department to provide (A) services 107
143+on an out-patient basis to persons requiring dialysis on a short-term 108
144+basis or for a chronic condition, or (B) training for home dialysis, or (2) 109
145+an in-hospital dialysis unit that is a special unit of a licensed hospital 110
146+designed, equipped and staffed to (A) offer dialysis therapy on an out-111
147+patient basis, (B) provide training for home dialysis, and (C) perform 112
148+renal transplantations; 113 Substitute Bill No. 986
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163-2024, no person, entity, firm, partnership, corporation, limited liability
164-company or association shall establish, conduct, operate or maintain a
165-birth center, as defined in section 19a-490 of the general statutes, as
166-amended by this act, in this state without obtaining a license pursuant
167-to the provisions of this section. Except in the case of an emergency, an
168-outpatient clinic shall not offer any birth center services as part of its
169-ambulatory medical services without being licensed as a birth center.
170-For the purposes of this subsection, "birth center services" means
171-perinatal, labor, delivery and postpartum care during and immediately
172-after delivery to persons presenting with a low-risk pregnancy and
173-healthy newborns for a period typically less than twenty-four hours and
174-"low-risk pregnancy" has the same meaning as provided in subsection
175-(t) of section 19a-490 of the general statutes, as amended by this act.
176-(b) Each birth center shall be accredited by the Commission for the
177-Accreditation of Birth Centers on or before the effective date of its
178-licensure and maintain such accreditation during the time it is licensed.
179-If a birth center loses its accreditation, the birth center shall immediately
180-notify the Commissioner of Public Health and cease providing birth
181-center services to patients until authorized by the commissioner to
182-reinstate such services.
183-(c) (1) Each birth center shall have a written plan to obtain services
184-for its patients from a hospital, licensed pursuant to chapter 368v of the
185-general statutes, to provide services in the event of an emergency or
186-other conditions that pose a risk to the health of a patient that require
187-transfer of the patient to a hospital. Before issuing a license pursuant to
188-this section, the commissioner shall review and approve the information
189-submitted by the birth center to the Commission for the Accreditation
190-of Birth Centers, including, but not limited to, (A) information relating
191-to the birth center's plan for ongoing risk assessment and adherence to
192-patient eligibility criteria, as determined by the Commission for the
193-Accreditation of Birth Centers, during the delivery of birth center Substitute Senate Bill No. 986
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197-services to a patient, and (B) information relating to the birth center's
198-policies and procedures for the prenatal, intrapartum or postpartum
199-transfer of a patient in the event that such patient no longer meets such
200-patient eligibility criteria.
201-(2) If a patient receiving birth center services no longer presents with
202-a low-risk pregnancy, as defined in section 19a-490 of the general
203-statutes, as amended by this act, or otherwise fails to meet the patient
204-eligibility criteria described subparagraph (A) of subdivision (1) of this
205-subsection, the birth center providing such services shall ensure the
206-patient's care is transferred to a licensed health care provider capable of
207-providing the appropriate level of obstetrical care for the patient.
208-(d) Each hospital licensed pursuant to chapter 368v of the general
209-statutes that maintains an emergency department, other than a
210-children's hospital, shall work cooperatively with birth centers to
211-coordinate the care of patients who may require services in the event of
212-an emergency or other conditions that pose a risk to the health of a
213-patient that require transfer of the patient to a hospital. Each children's
214-hospital that maintains an emergency department sh all work
215-cooperatively with birth centers to coordinate the care of neonatal
216-patients who may require services in the event of an emergency or other
217-conditions that pose a risk to the health of a patient that require transfer
218-of the patient to a children's hospital.
219-(e) The commissioner shall adopt regulations, in accordance with the
220-provisions of chapter 54 of the general statutes, to implement the
221-provisions of this section and section 19a-495 of the general statutes. The
222-commissioner may implement policies and procedures necessary to
223-administer the provisions of this section while in the process of adopting
224-such policies and procedures as regulations, provided notice of intent to
225-adopt regulations is published on the eRegulations system not later than
226-twenty days after the date of implementation. Policies and procedures
227-implemented pursuant to this section shall be valid until the time final Substitute Senate Bill No. 986
155+(q) "Hospice agency" means a public or private organization that 114
156+provides home care and hospice services to terminally ill patients; 115
157+(r) "Psychiatric residential treatment facility" means a nonhospital 116
158+facility with a provider agreement with the Department of Social 117
159+Services to provide inpatient services to Medicaid-eligible individuals 118
160+under the age of twenty-one; [and] 119
161+(s) "Chronic disease hospital" means a long-term hospital having 120
162+facilities, medical staff and all necessary personnel for the diagnosis, 121
163+care and treatment of chronic diseases; and 122
164+(t) "Birth center" means a freestanding facility that is licensed by the 123
165+department (1) to provide prenatal, labor, delivery and postpartum care 124
166+during and immediately after delivery to persons presenting with a low-125
167+risk pregnancy and healthy newborns for a period typically less than 126
168+twenty-four hours, and (2) that is not a hospital licensed pursuant to the 127
169+provisions of this chapter, or attached to or located in such a hospital. 128
170+For the purposes of this subsection, "low-risk pregnancy" means an 129
171+uncomplicated, singleton pregnancy that has vertex presentation and is 130
172+at low risk for developing complications during labor and birth, as 131
173+determined by an evaluation and examination conducted by a licensed 132
174+physician or other licensed practitioner acting within the scope of such 133
175+practitioner's practice. 134
176+Sec. 2. (NEW) (Effective October 1, 2023) (a) On and after January 1, 135
177+2024, no person, entity, firm, partnership, corporation, limited liability 136
178+company or association shall establish, conduct, operate or maintain a 137
179+birth center, as defined in section 19a-490 of the general statutes, as 138
180+amended by this act, in this state without obtaining a license in 139
181+accordance with the provisions of chapter 368v of the general statutes. 140
182+An outpatient clinic shall not provide any birth center services without 141
183+being licensed as a birth center pursuant to the provisions of chapter 142
184+368v of the general statutes. For the purposes of this subsection, "birth 143
185+center services" means prenatal, labor, delivery and postpartum care 144
186+during and immediately after delivery to persons presenting with a low-145 Substitute Bill No. 986
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231-regulations are adopted. The regulations and policies and procedures
232-shall include, but need not be limited to, provisions regarding the
233-administration of the facility, staffing requirements, infection control
234-protocols, physical plant requirements, accommodation of the
235-participation of support persons of the patient's choice, limitations on
236-the provision of anesthesia and surgical procedures, operating
237-procedures for determining risk status of patients at admission and
238-during labor, reportable events, medical records, pharmaceutical
239-services, laundry services, requirements for professional and medical
240-liability insurance for the facility and health care providers and
241-emergency planning.
242-Sec. 3. Subsection (c) of section 19a-491 of the general statutes is
243-repealed and the following is substituted in lieu thereof (Effective January
244-1, 2024):
245-(c) [Notwithstanding any regulation, the] The Commissioner of
246-Public Health shall charge the following fees for the biennial licensing
247-and inspection of the following institutions: (1) Chronic and
248-convalescent nursing homes, per site, four hundred forty dollars; (2)
249-chronic and convalescent nursing homes, per bed, five dollars; (3) rest
250-homes with nursing supervision, per site, four hundred forty dollars; (4)
251-rest homes with nursing supervision, per bed, five dollars; (5) outpatient
252-dialysis units and outpatient surgical facilities, six hundred twenty-five
253-dollars; (6) mental health residential facilities, per site, three hundred
254-seventy-five dollars; (7) mental health residential facilities, per bed, five
255-dollars; (8) hospitals, per site, nine hundred forty dollars; (9) hospitals,
256-per bed, seven dollars and fifty cents; (10) nonstate agency educational
257-institutions, per infirmary, one hundred fifty dollars; (11) nonstate
258-agency educational institutions, per infirmary bed, twenty-five dollars;
259-(12) home health care agencies, except certified home health care
260-agencies described in subsection (d) of this section, per agency, three
261-hundred dollars; (13) home health care agencies, hospice agencies or Substitute Senate Bill No. 986
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193+risk pregnancy and healthy newborns for a period typically less than 146
194+twenty-four hours and "low-risk pregnancy" has the same meaning as 147
195+provided in subsection (t) of section 19a-490 of the general statutes, as 148
196+amended by this act. 149
197+(b) Each applicant for licensure as a birth center shall be accredited 150
198+by the Commission for the Accreditation of Birth Centers at the time it 151
199+submits an application for licensure to the Department of Public Health 152
200+and maintain such accreditation during the time it is licensed. If a birth 153
201+center loses its accreditation, the birth center shall immediately notify 154
202+the Commissioner of Public Health and cease providing birth center 155
203+services to patients until authorized by the commissioner to reinstate 156
204+such services. 157
205+(c) Each birth center shall have a written plan to obtain services from 158
206+a hospital, licensed pursuant to chapter 368v of the general statutes, to 159
207+provide obstetrical, pediatric and neonatal services in the event of an 160
208+emergency or other conditions that pose a risk to the health of a patient 161
209+that require transfer of the patient to a hospital. No hospital shall refuse 162
210+to enter into or terminate an agreement with a birth center for the 163
211+implementation of such plan without the commissioner's approval. 164
212+(d) The commissioner may adopt regulations, in accordance with the 165
213+provisions of chapter 54 of the general statutes, to implement the 166
214+provisions of this section and section 19a-495 of the general statutes. 167
215+Such regulations may include, but need not be limited to, provisions 168
216+regarding the administration of the facility, staffing requirements, 169
217+infection control protocols, physical plant requirements, 170
218+accommodation of the participation of support persons of the patient's 171
219+choice, limitations on the provision of anesthesia and surgical 172
220+procedures, operating procedures for determining risk status of patients 173
221+at admission and during labor, reportable events, medical records, 174
222+pharmaceutical services, laundry services and emergency planning. The 175
223+commissioner may implement policies and procedures necessary to 176
224+administer the provisions of this section while in the process of adopting 177
225+such policies and procedures as regulations, provided notice of intent to 178 Substitute Bill No. 986
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265-home health aide agencies, except certified home health care agencies,
266-hospice agencies or home health aide agencies described in subsection
267-(d) of this section, per satellite patient service office, one hundred
268-dollars; (14) assisted living services agencies, except such agencies
269-participating in the congregate housing facility pilot program described
270-in section 8-119n, per site, five hundred dollars; (15) short-term hospitals
271-special hospice, per site, nine hundred forty dollars; (16) short-term
272-hospitals special hospice, per bed, seven dollars and fifty cents; (17)
273-hospice inpatient facility, per site, four hundred forty dollars; [and] (18)
274-hospice inpatient facility, per bed, five dollars; and (19) birth centers, per
275-site, nine hundred forty dollars and, per bed, seven dollars and fifty
276-cents.
277-Sec. 4. Section 20-86b of the general statutes is repealed and the
278-following is substituted in lieu thereof (Effective January 1, 2024):
279-Nurse-midwives shall practice within a health care system or birth
280-center and have clinical relationships with obstetrician-gynecologists
281-that provide for consultation, collaborative management or referral, as
282-indicated by the health status of the patient. Nurse-midwifery care shall
283-be consistent with the standards of care established by the Accreditation
284-Commission for Midwifery Education. Each nurse-midwife shall
285-provide each patient with information regarding, or referral to, other
286-providers and services upon request of the patient or when the care
287-required by the patient is not within the midwife's scope of practice.
288-Each nurse-midwife shall sign the birth certificate of each infant
289-delivered by the nurse-midwife. If an infant is born alive and then dies
290-within the twenty-four-hour period after birth, the nurse-midwife may
291-make the actual determination and pronouncement of death provided:
292-(1) The death is an anticipated death; (2) the nurse-midwife attests to
293-such pronouncement on the certificate of death; and (3) the nurse-
294-midwife or a physician licensed pursuant to chapter 370 certifies the
295-certificate of death not later than twenty-four hours after such Substitute Senate Bill No. 986
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299-pronouncement. In a case of fetal death, as described in section 7-60, the
300-nurse-midwife who delivered the fetus may make the actual
301-determination of fetal death and certify the date of delivery and that the
302-fetus was born dead.
303-Sec. 5. Subsection (a) of section 19a-613 of the general statutes is
304-repealed and the following is substituted in lieu thereof (Effective October
305-1, 2023):
306-(a) The Health Systems Planning Unit may employ the most effective
307-and practical means necessary to fulfill the purposes of this chapter,
308-which may include, but need not be limited to:
309-(1) Collecting patient-level outpatient data from health care facilities,
310-[or institutions,] as defined in section 19a-630, and birth centers, as
311-defined in section 19a-490, as amended by this act;
312-(2) Establishing a cooperative data collection effort, across public and
313-private sectors, to assure that adequate health care personnel
314-demographics are readily available; and
315-(3) Performing the duties and functions as enumerated in subsection
316-(b) of this section.
317-Sec. 6. Subsection (b) of section 19a-127n of the general statutes is
318-repealed and the following is substituted in lieu thereof (Effective October
319-1, 2023):
320-(b) On and after October 1, [2002] 2023, a hospital or birth center, as
321-such terms are defined in section 19a-490, as amended by this act, or
322-outpatient surgical facility, as defined in section 19a-493b, shall report
323-adverse events to the Department of Public Health on a form prescribed
324-by the commissioner as follows: (1) A written report and the status of
325-any corrective steps shall be submitted not later than seven days after
326-the date on which the adverse event occurred; and (2) a corrective action Substitute Senate Bill No. 986
232+adopt regulations is published on the eRegulations System not later than 179
233+twenty days after the date of implementation. Policies and procedures 180
234+implemented pursuant to this subsection shall be valid until the date on 181
235+which final regulations are adopted. 182
236+Sec. 3. Subsection (c) of section 19a-491 of the general statutes is 183
237+repealed and the following is substituted in lieu thereof (Effective January 184
238+1, 2024): 185
239+(c) [Notwithstanding any regulation, the] The Commissioner of 186
240+Public Health shall charge the following fees for the biennial licensing 187
241+and inspection of the following institutions: (1) Chronic and 188
242+convalescent nursing homes, per site, four hundred forty dollars; (2) 189
243+chronic and convalescent nursing homes, per bed, five dollars; (3) rest 190
244+homes with nursing supervision, per site, four hundred forty dollars; (4) 191
245+rest homes with nursing supervision, per bed, five dollars; (5) outpatient 192
246+dialysis units and outpatient surgical facilities, six hundred twenty-five 193
247+dollars; (6) mental health residential facilities, per site, three hundred 194
248+seventy-five dollars; (7) mental health residential facilities, per bed, five 195
249+dollars; (8) hospitals, per site, nine hundred forty dollars; (9) hospitals, 196
250+per bed, seven dollars and fifty cents; (10) nonstate agency educational 197
251+institutions, per infirmary, one hundred fifty dollars; (11) nonstate 198
252+agency educational institutions, per infirmary bed, twenty-five dollars; 199
253+(12) home health care agencies, except certified home health care 200
254+agencies described in subsection (d) of this section, per agency, three 201
255+hundred dollars; (13) home health care agencies, hospice agencies or 202
256+home health aide agencies, except certified home health care agencies, 203
257+hospice agencies or home health aide agencies described in subsection 204
258+(d) of this section, per satellite patient service office, one hundred 205
259+dollars; (14) assisted living services agencies, except such agencies 206
260+participating in the congregate housing facility pilot program described 207
261+in section 8-119n, per site, five hundred dollars; (15) short-term hospitals 208
262+special hospice, per site, nine hundred forty dollars; (16) short-term 209
263+hospitals special hospice, per bed, seven dollars and fifty cents; (17) 210
264+hospice inpatient facility, per site, four hundred forty dollars; [and] (18) 211 Substitute Bill No. 986
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329266
330-plan shall be filed not later than thirty days after the date on which the
331-adverse event occurred. Emergent reports, as defined in the regulations
332-adopted pursuant to subsection (c) of this section, shall be made to the
333-department immediately. Failure to implement a corrective action plan
334-may result in disciplinary action by the commissioner, pursuant to
335-section 19a-494.
336-Sec. 7. Section 19a-505 of the general statutes is repealed and the
337-following is substituted in lieu thereof (Effective October 1, 2023):
338-(a) No person shall keep a maternity hospital or lying-in place unless
339-such person has previously obtained a license therefor, issued by the
340-Department of Public Health. Each such license shall be valid for a term
341-of two years and may be revoked by the Department of Public Health
342-upon proof that the institution for which such license was issued is
343-being improperly conducted or for the violation of any of the provisions
344-of this section or of the Public Health Code, or on the basis of lack of
345-demonstrable need, provided the licensee shall be given a reasonable
346-opportunity to be heard in reference to such proposed revocation.
347-(b) Within six hours after the departure, removal or withdrawal of
348-any child born at such maternity hospital or lying-in place, the keeper
349-thereof shall make a record of such departure, removal or withdrawal
350-of such child, the names and residences of the persons who took such
351-child or its body and the place to which it was taken and where it was
352-left, which record shall be produced by the keeper or licensee of such
353-hospital or lying-in place, for inspection by and upon the demand of any
354-person authorized to make such inspection by the Department of Public
355-Health or the council. Each keeper of any such hospital or lying-in place,
356-and his servants and agents, shall permit any person so authorized to
357-enter such hospital or lying-in place and inspect such hospital or lying-
358-in place and all of its appurtenances, for the purpose of detecting any
359-improper treatment of any child or any improper management or
360-conduct in such hospital or lying-in place or its appurtenances. Each Substitute Senate Bill No. 986
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271+hospice inpatient facility, per bed, five dollars; and (19) birth centers, per 212
272+site, nine hundred forty dollars and, per bed, seven dollars and fifty 213
273+cents. 214
274+Sec. 4. Section 20-86b of the general statutes is repealed and the 215
275+following is substituted in lieu thereof (Effective January 1, 2024): 216
276+Nurse-midwives shall practice within a health care system or birth 217
277+center and have clinical relationships with obstetrician-gynecologists 218
278+that provide for consultation, collaborative management or referral, as 219
279+indicated by the health status of the patient. Nurse-midwifery care shall 220
280+be consistent with the standards of care established by the Accreditation 221
281+Commission for Midwifery Education. Each nurse-midwife shall 222
282+provide each patient with information regarding, or referral to, other 223
283+providers and services upon request of the patient or when the care 224
284+required by the patient is not within the midwife's scope of practice. 225
285+Each nurse-midwife shall sign the birth certificate of each infant 226
286+delivered by the nurse-midwife. If an infant is born alive and then dies 227
287+within the twenty-four-hour period after birth, the nurse-midwife may 228
288+make the actual determination and pronouncement of death provided: 229
289+(1) The death is an anticipated death; (2) the nurse-midwife attests to 230
290+such pronouncement on the certificate of death; and (3) the nurse-231
291+midwife or a physician licensed pursuant to chapter 370 certifies the 232
292+certificate of death not later than twenty-four hours after such 233
293+pronouncement. In a case of fetal death, as described in section 7-60, the 234
294+nurse-midwife who delivered the fetus may make the actual 235
295+determination of fetal death and certify the date of delivery and that the 236
296+fetus was born dead. 237
297+Sec. 5. Section 19a-505 of the general statutes is repealed and the 238
298+following is substituted in lieu thereof (Effective October 1, 2023): 239
299+(a) No person shall keep a maternity hospital or lying-in place unless 240
300+such person has previously obtained a license therefor, issued by the 241
301+Department of Public Health. Each such license shall be valid for a term 242
302+of two years and may be revoked by the Department of Public Health 243 Substitute Bill No. 986
363303
364-person so authorized may remove any article which he may think
365-presents evidence of any crime being committed therein and deliver the
366-same to the appropriate law enforcement official to be disposed of
367-according to law. Any person who violates any provision of this section
368-shall be fined not more than two hundred dollars or imprisoned not
369-more than six months or both.
370-(c) On and after January 1, 2024, the Commissioner of Public Health
371-shall not grant or renew a maternity hospital license pursuant to this
372-section.
373-Sec. 8. Subsection (b) of section 19a-638 of the general statutes is
374-repealed and the following is substituted in lieu thereof (Effective January
375-1, 2024):
376-(b) A certificate of need shall not be required for:
377-(1) Health care facilities owned and operated by the federal
378-government;
379-(2) The establishment of offices by a licensed private practitioner,
380-whether for individual or group practice, except when a certificate of
381-need is required in accordance with the requirements of section 19a-
382-493b or subdivision (3), (10) or (11) of subsection (a) of this section;
383-(3) A health care facility operated by a religious group that
384-exclusively relies upon spiritual means through prayer for healing;
385-(4) Residential care homes, as defined in subsection (c) of section 19a-
386-490, as amended by this act, and nursing homes and rest homes, as
387-defined in subsection (o) of section 19a-490, as amended by this act;
388-(5) An assisted living services agency, as defined in section 19a-490,
389-as amended by this act;
390-(6) Home health agencies, as defined in section 19a-490, as amended Substitute Senate Bill No. 986
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394-by this act;
395-(7) Hospice services, as described in section 19a-122b;
396-(8) Outpatient rehabilitation facilities;
397-(9) Outpatient chronic dialysis services;
398-(10) Transplant services;
399-(11) Free clinics, as defined in section 19a-630;
400-(12) School-based health centers and expanded school health sites, as
401-such terms are defined in section 19a-6r, community health centers, as
402-defined in section 19a-490a, not-for-profit outpatient clinics licensed in
403-accordance with the provisions of chapter 368v and federally qualified
404-health centers;
405-(13) A program licensed or funded by the Department of Children
406-and Families, provided such program is not a psychiatric residential
407-treatment facility;
408-(14) Any nonprofit facility, institution or provider that has a contract
409-with, or is certified or licensed to provide a service for, a state agency or
410-department for a service that would otherwise require a certificate of
411-need. The provisions of this subdivision shall not apply to a short-term
412-acute care general hospital or children's hospital, or a hospital or other
413-facility or institution operated by the state that provides services that are
414-eligible for reimbursement under Title XVIII or XIX of the federal Social
415-Security Act, 42 USC 301, as amended;
416-(15) A health care facility operated by a nonprofit educational
417-institution exclusively for students, faculty and staff of such institution
418-and their dependents;
419-(16) An outpatient clinic or program operated exclusively by or Substitute Senate Bill No. 986
309+upon proof that the institution for which such license was issued is 244
310+being improperly conducted or for the violation of any of the provisions 245
311+of this section or of the Public Health Code, or on the basis of lack of 246
312+demonstrable need, provided the licensee shall be given a reasonable 247
313+opportunity to be heard in reference to such proposed revocation. 248
314+(b) Within six hours after the departure, removal or withdrawal of 249
315+any child born at such maternity hospital or lying-in place, the keeper 250
316+thereof shall make a record of such departure, removal or withdrawal 251
317+of such child, the names and residences of the persons who took such 252
318+child or its body and the place to which it was taken and where it was 253
319+left, which record shall be produced by the keeper or licensee of such 254
320+hospital or lying-in place, for inspection by and upon the demand of any 255
321+person authorized to make such inspection by the Department of Public 256
322+Health or the council. Each keeper of any such hospital or lying-in place, 257
323+and his servants and agents, shall permit any person so authorized to 258
324+enter such hospital or lying-in place and inspect such hospital or lying-259
325+in place and all of its appurtenances, for the purpose of detecting any 260
326+improper treatment of any child or any improper management or 261
327+conduct in such hospital or lying-in place or its appurtenances. Each 262
328+person so authorized may remove any article which he may think 263
329+presents evidence of any crime being committed therein and deliver the 264
330+same to the appropriate law enforcement official to be disposed of 265
331+according to law. Any person who violates any provision of this section 266
332+shall be fined not more than two hundred dollars or imprisoned not 267
333+more than six months or both. 268
334+(c) On and after January 1, 2024, the Commissioner of Public Health 269
335+shall not grant or renew a maternity hospital license pursuant to this 270
336+section. 271
337+Sec. 6. Subsection (b) of section 19a-638 of the general statutes is 272
338+repealed and the following is substituted in lieu thereof (Effective January 273
339+1, 2024): 274
340+(b) A certificate of need shall not be required for: 275 Substitute Bill No. 986
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421-Public Act No. 23-147 14 of 29
422342
423-contracted to be operated exclusively by a municipality, municipal
424-agency, municipal board of education or a health district, as described
425-in section 19a-241;
426-(17) A residential facility for persons with intellectual disability
427-licensed pursuant to section 17a-227 and certified to participate in the
428-Title XIX Medicaid program as an intermediate care facility for
429-individuals with intellectual disabilities;
430-(18) Replacement of existing imaging equipment if such equipment
431-was acquired through certificate of need approval or a certificate of need
432-determination, provided a health care facility, provider, physician or
433-person notifies the unit of the date on which the equipment is replaced
434-and the disposition of the replaced equipment;
435-(19) Acquisition of cone-beam dental imaging equipment that is to be
436-used exclusively by a dentist licensed pursuant to chapter 379;
437-(20) The partial or total elimination of services provided by an
438-outpatient surgical facility, as defined in section 19a-493b, except as
439-provided in subdivision (6) of subsection (a) of this section and section
440-19a-639e;
441-(21) The termination of services for which the Department of Public
442-Health has requested the facility to relinquish its license;
443-(22) Acquisition of any equipment by any person that is to be used
444-exclusively for scientific research that is not conducted on humans; [or]
445-(23) On or before June 30, 2026, an increase in the licensed bed
446-capacity of a mental health facility, provided (A) the mental health
447-facility demonstrates to the unit, in a form and manner prescribed by
448-the unit, that it accepts reimbursement for any covered benefit provided
449-to a covered individual under: (i) An individual or group health
450-insurance policy providing coverage of the type specified in Substitute Senate Bill No. 986
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347+(1) Health care facilities owned and operated by the federal 276
348+government; 277
349+(2) The establishment of offices by a licensed private practitioner, 278
350+whether for individual or group practice, except when a certificate of 279
351+need is required in accordance with the requirements of section 19a-280
352+493b or subdivision (3), (10) or (11) of subsection (a) of this section; 281
353+(3) A health care facility operated by a religious group that 282
354+exclusively relies upon spiritual means through prayer for healing; 283
355+(4) Residential care homes, as defined in subsection (c) of section 19a-284
356+490, as amended by this act, and nursing homes and rest homes, as 285
357+defined in subsection (o) of section 19a-490, as amended by this act; 286
358+(5) An assisted living services agency, as defined in section 19a-490, 287
359+as amended by this act; 288
360+(6) Home health agencies, as defined in section 19a-490, as amended 289
361+by this act; 290
362+(7) Hospice services, as described in section 19a-122b; 291
363+(8) Outpatient rehabilitation facilities; 292
364+(9) Outpatient chronic dialysis services; 293
365+(10) Transplant services; 294
366+(11) Free clinics, as defined in section 19a-630; 295
367+(12) School-based health centers and expanded school health sites, as 296
368+such terms are defined in section 19a-6r, community health centers, as 297
369+defined in section 19a-490a, not-for-profit outpatient clinics licensed in 298
370+accordance with the provisions of chapter 368v and federally qualified 299
371+health centers; 300
372+(13) A program licensed or funded by the Department of Children 301 Substitute Bill No. 986
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454-subdivisions (1), (2), (4), (11) and (12) of section 38a-469; (ii) a self-
455-insured employee welfare benefit plan established pursuant to the
456-federal Employee Retirement Income Security Act of 1974, as amended
457-from time to time; or (iii) HUSKY Health, as defined in section 17b-290,
458-and (B) if the mental health facility does not accept or stops accepting
459-reimbursement for any covered benefit provided to a covered
460-individual under a policy, plan or program described in clause (i), (ii) or
461-(iii) of subparagraph (A) of this subdivision, a certificate of need for such
462-increase in the licensed bed capacity shall be required; or
463-(24) On or before June 30, 2028, a birth center, as defined in section
464-19a-490, as amended by this act, that is enrolled as a provider in the
465-Connecticut medical assistance program, as defined in section 17b-245g.
466-Sec. 9. (Effective October 1, 2023) The executive director of the Office of
467-Health Strategy, in consultation with the Commissioner of Public
468-Health, shall, within available appropriations, study whether the
469-certificate of need exemption for birth centers described in subdivision
470-(24) of subsection (b) of section 19a-638 of the general statutes, as
471-amended by this act, should be extended. Pursuant to such study, the
472-executive director shall collect data from birth centers in the state
473-concerning (1) the number of deliveries performed at each birth center
474-and the number of patient transfers or referrals to other settings of care,
475-including the reason for such transfers and referrals, (2) the number and
476-percentages of patients who are self-pay, covered by commercial
477-insurance and covered by a government payer program, including, but
478-not limited to, the Connecticut medical assistance program, as defined
479-in section 17b-245g of the general statutes, (3) patient demographic
480-information, including the race, ethnicity and preferred language of
481-patients, (4) geographic locations of birth centers and catchment areas,
482-(5) financial assistance and uncompensated care provided by each birth
483-center, and (6) any other information deemed necessary by the executive
484-director. Not later than July 1, 2027, the executive director shall report, Substitute Senate Bill No. 986
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488-in accordance with the provisions of section 11-4a of the general statutes,
489-regarding such study to the joint standing committee of the General
490-Assembly having cognizance of matters relating to public health.
491-Sec. 10. (NEW) (Effective October 1, 2023) (a) As used in this section
492-and section 11 of this act, "infant death" means the death of a child that
493-occurs between birth and one year of age.
494-(b) There is established, within the Department of Public Health, an
495-infant mortality review program. The purpose of the program shall be
496-to review medical records and other relevant data related to infant
497-deaths, including, but not limited to, information collected from death
498-and birth records, and medical records from health care providers and
499-health care facilities for the purposes of making recommendations to
500-reduce health care disparities and identify gaps in or problems with the
501-delivery of care or services to reduce infant deaths.
502-(c) All health care providers, health care facilities and pharmacies
503-shall provide the Commissioner of Public Health, or the commissioner's
504-designee, with access to all medical and other records associated with
505-an infant death case under review by the program, including, but not
506-limited to, prenatal care records, upon the request of the commissioner.
507-(d) A person who completes a death certificate pursuant to section 7-
508-62b or section 19a-409 of the general statutes for an infant death shall
509-report such death to the department in a form and manner prescribed
510-by the commissioner.
511-(e) Notwithstanding any provision of the general statutes, the
512-commissioner shall notify the child fatality review panel, established
513-pursuant to section 46a-13l of the general statutes, of an infant death if,
514-pursuant to a review performed by the infant mortality review program,
515-the commissioner determines that such infant death occurred in out-of-
516-home care or was due to unexpected or unexplained causes. Substitute Senate Bill No. 986
379+and Families, provided such program is not a psychiatric residential 302
380+treatment facility; 303
381+(14) Any nonprofit facility, institution or provider that has a contract 304
382+with, or is certified or licensed to provide a service for, a state agency or 305
383+department for a service that would otherwise require a certificate of 306
384+need. The provisions of this subdivision shall not apply to a short-term 307
385+acute care general hospital or children's hospital, or a hospital or other 308
386+facility or institution operated by the state that provides services that are 309
387+eligible for reimbursement under Title XVIII or XIX of the federal Social 310
388+Security Act, 42 USC 301, as amended; 311
389+(15) A health care facility operated by a nonprofit educational 312
390+institution exclusively for students, faculty and staff of such institution 313
391+and their dependents; 314
392+(16) An outpatient clinic or program operated exclusively by or 315
393+contracted to be operated exclusively by a municipality, municipal 316
394+agency, municipal board of education or a health district, as described 317
395+in section 19a-241; 318
396+(17) A residential facility for persons with intellectual disability 319
397+licensed pursuant to section 17a-227 and certified to participate in the 320
398+Title XIX Medicaid program as an intermediate care facility for 321
399+individuals with intellectual disabilities; 322
400+(18) Replacement of existing imaging equipment if such equipment 323
401+was acquired through certificate of need approval or a certificate of need 324
402+determination, provided a health care facility, provider, physician or 325
403+person notifies the unit of the date on which the equipment is replaced 326
404+and the disposition of the replaced equipment; 327
405+(19) Acquisition of cone-beam dental imaging equipment that is to be 328
406+used exclusively by a dentist licensed pursuant to chapter 379; 329
407+(20) The partial or total elimination of services provided by an 330
408+outpatient surgical facility, as defined in section 19a-493b, except as 331 Substitute Bill No. 986
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520-(f) All information obtained by the commissioner, or the
521-commissioner's designee, for the infant mortality review program shall
522-be confidential pursuant to section 19a-25 of the general statutes, as
523-amended by this act.
524-(g) Notwithstanding any provision of the general statutes, the
525-commissioner, or the commissioner's designee may provide the infant
526-mortality review committee, established pursuant to section 11 of this
527-act, with information as is necessary, in the commissioner's discretion,
528-for the committee to make recommendations regarding the prevention
529-of infant deaths.
530-(h) The provisions of this section and section 11 of this act shall not
531-be construed to limit or alter the authority of the Office of the Child
532-Advocate or the child fatality review panel, established pursuant to
533-section 46a-13l of the general statutes, to investigate or make
534-recommendations regarding a child's death pursuant to the provisions
535-of said section.
536-Sec. 11. (NEW) (Effective October 1, 2023) (a) There is established an
537-infant mortality review committee within the department to conduct a
538-comprehensive, multidisciplinary review of infant deaths for purposes
539-of reducing health care disparities, identifying factors associated with
540-infant deaths and making recommendations to reduce infant deaths.
541-(b) The cochairpersons of the infant mortality review committee shall
542-be the Commissioner of Public Health, or the commissioner's designee,
543-and a representative designated by the Connecticut chapter of the
544-American Academy of Pediatrics. The cochairpersons shall convene a
545-meeting of the infant mortality review committee upon the request of
546-the Commissioner of Public Health.
547-(c) The infant mortality review committee may include, but need not
548-be limited to, any of the following members, as needed, depending on Substitute Senate Bill No. 986
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415+provided in subdivision (6) of subsection (a) of this section and section 332
416+19a-639e; 333
417+(21) The termination of services for which the Department of Public 334
418+Health has requested the facility to relinquish its license; 335
419+(22) Acquisition of any equipment by any person that is to be used 336
420+exclusively for scientific research that is not conducted on humans; [or] 337
421+(23) On or before June 30, 2026, an increase in the licensed bed 338
422+capacity of a mental health facility, provided (A) the mental health 339
423+facility demonstrates to the unit, in a form and manner prescribed by 340
424+the unit, that it accepts reimbursement for any covered benefit provided 341
425+to a covered individual under: (i) An individual or group health 342
426+insurance policy providing coverage of the type specified in 343
427+subdivisions (1), (2), (4), (11) and (12) of section 38a-469; (ii) a self-344
428+insured employee welfare benefit plan established pursuant to the 345
429+federal Employee Retirement Income Security Act of 1974, as amended 346
430+from time to time; or (iii) HUSKY Health, as defined in section 17b-290, 347
431+and (B) if the mental health facility does not accept or stops accepting 348
432+reimbursement for any covered benefit provided to a covered 349
433+individual under a policy, plan or program described in clause (i), (ii) or 350
434+(iii) of subparagraph (A) of this subdivision, a certificate of need for such 351
435+increase in the licensed bed capacity shall be required; or 352
436+(24) A birth center, as defined in section 19a-490, as amended by this 353
437+act. 354
438+Sec. 7. (NEW) (Effective October 1, 2023) (a) As used in this section and 355
439+section 8 of this act, "infant death" means the death of a child that occurs 356
440+between birth and one year of age. 357
441+(b) There is established, within the Department of Public Health, an 358
442+infant mortality review program. The purpose of the program shall be 359
443+to review medical records and other relevant data related to infant 360
444+deaths, including, but not limited to, information collected from death 361
445+and birth records, and medical records from health care providers and 362 Substitute Bill No. 986
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552-the infant death case being reviewed:
553-(1) A physician licensed pursuant to chapter 370 of the general
554-statutes, who specializes in obstetrics and gynecology, designated by
555-the Connecticut Chapter of the American College of Obstetrics and
556-Gynecology;
557-(2) A community health worker, designated by the Commission on
558-Women, Children, Seniors, Equity and Opportunity;
559-(3) A pediatric nurse licensed pursuant to chapter 378 of the general
560-statutes, designated by the Connecticut Nurses Association;
561-(4) A clinical social worker licensed pursuant to chapter 383b of the
562-general statutes, designated by the Connecticut Chapter of the National
563-Association of Social Workers;
564-(5) The Chief Medical Examiner, or the Chief Medical Examiner's
565-designee;
566-(6) A member of the Connecticut Hospital Association representing a
567-pediatric facility;
568-(7) A representative of The University of Connecticut-sponsored
569-Health Disparities Institute;
570-(8) A physician licensed pursuant to chapter 370 of the general
571-statutes, who practices neonatology, designated by the Connecticut
572-Medical Society;
573-(9) A physician assistant licensed pursuant to chapter 370 of the
574-general statutes or advanced practice registered nurse licensed pursuant
575-to chapter 378 of the general statutes, designated by an association
576-representing physician assistants or advanced practice registered nurses
577-in the state; Substitute Senate Bill No. 986
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581-(10) The Child Advocate, or the Child Advocate's designee;
582-(11) The Commissioner of Social Services, or the commissioner's
583-designee;
584-(12) The Commissioner of Children and Families, or the
585-commissioner's designee;
586-(13) The Commissioner of Early Childhood, or the commissioner's
587-designee;
588-(14) The Commissioner of Mental Health and Addiction Services, or
589-the commissioner's designee; and
590-(15) Any additional member the cochairpersons determine would be
591-beneficial to serve as a member of the committee.
592-(d) For any infant mortality review, the committee may consult with
593-relevant experts to evaluate the information and findings obtained from
594-the department pursuant to section 10 of this act and make
595-recommendations regarding the prevention of infant deaths.
596-(e) The infant mortality review committee shall include available
597-infant death reports and recommendations produced by the child
598-fatality review panel, established pursuant to section 46a-13l of the
599-general statutes, in its review of infant deaths for the purposes of
600-making recommendations to reduce health care disparities and identify
601-gaps in or problems with the delivery of care or services to reduce infant
602-deaths.
603-(f) Not later than ninety days after completing an infant mortality
604-review, the committee shall, in consultation with the Office of the Child
605-Advocate, report to the Commissioner of Public Health the
606-recommendations and findings of the committee in a manner that
607-complies with section 19a-25 of the general statutes, as amended by this Substitute Senate Bill No. 986
452+health care facilities for the purposes of making recommendations to 363
453+reduce health care disparities and identify gaps in or problems with the 364
454+delivery of care or services to reduce infant deaths. 365
455+(c) All health care providers, health care facilities and pharmacies 366
456+shall provide the Commissioner of Public Health, or the commissioner's 367
457+designee, with access to all medical and other records associated with 368
458+an infant death case under review by the program, including, but not 369
459+limited to, prenatal care records, upon the request of the commissioner. 370
460+(d) A person who completes a death certificate pursuant to section 7-371
461+62b or section 19a-409 of the general statutes for an infant death shall 372
462+report such death to the department in a form and manner prescribed 373
463+by the commissioner. 374
464+(e) Notwithstanding any provision of the general statutes, the 375
465+commissioner shall notify the child fatality review panel, established 376
466+pursuant to section 46a-13l of the general statutes, of an infant death if, 377
467+pursuant to a review performed by the infant mortality review program, 378
468+the commissioner determines that such infant death occurred in out-of-379
469+home care or was due to unexpected or unexplained causes. 380
470+(f) All information obtained by the commissioner, or the 381
471+commissioner's designee, for the infant mortality review program shall 382
472+be confidential pursuant to section 19a-25 of the general statutes, as 383
473+amended by this act. 384
474+(g) Notwithstanding any provision of the general statutes, the 385
475+commissioner, or the commissioner's designee may provide the infant 386
476+mortality review committee, established pursuant to section 8 of this act, 387
477+with information as is necessary, in the commissioner's discretion, for 388
478+the committee to make recommendations regarding the prevention of 389
479+infant deaths. 390
480+(h) The provisions of this section and section 8 of this act shall not be 391
481+construed to limit or alter the authority of the Office of the Child 392
482+Advocate or the child fatality review panel, established pursuant to 393 Substitute Bill No. 986
608483
609-Public Act No. 23-147 20 of 29
610484
611-act.
612-(g) All information provided by the department to the infant
613-mortality review committee or provided to any expert consulted by the
614-committee shall be subject to the provisions of section 19a-25 of the
615-general statutes, as amended by this act.
616-Sec. 12. Subsection (a) of section 19a-25 of the general statutes is
617-repealed and the following is substituted in lieu thereof (Effective October
618-1, 2023):
619-(a) All information, records of interviews, written reports, statements,
620-notes, memoranda or other data, including personal data as defined in
621-subdivision (9) of section 4-190, procured by: (1) The Department of
622-Public Health, by staff committees of facilities accredited by the
623-Department of Public Health, [or] the maternity mortality review
624-committee, established pursuant to section 19a-59i, or the infant
625-mortality review committee, established pursuant to section 11 of this
626-act, in connection with studies of morbidity and mortality conducted by
627-the Department of Public Health, such staff committees, [or] the
628-maternal mortality review committee or the infant mortality review
629-committee, or carried on by said department, such staff committees or
630-the maternal mortality review committee jointly with other persons,
631-agencies or organizations, (2) the directors of health of towns, cities or
632-boroughs or the Department of Public Health pursuant to section 19a-
633-215, or (3) the Department of Public Health or such other persons,
634-agencies or organizations, for the purpose of reducing the morbidity or
635-mortality from any cause or condition, shall be confidential and shall be
636-used solely for the purposes of medical or scientific research and, for
637-information obtained pursuant to section 19a-215, disease prevention
638-and control by the local director of health and the Department of Public
639-Health and reducing the morbidity or mortality from any cause or
640-condition. Such information, records, reports, statements, notes,
641-memoranda or other data shall not be admissible as evidence in any Substitute Senate Bill No. 986
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489+section 46a-13l of the general statutes, to investigate or make 394
490+recommendations regarding a child's death pursuant to the provisions 395
491+of said section. 396
492+Sec. 8. (NEW) (Effective October 1, 2023) (a) There is established an 397
493+infant mortality review committee within the department to conduct a 398
494+comprehensive, multidisciplinary review of infant deaths for purposes 399
495+of reducing health care disparities, identifying factors associated with 400
496+infant deaths and making recommendations to reduce infant deaths. 401
497+(b) The cochairpersons of the infant mortality review committee shall 402
498+be the Commissioner of Public Health, or the commissioner's designee, 403
499+and a representative designated by the Connecticut chapter of the 404
500+American Academy of Pediatrics. The cochairpersons shall convene a 405
501+meeting of the infant mortality review committee upon the request of 406
502+the Commissioner of Public Health. 407
503+(c) The infant mortality review committee may include, but need not 408
504+be limited to, any of the following members, as needed, depending on 409
505+the infant death case being reviewed: 410
506+(1) A physician licensed pursuant to chapter 370 of the general 411
507+statutes, who specializes in obstetrics and gynecology, designated by 412
508+the Connecticut Chapter of the American College of Obstetrics and 413
509+Gynecology; 414
510+(2) A community health worker, designated by the Commission on 415
511+Women, Children, Seniors, Equity and Opportunity; 416
512+(3) A pediatric nurse licensed pursuant to chapter 378 of the general 417
513+statutes, designated by the Connecticut Nurses Association; 418
514+(4) A clinical social worker licensed pursuant to chapter 383b of the 419
515+general statutes, designated by the Connecticut Chapter of the National 420
516+Association of Social Workers; 421
517+(5) The Chief Medical Examiner, or the Chief Medical Examiner's 422 Substitute Bill No. 986
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645-action of any kind in any court or before any other tribunal, board,
646-agency or person, nor shall it be exhibited or its contents disclosed in
647-any way, in whole or in part, by any officer or representative of the
648-Department of Public Health or of any such facility, by any person
649-participating in such a research project or by any other person, except
650-as may be necessary for the purpose of furthering the research project
651-or public health use to which it relates.
652-Sec. 13. (NEW) (Effective July 1, 2023) (a) As used in this section:
653-(1) "Certified doula" means a doula that is certified by the Department
654-of Public Health; and
655-(2) "Doula" means a trained, nonmedical professional who provides
656-physical, emotional and informational support, virtually or in person,
657-to a pregnant person and any family or friends supporting such person
658-before, during and after birth.
659-(b) The Commissioner of Public Health shall, within available
660-resources, establish a Doula Advisory Committee within the
661-Department of Public Health. The Doula Advisory Committee shall
662-develop recommendations for (1) requirements for certification and
663-certification renewal of doulas, including, but not limited to, training,
664-experience or continuing education requirements; and (2) standards for
665-recognizing doula training program curricula that are sufficient to
666-satisfy the requirements for doula certification.
667-(c) The Commissioner of Public Health, or the commissioner's
668-designee, shall be the chairperson of the Doula Advisory Committee.
669-(d) The Doula Advisory Committee shall consist of the following
670-members:
671-(1) Seven appointed by the Commissioner of Public Health, or the
672-commissioner's designee, who are actively practicing as doulas in the Substitute Senate Bill No. 986
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676-state;
677-(2) One appointed by the Commissioner of Public Health, or the
678-commissioner's designee, who is a nurse-midwife, licensed pursuant to
679-chapter 377 of the general statutes, who has experience working with a
680-doula;
681-(3) One appointed by the Commissioner of Public Health, or the
682-commissioner's designee, in consultation with the Connecticut Hospital
683-Association, who shall represent an acute care hospital;
684-(4) One appointed by the Commissioner of Public Health, or the
685-commissioner's designee, who shall represent an association that
686-represents hospitals and health-related organizations in the state;
687-(5) One appointed by the Commissioner of Public Health, or the
688-commissioner's designee, who shall be a licensed health care provider
689-who specializes in obstetrics and has experience working with a doula;
690-(6) One appointed by the Commissioner of Public Health, or the
691-commissioner's designee, who shall represent a community-based
692-doula training organization;
693-(7) One appointed by the Commissioner of Public Health, or the
694-commissioner's designee, who shall represent a community-based
695-maternal and child health organization;
696-(8) One appointed by the Commissioner of Public Health, or the
697-commissioner's designee, who shall have expertise in health equity;
698-(9) The Commissioner of Social Services, or the commissioner's
699-designee;
700-(10) The Commissioner of Mental Health and Addiction Services, or
701-the commissioner's designee; and Substitute Senate Bill No. 986
524+designee; 423
525+(6) A member of the Connecticut Hospital Association representing a 424
526+pediatric facility; 425
527+(7) A representative of The University of Connecticut-sponsored 426
528+Health Disparities Institute; 427
529+(8) A physician licensed pursuant to chapter 370 of the general 428
530+statutes, who practices neonatology, designated by the Connecticut 429
531+Medical Society; 430
532+(9) A physician assistant licensed pursuant to chapter 370 of the 431
533+general statutes or advanced practice registered nurse licensed pursuant 432
534+to chapter 378 of the general statutes, designated by an association 433
535+representing physician assistants or advanced practice registered nurses 434
536+in the state; 435
537+(10) The Child Advocate, or the Child Advocate's designee; 436
538+(11) The Commissioner of Social Services, or the commissioner's 437
539+designee; 438
540+(12) The Commissioner of Children and Families, or the 439
541+commissioner's designee; 440
542+(13) The Commissioner of Early Childhood, or the commissioner's 441
543+designee; 442
544+(14) The Commissioner of Mental Health and Addiction Services, or 443
545+the commissioner's designee; and 444
546+(15) Any additional member the cochairpersons determine would be 445
547+beneficial to serve as a member of the committee. 446
548+(d) For any infant mortality review, the committee may consult with 447
549+relevant experts to evaluate the information and findings obtained from 448
550+the department pursuant to section 7 of this act and make 449 Substitute Bill No. 986
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704552
705-(11) The Commissioner of Early Childhood, or the commissioner's
706-designee.
707-(e) The Doula Advisory Committee shall establish a Doula Training
708-Program Review Committee. Such committee shall (1) conduct a
709-continuous review of doula training programs; and (2) provide a list of
710-approved doula training programs in the state that meet the
711-requirements established by the Doula Advisory Committee.
712-Sec. 14. (NEW) (Effective July 1, 2023) (a) As used in this section, (1)
713-"certified doula" means a doula who is certified by the Department of
714-Public Health, and (2) "doula" means a trained, nonmedical professional
715-who provides physical, emotional and informational support, virtually
716-or in person, to a pregnant person and any family or friends supporting
717-such person before, during and after birth.
718-(b) The Doula Advisory Committee, established pursuant to section
719-13 of this act, shall advise the Commissioner of Public Health, or the
720-commissioner's designee, on matters relating to doula services,
721-including, but not limited to, (1) access and promotion of education and
722-resources for pregnant persons, and any family and friends supporting
723-such person; (2) recommendations to improve access to doula care; and
724-(3) furthering interagency efforts to address maternal health disparities.
725-The committee shall decide to renew or disband the committee on an
726-annual basis in a manner determined by the commissioner or the
727-commissioner's designee.
728-(c) The Doula Training Program Review Committee, established
729-pursuant to section 13 of this act, shall (1) conduct an ongoing review of
730-doula education and training programs, (2) provide the commissioner,
731-or the commissioner's designee, with a list of approved doula education
732-and training programs, which shall include training in core doula
733-competencies, and (3) recommend certified doula continuing education
734-requirements to the commissioner. Substitute Senate Bill No. 986
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557+recommendations regarding the prevention of infant deaths. 450
558+(e) The infant mortality review committee shall include available 451
559+infant death reports and recommendations produced by the child 452
560+fatality review panel, established pursuant to section 46a-13l of the 453
561+general statutes, in its review of infant deaths for the purposes of 454
562+making recommendations to reduce health care disparities and identify 455
563+gaps in or problems with the delivery of care or services to reduce infant 456
564+deaths. 457
565+(f) Not later than ninety days after completing an infant mortality 458
566+review, the committee shall, in consultation with the Office of the Child 459
567+Advocate, report to the Commissioner of Public Health the 460
568+recommendations and findings of the committee in a manner that 461
569+complies with section 19a-25 of the general statutes, as amended by this 462
570+act. 463
571+(g) All information provided by the department to the infant 464
572+mortality review committee or provided to any expert consulted by the 465
573+committee shall be subject to the provisions of section 19a-25 of the 466
574+general statutes, as amended by this act. 467
575+Sec. 9. Subsection (a) of section 19a-25 of the general statutes is 468
576+repealed and the following is substituted in lieu thereof (Effective October 469
577+1, 2023): 470
578+(a) All information, records of interviews, written reports, statements, 471
579+notes, memoranda or other data, including personal data as defined in 472
580+subdivision (9) of section 4-190, procured by: (1) The Department of 473
581+Public Health, by staff committees of facilities accredited by the 474
582+Department of Public Health, [or] the maternity mortality review 475
583+committee, established pursuant to section 19a-59i, or the infant 476
584+mortality review committee, established pursuant to section 8 of this act, 477
585+in connection with studies of morbidity and mortality conducted by the 478
586+Department of Public Health, such staff committees, [or] the maternal 479
587+mortality review committee or the infant mortality review committee, 480 Substitute Bill No. 986
737588
738-(d) On and after October 1, 2023, no person shall use the title "certified
739-doula" unless such person is certified pursuant to this section. The
740-provisions of this section shall not be construed to prohibit a doula, who
741-is not a certified doula, from providing doula services, provided such
742-doula does not use the title "certified doula".
743-(e) Each person seeking certification to practice as a certified doula
744-shall apply to the Department of Public Health, on forms prescribed by
745-the commissioner, and pay an application fee of one hundred dollars.
746-Such application shall include: (1) Proof that the applicant is eighteen
747-years of age or older; (2) two reference letters from families or
748-professionals with direct knowledge of the applicant's experience as a
749-doula verifying the applicant's training or experience; and (3) (A)
750-demonstration of the applicant's completion of a doula training
751-program or a combination of such programs approved pursuant to
752-subsection (c) of this section, or (B) an attestation by the applicant that
753-such applicant has provided doula services to at least three families and
754-training in not less than four core competencies identified by the Doula
755-Training Program Review Committee during the five years preceding
756-the date of the application.
757-(f) The commissioner may grant certification by endorsement to a
758-doula who presents evidence satisfactory to the commissioner that the
759-applicant is certified as a doula in another state or jurisdiction whose
760-requirements for certification are substantially similar to those of this
761-state for not less than two years before the date such doula submits an
762-application for certification. No certification shall be issued under this
763-section to any applicant against whom professional disciplinary action
764-is pending or who is the subject of an unresolved complaint.
765-(g) The commissioner shall adopt continuing education requirements
766-for certified doulas provided by the Doula Training Program Review
767-Committee pursuant to subsection (c) of this section. Substitute Senate Bill No. 986
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771-(h) Certification issued under this section may be renewed every
772-three years. The certification shall be renewed in accordance with the
773-provisions for renewal under section 19a-88 of the general statutes for a
774-fee of one hundred dollars. Each certified doula applying for renewal
775-shall provide to the commissioner evidence of completion of the
776-continuing education requirements adopted pursuant to subsection (g)
777-of this section.
778-(i) The commissioner may take any disciplinary action set forth in
779-section 19a-17 of the general statutes against a certified doula for failure
780-to conform to the accepted standards of the profession including, but
781-not limited to, any of the following reasons: (1) Fraud or deceit in
782-obtaining or seeking reinstatement of a certification to practice as a
783-certified doula; (2) engaging in fraud or material deception in the course
784-of professional services or activities; (3) negligent, incompetent or
785-wrongful conduct in professional activities; (4) aiding or abetting the use
786-of the title "certified doula" by an individual who is not certified; (5)
787-physical, mental or emotional illness or disorder resulting in an inability
788-to conform to the accepted standards of the profession; or (6) abuse or
789-excessive use of drugs, including alcohol, narcotics or chemicals. The
790-commissioner may order a certified doula to submit to a reasonable
791-physical or mental examination if such certified doula's physical or
792-mental capacity to practice safely is the subject of an investigation. The
793-commissioner may petition the superior court for the judicial district of
794-Hartford to enforce such order or any action taken pursuant to section
795-19a-17 of the general statutes. The commissioner shall give notice and
796-an opportunity to be heard on any contemplated action under section
797-19a-17 of the general statutes.
798-Sec. 15. (NEW) (Effective July 1, 2023) (a) As used in this section:
799-(1) "Certified midwife" means any individual who completes a
800-graduate degree in midwifery and passes a national certification
801-examination administered by the American Midwifery Certification Substitute Senate Bill No. 986
594+or carried on by said department, such staff committees or the maternal 481
595+mortality review committee jointly with other persons, agencies or 482
596+organizations, (2) the directors of health of towns, cities or boroughs or 483
597+the Department of Public Health pursuant to section 19a-215, or (3) the 484
598+Department of Public Health or such other persons, agencies or 485
599+organizations, for the purpose of reducing the morbidity or mortality 486
600+from any cause or condition, shall be confidential and shall be used 487
601+solely for the purposes of medical or scientific research and, for 488
602+information obtained pursuant to section 19a-215, disease prevention 489
603+and control by the local director of health and the Department of Public 490
604+Health and reducing the morbidity or mortality from any cause or 491
605+condition. Such information, records, reports, statements, notes, 492
606+memoranda or other data shall not be admissible as evidence in any 493
607+action of any kind in any court or before any other tribunal, board, 494
608+agency or person, nor shall it be exhibited or its contents disclosed in 495
609+any way, in whole or in part, by any officer or representative of the 496
610+Department of Public Health or of any such facility, by any person 497
611+participating in such a research project or by any other person, except 498
612+as may be necessary for the purpose of furthering the research project 499
613+or public health use to which it relates. 500
614+Sec. 10. (NEW) (Effective July 1, 2023) (a) As used in this section, (1) 501
615+"certified doula" means a doula who is certified by the Department of 502
616+Public Health, and (2) "doula" means a trained, nonmedical professional 503
617+who provides physical, emotional and informational support, virtually 504
618+or in person, to a pregnant person and any family or friends supporting 505
619+such person before, during and after birth. 506
620+(b) The Doula Advisory Committee, established pursuant to section 507
621+40 of public act 22-58, shall advise the Commissioner of Public Health, 508
622+or the commissioner's designee, on matters relating to doula services, 509
623+including, but not limited to, (1) access and promotion of education and 510
624+resources for pregnant persons, and any family and friends supporting 511
625+such person; (2) recommendations to improve access to doula care; and 512
626+(3) furthering interagency efforts to address maternal health disparities. 513 Substitute Bill No. 986
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805-Board to receive the professional designation of certified midwife;
806-(2) "Community birth" means a planned home birth or a birth
807-occurring at a birth center;
808-(3) "Direct entry midwife" means any individual trained in planned
809-out-of-hospital births other than a nurse-midwife, which may include
810-certified midwives, certified professional midwives, community
811-midwives and traditional midwives; and
812-(4) "Licensed nurse-midwife" means any individual licensed as a
813-nurse-midwife pursuant to chapter 377 of the general statutes.
814-(b) The Commissioner of Public Health shall establish a midwifery
815-working group. The working group shall study and make
816-recommendations concerning the advancement of choices in care for
817-community birth and the role of direct entry midwives in addressing
818-maternal and infant health disparities. Such study shall include, but
819-need not be limited to:
820-(1) Improvements in birthing care quality and safety, including
821-improvements addressing racial disparities in maternal and infant
822-health outcomes;
823-(2) Regulation, licensure or certification of direct entry midwives not
824-otherwise licensed to practice midwifery in the state;
825-(3) Regulation, licensure or certification of certified midwives not
826-otherwise licensed to practice midwifery in the state; and
827-(4) Advancements of interprofessional coordination of birthing care,
828-including community birth.
829-(c) The Commissioner of Public Health shall appoint members of the
830-working group. Such members shall include, but need not be limited to,
831-the commissioner's designee, at least six direct-entry midwives Substitute Senate Bill No. 986
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633+The committee shall decide to renew or disband the committee on an 514
634+annual basis in a manner determined by the commissioner or the 515
635+commissioner's designee. 516
636+(c) The Doula Training Program Review Committee, established 517
637+pursuant to section 40 of public act 22-58, shall (1) conduct an ongoing 518
638+review of doula education and training programs; (2) provide the 519
639+commissioner, or the commissioner's designee, with a list of approved 520
640+doula education and training programs, which shall include training in 521
641+core doula competencies; and (3) recommend certified doula continuing 522
642+education requirements to the commissioner. 523
643+(d) On and after October 1, 2023, no person shall use the title "certified 524
644+doula" unless such person is certified pursuant to this section. 525
645+(e) Each person seeking certification to practice as a certified doula 526
646+shall apply to the Department of Public Health, on forms prescribed by 527
647+the commissioner, and pay an application fee of one hundred dollars. 528
648+Such application shall include: (1) Proof that the applicant is eighteen 529
649+years of age or older; (2) two reference letters from families or 530
650+professionals with direct knowledge of the applicant's experience as a 531
651+doula verifying the applicant's training or experience; and (3) (A) 532
652+demonstration of the applicant's completion of a doula training 533
653+program or a combination of such programs approved pursuant to 534
654+subsection (c) of this section, or (B) an attestation by the applicant that 535
655+such applicant has provided doula services to at least three families 536
656+during the five years preceding the date of the application. 537
657+(f) The commissioner may grant certification by endorsement to a 538
658+doula who presents evidence satisfactory to the commissioner that the 539
659+applicant is certified as a doula in another state or jurisdiction whose 540
660+requirements for certification are substantially similar to those of this 541
661+state. No certification shall be issued under this section to any applicant 542
662+against whom professional disciplinary action is pending or who is the 543
663+subject of an unresolved complaint. 544 Substitute Bill No. 986
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835-practicing in the state, a certified nurse-midwife with experience
836-working with direct entry midwives, a certified midwife representing
837-an entity that certifies midwives, a doula serving communities of color,
838-a representative of families or a community-based organization with an
839-interest in maternity care, a representative of a community organization
840-furthering health equity, representatives of associated maternity care
841-professions, a representative of the state hospital association and a
842-representative of the Department of Social Services.
843-(d) Not later than February 1, 2024, and annually thereafter, the
844-midwifery working group shall report to the Commissioner of Public
845-Health and, in accordance with the provisions of section 11-4a of the
846-general statutes, to the joint standing committee of the General
847-Assembly having cognizance of matters relating to public health on its
848-findings and recommendations.
849-(e) The midwifery working group shall select to renew or disband the
850-group on an annual basis in a manner determined by the commissioner
851-or the commissioner's designee.
852-Sec. 16. (NEW) (Effective July 1, 2023) (a) As used in this section,
853-"universal nurse home visiting" means an evidence-based nurse home
854-visiting model in which a registered nurse, licensed pursuant to chapter
855-378 of the general statutes, with specialized training provides services
856-in the home to families with newborns in accordance with the
857-provisions of this section.
858-(b) The Commissioner of Early Childhood, in collaboration with the
859-Commissioners of Social Services and Public Health and the Executive
860-Director of the Office of Health Strategy, shall, within available
861-appropriations, develop a state-wide program to offer universal nurse
862-home visiting services to all families with newborns residing in the state
863-to support parental health, healthy child development and strengthen
864-families. Substitute Senate Bill No. 986
865665
866-Public Act No. 23-147 28 of 29
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867669
868-(c) When developing the program, said commissioners and executive
869-director, shall (1) consult with insurers that offer health benefit plans in
870-the state, hospitals, local public health authorities, existing early
871-childhood home visiting programs, community-based organizations
872-and social service providers; and (2) maximize the use of available
873-federal funding.
874-(d) The program shall provide universal nurse home visiting services
875-that are (1) evidence-based, and (2) designed to improve outcomes in
876-one or more of the following areas: (A) Child safety; (B) child health and
877-development; (C) family economic self-sufficiency; (D) maternal and
878-parental health; (E) positive parenting; (F) reducing child mistreatment;
879-(G) reducing family violence; (H) parent-infant bonding; and (I) any
880-other appropriate area established, in writing, by the Commissioners of
881-Early Childhood, Social Services and Public Health and the executive
882-director of the Office of Health Strategy.
883-(e) The universal nurse home visiting services provided pursuant to
884-the program shall (1) be voluntary and carry no negative consequences
885-for a family that declines to participate, (2) include an evidence-based
886-assessment of the physical, social and emotional factors affecting a
887-family receiving such services, (3) include at least one visit during a
888-newborn's first three months of life or other timeframe as deemed
889-appropriate by said commissioners and executive director and that is
890-consistent with an evidence-based model, (4) allow families to choose
891-up to a certain number of additional visits consistent with such model,
892-(5) include a follow-up visit no later than three months or other time
893-frame established by such model after the last visit, and (6) provide
894-information and referrals to address each family's identified needs. Such
895-services may be offered in every community in the state and to all
896-families with newborns based on the full extent of available provider
897-capacity.
898-(f) The Commissioner of Social Services may seek approval of an Substitute Senate Bill No. 986
670+(g) The commissioner shall adopt continuing education requirements 545
671+for certified doulas provided by the Doula Training Program Review 546
672+Committee pursuant to subsection (c) of this section. 547
673+(h) Certification issued under this section may be renewed every 548
674+three years. The certification shall be renewed in accordance with the 549
675+provisions for renewal under section 19a-88 of the general statutes for a 550
676+fee of one hundred dollars. Each certified doula applying for renewal 551
677+shall provide to the commissioner evidence of completion of the 552
678+continuing education requirements adopted pursuant to subsection (g) 553
679+of this section. 554
680+(i) The commissioner may take any disciplinary action set forth in 555
681+section 19a-17 of the general statutes against a certified doula for failure 556
682+to conform to the accepted standards of the profession including, but 557
683+not limited to, any of the following reasons: (1) Fraud or deceit in 558
684+obtaining or seeking reinstatement of a certification to practice as a 559
685+certified doula; (2) engaging in fraud or material deception in the course 560
686+of professional services or activities; (3) negligent, incompetent or 561
687+wrongful conduct in professional activities; (4) aiding or abetting the use 562
688+of the title "certified doula" by an individual who is not certified; (5) 563
689+physical, mental or emotional illness or disorder resulting in an inability 564
690+to conform to the accepted standards of the profession; or (6) abuse or 565
691+excessive use of drugs, including alcohol, narcotics or chemicals. The 566
692+commissioner may order a certified doula to submit to a reasonable 567
693+physical or mental examination if such certified doula's physical or 568
694+mental capacity to practice safely is the subject of an investigation. The 569
695+commissioner may petition the superior court for the judicial district of 570
696+Hartford to enforce such order or any action taken pursuant to section 571
697+19a-17 of the general statutes. The commissioner shall give notice and 572
698+an opportunity to be heard on any contemplated action under section 573
699+19a-17 of the general statutes. 574
700+Sec. 11. (NEW) (Effective July 1, 2023) (a) As used in this section: 575
701+(1) "Certified midwife" means any individual who completes a 576 Substitute Bill No. 986
899702
900-Public Act No. 23-147 29 of 29
901703
902-amendment to the state Medicaid plan or a waiver from federal law to
903-provide coverage for universal nurse home visiting services provided
904-pursuant to this section and in a time frame and manner to ensure that
905-such coverage does not duplicate other applicable federal funding.
906-(g) The Commissioner of Early Childhood, in collaboration with the
907-Commissioners of Social Services and Public Health and the executive
908-director of the Office of Health Strategy, shall collect and analyze data
909-generated by the program to assess the effectiveness of the program in
910-meeting the goals described in subsection (d) of this section and
911-collaborate with other state agencies to develop protocols for sharing
912-such data, including the timely sharing of data with primary care
913-providers that provide care to families with newborns receiving
914-universal nurse home visiting services pursuant to the provisions of this
915-section.
916-Sec. 17. Section 19a-505 of the general statutes is repealed. (Effective
917-July 1, 2025)
918-Sec. 18. Section 40 of public act 22-58 is repealed. (Effective July 1, 2023)
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706+20 of 24
707+
708+graduate degree in midwifery and passes a national certification 577
709+examination administered by the American Midwifery Certification 578
710+Board to receive the professional designation of certified midwife; 579
711+(2) "Community birth" means a planned home birth or a birth 580
712+occurring at a birth center; 581
713+(3) "Direct entry midwife" means any individual trained in planned 582
714+out-of-hospital births other than a nurse-midwife, which may include 583
715+certified midwives, certified professional midwives, community 584
716+midwives and traditional midwives; and 585
717+(4) "Licensed nurse-midwife" means any individual licensed as a 586
718+nurse-midwife pursuant to chapter 377 of the general statutes. 587
719+(b) The Commissioner of Public Health shall establish a midwifery 588
720+working group. The working group shall study and make 589
721+recommendations concerning the advancement of choices in care for 590
722+community birth and the role of community midwives in addressing 591
723+maternal and infant health disparities. Such study shall include, but 592
724+need not be limited to: 593
725+(1) Improvements in birthing care quality and safety, including 594
726+improvements addressing racial disparities in maternal and infant 595
727+health outcomes; 596
728+(2) Regulation, licensure or certification of direct entry midwives not 597
729+otherwise licensed to practice midwifery in the state; 598
730+(3) Regulation, licensure or certification of certified midwives not 599
731+otherwise licensed to practice midwifery in the state; and 600
732+(4) Advancements of interprofessional coordination of birthing care, 601
733+including community birth. 602
734+(c) The Commissioner of Public Health shall appoint members of the 603
735+working group. Such members shall include, but need not be limited to, 604 Substitute Bill No. 986
736+
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741+
742+the commissioner's designee, at least six direct-entry midwives 605
743+practicing in the state, a certified nurse-midwife with experience 606
744+working with direct entry midwives, a certified midwife representing 607
745+an entity that certifies midwives, a doula serving communities of color, 608
746+a representative of families or a community-based organization with an 609
747+interest in maternity care, a representative of a community organization 610
748+furthering health equity, representatives of associated maternity care 611
749+professions, a representative of the state hospital association and a 612
750+representative of the Department of Social Services. 613
751+(d) Not later than February 1, 2024, and annually thereafter, the 614
752+midwifery working group shall report to the Commissioner of Public 615
753+Health and, in accordance with the provisions of section 11-4a of the 616
754+general statutes, to the joint standing committee of the General 617
755+Assembly having cognizance of matters relating to public health on its 618
756+findings and recommendations. 619
757+(e) The midwifery working group shall select to renew or disband the 620
758+group on an annual basis in a manner determined by the commissioner 621
759+or the commissioner's designee. 622
760+Sec. 12. (NEW) (Effective July 1, 2023) (a) As used in this section, 623
761+"universal newborn nurse home visiting" means an evidence-based 624
762+nurse home visiting model in which a registered nurse, licensed 625
763+pursuant to chapter 378 of the general statutes, with specialized training 626
764+provides services in the home to families with newborns in accordance 627
765+with the provisions of this section. 628
766+(b) The Commissioner of Early Childhood, in collaboration with the 629
767+Commissioners of Social Services and Public Health and the Executive 630
768+Director of the Office of Health Strategy, shall, within available 631
769+appropriations, develop and implement a state-wide program to offer 632
770+universal newborn nurse home visiting services to all families with 633
771+newborns residing in the state to support parental health, healthy child 634
772+development and strengthen families. 635 Substitute Bill No. 986
773+
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777+22 of 24
778+
779+(c) When developing the program, said commissioners and executive 636
780+director, shall (1) consult with insurers that offer health benefit plans in 637
781+the state, hospitals, local public health authorities, existing early 638
782+childhood home visiting programs, community-based organizations 639
783+and social service providers; and (2) maximize the use of available 640
784+federal funding. 641
785+(d) The program shall provide universal newborn nurse home 642
786+visiting services that are (1) evidence-based, and (2) designed to 643
787+improve outcomes in one or more of the following areas: (A) Child 644
788+safety; (B) child health and development; (C) family economic self-645
789+sufficiency; (D) maternal and parental health; (E) positive parenting; (F) 646
790+reducing child mistreatment; (G) reducing family violence; (H) parent-647
791+infant bonding; and (I) any other appropriate area established, in 648
792+writing, by the Commissioners of Early Childhood, Social Services and 649
793+Public Health and the Executive Director of the Office of Health 650
794+Strategy. 651
795+(e) The universal newborn nurse home visiting services provided 652
796+pursuant to the program shall: (1) Be voluntary and carry no negative 653
797+consequences for a family that declines to participate; (2) be offered in 654
798+every community in the state; (3) include an evidence-based assessment 655
799+of the physical, social and emotional factors affecting a family receiving 656
800+such services; (4) be offered to all families with newborns based on the 657
801+full extent of available provider capacity; (5) include at least one visit 658
802+during a newborn's first three months of life or other timeframe as 659
803+deemed appropriate by said commissioners and executive director; (6) 660
804+allow families to choose up to a certain number of additional visits 661
805+consistent with an evidence-based model; (7) include a follow-up visit 662
806+no later than three months or other time frame established by such 663
807+model after the last visit; and (8) provide information and referrals to 664
808+address each family's identified needs. 665
809+(f) The Commissioner of Social Services may seek approval of an 666
810+amendment to the state Medicaid plan or a waiver from federal law to 667
811+provide coverage for universal newborn nurse home visiting services 668 Substitute Bill No. 986
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817+
818+provided pursuant to this section and in a time frame and manner to 669
819+ensure that such coverage does not duplicate other applicable federal 670
820+funding. 671
821+(g) The Commissioner of Early Childhood, in collaboration with the 672
822+Commissioners of Social Services and Public Health and the executive 673
823+director of the Office of Health Strategy, shall collect and analyze data 674
824+generated by the program to assess the effectiveness of the program in 675
825+meeting the goals described in subsection (d) of this section and 676
826+collaborate with other state agencies to develop protocols for sharing 677
827+such data, including the timely sharing of data with primary care 678
828+providers that provide care to families with newborns receiving 679
829+universal newborn nurse home visiting services pursuant to the 680
830+provisions of this section. 681
831+Sec. 13. Section 19a-505 of the general statutes is repealed. (Effective 682
832+July 1, 2025) 683
833+This act shall take effect as follows and shall amend the following
834+sections:
835+
836+Section 1 January 1, 2024 19a-490
837+Sec. 2 October 1, 2023 New section
838+Sec. 3 January 1, 2024 19a-491(c)
839+Sec. 4 January 1, 2024 20-86b
840+Sec. 5 October 1, 2023 19a-505
841+Sec. 6 January 1, 2024 19a-638(b)
842+Sec. 7 October 1, 2023 New section
843+Sec. 8 October 1, 2023 New section
844+Sec. 9 October 1, 2023 19a-25(a)
845+Sec. 10 July 1, 2023 New section
846+Sec. 11 July 1, 2023 New section
847+Sec. 12 July 1, 2023 New section
848+Sec. 13 July 1, 2025 Repealer section
849+
850+PH Joint Favorable Subst.
851+APP Joint Favorable Substitute Bill No. 986
852+
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