Substitute Senate Bill No. 986
Public Act No. 23-147
AN ACT PROTECTING MATERNAL HEALTH.
Be it enacted by the Senate and House of Representatives in General
Assembly convened:
Section 1. Section 19a-490 of the general statutes is repealed and the
following is substituted in lieu thereof (Effective January 1, 2024):
As used in this chapter, unless the context otherwise requires:
(a) "Institution" means a hospital, short-term hospital special hospice,
hospice inpatient facility, residential care home, nursing home facility,
home health care agency, home health aide agency, behavioral health
facility, assisted living services agency, substance abuse treatment
facility, outpatient surgical facility, outpatient clinic, clinical laboratory,
birth center, an infirmary operated by an educational institution for the
care of students enrolled in, and faculty and employees of, such
institution; a facility engaged in providing services for the prevention,
diagnosis, treatment or care of human health conditions, including
facilities operated and maintained by any state agency; and a residential
facility for persons with intellectual disability licensed pursuant to
section 17a-227 and certified to participate in the Title XIX Medicaid
program as an intermediate care facility for individuals with intellectual
disability. "Institution" does not include any facility for the care and
treatment of persons with mental illness or substance use disorder Substitute Senate Bill No. 986
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operated or maintained by any state agency, except Whiting Forensic
Hospital and the hospital and psychiatric residential treatment facility
units of the Albert J. Solnit Children's Center;
(b) "Hospital" means an establishment for the lodging, care and
treatment of persons suffering from disease or other abnormal physical
or mental conditions and includes inpatient psychiatric services in
general hospitals;
(c) "Residential care home" or "rest home" means a community
residence that furnishes, in single or multiple facilities, food and shelter
to two or more persons unrelated to the proprietor and, in addition,
provides services that meet a need beyond the basic provisions of food,
shelter and laundry and may qualify as a setting that allows residents to
receive home and community-based services funded by state and
federal programs;
(d) "Home health care agency" means a public or private
organization, or a subdivision thereof, engaged in providing
professional nursing services and the following services, available
twenty-four hours per day, in the patient's home or a substantially
equivalent environment: Home health aide services as defined in this
section, physical therapy, speech therapy, occupational therapy or
medical social services. The agency shall provide professional nursing
services and at least one additional service directly and all others
directly or through contract. An agency shall be available to enroll new
patients seven days a week, twenty-four hours per day;
(e) "Home health aide agency" means a public or private
organization, except a home health care agency, which provides in the
patient's home or a substantially equivalent environment supportive
services which may include, but are not limited to, assistance with
personal hygiene, dressing, feeding and incidental household tasks
essential to achieving adequate household and family management. Substitute Senate Bill No. 986
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Such supportive services shall be provided under the supervision of a
registered nurse and, if such nurse determines appropriate, shall be
provided by a social worker, physical therapist, speech therapist or
occupational therapist. Such supervision may be provided directly or
through contract;
(f) "Home health aide services" as defined in this section shall not
include services provided to assist individuals with activities of daily
living when such individuals have a disease or condition that is chronic
and stable as determined by a physician licensed in the state;
(g) "Behavioral health facility" means any facility that provides
mental health services to persons eighteen years of age or older or
substance use disorder services to persons of any age in an outpatient
treatment or residential setting to ameliorate mental, emotional,
behavioral or substance use disorder issues;
(h) "Clinical laboratory" means any facility or other area used for
microbiological, serological, chemical, hema tological,
immunohematological, biophysical, cytological, pathological or other
examinations of human body fluids, secretions, excretions or excised or
exfoliated tissues for the purpose of providing information for the (1)
diagnosis, prevention or treatment of any human disease or
impairment, (2) assessment of human health, or (3) assessment of the
presence of drugs, poisons or other toxicological substances;
(i) "Person" means any individual, firm, partnership, corporation,
limited liability company or association;
(j) "Commissioner" means the Commissioner of Public Health or the
commissioner's designee;
(k) "Home health agency" means an agency licensed as a home health
care agency or a home health aide agency; Substitute Senate Bill No. 986
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(l) "Assisted living services agency" means an agency that provides,
among other things, nursing services and assistance with activities of
daily living to a population that is chronic and stable and may have a
dementia special care unit or program as defined in section 19a-562;
(m) "Outpatient clinic" means an organization operated by a
municipality or a corporation, other than a hospital, that provides (1)
ambulatory medical care, including preventive and health promotion
services, (2) dental care, or (3) mental health services in conjunction with
medical or dental care for the purpose of diagnosing or treating a health
condition that does not require the patient's overnight care;
(n) "Multicare institution" means a hospital that provides outpatient
behavioral health services or other health care services, psychiatric
outpatient clinic for adults, free-standing facility for the care or
treatment of substance abusive or dependent persons, hospital for
psychiatric disabilities, as defined in section 17a-495, or a general acute
care hospital that provides outpatient behavioral health services that (1)
is licensed in accordance with this chapter, (2) has more than one facility
or one or more satellite units owned and operated by a single licensee,
and (3) offers complex patient health care services at each facility or
satellite unit. For purposes of this subsection, "satellite unit" means a
location where a segregated unit of services is provided by the multicare
institution;
(o) "Nursing home" or "nursing home facility" means (1) any chronic
and convalescent nursing home or any rest home with nursing
supervision that provides nursing supervision under a medical director
twenty-four hours per day, or (2) any chronic and convalescent nursing
home that provides skilled nursing care under medical supervision and
direction to carry out nonsurgical treatment and dietary procedures for
chronic diseases, convalescent stages, acute diseases or injuries;
(p) "Outpatient dialysis unit" means (1) an out-of-hospital out-patient Substitute Senate Bill No. 986
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dialysis unit that is licensed by the department to provide (A) services
on an out-patient basis to persons requiring dialysis on a short-term
basis or for a chronic condition, or (B) training for home dialysis, or (2)
an in-hospital dialysis unit that is a special unit of a licensed hospital
designed, equipped and staffed to (A) offer dialysis therapy on an out-
patient basis, (B) provide training for home dialysis, and (C) perform
renal transplantations;
(q) "Hospice agency" means a public or private organization that
provides home care and hospice services to terminally ill patients;
(r) "Psychiatric residential treatment facility" means a nonhospital
facility with a provider agreement with the Department of Social
Services to provide inpatient services to Medicaid-eligible individuals
under the age of twenty-one; [and]
(s) "Chronic disease hospital" means a long-term hospital having
facilities, medical staff and all necessary personnel for the diagnosis,
care and treatment of chronic diseases; and
(t) "Birth center" means a freestanding facility that is licensed by the
department (1) to provide perinatal, labor, delivery and postpartum
care during and immediately after delivery to persons presenting with
a low-risk pregnancy and healthy newborns for a period typically less
than twenty-four hours, and (2) that is not a hospital licensed pursuant
to the provisions of this chapter, or attached to or located in such a
hospital. For the purposes of this subsection, "low-risk pregnancy"
means an uncomplicated, singleton pregnancy that has vertex
presentation and is at low risk for developing complications during
labor and birth, as determined by an evaluation and examination
conducted by a licensed health care provider acting within the scope of
such provider's practice.
Sec. 2. (NEW) (Effective October 1, 2023) (a) On and after January 1, Substitute Senate Bill No. 986
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2024, no person, entity, firm, partnership, corporation, limited liability
company or association shall establish, conduct, operate or maintain a
birth center, as defined in section 19a-490 of the general statutes, as
amended by this act, in this state without obtaining a license pursuant
to the provisions of this section. Except in the case of an emergency, an
outpatient clinic shall not offer any birth center services as part of its
ambulatory medical services without being licensed as a birth center.
For the purposes of this subsection, "birth center services" means
perinatal, labor, delivery and postpartum care during and immediately
after delivery to persons presenting with a low-risk pregnancy and
healthy newborns for a period typically less than twenty-four hours and
"low-risk pregnancy" has the same meaning as provided in subsection
(t) of section 19a-490 of the general statutes, as amended by this act.
(b) Each birth center shall be accredited by the Commission for the
Accreditation of Birth Centers on or before the effective date of its
licensure and maintain such accreditation during the time it is licensed.
If a birth center loses its accreditation, the birth center shall immediately
notify the Commissioner of Public Health and cease providing birth
center services to patients until authorized by the commissioner to
reinstate such services.
(c) (1) Each birth center shall have a written plan to obtain services
for its patients from a hospital, licensed pursuant to chapter 368v of the
general statutes, to provide services in the event of an emergency or
other conditions that pose a risk to the health of a patient that require
transfer of the patient to a hospital. Before issuing a license pursuant to
this section, the commissioner shall review and approve the information
submitted by the birth center to the Commission for the Accreditation
of Birth Centers, including, but not limited to, (A) information relating
to the birth center's plan for ongoing risk assessment and adherence to
patient eligibility criteria, as determined by the Commission for the
Accreditation of Birth Centers, during the delivery of birth center Substitute Senate Bill No. 986
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services to a patient, and (B) information relating to the birth center's
policies and procedures for the prenatal, intrapartum or postpartum
transfer of a patient in the event that such patient no longer meets such
patient eligibility criteria.
(2) If a patient receiving birth center services no longer presents with
a low-risk pregnancy, as defined in section 19a-490 of the general
statutes, as amended by this act, or otherwise fails to meet the patient
eligibility criteria described subparagraph (A) of subdivision (1) of this
subsection, the birth center providing such services shall ensure the
patient's care is transferred to a licensed health care provider capable of
providing the appropriate level of obstetrical care for the patient.
(d) Each hospital licensed pursuant to chapter 368v of the general
statutes that maintains an emergency department, other than a
children's hospital, shall work cooperatively with birth centers to
coordinate the care of patients who may require services in the event of
an emergency or other conditions that pose a risk to the health of a
patient that require transfer of the patient to a hospital. Each children's
hospital that maintains an emergency department sh all work
cooperatively with birth centers to coordinate the care of neonatal
patients who may require services in the event of an emergency or other
conditions that pose a risk to the health of a patient that require transfer
of the patient to a children's hospital.
(e) The commissioner shall adopt regulations, in accordance with the
provisions of chapter 54 of the general statutes, to implement the
provisions of this section and section 19a-495 of the general statutes. The
commissioner may implement policies and procedures necessary to
administer the provisions of this section while in the process of adopting
such policies and procedures as regulations, provided notice of intent to
adopt regulations is published on the eRegulations system not later than
twenty days after the date of implementation. Policies and procedures
implemented pursuant to this section shall be valid until the time final Substitute Senate Bill No. 986
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regulations are adopted. The regulations and policies and procedures
shall include, but need not be limited to, provisions regarding the
administration of the facility, staffing requirements, infection control
protocols, physical plant requirements, accommodation of the
participation of support persons of the patient's choice, limitations on
the provision of anesthesia and surgical procedures, operating
procedures for determining risk status of patients at admission and
during labor, reportable events, medical records, pharmaceutical
services, laundry services, requirements for professional and medical
liability insurance for the facility and health care providers and
emergency planning.
Sec. 3. Subsection (c) of section 19a-491 of the general statutes is
repealed and the following is substituted in lieu thereof (Effective January
1, 2024):
(c) [Notwithstanding any regulation, the] The Commissioner of
Public Health shall charge the following fees for the biennial licensing
and inspection of the following institutions: (1) Chronic and
convalescent nursing homes, per site, four hundred forty dollars; (2)
chronic and convalescent nursing homes, per bed, five dollars; (3) rest
homes with nursing supervision, per site, four hundred forty dollars; (4)
rest homes with nursing supervision, per bed, five dollars; (5) outpatient
dialysis units and outpatient surgical facilities, six hundred twenty-five
dollars; (6) mental health residential facilities, per site, three hundred
seventy-five dollars; (7) mental health residential facilities, per bed, five
dollars; (8) hospitals, per site, nine hundred forty dollars; (9) hospitals,
per bed, seven dollars and fifty cents; (10) nonstate agency educational
institutions, per infirmary, one hundred fifty dollars; (11) nonstate
agency educational institutions, per infirmary bed, twenty-five dollars;
(12) home health care agencies, except certified home health care
agencies described in subsection (d) of this section, per agency, three
hundred dollars; (13) home health care agencies, hospice agencies or Substitute Senate Bill No. 986
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home health aide agencies, except certified home health care agencies,
hospice agencies or home health aide agencies described in subsection
(d) of this section, per satellite patient service office, one hundred
dollars; (14) assisted living services agencies, except such agencies
participating in the congregate housing facility pilot program described
in section 8-119n, per site, five hundred dollars; (15) short-term hospitals
special hospice, per site, nine hundred forty dollars; (16) short-term
hospitals special hospice, per bed, seven dollars and fifty cents; (17)
hospice inpatient facility, per site, four hundred forty dollars; [and] (18)
hospice inpatient facility, per bed, five dollars; and (19) birth centers, per
site, nine hundred forty dollars and, per bed, seven dollars and fifty
cents.
Sec. 4. Section 20-86b of the general statutes is repealed and the
following is substituted in lieu thereof (Effective January 1, 2024):
Nurse-midwives shall practice within a health care system or birth
center and have clinical relationships with obstetrician-gynecologists
that provide for consultation, collaborative management or referral, as
indicated by the health status of the patient. Nurse-midwifery care shall
be consistent with the standards of care established by the Accreditation
Commission for Midwifery Education. Each nurse-midwife shall
provide each patient with information regarding, or referral to, other
providers and services upon request of the patient or when the care
required by the patient is not within the midwife's scope of practice.
Each nurse-midwife shall sign the birth certificate of each infant
delivered by the nurse-midwife. If an infant is born alive and then dies
within the twenty-four-hour period after birth, the nurse-midwife may
make the actual determination and pronouncement of death provided:
(1) The death is an anticipated death; (2) the nurse-midwife attests to
such pronouncement on the certificate of death; and (3) the nurse-
midwife or a physician licensed pursuant to chapter 370 certifies the
certificate of death not later than twenty-four hours after such Substitute Senate Bill No. 986
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pronouncement. In a case of fetal death, as described in section 7-60, the
nurse-midwife who delivered the fetus may make the actual
determination of fetal death and certify the date of delivery and that the
fetus was born dead.
Sec. 5. Subsection (a) of section 19a-613 of the general statutes is
repealed and the following is substituted in lieu thereof (Effective October
1, 2023):
(a) The Health Systems Planning Unit may employ the most effective
and practical means necessary to fulfill the purposes of this chapter,
which may include, but need not be limited to:
(1) Collecting patient-level outpatient data from health care facilities,
[or institutions,] as defined in section 19a-630, and birth centers, as
defined in section 19a-490, as amended by this act;
(2) Establishing a cooperative data collection effort, across public and
private sectors, to assure that adequate health care personnel
demographics are readily available; and
(3) Performing the duties and functions as enumerated in subsection
(b) of this section.
Sec. 6. Subsection (b) of section 19a-127n of the general statutes is
repealed and the following is substituted in lieu thereof (Effective October
1, 2023):
(b) On and after October 1, [2002] 2023, a hospital or birth center, as
such terms are defined in section 19a-490, as amended by this act, or
outpatient surgical facility, as defined in section 19a-493b, shall report
adverse events to the Department of Public Health on a form prescribed
by the commissioner as follows: (1) A written report and the status of
any corrective steps shall be submitted not later than seven days after
the date on which the adverse event occurred; and (2) a corrective action Substitute Senate Bill No. 986
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plan shall be filed not later than thirty days after the date on which the
adverse event occurred. Emergent reports, as defined in the regulations
adopted pursuant to subsection (c) of this section, shall be made to the
department immediately. Failure to implement a corrective action plan
may result in disciplinary action by the commissioner, pursuant to
section 19a-494.
Sec. 7. Section 19a-505 of the general statutes is repealed and the
following is substituted in lieu thereof (Effective October 1, 2023):
(a) No person shall keep a maternity hospital or lying-in place unless
such person has previously obtained a license therefor, issued by the
Department of Public Health. Each such license shall be valid for a term
of two years and may be revoked by the Department of Public Health
upon proof that the institution for which such license was issued is
being improperly conducted or for the violation of any of the provisions
of this section or of the Public Health Code, or on the basis of lack of
demonstrable need, provided the licensee shall be given a reasonable
opportunity to be heard in reference to such proposed revocation.
(b) Within six hours after the departure, removal or withdrawal of
any child born at such maternity hospital or lying-in place, the keeper
thereof shall make a record of such departure, removal or withdrawal
of such child, the names and residences of the persons who took such
child or its body and the place to which it was taken and where it was
left, which record shall be produced by the keeper or licensee of such
hospital or lying-in place, for inspection by and upon the demand of any
person authorized to make such inspection by the Department of Public
Health or the council. Each keeper of any such hospital or lying-in place,
and his servants and agents, shall permit any person so authorized to
enter such hospital or lying-in place and inspect such hospital or lying-
in place and all of its appurtenances, for the purpose of detecting any
improper treatment of any child or any improper management or
conduct in such hospital or lying-in place or its appurtenances. Each Substitute Senate Bill No. 986
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person so authorized may remove any article which he may think
presents evidence of any crime being committed therein and deliver the
same to the appropriate law enforcement official to be disposed of
according to law. Any person who violates any provision of this section
shall be fined not more than two hundred dollars or imprisoned not
more than six months or both.
(c) On and after January 1, 2024, the Commissioner of Public Health
shall not grant or renew a maternity hospital license pursuant to this
section.
Sec. 8. Subsection (b) of section 19a-638 of the general statutes is
repealed and the following is substituted in lieu thereof (Effective January
1, 2024):
(b) A certificate of need shall not be required for:
(1) Health care facilities owned and operated by the federal
government;
(2) The establishment of offices by a licensed private practitioner,
whether for individual or group practice, except when a certificate of
need is required in accordance with the requirements of section 19a-
493b or subdivision (3), (10) or (11) of subsection (a) of this section;
(3) A health care facility operated by a religious group that
exclusively relies upon spiritual means through prayer for healing;
(4) Residential care homes, as defined in subsection (c) of section 19a-
490, as amended by this act, and nursing homes and rest homes, as
defined in subsection (o) of section 19a-490, as amended by this act;
(5) An assisted living services agency, as defined in section 19a-490,
as amended by this act;
(6) Home health agencies, as defined in section 19a-490, as amended Substitute Senate Bill No. 986
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by this act;
(7) Hospice services, as described in section 19a-122b;
(8) Outpatient rehabilitation facilities;
(9) Outpatient chronic dialysis services;
(10) Transplant services;
(11) Free clinics, as defined in section 19a-630;
(12) School-based health centers and expanded school health sites, as
such terms are defined in section 19a-6r, community health centers, as
defined in section 19a-490a, not-for-profit outpatient clinics licensed in
accordance with the provisions of chapter 368v and federally qualified
health centers;
(13) A program licensed or funded by the Department of Children
and Families, provided such program is not a psychiatric residential
treatment facility;
(14) Any nonprofit facility, institution or provider that has a contract
with, or is certified or licensed to provide a service for, a state agency or
department for a service that would otherwise require a certificate of
need. The provisions of this subdivision shall not apply to a short-term
acute care general hospital or children's hospital, or a hospital or other
facility or institution operated by the state that provides services that are
eligible for reimbursement under Title XVIII or XIX of the federal Social
Security Act, 42 USC 301, as amended;
(15) A health care facility operated by a nonprofit educational
institution exclusively for students, faculty and staff of such institution
and their dependents;
(16) An outpatient clinic or program operated exclusively by or Substitute Senate Bill No. 986
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contracted to be operated exclusively by a municipality, municipal
agency, municipal board of education or a health district, as described
in section 19a-241;
(17) A residential facility for persons with intellectual disability
licensed pursuant to section 17a-227 and certified to participate in the
Title XIX Medicaid program as an intermediate care facility for
individuals with intellectual disabilities;
(18) Replacement of existing imaging equipment if such equipment
was acquired through certificate of need approval or a certificate of need
determination, provided a health care facility, provider, physician or
person notifies the unit of the date on which the equipment is replaced
and the disposition of the replaced equipment;
(19) Acquisition of cone-beam dental imaging equipment that is to be
used exclusively by a dentist licensed pursuant to chapter 379;
(20) The partial or total elimination of services provided by an
outpatient surgical facility, as defined in section 19a-493b, except as
provided in subdivision (6) of subsection (a) of this section and section
19a-639e;
(21) The termination of services for which the Department of Public
Health has requested the facility to relinquish its license;
(22) Acquisition of any equipment by any person that is to be used
exclusively for scientific research that is not conducted on humans; [or]
(23) On or before June 30, 2026, an increase in the licensed bed
capacity of a mental health facility, provided (A) the mental health
facility demonstrates to the unit, in a form and manner prescribed by
the unit, that it accepts reimbursement for any covered benefit provided
to a covered individual under: (i) An individual or group health
insurance policy providing coverage of the type specified in Substitute Senate Bill No. 986
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subdivisions (1), (2), (4), (11) and (12) of section 38a-469; (ii) a self-
insured employee welfare benefit plan established pursuant to the
federal Employee Retirement Income Security Act of 1974, as amended
from time to time; or (iii) HUSKY Health, as defined in section 17b-290,
and (B) if the mental health facility does not accept or stops accepting
reimbursement for any covered benefit provided to a covered
individual under a policy, plan or program described in clause (i), (ii) or
(iii) of subparagraph (A) of this subdivision, a certificate of need for such
increase in the licensed bed capacity shall be required; or
(24) On or before June 30, 2028, a birth center, as defined in section
19a-490, as amended by this act, that is enrolled as a provider in the
Connecticut medical assistance program, as defined in section 17b-245g.
Sec. 9. (Effective October 1, 2023) The executive director of the Office of
Health Strategy, in consultation with the Commissioner of Public
Health, shall, within available appropriations, study whether the
certificate of need exemption for birth centers described in subdivision
(24) of subsection (b) of section 19a-638 of the general statutes, as
amended by this act, should be extended. Pursuant to such study, the
executive director shall collect data from birth centers in the state
concerning (1) the number of deliveries performed at each birth center
and the number of patient transfers or referrals to other settings of care,
including the reason for such transfers and referrals, (2) the number and
percentages of patients who are self-pay, covered by commercial
insurance and covered by a government payer program, including, but
not limited to, the Connecticut medical assistance program, as defined
in section 17b-245g of the general statutes, (3) patient demographic
information, including the race, ethnicity and preferred language of
patients, (4) geographic locations of birth centers and catchment areas,
(5) financial assistance and uncompensated care provided by each birth
center, and (6) any other information deemed necessary by the executive
director. Not later than July 1, 2027, the executive director shall report, Substitute Senate Bill No. 986
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in accordance with the provisions of section 11-4a of the general statutes,
regarding such study to the joint standing committee of the General
Assembly having cognizance of matters relating to public health.
Sec. 10. (NEW) (Effective October 1, 2023) (a) As used in this section
and section 11 of this act, "infant death" means the death of a child that
occurs between birth and one year of age.
(b) There is established, within the Department of Public Health, an
infant mortality review program. The purpose of the program shall be
to review medical records and other relevant data related to infant
deaths, including, but not limited to, information collected from death
and birth records, and medical records from health care providers and
health care facilities for the purposes of making recommendations to
reduce health care disparities and identify gaps in or problems with the
delivery of care or services to reduce infant deaths.
(c) All health care providers, health care facilities and pharmacies
shall provide the Commissioner of Public Health, or the commissioner's
designee, with access to all medical and other records associated with
an infant death case under review by the program, including, but not
limited to, prenatal care records, upon the request of the commissioner.
(d) A person who completes a death certificate pursuant to section 7-
62b or section 19a-409 of the general statutes for an infant death shall
report such death to the department in a form and manner prescribed
by the commissioner.
(e) Notwithstanding any provision of the general statutes, the
commissioner shall notify the child fatality review panel, established
pursuant to section 46a-13l of the general statutes, of an infant death if,
pursuant to a review performed by the infant mortality review program,
the commissioner determines that such infant death occurred in out-of-
home care or was due to unexpected or unexplained causes. Substitute Senate Bill No. 986
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(f) All information obtained by the commissioner, or the
commissioner's designee, for the infant mortality review program shall
be confidential pursuant to section 19a-25 of the general statutes, as
amended by this act.
(g) Notwithstanding any provision of the general statutes, the
commissioner, or the commissioner's designee may provide the infant
mortality review committee, established pursuant to section 11 of this
act, with information as is necessary, in the commissioner's discretion,
for the committee to make recommendations regarding the prevention
of infant deaths.
(h) The provisions of this section and section 11 of this act shall not
be construed to limit or alter the authority of the Office of the Child
Advocate or the child fatality review panel, established pursuant to
section 46a-13l of the general statutes, to investigate or make
recommendations regarding a child's death pursuant to the provisions
of said section.
Sec. 11. (NEW) (Effective October 1, 2023) (a) There is established an
infant mortality review committee within the department to conduct a
comprehensive, multidisciplinary review of infant deaths for purposes
of reducing health care disparities, identifying factors associated with
infant deaths and making recommendations to reduce infant deaths.
(b) The cochairpersons of the infant mortality review committee shall
be the Commissioner of Public Health, or the commissioner's designee,
and a representative designated by the Connecticut chapter of the
American Academy of Pediatrics. The cochairpersons shall convene a
meeting of the infant mortality review committee upon the request of
the Commissioner of Public Health.
(c) The infant mortality review committee may include, but need not
be limited to, any of the following members, as needed, depending on Substitute Senate Bill No. 986
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the infant death case being reviewed:
(1) A physician licensed pursuant to chapter 370 of the general
statutes, who specializes in obstetrics and gynecology, designated by
the Connecticut Chapter of the American College of Obstetrics and
Gynecology;
(2) A community health worker, designated by the Commission on
Women, Children, Seniors, Equity and Opportunity;
(3) A pediatric nurse licensed pursuant to chapter 378 of the general
statutes, designated by the Connecticut Nurses Association;
(4) A clinical social worker licensed pursuant to chapter 383b of the
general statutes, designated by the Connecticut Chapter of the National
Association of Social Workers;
(5) The Chief Medical Examiner, or the Chief Medical Examiner's
designee;
(6) A member of the Connecticut Hospital Association representing a
pediatric facility;
(7) A representative of The University of Connecticut-sponsored
Health Disparities Institute;
(8) A physician licensed pursuant to chapter 370 of the general
statutes, who practices neonatology, designated by the Connecticut
Medical Society;
(9) A physician assistant licensed pursuant to chapter 370 of the
general statutes or advanced practice registered nurse licensed pursuant
to chapter 378 of the general statutes, designated by an association
representing physician assistants or advanced practice registered nurses
in the state; Substitute Senate Bill No. 986
Public Act No. 23-147 19 of 29
(10) The Child Advocate, or the Child Advocate's designee;
(11) The Commissioner of Social Services, or the commissioner's
designee;
(12) The Commissioner of Children and Families, or the
commissioner's designee;
(13) The Commissioner of Early Childhood, or the commissioner's
designee;
(14) The Commissioner of Mental Health and Addiction Services, or
the commissioner's designee; and
(15) Any additional member the cochairpersons determine would be
beneficial to serve as a member of the committee.
(d) For any infant mortality review, the committee may consult with
relevant experts to evaluate the information and findings obtained from
the department pursuant to section 10 of this act and make
recommendations regarding the prevention of infant deaths.
(e) The infant mortality review committee shall include available
infant death reports and recommendations produced by the child
fatality review panel, established pursuant to section 46a-13l of the
general statutes, in its review of infant deaths for the purposes of
making recommendations to reduce health care disparities and identify
gaps in or problems with the delivery of care or services to reduce infant
deaths.
(f) Not later than ninety days after completing an infant mortality
review, the committee shall, in consultation with the Office of the Child
Advocate, report to the Commissioner of Public Health the
recommendations and findings of the committee in a manner that
complies with section 19a-25 of the general statutes, as amended by this Substitute Senate Bill No. 986
Public Act No. 23-147 20 of 29
act.
(g) All information provided by the department to the infant
mortality review committee or provided to any expert consulted by the
committee shall be subject to the provisions of section 19a-25 of the
general statutes, as amended by this act.
Sec. 12. Subsection (a) of section 19a-25 of the general statutes is
repealed and the following is substituted in lieu thereof (Effective October
1, 2023):
(a) All information, records of interviews, written reports, statements,
notes, memoranda or other data, including personal data as defined in
subdivision (9) of section 4-190, procured by: (1) The Department of
Public Health, by staff committees of facilities accredited by the
Department of Public Health, [or] the maternity mortality review
committee, established pursuant to section 19a-59i, or the infant
mortality review committee, established pursuant to section 11 of this
act, in connection with studies of morbidity and mortality conducted by
the Department of Public Health, such staff committees, [or] the
maternal mortality review committee or the infant mortality review
committee, or carried on by said department, such staff committees or
the maternal mortality review committee jointly with other persons,
agencies or organizations, (2) the directors of health of towns, cities or
boroughs or the Department of Public Health pursuant to section 19a-
215, or (3) the Department of Public Health or such other persons,
agencies or organizations, for the purpose of reducing the morbidity or
mortality from any cause or condition, shall be confidential and shall be
used solely for the purposes of medical or scientific research and, for
information obtained pursuant to section 19a-215, disease prevention
and control by the local director of health and the Department of Public
Health and reducing the morbidity or mortality from any cause or
condition. Such information, records, reports, statements, notes,
memoranda or other data shall not be admissible as evidence in any Substitute Senate Bill No. 986
Public Act No. 23-147 21 of 29
action of any kind in any court or before any other tribunal, board,
agency or person, nor shall it be exhibited or its contents disclosed in
any way, in whole or in part, by any officer or representative of the
Department of Public Health or of any such facility, by any person
participating in such a research project or by any other person, except
as may be necessary for the purpose of furthering the research project
or public health use to which it relates.
Sec. 13. (NEW) (Effective July 1, 2023) (a) As used in this section:
(1) "Certified doula" means a doula that is certified by the Department
of Public Health; and
(2) "Doula" means a trained, nonmedical professional who provides
physical, emotional and informational support, virtually or in person,
to a pregnant person and any family or friends supporting such person
before, during and after birth.
(b) The Commissioner of Public Health shall, within available
resources, establish a Doula Advisory Committee within the
Department of Public Health. The Doula Advisory Committee shall
develop recommendations for (1) requirements for certification and
certification renewal of doulas, including, but not limited to, training,
experience or continuing education requirements; and (2) standards for
recognizing doula training program curricula that are sufficient to
satisfy the requirements for doula certification.
(c) The Commissioner of Public Health, or the commissioner's
designee, shall be the chairperson of the Doula Advisory Committee.
(d) The Doula Advisory Committee shall consist of the following
members:
(1) Seven appointed by the Commissioner of Public Health, or the
commissioner's designee, who are actively practicing as doulas in the Substitute Senate Bill No. 986
Public Act No. 23-147 22 of 29
state;
(2) One appointed by the Commissioner of Public Health, or the
commissioner's designee, who is a nurse-midwife, licensed pursuant to
chapter 377 of the general statutes, who has experience working with a
doula;
(3) One appointed by the Commissioner of Public Health, or the
commissioner's designee, in consultation with the Connecticut Hospital
Association, who shall represent an acute care hospital;
(4) One appointed by the Commissioner of Public Health, or the
commissioner's designee, who shall represent an association that
represents hospitals and health-related organizations in the state;
(5) One appointed by the Commissioner of Public Health, or the
commissioner's designee, who shall be a licensed health care provider
who specializes in obstetrics and has experience working with a doula;
(6) One appointed by the Commissioner of Public Health, or the
commissioner's designee, who shall represent a community-based
doula training organization;
(7) One appointed by the Commissioner of Public Health, or the
commissioner's designee, who shall represent a community-based
maternal and child health organization;
(8) One appointed by the Commissioner of Public Health, or the
commissioner's designee, who shall have expertise in health equity;
(9) The Commissioner of Social Services, or the commissioner's
designee;
(10) The Commissioner of Mental Health and Addiction Services, or
the commissioner's designee; and Substitute Senate Bill No. 986
Public Act No. 23-147 23 of 29
(11) The Commissioner of Early Childhood, or the commissioner's
designee.
(e) The Doula Advisory Committee shall establish a Doula Training
Program Review Committee. Such committee shall (1) conduct a
continuous review of doula training programs; and (2) provide a list of
approved doula training programs in the state that meet the
requirements established by the Doula Advisory Committee.
Sec. 14. (NEW) (Effective July 1, 2023) (a) As used in this section, (1)
"certified doula" means a doula who is certified by the Department of
Public Health, and (2) "doula" means a trained, nonmedical professional
who provides physical, emotional and informational support, virtually
or in person, to a pregnant person and any family or friends supporting
such person before, during and after birth.
(b) The Doula Advisory Committee, established pursuant to section
13 of this act, shall advise the Commissioner of Public Health, or the
commissioner's designee, on matters relating to doula services,
including, but not limited to, (1) access and promotion of education and
resources for pregnant persons, and any family and friends supporting
such person; (2) recommendations to improve access to doula care; and
(3) furthering interagency efforts to address maternal health disparities.
The committee shall decide to renew or disband the committee on an
annual basis in a manner determined by the commissioner or the
commissioner's designee.
(c) The Doula Training Program Review Committee, established
pursuant to section 13 of this act, shall (1) conduct an ongoing review of
doula education and training programs, (2) provide the commissioner,
or the commissioner's designee, with a list of approved doula education
and training programs, which shall include training in core doula
competencies, and (3) recommend certified doula continuing education
requirements to the commissioner. Substitute Senate Bill No. 986
Public Act No. 23-147 24 of 29
(d) On and after October 1, 2023, no person shall use the title "certified
doula" unless such person is certified pursuant to this section. The
provisions of this section shall not be construed to prohibit a doula, who
is not a certified doula, from providing doula services, provided such
doula does not use the title "certified doula".
(e) Each person seeking certification to practice as a certified doula
shall apply to the Department of Public Health, on forms prescribed by
the commissioner, and pay an application fee of one hundred dollars.
Such application shall include: (1) Proof that the applicant is eighteen
years of age or older; (2) two reference letters from families or
professionals with direct knowledge of the applicant's experience as a
doula verifying the applicant's training or experience; and (3) (A)
demonstration of the applicant's completion of a doula training
program or a combination of such programs approved pursuant to
subsection (c) of this section, or (B) an attestation by the applicant that
such applicant has provided doula services to at least three families and
training in not less than four core competencies identified by the Doula
Training Program Review Committee during the five years preceding
the date of the application.
(f) The commissioner may grant certification by endorsement to a
doula who presents evidence satisfactory to the commissioner that the
applicant is certified as a doula in another state or jurisdiction whose
requirements for certification are substantially similar to those of this
state for not less than two years before the date such doula submits an
application for certification. No certification shall be issued under this
section to any applicant against whom professional disciplinary action
is pending or who is the subject of an unresolved complaint.
(g) The commissioner shall adopt continuing education requirements
for certified doulas provided by the Doula Training Program Review
Committee pursuant to subsection (c) of this section. Substitute Senate Bill No. 986
Public Act No. 23-147 25 of 29
(h) Certification issued under this section may be renewed every
three years. The certification shall be renewed in accordance with the
provisions for renewal under section 19a-88 of the general statutes for a
fee of one hundred dollars. Each certified doula applying for renewal
shall provide to the commissioner evidence of completion of the
continuing education requirements adopted pursuant to subsection (g)
of this section.
(i) The commissioner may take any disciplinary action set forth in
section 19a-17 of the general statutes against a certified doula for failure
to conform to the accepted standards of the profession including, but
not limited to, any of the following reasons: (1) Fraud or deceit in
obtaining or seeking reinstatement of a certification to practice as a
certified doula; (2) engaging in fraud or material deception in the course
of professional services or activities; (3) negligent, incompetent or
wrongful conduct in professional activities; (4) aiding or abetting the use
of the title "certified doula" by an individual who is not certified; (5)
physical, mental or emotional illness or disorder resulting in an inability
to conform to the accepted standards of the profession; or (6) abuse or
excessive use of drugs, including alcohol, narcotics or chemicals. The
commissioner may order a certified doula to submit to a reasonable
physical or mental examination if such certified doula's physical or
mental capacity to practice safely is the subject of an investigation. The
commissioner may petition the superior court for the judicial district of
Hartford to enforce such order or any action taken pursuant to section
19a-17 of the general statutes. The commissioner shall give notice and
an opportunity to be heard on any contemplated action under section
19a-17 of the general statutes.
Sec. 15. (NEW) (Effective July 1, 2023) (a) As used in this section:
(1) "Certified midwife" means any individual who completes a
graduate degree in midwifery and passes a national certification
examination administered by the American Midwifery Certification Substitute Senate Bill No. 986
Public Act No. 23-147 26 of 29
Board to receive the professional designation of certified midwife;
(2) "Community birth" means a planned home birth or a birth
occurring at a birth center;
(3) "Direct entry midwife" means any individual trained in planned
out-of-hospital births other than a nurse-midwife, which may include
certified midwives, certified professional midwives, community
midwives and traditional midwives; and
(4) "Licensed nurse-midwife" means any individual licensed as a
nurse-midwife pursuant to chapter 377 of the general statutes.
(b) The Commissioner of Public Health shall establish a midwifery
working group. The working group shall study and make
recommendations concerning the advancement of choices in care for
community birth and the role of direct entry midwives in addressing
maternal and infant health disparities. Such study shall include, but
need not be limited to:
(1) Improvements in birthing care quality and safety, including
improvements addressing racial disparities in maternal and infant
health outcomes;
(2) Regulation, licensure or certification of direct entry midwives not
otherwise licensed to practice midwifery in the state;
(3) Regulation, licensure or certification of certified midwives not
otherwise licensed to practice midwifery in the state; and
(4) Advancements of interprofessional coordination of birthing care,
including community birth.
(c) The Commissioner of Public Health shall appoint members of the
working group. Such members shall include, but need not be limited to,
the commissioner's designee, at least six direct-entry midwives Substitute Senate Bill No. 986
Public Act No. 23-147 27 of 29
practicing in the state, a certified nurse-midwife with experience
working with direct entry midwives, a certified midwife representing
an entity that certifies midwives, a doula serving communities of color,
a representative of families or a community-based organization with an
interest in maternity care, a representative of a community organization
furthering health equity, representatives of associated maternity care
professions, a representative of the state hospital association and a
representative of the Department of Social Services.
(d) Not later than February 1, 2024, and annually thereafter, the
midwifery working group shall report to the Commissioner of Public
Health and, in accordance with the provisions of section 11-4a of the
general statutes, to the joint standing committee of the General
Assembly having cognizance of matters relating to public health on its
findings and recommendations.
(e) The midwifery working group shall select to renew or disband the
group on an annual basis in a manner determined by the commissioner
or the commissioner's designee.
Sec. 16. (NEW) (Effective July 1, 2023) (a) As used in this section,
"universal nurse home visiting" means an evidence-based nurse home
visiting model in which a registered nurse, licensed pursuant to chapter
378 of the general statutes, with specialized training provides services
in the home to families with newborns in accordance with the
provisions of this section.
(b) The Commissioner of Early Childhood, in collaboration with the
Commissioners of Social Services and Public Health and the Executive
Director of the Office of Health Strategy, shall, within available
appropriations, develop a state-wide program to offer universal nurse
home visiting services to all families with newborns residing in the state
to support parental health, healthy child development and strengthen
families. Substitute Senate Bill No. 986
Public Act No. 23-147 28 of 29
(c) When developing the program, said commissioners and executive
director, shall (1) consult with insurers that offer health benefit plans in
the state, hospitals, local public health authorities, existing early
childhood home visiting programs, community-based organizations
and social service providers; and (2) maximize the use of available
federal funding.
(d) The program shall provide universal nurse home visiting services
that are (1) evidence-based, and (2) designed to improve outcomes in
one or more of the following areas: (A) Child safety; (B) child health and
development; (C) family economic self-sufficiency; (D) maternal and
parental health; (E) positive parenting; (F) reducing child mistreatment;
(G) reducing family violence; (H) parent-infant bonding; and (I) any
other appropriate area established, in writing, by the Commissioners of
Early Childhood, Social Services and Public Health and the executive
director of the Office of Health Strategy.
(e) The universal nurse home visiting services provided pursuant to
the program shall (1) be voluntary and carry no negative consequences
for a family that declines to participate, (2) include an evidence-based
assessment of the physical, social and emotional factors affecting a
family receiving such services, (3) include at least one visit during a
newborn's first three months of life or other timeframe as deemed
appropriate by said commissioners and executive director and that is
consistent with an evidence-based model, (4) allow families to choose
up to a certain number of additional visits consistent with such model,
(5) include a follow-up visit no later than three months or other time
frame established by such model after the last visit, and (6) provide
information and referrals to address each family's identified needs. Such
services may be offered in every community in the state and to all
families with newborns based on the full extent of available provider
capacity.
(f) The Commissioner of Social Services may seek approval of an Substitute Senate Bill No. 986
Public Act No. 23-147 29 of 29
amendment to the state Medicaid plan or a waiver from federal law to
provide coverage for universal nurse home visiting services provided
pursuant to this section and in a time frame and manner to ensure that
such coverage does not duplicate other applicable federal funding.
(g) The Commissioner of Early Childhood, in collaboration with the
Commissioners of Social Services and Public Health and the executive
director of the Office of Health Strategy, shall collect and analyze data
generated by the program to assess the effectiveness of the program in
meeting the goals described in subsection (d) of this section and
collaborate with other state agencies to develop protocols for sharing
such data, including the timely sharing of data with primary care
providers that provide care to families with newborns receiving
universal nurse home visiting services pursuant to the provisions of this
section.
Sec. 17. Section 19a-505 of the general statutes is repealed. (Effective
July 1, 2025)
Sec. 18. Section 40 of public act 22-58 is repealed. (Effective July 1, 2023)