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General Assembly Substitute Bill No. 5411
February Session, 2024
AN ACT CONCERNING REQUESTS FOR HEALTH RECORDS AND
THE FEES CHARGED FOR ACCESS TO SUCH RECORDS.
Be it enacted by the Senate and House of Representatives in General
Assembly convened:
Section 1. Section 31-294f of the general statutes is repealed and the 1
following is substituted in lieu thereof (Effective October 1, 2024): 2
(a) An injured employee shall submit [himself] to an examination by 3
a reputable practicing physician or surgeon, at any time while claiming 4
or receiving compensation, upon the reasonable request of the employer 5
or at the direction of the administrative law judge. The examination 6
shall be performed to determine the nature of the injury and the 7
incapacity resulting from the injury. The physician or surgeon shall be 8
selected by the employer from an approved list of physicians and 9
surgeons prepared by the chairperson of the Workers' Compensation 10
Commission and shall be paid by the employer. At any examination 11
requested by the employer or directed by the administrative law judge 12
under this section, the injured employee shall be allowed to have in 13
attendance any reputable practicing physician or surgeon that the 14
employee obtains and [pays for himself] is paid for by the employee. 15
The employee shall submit to all other physical examinations as 16
required by this chapter. The refusal of an injured employee to submit 17
[himself] to a reasonable examination under this section shall suspend 18
[his] the employee's right to compensation during such refusal. 19 Substitute Bill No. 5411
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(b) All medical reports concerning any injury of an employee 20
sustained in the course of [his] the employee's employment shall be 21
furnished [within] not later than thirty days after the date of completion 22
of the reports, at the same time and in the same manner, to the employer 23
and the employee or [his] the employee's attorney. 24
(c) The administrative law judge may penalize a practicing physician, 25
surgeon or a third-party vendor acting on behalf of such physician or 26
surgeon if a medical report is not furnished not later than thirty days 27
after the date of completion of the report. Penalties imposed by an 28
administrative law judge shall include (1) issuance of written 29
notification of noncompliance in furnishing a medical report to the 30
practicing physician, surgeon or a third-party vendor acting on behalf 31
of such physician or surgeon, (2) an order requiring a physician, surgeon 32
or third-party vendor to appear at a hearing to explain the reasons for 33
not furnishing the report in a timely fashion, or (3) a fine not to exceed 34
five hundred dollars payable to the claimant. 35
Sec. 2. Section 20-7c of the general statutes is repealed and the 36
following is substituted in lieu thereof (Effective October 1, 2024): 37
(a) For purposes of this section, "clinical laboratory" has the same 38
meaning as provided in section 19a-490. "Clinical laboratory" does not 39
include any state laboratory established by the Department of Public 40
Health pursuant to section 19a-26 or 19a-29. 41
(b) Except as provided for in subsection (e) of this section, a provider 42
shall (1) supply to a patient upon request complete and current 43
information possessed by that provider concerning any diagnosis, 44
treatment and prognosis of the patient, and (2) notify a patient of any 45
test results in the provider's possession or requested by the provider for 46
the purposes of diagnosis, treatment or prognosis of such patient. In 47
addition, upon the request of a patient or a provider who orders medical 48
tests on behalf of a patient, a clinical laboratory shall provide medical 49
test results relating to the patient to (A) the patient, or (B) any other 50
provider who is treating the patient for the purposes of diagnosis, 51 Substitute Bill No. 5411
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treatment or prognosis of such patient. 52
(c) A provider, who requests that his or her patient submit to repeated 53
medical testing at regular intervals, over a specified period of time, for 54
purposes of ascertaining a diagnosis, prognosis or recommended course 55
of treatment for such patient, may issue a single authorization that 56
allows the entity that conducts such medical testing, including, but not 57
limited to, a clinical laboratory, to directly communicate the results of 58
such testing to the patient for the period of time that such testing is 59
requested by the provider. 60
(d) (1) Upon a written request of a patient, a patient's attorney or 61
authorized representative, or pursuant to a written authorization, a 62
provider, or entity acting on behalf of a provider, except as provided in 63
section 4-194, shall furnish to the person making such request a copy of 64
the patient's health record, including but not limited to, bills, x-rays and 65
copies of laboratory reports, contact lens specifications based on 66
examinations and final contact lens fittings given within the preceding 67
three months or such longer period of time as determined by the 68
provider but no longer than six months, records of prescriptions and 69
other technical information used in assessing the patient's health 70
condition. The written request shall specify if a paper or electronic copy 71
of the record is preferred, and if an electronic copy is preferred and is 72
able to be produced, then the provider, or entity acting on behalf of the 73
provider, shall furnish the electronic copy of the requested record. (2) 74
No provider, or entity acting on behalf of the provider, shall refuse to 75
return to a patient original records or copies of records that the patient 76
has brought to the provider from another provider. When returning 77
records to a patient, a provider may retain copies of such records for the 78
provider's file, provided such provider does not charge the patient for 79
the costs incurred in copying such records. No provider, or entity acting 80
on behalf of the provider, shall charge more than [sixty-five cents per 81
page, including] the following for a paper copy of a health record: (A) 82
Seventy-five cents per page for pages one to twenty-five, (B) fifty cents 83
per page for pages twenty-six to fifty, (C) twenty-five cents per page for 84
pages fifty-one to ninety-nine, and (D) ten cents per page for page one 85 Substitute Bill No. 5411
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hundred and each succeeding page thereafter. The fees prescribed in 86
this subdivision shall include any [research fees, handling] clerical fees 87
or related costs, and the cost of first class postage, if applicable, for 88
furnishing a health record pursuant to this subsection, except such 89
provider, or entity acting on behalf of the provider, may charge a patient 90
the amount necessary to cover the cost of materials for furnishing a copy 91
of an x-ray, provided no such charge shall be made for furnishing a 92
health record or part thereof to a patient, a patient's attorney or 93
authorized representative if the record or part thereof is necessary for 94
the purpose of supporting a claim or appeal under any provision of the 95
Social Security Act or a claim or appeal for veterans' benefits under any 96
provision of Title 38 of the United States Code or chapter 506 and the 97
request is accompanied by documentation of the claim or appeal. If an 98
electronic copy of a health record is requested and furnished, the 99
provider, or an entity acting on behalf of the provider, shall charge the 100
requestor not more than thirty-five cents per page with a maximum fee 101
of two hundred fifty dollars per record for such electronic copy. No 102
provider, or entity acting on behalf of a provider, shall charge a research 103
fee or handling fee for a paper or electronic health record unless the 104
patient, the patient's attorney or authorized representative requests that 105
the provider, or an entity acting on behalf of the provider, make 106
redactions to the requested health record. If a research fee or handling 107
fee is charged, such fee shall not exceed fifty dollars. If a patient, a 108
patient's attorney or authorized representative requests that the 109
provider, or an entity acting on behalf of a provider, furnish a health 110
record not later than seventy-two hours following the receipt of such 111
request, the provider, or entity acting on behalf of the provider, may 112
charge not more than an additional fee of fifty dollars to expedite the 113
furnishing of the health record. On and after January 1, 2025, the 114
Commissioner of Public Health shall publish on the department's 115
Internet web site, the fees prescribed for the furnishing of paper or 116
electronic copies of a health record pursuant to this subdivision. On 117
January 1, 2026, and each January first thereafter, the Commissioner of 118
Public Health shall adjust the fees prescribed in this subdivision for the 119
furnishing of paper or electronic copies of a health record, based upon 120 Substitute Bill No. 5411
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the consumer price index calculator published by the United States 121
Bureau of Labor and Statistics. (3) A provider, or an entity acting on 122
behalf of a provider, shall furnish a health record requested pursuant to 123
this section [within] not later than thirty days after the date of receipt of 124
the request. If such provider, or an entity acting on behalf of a provider, 125
fails to furnish the health record requested to the requestor not later than 126
thirty days after the date of receipt of request, the fee charged to furnish 127
such health record shall be reduced by fifty per cent. If such provider, 128
or an entity acting on behalf of a provider, fails to furnish the health 129
record requested to the requestor not later than sixty days after the date 130
of receipt of the request, the fee charged to furnish such health record 131
shall be reduced by seventy-five per cent. If such provider, or an entity 132
acting on behalf of a provider, fails to furnish the health record 133
requested to the requestor not later than ninety days after the date of 134
receipt of the request, the fee charged to furnish such health record shall 135
be reduced by ninety per cent. Nothing in this subsection shall be 136
construed to require a provider, or an entity acting on behalf of a 137
provider, to furnish a requested health record until such time as a 138
medical authorization form that is compliant with the provisions of the 139
Health Insurance Portability and Accountability Act of 1996, P.L. 104-140
191, as amended from time to time, has been submitted to the provider, 141
or an entity acting on behalf of a provider. (4) No health care provider, 142
[who] or entity acting on behalf of the provider, that has purchased or 143
assumed the practice of a provider who is retiring or deceased, may 144
refuse to return original records or copied records to a patient who 145
decides not to seek care from the successor provider. When returning 146
records to a patient who has decided not to seek care from a successor 147
provider, such provider may not charge a patient for costs incurred in 148
copying the records of the retired or deceased provider. 149
(e) If a provider reasonably determines that the information is 150
detrimental to the physical or mental health of the patient, or is likely to 151
cause the patient to harm himself, herself or another, the provider may 152
withhold the information from the patient. The information may be 153
supplied to an appropriate third party or to another provider who may 154 Substitute Bill No. 5411
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release the information to the patient. If disclosure of information is 155
refused by a provider under this subsection, any person aggrieved 156
[thereby] by such disclosure may, [within] not later than thirty days 157
after the date of such refusal, petition the superior court for the judicial 158
district in which such person resides for an order requiring the provider 159
to disclose the information. Such a proceeding shall be privileged with 160
respect to assignment for trial. The court, after hearing and an in camera 161
review of the information in question, shall issue the order requested 162
unless it determines that such disclosure would be detrimental to the 163
physical or mental health of the person or is likely to cause the person 164
to harm himself, herself or another. 165
(f) The provisions of this section shall not apply to any information 166
relative to any psychiatric or psychological problems or conditions. 167
(g) In the event that a provider abandons his or her practice, the 168
Commissioner of Public Health may appoint a licensed health care 169
provider to be the keeper of the records, who shall be responsible for 170
disbursing the original records to the provider's patients, upon the 171
request of any such patient. 172
(h) The Commissioner of Public Health shall adopt regulations, in 173
accordance with the provisions of chapter 54, to carry out the provisions 174
of this section. 175
Sec. 3. Section 19a-490b of the general statutes is repealed and the 176
following is substituted in lieu thereof (Effective October 1, 2024): 177
(a) Upon the written request of a patient or the patient's attorney or 178
authorized representative, or pursuant to a written authorization, an 179
institution licensed pursuant to this chapter, or an entity acting on 180
behalf of such institution, shall furnish to the person making such 181
request a copy of the patient's health record, including but not limited 182
to, copies of bills, laboratory reports, prescriptions and other technical 183
information used in assessing the patient's health condition. The written 184
request shall specify if a paper or electronic copy of the record is 185
preferred, and if an electronic copy is preferred and is able to be 186 Substitute Bill No. 5411
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produced, the institution or an entity acting on behalf of the institution 187
shall furnish the electronic copy of the requested record. In addition, an 188
institution shall provide the patient or the patient's designated health 189
care provider with a reasonable opportunity to examine retained tissue 190
slides and retained pathology tissue blocks. Upon the written request of 191
the patient, the patient's attorney or the patient's designated health care 192
provider, an institution shall send the original retained tissue slide or 193
original retained tissue block directly to the patient's designated 194
licensed institution, laboratory or physician. If the original slide or block 195
is not available or if a new section cut of the original slide or block is a 196
fair representation of the original slide or block, then the institution may 197
send the new section cut, [which] that is clearly labeled as a new section 198
cut, to the patient's designated health care provider. Any patient or the 199
patient's attorney or authorized representative who is provided with an 200
original retained slide, tissue block or a new section under the 201
provisions of this subsection shall be solely responsible for safeguarding 202
and returning the slide, block or new section to the institution. Any 203
institution or laboratory that has released an original slide, an original 204
tissue block or new section pursuant to the provisions of this subsection 205
shall not be subject to any liability arising out of releasing or not 206
retaining the slide, block or new section and no cause of action for 207
damages shall arise against any such institution for releasing or not 208
retaining the slide, block or new section. No such institution, or an entity 209
acting on behalf of such institution, shall charge more than [sixty-five 210
cents per page, including] the following for a paper copy of a health 211
record: (1) Seventy-five cents per page for pages one to twenty-five, (2) 212
fifty cents per page for pages twenty-six to fifty, (3) twenty-five cents 213
per page for pages fifty-one to ninety-nine, and (4) ten cents per page 214
for page one hundred and each succeeding page thereafter. The fees 215
prescribed in this subsection shall include any [research fees,] clerical 216
fees, [handling fees] or related costs, and the cost of first class postage, 217
if applicable, for furnishing or providing access to a health record 218
pursuant to this subsection, except such an institution, or entity acting 219
on behalf of the institution, may charge the amount necessary to cover 220
its cost of materials for furnishing a copy of an x-ray or for furnishing 221 Substitute Bill No. 5411
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an original retained slide, an original tissue block or a new section cut 222
from a retained pathology tissue block. If an electronic copy of the health 223
record is requested and furnished, the institution, or an entity acting on 224
behalf of the institution, shall charge the requestor not more than thirty-225
five cents per page with a maximum fee of two hundred fifty dollars per 226
record for such electronic copy. No institution, or entity acting on behalf 227
of an institution, shall charge a research fee or handling fee for a paper 228
or electronic health record unless the patient, the patient's attorney or 229
authorized representative, requests that the institution, or an entity 230
acting on behalf of the institution, make redactions to the requested 231
health record. If a research fee or handling fee is charged, such fee shall 232
not exceed fifty dollars. If a patient, a patient's attorney or authorized 233
representative requests that the institution, or an entity acting on behalf 234
of an institution, furnish a health record not later than seventy-two 235
hours following the receipt of such request, the institution, or entity 236
acting on behalf of the institution, may charge not more than an 237
additional fee of fifty dollars to expedite the furnishing of the health 238
record. On and after January 1, 2025, the Commissioner of Public Health 239
shall publish on the department's Internet web site, the fees prescribed 240
for the furnishing of paper or electronic copies of a health record 241
pursuant to this subsection. On January 1, 2026, and each January first 242
thereafter, the Commissioner of Public Health shall adjust the fees 243
prescribed in this subsection for the furnishing of paper or electronic 244
copies of a health record, based upon the consumer price index 245
calculator published by the United States Bureau of Labor and Statistics. 246
For purposes of this subsection, "health care provider" means an 247
institution or laboratory licensed under this chapter or licensed in the 248
state where located, a physician licensed under chapter 370 or licensed 249
in the state where located or an advanced practice registered nurse 250
licensed under chapter 378 or licensed in the state where located. 251
(b) No institution licensed pursuant to this chapter shall charge for 252
furnishing a health record or part thereof to a patient, his attorney or 253
conservator if the record or part thereof is necessary for the purpose of 254
supporting a claim or appeal under any provision of the Social Security 255 Substitute Bill No. 5411
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Act or a claim or appeal for veterans' benefits under any provision of 256
Title 38 of the United States Code or chapter 506 and the request for the 257
records is accompanied by documentation of the claim or appeal. An 258
institution shall furnish the requested record [within] not later than 259
thirty days [of] after the date of receipt of the request, unless the request 260
was received in less than thirty days subsequent to the date the patient 261
was discharged, in which case the institution shall furnish the requested 262
record upon its completion. If such institution, or an entity acting on 263
behalf of an institution, fails to furnish the health record requested to 264
the requestor not later than thirty days after the date of receipt of the 265
request, the fee charged to furnish such health record shall be reduced 266
by fifty per cent. If such institution, or an entity acting on behalf of an 267
institution, fails to furnish the health record requested to the requestor 268
not later than sixty days after the date of receipt of the request, the fee 269
charged to furnish such health record shall be reduced by seventy-five 270
per cent. If such institution, or an entity acting on behalf of an 271
institution, fails to furnish the health record requested to the requestor 272
not later than ninety days after the date of receipt of the request, the fee 273
charged to furnish such health record shall be reduced by ninety per 274
cent. Nothing in this subsection shall be construed to require an 275
institution, or an entity acting on behalf of an institution, to furnish a 276
requested health record until such time as a medical authorization form 277
that is compliant with the provisions of the Health Insurance Portability 278
and Accountability Act of 1996, P.L. 104-191, as amended from time to 279
time, has been submitted to the institution, or an entity acting on behalf 280
of an institution. 281
(c) Each institution licensed pursuant to this chapter shall maintain 282
information regarding each patient's status as a veteran, as defined in 283
subsection (a) of section 27-103. Said information shall be made 284
available, upon request, to any duly authorized representative of the 285
Department of Veterans Affairs. 286
(d) No institution may deny a person the records available under 287
subsection (a) of this section because of the person's inability to pay the 288
required fees. An affidavit from such person attesting to an inability to 289 Substitute Bill No. 5411
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pay such fees shall be presumptive evidence thereof. 290
(e) Each institution licensed pursuant to this chapter that ceases to 291
operate shall, at the time it relinquishes its license to the department, 292
provide to the department a certified document specifying: (1) The 293
location at which patient health records will be stored; (2) the procedure 294
that has been established for patients, former patients or their 295
authorized representatives to secure access to such health records; (3) 296
provisions for storage, should the storage location cease to operate or 297
change ownership; and (4) that the department is authorized to enforce 298
the certified document should the storage location cease to operate or 299
change ownership. An institution that fails to comply with the terms of 300
a certified document provided to the department in accordance with 301
this subsection shall be assessed a civil penalty not to exceed one 302
hundred dollars per day for each day of noncompliance with the terms 303
of the certified agreement. 304
This act shall take effect as follows and shall amend the following
sections:
Section 1 October 1, 2024 31-294f
Sec. 2 October 1, 2024 20-7c
Sec. 3 October 1, 2024 19a-490b
Statement of Legislative Commissioners:
Provisions in Sections 1(c), 2(d)(2), 2(e) and 3(a) were redrafted for
clarity and consistency with standard drafting conventions.
JUD Joint Favorable Subst. -LCO