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OLR Bill Analysis
sHB 5488
AN ACT CONCERNING VARIOUS REVISIONS TO THE PUBLIC
HEALTH STATUTES.
TABLE OF CONTENTS:
SUMMARY
§ 1 — MEDICAL ASSISTANTS
Adds to the list of organizations from whom a clinical medical assistant may be certified
for purposes of qualifying to administer vaccines in non-hospital settings
§ 2 — ADVERSE EVENT REPORTING
Allows DPH to impose disciplinary action on a hospital, birth center, or outpatient
surgical facility that fails to report an adverse event
§ 3 — EMS ADMINISTRATION OF GLUCAGON NAS AL POWDER
Requires ambulances to be equipped with glucagon nasal powder, and under certain
conditions, EMS personnel to administer it to patients
§ 4 — MARITAL AND FAMILY THERAPIST LICENSURE
Increases, from 12 to 24 months, the duration of the postgraduate experience generally
required for MFT licensure
§§ 5 & 11 — FACILITY FEES
Reinstates a provision making it an unfair trade practice for a hospital, health system, or
hospital-based facility to violate facility fee limits; adds injection and infusion and drug
administration to the list of outpatient procedures for which these entities generally
cannot collect facility fees, and makes related changes to notice requirements
§ 6 — LIMITS ON BALANCE BILLING AND CREDIT REPORTING
Makes it an unfair trade practice for EMS organizations or health care institutions to (1)
request payments (other than out-of-pocket expenses, such as copayments) in certain
situations, such as for covered facility fees, or (2) report to a credit reporting agency if the
patient fails to pay for these services
§ 7 — STATE-TRIBAL AGREEMENT ON VITAL RECORDS FILING
Allows the governor to enter into an agreement with the state’s federally recognized tribes
to allow birth and death certificates to be issued by, and filed with, the tribe instead of the
municipality
§ 8 — MASTER SOCIAL WORKER LICENSURE
Allows a master social worker licensure candidate’s degree to be from a program that is in
the process of getting accredited, before the fall 2027 semester 2024HB-05488-R000423-BA.DOCX
Researcher: JO Page 2 4/10/24
§ 9 — HAIRDRESSER AND COSMETICIAN LICENSURE TESTING
ACCOMMODATIONS
Requires the DPH commissioner to notify hairdresser and cosmetician licensure
applicants that they may be eligible for certain testing accommodations
§ 10 — FLUOROSCOPY BY ADVANCED PRACTICE REGISTERED
NURSES
Allows APRNs meeting certain requirements to use fluoroscopy for diagnostic and
therapeutic procedures
§§ 12-29 — TECHNICAL CHANGES
Makes technical changes in various statutes
§ 30 — NATUROPATH SCOPE OF PRACTICE COMMITTEE
Requires DPH to conduct a scope of practice review on whether naturopathic physicians
should be allowed to prescribe, dispense, and administer prescription medication and if so,
whether DPH should establish qualifications for this or develop a naturopathic formulary
SUMMARY
This bill makes various substantive, minor, and technical changes in
public health-related statutes and programs.
EFFECTIVE DATE: Various; see below.
§ 1 — MEDICAL ASSISTANTS
Adds to the list of organizations from whom a clinical medical assistant may be certified
for purposes of qualifying to administer vaccines in non-hospital settings
By law, clinical medical assistants meeting specified certification,
education, training, and supervision requirements may administer
vaccines in any setting other than a hospital.
The bill adds the American Medical Certification Association
(AMCA) to the list of organizations from whom a clinical medical
assistant may be certified for this purpose. It makes a corresponding
change by adding the AMCA to the list of organizations from whom the
Department of Public Health (DPH) must annually obtain a list of state
residents certified as medical assistants.
Under existing law, to qualify to administer vaccines, medical
assistants may also be certified by the American Association of Medical
Assistants, National Healthcareer Association, National Center for
Competency Testing, or American Medical Technologists. 2024HB-05488-R000423-BA.DOCX
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EFFECTIVE DATE: Upon passage
§ 2 — ADVERSE EVENT REPORTING
Allows DPH to impose disciplinary action on a hospital, birth center, or outpatient
surgical facility that fails to report an adverse event
By law, hospitals, birth centers, and outpatient surgical facilities must
report adverse events to DPH in a specified format and generally within
seven days after the event. The bill allows DPH to impose disciplinary
action if any of these institutions fail to report. By law, these actions
include, among other things, revoking or suspending a license, issuing
a letter of reprimand, or placing the licensee on probationary status.
DPH may only impose this discipline after a hearing.
Existing law already allows DPH to impose these actions if any of
these institutions, after an adverse event, fails to implement a corrective
action plan as required.
EFFECTIVE DATE: October 1, 2024
Background — Adverse Events
By law, an adverse event is any event that is identified on the
National Quality Forum’s (NQF) “List of Serious Reportable Events” or
on a list compiled by DPH (CGS § 19a-127n(a)). NQF’s list includes 29
events in seven categories (e.g., surgical or invasive procedure events).
§ 3 — EMS ADMINISTRATION OF GLUCAGON NAS AL POWDER
Requires ambulances to be equipped with glucagon nasal powder, and under certain
conditions, EMS personnel to administer it to patients
The bill requires licensed or certified ambulances to have glucagon
nasal powder for emergency medical services (EMS) personnel to
administer. (Glucagon nasal powder is used to treat severely low blood
sugar in people with diabetes.)
Specifically, it requires EMS personnel to administer glucagon nasal
powder when each of the following conditions are met:
1. the EMS professional has been trained to do so under DPH-
recognized national standards, 2024HB-05488-R000423-BA.DOCX
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2. the medication is administered according to written protocols
and standing orders of a physician serving as an emergency
department director, and
3. the EMS professional determines that administering the
medication is necessary to treat the person.
The bill requires all EMS personnel to receive this training from a
DPH-designated organization. Under the bill, “EMS personnel” include
emergency medical technicians (EMTs), including advanced EMTs;
paramedics; and emergency medical responders.
EFFECTIVE DATE: October 1, 2024
§ 4 — MARITAL AND FAMILY THERAPIST LICENSURE
Increases, from 12 to 24 months, the duration of the postgraduate experience generally
required for MFT licensure
The bill increases, from 12 to 24 months, the duration of the
postgraduate experience generally required for initial licensure as a
marital and family therapist (MFT). (This change generally corresponds
to a recent change in federal law allowing MFTs who meet certain
criteria to bill Medicare independently for their mental health services.)
Under existing law, this postgraduate experience must include at
least (1) 1,000 hours of direct client contact meeting certain requirements
and (2) 100 hours of postgraduate clinical supervision by an MFT.
EFFECTIVE DATE: July 1, 2024
§§ 5 & 11 — FACILITY FEES
Reinstates a provision making it an unfair trade practice for a hospital, health system, or
hospital-based facility to violate facility fee limits; adds injection and infusion and drug
administration to the list of outpatient procedures for which these entities generally
cannot collect facility fees, and makes related changes to notice requirements
Existing law limits when hospitals, health systems, and hospital-
based facilities may charge facility fees for outpatient services provided
off-site from a hospital campus. Starting July 1, 2024, the law also
prohibits hospitals or health systems from charging facility fees for
certain on-campus outpatient procedures that are not performed in the 2024HB-05488-R000423-BA.DOCX
Researcher: JO Page 5 4/10/24
emergency department.
The bill reinstates a provision, repealed by PA 23-171, making it an
unfair trade practice (see Background — Connecticut Unfair Trade Practices
Act (CUTPA)) to violate facility fee limits. Starting July 1, 2024, PA 23-
171 also allows the Office of Health Strategy to impose civil penalties of
up to $1,000 for certain violations of these limits.
Among other limits on off-site outpatient services, existing law
generally prohibits hospitals, health systems, and hospital-based
facilities from charging facility fees for these services that use a current
procedural terminology evaluation and management (CPT E/M) code
or CPT assessment and management (CPT A/M) code. The bill
additionally prohibits them from charging facility fees for injection and
infusion or drug administration CPT codes at these locations. As under
existing law, these limits do not apply to Medicare and Medicaid
patients, patients receiving services under a workers’ compensation
plan, or freestanding emergency departments.
The bill also adds these new codes to the list of codes for which
facility fee notices must include more information than is otherwise
required.
By law, a “facility fee” is any fee a hospital or health system charges
or bills for outpatient hospital services provided in a hospital-based
facility that is (1) intended to compensate the hospital or health system
for its operational expenses and (2) separate and distinct from the
provider’s professional fee.
EFFECTIVE DATE: October 1, 2024
Patient Notification Requirements (§ 11(b) & (c))
Under existing law, hospitals or health systems that charge facility
fees must give patients receiving outpatient services written notice
about their potential financial liability. The notice must include
additional information when the hospital or health system (1) uses CPT
E/M or A/M codes for these services and (2) expects to charge a
separate fee for professional medical services. The bill also applies the 2024HB-05488-R000423-BA.DOCX
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additional notice requirements if the hospital or health system uses
injection and infusion or drug administration CPT codes in these
situations. (As noted above, under the bill, these fees are generally
prohibited at off-campus facilities.)
Generally, the notice must include, among other things, (1) the
amount of the patient’s potential financial liability or (2) an estimate,
based on the facility’s typical or average charges, if the exact type and
extent of services are unknown or the terms of the patient’s insurance
coverage are not known with reasonable certainty.
As under existing law, these notice requirements do not apply to
Medicare or Medicaid patients or patients receiving services under a
workers’ compensation plan.
Background — Connecticut Unfair Trade Practices Act (CUTPA)
The law prohibits businesses from engaging in unfair and deceptive
acts or practices. CUTPA allows the Department of Consumer
Protection (DCP) commissioner to issue regulations defining what
constitutes an unfair trade practice, investigate complaints, issue cease
and desist orders, order restitution in cases involving less than $10,000,
enter into consent agreements, ask the attorney general to seek
injunctive relief, and accept voluntary statements of compliance. It also
allows individuals to sue. Courts may issue restraining orders; award
actual and punitive damages, costs, and reasonable attorney’s fees; and
impose civil penalties of up to $5,000 for willful violations and $25,000
for violation of a restraining order.
Background — Related Bill
sHB 5236 (File 103), § 25, favorably reported by the General Law
Committee, among other things, allows DCP to impose a civil penalty
of up to $5,000 for CUTPA violations, after an administrative hearing.
§ 6 — LIMITS ON BALANCE BILLING AND CREDIT REPORTING
Makes it an unfair trade practice for EMS organizations or health care institutions to (1)
request payments (other than out-of-pocket expenses, such as copayments) in certain
situations, such as for covered facility fees, or (2) report to a credit reporting agency if the
patient fails to pay for these services 2024HB-05488-R000423-BA.DOCX
Researcher: JO Page 7 4/10/24
The bill makes it a CUTPA violation for a licensed EMS organization
or health care institution to “balance bill” an insured (i.e., bill more than
the collectable cost-sharing under the policy) for the following:
1. covered health care services or facilities fees, or
2. covered emergency services, or services at a Department of
Children and Families (DCF)-licensed urgent crisis center,
provided by an out-of-network provider.
The bill also makes it a CUTPA violation for licensed EMS
organizations or health care institutions to bill an insured for a surprise
bill (see Background — Surprise Bills), other than collectable cost-sharing.
Finally, it makes it a CUTPA violation for these organizations or
institutions to report to a credit reporting agency when an enrollee fails
to pay for any of the above when a health carrier (e.g., insurer or HMO)
has primary responsibility for paying.
Under existing law, these restrictions already apply to most health
care providers.
EFFECTIVE DATE: October 1, 2024
Background — Surprise Bills
Generally, a “surprise bill” is a bill for health care services (other than
emergency services or DCF-licensed crisis center services) received by
an insured for services by an out-of-network provider at an in-network
facility during a service or procedure that was performed by an in-
network provider or previously approved by the health carrier, if the
insured did not knowingly elect to receive the services from the out-of-
network provider (CGS § 38a-477aa).
§ 7 — STATE-TRIBAL AGREEMENT ON VITAL RE CORDS FILING
Allows the governor to enter into an agreement with the state’s federally recognized tribes
to allow birth and death certificates to be issued by, and filed with, the tribe instead of the
municipality
Existing law requires the governor to submit any compact between
the state and an Indian tribe to the legislature for approval or rejection 2024HB-05488-R000423-BA.DOCX
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(CGS § 3-6c). Regardless of this provision, the bill allows the governor
to enter into a compact, memorandum of understanding, or agreement
with any federally recognized tribe in the state over certificates for births
or deaths occurring on tribal land. Specifically, they may enter an
agreement allowing these certificates to be issued by, and filed with, the
tribe’s clerk or registrar of vital statistics, instead of the municipality’s
registrar.
EFFECTIVE DATE: Upon passage
§ 8 — MASTER SOCIAL WORKER LICENSURE
Allows a master social worker licensure candidate’s degree to be from a program that is in
the process of getting accredited, before the fall 2027 semester
By law, an applicant for a master social worker license must have a
master’s degree in social work. The bill allows the degree to be from a
program that (1) is in the process of getting accredited by the Council on
Social Work Education and (2) was offered from the spring 2024
semester and before the fall 2027 semester. Under current law, the
program must already be accredited.
Existing law requires applicants educated outside of the country to
have passed an educational program that the council deems equivalent.
EFFECTIVE DATE: Upon passage
§ 9 — HAIRDRESSER AN D COSMETICIAN LICENS URE TESTING
ACCOMMODATIONS
Requires the DPH commissioner to notify hairdresser and cosmetician licensure
applicants that they may be eligible for certain testing accommodations
The bill requires the DPH commissioner to notify hairdresser and
cosmetician licensure applicants approved to take the written licensure
examination that they may be eligible for testing accommodations
under the federal Americans with Disabilities Act or other
accommodations determined by the state Examining Board for Barbers,
Hairdressers and Cosmeticians. Under the bill, these accommodations
may include (1) using a dictionary while taking the licensure
examination or (2) additional time to complete it.
EFFECTIVE DATE: October 1, 2024 2024HB-05488-R000423-BA.DOCX
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§ 10 — FLUOROSCOPY B Y ADVANCED PRACTICE REGISTERED
NURSES
Allows APRNs meeting certain requirements to use fluoroscopy for diagnostic and
therapeutic procedures
The bill authorizes advanced practice registered nurses (APRN) to
use fluoroscopy to guide diagnostic and treatment procedures if they
meet certain training, experience, and examination requirements.
Under the bill, to use fluoroscopy, an APRN must do the following:
1. complete 40 hours of relevant instruction that includes radiation
biology and physics, exposure reduction, equipment operation,
image evaluation, quality control, and patient considerations;
2. complete 40 hours of supervised clinical experience that includes
a demonstration of patient dose reduction, occupational dose
reduction, image recording, and equipment quality control; and
3. pass a DPH-prescribed test.
Under the bill, documentation that an APRN has met these
requirements must be kept at the APRN’s worksite and be available to
DPH upon request.
EFFECTIVE DATE: October 1, 2024
§§ 12-29 — TECHNICAL CHANGES
Makes technical changes in various statutes
The bill makes technical changes in various public health-related
statutes.
EFFECTIVE DATE: Upon passage (§§ 12-22) or October 1, 2024 (§§
23-29).
§ 30 — NATUROPATH SCOPE O F PRACTICE COMMITTEE
Requires DPH to conduct a scope of practice review on whether naturopathic physicians
should be allowed to prescribe, dispense, and administer prescription medication and if so,
whether DPH should establish qualifications for this or develop a naturopathic formulary
The bill requires the DPH commissioner to conduct a scope of
practice review, under the existing process for scope of practice review 2024HB-05488-R000423-BA.DOCX
Researcher: JO Page 10 4/10/24
committees, to determine whether (1) naturopathic physicians should
be allowed to prescribe, dispense, and administer prescription
medication and (2) if so, DPH should establish educational,
examination, or other qualifications for this or develop a naturopathic
formulary. The commissioner must report the committee’s findings and
recommendations to the Public Health Committee by January 1, 2025.
Existing law establishes a process to review requests from health care
professions seeking to establish or revise a scope of practice prior to
consideration by the legislature. Within available appropriations, DPH
appoints members to scope of practice review committees. The
committees consist of (1) the DPH commissioner or her designee (who
serves as the committee chairperson and in a non-voting capacity); (2)
two members representing the profession making the request; and (3)
two members recommended by each person or entity that submitted a
written impact statement to represent the professions directly impacted
by the request. DPH may also appoint additional members representing
health care professions with a close relationship to the underlying scope
of practice request (CGS § 19a-16e).
EFFECTIVE DATE: Upon passage
COMMITTEE ACTION
Public Health Committee
Joint Favorable Substitute
Yea 23 Nay 13 (03/22/2024)