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General Assembly Substitute Bill No. 5488
February Session, 2024
AN ACT CONCERNING VARIOUS REVISIONS TO THE PUBLIC
HEALTH STATUTES.
Be it enacted by the Senate and House of Representatives in General
Assembly convened:
Section 1. Section 19a-6s of the general statutes is repealed and the 1
following is substituted in lieu thereof (Effective from passage): 2
(a) For purposes of this section, "clinical medical assistant" means a 3
person who (1) (A) is certified by the American Association of Medical 4
Assistants, the National Healthcareer Association, the National Center 5
for Competency Testing, [or] the American Medical Technologists or the 6
American Medical Certification Association, and (B) has graduated 7
from a postsecondary medical assisting program (i) that is accredited by 8
the Commission on Accreditation of Allied Health Education Programs, 9
the Accrediting Bureau of Health Education Schools or another 10
accrediting organization recognized by the United States Department of 11
Education, or (ii) offered by an institution of higher education 12
accredited by an accrediting organization recognized by the United 13
States Department of Education and that includes a total of seven 14
hundred twenty hours, including one hundred sixty hours of clinical 15
practice skills, including, but not limited to, administering injections, or 16
(2) has completed relevant medical assistant training provided by any 17
branch of the armed forces of the United States. 18 Substitute Bill No. 5488
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(b) A clinical medical assistant may administer a vaccine under the 19
supervision, control and responsibility of a physician licensed pursuant 20
to chapter 370, a physician assistant licensed pursuant to chapter 370 or 21
an advanced practice registered nurse licensed pursuant to chapter 378 22
to any person in any setting other than a hospital setting. Prior to 23
administering a vaccine, a clinical medical assistant shall complete not 24
less than twenty-four hours of classroom training and not less than eight 25
hours of training in a clinical setting regarding the administration of 26
vaccines. Nothing in this section shall be construed to permit an 27
employer of a physician, a physician assistant or an advanced practice 28
registered nurse to require the physician, physician assistant or 29
advanced practice registered nurse to oversee a clinical medical 30
assistant in the administration of a vaccine without the consent of the 31
physician, physician assistant or advanced practice registered nurse. 32
(c) On or before January first annually, the Commissioner of Public 33
Health shall obtain from the American Association of Medical 34
Assistants, the National Healthcareer Association, the National Center 35
for Competency Testing, [and] the American Medical Technologists and 36
the American Medical Certification Association a listing of all state 37
residents maintained on said organizations' registries of certified 38
medical assistants. The commissioner shall make such listings available 39
for public inspection. 40
Sec. 2. Subsection (b) of section 19a-127n of the 2024 supplement to 41
the general statutes is repealed and the following is substituted in lieu 42
thereof (Effective October 1, 2024): 43
(b) On and after October 1, 2023, a hospital or birth center, as such 44
terms are defined in section 19a-490, as amended by this act, or 45
outpatient surgical facility, as defined in section 19a-493b, shall report 46
adverse events to the Department of Public Health on a form prescribed 47
by the commissioner as follows: (1) A written report and the status of 48
any corrective steps shall be submitted not later than seven days after 49
the date on which the adverse event occurred; and (2) a corrective action 50
plan shall be filed not later than thirty days after the date on which the 51 Substitute Bill No. 5488
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adverse event occurred. Emergent reports, as defined in the regulations 52
adopted pursuant to subsection (c) of this section, shall be made to the 53
department immediately. Failure to report an adverse event to the 54
department or implement a corrective action plan may result in 55
disciplinary action by the commissioner, pursuant to section 19a-494. 56
Sec. 3. Section 19a-197a of the 2024 supplement to the general statutes 57
is repealed and the following is substituted in lieu thereof (Effective 58
October 1, 2024): 59
(a) As used in this section, "emergency medical services personnel" 60
means (1) any class of emergency medical technician certified pursuant 61
to sections 20-206ll and 20-206mm, including, but not limited to, any 62
advanced emergency medical technician, (2) any paramedic licensed 63
pursuant to sections 20-206ll and 20-206mm, and (3) any emergency 64
medical responder certified pursuant to sections 20-206ll and 20-65
206mm. 66
(b) Any emergency medical services personnel who has been trained, 67
in accordance with national standards recognized by the Commissioner 68
of Public Health, in the administration of (1) epinephrine using 69
automatic prefilled cartridge injectors, similar automatic injectable 70
equipment or prefilled vial and syringe, or (2) glucagon nasal powder, 71
and who functions in accordance with written protocols and the 72
standing orders of a licensed physician serving as an emergency 73
department director [may administer, on or before June 30, 2024, and] 74
shall administer [, on and after July 1, 2024,] epinephrine using such 75
injectors, equipment or prefilled vial and syringe or glucagon nasal 76
powder when the use of epinephrine or glucagon is deemed necessary 77
by the emergency medical services personnel for the treatment of a 78
patient. All emergency medical services personnel shall receive such 79
training from an organization designated by the commissioner. 80
(c) All licensed or certified ambulances shall be equipped with 81
epinephrine in such injectors, equipment or prefilled vials and syringes 82
and glucagon nasal powder to be administered as described in 83 Substitute Bill No. 5488
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subsection (b) of this section and in accordance with written protocols 84
and standing orders of a licensed physician serving as an emergency 85
department director. 86
Sec. 4. Subsection (a) of section 20-195c of the 2024 supplement to the 87
general statutes is repealed and the following is substituted in lieu 88
thereof (Effective July 1, 2024): 89
(a) Each applicant for licensure as a marital and family therapist shall 90
present to the department satisfactory evidence that such applicant has: 91
(1) Completed a graduate degree program specializing in marital and 92
family therapy offered by a regionally accredited college or university 93
or an accredited postgraduate clinical training program accredited by 94
the Commission on Accreditation for Marriage and Family Therapy 95
Education offered by a regionally accredited institution of higher 96
education; (2) completed a supervised practicum or internship with 97
emphasis in marital and family therapy supervised by the program 98
granting the requisite degree or by an accredited postgraduate clinical 99
training program accredited by the Commission on Accreditation for 100
Marriage and Family Therapy Education and offered by a regionally 101
accredited institution of higher education; (3) completed [twelve] 102
twenty-four months of relevant postgraduate experience, including (A) 103
a minimum of one thousand hours of direct client contact offering 104
marital and family therapy services subsequent to being awarded a 105
master's degree or doctorate or subsequent to the training year specified 106
in subdivision (2) of this subsection, and (B) one hundred hours of 107
postgraduate clinical supervision provided by a licensed marital and 108
family therapist; and (4) passed an examination prescribed by the 109
department. The fee shall be two hundred dollars for each initial 110
application. 111
Sec. 5. Subdivision (3) of subsection (l) of section 19a-508c of the 2024 112
supplement to the general statutes is repealed and the following is 113
substituted in lieu thereof (Effective October 1, 2024): 114
(3) Notwithstanding the provisions of subdivisions (1) and (2) of this 115 Substitute Bill No. 5488
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subsection, in circumstances when an insurance contract that is in effect 116
on July 1, 2016, provides reimbursement for facility fees prohibited 117
under the provisions of subdivision (1) of this subsection, and in 118
circumstances when an insurance contract that is in effect on July 1, 119
2024, provides reimbursement for facility fees prohibited under the 120
provisions of subdivision (2) of this subsection, a hospital or health 121
system may continue to collect reimbursement from the health insurer 122
for such facility fees until the applicable date of expiration, renewal or 123
amendment of such contract, whichever such date is the earliest. A 124
violation of this subsection shall be considered an unfair trade practice 125
pursuant to chapter 735a. 126
Sec. 6. Section 20-7f of the general statutes is repealed and the 127
following is substituted in lieu thereof (Effective October 1, 2024): 128
(a) For purposes of this section: 129
(1) "Request payment" includes, but is not limited to, submitting a bill 130
for services not actually owed or submitting for such services an invoice 131
or other communication detailing the cost of the services that is not 132
clearly marked with the phrase "This is not a bill". 133
(2) "Health care provider" means a person licensed to provide health 134
care services under chapter 368d or 368v, chapters 370 to 373, inclusive, 135
chapters 375 to 383b, inclusive, chapters 384a to 384c, inclusive, or 136
chapter 400j. 137
(3) "Enrollee" means a person who has contracted for or who 138
participates in a health care plan for such enrollee or such enrollee's 139
eligible dependents. 140
(4) "Coinsurance, copayment, deductible or other out-of-pocket 141
expense" means the portion of a charge for services covered by a health 142
care plan that, under the plan's terms, it is the obligation of the enrollee 143
to pay. 144
(5) "Health care plan" has the same meaning as provided in 145 Substitute Bill No. 5488
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subsection (a) of section 38a-477aa. 146
(6) "Health carrier" has the same meaning as provided in subsection 147
(a) of section 38a-477aa. 148
(7) "Emergency services" has the same meaning as provided in 149
subsection (a) of section 38a-477aa. 150
(b) It shall be an unfair trade practice in violation of chapter 735a for 151
any health care provider to request payment from an enrollee, other 152
than a coinsurance, copayment, deductible or other out-of-pocket 153
expense, for (1) health care services or a facility fee, as defined in section 154
19a-508c, as amended by this act, covered under a health care plan, (2) 155
emergency services, or services rendered to an insured at an urgent 156
crisis center, as defined in section 19a-179f, covered under a health care 157
plan and rendered by an out-of-network health care provider, or (3) a 158
surprise bill, as defined in section 38a-477aa. 159
(c) It shall be an unfair trade practice in violation of chapter 735a for 160
any health care provider to report to a credit reporting agency an 161
enrollee's failure to pay a bill for the services, facility fee or surprise bill 162
as set forth in subsection (b) of this section, when a health carrier has 163
primary responsibility for payment of such services, fees or bills. 164
Sec. 7. (NEW) (Effective from passage) Notwithstanding the provisions 165
of section 3-6c of the general statutes, the Governor may enter into a 166
compact, memorandum of understanding or agreement with any 167
federally recognized Indian tribe located within the geographical 168
boundaries of this state pursuant to which birth and death certificates 169
issued pursuant to chapter 93 of the general statutes concerning a birth 170
or death occurring on land held in trust by the United States for such 171
tribe shall be filed with and issued by the clerk or registrar of vital 172
statistics of such tribe in lieu of being filed with and issued by the 173
registrar of vital statistics of a town or municipality. 174
Sec. 8. Subsection (b) of section 20-195n of the 2024 supplement to the 175
general statutes is repealed and the following is substituted in lieu 176 Substitute Bill No. 5488
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thereof (Effective from passage): 177
(b) An applicant for licensure as a master social worker shall: (1) (A) 178
Hold a master's degree from a social work program (i) accredited by the 179
Council on Social Work Education, or (ii) that is in candidate status for 180
accreditation by said council and offered by an institution of higher 181
education in the state during or after the spring semester of 2024, and 182
prior to the fall semester of 2027, or [,] (B) if educated outside the United 183
States or its territories, have completed an educational program deemed 184
equivalent by the council; and (2) pass the masters level examination of 185
the Association of Social Work Boards or any other examination 186
prescribed by the commissioner. 187
Sec. 9. Section 20-252 of the general statutes is repealed and the 188
following is substituted in lieu thereof (Effective October 1, 2024): 189
(a) No person shall engage in the occupation of registered hairdresser 190
and cosmetician without having obtained a license from the 191
department. Persons desiring such licenses shall apply in writing on 192
forms furnished by the department. No license shall be issued, except a 193
renewal of a license, to a registered hairdresser and cosmetician unless 194
the applicant has shown to the satisfaction of the department that the 195
applicant has complied with the laws and the regulations administered 196
or adopted by the department. No applicant shall be licensed as a 197
registered hairdresser and cosmetician, except by renewal of a license, 198
until the applicant has made written application to the department, 199
setting forth by affidavit that the applicant has (1) (A) successfully 200
completed the ninth grade, (B) completed a course of not less than 201
fifteen hundred hours of study in a school approved in accordance with 202
the provisions of this chapter or in a school teaching hairdressing and 203
cosmetology under the supervision of the State Board of Education, or, 204
if trained outside of Connecticut, in a school teaching hairdressing and 205
cosmetology whose requirements are equivalent to those of a 206
Connecticut school, and (C) passed a written examination satisfactory 207
to the department, or (2) if the applicant is an apprentice, (A) 208
successfully completed the eighth grade, (B) completed an 209 Substitute Bill No. 5488
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apprenticeship approved by the Labor Department and conducted in 210
accordance with sections 31-22m to 31-22u, inclusive, and (C) passed a 211
written examination satisfactory to the Department of Public Health. 212
Examinations required for licensure under this chapter shall be 213
prescribed by the department with the advice and assistance of the 214
board. The department shall establish a passing score for examinations 215
with the advice and assistance of the board which shall be the same as 216
the passing score established in section 20-236. 217
(b) No person applying for licensure as a hairdresser and cosmetician 218
under this chapter shall be required to submit to a state or national 219
criminal history records check as a prerequisite to licensure. 220
(c) The commissioner shall notify each applicant who is approved to 221
take a written examination required under subsection (a) of this section 222
that such applicant may be eligible for testing accommodations 223
pursuant to the federal Americans with Disabilities Act, 42 USC 12101 224
et seq., as amended from time to time, or other accommodations, as 225
determined by the board, which may include the use of a dictionary 226
while taking such examination and additional time within which to take 227
such examination. 228
Sec. 10. Section 20-12i of the general statutes is repealed and the 229
following is substituted in lieu thereof (Effective October 1, 2024): 230
(a) [On and after October 1, 2011, prior] Prior to engaging in the use 231
of fluoroscopy for guidance of diagnostic and therapeutic procedures, a 232
physician assistant or advanced practice registered nurse shall: (1) 233
Successfully complete a course that includes forty hours of didactic 234
instruction relevant to fluoroscopy which includes, but is not limited to, 235
radiation biology and physics, exposure reduction, equipment 236
operation, image evaluation, quality control and patient considerations; 237
(2) successfully complete a minimum of forty hours of supervised 238
clinical experience that includes a demonstration of patient dose 239
reduction, occupational dose reduction, image recording and quality 240
control of fluoroscopy equipment; and (3) pass an examination 241 Substitute Bill No. 5488
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prescribed by the Commissioner of Public Health. Documentation that 242
the physician assistant or advanced practice registered nurse has met 243
the requirements prescribed in this subsection shall be maintained at the 244
employment site of the physician assistant or advanced practice 245
registered nurse and made available to the Department of Public Health 246
upon request. 247
(b) Notwithstanding the provisions of this section or sections 20-74bb 248
and 20-74ee, nothing shall prohibit a physician assistant who is 249
engaging in the use of fluoroscopy for guidance of diagnostic and 250
therapeutic procedures or positioning and utilizing a mini C-arm in 251
conjunction with fluoroscopic procedures prior to October 1, 2011, from 252
continuing to engage in such procedures, or require the physician 253
assistant to complete the course or supervised clinical experience 254
described in subsection (a) of this section, provided such physician 255
assistant shall pass the examination prescribed by the commissioner on 256
or before September 1, 2012. If a physician assistant does not pass the 257
required examination on or before September 1, 2012, such physician 258
assistant shall not engage in the use of fluoroscopy for guidance of 259
diagnostic and therapeutic procedures or position and utilize a mini C-260
arm in conjunction with fluoroscopic procedures until such time as such 261
physician assistant meets the requirements of subsection (a) of this 262
section. 263
Sec. 11. Section 19a-508c of the 2024 supplement to the general 264
statutes is repealed and the following is substituted in lieu thereof 265
(Effective October 1, 2024): 266
(a) As used in this section: 267
(1) "Affiliated provider" means a provider that is: (A) Employed by a 268
hospital or health system, (B) under a professional services agreement 269
with a hospital or health system that permits such hospital or health 270
system to bill on behalf of such provider, or (C) a clinical faculty member 271
of a medical school, as defined in section 33-182aa, that is affiliated with 272
a hospital or health system in a manner that permits such hospital or 273 Substitute Bill No. 5488
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health system to bill on behalf of such clinical faculty member; 274
(2) "Campus" means: (A) The physical area immediately adjacent to a 275
hospital's main buildings and other areas and structures that are not 276
strictly contiguous to the main buildings but are located within two 277
hundred fifty yards of the main buildings, or (B) any other area that has 278
been determined on an individual case basis by the Centers for Medicare 279
and Medicaid Services to be part of a hospital's campus; 280
(3) "Facility fee" means any fee charged or billed by a hospital or 281
health system for outpatient services provided in a hospital-based 282
facility that is: (A) Intended to compensate the hospital or health system 283
for the operational expenses of the hospital or health system, and (B) 284
separate and distinct from a professional fee; 285
(4) "Health care provider" means an individual, entity, corporation, 286
person or organization, whether for-profit or nonprofit, that furnishes, 287
bills or is paid for health care service delivery in the normal course of 288
business, including, but not limited to, a health system, a hospital, a 289
hospital-based facility, a freestanding emergency department and an 290
urgent care center; 291
(5) "Health system" means: (A) A parent corporation of one or more 292
hospitals and any entity affiliated with such parent corporation through 293
ownership, governance, membership or other means, or (B) a hospital 294
and any entity affiliated with such hospital through ownership, 295
governance, membership or other means; 296
(6) "Hospital" has the same meaning as provided in section 19a-490, 297
as amended by this act; 298
(7) "Hospital-based facility" means a facility that is owned or 299
operated, in whole or in part, by a hospital or health system where 300
hospital or professional medical services are provided; 301
(8) "Medicaid" means the program operated by the Department of 302
Social Services pursuant to section 17b-260 and authorized by Title XIX 303 Substitute Bill No. 5488
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of the Social Security Act, as amended from time to time; 304
(9) "Observation" means services furnished by a hospital on the 305
hospital's campus, regardless of length of stay, including use of a bed 306
and periodic monitoring by the hospital's nursing or other staff to 307
evaluate an outpatient's condition or determine the need for admission 308
to the hospital as an inpatient; 309
(10) "Payer mix" means the proportion of different sources of 310
payment received by a hospital or health system, including, but not 311
limited to, Medicare, Medicaid, other government-provided insurance, 312
private insurance and self-pay patients; 313
(11) "Professional fee" means any fee charged or billed by a provider 314
for professional medical services provided in a hospital-based facility; 315
(12) "Provider" means an individual, entity, corporation or health 316
care provider, whether for profit or nonprofit, whose primary purpose 317
is to provide professional medical services; and 318
(13) "Tagline" means a short statement written in a non-English 319
language that indicates the availability of language assistance services 320
free of charge. 321
(b) If a hospital or health system charges a facility fee utilizing a 322
current procedural terminology evaluation and management (CPT 323
E/M) code, [or] assessment and management (CPT A/M) code , 324
injection and infusion (CPT) code or drug administration (CPT) code for 325
outpatient services provided at a hospital-based facility where a 326
professional fee is also expected to be charged, the hospital or health 327
system shall provide the patient with a written notice that includes the 328
following information: 329
(1) That the hospital-based facility is part of a hospital or health 330
system and that the hospital or health system charges a facility fee that 331
is in addition to and separate from the professional fee charged by the 332
provider; 333 Substitute Bill No. 5488
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(2) (A) The amount of the patient's potential financial liability, 334
including any facility fee likely to be charged, and, where professional 335
medical services are provided by an affiliated provider, any professional 336
fee likely to be charged, or, if the exact type and extent of the 337
professional medical services needed are not known or the terms of a 338
patient's health insurance coverage are not known with reasonable 339
certainty, an estimate of the patient's financial liability based on typical 340
or average charges for visits to the hospital-based facility, including the 341
facility fee, (B) a statement that the patient's actual financial liability will 342
depend on the professional medical services actually provided to the 343
patient, (C) an explanation that the patient may incur financial liability 344
that is greater than the patient would incur if the professional medical 345
services were not provided by a hospital-based facility, and (D) a 346
telephone number the patient may call for additional information 347
regarding such patient's potential financial liability, including an 348
estimate of the facility fee likely to be charged based on the scheduled 349
professional medical services; and 350
(3) That a patient covered by a health insurance policy should contact 351
the health insurer for additional information regarding the hospital's or 352
health system's charges and fees, including the patient's potential 353
financial liability, if any, for such charges and fees. 354
(c) If a hospital or health system charges a facility fee without 355
utilizing a current procedural terminology evaluation and management 356
(CPT E/M) code, assessment and management (CPT A/M) code, 357
injection and infusion (CPT) code or drug administration (CPT) code for 358
outpatient services provided at a hospital-based facility, located outside 359
the hospital campus, the hospital or health system shall provide the 360
patient with a written notice that includes the following information: 361
(1) That the hospital-based facility is part of a hospital or health 362
system and that the hospital or health system charges a facility fee that 363
may be in addition to and separate from the professional fee charged by 364
a provider; 365 Substitute Bill No. 5488
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(2) (A) A statement that the patient's actual financial liability will 366
depend on the professional medical services actually provided to the 367
patient, (B) an explanation that the patient may incur financial liability 368
that is greater than the patient would incur if the hospital-based facility 369
was not hospital-based, and (C) a telephone number the patient may call 370
for additional information regarding such patient's potential financial 371
liability, including an estimate of the facility fee likely to be charged 372
based on the scheduled professional medical services; and 373
(3) That a patient covered by a health insurance policy should contact 374
the health insurer for additional information regarding the hospital's or 375
health system's charges and fees, including the patient's potential 376
financial liability, if any, for such charges and fees. 377
(d) Each initial billing statement that includes a facility fee shall: (1) 378
Clearly identify the fee as a facility fee that is billed in addition to, or 379
separately from, any professional fee billed by the provider; (2) provide 380
the corresponding Medicare facility fee reimbursement rate for the same 381
service as a comparison or, if there is no corresponding Medicare facility 382
fee for such service, (A) the approximate amount Medicare would have 383
paid the hospital for the facility fee on the billing statement, or (B) the 384
percentage of the hospital's charges that Medicare would have paid the 385
hospital for the facility fee; (3) include a statement that the facility fee is 386
intended to cover the hospital's or health system's operational expenses; 387
(4) inform the patient that the patient's financial liability may have been 388
less if the services had been provided at a facility not owned or operated 389
by the hospital or health system; and (5) include written notice of the 390
patient's right to request a reduction in the facility fee or any other 391
portion of the bill and a telephone number that the patient may use to 392
request such a reduction without regard to whether such patient 393
qualifies for, or is likely to be granted, any reduction. Not later than 394
October 15, 2022, and annually thereafter, each hospital, health system 395
and hospital-based facility shall submit to the Health Systems Planning 396
Unit of the Office of Health Strategy a sample of a billing statement 397
issued by such hospital, health system or hospital-based facility that 398
complies with the provisions of this subsection and which represents 399 Substitute Bill No. 5488
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the format of billing statements received by patients. Such billing 400
statement shall not contain patient identifying information. 401
(e) The written notice described in subsections (b) to (d), inclusive, 402
and (h) to (j), inclusive, of this section shall be in plain language and in 403
a form that may be reasonably understood by a patient who does not 404
possess special knowledge regarding hospital or health system facility 405
fee charges. On and after October 1, 2022, such notices shall include tag 406
lines in at least the top fifteen languages spoken in the state indicating 407
that the notice is available in each of those top fifteen languages. The 408
fifteen languages shall be either the languages in the list published by 409
the Department of Health and Human Services in connection with 410
section 1557 of the Patient Protection and Affordable Care Act, P.L. 111-411
148, or, as determined by the hospital or health system, the top fifteen 412
languages in the geographic area of the hospital-based facility. 413
(f) (1) For nonemergency care, if a patient's appointment is scheduled 414
to occur ten or more days after the appointment is made, such written 415
notice shall be sent to the patient by first class mail, encrypted electronic 416
mail or a secure patient Internet portal not less than three days after the 417
appointment is made. If an appointment is scheduled to occur less than 418
ten days after the appointment is made or if the patient arrives without 419
an appointment, such notice shall be hand-delivered to the patient when 420
the patient arrives at the hospital-based facility. 421
(2) For emergency care, such written notice shall be provided to the 422
patient as soon as practicable after the patient is stabilized in accordance 423
with the federal Emergency Medical Treatment and Active Labor Act, 424
42 USC 1395dd, as amended from time to time, or is determined not to 425
have an emergency medical condition and before the patient leaves the 426
hospital-based facility. If the patient is unconscious, under great duress 427
or for any other reason unable to read the notice and understand and 428
act on his or her rights, the notice shall be provided to the patient's 429
representative as soon as practicable. 430
(g) Subsections (b) to (f), inclusive, and (l) of this section shall not 431 Substitute Bill No. 5488
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apply if a patient is insured by Medicare or Medicaid or is receiving 432
services under a workers' compensation plan established to provide 433
medical services pursuant to chapter 568. 434
(h) A hospital-based facility shall prominently display written notice 435
in locations that are readily accessible to and visible by patients, 436
including patient waiting or appointment check-in areas, stating: (1) 437
That the hospital-based facility is part of a hospital or health system, (2) 438
the name of the hospital or health system, and (3) that if the hospital-439
based facility charges a facility fee, the patient may incur a financial 440
liability greater than the patient would incur if the hospital-based 441
facility was not hospital-based. On and after October 1, 2022, such 442
notices shall include tag lines in at least the top fifteen languages spoken 443
in the state indicating that the notice is available in each of those top 444
fifteen languages. The fifteen languages shall be either the languages in 445
the list published by the Department of Health and Human Services in 446
connection with section 1557 of the Patient Protection and Affordable 447
Care Act, P.L. 111-148, or, as determined by the hospital or health 448
system, the top fifteen languages in the geographic area of the hospital-449
based facility. Not later than October 1, 2022, and annually thereafter, 450
each hospital-based facility shall submit a copy of the written notice 451
required by this subsection to the Health Systems Planning Unit of the 452
Office of Health Strategy. 453
(i) A hospital-based facility shall clearly hold itself out to the public 454
and payers as being hospital-based, including, at a minimum, by stating 455
the name of the hospital or health system in its signage, marketing 456
materials, Internet web sites and stationery. 457
(j) A hospital-based facility shall, when scheduling services for which 458
a facility fee may be charged, inform the patient (1) that the hospital-459
based facility is part of a hospital or health system, (2) of the name of the 460
hospital or health system, (3) that the hospital or health system may 461
charge a facility fee in addition to and separate from the professional fee 462
charged by the provider, and (4) of the telephone number the patient 463
may call for additional information regarding such patient's potential 464 Substitute Bill No. 5488
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financial liability. 465
(k) (1) If any transaction described in subsection (c) of section 19a-466
486i, results in the establishment of a hospital-based facility at which 467
facility fees may be billed, the hospital or health system, that is the 468
purchaser in such transaction shall, not later than thirty days after such 469
transaction, provide written notice, by first class mail, of the transaction 470
to each patient served within the three years preceding the date of the 471
transaction by the health care facility that has been purchased as part of 472
such transaction. 473
(2) Such notice shall include the following information: 474
(A) A statement that the health care facility is now a hospital-based 475
facility and is part of a hospital or health system, the health care facility's 476
full legal and business name and the date of such facility's acquisition 477
by a hospital or health system; 478
(B) The name, business address and phone number of the hospital or 479
health system that is the purchaser of the health care facility; 480
(C) A statement that the hospital-based facility bills, or is likely to bill, 481
patients a facility fee that may be in addition to, and separate from, any 482
professional fee billed by a health care provider at the hospital-based 483
facility; 484
(D) (i) A statement that the patient's actual financial liability will 485
depend on the professional medical services actually provided to the 486
patient, and (ii) an explanation that the patient may incur financial 487
liability that is greater than the patient would incur if the hospital-based 488
facility were not a hospital-based facility; 489
(E) The estimated amount or range of amounts the hospital-based 490
facility may bill for a facility fee or an example of the average facility fee 491
billed at such hospital-based facility for the most common services 492
provided at such hospital-based facility; and 493
(F) A statement that, prior to seeking services at such hospital-based 494 Substitute Bill No. 5488
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facility, a patient covered by a health insurance policy should contact 495
the patient's health insurer for additional information regarding the 496
hospital-based facility fees, including the patient's potential financial 497
liability, if any, for such fees. 498
(3) A copy of the written notice provided to patients in accordance 499
with this subsection shall be filed with the Health Systems Planning 500
Unit of the Office of Health Strategy, established under section 19a-612. 501
Said unit shall post a link to such notice on its Internet web site. 502
(4) A hospital, health system or hospital-based facility shall not collect 503
a facility fee for services provided at a hospital-based facility that is 504
subject to the provisions of this subsection from the date of the 505
transaction until at least thirty days after the written notice required 506
pursuant to this subsection is mailed to the patient or a copy of such 507
notice is filed with the Health Systems Planning Unit of the Office of 508
Health Strategy, whichever is later. A violation of this subsection shall 509
be considered an unfair trade practice pursuant to section 42-110b. 510
(5) Not later than July 1, 2023, and annually thereafter, each hospital-511
based facility that was the subject of a transaction, as described in 512
subsection (c) of section 19a-486i, during the preceding calendar year 513
shall report to the Health Systems Planning Unit of the Office of Health 514
Strategy the number of patients served by such hospital-based facility 515
in the preceding three years. 516
(l) (1) Notwithstanding the provisions of this section, no hospital, 517
health system or hospital-based facility shall collect a facility fee for (A) 518
outpatient health care services that use a current procedural 519
terminology evaluation and management (CPT E/M) code , [or] 520
assessment and management (CPT A/M) code, injection and infusion 521
(CPT) code or drug administration (CPT) code and are provided at a 522
hospital-based facility located off-site from a hospital campus, or (B) 523
outpatient health care services provided at a hospital-based facility 524
located off-site from a hospital campus received by a patient who is 525
uninsured of more than the Medicare rate. 526 Substitute Bill No. 5488
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(2) Notwithstanding the provisions of this section, on and after July 527
1, 2024, no hospital or health system shall collect a facility fee for 528
outpatient health care services that use a current procedural 529
terminology evaluation and management (CPT E/M) code or 530
assessment and management (CPT A/M) code and are provided on the 531
hospital campus. The provisions of this subdivision shall not apply to 532
(A) an emergency department located on a hospital campus, or (B) 533
observation stays on a hospital campus and (CPT E/M) and (CPT A/M) 534
codes when billed for the following services: (i) Wound care, (ii) 535
orthopedics, (iii) anticoagulation, (iv) oncology, (v) obstetrics, and (vi) 536
solid organ transplant. 537
(3) Notwithstanding the provisions of subdivisions (1) and (2) of this 538
subsection, in circumstances when an insurance contract that is in effect 539
on July 1, 2016, provides reimbursement for facility fees prohibited 540
under the provisions of subdivision (1) of this subsection, and in 541
circumstances when an insurance contract that is in effect on July 1, 542
2024, provides reimbursement for facility fees prohibited under the 543
provisions of subdivision (2) of this subsection, a hospital or health 544
system may continue to collect reimbursement from the health insurer 545
for such facility fees until the applicable date of expiration, renewal or 546
amendment of such contract, whichever such date is the earliest. 547
(4) The provisions of this subsection shall not apply to a freestanding 548
emergency department. As used in this subdivision, "freestanding 549
emergency department" means a freestanding facility that (A) is 550
structurally separate and distinct from a hospital, (B) provides 551
emergency care, (C) is a department of a hospital licensed under chapter 552
368v, and (D) has been issued a certificate of need to operate as a 553
freestanding emergency department pursuant to chapter 368z. 554
(5) (A) On and after July 1, 2024, if the executive director of the Office 555
of Health Strategy receives information and has a reasonable belief, after 556
evaluating such information, that any hospital, health system or 557
hospital-based facility charged facility fees, other than through isolated 558
clerical or electronic billing errors, in violation of any provision of this 559 Substitute Bill No. 5488
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section, or rule or regulation adopted thereunder, such hospital, health 560
system or hospital-based facility shall be subject to a civil penalty of up 561
to one thousand dollars. The executive director may issue a notice of 562
violation and civil penalty by first class mail or personal service. Such 563
notice shall include: (i) A reference to the section of the general statutes, 564
rule or section of the regulations of Connecticut state agencies believed 565
or alleged to have been violated; (ii) a short and plain language 566
statement of the matters asserted or charged; (iii) a description of the 567
activity to cease; (iv) a statement of the amount of the civil penalty or 568
penalties that may be imposed; (v) a statement concerning the right to a 569
hearing; and (vi) a statement that such hospital, health system or 570
hospital-based facility may, not later than ten business days after receipt 571
of such notice, make a request for a hearing on the matters asserted. 572
(B) The hospital, health system or hospital-based facility to whom 573
such notice is provided pursuant to subparagraph (A) of this 574
subdivision may, not later than ten business days after receipt of such 575
notice, make written application to the Office of Health Strategy to 576
request a hearing to demonstrate that such violation did not occur. The 577
failure to make a timely request for a hearing shall result in the issuance 578
of a cease and desist order or civil penalty. All hearings held under this 579
subsection shall be conducted in accordance with the provisions of 580
chapter 54. 581
(C) Following any hearing before the Office of Health Strategy 582
pursuant to this subdivision, if said office finds, by a preponderance of 583
the evidence, that such hospital, health system or hospital-based facility 584
violated or is violating any provision of this subsection, any rule or 585
regulation adopted thereunder or any order issued by said office, said 586
office shall issue a final cease and desist order in addition to any civil 587
penalty said office imposes. 588
(m) (1) Each hospital and health system shall report not later than 589
October 1, 2023, and thereafter not later than July 1, 2024, and annually 590
thereafter, to the executive director of the Office of Health Strategy, on 591
a form prescribed by the executive director, concerning facility fees 592 Substitute Bill No. 5488
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charged or billed during the preceding calendar year. Such report shall 593
include, but need not be limited to, (A) the name and address of each 594
facility owned or operated by the hospital or health system that 595
provides services for which a facility fee is charged or billed, and an 596
indication as to whether each facility is located on or outside of the 597
hospital or health system campus, (B) the number of patient visits at 598
each such facility for which a facility fee was charged or billed, (C) the 599
number, total amount and range of allowable facility fees paid at each 600
such facility disaggregated by payer mix, (D) for each facility, the total 601
amount of facility fees charged and the total amount of revenue received 602
by the hospital or health system derived from facility fees, (E) the total 603
amount of facility fees charged and the total amount of revenue received 604
by the hospital or health system from all facilities derived from facility 605
fees, (F) a description of the ten procedures or services that generated 606
the greatest amount of facility fee gross revenue, disaggregated by 607
current procedural terminology category (CPT) code for each such 608
procedure or service and, for each such procedure or service, patient 609
volume and the total amount of gross and net revenue received by the 610
hospital or health system derived from facility fees, disaggregated by 611
on-campus and off-campus, and (G) the top ten procedures or services 612
for which facility fees are charged based on patient volume and the 613
gross and net revenue received by the hospital or health system for each 614
such procedure or service, disaggregated by on-campus and off-615
campus. For purposes of this subsection, "facility" means a hospital-616
based facility that is located on a hospital campus or outside a hospital 617
campus. 618
(2) The executive director shall publish the information reported 619
pursuant to subdivision (1) of this subsection, or post a link to such 620
information, on the Internet web site of the Office of Health Strategy. 621
Sec. 12. Subsection (d) of section 17a-673c of the 2024 supplement to 622
the general statutes is repealed and the following is substituted in lieu 623
thereof (Effective from passage): 624
(d) The Commissioner of Mental Health and Addiction Services may 625 Substitute Bill No. 5488
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request a disbursement of funds from the Opioid Settlement Fund 626
established pursuant to section 17a-674c, in whole or in part, for the 627
establishment and administration of the pilot program. 628
Sec. 13. Subsection (c) of section 17a-674h of the 2024 supplement to 629
the general statutes is repealed and the following is substituted in lieu 630
thereof (Effective from passage): 631
(c) Not later than January 1, 2024, the Department of Mental Health 632
and Addiction Services, in collaboration with the Department of Public 633
Health, shall use the Opioid Antagonist Bulk Purchase Fund for the 634
provision of opioid antagonists to eligible entities and by emergency 635
medical services personnel to certain members of the public. Emergency 636
medical services personnel shall distribute an opioid antagonist kit 637
containing a personal supply of opioid antagonists and the one-page 638
fact sheet developed by the Connecticut Alcohol and Drug Policy 639
Council pursuant to section 17a-667a regarding the risks of taking an 640
opioid drug, symptoms of opioid use disorder and services available in 641
the state for persons who experience symptoms of or are otherwise 642
affected by opioid use disorder to a patient who (1) is treated by such 643
personnel for an overdose of an opioid drug, (2) displays symptoms to 644
such personnel of opioid use disorder, or (3) is treated at a location 645
where such personnel observes evidence of illicit use of an opioid drug, 646
or to such patient's family member, caregiver or friend who is present 647
at the location. Emergency medical services personnel shall refer the 648
patient or such patient's family member, caregiver or friend to the 649
written instructions regarding the administration of such opioid 650
antagonist, as deemed appropriate by such personnel. 651
Sec. 14. Subdivision (5) of subsection (a) of section 19a-77 of the 2024 652
supplement to the general statutes is repealed and the following is 653
substituted in lieu thereof (Effective from passage): 654
(5) ["Year-round" program] "Year-round program" means a program 655
open at least fifty weeks per year. 656
Sec. 15. Subsection (q) of section 19a-89e of the 2024 supplement to 657 Substitute Bill No. 5488
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the general statutes is repealed and the following is substituted in lieu 658
thereof (Effective from passage): 659
(q) The Commissioner of Public Health may order an audit of the 660
nurse staffing assignments of each hospital to determine compliance 661
with the nurse staffing assignments for each hospital unit set forth in the 662
nurse staffing plan developed pursuant to subsections (d) and (e) of this 663
section. Such audit may include an assessment of the hospital's 664
compliance with the requirements of this section for the content of such 665
plan, accuracy of reports submitted to the department and the 666
membership of the hospital staffing committee. In determining whether 667
to order an audit, the commissioner shall consider whether there has 668
been consistent noncompliance by the hospital with the nurse staffing 669
plan, fear of false reporting by the hospital [,] or any other health care 670
quality safety concerns. The hospital that is subject to the audit shall pay 671
the cost of the audit. The audit shall not affect the conduct by the 672
hospital of peer review as defined in section 19a-17b. 673
Sec. 16. Subsection (a) of section 19a-133c of the 2024 supplement to 674
the general statutes is repealed and the following is substituted in lieu 675
thereof (Effective from passage): 676
(a) As used in this section, "structural racism" means a system that 677
structures opportunity and assigns value in a way that 678
disproportionally and negatively impacts Black, Indigenous, Latino or 679
Asian people or other people of color, and "state agency" has the same 680
meaning as provided in section 1-79. The Commission on Racial Equity 681
in Public Health, established under section 19a-133a, shall recommend 682
best practices for state agencies to (1) evaluate structural racism within 683
their own policies, practices [,] and operations, and (2) create and 684
implement a plan, which includes the establishment of benchmarks for 685
improvement, to ultimately eliminate any such structural racism within 686
the agency. 687
Sec. 17. Subdivision (1) of subsection (k) of section 19a-508c of the 688
2024 supplement to the general statutes is repealed and the following is 689 Substitute Bill No. 5488
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substituted in lieu thereof (Effective from passage): 690
(k) (1) If any transaction described in subsection (c) of section 19a-691
486i [,] results in the establishment of a hospital-based facility at which 692
facility fees may be billed, the hospital or health system, that is the 693
purchaser in such transaction shall, not later than thirty days after such 694
transaction, provide written notice, by first class mail, of the transaction 695
to each patient served within the three years preceding the date of the 696
transaction by the health care facility that has been purchased as part of 697
such transaction. 698
Sec. 18. Subdivision (21) of section 20-73e of the 2024 supplement to 699
the general statutes is repealed and the following is substituted in lieu 700
thereof (Effective from passage): 701
(21) "Rule" means a regulation, principle [,] or directive promulgated 702
by the commission that has the force of law; and 703
Sec. 19. Subparagraph (B) of subdivision (2) of subsection (b) of 704
section 20-87a of the 2024 supplement to the general statutes is repealed 705
and the following is substituted in lieu thereof (Effective from passage): 706
(B) An advanced practice registered nurse having been issued a 707
license pursuant to subsection (d) of section 20-94a who collaborated, 708
prior to the issuance of such license, with a physician licensed to practice 709
medicine in another state may count the time of such collaboration 710
toward the three-year requirement set forth in subparagraph (A) of this 711
[subsection] subdivision, provided such collaboration otherwise 712
satisfies the requirements set forth in said subparagraph. 713
Sec. 20. Subsection (d) of section 20-185aa of the 2024 supplement to 714
the general statutes is repealed and the following is substituted in lieu 715
thereof (Effective from passage): 716
(d) Any health care facility that employs or retains a surgical 717
technologist shall submit to the Department of Public Health, upon 718
request of the department, documentation [demonstration] 719 Substitute Bill No. 5488
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demonstrating that the surgical technologist is in compliance with the 720
requirements set forth in this section. 721
Sec. 21. Subsection (b) of section 38a-479jjj of the 2024 supplement to 722
the general statutes is repealed and the following is substituted in lieu 723
thereof (Effective from passage): 724
(b) On and after January 1, 2024, a contract entered into between a 725
pharmacy [benefit] benefits manager and a 340B covered entity shall not 726
contain any of the following provisions: 727
(1) A reimbursement rate for a prescription drug that is less than the 728
reimbursement rate paid to pharmacies that are not 340B covered 729
entities; 730
(2) A fee or adjustment that is not imposed on providers or 731
pharmacies that are not 340B covered entities; 732
(3) A fee or adjustment amount that exceeds the fee or adjustment 733
amount imposed on providers or pharmacies that are not 340B covered 734
entities; 735
(4) Any provision that prevents or interferes with a patient's choice 736
to receive a prescription drug from a 340B covered entity, including the 737
administration of the drug; and 738
(5) Any provision that excludes a 340B covered entity from pharmacy 739
[benefit] benefits manager networks based on the 340B covered entity's 740
participation in the federal 340B Drug Pricing Program. 741
Sec. 22. Subsection (d) of section 38a-518v of the 2024 supplement to 742
the general statutes is repealed and the following is substituted in lieu 743
thereof (Effective from passage): 744
(d) Nothing in this section shall prohibit or limit a health insurer, 745
health care center, hospital service corporation, medical service 746
corporation or other entity from conducting utilization review for an in-747
home hospice [services] service, provided such utilization review is 748 Substitute Bill No. 5488
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conducted in the same manner and uses the same clinical review criteria 749
as a utilization review for the same hospice services provided in a 750
hospital. 751
Sec. 23. Subsection (c) of section 10-532 of the 2024 supplement to the 752
general statutes is repealed and the following is substituted in lieu 753
thereof (Effective October 1, 2024): 754
(c) When developing the program, said commissioners and executive 755
director [,] shall (1) consult with insurers that offer health benefit plans 756
in the state, hospitals, local public health authorities, existing early 757
childhood home visiting programs, community-based organizations 758
and social service providers; and (2) maximize the use of available 759
federal funding. 760
Sec. 24. Subsection (g) of section 19a-59j of the 2024 supplement to the 761
general statutes is repealed and the following is substituted in lieu 762
thereof (Effective October 1, 2024): 763
(g) Notwithstanding any provision of the general statutes, the 764
commissioner, or the commissioner's designee, may provide the infant 765
mortality review committee, established pursuant to section 19a-59k, 766
with information as is necessary, in the commissioner's discretion, for 767
the committee to make recommendations regarding the prevention of 768
infant deaths. 769
Sec. 25. Subdivision (3) of section 19a-111b of the 2024 supplement to 770
the general statutes is repealed and the following is substituted in lieu 771
thereof (Effective October 1, 2024): 772
(3) The commissioner shall establish a program for the detection of 773
sources of lead poisoning. Within available appropriations, such 774
program shall include the identification of dwellings in which paint, 775
plaster or other accessible substances contain toxic levels of lead and the 776
inspection of areas surrounding such dwellings for lead-containing 777
materials. Any person who detects a toxic level of lead, as defined by 778
the commissioner, shall report such findings to the commissioner. The 779 Substitute Bill No. 5488
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commissioner shall inform all interested parties, including, but not 780
limited to, the owner of the building, the occupants of the building, 781
enforcement officials and other necessary parties. 782
Sec. 26. Subsection (l) of section 19a-490 of the 2024 supplement to the 783
general statutes is repealed and the following is substituted in lieu 784
thereof (Effective October 1, 2024): 785
(l) "Assisted living services agency" means an agency that provides 786
chronic and stable individuals with services that include, but need not 787
be limited to, nursing services and assistance with activities of daily 788
living and may have a dementia special care unit or program as defined 789
in section 19a-562; 790
Sec. 27. Subdivisions (2) and (3) of subsection (b) of section 19a-181 of 791
the 2024 supplement to the general statutes are repealed and the 792
following is substituted in lieu thereof (Effective October 1, 2024): 793
(2) Each authorized emergency medical [service] services vehicle 794
shall be equipped with the equipment required for its specific vehicle 795
classification as specified in the 2022 Connecticut EMS Minimum 796
Equipment Checklist, as amended from time to time; and 797
(3) Each authorized emergency medical [service] services vehicle 798
shall comply with all state and federal safety, design and equipment 799
requirements. 800
Sec. 28. Subdivision (9) of subsection (c) of section 19a-493 of the 2024 801
supplement to the general statutes is repealed and the following is 802
substituted in lieu thereof (Effective October 1, 2024): 803
(9) The provisions of this subsection shall not apply in the event of a 804
change of ownership or beneficial ownership of ten per cent or less of 805
the ownership of a licensed outpatient surgical facility, as defined in 806
section 19a-493b, resulting in a transfer to a physician licensed under 807
chapter 370 if such facility provides information, in a form and manner 808
prescribed by the commissioner, to update such facility's licensing 809 Substitute Bill No. 5488
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information. 810
Sec. 29. Subdivision (2) of subsection (c) of section 19a-566 of the 2024 811
supplement to the general statutes is repealed and the following is 812
substituted in lieu thereof (Effective October 1, 2024): 813
(2) If a patient receiving birth center services no longer presents with 814
a low-risk pregnancy, as defined in section 19a-490, as amended by this 815
act, or otherwise fails to meet the patient eligibility criteria described in 816
subparagraph (A) of subdivision (1) of this subsection, the birth center 817
providing such services shall ensure the patient's care is transferred to a 818
licensed health care provider capable of providing the appropriate level 819
of obstetrical care for the patient. 820
Sec. 30. (Effective from passage) The Commissioner of Public Health 821
shall conduct a scope of practice review pursuant to sections 19a-16d to 822
19a-16f, inclusive, of the general statutes, to determine whether 823
naturopathic physicians licensed pursuant to chapter 373 of the general 824
statutes should be permitted to prescribe, dispense and administer 825
prescription medication and, if so, whether the Department of Public 826
Health should (1) establish educational and examination requirements 827
or other qualifications to permit a naturopathic physician to prescribe, 828
dispense and administer prescription medication, or (2) develop a 829
naturopathic formulary of prescription medication that a naturopathic 830
physician who meets such educational and examination requirements 831
or other qualifications may use. Not later than January 1, 2025, the 832
commissioner shall report, in accordance with the provisions of section 833
11-4a of the general statutes, the findings of such review and any 834
recommendations to the joint standing committee of the General 835
Assembly having cognizance of matters relating to public health. 836
This act shall take effect as follows and shall amend the following
sections:
Section 1 from passage 19a-6s
Sec. 2 October 1, 2024 19a-127n(b)
Sec. 3 October 1, 2024 19a-197a Substitute Bill No. 5488
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Sec. 4 July 1, 2024 20-195c(a)
Sec. 5 October 1, 2024 19a-508c(l)(3)
Sec. 6 October 1, 2024 20-7f
Sec. 7 from passage New section
Sec. 8 from passage 20-195n(b)
Sec. 9 October 1, 2024 20-252
Sec. 10 October 1, 2024 20-12i
Sec. 11 October 1, 2024 19a-508c
Sec. 12 from passage 17a-673c(d)
Sec. 13 from passage 17a-674h(c)
Sec. 14 from passage 19a-77(a)(5)
Sec. 15 from passage 19a-89e(q)
Sec. 16 from passage 19a-133c(a)
Sec. 17 from passage 19a-508c(k)(1)
Sec. 18 from passage 20-73e(21)
Sec. 19 from passage 20-87a(b)(2)(B)
Sec. 20 from passage 20-185aa(d)
Sec. 21 from passage 38a-479jjj(b)
Sec. 22 from passage 38a-518v(d)
Sec. 23 October 1, 2024 10-532(c)
Sec. 24 October 1, 2024 19a-59j(g)
Sec. 25 October 1, 2024 19a-111b(3)
Sec. 26 October 1, 2024 19a-490(l)
Sec. 27 October 1, 2024 19a-181(b)(2) and (3)
Sec. 28 October 1, 2024 19a-493(c)(9)
Sec. 29 October 1, 2024 19a-566(c)(2)
Sec. 30 from passage New section
PH Joint Favorable Subst.