PA 08-184—sHB 5701

Public Health Committee


SUMMARY: This act makes a number of substantive and technical changes to Department of Public Health (DPH) and other related statutes concerning health care practitioner licensing and regulation and DPH programs. Among its substantive changes, the act (1) broadens the requirement to notify neighbors about subsurface sewage disposal system work, (2) increases the amount health care providers can charge for providing copies of patient records, (3) allows towns to regulate outdoor smoking on public property, (4) eliminates a requirement for physicians and hospitals to order specific kidney function tests, (5) shifts responsibility for hospital community benefits reports from DPH to the HealthCare Advocate's Office, (6) requires newly matriculating college students to show proof of mumps and chickenpox immunization, (7) expands the use of an organ transplant account to include helping donors pay for travel and lost wages, and (8) authorizes fines for minors for possessing tobacco products.

EFFECTIVE DATE: October 1, 2008 except as noted below.


Existing law requires that each birth certificate contain the birth mother's name. It directs DPH to create a replacement certificate, within 45 days after receiving a court order or 45 days after the child's birth, whichever is later. It must include all information required for the birth certificate as of the date of the birth. The act limits the replacement certificate requirement to births that are subject to a gestational agreement, which is one between a woman and a couple that obligates the woman, often referred to as a surrogate mother, to carry the child for the intended parents.


By law, a sexton in charge of any burial place must provide a monthly list of all interments, disinterments, and removal of bodies to the town's registrar and the sexton also must file with the registrar the permits received when a body was brought into the town from another town or state for burial. The act specifies that the list must be in a DPH-prescribed format and requires the sexton also to file, during the first week of each month, all completed burial permits he or she received in the preceding month. It deletes an obsolete provision concerning books furnished by DPH.


The act amends existing law concerning mechanisms to report diseases on the DPH commissioner's list of reportable diseases and laboratory findings. By law, health care providers must file these reports by telephone or in writing with the department and the local health director where the subject resides. The act allows electronic reporting in a format specified by DPH.


Prior law required any person applying to DPH for authorization to repair or construct a subsurface sewage disposal system involving a waiver of the proximity requirement for a private residential well to notify in writing all abutting property owners. (The law does not further explain “proximity requirement. ”) By law, a DPH decision on the application constitutes a final decision for purposes of appeal to Superior Court. The law also states that DPH's approval does not constitute an affirmative defense to liability claims related to a disposal system's proximity to a well.

The act: (1) replaces the term “private residential well” with “water supply well,” thus broadening applicability to also include non-residential wells and public water supply wells; (2) requires written notification to all property owners with water supply wells affected by the exception request, not just abutting property owners; and (3) eliminates the language on a final decision for appeal to court.


By law, the DPH commissioner can establish and amend the Public Health Code (i. e. , DPH regulations). The code can address regulations concerning retail food establishments, including catering food service establishments and itinerant food vending establishments.

The act also allows the code to include regulations concerning permitting required from local health departments or districts for the operation of such establishments.


The act allows food service establishments to purchase Connecticut-grown farm products, instead of just fresh produce, that have been produced and are sold according to applicable state regulations at a farmer's market. “Farm products,” as defined under current law, include fresh fruits and vegetables; nuts; shell eggs; honey; maple syrup; nursery stock and other horticultural products; livestock food products such as meat, milk, cheese, and other dairy products; sugar; flowers; aquaculture products; products from trees, vines, or plants; and products processed by the farmer, such as baked goods made with farm products.

EFFECTIVE DATE: Upon passage


Existing law allows nurses working for home health care or homemaker home health care agencies to administer flu and pneumonia vaccines to persons in their homes without a physician's order after an assessment for contraindications and according to a physician-approved agency policy.

The act requires the policy to include an anaphylaxis protocol. In the case of an adverse reaction to a vaccine, the act authorizes the nurse to also administer epinephrine or other anaphylaxis medication without a physician's order according to the approved agency policy.


The act establishes continuing education requirements for natureopaths. For registration periods beginning on and after October 1, 2009, a natureopath applying for license renewal must earn a minimum of 15 contact hours of continuing education within the preceding registration period. “Registration period” means the one-year period for which a renewed license is current and valid. “Contact hour” means a minimum of 50 minutes of continuing education activity.

The continuing education must be directly related to natureopathy practice and reflect the professional needs of the licensee in meeting the public's health care needs. Qualifying continuing education includes courses offered on-line and those offered or approved by the American Association of Naturopathic Medical Colleges, regionally accredited higher education institutions, or state or local health departments.

A license renewal applicant must sign a statement attesting that he or she has met the continuing education requirements on a DPH-prescribed form. The licensee must retain attendance records or certificates of completion that demonstrate compliance with the continuing education requirements for at least five years after the continuing education was completed and provide them to DPH for inspection within 45 days of its requesting them.

A first-time license renewal applicant is exempt from the continuing education requirements. The act gives the DPH commissioner the discretion to waive the continuing education requirements or grant a time extension in cases of medical disability or illness if the licensee submits an application for the waiver or extension on a DPH-prescribed form and provides certification of the disability or illness by a licensed physician and other documentation the commissioner may require. The commissioner can grant a waiver or time extension for up to one registration period; he may grant additional waivers or extensions if the disability or illness continues beyond that period and the person files for the additional waiver or extension.

A person whose license becomes void for failure to renew and who applies for reinstatement must provide evidence documenting completion of 15 contact hours of continuing education within the one-year period immediately preceding his or her reinstatement application.


The act authorizes physician assistants, as delegated by a supervising physician within the scope of the physician's license, to prescribe and approve the use of durable medical equipment.

It also allows physician assistants to certify a person's disability for purposes of applications to the Department of Motor Vehicles for special license plates and removable windshield placards. Previously, only physicians and advance practice registered nurses could do this.


On and after October 1, 2008, the act bars any agreement, lease, or other contract entered into, renewed, or extended between an optometrist and another person from (1) impeding an optometrist's ability to gain access to his or her professional office or patient records except that it may include a provision that provides a reasonable protocol for the optometrist to gain access during nonbusiness hours for medical emergencies or (2) limiting, inhibiting, or preventing an optometrist's ability to communicate with his or her patients at any time.

It extends from eight to 12 years the maximum time a person can serve on the Connecticut Board of Examiners for Optometrists.


The act adds courses offered or approved by the Connecticut Assisted Living Association and the Connecticut Alliance for Subacute Care to those that meet continuing education requirements for nursing home administrator licensure.


The act adds the executive directors, or their designees, of the Permanent Commission on the Status of Women, the African-American Affairs Commission, and the Latino and Puerto Rican Affairs Commission to the HealthFirst Connecticut Authority.

The HealthFirst Connecticut Authority, created by PA 07-185, must recommend alternatives for affordable quality health care coverage for un- and under-insured people, cost containment measures, and insurance financing mechanisms.

EFFECTIVE DATE: Upon passage


The act adds two members to the State-wide Primary Care Access Authority, one appointed by the Connecticut State Dental Association and one appointed by the Connecticut Community Providers Association.

This authority, created by PA 07-185, must develop a universal system for providing primary care services to all Connecticut residents.

EFFECTIVE DATE: Upon passage


The act allows DPH to license as a perfusionist a person who (1) is currently certified by the American Board of Cardiovascular Perfusion, (2) has worked as a perfusionist in a licensed health care facility in another state for at least five years, and (3) has had no lapse in active practice as a perfusionist for more than 24 months at the time of filing for Connecticut licensure.

The law defines “perfusion” as the functions necessary for the support, treatment, measurement, or supplementation of the cardiovascular, circulatory, or respiratory systems or other organs, and to ensure the safe management of physiologic functions by monitoring and analyzing the parameters of these systems under a licensed physician's order and supervision.

EFFECTIVE DATE: Upon passage


The act allows DPH to license as a radiographer, for a 30-day period starting on the act's effective date, an applicant presenting satisfactory evidence of (1) holding a current radiologic technician license from another state issued on or before October 1, 1965 and with no disciplinary history; (2) completing a course of study in radiologic technology on or before June 30, 1964; and (3) practicing as a radiologic technologist, including taking x-rays, for at least two years within the five-year period immediately preceding the date he or she applies to DPH.

The act specifies that the radiographer statutes should not be construed as requiring licensure as a radiographer of a dental assistant student, intern, or trainee pursuing practical training in taking of dental x-rays if such activities are part of a supervised course or training program and the person is designated by a title clearly indicating his or her student, trainee, or intern status. This provision already applies to dental assistants.

EFFECTIVE DATE: Upon passage


The act increases from 45 to 65 cents per page the maximum amount a provider can charge for providing a patient with his or her health records. This cost includes any research fees, handling fees or related costs, and the cost of first class postage, if applicable.


For a 30 day period following the act's passage, the act allows DPH to license as an acupuncturist any applicant presenting satisfactory evidence to DPH of (1) receiving a bachelor of medicine degree before 1985, (2) successfully completing all portions of the acupuncturist examination administered by the national Commission for the Certification of Acupuncturists, and (3) successfully completing the Clean Needle Technique Course offered by the Council of Colleges of Acupuncture and Oriental Medicine.



The act empowers a municipality to regulate, on any property it owns, any activity deemed to be deleterious to public health, including the lighting or carrying of a lighted cigarette, cigar, pipe, or similar device.


Previously, any school-based health clinic (SBHC) constructed on or after October 1, 2007 that was located in or attached to a school building had to have an entrance separate from the school's entrance. This act requires the separate entrance requirement only for SBHCs located in a school built on or after July 1, 2009 where the SBHC shares a first floor exterior wall with the school building.

EFFECTIVE DATE: Upon passage


Prior law required physicians to order a serum creatinine test (test for kidney disease) as part of each patient's routine general medical examination, if not performed within the previous 12 months. The law provided that this did not apply to patients under 18 years old and a “routine general medical examination” did not include an annual gynecological examination. Also, prior law required that if this test was performed on a hospital inpatient, the ordering provider had to request at least once during the patient's stay that the testing laboratory report an estimated glomerular filtration rate (eGFR). This was required if the patient had not had the test in the year preceding the hospitalization.

The act eliminates the testing requirements placed on physicians and hospitals. It continues the existing requirements that a clinical laboratory, when it tests a specimen to determine a patient's serum creatinine level if ordered by a physician or hospital provider, to (1) calculate the patient's eGFR using the patient's age and gender and (2) include the patient's eGFR with its report to the physician or hospital provider. (eGFR is a measure of how effectively the kidneys are removing waste and excess fluid from the blood. It is calculated on a blood test for creatinine. )


The act increases from three to eight hours annually the required dementia-specific training that must be provided by each Alzheimer's special care unit or program to all licensed and registered direct care staff and nurse's aides providing direct patient care to residents in the special care unit or program. Existing law requires them also to receive eight hours of training within the first six months of employment.


Prior law required each hospital and managed care organization (MCO) to submit a biennial report to DPH on whether it had a community benefits program. The law defines these programs as voluntary programs to promote preventive care and improve the health status of working families and populations at risk in the communities within the MCO's or hospital's geographic area. The DPH commissioner had to summarize and analyze the required reports biennially and make summaries available to the public. He was authorized to impose civil penalties on hospitals and MCOs that failed to submit required reports.

The act instead requires that the hospitals and MCOs provide their community benefits reports to the healthcare advocate or his designee and transfers the DPH commissioner's powers and duties to the healthcare advocate, who must summarize and analyze the reports, within available appropriations.


The law permits a licensed or certified volunteer municipal ambulance service that is a primary service area provider to add one emergency vehicle every three years without having a public hearing. The one vehicle limit applies to the provider's entire fleet regardless of the number of towns it serves. The act allows hospital-based ambulance services to add a vehicle under this process.


The act changes some of the requirements for licensure as a psychologist and eliminates some of DPH's responsibilities concerning licensure exam administration. Prior law required a licensure applicant to have at least one year's postdoctoral experience of a type satisfactory to the Board of Examiners of Psychology. The act instead requires experience (but not necessarily postdoctoral) that meets requirements established in regulations adopted by DPH in consultation with the board. The act eliminates a requirement that the applicant verify that he or she intends in good faith to practice in the state. The act also clarifies that an applicant's doctoral degree be from an educational institution approved by the board with the consent of DPH rather than registered.

The act eliminates a requirement that DPH grade the licensure examinations of licensure candidates. It also no longer requires DPH to (1) determine the time and place of the examination and (2) administer the exam under the board's supervision.


The act specifically excludes a state-funded consortium of FQHCs, providing services only to Department of Social Services (DSS) program recipients, from certain financial security requirements for preferred provider networks (PPNs). DSS must adopt regulations to establish criteria to certify any such FQHC, including minimum reserve fund requirements. (DSS currently administers the State Administered General Assistance program through a contract with an FQHC consortium. )

EFFECTIVE DATE: Upon passage


Beginning August 1, 2010, the act requires full-time or matriculating students at a Connecticut college or university who were born after December 31, 1956 to show proof that they have been adequately immunized against mumps and chickenpox as recommended by the national Advisory Committee for Immunization Practices. The law already contains a similar requirement for measles and rubella immunization.

The act provides exemptions from the mumps and chickenpox immunization requirement that parallel those already permitted for measles and rubella. A student can be exempted by: (1) presenting a (a) doctor's certification that the immunization is contraindicated, (b) statement that immunization is contrary to his or her religious beliefs, or (c) doctor's or health director's certification that the student has had a confirmed case of the disease; (2) enrolling only in a distance learning or other program in which students do not congregate on campus; or (3) having graduated from a high school in the state after 1998 without being exempt from the mumps immunization requirement.


An assembly of 3,000 or more people that is expected to last 18 or more consecutive hours must be licensed by the local police chief. The act revises one of the licensing requirements.

It requires a license applicant to show proof that he or she will furnish a written plan that has been reviewed by the primary service area responder for the town in which the event is to be held that indicates satisfactory planning and arrangements for an ambulance service to be on the site for the event's duration. Previously, the applicant had to show proof that he or she would provide (1) at least one doctor for every 1,000 people and one nurse for every 1,500 anticipated attendees, (2) an enclosed structure for treatments, and (3) at least one ambulance available at all times.


Birth and Fetal Death Records

The act repeals a provision of PA 08-66 that required recording the mother's and father's Social Security numbers (SSN) in the confidential portion of the birth certificate and makes a conforming change concerning recording the SSN of the father of a child born out of wedlock. It prohibits releasing a parent's SSN recorded on a birth or fetal death record or certificate to any person or entity that is not authorized by state or federal law (e. g. , for child support enforcement).

By law, only specified parties can obtain, access, or examine copies of birth and fetal death records and certificates less than 100 years old. These parties include the child's close relatives; the chief elected official or health director of the town where the birth or fetal death occurred; attorneys representing the child, the child's parents, children, or surviving spouse; genealogists; authorized federal and state officials; and people the DPH specifically authorizes for statistical or research purposes.

The law also provides that it is not to be construed to permit disclosure of any information contained in the “health and statistical use only” and “administrative purposes only” sections of birth or fetal death records to anyone, including these specified parties, unless DPH specifically authorizes disclosure for statistical or research purposes. The act repeals (1) a provision of PA 08-66 that also permitted disclosure of SSNs and other certificate information from these sections if state or federal law authorized it and (2) a provision of prior law that permitted disclosure of information about the parents' ethnic and racial background regardless of its use.

Marriage and Death Records

PA 08-66 limited who could receive a certified copy of a (1) marriage or civil union license or (2) for a death occurring after July 1, 1997, a certificate containing the SSNs of the parties or decedent or the complete “administrative purposes only” section to the parties to the marriage or civil union or the surviving spouse or next of kin of the deceased, as appropriate. This act also allows entities authorized by state or federal law to receive such records.


The act requires DPH, by January 1, 2009, to report to the Public Health Committee on the feasibility and implications of implementing a biennial license renewal system for nurses (registered nurses, licensed practical nurses, and advanced practice registered nurses).

EFFECTIVE DATE: July 1, 2008


The act requires DPH, in consultation with the departments of Environmental Protection (DEP) and Consumer Protection (DCP), to convene a working group to study and make legislative recommendations to ensure that property owners of new construction served by a private water supply well have an adequate water supply meeting current regulatory portability standards. The group must also study and make recommendations on the installation of replacement water supply wells on properties with insufficient area to meet current separation distances as specified in regulations.

The working group includes: (1) the commissioners of DPH, DEP, and DCP, or their designees and (2) various interested stakeholders who have indicated to DPH their willingness to work on these issues. The group must report to the public health, environment, and general law committees by July 1, 2009.

EFFECTIVE DATE: Upon passage


The act expands the uses of the existing “organ transplant account” to include assisting individuals who have donated an organ to a state resident in paying all or part of any costs associated with the donation, including transportation and accommodation costs and lost wages.

The organ transplant account is a separate, nonlapsing account within the General Fund. It receives money collected under the income tax contribution system established by law and deposited with the revenue services commissioner. It can also receive money from public and private sources or from the federal government. Previously, money in the account could be used only to (1) assist state residents in paying all or part of the costs associated with a medically required organ transplant or (2) the promotion of the income tax contribution system and the organ transplant account.

EFFECTIVE DATE: July 1, 2008


The act prohibits the Office of the Chief Medical Examiner (OCME) from assessing any fees or costs concerning the cremation of a stillborn fetus. By law, cremation fees must be paid unless the body is donated for research. In practice, OCME charges $100, which covers, among other costs, sending OCME staff to funeral homes to investigate the death. It collects this fee from the funeral home.


By law, DPH can establish state laboratories to test for preventable disease, as well as to perform sanitation, environmental, and occupational testing. The law also allows the DPH commissioner to set laboratory fees. Laboratory services are provided without charge for local health directors and local law enforcement officials.

The law allows for partial, as well as full fee waivers for others if the commissioner determines the public health requires it. He may also waive fees for chlamydia and gonorrhea testing for nonprofit organizations if the organization provides combination chlamydia and gonorrhea test kits. The act extends the fee waiver to chlamydia and gonorrhea testing for higher education institutions that offer the kits.

EFFECTIVE DATE: July 1, 2008


The act requires DPH, in collaboration with the Department of Education, to contact each local and regional board of education to make them aware of meningococcal meningitis information. This must be done by September 1, 2008 and include information on the causes, symptoms, and spread of meningococcal meningitis and vaccination information reflecting the Centers for Disease Control and Protection's (CDC) current recommendations. DPH must periodically update the meningitis information it provides.

EFFECTIVE DATE: July 1, 2008


Existing law establishes a quality of care program within DPH and an advisory committee to advise the department on quality of care issues. The act requires the committee to meet at least semiannually instead of quarterly.

EFFECTIVE DATE: July 1, 2008


Federal law requires screening patients before they enter a nursing home to determine whether they have serious mental illness (a level I screening) and, if they do, whether they need specialized mental health services (level II screening). The act requires nursing home administrators or their designees to notify the Department of Mental Health and Addiction Services (DMHAS) within 14 days of admitting anyone whose level II screening confirms a psychiatric diagnosis. It requires DMHAS, within available appropriations, to consult with the home's staff about the status and discharge of any DMHAS client. DMHAS must, within available appropriations, protect to the fullest possible extent the housing of any client who a level II screening identifies as needing admission to a nursing home for 90 days or less.

The act requires DPH, when it conducts its annual survey of a nursing home, to compare the services recommended for any resident with a level II screening with the actual services he or she receives as indicated in the resident's care plan. DPH must include the results of the comparison, along with any regulatory violations it uncovered in its inspection, in the survey.

EFFECTIVE DATE: Upon passage


The act exempts Solar Youth, Inc. a nonprofit youth development and environmental education program in New Haven, from day care licensing requirements from the act's passage to June 30, 2009.

EFFECTIVE DATE: Upon passage


The act permits the DPH commissioner to make agreements with other states' agencies concerning training for asbestos and lead abatement practitioners and consultants that run from the act's passage to June 30, 2009. The agreements must establish criteria out-of-state agencies approve to satisfy the training DPH requires for practitioners' and consultants' licensure and certification.

EFFECTIVE DATE: Upon passage


The act prohibits DPH from denying any vendor authorization to participate in the WIC program, either initially or on reapplying, based on DPH's minimum distance requirements between participating vendors in the applicant's geographic area. It requires DPH to give vendors 15 days to cure any deficiency DPH finds in their application for initial or continued authorization. The 15 days begin when DPH notifies the vendor of the deficiency.

The act requires DPH to permit any vendor that was disqualified between January 1, 2007 and the act's passage for failure to maintain the minimum inventory or submit a completed application to reapply for authorization. DPH must notify such vendors of this opportunity within 30 days' of the act's passage, and vendors have 30 days from receiving this notice to apply for reinstatement. DPH must notify a vendor of its decision within 60 days of receiving its reinstatement application.

The act requires DPH to submit a revised state WIC plan for program administration that incorporates the act's vendor selection, notification, and disqualification provisions and all requirements of federal law. It must submit the plan to the U. S. Agriculture Department's Food and Nutrition Service (FNS), which administers the WIC program, by January 1, 2009. The act specifies that if a comprehensive FNS audit finds that Connecticut's WIC program does not comply with federal law and that the state consequently may face financial penalties, DPH must take any action needed to comply, including suspending the act's provisions on vendor authorization and reinstatement.

The act specifies that all of its requirements are subject to DPH's available appropriations.

EFFECTIVE DATE: Upon passage


The law required DSS to amend the state Medicaid plan to cover smoking cessation drugs if the state budget provided funds for this coverage. Currently, Connecticut's Medicaid program does not cover smoking cessation drugs. The act requires it to cover all prescriptive options, not just drugs, if the initial treatment does not work.

EFFECTIVE DATE: July 1, 2008


The act prohibits an individual under age 18 from possessing tobacco in any form in a public place. It imposes a fine of up to $50 for the first offense and between $50 and $100 for each subsequent offense. The act defines “public place” as any area used or held out for use by the public, whether owned or operated by public or private interests.

Existing law requires purchasers of tobacco products to be age 18. Persons under age 18 who buy tobacco products or misrepresent their age to buy such products are subject to the same fines noted above.


The bill repeals (1) the Childhood Immunization Advisory Council, (2) an outdated pilot program concerning municipal selection of emergency medical service providers, (3) an automatic external defibrillator (AED) notice and registry requirement, (4) a DPH annual report concerning the activities of the Connecticut Medical Examining Board, and (5) a DPH reporting requirement concerning the monitoring of public water supplies for organic chemicals. It also repeals internal references to them in other statutes.

Prior law required any person possessing an AED to notify the Office of Emergency Medical Services (OEMS) of its location. OEMS was required to establish an AED registry and a procedure for the use of the enhanced 9-1-1 service for the location of AEDs nearest to the caller. The act repeals these provisions.

Prior law required each water company to monitor, according to DPH regulations, the organic chemical content of all public water supplies to determine potentially harmful carcinogens in the water supply and report this to DPH. DPH ranked the carcinogens in order of potential danger and estimated the cost of removal of the more dangerous ones. DPH was required to report on this annually to the governor and General Assembly. The act eliminates these requirements.

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