PA 09-232—sHB 6678

Public Health Committee

Judiciary Committee


SUMMARY: This act makes numerous substantive and minor changes to laws governing Department of Public Health (DPH) programs and health professional licensing. The DPH program changes relate to funeral home practices and death records, the Connecticut Tumor Registry, mass gatherings, home health agency inspection schedules, water company lands and geothermal wells, health information technology, emergency medical services, and day care licensing. The professional licensing changes affect physicians, physician assistants, nursing home administrators, dental hygienists, physical therapists, veterinarians, barbers and cosmeticians, audiologists, speech and language pathologists, and radiographers.

The act makes changes in the Office of Health Care Access certificate of need program. It requires (1) certain health care practitioners to inform pregnant women about umbilical cord blood and cord blood banks, (2) direct billing for pathology services and (3) the University of Connecticut Health Center to establish a program that provides evidence-based outreach and education to prescribers about the therapeutic and cost-effective use of prescription drugs. It (1) allows towns to buy abandoned cemeteries, (2) expands the types of incidents of child abuse and neglect that the Department of Children and Families (DCF) must report to DPH when they involve certain DPH-licensed facilities, and (3) limits where people can get a marriage license to the town where the wedding will occur. And it makes minor changes in several laws and repeals others.

EFFECTIVE DATE: October 1, 2009, except as noted below.


The law requires funeral directors to wash or embalm a body before transporting it from the place where the death occurred. The act makes an exception when the person who assumes custody of the body for burial purposes determines that doing this is contrary to the deceased's religious beliefs or customs. The law still requires funeral directors to wash, embalm, or wrap a body as soon as practicable after it arrives at the funeral home if the person died from a disease that must be reported to DPH (CGS 19a-91(c)).

The act requires placing any body entombed in a crypt or mausoleum in a zinc-lined or plastic container (made of acrylonitrile butadiene styrene (ABS)) or, if the cemetery permits, a non-rusting or ABS sheeting tray.

It extends, to six from three years, the period:

1. after death that funeral homes must keep their records related to funeral services, prepaid funeral contracts, and escrow accounts;

2. after a body's final disposition that funeral homes must keep copies of permits, certificates, and written agreements about disposition, including the final bill; and

3. after last distributing price lists to consumers that funeral homes must keep copies of them.


The act adds another circumstance for which DPH can take action against a nursing home administrator—violating any state or federal law governing the administrator's practice in a nursing home. DPH can already take action against a licensee who is found guilty of a felony under this state's, another state's, or federal law. Sanctions include censure or reprimand, suspending or revoking the administrator's license, and civil penalties up to $25,000.


Medical residents and interns must get a DPH permit to participate in their programs. Under the act, the person's ability to practice medicine under the permit automatically ends when the internship or residency ends or he or she leaves the program. Anyone who continues to perform medicine is subject to DPH sanctions.


The act permits dental hygienists with two years of experience to practice independently (i. e. , without a dentist's general supervision) in programs offered or sponsored by the Women, Infants, and Childrens (WIC) program. Hygienists with this experience can already practice independently in community health centers, group homes, schools, public preschools, and Head Start programs.

EFFECTIVE DATE: July 1, 2009


The act lowers the attendance and durational thresholds, from 3,000 to 2,000 people and from 18 to 12 consecutive hours, that trigger the requirement for an event organizer to obtain a mass event license from the local police chief or first selectman. It also reduces, from 30 to 15 days before the event, the deadline for applying to the town for a permit to hold the event.


The act updates the law governing the Connecticut Tumor Registry. Existing regulations (1) require all hospitals and clinical laboratories to report to DPH, by June 30 annually, laboratory data, diagnosis, medical and occupational history, treatment, and lifetime follow-up information for anyone newly diagnosed with cancer and (2) subject any entity that does not report to license suspension or revocation.

The act requires the registry to include reports of all tumors and conditions that are diagnosed or treated in the state for which DPH requires reports. It extends the reporting requirement to physicians, chiropractors, naturopaths, podiatrists, athletic trainers, physical and occupational therapists, alcohol and drug counselors, radiographers and radiologic technologists, midwives, nurses, nurse's aides, dentists, dental hygienists, optometrists, opticians, respiratory care practitioners, perfusionists, psychologists, marital and family therapists, clinical social workers, professional counselors, veterinarians, massage therapists, electrologists, hearing instrument specialists, speech and language pathologists, audiologists, paramedics, and emergency medical technicians.

It requires the reports to cover every occurrence of a reportable tumor and condition (DPH determines what must be reported) that was diagnosed or treated during the calendar year. The reports must include information from any health care provider's records; follow-up data; and demographic, diagnostic, treatment, and other medical information. They may include actual tissue samples and other information DPH prescribes. The act requires the DPH commissioner to develop a list of data that must be reported. Reports are due annually beginning July 1, 2010.

Any hospital, lab, or provider that fails to report within nine months of its first contact with a patient for diagnosis or treatment must be assessed a $250 civil penalty for each business day after the DPH commissioner orders it to report. The act also imposes a civil penalty of up to $500 for each tumor a provider fails to report. The commissioner may ask the attorney general to enforce both penalties.

The act requires all health care providers to give DPH access to their records to perform case finding or other quality improvement audits. It allows DPH to (1) contract for the storage, holding, and maintenance of tissue samples and (2) make reciprocal reporting agreements with other states' tumor registries to exchange tumor reports.

The act authorizes DPH to perform “registry services” for any hospital, lab, or provider that fails to comply with its reporting requirements. The act does not define this term, but it presumably includes reporting all required data. In such cases, the hospital, lab, or provider must reimburse DPH for its expenses.

Under the act, DPH can assess reimbursements, expenses, or civil penalties only after it notifies the provider in writing and gives it an opportunity to respond. The provider must respond within 14 business days of receiving the notice and must give DPH any information it requests.



The act requires local registrars of vital statistics to appoint at least two subregistrars who can issue needed permits when the registrar's office is closed; prior law did not set a minimum number. It allows subregistrars to issue cremation permits as well as removal, transit, and burial permits. Before authorizing a cremation permit, the act requires the subregistrar to receive and review a completed cremation certificate and permit. The act prohibits a funeral director, embalmer, or an employee of either, acting as a subregistrar, to issue a cremation permit to him or herself.

The act specifies that subregistrars must forward the death and cremation certificates upon which they issued permits to the registrar of the town where the death occurred, not the registrar that appointed them. It requires them to submit a cremation permit within seven days after receiving the cremation certificate, the same time currently required for submitting a death certificate. It also specifies that the chief, deputy chief, and associate medical examiners are considered subregistrars in any town where a death occurs only for issuing removal, transit, and burial permits (thus, not for issuing cremation permits).

Cemetery Sextons

The act specifies time frames and procedures for cemetery sextons to follow for transmitting removal, transit, and burial permits to registrars. If they record a permit on an electronic registry, they must do so within three days of the burial. The act requires them to send the completed and signed permit in paper format to the registrar of the town where the body is buried and a copy to the registrar of the town where the death occurred. A sexton in charge of reinterring a disinterred body must (1) complete and return a disinterment permit to the registrar of the town where the body is buried and (2) send a copy to the registrar of the town where the death occurred. The act requires sextons to send all paper permit forms within the first week of the month following the burial or disinterment. It subjects sextons to a $500 fine or imprisonment for up to five years for failure to follow these procedures.

The law requires sextons to report all interments, disinterments, and removals to the registrar of the town where the cemetery is located. Under the act, they can fulfill this requirement by recording removal, transit, and burial permits in an electronic registry. The act removes requirements that reports be on a DPH-prescribed form and that sextons (1) include in their monthly reports a separate statement about bodies that were temporarily stored in their cemeteries' receiving vaults before burial and (2) send a copy of the permits for such burials to the registrar of the town where the death occurred. It retains the existing fine of up to $100 per day fine for failure to file these reports on time.


The act allows embalmers and funeral directors from other states that have reciprocal agreements with Connecticut to apply for a disinterment permit. It specifies that they and DPH-licensed funeral directors and embalmers and people acting under a court order, who are currently allowed to apply for such permits, can apply to either the registrar of the town where the body is buried or of the town where the death occurred.

The act also repeals and incorporates into its provisions two statutes governing disinterment and sexton reporting and makes related technical changes.


The act adds eliminating gender-related health disparities to the Commission on Health Equity's charge and requires at least one of its eight public members to represent women. The top four legislative leaders each appoint two public members.

EFFECTIVE DATE: Upon passage


The act requires veterinarians to take at least 24 contact hours (a contact hour is 50 minutes) of continuing education every two years as a condition of license renewal and permits DPH to sanction a veterinarian who fails to comply. The requirement applies to license renewals occurring on or after July 1, 2011.

The continuing education must (1) be in an area of the veterinarian's practice and (2) reflect his or her professional needs. In-person and online courses offered by national and state veterinarian organizations, veterinary schools, and other professional organizations qualify as continuing education activities. A veterinarian applying for license renewal must (1) attest in writing to DPH that he or she satisfied the continuing education requirements and (2) keep records to that effect for at least three years after completion. The veterinarian must submit these records to DPH with 45 days of its asking for them.

The requirements do not apply to veterinarians who (1) renew a license for the first time or (2) submit a notarized exemption application to DPH stating they do not practice actively. The act allows the DPH commissioner to waive the requirement or grant an extension for up to one year for a veterinarian who is ill or medically disabled. A doctor's note certifying the condition must accompany the veterinarian's waiver or extension application. Upon application, the commissioner can grant additional waivers and extensions if the condition continues.

A veterinarian whose license is voided for failure to renew must document successfully completing at least 12 contact hours of continuing education in the year immediately preceding the year he or she applies to reinstate the license.

EFFECTIVE DATE: July 1, 2009 for the continuing education requirements; October 1, 2009 for DPH's ability to sanction veterinarians who do not comply with them.


Under current law, DPH must conduct an unscheduled inspection of a home health agency before the agency's license can be renewed. Licenses are renewable every two years. Agencies that participate in Medicare must, under federal law, be inspected every three years; DPH also conducts these inspections.

The act exempts Medicare-certified home health agencies from the two-year inspection schedule, thus bringing inspections into line with the triennial federal schedule. But it retains the biennial licensing requirement, which means inspections and license renewals will no longer be aligned. (While the act appears to affect homemaker-home health aide agencies and homemaker-home health aide services, Medicare does not certify these. )

EFFECTIVE DATE: July 1, 2009


The act removes an obsolete reference to DPH-operated institutions from the law concerning the Administrative Services Department's ability to recoup funeral and certain other payments the state made on behalf of public assistance recipients who die with a small estate. DPH does not operate any institutions serving public assistance recipients.


The act adds cultural competency to the list of continuing medical education topics physicians must take every two years. The requirement begins with license registration periods starting on and after October 1, 2010. The list currently covers infectious diseases, risk management, sexual assault, and domestic violence. Physicians must take at least 50 minutes (one contact hour) of education in each of these topics every two years.


The act adds to physical therapists' scope of practice the use of “low-level light laser therapy” to accelerate tissue repair, decrease edema (swelling), or minimize or eliminate pain. It defines this therapy (also known as “cold laser” therapy) as having wave lengths ranging from 600 to 1,000 nanometers.


The act permits the DPH commissioner, with the concurrence of the environmental and consumer protection commissioners, to give a university located in a city whose population is between 100,000 and 150,000 a variance from state regulations to install standing column geothermal wells in a class GB groundwater zone (not fit for human consumption without treatment). The commissioners may require the wells to meet minimum safeguards that exceed existing regulatory requirements.

Before the variance may be granted, the school must submit information these agencies deem necessary to assure the public health and the environment are protected. The school must hire, at its expense, an independent expert to help the state agencies develop regulations for geothermal wells.

If, once it is operating, the public health or environmental protection commissioners determine the well is injuring public health or the environment, either may order it closed and abandoned according to regulatory requirements.

EFFECTIVE DATE: Upon passage


The act requires doctors and other health care providers who provide pregnancy-related care for women during their third trimester to provide the women with timely, relevant, and appropriate information about umbilical cord blood and cord blood banks. The information must be sufficient to allow women to make informed choices about banking or donating their child's cord blood.

EFFECTIVE DATE: July 1, 2009


The act makes several minor and technical changes to the EMS laws. It renames several terms used in those laws to conform to newer national usages: (1) “emergency medical technician-intermediate” becomes “advanced emergency medical technician,” (2) “medical response technician” becomes “emergency medical responder,” and (3) “medical control” becomes “medical oversight.

It requires all emergency medical technicians (EMTs) to be recertified every three years; prior law required EMTs to be recertified every two years, except for those with six years of continuous service, who had to be recertified every three years. The act also increases, from 25 to 30 hours, the amount of refresher training EMTs must obtain to be recertified. It allows the DPH commissioner to prescribe alternative recertification requirements.

The act removes the (1) requirement for the DPH commissioner to establish minimum standards and adopt regulations concerning life saving equipment on EMS vehicles and (2) authority for him to issue regulations governing mandatory equipment for motorcycles used as rescue vehicles. Instead, it requires him to issue an annual list of minimum equipment requirements for ambulances and rescue vehicles that is based on national standards. The commissioner must distribute the list to all EMS organizations and sponsor-hospital medical directors and make it available to other interested parties. The act give EMS organizations one year from the date the list is issued to comply with it.

The act removes a provision in DPH's EMS certificate of need (CON) process that limits the primary service area responder (PSAR) that may be granted intervernor status to the PSAR in the town where the CON applicant operates or intends to operate. This codifies DPH's practice.

It specifies that the state medical director who serves on the EMS Advisory Board is DPH's EMS medical director.

EFFECTIVE DATE: January 1, 2010, except the CON provision is effective upon passage.


The act amends a provision in PA 09-206 to eliminate the insurance commissioner's consultative role in developing a plan to implement a state prescription drug bulk purchasing program.

EFFECTIVE DATE: July 1, 2009


The act prohibits local zoning regulations from permitting a crematory to be located within 500 feet of any residential structure or land zoned for residential purposes that is not owned by the crematory's owner. The prohibition applies to both human and large animal (defined as cattle, horses, sheep, goats, swine, and other livestock) crematories. It repeals the previous law governing local approval of crematory locations, which contained a similar prohibition on siting crematories after October 1, 1998.


The act permits a swine breeding barn that meets certain criteria to continue in use regardless of state law or regulations to the contrary. The barn must be (1) on property that has been used continuously as a farm for at least 50 years and (2) at least 200 feet from any inhabited house on the property other than the barn owner's house.

EFFECTIVE DATE: Upon passage


The act exempts Solar Youth, Inc. from day care licensing requirements. It requires Solar Youth to inform parents and guardians of any child it enrolls that its programs are not licensed to provide day care services. Solar Youth is a youth development and environmental education organization located in New Haven. PA 08-184 exempted it from licensing requirements until June 30, 2009.

When a licensee vacates a leased space that DPH has already approved for day care services, the act permits DPH to determine whether a subsequent applicant is eligible for a license once the landlord establishes to its satisfaction that the previous licensee has no legal right or interest in the premises.

The act requires DPH to offer an expedited review process when a municipal department or agency applies for a day care license.

EFFECTIVE DATE: Upon passage, except for the Solar Youth provision, which is effective July 1, 2009

43 — FLU

The act specifies the type of flu that qualifies as an infectious disease for purposes of PA 09-76, which requires hospitals to notify emergency service organizations when a patient they have transported is found to have an infectious disease. Under that act, “pandemic flu” was termed an infectious disease; this act, instead, makes it “novel influenza A virus infections with pandemic potential,” as defined by the Centers for Disease Control and Prevention.


The act allows people performing the 100 hours of supervised postgraduate clinical training required for licensure as a marital and family therapist to pay the therapist who supervises them. Current law bars them from directly compensating a supervisor.


The act repeals the requirement that a barber, hairdresser, or cosmetician from another state or U. S. territory or commonwealth who is seeking licensure- or registration-by-endorsement here (i. e. , without taking the Connecticut licensing exam) successfully complete an English proficiency test if the licensing exam he or she passed in the other jurisdiction was not in English.

EFFECTIVE DATE: July 1, 2009


The law requires a water company to get a permit from DPH in order to sell, lease, assign, otherwise dispose of, or change the use of watershed lands. The act establishes conditions under which a company can obtain a permit to lease class I land.

It allows DPH to grant a permit under certain conditions for the lease of class I land associated with a groundwater source used for public drinking water to another water company that serves 1,000 or more people or 250 or more customers and maintains an approved water supply plan. The lessee water company must demonstrate that the lease will improve the existing public drinking water system's conditions and will not have a significant adverse effect on the public drinking water supply's purity and adequacy now or in the future. DPH may require the water company seeking the permit to convey an easement that protects the water supply source and submit the easement and any lease provisions that pertain to public water supply protection to the commissioner for approval.

Under existing law, these new lease conditions do not prevent a water company from leasing class I land or changing its use for (1) recreational purposes that do not require intense development or improvements for water supply purposes, (2) radio or telecommunications towers, or (3) leasing existing structures (CGS 25-32(f)).

EFFECTIVE DATE: Upon passage


By law, only a DPH-licensed radiographer can operate x-ray equipment. The act specifies that operating such equipment includes energizing the beam, positioning the patient, and positioning or moving equipment in relation to the patient.

EFFECTIVE DATE: Upon passage


Beginning October 1, 2011, the act establishes training criteria that a physician assistant (PA) must meet in order to use fluoroscopy to guide diagnostic and treatment procedures and a mini C-arm in conjunction with it. A PA must complete 40 hours of training that includes radiation physics and biology, safety, and management applicable to fluoroscopy. At least 10 hours of the training must address radiation safety, and at least 15 hours must address radiation physics and biology. A PA must also pass a DPH-prescribed test. Documentation that a PA has met these requirements must be kept at the PA's worksite and be available to DPH upon request.

But the act permits a PA to perform fluoroscopy and use a mini C-arm before October 1, 2011 without this training by passing the DPH-prescribed exam. A PA who does not pass this test cannot use a fluoroscope or mini C-arm until he or she meets the act's training and test requirements.

The act specifies that the radiographer licensing laws should not be construed to prohibit a PA who is not a licensed radiographer from using a fluoroscope or a mini C-arm in conjunction with fluoroscopic procedures.

EFFECTIVE DATE: Upon passage


SA 09-3 requires the social services, public health, and education commissioners to collaborate on developing and implementing, by January 1, 2010, a single form for preschool and child day care providers to report information needed for state funding. This act specifies the information needed: daily attendance records for children and staff, staff qualifications, and work schedules. It permits the social services commissioner to develop additional forms for each type of information and specifies that any form developed must be designed to facilitate the departments' collection of the required information. It eliminates the requirement that the commissioners collaboratively implement use of the form.

EFFECTIVE DATE: Upon passage


The act establishes separate licenses for audiologists and speech and language pathologists; these professions were previously subject to the same license requirements, which the act eliminates. It imposes continuing education requirements on both. It permits, rather than requires, DPH to adopt regulations governing speech and language pathology; it is silent on audiologist regulations, which prior law required.

53-60 — Audiologist Licensure

The act maintains the existing definition of the practice of audiology, that is measuring, testing, and determining appropriate amplification related to hearing disorders, including fitting and selling hearing aids to modify communication disorders. It defines “audiologist” as anyone who practices audiology using any title or description of service that use the words audiology; audiologist; audiological; hearing clinician, therapy, therapist, or conservationist; industrial audiologist; or similar title or description.

The act requires anyone applying for an audiologist license who graduated on or after January 1, 2007 to have a doctorate in audiology from an accredited program; people who graduated before that date with only a master's degree can still obtain a license. It allows the Accreditation Commission for Audiology Education or any other organization the U. S. Department of Education recognizes to accredit audiology programs to accredit programs; currently only the Speech Language-Hearing Association can do this. It continues to permit licensure for someone who has completed an integrated educational program that, at the time of completion, satisfied the Speech Language-Hearing Association's requirements for clinical competence.

The act maintains the same supervised postgraduate work experience requirements for licensure candidates but adds the requirement that the supervised work consist of at least six sessions per month totaling at least four hours. Two of the sessions must provide a total of at least two hours of direct, on-site observation. It permits DPH to waive these requirements for a candidate who graduated with a PhD after January 1, 2007. It also continues to permit DPH to waive the licensing exam for audiologists (1) licensed in other states or U. S. territories with standards at least as rigorous as Connecticut's or (2) who hold a certificate in audiology from a national professional organization approved by the DPH commissioner.

The annual license fee continues to be $100.

The act imposes continuing education requirements on audiologists beginning with licenses renewed on and after October 1, 2011. Audiologists must show they have earned at least 20 contact hours (50 minutes to an hour) in areas of their practice. Courses, workshops, conferences, professional journals, and in-person or on-line activities all qualify for continuing education credits if they are accepted or approved by national or state audiology associations or by related professional societies and organizations. Audiology-related graduate courses also qualify if they are offered by an accredited college (it is not clear if the accreditation is by an audiology or speech-language body or by any college accrediting body). Licensees must keep records attesting to their compliance with these requirements for three years and submit them to DPH within 45 days of any request to do so.

These continuing education requirements do not apply to audiologists who (1) renew a license for the first time or (2) submit a notarized exemption application to DPH stating they do not practice actively. The act allows the DPH commissioner to waive the requirement or grant an extension for up to one year for an audiologist who is ill or medically disabled. A doctor's note certifying the condition must accompany the audiologist's waiver or extension application. Upon application, the commissioner can grant additional waivers and extensions if the condition continues.

An audiologist whose license is voided for failure to renew must document successfully completing at least 10 contact hours of continuing education in the year immediately preceding the year he or she applies to reinstate the license.

The act continues the existing exemptions from licensure for (1) graduate students and interns in their coursework and others working to meet the professional employment requirements for licensure, (2) qualified people from other states and countries working in Connecticut for limited periods, (3) nurses and others screening people for hearing loss, (4) hearing instrument specialists, and (5) people consulting or providing research findings and scientific information to accredited academic institutions or government agencies or lecturing to the public for a fee. It adds exemptions for:

1. anyone who holds a valid certificate (a) in occupational hearing conservation from the Council for Accreditation in Occupational Hearing Conservation or another organization recognized by DPH or (b) as a certified industrial audiometric technician or occupational hearing conservationist from a DPH-recognized organization, if his or her service is performed in cooperation with either a licensed audiologist or physician;

2. audiometric tests administered under federal occupational safety law by a state employee or a person engaged in a business in which such tests are reasonably required, if the person administering the tests does not perform any other functions for which an audiology license is required; or

3. another licensed or registered professional practicing his or her profession.

The act establishes actions for which the DPH commissioner can refuse to issue a license; suspend or revoke a license; or issue other sanctions against a license holder, including letters of reprimand and civil penalties. These actions are:

1. obtaining a license by fraud or material misrepresentation or engaging in fraud or material deception in the course of professional services or activities;

2. violating professional conduct guidelines or a code of ethics established by DPH regulations (the act does not authorize DPH to adopt regulations governing audiologists);

3. violating any provision of the audiology licensing statutes;

4. physical or mental illness or emotional disorder or loss of motor skill, including age-related deterioration;

5. abuse or excessive use of drugs or alcohol; or

6. illegal, incompetent, or negligent conduct in practicing audiology.

The act permits the DPH commissioner to order a licensee to submit to a reasonable examination if his or her physical or mental capacity to practice safely is the subject of an investigation. It allows him to ask the Hartford-New Britain Superior Court to enforce this order or any DPH sanction.

The act permits unlicensed audiologist assistants to perform services under the direct, on-site supervision of a licensed audiologist who must assume responsibility for the assistant's performance. It prohibits an assistant from:

1. interpreting obtained observations or data into diagnostic statements of clinical management or procedures;

2. determining case selection;

3. transmitting verbally or in writing clinical information, including data or impressions about client performance, behavior, or progress, to anyone other than the audiologist;

4. independently composing clinical reports, except for progress notes to be held in the patient's file;

5. referring a patient to other agencies; or

6. using any title not determined by the audiologist or that implies the individual is a licensed audiologist.

As under current law, the act subjects anyone who violates any of the audiologist licensing laws, except failure to renew a license, to a fine of up to $500, up to five years in prison, or both. It makes each instance of patient contact a separate offense.

61-67 — Speech and Language Pathologist Licensure

The act adds the following to speech and language pathologists' scope of practice: screening individuals for hearing loss or middle ear pathology using otoacoustic emissions screening; screening tympanometry; or conventional pure-tone air conduction methods, including otoscopic inspection. It defines a speech and language pathologist as someone who engages in the practice of speech and language pathology under any title or description of service that uses the words speech pathologist, pathology, therapist, therapy, correction, correctionist, or clinician; language pathologist or pathology; aphasiologist; aphasia therapist; voice therapy, therapist, or pathologist; phoniatrist; communication or communication disorder specialist; or any similar title or description of services.

It maintains the existing educational requirements for licensure but specifies that:

1. the statutory hours for required postgraduate experience (1,080 full-time or 1,440 part-time) are the minimum level and must be satisfactorily completed and

2. the experience must consist of (a) at least six supervised sessions each month, totaling at least four supervised hours and (b) at least two sessions of direct, on-site observation totaling at least two hours.

The act permits the DPH commissioner to waive the written licensing exam requirement for people licensed as speech and language pathologists in U. S. territories; he may already do this for people licensed in other states.

The act continues the existing exemptions from licensure for:

graduate students and interns in their coursework and others working to meet the professional employment requirements for licensure,

qualified people from other states and countries working in Connecticut for limited periods,

people consulting or providing research findings and scientific information, and

supervised support personnel who assist a licensed speech and language pathologist with routine tasks. It eliminates exemptions related to audiology.

The act establishes continuing education requirements for speech and language pathologists. Like audiologists, it requires 20 contact hours every two years, but it does not specify the duration of a contact hour. The requirements, exemptions, and waivers parallel those described above for audiologists, except the act specifies that the content of courses or workshops must be accepted by the American-Speech-Language Hearing Association. National and regional speech-language groups, professional societies, state and local education agencies, hospitals and other health care institutions, and colleges can all offer continuing education.


The act takes two approaches to recognizing radiologist assistants. One is to carve out a “radiologist assistant” category within the existing radiographer licensing law; the other is to create, conditionally, a separate license for assistants.

68 — New Radiologist Assistant Category

The act enables a licensed radiologic technologist (someone who operates x-ray equipment, also known as a radiographer) to perform more advanced radiologic procedures as a radiologist assistant. In addition to the existing licensing requirements, to be a radiologist assistant a radiologic technologist must:

1. have graduated from a radiologist assistant education program recognized by the American Registry of Radiologic Technologists and passed that group's radiologist assistant examination;

2. maintain a current Connecticut license in good standing as a radiologic technologist;

3. hold current certification in (a) advanced cardiac life support and (b) as a radiographer and a radiologist assistant from the American Registry of Radiologic Technologists; and

4. maintain professional liability insurance or other indemnity against liability for professional malpractice for at least $500,000 for one person, per occurrence, with an aggregate of at least $1. 5 million.

Each radiologist assistant must have a clearly identified supervising radiologist who has final responsibility for patient care and the assistant's performance. A radiologist may concurrently supervise no more than two full-time radiologists assistants, or their part-time equivalent. An assistant can perform services only at the supervising radiologist's primary medical practice location or in a health care facility where the supervising radiologist holds staff privileges.

The act defines supervision to include the ability for direct communication between the radiologist and the assistant, active overview to assure the assistant is following directions, personal review of an assistant's practice at least weekly, and regular chart review. It defines “direct supervision” as a radiologist's presence in the office suite and immediate availability to furnish assistance and direction throughout the performance of the procedure.

A radiologist assistant who meets the above criteria may perform radiologic procedures delegated by and under the direct supervision of a supervising radiologist if:

1. the supervising radiologist is satisfied of the assistant's ability and competence;

2. the delegation is consistent with the patient's health and welfare and in keeping with sound medical practice;

3. the supervising radiologist assumes full control and responsibility for all procedures the assistant performs;

4. the procedures are performed under the oversight, control, and direction of the supervising radiologist; and

5. the supervising radiologist establishes written protocols for implementing the delegated procedures.

The act specifies certain procedures that must be performed while the supervising radiologist is in the same room (i. e. , personal supervision). These are: (1) contrast media administration; (2) needle or catheter placement; (3) lumbar puncture under fluoroscopic guidance; (4) lumbar myelogram; (5) thoracic or cervical myelogram; (6) nontunneled venous central line placement, venous catheter placement for dialysis, and breast needle localization; and (7) ductogram. In addition, the act permits a supervising radiologist to determine other procedures that are appropriate to be performed under personal supervision.

The act prohibits an assistant from (1) interpreting images, (2) diagnosing, (3) prescribing medication or therapy, or (4) administering anesthesia.

The act specifies that it does not apply to students in a radiologist assistant program recognized by the American Registry of Radiologic Technologists who are performing activities and services that are part of the course of study.

EFFECTIVE DATE: October 1, 2009

83-90 — Licensure

Beginning July 1, 2011, the act creates a new license category for radiologist assistants, but only if DPH has appropriations available to implement it. The license and license renewal fee is $150. The licensure criteria is the same as the “carve-out” criteria. The act prohibits anyone who is subject to pending disciplinary action or an unresolved complaint in Connecticut or elsewhere from obtaining a license.

The act permits DPH to take disciplinary action against, and impose the same penalties on, a radiologist assistant for the same reasons it can against most health professionals.

EFFECTIVE DATE: July 1, 2011, except for the provision making DPH the governing authority over licensed radiologist assistants, which is effective July 1, 2009 but applicable only after July 1, 2011.


The act allows a municipality to acquire an abandoned cemetery, including ownership of any occupied or unoccupied lots or grave sites in it. Under the act, an abandoned cemetery is one:

1. where no burial has occurred during the previous 40 years and in which the lots or graves have not been maintained during the last 10 years except for maintenance by the municipality;

2. where no lots have been sold in the last 40 years and in which most lots or graves have not been maintained during the last 10 years except for maintenance by the municipality; or

3. where one burial has occurred in the past 40 years when a permit was issued after the burial, if the municipality where the cemetery is located fully complies with the act's notice requirements and sends the notice to the surviving owner.

The municipality may survey such a cemetery to ascertain its extent. It must use due diligence to identify any owners of the cemetery or any of its lots or grave sites. It must notify the owners of its intention to acquire the cemetery, and if it cannot locate them, it must publish notice of its intention in a newspaper having a general circulation in the municipality. The notice must be published for three successive weeks. It must give a basic description of the cemetery, by reference to the municipality's tax maps, and set a date and place where the municipality will hear objections to the acquisition.

Any owner who receives the notice may reassert his or her right of ownership over the cemetery, unoccupied or occupied lot, or grave site by sending a written objection to the municipality within 14 days after receiving the notice. Any owner who reasserts his or her rights must promptly comply with all municipal ordinances concerning the cemetery, lot, or grave site.

If the municipality receives no objection within 15 days after the last date the notice was published, title to the cemetery and any lots or graves vests in the municipality. The municipality must (1) record a confirmation of the vesting, including a basic description of the cemetery, on the municipality's land records; (2) maintain title to the cemetery, which it may not transfer; and (3) maintain the cemetery's characteristics and make no changes in the use of its land. The municipality may appoint a sexton for the cemetery and appropriate funds for its care, maintenance, and support.

EFFECTIVE DATE: Upon passage


The act requires Sunshine House, beginning September 21, 2009, to establish a pilot program creating a freestanding “comfort care center” for terminally ill children and their families and sets criteria for its doing so. It permits the care provided in the pilot program to include: respite care; end-of-life care that includes whole child care in a child-centered, family-oriented, home-like setting for families who need such care outside their home; and whole family care that includes accommodation for parents, specialized support for siblings and others, and bereavement support.

The act requires the pilot program to obtain a certificate of need from the Office of Health Care Access before September 30, 2011 and a hospice license from DPH by September 30, 2014. If it fails to do either, the pilot program ends.

EFFECTIVE DATE: Upon passage


The act requires direct billing to the patient or insurer by a clinical laboratory performing anatomic pathology services. It prohibits any entity other than a physician, clinical laboratory, or a “referring clinical laboratory” from directly or indirectly charging, billing, or seeking payment for pathology services unless the physician or lab personally performed or directly supervised the service according to federal standards governing clinical labs. Patients and third-party payors are not required to reimburse providers for charges or claims that violate the act's prohibitions.

The act allows clinical and referring labs to seek payment only from a patient, hospital, responsible insurer of a third-party payor, or a government agency or the agency's public or private agent. It states that it is not to be construed to prohibit a clinical lab from billing a referring lab for specimens transferred for histologic (tissue) or cytologic (cell) processing or for consultations.

The act defines “referring clinical laboratory” as a lab that refers a patient specimen for consultation or anatomic pathology services. The definition excludes a physician's or physician group's lab that takes a patient specimen and does not perform the professional diagnostic component of the anatomic pathology services involved. It defines “anatomic pathology services” as the gross and microscopic examination and histologic and cytologic processing of human specimens, including histopathology or surgical pathology, cytopathology, hematology, subcellular or molecular pathology, or blood banking service performed by a pathologist.

EFFECTIVE DATE: July 1, 2009


The act repeals a couple's ability to obtain a marriage license in the town where either of the parties lives. Thus, under the act, only the clerk of the town where the marriage is to be performed can issue a marriage license.


PA 07-2, JSS, required DPH to contract for the development of a statewide HIT plan. This act requires DPH to submit the plan to the Public Health Committee by July 1, 2009. By law, the plan must include (1) standards and protocols for health information exchange; (2) standards to facilitate the development of a statewide, integrated electronic health information system for use by state-funded health care providers and institutions; and (3) pilot programs for health information exchange, including costs and funding sources. The act eliminates the requirement that DPH, beginning December 1, 2008, annually report to the Public Health, Human Services, Government Administration and Elections, and Appropriations committees on the plan's status.

Lead Health Information Exchange Organization

PA 07-2, JSS, designated the entity that received the DPH contract for the HIT plan as the state's lead health information exchange organization between December 1, 2007 and June 30, 2009. This act designates DPH as the state's lead health information exchange organization beginning July 1, 2009. It requires DPH to seek private and federal funds, including those available through the federal American Recovery and Reinvestment Act, for the initial development of a statewide health information exchange. DPH can use any private or federal funds it receives to establish HIT pilot programs and the grant programs described below.

DPH must (1) assist with implementation and periodic revisions of the HIT plan after its initial submittal, including implementing an integrated statewide infrastructure for sharing electronic health information among health care facilities, health care professionals, public and private payors, and patients and (2) develop privacy standards and protocols for sharing this information. These standards and protocols must be at least as stringent as the “standards for privacy of individually identifiable health information” established under the federal Health Insurance Portability and Accountability Act. They must require that individually identifiable health information be secure and access to it traceable by electronic audit trail.

Health Information Technology and Exchange Advisory Committee Membership

The act establishes a 12-member health information technology and exchange advisory committee. Members and their appointing authorities are as follows:

1. the lieutenant governor;

2. (a) a representative of a medical research organization, (b) an insurer or health plan representative, and (c) an attorney with experience in privacy, health data security, or patient rights, each appointed by the governor;

3. (a) one person with experience with a private sector health information exchange or HIT entity and (b) one with expertise in public health, each appointed by the Senate president pro tempore;

4. (a) a representative of hospitals, an integrated delivery network, or a hospital association and (b) one person with expertise with federally qualified health centers, each appointed by the House speaker;

5. a primary care physician whose practice uses electronic health records, appointed by the Senate majority leader;

6. a consumer or consumer advocate, appointed by the House majority leader;

7. a person with experience as a pharmacist or other health care provider that uses electronic health information exchange, appointed by the Senate minority leader; and

8. a large employer or business group representative, appointed by the House minority leader.

The commissioners of public health, social services, consumer protection, and health care access, the chief information officer (it is unclear to whom this refers), the Office of Policy and Management secretary, and the health care advocate, or their designees, are ex-officio, nonvoting committee members.

All initial appointments must be made by October 1, 2009. Members' terms are staggered. The initial term for the governor's appointees is four years, three years for the House speaker's and House majority leader's appointees, two years for the House and Senate minority leaders' appointees, and one year for the members appointed by the Senate president pro tempore and majority leader. Terms expire on September 30. The appointing authority must fill vacancies for the balance of an unexpired term. Other than an initial term, a committee member can serve for a four-year term, and no member can serve more than two terms. A member can be removed by the appropriate appointing authority for malfeasance, misfeasance, or willful neglect of duty. Any member failing to attend three consecutive meetings or 50% of all meetings in a calendar year is deemed to have resigned.

Committee members select a member to serve as the committee chairperson. The first meeting must be held by November 1, 2009.

All committee members are deemed public officials and must adhere to the state code of ethics for public officials. The act specifies that it is not a conflict of interest for a trustee, director, partner, officer, stockholder, proprietor, counsel, or employee of any eligible institution, or any other individual with a financial interest in an eligible institution, to be on the committee. An “eligible institution” is a hospital, clinic, physician or other health care provider, laboratory, or public health agency that uses health information exchange or HIT.

Members may participate in committee affairs concerning review or consideration of grant applications, including their approval or disapproval. But no member can participate in any committee affairs concerning the review or consideration of any grant application filed by a member or an eligible institution in which the member has a financial interest or with whom the member engages in any business, employment, transaction, or professional activity.

Committee Duties

The committee must advise DPH on implementation of the HIT plan. It must develop, in consultation with DPH, (1) appropriate protocols for health information exchange and (2) electronic data standards to promote the development of a statewide, integrated electronic health information system for use by state-funded health care providers and institutions. These data standards must (1) include provisions on security, privacy, data content, structures and format, vocabulary, and transmission protocols, with the privacy standards consistent with the requirements specified above; (2) be compatible with any national data standards to allow for interstate interoperability; (3) permit the collection of health information in standard electronic format; and (4) be compatible with the requirements for an electronic health information system as described in law.

The committee must identify ways to improve and promote health information exchange in the state, including identifying public and private funding sources for HIT. Beginning November 1, 2009, the DPH commissioner must submit any proposed application for private or federal funds for development of health information exchange to the committee. The act requires the committee to advise the commissioner in writing, within 20 days after the committee receives this proposed application, of its comments and any recommended changes it believes the commissioner should consider in making decisions. It requires the commissioner to offer at least one committee member the opportunity to participate on any review panel established to identify or apply for funds or make grants.

HIT Grant Program

The committee must advise the DPH commissioner on the development and implementation of an HIT grant program which may, within available appropriations, provide funds to eligible institutions to advance HIT and health information exchange in the state. DPH must, within available funds, provide administrative support to the committee and help it (1) develop the grant application, (2) review the applications, (3) prepare and execute any assistance or other agreements in connection with grant awards, and (4) perform other administrative duties as the commissioner deems necessary. The commissioner may, within available funds, contract for administrative support for the committee.


Annually between February 1, 2010, and February 1, 2015, the DPH commissioner and the committee must report to the governor and General Assembly on (1) any private or federal funds received during the preceding quarter and if applicable, how the funds were spent; (2) the amount of grants awarded; (3) the grant recipients; and (4) the current status of health information exchange and HIT in the state.

EFFECTIVE DATE: Upon passage


This act requires the University of Connecticut Health Center (UCHC), in consultation with the Yale School of Medicine, to develop, implement, and promote an evidence-based outreach and education program concerning the therapeutic and cost-effective use of prescription drugs. This type of program, known as “academic detailing,” is directed at licensed physicians, pharmacists, and other health care professionals authorized to prescribe and dispense prescription drugs.

The act requires the UCHC to consider whether the program can be developed in coordination with, or as part of, the Connecticut Area Health Education Program, which it administers.

The act specifies that physician participation in the academic detailing program qualifies for continuing education credit and requires the UCHC to develop the program so that it allows participating physicians to apply hours spent in the program towards their continuing education requirements.

It requires the UCHC to seek federal funds to administer the program. The UCHC may also seek funding from nongovernmental health access foundations. It is not required to develop, implement, and promote the program if total federal, state, and private funds are insufficient to pay for the program's initial and ongoing expenses.

The program must:

1. arrange for licensed physicians, pharmacists, and nurses to personally conduct educational visits with prescribing practitioners, using evidence-based materials, methods from behavioral science and educational theory, and when appropriate, pharmaceutical industry data and outreach techniques;

2. inform prescribing practitioners about drug marketing designed to prevent competition with brand name drugs from generics or other evidence-based treatment options; and

3. provide outreach and education to physicians and other practitioners participating in Medicaid, HUSKY A and B, State Administered General Assistance, Charter Oak Health Plan, ConnPACE, the state employees' health insurance plan, and Department of Correction inmate health services.

The act requires the UCHC, to the extent feasible, to use or incorporate in the program other independent educational resources or models proven effective in providing high quality, evidence-based, cost-effective information to prescribing practitioners on the effectiveness and safety of prescription drugs. These include the (1) Pennsylvania PACE Independent Drug Information Service, (2) Vermont Academic Detailing Program, and (3) the Oregon Drug Effectiveness Review Project.

EFFECTIVE DATE: July 1, 2011


This act changes several aspects of the Office of Health Care Access's (OHCA) Certificate of Need (CON) program.

Ownership and Control

Under current law, a health care institution or facility must submit a letter of intent to OHCA before transferring all or part of its ownership or control. OHCA then determines whether a CON review is needed. The act eliminates the requirement that an institution or facility notify OHCA whenever partial ownership or control is to be transferred. Instead, it defines a transfer of ownership or control to mean an action that affects or changes the governance or controlling body of the institution or facility. Transfers include mergers, affiliations, or any sale or transfer of a facility's or institution's net assets. The law continues to require facilities and institutions to notify OHCA when they intend to (1) change the governing powers of the parent company's or an affiliate's board and (2) change or transfer the powers or control of an affiliate's governing or controlling body.

The law applies to hospitals, outpatient surgical facilities, imaging centers, and mental health facilities, among other institutions, and their parents, subsidiaries, affiliates, and joint ventures.

Exemptions and Waivers—Outpatient Facilities

The act exempts from CON review an acute care, children's, mental health, or chronic disease hospital's plan to provide services at an alternative location in its “primary service area. ” (The act does not define “primary service area; ” in practice, a CON applicant providing these services on July 1, 2009 determines its primary service area. ) The hospital must submit to OHCA information about the alternate location, the type of services it intends to provide there, and the reasons for providing them at an alternate location. The exemption applies to services like physical, speech, and occupational therapy; occupational injury and disease management; and “company-contracted services,” (i. e. , services the institution or facility obtains through contracting with a third party).

Exemptions and Waivers—Department of Children and Families (DCF) Programs

The act adds DCF-licensed or –funded programs to the list of entities that are exempt from CON review. By law, exempt facilities and institutions must register with OHCA by submitting all the information otherwise required for a letter of intent. They must do this 14 to 60 days before beginning the activity that would otherwise require review. They must also renew their exemption every two years.

Exemptions and Waivers—Cineangiography

The act exempts the acquisition of new cineangiography equipment from CON review. Cineangiography equipment is used to diagnose heart and vascular conditions by filming the passage of a contrast medium through blood vessels.

Exemptions and Waivers— Imaging Equipment Replacement

The act permits OHCA to waive CON review for certain institutions, facilities, and providers that want to replace imaging equipment. It applies to entities that received a CON exemption for the acquisition of the original equipment under PA 05-93 (as amended by PA 06-28). To obtain the initial exemption, that act required an entity to (1) prove that it had acquired the equipment before July 1, 2005 for less than $ 400,000 and had put it into operation before July 1, 2006 or (2) obtain a CON or a determination that one was not needed by July 1, 2005.

Psychiatric Residential Treatment Facilities

The act requires OHCA to review all proposals to establish a psychiatric residential treatment facility, change its ownership or control, or spend $3 million or more in capital expenditures for such a facility. The review is required even for proposals from nonprofit facilities, institutions, and providers that contract with the state and from DCF-licensed or –funded programs, which, under current law and the act, OHCA can exempt from CON review under certain conditions. Under federal law, a psychiatric residential treatment facility is a facility, other than a hospital, that provides inpatient psychiatric services to people under age 21.

EFFECTIVE DATE: July 1, 2009, except for the provision concerning psychiatric residential treatment facilities, which is effective October 1, 2009.


This act expands the types of incidents of child abuse and neglect that DCF must report to DPH when they involve certain DPH-licensed facilities. It broadens DCF's reporting requirement to include (1) all records of reports of abuse and neglect, rather than all information on substantiated reports, and (2) incidents in youth camps, as well as day care facilities. It revises the information DPH maintains on its list of abuse and neglect at these facilities and the kind of information it can disclose from that list.

DCF Reports to DPH

The act revises the kind of information DCF must report to DPH about child abuse and neglect. Under prior law, when DCF substantiated that abuse or neglect occurred in a day care center, group day care home, or family day care home, it had to notify DPH of all information about the incident. The act, instead, requires DCF to provide all records concerning reports and investigations of suspected abuse or neglect, including records of any administrative hearings it holds, (1) occurring in one of these facilities or in a DPH-licensed youth camp or (2) involving a facility's license holder, any facility staff, or any household member of a family day care home, regardless of where the abuse or neglect occurred. The law governing DCF record confidentiality defines a record as information the department creates or obtains in connection with its child protection activities or activities related to a child in its custody, including information in DCF's child abuse registry. Records DCF does not create can be disclosed only in limited circumstances (CGS 17a-28).

The act supersedes existing laws that govern DCF reports about allegations of incidents in state-licensed facilities that care for children, such as day care facilities. These require DCF, before notifying the agency and providing investigative records, to (1) first investigate the allegations and find reasonable cause to believe abuse or neglect occurred and (2) exhaust or waive all administrative appeals available to the person suspected of the abuse, unless the alleged act meets certain criteria (CGS 17a-101j(b) and 17a-101g(c)).

The act allows any child abuse or neglect record DCF provides to DPH to be used in an administrative hearing or court proceeding related to a facility's license. It requires these records to be kept confidential, except in a contested case (a proceeding in which an agency determines a party's rights, duties, or privileges) where the law allows parties to inspect and copy records. The records are not subject to disclosure under the Freedom of Information Act.

DPH Abuse and Neglect List

Prior law required DPH to keep a list of (1) complaints it substantiated about day care facilities during the prior three years and (2) the substantiated child abuse and neglect reports DCF sends it. The act, instead, requires DPH to keep a list of violations (presumably regulatory violations) it substantiates over that period concerning day care facilities and youth camps. As under prior law, DPH must disclose information on this list, with certain exceptions, upon request. Information identifying children or their family members continues to be confidential. But the act permits DPH to disclose information that identifies facility staff and employees and people who live in a family day care home. This information is confidential under current law.

The act allows DPH to include on this list, and disclose information about, specific DCF findings and notices of abuse and neglect. It can list and disclose:

1. substantiated findings that DCF includes on its child abuse and neglect registry of abuse or neglect occurring in a covered facility or being committed by the facility license holder, any facility staff member, or anyone living in a family day care home; and

2. DCF reports of suspected abuse or neglect at a facility that resulted in or involved (a) a child's death, (b) serious physical harm or the risk of serious physical injury or emotional harm to a child, (c) child sexual abuse, (d) a person's arrest for child abuse or neglect, or (e) DCF petitioning to commit a child to its care or terminate a parent's rights to the child. If DCF subsequently informs DPH that its investigation did not substantiate this abuse or neglect or that its finding was reversed after an appeal, DPH must immediately remove the information from its list and stop disclosing the information.

Youth Camps

The act specifies that to be exempt from DPH youth camp licensure requirements, summer educational programs must be operated by a (1) public school or (2) private school that (a) is approved by the State Board of Education (SBE) or accredited by an SBE-approved agency and (b) files required attendance reports with the State Education Department.

The act permits DPH to issue a cease and desist order limiting a youth camp's license and halting a specific activity. It can do so if it determines a camper's or staff member's health, safety, or welfare requires immediate emergency action. As soon as it receives such an order, the camp must stop the activity and notify all parents and staff that the activity is halted until DPH dissolves the order. DPH must hold a hearing on the issue within 10 days of issuing the order.


The act repeals the requirement that any school-based health clinic located in or attached to a school building constructed on or after July 1, 2009 that shares a first floor exterior wall with the school building include an entrance separate from the school building entrance.

EFFECTIVE DATE: Upon passage

OLR Tracking: SS: JLK: PF: DF