Sec. 19a-905. Health care providers who provide direct patient care to wear badges.
Sec. 19a-906. Telehealth services.
Sec. 19a-911. Council on Protecting Women's Health established. Membership. Report.
Sec. 19a-900. Use of cartridge injector by staff member of before or after school program, day camp or child care facility. (a) For the purposes of this section:
(1) “Before or after school program” means any educational or recreational program for children administered in any building or on the grounds of any school by a local or regional board of education or other municipal agency, before or after regular school hours, or both, but does not include a program that is licensed by the Department of Public Health;
(2) “Cartridge injector” means an automatic prefilled cartridge injector or similar automatic injectable equipment used to deliver epinephrine in a standard dose for emergency first aid response to allergic reactions;
(3) “Day camp” means any recreational camp program operated by a municipal agency; and
(4) “Child care facility” means any child care center or group child care home, as described in subdivisions (1) and (2) of subsection (a) of section 19a-77, that is excluded from the licensing requirements of sections 19a-77 to 19a-87, inclusive, by subsection (b) of section 19a-77.
(b) Upon the request and with the written authorization of the parent or guardian of a child attending any before or after school program, day camp or child care facility, and pursuant to the written order of (1) a physician licensed to practice medicine, (2) a physician assistant licensed to prescribe in accordance with section 20-12d, or (3) an advanced practice registered nurse licensed to prescribe in accordance with sections 20-94a and 20-94b, the owner or operator of such before or after school program, day camp or child care facility shall approve and provide general supervision to an identified staff member trained to administer medication with a cartridge injector to such child if the child has a medically diagnosed allergic condition that may require prompt treatment in order to protect the child against serious harm or death. Such staff member shall be trained in the use of a cartridge injector by a licensed physician, physician assistant, advanced practice registered nurse or registered nurse or shall complete a course in first aid offered by the American Red Cross, the American Heart Association, the National Ski Patrol, the Department of Public Health, any director of health or an organization using guidelines for first aid and published by the American Heart Association and the American Red Cross.
(P.A. 05-144, S. 2; 05-272, S. 35; P.A. 06-196, S. 151; P.A. 15-227, S. 25; P.A. 16-163, S. 36; P.A. 19-105, S. 6.)
History: P.A. 05-272 amended Subsec. (a)(1) by redefining “Before or after school program” to include programs administered, rather than offered, by a school board or municipality and by removing private providers from the definition, and amended Subsec. (b) by changing “and” to “or” in provision re training and education of staff members; P.A. 06-196 made a technical change in Subsec. (b), effective June 7, 2006; pursuant to P.A. 15-227, “child day care center” and “group day care home” were changed editorially by the Revisors to “child care center” and “group child care home”, respectively, in Subsec. (a)(4), effective July 1, 2015; P.A. 16-163 replaced “day care facility” with “child care facility” and made a technical change, effective June 9, 2016; P.A. 19-105 amended Subsec. (b) by adding provision re organization using guidelines published by the American Heart Association and American Red Cross and make technical changes, effective July 1, 2019.
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Sec. 19a-902. Dual licensure program for providers of mental health services and substance abuse services. Drug testing at facilities licensed by Department of Public Health. Regulations. On or before January 1, 2011, the Department of Public Health, in consultation with the Department of Mental Health and Addiction Services, may (1) amend the department's substance abuse treatment regulations; (2) implement a dual licensure program for behavioral health care providers who provide both mental health services and substance abuse services; or (3) permit the use of saliva-based drug screening or urinalysis when conducting initial and subsequent drug screenings of persons who abuse substances other than alcohol at facilities which are licensed by the Department of Public Health.
(P.A. 09-149, S. 3; P.A. 11-242, S. 43; P.A. 19-118, S. 17.)
History: P.A. 09-149 effective June 29, 2009; P.A. 11-242 designated existing requirements re regulations and program as Subdivs. (1) and (2), added Subdiv. (3) re use of saliva-based drug screening and urinalysis at facilities licensed by Department of Public Health and made a technical change; P.A. 19-118 replaced “shall” with “may” and replaced “and” with “or”, effective July 1, 2019.
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Sec. 19a-905. Health care providers who provide direct patient care to wear badges. (a) As used in this section:
(1) “Health care provider” means any person employed by or acting on behalf of a health care facility or institution; and
(2) “Health care facility or institution” means a hospital, nursing home, rest home, home health care agency, home health aide agency, emergency medical services organization, assisted living services agency, outpatient surgical facility and an infirmary operated by an educational institution for the care of students enrolled in, and faculty and employees of, such institution.
(b) Any health care provider who provides direct patient care shall wear in plain view during such provider's working hours a photographic identification badge issued by the health care facility or institution that includes the name of the health care facility or institution, the name of the health care provider, and the type of license, certificate or employment title that the health care provider holds with the health care facility or institution. Health care facilities or institutions, in consultation with the Department of Public Health, shall develop policies and procedures concerning (1) the size, content and format of the photographic identification badge required pursuant to this subsection, and (2) any exemptions to the requirements of this subsection necessary to ensure the safety of patients and health care providers.
(P.A. 11-32, S. 1; P.A. 19-97, S. 10.)
History: P.A. 19-97 amended Subsec. (a)(2) by replacing “homemaker-home health aide agency” with “home health aide agency”, effective July 1, 2019.
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Sec. 19a-906. Telehealth services. (a) As used in this section:
(1) “Asynchronous” means any transmission to another site for review at a later time that uses a camera or other technology to capture images or data to be recorded.
(2) “Facility fee” has the same meaning as in section 19a-508c.
(3) “Health record” means the record of individual, health-related information that may include, but need not be limited to, continuity of care documents, discharge summaries and other information or data relating to a patient's demographics, medical history, medication, allergies, immunizations, laboratory test results, radiology or other diagnostic images, vital signs and statistics.
(4) “Medical history” means information, including, but not limited to, a patient's past illnesses, medications, hospitalizations, family history of illness if known, the name and address of the patient's primary care provider if known and other matters relating to the health condition of the patient at the time of a telehealth interaction.
(5) “Medication-assisted treatment” means the use of medications approved by the federal Food and Drug Administration, in combination with counseling and behavioral therapies, to provide a whole-patient approach to the treatment of substance use disorders.
(6) “Originating site” means a site at which a patient is located at the time health care services are provided to the patient by means of telehealth.
(7) “Peripheral devices” means the instruments a telehealth provider uses to perform a patient exam, including, but not limited to, stethoscope, otoscope, ophthalmoscope, sphygmomanometer, thermometer, tongue depressor and reflex hammer.
(8) “Remote patient monitoring” means the personal health and medical data collection from a patient in one location via electronic communication technologies that is then transmitted to a telehealth provider located at a distant site for the purpose of health care monitoring to assist the effective management of the patient's treatment, care and related support.
(9) “Store and forward transfer” means the asynchronous transmission of a patient's medical information from an originating site to the telehealth provider at a distant site.
(10) “Synchronous” means real-time interactive technology.
(11) “Telehealth” means the mode of delivering health care or other health services via information and communication technologies to facilitate the diagnosis, consultation and treatment, education, care management and self-management of a patient's physical and mental health, and includes (A) interaction between the patient at the originating site and the telehealth provider at a distant site, and (B) synchronous interactions, asynchronous store and forward transfers or remote patient monitoring. Telehealth does not include the use of facsimile, audio-only telephone, texting or electronic mail.
(12) “Telehealth provider” means any physician licensed under chapter 370, physical therapist licensed under chapter 376, chiropractor licensed under chapter 372, naturopath licensed under chapter 373, podiatrist licensed under chapter 375, occupational therapist licensed under chapter 376a, optometrist licensed under chapter 380, registered nurse or advanced practice registered nurse licensed under chapter 378, physician assistant licensed under chapter 370, psychologist licensed under chapter 383, marital and family therapist licensed under chapter 383a, clinical social worker or master social worker licensed under chapter 383b, alcohol and drug counselor licensed under chapter 376b, professional counselor licensed under chapter 383c, dietitian-nutritionist certified under chapter 384b, speech and language pathologist licensed under chapter 399, respiratory care practitioner licensed under chapter 381a, audiologist licensed under chapter 397a, pharmacist licensed under chapter 400j or paramedic licensed pursuant to chapter 384d who is providing health care or other health services through the use of telehealth within such person's scope of practice and in accordance with the standard of care applicable to the profession.
(b) (1) A telehealth provider shall only provide telehealth services to a patient when the telehealth provider: (A) Is communicating through real-time, interactive, two-way communication technology or store and forward technologies; (B) has access to, or knowledge of, the patient's medical history, as provided by the patient, and the patient's health record, including the name and address of the patient's primary care provider, if any; (C) conforms to the standard of care applicable to the telehealth provider's profession and expected for in-person care as appropriate to the patient's age and presenting condition, except when the standard of care requires the use of diagnostic testing and performance of a physical examination, such testing or examination may be carried out through the use of peripheral devices appropriate to the patient's condition; and (D) provides the patient with the telehealth's provider license number and contact information.
(2) At the time of the telehealth provider's first telehealth interaction with a patient, the telehealth provider shall inform the patient concerning the treatment methods and limitations of treatment using a telehealth platform and, after providing the patient with such information, obtain the patient's consent to provide telehealth services. The telehealth provider shall document such notice and consent in the patient's health record. If a patient later revokes such consent, the telehealth provider shall document the revocation in the patient's health record.
(c) Notwithstanding the provisions of this section or title 20, no telehealth provider shall prescribe any schedule I, II or III controlled substance through the use of telehealth, except a schedule II or III controlled substance other than an opioid drug, as defined in section 20-14o, in a manner fully consistent with the Ryan Haight Online Pharmacy Consumer Protection Act, 21 USC 829(e), as amended from time to time, for the treatment of a person with a psychiatric disability or substance use disorder, as defined in section 17a-458, including, but not limited to, medication-assisted treatment. A telehealth provider using telehealth to prescribe a schedule II or III controlled substance pursuant to this subsection shall electronically submit the prescription pursuant to section 21a-249.
(d) Each telehealth provider shall, at the time of the initial telehealth interaction, ask the patient whether the patient consents to the telehealth provider's disclosure of records concerning the telehealth interaction to the patient's primary care provider. If the patient consents to such disclosure, the telehealth provider shall provide records of all telehealth interactions to the patient's primary care provider, in a timely manner, in accordance with the provisions of sections 20-7b to 20-7e, inclusive.
(e) Any consent required under this section shall be obtained from the patient, or the patient's legal guardian, conservator or other authorized representative, as applicable.
(f) The provision of telehealth services and health records maintained and disclosed as part of a telehealth interaction shall comply with the provisions of the Health Insurance Portability and Accountability Act of 1996 P.L. 104-191, as amended from time to time.
(g) Nothing in this section shall prohibit: (1) A health care provider from providing on-call coverage pursuant to an agreement with another health care provider or such health care provider's professional entity or employer; (2) a health care provider from consulting with another health care provider concerning a patient's care; (3) orders of health care providers for hospital outpatients or inpatients; or (4) the use of telehealth for a hospital inpatient, including for the purpose of ordering any medication or treatment for such patient in accordance with Ryan Haight Online Pharmacy Consumer Protection Act, 21 USC 829(e), as amended from time to time. For purposes of this subsection, “health care provider” means a person or entity licensed or certified pursuant to chapter 370, 372, 373, 375, 376 to 376b, inclusive, 378, 379, 380, 381a, 383 to 383c, inclusive, 384b, 397a, 399 or 400j, or licensed or certified pursuant to chapter 368d or 384d.
(h) No telehealth provider shall charge a facility fee for telehealth services.
(P.A. 15-88, S. 1; P.A. 16-25, S. 1, 2; P.A. 18-148, S. 1; P.A. 19-118, S. 67.)
History: P.A. 16-25 amended Subsec. (a)(11) by adding references to speech and language pathologist, respiratory care practitioner and audiologist, and amended Subsec. (f) by adding references to chapters 376 to 376b, 380, 381a, 383 to 383c, 384b, 397a and 399; P.A. 18-148 amended Subsec. (a) by adding new Subdiv. (2) re definition of “facility fee”, redesignating existing Subdiv. (2) re definition of “health record” as Subdiv. (3), deleting former Subdiv. (3) re definition of “facility fee”, adding new Subdiv. (5) re definition of “medication-assisted treatment”, redesignating existing Subdivs. (5) to (11) as Subdivs. (6) to (12), and amending redesignated Subdiv. (12) by adding references to registered nurse and pharmacist, amended Subsec. (b)(2) by adding provision re patient revoking consent, amended Subsec. (c) by adding provision re exception for schedule II or III controlled substance other than opioid drug, and amended Subsec. (d) by replacing “each telehealth interaction” with “the initial telehealth interaction”, added new Subsec. (e) re consent required under section, redesignated existing Subsecs. (e) to (g) as Subsecs. (f) to (h), and amended redesignated Subsec. (g) by adding Subdiv. (4) re use of telehealth for a hospital inpatient, and adding reference to Ch. 400j, and made technical changes, effective July 1, 2018; P.A. 19-118 amended Subsec. (a)(12) by adding reference to paramedic and made technical changes, effective July 1, 2019.
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Sec. 19a-909. Access to and maintenance and administration of epinephrine cartridge injectors by authorized entities. Limitation on liability. (a) As used in this section and sections 21a-70 and 52-557v:
(1) “Epinephrine cartridge injector” means an automatic prefilled cartridge injector or similar automatic injectable equipment used to deliver epinephrine in a standard dose for an emergency first aid response to allergic reactions;
(2) “Person with training” means a person who (A) (i) has completed a course in first aid that includes training in recognizing the signs and symptoms of anaphylaxis, administering epinephrine and following emergency protocol, approved by a prescribing practitioner pursuant to a medical protocol established in accordance with subsection (b) of this section, which course may be offered by the American Red Cross, the American Heart Association, the National Ski Patrol, the Department of Public Health or any director of health, and (ii) is certified by said organizations, department or director of health offering the course, or (B) who has received training in the recognition of the signs and symptoms of anaphylaxis, the use of an epinephrine cartridge injector and emergency protocol by a licensed physician, physician assistant, advanced practice registered nurse or emergency medical services personnel;
(3) “Documentation evidencing training” includes a certificate issued by the American Red Cross, the American Heart Association, the National Ski Patrol, the Department of Public Health or any director of health or a written statement of acknowledgment of training signed by a licensed physician, physician assistant, advanced practice registered nurse or emergency medical services personnel; and
(4) “Authorized entity” means any for-profit or nonprofit entity or organization that employs at least one person with training. “Authorized entity” does not include the state or any political subdivision thereof authorized to purchase epinephrine pursuant to subsection (h) of section 21a-70, a local or regional board of education required to maintain epinephrine cartridge injectors pursuant to subdivision (2) of subsection (d) of section 10-212a or a licensed or a certified ambulance service required to be equipped with epinephrine cartridge injectors pursuant to subsection (b) of section 19a-197a.
(b) An authorized entity and a prescribing practitioner, as defined in section 20-14c, who is authorized to prescribe an epinephrine cartridge injector, may establish a medical protocol regarding the administration of an epinephrine cartridge injector by a person with training who is employed by or an agent of an authorized entity for the purpose of rendering emergency care in accordance with subsection (d) of this section. Such medical protocol shall include, but need not be limited to, (1) any training required, in addition to the training required under subdivision (2) of subsection (a) of this section, for an employee or agent of an authorized entity to be designated as a person with training, (2) the records to be maintained in accordance with this subsection and subsections (c) and (e) of this section, (3) the proper storage and maintenance of epinephrine cartridge injectors, and (4) the procedure for handling emergency medical situations involving anaphylactic allergic reactions at the authorized entity's place of business. Any such medical protocol shall be deemed established for a legitimate medical purpose in the usual course of the prescribing practitioner's professional practice. An authorized entity shall maintain a copy of such medical protocol established under this section at the place of business to which it applies and, not less than annually, review such medical protocol with the designated persons with training and the prescribing practitioner.
(c) An authorized entity that has established a medical protocol with a prescribing practitioner pursuant to subsection (b) of this section may acquire and maintain a supply of epinephrine cartridge injectors from a wholesaler, as defined in section 21a-70. The epinephrine cartridge injectors shall be stored in a location readily accessible in an emergency, in accordance with the instructions for use included with such epinephrine cartridge injectors and the established medical protocol. An authorized entity shall designate a person or persons with training who are employees or agents of the authorized entity to be responsible for the storage, maintenance and control of the epinephrine cartridge injectors. An authorized entity shall maintain documentation (1) of all epinephrine cartridge injectors acquired by such authorized entity, and (2) evidencing the training acquired by each such designated person with training.
(d) A person with training who is an employee or agent of an authorized entity that acquires and maintains a supply of epinephrine cartridge injectors pursuant to subsection (c) of this section may, in accordance with the established medical protocol, (1) provide an epinephrine cartridge injector to an individual or to the parent, guardian or caregiver of an individual, whom the person with training believes in good faith is experiencing anaphylaxis, regardless of whether the individual has a prescription for an epinephrine cartridge injector or a prior medical diagnosis of an allergic condition, for the purpose of immediate administration of such epinephrine cartridge injector by such individual, parent, guardian or caregiver, or (2) administer an epinephrine cartridge injector to an individual whom the person with training believes in good faith is experiencing anaphylaxis, regardless of whether the individual has a prescription for an epinephrine cartridge injector or a prior medical diagnosis of an allergic condition. The person with training or any other employee or agent of the authorized entity shall promptly notify a local emergency medical services organization after any administration of an epinephrine cartridge injector acquired and maintained by the authorized entity.
(e) Each authorized entity shall report to the prescribing practitioner with whom it has established a medical protocol any incident that involves the administration of an epinephrine cartridge injector acquired and maintained by the authorized entity under this section not later than thirty days after the date of such incident and shall maintain a record of such incident.
(f) (1) A prescribing practitioner who is authorized to prescribe epinephrine may establish a medical protocol with an authorized entity in accordance with this section without being liable for damages in a civil action or subject to criminal prosecution for establishing such medical protocol or for any subsequent use of an epinephrine cartridge injector acquired and maintained by the authorized entity under this section. A prescribing practitioner who has established a medical protocol with an authorized entity in accordance with the provisions of this section shall be deemed not to have violated the standard of care for such licensed health care provider.
(2) A person with training or an authorized entity that employs or has an agent who is a person with training who provides or administers an epinephrine cartridge injector to an individual whom the person with training believes in good faith is experiencing anaphylaxis in accordance with the provisions of this section shall not be liable to such individual for civil damages or subject to criminal prosecution for any personal injuries that result from acts or omissions by such person with training in using an epinephrine cartridge injector, which may constitute ordinary negligence. The immunity provided in this subsection shall not apply to wilful or wanton misconduct or acts or omissions constituting gross negligence.
(g) The Commissioners of Consumer Protection or Public Health may adopt regulations, in accordance with chapter 54, to implement the provisions of this section.
(P.A. 19-19, S. 1; 19-118, S. 63.)
History: P.A. 19-19 effective June 13, 2019 (Revisor's note: In Subsec. (b) “subdivision (2) of section 1 of this act” was changed to “subdivision (2) of subsection (a) of this section” for accuracy); P.A. 19-118 amended Subsec. (a) by adding “and sections 2 and 3 of this act”, effective July 9, 2019 (Revisor's note: In codifying this section, an incorrect reference to “sections 2 and 3 of this act” was deemed by the Revisors to be a reference to Secs. 21a-70 and 52-557v, which are Secs. 2 and 3 of P.A. 19-19).
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Sec. 19a-910. Development of communication aid for use during emergencies. Maintenance of communication aid in vehicle. (a) As used in this section:
(1) “Emergency medical services personnel” has the same meaning as provided in section 20-206jj;
(2) “Firefighter” means a uniformed member of a paid or volunteer fire department; and
(3) “Police officer” has the same meaning as provided in section 46b-15.
(b) The University of Connecticut Center for Excellence in Developmental Disabilities shall develop a communication aid for use by emergency medical services personnel, firefighters, police officers, active members of ambulance services licensed or certified in accordance with section 19a-180, emergency mobile psychiatric services personnel and mental health crisis intervention services personnel. Such communication aid shall describe techniques for serving and interacting with juveniles and adults with autism spectrum disorder, cognitive impairment and nonverbal learning disorder and contain communication aids for use during emergencies when verbal communication may be hindered or impossible. Not later than December 1, 2019, the center shall publish such communication aid on its Internet web site.
(c) On and after January 1, 2020, each emergency medical services personnel, firefighter, police officer, active member of an ambulance service licensed or certified in accordance with section 19a-180, emergency mobile psychiatric services personnel and mental health crisis intervention services personnel shall maintain a paper or electronic copy of the communication aid developed pursuant to subsection (b) of this section in any vehicle used by such personnel, officer or member in the course of his or her duties.
(P.A. 19-147, S. 4.)
History: P.A. 19-147 effective July 1, 2019.
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Sec. 19a-911. Council on Protecting Women's Health established. Membership. Report. (a) There is established a Council on Protecting Women's Health that shall advise the joint standing committees of the General Assembly having cognizance of matters relating to public health and insurance on strategies and any necessary legislative changes to ensure that the actions of the federal government do not impede the provision of health care to women in the state. The council shall monitor legislation at the federal level and any litigation relating to women's health and wellness that has the potential to negatively impact women's health in the state and immediately report, in accordance with the provisions of section 11-4a, to such joint standing committees on strategies, including, but not limited to, the initiation of legislation to protect women's health in the state.
(b) The Council on Protecting Women's Health shall be comprised of (1) the following ex-officio voting members: (A) The Commissioner of Public Health, or the commissioner's designee; (B) the Commissioner of Mental Health and Addiction Services, or the commissioner's designee; (C) the Insurance Commissioner, or the commissioner's designee; (D) the executive director of Office of Health Strategy, or the executive director's designee; (E) the Healthcare Advocate, or the Healthcare Advocate's designee; and (F) the Secretary of the Office of Policy and Management, or the secretary's designee; and (2) fourteen public members, three of whom shall be appointed by the president pro tempore of the Senate, three of whom shall be appointed by the speaker of the House of Representatives, two of whom shall be appointed by the majority leader of the Senate, two of whom shall be appointed by the majority leader of the House of Representatives, two of whom shall be appointed by the minority leader of the Senate and two of whom shall be appointed by the minority leader of the House of Representatives, and all of whom shall be knowledgeable on issues relative to women's health care in the state. The membership of the council shall fairly and adequately represent women who have had issues accessing quality health care in the state.
(c) All appointments to the council shall be made not later than sixty days after July 1, 2019. Any vacancy shall be filled by the appointing authority. Members shall serve two-year terms and no public member shall serve for more than two consecutive terms.
(d) The council shall elect two cochairpersons from among its members. The council shall meet at least quarterly. Members of the council shall serve without compensation, except for necessary expenses incurred in the performance of their duties.
(e) The Joint Committee on Legislative Management shall provide administrative support to the chairpersons of the council and assistance in convening the council's meetings.
(f) Not later than January 1, 2020, and annually thereafter, the council shall submit a status report on protecting women's health care in the state, in accordance with the provisions of section 11-4a, to the joint standing committees of the General Assembly having cognizance of matters relating to public health and insurance.
(P.A. 19-70, S. 1.)
History: P.A. 19-70 effective July 1, 2019.
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