Text of CT HB 6666 (2021)

LCO No. 5823 1 of 89 General Assembly Raised Bill No. 6666 January Session, 2021 LCO No. 5823 *05823_______PH_* Referred to Committee on PUBLIC HEALTH Introduced by: (PH) AN ACT CONCERNING THE DEPARTMENT OF PUBLIC HEALTH'S RECOMMENDATIONS REGARDING VARIOUS REVISIONS TO THE PUBLIC HEALTH STATUTES. Be it enacted by the Senate and House of Representatives in General Assembly convened: Section 1. Section 73 of public act 19-117 is repealed and the following 1 is substituted in lieu thereof (Effective October 1, 2021): 2 Notwithstanding any provision of title 19a or 25 of the general 3 statutes, [and not later than March 1, 2020,] a director of health of a town, 4 city or borough or of a district department of health appointed pursuant 5 to section 19a-200 or 19a-242 of the general statutes may issue a permit 6 for a replacement public well if the Department of Public Health has 7 approved such replacement public well pursuant to subsection (b) of 8 section 25-33 of the general statutes, as amended by this act. For 9 purposes of this section, "replacement public well" means a public well 10 that (1) replaces an existing public well, [in a town in southeastern 11 Connecticut with a population between fifteen thousand and fifteen 12 thousand three hundred, as enumerated by the 2010 federal decennial 13 census,] and (2) does not meet the sanitary radius and minimum setback 14 Raised Bill No. 6666 LCO No. 5823 2 of 89 requirements as specified in the regulations of Connecticut State 15 Agencies. 16 Sec. 2. Subsection (b) of section 25-33 of the general statutes is 17 repealed and the following is substituted in lieu thereof (Effective October 18 1, 2021): 19 (b) No system of water supply owned or used by a water company 20 shall be constructed or expanded or a new additional source of water 21 supply utilized until the plans therefor have been submitted to and 22 reviewed and approved by the department, except that no such prior 23 review or approval is required for distribution water main installations 24 that are constructed in accordance with sound engineering standards 25 and all applicable laws and regulations. A plan for any proposed new 26 source of water supply submitted to the department pursuant to this 27 subsection shall include documentation that provides for: (1) A brief 28 description of potential effects that the proposed new source of water 29 supply may have on nearby water supply systems including public and 30 private wells; and (2) the water company's ownership or control of the 31 proposed new source of water supply's sanitary radius and minimum 32 setback requirements as specified in the regulations of Connecticut state 33 agencies and that such ownership or control shall continue to be 34 maintained as specified in such regulations. If the department 35 determines, based upon documentation provided, that the water 36 company does not own or control the proposed new source of water 37 supply's sanitary radius or minimum setback requirements as specified 38 in the regulations of Connecticut state agencies, the department shall 39 require the water company proposing a new source of water supply to 40 supply additional documentation to the department that adequately 41 demonstrates the alternative methods that will be utilized to assure the 42 proposed new source of water supply's long-term purity and adequacy. 43 In reviewing any plan for a proposed new source of water supply, the 44 department shall consider the issues specified in this subsection. The 45 Commissioner of Public Health may adopt regulations, in accordance 46 with the provisions of chapter 54, to carry out the provisions of this 47 subsection and subsection (c) of this section. For purposes of this 48 Raised Bill No. 6666 LCO No. 5823 3 of 89 subsection and subsection (c) of this section, "distribution water main 49 installations" means installations, extensions, replacements or repairs of 50 public water supply system mains from which water is or will be 51 delivered to one or more service connections and which do not require 52 construction or expansion of pumping stations, storage facilities, 53 treatment facilities or sources of supply. Notwithstanding the 54 provisions of this subsection, the department may approve any location 55 of a replacement public well, if such replacement public well is (A) 56 necessary for the water company to maintain and provide to its 57 consumers a safe and adequate water supply, (B) located in an aquifer 58 of adequate water quality determined by historical water quality data 59 from the source of water supply it is replacing, and (C) in a more 60 protected location when compared to the source of water supply it is 61 replacing, as determined by the department. For purposes of this 62 subsection, "replacement public well" means a public well that (i) 63 replaces an existing public well, [in a town in southeastern Connecticut 64 with a population between fifteen thousand and fifteen thousand three 65 hundred, as enumerated by the 2010, federal decennial census,] and (ii) 66 does not meet the sanitary radius and minimum setback requirements 67 as specified in the regulations of Connecticut state agencies. 68 Sec. 3. Section 8-3i of the general statutes is repealed and the 69 following is substituted in lieu thereof (Effective October 1, 2021): 70 (a) As used in this section "water company" means a water company, 71 as defined in section 25-32a, and "petition" includes a petition or 72 proposal to change the regulations, boundaries or classifications of 73 zoning districts. 74 (b) When an application, petition, request or plan is filed with the 75 zoning commission, planning and zoning commission or zoning board 76 of appeals of any municipality concerning any project on any site that is 77 within the aquifer protection area delineated pursuant to section 22a- 78 354c or the watershed of a water company, the applicant or the person 79 making the filing shall: (1) [provide] Provide written notice of the 80 application, petition, request or plan to the water company and the 81 Raised Bill No. 6666 LCO No. 5823 4 of 89 [Commissioner of Public Health in a format prescribed by said 82 commissioner, provided such water company or said commissioner has 83 filed a map showing the boundaries of the watershed on the land 84 records of the municipality in which the application, petition, request or 85 plan is made and with the planning commission, zoning commission, 86 planning and zoning commission or zoning board of appeals of such 87 municipality or the aquifer protection area has been delineated in 88 accordance with section 22a-354c, as the case may be] Department of 89 Public Health; and (2) determine if the project is within the watershed 90 of a water company by consulting the maps posted on the department's 91 Internet web site showing the boundaries of the watershed. Such notice 92 shall be [made] sent to the water company by certified mail, return 93 receipt requested, and to the department by electronic mail to the 94 electronic mail address designated on its Internet web site for receipt of 95 such notice. Such notice shall be mailed not later than seven days after 96 the date of the application. Such water company and the Commissioner 97 of Public Health may, through a representative, appear and be heard at 98 any hearing on any such application, petition, request or plan. 99 (c) Notwithstanding the provisions of subsection (b) of this section, 100 when an agent of the zoning commission, planning and zoning 101 commission or zoning board of appeals is authorized to approve an 102 application, petition, request or plan concerning any site that is within 103 the aquifer protection area delineated pursuant to section 22a-354c or 104 the watershed of a water company without the approval of the zoning 105 commission, planning and zoning commission or zoning board of 106 appeals, and such agent determines that the proposed activity will not 107 adversely affect the public water supply, the applicant or person making 108 the filing shall not be required to notify the water company or the 109 [Commissioner] Department of Public Health. 110 Sec. 4. Section 22a-42f of the general statutes is repealed and the 111 following is substituted in lieu thereof (Effective October 1, 2021): 112 When an application is filed to conduct or cause to be conducted a 113 regulated activity upon an inland wetland or watercourse, any portion 114 Raised Bill No. 6666 LCO No. 5823 5 of 89 of which is within the watershed of a water company as defined in 115 section 25-32a, the applicant shall: (1) [provide] Provide written notice 116 of the application to the water company and the [Commissioner of 117 Public Health in a format prescribed by said commissioner, provided 118 such water company or said commissioner has filed a map showing the 119 boundaries of the watershed on the land records of the municipality in 120 which the application is made and with the inland wetlands agency of 121 such municipality] Department of Public Health; and (2) determine if 122 the project is within the watershed of a water company by consulting 123 the maps posted on the department's Internet web site showing the 124 boundaries of the watershed. Such notice shall be [made] sent to the 125 water company by certified mail, return receipt requested, and to the 126 department by electronic mail to the electronic mail address designated 127 by the department on its Internet web site for receipt of such notice. Such 128 notice shall be mailed not later than seven days after the date of the 129 application. The water company and the Commissioner of Public 130 Health, through a representative, may appear and be heard at any 131 hearing on the application. 132 Sec. 5. Section 19a-111 of the general statutes is repealed and the 133 following is substituted in lieu thereof (Effective October 1, 2021): 134 Upon receipt of each report of confirmed venous blood lead level 135 equal to or greater than twenty micrograms per deciliter of blood, the 136 local director of health shall make or cause to be made an 137 epidemiological investigation of the source of the lead causing the 138 increased lead level or abnormal body burden and shall order action to 139 be taken by the appropriate person responsible for the condition that 140 brought about such lead poisoning as may be necessary to prevent 141 further exposure of persons to such poisoning. In the case of any 142 residential unit where such action will not result in removal of the 143 hazard within a reasonable time, the local director of health shall utilize 144 such community resources as are available to effect relocation of any 145 family occupying such unit. The local director of health may permit 146 occupancy in said residential unit during abatement if, in such director's 147 judgment, occupancy would not threaten the health and well-being of 148 Raised Bill No. 6666 LCO No. 5823 6 of 89 the occupants. The local director of health shall, not later than thirty 149 days after the conclusion of such director's investigation, report to the 150 Commissioner of Public Health, using a web-based surveillance system 151 as prescribed by the commissioner, the result of such investigation and 152 the action taken to ensure against further lead poisoning from the same 153 source, including any measures taken to effect relocation of families. 154 Such report shall include information relevant to the identification and 155 location of the source of lead poisoning and such other information as 156 the commissioner may require pursuant to regulations adopted in 157 accordance with the provisions of chapter 54. The commissioner shall 158 maintain comprehensive records of all reports submitted pursuant to 159 this section and section 19a-110. Such records shall be geographically 160 indexed in order to determine the location of areas of relatively high 161 incidence of lead poisoning. The commissioner shall establish, in 162 conjunction with recognized professional medical groups, guidelines 163 consistent with the National Centers for Disease Control and Prevention 164 for assessment of the risk of lead poisoning, screening for lead poisoning 165 and treatment and follow-up care of individuals including children with 166 lead poisoning, women who are pregnant and women who are planning 167 pregnancy. Nothing in this section shall be construed to prohibit a local 168 building official from requiring abatement of sources of lead. 169 Sec. 6. Section 19a-37 of the general statutes is repealed and the 170 following is substituted in lieu thereof (Effective October 1, 2021): 171 (a) As used in this section: 172 (1) "Laboratory or firm" means an environmental laboratory 173 registered by the Department of Public Health pursuant to section 19a- 174 29a; 175 (2) "Private well" means a water supply well that meets all of the 176 following criteria: (A) Is not a public well; (B) supplies a residential 177 population of less than twenty-five persons per day; and (C) is owned 178 or controlled through an easement or by the same entity that owns or 179 controls the building or parcel that is served by the water supply well; 180 Raised Bill No. 6666 LCO No. 5823 7 of 89 (3) "Public well" means a water supply well that supplies a public 181 water system; 182 (4) "Semipublic well" means a water supply well that (A) does not 183 meet the definition of a private well or public well, and (B) provides 184 water for drinking and other domestic purposes; and 185 (5) "Water supply well" means an artificial excavation constructed by 186 any method for the purpose of obtaining or providing water for 187 drinking or other domestic, industrial, commercial, agricultural, 188 recreational or irrigation use, or other outdoor water use. 189 (b) The Commissioner of Public Health may adopt regulations in the 190 [Public Health Code] regulations of Connecticut state agencies for the 191 preservation of the public health pertaining to (1) protection and 192 location of new water supply wells or springs for residential or 193 nonresidential construction or for public or semipublic use, and (2) 194 inspection for compliance with the provisions of municipal regulations 195 adopted pursuant to section 22a-354p. 196 (c) The Commissioner of Public Health shall adopt regulations, in 197 accordance with chapter 54, for the testing of water quality in private 198 [residential] wells and semipublic wells. Any laboratory or firm which 199 conducts a water quality test on a private well serving a residential 200 property or semipublic well shall, not later than thirty days after the 201 completion of such test, report the results of such test to (1) the public 202 health authority of the municipality where the property is located, and 203 (2) the Department of Public Health in a format specified by the 204 department, provided such report shall only be required if the party for 205 whom the laboratory or firm conducted such test informs the laboratory 206 or firm identified on the chain of custody documentation submitted 207 with the test samples that the test was conducted in connection with the 208 sale of such property. No regulation may require such a test to be 209 conducted as a consequence or a condition of the sale, exchange, 210 transfer, purchase or rental of the real property on which the private 211 [residential] well or semipublic well is located. 212 Raised Bill No. 6666 LCO No. 5823 8 of 89 (d) Prior to the sale, exchange, purchase, transfer or rental of real 213 property on which a [residential] private or semipublic well is located, 214 the owner shall provide the buyer or tenant notice that educational 215 material concerning private well testing is available on the Department 216 of Public Health web site. Failure to provide such notice shall not 217 invalidate any sale, exchange, purchase, transfer or rental of real 218 property. If the seller or landlord provides such notice in writing, the 219 seller or landlord and any real estate licensee shall be deemed to have 220 fully satisfied any duty to notify the buyer or tenant that the subject real 221 property is located in an area for which there are reasonable grounds for 222 testing under subsection (g) or (j) of this section. 223 (e) The Commissioner of Public Health shall adopt regulations, in 224 accordance with chapter 54, to clarify the criteria under which the 225 commissioner may issue a well permit exception and to describe the 226 terms and conditions that shall be imposed when a well is allowed at a 227 premises (1) that is connected to a public water supply system, or (2) 228 whose boundary is located within two hundred feet of an approved 229 community water supply system, measured along a street, alley or 230 easement. Such regulations shall (A) provide for notification of the 231 permit to the public water supplier, (B) address the quality of the water 232 supplied from the well, the means and extent to which the well shall not 233 be interconnected with the public water supply, the need for a physical 234 separation, and the installation of a reduced pressure device for 235 backflow prevention, the inspection and testing requirements of any 236 such reduced pressure device, and (C) identify the extent and frequency 237 of water quality testing required for the well supply. 238 (f) No regulation may require that a certificate of occupancy for a 239 dwelling unit on such residential property be withheld or revoked on 240 the basis of a water quality test performed on a private [residential] well 241 pursuant to this section, unless such test results indicate that any 242 maximum contaminant level applicable to public water supply systems 243 for any contaminant listed in the [public health code] regulations of 244 Connecticut state agencies has been exceeded. No administrative 245 agency, health district or municipal health officer may withhold or 246 Raised Bill No. 6666 LCO No. 5823 9 of 89 cause to be withheld such a certificate of occupancy except as provided 247 in this section. 248 (g) The local director of health may require a private [residential] well 249 or semipublic well to be tested for arsenic, radium, uranium, radon or 250 gross alpha emitters, when there are reasonable grounds to suspect that 251 such contaminants are present in the groundwater. For purposes of this 252 subsection, "reasonable grounds" means (1) the existence of a geological 253 area known to have naturally occurring arsenic, radium, uranium, 254 radon or gross alpha emitter deposits in the bedrock; or (2) the well is 255 located in an area in which it is known that arsenic, radium, uranium, 256 radon or gross alpha emitters are present in the groundwater. 257 (h) Except as provided in subsection (i) of this section, the collection 258 of samples for determining the water quality of private [residential] 259 wells and semipublic wells may be made only by (1) employees of a 260 laboratory or firm certified or approved by the Department of Public 261 Health to test drinking water, if such employees have been trained in 262 sample collection techniques, (2) certified water operators, (3) local 263 health departments and state employees trained in sample collection 264 techniques, or (4) individuals with training and experience that the 265 Department of Public Health deems sufficient. 266 (i) Any owner of a residential construction, including, but not limited 267 to, a homeowner, on which a private [residential] well is located or any 268 general contractor of a new residential construction on which a private 269 [residential] well is located may collect samples of well water for 270 submission to a laboratory or firm for the purposes of testing water 271 quality pursuant to this section, provided (1) such laboratory or firm has 272 provided instructions to said owner or general contractor on how to 273 collect such samples, and (2) such owner or general contractor is 274 identified to the subsequent owner on a form to be prescribed by the 275 Department of Public Health. No regulation may prohibit or impede 276 such collection or analysis. 277 (j) The local director of health may require private [residential] wells 278 Raised Bill No. 6666 LCO No. 5823 10 of 89 and semipublic wells to be tested for pesticides, herbicides or organic 279 chemicals when there are reasonable grounds to suspect that any such 280 contaminants might be present in the groundwater. For purposes of this 281 subsection, "reasonable grounds" means (1) the presence of nitrate- 282 nitrogen in the groundwater at a concentration greater than ten 283 milligrams per liter, or (2) that the private [residential] well or 284 semipublic well is located on land, or in proximity to land, associated 285 with the past or present production, storage, use or disposal of organic 286 chemicals as identified in any public record. 287 (k) Any water transported in bulk by any means to a premises 288 currently supplied by a private well or semipublic well where the water 289 is to be used for purposes of drinking or domestic use shall be provided 290 by a bulk water hauler licensed pursuant to section 20-278h. No bulk 291 water hauler shall deliver water without first notifying the owner of the 292 premises of such delivery. Bulk water hauling to a premises currently 293 supplied by a private well or semipublic well shall be permitted only as 294 a temporary measure to alleviate a water supply shortage. 295 Sec. 7. Section 19a-524 of the general statutes is repealed and the 296 following is substituted in lieu thereof (Effective October 1, 2021): 297 If, upon review, investigation or inspection pursuant to section 19a- 298 498, the Commissioner of Public Health determines that a nursing home 299 facility or residential care home has violated any provision of section 300 17a-411, 19a-491a to 19a-491c, inclusive, as amended by this act, 19a- 301 493a, 19a-521 to 19a-529, inclusive, 19a-531 to 19a-551, inclusive, or 19a- 302 553 to 19a-555, inclusive, or any provision of any regulation of 303 Connecticut state agencies relating to licensure, the Fire Safety Code or 304 the operation or maintenance of a nursing home facility or residential 305 care home, which violation has been classified in accordance with 306 section 19a-527, the commissioner may immediately issue or cause to be 307 issued a citation to the licensee of such nursing home facility or 308 residential care home. Governmental immunity shall not be a defense to 309 any citation issued or civil penalty imposed pursuant to this section or 310 sections 19-525 to 19a-528, inclusive. Each such citation shall be in 311 Raised Bill No. 6666 LCO No. 5823 11 of 89 writing, provide notice of the nature and scope of the alleged violation 312 or violations, and include, but not be limited to, the citation and notice 313 of noncompliance issued in accordance with section 19a-496. Each 314 citation and notice of noncompliance issued under this section shall be 315 sent to the licensee electronically in a form and manner prescribed by 316 the commissioner or by certified mail [to the licensee] at the address of 317 the nursing home facility or residential care home in issue. A copy of 318 such citation and notice of noncompliance shall also be sent to the 319 licensed administrator at the address of the nursing home facility or 320 residential care home. 321 Sec. 8. Subdivision (2) of subsection (c) of section 19a-491c of the 322 general statutes is repealed and the following is substituted in lieu 323 thereof (Effective July 1, 2021): 324 (2) No long-term care facility shall be required to comply with the 325 provisions of this subsection if (A) the individual provides evidence to 326 the long-term care facility that such individual submitted to a 327 background search conducted pursuant to subdivision (1) of this 328 subsection not more than three years immediately preceding the date 329 such individual applies for employment, seeks to enter into a contract 330 or begins volunteering with the long-term care facility and that the prior 331 background search confirmed that the individual did not have a 332 disqualifying offense, or (B) the commissioner determines the need to 333 temporarily suspend the requirements of this subsection in the event of 334 an emergency or significant disruption. The commissioner shall inform 335 the long-term care facility when the commissioner has suspended the 336 requirements of this subsection pursuant to subparagraph (B) of this 337 subdivision and when such suspension is rescinded. 338 Sec. 9. Section 19a-177 of the general statutes is repealed and the 339 following is substituted in lieu thereof (Effective October 1, 2021): 340 The commissioner shall: 341 (1) With the advice of the Office of Emergency Medical Services 342 established pursuant to section 19a-178 and of an advisory committee 343 Raised Bill No. 6666 LCO No. 5823 12 of 89 on emergency medical services and with the benefit of meetings held 344 pursuant to subsection (b) of section 19a-184, adopt every five years a 345 state-wide plan for the coordinated delivery of emergency medical 346 services; 347 (2) License or certify the following: (A) Ambulance operations, 348 ambulance drivers, emergency medical services personnel and 349 communications personnel; (B) emergency room facilities and 350 communications facilities; and (C) transportation equipment, including 351 land, sea and air vehicles used for transportation of patients to 352 emergency facilities and periodically inspect life saving equipment, 353 emergency facilities and emergency transportation vehicles to ensure 354 state standards are maintained; 355 (3) Annually inventory emergency medical services resources within 356 the state, including facilities, equipment, and personnel, for the 357 purposes of determining the need for additional services and the 358 effectiveness of existing services; 359 (4) Review and evaluate all area-wide plans developed by the 360 emergency medical services councils pursuant to section 19a-182 in 361 order to insure conformity with standards issued by the commissioner; 362 (5) Not later than thirty days after their receipt, review all grant and 363 contract applications for federal or state funds concerning emergency 364 medical services or related activities for conformity to policy guidelines 365 and forward such application to the appropriate agency, when required; 366 (6) Establish such minimum standards and adopt such regulations in 367 accordance with the provisions of chapter 54, as may be necessary to 368 develop the following components of an emergency medical service 369 system: (A) Communications, which shall include, but not be limited to, 370 equipment, radio frequencies and operational procedures; (B) 371 transportation services, which shall include, but not be limited to, 372 vehicle type, design, condition and maintenance, and operational 373 procedures; (C) training, which shall include, but not be limited to, 374 emergency medical services personnel, communications personnel, 375 Raised Bill No. 6666 LCO No. 5823 13 of 89 paraprofessionals associated with emergency medical services, 376 firefighters and state and local police; (D) emergency medical service 377 facilities, which shall include, but not be limited to, categorization of 378 emergency departments as to their treatment capabilities and ancillary 379 services; and (E) mobile integrated health care programs, which shall 380 include, but not be limited to, the standards to ensure the health, safety 381 and welfare of the patients being served by such programs and data 382 collection and reporting requirements to ensure and measure quality 383 outcomes of such programs; 384 (7) Coordinate training of all emergency medical services personnel; 385 (8) (A) Develop an emergency medical services data collection 386 system. Each emergency medical service organization licensed or 387 certified pursuant to this chapter shall submit data to the commissioner, 388 on a quarterly basis, from each licensed ambulance service, certified 389 ambulance service or paramedic intercept service that provides 390 emergency medical services. Such submitted data shall include, but not 391 be limited to: (i) The total number of calls for emergency medical 392 services received by such licensed ambulance service, certified 393 ambulance service or paramedic intercept service through the 9-1-1 394 system during the reporting period; (ii) each level of emergency medical 395 services, as defined in regulations adopted pursuant to section 19a-179, 396 required for each such call; (iii) the response time for each licensed 397 ambulance service, certified ambulance service or paramedic intercept 398 service during the reporting period; (iv) the number of passed calls, 399 cancelled calls and mutual aid calls, both made and received, during the 400 reporting period; and (v) for the reporting period, the prehospital data 401 for the nonscheduled transport of patients required by regulations 402 adopted pursuant to subdivision (6) of this section. The data required 403 under this subdivision may be submitted in any electronic form selected 404 by such licensed ambulance service, certified ambulance service or 405 paramedic intercept service and approved by the commissioner, 406 provided the commissioner shall take into consideration the needs of 407 such licensed ambulance service, certified ambulance service or 408 paramedic intercept service in approving such electronic form. The 409 Raised Bill No. 6666 LCO No. 5823 14 of 89 commissioner may conduct an audit of any such licensed ambulance 410 service, certified ambulance service or paramedic intercept service as 411 the commissioner deems necessary in order to verify the accuracy of 412 such reported data. 413 (B) On or before December 31, 2018, and annually thereafter, the 414 commissioner shall prepare a report to the Emergency Medical Services 415 Advisory Board, established pursuant to section 19a-178a, as amended 416 by this act, that shall include, but not be limited to, the following data: 417 (i) The total number of calls for emergency medical services received 418 during the reporting year by each licensed ambulance service, certified 419 ambulance service or paramedic intercept service; (ii) the level of 420 emergency medical services required for each such call; (iii) the name of 421 the emergency medical service organization that provided each such 422 level of emergency medical services furnished during the reporting 423 year; (iv) the response time, by time ranges or fractile response times, 424 for each licensed ambulance service, certified ambulance service or 425 paramedic intercept service, using a common definition of response 426 time, as provided in regulations adopted pursuant to section 19a-179; 427 and (v) the number of passed calls, cancelled calls and mutual aid calls 428 during the reporting year. The commissioner shall prepare such report 429 in a format that categorizes such data for each municipality in which the 430 emergency medical services were provided, with each such 431 municipality grouped according to urban, suburban and rural 432 classifications. 433 (C) If any licensed ambulance service, certified ambulance service or 434 paramedic intercept service does not submit the data required under 435 subparagraph (A) of this subdivision for a period of six consecutive 436 months, or if the commissioner believes that such licensed ambulance 437 service, certified ambulance service or paramedic intercept service 438 knowingly or intentionally submitted incomplete or false data, the 439 commissioner shall issue a written order directing such licensed 440 ambulance service, certified ambulance service or paramedic intercept 441 service to comply with the provisions of subparagraph (A) of this 442 subdivision and submit all missing data or such corrected data as the 443 Raised Bill No. 6666 LCO No. 5823 15 of 89 commissioner may require. If such licensed ambulance service, certified 444 ambulance service or paramedic intercept service fails to fully comply 445 with such order not later than three months from the date such order is 446 issued, the commissioner (i) shall conduct a hearing, in accordance with 447 chapter 54, at which such licensed ambulance service, certified 448 ambulance service or paramedic intercept service shall be required to 449 show cause why the primary service area assignment of such licensed 450 ambulance service, certified ambulance service or paramedic intercept 451 service should not be revoked, and (ii) may take such disciplinary action 452 under section 19a-17 as the commissioner deems appropriate. 453 (D) The commissioner shall collect the data required by 454 subparagraph (A) of this subdivision, in the manner provided in said 455 subparagraph, from each emergency medical service organization 456 licensed or certified pursuant to this chapter. Any such emergency 457 medical service organization that fails to comply with the provisions of 458 this section shall be liable for a civil penalty not to exceed one hundred 459 dollars per day for each failure to report the required data regarding 460 emergency medical services provided to a patient, as determined by the 461 commissioner. The civil penalties set forth in this subparagraph shall be 462 assessed only after the department provides a written notice of 463 deficiency and the organization is afforded the opportunity to respond 464 to such notice. An organization shall have not more than fifteen business 465 days after the date of receiving such notice to provide a written response 466 to the department. The commissioner may adopt regulations, in 467 accordance with chapter 54, concerning the development, 468 implementation, monitoring and collection of emergency medical 469 service system data. All state agencies licensed or certified as emergency 470 medical service organizations shall be exempt from the civil penalties 471 set forth in this subparagraph. 472 (E) The commissioner shall, with the recommendation of the 473 Connecticut Emergency Medical Services Advisory Board established 474 pursuant to section 19a-178a, as amended by this act, adopt for use in 475 trauma data collection the most recent version of the National Trauma 476 Data Bank's National Trauma Data Standards and Data Dictionary and 477 Raised Bill No. 6666 LCO No. 5823 16 of 89 nationally recognized guidelines for field triage of injured patients; 478 (9) (A) Establish rates for the conveyance and treatment of patients 479 by licensed ambulance services and invalid coaches and establish 480 emergency service rates for certified ambulance services and paramedic 481 intercept services, provided (i) the present rates established for such 482 services and vehicles shall remain in effect until such time as the 483 commissioner establishes a new rate schedule as provided in this 484 subdivision, and (ii) any rate increase not in excess of the Medical Care 485 Services Consumer Price Index, as published by the Bureau of Labor 486 Statistics of the United States Department of Labor, for the prior year, 487 filed in accordance with subparagraph (B)(iii) of this subdivision shall 488 be deemed approved by the commissioner. For purposes of this 489 subdivision, licensed ambulance services and paramedic intercept 490 services shall not include emergency air transport services or mobile 491 integrated health care programs. 492 (B) Adopt regulations, in accordance with the provisions of chapter 493 54, establishing methods for setting rates and conditions for charging 494 such rates. Such regulations shall include, but not be limited to, 495 provisions requiring that on and after July 1, 2000: (i) Requests for rate 496 increases may be filed no more frequently than once a year, except that, 497 in any case where an agency's schedule of maximum allowable rates 498 falls below that of the Medicare allowable rates for that agency, the 499 commissioner shall immediately amend such schedule so that the rates 500 are at or above the Medicare allowable rates; (ii) only licensed 501 ambulance services, certified ambulance services and paramedic 502 intercept services that apply for a rate increase in excess of the Medical 503 Care Services Consumer Price Index, as published by the Bureau of 504 Labor Statistics of the United States Department of Labor, for the prior 505 year, and do not accept the maximum allowable rates contained in any 506 voluntary state-wide rate schedule established by the commissioner for 507 the rate application year shall be required to file detailed financial 508 information with the commissioner, provided any hearing that the 509 commissioner may hold concerning such application shall be conducted 510 as a contested case in accordance with chapter 54; (iii) licensed 511 Raised Bill No. 6666 LCO No. 5823 17 of 89 ambulance services, certified ambulance services and paramedic 512 intercept services that do not apply for a rate increase in any year in 513 excess of the Medical Care Services Consumer Price Index, as published 514 by the Bureau of Labor Statistics of the United States Department of 515 Labor, for the prior year, or that accept the maximum allowable rates 516 contained in any voluntary state-wide rate schedule established by the 517 commissioner for the rate application year shall, not later than the last 518 business day in August of such year, file with the commissioner a 519 statement of emergency and nonemergency call volume, and, in the case 520 of a licensed ambulance service, certified ambulance service or 521 paramedic intercept service that is not applying for a rate increase, a 522 written declaration by such licensed ambulance service, certified 523 ambulance service or paramedic intercept service that no change in its 524 currently approved maximum allowable rates will occur for the rate 525 application year; and (iv) detailed financial and operational information 526 filed by licensed ambulance services, certified ambulance services and 527 paramedic intercept services to support a request for a rate increase in 528 excess of the Medical Care Services Consumer Price Index, as published 529 by the Bureau of Labor Statistics of the United States Department of 530 Labor, for the prior year, shall cover the time period pertaining to the 531 most recently completed fiscal year and the rate application year of the 532 licensed ambulance service, certified ambulance service or paramedic 533 intercept service. 534 (C) Establish rates for licensed ambulance services, certified 535 ambulance services or paramedic intercept services for the following 536 services and conditions: (i) "Advanced life support assessment" and 537 "specialty care transports", which terms have the meanings provided in 538 42 CFR 414.605; and (ii) mileage, which may include mileage for an 539 ambulance transport when the point of origin and final destination for 540 a transport is within the boundaries of the same municipality. The rates 541 established by the commissioner for each such service or condition shall 542 be equal to (I) the ambulance service's base rate plus its established 543 advanced life support/paramedic surcharge when advanced life 544 support assessment services are performed; (II) two hundred twenty- 545 Raised Bill No. 6666 LCO No. 5823 18 of 89 five per cent of the ambulance service's established base rate for 546 specialty care transports; and (III) "loaded mileage", as the term is 547 defined in 42 CFR 414.605, multiplied by the ambulance service's 548 established rate for mileage. Such rates shall remain in effect until such 549 time as the commissioner establishes a new rate schedule as provided 550 in this subdivision. 551 (D) Establish rates for the treatment and release of patients by a 552 licensed or certified emergency medical services organization or a 553 provider who does not transport such patients to an emergency 554 department and who is operating within the scope of such 555 organization's or provider's practice and following protocols approved 556 by the sponsor hospital. The rates established pursuant to this 557 subparagraph shall not apply to the treatment provided to patients 558 through mobile integrated health care programs; 559 (10) Establish primary service areas and assign in writing a primary 560 service area responder for each primary service area. Each state-owned 561 campus having an acute care hospital on the premises shall be 562 designated as the primary service area responder for that campus; 563 (11) Revoke primary service area assignments upon determination by 564 the commissioner that it is in the best interests of patient care to do so; 565 [and] 566 (12) Annually issue a list of minimum equipment requirements for 567 [ambulances and rescue vehicles] authorized emergency medical 568 services vehicles based upon current national standards. The 569 commissioner shall distribute such list to all emergency medical service 570 organizations and sponsor hospital medical directors and make such list 571 available to other interested stakeholders. Emergency medical service 572 organizations shall have one year from the date of issuance of such list 573 to comply with the minimum equipment requirements; and 574 (13) The commissioner may waive any provisions of the regulations 575 affecting an emergency medical service organization, as defined in 576 section 19a-175, if the commissioner determines that such waiver would 577 Raised Bill No. 6666 LCO No. 5823 19 of 89 not endanger the health, safety or welfare of any patient or resident. The 578 commissioner may impose conditions, upon granting the waiver, that 579 assure the health, safety or welfare of patients or residents and may 580 revoke the waiver upon a finding that the health, safety or welfare of 581 any patient or resident has been jeopardized. The commissioner may 582 adopt regulations, in accordance with the provisions of chapter 54, 583 establishing procedures for an application for a waiver pursuant to this 584 subdivision. 585 Sec. 10. Section 20-207 of the general statutes is repealed and the 586 following is substituted in lieu thereof (Effective October 1, 2021): 587 As used in this chapter, unless the context otherwise requires, the 588 following terms shall have the meanings specified: 589 (1) "Board" means the Connecticut Board of Examiners of Embalmers 590 and Funeral Directors; 591 (2) "Person" means an individual or corporation, but not a 592 partnership; 593 (3) "Funeral directing" means the business, practice or profession, as 594 commonly practiced, of (A) directing or supervising funerals, or 595 providing funeral services; (B) handling or encasing or providing 596 services for handling and encasing dead human bodies, otherwise than 597 by embalming, for burial or disposal; (C) providing embalming services; 598 (D) providing transportation, interment and disinterment of dead 599 human bodies; (E) maintaining an establishment so located, constructed 600 and equipped as to permit the decent and sanitary handling of dead 601 human bodies, with suitable equipment in such establishment for such 602 handling; (F) conducting an establishment from which funerals may be 603 held; (G) engaging in consultations concerning arrangements for the 604 disposition of human remains, including, but not limited to, 605 arrangements for cremation or alkaline hydrolysis; (H) casketing human 606 remains; (I) making cemetery and cremation arrangements; and (J) 607 preparing funeral service contracts, as defined in section 42-200; 608 Raised Bill No. 6666 LCO No. 5823 20 of 89 (4) "Funeral director" means any person engaged or holding himself 609 or herself out as engaged in funeral directing whether or not he or she 610 uses in connection with his or her name or business the words "funeral 611 director," "undertaker" or "mortician" or any other word or title 612 intended to designate him or her as a funeral director or mortician or as 613 one so engaged; 614 (5) "Funeral service business" means the business, practice or 615 profession of funeral directing; 616 (6) "Licensed embalmer" means an embalmer holding a license as 617 provided in this chapter; 618 (7) "Licensed funeral director" means a funeral director holding a 619 license as provided in this chapter; 620 (8) ["Student embalmer"] "Registered apprentice embalmer" means a 621 person [studying embalming and] registered with the Department of 622 Public Health as an apprentice pursuant to the provisions of this 623 chapter; 624 (9) ["Student funeral director"] "Registered apprentice funeral 625 director" means a person [studying the funeral service business and] 626 registered with the Department of Public Health as an apprentice 627 pursuant to the provisions of this chapter; 628 (10) "Full-time employment" means regular and steady work during 629 the normal working hours by any person at the establishment at which 630 he is employed; and 631 (11) "Manager" means an individual who (A) is licensed as an 632 embalmer or funeral director pursuant to this chapter and (B) has direct 633 and personal responsibility for the daily operation and management of 634 a funeral service business. 635 Sec. 11. Section 20-212 of the general statutes is repealed and the 636 following is substituted in lieu thereof (Effective October 1, 2021): 637 Raised Bill No. 6666 LCO No. 5823 21 of 89 No person, except a licensed embalmer, shall inject any fluid or 638 substance into any dead human body, except that a registered [student] 639 apprentice embalmer may, even if not in the presence of a licensed 640 embalmer, make such injection or perform any other act under [his] 641 such licensed embalmer's instruction; and no person, firm or 642 corporation shall enter, engage in, carry on or manage for another the 643 business of caring for, preserving or disposing of dead human bodies 644 until each person, firm or corporation so engaged has obtained from the 645 Department of Public Health and holds a license as provided in this 646 chapter; nor shall any person be employed to remove a dead human 647 body, except a licensed embalmer, a registered [student] apprentice 648 embalmer, a licensed funeral director, or a person authorized in each 649 instance by the Chief Medical Examiner, Deputy Medical Examiner or 650 assistant medical examiner incidental to examining the body of a 651 deceased person, except that once a dead human body has been 652 prepared in accordance with the [Public Health Code] regulations of 653 Connecticut state agencies and the applicable provisions of the general 654 statutes, an embalmer or funeral director licensed in this state may 655 authorize an unlicensed employee to transport such body. Nothing in 656 this section shall be construed to prohibit any person licensed as an 657 embalmer or as a funeral director under the laws of another state from 658 bringing into or removing from this state a dead human body, provided 659 any and all other laws of this state relative to such body have been 660 complied with. Nothing in this chapter shall be construed to prohibit 661 any student who is enrolled in a program of education in mortuary 662 science, approved by the board, with the consent of the Commissioner 663 of Public Health, from embalming up to ten human bodies under the 664 supervision of a licensed embalmer and incidental to such student's 665 course of study. 666 Sec. 12. Subsections (a) and (b) of section 20-213 of the general statutes 667 are repealed and the following is substituted in lieu thereof (Effective 668 October 1, 2021): 669 (a) (1) After a [student] registered apprentice embalmer has (A) 670 completed a program of education in mortuary science approved by the 671 Raised Bill No. 6666 LCO No. 5823 22 of 89 board with the consent of the Commissioner of Public Health, (B) 672 successfully completed an examination prescribed by the Department 673 of Public Health with the consent of the board, (C) completed one year 674 of practical training and experience of a grade and character satisfactory 675 to the commissioner in the state in full-time employment under the 676 personal supervision and instruction of an embalmer licensed under the 677 provisions of this chapter, and (D) embalmed fifty human bodies in not 678 more than two years under the supervision of a licensed embalmer or 679 embalmers, (2) the [student] registered apprentice embalmer shall (A) 680 submit to the department an application and fee of two hundred ten 681 dollars, (B) take a written examination on the Connecticut public health 682 laws and the regulations of Connecticut state agencies pertaining to the 683 activities of an embalmer, and (C) take an examination in practical 684 embalming that shall include an actual demonstration upon a cadaver. 685 When the [student] registered apprentice embalmer has satisfactorily 686 passed such examinations, said department shall issue to him or her a 687 license to practice embalming. At the expiration of such license, if the 688 holder thereof desires a renewal, said department shall grant it pursuant 689 to section 20-222a, except for cause. 690 (b) Examinations for registration as a [student] registered apprentice 691 embalmer and for an embalmer's license shall be administered to 692 applicants by the Department of Public Health, under the supervision 693 of the board, semiannually and at such other times as may be 694 determined by the department. 695 Sec. 13. Section 20-215 of the general statutes is repealed and the 696 following is substituted in lieu thereof (Effective October 1, 2021): 697 No licensed embalmer shall sign an affidavit attesting the 698 preparation or embalming of any body unless such body has been 699 prepared or embalmed by [him] such licensed embalmer, or by a 700 registered [student] apprentice embalmer under [his] such licensed 701 embalmer's personal supervision. 702 Sec. 14. Subsection (a) of section 20-217 of the general statutes is 703 Raised Bill No. 6666 LCO No. 5823 23 of 89 repealed and the following is substituted in lieu thereof (Effective October 704 1, 2021): 705 (a) When a [student] registered apprentice funeral director has 706 completed a program of education approved by the board with the 707 consent of the Commissioner of Public Health, has successfully 708 completed an examination prescribed by the department with the 709 consent of the board and furnishes the department with satisfactory 710 proof that he or she has completed one year of practical training and 711 experience in full-time employment under the personal supervision of 712 a licensed embalmer or funeral director, and pays to the department a 713 fee of two hundred ten dollars, [he] such registered apprentice funeral 714 director shall be entitled to be examined upon the Connecticut state law 715 and regulations pertaining to his or her professional activities. If found 716 to be qualified by the Department of Public Health, [he] such registered 717 apprentice funeral director shall be licensed as a funeral director. 718 Renewal licenses shall be issued by the Department of Public Health 719 pursuant to section 20-222a, unless withheld for cause as herein 720 provided, upon a payment of a fee of two hundred thirty dollars. 721 Sec. 15. Section 20-224 of the general statutes is repealed and the 722 following is substituted in lieu thereof (Effective October 1, 2021): 723 (a) The provisions of sections 20-217, as amended by this act, 20-220 724 and 20-227 shall not prohibit the employment of assistants or of 725 [student] registered apprentice embalmers and [student] registered 726 apprentice funeral directors as provided in this chapter, provided a 727 licensed funeral service business may employ no more than two 728 [student] registered apprentice embalmers at any one time, and any 729 person, firm, corporation or other organization engaged in the business 730 of funeral directing may employ no more than one [student] registered 731 apprentice funeral director at any one time, without the approval of the 732 Board of Examiners of Embalmers and Funeral Directors. 733 (b) [Student] Registered apprentice embalmers and [student] 734 registered apprentice funeral directors shall register as apprentices with 735 Raised Bill No. 6666 LCO No. 5823 24 of 89 the Department of Public Health, in the manner prescribed by the 736 commissioner in regulations adopted pursuant to section 20-211, for 737 purposes of completing practical training and experience pursuant to 738 the provisions of this chapter. 739 Sec. 16. Section 20-195dd of the general statutes is repealed and the 740 following is substituted in lieu thereof (Effective October 1, 2021): 741 (a) Except as otherwise provided in subsections (c) and (d) of this 742 section, an applicant for a license as a professional counselor shall 743 submit evidence satisfactory to the commissioner of having: (1) (A) 744 Earned a graduate degree in clinical mental health counseling as part of 745 a program of higher learning accredited by the Council for 746 Accreditation of Counseling and Related Educational Programs, or a 747 successor organization, or (B) (i) completed at least sixty graduate 748 semester hours in counseling or a related mental health field at a 749 regionally accredited institution of higher education that included 750 coursework in each of the following areas: (I) Human growth and 751 development; (II) social and cultural foundations; (III) counseling 752 theories; (IV) counseling techniques; (V) group counseling; (VI) career 753 counseling; (VII) appraisals or tests and measurements to individuals 754 and groups; (VIII) research and evaluation; (IX) professional orientation 755 to mental health counseling; (X) addiction and substance abuse 756 counseling; (XI) trauma and crisis counseling; and (XII) diagnosis and 757 treatment of mental and emotional disorders, (ii) earned from a 758 regionally accredited institution of higher education a graduate degree 759 in counseling or a related mental health field, (iii) completed a one- 760 hundred-hour practicum in counseling taught by a faculty member 761 licensed or certified as a professional counselor or its equivalent in 762 another state, and (iv) completed a six-hundred-hour clinical mental 763 health counseling internship taught by a faculty member licensed or 764 certified as a professional counselor or its equivalent in another state; (2) 765 acquired three thousand hours of postgraduate experience under 766 professional supervision, including a minimum of one hundred hours 767 of direct professional supervision, in the practice of professional 768 counseling, performed over a period of not less than two years; and (3) 769 Raised Bill No. 6666 LCO No. 5823 25 of 89 passed an examination prescribed by the commissioner. The provisions 770 of subparagraphs (B)(i)(X) to (B)(i)(XII), inclusive, (B)(iii) and (B)(iv) of 771 this subsection shall not apply to any applicant who, on or before July 772 1, 2017, was a matriculating student in good standing in a graduate 773 degree program at a regionally accredited institution of higher 774 education in one of the fields required under subparagraph (B) of this 775 subsection. 776 (b) An applicant for a license as a professional counselor associate 777 shall submit to the Commissioner of Public Health evidence satisfactory 778 to the commissioner of having (1) earned a graduate degree in clinical 779 mental health counseling as part of a program of higher learning 780 accredited by the Council for Accreditation of Counseling and Related 781 Educational Programs, or a successor organization, or (2) (A) completed 782 at least sixty graduate semester hours in counseling or a related mental 783 health field at a regionally accredited institution of higher education 784 that included coursework in each of the following areas: Human growth 785 and development; social and cultural foundations; counseling theories; 786 counseling techniques; group counseling; career counseling; appraisals 787 or tests and measurements to individuals and groups; research and 788 evaluation; professional orientation to mental health counseling; 789 addiction and substance abuse counseling; trauma and crisis 790 counseling; and diagnosis and treatment of mental and emotional 791 disorders, (B) completed a one-hundred-hour practicum in counseling 792 taught by a faculty member licensed or certified as a professional 793 counselor or its equivalent in another state, (C) completed a six- 794 hundred-hour clinical mental health counseling internship taught by a 795 faculty member licensed or certified as a professional counselor or its 796 equivalent in another state, and (D) earned from a regionally accredited 797 institution of higher education a graduate degree in counseling or a 798 related mental health field. The provisions of subparagraphs (A) to (C), 799 inclusive, of subdivision (2) of this subsection shall not apply to any 800 applicant who, on or before July 1, 2022, earned a graduate degree at a 801 regionally accredited institution of higher education in counseling or a 802 related mental health field and has accumulated at least three thousand 803 Raised Bill No. 6666 LCO No. 5823 26 of 89 hours of experience under professional supervision, as defined in 804 section 20-195aa. 805 (c) An applicant for licensure by endorsement shall present evidence 806 satisfactory to the commissioner that the applicant is licensed or 807 certified as a professional counselor or professional counselor associate, 808 or as a person entitled to perform similar services under a different 809 designation, in another state or jurisdiction whose requirements for 810 practicing in such capacity are substantially similar to or higher than 811 those of this state and that there are no disciplinary actions or 812 unresolved complaints pending. 813 (d) An applicant who is licensed or certified as a professional 814 counselor or its equivalent in another state, territory or commonwealth 815 of the United States may substitute three years of licensed or certified 816 work experience in the practice of professional counseling in lieu of the 817 requirements of subdivision (2) of subsection (a) of this section, 818 provided the commissioner finds that such experience is equal to or 819 greater than the requirements of this state. 820 Sec. 17. Subsection (a) of section 20-195c of the general statutes is 821 repealed and the following is substituted in lieu thereof (Effective October 822 1, 2021): 823 (a) Each applicant for licensure as a marital and family therapist shall 824 present to the department satisfactory evidence that such applicant has: 825 (1) Completed a graduate degree program specializing in marital and 826 family therapy offered by a regionally accredited college or university 827 or an accredited postgraduate clinical training program accredited by 828 the Commission on Accreditation for Marriage and Family Therapy 829 Education offered by a regionally accredited institution of higher 830 education; (2) completed a supervised practicum or internship with 831 emphasis in marital and family therapy supervised by the program 832 granting the requisite degree or by an accredited postgraduate clinical 833 training program accredited by the Commission on Accreditation for 834 Marriage and Family Therapy Education and offered by a regionally 835 Raised Bill No. 6666 LCO No. 5823 27 of 89 accredited institution of higher education; [, in which the student 836 received a minimum of five hundred direct clinical hours that included 837 one hundred hours of clinical supervision;] (3) completed twelve 838 months of relevant postgraduate experience, including (A) a minimum 839 of one thousand hours of direct client contact offering marital and 840 family therapy services subsequent to being awarded a master's degree 841 or doctorate or subsequent to the training year specified in subdivision 842 (2) of this subsection, and (B) one hundred hours of postgraduate 843 clinical supervision provided by a licensed marital and family therapist; 844 and (4) passed an examination prescribed by the department. The fee 845 shall be three hundred fifteen dollars for each initial application. 846 Sec. 18. Subdivision (12) of subsection (a) of section 19a-14 of the 847 general statutes is repealed and the following is substituted in lieu 848 thereof (Effective October 1, 2021): 849 (12) With respect to any complaint filed with the department on or 850 after October 1, 2010, alleging incompetence, negligence, fraud or deceit 851 by a person subject to regulation or licensing by any board or 852 commission described in subdivision (1) to [(5), inclusive, (7),] (8), 853 inclusive, (12) to (14), inclusive, or subdivision (16) of subsection (b) of 854 this section: 855 (A) Upon request of the person who filed the complaint, provide such 856 person with information on the status of the complaint; 857 (B) Upon request of the person who filed the complaint, provide such 858 person with an opportunity to review, at the department, records 859 compiled as of the date of the request pursuant to any investigation of 860 the complaint, including, but not limited to, the respondent's written 861 response to the complaint, except that such person shall not be entitled 862 to copy such records and the department (i) shall not disclose (I) 863 information concerning a health care professional's referral to, 864 participation in or completion of an assistance program in accordance 865 with sections 19a-12a and 19a-12b, that is confidential pursuant to 866 section 19a-12a, (II) information not related to such person's specific 867 Raised Bill No. 6666 LCO No. 5823 28 of 89 complaint, including, but not limited to, information concerning 868 patients other than such person, or (III) personnel or medical records 869 and similar files the disclosure of which would constitute an invasion of 870 personal privacy pursuant to section 1-210, except for such records or 871 similar files solely related to such person; (ii) shall not be required to 872 disclose any other information that is otherwise confidential pursuant 873 to federal law or state statute, except for information solely related to 874 such person; and (iii) may require up to ten business days written notice 875 prior to providing such opportunity for review; 876 (C) Prior to resolving the complaint with a consent order, provide the 877 person who filed the complaint with not less than ten business days to 878 submit a written statement as to whether such person objects to 879 resolving the complaint with a consent order; 880 (D) If a hearing is held with respect to such complaint after a finding 881 of probable cause, provide the person who filed the complaint with a 882 copy of the notice of hearing issued pursuant to section 4-177, which 883 shall include information concerning the opportunity to present oral or 884 written statements pursuant to subsection (b) of section 4-177c; and 885 (E) Notify the person who filed the complaint of the final disposition 886 of such complaint not later than seven business days after such final 887 disposition; 888 Sec. 19. Subsections (a) to (c), inclusive, of section 20-204a of the 889 general statutes are repealed and the following is substituted in lieu 890 thereof (Effective October 1, 2021): 891 (a) The department shall investigate each allegation of any act or 892 omission by a veterinarian specified in section 20-202. The investigation 893 shall be conducted in accordance with the provisions of section 19a-14, 894 as amended by this act, to determine if probable cause exists to issue a 895 statement of charges and to institute proceedings against the 896 veterinarian. Such investigation shall be concluded not later than twelve 897 months from the date the allegation is submitted to the department. 898 Raised Bill No. 6666 LCO No. 5823 29 of 89 (b) Except as provided in subsections (c) and (d) of this section, the 899 investigation shall be confidential and not subject to disclosure under 900 section 1-210 and no person may disclose knowledge of the 901 investigation to a third party unless the veterinarian requests that the 902 investigation be open, [The owner of any animal that is the subject of 903 such an investigation shall not be deemed a third party to such an 904 investigation for purposes of disclosure under this section] except that 905 the department shall provide information to the person who filed the 906 complaint pursuant to subdivision (12) of subsection (a) of section 19a- 907 14, as amended by this act. 908 (c) If the department makes a finding of no probable cause to take 909 action under section 20-202 or fails to make a finding within the twelve- 910 month period required by subsection [(b)] (a) of this section, the 911 allegation submitted pursuant to subsection (a) of this section and the 912 entire record of the investigation may remain confidential and no 913 person shall disclose knowledge of such investigation to a third party 914 unless the veterinarian requests that it be open, except that the 915 department shall provide information to the person who filed the 916 complaint pursuant to subdivision (12) of subsection (a) of section 19a- 917 14, as amended by this act. 918 Sec. 20. Subsections (b) and (c) of section 7-62b of the general statutes 919 are repealed and the following is substituted in lieu thereof (Effective 920 January 1, 2022): 921 (b) The funeral director or embalmer licensed by the department, or 922 the funeral director or embalmer licensed in another state and 923 complying with the terms of a reciprocal agreement on file with the 924 department, in charge of the burial of the deceased person shall 925 complete the death certificate through the electronic death registry 926 system, or, if the electronic death registry system is unavailable, on a 927 form provided by the department. Said certificate shall be filed by a 928 licensed embalmer or such embalmer's designee or a funeral director or 929 such director's designee, in accordance with the provisions of this 930 section, except when inquiry is required by the Chief Medical 931 Raised Bill No. 6666 LCO No. 5823 30 of 89 Examiner's Office, in which case the death certificate shall be filed in 932 accordance with section 19a-409. The Social Security number of the 933 deceased person shall be recorded on such certificate. Such licensed 934 funeral director or licensed embalmer shall obtain the personal data 935 from the next of kin or the best qualified person or source available and 936 shall obtain a medical certification from the person responsible therefor, 937 in accordance with the provisions of this section. Only a licensed 938 embalmer may assume charge of the burial of a deceased person who 939 had a communicable disease, as designated in the [Public Health Code] 940 regulations of Connecticut state agencies, at the time of death and such 941 licensed embalmer shall file an affidavit, on a form provided by the 942 department, signed and sworn to by such licensed embalmer stating 943 that the body has been disinfected in accordance with the [Public Health 944 Code] regulations of Connecticut State Agencies. 945 (c) The medical certification portion of the death certificate shall be 946 completed, signed and returned to the licensed funeral director or 947 licensed embalmer no later than twenty-four hours after death by the 948 physician or advanced practice registered nurse in charge of the 949 patient's care for the illness or condition which resulted in death, or 950 upon the death of an infant delivered by a nurse-midwife, by such 951 nurse-midwife, as provided in section 20-86b. In the absence of such 952 physician or advanced practice registered nurse, or with the physician's 953 or advanced practice registered nurse's approval, the medical 954 certification may be completed and signed by an associate physician, an 955 advanced practice registered nurse, a physician assistant as provided in 956 subsection (d) of section 20-12d, a registered nurse as provided in 957 section 20-101a, the chief medical officer of the institution in which 958 death occurred, or by the pathologist who performed an autopsy upon 959 the decedent. No physician, advanced practice registered nurse, 960 physician assistant, registered nurse, nurse-midwife, chief medical 961 officer or pathologist shall sign and return the medical certification 962 unless such physician, advanced practice registered nurse, physician 963 assistant, registered nurse, nurse-midwife, chief medical officer or 964 pathologist has personally viewed and examined the body of the person 965 Raised Bill No. 6666 LCO No. 5823 31 of 89 to whom the medical certification relates and is satisfied that at the time 966 of the examination such person was in fact dead, except in the event a 967 medical certification is completed by a physician, advanced practice 968 registered nurse, physician assistant, registered nurse, nurse-midwife, 969 chief medical officer or pathologist other than the one who made the 970 determination and pronouncement of death, an additional viewing and 971 examination of the body shall not be required. Such physician, 972 advanced practice registered nurse, physician assistant, registered 973 nurse, nurse-midwife, chief medical officer or pathologist shall certify 974 to the facts of death through the electronic death registry system, or, if 975 the electronic death registry is unavailable, on a form provided by the 976 department. If a physician, advanced practice registered nurse, 977 physician assistant, registered nurse, nurse-midwife, chief medical 978 officer or pathologist refuses or otherwise fails to complete, sign and 979 return the medical portion of the death certificate to the licensed funeral 980 director or licensed embalmer within twenty-four hours after death, 981 such licensed funeral director or embalmer may notify the 982 Commissioner of Public Health of such refusal. The commissioner may, 983 upon receipt of notification and investigation, assess a civil penalty 984 against such physician, advanced practice registered nurse, physician 985 assistant, registered nurse, chief medical officer or pathologist not to 986 exceed two hundred fifty dollars. The medical certification shall state 987 the cause of death, defined so that such death may be classified under 988 the international list of causes of death, the duration of disease if known 989 and such additional information as the Department of Public Health 990 requires. The department shall give due consideration to national 991 uniformity in vital statistics in prescribing the form and content of such 992 information. 993 Sec. 21. Section 19a-200 of the general statutes is repealed and the 994 following is substituted in lieu thereof (Effective July 1, 2021): 995 (a) The mayor of each city, the chief executive officer of each town 996 and the warden of each borough shall, unless the charter of such city, 997 town or borough otherwise provides, nominate some person to be 998 director of health for such city, town or borough. [, which] Such person 999 Raised Bill No. 6666 LCO No. 5823 32 of 89 shall possess the qualifications specified in subsection (b) of this section. 1000 Upon approval of the commissioner, such nomination shall be 1001 confirmed or rejected by the board of selectmen, if there be such a board, 1002 otherwise by the legislative body of such city or town or by the 1003 burgesses of such borough within thirty days thereafter. 1004 (b) Notwithstanding the charter provisions of any city, town or 1005 borough with respect to the qualifications of the director of health, on 1006 and after October 1, 2010, any person nominated to be a director of 1007 health shall (1) be a licensed physician and hold a degree in public health 1008 from an accredited school, college, university or institution, or (2) hold 1009 a graduate degree in public health from an accredited institution of 1010 higher education. The educational requirements of this section shall not 1011 apply to any director of health nominated or otherwise appointed as 1012 director of health prior to October 1, 2010. 1013 (c) In cities, towns or boroughs with a population of forty thousand 1014 or more for five consecutive years, according to the estimated 1015 population figures authorized pursuant to subsection (b) of section 1016 8-159a, such director of health shall serve in a full-time capacity, except 1017 where a town has designated such director as the chief medical advisor 1018 for its public schools under section 10-205. [, and] 1019 (d) No director shall not, during such director's term of office, have 1020 any financial interest in or engage in any employment, transaction or 1021 professional activity that is in substantial conflict with the proper 1022 discharge of the duties required of directors of health by the general 1023 statutes or the regulations of Connecticut state agencies or specified by 1024 the appointing authority of the city, town or borough in its written 1025 agreement with such director. A written agreement with such director 1026 shall be submitted to the Commissioner of Public Health upon such 1027 director's appointment or reappointment. 1028 (e) Such director of health shall have and exercise within the limits of 1029 the city, town or borough for which such director is appointed all 1030 powers necessary for enforcing the general statutes, provisions of the 1031 Raised Bill No. 6666 LCO No. 5823 33 of 89 regulations of Connecticut state agencies relating to the preservation 1032 and improvement of the public health and preventing the spread of 1033 diseases therein. 1034 (f) In case of the absence or inability to act of a city, town or borough 1035 director of health or if a vacancy exists in the office of such director, the 1036 appointing authority of such city, town or borough may, with the 1037 approval of the Commissioner of Public Health, designate in writing a 1038 suitable person to serve as acting director of health during the period of 1039 such absence or inability or vacancy, provided the commissioner may 1040 appoint such acting director if the city, town or borough fails to do so. 1041 The person so designated, when sworn, shall have all the powers and 1042 be subject to all the duties of such director. In case of vacancy in the 1043 office of such director, if such vacancy exists for [thirty] sixty days, said 1044 commissioner may appoint a director of health for such city, town or 1045 borough. Said commissioner, may, for cause, remove an officer the 1046 commissioner or any predecessor in said office has appointed, and the 1047 common council of such city, town or the burgesses of such borough 1048 may, respectively, for cause, remove a director whose nomination has 1049 been confirmed by them, provided such removal shall be approved by 1050 said commissioner; and, within two days thereafter, notice in writing of 1051 such action shall be given by the clerk of such city, town or borough, as 1052 the case may be, to said commissioner, who shall, within ten days after 1053 receipt, file with the clerk from whom the notice was received, approval 1054 or disapproval. 1055 (g) Each such director of health shall hold office for the term of four 1056 years from the date of appointment and until a successor is nominated 1057 and confirmed in accordance with this section. 1058 (h) Each director of health shall, annually, at the end of the fiscal year 1059 of the city, town or borough, file with the Department of Public Health 1060 a report of the doings as such director for the year preceding. 1061 [(b)] (i) On and after July 1, 1988, each city, town and borough shall 1062 provide for the services of a sanitarian licensed under chapter 395 to 1063 Raised Bill No. 6666 LCO No. 5823 34 of 89 work under the direction of the local director of health. Where practical, 1064 the local director of health may act as the sanitarian. 1065 [(c)] (j) As used in this chapter, "authorized agent" means a sanitarian 1066 licensed under chapter 395 and any individual certified for a specific 1067 program of environmental health by the Commissioner of Public Health 1068 in accordance with the general statutes and regulations of Connecticut 1069 state agencies. 1070 Sec. 22. Section 19a-202a of the general statutes is repealed and the 1071 following is substituted in lieu thereof (Effective July 1, 2021): 1072 (a) Any municipality may designate itself as having a part-time 1073 health department if: (1) The municipality has not had a full-time health 1074 department or been in a full-time health district prior to January 1, 1998; 1075 (2) the municipality has the equivalent of at least one full-time 1076 employee, as determined by the Commissioner of Public Health, who 1077 performs public health functions required by the general statutes and 1078 the regulations of Connecticut states agencies; (3) the municipality 1079 annually submits a public health program plan and budget to the 1080 commissioner. [; and (4) the commissioner approves the program plan 1081 and budget.] 1082 (b) The Commissioner of Public Health [shall] may adopt regulations, 1083 in accordance with the provisions of chapter 54, for the development 1084 and approval of the program plan and budget required by subdivision 1085 (3) of subsection (a) of this section. 1086 Sec. 23. Section 19a-244 of the general statutes is repealed and the 1087 following is substituted in lieu thereof (Effective July 1, 2021): 1088 On and after October 1, 2010, any person nominated to be the director 1089 of health shall (1) be a licensed physician and hold a degree in public 1090 health from an accredited school, college, university or institution, or (2) 1091 hold a graduate degree in public health from an accredited school, 1092 college or institution. The educational requirements of this section shall 1093 not apply to any director of health nominated or otherwise appointed 1094 Raised Bill No. 6666 LCO No. 5823 35 of 89 as director of health prior to October 1, 2010. The board may specify in 1095 a written agreement with such director the term of office, which shall 1096 not exceed three years, salary and duties required of and responsibilities 1097 assigned to such director in addition to those required by the general 1098 statutes or the [Public Health Code] regulations of Connecticut state 1099 agencies, if any. Such director shall be removed during the term of such 1100 written agreement only for cause after a public hearing by the board on 1101 charges preferred, of which reasonable notice shall have been given. No 1102 director shall, during such director's term of office, have any financial 1103 interest in or engage in any employment, transaction or professional 1104 activity that is in substantial conflict with the proper discharge of the 1105 duties required of directors of health by the general statutes or the 1106 [Public Health Code] regulations of Connecticut state agencies or 1107 specified by the board in its written agreement with such director. The 1108 written agreement shall be submitted to the Commissioner of Public 1109 Health upon such director's appointment or reappointment. Such 1110 director shall serve in a full-time capacity and act as secretary and 1111 treasurer of the board, without the right to vote. Such director shall give 1112 to the district a bond with a surety company authorized to transact 1113 business in the state, for the faithful performance of such director's 1114 duties as treasurer, in such sum and upon such conditions as the board 1115 requires. Such director shall be the executive officer of the district 1116 department of health. Full-time employees of a city, town or borough 1117 health department at the time such city, town or borough votes to form 1118 or join a district department of health shall become employees of such 1119 district department of health. Such employees may retain their rights 1120 and benefits in the pension system of the town, city or borough by which 1121 they were employed and shall continue to retain their active 1122 participating membership therein until retired. Such employees shall 1123 pay into such pension system the contributions required of them for 1124 their class and membership. Any additional employees to be hired by 1125 the district or any vacancies to be filled shall be filled in accordance with 1126 the rules and regulations of the merit system of the state of Connecticut 1127 and the employees who are employees of cities, towns or boroughs 1128 which have adopted a local civil service or merit system shall be 1129 Raised Bill No. 6666 LCO No. 5823 36 of 89 included in their comparable grade with fully attained seniority in the 1130 state merit system. Such employees shall perform such duties as are 1131 prescribed by the director of health. In the event of the withdrawal of a 1132 town, city or borough from the district department, or in the event of a 1133 dissolution of any district department, the employees thereof, originally 1134 employed therein, shall automatically become employees of the 1135 appropriate town, city or borough's board of health. At the end of each 1136 fiscal year, each director of health shall submit a report to the 1137 Department of Public Health detailing the activities of such director 1138 during the preceding fiscal year. 1139 Sec. 24. Subdivision (3) of subsection (a) of section 19a-12a of the 1140 general statutes is repealed and the following is substituted in lieu 1141 thereof (Effective July 1, 2021): 1142 (3) "Health care professionals" includes any person licensed or who 1143 holds a permit pursuant to chapter 370, 372, 373, 375, 375a, 376, 376a, 1144 376b, 376c, 377, 378, 379, 379a, 380, 381, 381a, 382a, 383, 383a, 383b, 383c, 1145 384, 384a, 384b, 384c, 384d, 385, 398 or 399; 1146 Sec. 25. Section 19a-12d of the general statutes is repealed and the 1147 following is substituted in lieu thereof (Effective July 1, 2021): 1148 On or before the last day of January, April, July and October in each 1149 year, the Commissioner of Public Health shall certify the amount of 1150 revenue received as a result of any fee increase in the amount of five 1151 dollars (1) that took effect October 1, 2015, pursuant to sections 19a-88, 1152 19a-515, 20-65k, 20-74bb, 20-74h, 20-74s, 20-149, 20-162o, 20-162bb, 20- 1153 191a, 20-195c, as amended by this act, 20-195o, 20-195cc, 20-201, 20-206b, 1154 20-206n, 20-206r, 20-206bb, 20-206ll, 20-222a, 20-275, 20-395d, 20-398 and 1155 20-412, and (2) that took effect October 1, 2021, pursuant to section 20- 1156 185k, as amended by this act, and transfer such amount to the 1157 professional assistance program account established in section 19a-12c. 1158 Sec. 26. Subsection (a) of section 19a-12e of the general statutes is 1159 repealed and the following is substituted in lieu thereof (Effective October 1160 1, 2021): 1161 Raised Bill No. 6666 LCO No. 5823 37 of 89 (a) As used in this section: 1162 (1) "Health care professional" means any individual licensed or who 1163 holds a permit pursuant to chapter 368v, 370, 372, 373, 375 to 378, 1164 inclusive, 379 to 381b, inclusive, 382a, 383 to 385, inclusive, 388 or 397a 1165 to 399, inclusive; 1166 (2) "Assistance program" means the program established pursuant to 1167 section 19a-12a, as amended by this act, to provide education, 1168 prevention, intervention, referral assistance, rehabilitation or support 1169 services to health care professionals who have a chemical dependency, 1170 emotional or behavioral disorder or physical or mental illness; and 1171 (3) "Hospital" has the same meaning as provided in section 19a-490. 1172 Sec. 27. Subsection (b) of section 20-185k of the general statutes is 1173 repealed and the following is substituted in lieu thereof (Effective from 1174 passage): 1175 (b) A license issued under this section may be renewed annually. The 1176 license shall be renewed in accordance with the provisions of section 1177 19a-88, for a fee of one hundred [seventy-five] eighty dollars for 1178 applications for renewal of licenses that expire on or after October 1, 1179 2021. Each behavior analyst applying for license renewal shall furnish 1180 evidence satisfactory to the commissioner of having current certification 1181 with the Behavior Analyst Certification Board. 1182 Sec. 28. Subsection (a) of section 17a-412 of the general statutes is 1183 repealed and the following is substituted in lieu thereof (Effective October 1184 1, 2021): 1185 (a) Any physician or surgeon licensed under the provisions of chapter 1186 370, any resident physician or intern in any hospital in this state, 1187 whether or not so licensed, [and] any registered nurse, licensed practical 1188 nurse, medical examiner, dentist, optometrist, chiropractor, podiatrist, 1189 social worker, clergyman, police officer, pharmacist, physical therapist, 1190 long-term care facility administrator, nurse's aide or orderly in a long- 1191 Raised Bill No. 6666 LCO No. 5823 38 of 89 term care facility, any person paid for caring for a patient in a long-term 1192 care facility, any staff person employed by a long-term care facility, 1193 [and] any person who is a sexual assault counselor or a domestic 1194 violence counselor as defined in section 52-146k, and any behavior 1195 analyst licensed under the provisions of chapter 382a, who has 1196 reasonable cause to suspect or believe that a resident in a long-term care 1197 facility has been abused, neglected, exploited or abandoned, or is in a 1198 condition that is the result of such abuse, neglect, exploitation or 1199 abandonment, shall, not later than seventy-two hours after such 1200 suspicion or belief arose, report such information or cause a report to be 1201 made in any reasonable manner to the Commissioner of Social Services 1202 pursuant to chapter 319dd. Any person required to report under the 1203 provision of this section who fails to make such report within the 1204 prescribed time period shall be fined not more than five hundred 1205 dollars, except that, if such person intentionally fails to make such report 1206 within the prescribed time period, such person shall be guilty of a class 1207 C misdemeanor for the first offense and a class A misdemeanor for any 1208 subsequent offense. 1209 Sec. 29. Subsection (a) of section 17b-451 of the general statutes is 1210 repealed and the following is substituted in lieu thereof (Effective October 1211 1, 2021): 1212 (a) A mandatory reporter [, as defined in this section,] who has 1213 reasonable cause to suspect or believe that any elderly person has been 1214 abused, neglected, exploited or abandoned, or is in a condition that is 1215 the result of such abuse, neglect, exploitation or abandonment, or is in 1216 need of protective services, shall, not later than seventy-two hours after 1217 such suspicion or belief arose, report such information or cause a report 1218 to be made in any reasonable manner to the Commissioner of Social 1219 Services or to the person or persons designated by the commissioner to 1220 receive such reports. The term "mandatory reporter" means (1) any 1221 physician or surgeon licensed under the provisions of chapter 370, (2) 1222 any resident physician or intern in any hospital in this state, whether or 1223 not so licensed, (3) any registered nurse, (4) any nursing home 1224 administrator, nurse's aide or orderly in a nursing home facility or 1225 Raised Bill No. 6666 LCO No. 5823 39 of 89 residential care home, (5) any person paid for caring for a resident in a 1226 nursing home facility or residential care home, (6) any staff person 1227 employed by a nursing home facility or residential care home, (7) any 1228 residents' advocate, other than a representative of the Office of the Long- 1229 Term Care Ombudsman, as established under section 17a-405, 1230 including the State Ombudsman, (8) any licensed practical nurse, 1231 medical examiner, dentist, optometrist, chiropractor, podiatrist, 1232 behavior analyst, social worker, clergyman, police officer, pharmacist, 1233 psychologist or physical therapist, (9) any person paid for caring for an 1234 elderly person by any institution, organization, agency or facility, 1235 including without limitation, any employee of a community-based 1236 services provider, senior center, home care agency, homemaker and 1237 companion agency, adult day care center, village-model community 1238 and congregate housing facility, and (10) any person licensed or 1239 certified as an emergency medical services provider pursuant to chapter 1240 368d or chapter 384d, including any such emergency medical services 1241 provider who is a member of a municipal fire department. Any 1242 mandatory reporter who fails to make such report within the prescribed 1243 time period shall be fined not more than five hundred dollars, except 1244 that, if such person intentionally fails to make such report within the 1245 prescribed time period, such person shall be guilty of a class C 1246 misdemeanor for the first offense and a class A misdemeanor for any 1247 subsequent offense. Any institution, organization, agency or facility 1248 employing individuals to care for persons sixty years of age or older 1249 shall provide mandatory training on detecting potential abuse, neglect, 1250 exploitation and abandonment of such persons and inform such 1251 employees of their obligations under this section. For purposes of this 1252 subsection, "person paid for caring for an elderly person by any 1253 institution, organization, agency or facility" includes an employee of a 1254 community-based services provider, senior center, home health care 1255 agency, homemaker and companion agency, adult day care center, 1256 village-model community and congregate housing facility. 1257 Sec. 30. Section 19a-6o of the general statutes is repealed and the 1258 following is substituted in lieu thereof (Effective July 1, 2021): 1259 Raised Bill No. 6666 LCO No. 5823 40 of 89 (a) There is established, within available appropriations, within the 1260 Department of Public Health, a Palliative Care Advisory Council. The 1261 advisory council shall: (1) Analyze the current state of palliative care in 1262 the state; and (2) advise the department on matters relating to the 1263 improvement of palliative care and the quality of life for persons with 1264 serious or chronic illnesses. 1265 (b) The advisory council shall consist of the following members: 1266 (1) Two appointed by the Governor, one of whom shall be a physician 1267 certified by the American Board of Hospice and Palliative Medicine and 1268 one of whom shall be a registered nurse or advanced practice registered 1269 nurse certified by the National Board for Certification of Hospice and 1270 Palliative Nurses; 1271 (2) Seven appointed by the Commissioner of Public Health, each of 1272 whom shall be a licensed health care provider, with each appointee 1273 having experience or expertise in the provision of one of the following: 1274 (A) Inpatient palliative care in a hospital; (B) inpatient palliative care in 1275 a nursing home facility; (C) palliative care in the patient's home or a 1276 community setting; (D) pediatric palliative care; (E) palliative care for 1277 young adults; (F) palliative care for adults or elderly persons; and (G) 1278 inpatient palliative care in a psychiatric facility; 1279 (3) One appointed by the speaker of the House of Representatives, 1280 who shall be a licensed social worker experienced in working with 1281 persons with serious or chronic illness and their family members; 1282 (4) One appointed by the president pro tempore of the Senate, who 1283 shall be a licensed pharmacist experienced in working with persons 1284 with serious or chronic illness; 1285 (5) One appointed by the minority leader of the House of 1286 Representatives, who shall be a spiritual counselor experienced in 1287 working with persons with serious or chronic illness and their family 1288 members; and 1289 Raised Bill No. 6666 LCO No. 5823 41 of 89 (6) One appointed by the minority leader of the Senate, who shall be 1290 a representative of the American Cancer Society or a person experienced 1291 in advocating for persons with serious or chronic illness and their family 1292 members. 1293 (c) All appointments to the advisory council shall be made not later 1294 than December 31, 2013. Advisory council members shall serve three- 1295 year terms. Any vacancy shall be filled by the appointing authority. 1296 (d) Any appointment that is vacant for one year or more shall be 1297 made by the Commissioner of Public Health. The commissioner shall 1298 notify the appointing authority of the identity of the commissioner's 1299 choice for appointment not later than thirty days before making such 1300 appointment. 1301 [(d)] (e) Members shall receive no compensation except for 1302 reimbursement for necessary expenses incurred in performing their 1303 duties. 1304 [(e)] (f) The members shall elect the chairperson of the advisory 1305 council from among the members of the advisory council. A majority of 1306 the advisory council members shall constitute a quorum. Any action 1307 taken by the advisory council shall require a majority vote of those 1308 present. The first meeting of the advisory council shall be held not later 1309 than December 31, 2013. The advisory council shall meet biannually and 1310 at other times upon the call of the chairperson, upon the request of the 1311 Commissioner of Public Health or upon the request of a majority of the 1312 advisory council members. 1313 [(f)] (g) Not later than January 1, [2015] 2022, and [annually] 1314 biennially thereafter, the advisory council shall submit a report on its 1315 findings and recommendations to the Commissioner of Public Health 1316 and the joint standing committee of the General Assembly having 1317 cognizance of matters relating to public health, in accordance with the 1318 provisions of section 11-4a. 1319 Sec. 31. Section 19a-6q of the general statutes is repealed and the 1320 Raised Bill No. 6666 LCO No. 5823 42 of 89 following is substituted in lieu thereof (Effective from passage): 1321 [(a)] The Commissioner of Public Health, in consultation with the 1322 executive director of the Office of Health Strategy, established under 1323 section 19a-754a, and local and regional health departments, shall, 1324 within available resources, develop a plan that is consistent with the 1325 Department of Public Health's Healthy Connecticut 2020 health 1326 improvement plan and the state healthcare innovation plan developed 1327 pursuant to the State Innovation Model Initiative by the Centers for 1328 Medicare and Medicaid Services Innovation Center. The commissioner 1329 shall develop and implement such plan to: (1) Reduce the incidence of 1330 tobacco use, high blood pressure, health care associated infections, 1331 asthma, unintended pregnancy and diabetes; (2) improve chronic 1332 disease care coordination in the state; and (3) reduce the incidence and 1333 effects of chronic disease and improve outcomes for conditions 1334 associated with chronic disease in the state. The commissioner shall post 1335 such plan on the Department of Public Health's Internet web site. 1336 [(b) The commissioner shall, on or before January 15, 2015, and 1337 biennially thereafter, submit a report, in consultation with the executive 1338 director of the Office of Health Strategy, in accordance with the 1339 provisions of section 11-4a to the joint standing committee of the 1340 General Assembly having cognizance of matters relating to public 1341 health concerning chronic disease and implementation of the plan 1342 described in subsection (a) of this section. The commissioner shall post 1343 each report on the Department of Public Health's Internet web site not 1344 later than thirty days after submitting such report. Each report shall 1345 include, but need not be limited to: (1) A description of the chronic 1346 diseases that are most likely to cause a person's death or disability, the 1347 approximate number of persons affected by such chronic diseases and 1348 an assessment of the financial effects of each such disease on the state 1349 and on hospitals and health care facilities; (2) a description and 1350 assessment of programs and actions that have been implemented by the 1351 department and health care providers to improve chronic disease care 1352 coordination and prevent chronic disease; (3) the sources and amounts 1353 of funding received by the department to treat persons with multiple 1354 Raised Bill No. 6666 LCO No. 5823 43 of 89 chronic diseases and to treat or reduce the most prevalent chronic 1355 diseases in the state; (4) a description of chronic disease care 1356 coordination between the department and health care providers, to 1357 prevent and treat chronic disease; and (5) recommendations concerning 1358 actions that health care providers and persons with chronic disease may 1359 take to reduce the incidence and effects of chronic disease.] 1360 Sec. 32. Subsection (b) of section 19a-493 of the general statutes is 1361 repealed and the following is substituted in lieu thereof (Effective July 1, 1362 2021): 1363 (b) (1) A nursing home license may be renewed biennially after (A) 1364 an unscheduled inspection conducted by the department, (B) 1365 submission of the information required by section 19a-491a, and (C) 1366 submission of evidence satisfactory to the department that the nursing 1367 home is in compliance with the provisions of this chapter, the [Public 1368 Health Code] regulations of Connecticut state agencies and licensing 1369 regulations. 1370 (2) Any change in the ownership of a facility or institution, as defined 1371 in section 19a-490, owned by an individual, partnership or association 1372 or the change in ownership or beneficial ownership of ten per cent or 1373 more of the stock of a corporation which owns, conducts, operates or 1374 maintains such facility or institution, shall be subject to prior approval 1375 of the department after a scheduled inspection of such facility or 1376 institution is conducted by the department, provided such approval 1377 shall be conditioned upon a showing by such facility or institution to the 1378 commissioner that it has complied with all requirements of this chapter, 1379 the regulations relating to licensure and all applicable requirements of 1380 the [Public Health Code] regulations of Connecticut state agencies. Any 1381 such change in ownership or beneficial ownership resulting in a transfer 1382 to a person related by blood or marriage to such an owner or beneficial 1383 owner shall not be subject to prior approval of the department unless: 1384 (A) Ownership or beneficial ownership of ten per cent or more of the 1385 stock of a corporation, limited liability company, partnership or 1386 association which owns, conducts, operates or maintains more than one 1387 Raised Bill No. 6666 LCO No. 5823 44 of 89 facility or institution is transferred; (B) ownership or beneficial 1388 ownership is transferred in more than one facility or institution; or (C) 1389 the facility or institution is the subject of a pending complaint, 1390 investigation or licensure action. If the facility or institution is not in 1391 compliance, the commissioner may require the new owner to sign a 1392 consent order providing reasonable assurances that the violations shall 1393 be corrected within a specified period of time. Notice of any such 1394 proposed change of ownership shall be given to the department at least 1395 one hundred twenty days prior to the effective date of such proposed 1396 change. For the purposes of this subdivision, "a person related by blood 1397 or marriage" means a parent, spouse, child, brother, sister, aunt, uncle, 1398 niece or nephew. For the purposes of this subdivision, a change in the 1399 legal form of the ownership entity, including, but not limited to, changes 1400 from a corporation to a limited liability company, a partnership to a 1401 limited liability partnership, a sole proprietorship to a corporation and 1402 similar changes, shall not be considered a change of ownership if the 1403 beneficial ownership remains unchanged and the owner provides such 1404 information regarding the change to the department as may be required 1405 by the department in order to properly identify the current status of 1406 ownership and beneficial ownership of the facility or institution. For the 1407 purposes of this subdivision, a public offering of the stock of any 1408 corporation that owns, conducts, operates or maintains any such facility 1409 or institution shall not be considered a change in ownership or beneficial 1410 ownership of such facility or institution if the licensee and the officers 1411 and directors of such corporation remain unchanged, such public 1412 offering cannot result in an individual or entity owning ten per cent or 1413 more of the stock of such corporation, and the owner provides such 1414 information to the department as may be required by the department in 1415 order to properly identify the current status of ownership and beneficial 1416 ownership of the facility or institution. 1417 Sec. 33. (NEW) (Effective July 1, 2021) A health care facility licensed 1418 pursuant to chapter 368v of the general statutes shall have policies and 1419 procedures in place that reflect the National Centers for Disease Control 1420 and Prevention's recommendations for tuberculosis screening, testing, 1421 Raised Bill No. 6666 LCO No. 5823 45 of 89 treatment and education for health care personnel. Notwithstanding 1422 any provision of the general statutes or any regulations adopted 1423 thereunder, any employee providing direct patient care in a facility 1424 licensed pursuant to chapter 368v of the general statutes shall receive 1425 tuberculosis screening and testing in compliance with the licensed 1426 health care facility's policies and procedures. 1427 Sec. 34. Subsection (c) of section 19a-343 of the general statutes is 1428 repealed and the following is substituted in lieu thereof (Effective October 1429 1, 2021): 1430 (c) Three or more arrests, the issuance of three or more arrest 1431 warrants indicating a pattern of criminal activity and not isolated 1432 incidents or the issuance of three or more citations for a violation of a 1433 municipal ordinance as described in subdivision (14) of this subsection, 1434 for the following offenses shall constitute the basis for bringing an action 1435 to abate a public nuisance: 1436 (1) Prostitution under section 53a-82, 53a-83, 53a-86, 53a-87, 53a-88 or 1437 53a-89. 1438 (2) Promoting an obscene performance or obscene material under 1439 section 53a-196 or 53a-196b, employing a minor in an obscene 1440 performance under section 53a-196a, importing child pornography 1441 under section 53a-196c, possessing child pornography in the first degree 1442 under section 53a-196d, possessing child pornography in the second 1443 degree under section 53a-196e or possessing child pornography in the 1444 third degree under section 53a-196f. 1445 (3) Transmission of gambling information under section 53-278b or 1446 53-278d or maintaining of a gambling premises under section 53-278e. 1447 (4) Offenses for the sale of controlled substances, possession of 1448 controlled substances with intent to sell, or maintaining a drug factory 1449 under section 21a-277, 21a-278 or 21a-278a or use of the property by 1450 persons possessing controlled substances under section 21a-279. 1451 Nothing in this section shall prevent the state from also proceeding 1452 Raised Bill No. 6666 LCO No. 5823 46 of 89 against property under section 21a-259 or 54-36h. 1453 (5) Unauthorized sale of alcoholic liquor under section 30-74 or 1454 disposing of liquor without a permit under section 30-77, or sale or 1455 delivery of alcoholic liquor to any minor under subdivision (1) of 1456 subsection (b) of section 30-86 or the sale, delivery or giving of alcoholic 1457 liquor to a minor under subdivision (2) of subsection (b) of section 30- 1458 86. 1459 (6) Maintaining a motor vehicle chop shop under section 14-149a. 1460 (7) Inciting injury to persons or property under section 53a-179a. 1461 (8) Murder or manslaughter under section 53a-54a, 53a-54b, 53a-55, 1462 53a-56 or 53a-56a. 1463 (9) Assault under section 53a-59, 53a-59a, subdivision (1) of 1464 subsection (a) of section 53a-60 or section 53a-60a or 53a-61. 1465 (10) Sexual assault under section 53a-70 or 53a-70a. 1466 (11) Fire safety violations under section 29-291a, 29-291c, 29-292, 1467 subsection (b) of section 29-310, or section 29-315, 29-349 or 29-357. 1468 (12) Firearm offenses under section 29-35, 53-202aa, 53-203, 53a-211, 1469 53a-212, 53a-216, 53a-217 or 53a-217c. 1470 (13) Illegal manufacture, sale, possession or dispensing of a drug 1471 under subdivision (2) of section 21a-108. 1472 (14) Violation of a municipal ordinance resulting in the issuance of a 1473 citation for (A) excessive noise on nonresidential real property that 1474 significantly impacts the surrounding area, provided the municipality's 1475 excessive noise ordinance is based on an objective standard, (B) owning 1476 or leasing a dwelling unit that provides residence to an excessive 1477 number of unrelated persons resulting in dangerous or unsanitary 1478 conditions that significantly impact the safety of the surrounding area, 1479 or (C) impermissible operation of (i) a business that permits persons 1480 Raised Bill No. 6666 LCO No. 5823 47 of 89 who are not licensed pursuant to section 20-206b to engage in the 1481 practice of massage therapy, or (ii) a massage parlor, as defined by the 1482 applicable municipal ordinance, that significantly impacts the safety of 1483 the surrounding area. 1484 Sec. 35. Section 19a-131g of the general statutes is repealed and the 1485 following is substituted in lieu thereof (Effective from passage): 1486 The Commissioner of Public Health shall establish a Public Health 1487 Preparedness Advisory Committee for purposes of advising the 1488 Department of Public Health on matters concerning emergency 1489 responses to a public health emergency. The advisory committee shall 1490 consist of the Commissioner of Public Health, or his or her designee, the 1491 Commissioner of Emergency Services and Public Protection, or his or 1492 her designee, the president pro tempore of the Senate, or his or her 1493 designee, the speaker of the House of Representatives, or his or her 1494 designee, the majority and minority leaders of both houses of the 1495 General Assembly, or their designees, and the chairpersons and ranking 1496 members of the joint standing committees of the General Assembly 1497 having cognizance of matters relating to public health, public safety and 1498 the judiciary, or their designees, and representatives of town, city, 1499 borough and district directors of health, as appointed by the 1500 commissioner, and any other organization or persons that the 1501 commissioner deems relevant to the issues of public health 1502 preparedness. Upon the request of the commissioner, the Public Health 1503 Preparedness Advisory Committee may meet to review the plan for 1504 emergency responses to a public health emergency and other matters as 1505 deemed necessary by the commissioner. 1506 Sec. 36. Subsection (d) of section 19a-30 of the general statutes is 1507 repealed and the following is substituted in lieu thereof (Effective July 1, 1508 2021): 1509 (d) A nonrefundable fee of two hundred dollars shall accompany 1510 each application for a license or for renewal thereof, except in the case 1511 of a clinical laboratory owned and operated by a municipality, the state, 1512 Raised Bill No. 6666 LCO No. 5823 48 of 89 the United States, [or] any agency of said municipality, state or United 1513 States or any hospital. Each license shall be issued for a period of not 1514 less than twenty-four nor more than twenty-seven months from the 1515 deadline for applications established by the commissioner. Renewal 1516 applications shall be made (1) biennially within the twenty-fourth 1517 month of the current license; (2) before any change in ownership or 1518 change in director is made; and (3) prior to any major expansion or 1519 alteration in quarters. The licensed clinical laboratory shall report to the 1520 Department of Public Health, in a form and manner prescribed by the 1521 commissioner, the name and address of each blood collection facility 1522 owned and operated by the clinical laboratory, prior to the issuance of 1523 a new license, prior to the issuance of a renewal license or whenever a 1524 blood collection facility opens or closes. 1525 Sec. 37. Subsection (b) of section 20-365 of the general statutes is 1526 repealed and the following is substituted in lieu thereof (Effective July 1, 1527 2021): 1528 (b) Nothing in section 19a-200, as amended by this act, subsection (a) 1529 of section 19a-206, or sections 19a-207, 19a-242, 20-358 or 20-360 to 20- 1530 365, inclusive, shall prevent any of the following persons from engaging 1531 in the performance of their duties: (1) Any person certified by the 1532 Department of Public Health as a food or sewage inspector in 1533 accordance with regulations adopted pursuant to section 19a-36, (2) any 1534 person employed by a local health department performing the duties of 1535 a lead inspector who complies with training standards established 1536 pursuant to section 20-479, (3) a director of health acting pursuant to 1537 [subsection (a) of] section 19a-200, as amended by this act or section 19a- 1538 244, as amended by this act, (4) any employee of a water utility or federal 1539 or state agency performing his duties in accordance with applicable 1540 statutes and regulations, (5) any person employed by a local health 1541 department working under the direct supervision of a licensed 1542 sanitarian, (6) any person licensed or certified by the Department of 1543 Public Health in a specific program performing certain duties that are 1544 included within the duties of a sanitarian, or (7) a student enrolled in an 1545 accredited academic program leading to a degree in environmental 1546 Raised Bill No. 6666 LCO No. 5823 49 of 89 health or completing a special training course in environmental health 1547 approved by the commissioner, provided such student is clearly 1548 identified by a title which indicates his or her status as a student. 1549 Sec. 38. Subsection (b) of section 20-195u of the general statutes is 1550 repealed and the following is substituted in lieu thereof (Effective from 1551 passage): 1552 (b) Continuing education required pursuant to this section shall be 1553 related to the practice of social work and shall include not less than one 1554 contact hour of training or education each registration period on the 1555 topic of cultural competency and, on and after January 1, 2016, not less 1556 than two contact hours of training or education during the first renewal 1557 period in which continuing education is required and not less than once 1558 every six years thereafter on the topic of mental health conditions 1559 common to veterans and family members of veterans, including (1) 1560 determining whether a patient is a veteran or family member of a 1561 veteran, (2) screening for conditions such as post-traumatic stress 1562 disorder, risk of suicide, depression and grief, and (3) suicide prevention 1563 training. Such continuing education shall consist of courses, workshops 1564 and conferences offered or approved by the Association of Social Work 1565 Boards, the National Association of Social Workers or a school or 1566 department of social work accredited by the Council on Social Work 1567 Education. A licensee's ability to engage in on-line and home study 1568 continuing education shall be limited to not more than [six] ten hours 1569 per registration period. Within the registration period, an initial 1570 presentation by a licensee of an original paper, essay or formal lecture 1571 in social work to a recognized group of fellow professionals may 1572 account for five hours of continuing education hours of the aggregate 1573 continuing education requirements prescribed in this section. 1574 Sec. 39. Subsection (a) of section 20-265h of the general statutes is 1575 repealed and the following is substituted in lieu thereof (Effective from 1576 passage): 1577 (a) On and after July 1, 2021, each spa or salon that employs 1578 Raised Bill No. 6666 LCO No. 5823 50 of 89 hairdressers and cosmeticians, estheticians, eyelash technicians, [or] nail 1579 technicians or massage therapists shall be under the management of a 1580 hairdresser and cosmetician registered under this chapter, an esthetician 1581 licensed under section 20-265b or 20-265f, an eyelash technician licensed 1582 under section 20-265c or 20-265f, [or] a nail technician licensed under 1583 section 20-265d or 20-265f or a massage therapist licensed under chapter 1584 384a. 1585 Sec. 40. Subsection (a) of section 19a-131j of the general statutes is 1586 repealed and the following is substituted in lieu thereof (Effective from 1587 passage): 1588 (a) The commissioner may issue an order to temporarily suspend, for 1589 a period not to exceed sixty consecutive days, the requirements for 1590 licensure, certification or registration, pursuant to chapters 368d, 370, 1591 376 to 376c, inclusive, 378, 378a, 379, 379a, 381a, 382a, 383 to 383c, 1592 inclusive, 383d, 383f, 383g, 384b, 384d, 385, 395, 399, 400a, 400j and 474, 1593 to allow persons who are appropriately licensed, certified or registered 1594 in another state or territory of the United States or the District of 1595 Columbia, to render temporary assistance within the scope of the 1596 profession for which a person is licensed, certified or registered, in 1597 managing a public health emergency in this state, declared by the 1598 Governor pursuant to section 19a-131a. Nothing in this section shall be 1599 construed to permit a person to provide services beyond the scope 1600 allowed in the chapter specified in this section that pertains to such 1601 person's profession. 1602 Sec. 41. Subsection (a) of section 19a-512 of the general statutes is 1603 repealed and the following is substituted in lieu thereof (Effective July 1, 1604 2021): 1605 (a) In order to be eligible for licensure by examination pursuant to 1606 sections 19a-511 to 19a-520, inclusive, a person shall submit an 1607 application, together with a fee of two hundred dollars, and proof 1608 satisfactory to the Department of Public Health that he (1) is physically 1609 and emotionally capable of administering a nursing home; (2) has 1610 Raised Bill No. 6666 LCO No. 5823 51 of 89 satisfactorily completed a program of instruction and training, 1611 including residency training which meets the requirements of 1612 subsection (b) of this section and which is approved by the 1613 Commissioner of Public Health; and (3) has passed an examination 1614 prescribed [and administered] by the Department of Public Health 1615 designed to test the applicant's knowledge and competence in the 1616 subject matter referred to in subsection (b) of this section. Passing scores 1617 shall be established by the department. 1618 Sec. 42. Section 19a-490 of the general statutes is repealed and the 1619 following is substituted in lieu thereof (Effective July 1, 2021): 1620 (a) "Institution" means a hospital, short-term hospital special hospice, 1621 hospice inpatient facility, residential care home, nursing home facility, 1622 home health care agency, hospice home health care agency, home health 1623 aide agency, behavioral health facility, assisted living services agency, 1624 [substance abuse treatment facility,] outpatient surgical facility, 1625 outpatient clinic, an infirmary operated by an educational institution for 1626 the care of students enrolled in, and faculty and employees of, such 1627 institution; a facility engaged in providing services for the prevention, 1628 diagnosis, treatment or care of human health conditions, including 1629 facilities operated and maintained by any state agency; and a residential 1630 facility for persons with intellectual disability licensed pursuant to 1631 section 17a-227 and certified to participate in the Title XIX Medicaid 1632 program as an intermediate care facility for individuals with intellectual 1633 disability. "Institution" does not include any facility for the care and 1634 treatment of persons with mental illness or substance use disorder 1635 operated or maintained by any state agency, except Whiting Forensic 1636 Hospital; 1637 (b) "Hospital" means an establishment for the lodging, care and 1638 treatment of persons suffering from disease or other abnormal physical 1639 or mental conditions and includes inpatient psychiatric services in 1640 general hospitals; 1641 (c) "Residential care home" or "rest home" means a community 1642 Raised Bill No. 6666 LCO No. 5823 52 of 89 residence that furnishes, in single or multiple facilities, food and shelter 1643 to two or more persons unrelated to the proprietor and, in addition, 1644 provides services that meet a need beyond the basic provisions of food, 1645 shelter and laundry and may qualify as a setting that allows residents to 1646 receive home and community-based services funded by state and 1647 federal programs; 1648 (d) "Home health care agency" means a public or private 1649 organization, or a subdivision thereof, engaged in providing 1650 professional nursing services and the following services, available 1651 twenty-four hours per day, in the patient's home or a substantially 1652 equivalent environment: Home health aide services as defined in this 1653 section, physical therapy, speech therapy, occupational therapy or 1654 medical social services. The agency shall provide professional nursing 1655 services and at least one additional service directly and all others 1656 directly or through contract. An agency shall be available to enroll new 1657 patients seven days a week, twenty-four hours per day; 1658 (e) "Home health aide agency" means a public or private 1659 organization, except a home health care agency, which provides in the 1660 patient's home or a substantially equivalent environment supportive 1661 services which may include, but are not limited to, assistance with 1662 personal hygiene, dressing, feeding and incidental household tasks 1663 essential to achieving adequate household and family management. 1664 Such supportive services shall be provided under the supervision of a 1665 registered nurse and, if such nurse determines appropriate, shall be 1666 provided by a social worker, physical therapist, speech therapist or 1667 occupational therapist. Such supervision may be provided directly or 1668 through contract; 1669 (f) "Home health aide services" as defined in this section shall not 1670 include services provided to assist individuals with activities of daily 1671 living when such individuals have a disease or condition that is chronic 1672 and stable as determined by a physician licensed in the state; 1673 (g) "Behavioral health facility" means any facility that provides 1674 Raised Bill No. 6666 LCO No. 5823 53 of 89 mental health services to persons eighteen years of age or older or 1675 substance use disorder services to persons of any age in an outpatient 1676 treatment or residential setting to ameliorate mental, emotional, 1677 behavioral or substance use disorder issues; 1678 (h) "Alcohol or drug treatment facility" means any facility for the care 1679 or treatment of persons suffering from alcoholism or other drug 1680 addiction; 1681 (i) "Person" means any individual, firm, partnership, corporation, 1682 limited liability company or association; 1683 (j) "Commissioner" means the Commissioner of Public Health or the 1684 commissioner's designee; 1685 (k) "Home health agency" means an agency licensed as a home health 1686 care agency or a home health aide agency; 1687 (l) "Assisted living services agency" means an agency that provides, 1688 among other things, nursing services and assistance with activities of 1689 daily living and that may provide memory care to a population that is 1690 chronic and stable; 1691 (m) "Outpatient clinic" means an organization operated by a 1692 municipality or a corporation, other than a hospital, that provides (1) 1693 ambulatory medical care, including preventive and health promotion 1694 services, (2) dental care, or (3) mental health services in conjunction with 1695 medical or dental care for the purpose of diagnosing or treating a health 1696 condition that does not require the patient's overnight care; 1697 (n) "Multicare institution" means a hospital that provides outpatient 1698 behavioral health services or other health care services, psychiatric 1699 outpatient clinic for adults, free-standing facility for the care or 1700 treatment of substance abusive or dependent persons, hospital for 1701 psychiatric disabilities, as defined in section 17a-495, or a general acute 1702 care hospital that provides outpatient behavioral health services that (1) 1703 is licensed in accordance with this chapter, (2) has more than one facility 1704 Raised Bill No. 6666 LCO No. 5823 54 of 89 or one or more satellite units owned and operated by a single licensee, 1705 and (3) offers complex patient health care services at each facility or 1706 satellite unit. For purposes of this subsection, "satellite unit" means a 1707 location where a segregated unit of services is provided by the multicare 1708 institution; 1709 (o) "Nursing home" or "nursing home facility" means (1) any chronic 1710 and convalescent nursing home or any rest home with nursing 1711 supervision that provides nursing supervision under a medical director 1712 twenty-four hours per day, or (2) any chronic and convalescent nursing 1713 home that provides skilled nursing care under medical supervision and 1714 direction to carry out nonsurgical treatment and dietary procedures for 1715 chronic diseases, convalescent stages, acute diseases or injuries; [and] 1716 (p) "Outpatient dialysis unit" means (1) an out-of-hospital out-patient 1717 dialysis unit that is licensed by the department to provide (A) services 1718 on an out-patient basis to persons requiring dialysis on a short-term 1719 basis or for a chronic condition, or (B) training for home dialysis, or (2) 1720 an in-hospital dialysis unit that is a special unit of a licensed hospital 1721 designed, equipped and staffed to (A) offer dialysis therapy on an out- 1722 patient basis, (B) provide training for home dialysis, and (C) perform 1723 renal transplantations; [.] and 1724 (q) "Hospice home health care agency" means a public or private 1725 organization that provides home care and hospice services to terminally 1726 ill patients. 1727 Sec. 43. Subsections (b) to (i), inclusive, of section 19a-491 of the 1728 general statutes are repealed and the following is substituted in lieu 1729 thereof (Effective July 1, 2021): 1730 (b) If any person acting individually or jointly with any other person 1731 owns real property or any improvements thereon, upon or within which 1732 an institution, as defined in subsections (c) and (o) of section 19a-490, is 1733 established, conducted, operated or maintained and is not the licensee 1734 of the institution, such person shall submit a copy of the lease agreement 1735 to the department at the time of any change of ownership and with each 1736 Raised Bill No. 6666 LCO No. 5823 55 of 89 license renewal application. The lease agreement shall, at a minimum, 1737 identify the person or entity responsible for the maintenance and repair 1738 of all buildings and structures within which such an institution is 1739 established, conducted or operated. If a violation is found as a result of 1740 an inspection or investigation, the commissioner may require the owner 1741 to sign a consent order providing assurances that repairs or 1742 improvements necessary for compliance with the provisions of the 1743 [Public Health Code] regulations of Connecticut state agencies shall be 1744 completed within a specified period of time or may assess a civil penalty 1745 of not more than one thousand dollars for each day that such owner is 1746 in violation of the [Public Health Code] regulations of Connecticut state 1747 agencies or a consent order. A consent order may include a provision 1748 for the establishment of a temporary manager of such real property who 1749 has the authority to complete any repairs or improvements required by 1750 such order. Upon request of the Commissioner of Public Health, the 1751 Attorney General may petition the Superior Court for such equitable 1752 and injunctive relief as such court deems appropriate to ensure 1753 compliance with the provisions of a consent order. The provisions of 1754 this subsection shall not apply to any property or improvements owned 1755 by a person licensed in accordance with the provisions of subsection (a) 1756 of this section to establish, conduct, operate or maintain an institution 1757 on or within such property or improvements. 1758 (c) Notwithstanding any regulation, the Commissioner of Public 1759 Health shall charge the following fees for the biennial licensing and 1760 inspection of the following institutions: (1) Chronic and convalescent 1761 nursing homes, per site, four hundred forty dollars; (2) chronic and 1762 convalescent nursing homes, per bed, five dollars; (3) rest homes with 1763 nursing supervision, per site, four hundred forty dollars; (4) rest homes 1764 with nursing supervision, per bed, five dollars; (5) outpatient dialysis 1765 units and outpatient surgical facilities, six hundred twenty-five dollars; 1766 (6) mental health residential facilities, per site, three hundred seventy- 1767 five dollars; (7) mental health residential facilities, per bed, five dollars; 1768 (8) hospitals, per site, nine hundred forty dollars; (9) hospitals, per bed, 1769 seven dollars and fifty cents; (10) nonstate agency educational 1770 Raised Bill No. 6666 LCO No. 5823 56 of 89 institutions, per infirmary, one hundred fifty dollars; (11) nonstate 1771 agency educational institutions, per infirmary bed, twenty-five dollars; 1772 (12) home health care agencies, except certified home health care 1773 agencies described in subsection (d) of this section, per agency, three 1774 hundred dollars; (13) home health care agencies, hospice home health 1775 care agencies, or home health aide agencies, except certified home 1776 health care agencies, hospice home health care agencies or home health 1777 aide agencies described in subsection (d) of this section, per satellite 1778 patient service office, one hundred dollars; (14) assisted living services 1779 agencies, except such agencies participating in the congregate housing 1780 facility pilot program described in section 8-119n, per site, five hundred 1781 dollars; (15) short-term hospitals special hospice, per site, nine hundred 1782 forty dollars; (16) short-term hospitals special hospice, per bed, seven 1783 dollars and fifty cents; (17) hospice inpatient facility, per site, four 1784 hundred forty dollars; and (18) hospice inpatient facility, per bed, five 1785 dollars. 1786 (d) Notwithstanding any regulation, the commissioner shall charge 1787 the following fees for the triennial licensing and inspection of the 1788 following institutions: (1) Residential care homes, per site, five hundred 1789 sixty-five dollars; (2) residential care homes, per bed, four dollars and 1790 fifty cents; (3) home health care agencies that are certified as a provider 1791 of services by the United States Department of Health and Human 1792 Services under the Medicare or Medicaid program, three hundred 1793 dollars; and (4) certified home health care agencies or hospice home 1794 health care agencies, as described in section 19a-493, as amended by this 1795 act, per satellite patient service office, one hundred dollars. 1796 (e) The commissioner shall charge one thousand dollars for the 1797 licensing and inspection of outpatient clinics that provide either medical 1798 or mental health service, urgent care services and well-child clinical 1799 services, except those operated by a municipal health department, 1800 health district or licensed nonprofit nursing or community health 1801 agency. Such licensing and inspection shall be performed every three 1802 years, except those outpatient clinics that have obtained accreditation 1803 from a national accrediting organization within the immediately 1804 Raised Bill No. 6666 LCO No. 5823 57 of 89 preceding twelve-month period may be inspected by the commissioner 1805 once every four years, provided the outpatient clinic has not committed 1806 any violation that the commissioner determines would pose an 1807 immediate threat to the health, safety or welfare of the patients of the 1808 outpatient clinic. The provisions of this subsection shall not be 1809 construed to limit the commissioner's authority to inspect any applicant 1810 for licensure or renewal of licensure as an outpatient clinic, suspend or 1811 revoke any license granted to an outpatient clinic pursuant to this 1812 section or take any other legal action against an outpatient clinic that is 1813 authorized by any provision of the general statutes. 1814 (f) Any institution that is planning a project for construction or 1815 building alteration shall provide the plan for such project to the 1816 Department of Public Health for review. Any such project shall comply 1817 with nationally established facility guidelines for health care 1818 construction, as approved by the commissioner, that are in place at the 1819 time the institution provides the plan to the department. The 1820 commissioner shall post a reference to such guidelines, including the 1821 effective date of such guidelines, on the Department of Public Health's 1822 Internet web site. No institution shall be required to include matters 1823 outside the scope and applicability of such guidelines in the institution's 1824 plan. 1825 (g) The commissioner shall charge a fee of five hundred sixty-five 1826 dollars for the technical assistance provided for the design, review and 1827 development of an institution's construction, renovation, building 1828 alteration, sale or change in ownership when the cost of the project is 1829 one million dollars or less and shall charge a fee of one-quarter of one 1830 per cent of the total construction cost when the cost of the project is more 1831 than one million dollars. Such fee shall include all department reviews 1832 and on-site inspections. For purposes of this subsection, "institution" 1833 does not include a facility owned by the state. 1834 (h) The commissioner may require as a condition of the licensure of a 1835 home health care [agencies] agency, hospice home health care agency 1836 and home health aide [agencies] agency that each agency meet 1837 Raised Bill No. 6666 LCO No. 5823 58 of 89 minimum service quality standards. In the event the commissioner 1838 requires such agencies to meet minimum service quality standards as a 1839 condition of their licensure, the commissioner shall adopt regulations, 1840 in accordance with the provisions of chapter 54, to define such 1841 minimum service quality standards, which shall (1) allow for training of 1842 home health aides by adult continuing education, (2) require a 1843 registered nurse to visit and assess each patient receiving home health 1844 aide services as often as necessary based on the patient's condition, but 1845 not less than once every sixty days, and (3) require the assessment 1846 prescribed by subdivision (2) of this subsection to be completed while 1847 the home health aide is providing services in the patient's home. 1848 (i) No person acting individually or jointly with any other person 1849 shall establish, conduct, operate or maintain a home health care agency, 1850 hospice home health care agency or home health aide agency without 1851 maintaining professional liability insurance or other indemnity against 1852 liability for professional malpractice. The amount of insurance which 1853 such person shall maintain as insurance or indemnity against claims for 1854 injury or death for professional malpractice shall be not less than one 1855 million dollars for one person, per occurrence, with an aggregate of not 1856 less than three million dollars. 1857 Sec. 44. Subdivision (4) of subsection (a) of section 19a-491c of the 1858 general statutes is repealed and the following is substituted in lieu 1859 thereof (Effective July 1, 2021): 1860 (4) "Long-term care facility" means any facility, agency or provider 1861 that is a nursing home, as defined in section 19a-521, a residential care 1862 home, as defined in section 19a-521, a home health care agency, hospice 1863 home health care agency or home health aide agency, as defined in 1864 section 19a-490, as amended by this act, an assisted living services 1865 agency, as defined in section 19a-490, as amended by this act, an 1866 intermediate care facility for individuals with intellectual disabilities, as 1867 defined in 42 USC 1396d(d), except any such facility operated by a 1868 Department of Developmental Services' program subject to background 1869 checks pursuant to section 17a-227a, a chronic disease hospital, as 1870 Raised Bill No. 6666 LCO No. 5823 59 of 89 defined in section 19a-550, or an agency providing hospice care which 1871 is licensed to provide such care by the Department of Public Health or 1872 certified to provide such care pursuant to 42 USC 1395x. 1873 Sec. 45. Section 19a-492b of the general statutes is repealed and the 1874 following is substituted in lieu thereof (Effective July 1, 2021): 1875 (a) A home health care agency or hospice home health care agency 1876 that receives payment for rendering care to persons receiving medical 1877 assistance from the state, assistance from the Connecticut home-care 1878 program for the elderly pursuant to section 17b-342, or funds obtained 1879 through Title XVIII of the Social Security Amendments of 1965 shall be 1880 prohibited from discriminating against such persons who apply for 1881 enrollment to such home health care agency on the basis of source of 1882 payment. 1883 (b) Any home health care agency or hospice home health care agency 1884 which violates the provisions of this section shall be subject to 1885 suspension or revocation of license. 1886 Sec. 46. Subsection (b) of section 19a-492c of the general statutes is 1887 repealed and the following is substituted in lieu thereof (Effective July 1, 1888 2021): 1889 (b) A home health care agency or hospice home health care agency 1890 licensed pursuant to this chapter that provides hospice services in a 1891 rural town and is unable to access licensed or Medicare-certified hospice 1892 care to consistently provide adequate services to patients in the rural 1893 town may apply to the Commissioner of Public Health for a waiver from 1894 the regulations licensing such agency adopted pursuant to this chapter. 1895 The waiver may authorize one or more of the following: (1) The agency's 1896 supervisor of clinical services may also serve as the supervisor of clinical 1897 services assigned to the hospice program; (2) the hospice volunteer 1898 coordinator and the hospice program director may be permanent part- 1899 time employees; and (3) the program director may perform other 1900 services at the agency, including, but not limited to, hospice volunteer 1901 coordinator. The commissioner shall not grant a waiver unless the 1902 Raised Bill No. 6666 LCO No. 5823 60 of 89 commissioner determines that such waiver will not adversely impact 1903 the health, safety and welfare of hospice patients and their families. The 1904 waiver shall be in effect for two years. An agency may reapply for such 1905 a waiver. 1906 Sec. 47. Section 19a-492d of the general statutes is repealed and the 1907 following is substituted in lieu thereof (Effective July 1, 2021): 1908 On and after October 1, 2007, a nurse who is employed by an agency 1909 licensed by the Department of Public Health as a home health care 1910 agency, hospice home health care agency or [a] home health aide agency 1911 may administer influenza and pneumococcal vaccines to persons in 1912 their homes, after an assessment for contraindications, without a 1913 physician's order in accordance with a physician-approved agency 1914 policy that includes an anaphylaxis protocol. In the event of an adverse 1915 reaction to the vaccine, such nurse may also administer epinephrine or 1916 other anaphylaxis medication without a physician's order in accordance 1917 with the physician-approved agency policy. For purposes of this 1918 section, "nurse" means an advanced practice registered nurse, registered 1919 nurse or practical nurse licensed under chapter 378. 1920 Sec. 48. Section 19a-492e of the general statutes is repealed and the 1921 following is substituted in lieu thereof (Effective July 1, 2021): 1922 (a) For purposes of this section "home health care agency" and 1923 "hospice home health care agency" [has] have the same [meaning] 1924 meanings as provided in section 19a-490, as amended by this act. 1925 Notwithstanding the provisions of chapter 378, a registered nurse may 1926 delegate the administration of medications that are not administered by 1927 injection to home health aides and hospice home health care aides who 1928 have obtained certification and recertification every three years 1929 thereafter for medication administration in accordance with regulations 1930 adopted pursuant to subsection (b) of this section, unless the prescribing 1931 practitioner specifies that a medication shall only be administered by a 1932 licensed nurse. Any home health aide or hospice home health care aide 1933 who obtained certification in the administration of medications on or 1934 Raised Bill No. 6666 LCO No. 5823 61 of 89 before June 30, 2015, shall obtain recertification on or before July 1, 2018. 1935 (b) (1) The Commissioner of Public Health shall adopt regulations, in 1936 accordance with the provisions of chapter 54, to carry out the provisions 1937 of this section. Such regulations shall require each home health care 1938 agency or hospice home health care agency that serves clients requiring 1939 assistance with medication administration to (A) adopt practices that 1940 increase and encourage client choice, dignity and independence; (B) 1941 establish policies and procedures to ensure that a registered nurse may 1942 delegate allowed tasks of nursing care, to include medication 1943 administration, to home health aides or hospice home health care aides 1944 when the registered nurse determines that it is in the best interest of the 1945 client and the home health aide or hospice home health care aide has 1946 been deemed competent to perform the task; (C) designate home health 1947 aides or hospice home health care aides to obtain certification and 1948 recertification for the administration of medication; and (D) ensure that 1949 such home health aides receive such certification and recertification. 1950 (2) The regulations shall establish certification and recertification 1951 requirements for medication administration and the criteria to be used 1952 by home health care agencies or hospice home health care agencies that 1953 provide services for clients requiring assistance with medication 1954 administration in determining (A) which home health aides or hospice 1955 home health care aides shall obtain such certification and recertification, 1956 and (B) education and skill training requirements, including ongoing 1957 training requirements for such certification and recertification. 1958 (3) Education and skill training requirements for initial certification 1959 and recertification shall include, but not be limited to, initial orientation, 1960 training in client rights and identification of the types of medication that 1961 may be administered by unlicensed personnel, behavioral management, 1962 personal care, nutrition and food safety, and health and safety in 1963 general. 1964 (c) Each home health care agency or hospice home health care agency 1965 shall ensure that, on or before January 1, 2013, delegation of nursing care 1966 Raised Bill No. 6666 LCO No. 5823 62 of 89 tasks in the home care setting is allowed within such agency and that 1967 policies are adopted to employ home health aides or hospice home 1968 health care aides for the purposes of allowing nurses to delegate such 1969 tasks. 1970 (d) A registered nurse licensed pursuant to the provisions of chapter 1971 378 who delegates the task of medication administration to a home 1972 health aide or hospice home health care aide pursuant to this section 1973 shall not be subject to disciplinary action based on the performance of 1974 the home health aide or hospice home health care aide to whom tasks 1975 are delegated, unless the home health aide or hospice home health care 1976 aide is acting pursuant to specific instructions from the registered nurse 1977 or the registered nurse fails to leave instructions when the nurse should 1978 have done so, provided the registered nurse: (1) Documented in the 1979 patient's care plan that the medication administration could be properly 1980 and safely performed by the home health aide or hospice home health 1981 care aide to whom it is delegated, (2) provided initial direction to the 1982 home health aide or hospice home health care aide, and (3) provided 1983 ongoing supervision of the home health aide or hospice home health 1984 care aide, including the periodic assessment and evaluation of the 1985 patient's health and safety related to medication administration. 1986 (e) A registered nurse who delegates the provision of nursing care to 1987 another person pursuant to this section shall not be subject to an action 1988 for civil damages for the performance of the person to whom nursing 1989 care is delegated unless the person is acting pursuant to specific 1990 instructions from the nurse or the nurse fails to leave instructions when 1991 the nurse should have done so. 1992 (f) No person may coerce a registered nurse into compromising 1993 patient safety by requiring the nurse to delegate the administration of 1994 medication if the nurse's assessment of the patient documents a need for 1995 a nurse to administer medication and identifies why the need cannot be 1996 safely met through utilization of assistive technology or administration 1997 of medication by certified home health aides or hospice home health 1998 care aides. No registered nurse who has made a reasonable 1999 Raised Bill No. 6666 LCO No. 5823 63 of 89 determination based on such assessment that delegation may 2000 compromise patient safety shall be subject to any employer reprisal or 2001 disciplinary action pursuant to chapter 378 for refusing to delegate or 2002 refusing to provide the required training for such delegation. The 2003 Department of Social Services, in consultation with the Department of 2004 Public Health, [and] home health care agencies and hospice home health 2005 care agencies, shall develop protocols for documentation pursuant to 2006 the requirements of this subsection. The Department of Social Services 2007 shall notify all licensed home health care agencies and hospice home 2008 health care agencies of such protocols prior to the implementation of 2009 this section. 2010 (g) The Commissioner of Public Health may implement policies and 2011 procedures necessary to administer the provisions of this section while 2012 in the process of adopting such policies and procedures as regulations, 2013 provided notice of intent to adopt regulations is published in the 2014 Connecticut Law Journal not later than twenty days after the date of 2015 implementation. Policies and procedures implemented pursuant to this 2016 section shall be valid until the time final regulations are adopted. 2017 Sec. 49. Section 19a-496a of the general statutes is repealed and the 2018 following is substituted in lieu thereof (Effective July 1, 2021): 2019 (a) Notwithstanding any provision of the regulations of Connecticut 2020 state agencies, all home health care agency, hospice home health care 2021 agency or home health aide agency services shall be performed upon 2022 the order of a physician or physician assistant licensed pursuant to 2023 chapter 370 or an advanced practice registered nurse licensed pursuant 2024 to chapter 378. 2025 (b) All home health care agency services which are required by law 2026 to be performed upon the order of a licensed physician may be 2027 performed upon the order of a physician, physician assistant or 2028 advanced practice registered nurse licensed in a state which borders 2029 Connecticut. 2030 Sec. 50. Section 19a-504d of the general statutes is repealed and the 2031 Raised Bill No. 6666 LCO No. 5823 64 of 89 following is substituted in lieu thereof (Effective July 1, 2021): 2032 (a) If a hospital recommends home health care to a patient, the 2033 hospital discharge plan shall include two or more available options of 2034 home health care agencies or hospice home health care agencies. 2035 (b) A hospital which (1) has an ownership or investment interest in a 2036 home health care agency or hospice home health care agency, or (2) 2037 receives compensation or remuneration for referral of patients to a home 2038 health care agency or hospice home health care agency shall disclose 2039 such interest to any patient prior to including such agency as an option 2040 in a hospital discharge plan. Such information shall be verbally 2041 disclosed to each patient or shall be posted in a conspicuous place visible 2042 to patients. As used in this subsection, "ownership or investment 2043 interest" does not include ownership of investment securities purchased 2044 by the practitioner on terms available to the general public and which 2045 are publicly traded. 2046 Sec. 51. (NEW) (Effective July 1, 2021) (a) The Commissioner of Public 2047 Health may suspend the requirements for licensure to authorize a 2048 licensed chronic and convalescent nursing home to provide services to 2049 patients with a reportable disease, emergency illness or health 2050 condition, pursuant to section 19-91 of the general statutes, under their 2051 existing license if such licensed chronic and convalescent nursing home 2052 (1) provides services to such patients in a building that is not physically 2053 connected to its licensed facility, or (2) expands its bed capacity in a 2054 portion of a facility that is separate from the licensed facility. Such 2055 services may only be provided in order to render temporary assistance 2056 in managing a public health emergency in this state, declared by the 2057 Governor pursuant to section 19a-131a of the general statutes. 2058 (b) Each chronic and convalescent nursing home that intends to 2059 provide services pursuant to subsection (a) of this section shall submit 2060 an application to the Department of Public Health in a form and manner 2061 prescribed by the commissioner. Such application shall include, but 2062 need not be limited to: (1) Information regarding the facility's ability to 2063 Raised Bill No. 6666 LCO No. 5823 65 of 89 sufficiently address the health, safety or welfare of such chronic and 2064 convalescent nursing home's residents and staff; (2) the address of such 2065 facility; (3) an attestation that all equipment located at such facility is 2066 maintained according to the manufacturers' specifications, and is 2067 capable of meeting the needs of such facility's residents; (4) information 2068 regarding such facility's maximum bed capacity; and (5) information 2069 indicating that such facility is in compliance with any provisions of the 2070 general statutes or regulations of Connecticut state agencies pertaining 2071 to the operation of such facility. 2072 (c) Upon receipt of an application pursuant to subsection (a) of this 2073 section, the Department of Public Health shall conduct a scheduled 2074 inspection and investigation of the applicant's facilities to ensure 2075 compliance with any provisions of the general statutes or regulations of 2076 Connecticut state agencies pertaining to the licensing of such facilities. 2077 After conducting such inspection and investigation, the department 2078 shall notify the applicant of the department's approval or denial of such 2079 application. 2080 Sec. 52. Section 19a-522f of the general statutes is repealed and the 2081 following is substituted in lieu thereof (Effective July 1, 2021): 2082 (a) As used in this section: 2083 (1) "Administer" means to initiate the venipuncture and deliver an IV 2084 fluid or IV admixture into the blood stream through a vein, and to 2085 monitor and care for the venipuncture site, terminate the procedure and 2086 record pertinent events and observations; 2087 (2) "IV admixture" means an IV fluid to which one or more additional 2088 drug products have been added; 2089 (3) "IV fluid" means sterile solutions of fifty milliliters or more, 2090 intended for intravenous infusion, but does not include blood and blood 2091 products; 2092 (4) "IV therapy" means the introduction of an IV fluid or IV admixture 2093 Raised Bill No. 6666 LCO No. 5823 66 of 89 into the blood stream through a vein for the purpose of correcting water 2094 deficit and electrolyte imbalances, providing nutrition, and delivering 2095 antibiotics and other therapeutic agents approved by a chronic and 2096 convalescent nursing home's or a rest home with nursing supervision's 2097 medical staff; 2098 (5) "IV therapy program" means the overall plan by which a chronic 2099 and convalescent nursing home or a rest home with nursing supervision 2100 implements, monitors and safeguards the administration of IV therapy 2101 to patients; and 2102 (6) "IV therapy nurse" means a registered nurse who is qualified by 2103 education and training and has demonstrated proficiency in the 2104 theoretical and clinical aspects of IV therapy to administer an IV fluid 2105 or IV admixture. 2106 (b) An IV therapy nurse or a physician assistant licensed pursuant to 2107 section 20-12b, who is employed by, or operating under a contract to 2108 provide services in, a chronic and convalescent nursing home or a rest 2109 home with nursing supervision that operates an IV therapy program 2110 may administer a peripherally inserted central catheter as part of such 2111 facility's IV therapy program. The Department of Public Health shall 2112 adopt regulations in accordance with the provisions of chapter 54 to 2113 carry out the purposes of this section. 2114 (c) A chronic and convalescent nursing home may permit a registered 2115 nurse licensed pursuant to chapter 378 and employed by such chronic 2116 and convalescent nursing home who has been properly trained by the 2117 director of nursing or by an intravenous infusion company to (1) draw 2118 blood from a central line for laboratory purposes, provided the facility 2119 has an agreement with a laboratory to process such specimens, or (2) 2120 administer a dose of medication by intravenous injection, provided such 2121 medication is on a list of medications approved by the Commissioner of 2122 Public Health for intravenous injection by a registered nurse. Such 2123 chronic and convalescent nursing home shall notify the Commissioner 2124 of Public Health of any such services being provided. The 2125 Raised Bill No. 6666 LCO No. 5823 67 of 89 Commissioner of Public Health shall notify all chronic and convalescent 2126 nursing homes of the list of medications approved for intravenous 2127 injection by a registered nurse. The administrator of each chronic and 2128 convalescent nursing home shall ensure that each registered nurse who 2129 is permitted to perform the services described in subdivisions (1) and 2130 (2) of this subsection is appropriately trained and competent to perform 2131 such services. Each administrator shall provide documentation 2132 regarding the training and competency of such registered nurses to the 2133 department upon the department's request. 2134 Sec. 53. (NEW) (Effective July 1, 2021) (a) The Commissioner of Public 2135 Health shall license assisted living services agencies, as defined in 2136 section 19a-490 of the general statutes, as amended by this act. A 2137 managed residential community wishing to provide assisted living 2138 services shall become licensed as an assisted living services agency. 2139 (b) A managed residential care community that intends to arrange for 2140 assisted living services, shall only do so with a currently licensed 2141 assisted living services agency. Such managed residential community 2142 shall submit an application to arrange for the assisted living services to 2143 the Department of Public Health. Such application shall be submitted in 2144 a form and manner prescribed by the commissioner. 2145 (c) No assisted living services agency shall provide memory care to 2146 residents with early to mid-stage cognitive impairment from 2147 Alzheimer's disease or other dementias unless they have obtained 2148 approval from the Department of Public Health. Such assisted living 2149 services agencies shall ensure that they have adequate staff to meet the 2150 needs of the residents. Each assisted living services agency that offers 2151 memory care services shall submit to the Department of Public Health a 2152 list of memory care units or locations and their staffing plans when 2153 completing an initial or a renewal licensure application, or upon request 2154 from the department. 2155 (d) An assisted living services agency shall ensure all services being 2156 provided on an individual basis to clients are (1) fully understood and 2157 Raised Bill No. 6666 LCO No. 5823 68 of 89 agreed upon between either the client or the client's representative, and 2158 (2) that the client or the client's representative are made aware of the 2159 cost of any such services. 2160 (e) The Department of Public Health may adopt regulations, in 2161 accordance with the provisions of chapter 54 of the general statutes, to 2162 carry out the purposes of this section. 2163 Sec. 54. Section 19a-521b of the general statutes is repealed and the 2164 following is substituted in lieu thereof (Effective July 1, 2021): 2165 [In each] Each licensed chronic and convalescent nursing home, 2166 chronic disease hospital associated with a chronic and convalescent 2167 nursing home, rest home with nursing supervision and residential care 2168 home [, at least a three-foot clearance shall be provided at the sides and 2169 the foot of each bed.] shall position beds in a manner that promotes 2170 resident care. Such bed position shall (1) not act as a restraint to the 2171 resident, (2) ensure that the resident's call bell, overhead bed light and 2172 privacy curtain function and are readily useable by such resident, (3) not 2173 create a hazardous situation, including, but not limited to, creating an 2174 entrapment possibility, obstacle to evacuation or is close to or blocking 2175 a heat source, (4) prevent the spread of pathogens, (5) allow for infection 2176 control, (6) ensure residence privacy, and (7) provide at least six-foot 2177 clearance at the sides and foot of each bed. 2178 Sec. 55. Section 19a-195 of the general statutes is repealed and the 2179 following is substituted in lieu thereof (Effective October 1, 2021): 2180 The commissioner shall adopt regulations in accordance with the 2181 provisions of chapter 54 to require all [emergency medical response 2182 services] ambulances to be staffed by at least one certified emergency 2183 medical technician, who shall be in the patient compartment attending 2184 the patient during all periods in which a patient is being transported, 2185 and one certified [medical response technician] emergency medical 2186 responder. 2187 Sec. 56. Section 20-206jj of the general statutes is repealed and the 2188 Raised Bill No. 6666 LCO No. 5823 69 of 89 following is substituted in lieu thereof (Effective from passage): 2189 As used in this section and sections 20-206kk to 20-206oo, inclusive: 2190 (1) "Advanced emergency medical technician" means an individual 2191 who is certified as an advanced emergency medical technician by the 2192 Department of Public Health; 2193 (2) "Commissioner" means the Commissioner of Public Health; 2194 (3) "Emergency medical services instructor" means a person who is 2195 certified under the provisions of section 20-206ll or 20-206mm, as 2196 amended by this act, by the Department of Public Health to teach 2197 courses, the completion of which is required in order to become an 2198 emergency medical technician; 2199 (4) "Emergency medical responder" means an individual who is 2200 certified to practice as an emergency medical responder under the 2201 provisions of section 20-206ll or 20-206mm, as amended by this act; 2202 (5) "Emergency medical services personnel" means an individual 2203 certified to practice as an emergency medical responder, emergency 2204 medical technician, advanced emergency medical technician, 2205 emergency medical services instructor or an individual licensed as a 2206 paramedic; 2207 (6) "Emergency medical technician" means a person who is certified 2208 to practice as an emergency medical technician under the provisions of 2209 section 20-206ll or 20-206mm, as amended by this act; 2210 (7) "National organization for emergency medical certification" 2211 means a national organization approved by the Department of Public 2212 Health and identified on the department's Internet web site, or such 2213 national organization's successor organization, that tests and provides 2214 certification to emergency medical responders, emergency medical 2215 technicians, advanced medical technicians and paramedics; 2216 (8) "Office of Emergency Medical Services" means the office 2217 Raised Bill No. 6666 LCO No. 5823 70 of 89 established within the Department of Public Health pursuant to section 2218 19a-178; 2219 (9) "Paramedicine" means the carrying out of (A) all phases of 2220 cardiopulmonary resuscitation and defibrillation, (B) the administration 2221 of drugs and intravenous solutions under written or oral authorization 2222 from a licensed physician or a licensed advanced practice registered 2223 nurse, and (C) the administration of controlled substances, as defined in 2224 section 21a-240, in accordance with written protocols or standing orders 2225 of a licensed physician or a licensed advanced practice registered nurse; 2226 (10) "Paramedic" means a person licensed to practice as a paramedic 2227 under the provisions of section 20-206ll; and 2228 [(11) "Continuing education platform Internet web site" means an 2229 online database, approved by the Commissioner of Public Health, for 2230 emergency medical services personnel to enter, track and reconcile the 2231 hours and topics of continuing education completed by such personnel.] 2232 Sec. 57. Subsection (f) of section 20-206mm of the general statutes is 2233 repealed and the following is substituted in lieu thereof (Effective from 2234 passage): 2235 (f) A certified emergency medical responder, emergency medical 2236 technician, advanced emergency medical technician or emergency 2237 medical services instructor shall document the completion of his or her 2238 continuing educational requirements [through the continuing education 2239 platform Internet web site] in a form and manner prescribed by the 2240 commissioner. A certified emergency medical responder, emergency 2241 medical technician, advanced emergency medical technician or 2242 emergency medical services instructor who is not engaged in active 2243 professional practice in any form during a certification period shall be 2244 exempt from the continuing education requirements of this section, 2245 provided the emergency medical responder, emergency medical 2246 technician, advanced emergency medical technician or emergency 2247 medical services instructor submits to the department, prior to the 2248 expiration of the certification period, an application for inactive status 2249 Raised Bill No. 6666 LCO No. 5823 71 of 89 on a form prescribed by the department and such other documentation 2250 as may be required by the department. The application for inactive 2251 status pursuant to this subsection shall contain a statement that the 2252 emergency medical responder, emergency medical technician, 2253 advanced emergency medical technician or emergency medical services 2254 instructor may not engage in professional practice until the continuing 2255 education requirements of this section have been met. 2256 Sec. 58. Subsection (b) of section 19a-178a of the general statutes is 2257 repealed and the following is substituted in lieu thereof (Effective from 2258 passage): 2259 (b) The advisory board shall consist of members appointed in 2260 accordance with the provisions of this subsection and shall include the 2261 Commissioner of Public Health, the department's emergency medical 2262 services medical director and the president of each of the regional 2263 emergency medical services councils, or their designees. The Governor 2264 shall appoint the following members: (1) One person from the 2265 Connecticut Association of Directors of Health; (2) three persons from 2266 the Connecticut College of Emergency Physicians; (3) one person from 2267 the Connecticut Committee on Trauma of the American College of 2268 Surgeons; (4) one person from the Connecticut Medical Advisory 2269 Committee; (5) one person from the Emergency Nurses Association; (6) 2270 one person from the Connecticut Association of Emergency Medical 2271 Services Instructors; (7) one person from the Connecticut Hospital 2272 Association; (8) two persons representing commercial ambulance 2273 services; (9) one person from the Connecticut State Firefighters 2274 Association; (10) one person from the Connecticut Fire Chiefs 2275 Association; (11) one person from the Connecticut Police Chiefs 2276 Association; (12) one person from the Connecticut State Police; and (13) 2277 one person from the Connecticut Commission on Fire Prevention and 2278 Control. An additional eighteen members shall be appointed as follows: 2279 (A) Three by the president pro tempore of the Senate; (B) three by the 2280 majority leader of the Senate; (C) four by the minority leader of the 2281 Senate; (D) three by the speaker of the House of Representatives; (E) two 2282 by the majority leader of the House of Representatives; and (F) three by 2283 Raised Bill No. 6666 LCO No. 5823 72 of 89 the minority leader of the House of Representatives. The appointees 2284 shall include a person with experience in municipal ambulance services; 2285 a person with experience in for-profit ambulance services; three persons 2286 with experience in volunteer ambulance services; a paramedic; an 2287 emergency medical technician; an advanced emergency medical 2288 technician; three consumers and four persons from state-wide 2289 organizations with interests in emergency medical services as well as 2290 any other areas of expertise that may be deemed necessary for the 2291 proper functioning of the advisory board. Any appointment that is 2292 vacant for more than one year shall be filled by the Commissioner of 2293 Public Health. The commissioner shall notify the appointing authority 2294 of the identity of the commissioner's appointment not later than thirty 2295 days before making such appointment. 2296 Sec. 59. Subsection (a) of section 19a-36h of the general statutes is 2297 repealed and the following is substituted in lieu thereof (Effective from 2298 passage): 2299 (a) Not later than January 1, [2020] 2022, the commissioner shall adopt 2300 and administer by reference the United States Food and Drug 2301 Administration's Food Code, as amended from time to time, and any 2302 Food Code Supplement published by said administration as the state's 2303 food code for the purpose of regulating food establishments. 2304 Sec. 60. Subsection (a) of section 19a-36j of the general statutes is 2305 repealed and the following is substituted in lieu thereof (Effective from 2306 passage): 2307 (a) On and after January 1, [2019] 2022, no person shall engage in the 2308 practice of a food inspector unless such person has obtained a 2309 certification from the commissioner in accordance with the provisions 2310 of this section. The commissioner shall develop a training and 2311 verification program for food inspector certification that shall be 2312 administered by the food inspection training officer at a local health 2313 department. 2314 (1) Each person seeking certification as a food inspector shall submit 2315 Raised Bill No. 6666 LCO No. 5823 73 of 89 an application to the department on a form prescribed by the 2316 commissioner and present to the department satisfactory evidence that 2317 such person (A) is sponsored by the director of health in the jurisdiction 2318 in which the applicant is employed to conduct food inspections, (B) 2319 possesses a bachelor's degree or three years of experience in a regulatory 2320 food protection program, (C) has successfully completed a training and 2321 verification program, (D) has successfully completed the field 2322 standardization inspection prescribed by the commissioner, and (E) is 2323 not involved in the ownership or management of a food establishment 2324 located in the applicant's jurisdiction. 2325 (2) Each director of health sponsoring an applicant for certification as 2326 a food inspector shall submit to the commissioner a form documenting 2327 the applicant's qualifications and successful completion of the 2328 requirements described in subdivision (1) of this subsection. 2329 (3) Certifications issued under this section shall be subject to renewal 2330 once every three years. A food inspector applying for renewal of his or 2331 her certification shall demonstrate successful completion of twenty 2332 contact hours in food protection training, as approved by the 2333 commissioner, and reassessment by the food inspection training officer. 2334 Sec. 61. Section 19a-36o of the general statutes is repealed and the 2335 following is substituted in lieu thereof (Effective from passage): 2336 Notwithstanding any provision of the general statutes, from June 30, 2337 2017, until December 31, [2018] 2021, a food service establishment may 2338 request a variance from the Commissioner of Public Health from the 2339 requirements of the Public Health Code, established under section 19a- 2340 36, to utilize the process of sous vide and acidification of sushi rice, as 2341 defined in section 3-502.11 of the United States Food and Drug 2342 Administration's Food Code, as amended from time to time. The 2343 Commissioner of Public Health shall review the request for a variance 2344 and provide the food establishment with notification regarding the 2345 status of its request not later than thirty days after the commissioner 2346 receives such request. The commissioner may grant such variance if he 2347 Raised Bill No. 6666 LCO No. 5823 74 of 89 or she determines that such variance would not result in a health hazard 2348 or nuisance. 2349 Sec. 62. Subdivision (5) of section 19a-332 of the general statutes is 2350 repealed and the following is substituted in lieu thereof (Effective October 2351 1, 2021): 2352 (5) "Asbestos-containing material" means material composed of 2353 asbestos of any type and in an amount equal to or greater than [one] 1.0 2354 per cent by weight, either alone or mixed with other fibrous or 2355 nonfibrous material; 2356 Sec. 63. Subdivision (4) of section 20-250 of the general statutes is 2357 repealed and the following is substituted in lieu thereof (Effective from 2358 passage): 2359 (4) "Hairdressing and cosmetology" means the art of dressing, 2360 arranging, curling, waving, weaving, cutting, singeing, bleaching and 2361 coloring the hair and treating the scalp of any person, and massaging, 2362 cleansing, stimulating, manipulating, exercising or beautifying with the 2363 use of the hands, appliances, cosmetic preparations, antiseptics, tonics, 2364 lotions, creams, powders, oils or clays and doing similar work on the 2365 face, neck and arms for compensation, removing hair from the face or 2366 neck using manual or mechanical means, excluding esthetics, as defined 2367 in section 20-265a or any of the actions listed in this subdivision 2368 performed on the nails of the hands or feet, provided nothing in this 2369 subdivision shall prohibit an unlicensed person from performing 2370 shampooing or braiding hair; 2371 Sec. 64. Subsection (b) of section 20-265b of the general statutes is 2372 repealed and the following is substituted in lieu thereof (Effective July 1, 2373 2021): 2374 (b) On and after January 1, 2020, each person seeking an initial license 2375 as an esthetician shall apply to the department on a form prescribed by 2376 the department, accompanied by an application fee of one hundred 2377 dollars and evidence that the applicant (1) has completed a course of not 2378 Raised Bill No. 6666 LCO No. 5823 75 of 89 less than six hundred hours of study and received a certification of 2379 completion from a school approved under section 20-265g or section 20- 2380 26 or in a school outside of the state whose requirements are equivalent 2381 to a school approved under section 20-265g, or (2) (A), if applying before 2382 January 1, 2022, has practiced esthetics continuously in this state for a 2383 period of not less than two years prior to July 1, 2020, and (B) is in 2384 compliance with the infection prevention and control plan guidelines 2385 prescribed by the department under section 19a-231 in the form of an 2386 attestation. 2387 Sec. 65. Subsection (f) of section 10-206 of the general statutes is 2388 repealed and the following is substituted in lieu thereof (Effective July 1, 2389 2021): 2390 (f) On and after October 1, 2017, each local or regional board of 2391 education shall report to the local health department and the 2392 Department of Public Health, on an triennial basis, the total number of 2393 pupils per school and per school district having a diagnosis of asthma 2394 (1) at the time of public school enrollment, (2) in grade six or seven, and 2395 (3) in grade nine or ten. [or eleven.] The report shall contain the asthma 2396 information collected as required under subsections (b) and (c) of this 2397 section and shall include pupil age, gender, race, ethnicity and school. 2398 Beginning on October 1, 2021, and every three years thereafter, the 2399 Department of Public Health shall review the asthma screening 2400 information reported pursuant to this section and shall submit a report 2401 to the joint standing committees of the General Assembly having 2402 cognizance of matters relating to public health and education 2403 concerning asthma trends and distributions among pupils enrolled in 2404 the public schools. The report shall be submitted in accordance with the 2405 provisions of section 11-4a and shall include, but not be limited to, (A) 2406 trends and findings based on pupil age, gender, race, ethnicity, school 2407 and the education reference group, as determined by the Department of 2408 Education for the town or regional school district in which such school 2409 is located, and (B) activities of the asthma screening monitoring system 2410 maintained under section 19a-62a. 2411 Raised Bill No. 6666 LCO No. 5823 76 of 89 Sec. 66. Subsections (b) to (f), inclusive, of section 19a-215 of the 2412 general statutes are repealed and the following is substituted in lieu 2413 thereof (Effective from passage): 2414 (b) A health care provider shall report each case occurring in such 2415 provider's practice, of any disease on the commissioner's list of 2416 reportable diseases, emergency illnesses and health conditions to the 2417 director of health of the town, city or borough in which such case resides 2418 and to the Department of Public Health, no later than twelve hours after 2419 such provider's recognition of the disease. Such reports shall be [in 2420 writing, by telephone or] in an electronic format approved by the 2421 commissioner. Such reports of disease shall be confidential and not open 2422 to public inspection except as provided for in section 19a-25. 2423 (c) A clinical laboratory shall report each finding identified by such 2424 laboratory of any disease identified on the commissioner's list of 2425 reportable laboratory findings to the Department of Public Health not 2426 later than forty-eight hours after such laboratory's finding. A clinical 2427 laboratory [that reports an average of more than thirty findings per 2428 month] shall make such reports electronically in a format approved by 2429 the commissioner. [Any clinical laboratory that reports an average of 2430 less than thirty findings per month shall submit such reports, in writing, 2431 by telephone or in an electronic format approved by the commissioner.] 2432 All such reports shall be confidential and not open to public inspection 2433 except as provided for in section 19a-25. The Department of Public 2434 Health shall provide a copy of all such reports to the director of health 2435 of the town, city or borough in which the affected person resides or, in 2436 the absence of such information, the town where the specimen 2437 originated. 2438 (d) When a local director of health, the local director's authorized 2439 agent or the Department of Public Health receives a report of a disease 2440 or laboratory finding on the commissioner's lists of reportable diseases, 2441 emergency illnesses and health conditions and laboratory findings, the 2442 local director of health, the local director's authorized agent or the 2443 Department of Public Health may contact first the reporting health care 2444 Raised Bill No. 6666 LCO No. 5823 77 of 89 provider and then the person with the reportable finding to obtain such 2445 information as may be necessary to lead to the effective control of 2446 further spread of such disease. In the case of reportable communicable 2447 diseases and laboratory findings, this information may include 2448 obtaining the identification of persons who may be the source or 2449 subsequent contacts of such infection. 2450 (e) All personal information obtained from disease prevention and 2451 control investigations as performed in subsections (c) and (d) of this 2452 section including the health care provider's name and the identity of the 2453 reported case of disease and suspected source persons and contacts shall 2454 not be divulged to anyone and shall be held strictly confidential 2455 pursuant to section 19a-25, by the local director of health and the 2456 director's authorized agent and by the Department of Public Health. 2457 (f) [Any person who violates any reporting or confidentiality 2458 provision of this section shall be fined not more than five hundred 2459 dollars.] The Commissioner of Public Health may impose a civil penalty 2460 not to exceed one thousand dollars on any person who violates any 2461 reporting provision of this section for each such violation. Each failure 2462 to report a case or finding of a disease as required by this section shall 2463 constitute a separate violation. 2464 (g) If the Commissioner of Public Health has reason to believe that a 2465 violation has occurred for which a civil penalty is authorized by 2466 subsection (f) of this section, he or she may send to such person by 2467 certified mail, return receipt requested, or personally serve upon such 2468 person, a notice which shall include: (1) A short and plain statement of 2469 the matters asserted or charged; (2) a statement of the maximum civil 2470 penalty which may be imposed for such violation; and (3) a statement 2471 of the party's right to request a hearing, which such request shall 2472 submitted in writing to the commissioner not later than ten days after 2473 the notice is mailed or served. 2474 (h) If such person so requests, the commissioner shall cause a hearing 2475 to be held, in accordance with the provisions of chapter 54. If such 2476 Raised Bill No. 6666 LCO No. 5823 78 of 89 person fails to request a hearing or fails to appear at the hearing or if, 2477 after the hearing, the commissioner finds that the person has committed 2478 such violation, the commissioner may, in his or her discretion, order that 2479 a civil penalty be imposed that is not greater than the penalty stated in 2480 the notice. The commissioner shall send a copy of any order issued 2481 pursuant to this subsection by certified mail, return receipt requested, 2482 to the person named in such order. 2483 (i) No provision of this section shall be deemed to supersede section 2484 19a-584. 2485 Sec. 67. Section 19a-490w of the general statutes is repealed and the 2486 following is substituted in lieu thereof (Effective October 1, 2021): 2487 (a) Not later than October 1, 2017, and annually thereafter, any 2488 hospital that has been certified as a comprehensive stroke center, a 2489 primary stroke center, a thrombectomy-capable stroke center or an 2490 acute stroke-ready hospital by the American Heart Association, the Joint 2491 Commission or any other nationally recognized certifying organization 2492 shall submit an attestation of such certification to the Commissioner of 2493 Public Health, in a form and manner prescribed by the commissioner. 2494 Not later than October 15, 2017, and annually thereafter, the Department 2495 of Public Health shall post a list of certified stroke centers on its Internet 2496 web site. 2497 (b) The department may remove a hospital from the list posted 2498 pursuant to subsection (a) of this section if (1) the hospital requests such 2499 removal, (2) the department is informed by the American Heart 2500 Association, the Joint Commission or other nationally recognized 2501 certifying organization that a hospital's certification has expired or been 2502 suspended or revoked, or (3) the department does not receive attestation 2503 of certification from a hospital on or before October first. The 2504 department shall report to the nationally recognized certifying 2505 organization any complaint it receives related to the certification of a 2506 hospital as a comprehensive stroke center, a primary stroke center, a 2507 thrombectomy-capable stroke center or an acute stroke-ready hospital. 2508 Raised Bill No. 6666 LCO No. 5823 79 of 89 The department shall provide the complainant with the name and 2509 contact information of the nationally recognized certifying organization 2510 if the complainant seeks to pursue a complaint with such organization. 2511 Sec. 68. (NEW) (Effective October 1, 2021) (a) The Department of Public 2512 Health shall maintain and operate a state-wide stroke registry. Said 2513 registry shall use the American Heart Association's Get With The 2514 Guidelines–Stroke program's data set platform and include information 2515 and data on stroke care in the state that align with the stroke consensus 2516 metrics developed and approved by the American Heart Association 2517 and American Stroke Association. 2518 (b) On and after January 1, 2022, each comprehensive stroke center, 2519 thrombectomy-capable stroke center, primary stroke center or acute 2520 stroke-ready hospital shall, on a quarterly basis, submit to the 2521 Department of Public Health data concerning stroke care that are 2522 necessary for including in the state-wide stroke registry, as determined 2523 by the Commissioner of Public Health, and that, at a minimum, align 2524 with the stroke consensus metrics developed and approved by the 2525 American Heart Association and American Stroke Association. 2526 (c) The Department of Public Health shall be provided access to 2527 records of any comprehensive stroke center, thrombectomy-capable 2528 stroke center, primary stroke center or acute stroke-ready hospital, as 2529 the department deems necessary, to perform case finding or other 2530 quality improvement audits to ensure completeness of reporting and 2531 data accuracy consistent with the purposes of this section. 2532 (d) The Department of Public Health may enter into a contract for the 2533 receipt, storage, holding or maintenance of the data or files under its 2534 control and management. 2535 (e) The Department of Public Health may enter into reciprocal 2536 reporting agreements with the appropriate agencies of other states to 2537 exchange stroke care data. 2538 (f) (1) Failure by a comprehensive stroke center, thrombectomy- 2539 Raised Bill No. 6666 LCO No. 5823 80 of 89 capable stroke center, primary stroke center or acute stroke-ready 2540 hospital to comply with the reporting requirements prescribed in this 2541 section may result in the department electing to perform the registry 2542 services for such comprehensive stroke center, thrombectomy-capable 2543 stroke center, primary stroke center or acute stroke-ready hospital. In 2544 such case, the comprehensive stroke center, thrombectomy-capable 2545 stroke center, primary stroke center or acute stroke-ready hospital shall 2546 reimburse the department for actual expenses incurred in performing 2547 such services. 2548 (2) Any comprehensive stroke center, thrombectomy-capable stroke 2549 center, primary stroke center or acute stroke-ready hospital that fails to 2550 comply with the provisions of this section shall be liable for a civil 2551 penalty not to exceed five hundred dollars for each failure to disclose a 2552 stroke care data, as determined by the commissioner. 2553 (3) The reimbursements, expenses and civil penalties set forth in this 2554 section shall be assessed only after the Department of Public Health has 2555 provided a comprehensive stroke center, thrombectomy-capable stroke 2556 center, primary stroke center or acute stroke-ready hospital with written 2557 notice of deficiency and such comprehensive stroke center, 2558 thrombectomy-capable stroke center, primary stroke center or acute 2559 stroke-ready hospital has been afforded not less than fourteen business 2560 days after the date of receiving such notice to provide a written response 2561 to the department. Such written response shall include any information 2562 requested by the department. 2563 (g) The Commissioner of Public Health may request that the Attorney 2564 General initiate an action to collect any civil penalties assessed pursuant 2565 to this section and obtain such orders as necessary to enforce any 2566 provision of this section. 2567 (h) Not later than January 1, 2022, the Department of Public Health, 2568 in consultation with the State of Connecticut Stroke Advisory Council, 2569 shall establish a stroke registry data oversight committee. Such 2570 committee shall monitor the operations of the state-wide stroke registry, 2571 Raised Bill No. 6666 LCO No. 5823 81 of 89 provide advice regarding the oversight of such registry, develop a plan 2572 to improve quality of stroke care and address disparities in the 2573 provision of such care and develop short and long-term goals for 2574 improvement of stroke care in comprehensive stroke centers, 2575 thrombectomy-capable stroke centers, primary stroke centers and acute 2576 stroke-ready hospitals. 2577 (i) The Commissioner of Public Health may adopt regulations, in 2578 accordance with the provisions of chapter 54 of the general statutes, to 2579 implement the provisions of this section. 2580 Sec. 69. Subsection (k) of section 19a-180 of the general statutes is 2581 repealed and the following is substituted in lieu thereof (Effective from 2582 passage): 2583 (k) Notwithstanding the provisions of subsection (a) of this section, 2584 any [volunteer, hospital-based or municipal ambulance service] 2585 emergency medical services organization that is licensed or certified and 2586 a primary service area responder may apply to the commissioner, on a 2587 short form application prescribed by the commissioner, to change the 2588 address of a principal or branch location or to add a branch location 2589 within its primary service area. Upon making such application, the 2590 applicant shall notify in writing all other primary service area 2591 responders in any municipality or abutting municipality in which the 2592 applicant proposes to change principal or branch locations. Unless a 2593 primary service area responder entitled to receive notification of such 2594 application objects, in writing, to the commissioner and requests a 2595 hearing on such application not later than fifteen calendar days after 2596 receiving such notice, the application shall be deemed approved thirty 2597 calendar days after filing. If any such primary service area responder 2598 files an objection with the commissioner within the fifteen-calendar-day 2599 time period and requests a hearing, the applicant shall be required to 2600 demonstrate need to change the address of a principal or branch 2601 location within its primary service area at a public hearing as required 2602 under subsection (a) of this section. 2603 Raised Bill No. 6666 LCO No. 5823 82 of 89 Sec. 70. Section 7-36 of the general statutes is repealed and the 2604 following is substituted in lieu thereof (Effective July 1, 2021): 2605 As used in this chapter and sections 19a-40 to 19a-45, inclusive, unless 2606 the context otherwise requires: 2607 (1) "Registrar of vital statistics" or "registrar" means the registrar of 2608 births, marriages, deaths and fetal deaths or any public official charged 2609 with the care of returns relating to vital statistics; 2610 (2) "Registration" means the process by which vital records are 2611 completed, filed and incorporated into the official records of the 2612 department; 2613 (3) "Institution" means any public or private facility that provides 2614 inpatient medical, surgical or diagnostic care or treatment, or nursing, 2615 custodial or domiciliary care, or to which persons are committed by law; 2616 (4) "Vital records" means a certificate of birth, death, fetal death or 2617 marriage; 2618 (5) "Certified copy" means a copy of a birth, death, fetal death or 2619 marriage certificate that (A) includes all information on the certificate 2620 except such information that is nondisclosable by law, (B) is issued or 2621 transmitted by any registrar of vital statistics, (C) includes an attested 2622 signature and the raised seal of an authorized person, and (D) if 2623 submitted to the department, includes all information required by the 2624 commissioner; 2625 (6) "Uncertified copy" means a copy of a birth, death, fetal death or 2626 marriage certificate that includes all information contained in a certified 2627 copy except an original attested signature and a raised seal of an 2628 authorized person; 2629 (7) "Authenticate" or "authenticated" means to affix to a vital record 2630 in paper format the official seal, or to affix to a vital record in electronic 2631 format the user identification, password, or other means of electronic 2632 identification, as approved by the department, of the creator of the vital 2633 Raised Bill No. 6666 LCO No. 5823 83 of 89 record, or the creator's designee, by which affixing the creator of such 2634 paper or electronic vital record, or the creator's designee, affirms the 2635 integrity of such vital record; 2636 (8) "Attest" means to verify a vital record in accordance with the 2637 provisions of subdivision (5) of this section; 2638 (9) "Correction" means to change or enter new information on a 2639 certificate of birth, marriage, death or fetal death, within one year of the 2640 date of the vital event recorded in such certificate, in order to accurately 2641 reflect the facts existing at the time of the recording of such vital event, 2642 where such changes or entries are to correct errors on such certificate 2643 due to inaccurate or incomplete information provided by the informant 2644 at the time the certificate was prepared, or to correct transcribing, 2645 typographical or clerical errors; 2646 (10) "Amendment" means to (A) change or enter new information on 2647 a certificate of birth, marriage, death or fetal death, more than one year 2648 after the date of the vital event recorded in such certificate, in order to 2649 accurately reflect the facts existing at the time of the recording of the 2650 event, (B) create a replacement certificate of birth for matters pertaining 2651 to parentage and gender change, or (C) reflect a legal name change in 2652 accordance with section 19a-42 or make a modification to a cause of 2653 death; 2654 (11) "Acknowledgment of paternity" means to legally acknowledge 2655 paternity of a child pursuant to section 46b-172; 2656 (12) "Adjudication of paternity" means to legally establish paternity 2657 through an order of a court of competent jurisdiction; 2658 (13) "Parentage" includes matters relating to adoption, gestational 2659 agreements, paternity and maternity; 2660 (14) "Department" means the Department of Public Health; 2661 (15) "Commissioner" means the Commissioner of Public Health or the 2662 commissioner's designee; 2663 Raised Bill No. 6666 LCO No. 5823 84 of 89 (16) "Gestational agreement" means a written agreement for assisted 2664 reproduction in which a woman agrees to carry a child to birth for an 2665 intended parent or intended parents, which woman contributed no 2666 genetic material to the child and which agreement (A) names each party 2667 to the agreement and indicates each party's respective obligations under 2668 the agreement, (B) is signed by each party to the agreement and the 2669 spouse of each such party, if any, and (C) is witnessed by at least two 2670 disinterested adults and acknowledged in the manner prescribed by 2671 law; 2672 (17) "Intended parent" means a party to a gestational agreement who 2673 agrees, under the gestational agreement, to be the parent of a child born 2674 to a woman by means of assisted reproduction, regardless of whether 2675 the party has a genetic relationship to the child; 2676 (18) "Foundling" means (A) a child of unknown parentage, or (B) an 2677 infant voluntarily surrendered pursuant to the provisions of section 17a- 2678 58; [and] 2679 (19) "Certified homeless youth" means a person who is at least fifteen 2680 years of age but less than eighteen years of age, is not in the physical 2681 custody of a parent or legal guardian, who is a homeless child or youth, 2682 as defined in 42 USC 11434a, as amended from time to time, and who 2683 has been certified as homeless by (A) a school district homeless liaison, 2684 (B) the director of an emergency shelter program funded by the United 2685 States Department of Housing and Urban Development, or the 2686 director's designee, [or] (C) the director of a runaway or homeless youth 2687 basic center or transitional living program funded by the United States 2688 Department of Health and Human Services, or the director's designee, 2689 or (D) the director of a program of a nonprofit organization or 2690 municipality that is contracted with the homeless youth program 2691 established pursuant to section 17a-62a; and 2692 (20) "Certified homeless young adult" means a person who is at least 2693 eighteen years of age but less than twenty-five years of age who has 2694 been certified as homeless by (A) a school district homeless liaison, (B) 2695 Raised Bill No. 6666 LCO No. 5823 85 of 89 the director of an emergency shelter program funded by the United 2696 States Department of Housing and Urban Development, or the 2697 director's designee, (C) the director of a runaway or homeless youth 2698 basic center or transitional living program funded by the United States 2699 Department of Health and Human Services, or the director's designee, 2700 or (D) the director of a program of a nonprofit organization or 2701 municipality that is contracted with the homeless youth program 2702 established pursuant to section 17a-62a. 2703 Sec. 71. Subsection (c) of section 7-51 of the general statutes is 2704 repealed and the following is substituted in lieu thereof (Effective July 1, 2705 2021): 2706 (c) (1) The registrar of the town in which the birth or fetal death 2707 occurred or of the town in which the mother resided at the time of the 2708 birth or fetal death, or the department, may issue a certified copy of the 2709 certificate of birth or fetal death of any person born in this state that is 2710 kept in paper form in the custody of the registrar. Except as provided in 2711 subdivision (2) of this subsection, such certificate shall be issued upon 2712 the written request of an eligible party listed in subsection (a) of this 2713 section. Any registrar of vital statistics in this state with access, as 2714 authorized by the department, to the electronic vital records system of 2715 the department may issue a certified copy of the electronically filed 2716 certificate of birth or fetal death of any person born in this state upon 2717 the written request of an eligible party listed in subsection (a) of this 2718 section. The registrar and the department may waive the fee for the 2719 issuance of a certified copy of the certificate of birth of a certified 2720 homeless young adult to such young adult under this subsection. 2721 (2) In the case of a certified homeless youth, such certified homeless 2722 youth and the person who is certifying the certified homeless youth as 2723 homeless, as described in section 7-36, as amended by this act, shall 2724 appear in person when the certified homeless youth is presenting the 2725 written request described in subdivision (1) of this subsection at (A) the 2726 office of the registrar of the town in which the certified homeless youth 2727 was born, (B) the office of the registrar of the town in which the mother 2728 Raised Bill No. 6666 LCO No. 5823 86 of 89 of the certified homeless youth resided at the time of the birth, (C) if the 2729 birth certificate of the certified homeless youth has been electronically 2730 filed, any registrar of vital statistics in the state with access, as 2731 authorized by the department, to the electronic vital records system, or 2732 (D) the state vital records office of the department. The certified 2733 homeless youth shall present to the registrar or the department 2734 information sufficient to identify himself or herself as may be required 2735 by regulations adopted by the commissioner pursuant to section 7-41. 2736 The person who is certifying the certified homeless youth as homeless 2737 shall present to the registrar or the department information sufficient to 2738 identify himself or herself as meeting the certification requirements of 2739 section 7-36, as amended by this act. The registrar and the department 2740 may waive the fee for the issuance of a certified copy of the certificate of 2741 birth of a homeless youth to such youth under this subsection. 2742 Sec. 72. Subsection (a) of section 1-1h of the general statutes is 2743 repealed and the following is substituted in lieu thereof (Effective July 1, 2744 2021): 2745 (a) Any person who does not possess a valid motor vehicle operator's 2746 license may apply to the Department of Motor Vehicles for an identity 2747 card. The application for an identity card shall be accompanied by the 2748 birth certificate of the applicant or a certificate of identification of the 2749 applicant issued and authorized for such use by the Department of 2750 Correction and a fee of twenty-eight dollars. Such application shall 2751 include: (1) The applicant's name; (2) the applicant's address; (3) 2752 whether the address is permanent or temporary; (4) the applicant's date 2753 of birth; (5) notice to the applicant that false statements on such 2754 application are punishable under section 53a-157b; and (6) such other 2755 pertinent information as the Commissioner of Motor Vehicles deems 2756 necessary. The applicant shall sign the application in the presence of an 2757 official of the Department of Motor Vehicles. The commissioner may 2758 waive the fee for any applicant (A) who has voluntarily surrendered 2759 such applicant's motor vehicle operator's license, (B) whose license has 2760 been refused by the commissioner pursuant to subdivision (4) of 2761 subsection (e) of section 14-36, (C) who is both a veteran, as defined in 2762 Raised Bill No. 6666 LCO No. 5823 87 of 89 subsection (a) of section 27-103, and blind, as defined in subsection (a) 2763 of section 1-1f, or (D) who is a resident of a homeless shelter or other 2764 facility for homeless persons or a certified homeless youth or certified 2765 homeless young adult. The commissioner shall adopt regulations, in 2766 accordance with the provisions of chapter 54, to establish the procedure 2767 and qualifications for the issuance of an identity card to any such 2768 homeless applicant. For the purposes of this subsection, "certified 2769 homeless youth" and "certified homeless young adult" have the same 2770 meanings as provided in section 7-36, as amended by this act. 2771 Sec. 73. Section 20-226 of the general statutes is repealed. (Effective 2772 from passage) 2773 This act shall take effect as follows and shall amend the following sections: Section 1 October 1, 2021 PA 19-117, Sec. 73 Sec. 2 October 1, 2021 25-33(b) Sec. 3 October 1, 2021 8-3i Sec. 4 October 1, 2021 22a-42f Sec. 5 October 1, 2021 19a-111 Sec. 6 October 1, 2021 19a-37 Sec. 7 October 1, 2021 19a-524 Sec. 8 July 1, 2021 19a-491c(c)(2) Sec. 9 October 1, 2021 19a-177 Sec. 10 October 1, 2021 20-207 Sec. 11 October 1, 2021 20-212 Sec. 12 October 1, 2021 20-213(a) and (b) Sec. 13 October 1, 2021 20-215 Sec. 14 October 1, 2021 20-217(a) Sec. 15 October 1, 2021 20-224 Sec. 16 October 1, 2021 20-195dd Sec. 17 October 1, 2021 20-195c(a) Sec. 18 October 1, 2021 19a-14(a)(12) Sec. 19 October 1, 2021 20-204a(a) to (c) Sec. 20 January 1, 2022 7-62b(b) and (c) Sec. 21 July 1, 2021 19a-200 Sec. 22 July 1, 2021 19a-202a Sec. 23 July 1, 2021 19a-244 Raised Bill No. 6666 LCO No. 5823 88 of 89 Sec. 24 July 1, 2021 19a-12a(a)(3) Sec. 25 July 1, 2021 19a-12d Sec. 26 October 1, 2021 19a-12e(a) Sec. 27 from passage 20-185k(b) Sec. 28 October 1, 2021 17a-412(a) Sec. 29 October 1, 2021 17b-451(a) Sec. 30 July 1, 2021 19a-6o Sec. 31 from passage 19a-6q Sec. 32 July 1, 2021 19a-493(b) Sec. 33 July 1, 2021 New section Sec. 34 October 1, 2021 19a-343(c) Sec. 35 from passage 19a-131g Sec. 36 July 1, 2021 19a-30(d) Sec. 37 July 1, 2021 20-365(b) Sec. 38 from passage 20-195u(b) Sec. 39 from passage 20-265h(a) Sec. 40 from passage 19a-131j(a) Sec. 41 July 1, 2021 19a-512(a) Sec. 42 July 1, 2021 19a-490 Sec. 43 July 1, 2021 19a-491(b) to (i) Sec. 44 July 1, 2021 19a-491c(a)(4) Sec. 45 July 1, 2021 19a-492b Sec. 46 July 1, 2021 19a-492c(b) Sec. 47 July 1, 2021 19a-492d Sec. 48 July 1, 2021 19a-492e Sec. 49 July 1, 2021 19a-496a Sec. 50 July 1, 2021 19a-504d Sec. 51 July 1, 2021 New section Sec. 52 July 1, 2021 19a-522f Sec. 53 July 1, 2021 New section Sec. 54 July 1, 2021 19a-521b Sec. 55 October 1, 2021 19a-195 Sec. 56 from passage 20-206jj Sec. 57 from passage 20-206mm(f) Sec. 58 from passage 19a-178a(b) Sec. 59 from passage 19a-36h(a) Sec. 60 from passage 19a-36j(a) Sec. 61 from passage 19a-36o Sec. 62 October 1, 2021 19a-332(5) Sec. 63 from passage 20-250(4) Sec. 64 July 1, 2021 20-265b(b) Raised Bill No. 6666 LCO No. 5823 89 of 89 Sec. 65 July 1, 2021 10-206(f) Sec. 66 from passage 19a-215(b) to (f) Sec. 67 October 1, 2021 19a-490w Sec. 68 October 1, 2021 New section Sec. 69 from passage 19a-180(k) Sec. 70 July 1, 2021 7-36 Sec. 71 July 1, 2021 7-51(c) Sec. 72 July 1, 2021 1-1h(a) Sec. 73 from passage Repealer section Statement of Purpose: To implement the recommendations of the Department of Public Health regarding various revisions to the public health statutes. [Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline, except that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is not underlined.]

Substitute House Bill No. 6666 Public Act No. 21-121 AN ACT CONCERNING THE DEPARTMENT OF PUBLIC HEALTH'S RECOMMENDATIONS REGARDING VARIOUS REVISIONS TO THE PUBLIC HEALTH STATUTES. Be it enacted by the Senate and House of Representatives in General Assembly convened: Section 1. Section 73 of public act 19-117 is repealed and the following is substituted in lieu thereof (Effective October 1, 2021): Notwithstanding any provision of title 19a or 25 of the general statutes, [and not later than March 1, 2020,] a director of health of a town, city or borough or of a district department of health appointed pursuant to section 19a-200, as amended by this act, or 19a-242 of the general statutes may issue a permit for a replacement public well if the Department of Public Health has approved such replacement public well pursuant to subsection (b) of section 25-33 of the general statutes, as amended by this act. For purposes of this section, "replacement public well" means a public well that (1) replaces an existing public well, [in a town in southeastern Connecticut with a population between fifteen thousand and fifteen thousand three hundred, as enumerated by the 2010 federal decennial census,] and (2) does not meet the sanitary radius and minimum setback requirements as specified in the regulations of Connecticut State Agencies. Substitute House Bill No. 6666 Public Act No. 21-121 2 of 132 Sec. 2. Subsection (b) of section 25-33 of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2021): (b) No system of water supply owned or used by a water company shall be constructed or expanded or a new additional source of water supply utilized until the plans therefor have been submitted to and reviewed and approved by the department, except that no such prior review or approval is required for distribution water main installations that are constructed in accordance with sound engineering standards and all applicable laws and regulations. A plan for any proposed new source of water supply submitted to the department pursuant to this subsection shall include documentation that provides for: (1) A brief description of potential effects that the proposed new source of water supply may have on nearby water supply systems including public and private wells; and (2) the water company's ownership or control of the proposed new source of water supply's sanitary radius and minimum setback requirements as specified in the regulations of Connecticut state agencies and that such ownership or control shall continue to be maintained as specified in such regulations. If the department determines, based upon documentation provided, that the water company does not own or control the proposed new source of water supply's sanitary radius or minimum setback requirements as specified in the regulations of Connecticut state agencies, the department shall require the water company proposing a new source of water supply to supply additional documentation to the department that adequately demonstrates the alternative methods that will be utilized to assure the proposed new source of water supply's long-term purity and adequacy. In reviewing any plan for a proposed new source of water supply, the department shall consider the issues specified in this subsection. The Commissioner of Public Health may adopt regulations, in accordance with the provisions of chapter 54, to carry out the provisions of this subsection and subsection (c) of this section. For purposes of this Substitute House Bill No. 6666 Public Act No. 21-121 3 of 132 subsection and subsection (c) of this section, "distribution water main installations" means installations, extensions, replacements or repairs of public water supply system mains from which water is or will be delivered to one or more service connections and which do not require construction or expansion of pumping stations, storage facilities, treatment facilities or sources of supply. Notwithstanding the provisions of this subsection, the department may approve any location of a replacement public well, if such replacement public well is (A) necessary for the water company to maintain and provide to its consumers a safe and adequate water supply, (B) located in an aquifer of adequate water quality determined by historical water quality data from the source of water supply it is replacing, and (C) in a more protected location when compared to the source of water supply it is replacing, as determined by the department. For purposes of this subsection, "replacement public well" means a public well that (i) replaces an existing public well, [in a town in southeastern Connecticut with a population between fifteen thousand and fifteen thousand three hundred, as enumerated by the 2010, federal decennial census,] and (ii) does not meet the sanitary radius and minimum setback requirements as specified in the regulations of Connecticut state agencies. Sec. 3. Section 8-3i of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2021): (a) As used in this section "water company" means a water company, as defined in section 25-32a, and "petition" includes a petition or proposal to change the regulations, boundaries or classifications of zoning districts. (b) When an application, petition, request or plan is filed with the zoning commission, planning and zoning commission or zoning board of appeals of any municipality concerning any project on any site that is within the aquifer protection area delineated pursuant to section 22a- 354c or the watershed of a water company, the applicant or the person Substitute House Bill No. 6666 Public Act No. 21-121 4 of 132 making the filing shall: [provide] (1) Provide written notice of the application, petition, request or plan to the water company and the [Commissioner of Public Health in a format prescribed by said commissioner, provided such water company or said commissioner has filed a map showing the boundaries of the watershed on the land records of the municipality in which the application, petition, request or plan is made and with the planning commission, zoning commission, planning and zoning commission or zoning board of appeals of such municipality or the aquifer protection area has been delineated in accordance with section 22a-354c, as the case may be] Department of Public Health; and (2) determine if the project is within the watershed of a water company by consulting the maps posted on the department's Internet web site showing the boundaries of the watershed. Such [notice shall be made] applicant shall send such notice to the water company by certified mail, return receipt requested, and to the department by electronic mail to the electronic mail address designated on its Internet web site for receipt of such notice. Such applicant shall [be mailed] mail such notice not later than seven days after the date of the application. Such water company and the Commissioner of Public Health may, through a representative, appear and be heard at any hearing on any such application, petition, request or plan. (c) Notwithstanding the provisions of subsection (b) of this section, when an agent of the zoning commission, planning and zoning commission or zoning board of appeals is authorized to approve an application, petition, request or plan concerning any site that is within the aquifer protection area delineated pursuant to section 22a-354c or the watershed of a water company without the approval of the zoning commission, planning and zoning commission or zoning board of appeals, and such agent determines that the proposed activity will not adversely affect the public water supply, the applicant or person making the filing shall not be required to notify the water company or the [Commissioner] Department of Public Health. Substitute House Bill No. 6666 Public Act No. 21-121 5 of 132 Sec. 4. Section 22a-42f of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2021): When an application is filed to conduct or cause to be conducted a regulated activity upon an inland wetland or watercourse, any portion of which is within the watershed of a water company as defined in section 25-32a, the applicant shall: [provide] (1) Provide written notice of the application to the water company and the [Commissioner of Public Health in a format prescribed by said commissioner, provided such water company or said commissioner has filed a map showing the boundaries of the watershed on the land records of the municipality in which the application is made and with the inland wetlands agency of such municipality] Department of Public Health; and (2) determine if the project is within the watershed of a water company by consulting the maps posted on the department's Internet web site showing the boundaries of the watershed. Such [notice shall be made] applicant shall send such notice to the water company by certified mail, return receipt requested, and to the department by electronic mail to the electronic mail address designated by the department on its Internet web site for receipt of such notice. Such applicant shall [be mailed] mail such notice not later than seven days after the date of the application. The water company and the Commissioner of Public Health, through a representative, may appear and be heard at any hearing on the application. Sec. 5. Section 19a-111 of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2021): Upon receipt of each report of confirmed venous blood lead level equal to or greater than twenty micrograms per deciliter of blood, the local director of health shall make or cause to be made an epidemiological investigation of the source of the lead causing the increased lead level or abnormal body burden and shall order action to be taken by the appropriate person responsible for the condition that Substitute House Bill No. 6666 Public Act No. 21-121 6 of 132 brought about such lead poisoning as may be necessary to prevent further exposure of persons to such poisoning. In the case of any residential unit where such action will not result in removal of the hazard within a reasonable time, the local director of health shall utilize such community resources as are available to effect relocation of any family occupying such unit. The local director of health may permit occupancy in said residential unit during abatement if, in such director's judgment, occupancy would not threaten the health and well-being of the occupants. The local director of health shall, not later than thirty days after the conclusion of such director's investigation, report to the Commissioner of Public Health, using a web-based surveillance system as prescribed by the commissioner, the result of such investigation and the action taken to ensure against further lead poisoning from the same source, including any measures taken to effect relocation of families. Such report shall include information relevant to the identification and location of the source of lead poisoning and such other information as the commissioner may require pursuant to regulations adopted in accordance with the provisions of chapter 54. The commissioner shall maintain comprehensive records of all reports submitted pursuant to this section and section 19a-110. Such records shall be geographically indexed in order to determine the location of areas of relatively high incidence of lead poisoning. The commissioner shall establish, in conjunction with recognized professional medical groups, guidelines consistent with the National Centers for Disease Control and Prevention for assessment of the risk of lead poisoning, screening for lead poisoning and treatment and follow-up care of individuals including children with lead poisoning, women who are pregnant and women who are planning pregnancy. Nothing in this section shall be construed to prohibit a local building official from requiring abatement of sources of lead. Sec. 6. Section 19a-37 of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2021): Substitute House Bill No. 6666 Public Act No. 21-121 7 of 132 (a) As used in this section: (1) "Laboratory or firm" means an environmental laboratory registered by the Department of Public Health pursuant to section 19a- 29a; (2) "Private well" means a water supply well that meets all of the following criteria: (A) Is not a public well; (B) supplies a residential population of less than twenty-five persons per day; and (C) is owned or controlled through an easement or by the same entity that owns or controls the building or parcel that is served by the water supply well; (3) "Public well" means a water supply well that supplies a public water system; (4) "Semipublic well" means a water supply well that (A) does not meet the definition of a private well or public well, and (B) provides water for drinking and other domestic purposes; and (5) "Water supply well" means an artificial excavation constructed by any method for the purpose of obtaining or providing water for drinking or other domestic, industrial, commercial, agricultural, recreational or irrigation use, or other outdoor water use. (b) The Commissioner of Public Health may adopt regulations in the [Public Health Code] regulations of Connecticut state agencies for the preservation of the public health pertaining to (1) protection and location of new water supply wells or springs for residential or nonresidential construction or for public or semipublic use, and (2) inspection for compliance with the provisions of municipal regulations adopted pursuant to section 22a-354p. (c) The Commissioner of Public Health shall adopt regulations, in accordance with chapter 54, for the testing of water quality in private [residential] wells and semipublic wells. Any laboratory or firm which Substitute House Bill No. 6666 Public Act No. 21-121 8 of 132 conducts a water quality test on a private well serving a residential property or semipublic well shall, not later than thirty days after the completion of such test, report the results of such test to (1) the public health authority of the municipality where the property is located, and (2) the Department of Public Health in a format specified by the department, provided such report shall only be required if the party for whom the laboratory or firm conducted such test informs the laboratory or firm identified on the chain of custody documentation submitted with the test samples that the test was conducted in connection with the sale of such property. No regulation may require such a test to be conducted as a consequence or a condition of the sale, exchange, transfer, purchase or rental of the real property on which the private [residential] well or semipublic well is located. (d) Prior to the sale, exchange, purchase, transfer or rental of real property on which a [residential] private or semipublic well is located, the owner shall provide the buyer or tenant notice that educational material concerning private well testing is available on the Department of Public Health web site. Failure to provide such notice shall not invalidate any sale, exchange, purchase, transfer or rental of real property. If the seller or landlord provides such notice in writing, the seller or landlord and any real estate licensee shall be deemed to have fully satisfied any duty to notify the buyer or tenant that the subject real property is located in an area for which there are reasonable grounds for testing under subsection (g) or (j) of this section. (e) The Commissioner of Public Health shall adopt regulations, in accordance with chapter 54, to clarify the criteria under which the commissioner may issue a well permit exception and to describe the terms and conditions that shall be imposed when a well is allowed at a premises (1) that is connected to a public water supply system, or (2) whose boundary is located within two hundred feet of an approved community water supply system, measured along a street, alley or Substitute House Bill No. 6666 Public Act No. 21-121 9 of 132 easement. Such regulations shall (A) provide for notification of the permit to the public water supplier, (B) address the quality of the water supplied from the well, the means and extent to which the well shall not be interconnected with the public water supply, the need for a physical separation, and the installation of a reduced pressure device for backflow prevention, the inspection and testing requirements of any such reduced pressure device, and (C) identify the extent and frequency of water quality testing required for the well supply. (f) No regulation may require that a certificate of occupancy for a dwelling unit on such residential property be withheld or revoked on the basis of a water quality test performed on a private [residential] well pursuant to this section, unless such test results indicate that any maximum contaminant level applicable to public water supply systems for any contaminant listed in the [public health code] regulations of Connecticut state agencies has been exceeded. No administrative agency, health district or municipal health officer may withhold or cause to be withheld such a certificate of occupancy except as provided in this section. (g) The local director of health may require a private [residential] well or semipublic well to be tested for arsenic, radium, uranium, radon or gross alpha emitters, when there are reasonable grounds to suspect that such contaminants are present in the groundwater. For purposes of this subsection, "reasonable grounds" means (1) the existence of a geological area known to have naturally occurring arsenic, radium, uranium, radon or gross alpha emitter deposits in the bedrock; or (2) the well is located in an area in which it is known that arsenic, radium, uranium, radon or gross alpha emitters are present in the groundwater. (h) Except as provided in subsection (i) of this section, the collection of samples for determining the water quality of private [residential] wells and semipublic wells may be made only by (1) employees of a laboratory or firm certified or approved by the Department of Public Substitute House Bill No. 6666 Public Act No. 21-121 10 of 132 Health to test drinking water, if such employees have been trained in sample collection techniques, (2) certified water operators, (3) local health departments and state employees trained in sample collection techniques, or (4) individuals with training and experience that the Department of Public Health deems sufficient. (i) Any owner of a residential construction, including, but not limited to, a homeowner, on which a private [residential] well is located or any general contractor of a new residential construction on which a private [residential] well is located may collect samples of well water for submission to a laboratory or firm for the purposes of testing water quality pursuant to this section, provided (1) such laboratory or firm has provided instructions to said owner or general contractor on how to collect such samples, and (2) such owner or general contractor is identified to the subsequent owner on a form to be prescribed by the Department of Public Health. No regulation may prohibit or impede such collection or analysis. (j) The local director of health may require private [residential] wells and semipublic wells to be tested for pesticides, herbicides or organic chemicals when there are reasonable grounds to suspect that any such contaminants might be present in the groundwater. For purposes of this subsection, "reasonable grounds" means (1) the presence of nitrate- nitrogen in the groundwater at a concentration greater than ten milligrams per liter, or (2) that the private [residential] well or semipublic well is located on land, or in proximity to land, associated with the past or present production, storage, use or disposal of organic chemicals as identified in any public record. (k) Any water transported in bulk by any means to a premises currently supplied by a private well or semipublic well where the water is to be used for purposes of drinking or domestic use shall be provided by a bulk water hauler licensed pursuant to section 20-278h. No bulk water hauler shall deliver water without first notifying the owner of the Substitute House Bill No. 6666 Public Act No. 21-121 11 of 132 premises of such delivery. Bulk water hauling to a premises currently supplied by a private well or semipublic well shall be permitted only as a temporary measure to alleviate a water supply shortage. Sec. 7. (NEW) (Effective October 1, 2021) The owner of any residential or commercial property shall notify each tenant of any leased or rented unit located on such property and the lessee of such property whenever any testing of the water supply for such property indicates that the water exceeds a maximum contaminant level applicable to water supply systems for any contaminant listed in the regulations of Connecticut state agencies or for any contaminant listed on the state drinking water action level list established pursuant to section 22a-471 of the general statutes. As soon as practicable, but not later than forty-eight hours after receiving notification of the results of such testing, the owner shall forward a copy of such notification to each such tenant and lessee. The local director of health shall take all reasonable steps to verify that such owner forwarded the notice required pursuant to this section. Sec. 8. Section 19a-524 of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2021): If, upon review, investigation or inspection pursuant to section 19a- 498, the Commissioner of Public Health determines that a nursing home facility or residential care home has violated any provision of section 17a-411, 19a-491a to 19a-491c, inclusive, as amended by this act, 19a- 493a, 19a-521 to 19a-529, inclusive, 19a-531 to 19a-551, inclusive, or 19a- 553 to 19a-555, inclusive, or any provision of any regulation of Connecticut state agencies relating to licensure, the Fire Safety Code or the operation or maintenance of a nursing home facility or residential care home, which violation has been classified in accordance with section 19a-527, the commissioner may immediately issue or cause to be issued a citation to the licensee of such nursing home facility or residential care home. Governmental immunity shall not be a defense to any citation issued or civil penalty imposed pursuant to this section or Substitute House Bill No. 6666 Public Act No. 21-121 12 of 132 sections 19-525 to 19a-528, inclusive. Each such citation shall be in writing, provide notice of the nature and scope of the alleged violation or violations, and include, but not be limited to, the citation and notice of noncompliance issued in accordance with section 19a-496. Each citation and notice of noncompliance issued under this section shall be sent to the licensee electronically in a form and manner prescribed by the commissioner or by certified mail [to the licensee] at the address of the nursing home facility or residential care home in issue. A copy of such citation and notice of noncompliance shall also be sent to the licensed administrator at the address of the nursing home facility or residential care home. Sec. 9. Subdivision (2) of subsection (c) of section 19a-491c of the general statutes is repealed and the following is substituted in lieu thereof (Effective July 1, 2021): (2) No long-term care facility shall be required to comply with the provisions of this subsection if (A) the individual provides evidence to the long-term care facility that such individual submitted to a background search conducted pursuant to subdivision (1) of this subsection not more than three years immediately preceding the date such individual applies for employment, seeks to enter into a contract or begins volunteering with the long-term care facility and that the prior background search confirmed that the individual did not have a disqualifying offense, or (B) the commissioner determines the need to temporarily suspend the requirements of this subsection in the event of an emergency or significant disruption. The commissioner shall inform the long-term care facility when the commissioner has suspended the requirements of this subsection pursuant to subparagraph (B) of this subdivision and when such suspension is rescinded. Sec. 10. Section 19a-177 of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2021): Substitute House Bill No. 6666 Public Act No. 21-121 13 of 132 The commissioner shall: (1) With the advice of the Office of Emergency Medical Services established pursuant to section 19a-178 and of an advisory committee on emergency medical services and with the benefit of meetings held pursuant to subsection (b) of section 19a-184, adopt every five years a state-wide plan for the coordinated delivery of emergency medical services; (2) License or certify the following: (A) Ambulance operations, [ambulance drivers,] emergency medical services personnel and communications personnel; (B) emergency room facilities and communications facilities; and (C) transportation equipment, including land, sea and air vehicles used for transportation of patients to emergency facilities and periodically inspect life saving equipment, emergency facilities and emergency transportation vehicles to ensure state standards are maintained; (3) Annually inventory emergency medical services resources within the state, including facilities, equipment, and personnel, for the purposes of determining the need for additional services and the effectiveness of existing services; (4) Review and evaluate all area-wide plans developed by the emergency medical services councils pursuant to section 19a-182 in order to insure conformity with standards issued by the commissioner; (5) Not later than thirty days after their receipt, review all grant and contract applications for federal or state funds concerning emergency medical services or related activities for conformity to policy guidelines and forward such application to the appropriate agency, when required; (6) Establish such minimum standards and adopt such regulations in accordance with the provisions of chapter 54, as may be necessary to develop the following components of an emergency medical service Substitute House Bill No. 6666 Public Act No. 21-121 14 of 132 system: (A) Communications, which shall include, but not be limited to, equipment, radio frequencies and operational procedures; (B) transportation services, which shall include, but not be limited to, vehicle type, design, condition and maintenance, and operational procedures; (C) training, which shall include, but not be limited to, emergency medical services personnel, communications personnel, paraprofessionals associated with emergency medical services, firefighters and state and local police; (D) emergency medical service facilities, which shall include, but not be limited to, categorization of emergency departments as to their treatment capabilities and ancillary services; and (E) mobile integrated health care programs, which shall include, but not be limited to, the standards to ensure the health, safety and welfare of the patients being served by such programs and data collection and reporting requirements to ensure and measure quality outcomes of such programs; (7) Coordinate training of all emergency medical services personnel; (8) (A) Develop an emergency medical services data collection system. Each emergency medical service organization licensed or certified pursuant to this chapter shall submit data to the commissioner, on a quarterly basis, from each licensed ambulance service, certified ambulance service or paramedic intercept service that provides emergency medical services. Such submitted data shall include, but not be limited to: (i) The total number of calls for emergency medical services received by such licensed ambulance service, certified ambulance service or paramedic intercept service through the 9-1-1 system during the reporting period; (ii) each level of emergency medical services, as defined in regulations adopted pursuant to section 19a-179, required for each such call; (iii) the response time for each licensed ambulance service, certified ambulance service or paramedic intercept service during the reporting period; (iv) the number of passed calls, cancelled calls and mutual aid calls, both made and received, during the Substitute House Bill No. 6666 Public Act No. 21-121 15 of 132 reporting period; and (v) for the reporting period, the prehospital data for the nonscheduled transport of patients required by regulations adopted pursuant to subdivision (6) of this section. The data required under this subdivision may be submitted in any electronic form selected by such licensed ambulance service, certified ambulance service or paramedic intercept service and approved by the commissioner, provided the commissioner shall take into consideration the needs of such licensed ambulance service, certified ambulance service or paramedic intercept service in approving such electronic form. The commissioner may conduct an audit of any such licensed ambulance service, certified ambulance service or paramedic intercept service as the commissioner deems necessary in order to verify the accuracy of such reported data. (B) On or before December 31, 2018, and annually thereafter, the commissioner shall prepare a report to the Emergency Medical Services Advisory Board, established pursuant to section 19a-178a, as amended by this act, that shall include, but not be limited to, the following data: (i) The total number of calls for emergency medical services received during the reporting year by each licensed ambulance service, certified ambulance service or paramedic intercept service; (ii) the level of emergency medical services required for each such call; (iii) the name of the emergency medical service organization that provided each such level of emergency medical services furnished during the reporting year; (iv) the response time, by time ranges or fractile response times, for each licensed ambulance service, certified ambulance service or paramedic intercept service, using a common definition of response time, as provided in regulations adopted pursuant to section 19a-179; and (v) the number of passed calls, cancelled calls and mutual aid calls during the reporting year. The commissioner shall prepare such report in a format that categorizes such data for each municipality in which the emergency medical services were provided, with each such municipality grouped according to urban, suburban and rural Substitute House Bill No. 6666 Public Act No. 21-121 16 of 132 classifications. (C) If any licensed ambulance service, certified ambulance service or paramedic intercept service does not submit the data required under subparagraph (A) of this subdivision for a period of six consecutive months, or if the commissioner believes that such licensed ambulance service, certified ambulance service or paramedic intercept service knowingly or intentionally submitted incomplete or false data, the commissioner shall issue a written order directing such licensed ambulance service, certified ambulance service or paramedic intercept service to comply with the provisions of subparagraph (A) of this subdivision and submit all missing data or such corrected data as the commissioner may require. If such licensed ambulance service, certified ambulance service or paramedic intercept service fails to fully comply with such order not later than three months from the date such order is issued, the commissioner (i) shall conduct a hearing, in accordance with chapter 54, at which such licensed ambulance service, certified ambulance service or paramedic intercept service shall be required to show cause why the primary service area assignment of such licensed ambulance service, certified ambulance service or paramedic intercept service should not be revoked, and (ii) may take such disciplinary action under section 19a-17 as the commissioner deems appropriate. (D) The commissioner shall collect the data required by subparagraph (A) of this subdivision, in the manner provided in said subparagraph, from each emergency medical service organization licensed or certified pursuant to this chapter. Any such emergency medical service organization that fails to comply with the provisions of this section shall be liable for a civil penalty not to exceed one hundred dollars per day for each failure to report the required data regarding emergency medical services provided to a patient, as determined by the commissioner. The civil penalties set forth in this subparagraph shall be assessed only after the department provides a written notice of Substitute House Bill No. 6666 Public Act No. 21-121 17 of 132 deficiency and the organization is afforded the opportunity to respond to such notice. An organization shall have not more than fifteen business days after the date of receiving such notice to provide a written response to the department. The commissioner may adopt regulations, in accordance with chapter 54, concerning the development, implementation, monitoring and collection of emergency medical service system data. All state agencies licensed or certified as emergency medical service organizations shall be exempt from the civil penalties set forth in this subparagraph. (E) The commissioner shall, with the recommendation of the Connecticut Emergency Medical Services Advisory Board established pursuant to section 19a-178a, as amended by this act, adopt for use in trauma data collection the most recent version of the National Trauma Data Bank's National Trauma Data Standards and Data Dictionary and nationally recognized guidelines for field triage of injured patients; (9) (A) Establish rates for the conveyance and treatment of patients by licensed ambulance services and invalid coaches and establish emergency service rates for certified ambulance services and paramedic intercept services, provided (i) the present rates established for such services and vehicles shall remain in effect until such time as the commissioner establishes a new rate schedule as provided in this subdivision, and (ii) any rate increase not in excess of the Medical Care Services Consumer Price Index, as published by the Bureau of Labor Statistics of the United States Department of Labor, for the prior year, filed in accordance with subparagraph (B)(iii) of this subdivision shall be deemed approved by the commissioner. For purposes of this subdivision, licensed ambulance services and paramedic intercept services shall not include emergency air transport services or mobile integrated health care programs. (B) Adopt regulations, in accordance with the provisions of chapter 54, establishing methods for setting rates and conditions for charging Substitute House Bill No. 6666 Public Act No. 21-121 18 of 132 such rates. Such regulations shall include, but not be limited to, provisions requiring that on and after July 1, 2000: (i) Requests for rate increases may be filed no more frequently than once a year, except that, in any case where an agency's schedule of maximum allowable rates falls below that of the Medicare allowable rates for that agency, the commissioner shall immediately amend such schedule so that the rates are at or above the Medicare allowable rates; (ii) only licensed ambulance services, certified ambulance services and paramedic intercept services that apply for a rate increase in excess of the Medical Care Services Consumer Price Index, as published by the Bureau of Labor Statistics of the United States Department of Labor, for the prior year, and do not accept the maximum allowable rates contained in any voluntary state-wide rate schedule established by the commissioner for the rate application year shall be required to file detailed financial information with the commissioner, provided any hearing that the commissioner may hold concerning such application shall be conducted as a contested case in accordance with chapter 54; (iii) licensed ambulance services, certified ambulance services and paramedic intercept services that do not apply for a rate increase in any year in excess of the Medical Care Services Consumer Price Index, as published by the Bureau of Labor Statistics of the United States Department of Labor, for the prior year, or that accept the maximum allowable rates contained in any voluntary state-wide rate schedule established by the commissioner for the rate application year shall, not later than the last business day in August of such year, file with the commissioner a statement of emergency and nonemergency call volume, and, in the case of a licensed ambulance service, certified ambulance service or paramedic intercept service that is not applying for a rate increase, a written declaration by such licensed ambulance service, certified ambulance service or paramedic intercept service that no change in its currently approved maximum allowable rates will occur for the rate application year; and (iv) detailed financial and operational information filed by licensed ambulance services, certified ambulance services and Substitute House Bill No. 6666 Public Act No. 21-121 19 of 132 paramedic intercept services to support a request for a rate increase in excess of the Medical Care Services Consumer Price Index, as published by the Bureau of Labor Statistics of the United States Department of Labor, for the prior year, shall cover the time period pertaining to the most recently completed fiscal year and the rate application year of the licensed ambulance service, certified ambulance service or paramedic intercept service. (C) Establish rates for licensed ambulance services, certified ambulance services or paramedic intercept services for the following services and conditions: (i) "Advanced life support assessment" and "specialty care transports", which terms have the meanings provided in 42 CFR 414.605; and (ii) mileage, which may include mileage for an ambulance transport when the point of origin and final destination for a transport is within the boundaries of the same municipality. The rates established by the commissioner for each such service or condition shall be equal to (I) the ambulance service's base rate plus its established advanced life support/paramedic surcharge when advanced life support assessment services are performed; (II) two hundred twenty- five per cent of the ambulance service's established base rate for specialty care transports; and (III) "loaded mileage", as the term is defined in 42 CFR 414.605, multiplied by the ambulance service's established rate for mileage. Such rates shall remain in effect until such time as the commissioner establishes a new rate schedule as provided in this subdivision. (D) Establish rates for the treatment and release of patients by a licensed or certified emergency medical services organization or a provider who does not transport such patients to an emergency department and who is operating within the scope of such organization's or provider's practice and following protocols approved by the sponsor hospital. The rates established pursuant to this subparagraph shall not apply to the treatment provided to patients Substitute House Bill No. 6666 Public Act No. 21-121 20 of 132 through mobile integrated health care programs; (10) Establish primary service areas and assign in writing a primary service area responder for each primary service area. Each state-owned campus having an acute care hospital on the premises shall be designated as the primary service area responder for that campus; (11) Revoke primary service area assignments upon determination by the commissioner that it is in the best interests of patient care to do so; and (12) Annually issue a list of minimum equipment requirements for [ambulances and rescue vehicles] authorized emergency medical services vehicles based upon current national standards. The commissioner shall distribute such list to all emergency medical service organizations and sponsor hospital medical directors and make such list available to other interested stakeholders. Emergency medical service organizations shall have one year from the date of issuance of such list to comply with the minimum equipment requirements. Sec. 11. (NEW) (Effective July 1, 2021) The Commissioner of Public Health may waive any provisions of the regulations applying to an emergency medical service organization or emergency medical services personnel, as such terms are defined in section 19a-175 of the general statutes, as amended by this act, if the commissioner determines that such waiver (1) would not endanger the health, safety or welfare of any patient or resident, and (2) does not affect the maximum allowable rates for each emergency medical service organization or primary service area assignments. The commissioner may impose conditions, upon granting the waiver, that assure the health, safety or welfare of patients or residents and may terminate the waiver upon a finding that the health, safety or welfare of any patient or resident has been jeopardized. The commissioner may adopt regulations, in accordance with the provisions of chapter 54 of the general statutes, establishing procedures Substitute House Bill No. 6666 Public Act No. 21-121 21 of 132 for an application for a waiver pursuant to this subdivision. Sec. 12. Section 20-207 of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2021): As used in this chapter, unless the context otherwise requires, the following terms shall have the meanings specified: (1) "Board" means the Connecticut Board of Examiners of Embalmers and Funeral Directors; (2) "Person" means an individual or corporation, but not a partnership; (3) "Funeral directing" means the business, practice or profession, as commonly practiced, of (A) directing or supervising funerals, or providing funeral services; (B) handling or encasing or providing services for handling and encasing dead human bodies, otherwise than by embalming, for burial or disposal; (C) providing embalming services; (D) providing transportation, interment and disinterment of dead human bodies; (E) maintaining an establishment so located, constructed and equipped as to permit the decent and sanitary handling of dead human bodies, with suitable equipment in such establishment for such handling; (F) conducting an establishment from which funerals may be held; (G) engaging in consultations concerning arrangements for the disposition of human remains, including, but not limited to, arrangements for cremation or alkaline hydrolysis; (H) casketing human remains; (I) making cemetery and cremation arrangements; and (J) preparing funeral service contracts, as defined in section 42-200; (4) "Funeral director" means any person engaged or holding himself or herself out as engaged in funeral directing whether or not he or she uses in connection with his or her name or business the words "funeral director," "undertaker" or "mortician" or any other word or title intended to designate him or her as a funeral director or mortician or as Substitute House Bill No. 6666 Public Act No. 21-121 22 of 132 one so engaged; (5) "Funeral service business" means the business, practice or profession of funeral directing; (6) "Licensed embalmer" means an embalmer holding a license as provided in this chapter; (7) "Licensed funeral director" means a funeral director holding a license as provided in this chapter; (8) ["Student embalmer"] "Registered apprentice embalmer" means a person [studying embalming and] registered with the Department of Public Health as an apprentice pursuant to the provisions of this chapter; (9) ["Student funeral director"] "Registered apprentice funeral director" means a person [studying the funeral service business and] registered with the Department of Public Health as an apprentice pursuant to the provisions of this chapter; (10) "Full-time employment" means regular and steady work during the normal working hours by any person at the establishment at which he is employed; and (11) "Manager" means an individual who (A) is licensed as an embalmer or funeral director pursuant to this chapter and (B) has direct and personal responsibility for the daily operation and management of a funeral service business. Sec. 13. Section 20-212 of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2021): No person, except a licensed embalmer, shall inject any fluid or substance into any dead human body, except that a registered [student] apprentice embalmer may, even if not in the presence of a licensed Substitute House Bill No. 6666 Public Act No. 21-121 23 of 132 embalmer, make such injection or perform any other act under [his] such licensed embalmer's instruction; and no person, firm or corporation shall enter, engage in, carry on or manage for another the business of caring for, preserving or disposing of dead human bodies until each person, firm or corporation so engaged has obtained from the Department of Public Health and holds a license as provided in this chapter; nor shall any person be employed to remove a dead human body, except a licensed embalmer, a registered [student] apprentice embalmer, a licensed funeral director, or a person authorized in each instance by the Chief Medical Examiner, Deputy Medical Examiner or assistant medical examiner incidental to examining the body of a deceased person, except that once a dead human body has been prepared in accordance with the [Public Health Code] regulations of Connecticut state agencies and the applicable provisions of the general statutes, an embalmer or funeral director licensed in this state may authorize an unlicensed employee to transport such body. Nothing in this section shall be construed to prohibit any person licensed as an embalmer or as a funeral director under the laws of another state from bringing into or removing from this state a dead human body, provided any and all other laws of this state relative to such body have been complied with. Nothing in this chapter shall be construed to prohibit any student who is enrolled in a program of education in mortuary science, approved by the board, with the consent of the Commissioner of Public Health, from embalming up to ten human bodies under the supervision of a licensed embalmer and incidental to such student's course of study. Such embalming shall be counted toward the embalming requirement outlined in section 20-213, as amended by this act, when such student becomes a registered apprentice embalmer. Sec. 14. Subsections (a) and (b) of section 20-213 of the general statutes are repealed and the following is substituted in lieu thereof (Effective October 1, 2021): Substitute House Bill No. 6666 Public Act No. 21-121 24 of 132 (a) (1) After a [student] registered apprentice embalmer has (A) completed a program of education in mortuary science approved by the board with the consent of the Commissioner of Public Health, (B) successfully completed an examination prescribed by the Department of Public Health with the consent of the board, (C) completed one year of practical training and experience of a grade and character satisfactory to the commissioner in the state in full-time employment under the personal supervision and instruction of an embalmer licensed under the provisions of this chapter, and (D) embalmed fifty human bodies in not more than two years under the supervision of a licensed embalmer or embalmers, (2) the [student] registered apprentice embalmer shall (A) submit to the department an application and fee of two hundred ten dollars, (B) take a written examination on the Connecticut public health laws and the regulations of Connecticut state agencies pertaining to the activities of an embalmer, and (C) take an examination in practical embalming that shall include an actual demonstration upon a cadaver. When the [student] registered apprentice embalmer has satisfactorily passed such examinations, said department shall issue to him or her a license to practice embalming. At the expiration of such license, if the holder thereof desires a renewal, said department shall grant it pursuant to section 20-222a, except for cause. (b) Examinations for registration as a [student] registered apprentice embalmer and for an embalmer's license shall be administered to applicants by the Department of Public Health, under the supervision of the board, semiannually and at such other times as may be determined by the department. Sec. 15. Section 20-215 of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2021): No licensed embalmer shall sign an affidavit attesting the preparation or embalming of any body unless such body has been prepared or embalmed by [him] such licensed embalmer, or by a Substitute House Bill No. 6666 Public Act No. 21-121 25 of 132 registered [student] apprentice embalmer under [his] such licensed embalmer's personal supervision. Sec. 16. Subsection (a) of section 20-217 of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2021): (a) When a [student] registered apprentice funeral director has completed a program of education approved by the board with the consent of the Commissioner of Public Health, has successfully completed an examination prescribed by the department with the consent of the board and furnishes the department with satisfactory proof that he or she has completed one year of practical training and experience in full-time employment under the personal supervision of a licensed embalmer or funeral director, and pays to the department a fee of two hundred ten dollars, [he] such registered apprentice funeral director shall be entitled to be examined upon the Connecticut state law and regulations pertaining to his or her professional activities. If found to be qualified by the Department of Public Health, [he] such registered apprentice funeral director shall be licensed as a funeral director. Renewal licenses shall be issued by the Department of Public Health pursuant to section 20-222a, unless withheld for cause as herein provided, upon a payment of a fee of two hundred thirty dollars. Sec. 17. Section 20-224 of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2021): (a) The provisions of sections 20-217, as amended by this act, 20-220 and 20-227 shall not prohibit the employment of assistants or of [student] registered apprentice embalmers and [student] registered apprentice funeral directors as provided in this chapter, provided a licensed funeral service business may employ no more than two [student] registered apprentice embalmers at any one time, and any person, firm, corporation or other organization engaged in the business Substitute House Bill No. 6666 Public Act No. 21-121 26 of 132 of funeral directing may employ no more than one [student] registered apprentice funeral director at any one time, without the approval of the Board of Examiners of Embalmers and Funeral Directors. (b) [Student] Registered apprentice embalmers and [student] registered apprentice funeral directors shall register as apprentices with the Department of Public Health, in the manner prescribed by the commissioner in regulations adopted pursuant to section 20-211, for purposes of completing practical training and experience pursuant to the provisions of this chapter. Sec. 18. Section 20-195dd of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage): (a) Except as otherwise provided in subsections (c) and (d) of this section, an applicant for a license as a professional counselor shall submit evidence satisfactory to the commissioner of having: (1) (A) Earned a graduate degree in clinical mental health counseling as part of a program of higher learning accredited by the Council for Accreditation of Counseling and Related Educational Programs, or a successor organization, or (B) (i) completed at least sixty graduate semester hours in counseling or a related mental health field at a regionally accredited institution of higher education that included coursework in each of the following areas: (I) Human growth and development; (II) social and cultural foundations; (III) counseling theories; (IV) counseling techniques; (V) group counseling; (VI) career counseling; (VII) appraisals or tests and measurements to individuals and groups; (VIII) research and evaluation; (IX) professional orientation to mental health counseling; (X) addiction and substance abuse counseling; (XI) trauma and crisis counseling; and (XII) diagnosis and treatment of mental and emotional disorders, (ii) earned from a regionally accredited institution of higher education a graduate degree in counseling or a related mental health field, (iii) completed a one- hundred-hour practicum in counseling taught by a faculty member Substitute House Bill No. 6666 Public Act No. 21-121 27 of 132 licensed or certified as a professional counselor or its equivalent in another state, and (iv) completed a six-hundred-hour clinical mental health counseling internship taught by a faculty member licensed or certified as a professional counselor or its equivalent in another state; (2) acquired three thousand hours of postgraduate experience under professional supervision, including a minimum of one hundred hours of direct professional supervision, in the practice of professional counseling, performed over a period of not less than two years; and (3) passed an examination prescribed by the commissioner. The provisions of subparagraphs (B)(i)(X) to (B)(i)(XII), inclusive, (B)(iii) and (B)(iv) of this subsection shall not apply to any applicant who, on or before July 1, 2017, was a matriculating student in good standing in a graduate degree program at a regionally accredited institution of higher education in one of the fields required under subparagraph (B) of this subsection. (b) An applicant for a license as a professional counselor associate shall submit to the Commissioner of Public Health evidence satisfactory to the commissioner of having (1) earned a graduate degree in clinical mental health counseling as part of a program of higher learning accredited by the Council for Accreditation of Counseling and Related Educational Programs, or a successor organization, or (2) (A) completed at least sixty graduate semester hours in counseling or a related mental health field at a regionally accredited institution of higher education that included coursework in each of the following areas: Human growth and development; social and cultural foundations; counseling theories; counseling techniques; group counseling; career counseling; appraisals or tests and measurements to individuals and groups; research and evaluation; professional orientation to mental health counseling; addiction and substance abuse counseling; trauma and crisis counseling; and diagnosis and treatment of mental and emotional disorders, (B) completed a one-hundred-hour practicum in counseling taught by a faculty member licensed or certified as a professional Substitute House Bill No. 6666 Public Act No. 21-121 28 of 132 counselor or its equivalent in another state, (C) completed a six- hundred-hour clinical mental health counseling internship taught by a faculty member licensed or certified as a professional counselor or its equivalent in another state, and (D) earned from a regionally accredited institution of higher education a graduate degree in counseling or a related mental health field. The provisions of subparagraphs (A) to (C), inclusive, of subdivision (2) of this subsection shall not apply to any applicant who, on or before July 1, 2022, earned a graduate degree at a regionally accredited institution of higher education in counseling or a related mental health field and has accumulated at least three thousand hours of experience under professional supervision, as defined in section 20-195aa. (c) An applicant for licensure by endorsement shall present evidence satisfactory to the commissioner that the applicant is licensed or certified as a professional counselor or professional counselor associate, or as a person entitled to perform similar services under a different designation, in another state or jurisdiction whose requirements for practicing in such capacity are substantially similar to or higher than those of this state and that there are no disciplinary actions or unresolved complaints pending. (d) An applicant who is licensed or certified as a professional counselor or its equivalent in another state, territory or commonwealth of the United States may substitute three years of licensed or certified work experience in the practice of professional counseling in lieu of the requirements of subdivision (2) of subsection (a) of this section, provided the commissioner finds that such experience is equal to or greater than the requirements of this state. Sec. 19. Subsection (a) of section 20-195c of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage): Substitute House Bill No. 6666 Public Act No. 21-121 29 of 132 (a) Each applicant for licensure as a marital and family therapist shall present to the department satisfactory evidence that such applicant has: (1) Completed a graduate degree program specializing in marital and family therapy offered by a regionally accredited college or university or an accredited postgraduate clinical training program accredited by the Commission on Accreditation for Marriage and Family Therapy Education offered by a regionally accredited institution of higher education; (2) completed a supervised practicum or internship with emphasis in marital and family therapy supervised by the program granting the requisite degree or by an accredited postgraduate clinical training program accredited by the Commission on Accreditation for Marriage and Family Therapy Education and offered by a regionally accredited institution of higher education; [, in which the student received a minimum of five hundred direct clinical hours that included one hundred hours of clinical supervision;] (3) completed twelve months of relevant postgraduate experience, including (A) a minimum of one thousand hours of direct client contact offering marital and family therapy services subsequent to being awarded a master's degree or doctorate or subsequent to the training year specified in subdivision (2) of this subsection, and (B) one hundred hours of postgraduate clinical supervision provided by a licensed marital and family therapist; and (4) passed an examination prescribed by the department. The fee shall be three hundred fifteen dollars for each initial application. Sec. 20. Subdivision (12) of subsection (a) of section 19a-14 of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2021): (12) With respect to any complaint filed with the department on or after October 1, 2010, alleging incompetence, negligence, fraud or deceit by a person subject to regulation or licensing by any board or commission described in subdivision (1) to [(5), inclusive, (7),] (8), inclusive, (12) to (14), inclusive, or subdivision (16) of subsection (b) of Substitute House Bill No. 6666 Public Act No. 21-121 30 of 132 this section: (A) Upon request of the person who filed the complaint, provide such person with information on the status of the complaint; (B) Upon request of the person who filed the complaint, provide such person with an opportunity to review, at the department, records compiled as of the date of the request pursuant to any investigation of the complaint, including, but not limited to, the respondent's written response to the complaint, except that such person shall not be entitled to copy such records and the department (i) shall not disclose (I) information concerning a health care professional's referral to, participation in or completion of an assistance program in accordance with sections 19a-12a, as amended by this act, and 19a-12b, that is confidential pursuant to section 19a-12a, as amended by this act, (II) information not related to such person's specific complaint, including, but not limited to, information concerning patients other than such person, or (III) personnel or medical records and similar files the disclosure of which would constitute an invasion of personal privacy pursuant to section 1-210, except for such records or similar files solely related to such person; (ii) shall not be required to disclose any other information that is otherwise confidential pursuant to federal law or state statute, except for information solely related to such person; and (iii) may require up to ten business days written notice prior to providing such opportunity for review; (C) Prior to resolving the complaint with a consent order, provide the person who filed the complaint with not less than ten business days to submit a written statement as to whether such person objects to resolving the complaint with a consent order; (D) If a hearing is held with respect to such complaint after a finding of probable cause, provide the person who filed the complaint with a copy of the notice of hearing issued pursuant to section 4-177, which Substitute House Bill No. 6666 Public Act No. 21-121 31 of 132 shall include information concerning the opportunity to present oral or written statements pursuant to subsection (b) of section 4-177c; and (E) Notify the person who filed the complaint of the final disposition of such complaint not later than seven business days after such final disposition; Sec. 21. Subsections (a) to (c), inclusive, of section 20-204a of the general statutes are repealed and the following is substituted in lieu thereof (Effective October 1, 2021): (a) The department shall investigate each allegation of any act or omission by a veterinarian specified in section 20-202. The investigation shall be conducted in accordance with the provisions of section 19a-14, as amended by this act, to determine if probable cause exists to issue a statement of charges and to institute proceedings against the veterinarian. Such investigation shall be concluded not later than twelve months from the date the allegation is submitted to the department. (b) Except as provided in subsections (c) and (d) of this section, the investigation shall be confidential and not subject to disclosure under section 1-210 and no person may disclose knowledge of the investigation to a third party unless the veterinarian requests that the investigation be open, [The owner of any animal that is the subject of such an investigation shall not be deemed a third party to such an investigation for purposes of disclosure under this section] except that the department shall provide information to the person who filed the complaint pursuant to subdivision (12) of subsection (a) of section 19a- 14, as amended by this act. (c) If the department makes a finding of no probable cause to take action under section 20-202 or fails to make a finding within the twelve- month period required by subsection [(b)] (a) of this section, the allegation submitted pursuant to subsection (a) of this section and the Substitute House Bill No. 6666 Public Act No. 21-121 32 of 132 entire record of the investigation may remain confidential and no person shall disclose knowledge of such investigation to a third party unless the veterinarian requests that it be open, except that the department shall provide information to the person who filed the complaint pursuant to subdivision (12) of subsection (a) of section 19a- 14, as amended by this act. Sec. 22. Subsections (b) and (c) of section 7-62b of the general statutes are repealed and the following is substituted in lieu thereof (Effective January 1, 2022): (b) The funeral director or embalmer licensed by the department, or the funeral director or embalmer licensed in another state and complying with the terms of a reciprocal agreement on file with the department, in charge of the burial of the deceased person shall complete the death certificate through the electronic death registry system, or, if the electronic death registry system is unavailable, on a form provided by the department. Said certificate shall be filed by a licensed embalmer or such embalmer's designee or a funeral director or such director's designee, in accordance with the provisions of this section, except when inquiry is required by the Chief Medical Examiner's Office, in which case the death certificate shall be filed in accordance with section 19a-409. The Social Security number of the deceased person shall be recorded on such certificate. Such licensed funeral director or licensed embalmer shall obtain the personal data from the next of kin or the best qualified person or source available and shall obtain a medical certification from the person responsible therefor, in accordance with the provisions of this section. Only a licensed embalmer may assume charge of the burial of a deceased person who had a communicable disease, as designated in the [Public Health Code] regulations of Connecticut state agencies, at the time of death and such licensed embalmer shall file an affidavit, on a form provided by the department, signed and sworn to by such licensed embalmer stating Substitute House Bill No. 6666 Public Act No. 21-121 33 of 132 that the body has been disinfected in accordance with the [Public Health Code] regulations of Connecticut state agencies. (c) The medical certification portion of the death certificate shall be completed, signed and returned to the licensed funeral director or licensed embalmer no later than twenty-four hours after death by the physician or advanced practice registered nurse in charge of the patient's care for the illness or condition which resulted in death, or upon the death of an infant delivered by a nurse-midwife, by such nurse-midwife, as provided in section 20-86b. In the absence of such physician or advanced practice registered nurse, or with the physician's or advanced practice registered nurse's approval, the medical certification may be completed and signed by an associate physician, an advanced practice registered nurse, a physician assistant as provided in subsection (d) of section 20-12d, a registered nurse as provided in section 20-101a, the chief medical officer of the institution in which death occurred, or by the pathologist who performed an autopsy upon the decedent. No physician, advanced practice registered nurse, physician assistant, registered nurse, nurse-midwife, chief medical officer or pathologist shall sign and return the medical certification unless such physician, advanced practice registered nurse, physician assistant, registered nurse, nurse-midwife, chief medical officer or pathologist has personally viewed and examined the body of the person to whom the medical certification relates and is satisfied that at the time of the examination such person was in fact dead, except in the event a medical certification is completed by a physician, advanced practice registered nurse, physician assistant, registered nurse, nurse-midwife, chief medical officer or pathologist other than the one who made the determination and pronouncement of death, an additional viewing and examination of the body shall not be required. Such physician, advanced practice registered nurse, physician assistant, registered nurse, nurse-midwife, chief medical officer or pathologist shall certify to the facts of death through the electronic death registry system, or, if Substitute House Bill No. 6666 Public Act No. 21-121 34 of 132 the electronic death registry is unavailable, on a form provided by the department. If a physician, advanced practice registered nurse, physician assistant, registered nurse, nurse-midwife, chief medical officer or pathologist refuses or otherwise fails to complete, sign and return the medical portion of the death certificate to the licensed funeral director or licensed embalmer within twenty-four hours after death, such licensed funeral director or embalmer may notify the Commissioner of Public Health of such refusal. The commissioner may, upon receipt of notification and investigation, assess a civil penalty against such physician, advanced practice registered nurse, physician assistant, registered nurse, chief medical officer or pathologist not to exceed two hundred fifty dollars. The medical certification shall state the cause of death, defined so that such death may be classified under the international list of causes of death, the duration of disease if known and such additional information as the Department of Public Health requires. The department shall give due consideration to national uniformity in vital statistics in prescribing the form and content of such information. Sec. 23. Section 19a-200 of the general statutes is repealed and the following is substituted in lieu thereof (Effective July 1, 2021): (a) The mayor of each city, the chief executive officer of each town and the warden of each borough shall, unless the charter of such city, town or borough otherwise provides, nominate some person to be director of health for such city, town or borough. [, which] Such person shall possess the qualifications specified in subsection (b) of this section. Upon approval of the Commissioner of Public Health, such nomination shall be confirmed or rejected by the board of selectmen, if there be such a board, otherwise by the legislative body of such city or town or by the burgesses of such borough within thirty days thereafter. (b) Notwithstanding the charter provisions of any city, town or borough with respect to the qualifications of the director of health, on Substitute House Bill No. 6666 Public Act No. 21-121 35 of 132 and after October 1, 2010, any person nominated to be a director of health shall (1) be a licensed physician and hold a degree in public health from an accredited school, college, university or institution, or (2) hold a graduate degree in public health from an accredited institution of higher education. The educational requirements of this section shall not apply to any director of health nominated or otherwise appointed as director of health prior to October 1, 2010. (c) In cities, towns or boroughs with a population of forty thousand or more for five consecutive years, according to the estimated population figures authorized pursuant to subsection (b) of section 8-159a, such director of health shall serve in a full-time capacity, except where a town has designated such director as the chief medical advisor for its public schools under section 10-205. [, and] (d) No director shall, [not,] during such director's term of office, have any financial interest in or engage in any employment, transaction or professional activity that is in substantial conflict with the proper discharge of the duties required of directors of health by the general statutes or the regulations of Connecticut state agencies or specified by the appointing authority of the city, town or borough in its written agreement with such director. A written agreement with such director shall be submitted to the Commissioner of Public Health by such appointing authority upon such director's appointment or reappointment. (e) Such director of health shall have and exercise within the limits of the city, town or borough for which such director is appointed all powers necessary for enforcing the general statutes, provisions of the regulations of Connecticut state agencies relating to the preservation and improvement of the public health and preventing the spread of diseases therein. (f) In case of the absence or inability to act of a city, town or borough Substitute House Bill No. 6666 Public Act No. 21-121 36 of 132 director of health or if a vacancy exists in the office of such director, the appointing authority of such city, town or borough may, with the approval of the Commissioner of Public Health, designate in writing a suitable person to serve as acting director of health during the period of such absence or inability or vacancy [, provided the] and such person's start date. The commissioner may appoint such acting director if the city, town or borough fails to do so. The person so designated, when sworn, shall have all the powers and be subject to all the duties of such director. (g) In case of vacancy in the office of such director, if such vacancy exists for [thirty] sixty days, said commissioner may appoint a director of health for such city, town or borough. The person so designated, when sworn, shall (1) be considered an employee of the city, town or borough, and (2) have all the powers and be subject to all the duties of such director. (h) Said commissioner, may, for cause, remove an officer the commissioner or any predecessor in said office has appointed, and the common council of such city, town or the burgesses of such borough may, respectively, for cause, remove a director whose nomination has been confirmed by them, provided such removal shall be approved by said commissioner; and, within two days thereafter, notice in writing of such action shall be given by the clerk of such city, town or borough, as the case may be, to said commissioner, who shall, within ten days after receipt, file with the clerk from whom the notice was received, approval or disapproval. (i) Each such director of health shall hold office for the term of four years from the date of appointment and until a successor is nominated and confirmed in accordance with this section. (j) Each director of health shall, annually, at the end of the fiscal year, [of the city, town or borough, file with the Department of Public Health Substitute House Bill No. 6666 Public Act No. 21-121 37 of 132 a report of the doings as such director for the year preceding] submit a report to the Department of Public Health detailing the activities of such director during the preceding fiscal year. [(b)] (k) On and after July 1, 1988, each city, town and borough shall provide for the services of a sanitarian licensed under chapter 395 to work under the direction of the local director of health. Where practical, the local director of health may act as the sanitarian. [(c)] (l) As used in this chapter, "authorized agent" means a sanitarian licensed under chapter 395 and any individual certified for a specific program of environmental health by the Commissioner of Public Health in accordance with the general statutes and regulations of Connecticut state agencies. Sec. 24. Section 19a-202a of the general statutes is repealed and the following is substituted in lieu thereof (Effective July 1, 2021): [(a)] Any municipality may designate itself as having a part-time health department if: (1) The municipality has not had a full-time health department or been in a full-time health district [prior to] as of January 1, 1998, [;] and (2) the municipality has the equivalent of at least one full- time employee, as determined by the Commissioner of Public Health, [; (3) the municipality annually submits a public health program plan and budget to the commissioner; and (4) the commissioner approves the program plan and budget] who performs public health functions required by the general statutes and the regulations of Connecticut states agencies. [(b) The Commissioner of Public Health shall adopt regulations, in accordance with the provisions of chapter 54, for the development and approval of the program plan and budget required by subdivision (3) of subsection (a) of this section.] Sec. 25. Section 19a-244 of the general statutes is repealed and the Substitute House Bill No. 6666 Public Act No. 21-121 38 of 132 following is substituted in lieu thereof (Effective July 1, 2021): On and after October 1, 2010, any person nominated to be the director of health shall (1) be a licensed physician and hold a degree in public health from an accredited school, college, university or institution, or (2) hold a graduate degree in public health from an accredited school, college or institution. The educational requirements of this section shall not apply to any director of health nominated or otherwise appointed as director of health prior to October 1, 2010. The board may specify in a written agreement with such director the term of office, which shall not exceed three years, salary and duties required of and responsibilities assigned to such director in addition to those required by the general statutes or the [Public Health Code] regulations of Connecticut state agencies, if any. Such director shall be removed during the term of such written agreement only for cause after a public hearing by the board on charges preferred, of which reasonable notice shall have been given. No director shall, during such director's term of office, have any financial interest in or engage in any employment, transaction or professional activity that is in substantial conflict with the proper discharge of the duties required of directors of health by the general statutes or the [Public Health Code] regulations of Connecticut state agencies or specified by the board in its written agreement with such director. The board shall submit such written agreement to the Commissioner of Public Health upon such director's appointment or reappointment. Such director shall serve in a full-time capacity and act as secretary and treasurer of the board, without the right to vote. Such director shall give to the district a bond with a surety company authorized to transact business in the state, for the faithful performance of such director's duties as treasurer, in such sum and upon such conditions as the board requires. Such director shall be the executive officer of the district department of health. Full-time employees of a city, town or borough health department at the time such city, town or borough votes to form or join a district department of health shall become employees of such Substitute House Bill No. 6666 Public Act No. 21-121 39 of 132 district department of health. Such employees may retain their rights and benefits in the pension system of the town, city or borough by which they were employed and shall continue to retain their active participating membership therein until retired. Such employees shall pay into such pension system the contributions required of them for their class and membership. Any additional employees to be hired by the district or any vacancies to be filled shall be filled in accordance with the rules and regulations of the merit system of the state of Connecticut and the employees who are employees of cities, towns or boroughs which have adopted a local civil service or merit system shall be included in their comparable grade with fully attained seniority in the state merit system. Such employees shall perform such duties as are prescribed by the director of health. In the event of the withdrawal of a town, city or borough from the district department, or in the event of a dissolution of any district department, the employees thereof, originally employed therein, shall automatically become employees of the appropriate town, city or borough's board of health. At the end of each fiscal year, each director of health shall submit a report to the Department of Public Health detailing the activities of such director during the preceding fiscal year. Sec. 26. Subdivision (3) of subsection (a) of section 19a-12a of the general statutes is repealed and the following is substituted in lieu thereof (Effective July 1, 2021): (3) "Health care professionals" includes any person licensed or who holds a permit pursuant to chapter 370, 372, 373, 375, 375a, 376, 376a, 376b, 376c, 377, 378, 379, 379a, 380, 381, 381a, 382a, 383, 383a, 383b, 383c, 384, 384a, 384b, 384c, 384d, 385, 398 or 399; Sec. 27. Section 19a-12d of the general statutes is repealed and the following is substituted in lieu thereof (Effective July 1, 2021): On or before the last day of January, April, July and October in each Substitute House Bill No. 6666 Public Act No. 21-121 40 of 132 year, the Commissioner of Public Health shall certify the amount of revenue received as a result of any fee increase in the amount of five dollars (1) that took effect October 1, 2015, pursuant to sections 19a-88, as amended by this act, 19a-515, 20-65k, 20-74bb, 20-74h, 20-74s, 20-149, 20-162o, 20-162bb, 20-191a, 20-195c, as amended by this act, 20-195o, 20- 195cc, 20-201, 20-206b, 20-206n, 20-206r, 20-206bb, 20-206ll, 20-222a, 20- 275, 20-395d, 20-398 and 20-412, and (2) that took effect October 1, 2021, pursuant to section 20-185k, as amended by this act, and transfer such amount to the professional assistance program account established in section 19a-12c. Sec. 28. Subsection (a) of section 19a-12e of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2021): (a) As used in this section: (1) "Health care professional" means any individual licensed or who holds a permit pursuant to chapter 368v, 370, 372, 373, 375 to 378, inclusive, 379 to 381b, inclusive, 382a, 383 to 385, inclusive, 388 or 397a to 399, inclusive; (2) "Assistance program" means the program established pursuant to section 19a-12a, as amended by this act, to provide education, prevention, intervention, referral assistance, rehabilitation or support services to health care professionals who have a chemical dependency, emotional or behavioral disorder or physical or mental illness; and (3) "Hospital" has the same meaning as provided in section 19a-490. Sec. 29. Subsection (b) of section 20-185k of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage): (b) A license issued under this section may be renewed annually. The Substitute House Bill No. 6666 Public Act No. 21-121 41 of 132 license shall be renewed in accordance with the provisions of section 19a-88, as amended by this act, for a fee of one hundred [seventy-five] eighty dollars for applications for renewal of licenses that expire on or after October 1, 2021. Each behavior analyst applying for license renewal shall furnish evidence satisfactory to the commissioner of having current certification with the Behavior Analyst Certification Board. Sec. 30. Subsection (a) of section 17a-412 of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2021): (a) Any physician or surgeon licensed under the provisions of chapter 370, any resident physician or intern in any hospital in this state, whether or not so licensed, [and] any registered nurse, licensed practical nurse, medical examiner, dentist, optometrist, chiropractor, podiatrist, social worker, clergyman, police officer, pharmacist, physical therapist, long-term care facility administrator, nurse's aide or orderly in a long- term care facility, any person paid for caring for a patient in a long-term care facility, any staff person employed by a long-term care facility, [and] any person who is a sexual assault counselor or a domestic violence counselor as defined in section 52-146k, and any behavior analyst licensed under the provisions of chapter 382a, who has reasonable cause to suspect or believe that a resident in a long-term care facility has been abused, neglected, exploited or abandoned, or is in a condition that is the result of such abuse, neglect, exploitation or abandonment, shall, not later than seventy-two hours after such suspicion or belief arose, report such information or cause a report to be made in any reasonable manner to the Commissioner of Social Services pursuant to chapter 319dd. Any person required to report under the provision of this section who fails to make such report within the prescribed time period shall be fined not more than five hundred dollars, except that, if such person intentionally fails to make such report within the prescribed time period, such person shall be guilty of a class Substitute House Bill No. 6666 Public Act No. 21-121 42 of 132 C misdemeanor for the first offense and a class A misdemeanor for any subsequent offense. Sec. 31. Subsection (a) of section 17b-451 of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2021): (a) A mandatory reporter [, as defined in this section,] who has reasonable cause to suspect or believe that any elderly person has been abused, neglected, exploited or abandoned, or is in a condition that is the result of such abuse, neglect, exploitation or abandonment, or is in need of protective services, shall, not later than seventy-two hours after such suspicion or belief arose, report such information or cause a report to be made in any reasonable manner to the Commissioner of Social Services or to the person or persons designated by the commissioner to receive such reports. [The term] As used in this section, "mandatory reporter" means (1) any physician or surgeon licensed under the provisions of chapter 370, (2) any resident physician or intern in any hospital in this state, whether or not so licensed, (3) any registered nurse, (4) any nursing home administrator, nurse's aide or orderly in a nursing home facility or residential care home, (5) any person paid for caring for a resident in a nursing home facility or residential care home, (6) any staff person employed by a nursing home facility or residential care home, (7) any residents' advocate, other than a representative of the Office of the Long-Term Care Ombudsman, as established under section 17a-405, including the State Ombudsman, (8) any licensed practical nurse, medical examiner, dentist, optometrist, chiropractor, podiatrist, behavior analyst, social worker, clergyman, police officer, pharmacist, psychologist or physical therapist, (9) any person paid for caring for an elderly person by any institution, organization, agency or facility, including without limitation, any employee of a community-based services provider, senior center, home care agency, homemaker and companion agency, adult day care center, village-model community Substitute House Bill No. 6666 Public Act No. 21-121 43 of 132 and congregate housing facility, and (10) any person licensed or certified as an emergency medical services provider pursuant to chapter 368d or chapter 384d, including any such emergency medical services provider who is a member of a municipal fire department. Any mandatory reporter who fails to make such report within the prescribed time period shall be fined not more than five hundred dollars, except that, if such person intentionally fails to make such report within the prescribed time period, such person shall be guilty of a class C misdemeanor for the first offense and a class A misdemeanor for any subsequent offense. Any institution, organization, agency or facility employing individuals to care for persons sixty years of age or older shall provide mandatory training on detecting potential abuse, neglect, exploitation and abandonment of such persons and inform such employees of their obligations under this section. For purposes of this subsection, "person paid for caring for an elderly person by any institution, organization, agency or facility" includes an employee of a community-based services provider, senior center, home health care agency, homemaker and companion agency, adult day care center, village-model community and congregate housing facility. Sec. 32. Subsection (g) of section 17b-451 of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2021): (g) The Commissioner of Social Services shall develop an educational training program to promote and encourage the accurate and prompt identification and reporting of abuse, neglect, exploitation and abandonment of elderly persons. Such training program shall be made available on the Internet web site of the Department of Social Services to [mandated] mandatory reporters and other interested persons. The commissioner shall also make such training available in person or otherwise at various times and locations throughout the state as determined by the commissioner. Substitute House Bill No. 6666 Public Act No. 21-121 44 of 132 Sec. 33. Section 19a-6o of the general statutes is repealed and the following is substituted in lieu thereof (Effective July 1, 2021): (a) There is established, within available appropriations, within the Department of Public Health, a Palliative Care Advisory Council. The advisory council shall: (1) Analyze the current state of palliative care in the state; and (2) advise the department on matters relating to the improvement of palliative care and the quality of life for persons with serious or chronic illnesses. (b) The advisory council shall consist of the following members: (1) Two appointed by the Governor, one of whom shall be a physician certified by the American Board of Hospice and Palliative Medicine and one of whom shall be a registered nurse or advanced practice registered nurse certified by the National Board for Certification of Hospice and Palliative Nurses; (2) Seven appointed by the Commissioner of Public Health, each of whom shall be a licensed health care provider, with each appointee having experience or expertise in the provision of one of the following: (A) Inpatient palliative care in a hospital; (B) inpatient palliative care in a nursing home facility; (C) palliative care in the patient's home or a community setting; (D) pediatric palliative care; (E) palliative care for young adults; (F) palliative care for adults or elderly persons; and (G) inpatient palliative care in a psychiatric facility; (3) One appointed by the speaker of the House of Representatives, who shall be a licensed social worker experienced in working with persons with serious or chronic illness and their family members; (4) One appointed by the president pro tempore of the Senate, who shall be a licensed pharmacist experienced in working with persons with serious or chronic illness; Substitute House Bill No. 6666 Public Act No. 21-121 45 of 132 (5) One appointed by the minority leader of the House of Representatives, who shall be a spiritual counselor experienced in working with persons with serious or chronic illness and their family members; and (6) One appointed by the minority leader of the Senate, who shall be a representative of the American Cancer Society or a person experienced in advocating for persons with serious or chronic illness and their family members. (c) All appointments to the advisory council shall be made not later than December 31, 2013. Advisory council members shall serve three- year terms. Any vacancy shall be filled by the appointing authority. (d) Any appointment that is vacant for one year or more shall be made by the Commissioner of Public Health. The commissioner shall notify the appointing authority of the identity of the commissioner's choice for appointment not later than thirty days before making such appointment. [(d)] (e) Members shall receive no compensation except for reimbursement for necessary expenses incurred in performing their duties. [(e)] (f) The members shall elect the chairperson of the advisory council from among the members of the advisory council. A majority of the advisory council members shall constitute a quorum. Any action taken by the advisory council shall require a majority vote of those present. The first meeting of the advisory council shall be held not later than December 31, 2013. The advisory council shall meet biannually and at other times upon the call of the chairperson, upon the request of the Commissioner of Public Health or upon the request of a majority of the advisory council members. [(f)] (g) Not later than January 1, [2015] 2022, and [annually] Substitute House Bill No. 6666 Public Act No. 21-121 46 of 132 biennially thereafter, the advisory council shall submit a report on its findings and recommendations to the Commissioner of Public Health and the joint standing committee of the General Assembly having cognizance of matters relating to public health, in accordance with the provisions of section 11-4a. Sec. 34. Section 19a-6q of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage): [(a)] The Commissioner of Public Health, in consultation with the executive director of the Office of Health Strategy, established under section 19a-754a, and local and regional health departments, shall, within available resources, develop a plan that is consistent with the Department of Public Health's Healthy Connecticut 2020 health improvement plan and the state healthcare innovation plan developed pursuant to the State Innovation Model Initiative by the Centers for Medicare and Medicaid Services Innovation Center. The commissioner shall develop and implement such plan to: (1) Reduce the incidence of tobacco use, high blood pressure, health care associated infections, asthma, unintended pregnancy and diabetes; (2) improve chronic disease care coordination in the state; and (3) reduce the incidence and effects of chronic disease and improve outcomes for conditions associated with chronic disease in the state. The commissioner shall post such plan on the Department of Public Health's Internet web site. [(b) The commissioner shall, on or before January 15, 2015, and biennially thereafter, submit a report, in consultation with the executive director of the Office of Health Strategy, in accordance with the provisions of section 11-4a to the joint standing committee of the General Assembly having cognizance of matters relating to public health concerning chronic disease and implementation of the plan described in subsection (a) of this section. The commissioner shall post each report on the Department of Public Health's Internet web site not later than thirty days after submitting such report. Each report shall Substitute House Bill No. 6666 Public Act No. 21-121 47 of 132 include, but need not be limited to: (1) A description of the chronic diseases that are most likely to cause a person's death or disability, the approximate number of persons affected by such chronic diseases and an assessment of the financial effects of each such disease on the state and on hospitals and health care facilities; (2) a description and assessment of programs and actions that have been implemented by the department and health care providers to improve chronic disease care coordination and prevent chronic disease; (3) the sources and amounts of funding received by the department to treat persons with multiple chronic diseases and to treat or reduce the most prevalent chronic diseases in the state; (4) a description of chronic disease care coordination between the department and health care providers, to prevent and treat chronic disease; and (5) recommendations concerning actions that health care providers and persons with chronic disease may take to reduce the incidence and effects of chronic disease.] Sec. 35. Subsection (b) of section 19a-493 of the general statutes is repealed and the following is substituted in lieu thereof (Effective July 1, 2021): (b) (1) A nursing home license may be renewed biennially after (A) an unscheduled inspection conducted by the department, (B) submission of the information required by section 19a-491a, and (C) submission of evidence satisfactory to the department that the nursing home is in compliance with the provisions of this chapter, the [Public Health Code] regulations of Connecticut state agencies and licensing regulations. (2) Any change in the ownership of a facility or institution, as defined in section 19a-490, owned by an individual, partnership or association or the change in ownership or beneficial ownership of ten per cent or more of the stock of a corporation which owns, conducts, operates or maintains such facility or institution, shall be subject to prior approval of the department after a scheduled inspection of such facility or Substitute House Bill No. 6666 Public Act No. 21-121 48 of 132 institution is conducted by the department, provided such approval shall be conditioned upon a showing by such facility or institution to the commissioner that it has complied with all requirements of this chapter, the regulations relating to licensure and all applicable requirements of the [Public Health Code] regulations of Connecticut state agencies. Any such change in ownership or beneficial ownership resulting in a transfer to a person related by blood or marriage to such an owner or beneficial owner shall not be subject to prior approval of the department unless: (A) Ownership or beneficial ownership of ten per cent or more of the stock of a corporation, limited liability company, partnership or association which owns, conducts, operates or maintains more than one facility or institution is transferred; (B) ownership or beneficial ownership is transferred in more than one facility or institution; or (C) the facility or institution is the subject of a pending complaint, investigation or licensure action. If the facility or institution is not in compliance, the commissioner may require the new owner to sign a consent order providing reasonable assurances that the violations shall be corrected within a specified period of time. Notice of any such proposed change of ownership shall be given to the department at least one hundred twenty days prior to the effective date of such proposed change. For the purposes of this subdivision, "a person related by blood or marriage" means a parent, spouse, child, brother, sister, aunt, uncle, niece or nephew. For the purposes of this subdivision, a change in the legal form of the ownership entity, including, but not limited to, changes from a corporation to a limited liability company, a partnership to a limited liability partnership, a sole proprietorship to a corporation and similar changes, shall not be considered a change of ownership if the beneficial ownership remains unchanged and the owner provides such information regarding the change to the department as may be required by the department in order to properly identify the current status of ownership and beneficial ownership of the facility or institution. For the purposes of this subdivision, a public offering of the stock of any corporation that owns, conducts, operates or maintains any such facility Substitute House Bill No. 6666 Public Act No. 21-121 49 of 132 or institution shall not be considered a change in ownership or beneficial ownership of such facility or institution if the licensee and the officers and directors of such corporation remain unchanged, such public offering cannot result in an individual or entity owning ten per cent or more of the stock of such corporation, and the owner provides such information to the department as may be required by the department in order to properly identify the current status of ownership and beneficial ownership of the facility or institution. Sec. 36. (NEW) (Effective July 1, 2021) A health care facility licensed pursuant to chapter 368v of the general statutes shall have policies and procedures in place that reflect the National Centers for Disease Control and Prevention's recommendations for tuberculosis screening, testing, treatment and education for health care personnel. Notwithstanding any provision of the general statutes or any regulations adopted thereunder, any employee providing direct patient care in a facility licensed pursuant to chapter 368v of the general statutes shall receive tuberculosis screening and testing in compliance with the licensed health care facility's policies and procedures. Sec. 37. Subsection (c) of section 19a-343 of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2021): (c) Three or more arrests, the issuance of three or more arrest warrants indicating a pattern of criminal activity and not isolated incidents or the issuance of three or more citations for a violation of a municipal ordinance as described in subdivision (14) of this subsection, for the following offenses shall constitute the basis for bringing an action to abate a public nuisance: (1) Prostitution under section 53a-82, 53a-83, 53a-86, 53a-87, 53a-88 or 53a-89. Substitute House Bill No. 6666 Public Act No. 21-121 50 of 132 (2) Promoting an obscene performance or obscene material under section 53a-196 or 53a-196b, employing a minor in an obscene performance under section 53a-196a, importing child pornography under section 53a-196c, possessing child pornography in the first degree under section 53a-196d, possessing child pornography in the second degree under section 53a-196e or possessing child pornography in the third degree under section 53a-196f. (3) Transmission of gambling information under section 53-278b or 53-278d or maintaining of a gambling premises under section 53-278e. (4) Offenses for the sale of controlled substances, possession of controlled substances with intent to sell, or maintaining a drug factory under section 21a-277, 21a-278 or 21a-278a or use of the property by persons possessing controlled substances under section 21a-279. Nothing in this section shall prevent the state from also proceeding against property under section 21a-259 or 54-36h. (5) Unauthorized sale of alcoholic liquor under section 30-74 or disposing of liquor without a permit under section 30-77, or sale or delivery of alcoholic liquor to any minor under subdivision (1) of subsection (b) of section 30-86 or the sale, delivery or giving of alcoholic liquor to a minor under subdivision (2) of subsection (b) of section 30- 86. (6) Maintaining a motor vehicle chop shop under section 14-149a. (7) Inciting injury to persons or property under section 53a-179a. (8) Murder or manslaughter under section 53a-54a, 53a-54b, 53a-55, 53a-56 or 53a-56a. (9) Assault under section 53a-59, 53a-59a, subdivision (1) of subsection (a) of section 53a-60 or section 53a-60a or 53a-61. Substitute House Bill No. 6666 Public Act No. 21-121 51 of 132 (10) Sexual assault under section 53a-70 or 53a-70a. (11) Fire safety violations under section 29-291a, 29-291c, 29-292, subsection (b) of section 29-310, or section 29-315, 29-349 or 29-357. (12) Firearm offenses under section 29-35, 53-202aa, 53-203, 53a-211, 53a-212, 53a-216, 53a-217 or 53a-217c. (13) Illegal manufacture, sale, possession or dispensing of a drug under subdivision (2) of section 21a-108. (14) Violation of a municipal ordinance resulting in the issuance of a citation for (A) excessive noise on nonresidential real property that significantly impacts the surrounding area, provided the municipality's excessive noise ordinance is based on an objective standard, (B) owning or leasing a dwelling unit that provides residence to an excessive number of unrelated persons resulting in dangerous or unsanitary conditions that significantly impact the safety of the surrounding area, or (C) impermissible operation of (i) a business that permits persons who are not licensed pursuant to section 20-206b to engage in the practice of massage therapy, or (ii) a massage parlor, as defined by the applicable municipal ordinance, that significantly impacts the safety of the surrounding area. Sec. 38. Section 19a-131g of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage): The Commissioner of Public Health shall establish a Public Health Preparedness Advisory Committee for purposes of advising the Department of Public Health on matters concerning emergency responses to a public health emergency. The advisory committee shall consist of the Commissioner of Public Health, or his or her designee, the Commissioner of Emergency Services and Public Protection, or his or her designee, the president pro tempore of the Senate, or his or her designee, the speaker of the House of Representatives, or his or her Substitute House Bill No. 6666 Public Act No. 21-121 52 of 132 designee, the majority and minority leaders of both houses of the General Assembly, [and] or their designees, the chairpersons and ranking members of the joint standing committees of the General Assembly having cognizance of matters relating to public health, public safety and the judiciary, [and] or their designees, representatives of town, city, borough and district directors of health, as appointed by the commissioner, and any other organization or persons that the commissioner deems relevant to the issues of public health preparedness. Upon the request of the commissioner, the Public Health Preparedness Advisory Committee may meet to review the plan for emergency responses to a public health emergency and other matters as deemed necessary by the commissioner. Sec. 39. Subsection (d) of section 19a-30 of the general statutes is repealed and the following is substituted in lieu thereof (Effective July 1, 2021): (d) A nonrefundable fee of two hundred dollars shall accompany each application for a license or for renewal thereof, except in the case of a clinical laboratory owned and operated by a municipality, the state, the United States or any agency of said municipality, state or United States. Each license shall be issued for a period of not less than twenty- four nor more than twenty-seven months from the deadline for applications established by the commissioner. Renewal applications shall be made (1) biennially within the twenty-fourth month of the current license; (2) before any change in ownership or change in director is made; and (3) prior to any major expansion or alteration in quarters. The licensed clinical laboratory shall report to the Department of Public Health, in a form and manner prescribed by the commissioner, the name and address of each blood collection facility owned and operated by the clinical laboratory, prior to the issuance of a new license, prior to the issuance of a renewal license or whenever a blood collection facility opens or closes. Substitute House Bill No. 6666 Public Act No. 21-121 53 of 132 Sec. 40. Subsection (b) of section 20-365 of the general statutes is repealed and the following is substituted in lieu thereof (Effective July 1, 2021): (b) Nothing in section 19a-200, as amended by this act, subsection (a) of section 19a-206, or sections 19a-207, 19a-242, 20-358 or 20-360 to 20- 365, inclusive, shall prevent any of the following persons from engaging in the performance of their duties: (1) Any person certified by the Department of Public Health as a food or sewage inspector in accordance with regulations adopted pursuant to section 19a-36, (2) any person employed by a local health department performing the duties of a lead inspector who complies with training standards established pursuant to section 20-479, (3) a director of health acting pursuant to [subsection (a) of] section 19a-200, as amended by this act, or section 19a-244, as amended by this act, (4) any employee of a water utility or federal or state agency performing his duties in accordance with applicable statutes and regulations, (5) any person employed by a local health department working under the direct supervision of a licensed sanitarian, (6) any person licensed or certified by the Department of Public Health in a specific program performing certain duties that are included within the duties of a sanitarian, or (7) a student enrolled in an accredited academic program leading to a degree in environmental health or completing a special training course in environmental health approved by the commissioner, provided such student is clearly identified by a title which indicates [his] such student's status as a student. Sec. 41. Subsection (b) of section 20-195u of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage): (b) Continuing education required pursuant to this section shall be related to the practice of social work and shall include not less than one contact hour of training or education each registration period on the Substitute House Bill No. 6666 Public Act No. 21-121 54 of 132 topic of cultural competency and, on and after January 1, 2016, not less than two contact hours of training or education during the first renewal period in which continuing education is required and not less than once every six years thereafter on the topic of mental health conditions common to veterans and family members of veterans, including (1) determining whether a patient is a veteran or family member of a veteran, (2) screening for conditions such as post-traumatic stress disorder, risk of suicide, depression and grief, and (3) suicide prevention training. Such continuing education shall consist of courses, workshops and conferences offered or approved by the Association of Social Work Boards, the National Association of Social Workers or a school or department of social work accredited by the Council on Social Work Education. A licensee's ability to engage in on-line and home study continuing education shall be limited to not more than [six] ten hours per registration period. Within the registration period, an initial presentation by a licensee of an original paper, essay or formal lecture in social work to a recognized group of fellow professionals may account for five hours of continuing education hours of the aggregate continuing education requirements prescribed in this section. Sec. 42. Subsection (a) of section 20-265h of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage): (a) On and after July 1, 2021, each spa or salon that employs hairdressers and cosmeticians, estheticians, eyelash technicians, [or] nail technicians or massage therapists shall be under the management of a hairdresser and cosmetician registered under this chapter, an esthetician licensed under section 20-265b or 20-265f, an eyelash technician licensed under section 20-265c, as amended by this act, or 20-265f, [or] a nail technician licensed under section 20-265d, as amended by this act, or 20- 265f or a massage therapist licensed under chapter 384a. Sec. 43. Subsection (a) of section 19a-131j of the general statutes is Substitute House Bill No. 6666 Public Act No. 21-121 55 of 132 repealed and the following is substituted in lieu thereof (Effective from passage): (a) The commissioner may issue an order to temporarily suspend, for a period not to exceed sixty consecutive days, the requirements for licensure, certification or registration, pursuant to chapters 368d, 370, 376 to 376c, inclusive, 378, 378a, 379, 379a, 381a, 382a, 383 to 383c, inclusive, 383d, 383f, 383g, 384b, 384d, 385, 395, 399, 400a, 400j and 474, to allow persons who are appropriately licensed, certified or registered in another state or territory of the United States or the District of Columbia, to render temporary assistance within the scope of the profession for which a person is licensed, certified or registered, in managing a public health emergency in this state, declared by the Governor pursuant to section 19a-131a. Nothing in this section shall be construed to permit a person to provide services beyond the scope allowed in the chapter specified in this section that pertains to such person's profession. Sec. 44. Subsection (a) of section 19a-512 of the general statutes is repealed and the following is substituted in lieu thereof (Effective July 1, 2021): (a) In order to be eligible for licensure by examination pursuant to sections 19a-511 to 19a-520, inclusive, a person shall submit an application, together with a fee of two hundred dollars, and proof satisfactory to the Department of Public Health that [he] such person (1) is physically and emotionally capable of administering a nursing home; (2) has satisfactorily completed a program of instruction and training, including residency training which meets the requirements of subsection (b) of this section and which is approved by the Commissioner of Public Health; and (3) has passed an examination prescribed [and administered] by the Department of Public Health designed to test the applicant's knowledge and competence in the subject matter referred to in subsection (b) of this section. Passing scores Substitute House Bill No. 6666 Public Act No. 21-121 56 of 132 shall be established by the department. Sec. 45. Section 19a-490 of the general statutes is repealed and the following is substituted in lieu thereof (Effective July 1, 2021): (a) "Institution" means a hospital, short-term hospital special hospice, hospice inpatient facility, residential care home, nursing home facility, home health care agency, hospice agency, home health aide agency, behavioral health facility, assisted living services agency, [substance abuse treatment facility,] outpatient surgical facility, outpatient clinic, an infirmary operated by an educational institution for the care of students enrolled in, and faculty and employees of, such institution; a facility engaged in providing services for the prevention, diagnosis, treatment or care of human health conditions, including facilities operated and maintained by any state agency; and a residential facility for persons with intellectual disability licensed pursuant to section 17a- 227 and certified to participate in the Title XIX Medicaid program as an intermediate care facility for individuals with intellectual disability. "Institution" does not include any facility for the care and treatment of persons with mental illness or substance use disorder operated or maintained by any state agency, except Whiting Forensic Hospital; (b) "Hospital" means an establishment for the lodging, care and treatment of persons suffering from disease or other abnormal physical or mental conditions and includes inpatient psychiatric services in general hospitals; (c) "Residential care home" or "rest home" means a community residence that furnishes, in single or multiple facilities, food and shelter to two or more persons unrelated to the proprietor and, in addition, provides services that meet a need beyond the basic provisions of food, shelter and laundry and may qualify as a setting that allows residents to receive home and community-based services funded by state and federal programs; Substitute House Bill No. 6666 Public Act No. 21-121 57 of 132 (d) "Home health care agency" means a public or private organization, or a subdivision thereof, engaged in providing professional nursing services and the following services, available twenty-four hours per day, in the patient's home or a substantially equivalent environment: Home health aide services as defined in this section, physical therapy, speech therapy, occupational therapy or medical social services. The agency shall provide professional nursing services and at least one additional service directly and all others directly or through contract. An agency shall be available to enroll new patients seven days a week, twenty-four hours per day; (e) "Home health aide agency" means a public or private organization, except a home health care agency, which provides in the patient's home or a substantially equivalent environment supportive services which may include, but are not limited to, assistance with personal hygiene, dressing, feeding and incidental household tasks essential to achieving adequate household and family management. Such supportive services shall be provided under the supervision of a registered nurse and, if such nurse determines appropriate, shall be provided by a social worker, physical therapist, speech therapist or occupational therapist. Such supervision may be provided directly or through contract; (f) "Home health aide services" as defined in this section shall not include services provided to assist individuals with activities of daily living when such individuals have a disease or condition that is chronic and stable as determined by a physician licensed in the state; (g) "Behavioral health facility" means any facility that provides mental health services to persons eighteen years of age or older or substance use disorder services to persons of any age in an outpatient treatment or residential setting to ameliorate mental, emotional, behavioral or substance use disorder issues; Substitute House Bill No. 6666 Public Act No. 21-121 58 of 132 (h) "Alcohol or drug treatment facility" means any facility for the care or treatment of persons suffering from alcoholism or other drug addiction; (i) "Person" means any individual, firm, partnership, corporation, limited liability company or association; (j) "Commissioner" means the Commissioner of Public Health or the commissioner's designee; (k) "Home health agency" means an agency licensed as a home health care agency or a home health aide agency; (l) "Assisted living services agency" means an agency that provides, among other things, nursing services and assistance with activities of daily living to a population that is chronic and stable and that may have a dementia special care unit or program as defined in section 19a-562, as amended by this act; (m) "Outpatient clinic" means an organization operated by a municipality or a corporation, other than a hospital, that provides (1) ambulatory medical care, including preventive and health promotion services, (2) dental care, or (3) mental health services in conjunction with medical or dental care for the purpose of diagnosing or treating a health condition that does not require the patient's overnight care; (n) "Multicare institution" means a hospital that provides outpatient behavioral health services or other health care services, psychiatric outpatient clinic for adults, free-standing facility for the care or treatment of substance abusive or dependent persons, hospital for psychiatric disabilities, as defined in section 17a-495, or a general acute care hospital that provides outpatient behavioral health services that (1) is licensed in accordance with this chapter, (2) has more than one facility or one or more satellite units owned and operated by a single licensee, and (3) offers complex patient health care services at each facility or Substitute House Bill No. 6666 Public Act No. 21-121 59 of 132 satellite unit. For purposes of this subsection, "satellite unit" means a location where a segregated unit of services is provided by the multicare institution; (o) "Nursing home" or "nursing home facility" means (1) any chronic and convalescent nursing home or any rest home with nursing supervision that provides nursing supervision under a medical director twenty-four hours per day, or (2) any chronic and convalescent nursing home that provides skilled nursing care under medical supervision and direction to carry out nonsurgical treatment and dietary procedures for chronic diseases, convalescent stages, acute diseases or injuries; [and] (p) "Outpatient dialysis unit" means (1) an out-of-hospital out-patient dialysis unit that is licensed by the department to provide (A) services on an out-patient basis to persons requiring dialysis on a short-term basis or for a chronic condition, or (B) training for home dialysis, or (2) an in-hospital dialysis unit that is a special unit of a licensed hospital designed, equipped and staffed to (A) offer dialysis therapy on an out- patient basis, (B) provide training for home dialysis, and (C) perform renal transplantations; [.] and (q) "Hospice agency" means a public or private organization that provides home care and hospice services to terminally ill patients. Sec. 46. Subsections (b) to (i), inclusive, of section 19a-491 of the general statutes are repealed and the following is substituted in lieu thereof (Effective July 1, 2021): (b) If any person acting individually or jointly with any other person owns real property or any improvements thereon, upon or within which an institution, as defined in subsections (c) and (o) of section 19a-490, is established, conducted, operated or maintained and is not the licensee of the institution, such person shall submit a copy of the lease agreement to the department at the time of any change of ownership and with each Substitute House Bill No. 6666 Public Act No. 21-121 60 of 132 license renewal application. The lease agreement shall, at a minimum, identify the person or entity responsible for the maintenance and repair of all buildings and structures within which such an institution is established, conducted or operated. If a violation is found as a result of an inspection or investigation, the commissioner may require the owner to sign a consent order providing assurances that repairs or improvements necessary for compliance with the provisions of the [Public Health Code] regulations of Connecticut state agencies shall be completed within a specified period of time or may assess a civil penalty of not more than one thousand dollars for each day that such owner is in violation of the [Public Health Code] regulations of Connecticut state agencies or a consent order. A consent order may include a provision for the establishment of a temporary manager of such real property who has the authority to complete any repairs or improvements required by such order. Upon request of the Commissioner of Public Health, the Attorney General may petition the Superior Court for such equitable and injunctive relief as such court deems appropriate to ensure compliance with the provisions of a consent order. The provisions of this subsection shall not apply to any property or improvements owned by a person licensed in accordance with the provisions of subsection (a) of this section to establish, conduct, operate or maintain an institution on or within such property or improvements. (c) Notwithstanding any regulation, the Commissioner of Public Health shall charge the following fees for the biennial licensing and inspection of the following institutions: (1) Chronic and convalescent nursing homes, per site, four hundred forty dollars; (2) chronic and convalescent nursing homes, per bed, five dollars; (3) rest homes with nursing supervision, per site, four hundred forty dollars; (4) rest homes with nursing supervision, per bed, five dollars; (5) outpatient dialysis units and outpatient surgical facilities, six hundred twenty-five dollars; (6) mental health residential facilities, per site, three hundred seventy- five dollars; (7) mental health residential facilities, per bed, five dollars; Substitute House Bill No. 6666 Public Act No. 21-121 61 of 132 (8) hospitals, per site, nine hundred forty dollars; (9) hospitals, per bed, seven dollars and fifty cents; (10) nonstate agency educational institutions, per infirmary, one hundred fifty dollars; (11) nonstate agency educational institutions, per infirmary bed, twenty-five dollars; (12) home health care agencies, except certified home health care agencies described in subsection (d) of this section, per agency, three hundred dollars; (13) home health care agencies, hospice agencies, or home health aide agencies, except certified home health care agencies, hospice agencies or home health aide agencies described in subsection (d) of this section, per satellite patient service office, one hundred dollars; (14) assisted living services agencies, except such agencies participating in the congregate housing facility pilot program described in section 8-119n, per site, five hundred dollars; (15) short-term hospitals special hospice, per site, nine hundred forty dollars; (16) short-term hospitals special hospice, per bed, seven dollars and fifty cents; (17) hospice inpatient facility, per site, four hundred forty dollars; and (18) hospice inpatient facility, per bed, five dollars. (d) Notwithstanding any regulation, the commissioner shall charge the following fees for the triennial licensing and inspection of the following institutions: (1) Residential care homes, per site, five hundred sixty-five dollars; (2) residential care homes, per bed, four dollars and fifty cents; (3) home health care agencies that are certified as a provider of services by the United States Department of Health and Human Services under the Medicare or Medicaid program, three hundred dollars; and (4) certified home health care agencies or hospice agencies, as described in section 19a-493, as amended by this act, per satellite patient service office, one hundred dollars. (e) The commissioner shall charge one thousand dollars for the licensing and inspection of outpatient clinics that provide either medical or mental health service, urgent care services and well-child clinical services, except those operated by a municipal health department, Substitute House Bill No. 6666 Public Act No. 21-121 62 of 132 health district or licensed nonprofit nursing or community health agency. Such licensing and inspection shall be performed every three years, except those outpatient clinics that have obtained accreditation from a national accrediting organization within the immediately preceding twelve-month period may be inspected by the commissioner once every four years, provided the outpatient clinic has not committed any violation that the commissioner determines would pose an immediate threat to the health, safety or welfare of the patients of the outpatient clinic. The provisions of this subsection shall not be construed to limit the commissioner's authority to inspect any applicant for licensure or renewal of licensure as an outpatient clinic, suspend or revoke any license granted to an outpatient clinic pursuant to this section or take any other legal action against an outpatient clinic that is authorized by any provision of the general statutes. (f) Any institution that is planning a project for construction or building alteration shall provide the plan for such project to the Department of Public Health for review. Any such project shall comply with nationally established facility guidelines for health care construction, as approved by the commissioner, that are in place at the time the institution provides the plan to the department. The commissioner shall post a reference to such guidelines, including the effective date of such guidelines, on the Department of Public Health's Internet web site. No institution shall be required to include matters outside the scope and applicability of such guidelines in the institution's plan. (g) The commissioner shall charge a fee of five hundred sixty-five dollars for the technical assistance provided for the design, review and development of an institution's construction, renovation, building alteration, sale or change in ownership when the cost of the project is one million dollars or less and shall charge a fee of one-quarter of one per cent of the total construction cost when the cost of the project is more Substitute House Bill No. 6666 Public Act No. 21-121 63 of 132 than one million dollars. Such fee shall include all department reviews and on-site inspections. For purposes of this subsection, "institution" does not include a facility owned by the state. (h) The commissioner may require as a condition of the licensure of a home health care [agencies] agency, hospice agency and home health aide [agencies] agency that each agency meet minimum service quality standards. In the event the commissioner requires such agencies to meet minimum service quality standards as a condition of their licensure, the commissioner shall adopt regulations, in accordance with the provisions of chapter 54, to define such minimum service quality standards, which shall (1) allow for training of home health aides by adult continuing education, (2) require a registered nurse to visit and assess each patient receiving home health aide services as often as necessary based on the patient's condition, but not less than once every sixty days, and (3) require the assessment prescribed by subdivision (2) of this subsection to be completed while the home health aide is providing services in the patient's home. (i) No person acting individually or jointly with any other person shall establish, conduct, operate or maintain a home health care agency, hospice agency or home health aide agency without maintaining professional liability insurance or other indemnity against liability for professional malpractice. The amount of insurance which such person shall maintain as insurance or indemnity against claims for injury or death for professional malpractice shall be not less than one million dollars for one person, per occurrence, with an aggregate of not less than three million dollars. Sec. 47. Subdivision (4) of subsection (a) of section 19a-491c of the general statutes is repealed and the following is substituted in lieu thereof (Effective July 1, 2021): (4) "Long-term care facility" means any facility, agency or provider Substitute House Bill No. 6666 Public Act No. 21-121 64 of 132 that is a nursing home, as defined in section 19a-521, a residential care home, as defined in section 19a-521, a home health care agency, hospice agency or home health aide agency, as defined in section 19a-490, as amended by this act, an assisted living services agency, as defined in section 19a-490, as amended by this act, an intermediate care facility for individuals with intellectual disabilities, as defined in 42 USC 1396d(d), except any such facility operated by a Department of Developmental Services' program subject to background checks pursuant to section 17a- 227a, a chronic disease hospital, as defined in section 19a-550, or an agency providing hospice care which is licensed to provide such care by the Department of Public Health or certified to provide such care pursuant to 42 USC 1395x. Sec. 48. Section 19a-492b of the general statutes is repealed and the following is substituted in lieu thereof (Effective July 1, 2021): (a) A home health care agency or hospice agency that receives payment for rendering care to persons receiving medical assistance from the state, assistance from the Connecticut home-care program for the elderly pursuant to section 17b-342, or funds obtained through Title XVIII of the Social Security Amendments of 1965 shall be prohibited from discriminating against such persons who apply for enrollment to such home health care agency on the basis of source of payment. (b) Any home health care agency or hospice agency which violates the provisions of this section shall be subject to suspension or revocation of license. Sec. 49. Subsection (b) of section 19a-492c of the general statutes is repealed and the following is substituted in lieu thereof (Effective July 1, 2021): (b) A home health care agency or hospice agency licensed pursuant to this chapter that provides hospice services in a rural town and is Substitute House Bill No. 6666 Public Act No. 21-121 65 of 132 unable to access licensed or Medicare-certified hospice care to consistently provide adequate services to patients in the rural town may apply to the Commissioner of Public Health for a waiver from the regulations licensing such agency adopted pursuant to this chapter. The waiver may authorize one or more of the following: (1) The agency's supervisor of clinical services may also serve as the supervisor of clinical services assigned to the hospice program; (2) the hospice volunteer coordinator and the hospice program director may be permanent part- time employees; and (3) the program director may perform other services at the agency, including, but not limited to, hospice volunteer coordinator. The commissioner shall not grant a waiver unless the commissioner determines that such waiver will not adversely impact the health, safety and welfare of hospice patients and their families. The waiver shall be in effect for two years. An agency may reapply for such a waiver. Sec. 50. Section 19a-492d of the general statutes is repealed and the following is substituted in lieu thereof (Effective July 1, 2021): On and after October 1, 2007, a nurse who is employed by an agency licensed by the Department of Public Health as a home health care agency, hospice agency or [a] home health aide agency may administer influenza and pneumococcal vaccines to persons in their homes, after an assessment for contraindications, without a physician's order in accordance with a physician-approved agency policy that includes an anaphylaxis protocol. In the event of an adverse reaction to the vaccine, such nurse may also administer epinephrine or other anaphylaxis medication without a physician's order in accordance with the physician-approved agency policy. For purposes of this section, "nurse" means an advanced practice registered nurse, registered nurse or practical nurse licensed under chapter 378. Sec. 51. Section 19a-492e of the general statutes is repealed and the following is substituted in lieu thereof (Effective July 1, 2021): Substitute House Bill No. 6666 Public Act No. 21-121 66 of 132 (a) For purposes of this section "home health care agency" [has] and "hospice agency" have the same [meaning] meanings as provided in section 19a-490, as amended by this act. Notwithstanding the provisions of chapter 378, a registered nurse may delegate the administration of medications that are not administered by injection to home health aides and hospice aides who have obtained certification and recertification every three years thereafter for medication administration in accordance with regulations adopted pursuant to subsection (b) of this section, unless the prescribing practitioner specifies that a medication shall only be administered by a licensed nurse. Any home health aide or hospice aide who obtained certification in the administration of medications on or before June 30, 2015, shall obtain recertification on or before July 1, 2018. (b) (1) The Commissioner of Public Health shall adopt regulations, in accordance with the provisions of chapter 54, to carry out the provisions of this section. Such regulations shall require each home health care agency or hospice agency that serves clients requiring assistance with medication administration to (A) adopt practices that increase and encourage client choice, dignity and independence; (B) establish policies and procedures to ensure that a registered nurse may delegate allowed tasks of nursing care, to include medication administration, to home health aides or hospice aides when the registered nurse determines that it is in the best interest of the client and the home health aide or hospice aide has been deemed competent to perform the task; (C) designate home health aides and hospice aides to obtain certification and recertification for the administration of medication; and (D) ensure that such home health aides receive such certification and recertification. (2) The regulations shall establish certification and recertification requirements for medication administration and the criteria to be used by home health care agencies and hospice agencies that provide services for clients requiring assistance with medication administration in Substitute House Bill No. 6666 Public Act No. 21-121 67 of 132 determining (A) which home health aides and hospice aides shall obtain such certification and recertification, and (B) education and skill training requirements, including ongoing training requirements for such certification and recertification. (3) Education and skill training requirements for initial certification and recertification shall include, but not be limited to, initial orientation, training in client rights and identification of the types of medication that may be administered by unlicensed personnel, behavioral management, personal care, nutrition and food safety, and health and safety in general. (c) Each home health care agency and, on or before January 1, 2022, each hospice agency shall ensure that, on or before January 1, 2013, delegation of nursing care tasks in the home care setting is allowed within such agency and that policies are adopted to employ home health aides or hospice aides for the purposes of allowing nurses to delegate such tasks. (d) A registered nurse licensed pursuant to the provisions of chapter 378 who delegates the task of medication administration to a home health aide or hospice aide pursuant to this section shall not be subject to disciplinary action based on the performance of the home health aide or hospice aide to whom tasks are delegated, unless the home health aide or hospice aide is acting pursuant to specific instructions from the registered nurse or the registered nurse fails to leave instructions when the nurse should have done so, provided the registered nurse: (1) Documented in the patient's care plan that the medication administration could be properly and safely performed by the home health aide or hospice aide to whom it is delegated, (2) provided initial direction to the home health aide or hospice aide, and (3) provided ongoing supervision of the home health aide or hospice aide, including the periodic assessment and evaluation of the patient's health and safety related to medication administration. Substitute House Bill No. 6666 Public Act No. 21-121 68 of 132 (e) A registered nurse who delegates the provision of nursing care to another person pursuant to this section shall not be subject to an action for civil damages for the performance of the person to whom nursing care is delegated unless the person is acting pursuant to specific instructions from the nurse or the nurse fails to leave instructions when the nurse should have done so. (f) No person may coerce a registered nurse into compromising patient safety by requiring the nurse to delegate the administration of medication if the nurse's assessment of the patient documents a need for a nurse to administer medication and identifies why the need cannot be safely met through utilization of assistive technology or administration of medication by certified home health aides or hospice aides. No registered nurse who has made a reasonable determination based on such assessment that delegation may compromise patient safety shall be subject to any employer reprisal or disciplinary action pursuant to chapter 378 for refusing to delegate or refusing to provide the required training for such delegation. The Department of Social Services, in consultation with the Department of Public Health, [and] home health care agencies and hospice agencies, shall develop protocols for documentation pursuant to the requirements of this subsection. The Department of Social Services shall notify all licensed home health care agencies and hospice agencies of such protocols prior to the implementation of this section. (g) The Commissioner of Public Health may implement policies and procedures necessary to administer the provisions of this section while in the process of adopting such policies and procedures as regulations, provided notice of intent to adopt regulations is published in the Connecticut Law Journal not later than twenty days after the date of implementation. Policies and procedures implemented pursuant to this section shall be valid until the time final regulations are adopted. Sec. 52. Section 19a-496a of the general statutes is repealed and the Substitute House Bill No. 6666 Public Act No. 21-121 69 of 132 following is substituted in lieu thereof (Effective July 1, 2021): (a) Notwithstanding any provision of the regulations of Connecticut state agencies, all home health care agency, hospice agency and home health aide agency services shall be performed upon the order of a physician or physician assistant licensed pursuant to chapter 370 or an advanced practice registered nurse licensed pursuant to chapter 378. (b) All home health care agency services which are required by law to be performed upon the order of a licensed physician may be performed upon the order of a physician, physician assistant or advanced practice registered nurse licensed in a state which borders Connecticut. Sec. 53. Section 19a-504d of the general statutes is repealed and the following is substituted in lieu thereof (Effective July 1, 2021): (a) If a hospital recommends home health care to a patient, the hospital discharge plan shall include two or more available options of home health care agencies or hospice agencies. (b) A hospital which (1) has an ownership or investment interest in a home health care agency or hospice agency, or (2) receives compensation or remuneration for referral of patients to a home health care agency or hospice agency shall disclose such interest to any patient prior to including such agency as an option in a hospital discharge plan. Such information shall be verbally disclosed to each patient or shall be posted in a conspicuous place visible to patients. As used in this subsection, "ownership or investment interest" does not include ownership of investment securities purchased by the practitioner on terms available to the general public and which are publicly traded. Sec. 54. (NEW) (Effective July 1, 2021) (a) The Commissioner of Public Health may suspend the requirements for licensure to authorize a licensed chronic and convalescent nursing home to provide services to Substitute House Bill No. 6666 Public Act No. 21-121 70 of 132 patients with a reportable disease, emergency illness or health condition, pursuant to section 19-91 of the general statutes, under their existing license if such licensed chronic and convalescent nursing home (1) provides services to such patients in a building that is not physically connected to its licensed facility, or (2) expands its bed capacity in a portion of a facility that is separate from the licensed facility. Such services may only be provided in order to render temporary assistance in managing a public health emergency in this state, declared by the Governor pursuant to section 19a-131a of the general statutes. (b) Each chronic and convalescent nursing home that intends to provide services pursuant to subsection (a) of this section shall submit an application to the Department of Public Health in a form and manner prescribed by the commissioner. Such application shall include, but need not be limited to: (1) Information regarding the facility's ability to sufficiently address the health, safety or welfare of such chronic and convalescent nursing home's residents and staff; (2) the address of such facility; (3) an attestation that all equipment located at such facility is maintained according to the manufacturers' specifications, and is capable of meeting the needs of such facility's residents; (4) information regarding such facility's maximum bed capacity; and (5) information indicating that such facility is in compliance with any provisions of the general statutes or regulations of Connecticut state agencies pertaining to the operation of such facility. (c) Upon receipt of an application pursuant to subsection (a) of this section, the Department of Public Health shall conduct a scheduled inspection and investigation of the applicant's facilities to ensure compliance with any provisions of the general statutes or regulations of Connecticut state agencies pertaining to the licensing of such facilities. After conducting such inspection and investigation, the department shall notify the applicant of the department's approval or denial of such application. Substitute House Bill No. 6666 Public Act No. 21-121 71 of 132 Sec. 55. Section 19a-522f of the general statutes is repealed and the following is substituted in lieu thereof (Effective July 1, 2021): (a) As used in this section: (1) "Administer" means to initiate the venipuncture and deliver an IV fluid or IV admixture into the blood stream through a vein, and to monitor and care for the venipuncture site, terminate the procedure and record pertinent events and observations; (2) "IV admixture" means an IV fluid to which one or more additional drug products have been added; (3) "IV fluid" means sterile solutions of fifty milliliters or more, intended for intravenous infusion, but does not include blood and blood products; (4) "IV therapy" means the introduction of an IV fluid or IV admixture into the blood stream through a vein for the purpose of correcting water deficit and electrolyte imbalances, providing nutrition, and delivering antibiotics and other therapeutic agents approved by a chronic and convalescent nursing home's or a rest home with nursing supervision's medical staff; (5) "IV therapy program" means the overall plan by which a chronic and convalescent nursing home or a rest home with nursing supervision implements, monitors and safeguards the administration of IV therapy to patients; and (6) "IV therapy nurse" means a registered nurse who is qualified by education and training and has demonstrated proficiency in the theoretical and clinical aspects of IV therapy to administer an IV fluid or IV admixture. (b) An IV therapy nurse or a physician assistant licensed pursuant to Substitute House Bill No. 6666 Public Act No. 21-121 72 of 132 section 20-12b, who is employed by, or operating under a contract to provide services in, a chronic and convalescent nursing home or a rest home with nursing supervision that operates an IV therapy program may administer a peripherally inserted central catheter as part of such facility's IV therapy program. The Department of Public Health shall adopt regulations in accordance with the provisions of chapter 54 to carry out the purposes of this section. (c) A chronic and convalescent nursing home may allow a registered nurse licensed pursuant to chapter 378 and employed by such chronic and convalescent nursing home who has been properly trained by the director of nursing or by an intravenous infusion company to (1) administer IV therapy or a dose of medication by intravenous injection, provided such medication is on a list of medications approved by the facility's governing body, pharmacist and medical director for intravenous injection by a registered nurse, or (2) draw blood from a central line for laboratory purposes, provided the facility has an agreement with a laboratory to process such specimens. Such chronic and convalescent nursing home shall notify the Commissioner of Public Health of any such services being provided under subdivisions (1) and (2) of this subsection. The administrator of each chronic and convalescent nursing home shall ensure that each registered nurse who is permitted to perform the services described in subdivisions (1) and (2) of this subsection is appropriately trained and competent to perform such services. Each administrator shall provide documentation regarding the training and competency of such registered nurses to the department upon the department's request. Sec. 56. (NEW) (Effective July 1, 2021) (a) The Commissioner of Public Health shall license assisted living services agencies, as defined in section 19a-490 of the general statutes, as amended by this act. A managed residential community wishing to provide assisted living services shall become licensed as an assisted living services agency or Substitute House Bill No. 6666 Public Act No. 21-121 73 of 132 shall arrange for assisted living services to be provided by another entity that is licensed as an assisted living services agency. (b) A managed residential care community that intends to arrange for assisted living services shall only do so with a currently licensed assisted living services agency. Such managed residential community shall submit an application to arrange for the assisted living services to the Department of Public Health in a form and manner prescribed by the commissioner. (c) An assisted living services agency providing services as a dementia special care unit or program, as defined in section 19a-562 of the general statutes, as amended by this act, shall obtain approval for such unit or program from the Department of Public Health. Such assisted living services agencies shall ensure that they have adequate staff to meet the needs of the residents. Each assisted living services agency that provides services as a dementia special care unit or program, as defined in section 19a-562 of the general statutes, as amended by this act, shall submit to the Department of Public Health a list of dementia special care units or locations and their staffing plans for any such units and locations when completing an initial or a renewal licensure application, or upon request from the department. (d) An assisted living services agency shall ensure that (1) all services being provided on an individual basis to clients are fully understood and agreed upon between either the client or the client's representative, and (2) the client or the client's representative are made aware of the cost of any such services. (e) The Department of Public Health may adopt regulations, in accordance with the provisions of chapter 54 of the general statutes, to carry out the purposes of this section. Sec. 57. Section 19a-521b of the general statutes is repealed and the Substitute House Bill No. 6666 Public Act No. 21-121 74 of 132 following is substituted in lieu thereof (Effective July 1, 2021): [In each] Each licensed chronic and convalescent nursing home, chronic disease hospital associated with a chronic and convalescent nursing home, rest home with nursing supervision and residential care home [, at least a three-foot clearance shall be provided at the sides and the foot of each bed] shall position beds in a manner that promotes resident care and that provides at least a three-foot clearance at the sides and foot of each bed. Such bed position shall (1) not act as a restraint to the resident, (2) not create a hazardous situation, including, but not limited to, an entrapment possibility, or obstacle to evacuation or being close to or blocking a heat source, and (3) allow for infection control. Sec. 58. Section 19a-195 of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2021): The commissioner shall adopt regulations in accordance with the provisions of chapter 54 to require all [emergency medical response services] ambulances to be staffed by at least one certified emergency medical technician, who shall be in the patient compartment attending the patient during all periods in which a patient is being transported, and one certified [medical response technician] emergency medical responder. Sec. 59. Section 20-206jj of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage): As used in this section and sections 20-206kk to 20-206oo, inclusive: (1) "Advanced emergency medical technician" means an individual who is certified as an advanced emergency medical technician by the Department of Public Health; (2) "Commissioner" means the Commissioner of Public Health; Substitute House Bill No. 6666 Public Act No. 21-121 75 of 132 (3) "Emergency medical services instructor" means a person who is certified under the provisions of section 20-206ll or 20-206mm, as amended by this act, by the Department of Public Health to teach courses, the completion of which is required in order to become an emergency medical technician; (4) "Emergency medical responder" means an individual who is certified to practice as an emergency medical responder under the provisions of section 20-206ll or 20-206mm, as amended by this act; (5) "Emergency medical services personnel" means an individual certified to practice as an emergency medical responder, emergency medical technician, advanced emergency medical technician, emergency medical services instructor or an individual licensed as a paramedic; (6) "Emergency medical technician" means a person who is certified to practice as an emergency medical technician under the provisions of section 20-206ll or 20-206mm, as amended by this act; (7) "National organization for emergency medical certification" means a national organization approved by the Department of Public Health and identified on the department's Internet web site, or such national organization's successor organization, that tests and provides certification to emergency medical responders, emergency medical technicians, advanced medical technicians and paramedics; (8) "Office of Emergency Medical Services" means the office established within the Department of Public Health pursuant to section 19a-178; (9) "Paramedicine" means the carrying out of (A) all phases of cardiopulmonary resuscitation and defibrillation, (B) the administration of drugs and intravenous solutions under written or oral authorization from a licensed physician or a licensed advanced practice registered Substitute House Bill No. 6666 Public Act No. 21-121 76 of 132 nurse, and (C) the administration of controlled substances, as defined in section 21a-240, in accordance with written protocols or standing orders of a licensed physician or a licensed advanced practice registered nurse; and (10) "Paramedic" means a person licensed to practice as a paramedic under the provisions of section 20-206ll. [; and] [(11) "Continuing education platform Internet web site" means an online database, approved by the Commissioner of Public Health, for emergency medical services personnel to enter, track and reconcile the hours and topics of continuing education completed by such personnel.] Sec. 60. Subsection (b) of section 19a-178a of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage): (b) The advisory board shall consist of members appointed in accordance with the provisions of this subsection and shall include the Commissioner of Public Health, the department's emergency medical services medical director and the president of each of the regional emergency medical services councils, or their designees. The Governor shall appoint the following members: (1) One person from the Connecticut Association of Directors of Health; (2) three persons from the Connecticut College of Emergency Physicians; (3) one person from the Connecticut Committee on Trauma of the American College of Surgeons; (4) one person from the Connecticut Medical Advisory Committee; (5) one person from the Emergency Nurses Association; (6) one person from the Connecticut Association of Emergency Medical Services Instructors; (7) one person from the Connecticut Hospital Association; (8) two persons representing commercial ambulance services; (9) one person from the Connecticut State Firefighters Association; (10) one person from the Connecticut Fire Chiefs Association; (11) one person from the Connecticut Police Chiefs Substitute House Bill No. 6666 Public Act No. 21-121 77 of 132 Association; (12) one person from the Connecticut State Police; and (13) one person from the Connecticut Commission on Fire Prevention and Control. An additional eighteen members shall be appointed as follows: (A) Three by the president pro tempore of the Senate; (B) three by the majority leader of the Senate; (C) four by the minority leader of the Senate; (D) three by the speaker of the House of Representatives; (E) two by the majority leader of the House of Representatives; and (F) three by the minority leader of the House of Representatives. The appointees shall include a person with experience in municipal ambulance services; a person with experience in for-profit ambulance services; three persons with experience in volunteer ambulance services; a paramedic; an emergency medical technician; an advanced emergency medical technician; three consumers and four persons from state-wide organizations with interests in emergency medical services as well as any other areas of expertise that may be deemed necessary for the proper functioning of the advisory board. Any appointment to the advisory board that is vacant for more than one year shall be filled by the Commissioner of Public Health. The commissioner shall notify the appointing authority of the identity of the commissioner's appointment not later than thirty days before making such appointment. Sec. 61. Subsection (a) of section 19a-36h of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage): (a) Not later than January 1, [2020] 2023, the commissioner shall adopt and administer by reference the United States Food and Drug Administration's Food Code, as amended from time to time, and any Food Code Supplement published by said administration as the state's food code for the purpose of regulating food establishments. Sec. 62. Subsection (a) of section 19a-36j of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage): Substitute House Bill No. 6666 Public Act No. 21-121 78 of 132 (a) On and after January 1, [2019] 2023, no person shall engage in the practice of a food inspector unless such person has obtained a certification from the commissioner in accordance with the provisions of this section. The commissioner shall develop a training and verification program for food inspector certification that shall be administered by the food inspection training officer at a local health department. (1) Each person seeking certification as a food inspector shall submit an application to the department on a form prescribed by the commissioner and present to the department satisfactory evidence that such person (A) is sponsored by the director of health in the jurisdiction in which the applicant is employed to conduct food inspections, (B) possesses a bachelor's degree or three years of experience in a regulatory food protection program, (C) has successfully completed a training and verification program, (D) has successfully completed the field standardization inspection prescribed by the commissioner, and (E) is not involved in the ownership or management of a food establishment located in the applicant's jurisdiction. (2) Each director of health sponsoring an applicant for certification as a food inspector shall submit to the commissioner a form documenting the applicant's qualifications and successful completion of the requirements described in subdivision (1) of this subsection. (3) Certifications issued under this section shall be subject to renewal once every three years. A food inspector applying for renewal of his or her certification shall demonstrate successful completion of twenty contact hours in food protection training, as approved by the commissioner, and reassessment by the food inspection training officer. Sec. 63. Section 19a-36o of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage): Substitute House Bill No. 6666 Public Act No. 21-121 79 of 132 Notwithstanding any provision of the general statutes, from June 30, 2017, until December 31, [2018] 2022, a food service establishment may request a variance from the Commissioner of Public Health from the requirements of the [Public Health Code] regulations of Connecticut state agencies, established under section 19a-36, to utilize the process of sous vide and acidification of sushi rice, as defined in section 3-502.11 of the United States Food and Drug Administration's Food Code, as amended from time to time. The Commissioner of Public Health shall review the request for a variance and provide the food establishment with notification regarding the status of its request not later than thirty days after the commissioner receives such request. The commissioner may grant such variance if he or she determines that such variance would not result in a health hazard or nuisance. Sec. 64. Subdivision (5) of section 19a-332 of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2021): (5) "Asbestos-containing material" means material composed of asbestos of any type and in an amount equal to or greater than one per cent by weight, either alone or mixed with other fibrous or nonfibrous material; Sec. 65. Subdivision (4) of section 20-250 of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage): (4) "Hairdressing and cosmetology" means the art of dressing, arranging, curling, waving, weaving, cutting, singeing, bleaching and coloring the hair and treating the scalp of any person, and massaging, cleansing, stimulating, manipulating, exercising or beautifying with the use of the hands, appliances, cosmetic preparations, antiseptics, tonics, lotions, creams, powders, oils or clays and doing similar work on the face, neck and arms for compensation, removing hair from the face or Substitute House Bill No. 6666 Public Act No. 21-121 80 of 132 neck using manual or mechanical means, excluding esthetics, as defined in section 20-265a or any of the actions listed in this subdivision performed on the nails of the hands or feet, provided nothing in this subdivision shall prohibit an unlicensed person from performing shampooing or braiding hair; Sec. 66. Subsection (b) of section 20-265b of the general statutes is repealed and the following is substituted in lieu thereof (Effective July 1, 2021): (b) On and after January 1, 2020, each person seeking an initial license as an esthetician shall apply to the department on a form prescribed by the department, accompanied by an application fee of one hundred dollars and evidence that the applicant (1) has completed a course of not less than six hundred hours of study and received a certification of completion from a school approved under section 20-265g or section 20- 26 or in a school outside of the state whose requirements are equivalent to a school approved under section 20-265g, or (2) (A) if applying before January 1, 2022, has practiced esthetics continuously in this state for a period of not less than two years prior to July 1, 2020, and (B) is in compliance with the infection prevention and control plan guidelines prescribed by the department under section 19a-231 in the form of an attestation. Sec. 67. Subsection (f) of section 10-206 of the general statutes is repealed and the following is substituted in lieu thereof (Effective July 1, 2021): (f) On and after October 1, 2017, each local or regional board of education shall report to the local health department and the Department of Public Health, on an triennial basis, the total number of pupils per school and per school district having a diagnosis of asthma (1) at the time of public school enrollment, (2) in grade six or seven, and (3) in grade nine or ten. [or eleven.] The report shall contain the asthma Substitute House Bill No. 6666 Public Act No. 21-121 81 of 132 information collected as required under subsections (b) and (c) of this section and shall include pupil age, gender, race, ethnicity and school. Beginning on October 1, 2021, and every three years thereafter, the Department of Public Health shall review the asthma screening information reported pursuant to this section and shall submit a report to the joint standing committees of the General Assembly having cognizance of matters relating to public health and education concerning asthma trends and distributions among pupils enrolled in the public schools. The report shall be submitted in accordance with the provisions of section 11-4a and shall include, but not be limited to, (A) trends and findings based on pupil age, gender, race, ethnicity, school and the education reference group, as determined by the Department of Education for the town or regional school district in which such school is located, and (B) activities of the asthma screening monitoring system maintained under section 19a-62a. Sec. 68. Section 19a-490w of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2021): (a) Not later than October 1, 2017, and annually thereafter, any hospital that has been certified as a comprehensive stroke center, a primary stroke center, a thrombectomy-capable stroke center or an acute stroke-ready hospital by the American Heart Association, the Joint Commission or any other nationally recognized certifying organization shall submit an attestation of such certification to the Commissioner of Public Health, in a form and manner prescribed by the commissioner. Not later than October 15, 2017, and annually thereafter, the Department of Public Health shall post a list of certified stroke centers on its Internet web site. (b) The department may remove a hospital from the list posted pursuant to subsection (a) of this section if (1) the hospital requests such removal, (2) the department is informed by the American Heart Association, the Joint Commission or other nationally recognized Substitute House Bill No. 6666 Public Act No. 21-121 82 of 132 certifying organization that a hospital's certification has expired or been suspended or revoked, or (3) the department does not receive attestation of certification from a hospital on or before October first. The department shall report to the nationally recognized certifying organization any complaint it receives related to the certification of a hospital as a comprehensive stroke center, a primary stroke center, a thrombectomy-capable stroke center or an acute stroke-ready hospital. The department shall provide the complainant with the name and contact information of the nationally recognized certifying organization if the complainant seeks to pursue a complaint with such organization. Sec. 69. Subsection (k) of section 19a-180 of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage): (k) Notwithstanding the provisions of subsection (a) of this section, any [volunteer, hospital-based or municipal ambulance service] emergency medical services organization that is licensed or certified and a primary service area responder may apply to the commissioner, on a short form application prescribed by the commissioner, to change the address of a principal or branch location or to add a branch location within its primary service area. Upon making such application, the applicant shall notify in writing all other primary service area responders in any municipality or abutting municipality in which the applicant proposes to change principal or branch locations. Unless a primary service area responder entitled to receive notification of such application objects, in writing, to the commissioner and requests a hearing on such application not later than fifteen calendar days after receiving such notice, the application shall be deemed approved thirty calendar days after filing. If any such primary service area responder files an objection with the commissioner within the fifteen-calendar-day time period and requests a hearing, the applicant shall be required to demonstrate need to change the address of a principal or branch Substitute House Bill No. 6666 Public Act No. 21-121 83 of 132 location within its primary service area at a public hearing as required under subsection (a) of this section. Sec. 70. Section 7-36 of the general statutes is repealed and the following is substituted in lieu thereof (Effective July 1, 2021): As used in this chapter and sections 19a-40 to 19a-45, inclusive, unless the context otherwise requires: (1) "Registrar of vital statistics" or "registrar" means the registrar of births, marriages, deaths and fetal deaths or any public official charged with the care of returns relating to vital statistics; (2) "Registration" means the process by which vital records are completed, filed and incorporated into the official records of the department; (3) "Institution" means any public or private facility that provides inpatient medical, surgical or diagnostic care or treatment, or nursing, custodial or domiciliary care, or to which persons are committed by law; (4) "Vital records" means a certificate of birth, death, fetal death or marriage; (5) "Certified copy" means a copy of a birth, death, fetal death or marriage certificate that (A) includes all information on the certificate except such information that is nondisclosable by law, (B) is issued or transmitted by any registrar of vital statistics, (C) includes an attested signature and the raised seal of an authorized person, and (D) if submitted to the department, includes all information required by the commissioner; (6) "Uncertified copy" means a copy of a birth, death, fetal death or marriage certificate that includes all information contained in a certified copy except an original attested signature and a raised seal of an Substitute House Bill No. 6666 Public Act No. 21-121 84 of 132 authorized person; (7) "Authenticate" or "authenticated" means to affix to a vital record in paper format the official seal, or to affix to a vital record in electronic format the user identification, password, or other means of electronic identification, as approved by the department, of the creator of the vital record, or the creator's designee, by which affixing the creator of such paper or electronic vital record, or the creator's designee, affirms the integrity of such vital record; (8) "Attest" means to verify a vital record in accordance with the provisions of subdivision (5) of this section; (9) "Correction" means to change or enter new information on a certificate of birth, marriage, death or fetal death, within one year of the date of the vital event recorded in such certificate, in order to accurately reflect the facts existing at the time of the recording of such vital event, where such changes or entries are to correct errors on such certificate due to inaccurate or incomplete information provided by the informant at the time the certificate was prepared, or to correct transcribing, typographical or clerical errors; (10) "Amendment" means to (A) change or enter new information on a certificate of birth, marriage, death or fetal death, more than one year after the date of the vital event recorded in such certificate, in order to accurately reflect the facts existing at the time of the recording of the event, (B) create a replacement certificate of birth for matters pertaining to parentage and gender change, or (C) reflect a legal name change in accordance with section 19a-42, as amended by this act, or make a modification to a cause of death; (11) "Acknowledgment of paternity" means to legally acknowledge paternity of a child pursuant to section 46b-172; (12) "Adjudication of paternity" means to legally establish paternity Substitute House Bill No. 6666 Public Act No. 21-121 85 of 132 through an order of a court of competent jurisdiction; (13) "Parentage" includes matters relating to adoption, gestational agreements, paternity and maternity; (14) "Department" means the Department of Public Health; (15) "Commissioner" means the Commissioner of Public Health or the commissioner's designee; (16) "Gestational agreement" means a written agreement for assisted reproduction in which a woman agrees to carry a child to birth for an intended parent or intended parents, which woman contributed no genetic material to the child and which agreement (A) names each party to the agreement and indicates each party's respective obligations under the agreement, (B) is signed by each party to the agreement and the spouse of each such party, if any, and (C) is witnessed by at least two disinterested adults and acknowledged in the manner prescribed by law; (17) "Intended parent" means a party to a gestational agreement who agrees, under the gestational agreement, to be the parent of a child born to a woman by means of assisted reproduction, regardless of whether the party has a genetic relationship to the child; (18) "Foundling" means (A) a child of unknown parentage, or (B) an infant voluntarily surrendered pursuant to the provisions of section 17a- 58; [and] (19) "Certified homeless youth" means a person who is at least fifteen years of age but less than eighteen years of age, is not in the physical custody of a parent or legal guardian, who is a homeless child or youth, as defined in 42 USC 11434a, as amended from time to time, and who has been certified as homeless by (A) a school district homeless liaison, (B) the director of an emergency shelter program funded by the United Substitute House Bill No. 6666 Public Act No. 21-121 86 of 132 States Department of Housing and Urban Development, or the director's designee, [or] (C) the director of a runaway or homeless youth basic center or transitional living program funded by the United States Department of Health and Human Services, or the director's designee, [.] or (D) the director of a program of a nonprofit organization or municipality that is contracted with the homeless youth program established pursuant to section 17a-62a; and (20) "Certified homeless young adult" means a person who is at least eighteen years of age but less than twenty-five years of age who has been certified as homeless by (A) a school district homeless liaison, (B) the director of an emergency shelter program funded by the United States Department of Housing and Urban Development, or the director's designee, (C) the director of a runaway or homeless youth basic center or transitional living program funded by the United States Department of Health and Human Services, or the director's designee, or (D) the director of a program of a nonprofit organization or municipality that is contracted with the homeless youth program established pursuant to section 17a-62a. Sec. 71. Subsection (c) of section 7-51 of the general statutes is repealed and the following is substituted in lieu thereof (Effective July 1, 2021): (c) (1) The registrar of the town in which the birth or fetal death occurred or of the town in which the [mother] birth parent resided at the time of the birth or fetal death, or the department, may issue a certified copy of the certificate of birth or fetal death of any person born in this state that is kept in paper form in the custody of the registrar. Except as provided in subdivision (2) of this subsection, such certificate shall be issued upon the written request of an eligible party listed in subsection (a) of this section. Any registrar of vital statistics in this state with access, as authorized by the department, to the electronic vital records system of the department may issue a certified copy of the electronically filed Substitute House Bill No. 6666 Public Act No. 21-121 87 of 132 certificate of birth or fetal death of any person born in this state upon the written request of an eligible party listed in subsection (a) of this section. The registrar and the department may waive the fee for the issuance of a certified copy of the certificate of birth of a certified homeless young adult to such young adult under this subsection. (2) In the case of a certified homeless youth, such certified homeless youth and the person who is certifying the certified homeless youth as homeless, as described in section 7-36, as amended by this act, shall appear in person when the certified homeless youth is presenting the written request described in subdivision (1) of this subsection at (A) the office of the registrar of the town in which the certified homeless youth was born, (B) the office of the registrar of the town in which the [mother] birth parent of the certified homeless youth resided at the time of the birth, (C) if the birth certificate of the certified homeless youth has been electronically filed, any registrar of vital statistics in the state with access, as authorized by the department, to the electronic vital records system, or (D) the state vital records office of the department. The certified homeless youth shall present to the registrar or the department information sufficient to identify himself or herself as may be required by regulations adopted by the commissioner pursuant to section 7-41. The person who is certifying the certified homeless youth as homeless shall present to the registrar or the department information sufficient to identify himself or herself as meeting the certification requirements of section 7-36, as amended by this act. The registrar and the department may waive the fee for the issuance of a certified copy of the certificate of birth of a homeless youth to such youth under this subsection. Sec. 72. Subsection (a) of section 1-1h of the general statutes is repealed and the following is substituted in lieu thereof (Effective July 1, 2021): (a) Any person who does not possess a valid motor vehicle operator's license may apply to the Department of Motor Vehicles for an identity Substitute House Bill No. 6666 Public Act No. 21-121 88 of 132 card. The application for an identity card shall be accompanied by the birth certificate of the applicant or a certificate of identification of the applicant issued and authorized for such use by the Department of Correction and a fee of twenty-eight dollars. Such application shall include: (1) The applicant's name; (2) the applicant's address; (3) whether the address is permanent or temporary; (4) the applicant's date of birth; (5) notice to the applicant that false statements on such application are punishable under section 53a-157b; and (6) such other pertinent information as the Commissioner of Motor Vehicles deems necessary. The applicant shall sign the application in the presence of an official of the Department of Motor Vehicles. The commissioner may waive the fee for any applicant (A) who has voluntarily surrendered such applicant's motor vehicle operator's license, (B) whose license has been refused by the commissioner pursuant to subdivision (4) of subsection (e) of section 14-36, (C) who is both a veteran, as defined in subsection (a) of section 27-103, and blind, as defined in subsection (a) of section 1-1f, or (D) who is a resident of a homeless shelter or other facility for homeless persons or a certified homeless youth or certified homeless young adult. The commissioner shall adopt regulations, in accordance with the provisions of chapter 54, to establish the procedure and qualifications for the issuance of an identity card to any such homeless applicant. For the purposes of this subsection, "certified homeless youth" and "certified homeless young adult" have the same meanings as provided in section 7-36, as amended by this act. Sec. 73. Subsection (b) of section 20-265d of the general statutes is repealed and the following is substituted in lieu thereof (Effective July 1, 2021): (b) On and after October 1, 2020, each person seeking an initial license as a nail technician shall apply to the department on a form prescribed by the department, accompanied by an application fee of one hundred dollars and evidence that the applicant (1) has completed a course of not Substitute House Bill No. 6666 Public Act No. 21-121 89 of 132 less than one hundred hours of study and received a certificate of completion from a school approved under section 20-265g or section 20- 262 or in a school outside of the state whose requirements are equivalent to a school approved under section 20-265g, or (2) (A) if the applicant is applying on or before January 1, 2022, has practiced as a nail technician continuously in this state for a period of not less than two years prior to January 1, 2021, and is in compliance with the infection prevention and control plan guidelines prescribed by the department under section 19a- 231 in the form of an attestation, or (B) has obtained a license as a nail technician trainee and a statement signed by the applicant's supervisor at the spa or salon where the licensed nail technician trainee is employed documenting completion of the minimum requirements specified in section 20-265e. If an applicant employed as a nail technician on or after September 30, 2020, does not have evidence satisfactory to the commissioner of continuous practice as a nail technician for not less than two years, such applicant may apply to the department for a nail technician trainee license, under section 20-265e, provided such person applies for an initial trainee license not later than January 1, 2021. Sec. 74. Subsection (b) of section 20-265c of the general statutes is repealed and the following is substituted in lieu thereof (Effective July 1, 2021): (b) On and after January 1, 2020, each person seeking an initial license as an eyelash technician shall apply to the department on a form prescribed by the department, accompanied by an application fee of one hundred dollars and evidence that the applicant (1) has completed a course of not less than fifty hours of study and received a certificate of completion from a school approved under section 20-265g or section 20- 262 or in a school outside of the state whose requirements are equivalent to a school approved under section 20-265g, or (2) (A) if the applicant is applying on or before January 1, 2022, has practiced as an eyelash technician continuously in this state for a period of not less than two Substitute House Bill No. 6666 Public Act No. 21-121 90 of 132 years prior to July 1, 2020, and (B) is in compliance with the infection prevention and control plan guidelines prescribed by the department under section 19a-231 in the form of an attestation. Sec. 75. Section 19a-55 of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage): (a) [The administrative officer or other person in charge of each institution caring for newborn infants shall cause to have administered to every such infant in its care an HIV-related test, as defined in section 19a-581, a test for phenylketonuria and other metabolic diseases, hypothyroidism, galactosemia, sickle cell disease, maple syrup urine disease, homocystinuria, biotinidase deficiency, congenital adrenal hyperplasia, severe combined immunodeficiency disease, adrenoleukodystrophy and such other tests for inborn errors of metabolism as shall be prescribed by the Department of Public Health. The tests shall be administered as soon after birth as is medically appropriate. If the mother has had an HIV-related test pursuant to section 19a-90 or 19a-593, the person responsible for testing under this section may omit an HIV-related test.] There is established a newborn screening program. The Commissioner of Public Health shall (1) administer the newborn screening program, (2) direct persons identified through the screening program to appropriate specialty centers for treatments, consistent with any applicable confidentiality requirements, and (3) set the fees to be charged to institutions to cover all expenses of the comprehensive screening program including testing, tracking and treatment, subject to the approval of the Secretary of the Office of Policy and Management. The fees to be charged pursuant to subdivision (3) of this subsection shall be set at a minimum of ninety-eight dollars. (b) The administrative officer or other person in charge of each institution caring for newborn infants, a nurse-midwife licensed pursuant to chapter 377 or a midwife shall cause to have administered to every such newborn infant in his or her care a blood spot specimen Substitute House Bill No. 6666 Public Act No. 21-121 91 of 132 and an HIV-related test, as defined in section 19a-581, except that the person responsible for testing may omit such test if the mother has had an HIV-related test pursuant to section 19a-90 or 19a-593. The blood spot specimen shall be collected not earlier than twenty-four hours after the birth of the newborn infant and not later than forty-eight hours after the birth of such infant, unless the institution caring for newborn infants, nurse-midwife licensed pursuant to chapter 377 or midwife determines that a situation exists to warrant an early collection of the specimen or if collection of the specimen is medically contraindicated. Situations that warrant early collection of the specimen shall include, but not be limited to, the imminent transfusion of blood products, dialysis, early discharge of the newborn infant from the institution, transfer of the newborn infant to another institution or imminent death. If the newborn infant dies before a blood spot specimen can be obtained, the specimen shall be collected as soon as practicable after death. The institution licensed to care for newborn infants, nurse-midwife or midwife shall notify the Department of Public Health when a specimen is not collected within forty-eight hours after the birth of such infant due to: (1) The infant's medical fragility, (2) refusal by the parents when newborn infant screening is in conflict with their religious tenets and practice, (3) the newborn infant receiving comfort measures only, or (4) any other reason. Such notification shall be documented in the department's newborn screening system pursuant to section 19a-53 by the institution caring for newborn infants, nurse-midwife or midwife or sent in writing to the department not later than seventy-two hours after the birth of the newborn infant. The institution caring for newborn infants, nurse- midwife or midwife shall send the blood spot specimen to the state public health laboratory not later than twenty-four hours after the time of collection. The department may request an additional blood spot specimen if: (A) There was an early collection of the specimen, (B) the specimen was collected following a transfusion of blood products, (C) the specimen is unsatisfactory for testing, or (D) the department determines that there is an abnormal result. The state public health Substitute House Bill No. 6666 Public Act No. 21-121 92 of 132 laboratory shall make and maintain a record of the date and time of its receipt of each blood spot specimen and make such record available for inspection by the institution caring for newborn infants, nurse-midwife or midwife that sent the blood spot specimen not later than forty-eight hours after such institution, nurse-midwife or midwife submits a request to inspect such record. (c) The Commissioner of Public Health shall publish a list of all the abnormal conditions for which the department screens newborns under the newborn screening program, which shall include, [screening] but need not be limited to, testing for amino acid disorders, including phenylketonuria, organic acid disorders, fatty acid oxidation disorders, including, but not limited to, long-chain 3-hydroxyacyl CoA dehydrogenase (L-CHAD) and medium-chain acyl-CoA dehydrogenase (MCAD), hypothyroidism, galactosemia, sickle cell disease, maple syrup urine disease, homocystinuria, biotinidase deficiency, congenital adrenal hyperplasia, severe combined immunodeficiency disease, adrenoleukodystrophy, spinal muscular atrophy and [, subject to the approval of the Secretary of the Office of Policy and Management,] any other disorder included on the recommended uniform screening panel pursuant to 42 USC 300b-10, as amended from time to time, and as prescribed by the Commissioner of Public Health. [(b)] (d) In addition to the testing requirements prescribed in subsection [(a)] (b) of this section, the administrative officer or other person in charge of each institution caring for newborn infants shall cause to have administered to (1) every such infant in its care a screening test for (A) cystic fibrosis, and (B) critical congenital heart disease, [and (C) on and after January 1, 2020, spinal muscular atrophy, and] (2) any newborn infant who fails a newborn hearing screening, as described in section 19a-59, a screening test for cytomegalovirus. [, provided such screening test shall be administered within available appropriations. Substitute House Bill No. 6666 Public Act No. 21-121 93 of 132 The administrative officer or other person in charge of each institution caring for newborn infants who performs the testing for critical congenital heart disease shall enter the results of such test into the newborn screening system pursuant to section 19a-53.] Such screening tests shall be administered as soon after birth as is medically appropriate. (e) (1) The clinical laboratory that completes the testing for cystic fibrosis, shall report the number of newborn infants screened and the results of such testing, not less than annually, to the Department of Public Health into the newborn screening system pursuant to section 19a-53. The administrative officer or other person in charge of each institution caring for newborn infants who performs the testing for critical congenital heart disease shall enter the results of such test into the newborn screening system pursuant to section 19a-53. [(c)] (2) The administrative officer or other person in charge of each institution caring for newborn infants shall [report] enter any case of cytomegalovirus that is confirmed as a result of a screening test administered pursuant to subdivision (2) of subsection [(b)] (d) of this section to the Department of Public Health [in a form and manner prescribed by the Commissioner of Public Health] into the newborn screening system pursuant to section 19a-53. The provisions of this subsection shall apply regardless of the patient's insurance status or source of payment, including self-pay status. [(d)] (f) The provisions of this section shall not apply to any infant whose parents object to the test or treatment as being in conflict with their religious tenets and practice. The commissioner shall adopt regulations, in accordance with the provisions of chapter 54, to implement the provisions of this section. Sec. 76. Subdivision (10) of section 7-36 of the general statutes is repealed and the following is substituted in lieu thereof (Effective October Substitute House Bill No. 6666 Public Act No. 21-121 94 of 132 1, 2021): (10) "Amendment" means to (A) change or enter new information on a certificate of birth, marriage, death or fetal death, more than one year after the date of the vital event recorded in such certificate, in order to accurately reflect the facts existing at the time of the recording of the event, (B) create a replacement certificate of birth for matters pertaining to parentage and gender change, [or] (C) create a replacement certificate of marriage for matters pertaining to gender change, or (D) reflect a legal name change in accordance with section 19a-42, as amended by this act, or make a modification to a cause of death; Sec. 77. Section 19a-42 of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2021): (a) To protect the integrity and accuracy of vital records, a certificate registered under chapter 93 may be amended only in accordance with sections 19a-41 to 19a-45, inclusive, chapter 93, regulations adopted by the Commissioner of Public Health pursuant to chapter 54 and uniform procedures prescribed by the commissioner. Only the commissioner may amend birth certificates to reflect changes concerning parentage or birth or marriage certificates to reflect changes concerning gender change. Amendments related to parentage or gender change shall result in the creation of a replacement certificate that supersedes the original, and shall in no way reveal the original language changed by the amendment. Any amendment to a vital record made by the registrar of vital statistics of the town in which the vital event occurred or by the commissioner shall be in accordance with such regulations and uniform procedures. (b) The commissioner and the registrar of vital statistics shall maintain sufficient documentation, as prescribed by the commissioner, to support amendments and shall ensure the confidentiality of such documentation as required by law. The date of amendment and a Substitute House Bill No. 6666 Public Act No. 21-121 95 of 132 summary description of the evidence submitted in support of the amendment shall be endorsed on or made part of the record and the original certificate shall be marked "Amended", except for amendments due to parentage or gender change. When the registrar of the town in which the vital event occurred amends a certificate, such registrar shall, within ten days of making such amendment, forward an amended certificate to the commissioner and to any registrar having a copy of the certificate. When the commissioner amends a birth certificate, including changes due to parentage or gender, the commissioner shall forward an amended certificate to the registrars of vital statistics affected and their records shall be amended accordingly. (c) An amended certificate shall supersede the original certificate that has been changed and shall be marked "Amended", except for amendments due to parentage or gender change. The original certificate in the case of parentage or gender change shall be physically or electronically sealed and kept in a confidential file by the department and the registrar of any town in which the birth was recorded, and may be unsealed for issuance only as provided in section 7-53 with regard to an original birth certificate or upon a written order of a court of competent jurisdiction. The amended certificate shall become the official record. (d) (1) Upon receipt of (A) an acknowledgment of paternity executed in accordance with the provisions of subsection (a) of section 46b-172 by both parents of a child born out of wedlock, or (B) a certified copy of an order of a court of competent jurisdiction establishing the paternity of a child born out of wedlock, the commissioner shall include on or amend, as appropriate, such child's birth certificate to show such paternity if paternity is not already shown on such birth certificate and to change the name of the child under eighteen years of age if so indicated on the acknowledgment of paternity form or within the certified court order as part of the paternity action. If a person who is the subject of a voluntary Substitute House Bill No. 6666 Public Act No. 21-121 96 of 132 acknowledgment of paternity, as described in this subdivision, is eighteen years of age or older, the commissioner shall obtain a notarized affidavit from such person affirming that he or she agrees to the commissioner's amendment of such person's birth certificate as such amendment relates to the acknowledgment of paternity. The commissioner shall amend the birth certificate for an adult child to change his or her name only pursuant to a court order. (2) If another father is listed on the birth certificate, the commissioner shall not remove or replace the father's information unless presented with a certified court order that meets the requirements specified in section 7-50, or upon the proper filing of a rescission, in accordance with the provisions of section 46b-172. The commissioner shall thereafter amend such child's birth certificate to remove or change the father's name and to change the name of the child, as requested at the time of the filing of a rescission, in accordance with the provisions of section 46b-172. Birth certificates amended under this subsection shall not be marked "Amended". (e) When the parent or parents of a child request the amendment of the child's birth certificate to reflect a new mother's name because the name on the original certificate is fictitious, such parent or parents shall obtain an order of a court of competent jurisdiction declaring the putative mother to be the child's mother. Upon receipt of a certified copy of such order, the department shall amend the child's birth certificate to reflect the mother's true name. (f) Upon receipt of a certified copy of an order of a court of competent jurisdiction changing the name of a person born in this state and upon request of such person or such person's parents, guardian, or legal representative, the commissioner or the registrar of vital statistics of the town in which the vital event occurred shall amend the birth certificate to show the new name by a method prescribed by the department. Substitute House Bill No. 6666 Public Act No. 21-121 97 of 132 (g) When an applicant submits the documentation required by the regulations to amend a vital record, the commissioner shall hold a hearing, in accordance with chapter 54, if the commissioner has reasonable cause to doubt the validity or adequacy of such documentation. (h) When an amendment under this section involves the changing of existing language on a death certificate due to an error pertaining to the cause of death, the death certificate shall be amended in such a manner that the original language is still visible. A copy of the death certificate shall be made. The original death certificate shall be sealed and kept in a confidential file at the department and only the commissioner may order it unsealed. The copy shall be amended in such a manner that the language to be changed is no longer visible. The copy shall be a public document. (i) The commissioner shall issue a new birth certificate to reflect a gender change upon receipt of the following documents submitted in the form and manner prescribed by the commissioner: (1) A written request from the applicant, signed under penalty of law, for a replacement birth certificate to reflect that the applicant's gender differs from the sex designated on the original birth certificate; (2) a notarized affidavit by a physician licensed pursuant to chapter 370 or holding a current license in good standing in another state, a physician assistant licensed pursuant to chapter 370 or holding a current license in good standing in another state, an advanced practice registered nurse licensed pursuant to chapter 378 or holding a current license in good standing in another state, or a psychologist licensed pursuant to chapter 383 or holding a current license in good standing in another state, stating that the applicant has undergone surgical, hormonal or other treatment clinically appropriate for the applicant for the purpose of gender transition; and (3) if an applicant is also requesting a change of name listed on the original birth certificate, proof of a legal name change. The Substitute House Bill No. 6666 Public Act No. 21-121 98 of 132 new birth certificate shall reflect the new gender identity by way of a change in the sex designation on the original birth certificate and, if applicable, the legal name change. (j) The commissioner shall issue a new marriage certificate to reflect a gender change upon receipt of the following documents, submitted in a form and manner prescribed by the commissioner: (1) A written request from the applicant, signed under penalty of law, for a replacement marriage certificate to reflect that the applicant's gender differs from the sex designated on the original marriage certificate, along with an affirmation that the marriage is still legally intact; (2) a notarized statement from the spouse named on the marriage certificate to be amended, consenting to the amendment; (3) (A) a United States passport or amended birth certificate or court order reflecting the applicant's gender as of the date of the request or (B) a notarized affidavit by a physician licensed pursuant to chapter 370 or holding a current license in good standing in another state, physician assistant licensed pursuant to chapter 370 or holding a current license in good standing in another state, an advanced practice registered nurse licensed pursuant to chapter 378 or holding a current license in good standing in another state or a psychologist licensed pursuant to chapter 383 or holding a current license in good standing in another state stating that the applicant has undergone surgical, hormonal or other treatment clinically appropriate for the applicant for the purpose of gender transition; and (4) if an applicant is also requesting a change of name listed on the original marriage certificate, proof of a legal name change. The new marriage certificate shall reflect the new gender identity by way of a change in the sex designation on the original marriage certificate and, if applicable, the legal name change. Sec. 78. Section 19a-215 of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2021): (a) For the purposes of this section: Substitute House Bill No. 6666 Public Act No. 21-121 99 of 132 (1) "Clinical laboratory" means any facility or other area used for microbiological, serological, chemical, hematological, immunohematological, biophysical, cytological, pathological or other examinations of human body fluids, secretions, excretions or excised or exfoliated tissues, for the purpose of providing information for the diagnosis, prevention or treatment of any human disease or impairment, for the assessment of human health or for the presence of drugs, poisons or other toxicological substances. (2) "Commissioner's list of reportable diseases, emergency illnesses and health conditions" and "commissioner's list of reportable laboratory findings" means the lists developed pursuant to section 19a-2a. (3) "Confidential" means confidentiality of information pursuant to section 19a-25. (4) "Health care provider" means a person who has direct or supervisory responsibility for the delivery of health care or medical services, including licensed physicians, nurse practitioners, nurse midwives, physician assistants, nurses, dentists, medical examiners and administrators, superintendents and managers of health care facilities. (5) "Reportable diseases, emergency illnesses and health conditions" means the diseases, illnesses, conditions or syndromes designated by the Commissioner of Public Health on the list required pursuant to section 19a-2a. (b) A health care provider shall report each case occurring in such provider's practice, of any disease on the commissioner's list of reportable diseases, emergency illnesses and health conditions to the director of health of the town, city or borough in which such case resides and to the Department of Public Health, no later than twelve hours after such provider's recognition of the disease. Such reports shall be in writing, by telephone or in an electronic format approved by the Substitute House Bill No. 6666 Public Act No. 21-121 100 of 132 commissioner. [Such reports of disease shall be confidential and not open to public inspection except as provided for in section 19a-25.] (c) A clinical laboratory shall report each finding identified by such laboratory of any disease identified on the commissioner's list of reportable laboratory findings to the Department of Public Health not later than forty-eight hours after such laboratory's finding. A clinical laboratory that reports an average of more than thirty findings per month shall make such reports electronically in a format approved by the commissioner. Any clinical laboratory that reports an average of less than thirty findings per month shall submit such reports, in writing, by telephone or in an electronic format approved by the commissioner. [All such reports shall be confidential and not open to public inspection except as provided for in section 19a-25.] The Department of Public Health shall provide a copy of all such reports to the director of health of the town, city or borough in which the affected person resides or, in the absence of such information, the town where the specimen originated. (d) When a local director of health, the local director's authorized agent or the Department of Public Health receives a report of a disease or laboratory finding on the commissioner's lists of reportable diseases, emergency illnesses and health conditions and laboratory findings, the local director of health, the local director's authorized agent or the Department of Public Health may contact first the reporting health care provider and then the person with the reportable finding to obtain such information as may be necessary to lead to the effective control of further spread of such disease. In the case of reportable communicable diseases and laboratory findings, this information may include obtaining the identification of persons who may be the source or subsequent contacts of such infection. (e) A hospital, as defined in section 19a-490 and licensed pursuant to chapter 368v, shall provide the Department of Public Health with access, Substitute House Bill No. 6666 Public Act No. 21-121 101 of 132 including remote access, in a manner approved by the Commissioner of Public Health, to the entirety of each electronic medical record that concerns a reportable disease, emergency illness or health condition listed by the commissioner pursuant to subdivision (9) of section 19a-2a that occurs at such hospital. Such remote access shall take place on or before October 1, 2022, if technically feasible. [(e)] (f) All personal information obtained from disease prevention and control investigations [as performed in subsections (c) and (d) of] pursuant to this section including the health care provider's name and the identity of the reported case of disease and suspected source persons and contacts shall not be divulged to anyone and shall be held strictly confidential pursuant to section 19a-25, by the local director of health and the director's authorized agent and by the Department of Public Health. [(f)] (g) Any person who violates any reporting or confidentiality provision of this section shall be fined not more than five hundred dollars. No provision of this section shall be deemed to supersede section 19a-584. Sec. 79. Subsection (c) of section 19a-72 of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2021): (c) [The] (1) A health care provider shall provide the Department of Public Health, [shall be provided such] at the request of the department, access to the clinical records of any [health care provider] patient, as the department deems necessary, to perform case finding or other quality improvement audits to ensure completeness of reporting and data accuracy consistent with the purposes of this section. (2) A hospital shall provide the Department of Public Health with access, including remote access, to the entirety of a patient's medical Substitute House Bill No. 6666 Public Act No. 21-121 102 of 132 record, as the department deems necessary, to perform case finding or other quality improvement audits to ensure completeness of reporting and data accuracy consistent with the purposes of this section. Such remote access shall be provided on or before October 1, 2022, if technically feasible. The department shall not divulge any personal information obtained from the medical record to anyone and shall hold any such personal information strictly confidential pursuant to section 19a-25. Sec. 80. (NEW) (Effective October 1, 2021) A hospital shall provide the Department of Public Health with access, including remote access, to the entirety of a patient's medical record, as the department deems necessary, to perform quality improvement audits to ensure completeness of reporting and data accuracy of birth, fetal death and death occurrences. Such remote access shall take place on or before October 1, 2022, if technically feasible. No personal information obtained from the medical record shall be divulged to anyone and shall be held strictly confidential pursuant to section 19a-25 of the general statutes by the Department of Public Health. Sec. 81. Section 19a-59h of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2021): (a) As used in this section and section 19a-59i, "maternal death" means the death of a woman while pregnant or not later than one year after the date on which the woman ceases to be pregnant, regardless of whether the woman's death is related to her pregnancy, and "department" means the Department of Public Health. (b) There is established, within the department, a maternal mortality review program. The program shall be responsible for identifying maternal death cases in Connecticut and reviewing medical records and other relevant data related to each maternal death case, including, but not limited to, information collected from death and birth records, files Substitute House Bill No. 6666 Public Act No. 21-121 103 of 132 from the Office of the Chief Medical Examiner, and physician office and hospital records. (c) Licensed health care providers, health care facilities and pharmacies shall provide the maternal mortality review program, established under this section with reasonable access to all relevant medical records associated with a maternal death case under review by the program. (d) A hospital shall provide the department with access, including remote access, to the entirety of a patient's medical record, as the department deems necessary, to review case information related to a maternal death case under review by the program. Such remote access shall be provided on or before October 1, 2022, if technically feasible. All personal information obtained from the medical record shall not be divulged to anyone and shall be held strictly confidential pursuant to section 19a-25 by the department. [(d)] (e) All information obtained by the department for the maternal mortality review program shall be confidential pursuant to section 19a- 25. [(e)] (f) Notwithstanding subsection [(d)] (e) of this section, the department may provide the maternal mortality review committee, established pursuant to section 19a-59i, with information as is necessary, in the department's discretion, for the committee to make recommendations regarding the prevention of maternal death. Sec. 82. (NEW) (Effective October 1, 2021) (a) As used in this section: (1) "Bottled water" has the same meaning as defined in section 21a- 150 of the general statutes; (2) "Commissioner" means the Commissioner of Public Health, or his or her designee; Substitute House Bill No. 6666 Public Act No. 21-121 104 of 132 (3) "Department" means the Department of Public Health; (4) "Fill station" means a location at which customers of a water company may obtain potable water; (5) "Small community water system" has the same meaning as provided in section 19a-37e of the general statutes; and (6) "Water company" has the same meaning as provided in section 25- 32a of the general statutes. (b) A water company shall update its emergency contingency plan prepared pursuant to section 25-32d of the general statutes and section 25-32d-3 of the regulations of Connecticut state agencies, to include information regarding the provision of alternative sources of potable water for human consumption that can be utilized as a temporary measure when there is a water supply emergency. Such plan shall identify alternative sources of potable water for possible use at various stages of an emergency, including, but not limited to, bulk water provided by a bulk water hauler licensed pursuant to section 20-278h of the general statutes, bottled water, a fill station, interconnection or agreement with a nearby public water system for supplemental water supplies in the event of an emergency, other approved public water supply source or mechanism for providing water identified in the emergency contingency plan, or as otherwise approved by the commissioner. The commissioner, in consultation with water companies, shall prepare materials and provide guidance to such water companies to implement the provisions of this subsection. Nothing in this section shall prevent a water company from providing an alternative source of potable water for an event lasting less than twelve hours that may adversely impact the quality or quantity of potable water supplies. As used in this subsection, "water supply emergency" means any event lasting more than twelve consecutive hours that results in the water supplied from the water company to residents that is not in Substitute House Bill No. 6666 Public Act No. 21-121 105 of 132 compliance with the regulations of Connecticut state agencies concerning the purity and adequacy of drinking water. (c) A small community water system shall update its emergency response plan required pursuant to section 19-13-B102 of the regulations of Connecticut state agencies to include information regarding the provision of alternative sources of potable water for human consumption that can be utilized as a temporary measure when there is a water supply emergency. Such plan shall identify alternative sources of potable water for possible use at various stages of an emergency, including, but not limited to, bulk water provided by a bulk water hauler licensed pursuant to section 20-278h of the general statutes, bottled water, a fill station, interconnection or agreement with a nearby public water system for supplemental water supplies in the event of an emergency, or other approved public water supply source or mechanism for providing water identified in the emergency contingency plan. The commissioner, in consultation with small community water systems, shall prepare materials and provide guidance to such water systems to implement the provisions of this section. Nothing in this section shall prevent a small community water system from providing an alternative source of potable water for an event lasting less than twelve hours that may adversely impact the quality or quantity of potable water supplies. As used in this subsection, "water supply emergency" means any event lasting more than twelve consecutive hours that results in the water supplied from the small community water system to residents that is not in compliance with the regulations of Connecticut state agencies concerning the purity and adequacy of drinking water. Sec. 83. (NEW) (Effective October 1, 2021) A water company shall provide tier 1 notices to its consumers in the languages predominantly spoken by the consumers in the water company's service area. A water company shall update its emergency response plan prepared pursuant Substitute House Bill No. 6666 Public Act No. 21-121 106 of 132 to section 25-32d of the general statutes or pursuant to section 19-13- B102 of the regulations of Connecticut state agencies to include information regarding the provision of such multilingual communications. As used in this section, "water company" has the same meaning as provided in section 25-32a of the general statutes and "tier 1 notices" has the same meaning as provided in section 19-13-B102 of the regulations of Connecticut state agencies. Sec. 84. (NEW) (Effective October 1, 2021) In the event that the Governor declares a state of civil preparedness emergency pursuant to section 28-9 of the general statutes, or a public health emergency, pursuant to section 19a-131 of the general statutes, each community water system shall report the community water system's operational status to WebEOC as soon as practicable, but not later than eight hours after the time reporting on WebEOC is made available regarding such declaration, and at any time thereafter that the status of such system significantly changes. As used in this section, "community water system" means a public water system that serves at least twenty-five residents, and "WebEOC" means a web-based emergency management information system used by the state to document routine and emergency events or incidents and provide a real-time common operating picture and resource request management tool for emergency managers at the local and state levels during exercises, drills, local or regional emergencies or state-wide emergencies. Sec. 85. (NEW) (Effective October 1, 2021) (a) As used in this section: (1) "Consumer" has the same meaning as provided in section 25-32a of the general statutes; (2) "Owner" means the person or entity that owns or controls the small community water system; and (3) "Small community water system" has the same meaning as Substitute House Bill No. 6666 Public Act No. 21-121 107 of 132 provided in section 19a-37e of the general statutes. (b) Not later than January 1, 2025, each owner of a small community water system shall complete a small community water system capacity implementation plan on a form prescribed by the Department of Public Health demonstrating that such owner has the managerial, technical and financial capacity to continue to own and operate such system and shall implement such plan. Following the completion of the initial small community water system capacity implementation plan, each small community water system shall update such small community water system capacity implementation plan annually and make such small community water system capacity implementation plan available to the department upon request. Such plan shall include: (1) A description of the small community water system, including the number of consumers and persons served and sources of drinking water; (2) Ownership and management information, including the type of ownership structure and the current names, addresses and telephone numbers of the owners, certified operators and emergency contact persons for the small community water system; (3) Service area maps; (4) Facilities maps, including the location of and specific information regarding sources, storage facilities, treatment facilities, pressure zones, booster pumps, hydrants, distribution lines, valves and sampling points; (5) A description of such system's cross-connection control program; (6) A description of such system's source water protection program; (7) A copy of such system's emergency response plan required Substitute House Bill No. 6666 Public Act No. 21-121 108 of 132 pursuant to section 19-13-B102 of the regulations of Connecticut state agencies; (8) A capital improvement program, including the schedule that identifies all capital improvements scheduled for a five-year planning period and capital improvements or major projects scheduled for a twenty-year planning period; (9) Water production and consumption information; (10) Information regarding public water systems that are nearby, including the distance from the small community water system and type of public water system, if any. Such information shall be based on the coordinated water system plan approved by the Commissioner of Public Health pursuant to section 25-33h of the general statutes for the water utility coordinating committee in which such small community water system is located; and (11) Financial capacity information, including: (A) An evaluation of the small community water system's fiscal and assessment management plan prepared pursuant to section 19a-37e of the general statutes; (B) A summary of the income and expenses for the five years preceding the date of submission of the plan; (C) A five-year balanced operation budget; (D) Water rate structure and fees charged, including information regarding how such rates and fees are updated and whether such rates and fees are sufficient to maintain cash flow stability and to fund the capital improvement program, as well as any emergency improvements; and (E) An evaluation that has considered the affordability of water rates. Substitute House Bill No. 6666 Public Act No. 21-121 109 of 132 (c) On or before July 1, 2025, and annually thereafter, the small community water system shall provide a summary of its small community water system capacity plan in the small community water system's consumer confidence report required by section 19-13-B102 of the regulations of Connecticut state agencies. (d) The provisions of this section shall not apply to a small community water system that is (1) regulated by the Public Utilities Regulatory Authority, (2) subject to the requirements set forth in section 25-32d of the general statutes, or (3) a state agency. (e) The provisions of this section shall be deemed to relate to the purity and adequacy of water supplies for the purposes of the imposition of a penalty under section 25-32e of the general statutes. (f) The commissioner may adopt regulations, in accordance with the provisions of chapter 54 of the general statutes, to carry out the provisions of this section. Sec. 86. Section 21a-150b of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2021): (a) Qualified employees of a bottler shall collect samples of water from each approved source used by such bottler not less than once annually to test for contaminants for which allowable levels have been established in accordance with 21 CFR 165.110 and regulations adopted pursuant to sections 21a-150 to 21a-150j, inclusive, and not less than once every three years to test for contaminants for which monitoring is required pursuant to sections 21a-150 to 21a-150j, inclusive, but for which no allowable level has been established. Qualified employees of an approved laboratory shall analyze such samples to determine whether such source complies with the provisions of sections 21a-150 to 21a-150j, inclusive, any regulation adopted pursuant to said sections and any allowable contaminant level set forth in 21 CFR 165.110. Substitute House Bill No. 6666 Public Act No. 21-121 110 of 132 Microbiological analysis shall be conducted not less than once each calendar quarter if the source of such water is other than a public water supply and shall be in addition to any sampling and analysis conducted by any government agency or laboratory. (b) Qualified employees of a bottler shall collect samples of water from any source used by such bottler when such bottler knows or has reason to believe that water obtained from such source contains an unregulated contaminant in an amount which may adversely affect the health or welfare of the public. Qualified employees of an approved laboratory shall analyze such samples periodically to determine whether water obtained from any such source is safe for public consumption or use. (c) On or before January 1, 2022, and annually thereafter, qualified employees of a bottler shall (1) collect samples of water from each approved source that is located in the state, that has been inspected and approved by the Department of Public Health pursuant to subdivision (2) of subsection (a) of section 21a-150a and is used by such bottler, prior to any treatment, to test for perfluoroalkyl substances and other unregulated contaminants, and (2) have such samples analyzed by an environmental laboratory registered by the Department of Public Health pursuant to section 19a-29a that has the Environmental Protection Agency approved certification to conduct such analysis. As used in this subsection, "unregulated contaminant" means a contaminant for which the Commissioner of Public Health, pursuant to section 22a-471, has set a level at which such contaminant creates or can reasonably be expected to create an unacceptable risk of injury to the health or safety of persons drinking such source of water. Sec. 87. Section 21a-150d of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2021): (a) A laboratory which analyzes any water sample in accordance with Substitute House Bill No. 6666 Public Act No. 21-121 111 of 132 any provision of sections 21a-150 to 21a-150j, inclusive, shall report the results of such analysis to the bottler of such water. (b) Such results shall be available for inspection by the Department of Consumer Protection. (c) A bottler shall report any result which indicates that a water sample contains contaminants in an amount exceeding any applicable standard to the Department of Consumer Protection not later than twenty-four hours after learning of such result. (d) A bottler shall report the results of the analysis conducted pursuant to subsection (c) of section 21a-150b, as amended by this act, to the Department of Public Health and the Department of Consumer Protection not later than nine calendar days after receipt of the results from the environmental laboratory. If such results exceed the level set by the Commissioner of Public Health pursuant to section 22a-471 for such perfluoroalkyl substances and other unregulated contaminants, the Department of Public Health may require such bottler to discontinue use of its approved source until such source no longer creates an unacceptable risk of injury to the health or safety of persons drinking the bottled water that comes from such source. The Department of Public Health shall notify the Department of Consumer Protection of any source for which the Department of Public Health has discontinued use until such source no longer creates an unacceptable risk of injury to the health or safety of the persons drinking the bottled water that comes from such source. As used in this subsection, "unregulated contaminant" means a contaminant for which the Commissioner of Public Health, pursuant to section 22a-471, has set a level at which such contaminant creates or can reasonably be expected to create an unacceptable risk of injury to the health or safety of the persons drinking such source of water. [(d)] (e) All records of any sampling or analysis conducted in Substitute House Bill No. 6666 Public Act No. 21-121 112 of 132 accordance with the provisions of sections 21a-150 to 21a-150j, inclusive, shall be maintained on the premises of the bottler for not less than five years. Sec. 88. Section 25-40a of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2021): (a) Not later than twenty-four hours after obtaining a public water system test result that shows a contaminant at a level that is in violation of the federal Environmental Protection Agency national primary drinking water standards for a public water system that does not submit a water supply plan pursuant to section 25-32d of the general statutes, the environmental laboratory that performed the test shall notify any persons who requested such test or such person's designee, in a form and manner prescribed by the Commissioner of Public Health, of such test result. Such person shall notify the Department of Public Health in a form and manner prescribed by the Commissioner of Public Health not later than twenty-four hours after obtaining such notification. As used in this subsection, "contaminant" means e. coli, lead, nitrate and nitrite. (b) Not later than five business days after receiving notice that a public water system is in violation of the federal Environmental Protection Agency national primary drinking water standards, the Commissioner of Public Health, or the commissioner's designee, shall give written or electronic notification of such violation to the chief elected official of the municipality where such public water system is located and of any municipality that is served by such public water system. Sec. 89. (NEW) (Effective October 1, 2021) Each health care institution, as defined in section 19a-490 of the general statutes, required to obtain potable water as a temporary measure to alleviate a water supply shortage shall obtain such potable water from (1) a bulk water hauler, Substitute House Bill No. 6666 Public Act No. 21-121 113 of 132 licensed pursuant to section 20-278h of the general statutes, or (2) a bottler, as defined in section 21a-150 of the general statutes. Sec. 90. Section 19a-175 of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage): As used in this chapter and section 19a-906, unless the context otherwise requires: (1) "Emergency medical service system" means a system which provides for (A) the arrangement of personnel, facilities and equipment for the efficient, effective and coordinated delivery of health care services under emergency conditions, and (B) mobile integrated health care; (2) "Patient" means an injured or ill person or a person with a physical disability requiring assistance and transportation; (3) "Ambulance" means a motor vehicle specifically designed to carry patients; (4) "Ambulance service" means an organization which transports patients; (5) "Emergency medical technician" means a person who is certified pursuant to chapter 384d; [(6) "Ambulance driver" means a person whose primary function is driving an ambulance;] [(7)] (6) "Emergency medical services instructor" means a person who is certified pursuant to chapter 384d; [(8)] (7) "Communications facility" means any facility housing the personnel and equipment for handling the emergency communications needs of a particular geographic area; Substitute House Bill No. 6666 Public Act No. 21-121 114 of 132 [(9)] (8) "Life saving equipment" means equipment used by emergency medical personnel for the stabilization and treatment of patients; [(10)] (9) "Emergency medical service organization" means any corporation or organization whether public, private or voluntary that (A) is licensed or certified by the Department of Public Health's Office of Emergency Medical Services, and (B) offers ambulance transportation or treatment services to patients primarily under emergency conditions or a mobile integrated health care program; [(11)] (10) "Invalid coach" means a vehicle used exclusively for the transportation of nonambulatory patients, who are not confined to stretchers, to or from either a medical facility or the patient's home in nonemergency situations or utilized in emergency situations as a backup vehicle when insufficient emergency vehicles exist; [(12)] (11) "Rescue service" means any organization, whether for- profit or nonprofit, whose primary purpose is to search for persons who have become lost or to render emergency service to persons who are in dangerous or perilous circumstances; [(13)] (12) "Commissioner" means the Commissioner of Public Health; [(14)] (13) "Paramedic" means a person licensed pursuant to chapter 384d; [(15)] (14) "Commercial ambulance service" means an ambulance service which primarily operates for profit; [(16)] (15) "Licensed ambulance service" means a commercial ambulance service or a volunteer or municipal ambulance service issued a license by the commissioner; Substitute House Bill No. 6666 Public Act No. 21-121 115 of 132 [(17)] (16) "Certified ambulance service" means a municipal, volunteer or nonprofit ambulance service issued a certificate by the commissioner; [(18)] (17) "Automatic external defibrillator" means a device that: (A) Is used to administer an electric shock through the chest wall to the heart; (B) contains internal decision-making electronics, microcomputers or special software that allows it to interpret physiologic signals, make medical diagnosis and, if necessary, apply therapy; (C) guides the user through the process of using the device by audible or visual prompts; and (D) does not require the user to employ any discretion or judgment in its use; [(19)] (18) "Mutual aid call" means a call for emergency medical services that, pursuant to the terms of a written agreement, is responded to by a secondary or alternate emergency medical service organization if the primary or designated emergency medical service organization is unable to respond because such primary or designated emergency medical service organization is responding to another call for emergency medical services or the ambulance or nontransport emergency vehicle operated by such primary or designated emergency medical service organization is out of service. For purposes of this subdivision, "nontransport emergency vehicle" means a vehicle used by emergency medical technicians or paramedics in responding to emergency calls that is not used to carry patients; [(20)] (19) "Municipality" means the legislative body of a municipality or the board of selectmen in the case of a municipality in which the legislative body is a town meeting; [(21)] (20) "Primary service area" means a specific geographic area to which one designated emergency medical service organization is assigned for each category of emergency medical response services; Substitute House Bill No. 6666 Public Act No. 21-121 116 of 132 [(22)] (21) "Primary service area responder" means an emergency medical service organization who is designated to respond to a victim of sudden illness or injury in a primary service area; [(23)] (22) "Interfacility critical care transport" means the interfacility transport of a patient between licensed health care institutions; [(24)] (23) "Advanced emergency medical technician" means an individual who is certified as an advanced emergency medical technician pursuant to chapter 384d; [(25)] (24) "Emergency medical responder" means an individual who is certified pursuant to chapter 384d; [(26)] (25) "Medical oversight" means the active surveillance by physicians of the provision of emergency medical services sufficient for the assessment of overall emergency medical service practice levels, as defined by state-wide protocols; [(27)] (26) "Office of Emergency Medical Services" means the office established within the Department of Public Health pursuant to section 19a-178; [(28)] (27) "Sponsor hospital" means a hospital that has agreed to maintain staff for the provision of medical oversight, supervision and direction to an emergency medical service organization and its personnel and has been approved for such activity by the Department of Public Health; [(29)] (28) "Paramedic intercept service" means paramedic treatment services provided by an entity that does not provide the ground ambulance transport; [(30)] (29) "Authorized emergency medical services vehicle" means an ambulance, invalid coach or advanced emergency technician-staffed Substitute House Bill No. 6666 Public Act No. 21-121 117 of 132 intercept vehicle or a paramedic-staffed intercept vehicle licensed or certified by the Department of Public Health for purposes of providing emergency medical care to patients; [and] [(31)] (30) "Emergency medical services personnel" means an individual certified to practice as an emergency medical responder, emergency medical technician, advanced emergency medical technician, emergency medical services instructor or an individual licensed as a paramedic; [.] [(32)] (31) "Mobile integrated health care program" means a program approved by the commissioner in which a licensed or certified ambulance service or paramedic intercept service provides services, including clinically appropriate medical evaluations, treatment, transport or referrals to other health care providers under nonemergency conditions by a paramedic acting within the scope of his or her practice as part of an emergency medical services organization within the emergency medical services system; and [(33)] (32) "Alternate destination" means a destination other than an emergency department that is a medically appropriate facility. Sec. 91. Section 19a-562 of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage): (a) As used in this section and section 19a-562a, as amended by this act, ["Alzheimer's special care unit or program"] "dementia special care unit or program" means any nursing facility, residential care home, assisted living facility, adult congregate living facility, adult day care center, hospice or adult foster home that locks, secures, segregates or provides a special program or unit for residents with a diagnosis of probable Alzheimer's disease, dementia or other similar disorder, in order to prevent or limit access by a resident outside the designated or separated area, or that advertises or markets the facility as providing Substitute House Bill No. 6666 Public Act No. 21-121 118 of 132 specialized care or services for persons suffering from Alzheimer's disease or dementia. (b) On and after January 1, 2007, each [Alzheimer's] dementia special care unit or program shall provide written disclosure to any person who will be placed in such a unit or program or to that person's legal representative or other responsible party. Such disclosure shall be signed by the patient or responsible party and shall explain what additional care and treatment or specialized program will be provided in the [Alzheimer's] dementia special care unit or program that is distinct from the care and treatment required by applicable licensing rules and regulations, including, but not limited to: (1) Philosophy. A written statement of the overall philosophy and mission of the [Alzheimer's] dementia special care unit or program that reflects the needs of residents with Alzheimer's disease, dementia or other similar disorders. (2) Preadmission, admission and discharge. The process and criteria for placement within or transfer or discharge from the [Alzheimer's] dementia special care unit or program. (3) Assessment, care planning and implementation. The process used for assessing and establishing and implementing the plan of care, including the method by which the plan of care is modified in response to changes in condition. (4) Staffing patterns and training ratios. The nature and extent of staff coverage, including staff to patient ratios and staff training and continuing education. (5) Physical environment. The physical environment and design features appropriate to support the functioning of cognitively impaired adult residents. Substitute House Bill No. 6666 Public Act No. 21-121 119 of 132 (6) Residents' activities. The frequency and types of resident activities and the ratio of residents to recreation staff. (7) Family role in care. The involvement of families and family support programs. (8) Program costs. The cost of care and any additional fees. (c) Each [Alzheimer's] dementia special care unit or program shall develop a standard disclosure form for compliance with subsection (b) of this section and shall annually review and verify the accuracy of the information provided by [Alzheimer's] dementia special care units or programs. Each [Alzheimer's] dementia special care unit or program shall update any significant change to the information reported pursuant to subsection (b) of this section not later than thirty days after such change. Sec. 92. Section 19a-562a of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage): (a) Each nursing home facility that is not a residential care home or an [Alzheimer's] dementia special care unit or program shall (1) annually provide a minimum of two hours of training in pain recognition and administration of pain management techniques, and (2) provide a minimum of one hour of training in oral health and oral hygiene techniques not later than one year after the date of hire and subsequent training in said techniques annually thereafter, to all licensed and registered direct care staff and nurse's aides who provide direct patient care to residents. (b) Each [Alzheimer's] dementia special care unit or program shall annually provide Alzheimer's and dementia specific training to all licensed and registered direct care staff and nurse's aides who provide direct patient care to residents enrolled in the [Alzheimer's] dementia special care unit or program. Such requirements shall include, but not Substitute House Bill No. 6666 Public Act No. 21-121 120 of 132 be limited to, (1) not less than eight hours of dementia-specific training, which shall be completed not later than six months after the date of employment or, if the date of employment is on or after October 1, 2014, not later than one hundred twenty days after the date of employment and not less than eight hours of such training annually thereafter, and (2) annual training of not less than two hours in pain recognition and administration of pain management techniques for direct care staff. (c) Each [Alzheimer's] dementia special care unit or program shall annually provide a minimum of one hour of Alzheimer's and dementia specific training to all unlicensed and unregistered staff, except nurse's aides, who provide services and care to residents enrolled in the [Alzheimer's] dementia special care unit or program. For such staff hired on or after October 1, 2007, such training shall be completed not later than six months after the date of employment and, for such staff hired on or after October 1, 2014, not later than one hundred twenty days after the date of employment. Sec. 93. Section 2 of substitute senate bill 2 of public act 21-46 is repealed and the following is substituted in lieu thereof (Effective July 1, 2021): (a) As used in this section: (1) "Contact hour" means a minimum of fifty minutes of continuing education and activities; and (2) "Registration period" means the one-year period for which a license has been renewed in accordance with section 19a-88 of the general statutes, as amended by this act, and is current and valid. (b) [For registration periods beginning on and after January 1, 2022, a physician assistant licensed pursuant to chapter 370 of the general statutes applying for license renewal shall, during the first renewal period and not less than once every six years thereafter, earn not less Substitute House Bill No. 6666 Public Act No. 21-121 121 of 132 than two contact hours of training or education administered by the American Association of Physician Assistants, a hospital or other licensed health care institution or a regionally accredited institution of higher education, on (1) screening for post-traumatic stress disorder, risk of suicide, depression and grief, and (2) suicide prevention training.] Each person holding a license as a physician assistant shall, annually, during the month of such person's birth, register with the Department of Public Health, upon payment of a fee of one hundred fifty dollars, on blanks to be furnished by the department for such purpose, giving such person's name in full, such person's residence and business address and such other information as the department requests. No such license shall be renewed unless the department is satisfied that the practitioner (1) has met the mandatory continuing medical education requirements of the National Commission on Certification of Physician Assistants or a successor organization for the certification or recertification of physician assistants that may be approved by the department; (2) has passed any examination or continued competency assessment the passage of which may be required by said commission for maintenance of current certification by said commission; (3) has completed not less than one contact hour of training or education in prescribing controlled substances and pain management in the preceding two-year period; and (4) for registration periods beginning on or before January 1, 2022, during the first renewal period and not less than once every six years thereafter, earn not less than two contact hours of training or education screening for post- traumatic stress disorder, risk of suicide, depression and grief and suicide prevention training administered by the American Association of Physician Assistants, a hospital or other licensed health care institution or a regionally accredited institution of higher education. (c) Each physician assistant applying for license renewal pursuant to section 19a-88 of the general statutes, as amended by this act, shall sign a statement attesting that he or she has satisfied the continuing Substitute House Bill No. 6666 Public Act No. 21-121 122 of 132 education requirements of subsection (b) of this section on a form prescribed by the Department of Health. Each licensee shall retain records of attendance or certificates of completion that demonstrate compliance with the continuing education requirements of subsection (b) of this section for a minimum of three years following the year in which the continuing education was completed and shall submit such records or certificates to the department for inspection not later than forty-five days after a request by the department for such records or certificates. Sec. 94. Subsection (c) of section 19a-88 of the general statutes is repealed and the following is substituted in lieu thereof (Effective July 1, 2021): (c) (1) Each person holding a license to practice as a registered nurse, shall, annually, during the month of such person's birth, register with the Department of Public Health, upon payment of one hundred ten dollars, on blanks to be furnished by the department for such purpose, giving such person's name in full, such person's residence and business address and such other information as the department requests. Each person holding a license to practice as a registered nurse who has retired from the profession may renew such license, but the fee shall be ten per cent of the professional services fee for class B, as defined in section 33- 182l, plus five dollars. Any license provided by the department at a reduced fee shall indicate that the registered nurse is retired. (2) Each person holding a license as an advanced practice registered nurse shall, annually, during the month of such person's birth, register with the Department of Public Health, upon payment of one hundred thirty dollars, on blanks to be furnished by the department for such purpose, giving such person's name in full, such person's residence and business address and such other information as the department requests. No such license shall be renewed unless the department is satisfied that the person maintains current certification as either a nurse Substitute House Bill No. 6666 Public Act No. 21-121 123 of 132 practitioner, a clinical nurse specialist or a nurse anesthetist from one of the following national certifying bodies which certify nurses in advanced practice: The American Nurses' Association, the Nurses' Association of the American College of Obstetricians and Gynecologists Certification Corporation, the National Board of Pediatric Nurse Practitioners and Associates or the American Association of Nurse Anesthetists. Each person holding a license to practice as an advanced practice registered nurse who has retired from the profession may renew such license, but the fee shall be ten per cent of the professional services fee for class C, as defined in section 33-182l, plus five dollars. Any license provided by the department at a reduced fee shall indicate that the advanced practice registered nurse is retired. (3) Each person holding a license as a licensed practical nurse shall, annually, during the month of such person's birth, register with the Department of Public Health, upon payment of seventy dollars, on blanks to be furnished by the department for such purpose, giving such person's name in full, such person's residence and business address and such other information as the department requests. Each person holding a license to practice as a licensed practical nurse who has retired from the profession may renew such license, but the fee shall be ten per cent of the professional services fee for class A, as defined in section 33-182l, plus five dollars. Any license provided by the department at a reduced fee shall indicate that the licensed practical nurse is retired. (4) Each person holding a license as a nurse-midwife shall, annually, during the month of such person's birth, register with the Department of Public Health, upon payment of one hundred thirty dollars, on blanks to be furnished by the department for such purpose, giving such person's name in full, such person's residence and business address and such other information as the department requests. No such license shall be renewed unless the department is satisfied that the person maintains current certification from the Accreditation Midwifery Certification Substitute House Bill No. 6666 Public Act No. 21-121 124 of 132 Board. (5) (A) Each person holding a license to practice physical therapy shall, annually, during the month of such person's birth, register with the Department of Public Health, upon payment of the professional services fee for class B, as defined in section 33-182l, plus five dollars, on blanks to be furnished by the department for such purpose, giving such person's name in full, such person's residence and business address and such other information as the department requests. (B) Each person holding a physical therapist assistant license shall, annually, during the month of such person's birth, register with the Department of Public Health, upon payment of the professional services fee for class A, as defined in section 33-182l, plus five dollars, on blanks to be furnished by the department for such purpose, giving such person's name in full, such person's residence and business address and such other information as the department requests. [(6) Each person holding a license as a physician assistant shall, annually, during the month of such person's birth, register with the Department of Public Health, upon payment of a fee of one hundred fifty-five dollars, on blanks to be furnished by the department for such purpose, giving such person's name in full, such person's residence and business address and such other information as the department requests. No such license shall be renewed unless the department is satisfied that the practitioner (A) has met the mandatory continuing medical education requirements of the National Commission on Certification of Physician Assistants or a successor organization for the certification or recertification of physician assistants that may be approved by the department, (B) has passed any examination or continued competency assessment the passage of which may be required by said commission for maintenance of current certification by said commission, and (C) has completed not less than one contact hour of training or education in prescribing controlled substances and pain Substitute House Bill No. 6666 Public Act No. 21-121 125 of 132 management in the preceding two-year period.] Sec. 95. Section 20-206mm of the general statutes, as amended by section 9 of substitute senate bill 2 of public act 21-46, is repealed and the following is substituted in lieu thereof (Effective July 1, 2021): (a) Except as provided in subsections (b) and (c) of this section, an applicant for a license as a paramedic shall submit evidence satisfactory to the Commissioner of Public Health that the applicant has successfully (1) completed a paramedic training program approved by the commissioner, (2) for applicants applying on and after January 1, 2020, completed mental health first aid training as part of a program provided by an instructor certified by the National Council for Behavioral Health, and (3) passed an examination prescribed by the commissioner. (b) An applicant for licensure by endorsement shall present evidence satisfactory to the commissioner that the applicant (1) is licensed or certified as a paramedic in another state or jurisdiction whose requirements for practicing in such capacity are substantially similar to or higher than those of this state and that the applicant has no pending disciplinary action or unresolved complaint against him or her, or (2) (A) is currently licensed or certified as a paramedic in good standing in any New England state, New York or New Jersey, (B) has completed an initial training program consistent with the National Emergency Medical Services Education Standards, as promulgated by the National Highway Traffic Safety Administration for the paramedic scope of practice model conducted by an organization offering a program that is recognized by the national emergency medical services program accrediting organization, (C) for applicants applying on or after January 1, 2020, has completed mental health first aid training as part of a program provided by an instructor certified by the National Council for Behavioral Health, and (D) has no pending disciplinary action or unresolved complaint against him or her. Substitute House Bill No. 6666 Public Act No. 21-121 126 of 132 (c) Any person who is certified as an emergency medical technician- paramedic by the Department of Public Health on October 1, 1997, shall be deemed a licensed paramedic. Any person so deemed shall renew his license pursuant to section 19a-88, as amended by this act, for a fee of one hundred fifty-five dollars. (d) On or after January 1, 2020, each person seeking certification as an emergency medical responder, emergency medical technician or advanced emergency medical technician shall apply to the department on forms prescribed by the commissioner. Applicants for certification shall comply with the following requirements: (1) For initial certification, an applicant shall present evidence satisfactory to the commissioner that the applicant (A) has completed an initial training program consistent with the National Emergency Medical Services Education Standards, as promulgated by the National Highway Traffic Safety Administration for the emergency medical responder, emergency medical technician or advanced emergency medical technician curriculum, (B) has passed the examination administered by the national organization for emergency medical certification for an emergency medical responder, emergency medical technician or advanced emergency medical technician as necessary for the type of certification sought by the applicant or an examination approved by the department, and (C) has no pending disciplinary action or unresolved complaints against such applicant, (2) a certificate issued under this subsection shall be renewed once every two years in accordance with the provisions of section 19a-88, as amended by this act, upon presentation of evidence satisfactory to the commissioner that the applicant (A) has successfully completed continuing education for an emergency medical responder, emergency medical technician or advanced emergency medical technician as required by the national organization for emergency medical certification or as approved by the department, or (B) presents a current certification as an emergency medical responder, emergency medical technician or advanced Substitute House Bill No. 6666 Public Act No. 21-121 127 of 132 emergency medical technician from the national organization for emergency medical certification, or (3) for certification by endorsement from another state, an applicant shall present evidence satisfactory to the commissioner that the applicant (A) is currently certified as an emergency medical responder, emergency medical technician or advanced emergency medical technician in good standing by a state that maintains certification or licensing requirements that the commissioner determines are equal to or greater than those in this state, or (B) holds a current certification as an emergency medical responder, emergency medical technician or advanced emergency medical technician from the national organization for emergency medical certification. (e) On or after January 1, 2022, each person seeking renewal of a certification as an emergency medical responder, [or] emergency medical technician or advanced emergency medical technician under subdivision (2) of subsection (d) of this section, shall present evidence satisfactory to the commissioner that such person has, in the previous six year period, completed (1) the evidence-based youth suicide prevention training program administered pursuant to section 1 of substitute senate bill 2 of public act 21-46, or (2) not less than two hours of training or education, approved by the Commissioner of Public Health, on (A) screening for post-traumatic stress disorder, risk of suicide, depression and grief, and (B) suicide prevention. (f) On or after January 1, 2020, each person seeking certification as an emergency medical services instructor shall apply to the department on forms prescribed by the commissioner. Applicants for certification shall comply with the following requirements: (1) For initial certification, an applicant shall present evidence satisfactory to the commissioner that the applicant (A) is currently certified by the department as an emergency medical technician or advanced emergency medical technician or licensed by the department as a paramedic, (B) has completed a program of training as an emergency medical instructor Substitute House Bill No. 6666 Public Act No. 21-121 128 of 132 based on current national education standards within the prior two years, (C) has completed twenty-five hours of teaching activity under the supervision of a currently certified emergency medical services instructor, (D) has completed written and practical examinations as prescribed by the commissioner, (E) has no pending disciplinary action or unresolved complaints against the applicant, and (F) effective on a date prescribed by the commissioner, presents documentation satisfactory to the commissioner that the applicant is currently certified as an emergency medical technician, advanced emergency medical technician or paramedic by the national organization for emergency medical certification, or (2) for renewal certification, an applicant shall present evidence satisfactory to the commissioner that the applicant (A) has successfully completed continuing education and teaching activity as required by the department, [which, on and after January 1, 2022, shall include not less than two hours of training or education, approved by the Commissioner of Public Health, on (i) screening for post- traumatic stress disorder, risk of suicide, depression and grief, and (ii) suicide prevention training, during the first renewal period and not less than once every six years thereafter,] (B) maintains current certification by the department as an emergency medical technician, advanced emergency medical technician or licensure by the department as a paramedic, and (C) effective on a date as prescribed by the commissioner, presents documentation satisfactory to the commissioner that the applicant is currently certified as an emergency medical technician, advanced emergency medical technician or paramedic by the national organization for emergency medical certification. (g) A certified emergency medical responder, emergency medical technician, advanced emergency medical technician or emergency medical services instructor shall document the completion of his or her continuing educational requirements [through the continuing education platform Internet web site] in a form and manner prescribed by the Substitute House Bill No. 6666 Public Act No. 21-121 129 of 132 commissioner. A certified emergency medical responder, emergency medical technician, advanced emergency medical technician or emergency medical services instructor who is not engaged in active professional practice in any form during a certification period shall be exempt from the continuing education requirements of this section, provided the emergency medical responder, emergency medical technician, advanced emergency medical technician or emergency medical services instructor submits to the department, prior to the expiration of the certification period, an application for inactive status on a form prescribed by the department and such other documentation as may be required by the department. The application for inactive status pursuant to this subsection shall contain a statement that the emergency medical responder, emergency medical technician, advanced emergency medical technician or emergency medical services instructor may not engage in professional practice until the continuing education requirements of this section have been met. (h) The commissioner may issue a temporary emergency medical technician certificate to an applicant who presents evidence satisfactory to the commissioner that (1) the applicant was certified by the department as an emergency medical technician prior to becoming licensed as a paramedic pursuant to section 20-206ll, or (2) the applicant's certification as an emergency medical technician has expired and the applicant's license as a paramedic has become void pursuant to section 19a-88, as amended by this act. Such temporary certificate shall be valid for a period not to exceed one year and shall not be renewable. (i) An applicant who is issued a temporary emergency medical technician certificate pursuant to subsection (h) of this section may, prior to the expiration of such temporary certificate, apply to the department for: (1) Renewal of such person's paramedic license, giving such person's name in full, such person's residence and business address and such other information as the department requests, provided the Substitute House Bill No. 6666 Public Act No. 21-121 130 of 132 application for license renewal is accompanied by evidence satisfactory to the commissioner that the applicant was under the medical oversight of a sponsor hospital, as those terms are defined in section 19a-175, as amended by this act, on the date the applicant's paramedic license became void for nonrenewal; or (2) recertification as an emergency medical technician, provided the application for recertification is accompanied by evidence satisfactory to the commissioner that the applicant completed emergency medical technician refresher training approved by the commissioner not later than one year after issuance of the temporary emergency medical technician certificate. The department shall recertify such person as an emergency medical technician without the examination required for initial certification specified in regulations adopted by the commissioner pursuant to section 20-206oo. (j) Any person certified as an emergency medical responder, emergency medical technician, advanced emergency medical technician or emergency medical services instructor pursuant to this chapter and the regulations adopted pursuant to section 20-206oo whose certification has expired may apply to the Department of Public Health for reinstatement of such certification, provided such person completes the requirements for renewal certification specified in this section. Any certificate issued pursuant to this section shall remain valid for ninety days after the expiration date of such certificate and become void upon the expiration of such ninety-day period. (k) The Commissioner of Public Health shall issue an emergency medical technician certification to an applicant who is a member of the armed forces or the National Guard or a veteran and who (1) presents evidence satisfactory to the commissioner that such applicant holds a current certification as a person entitled to perform similar services under a different designation by the National Registry of Emergency Medical Technicians, or (2) satisfies the regulations promulgated Substitute House Bill No. 6666 Public Act No. 21-121 131 of 132 pursuant to subdivision (3) of subsection (a) of section 19a-179. Such applicant shall be exempt from any written or practical examination requirement for certification. (l) For the purposes of this section, "veteran" means any person who was discharged or released under conditions other than dishonorable from active service in the armed forces and "armed forces" has the same meaning as provided in section 27-103. Sec. 96. Subdivision (2) of subsection (e) of section 14-100a of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage): (2) The following motor vehicles registered in this state for the first time on or after October 1, 2007, that transport individuals who remain in wheelchairs while being transported, shall, in addition to the requirements of subdivision (1) of this subsection, install or provide and require the use of a device that secures the wheelchair to the motor vehicle's mechanical lift or otherwise prevents or seeks to prevent an individual in a wheelchair from falling from such mechanical lift or motor vehicle: (A) Motor vehicles in livery service, as defined in section 13b-101, (B) service buses, as defined in section 14-1, (C) invalid coaches, as defined in [subdivision (11) of] section 19a-175, as amended by this act, (D) vanpool vehicles, as defined in section 14-1, (E) school buses, as defined in section 14-1, (F) motor buses, as defined in section 14-1, (G) student transportation vehicles, as defined in section 14-212, and (H) camp vehicles, as defined in section 14-1. The provisions of this subsection shall also apply to all motor vehicles used by municipal, volunteer and commercial ambulance services and rescue services, as defined in section 19a-175, as amended by this act. Sec. 97. Subdivision (14) of subsection (b) of section 20-9 of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage): Substitute House Bill No. 6666 Public Act No. 21-121 132 of 132 (14) Any person rendering service as a physician assistant licensed pursuant to section 20-12b, a registered nurse, a licensed practical nurse or a paramedic, as defined in [subdivision (14) of] section 19a-175, as amended by this act, acting within the scope of regulations adopted pursuant to section 19a-179, if such service is rendered under the supervision, control and responsibility of a licensed physician; Sec. 98. Section 20-195ff of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage): The Commissioner of Public Health may adopt regulations, in accordance with the provisions of chapter 54, to further the purposes of subdivision (18) of subsection (c) of section 19a-14, subsection (e) of section 19a-88, subdivision [(14)] (13) of section 19a-175, as amended by this act, subsection (b) of section 20-9, as amended by this act, sections 20-195aa to 20-195ee, inclusive, and section 20-195gg. Sec. 99. Section 20-226 of the general statutes is repealed. (Effective from passage)