SB 9 — AN ACT CONCERNING HEALTH AND WELLNESS FOR CONNECTICUT RESIDENTS.

(9)(15) OneA memberhealth appointedcare byfacility theoperated majorityby leadera ofnonprofit theeducational Houseinstitution ofexclusively Representatives,for whostudents, shallfaculty beand astaff currentof orsuch formerinstitution lawand enforcementtheir official;dependents;

(10)Onemember(16) appointedbyAn themajorityoutpatient leaderclinic oftheSenate,or whoprogram shalloperated exclusively by or contracted to be operated exclusively by a familymunicipality, membermunicipal agency, municipal board of education or a personhealth whodistrict, sufferedas adescribed fatalin drugsection overdose;19a-241;

(11)(17) OneA memberresidential appointedfacility byfor thepersons minoritywith leaderintellectual ofdisability thelicensed Housepursuant ofto Representatives,section who17a-227 shalland becertified ato licensedparticipate mentalin healththe careTitle providerXIX withMedicaid experienceprogram treatingas personsan withintermediate opioidcare usefacility disorder;for individuals with intellectual disabilities;

and(18) (12)OnememberappointedbytheminorityleaderoftheSenate,Replacement whoof shallexisting beimaging aequipment licensedif such equipment wasacquired throughcertificate ofneedapprovaloracertificate ofneed determination, provided a health care providerfacility, withprovider, experiencephysician treatingor personsperson whonotifies havethe experiencedunit aof drugthe overdose.date on which the equipment is replaced and the disposition of the replaced equipment;

(c)Public TheAct CommissionerNo. of Mental Health and Addiction Services, or saidcommissioner'sdesignee,shallbethechairpersonofthecommittee.

The23-97 chairperson5 of the80 committee,Substitute withSenate aBill voteNo. of the majority of the members present, may appoint ex-officio nonvoting members in specialties not represented among voting members.

Any9 vacancy(19) shallAcquisition of cone-beam dental imaging equipment that is to be filledused exclusively by thea appointingdentist authority.licensed pursuant to chapter 379;

(d)(20) The chairpersonpartial or total elimination of theservices advisoryprovided committeeby mayan designateoutpatient onesurgical orfacility, moreas workingdefined groupsin tosection address19a-493b, specificexcept issuesas andprovided shallin appointsubdivision the(6) membersof subsection (a) of eachthis workingsection group.and section 19a-639e;

Each(21) workingThe grouptermination shallof reportservices itsfor findingswhich andthe recommendationsDepartment toof Public Health has requested the fullfacility advisoryto committee.relinquish its license;

LCO(22) {\\PRDFS1\SCOUSERS\FORZANOF\WS\2023SB-0005Acquisition of 53any R03-SB.docxequipment }by Substituteany Billperson No.that is to be used exclusively for scientific research that is not conducted on humans;

9[or] (e)(23) NotOn lateror thanbefore JanuaryJune 1,30, 2024,2026, andan annuallyincrease thereafterin until the terminationlicensed ofbed thecapacity pilot program, the Commissioner of Mentala Healthmental andhealth Addictionfacility, Servicesprovided shall(A) report, in accordance with the provisionsmental ofhealth sectionfacility 11-4ademonstrates of the general statutes, to the jointunit, standingin committeea ofform theand GeneralAssemblymanner havingprescribed cognizanceby of mattersrelating to public health regarding the recommendationsunit, ofthat theit advisoryaccepts committeereimbursement andfor theany outcomecovered ofbenefit theprovided harm reduction center pilot program established pursuant to sectiona 3covered ofindividual thisunder: act.

(i) An individual or group health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469;

(ii) a self- insured employee welfare benefit plan established pursuant to the federal Employee Retirement Income Security Act of 1974, as amended from time to time;

or (iii) HUSKY Health, as defined in section 17b-290, and (B) if the mental health facility does not accept or stops accepting reimbursement for any covered benefit provided to a covered individual under a policy, plan or program described in clause (i), (ii) or (iii)ofsubparagraph(A)ofthissubdivision,acertificateofneedforsuch increase in the licensed bed capacity shall be required;

or (24) The establishment of harm reduction centers through the pilot program established pursuant to section 3 of this act.

(NEW) (Effective October 1, 2023) (a) As used in this section,section: (1) "eligible entity" means a (A) municipality, (B) local or regional board of education, (C) similar body governing one or more nonpublic school, (D) district department of health, (E) municipal health department, or (F)lawenforcementagency,and(2)"opioidantagonist"meansnaloxone hydrochloride or any other similarly acting and equally safe drug approved by the federal Food and Drug Administration for the treatment of a drug overdose.

Public Act No.

23-97 6 of 80 Substitute Senate Bill No.

9 (1) "Eligible entity" means (A) a municipality, (B) a local or regional board of education, (C)a similar body governing oneor more nonpublic schools, (D) a district department of health, (E) a municipal health department, (F)a lawenforcement agency,or(G)an emergency medical services organization;

(2) "Emergency medical services personnel" has the same meaning as provided in section 19a-175 of the general statutes;

(3) "Opioid antagonist" means naloxone hydrochloride or any other similarly acting andequally safedrug approvedby thefederalFoodand Drug Administration for the treatment of a drug overdose;

(4) "Opioid drug" has the same meaning as provided in 42 CFR 8.2, as amended from time to time;

(5) "Opioid use disorder" means a medical condition characterized by a problematic pattern of opioid use and misuse leading to clinically significant impairment or distress;

(6) "Pharmacist" has the same meaning as provided in section 20-609a of the general statutes;

and (7) "Wholesaler" or "distributor" has the same meaning as provided in section 21a-70 of the general statutes.

Any balance remaining in the account at the end of any fiscal year shall be carried forward in the account for the fiscal yearPublic nextAct succeeding.No.

23-97 7 of 80 Substitute Senate Bill No.

9 year next succeeding.

LCO(c) {\\PRDFS1\SCOUSERS\FORZANOF\WS\2023SB-0006Not later than January 1, 2024 the Department of 53Mental R03-SB.docxHealth }and SubstituteAddiction BillServices, No.in collaboration with the Department of Public Health, shall use the Opioid Antagonist Bulk Purchase Fund for the provision of opioid antagonists to eligible entities and by emergency medical services personnel to certain members of the public.

9Emergency (c)medical Theservices Departmentpersonnel shall distribute an opioid antagonist kit containing a personal supply of Mentalopioid Healthantagonists and Addictionthe Servicesone-page shallfact usesheet developed by the OpioidConnecticut AntagonistAlcohol Bulkand PurchaseDrug FundPolicy Council pursuant to makesection grants17a-667a toof eligiblethe entitiesgeneral forstatutes thepurchaseregarding the risks of largetaking quantitiesan opioid drug, symptoms of opioid antagonistsuse disorder and services available in bulkthe state for persons who experience symptoms of or are otherwise affected by opioid use disorder to a patient who (1) is treatedbysuchpersonnelforanoverdoseofanopioiddrug,(2)displays symptoms to such personnel of opioid use disorder, or (3) is treated at a discountedlocation price.where such personnel observes evidence of illicit use of an opioiddrug,ortosuchpatient'sfamilymember,caregiverorfriendwho is present at the location.

TheEmergency departmentmedical mayservices contractpersonnel withshall arefer wholesalerthe ofpatient prescriptionor drugssuch forpatient's family member, caregiver or friend to the purchasingwritten andinstructions distributionregarding the administration of such opioid antagonistsantagonist, inas bulk.deemed appropriate by such personnel.

(d) The CommissionerDepartment of Mental Health and Addiction Services shallmay, establishwithin anavailable applicationappropriations, processcontract forwith eligiblea entitieswholesaler toor applydistributor for athe grantpurchasing underand thisdistribution subsection.of opioid antagonists in Public Act No.

(d)23-97 The8 Department of Mental80 HealthSubstitute andSenate AddictionBill ServicesNo. shall adopt regulations implementing the provisions of this section, in accordance with the provisions of chapter 54of the general statutes.

The9 departmentbulk mayto implementeligible theentities policiespursuant andto proceduressubsection contained(c) in such proposed regulations while in the process of adoptingthis suchsection. proposed regulations, provided the department publishes notice of intention to adopt the regulations on the department's Internet web site and on the eRegulations System not later than twenty days after implementing such policies and procedures.

PoliciesEach andeligible proceduresentity implementedshall pursuantmake tosuch thisbulk-purchased subsectionopioid shallantagonists beavailable validat untilno thecharge earlierto ofa thefamily datemember, oncaregiver whichor suchfriend regulationsof area effectiveperson orwho onehas yearexperienced afteran theoverdose publication of suchan noticeopioid drug or displays symptoms of intention.opioid use disorder.

(e) NotEmergency latermedical thanservices Januaryorganizations 1,may 2025,obtain andopioid annuallyantagonists thereafter,for thedissemination Commissionerpursuant of Mental Health and Addiction Services shall report, in accordance with the provisions of section 11-4a of the general statutes, to thesubsection joint(c) standing committees of thethis Generalsection Assemblyfrom havinga cognizancepharmacist ofpursuant matters relating to publicsection health20-633c, and20-633d appropriationsor and21a-286 the budgets of state agencies regarding the followinggeneral informationstatutes. for the preceding calendar year:

(1)(f) TheEmergency numbermedical ofservices grantspersonnel applicationsshall received,document (2) the number of eligibleopioid entitiesantagonist thatkits receiveddistributed grantspursuant underto thissubsection section,(c) (3)of thethis amountsection, inincluding, grantsbut madenot tolimited eachto, such eligible entity, (4) the amountnumber of opioiddoses antagonists purchased by each such eligible entity, (5) the use of thean opioid antagonistsantagonist purchasedincluded within such grants by each suchkit. eligible entity, if known by the commissioner, and (6) any recommendations regarding the Opioid Antagonist Bulk Purchase LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2023SB-0007 of 53 R03-SB.docx } Substitute Bill No.

9(g) Fund,Not includinglater anythan proposedJanuary legislation1, 2025, and annually thereafter, the executive director of the Office of Emergency Medical Services shall report to facilitatethe Department of Mental Health and Addiction Services regarding the purposesimplementation of the provisions of subsections (c), (e) and (f) of this section.section, including, but not limited to, any information required under subsection (h) of this section for inclusion in the state substance use disorder plan developed pursuant to subsection (j) of section 17a-451 of the general statutes known to the executive director.

(h) The Commissioner of Mental Health and Addiction Services shall include in the state substance use disorder plan developed pursuant to subsection (j) of section 17a-451 of the general statutes the following information:

(1) The amount of funds used to purchase and distribute opioid antagonists, (2) the number of eligible entities that received opioid antagonists under this section, (3) the amount of opioid antagonists purchased under this section, (4) the use of the opioid antagonists purchased by each such eligible entity, if known by the commissioner, and (5) any recommendations regarding the Opioid Public Act No.

23-97 9 of 80 Substitute Senate Bill No.

9 Antagonist Bulk Purchase Fund, including any proposed legislation to facilitate the purposes of this section.

(b) When issuing a prescription for an opioid drug to an adult patient for the first time for outpatient use, a prescribing practitioner who is authorized to prescribe an opioid drug shall not issue a prescription for more than a seven-day supply of such drug, as recommended in the NationalPublic CentersAct forNo. Disease Control and Prevention's Guideline for Prescribing Opioids for Chronic Pain.

LCO23-97 {\\PRDFS1\SCOUSERS\FORZANOF\WS\2023SB-00009810 of 5380 R03-SB.docx } Substitute Senate Bill No.

9 (c)National ACenters prescribingfor practitionerDisease shallControl notand issuePrevention's aGuideline prescription for anPrescribing opioidOpioids drug to a minor for moreChronic thanPain. a five-day supply of such drug.

(c) A prescribing practitioner shall not issue a prescription for an opioid drug to a minor for more than a five-day supply of such drug.

(f) When issuing a prescription for an opioid drug to an adult or minor patient, the prescribing practitioner shall (1) discuss with the patient the risks associated with the use of such opioid drug, including, but not limited to, the risks of addiction and overdose associated with opioid drugs and the dangers of taking opioid drugs with alcohol, benzodiazepines and other central nervous system depressants, and the reasonsPublic theAct prescriptionNo. is necessary, and, if applicable, with the custodial parent, guardian or other person having legal custody of the minor if such parent, guardian or other person is present at the time of issuance of the prescription.

LCO23-97 {\\PRDFS1\SCOUSERS\FORZANOF\WS\2023SB-000911 of 5380 R03-SB.docx } Substitute Senate Bill No.

9 (g)reasons Whenthe issuingprescription ais prescriptionnecessary, forand, anif opioidapplicable, drugwith tothe ancustodial adultparent, guardian or other person having legal custody of the minor patient,patient if such parent, guardian or other person is present at the prescribingtime practitionerof shallissuance alsoof issuethe aprescription, prescriptionand for(2) anencourage opioidthe antagonistpatient toand, ifapplicable, thecustodialparent,guardianor other personhaving legal custody of the minor patient whenif such parent, guardian or other person is present at the followingtime riskof factorsissuance areof present:the prescription, to obtain an opioid antagonist.

(1) The patient has a history of a substance use disorder;

(2) the prescribing practitioner issued a prescription for a high-dose opioid drug that results in ninety morphine milligram equivalents or higher per day;

or (3) concurrent use by the patient of an opioid drug and a benzodiazepine or nonbenzodiazepine sedative hypnotic.

(NEW) (Effective July 1, 2023) (a) AsThe usedCommissioner of Education shall, in thiscollaboration section:with the Chief Workforce Officer, utilize the plan required of the Office of Workforce Strategy pursuant to section 2 of special act 22-9 in (1) the promotion of the health care professions as career options to students in middle and high school, including, but not limited to, through career day presentations regarding health care career opportunities in the state, the development of partnerships with health care career education programs in the state and the creation of counseling programs directed to high school students to inform such students about, and recruit them to, the health care professions, and (2) job shadowing and internship experiences in health care fields for high school students.

(1)(b) "EmergencyNot medicallater servicesthan personnel"September has1, 2023, the sameCommissioner meaningof asEducation providedshall provide each local and regional board of education with the plan described in sectionsubsection 19a-175(a) of this section, and through the generalGovernor's statutes;Workforce Council Education Committee, support implementation of such plan.

(2) "Opioid antagonist" means naloxone hydrochloride or any other similarly acting andequally safedrug approvedby thefederalFoodand Drug Administration for the treatment of a drug overdose;

(3) "Opioid use disorder" means a medical condition characterized by a problematic pattern of opioid use and misuse leading to clinically significant impairment or distress;

(4) "Opioid drug" has the same meaning as provided in 42 CFR 8.2, as amended from time to time;

and (5) "Pharmacist" has the same meaning as provided in section 20-609a of the general statutes.

(b) Not later than January 1, 2024, the Office of Emergency Medical Services, in collaboration with the Departments of Mental Health and Addiction Services and Consumer Protection, shall develop a program for the provision of opioid antagonists and related information by emergency medical services personnel to certain members of the public.

Emergency medical services personnel shall distribute an opioid antagonist kit containing a personal supply of opioid antagonists and the one-page fact sheet developed by the Connecticut Alcohol and Drug Policy Council pursuant to section 17a-667a of the general statutes LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2023SB-000010 of 53 R03-SB.docx } Substitute Bill No.

9 regarding the risks of taking an opioid drug, symptoms of opioid use disorder and services available in the state for persons who experience symptoms of or are otherwise affected by opioid use disorder to a patient who (1) istreated by suchpersonnel for anoverdose ofanopioid drug, (2) displays symptoms to such personnel of opioid use disorder, or (3) is treated at a location where such personnel observes evidence of illicit use of an opioid drug, or to such patient's family member, caregiver or friend who is present at the location.

Emergency medical services personnel shall refer the patient or such patient's family member, caregiver or friend to the written instructions regarding the administration of such opioid antagonist, as deemed appropriate by such personnel.

(c) Emergency medical services organizations may obtain opioid antagonistsfor disseminationthroughtheprogramdevelopedpursuant to subsection (b) of this section from a pharmacist pursuant to section 20-633c, 20-633d, as amended by this act, or 21a-286 of the general statutes.

(d) Emergency medical services personnel shall document the number of opioid antagonist kits distributed pursuant to subsection (b) of this section, including, but not limited to, the number of doses of an opioid antagonist included in each kit.

(e) Not later than January 1, 2025, and annually thereafter, the executive director of the Office of Emergency Medical Services shall report, in accordance with the provisions of section 11-4a of the general statutes, to the joint standing committee of the General Assembly having cognizance of matters relating to public health regarding the implementation of the program developed pursuant to subsection (b) of this section, including, but not limited to, information contained in the documentation prepared pursuant to subsection (d) of this section.

(f) The Department of Public Health may adopt regulations, in accordance with the provisions of chapter 54 of the general statutes, to implement the provisions of this section.

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9 Sec.

8.

Subsection (a) of section 20-633d of the general statutes is repealed and the following is substituted in lieu thereof (Effective July 1, 2023):

(a) A prescribing practitioner, as defined in section 20-14c, who is authorized to prescribe an opioid antagonist, as defined in section 17a- 714a, and a pharmacy may enter into an agreement for a medical protocol standing order at such pharmacy allowing a pharmacist licensed under part II of this chapter to dispense an opioid antagonist that is [(1)] administered by an intranasal application delivery systemor an auto-injection delivery system [, (2)] and approved by the federal Food and Drug Administration [, and (3) dispensed to] to (1) any person at risk of experiencing an overdose of an opioid drug, as defined in 42 CFR 8.2, [or to] (2) a family member, friend or other person in a position to assist a person at risk of experiencing an overdose of an opioid drug, or (3) an emergency medical services organization for purposes of section 7 of this act.

9.8.

(NEW) (Effective Julyfrom 1,passage) 2023) (a) The CommissionerOffice of EducationWorkforce Strategy shall establishconvene a Healthworking Caregroup Careerto Advisorydevelop Councilrecommendations consistingfor ofexpanding the followinghealth members:care workforce in the state.

(1) A representative of an association of hospitals in the state;

(2) A representative of a medical society in the state;

(3) A representative of the Connecticut chapter of a national association of nurse practitioners;

(4) A representative of an association of nurses in the state;

(5) A representative of an association of physician assistants in the state;

(6) A representative of the Connecticut chapter of a national association of social workers;

LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2023SB-0012 of 53 R03-SB.docx } Substitute Bill No.

9 (7) A representative of the Connecticut chapter of a national association of psychologists in the state;

and (8) A representative of an association of pharmacists in the state.

(b) The advisory council shall advise the Commissioner of Education concerning the development of a health care career program consisting of (1) the promotion of the health care professions as career options to students in middle and high school, including, but not limited to, through career day presentations regarding health care career opportunities in the state, the development of partnerships with health care career education programs in the state and the creation of counseling programs directed to high school students in order to inform them about and recruit them to the health care professions, and (2) job shadowing and internship experiences in health care fields for high school students.

(c)Membersshallreceive no compensationexcept for reimbursement for necessary expenses incurred in performing their duties.

(d) The Commissioner of Education shall schedule the first meeting of the advisory council, which shall be held not later than September 1, 2023.

The members shall elect the chairperson of the advisory council from among the members of the council.

A majority of the council members shall constitute a quorum.

A majority vote of a quorum shall be required for any official action of the advisory council.

The advisory council shall meet upon the call of the chairperson or upon the majority request of the council members.

(e) Not later than January 1, 2024, and not less than annually thereafter, theadvisorycouncilshallsubmit areport,inaccordancewith the provisions of section 11-4a of the general statutes, on its recommendations to the Commissioner of Education and to the joint standing committees of the General Assembly having cognizance of matters relating to education and public health.

(f) The Commissioner of Education shall notify each local and LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2023SB-0013 of 53 R03-SB.docx } Substitute Bill No.

9 regional board of education of the advisory council's recommendations notlaterthanthirtydaysafterthecommissioner'sreceiptoftheadvisory council's report containing such recommendations.

Sec.

10.

(Effective from passage) (a) The Commissioner of Public Health shall convene a working group to develop recommendations for expanding the nursing workforce in the state.

(3) the potentialPublic forAct increasingNo. the number of clinical training sites for nurses and nurse's aides;

23-97 12 of 80 Substitute Senate Bill No.

9 potential for increasing the number of clinical training sites for nurses and nurse's aides;

and (5) barriers to recruitment and retention of health care providers, including, but not limited to, nurses and nurse's aides.aides;

(6) the impact of the state health care staffing shortage on the provision of health care services, the public's access to health care services and wait times for health care services;

and (7) the impact of federal and state reimbursement for the costs of health care services on the public's access to such services.

(4)Thepresident(4) oftheThe BoardofRegentsforchairperson of the Board of Regents for Higher Education,orEducation, or the president'schairperson's designee;

(7) One member of the administration of The University of LCOConnecticut {\\PRDFS1\SCOUSERS\FORZANOF\WS\2023SB-0014Health ofCenter; 53 R03-SB.docx } Substitute Bill No.

9 Connecticut Health Center;

(9) The Commissioner of Public Health,Act orNo. the commissioner's designee;

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9 (9) The Commissioner of Public Health, or the commissioner's designee;

(14) TheA chairpersonsrepresentative and ranking members of the jointState standingEmployees committeeBargaining ofAgent theCoalition; General Assembly having cognizance of matters relating to public health, or the chairpersons' and ranking members' designees;

and (15) The chairpersons and ranking members of the joint standing committee of the General Assembly having cognizance of matters relating to higherpublic educationhealth, and employment advancement, or the chairpersons' and ranking members' designees.designees;

(c)and (16) The cochairpersonschairpersons and ranking members of the workingjoint groupstanding shallcommittee beof the CommissionerofPublicHealth,orthecommissioner'sdesignee,andGeneral theAssembly presidenthaving cognizance of thematters Boardrelating ofto Regentshigher foreducation Higherand Education,employment advancement, or the president'schairpersons' designee.and ranking members' designees.

(c) The cochairpersons of the working group shall be the CommissionerofPublicHealth,orthecommissioner'sdesignee,and the chairperson of the Board of Regents for Higher Education, or the president's designee.

(d) Not later than January 1, 2024, the working group shall submit a report, in accordance with the provisions of section 11-4a of the general LCOPublic {\\PRDFS1\SCOUSERS\FORZANOF\WS\2023SB-0015Act of 53 R03-SB.docx } Substitute Bill No.

923-97 statutes,14 to the joint standing committees of the80 GeneralSubstitute AssemblySenate havingBill cognizanceNo. of matters relating to public health and higher education and employment advancement on its findings and any recommendations for improving the recruitment and retention of nurses and nurse's aides in the state, including, but not limitedto,a five- year plan and a ten-year plan for increasing the nursing workforce in the state.

9 statutes, to the joint standing committees of the General Assembly having cognizance of matters relating to public health and higher education and employment advancement on its findings and any recommendationsfor improving therecruitment andretentionofhealth care providers in the state, including, but not limited to, a five-year plan and a ten-year plan for increasing the health care workforce in the state.

11.9.

12.10.

(NEW) (Effective July 1, 2023) (a) On or before January 1, 2024, the Office of Higher Education shall establish and administeradminister, within available appropriations, an adjunct professor incentive grant program.

The program shall provide an incentive grantsgrant in an amount of twenty thousand dollars to each licensed health care provider who (1) accepts a position as an adjunct professor at a public institution of higher education that was offered to such provider after being considered asasan an applicant for such position pursuant to section 119 of this act.act, and (2) remains in such position for not less than one academic year.

SuchEach grants shall be in an annual amount that represents the difference between the provider's most recent annual salary as a licensed health care provider inwho thereceives clinicalagrant settingunder andthis thesubsection provider'sshallbeeligibleforanadditionalgrantinanamountoftwentythousand salaryPublic asAct anNo. adjunct professor at such institution of higher education, for as long as such provider remains employed as an adjunct professor in a health care related field at such institution of higher education.

The23-97 executive15 director of the80 Office of LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2023SB-0016 of 53 R03-SB.docx } Substitute Senate Bill No.

9 Higherdollars Educationif the provider remains in such position for not less than two academicyears.TheexecutivedirectoroftheOfficeofHigherEducation shall establish the application process for the grant program.

13.11.

(NEW) (Effective July 1, 2023) On and after January 1, 2024, the Department of Public Health shall offer any competency evaluations prescribed by the Commissioner of Public Health for nurse's aides, as defined in section 20-102aa of the general statutes, in both English and Spanish.

Sec.

14.

LCO(c) {\\PRDFS1\SCOUSERS\FORZANOF\WS\2023SB-0017The ofcareer 53pathways R03-SB.docxprogram }shall Substituteinclude, Billbut No.need not be limited to, the following objectives:

9Public (c)Act TheNo. career pathways program shall include, but need not be limited to, the following objectives:

(1)23-97 Increase16 in employment retention and recruitment of personal80 careSubstitute attendantstomaintainastableworkforceforSenate consumers,including,Bill butNo. not limited to, through the creation of career pathways for such attendants that improve skill and knowledge and increase wages;

9 (1) Increase in employment retention and recruitment of personal care attendantstomaintainastableworkforcefor consumers,including, but not limited to, through the creation of career pathways for such attendants that improve skill and knowledge and increase wages;

(e) The Commissioner of Social Services shall develop or identify, in consultation with a labor management committee at a hospital or health care organization, the training curriculum for each career pathway of LCOthe {\\PRDFS1\SCOUSERS\FORZANOF\WS\2023SB-000018career ofpathways 53program. R03-SB.docx } Substitute Bill No.

9Public theAct careerNo. pathways program.

(f)Not23-97 later17 thanJanuary 1,2025,theCommissioner ofSocialServices shall report in accordance with the provisions of section80 11-4aSubstitute ofSenate theBill generalNo. statutes, to the joint standing committees of the General Assembly having cognizance of matters relating to human services and public health, on the following information concerning the career pathways program:

9 (f)Not later thanJanuary 1,2025,theCommissioner ofSocialServices shall report in accordance with the provisions of section 11-4a of the general statutes, to the joint standing committees of the General Assembly having cognizance of matters relating to human services and public health, on the following information concerning the career pathways program:

15.12.

(NEW) (Effective October 1, 2023) (a) As used in this section, (1) "board eligible" means aeligible physicianto hastake passeda thequalifying written portion of the examination administered by a medical specialty board toafter becomehaving certifiedgraduated infrom a particularmedical specialty,school, andcompleted (2) "board certified" means a physicianresidency hasprogram passed the written and oraltrained portionsunder ofsupervision thein examinationa LCOspecialty {\\PRDFS1\SCOUSERS\FORZANOF\WS\2023SB-0019fellowship ofprogram, 53(2) R03-SB.docx"board }certified" SubstitutePublic BillAct No.

923-97 administered18 byof a80 medicalSubstitute specialtySenate boardBill toNo. become board certified in a particular specialty.

(b)9 Nomeans hospital,having orpassed medicalthe reviewqualifying committeeexamination ofadministered by a hospital,medical shallspecialty require,board asto partbecome ofboard itscertified credentialingin requirements for a (1)particular boardspecialty, eligibleand physician(3) to"board berecertification" grantedmeans privilegesrecertification to practice in thea hospital,particular thatspecialty theafter physiciana providepredetermined credentialstime ofperiod boardprescribed certificationby in a particularmedical specialty untilboard fiveafter yearshaving afterpassed the datequalifying onexamination whichadministered by the physicianmedical becamespecialty board eligibleto inbecome such specialty, or (2) board certified physician to be granted privileges to practice in thea hospital,particular thatspecialty. the physician provide credentials of board recertification.

(b) No hospital, or medical review committee of a hospital, shall require, as part of its credentialing requirements (1) for a board eligible physician to acquire privileges to practice in the hospital, that the physician provide credentials of board certification in a particular specialty until five years after the date on which the physician became board eligible in such specialty, or (2) for a board certified physician to acquire or retain privileges to practice in the hospital, that the physician provide credentials of board recertification.

16.13.

and (3) "primary site where such physician practices" meansmeans[(A)theoffice, (A) the office, facility or locationlocationwhere whereamajority aoftherevenue majority of the revenue derived from such physician's services is generated, or (B) any otherother] any single office, facility or location where such physician practicespractices, and[and] as mutually agreed to by the parties and identified[identified] defined in the covenant not to compete.

(b)Public (1)Act ANo. covenant not to compete that is entered into, amended, extended or renewed prior to July 1, 2023, is valid and enforceable only if it is:

23-97 19 of 80 Substitute Senate Bill No.

9 (b) (1) A covenant not to compete is valid and enforceable only if it is:

LCO(2) {\\PRDFS1\SCOUSERS\FORZANOF\WS\2023SB-0000920A ofcovenant 53not R03-SB.docxto }compete Substitutethat Billis No.entered into, amended, extended or renewed on or after July 1, 2016, shall not:

9 (2) A covenant not to compete that is entered into, amended, extended or renewed on or after July 1, 2016, but before June 30, 2023, shall not:

(3) EachA covenant not to compete that is entered into, amendedamended, extendedorrenewedonorafterOctober1,2023,shallnotbeenforceable if (A) the physician who is a party to the employment or renewedother oncontract andor afteragreement Julydoes 1,not 2016,agree untilto Junea 30,proposed 2023,material shallchange beto separatelythe compensationtermsof such contract or agreement prior to or at thetime of the extension or renewal of such contract or agreement, and individually(B) signedthe contract or agreement expires and is not renewed by the physician.employer or the employment or contractual relationship is terminated by the employer, unless such employment or contractual relationship is terminatedbytheemployerforcause.Theprovisionsofthissubdivision shallnot apply to a covenant not to compete that is enteredinto between a physician and a group practice, as defined in section 19a-486i, of not Public Act No.

(4)23-97 On20 andof after80 JulySubstitute 1,Senate 2023,Bill noNo. employment, partnership or ownership contract or agreement entered into, amended or renewed shall contain a covenant not to compete and each covenant not to compete entered into, amended or renewed on and after said date shall be void and unenforceable.

Any9 physicianmore whothan isthirty-five aggrievedphysicians bythe amajority violationownership of thiswhich subdivisionis maycomprised bringof aphysicians. civil action in the Superior Court to recover damages, together with court costs and reasonable attorney's fees, and for such injunctive and equitable relief as the court deems appropriate.

[(3)] (4) Each covenant not to compete entered into, amended or renewed on and after July 1, 2016, shall be separately and individually signed by the physician.

17.14.

LCO(1) {\\PRDFS1\SCOUSERS\FORZANOF\WS\2023SB-0021"Covenant not to compete" means any provision of 53an R03-SB.docxemployment }or Substituteother Billcontract No.or agreement that creates or establishes a professional relationshipwithanadvancedpractice registerednurse andrestrictsthe right of an advanced practice registered nurse to practice as an advanced practice registered nurse in any geographic area of the state for any period of time after the termination or cessation of such partnership, employment or other professional relationship;

9(2) (1)"advanced "Covenantpractice notregistered tonurse" compete" means any provision of an employmentindividual orlicensed otheras contract or agreement that creates or establishes a professional relationshipwithanadvancedpractice registerednurse andrestrictsthe right of an advanced practice registered nurse pursuant to providechapter health378 care servicesasanadvanced practice registerednurseinany geographicarea of the stategeneral forstatutes; any period of time after the termination or cessation of such partnership, employment or other professional relationship;

and (2)(3) "advanced"primary site where such advanced practice registered nurse"nurse practices" means anany individualsingle licensedoffice, asfacility anor location where such advanced practice registered nurse pursuantpractices, as mutually agreed to chapterby 378the ofparties and defined in the generalcovenant statutes.not to compete.

(b) On(1) andA after July 1, 2023, no employment, partnership or ownership contract or agreement entered into, amended or renewed shall contain a covenant not to compete andthat eachis covenant not to compete entered into, amendedamended, extended or renewed on andor after saidOctober date1, 2023, shall be voidvalid and unenforceable.enforceable only if it is:

Any(A) advancedNecessary practiceto registeredprotect nurse who is aggrieved by a violationlegitimate ofbusiness thisinterest; subsection may bring a civil action in the Superior Court to recover damages, together with court costs and reasonable attorney's fees, and for such injunctive and equitable relief as the court deems appropriate.

(B) reasonably limited in time, geographic scope and practice restrictions as necessary to protect such business interest;

and (C) Public Act No.

23-97 21 of 80 Substitute Senate Bill No.

9 otherwise consistent with the law and public policy.

The party seeking to enforce a covenant not to compete shall have the burden of proof in any proceeding.

(2) A covenant not to compete that is entered into, amended, extended or renewed on or after October 1, 2023, shall not:

(A) Restrict the advanced practice registered nurse's competitive activities (i) for a period of more than one year, and (ii) in a geographic region of more than fifteen miles from the primary site where such advanced practice registered nurse practices;

or (B) be enforceable against an advanced practice registered nurse if (i) such employment contract or agreement was not made in anticipation of, or as part of, a partnership or ownership agreement and such contract or agreement expires and is not renewed, unless, prior to such expiration, the employer makes a bona fide offer to renew the contract on the same or similar terms and conditions, or (ii) the employment or contractual relationship is terminated by the employer, unless such employment or contractual relationship is terminated for cause.

(3) A covenant not to compete that is entered into, amended, extendedorrenewedonorafterOctober1,2023,shallnotbeenforceable if (A) the advanced practice registered nurse who is a party to the employment or other contract or agreement does not agree to a proposed material change to the compensation terms of such contract or agreement prior to or at the time of the extension or renewal of such contract or agreement;

and (B) the contract or agreement expires and is not renewed by the employer or the employment or contractual relationship is terminated by the employer, unless such employment or contractual relationship is terminated for cause.

(4) Each covenant not to compete entered into, amended or renewed on or after October 1, 2023, shall be separately and individually signed by the advanced practice registered nurse.

Public Act No.

23-97 22 of 80 Substitute Senate Bill No.

9 (c) The remaining provisions of any contract or agreement that includes a covenant not to compete that is rendered void and unenforceable, in whole or in part, under the provisions of this section shall remain in full force and effect, including provisions that require the payment of damages resulting from any injury suffered by reason of termination of such contract or agreement.

Sec.

15.

(NEW) (Effective July 1, 2023) (a) For purposes of this section:

(1) "Covenant not to compete" means any provision of an employment or other contract or agreement that creates or establishes a professional relationship with a physician assistant and restricts the right of a physician assistant to practice as a physician assistant in any geographic area of the state for any period of time after the termination or cessation of such partnership, employment or other professional relationship;

(2) "physician assistant" means an individual licensed as a physician assistant pursuant to chapter 370 of the general statutes;

and (3) "primarysitewheresuchphysicianassistant practices"meansanysingle office, facility or location where such physician assistant practices, as mutually agreed to by the parties and defined in the covenant not to compete.

(b) (1) A covenant not to compete that is entered into, amended, extended or renewed on or after October 1, 2023, shall be valid and enforceable only if it is:

(A) Necessary to protect a legitimate business interest;

(B) reasonably limited in time, geographic scope and practice restrictions as necessary to protect such business interest;

and (C) otherwise consistent with the law and public policy.

The party seeking to enforce a covenant not to compete shall have the burden of proof in any proceeding.

(2) A covenant not to compete that is entered into, amended, extended or renewed on or after October 1, 2023, shall not:

(A) Restrict the physician assistant's competitive activities (i) for a period of more than one year, and (ii) in a geographic region of more than fifteen miles Public Act No.

23-97 23 of 80 Substitute Senate Bill No.

9 from the primary site where such physician assistant practices;

or (B) be enforceable against a physician assistant if (i) such employment contract or agreement was not made in anticipation of, or as part of, a partnership or ownership agreement and such contract or agreement expires and is not renewed, unless, prior to such expiration, the employer makes a bona fide offer to renew the contract on the same or similar terms and conditions, or (ii) the employment or contractual relationship is terminated by the employer, unless such employment or contractual relationship is terminated for cause.

(3) A covenant not to compete that is entered into, amended, extendedorrenewedonorafterOctober1,2023,shallnotbeenforceable if (A) the physician assistant who is a party to the employment or other contract or agreement does not agree to a proposed material change to the compensation terms of such contract or agreement prior to or at the time of the extension or renewal of such contract or agreement;

and (B) the contract or agreement expires and is not renewed by the employer or the employment or contractual relationship is terminated by the employer, unless such employment or contractual relationship is terminated for cause.

(4) Each covenant not to compete entered into, amended or renewed on or after October 1, 2023, shall be separately and individually signed by the physician assistant.

18.16.

(NEW) (Effective fromJuly passage)1, (a)2023) ThereThe isPhysical establishedTherapy aLicensure taskCompact forceis tohereby studyenacted medicalinto malpracticelaw reform to incentivize physicians and otherentered licensedinto healthby carethe providersstate toof practicePublic inAct theNo. state.

(b)23-97 The24 taskof force80 shallSubstitute consistSenate ofBill theNo. following members:

(1)9 TwoConnecticut appointedwith byany theand speakerall ofjurisdictions thelegally Housejoining oftherein Representatives, one of whom has expertise in medicalaccordance malpracticewith lawsits andterms. one of LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2023SB-0022 of 53 R03-SB.docx } Substitute Bill No.

9 whom has expertise in tort reform;

(2) Two appointed by the president pro tempore of the Senate, one of whom shall be a representative of a medical society in the state and one of whom shall be a representative of a hospital association in the state;

(3) One appointed by the majority leader of the House of Representatives, who shall be a representative of a nurse's association in the state;

(4) One appointed by the majority leader of the Senate, who shall be a member of the judiciary;

(5) One appointed by the minority leader of the House of Representatives, who shall be a member of an association of trial lawyers in the state;

(6) One appointed by the minority leader of the Senate, who shall be a health care advocate in the state;

and (7) The Commissioner of Public Health, or the commissioner's designee.

(c) Any member of the task force appointed under subdivision (1), (2), (3), (4), (5) or (6) of subsection (b) of this section may be a member of the General Assembly.

(d) All initial appointments to the task force shall be made not later thanthirty daysafter theeffective date ofthis section.Any vacancy shall be filled by the appointing authority.

(e)The speaker oftheHouse ofRepresentativesandthepresident pro tempore of the Senate shall select the chairpersons of the task force from among the members of the task force.

Such chairpersons shall schedule thefirst meeting ofthe task force, whichshall beheld not later thansixty days after the effective date of this section.

(f) The administrative staff of the joint standing committee of the LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2023SB-0023 of 53 R03-SB.docx } Substitute Bill No.

9 General Assembly having cognizance of matters relating to public health shall serve as administrative staff of the task force.

(g) Not later than January 1, 2024, the task force shall submit a report on its findings and recommendations to 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 of the general statutes.

The task force shall terminate on the date that it submits such report or January 1, 2024, whichever is later.

Sec.

19.

(NEW) (Effective July 1, 2023) The Physical Therapy Licensure Compact is hereby enacted into law and entered into by the state of Connecticut with any and all jurisdictions legally joining therein in accordance with its terms.

LCO(5) {\\PRDFS1\SCOUSERS\FORZANOF\WS\2023SB-0024Enhance the exchange of 53licensure, R03-SB.docxinvestigative }and Substitutedisciplinary Billinformation No.between member states;

9 (5) Enhance the exchange of licensure, investigative and disciplinary information between member states;

(1)Public "ActiveAct dutyNo. military" means full-time duty status in the active uniformed service of the United States, including members of the National Guard and Reserve on active duty orders pursuant to 10 USC 1209 and 1211, as amended from time to time;

23-97 25 of 80 Substitute Senate Bill No.

9 (1) "Active duty military" means full-time duty status in the active uniformed service of the United States, including members of the National Guard and Reserve on active duty orders pursuant to 10 USC and 1211, as amended from time to time;

(6) "Data system" means a repository of information about licensees, LCOincluding {\\PRDFS1\SCOUSERS\FORZANOF\WS\2023SB-0025examination, oflicensure, 53investigative, R03-SB.docxcompact }privilege Substituteand Billadverse No.action;

9 including examination, licensure, investigative, compact privilege and adverse action;

(9)Public "HomeAct state"No. means the member state that is the licensee's primary state of residence;

23-97 26 of 80 Substitute Senate Bill No.

9 (9) "Home state" means the member state that is the licensee's primary state of residence;

LCO(17) {\\PRDFS1\SCOUSERS\FORZANOF\WS\2023SB-0026"Physical therapy", "physical therapy practice" and "the practice of 53physical R03-SB.docxtherapy" }mean Substitutethe Billcare No.and services provided by or under the direction and supervision of a licensed physical therapist;

9 (17) "Physical therapy", "physical therapy practice" and "the practice of physical therapy" mean the care and services provided by or under the direction and supervision of a licensed physical therapist;

(19)"Physicaltherapylicensingboard"or"licensingboard"meansthePublic agencyAct ofNo. a state that is responsible for the licensing and regulation of physical therapists and physical therapist assistants;

23-97 27 of 80 Substitute Senate Bill No.

9 (19)"Physicaltherapylicensingboard"or"licensingboard"meansthe agency of a state that is responsible for the licensing and regulation of physical therapists and physical therapist assistants;

(4) Fully implement a criminal background check requirement, LCOwithin {\\PRDFS1\SCOUSERS\FORZANOF\WS\2023SB-0027a time frame established by rule, by receiving the results of 53the R03-SB.docxFederal }Bureau Substituteof BillInvestigation No.record search on criminal background checks and use the results in making licensure decisions in accordance with subsection (b) of this section;

9 within a time frame established by rule, by receiving the results of the Federal Bureau of Investigation record search on criminal background checks and use the results in making licensure decisions in accordance with subsection (b) of this section;

(6)Public UtilizeAct aNo. recognized national examination as a requirement for licensure pursuant to the rules of the commission;

23-97 28 of 80 Substitute Senate Bill No.

9 (6) Utilize a recognized national examination as a requirement for licensure pursuant to the rules of the commission;

LCO(4) {\\PRDFS1\SCOUSERS\FORZANOF\WS\2023SB-0028Have ofnot 53had R03-SB.docxany }adverse Substituteaction Billagainst No.any license or compact privilege within the previous two years;

9 (4) Have not had any adverse action against any license or compact privilege within the previous two years;

(6)Public PayAct anyNo. applicable fees, including any state fee, for the compact privilege;

23-97 29 of 80 Substitute Senate Bill No.

9 (6) Pay any applicable fees, including any state fee, for the compact privilege;

and LCO(2) {\\PRDFS1\SCOUSERS\FORZANOF\WS\2023SB-00029Two ofyears 53have R03-SB.docxelapsed }from Substitutethe Billdate No.of the adverse action.

9(f) (2)Once Twoan yearsencumbered havelicense elapsedin fromthe home state is restored to good standing, the datelicensee ofshall meet the adverserequirements action.of subsection (a) of Public Act No.

(f)23-97 Once30 an encumbered license in the home state is restored to good standing, the licensee shall meet the requirements of subsection80 (a)Substitute ofSenate thisBill sectionNo. of the compact to obtain a compact privilege in any remote state.

9 this section of the compact to obtain a compact privilege in any remote state.

ADVERSE ACTIONS LCO(a) {\\PRDFS1\SCOUSERS\FORZANOF\WS\2023SB-0030A ofhome 53state R03-SB.docxshall }have Substituteexclusive Billpower No.to impose adverse action against a license issued by the home state.

9Public (a)Act ANo. home state shall have exclusive power to impose adverse action against a license issued by the home state.

(b)23-97 A31 home state may take adverse action based on the investigative information of a80 remoteSubstitute state,Senate soBill longNo. as the home state follows its own procedures for imposing adverse action.

9 (b) A home state may take adverse action based on the investigative information of a remote state, so long as the home state follows its own procedures for imposing adverse action.

and LCOPublic {\\PRDFS1\SCOUSERS\FORZANOF\WS\2023SB-0031Act of 53 R03-SB.docx } Substitute Bill No.

23-97 32 of 80 Substitute Senate Bill No.

(b) Membership, Voting and Meetings (1) Each member state shall have and be limited to one delegate selectedPublic byAct suchNo. member state's licensing board.

LCO23-97 {\\PRDFS1\SCOUSERS\FORZANOF\WS\2023SB-003233 of 5380 R03-SB.docx } Substitute Senate Bill No.

9 (2)Thedelegateselected shallby besuch acurrent member ofstate's thelicensinglicensing boardwhoboard. is a physical therapist, a physical therapist assistant, a public member or the board administrator.

(2)Thedelegate shall be acurrent member of thelicensing boardwho is a physical therapist, a physical therapist assistant, a public member or the board administrator.

(5) Promulgate uniform rules to facilitateandfacilitate coordinate implementation and administrationcoordinate ofPublic thecompact.Act No.

23-97 34 of 80 Substitute Senate Bill No.

9 implementation and administration of thecompact.

LCO(6) {\\PRDFS1\SCOUSERS\FORZANOF\WS\2023SB-0033Bring and prosecute legal proceedings or actions in the name of 53the R03-SB.docxcommission, }provided Substitutethe Billstanding No.of any state physical therapy licensing board to sue or be sued under applicable law shall not be affected;

9 (6) Bring and prosecute legal proceedings or actions in the name of the commission, provided the standing of any state physical therapy licensing board to sue or be sued under applicable law shall not be affected;

(8)Borrow, accept or contract for servicesofpersonnel, including,butincluding, but not limited to, employees of a member state;

(15)Public AppointAct committees, including standing committees composed of members, state regulators, state legislators or their representatives, and consumer representatives and such other interested persons as may LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2023SB-00034 of 53 R03-SB.docx } Substitute Bill No.

923-97 be35 designatedof in80 theSubstitute compactSenate andBill theNo. bylaws;

9 (15) Appoint committees, including standing committees composed of members, state regulators, state legislators or their representatives, and consumer representatives and such other interested persons as may be designated in the compact and the bylaws;

(4)Public TheAct executiveNo. board shall meet at least annually.

23-97 36 of 80 Substitute Senate Bill No.

9 (4) The executive board shall meet at least annually.

LCO(A) {\\PRDFS1\SCOUSERS\FORZANOF\WS\2023SB-0035Recommend ofto 53the R03-SB.docxentire }commission Substitutechanges Billto No.the rules or bylaws, changes to the compact legislation, fees paid by compact memberstates,includingannualdues,andanycommissioncompact fee charged to licensees for the compact privilege;

9 (A) Recommend to the entire commission changes to the rules or bylaws, changes to the compact legislation, fees paid by compact memberstates,includingannualdues,andanycommissioncompact fee charged to licensees for the compact privilege;

(B)Public TheAct employment,No. compensation, discipline or other matters, practices or procedures related to specific employees or other matters relatedtothecommission'sinternalpersonnelpracticesandprocedures;

23-97 37 of 80 Substitute Senate Bill No.

9 (B) The employment, compensation, discipline or other matters, practices or procedures related to specific employees or other matters relatedtothecommission'sinternalpersonnelpracticesandprocedures;

LCO(D) {\\PRDFS1\SCOUSERS\FORZANOF\WS\2023SB-0036Negotiation of 53contracts R03-SB.docxfor }the Substitutepurchase, Billlease No.or sale of goods, services or real estate;

9 (D) Negotiation of contracts for the purchase, lease or sale of goods, services or real estate;

(4) The commission shall keep minutes that fully and clearly describe all matters discussed in a meeting and shall provide a full and accurate summary of actions taken and the reasons therefor, including a descriptionPublic ofAct theNo. views expressed.

23-97 38 of 80 Substitute Senate Bill No.

9 description of the views expressed.

(f) Financing of the Commission LCO(1) {\\PRDFS1\SCOUSERS\FORZANOF\WS\2023SB-0037The commission shall pay or provide for the payment of 53the R03-SB.docxreasonable }expenses Substituteof Billits No.establishment, organization and ongoing activities.

9 (1) The commission shall pay or provide for the payment of the reasonable expenses of its establishment, organization and ongoing activities.

All receipts and disbursements of funds handled by the commission shall be audited annually by a certified or licensed public accountantPublic andAct theNo. report of the audit shall be included in and become part of the annual report of the commission.

(g)23-97 Qualified39 Immunity, Defense and Indemnification (1) The members, officers, executive director, employees and representatives of the80 commission shall be immune from suit and liability, either personally or in their official capacity, for any claim for damage to or loss of property or personal injury or other civil liability caused by or arising out of any actual or alleged act, error or omission LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2023SB-0038 of 53 R03-SB.docx } Substitute Senate Bill No.

9 thataccountant occurredand or that the personreport againstof whom the claimaudit is made had a reasonable basis for believing occurred within the scope of commission employment, duties or responsibilities, provided nothing in this subdivision shall be construedincluded toin protectand anybecome suchpart personof fromthe suitannual orreport liabilityforanydamage,loss,injuryorliabilitycausedbytheintentional or wilful or wanton misconduct of suchthe person.commission.

(g) Qualified Immunity, Defense and Indemnification (1) The members, officers, executive director, employees and representatives of the commission shall be immune from suit and liability, either personally or in their official capacity, for any claim for damage to or loss of property or personal injury or other civil liability caused by or arising out of any actual or alleged act, error or omission that occurred or that the person against whom the claim is made had a reasonable basis for believing occurred within the scope of commission employment, duties or responsibilities, provided nothing in this subdivision shall be construed to protect any such person from suit or liabilityforanydamage,loss,injuryorliabilitycausedbytheintentional or wilful or wanton misconduct of such person.

(3) The commission shall indemnify and hold harmless any member, officer, executive director, employee or representative of the commission for the amount of any settlement or judgment obtained against such person arising out of any actual or alleged act, error or omission that occurred within the scope of commission employment, dutiesPublic orAct responsibilitiesNo. or that such person had a reasonable basis for believing occurred within the scope of commission employment, duties or responsibilities, provided the actual or alleged act, error or omission did not result from the intentional or wilful or wanton misconduct of such person.

23-97 40 of 80 Substitute Senate Bill No.

9 duties or responsibilities or that such person had a reasonable basis for believing occurred within the scope of commission employment, duties or responsibilities, provided the actual or alleged act, error or omission did not result from the intentional or wilful or wanton misconduct of such person.

LCO(b) {\\PRDFS1\SCOUSERS\FORZANOF\WS\2023SB-0039Notwithstanding any other provision of 53state R03-SB.docxlaw }to Substitutethe Billcontrary, No.a member state shall submit a uniform data set to the data system on all individuals to whom the compact is applicable as required by the rules of the commission, including:

9 (b) Notwithstanding any other provision of state law to the contrary, a member state shall submit a uniform data set to the data system on all individuals to whom the compact is applicable as required by the rules of the commission, including:

(d)Public TheAct commissionNo. shall promptly notify all member states of any adverse action taken against a licensee or an individual applying for a license.

23-97 41 of 80 Substitute Senate Bill No.

9 (d) The commission shall promptly notify all member states of any adverse action taken against a licensee or an individual applying for a license.

RULEMAKING LCO(a) {\\PRDFS1\SCOUSERS\FORZANOF\WS\2023SB-000040The ofcommission 53shall R03-SB.docxexercise }its Substituterulemaking Billpowers No.pursuant to the criteria set forth in this section and the rules adopted thereunder.

9 (a) The commission shall exercise its rulemaking powers pursuant to the criteria set forth in this section and the rules adopted thereunder.

(b) If a majority of the legislatures of the member states rejects a rule, byenactmentofastatuteorresolutioninthebyenactmentofastatuteorresolutioninthesame samemannerusedtoadoptmannerusedtoadopt the compact not later than four years after the date of adoption of the rule, such rule shall have no further force and effect in any member state.

(1) On the Internet web site of the commission or other publicly accessiblePublic platform;Act No.

23-97 42 of 80 Substitute Senate Bill No.

9 accessible platform;

and (4) The manner in which interested persons may submit notice to the LCOcommission {\\PRDFS1\SCOUSERS\FORZANOF\WS\2023SB-000041 of 53their R03-SB.docxintention }to Substituteattend Billthe No.public hearing and any written comments.

9 commission of their intention to attend the public hearing and any written comments.

If the hearing is held via electronic means, the commissionPublic shallAct publishNo. the mechanism for access to the electronic hearing.

23-97 43 of 80 Substitute Senate Bill No.

9 commission shall publish the mechanism for access to the electronic hearing.

LCO(i) {\\PRDFS1\SCOUSERS\FORZANOF\WS\2023SB-000042Following the scheduled hearing date, or by the close of 53business R03-SB.docxon }the Substitutescheduled Billhearing No.date if the hearing was not held, the commission shall consider all written and oral comments received.

9 (i) Following the scheduled hearing date, or by the close of business on the scheduled hearing date if the hearing was not held, the commission shall consider all written and oral comments received.

(l) Upon determination that an emergency exists, the commission may consider and adopt an emergency rule without prior notice, opportunity for comment or hearing, provided the usual rulemaking procedures provided in the compact and in this section shall be retroactivelyPublic appliedAct toNo. the rule as soon as reasonably possible, but in no event later than ninety days after the effective date of the rule.

23-97 44 of 80 Substitute Senate Bill No.

9 retroactively applied to the rule as soon as reasonably possible, but in no event later than ninety days after the effective date of the rule.

The revision may be challenged only on grounds that the LCOrevision {\\PRDFS1\SCOUSERS\FORZANOF\WS\2023SB-0043results ofin 53a R03-SB.docxmaterial }change Substituteto Billa No.rule.

9A revisionchallenge resultsshall be made in awriting materialand changedelivered to athe rule.chair of the commission prior to the end ofthenotice period.If no challenge ismade, therevisionshalltake effect without further action.If therevision ischallenged, therevisionmaynot take effect without the approval of the commission.

A challenge shall be made in writing and delivered to the chair of the commission prior to the end ofthenotice period.If no challenge ismade, therevisionshalltake effect without further action.If therevisionischallenged, therevisionmaynot take effect without the approval of the commission.

OVERSIGHT, DISPUTE RESOLUTION AND ENFORCEMENT (a) Oversight (1) The executive, legislative and judicial branches of state government in each member state shall enforce the compact and take all actions necessary and appropriate to effectuate the compact's purposes andPublic intent.Act No.

23-97 45 of 80 Substitute Senate Bill No.

9 and intent.

Failure to provide service of process to the commission shall render ajudgmenta judgment or ordervoid asto the commission, the compact or promulgated rules.

and LCO(B) {\\PRDFS1\SCOUSERS\FORZANOF\WS\2023SB-0044Provide ofremedial 53training R03-SB.docxand }specific Substitutetechnical Billassistance No.regarding the default.

9 (B) Provide remedial training and specific technical assistance regarding the default.

(3) Termination of membership in the compact shall be imposed only afterPublic allAct otherNo. means of securing compliance have been exhausted.

23-97 46 of 80 Substitute Senate Bill No.

9 after all other means of securing compliance have been exhausted.

LCO(2) {\\PRDFS1\SCOUSERS\FORZANOF\WS\2023SB-0045The ofcommission 53shall R03-SB.docxpromulgate }a Substituterule Billproviding No.for both mediation and binding dispute resolution for disputes as appropriate.

9 (2) The commission shall promulgate a rule providing for both mediation and binding dispute resolution for disputes as appropriate.

(2) By majority vote, the commission may initiate legal action in the UnitedPublic StatesAct DistrictNo. Court for the District of Columbia or the federal district where the commission has its principal offices against a member stateindefaulttoenforcecompliance withtheprovisionsofthecompact and its promulgated rules and bylaws.

23-97 47 of 80 Substitute Senate Bill No.

9 United States District Court for the District of Columbia or the federal district where the commission has its principal offices against a member stateindefaulttoenforcecompliance withtheprovisionsofthecompact and its promulgated rules and bylaws.

Any rule that has been previously adopted by the commission shall have the full force LCOand {\\PRDFS1\SCOUSERS\FORZANOF\WS\2023SB-0046effect of 53law R03-SB.docxon }the Substituteday Billthe No.compact becomes law in such state.

9 and effect of law on the day the compact becomes law in such state.

(2)Public WithdrawalAct shallNo. not affect the continuing requirement of the withdrawingstate'sphysicaltherapylicensingboardtocomplywiththe investigative and adverse action reporting requirements of the compact prior to the effective date of withdrawal.

23-97 48 of 80 Substitute Senate Bill No.

9 (2) Withdrawal shall not affect the continuing requirement of the withdrawingstate'sphysicaltherapylicensingboardtocomplywiththe investigative and adverse action reporting requirements of the compact prior to the effective date of withdrawal.

If the compact shall be held contrary to the constitution of any party state, the compact shall remain in full force and effect as to the remaining party states and in full force and effect as to the party state affected as to all severable matters." LCOSec. {\\PRDFS1\SCOUSERS\FORZANOF\WS\2023SB-0047 of 53 R03-SB.docx } Substitute Bill No.

917. Sec.

20.(NEW) (Effective July 1, 2023) The Commissioner of Public Health shall require each person applying for licensure as a physical therapist or physical therapist assistant to submit to a state and national fingerprint-based criminal history records check pursuant to section 29- 17a of the general statutes.

(NEW)For (Effectivethe Julypurposes 1,of 2023)this Thesection, Commissioner"physical of Public HealthAct shallNo. require each person applying for licensure as a physical therapist to submit to a state and national fingerprint-based criminal history records check pursuant to section 29-17a of the general statutes.

For23-97 the49 purposes of this80 section,Substitute "physicalSenate therapist"Bill meansNo. an individual licensed for the independent practice of physical therapy, and "licensure" means authorization by a state physical therapy regulatory authority to engage in the independent practice of physical therapy, the practice of which would be unlawful without such authorization.

9 therapist" means an individual licensed for the independent practice of physical therapy, "physical therapist assistant" means an individual licensed to assist in the practice of physical therapy in this state under the supervision of a physical therapist and "licensure" means authorization by a state physical therapy regulatory authority to engage in the independent practice of physical therapy, the practice of which would be unlawful without such authorization.

21.18.

22.19.

(a) The Department of Public Health may issue an advanced practice LCOregistered {\\PRDFS1\SCOUSERS\FORZANOF\WS\2023SB-0048nurse oflicense 53to R03-SB.docxa }person Substituteseeking Billto perform the activities Public Act No.

923-97 registered50 nurse license to a person seeking to perform the activities described in subsection (b) of section80 20-87a,Substitute uponSenate receiptBill ofNo. a fee of two hundred dollars, to an applicant who:

9 described in subsection (b) of section 20-87a, as amended by this act, upon receipt of a fee of two hundred dollars, to an applicant who:

(b) During the period commencing January 1, 1990, and ending January 1, 1992, the Department of Public Health may in its discretion allow a registered nurse, who has been practicing as an advanced practice registered nurse in a nurse practitioner role and who is unable to obtain certification as a nurse practitioner by one of the national certifying bodies specified in subsection (a) of this section, to be licensed asPublic anAct advancedNo. practice registered nurse provided the individual:

LCO23-97 {\\PRDFS1\SCOUSERS\FORZANOF\WS\2023SB-004951 of 5380 R03-SB.docx } Substitute Senate Bill No.

9 (1)Holdsaas currentan Connecticutadvanced licensepractice asaregisteredregistered nurse pursuantprovided tothe thisindividual: chapter;

(1)Holdsa current Connecticut license asaregistered nurse pursuant to this chapter;

and (8) Notifies the department of each change of employment to a new setting where he will function as an advanced practice registered nurse and will be exercising prescriptive and dispensing privileges.

If an individual licensed pursuantPublic toAct subsection (b) of this subsection becomes eligible at any time for certification as a nurse practitioner by one of the national certifying bodies specified in subsection (a) of this section, the LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2023SB-0000950 of 53 R03-SB.docx } Substitute Bill No.

923-97 individual52 shallof apply80 forSubstitute certification,Senate andBill uponNo. certification so notify the department, and apply to be licensed as an advanced practice registered nurse in accordance with subsection (a) of this section.

9 pursuant to subsection (b) of this subsection becomes eligible at any time for certification as a nurse practitioner by one of the national certifying bodies specified in subsection (a) of this section, the individual shall apply for certification, and upon certification so notify the department, and apply to be licensed as an advanced practice registered nurse in accordance with subsection (a) of this section.

20.

Subsection (b) of section 20-87a of the general statutes is repealed andthefollowing issubstituted inlieu thereof(EffectiveOctober 1, 2023):

(b) (1) Advanced nursing practice is defined as the performance of advanced level nursing practice activities that, by virtue of post-basic specialized education and experience, are appropriate to and may be performed by an advanced practice registered nurse.

The advanced Public Act No.

23-97 53 of 80 Substitute Senate Bill No.

9 practice registered nurse performs acts of diagnosis and treatment of alterations in health status, as described in subsection (a) of this section.

(2) (A) An advanced practice registered nurse having been issued a license pursuant to section 20-94a, as amended by this act, shall, for the first three years after having been issued such license, collaborate with a physician licensed to practice medicine in this state.

In all settings, such advanced practice registered nurse may, in collaboration with a physician licensed to practice medicine in this state, prescribe, dispense and administer medical therapeutics and corrective measures and may request, sign for, receive and dispense drugs in the form of professional samples in accordance with sections 20-14c to 20-14e, inclusive, except such advanced practice registerednurse licensedpursuant to section 20- 94a, as amended by this act, and maintaining current certification from the American Association of Nurse Anesthetists who is prescribing and administrating medical therapeutics during surgery may only do so if the physician who is medically directing the prescriptive activity is physically present in the institution, clinic or other setting where the surgery is being performed.

For purposes of this subdivision, "collaboration" means a mutually agreed upon relationship between such advanced practice registered nurse and a physician who is educated, trained or has relevant experience that is related to the work of such advanced practice registered nurse.

The collaboration shall address a reasonable and appropriate level of consultation and referral, coverage for the patient in the absence of such advanced practice registered nurse, a method to review patient outcomes and a method of disclosure of the relationship to the patient.

Relative to the exercise of prescriptive authority, the collaboration between such advanced practice registered nurse and a physician shall be in writing and shall address the level of schedule II and III controlled substances that such advancedpracticeregisterednursemayprescribeandprovideamethod to review patient outcomes, including, but not limited to, the review of medical therapeutics, corrective measures, laboratory tests and other Public Act No.

23-97 54 of 80 Substitute Senate Bill No.

9 diagnosticproceduresthatsuchadvancedpracticeregisterednursemay prescribe, dispense and administer.

(B) An advanced practice registered nurse having been issued a license pursuant to subsection (d) of section 20-94a, as amended by this act, who collaborated, prior to the issuance of such license, with a physician licensed to practice medicine in another state may count the time of such collaboration toward the three-year requirement set forth in subparagraph (A) of this subsection, provided such collaboration otherwise satisfies the requirements set forth in said subparagraph.

(3) An advanced practice registered nurse having (A) been issued a license pursuant to section 20-94a, as amended by this act, (B) maintained such license, or, for an advanced practice registered nurse having been issued a license pursuant to subsection (d) of said section, such license or a license to practice in another state as an advanced practice registered nurse or as a person entitled to perform similar services under a different designation, for a period of not less than three years, and (C) engaged in the performance of advanced practice level nursing activities in collaboration with a physician for a period of not lessthanthreeyearsandnotlessthantwothousandhoursinaccordance withtheprovisionsofsubdivision(2)ofthissubsection,may,thereafter, alone or in collaboration with a physician or another health care provider licensed to practice in this state:

(i) Perform the acts of diagnosis and treatment of alterations in health status, as described in subsection (a) of this section;

and (ii) prescribe, dispense and administer medical therapeutics and corrective measures and dispense drugs in the form of professional samples as described in subdivision (2) of this subsection in all settings.

Any advanced practice registered nurse electing to practice not in collaboration with a physician in accordance with the provisions of this subdivision shall maintain documentation of having engaged in the performance of advanced practice level nursing activities in collaboration with a physician for a period of not less than Public Act No.

23-97 55 of 80 Substitute Senate Bill No.

9 three years and not less than two thousand hours.

Such advanced practice registered nurse shall maintain such documentation for a period of not less than three years after completing such requirements and shall submit such documentation to the Department of Public Health for inspection not later than forty-five days after a request made by thedepartmentfor suchdocumentation.Any suchadvanced practice registered nurse shall submit written notice to the Commissioner of Public Health of his or her intention to practice without collaboration with a physician after completing the requirements described in this subdivision and prior to beginning such practice.

Not later than December first, annually, the Commissioner of Public Health shall publish on the department's Internet web site a list of such advanced practice registered nurses who are authorized to practice not in collaboration with a physician.

(4) An advanced practice registered nurse licensed under the provisions of this chapter may make the determination and pronouncement of death of a patient, provided the advanced practice registered nurse attests to such pronouncement on the certificate of death and signs the certificate of death not later than twenty-four hours after the pronouncement.

Sec.

21.

(NEW) (Effective July 1, 2023) Not later than January 1, 2024, the owner or operator of each splash pad and spray park where water is recirculated shall post a sign in a conspicuous location at or near the entryway to the splash pad or spray park stating that the water is recirculated and warning that there is a potential health risk to persons ingesting the water.

Sec.

22.

(NEW) (Effective from passage) (a) Notwithstanding the provisionsofchapter378ofthegeneralstatutes,apublicorindependent institutionofhigher educationthat (1)isaccreditedasadegree-granting institution in good standing by a regional accrediting association recognized by the Secretary of the United States Department of Public Act No.

23-97 56 of 80 Substitute Senate Bill No.

9 Education and maintains such accreditation status;

and (2) offers, or is seeking state approval to offer, a nursing program pursuant to section 10a-34 of the general statutes, may apply to the Connecticut State Board of Examiners for Nursing to establish a pilot program that offers licensed practical nursing education and training on or before January 30, 2024.

As used in this subsection, "public institution of higher education" and "independent institution of higher education" have the same meanings as described in section 10a-173 of the general statutes.

(b) An institution of higher education that applies to the Connecticut State Board of Examiners for Nursing to establish a pilot program pursuant to subsection (a) of this section shall provide to said board the following information, in writing, not later than sixty days prior to the date on which it seeks to establish the pilot program:

(1) Identifying information regarding the pilot program, including, but not limited to, the name of the program, address where such program will be administered, responsible party for the program and contact information for the program;

(2) A description of the pilot program, including accreditation status, any clinical partner and anticipated enrollment by academic term;

(3) An identification of resources that support the program;

(4) Graduation rates and National Council Licensure Examination licensure and certification pass rates for the past three years for any existing nursing programs offered by the institution of higher education;

(5) A plan for employing qualified faculty and administrators and clinical experiences;

and (6) Other information as requested by the Connecticut State Board of Examiners for Nursing.

Public Act No.

23-97 57 of 80 Substitute Senate Bill No.

9 (c) The Connecticut State Board of Examiners for Nursing shall review and consider an application made by an institution of higher education described in subsection (a) of this section to establish a pilot program pursuant to said subsection if the institution of higher education provides the information required pursuant to subsection (b) of this section.

The Connecticut State Board of Examiners for Nursing may hold a public hearing on such application.

(d) The pilot program established pursuant to this section shall comply with the relevant provisions of chapter 378 of the general statutes and sections 20-90-45 to 20-90-59, inclusive, of the regulations ofConnecticut state agencies.Notwithstanding theprovisionsofsection 10a-34 of the general statutes, if such pilot program complies with such provisions for not less than two years, and provides evidence that the program is meeting its educational outcomes, as defined in section 20- 90-47 of the regulations of Connecticut state agencies, such pilot programshallbedeemedfullyapprovedbytheConnecticutStateBoard of Examiners for Nursing.

Sec.

Section(NEW) 10a-19l(Effective from passage) The Office of theHigher generalEducation statutesmay isenter repealedinto anda thereciprocity followingagreement iswith substitutedone or more neighboring states that permits such neighboring state to allow a student attending an institution of higher education in lieusuch thereofneighboring (Effectivestate Julyto 1,train 2023):in a clinical rotation for credit in Connecticut, provided such neighboring state allows a student attending a Connecticut institution of higher education to train in a clinical rotation for credit in such neighboring state.

(a)NotlaterthanJanuary1,2023,theOfficeofHigherEducationshall establish a health care provider loan reimbursement program.

The health care provider loan reimbursement program shall provide loan reimbursement grants to health care providers licensed by the Department of Public Health who are employed full-time as a health care provider in the state.

(b) The executive director of the Office of Higher Education shall (1) develop, in consultation with the Department of Public Health, eligibility requirements for recipients of such loan reimbursement LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2023SB-0051 of 53 R03-SB.docx } Substitute Bill No.

9 grants, which requirements may include, but need not be limited to, income guidelines, [and] (2) award at least twenty per cent of such loan reimbursement grants to graduates of a regional community-technical college, and (3) award at least ten per cent of such loan reimbursement grants to persons employed full-time as health care providers in a rural community in thestate.

The executive director shall consider health care workforce shortage areas when developing such eligibility requirements.

A person who qualifies for a loan reimbursement grant shall be reimbursed on an annual basis for qualifying student loan payments in amounts determined by the executive director.

A health care provider shall only be reimbursed for loan payments made while such person is employed full-time in the state as a health care provider.

Persons may apply for loan reimbursement grants to the Office of Higher Education at such time and in such manner as the executive director prescribes.

(c) The Office of Higher Education may accept gifts, grants and donations, from any source, public or private, for the health care provider loan reimbursement program.

(NEW)Subsection (Effective(f) Julyof 1,section 2023)19a-112j Not later than January 1, 2024, the owner or operator of each splash pad and spray park where water is recirculated shall post a sign in a conspicuous location at or near the entrywaygeneral tostatutes the splash pad or spray park stating that the water is recirculatedrepealed and warningthe thatfollowing there is asubstituted potentialin healthlieu riskthereof to(Effective personsJuly ingesting1, the2023): water.

This(f) actA majority of the membership of the commission shall takeconstitute effecta asquorum followsfor the transaction of any business and any decision shall amendbe thePublic followingAct sections:No.

Section23-97 158 fromof passage80 NewSubstitute sectionSenate Sec.Bill No.

29 Julyby 1,a 2023majority Newvote sectionof fromthose passagepresent Sec.at a meeting, except the commission may establish such subcommissions, advisory groups or other entities as it deems necessary to further the purposes of the commission, including, but not limited to, a subcommission, advisory group or other entity to evaluate the challenges associated with the provision of home health care to victims of gun violence and methods to foster a system that unites community service providers with adults and juveniles needing supports and services in order to address trauma suffered as a result of gun violence.

3 New section Sec.

425. from passage New section Sec.

5(Effective Octoberfrom 1,passage) 2023The NewDepartment sectionof Sec.Public Health, in consultation with the Department of Mental Health and Addiction Services, and organizations representing health care facilities and licensed health care professionals, shall develop a maternal mental health toolkit to provide information and resources regarding maternal mental health to licensed health care professionals and new parents in the state.

6Such Octobertoolkit 1,shall 2023include, 20-14obut Sec.need not be limited to, (1) information about perinatal mood and anxiety disorders, including, but not limited to, the symptoms of such disorders, potential impact of such disordersonfamiliesandtreatmentoptionsforapersonwithaperinatal mood or anxiety disorder;

7and July(2) 1,a 2023list Newof sectionlicensed LCOhealth {\\PRDFS1\SCOUSERS\FORZANOF\WS\2023SB-0000952care ofprofessionals, 53peer R03-SB.docxsupport }networksandnonprofit Substituteorganizationsin Billthe No.state that treat perinatal mood and anxiety disordersor provide support for persons with a perinatal mood or anxiety disorder and the family members of such persons.

Not later than October 1, 2023, the Department of Public Health shall make such toolkit available on its Internet web site.

Sec.

26.

Section 19a-490u of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2023):

(a) Each hospital, as defined in section 19a-490, shall include training in the symptoms of dementia as part of such hospital's regularly provided training to staff members who provide direct care to patients.

Public Act No.

23-97 59 of 80 Substitute Senate Bill No.

9 (b) On and after October 1, 2021, each hospital shall include training in implicit bias as part of such hospital's regularly provided training to staff members who provide direct care to women who are pregnant or in the postpartum period.

As used in this subsection, "implicit bias" means an attitude or internalized stereotype that affects a person's perceptions, actions and decisions in an unconscious manner and often contributes to unequal treatment of a person based on such person's race, ethnicity, gender identity, sexual orientation, age, disability or other characteristic.

(c) On and after October 1, 2023, each hospital shall include training in perinatal mood and anxiety disorders as part of such hospital's regularly provided training to staff members who provide direct care to women who are pregnant or in the postpartum period.

Sec.

27.

(Effective from passage) (a) On or before July 1, 2023, the CommissionerofPublicHealthshallconveneaworkinggrouptoadvise the commissioner regarding methods to alleviate emergency department crowding and the lack of available emergency department beds in the state, including, but not limited to, the following:

(1) The establishment of a quality measure for the timeliness of the transfer of an emergency department patient, who will be admitted to the hospital, out of the hospital's emergency department;

(2) The establishment of emergency department discharge units to expedite the discharge of patients from the emergency department;

(3) (A) An evaluation of the percentage of emergency department patients who are held in the emergency department after being admitted to the hospital and while waiting for an inpatient bed to become available, and (B) the development of a plan to decrease such percentage;

and (4) The reduction in liability for hospitals and their emergency Public Act No.

23-97 60 of 80 Substitute Senate Bill No.

9 physicians when patient crowding of a hospital's emergency department has reached the point of causing significant wait times for patients seeking emergency department services.

(b) The working group convened pursuant to subsection (a) of this section may include, but need not be limited to, the following members:

(1) Two emergency physicians licensed pursuant to chapter 370 of the general statutes representing the Connecticut chapter of a national college of emergency physicians;

(2) two emergency physicians licensed pursuant to chapter 370 of the general statutes, one of whom shall be the director of the emergency department of a larger hospital system in the state, and one of whom shall be the director of the emergency department of an independent community hospital;

(3) one primary care physician licensed pursuant to chapter 370 of the general statutes representing the Connecticut chapter of a national college of physicians;

(4) two representatives of a hospital association in the state;

(5) one representative of a medical society in the state;

(6) one representative of the Connecticut chapter of a national organization of emergency nurses;

(7) one representative of the Connecticut chapter of a national organization of pediatric physicians;

(8) one representative of the Connecticut chapter of a national association of psychiatrists;

(9) one representative of an association of nurses in the state;

(10) two nurses licensed pursuant to chapter 378 of the general statutes, one of whom shall be the nurse director of the emergency department in a larger hospital system, and one of whom shall be the nurse director of the emergency departmentinanindependent community hospital;(11) two patient care navigators, one of whom shall be employed by a larger hospitalsystem,andoneofwhomshallbeemployedby anindependent community hospital;

(12) one representative of hospital patients in the state;

(13) one provider of emergency medical transportation services in the state;

(14) one representative of a national association of retired persons;

(15) the Healthcare Advocate, or the Healthcare Advocate's designee;

(16) the Commissioner of Mental Health and Addiction Public Act No.

23-97 61 of 80 Substitute Senate Bill No.

9 Services, or the commissioner's designee;

(17) the Commissioner of Children and Families, or the commissioner's designee;

(18) one representative from the Department of Public Health's Office of Emergency Medical Services;

(19) one representative from the Department of Public Health's facilities licensing and investigations section;

(20) one representative of the Office of the Long-Term Care Ombudsman;

(21) the Child Advocate, or the Child Advocate's designee;

(22) one representative of a nonprofit nursing home in the state;

(23) one representative from a for-profit nursing home in the state;

(24) one representative from the insurance industry in the state;

and (25) one member of an association of trial lawyers in the state.

The chairpersons of the working group shall be one of the emergency physicians representing the Connecticut chapter of a national college of emergency physicians and one of the representatives of a hospital association in the state, who shall be selected by the Commissioner of Public Health.

Once selected, the chairpersons of the working group may convene the first meeting of the working group whether or not any other members of the working group identified in subdivisions (1) to (25), inclusive, of this subsection have been selected by the Commissioner of Public Health.

If said commissioner has not selected any member of the working group described in said subdivisions on or before August 1, 2023, the cochairpersons may jointly select such member.

The first meeting of the working group shall be held not later than December 1, 2023.

The working group shall meet biannually and at other times upon the call of the cochairpersons.

(c)Onor beforeJanuary 1,2024,andannuallythereafter untilJanuary 1, 2025, the working group shall report its findings and recommendations to the Commissioner of Public Health and, in accordance with the provisions of section 11-4a of the general statutes, to the joint standing committee of the General Assembly having cognizance of matters relating to public health.

Public Act No.