SB 1 — AN ACT CONCERNING THE HEALTH AND SAFETY OF CONNECTICUT RESIDENTS.

The commissioner shall, upon the receipt of all documentation necessary to evaluate the request, determine whether there has been such a change in circumstances and shall conduct a hearing if appropriate.

The Commissioner of Social Services shall adopt regulations, in accordance with chapter 54,to implement the provisions of this subsection.

The commissioner may implement policies and procedures to carry out the provisions of this subsection while in the process of adopting regulations, provided notice of intent to adopt the regulations is posted on the eRegulations System not later than twenty days after the date of implementing the policies and procedures.

Such policies and procedures shall be valid for not longer than nine months.

For purposes of this subsection, "complex care nursing services" means intensive, specialized nursing services provided to a patient with complex care needs who requires skilled nursing care at home.

(NEW) (Effective JanuaryOctober 1, 2025)2024) Each(a) individualAny healthhospital, insurancechronic policydisease providinghospital, coveragenursing ofhome, thebehavioral typehealth specifiedfacility, inmulticare subdivisionsinstitution (1),or (2),psychiatric (4),residential (11)treatment andfacility, (12)as ofsuch terms are defined in section 38a-46919a-490 of the general statutesstatutes, delivered,that issuedreceives reimbursement for delivery,services renewed,rendered amendedunder orthe continuedConnecticut inmedical thisassistance state,program, shallas providedefined coveragein forsection escorts17b-245g forof the safetygeneral ofstatutes, homeshall healthadopt careand agencyimplement orworkplace homeviolence healthprevention aidestandards agencythat staff,are asconsistent deemedwith necessarythe workplace violence prevention standards set forth by suchthe staffJoint Commission or any applicable certification or accreditation agency.

(b) The Commissioner of Social Services may require any institution listed in subsection (a) of this section to provide evidence of adoption and implementation of such workplace violence prevention standards to obtain reimbursement for services provided under the medical assistance program.

(NEW)(Effectivefrom (Effectivepassage)(a)The Januarychairpersonsofthejointstanding 1,committee 2025)of Eachthe groupGeneral Assembly having cognizance of matters relating to public health insuranceshall policyconvene providinga coverageworking ofgroup theto typestudy specifiedstaff insafety subdivisionsissues (1),affecting (2),(1) (4),home (11)health care and (12)home ofhealth aide agencies, as such terms are defined in section 38a-46919a-490 of the general statutesstatutes, delivered,and issued(2) forhospice delivery,organizations renewed,licensed amendedby orthe continuedDepartment inof thisPublic state,Health shallpursuant LCOto 4section 19a-122b of 37the Substitutegeneral Billstatutes. No.

1 provide coverage for escorts for the safety of home health care agency or home health aide agency staff, as deemed necessary by such staff or agency.

Sec.

7.

(Effective July 1, 2024) On or before October 1, 2024, the Commissioner of Public Health shall establish and administer a home care staff safety grant program.

Such program shall provide grants to home health care and home health aide agencies for the purposes of purchasing staff safety technology, which may include, but need not be limited to, (1) a mobile application that allows staff to access safety information relating to a client, including information collected pursuant to section 1 of this act, and a method of communicating with either local police or other staff in the event of a safety emergency, and (2) a global positioning system-enabled, wearable device that allows staff to contact local police by pressing a button or through another mechanism.

The commissioner shall establish eligibility requirements, priority categories, funding limitations and the application process for the grant program.

Not later than January 1, 2025, and annually thereafter, the commissioner 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 grant program.

Sec.

8.

(Effectivefrom passage)(a)The chairpersonsofthejointstanding committee of the General Assembly having cognizance of matters relating to public health shall convene a working group to study staff safety issues affecting home health care and home health aide agencies, as such terms are defined in section 19a-490 of the general statutes.

(1)Public ThreeAct employeesNo. of a home health care or home health aide agency;

(2)24-19 Two5 representatives of a46 homeSubstitute healthSenate careBill orNo. home health aide agency;

LCO1 5(1) Three employees of 37one Substituteor Billmore No.home health care or home health aide agencies, at least one of whom shall be a direct care worker;

1(2) (3)Three Oneemployees representative of aone collectiveor bargainingmore unithospice representingcare homeorganizations, healthat careleast orone homeof healthwhom aideshall agencybe employees;a direct care worker;

(4)(3) OneTwo representativerepresentatives of a mobilehome crisishealth responsecare servicesor provider;home health aide agency;

(5)(4) One representative of ana assertivecollective communitybargaining treatmentunit team;representing home health care or home health aide agency employees;

(6)(5) One representative of a policecollective department;bargaining unit representing hospice care organizations or hospice care employees;

and(6) (7) One representative of ana associationmobile ofcrisis hospitalsresponse inservices theprovider; state.

(7) One representative of an assertive community treatment team;

(8) One representative of a police department;

(9) One representative of an association of hospitals in the state;

(10) One representative of an association of home health care and home health aide agencies in the state;

(11) Two representatives of an association of nurses in the state;

(12) One representative of the Division of State Police within the Department of Emergency Services and Public Protection;

(13) One representative of a municipal police department in the state;

(14) One member of a labor union in the state;

(15) The Commissioner of Mental Health and Addiction Services, or the commissioner's designee;

Public Act No.

24-19 6 of 46 Substitute Senate Bill No.

1 (16) The Commissioner of Correction, or the commissioner's designee;

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

(18) The Commissioner of Social Services, or the commissioner's designee;

(19) One member or employee of the Board of Pardons and Paroles;

and (20) One member of the judiciary.

(f) Not later than January 1, 2025, the working group shall submit a report on its findings and recommendations to the joint standing committee of the General Assembly having cognizance of matters relating to publichealth,inaccordance withtheprovisionsofsection11- 4a ofthegeneralstatutes.Theofthegeneralstatutes. working groupshallterminate onthedate that it submits such report or January 1, 2025, whichever is later.

The working groupshallterminate onthedate that it submits such report or January 1, 2025, whichever is later.

9.7.

(NEW) (Effective July 1, 2024) The(a) sumAs ofused onein million dollars is appropriated to the Department of Public Health from the General Fund, for the fiscal year ending June 30, 2025, for the purposes of establishing andadministering thehomecare staff safety grant program established pursuant to section 7 of this act.section:

(1) "Primary care provider" means a physician, advanced practice Public Act No.

24-19 7 of 46 Substitute Senate Bill No.

1 registered nurse or physician assistant who provides primary care services and is licensed by the Department of Public Health pursuant to title 20 of the general statutes;

and (2) "Primary care" means the medical fields of family medicine, general pediatrics, primary care, internal medicine, primary care obstetrics or primary care gynecology, without regard to board certification.

(b) On or before January 1, 2025, the Commissioner of Public Health, in consultation with the Commission on Community Gun Violence Intervention and Prevention, established pursuant to section 19a-112j of the general statutes, and the Connecticut chapters of a national professional association of physicians, a national professional association of pediatricians, a national professional association of advanced practice registered nurses and a national professional association of physician assistants, provided such chapters and associations agree to such consultation, shall develop or procure educational material concerning gun safety practices to be provided by primary care providers to patients during the patient's appointment with such patient's primary care provider.

On or before February 1, 2025, the Department of Public Health shall make the educational material available to all primary care providers in the state, at no cost to the provider, and make recommendations to such primary care providers for the effective use of such educational material.

Such primary care providers shall make such educational material available to each patient on an annual basis at the patient's appointment with the primary care provider, or at each appointment if the patient visits the primary care provider less frequently than annually.

10.8.

(NEW) (Effective Januaryfrom 1,passage) 2025)(a) AsThe usedcochairpersons inof thisthe sectionjoint andstanding sectionscommittee 11of tothe 18,General inclusive,Assembly having cognizance of thismatters act:relating to public health shall establish a working group to study nonalcoholic fatty liver disease, including nonalcoholic fatty liver Public Act No.

LCO24-19 68 of 3746 Substitute Senate Bill No.

1 (1)and "Graduatenonalcoholic physician"steatohepatitis. means a medical school graduate who:

(A) Is a resident and citizen of the United States or a resident alien in the United States;

and (B) Has successfully completed step 1 and step 2 of the United States Medical Licensing Examination, or the equivalent of step 1 and step 2 of any other medical licensing examination or combination of examinations that is approved by the National Board of Medical Examiners or National Board of Osteopathic Medical Examiners, within the two-year period immediately preceding the date of the person's application for licensure as a graduate physician, but not more than three years after graduation from a medical school or a school of osteopathic medicine;

(2) "Graduate physician collaborative practice arrangement" means an agreement between a physician licensed pursuant to chapter 370 of the general statutes and a graduate physician who meets the requirements of sections 11 to 18, inclusive, of this act;

(3) "Medical school graduate" means a person who has graduated from a medical school accredited by the Liaison Committee on Medical Education or the Commission on Osteopathic College Accreditation or a medical school listed in the World Directory of Medical Schools, or its equivalent;

and (4) "Primary care services" means medical services in pediatrics, internal medicine, family medicine, obstetrics and gynecology or psychiatry.

Sec.

11.

(NEW) (Effective January 1, 2025) (a) A graduate physician collaborative practice arrangement shall limit the graduate physician to providing primary care services.

(b) A graduate physician shall be subject to the supervision requirements established in any controlling federal law, the supervision requirements adopted pursuant to sections 12 to 18, inclusive, of this act LCO 7 of 37 Substitute Bill No.

1 and any supervision requirements established by the National Board of Medical Examiners.

A graduate physician shall not be subject to any additional supervision requirements.

Sec.

12.

(NEW) (Effective January 1, 2025) (a) The Connecticut Medical Examining Board, established pursuant to section 20-8a of the general statutes, shall promulgate rules to:

(1) Establish the process for licensure of graduate physicians, supervision requirements for graduate physicians and additional requirements for graduate physician collaborative practice arrangements;

(2) Set fees for licensure, including, but not limited to, a requirement that the total fees collected each year shall be greater than or equal to the total costs necessary to facilitate the graduate physician collaborative practice arrangement each year;

and (3)Addressanyothermattersnecessarytoprotectthepublicandtake disciplinary action against participants in graduate physician collaborative practice arrangements.

(b) A graduate physician's license issued pursuant to sections 11 to 18, inclusive, of this act and the rules promulgated by the Connecticut Medical Examining Board concerning graduate physician collaborative practice arrangements shall be valid for two years from the date of issuance and are not subject to renewal.

Said board may deny an application for licensure as a graduate physician or suspend or revoke the license of a graduate physician for violation of any provision of sections 11 to 18, inclusive, of this act, as applicable, or for a violation of the rules or standards of conduct established by said board.

(c)Anyrulepromulgatedundertheauthoritydelegatedtosaidboard under this section shall become effective upon promulgation, provided such rule complies with the Uniform Administrative Procedures Act, sections 4-166 to 4-189, inclusive of the general statutes.

LCO 8 of 37 Substitute Bill No.

1 Sec.

13.

(NEW) (Effective January 1, 2025) A graduate physician shall clearly identify as a graduate physician and may use the identifiers "doctor" or "Dr.".

A graduate physician shall not practice or attempt to practice without a graduate physician collaborative practice arrangement, except as otherwise provided in sections 11 to 18, inclusive, of this act or permitted under rules promulgated by the Connecticut Medical Examining Board pursuant to section 12 of this act.

Sec.

14.

(NEW) (Effective January 1, 2025) A licensed physician collaborating with a graduate physician shall be responsible for supervising the activities of the graduate physician and shall accept full responsibility for the primary care services provided by the graduate physician.

Sec.

15.

(NEW) (Effective January 1,2025)(a)The provisionsofsections 11 to 18, inclusive, of this act shall apply to all graduate physician collaborative practice arrangements.

To be eligible to practice as a graduate physician, a licensed graduate physician shall enter into a graduate physician collaborative practice arrangement with a licensed physician not later than six months after the date on which the graduate physician obtains initial licensure as a graduate physician.

(b) Only a physician licensed pursuant to chapter 370 of the general statutes may enter into a graduate physician collaborative practice arrangement with a graduate physician.

A graduate physician collaborative practice arrangement shall take the form of a written agreement, including mutually agreed-upon protocols or standing orders, for the delivery of primary care services.

A graduate physician collaborative practice arrangement may delegate to a graduate physician the authority to administer or dispense drugs, except a controlled substance, and provide treatment, provided the delivery of the primary care services is within the scope of the graduate physician's practice and is consistent with the graduate physician's skill, training and competence and the skill, training and competence of the collaborating physician.

The collaborating physician shall be board certified in the specialty that the graduate physician is practicing, which LCO 9 of 37 Substitute Bill No.

1 shall only include pediatrics, internal medicine, family medicine, obstetrics and gynecology or psychiatry.

(c) A graduate physician collaborative practice arrangement shall contain the following provisions:

(1) The complete names, home and business addresses and telephone numbers of the collaborating physician and the graduate physician;

(2) A requirement that the graduate physician practice at the same location as the collaborating physician;

(3) A requirement that the graduate physician or collaborating physician prominently display, in every office where the graduate physician is authorized to prescribe, a disclosure statement informing patients that they may be seen by a graduate physician and advising patients that they have the right to see the collaborating physician;

(4) A list of each specialty and board certification of the collaborating physician and each certification of the graduate physician;

(5) The manner of collaboration between the collaborating physician and the graduate physician, including, but not limited to, a description of the manner in which the collaborating physician and the graduate physician shall:

(A) Engage in collaborative practice consistent with each professional's skill, training, education and competence;

and (B) Maintain geographic proximity to a hospital, provided the graduate physician collaborative practice arrangement may allow for geographic proximity to be waived for not more than twenty-eight days per calendar year for the provision of primary care services in health care servicesina rural healthclinic.As used inthis subparagraph,"rural health clinic" means (i) an independent health clinic, (ii) provider-based health clinic, if the provider is a critical access hospital, as defined in 42 USC 1395i-4, as amended from time to time, or (iii) a provider-based health clinic, if the primary location of the hospital sponsor is more than LCO 10 of 37 Substitute Bill No.

1 twenty-five miles from the clinic, which clinic is located in a town that has either seventy-five per cent or more of its population classified as rural in the 1990 federal decennial census of population, or in the most recent such census used by the State Office of Rural Health to determine rural towns, or a town that is not designated as a metropolitan area on the list maintained by the federal Office of Management and Budget, used by the State Office of Rural Health to determine rural towns.

The collaborating physician shall maintain documentation related to the geographic proximity requirement and present the documentation to the Connecticut Medical Examining Board upon request;

(6) A requirement that the graduate physician shall not provide primarycareservicestoapatientduringtheabsenceofthecollaborating physician from the practice location for any reason;

(7) A list of all other graduate physician collaborative practice arrangements of (A) the collaborating physician with another graduate physician, and (B) the graduate physician with another collaborating physician;

(8) The duration of the graduate physician collaborative practice arrangement between the collaborating physician and the graduate physician;

(9) A provision describing the time and manner of the collaborating physician's review of the graduate physician's delivery of primary care services and requiring the graduate physician to submit to the collaborating physician every fourteen days after the initial observation year a minimum of twenty-five per cent of the charts documenting the graduate physician's delivery of primary care services for review by the collaborating physician or by any other physician designated in the graduate physician collaborative practice arrangement.

For the first three months of the initial observation year, the collaborating physician shall review one hundred per cent of the charts documenting the graduate physician's delivery of primary care services.

For months four to twelve, inclusive, of the initial observation year, the collaborating LCO 11 of 37 Substitute Bill No.

1 physician shall review seventy-five per cent of the charts documenting the graduate physician's delivery of primary care services;

and (10) A requirement that a collaborating physician be on premises if the graduate physician performs primary care services in a hospital or emergency department.

Sec.

16.

(NEW) (Effective January 1, 2025) (a) The Connecticut Medical Examining Board shall promulgate rules regulating the use of graduate physician collaborative practice arrangements for graduate physicians.

The rules shall:

(1) Specify the geographic areas to be covered by graduate physician collaborative practice arrangements;

(2)Specify themethodsoftreatment that maybecovered bygraduate physician collaborative practice arrangements;

(3) Specify, in consultation with the deans of medical schools and primary care residency program directors in the state, the educational methods and programs to be implemented by the collaborating physician during graduate physician collaborative practice service arrangements, to facilitate the advancement of the graduate physician's medical knowledge and capabilities and the successful completion of which may lead to credit toward a future residency program that accepts the documented educational achievements of the graduate physician through such methods and programs;

and (4) Require a review of the primary care services provided under a graduate physician collaborative practice arrangement.

(b)A collaboratingphysicianshallnotenterintoagraduatephysician collaborative practice arrangement with more than three graduate physicians at the same time.

Sec.

17.

(NEW) (Effective January 1, 2025) (a) The Connecticut Medical Examining Board shall promulgate rules applicable to graduate physicians that are consistent with the federal guidelines established for LCO 12 of 37 Substitute Bill No.

1 federally qualified health centers.

The rulemaking authority granted to said board under this subsection shall not extend to any graduate physician collaborative practice arrangement governing a hospital employee providing inpatient care within a hospital.

(b) The board shall not deny, revoke, suspend or otherwise take disciplinary action against a collaborating physician for primary care services delegated to a graduate physician, provided the provisions of this section and any applicable rule promulgated by said board are satisfied.

(c) Not later than thirty days after any licensure change of a physician, the board shall require the physician to identify whether the physician is engaged in a graduate physician collaborative practice arrangement, and to report to the board the name of each graduate physician with whom the physician has entered into such an arrangement.

The board may make the information regarding such arrangement available to the public.

The board shall track the reported informationandmayroutinelyconductreviewsorinspectionstoensure that the arrangements are being carried out in compliance with this chapter.

(d) No contract or other agreement shall require a physician to act as a collaborating physician for a graduate physician against the physician's will.

A physician may refuse to act as a collaborating physician, without penalty, for a particular graduate physician.

No contract or other agreement shall limit the collaborating physician's authority over any protocols or standing orders or delegate the physician'sauthoritytoagraduatephysician.Nothinginthissubsection shall be construed to authorize a physician, in implementing protocols, standing orders or delegation to violate any standards for safe medical practice established by a hospital's medical staff.

(e) No contract or other agreement shall require a graduate physician to serve as a graduate physician for any collaborating physician against the graduate physician's will.

A graduate physician may refuse to LCO 13 of 37 Substitute Bill No.

1 collaborate, without penalty, with a particular physician.

(f) Each collaborating physician and graduate physician that is party to a graduate physician collaborative practice arrangement shall wear an identification badge while acting within the scope of the arrangement.

The identification badge shall prominently display the licensure status of the collaborating physician and the graduate physician.

Sec.

18.

(NEW) (Effective January 1, 2025) (a) A collaborating physician shall complete a certification course approved by the Connecticut Medical Examining Board that shall include material on the laws pertaining to the professional relationship of a collaborating physician with a graduate physician prior to entering into a collaborative practice arrangement with a graduate physician.

(b) A graduate physician collaborative practice arrangement shall supersede any hospital licensing regulation concerning hospital medication orders under a protocol or standing order for the purpose of delivering inpatient or emergency care within a hospital if the protocol or standing order has been approved by the hospital's medical staff and pharmaceutical therapeutics committee.

Sec.

19.

(NEW) (Effective July 1, 2024) On or before January 1, 2025, the Commissioner of Public Health, in consultation with the Commission on Community Gun Violence Intervention and Prevention, established pursuant to section 19a-112j of the general statutes, and the Connecticut chapters of a national professional association of physicians, a national professional association of advanced practice registered nurses and a national professional association of physician assistants, shall develop or procure educational material concerning gun safety practices to be provided by primary care providers to patients who are eighteen years of age or older during the patient's appointment with such patient's primary care provider.

On or before February 1, 2025, the Department of Public Health shall make the educational material available to all primary care providers of persons eighteen years of age or older in the LCO 14 of 37 Substitute Bill No.

1 state, at no cost to the provider, and make recommendations to such primary care providers for the effective use of such educational material.

Such primary care providers shall provide such educational material to each patient who is eighteen years of age or older on an annual basis at the patient's appointment with the primary care provider.

Sec.

20.

(Effective from passage) (a) The cochairpersons of the joint standing committee of the General Assembly having cognizance of matters relating to public health shall establish a working group to study nonalcoholic fatty liver disease, including nonalcoholic fatty liver and nonalcoholic steatohepatitis.

(4) Methods of increasing public awareness of such disease, including, but not limitedto,publicawarenesslimited to,publicawareness campaignseducating the public regarding liver health;

(8) The creation of patient advocacy and support networks to assist LCOpersons 15living ofwith 37such Substitutedisease; Bill No.

1 persons living with such disease;

(1)Public AAct physicianNo. with expertise in hepatology and gastroenterology representing an institution of higher education in the state;

24-19 9 of 46 Substitute Senate Bill No.

1 (1) A physician with expertise in hepatology and gastroenterology representing an institution of higher education in the state;

LCO(c) 16The cochairpersons of 37the Substitutejoint Billstanding No.committee of the General Assembly having cognizance of matters relating to public health shall convene the first meeting of the working group, which shall be held not later than sixty days after the effective date of this section.

1(d) (c) The cochairpersonsmembers of the joint standing committee of the General Assembly having cognizance of matters relating to public health shall convene the first meeting of the working group,group which shall beselect heldtwo notPublic laterAct thanNo. sixty days after the effective date of this section.

(d)24-19 The10 members of the46 workingSubstitute groupSenate shallBill selectNo. two cochairpersons from among the members of the working group.

1 cochairpersons from among the members of the working group.

(f) Not later than January 1, 2025, the working group shall submit a report on its findings and recommendations to the joint standing committee of the General Assembly having cognizance of matters relating to publichealth,inaccordance withtheprovisionsofsection11- 4a ofthegeneralstatutes.Theofthegeneralstatutes. working groupshallterminate onthedate that it submits such report or January 1, 2025, whichever is later.

The working groupshallterminate onthedate that it submits such report or January 1, 2025, whichever is later.

21.9.

LCO(2) 17Three owners or managers of 37three Substitutedifferent Billnail No.salons in the state;

1Public (2)Act ThreeNo. owners or managers of three different nail salons in the state;

(3)24-19 A11 health care professional licensed in the state with experience treating patients experiencing symptoms of an46 illnessSubstitute attributableSenate toBill suchNo. patients' exposure to health hazards while working in a nail salon;

1 (3) A health care professional licensed in the state with experience treating patients experiencing symptoms of an illness attributable to such patients' exposure to health hazards while working in a nail salon;

(f) Not later than January 1, 2025, the working group shall submit a report on its findings and recommendations to the joint standing committee of the General Assembly having cognizance of matters relating to publichealth,inaccordancepublichealth, inaccordance withtheprovisionsofsection11- 4a ofthegeneralstatutes.Theofthegeneralstatutes. working groupshallterminate on thedate that it submits such report or January 1, 2025, whichever is later.

The working groupshallterminate onthedate that it submits such report or January 1, 2025, whichever is later.

22.10.

(Effective from passage) The Commissioner of Consumer Public Health,Act in LCO 18 of 37 Substitute Bill No.

124-19 collaboration12 with the Commissioner of Consumer46 Protection,Substitute shallSenate studyBill incidencesofNo. prescriptiondrug shortagesinthestate andwhether the state has a role in alleviating such shortages.

Not1 laterProtection, than January 1, 2025, the Commissioners of Public Health and Consumer Protection shall jointly report, in accordancecollaboration with theThe provisionsUniversity of sectionConnecticut 11-4aSchool of thePharmacy, generalshall statutes,study toincidences theof jointprescription standingdrug committeesshortages ofin the Generalstate Assembly having cognizance of matters relating to public health and consumerwhether protectionthe regardingstate suchhas studya androle anyin recommendationsalleviating for legislation that would help alleviate or prevent such shortages.

Not later than January 1, 2025, the commissioner 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 consumer protection and public health regarding such study and any recommendations for legislation that would help alleviate or prevent such shortages.

23.11.

(NEW) (Effective July 1, 2024) (a) For the purposes of this section, "safety plan" means any plan established by the Department of Children and Families to address or mitigate behaviors of a parent or guardianorconditionsor circumstancesinahomethat mayrender such home unsafe for a child, by (1) identifying actions that have been or will be taken to address or mitigate such behaviors, conditions or circumstances, and (2) specifying the individuals or providers responsible for taking such actions, and timeframes for review of such actions by the department.

(b) When the Commissioner of Children and Families, or the commissioner's designee, conducts a visit to, or evaluation of, a home pursuant to a safety plan, such visit or evaluation shall be conducted in person if such safety plan indicates that a parent or guardian in such home has a substance use disorder, as defined in section 20-74s of the general statutes.

Sec.

24.

(a) As used in this section, (1) "board eligible" means eligible to take a qualifying examination administered by a medical specialty board after having graduated from a medical school, completed a residency program and trained under supervision in a specialty fellowship program, (2) "board certified" means having passed the qualifying LCOexamination 19administered by a medical specialty board to become board certified in a particular specialty, and (3) "board recertification" meansrecertificationina particular specialtyafter apredeterminedtime period prescribed by a medical specialty board, including, but not limited to, through participation in any required maintenance of 37certification Substituteprogram, Billafter No.having passed the qualifying examination administered by the medical specialty board to become board certified in a particular specialty.

1(b) examinationNo administeredhospital, byor a medical specialtyreview boardcommittee toof becomea boardhospital, certifiedshall inrequire, aas particularpart specialty,of andits (3)credentialing "boardrequirements recertification"(1) meansrecertificationinaparticularfor specialtyaftera apredeterminedtimeboard periodeligible prescribedphysician byto aacquire medicalprivileges specialtyto board,practice including,in butthe nothospital, limitedthat to,the throughphysician participationprovide credentials of board certification in anya requiredparticular maintenancespecialty ofuntil certificationfive program,years after havingthe passeddate on which the qualifyingphysician examinationbecame administeredboard byeligible thein medicalsuch specialtyspecialty, boardor to(2) becomefor a board certified inphysician ato particularPublic specialty.Act No.

(b)24-19 No13 hospital, or medical review committee of a46 hospital,Substitute shallSenate require,Bill asNo. 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.

1 acquire or retain privileges to practice in the hospital, that the physician provide credentials of board recertification.

25.12.

and (3) "Specialty certification" means any certification by a medical board that specializes in one area of medicine and has requirements in addition to licensing requirements in this state.

(b) No insurer, health care center, hospital service corporation, medical service corporation, fraternal benefit society or other entity that delivers, issues for delivery, renews, amends or continues 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 of the general statutes in this state on or after January 1, 2025, shall deny reimbursement to a health care provider or prevent any health care provider from participating in any provider network based solely on such health care provider's decision not to maintain a specialty certification, including, but not limited to, through participation in any maintenance of certification program, provided such health care provider does not hold such health care provider out to be a specialist under such specialty certification.

Sec.

13.

(NEW) (Effective January 1, 2025) (a) For purposes of this section:

(1) "Health care provider" has the same meaning as provided in Public Act No.

24-19 14 of 46 Substitute Senate Bill No.

1 section 38a-477aa of the general statutes;

(2) "Maintenance of certification" means any process requiring periodic recertification examinations or other professional development activities to maintain specialty certification;

(b) No insurer,insurance company that delivers, issues for delivery, renews, amendsorcontinuesa professionalliabilityinsurancepolicyinthisstate on or after January 1, 2025, shall (1) deny coverage of a health care center,provider hospitalbased servicesolely corporation,on medicalsuch servicehealth corporation,provider's fraternaldecisions benefitnot societyto maintain a specialty certification, including, but not limited to, through participation in a maintenance of certification program, or other(2) entityrequire thatevidence LCOof 20maintenance of 37such Substitutespecialty Billcertification No.as a prerequisite for obtaining professional liability insurance or other indemnity against liability for professional malpractice in accordance with section 20-11b ofthegeneralstatutes,providedsuchhealthcareproviderdoesnothold such health care provider out to be a specialist under such specialty certification.

1 delivers, issues for delivery, renews, amends or continues 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 of thegeneral statutesinthisstate onor after January 1,2025, shall(1) deny reimbursement to such health care provider, or prevent any health care provider from participating in any provider network based solely on such health care provider's decision not to maintain a specialty certification through any maintenance of certification program, or (2) require any health care provider to maintain a specialty certification through a maintenance of certification program as a prerequisite for obtaining professional liability insurance or other indemnity against liability for professional malpractice in accordance with section 20-11b of the general statutes, provided that such health care provider does not hold suchhealth care provider out to beaspecialist under suchspecialty certification.

26.14.

(3) "Personal opioid drug deactivation and disposal system" means a productPublic thatAct isNo. designed for personal use and enables a patient to permanently deactivate and destroy an opioid drug;

24-19 15 of 46 Substitute Senate Bill No.

1 product that is designed for personal use and enables a patient to permanently deactivate and destroy an opioid drug;

(b) (1)Each Except as provided in subdivision (2) of this subsection, each pharmacist who dispenses an opioid drug to a patient in this state shallmay provideprovideto suchpatient, at thetime suchpharmacist dispenses such drug to such patient, atinformation concerning a personal opioid drug deactivationanddisposalsystem,including,but not limitedto,the Internet web site address for the timeDepartment suchof pharmacistMental dispensesHealth and Addiction Services containing such LCOinformation 21pursuant ofto 37section Substitute15 Billof No.this act.

1Nothing drugin this section shall be construed to suchapply patient,to a personalpharmacist who dispenses an opioid drug deactivationfor anda disposalpatient system.while the patient is in a facility or health care setting.

No pharmacy or pharmacist shall charge any fee to, or impose any cost on, any patient for a personal opioid drug deactivation and disposal system that a pharmacist provides to a patient pursuant to this subdivision.

(2) Any pharmacy or pharmacist may seek reimbursement from the Opioid Settlement Advisory Committee established pursuant to section 17a-674d of the general statutes for documented expenses incurred by such pharmacy or pharmacist in providing personal opioid drug deactivation and disposal systems to patients pursuant to subdivision (1)ofthissubsection.

No suchpharmacy or pharmacist shallberequired to bear any documented expense for providing personal opioid drug deactivation and disposal systems to patients pursuant to subdivision (1) of this subsection and, if there are insufficient funds in the Opioid Settlement Fund established pursuant to section 17a-674c of the general statutes, as amended by this act, to cover such documented expenses or such funds are otherwise unavailable, no pharmacist shall be required to provide a personal opioid drug deactivation and disposal system pursuant to subdivision (1) of this subsection.

(c) The Commissioner of Consumer Protection may adopt regulations, in accordance with the provisions of chapter 54 of the general statutes, to implement the provisions of this section.

27.15.

Subsection(NEW) (f)(Effective offrom sectionpassage) 17a-674cNot oflater thethan 2024October supplement1, to2024, the generalCommissioner statutesof isMental repealedHealth and Addiction Services shall post on the followingDepartment isof substitutedMental inHealth lieuand thereofAddiction (EffectiveServices' OctoberInternet 1,web 2024):site information regarding personal opioid drug deactivation and disposal systems.

(f)As Moneysused in thethis fundsection, shall"personal beopioid spentdrug onlydeactivation forand thedisposal followingsystem" substancemeans usea disorderproduct abatementthat purposes,is indesigned accordancefor withpersonal theuse controllingand judgment,enables consenta decreepatient orto settlement,permanently asdeactivate confirmed by the Attorney General's review of such judgment, consent decree or settlement and upondestroy thean approvalopioid ofdrug, theas committeedefined andin thesection Secretary20-14o of the Officegeneral ofstatutes. Policy and Management:

(1) State-wide, regional or community substance use disorder needs LCO 22 of 37 Substitute Bill No.

1 assessments to identify structural gaps and needs to inform expenditures from the fund;

(2) Infrastructure required for evidence-based substance use disorder prevention, treatment, recovery or harm reduction programs, services and supports;

(3) Programs, services, supports and resources for evidence-based substance use disorder prevention, treatment, recovery or harm reduction;

(4) Evidence-informed substance use disorder prevention, treatment, recovery or harm reduction pilot programs or demonstration studies that are not evidence-based, but are approved by the committee as an appropriate use of moneys for a limited period of time as specified by the committee, provided the committee shall assess whether the evidence supports funding such programs or studies or whether it provides a basis for funding such programs or studies with an expectation of creating an evidence base for such programs and studies;

(5) Evaluation of effectiveness and outcomes reporting for substance usedisorderabatementinfrastructure,programs,services,supportsand resources for which moneys from the fund have been disbursed, including, but not limited to, impact on access to harm reduction services or treatment for substance use disorders or reduction in drug- related mortality;

(6) One or more publicly available data interfaces managed by the commissioner to aggregate, track and report data on (A) substance use disorders, overdoses and drug-related harms, (B) spending recommendations, plans and reports, and (C) outcomes of programs, services, supports and resources for which moneys from the fund were disbursed;

(7) Research on opioid abatement, including, but not limited to, development of evidence-based treatment, barriers to treatment, nonopioid treatment of chronic pain and harm reduction, supply-side LCO 23 of 37 Substitute Bill No.

1 enforcement;

(8) Documented expenses incurred in administering and staffing the fund and the committee, and expenses, including, but not limited to, legal fees, incurred by the state or any municipality in securing settlement proceeds, deposited in the fund as permitted by the controlling judgment, consent decree or settlement;

(9) Documented expenses associated with managing, investing and disbursing moneys in the fund;

(10) Documented expenses, including legal fees, incurred by the state or any municipality in securing settlement proceeds deposited in the fundto theextent such expensesare not otherwise reimbursedpursuant to a fee agreement provided for by the controlling judgment, consent decree or settlement;

[and] (11) Provision of funds to municipal police departments for the purpose of equipping police officers with opioid antagonists, with priority given to departments that do not currently have a supply of opioid antagonists;

and (12) Documented expenses incurred by pharmacies and pharmacists in providing personal opioid drug deactivation and disposal systems to patients pursuant to section 26 of this act.

28.16.

Subdivision(Effective (7)from ofpassage) section(a) 31-101As ofused thein generalthis statutessection: is repealed andthefollowing issubstituted inlieuthereof(EffectiveOctober 1, 2024):

(7)(1) "Employer""Opioid meansdrug" anyhas person acting directly or indirectly in the interestsame ofmeaning anas employerprovided in relationsection to20- an14o employee, but shall not include any person engaged in farming, or any person subject to the provisions of the Nationalgeneral LaborRelationsstatutes; Act, unless the National Labor Relations Boardhasdeclined to assert jurisdictionover suchperson,or anyperson subject to the provisions of the Federal Railway Labor Act, or the state or any political or civil subdivision thereof or any religious agency or LCO 24 of 37 Substitute Bill No.

1and corporation,(2) or"Personal anyopioid labordrug organization,deactivation exceptand whendisposal actingsystem" asmeans ana employer,Public orAct anyNo. one acting as an officer or agent of such labor organization.

An24-19 employer16 licensed by the Department of Public46 HealthSubstitute underSenate sectionBill 19a-490No. shall be subject to the provisions of this chapter with respect to all its employees except those licensed under [chapters 370 and] chapter 379, unless such employer is the state or any political subdivision thereof;

1 product that is designed for personal use and enables a patient to permanently deactivate and destroy an opioid drug.

(b) The Commissioner of Mental Health and Addiction Services, in collaboration with the Commissioners of Consumer Protection and Public Health, the Insurance Commissioner and the Governor's Prevention Partnership, shall study long-term payment options for the dispensing of personal opioid drug deactivation and disposal systems topatientsinthestate,including,butnotlimitedto,atthetimeanopioid drug is dispensed to the patient.

Not later than January 1, 2025, the Commissioner of Mental Health and Addiction Services 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 cognizanceofmattersrelatingtopublichealthandconsumerprotection, regarding such study.

29.17.

Subdivision (7) of section 31-101 of the general statutes is repealed andthefollowing issubstituted inlieuthereof(EffectiveOctober 1, 2024):

(7) "Employer" means any person acting directly or indirectly in the interest of an employer in relation to an employee, but shall not include any person engaged in farming, or any person subject to the provisions of the National LaborRelations Act, unless the National Labor Relations Boardhasdeclined to assert jurisdictionover suchperson,or anyperson subject to the provisions of the Federal Railway Labor Act, or the state or any political or civil subdivision thereof or any religious agency or corporation, or any labor organization, except when acting as an employer, or any one acting as an officer or agent of such labor organization.

An employer licensed by the Department of Public Health under section 19a-490 shall be subject to the provisions of this chapter with respect to all its employees except those licensed under [chapters and] chapter 379, unless such employer is the state or any political subdivision thereof;

Public Act No.

24-19 17 of 46 Substitute Senate Bill No.

1 Sec.

18.

(c) The provisions of this section shall apply to a high deductible health plan, as such term is used in subsection (f) of section 38a-493 of the general statutes, to the maximum extent permitted by federal law, except if such plan is used to establish a medical savings account or an Archer MSA pursuant to Section 220 of the Internal Revenue Code of 1986, as amended from time to time, or any subsequent corresponding internal revenue code of the United States, as amended from time to time, or a health savings account pursuant to Section 223 of said Internal Revenue Code of 1986, as amended from time to time, the provisions of this section shall apply to such plan to the maximum extent that (1) is permitted by federal law, and (2) does not disqualify such account for thedeductionallowedthe deduction allowed under Section220orsaid 223ofsaidInternalRevenueSection 220 or 223 of said Internal Revenue Code of 1986, as applicable.

30.19.

(b) Each group health insurance policy providing coverage of the LCOtype 25specified in subdivisions (1), (2), (4), (11) and (12) of 37section Substitute38a-469 Billof No.the general statutes and delivered, issued for delivery, renewed, amended or continued in this state on or after January 1, 2025, shall provide coverage for coronary calcium scans.

1Public typeAct specifiedNo. in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general statutes and delivered, issued for delivery, renewed, amended or continued in this state on or after January 1, 2025, shall provide coverage for coronary calcium scans.

(c)24-19 The18 provisions of this46 sectionSubstitute shallSenate applyBill toNo. a high deductible health plan, as such term is used in subsection (f) of section 38a-493 of the general statutes, to the maximum extent permitted by federal law, except if such plan is used to establish a medical savings account or an Archer MSA pursuant to Section 220 of the Internal Revenue Code of 1986, as amended from time to time, or any subsequent corresponding internal revenue code of the United States, as amended from time to time, or a health savings account pursuant to Section 223 of said Internal Revenue Code of 1986, as amended from time to time, the provisions of this section shall apply to such plan to the maximum extent that (1) is permitted by federal law, and (2) does not disqualify such account for thedeductionallowed under Section220or 223ofsaidInternalRevenue Code, as applicable.

1 (c) The provisions of this section shall apply to a high deductible health plan, as such term is used in subsection (f) of section 38a-493 of the general statutes, to the maximum extent permitted by federal law, except if such plan is used to establish a medical savings account or an Archer MSA pursuant to Section 220 of the Internal Revenue Code of 1986, as amended from time to time, or any subsequent corresponding internal revenue code of the United States, as amended from time to time, or a health savings account pursuant to Section 223 of said Internal Revenue Code of 1986, as amended from time to time, the provisions of this section shall apply to such plan to the maximum extent that (1) is permitted by federal law, and (2) does not disqualify such account for the deduction allowed under said Section 220 or 223 of said Internal Revenue Code, as applicable.

31.20.

(NEW) (Effective from passage) (a)Not Aslater usedthan inJanuary this1, section:2025, and not less than annually thereafter, each hospital licensed pursuant to chapter 368v of the general statutes, except any such hospital that is operated exclusively by the state, shall (1) submit the hospital's plans and processes to respond to a cybersecurity disruption of the hospital's operations to an audit by an independent, certified cybersecurity auditor or cybersecurity expert credentialedby theInformationSystems Audit and Control Association, or similar entity that provides such credentials, to determine the adequacy of such plans and processes and identify any necessary improvements to such plans and processes, and (2) make available for inspection on a confidential basis to the Departments of Public Health and Administrative Services and the Division of Emergency Management and Homeland Security within the Department of Emergency Services and Public Protection information regarding whether such plans and processes have been determined to be adequate pursuant to such audit and the steps the hospital is taking to implement any recommended improvements by the auditor.

(1)Any "Cyberrecipient security event" means any observable occurrence of actionthe thatinformation couldsubmitted potentiallyor affectmade theavailable securitypursuant ofto computerthissectionshallmaintainthemaximumlevel systems,ofconfidentiality networksallowed orPublic data;Act No.

and24-19 (2)19 "Health care facility" means any institution, as defined in section 19a-490 of the46 generalSubstitute statutes,Senate thatBill isNo. licensed pursuant to chapter 368v of the general statutes.

(b)1 Notunder laterlaw thanfor Januarysuch 1,information 2025,and theshall Departmentnot ofdisclose Publicsuch Health'sinformation Officeexceptasexpresslyrequiredbylaw.Theinformationsubmittedormade ofavailable Publicpursuant Preparednessto andthis Response,section inshall collaborationbe withexempt thefrom state'sdisclosure Chiefunder Information Security Officer, shall include in the state'sFreedom publicof healthInformation emergencyAct, responseas plandefined anin initiativesection for1-200 healthof carethe facilitygeneral readinessstatutes. during a cyber security event.

Such initiative shall include, but need not be limited to, the acquisition or establishment of the following by each health care facility for use during a cyber security event, as necessary or appropriate for each health care facility:

LCO 26 of 37 Substitute Bill No.

1 (1) A radio communication system to enable the various units of the health care facility to continue to function;

(2) A separate intranet system for secure communications within the health care facility;

(3) Facsimile machines, local printers or local laptops for printing and intranet communications;

(4) Medical devices that are not connected to the Internet;

(5) An intranet-based emergency management information system to document routine and emergency events or incidents;

(6) A diversion management system for hospital emergency departments to communicate to emergency medical services organizations, other first responders and patients the need to divert patients seeking emergency medical services to another emergency department or health care facility;

and (7) Methods of communicating and coordinating with the Department of Social Services and health carriers to reduce the risk of a sudden reduction in cash flow from the inability to bill for health care services.

32.21.

(EffectiveSubsection July(b) 1,of 2024)section The17b-59d sum of twenty-fivethe thousandgeneral dollarsstatutes is appropriatedrepealed to the Department of Emergency Services and Public Protection, for each of the fiscalfollowing yearsis endingsubstituted June 30, 2025, June 30, 2026, June 30, 2027, and June 30, 2028, for an annual meeting focused on prevention, identification and management of a cyber security event, as defined in sectionlieu 31thereof of(Effective thisJuly act.1, 2024):

The(b) annualIt meeting shall (1) include, but need not be limited to, representatives of the Departmentgoal of Public Health, the DivisionState-wide ofHealth EmergencyInformation ManagementExchange andto: Homeland Security within the Department of Emergency Services and Public Protection, the state National Guard and other local, regional and state- wide law enforcement agencies dealing with cyber security events, and (2) consider the (A) creation of cyber security event command scenarios;

LCO(1) 27Allow ofreal-time, 37secure Substituteaccess Billto No.patient health information and complete medical records across all health care provider settings;

1(2) (B)provide functioningpatients and training of individuals within hospitals working with pharmaceuticalssecure whileelectronic withoutaccess technology to ensuretheir medicationhealth administrationinformation andin documentationaccordance inwith a45 safeCFR manner;171;

(C)(3) functioningallow andvoluntary trainingparticipation ofby individualspatients withinto hospitalsaccess workingtheir withhealth laboratoryinformation samplesat andno testingcost; and reporting regarding such samples and test resultsforpatientswhilewithouttechnologytoensuresafeandaccurate documentation and communication;

and(4) (D)support functioningcare andcoordination trainingthrough ofreal-time individualsalerts within hospitals performing imaging studies and testingtimely andaccess reporting results for patients while working without technology to ensureclinical safeinformation; and accurate documentation and communication.

(5) reduce costs associated with preventable readmissions, duplicative testing and medical errors;

(6) promote the highest level of interoperability;

(7) meet all state and federal privacy and security requirements;

(8) support public health reporting, quality improvement, academic research and health care delivery and payment reform through data aggregation and analytics;

(9) support population health analytics;

(10) be standards-based;

and (11) provide for broad local governance that (A) includes stakeholders, including, but not limited to, representatives of the Department of Social Services, hospitals, physicians, behavioral health care providers, long-term care providers, health insurers, employers,patientsandacademic or medical research institutions, and (B) is committed to the successful development and implementation of the State-wide Health Information Exchange.

33.22.

(NEW)Section (Effective17b-59e from passage) (a) Not later than January 1, 2025, the Department of Public Health, in collaboration with the Officegeneral ofstatutes Healthis Strategy,repealed shalland establish a healthy brain initiative by developing a plan to address health conditions affecting the brain,following including,is butsubstituted notin limitedlieu to,thereof Alzheimer's(Effective disease,July dementia,1, Parkinson's2024): disease, stroke and epilepsy.

SuchPublic planAct shallNo. include, but need not be limited to, the following objectives:

(1)24-19 Strengthening20 (A) policies concerning the prevention and treatment of such46 healthSubstitute conditions,Senate andBill (B)No. partnerships with organizations and health care providers to develop such policies;

(2)1 Evaluating(a) andFor utilizingpurposes dataof regardingthis suchsection: health conditions;

(3)(1) Building"Health a skilled and diverse health care workforceprovider" tomeans engageany inindividual, preventioncorporation, effortsfacility andor provideinstitution treatmentlicensed toby personsthe withstate such health conditions, including, but not limited to, through obtaining grant funding and using data to estimateprovide and address the gap between the health care workforceservices; capacity and the anticipated demand for health care services from persons with such health conditions;

(4)and Educating(2) the"Electronic publichealth regardingrecord suchsystem" healthmeans conditions,a methodscomputer-based information system that is used to preventcreate, suchcollect, healthstore, conditionsmanipulate, andshare, treatmentexchange optionsor make available electronic health records for personsthe withpurposes suchof healththe conditions;delivery of patient care.

(5)(b) EstablishingNot alater diseasethan managementone programyear after commencement of the operation of the State-wide Health Information Exchange, each hospital licensed under chapter 368v and clinical laboratory licensed under section 19a- shall maintain an electronic health record system capable of connecting to promoteand earlyparticipating LCOin 28the State-wide Health Information Exchange and shall apply to begin the process of 37connecting Substituteto, Billand No.participating in, the State-wide Health Information Exchange.

1(c) diagnosisNot later than two years after commencement of suchthe healthoperation conditionsof andthe developState-wide protocolsHealth forInformation providingExchange, education,careconsultationandreferralsformedicalandsocialservices(1) toeach personshealth care provider with suchan electronic health conditionsrecord system capable of connecting to, and suchparticipating persons'in, caregivers,the including,State-wide butHealth notInformation limitedExchange shall apply to begin the process of connecting to, throughand collaborationsparticipating amongin, teachingthe hospitalsState-wide inHealth Information Exchange, and (2) each health care provider without an electronic health record system capable of connecting to, and participating in, the stateState-wide Health Information Exchange shall be capable of sending and partnershipsreceiving secure messages that comply with nonprofitthe organizationsDirect thatProject deliverspecifications apublished rangeby the federal Office of supportthe servicesNational promotingCoordinator for Health Information Technology.Ahealthcareprovidershallnotberequiredtoconnectwith the mentalState-wide andHealth physicalInformation healthExchange if the provider (A) possesses no patient medical records, or (B) is an individual licensed by the state that exclusively practices as an employee of personsa withcovered suchentity, healthas conditionsdefined andby theirthe caregiversHealth Insurance Portability and familyAccountability members;Act Public Act No.

and24-19 (6)21 Creating a program that is specific to persons with dementia, including, but not limited to (A) community-based opportunities for exercise, self-care and caregiver education, (B) peer support groups and social gatherings for such persons and their caregivers, family members and friends, (C) the provision of information46 onSubstitute theSenate department'sBill InternetNo. web site regarding dementia and support for persons with dementia and their caregivers, family members and friends, (D) the development of mobile applications that allow caregivers and family membersofpersons withdementiato track suchpersonsusing personal global positioning system units or mobile telephones with a global positioning system, (E) adult day care networks, and (F) transportation services.

(b)1 Not later than January 1, 2025, the Commissioner of Public1996, HealthP.L. 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 plan developed pursuant to subsection (a) of this section and the department's anticipated implementation date of such plan.

104-191, as amended from time to time, and such covered entity is legally responsible for decisions regarding the safeguarding, release or exchange of health information and medical records, in which case such covered entity is responsible for compliance with the provisions of this section.

(d) Nothing in this section shall be construed to require a health care provider to share patient information with the State-wide Health Information Exchange if (1) sharing such information is prohibited by state or federal privacy and security laws, or (2) affirmative consent from the patient is legally required and such consent has not been obtained.

(e) No health care provider shall be liable for any private or public claim related directly to a data breach, ransomware or hacking experienced by the State-wide Health Information Exchange, provided a health care provider shall be liable for any failure to comply with applicable state and federal data privacy and security laws and regulationsinsharing informationwithandconnecting to theexchange.

Any health care provider that would violate any other law by sharing information with or connecting to the exchange shall not be required to share such information with or connect to the exchange.

[(d)] (f) The executive director of the Office of Health Strategy shall adopt regulations in accordance with the provisions of chapter 54 that set forth requirements necessary to implement the provisions of this section.

The executive director may implement policies and procedures necessary to administer the provisions of this section while in the process of adopting such policies and procedures in regulation form, provided the executive director holds a public hearing at least thirty days prior to implementing such policies and procedures and publishes notice of intention to adopt the regulations on the Office of Health Strategy's Internet web site and the eRegulations System not later than twenty days after implementing such policies and procedures.

Policies Public Act No.

24-19 22 of 46 Substitute Senate Bill No.

1 and procedures implemented pursuant to this subsection shall be valid until the time such regulations are effective.

(g) Not later than eighteen months after the date of implementation ofpoliciesandprocedurespursuant tosubsection(f)ofthissection,each health care provider shall be connected to and actively participating in theState-wideHealth InformationExchange.

Asusedinthis subsection, (1) "connection" includes, but is not limited to, onboarding with the exchange, and (2) "participation" means the active sharing of medical records with the exchange in accordance with applicable law including, but not limited to, the Health Insurance Portability and Accountability Act of 1996, P.L.

104-191, as amended from time to time, and 42 CFR 2.

34.23.

(Effective from passage) (a) Not later than September 1, 2025, the executive director of the Office of Health Strategy shall establish a working group to make recommendations to the office regarding the parameters of the regulations to be adopted by, and any policies and procedures to be implemented by, the office pursuant to subsection (f) of section 17b-59e of the general statutes, as amended by this act.

Such recommendations shall include, but need not be limited to (1) privacy of protected health care information, (2) cybersecurity, (3) health care provider liability, (4) any contract required of health care providers to participate in the State-wide Health Information Exchange, and (5) any statutory changes that may be necessary to address any concerns raised by the working group.

(b) The working group shall consist of not more than fifteen members, including, but not limited to, (1) the executive director of the Office of Health Strategy, or the executive director's designee, who shall serve as chairperson of the working group, (2) the Health Information Technology Officer, designated pursuant to section 19a-754a of the general statutes, or the officer's designee, (3) the chairpersons and ranking members of the joint standing committee of the General Assembly having cognizance of matters relating to public health, and Public Act No.

24-19 23 of 46 Substitute Senate Bill No.

1 (4) representatives of health care provider associations in the state, which may include associations representing hospitals, ambulatory surgical centers, physicians, women's health care providers, behavioral and mental health care providers, health care services providers for the aging, gender-affirming care providers, patient advocates and health care payers.

(c) Not later than January 1, 2025, the executive director of the Office of Health Strategy 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 recommendations of the working group.

Sec.

24.

Subsection (b) of section 17b-59f of the general statutes is repealed and the following is substituted in lieu thereof (Effective July 1, 2024):

(b) The council shall consist of the following members:

(1) One member appointed by the executive director of the Office of Health Strategy, who shall be an expert in state health care reform initiatives;

(2) The health information technology officer, designated in accordance with section 19a-754a, or the health information technology officer's designee;

(3) The Commissioners of Social Services, Mental Health and Addiction Services, Children and Families, Correction, Public Health and Developmental Services, or the commissioners' designees;

(4)TheChiefInformationOfficerofthestate,ortheChiefInformation Officer's designee;

(5) The chief executive officer of the Connecticut Health Insurance Public Act No.

24-19 24 of 46 Substitute Senate Bill No.

1 Exchange, or the chief executive officer's designee;

(6) The chief information officer of The University of Connecticut Health Center, or the chief information officer's designee;

(7) The Healthcare Advocate, or the Healthcare Advocate's designee;

(8) The Comptroller, or the Comptroller's designee;

(9) The Attorney General, or the Attorney General's designee;

[(9)] (10) Five members appointed by the Governor, one each who shall be (A) a representative of a health system that includes more than one hospital, (B) a representative of the health insurance industry, (C) an expert in health information technology, (D) a health care consumer or consumer advocate, and (E) a current or former employee or trustee of a plan established pursuant to subdivision (5) of subsection (c) of 29 USC 186;

[(10)] (11) Three members appointed by the president pro tempore of the Senate, one each who shall be (A) a representative of a federally qualified health center, (B) a provider of behavioral health services, and (C) a physician licensed under chapter 370;

[(11)] (12) Three members appointed by the speaker of the House of Representatives, one each who shall be (A) a technology expert who represents a hospital system, as defined in section 19a-486i, (B) a provider of home health care services, and (C) a health care consumer or a health care consumer advocate;

[(12)] (13) One member appointed by the majority leader of the Senate, who shall be a representative of an independent community hospital;

[(13)](14)OnememberappointedbythemajorityleaderoftheHouse of Representatives, who shall be a physician who provides services in a Public Act No.

24-19 25 of 46 Substitute Senate Bill No.

1 multispecialty group and who is not employed by a hospital;

[(14)] (15) One member appointed by the minority leader of the Senate, who shall be a primary care physician who provides services in a small independent practice;

[(15)] (16) One member appointed by the minority leader of the HouseofRepresentatives,whoshallbeanexpertinhealthcareanalytics and quality analysis;

[(16)] (17) The president pro tempore of the Senate, or the president's designee;

[(17)] (18) The speaker of the House of Representatives, or the speaker's designee;

[(18)] (19) The minority leader of the Senate, or the minority leader's designee;

and [(19)] (20) The minority leader of the House of Representatives, or the minority leader's designee.

Sec.

25.

(NEW) (Effective from passage) Not later than January 1, 2025, and annually thereafter, the Department of Public Health shall report, within available appropriations and in accordance with the provisions of section 11-4a of the general statutes, to the joint standing committee of the GeneralAssembly having cognizance of mattersrelating to public health regarding the department's work on the Healthy Brain Initiative.

As used in this section, "Healthy Brain Initiative" means the National Centers for Disease Control and Prevention's collaborative approach to fully integrate cognitive health into public health practice and reduce the risk and impact of Alzheimer's disease and other dementias.

Sec.

26.

(1) "Health care provider" means any person or organization that furnishesPublic healthAct careNo. services to persons with Parkinson's disease or Parkinsonism and is licensed or certified to furnish such services pursuant to chapters 370 and 378 of the general statutes;

and24-19 (2)26 "Hospital" has the same meaning as provided in section 19a-490 LCO 29 of 3746 Substitute Senate Bill No.

1 furnishes health care services to persons with Parkinson's disease or Parkinsonism and is licensed or certified to furnish such services pursuant to chapters 370 and 378 of the general statutes.statutes;

(b)and Not(2) later"Hospital" thanhas July 1, 2025, the Departmentsame ofmeaning Publicas Healthprovided shallin maintainsection and19a-490 operate a state-wide registry of datathe ongeneral Parkinson'sstatutes. disease and Parkinsonism.

(b) Not later than April 1, 2026, the Department of Public Health, in collaboration with a public institution of higher education in the state, shall maintain and operate, within available appropriations, a state- wide registry of data on Parkinson's disease and Parkinsonism.

Each hospital and health care provider shall provide each such patient withnoticeof,andtheopportunitywithnoticeof,andtheopportunityto to opt outof,suchdisclosure.

(e) Each hospital shall provide access to its records to the Department of Public Health,Act asNo. the department deems necessary, to perform case finding or other quality improvement audits to ensure completeness of reporting and data accuracy consistent with the purposes of this section.

24-19 27 of 46 Substitute Senate Bill No.

1 (e) Each hospital shall provide access to its records to the Department of Public Health, as the department deems necessary, to perform case finding or other quality improvement audits to ensure completeness of reporting and data accuracy consistent with the purposes of this section.

LCO(g) 30The Department of 37Public SubstituteHealth Billmay No.enter into reciprocal reporting agreements with the appropriate agencies of other states to exchange Parkinson's disease and Parkinsonism care data.

1 (g) The Department of Public Health may enter into reciprocal reporting agreements with the appropriate agencies of other states to exchange Parkinson's disease and Parkinsonism care data.

(i) Said committee shall include, but need not be limited to, the following members, who shall be appointed by the Commissioner of Public Health not later than JuneApril 1, 2025:2026:

(12) an occupationalPublic therapistAct withNo. experience working with persons with Parkinson's disease;

24-19 28 of 46 Substitute Senate Bill No.

1 occupational therapist with experience working with persons with Parkinson's disease;

The commissioner shall appoint, from among the members of the oversight committee, a chairperson who shall schedule the first meeting of the oversight committee on or before July1,2025.TheDepartmentofPublicHealthshallassistsaidcommitteeApril in1, its2026. work and provide any information or data that the committee deems necessary to fulfil its duties, unless the disclosure of such information or data is prohibited by state or federal law.

NotThe laterDepartment thanof LCOPublic 31Health shall assist said committee in its work and provide any information or data that the committee deems necessary to fulfil its duties, unless the disclosure of 37such Substituteinformation Billor No.data is prohibited by state or federal law.

1Not later than January 1, 2026,2027, and annually thereafter, the chairperson of the committee 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, regardingthework ofthecommittee.

Not later thanJanuary 1,2026,and1,2027,and at least annually thereafter, such chairperson shall report to the Commissioner of Public Health regarding the work of the committee.

Sec.35.(NEW)(Effectivefrompassage)(a)TheCommissionerofMentalThe Healthcommissioner andmay Addictionimplement Services,policies inand consultationprocedures withnecessary to administer the Commissionerprovisions of Childrenthis andsection Families,while shallin establishthe aprocess programof foradopting personssuch diagnosedpolicies withand recent-onsetprocedures schizophreniaas spectrumregulations, disorder,provided atnotice aof hospitalintent into adopt regulations is published on the state,eRegulations forSystem specializednot treatmentlater earlythan intwenty suchdays persons'after psychosis.the date of implementation.

Policies and procedures implemented pursuant to this section shall be valid until the time final regulations are adopted.

Sec.27.(NEW)(Effectivefrompassage)(a)TheCommissionerofMental Health and Addiction Services, in consultation with the Commissioner Public Act No.

24-19 29 of 46 Substitute Senate Bill No.

1 of Children and Families, shall establish, within available appropriations, a program for persons diagnosed with recent-onset schizophrenia spectrum disorder for specialized treatment early in such persons' psychosis.

(1) Develop structured curricula, online resources and videoconferencing-based case conferences to disseminate information for the development of knowledge and skills relevant to patients with LCOfirst-episode 32psychosis ofand 37such Substitutepatients' Billfamilies; No.

1 first-episode psychosis and such patients' families;

(4) Share lessons and resources from any campaigns aimed at reducing thedurationofuntreatedpsychosisto improve localpathways toPublic careAct forNo. persons with such disorders;

24-19 30 of 46 Substitute Senate Bill No.

1 to care for persons with such disorders;

36.28.

(Effective from passage) (a) The cochairpersons of the joint standing committee of the General Assembly having cognizance of matters relating to public health shall establish a working group to study and make recommendations concerning methods of addressing LCOloneliness 33and isolation experienced by persons in the state and to improve social connection among such persons, including, but not limited to, through the establishment of 37a Substitutepilot Billprogram No.that utilizes technology to combat loneliness and foster social engagement.

1 loneliness and isolation experienced by persons in the state and to improve social connection among such persons.

(2)Public EvaluateAct methodsNo. of preventing and eliminating the sense of isolation and loneliness experienced by persons in the state;

24-19 31 of 46 Substitute Senate Bill No.

1 (2) Evaluate methods of preventing and eliminating the sense of isolation and loneliness experienced by persons in the state;

(1) A high school teacher from an urban high school in the state;

(2) ATwo highrepresentatives schoolof teacheran fromalliance aof ruralprivate highand schoolpublic entities in the state that recognize the importance of, and need for, addressing loneliness and social disconnectedness among residents of all ages across the state;

(6) A student of a school of social work at an institution of higher LCOeducation 34in ofthe 37state; Substitute Bill No.

1Public educationAct inNo. the state;

(7)24-19 A32 resident of an46 assistedSubstitute livingSenate facilityBill forNo. veterans in the state;

1 (7) A resident of an assisted living facility for veterans in the state;

(9) A member of the administration of a senior center in a rural area of the state;

(10) A memberlibrarian offrom the administration of a seniorlibrary center in an urban area of the state;

(16)A representative ofanofanorganizationinthe organizationinthe state that advocatesfor persons with a physical disability;

LCO(19) 35A representative of 37an Substituteorganization Billthat No.is exploring the use of technology to address loneliness and isolation;

1Public (19)Act ANo. psychiatrist who treats adolescents in the state;

(20)24-19 A33 psychiatristof who46 treatsSubstitute adultsSenate inBill theNo. state;

(21)1 (20) A librarianpsychiatrist fromwho atreats libraryadolescents in a rural area of the state;

(22)(21) A socialpsychiatrist worker who practicestreats inadults anin urban area of the state;

(23)(22) TheA Commissionerlibrarian offrom Mentala Healthlibrary andin Addictiona Services,rural orarea of the commissioner'sstate; designee;

and(23) (24)A Thesocial Commissionerworker ofwho Childrenpractices andin Families,an orurban thearea commissioner'sof designee.the state;

(24) The Commissioner of Mental Health and Addiction Services, or the commissioner's designee;

and (25) The Commissioner of Children and Families, or the commissioner's designee.

(f) Not later than January 1, 2025, the working group shall submit a report on its findings and recommendations to the joint standing committee of the General Assembly having cognizance of matters relating to publichealth,inaccordance withtheprovisionsofsection11-withtheprovisionsofsection 11- 4a ofthegeneralstatutes.Theofthegeneralstatutes. working groupshallterminate onthedate that it submits such report or January 1, 2025, whichever is later.

ThisThe actworking shallgroupshallterminate takeonthedate effectthat asit followssubmits andsuch shallreport amendor theJanuary following1, sections:2025, whichever is later.

Section 1 October 1, 2024 New section Sec.

229. October 1, 2024 New section Sec.

3(Effective Octoberfrom 1,passage) 2024(a) NewThe sectionchairpersons LCOof 36the joint standing committee of 37the SubstituteGeneral BillAssembly having cognizance of matters relating to public health shall establish a working group to Public Act No.

124-19 Sec.34 of 46 Substitute Senate Bill No.

41 fromexamine passagehospice 17b-242(a)services Sec.for pediatric patients across the state.

5The Januaryworking 1,group 2025shall Newinclude, sectionbut Sec.need not be limited to, the following members:

6(1) JanuaryAt 1,least 2025one Newrepresentative sectionof Sec.each pediatric hospice association in the state;

7(2) JulyOne 1,representative 2024of Neweach organization licensed as a hospice by the Department of Public Health pursuant to section from19a-122b passageof Sec.the general statutes;

8(3) NewAt sectionleast Sec.one representative of an association of hospitals in the state;

9(4) JulyOne 1,representative 2024each Newof sectiontwo Sec.children's hospitals in the state;

10(5) JanuaryOne 1,pediatric 2025oncologist; New section Sec.

11(6) JanuaryOne 1,pediatric 2025intensivist; New section Sec.

12(7) JanuaryThe 1,chairpersons 2025and Newranking sectionmembers Sec.of the joint standing committee of the General Assembly having cognizance of matters relating to public health;

13(8) JanuaryThe 1,Commissioner 2025of NewPublic sectionHealth, Sec.or the commissioner's designee;

14and January(9) 1,The 2025Commissioner Newof sectionSocial JanuaryServices, 1,or 2025the Sec.commissioner's designee.

15(b) NewThe sectionworking Sec.group shall be responsible for the following:

16(1) JanuaryReviewing 1,existing 2025hospice Newservices sectionfor Sec.pediatric patients across the state;

17(2) JanuaryMaking 1,recommendations 2025for Newappropriate sectionlevels Sec.of hospice services for pediatric patients across the state;

18and JanuaryPublic 1,Act 2025No. New section Sec.

1924-19 July35 1,of 202446 NewSubstitute sectionSenate Sec.Bill No.

201 from(3) passageEvaluating Newpayment sectionand Sec.funding options for pediatric hospice care.

21(c) fromThe passagecochairpersons Newof sectionthe Sec.joint standing committee of the General Assembly having cognizance of matters relating to public health shall schedule the first meeting of the working group, which shall be held not later than sixty days after the effective date of this section.

22(d) The members of the working group shall elect two chairpersons from passageamong Newthe sectionmembers Sec.of the working group.

23(e) JulyThe 1,administrative 2024staff Newof sectionthe Sec.joint standing committee of the General Assembly having cognizance of matters relating to public health shall serve as administrative staff of the working group.

24(f) fromNot passagelater 19a-490ffthan Sec.March 1, 2025, the chairpersons of the working group 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 concerning the findings of the working group.

25 January 1, 2025 New section Sec.

2630. October 1, 2024 New section Sec.

27(NEW) October(Effective from passage) Not later than July 1, 20242025, 17a-674c(f)and Sec.at the time of hiring of each new member of its nursing staff, each organization licensed as a hospice by the Department of Public Health pursuant to section 19a-122b of the general statutes shall encourage its nursing staffto spendthree weekseachinapediatricintensive careunit, pediatric oncology unit and pediatric hospice facility to (1) enhance the skills and expertise of hospice nurses in pediatric care;

28and October(2) 1,prepare 2024hospice 31-101(7)nurses Sec.for future roles in pediatric hospice care.

29 January 1, 2025 New section Sec.

3031. January 1, 2025 New section Sec.

31Section from19a-563h passageof Newthe sectiongeneral Sec.statutes is repealed and the following is substituted in lieu thereof (Effective from passage):

32(a) JulyAs 1,used 2024in Newthis sectionsection, Sec."direct care" means hands-on care provided by a registered nurse, licensed pursuant to chapter 378, Public Act No.

3324-19 from36 passageof New46 sectionSubstitute Sec.Senate Bill No.

341 fromlicensed passagepractical Newnurse, licensed pursuant to chapter 378, or a nurse's aide, registered pursuant to chapter 378a,to residents of nursing homes, as defined in section Sec.19a-563, including, but not limited to, assistance with feeding, bathing, toileting, dressing, lifting and moving, administering medication, promoting socialization and personal care services, but does not include food preparation, housekeeping, laundry services, maintenance of the physical environment of the nursing home or performance of administrative tasks.

35[(a)](b)OnorbeforeJanuary1,2022,theDepartmentofPublicHealth fromshall passage(1) Newestablish sectionminimum Sec.staffing level requirements for nursing homes of three hours of direct care per resident per day, and (2) modify staffing level requirements for social work and recreational staff of nursing homes such that the requirements (A) for social work, anumber of hours that is based on one full-time social worker per sixty residents and that shall vary proportionally based on the number of residents in the nursing home, and (B) for recreational staff are lower than the current requirements, as deemed appropriate by the Commissioner of Public Health.

36[(b)] from(c) passageThe Newcommissioner sectionshall PHadopt Jointregulations Favorablein Subst.accordance with the provisions of chapter 54 that set forth nursing home staffing level requirements to implement the provisions of this section.

-LCOThe APPCommissioner JointofPublicHealthmay Favorableimplement LCOpoliciesandprocedures 37necessary to administer the provisions of 37this section while in the process of adopting such policies and procedures as regulations, provided notice of intent to adopt regulations is published on the eRegulations System not later than twenty days after the date of implementation.

Policies and procedures implemented pursuant to this section shall be valid until the time final regulations are adopted.

Sec.

32.

Subdivision (7) of section 38a-591a of the 2024 supplement to the general statutes is repealed and the following is substituted in lieu thereof (Effective January 1, 2026):

Public Act No.

24-19 37 of 46 Substitute Senate Bill No.

1 (7) "Clinical peer" means a physician or other health care professional who:

(A)[holds]Forareviewotherthanonespecifiedundersubparagraph (B) or (C) of subdivision (38) of this section, holds a nonrestricted license in a state of the United States [and] in the same [or similar] specialty as [typically manages] the treating physician or other health care professional who is managing the medical condition, procedure or treatment under review;

[, and] or (B) [for] For a review specified under subparagraph (B) or (C) of subdivision (38) of this section concerning:

(i) [a] A child or adolescent substance use disorder or a child or adolescent mental disorder, holds (I) a national board certification in child and adolescent psychiatry, or (II) a doctoral level psychology degree with training and clinical experience in the treatment of child and adolescent substance use disorder or child and adolescent mental disorder, as applicable;

[,] or (ii) [an] An adult substance use disorder or an adult mental disorder, holds (I) a national board certification in psychiatry, or (II) a doctoral level psychology degree with training and clinical experience in the treatment of adult substance use disorders or adult mental disorders, as applicable.

Sec.

33.

Subsection (a) of section 38a-591d of the 2024 supplement to the general statutes is repealed and the following is substituted in lieu thereof (Effective January 1, 2025):

(a) (1) Each health carrier shall maintain written procedures for (A) utilization review and benefit determinations, (B) expedited utilization review and benefit determinations with respect to prospective urgent care requests and concurrent review urgent care requests, and (C) notifying covered persons or covered persons' authorized Public Act No.

24-19 38 of 46 Substitute Senate Bill No.

1 representatives of such review and benefit determinations.

Each health carrier shall make such review and benefit determinations within the specified time periods under this section.

(2) In determining whether a benefit request shall be considered an urgent care request, an individual acting on behalf of a health carrier shall apply the judgment of a prudent layperson who possesses an average knowledge of health and medicine, except that any benefit request (A) determined to be an urgent care request by a health care professional with knowledge of the covered person's medical condition, or (B) specified under subparagraph (B) or (C) of subdivision (38) of section 38a-591a shall be deemed an urgent care request.

(3)(A)Atthetimeahealthcarriernotifiesacoveredperson,acovered person's authorized representative or a covered person's health care professionalofaninitialadversedeterminationthatwasbased,inwhole or in part, on medical necessity, of a concurrent or prospective utilization review or of a benefit request, the health carrier shall notify the covered person's health care professional (i) of the opportunity for a conference as provided in subparagraph (B) of this subdivision, and (ii) that such conference shall not be considered a grievance of such initial adverse determination as long as a grievance has not been filed as set forth in subparagraph (B) of this subdivision.

(B) After a health carrier notifies a covered person, a covered person's authorized representative or a covered person's health care professional of an initial adverse determination that was based, in whole or in part, on medical necessity, of a concurrent or prospective utilization review or of a benefit request, the health carrier shall offer a covered person's health care professional the opportunity to confer, at the request of the covered person's health care professional, with a clinical peer of such health carrier, provided such covered person, covered person's authorized representative or covered person's health care professional has not filed a grievance of such initial adverse determination prior to Public Act No.

24-19 39 of 46 Substitute Senate Bill No.

1 such conference.

Such conference shall not be considered a grievance of such initial adverse determination.

Such health carrier shall grant such clinical peer the authority to reverse such initial adverse determination.

Sec.

34.

Section 38a-498a of the general statutes is repealed and the following is substituted in lieu thereof (Effective January 1, 2025):

(a) No individual health insurance policy providing coverage of the typespecifiedinsubdivisions(1),(2),(4),(6),(10),(11)and(12)ofsection 38a-469, delivered, issued for delivery or renewed in this state, on or after [October 1, 1996] January 1, 2025, shall direct or require an enrollee to obtain approval from the insurer or health care center prior to (1) calling a 9-1-1 local prehospital emergency medical service system whenever such enrollee is confronted with a life or limb threatening emergency, or (2) transporting such enrollee when medically necessary by ambulance to a hospital.

For purposes of this section, a "life or limb threatening emergency" means any event which the enrollee believes threatens [his] such enrollee's life or limb in such a manner that a need for immediate medical care is created to prevent death or serious impairment of health.