SB 1 — AN ACT EQUALIZING COMPREHENSIVE ACCESS TO MENTAL, BEHAVIORAL AND PHYSICAL HEALTH CARE IN RESPONSE TO THE PANDEMIC.

Appointed members shall serve a term that is coterminous with the appointing official and may serve more than one term.

(d) The Secretary of the Office of Policy and Management, or the secretary's designee, and the representative appointed under subdivision (1) of subsection (b) of this section as a representative of Health Equity Solutions, shall serve as chairpersons of the commission.

Such chairpersons shall schedule the first meeting of the commission, which shall be held not later than sixty days after the effective date of this section.

If appointments under subsection (b) of this section are not made within such sixty-day period, the chairpersons may designate individuals with the required qualifications stated for the applicable appointment to serve on the commission until appointments are made pursuant to subsection (b) of this section.

(e) Members shall continue to serve until their successors are appointed.

Any vacancy shall be filled by the appointing authority.Any vacancy occurring other than by expiration of term shall be filled for the balance of the unexpired term.

(f) A majority of the membership shall constitute a quorum for the transaction of any business and any decision shall be by a majority vote of those present at a meeting, except the commission may establish such committees, subcommittees or other entities as it deems necessary to further the purposes of the commission.

The commission may adopt rules of procedure.

(g) The members of the commission shall serve without compensation, but shall, within the limits of available funds, be reimbursed for expenses necessarily incurred in the performance of their duties.

Public Act No.

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1 (h) The commission, by majority vote, shall hire an executive director to serve as administrative staff of the commission, who shall serve at the pleasure of the commission.

The commission may request the assistance of the Joint Committee on Legislative Management in hiring the executive director.

The executive director may hire not more than two executive assistants to assist in carrying out the duties of the commission.

(i) The commission shall have the following powers and duties:

To (1) support collaboration by bringing together partners from many different sectors to recognize the links between health and other issues and policy areas and build new partnerships to promote health and equity and increase government efficiency;

(2) create a comprehensive strategic plan to eliminate health disparities and inequities across sectors, in accordance with section 3 of this act;

(3) study the impact that the public health crisis of racism has on vulnerable populations within diverse groups of the state population, including on the basis of race, ethnicity, sexual orientation, gender identity and disability, including, but not limited to, Black American descendants of slavery;

(4) obtain from any legislative or executive department, board, commission or other agency of the state or any organization or other entity such assistance as necessary and available to carry out the purposes of this section;

(5) accept any gift, donation or bequest for the purpose of performing the duties described in this section;

(6) establish bylaws to govern its procedures;

and (7) perform such other acts as may be necessary and appropriate to carry out the duties described in this section, including, but not limited to, the creation of subcommittees.

(j) The commission shall engage with a diverse range of community members, including people of color who identify as members of diverse groups of the state population, including on the basis of race, ethnicity, sexual orientation, gender identity and disability, who experience inequities in health, to make recommendations to the relevant state Public Act No.

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1 agencies or other entities on an ongoing basis concerning the following:

(1)Structural racism in thestate'slaws and regulationsimpacting public health, where, as used in this subdivision, "structural racism" means a system that structures opportunity and assigns value in a way that disproportionally and negatively impacts Black, Indigenous, Latino or Asian people or other people of color;

(2) racial disparities in the state's criminal justice system and its impact on the health and well-being of individuals and families, including overall health outcomes and rates of depression, suicide, substance use disorder and chronic disease;

(3) racial disparities in access to the resources necessary for healthy living, including, but not limited to, access to adequate fresh food and physical activity, public safety and the decrease of pollution in communities;

(4) racial disparities in health outcomes;

(5) the impact of zoning restrictions on the creation of housing disparities and such disparities' impact on public health;

(6) racial disparities in state hiring and contracting processes;

and (7) any suggestions to reduce the impact of the public health crisis of racism within the vulnerable populations studied under subdivision (3) of subsection (i) of this section.

(k) Not later than January 1, 2022, and every six months thereafter, the commission shall submit a report to the Secretary of the Office of Policy and Management and the joint standing committees of the General Assembly having cognizance of matters relating to public health and appropriations and the budgets of state agencies, in accordance with the provisions of section 11-4a of the general statutes, concerning (1) the activities of the commission during the prior six- month period;

(2) any progress made in attaining the goal described in subsection (c) of section 3 of this act;

(3) any recommended changes to such goal based on the research conducted by the commission, any disparity study performed by any state agency or entity, or any community input received;

(4) the status of the comprehensive strategic plan required under section 3 of this act;

and (5) any recommendations for policy changes or amendments to state law.

Public Act No.

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3.

(NEW) (Effective from passage) (a) The Commission on Racial Equity in Public Health, established under section 2 of this act, shall develop and periodically update a comprehensive strategic plan to eliminate health disparities and inequities across sectors, including consideration of the following:

Air and water quality, natural resources andagriculturalland,affordablehousing,infrastructuresystems,public health, access to quality health care, social services, sustainable communities and the impact of climate change.

(b)Suchplanshalladdresstheincorporationofhealthandequityinto specific policies, programs and government decision-making processes including, but not limited to, the following:

(1) Disparities in laws and regulationsimpactingpublichealth;(2)disparitiesinthecriminaljustice system;

(3) disparities in access to resources, including, but not limited to, healthy food, safe housing, public safety and environments free of excess pollution;

and (4) disparities in access to quality health care.

(c) Not later than January 1, 2022, as part of such plan, the commission shall determine, using available scientifically based measurements, the percentages of disparity in the state based on race, in the following areas:

(1) Education indicators, including kindergarten readiness, third grade reading proficiency, scores on the mastery examination, administered pursuant to section 10-14n of the general statutes, rates of school-based discipline, high school graduation rates and retention rates after the first year of study for institutions of higher education in the state, as defined in section 3-22a of the general statutes;

(2) health care utilization and outcome indicators, including health insurance coverage rates, pregnancy and infant health outcomes, emergency room visits and deaths related to conditions associated with exposure to environmental pollutants, including respiratory ailments, quality of life, life expectancy, lead poisoning and access to adequate healthy nutrition and self-reported well-being surveys;

(3) criminal justice indicators, including rates of involvement with the justice Public Act No.

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1 system;

and (4) economic indicators, including rates of poverty, income and housing insecurity.

It shall be the goal of the state to attain at least a seventy per cent reduction in the racial disparities set forth in subdivisions (1) to (4), inclusive, of this subsection from the percentage of disparities determined by the commission on or before January 1, 2022.

(d) Upon completion of the initial comprehensive strategic plan, and thereafter of any update to such plan, the commission shall submit the plan to the joint standing committee of the General Assembly having cognizance of matters relating to public health, in accordance with the provisions of section 11-4a of the general statutes, and to any other joint standing committee of the General Assembly having cognizance of matters relevant to what is contained in such plan, as determined by the commission.

Sec.

(Effective from passage) The(a) DepartmentAs ofused Publicin Healththis shallsection, conduct"structural racism" means a studysystem onthat structures opportunity and assigns value in a way that disproportionally and negatively impacts Black, Indigenous, Latino or Asian people or other people of color, and "state agency" has the state'ssame COVID-19meaning response.as provided in section 1-79 of the general statutes.

NotThe laterCommission thanon JanuaryRacial 1,Equity 2022,in thePublic CommissionerHealth, established under section 2 of Publicthis Healthact, shall report,determine inbest accordancepractices withfor thestate provisionsagencies ofto section(1) 11-4aevaluate ofstructural theracism generalwithin statutes,their toown thepolicies, jointpractices, standingand committeeoperations, ofand the(2) Generalcreate Assemblyand havingimplement cognizancea plan, which includes the establishment of mattersbenchmarks relatingfor improvement, to publicultimately healtheliminate regardingany thesuch findingsstructural ofracism suchwithin study.the agency.

Such(b) reportNot shalllater includethan January 1, 2023, the commissioner'scommission recommendationsshall forsubmit policya changesreport, andin amendmentsaccordance towith the generalprovisions statutesof necessarysection to11-4a improveof the state'sgeneral responsestatutes, to futurethe pandemics,joint including,standing butcommittee notof limitedthe to,General recommendationsAssembly regardinghaving howcognizance to improve administration of massmatters vaccinations,relating personalto protectivegovernment equipmentadministration. supply and health care facilities' care for patients.

Such report shall include the best practices established by the commissionunderthissectionandarecommendationonanylegislation Public Act No.

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1 to implement such practices within state agencies.

Sec.5.(Effectivefrompassage)TheCommissionerofPublicHealthshall study the development and implementation of a recruitment and retention program for health care workers in the state who are people of color.

Not later than February 1, 2022, the commissioner shall report the results of such study, 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.

Such report shall include any legislative recommendations to improve the recruitment and retention of people of color in the health care sector, including, but not limited to, recommendations for the implementation of such recruitment and retention program.

5.

(NEW) (Effective October 1, 2021) The Department of Public Health shall designate an employee within its Office of Public Health Preparedness and Response to serve as the pandemic preparedness officer.

Such officer shall be responsible for the state's pandemic preparedness, including, but not limited to (1) conducting an annual inventory of the state's medical stockpile of medical equipment and supplies, (2) reviewing and ensuring the adequacy of infection prevention at health care facilities in the state, and (3) providing periodic updates to members of the General Assembly during a pandemic-related public health emergency.

On or before January 1, 2022, and annually thereafter, the pandemic preparedness officer 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 related to public health regarding the state's preparedness to respond to a pandemic.

Sec.

(NEW) (Effective from passage) ItThe isDepartment herebyof declaredEnergy theand policyEnvironmental ofProtection theshall stateperform an assessment of Connecticutracial toequity recognizewithin thatenvironmental racismhealth isquality aprograms publicadministered healthby crisis.said department.

Not later than January 1, 2022, the department shall submit areport,inaccordancewiththeprovisionsofsection11-4aofthegeneral statutes, to the joint standing committee of the General Assembly having cognizance of matters relating to the environment.

Such report shall include the results of such assessment and any legislative recommendations to improve racial equity within such programs.

(NEW) (Effective Julyfrom 1,passage) 2021) (a) ThereAs isused establishedin this section, "cultural humility" means a Truthcontinuing commitment to (1) self-evaluation and Reconciliationcritique Commissionof toone's examineown racialworldview disparitieswith regard to differences in publiccultural health.traditions and belief systems, and (2) awareness of, and active mitigation of, power imbalances between cultures.

(b) The commissionOffice shallof studyHigher (1)Education, institutionalin racismcollaboration inwith the state'sBoard LCOof {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-0003Regents for Higher Education and the Board of 31Trustees R03-SB.docxof }The SubstituteUniversity Billof Connecticut, shall evaluate the recruitment and retention of people of color in health care preparation programs offered by the Public Act No.

121-35 lawsand9 regulationsimpacting publichealth,(2)racialdisparitiesin the state's criminal justice system and the impact of such28 disparitiesSubstitute onSenate theBill healthNo. and well-being of individuals and families, including, but not limited to, overall health outcomes and rates of depression, suicide, substance use disorder and chronic disease, (3) racial disparities in access to healthy living resources, including, but not limited to, fresh food, produce, physical activity, public safety, clean air and clean water, (4) racial disparities in access to health care, (5) racial disparities in healthoutcomesin hospitalsandlong-termcare facilities,including, but not limited to, nursing homes, and (6) the impact of zoning restrictions on the creation of housing disparities and the impact of such disparities on public health.

The1 commissionconstituent shallunits developof legislativethe proposalsstate tosystem addressof racialhigher disparitieseducation and the inclusion of cultural humility education in publicsuch health.programs.

(b)Not Thelater commissionthan January 1, 2022, the office shall consistsubmit a report, in accordance with the provisions of section 11-4a of the followinggeneral members:statutes, to the joint standing committee of the General Assembly having cognizance of matters relating to higher education.

(1)Such Thereport executiveshall directorinclude forthe results of such evaluation and any legislative recommendations to improve the Commissionrecruitment onand Women,retention Children,of Seniors,people Equityof color in such programs and Opportunity,include oradditional thecultural executivehumility director'seducation designee;in such programs.

(2) The chairpersons and ranking members of the joint standing committee of the General Assembly having cognizance of matters relating to public health, or the chairpersons' or ranking members' designees;

(3) The Secretary of the Office of Policy and Management, or the secretary's designee;

(4) The chairperson of the Black and Puerto Rican Caucus of the General Assembly, or the chairperson's designee;

(5) Three members appointed by the speaker of the House of Representatives, one of whom is a representative from the Connecticut Health Foundation, one of whom is a representative from Health Equity Solutions and one of whom has experience in philanthropy related to health care equity and access for minority communities;

(6) Three members appointed by the president pro tempore of the LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-0004 of 31 R03-SB.docx } Substitute Bill No.

1 Senate, oneofwhomis arepresentative fromtheConnecticut Children's Medical Center Foundation, one of whom is a representative from Yale University with a professional focus on health care equity and access and one of whom is a representative from a school-based health care center;

(7) One member appointed by the majority leader of the House of Representatives who has experience and expertise in infant and maternal care;

(8) One member appointed by the majority leader of the Senate who is a representative from the Civilian Corrections Academy with knowledge and experience regarding the issues faced by individuals released from correctional institutions;

(9) One member appointed by the minority leader of the House of Representatives who is a representative from Partnership for Strong Communities with knowledge and experience regarding the impact of housing issues on the health of minority communities;

and (10) One member appointed by the minority leader of the Senate who is a representative from the Connecticut Bar Association with knowledge and experience regarding health care equity and access.

(c) The speaker ofthe House ofRepresentativesandthepresident pro tempore of the Senate shall jointly select the chairperson of the commission from among the members of the commission.

Such chairperson shall schedule the first meeting of the commission, which shall be held not later than August 31, 2021.

(d) (1) All initial appointments to the commission shall be made not later than July 31, 2021, and the term of such initial members shall terminate on June 30, 2023, regardless of when the initial appointment was made.

(2) Members of the commission appointed on or after July 1, 2023, shall serve for two-year terms.

Members shall continue to serve until LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-0005 of 31 R03-SB.docx } Substitute Bill No.

1 their successors are appointed.

Any vacancy occurring other than by expiration of term shall be filled for the balance of the unexpired term.

(3) Any vacancy shall be filled by the appointing authority, provided the chair of the commission shall have the authority to temporarily fill any vacancy lasting more than thirty days.

Any member appointed by the chair of the commission to fill a vacancy lasting more than thirty days shall serve as a member of the commission until an appointment is made by the appointing authority as provided in subsection (b) of this section or until the expiration of a two-year term if such appointment is not made by the appointing authority.

(e) The administrative staff of the joint standing committee of the General Assembly having cognizance of matters relating to public health shall serve as administrative staff of the commission.

(f) Not later than January 1, 2022, and annually thereafter, the commission shall submit a report to the joint standing committee of the General Assembly having cognizance of matters relating to public health, in accordance with the provisions of section 11-4a of the general statutes, which shall include, but need not be limited to, a detailed summary of any findings of the commission relating to racial disparities in public health and any legislative proposals to address such disparities.

(NEW)Subsection (Effective(b) Octoberof 1,section 2021)2-128 (a)of Asthe usedgeneral statutes is repealed and the following is substituted in thislieu section:thereof (Effective from passage):

(b) Not later than January first, annually, the executive director of the commission shall submit a status report, organized by subcommission, concerning its efforts in promoting the desired results listed in subdivision (1) "Hospital"of meanssubsection an(a) establishmentof licensedthis pursuantsection to chapterthe 368vjoint standing committee of the generalGeneral statutesAssembly forhaving lodging,cognizance careof matters relating to appropriations and treatmentthe budgets of personsstate sufferingagencies fromin diseaseaccordance orwith otherthe abnormalprovisions physicalof orsection mental11-4a. conditions;

On and (2)after "nurse"January means1, a2022, nursesuch licensedreport inshall accordanceinclude withthe chapterstatus 378of amendments to the joint rules of the generalHouse statutes.of Representatives and the Senate concerning the preparation of racial and ethnic impact statements pursuant to section 2-24b.

(b) On and after October 1, 2021, the Commissioner of Public Health shall require each hospital to maintain a daily minimum staffing ratio of two nurses per patient in the intensive care unit.

The daily minimum staffing ratio shall not include break, vacation, sick, personal, training, LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00006 of 31 R03-SB.docx } Substitute Bill No.

1 educational or other time that is not spent on medical care provided to an intensive care unit patient.

(c) Each hospital shall maintain a daily record of (1) the number of intensive care unit patients at such hospital, (2) the number of nurses scheduled and available to provide medical care, and (3) whether a sufficient number of nurses are scheduled and available to comply with the requirements of this section.

On and after January 1, 2022, each hospital shall file quarterly reports not later than fifteen days after the start of the quarters commencing in January, April, July and October of each year with the Department of Public Health on the number and percentage of days in the preceding quarter that such hospital has failed to comply with the provisions of this section and the reasons therefore.

(d) The Commissioner of Public Health may randomly audit a hospital for compliance with the provisions of this section and take disciplinary action against the hospital as permitted under section 19a- 494 of the general statutes for failure to comply with the provisions of this section.

(e) The Commissioner of Public Health, in accordance with the provisions of chapter 54 of the general statutes, shall adopt regulations to implement the provisions of this section.

(Effective Octoberfrom 1,passage) 2021)(a) NotThere lateris thanestablished Januarya 1,gun 2022,violence intervention and prevention advisory committee for the Commissionerpurpose of Publicadvising Healththe shall,joint withinstanding availablecommittees appropriations,of establishthe aGeneral programAssembly tohaving advancecognizance breastof healthmatters andrelating breastto cancerpublic awarenesshealth and promotehuman greaterservices understandingon of the importanceestablishment of earlya breastCommission canceron detectionGun inViolence Intervention and Prevention to coordinate the state.funding and implementation of evidence- based,community-centricprogramsandstrategiestoreducestreet-level Public Act No.

As21-35 part10 of the28 program,Substitute theSenate commissionerBill shall,No. at a minimum, provide outreach to individuals, including, but not limited to, young women of color, in the state regarding the importance of breast health and early breast cancer detection.

1 gun violence in the state.

The committee shall:

(1) Consult with community outreach organizations, victim service providers, victims of community violence and gun violence, community violence and gun violence researchers and public safety and law enforcement representatives regarding strategies to reduce community violence and gun violence;

(2) identify effective, evidence-based community violence and gun violence reduction strategies;

(3) identify strategies to align the resources of state agencies to reduce community violence and gun violence;

(4) identify state, federaland private funding opportunitiesfor community violence and gun violence reduction initiatives;

and (5) develop a public health and community engagement strategy for the Commission on Gun Violence Intervention and Prevention.

(b) The committee shall be composed of the following members:

(1) Two appointed by the speaker of the House of Representatives, one of whom shall be a representative of the Connecticut Hospital Association and one of whom shall be a representative of Compass Youth Collaborative;

(2) Two appointed by the president pro tempore of the Senate, one of whomshallbea representativeoftheConnecticut Violence Intervention Program and one of whom shall be a representative of Regional Youth Adult Social Action Partnership;

(3) Two appointed by the majority leader of the House of Representatives, one of whom shall be a representative of Hartford Communities That Care, Inc.

and one of whom shall be a representative of CT Against Gun Violence;

(4) Two appointed by the majority leader of the Senate, one of whom shall be a representative of Project Longevity and one of whom shall be a representative of Saint Francis Hospital and Medical Center;

(5) One appointed by the minority leader of the House of Public Act No.

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1 Representatives, who shall be a representative of Yale New Haven Hospital;

(6) One appointed by the minority leader of the Senate, who shall be a representative of Hartford Hospital;

(7) One appointed by the House chairperson of the joint standing committee of the General Assembly having cognizance of matters relating to public health, who shall be a representative of You Are Not Alone (YANA);

(8) One appointed by the Senate chairperson of the joint standing committee of the General Assembly having cognizance of matters relating to public health, who shall be a representative of Mothers United Against Violence;

(9) One appointed by the executive director of the Commission on Women, Children, Seniors, Equity and Opportunity, who shall be a representative of the Health Alliance for Violence Intervention;

and (10) Two appointed by the Commissioner of Public Health, who shall be representatives of the Department of Public Health's Injury and Violence Surveillance Unit.

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

(d) The president pro tempore of the Senate shall select the chairperson of the committee from among the members of the committee.

Such chairperson shall schedule the first meeting of the committee, which shall be held not later than sixty days after the effective date of this section.

The committee shall meet not less than bimonthly.

Public Act No.

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1 (e) The administrative staff of the Commission on Women, Children, Seniors, Equity and Opportunity shall serve as administrative staff of the committee.

(f) Not later than January 1, 2022, the committee shall submit a report on its findings and recommendations to the joint standing committees of the GeneralAssembly having cognizance of mattersrelating to public health and human services, in accordance with the provisions of section 11-4a of the general statutes.

The committee shall terminate on the date that it submits such report or January 1, 2022, whichever is later.

(Effective from passage) (a)The AsDepartment usedof inPublic thisHealth section,shall "doula"conduct means a trained,study nonmedicalon professionalthe whostate's providesCOVID-19 continuousresponse. LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-0007 of 31 R03-SB.docx } Substitute Bill No.

1Not physical,later emotionalthan andFebruary informational1, support2022, tothe Commissioner of Public Health shall submit a pregnantpreliminary personreport, duringin accordance with the antepartumprovisions andof intrapartumsection periods11-4a andof upthe general statutes, to the firstjoint sixstanding weekscommittee of the postpartumGeneral period.Assembly having cognizance of matters relating to public health regarding the findings of such study.

(b)Such Thereport Commissionermay ofinclude Publicthe Healthcommissioner's shallrecommendations conductfor a(1) studyany policy changes and amendments to determinethe whethergeneral statutes necessary to improve the Departmentstate's response to future pandemics, including, but not limited to, recommendations regarding provisions of Publicthe Healthgeneral shouldstatutes establishor athe regulations of Connecticut state certificationagencies processthat byshould whichautomatically be waived in the event of an occurrence or imminent threat of an occurrence of a personcommunicable candisease, beexcept certifieda assexually transmitted disease, or a doula.public health emergency declared by the Governor pursuant to section 19a-131a of the general statutes in response to an epidemic or pandemic, and (2) how to improve administration of mass vaccinations, reportingandutilizationofpersonalprotective equipment supplyduringapublic healthemergency,clusteroutbreakinvestigation and health care facilities' care for patients.

TheAs commissionerused shall report, in accordancethis withsection, the"COVID-19" provisionsmeans of section 11-4a of the generalrespiratory statutes,disease thedesignated findingsby of such study and any recommendations to the jointWorld standingHealth committeeOrganization ofon theFebruary General11, Assembly2020, havingas cognizancecoronavirus of2019, mattersand relatingany toPublic publicAct healthNo. on or before January 1, 2022.

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1 related mutation thereof recognized by said organization as a communicable respiratory disease.

(NEW) (Effective from passage) (a) Onandafter January 1,2022, any state agency, board or commission that directly, or by contract with another entity, collects demographic data concerning the ancestry or ethnicorigin,ethnicity,raceorprimarylanguageofresidentsofthestate in the context of health care or for the provision or receipt of health care services or for any public health purpose shall:

(1) Collect such data in a manner that allows for aggregation and disaggregation of data;

(2) Expand race and ethnicity categories to include subgroup identities as specified by the Community and Clinical Integration Program of the Office of Health Strategy and follow the hierarchical mapping to align with United States Office of Management and Budget standards;

(3) Provide the option to individuals of selecting one or more ethnic orracialdesignationsandincludean"other"designationwiththeability to write in identities not represented by other codes;

(4) Provide the option to individuals to refuse to identify with any ethnic or racial designations;

(5) Collect primary language data employing language codes set by the International Organization for Standardization;

and (6) Ensure, in cases where data concerning an individual's ethnic origin, ethnicity or race is reported to any other state agency, board or commission, that such data is neither tabulated nor reported without all of the following information:

(A) The number or percentage of individuals who identify with each ethnic or racial designation as their sole ethnic or racial designation and not in combination with any other Public Act No.

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1 ethnic or racial designation;

(B) the number or percentage of individuals whoidentifywitheachethnicorracialdesignation,whetherastheirsole ethnic or racial designation or in combination with other ethnic or racial designations;

(C) the number or percentage of individuals who identify with multiple ethnic or racial designations;

and (D) the number or percentage of individuals who do not identify or refuse to identify with any ethnic or racial designations.

(b) Each health care provider with an electronic health record system capable of connecting to and participating in the State-wide Health Information Exchange as specified in section 17b-59e of the general statutes shall, collect and include in its electronic health record system self-reported patient demographic data including, but not limited to, race, ethnicity, primary language, insurance status and disability status based upon the implementation plan developed under subsection (c) of this section.

Race and ethnicity data shall adhere to standard categories as determined in subsection (a) of this section.

(c) Not later than August 1, 2021, the Office of Health Strategy shall consult with consumer advocates, health equity experts, state agencies and health care providers, to create an implementation plan for the changes required by this section.

(d) The Office of Health Strategy shall (1) review (A) demographic changes in race and ethnicity, as determined by the U.S.

Census Bureau, and(B)healthdatacollectedbythestate,and(2)reevaluatethestandard race and ethnicity categories from time to time, in consultation with health care providers, consumers and the joint standing committee of the General Assembly having cognizance of matters relating to public health.

Sec.

12.

Section 19a-59i of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage):

Public Act No.

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1 (a)Thereisestablishedamaternalmortalityreviewcommitteewithin the department to conduct a comprehensive, multidisciplinary review of maternal deaths for purposes of identifying factors associated with maternal death and making recommendations to reduce maternal deaths.

(b) The cochairpersons of the maternal mortality review committee shall be the Commissioner of Public Health, or the commissioner's designee, and a representative designated by the Connecticut State Medical Society.

The cochairpersons shall convene a meeting of the maternal mortality review committee upon the request of the Commissioner of Public Health.

(c) The maternal mortality review committee may include, but need not be limited to, any of the following members, as needed, depending on the maternal death case being reviewed:

(1) A physician licensed pursuant to chapter 370 who specializes in obstetrics and gynecology, appointed by the Connecticut State Medical Society;

(2) A physician licensed pursuant to chapter 370 who is a pediatrician, appointed by the Connecticut State Medical Society;

(3) A community health worker, appointed by the Commission on Women, Children, Seniors, Equity and Opportunity;

(4) A nurse-midwife licensed pursuant to chapter 377, appointed by the Connecticut Nurses Association;

(5) A clinical social worker licensed pursuant to chapter 383b, appointed by the Connecticut Chapter of the National Association of Social Workers;

(6) A psychiatrist licensed pursuant to chapter 370, appointed by the Public Act No.

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1 Connecticut Psychiatric Society;

(7) A psychologist licensed pursuant to chapter 20-136, appointed by the Connecticut Psychological Association;

(8) The Chief Medical Examiner, or the Chief Medical Examiner's designee;

(9) A member of the Connecticut Hospital Association;

(10) A representative of a community or regional program or facility providing services for persons with psychiatric disabilities or persons with substance use disorders, appointed by the Commissioner of Public Health;

(11) A representative of The University of Connecticut-sponsored health disparities institute;

or (12) Any additional member the cochairpersons determine would be beneficial to serve as a member of the committee.

(d) Whenever a meeting of the maternal mortality review committee takes place, the committee shall consult with relevant experts to evaluate the information and findings obtained from the department pursuant to section 19a-59h and make recommendations regarding the prevention of maternal deaths.

Not later than ninety days after such meeting, the committee shall report, to the Commissioner of Public Health, any recommendations and findings of the committee in a manner that complies with section 19a-25.

(e) Not later than January 1, 2022, and annually thereafter, the maternal mortality review committee shall submit a report of disaggregated data, in accordance with the provisions of section 19a-25, regarding the information and findings obtained through the committee's investigation process to the joint standing committee of the Public Act No.

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1 General Assembly having cognizance of matters relating to public health, in accordance with the provisions of section 11-4a.

Such report may include recommendations to reduce or eliminate racial inequities and other public health concerns regarding maternal mortality and severe maternal morbidity in the state.

[(e)] (f) All information provided by the department to the maternal mortality review committee shall be subject to the provisions of section 19a-25.

Sec.

13.

12.

(Effective from passage) (a) There is established a task force to study racial inequities in maternal mortality and severe maternal morbidity in the state.

The task force shall examine and make recommendations to reduce or eliminate racial inequities in maternal mortality and severe maternal morbidity in the state.

For the purposes LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-0008 of 31 R03-SB.docx } Substitute Bill No.

1 of this section, "maternal mortality" means the death of a woman during pregnancy or within one year of the end of such pregnancy.

(b) The task force shall consist of the following members:

(1) Three appointed by the speaker of the House of Representatives;

(2) Three appointed by the president pro tempore of the Senate;

(3) Two appointed by the majority leader of the House of Representatives;

(4) Two appointed by the majority leader of the Senate;

(5) Two appointed by the minority leader of the House of Representatives;

(6) Two appointed by the minority leader of the Senate;

(7) Two appointed by the Governor;

(8) Two appointed by the chairperson of the Black and Puerto Rican Caucus of the General Assembly;

(9) The chairpersons of the joint standing committee of the General Assembly having cognizance of matters relating to public health, or the chairpersons' designees;

and (10) The Commissioner of Public Health, or the commissioner's designee.

(c) Any member of the task force appointed under subdivisions (1) to (9), inclusive, of subsection (b) of this section may be a member of the General Assembly.

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

LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-0009 of 31 R03-SB.docx } Substitute Bill No.

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

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

(f) The administrative staff of the joint standing committee of the General Assembly having cognizance of matters relating to public health shall serve as administrative staff of the task force.

(g) Not later than January 1, 2022, the task force shall submit a report on its findings and recommendations to the joint standing committee of the General Assembly having cognizance of matters relating to public health, in accordance with the provisions of section 11-4a of the general statutes.

The task force shall terminate on the date that it submits such report or January 1, 2022, whichever is later.

Sec.

13.

(NEW) (Effective from passage) Not later than January 1, 2022, the Commissioner of Public Health shall establish a pilot program that allows emergency medical services personnel, in coordination with community health workers, to conduct home visits for individuals who are at a high risk of being repeat users of emergency medical services to assist such individuals with managing chronic illnesses and adhering to medication plans.

Sec.

(NEW) (Effective from passage) OnThe andchairpersons afterof Octoberthe 1,joint 2021,standing eachcommittee physicianof licensedthe pursuantGeneral toAssembly chapterhaving 370cognizance of thematters generalrelating statutesto public health shall conductconvene a mentalworking group to advance breast health examinationand ofbreast acancer patientawareness duringand promote greater understanding of the patient'simportance annualof physicalearly examination.breast cancer detection in the state.

The working group shall (1) identify organizations that provide Public Act No.

21-35 18 of 28 Substitute Senate Bill No.

1 outreach to individuals, including, but not limited to, young women of color and high school students, regarding the importance of breast health and early breast cancer detection;

and (2) examine payment options for early breast cancer detection services available to such individuals.

Not later than February 1, 2022, the working group shall submit, in accordance with the provisions of section 11-4a of the general statutes, recommendations to the joint standing committee of the General Assembly having cognizance of matters relating to public health, regarding appropriations or legislative proposals that will improve breast cancer awareness and early detection of breast cancer.

(Effective from passage) The(a) SecretaryAs ofused the Office of Policy and Management, in consultationthis withsection, relevant"doula" statemeans agencies,a including,trained, butnonmedical notprofessional limitedwho toprovides thephysical, Departmentsemotional of Public Health, Mental Health and Addictioninformational Services,support, Childrenvirtually andor Families,in Socialperson, Services,to Developmentala Services,pregnant Education,person Housingbefore, andduring Aging and Disabilityafter Services,birth. the Labor Department and the Office of Early Childhood, shall LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00010 of 31 R03-SB.docx } Substitute Bill No.

1(b) The Commissioner of Public Health shall conduct a studyscope onof thepractice impactsreview pursuant to sections 19a-16d to 19a-16f, inclusive, of the COVID-19general pandemicstatutes onto determine whether the stateDepartment of Connecticut.Public Health should establish a state certification process by which a person can be certified as a doula.

SuchThe studycommissioner shall include,report, butin needaccordance notwith bethe limitedprovisions to,of section 11-4a of the disparategeneral impactstatutes, the findings of such committee and any recommendations to the COVID-19joint pandemicstanding oncommittee individualsof basedthe General Assembly having cognizance of matters relating to public health on race,or ethnicity,before languageFebruary and1, geography.2022.

Not later than February 1, 2022, the Secretary of the Office of Policy and Management shall submit a report on the study to the joint standing committee of the General Assembly having cognizance of matters relating to public health, in accordance with the provisions of section 11-4a of the general statutes.

As used in this section, "COVID-19" means the respiratory disease designated by the World Health Organization on February 11, 2020, as coronavirus 2019, and any related mutation thereof recognized by said organization as a communicable respiratory disease.

Subsection(Effective from passage) (a) ofThere sectionis 19a-200established ofa theworking generalgroup statutesto isdevelop repealedrecommendations andthefollowingfor issubstitutedthe inlieuthereof(EffectiveOctoberstrategic 1,expansion 2021):of school-based health center servicesin thestate.

(a) The mayorworking ofgroupshall eachconsider, city,but theneed chiefnot executive officer of each town and the warden of each borough shall, unless the charter of such city, town or borough otherwise provides, nominate some person to be directorlimited ofto, health for such city, town or borough, which nomination shall be confirmed or rejected by the boardfollowing: of selectmen, if there be such a board, otherwise by the legislative body of such city or town or by the burgesses of such borough within thirty days thereafter.

Notwithstanding(1) theSpecific chartergeographical provisionsregions of any city, town or borough with respect to the qualificationsstate ofwhere theadditional directorschool-based ofhealth health,centers onmay andbe afterneeded, October(2) 1,options 2010,to anyexpand personor nominatedadd toservices beat aexisting directorschool-based of health shallcenters, (1)(3) bemethods afor licensedproviding physicianadditional andsupport holdfor aschool-based degree in public health fromcenters anto accreditedexpand school,telehealth college,services, universityPublic orAct institution,No. or (2) hold a graduatedegreeinpublichealthfromanaccreditedinstitutionofhigher education.

The21-35 educational19 requirements of this28 sectionSubstitute shallSenate notBill applyNo. to any director of health nominated or otherwise appointed as director of health prior to October 1, 2010.

In1 cities,(4) townsoptions orfor boroughsexpanding withinsurance areimbursement populationfor ofschool-based fortyhealth thousandcenters, orand more(5) foroptions fiveto consecutiveexpand years,access according to theschool-based estimatedhealth populationcenters figuresor authorizedexpand pursuantschool-based tohealth LCOcenter {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-0011sites, ofwhich 31may R03-SB.docxinclude }establishing Substituteschool-based Billmental No.health clinics.

1As subsectionused (b)in ofthis sectionsubsection, 8-159a,"school-based suchmental director of health shallclinic" servemeans in a full-timeclinic capacity,that except(A) whereis alocated townin hasor designatedon such director as the chiefgrounds medicalof advisora forschool itsfacility publicof schoolsa underschool sectiondistrict 10-205,or andschool shallboard not,or during such director's term of office,an haveIndian anytribe financialor interesttribal inorganization, or(B) engageis inorganized anythrough employment,school, transactioncommunity orand professionalhealth activityprovider thatrelationships, (C) is inadministered substantialby conflicta withsponsoring thefacility, properand discharge(D) ofprovides theon-site dutiesmental, requiredemotional ofor directorsbehavioral of health byservices theto generalchildren statutesand oradolescents thein regulationsaccordance ofwith Connecticut state agenciesand orlocal specifiedlaw, byincluding thelaws appointingrelating authorityofthecity,townorboroughto initswrittenagreementwithsuchlicensure director.and certification.

Such(b) directorThe ofworking healthgroup shall haveconsist and exercise within the limits of the city,following townmembers: or borough for which such director is appointed all powers necessary for enforcing the general statutes, provisions of the regulations of Connecticut state agencies relating to the preservation and improvement of the public health and preventing the spread of diseases therein.

In(1) caseThe of the absence or inability to act of a city, town or borough director of health or if a vacancy exists in the office of such director, the appointing authority of such city, town or borough may, with the approval of the Commissioner of Public Health, designate in writing a suitable person to serve as acting director of health during the period of such absence or inability or vacancy, provided the commissionercommissioner's maydesignee; appoint such acting director if the city, town or borough fails to do so.

(2) The personCommissioner soof designated,Social whenServices, sworn,or shall have all the powerscommissioner's anddesignee; be subject to all the duties of such director.

If(3) theThe appointingCommissioner authority of suchChildren city,and townFamilies, or borough designates a person to serve as acting director of health, such appointing authority shall notify the commissionercommissioner's indesignee; writing of such designation, including the start date of such acting director of health.

In(4) caseThe ofCommissioner vacancy in the office of suchEducation, director, if such vacancy exists for thirty days, said commissioner[may]shallappointadirectorofhealthforsuchcity,town or borough who meets the qualificationscommissioner's specifieddesignee; in this subsection.

Said(5) commissioner,The may,Insurance forCommissioner, cause, remove an officer the commissioner oranypredecessorinsaidofficehasappointed,andthecommoncouncil of such city, town or the burgessescommissioner's ofdesignee; such borough may, respectively, for cause, remove a director whose nomination has been confirmed by them, provided such removal shall be approved by said commissioner;

LCO(6) {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-0012The chairpersons of 31the R03-SB.docxjoint }standing Substitutecommittee Billof No.the General Assembly having cognizance of matters relating to public health, or the chairpersons' designees;

1(7) and,The withinranking twomembers days thereafter, notice in writing of suchthe actionjoint shallstanding becommittee given by the clerk of such city, town or borough, as the caseGeneral mayAssembly be,having tocognizance said commissioner, who shall, within ten days after receipt, file with the clerkfromwhomthenoticewasreceived,approvalordisapproval.Each such director of healthmatters shallrelating holdto officepublic forhealth, theor term of four years from the dateranking ofmembers' appointmentdesignees; and until a successor is nominated and confirmed in accordance with this section.

Each director of health shall, annually, at the end of the fiscal year of the city, town or borough, file with the Department of Public HealthAct aNo. report of the doings as such director for the year preceding.

21-35 20 of 28 Substitute Senate Bill No.

1 (8) The chairpersons of the joint standing committee of the General Assembly having cognizance of matters relating to appropriations, or the chairpersons' designees;

(9) The ranking members of the joint standing committee of the General Assembly having cognizance of matters relating to appropriations, or the ranking members' designees;

(10) Two persons designated by the Connecticut Association of School Based Health Centers;

(11) One person designated by the Community Health Center Association of Connecticut;

(12) One person designated by the Connecticut Association of Healthcare Plans;

(13) One person designated by Connecticut Health Center, Inc.;

and (14) One person who is a children's mental health service provider, appointed by the Commissioner of Children and Families.

(c) The cochairpersons of the working group shall be the Commissioner of Public Health, or the commissioner's designee, and a member of the working group appointed pursuant to subdivisions (6) to (9), inclusive, of subsection (b) of this section, elected by the members of the working group.

The cochairpersons 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.

(d) Not later than February 1, 2022, the working group shall submit a report on its findings and any recommendations for the strategic expansion of school-based health center services, in accordance with section 11-4a of the general statutes, to the joint standing committees of the General Assembly having cognizance of matters relating to public Public Act No.

21-35 21 of 28 Substitute Senate Bill No.

1 health and appropriations.

The working group shall terminate on the date that it submits such report or February 1, 2022, whichever is later.

(NEW) (Effective from passage) On(a) andFor afterthe Januaryfiscal 1,years 2022,ending anyJune state30, agency,2022,andJune30,2023,theDepartmentofMentalHealthandAddiction boardServicesshall, orwithinavailableappropriations,increase commissionaccessto thatmobile directly,crisis orservices bythroughout contract with another entity, collects demographic data concerning the ancestrystate orby ethnicorigin,ethnicity,raceorprimarylanguageofresidentsofthestateexpanding insuch theservices' contexthours of healthoperation careto orinclude fornights theand provisionweekends. or receipt of health care services or for any public health purpose shall:

(1)(b) CollectThe suchDepartment dataof inMental Health and Addiction Services shall develop a mannerplan thatto allowsincrease foraccess aggregationto mobile crisis services throughout the state by making such services available twenty-four hours per day and disaggregationseven ofdays data;per week.

(2)Not Expandlater racethan andJanuary ethnicity1, categories2022, tothe includeCommissioner subgroupof identitiesMental asHealth specifiedand inAddiction theServices Centersshall forsubmit Medicarea andreport, Medicaidin Services'accordance Statewith Innovationthe Modelsprovisions Initiativeof andsection follow11-4a of the hierarchicalgeneral mappingstatutes, to alignthe withjoint Unitedstanding Statescommittees Officeof the General Assembly having cognizance of Managementmatters relating to public health and Budgetappropriations, standards;regarding such plan.

(3)Such Providereport theshall optioninclude toany individualslegislative ofrecommendations selectingnecessary one or more ethnic orracialdesignationsandincludean"other"designationwiththeability to writeimplement insuch identitiesplan. not represented by other codes;

(4) Collect primary language data employing language codes set by the International Organization for Standardization;

and (5) Ensure, in cases where data concerning an individual's ethnic origin, ethnicity or race is reported to any other state agency, board or commission, that such data is neither tabulated nor reported without all LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-0013 of 31 R03-SB.docx } Substitute Bill No.

1 of the following information:

(A) The number or percentage of individuals who identify with each ethnic or racial designation as their sole ethnic or racial designation and not in combination with any other ethnic or racial designation;

(B) the number or percentage of individuals whoidentifywitheachethnicorracialdesignation,whetherastheirsole ethnic or racial designation or in combination with other ethnic or racial designations;

and (C) the number or percentage of individuals who identify with multiple ethnic or racial designations.

Section(Effective 19a-127kfrom ofpassage) the(a) generalAs statutesused is repealed and the following is substituted in lieuthis thereofsection: (Effective from passage):

(a)(1) As"Peer usedsupport inservices" thismeans section:all nonmedical mental health care services and substance use services provided by peer support specialists;

(1)and "Community(2) benefits"Peer program"support specialist" means anyan [voluntary]individual programproviding topeer promotesupport preventiveservices care, to reduceanother racialindividual ethnic, linguistic, sexual orientation and gender identity, and cultural disparities in health and to improve the healthstate. status for [working families and] all populations [at risk in the communities] within the geographic service areas of [a managed care organization or] a hospital in accordance with guidelines established pursuant to subsection (c) of this section;

[(2)(b)Thereisestablished "Managedataskforcetostudypeersupportservicesand careto organization"encourage has the same meaning as provided in section 38a-478;] (2) "Community building" means activity that protects or improves a community's health orcare safetyproviders and is eligible to beuse reportedsuch onpeer thesupport Internalservices Revenuewhen Serviceproviding formcare 990;to patients.

(3)Such "Communitystudy healthshall needsinclude, assessment"but meansneed anot writtenbe assessment,limited asto, describedan inexamination 26of CFRmethods 1.501(r)-(3)available conductedfor by a hospital that defines the communitydelivery itand serves,certification assesses the health needs of suchpeer community,support andservices solicits and takespayment intomechanisms accountfor personssuch thatservices. represent the broad interests of the community;

[(3)]Public (4)Act "Hospital"No. has the same meaning as provided in section 19a- 490;

and21-35 LCO22 {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-0014 of 3128 R03-SB.docx } Substitute Senate Bill No.

1 (5)(c) "ImplementationThe strategy"task meansforce ashall writtenconsist plan required by 26 CFR 1.501(r)-(3) that addresses community health needs identified through a community health needs assessment that (A) describes the actions a hospital intends to take to address the health needs and impacts of such actions, (B) identifies resources that the hospitalfollowing plansmembers: to commit to address such needs, and (C) describes the planned collaborationbetweenthehospital andother facilitiesandorganizations to address such health needs.

(b)(1) OnTwo orappointed beforeby January 1, [2005] 2022, and [biennially] annually thereafter, [each managed care organization and] each hospital shall submit to the [Healthcarespeaker Advocate, or the Healthcare Advocate's] Health Systems Planning Unit of the OfficeHouse of HealthRepresentatives, Strategy,one or to a designee selected by the executive director of thewhom Officehas ofpersonal Healthexperience Strategy,with apsychiatric report on [whether the managed care organization or hospitalsubstance hasuse indisorders; place a] such hospital's community benefits program.

[If(2) aTwo managedappointed careby organizationthe orpresident hospitalpro electstempore toof developthe aSenate, communityone benefitsof program,whom the]has Thepersonal reportexperience requiredwith bypsychiatric thisor subsectionsubstance shalluse complydisorders; withthereporting requirementsofsubsection(d) ofthis section.

(c)(3) [AOne managedappointed careby organization or] Each hospital [may] shall develop community benefit guidelines intended to promote preventive care, reduce racial, ethnic, linguistic, sexual orientation and gender identity, and cultural disparities in health and [to] improve the healthmajority statusleader for [working families and] all populations [at risk] within the geographic service areas of such hospital, whether or not those individuals are [enrollees of the managedHouse care plan or] patients of theRepresentatives; hospital.

The(4) guidelinesOne shallappointed focusby on the followingmajority principles:leader of the Senate;

(1)(5) AdoptionOne andappointed publicationby ofthe aminority communityleader benefitsof policythe statementHouse settingof forthRepresentatives, [thewho organization'shas or]personal suchexperience hospital'swith commitmentpsychiatric toor asubstance formaluse communitydisorders; benefits program;

(2)(6) TheOne responsibilityappointed forby overseeing the developmentminority andleader implementation of the communitySenate, benefitswho program,has thepersonal resourcesexperience towith bepsychiatric allocatedor andsubstance theuse administrativedisorders; mechanisms for the regular evaluation LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-0015 of 31 R03-SB.docx } Substitute Bill No.

1(7) The Commissioner of Mental Health and Addiction Services, or the program;commissioner's designee;

(3) Seeking assistance and meaningful(8) participationTwo frompersons theappointed communitiesby within [the organization's or] such hospital's geographic service areas in developing and implementing the communityGovernor, benefitsone programof andwhom ahas planpersonal forexperience meaningfulwith communitypsychiatric benefitor andsubstance communityuse buildingdisorders. investments, and in defining the targeted populations and the specific health care needs [it] such hospital should address.

In(d) doingAny so,member the governing body or management of [thethe organizationtask or]force suchappointed hospitalunder shallsubdivision give(1), priority(2), to(3), (A)(4), the(5) publicor health(6) needs outlined in the most recent version of thesubsection state(c) health plan prepared by the Department of Publicthis Health pursuant to section 19a-7,may andbe (B)a suchmember hospital'sof triennialthe communityGeneral healthAssembly. needs assessment and implementation strategy;

and(e) (4)All Developinginitial itsappointments [program]to implementation strategy based upon an assessment of (A) the healthtask careforce needsshall andbe resourcesmade of the targeted populations, particularly a broad spectrum of age, racial and ethnic groups, low and middle-income [,] populations and medically underserved populations, and (B) barriers to accessing health care, including, but not limitedlater to,thanthirty cultural,daysafter linguistictheeffective anddate physicalofthis barrierssection.Any tovacancy accessibleshall healthbe care,filled lackby of information on available sources of health care coverage and services, and the benefitsappointing ofauthority. preventive health care.

[ThePublic programAct shallNo. consider the health care needs of a broad spectrum of age groups and health conditions] Each hospital shall solicit commentary on its implementation strategy from the communities within such hospital's geographic service area and consider revisions to such strategy based on such commentary.

(d)21-35 Each23 [managed care organization and each] hospital [that chooses to participate in developing a community benefits program] shall include in the [biennial] annual report required by subsection (b) of this28 sectionSubstitute [theSenate statusBill ofNo. the program, if any, that the organization or hospital established.

If1 (f) The speaker of the managedHouse careof organizationRepresentatives orand hospitalthe haspresident chosenpro totempore participateof inthe aSenate communityshall benefitsselect program,the chairpersons of the reporttask shallforce include]from among the followingmembers components:of the task force.

(1)Such Thechairpersons communityshall benefitsschedule policythefirst LCOmeeting {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-0016ofthe oftask 31force, R03-SB.docxwhichshall }beheld Substitutenot Billlater No.thansixty days after the effective date of this section.

1(g) statementThe administrative staff of [thethe managedjoint carestanding organizationcommittee or]of suchthe hospital;General Assembly having cognizance of matters relating to public health shall serve as administrative staff of the task force.

(2)(h) Not later than January 1, 2022, the [mechanism]task processforce byshall whichsubmit communitya inputreport on its findings and participationrecommendations isto solicitedthe andjoint incorporatedstanding committee of the General Assembly having cognizance of matters relating to public health, in accordance with the communityprovisions benefitsof program;section 11-4a of the general statutes.

(3)The identificationtask offorce communityshall healthterminate needson thatthe weredate [considered]that prioritizedit insubmits developingsuch [andreport implementing]or theJanuary [community1, benefits2022, program]whichever implementationis strategy;later.

(4) a narrative description of the community benefits, community services, and preventive health education provided or proposed, which may include measurements related to the number of people served and health status outcomes;

(5) outcome measures [taken] used to evaluate the [results] impact of the community benefits program and proposed revisions to the program;

(6) to the extent feasible, a community benefits budget and a good faith effort to measure expenditures and administrative costs associated with the community benefits program, including both cash and in-kind commitments;

[and] (7) a summary of the extent to which [the managed care organization or] such hospital has developed and met the guidelines listed in subsection (c) of this section;

[.

Each managed care organization and each hospital] (8) for the prior taxable year, the demographics of the population within the geographic service area of such hospital;

(9) the cost and description of each investment included in the "Financial Assistance and Certain Other Community Benefits at Cost" and the "Community Building Activities" sections of such hospital's Internal Revenue Service form 990;(10) an explanation ofhow each investment described in subdivision (9) of this subsection addresses the needs identified in the hospital's triennial community health needs assessment and implementation strategy;

and (11) a description of available evidence that shows how each investment described in subdivision (9) of this subsection improves community health outcomes.

The Office of Health Strategy shall [make a copy of] post the annual report [available, upon request, to any member of the public] required by subsection (b) of this section on its Internet web site.

(e) (1) Not later than January 1, 2023, and biennially thereafter, the Office of Health Strategy, or a designee selected by the executive director of the Office of Health Strategy, shall establish a minimum LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-0017 of 31 R03-SB.docx } Substitute Bill No.

1 community benefit and community building spending threshold that hospitalsshallmeetorexceedduringthebiennium.Suchthresholdshall be based on objective data and criteria, including, but not limited to, the following:

(A) Historical and current expenditures on community benefits by the hospital;

(B) the community needs identified in the hospital's triennial community health needs assessment;

(C) the overall financial position of the hospital based on audited financial statements and other objective data;

and (D) taxes and payments in lieu of taxes paid by the hospital.

(2) The Office of Health Strategy shall consult with hospital representatives, solicit and consider comments from the public and consult with one or more individuals with expertise in health care economics when establishing a community benefit and community building spending threshold.

(3) The community benefit and community building spending threshold established pursuant to this subsection shall include the minimum proportion of community benefit spending that shall be directed to addressing health disparities and social determinants of health identified in the community health needs assessment during the next biennium.

[(e)] (f) The [Healthcare Advocate, or the Healthcare Advocate's] Office of Health Strategy, or a designee selected by the executive director of the Office of Health Strategy, shall, within available appropriations, develop a summary and analysis of the community benefits program reports submitted by [managed care organizations and] hospitals under this section and shall review such reports for adherence to theguidelines set forth in subsection (c) of this section.Not later than October 1, [2005] 2022, and [biennially] annually thereafter, the [Healthcare Advocate, or the Healthcare Advocate's] Office of Health Strategy, or a designee selected by the executive director of the Office of Health Strategy, shall [make such summary and analysis available to the public upon request] post such summary and analysis on its Internet web site.

LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-0018 of 31 R03-SB.docx } Substitute Bill No.

1 [(f)] (g) The [Healthcare Advocate] executive director of the Office of Health Strategy, or the executive director's designee, may, after notice and opportunity for a hearing, in accordance with chapter 54, impose a civil penalty on any [managed care organization or] hospital that fails to submit the report required pursuant to this section by the date specified in subsection (b) of this section.

Such penalty shall be not more than fifty dollars a day for each day after the required submittal date that such report is not submitted.

(NEW) (Effective from passage) The CommissionerDepartment of PublicMental Health,Health in consultation with the Commissioner of Children and Families,Addiction Services shall conductdevelop a study to identify areas of the state where access to quality and affordable mental and behavioral health caretoolkit services for children is limited due to variousbarriers,help including,employers butin notthe limitedstate to,address geographicemployee and transportation barriers, mental health professionalneeds shortagesthat andarise lackas a result of insurance.COVID-19.

NotSuch latertoolkit thanshall January(1) 1,identify 2022,common themental Commissionerhealth ofissues Publicthat Healthemployees shallexperience submitas a report,result inof accordanceCOVID-19, with(2) theidentify provisionssymptoms of sectionsuch 11-4amental ofhealth theissues, generaland statutes,(3) toprovide theinformation jointand standingother committeeresources ofregarding theactions GeneralAssemblythat havingemployers cognizancemay oftake mattersrelating to publichelpemployeesaddresssuch healthmentalhealthissues.Not regardinglater than October 1, 2021, the findingsDepartment of Mental Health and Addiction Services shall post such study.mental health toolkit on its Internet web site.

As used in this section, "COVID-19" means the respiratory disease designated by the World Health Organization on February 11, 2020, as coronavirus 2019, and any related mutation thereof recognized by said organization as a communicable respiratory disease.

(NEW)Section (Effective19a-200 fromof passage)the Sectionsgeneral 21statutes tois 32,repealed inclusive,and ofthe thisfollowing actis maysubstituted bein citedlieu asthereof the(Effective UniformJuly Emergency1, Volunteer2021): Health Practitioners Act.

Public Act No.

21-35 24 of 28 Substitute Senate Bill No.

1 (a) The mayor of each city, the chief executive officer of each town and the warden of each borough shall, unless the charter of such city, town or borough otherwise provides, nominate some person to be director of health for such city, town or borough.

[, which] Such person shall possess the qualifications specified in subsection (b) of this section.

Upon approval of the Commissioner of Public Health, such nomination shall be confirmed or rejected by the board of selectmen, if there be such a board, otherwise by the legislative body of such city or town or by the burgesses of such borough within thirty days thereafter.

(b) Notwithstanding the charter provisions of any city, town or borough with respect to the qualifications of the director of health, on and after October 1, 2010, any person nominated to be a director of healthshall(1)bealicensedphysicianandholdadegreeinpublichealth from an accredited school, college, university or institution, or (2) hold a graduate degree in public health from an accredited institution of higher education.

The educational requirements of this section shall not apply to any director of health nominated or otherwise appointed as director of health prior to October 1, 2010.

(c) In cities, towns or boroughs with a population of forty thousand or more for five consecutive years, according to the estimated population figures authorized pursuant to subsection (b) of section 8-159a, such director of health shall serve in a full-time capacity, except where a town has designated such director as the chief medical advisor for its public schools under section 10-205.

[, and] (d) No director shall, [not,] during such director's term of office, have any financial interest in or engage in any employment, transaction or professional activity that is in substantial conflict with the proper discharge of the duties required of directors of health by the general statutes or the regulations of Connecticut state agencies or specified by the appointing authority of the city, town or borough in its written agreement with such director.

A written agreement with such director Public Act No.

21-35 25 of 28 Substitute Senate Bill No.

1 shall be submitted to the Commissioner of Public Health by such appointing authority upon such director's appointment or reappointment.

(e) Such director of health shall have and exercise within the limits of the city, town or borough for which such director is appointed all powers necessary for enforcing the general statutes, provisions of the regulations of Connecticut state agencies relating to the preservation and improvement of the public health and preventing the spread of diseases therein.

(f) In case of the absence or inability to act of a city, town or borough director of health or if a vacancy exists in the office of such director, the appointing authority of such city, town or borough may, with the approval of the Commissioner of Public Health, designate in writing a suitable person to serve as acting director of health during the period of such absence or inability or vacancy and such person's start date.

[, provided the] The commissioner may appoint such acting director if the city, town or borough fails to do so.

The person so designated, when sworn, shall have all the powers and be subject to all the duties of such director.

(g) In case of vacancy in the office of such director, if such vacancy exists for [thirty] sixty days, said commissioner may appoint a director of health for such city, town or borough.

The person so designated, when sworn, shall (1) be considered an employee of the city, town or borough, and (2) have all the powers and be subject to all the duties of such director.

(h) In case of the absence or inability to act of a city, town or borough director of health during a public health emergency declared pursuant to section 19a-131a, the appointing authority of such city, town or borough shall, with the approval of the Commissioner of Public Health, designate in writing a suitable person to serve as acting director of Public Act No.

21-35 26 of 28 Substitute Senate Bill No.

1 health during the period of such absence or inability or vacancy and suchperson'sstartdate.Ifthecity,townorboroughfailstoappointsuch acting director of health, or fails to notify the commissioner of such appointment within thirty days, the commissioner shall appoint an acting director who meets the qualifications specified in subsection (b) of this section.

The person designated as acting director of health pursuant to this subsection, when sworn, shall (1) be considered an employee of the city, town or borough, and (2) have all the powers and be subject to all the duties of such director.

(i) Said commissioner, may, for cause, remove an officer the commissioner or any predecessor in said office has appointed, and the common council of such city, town or the burgesses of such borough may, respectively, for cause, remove a director whose nomination has been confirmed by them, provided such removal shall be approved by said commissioner;

and, within two days thereafter, notice in writing of such action shall be given by the clerk of such city, town or borough, as the case may be, to said commissioner, who shall, within ten days after receipt, file with the clerk from whom the notice was received, approval or disapproval.

(j) Each such director of health shall hold office for the term of four years from the date of appointment and until a successor is nominated and confirmed in accordance with this section.

(k) Each director of health shall, annually, at the end of the fiscal year, [of the city, town or borough, file with the Department of Public Health a report of the doings as such director for the year preceding] submit a report to the Department of Public Health detailing the activities of such director during the preceding fiscal year.

[(b)] (l) On and after July 1, 1988, each city, town and borough shall provide for the services of a sanitarian licensed under chapter 395 to work under the direction of the local director of health.

Where practical, Public Act No.

21-35 27 of 28 Substitute Senate Bill No.

1 the local director of health may act as the sanitarian.

[(c)] (m) As used in this chapter, "authorized agent" means a sanitarian licensed under chapter 395 and any individual certified for a specific program of environmental health by the Commissioner of Public Health in accordance with the general statutes and regulations of Connecticut state agencies.

(NEW) (Effective from passage) AsFor usedthe infiscal thisyear sectionending andJune sections30, 222022, tothe 32,Department inclusive, of thisPublic act:Health shall, within available appropriations, implement the state loan repayment program for community-based health care providers in primary care settings.

(1)Approved "DisasterJune relief14, organization"2021 meansPublic anAct entityNo. that provides emergency or disaster relief services that include health or veterinary services provided by volunteer health practitioners and that:

(A)21-35 Is28 designated or recognized as a provider of those28 services pursuant to a disaster response andrecoveryplanadoptedby anagency of the federal government or the Department of Public Health;

or (B) Regularly plans and conducts its activities in coordination with LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-000019 of 31 R03-SB.docx } Substitute Bill No.

1 an agency of the federal government or the Department of Public Health.

(2) "Emergency" means an event or condition that is a public health emergency under section 19a-131a of the general statutes.

(3)"Emergencydeclaration"meansadeclarationofemergencyissued by a person authorized to do so under the laws of this state.

(4) "Emergency Management Assistance Compact" means the interstate compact approved by Congress by Public Law No.

104- 321,110 Stat.

3877.

(5) "Entity" means a person other than an individual.

(6) "Health facility" means an entity licensed under the laws of this or another state to provide health or veterinary services.

(7) "Health practitioner" means an individual licensed under the laws of this or another state to provide health or veterinary services.

(8) "Health services" means the provision of treatment, care, advice or guidance, or other services or supplies, related to the health or death of individuals or human populations, to the extent necessary to respond to an emergency, including:

(A) The following, concerning the physical or mental condition or functional status of an individual or affecting the structure or function of the body:

(i) Preventive, diagnostic, therapeutic, rehabilitative, maintenance or palliative care;

and (ii) Counseling, assessment, procedures or other services;

(B) Sale or dispensing of a drug, a device, equipment or another item to an individual in accordance with a prescription;

and LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-0020 of 31 R03-SB.docx } Substitute Bill No.

1 (C) Funeral, cremation, cemetery or other mortuary services.

(9) "Host entity" means an entity operating in this state which uses volunteer health practitioners to respond to an emergency.

(10) "License" means authorization by a state to engage in health or veterinary services that are unlawful without the authorization.

"License" includes authorization under the laws of this state to an individual to provide health or veterinary services based upon a national certification issued by a public or private entity.

(11) "Person" means an individual, corporation, business trust, trust, partnership, limited liability company, association, joint venture, public corporation, government or governmental subdivision, agency or instrumentality or any other legal or commercial entity.

(12) "Scope of practice" means the extent of the authorization to provide health or veterinary services granted to a health practitioner by a license issued to thepractitioner inthestate inwhichtheprincipal part of the practitioner's services are rendered, including any conditions imposed by the licensing authority.

(13) "State" means a state of the United States, the District of Columbia, Puerto Rico, the United States Virgin Islands or any territory or insular possession subject to the jurisdiction of the United States.

(14) "Veterinary services" means the provision of treatment, care, advice or guidance or other services, or supplies, related to the health or death of an animal or to animal populations, to the extent necessary to respond to an emergency, including:

(A) Diagnosis, treatment or prevention of an animal disease, injury or other physical or mental condition by the prescription, administration or dispensing of vaccine, medicine, surgery or therapy;

(B) Use of a procedure for reproductive management;

and LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-0000121 of 31 R03-SB.docx } Substitute Bill No.

1 (C) Monitoring and treatment of animal populations for diseases that have spread or demonstrate the potential to spread to humans.

(15) "Volunteer health practitioner" means a health practitioner who provides health or veterinary services, whether or not the practitioner receives compensation for those services.

"Volunteer health practitioner" does not include a practitioner who receives compensation pursuant to a preexisting employment relationship with a host entity or affiliate which requires the practitioner to provide health services in this state, unless the practitioner is not a resident of this state and is employed by a disaster relief organization providing services in this state while an emergency declaration is in effect.

Sec.

22.

(NEW) (Effective from passage) Sections 21 to 32, inclusive, of this act apply to volunteer health practitioners registered with a registration system that complies with section 24 of this act and who provide health or veterinary services in this state for a host entity while an emergency declaration is in effect.

Sec.

23.

(NEW) (Effective from passage) (a) While an emergency declaration is in effect, the Department of Public Health may limit, restrict or otherwise regulate:

(1) The duration of practice by volunteer health practitioners;

(2) The geographical areas in which volunteer health practitioners may practice;

(3) The types of volunteer health practitioners who may practice;

and (4) Any other matters necessary to coordinate effectively the provision of health or veterinary services during the emergency.

(b)Anorderissuedpursuanttosubsection(a)ofthissectionmaytake effect immediately, without prior notice or comment, and is not a rule within the meaning of chapter 54 of the general statutes.

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1 (c) A host entity that uses volunteer health practitioners to provide health or veterinary services in this state shall:

(1) Consult and coordinate its activities with the Department of Public Health to the extent practicable to provide for the efficient and effective use of volunteer health practitioners;

and (2) Comply with any laws other than sections 21 to 32, inclusive, of this act relating to the management of emergency health or veterinary services.

Sec.

24.

(NEW) (Effective from passage) (a) To qualify as a volunteer health practitioner registration system, a system shall:

(1) Accept applications for the registration of volunteer health practitioners before or during an emergency;

(2) Include information about the licensure and good standing of health practitioners which is accessible by authorized persons;

(3) Be capable of confirming the accuracy of information concerning whether a health practitioner is licensed and in good standing before health services or veterinary services are provided under sections 21 to 32, inclusive, of this act;

and (4) Meet one of the following conditions:

(A) Be an emergency system for advance registration of volunteer health care practitioners established by a state and funded through the Department of Health and Human Services under Section 319I of the Public Health Services Act, 42 USC 247d-7b, as amended from time to time;

(B) Be a local unit consisting of trained and equipped emergency response, public health and medical personnel formed pursuant to Section 2801 of the Public Health Services Act, 42 USC 300hh, as amended from time to time;

LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00023 of 31 R03-SB.docx } Substitute Bill No.

1 (C) Be operated by a:

(i) Disaster relief organization;

(ii) Licensing board;

(iii) National or regional association of licensing boards or health practitioners;

(iv) Health facility that provides comprehensive inpatient and outpatient health care services, including a tertiary care and teaching hospital;

or (v) Governmental entity;

or (D) Be designated by the Department of Public Health as a registration system for purposes of sections 21 to 32, inclusive, of this act.

(b) While an emergency declaration is in effect, the Department of Public Health, a person authorized to act on behalf of the Department of Public Health, or a host entity, may confirm whether volunteer health practitioners utilized in this state are registered with a registration system that complies with subsection (a) of this section.

Confirmation is limited to obtaining identities of the practitioners from the system and determining whether the system indicates that the practitioners are licensed and in good standing.

(c) Upon request of a person in this state authorized under subsection (b) of this section, or a similarly authorized person in another state, a registration system located in this state shall notify the person of the identitiesofvolunteerhealthpractitionersandwhetherthepractitioners are licensed and in good standing.

(d) A host entity is not required to use the services of a volunteer health practitioner even if the practitioner is registered with a registration system that indicates that the practitioner is licensed and in LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-000024 of 31 R03-SB.docx } Substitute Bill No.

1 good standing.

Sec.

25.

(NEW) (Effective from passage) (a) While an emergency declaration is in effect, a volunteer health practitioner, registered with a registration system that complies with section 24 of this act and licensed and in good standing in the state upon which the practitioner's registration is based, may practice in this state to the extent authorized by sections 21 to 32, inclusive, of this act as if the practitioner were licensed in this state.

(b) A volunteer health practitioner qualified under subsection (a) of this section is not entitled to the protections of sections 21 to 32, inclusive, of this act if the practitioner is licensed in more than one state and any license of the practitioner is suspended, revoked or subject to an agency order limiting or restricting practice privileges or has been voluntarily terminated under threat of sanction.

Sec.

26.

(NEW) (Effective from passage) (a) As used in this section:

(1) "Credentialing" means obtaining, verifying and assessing the qualifications of a health practitioner to provide treatment, care or services in or for a health facility;

and (2) "privileging" means the authorizing by an appropriate authority, such as a governing body, of a health practitioner to provide specific treatment, care or services at a health facility subject to limits based on factors that include license, education, training, experience, competence, health status and specialized skill.

(b) Sections 21 to 32, inclusive, of this act do not affect credentialing or privileging standards of a health facility and do not preclude a health facility from waiving or modifying those standards while an emergency declaration is in effect.

Sec.

27.

(NEW) (Effective from passage) (a) Subject to subsections (b) and (c) of this section, a volunteer health practitioner shall adhere to the scope of practice for a similarly licensed practitioner established by the licensing provisions, practice acts or other laws of this state.

LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-000025 of 31 R03-SB.docx } Substitute Bill No.

1 (b) Except as otherwise provided in subsection (c) of this section, sections21to32,inclusive,ofthisactdonotauthorizeavolunteerhealth practitioner to provide services that are outside the practitioner's scope of practice, even if a similarly licensed practitioner in this state would be permitted to provide the services.

(c)The Department ofPublicHealthmay modify orrestrictthehealth or veterinary services that volunteer health practitioners may provide pursuant to sections 21 to 32, inclusive, of this act.

An order under this subsection may take effect immediately, without prior notice or comment, and is not a rule within the meaning of chapter 54 of the general statutes.

(d) A host entity may restrict the health or veterinary services that a volunteer health practitioner may provide pursuant to sections 21 to 32, inclusive, of this act.

(e) A volunteer health practitioner does not engage in unauthorized practice unless the practitioner has reason to know of any limitation, modification or restriction under this section or that a similarly licensed practitioner in this state would not be permitted to provide the services.

A volunteer health practitioner has reason to know of a limitation, modificationor restrictionor that asimilarly licensedpractitioner inthis state would not be permitted to provide a service if:

(1) The practitioner knows the limitation, modification or restriction exists or that a similarly licensed practitioner in this state would not be permitted to provide the service;

or (2) From all the facts and circumstances known to the practitioner at the relevant time, a reasonable person would conclude that the limitation, modification or restriction exists or that a similarly licensed practitioner in this state would not be permitted to provide the service.

(f) In addition to the authority granted by law of this state other than sections 21 to 32, inclusive, of this act to regulate the conduct of health practitioners, a licensing board or other disciplinary authority in this LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-0026 of 31 R03-SB.docx } Substitute Bill No.

1 state:

(1) May impose administrative sanctions upon a health practitioner licensed in this state for conduct outside of this state in response to an out-of-state emergency;

(2) May impose administrative sanctions upon a practitioner not licensed in this state for conduct in this state in response to an in-state emergency;

and (3) Shall report any administrative sanctions imposed upon a practitioner licensed in another state to the appropriate licensing board or other disciplinary authority in any other state in which the practitioner is known to be licensed.

(g) In determining whether to impose administrative sanctions under subsection (f) of this section, a licensing board or other disciplinary authority shall consider the circumstances in which the conduct took place, including any exigent circumstances, and the practitioner's scope of practice, education, training, experience and specialized skill.

Sec.

28.

(NEW) (Effective from passage) (a) Sections 21 to 32, inclusive, of this act do not limit rights, privileges or immunities provided to volunteer health practitioners by laws other than sections 21 to 32, inclusive, of this act.

Except as otherwise provided in subsection (b) of this section, sections 21 to 32, inclusive, of this act do not affect requirements for the use of health practitioners pursuant to the Emergency Management Assistance Compact.

(b) The Department of Public Health, pursuant to the Emergency Management Assistance Compact, may incorporate into the emergency forces of this state volunteer health practitioners who are not officers or employees of this state, a political subdivision of this state or a municipality or other local government within this state.