The 2024 legislative session of the Connecticut General Assembly produced a number of new statutory provisions impacting the operations of hospitals, physician groups and other health care providers. To alert the health care industry of the changes ahead, we’ve highlighted below some of the more noteworthy pieces of legislation that take effect on October 1, 2024.
Workplace Violence Prevention Standards (PA 24-19, §5)
Hospitals, chronic disease hospitals, nursing homes, behavioral health facilities, multicare institutions and psychiatric residential treatment facilities that receive reimbursement for services rendered under the Connecticut medical assistance program (CMAP) must adopt and implement workplace violence prevention standards that are consistent with the workplace violence prevention standards of the Joint Commission (or any applicable certification or accreditation agency). The Connecticut Department of Social Services (DSS) may require these institutions to provide evidence of adoption and implementation of these standards to obtain reimbursement for services provided under CMAP.
New Poster Requirement for Health Care Providers (PA 24-5, §3)
Health care providers must display, in a clear and conspicuous manner, a new poster informing patients and caregivers about the Connecticut Paid Family and Medical Leave Act. The Paid Family and Medical Leave Insurance Authority is responsible for making the poster available.
“Health care provider” includes (but is not limited to) a licensed physician, podiatrist, dentist, psychologist, optometrist, chiropractor, advanced practice registered nurse, nurse practitioner, nurse midwife or clinical social worker. It also includes Christian Science practitioners listed with the First Church of Christ, Scientist in Boston, as well as any health care provider from whom an employer or a group health plan's benefits manager will accept certification of the existence of a serious health condition to substantiate a claim for benefits under the Connecticut Paid Family and Medical Leave Act.
Sedation by Dentists (PA 24-68, §8)
The law governing the permit that dentists must obtain for the use of anesthesia has been amended to allow a dentist holding a permit to administer moderate sedation or general anesthesia at an additional facility if the additional facility has had an approved on-site evaluation conducted in consultation with the Connecticut Society of Oral and Maxillo-Facial Surgeons without cost to the state. The Department of Public Health (DPH) may waive the on-site evaluation under certain circumstances.
Additionally, DPH, in consultation with the Anesthesia Committee of the Connecticut Society of Oral and Maxillo-Facial Surgeons, must post a list of office equipment, personnel and emergency medications that are required to be maintained at a facility that administers moderate sedation, deep sedation or general anesthesia on the DPH web site and distribute the list to each permitted dentist in the state. These dentists must maintain the equipment, personnel and emergency medications on the list at each facility.
Fluoroscopy Added to Scope of Practice for APRNs (PA 24-68, §42)
Beginning October 1, 2024, advanced practice registered nurses (APRNs) may engage in the use of fluoroscopy for guidance of diagnostic and therapeutic procedures in “collaboration” with a physician who is trained in radiation protection. The new law provides that “collaboration” requires more than the “collaboration” between a physician and an APRN under other circumstances, as it also requires the continuous availability of in-person communication between the APRN and the physician.
In order to engage in the use of fluoroscopy, the APRN must meet the requirements that physician assistants are currently subject to, including 40 hours of didactic instruction and supervised clinical experience, as well as a passing grade on the DPH-prescribed exam. Further, an APRN engaging in the use of fluoroscopy during a procedure must wear a radiation safety badge that monitors his/her exposure to radiation and displays the level of exposure.
Podiatrists (PA 24-112, §1)
The scope of practice for podiatrists is amended to expand the definition of “surgical treatment of the ankle” to include Chopart joint-level amputation (that is, removal of forefoot and midfoot).
State Labor Relations Act (PA 24-19, §17)
Under current law, private-sector institutions licensed by DPH are subject to the state Labor Relations Act for most of their employees except for physicians and physician assistants. The law is revised to remove the exception for these practitioners, allowing them to unionize under state law.
Toxicology Screenings following Nonfatal Opioid Overdose (PA 24-120)
For the period beginning January 1, 2025, until August 31, 2028, a new law requires hospitals that treat patients for a nonfatal overdose of an opioid drug to administer, with the patient's consent, a toxicology screening of the patient, if medically appropriate. The screening must include, but need not be limited to, screening for opiates, opioids, benzodiazepines, cannabinoids, methadone, cocaine, gabapentin, xylazine and any other substance DPH deems appropriate. A hospital that administers a toxicology screening is required to report the screening results to DPH.
On or before January 1, 2026, and annually thereafter, until January 1, 2029, DPH must report to the Public Health Committee of the General Assembly regarding these toxicology screening results, including the identification and analysis of any trends identified; the identification of any benefits experienced by patients as a result of the toxicology screening results; and a recommendation regarding whether toxicology screening reporting should continue after August 31, 2028.
Pharmacists Dispensing Opioid Drugs (PA 24-19, §14)
Pharmacists who dispense an opioid drug to a patient (not in a facility or health care setting) may provide to the patient, at the time of dispensing the drug, information concerning a “personal opioid drug deactivation and disposal system” and the web site address for the Connecticut Department of Mental Health and Addiction Services (DMHAS) containing information regarding these disposal systems. A "personal opioid drug deactivation and disposal system" is a product that is designed for personal use and enables a patient to deactivate and destroy an opioid drug permanently.
Pharmacy Technicians, Advanced Pharmacy Technicians and Pharmacy Clerks (PA 24-73, various sections)
Section 6 of Public Act 24-73 amends the law governing pharmacy technicians, allowing an individual enrolled in an accredited pharmacy technician education program to engage in the duties of a pharmacy technician under certain circumstances, as part of the curriculum of such program.
Public Act 24-73 also provides for two new pharmacy occupational categories and establishes the qualifications and duties of each:
- Advanced pharmacy technicians are actively registered and qualified pharmacy technicians who meet the standards set forth in the new law, including but not limited to, an educational course and competency assessment. Pharmacists must supervise advanced pharmacy technicians and may delegate certain duties to them, including but not limited to: (1) “final verification” (a new defined term describing the last review that is conducted to complete the dispensing process) under certain circumstances; and (2) dispensing and re-dispensing of compatible drugs in “compliance packaging.” (See below regarding compliance packaging.) (Sections 1, 2, 4, 7, 9 and 10).
- The new law provides that a pharmacy or institutional pharmacy that employs an advanced pharmacy technician must use bar code technology, or another technology approved by the Department of Consumer Protection (DCP), to assist in dispensing drugs and confirm accuracy in dispensing. (Section 2).
- The new law generally requires a pharmacist to supervise not more than one advanced pharmacy technician, and not more than three pharmacy technicians (not including advanced pharmacy technicians). (Section 2).
- Pharmacy clerks work under the direct supervision of a pharmacist. The law specifies that any person who physically works in an area of a pharmacy or institutional pharmacy where controlled substances or other legend drugs are dispensed by pharmacists (or others under their supervision) must register with DCP as a clerk, except for an individual who is already registered with, or licensed by, DCP. Pharmacy clerks may, among other things: (1) handle dispensed drugs and deliver such drugs to patients; (2) collect patient demographic information; (3) collect a prescription number for the purposes of a refill; and (4) conduct inventory management. The new law also specifies what pharmacy clerks may not do. For example, they may not review a drug to determine whether it is an appropriate treatment; verify the accuracy of prescription data; or perform any task that requires any professional pharmaceutical judgment. (Sections 3 and 7).
Compliance Packaging (PA 24-73, §§1 and 4)
A new law authorizes pharmacists and advanced pharmacy technicians to dispense “compatible drugs” to patients in “compliance packaging,” at the patient’s or prescribing practitioner’s request.
- “Compatible drugs” are multiple drugs that are not adversely impacted, whether chemically or physically, in constitution or quality by one another.
- “Compliance packaging” generally means packaging prepared at a pharmacy that separates drugs into individual compartments or containers according to their directions for use and when they are to be taken. Compliance packaging is generally limited to a 90-day supply.
The new law addresses the types of drugs that may be placed in the same individual compartment of compliance packing, and when drugs dispensed in compliance packaging may be returned and re-dispensed. A pharmacy that provides compliance packaging must maintain an area dedicated to compliance packaging that meets the new law’s standards and must comply with specific recordkeeping requirements.
Pharmacists and Vaccines (PA 24-73, §9)
Effective October 1, 2024, pharmacists may order and prescribe the following vaccines:
- Vaccines listed on the National Centers for Disease Control and Prevention's (CDC’s) age-appropriate immunization schedule for individuals 18 and over; individuals 12-17 with parental/guardian consent; and emancipated minors (and, under certain circumstances, a pharmacist may delegate the administration of these vaccines to an advanced pharmacy technician under the direct supervision of the pharmacist); and
- Vaccines that are not listed on the CDC’s Adult Immunization Schedule to any patient who is 18 or older, provided the vaccine administration instructions are available on the CDC’s web site.
Disciplinary Action Against Pharmacists and Other Pharmacy Professionals (PA 24-73, §5)
Connecticut General Statutes §20-579 lists the offenses for which the Commission of Pharmacy may take disciplinary action against pharmacists, pharmacy operators, pharmacy interns and pharmacy technicians. Public Act 24-73 adds another offense for which disciplinary action may be taken, namely, the acceptance, for return to general inventory or regular stock, of any drug sold or delivered to a patient, unless accepting such drug is otherwise permitted or required by law.
Parking Placards and Certification of Disability by Health Care Professionals (PA 24-20, §§43-44)
The law governing applications for removable windshield parking placards by individuals with disabilities has been amended to provide that the required certification of disability issued by a health care professional must be based upon the professional’s opinion after having completed a medically reasonable assessment of the applicant's medical history and current medical condition made in the course of a bona fide health care professional-patient relationship. “Health care professional” is defined in the amended law as a licensed physician, licensed physician assistant, licensed APRN, psychiatrist who is employed by, or under contract with, the United States Department of Veterans Affairs, ophthalmologist or optometrist.
These health care professionals may not charge a fee for the provision of services to an applicant for the placard that is contingent on the health care professional’s certifying that the applicant meets the definition of “persons with disabilities which limit or impair the ability to walk,” as defined in 23 CFR 1235.2. The new law authorizes civil penalties for violations of this provision.
Home Care Registry (PA 24-39, §§1-4)
On and after January 1, 2025, the Commissioner of Social Services, in consultation with the Commissioners of Public Health and Consumer Protection, is charged with developing and maintaining a home care provider registry and data processing system that will promote awareness of, and access to, qualified home care providers for persons who receive Medicaid-covered home and community-based services, and may support recruitment and retention of qualified home care providers and support oversight of home care providers. The DSS web site must contain a link to the registry, as well as a link to the Medicare online reporting tool that allows the public to compare nursing homes by quality of care. A home care provider need not provide information about himself or herself for inclusion on the registry under certain circumstances (e.g., if the provider is a victim of domestic violence or sexual assault, or is protected by a protective order).
ID Badges Required for Home Health Care Agencies, Home Health Aide Agencies, Hospice Agencies and Homemaker-Companion Agencies (PA 24-39, §§7-9)
Home health care agencies, home health aide agencies and hospice agencies must require their employees to wear an identification badge that includes the employee's name and photograph during each appointment with a client. DPH may impose disciplinary action against an agency that fails to comply with this requirement. Homemaker-companion agencies are subject to a similar requirement beginning July 1, 2025.
Peer-Run Respite Center (PA 24-19, §36)
DMHAS is required to establish, within available appropriations, a peer-run respite center to be operated by a “peer-run organization” with which DMHAS contracts.
A “peer-run organization” is nonprofit organization that: (1) is controlled and operated by persons who have psychiatric histories or have experienced other life-interrupting challenges; and (2) provides a place for support and advocacy for persons who experience similar challenges, including, but not limited to, peer respite services and peer support services.
Not later than October 1, 2025, DMHAS must report to the Public Health Committee of the General Assembly regarding the peer-run respite center and post the report on the DMHAS web site. The report must, among other things, identify any barriers to implementing the peer-run respite center; include recommendations for addressing these barriers; and share data regarding the outcomes and effectiveness of the peer-run respite center.
Discrimination against Nursing Home Applicants (PA 24-19, §§38-39)
A new law prohibits nursing homes from discriminating against an applicant solely on the basis that the applicant has, at any time, received mental health services. Applicants may file a complaint with the Connecticut Commission on Human Rights and Opportunities for violations. The law also provides that a nursing home is not required to admit a person if the person poses a direct threat to the health or safety of others or does not require the level of care provided in a nursing home, or if admitting the person as a resident would result in converting the nursing home into an institution for mental diseases (as defined in 42 CFR 435.1010).
Assisted Living Services Agency Fees (PA 24-141, §9)
An assisted living services agency must disclose fee increases to a resident or a resident's representative not later than 60 days prior to such fees taking effect, and provide, upon request, to a resident and a resident's representative the history of fee increases over the past three calendar years. However, this new provision is not to be construed to limit an assisted living services agency from immediately adjusting fees to the extent these adjustments are directly related to a change in the level of care or services necessary to meet individual resident safety needs at the time of a scheduled resident care meeting or if a resident's change of condition requires a change in services.
Managed Residential Communities (PA 24-39, §19)
A new law requires managed residential communities to provide not less than 30 days' notice to its residents and residents' legal representatives before: (1) the operator of the managed residential community changes from one business entity to another; or (2) the assisted living services agency providing services at the managed residential community changes from one agency to another.
[View source.]
