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Substitute House Bill No. 5023

PUBLIC ACT NO. 96-19

AN ACT REVISING THE GENERAL STATUTES TO REFLECT THE AUTHORITY OF ADVANCED PRACTICE REGISTERED NURSES AND PHYSICIAN ASSISTANTS.

Be it enacted by the Senate and House of Representatives in General Assembly convened:

Section 1. Subsection (b) of section 19a-87b of the general statutes, as amended by sections 12 and 21 of public act 95-257, is repealed and the following is substituted in lieu thereof:

(b) The Commissioner of Public Health shall adopt regulations, in accordance with the provisions of chapter 54, to assure that family day care homes, as defined in section 19a-77, AS AMENDED shall meet the health, educational, and social needs of children utilizing such homes. Such regulations shall ensure that the family day care home is treated as a residence, and not an institutional facility. Such regulations shall specify that each child be protected as age-appropriate by adequate immunization against diphtheria, pertussis, tetanus, poliomyelitis, measles, mumps, rubella, hemophilus influenzae type B and any other vaccine required by the schedule of active immunization adopted pursuant to section 19a-7f AS AMENDED. Such regulations shall provide appropriate exemptions for children for whom such immunization is medically contraindicated and for children whose parents object to such immunization on religious grounds. Such regulations shall also specify conditions under which family day care home providers may administer medicinal preparations, including controlled drugs specified in the regulations by the commissioner, to a child receiving day care services at a family day care home pursuant to a written order of a physician licensed to practice medicine in this or another state [4m, [0m AN ADVANCED PRACTICE REGISTERED NURSE LICENSED TO PRESCRIBE IN ACCORDANCE WITH SECTION 20-94a, AS AMENDED, OR A PHYSICIAN ASSISTANT LICENSED TO PRESCRIBE IN ACCORDANCE WITH SECTION 20-12d, AS AMENDED and the written authorization of a parent or guardian of such child. Such regulations shall specify appropriate standards for extended care and intermittent short-term overnight care.

Sec. 2. Section 20-14i of the general statutes is repealed and the following is substituted in lieu thereof:

Any provisions to the contrary notwithstanding, chapter 378 shall not prohibit the administration of medication to persons attending day programs, or residing in residential facilities, under the jurisdiction of the Departments of Children and Families, Correction, Mental Retardation and Mental Health, or being detained in juvenile detention centers, when such medication is administered by trained persons pursuant to the written order of a physician [,] licensed under this chapter, [or] a dentist [,] licensed under chapter 379, AN ADVANCED PRACTICE REGISTERED NURSE LICENSED TO PRESCRIBE IN ACCORDANCE WITH SECTION 20-94a, AS AMENDED, OR A PHYSICIAN ASSISTANT LICENSED TO PRESCRIBE IN ACCORDANCE WITH SECTION 20-12d, AS AMENDED authorized to prescribe such medication. The provisions of this section shall not apply to institutions, facilities or programs licensed pursuant to chapter 368v.

Sec. 3. Subsection (b) of section 21a-256 of the general statutes is repealed and the following is substituted in lieu thereof:

(b) When a pharmacist sells or dispenses any controlled substance on prescription issued by a physician, ADVANCED PRACTICE REGISTERED NURSE, PHYSICIAN ASSISTANT podiatrist, osteopath, dentist or veterinarian, he shall affix, to the container in which such substance is sold or dispensed, a label showing the name and address of the pharmacy for which he is lawfully acting, the full name of the patient, or, if the patient is an animal, the name of the owner of the animal and the species of the animal, the last name of the physician, ADVANCED PRACTICE REGISTERED NURSE, PHYSICIAN ASSISTANT osteopath, podiatrist, dentist or veterinarian by whom the prescription was written, such directions as may be stated on the prescription, the serial number of the prescription, the date of filling or refilling and any cautionary statement in such prescription as may be required by law.

Sec. 4. Section 30-36 of the general statutes, as amended by section 40 of public act 95-195, is repealed and the following is substituted in lieu thereof:

A druggist permit may be issued by the Department of Consumer Protection to a drug store proprietor. No druggist permit shall be issued covering a new drug store or a new location for an old drug store until the Commission of Pharmacy is satisfied that a drug store at such location is necessary to the convenience and best interest of the public. A druggist permit (1) shall allow the use of alcoholic liquors for the compounding of [physicians' and dentists'] prescriptions OF PHYSICIANS, ADVANCED PRACTICE REGISTERED NURSES, PHYSICIAN ASSISTANTS AND DENTISTS and for the manufacturing of all United States Pharmacopoeia and National Formulary preparations and all other medicinal preparations, (2) shall allow the retail sale of alcoholic liquor in containers of not less than eight ounces or one hundred eighty-seven and one-half milliliters and not more than one quart or one liter capacity except that beer may be sold in containers of not more than forty ounces or twelve hundred milliliters capacity, to any person, and (3) shall forbid the drinking of such alcoholic liquor on the premises of any drug store. Such permittee shall keep all alcoholic liquors in compartments, which compartments shall be securely locked except during those hours when the sale of alcoholic liquor is permitted by law. The holder of a druggist permit shall not display any alcoholic liquors or containers, marked or labeled or in any other way suggesting the contents of intoxicating liquors, in the windows of the permit premises. The Commission of Pharmacy shall revoke or suspend the pharmacy license of any pharmacist upon whose premises any violation of any provision of this section occurs. The annual fee for a druggist permit shall be four hundred dollars plus the sum required by section 30-66 AS AMENDED.

Sec. 5. Section 30-37 of the general statutes, as amended by section 41 of public act 95-195, is repealed and the following is substituted in lieu thereof:

Any pharmacy licensed by the Commission of Pharmacy may fill the prescription of a licensed physician ADVANCED PRACTICE REGISTERED NURSE, PHYSICIAN ASSISTANT or dentist for alcoholic liquors at any time without regard to the vote of any town prohibiting the sale of such liquors and may use alcoholic liquors for the compounding of [physicians' and dentists'] SUCH prescriptions and for the manufacture of all United States Pharmacopoeia and National Formulary preparations and all other medicinal preparations without the necessity of obtaining a permit from the Department of Consumer Protection, provided each such prescription shall include the name and address of the person for whom it is prescribed and shall be signed with his full name by the [physician or dentist] PERSON issuing such prescription. Each such prescription shall be filled only once, and the person making a sale on such prescription shall write on the face thereof the number of such prescription and the date of the sale or delivery of such liquor and shall keep such prescription on file and available at all reasonable times for inspection. All alcoholic liquors sold by licensed pharmacies on prescriptions alone shall be kept in compartments, which compartments shall be securely locked except when such liquors are being used in the compounding of [physicians' or dentists'] THE prescriptions.

Sec. 6. Subsection (d) of section 38a-493 of the general statutes is repealed and the following is substituted in lieu thereof:

(d) Home health care shall consist of, but shall not be limited to, the following: (1) Part-time or intermittent nursing care by a registered nurse or by a licensed practical nurse under the supervision of a registered nurse, if the services of a registered nurse are not available; (2) part-time or intermittent home health aide services, consisting primarily of patient care of a medical or therapeutic nature by other than a registered or licensed practical nurse; (3) physical, occupational or speech therapy; (4) medical supplies, drugs and medicines prescribed by a physician [4m, [0m ADVANCED PRACTICE REGISTERED NURSE OR PHYSICIAN ASSISTANT and laboratory services to the extent such charges would have been covered under the policy or contract if the covered person had remained or had been confined in the hospital; (5) medical social services, as hereinafter defined, provided to or for the benefit of a covered person diagnosed by a physician as terminally ill with a prognosis of six months or less to live. Medical social services are defined to mean services rendered, under the direction of a physician by a qualified social worker holding a master's degree from an accredited school of social work, including but not limited to (A) assessment of the social, psychological and family problems related to or arising out of such covered person's illness and treatment; (B) appropriate action and utilization of community resources to assist in resolving such problems; (C) participation in the development of the overall plan of treatment for such covered person.

Sec. 7. Subsection (d) of section 38a-520 of the general statutes is repealed and the following is substituted in lieu thereof:

(d) Home health care shall consist of, but shall not be limited to, the following: (1) Part-time or intermittent nursing care by a registered nurse or by a licensed practical nurse under the supervision of a registered nurse, if the services of a registered nurse are not available; (2) part-time or intermittent home health aide services, consisting primarily of patient care of a medical or therapeutic nature by other than a registered or licensed practical nurse; (3) physical, occupational or speech therapy; (4) medical supplies, drugs and medicines prescribed by a physician [4m, [0m AN ADVANCED PRACTICE REGISTERED NURSE OR A PHYSICIAN ASSISTANT and laboratory services to the extent such charges would have been covered under the policy or contract if the covered person had remained or had been confined in the hospital; (5) medical social services, as hereinafter defined, provided to or for the benefit of a covered person diagnosed by a physician as terminally ill with a prognosis of six months or less to live. Medical social services are defined to mean services rendered, under the direction of a physician by a qualified social worker holding a master's degree from an accredited school of social work, including but not limited to (A) assessment of the social, psychological and family problems related to or arising out of such covered person's illness and treatment; (B) appropriate action and utilization of community resources to assist in resolving such problems; (C) participation in the development of the overall plan of treatment for such covered person.

Sec. 8. Subsection (a) of section 38a-553 of the general statutes, as amended by section 39 of public act 95-257, is repealed and the following is substituted in lieu thereof:

(a) Except as provided in subsections (b) and (c), minimum standard benefits shall be benefits, including coverage for catastrophic illness, with a lifetime maximum of one million dollars per individual, for reasonable charges or, when applicable, the allowance agreed upon between a provider and a carrier for charges actually incurred, for the following health care services, rendered to an individual covered by such plan for the diagnosis or treatment of nonoccupational disease or injury: (1) Hospital services; (2) professional services which are rendered by a physician or, at his direction, by a registered nurse, other than services for mental or dental conditions; (3) the diagnosis or treatment of mental conditions, in accordance with the minimum requirements established in section 38a-514 AS AMENDED; (4) legend drugs requiring a [physician's] prescription OF A PHYSICIAN, ADVANCED PRACTICE REGISTERED NURSE OR PHYSICIAN ASSISTANT; (5) services of a skilled nursing facility for not more than one hundred twenty days in a calendar year, provided such services commence within fourteen days following a confinement of at least three consecutive days in a hospital for the same condition; (6) home health agency services, as defined by the commissioner, up to a maximum of one hundred eighty visits in a calendar year, provided such services commence within seven days following confinement in a hospital or skilled nursing facility of at least three consecutive days for the same condition, provided further, in the case of an individual diagnosed by a physician as terminally ill with a prognosis of six months or less to live, such home health agency services may commence irrespective of whether such covered person was so confined or, if such covered person was so confined, irrespective of such seven-day period, and the yearly benefit for medical social services, as hereinafter defined, shall not exceed two hundred dollars. "Medical social services" means services rendered, under the direction of a physician by a qualified social worker holding a master's degree from an accredited school of social work, including but not limited to (A) assessment of the social, psychological and family problems related to or arising out of such covered person's illness and treatment; (B) appropriate action and utilization of community resources to assist in resolving such problems; (C) participation in the development of treatment for such covered person; (7) use of radium or other radioactive materials; (8) outpatient chemotherapy for the removal of tumors and treatment of leukemia, including outpatient chemotherapy; (9) oxygen; (10) anesthetics; (11) nondental prosthesis and maxillo-facial prosthesis used to replace any anatomic structure lost during treatment for head and neck tumors or additional appliances essential for the support of such prosthesis; (12) rental of durable medical equipment which has no personal use in the absence of the condition for which prescribed; (13) diagnostic x-rays and laboratory tests as defined by the commissioner; (14) oral surgery for: (A) Excision of partially or completely unerupted impacted teeth, or (B) excision of a tooth root without the extraction of the entire tooth; (15) services of a licensed physical therapist, rendered under the direction of a physician; (16) transportation by a local professional ambulance to the nearest health care institution qualified to treat the illness or injury; (17) certain other services which are medically necessary in the treatment or diagnosis of an illness or injury as may be designated or approved by the Insurance Commissioner; (18) confinement in a facility established primarily for the treatment of alcoholism and licensed for such care by the state, or in a part of a hospital used primarily for such treatment, shall be a covered expense for a period of at least forty-five days within any calendar year.

Sec. 9. Section 46b-26 of the general statutes, as amended by sections 12 and 21 of public act 95-257, is repealed and the following is substituted in lieu thereof:

(a) No license may be issued by any registrar until there has been filed with him, for each applicant a statement signed by a physician licensed to practice medicine or osteopathy in any state or territory of the United States, the District of Columbia, or any province of Canada, AN ADVANCED PRACTICE REGISTERED NURSE LICENSED PURSUANT TO CHAPTER 378, A NURSE-MIDWIFE LICENSED PURSUANT TO CHAPTER 377 OR A PHYSICIAN ASSISTANT LICENSE PURSUANT TO CHAPTER [4m370, [0m or by a commissioned medical officer in the armed forces or the Public Health Service of the United States, that the applicant has submitted to a standard laboratory blood test, that, if the test was positive, the person has submitted to a physical examination of the skin and appropriate mucous membranes, and that, in the opinion of such physician, ADVANCED PRACTICE REGISTERED NURSE, NURSE-MIDWIFE OR PHYSICIAN ASSISTANT [4m, [0m the person is not infected with syphilis or in a stage of that disease that is communicable.

(b) Except as provided in this section, the statement of any such physician or medical officer shall be accompanied by a statement by the person in charge of an approved laboratory or his representative giving the name of the standard laboratory blood test made, and the exact name of the applicant but not the results of the test. A standard laboratory blood test shall be a laboratory test for syphilis approved by the Department of Public Health and shall be performed by said department on request of a licensed physician or at a laboratory approved by it. No license may be issued if the date of the blood test for either applicant is more than thirty-five days before the date of application.

(c) Nothing in this section shall prohibit any registrar from accepting a statement executed on a form officially used for the same purpose in any other state or territory of the United States or in any province of Canada, provided the other state, territory or province requires a premarital blood test, and the date of that test, or the date of the physician's statement when the date of the test is not a part of the official blood test form of such other state, territory or province, is not more than thirty-five days before the date of application for the license.

(d) With the approval of the administrative head of the municipality and the Public Records Administrator, as provided in section 7-109, the statements filed with the registrar in compliance with the provisions of this section may be destroyed one year after the date of filing.

(e) In addition to the standard laboratory test required in subsection (a), a female applicant who is less than fifty years of age and is capable of pregnancy shall also provide a statement upon a form provided by the Department of Public Health, signed by a physician licensed to practice medicine or osteopathy in any state or territory of the United States, the District of Columbia, or any province of Canada, AN ADVANCED PRACTICE REGISTERED NURSE LICENSED PURSUANT TO CHAPTER 378, A NURSE-MIDWIFE LICENSED PURSUANT TO CHAPTER 377 OR A PHYSICIAN ASSISTANT LICENSE PURSUANT TO CHAPTER [4m370, [0m or by a commissioned medical officer in the armed forces or the Public Health Service of the United States, that such applicant has submitted to a test for rubella immunity. Such test shall be a standard laboratory test for rubella immunity approved by the Department of Public Health. The results of the test shall be disclosed in writing to the applicant by such physician [4m, [0m ADVANCED PRACTICE REGISTERED NURSE, NURSE-MIDWIFE OR PHYSICIAN ASSISTANT. Nothing in this subsection shall prohibit any registrar from accepting a statement executed on a form officially used for such purpose in any other state provided the other state, territory or province requires a test for rubella immunity. Nothing in this subsection shall be construed to require an applicant to receive immunization from rubella prior to the issuance of a license but shall be construed as requiring that the applicant be informed as to whether or not such applicant is immune to rubella and the consequences of such lack of immunity with respect to pregnancy.

Approved April 29, 1996. Effective October 1, 1996.

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