HB 7157, An Act Concerning Various Revisions To The Public Health Statutes

TESTIMONY OF THE CONNECTICUT HOSPITAL ASSOCIATION
SUBMITTED TO THE PUBLIC HEALTH COMMITTEE

Monday, March 10, 2025

The Connecticut Hospital Association (CHA) appreciates this opportunity to submit testimony concerning HB 7157, An Act Concerning Various Revisions To The Public Health Statutes. CHA opposes various sections of the bill, as discussed below, and respectfully requests the addition of certain statutory changes.

HB 7157 contains multiple proposed changes to public health laws.

Unfair Trade Practice (Section 4)

Section 4 of the bill seeks to make it an unfair trade practice for any healthcare provider to require a patient to provide bank information, credit or debit card numbers, or other forms of electronic payment on file as a prerequisite to seeing the patient for an office visit or providing health services.

This language implies that a provider is not allowed to collect payment source information in advance. It also implies providers might not be able to collect payment for their services in many cases. It also risks making it difficult for patients who would like their information kept on file for future use to be accommodated.

In order to avoid codifying those as unintended inferences, the bill should be revised to include a clear statement as follows:

Nothing in this section shall be interpreted to (1) affect a patient’s obligation to pay for healthcare services or (2) prohibit a provider from requesting, collecting or storing bank, credit or debit card, or other payment-related information if the patient agrees.

Psychologist Medical Information “Evidence” Law (Sections 5-17 and 19)

Sections 5-17 and 19 seek to delete the psychologist medical information “evidence” law (Section 52-146c), and make corresponding changes in Chapter 899, to integrate the elements of the psychologist-specific law into the similar but not identical psychiatrist laws.

CHA opposes these changes because they fail to address long overdue problems with Connecticut’s scattered and outmoded series of laws that affect evidence, medical records, health information exchange, privacy, security, and other issues.

The bulk of Connecticut’s medical information and related laws were designed for an all-paper world that was pre-HIPAA, pre-electronic health records, and pre-interoperability. Confusingly, many statutes that affect the disclosure of medical records are in the courts and evidence statutes. They do not belong there. They belong in public health laws. The current outdated design causes unlimited problems in the field.

CHA urges the committee to reject these piecemeal changes in Sections 5-17 and 19 that were not subject to review across the care continuum. Instead, CHA recommends the committee create a viable, expert-laden working group that could provide a comprehensive, transparent, and rational set of recommendations to the legislature so that there can be a comprehensive, informed, and meaningful update to Connecticut’s medical information law.

Civil Penalty (Section 18)

Section 18 of the bill seeks to raise the maximum civil penalty from $10,000 to $25,000 on professionals who are governed by a board or commission established under chapters 369-376, 495, 378-381, and 383-388, as well as those under direct Department of Public Health (DPH) oversight. CHA opposes that change.

We continue to seek solutions-based legislation and regulation that are designed to improve healthcare. There is no evidence that a punitive, penalties-based approach to healthcare regulation improves healthcare.

We urge the committee to reject Section 18 of the bill.

CHA Requests

CHA requests that the committee make the following additions to the bill:

1. Current statute sets the relevant period for a health care employer’s collection of information about workplace violence on a calendar basis, with the last day of data capture for the period on December 31. The reporting deadline is the very next day, a state holiday (January 1). To avoid unnecessary burden and ensure accurate and timely reporting, we request that the reporting deadline be extended by a month.

The solution to this issue would be accomplished by the following recommended language change to Section 19a-490r of the General Statutes:

Sec. 19a-490r. Health care employer: Records and report re incidents of workplace violence. A health care employer shall maintain records which detail incidents of workplace violence and include the specific area or department of the employer’s premises where the incident occurred. A health care employer shall report not later than February [January] 1 of each year [2016, and annually thereafter], to the Department of Public Health the number of workplace violence incidents occurring on the employer’s premises during the preceding calendar year and the specific area or department where such incidents occurred.

2. Current law (Section 19a-903b) outlines which professionals are permitted to perform specific oxygen-related activities in a hospital setting, but a portion of the statutory language is unclear, causing confusion for imaging procedures that risk unnecessary delays in patient care. We seek a legislative change to clarify that MRI technologists and other radiologic support staff are permitted to perform these activities, the statute should be revised as follows: 

Sec. 19a-903b. Hospital designation of health care providers and technologists to perform oxygen-related patient care activities. Training. Competency testing. Exception. A hospital, as defined in section 19a-490b, may designate any licensed health care provider and any certified ultrasound, [or] nuclear medicine, magnetic resonance imaging, radiologic, or polysomnographic technologist to perform the following oxygen-related patient care activities in a hospital: (1) Connecting or disconnecting oxygen supply; (2) transporting a portable oxygen source; (3) connecting, disconnecting or adjusting the mask, tubes and other patient oxygen delivery apparatus; and (4) adjusting the rate or flow of oxygen consistent with a medical order. Such provider or technologist may perform such activities only to the extent permitted by hospital policies and procedures, including bylaws, rules and regulations applicable to the medical staff. A hospital shall document that each person designated to perform oxygen-related patient care activities has been properly trained, either through such person’s professional education or through training provided by the hospital. In addition, a hospital shall require that such person satisfy annual competency testing. Nothing in this section shall be construed to prohibit a hospital from designating persons who are authorized to transport a patient with a portable oxygen source. The provisions of this section shall not apply to any type of ventilator, continuous positive airway pressure or bi-level positive airway pressure units or any other noninvasive positive pressure ventilation.

3. CHA is seeking a modification to the reporting date relating to nurse staffing plans so that the reporting date does not fall on a state holiday and to eliminate confusion around the timing of the reports with other requirements. That change would be accomplished by revising subsection (n) of Section 19a-89e, as follows:

19a-89e (n) [Not later than October 1, 2024, and biannually thereafter, a] A hospital shall report biannually to the Department of Public Health, in a form and manner prescribed by the Commissioner of Public Health, whether it has been in compliance, for the previous six months, with at least eighty per cent of the nurse staffing assignments as required by any component outlined in the nurse staffing plan developed pursuant to subsections (d) and (e) of this section. Such reports shall be due on or before January 15 for the most recent six-month period ending January 1, and July 15 for the most recent six-month period ending July 1.

4. Section 17a-20 of the General Statutes gives the Department of Children and Families (DCF) the ability to license certain psychiatric clinic and child guidance services, while providing a mechanism for DCF to fund and place grants supporting those services. Recently, that statute has been misinterpreted to divest hospitals from being able to provide outpatient hospital services for minors, drastically limiting access to these vital services for children and adolescents. Although a hospital should be permitted to provide services through a DCF licensed pathway (and qualify for available DCF funding or grants), a hospital should not be required to obtain a second, unnecessary license to provide services already a part of, or integrated with, services permitted through licensure from the Department of Public Health.

CHA is seeking legislative clarification by adding a new subsection (d) to Section 17a-20, as set forth below:

Sec. 17a-20. (Formerly Sec. 17-424). Definition of psychiatric clinic and child guidance clinic. Grant of funds. (a) For the purposes of this section, “psychiatric clinic” means an organization licensed by the Department of Children and Families and staffed by psychiatrists, psychologists, social workers and such other professional, paraprofessional and clerical personnel as local circumstances may require, working in collaboration with other social service agencies, to provide mental health services that are designed to (1) effectively decrease the prevalence and incidence of mental illness, emotional disturbance and social disfunctioning, and (2) promote mental health in individuals, groups and institutions, and may include [includes] a general hospital with such clinic services. The Department of Children and Families shall develop and maintain a program of outpatient psychiatric clinics for children and youths and their families.
(b) For the purposes of this section, “child guidance clinic” means a subset of psychiatric clinics for children designated by the Department of Children and Families pursuant to this section to receive grant funds for the purpose of assisting the department to provide community-based psychiatric services for children, youths and families. In order to meet such mandate, the department shall designate a subset of outpatient psychiatric clinics for children to be known as child guidance clinics. The department shall provide grants to such child guidance clinics in accordance with the provisions of this section. Any town having a population of not less than forty thousand, as most recently determined by the Secretary of the Office of Policy and Management, or any combination of towns with a combined population of not less than forty thousand as similarly determined, or any nonprofit corporation organized or existing for the purpose of establishing or maintaining a psychiatric clinic for children and youths or for children and youths and their families, or any clinic designated by the Department of Children and Families [as of January 1, 1995], may apply to the Department of Children and Families for funds to be used to assist in establishing, maintaining or expanding a psychiatric clinic. The applications, and any grant of funds pursuant thereto, shall not be subject to the provisions of section 17a-476, except to the extent required by federal law. The department shall base any grant of funds on the services provided to children and youths under eighteen years of age and on the effectiveness of the services. No grant shall exceed two-thirds of the ordinary recurring operating expenses of the clinic, nor shall any grant be made to pay for any portion of capital expenditures for the clinic. [No clinic in existence as of October 1, 1995, shall be eligible for grants of any funds under this section unless it has obtained a license within six months of the adoption of regulations under subsection (c) of this section.] No clinic receiving funds under this section shall refuse services to any resident of this state solely because of his or her place of residence.
(c) The Department of Children and Families shall adopt regulations, in accordance with the provisions of chapter 54, defining the minimum requirements for outpatient psychiatric clinics for children to be eligible for licensure under this section in regard to (1) qualification and number of staff members, (2) clinic operation including but not limited to physical plant, governing body and recordkeeping, (3) effectiveness of services, and (4) populations targeted for priority access. The regulations shall also govern the granting of the funds to assist in establishing, maintaining and expanding psychiatric clinics. The department shall, upon payment of a fee of three hundred dollars, issue to any qualifying clinic a license that shall be in force for twenty-four months from the date of issue and shall be renewable for additional twenty-four-month periods, upon payment of a fee of three hundred dollars for each such period, provided the clinic continues to meet conditions satisfactory to the department. The department shall make available to child guidance clinics forms to be used in making application for available funds. Upon receipt of proper application, the department shall grant the funds, provided the plans for financing, the standards of operation and the effectiveness of services of the clinics are approved by the department in accordance with the provisions of this section. The grants shall be made on an annual basis.

NEW (d) The provisions of this section shall not require a hospital licensed by the Department of Public Health to obtain licensure from the Department of Children and Families to provide inpatient or outpatient mental health services to patients of any age.

We look forward to working with the committee on these matters.

Thank you for your consideration of our position. For additional information, contact CHA Government Relations at (203) 294-7301.