AN ACT IMPLEMENTING THE RURAL HEALTH TRANSFORMATION PROGRAM TO EXPAND HEALTH CARE ACCESS.

Senate
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General Assembly File No. 44
February Session, 2026 Substitute Senate Bill No. 93

Senate, March 17, 2026

The Committee on Public Health reported through SEN.
ANWAR of the 3rd Dist., Chairperson of the Committee on the
part of the Senate, that the substitute bill ought to pass.

AN ACT IMPLEMENTING THE RURAL HEALTH TRANSFORMATION
PROGRAM TO EXPAND HEALTH CARE ACCESS.
Be it enacted by the Senate and House of Representatives in General
Assembly convened:

Section 1. Section 20-102aa of the general statutes is repealed and the 1
following is substituted in lieu thereof (Effective October 1, 2027): 2
As used in subsection (c) of section 19a -14 and sections 20 -102aa to 3
20-102ff, inclusive, as amended by this act: 4
(1) "Commissioner" means the Commissioner of Public Health; 5
(2) ["nurse's aide"] "Nurse's aide" means [an individual providing] a 6
registered nurse's aide who provides nursing or nursing -related 7
services [to residents in a chronic and convalescent nursing home or rest 8
home with nursing supervision ] pursuant to such nurse's aide's 9
employment or contract with an institution, as defined in section 19a -10
490, but does not include an individual who is a health professional 11
otherwise licensed or certified by the Department of Public Health, or 12
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who volunteers to provide such services without monetary 13
compensation; 14
(3) ["registration"] "Registration" means a document issued by the 15
Department of Public Health to a nurse's aide which certifies that such 16
aide has satisfied the training and competency evaluation requirements 17
prescribed by the commissioner ; [and has been found qualified for 18
employment in a chronic and convalescent nursing home or rest home 19
with nursing supervision;] and 20
(4) ["registered nurse's aide" ] "Registered nurse's aide" means an 21
individual who has been issued a registration as defined in this section. 22
Sec. 2. Subsection (a) of section 20 -102cc of the general statutes is 23
repealed and the following is substituted in lieu thereof (Effective October 24
1, 2027): 25
(a) The Department of Public Health shall receive, investigate and 26
prosecute complaints against individuals who are providing or have 27
provided services as a nurse's aide in [a chronic and convalescent 28
nursing home or rest home with nursing supervision ] an institution, as 29
defined in section 19a -490. The grounds for complaint shall include 30
[resident abuse, resident neglect, ] (1) illegal, incompetent or negligent 31
conduct in the provision of nursing or nursing -related services, (2) 32
abuse, as defined in 42 CFR 483.5, as amended from time to time, of a 33
resident, patient or client, (3) neglect, as defined in 42 CFR 483.5, as 34
amended from time to time, of a resident, patient or client, (4) 35
misappropriation of resident, patient or client property, and (5) fraud or 36
deceit in obtaining or attempting to obtain a registration as a nurse's 37
aide. A nurse's aide shall be given written notice by certified mail by the 38
commissioner of any complaint against him or her. The department may 39
summarily suspend a nurse's aide's ability to practice in advance of a 40
final adjudication on a complaint or during the appeals process in 41
accordance with subsection (c) of section 19a -17. A nurse's aide who 42
wishes to appeal a complaint against him or her shall, not later than 43
thirty days after the date of the mailing, file with the department a 44
request in writing for a hearing to contest the complaint. The 45
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commissioner shall render a finding on such complaint, and, if a hearing 46
is requested, it shall be conducted pursuant to chapter 54. The 47
commissioner shall have the authority to take any action against a 48
nurse's aide set forth in section 19a -17, as amended by this act, and to 49
render a finding and enter such finding on the registry against an 50
individual who is providing or has provided services as a nurse's aide , 51
[in a chronic and convalescent nursing home or rest home with nursing 52
supervision,] without regard to whether such individual is on the 53
registry or has obtained registration as a nurse's aide from the 54
department. 55
Sec. 3. Section 19a -17 of the 2026 supplement to the general statutes 56
is amended by adding subsection (i) as follows (Effective October 1, 2026): 57
(NEW) (i) Such board or commission or the department may take any 58
of the actions permitted under this section against a practitioner for 59
failure to fulfill any obligation resulting from the receipt of funds 60
provided by the department pursuant to the Rural Health 61
Transformation Program established pursuant to 42 USC 1397ee(h). 62
Sec. 4. Section 31 -57e of the 2026 supplement to the general statutes 63
is amended by adding subsection (f) as follows (Effective from passage): 64
(NEW) (f) The provisions of this section shall not apply to the 65
provision of funds to a tribe pursuant to the Rural Health 66
Transformation Program established pursuant to 42 USC 1397ee(h). 67
Sec. 5. Subsection (a) of section 20 -102ee of the general statutes is 68
repealed and the following is substituted in lieu thereof (Effective October 69
1, 2027): 70
(a) The Commissioner of Public Health shall adopt regulations, in 71
accordance with the provisions of chapter 54, concerning the regulation 72
of nurse's aides. Such regulations shall require a training program for 73
nurse's aides of not less than one hundred hours. Not less than seventy-74
five of such hours shall include, but not be limited to, basic nursing 75
skills, personal care skills, care of cognitively impaired [residents] 76
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patients, recognition of mental health and social service needs, basic 77
restorative services and [residents'] patients' rights. Not less than 78
twenty-five of such hours shall include, but not be limited to, specialized 79
training in understanding and responding to challenging behaviors 80
related to physical, psychiatric, psychosocial and cognitive disorders. 81
On and after January 1, 2022, not less than two of such hours shall 82
include (1) screening for post -traumatic stress disorder, risk of suicide, 83
depression and grief, and (2) suicide prevention training offered or 84
approved by the American Nurses Association, Connecticut Hospital 85
Association, Connecticut Nurses Association or Connecticut League for 86
Nursing, a specialty nursing society or equivalent organization in 87
another jurisdiction, a hospital or other health care institution, a 88
regionally accredited academic institution, or a state or local health 89
department. The requirement described in subdivision (2) of this section 90
may be satisfied by the completion of the evidence-based youth suicide 91
prevention training program administered pursuant to section 17a-52a. 92
Sec. 6. (NEW) ( Effective October 1, 2026 ) The Recognition of 93
Emergency Medical Services Personnel Licensure Interstate Compact 94
shall be enacted into law and entered into by the state of Connecticut 95
with any and all states legally joining therein in accordance with its 96
terms not earlier than one year after the date on which such compact is 97
enacted in at least one of the states of Massachusetts, New York or 98
Rhode Island. The compact is substantially as follows: 99
RECOGNITION OF EMERGENCY MEDICAL SERVICES 100
PERSONNEL LICENSURE INTERSTATE COMPACT 101
SECTION 1. PURPOSE 102
In order to protect the public through verification of competency and 103
ensure accountability for patient care related activities, all states license 104
emergency medical services (EMS) personnel, such as emergency 105
medical technicians (EMTs), advanced EMTs and paramedics. This 106
compact is intended to facilitate the day -to-day movement of EMS 107
personnel across state boundaries in the performance of their EMS 108
duties as assigned by an appropriate authority and authorize state EMS 109
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offices to afford immediate legal recognition to EMS personnel licensed 110
in a member state. 111
This compact recognizes that states have a vested interest in 112
protecting the public's health and safety through their licensing and 113
regulation of EMS personnel and that such state regulation shared 114
among the member states will best protect public health and safety. This 115
compact is designed to achieve the following purposes and objectives: 116
(1) Increase public access to EMS personnel; 117
(2) Enhance the states' ability to protect the public's health and safety, 118
especially patient safety; 119
(3) Encourage the cooperation of member states in the areas of EMS 120
personnel licensure and regulation; 121
(4) Support licensing of military members who are separating from 122
an active-duty tour and their spouses; 123
(5) Facilitate the exchange of information between member states 124
regarding EMS personnel licensure, adverse action and significant 125
investigatory information; 126
(6) Promote compliance with the laws governing EMS personnel 127
practice in each member state; and 128
(7) Invest all member states with the authority to hold EMS personnel 129
accountable through the mutual recognition of member state licenses. 130
SECTION 2. DEFINITIONS 131
As used in section 1, this section and sections 3 to 15, inclusive, of 132
the compact: 133
(1) "Advanced emergency medical technician" or "AEMT" means an 134
individual licensed with cognitive knowledge and a scope of practice 135
that corresponds to that level in the National EMS Education Standards 136
and National EMS Scope of Practice Model. 137
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(2) "Adverse action" means any administrative, civil, equitable or 138
criminal action permitted by a state's laws that may be imposed against 139
licensed EMS personnel by a state EMS authority or state court, 140
including, but not limited to, actions against an individual's license such 141
as revocation, suspension, probation, consent agreement, monitoring or 142
other limitation or encumbrance on the individual's practice, letters of 143
reprimand or admonition, fines, criminal convictions and state court 144
judgments enforcing adverse actions by the state EMS authority. 145
(3) "Alternative program" means a voluntary, nondisciplinary 146
substance abuse recovery program approved by a state EMS authority. 147
(4) "Certification" means the successful verification of entry -level 148
cognitive and psychomotor competency using a reliable, validated and 149
legally defensible examination. 150
(5) "Commission" means the national administrative body of which 151
all states that have enacted the compact are members. 152
(6) "Emergency medical technician" or "EMT" means an individual 153
licensed with cognitive knowledge and a scope of practice that 154
corresponds to that level in the National EMS Education Standards and 155
National EMS Scope of Practice Model. 156
(7) "Home state" means a member state where an individual is 157
licensed to practice emergency medical services. 158
(8) "License" means the authorization by a state for an individual to 159
practice as an EMT, AEMT or paramedic, or a level between EMT and 160
paramedic. 161
(9) "Medical director" means a physician licensed in a member state 162
who is accountable for the care delivered by EMS personnel. 163
(10) "Member state" means a state that has enacted this compact. 164
(11) "Privilege to practice" means an individual's authority to deliver 165
emergency medical services in remote states as authorized under this 166
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compact. 167
(12) "Paramedic" means an individual licensed with cognitive 168
knowledge and a scope of practice that corresponds to that level in the 169
National EMS Education Standards and National EMS Scope of Practice 170
Model. 171
(13) "Remote state" means a member state in which an individual is 172
not licensed. 173
(14) "Restricted" means the outcome of an adverse action that limits a 174
license or the privilege to practice. 175
(15) "Rule" means a written statement by the Interstate Commission 176
promulgated pursuant to section 12 of this compact that (A) is of general 177
applicability, (B) implements, interprets or prescribes a policy or 178
provision of the compact, or (C) is an organizational, procedural or 179
practice requirement of the Commission, and (D) has the force and effect 180
of statutory law in a member state and includes the amendment, repeal 181
or suspension of an existing rule. 182
(16) "Scope of practice" means defined parameters of various duties 183
or services that may be provided by an individual with specific 184
credentials. Whether regulated by rule, statute or court decision, it tends 185
to represent the limits of services an individual may perform. 186
(17) "Significant investigatory information" means: 187
(A) Investigative information that a state EMS authority, after a 188
preliminary inquiry that includes notification and an opportunity to 189
respond if required by state law, has reason to believe, if proved true, 190
would result in the imposition of an adverse action on a license or 191
privilege to practice; or 192
(B) Investigative information that indicates that the individual 193
represents an immediate threat to public health and safety regardless of 194
whether the individual has been notified and had an opportunity to 195
respond. 196
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(18) "State" means any state, commonwealth, district or territory of 197
the United States. 198
(19) "State EMS authority" means the board, office or other agency 199
with the legislative mandate to license EMS personnel. 200
SECTION 3. HOME STATE LICENSURE 201
(a) Any member state in which an individual holds a current license 202
shall be deemed a home state for purposes of this compact. 203
(b) Any member state may require an individual to obtain and retain 204
a license to be authorized to practice in the member state under 205
circumstances not authorized by the privilege to practice under the 206
terms of this compact. 207
(c) A home state's license authorizes an individual to practice in a 208
remote state under the privilege to practice only if the home state: 209
(1) Currently requires the use of the National Registry of Emergency 210
Medical Technicians (NREMT) examination as a condition of issuing 211
initial licenses at the EMT and paramedic levels; 212
(2) Has a mechanism in place for receiving and investigating 213
complaints about individuals; 214
(3) Notifies the Commission, in compliance with the terms herein, of 215
any adverse action or significant investigatory information regarding an 216
individual; 217
(4) Not later than five years after activation of the compact, requires 218
a criminal background check of all applicants for initial licensure, 219
including the use of the results of fingerprint or other biometric data 220
checks compliant with the requirements of the Federal Bureau of 221
Investigation with the exception of federal employees who have 222
suitability determination in accordance with US CFR 731.202 and 223
submit documentation of such as promulgated in the rules of the 224
Commission; and 225
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(5) Complies with the rules of the Commission. 226
SECTION 4. COMPACT PRIVILEGE TO PRACTICE 227
(a) Member states shall recognize the privilege to practice of an 228
individual licensed in another member state that is in conformance with 229
section 3 of this compact. 230
(b) To exercise the privilege to practice under the terms and 231
provisions of this compact, an individual shall: 232
(1) Be at least eighteen years of age; 233
(2) Possess a current unrestricted license in a member state as an 234
EMT, AEMT, paramedic or state -recognized and licensed level with a 235
scope of practice and authority between EMT and paramedic; and 236
(3) Practice under the supervision of a medical director. 237
(c) An individual providing patient care in a remote state under the 238
privilege to practice shall function within the scope of practice 239
authorized by the home state unless and until modified by an 240
appropriate authority in the remote state as may be defined in the rules 241
of the Commission. 242
(d) Except as provided in subsection (c) of this section, an individual 243
practicing in a remote state shall be subject to the remote state's 244
authority and laws. A remote state may, in accordance with due process 245
and that state's laws, restrict, suspend or revoke an individual's 246
privilege to practice in the remote state and may take any other 247
necessary actions to protect the health and safety of its citizens. If a 248
remote state takes action, it shall promptly notify the home state and the 249
Commission. 250
(e) If an individual's license in any home state is restricted or 251
suspended, the individual shall not be eligible to practice in a remote 252
state under the privilege to practice until the individual's home state 253
license is restored. 254
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(f) If an individual's privilege to practice in any remote state is 255
restricted, suspended or revoked, the individual shall not be eligible to 256
practice in any remote state until the individual's privilege to practice is 257
restored. 258
SECTION 5. CONDITIONS OF PRACTICE IN A REMOTE STATE 259
An individual may practice in a remote state under a privilege to 260
practice only in the performance of the individual's EMS duties as 261
assigned by an appropriate authority, as defined in the rules of the 262
Commission, and under the following circumstances: 263
(1) The individual originates a patient transport in a home state and 264
transports the patient to a remote state; 265
(2) The individual originates in the home state and enters a remote 266
state to pick up a patient and provide care and transport of the patient 267
to the home state; 268
(3) The individual enters a remote state to provide patient care or 269
transport within that remote state; 270
(4) The individual enters a remote state to pick up a patient and 271
provide care and transport to a third member state; or 272
(5) Other conditions as determined by rules promulgated by the 273
Commission. 274
SECTION 6. RELATIONSHIP TO EMERGENCY MANAGEMENT 275
ASSISTANCE COMPACT 276
Upon a member state's Governor's declaration of a state of emergency 277
or disaster that activates the Emergency Management Assistance 278
Compact (EMAC), all relevant terms and provisions of EMAC shall 279
apply and to the extent any terms or provisions of this compact conflict 280
with EMAC, the terms of EMAC shall prevail with respect to any 281
individual practicing in the remote state in response to such declaration. 282
SECTION 7. VETERANS, SERVICE MEMBERS SEPARATING 283
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FROM ACTIVE-DUTY MILITARY AND THEIR SPOUSES 284
(a) Member states shall consider a veteran, active military service 285
member and member of the National Guard and Reserve separating 286
from an active -duty tour, and a spouse thereof, who holds a current 287
valid and unrestricted NREMT certification at or above the level of the 288
state license being sought as satisfying the minimum training and 289
examination requirements for such licensure. 290
(b) Member states shall expedite the processing of licensure 291
applications submitted by veterans, active military service members 292
and members of the National Guard and Reserve separating from an 293
active-duty tour, and their spouses. 294
(c) All individuals functioning with a privilege to practice under this 295
section shall remain subject to the adverse actions provisions of section 296
8 of this compact. 297
SECTION 8. ADVERSE ACTIONS 298
(a) A home state shall have exclusive power to impose adverse action 299
against an individual's license issued by the home state. 300
(b) If an individual's license in any home state is restricted or 301
suspended, the individual shall not be eligible to practice in a remote 302
state under the privilege to practice until the individual's home state 303
license is restored. 304
(1) All home state adverse action orders shall include a statement that 305
the individual's compact privileges are inactive. The order may allow 306
the individual to practice in remote states with prior written 307
authorization from both the home state and the remote state's EMS 308
authority. 309
(2) An individual currently subject to adverse action in the home state 310
shall not practice in any remote state without prior written 311
authorization from both the home state and the remote state's EMS 312
authority. 313
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(c) A member state shall report adverse actions and any occurrences 314
that the individual's compact privileges are restricted, suspended or 315
revoked to the Commission in accordance with the rules of the 316
Commission. 317
(d) A remote state may take adverse action on an individual's 318
privilege to practice within that state. 319
(e) Any member state may take adverse action against an individual's 320
privilege to practice in that state based on the factual findings of another 321
member state, so long as each state follows its own procedures for 322
imposing such adverse action. 323
(f) A home state's EMS authority shall investigate and take 324
appropriate action with respect to reported conduct in a remote state as 325
it would if such conduct had occurred within the home state. In such 326
cases, the home state's law shall control in determining the appropriate 327
adverse action. 328
(g) Nothing in this compact shall override a member state's decision 329
that participation in an alternative program may be used in lieu of 330
adverse action and that such participation shall remain nonpublic if 331
required by the member state's laws. Member states shall require 332
individuals who enter any alternative programs to agree not to practice 333
in any other member state during the term of the alternative program 334
without prior authorization from such other member state. 335
SECTION 9. ADDITIONAL POWERS INVESTED IN A MEMBER 336
STATE'S EMS AUTHORITY 337
A member state's EMS authority, in addition to any other powers 338
granted under state law, is authorized under this compact to: 339
(1) Issue subpoenas for both hearings and investigations that require 340
the attendance and testimony of witnesses and the production of 341
evidence. Subpoenas issued by a member state's EMS authority for the 342
attendance and testimony of witnesses or the production of evidence 343
from another member state shall be enforced in the remote state by any 344
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court of competent jurisdiction according to that court's practice and 345
procedure in considering subpoenas issued in its own proceedings. The 346
issuing state's EMS authority shall pay any witness fees, travel expenses, 347
mileage and other fees required by the service statutes of the state where 348
the witnesses or evidence are located; and 349
(2) Issue cease and desist orders to restrict, suspend or revoke an 350
individual's privilege to practice in the state. 351
SECTION 10. ESTABLISHMENT OF THE INTERSTATE 352
COMMISSION FOR EMS PERSONNEL PRACTICE 353
(a) The compact states hereby create and establish a joint public 354
agency known as the Interstate Commission for EMS Personnel Practice. 355
(1) The Commission is a body politic and an instrumentality of the 356
compact states. 357
(2) Venue is proper and judicial proceedings by or against the 358
Commission shall be brought solely and exclusively in a court of 359
competent jurisdiction where the principal office of the Commission is 360
located. The Commission may waive venue and jurisdictional defenses 361
to the extent it adopts or consents to participate in alternative dispute 362
resolution proceedings. 363
(3) Nothing in this compact shall be construed to be a waiver of 364
sovereign immunity. 365
(b) Membership, voting and meetings 366
(1) Each member state shall have and be limited to one delegate. The 367
responsible official of the state EMS authority, or such official's 368
designee, shall be the delegate to this compact for each member state. 369
Any delegate may be removed or suspended from office as provided by 370
the law of the state from which the delegate is appointed. Any vacancy 371
occurring in the Commission shall be filled in accordance with the laws 372
of the member state in which the vacancy exists. In the event that more 373
than one board, office or other agency with the legislative mandate to 374
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license EMS personnel at and above the level of EMT exists, the 375
Governor of the state shall determine which entity will be responsible 376
for assigning the delegate. 377
(2) Each delegate shall be entitled to one vote with regard to the 378
promulgation of rules and creation of bylaws and shall otherwise have 379
an opportunity to participate in the business and affairs of the 380
Commission. A delegate shall vote in person or by such other means as 381
provided in the bylaws. The bylaws may provide for delegates' 382
participation in meetings by telephone or other means of 383
communication. 384
(3) The Commission shall meet at least once during each calendar 385
year. Additional meetings shall be held as set forth in the bylaws. 386
(4) All meetings shall be open to the public, and public notice of 387
meetings shall be given in the same manner as required under the 388
rulemaking provisions in section 12 of this compact. 389
(5) The Commission may convene in a closed, nonpublic meeting if 390
the Commission intends to discuss: 391
(A) Noncompliance of a member state with its obligations under the 392
compact; 393
(B) The employment, compensation, discipline or other personnel 394
matters, practices or procedures related to specific employees or other 395
matters related to the Commission's internal personnel practices and 396
procedures; 397
(C) Current, threatened or reasonably anticipated litigation; 398
(D) Negotiation of contracts for the purchase or sale of goods, services 399
or real estate; 400
(E) Accusing any person of a crime or formally censuring any person; 401
(F) Disclosure of trade secrets or commercial or financial information 402
that is privileged or confidential; 403
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(G) Disclosure of information of a personal nature where disclosure 404
would constitute a clearly unwarranted invasion of personal privacy; 405
(H) Disclosure of investigatory records compiled for law enforcement 406
purposes; 407
(I) Disclosure of information related to any investigatory reports 408
prepared by or on behalf of or for use of the Commission or other 409
committee charged with responsibility of investigation or determination 410
of compliance issues pursuant to the compact; or 411
(J) Matters specifically exempted from disclosure by federal or 412
member state statute. 413
(6) If a meeting, or portion of a meeting, is closed pursuant to this 414
provision, the Commission's legal counsel or designee shall certify that 415
the meeting may be closed and shall reference each relevant exempting 416
provision. The Commission shall keep minutes that fully and clearly 417
describe all matters discussed in a meeting and shall provide a full and 418
accurate summary of actions taken, and the reasons therefor, including 419
a description of the views expressed. All documents considered in 420
connection with an action shall be identified in such minutes. All 421
minutes and documents of a closed meeting shall remain under seal, 422
subject to release by a majority vote of the Commission or order of a 423
court of competent jurisdiction. 424
(c) (1) The Commission shall, by a majority vote of the delegates, 425
prescribe bylaws or rules to govern its conduct as may be necessary or 426
appropriate to carry out the purposes and exercise the powers of the 427
compact, including, but not limited to: 428
(A) Establishing the fiscal year of the Commission; 429
(B) Providing reasonable standards and procedures (i) for the 430
establishment and meetings of other committees, and (ii) governing any 431
general or specific delegation of any authority or function of the 432
Commission; 433
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(C) Providing reasonable procedures for calling and conducting 434
meetings of the Commission, ensuring reasonable advance notice of all 435
meetings and providing an opportunity for attendance of such meetings 436
by interested parties, with enumerated exceptions designed to protect 437
the public's interest, the privacy of individuals and proprietary 438
information, including trade secrets. The Commission may meet in 439
closed session only after a majority of the membership votes to close a 440
meeting in whole or in part. As soon as practicable, the Commission 441
shall make public a copy of the vote to close the meeting revealing the 442
vote of each member with no proxy votes allowed; 443
(D) Establishing the titles, duties and authority and reasonable 444
procedures for the election of the officers of the Commission; 445
(E) Providing reasonable standards and procedures for the 446
establishment of the personnel policies and programs of the 447
Commission. Notwithstanding any civil service or other similar laws of 448
any member state, the bylaws shall exclusively govern the personnel 449
policies and programs of the Commission; 450
(F) Promulgating a code of ethics to address permissible and 451
prohibited activities of Commission members and employees; and 452
(G) Providing a mechanism for winding up the operations of the 453
Commission and the equitable disposition of any surplus funds that 454
may exist after the termination of the compact and after the payment or 455
reserving of all of its debts and obligations. 456
(2) The Commission shall publish its bylaws and file a copy thereof, 457
and a copy of any amendment thereto, with the appropriate agency or 458
officer in each of the member states, if any. 459
(3) The Commission shall maintain its financial records in accordance 460
with the bylaws. 461
(4) The Commission shall meet and take such actions as are consistent 462
with the provisions of this Compact and the bylaws. 463
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(d) The Commission shall have the following powers: 464
(1) The authority to promulgate uniform rules to facilitate and 465
coordinate implementation and administration of this compact. The 466
rules shall have the force and effect of law and shall be binding in all 467
member states; 468
(2) To bring and prosecute legal proceedings or actions in the name 469
of the Commission, provided the standing of any state EMS authority or 470
other regulatory body responsible for EMS personnel licensure to sue or 471
be sued under applicable law shall not be affected; 472
(3) To purchase and maintain insurance and bonds; 473
(4) To borrow, accept or contract for services of personnel, including, 474
but not limited to, employees of a member state; 475
(5) To hire employees, elect or appoint officers, fix compensation, 476
define duties and grant such individuals appropriate authority to carry 477
out the purposes of the compact and to establish the Commission's 478
personnel policies and programs relating to conflicts of interest, 479
qualifications of personnel and other related personnel matters; 480
(6) To accept any and all appropriate donations and grants of money, 481
equipment, supplies, materials and services and to receive, utilize and 482
dispose of the same, provided at all times the Commission shall strive 483
to avoid any appearance of impropriety or conflict of interest; 484
(7) To lease, purchase, accept appropriate gifts or donations of or 485
otherwise to own, hold, improve or use any property, real, personal or 486
mixed, provided at all times the Commission shall strive to avoid any 487
appearance of impropriety; 488
(8) To sell, convey, mortgage, pledge, lease, exchange, abandon or 489
otherwise dispose of any property, real, personal or mixed; 490
(9) To establish a budget and make expenditures; 491
(10) To borrow money; 492
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(11) To appoint committees, including advisory committees, 493
comprised of members, state regulators, state legislators or their 494
representatives and consumer representatives, and such other 495
interested persons as may be designated in this compact and the bylaws; 496
(12) To provide and receive information from, and to cooperate with, 497
law enforcement agencies; 498
(13) To adopt and use an official seal; and 499
(14) To perform such other functions as may be necessary or 500
appropriate to achieve the purposes of this compact consistent with the 501
state regulation of EMS personnel licensure and practice. 502
(e) Financing of the Commission 503
(1) The Commission shall pay, or provide for the payment of, the 504
reasonable expenses of its establishment, organization and ongoing 505
activities. 506
(2) The Commission may accept any and all appropriate revenue 507
sources, donations and grants of money, equipment, supplies, materials 508
and services. 509
(3) The Commission may levy on and collect an annual assessment 510
from each member state or impose fees on other parties to cover the cost 511
of the operations and activities of the Commission and its staff, which 512
shall be in a total amount sufficient to cover its annual budget as 513
approved each year for which revenue is not provided by other sources. 514
The aggregate annual assessment amount shall be allocated based upon 515
a formula to be determined by the Commission, which shall promulgate 516
a rule binding upon all member states. 517
(4) The Commission shall not incur obligations of any kind prior to 518
securing the funds adequate to meet the same, nor shall the Commission 519
pledge the credit of any of the member states, except by and with the 520
authority of the member state. 521
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(5) The Commission shall keep accurate accounts of all receipts and 522
disbursements. The receipts and disbursements of the Commission shall 523
be subject to the audit and accounting procedures established under its 524
bylaws. However, all receipts and disbursements of funds handled by 525
the Commission shall be audited yearly by a certified or licensed public 526
accountant and the report of the audit shall be included in and become 527
part of the annual report of the Commission. 528
(f) Qualified immunity, defense and indemnification 529
(1) The members, officers, executive director, employees and 530
representatives of the Commission shall be immune from suit and 531
liability, either personally or in their official capacity, for any claim for 532
damage to or loss of property or personal injury or other civil liability 533
caused by or arising out of any actual or alleged act, error or omission 534
that occurred, or that the person against whom the claim is made had a 535
reasonable basis for believing occurred, within the scope of Commission 536
employment, duties or responsibilities, provided nothing in this 537
subdivision shall be construed to protect any such person from suit or 538
liability for any damage, loss, injury or liability caused by the intentional 539
or wilful or wanton misconduct of that person. 540
(2) The Commission shall defend any member, officer, executive 541
director, employee or representative of the Commission in any civil 542
action seeking to impose liability arising out of any actual or alleged act, 543
error or omission that occurred within the scope of Commission 544
employment, duties or responsibilities, or that the person against whom 545
the claim is made had a reasonable basis for believing occurred within 546
the scope of Commission employment, duties or responsibilities, 547
provided nothing herein shall be construed to prohibit that person from 548
retaining his or her own counsel, and, provided further, the actual or 549
alleged act, error or omission did not result from that person's 550
intentional or wilful or wanton misconduct. 551
(3) The Commission shall indemnify and hold harmless any member, 552
officer, executive director, employee or representative of the 553
Commission for the amount of any settlement or judgment obtained 554
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against that person arising out of any actual or alleged act, error or 555
omission that occurred within the scope of Commission employment, 556
duties or responsibilities, or that such person had a reasonable basis for 557
believing occurred within the scope of Commission employment, duties 558
or responsibilities, provided the actual or alleged act, error or omission 559
did not result from the intentional or wilful or wanton misconduct of 560
that person. 561
SECTION 11. COORDINATED DATABASE 562
(a) The Commission shall provide for the development and 563
maintenance of a coordinated database and reporting system containing 564
licensure, adverse action and significant investigatory information on 565
all licensed individuals in member states. 566
(b) Notwithstanding any other provision of state law to the contrary, 567
a member state shall submit a uniform data set to the coordinated 568
database on all individuals to whom this compact is applicable as 569
required by the rules of the Commission, including: 570
(1) Identifying information; 571
(2) Licensure data; 572
(3) Significant investigatory information; 573
(4) Adverse actions against an individual's license; 574
(5) An indicator that an individual's privilege to practice is restricted, 575
suspended or revoked; 576
(6) Nonconfidential information related to alternative program 577
participation; 578
(7) Any denial of application for licensure and the reason or reasons 579
for such denial; and 580
(8) Other information that may facilitate the administration of this 581
compact, as determined by the rules of the Commission. 582
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(c) The coordinated database administrator shall promptly notify all 583
member states of any adverse action taken against, or significant 584
investigative information on, any individual in a member state. 585
(d) Member states contributing information to the coordinated 586
database may designate information that shall not be shared with the 587
public without the express permission of the contributing state. 588
(e) Any information submitted to the coordinated database that is 589
subsequently required to be expunged by the laws of the member state 590
contributing the information shall be removed from the coordinated 591
database. 592
SECTION 12. RULEMAKING 593
(a) The Commission shall exercise its rulemaking powers pursuant to 594
the criteria set forth in this section and the rules adopted thereunder. 595
Rules and amendments shall become binding as of the date specified in 596
each rule or amendment. 597
(b) If a majority of the legislatures of the member states rejects a rule, 598
by enactment of a statute or resolution in the same manner used to adopt 599
the compact, such rule shall have no further force and effect in any 600
member state. 601
(c) Rules or amendments to the rules shall be adopted at a regular or 602
special meeting of the Commission. 603
(d) Prior to promulgation and adoption of a final rule or rules by the 604
Commission, and at least sixty days in advance of the meeting at which 605
the rule will be considered and voted upon, the Commission shall file a 606
Notice of Proposed Rulemaking: 607
(1) On the Internet web site of the Commission; and 608
(2) On the Internet web site of each member state's EMS authority or 609
in the publication in which each state would otherwise publish 610
proposed rules. 611
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(e) The Notice of Proposed Rulemaking shall include: 612
(1) The proposed time, date and location of the meeting in which the 613
rule will be considered and voted upon; 614
(2) The text of the proposed rule or amendment and the reason for 615
the proposed rule; 616
(3) A request for comments on the proposed rule from any interested 617
person; and 618
(4) The manner in which interested persons may submit notice to the 619
Commission of their intention to attend the public hearing and any 620
written comments. 621
(f) Prior to adoption of a proposed rule, the Commission shall allow 622
persons to submit written data, facts, opinions and arguments, which 623
shall be made available to the public. 624
(g) The Commission shall grant an opportunity for a public hearing 625
before it adopts a rule or amendment if a hearing is requested by: 626
(1) At least twenty-five persons; 627
(2) A governmental subdivision or agency; or 628
(3) An association having at least twenty-five members. 629
(h) If a hearing is held on the proposed rule or amendment, the 630
Commission shall publish the place, time and date of the scheduled 631
public hearing. 632
(1) All persons wishing to be heard at the hearing shall notify the 633
executive director of the Commission or other designated member in 634
writing of their desire to appear and testify at the hearing not less than 635
five business days before the scheduled date of the hearing. 636
(2) Hearings shall be conducted in a manner providing each person 637
who wishes to comment a fair and reasonable opportunity to comment 638
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sSB93 / File No. 44 23

orally or in writing. 639
(3) No transcript of the hearing is required, unless a written request 640
for a transcript is made, in which case the person requesting the 641
transcript shall bear the cost of producing the transcript. A recording 642
may be made in lieu of a transcript under the same terms and conditions 643
as a transcript. This subdivision shall not preclude the Commission from 644
making a transcript or recording of the hearing if it so chooses. 645
(4) Nothing in this section shall be construed as requiring a separate 646
hearing on each rule. Rules may be grouped for the convenience of the 647
Commission at hearings required by this section. 648
(i) Following the scheduled hearing date, or by the close of business 649
on the scheduled hearing date if the hearing was not held, the 650
Commission shall consider all written and oral comments received. 651
(j) The Commission shall, by majority vote of all members, take final 652
action on the proposed rule and shall determine the effective date of the 653
rule, if any, based on the rulemaking record and the full text of the rule. 654
(k) If no written notice of intent to attend the public hearing by 655
interested parties is received, the Commission may proceed with 656
promulgation of the proposed rule without a public hearing. 657
(l) Upon determination that an emergency exists, the Commission 658
may consider and adopt an emergency rule without prior notice, 659
opportunity for comment or hearing, provided the usual rulemaking 660
procedures provided in the compact and in this section shall be 661
retroactively applied to the rule as soon as reasonably possible, in no 662
event later than ninety days after the effective date of the rule. For the 663
purposes of this provision, an emergency rule is one that must be 664
adopted immediately in order to: 665
(1) Meet an imminent threat to public health, safety or welfare; 666
(2) Prevent a loss of Commission or member state funds; 667
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(3) Meet a deadline for the promulgation of an administrative rule 668
that is established by federal law or rule; or 669
(4) Protect public health and safety. 670
(m) The Commission or an authorized committee of the Commission 671
may direct revisions to a previously adopted rule or amendment for 672
purposes of correcting typographical errors, errors in format, errors in 673
consistency or grammatical errors. Public notice of any revisions shall 674
be posted on the Internet web site of the Commission. The revision shall 675
be subject to challenge by any person for a period of thirty days after 676
posting. The revision may be challenged only on grounds that the 677
revision results in a material change to a rule. A challenge shall be made 678
in writing and delivered to the chair of the Commission prior to the end 679
of the notice period. If no challenge is made, the revision will take effect 680
without further action. If the revision is challenged, the revision shall 681
not take effect without the approval of the Commission. 682
SECTION 13. OVERSIGHT, DISPUTE RESOLUTION AND 683
ENFORCEMENT 684
(a) Oversight 685
(1) The executive, legislative and judicial branches of state 686
government in each member state shall enforce this compact and take 687
all actions necessary and appropriate to effectuate the compact's 688
purposes and intent. The provisions of this compact and the rules 689
promulgated hereunder shall have standing as statutory law. 690
(2) All courts shall take judicial notice of the compact and the rules in 691
any judicial or administrative proceeding in a member state pertaining 692
to the subject matter of this compact that may affect the powers, 693
responsibilities or actions of the Commission. 694
(3) The Commission shall be entitled to receive service of process in 695
any such proceeding and shall have standing to intervene in such a 696
proceeding for all purposes. Failure to provide service of process to the 697
Commission shall render a judgment or order void as to the 698
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sSB93 / File No. 44 25

Commission, this compact or promulgated rules. 699
(b) Default, technical assistance and termination 700
(1) If the Commission determines that a member state has defaulted 701
in the performance of its obligations or responsibilities under this 702
compact or the promulgated rules, the Commission shall: 703
(A) Provide written notice to the defaulting state and other member 704
states of the nature of the default, the proposed means of curing the 705
default and any other action to be taken by the Commission; and 706
(B) Provide remedial training and specific technical assistance 707
regarding the default. 708
(2) If a state in default fails to cure the default, the defaulting state 709
may be terminated from the compact upon an affirmative vote of a 710
majority of the member states, and all rights, privileges and benefits 711
conferred by this compact may be terminated on the effective date of 712
termination. A cure of the default does not relieve the offending state of 713
obligations or liabilities incurred during the period of default. 714
(3) Termination of membership in the compact shall be imposed only 715
after all other means of securing compliance have been exhausted. 716
Notice of intent to suspend or terminate shall be given by the 717
Commission to the Governor and the majority and minority leaders of 718
the defaulting state's legislature, and each of the member states. 719
(4) A state that has been terminated is responsible for all assessments, 720
obligations and liabilities incurred through the effective date of 721
termination, including obligations that extend beyond the effective date 722
of termination. 723
(5) The Commission shall not bear any costs related to a state that is 724
found to be in default or that has been terminated from the compact, 725
unless agreed upon in writing between the Commission and the 726
defaulting state. 727
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sSB93 / File No. 44 26

(6) The defaulting state may appeal the action of the Commission by 728
petitioning the United States District Court for the District of Columbia 729
or the federal district where the Commission has its principal offices. 730
The prevailing member shall be awarded all costs of such litigation, 731
including reasonable attorney's fees. 732
(c) Dispute resolution 733
(1) Upon request by a member state, the Commission shall attempt to 734
resolve disputes related to the compact that arise among member states 735
and between member and nonmember states. 736
(2) The Commission shall promulgate a rule providing for both 737
mediation and binding dispute resolution for disputes as appropriate. 738
(d) Enforcement 739
(1) The Commission, in the reasonable exercise of its discretion, shall 740
enforce the provisions and rules of this compact. 741
(2) By majority vote, the Commission may initiate legal action in the 742
United States District Court for the District of Columbia or the federal 743
district where the Commission has its principal offices against a member 744
state in default to enforce compliance with the provisions of the compact 745
and its promulgated rules and bylaws. The relief sought may include 746
both injunctive relief and damages. In the event judicial enforcement is 747
necessary, the prevailing member shall be awarded all costs of such 748
litigation, including reasonable attorney's fees. 749
(3) The remedies herein shall not be the exclusive remedies of the 750
Commission. The Commission may pursue any other remedies 751
available under federal or state law. 752
SECTION 14. DATE OF IMPLEMENTATION OF THE INTERSTATE 753
COMMISSION FOR EMS PERSONNEL PRACTICE AND 754
ASSOCIATED RULES, WITHDRAWAL AND AMENDMENT 755
(a) The compact shall come into effect on the date on which the 756
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compact statute is enacted into law in the tenth member state. The 757
provisions, which become effective at that time, shall be limited to the 758
powers granted to the Commission relating to assembly and the 759
promulgation of rules. Thereafter, the Commission shall meet and 760
exercise rulemaking powers necessary to the implementation and 761
administration of the compact. 762
(b) Any state that joins the compact subsequent to the Commission's 763
initial adoption of the rules shall be subject to the rules as they exist on 764
the date on which the compact becomes law in that state. Any rule that 765
has been previously adopted by the Commission shall have the full force 766
and effect of law on the day the compact becomes law in that state. 767
(c) Any member state may withdraw from this compact by enacting 768
a statute repealing the same. 769
(1) A member state's withdrawal shall not take effect until six months 770
after enactment of the repealing statute. 771
(2) Withdrawal shall not affect the continuing requirement of the 772
withdrawing state's EMS authority to comply with the investigative and 773
adverse action reporting requirements of this act prior to the effective 774
date of withdrawal. 775
(d) Nothing contained in this compact shall be construed to 776
invalidate or prevent any EMS personnel licensure agreement or other 777
cooperative arrangement between a member state and a nonmember 778
state that does not conflict with the provisions of this compact. 779
(e) This compact may be amended by the member states. No 780
amendment to this compact shall become effective and binding upon 781
any member state until it is enacted into the laws of all member states. 782
SECTION 15. CONSTRUCTION AND SEVERABILITY 783
This compact shall be liberally construed so as to effectuate the 784
purposes thereof. If this compact shall be held contrary to the 785
constitution of any state member thereto, the compact shall remain in 786
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full force and effect as to the remaining member states. Nothing in this 787
compact supersedes state law or rules related to licensure of EMS 788
agencies. 789
Sec. 7. (NEW) ( Effective October 1, 2026 ) On and after one year after 790
the date on which the Recognition of Emergency Medical Services 791
Personnel Licensure Interstate Compact is enacted in at least one of the 792
states of Massachusetts, New York or Rhode Island, in accordance with 793
the provisions of section 6 of this act, the Commissioner of Public Health 794
shall require any applicant for licensure or certification pursuant to the 795
provisions of chapter 384d of the general statutes to submit to criminal 796
history records checks, including state and national criminal history 797
records checks, in accordance with the provisions of section 29 -17a of 798
the general statutes as a condition of licensure or certification. 799
This act shall take effect as follows and shall amend the following
sections:

Section 1 October 1, 2027 20-102aa
Sec. 2 October 1, 2027 20-102cc(a)
Sec. 3 October 1, 2026 19a-17(i)
Sec. 4 from passage 31-57e(f)
Sec. 5 October 1, 2027 20-102ee(a)
Sec. 6 October 1, 2026 New section
Sec. 7 October 1, 2026 New section

PH Joint Favorable Subst.

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sSB93 / File No. 44 29

The following Fiscal Impact Statement and Bill Analysis are prepared for the benefit of the members of
the General Assembly, solely for purposes of information, summarization and explanation and do not
represent the intent of the General Assembly or either chamber thereof for any pur pose. In general,
fiscal impacts are based upon a variety of informational sources, including the analyst’s professional
knowledge. Whenever applicable, agency data is consulted as part of the analysis, however final
products do not necessarily reflect an assessment from any specific department.

OFA Fiscal Note

State Impact:
Agency Affected Fund-Effect FY 27 $ FY 28 $
Public Health, Dept. GF - Revenue
Gain
Potential
Minimal
Potential
Minimal
Public Health, Dept. GF - Revenue
Loss
See Below See Below
Department of Emergency
Services and Public Protection
GF - Potential
Cost
See Below See Below
Resources of the General Fund GF - Potential
Revenue Gain
See Below See Below
Department of Emergency
Services and Public Protection
Applicant
Fingerprint Card
Submission
Account -
Potential
Revenue Gain
See Below See Below
Note: GF=General Fund

Municipal Impact:
Municipalities Effect FY 27 $ FY 28 $
Various Municipal Police
Departments
Potential
Revenue
Gain
See Below See Below

Explanation
The bill makes various changes implementing the Rural Health
Transformation (RHT) Program, including the Recognition of
Emergency Medical Services Personnel Licensure Interstate Compact
(EMS compact), resulting in several fiscal impacts described below.
Sections 1 and 5 expand the Department of Public Health’s (DPH's)
nurse’s aide registry to include nurse’s aides working with any licensed
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sSB93 / File No. 44 30

health care institution, resulting in no fiscal impact.
Sections 2 and 3 expand DPH authority to take disciplinary action
against nurse’s aides and RHT practitioners that commit specified
misconduct, resulting in a potential minimal revenue gain 1 to the
General Fund beginning in FY 27.
Section 4 makes procedural changes that allow tribes to receive RHT
Program funding without taking employment rights-related steps.
Section 6 enters Connecticut into the EMS compact, resulting in a
General Fund annual revenue loss2 of up to an estimated $31,000 due to
the loss of paramedic licensure renewal fees3 ($155 each 4) associated
with individuals who are also licensed within other participating
compact states. Of this total, $1,000 is a revenue loss to the professional
assistance program account that supports the Health Assistance
InterVention Education Network (HAVEN ). The revenue loss would
begin one year after Massachusetts, New York, or Rhode Island enacts
the EMS compact, and continue annually thereafter, as this triggers
Connecticut's adoption of the compact.
The revenue loss may be partially offset to the extent Connecticut
DPH charges a fee to out-of-state paramedics for granting compact
privilege. Currently, the state does not directly charge a separate fee for
privileges granted by any similar interstate occupational compacts.
Additionally, the EMS compact allows the United States EMS
Compact Commission to levy an annual assessment on member states

1 CGS Sec. 19a-17 gives DPH the authority to assess a civil penalty of up to $25,000 to
professionals under its jurisdiction as part of its disciplinary practices.
2 It is anticipated that DPH will receive up to 199 fewer paramedic renewals in the first
year of joining the compact based on current DPH licenses held by paramedics in
compact and neighboring states, assuming all neighbor states join the compact .
3 Paramedics are the only EMS provider license or certification covered by the compact
with any associated fees in Connecticut. A conflict of provisions in PA 25 -198 and PA
25-174 reconciled pursuant to CGS Sec. 2-30b eliminated the initial application fee, but
not the renewal fee.
4 Of each $155 renewal fee, $150 is directly deposited into the General Fund. The
remaining $5 fee is deposited into the professional assistance program account which
supports the Health Assistance InterVention Education Network (HAVEN).
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to cover the cost of its operations; however, such authority has never
imposed any state assessments or fees. The Compact Commission is
presently funded through a multi -year grant provided by the National
Registry of EMTs.
Section 7 requires, beginning one year after a neighboring state
enacts the EMS compact, applicants for EMS licensure and certification
to submit to a state and national fingerprint -based criminal history
records check , resulting in: (1) a potential cost to the Department of
Emergency Services and Public Protection (DESPP), (2) a potential
revenue gain to the General Fund, 5 and (3) a potential revenue gain to
the Applicant Fingerprint Card Submission Account and various
municipal police departments. 6 These fiscal impacts would further
depend on the volume of license and certification applications subject to
this requirement, which is unknown.7
The Out Years
The fiscal impacts identified above will continue in the future subject
to the timing of a neighboring state joining the EMS compact and the
number of criminal history records checks subsequently performed by
DESPP and various municipal police departments for EMS applicants.

5DESPP conducts state criminal history records checks for a fee of $75. The revenue
that is collected from this fee is deposited into the General Fund.
6 DESPP conducts fingerprinting for a fee of $15 per person paid to the Applicant
Fingerprint Card Submission Account. Municipal police departments may also
conduct the required fingerprinting for state criminal history records checks and
typically charge a fee of $10 to $15.
7 For context, DPH issued 2,375 new EMS licenses and certifications in FY 25.
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OLR Bill Analysis
sSB 93

AN ACT IMPLEMENTING THE RURAL HEALTH TRANSFORMATION
PROGRAM TO EXPAND HEALTH CARE ACCESS.

SUMMARY
This bill:
1. expands the Department of Public Health (DPH) nurse’s aide
registry to include nurse’s aides working at any DPH -licensed
health care institution, rather than just nursing homes as under
current law, and makes related changes to expand DPH’s
authority to take disciplinary action against nurse’s aides who
commit specified misconduct (§§ 1, 2 & 5);
2. allows DPH, or its licensing boards or commissions, to take
disciplinary action against a practitioner for failing to fulfill any
obligation resulting from the receipt of funding from DPH under
the federally -funded Rural Health Transformation (RHT)
Program (§ 3);
3. exempts funding to the Mashantucket Pequot or Mohegan tribe
under the RHT program from the law’s general requirement that
a tribe must first adopt an Employment Rights Code before the
state can provide funds that assist a tribe engaged in a
commercial enterprise (§ 4);
4. enters Connecticut into the Recognition of Emergency Medical
Services Personnel Licensure Interstate Compact, no earlier than
one year after a neighboring state enters it (the compact creates a
process authorizing emergency medical services (EMS)
personnel who are licensed in one member state to practice across
state boundaries without requiring licensure in each state) (§ 6);
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and
5. corresponding to a compact requirement, requires DPH to
institute a criminal background check requirement for EMS
personnel (starting one year after a neighboring state enters the
compact) (§ 7).
EFFECTIVE DATE: October 1, 2026, except that the tribal -related
provision (§ 4) takes effect upon passage, and the nurse’s aide -related
provisions (§§ 1, 2 & 5) take effect October 1, 2027.
§§ 1, 2 & 5 — NURSE’S AIDES
The bill expands DPH’s nurse’s aide registry to include nurse’s aides
working (as direct employees or under a contract) with any DPH -
licensed health care institution, rather than just nursing homes as under
current law. Under existing law , a nurse’s aide must meet specified
training and exam requirements to be registered.
The bill correspondingly expands DPH’s authority to receive and
investigate complaints and take disciplinary actions against nurse’s
aides to include those who work at any DPH-licensed institution. Under
current law, the grounds for complaints against nurse’s aides (just in
nursing homes) include, among other things, resident abuse or neglect.
The bill specifies that this applies to “abuse” or “neglect,” as defined in
specified federal regulations for long -term care facilities (42 C.F.R. §
483.5), of a health care institution resident, patient, or client. The bill also
expands the grounds for complaints to include illegal, incompetent, or
negligent conduct in providing nursing or related services.
The bill authorizes DPH to issue a summary suspension of a nurse’s
aide’s ability to practice before the final decision on a complaint or
during the appeals process. This authority applies only if DPH finds that
a nurse’s aide represents a clear and immedi ate danger if allowed to
continue to practice.
The bill also allows DPH, in line with existing procedures, to take
disciplinary action against a nurse’s aide after it investigat es a
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complaint. By law, disciplinary actions available to DPH include,
among other things, (1) revoking or suspending a credential ; (2)
censuring the violator; (3) issuing a letter of reprimand ; (4) placing the
violator on probationary status; or (5) imposing a civil penalty of up to
$25,000 (CGS § 19a-17).
Under existing law, DPH can also render a finding against someone
who is or has provided nurse’s aide services and enter the finding in the
registry, regardless of whether the aide is on the registry.
The bill also makes minor and conforming changes.
§§ 3 & 4 — RURAL HEALTH TRANSFORMATION PROGRAM
The bill allows DPH, or its licensing boards or commissions, to take
disciplinary action (see above) against a practitioner who fails to fulfill
any obligation resulting from receiving DPH funding under the RHT
program.
Generally, under existing law, before the state can give funds to help
the Mashantucket Pequot or Mohegan tribe when engaged in a
commercial enterprise, the tribe must first adopt an Employment Rights
Code with specified components. The bill exempts funding to tribes
under the RHT program from this requirement.
Under the RHT program, created under 2025 federal legislation (P.L.
119-21, § 71401), the Centers for Medicare and Medicaid Services is
giving all states grants to implement measures intended to expand rural
health care access and quality. Connecticut is receiving a first-year grant
of $154 million under the program. The Department of Social Services
will serve as the lead agency under the grant funding, collaborating with
several other agencies (including DPH) to implement projects across
four initiatives: population health outcomes, workforce, data and
technology, and care transformation and stability.
§ 6 — EMS COMPACT
The bill enters Connecticut into the Recognition of Emergency
Medical Services Personnel Licensure Interstate Compact (EMS
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sSB93 / File No. 44 35

compact), but no earlier than one year after Massachusetts, New York,
or Rhode Island enters it. (There are currently 25 member states to the
compact; our neighboring states have not yet joined.)
The compact creates a process authorizing EMS personnel who are
licensed in one member state to practice across state boundaries without
requiring licensure in each state. Member states must grant the privilege
to practice to EMS personnel who hold a valid , unencumbered license
(or other authorization) in another member state and who otherwise
meet the compact’s eligibility requirements. Generally, by joining the
compact, Connecticut retains broad authority to license and regulate
EMS personnel, but must grant qualifying EMS providers a privilege to
practice in Connecticut. The compact applies to emergency medical
technicians (EMTs), advanced EMTs (AEMTs), paramedics, or other
EMS providers at a level between EMT and paramedic.
The compact is administered by the Interstate Commission for EMS
Personnel Practice, which Connecticut joins under the bill once it enters
the compact.
Among various other provisions, the compact:
1. sets eligibility criteria for states to join the compact and for EMS
personnel to practice under it;
2. addresses several matters related to disciplinary actions for EMS
personnel practicing under the compact, such as information
sharing among member states and removal of the privilege to
practice;
3. allows the commission to levy an annual assessment on member
states or impose fees on other parties to cover its operational
costs;
4. only allows amendments to the compact to take effect if all
member states adopt them into law; and
5. has a process for states to withdraw from the compact.
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A broad overview of the compact appears below.
Compact Overview
The compact creates a process authorizing EMS personnel to work in
multiple states if they are licensed in one member state. A “license” is a
state’s authorization for someone to practice as an EMT, AEMT,
paramedic, or level between EMT or paramedic. (In C onnecticut,
paramedics are licensed, while EMTs and AEMTs are certified, but all
of these would constitute a “license” under the compact’s definition.)
Under the compact, a “state” is a U.S. state, commonwealth, district,
or territory. A “member state” is a state that has enacted the compact. A
“home state” is the member state where someone is licensed to practice
emergency medical services. A “remote sta te” is a member state where
someone is not licensed.
“Privilege to practice” is someone’s authorization to deliver
emergency medical services in remote states as authorized under the
compact.
Home State Licensure (§ 6(3))
Under the compact, any member state in which someone holds a
current license is a home state for the compact’s purposes. A home state
license authorizes someone to practice in a remote state under the
privilege to practice only if the home state:
1. requires the use of the National Registry of Emergency Medical
Technicians (NREMT) examination as a condition of issuing
initial EMT and paramedic licenses;
2. has a mechanism to receive and investigate complaints about
individuals;
3. notifies the commission about any adverse action (e.g.,
disciplinary action against a license or a criminal conviction) or
significant investigatory information (e.g., information that the
individual represents an immediate threat to public health and
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safety) about an individual;
4. requires a criminal background check for initial licensure
applicants, including fingerprints or other biometric -based
information that meets FBI requirements (except for federal
employees with a suitability determination under federal
regulations); and
5. complies with the commission’s rules.
A member state may require someone to get licensed in order to
practice in that state under circumstances not authorized by the
compact’s privilege to practice.
Compact Privilege to Practice (§ 6(4))
The compact requires member states to recognize the privilege to
practice of someone licensed in another member state that complies
with the above requirements. To exercise the privilege to practice under
the compact, an individual must:
1. be at least age 18;
2. have a current unrestricted license (see above) in a member state
as an EMT, AEMT, paramedic, or level between EMT and
paramedic; and
3. practice under the supervision of a medical director (a physician
licensed in a member state who is accountable for EMS
personnel’s care delivery).
Under the compact, someone providing patient care in a remote state
under the privilege to practice must function within the home state’s
scope of practice unless and until it is modified by an appropriate
authority in the remote state. Otherwise, someone practicing in a remote
state is subject to the remote state’s authority and rules.
Conditions of Practice in a Remote State (§ 6(5))
Under the compact, an individual may practice in a remote state
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under a privilege to practice only in performing their EMS duties as
assigned by an appropriate authority, and when the individual:
1. originates a patient transport in a home state and transports the
patient to a remote state;
2. originates in the home state and enters a remote state to pick up
a patient and provide care and transport to the home state;
3. enters a remote state to provide patient care or transport within
that state;
4. enters a remote state to pick up a patient and provide care and
transport to a third member state; or
5. complies with other conditions as determined by the
commission’s rules.
Relationship to Emergency Management Assistance Compact (§
6(6))
Under the compact, if a member state’s governor declares a state of
emergency or disaster that activates the Emergency Management
Assistance Compact (EMAC), the EMAC compact prevails over any
conflicting provisions of this compact as to anyone practicing i n a
remote state under the governor’s declaration. (All states are part of
EMAC, under which states may provide personnel, equipment, and
other supplies to assist other states in governor-declared emergencies.)
Veterans, Service Members Separating From Active-Duty Military,
and Their Spouses (§ 6(7))
Under the compact, member states must consider someone as
satisfying the minimum training and examination requirements for a
given EMS license if the person (1) is a veteran, active military service
member, member of the National Guard and Reserve separati ng from
an active -duty tour, or the spouse of such a person and (2) holds an
unrestricted NREMT certification at or about the level of the license
being sought. Member states must expedite the processing of their
licensure applications. These individuals p racticing under the compact
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remain subject to the compact’s adverse action provisions (§ 6(8)).
Respective States’ Authority and Adverse Actions (§ 6(4), (8) &
(9))
The compact addresses several matters related to states’ authority to
investigate and discipline EMS personnel practicing under its
procedures. Broadly, the compact maintains the home state’s authority
to regulate the home state license, while authorizing remote states to
regulate the compact privilege to practice in their states. For
investigations and adverse actions, a home state’s EMS authority must
give the same priority to conduct reported from remote states as it
would to conduct within the home state.
The following are examples of the regulatory structure under the
compact:
1. a home state has exclusive authority to impose adverse action
against a home state license, but a remote state may take adverse
action against an individual’s privilege to practice in that state or
take other actions needed to protect its citizens;
2. if someone’s (a) home state license is restricted or suspended or
(b) privilege to practice in any remote state is restricted,
suspended, or revoked, he or she cannot practice in any remote
state until the license or privilege is restored;
3. member states must report adverse actions and compact
privilege restrictions, suspensions, or revocations to the
commission;
4. member states may allow someone to participate in an alternative
program for substance abuse recovery rather than imposing an
adverse action, but the person must not practice in any other
member state during that time without its prior authorization;
5. member states’ EMS authorities may issue subpoenas to compel
someone’s testimony or the production of evidence (to be
enforced as applicable by a remote state’s courts), with the
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issuing state covering certain costs; and
6. member states may issue cease and desist orders to restrict,
suspend, or revoke someone’s privilege to practice in the state.
Compact Commission (§ 6(10) & (12))
The compact is administered by the Interstate Commission for EMS
Personnel Practice, which consists of one voting delegate from each
state. The delegate must be the responsible official of the state’s EMS
authority or the official’s designee. The compact sets several powers,
duties, and procedures for the commission. For example, the
commission:
1. may make rules, binding on member states, to coordinate the
compact’s implementation and administration (a rule has no
effect if a majority of the member states’ legislatures reject it);
2. may levy and collect an annual assessment from each member
state or impose fees on other parties to cover its operational costs;
and
3. must have its receipts and disbursements audited yearly and the
audit report included in the commission’s annual report.
The compact addresses several other matters regarding the
commission and its operations, such as setting conditions under which
its members, officers, and employees are immune from civil liability.
Coordinated Database (§ 6(11))
Member states must submit specified information (e.g., on licensure
and disciplinary actions) about individuals covered by the compact for
inclusion in a database the compact creates. The database administrator
must promptly notify all member states about any adverse action
against, or significant investigatory information on, someone in a
member state.
Member states that contribute information to the database may
designate information that may not be shared publicly without the
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state’s express permission. If a member state’s law requires information
to be expunged, it must be removed from the database.
Compact Oversight, Dispute Resolution, Enforcement, Member
Withdrawal, and Related Matters (§ 6(13)-(15))
Among other related provisions, the compact:
1. requires each member state’s executive, legislative, and judicial
branches to enforce the compact and take necessary steps to carry
out its purposes;
2. requires the commission to take specified steps if a member state
defaults on its obligations under the compact, and after all other
means of securing compliance have been exhausted, allows a
defaulting state to be terminated from the compact upon a
majority vote of the member states;
3. requires the commission, upon a member state’s request, to
attempt to resolve a compact -related dispute among member
states or between member and non-member states;
4. requires the commission to enforce the compact and rules and
allows it to bring legal action against a member state in default
upon a majority vote (the case may be brought in the U.S. District
Court for the District of Columbia or the federal district whe re
the commission’s principal offices are located);
5. allows a member state to withdraw from the compact by
repealing the enabling legislation, but withdrawal does not take
effect until six months after the repealing statute’s enactment;
6. allows member states to amend the compact, but no amendment
takes effect until all member states enact it into law;
7. requires the compact to be liberally construed to carry out its
purposes, and if the compact is held to violate a member state’s
constitution, it remains in effect in the remaining member states;
and
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8. specifies that the compact does not supersede state law or rules
on EMS agency licensure.
§ 7 — BACKGROUND CHECKS FOR EMS CREDENTIALING
Under the bill, the DPH commissioner must require anyone applying
for EMS professional licensure or certification to submit to a state and
national fingerprint-based criminal history records check. This applies
starting one year after Massachusetts, New York, or Rhode Island enacts
the EMS compact (i.e. when Connecticut can enter the compac t under
the bill).
COMMITTEE ACTION
Public Health Committee
Joint Favorable Substitute
Yea 30 Nay 0 (03/02/2026)