Public Health Committee
JOINT FAVORABLE REPORT
Bill No.: SB-1070
AN ACT ALLOWING ADVANCED PRACTICE REGISTERED NURSES AND
Title: PHYSICIAN ASSISTANTS TO ISSUE HOME HEALTH ORDERS.
Vote Date: 3/31/2021
Vote Action: Joint Favorable
PH Date: 3/29/2021
File No.: 536
Disclaimer: The following JOINT FAVORABLE Report is prepared for the benefit of the
members of the General Assembly, solely for purposes of information, summarization and
explanation and does not represent the intent of the General Assembly or either chamber
thereof for any purpose.
SPONSORS OF BILL:
The Public Health Committee
REASONS FOR BILL:
This bill allows physician assistants (PAs) and advanced practice registered nurses (APRNs)
licensed in Connecticut or a bordering state the ability to issue orders for home health care,
hospice care, and home health aide services. Current state law only allows a physician to
issue these orders.
RESPONSE FROM ADMINISTRATION/AGENCY:
Deidre S. Gifford, MD, MPH, Acting Commissioner, Department of Public Health (DPH):
Ms. Gifford and the DPH supports allowing physician assistants (PAs) and advanced practice
registered nurses (APRNs) the ability to issue home health care, hospice care, and home
health aide service orders. DPH anticipated this change, and in 2019 when they began the
home health regulation revision process, one of their first revisions was to allow PAs and
APRNs the ability to issue these orders. Initially the COVID-19 pandemic led the federal
government to issue guidance allowing PAs and APRNs the ability to issue these orders.
They later made that change permanent and amended their regulations. Additionally, this
language change is also part of Section 49 of HB 6666.
NATURE AND SOURCES OF SUPPORT:
Cale Bradford, Chief Governmental Relations Officer, Elara Caring:
Mr. Bradford and Elara Caring support HB 1070. Passage of the federal CARES Act in March
2020 allowed physician assistants (PAs) and advanced practice registered nurses (APRNs)
to sign home health care orders on a permanent basis. This was a historical change that
acknowledged the value and prominence of PAs and APRN's in patient treatment and care
coordination in a modern healthcare model. This change is necessary at the state level to
ensure continued and timely access and services to ensure quality care for patients across
the state.
Laurel Reagan, APRN, Director of Behavioral Health and Social Services, Hartford
HealthCare at Home:
Ms. Reagan and Hartford HealthCare at Home support this bill because allowing physician
assistants (PAs) and advanced practice nurse practitioners (APRNs) to issue home health
care orders creates a more efficient process, removes administrative roadblocks, and
increases timely care for patients that have most likely already been under their care and
supervision for some time. Waiting for a physician to order home health care admission
orders only creates unnecessary and timely delays resulting in increased health care costs
and negatively impacting health outcomes.
PAs and APRNs have been successfully writing home health care orders since the beginning
of the pandemic and need to continue this practice with permanent statutory change.
Veronica Mansfield, DNP, APRN, Middlesex Health:
Ms. Mansfield is an advanced practice registered nurse (APRNs) at Middlesex Health and
she supports this bill. After 25 years as an APRN in many different clinical settings she has
seen tremendous expansion in APRNs scope of practice. Unfortunately, this expansion did
not include being able to issue an order for her patients to receive home health care. This
required the order from a physician that may not have ever been under the care of said
physician. This extra step created unnecessary delays and sometimes increased need for
emergency care. This change will decrease delays in care and possibly lead to better
outcomes for patients.
Tracy Wodatch, President and CEO, Connecticut Association for Healthcare at Home:
Ms. Wodatch and the Association support HB 1070 to allow physician assistants (PAs) and
advanced practice nurse practitioners (APRNs) to issue home health care orders. Until the
COVID-19 emergency, PAs and APRNs were not able to issue home health care orders and
this was a serious constraint on patient care. Fortunately, the Federal CARES Act made it
allowable in every state, if the state allowed for PAs and APRNs to issue these orders.
Connecticut authorities soon issued an emergency order allowing PAs and APRNs to follow
federal law. The Association would like to see this change be made permanent with this bill.
NATURE AND SOURCES OF OPPOSITION:
Michael Aronow, MD, President, Connecticut Orthopaedic Society (COS):
Mr. Aronow and the COS do not support this bill because it is not required or necessary to
include physician assistants (PAs) in the language of the bill. Under current statute PAs work
under the supervision of a physician and if the supervising physician directs the PA to write
an order for home healthcare, hospice, or home health aide services, the order is valid. COS
is also concerned that the language in this bill will expand the scope of service definition in
state statute and allow for an "independent practice" interpretation of the law.
COS has similar concerns about advance practice registered nurses (APRNs) being
permitted to meet the requirements for independent practice before they have met all the
Page 2 of 3 SB-1070
requirements in Connecticut. These concerns extend to PAs and APRNs from bordering
states and the possibility of them operating beyond their scope of practice if licensed in
Connecticut. COS wants the DPH Scope of Practice Review process to evaluate this
language before moving the bill through the legislative process.
Reported by: Kate Hamilton Date: May 3, 2021
Page 3 of 3 SB-1070


Statutes affected:
Raised Bill:
PH Joint Favorable:
File No. 536:
Public Act No. 21-196: 20-12c, 12-94, 18-94, 20-14m, 26-29a, 26-29b, 31-294i