Assigned to HHS AS PASSED BY COMMITTEE
ARIZONA STATE SENATE
Fifty-Sixth Legislature, Second Regular Session
AMENDED
FACT SHEET FOR H.B. 2764
long-term care; enforcement; memory care
Purpose
Requires the Director of the Department of Health Services (DHS) to establish by rule
standards for memory care services for assisted living facilities that are licensed to provide directed
care services. Modifies DHS duties and authorities relating to oversight of health care institutions.
Establishes requirements relating to Adult Protective Services (APS) investigations into abuse or
neglect of a vulnerable adult. Modifies the membership of the Board of Examiners of Nursing Care
Institution Administrators and Assisted Living Facility Managers (NCIA Board). Establishes the
Vulnerable Adult System Study Committee (Study Committee) and outlines Study Committee
membership, duties and reporting requirements.
Background
Health Care Institutions
Health care institutions in Arizona are licensed and overseen by the Department of Health
Services (DHS), including enforcement of health care institution statutes, rules and regulations.
DHS must: 1) review and approve plans and specifications for institution construction or
modification; 2) have access to books, records, accounts and any other necessary health care
institution information; and 3) require nursing care institutions and assisted living facilities to
provide annual influenza and pneumonia vaccines to residents. Additionally, DHS may: 1) inspect
every part of a health care institution to ensure compliance with standard medical practice;
2) conduct investigations of health care institution conditions and problems with noncompliance;
and 3) develop facility manuals and guides to health care institutions and the general public (A.R.S.
§ 36-406).
A health care institution is every place, institution, building or agency, whether organized
for profit or not, that provides facilities with medical services, nursing services, behavioral health
services, health screening services, other health-related services, supervisory care services,
personal care services or directed care services and includes home health agencies, outdoor
behavioral health care programs and hospice service agencies. Residential care institutions are
health care institutions other than a hospital or a nursing care institution that provides resident beds
or residential units, supervisory care services, personal care services, behavioral health services,
directed care services or health-related services for persons who do not need continuous nursing
services. Assisted living facilities are residential care institutions, including an adult foster care
home, that provides or contracts to provide supervisory care services, personal care services or
directed care services on a continuous basis. Nursing care institutions are health care institutions
that provide inpatient beds or resident beds and nursing services to persons who need continuous
nursing services but who do not require hospital care or direct daily care from a physician (A.R.S.
§ 36-401) FACT SHEET – Amended
H.B. 2764
Page 2
The Director of DHS (Director) may assess a civil penalty of up to $500 for each violation
of health care institution statutes, for every day the violation occurs. The Director may then issue
a notice of assessment that includes the amount of the assessment to the violator. Monies collected
from civil penalties for violations of health care institutions are transmitted to the state General
Fund (state GF) (A.R.S. § 36-431.01).
Adult Protective Services
APS is the program within the Department of Economic Security (DES) responsible for
investigating allegations of abuse, exploitation and neglect of vulnerable adults. The duties and
responsibilities of APS workers include: 1) receiving reports of abused, exploited or neglected
vulnerable adults; 2) receiving oral or written information indicating that an adult may be in need
of protective services; 3) conducting evaluations to determine if an adult is in need of protective
services and which services are needed; 4) offering protective services to individuals in need; and
5) filing petitions for guardianship or conservatorship of vulnerable adults. A vulnerable adult is
an individual who is eighteen years of age or older and who is unable to protect himself from
abuse, neglect or exploitation by others because of a physical or mental impairment (A.R.S.
§§ 46-451 and 46-452).
NCIA Board
The NCIA Board regulates nursing care institution administrators and assisted living
facility managers in Arizona. The NCIA Board consists of 11 members appointed by the Governor,
including: 1) one administrator who holds an active license in nursing care institution
administration; 2) one manager who holds an active license in assisted living facility management;
3) one administrator of a nonprofit or faith-based skilled nursing facility; 4) one administrator of
a proprietary skilled nursing facility; 5) two managers of an assisted living center; 6) one manager
of an assisted living home; 7) two public members who are not affiliated with a nursing care
institution or an assisted living facility; 8) one public member who represents an organization that
advocates for the elderly; and 9) one person who is a family member of a resident in either a skilled
nursing facility or an assisted living facility at the time the person is appointed. (A.R.S.
§ 36-446.03).
Fiscal Impact
If there is a cost associated with the oversight of, and establishment of DHS training
standards for, health care institutions that provide directed care, there may be a fiscal impact to the
state GF. Additionally, H.B. 2764 increases the cap on civil penalties assessed for violations of
health care institution statutes from $500 to $1000, which is deposited into the state GF.
Provisions
Memory Care Services
1. Requires the Director to establish by rule standards for memory care services for assisted living
facilities that are licensed to provide directed care services.
2. Requires the Director to establish by rule minimum training standards for staff and contractors
who work in an assisted living facility that is licensed to provide directed care services. FACT SHEET – Amended
H.B. 2764
Page 3
3. Requires memory care services training standards to include at least eight hours of initial
memory care services training and four hours of annual continuing education.
4. Requires the training standards for assisted living facility managers, in addition to the eight
hours of initial training, to include a minimum of four hours of memory care services training
that is specifically for assisted living facility managers.
5. Requires DHS to approve memory care services training programs.
6. Requires memory care services training programs to provide staff and contractors who
complete the training a certificate of completion that may be used to work at any assisted living
facility that is licensed to provide directed care services.
7. Stipulates that, if a staff member or contractor does not work at an assisted living facility that
is licensed to provide directed care services for a period of 12 months, the person must
complete the initial 8-hour training within 30 days after the date of hire, rehire or returning to
work.
8. Specifies that an assisted living facility that is licensed to provide directed care services must
provide documentation of prescribed staff training during any investigation or compliance
survey.
9. Requires failure to provide complete staff training documentation to be cited as a deficiency.
10. Defines memory care services as services that support individuals with dementia and other
progressive and neurodegenerative brain disorders, including specialized environmental
features, care planning, directed care services, medication administration services, specialized
accommodations, activity programming or other services required by DHS in rule.
Health Care Institution Oversight
11. Requires the Director to establish:
a) a model in rule for on-site monitoring of health care institutions that are found to not be in
substantial compliance with applicable licensure requirements; and
b) on-site monitoring fees charged to applicable health care institutions.
12. Prohibits DHS from charging a fee for a complaint or compliance-related survey or inspection
if a health care institution is in substantial compliance.
13. Allows DHS to provide in-service training to health care institutions relating to regulatory
compliance outside of the survey process, if requested.
14. Requires the Director to establish by rule in-service training fees for health care institutions
that request training.
15. Prohibits the DHS Director from accepting an accreditation report in lieu of a compliance
inspection for residential care institutions and nursing care institutions, unless the institution
has the same direct or indirect owner as a licensed hospital. FACT SHEET – Amended
H.B. 2764
Page 4
16. Excludes residential care institutions and nursing care institutions that do not have the same
direct owner or indirect owner as a licensed hospital from statutes exempting deficiency-free
health care institutions a two-year reprieve from DHS compliance surveys.
17. Voids a health care institution license if the licensee does not pay civil penalties or provider
agreement fees before the due date or does not enter into an agreement with DHS to pay all
outstanding fees and civil penalties before the due date.
18. Increases the cap on civil penalties for violation of health care institution statutes or rules from
$500 to $1,000, which may be assessed for each resident or patient who DHS determines was
impacted by a violation.
19. Requires DHS to establish a rule with outlined considerations for determining the amount of a
civil penalty assessed against a health care institution.
20. Includes, in the criteria that DHS Director must consider when determining the amount of a
civil penalty, whether the health care institution and staff are in compliance with the vulnerable
adult reporting requirements.
21. Adds each of the following to the list of factors DHS must consider in determining the amount
of a civil penalty assessed against a health care institution:
a) the potential for and occurrences of actual harm to patients, staff or residents;
b) threats to health and safety of patients, staff or residents; and
c) the type of health care institution.
22. Allows the DHS Director to continue to pursue any court, administrative or enforcement action
against a licensee, even if the health care institution is in the process of being sold or has closed.
23. Authorizes DHS to deny:
a) a new license application for a currently licensed health care institution while any
enforcement or court action relating to the licensure of operation of the institution is
pending, if it is determined that patient safety may be in jeopardy due to the licensee's
actions; and
b) a change in ownership of a currently licensed health care institution, if it is determined that
the transfer would jeopardize patient safety.
Study Committee
24. Establishes the 20-member Study Committee, consisting of:
a) two members of the House of Representatives, appointed by the Speaker, who are members
of different political parties, one of whom to serve as Co-Chairperson;
b) two members of the Senate, appointed by the President, who are members of different
political parties, one of whom to serve as Co-Chairperson;
c) the Director of the DHS or the Director's designee;
d) the Director of DES or the Director's designee;
e) the Director of the AHCCCS or the Director's designee.
f) one member, appointed by the Governor, from the Governor's Office
g) one member, appointed by the Attorney General (AG), from the AG's Office
h) the current DES Long-Term Care Ombudsman or the Ombudsman's designee; FACT SHEET – Amended
H.B. 2764
Page 5
i) a current public fiduciary appointed by the Governor;
j) two Governor-appointed employees of a local law enforcement agency or statewide
organization representing law enforcement;
k) the Executive Director of the Navajo Area Agency on Aging or the Executive Director's
designee;
l) the Executive Director of the Intertribal Council of Arizona or the Executive Director's
designee;
m) a Speaker-appointed employee of a licensed assisted living facility
n) a Governor-appointed employee of a licensed nursing care institution;
o) two President-appointed members who represent different statewide organizations that
advocate for elderly vulnerable adults; and
p) a licensed health care professional, appointed by the Speaker, that provides health care
services to elderly vulnerable adults.
25. Requires the Study Committee to:
a) develop and implement a coordinated vulnerable adults delivery system that ensures the
health and safety of vulnerable adults;
b) recommend best practices relating to responding and investigating complaints;
c) research best practices related to APS at the state, municipal and community levels;
d) research and make recommendations on how the vulnerable adult system can ensure that
vulnerable adults receive required services, including assigning a specific agency the
responsibility to provide or coordinate case management;
e) research and identify common statewide outcomes;
f) identify best practices for data collection and data sharing by various entities involved in
providing vulnerable adult services; and
g) review and recommend changes to the statutes and rules that govern vulnerable adult
services.
26. Allows the Co-Chairpersons of the Study Committee to designate work groups to research,
study and make recommendations to the Study Committee.
27. Requires DES, in conjunction with the work groups, to develop an action plan for
implementation once a strategic direction is established.
28. Specifies that public members are eligible for travel, lodging, meal and incidental expense
reimbursement.
29. Requires, by October 1, 2025, the Study Committee to submit a report regarding its findings
and recommendations to the Governor, the President and the Speaker, and to provide a copy
of the report to the Secretary of State.
30. Repeals the Study Committee on December 31, 2025.
NCIA Board
31. Modifies the membership of the NCIA Board as follows:
a) removes the two public members who are not affiliated with a nursing care institution or
assisted living facility; FACT SHEET – Amended
H.B. 2764
Page 6
b) adds one person who is a current or former resident of a skilled nursing facility or assisted
living facility;
c) adds one public member who represents an organization that advocates for individuals with
Alzheimer's disease, dementia or other related neurocognitive disorders or diseases;
d) allows the position for a family member of a resident at a skilled nursing facility or assisted
living facility to be family of either a current or former resident; and
e) allows positions for managers or administrators to be filled by persons who are either
actively licensed or retired.
32. Prohibits the NCIA Board from having more than three members appointed to positions for
managers or administrators who are retired.
33. Specifies that NCIA Board members who are retired managers or administrators:
a) must have had an active license within the previous two years at the time of appointment;
and
b) may not have had any disciplinary action imposed or had a license revoked.
Adult Protective Services
34. Requires, beginning January 1, 2025, an owner of a residential care institution, nursing care
institution or home health agency to verify that an employee or potential employee is not on
the APS registry.
35. Requires an owner to terminate an employee, or not hire a potential employee, who is found
to be on the APS registry.
36. Requires protective service workers to file for an order of protection or an injunction against
harassment, as a third party on behalf of a vulnerable adult, to prevent an alleged perpetrator
from having access to the vulnerable adult.
37. Authorizes DES or a protective services worker, acting in an official capacity, to access law
enforcement records related to an APS case.
38. Requires law enforcement entities to furnish relevant records to APS on request.
39. Requires peace officers, as soon as possible, to notify and make available to the APS Central
Intake Unit any reports received relating to an allegation of abuse or neglect of a vulnerable
adult, including all related unredacted police records.
Miscellaneous
40. Exempts DHS from statutory rulemaking requirements, until July 1, 2025, for purposes of
health care institution and memory care services regulations.
41. Makes technical and conforming changes.
42. Enacts assisted living facility memory care service requirements on July 1, 2025.
43. Becomes effective on the general effective date. FACT SHEET – Amended
H.B. 2764
Page 7
Amendments Adopted by Committee
1. Requires, beginning January 1, 2025, an owner of a residential care institution, nursing care
institution or home health agency to verify that an employee or potential employee is not on
the APS registry.
2. Requires an owner to terminate an employee, or not hire a potential employee, who is found
to be on the APS registry.
3. Includes, in the criteria that DHS Director must consider when determining the amount of a
civil penalty, whether the health care institution and staff are in compliance with the vulnerable
adult reporting requirements.
4. Requires protective service workers to file for an order of protection or an injunction against
harassment, as a third party on behalf of a vulnerable adult, to prevent an alleged perpetrator
from having access to the vulnerable adult.
5. Authorizes DES or a protective services worker, acting in an official capacity, to access law
enforcement records related to an APS case.
6. Requires law enforcement entities to furnish relevant records to APS on request.
7. Requires peace officers, as soon as possible, to notify and make available to the APS Central
Intake Unit any reports received relating to an allegation of abuse or neglect of a vulnerable
adult, including all related unredacted police records.
8. Prohibits DHS from charging a fee for a complaint or compliance-related survey or inspection
if a health care institution is in substantial compliance.
9. Eliminates the requirement that DHS license assisted living facilities that provide memory care
services and instead requires DHS to establish standards for memory care services for assisted
living facilities required to provide directed care services.
10. Requires a person who does not work in an assisted living facility that provides directed care
services for a period of 12 months to complete initial training requirements within 30 days of
hire, rehire or returning to work.
11. Modifies NCIA Board membership and criteria for member qualification.
12. Establishes Study Committee and outlines membership, duties and reporting requirements.
House Action Senate Action
HHS 2/15/24 DPA 9-1-0-0 HHS 3/19/24 DPA 6-0-1
3
rd
Read 2/29/24 49-10-0-0-1
Prepared by Senate Research
March 20, 2024
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