HB 2764
Initials AG Page 1 Senate Engrossed
ARIZONA HOUSE OF REPRESENTATIVES
Fifty-sixth Legislature
Second Regular Session
House: HHS DPA 9-1-0-0 | 3
rd
Read 43-10-0-0-1
Senate: HHS DPA 6-0-1-0 | 3
rd
Read 18-7-5-0
HB 2764: long-term care; enforcement; memory care
Sponsor: Representative Dunn, LD 25
Senate Engrossed
Overview
Requires the Director of the Arizona Department of Health Services (DHS) to establish rules
for a licensure subclass for assisted living facilities wishing to provide memory care services.
Raises the maximum civil penalty the DHS Director may assess for violations of health care
institution statutes and rules. Increases the number of members on the Board of Examiners
of Nursing Care Institution Administrators and Assisted Living Facility Managers (NCIA
Board).
History
Health Care Institution Licensure
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).
Current law establishes processes and procedures that applicants must follow to obtain a
health care institution license. Applicants must submit to DHS: 1) an application on a written
or electronic form that contains certain information about the health care institution; 2) a
notarized attestation form that verifies the architectural plans and specifications of the
health care institution; and 3) the applicable application fee. An application for a health care
institution license must be submitted at least 60 days, but not more than 120 days before the
anticipated date of operation. An application for a substantial compliance survey must be
submitted at least 30 days before the date on which the survey was requested.
If a current licensee intends to terminate the operation of a licensed health care institution
or if a change in ownership is planned, the current licensee must notify the DHS Director in
writing at least 30 days before the termination of operation or change in ownership has taken
place. The current licensee is responsible for preventing any interruption of services required HB 2764
Initials AG Page 2 Senate Engrossed
to sustain the life, health and safety of the patients or residents. A new owner is prohibited
from beginning to operate the health care institution until the DHS Director issues a license
to the new owner (A.R.S. §§ 36-401 and 36-422).
Civil Penalties
The DHS Director may assess a civil penalty against a person who violates health care
institutions statutes or rules in an amount of up to $500 for each violation. Every day a
violation occurs constitutes a separate violation. The DHS Director may issue a notice of the
assessment which must include the proposed amount of the assessment. A person may appeal
the assessment by requesting a hearing from the Office of Administrative Hearings. If the
assessment is appealed, the DHS Director cannot take any further action to enforce and
collect the assessment until after the hearing. The DHS Director must consider certain
factors when determining a civil penalty. These factors include: 1) repeated violations of
statutes or rules; 2) patterns of noncompliance; 3) types of violations or severity of violations;
4) potential for and occurrences of actual harm; 5) threats to health and safety; 6) number of
persons affected by the violations; 7) number of violations; 8) size of the facility; and 9) length
of time that the violations have been occurring (A.R.S. § 36-431.01).
Inspections
The DHS Director must inspect the premises of each health care institution and investigate
the applicant's character and qualifications to ensure compliance with statutes and
administrative rules. The DHS Director may, in certain circumstances, accept an
accreditation report in lieu of a compliance inspection upon receiving a report for the
licensure period and the health care institution is accredited by an independent, nonprofit
accredited organization approved by the Secretary of the U.S. Department of Health and
Human Services. Statute prohibits the DHS Director from accepting an accreditation report
instead of a compliance inspection from: 1) an intermediate care facility for people with
intellectual disabilities; 2) a nursing-supported group home; and 3) a health care institution
that has been subject to an enforcement action within the year preceding the annual licensing
fee anniversary date (A.R.S. § 36-424).
Board of Examiners of Nursing Care Institution Administrators and Assisted
Living Facility Managers
The NCIA Board was established in 1975 to oversee nursing care institution administrators
and assisted living facility managers in Arizona. NCIA Board adopts rules for licensing and
certifying applicants, conducting examinations to determine applicant qualification and
adopting fees. It also conducts investigations or administrative hearings in response to
complaints and prescribes standards for assisted living facility training programs.
The NCIA Board consists of 11 members appointed by the Governor, including: 1) one
administrator holding an active license; 2) one manager holding an active license; 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 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 to the NCIA Board (A.R.S. §§ 36-446.02 and 36-446.03).
HB 2764
Initials AG Page 3 Senate Engrossed
Provisions
DHS Director
1. Requires the DHS Director to establish a model in rule for the agency to monitor health
care institutions on-site that are found to not be in substantial compliance with applicable
licensure requirements. (Sec. 1)
2. Allows DHS to provide in-service training to health care institutions that request in-
service training relating to regulatory compliance outside of the survey process. (Sec. 1)
3. Requires the DHS Director to establish the following:
a) on-site monitoring fees for health care institutions that are subject to the on-site
monitoring requirements; and
b) in-service training fees, by rule, for health care institutions that request in-service
training. (Sec. 1)
4. Allows DHS 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,
transferred or if the health care institution has closed. (Sec. 6)
5. Allows DHS, if it is determined that patient safety may be in jeopardy due to a licensee's
actions, to deny a new application for licensure or a currently licensed health care
institution while any enforcement or court action related to the licensure or operation of
the health care institution is pending against the licensee. (Sec. 6)
6. Permits DHS to deny the approval of a change in ownership of a currently licensed health
care institution if DHS determined that the transfer of ownership, whether involving a
direct owner or indirect owner may jeopardize patient safety. (Sec. 6)
Memory Care
7. Requires the DHS Director to establish rules for a licensure subclass, including fees, for
an assisted living facility that wishes to provide memory care services. (Sec. 2)
8. Requires an assisted living facility that represents to the public or advertises that the
entity provides memory care services to be licensed to provide memory care services.
(Sec. 2)
9. Directs the DHS Director to establish by rule minimum training standards for staff and
contractors who work in an assisted living facility licensed to provide memory care
services. (Sec. 2)
10. Requires the training standards to include a minimum of eight hours of initial memory
care services training and four hours of annual continuing education. (Sec. 2)
11. Requires, in addition to the eight hours of initial training, the training standards for
assisted living managers must include a minimum of four hours of memory care training
that is specifically for assisted living facility managers. (Sec. 2)
12. Directs DHS to approve the memory care services training programs. (Sec. 2)
13. Requires 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 memory care services. (Sec. 2)
☐ Prop 105 (45 votes) ☐ Prop 108 (40 votes) ☐ Emergency (40 votes) ☐ Fiscal Note HB 2764
Initials AG Page 4 Senate Engrossed
14. Asserts that if a staff member or contractor who has not worked at an assisted living
facility that is licensed to provide memory care services for a period of 12 months, the
person is required to repeat the initial training. (Sec. 2)
15. Mandates that an assisted living facility that is licensed to provide memory care services
is required to provide to DHS, during an investigation or compliance survey,
documentation of memory care staff training. (Sec. 2)
16. Asserts that failure to provide documentation of memory care staff training must be cited
as a deficiency. (Sec. 2)
17. Defines memory care services. (Sec. 2)
18. Prohibits the DHS Director from accepting an accreditation report in lieu of a compliance
inspection for the following entities:
a) a residential care institution unless it has the same direct owner or indirect owner as
a licensed hospital; and
b) a nursing care institution unless it has the same direct owner or indirect owner as a
licensed hospital. (Sec. 3)
Civil Penalties
19. Adds that a health care institution license does not expire and remains valid unless the
licensee did not pay the civil penalties or provider agreement fees before the relevant due
date or did not enter into an agreement with DHS before the relevant due date to pay all
outstanding fees or civil penalties. (Sec. 4)
20. States that if DHS determines a facility to be deficiency free on a compliance survey it
does not have to conduct a compliance survey for 24 months after the date of the deficiency
free survey, except for a residential care institution or a nursing care institution that does
not have the same direct or indirect owner as a licensed hospital. (Sec. 4)
21. Increases the maximum civil penalty assessed for violations of health care institution
statutes and rules from $500 to $1,000 per violation which may be assessed for each
resident or patient that DHS determines was impacted by the violation. (Sec. 5)
22. Expands on the criteria that DHS must consider when establishing a model by rule for
assessing civil penalties:
a) the potential for an occurrence of actual harm, including to patients, staff or residents;
b) threats to health and safety, including to patients, staff or residents; and
c) the type of health care institution. (Sec. 5)
Board of Examiners of Nursing Care Institution Administrators and Assisted
Living Facility Managers
23. Increases the NCIA Board membership from 11 to 13 by adding the following members:
a) one person who is a current or former resident of a skilled nursing or assisted living
facility;
b) one public member who represents an organization that advocates for individuals
with Alzheimer's disease, dementia or other related neurocognitive diseases or
disorders;
c) one person who represents an organization that advocates for persons who have
physical disabilities; and
d) one person who represents an organization that advocates for persons who have
intellectual or developmental disabilities. (Sec. 7) HB 2764
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24. Removes the two public members who are not affiliated with a nursing care institution or
assisted living facility from the NCIA Board. (Sec. 7)
Miscellaneous
25. Exempts DHS from rulemaking requirements until July 1, 2025, except that DHS must
hold at least two public meetings. (Sec. 8)
26. Makes the enhanced memory care certification provisions effective on July 1, 2025.
(Sec. 9)
27. Makes technical and conforming changes. (Sec. 1, 4, 5 and 7)
Senate Amendments
1. Prohibits DHS from charging a fee for a complaint or compliance-related survey or
inspection if a health care institution is in substantial compliance.
2. Replaces 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.
3. 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.
4. Eliminates the prohibition on the DHS Director from accepting an accreditation report in
lieu of a compliance inspection for residential care institutions and nursing care
institutions.
5. Requires, beginning January 1, 2025, nursing care institutions, residential care
institutions and home health agencies to:
a) verify, by March 31, 2025, that an employee or potential employee is not on the Adult
Protective Services (APS) registry; and
b) annually reverify, beginning March 31, 2025, that each employee is not on the APS
registry.
6. Requires nursing care institutions, residential care institutions and home health agencies
to take action to terminate an employee's employment if the employee is found to be on
the APS registry.
7. Prohibits owners of nursing care institutions, residential care institutions and home
health agencies from hiring a potential employee if the employee is found to be on the
APS registry.
8. Allows DHS 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,
transferred or closed.
9. Allows DHS to deny an application for a health care institution license if either:
a) the applicant, licensee or a controlling person has a health care institution license
that is in an enforcement action or court action related to the health and safety of the
residents or patients; or
b) DHS has determined for reasons other than those specified that the issuance of a new
license is likely to jeopardize resident or patient safety. HB 2764
Initials AG Page 6 Senate Engrossed
10. Enables DHS to deny the approval of a change in ownership of a currently licensed health
care institution if it determines that the transfer of ownership, whether involving a direct
owner or indirect owner may jeopardize patient safety.
11. Requires DHS to consider whether a health care institution and its staff are in compliance
with the vulnerable adult reporting requirements.
12. Modifies NCIA Board membership and criteria for member qualification.
13. Provides protective service workers the ability to file for an order of protection or
injunction against harassment as a third party on behalf of a vulnerable adult to prevent
an alleged perpetrator from having access to the vulnerable adults.
14. Allows DES or protective services workers, in performing official duties, to access law
enforcement records related to an APS case.
15. Requires law enforcement entities to furnish relevant records to APS on request.
16. Requires peace officers to provide to APS any information received relating to an
allegation of abuse or neglect of a vulnerable adult as soon as possible, including all
related police records.
17. Establishes the 25-member Vulnerable Adults Study Committee (Study Committee) and
outlines membership, duties and reporting requirements.
18. Repeals the Study Committee on January 1, 2026.
19. Requires DHS to adopt rules to implement this Act.
20. Makes additional technical and conforming changes.