| 47 | 46 | | |
|---|
| 48 | 47 | | |
|---|
| 49 | 48 | | |
|---|
| 50 | 49 | | |
|---|
| 51 | 50 | | |
|---|
| 52 | 51 | | |
|---|
| 53 | 52 | | |
|---|
| 54 | 53 | | An Act |
|---|
| 55 | 54 | | |
|---|
| 56 | 55 | | |
|---|
| 57 | 56 | | |
|---|
| 58 | 57 | | amending section 36-405, Arizona Revised Statutes; amending title 36, chapter 4, article 1, Arizona Revised Statutes, by adding section 36-405.03; amending section 36-411, Arizona Revised Statutes; amending title 36, chapter 4, article 1, Arizona Revised Statutes, by adding section 36-420.05; amending sections 36-425, 36-431.01, 36-446.02, 46-452 and 46-454, Arizona Revised Statutes; relating to health care institutions. |
|---|
| 59 | 58 | | |
|---|
| 60 | 59 | | |
|---|
| 61 | 60 | | |
|---|
| 62 | 61 | | |
|---|
| 63 | 62 | | |
|---|
| 64 | 63 | | (TEXT OF BILL BEGINS ON NEXT PAGE) |
|---|
| 65 | 64 | | |
|---|
| 66 | 65 | | |
|---|
| 67 | 66 | | |
|---|
| 68 | 67 | | Be it enacted by the Legislature of the State of Arizona: Section 1. Section 36-405, Arizona Revised Statutes, is amended to read: START_STATUTE36-405. Powers and duties of the director A. The director shall adopt rules to establish minimum standards and requirements for constructing, modifying and licensing health care institutions necessary to ensure the public health, safety and welfare. The standards and requirements shall relate to the construction, equipment, sanitation, staffing for medical, nursing and personal care services, and recordkeeping pertaining to administering medical, nursing, behavioral health and personal care services, in accordance with generally accepted practices of health care. The standards shall require that a physician who is licensed pursuant to title 32, chapter 13 or 17 medically discharge patients from surgery and shall allow an outpatient surgical center to require that either an anesthesia provider who is licensed pursuant to title 32, chapter 13, 15 or 17 or a physician who is licensed pursuant to title 32, chapter 13 or 17 remain present on the premises until all patients are discharged from the recovery room. Except as otherwise provided in this subsection, the director shall use the current standards adopted by the joint commission on accreditation of hospitals and the commission on accreditation of the American osteopathic association or those adopted by any recognized accreditation organization approved by the department as guidelines in prescribing minimum standards and requirements under this section. B. The director, by rule, may: 1. Classify and subclassify health care institutions according to character, size, range of services provided, medical or dental specialty offered, duration of care and standard of patient care required for the purposes of licensure. Classes of health care institutions may include hospitals, infirmaries, outpatient treatment centers, health screening services centers and residential care facilities. Whenever the director reasonably deems distinctions in rules and standards to be appropriate among different classes or subclasses of health care institutions, the director may make such distinctions. 2. Prescribe standards for determining a health care institution's substantial compliance with licensure requirements. 3. Prescribe the criteria for the licensure inspection process. 4. Prescribe standards for selecting health care-related demonstration projects. 5. Establish nonrefundable application and licensing fees for health care institutions, including a grace period and a fee for the late payment of licensing fees. 6. Establish a process for the department to notify a licensee of the licensee's licensing fee due date. 7. Establish a process for a licensee to request a different licensing fee due date, including any limits on the number of requests by the licensee. C. The director, by rule, shall adopt licensing provisions that facilitate the colocation and integration of outpatient treatment centers that provide medical, nursing and health-related services with behavioral health services consistent with article 3.1 of this chapter. D. The director shall establish a model in rule for the department to monitor health care institutions on-site that are found to not be in substantial compliance with the applicable licensure requirements. The director shall establish on-site monitoring fees for health care institutions that are subject to the on-site monitoring requirements. The department may not charge a fee pursuant to this subsection for a complaint or compliance-related survey or inspection IF a HEALTH care institution is in substantial compliance. E. The department may provide in-service training to health care institutions that request in-service training relating to regulatory compliance outside of the survey process. The director shall establish in rule in-service training fees for health care institutions that request in-service training from the department. D. F. Ninety percent of the fees collected pursuant to this section shall be deposited, pursuant to sections 35-146 and 35-147, in the health services licensing fund established by section 36-414 and ten percent of the fees collected pursuant to this section shall be deposited, pursuant to sections 35-146 and 35-147, in the state general fund. E. G. Subsection B, paragraph 5 of this section does not apply to a health care institution operated by a state agency pursuant to state or federal law or to adult foster care residential settings. END_STATUTE Sec. 2. Title 36, chapter 4, article 1, Arizona Revised Statutes, is amended by adding section 36-405.03, to read: START_STATUTE36-405.03. Memory care services standards; rules; staff training requirements; definition A. The director shall establish by rule standards for memory care services for ASSISTED living facilities that are licensed to provide directed care services. b. The director shall establish by rule MINIMUM training standards for memory care services for staff and contractors who work in an assisted living facility that is licensed to provide directed care services. The training standards shall include a minimum of eight hours of initial memory care services training and four hours of annual continuing education. In addition to the eight hours of initial training, the training standards for assisted living facility managers shall include a minimum of four hours of memory care services training that is specifically for assisted living facility managers. The department shall approve the memory care services training programs, and the training programs shall 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. If a staff member or contractor has not worked at an assisted living facility that is licensed to provide directed care services for a period of twelve months, the person is required to complete the initial training within thirty days after the date of hire, rehire or returning to work. c. An assisted living facility that is licensed to provide directed care services is required to provide to the department during an investigation or compliance survey documentation of staff training as prescribed in subsection b of this section. Failure to provide complete staff training documentation shall be cited as a deficiency. d. For the purposes of this section, "memory care services" means 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 the department in rule. END_STATUTE Sec. 3. Section 36-411, Arizona Revised Statutes, is amended to read: START_STATUTE36-411. Residential care institutions; nursing care institutions; home health agencies; fingerprinting requirements; exemptions; definitions A. Except as provided in subsection F of this section, as a condition of licensure or continued licensure of a residential care institution, a nursing care institution or a home health agency and as a condition of employment in a residential care institution, a nursing care institution or a home health agency, employees and owners of residential care institutions, nursing care institutions or home health agencies, contracted persons of residential care institutions, nursing care institutions or home health agencies or volunteers of residential care institutions, nursing care institutions or home health agencies who provide medical services, nursing services, behavioral health services, health-related services, home health services or direct supportive services and who have not been subject to the fingerprinting requirements of a health professional's regulatory board pursuant to title 32 shall have a valid fingerprint clearance cards card that are is issued pursuant to title 41, chapter 12, article 3.1 or shall apply for a fingerprint clearance card within twenty working days of after employment or beginning volunteer work or contracted work. B. A health professional who has complied with the fingerprinting requirements of the health professional's regulatory board as a condition of licensure or certification pursuant to title 32 is not required to submit an additional set of fingerprints to the department of public safety pursuant to this section. C. Owners Each residential care institution, nursing care institution and home health agency shall make documented, good faith efforts to: 1. Contact previous employers to obtain information or recommendations that may be relevant to a person's fitness to work in a residential care institution, nursing care institution or home health agency. 2. Verify the current status of a person's fingerprint clearance card. 3. Beginning January 1, 2025, verify that a potential employee is not on the adult protective services registry pursuant to section 46-459. If a potential employee is found to be on the adult protective services registry, the residential care institution, nursing care institution or home health agency may not hire the potential employee. 4. On or before March 31, 2025, verify that each employee is not on the adult protective services registry pursuant to section 46-459. If an employee is found to be on the adult protective services registry, the residential care institution, nursing care institution or home health agency shall take action to terminate the employment of that employee. 5. Beginning March 31, 2025, annually reverify that each employee is not on the adult protective services registry pursuant to section 46-459. D. An employee, an owner, a contracted person or a volunteer or a facility on behalf of the employee, the owner, the contracted person or the volunteer shall submit a completed application that is provided by the department of public safety within twenty days after the date the person begins work or volunteer service. E. Except as provided in subsection F of this section, a residential care institution, nursing care institution or home health agency shall not allow an employee to continue employment or a volunteer or contracted person to continue to provide medical services, nursing services, behavioral health services, health-related services, home health services or direct supportive services if the person has been denied a fingerprint clearance card pursuant to title 41, chapter 12, article 3.1, has been denied approval pursuant to this section before May 7, 2001 or has had a fingerprint clearance card suspended or revoked. F. An employee, volunteer or contractor of a residential care institution, nursing care institution or home health agency who is eligible pursuant to section 41-1758.07, subsection C to petition the board of fingerprinting for a good cause exception and who provides documentation of having applied for a good cause exception pursuant to section 41-619.55 but who has not yet received a decision is exempt from the fingerprinting requirements of this section if the person provides medical services, nursing services, behavioral health services, health-related services, home health services or direct supportive services to residents or patients while under the direct visual supervision of an owner or employee who has a valid fingerprint clearance card. G. If a person's employment record contains a six-month or longer time frame during which the person was not employed by any employer, a completed application with a new set of fingerprints shall be submitted to the department of public safety. H. For the purposes of this section: 1. "Direct supportive services": (a) Means services other than home health services that provide direct individual care and that are not provided in a common area of a health care institution, including: (i) Assistance with ambulating, bathing, toileting, grooming, eating and getting in and out of a bed or chair. (ii) Assistance with self-administration of medication. (iii) Janitorial, maintenance, housekeeping or other services provided in a resident's room. (iv) Transportation services, including van services. (b) Does not include services provided by persons contracted directly by a resident or the resident's family in a health care institution. 2. "Direct visual supervision" means continuous visual oversight of the supervised person that does not require the supervisor to be in a superior organizational role to the person being supervised. 3. "Home health services" has the same meaning prescribed in section 36-151. END_STATUTE Sec. 4. Title 36, chapter 4, article 1, Arizona Revised Statutes, is amended by adding section 36-420.05, to read: START_STATUTE36-420.05. Legal action or sale; effect on licensure A. The director may 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 transferred or has closed. B. The department may deny an application for a health care institution license if either: 1. The applicant, the 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. 2. The department has determined for reasons other than those specified in paragraph 1 of this subsection that the issuance of a new license is likely to jeopardize resident or patient safety. C. The department may deny the approval of a change in ownership of a currently licensed health care institution if the department determines that the transfer of ownership, whether involving a direct owner or indirect owner, may jeopardize patient safety.END_STATUTE Sec. 5. Section 36-425, Arizona Revised Statutes, is amended to read: START_STATUTE36-425. Inspections; issuance of license; posting requirements; provisional license; denial of license A. On receipt of a properly completed application for a health care institution license, the director shall conduct an inspection of the health care institution as prescribed by this chapter. If an application for a license is submitted due to a planned change of ownership, the director shall determine the need for an inspection of the health care institution. Based on the results of the inspection and after the submission of the applicable licensing fee, the director shall either deny the license or issue a regular or provisional license. A license issued by the department shall be posted in a conspicuous location in the reception area of that health care institution. B. The director shall issue a license if the director determines that an applicant and the health care institution for which the license is sought substantially comply with the requirements of this chapter and rules adopted pursuant to this chapter and the applicant agrees to carry out a plan acceptable to the director to eliminate any deficiencies. The director shall not require a health care institution that was designated as a critical access hospital to make any modifications required by this chapter or rules adopted pursuant to this chapter in order to obtain an amended license with the same licensed capacity the health care institution had before it was designated as a critical access hospital if all of the following are true: 1. The health care institution has subsequently terminated its critical access hospital designation. 2. The licensed capacity of the health care institution does not exceed its licensed capacity before its designation as a critical access hospital. 3. The health care institution remains in compliance with the applicable codes and standards that were in effect at the time the facility was originally licensed with the higher licensed capacity. C. A health care institution license does not expire and remains valid unless: 1. The department subsequently revokes or suspends the license. 2. The license is considered void because the licensee did not pay the licensing fee, civil penalties or provider agreement fees before the licensing fee relevant due date or did not enter into an agreement with the department before the relevant due date to pay all outstanding fees or civil penalties. D. Except as provided in section 36-424, subsection B and subsection E of this section, the department shall conduct a compliance inspection of a health care institution to determine compliance with this chapter and rules adopted pursuant to this chapter at least once annually. E. If the department determines a facility, except for a residential care INSTITUTION or a nursing care institution that does not have the same direct owner or indirect owner as a hospital licensed pursuant to this chapter, to be deficiency free on a compliance survey, the department shall not conduct a compliance survey of that facility for twenty-four months after the date of the deficiency free survey. This subsection does not prohibit the department from enforcing licensing requirements as authorized by section 36-424. F. A hospital licensed as a rural general hospital may provide intensive care services. G. The director shall issue a provisional license for a period of not more than one year if an inspection or investigation of a currently licensed health care institution or a health care institution for which an applicant is seeking a license reveals that the health care institution is not in substantial compliance with department licensure requirements and the director believes that the immediate interests of the patients and the general public are best served if the health care institution is given an opportunity to correct deficiencies. The applicant or licensee shall agree to carry out a plan to eliminate deficiencies that is acceptable to the director. The director shall not issue consecutive provisional licenses to a single health care institution. The director shall not issue a license to the current licensee or a successor applicant before the expiration of the provisional license unless the health care institution submits an application for a substantial compliance survey and is found to be in substantial compliance. The director may issue a license only if the director determines that the health care institution is in substantial compliance with the licensure requirements of the department and this chapter. This subsection does not prevent the director from taking action to protect the safety of patients pursuant to section 36-427. H. Subject to the confidentiality requirements of articles 4 and 5 of this chapter, title 12, chapter 13, article 7.1 and section 12-2235, the licensee shall keep current department inspection reports at the health care institution. Unless federal law requires otherwise, the licensee shall post in a conspicuous location a notice that identifies the location at that health care institution where the inspection reports are available for review. I. A health care institution shall immediately notify the department in writing when there is a change of the chief administrative officer specified in section 36-422, subsection A, paragraph 1, subdivision (g). J. When the department issues an original license or an original provisional license to a health care institution, it shall notify the owners and lessees of any agricultural land within one-fourth mile of the health care institution. The health care institution shall provide the department with the names and addresses of owners or lessees of agricultural land within one-fourth mile of the proposed health care institution. K. In addition to the grounds for denial of licensure prescribed pursuant to subsection A of this section, the director may deny a license because an applicant or anyone in a business relationship with the applicant, including stockholders and controlling persons, has had a license to operate a health care institution denied, revoked or suspended or a license or certificate issued by a health profession regulatory board pursuant to title 32 or issued by a state agency pursuant to chapter 6, article 7 or chapter 17 of this title denied, revoked or suspended or has a licensing history of recent serious violations occurring in this state or in another state that posed a direct risk to the life, health or safety of patients or residents. L. In addition to the requirements of this chapter, the director may prescribe by rule other licensure requirements. END_STATUTE Sec. 6. Section 36-431.01, Arizona Revised Statutes, is amended to read: START_STATUTE36-431.01. Violations; civil penalties; enforcement A. The director may assess a civil penalty against a person who violates this chapter or a rule adopted pursuant to this chapter in an amount of not to exceed five hundred dollars more than $1,000 for each violation, which may be assessed for each resident or patient who the department determines was impacted by the violation. Each day that a violation occurs constitutes a separate violation. B. The director may issue a notice of assessment that shall include the proposed amount of the assessment. A person may appeal the assessment by requesting a hearing pursuant to title 41, chapter 6, article 10. When an assessment is appealed, the director shall take no further action to enforce and collect the assessment until after the hearing. C. In determining the amount of the civil penalty pursuant to subsection A of this section, the department shall consider establish a model in rule that considers the following: 1. Repeated violations of statutes or rules. 2. Patterns of noncompliance. 3. Types of violations. 4. The severity of violations. 5. The potential for and occurrences of actual harm, including to patients, staff or residents. 6. Threats to health and safety, including to patients, staff or residents. 7. The number of persons affected by the violations. 8. The number of violations. 9. The size of the facility. 10. The length of time that the violations have been occurring. 11. The type of health care institution. 12. Whether the health care institution and staff are in compliance with the reporting requirements pursuant to section 46-454. D. Pursuant to interagency agreement specified in section 36-409, the director may assess a civil penalty, including interest, in accordance with 42 United States Code section 1396r. A person may appeal this assessment by requesting a hearing before the director in accordance with subsection B of this section. Civil penalty amounts may be established by rules adopted by the director that conform to guidelines or regulations adopted by the secretary of the United States department of health and human services pursuant to 42 United States Code section 1396r. E. Actions to enforce the collection of penalties assessed pursuant to subsections A and D of this section shall be brought by the attorney general or the county attorney in the name of the state in the justice court or the superior court in the county in which the violation occurred. F. Penalties assessed under subsection D of this section are in addition to and not in limitation of other penalties imposed pursuant to this chapter. All civil penalties and interest assessed pursuant to subsection D of this section shall be deposited, pursuant to sections 35-146 and 35-147, in the nursing care institution resident protection revolving fund established by section 36-431.02. The director shall use these monies for the purposes prescribed by 42 United States Code section 1396r, including payment for the costs of relocation of residents to other facilities, maintenance of operation of a facility pending correction of the deficiencies or closure and reimbursement of residents for personal monies lost. G. The department shall transmit deposit civil penalties assessed under subsection A of this section to in the state general fund. END_STATUTE Sec. 7. Section 36-446.02, Arizona Revised Statutes, is amended to read: START_STATUTE36-446.02. Board of examiners; terms; meetings; quorum; effect of vacancies; compensation A. The board of examiners of nursing care institution administrators and assisted living facility managers is established consisting of eleven members appointed by the governor. B. The board shall include: 1. One administrator who holds an active license issued pursuant to this article or who is retired. 2. One assisted living facility manager who holds an active license issued pursuant to this article or who is retired. 3. One administrator of a nonprofit or faith-based skilled nursing facility who either holds an active license issued pursuant to this article or who is retired. 4. One administrator of a proprietary skilled nursing facility who either holds an active license issued pursuant to this article or who is retired. 5. Two managers of an assisted living center as defined in section 36-401 who either hold an active license issued pursuant to this article or who are retired. 6. One manager of an assisted living home as defined in section 36-401 who either holds an active license issued pursuant to this article or who is retired. 7. Two public members who are not affiliated with a nursing care institution or an assisted living facility. 8. 7. One public member who represents an organization that advocates for the elderly. 9. 8. One person who is a family member of a resident or a person who was a resident in the previous three years in either a skilled nursing facility or an assisted living facility at the time the person is appointed to the board. 9. One person who is a current or former resident of a skilled nursing facility or an assisted living facility. 10. One public member who represents an organization that advocates for individuals with alzheimer's disease, dementia or other related neurocognitive diseases or disorders. C. The board may not have more than three board members who are appointed pursuant to subsection B, paragraphs 1 through 6 of this section and who are retired. Each board member specified in subsection B, paragraphs 1 through 6 of this section who is retired must have had an active license issued pursuant to this article within the previous two years at the time of appointment to the board and may not have had any disciplinary action taken against the person's license or had a license issued pursuant to this article revoked. C. d. Board members who are not affiliated with a nursing care institution or an assisted living facility shall not have a direct financial interest in nursing care institutions or assisted living facilities. D. e. A board member shall not serve on any other board relating to long-term care during the member's term with the board. E. f. The term of a board member automatically ends when that member no longer meets the qualifications for appointment to the board. The board shall notify the governor of the board vacancy. F. g. Board members who are not affiliated with a nursing care institution or an assisted living facility shall be appointed for two-year terms. Board members who are the administrator of a nursing care institution or the manager of an assisted living facility shall be appointed for three-year terms. G. h. A board member shall not serve for more than two consecutive terms. H. i. The board shall meet at least twice a year. I. j. A majority of the board members constitutes a quorum. J. k. Board members are eligible to receive compensation as determined pursuant to section 38-611 for each day actually spent performing their duties under this chapter. K. l. A board member who is absent from three consecutive regular meetings or who fails to attend more than fifty percent of board meetings over the course of one calendar year vacates the board member's position. The board shall notify the governor of the vacancy. END_STATUTE Sec. 8. Section 46-452, Arizona Revised Statutes, is amended to read: START_STATUTE46-452. Protective services workers; powers and duties; immunity; communications; access to records A. A Each protective services worker shall: 1. Receive reports of abused, exploited or neglected vulnerable adults. 2. Receive from any source oral or written information regarding an adult who may be in need of protective services. 3. On receipt of such information make an evaluation to determine if the adult is in need of protective services and what services, if any, are needed. 4. Offer an adult in need of protective services or his the adult's guardian whatever services appear appropriate in view of the evaluation. 5. File petitions as necessary for the appointment of a guardian or conservator or the appointment of a temporary guardian or temporary conservator or make application for a special visitation warrant as provided for in title 14, chapter 5. 6. File for an order of protection pursuant to section 13-3602 or an injunction against harassment pursuant to section 12-1809 as a third party on behalf of the vulnerable adult to prevent an alleged perpetrator from having access to the vulnerable adult. B. The department or a protective services worker employed by the department may not be appointed as guardian, conservator or temporary guardian. C. An adult protective services worker is immune from civil liability for applying for a special visitation warrant or for filing a petition for guardianship or conservatorship unless the application or filing is done in bad faith. D. For the purposes of this chapter, communications concerning a person who is incarcerated in any jail, prison, detention center or correctional facility or concerning a patient in the Arizona state hospital are not reports that require evaluation by a protective services worker. E. The department or a protective services worker, in performing official duties, may access law enforcement records RELATED to an adult protective services case. A law enforcement entity shall furnish relevant records to adult protective services on request. END_STATUTE Sec. 9. Section 46-454, Arizona Revised Statutes, is amended to read: START_STATUTE46-454. Duty to report abuse, neglect and exploitation of vulnerable adults; duty to make medical records available; violation; classification A. A health professional, emergency medical technician, home health provider, hospital intern or resident, speech, physical or occupational therapist, long-term care provider, social worker, peace officer, medical examiner, guardian, conservator, fire protection personnel, developmental disabilities provider, employee of the department of economic security or other person who has responsibility for the care of a vulnerable adult and who has a reasonable basis to believe that abuse, neglect or exploitation of the vulnerable adult has occurred shall immediately report or cause reports to be made of such reasonable basis to a peace officer or to the adult protective services central intake unit. The guardian or conservator of a vulnerable adult shall immediately report or cause reports to be made of such reasonable basis to the superior court and the adult protective services central intake unit. All of The above reports required by this subsection shall be made immediately by telephone or online. B. If an individual listed in subsection A of this section is an employee or agent of a health care institution as defined in section 36-401 and the health care institution's procedures require that all suspected abuse, neglect and exploitation be reported to adult protective services as required by law, the individual is deemed to have complied with the requirements of subsection A of this section by reporting or causing a report to be made to the health care institution in accordance with the health care institution's procedures. C. An attorney, accountant, trustee, guardian, conservator or other person who has responsibility for preparing the tax records of a vulnerable adult or a person who has responsibility for any other action concerning the use or preservation of the vulnerable adult's property and who, in the course of fulfilling that responsibility, discovers a reasonable basis to believe that abuse, neglect or exploitation of the vulnerable adult has occurred shall immediately report or cause reports to be made of such reasonable basis to a peace officer or to the adult protective services central intake unit. All of The above reports required by this subsection shall be made immediately by telephone or online. D. Reports pursuant to subsections A and C of this section shall contain: 1. The names and addresses of the vulnerable adult and any persons having control or custody of the vulnerable adult, if known. 2. The vulnerable adult's age and the nature and extent of the vulnerable adult's vulnerability. 3. The nature and extent of the abuse, neglect or exploitation. 4. Any other information that the person reporting believes might be helpful in establishing the cause of the abuse, neglect or exploitation. E. Any person other than one required to report or cause reports to be made in pursuant to subsection A or C of this section who has a reasonable basis to believe that abuse, neglect or exploitation of a vulnerable adult has occurred may report the information to a peace officer or to the adult protective services central intake unit. F. A person having custody or control of medical or financial records of a vulnerable adult for whom a report is required or authorized under this section shall make those records, or a copy of those records, available to a peace officer or adult protective services worker investigating the vulnerable adult's abuse, neglect or exploitation on written request for the records signed by the peace officer or adult protective services worker. Records disclosed pursuant to this subsection are confidential and may be used only in a judicial or administrative proceeding or investigation resulting from a report required or authorized under this section. G. If reports pursuant to this section are received by a peace officer, the peace officer shall notify the adult protective services central intake unit as soon as possible and make that information available to them, including all RELATED police records. A peace officer shall provide the information to adult protective services as soon as possible. H. A person required to receive reports pursuant to subsection A, C or E of this section may take or cause to be taken photographs of the abused vulnerable adult and the vicinity involved. Medical examinations, including radiological examinations of the involved vulnerable adult, may be performed. Accounts, inventories or audits of the exploited vulnerable adult's property may be performed. The person, department, agency or court that initiates the photographs, examinations, accounts, inventories or audits shall pay the associated costs in accordance with existing statutes and rules. If any person is found to be responsible for the abuse, neglect or exploitation of a vulnerable adult in a criminal or civil action, the court may order the person to make restitution as the court deems appropriate. I. If psychiatric records are requested pursuant to subsection F of this section, the custodian of the records shall notify the attending psychiatrist, who may excise from the records, before they are made available: 1. Personal information about individuals other than the patient. 2. Information regarding specific diagnosis or treatment of a psychiatric condition, if the attending psychiatrist certifies in writing that release of the information would be detrimental to the patient's health or treatment. J. If any portion of a psychiatric record is excised pursuant to subsection I of this section, a court, on application of a peace officer or adult protective services worker, may order that the entire record or any portion of the record containing information relevant to the reported abuse, neglect or exploitation be made available to the peace officer or adult protective services worker investigating the abuse, neglect or exploitation. K. A licensing agency shall not find that a reported incidence of abuse at a care facility by itself is sufficient grounds to allow the agency to close the facility or to find that all residents are in imminent danger. L. Retaliation against a person who in good faith reports abuse, neglect or exploitation is prohibited. Retaliation against a vulnerable adult who is the subject of a report is prohibited. Any adverse action taken against a person who reports abuse, neglect or exploitation or a vulnerable adult who is the subject of the report within ninety days after the report is filed is presumed to be retaliation. M. A person who violates this section is guilty of a class 1 misdemeanor, except that if the failure to report involves an offense listed in title 13, chapter 14, the person is guilty of a class 6 felony.END_STATUTE Sec. 10. Vulnerable adult system study committee; membership; duties; report; delayed repeal A. The vulnerable adult system study committee is established consisting of the following members: 1. Two members of the house of representatives who are appointed by the speaker of the house of representatives and who are members of different political parties. The speaker of the house of representatives shall designate one of these members to serve as cochairperson of the committee. 2. Two members of the senate who are appointed by the president of the senate and who are members of different political parties. The president of the senate shall designate one of these members to serve as cochairperson of the committee. 3. The director of the department of health services or the director's designee. 4. The director of the department of economic security or the director's designee. 5. The director of the Arizona health care cost containment system or the director's designee. 6. One member who represents the governor's office and who is appointed by the governor. 7. One member who represents the attorney general's office and who is appointed by the attorney general. 8. One member who currently serves as the department of economic security's long-term care ombudsman or the ombudsman's designee. 9. One member who currently serves as a public fiduciary and who is appointed by the governor. 10. Two members who are employed by a local law enforcement agency or who are employed by a statewide organization that represents law enforcement and who are appointed by the governor. 11. The executive director of the Navajo area agency on aging or the executive director's designee. 12. The executive director of the intertribal council of Arizona or the executive director's designee. 13. Two members who represent assisted living facilities and who are appointed by the speaker of the house of representatives. 14. Two members who represent nursing care institutions and who are appointed by the governor. 15. One member who represents a statewide organization that advocates for elderly vulnerable adults and who is appointed by the president of the senate. 16. One member who represents a statewide organization that advocates on behalf of persons affected by Alzheimer's disease and who is appointed by the president of the senate. 17. One member who represents a statewide association that advocates on behalf of persons who provide services to persons with developmental disabilities and who is appointed by the speaker of the house of representatives. 18. One health care professional who is appointed by the speaker of the house of representatives and who both: (a) Is licensed pursuant to title 32, Arizona Revised Statutes. (b) Provides health care services to elderly vulnerable adults. 19. One member who is on the governor's advisory council on aging and who is appointed by the governor. 20. One member who represents a statewide association representing firefighters in this state and who is appointed by the president of the senate. B. The vulnerable adult system study committee shall: 1. Develop and implement a coordinated vulnerable adult delivery system that ensures the health and safety of vulnerable adults. 2. Recommend best practices relating to responding to and investigating complaints. 3. Research best practices related to adult protective services at the state, municipality and community levels. 4. Research and make recommendations on how the vulnerable adult system can ensure that vulnerable adults receive services they require after the vulnerable adult system completes its investigatory duties, including assigning a specific agency with the responsibility to provide or coordinate case management. 5. Research and identify common statewide outcomes. 6. Identify best practices for data collection and data sharing by various entities involved in providing vulnerable adult services. 7. Review and recommend changes to the statutes and rules that govern vulnerable adult services. C. The cochairpersons may designate work groups to research, study and make recommendations to the study committee. At least two work groups shall be established to separately address the needs of persons with developmental disabilities and persons who are elderly or who have a physical disability, including the training requirements for persons who are caring for these populations. D. Once a strategic direction is established, the department of economic security, in conjunction with the work groups, shall develop an action plan for implementation. E. Public members are eligible to receive reimbursement of expenses pursuant to title 38, chapter 4, article 2, Arizona Revised Statutes. F. On or before December 31, 2024, the study committee shall provide a status update of its progress, including any recommended statutory changes, to the members of the health and human services committees of the house of representatives and the senate, or their successor committees. On or before October 1, 2025, the study committee shall submit a report of its findings and recommendations to the governor, the president of the senate and the speaker of the house of representatives and shall provide a copy of this report to the secretary of state. G. This section is repealed from and after December 31, 2025. Sec. 11. Rulemaking The department of health services shall adopt rules to implement this act. Sec. 12. Effective date Section 36-405.03, Arizona Revised Statutes, as added by this act, is effective from and after June 30, 2025. |
|---|
| 69 | 68 | | |
|---|
| 70 | 69 | | Be it enacted by the Legislature of the State of Arizona: |
|---|
| 71 | 70 | | |
|---|
| 72 | 71 | | Section 1. Section 36-405, Arizona Revised Statutes, is amended to read: |
|---|
| 73 | 72 | | |
|---|
| 74 | 73 | | START_STATUTE36-405. Powers and duties of the director |
|---|
| 75 | 74 | | |
|---|
| 76 | 75 | | A. The director shall adopt rules to establish minimum standards and requirements for constructing, modifying and licensing health care institutions necessary to ensure the public health, safety and welfare. The standards and requirements shall relate to the construction, equipment, sanitation, staffing for medical, nursing and personal care services, and recordkeeping pertaining to administering medical, nursing, behavioral health and personal care services, in accordance with generally accepted practices of health care. The standards shall require that a physician who is licensed pursuant to title 32, chapter 13 or 17 medically discharge patients from surgery and shall allow an outpatient surgical center to require that either an anesthesia provider who is licensed pursuant to title 32, chapter 13, 15 or 17 or a physician who is licensed pursuant to title 32, chapter 13 or 17 remain present on the premises until all patients are discharged from the recovery room. Except as otherwise provided in this subsection, the director shall use the current standards adopted by the joint commission on accreditation of hospitals and the commission on accreditation of the American osteopathic association or those adopted by any recognized accreditation organization approved by the department as guidelines in prescribing minimum standards and requirements under this section. |
|---|
| 77 | 76 | | |
|---|
| 78 | 77 | | B. The director, by rule, may: |
|---|
| 79 | 78 | | |
|---|
| 80 | 79 | | 1. Classify and subclassify health care institutions according to character, size, range of services provided, medical or dental specialty offered, duration of care and standard of patient care required for the purposes of licensure. Classes of health care institutions may include hospitals, infirmaries, outpatient treatment centers, health screening services centers and residential care facilities. Whenever the director reasonably deems distinctions in rules and standards to be appropriate among different classes or subclasses of health care institutions, the director may make such distinctions. |
|---|
| 81 | 80 | | |
|---|
| 82 | 81 | | 2. Prescribe standards for determining a health care institution's substantial compliance with licensure requirements. |
|---|
| 83 | 82 | | |
|---|
| 84 | 83 | | 3. Prescribe the criteria for the licensure inspection process. |
|---|
| 85 | 84 | | |
|---|
| 86 | 85 | | 4. Prescribe standards for selecting health care-related demonstration projects. |
|---|
| 87 | 86 | | |
|---|
| 88 | 87 | | 5. Establish nonrefundable application and licensing fees for health care institutions, including a grace period and a fee for the late payment of licensing fees. |
|---|
| 89 | 88 | | |
|---|
| 90 | 89 | | 6. Establish a process for the department to notify a licensee of the licensee's licensing fee due date. |
|---|
| 91 | 90 | | |
|---|
| 92 | 91 | | 7. Establish a process for a licensee to request a different licensing fee due date, including any limits on the number of requests by the licensee. |
|---|
| 93 | 92 | | |
|---|
| 94 | 93 | | C. The director, by rule, shall adopt licensing provisions that facilitate the colocation and integration of outpatient treatment centers that provide medical, nursing and health-related services with behavioral health services consistent with article 3.1 of this chapter. |
|---|
| 95 | 94 | | |
|---|
| 96 | 95 | | D. The director shall establish a model in rule for the department to monitor health care institutions on-site that are found to not be in substantial compliance with the applicable licensure requirements. The director shall establish on-site monitoring fees for health care institutions that are subject to the on-site monitoring requirements. The department may not charge a fee pursuant to this subsection for a complaint or compliance-related survey or inspection IF a HEALTH care institution is in substantial compliance. |
|---|
| 97 | 96 | | |
|---|
| 98 | 97 | | E. The department may provide in-service training to health care institutions that request in-service training relating to regulatory compliance outside of the survey process. The director shall establish in rule in-service training fees for health care institutions that request in-service training from the department. |
|---|
| 99 | 98 | | |
|---|
| 100 | 99 | | D. F. Ninety percent of the fees collected pursuant to this section shall be deposited, pursuant to sections 35-146 and 35-147, in the health services licensing fund established by section 36-414 and ten percent of the fees collected pursuant to this section shall be deposited, pursuant to sections 35-146 and 35-147, in the state general fund. |
|---|
| 101 | 100 | | |
|---|
| 102 | 101 | | E. G. Subsection B, paragraph 5 of this section does not apply to a health care institution operated by a state agency pursuant to state or federal law or to adult foster care residential settings. END_STATUTE |
|---|
| 103 | 102 | | |
|---|
| 104 | 103 | | Sec. 2. Title 36, chapter 4, article 1, Arizona Revised Statutes, is amended by adding section 36-405.03, to read: |
|---|
| 105 | 104 | | |
|---|
| 106 | 105 | | START_STATUTE36-405.03. Memory care services standards; rules; staff training requirements; definition |
|---|
| 107 | 106 | | |
|---|
| 108 | 107 | | A. The director shall establish by rule standards for memory care services for ASSISTED living facilities that are licensed to provide directed care services. |
|---|
| 109 | 108 | | |
|---|
| 110 | 109 | | b. The director shall establish by rule MINIMUM training standards for memory care services for staff and contractors who work in an assisted living facility that is licensed to provide directed care services. The training standards shall include a minimum of eight hours of initial memory care services training and four hours of annual continuing education. In addition to the eight hours of initial training, the training standards for assisted living facility managers shall include a minimum of four hours of memory care services training that is specifically for assisted living facility managers. The department shall approve the memory care services training programs, and the training programs shall 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. If a staff member or contractor has not worked at an assisted living facility that is licensed to provide directed care services for a period of twelve months, the person is required to complete the initial training within thirty days after the date of hire, rehire or returning to work. |
|---|
| 111 | 110 | | |
|---|
| 112 | 111 | | c. An assisted living facility that is licensed to provide directed care services is required to provide to the department during an investigation or compliance survey documentation of staff training as prescribed in subsection b of this section. Failure to provide complete staff training documentation shall be cited as a deficiency. |
|---|
| 113 | 112 | | |
|---|
| 114 | 113 | | d. For the purposes of this section, "memory care services" means 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 the department in rule. END_STATUTE |
|---|
| 115 | 114 | | |
|---|
| 116 | 115 | | Sec. 3. Section 36-411, Arizona Revised Statutes, is amended to read: |
|---|
| 117 | 116 | | |
|---|
| 118 | 117 | | START_STATUTE36-411. Residential care institutions; nursing care institutions; home health agencies; fingerprinting requirements; exemptions; definitions |
|---|
| 119 | 118 | | |
|---|
| 120 | 119 | | A. Except as provided in subsection F of this section, as a condition of licensure or continued licensure of a residential care institution, a nursing care institution or a home health agency and as a condition of employment in a residential care institution, a nursing care institution or a home health agency, employees and owners of residential care institutions, nursing care institutions or home health agencies, contracted persons of residential care institutions, nursing care institutions or home health agencies or volunteers of residential care institutions, nursing care institutions or home health agencies who provide medical services, nursing services, behavioral health services, health-related services, home health services or direct supportive services and who have not been subject to the fingerprinting requirements of a health professional's regulatory board pursuant to title 32 shall have a valid fingerprint clearance cards card that are is issued pursuant to title 41, chapter 12, article 3.1 or shall apply for a fingerprint clearance card within twenty working days of after employment or beginning volunteer work or contracted work. |
|---|
| 121 | 120 | | |
|---|
| 122 | 121 | | B. A health professional who has complied with the fingerprinting requirements of the health professional's regulatory board as a condition of licensure or certification pursuant to title 32 is not required to submit an additional set of fingerprints to the department of public safety pursuant to this section. |
|---|
| 123 | 122 | | |
|---|
| 124 | 123 | | C. Owners Each residential care institution, nursing care institution and home health agency shall make documented, good faith efforts to: |
|---|
| 125 | 124 | | |
|---|
| 126 | 125 | | 1. Contact previous employers to obtain information or recommendations that may be relevant to a person's fitness to work in a residential care institution, nursing care institution or home health agency. |
|---|
| 127 | 126 | | |
|---|
| 128 | 127 | | 2. Verify the current status of a person's fingerprint clearance card. |
|---|
| 129 | 128 | | |
|---|
| 130 | 129 | | 3. Beginning January 1, 2025, verify that a potential employee is not on the adult protective services registry pursuant to section 46-459. If a potential employee is found to be on the adult protective services registry, the residential care institution, nursing care institution or home health agency may not hire the potential employee. |
|---|
| 131 | 130 | | |
|---|
| 132 | 131 | | 4. On or before March 31, 2025, verify that each employee is not on the adult protective services registry pursuant to section 46-459. If an employee is found to be on the adult protective services registry, the residential care institution, nursing care institution or home health agency shall take action to terminate the employment of that employee. |
|---|
| 133 | 132 | | |
|---|
| 134 | 133 | | 5. Beginning March 31, 2025, annually reverify that each employee is not on the adult protective services registry pursuant to section 46-459. |
|---|
| 135 | 134 | | |
|---|
| 136 | 135 | | D. An employee, an owner, a contracted person or a volunteer or a facility on behalf of the employee, the owner, the contracted person or the volunteer shall submit a completed application that is provided by the department of public safety within twenty days after the date the person begins work or volunteer service. |
|---|
| 137 | 136 | | |
|---|
| 138 | 137 | | E. Except as provided in subsection F of this section, a residential care institution, nursing care institution or home health agency shall not allow an employee to continue employment or a volunteer or contracted person to continue to provide medical services, nursing services, behavioral health services, health-related services, home health services or direct supportive services if the person has been denied a fingerprint clearance card pursuant to title 41, chapter 12, article 3.1, has been denied approval pursuant to this section before May 7, 2001 or has had a fingerprint clearance card suspended or revoked. |
|---|
| 139 | 138 | | |
|---|
| 140 | 139 | | F. An employee, volunteer or contractor of a residential care institution, nursing care institution or home health agency who is eligible pursuant to section 41-1758.07, subsection C to petition the board of fingerprinting for a good cause exception and who provides documentation of having applied for a good cause exception pursuant to section 41-619.55 but who has not yet received a decision is exempt from the fingerprinting requirements of this section if the person provides medical services, nursing services, behavioral health services, health-related services, home health services or direct supportive services to residents or patients while under the direct visual supervision of an owner or employee who has a valid fingerprint clearance card. |
|---|
| 141 | 140 | | |
|---|
| 142 | 141 | | G. If a person's employment record contains a six-month or longer time frame during which the person was not employed by any employer, a completed application with a new set of fingerprints shall be submitted to the department of public safety. |
|---|
| 143 | 142 | | |
|---|
| 144 | 143 | | H. For the purposes of this section: |
|---|
| 145 | 144 | | |
|---|
| 146 | 145 | | 1. "Direct supportive services": |
|---|
| 147 | 146 | | |
|---|
| 148 | 147 | | (a) Means services other than home health services that provide direct individual care and that are not provided in a common area of a health care institution, including: |
|---|
| 149 | 148 | | |
|---|
| 150 | 149 | | (i) Assistance with ambulating, bathing, toileting, grooming, eating and getting in and out of a bed or chair. |
|---|
| 151 | 150 | | |
|---|
| 152 | 151 | | (ii) Assistance with self-administration of medication. |
|---|
| 153 | 152 | | |
|---|
| 154 | 153 | | (iii) Janitorial, maintenance, housekeeping or other services provided in a resident's room. |
|---|
| 155 | 154 | | |
|---|
| 156 | 155 | | (iv) Transportation services, including van services. |
|---|
| 157 | 156 | | |
|---|
| 158 | 157 | | (b) Does not include services provided by persons contracted directly by a resident or the resident's family in a health care institution. |
|---|
| 159 | 158 | | |
|---|
| 160 | 159 | | 2. "Direct visual supervision" means continuous visual oversight of the supervised person that does not require the supervisor to be in a superior organizational role to the person being supervised. |
|---|
| 161 | 160 | | |
|---|
| 162 | 161 | | 3. "Home health services" has the same meaning prescribed in section 36-151. END_STATUTE |
|---|
| 163 | 162 | | |
|---|
| 164 | 163 | | Sec. 4. Title 36, chapter 4, article 1, Arizona Revised Statutes, is amended by adding section 36-420.05, to read: |
|---|
| 165 | 164 | | |
|---|
| 166 | 165 | | START_STATUTE36-420.05. Legal action or sale; effect on licensure |
|---|
| 167 | 166 | | |
|---|
| 168 | 167 | | A. The director may 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 transferred or has closed. |
|---|
| 169 | 168 | | |
|---|
| 170 | 169 | | B. The department may deny an application for a health care institution license if either: |
|---|
| 171 | 170 | | |
|---|
| 172 | 171 | | 1. The applicant, the 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. |
|---|
| 173 | 172 | | |
|---|
| 174 | 173 | | 2. The department has determined for reasons other than those specified in paragraph 1 of this subsection that the issuance of a new license is likely to jeopardize resident or patient safety. |
|---|
| 175 | 174 | | |
|---|
| 176 | 175 | | C. The department may deny the approval of a change in ownership of a currently licensed health care institution if the department determines that the transfer of ownership, whether involving a direct owner or indirect owner, may jeopardize patient safety.END_STATUTE |
|---|
| 177 | 176 | | |
|---|
| 178 | 177 | | Sec. 5. Section 36-425, Arizona Revised Statutes, is amended to read: |
|---|
| 179 | 178 | | |
|---|
| 180 | 179 | | START_STATUTE36-425. Inspections; issuance of license; posting requirements; provisional license; denial of license |
|---|
| 181 | 180 | | |
|---|
| 182 | 181 | | A. On receipt of a properly completed application for a health care institution license, the director shall conduct an inspection of the health care institution as prescribed by this chapter. If an application for a license is submitted due to a planned change of ownership, the director shall determine the need for an inspection of the health care institution. Based on the results of the inspection and after the submission of the applicable licensing fee, the director shall either deny the license or issue a regular or provisional license. A license issued by the department shall be posted in a conspicuous location in the reception area of that health care institution. |
|---|
| 183 | 182 | | |
|---|
| 184 | 183 | | B. The director shall issue a license if the director determines that an applicant and the health care institution for which the license is sought substantially comply with the requirements of this chapter and rules adopted pursuant to this chapter and the applicant agrees to carry out a plan acceptable to the director to eliminate any deficiencies. The director shall not require a health care institution that was designated as a critical access hospital to make any modifications required by this chapter or rules adopted pursuant to this chapter in order to obtain an amended license with the same licensed capacity the health care institution had before it was designated as a critical access hospital if all of the following are true: |
|---|
| 185 | 184 | | |
|---|
| 186 | 185 | | 1. The health care institution has subsequently terminated its critical access hospital designation. |
|---|
| 187 | 186 | | |
|---|
| 188 | 187 | | 2. The licensed capacity of the health care institution does not exceed its licensed capacity before its designation as a critical access hospital. |
|---|
| 189 | 188 | | |
|---|
| 190 | 189 | | 3. The health care institution remains in compliance with the applicable codes and standards that were in effect at the time the facility was originally licensed with the higher licensed capacity. |
|---|
| 191 | 190 | | |
|---|
| 192 | 191 | | C. A health care institution license does not expire and remains valid unless: |
|---|
| 193 | 192 | | |
|---|
| 194 | 193 | | 1. The department subsequently revokes or suspends the license. |
|---|
| 195 | 194 | | |
|---|
| 196 | 195 | | 2. The license is considered void because the licensee did not pay the licensing fee, civil penalties or provider agreement fees before the licensing fee relevant due date or did not enter into an agreement with the department before the relevant due date to pay all outstanding fees or civil penalties. |
|---|
| 197 | 196 | | |
|---|
| 198 | 197 | | D. Except as provided in section 36-424, subsection B and subsection E of this section, the department shall conduct a compliance inspection of a health care institution to determine compliance with this chapter and rules adopted pursuant to this chapter at least once annually. |
|---|
| 199 | 198 | | |
|---|
| 200 | 199 | | E. If the department determines a facility, except for a residential care INSTITUTION or a nursing care institution that does not have the same direct owner or indirect owner as a hospital licensed pursuant to this chapter, to be deficiency free on a compliance survey, the department shall not conduct a compliance survey of that facility for twenty-four months after the date of the deficiency free survey. This subsection does not prohibit the department from enforcing licensing requirements as authorized by section 36-424. |
|---|
| 201 | 200 | | |
|---|
| 202 | 201 | | F. A hospital licensed as a rural general hospital may provide intensive care services. |
|---|
| 203 | 202 | | |
|---|
| 204 | 203 | | G. The director shall issue a provisional license for a period of not more than one year if an inspection or investigation of a currently licensed health care institution or a health care institution for which an applicant is seeking a license reveals that the health care institution is not in substantial compliance with department licensure requirements and the director believes that the immediate interests of the patients and the general public are best served if the health care institution is given an opportunity to correct deficiencies. The applicant or licensee shall agree to carry out a plan to eliminate deficiencies that is acceptable to the director. The director shall not issue consecutive provisional licenses to a single health care institution. The director shall not issue a license to the current licensee or a successor applicant before the expiration of the provisional license unless the health care institution submits an application for a substantial compliance survey and is found to be in substantial compliance. The director may issue a license only if the director determines that the health care institution is in substantial compliance with the licensure requirements of the department and this chapter. This subsection does not prevent the director from taking action to protect the safety of patients pursuant to section 36-427. |
|---|
| 205 | 204 | | |
|---|
| 206 | 205 | | H. Subject to the confidentiality requirements of articles 4 and 5 of this chapter, title 12, chapter 13, article 7.1 and section 12-2235, the licensee shall keep current department inspection reports at the health care institution. Unless federal law requires otherwise, the licensee shall post in a conspicuous location a notice that identifies the location at that health care institution where the inspection reports are available for review. |
|---|
| 207 | 206 | | |
|---|
| 208 | 207 | | I. A health care institution shall immediately notify the department in writing when there is a change of the chief administrative officer specified in section 36-422, subsection A, paragraph 1, subdivision (g). |
|---|
| 209 | 208 | | |
|---|
| 210 | 209 | | J. When the department issues an original license or an original provisional license to a health care institution, it shall notify the owners and lessees of any agricultural land within one-fourth mile of the health care institution. The health care institution shall provide the department with the names and addresses of owners or lessees of agricultural land within one-fourth mile of the proposed health care institution. |
|---|
| 211 | 210 | | |
|---|
| 212 | 211 | | K. In addition to the grounds for denial of licensure prescribed pursuant to subsection A of this section, the director may deny a license because an applicant or anyone in a business relationship with the applicant, including stockholders and controlling persons, has had a license to operate a health care institution denied, revoked or suspended or a license or certificate issued by a health profession regulatory board pursuant to title 32 or issued by a state agency pursuant to chapter 6, article 7 or chapter 17 of this title denied, revoked or suspended or has a licensing history of recent serious violations occurring in this state or in another state that posed a direct risk to the life, health or safety of patients or residents. |
|---|
| 213 | 212 | | |
|---|
| 214 | 213 | | L. In addition to the requirements of this chapter, the director may prescribe by rule other licensure requirements. END_STATUTE |
|---|
| 215 | 214 | | |
|---|
| 216 | 215 | | Sec. 6. Section 36-431.01, Arizona Revised Statutes, is amended to read: |
|---|
| 217 | 216 | | |
|---|
| 218 | 217 | | START_STATUTE36-431.01. Violations; civil penalties; enforcement |
|---|
| 219 | 218 | | |
|---|
| 220 | 219 | | A. The director may assess a civil penalty against a person who violates this chapter or a rule adopted pursuant to this chapter in an amount of not to exceed five hundred dollars more than $1,000 for each violation, which may be assessed for each resident or patient who the department determines was impacted by the violation. Each day that a violation occurs constitutes a separate violation. |
|---|
| 221 | 220 | | |
|---|
| 222 | 221 | | B. The director may issue a notice of assessment that shall include the proposed amount of the assessment. A person may appeal the assessment by requesting a hearing pursuant to title 41, chapter 6, article 10. When an assessment is appealed, the director shall take no further action to enforce and collect the assessment until after the hearing. |
|---|
| 223 | 222 | | |
|---|
| 224 | 223 | | C. In determining the amount of the civil penalty pursuant to subsection A of this section, the department shall consider establish a model in rule that considers the following: |
|---|
| 225 | 224 | | |
|---|
| 226 | 225 | | 1. Repeated violations of statutes or rules. |
|---|
| 227 | 226 | | |
|---|
| 228 | 227 | | 2. Patterns of noncompliance. |
|---|
| 229 | 228 | | |
|---|
| 230 | 229 | | 3. Types of violations. |
|---|
| 231 | 230 | | |
|---|
| 232 | 231 | | 4. The severity of violations. |
|---|
| 233 | 232 | | |
|---|
| 234 | 233 | | 5. The potential for and occurrences of actual harm, including to patients, staff or residents. |
|---|
| 235 | 234 | | |
|---|
| 236 | 235 | | 6. Threats to health and safety, including to patients, staff or residents. |
|---|
| 237 | 236 | | |
|---|
| 238 | 237 | | 7. The number of persons affected by the violations. |
|---|
| 239 | 238 | | |
|---|
| 240 | 239 | | 8. The number of violations. |
|---|
| 241 | 240 | | |
|---|
| 242 | 241 | | 9. The size of the facility. |
|---|
| 243 | 242 | | |
|---|
| 244 | 243 | | 10. The length of time that the violations have been occurring. |
|---|
| 245 | 244 | | |
|---|
| 246 | 245 | | 11. The type of health care institution. |
|---|
| 247 | 246 | | |
|---|
| 248 | 247 | | 12. Whether the health care institution and staff are in compliance with the reporting requirements pursuant to section 46-454. |
|---|
| 249 | 248 | | |
|---|
| 250 | 249 | | D. Pursuant to interagency agreement specified in section 36-409, the director may assess a civil penalty, including interest, in accordance with 42 United States Code section 1396r. A person may appeal this assessment by requesting a hearing before the director in accordance with subsection B of this section. Civil penalty amounts may be established by rules adopted by the director that conform to guidelines or regulations adopted by the secretary of the United States department of health and human services pursuant to 42 United States Code section 1396r. |
|---|
| 251 | 250 | | |
|---|
| 252 | 251 | | E. Actions to enforce the collection of penalties assessed pursuant to subsections A and D of this section shall be brought by the attorney general or the county attorney in the name of the state in the justice court or the superior court in the county in which the violation occurred. |
|---|
| 253 | 252 | | |
|---|
| 254 | 253 | | F. Penalties assessed under subsection D of this section are in addition to and not in limitation of other penalties imposed pursuant to this chapter. All civil penalties and interest assessed pursuant to subsection D of this section shall be deposited, pursuant to sections 35-146 and 35-147, in the nursing care institution resident protection revolving fund established by section 36-431.02. The director shall use these monies for the purposes prescribed by 42 United States Code section 1396r, including payment for the costs of relocation of residents to other facilities, maintenance of operation of a facility pending correction of the deficiencies or closure and reimbursement of residents for personal monies lost. |
|---|
| 255 | 254 | | |
|---|
| 256 | 255 | | G. The department shall transmit deposit civil penalties assessed under subsection A of this section to in the state general fund. END_STATUTE |
|---|
| 257 | 256 | | |
|---|
| 258 | 257 | | Sec. 7. Section 36-446.02, Arizona Revised Statutes, is amended to read: |
|---|
| 259 | 258 | | |
|---|
| 260 | 259 | | START_STATUTE36-446.02. Board of examiners; terms; meetings; quorum; effect of vacancies; compensation |
|---|
| 261 | 260 | | |
|---|
| 262 | 261 | | A. The board of examiners of nursing care institution administrators and assisted living facility managers is established consisting of eleven members appointed by the governor. |
|---|
| 263 | 262 | | |
|---|
| 264 | 263 | | B. The board shall include: |
|---|
| 265 | 264 | | |
|---|
| 266 | 265 | | 1. One administrator who holds an active license issued pursuant to this article or who is retired. |
|---|
| 267 | 266 | | |
|---|
| 268 | 267 | | 2. One assisted living facility manager who holds an active license issued pursuant to this article or who is retired. |
|---|
| 269 | 268 | | |
|---|
| 270 | 269 | | 3. One administrator of a nonprofit or faith-based skilled nursing facility who either holds an active license issued pursuant to this article or who is retired. |
|---|
| 271 | 270 | | |
|---|
| 272 | 271 | | 4. One administrator of a proprietary skilled nursing facility who either holds an active license issued pursuant to this article or who is retired. |
|---|
| 273 | 272 | | |
|---|
| 274 | 273 | | 5. Two managers of an assisted living center as defined in section 36-401 who either hold an active license issued pursuant to this article or who are retired. |
|---|
| 275 | 274 | | |
|---|
| 276 | 275 | | 6. One manager of an assisted living home as defined in section 36-401 who either holds an active license issued pursuant to this article or who is retired. |
|---|
| 277 | 276 | | |
|---|
| 278 | 277 | | 7. Two public members who are not affiliated with a nursing care institution or an assisted living facility. |
|---|
| 279 | 278 | | |
|---|
| 280 | 279 | | 8. 7. One public member who represents an organization that advocates for the elderly. |
|---|
| 281 | 280 | | |
|---|
| 282 | 281 | | 9. 8. One person who is a family member of a resident or a person who was a resident in the previous three years in either a skilled nursing facility or an assisted living facility at the time the person is appointed to the board. |
|---|
| 283 | 282 | | |
|---|
| 284 | 283 | | 9. One person who is a current or former resident of a skilled nursing facility or an assisted living facility. |
|---|
| 285 | 284 | | |
|---|
| 286 | 285 | | 10. One public member who represents an organization that advocates for individuals with alzheimer's disease, dementia or other related neurocognitive diseases or disorders. |
|---|
| 287 | 286 | | |
|---|
| 288 | 287 | | C. The board may not have more than three board members who are appointed pursuant to subsection B, paragraphs 1 through 6 of this section and who are retired. Each board member specified in subsection B, paragraphs 1 through 6 of this section who is retired must have had an active license issued pursuant to this article within the previous two years at the time of appointment to the board and may not have had any disciplinary action taken against the person's license or had a license issued pursuant to this article revoked. |
|---|
| 289 | 288 | | |
|---|
| 290 | 289 | | C. d. Board members who are not affiliated with a nursing care institution or an assisted living facility shall not have a direct financial interest in nursing care institutions or assisted living facilities. |
|---|
| 291 | 290 | | |
|---|
| 292 | 291 | | D. e. A board member shall not serve on any other board relating to long-term care during the member's term with the board. |
|---|
| 293 | 292 | | |
|---|
| 294 | 293 | | E. f. The term of a board member automatically ends when that member no longer meets the qualifications for appointment to the board. The board shall notify the governor of the board vacancy. |
|---|
| 295 | 294 | | |
|---|
| 296 | 295 | | F. g. Board members who are not affiliated with a nursing care institution or an assisted living facility shall be appointed for two-year terms. Board members who are the administrator of a nursing care institution or the manager of an assisted living facility shall be appointed for three-year terms. |
|---|
| 297 | 296 | | |
|---|
| 298 | 297 | | G. h. A board member shall not serve for more than two consecutive terms. |
|---|
| 299 | 298 | | |
|---|
| 300 | 299 | | H. i. The board shall meet at least twice a year. |
|---|
| 301 | 300 | | |
|---|
| 302 | 301 | | I. j. A majority of the board members constitutes a quorum. |
|---|
| 303 | 302 | | |
|---|
| 304 | 303 | | J. k. Board members are eligible to receive compensation as determined pursuant to section 38-611 for each day actually spent performing their duties under this chapter. |
|---|
| 305 | 304 | | |
|---|
| 306 | 305 | | K. l. A board member who is absent from three consecutive regular meetings or who fails to attend more than fifty percent of board meetings over the course of one calendar year vacates the board member's position. The board shall notify the governor of the vacancy. END_STATUTE |
|---|
| 307 | 306 | | |
|---|
| 308 | 307 | | Sec. 8. Section 46-452, Arizona Revised Statutes, is amended to read: |
|---|
| 309 | 308 | | |
|---|
| 310 | 309 | | START_STATUTE46-452. Protective services workers; powers and duties; immunity; communications; access to records |
|---|
| 311 | 310 | | |
|---|
| 312 | 311 | | A. A Each protective services worker shall: |
|---|
| 313 | 312 | | |
|---|
| 314 | 313 | | 1. Receive reports of abused, exploited or neglected vulnerable adults. |
|---|
| 315 | 314 | | |
|---|
| 316 | 315 | | 2. Receive from any source oral or written information regarding an adult who may be in need of protective services. |
|---|
| 317 | 316 | | |
|---|
| 318 | 317 | | 3. On receipt of such information make an evaluation to determine if the adult is in need of protective services and what services, if any, are needed. |
|---|
| 319 | 318 | | |
|---|
| 320 | 319 | | 4. Offer an adult in need of protective services or his the adult's guardian whatever services appear appropriate in view of the evaluation. |
|---|
| 321 | 320 | | |
|---|
| 322 | 321 | | 5. File petitions as necessary for the appointment of a guardian or conservator or the appointment of a temporary guardian or temporary conservator or make application for a special visitation warrant as provided for in title 14, chapter 5. |
|---|
| 323 | 322 | | |
|---|
| 324 | 323 | | 6. File for an order of protection pursuant to section 13-3602 or an injunction against harassment pursuant to section 12-1809 as a third party on behalf of the vulnerable adult to prevent an alleged perpetrator from having access to the vulnerable adult. |
|---|
| 325 | 324 | | |
|---|
| 326 | 325 | | B. The department or a protective services worker employed by the department may not be appointed as guardian, conservator or temporary guardian. |
|---|
| 327 | 326 | | |
|---|
| 328 | 327 | | C. An adult protective services worker is immune from civil liability for applying for a special visitation warrant or for filing a petition for guardianship or conservatorship unless the application or filing is done in bad faith. |
|---|
| 329 | 328 | | |
|---|
| 330 | 329 | | D. For the purposes of this chapter, communications concerning a person who is incarcerated in any jail, prison, detention center or correctional facility or concerning a patient in the Arizona state hospital are not reports that require evaluation by a protective services worker. |
|---|
| 331 | 330 | | |
|---|
| 332 | 331 | | E. The department or a protective services worker, in performing official duties, may access law enforcement records RELATED to an adult protective services case. A law enforcement entity shall furnish relevant records to adult protective services on request. END_STATUTE |
|---|
| 333 | 332 | | |
|---|
| 334 | 333 | | Sec. 9. Section 46-454, Arizona Revised Statutes, is amended to read: |
|---|
| 335 | 334 | | |
|---|
| 336 | 335 | | START_STATUTE46-454. Duty to report abuse, neglect and exploitation of vulnerable adults; duty to make medical records available; violation; classification |
|---|
| 337 | 336 | | |
|---|
| 338 | 337 | | A. A health professional, emergency medical technician, home health provider, hospital intern or resident, speech, physical or occupational therapist, long-term care provider, social worker, peace officer, medical examiner, guardian, conservator, fire protection personnel, developmental disabilities provider, employee of the department of economic security or other person who has responsibility for the care of a vulnerable adult and who has a reasonable basis to believe that abuse, neglect or exploitation of the vulnerable adult has occurred shall immediately report or cause reports to be made of such reasonable basis to a peace officer or to the adult protective services central intake unit. The guardian or conservator of a vulnerable adult shall immediately report or cause reports to be made of such reasonable basis to the superior court and the adult protective services central intake unit. All of The above reports required by this subsection shall be made immediately by telephone or online. |
|---|
| 339 | 338 | | |
|---|
| 340 | 339 | | B. If an individual listed in subsection A of this section is an employee or agent of a health care institution as defined in section 36-401 and the health care institution's procedures require that all suspected abuse, neglect and exploitation be reported to adult protective services as required by law, the individual is deemed to have complied with the requirements of subsection A of this section by reporting or causing a report to be made to the health care institution in accordance with the health care institution's procedures. |
|---|
| 341 | 340 | | |
|---|
| 342 | 341 | | C. An attorney, accountant, trustee, guardian, conservator or other person who has responsibility for preparing the tax records of a vulnerable adult or a person who has responsibility for any other action concerning the use or preservation of the vulnerable adult's property and who, in the course of fulfilling that responsibility, discovers a reasonable basis to believe that abuse, neglect or exploitation of the vulnerable adult has occurred shall immediately report or cause reports to be made of such reasonable basis to a peace officer or to the adult protective services central intake unit. All of The above reports required by this subsection shall be made immediately by telephone or online. |
|---|
| 343 | 342 | | |
|---|
| 344 | 343 | | D. Reports pursuant to subsections A and C of this section shall contain: |
|---|
| 345 | 344 | | |
|---|
| 346 | 345 | | 1. The names and addresses of the vulnerable adult and any persons having control or custody of the vulnerable adult, if known. |
|---|
| 347 | 346 | | |
|---|
| 348 | 347 | | 2. The vulnerable adult's age and the nature and extent of the vulnerable adult's vulnerability. |
|---|
| 349 | 348 | | |
|---|
| 350 | 349 | | 3. The nature and extent of the abuse, neglect or exploitation. |
|---|
| 351 | 350 | | |
|---|
| 352 | 351 | | 4. Any other information that the person reporting believes might be helpful in establishing the cause of the abuse, neglect or exploitation. |
|---|
| 353 | 352 | | |
|---|
| 354 | 353 | | E. Any person other than one required to report or cause reports to be made in pursuant to subsection A or C of this section who has a reasonable basis to believe that abuse, neglect or exploitation of a vulnerable adult has occurred may report the information to a peace officer or to the adult protective services central intake unit. |
|---|
| 355 | 354 | | |
|---|
| 356 | 355 | | F. A person having custody or control of medical or financial records of a vulnerable adult for whom a report is required or authorized under this section shall make those records, or a copy of those records, available to a peace officer or adult protective services worker investigating the vulnerable adult's abuse, neglect or exploitation on written request for the records signed by the peace officer or adult protective services worker. Records disclosed pursuant to this subsection are confidential and may be used only in a judicial or administrative proceeding or investigation resulting from a report required or authorized under this section. |
|---|
| 357 | 356 | | |
|---|
| 358 | 357 | | G. If reports pursuant to this section are received by a peace officer, the peace officer shall notify the adult protective services central intake unit as soon as possible and make that information available to them, including all RELATED police records. A peace officer shall provide the information to adult protective services as soon as possible. |
|---|
| 359 | 358 | | |
|---|
| 360 | 359 | | H. A person required to receive reports pursuant to subsection A, C or E of this section may take or cause to be taken photographs of the abused vulnerable adult and the vicinity involved. Medical examinations, including radiological examinations of the involved vulnerable adult, may be performed. Accounts, inventories or audits of the exploited vulnerable adult's property may be performed. The person, department, agency or court that initiates the photographs, examinations, accounts, inventories or audits shall pay the associated costs in accordance with existing statutes and rules. If any person is found to be responsible for the abuse, neglect or exploitation of a vulnerable adult in a criminal or civil action, the court may order the person to make restitution as the court deems appropriate. |
|---|
| 361 | 360 | | |
|---|
| 362 | 361 | | I. If psychiatric records are requested pursuant to subsection F of this section, the custodian of the records shall notify the attending psychiatrist, who may excise from the records, before they are made available: |
|---|
| 363 | 362 | | |
|---|
| 364 | 363 | | 1. Personal information about individuals other than the patient. |
|---|
| 365 | 364 | | |
|---|
| 366 | 365 | | 2. Information regarding specific diagnosis or treatment of a psychiatric condition, if the attending psychiatrist certifies in writing that release of the information would be detrimental to the patient's health or treatment. |
|---|
| 367 | 366 | | |
|---|
| 368 | 367 | | J. If any portion of a psychiatric record is excised pursuant to subsection I of this section, a court, on application of a peace officer or adult protective services worker, may order that the entire record or any portion of the record containing information relevant to the reported abuse, neglect or exploitation be made available to the peace officer or adult protective services worker investigating the abuse, neglect or exploitation. |
|---|
| 369 | 368 | | |
|---|
| 370 | 369 | | K. A licensing agency shall not find that a reported incidence of abuse at a care facility by itself is sufficient grounds to allow the agency to close the facility or to find that all residents are in imminent danger. |
|---|
| 371 | 370 | | |
|---|
| 372 | 371 | | L. Retaliation against a person who in good faith reports abuse, neglect or exploitation is prohibited. Retaliation against a vulnerable adult who is the subject of a report is prohibited. Any adverse action taken against a person who reports abuse, neglect or exploitation or a vulnerable adult who is the subject of the report within ninety days after the report is filed is presumed to be retaliation. |
|---|
| 373 | 372 | | |
|---|
| 374 | 373 | | M. A person who violates this section is guilty of a class 1 misdemeanor, except that if the failure to report involves an offense listed in title 13, chapter 14, the person is guilty of a class 6 felony.END_STATUTE |
|---|
| 375 | 374 | | |
|---|
| 376 | 375 | | Sec. 10. Vulnerable adult system study committee; membership; duties; report; delayed repeal |
|---|
| 377 | 376 | | |
|---|
| 378 | 377 | | A. The vulnerable adult system study committee is established consisting of the following members: |
|---|
| 379 | 378 | | |
|---|
| 380 | 379 | | 1. Two members of the house of representatives who are appointed by the speaker of the house of representatives and who are members of different political parties. The speaker of the house of representatives shall designate one of these members to serve as cochairperson of the committee. |
|---|
| 381 | 380 | | |
|---|
| 382 | 381 | | 2. Two members of the senate who are appointed by the president of the senate and who are members of different political parties. The president of the senate shall designate one of these members to serve as cochairperson of the committee. |
|---|
| 383 | 382 | | |
|---|
| 384 | 383 | | 3. The director of the department of health services or the director's designee. |
|---|
| 385 | 384 | | |
|---|
| 386 | 385 | | 4. The director of the department of economic security or the director's designee. |
|---|
| 387 | 386 | | |
|---|
| 388 | 387 | | 5. The director of the Arizona health care cost containment system or the director's designee. |
|---|
| 389 | 388 | | |
|---|
| 390 | 389 | | 6. One member who represents the governor's office and who is appointed by the governor. |
|---|
| 391 | 390 | | |
|---|
| 392 | 391 | | 7. One member who represents the attorney general's office and who is appointed by the attorney general. |
|---|
| 393 | 392 | | |
|---|
| 394 | 393 | | 8. One member who currently serves as the department of economic security's long-term care ombudsman or the ombudsman's designee. |
|---|
| 395 | 394 | | |
|---|
| 396 | 395 | | 9. One member who currently serves as a public fiduciary and who is appointed by the governor. |
|---|
| 397 | 396 | | |
|---|
| 398 | 397 | | 10. Two members who are employed by a local law enforcement agency or who are employed by a statewide organization that represents law enforcement and who are appointed by the governor. |
|---|
| 399 | 398 | | |
|---|
| 400 | 399 | | 11. The executive director of the Navajo area agency on aging or the executive director's designee. |
|---|
| 401 | 400 | | |
|---|
| 402 | 401 | | 12. The executive director of the intertribal council of Arizona or the executive director's designee. |
|---|
| 403 | 402 | | |
|---|
| 404 | 403 | | 13. Two members who represent assisted living facilities and who are appointed by the speaker of the house of representatives. |
|---|
| 405 | 404 | | |
|---|
| 406 | 405 | | 14. Two members who represent nursing care institutions and who are appointed by the governor. |
|---|
| 407 | 406 | | |
|---|
| 408 | 407 | | 15. One member who represents a statewide organization that advocates for elderly vulnerable adults and who is appointed by the president of the senate. |
|---|
| 409 | 408 | | |
|---|
| 410 | 409 | | 16. One member who represents a statewide organization that advocates on behalf of persons affected by Alzheimer's disease and who is appointed by the president of the senate. |
|---|
| 411 | 410 | | |
|---|
| 412 | 411 | | 17. One member who represents a statewide association that advocates on behalf of persons who provide services to persons with developmental disabilities and who is appointed by the speaker of the house of representatives. |
|---|
| 413 | 412 | | |
|---|
| 414 | 413 | | 18. One health care professional who is appointed by the speaker of the house of representatives and who both: |
|---|
| 415 | 414 | | |
|---|
| 416 | 415 | | (a) Is licensed pursuant to title 32, Arizona Revised Statutes. |
|---|
| 417 | 416 | | |
|---|
| 418 | 417 | | (b) Provides health care services to elderly vulnerable adults. |
|---|
| 419 | 418 | | |
|---|
| 420 | 419 | | 19. One member who is on the governor's advisory council on aging and who is appointed by the governor. |
|---|
| 421 | 420 | | |
|---|
| 422 | 421 | | 20. One member who represents a statewide association representing firefighters in this state and who is appointed by the president of the senate. |
|---|
| 423 | 422 | | |
|---|
| 424 | 423 | | B. The vulnerable adult system study committee shall: |
|---|
| 425 | 424 | | |
|---|
| 426 | 425 | | 1. Develop and implement a coordinated vulnerable adult delivery system that ensures the health and safety of vulnerable adults. |
|---|
| 427 | 426 | | |
|---|
| 428 | 427 | | 2. Recommend best practices relating to responding to and investigating complaints. |
|---|
| 429 | 428 | | |
|---|
| 430 | 429 | | 3. Research best practices related to adult protective services at the state, municipality and community levels. |
|---|
| 431 | 430 | | |
|---|
| 432 | 431 | | 4. Research and make recommendations on how the vulnerable adult system can ensure that vulnerable adults receive services they require after the vulnerable adult system completes its investigatory duties, including assigning a specific agency with the responsibility to provide or coordinate case management. |
|---|
| 433 | 432 | | |
|---|
| 434 | 433 | | 5. Research and identify common statewide outcomes. |
|---|
| 435 | 434 | | |
|---|
| 436 | 435 | | 6. Identify best practices for data collection and data sharing by various entities involved in providing vulnerable adult services. |
|---|
| 437 | 436 | | |
|---|
| 438 | 437 | | 7. Review and recommend changes to the statutes and rules that govern vulnerable adult services. |
|---|
| 439 | 438 | | |
|---|
| 440 | 439 | | C. The cochairpersons may designate work groups to research, study and make recommendations to the study committee. At least two work groups shall be established to separately address the needs of persons with developmental disabilities and persons who are elderly or who have a physical disability, including the training requirements for persons who are caring for these populations. |
|---|
| 441 | 440 | | |
|---|
| 442 | 441 | | D. Once a strategic direction is established, the department of economic security, in conjunction with the work groups, shall develop an action plan for implementation. |
|---|
| 443 | 442 | | |
|---|
| 444 | 443 | | E. Public members are eligible to receive reimbursement of expenses pursuant to title 38, chapter 4, article 2, Arizona Revised Statutes. |
|---|
| 445 | 444 | | |
|---|
| 446 | 445 | | F. On or before December 31, 2024, the study committee shall provide a status update of its progress, including any recommended statutory changes, to the members of the health and human services committees of the house of representatives and the senate, or their successor committees. On or before October 1, 2025, the study committee shall submit a report of its findings and recommendations to the governor, the president of the senate and the speaker of the house of representatives and shall provide a copy of this report to the secretary of state. |
|---|
| 447 | 446 | | |
|---|
| 448 | 447 | | G. This section is repealed from and after December 31, 2025. |
|---|
| 449 | 448 | | |
|---|
| 450 | 449 | | Sec. 11. Rulemaking |
|---|
| 451 | 450 | | |
|---|
| 452 | 451 | | The department of health services shall adopt rules to implement this act. |
|---|
| 453 | 452 | | |
|---|
| 454 | 453 | | Sec. 12. Effective date |
|---|
| 455 | 454 | | |
|---|
| 456 | 455 | | Section 36-405.03, Arizona Revised Statutes, as added by this act, is effective from and after June 30, 2025. |
|---|