HB 2764 — long-term care; enforcement; memory care

ABEGINNING NURSINGMARCH CARE31, INSTITUTION,2025, UNLESSANNUALLY ITREVERIFY HASTHAT THEEACH SAMEEMPLOYEE DIRECTIS OWNERNOT ORON INDIRECTTHE OWNERADULT ASPROTECTIVE ASERVICES HOSPITALREGISTRY LICENSED PURSUANT TO THISSECTION CHAPTER.46-459.

C.

On a determination by the director that there is reasonable cause to believe a health care institution is not adhering to the licensing requirements of this chapter, the director and any duly designated employee or agent of the director, including county health representatives and county or municipal fire inspectors, consistent with standard medical practices, may enter on and into the premises of any health care institution that is licensed or required to be licensed pursuant to this chapter at any reasonable time for the purpose of determining the state of compliance with this chapter, the rules adopted pursuant to this chapter and local fire ordinances or rules.

Any application for licensure under this chapter constitutes permission for and complete acquiescence in any entry or inspection of the premises during the pendency of the application and, if licensed, during the term of the license.

If an inspection reveals that the health care institution is not adhering to the licensing requirements established pursuant to this chapter, the director may take action authorized by this chapter.

Any health care institution, including an accredited hospital, whose license has been suspended or revoked in accordance with this section is subject to inspection on application for relicensure or reinstatement of license.

TheAn directoremployee, shallan immediatelyowner, reporta tocontracted theperson boardor ofa examinersvolunteer or a facility on behalf of nursingthe careemployee, institutionthe administratorsowner, andthe assistedcontracted livingperson facilityor managersthe informationvolunteer identifyingshall thatsubmit a nursingcompleted careapplication institutionthat administrator'sis conductprovided mayby bethe groundsdepartment forof disciplinarypublic actionsafety pursuantwithin totwenty sectiondays 36-446.07.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 - 4 - H.B.

2764 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.

Title 36, chapter 4, article 1, Arizona Revised Statutes, is amended by adding section 36-420.05, to read:

36-420.05.

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.

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2764 Sec.

5.

If an application -for 4a -license H.B.is submitted due to a planned change of ownership, the director shall determine the need for an inspection of the health care institution.

2764 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.

Except as provided in section 36-424, subsection B and subsection E of this section, the department shall conduct a compliance inspection- of6 a- healthH.B. care institution to determine compliance with this chapter and rules adopted pursuant to this chapter at least once annually.

2764 inspection of a health care institution to determine compliance with this chapter and rules adopted pursuant to this chapter at least once annually.

This -subsection 5does -not H.B.prohibit the department from enforcing licensing requirements as authorized by section 36-424.

2764 subsection does not prohibit the department from enforcing licensing requirements as authorized by section 36-424.

When the department issues an original license or an original provisional license to a health care institution, it shall notify the owners- and7 lessees- ofH.B. any agricultural land within one-fourth mile of the health care institution.

2764 owners and lessees of any agricultural land within one-fourth mile of the health care institution.

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, 6including -stockholders H.B.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.

2764 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.

5.6.

9.- 8 - H.B.

2764 9.

12.

WHETHER THE HEALTH CARE INSTITUTION AND STAFF ARE IN COMPLIANCE WITH THE REPORTING REQUIREMENTS PURSUANT TO SECTION 46-454.

Civil penalty amounts may be established by -rules 7adopted -by H.B.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.

2764 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.

6.

Title 36, chapter 4, article 2, Arizona Revised Statutes, is amended by adding section 36-431.03, to read:

36-431.03.

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 IF THE HEALTH CARE INSTITUTION HAS CLOSED.

B.

IF THE DEPARTMENT DETERMINES PATIENT SAFETY MAY BE IN JEOPARDY DUE TO THE ACTIONS OF A LICENSEE, THE DEPARTMENT MAY DENY A NEW APPLICATION FOR LICENSURE OF A CURRENTLY LICENSED HEALTH CARE INSTITUTION WHILE ANY ENFORCEMENT OR COURT ACTION RELATED TO THE LICENSURE OR OPERATION OF THE HEALTH CARE INSTITUTION IS PENDING AGAINST THAT HEALTH CARE INSTITUTION'S CURRENT LICENSEE.

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.

Sec.

The board of examiners of nursing care institution administrators and assisted living facility managers is established consisting of eleven THIRTEEN members appointed by the governor.

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2764 B.

One administrator who holds an active license issued pursuant to this article.article OR WHO IS RETIRED.

One ASSISTED LIVING FACILITY manager who holds an active license issued pursuant to this article.article OR WHO IS RETIRED.

One administrator of a nonprofit or faith-based skilled nursing facility.facility WHO EITHER HOLDS AN ACTIVE LICENSE ISSUED PURSUANT TO THIS ARTICLE OR WHO IS RETIRED.

4.- 9 - H.B.

One2764 administrator4. of a proprietary skilled nursing facility.

One administrator of a proprietary skilled nursing facility WHO EITHER HOLDS AN ACTIVE LICENSE ISSUED PURSUANT TO THIS ARTICLE OR WHO IS RETIRED.

Two managers of an assisted living center as defined in section 36-401.36-401 WHO EITHER HOLD AN ACTIVE LICENSE ISSUED PURSUANT TO THIS ARTICLE OR WHO ARE RETIRED.

One manager of an assisted living home as defined in section 36-401.36-401 WHO EITHER HOLDS AN ACTIVE LICENSE ISSUED PURSUANT TO THIS ARTICLE OR WHO IS RETIRED.

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.

11.

ONE PERSON WHO REPRESENTS AN ORGANIZATION THAT ADVOCATES FOR PERSONS WHO HAVE PHYSICAL DISABILITIES.

12.

ONE PERSON WHO REPRESENTS AN ORGANIZATION THAT ADVOCATES FOR PERSONS WHO HAVE INTELLECTUAL OR DEVELOPMENTAL DISABILITIES.

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.

E.

F.

G.

G.- 10 - H.B.

2764 G.

H.

-H. 9 - H.B.

2764I. H.

J.

K.

L.

RulemakingSection exemption46-452, Notwithstanding any other law, for the purposes of this act, the department of health services is exempt from the rulemaking requirements of title 41, chapters 6 and 6.1, Arizona Revised Statutes, untilis Julyamended 1,to 2025,read: except that the department shall hold at least two public meetings.

46-452.

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.

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2764 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.

Section 46-454, Arizona Revised Statutes, is amended to read:

46-454.

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.

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2764 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 - 13 - H.B.

2764 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.

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.

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2764 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.

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2764 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.

-APPROVED 10BY -THE GOVERNOR APRIL 8, 2024.

FILED IN THE OFFICE OF THE SECRETARY OF STATE APRIL 8, 2024.

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