Chapter 0158 - 521R - H Ver of SB1283

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 the construction, modification and licensure of health care institutions necessary to assure 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 record keeping pertaining to the administration of medical, nursing, behavioral health and personal care services, in accordance with generally accepted practices of health care. 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 the selection of health care related demonstration projects.

5. Establish and collect nonrefundable fees for health care institutions for license applications, initial licenses, renewal licenses and architectural drawing reviews.

C. The director, by rule, may 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, including provisions for avoiding duplicative requirements for construction, record keeping, ancillary services, equipment and operation for a facility at a single location that operates with more than one license consistent with article 3.1 of this chapter.

D. Ninety per cent 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 per cent 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. 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, Arizona Revised Statutes, is amended by adding article 3.1, to read:

ARTICLE 3.1. COLOCATION AT OUTPATIENT TREATMENT CENTERS

START_STATUTE36-439. Definitions

In this article, unless the context otherwise requires:

1. "Associated licensed provider" means one or more licensed outpatient treatment centers or one or more licensed counseling facilities that share common areas pursuant to a written agreement with a collaborating outpatient treatment center and that are liable and responsible for the treatment areas that are used by the respective associated licensed provider pursuant to written policies.

2. "Collaborating outpatient treatment center" means a licensed outpatient treatment center that has a written agreement with one or more outpatient treatment centers or exempt health care providers or licensed counseling facilities that requires the collaborating outpatient treatment center to be liable and responsible pursuant to written policies for all common areas that one or more colocators use.

3. "Colocator" means an exempt health care provider or a governing authority operating as an outpatient treatment center or a licensed counseling facility that may share common areas and nontreatment personnel with another colocator pursuant to an agreement as prescribed in this article.

4. "Common areas":

(a) Means the licensed public or nonpublic portions of outpatient treatment center premises that are not used for treatment and that are shared by one or more licensees or exempt health care providers.

(b) Includes hallways, entrances, elevators, staircases, restrooms, reception areas, conference areas, employee break rooms, records retention areas and other nontreatment areas of an outpatient treatment center.

5. "Emergency health care services" means treatment for a medical or behavioral health condition, including labor and delivery, that manifests itself by acute symptoms of sufficient severity, including severe pain, such that a prudent layperson who possesses an average knowledge of health and medicine could reasonably expect the absence of immediate medical attention to result in any of the following:

(a) Placing the patient's health, including mental health, in serious jeopardy.

(b) Serious impairment to a bodily function of the patient.

(d) Harm to the patient or others.

6. "Exempt health care provider" means a health care provider who is licensed pursuant to title 32, who holds an active license and whose private office or clinic is exempt from licensure pursuant to section 36‑402, subsection A, paragraph 3.

7. "Nontreatment personnel" means employees, agents, students, interns or independent contractors who provide services to an outpatient treatment center colocator that do not entail medical, nursing or behavioral health assessment or treatment.

8. "Treatment areas" means portions of licensed outpatient treatment center premises that are used for the provision of health care assessment and treatment of patients. END_STATUTE

START_STATUTE36-439.01. Colocation of licensees

Notwithstanding any other provision of this chapter, one or more outpatient treatment center licensees that provide medical, nursing and health‑related services may colocate or colocate with one or more licensees that provide behavioral health services or with one or more licensed counseling facilities and may share common areas at the collaborating outpatient treatment center premises and share nontreatment personnel pursuant to the requirements of this article. END_STATUTE

START_STATUTE36-439.02. Colocators; collaborating outpatient treatment centers; requirements

In addition to any other requirements of this chapter, colocators at a collaborating outpatient treatment center shall:

1. Designate which outpatient treatment center will act as the collaborating outpatient treatment center and be liable and responsible for the health, safety, cleanliness and maintenance of all common areas and the supervision and training of all shared nontreatment personnel pursuant to written policies of the collaborating outpatient treatment center.

2. Designate which areas are considered common areas and which personnel are designated as shared nontreatment personnel.

3. Designate the associated licensed providers.

4. Ensure that medical records that are located in common areas or shared by colocators are maintained pursuant to all federal and state confidentiality laws. A colocator may have access to a patient's medical records only if the patient has consented. END_STATUTE

START_STATUTE36-439.03. Use of treatment areas

Colocators shall solely maintain and use treatment areas that are designated pursuant to each of their respective licenses and may not use another colocator's treatment areas except as follows:

1. For the provision of emergency health care services.

2. During hours of operation by a colocator that are clearly identified by signage to the public and notice to the department. END_STATUTE

START_STATUTE36-439.04. Colocation; outpatient treatment centers; health care providers

A. The governing authority of a licensed collaborating outpatient treatment center, by agreement, may share common areas and may share nontreatment personnel with one or more exempt health care providers or one or more licensed counseling facilities pursuant to section 36‑439.02.

B. Treatment areas that are licensed under an outpatient treatment center may also be used by an exempt health care provider if the provider's treatment areas and hours of operation are clearly identified by signage to the public and notice to the department.

C. Notwithstanding subsections A and B of this section, an outpatient treatment center may contract with or employ an exempt health care provider to provide health care services to the outpatient treatment center's patients. END_STATUTE

Sec. 3. Rulemaking; exemption

A. For the purposes of the implementation of this act, the department of health services is exempt from the rulemaking requirements of title 41, chapter 6, Arizona Revised Statutes, until April 15, 2016, except that the department shall provide public notice and an opportunity for public comment on proposed rules at least thirty days before the rules are adopted or amended.

B. The director of the department of health services shall consider the adoption of and amendment to rules relating to the licensing of behavioral health residential facilities, outpatient treatment centers and behavioral health respite homes. For the purposes of implementing this subsection, the department is exempt from the rulemaking requirements of title 41, chapter 6, Arizona Revised Statutes, until April 15, 2016. The department shall provide public notice and an opportunity for public comment on proposed rules adopted or amended pursuant to this subsection at least thirty days before the rules are adopted or amended. In adopting the rules, the director shall:

1. Provide for the use of outpatient treatment centers for the provision of respite care for children receiving behavioral health services pursuant to rules adopted by the department.

2. Allow children who are receiving behavioral health services to receive respite care in a behavioral health residential facility without a nursing assessment or physical examination if the child will be receiving respite services for fewer than five consecutive days at the facility.

Sec. 4. Emergency

This act is an emergency measure that is necessary to preserve the public peace, health or safety and is operative immediately as provided by law.