Assigned to GOV AS
PASSED BY COMMITTEE
Assigned to GOV AS
PASSED BY COMMITTEE
ARIZONA STATE SENATE
Fifty-Third Legislature, Second Regular Session
AMENDED
sunrise process; health professionals; modifications
Purpose
Modifies the sunrise review process and written reports submitted for the regulation of health professions.
Background
Currently, each standing committee of both legislative chambers is required to appoint a subcommittee of five members, no more than three of whom may be from the same political party. Jointly, the subcommittees constitute a committee of reference (COR) in their respective subject areas (A.R.S. § 41-2954).
Established by Laws 1985, Chapter 352 and expanded by Laws 2008, Chapter 132, the sunrise review process allows both health professions and nonhealth professions to request regulation and expansion in scope of practice for health professions.
Statute prohibits the regulation of unregulated health professions except to protect the public health and safety. If the Legislature determines that it is necessary to regulate a health profession not previously regulated by law, the least restrictive method of regulation must be implemented (A.R.S. § 32-3103).
To initiate the sunrise process, an applicant must submit a written report to the President of the Senate (President) and the Speaker of the House of Representatives (Speaker) by September 1 addressing statutorily prescribed factors. These include: 1) a definition of the problem and why regulation is necessary; 2) the efforts made to address the problem; 3) the alternatives considered; 4) the public benefit if regulation is granted; 5) the extent to which regulation might harm the public; 6) the maintenance of standards; 7) a description of the group proposed for regulation; and 8) the expected costs of regulation (A.R.S. § 32-3105).
Applicants for increased scope of practice must explain the following factors: 1) a definition of the problem and why a change in scope of practice is necessary; 2) the extent to which the public can be confident that qualified practitioners are competent; 3) the extent to which an increase in the scope of practice may harm the public; and 4) the cost to the state and the general public of implementing the proposed increase scope of practice (A.R.S. § 32-3106).
A COR reviews reports by health professional groups proposing new regulations or increased scope of practice, holds hearings if necessary and issues reports of the COR's final recommendations to the Governor, President and Speaker on or before December 1 (A.R.S. § 32-3104).
There is no anticipated fiscal impact to the state General Fund associated with this legislation.
Provisions
Review of Written Reports
1. Requires health professional groups to submit a written report before the legislative session begins, instead of by September 1.
2. Allows the House of Representatives and the Senate to set an earlier report deadline by rule.
3. Stipulates the appropriate legislative committees, instead of a COR, must consider the written report in connection with any legislation to license a health professional or expand the scope of a health profession.
4. Allows the House Health Committee and the Senate Health and Human Services Committee, or their successor committees, to conduct hearings on the written report before the legislative session begins.
Regulation Criteria
5. Outlines state policy for health professions and regulatory entities by establishing that:
a) it is a fundamental right of individuals to pursue a lawful occupation;
b) it is not a legitimate use of state power to protect existing businesses and agencies, whether publicly or privately owned, against competition;
c) individuals can pursue any lawful employment, free from unnecessary regulation, and that the burden is on those who restrict individuals' ability to work;
d) an individual, whether licensed, certified or not subject to regulation, can engage in all practices or acts in the scope of practice of their health profession according to academic and professional training and continuing education; and
e) if the state determines its necessary to displace competition, the state will use the least restrictive regulation to protect consumers from present, significant and substantiated harms threatening public health and safety.
6. Adds criteria considered for regulation of a health profession including:
a) credible, empirical evidence that the unregulated practice poses a specific harm or danger to the public health, safety or welfare; and
b) the public is incapable of understanding the potential for harm and protecting itself.
7. Establishes before the Legislature enacts legislation affecting any occupation, practice or act of a previously unregulated health profession, there is a reputable presumption that market competition and private remedies are sufficient to protect the public.
8. Requires the Legislature to implement the least restrictive alternative method of regulation consistent with the public interest and the following:
a) if a regulation is to protect consumers against fraud, the regulation will strengthen powers under deceptive trade practice laws or require disclosures reducing misleading attributes of the specific good or service;
b) if the threat to public health, safety or economic well-being is relatively small, the regulation requires the health professional to register the professional's business with the Secretary of State;
c) if the need is to protect consumers against a shortfall or imbalance of knowledge, the regulation will authorize voluntary private or government certification;
d) if the need is to qualify providers of new or highly specialized medical services for reimbursement, the regulation will authorize a specialty license for medical reimbursement; and
e) if a less restrictive regulation cannot address a specific harm or danger identified, the regulation may include licensure by the state.
9. Establishes the state will recognize a license or certification from another state or jurisdiction of the United States for the same health profession, regardless of differences in the personal qualifications necessary for licensure or certification in the other state or jurisdiction, unless there is credible, empirical evidence that the out-of-state license or certification cannot address a specific harm or danger that is unique to this state.
10. Limits additional state licensure or certification requirements, for an individual licensed or certified out-of-state, to addressing a harm or danger unique to this state.
11. Specifies an analysis of the need for regulation will include the effects of regulation on opportunities for workers, consumer choices and costs, general unemployment, market competition and governmental costs and any other effects of the regulation.
12. Requires the Legislature to review any legislation increasing the scope of practice according to the following criteria:
a) an individual graduating from an accredited health professional training program, passing national board examinations and becoming licensed in the state is presumed to be qualified to provide the full scope of professional services for which they are trained;
b) any limit on a health profession scope of practice must be for the exclusive purpose of protecting the public interest from a clear and identified specific harm;
c) any proposed increase in the scope of practice restricting other individuals from the profession to a greater degree than current law must have credible, empirical evidence that the proposed changed is required; and
d) there is a presumption that having additional trained health professionals providing an expanded range of health care services will benefit the community and should be encouraged and supported.
Factors for Regulation and Expansion in Scope of Practice
13. Eliminates the requirement for health professional groups to define the problem in their written reports requesting regulation or an increased scope of practice.
14. Modifies the factors addressed in a written report for an increased scope of practice as follows:
a) why a change in scope of practice is beneficial, instead of necessary;
b) removes reference to public confidence in the competency of qualified practitioners including evidence of regulatory board adequacy and quality assurance standards;
c) removes the extent that increased regulation may harm the public; and
d) removes the cost of regulation for the state and general public.
15. Adds the following factors in a written report for an increased scope of practice concerning:
a) whether the practice is taught in accredited professional schools, in postgraduate training programs or in continuing education programs;
b) whether the practice is tested on national board examinations for professional licensure applicants;
c) the relevant health professional licensure laws in other states; and
d) any recommendations from the applicable licensing board, and professional degree and training programs in the state.
16. Makes technical and conforming changes.
17. Becomes effective on the general effective date.
Amendments Adopted by Committee
· Establishes additional legislative criteria for regulating and expanding scope of practice for health professions.
Senate Action
GOV 2/7/18 DPA 7-0-0
Prepared by Senate Research
February 9, 2018
JO/lat