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ARIZONA STATE SENATE
Fifty-Fourth Legislature, First Regular Session
AMENDED
intermediate care facilities; licensure
Purpose
An emergency measure that establishes licensing requirements for intermediate care facilities for individuals with intellectual disabilities (ICF-IIDs).
Background
ICF-IIDs are a Medicaid benefit that enables states to provide comprehensive health care and services to individuals with specified intellectual disabilities to promote their functional status and independence. ICF-IIDs must meet federally prescribed requirements and be certified by the U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services (U.S. CMS). ICF-IID services are only available in residential facilities that are licensed and certified by the appropriate state agency. Medicaid ICF-IID services are available for Medicaid-eligible individuals and only when other payment options are unavailable. Additionally, ICF-IIDs are only available for individuals in need of receiving active treatment services that include an aggressive, consistent implementation of a program of specialized and generic training, treatment and health services. Federal law prohibits states from limiting access to ICF-IID services, including the use of waitlists for services. According to statute, an ICF-IID is a facility that primarily provides health and rehabilitative services to individuals with developmental disabilities that are above the service level of room and board or supervisory care services or personal care services as prescribed for certain adult residential care facilities, but that are less intensive than skilled nursing services (A.R.S. § 36-551).
The Department of Health Services (DHS) is responsible for the licensure, regulation and inspection of health care institutions in Arizona, with certain exceptions. Health care institutions include every place, institution, building or agency, whether organized for profit or not, that provides facilities with medical services, nursing services, behavioral health services, health screening services, other health-related services, supervisory care services, personal care services or direct care services and includes home health agencies, outdoor behavioral health care programs and hospice service agencies (A.R.S. § 36-401). DHS is additionally responsible for licensing group homes for health and safety.
The
Division of Developmental Disabilities (DDD) is a division within the
Department of Economic Security (DES). DDD provides services to individuals
diagnosed with developmental and intellectual disabilities including cerebral
palsy, autism and epilepsy. Services provided by DDD include: 1) attendant
care; 2) habilitation; 3) home health aide; 4) home nursing;
5) occupational, physical and speech therapies; 6) respite care; and 7) medical
services. DES is responsible for licensing specified residential settings,
including adult developmental homes and child developmental homes. DDD is
additionally responsible for ensuring that state-operated residential settings,
that are owned or leased by DDD, meet standards prescribed for group homes, unless
they are certified as an ICF-IID as required by federal law. Certified ICF-IIDs
that are operated by DDD or private entities are not required to obtain DHS
licensure (A.R.S.
§ 36-591).
The Department of Child Safety (DCS) maintains a central registry of substantiated reports of abuse and neglect and the outcomes of the associated investigations and uses the central registry to perform background checks and as a factor to determine qualifications for employees and contractors that provide direct services to vulnerable adults and children (A.R.S. § 8-804). Similarly, DES maintains the Adult Protective Services Registry (APS Registry) of substantiated reports of abuse, neglect and exploitation of vulnerable adults, and contains: 1) the name and date of birth of the person determined to have abused, neglected or exploited a vulnerable adult; 2) the nature of the allegation; and 3) the date, description and disposition of the allegation. Reports must be maintained in the APS Registry for 25 years, and the names of the source of the report and the vulnerable adult must be excluded from the APS Registry (A.R.S. § 46-459).
There is no anticipated fiscal impact to the state General Fund associated with this legislation.
Provisions
1. Requires ICF-IIDs that are operated by DES or a private entity to be licensed by DHS and certified by U.S. CMS by January 1, 2020.
2. Allows DCS to provide information included in a central registry background check to licensees regarding employees or prospective employees in an ICF-IID.
3. Requires licensees that employ individuals who provide direct care in an ICF-IID to submit necessary information to DCS to conduct central registry background checks.
4. Authorizes DCS to enter into agreements with other state agencies to conduct required central registry background checks.
5. Prohibits the Director of DHS from accepting an accreditation report in lieu of an ICF-IID compliance inspection.
6. Directs DHS to verify whether licensees comply with central registry background check requirements.
7. Requires DES to conduct an APS Registry background check for anyone employed or seeking employment in a position that provides services to vulnerable adults or children in:
a) a community residential setting;
b) an ICF-IID;
c) home-based and community-based services; and
d) a day care for individuals with developmental disabilities.
8. Allows DES to conduct an APS Registry background check for a person who is employed or seeking employment with DES or a DES contractor in a position that provides direct services to vulnerable adults or children.
9. Requires DES to use information contained in the APS Registry to determine:
a) whether a person is qualified for certification to provide home-based and community-based services to vulnerable adults or children; and
b) whether the person who is employed, or seeking employment, with DES is qualified for a position that provides direct care to vulnerable adults or children.
10. Permits employers to use information contained in the APS Registry to determine qualifications for positions that provide direct services to vulnerable adults or children for:
a) applicants for a contract with DES and the applicant’s employees;
b) all employees of a contractor;
c) subcontractors and their employees; and
d) prospective employees of contractors and subcontractors, at the request of the employer.
11. Requires that prospective employees certify, prior to employment, whether an allegation of vulnerable adult abuse, neglect or exploitation has been made against them or has been substantiated.
12. Directs DHS to adopt rules that require employees and personnel of ICF-IIDs to report abuse, neglect and exploitation.
13. Exempts DHS from rulemaking requirements for one year after the effective date of this legislation.
14. Makes technical and conforming changes.
15. Becomes effective on signature of the Governor, if the emergency clause is enacted.
Amendments Adopted by Committee
1. Allow DCS to enter into agreements with other state agencies to conduct required background checks.
2. Requires DES, rather than all Arizona employers, to conduct an APS Registry check for certain employees in specified settings.
3. Permits DES to conduct an APS Registry check for employees and contractor employees who provide direct services to vulnerable adults or children.
4. Adds ICF-IIDs to notification requirements prescribed for DHS and DES.
5. Makes technical and conforming changes.
Senate Action
HHS 2/13/19 DPA 8-0-0
Prepared by Senate Research
February 25, 2019
CRS/kja