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ARIZONA STATE SENATE
Fifty-Fifth Legislature, First Regular Session
AMENDED
crisis standards of care; requirements
Purpose
An emergency measure that establishes requirements for a Crisis Standards of Care Plan (CSC Plan) adopted by the Department of Health Services (DHS).
Background
According to the U.S. Centers for Disease Control and Prevention CSC, are those that reflect a substantial change in usual health care operations and the level of care that health care providers are capable of delivering during a crisis (CDC). When a state government formally declares the need for CSC, this formal declaration enables specific legal and regulatory powers and protections for health care providers as they perform the necessary tasks of allocating and using scarce medical resources and adopting alternate health care operations during a crisis.
DHS, in collaboration with public health, emergency management, first responders, health care, legal and other partners created the Arizona CSC Plan (Arizona CSC Plan). The CSC Plan includes provisions regarding stewardship of resources, duty to care, reciprocity, proportionality and transparency for health care facilities and providers.
There is no anticipated fiscal impact to the state General Fund associated with this legislation.
Provisions
1. Applies the following requirements to a CSC Plan, crisis guidance or crisis standards adopted or established by DHS to address resource allocation when the demand for certain health care services exceeds the supply of resources:
a) the allocation of health care resource decisions must be made on the basis of valuing all life;
b) a patient or their health care decision maker has the right to make their own choices;
c) decisions regarding the allocation of health care resources cannot discriminate based on disability, age, race, sex, religion, veteran status or income;
d) health care providers can only consider short-term survival when making resource allocation decisions;
e) treatment resources cannot be allocated based on quality of life judgments, long-term life expectancy and mortality, resource intensity and duration of need due to disability or age;
f) each patient has a right to an individualized assessment on the basis of the best available objective medical evidence;
g) patients with a disability and the aged have the right to reasonable modifications to ensure equal access to medical care, including reasonable modification in patient assessment, communication and support needs; and
h) patients or their health care decision makers have the right to appeal any triage decision.
2. Prohibits a health care provider or health care institution staff member from requiring that a patient or their health care decision maker sign a do-not-resuscitate order or make any particular health care decision.
3. Establishes representatives of the state protection and advocacy agency and advocates for the aged as members of the State Disaster Medical Advisory Committee (Advisory Committee).
4. Asserts that the Advisory Committee is responsible for developing the crisis standards of care and other incident-specific priorities and guidance for the delivery of health care and use of scarce medical resources during a public health emergency.
5. Defines short-term survival.
6. Requires DHS to modify any adopted CSC Plan, crisis guidelines or crisis standards within 60 days after the effective date of this legislation.
7. Becomes effective on signature of the Governor, if the emergency clause is enacted.
Amendments Adopted by Committee
· Makes technical changes and defines short-term mortality.
Amendments Adopted by Committee of the Whole
1. Applies and expands proposed requirements for CSC Plans to related standards and guidelines established by DHS.
2. Prohibits CSC Plans, standards and guidelines from making discriminatory health care resource allocation decisions based on outlined characteristics, and eliminates proposed language regarding the denial of care based on stereotypes and quality of life judgements.
3. Limits health care providers to only considering short-term survival when making health care resource allocation decisions.
4. Establishes the right of any patient, their family or their health care decision maker to appeal any triage decision.
5. Defines short-term survival.
6. Establishes representatives of the state protection and advocacy agency and advocates for the aged as members of the Advisory Committee and authorizes the Advisory Committee to develop CSC for delivering health care and medical resources during a public health emergency.
7. Makes technical and conforming changes.
Senate Action
HHS 2/10/21 DPA 8-0-0
Prepared by Senate Research
March 10, 2021
CRS/kja