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ARIZONA STATE SENATE
Fifty-Sixth Legislature, Second Regular Session
long-term care; enforcement; memory care
Purpose
Effective July 1, 2025, requires the Director of the Department of Health Services (DHS) to establish by rule licensure subclass for assisted living facilities that wish to provide memory care services and prescribes requirements for licensure. Increases the cap on civil penalties for violation of health care institution statutes or rules from $500 to $1,000. Modifies the membership of the Board of Examiners of Nursing Care Institution Administrators and Assisted Living Facility Managers (NCIA Board).
Background
Health care institutions in Arizona are licensed and overseen by the
Department of Health Services (DHS), including enforcement of health care
institution statutes, rules and regulations. DHS must: 1) review and approve
plans and specifications for institution construction or modification; 2) have
access to books, records, accounts and any other necessary health care
institution information; and 3) require nursing care institutions and assisted
living facilities to provide annual influenza and pneumonia vaccines to
residents. Additionally, DHS may: 1) inspect every part of a health care
institution to ensure compliance with standard medical practice;
2) conduct investigations of health care institution conditions and problems
with noncompliance; and 3) develop facility manuals and guides to health care
institutions and the general public (A.R.S.
§ 36-406).
A health care institution is 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 directed care services and includes home health agencies, outdoor behavioral health care programs and hospice service agencies. Residential care institutions are health care institutions other than a hospital or a nursing care institution that provides resident beds or residential units, supervisory care services, personal care services, behavioral health services, directed care services or health-related services for persons who do not need continuous nursing services. Assisted living facilities are residential care institutions, including an adult foster care home, that provides or contracts to provide supervisory care services, personal care services or directed care services on a continuous basis. Nursing care institutions are health care institutions that provide inpatient beds or resident beds and nursing services to persons who need continuous nursing services but who do not require hospital care or direct daily care from a physician (A.R.S. § 36-401)
The Director of DHS (Director) may assess a civil penalty of up to $500 for each violation of health care institution statutes, for every day the violation occurs. The Director may then issue a notice of assessment that includes the amount of the assessment to the violator. Monies collected from civil penalties for violations of health care institutions are transmitted to the state General Fund (state GF) (A.R.S. § 36-431.01).
The NCIA Board
regulates nursing care institution administrators and assisted living facility
managers in Arizona. The NCIA Board consists of 11 members appointed by the
Governor, including: 1) one administrator who holds an active license in
nursing care institution administration; 2) one manager who holds an active
license in assisted living facility management; 3) one administrator of a
nonprofit or faith-based skilled nursing facility; 4) one administrator of a
proprietary skilled nursing facility; 5) two managers of an assisted living
center; 6) one manager of an assisted living home; 7) two public members who
are not affiliated with a nursing care institution or an assisted living
facility; 8) one public member who represents an organization that advocates
for the elderly; and 9) one person who is a family member of a resident in
either a skilled nursing facility or an assisted living facility at the time
the person is appointed. (A.R.S.
§ 36-446.03).
If there is a cost associated with DHS licensure and regulation of health care institution memory care services, there may be a fiscal impact to the state GF. Additionally, H.B. 2764 increases the cap on civil penalties assessed for violations of health care institution statutes from $500 to $1000, which is deposited into the state GF.
Provisions
Memory Care Services
1. Requires the Director to establish by rule licensure subclass, including fees, for assisted living facilities that wish to provide memory care services.
2. Requires an assisted living facility that advertises the provision of memory care services to be licensed to provide memory care services.
3. Requires the Director to establish by rule minimum training standards for staff and contractors who work in an assisted living facility that is licensed to provide memory care services.
4. Requires memory care services training standards to include at least eight hours of initial memory care services training and four hours of annual continuing education.
5. Requires the training standards for assisted living facility managers, in addition to the eight hours of initial training, to include a minimum of four hours of memory care services training that is specifically for assisted living facility managers.
6. Requires DHS to approve memory care services training programs.
7. Requires memory care services training programs to provide staff and contractors who complete the training a certificate of completion that may be used to work at any assisted living facility that is licensed to provide memory care services.
8. Stipulates that, if a staff member or contractor does not work at an assisted living facility that is licensed to provide memory care services for a period of 12 months, the person must repeat the initial 8-hour training.
9. Specifies that an assisted living facility that is licensed to provide memory care services must provide documentation of prescribed staff training during any investigation or compliance survey.
10. Requires failure to provide complete staff training documentation to be cited as a deficiency.
11. Defines memory care services as services that support individuals with dementia and other progressive and neurodegenerative brain disorders, including specialized environmental features, care planning, directed care services, medication administration services, specialized accommodations, activity programming or other services required by DHS in rule.
Health Care Institution Oversight
12. Requires the Director to establish:
a) a model in rule for on-site monitoring of health care institutions that are found to not be in substantial compliance with applicable licensure requirements; and
b) on-site monitoring fees charged to applicable health care institutions.
13. Allows DHS to provide in-service training to health care institutions relating to regulatory compliance outside of the survey process, if requested.
14. Requires the Director to establish by rule in-service training fees for health care institutions that request training.
15. Prohibits the DHS Director from accepting an accreditation report in lieu of a compliance inspection for residential care institutions and nursing care institutions, unless the institution has the same direct or indirect owner as a licensed hospital.
16. Excludes residential care institutions and nursing care institutions that do not have the same direct owner or indirect owner as a licensed hospital from statutes exempting deficiency-free health care institutions a two-year reprieve from DHS compliance surveys.
17. Voids a health care institution license if the licensee does not pay civil penalties or provider agreement fees before the due date or does not enter into an agreement with DHS to pay all outstanding fees and civil penalties before the due date.
19. Requires DHS to establish a rule with outlined considerations for determining the amount of a civil penalty assessed against a health care institution.
20. Adds each of the following to the list of factors DHS must consider in determining the amount of a civil penalty assessed against a health care institution:
a) the potential for and occurrences of actual harm to patients, staff or residents;
b) threats to health and safety of patients, staff or residents; and
c) the type of health care institution.
21. Allows the DHS Director to 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 has closed.
22. Authorizes DHS to deny:
a) a new license application for a currently licensed health care institution while any enforcement or court action relating to the licensure of operation of the institution is pending, if it is determined that patient safety may be in jeopardy due to the licensee's actions; and
b) a change in ownership of a currently licensed health care institution, if it is determined that the transfer would jeopardize patient safety.
Miscellaneous
23. Modifies the membership of the NCIA Board as follows:
a) removes the two public members who are not affiliated with a nursing care institution or assisted living facility;
b) adds one person who is a current or former resident of a skilled nursing facility or assisted living facility;
c) adds one public member who represents an organization that advocates for individuals with Alzheimer's disease, dementia or other related neurocognitive disorders or diseases;
d) adds one person who represents an organization that advocates for persons who have physical disabilities; and
e) adds one person who represents an organization that advocates for persons with intellectual or developmental disabilities.
24. Exempts DHS from statutory rulemaking requirements, until July 1, 2025, for purposes of health care institution and memory care services regulations.
25. Makes technical and conforming changes.
26. Becomes effective on July 1, 2025.
House Action
HHS 2/15/24 DPA 9-1-0-0
3rd Read 2/29/24 49-10-0-0-1
Prepared by Senate Research
March 15, 2024
MM/slp