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ARIZONA STATE SENATE
Fifty-Sixth Legislature, Second Regular Session
AMENDED
long-term care; enforcement; memory care
Purpose
Requires the Director of the Department of Health Services (DHS) to establish by rule standards for memory care services for assisted living facilities that are licensed to provide directed care services. Modifies DHS duties and authorities relating to oversight of health care institutions. Establishes requirements relating to Adult Protective Services (APS) investigations into abuse or neglect of a vulnerable adult. Modifies the membership of the Board of Examiners of Nursing Care Institution Administrators and Assisted Living Facility Managers (NCIA Board). Establishes the Vulnerable Adult System Study Committee (Study Committee) and outlines Study Committee membership, duties and reporting requirements.
Background
Health Care Institutions
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).
Adult Protective Services
APS is the
program within the Department of Economic Security (DES) responsible for
investigating allegations of abuse, exploitation and neglect of vulnerable
adults. The duties and responsibilities of APS workers include: 1) receiving
reports of abused, exploited or neglected vulnerable adults; 2) receiving oral
or written information indicating that an adult may be in need of protective
services; 3) conducting evaluations to determine if an adult is in need of
protective services and which services are needed; 4) offering protective
services to individuals in need; and 5) filing petitions for guardianship or
conservatorship of vulnerable adults. A
vulnerable adult is an individual who is eighteen years of age or older
and who is unable to protect himself from abuse, neglect or exploitation by
others because of a physical or mental impairment (A.R.S.
§§ 46-451 and 46-452).
NCIA Board
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).
Fiscal Impact
If there is a cost associated with the oversight of, and establishment of DHS training standards for, assisted living facilities that provide directed 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 standards for memory care services for assisted living facilities that are licensed to provide directed care services.
2. Requires the Director to establish by rule minimum memory care services training standards for staff and contractors who work in an assisted living facility that is licensed to provide directed care services.
3. 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.
4. 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.
5. Requires DHS to approve memory care services training programs.
6. 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 directed care services.
7. Stipulates that, if a staff member or contractor does not work at an assisted living facility that is licensed to provide directed care services for a period of 12 months, the person must complete the initial 8-hour training within 30 days after the date of hire, rehire or returning to work.
8. Specifies that an assisted living facility that is licensed to provide directed care services must provide documentation of prescribed staff training during any investigation or compliance survey.
9. Requires failure to provide complete staff training documentation to be cited as a deficiency.
10. 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
11. 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.
12. Prohibits DHS from charging a fee for a complaint or compliance-related survey or inspection if a health care institution is in substantial compliance.
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. 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.
16. 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.
18. Requires DHS to establish a rule with outlined considerations for determining the amount of a civil penalty assessed against a health care institution.
19. Includes, in the criteria that DHS Director must consider when determining the amount of a civil penalty, whether the health care institution and staff are in compliance with the vulnerable adult reporting requirements.
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 health care institution license application if:
a) the applicant, licensee or controlling person has a health care institution license that is under enforcement or court action related to the health and safety of the residents or patients; or
b) DHS has determined for other reasons that the issuance of a new license is likely to jeopardize resident or patient safety.
23. Authorizes DHS to deny a change in ownership of a currently licensed health care institution if it is determined that the transfer, whether involving a direct or indirect owner, would jeopardize patient safety.
Vulnerable Adult System Study Committee
24. Establishes the 25-member Study Committee, consisting of:
a) two members of the House of Representatives, appointed by the Speaker of the House (Speaker), who are members of different political parties, one of whom to serve as Co-Chairperson;
b) two members of the Senate, appointed by the Senate President (President), who are members of different political parties, one of whom to serve as Co-Chairperson;
c) the Director of DHS or the Director's designee;
d) the Director of DES or the Director's designee;
e) the Director of the Arizona Health Care Cost Containment System or the Director's designee;
f) one member representing the Governor's Office, appointed by the Governor;
g) one member representing the Attorney General's office, appointed by the Attorney General;
h) the current DES Long-Term Care Ombudsman or the Ombudsman's designee;
i) a current public fiduciary, appointed by the Governor;
j) two employees of a local law enforcement agency or statewide organization representing law enforcement, appointed by the Governor;
k) the Executive Director of the Navajo Area Agency on Aging or the Executive Director's designee;
l) the Executive Director of the Intertribal Council of Arizona or the Executive Director's designee;
m) two members representing assisted living facilities, appointed by the Speaker;
n) two members representing nursing care institutions, appointed by the Governor;
p) one member representing a statewide organization that advocates on behalf of persons affected by Alzheimer's disease, appointed by the President;
q) one member representing a statewide association that advocates on behalf of persons who provide services to persons with developmental disabilities, appointed by the Speaker;
r) a licensed health care professional that provides health care services to elderly vulnerable adults, appointed by the Speaker;
s) one member who serves on the Governor's Advisory Council on Aging, appointed by the Governor; and
t) one member who represents a statewide association representing Arizona firefighters, appointed by the President.
25. Requires the Study Committee to:
a) develop and implement a coordinated vulnerable adults delivery system that ensures the health and safety of vulnerable adults;
b) recommend best practices relating to responding and investigating complaints;
c) research best practices related to APS at the state, municipal and community levels;
d) research and make recommendations on how the vulnerable adult system can ensure that vulnerable adults receive required services, including assigning a specific agency the responsibility to provide or coordinate case management;
e) research and identify common statewide outcomes;
f) identify best practices for data collection and data sharing by various entities involved in providing vulnerable adult services; and
g) review and recommend changes to the statutes and rules that govern vulnerable adult services.
26. Allows the Co-Chairpersons of the Study Committee to designate work groups to research, study and make recommendations to the Study Committee.
27. Requires at least two work groups to be established to separately address the needs of persons with developmental disabilities and persons who are elderly or have a physical disability, including the training requirements for persons providing care for these populations.
28. Requires DES, in conjunction with the work groups, to develop an action plan for implementation once a strategic direction is established.
29. Specifies that public members are eligible for travel, lodging, meal and incidental expense reimbursement.
30. Requires, by December 31, 2024, the Study Committee to provide a status update of its progress, including any recommended statutory changes, to the members of the Health and Human Services Committees of the Senate and House of Representatives, or their successor committees.
31. Requires, by October 1, 2025, the Study Committee to submit a report regarding its findings and recommendations to the Governor, the President and the Speaker, and to provide a copy of the report to the Secretary of State.
32. Repeals the Study Committee on December 31, 2025.
NCIA Board
33. 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;
e) allows positions for managers or administrators to be filled by persons who are either actively licensed or retired.
34. Prohibits the NCIA Board from having more than three members appointed to positions for managers or administrators who are retired.
35. Specifies that NCIA Board members who are retired managers or administrators:
a) must have had an active license within the previous two years at the time of appointment; and
b) may not have had any disciplinary action imposed or had a license revoked.
Adult Protective Services
36. Requires, beginning January 1, 2025, each residential care institution, nursing care institution and home health agency to verify that a potential employee is not on the APS registry.
37. Prohibits residential care institutions, nursing care institutions and home health agencies from hiring a person found to be on the APS registry.
38. Requires residential care institutions, nursing care institutions and home health agencies to:
a) verify, by March 31, 2025, that each employee is not on the APS registry; and
b) annually reverify that each employee is not on the APS registry.
39. Requires residential care institutions, nursing care institutions and home health agencies to terminate an employee who is found to be on the APS registry.
40. Requires protective service workers to file for an order of protection or an injunction against harassment, as a third party on behalf of a vulnerable adult, to prevent an alleged perpetrator from having access to the vulnerable adult.
41. Authorizes DES or a protective services worker, acting in an official capacity, to access law enforcement records related to an APS case.
42. Requires law enforcement entities to furnish relevant records to APS on request.
43. Requires peace officers, as soon as possible, to notify and make available to the APS Central Intake Unit any reports received relating to an allegation of abuse or neglect of a vulnerable adult, including all related unredacted police records.
Miscellaneous
44. Requires DHS to adopt rules to implement this Act.
45. Makes technical and conforming changes.
46. Enacts assisted living facility memory care service requirements on July 1, 2025.
47. Becomes effective on the general effective date.
Amendments Adopted by Committee
1. Requires, beginning January 1, 2025, an owner of a residential care institution, nursing care institution or home health agency to verify that an employee or potential employee is not on the APS registry.
2. Requires an owner to terminate an employee, or not hire a potential employee, who is found to be on the APS registry.
3. Includes, in the criteria that DHS Director must consider when determining the amount of a civil penalty, whether the health care institution and staff are in compliance with the vulnerable adult reporting requirements.
4. Requires protective service workers to file for an order of protection or an injunction against harassment, as a third party on behalf of a vulnerable adult, to prevent an alleged perpetrator from having access to the vulnerable adult.
5. Authorizes DES or a protective services worker, acting in an official capacity, to access law enforcement records related to an APS case.
6. Requires law enforcement entities to furnish relevant records to APS on request.
7. Requires peace officers, as soon as possible, to notify and make available to the APS Central Intake Unit any reports received relating to an allegation of abuse or neglect of a vulnerable adult, including all related unredacted police records.
8. Prohibits DHS from charging a fee for a complaint or compliance-related survey or inspection if a health care institution is in substantial compliance.
9. Eliminates the requirement that DHS license assisted living facilities that provide memory care services and instead requires DHS to establish standards for memory care services for assisted living facilities required to provide directed care services.
10. Requires a person who does not work in an assisted living facility that provides directed care services for a period of 12 months to complete initial training requirements within 30 days of hire, rehire or returning to work.
11. Modifies NCIA Board membership and criteria for member qualification.
12. Establishes the Study Committee and outlines membership, duties and reporting requirements.
Amendments Adopted by Committee of the Whole
1. Requires residential care institutions, nursing care institutions and home health agencies to:
a) verify, by March 31, 2025, that each employee is not on the APS registry; and
b) annually reverify that each employee is not on the APS registry.
2. Describes the circumstances in which DHS may deny a health care institution license application.
3. Removes the prohibition on the DHS Director from accepting an accreditation report in lieu of a compliance inspection for residential care institutions and nursing care institutions.
4. Removes the DHS exemption from rulemaking requirements and the requirement that DHS hold at least two public meetings while establishing rules.
5. Allows the NCIA Board position for a family member of a resident at a skilled nursing facility or assisted living facility to be family of a person who was a resident in the previous three years.
6. Modifies the membership and duties of the Vulnerable Adult System Study Committee.
7. Requires DHS to adopt rules to implement this Act.
House Action Senate Action
HHS 2/15/24 DPA 9-1-0-0 HHS 3/19/24 DPA 6-0-1
3rd Read 2/29/24 49-10-0-0-1
Prepared by Senate Research
April 3, 2024
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