PREFILED DEC 19 2023
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REFERENCE TITLE: behavioral health transportation; providers; technicians |
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State of Arizona House of Representatives Fifty-sixth Legislature Second Regular Session 2024
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HB 2066 |
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Introduced by Representative Bliss
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An Act
amending sections 36-501 and 36-503.02, Arizona Revised Statutes; amending title 36, chapter 21.1, Arizona Revised Statutes, by adding article 5; relating to emergency medical services.
(TEXT OF BILL BEGINS ON NEXT PAGE)
Be it enacted by the Legislature of the State of Arizona:
Section 1. Section 36-501, Arizona Revised Statutes, is amended to read:
36-501. Definitions
In this chapter, unless the context otherwise requires:
1. "Administration" means the Arizona health care cost containment system administration.
2. "Admitting officer" means a psychiatrist or other physician or psychiatric and mental health nurse practitioner with experience in performing psychiatric examinations who has been designated as an admitting officer of the evaluation agency by the person in charge of the evaluation agency.
3. "Authorized transporter" means a transportation entity that is contracted with a city, town or county to provide services pursuant to this chapter and that is either:
(a) An ambulance service that holds a valid certificate of necessity.
(b) A behavioral health transportation provider authorized by this state that holds a certificate pursuant to chapter 21.1, article 5 of this title to provide safe behavioral health transportation for individuals requiring transportation pursuant to this chapter.
4. "Chief medical officer" means the chief medical officer under the supervision of the superintendent of the state hospital.
5. "Contraindicated" means that access is reasonably likely to endanger the life or physical safety of the patient or another person.
6. "Court" means the superior court in the county in this state in which the patient resides or was found before screening or emergency admission under this title.
7. "Criminal history" means police reports, lists of prior arrests and convictions, criminal case pleadings and court orders, including a determination that the person has been found incompetent to stand trial pursuant to section 13-4510.
8. "Danger to others" means that the judgment of a person who has a mental disorder is so impaired that the person is unable to understand the person's need for treatment and as a result of the person's mental disorder the person's continued behavior can reasonably be expected, on the basis of competent medical opinion, to result in serious physical harm.
9. "Danger to self":
(a) Means behavior that, as a result of a mental disorder:
(i) Constitutes a danger of inflicting serious physical harm on oneself, including attempted suicide or the serious threat thereof, if the threat is such that, when considered in the light of its context and in light of the individual's previous acts, it is substantially supportive of an expectation that the threat will be carried out.
(ii) Without hospitalization will result in serious physical harm or serious illness to the person.
(b) Does not include behavior that establishes only the condition of having a grave disability.
10. "Department" means the department of health services.
11. "Detention" means the taking into custody of a patient or proposed patient.
12. "Director" means the director of the administration.
13. "Evaluation" means:
(a) A professional multidisciplinary analysis that may include firsthand observations or remote observations by interactive audiovisual media and that is based on data describing the person's identity, biography and medical, psychological and social conditions carried out by a group of persons consisting of at least the following:
(i) Two licensed physicians who are qualified psychiatrists, if possible, or at least experienced in psychiatric matters, who shall examine and report their findings independently. The person against whom a petition has been filed shall be notified that the person may select one of the physicians. A psychiatric resident in a training program approved by the American medical association or by the American osteopathic association may examine the person in place of one of the psychiatrists if the resident is supervised in the examination and preparation of the affidavit and testimony in court by a qualified psychiatrist appointed to assist in the resident's training, and if the supervising psychiatrist is available for discussion with the attorneys for all parties and for court appearance and testimony if requested by the court or any of the attorneys.
(ii) Two other individuals, one of whom, if available, is a psychologist and in any event a social worker familiar with mental health and human services that may be available placement alternatives appropriate for treatment. An evaluation may be conducted on an inpatient basis, an outpatient basis or a combination of both, and every reasonable attempt shall be made to conduct the evaluation in any language preferred by the person.
(b) A physical examination that is consistent with the existing standards of care and that is performed by one of the evaluating physicians or by or under the supervision of a physician who is licensed pursuant to title 32, chapter 13 or 17 or a registered nurse practitioner who is licensed pursuant to title 32, chapter 15 if the results of that examination are reviewed or augmented by one of the evaluating physicians.
14. "Evaluation agency" means either of the following:
(a) A health care agency that is licensed by the department and that has been approved pursuant to this title to provide the services required of that agency by this chapter.
(b) A facility that is exempt from licensure pursuant to section 36-402, that possesses an accreditation from either a national commission on correctional health care or an American correctional association and that has been approved pursuant to this title to provide the services required of that facility by this chapter.
15. "Family member" means a spouse, parent, adult child, adult sibling or other blood relative of a person undergoing treatment or evaluation pursuant to this chapter.
16. "Grave disability" means a condition evidenced by behavior in which a person, as a result of a mental disorder, is likely to come to serious physical harm or serious illness because the person is unable to provide for the person's own basic physical needs.
17. "Health care decision maker" has the same meaning prescribed in section 12-2801.
18. "Health care entity" means a health care provider, the department, the administration or a regional behavioral health authority that is under contract with the administration.
19. "Health care provider" means a health care institution as defined in section 36-401 that is licensed as a behavioral health provider pursuant to department rules or a mental health provider.
20. "Independent evaluator" means a licensed physician, psychiatric and mental health nurse practitioner or psychologist who is selected by the person to be evaluated or by the person's attorney.
21. "Informed consent" means a voluntary decision following presentation of all facts necessary to form the basis of an intelligent consent by the patient or guardian with no minimizing of known dangers of any procedures.
22. "Least restrictive treatment alternative" means the treatment plan and setting that infringe in the least possible degree with the patient's right to liberty and that are consistent with providing needed treatment in a safe and humane manner.
23. "Licensed physician" means any medical doctor or doctor of osteopathy who is either:
(a) Licensed in this state.
(b) A full-time hospital physician licensed in another state and serving on the staff of a hospital operated or licensed by the United States government.
24. "Medical director of an evaluation agency" means a psychiatrist, or other licensed physician experienced in psychiatric matters, who is designated in writing by the governing body of the agency as the person in charge of the medical services of the agency for the purposes of this chapter and may include the chief medical officer of the state hospital.
25. "Medical director of a mental health treatment agency" means a psychiatrist, or other licensed physician experienced in psychiatric matters, who is designated in writing by the governing body of the agency as the person in charge of the medical services of the agency for the purposes of this chapter and includes the chief medical officer of the state hospital.
26. "Mental disorder" means a substantial disorder of the person's emotional processes, thought, cognition or memory. Mental disorder is distinguished from:
(a) Conditions that are primarily those of drug abuse, alcoholism or intellectual disability, unless, in addition to one or more of these conditions, the person has a mental disorder.
(b) The declining mental abilities that directly accompany impending death.
(c) Character and personality disorders characterized by lifelong and deeply ingrained antisocial behavior patterns, including sexual behaviors that are abnormal and prohibited by statute unless the behavior results from a mental disorder.
27. "Mental health provider" means any physician or provider of mental health or behavioral health services who is involved in evaluating, caring for, treating or rehabilitating a patient.
28. "Mental health treatment agency" means any of the following:
(a) The state hospital.
(b) A health care agency that is licensed by the department and that provides the services that are required of the agency by this chapter.
(c) A facility that is exempt from licensure pursuant to section 36-402, that possesses an accreditation from either a national commission on correctional health care or an American correctional association and that provides the services that are required of the facility by this chapter.
29. "Outpatient treatment" or "combined inpatient and outpatient treatment" means any treatment program not requiring continuous inpatient hospitalization.
30. "Outpatient treatment plan" means a treatment plan that does not require continuous inpatient hospitalization.
31. "Patient" means any person who is undergoing examination, evaluation or behavioral or mental health treatment under this chapter.
32. "Peace officers" means sheriffs of counties, constables, marshals and policemen of cities and towns.
33. "Persistent or acute disability" means a severe mental disorder that meets all the following criteria:
(a) Significantly impairs judgment, reason, behavior or capacity to recognize reality.
(b) If not treated, has a substantial probability of causing the person to suffer or continue to suffer severe and abnormal mental, emotional or physical harm.
(c) Substantially impairs the person's capacity to make an informed decision regarding treatment, and this impairment causes the person to be incapable of understanding and expressing an understanding of the advantages and disadvantages of accepting treatment and understanding and expressing an understanding of the alternatives to the particular treatment offered after the advantages, disadvantages and alternatives are explained to that person.
(d) Has a reasonable prospect of being treatable by outpatient, inpatient or combined inpatient and outpatient treatment.
34. "Prepetition screening" means the review of each application requesting court-ordered evaluation, including an investigation of facts alleged in the application, an interview with each applicant and an interview, if possible, with the proposed patient. The purpose of the interview with the proposed patient is to assess the problem, explain the application and, when indicated, attempt to persuade the proposed patient to receive, on a voluntary basis, evaluation or other services.
35. "Prescribed form" means a form established by a court or the rules of the administration in accordance with the laws of this state.
36. "Professional" means a physician who is licensed pursuant to title 32, chapter 13 or 17, a psychologist who is licensed pursuant to title 32, chapter 19.1 or a psychiatric and mental health nurse practitioner who is certified pursuant to title 32, chapter 15.
37. "Proposed patient" means a person for whom an application for evaluation has been made or a petition for court-ordered evaluation has been filed.
38. "Prosecuting agency" means the county attorney, attorney general or city attorney who applied or petitioned for an evaluation or treatment pursuant to this chapter.
39. "Psychiatric and mental health nurse practitioner" means a registered nurse practitioner as defined in section 32-1601 who has completed an adult or family psychiatric and mental health nurse practitioner program and who is certified as an adult or family psychiatric and mental health nurse practitioner by the state board of nursing.
40. "Psychiatrist" means a licensed physician who has completed three years of graduate training in psychiatry in a program approved by the American medical association or the American osteopathic association.
41. "Psychologist" means a person who is licensed under title 32, chapter 19.1 and who is experienced in the practice of clinical psychology.
42. "Records" means all communications that are recorded in any form or medium and that relate to patient examination, evaluation or behavioral or mental health treatment. Records include medical records that are prepared by a health care provider or other providers. Records do not include:
(a) Materials that are prepared in connection with utilization review, peer review or quality assurance activities, including records that a health care provider prepares pursuant to section 36-441, 36-445, 36-2402 or 36-2917.
(b) Recorded telephone and radio calls to and from a publicly operated emergency dispatch office relating to requests for emergency services or reports of suspected criminal activity.
43. "Regional behavioral health authority" has the same meaning prescribed in section 36-3401.
44. "Screening agency" means a health care agency that is licensed by the department and that provides those services required of the agency by this chapter.
45. "Social worker" means a person who has completed two years of graduate training in social work in a program approved by the council of social work education and who has experience in mental health.
46. "State hospital" means the Arizona state hospital.
47. "Superintendent" means the superintendent of the state hospital.
48. "Voluntary evaluation" means the ongoing collection and analysis of a person's medical, psychological, psychiatric and social conditions in order to initially determine if a health disorder exists and if there is a need for behavioral health services and, on an ongoing basis, to ensure that the person's service plan is designed to meet the person's and the person's family's current needs and long-term goals.
Sec. 2. Section 36-503.02, Arizona Revised Statutes, is amended to read:
36-503.02. Apprehension and transportation by authorized transporters; immunity
A. When in any section of articles 4 and 5 of this chapter, a court, a person, an evaluation agency or a mental health treatment agency is allowed to authorize, request or order the apprehension and transportation of a patient or proposed patient by a peace officer to an evaluation agency or mental health treatment agency, the court, person, evaluation agency or mental health treatment agency may authorize the apprehension and transportation by an authorized transporter if available in the city, town or county if there are reasonable grounds to believe that the patient or proposed patient may be safely apprehended and transported by an authorized transporter without the assistance of a peace officer.
B. Any person who provides a court, a person, an evaluation agency or a mental health treatment agency authorized to request or order the apprehension and transportation of a patient or proposed patient with facts and circumstances or expresses an opinion that there may be reasonable grounds to believe a patient or proposed patient may be safely apprehended and transported to an evaluation agency or mental health treatment agency by an authorized transporter without the assistance of a peace officer, the court, the person, the evaluation agency or the mental health treatment agency that authorizes the use of an authorized transporter and the authorized transporter that apprehends and transports the patient or proposed patient to an evaluation agency or mental health treatment agency pursuant to an authorization, request or order issued under this chapter are not subject to civil liability for the apprehension or transportation. This liability exclusion does not apply to a person who acts with gross negligence.
C. This chapter does not require a city, town or county to contract with an authorized transporter to provide services pursuant to this chapter instead of a peace officer. A city, town or county that enters into a contract with an authorized transporter is financially responsible for the contracted services provided pursuant to this chapter by the authorized transporter, except that services provided pursuant to this section to a person who is eligible pursuant to chapter 29, article 1 of this title shall be paid by the administration pursuant to chapter 29, article 1 of this title.
D. For the purposes of this chapter, an evaluation agency or mental health treatment agency authorizing the use of an authorized transporter is not financially responsible for the use of the authorized transporter.
Sec. 3. Title 36, chapter 21.1, Arizona Revised Statutes, is amended by adding article 5, to read:
ARTICLE 5. BEHAVIORAL HEALTH TRANSPORTATION
36-2269. Definitions
In this article, unless the context otherwise requires:
1. "Behavioral health emergency technician" MEANS a person who is certified to provide services on a behavioral health transport vehicle.
2. "Behavioral health transportation provider" means a transportation provider that holds a certificate issued pursuant to this article to provide transportation for individuals pursuant to chapter 5 of this title.
3. "Certificate" means a certificate that is issued by the department to a behavioral HEALTH transportation provider pursuant to this article and that describes the following:
(a) The effective date of the certificate.
(b) The expiration date of the certificate.
(c) The legal address and name of the certificate holder, including suboperation locations, if applicable.
(d) The vehicle identification number for each behavioral health transport vehicle for which the certificate is issued and the last inspection date and next inspection date of each behavioral health transport vehicle.
(e) the Minimum equipment list for behavioral health transport vehicles.
4. "Fit and proper" means that the director has determined that an applicant for a certificate under this article has the expertise, integrity, fiscal competence and resources to provide behavioral health transportation services.
36-2269.01. Duties of the director
The director shall:
1. Adopt any rules necessary to carry out this article consistent with section 36-2269.02.
2. Issue certificates for behavioral health transportation providers.
3. Maintain a system for the certification and recertification of behavioral health emergency technicians.
4. Create operating guidelines for behavioral health emergency technicians, including emergency notifications and procedures.
5. Prescribe the fees necessary to administer this article. all fees collected pursuant to this article shall be deposited, pursuant to sections 35-146 and 35-147, in the emergency medical services operating fund established by section 36-2218 and be used only to administer this article.
36-2269.02. Rules; behavioral health transport
a. The director shall adopt rules for the purposes of this article, including:
1. Minimum requirements for training, testing and certification and recertification of behavioral health emergency technicians, including:
(a) Courses in emergency first aid and lifesaving techniques.
(b) Completion of a training course approved by the director on mental health issues and patients with mental health impairments.
(c) Passing an examination approved by the director that is designed to test both:
(i) Knowledge and recognition of characteristics and symptoms of mental illness and mental health impairments.
(ii) Knowledge of mental health crisis intervention strategies for people with mental health impairments.
(d) Requiring a criminal background check and no conviction or deferred or probated sentence for any crime related to a sexual offense, homicide, theft, assault, battery or crime involving personal injury or threat to another person.
2. Minimum requirements for behavioral health transport vehicles, including:
(a) Requirements that each behavioral health transport vehicle be well maintained and equipped to ensure the protection of patients from harm or injury.
(b) A safety partition between the driver and passenger areas that does not reduce visibility.
(c) Safety locks to keep a patient from exiting a moving behavioral health transport vehicle.
(d) a two-way radio or cellular phone that works during the entire transport.
(e) Requirements for the documentation of behavioral health transports.
(f) Appropriate equipment for providing first aid and life-saving techniques.
3. Requirements for the issuance of a behavioral health transportation provider certificate, including requiring a clinical director who is licensed pursuant to title 32, chapter 13 or 17, a nurse practitioner who is certified pursuant to title 32, chapter 15 or a physician assistant who is licensed pursuant to title 32, chapter 25.
B. each patient shall be accompanied by appropriate medical personnel as defined by rule DUring a behavioral health transport if there is reasonable cause to believe that the patient will require medical assistance or the administration of medication during the behavioral health transport.
36-2269.03. Behavioral health transportation providers; certification; renewal; change of ownership; investigation; discipline
A. A person may not operate as a behavioral health transportation provider in this state unless the person has a certificate issued pursuant to this article and the rules adopted pursuant to this article.
B. A person may obtain a certificate to operate as a behavioral health transportation provider by submitting an application on a form prescribed by the director and by demonstrating to the director's satisfaction that the applicant is fit and proper, has paid the initial registration fee and is in compliance with this article and rules adopted pursuant to this article to operate as a behavioral health transportation provider.
c. A certificate issued to a behavioral health transportation provider is valid for one year. A behavioral health transportation provider may request that the department issue an initial certificate that expires before the end of the year in order for the department to conduct an annual inspection of all of the behavioral health transportation provider's behavior health transport vehicles at one time. A behavioral health transportation provider may renew a certificate by complying with the requirements of this article and the rules adopted pursuant to this article and paying a renewal fee prescribed by the director.
d. A certificate issued pursuant to this section terminates on any change of ownership or control of the behavioral health transportation provider. Following any change of ownership, the new owner of a behavioral health transportation provider shall apply for and receive a new certification from the director before the behavioral health transportation provider may again operate in this state. This subsection does not apply if a behavioral health transportation provider borrows, leases, rents or otherwise obtains a behavioral health transport vehicle from another behavioral health transportation provider to temporarily replace an inoperable behavioral health transport vehicle.
e. The director may investigate the operation of and complaints filed against behavioral health transportation providers and impose disciplinary measures against a behavioral health transportation provider's certificate issued pursuant to this article consistent with section 36-2245, except as that section applies to rates and charges.
36-2269.04. Behavioral health emergency technicians; grounds for censure, probation, suspension or revocation of certificate; confidentiality
a. The Director may censure or place on probation a behavioral health emergency technician or suspend or revoke the certification issued pursuant to this article to a behavioral health emergency technician consistent with section 36-2211. the director may investigate, interview and impose disciplinary action and civil penalties.
B. Information, documents and records received or prepared by the department in connection with an investigation that is conducted pursuant to this section, consistent with section 36-2245, and that relates to behavioral health emergency technicians are confidential and are not subject to public inspection or civil discovery. When the investigation has been completed and the investigation file has been closed, the results of the investigation and the decision of the department shall be available to the public.
36-2269.05. Behavioral health transportation advisory committee; membership; duties; compensation
A. The behavioral health transportation advisory committee is established in the department to advise the director regarding rulemaking and policies related to the qualifications, regulation and oversight of behavioral health transportation providers. The advisory shall consist of at least the following members who are appointed by the director:
1. An independent evaluator as defined in section 36-501.
2. A representative of a law enforcement agency for a city or town in a county with a population of at least one million persons.
3. A representative of a law enforcement agency for a city or town in a county with a population of less than one million persons.
4. A person who is responsible for operating a city or town ambulance service.
5. A representative of a hospital that operates an emergency department in this state.
B. The advisory committee members shall serve three-year terms.
C. Members of the advisory committee are not eligible to receive compensation but are eligible for reimbursement of expenses pursuant to title 38, chapter 4, article 2.