S.B. 1098

Reference Title: Conference Engrossed

State of Arizona Senate Forty-fourthFirst Regular1999 CHAPTER 333

SENATE BILL 1098

AN ACT

AMENDING TITLE 20, CHAPTER 4, ARTICLE 9, ARIZONA REVISED STATUTES, BY ADDING SECTION 20-1077; AMENDING SECTIONS 36-401 AND 36-402, ARIZONA REVISED STATUTES; AMENDING TITLE 36, CHAPTER 4, ARTICLE 5, ARIZONA REVISED STATUTES, BY ADDING SECTION 36-445.04; MAKING AN APPROPRIATION; RELATING TO HEALTH CARE INSTITUTIONS.

Be it enacted by the Legislature of the State of Arizona:

Section 1. Title 20, chapter 4, article 9, Arizona Revised Statutes, is amended by adding section 20-1077, to read:

20-1077 . Use of freestanding urgent care centers; policies and procedures

A HEALTH CARE SERVICES ORGANIZATION THAT REQUIRES ITS ENROLLEES TO USE A FREESTANDING URGENT CARE CENTER AS A CONDITION OF COVERAGE OR A REDUCTION IN COPAYMENT, COINSURANCE OR DEDUCTIBLE AMOUNTS FOR COVERED HEALTH CARE SERVICES SHALL:

1. DEVELOP AND MAINTAIN POLICIES FOR THE APPROPRIATE REFERRAL OF ITS ENROLLEES TO FREESTANDING URGENT CARE CENTERS. THE HEALTH CARE SERVICES ORGANIZATION'S MEDICAL DIRECTOR SHALL APPROVE THESE POLICIES.

2. INFORM ITS ENROLLEES THROUGH AN APPROPRIATE MEANS AS TO WHEN TO SEEK CARE AT A FREESTANDING URGENT CARE CENTER INSTEAD OF USING A HIGHER LEVEL OF CARE, SUCH AS A HOSPITAL EMERGENCY DEPARTMENT.

3. AT LEAST EVERY TWO YEARS, REVIEW THE PERFORMANCE OF AND RECREDENTIAL THE FREESTANDING URGENT CARE CENTERS UNDER CONTRACT WITH THE HEALTH CARE SERVICES ORGANIZATION.

Sec. 2. Section 36-401, Arizona Revised Statutes, is amended to read:

36-401 . Definitions; adult foster care

A. In this chapter, unless the context otherwise requires:

1. "Accredited health care institution" means a health care institution, other than a hospital, that is currently accredited by a nationally recognized accreditation organization.

2. "Accredited hospital" means a hospital currently accredited by a nationally recognized commission on hospital accreditation.

3. "Adaptive services" means medical services provided on an outpatient basis.

4. "Adult day health care facility" means a facility providing adult day health services during a portion of a continuous twenty-four hour period for compensation on a regular basis for five or more adults not related to the proprietor.

5. "Adult day health services" means a program that provides planned care supervision and activities, personal care, personal living skills training, meals and health monitoring in a group setting during a portion of a continuous twenty-four hour period. Adult day health services may also include preventive, therapeutic and restorative health related services that do not include behavioral health services.

6. "Adult foster care" means a residential setting which provides room and board and adult foster care services for at least one and no more than four adults who are participants in the Arizona long-term care system pursuant to chapter 29, article 2 of this title and in which the sponsor or the manager resides with the residents and integrates the residents who are receiving adult foster care into that person's family.

7. "Adult foster care services" means supervision, assistance with eating, bathing, toileting, dressing, self-medication and other routines of daily living or services authorized by section 36-2939, subsection C and rules adopted pursuant to that section.

8. "Ambulatory person" means any individual, including one who uses a cane or other ambulatory support device, who is physically and mentally capable under emergency conditions of finding a way to safety without assistance.

9. "Assisted living center" means an assisted living facility that provides resident rooms or residential units to eleven or more residents.

10. "Assisted living facility" means a residential care institution, including adult foster care, that provides or contracts to provide supervisory care services, personal care services or directed care services on a continuing basis.

11. "Assisted living home" means an assisted living facility that provides resident rooms to ten or fewer residents.

12. "Capital expenditure" means the acquisition by lease or purchase of a capital asset in the nature of buildings, fixtures or durable equipment.

13. "Construction" means the building, erection, fabrication, or installation of a health care institution.

14. "Continuous" means available at all times without cessation, break or interruption.

15. "Department" means the department of health services.

16. "Directed care services" means programs and services, including personal care services, provided to persons who are incapable of recognizing danger, summoning assistance, expressing need or making basic care decisions.

17. "Direction" means authoritative policy or procedural guidance for the accomplishment of a function or activity.

18. "Director" means the director of the department of health services.

19. "Facilities" means buildings used by a health care institution for providing any of the types of services as defined in this chapter.

20. "FREESTANDING URGENT CARE CENTER":

( a ) MEANS AN OUTPATIENT TREATMENT CENTER THAT REGARDLESS OF ITS POSTED OR ADVERTISED NAME, MEETS ANY OF THE FOLLOWING REQUIREMENTS:

( i ) IS OPEN TWENTY-FOUR HOURS A DAY, EXCLUDING AT ITS OPTION WEEKENDS OR CERTAIN HOLIDAYS, BUT IS NOT LICENSED AS A HOSPITAL.

( ii ) CLAIMS TO PROVIDE UNSCHEDULED MEDICAL SERVICES NOT OTHERWISE ROUTINELY AVAILABLE IN PRIMARY CARE PHYSICIAN OFFICES.

( iii ) BY ITS POSTED OR ADVERTISED NAME, GIVES THE IMPRESSION TO THE PUBLIC THAT IT PROVIDES MEDICAL CARE FOR URGENT, IMMEDIATE OR EMERGENCY CONDITIONS.

( iv ) ROUTINELY PROVIDES ONGOING UNSCHEDULED MEDICAL SERVICES FOR MORE THAN EIGHT CONSECUTIVE HOURS FOR AN INDIVIDUAL PATIENT.

( b ) DOES NOT INCLUDE THE FOLLOWING:

( i ) A MEDICAL FACILITY THAT IS LICENSED UNDER A HOSPITAL'S LICENSE AND THAT USES THE HOSPITAL'S MEDICAL PROVIDER NUMBER.

( ii ) A QUALIFYING COMMUNITY HEALTH CENTER PURSUANT TO SECTION 36-2907.06.

( iii ) ANY OTHER HEALTH CARE INSTITUTION LICENSED PURSUANT TO THIS CHAPTER.

20. 21. "Governing authority" means the individual, agency, group or corporation, appointed, elected or otherwise designated, in which the ultimate responsibility and authority for the conduct of the health care institution are vested.

21. 22. "Health care institution" means every place, institution, building or agency, whether organized for profit or not, which provides facilities with medical services, nursing services, health screening services, other health-related services, supervisory care services, personal care services , OR directed care services and includes home health agencies as defined in section 36-151 and hospice service agencies.

22. 23. "Health-related services" means services, other than medical, pertaining to general supervision, protective, preventive and personal care services, supervisory care services or directed care services.

23. 24. "Health screening services" means the acquisition, analysis and delivery of health-related data of individuals to aid in the determination of the need for medical services.

24. 25. "Hospice" means a hospice service agency or the provision of hospice services in an inpatient facility.

25. 26. "Hospice service" means a program of palliative and supportive care for terminally ill persons and their families or caregivers.

26. 27. "Hospice service agency" means an agency or organization, or a subdivision of that agency or organization, which is engaged in providing hospice services at the place of residence of its clients.

27. 28. "Inpatient beds" or "resident beds" means accommodations with supporting services, such as food, laundry and housekeeping, for patients or residents who generally stay in excess of twenty-four hours.

28. 29. "Medical services" means the services pertaining to medical care that are performed at the direction of a physician on behalf of patients by physicians, dentists, nurses and other professional and technical personnel.

29. 30. "Modification" means the substantial improvement, enlargement, reduction, alteration of or other change in a health care institution.

30. 31. "Nonproprietary institution" means any health care institution organized and operated exclusively for charitable purposes, no part of the net earnings of which inures to the benefit of any private shareholder or individual, or operated by the state or any political subdivision of the state.

31. 32. "Nursing care institution" means a health care institution providing inpatient beds or resident beds and nursing services to persons who need nursing services on a continuing basis but who do not require hospital care or direct daily care from a physician.

32. 33. "Nursing services" means those services pertaining to the curative, restorative and preventive aspects of nursing care that are performed at the direction of a physician by or under the supervision of a registered nurse licensed in this state.

33. 34. "Organized medical staff" means a formal organization of physicians, and dentists where appropriate, with the delegated authority and responsibility to maintain proper standards of medical care and to plan for continued betterment of that care.

34. 35. "Outpatient surgical center" means a type of health care institution with facilities and limited hospital services for the diagnosis or treatment of patients by surgery whose recovery, in the concurring opinions of the surgeon and the anesthesiologist, does not require inpatient care in a hospital.

35. 36. "Personal care services" means assistance with activities of daily living that can be performed by persons without professional skills or professional training and includes the coordination or provision of intermittent nursing services and the administration of medications and treatments by a nurse who is licensed pursuant to title 32, chapter 15 or as otherwise provided by law.

36. 37. "Physician" means any person licensed under title 32, chapter 13 or 17.

37. 38. "Residential care institution" means a health care institution other than a hospital or a nursing care institution which provides resident beds or residential units, supervisory care services, personal care services, directed care services or health-related services for persons who do not need inpatient nursing care.

38. 39. "Residential unit" means a private apartment, unless otherwise requested by a resident, that includes a living and sleeping space, kitchen area, private bathroom and storage area.

39. 40. "Respite care services" means services provided by a licensed health care institution to persons otherwise cared for in foster homes and in private homes to provide an interval of rest or relief of not more than thirty days to operators of foster homes or to family members.

40. 41. "Substantial compliance" means that the nature or number of violations revealed by any type of inspection or investigation of a licensed health care institution does not pose a direct risk to the life, health or safety of patients or residents.

41. 42. "Supervision" means direct overseeing and inspection of the act of accomplishing a function or activity.

42. 43. "Supervisory care services" means general supervision, including daily awareness of resident functioning and continuing needs, the ability to intervene in a crisis and assistance in the self-administration of prescribed medications.

44. "UNSCHEDULED MEDICAL SERVICES" MEANS MEDICALLY NECESSARY PERIODIC HEALTH CARE SERVICES THAT ARE UNANTICIPATED OR CANNOT REASONABLY BE ANTICIPATED AND THAT REQUIRE MEDICAL EVALUATION OR TREATMENT BEFORE THE NEXT BUSINESS DAY.

B. If there are fewer than four Arizona long-term care system participants receiving adult foster care in an adult foster care home, nonparticipating adults may receive other types of services authorized by law to be provided in the adult foster care home as long as the number of adults served, including the Arizona long-term care system participants, does not exceed four.

C. Nursing care services may be provided by the adult foster care licensee if such licensee is a nurse licensed pursuant to title 32, chapter 15 and the services are limited to those allowed pursuant to law. The licensee shall keep a record of nursing services rendered.

Sec. 3. Section 36-402, Arizona Revised Statutes, is amended to read:

36-402 . Exemptions

Nothing in This chapter or the rules adopted by the director pursuant to the provisions of this chapter authorizes DO NOT AUTHORIZE the licensure, supervision, regulation or control of:

1. The remedial care or treatment of residents or patients in any home or institution conducted only for those who rely solely upon ON treatment by prayer or spiritual means in accordance with the creed or tenets of any well recognized church or religious denomination.

2. Establishments, such as motels, hotels and boarding houses, which provide domiciliary and ancillary commercial services, but do not provide adaptive, medical, hospital, nursing, health-related or supervisory care services.

3. Private offices and clinics of health care providers licensed under title 32 THAT ARE NOT FREESTANDING URGENT CARE CENTERS, unless patients are kept overnight as bed patients or treated otherwise under general anesthesia except where treatment by general anesthesia is regulated by title 32, chapter 11.

4. Dispensaries and first aid stations located within business or industrial establishments maintained solely for the use of employees if the facility does not contain inpatient beds and is under the supervision of a physician.

5. The collection, processing or distribution of whole human blood, blood components, plasma, blood fractions or derivatives procured, processed or distributed by federally licensed and regulated blood banks.

6. Adult foster care homes certified by the county or the department pursuant to section 11-293.01 or 36-410.

7. Places where four or fewer adults not related to the administrator or owner receive adult day health services for compensation on a regular basis.

8. Places at which persons receive health related services only from relatives or from legal guardians or places that do not purport to be establishments that regularly provide health related services AND at which two or fewer ONE OR TWO persons receive health related services on a twenty-four hour basis.

9. The Arizona pioneers' home. However, the department of health services shall evaluate the health and sanitation conditions at the Arizona pioneers' home annually using the standards applicable to licensed nursing care institutions. THE DEPARTMENT SHALL PREPARE AND DISTRIBUTE reports of such THESE visits shall be prepared and disseminated to the president of the senate, the speaker of the house of representatives and the governor within thirty days of such visits EACH VISIT . Reports shall include information as to the extent of compliance with applicable standards as compared to licensed nursing care institutions and recommendations for the improvement of care and services provided.

10. The personal residence of a terminally ill person, or the personal residence of that person's relative or guardian, where that person receives hospice services from a hospice service agency.

11. All medical and health related facilities and services that are provided to inmates who are confined in a state prison. The state department of corrections shall annually evaluate the medical and health related facilities and services that are provided to inmates to determine that the facilities and services meet the applicable standards that are adopted by the director of the department of health services. The state department of corrections shall report the results of its annual evaluation and the actual findings, including a plan of correction for any deficiencies, to the director of the department of health services. The department of health services shall conduct validation surveys on a percentage of the medical and health related facilities, the number of which shall be determined by the state department of corrections and the department of health services. The director of the state department of corrections shall maintain the annual evaluation reports. This paragraph does not apply to licensed behavioral or mental health inpatient treatment facilities that the state department of corrections operates.

Sec. 4. Title 36, chapter 4, article 5, Arizona Revised Statutes, is amended by adding section 36-445.04, to read:

36-445.04 . Freestanding urgent care center incident reporting; confidentiality requirement

IF A PATIENT'S DEATH OCCURS AT A FREESTANDING URGENT CARE CENTER, THE CENTER SHALL REPORT THE DEATH TO THE DEPARTMENT NOT LATER THAN THE NEXT DEPARTMENT WORK DAY. THE DEPARTMENT SHALL NOT RELEASE PERSONALLY IDENTIFIABLE PATIENT OR PHYSICIAN INFORMATION.

Sec. 5. Legislative appropriations

The licensure of freestanding urgent care centers as defined in section 36-401, Arizona Revised Statutes, as amended by this act, is subject to legislative appropriations. In the general appropriations act or in other legislation, the legislature shall identify monies to fund the department of health services' administrative costs that are associated with the licensure of freestanding urgent care centers. The department of health services is not required to spend monies that exceed the appropriation made for this purpose.

Sec. 6. Appropriation

The sum of $100,000 is appropriated from the state general fund to the department of health services in fiscal year 2000-2001 for the purposes of this act.

Sec. 7. Effective date

This act is effective from and after June 30, 2000.

APPROVED BY THE GOVERNOR MAY 19, 1999.

FILED IN THE OFFICE OF THE SECRETARY OF STATE MAY 19, 1999.