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HB2251 - 572R - S Ver
Senate Engrossed
House Bill
midwives;
medication administration; advisory committee
(now:� midwifery;
prescriptions; naturopathic medical board)
State of Arizona
House of Representatives
Fifty-seventh Legislature
Second Regular Session
2026
HOUSE BILL 2251
AN
ACT
Amending sections 12-910, 20-3151
and 32-1502, Arizona Revised Statutes; Amending section 32-1505,
Arizona Revised Statutes, as amended by laws 2024, chapter 222, section 17;
Amending section 32-1505, Arizona Revised Statutes, as amended by laws
2024, chapter 222, section 18; providing for TRANSFERRING and renumbering; Amending
sections 32-1591, 32-1591.02, 32-1591.04, 32-1591.05,
32-1591.06, 32-1591.08, Arizona Revised Statutes, as transferred
and renumbered; amending title 32, chapter 14, article 5, Arizona Revised
Statutes, as transferred and renumbered, by adding sections 32-1591.11,
32-1591.12 and 32-1591.13; amending sections 32-3101, 32-3201,
36-301, 36-422, 36-425 and 36-3601, Arizona Revised
Statutes; appropriating monies; relating to midwifery.
(TEXT OF BILL BEGINS ON NEXT PAGE)
Be it
enacted by the Legislature of the State of Arizona:
Section 1. Section 12-910, Arizona Revised
Statutes, is amended to read:
START_STATUTE
12-910.
Scope of review
A. An action to review a final administrative
decision shall be heard and determined with convenient speed. If
requested by a party to an action within thirty days after filing a notice of
appeal, the court shall hold an evidentiary hearing, including testimony and
argument, to the extent necessary to make the determination required by subsection
F of this section. The court may hear testimony from witnesses who
testified at the administrative hearing and witnesses who were not called to
testify at the administrative hearing.
B. Relevant and admissible exhibits and testimony
that were not offered during the administrative hearing shall be admitted, and
objections that a party failed to make to evidence offered at the
administrative hearing shall be considered, unless either of the following is
true:
1. The exhibit, testimony or objection was withheld
for purposes of delay, harassment or other improper purpose.
2. Allowing admission of the exhibit or testimony or
consideration of the objection would cause substantial prejudice to another
party.
C. For review of final administrative decisions of
agencies that are exempt from sections 41-1092.03, 41-1092.04, 41-1092.05,
41-1092.06, 41-1092.07, 41-1092.08, 41-1092.09, 41-1092.10,
and 41-1092.11, pursuant to section 41-1092.02, the trial shall be
de novo if trial de novo is demanded in the notice of appeal or motion of an
appellee other than the agency and if a hearing was not held by the agency or
the proceedings before the agency were not stenographically reported or
mechanically recorded so that a transcript might be made. On demand
of any party, if a trial de novo is available under this section, it may be
with a jury, except that a trial of an administrative decision under section 25-522
shall be to the court.
D. For review of final administrative decisions of
agencies that regulate a profession or occupation pursuant to title 32, title
36, chapter 4, article 6
, title 36, chapter 6, article 7
or title 36, chapter 17, the trial shall be de novo if trial de novo is
demanded in the notice of appeal or motion of an appellee other than the
agency.
E. The record in the superior court shall consist of
the record of the administrative proceeding, and the record of any evidentiary
hearing, or the record of the trial de novo.
F. After reviewing the administrative record and
supplementing evidence presented at the evidentiary hearing, the court may
affirm, reverse, modify or vacate and remand the agency action. The
court shall affirm the agency action unless the court concludes that the
agency's action is contrary to law, is not supported by substantial evidence,
is arbitrary and capricious or is an abuse of discretion. In a
proceeding brought by or against the regulated party, the court shall decide
all questions of law, including the interpretation of a constitutional or
statutory provision or a rule adopted by an agency, without deference to any
previous determination that may have been made on the question by the
agency. In a proceeding brought by or against the regulated party,
the court shall decide all questions of fact without deference to any previous
determination that may have been made on the question by the agency.
Notwithstanding any other law, this subsection applies in any action for
judicial review of any agency action that is authorized by law.
G. Notwithstanding subsection F of this section, if
the action arises out of title 20, chapter 15, article 2, the court shall
affirm the agency action unless after reviewing the administrative record and
supplementing evidence presented at the evidentiary hearing the court concludes
that the action is not supported by substantial evidence, is contrary to law,
is arbitrary and capricious or is an abuse of discretion.
H. This section does not apply to any agency action
pursuant to title 40, chapter 2, article 5 or 6.2.
END_STATUTE
Sec. 2. Section 20-3151, Arizona Revised
Statutes, is amended to read:
START_STATUTE
20-3151.
Definitions
For the purposes of this section:
1. "Enrollee" means an individual who is
enrolled in a health care plan provided by a health care insurer.
2. "Health care insurer" means a
disability insurer, group disability insurer, blanket disability insurer,
health care services organization, hospital service corporation, medical
service corporation or hospital and medical service corporation.
3. "Health care plan" means a policy,
contract or evidence of coverage issued to an enrollee. Health care plan does
not include limited benefit coverage as defined in section 20-1137.
4. "Health care professional" means a
professional who is regulated pursuant to title 32, chapter 7, 8, 11, 13, 14,
15, 15.1, 16, 17, 18, 19, 19.1, 25, 28, 29, 33, 34, 35, 39 or 41
,
title 36, chapter 6, article 7
or title 36, chapter 17.
END_STATUTE
Sec. 3. Section 32-1502, Arizona Revised
Statutes, is amended to read:
START_STATUTE
32-1502.
Naturopathic physicians medical board; members; appointment;
qualifications; terms of office; immunity
A. The naturopathic physicians medical board is
established consisting of the following members:
1. Four physician members
who are
appointed by the governor. Each physician member shall be:
(a) A resident of this state for at least five years
immediately preceding the appointment.
(b) A doctor of naturopathic medicine with a degree
from a naturopathic school or college approved by the board who has engaged in
full-time practice of naturopathic medicine for at least five years
immediately preceding the appointment.
2. One licensed midwife who is
appointed by the governor and who shall be:
(
a
) A resident
of this state for at least five years immediately preceding the appointment.
(
b
) A midwife
who is licensed pursuant to article 5 of this chapter and who has engaged in a
full-time practice of midwifery for at least five years immediately
preceding the appointment.
2.
3.
Three
public members
who are
appointed by the governor.� Each
public member shall:
(a) Be a resident of this state for at least five
years immediately preceding the appointment.
(b) Not be connected, in any manner, with or have
any interest in a school of medicine, a health care institution or any person
practicing any form of healing or treatment of bodily or mental ailments.
(c) Demonstrate an interest in the health problems
in this state.
B. Before appointment by the governor, a prospective
member of the board shall submit a full set of fingerprints to the governor for
the purpose of obtaining a state and federal criminal records check pursuant to
section 41-1750 and Public Law 92-544. The department of public
safety may exchange this fingerprint data with the federal bureau of
investigation.
C. The terms of office of the physician members
, the midwife member
and the public members are five years to
begin and end on June 30. Each physician member
, each
midwife member
and each public member continue to hold office until the
appointment and qualification of their successors, subject to the following
exceptions:
1. A member of the board may be removed from office
if the governor finds the member was guilty of malfeasance, misfeasance or
dishonorable conduct.
2. The term of any member automatically ends on
resignation, permanent removal from this state or removal from this state for a
period of more than six months.
D. There shall be no monetary liability on the part
of and no cause of action shall arise against the members of the board, the
secretary-treasurer or permanent or temporary personnel of the board for
any act done or proceeding undertaken or performed in good faith and in
furtherance of the purposes of this chapter.
END_STATUTE
Sec. 4. Section 32-1505, Arizona Revised Statutes, as amended by Laws 2024, chapter 222, section
17, is amended to read:
START_STATUTE
32-1505.
Naturopathic physicians medical board fund; separate licensed
midwife account
A. The naturopathic
physicians medical board fund is established. The board shall administer the
fund. Pursuant to sections 35-146 and 35-147, the board
shall deposit fifteen percent of all monies from whatever source that come into
the possession of the board in the state general fund and deposit the remaining
eighty-five percent in the naturopathic physicians medical board fund.
B. Monies deposited in the naturopathic physicians
medical board fund are subject to section 35-143.01.
C. Beginning July 1, 2027, all monies
deposited in the naturopathic physicians medical board fund pursuant to section
32-1527 for naturopathic physician licensing and regulation must be used
only for licensing and regulating naturopathic physicians pursuant to this
article and articles 2, 3 and 4 of this chapter and may not be used for
licensing and regulating midwives pursuant to article 5 of this chapter.
D. Beginning July 1, 2027, all monies
deposited in the naturopathic physicians medical board fund pursuant to article
5 of this chapter for midwife licensing and regulation must be used only for
licensing and regulating midwives pursuant to article 5 of this chapter and may
not be used for licensing and regulating naturopathic physicians pursuant to
this article and articles 2, 3 and 4 of this chapter.
E. The board shall establish a
separate account in the fund for monies transferred to the fund pursuant to
article 5 of this chapter for midwife licensing and regulation.
END_STATUTE
Sec. 5. Section 32-1505, Arizona Revised
Statutes, as amended by Laws 2024, chapter 222, section 18, is amended to read:
START_STATUTE
32-1505.
Naturopathic physicians medical board fund; separate licensed
midwife account
A. The naturopathic physicians medical board fund is
established. The board shall administer the fund. Pursuant to
sections 35-146 and 35-147, the board shall deposit ten percent of
all monies from whatever source that come into the possession of the board in
the state general fund and deposit the remaining ninety percent in the
naturopathic physicians medical board fund.
B. Monies deposited in the naturopathic physicians
medical board fund are subject to section 35-143.01.
C. Beginning July 1, 2027, all monies
deposited in the naturopathic physicians medical board fund pursuant to section
32-1527 for naturopathic physician licensing and regulation must be used
only for licensing and regulating naturopathic physicians pursuant to this
article and articles 2, 3 and 4 of this chapter and may not be used for
licensing and regulating midwives pursuant to article 5 of this chapter.
D. Beginning July 1, 2027, all monies
deposited in the naturopathic physicians medical board fund pursuant to article
5 of this chapter for midwife licensing and regulation must be used only for
licensing and regulating midwives pursuant to article 5 of this chapter and may
not be used for licensing and regulating naturopathic physicians pursuant to
this article and articles 2, 3 and 4 of this chapter.
E. The board shall establish a
separate account in the fund for monies transferred to the fund pursuant to
article 5 of this chapter for midwife licensing and regulation.
END_STATUTE
Sec. 6.
Transfer and
renumber
Title 36, chapter 6, article 7,
Arizona Revised Statutes, is transferred and renumbered for placement in title
32, chapter 14, Arizona Revised Statutes, as article 5, as added by this act.
The following sections are transferred and renumbered for placement in title
32, chapter 14, article 5, Arizona Revised Statutes:
Former
Sections���������������������������������������� New Sections
36-751
���������������������������������������������������� 32-1591
36-752
������������������������������������������������� 32-1591.01
36-753
������������������������������������������������� 32-1591.02
36-754 �������������������������������������������������
32-1591.03
36-755
������������������������������������������������� 32-1591.04
36-756
������������������������������������������������� 32-1591.05
36-756.01
���������������������������������������������� 32-1591.06
36-757
������������������������������������������������� 32-1591.07
36-758
������������������������������������������������� 32-1591.08
36-759
������������������������������������������������� 32-1591.09
36-760
������������������������������������������������� 32-1591.10
Sec. 7. Section 32-1591, Arizona Revised
Statutes, as transferred and renumbered, is amended to read:
START_STATUTE
32-1591.
Definitions
In this article, unless the context otherwise requires:
1. "Department" means the
department of health services.
2.
1.
"Director"
means the
executive
director
of the
department of health services
board
.
2. "Licensed midwife" means
a midwife who is licensed pursuant to this article.
3. "Midwife" means a person who delivers a
baby or provides health care related to pregnancy, labor, delivery and
postpartum care of the mother and her infant.
END_STATUTE
Sec. 8. Section 32-1591.02, Arizona
Revised Statutes, as transferred and renumbered, is amended to read:
START_STATUTE
32-1591.02.
Application for license as midwife
A person who desires to obtain a license to practice midwifery
shall
make written application
apply
to the
director of the department of health services, upon
board in writing on
a form to be supplied by the
director
board
and shall
furnish such
provide the
information
as may be
required by the
director
board
.
END_STATUTE
Sec. 9. Section 32-1591.04, Arizona
Revised Statutes, as transferred and renumbered, is amended to read:
START_STATUTE
32-1591.04.
Powers and duties of the board
A. The
director
board
may adopt rules necessary for the proper administration and enforcement of this
article.
B. The
director
board
shall, by rule:
1. Define and describe, consistent with this article
and the laws of this state, the duties and limits of the practice of midwifery.
2. Adopt standards with respect to the practice of
midwifery designed to safeguard the health and safety of the mother and child.
3. Establish the criteria for granting, denying,
suspending and revoking a license in order to protect the health and safety of
the mother and child.
4. Describe and define reasonable and necessary
minimum qualifications for
licensed
midwives, including:
(a) The ability to read and write.
(b) Knowledge of the fundamentals of hygiene.
(c) The ability to recognize abnormal or potentially
abnormal conditions during pregnancy, labor and delivery and following birth.
(d) Knowledge of the laws of this state concerning
reporting of births, prenatal blood tests and newborn screening and of the
rules pertaining to midwifery.
(e) Education requirements.
(f) Age requirements.
END_STATUTE
Sec. 10. Section 32-1591.05, Arizona
Revised Statutes, as transferred and renumbered, is amended to read:
START_STATUTE
32-1591.05.
Denial, suspension and revocation of licenses; disciplinary
action; duty to report; investigatory powers; hearing; appeal; civil penalties;
injunctions
A. The
director
board
may deny, suspend or revoke the license of any midwife
or may
discipline any licensed midwife
who:
1. Violates any provision of this article or the
rules adopted under this article.
2. Has been convicted of a felony or a misdemeanor
involving moral turpitude.
3. Indulges in conduct or a practice detrimental to
the health or safety of the mother and child.
B. The
department
board
may deny a license without holding a
hearing. An applicant may appeal this decision pursuant to title 41,
chapter 6, article 10.
C. The
department shall conduct any hearing to suspend or revoke a license in
accordance with the procedures established pursuant to title 41, chapter 6,
article 10. If the director determines at the conclusion of a
hearing that grounds exist to suspend or revoke a license, he may do so
permanently or for any period of time he deems appropriate and under any
conditions that he deems appropriate. An applicant for licensure or
a licensee may appeal the final decision of the director.
C. The board on its own motion may
investigate any evidence that appears to show that a licensed midwife is or may
be medically incompetent, is or may be guilty of unprofessional conduct or is
or may be mentally or physically unable to engage safely in the practice of
midwifery.� Any person may and any health care institution shall report to the
board any information that appears to show that a licensed midwife is or may be
medically incompetent, is or may be guilty of unprofessional conduct or is or
may be mentally or physically unable to engage safely in the practice of
midwifery.� The board or the director shall notify the licensed midwife as to
the content of the complaint as soon as reasonable. Any person or entity that
reports or provides information to the board in good faith is not subject to an
action for civil damages.� If requested, the board may not disclose the name of
a person who supplies information regarding a licensed midwife's drug or
alcohol impairment.� It is an act of unprofessional conduct for any licensed
midwife to fail to report as required by this section. The board
shall report any health care institution that fails to report as required by
this section to that institution's licensing agency.
D. The board or, if delegated by
the board, the director shall require any combination of mental, physical or
oral or written medical competency examinations and conduct necessary
investigations, including investigational interviews between representatives of
the board and the licensed midwife, to fully inform itself with respect to any
information filed with the board under this section.� These examinations may
include biological fluid testing and psychological or psychiatric evaluation.�
The board or, if delegated by the board, the director may require the licensed
midwife, at the licensed midwife's expense, to undergo an assessment by a board-approved
rehabilitative, retraining or assessment program.
E. If the board finds, based on
the information it receives under this section, that the public health, safety
or welfare imperatively requires emergency action and incorporates a finding to
that effect in its order, the board may restrict, limit or order a summary
suspension of a license pending proceedings for revocation or other action.� If
the board takes action pursuant to this subsection, the board shall also serve
the licensed midwife with a written notice that states the charges and that the
licensed midwife is entitled to a formal hearing before the board or an
administrative law judge.
F. If, after completing its
investigation, the board finds that the information provided pursuant to
subsection C of this section is not of sufficient seriousness to merit
disciplinary action against the licensed midwife, the board may take any of the
following actions:
1. Dismiss if, in the opinion of
the board, the information is without merit.
2. File a letter of concern.
3. Issue a nondisciplinary order
requiring the licensed midwife to complete a prescribed number of hours of
continuing education in an area or areas prescribed by the board to provide the
licensed midwife with the necessary understanding of current developments,
skills, procedures or treatment.
G. If the board finds that it can
take rehabilitative or disciplinary action without the presence of the licensed
midwife at a formal interview, the board may enter into a consent agreement
with the licensed midwife to limit or restrict the licensed midwife's practice
or to rehabilitate the licensed midwife in order to protect the public and
ensure the licensed midwife's ability to safely engage in the practice of
midwifery. The board may also require the licensed midwife to successfully
complete a board-approved rehabilitative, retraining or assessment
program.
H. If after completing its
investigation the board believes that the information is or may be true, the
board may request a formal interview with the licensed midwife. If
the licensed midwife refuses the invitation or accepts and the results indicate
that grounds may exist for suspension of the licensed midwife's license for
more than twelve months or revocation of the license, the board may issue a
formal complaint and order that a hearing be held pursuant to title 41, chapter
6, article 10. If after completing a formal interview the board finds the
information provided under this section is not of sufficient seriousness to
merit suspension for more than twelve months or revocation of the license, the
board may take the following actions:
1. Dismiss if, in the opinion of
the board, the complaint is without merit.
2. File a letter of concern.
3. File a letter of reprimand.
4. Issue a decree of censure. A
decree of censure is an official action against the licensed midwife's license
and may include a requirement for restitution of fees to a patient resulting
from violations of this article or rules adopted under this chapter.
5. Fix a period and terms of
probation best adapted to protect the public health and safety and rehabilitate
or educate the licensed midwife concerned. Probation may include
temporary license suspension for not more than twelve months, restriction of
the licensed midwife's license to practice midwifery, a requirement for
restitution of fees to a patient or education or rehabilitation at the licensed
midwife's own expense.� If a licensed midwife fails to comply with the terms of
probation, the board shall serve the licensed midwife with a written notice
that states that the licensed midwife is subject to a formal hearing based on
the information considered by the board at the formal interview and any other
acts or conduct alleged to be in violation of this article or rules adopted by
the board pursuant to this chapter, including noncompliance with the terms of
probation, a consent agreement or a stipulated agreement.
6. Enter into an agreement with
the licensed midwife to restrict or limit the licensed midwife's practice or
medical activities in order to rehabilitate, retrain or assess the licensed
midwife, protect the public and ensure the licensed midwife's ability to safely
engage in the practice of midwifery. The board may also require the
licensed midwife to successfully complete a board-approved
rehabilitative, retraining or assessment program at the licensed midwife's own
expense pursuant to subsection G of this section.
7. Issue a nondisciplinary order
requiring the licensed midwife to complete a prescribed number of hours of
continuing education in an area or areas prescribed by the board to provide the
licensed midwife with the necessary understanding of current developments,
skills, procedures or treatment.
I. If the board finds that the
information provided in an investigation warrants suspension or revocation of a
license issued under this article, the board shall initiate formal proceedings
pursuant to title 41, chapter 6, article 10.
J. Any licensed midwife who after
a formal hearing is found by the board to be guilty of unprofessional conduct,
to be mentally or physically unable to safely engage in the practice of
midwifery or to be medically incompetent is subject to censure, probation as
provided in this section, suspension or revocation of a license or any
combination of these under any conditions as the board deems appropriate for
the protection of the public health and safety and just in the
circumstance. The board may charge the costs of formal hearings to
the licensed midwife whom the board finds to be in violation of this chapter.
K. If the board, during the course
of any investigation, determines that a criminal violation may have occurred
involving the delivery of health care, the board shall make the evidence of
violations available to the appropriate criminal justice agency for its
consideration.
L. Notice of a complaint and
hearing is effective by a true copy of it being sent by certified mail to the
licensed midwife's last known address of record in the board's files. Notice of
the complaint and hearing is complete on the date of its deposit in the mail.
M. The
board may accept the surrender of an active license from a licensed midwife who
admits in writing to any of the following:
1. Being
unable to safely engage in the practice of midwifery.
2. Having committed an act of
unprofessional conduct.
3. Having violated this article or
a board rule.
N. The board may administer the
oath to all witnesses and shall keep a written transcript of all oral testimony
submitted at the hearing and the original or a copy of all other evidence
submitted. The board may waive the technical rules of evidence at
any hearing conducted under this section.
O. Except as provided in section
41-1092.08, subsection H, an appeal to the superior court in Maricopa
county may be taken from decisions of the board pursuant to title 12, chapter
7, article 6.
D.
P.
In
addition to other disciplinary action, the
director
board
may assess a civil penalty of not more than
one hundred dollars
$100
for each
violation of this article or a rule adopted pursuant to this article as
determined by a hearing held pursuant to this section. Each day that
a violation continues constitutes a separate offense. The attorney
general or the county attorney may bring an action in the name of this state to
enforce a civil penalty. The action shall be filed in the superior court or in
justice court in the county where the violation occurred.
E.
Q.
In
addition to other available remedies, the
director
board
may apply to the superior court for an injunction to
restrain a person from violating a provision of this article or a rule adopted
pursuant to this article. The court shall grant a temporary
restraining order, a preliminary injunction or a permanent injunction without
bond. The defendant may be served in any county of this
state. The action shall be brought on behalf of the
director
board
by the attorney general or the county attorney of
the county in which the violation is occurring.
END_STATUTE
Sec. 11. Section 32-1591.06, Arizona
Revised Statutes, as transferred and renumbered, is amended to read:
START_STATUTE
32-1591.06.
Investigations; right to examine and copy evidence; witnesses;
documents; subpoenas; confidentiality
A.
The director may investigate
information that indicates that a person is violating this article.
In
connection with an investigation
by the board on its own motion,
or as the result of information received pursuant to section 32-1591.05
,
the
department
board and its duly
authorized agents or employees at all reasonable times
may examine and
copy documents
, reports, records
and other physical
evidence
of the person the board is investigating
wherever
located that relate to the conduct
,
or
competency
or mental or physical ability
of a midwife
pursuant to the requirements of this article
to
safely practice midwifery
.
B. Pursuant
to an investigation or an administrative proceeding, the director may issue
subpoenas to compel the testimony of witnesses or to demand the production of
relevant documents and other physical evidence. If a person refuses
to comply with a subpoena, the director may apply to the superior court for an
order to compel compliance.
B. For the purpose of all
investigations and proceedings conducted by the board:
1. The board on its own initiative or
on application of any person involved in the investigation may issue subpoenas
to require the attendance and testimony of witnesses or to demand the
production for examination or copying of documents or any other physical
evidence that relates to the competence, unprofessional conduct or mental or
physical ability of a licensed midwife to safely practice midwifery.� Within
five days after a person is served with a subpoena, that person may petition
the board to revoke, limit or modify the subpoena.� The board shall do so if in
the board's opinion the evidence required does not relate to unlawful practices
covered by this article or the rules adopted pursuant to this article, is not
relevant to the charge that is the subject matter of the hearing or
investigation or does not describe with sufficient particularity the physical
evidence required to be produced.� Any member of the board or any agent
designated by the board may administer oaths or affirmations, examine witnesses
and receive evidence.
2. Any person appearing before the
board may be represented by counsel.
3. On application by the board or by
the person subpoenaed, the superior court may issue an order to either:
(
a
) Require the
subpoenaed person to appear before the board or the duly authorized agent to
produce evidence relating to the matter under investigation.
(
b
) Revoke,
limit or modify the subpoena if in the court's opinion the evidence demanded
does not relate to unlawful practices covered by this article, is not relevant
to the charge that is the subject matter of the hearing or investigation or
does not describe with sufficient particularity the evidence whose production
is required.
C. Patient records, including clinical records,
medical reports, laboratory statements and reports, files, films and oral
statements relating to patient examinations, findings and treatment, that are
kept by the
director
board
pursuant
to an investigation are not available to the public. The
director
board
shall keep confidential the
names of patients whose records are reviewed during the course of an
investigation or hearing.
D. This section and any other law
making communications between a licensed midwife and a licensed midwife's
patient privileged do not apply to investigations or proceedings conducted
pursuant to this article. The board and its employees, agents and
representatives must keep in confidence the names of any patients whose records
are reviewed during the course of investigations and proceedings pursuant to
this article.
E. The court may find a person who
does not comply with a subpoena issued pursuant to this section in contempt of
court.
END_STATUTE
Sec. 12. Section 32-1591.08, Arizona Revised Statutes, as transferred and renumbered, is
amended to read:
START_STATUTE
32-1591.08.
Fees
The
director
board
,
by rule, shall establish and collect nonrefundable fees
for the
purposes of this article.
that do not exceed:
1. Twenty-five dollars for an
initial application.
2. Fifty dollars for an initial
license.
3. Two hundred fifty dollars for
testing.
4. Fifty dollars for license renewal.
5. Ten dollars for a duplicate
license.
END_STATUTE
Sec. 13. Title 32, chapter 14, article 5,
Arizona Revised Statutes, as transferred and renumbered, is amended by adding
sections 32-1591.11, 32-1591.12 and 32-1591.13, to read:
START_STATUTE
32-1591.11.
Prescription drugs; dispensing and administration authority;
storage; documentation
A. A licensed midwife who
, in addition to the requirements for initial licensure, has proof of
completion of a pharmacology course of at least eight continuing education
units from a midwifery education accreditation council-accredited
institution or a regionally accredited institution may dispense and administer
the following medications, therapies and devices with the following
limitations:
1. Antibiotics related to Group B
streptococcus prophylaxis consistent with the United States centers for disease
control and prevention guidelines
or other current
evidence-based guidelines.
2. The following antihemorrhagic
medications for preventing and treating postpartum hemorrhage as defined by the
American college of obstetricians and gynecologists:
(
a
) Oxytocin
for preventing uterine atony during or immediately following the third
stage of labor according to current evidence-based standards of care.
(
b
) Methylergonovine.
(
c
) Carboprost
tromethamine.
(
d
) Misoprostol.
(
e
) Tranexamic
acid.
A licensed midwife may not use the
antihemorrhagic medications specified in this paragraph to induce or augment
labor. The licensed midwife shall initiate a transfer of care if an
antihemorrhagic medication
is administered for managing
hemorrhage.
3. prophylactic ophthalmic
medications for newborn eye care.
4. Intravenous fluids for the following:
(
a
) medication
administration.
(
b
)
Routine fluid administration.
(
c
) treating
hypovolemic shock while awaiting emergency medical service.
5. Vitamin K prophylaxis for
newborns.
6. Rho immune globulin.
7. Topical, intramuscular or
subcutaneous local anesthetics for postpartum repair of
first
and second degree tears, lacerations or episiotomies. This PARAGRAPH does not
include any schedule i controlled substance.
8. Oxygen and Compressed air for
fetal or maternal distress and infant resuscitation.
9. Epinephrine for neonatal
resuscitation consistent with the neonatal resuscitation program guidelines and
to treat maternal allergic reactions.
10. Glucose gel administered orally
for neonatal hypoglycemia.
11.
Vitamins
and minerals for correcting electrolyte imbalances, including B vitamins,
calcium, magnesium, Dietary supplements, homeopathic remedies, plant substances
that are not designated as prescription drugs or controlled substances, and over-the-counter
medications.
12. Resuscitation supplies and
equipment according to the current neonatal resuscitation program algorithm.
13. Medical supplies and equipment
needed to administer the medications prescribed in this subsection.
14. Electronic breast pumps, Glucose
monitors, compression stockings and pregnancy support belts or devices.
B. A pharmacist who dispenses
prescription medications prescribed pursuant to this subsection to a licensed
midwife is not liable for any adverse reaction that is caused by the licensed
midwife's method of use.
C. A licensed midwife may lawfully
obtain, transport, administer and possess adequate quantities of the
medications prescribed in subsection A of this section and the equipment
normally required to administer those medications. The licensed midwife shall:
1. Store the medications prescribed
in subsection A of this section as directed by the manufacturer. a licensed
midwife may not administer a medication to any person after the listed
expiration date.
2. Record in the patient's chart each
use of medication and the medication's lot number and expiration date.
END_STATUTE
START_STATUTE
32-1591.12.
Arizona midwifery advisory committee; membership; duties;
sentinel events; definition
A. The Arizona midwifery advisory
committee is established in the board to assist in examining applicants for a
midwifery license, if requested, to collaborate with and assist the board in
disciplinary matters, if requested, and to perform any other duties at the
direction of the board.
b. The board shall appoint the
members of the advisory committee, which shall be composed of not more than
eleven of the following members:
1. At least
five
licensed midwives.
2. Two certified nurse midwives who
are licensed pursuant to chapter 15 of this title.
3. Two physicians who are licensed
pursuant to this chapter or chapter 13 or 17 of this title
,
one of whom is board-certified in
obstetrics and one of whom is board-certified in pediatrics.
The board shall solicit physician applications from state medical
societies and associations.
4. One consumer of midwifery care.
C. Advisory committee members are not
eligible for compensation or reimbursement of expenses.
D. The advisory committee shall meet
at least four times each year, once per quarter.
E. At the direction of the board, the
advisory committee shall conduct a review of sentinel events occurring during
the course of prenatal, intrapartum or postpartum care provided by licensed midwives
in this state.
F. At the direction of the board, the
advisory committee may convene an emergency meeting when a case or sentinel
event requires timely review or action to protect the public health and safety.
G. Following the review of a sentinel
event pursuant to subsection E or F of this section, the advisory committee
shall make recommendations to the board regarding whether the care provided
was:
1. Consistent with community
standards.
2. Consistent with community
standards but outside the scope of practice.
3. Outside of community standards and
requiring corrective action.
H. For care determined to be outside
of community standards or the scope of practice under subsection G of this
section, the advisory committee may recommend one or more of the following to
the board:
1. Additional continuing education
requirements.
2. Mentoring or supervised practice.
3. Administrative civil penalties.
4. Restriction or suspension of a
license.
5. Revocation of a license.
I. At the direction of the board, the
advisory committee shall review midwife reports submitted pursuant to section
32-1591.13 and may recommend modifications to reporting requirements to
the board to support quality improvement and patient safety.
J. For the purposes of this section,
"sentinel event":
1. Means an unexpected, serious
patient safety incident resulting in death, permanent harm or a significant
risk of harm.
2. includes
both:
(
a
) Maternal sentinel events, including:
(
i
) Maternal
deaths during the pregnancy through thirty days postpartum.
(
ii
) Maternal
intensive care unit admission in the first one hundred twenty hours postpartum.
(
iii
) Uterine
rupture.
(
iv
) Postpartum
hemorrhage requiring a blood transfusion.
(
v
) Shoulder
dystocia with brachial plexus injury.
(
b
) Neonatal
sentinel events, including:
(
i
) Neonatal
deaths in the first thirty days of life.
(
ii
) Neonatal
intensive care unit admission within one hundred twenty hours after birth, not
including observation-only admissions or admissions for congenital
anomalies.
(
iii
) A birth
weight of less than two thousand five hundred grams.
(
iv
) An apgar
score of less than seven at five minutes.
(
v
) Respiratory
distress requiring prolonged ventilation.
END_STATUTE
START_STATUTE
32-1591.13.
Disclosure; reporting requirements; definitions
A. At the initiation of care, eAch
licensed midwife shall disclose to each patient whether the licensed midwife
maintains professional liability insurance. This disclosure shall be
included in the informed consent document and acknowledged by the patient's
signature.
B. on or before January 31 each year,
Each licensed midwife shall file a report with the board, or if DELEGATED by
the board, at the direction of the director, in a format prescribed by the
board, the following information, not including any individually identifiable
health information of a patient, for the preceding calendar year:
1. The number of women for whom the
licensed midwife provided care.
2. The number of deliveries the
licensed midwife
attended as primary midwife.
3. The number, reason for and outcome
of each transfer or transport of a patient in the antepartum, intrapartum or
immediate postpartum periods.
4. The number of perinatal deaths,
including
both:
(
a
) Maternal
deaths occurring during pregnancy and through the first month postpartum.
(
b
) Neonatal
deaths occurring through the first month of life.
5. For each death reported pursuant
to paragraph 4 of this subsection, the cause of death, if known, and a
description of the circumstances surrounding the death.
6. The number and outcome of breech
births and vaginal births after cesarean.
7. The number of births that occurred
more than twenty-five miles from a hospital that provides obstetrics
services.
8. The number of fetal deaths after
twenty weeks' gestation.
9. The licensed midwife's full name,
license number and county.
C. In addition to the reporting
required in subsection B of this section, a licensed midwife shall report to
the board:
1. A perinatal mortality within
seventy-two hours after the death.
2. A sentinel event within fourteen
days after the event.
D. The information reported to the
board pursuant to
subsections B
and
C of this SECTION may be inspected, copied, obtained or provided to the
advisory committee for research and evidence.
E. The report required by subsection
B of this section replaces the report required by each licensed midwife
following the termination of care for each patient.
F. On or before September 1 of each
year, the data that is collected in the reports required by subsection B of
this section shall be compiled and shared with the speaker of the house of
representatives, the president of the senate and the governor and posted on the
board's
public website.
G. For the purposes of this section
:
1. "Individually identifiable
health information" has the same meaning prescribed in section 36-3801.
2. "Sentinel event" has the
same meaning prescribed in section 32-1591.12.
END_STATUTE
Sec. 14. Section 32-3101, Arizona Revised
Statutes, is amended to read:
START_STATUTE
32-3101.
Definitions
In this chapter, unless the context otherwise requires:
1. "Certification" means a voluntary
process by which a regulatory entity grants recognition to an individual who
has met certain prerequisite qualifications specified by that regulatory entity
and who may assume or use the word "certified" in a title or
designation to perform prescribed health professional tasks.
2. "Grandfather clause" means a provision
that is applicable to practitioners who are actively engaged in the regulated
health profession before the effective date of a law and that exempts the
practitioners from meeting the prerequisite qualifications set forth in the law
to perform prescribed occupational tasks.
3. "Health professional group" means any
health professional group or organization, any individual or any other
interested party that proposes that any health professional group that is not
presently regulated be regulated.
4. "Health professions" means professions
that are regulated pursuant to chapter 7, 8, 11, 13, 14, 15, 15.1, 16, 17, 18,
19, 19.1, 21, 25, 28, 29, 33, 34, 35, 39 or 41 of this title
,
title 36, chapter 6, article 7
or title 36, chapter 17.
5. "Inspection"
means the periodic examination of practitioners by a state agency in order to
ascertain whether the practitioners' occupation is being carried out in a
fashion consistent with the public health, safety and welfare.
6. "Licensure" or "license"
means an individual, nontransferable authorization to carry on a health
activity that would otherwise be unlawful in this state in the absence of the
permission and that is based on qualifications that include graduation from an
accredited or approved program and acceptable performance on a qualifying
examination or a series of examinations.
7. "Practitioner" means an individual who
has achieved knowledge and skill by practice and who is actively engaged in a
specified health profession.
8. "Public member" means an individual who
is not and never has been a member or the spouse of a member of the health
profession being regulated and who does not have and never has had a material
financial interest in either rendering the health professional service being
regulated or an activity directly related to the profession being regulated.
9. "Registration" means the formal
notification that, before rendering services, a practitioner must submit to a
state agency setting forth the name and address of the practitioner, the
location, nature and operation of the health activity to be practiced and, if
required by a regulatory entity, a description of the service to be provided.
10. "Regulatory entity" means any board,
commission, agency or department of this state that regulates one or more
health professions in this state.
11. "State agency" means any department,
board, commission or agency of this state.
END_STATUTE
Sec. 15. Section 32-3201, Arizona Revised
Statutes, is amended to read:
START_STATUTE
32-3201.
Definitions
In this chapter, unless the context otherwise requires:
2.
1.
"Health
professional" means a person who is certified or licensed pursuant to
chapter 7, 8, 11, 13, 14, 15, 15.1, 16, 17, 18, 19, 19.1, 21, 25, 28, 29, 33,
34, 35, 39, 41 or 42 of this title, title 36, chapter 4, article 6
, title 36, chapter 6, article 7
or title 36, chapter 17.
1.
2.
"Health
profession regulatory board" means any board that regulates one or more
health professionals in this state.
3. "Medical
record
records
" has the same meaning prescribed in section 12-2291
but does not include prescription orders.
END_STATUTE
Sec. 16. Section 36-301, Arizona Revised Statutes, is amended to read:
START_STATUTE
36-301.
Definitions
In this chapter, unless the
context otherwise requires:
1. "Administrative order" means a written
decision issued by an administrative law judge or quasi-judicial entity.
2. "Amend" means to make a change, other
than a correction, to a registered certificate by adding, deleting or
substituting information on that certificate.
3. "Birth" or "live birth" means
the complete expulsion or extraction of an unborn child from the child's
mother, irrespective of the duration of the pregnancy, that shows evidence of
life, with or without a cut umbilical cord or an attached placenta, such as
breathing, heartbeat, umbilical cord pulsation or definite voluntary muscle
movement after expulsion or extraction of the unborn child.
4. "Certificate" means a record that
documents a birth or death.
5. "Certified copy" means a written
reproduction of a registered certificate that a local registrar, a deputy local
registrar or the state registrar has authenticated as a true and exact written
reproduction of a registered certificate.
6. "Correction" means a change made to a
registered certificate because of a typographical error, including misspelling
and missing or transposed letters or numbers.
7. "Court order" means a written decision
issued by:
(a) The superior court, an appellate court or the
supreme court or an equivalent court in another state.
(b) A commissioner or judicial hearing officer of
the superior court.
(c) A judge of a tribal court in this state.
8. "Current care" means that a health care
provider has examined, treated or provided care for a person for a chronic or
acute condition within eighteen months preceding that person's
death. Current care does not include services provided in connection
with a single event of emergency or urgent care. For the purposes of this
paragraph, "treated" includes prescribing medication.
9. "Custody" means legal authority to act
on behalf of a child.
10. "Department" means the department of
health services.
11. "Electronic" means technology that has
electrical, digital, magnetic, wireless, optical or electromagnetic
capabilities or technology with similar capabilities.
12. "Evidentiary document" means written
information used to prove the fact for which the document is presented.
13. "Family
member" means:
(a) A person's
spouse, natural or adopted offspring, father, mother, grandparent, grandchild
to any degree, brother, sister, aunt, uncle or first or second cousin.
(b) The natural or adopted offspring, father,
mother, grandparent, grandchild to any degree, brother, sister, aunt, uncle or
first or second cousin of the person's spouse.
14. "Fetal death" means the cessation of
life before the complete expulsion or extraction of an unborn child from the
child's mother that is evidenced by the absence of breathing, heartbeat,
umbilical cord pulsation or definite voluntary muscle movement after expulsion
or extraction.
15. "Final disposition" means the
interment, cremation, removal from this state or other disposition of human
remains.
16. "Foundling" means:
(a) A newborn infant
who is
left with a safe haven provider pursuant to section 13-3623.01.
(b) A child whose father and mother cannot be
determined.
17. "Funeral establishment" has the same
meaning prescribed in section 32-1301.
18. "Health care institution" has the same
meaning prescribed in section 36-401.
19. "Health care provider" means:
(a) A physician
who is
licensed
pursuant to title 32, chapter 13 or 17.
(b) A doctor of naturopathic medicine
who is
licensed pursuant to title 32, chapter 14.
(c) A midwife
who is
licensed
pursuant to
chapter 6, article 7 of this
title
32, chapter 14, article 5
.
(d) A nurse midwife
who is
certified
pursuant to title 32, chapter 15.
(e) A nurse practitioner
who is
licensed
and certified pursuant to title 32, chapter 15.
(f) A physician assistant
who is
licensed
pursuant to title 32, chapter 25.
(g) A health care provider who is licensed or
certified by another state or jurisdiction of the United States and who works
in a federal health care facility.
20. "Human remains" means a lifeless human
body or parts of a human body that permit a reasonable inference that death
occurred.
21. "Issue" means:
(a) To provide a copy of a registered certificate.
(b) An action taken by a court of competent
jurisdiction, administrative law judge or quasi-judicial entity.
22. "Legal age" means a person who is at
least eighteen years of age or who is emancipated by a court order.
23. "Medical certification of death" means
the opinion of the health care provider who signs the certificate of probable
or presumed cause of death that complies with rules adopted by the state
registrar of vital records and that is based on any of the following that is
reasonably available:
(a) Personal examination.
(b) Medical history.
(c) Medical records.
(d) Other reasonable forms of evidence.
24. "Medical examiner" means a medical
examiner or alternate medical examiner as defined in section 11-591.
25. "Name" means a designation that
identifies a person, including a first name, middle name, last name or suffix.
26. "Natural causes" means those causes
that are due solely or nearly entirely to disease or the aging process.
27. "Presumptive death" means a
determination by a court that a death has occurred or is presumed to have
occurred but the human remains have not been located or recovered.
28. "Register" means to assign an official
state number and to incorporate into the state registrar's official records.
29. "Responsible person" means a person
listed in section 36-831.
30. "Seal" means to bar from access.
31. "Submit" means to present, physically
or electronically, a certificate, evidentiary document or form provided for in
this chapter to a local registrar, a deputy local registrar or the state
registrar.
32. "System of public health statistics"
means the processes and procedures for:
(a) Tabulating, analyzing and publishing public
health information derived from vital records data and other sources authorized
pursuant to section 36-125.05 or section 36-132, subsection A,
paragraph 3.
(b) Performing other activities related to public
health information.
33. "System of vital records" means the
statewide processes and procedures for:
(a) Electronically or physically collecting,
creating, registering, maintaining, copying and preserving vital records.
(b) Preparing and issuing certified and noncertified
copies of vital records.
(c) Performing other activities related to vital
records.
34. "Unborn child" has the same meaning
prescribed in section 36-2151.
35. "Vital record" means a registered
birth certificate or a registered death certificate.
END_STATUTE
Sec. 17. Section 36-422, Arizona Revised Statutes, is amended to read:
START_STATUTE
36-422.
Application for license; notification of proposed change in
status; joint licenses; definitions
A. A person who
wishes to apply for a license to operate a health care institution pursuant to
this chapter shall submit to the department all of the following:
1. An application on a written or electronic form
that is prescribed, prepared and furnished by the department and that contains
all of the following:
(a) The name and location of the health care
institution.
(b) Whether the health care institution is to be
operated as a proprietary or nonproprietary institution.
(c) The name of the governing
authority. The applicant shall be the governing authority having the
operative ownership of, or the governmental agency charged with the
administration of, the health care institution sought to be licensed. If
the applicant is a partnership that is not a limited partnership, the partners
shall apply jointly, and the partners are jointly the governing authority for
purposes of this article.
(d) The name and business or residential address of
each controlling person and an affirmation that none of the controlling persons
has been denied a license or certificate by a health profession regulatory
board pursuant to title 32 or by a state agency pursuant to
chapter
6, article 7 or
chapter 17 of this title or a license to operate a
health care institution in this state or another state or has had a license or
certificate issued by a health profession regulatory board pursuant to title 32
or issued by a state agency pursuant to
chapter 6, article 7 or
chapter 17 of this title or a license to operate a health care institution
revoked.� If a controlling person has been denied a license or certificate by a
health profession regulatory board pursuant to title 32 or by a state agency
pursuant to
chapter 6, article 7 or
chapter 17 of this
title or a license to operate a health care institution in this state or
another state or has had a health care professional license or a license to
operate a health care institution revoked, the controlling person shall include
in the application a comprehensive description of the circumstances for the
denial or the revocation.
(e) The class or subclass of health care institution
to be established or operated.
(f) The types and extent of the health care services
to be provided, including emergency services, community health services and
services to indigent patients.
(g) The name and qualifications of the chief
administrative officer implementing direction in that specific health care
institution.
(h) Other pertinent information required by the
department for the proper administration of this chapter and department rules.
2. The attestation required by section 36-421,
subsection A.
3. The applicable application fee.
B. An application submitted pursuant to this section
shall contain the written or electronic signature of:
1. If the applicant is an individual, the owner of
the health care institution.
2. If the applicant is a partnership, limited
liability company or corporation, two of the officers of the corporation or
managing members of the partnership or limited liability company or the sole
member of the limited liability company if it has only one member.
3. If the applicant is a governmental unit, the head
of the governmental unit.
C. An application for licensure shall be submitted
at least sixty but not more than one hundred twenty days before the anticipated
date of operation. An application for a substantial compliance
survey submitted pursuant to section 36-425, subsection G shall be
submitted at least thirty days before the date on which the substantial
compliance survey is requested.
D. If a current licensee intends to terminate the
operation of a licensed health care institution or if a change of ownership is
planned, the current licensee shall notify the director in writing at least
thirty days before the termination of operation or change in ownership is to
take place. The current licensee is responsible for preventing any
interruption of services required to sustain the life, health and safety of the
patients or residents. A new owner shall not begin operating the
health care institution until the director issues a license to the new owner.
E. A licensed health care institution for which
operations have not been terminated for more than thirty days may be relicensed
pursuant to the codes and standards for architectural plans and specifications
that were applicable under its most recent license.
F. If a person operates a hospital in a county with
a population of more than five hundred thousand persons in a setting that
includes satellite facilities of the hospital that are located separately from
the main hospital building, the department at the request of the applicant or
licensee shall issue a single group license to the hospital and its designated
satellite facilities located within one-half mile of the main hospital
building if all of the facilities meet or exceed department licensure requirements
for the designated facilities. At the request of the applicant or
licensee, the department shall also issue a single group license that includes
the hospital and its designated satellite facilities that are located farther
than one-half mile from the main hospital building if all of these
facilities meet or exceed applicable department licensure
requirements. Each facility included under a single group license is
subject to the department's licensure requirements that are applicable to that
category of facility. Subject to compliance with applicable licensure or
accreditation requirements, the department shall reissue individual licenses
for the facility of a hospital located in separate buildings from the main
hospital building when requested by the hospital. This subsection does not
apply to nursing care institutions and residential care
institutions. The department is not limited in conducting
inspections of an accredited health care institution to ensure that the
institution meets department licensure requirements. If a person
operates a hospital in a county with a population of five hundred thousand
persons or less in a setting that includes satellite facilities of the hospital
that are located separately from the main hospital building, the department at
the request of the applicant or licensee shall issue a single group license to
the hospital and its designated satellite facilities located within thirty-five
miles of the main hospital building if all of the facilities meet or exceed
department licensure requirements for the designated facilities. At
the request of the applicant or licensee, the department shall also issue a
single group license that includes the hospital and its designated satellite
facilities that are located farther than thirty-five miles from the main
hospital building if all of these facilities meet or exceed applicable
department licensure requirements.
G. If a county with a population of more than one
million persons or a special health care district in a county with a population
of more than one million persons operates an accredited hospital that includes
the hospital's accredited facilities that are located separately from the main
hospital building and the accrediting body's standards as applied to all
facilities meet or exceed the department's licensure requirements, the
department shall issue a single license to the hospital and its facilities if requested
to do so by the hospital. If a hospital complies with applicable
licensure or accreditation requirements, the department shall reissue
individual licenses for each hospital facility that is located in a separate
building from the main hospital building if requested to do so by the
hospital. This subsection does not limit the department's duty to
inspect a health care institution to determine its compliance with department
licensure standards. This subsection does not apply to nursing care
institutions and residential care institutions.
H. An applicant or licensee must notify the
department within thirty days after any change regarding a controlling person
and provide the information and affirmation required pursuant to subsection A,
paragraph 1, subdivision (d) of this section.
I. A behavioral health residential facility that
provides services to children must notify the department within thirty days
after the facility begins contracting exclusively with the federal government,
receives only federal monies and does not contract with this state.
J. This section does not limit the application of
federal laws and regulations to an applicant or licensee that is certified as a
medicare or an Arizona health care cost containment system provider under
federal law.
K. Except for an outpatient treatment center that
provides dialysis services or abortion procedures or that is exempt from
licensure pursuant to section 36-402, subsection A, paragraph 12, a
person wishing to begin operating an outpatient treatment center before a
licensing inspection is completed shall submit all of the following:
1. The license application required pursuant to this
section.
2. All applicable application and license fees.
3. A written request for a temporary license that
includes:
(a) The anticipated date of operation.
(b) An attestation signed by the applicant that the
applicant and the facility comply with and will continue to comply with the
applicable licensing statutes and rules.
L. Within seven days after the department's receipt
of the items required in subsection K of this section, but not before the
anticipated operation date submitted pursuant to subsection C of this section,
the department shall issue a temporary license that includes:
1. The name of the facility.
2. The name of the licensee.
3. The facility's class or subclass.
4. The temporary license's effective date.
5. The location of the licensed premises.
M. A facility may begin operating on the effective
date of the temporary license.
N. The director may cease the issuance of temporary
licenses at any time if the director believes that public health and safety is
endangered.
O. An outpatient treatment center that is exempt
from licensure pursuant to section 36-402, subsection A, paragraph 12 is
subject to reasonable inspection by the department if the director has
reasonable cause to believe that patient harm is or may be occurring at that
outpatient treatment center. A substantiated complaint that harm is occurring
at an exempt outpatient treatment center is a violation of this chapter against
the license of the hospital listed in the notice required by section 36-402,
subsection A, paragraph 12.
P. Each hospital that is licensed pursuant to this
chapter shall provide to and maintain with the department a current list of
exempt outpatient treatment centers that have the same direct owner or indirect
owner as the hospital.
Q. For the purposes of this section:
1. "Accredited" means accredited by a
nationally recognized accreditation organization.
2. "Satellite facility" means an
outpatient facility at which the hospital provides outpatient medical services.
END_STATUTE
Sec. 18. Section 36-425, Arizona Revised
Statutes, is amended to read:
START_STATUTE
36-425.
Inspections; issuance of license; posting requirements;
provisional license; denial of license
A. On receipt of a properly completed application
for a health care institution license, the director shall conduct an inspection
of the health care institution as prescribed by this chapter.� If an
application for a license is submitted due to a planned change of ownership,
the director shall determine the need for an inspection of the health care
institution. Based on the results of the inspection and after the
submission of the applicable licensing fee, the director shall either deny the
license or issue a regular or provisional license.� A license issued by the
department shall be posted in a conspicuous location in the reception area of
that health care institution.
B. The director shall issue a license if the
director determines that an applicant and the health care institution for which
the license is sought substantially comply with the requirements of this
chapter and rules adopted pursuant to this chapter and the applicant agrees to
carry out a plan acceptable to the director to eliminate any
deficiencies. The director shall not require a health care
institution that was designated as a critical access hospital to make any
modifications required by this chapter or rules adopted pursuant to this
chapter in order to obtain an amended license with the same licensed capacity
the health care institution had before it was designated as a critical access
hospital if all of the following are true:
1. The health care institution has subsequently
terminated its critical access hospital designation.
2. The licensed capacity of the health care
institution does not exceed its licensed capacity before its designation as a
critical access hospital.
3. The health care institution remains in compliance
with the applicable codes and standards that were in effect at the time the
facility was originally licensed with the higher licensed capacity.
C. A health care institution license does not expire
and remains valid unless:
1. The department subsequently revokes or suspends
the license.
2. The license is considered void because the
licensee did not pay the licensing fee, civil penalties or provider agreement
fees before the relevant due date or did not enter into an agreement with the
department before the relevant due date to pay all outstanding fees or civil
penalties.
D. Except as provided
in section 36-424, subsection B and subsection E of this section, the
department shall conduct a compliance inspection of a health care institution
to determine compliance with this chapter and rules adopted pursuant to this
chapter at least once annually.
E. If the department determines a facility, except
for a residential care institution or a nursing care institution
that does not have the same direct owner or indirect
owner as a hospital licensed pursuant to this chapter, to be deficiency free on
a compliance survey, the department shall not conduct a compliance survey of
that facility for twenty-four months after the date of the deficiency
free survey. This subsection does not prohibit the department from enforcing
licensing requirements as authorized by section 36-424.
F. A hospital licensed as a rural general hospital
may provide intensive care services.
G. The director shall issue a provisional license
for a period of not more than one year if an inspection or investigation of a
currently licensed health care institution or a health care institution for
which an applicant is seeking a license reveals that the health care
institution is not in substantial compliance with department licensure
requirements and the director believes that the immediate interests of the
patients and the general public are best served if the health care institution
is given an opportunity to correct deficiencies. The applicant or
licensee shall agree to carry out a plan to eliminate deficiencies that is
acceptable to the director. The director shall not issue consecutive
provisional licenses to a single health care institution. The
director shall not issue a license to the current licensee or a successor
applicant before the expiration of the provisional license unless the health
care institution submits an application for a substantial compliance survey and
is found to be in substantial compliance. The director may issue a
license only if the director determines that the health care institution is in
substantial compliance with the licensure requirements of the department and
this chapter. This subsection does not prevent the director from
taking action to protect the safety of patients pursuant to section 36-427.
H. Subject to the confidentiality requirements of
articles 4 and 5 of this chapter, title 12, chapter 13, article 7.1 and section
12-2235, the licensee shall keep current department inspection reports at
the health care institution. Unless federal law requires otherwise,
the licensee shall post in a conspicuous location a notice that identifies the
location at that health care institution where the inspection reports are
available for review.
I. A health care
institution shall immediately notify the department in writing when there is a
change of the chief administrative officer specified in section 36-422,
subsection A, paragraph 1, subdivision (g).
J. When the
department issues an original license or an original provisional license to a
health care institution, it shall notify the owners and lessees of any
agricultural land within one-fourth mile of the health care
institution. The health care institution shall provide the
department with the names and addresses of owners or lessees of agricultural
land within one-fourth mile of the proposed health care institution.
K. In addition to the grounds for denial of
licensure prescribed pursuant to subsection A of this section, the director may
deny a license because an applicant or anyone in a business relationship with
the applicant, including stockholders and controlling persons, has had a
license to operate a health care institution denied, revoked or suspended or a
license or certificate issued by a health profession regulatory board pursuant
to title 32 or issued by a state agency pursuant to
chapter 6,
article 7 or
chapter 17 of this title denied, revoked or suspended or
has a licensing history of recent serious violations occurring in this state or
in another state that posed a direct risk to the life, health or safety of
patients or residents.
L. In addition to the requirements of this chapter,
the director may prescribe by rule other licensure requirements.
END_STATUTE
Sec. 19. Section 36-3601, Arizona Revised
Statutes, is amended to read:
START_STATUTE
36-3601.
Definitions
For the purposes of this chapter:
1. "Health care decision maker" has the
same meaning prescribed in section 12-2801.
2. "Health care provider":
(a) Means a person licensed pursuant to title 32,
chapter 7, 8, 13, 14, 15, 15.1, 16, 17, 18, 19, 19.1, 25, 28, 29, 33, 34, 35,
39, 41 or 42, or chapter 4, article 6 of this title
, chapter 6,
article 7 of this title
or chapter 17 of this title.
(b) Includes:
(i) A health care institution licensed pursuant to
chapter 4 of this title.
(ii) A person who holds a training permit pursuant
to title 32, chapter 13 or 17.
3. "Health care provider regulatory board or
agency" means a board or agency that regulates one or more health care
provider professions in this state.
4. "Telehealth"
means:
(a) The interactive
use of audio, video or other electronic media, including asynchronous
store-and-forward technologies and remote patient monitoring technologies, for
the practice of health care, assessment, diagnosis, consultation or treatment
and the transfer of medical data.
(b) Includes the use of an audio-only telephone
encounter between the patient or client and health care provider if an
audio-visual telehealth encounter is not reasonably available due to the
patient's functional status, the patient's lack of technology or
telecommunications infrastructure limits, as determined by the health care
provider.
(c) Does not include the use of a fax machine,
instant messages, voice mail or email.
END_STATUTE
Sec. 20.
Succession
A.
As
provided by this act, the naturopathic physicians medical board succeeds to the
authority, powers, duties and responsibilities of the department of health
services relating to the licensure and regulation of midwives pursuant to title
36, chapter 6, article 7, Arizona Revised Statutes.
B. This act does not alter
the effect of any actions that were taken or impair the valid obligations of
the department of health services relating to the licensure and regulation of
midwives pursuant to title 36, chapter 6, article 7, Arizona Revised Statutes,
in existence before the effective date of this act.
C. All rules adopted by the
department of health services pursuant to title 36, chapter 6, article 7,
Arizona Revised Statutes, remain in full force until superseded by
administrative action by the naturopathic physicians medical board.
D. All administrative
matters, contracts and judicial and quasi-judicial actions, whether
completed, pending or in process, of the department of health services relating
to the licensure and regulation of midwives pursuant to title 36, chapter 6,
article 7, Arizona Revised Statutes, on the effective date of this act are
transferred to and retain the same status with the naturopathic physicians
medical board.
E. All certificates,
licenses and other indicia of qualification and authority that were issued by
the department of health services pursuant to title 36, chapter 6, article 7,
Arizona Revised Statutes, retain their validity for the duration of their terms
of validity as provided by law.
F. All records and other
property, all data and investigative findings, all obligations and all
appropriated monies that remain unexpended and unencumbered on the effective
date of this act of the department of health services relating to the licensure
and regulation of midwives pursuant to title 36, chapter 6, article 7, Arizona
Revised Statutes, are transferred to the naturopathic physicians medical board.
Sec. 21.
Expenditure authority
Notwithstanding
any other law, the naturopathic physicians medical board may spend for the
purposes of this act any monies transferred from the department of health
services relating to the licensure and regulation of midwives and any monies
appropriated to the naturopathic physicians medical board in fiscal year 2026-2027.
Sec. 22.
Effective date
Section 32-1505, Arizona Revised
Statutes, as amended by Laws 2024, chapter 222, section 18 and this act, is
effective from and after June 30, 2028.
Sec. 23.
Short title
This act may be cited as the
"Jordan and Mack Terry Act".