A.R.S. tit. 36 ch. 4 — Arizona Revised Statutes Title 36 Chapter 4 — Health Care Institutions

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 that is currently accredited by a nationally recognized organization on hospital accreditation. 3. "Adult behavioral health therapeutic home" means a residence for individuals who are at least eighteen years of age, have behavioral health issues and need behavioral health services that does all of the following for those individuals: (a) Provides room and board. (b) Assists in acquiring daily living skills. (c) Coordinates transportation to scheduled appointments. (d) Monitors behaviors. (e) Assists in the self-administration of medication. (f) Provides feedback to case managers related to behavior. 4. "Adult day health care facility" means a facility that provides 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 who are 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 home" means a residential setting that provides room and board and adult foster care services for at least one and not more than four adults who are participants in the Arizona long-term care system pursuant to chapter 29, article 2 of this title or contracts for services with the United States department of veterans affairs 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 rules adopted pursuant to section 36-405 and section 36-2939, subsection C. 8. "Assisted living center" means an assisted living facility that provides resident rooms or residential units to eleven or more residents. 9. "Assisted living facility" means a residential care institution, including an adult foster care home, that provides or contracts to provide supervisory care services, personal care services or directed care services on a continuous basis. 10. "Assisted living home" means an assisted living facility that provides resident rooms to ten or fewer residents. 11. "Behavioral health services" means services that pertain to mental health and substance use disorders and that are either: (a) Performed by or under the supervision of a professional who is licensed pursuant to title 32 and whose scope of practice allows the professional to provide these services. (b) Performed on behalf of patients by behavioral health staff as prescribed by rule. 12. "Construction" means building, erecting, fabricating or installing a health care institution. 13. "Continuous" means available at all times without cessation, break or interruption. 14. "Controlling person" means a person who: (a) Through ownership, has the power to vote at least ten percent of the outstanding voting securities. (b) If the applicant or licensee is a partnership, is the general partner or a limited partner who holds at least ten percent of the voting rights of the partnership. (c) If the applicant or licensee is a corporation, an association or a limited liability company, is the president, the chief executive officer, the incorporator or any person who owns or controls at least ten percent of the voting securities. For the purposes of this subdivision, corporation does not include nonprofit corporations. (d) Holds a beneficial interest in ten percent or more of the liabilities of the applicant or the licensee. 15. "Department" means the department of health services. 16. "Directed care services" means programs and services, including supervisory and personal care services, that are 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 to accomplish a function or activity. 18. "Director" means the director of the department. 19. "Direct owner" means a person that has an ownership or control interest in a health care institution totaling fifty-one percent or more. 20. "Enhanced residential treatment facility" means a residential care institution that is licensed to provide programs and services, including behavioral health services, structured support services and health-related services, to residents who are seriously mentally ill as defined in section 36-550. 21. "Facilities" means buildings that are used by a health care institution for providing any of the types of services as defined in this chapter. 22. "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 that are 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. (iv) A physician's office that offers extended hours or same-day appointments to existing and new patients and that does not meet the requirements of subdivision (a), item (i), (iii) or (iv) of this paragraph. 23. "Governing authority" means the individual, agency, partners, group or corporation, whether appointed, elected or otherwise designated, in which the ultimate responsibility and authority for the conduct of the health care institution are vested. 24. "Health care institution" means every place, institution, building or agency, whether organized for profit or not, that provides facilities with medical services, nursing services, behavioral health services, health screening services, other health-related services, supervisory care services, personal care services or directed care services and includes home health agencies as defined in section 36-151, outdoor behavioral health care programs and hospice service agencies. 25. "Health-related services" means services, other than medical, that pertain to general supervision, protective, preventive and personal care services, supervisory care services or directed care services. 26. "Health screening services" means the acquisition, analysis and delivery of health-related data of individuals to aid in determining the need for medical services. 27. "Hospice" means a hospice service agency or the provision of hospice services in an inpatient facility. 28. "Hospice service" means a program of palliative and supportive care for terminally ill persons and their families or caregivers. 29. "Hospice service agency" means an agency or organization, or a subdivision of that agency or organization, that provides hospice services at the place of residence of its clients. 30. "Indirect owner": (a) Means a person that has an ownership or control interest in a direct owner totaling fifty-one percent or more. (b) Includes an ownership or control interest in an indirect owner totaling fifty-one percent or more and a combination of direct ownership and indirect ownership or control interests totaling fifty-one percent or more in the health care institution. 31. "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. 32. "Intermediate care facility for individuals with intellectual disabilities" has the same meaning prescribed in section 36-551. 33. "Licensed capacity" means the total number of persons for whom the health care institution is authorized by the department to provide services as required pursuant to this chapter if the person is expected to stay in the health care institution for more than twenty-four hours. For a hospital, licensed capacity means only those beds specified on the hospital license. 34. "Medical services" means the services that pertain to medical care and that are performed at the direction of a physician on behalf of patients by physicians, dentists, nurses and other professional and technical personnel. 35. "Modification" means the substantial improvement, enlargement, reduction or alteration of or other change in a health care institution. 36. "Nonproprietary institution" means any health care institution that is 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 that is operated by the state or any political subdivision of the state. 37. "Nursing care institution" means a health care institution that provides inpatient beds or resident beds and nursing services to persons who need continuous nursing services but who do not require hospital care or direct daily care from a physician. 38. "Nursing services" means those services that pertain to the curative, restorative and preventive aspects of nursing care and that are performed at the direction of a physician by or under the supervision of a registered nurse licensed in this state. 39. "Nursing-supported group home" means a health care institution that is a community residential setting as defined in section 36-551 for not more than six persons with developmental disabilities, that is operated by a service provider under contract with the department of economic security and that provides room and board, daily habilitation and continuous nursing support and intervention. 40. "Organized medical staff" means a formal organization of physicians, and dentists if appropriate, with the delegated authority and responsibility to maintain proper standards of medical care and to plan for continued betterment of that care. 41. "Outdoor behavioral health care program" means an agency that provides behavioral health services in an outdoor environment as an alternative to behavioral health services that are provided in a health care institution with facilities. Outdoor behavioral health care programs do not include: (a) Programs, facilities or activities that are operated by a government entity or that are licensed by the department as a child care program pursuant to chapter 7.1 of this title. (b) Outdoor activities for youth that are designated to be primarily recreational and that are organized by church groups, scouting organizations or similar groups. (c) Outdoor youth programs that are licensed by the department of economic security. 42. "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. 43. "Physician" means any person who is licensed pursuant to title 32, chapter 13 or 17. 44. "Recidivism reduction services" means services that are delivered by an adult residential care institution to its residents to encourage lawful behavior and to discourage or prevent residents who are suspected of, charged with or convicted of one or more criminal offenses, or whose mental health and substance use can be reasonably expected to place them at risk for the future threat of prosecution, diversion or incarceration, from engaging in future unlawful behavior. 45. "Recidivism reduction staff" means a person who provides recidivism reduction services. 46. "Residential care institution" means a health care institution other than a hospital or a nursing care institution that provides resident beds or residential units, supervisory care services, personal care services, behavioral health services, directed care services or health-related services for persons who do not need continuous nursing services. 47. "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. 48. "Respite care services" means services that are provided by a licensed health care institution to persons who are 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. 49. "Structured support services" includes services that are available for up to twenty-four hours per day and case management, crisis intervention, social skills training and budgeting assistance. 50. "Substantial compliance" means that the nature or number of violations revealed by any type of inspection or investigation of a health care institution does not pose a direct risk to the life, health or safety of patients or residents. 51. "Supervision" means directly overseeing and inspecting the act of accomplishing a function or activity. 52. "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 self-administering prescribed medications. 53. "Temporary license" means a license that is issued by the department to operate a class or subclass of a health care institution at a specific location and that is valid until an initial licensing inspection. 54. "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 that are 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 the licensee is a nurse who is 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. 36-402. Exemptions A. This chapter and the rules adopted by the director pursuant to this chapter 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 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, that provide domiciliary and ancillary commercial services but do not provide adaptive, medical, hospital, nursing, behavioral health, 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: (a) Patients of the office or clinic are kept overnight as bed patients or treated otherwise under general anesthesia, except when treatment by general anesthesia is regulated by title 32, chapter 11. (b) The office or clinic is an abortion clinic. For the purposes of this subdivision, "abortion clinic" has the same meaning prescribed in section 36-449.01. (c) The office or clinic is a pain management clinic. For the purposes of this subdivision, "pain management clinic" has the same meaning prescribed in section 36-448.01. 4. Dispensaries and first aid stations that are located within business or industrial establishments and that are maintained solely for the use of employees if the facility does not contain inpatient beds and is under the supervision of a physician or a registered nurse practitioner. 5. The collection, processing or distribution of whole human blood, blood components, plasma, blood fractions or derivatives that are procured, processed or distributed by federally licensed and regulated blood banks. 6. Places where four or fewer adults who are not related to the administrator or owner receive adult day health services for compensation on a regular basis. 7. 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 one or two persons receive health-related services on a twenty-four-hour basis. 8. 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. 9. 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. 10. A facility that provides medical and health services to inmates who are confined in a county jail. The sheriff shall annually evaluate the facility to determine if it meets the applicable standards that are adopted by either a national corrections commission on health care or an American correctional association, or the sheriff shall annually submit the facility to a similar separate inspection by an outside agency with medical standards. The sheriff must submit the certificate of accreditation or proof of successful inspection to the department annually and keep a copy of the certificate or proof of inspection. 11. Community education, advocacy or recovery support groups that are not owned or operated by or contracted to provide services with a health care institution. 12. An outpatient treatment center that has the same direct owner or indirect owner as a hospital licensed pursuant to this chapter, that is staffed by health care providers who are licensed pursuant to title 32 and that provides notice to the department of its decision to be exempt from licensure under this chapter, unless: (a) Patients are kept overnight in the outpatient treatment center or are treated under general anesthesia, except when the treatment by general anesthesia is regulated pursuant to title 32, chapter 11. (b) The outpatient treatment center is an abortion clinic as defined in section 36-449.01. (c) The outpatient treatment center is a pain management clinic as defined in section 36-448.01. B. A medical and health-related facility that provides medical and health services exclusively to persons who are incarcerated, detained or confined under court order or court jurisdiction is exempt from the patient-per-room capacity requirements provided in rule if the facility: 1. Does not exceed its intended medical and custodial purposes. 2. Adopts policies and procedures to comply with the national commission on correctional health care standards, or equivalent standards. 3. As soon as practicable, becomes accredited by the national commission on correctional health care, or by an equivalent organization. 4. Once accreditation is obtained, submits a certificate of accreditation to the department of health services annually. 5. Maintains a copy of the certificate of accreditation. 6. Maintains patient and custodial records, including on-site current photographs and fingerprints, if permitted by applicable law. 7. Makes patient lists with inmate identifiers available to the state department of corrections on reasonable request. 8. Provides timely notice of any major incident involving public safety to the appropriate law enforcement agency and allows that agency access to the facility for the purposes of law enforcement and investigation. C. Subsection B of this section does not apply to health care institutions that exclusively provide behavioral health services. 36-403. Licensure by counties and municipalities Nothing in this chapter shall prevent counties or municipalities from adopting and enforcing building and zoning regulations for health care institutions which are equal to or more restrictive than regulations of the department. 36-404. Limitation of disclosure of information A. Information received and records kept by the department for the purpose of administering this chapter are available to the public except: 1. Information obtained for purposes of articles 4 and 5 of this chapter. 2. Personally identifiable medical information or any information from which a patient or the patient's family might be identified. 3. Sources of information that cause the department to believe that an inspection of an institution is needed to determine the extent of compliance with this chapter and rules adopted pursuant to this chapter. 4. Personally identifiable information of a physician that is received and any records kept regarding the physician's admitting privileges pursuant to section 36-449.02. B. The department may release information listed under subsection A of this section to an officer of the court pursuant to a court order, a department or agency of this state or the federal government, a law enforcement agency or a county medical examiner if the release of this information is necessary and pertinent to an investigation or proceeding unless the release of this information is prohibited by federal or state law. The recipient shall maintain patient and source name confidentiality. 36-405. Powers and duties of the director A. The director shall adopt rules to establish minimum standards and requirements for constructing, modifying and licensing health care institutions necessary to ensure the public health, safety and welfare. The standards and requirements shall relate to the construction, equipment, sanitation, staffing for medical, nursing and personal care services, and recordkeeping pertaining to administering medical, nursing, behavioral health and personal care services, in accordance with generally accepted practices of health care. The standards shall require that a physician who is licensed pursuant to title 32, chapter 13 or 17 medically discharge patients from surgery and shall allow an outpatient surgical center to require that either an anesthesia provider who is licensed pursuant to title 32, chapter 13, 15 or 17 or a physician who is licensed pursuant to title 32, chapter 13 or 17 remain present on the premises until all patients are discharged from the recovery room. Except as otherwise provided in this subsection, the director shall use the current standards adopted by the joint commission on accreditation of hospitals and the commission on accreditation of the American osteopathic association or those adopted by any recognized accreditation organization approved by the department as guidelines in prescribing minimum standards and requirements under this section. B. The director, by rule, may: 1. Classify and subclassify health care institutions according to character, size, range of services provided, medical or dental specialty offered, duration of care and standard of patient care required for the purposes of licensure. Classes of health care institutions may include hospitals, infirmaries, outpatient treatment centers, health screening services centers and residential care facilities. Whenever the director reasonably deems distinctions in rules and standards to be appropriate among different classes or subclasses of health care institutions, the director may make such distinctions. 2. Prescribe standards for determining a health care institution's substantial compliance with licensure requirements. 3. Prescribe the criteria for the licensure inspection process. 4. Prescribe standards for selecting health care-related demonstration projects. 5. Establish nonrefundable application, initial licensure inspection and licensing fees for health care institutions, including a grace period and a fee for the late payment of licensing fees. 6. Establish a process for the department to notify a licensee of the licensee's licensing fee due date. 7. Establish a process for a licensee to request a different licensing fee due date, including any limits on the number of requests by the licensee. C. The director, by rule, shall adopt licensing provisions that facilitate the colocation and integration of outpatient treatment centers that provide medical, nursing and health-related services with behavioral health services consistent with article 3.1 of this chapter. D. The director shall establish a model in rule for the department to monitor health care institutions on-site that are found to not be in substantial compliance with the applicable licensure requirements. The director shall establish on-site monitoring fees for health care institutions that are subject to the on-site monitoring requirements. The department may not charge a fee pursuant to this subsection for a complaint or compliance-related survey or inspection if a health care institution is in substantial compliance. E. The department may provide in-service training to health care institutions that request in-service training relating to regulatory compliance outside of the survey process. The director shall establish in rule in-service training fees for health care institutions that request in-service training from the department. F. Ninety percent of the fees collected pursuant to this section shall be deposited, pursuant to sections 35-146 and 35-147, in the health services licensing fund established by section 36-414 and ten percent of the fees collected pursuant to this section shall be deposited, pursuant to sections 35-146 and 35-147, in the state general fund. G. Subsection B, paragraph 5 of this section does not apply to a health care institution operated by a state agency pursuant to state or federal law or to adult foster care residential settings. 36-405.01. Health screening services; violation; classification A. Health screening services shall be conducted in the following manner: 1. Health screening services shall be conducted under the direction of or, when required by good medical practice, under the supervision of a physician. 2. Any diagnosis of collected health-related data shall be performed by a physician. 3. Any examination of secretions, body fluids or excretions of the human body shall be performed pursuant to title 36, chapter 4.1. 4. Individuals may obtain health screening services on their own initiative. 5. Data given health-screened individuals shall be properly informative and not misleading. 6. Activities engaged in or materials used to educate, promote or otherwise solicit individuals to use health screening services shall not: (a) Be misleading. (b) Include the name of any physician, physician's office or clinic. (c) Use or contain any language that directly or indirectly lauds the professional competence, skill or reputation of any physician. 7. A patient who is in need of medical care shall be informed that he should see a physician without referral to any particular physician. B. The director may adopt such other regulations necessary or appropriate to carry out the purposes of this section. C. Physicians affiliated with health screening services shall continue to be bound by the laws and ethics governing their practice. However, affiliation with health screening services conducted in conformity with this chapter shall not constitute a violation of such laws or ethics. D. Health-screened individuals, with respect to their disclosures to and records with health screening services, shall have the same protections regarding privileged communication and the same rights to the possession and confidentiality of their records as are accorded by law to patients of physicians. E. Health screening services shall be exempt from the provisions of articles 2 through 5 of this chapter. F. Any person who conducts health screening services in violation of this section or in violation of any rule or regulation adopted by the director is guilty of a class 2 misdemeanor. In addition, the director may exercise the same powers with respect to health screening services as are provided in section 36-427, subsection B with respect to licensed health care institutions. 36-405.02. Outpatient behavioral health and other related health care services; employees; rules The department shall allow a person who is employed at a health care institution that provides outpatient behavioral health services, who is not a licensed behavioral health professional and who is at least eighteen years of age to provide outpatient behavioral health or other related health care services pursuant to all applicable department rules. The director shall adopt rules consistent with this section. 36-405.03. Memory care services standards; rules; staff training requirements; definition A. The director shall establish by rule standards for memory care services for assisted living facilities that are licensed to provide directed care services. B. The director shall establish by rule minimum training standards for memory care services for staff and contractors who work in an assisted living facility that is licensed to provide directed care services. The training standards shall include a minimum of eight hours of initial memory care services training and four hours of annual continuing education. In addition to the eight hours of initial training, the training standards for assisted living facility managers shall include a minimum of four hours of memory care services training that is specifically for assisted living facility managers. The department shall approve the memory care services training programs, and the training programs shall provide staff and contractors who complete the training a certificate of completion that may be used to work at any assisted living facility that is licensed to provide directed care services. If a staff member or contractor has not worked at an assisted living facility that is licensed to provide directed care services for a period of twelve months, the person is required to complete the initial training within thirty days after the date of hire, rehire or returning to work. C. An assisted living facility that is licensed to provide directed care services is required to provide to the department during an investigation or compliance survey documentation of staff training as prescribed in subsection B of this section. Failure to provide complete staff training documentation shall be cited as a deficiency. D. For the purposes of this section, "memory care services" means services that support individuals with dementia and other progressive and neurodegenerative brain disorders, including specialized environmental features, care planning, directed care services, medication administration services, specialized accommodations, activity programming or other services required by the department in rule. 36-405.04. Licensing and monitoring of health care institutions; joint review of monitoring and compliance functions; reporting requirement A. The department shall license and monitor the operation of health care institutions to ensure compliance with this chapter. B. The department and the Arizona health care cost containment system shall coordinate to review monitoring and compliance functions to identify areas of overlap related to health care institution licensing standards. The review must include, at a minimum: 1. Licensing, certification and enrollment requirements. 2. On-site surveys, inspections, audits and other compliance activities. 3. Data collection and reporting requirements. 4. Corrective action and enforcement processes applicable to health care institutions. C. The department and the Arizona health care cost containment system shall: 1. Identify opportunities to eliminate or reduce duplicative, redundant or inconsistent requirements while maintaining patient safety and appropriate regulatory oversight. 2. Coordinate or align policies, procedures and operational practices to minimize administrative burdens on health care institutions. D. This section does not require any action that is inconsistent with federal medicaid conditions of participation or conditions of payment or other applicable federal requirements. E. On or before December 31, 2026 and on or before October 31 every four years thereafter, the department shall submit a written report to the house of representatives and the senate health and human services committees, or their successor committees, that summarizes the findings of the review, identifies areas of duplication or overlap and includes recommendations for statutory, regulatory or administrative changes. F. On or before December 31, 2026, the department and the Arizona health care cost containment system shall review their rules and policies relating to behavioral health technicians to ensure alignment with article 4.1 of this chapter. 36-406. Powers and duties of the department; access to personnel records A. In addition to its other powers and duties: 1. The department shall: (a) Administer and enforce this chapter and the rules, regulations and standards adopted pursuant to this chapter. (b) Review, and may approve, plans and specifications for construction or modification of or additions to health care institutions regulated by this chapter. (c) Except as provided in subsection B of this section, have access to books, records, accounts and any other information of any health care institution that are reasonably necessary for the purposes of this chapter. (d) Require as a condition of licensure that nursing care institutions and assisted living facilities make vaccinations for influenza and pneumonia available to residents on-site on a yearly basis. The department shall prescribe the manner by which the nursing care institutions and assisted living facilities must document compliance with this subdivision, including documenting residents who refuse to be immunized. The department shall not impose a violation on a licensee for not making a vaccination available if there is a shortage of that vaccination in this state as determined by the director. 2. The department may: (a) Make or cause to be made inspections consistent with standard medical practice of every part of the premises of health care institutions that are subject to this chapter as well as those that apply for or hold a license required by this chapter. (b) Make studies and investigations of conditions and problems in health care institutions, or any class or subclass thereof, as they relate to compliance with this chapter and rules, regulations and standards adopted pursuant to this chapter. (c) Develop manuals and guides relating to any of the several aspects of physical facilities and operations of health care institutions or any class or subclass thereof for distribution to the governing authorities of health care institutions and to the general public. B. The department's access to the personnel records of a nursing care institution is limited to the following information for each personnel member, employee or volunteer: 1. The individual's name, date of birth and contact telephone number. 2. The individual's starting date of employment or volunteer service and, if applicable, the ending date. 3. Documentation of all of the following as pertaining to the individual: (a) Qualifications, including skills and knowledge applicable to the individual's job duties. (b) Education and experience applicable to the individual's job duties. (c) Compliance with the requirements of section 36-411. (d) Orientation and in-service education as required by policies and procedures. (e) Licensure or certification, if the individual is required to be licensed or certified pursuant to this article or policies and procedures. (f) If the individual is a behavioral health technician, clinical oversight as required by rule. (g) Cardiopulmonary resuscitation training, if required for the individual by rule. (h) First aid training, if required for the individual pursuant to this article or policies and procedures. (i) Evidence of freedom from infectious tuberculosis, if required for the individual by rule. (j) If the individual is a nutrition and feeding assistant, both: (i) Completion of the nutrition and feeding assistant training course as required by rule. (ii) A nurse's observations as required by rule. 36-407. Prohibited acts; required acts A. A person shall not establish, conduct or maintain in this state a health care institution or any class or subclass of health care institution unless that person holds a current and valid license issued by the department specifying the class or subclass of health care institution the person is establishing, conducting or maintaining. The license is valid only for the establishment, operation and maintenance of the class or subclass of health care institution, the type of services and, except for emergency admissions as prescribed by the director by rule, the licensed capacity specified by the license. B. The licensee shall not imply by advertising, directory listing or otherwise that the licensee is authorized to perform services more specialized or of a higher degree of care than is authorized by this chapter and the underlying rules for the particular class or subclass of health care institution within which the licensee is licensed. C. The licensee may not transfer or assign the license. A license is valid only for the premises occupied by the institution at the time of its issuance. D. The licensee shall not personally or through an agent offer or imply an offer of rebate or fee splitting to any person regulated by title 32 or chapter 17 of this title. E. The licensee shall not advise a patient, whether directly or indirectly through staff, to enroll in or disenroll from a specific health insurance policy or plan issued by a specific insurance company unless the licensee or staff member is a licensed insurance producer in this state. This subsection does not: 1. Prohibit or prevent a licensee from discussing with patients whether the licensee is in network or out of network with any specific insurance company or under any specific insurance policy or plan. 2. Prohibit or prevent health insurance navigators or certified application counselors acting within the scope of their license or registration from assisting persons with enrollment in a health insurance policy or plan. F. The licensee shall submit an itemized statement of charges to each patient. G. A health care institution shall refer a patient who is discharged after receiving emergency services for a drug-related overdose to a behavioral health services provider. 36-407.01. Hospitals; visitation; religious purposes A hospital shall provide notice of its visitation policy to a patient or the patient's representative. If a hospital's visitation policy allows in-person visitation of any kind and if authorized by the patient or the patient's representative, the hospital must facilitate the ability of clergy to visit the patient in person for religious purposes. Clergy must comply with reasonable health and safety precautions imposed by hospitals in connection with in-person visitation. If a hospital's visitation policy does not allow in-person visitation of any kind at all times or temporarily for health and safety reasons, the hospital must facilitate a virtual clergy visit using communication technology. 36-407.02. Health care institutions; clergy visitation; health and safety precautions; immunity; civil action; definitions A. If a health care institution's visitation policy allows in-person visitation of any kind, the health care institution must allow a clergy member to visit a resident who requests an in-person visit or consents to be visited in person for religious purposes by the clergy member, including during a declared state of emergency. If a resident is unable, due to dementia or a similar cognitive impairment, to request an in-person visit or to consent to be visited in person by a clergy member for religious purposes, the request or consent must be made or given by the resident's legal representative. B. Notwithstanding any other provision in this chapter, when a resident's death is imminent, a health care institution must allow a clergy member to visit the resident in person for religious purposes if either of the following applies: 1. The resident requests or consents to be visited by the clergy member. 2. The resident's legal representative requests that the resident be visited by the clergy member. C. A health care institution may require clergy to comply with reasonable health and safety precautions, including undergoing health screenings and wearing personal protective equipment, that are imposed by the health care institution in connection with in-person visitation for preventing the spread of communicable diseases. If such a requirement would substantially burden the clergy member's free exercise of religion while carrying out the religious purpose for which the clergy member is visiting while with the resident in the resident's room or visiting area designated by the health care institution, the health care institution may require compliance with such precautions only if compliance in that instance furthers a compelling interest and the health care institution imposes the least restrictive burden on the clergy member's exercise of religion. Notwithstanding any other provision of this chapter, a health care institution may restrict visits of a clergy member who fails a health screening measure or tests positive for a communicable disease. D. A health care institution and its employees and contractors are not liable to a person visiting a resident or to a resident of the health care institution for civil damages for injury or death due to actual or alleged exposure to a communicable disease resulting from or related to a visitation in compliance with this section unless it is proven by clear and convincing evidence that the health care institution failed to substantially comply with the health care institution's applicable health and safety precautions. The immunity prescribed in this subsection does not apply to any act or omission unless there is clear and convincing evidence that the act or omission constitutes gross negligence or wilful or wanton misconduct. E. A person or religious organization may bring a civil action against a health care institution alleging a violation of this section. Any person that successfully asserts a claim or defense under this section may recover declaratory relief, injunctive relief, reasonable attorney fees and costs and any other appropriate relief. F. For the purposes of this section: 1. "Health care institution" has the same meaning prescribed in section 36-420. 2. "Resident" means a person living at or receiving inpatient services from a health care institution. 36-407.03. Hospitals; visitation policy; exceptions A. A hospital shall develop a visitation policy that allows a patient to have daily in-person visitation by a designated visitor of the patient's choice, which may include the patient's spouse or one parent or child of the patient. A hospital's policies regarding visitation shall ensure that the patient and the patient's visitors may have physical contact, especially during end-of-life visitation, unless a physician determines based on the patient's condition that the visitation does not meet health and safety standards or is reasonably likely to harm the patient. If a physician denies visitation with a patient pursuant to this section, the patient or the patient's representative, which may include the patient's spouse, parent or child, may request a meeting, as provided by the visitation policy, with the physician and the hospital's chief medical officer, chief of staff or chief executive officer to receive a review and explanation within twenty-four hours of the physician's decision to deny visitation. If the designated visitor's request to visit is denied or not resolved at the meeting, the visitor may file a complaint with the department. All visitors must comply with reasonable health and safety precautions imposed by the hospital in connection with the visit. B. This section does not apply to the Arizona state hospital, any other licensed facility under the jurisdiction of the superintendent of the Arizona state hospital or chapter 5 of this title. 36-407.04. Assisted living centers; assisted living homes; occupants; prohibitions Notwithstanding section 36-407, subsection A and if allowed by an assisted living center or an assisted living home, an individual who does not receive supervisory care services, personal care services or directed care services may live with a resident in the assisted living center or assisted living home in the resident's unit or may live in any other unit within the assisted living center or assisted living home. The department may not: 1. Place any requirement on that individual with which a resident would not need to comply. 2. Require that individual to have a service plan or to receive supervisory care services, personal care services or directed care services. 36-408. Required reports from health care institutions The department of health services shall not require any reports from health care institutions to be filed more frequently than annually unless such filings are otherwise required by state or federal law or result from necessary processing of applications or requests filed by such institutions. 36-409. Certification, licensure and monitoring of long-term care facilities, facilities and services A. The department shall perform all necessary functions, including licensing, certification or monitoring, to implement federally approved standards for institutions, facilities, agencies or persons providing services pursuant to chapter 29, article 2 of this title. These functions shall only be performed pursuant to an interagency agreement which the director of the Arizona health care cost containment system administration shall enter into with the department. A skilled nursing facility, hospice or home health agency shall not be certified pursuant to this section unless it is also certified under title XVIII of the social security act. B. Nursing care institutions and hospices shall make financial records available to the Arizona health care cost containment system administration for purposes of certified financial audits conducted pursuant to chapter 29, article 2 of this title. 36-409.01. Joint training sessions; survey process; compliance A. The department shall establish an annual joint training session between supervisors, compliance officers and investigators who perform duties related to section 36-409 and each of the following: 1. Skilled nursing providers. 2. Assisted living providers. B. The purpose of the joint training sessions is to report changes to the survey process and to educate both the compliance officers and the skilled nursing and assisted living providers on how compliance with the changes will be determined. The joint training sessions may be conducted in person or remotely. C. The department may receive and spend gifts, grants or donations to pay for the joint training sessions required by subsection A of this section. 36-410. County standards and guidelines; delegation A. The director shall provide counties with nonbinding guidelines for their use in establishing contract standards for adult foster care providers that do not provide services pursuant to chapter 29, article 2 of this title. These nonbinding guidelines shall include standards for the self-administration of drugs that the foster care provider shall follow in conjunction with home health services and outpatient services. B. The director shall adopt rules that the counties or the Arizona health care cost containment system administration shall use in prescribing minimum standards for adult foster care providers that provide services pursuant to chapter 29, article 2 of this title. The director shall conform these rules with federally approved applicable standards for adult foster care homes. The director shall delegate the authority to enforce these rules to each county that accepts this delegation or to the Arizona health care cost containment system administration. The department shall monitor an adult foster care program to ensure compliance with department rules. If a county or the Arizona health care cost containment system administration does not accept the delegation, the department shall certify and monitor an adult foster care home pursuant to section 36-409 if that home seeks to participate in the Arizona long-term care system pursuant to chapter 29, article 2 of this title. 36-411. Residential care institutions; nursing care institutions; home health agencies; fingerprinting requirements; exemptions; definitions A. Except as provided in subsection F of this section, as a condition of licensure or continued licensure of a residential care institution, a nursing care institution or a home health agency and as a condition of employment in a residential care institution, a nursing care institution or a home health agency, employees and owners of residential care institutions, nursing care institutions or home health agencies, contracted persons of residential care institutions, nursing care institutions or home health agencies or volunteers of residential care institutions, nursing care institutions or home health agencies who provide medical services, nursing services, behavioral health services, health-related services, home health services or direct supportive services and who have not been subject to the fingerprinting requirements of a health professional's regulatory board pursuant to title 32 shall have a valid fingerprint clearance card that is issued pursuant to title 41, chapter 12, article 3.1 or shall apply for a fingerprint clearance card within twenty working days after employment or beginning volunteer work or contracted work. B. A health professional who has complied with the fingerprinting requirements of the health professional's regulatory board as a condition of licensure or certification pursuant to title 32 is not required to submit an additional set of fingerprints to the department of public safety pursuant to this section. C. Each residential care institution, nursing care institution and home health agency shall make documented, good faith efforts to: 1. Contact previous employers to obtain information or recommendations that may be relevant to a person's fitness to work in a residential care institution, nursing care institution or home health agency. 2. Verify the current status of a person's fingerprint clearance card. 3. Beginning January 1, 2025, verify that a potential employee is not on the adult protective services registry pursuant to section 46-459. If a potential employee is found to be on the adult protective services registry, the residential care institution, nursing care institution or home health agency may not hire the potential employee. 4. On or before March 31, 2025, verify that each employee is not on the adult protective services registry pursuant to section 46-459. If an employee is found to be on the adult protective services registry, the residential care institution, nursing care institution or home health agency shall take action to terminate the employment of that employee. 5. Beginning March 31, 2025, annually reverify that each employee is not on the adult protective services registry pursuant to section 46-459. D. An employee, an owner, a contracted person or a volunteer or a facility on behalf of the employee, the owner, the contracted person or the volunteer shall submit a completed application that is provided by the department of public safety within twenty days after the date the person begins work or volunteer service. E. Except as provided in subsection F of this section, a residential care institution, nursing care institution or home health agency shall not allow an employee to continue employment or a volunteer or contracted person to continue to provide medical services, nursing services, behavioral health services, health-related services, home health services or direct supportive services if the person has been denied a fingerprint clearance card pursuant to title 41, chapter 12, article 3.1, has been denied approval pursuant to this section before May 7, 2001 or has had a fingerprint clearance card suspended or revoked. F. An employee, volunteer or contractor of a residential care institution, nursing care institution or home health agency who is eligible pursuant to section 41-1758.07, subsection C to petition the board of fingerprinting for a good cause exception and who provides documentation of having applied for a good cause exception pursuant to section 41-619.55 but who has not yet received a decision is exempt from the fingerprinting requirements of this section if the person provides medical services, nursing services, behavioral health services, health-related services, home health services or direct supportive services to residents or patients while under the direct visual supervision of an owner or employee who has a valid fingerprint clearance card. G. If a person's employment record contains a six-month or longer time frame during which the person was not employed by any employer, a completed application with a new set of fingerprints shall be submitted to the department of public safety. H. For the purposes of this section: 1. "Direct supportive services": (a) Means services other than home health services that provide direct individual care and that are not provided in a common area of a health care institution, including: (i) Assistance with ambulating, bathing, toileting, grooming, eating and getting in and out of a bed or chair. (ii) Assistance with self-administration of medication. (iii) Janitorial, maintenance, housekeeping or other services provided in a resident's room. (iv) Transportation services, including van services. (b) Does not include services provided by persons contracted directly by a resident or the resident's family in a health care institution. 2. "Direct visual supervision" means continuous visual oversight of the supervised person that does not require the supervisor to be in a superior organizational role to the person being supervised. 3. "Home health services" has the same meaning prescribed in section 36-151. 36-411.01. Adult residential care institutions; recidivism reduction services; rules A. An adult residential care institution subclass that is authorized to provide recidivism reduction services may employ recidivism reduction staff who are exempt from the requirements of section 36-411, subsection E to assist in the delivery of recidivism reduction services. B. An applicant for employment is exempt from the requirements of section 36-411, subsection E if the applicant does both of the following: 1. Successfully completes treatment for recidivism reduction as prescribed by rule. 2. Passes a background and screening evaluation conducted by the adult residential care institution as prescribed by rule that demonstrates that the individual is not a threat to the health or safety of staff or residents of the adult residential care institution. C. As prescribed by rule, only adult residents of an adult residential care institution who have been referred to receive recidivism reduction services may receive services from recidivism reduction staff. D. An adult resident of an adult residential care institution may be referred for recidivism reduction services if the adult resident is one or more of the following: 1. Charged with or convicted of one or more criminal offenses. 2. Referred by a court, prosecutor or probation officer. 3. Approved for placement at the adult residential care institution by a health care professional who is licensed pursuant to title 32 and whose scope of practice includes recidivism reduction services. 36-412. Nursing care institutions; employment The department shall not adopt any rule that prohibits an administrator of a nursing care institution from employing a person who is sixteen years of age or older, who provides direct care to residents and who otherwise meets the requirements of section 32-1645. 36-413. Nutrition and feeding assistants; training programs; regulation; civil penalty; definition A. The department may adopt rules to prescribe minimum standards for training programs for nutrition and feeding assistants in licensed skilled nursing facilities, including instructor qualifications, and may grant, deny, suspend and revoke approval of any training program that violates these standards. These standards must include: 1. Screening requirements. 2. Initial qualifications. 3. Continuing education requirements. 4. Testing requirements to assure competency. 5. Supervision requirements. 6. Requirements for additional training based on patient needs. 7. Maintenance of records. 8. Special feeding requirements based on level of care. B. Pursuant to section 36-431.01, the department may impose a civil penalty on a training program that violates standards adopted by the department. C. If the department adopts standards for training programs pursuant to subsection A of this section, the department, as part of its routine inspection of a health care facility that provides a training program, shall determine the facility's compliance with these standards. D. For the purposes of this section, "nutrition and fee