SB1034 - 532R

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

Section 1. Section 32-3101, Arizona Revised Statutes, is amended to read:

START_STATUTE32-3101. Definitions

In this chapter, unless the context otherwise requires:

2. 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.

3. 2. "Grandfather clause" means a provision applicable to practitioners actively engaged in the regulated health profession before the effective date of a law that exempts the practitioners from meeting the prerequisite qualifications set forth in the law to perform prescribed occupational tasks.

1. 3. "Applicant Health professional group" means any health professional group or organization, any individual or any other interested party that proposes that any health professional group not presently regulated be regulated or that proposes to increase the scope of practice of a health profession.

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. "Increase the scope of practice" means to engage in conduct beyond the authority granted to a health profession by law.

6. "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.

7. "Legislative committees of reference" means joint subcommittees composed of the members of the appropriate standing committees of the house of representatives and senate appointed pursuant to section 41‑2954.

8. 7. "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.

9. 8. "Practitioner" means an individual who has achieved knowledge and skill by practice and who is actively engaged in a specified health profession.

10. 9. "Public member" means an individual who is not and never has been a member or 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 the rendering of the health professional service being regulated or an activity directly related to the profession being regulated.

11. 10. "Registration" means the formal notification that, before rendering services, a practitioner shall 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.

12. 11. "Regulatory entity" means any board, commission, agency or department of this state that regulates one or more health professions in this state.

13. 12. "State agency" means any department, board, commission or agency of this state. END_STATUTE

Sec. 2. Section 32-3103, Arizona Revised Statutes, is amended to read:

START_STATUTE32-3103. Regulation of health professions; legislation; criteria

A. Regulation shall not be imposed on any unregulated health profession except for the purpose of prohibiting competition, but only for the exclusive purpose of protecting the public interest. All proposed legislation to regulate a health profession for the first time shall be reviewed according to the following criteria. A health profession shall be regulated by this state only if:

1. There is credible evidence that the unregulated practice of that health profession can clearly harm or endanger the public health, safety or welfare and the potential for harm is easily recognizable and not remote or dependent on tenuous argument.

2. The public needs and can reasonably be expected to benefit from an assurance of initial and continuing professional ability.

3. The public cannot be effectively protected by other means in a more cost beneficial cost‑beneficial manner.

B. After evaluating the criteria prescribed in subsection A of this section and considering governmental and societal costs and benefits, if the legislature finds that it is necessary to regulate a health profession not previously regulated by law, the legislature shall implement the least restrictive alternative method of regulation shall be implemented to address the specific harm or danger identified, consistent with the public interest and the following:

1. If existing common law and statutory civil actions and criminal prohibitions are not sufficient to eradicate existing harm, the regulation shall provide for stricter civil actions and criminal prohibitions.

2. If a service is being performed for individuals which that involves a hazard to the public health, safety or welfare, the regulation shall impose inspection requirements and enable an appropriate state agency to enforce violations by injunctive relief in court.

3. If the threat to the public health, safety or economic well‑being is relatively small as a result of the operation of the health profession, the regulation shall implement a system of registration.

4. If the consumer may have a substantial basis for relying on the services of a practitioner, the regulation shall implement a system of certification.

5. If it is apparent that adequate regulation cannot be achieved by means other than licensing, the regulation shall implement a system of licensing. END_STATUTE

Sec. 3. Section 32-3104, Arizona Revised Statutes, is amended to read:

START_STATUTE32-3104. Health professional groups; written report; legislative informational hearings; proposed legislation

A. Applicant groups A health professional group shall submit a written report explaining the factors prescribed in section 32‑3105 or 32‑3106 to the president of the senate and the speaker of the house of representatives. The report shall be submitted on or before September November 1 before the start of the legislative session for which the legislation is proposed, and the health professional group may request informational hearings pursuant to this section. The president of the senate or the speaker of the house of representatives shall assign the written report to the appropriate legislative committee of reference health committee of the house of representatives and the health and human services committee of the senate, or their respective successor committees, and the legislative committees may conduct informational hearings on the written report before the legislative session convenes. The legislative committee of reference report may be amended after it has been filed but before any hearing on the report. The committees shall study the written report and deliver the report of its recommendations to the speaker of the house of representatives, the president of the senate, the governor and, if appropriate, the regulatory board of the health profession on or before December 1 of the year in which the report is submitted. Legislative committees of reference may hold hearings as they deem necessary. and may take public comment on the report at the informational hearings but shall not vote whether to accept or reject the report filed by the health professional group. If a health professional group proposes to increase the scope of practice of its profession, the health professional group may send copies of the written report shall be sent to the regulatory board of the health profession and the department of health services for review and comment. If applicable, the regulatory board of the health profession shall make recommendations based on the report submitted by applicant groups to the extent requested by the legislative committees of reference. A health professional group may seek to introduce legislation in the legislative session regardless of comments, if any, from the informational hearings.

B. If a health professional group's report is not heard by a legislative committee pursuant to subsection A of this section, the health professional group may seek to have legislation introduced in the legislative session for certification, registration or licensure or to increase the scope of practice of an existing regulated health profession. The lack of a hearing shall not be considered as either support or rejection of the health professional group's proposed legislation.

C. Unless there is a material change in the proposed increased scope of practice, a health professional group is not required to refile a report if the health professional group filed the report within the previous five years. On or before November 1, the health professional group shall notify in writing the speaker of the house of representatives, the president of the senate and the chairpersons of the respective health committees if the health professional group intends to pursue the proposed increased scope of practice during the next legislative session and shall reference the specific report that was previously filed on which the health professional group is relying. END_STATUTE

Sec. 4. Section 32-3105, Arizona Revised Statutes, is amended to read:

START_STATUTE32-3105. Health professional groups; proposed regulation; factors

Applicant groups for A health professional group that is seeking regulation shall explain each of the following factors to the extent requested by the legislative committees of reference:

1. A definition of the problem and Why regulation is necessary, including:

(a) The nature of the potential harm to the public if the health profession is not regulated and the extent to which there is a threat to public health and safety.

(b) The extent to which consumers need and will benefit from a method of regulation, identifying competent practitioners and indicating typical employers, if any, of practitioners in the health profession.

(i) The extent to which the health profession calls for independent judgment and the extent of skill or experience required in making the independent judgment.

(ii) The extent to which practitioners are supervised.

2. The efforts made to address the problem, including:

(a) Voluntary efforts, if any, by members of the health profession to either:

(i) Establish a code of ethics.

(ii) Help resolve disputes between health practitioners and consumers.

(b) Recourse to and the extent of use of applicable law and whether it could be amended to control the problem.

3. The alternatives considered, including:

(a) Regulation of business employers or practitioners rather than employee practitioners.

(b) Regulation of the program or service rather than the individual practitioners.

(d) Certification of all practitioners.

(e) Other alternatives.

(f) Why the use of the alternatives specified in this paragraph would not be adequate to protect the public interest.

(g) Why licensing would serve to protect the public interest.

4. The benefit to the public if regulation is granted, including:

(a) The extent to which the incidence of specific problems present in the unregulated health profession can reasonably be expected to be reduced by regulation.

(b) Whether the public can identify qualified practitioners.

(i) Whether the proposed regulatory entity would be a board composed of members of the profession and public members or a state agency, or both, and, if appropriate, their respective responsibilities in administering the system of registration, certification or licensure, including the composition of the board and the number of public members, if any, the powers and duties of the board or state agency regarding examinations and for cause revocation, suspension and nonrenewal of registrations, certificates or licenses, the adoption of rules and canons of ethics, the conduct of inspections, the receipt of complaints and disciplinary action taken against practitioners and how fees would be levied and collected to pay for the expenses of administering and operating the regulatory system.

(ii) If there is a grandfather clause, whether grandfathered practitioners will be required to meet the prerequisite qualifications established by the regulatory entity at a later date.

(iii) The nature of the standards proposed for registration, certification or licensure as compared with the standards of other jurisdictions.

(iv) Whether the regulatory entity would be authorized to enter into reciprocity agreements with other jurisdictions.

(v) The nature and duration of any training, including whether the training includes a substantial amount of supervised field experience, whether training programs exist in this state, if there will be an experience requirement, whether the experience must be acquired under a registered, certified or licensed practitioner, whether there are alternative routes of entry or methods of meeting the prerequisite qualifications, whether all applicants will be required to pass an examination, and if an examination is required, by whom it will be developed and how the costs of development will be met.

(d) Assurance of the public that practitioners have maintained their competence, including:

(i) Whether the registration, certification or licensure will carry an expiration date.

(ii) Whether renewal will be based only on payment of a fee or whether renewal will involve reexamination, peer review or other enforcement.

5. The extent to which regulation might harm the public, including:

(a) The extent to which regulation will restrict entry into the health profession, including:

(i) Whether the proposed standards are more restrictive than necessary to ensure safe and effective performance.

(ii) Whether the proposed legislation requires registered, certified or licensed practitioners in other jurisdictions who migrate relocate to this state to qualify in the same manner as state applicants for registration, certification and licensure if the other jurisdiction has substantially equivalent requirements for registration, certification or licensure as those in this state.

(b) Whether there are professions similar to that of the applicant health professional group which that should be included in, or portions of the applicant health professional group which that should be excluded from, the proposed legislation.

6. The maintenance of standards, including:

(a) Whether effective quality assurance standards exist in the health profession, such as legal requirements associated with specific programs that define or enforce standards or a code of ethics.

(b) How the proposed legislation will assure ensure quality, including:

(i) The extent to which a code of ethics, if any, will be adopted.

(ii) The grounds for suspension or revocation of registration, certification or licensure.

7. A description of the group proposed for regulation, including a list of associations, organizations and other groups representing the practitioners in this state, an estimate of the number of practitioners in each group and whether the groups represent different levels of practice.

8. The expected costs of regulation, including:

(a) The impact that registration, certification or licensure will have on the costs of the services to the public.

(b) The cost to this state and to the general public of implementing the proposed legislation. END_STATUTE

Sec. 5. Section 32-3106, Arizona Revised Statutes, is amended to read:

START_STATUTE32-3106. Health professional groups; proposed increased scope of practice; factors; legislation

A. Applicant groups for A health professional group that is seeking an increased scope of practice shall explain each of the following factors to the extent requested by the legislative committee of reference:

1. A definition of the problem and Why a change in an increased scope of practice is necessary beneficial, including the extent to which health care consumers need and will benefit from safe, quality care from practitioners with this scope of practice.

2. The extent to which the public can be confident that qualified practitioners are competent including:

(a) Evidence that the profession's regulatory board has functioned adequately in protecting the public.

(b) Whether effective quality assurance standards exist in the health profession, such as legal requirements associated with specific programs that define or endorse standards or a code of ethics.

(c) Evidence that state approved educational programs provide or are willing to provide core curriculum adequate to prepare practitioners at the proposed level.

2. Whether those health professionals seeking an increased scope of practice currently have or will be required to have didactic and clinical education from accredited professional schools or training from recognized programs that prepare them to perform the proposed scope of practice, and details on what that education or training includes for that proposed scope of practice.

3. Whether the subject matter of the proposed increased scope of practice is currently tested by nationally recognized and accepted examinations for applicants for professional licensure and the details of the examination relating to the increased scope of practice.

3. 4. The extent to which an increase in the proposed increased scope of practice may harm the public including the extent to which an increased scope of practice will restrict entry into practice and whether the proposed legislation requires registered, certified or licensed practitioners in other jurisdictions who migrate to this state to qualify in the same manner as state applicants for registration, certification and licensure if the other jurisdiction has substantially equivalent requirements for registration, certification or licensure as those in this state will impact the practice of those who are currently licensed in this state or the entry into practice of those individuals who have relocated from other states with substantially equivalent requirements for registration, certification or licensure as this state.

4. 5. The extent to which implementing the proposed increased scope of practice may result in savings or a cost to this state and to the general public of implementing the proposed increase in scope of practice.

6. The relevant health profession licensure laws, if any, in this or other states.

7. Recommendations, if any, from the applicable regulatory entity or entities, from the department of health services and from accredited educational or training programs.

B. The legislature shall review any legislation to increase the scope of practice according to the following criteria:

1. Any limit on a health profession's scope of practice must be only for the purpose of protecting the public from a specific harm or danger.

2. Whether the addition of adequately trained health professionals providing an expanded range of professional health care services will have a beneficial effect to the public and increase access to safe, quality care.

3. Whether any changes in the health profession's regulatory entity are necessary to adequately protect the public.

C. The legislature shall not consider either of the following in its review of legislation to increase the scope of practice:

1. Competition from or with other licensed professions.

2. The ability or inability to obtain health insurance coverage for the proposed increased scope of practice. END_STATUTE

Sec. 6. Section 32-4402, Arizona Revised Statutes, is amended to read:

START_STATUTE32-4402. Applicant groups; nonhealth professions and occupations; written report

Applicant groups shall submit a written report explaining the factors prescribed in section 32‑4403 to the president of the senate and the speaker of the house of representatives. The report shall be submitted on or before September 1 before the start of the legislative session for which the legislation is proposed. The president of the senate or the speaker of the house of representatives shall assign the written report to the appropriate legislative committee of reference. The legislative committee of reference shall study the written report and deliver the report of its recommendations to the speaker of the house of representatives, the president of the senate, the governor and, if appropriate, the regulatory entity on or before December 1 the third Friday in January of the year following the year in which the report is submitted. Legislative committees of reference may hold hearings as they deem necessary. END_STATUTE

Sec. 7. Section 41-2952, Arizona Revised Statutes, is amended to read:

START_STATUTE41-2952. Definitions

In this chapter, unless the context otherwise requires:

1. "Agency" means any department, office, agency, commission, board or other instrumentality of this state specified in article 2 of this chapter regardless of whether monies are appropriated to such board.

2. "Committee" means the joint legislative audit committee.

3. "Committee of reference" means a joint subcommittee which is composed of the members of the appropriate standing committees committee of the house of representatives and or senate and which that is appointed for the purpose of evaluating agencies subject to termination pursuant to this chapter.

4. "Special performance audit" means a performance audit of limited scope.

5. "Sunset review" means a systematic evaluation by the committee of reference under the supervision of the joint legislative audit committee, with the assistance of the appropriate agency, joint legislative budget committee, committees of reference, auditor general and support staff, to determine if the merits of the program justify its continuation rather than termination, or its continuation at a level less than or greater than the existing level. Such review shall be undertaken in the scope and detail the committee of reference deems appropriate and shall include, without limitation, whether there is a need for the program in state government and, if so, an assessment of the degree to which the original objectives of the program have been achieved expressed in terms of the performance, impact or accomplishments of the program and of the situation it was intended to address. Such review shall be coordinated with the performance audit procedures of the auditor general as set forth in chapter 7, article 10.1 of this title or of the committees of reference, whichever is appropriate.

6. "Terminate" or "termination" means the date provided for termination of legislative authority for the existence of a particular agency pursuant to article 2 of this chapter. END_STATUTE

Sec. 8. Section 41-2954, Arizona Revised Statutes, is amended to read:

START_STATUTE41-2954. Committees of reference; performance review reports; hearings; recommendations; subpoena powers

A. Each standing committee of both legislative houses shall appoint a subcommittee of five members. Not more than three appointees of each house shall be of the same political party. The subcommittees shall jointly constitute a committee of reference in their the committee's respective subject matter areas and the committee's respective house.

B. After receipt of the preliminary sunset review report, the each committee of reference or each committee of reference meeting jointly shall hold at least one public hearing when the legislature is not in session or before the third Friday in January to receive testimony from the public and from the officials of the agency involved. The agency involved shall prepare a presentation for the first public meeting that addresses the elements of the written statement required by subsection F of this section.

C. The Each committee of reference shall hold public hearings for the following purposes:

1. To determine the actual need of the agency to regulate or direct the particular activity.

2. To determine the extent to which the statutory requirements of the agency are necessary and are being met.

3. To receive testimony from the public as to the relationship of the agency with the public.

4. To receive testimony from the executive director or other head of the agency as to reasons for the continuation of the agency.

D. The Each committee of reference shall consider but not be limited to the following factors in determining the need for continuation or termination of each agency:

1. The objective and purpose in establishing the agency and the extent to which the objective and purpose are met by private enterprises in other states.

2. The extent to which the agency has met its statutory objective and purpose and the efficiency with which it has operated.

3. The extent to which the agency serves the entire state rather than specific interests.

4. The extent to which rules adopted by the agency are consistent with the legislative mandate.

5. The extent to which the agency has encouraged input from the public before adopting its rules and the extent to which it has informed the public as to its actions and their the expected impact on the public.

6. The extent to which the agency has been able to investigate and resolve complaints that are within its jurisdiction.

7. The extent to which the attorney general or any other applicable agency of state government has the authority to prosecute actions under the enabling legislation.

8. The extent to which agencies have addressed deficiencies in their enabling statutes that prevent them from fulfilling their statutory mandate.

9. The extent to which changes are necessary in the laws of the agency to adequately comply with the factors listed in this subsection.

10. The extent to which the termination of the agency would significantly affect the public health, safety or welfare.

11. The extent to which the level of regulation exercised by the agency compares to other states and is appropriate and whether less or more stringent levels of regulation would be appropriate.

12. The extent to which the agency has used private contractors in the performance of its duties as compared to other states and how more effective use of private contractors could be accomplished.

13. The extent to which the agency potentially creates unexpected negative consequences that might require additional review by the committee of reference, including increasing the price of goods, affecting the availability of services, limiting the abilities of individuals and businesses to operate efficiently and increasing the cost of government.

E. The committee of reference shall deliver the final sunset review report of its recommendations to the committee, the president of the senate, the speaker of the house of representatives, the governor, the auditor general and the affected agency by December 1 on or before the third Friday in January. Such recommendations shall include one of the following:

1. That the state agency be continued.

2. That the state agency be revised or consolidated.

3. That the state agency be terminated pursuant to this chapter.

F. The final sunset review report by the each committee of reference shall also include a written statement prepared by the agency involved that contains:

1. An identification of the problem or the needs that the agency is intended to address.

2. A statement, to the extent practicable, in quantitative and qualitative terms, of the objectives of such agency and its anticipated accomplishments.

3. An identification of any other agencies having similar, conflicting or duplicate objectives, and an explanation of the manner in which the agency avoids duplication or conflict with other such agencies.

4. An assessment of the consequences of eliminating the agency or of consolidating it with another agency.

G. The each committee of reference shall oversee the preparation of any proposed legislation to implement the recommendations of the committees that committee of reference and is responsible for the introduction of such legislation.

H. If an agency is continued, it is not necessary to reappoint any member of the governing board or commission of the agency. Such members are eligible to complete their original terms without reappointment or reconfirmation.

I. Each committee of reference shall have the power of legislative subpoena pursuant to chapter 7, article 4 of this title. END_STATUTE