HB2691 - 552R

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

Section 1. Title 36, Arizona Revised Statutes, is amended by adding chapter 16, to read:

CHAPTER 16

HEALTH CARE WORKFORCE

ARTICLE 1. WORKFORCE DEVELOPMENT

START_STATUTE36-1801. Definitions

in this chapter, unless the context otherwise requires:

1. "Assisted living center" has the same meaning prescribed in section 36-401.

2. "assisted living facility" has the same meaning prescribed in section 36-401.

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

4. "Director" means the director of the department.

5. "health care institution" has the same meaning prescribed in section 36-401.

6. "Nursing care institution" has the same meaning prescribed in section 36-401.END_STATUTE

START_STATUTE36-1802. Arizona nurse education investment program; fund; appropriations; use of monies

A. The sum of $15,000,000 is appropriated from the state general fund in each of fiscal years 2022-2023 through 2026-2027 to the department for the Arizona nurse education investment program, which is established to increase the capacity of nursing education programs in this state by fostering collaboration among this state's education and health care communities and the state and federal governments. The program shall address this state's nursing shortage by increasing the number of all levels of nurses graduating from this state's nursing education programs by the end of fiscal year 2026-2027 from the number graduating in fiscal year 2021-2022.

B. The Arizona nurse education investment program fund is established consisting of legislative appropriations and monies provided by any federal agency, entity or program for nursing education and workforce expansion. the department shall administer the fund. Monies in the fund are continuously appropriated and exempt from the provisions of section 35-190 relating to lapsing of appropriations. Any monies remaining in the fund on July 1, 2028 revert to the state general fund.

C. The department shall allocate fund monies to the Arizona board of regents and community college districts based on the number of nursing students graduating in fiscal year 2021-2022 from eligible education programs offered or overseen by the Arizona board of regents and the community college districts. Eligible education programs include programs for nursing assistants, licensed practical nurses, registered nurses and advanced practice nurses.

D. Monies allocated from the Arizona nurse education investment program fund shall be used by the Arizona board of regents and the community college districts:

1. To pay for salaries, benefits, training and related expenses and operational costs necessary to increase the number of qualified nursing education faculty members teaching in nursing degree and certificate programs that are operated or overseen by the Arizona board of regents or the community college districts. The monies may be spent only for additional nursing education faculty members based on the number of faculty members who provided this education on June 30, 2021.

2. To supplement and not supplant monies that are appropriated by the legislature for each of fiscal years 2022-2023 through 2026-2027 based on the number of nursing education faculty members who provide this education and were funded in fiscal year 2021-2022.

3. for capital expenses that are directly related to additional faculty and students, including student support services.

e. The Arizona board of regents shall establish a process, which may include a grant program, to annually distribute fund monies to the universities under its jurisdiction for use as prescribed in this section.

f. The director shall award grants to community college districts for use as prescribed in this section based on the recommendations from a statewide organization that represents community colleges. The department shall establish an application form, process and procedure by which monies may be granted. The grants prescribed by this subsection are subject to the availability of monies and shall be distributed in a manner designed to increase the number of nurse graduates or students completing certificate programs by increasing available faculty and teaching resources in a manner that:

1. Provides for the efficient use of available monies and shared resources.

2. Distributes monies throughout geographic areas of this state and to underrepresented populations in the nursing workforce in this state.END_STATUTE

START_STATUTE36-1803. Nurse clinical rotation and licensed nurse training program; preceptor training; expansion; appropriations; grants

A. The sum of $27,000,000 is appropriated from the state general fund in each of fiscal years 2022-2023 through 2026-2027 to the department for the nurse clinical rotation and licensed nurse training program, which is established to expand the capacity of preceptor training programs at health care institutions for nursing students and licensed nurses. The appropriations are exempt from the provisions of section 35-190 relating to lapsing of appropriations. Any monies remaining unexpended on July 1, 2028 revert to the state general fund.

B. Except as provided in section 36-1804, the department shall develop a grant program to distribute these monies to health care institutions that are licensed pursuant to chapter 4 of this title to expand or create clinical training placements for undergraduate nursing students and licensed nurses to transition to practice and increase specialty nursing skills. Eligible preceptor training programs may include programs for nursing assistants, licensed practical nurses, registered nurses and advanced practice nurses, including nursing assistant programs offered by assisted living centers, assisted living facilities and nursing care institutions and approved by the arizona state board of nursing.

C. The grant monies are intended to supplement and not supplant existing preceptor training program expenses covered by the health care institution grantee. A health care institution applying for a grant for a licensed nurse training program pursuant to this section shall include matching monies from a revenue source other than the state general fund.

D. The department shall establish an application process for the grant program and may award grants for multiyear programs. Proposals must include outcome goals and measurements of the number of nurses planned to be trained and retention targets.

E. The department may use private donations, grants and federal monies to implement, support, promote or maintain the program.END_STATUTE

START_STATUTE36-1804. Licensed nurse transition to practice program; program administrator; program curricula; stipends

A. Of the monies appropriated pursuant to section 36-1803, up to $2,000,000 in each of fiscal years 2022-2023 through 2026-2027 is designated for the department to establish a licensed nurse transition to practice program to facilitate and improve the transition for nurses from education to practice. The program shall support and develop new nurses, provide evidence-based professional development and accelerate the novice nurse to a competent nurse more rapidly.

B. The department shall grant the monies to a statewide hospital association representing critical care access hospitals to administer and implement the program. The program administrator shall select curricula for the program from a national vendor with experience administering nurse training programs. The curricula must include the following elements:

1. Effective decision-making skills.

2. Clinical leadership while administering care.

3. Incorporating research-based evidence into practice.

4. Professional commitment to nursing.

5. Individual development goals.

C. The program administrator shall provide stipends to participating health care institutions to implement the licensed nurse transition to practice program using the selected curricula.

D. The monies provided under the program are intended to supplement and not supplant existing preceptor training program expenses covered by the participating health care institutions. The program established pursuant to this section shall require participating health care institutions to provide matching monies from a revenue source other than the state general fund. Participation in the program is voluntary. END_STATUTE

START_STATUTE36-1805. Annual report

The department shall develop reporting requirements for each institution of higher education and health care institution participating in the Arizona nurse education investment program, the nurse clinical rotation and licensed nurse training program, and the licensed nurse transition to practice program. on or before December 31, 2023 and each December 31 thereafter, the department shall provide a report to the governor, the president of the senate, the speaker of the house of representatives and the chairpersons of the health and human services committees of the senate and the house of representatives, or their successor committees, and shall provide a copy of the report to the secretary of state. The report shall include or address the following:

1. The number of participating entities and who participated in each program.

2. The number of nurses who completed each program.

3. The measurements developed by the department on the expansion of the statewide health care workforce and retention rates of health care institutions.

4. The expansion of university and community college programs.

5. The expansion of nurse preceptors, the number of students and licensed nurses trained by the expansion of preceptors and the turnover rate of licensed nurses within one year of hiring.

6. The number of health care institutions and the number of nurses participating in the licensed nurse transition to practice program and the turnover rate of licensed nurses within one year of hiring.

7. Any other benchmarking and outcome reports developed by the department to measure the effectiveness of the programs established pursuant to this chapter. END_STATUTE

START_STATUTE36-1806. Preceptor grant program for graduate students; appropriations; requirements; definition

A. The sum of $500,000 is appropriated from the state general fund in each of fiscal years 2022-2023 through 2026-2027 to the department for the preceptor grant program for graduate students, which is established to expand the capacity of preceptor training for graduate students pursuing degrees as physicians in allopathic or osteopathic medicine or as advanced practice registered nurses by eligible health professionals in those disciplines who are licensed pursuant to title 32. The appropriations made pursuant to this subsection are exempt from the provisions of section 35-190 relating to lapsing of appropriations. Any monies remaining unexpended on July 1, 2028 revert to the state general fund.

B. The purpose of the program is to encourage and support more preceptorships for the training and development of graduate students to become new physicians and advanced practice registered nurses in this state. Participation is voluntary.

C. The monies received by the department shall be allocated to the three largest statewide nonprofit organizations that represent allopathic physicians, osteopathic physicians or advanced practice registered nurses. The department shall allocate the monies in proportion to the number of health professionals in those specific disciplines who hold active licenses pursuant to title 32.

D. Eligible allopathic physicians, osteopathic physicians, certified nurse midwives, certified registered nurse anesthetists, clinical nurse specialists and registered nurse practitioners who are licensed pursuant to title 32 and who serve as volunteer preceptors may apply for grants from the statewide nonprofit organization that represents their discipline and that is allocated grant monies, pursuant to requirements and criteria prescribed in this section. To qualify for a grant, the licensed health professional must file a grant application and provide sufficient evidence of completion of a qualified preceptorship with a graduate student in the same professional discipline. Grant monies must be allocated by the organizations to qualified applicants based on the order in which the applications are received, with a maximum grant of $1,000 per calendar year to each qualified applicant, regardless of the number of preceptorships the applicant provides in that calendar year. Grant priority shall be given to preceptorships in primary health care and in rural areas of this state. Any grant monies remaining unused at the end of a calendar year may be rolled over to the next calendar year or reallocated by the department to one of the other statewide nonprofit organizations.

E. To qualify under this section, a preceptorship must meet all of the following:

1. provide An uncompensated mentoring experience in which the licensed health professional serving as the preceptor provides a program of personalized instruction, training and supervision to the graduate student.

2. be At least four weeks' duration.

3. Provide an educational opportunity for the graduate student to enable the student to obtain an eligible professional degree.

F. The department may use private donations, grants and federal monies to implement, support, promote or maintain the program.

G. For the purposes of this section, "graduate student" means an individual who is matriculating at the graduate level at any accredited institution of higher education in this state and who is seeking a degree in the areas of doctor of medicine, doctor of osteopathic medicine, certified nurse midwife, certified registered nurse anesthetist, clinical nurse specialist or registered nurse practitioner. END_STATUTE

START_STATUTE36-1807. Expansion of behavioral health workforce training; appropriations; demonstration project program fund; grant program; requirements

A. The sum of $5,000,000 is appropriated from the state general fund in each of fiscal years 2022-2023, 2023-2024 and 2024-2025 to the Arizona health care cost containment system for deposit in the demonstration project program fund to expand the capacity of the Maricopa county community college district and the NAVAJO county community college district to train students as behavioral health workers.

B. The demonstration project program fund is established. The Arizona health care cost containment system administration shall administer the fund. monies in the fund are continuously appropriated and are exempt from the provisions of section 35-190 relating to lapsing of appropriations. Monies in the fund shall be used to develop behavioral health curriculum in partnership with the Maricopa County community college district and the NAVAJO county community college district. Any monies remaining in the fund on July 1, 2026 revert to the state general fund.

C. The Arizona health care cost containment system may use private donations, grants and federal monies to implement, support, promote or maintain the grant program established pursuant to this section.

D. The director of the Arizona health care cost containment system shall develop a grant program in partnership with the Maricopa county community college district and the NAVAJO county community college district to distribute the monies in the fund to community colleges with qualifying programs to train students to address the shortage of the behavioral health workforce by increasing the number of students completing qualified programs by the end of fiscal year 2024-2025. Grants provided pursuant to this section shall be used:

1. To expand behavioral health curriculum and pay for salaries, benefits, training and related expenses and operational costs necessary to increase the number of qualified behavioral health education faculty members teaching in degree and certificate programs operated or overseen by the Maricopa County community college district and the NAVAJO county community college district.

2. To pay for tuition, fees and related educational expenses of eligible students enrolling in behavioral health programs. The Arizona health care cost containment system, in partnership with the community college districts, shall develop and implement requirements for payment of student expenses that include a requirement that students who complete a certification or degree program practice as a behavioral health worker in this state for a minimum of two years or the number of years that equals the length of the program completed by the student, whichever is greater.

E. The grants provided pursuant to this section are subject to the availability of monies. Fund monies shall be distributed in a manner designed to increase the number of students completing behavioral health degree or certificate programs.

F. The Arizona health care cost containment system shall develop reporting requirements for each community college using monies received from the demonstration project program fund. on or before December 31, 2023 and each December 31 thereafter, the director of the Arizona health care cost containment system shall provide a report to the governor, the president of the senate, the speaker of the house of representatives and the chairpersons of the health and human services committees of the senate and the house of representatives, or their successor committees, and shall provide a copy of the report to the secretary of state. The report shall include:

1. The number and type of behavioral health programs created at each community college district, including the number and type of programs at each individual community college in the district.

2. The number of students supported financially in each program at each individual community college.

3. The number of students completing each program by type of program and at each specific community college. END_STATUTE

Sec. 2. Delayed repeal

Title 36, chapter 16, Arizona Revised Statutes, as added by this act, is repealed from and after June 30, 2028.

Sec. 3. Legislative intent

The legislature intends that the state general fund monies appropriated in this act originate from the state's insurance premium tax collections.