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