SB1678 - 572R

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

Section 1. Section 36-420.04, Arizona Revised Statutes, is amended to read:

START_STATUTE36-420.04. Assisted living centers and homes; emergency responders; resident information; hospitals; discharge planning; patient screenings; discharge documents

A. An assisted living center or assisted living home that contacts an emergency responder on behalf of a resident shall provide to the emergency responder a written document that includes all of the following:

1. The reason or reasons the emergency responder was requested on behalf of the resident.

2. Whether the resident receives medication services and, if the resident has provided this information to the assisted living center or assisted living home, a list of all the resident's prescription and over-the-counter medications, their dosages and how frequently they are administered.

3. The name, address and telephone number of the resident's current pharmacy.

4. A list of any known allergies to any medications, additives, preservatives or materials like, such as latex or adhesive.

5. The name and contact information for the resident's primary care physician and power of attorney or authorized representative.

6. Basic information about the resident's physical and mental conditions and basic medical history, such as having diabetes or a pacemaker or experiencing frequent falls or cardiovascular and cerebrovascular events, as well as dates of recent episodes, if known.

7. The point-of-contact information for the assisted living center or assisted living home, including the telephone number and, if available, a cell phone number and email address. A point of contact must be available to respond to questions regarding the information provided twenty-four hours a day, seven days a week.

8. A copy of the resident's health insurance portability and accountability act release authorizing a receiving hospital to communicate with the assisted living center or assisted living home to plan for the resident's discharge. This paragraph does not preclude a resident from revoking the resident's health insurance portability and accountability act release authorization.

9. A copy of the resident's advance directives, if any, on file at the assisted living center or assisted living home. This paragraph does not preclude a resident from revoking or modifying the resident's advance directives.

B. Each assisted living center or assisted living home that contacts an emergency responder on behalf of a resident shall note in the resident's record that the assisted living center or assisted living home provided the document required by subsection A of this section to the emergency responder and shall obtain written or electronic acknowledgment from the emergency responder that the emergency responder received the document.

B. C. The assisted living center or assisted living home must notify the resident's authorized representative that the resident was transported to a hospital and provide the name and location of the hospital.

C. D. Each assisted living center and assisted living home must maintain a standardized form for each resident that includes the information prescribed in subsection A of this section, except for the information prescribed in subsection A, paragraph 1 of this section, which shall be provided at the time the emergency responder is contacted. Each assisted living center and assisted living home shall periodically update this form for each resident as necessary.

D. E. An assisted living center or assisted living home shall maintain a copy of the document provided to the emergency responder and documentation of the actions required by subsection B C of this section for a period of two years after the date of the emergency.

E. F. If the emergency responder transports the resident to a hospital, the emergency responder shall provide a copy of the written document required by subsection A of this section to the receiving hospital.

F. G. To protect the health and safety of patients being transferred by a hospital to an assisted living center or assisted living home, a discharging hospital shall coordinate with the health care institution from which the patient has been transferred or the health care institution to which the patient will be discharged and shall provide a written discharge plan for each inpatient. The discharge plan shall:

1. Be prepared by appropriate staff.

2. Include point-of-contact information for the discharging hospital, including a telephone number and, if available, an email address. The hospital's point of contact shall monitor the telephone and, if available, the email address provided and shall promptly respond to any inquiry. For forty-eight hours after discharge, the discharging hospital's designated point of contact must be available to respond to the receiving assisted living center or assisted living home to assist in returning or admitting the patient to the facility and to clarify any needed information in the discharge plan. Hospitals shall have a qualified hospital representative respond to discharge plan questions received from the assisted living center or assisted living home.

3. Document the patient's discharge evaluation and provide an assessment of the patient's medical or health conditions, including:

(a) Any documented pressure injuries or ulcers, the location on the body and the assessed stage level.

(b) Cognitive or physical conditions or impairments.

(d) Specified dietary requirements, if applicable.

(e) Whether the patient requires continuous medical services or continuous or intermittent nursing services or restraints.

(f) Whether the patient requires specialized medical equipment or home health services and a copy of the hospital's orders for that equipment or those services.

(g) Follow-up health care services and other services recommended for the patient.

4. Include, if applicable, a copy of any prescription that was transmitted to the patient's current pharmacy as designated in subsection A of this section or the medication summary or medication instructions. The copy of the prescription or medication summary or medication instructions shall include the patient's name, medication administration instructions and the signature of the prescriber or a record that the prescription was electronically signed by the prescriber.

5. Document that the hospital notified the receiving assisted living center or assisted living home of any new device orders for the patient.

6. Document that the discharging hospital notified the patient's authorized representative that the patient was discharged and provided the name, location and contact information of the receiving facility.

G. H. The discharging hospital shall contact the assisted living center or assisted living home from which the patient entered the hospital, after initial inpatient assessment, to discuss an evaluation of the patient's likely postdischarge health care needs. The hospital shall reevaluate and discuss with the assisted living center or assisted living home from which the patient entered the hospital the patient's condition, as appropriate, to identify changes to the patient's condition that may impact the patient's postdischarge health care needs, including recommendations, if any, by the hospital to transfer the patient to a different facility other than the facility from which the patient entered the hospital to address the patient's higher care needs. The discharging hospital shall provide an opportunity for a patient screening before discharge by the assisted living center or assisted living home from which the patient entered the hospital or to which the patient is being referred. The assisted living center or assisted living home shall determine through a screening and a review of or discussion about medical records whether the patient's postdischarge care needs, including additional ordered services, are within the facility's scope of services. After receiving notification from the discharging hospital, the assisted living center or assisted living home shall perform the screening promptly. For on-site screenings, the staff of the assisted living center or assisted living home may be required to follow standard hospital security and identification requirements. If the assisted living center or assisted living home from which the patient entered the hospital can no longer meet the patient's needs, the facility shall provide documentation to the hospital demonstrating the reasons why the facility cannot accept the patient back to the facility.

H. I. For patients being transferred from a hospital to an assisted living center or assisted living home who have not previously been admitted to the assisted living center or assisted living home, the hospital shall coordinate with the assisted living center or assisted living home to allow time to expeditiously obtain documentation from a physician, registered nurse practitioner, registered nurse or physician assistant coordinating the level of care needed in the assisted living center or assisted living home.

I. J. For emergency department or observation patients, the hospital shall provide the assisted living center or assisted living home from which the patient entered the hospital with a point of contact, including a telephone number and, if available, an email address. The hospital's point of contact shall monitor the telephone and, if available, the email address provided and promptly respond to any inquiry. For forty-eight hours after discharge, the discharging hospital's designated point of contact must be available to respond to the receiving assisted living center or assisted living home to assist in returning or admitting the patient to the assisted living center or assisted living home and to clarify any needed information in the discharge plan. Hospitals shall have a qualified hospital representative respond to discharge plan questions received from the assisted living center or assisted living home. The hospital shall also provide the patient's assisted living center or assisted living home with any new prescription orders as prescribed in subsection F G, paragraph 4 of this section, a record of medications administered and any identified follow-up care services recommended for the patient. The hospital shall provide the additional information outlined in subsection F G, paragraph 3 of this section if the hospital determines it is applicable. An assisted living center or assisted living home from which the patient entered the hospital shall readmit the patient if the assisted living center or assisted living home can meet the care needs for the patient.

J. K. Each hospital shall develop a discharge document that encompasses the information outlined in subsection F G of this section for inpatient discharges. The discharge document shall be provided to the assisted living center or assisted living home to which the patient is being discharged.END_STATUTE

Sec. 2. Title 36, chapter 4, article 1, Arizona Revised Statutes, is amended by adding section 36-420.06, to read:

START_STATUTE36-420.06. Patients and residents; advance directives; do-not-resuscitate orders; policies and procedures; definitions

A. IF THE DEPARTMENT RECEIVES A COMPLAINT FROM AN EMERGENCY MEDICAL CARE TECHNICIAN OR peace officer ALLEGING THAT a health care institution FAILED TO PROVIDE A patient's or resident's DO-NOT-RESUSCITATE ORDER or other advance directive, if on file with the health care institution, AFTER REQUESTING EMERGENCY MEDICAL SERVICES, the department shall determine whether the health care institution:

1. Is in COMPLIANCE with section 36-420.04, if applicable.

2. Has policies and procedures established, documented and implemented that cover advance directives, including do-not-resuscitate orders.

3. Complied with the policies and procedures in the situation that was the basis for the complaint.

B. This section does not require a patient or resident to have any advance directive, including a do-not-resuscitate order, on file with a health care institution unless otherwise required by law.

C. For the purposes of this section:

1. "Emergency medical care technician" has the same meaning prescribed in section 36-2201.

2. "Health care institution" means an assisted living center, an assisted living home, an assisted living facility, hospice, a nursing-supported group home, a nursing care institution or a residential care institution that is licensed pursuant to this chapter. END_STATUTE

Sec. 3. Title 36, chapter 5.1, article 1, Arizona Revised Statutes, is amended by adding section 36-576, to read:

START_STATUTE36-576. Residents; advance directives; do-not-resuscitate orders; policies and procedures; rules; definition

A. IF THE DEPARTMENT RECEIVES A COMPLAINT FROM AN EMERGENCY MEDICAL CARE TECHNICIAN OR peace officer ALLEGING THAT a group home or behavioral-supported group home failed to provide a resident's DO-NOT-RESUSCITATE ORDER or other advance directive, if on file with the group home or behavioral-supported group home, AFTER REQUESTING EMERGENCY MEDICAL SERVICES, tHE DEPARTMENT SHALL CONDUCT AN INVESTIGATION to determine whether the group home or behavioral-supported group home:

1. Has policies and procedures established, documented and implemented that cover advance directives, including do-not-resuscitate orders.

2. Complied with the policies and procedures in the situation that was the basis for the complaint.

B. This section does not require a resident to have any advance directive, including a do-not-resuscitate order, on file with a group home or behavioral-supported group home unless otherwise required by law.

C. The department shall adopt rules to ensure compliance with the requirements of this section.

D. for the purposes of this section, "emergency medical care technician" has the same MEANING prescribed in section 36-2201.END_STATUTE

Sec. 4. Vulnerable adult system study committee; membership; duties; report; delayed repeal

A. The vulnerable adult system study committee is established consisting of the following members:

1. Two members of the house of representatives who are appointed by the speaker of the house of representatives and who are members of different political parties. The speaker of the house of representatives shall designate one of these members to serve as cochairperson of the committee.

2. Two members of the senate who are appointed by the president of the senate and who are members of different political parties. The president of the senate shall designate one of these members to serve as cochairperson of the committee.

3. The director of the department of health services or the director's designee.

4. The director of the department of economic security or the director's designee.

5. The director of the Arizona health care cost containment system or the director's designee.

6. One member who represents the governor's office and who is appointed by the governor.

7. One member who represents the attorney general's office and who is appointed by the attorney general.

8. The department of economic security's long-term care ombudsman or the ombudsman's designee.

9. One member who currently serves as a public fiduciary and who is appointed by the governor.

10. Two members who are employed by a local law enforcement agency or by a statewide organization that represents law enforcement and who are appointed by the governor.

11. The executive director of the Navajo area agency on aging or the executive director's designee.

12. The executive director of the inter tribal council of Arizona or the executive director's designee.

13. Two members who represent assisted living facilities and who are appointed by the speaker of the house of representatives.

14. Two members who represent nursing care institutions and who are appointed by the governor.

15. One member who represents a statewide organization that advocates for elderly vulnerable adults and who is appointed by the president of the senate.

16. One member who represents a statewide organization that advocates on behalf of persons affected by Alzheimer's disease and who is appointed by the president of the senate.

17. One member who represents a statewide association that advocates on behalf of persons who provide services to persons with developmental disabilities and who is appointed by the speaker of the house of representatives.

18. One health care professional who is appointed by the speaker of the house of representatives and who both:

(a) Is licensed pursuant to title 32, Arizona Revised Statutes.

(b) Provides health care services to elderly vulnerable adults.

19. One member who is on the governor's advisory council on aging and who is appointed by the governor.

20. One member who represents a statewide association representing firefighters in this state and who is appointed by the president of the senate.

B. The vulnerable adult system study committee shall:

1. Develop and implement a coordinated vulnerable adult services delivery system that ensures the health and safety of vulnerable adults.

2. Recommend best practices relating to responding to and investigating complaints.

3. Research best practices related to adult protective services at the state, municipality and community levels.

4. Research and make recommendations on how the vulnerable adult system can ensure that vulnerable adults receive services they require after the vulnerable adult system completes its investigatory duties, including assigning a specific agency with the responsibility to provide or coordinate case management.

5. Research and identify common statewide outcomes.

6. Identify best practices for data collection and data sharing by various entities involved in providing vulnerable adult services.

7. Review and recommend changes to the statutes and rules that govern vulnerable adult services.

C. The cochairpersons may designate work groups to research, study and make recommendations to the study committee. At least two work groups shall be established to separately address the needs of persons with developmental disabilities and persons who are elderly or who have a physical disability, including the training requirements for persons who are caring for these populations.

D. Once the study committee establishes a strategic direction, the department of economic security, in conjunction with the work groups, shall develop an action plan for implementation.

E. Public members of the study committee are eligible to receive reimbursement of expenses pursuant to title 38, chapter 4, article 2, Arizona Revised Statutes.

F. On or before October 1, 2026 and each October 1 thereafter, the study committee shall submit a report of its findings and recommendations to the governor, the president of the senate and the speaker of the house of representatives and shall provide a copy of this report to the secretary of state.

G. This section is repealed from and after December 31, 2028.