AzAHRM LEGISLATIVE UPDATE September 10, 2010

1. AzAHRMLEGISLATIVE UPDATESeptember 10, 2010 Elizabeth Petersen 111 W. Monroe Street Suite 1000 Phoenix, AZ 85003 602-507-6100 Elizabeth Petersen 111 W. Monroe Street Suite 1000 Phoenix, AZ 85003 602-507-6100

2. Overview What was passed this session? What bills did not get passed? What will be decided on November ballot? Positive impact of past litigation.

3. What was passed this session?

4. SB 1043 – Kids Care • Restores the Children’s Health Insurance Program (CHIP) known as KidsCare and the Proposition 204 programs. Extends state employee health coverage for dependents up to their 26th birthday and makes a variety of changes to the 2010 Seventh Special Session health budget reconciliation bill.

5. KidsCare Faced with losing $9 billion in Medicare Funds, the state managed to find $7 million to fund the program. In the same bill, lawmakers also reversed cuts to AHCCCS, that threatened to pull health coverage of 310,000 low-income adults. That reversal is contingent on Arizona receiving about $400 million in federal stimulus dollars.

6. SB 1189 –Admissibility of expert opinion testimony Changes the standard used in civil and criminal trials relating to the admissibility of expert testimony from the Frye to the Daubert standard.

7. Frye v. Daubert Frye – generally accepted and leave other considerations to cross-examination. According to a 2002 RAND study, post Daubert, the percentage of expert testimony by scientists that was excluded from the courtroom significantly rose. Daubert has made it more difficult for plaintiffs to litigate successfully.

8. Frye Weaker Frye standard – Judges merely had to ensure that an expert’s proposed testimony was relevant and in some cases was of a nature that was “generally accepted” in a particular field when it applied. Not even applicable to experts who purportedly reached opinions “by inductive reasoning based on his or her own experience, observation, or research.”

9. Daubert It requires that judges take an active role in determining that an expert reached opinions in a reliable, scientific manner and that the opinions fit the facts of the case before the jury hears the expert evidence. .

10. Daubert Evidence must be reliable and scientifically valid. Trial court is gatekeeper to prevent "junk science" from entering the courtroom.

11. Daubert Daubert outlined four considerations: testing, peer review, error rates, and acceptability in the relevant scientific community.

12. HB 2425 - Vulnerable adult attorneys fees Specifies a court may order the payment of reasonable attorney fees not to exceed the amount of compensatory damages in a civil action involving a vulnerable adult. Limits the maximum amount of attorney fees from two times the amount of compensatory damages.

13. HB 2124 outpatient treatment; urgent care • Establishes procedures that allow the Arizona Department of Health Services to issue temporary licenses to outpatient treatment centers. • Except for outpatient treatment centers that provide dialysis services or abortion procedures.

14. HB 2124 outpatienttreatment; urgent care Requires DHS to issue a temporary license within seven days after receiving the application materials, but prohibits DHS from issuing the temporary license before the anticipated operation date.  The temporary license must include the following information: Name of the facility; Name of the licensee; Facility’s class or subclass; Effective date of the temporary license; and Location of the licensed premises.

15. HB 2124 outpatienttreatment; urgent care Must submit to apply for a temporary license: The initial application; All application and license fees; and A written request for a temporary license. Written request must include: Anticipated date of operation Attestation signed by the applicant that the applicant and facility will comply with and continue to comply with applicable licensing statutes and rules.

16. HB 2124 outpatienttreatment; urgent care Permits a facility to begin operating on the effective date of the temporary license. Allows the Director of DHS to stop issuing temporary licenses at any time if the Director believes the public health and safety is endangered.

17. HB 2150 Uniform Patient Reporting System • Requires hospitals that provide primarily psychiatric services to comply with the uniform patient reporting system.  Exempts the Arizona State Hospital from the uniform patient reporting system requirements. • Currently, hospitals that provide primarily psychiatric services are exempt from the system reporting requirements.

18. HB 2150 Uniform Patient Reporting System The uniform patient reporting system was instituted in Arizona in 1983.  The system requires hospitals to report inpatient and outpatient statistical data to the Arizona Department of Health Services twice a year.  Requirements for reporting are substantially the same as the uniform billing requirements prescribed by the U.S. Department of Health and Human Services for Medicare and Medicaid.  DHS is responsible for implementing and managing the system (A.R.S. § 36-125.05).  Statute specifies that reported information and data are designed to promote cost containment, and DHS uses the reported information to publish a semiannual comparative report of patient charges (A.R.S. § 36-125.06). 

19. HB 2150 Uniform Patient Reporting System For inpatient statistical data, statute requires the reported data to include the number of confinements, average length of stay, average charge per day, average charge per confinement and the average charge per confinement for each attending physician.  Each of these categories must be further categorized by discharge diagnosis, groupings of related diagnoses, groupings of diagnoses that typically have similar lengths of stay, and any other similar categories as DHS determines. For outpatient service statistical data, hospital emergency departments are required to report the date of service, surgical procedures, related diagnosis and charges for service.  DHS may also require hospitals and emergency departments to report other clinical and demographic data, such as patient age, sex or insurance coverage information.

20. HB 2545 – Board Information on Website Specifies that complaints, non-disciplinary orders, or actions and advisory letters or letters of concern issued by a health or non-health regulatory board be available to the board and the public at all times but NOT available on the board’s website.

21. HB 2545 – Board Information on Website Effective December 2012. However, the Board in June directed its staff to begin implementation. Non-disciplinary actions may not be posted to the internet, they would be available through a written public records request. Practice Limitations would remain posted to the Board’s website.

22. SB 1255 – Truth in Advertising Requires all licensed health professionals to disclose their title, type of professional license held, and field of practice on all advertisements in which they are named.

23. ARS §32-3213 – Truth in Advertising A. An advertisement for health care services that includes a health professional's name shall identify the title and type of license the health professional holds and under which the health professional is practicing. B. A health professional who violates this section commits an act of unprofessional conduct.

24. ARS §32-3213 – Truth in Advertising C. For the purposes of this section, "advertisement" includes billboards, brochures, pamphlets, radio and television scripts, electronic media, printed telephone directories, telephone and direct mail solicitations and any other means of promotion intended to directly or indirectly induce any person to enter into an agreement for services with the health professional. Advertisement does not include materials that provide information about network providers and that are created by an entity regulated under title 20.

25. HB 2187 – Osteopathic Board • Allows the President of the Board of Osteopathic Examiners in Medicine and Surgery to establish committees and committee duties.   • Exempts committee members from civil liability • Allows the Board to develop and publish standards and opinions governing the profession of osteopathy. • Amends ARS §32-1802

26. HB 2172 – Dental Board Complaints Sets forth provisions that allow the executive director, if delegated by the SBDE, to terminate a complaint filed against a licensee if the investigative staff’s review indicates the complaint is meritless.

27. HB 2172 – Dental Board Complaints Prohibits the Director from terminating a complaint if a court has entered a medical malpractice judgment against a licensee. Requires the Director to provide to the Board, at each regularly scheduled Board meeting, a list of each complaint the Director has dismissed since the preceding Board meeting. Permits a person who disagrees with the Director’s dismissal of a complaint to file a written request that the Board review the Director’s action.

28. HB 2172 – Dental Board Complaints Specifies that the person must file the request within 30 days after receiving notice of the Director’s action by personal delivery or within 35 days after the date the notification was mailed to the person’s last known residential or business address. Requires the Board, upon receiving a written request, to review the action and approve, modify or reject the Director’s action.

29. HB 2125 – DENTAL BOARD MEMBERSHIP Changes the composition of the membership of the SBDE by removing one public member and adding one business entity member. Stipulates that the business entity member may not be a licensed dentist, dental hygienist or denturist.

30. HB 2149 – PT BOARD Allows the Board of Physical Therapy to establish committees to assist in carrying out its duties. Additionally outlines the procedures for licensure, suspension and reinstatement of licenses or certificates.

31. HB 2123 –PT Records Specifies that a business entity that provides physical therapy services must establish a written protocol for patient records.

32. ARS §32-2501 – PA Practice Act Updates the Arizona Physician Assistant Practice Act by making numerous changes to existing statute regarding the Arizona Regulatory Board of Physician Assistants, supervising physician responsibilities, and the licensing and initiation of practice of physician assistants. Amends ARS §32-2501

33. HB 2021 – PA Practice Act Changes “supervising physician” notification process to Board– assumes responsibility Broadens the ability of a physician to supervise from a remote location by allowing the physician to supervise by any means of telecommunication, not just radio or telephone. Eliminates the requirement for a PA and a supervising physician to meet in person.

34. HB 2021 – PA Practice Act Requires the supervising physician to maintain a written agreement with the PA, stating that the physician will exercise supervision over the PA and retain professional and legal responsibility for the care provided by the PA. Requires the supervising physician and the PA to sign the agreement. Updated annually, kept on file at the practice site and made available to the Board on request.

35. HB 2021 – PA Practice Act May now supervise four PAs (from two). Can perform any duties and responsibilities that are delegated by the supervising physician, including ordering, prescribing, dispensing and administering drugs and medical devices. Can pronounce death.

36. HB 2021 – PA Practice Act Specifies that an approved program is any PA educational program accredited by one of the following: The Accreditation Review Commission on Education for Physician Assistants or one of its predecessor agencies; The Committee on Allied Health Education and Accreditation; or The Commission on the Accreditation of Allied Health Educational Program. Clarifies that the applicant must have specifically graduated from, rather than attended and completed training in, an approved program.

37. HB 2021 – PA Practice Act If delegated by the physician, to sign any form that would otherwise require authentication by a physician’s signature. Prohibiting performing surgical abortions. PA is the supervising physician’s agent in the performance of all practice related activities, including the ordering of diagnostic, therapeutic and other medical services.

38. HB 2469 – Certified MAsand Students Allows Certified Medication Assistants or nursing students to dispense medications under the supervision of a licensed nursing staff member in a nursing care institution. Implements pilot program

39. HB 2025 – Chiropractors Updates the language specifying what types of treatment a chiropractor may engage in and establishes requirements regarding the maintenance of patients’ records for business entities that provide chiropractic services.

40. HB 2499 - Prescriptions Allows prescriptions to be dispensed when the patient submits the written prescription by fax or email. The patient must presents the original signed prescription when picking up.

41. SB 1182 – Psychiatric Mental Health NP Authorizes the practice of certified psychiatric and mental health nurse practitioners and incorporates references to psychiatric and mental health nurse practitioners in court-ordered mental health evaluation and treatment procedures.

42. SB 1182 – Psychiatric Mental Health NP Defines psychiatric and mental health nurse practitioner as: Licensed registered nurse practitioner who has completed an adult or family psychiatric and mental health nurse practitioner program. And is certified as an adult or family psychiatric and mental health nurse practitioner by the Arizona State Board of Nursing.

43. SB 1419 – Contract Dentists Prevents dental service corporations and prepaid dental plans from entering into contracts with dentists that require non-covered services to be provided to subscribers at a set rate. Prohibits dental hygienists from performing any diagnostic procedures that are required to be performed by a dentist.

44. SB 1304 – Abortion reporting requirements Requires a hospital or facility that performs abortions and health professionals that treat women with complications due to an abortion to submit a report to DHS detailing non patient identifiable information so that DHS can prepare an annual statistical report based on the data gathered in the reports.

45. SB 1307 – Human Embryos Prohibits a person from knowingly or intentionally creating or attempting to create an in vitro human embryo by any means other than fertilization of a human egg by a human sperm.

46. SB 1306 – Human Egg Sets forth requirements for human egg donations and prohibits the purchase or sale of human eggs for purposes other than treatment of human infertility and clinical investigation.

47. SB 1181 – Autism Spectrum Disorder Task Force. Establishes the Autism Disorder Task Force.

48. SB 1161 – Death certificate deadline Requires local registrars, deputy local registrars or state registrars to register death certificates within 72 hours after receiving a medical certification of death. Instructs the medical examiner to sign the medical certification of death within 72 hours, excluding weekends and holidays.

49. HB 2116 ambulance servicesrates for AHCCCS • Codifies the AHCCCS reimbursement rate for ambulance services to be set at 80% of DHS’s approved ambulance service rates. • Establishes a voluntary process for hospitals and local entities to provide a state match for graduate medical education and disproportionate share payments.

50. Housekeeping Measures HB 2027  Continues the State Board of Psychologist Examiners for ten years.  HB 2026   Continues the Governor’s Advisory Council on Aging for ten years.