NOTICES OF EXEMPT RULEMAKING
NOTICES OF EXEMPT RULEMAKING
The Administrative Procedure Act requires the Register publication of the rules adopted by the state’s agencies under an exemption from all or part of the Administrative Procedure Act. Some of these rules are exempted by A.R.S. §§ 41-1005 or 41-1057; other rules are exempted by other statutes; rules of the Corporation Commission are exempt from Attorney General review pursuant to a court decision as determined by the Corporation Commission.
NOTICE OF EXEMPT RULEMAKING
TITLE 9. HEALTH SERVICES
CHAPTER 10. DEPARTMENT OF HEALTH SERVICES HEALTH CARE INSTITUTIONS: LICENSING
Editor’s Note: The following Notice of Exempt Rulemaking was reviewed per Executive Order 2012-03 as issued by Governor Brewer. (See the text of the executive order on page 2468.) The Governor’s Office authorized the notice to proceed through the rulemaking process on May 18, 2012.
[R13-115]
PREAMBLE
1. Article, Part, or Section Affected (as applicable) Rulemaking Action
R9-10-101 Amend
R9-10-102 Amend
R9-10-103 Amend
R9-10-104 Amend
R9-10-105 Amend
R9-10-106 Renumber
R9-10-106 Amend
R9-10-107 Amend
R9-10-108 Amend
R9-10-109 Amend
R9-10-110 Amend
R9-10-111 Amend
R9-10-112 Renumber
R9-10-112 New Section
R9-10-113 Renumber
R9-10-113 Amend
R9-10-114 New Section
R9-10-115 Repeal
R9-10-115 New Section
R9-10-116 New Section
R9-10-117 New Section
R9-10-122 Renumber
R9-10-201 Amend
R9-10-202 Amend
R9-10-203 Amend
R9-10-204 Amend
R9-10-205 Amend
R9-10-206 Amend
R9-10-207 Amend
R9-10-208 Renumber
R9-10-208 Amend
R9-10-209 Renumber
R9-10-209 Amend
R9-10-210 Renumber
R9-10-210 Amend
R9-10-211 Renumber
R9-10-211 Amend
R9-10-212 Renumber
R9-10-212 Amend
R9-10-213 Renumber
R9-10-213 Amend
R9-10-214 Renumber
R9-10-214 Amend
R9-10-215 Renumber
R9-10-215 Amend
R9-10-216 Renumber
R9-10-216 Amend
R9-10-217 Renumber
R9-10-217 Amend
R9-10-218 Renumber
R9-10-218 Amend
R9-10-219 Renumber
R9-10-219 Amend
R9-10-220 Renumber
R9-10-220 Amend
R9-10-221 Renumber
R9-10-221 Amend
R9-10-222 Renumber
R9-10-222 Amend
R9-10-223 Renumber
R9-10-223 Amend
R9-10-224 Renumber
R9-10-224 Amend
R9-10-225 Renumber
R9-10-225 Amend
R9-10-226 Renumber
R9-10-226 New Section
R9-10-227 Renumber
R9-10-227 Amend
R9-10-228 Renumber
R9-10-228 Amend
R9-10-229 Renumber
R9-10-229 Amend
R9-10-230 Renumber
R9-10-230 Amend
R9-10-231 Renumber
R9-10-231 Amend
R9-10-232 Renumber
R9-10-232 Amend
R9-10-233 Renumber
R9-10-233 Amend
R9-10-234 Renumber
R9-10-234 Amend
Article 3 New Article
R9-10-301 New Section
R9-10-302 New Section
R9-10-303 New Section
R9-10-304 New Section
R9-10-305 New Section
R9-10-306 New Section
R9-10-307 New Section
R9-10-308 New Section
R9-10-309 New Section
R9-10-310 New Section
R9-10-311 New Section
R9-10-312 New Section
R9-10-313 New Section
R9-10-314 New Section
R9-10-315 New Section
R9-10-316 New Section
R9-10-317 New Section
R9-10-318 New Section
R9-10-319 New Section
R9-10-320 New Section
R9-10-322 New Section
R9-10-323 New Section
Article 4 New Article
R9-10-401 New Section
R9-10-402 New Section
R9-10-403 New Section
R9-10-404 New Section
R9-10-405 New Section
R9-10-406 New Section
R9-10-407 New Section
R9-10-408 New Section
R9-10-409 New Section
R9-10-410 New Section
R9-10-411 New Section
R9-10-412 New Section
R9-10-413 New Section
R9-10-414 New Section
R9-10-415 New Section
R9-10-416 New Section
R9-10-417 New Section
R9-10-418 New Section
R9-10-419 New Section
R9-10-420 New Section
R9-10-421 New Section
R9-10-422 New Section
R9-10-423 New Section
R9-10-424 New Section
R9-10-425 New Section
R9-10-426 New Section
R9-10-427 New Section
Article 5 Amend
R9-10-501 Amend
R9-10-502 Amend
R9-10-503 Repeal
R9-10-503 New Section
R9-10-504 Repeal
R9-10-504 New Section
R9-10-505 Repeal
R9-10-505 New Section
R9-10-506 Repeal
R9-10-506 New Section
R9-10-507 Repeal
R9-10-507 New Section
R9-10-508 Amend
R9-10-509 Repeal
R9-10-509 New Section
R9-10-510 Repeal
R9-10-510 New Section
R9-10-511 Amend
R9-10-512 Repeal
R9-10-512 New Section
R9-10-513 Repeal
R9-10-513 New Section
R9-10-514 Repeal
R9-10-514 New Section
R9-10-515 New Section
R9-10-516 New Section
R9-10-517 New Section
R9-10-518 New Section
Article 6 New Article
R9-10-601 New Section
R9-10-602 New Section
R9-10-603 New Section
R9-10-604 New Section
R9-10-606 New Section
R9-10-607 New Section
R9-10-608 New Section
R9-10-609 New Section
R9-10-610 New Section
R9-10-611 New Section
R9-10-612 New Section
R9-10-613 New Section
R9-10-614 New Section
R9-10-615 New Section
R9-10-616 New Section
R9-10-617 New Section
R9-10-618 New Section
Article 7 Amend
R9-10-701 Amend
R9-10-702 Repeal
R9-10-702 New Section
R9-10-703 Amend
R9-10-704 Repeal
R9-10-704 New Section
R9-10-705 Repeal
R9-10-705 New Section
R9-10-706 Amend
R9-10-707 Repeal
R9-10-707 New Section
R9-10-708 Repeal
R9-10-708 New Section
R9-10-709 Repeal
R9-10-709 New Section
R9-10-710 Repeal
R9-10-710 New Section
R9-10-711 Repeal
R9-10-711 New Section
R9-10-712 Repeal
R9-10-712 New Section
R9-10-713 Repeal
R9-10-713 New Section
R9-10-714 Repeal
R9-10-714 New Section
R9-10-715 Repeal
R9-10-715 New Section
R9-10-716 Repeal
R9-10-716 New Section
R9-10-717 Repeal
R9-10-717 New Section
R9-10-718 Repeal
R9-10-718 New Section
R9-10-719 Repeal
R9-10-719 New Section
R9-10-720 Repeal
R9-10-720 New Section
R9-10-721 Repeal
R9-10-721 New Section
R9-10-722 Repeal
R9-10-722 New Section
R9-10-723 Repeal
R9-10-724 Repeal
Article 8 Amend
R9-10-801 Amend
R9-10-802 Repeal
R9-10-802 New Section
R9-10-803 Repeal
R9-10-803 New Section
R9-10-804 Repeal
R9-10-805 Repeal
R9-10-805 New Section
R9-10-806 Repeal
R9-10-806 New Section
R9-10-807 Repeal
R9-10-807 New Section
R9-10-808 Repeal
R9-10-808 New Section
R9-10-809 Repeal
R9-10-809 New Section
R9-10-810 Repeal
R9-10-810 New Section
R9-10-811 Repeal
R9-10-811 New Section
R9-10-812 Repeal
R9-10-812 New Section
R9-10-813 Repeal
R9-10-813 New Section
R9-10-814 Repeal
R9-10-814 New Section
R9-10-815 Repeal
R9-10-815 New Section
R9-10-816 Repeal
R9-10-816 New Section
R9-10-817 Repeal
R9-10-817 New Section
R9-10-818 Repeal
R9-10-818 New Section
R9-10-819 Repeal
R9-10-819 New Section
R9-10-820 New Section
Article 9 Repeal
Article 9 New Article
R9-10-901 Amend
R9-10-902 Repeal
R9-10-902 New Section
R9-10-903 Repeal
R9-10-903 New Section
R9-10-904 Repeal
R9-10-904 New Section
R9-10-905 Repeal
R9-10-905 New Section
R9-10-906 Repeal
R9-10-906 New Section
R9-10-907 Repeal
R9-10-907 New Section
R9-10-908 Repeal
R9-10-908 New Section
R9-10-909 Repeal
R9-10-909 New Section
R9-10-910 Repeal
R9-10-910 New Section
R9-10-911 Repeal
R9-10-911 New Section
R9-10-912 Repeal
R9-10-912 New Section
R9-10-913 Repeal
R9-10-913 New Section
R9-10-914 Repeal
R9-10-914 New Section
R9-10-915 Repeal
R9-10-915 New Section
R9-10-916 Amend
R9-10-917 Repeal
R9-10-917 New Section
R9-10-918 Repeal
R9-10-918 New Section
R9-10-919 Repeal
Article 10 Amend
R9-10-1001 Amend
R9-10-1002 Amend
R9-10-1003 Amend
R9-10-1004 Repeal
R9-10-1004 New Section
R9-10-1005 Repeal
R9-10-1005 New Section
R9-10-1006 Repeal
R9-10-1006 New Section
R9-10-1007 Repeal
R9-10-1007 New Section
R9-10-1008 Amend
R9-10-1009 Amend
R9-10-1010 Amend
R9-10-1011 Repeal
R9-10-1011 New Section
R9-10-1012 Repeal
R9-10-1012 New Section
R9-10-1013 Repeal
R9-10-1013 New Section
R9-10-1014 Repeal
R9-10-1014 New Section
R9-10-1015 Repeal
R9-10-1015 New Section
R9-10-1016 Repeal
R9-10-1016 New Section
R9-10-1017 Repeal
R9-10-1017 New Section
R9-10-1018 New Section
R9-10-1019 New Section
R9-10-1020 New Section
R9-10-1021 New Section
R9-10-1022 New Section
R9-10-1023 New Section
R9-10-1024 New Section
R9-10-1025 New Section
R9-10-1026 New Section
R9-10-1027 New Section
R9-10-1028 New Section
R9-10-1029 New Section
R9-10-1030 New Section
Article 11 Amend
R9-10-1101 Amend
R9-10-1102 Amend
R9-10-1103 Repeal
R9-10-1103 New Section
R9-10-1104 Repeal
R9-10-1104 New Section
R9-10-1105 Repeal
R9-10-1105 New Section
R9-10-1106 Repeal
R9-10-1106 New Section
R9-10-1107 Repeal
R9-10-1107 New Section
R9-10-1108 Repeal
R9-10-1108 New Section
R9-10-1109 Repeal
R9-10-1109 New Section
R9-10-1110 New Section
R9-10-1111 New Section
R9-10-1112 New Section
R9-10-1113 New Section
R9-10-1114 New Section
R9-10-1115 New Section
R9-10-1116 New Section
Article 12 New Article
R9-10-1201 New Section
R9-10-1202 New Section
R9-10-1203 New Section
R9-10-1204 New Section
R9-10-1205 New Section
R9-10-1206 New Section
R9-10-1207 New Section
R9-10-1208 New Section
R9-10-1209 New Section
R9-10-1210 New Section
R9-10-1211 New Section
Article 13 New Article
R9-10-1301 New Section
R9-10-1302 New Section
R9-10-1303 New Section
R9-10-1304 New Section
R9-10-1305 New Section
R9-10-1306 New Section
R9-10-1307 New Section
R9-10-1308 New Section
R9-10-1309 New Section
R9-10-1310 New Section
R9-10-1311 New Section
R9-10-1312 New Section
R9-10-1313 New Section
R9-10-1314 New Section
R9-10-1315 New Section
R9-10-1316 New Section
R9-10-1317 New Section
Article 14 Repeal
Article 14 New Article
R9-10-1401 Amend
R9-10-1402 Repeal
R9-10-1402 New Section
R9-10-1403 Repeal
R9-10-1403 New Section
R9-10-1404 Repeal
R9-10-1404 New Section
R9-10-1405 Repeal
R9-10-1405 New Section
R9-10-1406 Repeal
R9-10-1406 New Section
R9-10-1407 Repeal
R9-10-1407 New Section
R9-10-1408 Repeal
R9-10-1408 New Section
R9-10-1409 Repeal
R9-10-1409 New Section
R9-10-1410 Repeal
R9-10-1410 New Section
R9-10-1411 Repeal
R9-10-1411 New Section
R9-10-1412 Repeal
R9-10-1412 New Section
R9-10-1413 New Section
R9-10-1414 New Section
R9-10-1415 New Section
R9-10-1416 New Section
R9-10-1417 New Section
Article 16 New Article
R9-10-1601 New Section
R9-10-1602 New Section
R9-10-1603 New Section
R9-10-1604 New Section
R9-10-1605 New Section
R9-10-1606 New Section
R9-10-1607 New Section
R9-10-1608 New Section
R9-10-1609 New Section
R9-10-1610 New Section
R9-10-1611 New Section
Article 17 Repeal
Article 17 New Article
R9-10-1701 Amend
R9-10-1702 Amend
R9-10-1703 Repeal
R9-10-1703 New Section
R9-10-1704 Repeal
R9-10-1704 New Section
R9-10-1705 Repeal
R9-10-1705 New Section
R9-10-1706 Repeal
R9-10-1706 New Section
R9-10-1707 Repeal
R9-10-1707 New Section
R9-10-1708 Repeal
R9-10-1708 New Section
R9-10-1709 Repeal
R9-10-1709 New Section
R9-10-1710 Repeal
R9-10-1710 New Section
R9-10-1711 Repeal
R9-10-1711 New Section
R9-10-1712 Repeal
R9-10-1712 New Section
R9-10-1713 Repeal
2. Citations to the agency’s statutory rulemaking authority to include the authorizing statute (general) and the imple- menting statute (specific) and the statute or session law authorizing the exemption:
Authorizing statutes: A.R.S. §§ 36-104(3); 36-132(A)(1), (A)(4), and (A)(17); and 36-136 (F)
Implementing statutes: A.R.S. §§ 36-151 through 36-160; 36-207; 36-405 through 36-407; 36-409; 36-411 through
36-414; 36-421 through 36-427; 36-429; 36-430; 36-431.01; 36-434; 36-445 through 36-445.04; 36-446 through 36-
447.01; 36-448.51 through 36-448.55; 36-502; 36-513; 36-2003; 36-2023; 36-2052; 36-3707; 41-1073 through 41-
1077; 41-1079; 41-1080; and 46-454
Statute or session law authorizing the exemption: Laws 2011, Ch. 96, § 2
3. The effective date of the rule and the agency’s reason it selected the effective date:
October 1, 2013
The effective date provides regulated persons and the Arizona Department of Health Services (Department) with a 90-day period after the date the rules are adopted to implement the rules.
4. A list of all notices published in the Register as specified in R9-1-409(A) that pertain to the record of the exempt rulemaking:
Notice of Public Information: 19 A.A.R. 548, March 22, 2013
5. The agency’s contact person who can answer questions about the rulemaking:
Name: Cara Christ, M.D., Assistant Director
Address: Arizona Department of Health Services Division of Licensing Services
150 N. 18th Ave., Suite 510
Phoenix, AZ 85007
Telephone: (602) 364-3064
Fax: (602) 364-4808
E-mail: Cara.Christ@azdhs.gov or
Name: Thomas Salow, Manager
Address: Arizona Department of Health Services Office of Administrative Counsel and Rules 1740 W. Adams St., Suite 203
Phoenix, AZ 85007
Telephone: (602) 542-1020
Fax: (602) 364-1150
E-mail: Thomas.Salow@azdhs.gov
6. An agency’s justification and reason why a rule should be made, amended, repealed, or renumbered to include an explanation about the rulemaking:
Arizona Revised Statutes (A.R.S.) §§ 36-132(A)(17) and 36-405 authorize the Department to license and regulate health care institutions. A.R.S. § 36-405 further authorizes the Department to classify and subclassify health care institutions. Arizona Administrative Code (A.A.C.) Title 9, Chapter 10 contains the Department's licensing require- ments for health care institutions providing physical health services. The rules in 9 A.A.C. 20 contain the Depart- ment's licensing requirements for behavioral health service agencies, a class of health care institution. Laws 2011, Ch. 96, § 1 requires the Department to adopt rules regarding health care institutions that reduce monetary or regulatory costs on persons or individuals and facilitate licensing of “integrated health programs that provide both behavioral and physical health services.” The Department has reviewed the rules in 9 A.A.C. 10 and 9 A.A.C. 20 and, to comply with requirements in Laws 2011, Ch. 96, is revising the rules for health care institutions rules currently licensed under 9 A.A.C. 10 to allow for the integration of behavioral health services into the scope of services provided by these health care institutions. The Department is also reclassifying health care institutions currently licensed under 9
A.A.C. 20 and establishing the rules for the new classes of health care institutions in 9 A.A.C. 10, allowing for the integration of physical health services into the scope of services provided by these health care institutions. The Department is also revising the rules to be consistent with current practice and to provide consistency within health care institution licensing rules. The Department received an exception from the Governor’s rulemaking moratorium, established by Executive Order 2012-03, for this rulemaking. The rules conform to current rulemaking format and style requirements of the Governor’s Regulatory Review Council and the Office of the Secretary of State.
7. A reference to any study relevant to the rule that the agency reviewed and either relied on or did not rely on in its evaluation of or justification for the rule, where the public may obtain or review each study, all data underlying each study, and any analysis of each study and other supporting material:
None
8. A showing of good cause why the rule is necessary to promote a statewide interest if the rulemaking will diminish a previous grant of authority of a political subdivision of this state:
Not applicable
9. The summary of the economic, small business, and consumer impact, if applicable:
Not applicable
10. A description of any changes between the proposed rulemaking, including any supplemental proposed rulemaking, and final rulemaking package, (if applicable):
Not applicable
11. An agency’s summary of the public or stakeholder comments made about the rulemaking and the agency response to the comments, if applicable:
Not applicable
12. Any other matters prescribed by statute that are applicable to the specific agency or to any specific rule or class of rules. When applicable, matters shall include, but not be limited to:
a. Whether the rule requires a permit, whether a general permit is used and if not, the reasons why a general per- mit is not used:
A.R.S. § 36-407 prohibits a person from establishing, conducting, or maintaining “a health care institution or any class or subclass of health care institution unless that person holds a current and valid license issued by the [D]epartment specifying the class or subclass of health care institution the person is establishing, conducting or maintaining.” A health care institution license is specific to the licensee, class or subclass of health care institu- tion, facility location, and scope of services provided. As such, a general permit is not applicable and is not used.
b. Whether a federal law is applicable to the subject of the rule, whether the rule is more stringent than the fed- eral law and if so, citation to the statutory authority to exceed the requirements of the federal law:
Not applicable
c. Whether a person submitted an analysis to the agency that compares the rule’s impact of the competitiveness of business in this state to the impact on business in other states:
Not applicable
13. A list of any incorporated by reference material and its location in the rules:
None
14. Whether this rule previously made, amended, repealed or renumbered as an emergency rule. If so, the agency shall state where the text changed between the emergency and the exempt rulemaking packages:
The rule was not previously made, amended, repealed, or renumbered as an emergency rule.
15. The full text of the rules follows:
TITLE 9. HEALTH SERVICES
CHAPTER 10. DEPARTMENT OF HEALTH SERVICES HEALTH CARE INSTITUTIONS: LICENSING
ARTICLE 1. GENERAL
Section
R9-10-101. Definitions
R9-10-102. Health Care Institution Classes and Subclasses; Requirements R9-10-103. Licensure Exceptions
R9-10-104. Approval of Architectural Plans and Specifications R9-10-105. Initial License Application
R9-10-106. Reserved
R9-10-122. R9-10-106. Fees
R9-10-107. Renewal License Application R9-10-108. Time-frames
R9-10-109. Changes Affecting a License R9-10-110. Enforcement Actions
R9-10-111. Denial, Revocation, or Suspension of License R9-10-112. Tuberculosis Screening
R9-10-113. Repealed
R9-10-112. R9-10-113. Clinical Practice Restrictions for Hemodialysis Technician Trainees R9-10-114. Repealed Behavioral Health Paraprofessionals; Behavioral Health Technicians
R9-10-115. Unclassified Health Care Institutions Nutrition and Feeding Assistant Training Programs R9-10-116. Repealed Counseling Facilities
R9-10-117. Repealed Collaborating Health Care Institutions R9-10-122. Renumbered
ARTICLE 2. HOSPITALS
Section
R9-10-201. Definitions
R9-10-202. Supplemental Application Requirements R9-10-203. Administration
R9-10-204. Quality Management R9-10-205. Contracted Services R9-10-206. Personnel
R9-10-207. Medical Staff
R9-10-210.R9-10-208. Admission Admissions
R9-10-211.R9-10-209. Discharge Planning; Discharge R9-10-212.R9-10-210. Transport
R9-10-213.R9-10-211. Transfer
R9-10-209.R9-10-212. Patient Rights R9-10-228.R9-10-213. Medical Records
R9-10-208.R9-10-214. Nursing Services R9-10-214.R9-10-215. Surgical Services R9-10-215.R9-10-216. Anesthesia Services R9-10-216.R9-10-217. Emergency Services
R9-10-217.R9-10-218. Pharmaceutical Services
R9-10-218.R9-10-219. Clinical Laboratory Services and Pathology Services R9-10-219.R9-10-220. Radiology Services and Diagnostic Imaging Services R9-10-220.R9-10-221. Intensive Care Services
R9-10-221.R9-10-222. Respiratory Care Services R9-10-222.R9-10-223. Perinatal Services
R9-10-223.R9-10-224. Pediatric Services R9-10-224.R9-10-225. Psychiatric Services
R9-10-226. Behavioral Health Observation/Stabilization Services R9-10-225.R9-10-227. Rehabilitation Services
R9-10-234.R9-10-228. Multi-organized Service Unit R9-10-226.R9-10-229. Social Services
R9-10-229.R9-10-230. Infection Control R9-10-227.R9-10-231. Dietary Services
R9-10-231.R9-10-232. Disaster Management R9-10-230.R9-10-233. Environmental Standards R9-10-232.R9-10-234. Physical Plant Standards
ARTICLE 3. REPEALED BEHAVIORAL HEALTH INPATIENT FACILITIES
Section
R9-10-301. Reserved Definitions
R9-10-302. Reserved Supplemental Application Requirements R9-10-303. Reserved Administration
R9-10-304. Reserved Quality Management R9-10-305. Reserved Contracted Services R9-10-306. Reserved Personnel
R9-10-307. Reserved Admissions; Assessment R9-10-308. Reserved Treatment Plan
R9-10-309. Reserved Discharge
R9-10-310. Repealed Transport; Transfer R9-10-311. Repealed Patient Rights
R9-10-312. Repealed Medical Records R9-10-313. Repealed Patient Outings
R9-10-314. Repealed Physical Health Services R9-10-315. Repealed Behavioral Health Services R9-10-316. Repealed Restraint and Seclusion
R9-10-317. Repealed Behavioral Health Observation/Stabilization Services R9-10-318. Repealed Detoxification Services
R9-10-319. Repealed Medication Services R9-10-320. Repealed Food Services
R9-10-321. Repealed Emergency and Safety Standards R9-10-322. Repealed Environmental Standards
R9-10-323. Repealed Physical Plant Standards
ARTICLE 4. REPEALED NURSING CARE INSTITUTIONS
Section
R9-10-401. Reserved Definitions
R9-10-402. Reserved Supplemental Application Requirements R9-10-403. Reserved Administration
R9-10-404. Reserved Quality Management R9-10-405. Reserved Contracted Services R9-10-406. Reserved Personnel
R9-10-407. Reserved Admissions R9-10-408. Reserved Discharge
R9-10-409. Reserved Transport; Transfer R9-10-410. Reserved Resident Rights
R9-10-411. Repealed Medical Records R9-10-412. Repealed Nursing Services R9-10-413. Repealed Medical Services R9-10-414. Repealed Behavioral Care
R9-10-415. Repealed Behavioral Health Services R9-10-416. Repealed Clinical Laboratory Services R9-10-417. Repealed Dialysis Services
R9-10-418. Repealed Radiology Services and Diagnostic Imaging Services R9-10-419. Repealed Respiratory Care Services
R9-10-420. Repealed Rehabilitation Services R9-10-421. Repealed Medication Services R9-10-422. Repealed Infection Control
R9-10-423. Repealed Food Services
R9-10-424. Repealed Emergency and Safety Standards R9-10-425. Repealed Environmental Standards
R9-10-426. Repealed Physical Plant Standards R9-10-427. Repealed Quality Rating
ARTICLE 5. ADULT DAY HEALTH RECOVERY CARE FACILITIES CENTERS
Section
R9-10-501. Definitions
R9-10-502. Administration
R9-10-503. Personnel Quality Management R9-10-504. Staffing Contracted Services R9-10-505. Participant Rights Personnel
R9-10-506. Participants' Council Medical Staff R9-10-507. Enrollment Admissions
R9-10-508. Discharge
R9-10-509. Adult Day Health Services Transfer R9-10-510. Care Plan Patient Rights
R9-10-511. Participant Medical Records
R9-10-512. Physical Plant Requirements Nursing Services R9-10-513. Environmental Standards Medication Services R9-10-514. Safety Standards Ancillary Services
R9-10-515. Repealed Food Services
R9-10-516. Repealed Emergency and Safety Standards R9-10-517. Repealed Environmental Standards
R9-10-518. Repealed Physical Plant Standards
ARTICLE 6. REPEALED HOSPICES
Section
R9-10-601. Definitions
R9-10-602. Supplemental Application Requirements R9-10-603. Administration
R9-10-604. Quality Management R9-10-605. Contracted Services R9-10-606. Personnel
R9-10-607. Admissions R9-10-608. Transfer
R9-10-609. Patient Rights R9-10-610. Medical Records
R9-10-611. Repealed Care Plan
R9-10-612. Repealed Hospice Services R9-10-613. Repealed Medication Services R9-10-614. Repealed Infection Control
R9-10-615. Repealed Food Services for a Hospice Inpatient Facility
R9-10-616. Repealed Emergency and Safety Standards for a Hospice Inpatient Facility
R9-10-617. Repealed Environmental Standards for a Hospice Inpatient Facility R9-10-618. Repealed Physical Plant Standards for a Hospice Inpatient Facility
ARTICLE 7. ASSISTED LIVING BEHAVIORAL HEALTH RESIDENTIAL FACILITIES
Section
R9-10-701. Definitions
R9-10-702. Licensing Classifications Supplemental Application Requirements R9-10-703. Administration
R9-10-704. Abuse, Neglect, and Exploitation Prevention and Reporting Quality Management R9-10-705. Limitations on Level of Contracted Services
R9-10-706. Personnel Qualifications and Records
R9-10-707. Employee Orientation and Ongoing Training Admission; Assessment R9-10-708. Personnel Requirements Treatment Plan
R9-10-709. Residency Agreements Discharge R9-10-710. Resident Rights Transport; Transfer
R9-10-711. Requirements for Service Plans and Health-Related Services Resident Rights R9-10-712. Activity Programs Medical Records
R9-10-713. Medications Resident Outings R9-10-714. Resident Records Time Out R9-10-715. Food Physical Health Services
R9-10-716. Physical Plant Requirements Behavioral Health Services
R9-10-717. Fire and Safety Requirements Outdoor Behavioral Health Care Programs R9-10-718. Environmental Medication Services
R9-10-719. Supplemental Requirements for an Assisted Living Home Food Services
R9-10-720. Supplemental Requirements for an Assisted Living Center Emergency and Safety Standards
R9-10-721. Supplemental Requirements for an Assisted Living Facility Licensed to Provide Supervisory Care Services Environmental Standards
R9-10-722. Supplemental Requirements for an Assisted Living Facility Licensed to Provide Personal Care Services Phys- ical Plant Standards
R9-10-723. Supplemental Requirements for an Assisted Living Facility Licensed to Provide Directed Care Services Repealed
R9-10-724. Supplemental Requirements for Training Programs Repealed
ARTICLE 8. HOSPICES; HOSPICE INPATIENT ASSISTED LIVING FACILITIES
Section
R9-10-801. Definitions
R9-10-802. Hospice General Supplemental Application Requirements
R9-10-803. Application for an Initial Hospice License; Application for Renewal of a Hospice License Administration R9-10-804. Hospice Administration Quality Management
R9-10-805. Hospice Staff Contracted Services R9-10-806. Patient Admissions Personnel
R9-10-807. Patient Plan of Care Residency and Residency Agreements R9-10-808. Hospice Services Service Plans
R9-10-809. Hospice Pharmaceutical Services Transport; Transfer
R9-10-810. Hospice Dietary Counseling and Nutrition Services Required For a Patient Receiving Inpatient Services Resi- dent Rights
R9-10-811. Hospice Infection Control, Environmental Safety, and Sanitation Medical Records R9-10-812. Hospice Recordkeeping; Patient Clinical Record Behavioral Care
R9-10-813. Hospice Quality Assurance Behavioral Health Services
R9-10-814. Hospice Inpatient Facility General Requirements Personal Care Services
R9-10-815. Application for an Initial Hospice Inpatient Facility License; Application for Renewal of a Hospice Inpatient Facility License Directed Care Services
R9-10-816. Hospice Inpatient Facility Physical Plant Standards Medication Services R9-10-817. Hospice Inpatient Facility Food Service Food Services
R9-10-818. Hospice Inpatient Facility Environmental Emergency and Safety and Sanitation Standards R9-10-819. Hospice Inpatient Facility Disaster Preparedness Environmental Standards
R9-10-820. Physical Plant Standards
ARTICLE 9. NURSING CARE INSTITUTIONS OUTPATIENT SURGICAL CENTERS
Section
R9-10-901. Definitions
R9-10-902. Application Requirements Administration R9-10-903. Contracted Services Quality Management R9-10-904. Administration Contracted Services
R9-10-905. Staff and Volunteers Personnel R9-10-906. Nursing Services Medical Staff R9-10-907. Resident Rights Admission
R9-10-908. Admission Transfer
R9-10-909. Transfer or Discharge Patient Rights R9-10-910. Medical Services Records
R9-10-911. Medication Surgical Services R9-10-912. Food Nursing Services
R9-10-913. Medical Records Behavioral Health Services R9-10-914. Physical Plant Standards Medication Services
R9-10-915. Environmental and Equipment Standards Infection Control R9-10-916. Emergency and Safety Standards
R9-10-917. Infection Control Environmental Standards R9-10-918. Quality Management Physical Plant Standards R9-10-919. Quality Rating Repealed
ARTICLE 10. OUTPATIENT TREATMENT CENTERS PROVIDING DIALYSIS SERVICES, MEDICAL SER- VICES, AND NURSING SERVICES
Section
R9-10-1001. Definitions
R9-10-1002. Supplemental Application Requirements; Change of Information R9-10-1003. Administration
R9-10-1004. Contracted Services Quality Management
R9-10-1005. Quality Management Program Contracted Services R9-10-1006. Clinical Staff Members Personnel
R9-10-1007. Non-Clinical Staff Members Transport; Transfer R9-10-1008. Patient Rights
R9-10-1009. Medical Records
R9-10-1010. Medication Services
R9-10-1011. Discharge Behavioral Health Services
R9-10-1012. Dialysis Behavioral Health Observation/Stabilization Services R9-10-1013. Ancillary Services Court-ordered Evaluation
R9-10-1014. Infection Control Court-ordered Treatment
R9-10-1015. Environmental Clinical Laboratory Services and Equipment Standards R9-10-1016. Medical Emergency, Safety, and Disaster Standards Crisis Services R9-10-1017. Physical Plant Standards Diagnostic Imaging Services
R9-10-1018. Repealed Dialysis Services
R9-10-1019. Repealed Emergency Room Services R9-10-1020. Repealed Opioid Treatment Services R9-10-1021. Repealed Pain Management Services R9-10-1022. Repealed Physical Health Services R9-10-1023. Repealed Pre-petition Screening
R9-10-1024. Repealed Rehabilitation Services R9-10-1025. Repealed Respite Services
R9-10-1026. Repealed Sleep Disorder Services
R9-10-1027. Repealed Urgent Care Services Provided in a Freestanding Urgent Care Setting R9-10-1028. Repealed Infection Control
R9-10-1029. Repealed Emergency and Safety Standards
R9-10-1030. Repealed Physical Plant, Environmental Services, and Equipment Standards
ARTICLE 11. HOME ADULT DAY HEALTH AGENCIES CARE FACILITIES
Section
R9-10-1101. Definitions
R9-10-1102. Administration
R9-10-1103. Personnel Quality Management R9-10-1104. Home Health Contracted Services R9-10-1105. Supportive Services Personnel
R9-10-1106. Plan of Care Enrollment R9-10-1107. Patient Rights Care Plan R9-10-1108. Medical Records Discharge
R9-10-1109. Quality Management Participant Rights R9-10-1110. Reserved Medical Records
R9-10-1111. Repealed Participant’s Council
R9-10-1112. Repealed Adult Day Health Services R9-10-1113. Repealed Food Services
R9-10-1114. Repealed Emergency and Safety Standards R9-10-1115. Repealed Environmental Standards
R9-10-1116. Repealed Physical Plant Standards
ARTICLE 12. REPEALED HOME HEALTH AGENCIES
Section
R9-10-1201. Reserved Definitions
R9-10-1202. Reserved Supplemental Application Requirements R9-10-1203. Reserved Administration
R9-10-1204. Reserved Quality Management R9-10-1205. Reserved Contracted Services R9-10-1206. Reserved Personnel
R9-10-1207. Reserved Care Plan
R9-10-1208. Reserved Patient Rights R9-10-1209. Reserved Medical Records
R9-10-1210. Reserved Home Health Services R9-10-1211. Repealed Supportive Services
ARTICLE 13. REPEALED BEHAVIORAL HEALTH SPECIALIZED TRANSITIONAL FACILITY
R9-10-1301. Repealed Definitions
R9-10-1302. Repealed Administration
R9-10-1303. Repealed Quality Management R9-10-1304. Repealed Contracted Services
R9-10-1305. Repealed Personnel Requirements and Records R9-10-1306. Repealed Admission Requirements
R9-10-1307. Repealed Discharge or Conditional Release to a Less Restrictive Alternative R9-10-1308. Repealed Transport
R9-10-1309. Repealed Patient Rights
R9-10-1310. Repealed Behavioral Health Services R9-10-1311. Repealed Ancillary Services
R9-10-1312. Repealed Patient Records
R9-10-1313. Repealed Medication Services R9-10-1314. Repealed Food Services
R9-10-1315. Emergency and Safety Standards R9-10-1316. Environmental Standards
R9-10-1317. Physical Plant Standards
ARTICLE 14. RECOVERY CARE CENTERS SUBSTANCE ABUSE TRANSITIONAL FACILITIES
Section
R9-10-1401. Definitions
R9-10-1402. Administration Supplemental Application Requirements R9-10-1403. Patient Rights Administration
R9-10-1404. Personnel Quality Management R9-10-1405. Nursing Contracted Services R9-10-1406. Admissions Personnel
R9-10-1407. Ancillary Services Admission; Assessment R9-10-1408. Quality Management Discharge
R9-10-1409. Medical Records Transfer
R9-10-1410. Environmental Standards Participant Rights R9-10-1411. Emergency Standards Medical Records
R9-10-1412. Physical Plant Requirements Behavioral Health Services R9-10-1413. Medication Services
R9-10-1414. Food Services
R9-10-1415. Emergency and Safety Standards R9-10-1416. Environmental Standards
R9-10-1417. Physical Plant Standards
ARTICLE 16. RESERVED BEHAVIORAL HEALTH SUPPORTIVE HOMES
Section
R9-10-1601. Definitions
R9-10-1602. Administration R9-10-1603. Resident Rights
R9-10-1604. Providing Services
R9-10-1605. Assistance in the Self-Administration of Medication R9-10-1606. Resident Records
R9-10-1607. Food Services
R9-10-1608. Emergency and Safety Standards R9-10-1609. Environmental Standards
R9-10-1610. Adult Behavioral Health Therapeutic Homes R9-10-1611. Children’s Behavioral Health Respite Homes
ARTICLE 17. OUTPATIENT SURGICAL CENTERS UNCLASSIFIED HEALTH CARE INSTITUTIONS
Section
R9-10-1701. Definitions
R9-10-1702. Administration
R9-10-1703. Patient Rights Quality Management R9-10-1704. Personnel Contracted Services
R9-10-1705. Medical Staff Personnel
R9-10-1706. Nursing Services Transport; Transfer R9-10-1707. Admission Patient Rights
R9-10-1708. Quality Management Medical Records
R9-10-1709. Surgical Medication Services Requirements R9-10-1710. Medical Records Food Services
R9-10-1711. Environmental Emergency and Safety Standards
R9-10-1712. Emergency Physical Plant, Environmental Services, and Equipment Standards R9-10-1713. Physical Plant Standards Repealed
ARTICLE 1. GENERAL
R9-10-101. Definitions
In addition to the definitions in A.R.S. § 36-401(A), the following definitions apply in this Chapter unless otherwise specified:
1. “Accredited” means accredited by a nationally recognized accreditation organization.
2. “Administrative completeness review time-frame” means the number of days from agency receipt of an application for a license until the agency determines that the application contains all components required by statute or rule, including all information required to be submitted by other government agencies. The administrative completeness review time-frame does not include the period of time during which an agency provides public notice of the license application or performs a substantive review of the application.
3. “Adjacent” means not intersected by:
a. Property owned or operated by a person other than the applicant or licensee, or
b. A public thoroughfare.
4. “Administrative office” means a location used by personnel for recordkeeping and record retention but not for pro- viding medical services, nursing services, or health-related services.
5. “Adult day health care facility” means a facility providing adult day health services during a portion of a continuous twenty-four hour period for compensation on a regular basis for five or more adults not related to the proprietor.
6. “Applicant” means a governing authority requesting:
a. Approval of architectural plans and specifications of a health care institution,
b. Licensure of a health care institution, or
c. A change in a health care institution's license.
7. “Application packet” means the information, documents, and fees required by the Department for the:
a. Approval of a health care institution's modification or construction, or
b. Licensure of a health care institution.
8. “Assisted living center” means an assisted living facility that provides resident rooms or residential units to eleven or more residents.
9. “Assisted living facility” means a residential care institution, including adult foster care, that provides or contracts to provide supervisory care services, personal care services or directed care services on a continuing basis.
10. “Behavioral health service agency” has the same meaning as “agency” in A.A.C. R9-20-101.
11. “Certification” means a written statement that an item or a system complies with the applicable requirements incorpo- rated by reference in R9-1-412.
12. “Certified health physicist” means an individual recognized by the American Board of Health Physics as complying with the health physics criteria and examination requirements established by the American Board of Health Physics.
13. “Change in ownership” means conveyance of the ability to appoint, elect, or otherwise designate a health care institu- tion's governing authority from an owner of the health care institution to another person.
14. “Chief administrative officer” means an individual designated by a governing authority to implement the governing authority's direction in a health care institution.
15. “Contractor” has the same meaning as in A.R.S. § 32-1101.
16. “Construction” means the building, erection, fabrication, or installation of a health care institution.
17. “Day” means calendar day.
18. “Department” means the Arizona Department of Health Services.
19. “Directed care services” means programs and services, including personal care services, provided to persons who are incapable of recognizing danger, summoning assistance, expressing need or making basic care decisions.
20. “Equipment” means an apparatus, a device, a machine, or a unit that is required to comply with the specifications incorporated by reference in R9-1-412.
21. “Facilities” means buildings used by a health care institution for providing any of the types of services as defined in A.R.S. Title 36, Chapter 4.
22. “Factory-built building” has the same meaning as in A.R.S. § 41-2142.
23. “Governing authority” means the individual, agency, group or corporation, appointed, elected or otherwise desig- nated, in which the ultimate responsibility and authority for the conduct of the health care institution are vested.
24. “Health care institution” means every place, institution, building or agency, whether organized for profit or not, which provides facilities with medical services, nursing services, health screening services, other health-related ser- vices, supervisory care services, personal care services or directed care services and includes home health agencies as defined in A.R.S. § 36-151 and hospice service agencies.
25. “Health-related services” means services, other than medical, pertaining to general supervision, protective, preven- tive and personal care services, supervisory care services or directed care services.
26. “Home health agency” means an agency or organization, or a subdivision of such an agency or organization, which meets all of the following requirements:
a. Is primarily engaged in providing skilled nursing services and other therapeutic services.
b. Has policies, established by a group of professional personnel, associated with the agency or organization, including one or more physicians and one or more registered professional nurses, to govern the services referred to in subdivision (a), which it provides, and provides for supervision of such services by a physician or registered professional nurse.
c. Maintains clinical records on all patients.
27. “Hospice” means a hospice service agency or the provision of hospice services in an inpatient facility.
28. “Hospital” has the same meaning as in 9 A.A.C. 10, Article 2.
29. “Inpatient beds” or “resident beds” means accommodations with supporting services, such as food, laundry and housekeeping, for patients or residents who generally stay in excess of twenty-four hours.
30. “Leased facility” means a facility occupied or used during a set time in exchange for compensation.
31. “License” means:
a. Written approval issued by the Department to a person to operate a class or subclass of a health care institution, except for a behavioral health service agency, at a specific location;
b. Written approval issued by the Department to a person to operate one or more behavioral health service agency subclasses at a specific location; or
c. Written approval issued to an individual to practice a profession in this state.
32. “Licensee” means an owner approved by the Department to operate a health care institution.
33. “Medical services” means the services pertaining to medical care that are performed at the direction of a physician on behalf of patients by physicians, dentists, nurses and other professional and technical personnel.
34. “Mobile clinic” means a movable structure that:
a. Is not physically attached to a health care institution's facility,
b. Provides outpatient medical services under the direction of the health care institution's personnel, and
c. Is not intended to remain in one location indefinitely.
35. “Modification” means the substantial improvement, enlargement, reduction, alteration of or other change in a health care institution.
36. “Nursing care institution” means a health care institution providing inpatient beds or resident beds and nursing ser- vices to persons who need nursing services on a continuing basis but who do not require hospital care or direct daily care from a physician.
37. “Nursing services” means those services pertaining to the curative, restorative and preventive aspects of nursing care that are performed at the direction of a physician by or under the supervision of a registered nurse licensed in this state.
38. “Outpatient surgical center” means a type of health care institution with facilities and limited hospital services for the diagnosis or treatment of patients by surgery whose recovery, in the concurring opinions of the surgeon and the anes- thesiologist, does not require inpatient care in a hospital.
39. “Outpatient treatment center” means a health care institution class without inpatient beds that provides medical ser- vices for the diagnosis and treatment of patients.
40. “Overall time-frame” means the number of days after receipt of an application for a license during which an agency determines whether to grant or deny a license. The overall time-frame consists of both the administrative complete- ness review time-frame and the substantive review time-frame.
41. “Owner” means a person who appoints, elects, or designates a health care institution's governing authority.
42. “Patient” means an individual receiving medical services, nursing services, or health-related services from a health care institution.
43. “Person” has the same meaning as in A.R.S. § 1-215 and includes a governmental agency.
44. “Personal care services” means assistance with activities of daily living that can be performed by persons without professional skills or professional training and includes the coordination or provision of intermittent nursing services and the administration of medications and treatments by a nurse who is licensed pursuant to Title 32, Chapter 15 or as otherwise provided by law.
45. “Personnel” means, except as defined in specific Articles in this Chapter or 9 A.A.C. 20, an individual providing medical services, nursing services, or health-related services to a patient.
46. “Premises” means property that is licensed by the Department as part of the health care institution where medical ser- vices, nursing services, or health-related services are provided to a patient.
47. “Project” means specific construction or modification of a facility stated on an architectural plans and specifications approval application.
48. “Provisional license” means the Department's written approval to operate a health care institution issued to an appli- cant or licensee that is not in substantial compliance with the applicable laws and rules for the health care institution.
49. “Recovery care center” means a health care institution or subdivision of a health care institution that provides medical and nursing services limited to recovery care services.
50. “Residential care institution” means a health care institution other than a hospital or a nursing care institution which provides resident beds or residential units, supervisory care services, personal care service, directed care services or health-related services for persons who do not need inpatient nursing care.
51. “Room” means space contained by walls from and including the floor to ceiling with at least one door.
52. “Satellite facility” means an outpatient facility at which the hospital provides outpatient medical services.
53. “Substantial” when used in connection with a modification means:
a. An addition or deletion of an inpatient bed or a change in the use of one or more of the inpatient beds;
b. A change in a health care institution's licensed capacity;
c. A change in the physical plant, including facilities or equipment, that costs more than $300,000; or
d. A change in a health care institution that affects compliance with applicable physical plant codes and standards incorporated by reference in R9-1-412.
54. “Substantial compliance” means that the nature or number of violations revealed by any type of inspection or investi- gation of a licensed health care institution does not pose a direct risk to the life, health or safety of patients or resi- dents.
55. “Substantive review time-frame” means the number of days after the completion of the administrative completeness review time-frame during which an agency determines whether an application or applicant for a license meets all sub- stantive criteria required by statute or rule. Any public notice and hearings required by law shall fall within the sub- stantive review time-frame.
56. “Swimming pool” has the same meaning as “semipublic swimming pool” in A.A.C. R18-5-201.
57. “System” means interrelated, interacting, or interdependent elements forming a whole.
58. “Tax ID number” means a numeric identifier that a person uses to report financial information to the United States Internal Revenue Services.
59. “Treatment” means a procedure or method to cure, improve, or palliate an injury, an illness, or a disease.
60. “Unclassified health care institution” means a health care institution not classified or subclassified in statute or in rule that provides medical services, nursing services, or health-related services.
1. “Abuse” means:
a. The same:
i. For an adult, as in A.R.S. § 46-451; and
ii. For a child, as in A.R.S. § 8-201;
b. A pattern of ridiculing or demeaning a patient;
c. Making derogatory remarks or verbally harassing a patient; or
d. Threatening to inflict physical harm on a patient.
2. “Accredited” has the same meaning as in A.R.S. § 36-422.
3. “Activities of daily living” means ambulating, bathing, toileting, grooming, eating, and getting in or out of a bed or a chair.
4. “Adjacent” means not intersected by:
a. Property owned, operated, or controlled by a person other than the applicant or licensee; or
b. A public thoroughfare.
5. “Administrative completeness review time-frame” has the same meaning as in A.R.S. § 41-1072.
6. “Administrative office” means a location used by personnel for recordkeeping and record retention but not for pro- viding medical services, nursing services, or health-related services.
7. “Admission” means, after completion of an individual’s screening or registration by a health care institution, the indi- vidual begins receiving physical health services or behavioral health services and is accepted as a patient of the health care institution.
8. “Adult” has the same meaning as in A.R.S. § 1-215.
9. “Adult behavioral health therapeutic home” means a behavioral health supportive home that provides room and board, assists an individual 18 years of age or older in acquiring daily living skills, coordinates transportation to scheduled appointments, monitors behaviors, assists in the self-administration of medication, and provides feedback to a case manager related to behavior for the individual based on the individual’s behavioral health issue and need for behavioral health services.
10. “Adverse reaction” means an unexpected outcome that threatens the health or safety of a patient as a result of a med- ical service, nursing service, or health-related service provided to the patient.
11. “Ancillary services” means services other than medical services, nursing services, or health-related services provided to a patient.
12. “Anesthesiologist” means a physician granted clinical privileges to administer anesthesia.
13. “Applicant” means a governing authority requesting:
a. Approval of a health care institution’s architectural plans and specifications, or
b. A health care institution license.
14. “Application packet” means the information, documents, and fees required by the Department for the:
a. Approval of a health care institution's modification or construction, or
b. Licensure of a health care institution.
15. “Assessment” means an analysis of a patient’s need for physical health services or behavioral health services to deter- mine which services a health care institution will provide to the patient.
16. “Assistance in the self-administration of medication” means restricting a patient’s access to the patient’s medication and providing support to the patient while the patient takes the medication to ensure that the medication is taken as ordered.
17. “Attending physician” means a physician designated by a patient to participate in or coordinate the medical services provided to the patient.
18. “Authenticate” means to establish authorship of a document or an entry in a medical record by:
a. A written signature;
b. An individual's initials, if the individual's written signature appears on the document or in the medical record;
c. A rubber-stamp signature; or
d. An electronic signature code.
19. “Available” means:
a. For an individual, the ability to be contacted and to provide an immediate response by any means possible;
b. For equipment and supplies, physically retrievable at a health care institution; and
c. For a document, retrievable a health care institution or accessible according to the applicable time-frames in this Chapter.
20. “Behavioral health facility” means a behavioral health inpatient facility, a behavioral health residential facility, a sub- stance abuse transitional facility, a behavioral health specialized transitional facility, an outpatient treatment center that provides only behavioral health services, or a behavioral health supportive home.
21. “Behavioral health inpatient facility” means a health care institution that provides continuous treatment to an individ- ual experiencing a behavioral health issue that causes the individual to:
a. Have a limited or reduced ability to meet the individual's basic physical needs;
b. Suffer harm that significantly impairs the individual’s judgment, reason, behavior, or capacity to recognize real- ity;
c. Be a danger to self;
d. Be a danger to others;
e. Be persistently or acutely disabled as defined in A.R.S. § 36-501; or
f. Be gravely disabled.
22. “Behavioral health issue” means an individual's condition related to a mental disorder, a personality disorder, sub- stance abuse, or a significant psychological or behavioral response to an identifiable stressor or stressors.
23. “Behavioral health observation/stabilization services” means crisis services provided, in an outpatient setting, to an individual whose behavior or condition indicates that the individual:
a. Requires nursing services,
b. May require medical services, and
c. May be a danger to others or a danger to self.
24. “Behavioral health paraprofessional” means an individual who is not a behavioral health professional who provides behavioral health services at or for a health care institution according to the health care institution’s policies and pro- cedures that:
a. If the behavioral health services were provided in a setting other than a licensed health care institution, the indi- vidual would be required to be licensed as a behavioral professional under A.R.S. Title 32, Chapter 33; and
b. Are provided under supervision by a behavioral health professional.
25. “Behavioral health professional” means an individual licensed under A.R.S. Title 32 whose scope of practice allows the individual to:
a. Independently engage in the practice of behavioral health as defined in A.R.S. § 32-3251; or
b. Except for a licensed substance abuse technician, engage in the practice of behavioral health as defined in A.R.S.
§ 32-3251 under direct supervision as defined in A.A.C. R4-6-101.
26. “Behavioral health residential facility” means a health care institution that provides treatment to an individual experi- encing a behavioral health issue that:
a. Limits the individual’s ability to be independent, or
b. Causes the individual to require treatment to maintain or enhance independence.
27. “Behavioral health services” means medical services, nursing services, health-related services, or ancillary services provided to an individual to address the individual's behavioral health issue.
28. “Behavioral health specialized transitional facility” means a health care institution that provides behavioral health services and physical health services to an individual determined to be a sexually violent person according to A.R.S. Title 36, Chapter 37.
29. “Behavioral health supportive home” means an adult behavioral health therapeutic home or a children’s behavioral health respite home.
30. “Behavioral health technician” means an individual who is not a behavioral health professional who provides behav- ioral health services at or for a health care institution according to the health care institution’s policies and procedures that:
a. If the behavioral health services were provided in a setting other than a licensed health care institution, the indi- vidual would be required to be licensed as a behavioral professional under A.R.S. Title 32, Chapter 33; and
b. Are provided with clinical oversight by a behavioral health professional.
31. “Biohazardous medical waste” has the same meaning as in A.A.C. R18-13-1401.
32. “Calendar day” means each day, not including the day of the act, event, or default from which a designated period of time begins to run, but including the last day of the period unless it is a Saturday, Sunday, statewide furlough day, or legal holiday, in which case the period runs until the end of the next day that is not a Saturday, Sunday, statewide fur- lough day, or legal holiday.
33. “Case manager” means an individual assigned by an entity other than a health care institution to coordinate the phys- ical health services or behavioral health services provided to a patient at the health care institution.
34. “Certification” means, in this Article, a written statement that an item or a system complies with the applicable requirements incorporated by reference in A.A.C. R9-1-412.
35. “Certified health physicist” means an individual recognized by the American Board of Health Physics as complying with the health physics criteria and examination requirements established by the American Board of Health Physics.
36. “Change in ownership” means conveyance of the ability to appoint, elect, or otherwise designate a health care institu- tion's governing authority from an owner of the health care institution to another person.
37. “Chief administrative officer” or “administrator” means an individual designated by a governing authority to imple- ment the governing authority's direction in a health care institution.
38. “Children’s behavioral health respite home” means a behavioral health supportive home where respite services are provided to an individual under 18 years of age based on the individual’s behavioral health issue and need for behav- ioral health services and includes assistance in the self-administration of medication.
39. “Clinical laboratory services” means the biological, microbiological, serological, chemical, immunohematological, hematological, biophysical, cytological, pathological, or other examination of materials derived from the human body for the purpose of providing information for the diagnosis, prevention, or treatment of a disease or impairment of a human being, or for the assessment of the health of a human being, including procedures to determine, measure, or otherwise describe the presence or absence of various substances or organisms in the body.
40. “Clinical oversight” means:
a. Monitoring the behavioral health services provided by a behavioral health technician to ensure that the behav- ioral health technician is providing the behavioral health services according to the health care institution's poli- cies and procedures,
b. Providing on-going review of a behavioral health technician's skills and knowledge related to the provision of behavioral health services,
c. Providing guidance to improve a behavioral health technician's skills and knowledge related to the provision of behavioral health services, and
d. Recommending training for a behavior health technician to improve the behavioral health technician's skills and knowledge related to the provision of behavioral health services.
41. “Clinical privileges” means authorization to a medical staff member to provide medical services, granted by a gov- erning authority or according to medical staff bylaws.
42. “Collaborating health care institution” means a health care institution licensed to provide behavioral health services that has a written agreement with a provider to:
a. Coordinate behavioral health services provided to a resident, and
b. Work with the provider to ensure a resident receives behavioral health services according to the resident’s assessment or treatment plan.
43. “Communicable disease” has the same meaning as in A.R.S. § 36-661.
44. “Conspicuously posted” means placed at a location that is visible and accessible within the area where the public enters the premises of a health care institution.
45. “Consultation” means an evaluation of a patient requested by a medical staff member or personnel member.
46. “Contracted services” means medical services, nursing services, health-related services, ancillary services, or envi- ronmental services provided according to a documented agreement between a health care institution and the person providing the medical services, nursing services, health-related services, ancillary services, or environmental ser- vices.
47. “Contractor” has the same meaning as in A.R.S. § 32-1101.
48. “Controlled substance” has the same meaning as in A.R.S. § 36-2501.
49. “Counseling” has the same meaning as “practice of professional counseling” in A.R.S. § 32-3251.
50. “Counseling facility” means an outpatient treatment center that only provides and was licensed before October 1, 2013 to provide one or more of the following services:
a. Counseling;
b. DUI screening, education, or treatment according to the requirements in 9 A.A.C. 20, Article 1; or
c. Misdemeanor domestic violence offender treatment according to the requirements in 9 A.A.C. 20, Article 2.
51. “Court-ordered evaluation” has the same meaning as “evaluation” in A.R.S. § 36-501.
52. “Court-ordered pre-petition screening” has the same meaning as in A.R.S. § 36-501.
53. “Court-ordered treatment” means treatment provided according to A.R.S. Title 36, Chapter 5.
54. “Crisis services” means immediate and unscheduled behavioral health services provided to a patient to address an acute behavioral health issue affecting the patient.
55. “Current” means up-to-date, extending to the present time.
56. “Daily living skills” means activities necessary for an individual to live independently and include meal preparation, laundry, housecleaning, home maintenance, money management, and appropriate social interactions.
57. “Danger to others” has the same meaning as in A.R.S. § 36-501.
58. “Danger to self” has the same meaning as in A.R.S. § 36-501.
59. “Detoxification services” means behavioral health services and medical services provided to an individual to:
a. Reduce or eliminate the individual's dependence on alcohol or other drugs, or
b. Provide treatment for the individual's signs or symptoms of withdrawal from alcohol or other drugs.
60. “Diagnostic procedure” means a method or process performed to determine whether an individual has a medical con- dition or behavioral health issue.
61. “Dialyzer” means an apparatus containing semi-permeable membranes used as a filter to remove wastes and excess fluid from a patient's blood.
62. “Disaster” means an unexpected occurrence that adversely affects a health care institution’s ability to provide ser-
vices.
63. “Discharge” means a documented termination of services to a patient by a health care institution.
64. “Discharge instructions” means documented information relevant to a patient’s medical condition or behavioral health issue provided by a health care institution to the patient or the patient’s representative at the time of the patient’s discharge.
65. “Discharge planning” means a process of establishing goals and objectives for a patient or resident in preparation for the patient’s or resident’s discharge.
66. “Discharge summary” means a documented brief review of services provided to a patient, current patient status, and reasons for the patient’s discharge.
67. “Disinfect” means to clean in order to prevent the growth of or to destroy disease-causing microorganisms.
68. “Documentation” or “documented” means information in written, photographic, electronic, or other permanent form.
69. “Drill” means a response to a planned, simulated event.
70. “Drug” has the same meaning as in A.R.S. § 32-1901.
71. “Electronic” has the same meaning as in A.R.S. § 44-7002.
72. “Electronic signature” has the same meaning as in A.R.S. § 44-7002.
73. “Emergency” means an immediate threat to the life or health of a patient.
74. “Emergency medical services provider” has the same meaning as in A.R.S. § 36-2201.
75. “Environmental services” means activities such as housekeeping, laundry, facility maintenance, or equipment mainte- nance.
76. “Equipment” means, in this Article, an apparatus, a device, a machine, or a unit that is required to comply with the specifications incorporated by reference in A.A.C. R9-1-412.
77. “Exploitation” has the same meaning as in A.R.S. § 46-451.
78. “Factory-built building” has the same meaning as in A.R.S. § 41-2142.
79. “Family” or “family member” means an individual’s spouse, sibling, child, parent, grandparent, or another individual designated by the individual.
80. “Food services” means the storage, preparation, serving, and cleaning up of food intended for consumption in a health care institution.
81. “Garbage” has the same meaning as in A.A.C. R18-13-302.
82. “General consent” means documentation of an agreement from an individual or the individual’s representative to receive physical health services to address the individual’s medical condition or behavioral health services to address the individual’s behavioral health issues.
83. “General hospital” means a subclass of hospital that provides surgical services and emergency services.
84. “Gravely disabled” has the same meaning as in A.R.S. § 36-501.
85. “Hazard” or “hazardous” means a condition or situation where a patient or other individual may suffer physical injury.
86. “Health care directive” has the same meaning as in A.R.S. § 36-3201.
87. “Hemodialysis” means the process for removing wastes and excess fluids from a patient's blood by passing the blood through a dialyzer.
88. “Home health agency” has the same meaning as in A.R.S. § 36-151.
89. “Home health aide” means an individual employed by a home health agency to provide home health services under the direction of a registered nurse or therapist.
90. “Home health aide services” means those tasks that are provided to a patient by a home health aide under the direc- tion of a registered nurse or therapist.
91. “Home health services” has the same meaning as in A.R.S. § 36-151.
92. “Hospice inpatient facility” means a subclass of hospice that provides hospice services to a patient on a continuous basis with the expectation that the patient will remain on the hospice’s premises for 24 hours or more.
93. “Hospital” means a class of health care institution that provides, through an organized medical staff, inpatient beds, medical services, continuous nursing services, and diagnosis or treatment to a patient.
94. “Immediate” means without delay.
95. “Incident” means an unexpected occurrence that harms or has the potential to harm a patient, while the patient is:
a. On the premises of a health care institution, or
b. Not on the premises of a health care institution but directly receiving physical health services or behavioral health services from a personnel member who is providing the physical health services or behavioral health ser- vices on behalf of the health care institution.
96. “Infection control” means to identify, prevent, monitor, and minimize infections.
97. “Informed consent” means advising a patient of a proposed treatment, surgical procedure, psychotropic drug, or diag- nostic procedure; advising the patient of alternatives to the treatment, surgical procedure, psychotropic drug, or diag- nostic procedure; associated risks and possible complications; and obtaining documented authorization for the proposed treatment, surgical procedure, psychotropic drug, or diagnostic procedure from the patient or the patient’s
representative.
98. “In-service education” means organized instruction or information that is related to physical health services or behav- ioral health services and that is provided to a medical staff member, personnel member, employee, or volunteer.
99. “Interval note” means documentation updating a patient’s:
a. Medical condition after a medical history and physical examination is performed, or
b. Behavioral health issue after an assessment is performed.
100. “Isolation” means the separation, during the communicable period, of infected individuals from others, to limit the transmission of infectious agents.
101. “Leased facility” means a facility occupied or used during a set time period in exchange for compensation. 102. “License” means:
a. Written approval issued by the Department to a person to operate a class or subclass of health care institution, except for a behavioral health facility, at a specific location; or
b. Written approval issued to an individual to practice a profession in this state.
103. “Licensee” means an owner approved by the Department to operate a health care institution.
104. “Manage” means to implement policies and procedures established by a governing authority, an administrator, or an individual providing direction to a personnel member.
105. “Medical condition” means the state of a patient’s physical or mental health, including the patient’s illness, injury, or disease.
106. “Medical history” means an account of a patient’s health, including past and present illnesses, diseases, or medical conditions.
107. “Medical practitioner” means a physician, physician assistant, or registered nurse practitioner. 108. “Medical record” has the same meaning as “medical records” in A.R.S. § 12-2291.
109. “Medical staff” means physicians and other individuals licensed pursuant to A.R.S. Title 32 who have clinical privi- leges at a health care institution.
110. “Medical staff by-laws” means standards, approved by the medical staff and the governing authority, that provide the framework for the organization, responsibilities, and self-governance of the medical staff.
111. “Medical staff member” means an individual who is part of the medical staff of a health care institution.
112. “Medication” means one of the following used to maintain health or to prevent or treat a medical condition or behav- ioral health issue:
a. Biologicals as defined in A.A.C. R18-13-1401,
b. Prescription medication as defined in A.R.S. § 32-1901, or
c. Nonprescription medication as defined in A.R.S. § 32-1901.
113. “Medication administration” means the provision or application of a medication to the body of a patient by a medical practitioner or a nurse or as otherwise provided by law.
114. “Medication error” means:
a. The failure to administer an ordered medication; or
b. The administration of a medication:
i. Not ordered,
ii. In an incorrect dosage,
iii. More than 60 minutes before or after the ordered time of administration unless ordered to do so, or
iv. By an incorrect route of administration.
115. “Mental disorder” means the same as in A.R.S. § 36-501. 116. “Mobile clinic” means a movable structure that:
a. Is not physically attached to a health care institution's facility;
b. Provides medical services, nursing services, or health related service to an outpatient under the direction of the health care institution's personnel; and
c. Is not intended to remain in one location indefinitely.
117. “Monitor” or “monitoring” means to check systematically on a specific condition or situation. 118. “Neglect” has the same meaning:
a. For an individual less than 18 years of age, as in A.R.S. § 8-201; and
b. For an individual 18 years of age or older, as in A.R.S. § 46-451.
119. “Nephrologist” means a physician who is board eligible or board certified in nephrology by a professional credential- ing board.
120. “Nurse” has the same meaning as “registered nurse” or “practical nurse” as defined in A.R.S. § 32-1601.
121. “Nursing personnel” means individuals authorized according to A.R.S. Title 32, Chapter 15 to provided nursing ser- vices.
122. “Observation chair” means a physical piece of equipment that:
a. Is located in a designated area where behavioral health observation/stabilization services are provided,
b. Allows an individual to fully recline, and
c. Is used by the individual while receiving crisis services.
123. “Occupational therapist” has the same meaning as in A.R.S. § 32-3401.
124. “Occupational therapist assistant” has the same meaning as in A.R.S. § 32-3401.
125. “On-call” means a time during which an individual is available and required to come to a health care institution when requested by the health care institution.
126. “Order” means instructions to provide:
a. Physical health services to a patient from a medical practitioner or as otherwise provided by law; or
b. Behavioral health services to a patient from a behavioral health professional.
127. “Orientation” means the initial instruction and information provided to an individual before starting work or volun- teer services in a health care institution.
128. “Outing” means a social or recreational activity that:
a. Occurs away from the premises,
b. Is not part of a behavioral health residential facility’s daily routine, and
c. Lasts longer than four hours.
129. “Outpatient surgical center” means a class of health care institution that has the facility, staffing, and equipment to provide surgery and anesthesia services to a patient whose recovery, in the concurring opinions of the surgeon per- forming the surgery and the anesthesiologist, does not require inpatient care in a hospital.
130. “Outpatient treatment center” means a class of health care institution without inpatient beds that provides physical health services or behavioral health services for the diagnosis and treatment of patients.
131. “Overall time-frame” means the same as in A.R.S. § 41-1072.
132. “Owner” means a person who appoints, elects, or designates a health care institution's governing authority.
133. “Patient,” “resident,” or “participant” means an individual receiving physical health services or behavioral health ser- vices from a health care institution.
134. “Patient follow-up instructions” means information relevant to a patient's medical condition or behavioral health issue that is provided to the patient, the patient's representative, or a health care institution.
135. “Patient’s representative,” means a patient’s legal guardian, an individual acting on behalf of the patient with the written consent of the patient, or a surrogate as defined in A.R.S. § 36-3201.
136. “Person” means the same as in A.R.S. § 1-215 and includes a governmental agency.
137. “Personnel member” means, except as defined in specific Articles in this Chapter and excluding a medical staff member, an individual providing physical health services or behavioral health services to a patient.
138. “Pest control program” means activities that minimize the presence of insects and vermin in a health care institution to ensure that a patient’s health and safety is not at risk.
139. “Pharmacist” has the same meaning as in A.R.S. § 32-1901.
140. “Physical examination” means to observe, test, or inspect an individual’s body to evaluate health or determine cause of illness, injury, or disease.
141. “Physical health services” means medical services, nursing services, health-related services, or ancillary services provided to an individual to address the individual's medical condition.
142. “Physical therapist” has the same meaning as in A.R.S. § 32-2001.
143. “Physical therapist assistant” has the same meaning as in A.R.S. § 32-2001. 144. “Physician assistant” has the same meaning as in A.R.S. § 32-2501.
145. “Premises” means property that is designated by an applicant or licensee and licensed by the Department as part of a health care institution where physical health services or behavioral health services are provided to a patient.
146. “Professional credentialing board” means a non-governmental organization that designates individuals who have met or exceeded established standards for experience and competency in a specific field.
147. “Progress note” means documentation by a medical staff member, nurse, or personnel member of:
a. An observed patient response to a physical health service or behavioral health service provided to the patient,
b. A patient’s significant change in condition, or
c. Observed behavior of a patient related to the patient’s medical condition or behavioral health issue. 148. “PRN” means pro re nata or given as needed.
149. “Project” means specific construction or modification of a facility stated on an architectural plans and specifications approval application.
150. “Provider” means an individual to whom the Department issues a license to operate an adult behavioral health thera- peutic home or a children’s behavioral health respite home in the individual’s place of residence.
151. “Provisional license” means the Department's written approval to operate a health care institution issued to an appli- cant or licensee that is not in substantial compliance with the applicable laws and rules for the health care institution.
152. “Psychotropic medication” means a chemical substance that:
a. Crosses the blood-brain barrier and acts primarily on the central nervous system where it affects brain function, resulting in alterations in perception, mood, consciousness, cognition, and behavior; and
b. Is provided to a patient to address the patient’s behavioral health issue.
153. “Quality management program” means ongoing activities designed and implemented by a health care institution to improve the delivery of medical services, nursing services, health-related services, and ancillary services provided by the health care institution.
154. “Recovery care center” has the same meaning as in A.R.S. § 36-448.51.
155. “Referral” means providing an individual with a list of the class or subclass of health care institution or type of health care professional that may be able to provide the behavioral health services or physical health services that the indi- vidual may need and may include the name or names of specific health care institutions or health care professionals.
156. “Registered dietitian” means an individual approved to work as a dietitian by the American Dietetic Association’s Commission on Dietetic Registration.
157. “Registered nurse” has the same meaning as in A.R.S. § 32-1601.
158. “Registered nurse practitioner” has the same meaning as A.R.S. § 32-1601. 159. “Regular basis” means at recurring, fixed, or uniform intervals.
160. “Research” means the use of a human subject in the systematic study, observation, or evaluation of factors related to the prevention, assessment, treatment, or understanding of a medical condition or behavioral health issue.
161. “Respiratory care services” has the same meaning as “practice of respiratory care” as defined in A.R.S. § 32-3501. 162. “Restraint” means any physical or chemical method of restricting a patient’s freedom of movement, physical activity,
or access to the patient’s own body.
163. “Risk” means potential for an adverse outcome.
164. “Room” means space contained by a floor, a ceiling, and walls extending from the floor to the ceiling that has at least one door.
165. “Rural general hospital” means a subclass of hospital having 50 or fewer inpatient beds and located more than 20 surface miles from a general hospital or another rural general hospital that requests to be and is licensed as a rural general hospital rather than a general hospital.
166. “Satellite facility” has the same meaning as in A.R.S. § 36-422.
167. “Scope of services” means a list of the behavioral health services or physical health services the governing authority of a health care institution has designated as being available to a patient at the health care institution.
168. “Seclusion” means the involuntary solitary confinement of a patient in a room or an area where the patient is pre- vented from leaving.
169. “Sexual abuse” means the same as in A.R.S. § 13-1404(A). 170. “Sexual assault” means the same as in A.R.S. § 13-1406(A).
171. “Shift” means the beginning and ending time of a continuous work period established by a health care institution’s policies and procedures.
172. “Signature” means:
a. The first and last name of an individual written with his or her own hand as a form of identification or authoriza- tion, or
b. An electronic signature or code.
173. “Significant change” means an observable deterioration or improvement in a patient’s physical, cognitive, behav- ioral, or functional condition that may require an alteration to the physical health services or behavioral health ser- vices provided to the patient.
174. “Social worker” means an individual licensed according to A.R.S. Title 32, Chapter 33 to engage in the “practice of social work” as defined in A.R.S. § 32-3251.
175. “Social work services” has the same meaning as “practice of social work” in A.R.S. § 32-3251. 176. “Special hospital” means a subclass of hospital that:
a. Is licensed to provide hospital services within a specific branch of medicine; or
b. Limits admission according to age, gender, type of disease, or medical condition.
177. “Student” means an individual attending an educational institution and working under supervision in a health care institution through an arrangement between the health care institution and the educational institution.
178. “Substantial” when used in connection with a modification means:
a. An addition or deletion of an inpatient bed or a change in the use of one or more of the inpatient beds;
b. A change in a health care institution's licensed capacity;
c. A change in the physical plant, including facilities or equipment, that costs more than $300,000; or
d. A change in a health care institution that affects compliance with applicable physical plant codes and standards incorporated by reference in A.A.C. R9-1-412.
179. “Substance abuse” means an individual’s misuse of alcohol or other drug or chemical that:
a. Alters the individual’s behavior or mental functioning;
b. Has the potential to cause the individual to be psychologically or physiologically dependent on alcohol or other drug or chemical; and
c. Impairs, reduces, or destroys the individual’s social or economic functioning.
180. “Substance abuse transitional facility” means a class of health care institution that provides behavioral health ser-
vices to an individual who is intoxicated or may have a substance abuse problem.
181. “Supportive services” has the same meaning as in A.R.S. § 36-151.
182. “Substantive review time-frame” means the same as in A.R.S. § 41-1072.
183. “Surgical procedure” means the excision of a part of or incision in a patient’s body for the:
a. Correction of a deformity or defect,
b. Repair of an injury, or
c. Diagnosis, amelioration, or cure of disease.
184. “Swimming pool” has the same meaning as “semipublic swimming pool” in A.A.C. R18-5-201. 185. “System” means interrelated, interacting, or interdependent elements that form a whole.
186. “Tax ID number” means a numeric identifier that a person uses to report financial information to the United States Internal Revenue Services.
187. “Telemedicine” has the same meaning as in A.R.S. § 36-3601.
188. “Therapeutic diet” means foods or the manner in which food is to be prepared that are ordered for a patient.
189. “Time out” means providing a patient a voluntary opportunity to regain self-control in a designated area from which the patient is not physically prevented from leaving.
190. “Transfer” means a health care institution discharging a patient and sending the patient to another licensed health care institution as an inpatient or resident without intending that the patient be returned to the sending health care institution.
191. “Transport” means a health care institution:
a. Sending a patient to another licensed health care institution for outpatient services with the intent of returning the patient to the sending health care institution, or
b. Returning a patient to a sending licensed health care institution after the patient received outpatient services. 192. “Treatment” means a procedure or method to cure, improve, or palliate an individual’s medical condition or behav-
ioral health issue.
193. “Unclassified health care institution” means a health care institution not classified or subclassified in statute or in rule.
194. “Vascular access” means the point on a patient's body where blood lines are connected for hemodialysis.
195. “Volunteer” means an individual authorized by a health care institution to work for the health care institution on a regular basis without compensation from the health care institution and does not include a medical staff member who has clinical privileges at the health care institution.
196. “Working day” means a Monday, Tuesday, Wednesday, Thursday, or Friday that is not a state and federal holiday or a statewide furlough day.
R9-10-102. Health Care Institution Classes and Subclasses; Requirements
A. A person may apply for a license as an unclassified health care institution; a health care institution class or subclass in
A.R.S. Title 36, Chapter 4 or 9 A.A.C. 10; or one of the following classes or subclasses:
1. General hospital,
2. Rural general hospital,
3. Special hospital,
4. Adult day health care facility Behavioral health inpatient facility,
5. Adult foster care Nursing care institution,
6. Assisted living center Recovery care center,
7. Assisted living home Hospice inpatient facility,
8. Home health agency Hospice service agency,
9. Hospice Behavioral health residential facility,
10. Hospice inpatient facility Assisted living center,
11. Nursing care institution Assisted living home,
12. Home health agency Adult foster care home,
13. Abortion clinic Outpatient surgical center,
14. Outpatient treatment center,
14.15. Recovery care center Abortion clinic,
15.16. Outpatient surgical center, or Adult day health care facility,
16.17. Outpatient treatment center. Home health agency,
18. Substance abuse transitional facility,
19. Behavioral health specialized transitional facility,
20. Counseling facility,
21. Adult behavioral health therapeutic home, or
22. Children’s behavioral health respite home.
B. A person shall apply for a license for the class or subclass that authorizes the provision of the highest level of physical health services or behavioral health services the proposed health care institution plans to provide. The Department shall
review the proposed health care institution’s scope of services to determine whether the requested health care institution class or subclass is appropriate.
B.C. A health care institution shall comply with the requirements in R9-10-115 9 A.A.C. 10, Article 17 if:
1. There are no specific rules in 9 A.A.C. 10 or 9 A.A.C. 20 for the health care institution's class or subclass, or
2. The Department determines that the health care institution is an unclassified health care institution.
R9-10-103. Licensure Exceptions
A. Except for R9-10-122, this Article does not apply to a behavioral health service agency regulated under 9 A.A.C. 20.
B.A. A health care institution license is required for each health care institution except:
1. A facility exempt from licensure under A.R.S. § 36-402, or
2. A health care institution's administrative office.
C.B. The Department does not require a separate health care institution license for:
1. A satellite facility of a hospital under A.R.S. § 36-422(F);
1.2. An accredited facility of an accredited hospital under A.R.S. § 36-422(F) or (G) 36-422(G);
2.3. A facility operated by a licensed health care institution that is:
a. Adjacent to and contiguous with the licensed health care institution premises; or
b. Not adjacent to or contiguous with the licensed health care institution but is connected to the licensed health care institution facility by an all-weather enclosure and that is:
i. Owned by the health care institution, or
ii. Leased by the health care institution with exclusive rights of possession; or
3.4. A mobile clinic operated by a licensed health care institution; or
5. A facility located on grounds that are not adjacent to or contiguous with the health care institution premises where only ancillary services are provided to a patient of the health care institution.
R9-10-104. Approval of Architectural Plans and Specifications
A. For approval of architectural plans and specifications for the construction or modification of a health care institution that is required by this Chapter to comply with any of the physical plant codes and standards incorporated by reference in
A.A.C. R9-1-412, an applicant shall submit to the Department an application packet including:
1. An application in a format provided by the Department that contains:
a. For construction of a new health care institution:
i. The health care institution's name, street address, city, state, zip code, telephone number, and fax number;
ii. The name and address of the health care institution's governing authority;
iii. The requested health care institution class or subclass; and
iv. If applicable, The the requested licensed capacity and licensed occupancy for the health care institution;
b. For modification of a licensed health care institution:
i. The health care institution's license number,
ii. The name and address of the licensee,
iii. The health care institution's class or subclass, and
iv. The health care institution's existing licensed capacity or licensed occupancy and the requested licensed capacity or licensed occupancy for the health care institution;
c. The health care institution's contact person's name, street address, city, state, zip code, telephone number, and fax number;
d. If the application includes a copy of architectural plans and specifications:
i. A statement signed by the governing authority or the licensee that the architectural plans and specifications comply with applicable licensure requirements in A.R.S. Title 36, Article 4 and 9 A.A.C. 10 and the health care institution is ready for an onsite inspection by a Department representative;
ii. The project architect's name, street address, city, state, zip code, telephone number, and fax number; and
iii. A statement signed and sealed by the project architect, according to the requirements in 4 A.A.C. 30, Article 3, that the project architect has complied with A.A.C. R4-30-301 and the architectural plans and specifica- tions are in substantial compliance with applicable licensure requirements in A.R.S. Title 36, Article 4 and 9
A.A.C. 10;
e. A narrative description of the project; and
f. If providing or planning to provide medical services, nursing services, or health-related services that which require compliance with specific physical plant codes and standards incorporated by reference in A.A.C. R9-1- 412, the number of rooms or inpatient beds designated for providing the medical services, nursing services, or health-related services; and
g. If providing or planning to provide behavioral health observation/stabilization services, the number of behavioral health observation/stabilization chairs designated for providing the behavioral health observation/stabilization services;
2. If the health care institution is located on land under the jurisdiction of a local governmental agency, one of the fol-
lowing:
a. A building permit for the construction or modification issued by the local governmental agency; or
b. If a building permit issued by the local governmental agency is not required, zoning clearance issued by the local governmental agency that includes:
i. The health care institution's name, street address, city, state, zip code, and county;
ii. The health care institution's class or subclass and each type of medical services, nursing services, or health- related services to be provided; and
iii. A statement signed by a representative of the local governmental agency stating that the address listed is zoned for the health care institution's class or subclass;
3. The following information on architectural plans and specifications that is necessary to demonstrate that the project described on the application form complies with applicable codes and standards incorporated by reference in A.A.C. R9-1-412:
a. A table of contents containing:
i. The architectural plans and specifications submitted,
ii. The physical plant codes and standards incorporated by reference in A.A.C. R9-1-412 that apply to the proj- ect or are required by a local governmental agency,
iii. An index of the abbreviations and symbols used in the architectural plans and specifications, and
iv. The facility's specific International Building Code construction type and International Building Code occu- pancy type;
b. If the facility is larger than 3,000 square feet and is or will be occupied by more than 20 individuals, the seal of an architect on the architectural plans and drawings according to the requirements in A.R.S. Title 32, Chapter 1;
c. A site plan, drawn to scale, of the entire premises showing streets, property lines, facilities, parking areas, out- door areas, fences, swimming pools, fire access roads, fire hydrants, and access to water mains;
d. For each facility, on architectural plans and specifications:
i. A floor plan, drawn to scale, for each level of the facility, showing the layout and dimensions of each room, the name and function of each room, means of egress, and natural and artificial lighting sources;
ii. A diagram of a section of the facility, drawn to scale, showing the vertical cross-section view from founda- tion to roof and specifying construction materials;
iii. Building elevations, drawn to scale, showing the outside appearance of each facility;
iv. The materials used for ceilings, walls, and floors;
v. The location, size, and fire rating of each door and each window and the materials and hardware used, including safety features such as fire exit door hardware and fireproofing materials;
vi. A ceiling plan, drawn to scale, showing the layout of each light fixture, each fire protection device, and each element of the mechanical ventilation system;
vii. An electrical floor plan, drawn to scale, showing the wiring diagram and the layout of each lighting fixture, each outlet, each switch, each electrical panel, and electrical equipment;
viii. A mechanical floor plan, drawn to scale, showing the layout of heating, ventilation, and air conditioning sys- tems;
ix. A plumbing floor plan, drawn to scale, showing the layout and materials used for water and sewer systems including the water supply and plumbing fixtures;
x. A floor plan, drawn to scale, showing the communication system within the health care institution including the nurse call system, if applicable;
xi. A floor plan, drawn to scale, showing the automatic fire extinguishing, fire detection, and fire alarm sys- tems; and
xii. Technical specifications describing installation and materials used in the health care institution;
4. The estimated total project cost including the costs of:
a. Site acquisition,
b. General construction,
c. Architect fees,
d. Fixed equipment, and
e. Movable equipment;
5. The following, as applicable:
a. If the health care institution is located on land under the jurisdiction of a local governmental agency, one of the following provided by the local governmental agency:
i. A copy of the Certificate of Occupancy,
ii. Documentation that the facility was approved for occupancy, or
iii. Documentation that a certificate of occupancy for the facility is not available;
b. A certification and a statement that the construction or modification of the facility is in substantial compliance with applicable licensure requirements in A.R.S. Title 36, Article 4 and 9 A.A.C. 10 signed by the project archi-
tect, the contractor, and the owner;
c. A written description of any work necessary to complete the construction or modification submitted by the proj- ect architect;
d. If the construction or modification affects the health care institution's fire alarm system, a contractor certification and description of the fire alarm system on a form in a format provided by the Department;
e. If the construction or modification affects the health care institution's automatic fire extinguishing system, a con- tractor certification of the automatic fire extinguishing system on a form in a format provided by the Department;
f. If the construction or modification affects the health care institution's heating, ventilation, or air conditioning, a copy of the heating, ventilation, air conditioning, and air balance tests and a contractor certification of the heat- ing, ventilation, or air conditioning systems;
g. If draperies, cubicle curtains, or floor coverings are installed or replaced, a copy of the manufacturer's certifica- tion of flame spread for the draperies, cubicle curtains, or floor coverings;
h. For a health care institution using inhalation anesthetics or nonflammable medical gas, a copy of the Compliance Certification for Inhalation Anesthetics or Nonflammable Medical Gas System required in the National Fire Codes incorporated by reference in A.A.C. R9-1-412;
i. If a generator is installed, a copy of the installation acceptance required in the National Fire Codes incorporated by reference in A.A.C. R9-1-412;
j. For a health care institution providing radiology, a written report from a certified health physicist of the location, type, and amount of radiation protection; and
k. If a factory-built building is used by a health care institution:
i. A copy of the installation permit and the copy of a certificate of occupancy for the factory-built building from the Office of Manufactured Housing; or
ii. A written report from an individual registered as an architect or a professional structural engineer under 4
A.A.C. 30, Article 2, stating that the factory-built building complies with applicable design standards;
6. A statement signed by the project architect that final architectural drawings and specifications have been submitted to the person applying for a health care institution license or the licensee of the health care institution; and
7. The applicable fee required by R9-10-122 R9-10-106.
B. Before an applicant submits an application for approval of architectural plans and specifications for the construction or modification of a health care institution, an applicant may request an architectural evaluation by submitting the documents in subsection (A)(3) to the Department.
C. The Department shall approve or deny an application for approval of architectural plans and specifications of a health care institution in this Section according to R9-10-108.
D. In addition to obtaining an approval of a health care institution's architectural plans and specifications, a person shall obtain a health care institution license before operating the health care institution.
R9-10-105. Initial License Application
A. A person applying for a health care institution license shall submit to the Department an application packet that contains:
1. An application form in a format provided by the Department including:
a. The health care institution's:
i. Name, street address, mailing address, telephone number, fax number, and e-mail address;
ii. Tax ID number; and
iii. Class or subclass listed in R9-10-102 for which licensure is requested;
b. As applicable, the specific services for which authorization is requested;
b.c. Except for a home health agency, or a hospice service agency, or behavioral health facility, whether the health care institution is located within 1/4 mile of agricultural land;
c.d. Whether the health care institution is located in a leased facility;
d.e. Whether the health care institution is ready for a licensing inspection by the Department;
e.f. If the health care institution is not ready for a licensing inspection by the Department, the date the health care institution will be ready for a licensing inspection;
f.g. Owner information including:
i. The owner's name, address, telephone number, and fax number;
ii. Whether the owner is a sole proprietorship, a corporation, a partnership, a limited liability partnership, a lim- ited liability company, or a governmental agency;
iii. If the owner is a partnership or a limited liability partnership, the name of each partner;
iv. If the owner is a limited liability company, the name of the designated manager or, if no manager is desig- nated, the names of any two members of the limited liability company;
v. If the owner is a corporation, the name and title of each corporate officer;
vi. If the owner is a governmental agency, the name and title of the individual in charge of the governmental agency or the name of an individual in charge of the health care institution designated in writing by the indi- vidual in charge of the governmental agency;
vii. Whether the owner or any person with 10% or more business interest in the health care institution has had a license to operate a health care institution denied, revoked, or suspended; the reason for the denial, suspen- sion, or revocation; the date of the denial, suspension, or revocation; and the name and address of the licens- ing agency that denied, suspended, or revoked the license;
viii. Whether the owner or any person with 10% or more business interest in the health care institution has had a health care professional license or certificate denied, revoked, or suspended; the reason for the denial, sus- pension, or revocation; the date of the denial, suspension, or revocation; and the name and address of the licensing agency that denied, suspended, or revoked the license or certificate; and
ix. The name, title, address, and telephone number of the owner's statutory agent or the individual designated by the owner to accept service of process and subpoenas;
g.h. The name and address of the governing authority;
h.i. The chief administrative officer's:
i. Name,
ii. Title,
iii. Highest educational degree, and
iv. Work experience related to the health care institution class or subclass for which licensing is requested; and
i.j. Signature required in A.R.S. § 36-422(B) that is notarized;
2. If the health care institution is located in a leased facility, a copy of the lease showing the rights and responsibilities of the parties and exclusive rights of possession of the leased facility;
3. If applicable, a copy of the owner's articles of incorporation, partnership or joint venture documents, or limited liabil- ity documents;
4. If applicable, the name and address of each owner or lessee of any agricultural land regulated under A.R.S. § 3-365 and a copy of the written agreement between the applicant and the owner or lessee of agricultural land as prescribed in A.R.S. § 36-421(D);
5. Except for a home health agency or a hospice service agency, one of the following:
a. If the health care institution or a part of the health care institution is required by this Chapter to comply with any of the physical plant codes and standards incorporated by reference in A.A.C. R9-1-412, documentation of the health care institution's architectural plans and specifications approval in R9-10-104; or
b. If a health care institution or a part of the health care institution is not required by this Chapter to comply with any of the physical plant codes and standards incorporated by reference in A.A.C. R9-1-412:
i. One of the following:
(1) Documentation from the local jurisdiction of compliance with applicable local building codes and zon- ing ordinances; or
(2) If documentation from the local jurisdiction is not available, documentation of the unavailability of the local jurisdiction compliance and documentation of a general contractor’s inspection of the facility that states the facility is safe for occupancy as the applicable health care institution class or subclass;
ii. The licensed capacity requested by the applicant for the health care institution;
iii. If applicable, the licensed occupancy requested by the applicant for the health care institution;
iv. A site plan showing each facility, the property lines of the health care institution, each street and walkway adjacent to the health care institution, parking for the health care institution, fencing and each gate on the health care institution premises, and, if applicable, each swimming pool on the health care institution prem- ises; and
v. A floor plan showing, for each story of a facility, the room layout, room usage, each door and each window, plumbing fixtures, each exit, and the location of each fire protection device; and
6. The health care institution’s proposed scope of services; and
6.7. The applicable application fee required by R9-10-122 R9-10-106.
B. In addition to the initial application requirements in this Section, an applicant shall comply with the initial application requirements in specific rules in 9 A.A.C. 10 for the health care institution class or subclass for which licensure is requested.
C. The Department shall approve or deny an application in this Section according to R9-10-108.
R9-10-106. Reserved R9-10-122. R9-10-106. Fees
A. An applicant who submits to the Department architectural plans and specifications for the construction or modification of a health care institution shall also submit an architectural drawing review fee as follows:
1. Fifty dollars for a project with a cost of $100,000 or less;
2. One hundred dollars for a project with a cost of more than $100,000 but less than $500,000; or
3. One hundred fifty dollars for a project with a cost of $500,000 or more.
B. An applicant submitting an initial application or a renewal application for a health care institution license shall submit to
the Department an application fee of $50.
C. Except as provided in subsection (D) or (E), an applicant submitting an initial application or a renewal application for a health care institution license shall submit to the Department a licensing fee as follows:
1. For an adult day health care facility, assisted living home, or assisted living center:
a. For a facility with no licensed capacity, $280;
b. For a facility with a licensed capacity of one to 59 beds, $280, plus the licensed capacity times $70;
c. For a facility with a licensed capacity of 60 to 99 beds, $560, plus the licensed capacity times $70;
d. For a facility with a licensed capacity of 100 to 149 beds, $840, plus the licensed capacity times $70; or
e. For a facility with a licensed capacity of 150 beds or more, $1,400, plus the licensed capacity times $70;
2. For a behavioral health service agency facility:
a. For a facility with no licensed capacity, $375;
b. For a facility with a licensed capacity of one to 59 beds, $375, plus the licensed capacity times $94;
c. For a facility with a licensed capacity of 60 to 99 beds, $750, plus the licensed capacity times $94;
d. For a facility with a licensed capacity of 100 to 149 beds, $1,125, plus the licensed capacity times $94; or
e. For a facility with a licensed capacity of 150 beds or more, $1,875, plus the licensed capacity times $94;
3. For a nursing care institution:
a. For a facility with a licensed capacity of one to 59 beds, $290, plus the licensed capacity times $73;
b. For a facility with a licensed capacity of 60 to 99 beds, $580, plus the licensed capacity times $73;
c. For a facility with a licensed capacity of 100 to 149 beds, $870, plus the licensed capacity times $73; or
d. For a facility with a licensed capacity of 150 beds or more, $1,450, plus the licensed capacity times $73; or
4. For a hospital, a home health agency, a hospice service agency, a hospice inpatient facility, an abortion clinic, a recov- ery care center, an outpatient surgical center, an outpatient treatment center that is not a behavioral health facility, or an unclassified health care institution:
a. For a facility with no licensed capacity, $365;
b. For a facility with a licensed capacity of one to 59 beds, $365, plus the licensed capacity times $91;
c. For a facility with a licensed capacity of 60 to 99 beds, $730, plus the licensed capacity times $91;
d. For a facility with a licensed capacity of 100 to 149 beds, $1,095, plus the licensed capacity times $91; or
e. For a facility with a licensed capacity of 150 beds or more, $1,825, plus the licensed capacity times $91.
D. Subsection (C) does not apply to a health care institution operated by a state agency according to state or federal law or to an adult foster care home.
E. All fees are nonrefundable except as provided in A.R.S. § 41-1077.
R9-10-107. Renewal License Application
A. A licensee applying to renew a health care institution license shall submit an application packet to the Department at least 60 calendar days but not more than 120 calendar days before the expiration date of the current license that contains:
1. A renewal application in a format provided by the Department including:
a. The health care institution's:
i. Name, license number, mailing address, telephone number, fax number, and e-mail address; and
ii. Class or subclass; and
iii. Scope of services;
b. Owner information including:
i. The owner's name, address, telephone number, and fax number;
ii. Whether the owner is a sole proprietorship, a corporation, a partnership, a limited liability partnership, a lim- ited liability company, or a governmental agency;
iii. If the owner is a partnership or a limited liability partnership, the name of each partner;
iv. If the owner is a limited liability company, the name of the designated manager or, if no manager is desig- nated, the names of any two members of the limited liability company;
v. If the owner is a corporation, the name and title of each corporate officer;
vi. If the owner is a governmental agency, the name and title of the individual in charge of the governmental agency or the individual designated in writing by the individual in charge of the governmental agency;
vii. Whether the owner or any person with 10% or more business interest in the health care institution has had a license to operate a health care institution denied, revoked, or suspended since the previous license applica- tion was submitted; the reason for the denial, suspension, or revocation; the date of the denial, suspension, or revocation; and the name and address of the licensing agency that denied, suspended, or revoked the license;
viii. Whether the owner or any person with 10% or more business interest in the health care institution has had a health care professional license or certificate denied, revoked, or suspended since the previous license appli- cation was submitted; the reason for the denial, suspension, or revocation; the date of the denial, suspension, or revocation; and the name and address of the licensing agency that denied, suspended, or revoked the license or certificate; and
ix. The name, title, address, and telephone number of the owner's statutory agent or the individual designated by
the owner to accept service of process and subpoenas;
c. The name and address of the governing authority;
d. The chief administrative officer's:
i. Name,
ii. Title,
iii. Highest educational degree, and
iv. Work experience related to the health care institution class or subclass for which licensing is requested; and
e. Signature required in A.R.S. § 36-422(B) that is notarized;
2. If the health care institution is located in a leased facility, a copy of the lease showing the rights and responsibilities of the parties and exclusive rights of possession of the leased facility; and
3. The applicable renewal application and licensing fees required by R9-10-122 R9-10-106.
B. In addition to the renewal application requirements in this Section, a licensee shall comply with the renewal application requirements in specific rules in 9 A.A.C. 10 or 9 A.A.C. 20 for the health care institution's class or subclass.
C. If a licensee submits a health care institution's current accreditation report from a nationally recognized accrediting orga- nization, the Department shall not conduct an onsite compliance inspection of the health care institution as part of the sub- stantive review for a renewal license during the time the accreditation report is valid.
D. The Department shall approve or deny a renewal license according to R9-10-108.
E. The Department shall issue a renewal license for:
1. One year, if a licensee is in substantial compliance with the applicable statutes and this Chapter, and the licensee agrees to implement a plan acceptable to the Department to eliminate any deficiencies; or
2. Two years, if a licensee has no deficiencies at the time of the Department's licensure inspection; or
3.2. The duration of the accreditation period Three years, if:
a. A licensee's health care institution is a hospital accredited by a nationally recognized accreditation organization, and
b. The licensee submits a copy of the hospital's current accreditation report.
R9-10-108. Time-frames
A. The overall time-frame for each type of approval granted by the Department is listed in Table 1 1.1. The applicant and the Department may agree in writing to extend the substantive review time-frame and the overall time-frame. The substantive review time-frame and the overall time-frame may not be extended by more than 25% of the overall time-frame.
B. The administrative completeness review time-frame for each type of approval granted by the Department as prescribed in this Article is listed in Table 1 1.1. The administrative completeness review time-frame begins on the date the Department receives a complete application packet or a written request for a change in a health care institution license according to R9-10-109(E) R9-10-109(F):
1. The application packet for an initial health care institution license is not complete until the applicant provides the Department with written notice that the health care institution is ready for a licensing inspection by the Department.
2. If the application packet or written request is incomplete, the Department shall provide a written notice to the appli- cant specifying the missing document or incomplete information. The administrative completeness review time- frame and the overall time-frame are suspended from the date of the notice until the date the Department receives the missing document or information from the applicant.
3. When an application packet or written request is complete, the Department shall provide a written notice of adminis- trative completeness to the applicant.
4. For an initial health care institution application, the Department shall consider the application withdrawn if the appli- cant fails to supply the missing documents or information included in the notice described in subsection (B)(2) within 180 calendar days from after the date of the notice described in subsection (B)(2).
5. If the Department issues a license or grants an approval during the time provided to assess administrative complete- ness, the Department shall not issue a separate written notice of administrative completeness.
C. The substantive review time-frame is listed in Table 1 1.1 and begins on the date of the notice of administrative complete- ness.
1. The Department may conduct an onsite inspection of the facility:
a. As part of the substantive review for approval of architectural plans and specifications;
b. As part of the substantive review for issuing a health care institution initial or renewal license; or
c. As part of the substantive review for approving a change in a health care institution's license.
2. During the substantive review time-frame, the Department may make one comprehensive written request for addi- tional information or documentation. If the Department and the applicant agree in writing, the Department may make supplemental requests for additional information or documentation. The time-frame for the Department to complete the substantive review is suspended from the date of a written request for additional information or documentation until the Department receives the additional information or documentation.
3. The Department shall send a written notice of approval or a license to an applicant who is in substantial compliance with applicable requirements in A.R.S. Title 36, Chapter 4 and 9 A.A.C. 10.
4. After an applicant for an initial health care institution license receives the written notice of approval in subsection (C)(3), the applicant shall submit the applicable license fee in R9-10-122 R9-10-106 to the Department within 60 cal- endar days of after the date of the written notice of approval.
5. The Department shall provide a written notice of denial that complies with A.R.S. § 41-1076 to an applicant who does not:
a. For an initial health care institution application, submit the information or documentation in subsection (C)(2) within 120 calendar days of after the Department's written request to the applicant;
b. Comply with the applicable requirements in A.R.S. Title 36, Chapter 4 and 9 A.A.C. 10; or
c. Submit the fee required in R9-10-122 R9-10-106.
6. An applicant may file a written notice of appeal with the Department within 30 calendar days after receiving the notice described in subsection (C)(5). The appeal shall be conducted according to A.R.S. Title 41, Chapter 6, Article 10.
7. If a time-frame's last day falls on a Saturday, a Sunday, or an official state holiday, the Department shall consider the next business working day to be the time-frame's last day.
Table 1. 1.1.
Type of Approval | Statutory Authority | Overall Time-frame | Administrative Completeness Time-frame | Substantive Review Time-frame | |||||
Approval of architectural plans and specifi- cations R9-10-104 | A.R.S. §§ 36-405, 36-406(1)(b), and 36-421 | 105 calendar days | 45 days | calendar | 60 ca | lendar | days | ||
Health care institution initial license R9-10-105 | A.R.S. §§ 36-405, 36-407, 36-421, 36-422, 36-424, and 36-425 | 120 calendar days | 30 days | calendar | 90 calendar days | ||||
Health care institution renewal license R9-10-107 | A.R.S. §§ 36-405, 36-407, 36-422, 36-424, and 36- 425 | 180 days | 90 | calendar | 30 days | calendar | 150 days | 60 | calendar |
Approval of a change to a health care institu- tion license R9-10-109 (E) R9-10-109(F) | A.R.S. §§ 36-405, 36-407, and 36- 422 | 75 calendar days | 15 days | calendar | 60 calendar days | ||||
R9-10-109. Changes Affecting a License
A. A licensee shall ensure that the Department is notified in writing at least 30 calendar days before the effective date of:
1. A change in the name of:
a. A health care institution, or
b. The licensee; or
2. A change in the address of a health care institution that does not provide medical services, nursing services, or health- related services on the premises.
B. If a licensee intends to terminate the operation of a health care institution either during or at the expiration of the health care institution’s license, the licensee shall ensure that the Department is notified in writing of:
1. The termination of the health care institution’s operations, as required in A.R.S. § 36-422(D), at least 30 days before the termination; and
2. The address and contact information for the location where the health care institution’s medical records will be retained as required in A.R.S. § 12-2297.
B.C. A licensee of a health care institution that is required by this Chapter to comply with any of the physical plant codes and standards incorporated by reference in A.A.C. R9-1-412 shall submit an application for approval of architectural plans and specifications for a modification of the health care institution.
C.D. A governing authority shall submit a an initial license application required in R9-10-105 for:
1. A change in ownership of a health care institution;
2. A change in the address or location of a health care institution that provides medical services, nursing services, or health-related services, or behavioral health services on the premises; or
3. A change in a health care institution's class or subclass.
D.E. A governing authority is not required to submit documentation of a health care institution's architectural plans and speci- fications required in R9-10-105(A)(5) for an initial license application if:
1. The health care institution has not ceased operations for more than 30 calendar days,
2. A modification has not been made to the health care institution,
3. The services the health care institution is authorized by the Department to provide are not changed, and
4. The location of the health care institution's premises is not changed.
E.F. A licensee of a health care institution that is not required to comply with the physical plant codes and standards incorpo- rated by reference in A.A.C. R9-1-412 shall submit a written request for a change in the services the health care institution is authorized by the Department to provide or another modification of the health care institution including documentation of compliance with requirements in this Chapter for the change or the modification that contains:
1. The health care institution's name, address, and license number;
2. A narrative description of the change or modification;
3. The governing authority's name and dated signature; and
4. Any documentation that demonstrates that the requested change or modification complies with applicable require- ments in this Chapter.
F.G. The Department shall approve or deny a request for a change in services or another modification described in this Section subsection (C) or (F) according to R9-10-108.
G.H. A licensee shall not implement a change in services or another modification described in this Section subsection (C) or
(F) until an approval or amended license or a new license is issued by the Department.
R9-10-110. Enforcement Actions
A. If the Department determines that an applicant or licensee is not in substantial compliance with violating applicable laws statutes and rules and the violation poses a direct risk to the life, health, or safety of a patient, the Department may:
1. Issue a provisional license to the applicant or licensee under A.R.S. § 36-425,
2. Assess a civil penalty under A.R.S. § 36-431.01,
3. Impose an intermediate sanction under A.R.S. § 36-427,
4. Remove a licensee and appoint another person to continue operation of the health care institution pending further action under A.R.S. § 36-429,
5. Suspend or revoke a license under R9-10-111 and A.R.S. § 36-427 and R9-10-111,
6. Deny a license under A.R.S. § 36-425 and R9-10-111, or
7. Issue an injunction under A.R.S. § 36-430.
B. In determining which action in subsection (A) is appropriate, the Department shall consider the threat to the health, safety, and welfare of patients the direct risk to the life, health, or safety of a patient in the health care institution based on:
1. Repeated violations of statutes or rules,
2. Pattern of non-compliance violations,
3. Types of violation,
4. Severity of violation, and
5. Number of violations.
R9-10-111. Denial, Revocation, or Suspension of License
The Department may deny, revoke, or suspend a license to operate a health care institution if an applicant, a licensee, or a per- son with a business interest of 10% or more in the health care institution an individual in a business relationship with the appli- cant including a stockholder or controlling person:
1. Provides false or misleading information to the Department;
2. Has had in any state or jurisdiction any of the following:
a. An application or license to operate a health care institution denied, suspended, or revoked, unless the denial was based on failure to complete the licensing process within a required time-frame; or
b. A health care professional license or certificate denied, revoked, or suspended; or
3. Has operated a health care institution, within the ten years preceding the date of the license application, in violation of
A.R.S. Title 36, Chapter 4 or this Chapter, endangering the health and safety of patients that posed a direct risk to the life, health, or safety of a patient.
R9-10-112. Tuberculosis Screening
A health care institution's chief administrative officer shall ensure that the health care institution complies with the following if tuberculosis screening is required at the health care institution:
1. For each individual required to be screened for infectious tuberculosis, the health care institution obtains from the individual:
a. On or before the date the individual begins providing services at or on behalf of the health care institution or is
admitted to the health care institution, one of the following as evidence of freedom from infectious tuberculosis:
i. Documentation of a negative Mantoux skin test or other tuberculosis screening test recommended by the U.S. Centers for Disease Control and Prevention (CDC) administered within six months before the date the individual begins providing services at or on behalf of the health care institution or is admitted to the health care institution that includes the date and the type of tuberculosis screening test; or
ii. If the individual had a positive Mantoux skin test or other tuberculosis screening test, a written statement that the individual is free from infectious tuberculosis signed by a medical practitioner dated within six months before the date the individual begins providing services at or on behalf of the health care institution or is admitted to the health care institution; and
b. Every 12 months after the date of the individual's most recent tuberculosis screening test or written statement, one of the following as evidence of freedom from infectious tuberculosis:
i. Documentation of a negative Mantoux skin test or other tuberculosis screening test recommended by the CDC administered to the individual within 30 calendar days before or after the anniversary date of the most recent tuberculosis screening test or written statement that includes the date and the type of tuberculosis screening test; or
ii. If the individual has had a positive Mantoux skin test or other tuberculosis screening test, a written statement that the individual is free from infectious tuberculosis signed by a medical practitioner dated within 30 cal- endar days before or after the anniversary date of the most recent tuberculosis screening test or written state- ment; or
2. Establish, document, and implement a tuberculosis infection control program that complies with the Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-care Settings, 2005, published by the U.S. Department of Health and Human Services, Atlanta, GA 30333 and available at http://www.cdc.gov/mmwr/PDF/rr/ rr5417.pdf, incorporated by reference, on file with the Department, and including no future editions or amendments and includes:
a. Conducting tuberculosis risk assessments, conducting tuberculosis screening testing, screening for signs or symptoms of tuberculosis, and providing training and education related to recognizing the signs and symptoms of tuberculosis; and
b. Maintaining documentation of any:
i. Tuberculosis risk assessment;
ii. Tuberculosis screening test of an individual who is employed by the health care institution, provides volun- teer services for the health care institution, or is admitted to the health care institution; and
iii. Screening for signs or symptoms of tuberculosis of an individual who is employed by the health care institu- tion, provides volunteer services for the health care institution, or is admitted to the health care institution.
R9-10-113. Repealed
R9-10-112. R9-10-113. Clinical Practice Restrictions for Hemodialysis Technician Trainees
A. The following definitions apply in this Section:
1. “Assess” means collecting data about a patient by:
a. Obtaining a history of the patient,
b. Listening to the patient's heart and lungs, and
c. Checking the patient for edema.
2. “Blood-flow rate” means the quantity of blood pumped into a dialyzer per minute of hemodialysis.
3. “Blood lines” means the tubing used during hemodialysis to carry blood between a vascular access and a dialyzer.
4. “Central line catheter” means a type of vascular access created by surgically implanting a tube into a large vein.
5. “Clinical practice restriction” means a limitation on the hemodialysis tasks that may be performed by a hemodialysis technician trainee.
6. “Conductivity test” means a determination of the electrolytes in a dialysate.
7. “Dialysate” means a mixture of water and chemicals used in hemodialysis to remove wastes and excess fluid from a patient's body.
8. “Dialysate-flow rate” means the quantity of dialysate pumped per minute of hemodialysis.
9. “Dialyzer” means a blood filter used in hemodialysis to remove wastes and excess fluid from a patient's blood.
10.9. “Directly observing” or “direct observation” means a medical person stands next to an inexperienced hemodialysis technician trainee and watches the inexperienced hemodialysis technician trainee perform a hemodialysis task.
11.10. “Direct supervision” means a nurse or a physician is physically present within sight or hearing of the patient and readily available to provide care to a patient has the same meaning as “supervision” in A.R.S. § 36-401.
12.11. “Electrolytes” means compounds chemicals, such as sodium, potassium, and calcium, that break apart into electri- cally charged particles when dissolved in water.
13.12. “Experienced hemodialysis technician trainee” means an individual who has passed all didactic, skills, and compe- tency examinations provided by a health care institution that measure the individual's knowledge and ability to per-
form hemodialysis.
14.13. “Fistula” means a type of vascular access created by a surgical connection between an artery and vein.
15.14. “Fluid-removal rate” means the quantity of wastes and excess fluid eliminated from a patient's blood per minute of hemodialysis to achieve the patient's prescribed weight, determined by:
a. Dialyzer size,
b. Blood-flow rate,
c. Dialysate-flow rate, and
d. Hemodialysis duration.
16.15. “Germicide-negative test” means a determination that a chemical used to kill microorganisms is not present.
17.16. “Germicide-positive test” means a determination that a chemical used to kill microorganisms is present.
18.17. “Graft” means a type of vascular access created by a surgical connection between an artery and vein using a syn- thetic tube.
19. “Hemodialysis” means a process for removing wastes and excess fluids from a patient's blood by passing the blood through a dialyzer.
20.18. “Hemodialysis machine” means a mechanical pump that controls:
a. The blood-flow rate,
b. The mixing and temperature of dialysate,
c. The dialysate-flow rate,
d. The addition of anticoagulant, and
e. The fluid-removal rate.
21.19. “Hemodialysis technician” has the same meaning as in A.R.S. § 36-423.
22.20. “Hemodialysis technician trainee” means an individual who is working in a health care institution after March 31, 2003 to assist in providing hemodialysis and who is not certified as a hemodialysis technician according to A.R.S. § 36-423(A).
23.21. “Inexperienced hemodialysis technician trainee” means an individual who has not passed all didactic, skills, and competency examinations provided by a health care institution that measure the individual's knowledge and ability to perform hemodialysis.
24.22. “Medical person” means:
a. A doctor of medicine licensed under A.R.S. Title 32, Chapter 13, and experienced in dialysis;
b. A doctor of osteopathy licensed under A.R.S. Title 32, Chapter 17, and experienced in dialysis;
c. A registered nurse practitioner licensed under A.R.S. Title 32, Chapter 15, and experienced in dialysis;
d. A nurse licensed under A.R.S. Title 32, Chapter 15, and experienced in dialysis;
e. A hemodialysis technician who meets the requirements in A.R.S. § 36-423(A) approved by the governing authority; and
f. An experienced hemodialysis technician trainee approved by the governing authority.
25. “Medical records” has the same meaning as in A.R.S. § 12-2291.
26. “Nephrologist” means a physician who specializes in the structure, function, and diseases of the kidney.
27.23. “Not established” means not approved by a patient's nephrologist for use by the patient's nephrologist in hemodial- ysis.
28.24. “Patient” means an individual who receives hemodialysis.
29.25. “pH test” means a determination of the acidity of a dialysate.
30.26. “Preceptor course” means a health care institution's instruction and evaluation provided to a nurse or a hemodialy- sis technician trainee that enables the nurse or the hemodialysis technician trainee to provide direct observation and education to other hemodialysis technician trainees.
31.27. “Respond” means to mute, shut off, reset, or troubleshoot an alarm.
32.28. “Safety check” means successful completion of tests recommended by the manufacturer of a hemodialysis machine, a dialyzer, or a water system used for hemodialysis before initiating a patient's hemodialysis.
33. “Vascular access” means the point created on a patient's body where blood lines are connected for hemodialysis.
34.29. “Water-contaminant test” means a determination of the presence of chlorine or chloramine in a water system used for hemodialysis.
B. An experienced hemodialysis technician trainee may:
1. Perform hemodialysis under direct supervision after passing didactic, skills and competency examinations;, and
2. Provide direct observation to another hemodialysis technician trainee only after completing the health care institu- tion's preceptor course approved by the governing authority.
C. An experienced hemodialysis technician trainee shall not access a patient's:
1. Fistula that is not established;, or
2. Graft that is not established;.
D. An inexperienced hemodialysis technician trainee may perform the following hemodialysis tasks only under direct obser- vation:
1. Access a patient's central line catheter;
2. Respond to a hemodialysis-machine alarm;
3. Draw blood for laboratory tests;
4. Perform a water-contaminant test on a water system used for hemodialysis;
5. Inspect a dialyzer and perform a germicide-positive test before priming a dialyzer;
6. Set up a hemodialysis machine and blood lines before priming a dialyzer;
7. Prime a dialyzer;
8. Test a hemodialysis machine for germicide presence;
9. Perform a hemodialysis machine safety check;
10. Prepare a dialysate;
11. Perform a conductivity test and a pH test on a dialysate;
12. Assess a patient;
13. Check and record a patient's vital signs, weight, and temperature;
14. Determine the amount and rate of fluid removal from a patient;
15. Administer local anesthetic at an established fistula or graft, administer anticoagulant, or administer replacement saline solution;
16. Perform a germicide-negative test on a dialyzer before initiating hemodialysis;
17. Initiate or discontinue a patient's hemodialysis;
18. Adjust blood-flow rate, dialysate-flow rate, or fluid-removal rate during hemodialyisis hemodialysis; or
19. Prepare a blood, water, or dialysate culture to determine microorganism presence;.
E. An inexperienced hemodialysis technician trainee may perform, under direct supervision, any of the hemodialysis tasks listed in subsection (D) after the inexperienced hemodialysis technician trainee has passed the didactic, skills and compe- tency examination applicable to the hemodialysis task.
F.E. An inexperienced hemodialysis technician trainee shall not:
1. Access a patient's:
a. Fistula that is not established, or
b. Graft that is not established; or
2. Provide direct observation.
G.F. When a hemodialysis technician trainee performs hemodialysis tasks for a patient, the patient's medical record shall include:
1. The name of the hemodialysis technician trainee,;
2. The date, time, and hemodialysis task performed,;
3. The name of the medical person directly observing or the nurse or physician directly supervising the hemodialysis technician trainee,; and
4. The initials or signature of the medical person directly observing or the nurse or physician directly supervising the hemodialysis technician trainee.
H.G. If the Department determines that a health care institution is not in substantial compliance with this Section, the Depart- ment may take enforcement action according to R9-10-110.
R9-10-114. Repealed Behavioral Health Paraprofessionals; Behavioral Health Technicians
If a health care institution is licensed as a behavioral health inpatient facility, behavioral health residential facility, substance abuse transitional facility, or behavioral health specialized transitional facility, or is authorized to provide behavioral health services, an administrator shall ensure that policies and procedures are established, documented, and implemented that:
1. For a behavioral health paraprofessional providing services at the health care institution:
a. Delineate the services a behavioral health paraprofessional is allowed to provide at or for the health care institu- tion;
b. If a behavioral health paraprofessional provides services under the practice of marriage and family therapy, the practice of professional counseling, the practice of social work, or the practice of substance abuse counseling as defined in A.R.S. § 32-3251, ensure that the behavioral health paraprofessional is under the supervision of an individual licensed pursuant to A.R.S. Title 32, Chapter 33 to provide the specific service being provided by the behavioral health paraprofessional;
c. Establish the qualifications for individuals providing supervision to a behavioral health paraprofessional; and
d. Establish documentation requirements for the supervision required in subsection (1)(b);
2. For a behavioral health technician providing services at the health care institution:
a. Delineate the services a behavioral health technician is allowed to provide at or for the health care institution;
b. Establish the qualifications for a behavioral health professional providing clinical oversight to a behavioral health technician;
c. If the behavioral health technician provides services under the practice of marriage and family therapy, the prac- tice of professional counseling, the practice of social work, or the practice of substance abuse counseling as defined in A.R.S. § 32-3251, ensure that the behavioral health technician is under the clinical oversight of a
behavioral health professional licensed pursuant to A.R.S. Title 32, Chapter 33 to provide the specific service being provided by the behavioral health technician;
d. Delineate the methods used to provide clinical oversight including when clinical oversight is provided on an individual basis or in a group setting;
e. If clinical oversight is provided electronically, ensure that:
i. The clinical oversight is provided verbally with direct and immediate interaction between the behavioral health professional providing and the behavioral health technician receiving the clinical oversight,
ii. A secure connection is used, and
iii. The identities of the behavioral health professional providing and the behavioral health technician receiving the clinical oversight are verified before clinical oversight is provided;
f. Ensure that a behavioral health technician receives clinical oversight at least once during each two week period, if the behavioral health technician provides services related to patient care at the health care institution during the two week period;
g. Establish the duration of clinical oversight provided to a behavioral health technician to ensure that patient needs are met based on, for each behavioral health technician:
i. The scope and extent of the services provided,
ii. The acuity of the patients receiving services, and
iii. The number of patients receiving services;
h. Establish documentation requirements for the clinical oversight required in subsection (2)(c); and
i. Establish the process by which information pertaining to services provided by a behavioral health technician is provided to the behavioral health professional who is responsible for the clinical oversight of the behavioral health technician.
R9-10-115. Unclassified Health Care Institutions Nutrition and Feeding Assistant Training Programs
An administrator for a health care institution not otherwise classified or subclassified in A.R.S. Title 36, Chapter 4, 9 A.A.C. 10 or 9 A.A.C. 20 shall:
1. Adequately equip and staff the health care institution with qualified personnel to meet the needs and ensure the health and safety of patients and comply with applicable statutes and rules for the provision of medical services, nursing ser- vices or health-related services;
2. Establish and maintain a record of each inpatient and outpatient that documents the assessment of the patient's health needs and the medical services, nursing services and health-related services the patient receives;
3. Ensure that the facility premises, including the facility’s equipment, are clean, and free of insects, rodents, litter and rubbish;
4. Establish, document and implement policies and procedures for cleaning, sanitizing or sterilizing and storing equip- ment and supplies;
5. Ensure that the facility's physical plant and equipment are periodically inspected and, where appropriate, tested, cali- brated, serviced or repaired so that the facility’s plant and equipment are functioning properly and reliably;
6. Maintain physical plant and equipment inspection and maintenance records to assure that appropriate inspections and maintenance of equipment are accomplished by a qualified person;
7. Comply with applicable regulations adopted pursuant to A.R.S. § 36-136(G) for the control of communicable disease and maintenance of proper sanitation;
8. Comply with applicable fire and building codes;
9. Establish, document and implement policies and procedures that delineate the scope of services offered, hours of operation, admission and discharge criteria and type of personnel provided; and
10. If the health care institution meets the definition of “abortion clinic” in A.R.S. § 36-449.01, ensure that abortions and related services are provided in compliance with the requirements in 9 A.A.C. 10, Article 15.
A. For the purposes of this Section, “agency” means an entity other than a nursing care institution that provides the nutrition and feeding assistant training required in A.R.S. § 36-413.
B. An agency shall apply for approval to operate a nutrition and feeding assistant training program by submitting:
1. An application in a format provided by the Department that contains:
a. The name of the individual in charge of the proposed nutrition and feeding assistant training program;
b. The address where the nutrition and feeding assistant training program records are maintained;
c. A description of the training course being offered by the nutrition and feeding assistant training program includ- ing for each topic in subsection (I):
i. The information presented for each topic,
ii. The amount of time allotted to each topic,
iii. The skills an individual is expected to acquire for each topic, and
iv. The testing method used to verify an individual has acquired the stated skills for each topic; and
d. The signature of the individual in charge of the proposed nutrition and feeding assistant training program and the
date signed; and
2. A copy of the materials used for providing the nutrition and feeding assistant training program.
C. For an application for an approval of a nutrition and feeding assistant training program, the administrative review time- frame is 30 calendar days, the substantive review time-frame is 30 calendar days, and the overall time-frame is 60 calen- dar days.
D. Within 30 calendar days after the receipt of an application in subsection (B), the Department shall:
1. Issue an approval of the agency’s nutrition and feeding assistant training program;
2. Provide a notice of administrative completeness to the agency that submitted the application; or
3. Provide a notice of deficiencies to the agency that submitted the application, including a list of the information or documents needed to complete the application.
E. If the Department provides a notice of deficiencies to an applicant:
1. The administrative completeness review time-frame and the overall time-frame are suspended from the date of the notice of deficiencies until the date the Department receives the missing information or documents from the appli- cant;
2. If the applicant does not submit the missing information or documents to the Department within 30 calendar days, the Department shall consider the application withdrawn; and
3. If the applicant submits the missing information or documents to the Department within the time-frame in subsection (E)(2), the substantive review time-frame begins on the date the Department receives the missing information or doc- uments.
F. Within the substantive review time-frame, the Department:
1. Shall issue or deny an approval of a nutrition and feeding assistant training program; and
2. May make one written comprehensive request for more information, unless the Department and the applicant agree in writing to allow the Department to submit supplemental requests for information.
G. If the Department issues a written comprehensive request or a supplemental request for information:
1. The substantive review time-frame and the overall time-frame are suspended from the date of the written comprehen- sive request or the supplemental request for information until the date the Department receives the information requested, and
2. The applicant shall submit to the Department the information and documents listed in the written comprehensive request or supplemental request for information within 10 working days after the date of the comprehensive written request or supplemental request for information.
H. The Department shall issue:
1. An approval for an agency to operate a nutrition and feeding assistant training program, if the Department determines that the agency and the application comply with A.R.S. § 36-413 and this Section; or
2. A denial for an agency that includes the reason for the denial and the process for appealing the Department’s decision if:
a. The Department determines that the applicant does not comply with A.R.S. § 36-413 and this Section; or
b. The applicant does not submit information and documents listed in the written comprehensive request or supple- mental request for information within 10 working days after the date of the comprehensive written request or supplemental request for information.
I. An individual in charge of a nutrition and feeding assistant training program shall ensure that:
1. The materials and coursework for the nutrition and feeding assistant training program includes the following topics:
a. Feeding techniques;
b. Assistance with feeding and hydration;
c. Communication and interpersonal skills;
d. Appropriate responses to resident behavior;
e. Safety and emergency procedures, including the Heimlich maneuver;
f. Infection control;
g. Resident rights;
h. Recognizing a change in a resident that is inconsistent with the resident’s normal behavior; and
i. Reporting a change in subsection (I)(1)(h) to a nurse at a nursing care institution;
2. An individual providing the training course is:
a. A physician,
b. A physician assistant,
c. A registered nurse practitioner,
d. A registered nurse,
e. A registered dietitian,
f. A licensed practical nurse,
g. A speech-language pathologist, or
h. An occupation therapist; and
3. An individual taking the training course completes:
a. At least eight hours of classroom time, and
b. Demonstrates that the individual has acquired the skills the individual was expected to acquire.
J. An individual in charge of a nutrition and feeding assistant training program shall issue a certificate of completion to an individual who completes the training course and demonstrates the skills the individual was expected to acquire as a result of completing the training course that contains:
1. The name of the agency approved to operate the nutrition and feeding assistant training program;
2. The name of the individual completing the training course;
3. The date of completion;
4. The name, signature, and professional license of the individual providing the training course; and
5. The name and signature of the individual in charge of the nutrition and feeding assistant training program.
K. The Department may deny, revoke, or suspend an approval to operate a nutrition and feeding assistant training program if an applicant for or an agency operating a nutrition and feeding assistance training program:
1. Provides false or misleading information to the Department;
2. Does not comply with the applicable statutes and rules;
3. Issues a training completion certificate to an individual who did not:
a. Complete the nutrition and feeding assistant training program, or
b. Demonstrate the skills the individual was expected to acquire; or
4. Does not implement the nutrition and feeding assistant training program as described in or use the materials submit- ted with the agency’s application.
L. In determining which action in subsection (K) is appropriate, the Department shall consider the following:
1. Repeated violations of statutes or rules,
2. Pattern of non-compliance,
3. Types of violations,
4. Severity of violations, and
5. Number of violations.
R9-10-116. Repealed Counseling Facilities
An administrator of a counseling facility shall ensure that the counseling facility complies with the requirements in this Article and 9 A.A.C. 10, Article 10.
R9-10-117. Repealed Collaborating Health Care Institutions
If a collaborating health care institution has an agreement with an adult behavioral health therapeutic home or children’s behavioral health respite home, an administrator shall ensure that:
1. A description of the required skills and knowledge for a provider, based on the type of adult behavioral health thera- peutic services or children’s behavioral health respite services being provided, is established and documented;
2. A copy of an assessment or treatment plan for a resident that includes information necessary for a provider to meet the resident’s needs for adult behavioral health therapeutic services or children’s behavioral health respite services is completed and forwarded to the provider before the resident is admitted to the provider’s behavioral health support- ive home;
3. A resident’s assessment or treatment plan is reviewed and updated at least once every twelve months and a copy of the resident’s updated assessment or treatment plan is forwarded to the resident’s provider;
4. If documentation of a significant change in a resident’s behavioral, physical, cognitive, or functional condition and the action taken by a provider to address the resident’s changing needs is received by the collaborating health care institution, a behavioral health professional or behavioral health technician reviews the documentation and:
a. Documents the review; and
b. If applicable:
i. Updates the resident’s assessment or treatment plan, and
ii. Forwards the updated assessment or treatment plan to the provider within 10 working days after receipt of the documentation of a significant change;
5. If the review and updated assessment or treatment plan required in subsection (4) is performed by a behavioral health technician, a behavioral health professional reviews and signs the review and updated assessment or treatment plan to ensure the resident is receiving the appropriate behavioral health services:
a. Before the updated assessment or treatment plan is forwarded to a provider, and
b. Within 10 working days after receipt of the documentation of a significant change;
6. Training for a provider, other than a provider who is a medical practitioner or a nurse, in the assistance in the self- administration of medication:
a. Is provided by a medical practitioner or registered nurse or by the collaborating health care institution’s person- nel member trained by a medical practitioner or registered nurse;
b. Includes:
i. A demonstration of the provider’s skills and knowledge necessary to provide assistance in the self-adminis- tration of medication,
ii. Identification of medication errors and medical emergencies related to medication that require emergency medical intervention, and
iii. The process for notifying the appropriate entities when an emergency medical intervention is needed; and
c. Is documented;
7. The following documents are maintained as long as the written agreement with a provider of a behavioral health sup- portive home is in effect:
a. A copy of the written agreement with the provider;
b. Documentation of required skills and knowledge for the provider; and
c. Documentation of training in the assistance in the self-administration of medication; and
8. Documentation required in subsection (4) is maintained by the collaborating health care institution in the resident’s medical record.
R9-10-122. Renumbered
ARTICLE 2. HOSPITALS
R9-10-201. Definitions
In addition to the definitions in A.R.S. § 36-401 and 9 A.A.C. 10, Article 1 R9-10-101, the following definitions apply in this Article unless otherwise specified:
1. “Accredited” has the same meaning as in A.R.S. § 36-422(J)(1).
2. “Activities of daily living” means bathing, dressing, grooming, eating, ambulating, and toileting.
3.1. “Acuity” means a patient's need for hospital services based on the patient's medical condition.
4.2. “Acuity plan” means a method for establishing nursing personnel requirements by unit based on a patient’s acuity.
5. “Administrator” means a chief administrative officer, or an individual who has been designated by the governing authority to act on its behalf in the onsite direction of the hospital.
6. “Admission” or “admitted” means documented acceptance by a hospital of an individual as an inpatient on the order of a medical staff member.
7.3. “Adult” means an individual the hospital designates as an adult based on the hospital's criteria.
8. “Adverse reaction” means an unexpected outcome that threatens the health and safety of a patient as a result of medi- cal services provided to the patient.
9. “Anesthesiologist” means a physician granted clinical privileges to administer anesthesia.
10. “Assessment” means an analysis of a patient's current medical condition and need for hospital services.
11. “Attending physician” means a physician with clinical privileges who is accountable for the management of medical services delivered to a patient.
12. “Attending physician's designee” means a physician, physician assistant, registered nurse practitioner, or medical staff member who has clinical privileges and is authorized by medical staff bylaws to act on behalf of the attending physician.
13. “Authenticate” means to establish authorship of a document or an entry in a medical record by:
a. A written signature;
b. An individual's initials, if the individual's written signature already appears on the document or in the medical record;
c. A rubber-stamp signature; or
d. An electronic signature code.
14. “Available” means:
a. For an individual, the ability to be contacted by any means possible such as by telephone or pager;
b. For equipment and supplies, retrievable at a hospital; and
c. For a document, retrievable at a hospital or accessible according to the time-frames in the applicable rules in this Article.
15. “Biohazardous medical waste” has the same meaning as in A.A.C. R18-13-1401.
16. “Biologicals” mean medicinal compounds prepared from living organisms and their products such as serums, vac- cines, antigens, and antitoxins.
17.4. “Care plan” means a documented guide for providing nursing services and rehabilitative rehabilitation services to a patient that includes measurable objectives and the methods for meeting the objectives.
18. “Clinical laboratory services” means the biological, microbiological, serological, chemical, immunohematological, hematological, biophysical, cytological, pathological, or other examination of materials derived from the human body for the purpose of providing information for the diagnosis, prevention, or treatment of a disease or impairment of a human being, or for the assessment of the health of a human being, including procedures to determine, measure, or otherwise describe the presence or absence of various substances or organisms in the body.
19. “Clinical privilege” means authorization to a medical staff member to provide medical services granted by a govern-
ing authority or according to medical staff bylaws.
20. “Communicable disease” has the same meaning as in A.A.C. R9-6-101.
21. “Consultation” means an evaluation of a patient requested by a medical staff member.
22.5. “Continuing care nursery” means a nursery where medical services and nursing services are provided to a neonate who does not require intensive care services.
23. “Contracted services” means hospital services provided according to a written agreement between a hospital and the person providing the hospital services.
24. “Controlled substance” has the same meaning as in A.R.S. § 36-2501.
25.6. “Critically ill inpatient” means an inpatient whose severity of medical condition requires the nursing services of spe- cially trained registered nurses for:
a. Continuous monitoring and multi-system assessment,
b. Complex and specialized rapid intervention, and
c. Education of the inpatient or inpatient's representative.
26. “Current” means up-to-date and extending to the present time.
27.7. “Device” has the same meaning as in A.R.S. § 32-1901.
28.8. “Diet” means food and drink provided to a patient.
29.9. “Diet manual” means a written compilation of diets.
30.10. “Dietary services” means providing food and drink to a patient according to an order.
31. “Disaster” means an unexpected adverse occurrence that affects a hospital's ability to provide hospital services.
32. “Discharge” means a hospital's termination of hospital services to an inpatient or an outpatient.
33. “Discharge instructions” means written information relevant to a patient's medical condition provided by a hospital to the patient at the time of discharge.
34. “Discharge planning” means a process of establishing goals and objectives for an inpatient in preparation for the inpatient's discharge.
35.11. “Diversion” means notification to an emergency medical services provider, as defined in A.R.S. § 36-2201, that a hospital is unable to receive a patient from an emergency medical services provider.
36. “Documentation” or “documented” means information in written, photographic, electronic, or other permanent form.
37. “Drill” means a response to a planned, simulated event.
38. “Drug” has the same meaning as in A.R.S. § 32-1901.
39.12. “Drug formulary” means a written compilation of medication developed according to R9-10-217 R9-10-218.
40. “Electronic” has the same meaning as in A.R.S. § 44-7002.
41. “Electronic signature” has the same meaning as in A.R.S. § 44-7002.
42. “Emergency” means an immediate threat to the life or health of a patient.
43.13. “Emergency services” means unscheduled medical services provided in a designated area to an outpatient in an emergency.
44. “Environmental services” means activities such as housekeeping, laundry, and facility and equipment maintenance.
45. “Exploitation” has the same meaning as in A.R.S. § 46-451.
46. “General hospital” means a subclass of hospital that provides surgical services and emergency services.
47.14. “Gynecological services” means medical services for the diagnosis, treatment, and management of conditions or diseases of the female reproductive organs or breasts.
48. “Health care directive” has the same meaning as in A.R.S. § 36-3201.
49. “Hospital” means a class of health care institution that provides, through an organized medical staff, inpatient beds, medical services, and continuous nursing services for the diagnosis and treatment of patients.
50. “Hospital premises” means a hospital's licensed space excluding, if applicable, space in an accredited outpatient facil- ity under the hospital's single group license, or space leased by the hospital to another entity according to the lease terms.
51.15. “Hospital services” means medical services, nursing services, and other health-related services provided in a hospi- tal.
52. “Incident” means an unexpected occurrence that harms or has the potential to harm a patient while the patient is on a hospital's premises.
53.16. “Infection control risk assessment” means determining the risk probability for transmission of communicable dis- eases.
54. “Informed consent” means advising a patient of a proposed medical procedure, alternatives to the medical procedure, associated risks, and possible complications, and obtaining authorization of the patient or the patient's representative for the procedure.
55.17. “Inpatient” means an individual who:
a. Is admitted to a hospital as an inpatient according to policies and procedures, or
b. Is admitted to a hospital with the expectation that the individual will remain and receive hospital services for 24 consecutive hours or more, or
c. Receives hospital services for 24 consecutive hours or more.
56. “Inservice education” means organized instruction or information related to hospital services provided to a personnel member or a medical staff member.
57.18. “Intensive care services” means hospital services provided to a critically ill inpatient who requires the services of specially trained nursing and other personnel members as specified in hospital policies and procedures.
58. “Interval note” means documentation updating a patient's medical condition after a medical history and physical examination are performed.
59. “License” means documented authorization:
a. Issued by the Department to operate a health care institution, or
b. Issued to an individual to practice a profession in this state.
60. “Manage” means to implement policies and procedures established by a governing authority, an administrator, or an individual providing direction to a personnel member.
61. “Medical condition” means the state of a patient's physical or mental health, including the patient's illness, injury, or disease.
62. “Medical history” means a part of a patient's medical record consisting of an account of the patient's health, including past and present illnesses or diseases.
63. “Medical record” has the same meaning as in A.R.S. § 12-2291.
64. “Medical staff member” means a physician or other licensed individual who has clinical privileges in a hospital.
66. “Medical staff bylaws” means standards, approved by the medical staff and governing authority, that provides the framework for the organization, responsibilities and self-governance of the medical staff.
66.19. “Medical staff regulations” means standards, approved by the medical staff, that govern the day-to-day conduct of the medical staff members.
67. “Medication” has the same meaning as drug.
68. “Monitor” or “monitoring” means observing a patient's medical condition.
69.20. “Multi-organized service unit” means an inpatient unit in a hospital where more than one organized service may be provided to a patient in the inpatient unit.
70.21. “Neonate” means an individual:
a. From birth until discharge following birth, or
b. Who is designated as a neonate by hospital criteria.
71. “Nurse” has the same meaning as registered nurse or practical nurse as defined in A.R.S. § 32-1601.
72.22. “Nurse anesthetist” means a registered nurse who meets the requirements of A.R.S. § 32-1661 and who has clinical privileges to administer anesthesia.
73.23. “Nurse executive” means a registered nurse accountable for the direction of nursing services provided in a hospital.
74.24. “Nursery” means an area in a hospital designated only for neonates.
75.25. “Nurse supervisor” means a registered nurse accountable for managing nursing services provided in an organized service in a hospital.
76. “Nursing personnel” means an individual authorized by hospital policies and procedures to provide nursing services to a patient.
77.26. “Nutrition assessment” means a process for determining a patient's dietary needs using information contained in the patient's medical record.
78. “On call” means a time during which an individual is available and required to come to a hospital when requested by the hospital.
27. “On duty” means that an individual is at work and performing assigned responsibilities.
79. “Order” means an instruction to provide medical services, as authorized by the governing authority, to a patient by:
a. A medical staff member,
b. An individual licensed under A.R.S. Title 32 or authorized by a hospital within the scope of the individual's license, or
c. A physician who is not a medical staff member.
80.28. “Organized service” means specific medical services, such as surgical services or emergency services, provided in an area of a hospital designated for the provision of those medical services.
81. “Orientation” means the initial instruction and information provided to an individual starting work in a hospital.
82.29. “Outpatient” means an individual who:
a. Is not admitted to a hospital with the expectation that the individual will receive hospital services for less than 24 consecutive hours,; or
b. Except as provided in subsection (17), Receives receives hospital services for less than 24 consecutive hours.
83.30. “Pathology” means an examination of human tissue for the purpose of diagnosis or treatment of an illness or dis- ease.
84. “Patient” means an individual receiving hospital services.
85.31. “Patient care” means hospital services provided to a patient by a personnel member or a medical staff member.
86. “Patient's representative” means a patient's legal guardian, an individual acting on behalf of a patient with the written consent of the patient, or a surrogate as defined in A.R.S. § 36-3201.
87.32. “Pediatric” means pertaining to an individual designated by a hospital as a child based on the hospital's criteria.
88.33. “Perinatal services” means medical services for the treatment and management of obstetrical patients and neonates.
89. “Person” has the same meaning as in A.R.S. § 1-215 and includes governmental agencies.
90. “Personnel member” means:
a. A volunteer; or
b. An individual, except for a medical staff member or private duty staff, who provides hospital services for com- pensation, including an individual who is compensated by an employment agency.
91. “Pharmacist” has the same meaning as in A.R.S. § 32-1901.
92. “Physical examination” means to observe, test, or inspect an individual's body to evaluate health or determine cause of illness or disease.
93.34. “Postanesthesia Post-anesthesia care unit” means a designated area for monitoring a patient following a medical procedure for which anesthesia was administered to the patient.
94.35. “Private duty staff” means an individual, excluding a personnel member, compensated by a patient or the patient's representative.
95.36. “Psychiatric services” means the diagnosis, treatment, and management of a mental illness disorder as defined in A.R.S. § 36-501.
96. “Quality management program” means activities designed and implemented by a hospital to improve the delivery of hospital services.
97. “Registered dietitian” means an individual approved to work as a dietitian by the American Dietetic Association's Commission on Dietetic Registration.
98.37. “Rehabilitation services” means medical services provided to a patient to restore or to optimize functional capabil- ity.
99. “Registered nurse” has the same meaning as in A.R.S. § 32-1601.
100. “Respiratory care services” has the same meaning as practice of respiratory care as defined in A.R.S. § 32-3501. 101. “Restraint” means any chemical or physical method of restricting a patient's freedom of movement, physical activity,
or access to the patient's own body.
102. “Require” means to carry out an obligation imposed by this Article. 103. “Risk” means potential for an adverse outcome.
104. “Rural general hospital” means a subclass of hospital having 50 or fewer inpatient beds and located more than 20 surface miles from a general hospital or another rural general hospital, and that elects to be licensed as a rural general hospital rather than a general hospital.
105. “Satellite facility” has the same meaning as in A.R.S. § 36-422(J)(2).
106. “Seclusion” means the involuntary solitary confinement of a patient in a room or an area where the patient is pre- vented from leaving.
107. “Shift” means the beginning and ending time of a work period established by hospital policies and procedures.
108.38. “Single group license” means a license that includes authorization to operate health care institutions according to
A.R.S. § 36-422(F) or (G).
109.39. “Social services” means assistance, other than medical services or nursing services, provided by a personnel member to a patient to meet the needs of assist the patient to cope with concerns about the patient’s illness or injury while in the hospital or the anticipated needs of the patient after discharge.
110. “Social worker” means an individual who has at least a baccalaureate degree in social work from a program accred- ited by the Council on Social Work Education or who is certified according to A.R.S. Title 32, Chapter 33.
111. “Special hospital” means a subclass of hospital that:
a. Is licensed to provide hospital services within a specific branch of medicine; or
b. Limits admission according to age, gender, type of disease, or medical condition.
112.40. “Specialty” means a specific area branch of medicine practiced by a licensed individual who has obtained educa- tion or qualifications in the specific area branch in addition to the education or qualifications required for the individ- ual's license.
113. “Student” means an individual attending an educational institution and working under supervision in a hospital through an arrangement between the hospital and the educational institution.
114.41. “Surgical services” means medical services involving the excision or incision of a patient's body for the: a surgical procedure.
a. Correction of a deformity or a defect;
b. Repair of an injury; or
c. Diagnosis, amelioration, or cure of disease.
115. “Telemedicine” has the same meaning as in A.R.S. § 36-3601.
116. “Transfer” means a hospital discharging a patient and sending the patient to another licensed health care institution as
an inpatient or resident without intending that the patient be returned to the sending hospital.
117.42. “Transfusion” means the introduction of blood or blood products from one individual into the body of another individual.
118. “Transport” means a hospital sending a patient to another health care institution for outpatient medical services with the intent of returning the patient to the sending hospital.
119. “Treatment” means a procedure or method to cure, improve, or palliate a medical condition.
120.43. “Unit” means a designated area of an organized service. 121. “Verification” means:
a. A documented telephone call including the information obtained, the date, and the name of the documenting individual;
b. A documented observation including the information observed, the date, and the name of the documenting indi- vidual; or
c. A documented confirmation of a fact including the date and the name of the documenting individual.
122.44. “Vital records record” has the same meaning as in A.R.S. § 36-301. 123. “Vital statistics” has the same meaning as in A.R.S. § 36-301.
124. “Volunteer” means an individual, except a student, authorized by a hospital to work in the hospital who does not receive compensation.
125.45. “Well-baby bassinet” means a receptacle used for holding a neonate who does not require treatment and whose anticipated discharge is within 96 hours of after birth.
R9-10-202. Supplemental Application Requirements
A. For a hospital license, in In addition to the license application requirements in A.R.S. § 36-422 and 9 A.A.C. 10, Article 1, a governing authority applying for an initial or renewal license shall submit the following to the Department an applicant for:
1. A statement of the licensed capacity requested for the hospital, on a form provided by the Department, including:
a. The number of inpatient beds for each organized service, not including well-baby bassinets; and
b. If applicable, the number of inpatient beds for each multi-organized service unit;
2. A list on a form provided by the Department of medical staff specialties and subspecialties; and
3. A copy of an accreditation report if the hospital is accredited and chooses to submit a copy of the report instead of receiving a compliance inspection by the Department according to A.R.S. § 36-424(C).
1. An initial license shall include:
a. On the application the licensed capacity requested for the hospital, including:
i. The number of inpatient beds for each organized service, not including well-baby bassinets;
ii. If applicable, the number of inpatient beds for each multi-organized service unit; and
iii. If applicable, the licensed occupancy for providing observation/stabilization services to:
(1) Individuals who are under 18 years of age, and
(2) Individuals 18 years of age and older; and
b. A list in a format provided by the Department of medical staff specialties and subspecialties; and
2. A renewal license may submit to the Department a copy of an accreditation report if the hospital is accredited and chooses to submit a copy of the accreditation report instead of receiving a compliance inspection by the Department according to A.R.S. § 36-424(C).
B. For a single group license authorized in A.R.S. § 36-422(F) or (G), in addition to the requirements in subsection (A), a governing authority applying for an initial or renewal license shall submit the following to the Department on a form in a format provided by the Department, for each satellite facility under the single group license:
1. The name, address, and telephone number of each accredited facility under the single group license;
2. The name of the administrator for each accredited facility; and
3. The specific times each accredited hours of operation during which the satellite facility provides medical services, nursing services, or health-related services.
C. For a single group license authorized in A.R.S. § 36-422(G), in addition to the requirements in subsection (A), a govern- ing authority applying for an initial or renewal license shall submit the following to the Department in a format provided by the Department for each accredited satellite facility under the single group license:
1. The name, address, and telephone number;
2. The name of the administrator;
3. The hours of operation during which the accredited satellite facility provides medical services, nursing services, or health-related services; and
4. A copy of the accredited satellite facility’s current accreditation report.
C.D. An administrator A governing authority shall:
1. Notify the Department when there is a change in administrator according to A.R.S. § 36-425(I);
2.1. Notify the Department at least 30 calendar days before a satellite facility or an accredited satellite facility on a single group license terminates operations; and
3.2. Submit an application, according to the requirements in 9 A.A.C. 10, Article 1, at least 60 calendar days but not more than 120 calendar days before a satellite facility or an accredited satellite facility licensed under a single group license anticipates providing medical services, nursing services, or health-related services under a license separate from the single group license.
R9-10-203. Administration
A. A governing authority shall:
1. Consist of one or more individuals accountable responsible for the organization, operation, and administration of a hospital;
2. Designate Establish, in writing:
a. A hospital’s scope of services,
b. Qualifications for an administrator,
a.c. Which organized services are to be provided in the hospital, and
b.d. The organized services that are to be provided in a multi-organized service unit according to R9-10-228(A);
3. Appoint Designate an administrator, in writing, who: has the qualifications established in subsection (A)(2)(b);
a. Has a baccalaureate degree or a post-baccalaureate degree in a health care-related field;
b. Has at least three years of experience in health care administration; or
c. On December 5, 2006, was currently employed as an administrator in a licensed hospital;
4. Approve hospital a hospital’s policies and procedures or designate an individual to approve hospital policies and pro- cedures;
5. Approve medical staff bylaws and medical staff regulations;
6. Approve contracted services or designate an individual to approve contracted services;
7.4. Grant, deny, suspend, or revoke a clinical privilege of a medical staff member or delegate authority to an individual to grant or suspend a clinical privilege for a limited time, according to medical staff by-laws;
8.5. Adopt a quality management program according to R9-10-204;
9.6. Review and evaluate the effectiveness of the quality management program at least once every 12 months;
10. Appoint an acting administrator if the administrator is expected to be absent for more than 30 days;
7. Designate an acting administrator, in writing, who has the qualifications established in subsection (A)(2)(b) if the administrator is:
a. Expected not to be present on a hospital’s premises for more than 30 calendar days, or
b. Not present on a hospital’s premises for more than 30 calendar days;
11.8. Except if subsection (A)(10) applies Except as provided in subsection (A)(7), notify the Department in writing within five working days according to A.R.S. § 36-425(I), if there is a change of administrator and identify the name and qualifications of the new administrator; and
12.9. For a health care institution under a single group license, comply ensure that the health care institution complies with the applicable requirements in 9 A.A.C. 10 and 9 A.A.C. 20 this Chapter for the class or subclass of the health care institution; and.
13. Comply with federal and state laws, rules, and local ordinances governing operations of a health care institution.
B. An administrator shall:
1. Be Is directly accountable to the governing authority of a hospital for all the daily operation of the hospital and hospi- tal services and environmental services provided by a or at the hospital;
2. Have Has the authority and responsibility to manage the hospital; and
3. Act as a liaison between the governing authority and personnel; and
4.3. Designate Except as provided in subsection (A)(7), shall designate, in writing, an individual who is present on a hos- pital’s premises and available and accountable for hospital services and environmental services when the administra- tor is not available; present on the hospital’s premises.
C. An administrator shall require ensure that:
1. Hospital policies Policies and procedures are established, documented, and implemented that:
a. Include personnel Cover job descriptions, duties, and qualifications including required skills and knowledge for personnel members, employees, volunteers, and students;
b. Cover orientation and inservice in-service education for personnel members, employees, volunteers, and stu- dents;
c. Include duties of volunteers and students;
d.c. Include how a personnel member may submit a complaint relating to patient care;
e.d. Cover cardiopulmonary resuscitation training required in R9-10-206(6) R9-10-206(5) including:
i. The method and content of cardiopulmonary resuscitation training,
ii. The qualifications for an individual to provide cardiopulmonary resuscitation training,
iii. The time-frame for renewal of cardiopulmonary resuscitation training, and
iv. The documentation that verifies personnel have an individual has received cardiopulmonary resuscitation training;
f.e. Cover use of private duty staff, if applicable;
g.f. Cover diversion, including:
i. The criteria for initiating diversion;
ii. The categories or levels of personnel or medical staff that may authorize or terminate diversion;
iii. The method for notifying emergency medical services providers of initiation of diversion, the type of diver- sion, and termination of diversion; and
iv. When the need for diversion will be reevaluated;
h.g. Include a method to identify a patient to ensure the patient receives medical hospital services as ordered;
i.h. Cover patient rights including assisting a patient who does not speak English or who has a disability to become aware of patient rights;
j.i. Cover health care directives;
k.j. Cover medical records, including electronic medical records;
l.k. Cover quality management, including incident report and supporting documentation;
l. Cover contracted services;
m. Cover tissue and organ procurement and transplant; and
n. Cover hospital visitation, including visitations to when an individual may visit a patient in a hospital, including visiting a neonate in a nursery, if applicable;
2. Hospital policies Policies and procedures for hospital services are established, documented, and implemented that:
a. Cover patient screening, admission, transport, transfer, discharge planning, and discharge;
b. Cover the provision of hospital services;
b.c. Cover acuity, including a process for obtaining sufficient nursing personnel to meet the needs of patients at all times;
c.d. Include when general consent and informed consent is are required;
d.e. Include the age criteria for providing hospital services to pediatric patients;
e.f. Cover dispensing, administering, and disposing of medication;
f.g. Cover infection control;
g.h. Cover restraints that require an order, including the frequency of monitoring and assessing the restraint;
h.i. Cover seclusion of a patient including:
i. The requirements for an order, and
ii. The frequency of monitoring and assessing a patient in seclusion;
i.j. Cover telemedicine, if applicable; and
j.k. Cover environmental services that affect patient care;
3. Hospital policies Policies and procedures are reviewed at least once every 36 months and updated as needed;
4. Hospital policies Policies and procedures are available to personnel members and medical staff;
5. Licensed The licensed capacity in an organized service is not exceeded except for an emergency admission of a patient. If the licensed capacity of an organized service is exceeded:
a. A medical staff member reviews the medical history of a patient scheduled to be admitted to the organized ser- vice to determine whether the admission is an emergency, and
b. A patient is not admitted to the organized service except in an emergency;
6. A patient is free from:
a. The intentional infliction of physical, mental, or emotional pain unrelated to the patient's medical condition;
b. Exploitation;
c. Seclusion or restraint if not medically indicated or necessary to prevent harm to self or others;
d. Sexual abuse according to A.R.S. § 13-1404; and
e. Sexual assault according to A.R.S. § 13-1406.
6. A patient is only admitted to an organized service that has exceeded the organized service’s licensed capacity after a medical staff member reviews the medical history of the patient and determines that the patient’s admission is an emergency; and
7. Unless otherwise stated:
a. Documentation required by this Article is provided to the Department within two hours after a Department request; and
b. When documentation or information is required by this Chapter to be submitted on behalf of a hospital, the doc- umentation or information is provided to the unit in the Department that is responsible for licensing and monitor- ing the hospital.
D. An administrator of a special hospital shall require ensure that:
1. Medical services are available to an inpatient in an emergency based on the inpatient's medical conditions and the medical scope of services provided by the special hospital; and
2. A physician or a nurse, qualified in cardiopulmonary resuscitation, is on the hospital premises at all times.
E. An administrator of a hospital that meets the definition of “abortion clinic” in A.R.S. § 36-449.01 shall require that abor-
tions and related services are provided in compliance with the requirements in 9 A.A.C. 10,Article 15.
R9-10-204. Quality Management
A. A governing authority shall require ensure that an ongoing quality management program is established that:
1. Complies with the requirements in A.R.S. § 36-445;, and
2. Evaluates the quality of hospital services and environmental services related to patient care.
B. An administrator shall require ensure that:
1. A plan is established, documented, and implemented for an ongoing quality management program that, at a mini- mum, includes:
a. A method to identify, document, and evaluate incidents;
b. A method to collect data to evaluate hospital services and environmental services related to patient care;
c. A method to evaluate the data collected to identify a concern about the delivery of hospital services or environ- mental services related to patient care;
d. A method to make changes or take action as a result of the identification of a concern about the delivery of hos- pital services or environmental services related to patient care;
e. A method to identify and document each occurrence of exceeding licensed capacity, as described in R9-10- 203(C)(5), and to evaluate the occurrences of exceeding licensed capacity, including the actions taken for resolv- ing occurrences of exceeding licensed capacity; and
f. The frequency of submitting a documented report required in subsection (B)(2) to the governing authority;
2. A documented report is submitted to the governing authority that includes:
a. An identification of each concern about the delivery of hospital services or environmental services related to patient care, and
b. Any changes made or actions taken as a result of the identification of a concern about the delivery of hospital ser- vices or environmental services related to patient care;
3. The acuity plan required in R9-10-208(C)(2) R9-10-214(C)(2) is reviewed and evaluated every 12 months and the results are documented and reported to the governing authority; and
4. The reports required in subsections (B)(2) and (3) and the supporting documentation for the reports are:
a. Maintained on the hospital premises maintained for 12 months from after the date the report is submitted to the governing authority; and
b.5. Except for information or documents documentation that are is confidential under federal or state law, a report or doc- umentation required in this Section is provided to the Department for review as soon as possible after a Department request but not more than four hours from the time of the request within two hours after the Department’s request.
R9-10-205. Contracted Services
An administrator shall require ensure that:
1. Contracted services are provided according to the requirements in this Article, and
2. A contract includes the responsibilities of each contractor;
3.2. A documented list of current contracted services is maintained at the hospital that includes a description of the con- tracted services provided; and.
4. A contract and the list of contracted services required in subsection (3) is provided to the Department for review as soon as possible after a Department request but not more than four hours from the time of the request.
R9-10-206. Personnel
An administrator shall require that:
1. Personnel are available to meet the needs of a patient based on the acuity plan required in R9-10-208(C)(2);
2. A personnel member who provides medical services or nursing services demonstrates competency and proficiency according to criteria established in hospital policies and procedures for each type of unit and each type of patient to which the personnel member is assigned;
3. Before the initial date of providing hospital services or volunteer service, a personnel member submits one of the fol- lowing as evidence of freedom from infectious pulmonary tuberculosis according to the requirements in R9-10- 229(A)(4):
a. A report of a negative Mantoux skin test;
b. If the individual has had a positive Mantoux skin test for tuberculosis, a physician's written statement that the individual is free from infectious pulmonary tuberculosis; or
c. A report of a negative chest x-ray;
4. Orientation occurs within the first 30 days of providing hospital services or volunteer service and includes:
a. Informing personnel about Department rules for licensing and regulating hospitals and where the rules may be obtained;
b. Reviewing the process by which a personnel member may submit a complaint about patient care to a hospital; and
c. Providing the information required by hospital policies and procedures;
5. Hospital policies and procedures designate the categories of personnel providing medical services or nursing services who are:
a. Required to be qualified in cardiopulmonary resuscitation within 30 days of the individual's starting date; and
b. Required to maintain current qualifications in cardiopulmonary resuscitation;
6. Documentation of current qualifications in cardiopulmonary resuscitation is maintained at the hospital;
7. A personnel record for each personnel member is maintained electronically or in writing or a combination of both and includes:
a. Verification by the personnel member of receipt of the position job description for the position held by the per- sonnel member;
b. The personnel member's starting date;
c. Verification of a personnel member's certification, license, or education, if necessary for the position held;
d. Verification of current cardiopulmonary resuscitation qualifications, if necessary for the position held; and
e. Orientation documentation;
8. Personnel receive inservice education according to criteria established in hospital policies and procedures;
9. Inservice education documentation for each personnel member includes:
a. The subject matter;
b. The date of the inservice education; and
c. The signature, rubber stamp, or electronic signature code of each individual who participated in the inservice education;
10. Personnel records and inservice education documentation are maintained by the hospital for at least two years after the last date the personnel member worked; and
11. Personnel records and inservice education documentation are provided upon request to the Department for review:
a. For a current personnel member, as soon as possible but not more than four hours from the time of the Depart- ment's request; and
b. For a personnel member who is not currently working in the hospital, within 24 hours of the Department's request.
An administrator shall ensure that:
1. The qualifications, skills, and knowledge required for each type of personnel member:
a. Are based on:
i. The type of physical health services or behavioral health services expected to be provided by the personnel member according to the established job description, and
ii. The acuity of the patients receiving physical health services or behavioral health services from the personnel member according to the established job description; and
b. Include:
i. The specific skills and knowledge necessary for the personnel member to provide the expected physical health services and behavioral health services listed in the established job description,
ii. The type and duration of education that may allow the personnel member to acquire the specific skills and knowledge for the personnel member to provide the expected physical health services or behavioral health services listed in the established job description, and
iii. The type and duration of experience that may allow the personnel member to acquire the specific skills and knowledge for the personnel member to provide the expected physical health services or behavioral health services listed in the established job description;
2. A personnel member’s skills and knowledge are verified and documented:
a. Before the personnel member provides physical health services or behavioral health services, and
b. According to policies and procedures;
3. Personnel members are present on a hospital’s premises with the qualifications, skills, and knowledge necessary to:
a. Provide the services in the hospital’s scope of services,
b. Meet the needs of a patient, and
c. Ensure the health and safety of a patient;
4. Orientation occurs within the first 30 calendar days after a personnel member begins providing hospital services and includes:
a. Informing a personnel member about Department rules for licensing and regulating hospitals and where the rules may be obtained,
b. Reviewing the process by which a personnel member may submit a complaint about patient care to a hospital, and
c. Providing the information required by policies and procedures;
5. Policies and procedures designate the categories of personnel providing medical services or nursing services who are:
a. Required to be qualified in cardiopulmonary resuscitation within 30 calendar days after the individual's starting
date, and
b. Required to maintain current qualifications in cardiopulmonary resuscitation;
6. A personnel record for a personnel member is established and maintained and includes:
a. The personnel member’s name, date of birth, home address, and contact telephone number;
b. The personnel member's starting date;
c. Verification of a personnel member's certification, license, or education, if necessary for the position held;
d. Documentation of evidence of freedom from infectious tuberculosis required in R9-10-230(A)(5);
e. Verification of current cardiopulmonary resuscitation qualifications, if necessary for the position held; and
f. Orientation documentation;
7. Personnel receive in-service education according to criteria established in policies and procedures;
8. In-service education documentation for each personnel member includes:
a. The subject matter;
b. The date of the in-service education; and
c. The signature, rubber stamp, or electronic signature code of each individual who participated in the in-service education;
9. Personnel records and in-service education documentation are maintained by the hospital for at least two years after the last date the personnel member worked; and
10. Personnel records and in-service education documentation, for a personnel member who has not worked in the hospi- tal during the previous 12 months, are provided to the Department within 72 hours after the Department's request.
R9-10-207. Medical Staff
A. A governing authority shall require ensure that:
1. The organized medical staff is directly accountable to the governing authority for the quality of care provided by a medical staff member to a patient in a hospital;
2. The medical staff bylaws and medical staff regulations are approved according to the medical staff bylaws and gov- erning authority requirements;
3. A medical staff member complies with medical staff bylaws and medical staff regulations;
4. The medical staff of a general hospital or a special hospital includes at least two physicians who have clinical privi- leges to admit patients inpatients to the general hospital or special hospital;
5. The medical staff of a rural general hospital includes at least one physician who has clinical privileges to admit patients inpatients to the rural general hospital and one additional physician who serves on a committee according to subsection (A)(7)(c);
6. A medical staff member is available to direct patient care;
7. Medical staff bylaws or medical staff regulations are established, documented, and implemented for the process of:
a. Conducting peer review according to A.R.S. Title 36, Chapter 4, Article 5;
b. Appointing members to the medical staff, subject to approval by the governing authority;
c. Establishing committees including identifying the purpose and organization of each committee;
d. Appointing one or more medical staff members to a committee;
e. Obtaining and documenting permission for an autopsy of a patient, performing an autopsy, and notifying, if applicable, the attending physician medical practitioner coordinating the patient’s medical services when an autopsy is performed;
f. Requiring that each inpatient has an attending physician a medical practitioner who coordinates the inpatient’s care;
g. Defining the responsibilities of a medical staff member to provide medical services to the medical staff member's patient;
h. Defining a medical staff member's responsibilities for the transport or transfer of a patient;
i. Specifying requirements for oral, telephone, and electronic orders including which orders require identification of the time of the order;
j. Establishing a time-frame for a medical staff member to complete a patient’s medical records;
k. Establishing criteria for granting, denying, revoking, and suspending clinical privileges;
l. Specifying pre-anesthesia and post-anesthesia responsibilities for medical staff members; and
m. Approving the use of medication and devices under investigation by the U.S. Department of Health and Human Services, Food and Drug Administration including:
i. Establishing criteria for patient selection;
ii. Obtaining informed consent before administering the investigational medication or device; and
iii. Documenting the administration of and, if applicable, the adverse reaction to an investigational medication or device; and
8. The organized medical staff reviews the medical staff bylaws and the medical staff regulations at least once every 36 months and updates the bylaws and regulations as needed.
B. An administrator shall require ensure that:
1. By October 1, 2003, a medical staff member submits one of the following as evidence of freedom from infectious pulmonary tuberculosis according to the requirements in R9-10-229(A)(4):
a. A report of a negative Mantoux skin test;
b. If the individual has had a positive Mantoux skin test for tuberculosis, a physician's written statement that the individual is free from infectious pulmonary tuberculosis; or
c. A report of a negative chest x-ray;
1. A medical staff member provides evidence of freedom from infectious tuberculosis according to the requirements in R9-10-230(A)(5);
2. A record for each medical staff member is established and maintained electronically or in writing or a combination of both that includes:
a. A completed application for clinical privileges;
b. The dates and lengths of appointment and reappointment of clinical privileges;
c. The specific clinical privileges granted to the medical staff member, including revision or revocation dates for each clinical privilege; and
d. A verification of current Arizona health care professional active license according to A.R.S. Title 32; and
3. Except for documentation of peer review conducted according to A.R.S. § 36-445, a record under subsection (B)(2) is provided to the Department for review:
a. As soon as possible but not more than two hours from after the time of the Department's request if the individual is a current medical staff member; and
b. Within 72 hours from after the time of the Department's request if the individual is no longer a current medical staff member.
R9-10-210. R9-10-208. Admission Admissions
An administrator shall require ensure that:
1. A patient is admitted as an inpatient on the order of a medical staff member;
2. An individual, authorized by hospital policies and procedures, is available at all times to accept a patient for admis- sion;
3. Except in an emergency, informed consent is obtained from a patient or the patient's representative before or at the time of admission;
4. The informed consent obtained in subsection (3) or the lack of consent in an emergency is documented in the patient's medical record;
5. A physician or other medical staff member performs a medical history and physical examination on a patient within 30 calendar days before admission or within 48 hours after admission and documents the medical history and physi- cal examination in the patient's medical record within 48 hours of after admission; and
6. If a physician or a medical staff member performs a medical history and physical examination on a patient before admission, the physician or the medical staff member enters an interval note into the patient's medical record at the time of admission.
R9-10-211. R9-10-209. Discharge Planning; Discharge
A. For an inpatient, an administrator shall require ensure that discharge planning:
1. Identifies the specific needs of the patient after discharge, if applicable;
2. Includes the participation of the patient or the patient's representative;
3. Is completed before discharge occurs;
4. Provides the patient or the patient's representative with written information identifying classes or subclasses of health care institutions and the level of care that the health care institutions provide that may meet the patient's assessed and anticipated needs after discharge, if applicable; and
5. Is documented in the patient's medical record.
B. For an inpatient discharge or a transfer of an inpatient, an administrator shall require ensure that:
1. There is a discharge summary that includes:
a. A description of the patient's medical condition and the medical services provided to the patient; and
b. The signature of the patient’s attending physician or the attending physician's designee medical practitioner coor- dinating the patient’s medical services;
2. There is a documented discharge order by the attending physician or the attending physician's designee for the patient by a medical practitioner coordinating the patient’s medical services before discharge unless the patient leaves the hospital against a medical staff member's advice; and
3. If the patient is discharged to any location other than a health care institution not being transferred:
a. There are documented discharge instructions; and
b. The patient or the patient's representative is provided with a copy of the discharge instructions;.