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Regulating facilities where Arizonans receive services is a key, one might say cornerstone, function of a state health department. When a state health department is doing a good job regulating facilities like nursing homes, assisted living centers, behavioral health facilities, outpatient treatment clinics and the like, journalists’ stories are generally about how a facility did poorly on an inspection and highlight agency enforcement actions.

It’s an altogether different story when an agency deprioritizes their assurance and licensure mission. When that happens, journalists end up writing about poor regulation and unchecked substandard care.

That’s precisely what happened toward the end of the prior administration when ADHS licensing programs continued to atrophy until the Arizona Auditor General exposed gross nonfeasance on the part of the agency.

See ‘The Bitter End’ Series by Caitlin McGlade & Sahana Jayaraman: How The Arizona Republic reported on resident harm in senior living facilities & Licensing & Regulating Care Facilities: A Root Cause Analysis of Arizona’s Failure to Protect Vulnerable Persons & Pathway to Redemption

Legislators are rightfully frustrated by what they’re hearing from constituents and reading in the newspaper and are proposing several bills that would help the ADHS do a better job regulating institutions over the long run.

One focused on regulatory reform continued its advance this week (HB2764) while a sister bill that focused on internal accountability (e.g. incident reporting and allowing for limited elective electronic monitoring) died (HB2653).

HB2764 long-term care; enforcement; passed out of Senate Health this week with a unanimous pass recommendation. If it passes the Senate floor and is signed by the Governor, it would:

• Require in person agency inspections of health care institutions that aren’t in substantial compliance with licensure requirements.
• Stop ADHS from accepting an accreditation report in lieu of a compliance inspection for assisted living and skilled nursing care facilities (unless the institution is owned by a hospital). Deficiency free facilities would enjoy a two-year reprieve from ADHS compliance surveys.
• Increase the cap on civil penalties for violation of health care institution statutes or rules from $500 to $1,000 per resident/patient.
• Void a health care institution license if they don’t pay civil penalties or provider agreement fees before the due date.
• Let ADHS to pursue enforcement action against a licensee, even if they’re in the process of being sold or has closed.
• Let ADHS deny a new license application current licensee while enforcement action is pending if patient safety may be in jeopardy due to the licensee’s actions or if the change in ownership would jeopardize patient safety (i.e. prevents ‘license flipping’ to avoid accountability).

ADHS and AHCCCS signed up in favor of the bill – signaling that if it’s unchanged and passes the full Senate the Governor may sign the package.

Major Arizona assisted living reform proposal blocked despite widespread stakeholder support

Meanwhile, the long-term care industry killed HB2653 long-term care; reporting; monitoring; injury this week by denying it a hearing in the Senate Health committee before last week’s deadline.

That bill would have allowed for limited and optional electronic monitoring of some areas of a facility (with resident and roommate consent) and required more reporting of abuse, neglect, or exploitation of vulnerable adults in facilities.