Ariz. Admin. Code § 9-10-1031

Current through Register Vol. 30, No. 45, November 8, 2024

Section R9-10-1031 - Colocation Requirements

A. In addition to the definitions in A.R.S. §§ 36-401 and 36-439 and R9-10-101 and R9-10-1001, the following definition applies in this Section:

"Patient" means an individual who enters the premises of a collaborating outpatient treatment center to obtain physical health services or behavioral health services from the collaborating outpatient treatment center or a colocator that shares areas of the collaborating outpatient treatment center's premises.

B. Only one outpatient treatment center in a facility may be designated as a collaborating outpatient treatment center for the facility.

C. The following health care institutions are not permitted to be a collaborating outpatient treatment center or a colocator in a collaborating outpatient treatment center:

1. An affiliated counseling facility;

2. An outpatient treatment center authorized by the Department to provide dialysis services according to R9-10-1018;

3. An outpatient treatment center authorized by the Department to provide emergency room services according to R9-10-1019; or

4. An outpatient treatment center operating under a single group license according to A.R.S. § 36-422(F) or (G).

D. In addition to the requirements for a license application in R9-10-105, a governing authority of an outpatient treatment center requesting authorization to operate or continue to operate as a collaborating outpatient treatment center shall submit, in a Department-provided format:

1. The following information for each proposed colocator that may share an area of the collaborating outpatient treatment center's premises and nontreatment personnel at the collaborating outpatient treatment center:

a. For each proposed associated licensed provider:

i. Name,

ii. The associated licensed provider's license number or the date the associated licensed provider submitted to the Department a license application for an outpatient treatment center or a counseling facility license,

iii. Proposed scope of services, and

iv. A copy of the written agreement with the collaborating outpatient treatment center required in subsection (E); and

b. For each exempt health care provider:

i. Name,

ii. Current health care professional license number,

iii. Proposed scope of services, and

iv. A copy of the written agreement required in subsection (F) with the collaborating outpatient treatment center; and

2. In addition to the requirements in R9-10-105(A)(5)(b)(vi), a floor plan that shows:

a. Each colocator's proposed treatment area, and

b. The areas of the collaborating outpatient treatment center's premises shared with a colocator.

E. An administrator of a collaborating outpatient treatment center shall have a written agreement with each associated licensed provider that includes:

1. In a Department-provided format:

a. The associated licensed provider's name;

b. The name of the associated licensed provider's governing authority;

c. Whether the associated licensed provider plans to share medical records with the collaborating outpatient treatment center;

d. If the associated licensed provider plans to share medical records with the collaborating outpatient treatment center, specific information about which party will obtain a patient's:

i. General consent or informed consent, as applicable;

ii. Consent to allow a colocator access to the patient's medical record; and

iii. Advance directives;

e. How the associated licensed provider will transport or transfer a patient to another colocator within the collaborating outpatient treatment center;

f. How the associated licensed provider will ensure controlled substances stored in the associated licensed provider's licensed premises are not diverted;

g. How the associated licensed provider will ensure environmental services in the associated licensed provider's licensed premises will not affect patient care in the collaborating outpatient treatment center;

h. How the associated licensed provider's personnel members will respond to a patient's sudden, intense, or out-of-control behavior, in the associated licensed provider's treatment area, to prevent harm to the patient or another individual in the collaborating outpatient treatment center;

i. A statement that, if any of the colocators include children's behavioral health services in the colocator's scope of services, the associated licensed provider will ensure that all employees and personnel members of the associated licensed provider comply the fingerprint clearance card requirements in A.R.S. § 36-425.03;

j. A statement that the associated licensed provider will:

i. Document the following each time another colocator provides emergency health care services in the associated licensed provider's treatment area:

(1) The name of the colocator;

(2) If different from the name of the colocator, the name of the physician, physician assistant, registered nurse practitioner, or behavioral health professional providing the emergency health care services;

(3) A description of the emergency health care services provided; and

(4) The date and time the emergency health care services were provided;

ii. Maintain the documentation in subsection (E)(1)(j)(i) for at least 12 months after the emergency health care services were provided; and

iii. Submit a copy of the documentation to the collaborating outpatient treatment center within 48 hours after the provision of the emergency health care services;

k. A statement that the associated licensed provider will:

i. Document the following each time the associated licensed provider provides emergency health care services in another colocator's treatment area:

(1) If different from the name of the associated licensed provider, the name of the physician, physician assistant, registered nurse practitioner, or behavioral health professional providing the emergency health care services;

(2) The name of the colocator;

(3) A description of the emergency health care services provided; and

(4) The date and time the emergency health care services were provided;

ii. Maintain the documentation in subsection (E)(1)(k)(i) for at least 12 months after the emergency health care services were provided; and

iii. Submit a copy of the documentation to the collaborating outpatient treatment center within 48 hours after the provision of the emergency health care services;

l. An attestation that the associated licensed provider will comply with the written agreement;

m. The signature of the associated licensed provider's governing authority according to A.R.S. § 36-422(B) and the date signed; and

n. The signature of the collaborating outpatient treatment center's governing authority according to A.R.S. § 36-422(B) and the date signed; and

2. A copy of the associated licensed provider's scope of services, including whether the associated licensed provider plans to provide behavioral health services for children.

F. An administrator of a collaborating outpatient treatment center shall have a written agreement with each exempt health care provider that includes:

1. In a Department-provided format:

a. The exempt health care provider's name;

b. The exempt health care provider license type and license number;

c. Whether the exempt health care provider plans to share medical records with the collaborating outpatient treatment center;

d. If the exempt health care provider plans to share medical records with the collaborating outpatient treatment center, specific information about which party will obtain a patient's:

i. General consent or informed consent, as applicable;

ii. Consent to allow a colocator access to the patient's medical record; and

iii. Advance directives;

e. How the exempt health care provider will transport or transfer a patient to another colocator within the collaborating outpatient treatment center;

f. How the exempt health care provider will ensure controlled substances stored in the exempt health care provider's designated premises are not diverted;

g. How the exempt health care provider will ensure environmental services in the exempt health care provider's licensed premises will not affect patient care in the collaborating outpatient treatment center;

h. How the exempt health care provider and any staff of the exempt health care provider will respond to a patient's sudden, intense, or out-of-control behavior, in the exempt health care provider's treatment area, to prevent harm to the patient or another individual in the collaborating outpatient treatment center;

i. A statement that, if any of the colocators include children's behavioral health services in the colocator's statement of services, the exempt health care provider will ensure that all employees and staff of the exempt health care provider comply with the fingerprint clearance card requirements A.R.S. § 36-425.03;

j. A statement that the exempt health care provider will:

i. Document the following each time another colocator provides emergency health care services in the exempt health care provider's treatment area:

(1) The name of the colocator;

(2) If different from the name of the colocator, the name of the physician, physician assistant, registered nurse practitioner, or behavioral health professional providing the emergency health care services;

(3) A description of the emergency health care services provided; and

(4) The date and time the emergency health care services were provided;

ii. Maintain the documentation in subsection (F)(1)(j)(i) for at least 12 months after the emergency health care services were provided; and

iii. Submit a copy of the documentation to the collaborating outpatient treatment center within 48 hours after the provision of the emergency health care services;

k. A statement that the exempt health care provider will:

i. Document the following each time the exempt health care provider provides emergency health care services in another colocator's treatment area:

(1) If different from the name of the exempt health care provider, the name of the physician, physician assistant, registered nurse practitioner, or behavioral health professional providing the emergency health care services;

(2) The name of the colocator;

(3) A description of the emergency health care services provided; and

(4) The date and time the emergency health care services were provided;

ii. Maintain the documentation in subsection (F)(1)(k)(i) for at least 12 months after the emergency health care services were provided; and

iii. Submit a copy of the documentation to the collaborating outpatient treatment center within 48 hours after the provision of the emergency health care services;

l. An attestation that the exempt health care provider will comply with the written agreement;

m. The signature of the exempt health care provider and the date signed; and

n. The signature of the collaborating outpatient treatment center's governing authority according to A.R.S. § 36-422(B) and the date signed; and

2. A copy of the exempt health care provider's scope of services, including whether the exempt health care provider plans to provide behavioral health services for children.

G. As part of the policies and procedures required in this Article, an administrator of a collaborating outpatient treatment center shall ensure that policies and procedures are established, documented, and implemented to protect the health and safety of a patient based on the scopes of services of all colocators that:

1. Cover job descriptions, duties, and qualifications, including required skills, knowledge, education, and experience for nontreatment personnel who may provide services in the areas of the collaborating outpatient treatment center's premises shared with a colocator;

2. Cover orientation and in-service education for nontreatment personnel who may provide services in the areas of the collaborating outpatient treatment center's premises shared with a colocator;

3. Cover cardiopulmonary resuscitation training, including:

a. The method and content of cardiopulmonary resuscitation training, which includes a demonstration of the individual's ability to perform cardiopulmonary resuscitation;

b. The qualifications for an individual to provide cardiopulmonary resuscitation training;

c. The time-frame for renewal of cardiopulmonary resuscitation training; and

d. The documentation that verifies that an individual has received cardiopulmonary resuscitation training;

4. Cover first aid training;

5. Cover patient screening, including a method to ensure that, if a patient identifies a specific colocator, the patient is directed to the identified colocator;

6. Cover the provision of emergency treatment to protect the health and safety of a patient or individual present in an area of the collaborating outpatient treatment center's premises shared with a colocator according to the requirements for emergency treatment policies and procedures in R9-10-1029(A);

7. If medication is stored in an area of the collaborating outpatient treatment center's premises shared with a colocator, cover obtaining, storing, accessing, and disposing of medications, including provisions for controlling inventory and preventing diversion of controlled substances;

8. Cover biohazardous wastes, if applicable;

9. Cover environmental services in an area of the collaborating outpatient treatment center's premises shared with a colocator that affect patient care; and

10. Cover how personnel members and nontreatment personnel will respond to a patient's sudden, intense, or out-of-control behavior to prevent harm to the patient or another individual in an area of the collaborating outpatient treatment center's premises shared with a colocator.

H. An administrator of a collaborating outpatient treatment center shall ensure that:

1. Areas of the collaborating outpatient treatment center's premises shared with a colocator are:

a. Sufficient to accommodate the outpatient treatment center's and any colocators' scopes of services;

b. Cleaned and disinfected according to the outpatient treatment center's policies and procedures to prevent, minimize, and control illness and infection; and

c. Free from a condition or situation that may cause an individual to suffer physical injury;

2. A written log is maintained that documents the date, time, and circumstances each time a colocator provides emergency health care services in another colocator's designated treatment area; and

3. The documentation in the written log required in subsection (H)(2) is maintained for at least 12 months after the date the colocator provides emergency health care services in another colocator's designated treatment area.

I. If any colocator at a collaborating outpatient treatment center includes children's behavioral health services as part of the colocator's scope of services, an administrator of the collaborating outpatient treatment center shall ensure that the governing authority, employees, personnel members, nontreatment personnel, and volunteers of the collaborating outpatient treatment center comply with the fingerprint clearance card requirements in A.R.S. § 36-425.03.

Ariz. Admin. Code § R9-10-1031

Adopted by exempt rule making at 22 A.A.R. 1035, effective 5/1/2016. Amended by final rulemaking at 25 A.A.R. 1583, effective 10/1/2019.