ARIZONA.  Arizona Revised Statutes.  

 

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Title 13.  Criminal Code

 

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13-3603. Definition; punishment [These provisions have been held to be unconstitutional and unenforceable.]

A person who provides, supplies or administers to a pregnant woman, or procures such woman to take any medicine, drugs or substance, or uses or employs any instrument or other means whatever, with intent thereby to procure the miscarriage of such woman, unless it is necessary to save her life, shall be punished by imprisonment in the state prison for not less than two years nor more than five years.

 

13-3603.01. Partial-birth abortions; classification; civil action; definitions  [These provisions have been held to be unconstitutional and unenforceable.  However, there is also a Federal Abortion Ban, which applies nationwide.  The federal ban prohibits the performance of certain second trimester abortions and does not contain an exception for a woman's health.]

A. A person who knowingly performs a partial-birth abortion and who kills a human fetus is guilty of a class 6 felony.

B. This section does not apply to a partial-birth abortion that is necessary to save the life of a mother whose life is endangered by a physical disorder, illness or injury if no other medical procedure would save the mother's life.

C. The father of the fetus if married to the mother at the time she receives a partial-birth abortion and the maternal grandparents of the fetus if the mother is not at least eighteen years of age at the time of the partial-birth abortion may bring a civil action to obtain appropriate relief unless the pregnancy resulted from the plaintiff's criminal conduct or the plaintiff consented to the partial-birth abortion. Relief pursuant to this subsection includes the following:

1. Monetary damages for all injuries resulting from the partial-birth abortion, including psychological and physical damages.

2. Damages in an amount equal to three times the cost of the partial-birth abortion.

D. This section does not subject a woman upon whom a partial-birth abortion is performed to criminal prosecution or civil liability under this section.

E. For the purposes of this section:

1. "Partial-birth abortion" means an abortion in which the person performing the abortion partially vaginally delivers a living fetus before killing the fetus and completing the delivery.

2. "Person" includes a physician who is licensed pursuant to title 32, chapter 13 or 17, a person who is legally authorized by this state to perform abortions or a person who is not legally authorized by this state to perform abortions but who directly performs a partial-birth abortion.

 

13-3604. Soliciting abortion; punishment; exception   [These provisions have been held to be unconstitutional and unenforceable.]

A woman who solicits from any person any medicine, drug or substance whatever, and takes it, or who submits to an operation, or to the use of any means whatever, with intent thereby to procure a miscarriage, unless it is necessary to preserve her life, shall be punished by imprisonment in the state prison for not less than one nor more than five years.

 

13-3605. Advertising to produce abortion or prevent conception; punishment  [These provisions have been held to be unconstitutional and unenforceable.]

A person who wilfully writes, composes or publishes a notice or advertisement of any medicine or means for producing or facilitating a miscarriage or abortion, or for prevention of conception, or who offers his services by a notice, advertisement or otherwise, to assist in the accomplishment of any such purposes, is guilty of a misdemeanor.

 

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Title 15. Education

 

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15-1630. Abortion at educational facility prohibited; exception

No abortion shall be performed at any facility under the jurisdiction of the Arizona board of regents unless such abortion is necessary to save the life of the woman having the abortion.

 

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Title 32.  Professions and Occupations

 

32-2501.  Definitions  

In this chapter, unless the context otherwise requires:

1. "Active license" means a regular or temporary license issued pursuant to this chapter.

2. "Adequate records" means legible medical records containing, at a minimum, sufficient information to identify the patient, support the diagnosis, justify the treatment, accurately document the results, indicate advice and cautionary warnings provided to the patient and provide sufficient information for another practitioner to assume continuity of the patient's care at any point in the course of treatment.

3. "Advisory letter" means a nondisciplinary letter to notify a physician assistant that either:

(a) While there is insufficient evidence to support disciplinary action, the board believes that continuation of the activities that led to the investigation may result in further board action against the licensee.

(b) The violation is a minor or technical violation that is not of sufficient merit to warrant disciplinary action.

(c) While the licensee has demonstrated substantial compliance through rehabilitation or remediation that has mitigated the need for disciplinary action, the board believes that repetition of the activities that led to the investigation may result in further board action against the licensee.

4. "Approved program" means a physician assistant educational program that has been fully or provisionally accredited by the committee on allied health education and accreditation or by the commission on the accreditation for allied health education programs, or successor agencies, on the recommendation of the accreditation review committee on education for physician assistants.

5. "Board" means the Arizona regulatory board of physician assistants.

6. "Completed application" means an application for which the applicant has supplied all required fees, information and correspondence requested by the board on forms and in a manner acceptable to the board.

7. "Immediate family" means the spouse, natural or adopted children, father, mother, brothers and sisters of the physician assistant and the natural or adopted children, father, mother, brothers and sisters of the physician assistant's spouse.

8. "Letter of reprimand" means a disciplinary letter that is issued by the board and that informs the physician assistant that the physician assistant's conduct violates state or federal law and may require the board to monitor the physician assistant.

9. "Limit" means a nondisciplinary action that is taken by the board and that alters a physician assistant's practice or medical activities if there is evidence that the physician assistant is or may be mentally or physically unable to safely engage in health care tasks.

10. "Medically incompetent" means that a physician assistant lacks sufficient medical knowledge or skills, or both, in performing delegated health care tasks to a degree likely to endanger the health or safety of patients.

11. "Minor surgery" means those invasive procedures that may be delegated to a physician assistant by a supervising physician, that are consistent with the training and experience of the physician assistant, that are normally taught in courses of training approved by the board and that have been approved by the board as falling within a scope of practice of a physician assistant. Minor surgery does not include a surgical abortion.

12. "Notification of supervision" means a written notice that is provided to the board by a supervising physician and that notifies the board that the physician intends to supervise a physician assistant. The physician shall provide this notice on a form prescribed by the board before the physician assistant begins work.

13. "Physician" means a physician licensed pursuant to chapter 13 or 17 of this title.

14. "Physician assistant" means a person who is licensed pursuant to this chapter and who performs health care tasks pursuant to a dependent relationship with a physician.

15. "Primary place for meeting patients" includes the supervising physician's office, health care institutions in which the supervising physician's patients are located or homes of patients.

16. "Regular license" means a valid and existing license issued pursuant to section 32-2521 to perform health care tasks. Regular license does not include a temporary license.

17. "Restrict" means a disciplinary action that is taken by the board and that alters a physician assistant's practice or medical activities if there is evidence that the physician assistant is or may be medically incompetent or guilty of unprofessional conduct.

18. "Supervising physician" means a physician who holds a current unrestricted license, provides a notification of supervision, assumes legal responsibility for health care tasks performed by the physician assistant and is approved by the board.

19. "Supervising physician's agent" means a physician who holds a current unrestricted license, is a cosignatory on the notification of supervision, agrees to act as the supervising physician in the supervising physician's absence and is approved by the board.

20. "Supervision" means a physician's opportunity or ability to provide or exercise control over the services of a physician assistant. Supervision does not require a physician's constant physical presence if the supervising physician or the supervising physician's agent is or can be easily in contact with the physician assistant by radio, telephone or telecommunication.

21. "Unprofessional conduct" includes the following acts by a physician assistant that occur in this state or elsewhere:

(a) Violation of any federal or state law or rule that applies to the performance of health care tasks as a physician assistant. Conviction in any court of competent jurisdiction is conclusive evidence of a violation.

(b) Claiming to be a physician or knowingly permitting another person to represent that person as a physician.

(c) Performing health care tasks that have not been delegated by the supervising physician.

(d) Habitual intemperance in the use of alcohol or habitual substance abuse.

(e) Signing a blank, undated or predated prescription form.

(f) Gross malpractice, repeated malpractice or any malpractice resulting in the death of a patient.

(g) Representing that a manifestly incurable disease or infirmity can be permanently cured or that a disease, ailment or infirmity can be cured by a secret method, procedure, treatment, medicine or device, if this is not true.

(h) Refusing to divulge to the board on demand the means, method, procedure, modality of treatment or medicine used in the treatment of a disease, injury, ailment or infirmity.

(i) Prescribing or dispensing controlled substances or prescription-only drugs for which the physician assistant is not approved or in excess of the amount authorized pursuant to this chapter.

(j) Any conduct or practice that is or might be harmful or dangerous to the health of a patient or the public.

(k) Violation of a formal order, probation or stipulation issued by the board.

(l) Failing to clearly disclose the person's identity as a physician assistant in the course of the physician assistant's employment.

(m) Failing to use and affix the initials "P.A." or "P.A.-C." after the physician assistant's name or signature on charts, prescriptions or professional correspondence.

(n) Procuring or attempting to procure a physician assistant license by fraud, misrepresentation or knowingly taking advantage of the mistake of another.

(o) Having professional connection with or lending the physician assistant's name to an illegal practitioner of any of the healing arts.

(p) Failing or refusing to maintain adequate records on a patient.

(q) Using controlled substances that have not been prescribed by a physician, physician assistant, dentist or nurse practitioner for use during a prescribed course of treatment.

(r) Prescribing or dispensing controlled substances to members of the physician assistant's immediate family.

(s) Prescribing, dispensing or administering any controlled substance or prescription-only drug for other than accepted therapeutic purposes.

(t) Knowingly making any written or oral false or fraudulent statement in connection with the performance of health care tasks or when applying for privileges or renewing an application for privileges at a health care institution.

(u) Committing a felony, whether or not involving moral turpitude, or a misdemeanor involving moral turpitude. In either case, conviction by a court of competent jurisdiction or a plea of no contest is conclusive evidence of the commission.

(v) Having a certification or license refused, revoked, suspended, limited or restricted by any other licensing jurisdiction for the inability to safely and skillfully perform health care tasks or for unprofessional conduct as defined by that jurisdiction that directly or indirectly corresponds to any act of unprofessional conduct as prescribed by this paragraph.

(w) Having sanctions including restriction, suspension or removal from practice imposed by an agency of the federal government.

(x) Violating or attempting to violate, directly or indirectly, or assisting in or abetting the violation of or conspiring to violate a provision of this chapter.

(y) Using the term "doctor" or the abbreviation "Dr." on a name tag or in a way that leads the public to believe that the physician assistant is licensed to practice as an allopathic or an osteopathic physician in this state.

(z) Failing to furnish legally requested information to the board or its investigator in a timely manner.

(aa) Failing to allow properly authorized board personnel to examine on demand documents, reports and records of any kind relating to the physician assistant's performance of health care tasks.

(bb) Knowingly making a false or misleading statement on a form required by the board or in written correspondence or attachments furnished to the board.

(cc) Failing to submit to a body fluid examination and other examinations known to detect the presence of alcohol or other drugs pursuant to an agreement with the board or an order of the board.

(dd) Violating a formal order, probation agreement or stipulation issued or entered into by the board or its executive director.

(ee) Except as otherwise required by law, intentionally betraying a professional secret or intentionally violating a privileged communication.

(ff) Allowing the use of the licensee's name in any way to enhance or permit the continuance of the activities of, or maintaining a professional connection with, an illegal practitioner of medicine or the performance of health care tasks by a person who is not licensed pursuant to this chapter.

(gg) False, fraudulent, deceptive or misleading advertising by a physician assistant or the physician assistant's staff or representative.

(hh) Knowingly failing to disclose to a patient on a form that is prescribed by the board and that is dated and signed by the patient or guardian acknowledging that the patient or guardian has read and understands that the licensee has a direct financial interest in a separate diagnostic or treatment agency or in nonroutine goods or services that the patient is being prescribed and if the prescribed treatment, goods or services are available on a competitive basis. This subdivision does not apply to a referral by one physician assistant to another physician assistant or to a doctor of medicine or a doctor of osteopathy within a group working together.

(ii) Using chelation therapy in the treatment of arteriosclerosis or as any other form of therapy.

(jj) Prescribing, dispensing or administering anabolic or androgenic steroids for other than therapeutic purposes.

(kk) Prescribing, dispensing or furnishing a prescription medication or a prescription-only device as defined in section 32-1901 to a person unless the licensee first conducts a physical examination of that person or has previously established a professional relationship with the person. This subdivision does not apply to:

(i) A physician assistant who provides temporary patient care on behalf of the patient's regular treating licensed health care professional.

(ii) Emergency medical situations as defined in section 41-1831.

(iii) Prescriptions written to prepare a patient for a medical examination.

(iv) Prescriptions written or antimicrobials dispensed to a contact as defined in section 36-661 who is believed to have had significant exposure risk as defined in section 36-661 with another person who has been diagnosed with a communicable disease as defined in section 36-661 by the prescribing or dispensing physician assistant.

(ll) Engaging in sexual conduct with a current patient or with a former patient within six months after the last medical consultation unless the patient was the licensee's spouse at the time of the contact or, immediately preceding the professional relationship, was in a dating or engagement relationship with the licensee. For the purposes of this subdivision, "sexual conduct" includes:

(i) Engaging in or soliciting sexual relationships, whether consensual or nonconsensual.

(ii) Making sexual advances, requesting sexual favors or engaging in other verbal conduct or physical contact of a sexual nature with a patient.

(iii) Intentionally viewing a completely or partially disrobed patient in the course of treatment if the viewing is not related to patient diagnosis or treatment under current practice standards.

(mm) Performing health care tasks under a false or assumed name in this state.

 

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32-2531.  Health care tasks; scope of practice; restrictions; civil penalty 

A. After a supervising physician receives board approval of a notice of supervision, that physician may delegate health care tasks to the physician assistant. The physician assistant may perform these tasks in any setting authorized by the approved supervising physician and the board, pursuant to subsections E and F of this section, including clinics, hospitals, ambulatory surgical centers, patient homes, nursing homes and other health care institutions. These tasks may include:

1. Obtaining patient histories.

2. Performing physical examinations.

3. Ordering and performing diagnostic and therapeutic procedures.

4. Formulating a diagnostic impression.

5. Developing and implementing a treatment plan.

6. Monitoring the effectiveness of therapeutic interventions.

7. Assisting in surgery.

8. Offering counseling and education to meet patient needs.

9. Making appropriate referrals.

10. Prescribing schedule IV or V controlled substances as defined in the federal controlled substances act of 1970 (P.L. 91-513; 84 Stat. 1242; 21 United States Code section 802) and prescription-only medications.

11. Prescribing schedule II and III controlled substances as defined in the federal controlled substances act of 1970.

12. Performing minor surgery as defined in section 32-2501.

13. Performing other nonsurgical health care tasks that are normally taught in courses of training approved by the board, that are consistent with the training and experience of the physician assistant and that have been properly delegated by the approved supervising physician.

B. The approved supervising physician shall:

1. Meet the requirements established by the board for supervising a physician assistant and receive written board notification of this compliance.

2. Accept responsibility for all tasks and duties the physician delegates to a physician assistant.

3. Notify the board and the physician assistant in writing if the physician assistant exceeds the scope of the delegated health care tasks.

4. Notify the board if the physician has delegated authority to the physician assistant to prescribe medication. The physician shall also notify the board if the physician makes any changes to this authority.

C. Supervision does not require the personal presence of the physician at the place where health care tasks are performed. The board by order may require the personal presence of a physician when designated health care tasks are performed.

D. A physician assistant shall meet in person with the supervising physician at least once each week to discuss patient management. If the supervising physician is unavailable due to vacation, illness or continuing education programs, a physician assistant may meet with the supervising physician's agent. If the supervising physician is unavailable for any other reason, the fulfillment of this responsibility by the supervising physician's agent is subject to board approval.

E. A physician assistant shall not perform health care tasks in a place which is geographically separated from the supervising physician's primary place for meeting patients without the authorization of the supervising physician and the board.

F. The board may approve the performance of health care tasks by a physician assistant in a place which is geographically separated from the supervising physician's primary place for meeting patients if:

1. Adequate provision for immediate communication between the supervising physician or supervising physician's agent and the physician assistant exists.

2. The physician assistant's performance of health care tasks is adequately supervised and reviewed.

3. A printed announcement which contains the names of the physician assistant and supervising physician and states that the facility employs a physician assistant who is performing health care tasks under the supervision of a licensed physician is posted in the waiting room of the geographically separated site.

G. At all times while a physician assistant is on duty, he shall wear a name tag with the designation "physician assistant" on it.

H. The board by rule may prescribe a civil penalty for a violation of this article relating to charting, wearing tags, identifying prescriptions and posting signs in geographically separated locations. The penalty shall not exceed fifty dollars for each violation. The board shall deposit, pursuant to sections 35-146 and 35-147, all monies it receives from this penalty in the state general fund. A physician assistant and the supervising physician may contest the imposition of this penalty pursuant to board rule. The imposition of a civil penalty is public information, and the board may use this information in any future disciplinary actions.

 

Title 35.  Public Finances

 

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35-196.02. Use of public funds for abortion prohibited; exception  [These provisions have been held to be unconstitutional and unenforceable.]

Notwithstanding any provisions of law to the contrary, no public funds nor tax monies of this state or any political subdivision of this state nor any federal funds passing through the state treasury or the treasury of any political subdivision of this state may be expended for payment to any person or entity for the performance of any abortion unless an abortion is necessary to save the life of the woman having the abortion.

 

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Title 36.  Public Health and Safety

 

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36-326. Disposition-transit permits

A. A funeral establishment or responsible person who takes possession of human remains shall obtain a disposition-transit permit from a local registrar, a deputy local registrar or the state registrar before providing final disposition of the human remains.

B. A funeral establishment or responsible person who takes possession of human remains shall obtain a disposition-transit permit from a local registrar, a deputy local registrar or the state registrar before moving the human remains out of this state.

C. Human remains moved from a hospital, nursing care institution or hospice inpatient facility must be accompanied by a form provided by the hospital, nursing care institution or hospice inpatient facility authorizing the release of the human remains. The form shall contain the information required in rules adopted pursuant to this chapter.

D. A funeral establishment or responsible person may move human remains from a hospital, nursing care institution or hospice inpatient facility where death occurred without obtaining a disposition-transit permit if the funeral establishment or responsible person does not remove the human remains from this state and provides notice to the local registrar or deputy local registrar in the registration district where the death occurred within twenty-four hours after moving the human remains.

E. A funeral establishment or responsible person may move human remains from a place other than a hospital, nursing care institution or hospice inpatient facility where death occurred without obtaining a disposition-transit permit if the funeral establishment or responsible person does not remove the human remains from this state and provides notice to the local registrar or deputy local registrar in the registration district where death occurred within seventy-two hours after moving the human remains.

F. A hospital or abortion clinic is not required to obtain a disposition-transit permit if a product of human conception is expelled or extracted at the hospital or abortion clinic and all the following apply:

1. The gestation period of the product of human conception is less than twenty weeks or, if the gestation period is unknown, the weight of the product of human conception is less than three hundred fifty grams.

2. A county medical examiner's investigation is not required.

3. The woman on whom the abortion was performed has authorized the hospital or abortion clinic to dispose of the product of human conception.

G. To obtain a disposition-transit permit, a funeral establishment or responsible person must submit the information required pursuant to this chapter and rules adopted pursuant to this chapter to the state registrar or to the local registrar or deputy local registrar of the registration district where the death occurred.

H. A local registrar, a deputy local registrar or the state registrar shall provide a disposition-transit permit to a funeral establishment or other responsible person if the information provided pursuant to subsection B complies with this chapter and rules adopted pursuant to this chapter.

I. A local registrar, a deputy local registrar or the state registrar shall provide a disposition-transit permit for interment of human remains in a cemetery only if the location of the cemetery has been recorded in the office of the county recorder in the county where the cemetery is located or the cemetery is located on federal or tribal land.

J. A local registrar, a deputy local registrar or the state registrar shall provide a disposition-transit permit issued by this state for the final disposition of human remains in this state on receipt of a disposition-transit permit from another state that accompanies the human remains from the other state.

 

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36-329. Fetal death certificate registration

A. A hospital, abortion clinic, physician or midwife shall submit a completed fetal death certificate to the state registrar for registration within seven days after the fetal death for each fetal death occurring in this state after a gestational period of twenty completed weeks or if the product of human conception weighs more than three hundred fifty grams.

B. The requirements for registering a fetal death certificate are the same as the requirements for registering a death certificate prescribed in section 36-325.

 

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36-431. Violation; classification

A. A person is guilty of a class 3 misdemeanor who:

1. Establishes, operates or maintains any class or subclass of health care institution, as defined in this chapter, unless the person holds a current and valid license for such class or subclass from the department.

2. Knowingly violates any provision of this chapter unless another classification is specifically prescribed in this chapter.

B. Each day that a violation continues shall constitute a separate violation.

 

36-431.01. Violations; civil penalties

A. The director may assess a civil penalty against a person who violates this chapter or a rule adopted pursuant to this chapter in an amount of not to exceed five hundred dollars for each violation. Each day that a violation occurs constitutes a separate violation.

B. The director may issue a notice of assessment that shall include the proposed amount of the assessment. A person may appeal the assessment by requesting a hearing pursuant to title 41, chapter 6, article 10. When an assessment is appealed, the director shall take no further action to enforce and collect the assessment until after the hearing.

C. In determining the civil penalty pursuant to subsection A of this section, the department shall consider the following:

1. Repeated violations of statutes or rules.

2. Patterns of noncompliance.

3. Types of violations.

4. Severity of violations.

5. Potential for and occurrences of actual harm.

6. Threats to health and safety.

7. Number of persons affected by the violations.

8. Number of violations.

9. Size of the facility.

10. Length of time that the violations have been occurring.

D. Pursuant to interagency agreement specified in section 36-409, the director may assess a civil penalty, including interest, in accordance with 42 United States Code section 1396r. A person may appeal this assessment by requesting a hearing before the director in accordance with subsection B of this section. Civil penalty amounts may be established by rules adopted by the director that conform to guidelines or regulations adopted by the secretary of the United States department of health and human services pursuant to 42 United States Code section 1396r.

E. Actions to enforce the collection of penalties assessed pursuant to subsections A and D of this section shall be brought by the attorney general or the county attorney in the name of the state in the justice court or the superior court in the county in which the violation occurred.

F. Penalties assessed under subsection D of this section are in addition to and not in limitation of other penalties imposed pursuant to this chapter. All civil penalties and interest assessed pursuant to subsection D of this section shall be deposited in the nursing care institution resident protection revolving fund established by section 36-431.02. The director shall use these monies for the purposes prescribed by 42 United States Code section 1396r, including payment for the costs of relocation of residents to other facilities, maintenance of operation of a facility pending correction of the deficiencies or closure and reimbursement of residents for personal monies lost.

G. The department shall transmit penalties assessed under subsection A of this section to the state general fund.

 

36-449. Definitions

In this article, unless the context otherwise requires:

1. "Abortion" means the use of a surgical instrument or a machine with the intent to terminate a woman's pregnancy for reasons other than to increase the probability of a live birth, to preserve the life or health of the child after a live birth, to terminate an ectopic pregnancy or to remove a dead fetus. Abortion does not include birth control devices or oral contraceptives.

2. "Abortion clinic" means a facility, other than an accredited hospital, in which first, second or third trimester abortions are performed.

3. "Director" means the director of the department of health services.

4. "Viable fetus" has the same meaning prescribed in section 36-2301.01.

 

36-449.02. Abortion clinics; licensure requirements; rules

A. Beginning on April 1, 2000, an abortion clinic shall meet the same licensure requirements as prescribed in article 2 of this chapter for health care institutions.

B. An abortion clinic that holds an unclassified health care facility license issued before the effective date of this article may retain that classification until April 1, 2000 subject to compliance with all laws that relate to unclassified health care facilities.

C. Beginning on April 1, 2000, abortion clinics shall comply with department requirements for abortion clinics and department rules that govern abortion clinics.

 

36-449.03. Abortion clinics; rules

A. The director shall adopt rules for an abortion clinic's physical facilities. At a minimum these rules shall prescribe standards for:

1. Adequate private space that is specifically designated for interviewing, counseling and medical evaluations.

2. Dressing rooms for staff and patients.

3. Appropriate lavatory areas.

4. Areas for preprocedure hand washing.

5. Private procedure rooms.

6. Adequate lighting and ventilation for abortion procedures.

7. Surgical or gynecologic examination tables and other fixed equipment.

8. Postprocedure recovery rooms that are supervised, staffed and equipped to meet the patients' needs.

9. Emergency exits to accommodate a stretcher or gurney.

10. Areas for cleaning and sterilizing instruments.

11. Adequate areas for the secure storage of medical records and necessary equipment and supplies.

12. The display in the abortion clinic, in a place that is conspicuous to all patients, of the clinic's current license issued by the department.

B. The director shall adopt rules to prescribe abortion clinic supplies and equipment standards, including supplies and equipment that are required to be immediately available for use or in an emergency. At a minimum these rules shall:

1. Prescribe required equipment and supplies, including medications, required for the conduct, in an appropriate fashion, of any abortion procedure that the medical staff of the clinic anticipates performing and for monitoring the progress of each patient throughout the procedure and recovery period.

2. Require that the number or amount of equipment and supplies at the clinic is adequate at all times to assure sufficient quantities of clean and sterilized durable equipment and supplies to meet the needs of each patient.

3. Prescribe required equipment, supplies and medications that shall be available and ready for immediate use in an emergency and requirements for written protocols and procedures to be followed by staff in an emergency, such as the loss of electrical power.

4. Prescribe required equipment and supplies for required laboratory tests and requirements for protocols to calibrate and maintain laboratory equipment at the abortion clinic or operated by clinic staff.

5. Require ultrasound equipment in those facilities that provide abortions after twelve weeks' gestation.

6. Require that all equipment is safe for the patient and the staff, meets applicable federal standards and is checked annually to ensure safety and appropriate calibration.

C. The director shall adopt rules relating to abortion clinic personnel. At a minimum these rules shall require that:

1. The abortion clinic designate a medical director of the abortion clinic who is licensed pursuant to title 32, chapter 13, 17 or 29.

2. Physicians performing surgery are licensed pursuant to title 32, chapter 13 or 17, demonstrate competence in the procedure involved and are acceptable to the medical director of the abortion clinic.

3. A physician with admitting privileges at an accredited hospital in this state is available.

4. If a physician is not present, a registered nurse, nurse practitioner, licensed practical nurse or physician's assistant is present and remains at the clinic when abortions are performed to provide postoperative monitoring and care until each patient who had an abortion that day is discharged.

5. Surgical assistants receive training in counseling, patient advocacy and the specific responsibilities of the services the surgical assistants provide.

6. Volunteers receive training in the specific responsibilities of the services the volunteers provide, including counseling and patient advocacy as provided in the rules adopted by the director for different types of volunteers based on their responsibilities.

D. The director shall adopt rules relating to the medical screening and evaluation of each abortion clinic patient. At a minimum these rules shall require:

1. A medical history including the following:

(a) Reported allergies to medications, antiseptic solutions or latex.

(b) Obstetric and gynecologic history.

(c) Past surgeries.

2. A physical examination including a bimanual examination estimating uterine size and palpation of the adnexa.

3. The appropriate laboratory tests including:

(a) For an abortion in which an ultrasound examination is not performed before the abortion procedure, urine or blood tests for pregnancy performed before the abortion procedure.

(b) A test for anemia.

(c) Rh typing, unless reliable written documentation of blood type is available.

(d) Other tests as indicated from the physical examination.

4. An ultrasound evaluation for all patients who elect to have an abortion after twelve weeks' gestation. The rules shall require that if a person who is not a physician performs an ultrasound examination, that person shall have documented evidence that the person completed a course in the operation of ultrasound equipment as prescribed in rule. The physician or other health care professional shall review, at the request of the patient, the ultrasound evaluation results with the patient before the abortion procedure is performed, including the probable gestational age of the fetus.

5. That the physician is responsible for estimating the gestational age of the fetus based on the ultrasound examination and obstetric standards in keeping with established standards of care regarding the estimation of fetal age as defined in rule and shall write the estimate in the patient's medical history. The physician shall keep original prints of each ultrasound examination of a patient in the patient's medical history file.

E. The director shall adopt rules relating to the abortion procedure. At a minimum these rules shall require:

1. That medical personnel is available to all patients throughout the abortion procedure.

2. Standards for the safe conduct of abortion procedures that conform to obstetric standards in keeping with established standards of care regarding the estimation of fetal age as defined in rule.

3. Appropriate use of local anesthesia, analgesia and sedation if ordered by the physician.

4. The use of appropriate precautions, such as the establishment of intravenous access at least for patients undergoing second or third trimester abortions.

5. The use of appropriate monitoring of the vital signs and other defined signs and markers of the patient's status throughout the abortion procedure and during the recovery period until the patient's condition is deemed to be stable in the recovery room.

F. The director shall adopt rules that prescribe minimum recovery room standards. At a minimum these rules shall require that:

1. Immediate postprocedure care consists of observation in a supervised recovery room for as long as the patient's condition warrants.

2. The clinic arrange hospitalization if any complication beyond the management capability of the staff occurs or is suspected.

3. A licensed health professional who is trained in the management of the recovery area and is capable of providing basic cardiopulmonary resuscitation and related emergency procedures remains on the premises of the abortion clinic until all patients are discharged.

4. A physician with admitting privileges at an accredited hospital in this state remains on the premises of the abortion clinic until all patients are stable and are ready to leave the recovery room and to facilitate the transfer of emergency cases if hospitalization of the patient or viable fetus is necessary. A physician shall sign the discharge order and be readily accessible and available until the last patient is discharged.

5. A physician discusses RhO(d) immune globulin with each patient for whom it is indicated and assures it is offered to the patient in the immediate postoperative period or that it will be available to her within seventy-two hours after completion of the abortion procedure. If the patient refuses, a refusal form approved by the department shall be signed by the patient and a witness and included in the medical record.

6. Written instructions with regard to postabortion coitus, signs of possible problems and general aftercare are given to each patient. Each patient shall have specific instructions regarding access to medical care for complications, including a telephone number to call for medical emergencies.

7. There is a specified minimum length of time that a patient remains in the recovery room by type of abortion procedure and duration of gestation.

8. The physician assures that a licensed health professional from the abortion clinic makes a good faith effort to contact the patient by telephone, with the patient's consent, within twenty-four hours after surgery to assess the patient's recovery.

9. Equipment and services are located in the recovery room to provide appropriate emergency resuscitative and life support procedures pending the transfer of the patient or viable fetus to the hospital.

G. The director shall adopt rules that prescribe standards for follow-up visits. At a minimum these rules shall require that:

1. A postabortion medical visit is offered and, if requested, scheduled for three weeks after the abortion, including a medical examination and a review of the results of all laboratory tests.

2. A urine pregnancy test is obtained at the time of the follow-up visit to rule out continuing pregnancy. If a continuing pregnancy is suspected, the patient shall be evaluated and a physician who performs abortions shall be consulted.

H. The director shall adopt rules to prescribe minimum abortion clinic incident reporting. At a minimum these rules shall require that:

1. The abortion clinic records each incident resulting in a patient's or viable fetus' serious injury occurring at an abortion clinic and shall report them in writing to the department within ten days after the incident. For the purposes of this paragraph, "serious injury" means an injury that occurs at an abortion clinic and that creates a serious risk of substantial impairment of a major body organ.

2. If a patient's death occurs, other than a fetal death properly reported pursuant to law, the abortion clinic reports it to the department not later than the next department work day.

3. Incident reports are filed with the department and appropriate professional regulatory boards.

I. The department shall not release personally identifiable patient or physician information.

J. The rules adopted by the director pursuant to this section do not limit the ability of a physician or other health professional to advise a patient on any health issue.

 

36-2151. Right to refuse to participate in abortion

No hospital is required to admit any patient for the purpose of performing an abortion. A physician, or any other person who is a member of or associated with the staff of a hospital, or any employee of a hospital, doctor, clinic, or other medical or surgical facility in which an abortion has been authorized, who shall state in writing an objection to such abortion on moral or religious grounds shall not be required to participate in the medical or surgical procedures which will result in the abortion.

 

36-2152. Parental consent; exception; hearings; time limits; violation; classification; definitions

A. A person shall not knowingly perform an abortion on a pregnant unemancipated minor unless the attending physician has secured the written consent from one of the minor's parents or the minor's guardian or conservator or unless a judge of the superior court authorizes the physician to perform the abortion pursuant to subsection B.

B. A judge of the superior court shall, on petition or motion, and after an appropriate hearing, authorize a physician to perform the abortion if the judge determines that the pregnant minor is mature and capable of giving informed consent to the proposed abortion. If the judge determines that the pregnant minor is not mature or if the pregnant minor does not claim to be mature, the judge shall determine whether the performance of an abortion on her without the consent from one of her parents or her guardian or conservator would be in her best interests and shall authorize a physician to perform the abortion without consent if the judge concludes that the pregnant minor's best interests would be served.

C. The pregnant minor may participate in the court proceedings on her own behalf. The court may appoint a guardian ad litem for her. The court shall advise her that she has the right to court appointed counsel and shall, on her request, provide her with counsel unless she appears through private counsel or she knowingly and intelligently waives her right to counsel.

D. Proceedings in the court under this section are confidential and have precedence over other pending matters. Members of the public shall not inspect, obtain copies of or otherwise have access to records of court proceedings under this section unless authorized by law. A judge who conducts proceedings under this section shall make in writing specific factual findings and legal conclusions supporting the decision and shall order a confidential record of the evidence to be maintained including the judge's own findings and conclusions. The minor may file the petition using a fictitious name. For purposes of this subsection, public does not include judges, clerks, administrators, professionals or other persons employed by or working under the supervision of the court or employees of other public agencies who are authorized by state or federal rule or law to inspect and copy closed court records.

E. The court shall hold the hearing and shall issue a ruling within forty-eight hours, excluding weekends and holidays, after the petition is filed. If the court fails to issue a ruling within this time period the petition is deemed to have been granted and the consent requirement is waived.

F. An expedited confidential appeal is available to a pregnant minor for whom the court denies an order authorizing an abortion without parental consent. The appellate court shall hold the hearing and issue a ruling within forty-eight hours, excluding weekends and holidays, after the petition for appellate review is filed. Filing fees are not required of the pregnant minor at either the trial or the appellate level.

G. Parental consent or judicial authorization is not required under this section if either:

1. The pregnant minor certifies to the attending physician that the pregnancy resulted from sexual conduct with a minor by the minor's parent, stepparent, uncle, grandparent, sibling, adoptive parent, legal guardian or foster parent or by a person who lives in the same household with the minor and the minor's mother. The physician performing the abortion shall report the sexual conduct with a minor to the proper law enforcement officials pursuant to section 13-3620 and shall preserve and forward a sample of the fetal tissue to these officials for use in a criminal investigation.

2. The attending physician certifies in the pregnant minor's medical record that, on the basis of the physician's good faith clinical judgment, the pregnant minor has a condition that so complicates her medical condition as to necessitate the immediate abortion of her pregnancy to avert her death or for which a delay will create serious risk of substantial and irreversible impairment of major bodily function.

H. A person who performs an abortion in violation of this section is guilty of a class 1 misdemeanor. A person is not subject to any liability under this section if the person establishes by written evidence that the person relied on evidence sufficient to convince a careful and prudent person that the representations of the pregnant minor regarding information necessary to comply with this section are true.

I. For purposes of this section:

1. "Abortion" means the use of an instrument, medicine or drug or other substance or device with the intent to terminate a pregnancy for reasons other than to increase the probability of a live birth, to preserve the life or health of the child after a live birth, to terminate an ectopic pregnancy or to remove a dead fetus. Abortion does not include birth control devices or oral contraceptives that inhibit or prevent ovulation, fertilization or the implantation of a fertilized ovum within the uterus.

2. "Fetus" means any individual human organism from fertilization until birth.

 

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36-2301. Duty to promote life of fetus or embryo delivered alive

If an abortion is performed and a human fetus or embryo is delivered alive, it is the duty of any physician performing such abortion and any additional physician in attendance as required by section 36-2301.01 to see that all available means and medical skills are used to promote, preserve and maintain the life of such fetus or embryo.

 

36-2301.01. Abortion of viable fetus; requirements; definitions

A. A physician shall not knowingly perform an abortion of a viable fetus unless:

1. The physician states in writing before the abortion is performed that the abortion is necessary to preserve the life or health of the woman, specifying the medical indications for and the probable health consequences of the abortion. The physician shall attach a copy of this statement to any fetal death report filed pursuant to section 11-593 or fetal death registration filed pursuant to section 36-329, subsection C.

2. The physician uses the available method or technique of abortion most likely to preserve the life and health of the fetus, unless the use of such method or technique would present a greater risk to the life or health of the woman than the use of another available method or technique.

3. The physician states in writing the available methods or techniques considered, the method or technique used and the reasons for choosing that method or technique. The physician shall attach a copy of this statement to any fetal death report filed pursuant to section 11-593 or fetal death registration filed pursuant to section 36-329, subsection C.

4. In addition to the physician performing the abortion, there is another physician in attendance who shall take control of and provide immediate medical care for a living child born as a result of the abortion.

5. The physician takes all reasonable steps during the performance of the abortion, consistent with the procedure used and in keeping with good medical practice, to preserve the life and health of the fetus, if these steps do not pose an increased risk to the life or health of the woman on whom the abortion is performed.

B. This section does not apply if there is a medical emergency.

C. As used in this section and section 36-2301.02:

1. "Abortion" means the use of an instrument, medicine or drug or other substance or device with the intent to terminate a pregnancy for reasons other than to increase the probability of a live birth, to preserve the life or health of the child after live birth, to terminate an ectopic pregnancy or to remove a dead fetus. Abortion does not include birth control devices or oral contraceptives.

2. "Medical emergency" means a condition that, on the basis of the physician's good faith clinical judgment, so complicates a pregnancy as to necessitate the immediate abortion of the pregnancy to avoid the woman's death or for which a delay will create serious risk of substantial and irreversible impairment of a major bodily function.

3. "Viable fetus" means the unborn offspring of human beings that has reached a stage of fetal development so that, in the judgment of the attending physician on the particular facts of the case, there is a reasonable probability of the fetus' sustained survival outside the uterus, with or without artificial support.

4. "Physician" means any person licensed under title 32, chapter 13 or 17.

 

36-2301.02. Review of ultrasound results

A. Beginning on January 1, 2001, a person shall not knowingly perform an abortion after twelve weeks' gestation unless the person estimates the gestational age of the fetus based on biparietal diameter and femur length according to the hadlok measurement system or other equivalent measurement systems using ultrasound examination as provided in rule.

B. Beginning on January 1, 2001, a person shall not knowingly perform an abortion after twelve weeks' gestation unless the person ensures that a copy of each ultrasound result taken of a fetus of a woman as a result of a second or third trimester abortion is sent to persons or corporations contracted pursuant to this section. The person performing the abortion shall ensure that the ultrasound result or results from the woman is sent in a manner that is distinguishable from, and not mixed with, any other set of ultrasound results and is accompanied with a copy of any report that notes the estimate of the fetus' gestational age that was made before the abortion.

C. The department of health services shall contract with qualified public or private persons or corporations for review of ultrasound results to determine compliance with this section. The department shall issue requests for proposals for the purpose of establishing contracts pursuant to this section. At a minimum, the contracts shall require the contractor to review ultrasound results to verify the accuracy of the fetus' estimated gestational age made before the abortion and to verify that the estimate was made in reasonable compliance with the hadlok measurement system or another equivalent measurement system as provided in rule.

D. The contractor shall use a statistically valid method of sampling to conduct the review of ultrasound results from a woman as a result of a second trimester abortion of a fetus of up to eighteen weeks' gestation. The contractor shall conduct a review of all ultrasound results from a woman as a result of an abortion of a fetus of eighteen or more weeks' gestation.

E. Beginning on January 1, 2001, on a monthly basis, persons or corporations providing ultrasound review services to the department pursuant to this section shall file a report with the director regarding ultrasound results, noting:

1. Any instances in which the contractor believes there was a significant inaccuracy in the estimated gestational age of the fetus made before the abortion.

2. Any circumstances that, based on the contractor's professional judgment, might explain a significant inaccuracy reported pursuant to paragraph 1 of this subsection.

3. Whether there was reasonable compliance pursuant to subsection C of this section.

4. Whether, based on the results of the review of each ultrasound, the physician should have filed a fetal death certificate with the department of health services as required by section 36-329, subsection C.

F. The department of health services shall forward the report or portions of the report within thirty working days to the appropriate professional regulatory boards for their review and appropriate action.

G. Except as provided by subsection F of this section, the reports required by this section are confidential and disclosable by the department or its contractor only in aggregate form for statistical or research purposes. Except as provided by subsection F of this section, information relating to any physician, hospital, clinic or other institution shall not be released. Personally identifiable patient information shall not be released by the department or its contractor.

 

36-2302. Experimentation on human fetus or embryo prohibited; physician-patient privilege inapplicable

A. A person shall not knowingly use any human fetus or embryo, living or dead, or any parts, organs or fluids of any such fetus or embryo resulting from an induced abortion in any manner for any medical experimentation or scientific or medical investigation purposes except as is strictly necessary to diagnose a disease or condition in the mother of the fetus or embryo and only if the abortion was performed because of such disease or condition.

B. The physician-patient privilege as provided in section 13-4062, paragraph 4 shall not prevent the production of documents or records relevant to an investigation arising under this section. All documents or records produced in an action brought pursuant to this section shall be inspected by the court in camera, and before the documents or records are released to the requesting party, the court shall remove the names and other identifying information, if any, of the patients and substitute pseudonyms.

C. This section shall not prohibit routine pathological examinations conducted by a medical examiner or hospital laboratory provided such pathological examination is not a part of or in any way related to any medical or scientific experimentation.

 

36-2303. Violation; classification

Any person who violates any provision of this article is guilty of a class 5 felony.

 

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36-2907. Covered health and medical services; modifications; related delivery of service requirements

A. Unless modified pursuant to this section, contractors shall provide the following medically necessary health and medical services:

1. Inpatient hospital services that are ordinarily furnished by a hospital for the care and treatment of inpatients and that are provided under the direction of a physician or a primary care practitioner. For the purposes of this section, inpatient hospital services excludes services in an institution for tuberculosis or mental diseases unless authorized under an approved section 1115 waiver.

2. Outpatient health services that are ordinarily provided in hospitals, clinics, offices and other health care facilities by licensed health care providers. Outpatient health services include services provided by or under the direction of a physician or a primary care practitioner but do not include occupational therapy, or speech therapy for eligible persons who are twenty-one years of age or older.

3. Other laboratory and x-ray services ordered by a physician or a primary care practitioner.

4. Medications that are ordered on prescription by a physician or a dentist licensed pursuant to title 32, chapter 11. Beginning January 1, 2006, persons who are dually eligible for title XVIII and title XIX services must obtain available medications through a medicare licensed or certified medicare advantage prescription drug plan, a medicare prescription drug plan or any other entity authorized by medicare to provide a medicare part D prescription drug benefit.

5. Emergency dental care and extractions for persons who are at least twenty-one years of age.

6. Medical supplies, equipment and prosthetic devices, not including hearing aids, ordered by a physician or a primary care practitioner or dentures ordered by a dentist licensed pursuant to title 32, chapter 11. Suppliers of durable medical equipment shall provide the administration with complete information about the identity of each person who has an ownership or controlling interest in their business and shall comply with federal bonding requirements in a manner prescribed by the administration.

7. For persons who are at least twenty-one years of age, treatment of medical conditions of the eye excluding eye examinations for prescriptive lenses and the provision of prescriptive lenses.

8. Early and periodic health screening and diagnostic services as required by section 1905(r) of title XIX of the social security act for members who are under twenty-one years of age.

9. Family planning services that do not include abortion or abortion counseling. If a contractor elects not to provide family planning services, this election does not disqualify the contractor from delivering all other covered health and medical services under this chapter. In that event, the administration may contract directly with another contractor, including an outpatient surgical center or a noncontracting provider, to deliver family planning services to a member who is enrolled with the contractor that elects not to provide family planning services.

10. Podiatry services performed by a podiatrist licensed pursuant to title 32, chapter 7 and ordered by a primary care physician or primary care practitioner.

11. Nonexperimental transplants approved for title XIX reimbursement.

12. Ambulance and nonambulance transportation.

B. Beginning on October 1, 2002, circumcision of newborn males is not a covered health and medical service.

C. The system shall pay noncontracting providers only for health and medical services as prescribed in subsection A of this section and as prescribed by rule.

D. The director shall adopt rules necessary to limit, to the extent possible, the scope, duration and amount of services, including maximum limitations for inpatient services that are consistent with federal regulations under title XIX of the social security act (P.L. 89-97; 79 Stat. 344; 42 United States Code section 1396 (1980)). To the extent possible and practicable, these rules shall provide for the prior approval of medically necessary services provided pursuant to this chapter.

E. The director shall make available home health services in lieu of hospitalization pursuant to contracts awarded under this article. For the purposes of this subsection, "home health services" means the provision of nursing services, home health aide services or medical supplies, equipment and appliances, which are provided on a part-time or intermittent basis by a licensed home health agency within a member's residence based on the orders of a physician or a primary care practitioner. Home health agencies shall comply with the federal bonding requirements in a manner prescribed by the administration.

F. The director shall adopt rules for the coverage of behavioral health services for persons who are eligible under section 36-2901, paragraph 6, subdivision (a). The administration shall contract with the department of health services for the delivery of all medically necessary behavioral health services to persons who are eligible under rules adopted pursuant to this subsection. The division of behavioral health in the department of health services shall establish a diagnostic and evaluation program to which other state agencies shall refer children who are not already enrolled pursuant to this chapter and who may be in need of behavioral health services. In addition to an evaluation, the division of behavioral health shall also identify children who may be eligible under section 36-2901, paragraph 6, subdivision (a) or section 36-2931, paragraph 5 and shall refer the children to the appropriate agency responsible for making the final eligibility determination.

G. The director shall adopt rules for the provision of transportation services and rules providing for copayment by members for transportation for other than emergency purposes. Prior authorization is not required for medically necessary ambulance transportation services rendered to members or eligible persons initiated by dialing telephone number 911 or other designated emergency response systems.

H. The director may adopt rules to allow the administration, at the director's discretion, to use a second opinion procedure under which surgery may not be eligible for coverage pursuant to this chapter without documentation as to need by at least two physicians or primary care practitioners.

I. If the director does not receive bids within the amounts budgeted or if at any time the amount remaining in the Arizona health care cost containment system fund is insufficient to pay for full contract services for the remainder of the contract term, the administration, on notification to system contractors at least thirty days in advance, may modify the list of services required under subsection A of this section for persons defined as eligible other than those persons defined pursuant to section 36-2901, paragraph 6, subdivision (a). The director may also suspend services or may limit categories of expense for services defined as optional pursuant to title XIX of the social security act (P.L. 89-97; 79 Stat. 344; 42 United States Code section 1396 (1980)) for persons defined pursuant to section 36-2901, paragraph 6, subdivision (a). Such reductions or suspensions do not apply to the continuity of care for persons already receiving these services.

J. Additional, reduced or modified hospitalization and medical care benefits may be provided under the system to enrolled members who are eligible pursuant to section 36-2901, paragraph 6, subdivision (b), (c), (d) or (e).

K. All health and medical services provided under this article shall be provided in the geographic service area of the member, except:

1. Emergency services and specialty services provided pursuant to section 36-2908.

2. That the director may permit the delivery of health and medical services in other than the geographic service area in this state or in an adjoining state if the director determines that medical practice patterns justify the delivery of services or a net reduction in transportation costs can reasonably be expected. Notwithstanding the definition of physician as prescribed in section 36-2901, if services are procured from a physician or primary care practitioner in an adjoining state, the physician or primary care practitioner shall be licensed to practice in that state pursuant to licensing statutes in that state similar to title 32, chapter 13, 15, 17 or 25 and shall complete a provider agreement for this state.

L. Covered outpatient services shall be subcontracted by a primary care physician or primary care practitioner to other licensed health care providers to the extent practicable for purposes including, but not limited to, making health care services available to underserved areas, reducing costs of providing medical care and reducing transportation costs.

M. The director shall adopt rules that prescribe the coordination of medical care for persons who are eligible for system services. The rules shall include provisions for the transfer of patients, the transfer of medical records and the initiation of medical care.

 

36-2989. Covered health and medical services; modifications; related delivery of service requirements

(Conditionally Rpld.)

A. Except as provided in this section, beginning on October 1, 2001, health and medical services as defined in section 36-2907 are covered services and include:

1. Inpatient hospital services that are ordinarily furnished by a hospital for the care and treatment of inpatients, that are medically necessary and that are provided under the direction of a physician or a primary care practitioner. For the purposes of this paragraph, inpatient hospital services exclude services in an institution for tuberculosis or mental diseases unless authorized by federal law.

2. Outpatient health services that are medically necessary and ordinarily provided in hospitals, clinics, offices and other health care facilities by licensed health care providers. For the purposes of this paragraph, "outpatient health services" includes services provided by or under the direction of a physician or a primary care practitioner.

3. Other laboratory and x-ray services ordered by a physician or a primary care practitioner.

4. Medications that are medically necessary and ordered on prescription by a physician, a primary care practitioner or a dentist licensed pursuant to title 32, chapter 11.

5. Medical supplies, equipment and prosthetic devices.

6. Treatment of medical conditions of the eye including eye examinations for prescriptive lenses and the provision of prescriptive lenses for members.

7. Medically necessary dental services.

8. Well child services, immunizations and prevention services.

9. Family planning services that do not include abortion or abortion counseling. If a contractor elects not to provide family planning services, this election does not disqualify the contractor from delivering all other covered health and medical services under this article. In that event, the administration may contract directly with another contractor, including an outpatient surgical center or a noncontracting provider, to deliver family planning services to a member who is enrolled with a contractor who elects not to provide family planning services.

10. Podiatry services that are performed by a podiatrist licensed pursuant to title 32, chapter 7 and that are ordered by a primary care physician or primary care practitioner.

11. Medically necessary pancreas, heart, liver, kidney, cornea, lung and heart-lung transplants and autologous and allogeneic bone marrow transplants and immunosuppressant medications for these transplants ordered on prescription by a physician licensed pursuant to title 32, chapter 13 or 17.

12. Medically necessary emergency and nonemergency transportation.

13. Inpatient and outpatient behavioral health services that are the same as the least restrictive health benefits coverage plan for behavioral health services that are offered through a health care services organization for state employees under section 38-651.

B. The administration shall pay noncontracting providers only for health and medical services as prescribed in subsection A of this section.

C. To the extent possible and practicable, the administration and contractors shall provide for the prior approval of medically necessary services provided pursuant to this article.

D. The director shall make available home health services in lieu of hospitalization pursuant to contracts awarded under this article.

E. Behavioral health services shall be provided to members through the administration's intergovernmental agreement with the division of behavioral health in the department of health services. The division of behavioral health in the department of health services shall use its established diagnostic and evaluation program for referrals of children who are not already enrolled pursuant to this article and who may be in need of behavioral health services. In addition to an evaluation, the division of behavioral health shall also identify children who may be eligible under section 36-2901, paragraph 6, subdivision (a) or section 36-2931, paragraph 5 and shall refer the children to the appropriate agency responsible for making the final eligibility determination.

F. The director shall adopt rules for the provision of transportation services for members. Prior authorization is not required for medically necessary ambulance transportation services rendered to members initiated by dialing telephone number 911 or other designated emergency response systems.

G. The director may adopt rules to allow the administration to use a second opinion procedure under which surgery may not be eligible for coverage pursuant to this article without documentation as to need by at least two physicians or primary care practitioners.

H. All health and medical services provided under this article shall be provided in the geographic service area of the member, except:

1. Emergency services and specialty services.

2. The director may permit the delivery of health and medical services in other than the geographic service area in this state or in an adjoining state if it is determined that medical practice patterns justify the delivery of services or a net reduction in transportation costs can reasonably be expected. Notwithstanding section 36-2981, paragraph 8 or 11, if services are procured from a physician or primary care practitioner in an adjoining state, the physician or primary care practitioner shall be licensed to practice in that state pursuant to licensing statutes in that state that are similar to title 32, chapter 13, 15, 17 or 25.

I. Covered outpatient services shall be subcontracted by a primary care physician or primary care practitioner to other licensed health care providers to the extent practicable for purposes of making health care services available to underserved areas, reducing costs of providing medical care and reducing transportation costs.

J. The director shall adopt rules that prescribe the coordination of medical care for members and that include a mechanism to transfer members and medical records and initiate medical care.

K. The director shall adopt rules for the reimbursement of specialty services provided to the member if authorized by the member's primary care physician or primary care practitioner.

 

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Title 48.  Special Taxing Districts

 

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48-2212. Construction of facilities; provision of services; methods; contracting for services

A. The board of directors shall superintend the construction of medical facilities and the delivery of ambulatory medical services and ambulance service, if any, as specified in the approved report of the health services survey.

B. The construction of medical facilities or any portion thereof may be performed under the direction of the board of directors in consultation with the department and in any of the following ways, as ordered by the board of directors:

1. By purchasing the material and performing the work.

2. By purchasing the material and letting a contract for performance of the work.

3. By purchasing a portion or none of the material and letting a contract for furnishing the balance or all of the material and performance of the work.

C. Services authorized pursuant to subsection A may be performed, as ordered by the board, in any of the following ways, either singly or in combination:

1. By providing the facility and performing the services.

2. By supplying all, none or a portion of the facilities and letting a contract for the balance of the facilities, and providing the services.

3. By supplying the facility and providing all, none, or a portion of the services and letting a contract for the balance of the services.

D. All contracts shall be let to the lowest responsible bidder submitting a sealed bid in response to a call for bids published once each week for two consecutive weeks in a newspaper of general circulation in the county. The call for bids shall include a detailed description of the services required. If materials to be purchased without the letting of a contract cost one thousand dollars or more, they shall be purchased from the lowest responsible bidder after publication of a call for bids as provided by this subsection.

E. All work recommended in the approved report shall be performed in conformity with the plans and specifications contained in the report unless the board of directors by a two-thirds vote adopts a resolution declaring that the interest of the district requires a modification of or departure from the report, and specifying the modification or departure.

F. Contracts for direct health services provided by physicians, professional nurses, or physician assistants licensed or certified pursuant to title 32 shall be exempt from the bidding requirements prescribed by subsection D.

G. Among the medical services provided at such medical clinics, there shall be no drug, surgical procedure or other service provision administered or prescribed for the purpose of causing, directly or indirectly, an abortion of an unborn embryo or fetus at any stage of development. Neither shall such service be contracted to any other medical or paramedical group to be performed.

 

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Arizona Administrative Code.

 

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[Title 9.  Health Services.

Chapter 10. Department of Health Services, Health Care Institutions: Licensing]

 

R9-10-1501. Definitions

In this Article, unless the context otherwise requires:

1. "Abortion" means the use of a surgical instrument or a machine with the intent to terminate a woman's pregnancy for reasons other than to increase the probability of a live birth, to preserve the life or health of the child after live birth, to terminate an ectopic pregnancy or to remove a dead fetus. Abortion does not include birth control devices or oral contraceptives.

2. "Abortion clinic" means a facility, other than an accredited hospital, in which five or more first trimester abortions in any month or any second or third trimester abortions are performed.

3. "Adverse reaction" means an unexpected occurrence that threatens the health and safety of a patient.

4. "Biohazardous medical waste" means cultures and stocks, waste human blood and blood products, bodily fluids, uterine contents, and discarded medical sharps.

5. "Conspicuously posted" means placed at a location within an abortion clinic that is accessible and visible to patients and the public.

6. "Controlled substance" means the same as defined in A.R.S. § 32-1901(12).

7. "Course" means hands-on practice under the supervision of a physician, training, or education.

8. "Current" means up-to-date, extending to the present time.

9. "Department" means the same as defined in A.R.S. § 36-401.

10. "Direction" means the same as defined in A.R.S. § 36-401.

11. "Discharge" means a patient no longer requires the medical services, nursing services, or health-related services provided by the abortion clinic.

12. "Documentation" means written, supportive evidence.

13. "Emergency" means a potentially life-threatening occurrence that requires an immediate response or medical treatment.

14. "Employee" means an individual who receives compensation from a licensee, but does not provide medical services, nursing services, or health-related services.

15. "Fetus" means an individual human organism from fertilization until birth.

16. "First trimester" means 1 through 14 weeks as measured from the first day of the last menstrual period or 1 through 12 weeks as measured from the date of fertilization.

17. "Gestational age" means the number of completed weeks of the unborn fetus as calculated from the first day of the last menstrual period or the date of fertilization.

18. "Health-related services" means the same as defined in A.R.S. § 36-401.

19. "Immediately" means without delay.

20. "Incident" means an abortion related patient death or serious injury to a patient or viable fetus.

21. "Infection control" means to identify, prevent, monitor, and minimize infections.

22. "Licensee" means an individual, a partnership, an association, a limited liability company, or corporation authorized by the Department to operate an abortion clinic.

23. "Local" means under the jurisdiction of a city or county in Arizona.

24. "Medical director" means a physician who is responsible for the direction of the medical services, nursing services, and health-related services provided to patients at an abortion clinic.

25. "Medical evaluation" means obtaining a patient's medical history, performing a physical examination of a patient's body, and conducting laboratory tests as provided in R9-10-1508.

26. "Medical services" means the same as defined in A.R.S. § 36-401.

27. "Medication" means a prescription medication as defined in A.R.S. § 32-1901 or a nonprescription drug or over-the-counter drug as defined in A.R.S. § 32-1901.

28. "Monitor" means to observe and document, continuously or intermittently, the values of certain physiologic variables on a patient such as pulse, blood pressure, oxygen saturation, respiration and blood loss.

29. "Nationally recognized medical journal" means any publication distributed nationally that contains peer-reviewed medical information, such as the American Journal of Radiology or the Journal of Ultrasound in Medicine.

30. "Nurse" means an individual licensed and in good standing as a registered nurse or a practical nurse according to A.R.S. Title 32, Chapter 15.

31. "Nurse practitioner" means an individual licensed and in good standing as a registered nurse practitioner according to A.R.S. Title 32, Chapter 15.

32. "Nursing services" means the same as defined in A.R.S. § 36-401.

33. "Patient" means a female receiving medical services, nursing services, or health-related services related to an abortion.

34. "Patient care staff" means a physician, nurse practitioner, nurse, physician assistant, or surgical assistant who provides medical services, nursing services, or health-related services to a patient.

35. "Patient 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 according to A.R.S. § 36-3201(13).

36. "Patient transfer" means relocating a patient requiring medical services from an abortion clinic to another health care institution.

37. "Personnel" means patient care staff, employees, and volunteers.

38. "Physical facilities" means property that is:

a. Designated on an application for a license by the applicant; and

b. Licensed to provide services by the Department according to A.R.S. Title 36, Chapter 4.

39. "Physician" means an individual licensed according to A.R.S. Title 32, Chapter 13 or 17.

40. "Physician assistant" means an individual licensed according to A.R.S. Title 32, Chapter 25.

41. "Serious injury" means an injury that occurs at an abortion clinic and that creates a serious risk of substantial impairment of a major body organ.

42. "Supervision" means direct overseeing and inspection of the act of accomplishing a function or activity.

43. "Surgical assistant" means an individual who is not licensed as a physician, physician assistant, nurse practitioner, or nurse who performs duties as directed by a physician, physician assistant, nurse practitioner or nurse.

44. "Viable fetus" means the same as defined in A.R.S. § 36-2301.01.

45. "Volunteer" means an individual who, without compensation, performs duties as directed by a member of the patient care staff at an abortion clinic.

 

R9-10-1502. Application Requirements

An applicant shall submit an application for licensure that meets the requirements in A.R.S. § 36-422.

 

R9-10-1503. Administration

A. A licensee is responsible for the organization and management of an abortion clinic.

B. A licensee shall:

1. Ensure compliance with federal and state laws, rules, and local ordinances;

2. Adopt policies and procedures for the administration and operation of an abortion clinic;

3. Designate a medical director who is licensed according to A.R.S. Title 32, Chapter 13, 17, or 29. The licensee and the medical director may be the same individual;

4. Ensure that the Department's director or director's designee is allowed immediate access to the abortion clinic during the hours of operation;

5. Ensure the following documents are conspicuously posted at the physical facilities:

a. Current abortion clinic license issued by the Department;

b. Current telephone number and address of the Department's Office of Medical Facilities; and

c. Evacuation map.

C. A medical director shall ensure written policies and procedures are developed and implemented for:

1. Personnel qualifications, duties, and responsibilities;

2. Individuals qualified to provide counseling in the abortion clinic and the amount and type of training required for an individual to provide counseling;

3. Verification of the competency of the physician performing an abortion according to R9-10-1505;

4. The storage, administration, accessibility, disposal, and documentation of a medication, and a controlled substance;

5. Accessibility and security of patient medical records;

6. Abortion procedures including recovery and follow-up care; and the minimum length of time a patient remains in the recovery room or area based on:

a. The type of abortion performed;

b. The estimated gestational age of the fetus;

c. The type and amount of medication administered; and

d. The physiologic signs including vital signs and blood loss;

7. Infection control including methods of sterilizing equipment and supplies;

8. Medical emergencies; and

9. Patient discharge and patient transfer.

 

R9-10-1504. Incident Reporting

A. A licensee shall ensure that the Department is notified of an incident as follows:

1. For the death of a patient, verbal notification the next working day; and

2. For a serious injury, written notification within 10 calendar days from the date of the serious injury.

B. A medical director shall conduct an investigation of an incident and develop a written incident report that includes:

1. The date and time of the incident;

2. The name of the patient;

3. Description of the incident;

4. Names of individuals who observed the incident;

5. Action taken by patient care staff and employees during the incident or immediately following the incident; and

6. Action taken by the patient care staff and employees to prevent the incident from occurring in the future.

C. A medical director shall ensure that the written incident report is:

1. Submitted to the Department and a professional licensing board, if applicable, within 10 calendar days from the date of the notification in subsection (A); and

2. Maintained in the physical facilities for at least two years from the date of the report.

 

R9-10-1505. Personnel Qualifications and Records

A licensee shall ensure that:

1. A physician who performs an abortion demonstrates to the medical director that the physician is competent to perform an abortion by:

a. The submission of documentation of education and experience; and

b. Observation by or interaction with the medical director;

2. Surgical assistants and volunteers who provide counseling and patient advocacy receive training in these specific responsibilities and any other responsibilities assigned and that documentation is maintained in the individual's personnel file of the training received;

3. An individual who performs an ultrasound provides documentation that the individual is:

a. A physician who:

i. Has completed a course in performing an ultrasound from a manufacturer or distributor of ultrasound equipment; or

ii. Has performed ultrasounds during the physician's medical education;

b. A physician assistant, nurse practitioner, or nurse who completed a hands-on course in performing ultrasounds under the supervision of a physician qualified as required in subsection (3)(a); or

c. An individual who completed:

i. A postsecondary education institution course in performing ultrasound; and

ii. The hands-on course required in subsection (3)(b).

4. An individual has completed a course for the type of ultrasound the individual performs;

5. A personnel file for each member of the patient care staff and each volunteer is maintained either electronically or in writing and includes:

a. The individual's name, position title, and the first and last date of employment or volunteer service, if applicable;

b. Verification of qualifications, training, or licensure, if applicable;

c. Documentation of cardiopulmonary resuscitation certification, if applicable;

d. Documentation of verification of competency, as required in subsection (1), and signed and dated by the medical director;

e. Documentation of training for surgical assistants and volunteers; and

f. Documentation of completion of a course as required in subsection (3), for an individual performing ultrasounds; and

6. Personnel files are maintained in the physical facilities for at least two years from the ending date of employment or volunteer service.

 

R9-10-1506. Staffing Requirements

A. A licensee shall ensure that there are a sufficient number of patient care staff and employees to:

1. Meet the requirements of this Article;

2. Ensure the health and safety of a patient; and

3. Meet the needs of a patient based on the patient's medical evaluation.

B. A licensee shall ensure that:

1. A member of the patient care staff, except for a surgical assistant, who is current in cardiopulmonary resuscitation certification is in the physical facilities until all patients are discharged;

2. A physician with admitting privileges at an accredited hospital in this state is in the physical facilities until each patient is stable and ready to leave the recovery room;

3. A nurse, a nurse practitioner or a physician assistant:

a. Monitors each patient during the patient's recovery following the abortion; and

b. Remains in the physical facilities until each patient is discharged by a physician; and

4. A written schedule is maintained in the physical facilities for at least six months from the last date on the schedule and includes:

a. The date, work hours, and name of the patient care staff assigned to provide medical services, nursing services, health-related services, and the name of the volunteers assigned to provide volunteer services; and

b. The date, work hours and name of the patient care staff and volunteers who actually provided medical services, nursing services, health-related services, or volunteer services.

 

R9-10-1507. Patient Rights

A licensee shall ensure that a patient is afforded the following rights, and is informed of these rights:

1. To be treated with consideration, respect, and full recognition of the patient's dignity and individuality;

2. To refuse treatment, or withdraw consent for treatment;

3. To have medical records kept confidential; and

4. To be informed of:

a. Billing procedures and financial liability before abortion services are provided;

b. Proposed medical or surgical procedures, associated risks, possible complications and alternatives;

c. Counseling services that are provided in the physical facilities; and

d. If an ultrasound is performed, the right to review the ultrasound results with a physician, a physician assistant, a nurse practitioner, or a registered nurse before the abortion procedure.

 

R9-10-1508. Abortion Procedures

A. A medical director shall ensure that a medical evaluation of a patient is conducted before performing an abortion and includes:

1. A medical history including:

a. Allergies to medications, antiseptic solutions, or latex;

b. Obstetrical and gynecological history;

c. Past surgeries;

d. Medication the patient is currently taking; and

e. Other medical conditions;

2. A physical examination performed by a physician that includes a bimanual examination to estimate uterine size and palpation of adnexa; and

3. The following laboratory tests:

a. A urine or blood test to determine pregnancy if an ultrasound examination is not performed;

b. Rh typing unless the patient provides written documentation of blood type acceptable to the physician;

c. Anemia screening; and

d. Other laboratory tests recommended by the physician or medical director on the basis of the physical examination.

B. If the medical evaluation indicates a patient is Rh negative, a medical director shall ensure that:

1. The patient receives information from a physician on this condition;

2. The patient is offered RhO(d) immune globulin within 72 hours after the abortion procedure;

3. If a patient refuses RhO(d) immune globulin, the patient signs and dates a form acknowledging the patient's condition and refusing the RhO(d) immune globulin;

4. The form is maintained in the patient's medical record; and

5. If a patient refuses RhO(d) immune globulin or if a patient refuses to sign and date an acknowledgment and refusal form, the physician documents the patient's refusal in the patient's medical record.

C. A physician estimates the gestational age of the fetus, and records the estimated age in the patient's medical record. The estimated age is based upon:

1. Ultrasound measurements of the biparietal diameter, length of femur, abdominal circumference, visible pregnancy sac, or crown-rump length or a combination of these; or

2. The date of the last menstrual period or the date of fertilization and a bimanual examination of the patient.

D. If a physical examination or other information obtained from the patient or laboratory tests indicates the gestational age of the fetus is greater than 12 weeks, a medical director shall ensure that:

1. An ultrasound is performed by an individual who meets the requirements in R9-10-1505(3);

2. An ultrasound estimate of gestational age is performed using methods and tables or charts published in a nationally recognized medical journal;

3. An original ultrasound print is:

a. Interpreted by a physician; and

b. Maintained in the patient's medical record; and

4. If requested by the patient, the ultrasound is reviewed with the patient by a physician, a physician assistant, a nurse practitioner, or a registered nurse.

E. A medical director shall ensure that before an abortion is performed on a patient:

1. Written consent is signed and dated by the patient or the patient's representative; and

2. Information is provided to the patient on the abortion procedure including alternatives, risks, and potential complications.

F. A medical director shall ensure that an abortion is performed according to the abortion clinic's policies and procedures and this Article.

G. A medical director shall ensure that:

1. Patient care staff monitor the patient's vital signs throughout the abortion procedure to ensure the patient's health and safety;

2. Intravenous access is established and maintained on a patient undergoing an abortion after the first trimester; and

3. If a viable fetus shows signs of life:

a. Resuscitative measures are used to support life;

b. The viable fetus is transferred as required in R9-10-1509; and

c. Resuscitative measures and the transfer are documented.

H. A medical director shall ensure that following the abortion procedure:

1. A patient's vital signs and bleeding are monitored by a member of the patient care staff, except a surgical assistant, to ensure the patient's health and safety;

2. A patient remains in the recovery room or recovery area until a physician, a physician assistant, a nurse practitioner or a nurse examines the patient and determines that the patient's medical condition is stable and the patient is ready to leave the recovery room or recovery area; and

3. An ultrasound result print of each fetus with a gestational age estimate of more than 12 weeks is sent to persons or corporations contracted with the Department in compliance with A.R.S. § 36-2301.02.

I. A medical director shall ensure that follow-up care includes:

1. With a patient's consent, a telephone call to the patient by a member of the patient care staff, except a surgical assistant, within 24 hours of the patient's discharge to assess the patient's recovery. If the patient care staff is unable to speak with the patient, for any reason, the attempt to contact the patient is documented in the patient's medical record; and

2. A follow-up visit offered at least three weeks after the abortion, which includes:

a. A physical examination;

b. A review of all laboratory tests as required in R9-10-1508(A)(3); and

c. A urine pregnancy test.

J. If a continuing pregnancy is suspected as a result of the follow-up visit required in subsection (I)(2), a physician who performs abortions shall be consulted.

 

R9-10-1509. Patient Transfer and Discharge

A. A medical director shall ensure:

1. A patient is transferred to a hospital for an emergency involving the patient;

2. A viable fetus requiring emergency care is transferred to a hospital;

3. A patient transfer is documented in the patient's medical record; and

4. Documentation of a medical evaluation, treatment given, laboratory, and diagnostic information is transferred with a patient.

B. A medical director shall ensure that before a patient is discharged:

1. A physician signs the patient's discharge order; and

2. A patient receives written information at discharge that includes:

a. Signs of possible complications;

b. When to access medical care in response to complications;

c. A telephone number of an individual or entity to contact for medical emergencies;

d. Instructions and precautions for resuming vaginal intercourse after the abortion; and

e. Instructions specific to the patient's abortion or condition.

 

R9-10-1510. Medications and Controlled Substances

A medical director shall ensure that:

1. The abortion clinic complies with the requirements for medications and controlled substances in A.R.S. Title 32, Chapter 18, and A.R.S. Title 36, Chapter 27;

2. A medication is administered in compliance with an order from a physician, physician assistant, nurse practitioner, or as otherwise provided by law;

3. A medication is administered to a patient by a physician or as otherwise provided by law;

4. Medications and controlled substances are maintained in a locked area in the physical facilities;

5. Only personnel designated in the abortion clinic's policies and procedures have access to the locked area containing the medications and controlled substances;

6. Expired, mislabeled, or unusable medications and controlled substances are disposed of according to the abortion clinic's policies and procedures;

7. Medication errors and adverse reactions, including any actions taken in response to the medication errors or adverse reactions, are immediately reported to the medical director and licensee, and recorded in the patient's medical record;

8. Medication information is maintained in a patient's medical record and contains:

a. The patient's name, age, and weight;

b. The medications the patient is currently taking; and

c. Allergies or sensitivities to medications, antiseptic solutions, or latex; and

9. If medication is administered to a patient, the following are documented in the patient's medical record:

a. The date and time of administration;

b. The name, strength, dosage form, amount of medication, and route of administration; and

c. The identification and signature of the individual administering the medication.

 

R9-10-1511. Medical Records

A. A licensee shall ensure that:

1. A medical record is established and maintained for a patient that contains:

a. Patient identification including:

i. The patient's name, address, and date of birth;

ii. The designated patient representative, if applicable; and

iii. The name and telephone number of an individual to contact in an emergency;

b. The patient's medical history required in R9-10-1508(A)(1);

c. The patient's physical examination required in R9-10-1508(A)(2);

d. The laboratory test results required in R9-10-1508(A)(3);

e. The physician's estimated gestational age of the fetus required in R9-10-1508(C);

f. The ultrasound results, if applicable, including the original print as required in R9-10-1508(D);

g. Each consent form signed by the patient or the patient's representative;

h. A record of all orders issued by a physician, physician assistant or nurse practitioner;

i. A record of all medical, nursing, and health-related services provided to the patient; and

j. The patient's medication information;

2. A medical record is accessible only to the Department or personnel authorized by the abortion clinic's policies and procedures;

3. Medical record information is confidential and released only with the written informed consent of a patient or the patient's representative or as otherwise permitted by law;

4. A medical record is protected from loss, damage, or unauthorized use and is maintained and accessible for seven years from the date of an adult patient's discharge or if the patient is a child, either for at least three years after the child's 18th birthday or for at least seven years after the patient's discharge, whichever date occurs last;

a. A medical record is maintained at the abortion clinic for at least six months from the date of the patient's discharge;

b. A medical record maintained at the abortion clinic is provided to the Department for review no later than two hours from the time the Department requests the medical record; and

c. A medical record maintained off-site is provided to the Department for review no later than 24 hours from the time the Department requests the medical record;

5. Vital records and vital statistics are retained according to A.R.S. § 36-343; and

6. If an abortion clinic ceases operations, the Department is notified in writing, not less than 30 days before ceasing operations, of the location of the abortion clinic's medical records.

B. A medical director shall ensure that only personnel authorized by an abortion clinic's policies records or signs an entry in a medical record and:

1. An entry in a medical record is dated and legible;

2. An entry is authenticated by:

a. A written signature;

b. An individual's initials if the individual's written signature already appears in the medical record;

c. A rubber-stamp signature; or

d. A computer code;

3. An entry is not changed after it has been recorded but additional information related to an entry may be recorded in the medical record;

4. When a verbal or telephone order is entered in the medical record, the entry is authenticated within 21 days by the individual who issued the order;

5. If a rubber-stamp signature or a computer code is used:

a. An individual's rubber stamp or computer code is not used by another individual;

b. The individual who uses a rubber stamp or computer code signs a statement that the individual is responsible for the use of the rubber stamp or the computer code; and

c. The signed statement is included in the individual's personnel record; and

6. If an abortion clinic maintains medical records electronically, the medical director shall ensure the date and time of an entry is recorded by the computer's internal clock.

C. As required by A.R.S. § 36-449.03(I), the Department shall not release any personally identifiable patient or physician information.

 

R9-10-1512. Environmental and Safety Standards

A licensee shall ensure that:

1. Physical facilities:

a. Provide lighting and ventilation to ensure the health and safety of a patient;

b. Are maintained in a clean condition;

c. Are free from a condition or situation that may cause a patient to suffer physical injury;

d. Are maintained free from insects and vermin; and

e. Are smoke-free;

2. A warning notice is placed at the entrance to a room or area where oxygen is in use;

3. Soiled linen and clothing are kept in a covered container and in a separate area from clean linen and clothing;

4. Personnel wash hands after each direct patient contact and after handling soiled linen, soiled clothing, or biohazardous medical waste;

5. A written emergency plan is developed and implemented that includes procedures for protecting the health and safety of patients and other individuals in a fire, natural disaster, loss of electrical power, or threat or incidence of violence; and

6. An evacuation drill is conducted at least once every six months that includes all personnel in the physical facilities the day of the evacuation drill. Documentation of the evacuation drill is maintained in the physical facilities for one year from the date of the evacuation drill and includes:

a. The date and time of the evacuation drill; and

b. The names of personnel participating in the evacuation drill.

 

R9-10-1513. Equipment Standards

A licensee shall ensure that:

1. Equipment and supplies are maintained in a quantity sufficient to meet the needs of all patients present in the abortion clinic;

2. Equipment to monitor vital signs is in each room in which an abortion is performed;

3. A surgical or gynecologic examination table is used for an abortion;

4. The following equipment and supplies are provided in the abortion clinic:

a. Equipment to measure blood pressure;

b. A stethoscope;

c. A scale for weighing a patient;

d. Supplies for obtaining specimens, cultures and other laboratory tests; and

e. Equipment and supplies for use in a medical emergency including:

i. Ventilatory assistance equipment;

ii. Oxygen source;

iii. Suction apparatus; and

iv. Intravenous fluid equipment and supplies;

5. In addition to the requirements in subsection (4), the following equipment is available for an abortion procedure performed after the first trimester:

a. Ultrasound equipment;

b. Drugs to support cardiopulmonary function; and

c. Equipment to monitor cardiopulmonary status;

6. Equipment and supplies are clean and sterile, if applicable, before each use;

7. Equipment required in this Section is maintained in working order, tested and calibrated at least once every 12 months or according to the manufacturer's recommendations, and used according to the manufacturer's recommendations; and

8. Documentation of each equipment test, calibration, and repair is maintained in the physical facilities for one year from the date of the testing, calibration, or repair and provided to the Department for review within two hours from the time the Department requests the documentation.

 

R9-10-1514. Physical Facilities

A. A licensee shall ensure that an abortion clinic complies with all local building codes, ordinances, fire codes, and zoning requirements. If there are no local building codes, ordinances, fire codes, or zoning requirements, the abortion clinic shall comply with the applicable codes and standards incorporated by reference in A.A.C. R9-1-412.

B. A licensee shall ensure that an abortion clinic provides areas or rooms:

1. That provide privacy for:

a. A patient's interview, medical evaluation, and counseling;

b. A patient to dress; and

c. Performing an abortion procedure;

2. For personnel to dress;

3. With a sink in working order and a flushable toilet;

4. For cleaning and sterilizing equipment and supplies;

5. For storing medical records;

6. For storing equipment and supplies;

7. For hand washing before the abortion procedure; and

8. For a patient recovering after an abortion.

C. A licensee shall ensure that an abortion clinic has an emergency exit to accommodate a stretcher or gurney.

 

* * *

 

[Title 9.  Health Services.

Chapter 22.  Arizona Health Care Cost Containment System. Administration.]


R9-22-215. Other Medical Professional Services

A. The following medical professional services are covered services if a member receives these services in an inpatient, outpatient, or office setting as follows:

1. Dialysis;

2. The following family planning services if provided to delay or prevent pregnancy:

a. Medications;

b. Supplies;

c. Devices; and

d. Surgical procedures.

3. Family planning services are limited to:

a. Contraceptive counseling, medications, supplies, and associated medical and laboratory examinations, including HIV blood screening as part of a package of sexually transmitted disease tests provided with a family planning service;

b. Sterilization; and

c. Natural family planning education or referral;

4. Midwifery services provided by a certified nurse practitioner in midwifery;

5. Midwifery services for low-risk pregnancies and home deliveries provided by a licensed midwife;

6. Podiatry services when ordered by a member's primary care provider, attending physician, or practitioner;

7. Respiratory therapy;

8. Ambulatory and outpatient surgery facilities services;

9. Home health services under A.R.S. § 36-2907(D);

10. Private or special duty nursing services when medically necessary and prior authorized;

11. Rehabilitation services including physical therapy, occupational therapy, speech therapy, and audiology within limitations in subsection (C);

12. Total parenteral nutrition services, which are the provision of total caloric needs by intravenous route for individuals with severe pathology of the alimentary tract;

13. Inpatient chemotherapy; and

14. Outpatient chemotherapy.

B. Prior authorization from the Administration for a member is required for services listed in subsections (A)(4) through (12).

C. The following services are excluded as covered services:

1. Occupational and speech therapies provided on an outpatient basis for a member age 21 or older;

2. Physical therapy provided only as a maintenance regimen;

3. Abortion counseling; or

4. Services or items furnished solely for cosmetic purposes.

 

* * *

 

[Title 9.  Health Services.

Chapter 31.  Arizona Health Care Cost Containment System. Children’s Health Insurance Program.]


R9-31-215. Other Medical Professional Services

The following medical professional services are covered services if a member receives these services in an inpatient, outpatient, or office setting as follows:

1. Dialysis;

2. The following family planning services if provided to delay or prevent pregnancy:

a. Medications,

b. Supplies,

c. Devices, and

d. Surgical procedures.

3. Family planning services are limited to:

a. Contraceptive counseling, medication, supplies, and associated medical and laboratory examinations, including HIV blood screening as part of a package of sexually transmitted disease tests provided with a family planning service; and

b. Natural family planning education or referral;

4. Midwifery services provided by a nurse practitioner certified in midwifery;

5. Podiatry services if ordered by a member's primary care provider as specified in A.R.S. § 36-2989;

6. Respiratory therapy;

7. Ambulatory and outpatient surgery facilities services;

8. Home health services in A.R.S. § 36-2989;

9. Private or special duty nursing services if medically necessary and prior authorized;

10. Rehabilitation services including physical therapy, occupational therapy, speech therapy, and audiology provided under this Article;

11. Total parenteral nutrition services, (which are the provision of total caloric needs by intravenous route for individuals with severe pathology of the alimentary tract);

12. Inpatient chemotherapy;

13. Outpatient chemotherapy; and

14. Hospice care under R9-22-213.

 

-----------------------------------------

Arizona Health Care Cost Care Containment System.  Medical Policy Manual.

 Section 410.  maternity care services.

* * *

8. PREGNANCY TERMINATION

 

Description. AHCCCS covers pregnancy termination if one of the following conditions is

present:

1. The pregnant member suffers from a physical disorder, physical injury, or physical

illness, including a life-endangering physical condition caused by or arising from the

pregnancy itself, that would, as certified by a physician, place the member in danger of

death unless the pregnancy is terminated.

2. The pregnancy is a result of rape or incest.

3. The pregnancy termination is medically necessary according to the medical judgment

of a licensed physician who attests that continuation of the pregnancy could reasonably

be expected to pose a serious physical or mental health problem for the pregnant

member by:

a. Creating a serious physical or mental health problem for the pregnant member

b. Seriously impairing a bodily function of the pregnant member

c. Causing dysfunction of a bodily organ or part of the pregnant member

d. Exacerbating a health problem of the pregnant member, or

e. Preventing the pregnant member from obtaining treatment for a health problem.

 

Conditions, Limitations and Exclusions.

The attending physician must acknowledge that a pregnancy termination has been

determined medically necessary by submitting the Certificate of Necessity for Pregnancy

Termination (see Exhibit 410-1).

This form must be submitted to the appropriate assigned Contractor Medical Director or

designee for enrolled pregnant members, or the AHCCCS Chief Medical Officer or

designee for fee-for-service (FFS) members. The Certificate must certify that, in the

physician's professional judgment, one or more of the above criteria have been met.

 

Additional Required Documentation

1. A written informed consent must be obtained by the provider and kept in the

member’s chart for all pregnancy terminations. If the pregnant member is younger

than 18 years of age, or is 18 years of age or older and considered an incapacitated

adult (as defined in A.R.S. § 14-5101), a dated signature of the pregnant member's

parent or legal guardian indicating approval of the pregnancy termination procedure

is required.

2. When the pregnancy is the result of rape or incest, documentation must be obtained that

the incident was reported to the proper authorities, including the name of the agency to

which it was reported, the report number if available, and the date the report was filed.

 

NOTE: Contractors must submit a standardized monthly Pregnancy Termination report

(Exhibit 410-2) to AHCCCS/Division of Health Care Management which documents the

number of pregnancy terminations performed during the month. If no pregnancy

terminations were performed during the month, the monthly report must still be submitted

to attest to that information.

When pregnancy terminations have been authorized by the Contractor, the following

information must be provided with the monthly report:

1. A copy of the completed Certificate of Necessity for Pregnancy Termination which has

been signed by the Contractor Medical Director or designee, and

2. A copy of the official incident report in the case of rape or incest.

(See Exhibit 410-2 for the reporting form and Exhibit 400-1 for submission timeframes.)

 

Prior Authorization (PA). Except in cases of medical emergencies, the provider must

obtain PA for all covered pregnancy terminations from the Contractor Medical Director, or

his/her designee. PA for FFS pregnant members must be obtained from the AHCCCS

Chief Medical Officer or designee. A completed Certificate of Necessity for Pregnancy

Termination must be submitted with the request for PA. The Contractor Medical Director

or AHCCCS Chief Medical Officer or designee will review the request and the Certificate,

and expeditiously authorize the procedure if the documentation establishes the termination

of pregnancy to be a medically necessary covered service.

In cases of medical emergencies, the provider must submit all documentation of medical

necessity to the Contractor, or AHCCCS/Division of Fee for Service Management Prior

Authorization Unit, within two working days of the date on which the pregnancy

termination procedure was performed.

 

The following references apply to all information contained in this policy:

Refer to Chapter 500 for AHCCCS policy on the transfer of a neonate between acute care

centers.

Refer to Chapter 800 for AHCCCS/DFSM FFS policy regarding extended stays for normal

newborns.

Refer to Chapter 900 for quality management for all covered services.

 

EXHIBIT 410-1

ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM

CERTIFICATE OF NECESSITY FOR PREGNANCY TERMINATION

 

JUSTIFICATION FOR PREGNANCY TERMINATION (CHECK ONE AND PROVIDE ADDITIONAL RATIONALE):

LIFE OF MOTHER ENDANGERED

_______________________________________

___________________________________________

RAPE

Reported to authorities, pursuant to A.R.S. Section 13-

3620 or A.R.S. Section 46-454 Yes ______ No

If yes, to what Agency?

Report #: ______________ Date filed:

Incident report attached.

Member Name:

Last First Middle

Member Address: _________________________________

Date of Birth: ________________________________

Member AHCCCS ID #: ________________________

Facility: ____________________________________

Date of Service: ______________________________

Procedure Code(s): ____________________________

Health Plan: __________________________________

 

INCEST

Reported to authorities, pursuant to A.R.S. Section 13-

3620 or A.R.S. Section 46-454 Yes ______ No

If yes, to what Agency?

Report #: ______________ Date filed:

Incident report attached.

 

MEDICALLY NECESSARY

_______________________________________

___________________________________________

_______________________________________________

Physician’s Printed Name

______________________________________________

Physician’s Phone

______________________________________________

Fax

Physician Signature: __________________________________________ Date:

Prior Authorization Number: ____________________________ Date:

Denial Reason: ______________________________________________________ Date: ___________________

Contractor Medical Director/AHCCCS Chief Medical Officer Signature: _________________________________

 

EXHIBIT 410-2

ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM

MONTHLY PREGNANCY TERMINATION REPORT

Contractor Name:

Reporting Period:

Month Year

Name of Individual completing form:

Name Title

If the Contractor has not authorized any termination of pregnancies for the month, indicate with a zero here: ________________

When terminations have been authorized by the Contractor, the following information must be provided:

*Reason: **Age: AHCCCS Member ID Rate Code Procedure Code Amount

Paid

1.

2.

3.

4.

Choose one of the following codes:

*Reasons for Termination **Age/Condition

A. Life of Mother Endangered (a) Under 18 years of age

B. Result of Incest (b) Incapacitated, over 18 years of age

C. Result of Rape (c) 18 years of age and older

D. Medically Necessary

Attach to this report for each approved pregnancy termination:

• A copy of the AHCCCS Certificate of Necessity; and

• A copy of the official incident report when rape or incest is involved.

Mark the envelope confidential and send the completed information to the following address:

Arizona Health Care Cost Containment System

Division of Health Care Management

Clinical Quality Management Unit

701 East Jefferson, MD 6700

Phoenix, AZ 85034

 

DO NOT FAX

ANY REQUIRED INFORMATION THAT IS NOT AVAILABLE AT THE TIME OF THIS REPORT

MAY BE INCLUDED IN THE NEXT MONTH’S REPORT.