Arizona House of Representatives Committee on Regulatory Affairs — Report of Regular Meeting, March 22, 2023 (Fifty-sixth Legislature, First Regular Session)

Summary

Minutes of the regular meeting of the Arizona House of Representatives Committee on Regulatory Affairs held Wednesday, March 22, 2023, in the Fifty-sixth Legislature, First Regular Session, chaired by Representative Hendrix. The committee action table lists SB1252, SB1334 and SB1503 as DP and SB1382 as DPA. Attachments include the agenda, a Request to Speak report naming organizations that testified on the bills, and the committee attendance record. The bill analyses describe SB 1252, which establishes the Independent Maltreatment Fatality and Near Fatality Oversight Committee, SB 1334, which adopts the Advanced Practice Registered Nurse Compact, and SB 1503, on internet age verification for material harmful to minors. Roll call vote sheets for SB 1252 and SB 1503 are also included.

Summary drafted by a model from the document's text below and checked by script against that text before publication. It is a navigation aid, not a reading of what the document proves. Where AI is used

Full text

ARIZONA HOUSE OF REPRESENTATIVES
Fifty-sixth Legislature - First Regular Session

COMMITTEE ON REGULATORY AFFAIRS

Report of Regular Meeting
Wednesday, March 22, 2023
House Hearing Room 5 -- 2:00 P.M.

Convened 3:32 P.M.
Recessed
Reconyened
Adjourned 4:46 P.M.

Members Present

Representative Bravo

Representative Gutierrez
Representative Hernandez
Representative Payne

Representative McGarr, Vice-Chairman
Representative Hendrix, Chairman

Agenda
Original Agenda ~ Attachment |

Request to Speak
Report — Attachment 2

Committee Attendance
Report — Attachment 3

Committee Action

Bill Action
SB1252. DP
SB1334 DP
SB1382 DPA
SB1503. DP

MINUTES RECEIVED
CHIEF CLERK’S OFFICE
S-23-23
Vote Attachments
7-0-0-0 4,5
7-0-0-0 6,7

6-1-0-0 89,10
4-3-0-0 11, 12

fel

Juki Ryberg, Consrhittee Secretary
March 23, 202

(Original attachments on file in the Office of the Chief Clerk; video archives available at http:/Ayww.azleg.gov)

COMMITTEE ON REGULATORY AFFAIRS
March 22, 2023
REVISED - 3/21/23 REVISED - 3/21/23 REVISED - 3/21/23

ARIZONA HOUSE OF REPRESENTATIVES
Fifty-sixth Legislature - First Regular Session Ce sik | DS, ‘So2 fry

REGULAR MEETING AGENDA ,
(elsearveed YD Mp
COMMITTEE ON REGULATORY AFFAIRS

DATE Wednesday, March 22, 2023 ROOM HHR5 TIME 2:00 P.M.

Members of the public may access a livestream of the meeting here:
https://www.azleg.gov/videoplayer/?clientID=6361 162879&eventID=202303 1098

Members:
Representative Bravo Representative Payne Representative McGarr, Vice-Chairman
Representative Gutierrez, Representative Pefia Representative Hendrix, Chairman
Representative Hernandez A
Bills Short Title Strike Everything Title
-SB1202 banking feesicensing
——— raiser)

RA—WwAd WM, RULES

SB1252 dD LP child fatality review committee;

establishment(now: maltreatment oversight
committee; establishment)

YO On (Shamp: Borrelli, Gowan, et al)

RA, RULES

SB1334 advanced practice nurses; compact
Lf (Shamp)
7. O-0°O RA, RULES
*SB1382 pharmacy benefit managers; certificate
requirements

(Shamp)

CLO RA, RULES

SB1503 ) 4 explicit content; age verification; internet(now:

internet; verification; harmful to minors)

LZ, (Rogers: Bennett, Borrelli, et al)
RA, RULES

On previous agenda

ORDER OF BILLS TO BE SET BY THE CHAIRMAN

RA
03462623
03/21/2023

People with disabilities may request reasonable accommodations such as interpreters, alternative formats, or

assistance with physical accessibility. If you require accommodations, please contact the Chief Clerk's Office at
(602) 926-3032 or through Arizona Relay Service 7-1-1.

Page 1 of 1 Attachment /
Information Registered on the Request to Speak System

House Regulatory Affairs (3/22/2023)

$B1252, child fatality review committee; establishment (NOW:
maltreatment oversight committee: establishment)

Testified in support:
Meghaen Dell'Artino, The Center For The Rights Of Abused Children

Testified as neutral:
Melissa Compian, ARIZONA DEPARTMENT OF CHILD SAFETY

Support:

Lisa Gentry, representing self; Theresa Breithaupt, representing self

$B1334, advanced practice nurses: compact

Testified in support:
Steven Moortel, National Council Of State Boards Of Nursing (NCSBN) ; Shannon Bitza, representing self

Testified as opposed:
kathyrn busby, Arizona Nurses Association; Denise Link, PhD, WHNP, representing self; Heather Ross, representing
self

Support:

Mike Huckins, GREATER PHOENIX CHAMBER OF COMMERCE; Meghan McCabe, AZ HOSPITAL & HEALTHCARE ASSN;
Brittney Kaufmann, HEALTH SYSTEM ALLIANCE OF ARIZONA; Lisa Gentry, representing self; Theresa Breithaupt,
representing self; Kelli May Douglas (on behalf of the Department of Defense), representing self; Diane Caruso,
representing self

All Comments:

Meghan McCabe, AZ HOSPITAL & HEALTHCARE ASSN: AzHHA strongly supports the APRN Compact, which will
increase access to care, particularly for rural Arizona hospitals where APRNs serve as primary care providers.;
Brittney Kaufmann, HEALTH SYSTEM ALLIANCE OF ARIZONA: The ability for APRNS to work across states and
electronically is important to meeting our nursing workforce needs & improved access to quality healthcare.; Kelli
May Douglas (on behalf of the Department of Defense}, Self: Available to provide comments virtually or by phone,
if requested.; kathyrn busby, Arizona Nurses Association: Apparently amendment Is not being offered in
committee as was expected.; Denise Link, PhD, WHNP, Self: This APRN Compact does not increase patient access
to care nor does it facilitate APRN licensure where ever their patients reside

Attachment an
$B1382, pharmacy benefit managers; certificate requirements

Testified in support:
Dianne McCallister, Az Independent Pharmacists Coalition, AZ PHARMACY ASSOCIATION; Teresa Dickinson,
representing self; Julie Hoffman , representing self

Testified as neutral:
Kelsey Lundy, Pharmaceutical Care Management Association (PCMA)

Support:
Monique Whitney, representing self; Meghan McCabe, AZ HOSPITAL & HEALTHCARE ASSN; Amanda Rusing, AZ
MEDICAL ASSN; Theresa Breithaupt, representing self

Neutral:

Jay Kaprosy, CIGNA CORPORATE SERVICES LLC; Chad Heinrich, Arizonans For Affordable Health Coverage; Jaime
Molera, CVS HEALTH; Stan Barnes, UNITED HEALTHCARE SERVICES, INC.; Mike Huckins, GREATER PHOENIX
CHAMBER OF COMMERCE

Oppose:

Lisa Gentry, representing self

All Comments:

Jay Kaprosy, CIGNA CORPORATE SERVICES LLC: Neutral with proposed committee amendment.; Jaime Molera, CVS
HEALTH: Neutral with amendment; Stan Barnes, UNITED HEALTHCARE SERVICES, INC.: Neutral with amendment;
Mike Huckins, GREATER PHOENIX CHAMBER OF COMMERCE: Neutral with the adoption of the Hendrix
amendment

$B1503, explicit content; age verification; internet (NOW: internet:
verification: harmful to minors)

Testified in support:
Greg Blackie, representing self; Rob Hudelson, representing self; Luke Myers, representing self

Support:

Dianne Post, representing self; Lisa Gentry, representing self; Theresa Breithaupt, representing self

Oppose:

Sharon Lee, representing self

All Comments:
Dianne Post, Self: Contact information must be protected to prevent trolling. But pornography is very harmful and
violent to women and girls.

HOUSE OF REPRESENTATIVES

Please PRINT Clearly

Committee on ar eoviererd| WOFAACS — BillNumber (SOS

7)
Date Slz~ [es [Support Oppose O Neutral
Name WloA\WWA Co dS aut Need to Speak? &¢Yes No
Representing VY CUO: ce AA en a Are you a registered lobbyist? =
Complete Address
E-mail Address Phone Number
Comments:

oR] VE-MINUTE SPEAKING LIMIT***
ARIZONA STATE LEGISLATURE
Fifty-sixth Legislature - First Regular Session

COMMITTEE ATTENDANCE RECORD

COMMITTEE ON REGULATORY AFFAIRS
CHAIRMAN: Laurin Hendrix VICE-CHAIRMAN: _ Cory McGarr
DATE 03/22/23 123 /23 123 123
CONVENED F132 pm m m m m
RECESSED
RECONVENED
ADJOURNED SU pn
MEMBERS
Bravo VA
Gutierrez Va
Hernandez A i
Payne Va
| Pefa ~~
McGarr, Vice-Chairman L~
Hendrix, Chairman a

v Present --- Absent exc Excused

Attachment 2

ARIZONA HOUSE OF REPRESENTATIVES

Fifty-sixth Legislature
First Regular Session
Senate; GOV DP 5-3-0-0 | 3rd Read 18-12-0-0
Pisses a essai ec EN ase OT ATS ERNEST ST EE OTD SSIS ALAC CET ET RE EOS REE EE
SB 1252: maltreatment oversight committee; establishment
Sponsor: Senator Shamp, LD 29
Committee on Regulatory Affairs

Overview

Establishes the Independent Maltreatment Fatality and Near Fatality Oversight Committee
(Oversight Committee) to conduct reviews of each child maltreatment fatality or near fatality.
Describes the Oversight Committee’s membership, duties, powers and confidentiality
requirements.

History
Laws 1993, Chapter 245 established the Child Fatality Review Team (Team) within the

Department of Health Services (DHS). The Team is required to: 1) develop a child fatalities
collection system and provide system training; 2) conduct an annual report on the incidence and
causes of child fatalities during the past fiscal year; 3) encourage and assist in the development
of local child fatality review teams; 4) develop standards and protocols for local child fatality review
teams and child fatality investigations; 5) determine and take steps to implement changes that
are needed to decrease the incidence of preventable child fatalities; 6) provide case consultation
to local teams and educate the public on child fatalities; 7) develop and distribute an informational
brochure describing the Team; and 8) evaluate maternal fatalities and unexplained infant deaths
(A.R.S. § 36-3501).

The Department of Child Safety (DCS) must maintain DCS information as required by federal law
and provide the information, when necessary, to specified bodies for their duties. DCS information
includes ali information DCS gathers during an investigation, with outlined exclusions.
Furthermore, DCS must promptly provide the public with information regarding a case of child
abuse, abandonment or neglect that has resulted in a fatality or near fatality. A near fatality is an
act that, as certified by the child's treating physician, places a child in serious or critical condition
(A.R.S. §§ 8-807, 8-807.01). A health care provider must also disclose medical or payment
records or the information contained in such records without the patient's written authorization as
required by law or when ordered by specified bodies (A.R.S. § 12-2294).

Additionally, a qualified young adult is a former dependent child who is between 18 to 21 years
old, meets the criteria for an extended foster care program and signs a voluntary agreement to

participate (A.R.S. § 8-201).

Provisions

Oversight Committee Membership
1. Creates the Oversight Committee in the Arizona Department of Administration (ADOA) that
consists of five advisory members or their designees and nine members appointed by the
Director of ADOA. (Sec. 5)

2. Stipulates that the outlined advisory members are nonvoting members and do not count
toward a quorum. (Sec. 5)

3. Outlines criteria for the members appointed by the Director of ADOA, including that they:

SB 1252
Initials DC/SJ Page 1 Regulatory Affairs

Attachment So
a) may not be current or former DCS employees;
b) must select a chairperson; and
c) serve staggered three-year terms, with specified exceptions. (Sec. 5)

4. Specifies the Oversight Committee members:
a) may not receive compensation or reimbursement for expenses; and
b) may employ an executive director with experience in DCS. (Sec. 5)

5. Provides the term lengths for the members appointed by the Director of ADOA. (Sec. 6)

Oversight Committee Requirements
6. Requires the Oversight Committee to:

a) conduct a thorough review of each child maltreatment fatality or near fatality as prescribed;

b) inform the child's parents, guardian or caregiver that a review has commenced and of their
ability to present information to the Oversight Committee;

¢) develop an understanding of the circumstances surrounding a child maltreatment fatality
or near fatality;

d) critically analyze the child safety system's interactions with the child and their family to
identify specified improvements;

e) identify best practices and services that may have prevented the fatality or near fatality;

f) maintain a publicly accessible website that includes biographies of members, annual
reports, data and trends and reports of recommendations and responses;

g) analyze and publish annual data and trends on observations made during fatality and near
fatality reviews for a 10-year period as outlined;

h) produce, publish and distribute, on or before June 30th annually, the prescribed annual
child maltreatment fatality or near fatality report;

i} post the annual child maltreatment fatality or near fatality report, omitting any personal
identifying information, in an easily accessible format on its website; and

j) submit a copy of the annuai child maltreatment fatality or near fatality report to the
specified entities. (Sec. 5)

Oversight Committee Records Access and Confidentiality
7. Instructs DCS to provide the Oversight Committee access to necessary DCS information to
perform its duties. (Sec. 2)

8. Authorizes a health care provider to disclose medical or payment records and a clinical
laboratory to disclose laboratory results to the Oversight Committee without the written
authorization of the patient or their health care decision maker. (Sec. 3)

9. Directs the Team, upon finding that a child's fatality resulted from maltreatment, to submit to
the Oversight Committee:
a) the child's death certificate;
b) a notice of finding that abuse or neglect contributed to the child's death; and
c) the status of the case with DCS at the time of the child's death. (Sec. 4)

10. Allows the Oversight Committee to have ongoing access to complete and unredacted records
from DCS and direct remote access to any case management system used by DCS. (Sec. 5)

11. Enables the Oversight Committee to have access to relevant records and information from
any state agency, educational institution or medical provider of the child and their immediate
family and household members. (Sec. 5)

12. Entitles an Oversight Committee chairperson or their designee to be provided access to
relevant records and information as outlined within five days of their request. (Sec. 5)

SB 1252
Initials DC/SJ Page 2 Regulatory Affairs
13.

14.

15.

16.

17.

18.

19.

20.
21.
22.

Permits a law enforcement agency, with approval from a prosecuting attorney, to withhold
records that interfere with a pending criminal investigation or prosecution, including
information requested by a subpoena. (Sec. 5)

Grants the Oversight Committee chairperson or their designee the authority to apply to the
superior court for a subpoena to compel the production of evidence, in the manner provided
by the law. (Sec. 5)

States all information and records used by the Oversight Committee are confidential from civil
or criminal proceedings or subpoena, excluding any information that is otherwise available
from other sources. (Sec. 5)

Extends the confidentiality requirement to Oversight Committee members, attendees and
presenters, though a person may testify to independently obtained or publicly available
information. (Sec. 5)

Exempts Oversight Committee meetings when the facts and circumstances of a child
maltreatment fatality or near fatality are reviewed from the statutory requirement that they be
open to the public. (Sec. 5)

Designates a violation of the established confidentiality requirements as a class 2
misdemeanor. (Sec. 5)

Adds that DCS must notify the Oversight Committee of a confirmed child maltreatment fatality
or near fatality within 48 hours and provide ongoing and unredacted access to any material
about the case. (Sec. 5)

Miscellaneous
Defines child, committee, department, near fatality and qualified young adult. (Sec. 5)

Contains a purpose statement. (Sec. 6)
Makes technical and conforming changes. (Sec. 1, 2, 3, 4, 6)

C] Prop 105 (45 votes) O] Prop 108 (40 votes) 0 Emergency (40 votes) Fiscal Note

SB 1252

Initials DC/SJ Page 3 Regulatory Affairs
ARIZONA HOUSE OF REPRESENTATIVES
Fifty-sixth Legislature - First Regular Session

ROLL CALL VOTE
COMMITTEE ON Regulatory Affairs BILL NO. SB 1252
DATE March 22, 2023 MOTION: LY
PASS AYE NAY PRESENT | ABSENT
Bravo Va
Gutierrez a
Hernandez A LL
Payne “a
Pefia A
McGarr, Vice-Chairman L
Hendrix, Chairman Va
Y 2C\1fO <?

TEESECRETARY

APPROVED:

\URIN IX, Chairman
CORY MCGARR, Vice-Chairman

pm

“a
ATTACHMENT___<~7”
ARIZONA HOUSE OF REPRESENTATIVES

Fifty-sixth Legislature
First Regular Session

SB 1334: advanced practice nurses; Compact
Sponsor: Senator Shamp, LD 29
Committee on Regulatory Affairs

Overview
Adopts the Advanced Practice Registered Nurse Compact (Compact) to allow for multistate
uniform licensure for advanced practice registered nurses (APRNs).

History

An APRN is a registered nurse who meets all prescribed licensure or certification requirements
and who has undergone graduate-level education to practice advanced practice nursing
(American Nurses Association). Currently, Arizona provides for licensure for four types of APRNs:
1) registered nurse practitioner; 2) certified nurse midwife; 3) clinical nurse specialist; and 4)
certified registered nurse anesthetist (A.R.S. Title 32, Chapter 15, Articles 1 and 2). The Arizona
State Board of Nursing (AZBN) is tasked with certifying APRN applicants in accordance with
statutory requirements and AZBN rules (AZBN).

The Compact, a mutual recognition model of licensure for APRNs that allows an APRN to hold
one multistate license with a privilege to practice in other Compact states, was adopted by the
National Council of State Boards of Nursing (NCSBN) in 2002. The Compact went
through several revisions. In 2020, NCSBN introduced the newly revised APRN Compact. This
revised APRN Compact, including mandatory 2,080 practice hours among other uniform licensure
requirements, was adopted at the 2020 NCSBN Delegate Assembly (AZBN APRN Compact

Survey).
Provisions

Multistate APRN Uniform Licensure
4. Requires a party state to implement procedures for considering the criminal history records of
applicants for initial APRN licensure or APRN licensure by endorsement, which must include
submitting fingerprints or other biometric-based information to obtain such records from the
Federal Bureau of Investigation (FBI) and the agency responsible for retaining that state's
criminal records.

2. Outlines the APRN uniform licensure requirements for an applicant to obtain or retain a

multistate license in the home state as follows:

a) meets the home state’s qualifications for licensure or renewal and all applicable state laws;

b) completed either an accredited graduate-level education program that prepares the
applicant for one of the four recognized roles and one of the six population foci or a foreign
APRN education program as outlined.

c) passed an English proficiency examination, if applicable;

d) passed a national certification exam that measures APRN, role and population-
focused competencies;

e€) maintains continued competence as evidenced by recertification in the role and population
focus through the national certification program;

SB 1334
Initials Page 1 Regulatory Affairs

Attachment @
40.
44,

12.

13.

14.

f) holds an active, unencumbered license as a registered nurse and an active,
unencumbered authorization to practice as an APRN;

g) passed an NCLEX-RN exam or recognized predecessor, as applicable;

h) practiced for at least 2,080 hours, not including hours obtained as part of enrollment in an
APRN education program, as outlined;

i) submitted fingerprints or other biometric data to obtain criminal history records from the
FBI and agency responsible for retaining the state or, if applicable, foreign country's
criminal records;

j) has not been convicted or found guilty, or entered an agreed disposition of a felony offense
under applicable state, federal or foreign criminal law, or a misdemeanor offense related
to the practice of nursing as determined by rules adopted by the commission;

k) is not currently enrolled in an alternative program;

1) is subject to self-disclosure requirements regarding current participation in an alternative
program; and

m) has a valid U.S. social security number.

Requires an APRN who is issued a multistate license to be licensed in an approved role and
at least one approved population focus.

Defines population focus as a_ family/individual across the lifespan, adult-gerontology,
pediatrics, neonatal, women’s health/gender-related or psych/mental health.

Defines role as certified registered nurse anesthetists, certified nurse-midwives, clinical nurse
specialists or certified nurse practitioners.

Requires each party state to recognize an APRN multistate license as authorizing the APRN
to practice in each party state, under a multistate licensure privilege, in the same role and
population focus as the APRN is licensed in the home state.

Specifies that the Compact does not affect the requirements established by a party state for
issuing a single-state license, but an applicant's failure to opt for a single-state license may
result in the issuance of a multistate license.

Requires the issuance of a multistate license to include prescriptive authority for noncontrolled
prescription drugs.

Stipulates that an APRN seeking authority to prescribe controlled substances must satisfy all
requirements imposed by the state in which the APRN seeks such authority.

Authorizes an APRN issued a multistate license to assume responsibility and accountability
for patient care independent of a supervisory or collaborative relationship.

Authorizes all party states, in accordance with state due process laws, to take adverse action
against an APRN’s multistate licensure privileges, including revocation, suspension, probation
or any other action that affects the multistate licensure privilege.

Requires a party state that takes an adverse action to promptly notify the administrator of the
Coordinated License Information System (System), who must promptly notify the home state.

Defines the System as an integrated process for collecting, storing and sharing information
on APRN licensure and enforcement activities related to APRN licensure faws that is
administered by a nonprofit organization composed of and controlled by licensing boards.

Requires an APRN practicing in a party state to comply with the state practice laws of the
state in which the client is located at the time service is provided, except as otherwise
expressly provided in the Compact.

SB 1334

Initials Page 2 Regulatory Affairs
15. Specifies that APRN practice includes all advanced nursing practice as defined by the state
practice laws of the party state.

16. Specifies that APRN practice in a party state subjects the APRN to the jurisdiction of the
licensing board, courts and laws of the party state in which the client is located at the time
service is provided.

17. Stipulates that the Compact does not affect additional requirements imposed by states for
advanced practice registered nursing, except as otherwise specified, but requires party states
to recognize multistate licensure as satisfying any state law requirement for registered nurse
(RN) licensure as a precondition for authorization to practice as an APRN in that state.

18. Allows individuals who do not reside in party states to continue to apply for a single-state
APRN license as provided under the laws of that party state and specifies such a license will
not be recognized as granting the privilege to practice as an APRN in any other party state.

Application
19. Requires the licensing board in the issuing party state, on application for a license, to ascertain

through the System whether:

a) the applicant has ever held or is the holder of a licensed practical or vocational nursing,
RN or APRN license issued by another state;

b) there are any encumbrances on any license or multistate licensure privilege held by
the applicant;

c) any adverse action has been taken against any license or multistate licensure privilege
held by the applicant; and .

d) the applicant is currently participating in an alternative program.

20. Permits an APRN to hold a multistate APRN license issued by the home state in only one
party state at a time.

21. Requires an APRN who moves between party states to apply for APRN licensure in the new
home state of residence and specifies the license issued by the prior home state must be
deactivated in accordance with applicable rules of the Interstate Commission of APRN
Compact Administrators (Commission).

22. Allows an APRN to apply for licensure in advance of a change in primary state of residence.

23. Prohibits a license from being issued by the new home state until the APRN:
a) provides satisfactory evidence of a change in primary state of residence; and
b) satisfies all applicable requirements to obtain a license from the new home state.

24. Specifies that if an APRN moves from a party state to a nonparty state, the APRN multistate
license converts to a singie-state license valid only in the former home state.

Licensing Boards
Authorizes a licensing board to:

a) take adverse action against an APRN’s multistate licensure privilege to practice in that
party state, subject to specified limitations below;

b) issue cease and desist orders or impose an encumbrance on an APRN’s authority to
practice within that party state;

c) complete any pending investigations of an APRN who changes primary state of residence
during an investigation and take action, then promptly report the conclusions of the
investigation to System administrator, who must promptly notify the new home state of
any such actions;

d) issue subpoenas for hearings and investigations that require attendance and testimony of
witnesses and production of evidence;

SB 1334
Initials Page 3 Regulatory Affairs
25.

26,

27.
28.

29.

30.

31.

32.

33.

34.

35,

36.

37.

e) obtain and submit applicant fingerprints or other biometric-based information for criminal
background checks, receive the results and use them in making licensure decisions;

f) recover from the affected APRN, if allowed by state law, the costs of investigations and
disposition of cases resulting from any adverse action taken against that APRN; and

g) take adverse action based on the factual findings of another party state if the licensing
board follows its own procedures for taking such adverse action.

Specifies that only the home state has the power to take adverse action against an APRN’s
license issued by the home state.

Requires, for purposes of taking adverse action, the home state licensing board to give the
same priority and effect to reported conduct that occurred outside the home state as it
would have if the conduct occurred within the home state and directs the home state to apply
its own state laws to determine the appropriate action.

Prescribes the requirements for issuance of subpoenas by a party state licensing board.

Directs the issuing licensing board to pay any witness fees, travel expenses, mileage and
other fees required by the service statutes of the state in which the witnesses and evidence
are located.

Requires multistate licensure privilege to be deactivated if adverse action is taken by a home
state against an APRN’s license until all encumbrances have been removed.

States that all home state disciplinary orders that impose adverse action against a license fo
include a statement that the APRN’s licensure privilege is deactivated in all parly states during
the pendency of the order.

Specifies that the Compact does not override a party state’s decision that participation in an
alternative program may be used in lieu of adverse action.

Requires the home state licensing board to deactivate the multistate licensure privilege of any
APRN for the duration of fhe APRN’s participation in an alternative program.

System
Requires party states to participate in a System of all APRNs, licensed RNs and practical or
vocational nurses, including information on the license and disciplinary history of each APRN
submitted by party states, to assist in the coordinated administration of APRN licensure and
enforcement efforts.

Requires the Commission, in coordination with the System administrator, to formulate
procedures to identify, collect and exchange information under the Compact.

Stipulates that all licensing boards must promptly report the following to the System:

a) any adverse action and current significant investigative information;

b) denials of applications with the reasons for the denial; and

c) APRN participation in alternative programs known to the board, regardless of whether
such participation is deemed nonpublic or confidential under state law.

Allows all party state licensing boards contributing information to the System to designate
information that may not be shared with nonparty states or disclosed to others without the
express permission of the contributing state.

Prohibits any personally identifiable information obtained from the System by a party state
licensing board from being shared with nonparty states or disclosed to others except to the
extent allowed by the laws of the party state contributing the information.

SB 1334

Initials Page 4 Regulatory Affairs
38. Requires any information subsequently required to be expunged by the laws of the party state
contributing the information to be removed from the System.

39. Requires the Compact administrator of each party state to furnish a uniform data set to the
administrator of each party state that includes at least the following:
a) identifying information;
b) licensure data;
c) information related to alternative program participation; and
d) other information that may facilitate the administration of the Compact, as determined by
commission rules.

40. Requires the Compact administrator of a party state to provide all investigative documents
and information requested by another party state.

Commission
41. Establishes the Commission as an instrumentality of the party states.

42. Requires judicial proceedings by or against the Commission be brought in a court of
competent jurisdiction where the principal office of the Commission is located.

43. Allows the Commission to waive venue and jurisdictional defenses to the extent it adopts or
consents to participate in alternative dispute resolution proceedings.

44. States that the Compact is not a waiver of sovereign immunity.

45. Limits each party state to one Compact administrator who is the head of the state licensing
board or that person’s designee.

46. Allows the administrator to be suspended, removed from office or replaced as allowed
by state law.

47. Entitles each administrator to one vote related to rules and bylaws.
48. Requires the Commission to meet at least once during each calendar year.
49. Requires meetings to be open to the public and with public notice.

50. Allows a closed nonpublic meeting to discuss:

a) noncompliance of a party state with Compact obligations;

b) personnel matters as specified;

c) current, threatened or reasonably anticipated litigation;

d) negotiation of contracts to purchase or sell goods, service or real estate;

@) accusing any person of a crime or formally censuring any person;

f) disclosure of trade secrets or commercial or financial information that is privileged
or confidential;

g) disclosure of personal information that would constitute a clearly unwarranted invasion of
personal privacy;

h) disclosure of information related to reports prepared by or on behalf of the Commission to
investigate Compact compliance; and

i) matters specifically exempt from disclosure by federal or state statute.

51. Outlines requirements for certifying closed meetings, referencing the
relevant exemption and keeping minutes.

52. Requires the Commission to prescribe bylaws and rules, including:
a) establishing a fiscal year;
b) providing reasonable standards and procedures for establishing other committees and
delegating Commission authority or function;

SB 1334
Initials Page 5 Regulatory Affairs
53.

54.
55.

56.

57,

58.

59.

60.

c) providing reasonable procedures for calling and conducting meetings, including public
participation and closed meetings;

d) establishing titles, duties and authority and reasonable procedures for electing officers;

@) providing reasonable standards and procedures for establishing personnel policies and
Commission programs; and

f) providing a mechanism for winding up the operations and equitable disposition of surplus
monies after paying and reserving all debts and obligations.

Requires the Commission to publish its bylaws, rules and amendments in a convenient form
on its website.

Requires the Commission to maintain its financial records in accordance with its bylaws.

Authorizes the Commission to:

a) create uniform rules for the Compact, which have the force and effect of law and are
binding in all party states; '

b) bring and prosecute legal actions provided that the standing of any licensing board to sue
or be sued under applicable jaw is not affected;

c) purchase and maintain insurance and bonds;

d) borrow, accept or contract for personnel, including employees of a party state or
nonprofit organizations;

6) cooperate with other organizations that administer state Compacts regarding nursing,
as ouillined;

f} hire employees, elect or appoint officers, fix compensation, define duties, grant
authority and establish policies regarding conflicts of interest, qualifications of personnel
and other related personnel matters;

g) accept appropriate donations, grants and gifts of monies, equipment, supplies, materials
and services, striving to avoid any appearance of impropriety or conflict of interest;

h) lease, purchase, accept appropriate gifts or donations of property, whether real, personal
or mixed, striving to avoid any appearance of impropriety;

i) sell, convey or otherwise dispose of any property, whether real, personal or mixed;

j) establish a budget and make expenditures;

k) borrow monies;

l} appoint committees as specified;

m) issue advisory opinions;

n) provide and receive information from, and cooperate with, law enforcement agencies;

0) adopt and use an official seal; and

p) perform other functions as necessary to achieve the purposes of the Compact consistent
with state regulation of APRN licensure and practice.

Requires the Commission to pay or provide for the payment of reasonable expenses of its
establishment, organization and ongoing activities.

Allows the Commission to levy and coliect an annual assessment from each party state to
cover the cost of its operations, activities and staff in its annual budget as approved each year.

Requires the aggregate annual assessment amount to be allocated based on a formula to
be determined by the Commission by rule.

Prohibits the Commission from incurring obligations before securing the monies adequate to
meet those obligations or pledging the credit of any party state except by and with the authority
of such party state.

Requires the Commission to keep accurate accounts of all receipts and disbursements, which
are subject to the audit and accounting procedures under its bylaws and requires a yearly

SB 1334

initials Page 6 Regulatory Affairs
audit by a certified or licensed public accountant and the report to be included in the
Commission's annual report.

61. Details immunity from claims of civil liability as outlined for specified Commission-related
individuals.

62. Requires the Commission to defend specified Commission-related individuals in any civil
liability action arising out of prescribed circumstances.

63. Requires the Commission to indemnify and hold harmless any specified Commission-related
individual for any settlement or judgment obtained against that person as outlined if the actual
or alleged act, error or omission did not result from the intentional, wilful or wanton misconduct
of that person.

Rulemaking
64. Specifies that rules and amendments have the same force and effect as the Compact.

65. Requires rules or amendments to be adopted at a regular or special Commission meeting.

66. Requires the Commission to file a notice of proposed rulemaking on the Commission’s
website and the website of each licensing board or as each state would otherwise publish
proposed rules before promulgation and adoption of a final rule and at least 60 days before
the meeting at which the rule will be considered and voted on.

67. Details what must be included in the notice of proposed rulemaking.

68. Requires the Commission to allow persons to submit written data, facts, opinions and
arguments, which must be made available to the public, before adopting a rule.

69. Requires the Commission to publish information about the public hearing and to allow public
comment orally or in writing.

70. Requires all hearings to be recorded, with a copy made available on request.
71. Allows rules to be grouped at hearings.
72. Requires the Commission to consider all written and oral comments as specified.

73. Requires the Commission to take final action on the proposed rule by majority vote of all
administrators and to determine its effective date.

74, Allows emergency rules as outlined under specified circumstances but requires the usual
procedures to be followed as soon as reasonably possible but not later than 90 days after the
rule’s effective date.

75. Permits the Commission to direct revisions to a rule or amendment to correct typographical
or formatting errors, errors in consistency or grammatical errors, with public notice and subject
to challenge.

Oversight, Dispute Resolution and Enforcement
76. Requires each party state to enforce the Compact and take actions necessary and appropriate
to effectuate the Compact's purposes and intent.

77. Entitles the Commission to receive service of process in proceedings that may affect the
powers, responsibilities or actions of the Commission and specifies that the Commission has
standing to intervene in such a proceeding.

78. States that failing to provide service of process to the Commission renders a judgment or
order void as to the Commission, the Compact or rules.

SB 1334
Initials Page 7 Regulatory Affairs
79.

80.

81.

82.

83.

84.

85.

86.
87,

88.

89.
90.

91.

92.

93,

94.

95,

Specifies the Commission shall provide the following if it determines that a party state has

defaulted in performing its obligations or responsibilities under the Compact or rules:

a) written notice to the defaulting state and other party states of the nature of the default, the
proposed means of curing the default and any other action to be taken by the Commission;
and

b) remedial training and specific technical assistance regarding the default.

Allows the defaulting state’s membership in the Compact to be terminated if the state fails to
cure the default, on the affirmative vote of a majority of the administrators and all rights,
privileges and benefits conferred by the Compact to be terminated on the effective date of the
termination.

Specifies that a cure of the defauit does not relieve the offending state of obligations or
liabilities incurred during the period of default.

Allows termination of membership to be imposed only after all other means of securing
compliance have been exhausted.

Requires the Commission to give notice of intent to suspend or terminate to the governor of
the defaulting state and to the executive officers of the licensing board, the licensing board
and each of the party states.

Specifies that a terminated state is responsible for all assessments, obligations and liabilities
incurred through the effective date of termination, including obligations that extend beyond
the effective date of termination.

Prohibits the Commission from bearing any costs related to a state found to be in default or
whose membership has been terminated unless agreed in writing.

Outlines requirements for a defaulting state to appeal.

Requires the Commission, on request by a party state, to attempt to resolve
Compact disputes that arise among party states and between party and nonparty states.

Requires the Commission to adopt a rule providing for mediation and binding dispute
resolution for disputes, as appropriate.

Outlines requirements if the Commission cannot resolve disputes, including for arbitration.

Requires the Commission, in the reasonable exercise of its discretion, to enforce the Compact
and related rules and specifies requirements for legal action.

Stipulates the remedies in the Compact are not the exclusive remedies of the Commission,
which may pursue other remedies available under federal or state law.

Effective Date, Withdrawal and Amendment
Specifies that the Compact comes into limited effect when it is enacted in seven party states
for the sole purpose of establishing and convening the Commission to adopt rules relating to
its operation.

Subjects any state that joins the Compact after the Commission’s initial adoption of the
APRN uniform licensure requirements to all Commission rules that were previously adopted.

Allows a party state to withdraw from the Compact by repealing the Compact but prohibits the
withdrawal from taking effect until six months after enactment of the repealing statute.

Prohibits a party state’s withdrawai or termination from affecting the continuing requirement
of that state’s licensing board to report adverse actions and significant investigations occurring
before the effective date of the withdrawal or termination.

SB 1334

Initials Page 8 Regulatory Affairs
96. Specifies that the Compact does not invalidate or prevent any APRN licensure agreement or
other cooperative arrangement between a party state and a nonparty state that does not
conflict with the Compact.

97, Allows the Compact to be amended by the party states, which becomes effective and binding
after enactment into law by all party states.

98. Permits representatives of nonparty states to be invited to participate in Commission activities
on a nonvoting basis before the adoption of the Compact by all states.

Miscellaneous
99. Specifies that the Compact does not supersede state law related to the applicable APRN
scope of practice or related rules and does not alter the scope of practice.

100. Requires APRNs practicing in this state to comply with the applicable scope of practice
pursuant to state law.

101. Specifies that the Commission does not have the authority to alter the scope of practice
for APRNs practicing in this state.

102. Allows the Governor to withdraw the state from the Compact if:
a) the Commission adopts a rule to change the scope of practice of APRNs in this state; and
b) a law is enacted that repeals the Compact.

103. Outlines findings and purposes related to uniform APRN regulation and licensure.
104. Requires the Compact to be liberally construed to effectuate its purposes.

105. Contains a severability clause.

106, Defines pertinent terms.

SB 1334
Initials Page 9 Regulatory Affairs

ARIZONA HOUSE OF REPRESENTATIVES
Fifty-sixth Legislature - First Regular Session

ROLL CALL VOTE

COMMITTEE ON Regulatory Affairs BILLNO. __ $B 1334

DATE March 22, 2023 MOTION: DL

PASS AYE NAY | PRESENT ; ABSENT

Bravo L
Gutierrez a
Hernandez A “a
Payne —
Pefia a
McGarr, Vice-Chairman ae
Hendrix, Chairman ~

2 OQ |O CP

le. Lif

APPROVED: OOMMITTEE CRETARY

~~ LAURIS-AENDRIX, Chairman
CORY MCGARR, Vice-Chairman

ATTACHMENT. 7
ARIZONA HOUSE OF REPRESENTATIVES

Fifty-sixth Legislature
First Regular Session
Senate: 5-2-0-0 | 27-2-1-0

$B 1382: pharmacy benefit managers; certificate requirements
Sponsor: Senator Shamp, LD 29
Committee on Regulatory Affairs

Overview

Effective January 1, 2025, requires all pharmacy benefit managers to obtain a certificate of
authority to operate and prescribes the Department of Insurance and Financial Institution's role,
responsibilities and authority.

History

The Department of Insurance and Financial Institutions (DIFl) oversees insurance
companies and related professionals through its adopted administrative rules and
guidelines conferred by the power and authority of Arizona law. Statute allows the Director
of DIFI (Director) to conduct examinations and investigations of insurance matters,
including those for adjusters, producers and brokers and other regulated individuals. The
Director also establishes guidelines for insurers of home health services prescribed by a
physician or registered nurse practitioner, and skilled professional care in a home
comparable to that provided in a hospital as outlined. (A.R.S. § 20-142).

A pharmacy benefit manager (PBM) is a person, business or other entity that, under a contract or
an employment relationship with an insurer or third-party payor, either directly or through an
intermediary manages the prescription drug coverage provided by the insurer or other third-party
payor, including: 1) the processing and payment of claims for prescription drugs; 2) the
performance of drug utilization review; 3) the processing of drug prior authorization requests; 4)
the adjudication of appeals or grievances related to prescription drug coverage; 5) contracting
with network pharmacies; and 6) controlling the cost of covered prescription drugs (A.R.S. § 20-
3321)

Statute prohibits a PBM from: 1) limiting a pharmacist or pharmacy from providing an insured
individual information on the amount of the insured’s cost share for the insured’s prescription drug
and the clinical efficacy of a more affordable alternative; 2) penalizing a pharmacy or pharmacist
for disclosing such information to an insured; and 3) requiring a pharmacist or pharmacy to charge
or collect from an insured a copayment that exceeds the total submitted charged by the network

pharmacy (A.R.S. § 44-1752)

Provisions
1. Requires a valid certificate of authority to operate as a PBM and makes the certificate of
authority renewable on a biennial basis. (Sec. 1)

2. Describes the required information that a PBM must submit to the Director to obtain the
certificate of authority to operate. (Sec. 1)

OO Prop 105 (45 votes) ( Prop 108 (40 votes) (1 Emergency (40 votes) 1 Fiscal Note

DC SB 1382
Initials Page 17 Requiatory Affairs

Attachment &
3. Outlines information in the application, including pertinent identifying information of the PBM,
copy of the basic organizational documents with articles of incorporation, bylaws, articles of
association and trade name certificate and any related documents and amendments. (Sec. 1}

4. Prescribes the necessary information that must be submitted by an out-of-state PBM,
including an in-state appointed director, copy of the required power of attorney, and authority
to accept service of process in Arizona. (Sec. 1)

5. Requires a signed certificate of good standing, along with a description of the PBM and its
services, facilities, personnel and a document confirming the business practices and contracts
comply with state laws. (Sec. 1)

6. Authorizes the Director to prescribe an application fee. (Sec. 1)

7. Requires the Director to issue a certificate of authority to operate to a PBM within 90 days
after receipt of a completed and qualified application and related fee. (Sec. 1)

8. Requires the Director to state specific reasons for any denial and provides 60 days for the
PBM to remedy any stated deficiencies. (Sec. 1)

9. Prescribes that the PBM must file a notice of modification with the Director within 30 days after
any material modifications to the application. (Sec. 1)

10. Authorizes the Director to refuse to issue a certificate of authority to a PBM who had a license
or certificate of authority revoked for cause in another state. (Sec. 1)

11. Allows the Director to issue a cease-and-desist order, or to deny, suspend or revoke a
certificate of authority after notice and opportunity for hearing as outlined. (Sec. 1)

42. Permits the Director to allow a PBM to operate a maximum 120 days or more to ensure
minimal disruptions to the continuity of care if the certificate of authority is suspended or
restricted. (Sec. 1)

13. Prescribes the monthly civil penalties when a PBM's certificate of authority is suspended or
restricted for unintentional and intentional violations as follows:

a. Unintentional violation: no more than $1,000 for each violation and maximum aggregate
of $10,000 in any 6-month period.

b. Intentional violation: no more than $5,000 for each violation and maximum aggregate of
$50,000 in any 6-month period. (Sec. 1)

14. Authorizes the Director to revoke a certificate of authority if the PBM has been operating under
a suspended certificate of authority for more than 120 days. (Sec. 1)

15. Prescribes the same rights and notices for hearings for PBMs as others entitled under the
Administrative Procedures Act. (Sec. 1)

16. Allows the Director to investigate PBM officers, directors and owners. (Sec. 1)

17. Outlines requirements for renewals of certificates of authority and deems them expired by
operation of law pursuant to administrative rules if not timely renewed. (Sec. 1)

18. Requires the PBM to comply with Arizona laws and rules on the effective date of the certificate
of authority if a PBM and insurer enter into a contractual agreement. (Sec. 1)

19. Stipulates that the PBM must comply with records retention rules, the duties and appeals
process of a utilization review agent and permits the Director to examine and review books
and records as outlined. (Sec. 1)

DC SB 1382
Initials Page 2 Regulatory Affairs
20. Authorizes the Director to adopt and implement administrative rules, records retention
schedules and deems records, books documentation and other data obtained by DIFI as
confidential and proprietary information, which is not considered public records. (Sec. 1)

21. Contains an effective date of January 1, 2025. (Sec. 1)

DC SB 1382
Initials Page 3 Regulatory Affairs
Fifty-sixth Legislature Regulatory Affairs
First Regular Session S.B, 1382

PROPOSED
HOUSE OF REPRESENTATIVES AMENDMENTS TO S.B. 1382

(Reference to Senate engrossed bill)

Page 1, strike lines 23 through 28, insert:
"(c) THE NAME AND ADDRESS OF THE PHARMACY BENEFIT MANAGER’S AGENT IN
THIS STATE FOR SERVICE OF PROCESS,”
Page 4, between lines 3 and 4, insert:
"R. THIS SECTION SHALL ONLY APPLY TO A PHARMACY BENEFIT MANAGER
PERFORMING SERVICES FOR A HEALTH PLAN SUBJECT TO THE JURISDICTION OF THIS
STATE.
S. THIS SECTION DOES NOT APPLY TO A WORKERS’ COMPENSATION INSURER
PERFORMING SERVICES UNDER TITLE 23."

Amend title to conform

LAURIN HENDRIX

1382HENDRIX. docx
03/17/2023

09:19 AM

H: DC/1s

Attachment 7
ARIZONA HOUSE OF REPRESENTATIVES
Fifty-sixth Legislature - First Regular Session

ROLL CALL VOTE

COMMITTEE ON Regulatory Affairs BILL NO. __ SB 1382

DATE March 22, 2023 MOTION: DB, , |

PASS AYE NAY PRESENT | ABSENT

Bravo

Gutierrez

Hernandez A

Payne

Pefia

McGarr, Vice-Chairman

Hendrix, Chairman

BS AIA

CZ?

7, <
LL, Led,

APPROVED: MMITTE CPECRETARY

Mf

ELE ee Sy
ZE NOBINHE NBAIX Chairman
CORY MCGARR, Vice-Chairman

ATTACHMENT /O
ARIZONA HOUSE OF REPRESENTATIVES
Fifty-sixth Legislature

First Regular Session

Senate: TAT DP 5-2-0-0 | 3rd Read 19-11-0-0

La NESTA VE TT TE LEE TTT UTTER EL LO ao ese Tee ree ee |

SB 1503: internet; verification; harmful to minors
Sponsor: Senator Rogers, LD 7
Committee on Regulatory Affairs

Overview
Directs a commercial entity to verify that any person attempting to access an internet website
containing a substantial portion of material harmful to minors is at least 18 years old.

History

A person is prohibited, with knowledge of the character of the item, to present, provide, lend or
advertise to minors any item that is harmful to minors, including through electronic mail, personal
messaging or any other direct internet communication. However, this prohibition does not apply
to posting material on an internet website (A.R.S. § 13-3506, 13-3506.01).

The governing board of every school district must prescribe policies for public schools that provide
a public access computer to deploy a technology protection measure that prevents minors from
accessing child pornography or material that is harmful to minors or obscene. Furthermore, a
public library must deploy and enforce similar technology protection measures for minors. Statute
prescribes penalties for public schools and public libraries that are found to be in violation of the
outlined requirements (A.R.S. § 34-502).

Statute defines internet as collectively, the myriad of computer and telecommunications facilities,
including equipment and operating software, that comprise the interconnected worldwide network
of networks that employ the outlined protocols (A.R.S. § 18-541).

Provisions

1. Requires a commercial entity that intentionally or knowingly publishes or distributes material
harmful to minors, on an internet website that contains a substantial portion of such material,
to verify that any person attempting to access the material is at least 18 years old. (Sec. 1)

2. Authorizes the age verification to be made through:
a) acommercially available database that is regularly used by businesses or governmental
entities for the purposes of age and identity verification; or
b) any other commercially reasonable method of age and identity verification. (Sec. 1)

3. Subjects a commercial entity that violates the verification requirement to civil liability for
damages, including attorney fees and costs, resulting from the minor's access to the material.
(Sec. 1)

4. Clarifies that a provider or user of an interactive computer service on the internet is not
obligated to or liable for the verification requirement. (Sec. 1)

5. Defines material harmful to minors as any description or representation of nudity, sexual
conduct, sexual excitement or sadomasochistic abuse, that:
a) appeals to the prurient, shameful or morbid interest of minors;

( Prop 105 (45 votes) (1 Prop 108 (40 votes) © Emergency (40 votes) 1 Fiscal Note

SB 1503
Initiais DC/SJ Page 1 Reaulatory Affairs

Attachment / /

b) is patently offensive to prevailing standards in the adult community as a whole, with
respect to what is suitable material for minors; and

c) is, when taken as a whole, lacking in serious literary, artistic, political or scientific value for
minors. (Sec. 1)

6. Specifies that a substantial portion means that more than 33.3% of the total material on a
website is explicit, sexual material harmful to minors. (Sec. 1)

7. Defines internet and interactive computer service. (Sec. 1)

SB 1503
initials DC/SJ Page 2 Regulatory Affairs

ARIZONA HOUSE OF REPRESENTATIVES
Fifty-sixth Legislature - First Regular Session

ROLL CALL VOTE

COMMITTEE ON Regulatory Affairs BILL NO. SB 1503

DATE March 22, 2023 MOTION: Ps

PASS AYE NAY PRESENT | ABSENT
Bravo Va
Gutierrez a
Hernandez A ~
Payne ~~
Pefia Va
McGarr, Vice-Chairman ~~
Hendrix, Chairman a

Y | 3 o> <D

APPROVED: panies ECRETARY

Z, fem ge Vian Lom
AURIN HENDRIX/@hairman
CORY MCGARR, Vice-Chairman

ATTACHMENT /22.

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