Posts Tagged ‘Licensing’

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Rulemaking Stuff

May 10th, 2013

Our Licensing and Rulemaking teams spent the last week of April with hundreds of Stakeholders from numerous associations and licensees about our ongoing regulatory reform effort.  In addition, we’ve received hundreds of comments regarding our draft rules for Healthcare Institutions and Behavioral Health Service Agencies on our website (the comment period ended on May 5).  Our teams are now busy going through the written comments and our notes from the meetings as we prepare the final regulations, which are due by the end of June. 

We also have another Midwifery Scope of Practice Advisory Committee meeting on Wednesday, May 15 from 4-6 pm in the Lab.  We’ll be discussing the newest edition of the draft rules.  The latest draft still includes Vaginal Birth After Cesarean (VBAC) and Breech Delivery as within scope for Certified Professional Midwives under certain prescribed circumstances, although this latest version would not allow for the delivery of twins by a midwife.  We’ve also clarified monitoring reporting requirements regarding labor progression.  The final midwifery rules are also due at the end of June.

 

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Licensing’s Stakeholder Cornucopia

April 29th, 2013

Our Licensing and Rulemaking teams spent virtually all week hearing from hundreds of Stakeholders from numerous associations and licensees about our ongoing regulatory reform effort.  Our team met with representatives from:  Adult Day Health Care Facilities;  Assisted Living Facilities;  Home Health Agencies; Hospices; Hospitals; Nursing Care Institutions; Outpatient Surgical Centers; Outpatient Treatment Centers; Recovery Care Centers; Adult Therapeutic Foster Homes; DUI Services; Level 1 Residential Treatment Centers;  Level 1 Sub-Acute Facilities; Level 3 BH Residential Agencies; Level 4 Transitional Agencies; and Rural Substance Abuse Transitional Agencies. 

Most of the meetings went fairly well, with representatives providing us with specific and mostly constructive feedback which we’ll use to help construct better regulations.  Some meetings were more helpful than others.  The meetings in which folks gave us specific and targeted feedback regarding discrete parts of our draft rules were, of course, the most productive. 

We’ve posted our draft rules for Healthcare Institutions and Behavioral Health Service Agencies on our website.  Folks can continue to provide written comments and feedback via the respective on-line surveys on the Healthcare Institutions and Behavioral Health Service Agencies websites through May 5.

 

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Licensing Changes Near

April 9th, 2013

We’re getting near the end of the long journey of our licensing regulatory reform.  Last Wednesday we posted the revised draft rules for Chapter 10 (Health Care Institutions – Licensing) and Chapter 20 (Non-licensing approval).  Our goals is to simplify and streamline our rules so they align with our strategic plan and map to improve public health outcomes.  We’ve been working with representatives from the medical community, the behavioral health system, advocates and other affected folks to help reform our regulations.  We still need your help. Please provide comments for Chapter 10 using online surveys . Please provide comments for Chapter 20 using online survey .

The comment period will end on May 5th. The Department will revise the drafts and the final rules will take effect on July 1st of this year.  Please visit our Licensing webpage  to learn more about our integrated licensing rules implementation.

Thanks to all who have helped to advance the licensing of integrated health in Arizona!

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Licensing’s “ADVICE Collaborative”

March 28th, 2013

Our Licensing team routinely analyzes the most frequent and important deficiencies that we observe and posts the data on our website.  We use the data to help educate the folks that we license… and to identify good topics for provider training and technical assistance (public health interventions).  For example, our medical facilities licensing team has found that infection control is becoming increasingly troublesome among some dialysis providers. 

That info led our medical facilities licensing team to join with our Office of Infectious Disease Services and the ADHS Healthcare Associated Infections Advisory Committee to plan and provide a day-long collaboration to our licensed dialysis providers and public health professionals. This collaborative- (known as the ADVICE collaborative – Arizona Developing Value through Innovation and Communication) will provide tools for dialysis providers to improve their infection control performance by building relationships with public health, renal associations, federal partners and other stakeholders. 

The day will be spent sharing best practices, identifying new ways to promote infection control, and developing a strategic plan for future activities. We’ll also be passing on what we learn to our Healthcare Associated Infection Advisory Committee so they can develop and produce trainings and resources that will improve infection control.  You can find out more about the collaborative by visiting our website. This is just one of our many examples of how we’re leveraging licensing to improve public health outcomes.

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Hitting Our Mark at Showtime

February 28th, 2013

Last Saturday our Licensing team hit the mark at Showtime- when it matters most.  After hearing that the Fountain Retirement Hotel had put residents on notice it was closing, we immediately became concerned that staff would stop showing up, food and medication would not be given out, and the residents would be turned out into the streets to live. Many of the residents have significant medical and behavioral health needs, and need a caregiver to assist them with things like taking medication and preparing food.  

Our licensing team arrived at the facility immediately after hearing of the situation from the Sheriff’s Office…  and our licensing team pretty much right away called an “immediate jeopardy” (meaning that there was the potential for a real threat to health and safety of the residents).  Our team stayed all afternoon and into the night, working with the facility’s owner and manager to ensure all residents would be safe.  We maintained a strong presence at the facility throughout the weekend, making sure there were proper caregivers, enough food, and that residents were receiving their medication. 

We’re still sending surveyors out twice a day and are working with many other agencies, including AHCCCS, the VA, Adult Protective Services, Magellan, Partners in Recovery, and the Long Term Care Ombudsman’s Program to make sure the residents are finding new homes that will be able to meet their needs.  A huge thanks to Dr. Cara Christ, Kathy McCanna, Richard Young, Ellie Strang, and Jim Tiffany, for responding so effectively and ensuring the Health and Wellness of these Arizonans.  Thanks!

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Regulatory Reform Update

January 22nd, 2013

We’re continuing to make significant progress in our licensing regulatory reform efforts.  Our overall goal is to simplify and streamline our regulations so they align with our strategic plan and map to improve public health outcomes.  The new regulations will more acutely focus on health and safety criteria- and will put more emphasis on outcomes.  We’ve held numerous meetings with representatives from the medical community, the behavioral health system, advocates and other affected stakeholders to help us reform our regulations for Inpatient Behavioral Health Facilities, Residential Facilities, DUI Services, Domestic Violence Offender Treatment Programs, Outpatient Treatment Centers, Nursing Care Institutions, Assisted Living Facilities and Hospitals.  Public comments are being solicited through online surveys.  

In all, 18 Articles of regulations are being overhauled.  Draft Articles and online surveys can be found at the Health Care Institution and Behavioral Health Service Agency webpages.  By April 1st final drafts will be posted on our website for another round of comments.  The completed rules will be submitted to the Secretary of State by July 1, 2013. Thanks to all who have helped to advance the licensing of integrated health in Arizona!

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New “Empower” Standards Here

November 27th, 2012

It is hard to believe we’re in the 3rd year of our successful Empower Program. As a refresher for those of you that aren’t familiar with Empower, it’s a program that focuses on increasing healthy eating and active living, along with helping to provide smoke-free environments, in licensed child care facilities… reaching over 200,000 children throughout Arizona.  Empower is a voluntary program in which childcare licensees receive a discount on their 3-year licensing fee to become Empower centers and homes when they pledge to implement the 10 standards to Empower children to live healthier lives. The program has received national recognition from the White House and many other state and national partners. 

We’re excited to be rolling out updated 10 Empower standards beginning on 1/1/13.  We updated the standards to better impact the most significant health issues impacting Arizona’s children and families. New standards include those that will improve oral health, breastfeeding-friendly practices, training of childcare providers, and sun safety practices.  We’re committed to ensuring the successful implementation of the new standards, and we’ll be working with childcare providers throughout 2013 to learn how to apply the new standards. Licensed providers can look forward to receiving a new Empower Pack with new tools and resources to support the implementation of the new standards beginning mid-January, along with training and ongoing technical assistance.  

Thank you to all of the Licensing and Prevention Services staff (especially Adrienne Udarbe who helped lead the team) that worked so hard to update the standards…  thank you to the Stakeholders that have provided input along the way…  and thanks to our amazing “Superheroes for Health” out there in the childcares that support Arizona’s children every day!

 

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Evidence-Based Decision-Making: A Key Regulatory Benchmark

November 19th, 2012

The role of a surveyor can be a difficult one. Our team of licensing surveyors need to maintain neutrality as regulators and be able to apply the Arizona Administrative Code (otherwise known as “the rules”) to a wide variety of facilities within the healthcare system.  Part of our surveillance includes investigating complaints- which can be generated from an array of internal and external sources.  When the complaints come because of TV or other media coverage- it can pose unique challenges for our team.  But…  no matter where the complaint comes from, our job is to use facts and evidence to drive our investigation, decision-making, and interventions. 

There are 3 forms of evidence that we use to substantiate an allegation made in a complaint: 1) observation; 2) documentation; and 3) interviews. Two of these forms of evidence need to be present before we find that a complaint is “substantiated”.  By using these tried and true evidence-based tools we put ourselves in the best position to identify real health and safety problems without jumping to conclusions.

Focusing on facts and evidence (and not allowing one’s self to be driven by media coverage) is a good start…  but there are a few things that both surveyors and healthcare professionals can do to keep focus on providing a healthy and safe environment. Keep good records, document, sign and store up to date data, maintain consistent supervision for those that require it, follow your agency’s policies and procedures without fail, report what’s required, be proactive (not reactive), and seek out ongoing education in your field.  Don’t cut corners when it comes to care… and don’t be afraid to admit a mistake or that you do not have all the answers. 

So, if you happen to hear or see a TV story about a facility, keep in perspective that the story might focus on anecdotes and what the reporter thinks they know or even just their opinion- not necessarily what the evidence demonstrates.  In a time when information is disseminated second by second rather than day by day, let’s remember that we all share the same goal, to promote Health and Wellness for all Arizonans, which includes providing surveyors, community, clients and staff accurate and factual information.

Curious about the real scoop on how all of our licensed facilities are doing?  Check out our AZ Care Check website which has the details about our evidence-based investigations and surveys.

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Medical Marijuana @ 1 Year

November 9th, 2012

Our Vital Health Statistics team along with our partners at the UA College of Public Health completed the 1st Annual Report for the Arizona Medical Marijuana Program this week.  You’ll find a wide range of information in the report including data about the demographics and kinds and qualifying conditions of our cardholders, geographic distribution and rates as well as background information on the budget and fund, the various lawsuits, and de-identified information about physicians that are writing certifications. 

Perhaps the most striking thing in the report is that 24 doctors have signed about 80% of the 30,000 or so certifications in Year 1…  and a handful of doctors wrote more than 1,000 certifications.  That doesn’t necessarily mean that these doc’s aren’t acting in the best interests of their patients- but it does give us some insight into which ones we should be focusing on to ensure that they’re meeting our certification expectations.  The report goes into more detail if you’re interested. 

Dr. Cara Christ (our Agency Medical Director) did some outreach this week with the Executive Directors of the 4 medical licensing boards to brainstorm about what we can do as a system to ensure that doctors are truly acting in their patient’s best interests, complying with each licensing board’s expectations, and meeting our standards for certifications.  We’re also looking into doing some more intensive medical education among high frequency certifiers and have signed a contract with the AZ State Board of Pharmacy to help us with surveillance among the certifying physicians.  You can see some of the recommendations at the end of the report. 

Of course…  the info in the Annual Report is just a sub-set of all of the data we have about the program…  and you can see the full array of data and information including our summary monthly reports on our hub website.

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Our New Strategic Plan

October 17th, 2012

The vision of the Department is to ideally achieve a state of Health and Wellness for all Arizonans and our mission is to promote, protect, and improve the health and wellness of individuals and communities in Arizona. The updated mission and vision statements are helping us build public health value in-house as well as in the community.  The format was modernized and ADHS is making an effort to educate our partners and reinvigorate staff on our goals.

We’re among the largest and most complex of state agencies. With over 1,600 employees and an annual budget of more than $1.8B, we provide a wide variety of services and a diversity of programs housed within its five divisions: behavioral health; licensing; planning and operations; public health prevention; and public health preparedness. The two-fold mission of public health services includes prevention and preparedness for the state. The public behavioral health system oversees services for 150,000 enrolled clients and the state’s only public psychiatric hospital, the Arizona State Hospital. The division for licensing is charged with certification of nursing homes, assisted living and child care centers, hospitals and other health care facilities. The division for planning and operations oversees the budget, procurement, audit and special investigations, information technology, workforce development, rule-making, human resources, policy, continuous quality improvement, and accreditation.

Our strategic priorities are the pathways we use to achieve targeted improvements in public health outcomes. We’re committed to moving along with our partners in local health departments toward voluntary public health accreditation. The work towards accreditation will require the agency to look at the statewide public health system as a whole, collaborate with stakeholders, and provide evidence that our work meets the ten essential public health services. The ten essential services were set as a national standard in 1994 by a steering committee consisting of all US Public Health Service agencies and representatives from other major public health organizations. Accreditation focuses on quality, transparency, and partnerships. Through the accreditation process, our leadership will identify strengths, weaknesses, and opportunities for continuing to build public health infrastructure in a way that will best align our resources with key priorities.

Our new updated Strategic Plan lays out the framework for how we’ll use quality improvement, lean methodologies, best practices, and strategic alignment to achieve our vision of “Health and Wellness for All Arizonans”

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