Alabama Administrative Code › Title 420 - ALABAMA STATE BOARD OF HEALTH › Chapter 420-5-20 - SPECIALTY CARE ASSISTED LIVING FACILITIES › Appendix B - Code of Ala. 1975, Sections 22-21-20, Et Seq

Current through Register Vol. 42, No. 9, June 28, 2024
§
									22-21-20.
				Definitions.
For the purpose of this article, the following terms shall have
				the meanings respectively ascribed to them by this section:
(1) Hospitals.
General and specialized hospitals,
				including ancillary services; independent clinical laboratories; rehabilitation
				centers; ambulatory surgical treatment facilities for patients not requiring
				hospitalization; end stage renal disease treatment and transplant centers,
				including free-standing hemodialysis units; abortion or reproductive health
				centers; hospices; health maintenance organizations; and other related health
				care institutions when such institution is primarily engaged in offering to the
				public generally, facilities and services for the diagnosis and/or treatment of
				injury, deformity, disease, surgical or obstetrical care. Also included within
				the term are long term care facilities such as, but not limited to, skilled
				nursing facilities, intermediate care facilities, assisted living facilities,
				and specialty care assisted living facilities rising to the level of
				intermediate care. The term "hospitals" relates to health care institutions and
				shall not include the private offices of physicians or dentists, whether in
				individual, group, professional corporation or professional association
				practice. This section shall not apply to county or district health
				departments.
(2) Person.
The term includes individuals,
				partnerships, corporations, and associations. (Acts 1975, 3rd Ex. Sess., No.
				140, p. 382, §1; Acts 1979, No. 79-798, p. 1461; Acts 1991, No. 91-548, p.
				1010, §1; Act 2001-1058, 4th Sp. Sess., p. 1044, §1.)
§
									22-21-21. Purpose of
				Article.
The purpose of this article is to promote the public health,
				safety and welfare by providing for the development, establishment and
				enforcement of standards for the treatment and care of individuals in
				institutions within the purview of this article and the establishment,
				construction, maintenance and operation of such institutions which will promote
				safe and adequate treatment and care of individuals in such institutions. (Acts
				1949, No. 530, p. 835, §1; Acts 1962, Ex. Sess., No. 122, p. 157,
				§1.)
§
									22-21-22. License -- Required;
				exceptions.
No person shall establish, conduct or maintain any hospital as
				defined in Section
				22-21-20 without first obtaining
				the license provided in this article. Hospitals operated by the federal
				government and mental hospitals under the supervision of the board of trustees
				of the Alabama State Hospitals shall be exempt from the provisions of this
				article. (Acts 1949, No. 530, p. 835, §2; Acts 1962, Ex. Sess., No. 122,
				p. 157, §2.)
§
									22-21-23. License --
				Application.
Any person desiring licensing under this article shall apply to
				the State Board of Health therefore. The applicant shall state the name of the
				applicant and whether an individual, partnership, corporation or other entity,
				the type of institution for which a license is desired, the location thereof
				and the name of the person in direct supervision and charge thereof. The person
				in charge of such hospital must be at least 19 years of age and of reputable
				and responsible character. The applicant shall submit evidence of ability to
				comply with the minimum standards provided in this article or by regulations
				issued under its authority. (Acts 1949, No. 530, p. 835, §4; Act
				2001-1058, 4th Sp. Sess., p. 1044, §1.)
§
									22-21-24. License -- Fees;
				Expiration and Renewal; Accreditation
.
The application for a license to operate a hospital other than
				an assisted living facility or a specialty care assisted living facility rising
				to the level of intermediate care shall be accompanied by a standard fee of two
				hundred dollars ($200), plus a fee of five dollars ($5) per bed for each bed
				over 10 beds to be licensed in accordance with regulations promulgated under
				Section 22-21-28. Increase in a hospital's
				bed capacity during the calendar year is assessed at the standard fee of two
				hundred dollars ($200) plus five dollars ($5) each for the net gain in beds.
				The initial licensure fee and subsequent annual licensure renewal fee for an
				assisted living facility and for a specialty care assisted living facility
				rising to the level of intermediate care shall be two hundred dollars ($200)
				plus fifteen dollars ($15) for each bed. A license renewal application for any
				hospital, as defined by this article, which is not received by the expiration
				date in a properly completed form and accompanied by the appropriate renewal
				fee shall be subject to a late penalty equal to two hundred fifty dollars
				($250) or 100 percent of the renewal fee, whichever is greater. No fee shall be
				refunded. All fees received by the State Board of Health under the provision of
				this article shall be paid into the State Treasury to the credit of the State
				Board of Health and shall be used for carrying out the provisions of this
				article. A license granted under this article shall expire on December 31 of
				the year in which it was granted. A license certificate shall be on a form
				prescribed by the department, and shall be posted in a conspicuous place on the
				licensed premises. Licenses shall not be transferable or assignable and shall
				be granted only for the premises named in the application. Licenses may be
				renewed from year to year upon application, investigation, and payment of the
				required license fee, as in the case of procurement of the original license.
				All fees collected under this article are hereby appropriated for expenditure
				by the State Health Department. All hospitals which are accredited by the joint
				commission on accreditation of hospitals shall be deemed by the State Health
				Department to be licensable without further inspection or survey by the
				personnel of the State Department of Health. Further accreditation by the joint
				commission on accreditation of hospitals shall in no way relieve that hospital
				of the responsibility of applying for licensure and remitting the appropriate
				licensure fee as specified in this article. (Acts 1949, No. 530, p. 835,
				§5; Acts 1975, 3rd Ex. Sess., No. 140, p. 382, §2; Acts 1980, No.
				80-642, p. 1213; Acts 1988, 1st Ex. Sess., No. 88-902, p. 470; Act 2001-1058,
				4th Sp. Sess., p. 1044, §1.)
§
									22-21-25. License -- Issuance;
				Suspension or Revocation; New Applications After Revocation.
(a) The State Board of Health may grant licenses for the
				operation of hospitals which are found to comply with the provisions of this
				article and any regulations lawfully promulgated by the State Board of
				Health.
(b) The State Board of Health may suspend or revoke a license
				granted under this article on any of the following grounds:
(1) Violation of any of the provisions of this article or the
				rules and regulations issued pursuant thereto.
(2) Permitting, aiding or abetting the commission of any
				illegal act in the institution.
(3) Conduct or practices deemed by the State Board of Health to
				be detrimental to the welfare of the patients of the institution.
(c) Before any license granted under this article is suspended
				or revoked, written notice shall be given the licensee, stating the grounds of
				the complaint, and the date, time, and place set for the hearing of the
				complaint, which date of hearing shall be not less than 30 days from the date
				of the notice. The notice shall be sent by registered or certified mail to the
				licensee at the address where the institution concerned is located. The
				licensee shall be entitled to be represented by legal counsel at the
				hearing.
(d) If a license is revoked as provided in this section, a new
				application for license shall be considered by the State Board of Health if,
				when, and after the conditions upon which revocation was based have been
				corrected and evidence of this fact has been furnished. A new license shall
				then be granted after proper inspection has been made and all provisions of
				this article and rules and regulations promulgated under this article have been
				satisfied. (Acts 1949, No. 530, p. 835, §7; Act 2001-1058, 4th Sp. Sess.,
				p. 1044, §1.)
§
									22-21-26. License -- Judicial
				Review of Suspension or Revocation.
Any party aggrieved by a final decision or order of the Board
				of Health suspending or revoking a license is entitled to a review of such
				decision or order by taking an appeal to the circuit court of the county in
				which the hospital is located or is to be located. (Acts 1949, No. 530, p. 835,
				§11.)
§
									22-21-27. Advisory
				Board.
(a) There shall be an advisory board of 17 members to assist in
				the establishment of rules, regulations, and standards necessary to carry out
				the provisions of this article and to serve as consultants to the State Health
				Officer. The board shall meet at least twice each year and at the call of the
				State Health Officer. The members of the board shall annually elect one of its
				members to serve as chairman.
(b) The advisory board shall be constituted in the following
				manner:
(1) Four representatives of hospitals, who shall be appointed
				by the Board of Trustees of the Alabama Hospital Association as follows:
a. One administrator of a governmental hospital.
b. One administrator of a nongovernmental nonprofit
				hospital.
c. One owner or administrator of a proprietary hospital.
d. One member of a managing board of a nonprofit
				hospital.
(2) Three representatives who shall be doctors of medicine
				appointed by the Board of Censors of the Medical Association of the State of
				Alabama.
(3) One representative who shall be a registered nurse
				appointed by the Executive Board of the Alabama State Nurses
				Association.
(4) One representative from the State Board of Human Resources
				who shall be appointed by the board.
(5) One registered pharmacist actively engaged in the practices
				of pharmacy in the State of Alabama, to be appointed by the Executive Committee
				of the Alabama Pharmacy Association.
(6) Three members who shall be appointed by the Executive
				Committee of the Alabama Nursing Home Association, each of whom shall be the
				operator of a duly qualified licensed nursing home.
(7) One member who shall be appointed by the Alabama Hospice
				Association.
(8) Two members who shall be appointed by the Assisted Living
				Association of Alabama, one of whom shall be the operator of a licensed
				assisted living facility or licensed specialty care assisted living facility
				rising to the level of intermediate care with 16 or fewer beds, and one of whom
				shall be the operator of an assisted living facility or licensed specialty care
				assisted living facility rising to the level of intermediate care with more
				than 16 beds.
(9) One member who shall be appointed by the Governor to
				represent the interests of consumers. The consumer representative shall be at
				least 65 years of age and shall have no financial interest in any facility
				licensed under this article. Each new appointee shall serve for five years or
				until his or her successor is appointed, whichever is later. Any vacancy caused
				by a member leaving the position before the expiration of his or her term shall
				be filled by the organization selecting the original member. The replacement
				member appointed shall serve for the remainder of the unexpired term.
(c) A member of the advisory board shall not be eligible to
				succeed himself or herself after serving one full five-year term, but shall be
				eligible for reappointment if he or she has served only a portion of a
				five-year term or if he or she has not served immediately preceding the
				reappointment.
(d) Members of the advisory board shall serve without
				compensation, but shall be entitled to reimbursement for expenses incurred in
				the performance of the duties of the office at the same rate allowed state
				employees pursuant to general law. (Acts 1949, No. 530, p. 835, §9; Acts
				1959, No. 134, p. 656, §1; Acts 1991, No. 91-548, p. 1010, §1; Act
				2001-1058, 4th Sp. Sess., p. 1044, §1.)
§
									22-21-28. Rules and
				Regulations.
(a) In the manner provided in this section, the State Board of
				Health, with the advice and after approval by the advisory board, shall have
				the power to make and enforce, and may modify, amend, and rescind, reasonable
				rules and regulations governing the operation and conduct of hospitals as
				defined in Section
				22-21-20. All such regulations
				shall set uniform minimum standards applicable alike to all hospitals of like
				kind and purpose in view of the type of institutional care being offered there
				and shall be confined to setting minimum standards of sanitation and equipment
				found to be necessary and prohibiting conduct and practices inimical to the
				public interest and the public health. The board shall not have power to
				promulgate any regulation in conflict with law nor power to interfere with the
				internal government and operation of any hospital on matters of policy. The
				procedure for adopting, amending, or rescinding any rules authorized by this
				article shall conform to the Alabama Administrative Procedure Act. At any
				public hearing called for the purpose of soliciting public comment on proposed
				rules, any interested hospital or any member of the public may be heard.
(b) Any person affected by any regulation, amendment, or
				rescission thereof may appeal consideration thereof to the circuit court of the
				county of that person's residence or in which that person does business or to
				the Circuit Court of Montgomery County, pursuant to the Alabama Administrative
				Procedure Act. And upon appeal the question of the reasonableness of such
				regulation shall be a question of fact for the court to determine, and no
				presumption shall be indulged that the regulation adopted was and is a
				reasonable regulation.
(c) Regulations adopted under this section shall become
				effective as provided in the Alabama Administrative Procedure Act. (Acts 1949,
				No. 530, p. 835, §8; Act 2001-1058, 4th Sp. Sess., p. 1044,
				§1.)
§
									22-21-29.
				Inspections.
(a) Every hospital licensed under this article shall be open to
				inspection to the extent authorized in this section by employees and agents of
				the State Board of Health, under rules as shall be promulgated by the board
				with the advice and consent of the advisory board. Employees and agents of the
				board shall also inspect unlicensed and suspected unlicensed facilities.
				Nothing in this section shall authorize the board to inspect quarters therein
				occupied by members of any religious group or nurses engaged in work in any
				hospital or places of refuge for members of religious orders for whom care is
				provided, but any inspection shall be limited and confined to the parts and
				portions of the hospital as are used for the care and treatment of the patients
				and the general facilities for their care and treatment. No hospital shall, by
				reason of this section, be relieved from any other types of inspections
				authorized by law.
(b) All inspections undertaken by the State Board of Health
				shall be conducted without prior notice to the facility and its staff.
				Notwithstanding the foregoing, an inspection of a hospital or other health care
				facility, prior to its licensure, may be scheduled in advance. An employee or
				contract employee of the state shall not disclose in advance the date or the
				time of an inspection of a hospital or other health care facility to any person
				with a financial interest in any licensed health care facility, to any employee
				or agent of a licensed health care facility, to any consultant or contractor
				who performs services for or on behalf of licensed health care facilities, or
				to any person related by blood or marriage to an owner, employee, agent,
				consultant, or contractor of a licensed health care facility. For purposes of
				this section, the term inspection shall include periodic and follow-up
				compliance inspections and surveys on behalf of the State Board of Health,
				complaint investigations and follow-up investigations conducted by the State
				Board of Health, and compliance inspections and surveys, complaint
				investigations, and follow-up visits conducted on behalf of the United States
				Department of Health and Human Services, Health Care Financing Administration,
				or its successors. The board may prescribe by rule exceptions to the
				prohibition where considerations of public health or safety make advance
				disclosure of inspection dates or times reasonable. Disclosure in advance of
				inspection dates when such disclosure is required or authorized pursuant to
				federal law or regulation shall not be a violation of this section. Scheduling
				inspections of hospitals or other health care facilities by the board at
				regular, periodic intervals which may be predictable shall not be a violation
				of this section.
(c) Any employee or contract employee of the state who
				discloses in advance the date or time of an inspection in violation of
				subsection (b) shall be guilty of a Class A misdemeanor. Any person who
				solicits an employee or contract employee of the state to disclose in advance
				the date or time of an inspection in violation of subsection (b) for the
				purpose of disclosing the information to others shall be guilty of a Class A
				misdemeanor. (Acts 1949, No. 530, p. 835, §6; Acts 1997, No. 97-632, p.
				1146, §1; Act 2001-1058, 4th Sp. Sess., p. 1044, §1; Act 2006-617, p.
				1688, §1; Act 2009-492, p. 906, §1.)
§
									22-21-30. Disclosure of
				Information.
Information received by the State Board of Health through
				on-site inspections conducted by the state licensing agency is subject to
				public disclosure and may be disclosed upon written request. Information
				received through means other than inspection will be treated as confidential
				and shall not be directed publicly except in a proceeding involving the
				question of licensure or revocation of license. (Acts 1949, No. 530, p. 835,
				§10; Acts 1975, 3rd Ex. Sess., No. 140, p. 383, §3.)
§
									22-21-31. Practice of Medicine,
				etc., Not Authorized; Child Placing.
Nothing in this article shall be construed as authorizing any
				person to engage in any manner in the practice of medicine or any other
				profession nor to authorize any person to engage in the business of child
				placing. Any child born in any such institution whose mother is unable to care
				for such child or any child who, for any reason, will be left destitute of
				parental support shall be reported to the Department of Human Resources or to
				any agency authorized or licensed by the Department of Human Resources to
				engage in child placing for such service as the child and the mother may
				require. In the rendering of service, representatives of the Department of
				Human Resources and agencies authorized or licensed by the Department of Human
				Resources shall have free access to visit the child and the mother concerned.
				(Acts 1949, No. 530, p. 835, §2; Acts 1962, Ex. Sess., No. 122, p. 157,
				§2; Act 2001-1058, 4th Sp. Sess., p. 1044, §1.)
§
									22-21-33. Penalties for Operation
				of or Referring Persons to Unlicensed Hospital.
(a) (1) Any individual, association, corporation, partnership,
				limited liability company, or other business entity who operates or causes to
				be operated a hospital of any kind as defined in this article or any rules
				promulgated hereunder, without having been granted a license by the State Board
				of Health shall be guilty of a Class B misdemeanor upon conviction, except that
				any individual, association, corporation, partnership, limited liability
				company, or other business entity who operates or causes to be operated a
				hospital of any kind as defined in this article or any rules promulgated
				hereunder without having been granted a license by the State Board of Health
				shall be guilty of a Class A misdemeanor upon conviction of a second or any
				subsequent offense.
(2) The State Board of Health, upon determination that a
				facility or business is operating as a hospital, within the meaning of this
				article or any rules promulgated hereunder, and that the facility or business
				does not have a current and valid license granted by the State Board of Health,
				may apply to the circuit court of the county in which the unlicensed facility
				or business is located for declaratory and injunctive relief. The proceedings
				shall be expedited. The sole evidentiary questions before the court in a
				proceeding shall be whether the facility or business that is the subject of the
				action meets the definition of a hospital, within the meaning of this article
				and any rules promulgated hereunder, and whether the facility or business has
				been granted a current and valid license to operate by the State Board of
				Health. If the State Board of Health prevails on these questions, then the
				court, upon request of the State Board of Health, shall grant declaratory and
				injunctive relief requiring the operator or operators to close the facility or
				business and requiring the operator or operators to move all residents or
				patients to appropriate placements. Any individual failing to obey an
				injunction to close a hospital shall be guilty of a Class A misdemeanor. Any
				individual, after having once been subject to such an injunction, who shall
				later operate or cause to be operated a hospital, as defined in this article or
				any rules promulgated hereunder, without having been granted a license
				therefore by the State Board of Health shall be guilty of a Class A
				misdemeanor.
(3) The State Board of Health, upon the advice of the Attorney
				General, may maintain an action in the name of the state for an injunction to
				restrain any state, county, or local governmental unit, or any division,
				department, board, or agency thereof, or any individual, association,
				corporation, partnership, limited liability company, or other business entity,
				from operating, conducting, or managing a hospital in violation of this
				article, or any rule promulgated hereunder. Evidence that a person who is a
				licensed health care professional is or has been operating an unlicensed
				hospital or knowingly is or has been an employee of an unlicensed hospital
				shall be grounds for license revocation by the applicable professional
				licensing board or boards.
(4) No county or municipality shall grant a business license to
				a hospital, as defined in this article, unless the facility holds a current
				license to operate granted by the State Board of Health.
(5) In any action to collect a fee for services brought against
				a resident or patient by a hospital, as defined in this article or rules
				promulgated hereunder, it shall be a defense to the action to demonstrate that
				the operator of the hospital did not have a current and valid license to
				operate pursuant to this article at the time the services in question were
				rendered.
(b) (1) A licensed inpatient hospital acting through an
				authorized agent of the licensed inpatient hospital shall not knowingly refer
				to an unlicensed hospital any person who is in need of care rendered by a
				licensed hospital. A licensed hospice or certified home health agency acting
				through an authorized agent of the licensed hospice or certified home health
				agency shall not knowingly provide treatment or services in an unlicensed
				hospital to a person who is in need of care rendered by a licensed
				hospital.
(2) The Department of Public Health shall maintain, in
				electronic format and available on the Internet, a current directory of all
				licensed hospitals. The directory shall be maintained in a searchable database
				so that the licensure status of all licensed hospitals may be determined for
				the preceding four years and the then current year.
The Department, upon written request from a licensed inpatient
				hospital, shall provide to a designated representative of the hospital, a
				listing of any changes to the directory of all licensed hospitals through use
				of electronic communication, such as email, on a weekly basis.
(3) A determination of actual knowledge that a facility or
				business was unlicensed shall be supported by evidence that the unlicensed
				hospital was not listed in the directory maintained by the department on the
				day the referral or the admission was made or treatment was provided. In any
				action to levy a fine or revoke a license under this section, it shall be a
				defense to the action to demonstrate that the unlicensed inpatient hospital
				appeared in the directory as a licensed inpatient hospital on the day the
				referral or admission was made or the treatment was provided.
(4) Any licensed inpatient hospital acting through an
				authorized agent of the licensed inpatient hospital that knowingly makes a
				referral to an unlicensed hospital of a person in need of care rendered by a
				licensed hospital, or any licensed hospice or any certified home health agency
				acting through an authorized agent of the licensed hospice or certified home
				health agency that knowingly provides treatment in an unlicensed hospital to a
				person in need of care rendered by a licensed hospital, may be subject to a
				civil penalty imposed by the Board of Health not to exceed one thousand five
				hundred dollars ($1,500) per instance.
(5) All civil monetary penalties collected pursuant to this
				section or Section
				22-21-34 shall be paid to the
				Department of Human Resources and held in a dedicated fund for the sole purpose
				of making grants or disbursements to assist protected persons, as this term is
				defined in Section
				38-9-2, with appropriate placement
				or relocation from an unlicensed facility into a licensed facility or
				relocation from a facility undergoing license termination, suspension, or
				revocation, pursuant to Section
				22-21-25, to an appropriate
				setting. The Department of Human Resources is hereby authorized to make grants
				or disbursements from this fund to protected persons or to individuals or
				public or private organizations acting on behalf of a protected person.
(c) (1) For the purposes of this section, the term "licensed
				inpatient hospital" shall mean a licensed acute care hospital, long-term acute
				care hospital, rehabilitation hospital, inpatient hospice, skilled nursing
				facility, intermediate care facility, assisted living facility, or specialized
				care assisted living facility.
(2) For the purposes of this section, the term "knowingly"
				shall mean actual knowledge by a licensed inpatient hospital, licensed hospice,
				or certified home health agency acting through an authorized agent making a
				referral or providing services, that the unlicensed hospital to which the
				referral is made or services rendered is unlicensed within the meaning of this
				section. (Acts 1949, No. 530, p. 835, §12; Act 2001-1058, 4th Sp. Sess.,
				p. 1044, §1; Act 2008-389, p. 732, §1; Act 2017-280, §1.)
§
									22-21-34. Assisted Living
				Facility, etc., Rising to Level of Intermediate Care.
Under the circumstances listed below, an assisted living
				facility or a specialty care assisted living facility rising to the level of
				intermediate care may be subject to a civil money penalty imposed by the Board
				of Health not to exceed ten thousand dollars ($10,000) per instance. The
				imposition of the penalty may be appealed pursuant to the Alabama
				Administrative Procedure Act. All money penalties imposed pursuant to this
				section shall be remitted to the Department of Public Health and shall be
				deposited in the State General Fund. The penalties shall be deposited in the
				General Fund and shall not be earmarked for the Department of Public Health.
				Failure of an assisted living facility or a specialty care assisted living
				facility rising to the level of intermediate care to pay a civil money penalty
				within 30 days after its imposition or within 30 days after the final
				disposition of any appeal shall be grounds for license revocation unless
				arrangements for payment are made that are satisfactory to the State Board of
				Health. No assisted living facility or specialty care assisted living facility
				rising to the level of intermediate care may renew its license to operate if it
				has any unpaid civil money penalties which were imposed more than 30 days prior
				to the facility's license expiration date, except for any penalties imposed
				which are still subject to appeal and except for penalties for which
				arrangements for payment have been made that are satisfactory to the State
				Board of Health.
(1) A civil money penalty may be imposed for falsification of
				any record kept by an assisted living facility or specialty care assisted
				living facility rising to the level of intermediate care, including a
				medication administration record or any record or document submitted to the
				State Board of Health, by an employee or agent of the facility, where such
				falsification is deliberate and undertaken with intent to mislead the Board of
				Health, or its agents or employees, or residents, sponsors, family members,
				another state, county, or municipal government agency, or the public, about any
				matter of legal compliance, regulatory compliance, compliance with fire or life
				safety codes, or quality of care.
(2) A civil money penalty may be imposed as a result of a false
				statement made by an employee or agent of an assisted living facility or a
				specialty care assisted living facility rising to the level of intermediate
				care to an employee or agent of the State Board of Health, if the statement is
				made with intent to deceive or mislead the Board of Health, its agents or
				employees, about any matter of legal compliance, regulatory compliance,
				compliance with fire or life safety codes, or quality of care. A civil money
				penalty shall not be imposed if the facility's employee or agent makes a false
				statement when he or she has no reason to believe the false statement is
				authorized by the administrator or operator of the facility and if it is likely
				that the facility's employee or agent made the statement with the intent to
				cause damage to the facility. (
Act 2001-1058, 4th Sp. Sess., p.
				1044, §2.
)
Author:
Rick Harris, Kelley Mitchell
Statutory Authority:
Code of Ala.
				  1975
, §§
										22-21-20, et
				  seq.