News and Insights
Visit regularly for up-to-date information on relevant news, firm announcements and additions to our AZ Health Law Blog.
In 2018, Governor Ducey signed the Arizona Opioid Epidemic Act, which set strict limits on opioid prescribing for physicians who practice in Arizona. That legislation prohibited health care professionals from prescribing more than a five-day supply of opioids, with certain exceptions, e.g., patients with cancer pain, and patients in hospice. The legislation was the product of nationwide concern about opioid addiction and overdoses. Subsequent developments have led many to conclude that laws of this type were overly intrusive, and likely to cause unintended adverse consequences.
For example, a recent Perspective in the New England Journal of Medicine, Inherited Patients Taking Opioids for Chronic Pain—Considerations for Primary Care, discussed the consequences of abrupt changes in prescribing practices, including increased risk of illicit opioid use, increased mental health crises and overdoses, and more frequent emergency department visits and hospitalizations. As a result, it appears that the regulatory pendulum is swinging away from hard-and-fast rules towards a recognition of the importance of allowing physicians to exercise good medical judgment.
In Arizona, physicians now have more discretion to prescribe opioids that exceed dosage limitations set in 2018. During its most recent legislative session, the Arizona Legislature approved Senate Bill 1162, which is effective on September 24, 2022. The Bill amends an Arizona law that prohibits physicians from prescribing more than ninety “morphine milligram equivalents” unless the patient falls into certain exempted categories such as patients receiving hospice, palliative, or end-of-life care.
Physicians may now exceed the ninety-milligram dosage limitation for patients who: (1) have “chronic intractable pain,” or (2) are “receiving opioid treatment for perioperative care following an inpatient surgical procedure.” The new law defines chronic intractable pain as pain that is “excruciating, constant, incurable and of such severity that it dominates virtually every constant moment” and that also “produces mental and physical debilitation.”
The opioid dosage limitation does not apply to patients with chronic intractable pain who have an established physician-patient relationship and have tried doses of less than ninety morphine milligram equivalents that have been ineffective. The law does not change the requirement that, if a physician prescribes more than the ninety-milligram dosage, the physician must also prescribe naloxone or an FDA-approved equivalent to treat opioid-related overdoses.
Physicians who prescribe opioids should update their policies and procedures to address the new law. If you have questions about the new law, or how it may affect your practice, please contact Milligan Lawless.
 Coffin, P and Barreveld, A, Inherited Patients Taking Opioids for Chronic Pain—Considerations for Primary Care, N. Engl. J. Med. 2022; 386:611-613.
 A.R.S. § 32-3248.01.
 Id. at (B)(4)(j)-(k).
 Id. at (G)(1).
 See A.R.S. § 32-3248.01(E). For purposes of the new law, an established health professional-patient relationship requires all of the following: (a) a patient has physically presented to a health professional with a medical complaint; (b) the health professional has taken a medical history of the patient; (c) the health professional has performed a physical examination of the patient; and, (d) some logical connection exists between the medical complaint, the medical history, the physical examination, and the drug prescribed. See A.R.S. § 32-3248.01(G)(2)(a)-(d).
 A.R.S. § 32-3248.01(D).
Arizona passed a new law clarifying that licensed health professionals can form and practice through different types of business entities.
Arizona Revised Statutes Section 32-3230; Health Professionals; Practice; Employment; Business Entities
This new law, A.R.S. § 32-3230, provides that health professionals may engage in their professional and licensed health care practices in any form of business entity recognized under Arizona law and be employed by any form of business entity in Arizona. Although Arizona health professionals have utilized various business entities for their practices for years, this new law appears to clarify the ability for professionals to work for business entities not owned or controlled by other licensed health professionals.
Lone Exception: Optometrists
Although the definition of health professional is broad, it’s important to note that this new law carves out an exception for optometrists. This exception provides that an optometrist may practice the profession of optometry only as: (i) a sole practitioner; (ii) a partner with other health professionals; (iii) a professional limited liability company or professional corporation in which health professionals collectively possess at least 51 percent of the ownership interest; or (iv) an employee or independent contractor of an authorized optometry business.
Health Care Facilities Licensure
This new law was added to Title 32 under which the laws covering health professionals are found. There is no mention of the relation between this new law and the existing laws under Title 36 governing health care facility licensure by the Arizona Department of Health Services (ADHS). Title 36 excludes from ADHS facility licensing the “private offices and clinics of health care providers licensed under Title 32.” However, ADHS’ longstanding interpretation is that this exemption only applies to practices wholly owned by licensed health professionals. Therefore, although this new law allows for health professionals to work through any type of business entity, whether owned by health professionals or not, ADHS still requires a health care facility license in the event the entity is not wholly owned by licensed health professionals.
In passing this new law, the Arizona legislature sent a signal—Arizona is a state that is open for business with respect to health professionals. However, health professionals should still be cognizant of how this new law will affect ADHS health care facility licensure requirements. For questions on how this new law applies to your practice, please contact Jim Taylor and Aaron Kacer.
We are pleased to announce today that Chambers USA ranked Milligan Lawless, P.C. and 3 of our attorneys among the best in Arizona for 2022. Among Arizona law firms, Milligan Lawless achieved a Band 1 ranking, Chambers USA’s highest recognition, in the Healthcare practice area.
The firm received the following “Leading Individual” rankings for Phoenix attorneys:
Bryan S. Bailey – Healthcare, Band 2
Steven T. Lawrence – Corporate/M&A, Band 3
Robert J. Milligan – Healthcare, Band 1
Chambers USA is an annual ranking that assesses each law firm and attorney on technical legal ability, professional conduct, client service, commercial awareness/astuteness, diligence, commitment and other qualities most valued by their clients. Additionally, independent interviews with clients and confidential submissions of law firms are part of the Chambers research and evaluation process.
On Friday, December 17, 2021, a federal circuit court of appeals lifted a stay banning implementation and enforcement of the Occupational Safety and Health Administration’s (“OSHA”) Emergency Temporary Standard on COVID-19 vaccination and testing for employees of employers with at least 100 employees (“OSHA Rule”). The OSHA Rule, also known as the vaccine-or-testing mandate, covers approximately 80 million workers in the United States.
What does the OSHA Rule require?
Generally, for employers with at least 100 employees (“Large Employers”), the OSHA Rule requires face covering requirements, a written policy, collection of proof of vaccination, creation of a vaccination status records, removal of COVID-19 positive or untested employees from the workplace, maintenance of employee medical records, and certain employee communications about the employer’s policies and vaccine information from the Centers for Disease Control and Prevention.
More specifically, the OSHA Rule requires all employees of Large Employers to be fully vaccinated or submit weekly COVID-19 testing and wear a face mask while in the workplace. Additionally, the employer must:
- Establish, implement, and enforce a written policy that either (1) requires mandatory vaccinations, or (2) allows employees to choose either to be fully vaccinated against COVID-19 or provide proof of regular testing for COVID-19 and wear a face covering.
- Determine the vaccination status of each employee. In instances where an employee is unable to produce acceptable proof of vaccination, a signed and dated statement by the employee is acceptable proof of vaccination.
- Keep records of employee vaccination status in a file separate from the employee’s personnel file.
- Provide a reasonable amount of time to each employee for each (or only) vaccine dose, including (1) up to 4 hours paid time off, including travel time, at the employee’s regular rate, and (2) reasonable paid sick leave to recover from vaccine-related side effects.
- Inform each employee about the OSHA Rule and the employer’s policy.
- Report to OSHA each work-related COVID-19 fatality within 8 hours of the employer learning about the fatality, and inpatient hospitalization within 24 hours of the employer learning about the inpatient patient hospitalization.
- Require employee notification of a positive COVID-19 test or diagnosis.
- Ensure that, for employees who are not fully vaccinated, employees submit to and report COVID-19 testing at least once every 7 days and provide documentation of the most recent COVID-19 test result to the employer no later than the seventh day following the date on which the employee last provided a test result. Unvaccinated employees must wear a face covering indoors and when occupying a work vehicle with another employee.
Are there any exemptions or exceptions to the OSHA Rule?
Yes. The OSHA Rule has specific exemptions for certain types of employers and employees. Specifically, the following are exempt from the OSHA Rule:
- Workplaces covered under the Safer Workforce Task Force COVID-19 Workplace Safety: Guidance for Federal Contractors and Subcontractors;
- Workplaces covered under the Safer Workforce Task Force COVID-19 Workplace Safety: Guidance for Federal Contractors and Subcontractors;
- Settings where any employee provides healthcare services or healthcare support services when subject to the requirements of the Healthcare ETS;
- Employees who telework;
- Employees who do not report to a workplace where other people are present; and
- Employees who work exclusively outside.
Exemptions are also available for employees for whom a vaccine is medically contraindicated, who require a delay in vaccination, or for those sincerely held religious beliefs or disabilities.
Which employers are “covered employers” under the OSHA Rule?
The OSHA Rule applies to employers with a total of 100 or more employees at any time the OSHA Rule is in effect. Further, the OSHA Rule applies to healthcare workers in healthcare settings who are not covered by OSHA’s Healthcare Emergency Temporary Standard (“Healthcare ETS”). If the Healthcare ETS no longer applies, workers previously covered by the Healthcare ETS who remain unvaccinated would be subject to the OSHA Rule.
Private Medical Practices:
The OSHA Rule does not apply to private medical practices with fewer than 100 employees. However, private medical practices with fewer than 100 employees may still be subject to the Healthcare ETS.
What should I do if I am a “Covered Employer”?
Businesses with 100 or more employees should determine the COVID-19 vaccination status of their employees and develop a “vaccine-or-test” policy. OSHA announced, however, that it will not issue citations for noncompliance until January 10, 2022. OSHA stated it will exercise its discretion and not issue citations for noncompliance with testing requirements before February 9, 2022, if an employer is exercising reasonable, good faith efforts to comply.
Will there be any more legal challenges to the OSHA Rule that would affect its implementation?
Yes. Multiple parties, including nearly 30 states, have filed emergency motions with the United States Supreme Court to block the OSHA Rule. In its opinion lifting the stay on the OSHA Rule, the Sixth Circuit Court of Appeals noted that OSHA “must be able to respond to dangers as they evolve.”
Emergency appeals, including the request to stay a federal circuit court of appeals’ decision, go directly to the Justice assigned to the particular circuit. Justice Brett Kavanaugh is assigned to the Sixth Circuit. Justice Kavanaugh may decide the motions on his own, or he may elect to distribute to the full court for consideration.
Stay tuned for additional developments and updates on federal vaccine mandates. If you have any questions about COVID-19 employment-related issues, please contact John Conley.
 See supra, fn.1.
What mandates presently apply?
Three federal COVID-19 vaccine mandates have proven to be a frequently-moving target for employers nationwide as to both implementation and compliance. As of the date of this article, all three vaccine mandates are blocked in full or in part.
On September 9, 2021, President Biden announced federal COVID-19 vaccination mandates as part of his COVID-19 Action Plan, Path Out of the Pandemic. The same day, the President issued Executive Orders on COVID-19 vaccination for Federal employees and safety protocols for Federal contractors (the “Federal Contractor Mandate”). On November 5, 2021, the Centers for Medicare and Medicaid Services (“CMS”) and the Occupational Safety and Health Administration (“OSHA”) released interim final rules directed towards employers to require (per CMS) or strongly suggest (per OSHA) employees receive the COVID-19 vaccination. According to the current Administration, approximately two thirds of all private sector employees in the United States would be covered by COVID-19 vaccination rules.
Many states, including Arizona, have challenged the new rules through state legislation and litigation. On November 12, 2021, a federal court in Louisiana stayed enforcement and implementation of the OSHA Rule. All petitions for review of the OSHA Rule, including the Fifth Circuit’s ruling, were consolidated and are now before the U.S. Court of Appeals for the Sixth Circuit.
Shortly thereafter, on November 29, 2021, a federal court in Missouri granted a preliminary injunction blocking the CMS Rule against any and all Medicare- and Medicaid-certified providers and suppliers within Alaska, Arkansas, Iowa, Kansas, Missouri, Nebraska, New Hampshire, North Dakota, South Dakota, and Wyoming pending a trial on the merits. The following day, the court issued a preliminary injunction to cover all 50 states.
On November 30, 2021, a federal court in Kentucky issued an order granting a preliminary injunction to block the enforcement of the Federal Contractor Mandate in all covered contracts in Kentucky, Ohio, and Tennessee. Presently, this means that any covered contractors not affected by the injunction must be fully vaccinated (unless they qualify for a legal exemption) on or before January 18, 2022. Challenges to the Federal Contractor Mandate are presently pending in other jurisdictions, which may result in an extension of the preliminary injunction to additional states.
Stay tuned for additional developments and updates on the federal vaccine mandates and contact Aaron Kacer or Lauren Crawford with any questions. In the meantime, if you have questions about any COVID-19 employment-related issues, please contact John Conley.
 See Executive Order on Ensuring Adequate COVID Safety Protocols for Federal Contractors, available here, signed September 9, 2021; Executive Order on Requiring Coronavirus Disease 2019 Vaccination for Federal Employees, available here, signed September 9, 2021.
 See BST Holdings, L.L.C., et al. v. Occupational Safety & Health Admin., et al., No. 21-60845, 2021 WL 5166656, at *1 (5th Cir. Nov. 6, 2021), adhered to sub nom. BST Holdings, L.L.C. v. Occupational Safety & Health Admin., United States Dep’t of Labor, 17 F.4th 604 (5th Cir. 2021), available here; see Petition for Review, available here.