AS Title 18, Chapter 20: Hospitals and Nursing Facilities

Article 1. Regulation of Hospitals. Chapter 20. Hospitals and Nursing Facilities. Secs. 18.20.010 — 18.20.040. Purpose; license required; application and fees; issuance and renewal of license and posting. [Repealed, § 45 ch 57 SLA 2005.] Sec. 18.20.045. Insurance required. [Repealed, § 40 ch 177 SLA 1978.] Secs. 18.20.050 — 18.20.070. Denial, suspension, or revocation of license; regulations and standards; compliance with regulations. [Repealed, § 45 ch 57 SLA 2005.] Sec. 18.20.075. Risk management. (a) To be eligible for a license, each hospital shall have in operation an internal risk management program that shall (1) investigate the frequency and causes of incidents in hospitals that cause injury to patients; (2) develop and implement measures to minimize the risk of injury to patients; in developing these measures each hospital shall take into account recommendations of its medical staff, private underwriters, industry standards, experience of other hospitals, and recommendations of licensing boards of other health care providers; and (3) analyze patient grievances that relate to patient care. (b) The department shall adopt by regulation standards for the risk management programs in hospitals in the state which may vary according to the size of the hospital, the type of care offered by the hospital, and other factors found relevant by the department. Regulations adopted under this subsection are subject to AS 44.62 (Administrative Procedure Act). Sec. 18.20.076. Reports of suspended or revoked staff privileges. [Repealed, § 21 ch 87 SLA 1987.] Sec. 18.20.080. Inspection and consultation for alterations. (a) The department shall make annual inspections and investigations of hospital facilities. The department may accept accreditation by the Joint Commission on the Accreditation of Hospitals in lieu of an annual inspection by the department for the year in which the accreditation was granted if the accreditation standards of the commission are substantially similar to the inspection standards of the department. (b) The department may by regulation require that a licensee or applicant desiring to make a specified type of alteration or addition to its facilities or to construct new facilities shall, before commencing the alteration, addition, or new construction, submit plans and specifications to the department for preliminary inspection and approval or recommendations with respect to compliance with its regulations and standards. Sec. 18.20.085. Hospital records retention. (a) Unless specified otherwise by the department a hospital shall retain and preserve records that relate directly to the care and treatment of a patient for a period of seven years following the discharge of the patient. However, the records of a patient under 19 years of age shall be kept until at least two years after the patient has reached the age of 19 years or until seven years following the discharge of the patient, whichever is longer. Records consisting of X-ray film are required to be retained for five years. (b) The department shall by regulation define the types of records and the information required to be included in the records retained and preserved under (a) of this section. The department may by regulation specify records and information to be retained for longer periods than those set out in (a) of this section. (c) If a hospital ceases operation, it shall make immediate arrangements, as approved by the department, for the preservation of its records. (d) This section is subject to AS 18.23.100 . (e) In this section, “hospital” includes those facilities defined as hospitals under AS 18.20.130 and 18.20.210. Sec. 18.20.090. Disclosure of information. [Repealed, § 45 ch 57 SLA 2005.] Sec. 18.20.095. Mental health patient's right to select staff; duties of hospital staff. (a) Except as provided in (d) of this section, a patient 18 years of age or older who is receiving mental health treatment and being provided intimate care at a hospital shall have a right to have care provided by a staff member who is the gender that the patient requests. (b) A supervisor or manager employed by a hospital shall (1) post a notice of the right provided under (a) of this section in a conspicuous place; and (2) if, after reasonable and good faith efforts to comply, the hospital is unable to comply with the requirement under (a) of this section, (A) document in the patient record that intimate care was provided by a licensed staff member of the gender opposite to the gender requested by the patient under (a) of this section; or (B) if a licensed staff member is not on duty at the time of the patient's request under (a) of this section, document in the patient record that the care was provided by an unlicensed staff member of the gender opposite to that requested under (a) of this section. (c) Staff members employed by a hospital shall, in regard to patients receiving mental health treatment, (1) provide privacy for each patient, especially for patients who are the opposite gender and especially when patient care involves intimate bodily functions, unavoidable intimate touching, or nudity; (2) except when necessitated by a medical emergency that is documented in the patient's record, avoid entering patient care areas for a person of the opposite gender and areas specified for persons of the opposite gender; and (3) conduct routine safety checks and rounds of bedrooms, bathrooms, and shower areas only of patients who are the same gender as the staff member. (d) A hospital is exempt from the requirements of (a) of this section if the treating psychiatrist for the patient at the hospital determines that compliance would adversely affect patient treatment and the psychiatrist documents the determination in the patient's record. (e) In this section, (1) “intimate care” means hygienic care, including bathing, dressing, changing, and toileting, that involves a patient's perineal area and, for a female patient, the patient's breasts; “intimate care” does not include activities done in preparation for medical procedures; (2) “licensed staff member” means a person who is employed by the hospital to provide direct patient care and who is licensed or certified in the state as a physician or physician assistant under AS 08.64 , direct-entry midwife under AS 08.65 , nurse or nurse aide under AS 08.68 , or physical therapist or occupational therapist under AS 08.84 ; (3) “mental health treatment” means admission to a hospital primarily for electroconvulsive treatment or treatment with psychotropic medication, or admission to and retention in a health care institution for other mental health treatment; (4) “staff member” means a person employed by a hospital to provide direct patient care. Sec. 18.20.100. Annual report of department. [Repealed, § 35 ch 126 SLA 1994.] Secs. 18.20.110 , 18.20.120. Misdemeanor to establish or conduct hospital without license; definitions. [Repealed, § 45 ch 57 SLA 2005.] Sec. 18.20.130. Definitions. In AS 18.20.075 — 18.20.130, (1) “department” means the Department of Health; (2) “hospital” means an institution or establishment, public or private, devoted primarily to providing diagnosis, treatment, or care over a continuous period of 24 hours each day for two or more nonrelated individuals suffering from illness, physical or mental disease, injury or deformity, or any other condition for which medical or surgical services would be appropriate. Article 2. Alaska Hospital and Medical Facilities Survey and Construction Act. Sec. 18.20.140. Purpose. The purpose of AS 18.20.140 — 18.20.220 is to make an inventory of existing hospitals and medical facilities, community mental health centers, and facilities for persons with intellectual and developmental disabilities; to survey the need for construction of hospitals and medical facilities, community mental health centers, and facilities for persons with intellectual and developmental disabilities; and to develop a program and plan of construction for each. Sec. 18.20.141. Department functions. The department shall be the sole agency for the administration of the plan as required by the federal act. The department shall develop and administer any programs necessary for compliance with the federal act. Sec. 18.20.150. Duties of department. (a) For each of the following groups of facilities, hospitals and medical facilities (Group 1), community mental health centers (Group 2), and facilities for persons with intellectual and developmental disabilities (Group 3), the department shall (1) make a statewide inventory of existing public, nonprofit, and proprietary facilities; (2) survey the need for construction of these facilities; (3) on the basis of the inventory and survey, develop a program for the construction of public and other nonprofit facilities for each of these groups that will, in conjunction with existing facilities, afford the necessary physical facilities for furnishing adequate facility services to all residents of the state. (b) [Repealed, § 19 ch 6 SLA 1998.] (c) The department shall (1) provide for adequate facilities to furnish needed services for persons unable to pay for them in accordance with regulations adopted under the federal act; (2) submit any reports that the surgeon general considers necessary for compliance with the federal act; (3) do all things on behalf of the state necessary to obtain benefits under the federal act. Sec. 18.20.160. Priority of projects. The state plan must set out the relative need for the projects included in the construction program determined in accordance with the regulations adopted under the federal act, and provide for the construction, maintenance, and operation to the extent financial resources permit, in the order of the relative need. Sec. 18.20.170. Application for construction projects. The state, a political subdivision of the state, or a public or other nonprofit agency requesting federal funds for a health facility construction project must apply to the department. The application must conform to federal and state requirements. Sec. 18.20.180. Approval of applications. The commissioner of the department shall give every applicant an opportunity for a fair hearing. If, after giving reasonable opportunity for development and presentation of applications in the order of relative need, the commissioner of the department finds that a project application complies with the requirements of AS 18.20.170 and conforms with the state plan, the commissioner shall approve and recommend the application and forward it to the surgeon general. Sec. 18.20.190. Inspection of projects. The commissioner of the department shall inspect each construction project approved by the surgeon general from time to time. If the commissioner finds that work has been performed upon the project or purchases have been made in accordance with the approved plans and specifications, the commissioner shall certify to the surgeon general that this is the fact and that payment of an installment of federal funds is due the applicant. Sec. 18.20.200. Acceptance of grants. The department may accept on behalf of the state and may deposit separate and apart from public money and funds, a grant from the federal government, or gift or contribution from any source made to assist in meeting the cost of carrying out the purposes of AS 18.20.140 — 18.20.220. Federal funds received and not expended for these purposes shall be repaid to the United States. Sec. 18.20.210. Definitions. In AS 18.20.140 — 18.20.220, (1) “community mental health center” means a facility providing services for the prevention or diagnosis of mental illness, or care and treatment of mentally ill patients, or rehabilitation of mentally ill persons, which services are provided principally for persons residing in a particular community or communities in or near which the facility is situated; (2) “department” means the Department of Health; (3) “facility for persons with intellectual and developmental disabilities” means a facility specially designed for the diagnosis, treatment, education, training, or custodial care of persons with intellectual and developmental disabilities, including facilities for training specialists and sheltered workshops for persons with intellectual and developmental disabilities, but only if the workshops are part of facilities that provide or will provide comprehensive services for persons with intellectual and developmental disabilities; (4) “federal act” means Title VI of the Public Health Service Act (42 U.S.C. 291 et seq.) concerning hospitals and medical facilities and the Mental Retardation Facilities and Community Mental Health Centers Construction Act of 1963 (P.L. 88-164) concerning facilities for persons with intellectual and developmental disabilities and community mental health centers, both as now or hereafter amended; (5) “hospital” includes a public health center and general, tuberculosis, mental, chronic disease, and other type of hospital, and related facilities, including laboratory, outpatient department, nurses' homes, and training facilities, and central services facilities operated in connection with a hospital, but does not include a hospital furnishing primarily domiciliary care; (6) “medical facilities” means diagnostic and treatment centers, rehabilitation facilities, and nursing homes, as those terms are defined in the federal act, and other medical facilities for which federal aid may be authorized under the federal act; (7) “nonprofit facility for persons with intellectual and developmental disabilities” and “nonprofit community mental health center” mean, respectively, a facility for persons with intellectual and developmental disabilities and a community mental health center that is owned and operated by one or more nonprofit corporations or associations no part of the net earnings of which inures, or may lawfully inure, to the benefit of any private shareholder or individual; and the term “nonprofit private agency or organization” means an agency or organization that is such a corporation or association or that is owned and operated by one or more of such corporations or associations; (8) “nonprofit hospital” and “nonprofit medical facility” mean a hospital or medical facility owned and operated by a nonprofit corporation or association, no part of the net earnings of which inures, or may lawfully inure, to the benefit of a private shareholder or individual; (9) “public health center” means a publicly owned facility providing public health services, including related facilities such as laboratory, clinic, and administrative offices operated in connection with the public health center; (10) “surgeon general” means the Surgeon General of the Public Health Service or any other federal agency designated to administer the federal act. Sec. 18.20.220. Short title. AS 18.20.140 — 18.20.220 may be cited as the Alaska Hospital and Medical Facilities Survey and Construction Act. Secs. 18.20.230 — 18.20.260. Leaving general hospital without arranging for payment; posting of law required; receipt of services without intent to pay a misdemeanor; definition. [Repealed, § 45 ch 57 SLA 2005.] Article 3. Nursing Facilities. Sec. 18.20.300. State policy. It is the policy of the state to ensure that the quality of care in nursing facilities in this state is maintained at a high standard in accordance with applicable state and federal law and regulations and to ensure the health, safety, and quality of life of nursing facility residents in Alaska is maintained or enhanced. Sec. 18.20.302. Criminal background check for employees. [Repealed, § 45 ch 57 SLA 2005.] Sec. 18.20.305. Nursing facility regulations. The department shall adopt necessary regulations to implement AS 18.20.300 — 18.20.390 in accordance with AS 44.62 (Administrative Procedure Act). The department shall, by regulation, specify criteria as to when and how the sanctions specified in AS 18.20.310 will be applied. The criteria must provide for the imposition of incrementally more severe penalties for deficiencies that are uncorrected or pervasive, or that present a threat to the health, safety, or welfare of nursing facility residents. Sec. 18.20.310. Sanctions for noncompliance. (a) If the department finds that a nursing facility, or a partner, officer, director, owner of five percent or more of the nursing facility's assets, or managing employee of the nursing facility substantially failed or refused to comply with AS 08.68.340 — 08.68.390, AS 08.70 , AS 18.20.075 — 18.20.085, AS 47.07 , or with a regulation adopted under any of those statutes, or, for a nursing facility that provides Medicaid services under AS 47.07 , failed or refused to comply with the Medicaid requirements of 42 U.S.C. 1396r (Title XIX of the Social Security Act, as amended) or a regulation adopted under that statute, the department may take the following actions: (1) ban the admission of new residents to the nursing facility; (2) as provided in AS 18.20.320 , deny payment under AS 47.07 and AS 47.25.120 — 47.25.300 for any Medicaid or general relief-medical resident admitted to the nursing facility after notice by the department of denial of payment; residents who are eligible for Medicaid or general relief-medical are not responsible for payment when the department takes action under this paragraph; (3) assess a civil fine in accordance with AS 18.20.340 ; (4) suspend or terminate the nursing facility's participation in the Medicaid program; (5) suspend, revoke, or refuse to renew the nursing facility's license issued under this chapter; (6) seek an appointment of temporary administration as provided in AS 18.20.360 or of a receiver under AS 18.20.370 ; (7) in case of an emergency, seek an order from the court either to close the nursing facility or to transfer residents from that facility, or both. (b) An order of the department imposing a sanction described in (1) (a)(1), (4), or (5) of this section takes effect immediately upon service of the order on the nursing facility; however, if the facility can demonstrate to the department's satisfaction that the deficiencies prompting the order do not jeopardize the health or safety of facility residents or seriously limit the nursing facility's capacity to provide adequate care, the department's order takes effect 10 days after service; (2) (a)(2) or (3) of this section takes effect 10 days after service of the order on the nursing facility. (c) A hearing may be requested under AS 18.20.330 regarding a sanction imposed by the department under this section. Sec. 18.20.320. Denial of payment. The department shall deny payment under AS 47.07 or AS 47.25.120 — 47.25.300 to a nursing facility (1) that is not in compliance, and, for the preceding three months, has not been in compliance, with the requirements of 42 U.S.C. 1396r (Title XIX of the Social Security Act, as amended), and regulations adopted under that statute, until correction of the deficiency; or (2) if the department finds, on three consecutive reviews, that the nursing facility provided substandard quality of care; the department shall deny payment under this paragraph for new admissions until the facility has demonstrated to the satisfaction of the department that it is in compliance with the Medicaid requirements of 42 U.S.C. 1396r, and that it will remain in compliance with the requirements. Sec. 18.20.330. Appeal; hearing. (a) Notwithstanding AS 44.62.330 — 44.62.630, the department, by regulation, shall establish a hearing procedure by which a nursing facility may present evidence to refute a deficiency found by the department, and by which it may appeal, in a hearing conducted by the office of administrative hearings ( AS 44.64.010 ), a sanction imposed by order of the department under AS 18.20.310 . A request for a hearing shall be made in writing within 10 days after service of the department's order on the nursing facility. Except for an order that takes effect immediately under AS 18.20.310 (b)(1), a request under this subsection has the effect of staying the department's order until the hearing is concluded and the department makes a final determination. (b) An appeal, or request for stay, regarding a sanction imposed by the court under AS 18.20.310 (a)(6) or (7), 18.20.360, or 18.20.370, shall be filed with the court in accordance with the Rules of Civil Procedure. Sec. 18.20.340. Civil fines. In accordance with regulations adopted by the department under AS 44.62.010 — 44.62.300, the department may assess and collect, with interest, a civil fine of up to $10,000 a day for each day a nursing facility is or was out of compliance with any of the federal or state statutes or regulations listed in AS 18.20.310 . The department shall annually increase the maximum amount of the civil fine authorized in this section by a percentage equal to the percentage of increase in all items of the Consumer Price Index for all urban consumers for Anchorage, Alaska. Each day upon which the same or a substantially similar noncompliance occurs is a separate violation subject to the assessment of a separate civil fine. A civil fine assessed under this section is not reimbursable under AS 47.07 or AS 47.25.120 — 47.25.300. The department shall deduct the amount of a civil fine from reimbursement due or to be due the nursing facility under AS 47.07 or AS 47.25.120 — 47.25.300. The department may also use any remedy available under law to pursue collection of an unpaid fine. Sec. 18.20.350. Nursing facility resident security fund. (a) There is established in the department, as a fund separate from other public money of the state, the nursing facility resident security fund. This fund consists of all civil fines collected under AS 18.20.310 (a)(3) and 18.20.340 related to noncompliance with 42 U.S.C. 1396r(b), (c), or (d), and all interest earned on money in the fund. (b) The nursing facility resident security fund shall be administered by the department. Money in the fund may only be used for the protection of the health or property of residents of nursing facilities found to be out of compliance with 42 U.S.C. 1396r(b), (c), or (d), or a regulation adopted under those statutes, including payment for the costs of relocation of residents to other facilities, maintenance of operation of a facility pending correction of deficiencies or closure, and reimbursement to a resident for personal money lost. Sec. 18.20.360. Temporary management. (a) If the department determines that the health or safety of the residents of a nursing facility is immediately jeopardized as the result of the nursing facility's failure or refusal to comply with a state statute or regulation, or failure or refusal to comply with the Medicaid requirements in 42 U.S.C. 1396r (Title XIX of the Social Security Act) or a regulation adopted under that statute, the department shall immediately petition the superior court for an order for appointment of temporary administration to (1) oversee the operation of the facility; and (2) ensure the health and safety of the facility's residents while orderly closure of the facility occurs or the deficiencies necessitating temporary administration are corrected. (b) The court shall grant the petition if it finds by a preponderance of the evidence that the conditions in (a) of this section exist. Sec. 18.20.370. Receivership. (a) The department may petition the superior court for establishment of a receivership for a nursing facility if the department finds that one of the following conditions exists and the current operator has demonstrated an inability or unwillingness to take action necessary to immediately correct the conditions alleged: (1) the facility is operating without a license; (2) the health, safety, or welfare of the facility's residents is immediately jeopardized; (3) the facility demonstrates a pattern and practice of violating state or federal statutes or regulations in such a way that minimum resident care is jeopardized. (b) The court shall grant the petition if it finds by a preponderance of the evidence that one or more of the conditions in (a) of this section exist and the current operator is unable or unwilling to take action necessary to correct the condition. Sec. 18.20.390. Definitions. In AS 18.20.300 — 18.20.390, unless the context requires otherwise, (1) “department” means the Department of Health; (2) “general relief-medical” means the medical assistance program authorized in AS 47.25.120 — 47.25.300; (3) “Medicaid” means the medical assistance program authorized in AS 47.07 ; (4) “nursing facility” means an institution, or a distinct part of an institution, as defined in 42 U.S.C. 1396r. Article 4. Overtime Limitations for Nurses. Sec. 18.20.400. Limitations on nursing overtime. (a) Except as provided in (c) of this section, a nurse in a health care facility may not be required or coerced, directly or indirectly, (1) to work beyond a predetermined and regularly scheduled shift that is agreed to by the nurse and the health care facility; or (2) to accept an assignment of overtime if, in the judgment of the nurse, the overtime would jeopardize patient or employee safety. (b) Except as provided by (c) of this section, after working a predetermined and regularly scheduled shift that is agreed to by the nurse and the health care facility as authorized by (a)(1) of this section, a nurse in a health care facility shall be allowed not less than 10 consecutive hours of off-duty time immediately following the end of that work. (c) Subsection (a) of this section does not apply to (1) a nurse who is employed by a health care facility providing services for a school, school district, or other educational institution, when the nurse is on duty for more than 14 consecutive hours during an occasional special event, such as a field trip, that is sponsored by the employer; (2) a nurse voluntarily working overtime on an aircraft in use for medical transport, so long as the shift worked is allowable under regulations adopted by the Board of Nursing based on accreditation standards adopted by the Commission on Accreditation of Medical Transport Systems; (3) a nurse on duty in overtime status (A) who is participating in the performance of a medical procedure or surgery that has begun but has not been completed; (B) because of an unforeseen emergency situation that could jeopardize patient safety; in this subparagraph, “unforeseen emergency situation” means an unusual, unpredictable, or unforeseen situation caused by an act of terrorism, disease outbreak, natural disaster, major disaster as defined in 42 U.S.C. 5122, or disaster emergency under AS 26.23.020 or 26.23.140, but does not include a situation in which a health care facility has reasonable knowledge of increased patient volume or inadequate staffing because of some other cause, if that cause is foreseeable; (C) because the health care facility has a scheduling problem caused by unforeseen weather conditions that prevent a second nurse from arriving at the facility to relieve the nurse on duty; in this subparagraph, “unforeseen weather conditions” means unusual, unpredictable, or unforeseen weather so extreme as to impair travel to the health care facility, but does not include a situation in which the health care facility has knowledge of the weather conditions far enough in advance to act so that a scheduling problem under this subparagraph can reasonably be avoided; or (D) at a health care facility located in a rural community that declares a temporary nurse staffing emergency under AS 18.20.410 ; (4) a nurse fulfilling on-call time that is agreed on by the nurse and a health care facility before it is scheduled unless fulfilling the on-call time would, in the nurse's judgment, create an unacceptable risk to the physical safety of the nurse, a patient, or an employee of the facility; (5) a nurse voluntarily working overtime so long as the work is consistent with professional standards and safe patient care and does not exceed 14 consecutive hours; (6) a nurse voluntarily working beyond 80 hours in a 14-day period so long as the nurse does not work more than 14 consecutive hours without a 10-hour break and the work is consistent with professional standards and safe patient care; (7) a nurse who (A) is employed (i) at a psychiatric treatment hospital that treats only children or at a residential psychiatric treatment center, as defined under AS 18.07.111 , that treats only children; in this sub-subparagraph, “children” means persons under 19 years of age who are receiving psychiatric treatment from a hospital or center or who are residing in a center and who were under 18 years of age on the date that the treatment or period of residence commenced; (ii) at a residential psychiatric treatment center as defined under AS 47.32.900 ; or (iii) at a secure residential psychiatric treatment center as defined under AS 47.12.990 ; (B) voluntarily agrees to work a 16-hour shift for the period between 5:00 p.m. on a Friday and 8:00 a.m. on the Monday that immediately follows and receives pay and benefits for that work that are equal to or greater than the pay and benefits the nurse would receive for working 20 regular hours in the same position; and (C) during the period described in (B) of this paragraph does not work a 16-hour shift consecutive with another shift of eight hours or more without an intervening break of at least eight hours; (8) the first two hours on overtime status when the health care facility is obtaining another nurse to work in place of the nurse in overtime status, so long as the nurse in overtime status is not on duty for more than 14 consecutive hours. Sec. 18.20.410. Temporary nurse staffing emergency. (a) If, after making a substantial and reasonable effort to increase the number of available nurses on staff and failing in that effort, a health care facility in a rural community determines it is not able to meet the overtime limitations in AS 18.20.400 without putting the safety of its patients at risk of serious harm, the health care facility may declare a temporary nurse staffing emergency. A declaration of a temporary nurse staffing emergency under this section (1) must be made in a writing, signed by the administrator of the health care facility or the administrator's designee, that describes the facility's reasonable effort to avoid the temporary nurse staffing emergency; and (2) may not exceed 30 days. (b) Immediately after declaring a temporary nurse staffing emergency under (a) of this section, a health care facility shall file with the division of labor standards and safety, Department of Labor and Workforce Development, a report that includes a copy of the signed writing required under (a) of this section. A report under this subsection is a public document. (c) In addition to the requirements of (a) and (b) of this section, a health care facility shall notify the legislature immediately by delivery of a written report to the Alaska Legislative Council each time the facility declares a temporary nurse staffing emergency under AS 18.20.400 (c) that exceeds two occurrences in a six-month period that begins on January 1 or July 1 of the year in which the declaration occurs, or three occurrences in the one-year period that begins on January 1 of that year. A report under this subsection must include a copy of each report that is required of the health care facility under (b) of this section for the one-year period that begins on January 1 of the year the excessive declaration under this subsection occurs. Sec. 18.20.420. Health care facility complaint process for overtime work by nurses. A health care facility shall provide for an anonymous process by which a patient or a nurse may make a complaint about staffing levels and patient safety that relate to overtime work by nurses and to limitations on overtime work by nurses under AS 18.20.400 . Sec. 18.20.430. Enforcement, offenses, and penalties. (a) The commissioner shall administer AS 18.20.400 — 18.20.499 and adopt regulations for implementing and enforcing AS 18.20.400 — 18.20.499. (b) A complaint alleging a violation of AS 18.20.400 — 18.20.499 must be filed with the commissioner within 30 days after the date of the alleged violation. The commissioner shall provide a copy of the complaint to the health care facility named in the filing within three business days after receiving the complaint. (c) If the commissioner finds that a health care facility has knowingly violated an overtime provision of AS 18.20.400 — 18.20.499, the following civil penalties shall apply: (1) for a first violation of AS 18.20.400 — 18.20.499, the commissioner shall reprimand the health care facility; (2) for a second violation of AS 18.20.400 — 18.20.499 within 12 months, the commissioner shall reprimand the health care facility and assess a penalty of $500; (3) for a third violation of AS 18.20.400 — 18.20.499 within 12 months, the commissioner shall reprimand the health care facility and assess a penalty of not less than $2,500 but not more than $5,000; (4) for each violation of AS 18.20.400 — 18.20.499 after a third violation of AS 18.20.400 — 18.20.499 within 12 months, the commissioner shall reprimand the health care facility and assess a penalty of not less than $5,000 but not more than $25,000. (d) As an employer, a health care facility violates an overtime provision of AS 18.20.400 — 18.20.499 “knowingly” when the facility is either aware that its conduct is of a nature prohibited by the overtime provision or aware that the circumstances described in the overtime prohibition exist; however, when knowledge of the existence of a particular fact is required to establish that the violation was knowing, that knowledge exists when the facility is aware of a substantial probability of its existence, unless the facility reasonably believes it does not exist. Sec. 18.20.440. Prohibition of retaliation. A health care facility may not discharge, discipline, threaten, discriminate against, penalize, or file a report with the Board of Nursing against a nurse for exercising rights under AS 18.20.400 — 18.20.499 or for the good faith reporting of an alleged violation of AS 18.20.400 — 18.20.499. Sec. 18.20.450. Report requirements. (a) A health care facility shall file with the division of labor standards and safety, Department of Labor and Workforce Development, a semiannual report on a form provided by the department. The report for the six-month period ending June 30 must be filed before the following August 1, and the report for the six-month period ending December 31 must be filed before the following February 1. The report must include, for each nurse employed by the health care facility or under contract with the health care facility, the number of overtime hours worked and the number of hours the nurse was on call. A health care facility that does not employ a nurse who worked overtime hours or who was on call during the reporting period is not required to describe hours worked as overtime and on-call hours for individual nurses but may instead complete the report by stating on the form that there are no reportable hours. (b) A primary care outpatient facility is not subject to the reporting requirements of (a) of this section. Sec. 18.20.460. Provisions not applicable to nurses employed in federal or tribal facilities. The provisions of AS 18.20.400 — 18.20.499 do not apply to a nurse employed in a health care facility that is operated by (1) the federal government; or (2) a tribal organization as defined in 25 U.S.C. 450b. Sec. 18.20.470. Notice to employees. A health care facility shall post and maintain, in places readily accessible to individuals in the service of the health care facility, printed statements that describe employee rights and employer obligations under AS 18.20.400 — 18.20.499 and regulations adopted under AS 18.20.430 . The commissioner shall supply the printed statements to a health care facility without cost to the facility. Sec. 18.20.499. Definitions. In AS 18.20.400 — 18.20.499, (1) “commissioner” means the commissioner of labor and workforce development; (2) “health care facility” means a private, municipal, or state hospital; independent diagnostic testing facility; primary care outpatient facility; skilled nursing facility; kidney disease treatment center, including freestanding hemodialysis units; intermediate care facility; ambulatory surgical facility; Alaska Pioneers' Home or Alaska Veterans' Home administered by the Department of Family and Community Services under AS 47.55 ; correctional facility owned or administered by the state; private, municipal, or state facility employing one or more public health nurses; long-term care facility; psychiatric hospital; residential psychiatric treatment center, as defined in AS 18.07.111 or AS 47.32.900 ; secure residential psychiatric treatment center under AS 47.12.990 ; juvenile detention facility or juvenile treatment facility, as those terms are defined in AS 47.12.990 ; or treatment institution as that term is defined in AS 47.14.990 ; (3) “nurse” means an individual licensed to practice registered nursing or practical nursing under AS 08.68 who provides nursing services through direct patient care or clinical services and includes a nurse manager when delivering in-hospital patient care; (4) “on-call” means a status in which a nurse must be ready to report to the health care facility and may be called to work by the health care facility; (5) “overtime” means the hours worked in excess of a predetermined and regularly scheduled shift that is agreed to by a nurse and a health care facility; (6) “rural community” means a village or city that has a population of less than 10,000, as determined by the Department of Labor and Workforce Development, and is in (A) the unorganized borough; or (B) an organized borough that has a population of less than 25,000, as determined by the Department of Labor and Workforce Development. Article 5. Discharge of Hospital Patients. Sec. 18.20.500. Aftercare assessment and designation of caregiver. Before discharging a patient, a hospital shall assess the patient's ability for self-care after discharge and provide the patient with the opportunity to designate a caregiver who agrees to provide aftercare for the patient in a private residence after discharge. Sec. 18.20.510. Planning, instruction, and training. (a) A hospital shall give the patient and the patient's designated caregiver the opportunity to participate in planning for the patient's discharge from the hospital. (b) Before discharge, a hospital shall provide a patient and the patient's designated caregiver with instruction and training as necessary for the designated caregiver to perform medical and nursing aftercare following discharge. Sec. 18.20.520. Notification of discharge. A hospital shall notify a patient's designated caregiver of the patient's discharge or transfer. Sec. 18.20.530. Discharge policies. (a) A hospital shall adopt and maintain written discharge policies. The policies must comply with AS 18.20.500 — 18.20.590. (b) The discharge policies of a hospital must specify the requirements for documenting the identity of a patient's designated caregiver and the details of the discharge plan for the patient, including professional follow-up as specified in the discharge plan. (c) The discharge policies of a hospital may incorporate established evidence-based practices that include (1) standards for accreditation adopted by a nationally recognized hospital accreditation organization; or (2) the conditions of participation for hospitals adopted by the Centers for Medicare and Medicaid Services. (d) The discharge policies of a hospital must ensure that the discharge planning is appropriate to the condition of the patient, and the hospital shall interpret the discharge policies in a manner and as necessary to meet the needs and condition of the patient and the abilities of the patient's designated caregiver. (e) AS 18.20.500 — 18.20.590 do not require that a hospital adopt discharge policies that would (1) delay a patient's discharge or transfer to another facility; or (2) require the disclosure of protected health information without obtaining a patient's consent as required by state and federal laws governing health information privacy and security. Sec. 18.20.540. Construction of provisions. The provisions of AS 18.20.500 — 18.20.590 may not be construed to (1) create a right of action against a hospital, a hospital employee, or a contractor of the hospital, including a person who contracts with the hospital to provide instruction to a designated caregiver, based on an action performed or not performed under AS 18.20.500 — 18.20.590; or (2) replace, change, or otherwise affect rights or remedies that are provided under another provision of law, including common law. Sec. 18.20.550. Coordination with other authority. AS 18.20.500 — 18.20.590 may not be interpreted to interfere with the powers or duties of (1) an agent operating under a valid advance health care directive under AS 13.52 ; or (2) a legal guardian of the patient. Sec. 18.20.590. Definitions. In AS 18.20.500 — 18.20.590, (1) “aftercare” includes (A) assistance with the activities of daily living or activities that are instrumental to the activities of daily living; (B) wound care, medication administration, medical equipment operation, mobility assistance, and other medical or nursing tasks; and (C) other assistance related to the patient's condition at the time of discharge; (2) “designated caregiver” means a caregiver designated by the patient who agrees to provide aftercare to the patient in a private residence; (3) “discharge” means a patient's release from a hospital following the patient's admission to the hospital; (4) “hospital” has the meaning given in AS 18.20.130 , but does not include a hospital that is limited to the treatment of mental disorders; (5) “private residence” does not include a rehabilitative facility, a hospital, a nursing home, an assisted living facility, a group home, or another licensed health care facility.