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ARIZONA STATE SENATE
Fifty-Seventh Legislature, First Regular Session
ambulances; response times; rates
Purpose
Modifies requirements of the Department of Health Services' (DHS') rules relating to certificates of necessity (CON) and ambulance service response times, operations and rate schedules.
Background
DHS issues CONs
to applicants who operate ambulance services if: 1) the ambulance service has
at least one ambulance registered by DHS; 2) public necessity requires the
service or any part of the proposed service; 3) the applicant is fit and proper
to provide the service; and
4) the appropriate fees and bonds have been paid and filed. A CON includes a
description of the ambulance service area, level and type of service, hours of
operation, effective and expiration date and the legal name and address of the
ambulance service. DHS prescribes rules for the operation of ambulance services
that include requirements for issuing, amending, transferring, suspending or
revoking a CON. In establishing rules governing ambulance services, DHS must
regulate ambulance operations and response times and, in doing so, must
consider the population density of each service area and geographic and medical
considerations. Ambulance response times are reviewed every six years by DHS,
but one additional review may be requested every six years by a city, town,
fire district, fire authority or any existing CON holders whose boundaries fall
within a CON service area (A.R.S. §§ 36-2201;
36-2232;
and 36-2233).
Initial CONs are issued to each ambulance service for a term of one year. Upon expiration of the CON, if the CON holder meets all requirements, applies for a renewal and pays the required fees, the Director of DHS must renew the CON for three years without a public hearing or waiver, unless there is cause to set a hearing to consider denial or renewal for a shorter term (A.R.S. § 36-2235).
There is no anticipated fiscal impact to the state General Fund associated with this legislation.
Provisions
1. Allows counties, municipalities, fire districts and health service districts to expend monies and enter into intergovernmental agreements for participation in emergency paramedic programs, regardless of whether the jurisdiction holds a CON.
2. Allows the Director of DHS to establish additional ambulance rate categories based on current standards of care or scope of practice.
3. Allows existing CON holders, if a new rate category is established, to apply to add the new rate to their existing rate structure without changing the other approved rates and charges.
4. Requires DHS to consider call density in the regulation and review of ambulance response times.
5.
Specifies that if the service area of multiple CON holders includes all
or part of the same political subdivision, the primary provider for that
subdivision is deemed to be the political subdivision CON holder, if one
exists, or a provider who is contracted to be the designated
9-1-1 ambulance provider for the CON.
6. Stipulates that, if a primary provider exists within a service area with multiple CON holders, the other CON holders are considered secondary providers.
7. Requires DHS to establish less stringent response time requirements for secondary providers.
8. Stipulates that, if a CON holder requests mutual aid through an automated process or another CON holder's dispatch center, the requesting CON holder must count the call in its response time calculation.
9. Removes the ability of each of the following to request an additional DHS review of ambulance response times every six years:
a) municipalities, fire districts or fire authorities whose jurisdictional boundaries are within the service area of a CON; or
b) an existing CON holder within the service area of the CON.
10. Allows the Director of DHS, if a CON is granted within an area with uniform rates, to make the new CON holder part of the existing uniform rate group and establish rates that are the same as the uniform rate.
11. Specifies that, if DHS establishes rates for a new CON holder within a uniform rate group area that are different than the current rates, the uniform rate group is dissolved and the rates for each member of the former rate group become the last approved rates for the group.
12. Requires the Director of DHS, in reviewing ambulance service response times, to consider the:
a) number of ambulance services serving an affected area; and
b) dispatch protocols for the affected services area that determine which ambulance service receives the call.
13. Requires DHS to post on its website, within three days of issuance or receipt:
a) a notice of whether a CON application is administratively complete or incomplete;
b) the responses to a notice of administrative completeness or incompleteness;
c) a notice of whether a CON application is substantively incomplete;
d) the responses to a notice of substantive incompleteness; and
e) any additional DHS information requests and the responses to those requests.
14. Reduces, from 60 to 30, the number of days in which an interested party may provide information to the Director of DHS relating to an application for an initial or amended CON.
15. Specifies that the 30-day period for interested parties to submit information to the Director of DHS relating to an initial or amended CON does not include the time the applicant uses to respond to a request for additional information.
16. Allows a CON appeal hearing to last more than five consecutive business days only if, in addition to the administrative law judge, the parties to the hearing determine that more time is required before the hearing or before the end of the scheduled final day of the hearing.
17. Removes the requirement that any additional days added to a CON appeal hearing be calendared within 30 days after the end of the initial hearing.
18. Specifies that a CON renewal application is automatically renewed for one year if the CON holder applied and paid all fees at least 60 days before the CON expired but DHS had not yet made a determination to renew by the expiration date.
19. Requires each air ambulance service's rate schedule and any changes to the schedule to be filed with DHS.
20. Requires DHS to maintain a list of all air ambulance service rate schedules on its website.
21. Adds, to the criteria necessary for ambulance services to charge the advanced life support base rate, the requirement that the ambulance be staffed by an additional ambulance attendant who is qualified to administer advanced life support.
22. Defines call density as the number of ambulance calls per square mile within a described area of service over twelve consecutive months.
23. Makes technical and conforming changes.
24. Becomes effective on the general effective date.
Prepared by Senate Research
February 10, 2025
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