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ARIZONA STATE SENATE
Fifty-Seventh Legislature, Second Regular Session
AMENDED
ambulance services; certificates of necessity
Purpose
Prescribes exceptions to the certification requirements for ambulance services, as modified, establishes quarterly reporting requirements for ambulance services, requires the Department of Health Services (DHS) to make outlined information available to the public and assesses penalties for noncompliance.
Background
DHS must adopt rules to regulate the operation of ambulances and
ambulance services that include: 1) determining, fixing, altering and
regulating just, reasonable and sufficient rates and charges for ambulances; 2)
regulating operating and response times of ambulances to meet the needs of the
public and to ensure adequate service; 3) issuing, amending, transferring,
suspending or revoking certificates of necessity; and 4) inspecting each
registered ambulance at least annually to ensure that the vehicle and all
required medical equipment are operational and safe. Within 180 days after
receiving an application for a certificate of necessity for an ambulance
service, the Director of DHS (Director) must make a determination based on
whether necessity for the service is found to exist and if: 1) the Director
finds that the applicant is fit and proper to provide the service and public
necessity requires the service or any part of the service proposed by the
applicant; and 2) the applicant has paid the appropriate fees and has filed a
surety bond (A.R.S.
§ 36-2233). A certificate of necessity is a certificate issued to an
ambulance service by DHS that describes: 1) the service area; 2) the level and
type of service; 3) the hours of operation; 4) the effective and expiration
dates; 5) the legal name and address of the service; and 6) any limiting or
special provisions the Director prescribes (A.R.S.
§ 36-2201).
The Bureau of Emergency Medical Services and Trauma System within DHS is responsible for coordinating, establishing and administering a statewide system of emergency medical services, trauma care and a trauma registry. The Director must develop an annual statewide emergency medical and trauma services plan (statewide plan) and submit the plan to the Emergency Medical Services Council for review and approval. The statewide plan is then submitted to the Governor for final adoption. Local emergency medical services coordinating systems must develop regional emergency medical services plans (regional plans) that include a needs assessment and submit the plans to the Director and the authorized local agencies within the area. Regional plans must be integrated into the statewide plan by DHS (A.R.S. § 36-2208).
The Joint Legislative Budget Committee (JLBC) fiscal note estimates that H.B. 2402 may increase state General Fund revenues associated with new civil penalties and will generate additional IT and staffing costs for DHS to develop a certificate of necessity application portal and public ambulance response time dashboard; however, DHS input is needed to provide a precise estimate (JLBC fiscal note).
Provisions
Ambulance Service Certification
1. Requires the Director, notwithstanding any other requirement to the contrary, to issue a certificate of necessity to a city, town, fire district or private ambulance service to provide ambulance services to a geographic area of a city, town or fire district that has a population of fewer than 10,000 persons and is not within the service area of a certificate of necessity if the city, town, fire district or private ambulance service can demonstrate the ability to provide all services required of an issued certificate of necessity.
2. Allows the Director to issue a certificate of necessity to a city, town, fire district or private ambulance service to provide ambulance services to a geographic area of a city, town or fire district that has a population of fewer than 10,000 persons if:
a) the city, town, fire district or private ambulance service can demonstrate the ability to provide all services required of an issued certificate of necessity; and
b) the geographic area has a current certificate of necessity holder that has, for at least 12 months, either:
i. demonstrated noncompliance with the certificate of necessity conditions with such severity as to affect the public health and safety; or
ii. blatantly disregarded the requirements of the certificate of necessity conditions.
3.
Exempts, from emergency medical services regulations, ambulance service
providers that are responding with a registered ambulances from Arizona
to a major catastrophe, natural disaster or wildland fire event in Arizona
because there are insufficient ambulance service providers responding with registered
ambulances in the area affected by the event.
4. Prohibits the Director from requiring an applicant to purchase equipment, ambulances or other vehicles before approving the certificate of necessity if the applicant can demonstrate the ability to provide all services required by an issued certificate of necessity.
5. Allows DHS to provide a waiver on a DHS-approved form to an ambulance service that can reasonably demonstrate it is unable to install and maintain an electronic global positioning system monitoring device because at least 30 percent of the service area does not have global positioning system coverage.
6. Specifies that the waiver issued by DHS expires on April 1 of each year and may be renewed annually.
7. Stipulates that for an appeal of an initial or amended certificate of necessity determination, an ambulance service in the affected region and each interested party, as specified, have seven days after receiving the hearing notice to intervene.
8. Requires the Director to base all decisions relating to the renewal of a certificate of necessity on current data.
9. Requires the Director to assess a civil penalty of $1,500 on an ambulance service if the service is not complying with the certificate of necessity's requirements.
10. Allows the certificate of necessity holder that is assessed a civil penalty to appeal the Director's decision by requesting a hearing.
11. Requires DHS to establish an online certificate of necessity application portal to allow applicants to track the status of their application and the applicable deadlines as prescribed in rule by DHS.
Reporting Requirements
12. Requires DHS to make available to the public on DHS's public website a dashboard of ambulance service response times that can be reviewed by call type and the percentage of calls that required advanced life support services.
13. Requires each ambulance service to provide the following information to DHS in a DHS-approved format on a quarterly basis, as applicable:
a) the emergency medical dispatch classification for each call for service or interfacility transport;
b) if an ambulance service provider made a request for assistance to another ambulance service provider, the date and time of any instance in which an ambulance service declined to provide mutual aid to another certificate of necessity holder and an explanation why the request for assistance was declined;
c) the details of substantiated complaints received from an individual or health care institution as prescribed in rule by DHS;
d) the details of any medication error that results in patient injury or patient death;
e) any unintended injury or harm to a patient that occurred while providing prehospital care; and
f) for each call for service for which an ambulance is dispatched, as applicable, the dispatch time, staging time, canceled time, on-scene time, en route time, hospital arrival time and hospital release time.
14. Directs DHS to make the received information available to the public on request, except as specified.
15. Specifies that DHS must redact any personally identifying information from the information received from each ambulance service.
16. Requires DHS to post the received information, as redacted, on DHS's public website.
17. Requires DHS, if an ambulance service fails to comply with the quarterly reporting requirements, to issue a notice to the service to comply within 30 calendar days after the end of the quarter.
18. Grants the ambulance 15 calendar days after receiving the notice to comply with the quarterly reporting requirements.
19. Allows the Director to impose a civil penalty up to $500 if the ambulance service continues to fail to comply with the quarterly reporting requirements.
Miscellaneous
20. Adds the Speaker of the House of Representatives and President of the Senate to the list of recipients to whom each local emergency medical services coordinating system must submit a regional plan.
21. Defines emergency medical dispatch classification as the standardized system used by emergency medical dispatchers to evaluate and categorize emergency medical calls based on the nature and severity of the incident.
22. Makes technical and conforming changes.
23. Becomes effective on the general effective date.
Amendments Adopted by Committee
1. Requires, rather than allows, the Director to issue a certificate of necessity to a city, town, fire district or private ambulance service that demonstrates the ability to provide all required services to provide ambulance services to a specified geographic area if the geographic area is not within the service area of a certificate of necessity.
2. Allows the Director to issue a certificate of necessity to a city, town, fire district or private ambulance service to provide ambulance services to a specified geographic area if the geographic area has a current certificate of necessity holder that has demonstrated noncompliance with such severity as to affect the public health and safety or blatantly disregarded the requirements of the certificate's conditions for at least 12 months, rather than has not met the certificate's conditions for at least 12 months.
3. Makes technical changes.
House Action Senate Action
COM 2/3/26 DP 10-1-0-0 PS 3/18/26 DPA 7-0-0
3rd Read 3/5/26 43-7-9-0-1
Prepared by Senate Research
April 8, 2026
KJA/KM/hk