HB2402 - 572R

Be it enacted by the Legislature of the State of Arizona:

Section 1. Section 36-2208, Arizona Revised Statutes, is amended to read:

START_STATUTE36-2208. Bureau of emergency medical services and trauma system; annual statewide plan; regional plans

A. There is established within the department a The bureau of emergency medical services and trauma system that is responsible for coordinating, establishing and administering established in the department to coordinate, establish and administer a statewide system of emergency medical services, trauma care and a trauma registry.

B. This chapter does not prevent any individual, law enforcement officer, public agency or member of a city, town, fire district or volunteer fire department from rendering on-site emergency medical care or, if, in terms of the existing medical situation, it is deemed not advisable to await the arrival of an ambulance, from transporting emergency medical patients to a hospital or an emergency receiving facility, except that if any patient objects on religious grounds, that patient shall not be administered any medical treatment or be transported to a hospital or an emergency receiving facility.

C. The director shall develop an annual statewide emergency medical and trauma services plan and submit that plan to the council for review and approval. The statewide plan shall then be submitted to the governor for final adoption. Before submitting the plan to the governor, the director shall accept comments from the authorized local agencies and governmental entities.

D. A Each local emergency medical services coordinating system shall develop a regional emergency medical services plan that includes a needs assessment and shall submit the plan to the director, the speaker of the house of representatives, the president of the senate and to the authorized local agencies within the area. The department shall integrate the regional plans shall be integrated into the statewide plan by the department.

E. The state statewide plan shall contain a budget component for funding local and state emergency medical services systems from the emergency medical services operating fund established pursuant to by section 36-2218 based on the needs assessment of the local emergency medical services coordinating system plans. The components shall be included in the department's budget through the normal appropriation process. END_STATUTE

Sec. 2. Section 36-2217, Arizona Revised Statutes, is amended to read:

START_STATUTE36-2217. Exemption from regulation

A. This chapter does not apply to:

1. Vehicles used for the emergency transportation of persons injured at an industrial site.

2. Persons engaged in and vehicles used for air transportation of sick or injured people in a noncritical or nonemergency situation as determined by a physician.

3. Medical evacuation equipment used and owned by the department of public safety in air, ground or water evacuation, and including fixed wing aircraft, helicopters, ground ambulances and similar ground conveyances, snowmobiles and water traversing equipment.

4. Vehicles provided or contracted for emergency medical services by a political subdivision if these vehicles are primarily used to provide on the scene stabilization of sick, injured, wounded, incapacitated or helpless persons.

5. Ambulances from other states that are:

(a) Responding to a major catastrophe or emergency in this state because there are insufficient registered ambulances in this state to respond in that situation.

(b) Either operating either from a location outside of this state to transport a patient to a location within this state or operating from a location outside of this state and crossing through this state to transport a patient to a location outside this state.

6. Registered ambulances from this state that are responding to a major catastrophe, natural disaster or wildland fire event in this state because there are insufficient registered ambulances in the area affected by the major catastrophe, natural disaster or wildland fire event.

6. 7. Stretcher vans that meet the requirements of section 36-2223.

B. Except as provided in subsection A, paragraph 5, subdivision (a) of this section, an ambulance from another state shall not pick up a patient in this state and transport that patient to another location in this state unless that ambulance is registered under this chapter.END_STATUTE

Sec. 3. Title 36, chapter 21.1, article 1, Arizona Revised Statutes, is amended by adding section 36-2220.01, to read:

START_STATUTE36-2220.01. Ambulance services; information on calls; public availability; civil penalty; definition

A. each ambulance service shall provide the following information on a quarterly basis to the department in a department-approved format, as applicable:

1. The emergency medical dispatch classification for each call for service or interfacility transport.

2. For each Call for service for which an ambulance is dispatched, the following information, as applicable:

(a) The dispatch time.

(b) The staging time.

(d) The on-scene time.

(e) The en route time.

(f) The hospital arrival time.

(g) The hospital release time.

3. 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.

4. the details of substantiated complaints received from an individual or health care institution as prescribed in rule by the department.

5. The details of any medication error that results in patient injury or patient death.

6. Any unintended injury or harm to a patient that occurred WHILE providing prehospital care.

B. The department shall make the information received pursuant to subsection A of this section available to the public on request, except that the department shall redact any personally identifying information. The department shall post the information received pursuant to subsection a of this section, as redacted, on the department's public website.

C. If an ambulance service fails to comply with the quarterly reporting requirements of this section, the department shall issue a notice to comply to the ambulance service within thirty calendar days AFTER the end of the quarter. The ambulance has fifteen calendar days after receiving the notice to comply with the quarterly reporting requirements of this section. If the ambulance service continues to fail to comply with the quarterly reporting requirements of this section, the director may impose a civil penalty of not more than $500.

D. For the purposes of this section, "emergency medical dispatch classification" means the standardized system used by emergency medical dispatchers to evaluate and categorize emergency medical calls based on the nature and severity of the incident. END_STATUTE

Sec. 4. Section 36-2232, Arizona Revised Statutes, is amended to read:

START_STATUTE36-2232. Director; powers and duties; regulation of ambulance services; inspections; response time compliance; mileage rate calculation factors; online portal and dashboard

A. The director shall adopt rules to regulate the operation of ambulances and ambulance services in this state. Each rule shall identify all sections and subsections of this chapter under which the rule was formulated. The rules shall provide for the department to do the following:

1. Consistent with the requirements of subsection H of this section, determine, fix, alter and regulate just, reasonable and sufficient rates and charges for the provision of ambulances, including rates and charges for advanced life support service, basic life support service, patient loaded mileage, standby waiting, subscription service contracts and other contracts for services related to the provision of ambulances. The director shall inform all ambulance services of the procedures and methodology used to determine ambulance rates or charges.

2. Ensure that evidence-based quality patient care is the priority for decision-making.

3. Regulate operating and response times of ambulances to meet the needs of the public and to ensure adequate service. The rules adopted by the director for certificated ambulance service response times shall include uniform standards for urban, suburban, rural and wilderness geographic areas within the certificate of necessity based on, at a minimum, population density and geographic and medical considerations. The calculation of response times shall begin when the public safety answering point contacts an ambulance service for dispatch and conclude when the ambulance service arrives at the dispatched location. On-scene arrival times for response time measurement shall be documented by the ambulance service using dispatch or global positioning system data, or a combination of both, and kept on file. Response time data that is compliant with the health insurance portability and accountability act of 1996 shall be filed annually with the department. When dispatch or global positioning system connectivity is not available, the ambulance service shall manually document on-scene arrival times for response time measurement. The response time data shall be filed in a department-approved format, and the department shall make the response time data publicly available.

4. Review response times established pursuant to paragraph 3 of this subsection with the ambulance service and update the response times based on, at a minimum, population density and geographic and medical considerations, and the financial impact on rates and charges, every six years. One additional review each six-year period may be requested by a city, town, fire district or fire authority whose jurisdictional boundaries in whole or in part are within the service area of a certificate of necessity or an existing certificate of necessity holder within the service area of the certificate of necessity.

5. Determine, fix, alter and regulate bases of operation. The director may issue a certificate of necessity to more than one ambulance service within any base of operation. For the purposes of this paragraph, "base of operation" means a service area granted under a certificate of necessity.

6. Issue, amend, transfer, suspend or revoke certificates of necessity under terms consistent with this article.

7. Prescribe a uniform system of accounts to be used by ambulance services that conforms to standard accounting forms and principles for the ambulance industry and generally accepted accounting principles.

8. Require the filing of an annual financial report and other data. These rules shall require an ambulance service to file the report with the department not later than one hundred eighty days after the completion of its annual accounting period.

9. Regulate ambulance services in all matters affecting services to the public to the end that this article may be fully carried out.

10. Prescribe bonding requirements, if any, for ambulance services that are granted authority to provide any type of subscription service.

11. Offer technical assistance to ambulance services to ensure compliance with the rules.

12. Offer technical assistance to ambulance services in order to obtain or to amend a certificate of necessity.

13. Inspect, at a maximum of twelve-month intervals, each ambulance registered pursuant to section 36-2212 to ensure that the vehicle is operational and safe and that all required medical equipment is operational. At the request of the provider, the inspection may be performed by a facility approved by the director. If a provider requests that the inspection be performed by a facility approved by the director, the provider shall pay the cost of the inspection.

B. The director may require any ambulance service offering subscription service contracts to obtain a bond in an amount determined by the director that is based on the number of subscription service contract holders and to file the bond with the director to protect all subscription service contract holders in this state who that are covered under that subscription contract.

C. An Each ambulance service shall:

1. Maintain, establish, add, move or delete suboperation stations within its base of operation to ensure that the ambulance service meets the established response times or those approved by the director in a political subdivision contract.

2. Determine the operating hours of its suboperation stations to provide for coverage of its base of operation.

3. Provide the department with a list of suboperation station locations.

4. Notify the department not later than thirty days after the ambulance service makes a change in the number or location of its suboperation stations.

5. Beginning January 1, 2024, Install and maintain an electronic global positioning system monitoring device in each vehicle that is used for transport to record on-scene arrival times for response time measurement. The department shall may provide a waiver on a department-approved form to an ambulance service that can reasonably demonstrate it is unable to meet the requirements of this paragraph because at least thirty percent of the service area does not have global positioning system coverage. A waiver issued pursuant to this paragraph expires on April 1 of each year and may be renewed annually.

D. At any time, the director or the director's agents may:

1. Inquire into the operation of an ambulance service, including a person operating an ambulance that has not been issued a certificate of registration or a person who does not have or is operating outside of a certificate of necessity.

2. Conduct on-site inspections of facilities, communications equipment, vehicles, procedures, materials and equipment.

3. Review the qualifications of ambulance attendants.

E. If all ambulance services that have been granted authority to operate within the same service area or that have overlapping certificates of necessity apply for uniform rates and charges, the director may establish uniform rates and charges for the service area.

F. In consultation with the medical director of the bureau of emergency medical services and trauma system, the emergency medical services council and the medical direction commission, the director of the department of health services shall establish protocols for ambulance services to refer and advise a patient or transport a patient by the most appropriate means to the most appropriate provider of medical services based on the patient's condition. The protocols shall include triage and treatment protocols that allow all classifications of emergency medical care technicians responding to a person who has accessed 911, or a similar public dispatch number, for a condition that does not pose an immediate threat to life or limb to refer and advise a patient or transport a patient to the most appropriate health care institution as defined in section 36-401 based on the patient's condition, taking into consideration factors including patient choice, the patient's health care provider, specialized health care facilities and local protocols.

G. The director, when reviewing an ambulance service's response time compliance with its certificate of necessity, shall consider in addition to other factors the effect of hospital diversion, delayed emergency department admission and the number of ambulances engaged in response or transport in the affected area.

H. The department shall incorporate all of the following factors when calculating the proposed mileage rate:

1. The cost of licensure and registration of each ground ambulance vehicle.

2. The cost of fuel.

3. The cost of ground ambulance vehicle maintenance.

4. The cost of ground ambulance vehicle repair.

5. The cost of tires.

6. The cost of ground ambulance vehicle insurance.

7. The cost of mechanic wages, benefits and payroll taxes.

8. The cost of loan interest related to the ground ambulance vehicles.

9. The cost of the weighted allocation of overhead.

10. The cost of ground ambulance vehicle depreciation.

11. The cost of reserves for replacement of ground ambulance vehicles and equipment.

I. The department shall:

1. 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 the department.

2. Make available to the public on the department'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. END_STATUTE

Sec. 5. Section 36-2233, Arizona Revised Statutes, is amended to read:

START_STATUTE36-2233. Certificate of necessity to operate an ambulance service; application; notification of interested parties; exceptions; service areas

A. Any person wishing to operate an ambulance service in this state shall apply to the department on a form prescribed by the director for a certificate of necessity.

B. Within one hundred eighty days after receiving an application for a certificate of necessity as prescribed in this section, the director shall make a determination based on whether necessity for the ambulance service is found to exist and the applicant meets the requirements of subsection F of this section. If the director requests additional information from the applicant after initial review, the applicant shall have has thirty business days to respond. On request, the director may give the applicant one additional period of thirty business days to respond. If the applicant fails to respond to the director's request for additional information, the department shall deem the initial or amended application withdrawn. An application deemed withdrawn is not an appealable agency action pursuant to title 41, chapter 6, article 10. The applicant may appeal a denial only pursuant to section 36-2234. The one hundred eighty-day period for the director to make the determination of necessity does not include the time the applicant uses to respond to requests for additional information.

C. On receipt of an initial or amended application for a certificate of necessity, the department shall post a notice of the application on its website. Within thirty days after the department posts a notice pursuant to this subsection, any interested party may provide information to the director on a form in a department-approved format for consideration. If an interested party fails to respond to the notice within sixty days in a department-approved format, the information may not be considered during the review of the application.

D. For the purposes of this section, a city, town, fire district, fire authority or tribal government whose jurisdictional boundaries in whole or in part are within the service area of a certificate of necessity, an existing certificate of necessity holder within the service area of the certificate of necessity or a hospital that is licensed pursuant to chapter 4 of this title and that is located within the service area of a certificate of necessity is considered to be an interested party as a matter of law.

E. All interested parties shall be notified of any application for an initial or amended certificate of necessity within fifteen days after the application is filed, within fifteen days after the application is complete and within fifteen days after a decision by the director. The director's decision pursuant to subsection F of this section is final unless appealed pursuant to section 36-2234, subsection A.

F. The director shall issue a certificate of necessity if all of the following apply:

1. The director finds that public necessity requires the service or any part of the service proposed by the applicant.

2. The director finds that the applicant is fit and proper to provide the service.

3. The applicant has paid the appropriate fees pursuant to section 36-2240.

4. The applicant has filed a surety bond pursuant to section 36-2237.

g. The director may not require 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 pursuant to a certificate of necessity issued pursuant to this article.

G. h. A certificate of necessity issued pursuant to subsection F of this section shall be for all or part of the service proposed by the applicant as determined necessary by the director for public convenience and necessity.

i. Notwithstanding any other requirement of this chapter to the contrary, If a geographic area of a city, town or fire district has a population of less than ten thousand persons and is not within the service area of a certificate of necessity, the director may issue a certificate of necessity to the city, town or fire district or a private ambulance service to provide ambulance services to that geographic area if the city, town or fire district or the private ambulance service can demonstrate the ability to provide all services required pursuant to a certificate of necessity issued pursuant to this article.

J. If a geographic area of a city, town or fire district has a population of less than ten thousand persons and has a current certificate of necessity holder that has not met the certificate of necessity conditions for at least twelve months, the director may issue a certificate of necessity to a city, town or fire district or private ambulance service to provide ambulance services to that geographic area if the city, town or fire district or private ambulance service can demonstrate the ability to provide all services required pursuant to a certificate of necessity issued pursuant to this article.

H. K. This section does not require a certificate of necessity for:

1. Vehicles and persons that are exempt from a certificate of registration pursuant to section 36-2217.

2. Ambulance services operating under temporary authority pursuant to section 36-2242.

I. L. The director may grant a service area by one or any combination of the following descriptions:

1. Metes and bounds.

2. A city, town or political subdivision not limited to a specific date. The merger or consolidation of two or more fire districts pursuant to section 48-820 or 48-822 does not expand the service area boundaries of an existing certificate of necessity.

3. A city, town or political subdivision as of a specific date that does not include annexation. END_STATUTE

Sec. 6. Section 36-2234, Arizona Revised Statutes, is amended to read:

START_STATUTE36-2234. Hearings; waiver of hearing; appeals; emergency action; suspension; judicial review; definition

A. The applicant or any certificate of necessity holder whose ambulance service area in whole or in part is within the affected service area of the initial or amended certificate of necessity may appeal pursuant to title 41, chapter 6, article 10 the director's determination within thirty days after the decision. If an appeal is made, the director shall require that a public hearing be held within one hundred twenty days after the hearing notice is issued on the director's determination on the initial or amended certificate of necessity.

B. For the purposes of any hearing held pursuant to this section, a city, town, fire district, fire authority or tribal government whose jurisdictional boundaries in whole or in part are within the service area of a certificate of necessity, an existing certificate of necessity holder within the service area of the certificate of necessity or a hospital that is licensed pursuant to chapter 4 of this title and that is located within the service area of a certificate of necessity is considered to be an interested party as a matter of law.

C. The director shall require a public hearing on any proposed action relating to an adjustment of general public rates, charges or certificate of necessity transfers unless subsection E, G or O P of this section applies.

D. An appeal pursuant to subsection A of this section or a public hearing held pursuant to subsection C of this section shall meet the following requirements:

1. The hearing shall be held pursuant to title 41, chapter 6, article 10, except as specifically provided in this section.

2. The director shall mail notice of the hearing to every ambulance service in the affected region and every interested party as specified in subsection B of this section not later than fifteen days before the hearing.

3. The director may mail notice to other persons who the director determines are interested in the hearing.

4. In a hearing or rehearing conducted pursuant to this article, an ambulance service may be represented by a corporate officer, an employee or a designee who has been specifically authorized by the ambulance service to represent it.

5. For an appeal pursuant to subsection A of this section, an ambulance service in the affected region and each interested party as specified in subsection B of this section have seven days after receiving the hearing notice mailed pursuant to paragraph 2 of this subsection to intervene.

5. 6. A certificate of necessity appeal hearing may not last more than five consecutive business days unless the administrative law judge determines, in writing, on the final day of the hearing that there is an extraordinary need for additional hearing days. The administrative law judge in that case may add up to five additional consecutive business days for the hearing. The additional hearing days shall be calendared within thirty days after the end of the initial hearing.

6. 7. The administrative law judge of the office of administrative hearings shall issue a written decision within twenty days after the hearing is concluded. The written decision shall contain a concise explanation of the reasons supporting the decision, including the findings of fact and conclusions of law. The administrative law judge shall serve a copy of the decision on the department and all parties to the action. On request of the department, the office of administrative hearings shall also transmit to the department the record of the hearing as described in section 12-904. A copy of the administrative law judge's decision is deemed sent on personal delivery of the decision or five days after the decision is mailed to the director.

7. 8. Within thirty days after the date the office of administrative hearings sends a copy of the administrative law judge's decision to the department, the director shall review the decision and accept, reject or modify the decision. If the director rejects or modifies the decision, the director must file with the office of administrative hearings and serve on all parties a copy of the administrative law judge's decision with the director's rejection or modification and a written justification setting forth the reasons for the rejection or modification of each finding of fact or conclusion of law. If there is a rejection or modification of a conclusion of law, the written justification shall be sent to the president of the senate and the speaker of the house of representatives.

8. 9. If the director does not accept, reject or modify the administrative law judge's decision within thirty days after the date the office of administrative hearings sends a copy of the administrative law judge's decision to the director, as evidenced by receipt of such action by the office of administrative hearings on or before the thirtieth day, the office of administrative hearings shall certify the administrative law judge's decision as the final administrative decision.

9. 10. The decision entered as specifically provided by this subsection is the final administrative decision.

E. The director may waive the hearing required under subsection C of this section if notification, including a general description of the proposed action of the department and the time and manner for any interested person to request a hearing, is given and all of the following apply:

1. Notification of the proposed action has been sent to every ambulance service in the affected region not later than fifteen days before the action.

2. The director has notified other persons who the director determines are interested in the proposed action not later than fifteen days before the action.

3. The director has published notice of the proposed action in a newspaper of general circulation in the affected region at least once each week for two consecutive weeks before the action is taken.

4. The director has received no requests within the fifteen-day notification period for a hearing to be held on the proposed action.

F. If the director receives a request pursuant to subsection E, paragraph 4 of this section, the director shall hold a hearing in compliance with subsection D of this section.

G. The director shall not hold a hearing if a person requests a hearing regarding a rate increase that does not exceed the amount computed as follows:

1. Determine the percentage growth in the transportation consumer price index of the United States department of labor, bureau of labor statistics, from the end of the second preceding calendar year to the calendar year immediately preceding the calendar year for which the rate increase is requested.

2. Determine the percentage growth in the medical care consumer price index of the United States department of labor, bureau of labor statistics, from the end of the second preceding calendar year to the calendar year immediately preceding the calendar year for which the rate increase is requested.

3. Add the amount determined in paragraph 1 of this subsection to the amount determined in paragraph 2 of this subsection and divide the sum by two.

H. A rate increase authorized pursuant to subsection G of this section is deemed to be fixed by the department at the requested level. Notwithstanding subsection E of this section, the department shall hold a hearing pursuant to section 36-2232, subsection E for any proposed uniform rate or charge that exceeds the annual rate increase prescribed in subsection G of this section. The department shall require the applicants to submit the following information signed by the designated financial officer and the chief executive of the ambulance service who has fiduciary responsibility for providing accurate financial information:

1. A financial statement for the previous twenty-four months relating to the certificated areas.

2. Any additional information the department requires to analyze the request.

I. If an ambulance service with an established general public rate applies for a contract rate or range of rates that is up to thirty percent less than its established rate, the director shall grant the rate without a public hearing or waiver, and without any right of intervention, unless within ninety days after the filing of a completed application the director determines that the contract rate or range of rates applied for does not accurately reflect the cost and economics of providing the contract services, would adversely affect the service available to the general public in the area of service as designated by its certificate of necessity or would cause any fixed rate, fare or charge to the general public to be adversely affected.

J. If the department disallows a proposed contract rate pursuant to subsection I of this section, the ambulance service has a right to a hearing for review of the proposed contract rate or range of rates.

K. The director may adopt rules for the establishment of a contract rate or range of rates that may be implemented and that exceeds the thirty percent rate variance identified pursuant to subsection I of this section.

L. Subsections I, J and K of this section are limited to contract rates or a range of rates applied for prescheduled, interfacility or convalescent transports.

M. A service contract between an ambulance service and a political subdivision of this state, including local fire districts, shall be filed with and approved by the department in accordance with the following requirements:

1. On receipt of the proposed contract, the department has fifteen days to review the contract and notify the ambulance service of any additional information the department requires, recommended corrections or any provision that does or may violate this article.

2. The ambulance service has fifteen days to provide the department with the information requested or to submit a revised or amended contract if required under paragraph 1 of this subsection.

3. The contract becomes effective fifteen days after the ambulance service complies with the department's request unless the department determines that any rate or charge or other provisions specified in the contract will cause any fixed rate or charge to the general public rate to be adversely affected or the contract would be in violation of the ambulance service's certificate of necessity.

4. If the department disallows a proposed contract pursuant to this subsection, the ambulance service has a right to a hearing for review of the proposed contract.

5. The rates and charges contained in the contract are the rates and charges fixed by the director in a decision or order for the ambulance service and conform to the ambulance service's current or subsequent general public rates and charges.

6. The area of response is within the ambulance service's certificated area.

N. In case of emergency, the director may take action providing for immediate suspension of a certificate of registration or a certificate of necessity, or both, under this section without notice or a hearing if the director determines that a potential threat to the public health and safety exists. If such an action is taken by the director, the director shall conduct a hearing within ten days after the date of the director's action unless the person against whom the action is directed waives the right to have a hearing held within ten days. If the ten-day hearing requirement is waived, the director shall set a date mutually agreeable to the interested parties. The purpose of the hearing is to review the decision of the director to take such an action. The director shall make findings of fact and may continue, suspend or modify the director's action.

O. The director shall assess a civil penalty of $1,500 on an ambulance service if the ambulance service is not complying with the certificate of necessity's requirements. The certificate of necessity holder may appeal the director's decision pursuant to this subsection by requesting a hearing pursuant to title 41, chapter 6, article 10.

O. P. The director shall waive the hearing required under subsection C of this section if geographic changes in suboperation stations do not alter the service area or adversely affect approved response times.

P. Q. Except as provided in section 41-1092.08, subsection H, a final decision of the director relating to an adjustment of general public rates, charges or certificate of necessity transfers is subject to judicial review pursuant to title 12, chapter 7, article 6.

Q. R. The final administrative decision of the director or the administrative law judge as prescribed in subsection D of this section for an initial or amended certificate of necessity is subject to judicial review pursuant to title 12, chapter 7, article 6.

R. S. For the purposes of this section, "hearing day":

1. Means any portion of a business day that is used for any hearing-related activity, including testimony, argument or presentation of evidence.

2. Does not include prehearing conferences or other administrative matters that occur before the start of the hearing. END_STATUTE

Sec. 7. Section 36-2235, Arizona Revised Statutes, is amended to read:

START_STATUTE36-2235. Terms of certificates of necessity; initial term; renewal

A. The initial certificate of necessity issued pursuant to section 36-2233 to each ambulance service shall be for a term of one year.

B. On the expiration of a certificate of necessity, if the holder of the certificate of necessity meets all requirements, applies for a renewal and pays the fees prescribed in section 36-2240, the director shall renew the certificate of necessity for a term of three years without public hearing or waiver unless cause is shown to set a hearing to consider denial or renewal for a shorter term.

C. If the director does not conclude a hearing to show cause within ninety days of the expiration date of the certificate of necessity, the certificate of necessity shall be renewed for a period of not less than at least one year. The term of the certificate of necessity shall be extended to renewed for three years if the director determines that cause is not established for denial or renewal for a shorter term. For the purposes of this subsection, "hearing to show cause" means a hearing ordered by the director pursuant to section 36-2245 to determine if whether any grounds exist to prevent an ambulance service from carrying out the provisions of subsection B of this section during the current term of the certificate of necessity.

D. The director shall base all decisions relating to the renewal of a certificate of necessity on current data. END_STATUTE

Sec. 8. Section 36-2236, Arizona Revised Statutes, is amended to read:

START_STATUTE36-2236. Certificates of necessity; nature; transfer; suspension; service area; population changes

A. A certificate of necessity issued pursuant to this article is not a franchise, may be revoked by the director and does not confer a property right on its holder.

B. A certificate of necessity shall not be assigned or otherwise transferred without the written approval of the director. When any certificate of necessity is assigned or transferred, the director shall issue to the assignee or transferee a new certificate of necessity that is valid only for the unexpired term of the transferred or assigned certificate of necessity.

C. In case of emergency, the director may suspend a certificate of necessity as provided in section 36-2234.

D. If a certificate of necessity issued pursuant to this article is issued to a city, town, fire district, fire authority or other political subdivision of this state, the service area shall be all the geographic area lying within the jurisdictional boundaries of the city, town, fire district, fire authority or political subdivision, unless the certificate of necessity issued by the director specifically excludes a portion of the city, town, fire district, fire authority or political subdivision or includes an additional service area outside the jurisdictional boundaries of the city, town, fire district, fire authority or other political subdivision. If the jurisdictional boundaries of a city, town, fire district, fire authority or other political subdivision expand, the service area in the certificate of necessity expands to reflect those jurisdictional boundaries, except as prescribed in section 36-2233, subsection I L, paragraph 2. This subsection does not affect the validity of any previously granted certificate of necessity for an unincorporated area lying within the boundaries of a city.

E. If the population of a service area changes by ten percent or more based on the most recent decennial census or five-year census estimate, the department must conduct a review to determine whether adjustments must be made to the response times in the service area, taking into consideration the impact on rates and charges. END_STATUTE