HB2588 - 521R

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

Section 1. Title 36, chapter 21.1, article 2, Arizona Revised Statutes, is amended by adding section 36-2233.01, to read:

START_STATUTE36-2233.01. Integrated paramedicine; certificates of necessity; written request; rates and charges; annual report

A. Notwithstanding sections 36‑2233 and 36‑2234, in a county with a population of three million persons or more, to manage the needs in emergency medical services for local community-integrated paramedicine that provides for timely, sustainable and reliable access, all of the following apply:

1. The director shall issue a certificate of necessity for ambulance service for local community-integrated paramedicine to a city, town or fire district established pursuant to title 48 or a city, town or fire district that has an intergovernmental agreement under an automatic aid system of fire department response with a contiguous city, town or fire district or any portion of that city, town or fire district that is located in another county.

2. The certificate of necessity shall be issued without a hearing within thirty days after receiving a written request.

3. The written request shall include all of the following:

(a) A description of the local community-integrated paramedicine model or mobile health care service.

(b) The service area requested, which may include any contiguous service areas outside the county.

(d) The type of the ambulance service.

(e) The hours of operation of the ambulance service.

(f) The proposed effective date of the ambulance service.

(g) The legal name and address of the ambulance service.

(h) The response times of the ambulance service.

(i) The name of the ambulance service's authorized representative.

(j) A request for a certificate of registration for a vehicle pursuant to section 36‑2212.

(k) A description of the collection of real-time on-scene clinical data and informational exchange system method or electronic patient care record that will be electronically submitted to the department and to other health care providers.

(l) A copy of the department approved or proposed contract with the city, town or fire district with a certificated ambulance service for ambulance transport in response to the 911 emergency telephone system, for all or part of the service area by another certificated ambulance service, if any.

(m) A list of health care facilities, networks, systems or organizations, which include contractors under chapter 29 of this title, for use within the service area that affect the delivery of cost-effective health care and the continuity of care for the patient.

B. The director's established uniform rates and charges for ambulance service in the service area are the general rates and charges for the ambulance service's certificate of necessity requested pursuant to this section. The service area granted under this section shall be described pursuant to section 36‑2233, subsection E.

C. On or before January 31 of each year, the holder of a certificate of necessity granted pursuant to this section shall submit an annual report to the director that includes any changes to the information required to be submitted pursuant to subsection A of this section and a description of the categories and volume in ambulance transport to emergency rooms, transport to alternative destinations and treatment with no transport and referral outcomes in community-integrated paramedicine and ambulance service.END_STATUTE

Sec. 2. Section 36-2239, Arizona Revised Statutes, is amended to read:

START_STATUTE36-2239. Rates or charges of ambulance service

A. An ambulance service that applies for an adjustment in its rates or charges shall automatically be granted a rate increase equal to the amount determined under section 36‑2234, subsection E, if the ambulance service is so entitled. An automatic rate adjustment that is granted pursuant to this subsection and that is filed on or before April 1 is effective June 1 of that year. The department shall notify the applicant and each health care services organization as defined in section 20‑1051 of the rate adjustment on or before May 1 of that year.

B. Notwithstanding subsection E of this section, if the department does not hold a hearing within ninety days after an ambulance service submits an application to the department for an adjustment of its rates or charges, the ambulance service may adjust its rates or charges to an amount not to exceed the amount sought by the ambulance service in its application to the department. An ambulance service shall not apply for an adjustment of its rates or charges more than once every six months.

C. At the time it holds a hearing on the rates or charges of an ambulance service pursuant to section 36‑2234, the department may adjust the rates or charges adjusted by the ambulance service pursuant to subsection B of this section, but the adjustment shall not be retroactive.

D. Except as provided in subsection H of this section, an ambulance service shall not charge, demand or collect any remuneration for any service greater or less than or different from the rate or charge determined and fixed by the department as the rate or charge for that service. An ambulance service may charge for disposable supplies, medical supplies and medication and oxygen related costs if the charges do not exceed the manufacturer's suggested retail price, are uniform throughout the ambulance service's certificated area and are filed with the director. An ambulance service shall not refund or limit in any manner or by any device any portion of the rates or charges for a service that the department has determined and fixed or ordered as the rate or charge for that service.

E. The department shall determine and render its decision regarding all rates or charges within ninety days after commencement of the applicant's hearing for an adjustment of rates or charges. If the department does not render its decision as required by this subsection, the ambulance service may adjust its rates and charges to an amount that does not exceed the amounts sought by the ambulance service in its application to the department. If the department renders a decision to adjust the rates or charges to an amount less than that requested in the application and the ambulance service has made an adjustment to its rates and charges that is higher than the adjustment approved by the department, within thirty days after the department's decision the ambulance service shall refund to the appropriate ratepayer the difference between the ambulance service's adjusted rates and charges and the rates and charges ordered by the department. The ambulance service shall provide evidence to the department that the refund has been made. If the ambulance service fails to comply with this subsection, the director may impose a civil penalty subject to the limitations provided in section 36‑2245.

F. An ambulance service shall charge the advanced life support base rate as prescribed by the director under any of the following circumstances:

1. A person requests an ambulance by dialing telephone number 911, or a similarly designated telephone number for emergency calls, and the ambulance service meets the following:

(a) The ambulance is staffed with at least one ambulance attendant.

(b) The ambulance is equipped with all required advanced life support medical equipment and supplies for the advanced life support attendants in the ambulance.

2. Advanced life support is requested by a medical authority or by the patient.

3. The ambulance attendants administer one or more specialized treatment activities or procedures as prescribed by the department by rule.

G. An ambulance service shall charge the basic life support base rate as prescribed by the director under any of the following circumstances:

1. A person requests an ambulance by dialing telephone number 911, or a similarly designated telephone number for emergency calls, and the ambulance service meets the following:

(a) The ambulance is staffed with two ambulance attendants certified by this state.

(b) The ambulance is equipped with all required basic life support medical equipment and supplies for the basic life support medical attendants in the ambulance.

2. Basic life support transportation or service is requested by a medical authority or by the patient, unless any provision of subsection F of this section applies, in which case the advanced life support rate shall apply.

H. For each contract year, the Arizona health care cost containment system administration and its contractors and subcontractors shall provide remuneration for ambulance services for persons who are enrolled in or covered by the Arizona health care cost containment system in an amount equal to eighty per cent of the amounts as prescribed by the department as of July 1 of each year for services specified in subsections F and G of this section and eighty per cent of the mileage charges as determined by the department as of July 1 of each year pursuant to section 36-2232. The Arizona health care cost containment system administration shall make annual adjustments to the Arizona health care cost containment system fee schedule according to the department's approved ambulance service rate in effect as of July 1 of each year. The rate adjustments made pursuant to this subsection are effective beginning October 1 of each year.

I. In establishing rates and charges the director shall consider the following factors:

1. The transportation needs assessment of the medical response system in a political subdivision.

2. The medical care consumer price index of the United States department of labor, bureau of labor statistics.

3. Whether a review is made by a local emergency medical services coordinating system in regions where that system is designated as to the appropriateness of the proposed service level.

4. The rate of return on gross revenue.

5. Response times pursuant to section 36‑2232, subsection A, paragraph 2.

J. Notwithstanding section 36‑2234, an ambulance service may charge an amount for medical assessment, equipment or treatment that exceeds the requirements of section 36‑2205 if requested or required by a medical provider or patient.

K. In addition to any other rates and charges authorized by this section, a certificated ambulance service provider may establish additional rates and charges to third‑party payors, including payments for treatments at home or on‑scene treatments with no transport, treatments at home or on‑scene treatments with a referral for the patient's health care plan, referral services and outcomes for community‑integrated paramedicine services and mobile health services. Additional rates and charges authorized by this subsection do not include additional rates or charges for ambulance transport to emergency departments or interfacility transports between health care facilities.

K. L. Notwithstanding subsections D, F and G of this section, an ambulance service may provide gratuitous services if an ambulance is dispatched and the patient subsequently declines to be treated or transported. END_STATUTE