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ARIZONA STATE SENATE
Fifty-Fifth Legislature, Second Regular Session
AMENDED
ambulance services; service areas
Purpose
Effective January 1, 2024, modifies application and issuance procedures for certificates of necessity (CON) for ambulance services.
Background
The Department
of Health Services (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 (A.R.S. §§ 36-2201;
36-2232;
and
36-2233).
The Director of DHS (Director) is required to hold a public hearing on any proposed action related to rates, fares, charges, operating or response times, bases of operation or CONs. The Director is required to mail a notice of the hearing to every ambulance service in the affected area no more than 15 days before the hearing. Other persons determined to be interested in the hearing may also be mailed a notice (A.R.S. § 36-2234).
There is no anticipated fiscal impact to the state General Fund associated with this legislation.
Provisions
1. Requires DHS ambulance services rules to:
a) ensure evidence-based quality patient care is the priority for decision-making; and
b) review response times with the ambulance service and update the response times every six years based on, at a minimum, population density, geographic and medical considerations, and the financial impact on rates and charges.
2. Allows a city, town, fire district or fire authority whose jurisdictional boundaries are within the service area of a CON to request one additional review each six-year period.
3. Requires the calculation of ambulance response times to begin when the public safety answering point contacts an ambulance service for dispatch and to conclude when the ambulance service arrives at the dispatched location on scene.
4. Requires ambulance arrival times to be documented by the ambulance service using dispatch or global positioning system (GPS) data, or a combination of both, and kept on file.
5. Requires ambulance services to manually document arrival times when dispatch or GPS connectivity is not available.
6. Requires response time data that is compliant with the Health Information Portability and Accountability Act to be filed with DHS.
7. Requires response time data to be filed in a DHS-approved format and directs DHS to make response time data publicly available.
8. Requires, effective January 1, 2024, ambulance services to install and maintain GPS monitoring devices in each vehicle used for transport to record on scene arrival times for response time measurements.
9. Requires DHS to provide a waiver to the GPS device requirement to an ambulance service that can reasonably demonstrate it is unable to meet the requirements.
10. Requires the Director, within 180 days of receipt of a CON application, to determine whether the CON is necessary and whether the applicant meets all requirements, excluding time given to the applicant to provide additional information.
11. Stipulates that if the Director requests additional information after initial application review, the applicant is granted 30 business days to respond.
12. Allows the Director, on request, to grant an additional 30 business days to an applicant that is requested to provide additional information.
13. Requires DHS to deem an application withdrawn if the applicant fails to respond to the Director's request for additional information.
14. Requires DHS to post notice of any application for an initial or amended CON on its website, upon receipt of the application.
15. Allows any interested parties to provide information to the Director, on a DHS-approved form, for 30 days after the application is posted.
16. Prohibits information received more than 60 days after an application is posted on the DHS website from being considered during review of the application.
17. Removes the requirement that the Director issue a CON if an ambulance service has an existing CON issued for at least one ambulance.
18. Modifies the public hearing requirements of the Director to require a public hearing only on any proposed action relating to adjustments of general public rates, charges or CON transfers, unless outlined exceptions apply.
19. Allows a CON applicant or any CON holder whose ambulance service area, in whole or in part, is within the affected service area of an initial or amended CON to appeal the Director's determination within 30 days of the decision.
20. Requires the Director, if an appeal is made, to require a public hearing to be held within 120 days of noticing the hearing.
21. Specifies that the Director's decision to issue a new CON stands if no appeals are filed.
22. Specifies that a municipality, tribal government, fire district or fire authority whose jurisdictional boundaries intersect with the service area of a CON or licensed hospital is considered to be an interested party as a matter of law for purposes of CON appeals hearings.
23. Applies outlined statutory requirements of CON hearings to CON appeals hearings.
24. Requires all interested parties to be notified of any applications for a new or expanded CON within 15 days of each of the following:
a) filing an application;
b) completing the application; and
c) decision by the Director.
25. Reduces the maximum allowable length of a CON appeal hearing from 10 days to 5 consecutive business days.
26. Allows an administrative law judge to add up to five additional consecutive business days for a CON hearing, which must be calendared within 30 days of the end of the initial hearing.
27. Specifies that both of the following are subject to judicial review under statutory uniform administrative hearing procedures:
a) final decisions of the Director relating to adjustment of general public rates, charges or CON transfers; and
b) final administrative decisions of the Director of an administrative law judge for an initial or amended CON.
28. Specifies that the service area of a CON issued to a municipality, fire district, fire authority or other political subdivision is all of the geographic area within the boundaries of the jurisdiction, unless the CON includes an additional service area outside of the entity's jurisdictional boundaries.
29. Stipulates that the boundaries of a CON are adjusted accordingly if a CON-issued municipality, fire district, fire authority or other political subdivision modifies its jurisdictional boundaries.
31. Allows the Director to extend the length of a temporary authority for ambulance services for one additional 90-day period.
32. Requires an applicant for temporary authority of ambulance services to demonstrate that the provided services will be in appropriately equipped vehicles designed for patient transport and staffed with appropriately certified personnel for patient care.
33. Exempts DHS from statutory rulemaking requirements for one year for purposes of modifying ambulance service rules.
34. Specifies that this legislation applies to initial and amended CONs filed with DHS on or after January 1, 2024.
35. Modifies the definition of emergency medical responder.
36. Defines emergency medical responder program.
37. Makes technical and conforming changes.
38. Becomes effective on January 1, 2024.
Amendments Adopted by Committee
1. Requires ambulance services to manually document arrival times when dispatch or GPS connectivity is not available.
2. Requires response time data to be filed with DHS in a DHS-approved format and removes the requirement that DHS post response times publicly on its website.
3. Reinserts the requirement that DHS ambulance rules include a requirement that DHS regulate ambulance services in all matters affecting services to the public.
4. Requires, rather than allows, DHS to provide a waiver to the GPS device requirement to an ambulance service that can reasonably demonstrate it is unable to meet the requirements.
5. Removes the requirement that ambulance services maintain response records for three years and provide records to DHS on request.
6. Requires DHS to deem an application withdrawn if the applicant fails to respond to the Director's request for additional information.
7. Requires DHS to post notice of any application for an initial or amended CON on its website, upon receipt of the application.
8. Allows any interested parties to provide information to the Director, on a DHS-approved form, for 30 days after the application is posted.
9. Prohibits information received more than 60 days after an application is posted on the DHS website from being considered during review of the application.
10. Modifies the public hearing requirements of the Director to require a public hearing only on any proposed action relating to adjustments of general public rates, charges or CON transfers, unless outlined exceptions apply.
11. Allows a CON applicant to appeal a determination of the Director within 30 days.
12. Specifies that tribal governments whose jurisdictional boundaries intersect with the service area of a CON or licensed hospital are considered to be an interested party as a matter of law for purposes of CON appeals hearings.
13. Applies outlined statutory requirements of CON hearings to CON appeals hearings.
14. Specifies that both of the following are subject to judicial review under statutory uniform administrative hearing procedures:
a) final decisions of the Director relating to adjustment of general public rates, charges or CON transfers; and
b) final administrative decisions of the Director of an administrative law judge for an initial or amended CON.
15. Requires DHS to conduct a review to determine whether adjustments must be made to the response times in an area, taking into consideration the impact on rates and charges, if the population of a service area changes by at least 10 percent based on the most recent decennial census or five-year estimate.
16. Delays the effective date to January 1, 2024.
17. Modifies the definition of emergency medical responder.
18. Defines emergency medical responder program.
19. Adds an applicability clause.
20. Makes technical and conforming changes.
House Action Senate Action
MAPS 2/14/22 DP 12-1-1-1 HHS 3/23/22 DPA 7-0-1
3rd Read 3/2/22 56-0-3
Prepared by Senate Research
March 28, 2022
MM/sr