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ARIZONA STATE SENATE
Fifty-Seventh Legislature, First Regular Session
AMENDED
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 (Director) 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 the Director to establish additional ambulance rate categories based on current standards of care or scope of practice.
2. 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.
3.
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.
4. Stipulates that, if a primary provider exists within a service area with multiple CON holders, the other CON holders are considered secondary providers.
5. Requires DHS to establish less stringent response time requirements for secondary providers.
6. Requires a request for an additional DHS review of ambulance response times, by a municipality, fire district, fire authority or CON holder whose boundaries are within the service area of the CON, to be made in writing to DHS and to show cause for the request.
7. Specifies that DHS decisions regarding requested reviews of ambulance response times are not appealable.
8. Allows the Director, 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.
9. 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.
10. Requires the Director to consider the number of ambulance services serving an affected area in reviewing ambulance service response times.
11. Requires DHS to post notices of substantive completeness on its website within 30 days of deeming a CON application substantively complete.
12. Reduces, from 60 to 30, the number of days in which an interested party may provide information to the Director relating to an application for an initial or amended CON.
13. Tolls the time frame DHS has to make a decision regarding an initial or amended CON application during the 30-day period in which interested parties may respond to a notice of substantive completeness.
14. 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.
15. 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.
16. 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.
17. Requires the Director, in the event a CON renewal application was timely filed but no determination to renew had been made by the CON expiration date, to:
a) issue a 120-day temporary CON; and
b) renew the CON for three years upon expiration of the temporary CON.
18. 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.
19. Makes technical and conforming changes.
20. Becomes effective on the general effective date.
Amendments Adopted by Committee
1. Removes the ability of counties, municipalities, fire districts and health service districts to participate in an emergency paramedic program without holding a CON.
2. Removes the requirement that DHS consider call density in the regulation and review of ambulance response times.
3. Reinserts the ability for outlined jurisdictions to request an additional DHS review of ambulance response times every six years and requires that requests be made in writing and demonstrate cause for review.
4. Specifies that DHS decisions regarding requested reviews of ambulance response times are not appealable.
5. Removes the requirement that air ambulance service rate schedules be filed with DHS and posted on the DHS website.
6. Removes the requirement that DHS consider a service area's dispatch protocols in reviewing ambulance response times.
Amendments Adopted by Committee of the Whole
1. Limits DHS noticing requirements to the posting of substantive completeness notices for CON applications within 30 days of determining the application is substantively complete.
2. Removes the exclusion of the time that an applicant uses to respond to a request for additional information from the 30-day period for interested parties to submit information to the Director relating to an initial or amended CON.
3. Tolls the time frame DHS has to make a decision regarding a CON application during the 30-day period in which interested parties may respond to a notice of substantive completeness.
4. Requires the Director, in the event a CON renewal application was timely filed but no determination to renew had been made by the expiration date, to:
a) issue a 120-day temporary CON, rather than a one-year CON renewal; and
b) renew the CON for three years upon expiration of the temporary CON.
Senate Action
HHS 2/19/25 DPA 6-1-0
Prepared by Senate Research
March 4, 2025
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