REFERENCE TITLE: ambulance services; service areas
State of Arizona
House of Representatives
First Regular Session
Representatives Burges: Cook, Fillmore, Finchem, Nguyen, Roberts
Amending sections 36-2232, 36-2233, 36-2234, 36-2236, 36-2239, 36-2242 and 39-2246, Arizona Revised Statutes; relating to emergency medical services.
(TEXT OF BILL BEGINS ON NEXT PAGE)
Be it enacted by the Legislature of the State of Arizona:
Section  1. 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
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. 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 may establish a rate and charge structure as defined by federal medicare guidelines for ambulance services. The director shall inform all ambulance services of the procedures and methodology used to determine ambulance rates or charges.
2. 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, geographic and medical considerations.
3. Determine a separate set of response times of ambulances for each city, town or fire district within each certificate of necessity if the service area within the city, town or fire district includes a response area designated as urban or suburban as defined in rule by the department.
3. 4. 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.
4. 5. Issue, amend, transfer, suspend or revoke certificates of necessity under terms consistent with this article.
5. 6. 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.
6. 7. 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.
7. 8. Regulate ambulance services in all matters affecting services to the public to the end that this article may be fully carried out.
8. 9. Prescribe bonding requirements, if any, for ambulance services granted authority to provide any type of subscription service.
9. 10. Offer technical assistance to ambulance services to maximize a healthy and viable business climate for the provision of ambulances.
10. 11. Offer technical assistance to ambulance services in order to obtain or to amend a certificate of necessity.
11. 12. Inspect, at a maximum of twelve month 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 for the protection of to protect all subscription service contract holders in this state who are covered under that subscription contract.
C. An 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.
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 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. END_STATUTE
Sec.  2. Section 36-2233, Arizona Revised Statutes, is amended to read:
START_STATUTE36-2233. Certificate of necessity to operate an ambulance service; 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. The director shall issue a certificate of necessity if all of the following apply:
1. The ambulance service has a certificate of registration issued by the department for at least one ambulance pursuant to section 36-2212.
2. The director finds that public necessity requires the service or any part of the service proposed by the applicant.
3. The director finds that the applicant is fit and proper to provide the service.
4. The applicant has paid the appropriate fees pursuant to section 36-2240.
5. The applicant has filed a surety bond pursuant to section 36-2237.
C. If an applicant meets the requirements of subsection B of this section, within ninety days after receiving a complete application for a certificate of necessity, the director shall determine whether public necessity requires the proposed ambulance service in a service area or any part of a service area and if necessity for the ambulance service is found to exist and shall issue a certificate of necessity to operate the ambulance service. Any certificate of necessity holder whose ambulance service area in whole or in part is within the affected service area of a the new ambulance service may appeal the director's determination as specified in section 36-2234, subsection o.
C. D. A certificate of necessity issued pursuant to subsection B 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.
D. E. 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.
E. F. 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.  3. Section 36-2234, Arizona Revised Statutes, is amended to read:
START_STATUTE36-2234. Hearings; waiver of hearing; emergency action; judicial review; definition
A. The director shall require a public hearing on any proposed action related to rates, fares or charges, operating or response times, bases of operation or certificates of necessity unless subsection C, E, or M of this section applies.
B. A public hearing held pursuant to subsection A of this section shall meet the following requirements:
1. The hearing shall be held pursuant to title 41, chapter 6, article 10.
2. The director shall mail notice of the hearing to every ambulance service AND INTERESTED PARTY AS SPECIFIED IN SUBSECTION n OF THIS SECTION in the affected region no 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. A certificate of necessity hearing may not last more than ten 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.
C. The director may waive the hearing required under subsection A 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 AND INTERESTED PARTY AS SPECIFIED IN SUBSECTION n OF THIS SECTION in the affected region no 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 no 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.
D. If the director receives a request pursuant to subsection C, paragraph 4 of this section, the director shall hold a hearing in compliance with subsection B of this section.
E. 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.
F. A rate increase authorized pursuant to subsection E of this section is deemed to be fixed by the department at the requested level.   Notwithstanding subsection C 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 E 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.
G. 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 of 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 affec