Ariz. Admin. Code § 9-25-902

Current through Register Vol. 30, No. 50, December 13, 2024

Section R9-25-902 - Application for an Initial Certificate of Necessity (Authorized by A.R.S. Sections 36-2201(11)(h), 36-2204, 36-2232, 36-2233, 36-2234, 36-2236(A), 36-2240)

A. An applicant for an initial certificate of necessity shall submit to the Department an application packet that includes:

1. The following information in a Department-provided format:

a. The legal business or corporate name, mailing address, physical address if different from the mailing address, telephone number, facsimile number if any, and e-mail address of the ground ambulance service;

b. Any other names by which the applicant is known;

c. If the applicant is a:

i. Governmental entity, the type of governmental entity; or

ii. Business organization:

(1) The type of business organization, and

(2) Whether the business organization is proprietary or non-profit;

d. A list of all business organizations or governmental entities affiliated with the applicant, if applicable, including for each:

i. The legal name;

ii. The type of business organization, if applicable; and

iii. Whether the relationship to the applicant is as a:

(1) Parent organization,

(2) Subordinate organization,

(3) Subsidiary organization,

(4) Member organization, or

(5) Business organization related to an ambulance service, ambulance response, or transport for which a controlling person of the applicant is also a controlling person of the business organization;

e. The name, title, address, e-mail address, and telephone number of the following:

i. Each applicant and individual responsible for managing the ground ambulance service,

ii. The individual acting for the applicant according to R9-25-102,

iii. The individual to contact to access the ground ambulance service's records required in R9-25-908(B), and

iv. The statutory agent for the ground ambulance service or the individual designated by the applicant to accept service of process and subpoenas for the ground ambulance service;

f. The name, address, email address, and telephone number of the person providing dispatch for the ground ambulance service;

g. The address, hours of operation, and, if available, telephone number of each suboperation station located within the proposed service area;

h. Whether the applicant has a proposed deployment plan for the ground ambulance vehicles in subsection (A)(1)(m), including:

i. Whether the purchase and deployment of additional ground ambulance vehicles are planned for the first 12 months following the applicant receiving a certificate of necessity;

ii. Whether additional purchases and further deployment of additional ground ambulance vehicles are planned for the second 12-month-period following the applicant receiving a certificate of necessity; and

iii. Whether ground ambulance vehicles will be deployed based on knowledge of the level of service, types of service provided, and locations of calls;

i. Whether the applicant has a plan for participating in the implementation of a political subdivision's emergency preparedness plan;

j. A list of EMS providers in surrounding service areas with whom the applicant has a back-up agreement or from whom the applicant has a letter of support;

k. A description of the communication equipment to be used in each ground ambulance vehicle and suboperation station;

l. If applicable, a description of traffic preemption equipment that the applicant plans to use to facilitate movement of a ground ambulance vehicle through traffic;

m. for each ground ambulance vehicle proposed to be used by the ground ambulance service, the manufacturer's name, the year the ground ambulance vehicle was manufactured, and, if available, the current mileage;

n. The number of ambulance attendants and the type of licensure, certification, or registration for each attendant;

o. The proposed hours of operation for the ground ambulance service;

p. The type of service;

q. The level of service;

r. If the applicant plans to provide ALS services or critical care services, a description of how the applicant plans to provide administrative medical direction according to R9-25-201 and on-line medical direction according to R9-25-202, including, as applicable:

i. The name, address, and telephone number of the base hospital or centralized medical direction communications center for the ground ambulance service;

ii. The name, address, professional license number, and telephone number of the physician providing administrative medical direction; and

iii. The name, address, professional license number, and telephone number of the physician or group of physicians providing on-line medical direction;

s. Whether the applicant agrees to allow the Department to submit supplemental requests for information under R9-25-1201(C)(3);

t. Attestation that the applicant is familiar with the requirements in A.R.S. Title 36, Chapter 21.1 and this Chapter and will comply with applicable statutes and rules in any matter relating to or affecting the ground ambulance service;

u. Attestation that any information or documents submitted to the Department are true and correct; and

v. The signature of the individual acting for the applicant according to R9-25-102 and the date signed;

2. The following information about the proposed service area:

a. The square miles within the proposed service area;

b. Whether a ground ambulance service currently operates in all or part of the proposed service area and, if so, a list of the ground ambulance services currently operating in the proposed service area;

c. The population demographics within the proposed service area;

d. Any changes in the population since the last national census;

e. Any change in the population demographics since the last national census;

f. The medical needs of the population within the proposed service area;

g. The number of anticipated requests for each type of service and level of service in the proposed service area, including the basis for the estimate;

h. The available routes of travel within the proposed service area;

i. The anticipated average mileage per transport within the proposed service area, including the basis for the estimate;

j. The geographic features and environmental conditions within the proposed service area;

k. The available medical and emergency medical resources within the proposed service area;

l. The geographic distribution of health care institutions within and surrounding the service area to which and from which the ground ambulance service may be transporting patients;

m. A statement of the proposed general public rates for services provided within the proposed service area;

n. A statement of the proposed charges;

o. The proposed response times and a compliance percentage, for each scene locality in the proposed service area and priority that will be assigned by the applicant to a response; and

p. If planning to provide interfacility transports within the proposed service area:

i. The response times and compliance percentages for the interfacility transport of a patient with a time-critical condition for each scene locality; and

ii. Either:

(1) A plan for complying with the requirements in R9-25-908(E)(3)(c) that demonstrates how quality patient care will be provided, including to patients with a time-sensitive condition; or

(2) A plan and justification for a standard different from that in R9-25-908(E)(3)(c);

3. A plan to provide temporary ambulance response or transport service to the proposed service area for a limited time when the applicant is unable to provide ambulance response or transport service to the proposed service area, including the criteria for the person providing dispatch to implement the plan;

4. Copies of the back-up agreements supporting the plan in subsection (A)(3) or letters of support specified according to subsection (A)(1)(j);

5. A plan for orientation and on-going training of employees;

6. If applicable, a copy of a plan for implementing deployment of ground ambulance vehicles as specified in subsection (A)(1)(h), including the timeframe, if applicable, for the purchase and deployment of additional ground ambulance vehicles during the first 12 months after receiving a certificate of necessity;

7. Whether the applicant or the individual acting for the applicant according to R9-25-102:

a. Has ever been convicted of a felony or a misdemeanor involving moral turpitude,

b. Has ever had a license or certificate of necessity for a ground ambulance service suspended or revoked by any state or political subdivision, or

c. Has ever operated a ground ambulance service without the required certification or licensure in this or any other state;

8. A description of the proposed service area by any method specified in A.R.S. § 36-2233(E) and global positioning system data, in a Department-specified format, that would allow a map to be created that illustrates the proposed service area;

9. Documentation for the individual specified according to subsection (A)(1)(e)(ii) that complies with A.R.S. § 41-1080;

10. A copy of the business organization's articles of incorporation, articles of organization, or partnership documents, if applicable;

11. A copy of an organizational chart, illustrating both:

a. The relationships in subsection (A)(1)(d) with two levels of supervision; and

b. At least three levels of supervision of key individuals operating the ground ambulance service, including the individuals listed in subsection (A)(1)(e)(i) through (iii);

12. A projected Ambulance Revenue and Cost Report covering the first consecutive 12 months of operation, as specified in R9-25-909(A);

13. A written explanation of why the applicant believes there is a public need for the applicant to receive an initial certificate of necessity, including:

a. A summary of how the applicant plans to address the factors in subsection (A)(2) to ensure the provision of quality patient care,

b. Justification for the proposed level of service,

c. Justification for proposed response times or compliance percentage, and

d. Supporting documentation;

14. If available, any study or statistical analysis that examines the need for ground ambulance service within a service area or proposed service area that:

a. Considers the current or proposed service area's medical, fire, and police services; and

b. Was created for or adopted by:

i. A political subdivision, or

ii. A local emergency medical services coordinating system under A.R.S. § 36-2210(1);

15. A summary of the applicant's financial history, including:

a. Documentation of capital resources and financial reserves, if applicable, that is available for the establishment and operation of the ground ambulance service; and

b. A plan for coverage of expected and unexpected expenses, including the source and amount of funding for cash flow from the date the ground ambulance service commences operation until the date cash flow covers monthly expenses, with supporting documentation;

16. If the applicant is intending to bill for services, the method and plan for the applicant to bill for services;

17. A list of all actual or anticipated purchase agreements or lease agreements to be used in connection with the ground ambulance service, including the monetary amount and duration of each agreement, for:

a. Real estate,

b. Ground ambulance vehicles, or

c. Equipment exceeding $10,000;

18. Documentation supporting the estimate of the number of transports to be provided, as shown in the Ambulance Revenue and Cost Report, including any proposed ground ambulance service contract under A.R.S. § 36-2232(A)(1) or 36-2234(M);

19. If the applicant is requesting to establish general public rates, the information and documents specified in R9-25-1101(A);

20. If the applicant is proposing charges to patients under R9-25-1109, the information required in R9-25-1109(A);

21. Any subscription service contract under A.R.S. § 36-2232(A)(1) and R9-25-1105;

22. If using a contracted person to provide dispatch, a copy of the contract;

23. If the applicant is planning to provide ALS services or critical care services:

a. A copy of each current written contract for providing administrative medical direction,

b. A copy of each current written contract for providing on-line medical direction, and

c. Proof of professional liability insurance for personnel providing ALS services or critical care services required in R9-25-908(A)(1)(a)(iii);

24. A certificate of insurance or documentation of self-insurance required in A.R.S. § 36-2237(A) and R9-25-908(A)(1)(a)(i) and (ii);

25. A surety bond if required under A.R.S. § 36-2237(B);

26. The resume or other description of experience and qualification to operate a ground ambulance service of the individuals specified according to subsection (A)(11)(b);

27. If applicable, a copy of the applicant's plan for participating in the implementation of a political subdivision's emergency preparedness plan according to subsection (A)(1)(h), including as applicable:

a. Mass casualty protocols;

b. The provision of ambulance response and transport in the event of a local, state-wide, or national emergency;

c. Description of the applicant's experience in disaster response command and control structure; and

d. Special situations in the proposed service area that need to be taken into consideration; and

28. Any other documents, exhibits, or statements that the applicant believes may assist the Director in evaluating the application or any other information or documents needed by the Director to clarify incomplete or ambiguous information or documents, such as:

a. The quality improvement process, as required in R9-25-908(K)(2);

b. A plan to collect and submit electronic patient care reports consistent with R9-25-908(K)(2)(a);

c. A plan to adopt clinical guidelines and operating procedures, consistent with national and state guidelines;

d. If applicable, a plan to initiate guideline-based pre-arrival instructions for all callers accessing 9-1-1 or a similar system for assistance;

e. Evidence of regular attendance and participation in meetings of the emergency medical services council, established according to A.R.S. § 36-2203, or a regional emergency medical and trauma services system, established according to A.R.S. § 36-2210;

f. Evidence of participation in a community-level injury prevention program; or

g. Documentation demonstrating that the service model will be cost effective.

B. In addition to the information and documents specified in subsection (A), applicant for an initial certificate of necessity shall submit the

$100 application filing fee for an initial certificate of necessity

.

C. The Department shall approve or deny an application under this Section according to A.R.S. § 36-2233 and Article 12 of this Chapter.

D. The Department may approve an application with special limitations or conditions, based on the best interest of the public.

E. If the Department approves an application and sends the applicant the written notice of approval, specified in R9-25-1201(C)(5), the Department shall issue the certificate of necessity to the applicant, consistent with A.R.S. §§ 36-2233(E) and 36-2234(A):

1. After the applicant has submitted to the Department for each ground ambulance vehicle to be operated by the ground ambulance service:

a. An application for registration of the ground ambulance vehicle that includes all of the information required according to R9-25-1001(B)(1);

b. A copy of a current and valid motor vehicle registration for the ground ambulance vehicle, issued according to A.R.S. Title 28, Chapter 7, Article 2, or similar statutes in another state; and

c. Unless the applicant intends to operate the ground ambulance vehicle only as a volunteer not-for-profit service, the following fees for each ground ambulance vehicle to be registered:

i. A $50 registration fee, as required under A.R.S. § 36-2212(D); and

ii. A $200 ambulance operation fee, as required under A.R.S. § 36-2240(3); and

2. When the certificate of registration for the first ground ambulance vehicle to be operated by the ground ambulance service is issued.

F. The Department may deny an application according to A.R.S. § 36-2233 if an applicant:

1. Fails to comply with any provision in A.R.S. Title 36, Chapter 21.1;

2. Fails to comply with any provision in this Article or Article 2, 10, or 11 of this Chapter;

3. Knowingly or negligently provides false documentation or false or misleading information to the Department; or

4. Fails to submit to the Department documents or information requested under R9-25-1201(B)(1) or (C)(3) and requests a denial as permitted under R9-25-1201(E).

Ariz. Admin. Code § R9-25-902

New Section adopted by final rulemaking at 7 A.A.R. 1098, effective February 13, 2001 (Supp. 01-1). Amended by final rulemaking at 30 A.A.R. 581, effective 3/7/2024.