Ariz. Admin. Code § 9-25-905

Current through Register Vol. 30, No. 45, November 8, 2024

Section R9-25-905 - Application for Amendment of a Certificate of Necessity (Authorized by A.R.S. Sections 36-2232, 36-2240, 36-2247)

A. A certificate holder requesting to amend the certificate of necessity due to a change in the legal name of the ground ambulance service shall submit to the Department:

1. The certificate of necessity number for the ground ambulance service;

2. The name of the ground ambulance services on the certificate of necessity;

3. The new legal name of the ground ambulance service;

4. The name, title, address, e-mail address, and telephone number of an individual whom the Department may contact about the requested amendment;

5. Documentation demonstrating that the change in the name of the ground ambulance service does not constitute a change of ownership; and

6. If applicable, documentation showing the new legal name of the ground ambulance service on:

a. Documentation of insurance coverage required according to R9-25-908(A), and

b. Coverage by a surety bond if required under A.R.S. § 36-2237(B).

B. A certificate holder requesting to amend the certificate of necessity for a reason other than a change in subsection (A) shall submit to the Department:

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

a. The certificate of necessity number for the ground ambulance service;

b. The name and address of the ground ambulance service on the certificate of necessity;

c. The name, title, address, e-mail address, and telephone number of an individual whom the Department may contact about the requested amendment;

d. A description of the requested change and the rationale for the change;

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

f. 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;

g. Attestation that the certificate holder will meet the conditions of a modified certificate of necessity, including billing only those rates and charges approved and set by the Director;

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

i. The signature of the applicant or the applicant's designated representative and the date signed;

2. For a change in the legal address of the ground ambulance service:

a. The new legal address of the ground ambulance service; and

b. If applicable, documentation showing the new legal address of the ground ambulance service on documentation of insurance coverage required according to R9-25-908(A);

3. For a change in the hours of service:

a. The current and proposed new hours of service,

b. The date on which the applicant plans to implement the change,

c. Information about the effect the requested change is expected to have on patients,

d. Information about the effect the requested change is expected to have on other EMS providers or ground ambulance services in or around the service area, and

e. Information about the financial effect the requested change is expected to have on the ground ambulance service;

4. For a change in the level of service to be provided:

a. If planning to begin providing critical care services or ALS services:

i. A description of how the certificate holder plans to provide administrative medical direction according to R9-25-201 and on-line medical direction according to R9-25-202,

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

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

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

b. If planning to begin providing only BLS services:

i. A description of the rationale for stopping the provision of ALS services or critical care services,

ii. An acknowledgement that another emergency medical services provider may be granted a certificate of necessity to provide ALS services or critical care services in the service area to meet the needs of patients, and

iii. A plan for rendezvousing with another ground ambulance service providing ALS services or critical care services, if applicable, for patients requiring more than BLS services, including the identification of the other ground ambulance service;

c. Information about the effect the requested change is expected to have on patients, including how the requested change will result in quality patient care;

d. Information about the effect the requested change is expected to have on other EMS providers or ground ambulance services in or around the service area; and

e. Information about the financial effect the requested change is expected to have on the ground ambulance service;

5. For a change in the type of service to be provided:

a. If planning to begin providing interfacility transports of patients with a time-critical condition:

i. An estimate of the number of transports to be provided;

ii. The names of the health care institutions anticipated to be the source or destination of the transports;

iii. The proposed response times and compliance percentages for the interfacility transport of a patient with a time-critical condition;

iv. A justification for the response time or compliance percentage that demonstrates how quality patient care will be provided; and

v. Whether another ground ambulance service is currently providing interfacility transports of patients with a time-critical condition in the service area and, if so, the name of the other ground ambulance service and the anticipated financial impact on the other ground ambulance service if the change is approved;

b. If planning to begin providing interfacility transports of patients who do not have a time-critical condition or convalescent transports:

i. An estimate of the number of transports to be provided;

ii. The names of the health care institutions anticipated to be the source or destination of the transports;

iii. 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);

iv. If the certificate holder is requesting to amend the certificate of necessity according to A.R.S. § 36-2234.01, the information required according to A.R.S. § 36-2234.01(B)(1) and (2); and

v. Whether another ground ambulance service is currently providing interfacility transports or convalescent transports in the service area and, if so, the name of the other ground ambulance service and the anticipated financial impact on the other ground ambulance service if the change is approved;

c. If planning to begin providing ambulance response or transport requested through 9-1-1 or a similar system:

i. An estimate of the number of transports to be provided;

ii. The names of the health care institutions anticipated to be the destination of the transports;

iii. The proposed response times or compliance percentage;

iv. A justification for the response times or compliance percentage that demonstrates how quality patient care will be provided; and

v. Whether another ground ambulance service is currently providing ambulance response or transport requested through 9-1-1 or a similar system in the service area and, if so, the name of the other ground ambulance service and the anticipated financial impact on the other ground ambulance service if the change is approved;

d. Information about the effect the requested change is expected to have on patients, including how the requested change will result in quality patient care;

e. Information about the effect the requested change is expected to have on health care institutions within and surrounding the service area to which and from which the ground ambulance service would be transporting patients;

f. Information about the effect the requested change is expected to have on other EMS providers or ground ambulance service in or around the service area;

g. Information about the financial effect the requested change is expected to have on the ground ambulance service; and

h. If the planned change will result in new or revised back-up agreements, a copy of the new or revised back-up agreement;

6. Except as specified in subsection (D), for a change in the service area:

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

b. The following information about the proposed service area to be used by the Director in assessing the need for the proposed change:

i. The square miles within the proposed service area;

ii. The population demographics within the proposed service area;

iii. The change in the population demographics since the last national census;

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

v. The number of anticipated requests for each type of service and level of service in the proposed service area;

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

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

viii. Whether a ground ambulance service currently operates in all or part of the proposed service area and if so, where;

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

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

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

c. Information about the effect the requested change is expected to have on patients, including how the requested change will result in quality patient care;

d. Information about the effect the requested change is expected to have on health care institutions within and surrounding the proposed service area to which and from which the ground ambulance service would be transporting patients;

e. Information about the effect the requested change is expected to have on EMS providers in the proposed service area that do not provide transport;

f. Information about the financial effect the requested change is expected to have on the ground ambulance service;

g. Whether the applicant has a proposed deployment plan for the ground ambulance vehicles registered under Article 10 of this Chapter to the applicant, including:

i. Whether suboperation stations will be used or whether ground ambulance vehicles will be deployed based on experience with the level and types of calls; and

ii. If suboperation stations will be used, where the applicant plans to locate suboperation stations within the applicant's proposed service area;

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

i. 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; and

j. Any other information specified in R9-25-906 that the applicant believes relevant to a determination of the public necessity for the change in the service area;

7. For a change in the ground ambulance service's response times for ambulance response or transport requested through 9-1-1 or a similar system or for an interfacility transport of a patient with a time-critical condition:

a. A description of the ground ambulance service's current response times and compliance percentage;

b. The results of the analysis of response time performance required in R9-25-908(G)(2);

c. The requested response times or compliance percentage, including a justification for each response time;

d. Information about the effect the requested change is expected to have on patients, including applicable information in subsections (B)(6)(b) and (c);

f. Information about the effect the requested change is expected to have on EMS providers in the service area that do not provide transport; and

g. Information about the financial effect the requested change is expected to have on the ground ambulance service;

8. For a change in the plan for complying with the requirements in R9-25-908(E)(3)(c), or with a standard different from that in R9-25-908(E)(3)(c), that demonstrates how quality patient care will be provided, including to patients with a time-sensitive condition:

a. A description of the ground ambulance service's current plan;

b. The results of the analysis of the performance required in R9-25-908(H)(2);

c. The requested standard if different from that in R9-25-908(E)(3)(c);

d. Information about the effect the requested change is expected to have on patients, including applicable information in subsections (B)(6)(b) and (c);

f. Information about the financial effect the requested change is expected to have on the ground ambulance service;

9. For a change in the special limitations or conditions on the ground ambulance service's certificate of necessity:

a. A description of the special limitations or conditions on the ground ambulance service's certificate of necessity;

b. The requested change to the special limitations or conditions on the ground ambulance service's certificate of necessity, including a justification for each change and how the change is in the best interest of the public;

c. Information about the effect the requested change is expected to have on patients, including how the requested change will result in quality patient care;

d. Information about the effect the requested change is expected to have on health care institutions within and surrounding the service area to which and from which the ground ambulance service would be transporting patients;

e. Information about the effect the requested change is expected to have on EMS providers in the service area that do not provide transport; and

f. Information about the financial effect the requested change is expected to have on the ground ambulance service;

10. Information required in R9-25-1102 and R9-25-1109(B), as applicable, related to the change, including any change in:

a. The proposed general public rates for services provided, or

b. The proposed charges;

11. If applicable, letters of support for the change;

12. Any other information or documentation demonstrating the public necessity for the change or otherwise justifying the change;

13. Any other information or documents requested by the Director to clarify incomplete or ambiguous information or documents;

14. Any documents, exhibits, or statements that the amending certificate holder wishes to submit to assist the Director in evaluating the proposed amendment; and

15. The $50 application filing fee.

C. A certificate holder subject to special limitations or conditions that are not displayed on the certificate holder's certificate of necessity may request, according to subsections (B)(1) and (9), to have the special limitations or conditions modified if the special limitations or conditions were the result of a final decision of the Director, established according to A.R.S. § 41-1092.08(F), issued before January 1, 2024.

D. If a certificate of necessity was granted to a certificate holder under A.R.S. § 36-2233(I)(2), the certificate holder shall notify the Department of a change in the service area within 30 calendar days after the change is finalized and include:

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

a. The certificate of necessity number for the ground ambulance service,

b. The name and address of the ground ambulance service on the certificate of necessity,

c. A description of the change and the reason for the change,

d. The effective date of the change,

e. Attestation that the information or documents submitted to the Department are true and correct, and

f. The signature of the certificate holder's designated representative and the date signed;

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

3. Documentation establishing that the change in service area is under A.R.S. § 36-2233(E)(2).

E. The Department shall approve or deny an application under subsection (B) or (C) according to A.R.S. § 36-2233, Article 12 of this Chapter, and, if applicable, R9-25-1106 and R9-25-1107.

Ariz. Admin. Code § R9-25-905

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.