Ariz. Admin. Code § R9-25-1102 - Application for Adjustment of General Public Rates (Authorized by A.R.S. Sections 36-2234, 36-2239)

A. A certificate holder applying for an adjustment of general public rates not exceeding the monetary amount calculated according to A.R.S. § 36-2234(G) shall submit to the Department, in a Department-provided format:

1. The name of the certificate holder,

2. The identifying number on the certificate holder's current certificate of necessity,

2.3. A statement that the certificate holder is making the request according to A.R.S. § 36-2234(G),

3.4. A statement that the certificate holder has not applied for an adjustment to the certificate holder's general public rates within the previous six months,

5. The amount of the requested general public rate,

4.6. The effective date of the requested general public rate adjustment,

5.7. An attestation 2 that the information provided by the certificate holder is true and correct, and

8. The signature of the individual acting for the certificate holder according to R9-25-102 and the date signed.

B. A certificate holder requesting an adjustment of general public rates exceeding the monetary amount calculated according to A.R.S. § 36-2234(G) shall submit to the Department:

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

a. The identifying number on the certificate holder's current certificate of necessity;

b. The legal business or corporate name, address, telephone number, and facsimile number of the ground ambulance service;

c. Any other names by which the certificate holder is known;

d. The names of all other business organizations or governmental entities operated by the certificate holder related to the ground ambulance service;

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

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

ii. The individual acting for the certificate holder 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 certificate holder to accept service of process and subpoenas for the ground ambulance service;

2.f. A statement that the certificate holder is making the request according to A.R.S. § 36-2234(C);

3.g. The reason for the general public rate adjustment request;

h. The requested general public rates;

4.i. A statement that the certificate holder has not applied for an adjustment to the certificate holder's general public rates within the previous six months;

5.j. The effective date of the requested general public rate adjustment;

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

l. An attestation that the information and documents provided by the certificate holder are true and correct, and

m. The signature of the individual acting for the certificate holder according to R9-25-102 and the date signed;

6. 2. A copy of the certificate holder's financial statements, covering at least:

a. If applicable under A.R.S. § 36-2234(H), the most recent consecutive 24-month period; or

b. The most recent consecutive 12-month period;

7.3. A copy of the certificate holder's most recent Ambulance Revenue and Cost Report;

4. A projected Ambulance Revenue and Cost Report covering the first consecutive 12 months of operation under the requested general public rates in subsection (B)(1)(h);

8. For a consecutive 12-month period:

a. A projected income statement; and

b. A projected cash-flow statement;

9. A list of all purchase agreements or lease agreements for real estate, ground ambulance vehicle, and equipment exceeding $5,000 used in connection with the ground ambulance service, that includes the monetary amount and duration of each agreement;

10. The identification of:

a. Each of the applicant's affiliations, such as a parent company or subsidiary owned or operated by the applicant; and

b. The methodology and calculations used in allocating costs among the applicant and government entities or profit or not for profit businesses;

11.5. If the ground ambulance service has a contract with a federal or tribal entity, a copy of the certificate holder's contract with each federal or tribal entity unless the contract has been submitted to the Department and reviewed according to R9-25-1104;

6. A copy 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;

7. For all business organizations or governmental entities affiliated with the certificate holder listed according to subsection (B)(1)(d), the methodology and calculations used in allocating costs among the certificate holder and business organizations or governmental entities;

12.8. Other documents, exhibits, or statements that support the reason for the general public rate adjustment request as specified in subsection (B)(1)(g) and may assist the Department in setting the general public rates;

13. An attestation signed by the applicant that the information and documents provided by the applicant are true and correct; and

14.9. Any other information or documents requested by the Director to clarify or complete the application.

C. An applicant under R9-25-902, requesting to join a group of certificate holders, with a uniform general public rate established according to A.R.S. § 36-2232(E) and R9-25-1101(C), shall submit to the Department:

1. The information required in R9-25-902(A) and R9-25-1101(A)(1);

2. The documents required in subsections (B)(5) through (9);

3. A copy of the applicant's financial statements, covering the most recent consecutive 24-month period;

4. Projected Ambulance Revenue and Cost Reports covering the first consecutive 24 months of operation under the uniform general public rate; and

5. Documentation supporting the request, signed by each certificate holder with the uniform general public rate.

D. A certificate holder with a uniform general public rate, established according to A.R.S. § 36-2232(E) and R9-25-1101(C), that wants to establish a different general public rate shall submit to the Department:

1. A request according to subsection (A) or (B), as applicable; and

2. Documentation that the certificate holder has notified the other certificate holders with the uniform public rate of the certificate holder's intention of establishing a different general public rate.

E. A certificate holder with a uniform general public rate, established according to A.R.S. § 36-2232(E) and R9-25-1101(C), that is notified according to subsection (D)(2) shall, within 60 calendar days after the date of notification of the Department's decision to grant the different general public rate:

1. Notify the Department of the intention to retain the rate currently on the certificate of necessity, or

2. Submit to the Department the information and documentation required in subsection (B).

C.F. The Department shall review an application under this Section according to R9-25-1106, R9-25-1107, and R9-25-1201 and approve or deny the application according to A.R.S. §§ 36-2234 and 36-2239 and Article 12 of this Chapter.

Notes

Ariz. Admin. Code § R9-25-1102

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.