Ariz. Admin. Code § R9-25-1103 - Application for a Contract Rate or Range of Rates Less than General Public Rates (A.R.S. Sections 36-2234(I) and (K), 36-2239)

A. Before providing interfacility transports or convalescent transports, a certificate holder shall apply to the Department for approval of a contract rate or range of contract rates under A.R.S. § 36-2234(G) .

1. For a contract rate or range of rates under A.R.S. § 36-2234(G), the certificate holder shall submit an application form to the Department that contains:

a. The name of the certificate holder;

b. A statement that the certificate holder is making the request under A.R.S. § 36-2234(G) ;

c. The contract rate or range of rates being requested; and

d. Information demonstrating the cost and economics of providing the transports for the requested contract rate or range of rates.

2. For a contract rate or range of rates under A.R.S. § 36-2234(I), the certificate holder shall submit the information required in R9-25-1102(B)(1) and (B)(6) through (B)(14) .

A. A certificate holder applying for approval of a contract rate or range of rates under A.R.S. § 36-2234(I) shall submit to the Department:

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

a. The name of the certificate holder,

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

c. A statement that the certificate holder is making the request under A.R.S. § 36-2234(I),

d. The contract rate or range of rates being requested,

e. The effective date of the requested contract rate or range of rates,

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

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

2. Information demonstrating the cost and economics of providing the transports for the requested contract rate or range of rates, such as:

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

b. A projected Ambulance Revenue and Cost Report covering the first consecutive 12 months of operation under the requested contract rate or range of rates in subsection (A)(1)(d).

B. A certificate holder applying for approval of a contract rate or range of contract rates under A.R.S. § 36-2234(K) shall submit to the Department:

1. The information in subsection (A)(1), in a Department-provided format; and

2. The documents required in R9-25-1102(B)(2) through (8).

B.C. 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 § R9-25-1103

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.