In addition to the definitions in A.R.S. §
36-2201 and
R9-25-101, the following
definitions apply in Articles 9, 10, 11, and 12 unless otherwise
specified:
1. "Accounting period"
means a continuous 12-month span of time used by an applicant or a certificate
holder for purposes of planning, budgeting, or annual financial reporting to
the Department.
1.2. "Adjustment" means a
modification, correction, or alteration to a rate or charge.
2.3. "ALS
base rate" means the monetary amount set by the Department for a certificate
holder to bill a patient according to A.R.S. §
36-2239(F).
4. "Ambulance response" means EMS provided by
a ground ambulance service.
3.5. "Ambulance Revenue
and Cost Report" means the information required in
R9-25-909, which records and
reports the financial activities of an applicant or a certificate
holder.
4.6. "Application packet"
means the information, applicable fees, and documents required by the
Department when making a decision for certification, licensure, or approval of
a request.
5.7. "Back-up agreement"
means a written arrangement, which may include one of the following, between a
certificate holder and a neighboring or overlapping certificate holder to allow
one of the certificate holders to provide ambulance response or transport
within the other certificate holder's service area on a limited basis when the
certificate holder's ambulances are temporarily not able to provide needed
services in the certificate holder's service area:
a. A mutual aid agreement, or
b. A Memorandum of Understanding.
6.8. "BLS base rate" means
the monetary amount set by the Department for a certificate holder to bill a
patient according to A.R.S. §
36-2239(G).
7.9.
"Certificate holder" means a person to whom the Department issues a certificate
of necessity.
8.10. "Certificate of
registration" means an authorization issued by the Department to a certificate
holder to operate a ground ambulance vehicle.
9.11. "Change of
ownership" means a transfer of controlling legal or controlling financial
interest and authority in a ground ambulance service, as demonstrated according
to
R9-25-904(A)(1) .
a. In the case of ownership by a
sole proprietor, 20% or more interest or a beneficial interest is sold or
transferred;
b. In the case of ownership by a
partnership or a private corporation, 20% or more of the stock, interest, or
beneficial interest is sold or transferred; or
c. The controlling influence
changes to the extent that the management and control of the ground ambulance
service is significantly altered.
10.12. "Charge" means the
monetary amount billed for disposable supplies, medical supplies, medication,
and oxygen-related costs used in providing care to a patient.
11.13.
"Chassis" means the part of a ground ambulance vehicle consisting of all base
components, including front and rear suspension, exhaust system, brakes,
engine, engine hood or cover, transmission, front and rear axles, front
fenders, drive train and shaft, fuel system, engine air intake and filter,
accelerator pedal, steering wheel, tires, heating and cooling system, battery,
and operating controls and instruments.
14. "Controlling person" means an individual
who:
a. Owns at least a 20% interest in the
business organization that operates or is applying to operate as a ground
ambulance service;
b. If an
applicant or certificate holder is a partnership, is a general partner or is a
limited partner who holds at least 20% of the voting rights of the
partnership;
c. If an applicant or
certificate holder is a corporation, association, or limited liability company,
is the president, chief executive officer, or incorporator, or an individual
who owns or controls at least 20% of the voting securities; or
d. Is responsible for the overall day-to-day
management and operation of the ground ambulance service.
15. "Contract rate or range of rates" means
the monetary amount established by the Department according to
R9-25-1103 .
12. "Convalescent transport" means
a scheduled transport other than an interfacility transport.
16. "Convalescent transport" means
a ground ambulance service's response to a request for ambulance response or
transport that is:
a. Not an interfacility
transport, and
b. Pre-arranged to
occur at a specific time.
17. "Critical care rate" means the monetary
amount that is set by the Department for a certificate holder to bill a patient
for critical care services.
18.
"Critical care services" means care provided during an interfacility transport
to a patient who has an illness or injury acutely or chronically impairing one
or more organ systems, such that the conditions are life-threatening and
require constant monitoring to avoid deterioration of the patient's
condition.
13.19. "Dispatch" means
the direction to a certificate holder or an emergency medical services provider
to respond to a call for ambulance response or transport.
14.20.
"Driver's compartment" means the part of a ground ambulance vehicle that
contains the controls and instruments for operation of the ground ambulance
vehicle.
15.21. "Financial
statements" means an applicant's balance sheet, annual income statement, and
annual cash flow statement, or corresponding documents if applicable to the
type of business organization, prepared according to the conventions, and rules
and procedures for accounting, including broad and specific guidelines,
established by the Financial Accounting Standards Board or the Governmental
Accounting Standards Board.
16.22. "Frame" means the
structural foundation on which a ground ambulance vehicle chassis is
constructed.
17.23. "General public
rate" means the monetary amount set by the Department for a certificate holder
to bill a patient for critical care services, ALS services, BLS services,
mileage, standby waiting, or according to a subscription service
contract.
18.24. "Generally accepted
accounting principles" means the conventions, and rules and procedures for
accounting, including broad and specific guidelines, established by the
Financial Accounting Standards Board.
19. "Goodwill" means the
difference between the purchase price of a ground ambulance service and the
fair market value of the ground ambulance service's identifiable net
assets.
20.25. "Gross revenue"
means the total monetary amount billed by a certificate holder during an
accounting period, prior to any deductions, for providing ambulance response or
transport.
a. The sum of revenues reported in
the Ambulance Revenue and Cost Report Exhibit A, page 2, lines 1, 9, and 20;
or
b. The sum of revenues reported in
the Ambulance Revenue and Cost Report Exhibit B, page 3, lines 1, 24, 25, and
26.
21.26. "Ground ambulance
service" means an ambulance service that operates on land.
22.27.
"Ground ambulance service contract" means a written agreement between a
certificate holder and a person for the provision of ambulance response or
transport.
23.28. "Ground ambulance
vehicle" means a motor vehicle, defined in A.R.S. §
28-101, specifically designed to
carry ambulance attendants and patients on land.
24. "Indirect costs" means the
cost of providing ground ambulance service that does not include the costs of
equipment.
25. "Interfacility transport"
means a scheduled transport between two health care
institutions.
26.29. "Level of service"
means critical care services, ALS services, or BLS services, based on the type
of ambulance attendants and the services provided by the ground ambulance
service.
27.30. "Major defect"
means a condition that exists on a ground ambulance vehicle that makes the
ground ambulance vehicle unsafe to use for providing transport.
28.31.
"Mileage rate" means the monetary amount set by the Department for a
certificate holder to bill for transport of a patient for each mile traveled
during the transport.
29.32. "Minor defect"
means a condition that exists on a ground ambulance vehicle that may cause the
ground ambulance vehicle to become unsafe to use for providing transport if
allowed to continue.
30. "Needs assessment" means a
study or statistical analysis that examines the need for ground ambulance
service within a service area or proposed service area that takes into account
the current or proposed service area's medical, fire, and police
services.
31.33. "Out-of-service"
means a ground ambulance vehicle cannot be operated for transport.
32.34.
"Patient compartment" means the part of a ground ambulance vehicle that is
intended to hold a patient during transport.
35. "Priority" means whether a response mode
to a dispatch, on the basis of the information available to the certificate
holder, is:
a. Emergent, that is, an immediate
response is required due to a patient's perceived condition; or
b. Non-emergent, that is, a response is
required at a time appropriate to a patient's perceived condition.
33.36. "Public necessity"
means that a need exists within an identified population and service area for
all or part of the services proposed by an applicant or determined by the
Department.
34. "Response code" means the
priority assigned to a request for immediate dispatch by a ground ambulance
service on the basis of the information available to the certificate holder or
the certificate holder's dispatch authority.
35.37.
"Response time" means the difference between the time a certificate holder
receives:
a. A 9-1-1 or similar system
dispatch and the time the certificate holder's first ground ambulance vehicle
arrives at the scene; or
b. A
request for an interfacility transport of a patient with a time-critical
condition and the time the certificate holder's ground ambulance vehicle
arrives at the health care institution to provide transport.
36. "Response-time tolerance"
means the percentage of actual response times for a response code and scene
locality that are compliant with the response time approved by the Department
for the response code and scene locality, for any 12-month
period.
37. "Rural area" means a
geographic region with a population of less than 40,000 residents that is not a
suburban area.
38. "Scene locality" means:
a. an urban area, a geographic region
delineated as an urbanized area by the United States Department of Commerce,
Bureau of the Census;
b. A suburban
area, a geographic region within a 10-mile radius of an urban area that has a
population density equal to or greater than 1,000 residents per square
mile;
c. A rural area, a geographic
region with a population of less than 40,000 residents that is not a suburban
area; or
d. A wilderness area, a
geographic region that has a population density of less than one resident per
square mile.
39.
"Scheduled transport" means to convey a patient at a prearranged time by a
ground ambulance vehicle for which an immediate dispatch and response is not
necessary.
40. "Service area" means
the geographical boundary designated on a certificate of necessity using the
criteria in A.R.S. §
36-2233(I).
41. "Settlement" means the
difference between the monetary amount Medicare establishes or AHCCCS pays as
an allowable rate and the general public rate a ground ambulance service
assesses a patient.
42.41. "Standby waiting
rate" means the monetary amount set by the Department for a certificate holder
to bill a patient when a ground ambulance vehicle is required to wait in excess
of 15 minutes to load or unload the patient, unless the excess delay is caused
by the ground ambulance vehicle or the ambulance attendants on the ground
ambulance vehicle.
43.42. "Subscription
service" means the provision of ambulance response or transport by a
certificate holder to a group of individuals within the certificate holder's
service area who contracted with the certificate holder for coverage to provide
ambulance response or transport and the allocation of annual costs among the
group of individuals.
44.43. "Subscription
service contract" means a written agreement for subscription service.
45.44.
"Subscription service rate" means the monetary amount set by the Department for
a certificate holder to bill to a person for coverage under a subscription
service contract.
46. "Substandard performance"
means a certificate holder's:
a. Noncompliance with A.R.S. Title
36, Chapter 21.1, Articles 1 and 2, or 9 A.A.C. 25, or the terms of the
certificate holder's certificate of necessity, including all decisions and
orders issued by the Director to the certificate holder;
b. Failure to ensure that an
ambulance attendant complies with A.R.S. Title 36, Chapter 21.1, Articles 1 and
2, or 9 A.A.C. 25, for the level of ground ambulance service provided by the
certificate holder; or
c. Failure to meet the
requirements in 9 A.A.C. 25, Article 10.
47. "Suburban area" means a
geographic region within a 10-mile radius of an urban area that has a
population density equal to or greater than 1,000 residents per square
mile.
48.45. "Third-party payor"
means a person, other than a patient, who is financially responsible for the
payment, in whole or in part, of a patient's billed general public rates and
charges for ambulance response or transport provided to the patient by a ground
ambulance service.
46.
"Time-critical condition" means a patient's illness or injury, such as ST
Elevated Myocardial Infarction, stroke, trauma that meets the criteria in
R9-25-1308(H)(6)(b)(i), or hemodynamic instability, for which research has
shown that a transport to a specialized health care institution or a higher
level of care improves patient outcomes.
47. "Time-sensitive condition" means a
patient's illness or injury for which, in the opinion of one of the following,
a delay in the patient receiving appropriate medical services may result in
harm to the patient:
a. For an interfacility
transport, a physician, physician assistant, or registered nurse practitioner
providing medical services to the patient; and
b. For a transport that results from a 9-1-1
or similar system dispatch, an EMCT or the physician providing on-line medical
direction for the patient.
50.48. "Transport" means
the conveyance of one or more patients in a ground ambulance vehicle from the
point of patient pick-up to a specified destination.
51.49. "Type of service"
means an interfacility transport, a convalescent transport, or a transport that
results from a 9-1-1 or similar system dispatch, which is provided by a ground
ambulance service.
52. Urban area" means a geographic
region delineated as an urbanized area by the United States Department of
Commerce, Bureau of the Census.
53. "Wilderness area" means a
geographic region that has a population density of less than one resident per
square mile.
