Ariz. Admin. Code § R9-25-903 - Application for Renewal of a Certificate of Necessity (Authorized by A.R.S. Sections 36-2233, 36-2235, 36-2238, 36-2240, 36-2242)
A. An
applicant for a renewal of a certificate of necessity shall submit to the
Department, not less than 30 days before the expiration date of the certificate
of necessity, an application packet that includes:
6.7.
$50 application filing fee.
1. The following information in a
Department-provided format:
a. The
identifying number on the applicant'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 applicant is known;
d. The names of all other business
organizations operated by the applicant related to the ground ambulance
service;
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. Whether the
applicant agrees to allow the Department to submit supplemental requests for
information under
R9-25-1201(C)(3);
g. Attestation that the applicant has
analyzed response times according to
R9-25-908(G)(2)
and, if applicable, performance of interfacility transports of patients with no
time-critical condition according to
R9-25-908(H)(1);
h. 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;
i. Attestation that the certificate holder,
except as provided in
R9-25-908(G)(4), R9-25-908(H)(3), or R9-25-908(K)(1)(c), has and is continuing to meet the conditions of the certificate of
necessity;
j. Attestation that any
information or documents submitted to the Department are true and correct;
and
k. The signature of the
applicant or the applicant's designated representative and the date
signed;
2. Proof of
continuous insurance coverage or a statement of continuing self-insurance,
including a copy of the current certificate of insurance or current statement
of self-insurance required in
R9-25-908(A);
3. Proof of continued coverage by a surety
bond if required under A.R.S. §
36-2237(B);
4. A copy of the list of current charges
required in
R9-25-1109;
5. An affirmation that the
certificate holder has and is continuing to meet the conditions of the
certificate of necessity, including assessing only those rates and charges
approved and set by the Director; and
5. A list of all certificate holders with
which the applicant has back-up agreements;
6. If an instance of noncompliance has been
identified, a corrective action plan or documentation specified in
R9-25-908(G)(4), R9-25-908(H)(3), or R9-25-908(K)(1)(c), as applicable, if not
already submitted to the Department; and
B. A certificate holder who fails to file a
timely application for renewal of the certificate of necessity according to
A.R.S. §
36-2235 and this Section, shall:
C.2. If planning to
continue operating as a ground ambulance service, file an initial certificate
of necessity application according to
R9-25-902; and
1. Cease operations at 12:01 a.m. on the date
the certificate of necessity expires;
3. Not resume operations without receiving a
new certificate of necessity from the Department.
1. Approve the
application;
2. Approve the
application with a corrective action plan, as specified in subsection
(A)(6);
3. Approve the application
with special limitations or conditions; or
4. Deny the application.
D. The Department may deny an application
according to A.R.S. §
36-2235 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).
E. If a certificate holder submits an
application for renewal according to subsection (A), the current certificate of
necessity does not expire until the Department has made a final determination
on the application for renewal, as provided in A.R.S. §
41-1092.11.
F. If a certificate holder does not intend to
apply for renewal of a certificate of necessity, the certificate holder shall:
1. At least 90 days before the expiration
date of the certificate of necessity, send the Department written notice of the
certificate holder's intention to cease operating, effective on the expiration
date; and
2. Not discontinue
service, except as provided in A.R.S. §
36-2238.
Notes
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