Ariz. Admin. Code § 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 that wants to amend its
certificate of necessity shall submit to the Department the application form in
R9-25-902(A)(1) and an application filing fee of $50 for changes in:
1. The legal name of the ground
ambulance service;
2. The legal address of the ground
ambulance service;
3. The level of ground ambulance
service;
4. The type of ground ambulance
service;
5. The service area;
or
6. The response times, response
codes, or response-time tolerances.
B.
In addition to the application form in subsection
(A), an amending certificate holder shall submit:
1. For the addition of ALS ground
ambulance service, the information required in
R9-25-902(B)(1) and
(B)(2) .
2. For a change in the service
area, the information required in
R9-25-902(A)(3)(a) ;
3. For a change in response times,
the information required in subsection
R9-25-902(A)(2)(d) ;
4. A statement explaining the
financial impact and impact on patient care anticipated by the proposed
amendment;
5. Any other information or
documents requested by the Director to clarify incomplete or ambiguous
information or documents; and
6. Any documents, exhibits, or
statements that the amending certificate holder wishes to submit to assist the
Director in evaluating the proposed amendment.
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);
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 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);
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;
and
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).
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.