A. In
determining public necessity for an initial or amended certificate of
necessity, the Director shall consider the following to ensure quality patient
care:
1. The following information, as
proposed by the applicant for the service area:
a. Proposed response times or compliance
percentage,
b. The priority that
may be assigned by an applicant or a certificate holder to a response,
and
c. The percentage of time the
actual response time for a run is or is anticipated to be compliant with the
proposed response times during a 12-month period;
2. The population demographics
within the proposed service area;
3. The geographic distribution of
health care institutions within and surrounding the service
area;
4. Whether issuing a certificate
of necessity to more than one ambulance service within the same service area is
in the public's best interest, based on:
a. The existence of ground
ambulance service to all or part of the service area;
b. The response times of and
response-time tolerances for ground ambulance service to all or part of the
service area;
c. The availability of certificate
holders in all or part of the service area; and
d. The availability of emergency
medical services in all or part of the service area;
2. Whether issuing the certificate
of necessity is in the public's best interest:
a. Based on a possible gap in service or
unmet needs in the service area; and
b. To ensure consistent service provision,
efficiency, cost-effectiveness, and the health and safety of individuals in the
service area;
5.3. The information in
R9-25-902(A)(1) through (4), (6), (8), (12) through (14), and (19) through
(22);
4. If applicable, the
information in subsection (B); and
6.5. Other matters
determined by the Director or the applicant to be relevant to the determination
of public necessity.
B.
In deciding whether issuing a certificate of necessity to more than one ground
ambulance service for the same service area or overlapping service areas is in
the public's best interest, the Director shall consider the following in
addition to the information in subsections (A)(1) through (3):
1. The factors in subsections
(A)(2), (A)(3), (A)(4)(a), (A)(4)(c), (A)(4)(d), (A)(5), and
(A)(6);
1. The existence of
another ground ambulance service providing ambulance response or transport to
all or part of the service area, including the level of service and type of
service being provided;
2. The
current response times and compliance percentages achieved for requests made
through 9-1-1 or a similar system in all or part of the service area;
3. If applicable, the current response times
and compliance percentages achieved for interfacility transports for patients
with a time-critical condition in all or part of the service area;
4. If applicable, the applicant's plans to
provide interfacility transports for patients with no time-critical condition
in all or part of the service area in compliance with
R9-25-908(E)(3);
5. The applicant's
plans for implementation, taking into consideration the stability and
consistency of service provision;
6. If available, information or data that
demonstrates the inability of the other certificate holder to provide services
in all or part of the service area;
7. How the applicant plans to interact with
the ground ambulance service currently providing services in all or part of the
service area, including the information in
R9-25-908(E)(1)(a),
(b), and (c);
8. The availability of emergency medical
services in all or part of the service area;
2.9. The financial impact
on certificate holders whose service area includes all or part of the service
area in the requested certificate of necessity;
3.10. The demonstrated
need for additional 9-1-1 or similarly dispatched transport, convalescent
transport, or interfacility transport, as applicable, including:
a. Whether a study or statistical analysis
demonstrating need has been created for or adopted by the applicant, a
political subdivision within the current or proposed service area, or a local
emergency medical services coordinating system under A.R.S. §
36-2210 that:
i. Examines whether another ground ambulance
service is necessary within the service area or proposed service area to
provide ambulance response or transport; and
ii. Takes into account the current or
proposed service area's medical, fire, and police services and the other ground
ambulance service;
b. If
a study or statistical analysis in subsection (B)(11)(a) exists, the content of
the study or statistical analysis demonstrating need; and
c. Information received by the Department
from a political subdivision, a health care institution, an elected official,
or another interested party, as described in A.R.S. §
36-2233(D),
indicating a need;
11. For
an application for additional 9-1-1 or similarly dispatched transport, the
difference between the current response times in the service area for 90%
compliance and the response times for 90% compliance proposed by the applicant;
and
4.12. Whether a
certificate holder for the service area has demonstrated noncompliance with
requirements in this Article, Articles 2, 10, or 11 of this Chapter, or A.R.S.
Title 36, Chapter 21.1.
C.
In deciding whether to issue a certificate of
necessity to more than one ground ambulance service for a 9-1-1 or similarly
dispatched transport within the same service area or overlapping service areas,
the Director shall consider the following:
1. The factors in subsections (A),
(B)(2), and (B)(4);
2. The difference between the
response times in the service area and proposed response times by the
applicant;
3. A needs assessment adopted by a
political subdivision, if any; and
4. A needs assessment, referenced
in A.R.S. §
36-2210, adopted by a local
emergency medical services coordinating system, if
any.
