Bill Text: AZ HB2280 | 2019 | Fifty-fourth Legislature 1st Regular | Introduced
Bill Title: Certificates of operation; interfacility transports
Spectrum: Partisan Bill (Republican 1-0)
Status: (Introduced - Dead) 2019-05-02 - Assigned to House RULES Committee [HB2280 Detail]
Download: Arizona-2019-HB2280-Introduced.html
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REFERENCE TITLE: certificates of operation; interfacility transports |
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State of Arizona House of Representatives Fifty-fourth Legislature First Regular Session 2019
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HB 2280 |
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Introduced by Representative Weninger
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AN ACT
Amending section 36‑2201, Arizona Revised Statutes; amending title 36, chapter 21.1, article 1, Arizona Revised Statutes, by adding sections 36‑2212.01, 36‑2212.02 and 36‑2212.03; amending sections 36‑2224, 36‑2233, 36‑2237, 36‑2239, 36‑2240, 36‑2241 and 36‑2245, Arizona Revised Statutes; relating to emergency medical services.
(TEXT OF BILL BEGINS ON NEXT PAGE)
Be it enacted by the Legislature of the State of Arizona:
Section 1. Section 36-2201, Arizona Revised Statutes, is amended to read:
36-2201. Definitions
In this chapter, unless the context otherwise requires:
1. "Administrative medical direction" means supervision of emergency medical care technicians by a base hospital medical director, administrative medical director or basic life support medical director. For the purposes of this paragraph, "administrative medical director" means a physician who is licensed pursuant to title 32, chapter 13 or 17 and who provides direction within the emergency medical services and trauma system.
2. "Advanced emergency medical technician" means a person who has been trained in an advanced emergency medical technician program certified by the director or in an equivalent training program and who is certified by the director to render services pursuant to section 36‑2205.
3. "Advanced life support" means the level of assessment and care identified in the scope of practice approved by the director for the advanced emergency medical technician, emergency medical technician I-99 and paramedic.
4. "Advanced life support base hospital" means a health care institution that offers general medical and surgical services, that is certified by the director as an advanced life support base hospital and that is affiliated by written agreement with a licensed ambulance service, municipal rescue service, fire department, fire district or health services district for medical direction, evaluation and control of emergency medical care technicians.
5. "Ambulance" means any publicly or privately owned surface, water or air vehicle, including a helicopter, that contains a stretcher and necessary medical equipment and supplies pursuant to section 36‑2202 and that is especially designed and constructed or modified and equipped to be used, maintained or operated primarily for the transportation of to transport individuals who are sick, injured or wounded or who require medical monitoring or aid. Ambulance does not include a surface vehicle that is owned and operated by a private sole proprietor, partnership, private corporation or municipal corporation for the emergency transportation and in‑transit care of its employees or a vehicle that is operated to accommodate an incapacitated person or person with a disability who does not require medical monitoring, care or treatment during transport and that is not advertised as having medical equipment and supplies or ambulance attendants.
6. "Ambulance attendant" means any of the following:
(a) An emergency medical technician, an advanced emergency medical technician, an emergency medical technician I-99 or a paramedic whose primary responsibility is the care of patients in an ambulance and who meets the standards and criteria adopted pursuant to section 36‑2204.
(b) An emergency medical responder who is employed by an ambulance service operating under section 36‑2202 and whose primary responsibility is the driving of an ambulance.
(c) A physician who is licensed pursuant to title 32, chapter 13 or 17.
(d) A professional nurse who is licensed pursuant to title 32, chapter 15 and who meets the state board of nursing criteria to care for patients in the prehospital care system.
(e) A professional nurse who is licensed pursuant to title 32, chapter 15 and whose primary responsibility is the care of caring for patients in an ambulance during an interfacility transport.
7. "Ambulance service" means a person who owns and operates one or more ambulances.
8. "Basic life support" means the level of assessment and care identified in the scope of practice approved by the director for the emergency medical responder and emergency medical technician.
9. "Bureau" means the bureau of emergency medical services and trauma system in the department.
10. "Centralized medical direction communications center" means a facility that is housed within a hospital, medical center or trauma center or a freestanding communication center that meets the following criteria:
(a) Has the ability to communicate with ambulance services and emergency medical services providers rendering patient care outside of the hospital setting via radio and telephone.
(b) Is staffed twenty‑four hours a day seven days a week by at least a physician licensed pursuant to title 32, chapter 13 or 17.
11. "Certificate of necessity" means a certificate that is issued to an ambulance service by the department and that describes the following:
(a) Service area.
(b) Level of service.
(c) Type of service.
(d) Hours of operation.
(e) Effective date.
(f) Expiration date.
(g) Legal name and address of the ambulance service.
(h) Any limiting or special provisions the director prescribes.
12. "Certificate of operation" means a certificate issued to an interfacility transfer ambulance service by the department.
12. 13. "Council" means the emergency medical services council.
13. 14. "Department" means the department of health services.
14. 15. "Director" means the director of the department of health services.
15. 16. "Emergency medical care technician" means an individual who has been certified by the department as an emergency medical technician, an advanced emergency medical technician, an emergency medical technician I‑99 or a paramedic.
16. 17. "Emergency medical responder" as an ambulance attendant means a person who has been trained in an emergency medical responder program certified by the director or in an equivalent training program and who is certified by the director to render services pursuant to section 36‑2205.
17. 18. "Emergency medical services" means those services required following an accident or an emergency medical situation:
(a) For on‑site emergency medical care.
(b) For the transportation of To transport the sick or injured by a licensed ground or air ambulance.
(c) In the use of using emergency communications media.
(d) In the use of using emergency receiving facilities.
(e) In administering initial care and preliminary treatment procedures by emergency medical care technicians.
18. 19. "Emergency medical services provider" means any governmental entity, quasi‑governmental entity or corporation, whether public or private, that renders emergency medical services in this state.
19. 20. "Emergency medical technician" means a person who has been trained in an emergency medical technician program certified by the director or in an equivalent training program and who is certified by the director as qualified to render services pursuant to section 36‑2205.
20. 21. "Emergency receiving facility" means a licensed health care institution that offers emergency medical services, is staffed twenty‑four hours a day and has a physician on call.
21. 22. "Fit and proper" means that the director determines that an applicant for a certificate of necessity or a certificate of operation or a certificate holder has the expertise, integrity, fiscal competence and resources to provide ambulance service in the service area or interfacility transfer ambulance service.
23. "Interfacility transfer ambulance service" means an ambulance that operates in a county with a population of more than three million persons and that is used exclusively for the nonemergency ground transportation of patients from one health care institution to another health care institution.
22. 24. "Medical record" means any patient record, including clinical records, prehospital care records, medical reports, laboratory reports and statements, any file, film, record or report or oral statements relating to diagnostic findings, treatment or outcome of patients, whether written, electronic or recorded, and any information from which a patient or the patient's family might be identified.
23. 25. "National certification organization" means a national organization that tests and certifies the ability of an emergency medical care technician and whose tests are based on national education standards.
24. 26. "National education standards" means the emergency medical services education standards of the United States department of transportation or other similar emergency medical services education standards developed by that department or its successor agency.
25. 27. "Paramedic" means a person who has been trained in a paramedic program certified by the director or in an equivalent training program and who is certified by the director to render services pursuant to section 36‑2205.
26. 28. "Physician" means any person licensed pursuant to title 32, chapter 13 or 17.
27. 29. "Stretcher van" means a vehicle that contains a stretcher and that is operated to accommodate an incapacitated person or person with a disability who does not require medical monitoring, aid, care or treatment during transport.
28. 30. "Suboperation station" means a physical facility or location at which an ambulance service conducts operations for the operates to dispatch of ambulances and personnel and that may be staffed twenty‑four hours a day or less as determined by system use.
29. 31. "Trauma center" means any acute care hospital that provides in‑house twenty‑four hour twenty‑four‑hour daily dedicated trauma surgical services and that is designated pursuant to section 36‑2225.
30. 32. "Trauma registry" means data collected by the department on trauma patients and on the incidence, causes, severity, outcomes and operation of a trauma system and its components.
31. 33. "Trauma system" means an integrated and organized arrangement of health care resources having the specific capability to perform triage, transport and provide care.
32. 34. "Validated testing procedure" means a testing procedure that is inclusive of includes practical skills, or an attestation of attests practical skills proficiency on a form developed by the department by the educational training program, identified pursuant to section 36‑2204, paragraph 2, that is certified as valid by an organization capable of determining testing procedure and testing content validity and that is recommended by the medical direction commission and the emergency medical services council before the director's approval.
33. 35. "Wheelchair van" means a vehicle that contains or that is designed and constructed or modified to contain a wheelchair and that is operated to accommodate an incapacitated person or a person with a disability who does not require medical monitoring, aid, care or treatment during transport.
Sec. 2. Title 36, chapter 21.1, article 1, Arizona Revised Statutes, is amended by adding sections 36-2212.01, 36‑2212.02 and 36‑2212.03, to read:
36-2212.01. Certificate of operation to operate an interfacility transfer ambulance service; fees; exceptions
A. A person may operate an interfacility transfer ambulance service by applying to the department on a form prescribed by the director for a certificate of operation.
B. The director shall issue a certificate of operation if all of the following apply:
1. The interfacility transfer ambulance service has a certificate of registration issued by the department for at least one ambulance pursuant to section 36‑2212.
2. The director finds that the applicant is fit and proper to provide the service.
3. The applicant has paid the appropriate fees pursuant to section 36‑2240.
4. The applicant has filed a surety bond pursuant to section 36‑2237.
C. A certificate of operation issued pursuant to subsection B of this section is limited to interfacility transfer ambulance services.
D. This section does not require a certificate of operation for:
1. Vehicles and persons that are exempt from a certificate of registration pursuant to section 36‑2217.
2. Ambulance services operating under temporary authority pursuant to section 36‑2242.
36-2212.02. Certificate of operation; initial term; renewal; denial; terms
A. The initial certificate of operation issued pursuant to section 36‑2212.01 to an interfacility transfer ambulance service is for a term of one year.
B. On the expiration of a certificate of operation, if the holder of the certificate meets all of the requirements of section 36‑2212.01, applies for a renewal and pays the fees prescribed in section 36‑2240, the director shall renew the certificate for a term of three years unless cause is shown to set a hearing to consider denying or renewing for a shorter term.
C. If the director does not act on the certificate of operation within ninety days before the certificate expires, the certificate is renewed for a period of at least one year. The term of the certificate of operation shall be extended to three years if the director determines that cause is not established for denying or renewing for a shorter term.
36-2212.03. Certificates of operation; nature of transfer
A. A certificate of operation issued pursuant to section 36‑2212.01 is not a franchise, may be revoked by the director and does not confer a property right on its holder.
B. A certificate of operation may not be assigned or otherwise transferred without the written approval of the director. If any certificate is assigned or transferred, the director shall issue to the assignee or transferee a new certificate that is valid only for the unexpired term of the transferred or assigned certificate.
Sec. 3. Section 36-2224, Arizona Revised Statutes, is amended to read:
36-2224. Interfacility transportation of patients; requirements; exemptions
A. An ambulance service that transports a patient from a hospital within its certificated area to a hospital outside the certificated area is only required to transport that patient under medical direction only to the nearest, most appropriate facility as defined by federal medicare guidelines for ambulance services.
B. This section shall does not apply to:
1. Any patient transport initiated or undertaken pursuant to the provisions of the federal emergency medical treatment and active labor act.
2. An interfacility transfer ambulance service with a certificate of operation issued pursuant to section 36‑2212.01.
Sec. 4. Section 36-2233, Arizona Revised Statutes, is amended to read:
36-2233. Certificate of necessity to operate an ambulance service; exceptions; service areas
A. Any person wishing to operate an ambulance service, except an interfacility transfer ambulance service, in this state shall apply to the department on a form prescribed by the director for a certificate of necessity.
B. The director shall issue a certificate of necessity if all of the following apply:
1. The ambulance service has a certificate of registration issued by the department for at least one ambulance pursuant to section 36‑2212.
2. The director finds that public necessity requires the service or any part of the service proposed by the applicant.
3. The director finds that the applicant is fit and proper to provide the service.
4. The applicant has paid the appropriate fees pursuant to section 36‑2240.
5. The applicant has filed a surety bond pursuant to section 36‑2237.
C. A certificate of necessity issued pursuant to subsection B of this section shall be for all or part of the service proposed by the applicant as determined necessary by the director for public convenience and necessity.
D. This section does not require a certificate of necessity for:
1. Vehicles and persons that are exempt from a certificate of registration pursuant to section 36‑2217.
2. Ambulance services operating under temporary authority pursuant to section 36‑2242.
E. The director may grant a service area by one or any combination of the following descriptions:
1. Metes and bounds.
2. A city, town or political subdivision not limited to a specific date. The merger or consolidation of two or more fire districts pursuant to section 48‑820 or 48‑822 does not expand the service area boundaries of an existing certificate of necessity.
3. A city, town or political subdivision as of a specific date that does not include annexation.
Sec. 5. Section 36-2237, Arizona Revised Statutes, is amended to read:
36-2237. Required insurance, financial responsibility or bond; revocation of certificate for failure to comply
A. The director shall not issue a certificate of necessity or certificate of operation to an ambulance service or interfacility transfer ambulance service unless the service has filed with the department a certificate of insurance or other evidence of financial responsibility in an amount the director deems necessary to adequately protect the interests of the public. The liability insurance shall bind the insurer to pay compensation for injuries to persons and for loss or damage to property resulting from the negligent operation of the ambulance service or interfacility transfer ambulance service.
B. If an application for a certificate of necessity includes any type of subscription service contract and, in the director's discretion, a surety bond is necessary pursuant to section 36‑2232, the director shall not issue a certificate of necessity until the applicant has filed a surety bond with the director in the form and amount determined by him the director on which bond the applicant is the principal obligor and this state is the obligee. The director shall approve the bond and the bond must be with a surety company authorized to transact business in this state as surety on the bond. The bond must be conditioned on the payment by the applicant to paying any subscribers that may be parties to any type of subscription service contract.
C. The director shall fix the total amount of the bond required and the director may increase or decrease the bond amount subject to criteria adopted by rule and regulation.
D. The director shall revoke the certificate of necessity of any ambulance service which or certificate of operation of any interfacility transfer ambulance service that fails to comply with this section.
Sec. 6. Section 36-2239, Arizona Revised Statutes, is amended to read:
36-2239. Ambulance services; interfacility transfer ambulance services; rates; charges; adjustment
A. An ambulance service or interfacility transfer ambulance service that applies for an adjustment in to adjust its rates or charges shall automatically be granted a rate increase equal to the amount determined under section 36‑2234, subsection E, if the ambulance service or interfacility transfer ambulance service is so entitled. An automatic rate adjustment that is granted pursuant to this subsection and that is filed on or before April 1 is effective June 1 of that year. The department shall notify the applicant and each health care services organization as defined in section 20‑1051 of the rate adjustment on or before May 1 of that year.
B. Notwithstanding subsection E of this section, if the department does not hold a hearing within ninety days after an ambulance service submits an application or interfacility transfer ambulance service applies to the department for an adjustment of to adjust its rates or charges, the ambulance service or interfacility transfer ambulance service may adjust its rates or charges to an amount not to exceed the amount sought by the ambulance service or interfacility transfer ambulance service in its application to the department. An ambulance service or interfacility transfer ambulance service shall not apply for an adjustment of to adjust its rates or charges more than once every six months.
C. At the time it the department holds a hearing on the rates or charges of an ambulance service or interfacility transfer ambulance service pursuant to section 36‑2234, the department may adjust the rates or charges adjusted by the ambulance service or interfacility transfer ambulance service pursuant to subsection B of this section, but the adjustment shall not be retroactive.
D. Except as provided in subsection H j of this section, an ambulance service or interfacility transfer ambulance service shall not charge, demand or collect any remuneration for any service greater or less than or different from the rate or charge determined and fixed by the department as the rate or charge for that service. An ambulance service or interfacility transfer ambulance service may charge for disposable supplies, medical supplies and medication and oxygen related costs if the charges do not exceed the manufacturer's suggested retail price, are uniform throughout the ambulance service's or interfacility transfer ambulance service's certificated area and are filed with the director. An ambulance service or interfacility transfer ambulance service shall not refund or limit in any manner or by any device any portion of the rates or charges for a service that the department has determined and fixed or ordered as the rate or charge for that service.
E. The department shall determine and render its decision regarding all rates or charges within ninety days after commencement of the applicant's hearing for an adjustment of to adjust rates or charges. If the department does not render its decision as required by this subsection, the ambulance service or interfacility transfer ambulance service may adjust its rates and charges to an amount that does not exceed the amounts sought by the ambulance service or interfacility transfer ambulance service in its application to the department. If the department renders a decision to adjust the rates or charges to an amount less than that requested in the application and the ambulance service or interfacility transfer ambulance service has made an adjustment to adjusted its rates and charges that is higher than the adjustment approved by the department, within thirty days after the department's decision the ambulance service or interfacility transfer ambulance service shall refund to the appropriate ratepayer the difference between the ambulance service's adjusted rates and charges and the rates and charges ordered by the department. The ambulance service or interfacility transfer ambulance service shall provide evidence to the department that the refund has been made. If the ambulance service or interfacility transfer ambulance service fails to comply with this subsection, the director may impose a civil penalty subject to the limitations limits provided in section 36‑2245.
F. An ambulance service shall charge the advanced life support base rate as prescribed by the director under any of the following circumstances:
1. A person requests an ambulance by dialing telephone number 911, or a similarly designated telephone number for emergency calls, and the ambulance service meets all of the following apply:
(a) The ambulance is staffed with at least one ambulance attendant.
(b) The ambulance is equipped with all required advanced life support medical equipment and supplies for the advanced life support attendants in the ambulance.
(c) The patient receives advanced life support services or is transported by the advanced life support unit.
2. Advanced life support is requested by a medical authority or by the patient.
3. The ambulance attendants administer one or more specialized treatment activities or procedures as prescribed by the department by rule.
G. An interfacility transfer ambulance service shall charge the advanced life support base rate as prescribed by the director under any of the following circumstances:
1. A hospital requests an ambulance from an interfacility transfer ambulance service and all of the following apply:
(a) The ambulance is staffed with at least one ambulance attendant.
(b) The ambulance is equipped with all required advanced life support medical equipment and supplies for the advanced life support attendants in the ambulance.
(c) The patient receives advanced life support services or is transported by the advanced life support unit.
2. Advanced life support is requested by a medical authority.
3. The ambulance attendants administer one or more specialized treatment activities or procedures as prescribed by the department by rule.
G. H. An ambulance service shall charge the basic life support base rate as prescribed by the director under any of the following circumstances:
1. A person requests an ambulance by dialing telephone number 911, or a similarly designated telephone number for emergency calls, and the ambulance service meets all of the following apply:
(a) The ambulance is staffed with two ambulance attendants certified by this state.
(b) The ambulance is equipped with all required basic life support medical equipment and supplies for the basic life support medical attendants in the ambulance.
(c) The patient receives basic life support services or is transported by the basic life support unit.
2. Basic life support transportation or service is requested by a medical authority or by the patient, unless any provision of subsection F of this section applies, in which case the advanced life support rate shall apply applies.
I. An interfacility transfer ambulance service shall charge the basic life support base rate as prescribed by the director under any of the following circumstances:
1. A hospital requests an ambulance from an interfacility transfer ambulance service and all of the following apply:
(a) The ambulance is staffed with two ambulance attendants certified by this state.
(b) The ambulance is equipped with all required basic life support medical equipment and supplies for the basic life support medical attendants in the ambulance.
(c) The patient receives basic life support services or is transported by the basic life support unit.
2. Basic life support transportation or service is requested by a medical authority or by the patient, unless any provision of subsection G of this section applies, in which case the advanced life support rate applies.
H. J. For each contract year, the Arizona health care cost containment system administration and its contractors and subcontractors shall provide remuneration for ambulance services for persons who are enrolled in or covered by the Arizona health care cost containment system in an amount equal to 68.59 percent of the amounts as prescribed by the department as of July 1 of each year for services specified in subsections F and G H of this section and 68.59 percent of the mileage charges as determined by the department as of July 1 of each year pursuant to section 36‑2232. The Arizona health care cost containment system administration shall make annual adjustments to the Arizona health care cost containment system fee schedule according to the department's approved ambulance service rate in effect as of July 1 of each year. The rate adjustments made pursuant to this subsection are effective beginning October 1 of each year.
I. K. In establishing rates and charges the director shall consider the following factors:
1. The transportation needs assessment of the medical response system in a political subdivision.
2. The medical care consumer price index of the United States department of labor, bureau of labor statistics.
3. Whether a review is made by a local emergency medical services coordinating system in regions where that system is designated as to the appropriateness of the proposed service level.
4. The rate of return on gross revenue.
5. Response times pursuant to section 36‑2232, subsection A, paragraph 2.
J. L. Notwithstanding section 36‑2234, an ambulance service may charge an amount for medical assessment, equipment or treatment that exceeds the requirements of section 36‑2205 if requested or required by a medical provider or patient.
K. M. Notwithstanding subsections D, F and G H of this section, an ambulance service may provide gratuitous services if an ambulance is dispatched and the patient subsequently declines to be treated or transported.
Sec. 7. Section 36-2240, Arizona Revised Statutes, is amended to read:
36-2240. Fees
Fees not to exceed the following amounts shall be paid by the owner of an ambulance service or interfacility transfer ambulance service to the department for deposit in the state general fund to be available for legislative appropriation in order to carry out the provisions of this chapter:
1. One hundred dollars upon filing an application $100 on applying for a certificate of necessity or certificate of operation.
2. Fifty dollars upon filing an application $50 on applying to amend, transfer or renew a certificate of necessity or certificate of operation.
3. For the issuance of To issue an initial certificate of necessity or certificate of operation, two hundred dollars $200 for each ambulance proposed to be operated by the ambulance service or interfacility transfer ambulance service to which the certificate is granted.
4. An annual regulatory fee of two hundred dollars $200 for each ambulance issued a certificate of registration pursuant to section 36‑2212, to be collected at the same time as the certificate of registration fee imposed by section 36‑2212.
Sec. 8. Section 36-2241, Arizona Revised Statutes, is amended to read:
36-2241. Required records; inspection by the department; rules
A. Pursuant to rules adopted by the director, an owner of an ambulance service or interfacility transfer ambulance service shall maintain and keep within this state reasonable records, books and other data the director requires to enforce the provisions of this article. These records, books and other data shall not be destroyed for a period of three years after they are recorded. The records, books and other data shall be open to inspection by the department during reasonable office hours if the department is conducting an investigation into the operation of an ambulance service or interfacility transfer ambulance service pursuant to section 36‑2245.
B. If the director is holding a public rate increase hearing pursuant to section 36‑2234, the department may inspect the records, books and other data to verify the truth and accuracy of these documents. The department shall conduct the inspection of inspect these documents for a rate increase hearing only during reasonable office hours and only after giving the ambulance service or interfacility transfer ambulance service at least one working day's notice.
C. If an audit is required, the department shall accept a certified audit that is performed by an independent auditor at the provider's ambulance service's or interfacility transfer ambulance service's expense in place of a department audit if the audit:
1. Is conducted in accordance with generally accepted auditing standards.
2. Includes findings regarding the ambulance service's compliance with the schedule of rates and charges approved by the director.
3. Is completed and forwarded to the department in a timely manner.
Sec. 9. Section 36-2245, Arizona Revised Statutes, is amended to read:
36-2245. Investigations; dispute resolution; informal interviews; hearings; stipulations; civil penalty; judicial review; confidentiality
A. The department may conduct an investigation into investigate the operation of ambulances, and ambulance services and interfacility transfer ambulance services.
B. Proceedings under this section may be initiated by the department.
C. If the department receives a written and signed statement of dissatisfaction or dispute of charges or any matter relating to the regulation of regulating ambulance services or interfacility transfer ambulance services, the customer is deemed to have filed an informal complaint against the ambulance service. Within fifteen days of receipt of after receiving the complaint, a designated representative of the department shall inform the ambulance service or interfacility transfer ambulance service that an informal complaint has been filed, state the nature of the allegations made, specify the purported rule violation and identify specific records relating to the purported rule violation that the ambulance service shall must provide to the department. The ambulance service or interfacility transfer ambulance service shall comply with the request for records in a timely manner.
D. Within forty‑five days of receipt of after receiving the records, the department shall determine if whether the complaint is nonsubstantive or substantive.
E. If the department determines that a complaint filed pursuant to this section is nonsubstantive, it shall render a written decision to all parties within five days of after that determination. The complainant may make a formal complaint to the department if the complainant disagrees with the department's decision. If the nonsubstantive complaint involves rates and charges, a designated representative of the department shall attempt to resolve the dispute by correspondence or telephone with the ambulance service or interfacility transfer ambulance service and the customer.
F. If the department determines that a complaint filed pursuant to this section is substantive, the complaint becomes a formal complaint. The department shall inform the ambulance service or interfacility transfer ambulance service that the initial investigation was substantive in nature and may warrant action pursuant to this article. The department shall inform the ambulance service or interfacility transfer ambulance service of the specific rule violation and shall allow the ambulance service thirty days to answer the complaint in writing.
G. The department may issue a written request for an informal interview with the ambulance service or interfacility transfer ambulance service if the department believes that the evidence indicates that grounds for action exist. The request shall state the reasons for the interview and shall schedule an interview at least ten days from after the date that the department sends the request for an interview.
H. If the department determines that evidence warrants action or if the ambulance service or interfacility transfer ambulance service refuses to attend the informal interview, the director shall institute formal proceedings and hold a hearing pursuant to title 41, chapter 6, article 10.
I. If the department believes that a lesser disciplinary action is appropriate, the department may enter into a stipulated agreement with the ambulance service or interfacility transfer ambulance service. This stipulation may include a civil penalty as provided under subsection J of this section.
J. In addition to other disciplinary action provided under this section, the director may impose a civil penalty of not more than three hundred fifty dollars $350 for each violation of this chapter that constitutes grounds to suspend or revoke a certificate of necessity. This penalty shall not exceed fifteen thousand dollars $15,000. Each day that a violation occurs constitutes a separate offense. The director shall deposit, pursuant to sections 35‑146 and 35‑147, all monies collected under this subsection in the emergency medical services operating fund established under by section 36‑2218.
K. The director may suspend a certificate of necessity or certificate of operation without holding a hearing if the director determines that the certificate holder has failed to pay a civil penalty imposed under this section. The director shall reinstate the certificate of necessity or certificate of operation when the certificate holder pays the penalty in full.
L. Except as provided in section 41‑1092.08, subsection H, a final decision of the department pursuant to this section is subject to judicial review pursuant to title 12, chapter 7, article 6.
M. Information, documents and records received by the department or prepared by the department in connection with an investigation that is conducted pursuant to this article and that relates to emergency medical care technicians are confidential and are not subject to public inspection or civil discovery. When the investigation has been completed and the investigation file has been closed, the results of the investigation and the decision of the department shall be available to the public.
