Bill Text: AZ HB2823 | 2020 | Fifty-fourth Legislature 2nd Regular | Introduced


Bill Title: Ambulance service; interfacility transfers

Spectrum: Moderate Partisan Bill (Republican 7-1)

Status: (Introduced - Dead) 2020-03-05 - House Committee of the Whole action: Retained on the Calendar [HB2823 Detail]

Download: Arizona-2020-HB2823-Introduced.html

 

 

 

REFERENCE TITLE: ambulance service; interfacility transfers

 

 

 

 

State of Arizona

House of Representatives

Fifty-fourth Legislature

Second Regular Session

2020

 

 

 

HB 2823

 

Introduced by

Representatives Weninger: Barto, Carroll, Cobb, Grantham, Meza, Petersen, Senator Fann

 

 

AN ACT

 

Amending sections 36‑2201, 36‑2232 and 36‑2233, Arizona Revised Statutes; amending title 36, chapter 21.1, article 2, Arizona Revised Statutes, by adding section 36‑2233.01; amending section 36‑2234, Arizona Revised Statutes; amending title 36, chapter 21.1, article 2, Arizona Revised Statutes, by adding section 36‑2235.01; amending sections 36‑2236, 36‑2237, 36‑2240, 36‑2245 and 36‑2247, 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:

START_STATUTE36-2201.  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)  The service area.

(b)  The level of service.

(c)  The type of service.

(d)  The hours of operation.

(e)  The effective date.

(f)  The expiration date.

(g)  The legal name and address of the ambulance service.

(h)  Any limiting or special provisions the director prescribes.

12.  "Certificate of operation" means a certificate that is issued to an ambulance service by the department for interfacility transfers and that describes all of the following:

(a)  The service area that is a county with a population of more than three million persons.

(b)  The level of service.

(c)  The hours of operation.

(d)  The effective date.

(e)  The expiration date.

(f)  The legal name and address of the ambulance service.

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 holder has the expertise, integrity, fiscal competence and resources to provide ambulance service in the service area.

23.  "Hospital system" means a hospital and other health care entities under a single ownership structure that includes affiliated health care partners that are connected through common ownership or control.

24.  "Interfacility transfer" means a non‑911 interfacility ground transportation of a patient from a health care institution within the sponsoring hospital system to another health care institution by an ambulance service that is used exclusively for this purpose and that operates under a certificate of operation.

22.  25.  "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.  26.  "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.  27.  "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.  28.  "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.  29.  "Physician" means any person licensed pursuant to title 32, chapter 13 or 17.

30.  "Sponsoring hospital system" means a hospital system that has an agreement with an ambulance service operating pursuant to a certificate of operation to provide interfacility transfers for that hospital system.

27.  31.  "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.  32.  "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.  33.  "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.  34.  "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.  35.  "Trauma system" means an integrated and organized arrangement of health care resources having the specific capability to perform triage, transport and provide care.

32.  36.  "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.  37.  "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. END_STATUTE

Sec. 2.  Section 36-2232, Arizona Revised Statutes, is amended to read:

START_STATUTE36-2232.  Director; powers and duties; regulation of ambulance services; inspections; response time compliance

A.  The director shall adopt rules to regulate the operation of ambulances and ambulance services in this state.  Each rule shall identify all sections and subsections of this chapter under which the rule was formulated.  The rules shall provide for the department to do the following:

1.  Determine, fix, alter and regulate just, reasonable and sufficient rates and charges for the provision of ambulances, including rates and charges for advanced life support service, basic life support service, patient loaded mileage, standby waiting, subscription service contracts and other contracts for services related to the provision of ambulances.  The director may establish a rate and charge structure as defined by federal medicare guidelines for ambulance services.  The director shall inform all ambulance services of the procedures and methodology used to determine ambulance rates or charges.

2.  Regulate operating and response times of ambulances to meet or exceed the needs of the public or the sponsoring hospital system and to ensure adequate service.  The rules adopted by the director for certificated ambulance service response times shall include:

(a)  For a certificated ambulance service operating pursuant to a certificate of necessity, uniform standards for urban, suburban, rural and wilderness geographic areas within the certificate of necessity based on, at a minimum, population density, geographic and medical considerations.

(b)  For a certificated ambulance service operating pursuant to a certificate of operation, uniform standards for its service area and medical considerations.

3.  Determine, fix, alter and regulate bases of operation.  The director may issue a certificate of necessity or certificate of operation to more than one ambulance service within any base of operation.  For the purposes of this paragraph, "base of operation" means a service area granted under a certificate of necessity or a certificate of operation.

4.  Issue, amend, transfer, suspend or revoke certificates of necessity or certificates of operation under terms consistent with this article.

5.  Prescribe a uniform system of accounts to be used by ambulance services that conforms to standard accounting forms and principles for the ambulance industry and generally accepted accounting principles.

6.  Require the filing of an annual financial report and other data. These rules shall require an ambulance service to file the report with the department not later than one hundred eighty days after the completion of its annual accounting period.

7.  Regulate ambulance services in all matters affecting services to the public to the end that this article may be fully carried out.

8.  Prescribe bonding requirements, if any, for ambulance services granted authority to provide any type of subscription service.

9.  Offer technical assistance to ambulance services to maximize a healthy and viable business climate for the provision of ambulances.

10.  Offer technical assistance to ambulance services in order to obtain or to amend a certificate of necessity or certificate of operation.

11.  Inspect, at a maximum of twelve month twelve-month intervals, each ambulance registered pursuant to section 36‑2212 to ensure that the vehicle is operational and safe and that all required medical equipment is operational. At the request of the provider, the inspection may be performed by a facility approved by the director.  If a provider requests that the inspection be performed by a facility approved by the director, the provider shall pay the cost of the inspection.

B.  The director may require any ambulance service offering subscription service contracts to obtain a bond in an amount determined by the director that is based on the number of subscription service contract holders and to file the bond with the director for the protection of to protect all subscription service contract holders in this state who are covered under that subscription contract.

C.  An ambulance service shall:

1.  Maintain, establish, add, move or delete suboperation stations within its base of operation to ensure that the ambulance service meets the established response times or those approved by the director in a political subdivision contract.

2.  Determine the operating hours of its suboperation stations to provide for coverage of its base of operation.

3.  Provide the department with a list of suboperation station locations.

4.  Notify the department not later than thirty days after the ambulance service makes a change in the number or location of its suboperation stations.

D.  At any time, the director or the director's agents may:

1.  Inquire into the operation of an ambulance service, including a person operating an ambulance that has not been issued a certificate of registration or a person who does not have or is operating outside of a certificate of necessity or certificate of operation.

2.  Conduct on‑site inspections of facilities, communications equipment, vehicles, procedures, materials and equipment.

3.  Review the qualifications of ambulance attendants.

4.  Inquire into the compliance of certification by the commission on accreditation of ambulance services.

E.  If all ambulance services that have been granted authority to operate within the same service area or that have overlapping certificates of necessity and certificate of operation apply for uniform rates and charges, the director may establish uniform rates and charges for the service area.  The department shall grant requests from an ambulance service to be part of the Phoenix uniform rate group.

F.  In consultation with the medical director of the emergency medical services and trauma system, the emergency medical services council and the medical direction commission, the director of the department of health services shall establish protocols for ambulance services to refer and advise a patient or transport a patient by the most appropriate means to the most appropriate provider of medical services based on the patient's condition.  The protocols shall include triage and treatment protocols that allow all classifications of emergency medical care technicians responding to a person who has accessed 911, or a similar public dispatch number, for a condition that does not pose an immediate threat to life or limb to refer and advise a patient or transport a patient to the most appropriate health care institution as defined in section 36‑401 based on the patient's condition, taking into consideration factors including patient choice, the patient's health care provider, specialized health care facilities and local protocols.

G.  The director, when reviewing an ambulance service's response time compliance with its certificate of necessity or certificate of operation, shall consider in addition to other factors the effect of hospital diversion, delayed emergency department admission and the number of ambulances engaged in response or transport in the affected area. END_STATUTE

Sec. 3.  Section 36-2233, Arizona Revised Statutes, is amended to read:

START_STATUTE36-2233.  Certificate of necessity to operate an ambulance service; exceptions; service areas

A.  Except as provided in subsection F of this section, any person wishing to operate an 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.

F.  This section does not apply to A person wishing to operate interfacility transfers under a certificate of operation issued pursuant to section 36‑2233.01. END_STATUTE

Sec. 4.  Title 36, chapter 21.1, article 2, Arizona Revised Statutes, is amended by adding section 36-2233.01, to read:

START_STATUTE36-2233.01.  Certificate of operation to provide interfacility transfers; requirements; definition

A.  Any person wishing to operate an ambulance service in this state to provide interfacility transfers shall apply 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 the applicant meets all of the following:

1.  Owns and operates an ambulance service and is providing interfacility transports at the location where the applicant's ambulance company is accredited by the commission on accreditation of ambulance services for the same level of service in another state.

2.  Has obtained a hospital system sponsorship.

3.  Contracts with a third‑party vendor to capture and report performance data to the department as prescribed pursuant to section 36‑2232, subsection A, paragraph 2, subdivision (b).

4.  Has paid the appropriate fees pursuant to section 36‑2240.

5.  Has filed a surety bond pursuant to section 36‑2237.

C.  An applicant that has been awarded a certificate of operation shall apply for a certification of registration pursuant to section 36‑2212.

D.  this section does not apply to any person that has been issued and holds a valid certificate of necessity pursuant to section 36‑2233 that authorizes interfacility transport.

E.  For the purposes of this section, "sponsorship" means an agreement between a hospital system and the applicant for a certificate of operation to provide interfacility transfers. END_STATUTE

Sec. 5.  Section 36-2234, Arizona Revised Statutes, is amended to read:

START_STATUTE36-2234.  Hearings; waiver of hearing; emergency action; judicial review; definition

A.  The director shall require a public hearing on any proposed action related to rates, fares or charges, operating or response times, bases of operation or certificates of necessity unless subsection C, E, or M of this section applies.  Public hearings and judicial review under this section do not apply to certificates of operation.

B.  A public hearing held pursuant to subsection A of this section shall meet the following requirements:

1.  The hearing shall be held pursuant to title 41, chapter 6, article 10.

2.  The director shall mail notice of the hearing to every ambulance service in the affected region no not later than fifteen days before the hearing.

3.  The director may mail notice to other persons who the director determines are interested in the hearing.

4.  In a hearing or rehearing conducted pursuant to this article, an ambulance service may be represented by a corporate officer, an employee or a designee who has been specifically authorized by the ambulance service to represent it.

5.  A certificate of necessity hearing may not last more than ten days unless the administrative law judge determines, in writing, on the final day of the hearing that there is an extraordinary need for additional hearing days.

C.  The director may waive the hearing required under subsection A of this section if notification, including a general description of the proposed action of the department and the time and manner for any interested person to request a hearing, is given and all of the following apply:

1.  Notification of the proposed action has been sent to every ambulance service in the affected region no not later than fifteen days before the action.

2.  The director has notified other persons who the director determines are interested in the proposed action no not later than fifteen days before the action.

3.  The director has published notice of the proposed action in a newspaper of general circulation in the affected region at least once each week for two consecutive weeks before the action is taken.

4.  The director has received no requests within the fifteen‑day notification period for a hearing to be held on the proposed action.

D.  If the director receives a request pursuant to subsection C, paragraph 4 of this section, the director shall hold a hearing in compliance with subsection B of this section.

E.  The director shall not hold a hearing if a person requests a hearing regarding a rate increase that does not exceed the amount computed as follows:

1.  Determine the percentage growth in the transportation consumer price index of the United States department of labor, bureau of labor statistics, from the end of the second preceding calendar year to the calendar year immediately preceding the calendar year for which the rate increase is requested.

2.  Determine the percentage growth in the medical care consumer price index of the United States department of labor, bureau of labor statistics, from the end of the second preceding calendar year to the calendar year immediately preceding the calendar year for which the rate increase is requested.

3.  Add the amount determined in paragraph 1 of this subsection to the amount determined in paragraph 2 of this subsection and divide the sum by two.

F.  A rate increase authorized pursuant to subsection E of this section is deemed to be fixed by the department at the requested level.  Notwithstanding subsection C of this section, the department shall hold a hearing pursuant to section 36‑2232, subsection E for any proposed uniform rate or charge that exceeds the annual rate increase prescribed in subsection E of this section.  The department shall require the applicants to submit the following information signed by the designated financial officer and the chief executive of the ambulance service who has fiduciary responsibility for providing accurate financial information:

1.  A financial statement for the previous twenty‑four months relating to the certificated areas.

2.  Any additional information the department requires to analyze the request.

G.  If an ambulance service with an established general public rate applies for a contract rate or range of rates that is up to thirty percent less than its established rate, the director shall grant the rate without a public hearing or waiver, and without any right of intervention, unless within ninety days of after the filing of a completed application the director determines that the contract rate or range of rates applied for does not accurately reflect the cost and economics of providing the contract services, would adversely affect the service available to the general public in the area of service as designated by its certificate of necessity or certificate of operation or would cause any fixed rate, fare or charge to the general public to be adversely affected.

H.  If the department disallows a proposed contract rate pursuant to subsection G of this section, the ambulance service has a right to a hearing for review of the proposed contract rate or range of rates.

I.  The director may adopt rules for the establishment of a contract rate or range of rates that may be implemented and that exceeds the thirty percent rate variance identified pursuant to subsection G of this section.

J.  Subsections G, H and I of this section are limited to contract rates or a range of rates applied for prescheduled, interfacility or convalescent transports.

K.  A service contract between an ambulance service and a political subdivision of this state, including local fire districts, shall be filed with and approved by the department in accordance with the following requirements:

1.  On receipt of the proposed contract, the department has fifteen days to review the contract and notify the ambulance service of any additional information the department requires, recommended corrections or any provision that does or may violate this article.

2.  The ambulance service has fifteen days to provide the department with the information requested or to submit a revised or amended contract if required under paragraph 1 of this subsection.

3.  The contract becomes effective fifteen days after the ambulance service complies with the department's request unless the department determines that any rate or charge or other provisions specified in the contract will cause any fixed rate or charge to the general public rate to be adversely affected or the contract would be in violation of the ambulance service's certificate of necessity.

4.  If the department disallows a proposed contract pursuant to this subsection, the ambulance service has a right to a hearing for review of the proposed contract.

5.  The rates and charges contained in the contract are the rates and charges fixed by the director in a decision or order for the ambulance service and conform to the ambulance service's current or subsequent general public rates and charges.

6.  The area of response is within the ambulance service's certificated area.

L.  In case of emergency, the director may take action providing for immediate suspension of a certificate of registration, or a certificate of necessity or a certificate of operation, or both any combination thereof, under this section without notice or a hearing if the director determines that a potential threat to the public health and safety exists.  If such an action is taken by the director, the director shall conduct a hearing within ten days after the date of the director's action unless the person against whom the action is directed waives the right to have a hearing held within ten days.  If the ten‑day hearing requirement is waived, the director shall set a date mutually agreeable to the interested parties. The purpose of the hearing is to review the decision of the director to take such an action.  The director shall make findings of fact and may continue, suspend or modify the director's action.

M.  The director shall waive the hearing required under subsection A of this section if geographical changes in suboperation stations do not alter the service area or adversely affect approved response times.

N.  Except as provided in section 41‑1092.08, subsection H, a final decision of the director is subject to judicial review pursuant to title 12, chapter 7, article 6.

O.  For the purposes of this section, "hearing day":

1.  Means any portion of a business day that is used for any hearing‑related activity, including testimony, argument or presentation of evidence.

2.  Does not include prehearing conferences or other administrative matters that occur before the start of the hearing. END_STATUTE

Sec. 6.  Title 36, chapter 21.1, article 2, Arizona Revised Statutes, is amended by adding section 36-2235.01, to read:

START_STATUTE36-2235.01.  Certificate of operation; initial term; renewal; terms; effect of sponsorship termination

A.  The initial certificate of operation issued pursuant to section 36‑2233.01 to an ambulance service shall be for a term of three years. 

B. After one year, the director may evaluate the performance of the certificate holder.  If performance is determined to be substandard, the certificate holder shall implement an improvement plan that complies with requirements set by the director.

C.  Before the expiration of the initial or any subsequent certificate of operation, the certificate holder must demonstrate accreditation in this state by the commission on accreditation of ambulance services.  If the certificate holder meets all requirements, applies for a renewal and pays the fees prescribed in section 36‑2240, the director shall renew the certificate of operation for a term of three years.

D.  If the director does not act on the certificate of operation within ninety days after the expiration date of the certificate of operation, the certificate of operation shall be 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.

E.  Notwithstanding any other provision of this section, if the hospital system sponsorship is terminated, the certificate of operation is void. END_STATUTE

Sec. 7.  Section 36-2236, Arizona Revised Statutes, is amended to read:

START_STATUTE36-2236.  Nature of certificates of necessity and certificate of operation; transfer; suspension; service area

A.  A certificate of necessity or certificate of operation issued pursuant to this article is not a franchise, may be revoked by the director and does not confer a property right on its holder.

B.  A certificate of necessity or certificate of operation shall not be assigned or otherwise transferred without the written approval of the director.  When any certificate is assigned or transferred, the director shall issue to the assignee or transferee a new certificate valid only for the unexpired term of the transferred or assigned certificate.

C.  In case of emergency, the director may suspend a certificate of necessity or certificate of operation as provided in section 36‑2234.

D.  If a certificate of necessity issued pursuant to this article includes any city, town or other political subdivision of this state, the service area shall be all the geographical area lying within the city, town, or political subdivision, unless the certificate issued by the director specifically excludes a portion of the city, town, or political subdivision.  This subsection does not affect the validity of any previously granted certificate of necessity for an unincorporated area lying within the boundaries of a city. END_STATUTE

Sec. 8.  Section 36-2237, Arizona Revised Statutes, is amended to read:

START_STATUTE36-2237.  Required insurance, financial responsibility or bond; revocation for failure to comply

A.  The director shall not issue a certificate of necessity or certificate of operation to an 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.

B.  If an application for a certificate of necessity or certificate of operation 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 or certificate of operation of any ambulance service which that fails to comply with this section. END_STATUTE

Sec. 9.  Section 36-2240, Arizona Revised Statutes, is amended to read:

START_STATUTE36-2240.  Fees

Fees not to exceed the following amounts shall be paid by the owner of an 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 $100 on filing an application for a certificate of necessity or certificate of operation.

2.  Fifty dollars upon $50 on filing an application 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 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. END_STATUTE

Sec. 10.  Section 36-2245, Arizona Revised Statutes, is amended to read:

START_STATUTE36-2245.  Investigations; dispute resolution; informal interviews; hearings; stipulations; judicial review; civil penalty; confidentially

A.  The department may conduct an investigation into investigate the operation of ambulances and 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 pertaining to patient care, wait time for interfacility transfers or dispute of charges or any matter relating to the regulation of ambulance services, the customer, patient, hospital system or health care provider 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 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 provide to the department.  The 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 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 that the initial investigation was substantive in nature and may warrant action pursuant to this article.  The department shall inform the 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 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 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.  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 or certificate of operation.  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. END_STATUTE

Sec. 11.  Section 36-2247, Arizona Revised Statutes, is amended to read:

START_STATUTE36-2247.  Certificates of necessity; certificates of operation; ambulance services; name change

At least thirty days before the date an ambulance service changes its legal name, the ambulance service shall send the department written notice of the name change.  Within thirty days after the date of receiving the notice, the department shall issue an amended certificate of necessity or certificate of operation that incorporates the name change but retains the expiration date of the current certificate of necessity or certificate of operation. END_STATUTE

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