1. A. The Department may periodically assess whether the following parameters, as associated with a certificate of necessity, are appropriate to ensure quality patient care:

   1. 1. Response times, consistent with A.R.S. §§ 36-2232(A)(4) and 36-2236(E);
   2. 2. The priority to be assigned by a certificate holder to a response;
   3. 3. The percentage of time that the actual response time for a run is compliant with the response times for the certificate of necessity during a 12-month period;
   4. 4. If applicable, 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; and
   5. 5. If applicable, the percentage of time that the certificate holder is compliant with the standards in the plan in subsection (A)(4) during a 12-month period.

2. B. In determining response times, the priority to be assigned by a certificate holder to a response, and the percentage of time the actual response time for a run is compliant with the proposed response times during a 12-month period for all or part of a service area or proposed service area, the Director may consider the following:

   1. 1. Differences in scene locality, if applicable;
   2. 2. The response times and compliance percentages of other ground ambulance services in similar scene localities, as determined by historical response time data;
   3. 3. The population density and demographics in the service area or proposed service area;
   4. 4. The geographic features and environmental conditions within the service area or proposed service area;
   5. 5. The geographic distribution of health care institutions within and surrounding the service area or proposed service area to which and from which the ground ambulance service would be transporting patients;
   6. 6. Requirements of a 9-1-1 or similar dispatch system for all or part of the service area;
   7. 7. Requirements in a contract approved by the Department between a ground ambulance service and a political subdivision or health care institution;

   8. 8. Whether the certificate holder provides interfacility transports of patients with a time-critical condition and, if so:

      1. a. The geographic distribution of health care institutions in the service area, and
      2. b. The anticipated volumes of 9-1-1 dispatches and of interfacility transports;
   9. 9. The basis for prioritization for the dispatch of a ground ambulance vehicle or an emergency medical services provider;
   10. 10. Information from a political subdivision, a health care institution, an elected official, or another interested party, as described in A.R.S. § 36-2233(D), in the service area that was received by the Department about the request; and
   11. 11. Other information submitted according to R9-25-902(A)(2) and (14) or R9-25-905(B), as applicable; and
   12. 12. Other matters determined by the Director to be relevant to a determination of response times and compliance percentage, for each scene locality and priority that will be assigned by the applicant to a response.

3. C. The Department may:

   1. 1. Develop a set of uniform standards for response times based on historical response time data:

      1. a. By using the scene locality of a service area or proposed service area, and
      2. b. Considering the response time for 90 percent of runs;
   2. 2. Compare the actual performance of a ground ambulance service to the applicable uniform standard developed according to subsection (C)(1);
   3. 3. Establish response times based on the applicable uniform standard and the factors specified in subsection (B); and
   4. 4. Take enforcement action, if appropriate, against a certificate holder based on response-time performance compared with the uniform standard, taking into consideration the factors in subsection (B).

4. D. In determining compliance with the standards in the plan in subsection (A)(4) during a 12-month period, the Director may consider the following:

   1. 1. The information submitted according to R9-25-902(A)(2) and (14) or R9-25-905(B), as applicable;
   2. 2. The geographic distribution of health care institutions in the service area and the anticipated volumes of interfacility transports and 9-1-1 dispatches;
   3. 3. Requirements in a contract approved by the Department between a ground ambulance service and health care institution;
   4. 4. The basis for prioritization for the dispatch of a ground ambulance vehicle according to procedures established by the certificate holder’s medical direction authority;
   5. 5. Information from a political subdivision, a health care institution, an elected official, or another interested party, as described in A.R.S. § 36-2233(D), in the service area that was received by the Department about the request; and
   6. 6. Other matters determined by the Director to be relevant to a determination of compliance with the standards in the plan in subsection (A)(4).

Historical Note

New Section adopted by final rulemaking at 7 A.A.R. 1098, effective February 13, 2001 (Supp. 01-1). Section R9-25-907 repealed; new Section R9-25-907 renumbered from R9-25-906 and amended by final rulemaking at 30 A.A.R. 581 (March 29, 2024), with an immediate effective date of March 7, 2024 (Supp. 24-1).