1. The department may declare a licensee a distressed ambulance service if the licensee: a. Failed to respond to the department in accordance with section 23-27.2-04; b. Failed to make sufficient progress to address the circumstances described in the notice; c. Failed to take corrective action in accordance with the approved response; d. Indicated an intention to cease operation or change licensure level within sixty days; or e. Indicated a substantial likelihood of failure to respond to requests for service.

2. The department shall provide notice of the declaration by first-class mail to the recipients under subsection 2 of section 23-27.2-03. The notice must include the department's basis for the declaration.