HB2402 - Ambulance services; certificates of necessity

House Engrossed ambulance services; certificates of necessity State of Arizona House of Representatives Fifty-seventh Legislature Second Regular Session 2026 HOUSE BILL 2402 AN ACT Amending sections 36-2208 and 36-2217, Arizona Revised Statutes; amending title 36, chapter 21.1, article 1, Arizona Revised Statutes, by adding section 36-2220.01; Amending sections 36-2232, 36-2233, 36-2234, 36-2235 and 36-2236, 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 36-2208, Arizona Revised Statutes, is amended to read: START_STATUTE 36-2208. Bureau of emergency medical services and trauma system; annual statewide plan; regional plans A. There is established within the department a The bureau of emergency medical services and trauma system that is responsible for coordinating, establishing and administering established in the department to coordinate, establish and administer a statewide system of emergency medical services, trauma care and a trauma registry. B. This chapter does not prevent any individual, law enforcement officer, public agency or member of a city, town, fire district or volunteer fire department from rendering on-site emergency medical care or, if, in terms of the existing medical situation, it is deemed not advisable to await the arrival of an ambulance, from transporting emergency medical patients to a hospital or an emergency receiving facility, except that if any patient objects on religious grounds, that patient shall not be administered any medical treatment or be transported to a hospital or an emergency receiving facility. C. The director shall develop an annual statewide emergency medical and trauma services plan and submit that plan to the council for review and approval. The statewide plan shall then be submitted to the governor for final adoption. Before submitting the plan to the governor, the director shall accept comments from the authorized local agencies and governmental entities. D. A Each local emergency medical services coordinating system shall develop a regional emergency medical services plan that includes a needs assessment and shall submit the plan to the director , the speaker of the house of representatives, the president of the senate and to the authorized local agencies within the area. The department shall integrate the regional plans shall be integrated into the statewide plan by the department . E. The state statewide plan shall contain a budget component for funding local and state emergency medical services systems from the emergency medical services operating fund established pursuant to by section 36-2218 based on the needs assessment of the local emergency medical services coordinating system plans. The components shall be included in the department's budget through the normal appropriation process. END_STATUTE Sec. 2. Section 36-2217, Arizona Revised Statutes, is amended to read: START_STATUTE 36-2217. Exemption from regulation A. This chapter does not apply to: 1. Vehicles used for the emergency transportation of persons injured at an industrial site. 2. Persons engaged in and vehicles used for air transportation of sick or injured people in a noncritical or nonemergency situation as determined by a physician. 3. Medical evacuation equipment used and owned by the department of public safety in air, ground or water evacuation , and including fixed wing aircraft, helicopters, ground ambulances and similar ground conveyances, snowmobiles and water traversing equipment. 4. Vehicles provided or contracted for emergency medical services by a political subdivision if these vehicles are primarily used to provide on the scene stabilization of sick, injured, wounded, incapacitated or helpless persons. 5. Ambulances from other states that are: (a) Responding to a major catastrophe or emergency in this state because there are insufficient registered ambulances in this state to respond in that situation. (b) Either operating either from a location outside of this state to transport a patient to a location within this state or operating from a location outside of this state and crossing through this state to transport a patient to a location outside this state. 6. Registered ambulances from this state that are responding to a major catastrophe, natural disaster or wildland fire event in this state because there are insufficient registered ambulances in the area affected by the major catastrophe, natural disaster or wildland fire event. 6. 7. Stretcher vans that meet the requirements of section 36-2223. B. Except as provided in subsection A, paragraph 5, subdivision (a) of this section, an ambulance from another state shall not pick up a patient in this state and transport that patient to another location in this state unless that ambulance is registered under this chapter. END_STATUTE Sec. 3. Title 36, chapter 21.1, article 1, Arizona Revised Statutes, is amended by adding section 36-2220.01, to read: START_STATUTE 36-2220.01. Ambulance services; information on calls; public availability; civil penalty; definition A. each ambulance service shall provide the following information on a quarterly basis to the department in a department-approved format, as applicable: 1. The emergency medical dispatch classification for each call for service or interfacility transport. 2. For each Call for service for which an ambulance is dispatched, the following information, as applicable: ( a ) The dispatch time. ( b ) The staging time. ( c ) The canceled time. ( d ) The on-scene time. ( e ) The en route time. ( f ) The hospital arrival time. ( g ) The hospital release time. 3. If an ambulance service provider made a request for assistance to another ambulance service provider, the date and time of any instance in which an ambulance service declined to provide mutual aid to another certificate of necessity holder and an explanation why the request for assistance was declined. 4. the details of substantiated complaints received from an individual or health care institution as prescribed in rule by the department. 5. The details of any medication error that results in patient injury or patient death. 6. Any unintended injury or harm to a patient that occurred WHILE providing prehospital care. B. The department shall make the information received pursuant to subsection A of this section available to the public on request, except that the department shall redact any personally identifying information. The department shall post the information received pursuant to subsection a of this section, as redacted, on the department's public website. C. If an ambulance service fails to comply with the quarterly reporting requirements of this section, the department shall issue a notice to comply to the ambulance service within thirty calendar days AFTER the end of the quarter. The ambulance has fifteen calendar days after receiving the notice to comply with the quarterly reporting requirements of this section. If the ambulance service continues to fail to comply with the quarterly reporting requirements of this section, the director may impose a civil penalty of not more than $500. D. For the purposes of this section, "emergency medical dispatch classification" means the standardized system used by emergency medical dispatchers to evaluate and categorize emergency medical calls based on the nature and severity of the incident. END_STATUTE Sec. 4. Section 36-2232, Arizona Revised Statutes, is amended to read: START_STATUTE 36-2232. Director; powers and duties; regulation of ambulance services; inspections; response time compliance; mileage rate calculation factors; online portal and dashboard 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. Consistent with the requirements of subsection H of this section, 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 shall inform all ambulance services of the procedures and methodology used to determine ambulance rates or charges. 2. Ensure that evidence-based quality patient care is the priority for decision-making. 3. Regulate operating and response times of ambulances to meet the needs of the public and to ensure adequate service. The rules adopted by the director for certificated ambulance service response times shall include uniform standards for urban, suburban, rural and wilderness geographic areas within the certificate of necessity based on, at a minimum, population density and geographic and medical considerations. The calculation of response times shall begin when the public safety answering point contacts an ambulance service for dispatch and conclude when the ambulance service arrives at the dispatched location. On-scene arrival times for response time measurement shall be documented by the ambulance service using dispatch or global positioning system data, or a combination of both, and kept on file. Response time data that is compliant with the health insurance portability and accountability act of 1996 shall be filed annually with the department. When dispatch or global positioning system connectivity is not available, the ambulance service shall manually document on-scene arrival times for response time measurement. The response time data shall be filed in a department-approved format, and the department shall make the response time data publicly available. 4. Review response times established pursuant to paragraph 3 of this subsection with the ambulance service and update the response times based on, at a minimum, population density and geographic and medical considerations, and the financial impact on rates and charges, every six years. One additional review each six-year period may be requested by a city, town, fire district or fire authority whose jurisdictional boundaries in whole or in part are within the service area of a certificate of necessity or an existing certificate of necessity holder within the service area of the certificate of necessity. 5. Determine, fix, alter and regulate bases of operation. The director may issue a certificate of necessity 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. 6. Issue, amend, transfer, suspend or revoke certificates of necessity under terms consistent with this article. 7. 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. 8. 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. 9. Regulate ambulance services in all matters affecting services to the public to the end that this article may be fully carried out. 10. Prescribe bonding requirements, if any, for ambulance services that are granted authority to provide any type of subscription service. 11. Offer technical assistance to ambulance services to ensure compliance with the rules. 12. Offer technical assistance to ambulance services in order to obtain or to amend a certificate of necessity. 13. Inspect, at a maximum of 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 to protect all subscription service contract holders in this state who that are covered under that subscription contract. C. An Each 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. 5. Beginning January 1, 2024, Install and maintain an electronic global positioning system monitoring device in each vehicle that is used for transport to record on-scene arrival times for response time measurement. The department shall may provide a waiver on a department-approved form to an ambulance service that can reasonably demonstrate it is unable to meet the requirements of this paragraph because at least thirty percent of the service area does not have global positioning system coverage . A waiver issued pursuant to this paragraph expires on April 1 of each year and may be renewed annually. 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. 2. Conduct on-site inspections of facilities, communications equipment, vehicles, procedures, materials and equipment. 3. Review the qualifications of ambulance attendants. E. If all ambulance services that have been granted authority to operate within the same service area or that have overlapping certificates of necessity apply for uniform rates and charges, the director may establish uniform rates and charges for the service area. F. In consultation with the medical director of the bureau of 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 ambu [Text truncated for display. Full text available on LegiScan.]