Arizona repealed its CON program—but it now has a “certificate of necessity” program that applies only to ground ambulances. For this reason, some have deemed Arizona a “quasi-CON” state. Despite the fact that Arizona maintains only one certificate of necessity requirement, the application process is the longest in the nation, lasting 450 days. Ariz. Admin. Code § R9-25-1201(A), Tbl. 12.1. During the 450-day application process, every existing ground ambulance service provider in the affected region must be notified and given the opportunity to object to the application. See Ariz. Rev. Stat. § 36-2234.
As of May 15, 2020, Arizona had not suspended its certificate of necessity requirement in response to COVID-19.
In Arizona, the certificate of necessity application process takes 450 days. Ariz. Admin. Code § R9-25-1201(A), Tbl. 12.1. Applications can be submitted at any time. The filing fee is $100 for the application and an additional $200 per ambulance. Ariz. Rev. Stat. § 36-2240(1), (3). Competitors can intervene in the application process and can offer evidence or argument as to why an application should be denied. Ariz. Rev. Stat. §§ 36-2234(B); 41-1092.03 et seq.
|CON?||Number of CONs||Moratoria||Temporary COVID-19 response:|
|Beds Outside Hospitals||No||–||–||–|
|Emergency Medical Transport||Yes||1||–||No action|
CON laws also create barriers for existing providers who simply wish to continue or expand their services.
In addition to creating barriers to entry for new providers, CON laws also create barriers for existing providers who simply wish to continue or expand their services. In Arizona, an initial certificate of necessity is only valid for 12 months. Ariz. Rev. Stat. § 36-2235(A). After that, an operator must renew its certificate by showing that it continues to meet all certificate of necessity requirements. Ariz. Rev. Stat. § 36-2235(B). A renewal certificate is valid for three years.
Existing certificate holders in Arizona are also required to ask permission for adjustments in service, such as changing their service area or adding a new service. See Ariz. Admin. Code § R9-25-905 (A). For example, in 2018, an ambulance service that provided advanced life support services applied to amend its certificate of necessity to add basic life support services. Even though the application was from an existing provider and contained 38 pages of documentation, including a letter of support from a competing ambulance service, it still took over a year of consideration before the expansion was approved.
Arizona Certificates in Detail
|Category||Types of Certificate||Ariz. Rev. Stat.|
|Hospital Beds||No CONs in this category.|
|Beds Outside Hospitals||No CONs in this category.|
|Equipment||No CONs in this category.|
|Facilities/Buildings||No CONs in this category.|
|Services||No CONs in this category.|
|Emergency Medical Transport||1.Ground ambulance.||§ 36-2233(B)|
Arizona Certificate Exceptions
No Certificate Required For:
Ariz. Rev. Stat.
1.Vehicles used for the emergency transportation of persons injured at industrial site.
2.Persons engaged in and vehicles used for air transportation of sick or injured people in a noncritical or nonemergency situation.
3.Medical evacuation equipment used and owned by Department of Public Safety.
4.Vehicles provided or contracted for emergency medical services by a political subdivision if vehicles primarily used for scene stabilization.
5.Ambulances from other states responding to an emergency in Arizona or transporting a patient to a location within this state.
7.Ambulances operating under temporary authority.
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