Arizona

Arizona repealed its CON program—but it now has a “certificate of necessity” program that applies only to ground ambulances.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. During the 180-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. 

Arizona’s COVID-19 Response  

As of May 15, 2020, Arizona had not suspended its certificate of necessity requirement in response to COVID-19.   

Application Process  

In Arizona, the certificate of necessity application process takes 180 days. Ariz. Rev. Stat. § 36-2233(B); Ariz. Admin. Code § R9-25-1201(A), Tbl. 12.1. Applications can be submitted at any time. The filing fee is $100 for the initial application, $50 for the annual renewal, and an additional $200 per ambulance at the time of the application or renewal. 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.  

Type of Certificates in Arizona 

	Certificate of Necessity	Certificate required for expenditure of:	Temporary  COVID-19 response:
Hospital Beds	No	–	–
Beds Outside Hospitals	No	–	–
Equipment	No	–	–
Facilities/Buildings	No	–	–
Services	No	–	–
Emergency Medical Transport	Yes	Any amount	–

 
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	Ground ambulance.	§ 36-2233

Arizona Certificate Exceptions 

No Certificate Required For:	Ariz. Rev. Stat.
Vehicles used for the emergency transportation of persons injured at an industrial site.	§ 36-2217(A)(1)
Persons engaged in and vehicles used for air transportation of sick or injured people in a noncritical or nonemergency situation.	§ 36-2217(A)(2)
Medical evacuation equipment used and owned by Department of Public Safety.	§ 36-2217(A)(3)
Vehicles provided or contracted for emergency medical services by a political subdivision if vehicles primarily used for scene stabilization.	§ 36-2217(A)(4)
Ambulances from other states responding to an emergency in Arizona or transporting a patient to a location within the state.	§ 36-2217(A)(5)
Stretcher vans.	§§ 36-2217(A)(6), -2223
Ambulances operating under temporary authority.	§§ 36-2233(D)(2), -2242

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.