Bill Text: AZ SB1606 | 2025 | Fifty-seventh Legislature 1st Regular | Introduced
Bill Title: Interfacility transport; hospitals
Spectrum: Slight Partisan Bill (Republican 2-1)
Status: (Introduced) 2025-02-11 - Senate read second time [SB1606 Detail]
Download: Arizona-2025-SB1606-Introduced.html
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REFERENCE TITLE: interfacility transport; hospitals |
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State of Arizona Senate Fifty-seventh Legislature First Regular Session 2025
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SB 1606 |
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Introduced by Senators Fernandez: Kavanagh; Representative Biasiucci
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An Act
amending sections 36-2201 and 36-2233, 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 36-2201, Arizona Revised Statutes, is amended to read:
36-2201. Definitions
In this chapter, unless the context otherwise requires:
1. "Administrative medical direction" means supervision of emergency medical care technicians by a base hospital medical director, administrative medical director or basic life support medical director. For the purposes of this paragraph, "administrative medical director" means a physician who is licensed pursuant to title 32, chapter 13 or 17 and who provides direction within the emergency medical services and trauma system.
2. "Advanced emergency medical technician" means a person who has been trained in an advanced emergency medical technician program certified by the director or in an equivalent training program and who is certified by the director to render services pursuant to section 36-2205.
3. "Advanced life support" means the level of assessment and care identified in the scope of practice approved by the director for the advanced emergency medical technician, emergency medical technician I-99 and paramedic.
4. "Advanced life support base hospital" means a health care institution that offers general medical and surgical services, that is certified by the director as an advanced life support base hospital and that is affiliated by written agreement with a licensed ambulance service, municipal rescue service, fire department, fire district or health services district for medical direction, evaluation and control of emergency medical care technicians.
5. "Ambulance":
(a) Means any publicly or privately owned surface, water or air vehicle, including a helicopter, that contains a stretcher and necessary medical equipment and supplies pursuant to section 36-2202 and that is especially designed and constructed or modified and equipped to be used, maintained or operated primarily to transport individuals who are sick, injured or wounded or who require medical monitoring or aid.
(b) Does not include a surface vehicle that is owned and operated by a private sole proprietor, partnership, private corporation or municipal corporation for the emergency transportation and in-transit care of its employees or a vehicle that is operated to accommodate an incapacitated person or person with a disability who does not require medical monitoring, care or treatment during transport and that is not advertised as having medical equipment and supplies or ambulance attendants.
6. "Ambulance attendant" means any of the following:
(a) An emergency medical technician, an advanced emergency medical technician, an emergency medical technician I-99 or a paramedic whose primary responsibility is the care of patients in an ambulance and who meets the standards and criteria adopted pursuant to section 36-2204.
(b) An emergency medical responder who is employed by an ambulance service operating under section 36-2202 and whose primary responsibility is driving an ambulance.
(c) A physician who is licensed pursuant to title 32, chapter 13 or 17.
(d) A professional nurse who is licensed pursuant to title 32, chapter 15 and who meets the state board of nursing criteria to care for patients in the prehospital care system.
(e) A professional nurse who is licensed pursuant to title 32, chapter 15 and whose primary responsibility is the care of patients in an ambulance during an interfacility transport.
7. "Ambulance service" means a person who owns and operates one or more ambulances.
8. "Basic life support" means the level of assessment and care identified in the scope of practice approved by the director for the emergency medical responder and emergency medical technician.
9. "Bureau" means the bureau of emergency medical services and trauma system in the department.
10. "Centralized medical direction communications center" means a facility that is housed within a hospital, medical center or trauma center or a freestanding communication center that meets the following criteria:
(a) Has the ability to communicate with ambulance services and emergency medical services providers rendering patient care outside of the hospital setting via radio and telephone.
(b) Is staffed twenty-four hours a day seven days a week by at least a physician licensed pursuant to title 32, chapter 13 or 17.
11. "Certificate of necessity" means a certificate that is issued to an ambulance service by the department and that describes the following:
(a) The service area.
(b) The level of service.
(c) The type of service.
(d) The hours of operation.
(e) The effective date.
(f) The expiration date.
(g) The legal name and address of the ambulance service.
(h) The any limiting or special provisions the director prescribes.
12. "Council" means the emergency medical services council.
13. "Department" means the department of health services.
14. "Director" means the director of the department of health services.
15. "Direct owner" means a person that has an ownership or control interest in a hospital totaling fifty-one percent or more.
15. 16. "Emergency medical care technician" means an individual who has been certified by the department as an emergency medical technician, an advanced emergency medical technician, an emergency medical technician I-99 or a paramedic.
16. 17. "Emergency medical responder" as an ambulance attendant, whose primary responsibility is driving an ambulance, means a person who has successfully completed training in an emergency medical responder program that is certified by the director or is approved by the emergency medical services provider's administrative medical director on file with the department or in an equivalent training program.
17. 18. "Emergency medical responder program" means a program that has been submitted for review by the department and includes at least the following:
(a) Emergency vehicle driver training.
(b) Cardiopulmonary resuscitation certification.
(c) Automated external defibrillator training.
(d) Training in the use of noninvasive diagnostic devices, including blood glucose monitors and pulse oximeters.
(e) Training on obtaining a patient's vital signs, including blood pressure, pulse and respiratory rate.
18. 19. "Emergency medical services" means those services required following an accident or an emergency medical situation:
(a) For on-site emergency medical care.
(b) To transport the sick or injured by a licensed ground or air ambulance.
(c) In using emergency communications media.
(d) In using emergency receiving facilities.
(e) In administering initial care and preliminary treatment procedures by emergency medical care technicians.
19. 20. "Emergency medical services provider" means any governmental entity, quasi-governmental entity or corporation whether public or private that renders emergency medical services in this state.
20. 21. "Emergency medical technician" means a person who has been trained in an emergency medical technician program certified by the director or in an equivalent training program and who is certified by the director as qualified to render services pursuant to section 36-2205.
21. 22. "Emergency receiving facility" means a licensed health care institution that offers emergency medical services, is staffed twenty-four hours a day and has a physician on call.
22. 23. "Fit and proper" means that the director determines that an applicant for a certificate of necessity, a hospital providing interfacility transport or a certificate holder has the expertise, integrity, fiscal competence and resources to provide ambulance service in the service area.
24. "Hospital" means a class of health care institution as defined in section 36-401 that, through an organized medical staff, provides inpatient beds, medical services, continuous nursing services and diagnoses or treatment, or both, to a patient.
25. "Indirect owner":
(a) means a person that has an ownership or control interest in a direct owner totaling fifty-one percent or more.
(b) Includes an ownership or control interest in an indirect owner totaling fifty-one percent or more and a combination of direct ownership and indirect ownership or control interests totaling fifty-one percent or more in the hospital.
26. "Interfacility transport" means an ambulance transport of a patient from one health care institution to another health care institution as defined in section 36-401.
23. 27. "Medical record" means any patient record, including clinical records, prehospital care records, medical reports, laboratory reports and statements, any file, film, record or report or oral statements relating to diagnostic findings, treatment or outcome of patients, whether written, electronic or recorded, and any information from which a patient or the patient's family might be identified.
24. 28. "National certification organization" means a national organization that tests and certifies the ability of an emergency medical care technician and whose tests are based on national education standards.
25. 29. "National education standards" means the emergency medical services education standards of the United States department of transportation or other similar emergency medical services education standards developed by that department or its successor agency.
26. 30. "Paramedic" means a person who has been trained in a paramedic program certified by the director or in an equivalent training program and who is certified by the director to render services pursuant to section 36-2205.
27. 31. "Physician" means any person licensed pursuant to title 32, chapter 13 or 17.
28. 32. "Police dog":
(a) Means a specially trained dog that is owned or used by a law enforcement department or agency of this state or any political subdivision of this state and that is used in the course of the department's or agency's official work.
(b) Includes a search and rescue dog, service dog, accelerant detection canine or other dog that is in use by the law enforcement department or agency for official duties.
29. 33. "Stretcher van" means a vehicle that contains a stretcher and that is operated to accommodate an incapacitated person or person with a disability who does not require medical monitoring, aid, care or treatment during transport.
30. 34. "Suboperation station" means a physical facility or location at which an ambulance service conducts operations for the dispatch of ambulances and personnel and that may be staffed twenty-four hours a day or less as determined by system use.
31. 35. "Trauma center" means any acute care hospital that provides in-house twenty-four-hour daily dedicated trauma surgical services that is designated pursuant to section 36-2225.
32. 36. "Trauma registry" means data collected by the department on trauma patients and on the incidence, causes, severity, outcomes and operation of a trauma system and its components.
33. 37. "Trauma system" means an integrated and organized arrangement of health care resources having the specific capability to perform triage, transport and provide care.
34. 38. "Validated testing procedure" means a testing procedure that includes practical skills, or attests practical skills proficiency on a form developed by the department by the educational training program, identified pursuant to section 36-2204, paragraph 2, that is certified as valid by an organization capable of determining testing procedure and testing content validity and that is recommended by the medical direction commission and the emergency medical services council before the director's approval.
35. 39. "Wheelchair van" means a vehicle that contains or that is designed and constructed or modified to contain a wheelchair and that is operated to accommodate an incapacitated person or person with a disability who does not require medical monitoring, aid, care or treatment during transport.
Sec. 2. Section 36-2233, Arizona Revised Statutes, is amended to read:
36-2233. Certificate of necessity to operate an ambulance service; notification of interested parties; exceptions; service areas
A. Any person wishing to operate an ambulance service in this state shall apply to the department on a form prescribed by the director for a certificate of necessity.
B. Within one hundred eighty days after receiving an application for a certificate of necessity as prescribed in this section, the director shall make a determination based on whether necessity for the ambulance service is found to exist and the applicant meets the requirements of subsection F of this section. If the director requests additional information from the applicant after initial review, the applicant shall have thirty business days to respond. On request, the director may give the applicant one additional period of thirty business days to respond. If the applicant fails to respond to the director's request for additional information, the department shall deem the initial or amended application withdrawn. An application deemed withdrawn is not an appealable agency action pursuant to title 41, chapter 6, article 10. The applicant may appeal a denial only pursuant to section 36-2234. The one hundred eighty-day period for the director to make the determination of necessity does not include the time the applicant uses to respond to requests for additional information.
C. On receipt of an initial or amended application for a certificate of necessity, the department shall post a notice of the application on its website. Within thirty days after the department posts a notice pursuant to this subsection, any interested party may provide information to the director on a form in a department-approved format for consideration. If an interested party fails to respond to the notice within sixty days in a department-approved format, the information may not be considered during the review of the application.
D. For the purposes of this section, a city, town, fire district, fire authority or tribal government whose jurisdictional boundaries in whole or in part are within the service area of a certificate of necessity, an existing certificate of necessity holder within the service area of the certificate of necessity or a hospital that is licensed pursuant to chapter 4 of this title and that is located within the service area of a certificate of necessity is considered to be an interested party as a matter of law.
E. All interested parties shall be notified of any application for an initial or amended certificate of necessity within fifteen days after the application is filed, within fifteen days after the application is complete and within fifteen days after a decision by the director. The director's decision pursuant to subsection F of this section is final unless appealed pursuant to section 36-2234, subsection A.
F. The director shall issue a certificate of necessity if all of the following apply:
1. The director finds that public necessity requires the service or any part of the service proposed by the applicant.
2. The director finds that the applicant is fit and proper to provide the service.
3. The applicant has paid the appropriate fees pursuant to section 36-2240.
4. The applicant has filed a surety bond pursuant to section 36-2237.
G. A certificate of necessity issued pursuant to subsection F of this section shall be for all or part of the service proposed by the applicant as determined necessary by the director for public convenience and necessity.
H. This section does not require a certificate of necessity for:
1. Vehicles and persons that are exempt from a certificate of registration pursuant to section 36-2217.
2. Ambulance services operating under temporary authority pursuant to section 36-2242.
3. in a county with a population of less than one million persons, Ambulance services owned or operated by a direct owner or indirect owner of a hospital for interfacility transports. All rules adopted by the department pursuant to this chapter relating to interfacility transportation apply to a direct owner or indirect owner of a hospital that operates an ambulance service for interfacility transport.
I. The director may grant a service area by one or any combination of the following descriptions:
1. Metes and bounds.
2. A city, town or political subdivision not limited to a specific date. The merger or consolidation of two or more fire districts pursuant to section 48-820 or 48-822 does not expand the service area boundaries of an existing certificate of necessity.
3. A city, town or political subdivision as of a specific date that does not include annexation.
