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Chapter 0051 - 572R - H Ver of HB2179
House Engrossed
air ambulance
services
State of Arizona
House of Representatives
Fifty-seventh Legislature
Second Regular Session
2026
CHAPTER 51
HOUSE BILL 2179
AN
ACT
Amending sections 12-516, 13-2929,
32-1471, 36-661, 36-2201, 36-2202, 36-2203, 36-2204,
36-2204.02 and 36-2209, Arizona Revised Statutes; amending section 36-2212,
Arizona Revised Statutes, as amended by laws 2025, chapter 212, section 1;
repealing section 36-2212, Arizona Revised Statutes, as amended by laws 2025,
chapter 212, section 2; amending sections 36-2213, 36-2215, 36-2216,
36-2217, 36-2226.02, 36-2230, 36-2232, 36-2239,
36-2245, 36-2264, 36-2907, 36-2989, 41-1831 and 41-2407,
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 12-516, Arizona Revised
Statutes, is amended to read:
START_STATUTE
12-516.
Emergency declaration for a public health pandemic; health
professionals; health care institutions; immunity; burden of proof;
presumption; applicability; definitions
A. If the governor declares a state of emergency for
a public health pandemic pursuant to title 26, chapter 2, a health professional
or health care institution that acts in good faith is not liable for damages in
any civil action for an injury or death that is alleged to be caused by the
health professional's or health care institution's action or omission while
providing health care services in support of this state's response to the state
of emergency declared by the governor unless it is proven by clear and
convincing evidence that the health professional or health care institution
failed to act or acted and the failure to act or action was due to that health
professional's or health care institution's wilful misconduct or gross
negligence.�
B. Subsection A of this section applies to any
action or omission that is alleged to have occurred during a person's
screening, assessment, diagnosis or treatment and that is related to the public
health pandemic that is the subject of the state of emergency or any action or
omission that occurs in the course of providing a person with health care
services and that is unrelated to the public health pandemic that is the
subject of the state of emergency if the health professional's or health care
institution's action or omission was in good faith support of this state's
response to the state of emergency, including any of the following:
1. Delaying or canceling a procedure that the health
professional determined in good faith was a nonurgent or elective dental,
medical or surgical procedure.
2. Providing nursing care or procedures.
3. Altering a person's diagnosis or treatment in
response to an order, directive or guideline that is issued by the federal
government, this state or a local government.
4. An act or omission undertaken by a health
professional or health care institution because of a lack of staffing,
facilities, equipment, supplies or other resources that
are
is
attributable to the state of emergency and that
render
renders
the health professional or
health care institution unable to provide the level or manner of care to a
person that otherwise would have been required in the absence of the state of
emergency.
C. A health professional or health care institution
is presumed to have acted in good faith if the health professional or health
care institution relied on and reasonably attempted to comply with applicable
published guidance relating to the public health pandemic that was issued by a
federal or state agency.� This subsection does not prohibit a party from
introducing any other evidence that proves the health professional or health
care institution acted in good faith.
D. In the case of a claim against a nursing care
institution or residential care institution
, where
in which
the care in question did not directly relate to the
public health pandemic, the burden is on the facility to prove that the act or
omission was a direct result of having to provide care to patients needing
treatment for the pandemic or due to limitations in equipment, supplies or
staff caused by the pandemic.
E. This section applies to all claims that are filed
before or after September 29, 2021 for an act or omission by a person that
occurred on or after March 11, 2020 and that relates to a public health
pandemic that is the subject of the state of emergency declared by the
governor.
F. This section does not apply to any claim that is
subject to title 23, chapter 6.
G. For the purposes of this section:
1. "Health care institution" has the same
meaning prescribed in section 36-401 and includes an ambulance service as
defined in section 36-2201.
2. "Health professional":
(
a
)
Has
the same meaning prescribed in section 32-3201
.
and
(
b
)
Includes
an
air ambulance attendant and
ambulance attendant as
defined in section 36-2201.
END_STATUTE
Sec. 2. Section 13-2929, Arizona Revised
Statutes, is amended to read:
START_STATUTE
13-2929.
Unlawful transporting, moving, concealing, harboring or shielding
of unlawful aliens; vehicle impoundment; exception; classification
A. It is unlawful for a person who is in violation
of a criminal offense to:
1. Transport or move or attempt to transport or move
an alien in this state, in furtherance of the illegal presence of the alien in
the United States, in a means of transportation if the person knows or
recklessly disregards the fact that the alien has come to, has entered or
remains in the United States in violation of law.
2. Conceal, harbor or shield or attempt to conceal,
harbor or shield an alien from detection in any place in this state, including
any building or any means of transportation, if the person knows or recklessly
disregards the fact that the alien has come to, has entered or remains in the
United States in violation of law.
3. Encourage or induce an alien to come to or reside
in this state if the person knows or recklessly disregards the fact that such
coming to, entering or residing in this state is or will be in violation of
law.
B. A means of transportation that is used in the
commission of a violation of this section is subject to mandatory vehicle
immobilization or impoundment pursuant to section 28-3511.
C. A law enforcement official or agency of this
state or a county, city, town or other political subdivision of this state may
not consider race, color or national origin in the enforcement of this section
except to the extent permitted by the United States
CONSTITUTION
or Arizona Constitution.
D. In the enforcement of this section, an alien's
immigration status may be determined by:
1. A law enforcement officer who is authorized by
the federal government to verify or ascertain an alien's immigration status.
2. The United States immigration and customs
enforcement or the United States customs and border protection pursuant to 8
United States Code section 1373(c).
E. This section does not apply to a child safety
worker acting in the worker's official capacity or a person who is acting in
the capacity of a first responder, an ambulance attendant
, an
air ambulance attendant
or an emergency medical technician and who is
transporting or moving an alien in this state pursuant to title 36, chapter
21.1.
F. A person who violates this section is guilty of a
class 1 misdemeanor and is subject to a fine of at least
one
thousand dollars
$1,000
, except that a violation
of this section that involves ten or more illegal aliens is a class 6 felony
and the person is subject to a fine of at least
one thousand
dollars
$1,000
for each alien who is involved.
END_STATUTE
Sec. 3. Section 32-1471, Arizona Revised
Statutes, is amended to read:
START_STATUTE
32-1471.
Health care providers; other persons; emergency aid; nonliability
Any health care provider
who is
licensed
or certified to practice as such in this state or elsewhere,
or
a licensed ambulance attendant,
air ambulance attendant,
driver or
ambulance
pilot as defined in section 41-1831
,
or any other person who renders emergency care at a
public gathering or at the scene of an emergency occurrence gratuitously and in
good faith
shall
IS
not
be
liable for any civil or other damages as the result of any
act or omission by
such
the
person
rendering the emergency care, or as the result of any act or failure to act to
provide or arrange for further medical treatment or care for the injured
persons, unless
such
the
person,
while rendering such emergency care, is guilty of gross negligence.
END_STATUTE
Sec. 4. Section 36-661, Arizona Revised
Statutes, is amended to read:
START_STATUTE
36-661.
Definitions
In this article, unless the context otherwise requires:
1. "Acquired immune deficiency syndrome"
has the same meaning as defined by the centers for disease control of the
United States public health service.
2. "Capacity to consent" means a person's
ability, determined without regard to the person's age, to understand and
appreciate the nature and consequences of a proposed health care service,
treatment or procedure and to make an informed decision concerning that
service, treatment or procedure.
3. "Child" means an unemancipated person
who is
under eighteen years of age.
4. "Communicable disease" means a
contagious, epidemic or infectious disease
that is
required
to be reported to the local board of health or the department pursuant to
chapter 1 of this title and this chapter.
5. "Communicable disease related
information" means information regarding a communicable disease
that is
in the possession of a person who provides health
services or who obtains the information pursuant to the release of communicable
disease related information.
6. "Contact" means a spouse or sex partner
of a protected person, a person who has shared hypodermic needles or syringes
with a protected person or a person
who is
otherwise
exposed to a protected person with a communicable disease in a manner that
poses an epidemiologically significant risk of transmission of that disease.
7. "Department" means the department
of health services
.
8. "Director" means the director of the
department of health services.
9. "First responder" means a law
enforcement officer, a firefighter
, an air ambulance attendant
as defined in section 36-2201
or an ambulance attendant as defined in
section 36-2201.
10. "Good Samaritan" means a person who
renders emergency care or assistance in good faith and without compensation at
the scene of any accident, fire or other life-threatening emergency and
who believes that a significant exposure risk occurred while the person
rendered care or assistance.
11. "Health care decision maker" has the
same meaning prescribed in section 12-2801.
12. "Health care provider" means a
physician, nurse or other person involved in providing health services.
13. "Health facility" means a health care
institution as defined in section 36-401, a blood bank, blood center,
milk bank, sperm bank, organ or tissue bank or clinical laboratory or a health
care services organization holding a certificate of authority pursuant to
section 20-1054.
14. "Health service" means public or
private care, treatment, clinical laboratory tests, counseling or educational
service for adults or children and acute, chronic, custodial, residential,
outpatient, home or other health care or activities related to
the
detection
detecting
, reporting,
prevention
preventing
and
control of
controlling
communicable or preventable diseases.
15. "HIV" means the human immunodeficiency
virus.
16. "HIV infection" means infection with
the human immunodeficiency virus or a related virus identified as a probable
causative agent of acquired immune deficiency syndrome.
17. "HIV-related illness" means an
illness that may result from or be associated with HIV infection.
18. "HIV-related information" means
information concerning whether a person has had an HIV-related test or
has
an
HIV infection,
an
HIV-related
illness or acquired immune deficiency syndrome and includes information that
identifies or reasonably
permits
allows
identification
of that person or the person's contacts.
19. "HIV-related test" means a
laboratory test or series of tests for the virus, components of the virus or
antibodies to the virus thought to indicate the presence of HIV infection.
20. "Occupational significant exposure
risk" means a significant exposure risk that occurs in the performance of
a health care provider's professional duties or a first responder's official
duties.
21. "Protected person" means a person who
takes an HIV-related test or who has been diagnosed as having
an
HIV infection, acquired immune deficiency syndrome,
an
HIV-related illness or another communicable disease.
22. "Significant exposure risk" means
contact with another person in a manner that, if the other person has a
communicable disease, poses an epidemiologically significant risk of
transmission of that disease as determined by the department.
END_STATUTE
Sec. 5. Section 36-2201, Arizona Revised
Statutes, is amended to read:
START_STATUTE
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,
air 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. "Air ambulance" means
any publicly or privately owned aircraft that is certificated under 14 Code of
Federal Regulations part 135, that contains a stretcher and necessary medical
equipment and supplies pursuant to section 36-2202 and that is
specifically 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.
6. "Air ambulance
attendant" means any of the following:
(
a
) A paramedic
whose primary responsibility is caring for patients in an air ambulance and who
meets the standards and criteria adopted pursuant to section 36-2204.
(
b
)
A respiratory therapist who is licensed pursuant to title 32, chapter
35.
(
c
)
A physician.
(
d
)
A professional nurse who is licensed pursuant to title 32, chapter 15
and whose primary responsibility is caring for patients in an air ambulance.
(
e
) A nurse
practitioner who is licensed pursuant to title 32, chapter 15.
7. "Air ambulance service"
means a person or organization that owns and operates one or more air
ambulances or that leases from an air carrier the use of one or more air
ambulances that are certificated under 14 Code of Federal Regulations part 135
for the purpose of providing emergency medical services in air ambulances.
5.
8.
"Ambulance":
(a) Means any publicly or privately owned surface
,
or
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
specifically
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.
9.
"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
arizona
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.
10.
"Ambulance
service" means a person who owns and operates one or more ambulances.
8.
11.
"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.
12.
"Bureau"
means the bureau of emergency medical services and trauma system in the
department.
10.
13.
"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.
14.
"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.
15.
"Council"
means the emergency medical services council.
13.
16.
"Department"
means the department of health services.
14.
17.
"Director"
means the director of the department
of health services
.
15.
18.
"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.
19.
"Emergency
medical responder" as an ambulance attendant whose primary responsibility
is driving an ambulance,
or an air ambulance attendant,
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.
20.
"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.
21.
"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
ambulance
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.
22.
"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.
23.
"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.
24.
"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.
25.
"Epinephrine
delivery system" means a single-use device or product that contains
a premeasured dose of epinephrine and that is approved by the United States
food and drug administration to prevent or treat a life-threatening allergic
reaction.
23.
26.
"Fit
and proper" means that the director determines that an applicant for a
certificate of necessity or a certificate holder has the expertise, integrity,
fiscal competence and resources to provide ambulance service in the service area.
24.
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.
25.
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.
26.
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.
27.
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.
28.
31.
"Physician" means any person
who is
licensed pursuant to title 32, chapter 13 or 17.
29.
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.
30.
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.
31.
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.
32.
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.
33.
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.
34.
37.
"Trauma
system" means an integrated and organized arrangement of health care
resources having the specific capability to perform triage, transport and
provide care.
35.
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.
36.
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.
END_STATUTE
Sec. 6. Section 36-2202, Arizona Revised
Statutes, is amended to read:
START_STATUTE
36-2202.
Duties of the director; qualifications of medical director
A. The director shall:
1. Appoint a medical director of the emergency
medical services and trauma system.
2. Adopt standards and criteria for the denial or
granting of certification and recertification of emergency medical care
technicians.� These standards shall allow the department to certify qualified
emergency medical care technicians who have completed statewide standardized
training required under section 36-2204, paragraph 1 and a standardized
certification test required under section 36-2204, paragraph 2, who hold
valid certification with a national certification organization or who have
completed training and testing by the United States armed forces at a level
comparable to the national standards for emergency medical care
technicians. Before the director may consider approving a statewide
standardized training or a standardized certification test, or both, each of
these must first be recommended by the medical direction commission and the
emergency medical services council to ensure that the standardized training
content is consistent with national education standards and that the standardized
certification test examines comparable material to that examined in the tests
of a national certification organization.
3. Adopt standards and criteria that pertain to the
quality of emergency care pursuant to section 36-2204.
4. Adopt rules necessary to carry out this
chapter. Each rule shall identify all sections and subsections of
this chapter under which the rule was formulated.
5. Adopt reasonable medical equipment, supply,
staffing and safety standards, criteria and procedures to issue a certificate
of registration to operate an ambulance
or air ambulance
.
6. Maintain a state system for recertifying emergency
medical care technicians, except as otherwise provided by section 36-2202.01,
that is independent from any national certification organization
recertification process. This system shall allow emergency medical
care technicians to choose to be recertified under the state or the national
certification organization recertification system subject to subsection H of
this section.
B. Emergency medical technicians who choose the
state recertification process shall recertify in one of the following ways:
1. Successfully completing an emergency medical
technician refresher course approved by the department.
2. Successfully completing an emergency medical
technician challenge course approved by the department.
3. For emergency medical care technicians who are
currently certified at the emergency medical technician level by the
department, attesting on a form provided by the department that the applicant
holds a valid and current cardiopulmonary resuscitation certification, has and
will maintain documented proof of a minimum of twenty-four hours of
continuing medical education within the last two years consistent with
department rules and has functioned in the capacity of an emergency medical
technician for at least two hundred forty hours during the last two years.
C. After consultation with the emergency medical
services council, the director may authorize pilot programs designed to improve
the safety and efficiency of ambulance
and air ambulance
inspections
for governmental or quasi-governmental entities that provide emergency
medical services in this state.
D. The rules, standards and criteria adopted by the
director pursuant to subsection A, paragraphs 2, 3, 4 and 5 of this section
shall be adopted in accordance with title 41, chapter 6, except that the
director may adopt on an emergency basis pursuant to section 41-1026
rules relating to the regulation of ambulance services
and air
ambulance services
in this state necessary to protect the public peace,
health and safety in advance of adopting rules, standards and criteria as
otherwise provided by this subsection.
E. The director may waive the requirement for
compliance with a protocol adopted pursuant to section 36-2205 if the
director determines that the techniques, drug formularies or training makes the
protocol inconsistent with contemporary medical practices.
F. The director may suspend a protocol adopted
pursuant to section 36-2205 if the director does all of the
following:
1. Determines that the rule is not in the public's
best interest.
2. Initiates procedures pursuant to title 41,
chapter 6 to repeal the rule.
3. Notifies all interested parties in writing of the
director's action and the reasons for that action. Parties
interested in receiving notification shall submit a written request to the
director.
G. To be eligible for appointment as the medical
director of the emergency medical services and trauma system, the person shall
be qualified in emergency medicine and shall be licensed as a physician in one
of the states of the United States.
H. Applicants for certification shall apply to the
director for certification. Emergency medical care technicians shall
apply for recertification to the director every two years. The
director may extend the expiration date of an emergency medical care
technician's certificate for thirty days. The department shall
establish a fee for this extension by rule. Emergency medical care
technicians shall pass an examination administered by the department as a
condition for recertification only if required to do so by the advanced life
support base hospital's medical director or the emergency medical care
technician's medical director.
I. The medical director of the emergency medical
services and trauma system is exempt from title 41, chapter 4, articles 5 and 6
and is entitled to receive compensation pursuant to section 38-611,
subsection A.
J. The standards, criteria and procedures adopted by
the director pursuant to subsection A, paragraph 5 of this section shall
require that ambulance services
and air ambulances services
:
1. Providing interfacility transportation
, by an ambulance,
in any certificate of necessity area of this
state have one ambulance attendant as defined in section 36-2201,
paragraph
6
9
, subdivision
(a), (c), (d) or (e) and one ambulance attendant as defined in section 36-2201,
paragraph
6
9
, subdivision
(a), (b), (c), (d), or (e) staffing an ambulance while transporting a patient.�
If an ambulance attendant as defined in section 36-2201, paragraph
6
9
, subdivision (b) is staffing the
ambulance pursuant to this paragraph, that ambulance attendant may exclusively
drive the ambulance.
2. Providing interfacility
transportation, by an air ambulance, have one air ambulance attendant as
defined in section 36-2201, paragraph 6, subdivision (
c
), (
d
) or (
e
) and one air
ambulance attendant as defined in section 36-2201, paragraph 6,
subdivision (
a
), (
b
) or (
d
) staffing an air ambulance while transporting a patient.
2.
3.
Serving
a rural or wilderness certificate of necessity area with a population of less
than ten thousand persons have at least one ambulance attendant as defined in
section 36-2201, paragraph
6
9
,
subdivision (a), (c), (d) or (e) and one ambulance attendant as defined in
section 36-2201, paragraph
6
9
,
subdivision (a) or (b) staffing an ambulance while transporting a patient.
3.
4.
Serving
a population of ten thousand persons or more have at least one ambulance
attendant as defined in section 36-2201, paragraph
6
9
, subdivision (a) and one ambulance attendant as defined in
section 36-2201, paragraph
6
9
,
subdivision (a), (c), (d) or (e) staffing an ambulance while transporting a
patient.
K. If the department determines there is not a
qualified administrative medical director, the department shall ensure the
provision of administrative medical direction for an emergency medical
technician if the emergency medical technician meets all of the following
criteria:
1. Is employed by a nonprofit or governmental
provider employing less than twelve full-time emergency medical
technicians.
2. Stipulates to the inability to secure a physician
who is willing to provide administrative medical direction.
3. Stipulates that the provider agency does not
provide administrative medical direction for its employees.
END_STATUTE
Sec. 7. Section 36-2203, Arizona Revised
Statutes, is amended to read:
START_STATUTE
36-2203.
Emergency medical services council; membership; delayed repeal
A. The emergency medical services council is
established. The medical director of the emergency medical services
and trauma system shall chair the council. The council is composed
of the director of the department of public safety and the governor's highway
safety coordinator, or their designees, and the following members who are
appointed by the governor to three-year terms:
1. One representative from each of the four local
emergency medical services coordinating systems prescribed in section 36-2210.
2. One physician specializing in emergency medicine
from each of the four local emergency medical services coordinating regions
prescribed in section 36-2210.
3. One professional nurse who is licensed pursuant
to title 32, chapter 15 and who specializes in emergency medicine.
4. One emergency medical care technician.
5. Two representatives from ambulance service
corporations
or air ambulance service corporations
.
6. Two hospital administrators, one of whom
represents a county with a population of less than five hundred thousand
persons.
7. One representative from each of the three
employers of the largest number of emergency medical care technicians and
paramedics.
8. One representative from a nongovernmental
employer of emergency medical technicians I-99.
9. One representative from the state fire districts.
10. One physician who is licensed pursuant to title
32, chapter 13 or 17 and who specializes in trauma surgery.
11. One representative of a prehospital emergency
medical training program.
12. Six public members.
13. One representative of a volunteer medical rescue
program.
B. Public members of the council are eligible to
receive compensation pursuant to section 38-611.
C. This section is repealed from and after January
1, 2028.
END_STATUTE
Sec. 8. Section 36-2204, Arizona Revised
Statutes, is amended to read:
START_STATUTE
36-2204.
Medical control; standards and criteria
The medical director of the statewide emergency medical
services and trauma system, the emergency medical services council and the
medical direction commission shall recommend to the director
of
the department
the following standards and criteria that pertain to the
quality of emergency patient care:
1. Statewide standardized training, certification
and recertification standards for all classifications of emergency medical care
technicians.
2. A standardized and validated testing procedure
for all classifications of emergency medical care technicians.
3. Medical standards for certification and
recertification of training programs for all classifications of emergency
medical care technicians.
4. Standardized continuing education criteria for
all classifications of emergency medical care technicians.
5. Medical standards for certification and
recertification of certified emergency receiving facilities and advanced life
support base hospitals and approval of physicians providing medical control or
medical direction for any classification of emergency medical care technicians
who are required to be under medical control or medical direction.
6. Standards and mechanisms for monitoring and
ongoing evaluation of performance levels of all classifications of emergency
medical care technicians, emergency receiving facilities and advanced life
support base hospitals and approval of physicians providing medical control or
medical direction for any classification of emergency medical care technicians
who are required to be under medical control or medical direction.
7. Objective criteria and mechanisms for
decertification of all classifications of emergency medical care technicians,
emergency receiving facilities and advanced life support base hospitals and for
disapproval of physicians providing medical control or medical direction for
any classification of emergency care technicians who are required to be under
medical control or medical direction.
8. Medical standards for nonphysician prehospital
treatment and prehospital triage of patients requiring emergency medical
services.
9. Standards for emergency medical
dispatcher
dispatch
training, including prearrival
instructions. For the purposes of this paragraph, "emergency
medical dispatch" means the receipt of calls requesting emergency medical
services and the response of appropriate resources to the appropriate location.
10. Standards for a quality assurance process for
components of the statewide emergency medical services and trauma system,
including standards for maintaining the confidentiality of the information
considered in the course of quality assurance and the records of the quality
assurance activities pursuant to section 36-2403.
11. Standards for ambulance
service
services, air ambulance services
and medical transportation
that give consideration to the differences between urban, rural and wilderness
areas.
12. Standards to allow an ambulance to transport a
patient to a health care institution that is licensed as a special hospital and
that is physically connected to an emergency receiving facility.
END_STATUTE
Sec. 9. Section 36-2204.02, Arizona Revised
Statutes, is amended to read:
START_STATUTE
36-2204.02.
Emergency medical services providers; ambulance services; air
ambulance services; investigations of employees
A. In lieu of the requirements of section 36-2211,
the director may authorize an ambulance service
, air ambulance
service
or emergency medical services provider to investigate,
discipline or determine the fitness of an employee to continue to provide
patient care. This authority does not apply to the conviction of, a
plea of guilty or no contest to or admission in a court proceeding to the
elements of a felony.� The employer listed on the emergency medical care
technician's
,
or
ambulance
attendant's
or air ambulance attendant's
certification or
recertification application may limit the practice of the emergency medical
care technician
,
or
ambulance
attendant
or air ambulance attendant
during the
investigation if the employer meets all of the following requirements:
1. Has separate investigative or supervisory staff
to conduct an investigation.
2. Has an employee assistance program for
counseling.
3. Has policies and procedures for drug testing
through urinalysis or other generally accepted methods.
4. Has policies and procedures for monitoring
of
personnel who are suspected of or who have been convicted of
substance abuse.
B. An ambulance service
, air
ambulance service
or emergency medical services provider that conducts
its own disciplinary investigations pursuant to subsection A of this section
shall report the following to the medical director of the emergency medical
services and trauma system:
1. The nature of the allegation.
2. The level of patient care being delivered by the
employee and the supervision of the employee during the investigation or
rehabilitative period, or both.
3. The final outcome of the investigation and the
final recommendation on the employee's certification status.
C. The decisions of the employer
under
this section
are appealable under the employer's personnel policies and
procedures. Except as provided in section 41-1092.08, subsection H,
the final administrative decisions of the director are subject to judicial
review pursuant to title 12, chapter 7, article 6.
END_STATUTE
Sec. 10. Section 36-2209, Arizona Revised
Statutes, is amended to read:
START_STATUTE
36-2209.
Powers and duties of the director
A. The director shall:
1. Appoint and define the duties and prescribe the
terms of employment of all employees of the bureau.
2. Adopt rules necessary for the operation of the
bureau and for carrying out the purposes of this chapter.
3. Cooperate with and assist the personnel of
emergency receiving facilities and other health care institutions in preparing
a plan to be followed by
these
emergency
receiving
facilities and
health care
institutions
in the event of a major disaster.
4. Cooperate with the state director of emergency
management when a state of emergency or a state of war emergency has been
declared by the governor.
B. The director may:
1. Request the cooperation of utilities,
communications media and public and private agencies to aid and assist in
the implementation
implementing
and
maintenance of
maintaining
a statewide
emergency medical services system.
2. Enter into contracts and agreements with any
local governmental entity, agency, facility or group that provides a similar
program of emergency medical services in a contiguous state.
3. Enter into contracts and agreements
for the acquisition
to acquire
and
purchase
of
any equipment, tools, supplies, materials and
services necessary
in the administration of
to administer
this chapter.
4. Enter into contracts with emergency receiving
facilities, governmental entities, emergency rescue services
,
air ambulance services
and ambulance services
,
and
the director may
establish emergency medical services,
including emergency receiving facilities, if necessary to
assure
ensure
the availability and quality of
these
emergency medical
services.
5. Accept and
expend
spend
federal funds and private grants, gifts, contributions
and devises to assist in carrying out the purposes of this
chapter. These funds do not revert to the state general fund at the
close of a fiscal year.
6. Establish an emergency medical services
notification system that uses existing telephone communications networks.
7. Contract with private telephone companies
for the establishment of
to establish
a
statewide emergency reporting telephone number.
8. Authorize the testing entity to collect fees
determined by the director. In determining fees for testing entities
,
the director shall consider the fees required by national
certification organizations.
END_STATUTE
Sec. 11. Section 36-2212, Arizona Revised
Statutes, as amended by Laws 2025, chapter 212, section 1, is amended to read:
START_STATUTE
36-2212.
Certificate of registration to operate an ambulance or air
ambulance; termination on change in ownership; fees
A. A person shall not operate an ambulance
or air ambulance
in this state unless the ambulance
or air ambulance
has a certificate of registration and complies
with this article and the rules, standards and criteria adopted pursuant to
this article.
B. A person may obtain a certificate of registration
to operate an ambulance
or air ambulance
by submitting an
application on a form prescribed by the director and by demonstrating to the
director's satisfaction that the applicant is in compliance with this article
and all rules, standards and criteria adopted by the director for the operation
of an ambulance
or air ambulance
.
C. A certificate of registration issued under this
section terminates on any change of ownership or control of the ambulance
or air ambulance
. Following any change of ownership,
the new owner of an ambulance
or air ambulance
shall
apply for and receive a new certificate of registration from the director
before the ambulance
or air ambulance
may again be
operated in this state. This subsection does not apply if an
ambulance service
or air ambulance service
borrows,
leases, rents or otherwise obtains a registered ambulance
or air
ambulance
from another ambulance service
or air ambulance
service
to temporarily replace an inoperable ambulance
or
air ambulance
.
D. The department shall issue a certificate of
registration to a person that complies with the requirements of this article
and that pays an initial registration fee. A certificate of
registration is valid for one year but an ambulance service
or
air ambulance service
may request that the department issue an initial
certificate of registration that expires before the end of one year in order
for the department to conduct an annual inspection of all of the ambulance
service's ambulances
or air ambulance service's air ambulances
at
one time. A person may renew a certificate of registration by
complying with the requirements of this article and by paying a renewal fee
prescribed by the director. The fee for initial registration and
registration renewal shall not exceed $50 for each ambulance
or
air ambulance
. The department shall base these fees on an
amount that approximates the per vehicle costs incurred by the department to
administer this chapter. The director shall deposit, pursuant to
sections 35-146 and 35-147, fees collected under this subsection in the
state general fund. The department shall not charge a registration
fee for an ambulance to an ambulance service that operates an ambulance or
ambulances
, or a registration fee for an air ambulance to an air
ambulance service that operates an air ambulance or air ambulances,
only
as a volunteer not-for-profit service.
E. Notwithstanding the period of time
for which a certificate of registration is valid pursuant to subsection D of
this section, if the
certificate of registration holder
timely submits a complete renewal application in compliance with this article
and the rules adopted pursuant to this article and the department
is unable to perform an inspection of an ambulance within the time
frame prescribed by section 36-2232, subsection A, paragraph 13,
the department may allow an ambulance's registration
to remain valid and in effect until the department completes the
required inspection.
END_STATUTE
Sec. 12.
Repeal
Section 36-2212, Arizona Revised
Statutes, as amended by Laws 2025, chapter 212, section 2, is repealed.
Sec. 13. Section 36-2213, Arizona Revised
Statutes, is amended to read:
START_STATUTE
36-2213.
Air ambulance services; rules
The director shall adopt rules to establish minimum standards
for the operation of air ambulance services that are necessary to
assure
ensure
the public health and
safety. The director may use the current standards adopted by the
commission on accreditation of air medical services. Each rule shall
reference the specific authority from this chapter under which the rule was
formulated. The rules shall provide for the department to do the
following:
1. Establish standards and requirements relating to
at least the following:
(a) Medical control plans. These plans
shall conform to the standards adopted pursuant to section 36-2204, paragraph
9.
(b) Qualifications of the medical director of the
air ambulance services.
(c) Operation of only those air ambulances
registered pursuant to section 36-2212 and licensed pursuant to title 28,
chapter 25.
2. Establish response times and
operation times to assure that the health and safety needs of the public are
met.
3.
2.
Establish standards for emergency
medical dispatch training, including prearrival instruction. For the
purposes of this paragraph, "emergency medical dispatch" means the
receipt of calls requesting emergency medical services and the response of
appropriate resources to the appropriate location.
4.
3.
Require
the filing of run log information.
5.
4.
Issue,
transfer, suspend or revoke air ambulance service licenses under terms and
conditions consistent with this chapter. These rules shall be
consistent for all
air
ambulance services.
6.
5.
Investigate
the operation of an air ambulance service
,
including a
person operating an
air
ambulance that has not been
issued a certificate of registration
,
and conduct on-site
investigations of facilities communications equipment, vehicles, procedures,
materials and equipment.
7.
6.
Prescribe
the terms of the air ambulance service license.
8.
7.
Prescribe
the criteria for the air ambulance service license inspection process and for
determining an air ambulance service's compliance with licensure
requirements. The director shall accept proof that an air ambulance
service is accredited by the commission on accreditation of air medical
services in lieu of all licensing inspections required if the director receives
a copy of the air ambulance service's accreditation report.
END_STATUTE
Sec. 14. Section 36-2215, Arizona Revised
Statutes, is amended to read:
START_STATUTE
36-2215.
Required insurance or
financial responsibility; denial or revocation for failure to comply
A. The director shall not issue an air ambulance
service license to an
air
ambulance service unless the
applicant for the license or the licensee files with the department a
certificate of insurance completed by an insurance company that is authorized
to transact business in this state or other evidence of financial responsibility
in an amount that the director by rule determines is necessary to adequately
protect the interest of the public. The applicant for a license or
the licensee shall have malpractice and liability insurance that requires the
insurer to compensate for injuries to persons and for loss or damage to
property resulting from the negligent operation of the air ambulance service.
B. The director shall deny the application for a
license or revoke the license of any air ambulance service that fails to comply
with this section.
END_STATUTE
Sec. 15. Section 36-2216, Arizona Revised
Statutes, is amended to read:
START_STATUTE
36-2216.
Prohibited acts; classification
A. It is unlawful for any person to operate an
ambulance
or air ambulance
in this state
which
that
does not comply with
the provisions of
this article or the rules adopted by the director under this article.
B. A person who violates subsection A
of this section
is guilty of a class 1 misdemeanor.
END_STATUTE
Sec. 16. 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
and air 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) 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. 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
or an air
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
or air ambulance
is registered under this
chapter.
END_STATUTE
Sec. 17. Section 36-2226.02, Arizona Revised
Statutes, is amended to read:
START_STATUTE
36-2226.02.
Administration of epinephrine; first responders; immunity;
definitions
A. A first responder who is trained in administering
epinephrine injections may administer an epinephrine injection or epinephrine
delivery system to a person who the first responder believes in good faith is
experiencing anaphylaxis pursuant to a standing order issued by any of the
following:
1. A physician
licensed pursuant to
title 32, chapter 13 or 17
.
2. A naturopathic physician licensed pursuant to
title 32, chapter 14.
3. A physician assistant licensed pursuant to title
32, chapter 25.
4. A nurse practitioner licensed pursuant to title
32, chapter 15 who is authorized by law to prescribe drugs.
B. The following individuals are immune from
professional liability and criminal prosecution for any decision made, act or
omission or injury that results from
that
an
act
prescribed in subsection A of this section
if
the person acts with reasonable care and in good faith, except in cases of
wanton or wilful neglect:
1. Physicians who
are licensed
pursuant to title 32, chapter 13 or 17 and who
issue a standing order.
2. Naturopathic physicians who are licensed pursuant
to title 32, chapter 14 and who issue a standing order.
3. Physician assistants who are licensed pursuant to
title 32, chapter 25 and who issue a standing order.
4. Nurse practitioners who are licensed pursuant to
title 32, chapter 15 and authorized by law to prescribe drugs and who issue a
standing order.
5. First responders who administer epinephrine
injections or epinephrine delivery systems pursuant to this section.
C. This section does not create a duty to act or
standard of care for a first responder to administer an epinephrine injectionor
epinephrine delivery system.
D. For the purposes of this section:
1. "Ambulance attendant" means
either
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
caring for
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
the
driving
of
an
ambulance.
(
c
) An air
ambulance attendant.
2. "First responder" means a law
enforcement officer, a firefighter or an ambulance attendant.
END_STATUTE
Sec. 18. Section 36-2230, Arizona Revised
Statutes, is amended to read:
START_STATUTE
36-2230.
Ambulance services; police dogs; authorization; policies and
procedures; immunity; billing
A. Each ambulance service shall require its
emergency medical care technicians and ambulance attendants as defined in
section 36-2201, paragraph
6
9
,
subdivision (b) to transport a police dog that is injured in the line of duty,
along with a police officer who is trained in dog handling, if available, or
other police personnel who are medically trained, by a ground ambulance or
another emergency medical services vehicle to a veterinary clinic or veterinary
hospital equipped to provide emergency treatment to dogs, if all of the
following apply:
1. A person is not requiring emergency medical
treatment or transport by the ground ambulance or other emergency medical
services vehicle at that time.
2. The transport is not expected to take more than
thirty minutes from the point of pickup to the veterinary clinic or veterinary
hospital.
3. The ambulance service has at least one additional
ground ambulance in service and available to respond to emergency calls.
4. The transport by a police officer in the police
officer's emergency vehicle is not deemed to be more safe and more expeditious
than transport by a ground ambulance.
B. An ambulance service may authorize its emergency
medical care technicians, if trained, to provide emergency treatment to a
police dog that is injured in the line of duty.
C. Each ambulance service may develop written
policies and procedures for all of the following:
1. Appropriate training of the ambulance service's
emergency medical care technician personnel to provide police dogs with basic
level first aid, cardiopulmonary resuscitation and lifesaving interventions,
including administering naloxone, that are developed in consultation with a
veterinarian who is licensed in this state.
2. Safe handling procedures for injured police dogs,
including the use of a muzzle, and response coordination with a law enforcement
agency member who is trained in handling police dogs, that are developed in
consultation with a veterinarian who is licensed in this state and a law
enforcement police dog handler or trainer.
3. Identification of local veterinary facilities
that will provide emergency treatment of injured police dogs on short notice.
4. Proper and complete decontamination of
stretchers, the patient compartment and all contaminated medical equipment
after a police dog has been transported by a ground ambulance or other
emergency medical services vehicle.
5. Sterilization of the interior of a ground
ambulance or other emergency medical services vehicle, including complete
sanitizing of all allergens and disinfection to a standard safe for human
transport before the ground ambulance or other vehicle is returned to human
service.
D. Emergency medical care technicians and any other
personnel certified under this chapter who in the performance of their duties
and in good faith render emergency first aid, cardiopulmonary resuscitation,
transportation or other emergency medical services to an injured police dog
pursuant to this section are not personally liable as a result of rendering
such aid or services.
E. An ambulance service that provides transport for
an injured police dog pursuant to this section may bill the governmental entity
that owns the police dog for the cost of the transport.
F. This section does not preclude a police officer
who is trained in dog handling of an injured police dog from choosing to
transport the injured police dog in the police officer's own emergency vehicle.
END_STATUTE
Sec. 19. Section 36-2232, Arizona Revised
Statutes, is amended to read:
START_STATUTE
36-2232.
Director; powers and duties; regulation of ambulance services and
air ambulance services; inspections; response time compliance; mileage rate
calculation factors
A. The director shall adopt rules to regulate the
operation of ambulances
,
and
ambulance services
, air ambulances and air 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
and air ambulance services that are
granted
authority to provide any type of subscription service.
11. Offer technical assistance to ambulance services
and air 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
and air 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
or air 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 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.
D. At any time, the director or the director's
agents may:
1. Inquire into the operation of an ambulance
service
or air ambulance service
, including a person
operating an ambulance
or air ambulance
that has not been
issued a certificate of registration or a person
who
operating an ambulance that
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
and air 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
ambulance services to refer and advise a patient or transport a patient by the
most appropriate means to the most appropriate provider of medical services
based on the patient's condition. The protocols shall include triage
and treatment protocols that allow all classifications of emergency medical
care technicians responding to a person who has accessed 911, or a similar
public dispatch number, for a condition that does not pose an immediate threat
to life or limb to refer and advise a patient or transport a patient to the
most appropriate health care institution as defined in section 36-401
based on the patient's condition, taking into consideration factors including
patient choice, the patient's health care provider, specialized health care facilities
and local protocols.
G. The director, when reviewing an ambulance
service's response time compliance with its certificate of necessity, shall
consider in addition to other factors the effect of hospital diversion, delayed
emergency department admission and the number of ambulances engaged in response
or transport in the affected area.
H. The department shall incorporate all of the
following factors when calculating the proposed mileage rate:
1. The cost of licensure and registration of each
ground ambulance vehicle.
2. The cost of fuel.
3. The cost of ground ambulance vehicle maintenance.
4. The cost of ground ambulance vehicle repair.
5. The cost of tires.
6. The cost of ground ambulance vehicle insurance.
7. The cost of mechanic wages, benefits and payroll
taxes.
8. The cost of loan interest related to the ground
ambulance vehicles.
9. The cost of the weighted allocation of overhead.
10. The cost of ground ambulance vehicle
depreciation.
11. The cost of reserves for replacement of ground
ambulance vehicles and equipment.
END_STATUTE
Sec. 20. Section 36-2239, Arizona Revised
Statutes, is amended to read:
START_STATUTE
36-2239.
Ambulance services; rates; charges; adjustment; civil penalty
A. An ambulance service that applies to adjust its
rates or charges shall automatically be granted a rate increase equal to the
amount determined under section 36-2234, subsection G, if the ambulance
service is so entitled.� An automatic rate adjustment that is granted pursuant
to this subsection and that is filed on or before April 1 is effective June 1
of that year. The department shall notify the applicant and each
health care services organization as defined in section 20-1051 of the
rate adjustment on or before May 1 of that year.
B. Notwithstanding subsection E of this section, if
the department does not hold a hearing within ninety days after an ambulance
service applies to the department to adjust its rates or charges, the ambulance
service may adjust its rates or charges to an amount not to exceed the amount
sought by the ambulance service in its application to the
department. An ambulance service shall not apply to adjust its rates
or charges more than once every six months.
C. At the time the department holds a hearing on the
rates or charges of an ambulance service pursuant to section 36-2234, the
department may adjust the rates or charges adjusted by the ambulance service
pursuant to subsection B of this section, but the adjustment shall not be
retroactive.
D. Except as provided in subsection H of this
section, an ambulance service shall not charge, demand or collect any
remuneration for any service greater or less than or different from the rate or
charge determined and fixed by the department as the rate or charge for that
service. An ambulance service may charge for disposable supplies,
medical supplies and medication and oxygen related costs if the charges do not
exceed the manufacturer's suggested retail price, are uniform throughout the
ambulance service's certificated area and are filed with the director.� An
ambulance service shall not refund or limit in any manner or by any device any
portion of the rates or charges for a service that the department has
determined and fixed or ordered as the rate or charge for that service.
E. The department shall determine and render its
decision regarding all rates or charges within ninety days after commencement
of the applicant's hearing to adjust rates or charges. If the
department does not render its decision as required by this subsection, the
ambulance service may adjust its rates and charges to an amount that does not
exceed the amounts sought by the ambulance service in its application to the
department. If the department renders a decision to adjust the rates
or charges to an amount less than that requested in the application and the
ambulance service has adjusted its rates and charges higher than the adjustment
approved by the department, within thirty days after the department's decision
the ambulance service shall refund to the appropriate ratepayer the difference
between the ambulance service's adjusted rates and charges and the rates and
charges ordered by the department. The ambulance service shall
provide evidence to the department that the refund has been made. If
the ambulance service fails to comply with this subsection, the director may
impose a civil penalty subject to the limits provided in section 36-2245.
F. An ambulance service shall charge the advanced
life support base rate as prescribed by the director under any of the following
circumstances:
1. A person requests an ambulance by dialing
telephone number 911, or a similarly designated telephone number for emergency
calls, and all of the following apply:
(a) The ambulance is staffed with at least one
ambulance attendant.
(b) The ambulance is equipped with all required
advanced life support medical equipment and supplies for the advanced life
support attendants in the ambulance.
(c) The patient receives advanced life support
services or is transported by the advanced life support unit.
2. Advanced life support is requested by a medical authority
or by the patient.
3. The ambulance attendants administer one or more
specialized treatment activities or procedures as prescribed by the department
by rule.
G. An ambulance service shall charge the basic life
support base rate as prescribed by the director under any of the following
circumstances:
1. A person requests an ambulance by dialing
telephone number 911, or a similarly designated telephone number for emergency
calls, and all of the following apply:
(a) The ambulance is staffed with two ambulance
attendants certified by this state.
(b) The ambulance is equipped with all required
basic life support medical equipment and supplies for the basic life support
medical attendants in the ambulance.
(c) The patient receives basic life support services
or is transported by the basic life support unit.
2. Basic life support transportation or service is
requested by a medical authority or by the patient, unless any provision of
subsection F of this section applies, in which case the advanced life support
rate applies.
3. For an interfacility transport when the ambulance
is staffed with at least one ambulance attendant as defined in section 36-2201,
paragraph
6
9
, subdivision
(a), (c), (d) or (e).
H. For each contract year, the Arizona health care
cost containment system administration and its contractors and subcontractors
shall provide remuneration for ambulance services for persons who are enrolled
in or covered by the Arizona health care cost containment system in an amount
equal to 68.59 percent of the amounts as prescribed by the department as of
July 1 of each year for services specified in subsections F and G of this
section and 68.59 percent of the mileage charges as determined by the department
as of July 1 of each year pursuant to section 36-2232. The
Arizona health care cost containment system administration shall annually
adjust the Arizona health care cost containment system fee schedule according
to the department's approved ambulance service rate in effect as of July 1 of
each year. The rate adjustments made pursuant to this subsection are
effective beginning October 1 of each year.
I. In establishing rates and charges, the director
shall consider the following factors:
1. The transportation needs assessment of the
medical response system in a political subdivision.
2. The medical care consumer price index of the
United States department of labor, bureau of labor statistics.
3. Whether a review is made by a local emergency
medical services coordinating system in regions where that system is designated
as to the appropriateness of the proposed service level.
4. The rate of return on gross revenue.
5. Response times pursuant to section 36-2232,
subsection A, paragraphs 3 and 4.
J. Notwithstanding section 36-2234, an
ambulance service may charge an amount for medical assessment, equipment or
treatment that exceeds the requirements of section 36-2205 if requested
or required by a medical provider or patient.
K. Notwithstanding
subsections D, F and G of this section, an ambulance service may provide
gratuitous services if an ambulance is dispatched and the patient subsequently
declines to be treated or transported.
END_STATUTE
Sec. 21. Section 36-2245, Arizona Revised
Statutes, is amended to read:
START_STATUTE
36-2245.
Investigations; complaints; informal interviews; hearings;
stipulations; judicial review; civil penalty; confidentiality; applicability
A. The department may conduct an investigation into
the operation of ambulances and ambulance services.
B. Proceedings under this section may be initiated
by the department.
C. If the department receives a written and signed
statement of dissatisfaction or dispute of charges or any matter relating to
the regulation of ambulance services, the customer is deemed to have filed an
informal complaint against the ambulance service.� Within fifteen days
of receipt of
after receiving
the
complaint, a designated representative of the department shall inform the
ambulance service that an informal complaint has been filed, state the nature
of the allegations made, specify the purported rule violation and identify
specific records relating to the purported rule violation that the ambulance
service shall provide to the department.� The ambulance service shall comply
with the request for records in a timely manner.
D. Within forty-five days
of
receipt of
after receiving
the records, the
department shall determine
if
whether
the
complaint is nonsubstantive or substantive.
E. If the department determines that a complaint
filed pursuant to this section is nonsubstantive,
it
the department
shall render a written decision to all parties
within five days
of
after
that
determination.� The complainant may make a formal complaint to the department
if the complainant disagrees with the department's decision. If the
nonsubstantive complaint involves rates and charges, a designated
representative of the department shall attempt to resolve the dispute by
correspondence or telephone with the ambulance service and the customer.
F. If the department
determines that a complaint filed pursuant to this section is substantive, the
complaint becomes a formal complaint.� The department shall inform the
ambulance service that the initial investigation was substantive in nature and
may warrant action pursuant to this article.� The department shall inform the
ambulance service of the specific rule violation and shall allow the ambulance
service thirty days to answer the complaint in writing.
G. The department may issue a written request for an
informal interview with the ambulance service if the department believes that
the evidence indicates that grounds for action exist.� The request shall state
the reasons for the
informal
interview and shall schedule
an interview at least ten days
from
after
the
date that the department sends the request for an interview.
H. If the department determines that evidence
warrants action or if the ambulance service refuses to attend the informal
interview, the director shall institute formal proceedings and hold a hearing
pursuant to title 41, chapter 6, article 10.
I. If the department believes that a lesser
disciplinary action is appropriate, the department may enter into a stipulated
agreement with the ambulance service.� This stipulation may include a civil
penalty as provided under subsection J of this section.
J. In addition to other disciplinary action provided
under this section, the director may impose a civil penalty of not more than
three hundred fifty dollars
$350
for each
violation of this chapter that constitutes grounds to suspend or revoke a
certificate of necessity.� This penalty shall not exceed
fifteen
thousand dollars
$15,000
. Each day that
a violation occurs constitutes a separate offense. The director
shall deposit, pursuant to sections 35-146 and 35-147, all monies
collected under this subsection in the emergency medical services operating
fund established
under
by
section 36-2218.
K. The director may suspend a certificate of
necessity without holding a hearing if the director determines that the
certificate holder has failed to pay a civil penalty imposed under this
section. The director shall reinstate the certificate of necessity when the
certificate holder pays the penalty in full.
L. Except as provided in section 41-1092.08,
subsection H, a final decision of the department pursuant to this section is subject
to judicial review pursuant to title 12, chapter 7, article 6.
M. Information, documents and records received by
the department or prepared by the department in connection with an
investigation that is conducted pursuant to this article and that relates to
emergency medical care technicians are confidential and are not subject to
public inspection or civil discovery. When the investigation has
been completed and the investigation file has been closed, the results of the
investigation and the decision of the department shall be available to the
public.
N. This section applies to air
ambulances and air ambulance services to the extent that:
1. The complaint or proceedings
initiated by the department relate to the emergency medical services provided
by the air ambulance or air ambulance service.
2. The investigation does not
conflict with any federal law or regulation governing air carriers.
END_STATUTE
Sec. 22. Section 36-2264, Arizona Revised
Statutes, is amended to read:
START_STATUTE
36-2264.
Exemption from regulation
A. A person who obtains an automated external
defibrillator for home use pursuant to a physician's prescription is exempt
from the requirements of this article.
B. A person who is employed as a firefighter,
emergency medical care technician
, air ambulance attendant
or ambulance attendant by a fire district established pursuant to title 48,
chapter 5 is exempt from the requirements of this article.
C. A person who is employed as a firefighter,
emergency medical care technician
, air ambulance attendant
or ambulance attendant by a public or private fire department
,
air ambulance service
or
an
ambulance service
regulated by this chapter is exempt from the requirements of this article.
END_STATUTE
Sec. 23. Section 36-2907, Arizona Revised
Statutes, is amended to read:
START_STATUTE
36-2907.
Covered health and medical services; modifications; related
delivery of service requirements; rules; definitions
A. Subject to the limits and exclusions specified in
this section, contractors shall provide the following medically necessary
health and medical services:
1. Inpatient hospital services that are ordinarily
furnished by a hospital to care for and treat inpatients and that are provided
under the direction of a physician or a primary care
practitioner. For the purposes of this section, inpatient hospital
services exclude services in an institution for tuberculosis or mental diseases
unless authorized under an approved section 1115 waiver.
2. Outpatient health services that are ordinarily
provided in hospitals, clinics, offices and other health care facilities by
licensed health care providers. Outpatient health services include
services provided by or under the direction of a physician or a primary care
practitioner, including occupational therapy.
3. Other laboratory and X-ray services ordered
by a physician or a primary care practitioner.
4. Medications that are ordered on prescription by a
physician or a dentist who is licensed pursuant to title 32, chapter 11.�
Persons who are dually eligible for title XVIII and title XIX services must
obtain available medications through a medicare licensed or certified medicare
advantage prescription drug plan, a medicare prescription drug plan or any
other entity authorized by medicare to provide a medicare part D prescription
drug benefit.
5. Medical supplies, durable medical equipment,
insulin pumps and prosthetic devices ordered by a physician or a primary care
practitioner. Suppliers of durable medical equipment shall provide the
administration with complete information about the identity of each person who
has an ownership or controlling interest in their business and shall comply
with federal bonding requirements in a manner prescribed by the administration.
6. For persons who are at least twenty-one
years of age, treatment of medical conditions of the eye, excluding eye
examinations for prescriptive lenses and the provision of prescriptive lenses.
7. Early and periodic health screening and
diagnostic services as required by section 1905(r) of title XIX of the social
security act for members who are under twenty-one years of age.
8. Family planning services that do not include
abortion or abortion counseling. If a contractor elects not to
provide family planning services, this election does not disqualify the
contractor from delivering all other covered health and medical services under
this chapter.� In that event, the administration may contract directly with
another contractor, including an outpatient surgical center or a noncontracting
provider, to deliver family planning services to a member who is enrolled with
the contractor that elects not to provide family planning services.
9. Podiatry services that are performed by a
podiatrist who is licensed pursuant to title 32, chapter 7 and ordered by a
primary care physician or primary care practitioner.
10. Nonexperimental transplants approved for title
XIX reimbursement.
11. Dental services as follows:
(a) Except as provided in subdivision (b) of this
paragraph, for persons who are at least twenty-one years of age,
emergency dental care and extractions in an annual amount of not more than
$1,000 per member.
(b) Subject to approval by the centers for medicare
and medicaid services, for persons treated at an Indian health service or
tribal facility, adult dental services that are eligible for a federal medical
assistance percentage of one hundred percent and that exceed the limit
prescribed in subdivision (a) of this paragraph.
12.
Air ambulance,
ambulance
and nonambulance transportation, except as provided in subsection G of this
section.
13. Hospice care.
14. Orthotics, if all of the following apply:
(a) The use of the orthotic is medically necessary
as the preferred treatment option consistent with medicare guidelines.
(b) The orthotic is less expensive than all other
treatment options or surgical procedures to treat the same diagnosed condition.
(c) The orthotic is ordered by a physician or
primary care practitioner.
15. Subject to approval by the centers for medicare
and medicaid services, medically necessary chiropractic services that are
performed by a chiropractor who is licensed pursuant to title 32, chapter 8 and
that are ordered by a primary care physician or primary care practitioner
pursuant to rules adopted by the administration. The primary care
physician or primary care practitioner may initially order up to twenty visits
annually that include treatment and may request authorization for additional
chiropractic services in that same year if additional chiropractic services are
medically necessary.
16. For up to ten program hours annually, diabetes
outpatient self-management training services, as defined in 42 United
States Code section 1395x, if prescribed by a primary care practitioner in
either of the following circumstances:
(a) The member is initially diagnosed with diabetes.
(b) For a member who has previously been diagnosed
with diabetes, either:
(i) A change occurs in the member's diagnosis,
medical condition or treatment regimen.
(ii) The member is not meeting appropriate clinical
outcomes.
17. Pursuant to the terms and conditions that are
approved by the centers for medicare and medicaid services and subject to
available funding, traditional healing services, if both of the following
apply:
(a) The member qualifies for services through the
Indian health service or a tribal facility pursuant to the conditions of
participation outlined in 42 Code of Federal Regulations section 136.12.
(b) The traditional healing service is delivered by
or through the Indian health service or a tribal facility.
B. The limits and exclusions for health and medical
services provided under this section are as follows:
1. Circumcision of newborn males is not a covered
health and medical service.
2. For eligible persons who are at least twenty-one
years of age:
(a) Prosthetic devices do not include hearing aids,
dentures or bone-anchored hearing aids. Prosthetic devices,
except prosthetic implants, may be limited to $12,500 per contract year.
(b) Percussive vests are not covered health and
medical services.
(c) Durable medical equipment is limited to items
covered by medicare.
(d) Nonexperimental transplants do not include
pancreas-only transplants.
(e) Bariatric surgery procedures, including
laparoscopic and open gastric bypass and restrictive procedures, are not
covered health and medical services.
C. The system shall pay noncontracting providers
only for health and medical services as prescribed in subsection A of this
section and as prescribed by rule.
D. The director shall adopt rules necessary to
limit, to the extent possible, the scope, duration and amount of services,
including maximum limits for inpatient services that are consistent with
federal regulations under title XIX of the social security act (P.L. 89-97;
79 Stat. 344; 42 United States Code section 1396 (1980)). To
the extent possible and practicable, these rules shall provide for the prior
approval of medically necessary services provided pursuant to this chapter.
E. The director shall make available home health
services in lieu of hospitalization pursuant to contracts awarded under this
article.� For the purposes of this subsection, "home health services"
means the provision of nursing services, home health aide services or medical
supplies, equipment and appliances that are provided on a part-time or
intermittent basis by a licensed home health agency within a member's residence
based on the orders of a physician or a primary care practitioner.� Home health
agencies shall comply with the federal bonding requirements in a manner
prescribed by the administration.
F. The director shall adopt rules for the coverage
of behavioral health services for persons who are eligible under section 36-2901,
paragraph 6, subdivision (a). The administration acting through
the regional behavioral health authorities shall establish a diagnostic and
evaluation program to which other state agencies shall refer children who are
not already enrolled pursuant to this chapter and who may be in need of
behavioral health services. In addition to an evaluation, the
administration acting through regional behavioral health authorities shall also
identify children who may be eligible under section 36-2901,
paragraph 6, subdivision (a) or section 36-2931, paragraph 5 and
shall refer the children to the appropriate agency responsible for making the
final eligibility determination.
G. The director shall adopt rules providing for
transportation services and rules providing for copayment by members for
transportation for other than emergency purposes. Subject to
approval by the centers for medicare and medicaid services, nonemergency
medical transportation shall not be provided except for stretcher vans
and air ambulance
and ambulance transportation. Prior
authorization is required for transportation by stretcher van and for medically
necessary
air ambulance and
ambulance transportation
initiated pursuant to a physician's direction. Prior authorization
is not required for medically necessary
air ambulance and
ambulance
transportation services rendered to members or eligible persons initiated by
dialing telephone number 911 or other designated emergency response systems.
H. The director may adopt rules to allow the
administration, at the director's discretion, to use a second opinion procedure
under which surgery may not be eligible for coverage pursuant to this chapter
without documentation as to need by at least two physicians or primary care
practitioners.
I. If the director does not receive bids within the
amounts budgeted or if at any time the amount remaining in the Arizona health
care cost containment system fund is insufficient to pay for full contract
services for the remainder of the contract term, the administration, on
notification to system contractors at least thirty days in advance, may modify
the list of services required under subsection A of this section for persons
defined as eligible other than those persons defined pursuant to section 36-2901,
paragraph 6, subdivision (a).� The director may also suspend services or may
limit categories of expense for services defined as optional pursuant to title
XIX of the social security act (P.L. 89-97; 79 Stat. 344; 42 United
States Code section 1396 (1980)) for persons defined pursuant to section 36-2901,
paragraph 6, subdivision (a). Such reductions or suspensions do not
apply to the continuity of care for persons already receiving these services.
J. All health and medical services provided under
this article shall be provided in the geographic service area of the member,
except:
1. Emergency services and specialty services
provided pursuant to section 36-2908.
2. That the director may allow the delivery of
health and medical services in other than the geographic service area in this
state or in an adjoining state if the director determines that medical practice
patterns justify the delivery of services or a net reduction in transportation
costs can reasonably be expected. Notwithstanding the definition of
physician as prescribed in section 36-2901, if services are procured from
a physician or primary care practitioner in an adjoining state, the physician
or primary care practitioner shall be licensed to practice in that state
pursuant to licensing statutes in that state that are similar to title 32,
chapter 13, 15, 17 or 25 and shall complete a provider agreement for this
state.
K. Covered outpatient services shall be
subcontracted by a primary care physician or primary care practitioner to other
licensed health care providers to the extent practicable for purposes
including, but not limited to, making health care services available to
underserved areas, reducing costs of providing medical care and reducing
transportation costs.
L. The director shall adopt rules that prescribe the
coordination of medical care for persons who are eligible for system
services. The rules shall include provisions for transferring
patients and medical records and initiating medical care.
M. Pursuant to the terms and conditions that are
approved by the centers for medicare and medicaid services and subject to
available funding, the director shall implement limited benefit coverage
prerelease services to eligible incarcerated individuals and committed youth
for up to ninety days immediately before
the individuals'
each individual's
or committed youth's expected date of
release from a prison, jail, secure care facility or tribal correctional
facility.
N. Notwithstanding section 36-2901.08, monies
from the hospital assessment fund established by section 36-2901.09 may
not be used to provide any of the following:
1. Chiropractic services as prescribed in subsection
A, paragraph 15 of this section.
2. Diabetes outpatient self-management training
services as prescribed in subsection A, paragraph 16 of this section.
3. Speech therapy provided in an outpatient setting
to eligible persons who are at least twenty-one years of age.
4. Cochlear implants to eligible persons who are at
least twenty-one years of age.
O. For the purposes of this section:
1. "Air ambulance" has the
same meaning prescribed in section 36-2201.
1.
2.
"Ambulance"
has the same meaning prescribed in section 36-2201.
2.
3.
"Tribal
facility" has the same meaning prescribed in section 36-2981.
END_STATUTE
Sec. 24. Section 36-2989, Arizona Revised
Statutes, is amended to read:
START_STATUTE
36-2989.
Covered health and medical services; modifications; related
delivery of service requirements
A. Except as provided in this section, health and
medical services prescribed in section 36-2907 are covered services and
include:
1. Inpatient hospital services that are ordinarily
furnished by a hospital for the care and treatment of inpatients, that are
medically necessary and that are provided under the direction of a physician or
a primary care practitioner. For the purposes of this paragraph,
inpatient hospital services exclude services in an institution for tuberculosis
or mental diseases unless authorized by federal law.
2. Outpatient health services that are medically
necessary and ordinarily provided in hospitals, clinics, offices and other
health care facilities by licensed health care providers. For the
purposes of this paragraph, "outpatient health services" includes
services provided by or under the direction of a physician or a primary care
practitioner.
3. Other laboratory and X-ray services ordered
by a physician or a primary care practitioner.
4. Medications that are medically necessary and
ordered on prescription by a physician, a primary care practitioner or a
dentist licensed pursuant to title 32, chapter 11.
5. Medical supplies, equipment and prosthetic
devices.
6. Treatment of medical conditions of the eye,
including eye examinations for prescriptive lenses and the provision of
prescriptive lenses for members.
7. Medically necessary dental services.
8. Well child services, immunizations and prevention
services.
9. Family planning services that do not include
abortion or abortion counseling. If a contractor elects not to
provide family planning services, this election does not disqualify the
contractor from delivering all other covered health and medical services under
this article.� In that event, the administration may contract directly with
another contractor, including an outpatient surgical center or a noncontracting
provider, to deliver family planning services to a member who is enrolled with
a contractor who elects not to provide family planning services.
10. Podiatry services that are performed by a
podiatrist licensed pursuant to title 32, chapter 7 and that are ordered by a
primary care physician or primary care practitioner.
11. Medically necessary pancreas, heart, liver,
kidney, cornea, lung and heart-lung transplants and autologous and
allogeneic bone marrow transplants and immunosuppressant medications for these
transplants ordered on prescription by a physician licensed pursuant to title
32, chapter 13 or 17.
12. Medically necessary emergency and nonemergency
transportation.
13. Inpatient and outpatient behavioral health
services that are the same as the least restrictive health benefits coverage
plan for behavioral health services that are offered through a health care
services organization for state employees under section 38-651.
14. Hospice care.
B. The administration shall pay noncontracting
providers only for health and medical services as prescribed in subsection A of
this section.
C. To the extent possible and practicable, the
administration and contractors shall provide for the prior approval of
medically necessary services provided pursuant to this article.
D. The director shall make available home health
services in lieu of hospitalization pursuant to contracts awarded under this
article.
E. Behavioral health services shall be provided to
members through the administration's contractors. The administration
acting through regional behavioral health authorities as defined in section 36-3401
shall use its established diagnostic and evaluation program for referrals of
children who are not already enrolled pursuant to this article and who may be
in need of behavioral health services. In addition to an evaluation,
the administration acting through regional behavioral health authorities as
defined in section 36-3401 shall also identify children who may be
eligible under section 36-2901, paragraph 6, subdivision (a) or section
36-2931, paragraph 5 and shall refer the children to the appropriate
agency responsible for making the final eligibility determination.
F. The director shall adopt rules for the provision
of transportation services for members. Prior authorization is not
required for medically necessary
air ambulance and
ambulance
transportation services rendered to members initiated by dialing telephone
number 911 or other designated emergency response systems.
G. The director may adopt rules to allow the
administration to use a second opinion procedure under which surgery may not be
eligible for coverage pursuant to this article without documentation as to need
by at least two physicians or primary care practitioners.
H. All health and medical services provided under
this article shall be provided in the geographic service area of the member,
except:
1. Emergency services and specialty services.
2. The director may permit the delivery of health
and medical services in other than the geographic service area in this state or
in an adjoining state if it is determined that medical practice patterns
justify the delivery of services or a net reduction in transportation costs can
reasonably be expected.� Notwithstanding section 36-2981, paragraph 8 or
11, if services are procured from a physician or primary care practitioner in
an adjoining state, the physician or primary care practitioner shall be licensed
to practice in that state pursuant to licensing statutes in that state that are
similar to title 32, chapter 13, 15, 17 or 25.
I. Covered outpatient services shall be
subcontracted by a primary care physician or primary care practitioner to other
licensed health care providers to the extent practicable for purposes of making
health care services available to underserved areas, reducing costs of
providing medical care and reducing transportation costs.
J. The director shall adopt rules that prescribe the
coordination of medical care for members and that include a mechanism to
transfer members and medical records and initiate medical care.
K. The director shall adopt rules for the
reimbursement of specialty services provided to the member if authorized by the
member's primary care physician or primary care practitioner.
L. Pursuant to the terms and conditions that are
approved by the centers for medicare and medicaid services and subject to
available funding, the director shall implement limited benefit coverage
prerelease services to eligible incarcerated individuals or committed youth for
up to ninety days immediately before
the individuals'
each individual's
or committed youth's expected date of
release from a prison, jail
,
secure care
facility or tribal correctional facility.
END_STATUTE
Sec. 25. Section 41-1831, Arizona Revised
Statutes, is amended to read:
START_STATUTE
41-1831.
Definitions
In this chapter, unless the context otherwise requires:
1. "Air ambulance" means
any publicly or privately owned aircraft that is certificated under 14 Code of
Federal Regulations part 135, that contains a stretcher and necessary medical
equipment and supplies pursuant to section 36-2202 and that is
specifically 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.
2. "Air ambulance service"
means a person or organization that owns and operates one or more air
ambulances or that leases from an air carrier the use of one or more air
ambulances that are certificated under 14 Code of Federal Regulations part 135,
for the purpose of providing emergency medical services in air ambulances.
1.
3.
"Ambulance"
:
(
a
)
Means any publicly or privately owned surface
,
or
water
or air
vehicle
, including a helicopter,
that is
specially
specifically
designed and constructed or modified and equipped
to be used, maintained or operated for transportation of individuals who are
sick, injured, wounded or otherwise incapacitated or helpless.
Ambulance
(
b
)
Does
not include surface vehicles owned and operated by a private sole proprietor,
partnership, private corporation or municipal corporation for the emergency
transportation or in transit care of its employees.
2.
4.
"Ambulance
pilot" means an individual who is responsible for the operation of an air
ambulance and who is trained and certified as provided in this chapter.
3.
5.
"Ambulance
service" means a person who owns and operates one or more ambulances.
5.
6.
"Department"
means the department of public safety.
6.
7.
"Director"
means the director of the department
of public safety
.
4.
8.
"Emergency
medical care technician" means an individual who has been certified by the
department of health services as an emergency medical technician, an advanced
emergency medical technician, an emergency medical technician I-99 or a
paramedic.
7.
9.
"Emergency
medical patient" means a person who is suffering from a condition that
requires immediate medical care or hospitalization, or both, in order to
preserve the person's health, life or limb.
8.
10.
"Emergency
medical services communication system" means the statewide system
that is
implemented, coordinated and administered by the
department of public safety
, which
and that
may have the capability of providing for the intercommunication of any
or all law enforcement agencies and personnel, ambulances, ambulance services
and air ambulance services
and dispatchers, emergency
receiving facilities, other health care institutions, medical practitioners,
motor vehicle repair, fire service vehicles and tow trucks, and any other
agencies and persons who may be serving on a volunteer basis.
9.
11.
"Emergency
medical situation" means a condition of emergency in which immediate
medical care or hospitalization, or both, is required by a person or persons
for the preservation of health, life or limb.
10.
12.
"Emergency
receiving facility" means a licensed health care institution that offers
emergency medical services, that is staffed twenty-four hours a day and
that has a physician who is licensed pursuant to title 32, chapter 13 or 17
,
on call.
END_STATUTE
Sec. 26. Section 41-2407, Arizona Revised
Statutes, is amended to read:
START_STATUTE
41-2407.
Victim compensation and assistance fund; subrogation; prohibited
debt collection activity; definition
A. The victim compensation and assistance fund is
established. The Arizona criminal justice commission shall
administer the fund.� The victim compensation and assistance fund shall consist
of monies collected pursuant to section 31-411, subsection E and sections
12-116.08, 13-4310, 31-418, 31-467.06 and 41-1674,
unclaimed victim restitution monies pursuant to sections 22-116 and 44-313
and monies available from any other source.
B. Subject to legislative appropriation, the Arizona
criminal justice commission shall allocate monies in the victim compensation
and assistance fund to public and private agencies for the purpose of
establishing, maintaining and supporting programs that compensate and assist
victims of crime.
C. The allocation of monies pursuant to this section
shall be made in accordance with rules adopted by the Arizona criminal justice
commission pursuant to section 41-2405, subsection A, paragraph
8. The rules shall provide that persons who suffered personal injury
or death that resulted from an attempt to aid a public safety officer in the
prevention of a crime or the apprehension of a criminal may be eligible for
compensation.
D. This state and the applicable operational unit or
qualified program, as defined in the victim compensation program rules, are
subrogated to the rights of an individual who receives monies from the victim
compensation and assistance fund to recover or receive monies or benefits from
a third party, to the extent of the amount of monies the individual receives
from the fund.
E. A licensed health care provider who agrees to the
victim compensation program rules may receive program monies for providing
health and medical services to a victim or claimant. A licensed
health care provider who accepts the full allowable payment for those services
from a victim compensation program funded pursuant to this section is deemed to
have accepted the payment as the full payment for those
services. The licensed health care provider may not collect or attempt
to collect any payment for the same health and medical services from the victim
or claimant, except that if a victim compensation program funded pursuant to
this section is unable to pay the full allowable payment to a licensed health
care provider because of a lack of available monies or for any other reason,
the licensed health care provider may collect the unpaid balance for the
services from the victim or claimant or from a third-party payor, and the
total amount billed or requested by the licensed health care provider may not
exceed the full allowable payment that the licensed health care provider agreed
to accept from the victim compensation program for the services.
F. If a licensed health care provider receives
notice that a person has filed a claim with a victim compensation program
funded by this section, the licensed health care provider is prohibited from
any debt collection activity for any monies owed by the person that are
included in the filed claim until an award is made on the claim or until a
determination is made that the claim is noncompensable.� For the purposes of
this subsection, "debt collection activity" includes repeatedly telephoning
or writing to the claimant and threatening to either turn the matter over to a
debt collection agency or to an attorney for collection, enforcement or filing
of any other debt collection process. Debt collection activity does
not include routine billing or inquiries about the status of the claim.
G. For the purposes of this section, "licensed
health care provider" means a person or institution that is licensed or
certified by this state to provide health care services, medical services,
nursing services, emergency medical services
, air ambulance
services
and ambulance services that are regulated pursuant to title 36,
chapter 21.1, article 2 or other health-related services.
END_STATUTE
APPROVED BY THE GOVERNOR APRIL 13, 2026.
FILED IN THE OFFICE OF THE SECRETARY OF STATE APRIL 13, 2026.