It takes a village to update Arizona’s ambulance rules

We are currently working on updating Arizona’s ambulance rules to align with House Bill 2609 and new statutory requirements that go into effect on Jan. 1, 2024. These new requirements create standard principles for the ambulance industry across the state, including response time standards and tracking and improving patient care. 

ADHS began the process of adjusting our EMS rules in 2017 and are currently in the public review phase of this project. One thing is clear as we meet with EMS and health care stakeholders to discuss rule changes: we all serve the people of Arizona and we all have the same goal of providing quality patient care. 

This rulemaking is an opportunity to address new challenges and issues that have been identified since these regulations were last updated. Arizona’s air ambulance rules were developed in 2006 and were updated in June 2023. Arizona’s ground ambulance rules were established in 2001 and will now be updated to align with the new statutory requirements.

ADHS originally conducted a five-year rule review in 2017 in preparation to update  ground ambulance rules. Today, we remain committed to this rulemaking and incorporating feedback from diverse stakeholders across the state. 

What is rulemaking?

Rulemaking is a process that the Department follows to update rules (also known as “Arizona Administrative Code (A.A.C.)”) that complement state law. In this case, the rules provide regulations for ambulance services to ensure patient and provider health and safety.

The rulemaking process requires multiple steps and can take several years to complete. 

• First, the Department must complete a five-year review on regulatory issues and recommendations to improve rules and submit it to the Governor’s Regulatory Review Council (GRRC). 
• Second, if the GRRC recommends moving forward, the Department will seek an exemption from the rule moratorium from the Governor’s Office to proceed with a rulemaking. 
• Next, the Department will engage diverse stakeholders to seek input on developing draft rules that ensure health and safety. 
• Finally, the draft rules will be submitted to GRRC for final review and approval before they go into effect. 

What is the rulemaking timeline?

The Department plans to complete the rulemaking in time for the new rules to go into effect at the same time as the new House Bill 2609 statutory requirements on Jan. 1, 2024, if approved by the GRRC. 

After receiving approval to move forward with the rulemaking process in May, the Department posted ground ambulance draft rules for public comment. The current June draft rules are available for online comment at the links below until July 16, 2023. During July, the Department will conduct listening sessions in each region to gather additional input from stakeholders. At the end of July, the Department will post a revised draft and will solicit additional comments in August. 

Next, the Department will begin the formal rulemaking steps including submitting the draft rules to the GRRC for review and approval several months in advance of January. These next steps require drafting a Notice of Proposed Rulemaking and Economic Impact Statement at the end of August, which will begin a formal comment period before the GRRC Study Session and Council meetings in November and December. If GRRC approves the draft rules at the end of the year,  they will become effective at the same time as the new statutes on Jan. 1, 2024. 

How do stakeholders participate in the rulemaking process?

Throughout July, ADHS is conducting workgroup meetings and regional listening sessions across the state to seek input from stakeholders before we post another revised draft.

The Department invites you to join an upcoming public meeting or visit the links below to review the draft rules and submit feedback during the online comment period by July 16, 2023 at 11:59 p.m.:

• Article 9 June 2023 Draft | Online Survey (Closes July 16, 2023)
• Article 10 June 2023 Draft | Online Survey (Closes July 16, 2023)
• Article 11 June 2023 Draft | Online Survey (Closes July 16, 2023)

At the end of July, ADHS will post a revised draft and solicit additional comments before the formal rulemaking process begins at the end of August.

What are the proposed rule changes?

Below is a summary of the proposed rule changes, which are focused on patient care and are not intended to be punitive:

• Aligns with House Bill 2609 Certificates of Necessity (CON) requirements effective Jan. 1, 2024.
• Defines new GPS device statutory requirement for every ambulance to record response times effective Jan. 1, 2024.
• Streamlines online application and payment process for CON holders and new applicants.
• Clarifies ground ambulance service contracts, rates and charges to be more clear and concise.
• Outlines interfacility transport and critical care requirements consistent with federal Emergency Medical Treatment and Labor Act (EMTALA) and Medicare guidelines.
• Establishes statewide response time and dispatching standards based on evidence-based practices shown to improve patient outcomes. 
• Recommends response time benchmarks based on the 90th percentile for urban, suburban, rural, and wilderness areas.
• Standardizes existing performance improvement reporting requirements to measure outcomes and improve patient care.

Although the proposed changes are not final yet, ADHS is committed to updating the ground ambulance rules to improve EMS patient care and outcomes in Arizona. We appreciate the privilege and opportunity to be able to collaborate with subject-matter experts across the state on this important rulemaking.

For more information, please visit the Department’s ground ambulance rulemaking website.