What’s a Certificate of Necessity, Anyway?

Arizona uses a Certificate of Necessity (CON) system to regulate ground ambulance service in Arizona– and to make sure that every place in the State has adequate emergency medical services, including the frontier parts of AZ.  The CON actually describes the geographic service area, level of service (advanced life support or basic life support), hours of operation, response times, effective date, expiration date and any limiting or special provisions for emergency medical services in the specific geographic area.  A ground ambulance service that is awarded one of our CONs must stick with the criteria on their certificate and operate in accordance to the statutes and rules by which it is governed.  Check out these links for statutes and ground ambulance rules for the details of how it works.

We just posted some new guidance for folks who are interested in applying for new CONs for emergency medical services.  The new guidance basically summarizes our statutes and rules for applying for a new CONs, which includes a requirement that the applicant shows that there is a “public necessity” for the new service.  Our new guidance makes it clear that we’ll evaluate public necessity by analyzing the needs of the community, the adequacy of the current services provided, maximizing the use of contemporary EMS protocols that have been demonstrated to save lives and quality of life, and ensuring cost controls.

Specifically, our new guidance clarifies the kind of information we’ll use to make our decision whether to approve new CONs, including whether the applicant demonstrates:

• A plan for a robust, on-going benchmarking and performance improvement process that encompasses all components of the EMS system from emergency medical dispatch through emergency department arrival;
• A plan to collect and submit electronic patient care reports consistent with our EMS Bureau’s guidelines;
• A plan to adopt clinical guidelines and operating procedures for time sensitive illness consistent with American Heart Association best practice guidelines;
• A plan to initiate guideline-based pre-arrival instructions for all callers accessing 9-1-1 for assistance;
• Evidence of regular attendance and participation in meetings of the regional and State EMS Councils;
• A plan to ensure that ambulance service will be maintained and improved for rural communities; and
• Assurance that the service model will be cost effective and not result in higher ambulance rates.

Our overall goal is to basically improve the quality of EMS service by championing effective life-saving practices while making sure that costs are contained.  The good news is that many of the recent developments in EMS care are operational and inexpensive (like using the new CCR method for resuscitation).