Late Monday, an Administrative Law Judge issued an Order recommending that I approve American Medical Response of Maricopa’s (AMR) application to operate ambulances (certificate of necessity or CON) in all of Maricopa County.
We regulate ambulance services differently than most states. In order to operate an ambulance here the applicant needs to meet a number of requirements including demonstrating that: 1) there’s “public necessity” for the services they want to provide; 2) they have the finances and operational skills necessary to operate the service; and that 3) they can provide high quality clinical care and evaluate their service with a performance improvement plan.
An application for a CON triggers a process that starts in our Bureau of EMS and Trauma System where we evaluate the application to see if it’s complete. Once that’s done, we notify folks in the area about the proposed CON. If the application is uncontested, then it comes directly to me for a decision. If the application is contested (as this one was), it goes to a hearing before a judge at the Office of Administrative Hearings.
The Administrative Law judge evaluates the application and the evidence presented during the hearing and issues a recommendation. The Judge sends the recommendation (called an Order) to me, and I have 30 days to make a decision. I can: 1) deny the application; 2) accept it as-is; 3) accept the application with amendments; or 4) allow the recommendation to take effect without acting.
The Judge reviewed several criterion in AMR’s application (public necessity, billing rate, fiscal and operational experience, clinical excellence, negative financial impact on the current provider). The Order concludes that: “In view of the foregoing, it is recommended that the Director approve the proposed Application, directing BEMSTS to issue a CON to American Medical Response of Maricopa, LLC (“AMR”) upon AMR’s confirmation that it is ready to immediately assume all rights and responsibilities under that CON.”
Before I make a decision, I’ll review the hearing record, the application and the judge’s decision and Order. I’ll be paying particular attention to how the Judge came to her conclusion. Stay tuned.