Ariz. Admin. Code § 9-25-909

Current through Register Vol. 30, No. 45, November 8, 2024

Section R9-25-909 - Ambulance Revenue and Cost Reporting Requirements (Authorized by A.R.S. Sections 36-2232, 36-2246)

A. Except as provided in subsection (C), a certificate holder shall ensure that an Ambulance Revenue and Cost Report for a ground ambulance service includes, in a Department-provided format:

1. The following information to identify the source and time period for the Ambulance Revenue and Cost Report:

a. The legal name of the ground ambulance service and any other names by which the ground ambulance service is known;

b. The identifying number on the certificate holder's current certificate of necessity, if applicable;

c. The physical address at which financial records on which the information in the Ambulance Service and Cost Report is based are maintained;

d. The mailing address for the ground ambulance service, if different from the address in subsection (A)(1)(c);

e. The name, title, e-mail address, and telephone number of the following:

i. The individual responsible for managing the ground ambulance service; and

ii. The individual to contact regarding the information in the Ambulance Service and Cost Report;

f. The beginning date and ending date of the reporting period; and

g. Whether the method of valuing inventory is:

i. First-in-first-out;

ii. Last-in-first-out; or

iii. Another method, including a description of the method;

2. The following information to provide data in support of information in other portions of the Ambulance Revenue and Cost Report:

a. Except as provided in subsection (B), for each of the following, for the reporting period, under the ground ambulance service's subscription service rate, contract rate, or general public rate, the number of:

i. Transports billed at the critical care rate,

ii. Transports billed at the ALS base rate,

iii. Transports billed at the BLS base rate,

iv. Miles billed at the mileage rate while a patient is being transported,

v. Hours and minutes billed according to R9-25-1108(E), and

vi. Canceled and non-billable runs;

b. For each of subsections (A)(2)(a)(i) through (vi), the total number for all three rates for the reporting period; and

c. If applicable, the number of hours different classifications of EMCT and other ambulance attendants volunteered for the ground ambulance service and the total number of volunteer hours for the reporting period;

3. The following information about revenue generated for the reporting period from routine operations of the ground ambulance service:

a. Except as provided in subsection (B), the amount of revenue generated from the following sources of revenue:

i. Transports billed at the critical care rate;

ii. Transports billed at the ALS base rate;

iii. Transports billed at the BLS base rate;

iv. Miles billed at the mileage rate while a patient is being transported;

v. Hours and minutes billed according to R9-25-1108(E),

vi. Charges for disposable supplies, medical supplies, medications, and oxygen-related items;

vii. Charges for nursing services;

viii. Charges for positioning a staffed ground ambulance vehicle at a public or private event, such as a sporting event or car race; and

ix. Other sources of routine operating revenue; and

b. The total amount of revenue generated for the reporting period from routine operations of the ground ambulance service;

4. The costs of goods, such as disposable supplies, medical supplies, medications, and oxygen-related items, charged to patients for the reporting period, calculated as:

a. Thecost of the beginning inventory of all such goods,

b. Plus the costs of purchased items,

c. Plus any other costs, and

d. Minus the cost of the ending inventory of all such goods;

5. The following information about revenue generated for the reporting period from sources other than routine operations of the ground ambulance service:

a. For each entity with which the ground ambulance service has a ground ambulance service contract:

i. The name of the entity with which the ground ambulance service has the contract,

ii. The total number of billable runs for the reporting period,

iii. The amount billed for the reporting period based on the general public rate,

iv. The percent discount under the contract, and

v. The resulting discount amount;

b. The total amount of the discount amount from all the entities listed according to subsection (A)(5)(a); and

c. For a ground ambulance service providing subscription service, subscription service revenue and direct expenses, including:

i. The amount billed for the reporting period at the general public rate established according to R9-25-1101 or R9-25-1102;

ii. Any reductions to the amount in subsection (A)(5)(c)(i) due to:

(1) The discount amount the ground ambulance service receives from AHCCCS as an allowable rate,

(2) The discount amount the ground ambulance service receives from Medicare as an allowable rate,

(3) The subscription service rate established according to R9-25-1105, and

(4) Uncollectable revenue associated with subscription service;

iii. The total of the amounts in subsections (A)(5)(c)(ii)(1) through (4);

iv. The difference between the amount in subsection (A)(5)(c)(i) and the amount in subsection (A)(5)(c)(iii);

v. The amount of revenue from the sales of subscription service contracts;

vi. A description of other revenue associated with subscription service and the amount of revenue;

vii. The total subscription service revenue, calculated as the sum of the amounts in subsections (A)(5)(c)(iv) through (vi); and

viii. Direct expenses incurred selling subscription service contracts, by type of expense and in total;

d. The amount of revenue generated for the reporting period, by type of source of revenue, including from any other sources of revenue besides routine operations of the ground ambulance service;

e. The total amount of revenue generated for the reporting period from sources other than routine operations of the ground ambulance service;

6. Except as provided in subsection (B), the following information about discounts for all applicable patients for the reporting period, based on the difference between the general public rate a ground ambulance service assesses a patient and the discount amount the ground ambulance service receives for each of the following:

a. From AHCCCS reimbursement;

b. From Medicare reimbursement;

c. From a contact rate or range of rates established according to R9-25-1103; and

d. From the provision of subscription service established according to R9-25-1105;

e. From any other discount amount, including a description of the source and the amount; and

f. The totals of subsections (A)(6)(a) through (e);

7. The total amount of revenue generated and allowances given by the ground ambulance service for the reporting period;

8. The following information about personnel of the ground ambulance service:

a. Except as provided in subsection (B), the number of FTEs, calculated as the sum of all hours for which employee wages were paid for the reporting period divided by 2,080, for each of the following categories of personnel, for the reporting period:

i. Owners or officers of the ground ambulance service;

ii. Managers of the ground ambulance service;

iii. Each classification of ambulance attendants who provide services on a ground ambulance vehicle, not including personnel who were paid wages on a per run basis; and

iv. Other types of employees;

b. The total number of FTEs for the reporting period;

c. Except as provided in subsection (B), the following for each category of personnel in subsections (A)(8)(a)(i) through (iv), including personnel who were paid wages on a per run basis:

i. Gross wages,

ii. Payroll taxes,

iii. Employee fringe benefits, and

iv. The totals of subsections (A)(8)(c)(i) through (iii);

d. The total amount of personnel expenses in subsection (A)(8)(c) for all personnel;

e. Details of salaries and wages paid to officers or owners of the ground ambulance service, including:

i. The name, title, and percentage ownership of each officer or owner;

ii. The salary or wages paid and FTE equivalent for the time the officer or owner spent performing management duties, for each officer or owner;

iii. The salary or wages paid and FTE equivalent for the time the officer or owner spent performing duties as an EMCT, for each officer or owner;

iv. The salary or wages paid and FTE equivalent for the time the officer or owner spent performing office or administerial duties, for each officer or owner;

v. The salary or wages paid and FTE equivalent for the time the officer or owner spent performing other types of duties, for each officer or owner; and

vi. The total salary or wages paid and FTE equivalent for the time all officers or owners spent performing the types of duties in subsections (A)(8)(e)(ii) through (v); and

f. Details on scheduled shifts, hourly wages, annual salary, and amount per run or shift for each category of personnel in subsection (A)(8)(b)(ii) through (iv);

9. Except as provided in subsection (B), the operating expenses incurred by the ground ambulance service for the reporting period, for each type of operating expense;

10. The total operating expenses incurred by the ground ambulance service for the reporting period;

11. Ambulance service income, calculated as the difference between the amount identified in subsection (A)(7) and the amount identified in subsection (A)(10);

12. The income and expenses, other than revenue and operating expenses, for each type of income received and expense incurred by the ground ambulance service for the reporting period;

13. The total income and expenses, other than revenue and operating expenses, for the reporting period;

14. The net income or loss for the reporting period, before taxes, calculated as the sum of the amounts identified in subsections (A)(11) and (A)(13);

15. The amounts of:

a. State income taxes,

b. Federal income taxes, and

c. The total of subsections (A)(15)(a) and (b);

16. The net income or loss for the reporting period, after taxes, calculated as the difference between the amounts in subsections (A)(14) and (A)(15)(c);

17. Information pertaining to depreciation of property or equipment;

18. The amount of assets, for each type of asset, of the ground ambulance service for the reporting period;

19. The total amount of assets of the ground ambulance service for the reporting period;

20. The amount of liabilities, for each type of liability, of the ground ambulance service for the reporting period;

21. The total amount of liabilities of the ground ambulance service for the reporting period;

22. The amount of long-term debt, for each type of long-term debt, of the ground ambulance service for the reporting period;

23. The total amount of long-term debt of the ground ambulance service for the reporting period;

24. The amount of equity, for each type of equity, of the ground ambulance service for the reporting period;

25. The total amount of equity of the ground ambulance service for the reporting period;

26. The total amount of liabilities and equity of the ground ambulance service for the reporting period;

27. The statement of cash flows for the reporting period;

28. A list of all business organizations or governmental entities affiliated with the certificate holder, if applicable, including for each:

a. The legal name;

b. The type of business organization, if applicable; and

c. Whether the relationship to the applicant is as a:

i. Parent organization,

ii. Subordinate organization,

iii. Subsidiary organization,

iv. Member organization, or

v. Business organization related to an ambulance service, EMS, or transport for which a controlling person of the applicant is also a controlling person of the business organization; and

29. An attestation including:

a. The signature of the individual specified in subsection (A)(1)(e)(i), including the individual's title and date of signature;

b. A statement that the individual in subsection (A)(29)(a) directed the preparation of the Ambulance Revenue and Cost Report in accordance with requirements in this Article and using an accrual basis of accounting; and

c. A statement that the information provided in the Ambulance Revenue and Cost Report is true and correct.

B. If a ground ambulance service applies local resident subsidization to reimbursement under the general public rate, a certificate holder shall ensure that the Ambulance Revenue and Cost Report for a ground ambulance service includes, in a Department-provided format:

1. The following, in total and broken out for both subsidized patients and non-subsidized patients:

a. The information for subsections (A)(2)(a)(i) through (vi) under the ground ambulance service's general public rate;

b. The amount of revenue generated from the sources of revenue specified in subsections (A)(3)(a)(i) through (ix) from routine operations of the ground ambulance service; and

c. The amount of discount for all applicable patients for the reporting period, based on the difference between the general public rate a ground ambulance service assesses a patient and the discount amount the ground ambulance service receives:

i. From AHCCCS reimbursement,

ii. From Medicare reimbursement, and

iii. Due to the local resident subsidization;

2. The number of FTEs, calculated as the sum of all hours for which employee wages were paid for the reporting period divided by 2,080, for each of the following categories of personnel, for the reporting period:

a. Managers of the ground ambulance service;

b. Ambulance attendants who provide services on a ground ambulance vehicle, not including personnel who were paid wages on a per run basis; and

c. Other types of employees;

3. The following for each category of personnel in subsection (B)(2)(a) through (c):

a. Gross wages,

b. Payroll taxes,

c. Employee fringe benefits, and

d. The totals of subsections (B)(3)(a) through (c);

4. If applicable, for each category of employee in subsection (B)(2)(a) through (c), the basis of allocation of gross wages, payroll taxes, employee fringe benefits, and the totals of the allocations; and

5. If applicable, for each category of employee in subsection (B)(2)(a) through (c), the allocation percentage for gross wages, payroll taxes, and employee fringe benefits;

6. The operating expenses incurred, for each type of operating expense, by the ground ambulance service for the reporting period in total and with the allocation percentage for each category of operating expense, including the basis of allocation.

C. A certificate holder shall ensure that an Ambulance Revenue and Cost Report for a ground ambulance service under A.R.S. § 36-2246(C) includes, in a Department-provided format:

1. The following information to identify the source and time period for the Ambulance Revenue and Cost Report:

a. The legal name of the ground ambulance service and any other names by which the ground ambulance service is known; and

b. The beginning date and ending date of the reporting period; and

2. The following information to provide data in support of information in other portions of the Ambulance Revenue and Cost Report:

a. For each of the following, for the reporting period, under the ground ambulance service's subscription service rate, contract rate, or general public rate, the number of:

i. Transports billed at the critical care rate,

ii. Transports billed at the ALS base rate,

iii. Transports billed at the BLS base rate,

iv. Miles billed at the mileage rate while a patient is being transported,

v. Hours and minutes billed according to R9-25-1108(E), and

vi. Canceled and non-billable runs;

b. For each of subsections (C)(2)(a)(i) through (vi), the total number for all three rates for the reporting period; and

c. If applicable, the number of hours different classifications of EMCT and other ambulance attendants volunteered for the ground ambulance service and the total number of volunteer hours for the reporting period;

3. The following information about revenue generated for the reporting period from routine operations of the ground ambulance service:

a. The amount of revenue generated from the following sources of revenue:

i. Transports billed at the critical care rate;

ii. Transports billed at the ALS base rate;

iii. Transports billed at the BLS base rate;

iv. Miles billed at the mileage rate while a patient is being transported;

v. Hours and minutes billed according to R9-25-1108(E),

vi. Charges for disposable supplies, medical supplies, medications, and oxygen-related items;

vii. Charges for nursing services; and

viii. Charges for positioning a staffed ground ambulance vehicle at a public or private event, such as a sporting event or car race; and

b. The total amount of revenue generated for the reporting period from routine operations of the ground ambulance service;

4. The following information about discounts for all applicable patients for the reporting period, based on the difference between the general public rate a ground ambulance service assesses a patient and the discount amount the ground ambulance service receives:

a. From AHCCCS reimbursement,

b. From Medicare reimbursement,

c. Due to a contact rate or range of rates established according to R9-25-1103,

d. Due to a subscription service rate established according to R9-25-1105,

e. Due to any other revenue reduction, and

f. From the totals of subsections (C)(4)(a) through (e);

5. The total amount of revenue generated, less allowances given, by the ground ambulance service from routine operations for the reporting period;

6. The following information about personnel of the ground ambulance service:

a. The total number of FTEs, calculated as the sum of all hours for which employee wages were paid for the reporting period divided by 2,080, for the reporting period;

b. The number of FTEs, for each of the following categories of personnel, for the reporting period, not including personnel who were paid wages on a per run basis:

i. Managers of the ground ambulance service,

ii. Ambulance attendants who provide services on a ground ambulance vehicle, and

iii. Other types of employees;

c. The gross wages for each category of personnel in subsection (C)(6)(b)(i) through (iii);

d. Payroll taxes and employee fringe benefits for each category of personnel; and

e. The total gross wages taxes and fringe benefits for all category of personnel in subsections (C)(6)(b)(i) through (iii);

7. The operating expenses incurred by the ground ambulance service for the reporting period for each type of operating expense;

8. The total operating expenses incurred by the ground ambulance service for the reporting period;

9. The total operating income or loss, calculated as the difference between the amount identified in subsection (C)(5) and the amount identified in subsection (C)(8);

10. The amount of revenue generated or income derived for the reporting period by type of source of revenue or income, from sources other than routine operations of the ground ambulance service, including from:

a. The sale of subscription service contracts under R9-25-1105;

b. Any other sources of operating revenue besides routine operations of the ground ambulance service, including a description of the sources and amount of revenue;

c. Local supportive funding; and

d. Any other sources of income besides routine operations of the ground ambulance service, including a description of the sources and amount of income;

11. Any other expenses incurred by the ground ambulance service for the reporting period, including a description of the sources and amount of expenses;

12. The net income or loss for the reporting period, before taxes, from sources other than routine operations of the ground ambulance service, calculated as the sum of the amounts identified in subsections (C)(9) and (C)(10), minus the amount in subsection (C)(11);

13. The amounts of:

a. State income taxes,

b. Federal income taxes, and

c. The total of subsections (C)(13)(a) and (b);

14. The net income or loss for the reporting period, after taxes, calculated as the difference between the amounts in subsections (C)(12) and (C)(13)(c);

15. The amount of assets, for each type of asset, of the ground ambulance service for the reporting period;

16. The total amount of current assets of the ground ambulance service for the reporting period;

17. Information pertaining to depreciation of property or equipment;

18. The amount of liabilities, for each type of liability, of the ground ambulance service for the reporting period;

19. The total amount of liabilities of the ground ambulance service for the reporting period;

20. The amount of long-term debt, for each type of long-term debt, of the ground ambulance service for the reporting period;

21. The total amount of long-term debt of the ground ambulance service for the reporting period;

22. The amount of equity, for each type of equity, of the ground ambulance service for the reporting period;

23. The total amount of equity of the ground ambulance service for the reporting period;

24. The total amount of liabilities and equity of the ground ambulance service for the reporting period;

25. The statement of cash flows for the reporting period.

Ariz. Admin. Code § R9-25-909

New Section adopted by final rulemaking at 7 A.A.R. 1098, effective February 13, 2001 (Supp. 01-1). Renumbered and amended from R9-25-910 by final rulemaking at 30 A.A.R. 581, effective 3/7/2024.