Certificate of Necessity: Application, Renewal, and Transfers

To operate a ground ambulance service in Arizona, you need an Arizona ambulance Certificate of Necessity (CON) issued by the Arizona Department of Health Services (ADHS). The certificate is a revocable authorization, not a franchise or property right, and the director can issue, amend, suspend, or revoke it.¹ To get one, you have to show the community actually needs the service you’re proposing and that you can deliver it.

Who Has to Apply

The default rule sweeps broadly: any person or entity that wants to run an ambulance service in Arizona must apply. Private companies, municipalities, and fire districts all fall under it.

Two narrow exemptions exist. Vehicles and individuals already exempt from ambulance registration under ARS 36-2217 don’t need a separate CON, and services operating under temporary authority granted under ARS 36-2242 are also exempt. That temporary-authority track is designed for urgent gaps in coverage when a community suddenly loses emergency transport.²

How the Application Works

You file on the form prescribed by the ADHS director, describing the proposed service, the geographic area you want to cover, and the resources you’ll bring to it. ADHS then reviews the filing under timelines set in the administrative rules.

One deadline inside that review deserves attention. If the director requests additional information and you don’t respond, ADHS treats the application as withdrawn. A withdrawn application isn’t an appealable agency action, which means there’s no route back except a fresh filing.²

During review, ADHS notifies interested parties and may post public notice so stakeholders can weigh in. The director then issues, denies, or conditionally grants the certificate, and that decision is final unless appealed under ARS 36-2234.²

What the Director Must Find Before Issuing

Four requirements have to be satisfied. Missing any one is enough for denial.²

Public necessity. The director must find the community needs the proposed service, or at least part of it. The evaluation looks at population, geographic gaps in coverage, and whether existing services already meet demand. The point is to fill real holes without duplicating adequate coverage.

Fitness of the applicant. You must be “fit and proper” to run an ambulance service. In practice that means the director looks at qualifications, operational plans, staffing, and track record. Money without experience can fail this test; so can experience without financial footing.

Fees. You have to pay the fees required under ARS 36-2240 before the certificate issues. For an initial CON, the fee is $200 for each ambulance you propose to operate.³

Surety bond. You must file a surety bond under ARS 36-2237. The bond acts as a financial guarantee that you’ll meet the obligations of a certificate holder, with the amount set by that statute.

Who Else Has a Say

Arizona law gives certain stakeholders standing as “interested parties as a matter of law” in the CON process:

Any city, town, fire district, fire authority, or tribal government whose boundaries fall wholly or partly within the proposed service area.
Any ambulance service already holding a CON for the same service area.
Any Arizona-licensed hospital located within the proposed service area.

The director must hold a public hearing on any proposed CON action and mail notice to every ambulance service in the affected region and every interested party at least 15 days before the hearing.⁴ Objections raised at that hearing carry real weight when they come with concrete evidence about local conditions.

How the Service Area Is Drawn

The CON defines a specific geographic service area, and the method depends on who’s applying. For political subdivisions (cities, towns, fire districts, fire authorities), the service area generally matches the entity’s jurisdictional boundaries. If those boundaries later expand through annexation or similar action, the CON service area automatically expands with them, subject to limited exceptions.¹

For other applicants, service areas can be described using physical landmarks and measurements or by reference to existing political boundaries, giving the director room to fit the state’s varied geography.

A common misconception is worth flagging. When fire districts merge or consolidate, the surviving entity doesn’t automatically pick up an expanded service area. The CON still covers only the area originally described, and any expansion runs through the amendment process.

Population shifts of 10 percent or more, measured against the most recent decennial census or five-year estimate, trigger a department review of whether response times need adjustment, including the effect on the service’s rates and charges.¹

Renewal and the 30-Day Trap

Arizona CONs expire and must be renewed. Your renewal application has to be filed at least 30 days before the certificate expires. File on time and the existing CON stays in effect until ADHS rules on the renewal, so operations continue without a gap.⁵

Miss that 30-day window and the consequences are severe. You must stop operating at 12:01 a.m. on the expiration date. To get back in service, you have to file a brand-new initial application and wait for ADHS to issue a new CON before resuming operations.⁵

If you decide not to renew, you must give ADHS written notice at least 90 days before expiration and keep providing service until that date arrives. Walking away early while the certificate is still active isn’t an option.

Transfers and Amendments

A CON can’t be sold, assigned, or otherwise transferred without the director’s written approval. When a transfer is approved, the director issues a new certificate to the buyer or assignee, but it’s only valid for the unexpired term of the original. Buying someone else’s CON doesn’t reset the clock.¹

Amendments, such as a change to the service area or level of service, also run through the director. ADHS is required to offer technical assistance to ambulance services seeking to obtain or amend a certificate, so contacting the department early is worth the call.⁶

Suspension, Revocation, and Appeals

The director can revoke a CON at any time; the statute is explicit that the certificate creates no property right. In an emergency, the director can also suspend a certificate under the hearing provisions of ARS 36-2234.¹

If your application is denied or your certificate is revoked, you can appeal under ARS 36-2234, which triggers a hearing where you present your case. An application deemed withdrawn for failing to respond to an information request isn’t appealable, though. Only an outright denial gives you that route.²

Ongoing Obligations After You’re Certified

Holding a CON comes with continuing duties that are easy to miss until they create problems. Every ambulance service must file an annual financial report with ADHS no later than 180 days after the close of its accounting period. You also have to notify the department within 30 days whenever you change the number or location of your suboperation stations.⁶

ADHS inspects each registered ambulance at least once every 12 months to confirm the vehicle is operational and safe and that required medical equipment is in working order. Response times set for your service area are also reviewed on a six-year cycle, with the department weighing population density, geography, medical considerations, and the financial impact on your rates.⁶

1
Arizona Legislature. Arizona Revised Statutes Title 36 – Section 36-2236
2
Arizona Legislature. Arizona Revised Statutes Title 36 – Section 36-2233
3
Arizona Legislature. Arizona Revised Statutes Title 36 – Section 36-2240
4
Arizona Legislature. Arizona Revised Statutes Title 36 – Section 36-2234
5
Cornell Law Institute. Arizona Administrative Code R9-25-903 – Application for Renewal of a Certificate of Necessity
6
Arizona Legislature. Arizona Revised Statutes Title 36 – Section 36-2232