Arizona is set to participate in the Federal Rural Health Transformation Program which will include funding for rural ambulance services and EMS programs. The application is an overview of plans that include EMS key stake stakeholder groups, workforce development, EMCT multi-state compact certification, training programs, resiliency and wellness programs, community paramedicine and telehealth, a behavioral health transfer program, as well as data tracking systems. Ambulance agencies, fire agencies and the 4 EMS Regional Councils submitted ideas directly to the Governor’s office and to ADHS BEMSTS so that rural EMS strategies were received. Rural ambulance and EMS agencies have an opportunity to get involved and structure funded programs that are needed. Please actively participate in the plan development and implementation of these rural programs, and it starts by reading what might be available for your rural agency!

 Excerpts from the Arizona Governors website:

“7 Arizona associations and organizations praised Arizona’s efforts to engage with the health care community to submit an application that will meet Arizona’s needs. Signers include health associations representing Arizona’s hospitals, community health centers, behavioral health providers, nursing homes, doctors, nurses, ambulances, fire chiefs, fire districts, and Medicaid health plans”. The letter of support includes the Arizona Ambulance Association and is attached. 

Letter of Support

 Link to the Arizona Governors Website

Excerpts from the Arizona Project Narrative that include ambulance and EMS:

Currently, Emergency Medical Services (EMS) personnel and Physician Assistants (PAs) are required to obtain Arizona-specific licenses, as the state does not participate in interstate licensure compacts for these professions. This approach, while maintaining rigorous standards, results in administrative barriers that can limit workforce mobility and emergency response coordination, particularly in rural and frontier regions.

Legislative Commitment and Timeline:

Arizona commits to pursuing legislation and associated regulatory changes to join both compacts by December 31, 2027, with full implementation by 2028:

● EMS Personnel Licensure Compact (REPLICA) The State understands and supports that the Arizona legislature will likely introduce legislation during the 2026 legislative session, with approval targeted by December 31, 2027. Arizona has engaged with and will continue to engage with Arizona’s EMS Councils, relevant professional associations, including the Arizona Ambulance Association, Arizona Fire District Association, and unions including the Professional Firefighters of Arizona and United Emergency Medical Professionals of Arizona. Upon enactment, the state will adopt administrative rules and integrate with the national EMS database and background check system to operationalize compact privileges. These actions will enable EMS professionals licensed in other compact states to practice in Arizona without delay, improving emergency response and mutual aid capabilities.

Key stakeholders: Emergency Medical Services EMS and First Responders:

County and Tribal EMS agencies, fire departments, and ambulance services.

Micro Grants for provider upskilling and residency support: Will fund specialized training programs for rural providers including Community Health Workers (CHW), Emergency Medical Technicians (EMTs), and behavioral health professionals, through partnerships with major health systems. The initiative also includes funding for wellbeing support and safety to improve retention and reduce burnout among the existing workforce.

For EMS workforce initiatives, collaboration with ADHS to leverage existing EMS infrastructure, including the State EMS Council and Medical Direction Commission, which meet quarterly. The ADHS Bureau of EMS and Trauma System (BEMSTS) also supports quarterly meetings of the Trauma and EMS Performance Improvement Committee, the Protocols, Medication

Integration of services into care coordination platforms, including mobile and fixed-site services, tele-behavioral health and chronic care services, and expanding EMS service networks to strengthen emergency response and continuity of care. Complementing these priorities, a key initiative under this grant is the AZ REACH Behavioral Health Transfer Program Expansion, this expansion will extend services to include behavioral health transfers for rural areas.

Across both programs, Arizona will institute processes to secure vendors who can build secure data pipelines, dashboards, and fiscal tracking tools that meet federal audit standards.

Stakeholder Engagement Plan

During the planning stage, Arizona engaged rural hospitals, frontline providers, and other healthcare stakeholders through surveys and a statewide RFI. Tribal health authorities were also consulted to tailor approaches for Tribal communities. As the program moves into implementation, the State will continue engaging existing stakeholders and expand engagement to include hospital IT directors, EMS agencies, and rural health clinics. This expanded collaboration will support alignment on strategies to increase access through technology and innovative care models.

Advisory committees composed of representatives from key stakeholder groups will meet quarterly to guide planning, implementation, and performance tracking for each grant component.

The Rural Health Innovative Care Pilot Program will be guided by an advisory committee including representatives from critical access and rural hospitals, FQHCs, EMS agencies, community mental health centers, Tribal 638 hospitals, Tribal health departments, and local government partners. This group will advise on pilot project selection, oversee integration of mobile and satellite service delivery and support community-based care coordination. It will also provide input on the adoption of alternative payment models to promote sustainability and alignment with value-based care goals.

The Rural Health Innovative Care Pilot Program supports broader health reform and Medicaid transformation goals by connecting rural delivery innovations to policy development. Insights from pilot implementation will inform AHCCCS and ADHS decisions on alternative payment models, care coordination standards, and performance-based contracting. The program also complements ongoing efforts in EMS integration and community paramedicine policy development advancement.

Network Structure: Statewide collaboration amongst agencies led by the OEO, as part of the Governor’s Workforce Cabinet and Talent Ready AZ workforce and education initiative, along with AHCCCS, ADHS, Arizona Area Health Education Centers (AHEC), the Arizona Advisory Council on Indian Health Care (AACIHC), and regional Emergency Medical Services (EMS) Councils. OEO will also coordinate with Arizona’s professional healthcare membership associations, Career and Technical Education Districts (CTEDs), public community colleges, and state universities. Integration with the Governor’s Workforce Cabinet ensures alignment with State workforce goals, as well as complementary resources and initiatives (e.g., broadband workforce).

1.7 Cause Identification and Mitigation

● Root Causes: Geographic isolation, workforce shortages, and fragmented service delivery remain primary drivers of poor rural health outcomes.

● Remediation Plan: Integrate co-located care models, expand telehealth and EMS interoperability, and enhance local capacity through shared staffing, data systems, and fiscal reforms. Community-based hubs will ensure continuity across the lifespan and reduce health disparities.