No. 37683 (New Rule): Rule R426-3. Licensure

(New Rule)

DAR File No.: 37683
Filed: 06/04/2013 09:16:10 AM

RULE ANALYSIS

Purpose of the rule or reason for the change:

This new rule is in response to the Governor's mandate for rule review and simplification. This proposed new rule is part of a change to the sequence of numbering for Title R426 that allows for a new set of rules that begins with Rules R426-1 through R426-9. This is part of a set of rules to update, and re-number all of the administrative rules in a more concise and logical order for implementation.

Summary of the rule or change:

The new rule includes all of the requirements for ambulance service licensure. It incorporates rules currently found in Rules R426-2 and R426-15 that specify licensure requirements. Rule R426-2 rules pertaining to air ambulance will be allowed to be expired and Rule R426-15 is being repealed. Licensure requirements have been modified to reflect current improvements and changes as directed by the EMS Rules Task Force and EMS Committee. (DAR NOTE: The proposed new Rule R426-2 is under DAR No. 37682, and the proposed repeal of Rule R426-15 is under DAR No. 37694 in this issue, July 1, 2013, of the Bulletin.)

State statutory or constitutional authorization for this rule:

• Title 26, Chapter 8a

Anticipated cost or savings to:

the state budget:

No anticipated fiscal impact to the state budget because there are no changes in the existing rule requirements that are imposed by this new rule.

local governments:

No anticipated fiscal impact to local governments because there are no changes in the existing rule requirements that are imposed by this new rule.

small businesses:

No anticipated fiscal impact to small businesses because there are no changes in the existing rule requirements that are imposed by this new rule.

persons other than small businesses, businesses, or local governmental entities:

No anticipated fiscal impact to businesses because there are no changes in the existing rule requirements that are imposed by this new rule.

Compliance costs for affected persons:

No anticipated fiscal impact for affected persons because there are no changes in the existing rule requirements that are imposed by this new rule.

Comments by the department head on the fiscal impact the rule may have on businesses:

There should be minimum impact on businesses as this clarifies any ambiguities in the requirements for provider designations.

David Patton, PhD, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Health
Family Health and Preparedness, Emergency Medical Services
3760 S HIGHLAND DR
SALT LAKE CITY, UT 84106

Direct questions regarding this rule to:

• Guy Dansie at the above address, by phone at 801-273-6671, by FAX at 801-273-4165, or by Internet E-mail at [e-mail]

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

07/31/2013

This rule may become effective on:

08/07/2013

Authorized by:

David Patton, Executive Director

RULE TEXT

R426. Health, Family Health and Preparedness, Emergency Medical Services.

R426-3. Licensure.

R426-3-100. Authority and Purpose.

(1) This Rule is established under Chapter 8, Title 26a, Chapter 8a. It establishes standards for the licensure of an air ambulance, ground ambulance, and paramedic services.

(2) The purpose of this rule is to set forth air and ground ambulance policies, rules, and standards adopted by the Utah Emergency Medical Services Committee, which promotes and protects the health and safety of the people of this state.

(3) The definitions in Title 26, Chapter 8a are adopted and incorporated by reference into this rule.

 

R426-3-200. Requirement for Licensure.

A person or entity that provides or represents that it provides air ambulance, ground ambulance, paramedic ground ambulance, or paramedic services must first be licensed by the Department.

 

R246-3-300. Licensure Types.

(1) The Department may issue exclusive ground ambulance transport licenses for the following types of service at the given levels:

(a) emergency medical technician (EMT);

(b) advanced emergency medical technician (AEMT); and

(c) paramedic

(d) current emergency medical technician intermediate advanced (EMT-IA) licenses will remain in effect, no new EMT-IA licenses will be issued.

(2) The Department may issue exclusive ground ambulance inter-facility transport licenses for the following types of service at the given levels:

(a) emergency medical technician (EMT);

(b) advanced emergency medical technician (AEMT); and

(c) paramedic.

(3) The Department may issue exclusive paramedic, non-transport licenses for the following types of service at the given response configurations:

(a) paramedic; and

(b) paramedic tactical

(4) The Department may issue Air Ambulance licenses for the following types of services at the given levels:

(a) advanced life support;

(b) specialized life support;

(5) The Department may issue Air Ambulance licenses for the following types of specialties for which the specialized Life support Air Ambulance Service is licensed.

(a) specialty obstetrics;

(b) specialty pediatrics;

(c) specialty neonatal;

(d) specialty burns; and

(e) specialty cardiac.

 

R426-3-400. Scope of Operations.

(1) A licensee may only provide service to its specific licensed geographic service area and is responsible to provide service to its entire specific geographic service area except as provided by R426-3-800 Aid Agreements. It will provide emergency medical services for its category of licensure that corresponds to the certification levels in R426-5 Emergency Medical Services Training and Certification Standards.

(2) A licensee may not subcontract. A subcontract is present if a licensee engages a person that is not licensed to provide emergency medical services to all or part of its specific geographic service area. A subcontract is not present if multiple licensees allocate responsibility to provide ambulance services between them within a specific geographic service area for which they are licensed to provide ambulance service.

(3) A ground ambulance inter-facility transfer licensee may only transport patients from a hospital, nursing facility, emergency patient receiving facility, mental health facility, or other licensed medical facility when arranged by the transferring physician for the particular patient.

(4) A person or entity may not furnish, operate, conduct, maintain, advertise, or provide ground or air ambulance transport services to patients within the state or from within the state to out of state unless licensed by the Department.

(5) All licensed Emergency Medical Services conforming to R426-3-200 must provide services 24 hours a day, every day of the year. Air Medical services must provide air medical services 24 hours a day, every day of the year as allowed by weather conditions.

(6) A ground ambulance or paramedic licensee must provide all ambulance or paramedic services, including standby services, for any special event that requires ground ambulance or paramedic services within its geographic service area.

 

R426-3-500. Minimum Licensure Requirements Air Ambulance, Ground Ambulance, and Paramedic Services.

A licensee conforming to R426-3-200 must meet the following minimum requirements:

(1) have sufficient air or ground ambulances, emergency response vehicle(s), equipment, and supplies that meet the requirements of this rule and as may be necessary to carry out its responsibilities under its license or proposed license without relying upon aid agreements with other licensees.

(2) have locations or staging areas for stationing its vehicles.

(3) have a current written dispatch agreement with a designated emergency medical dispatch center.

(4) have current written aid agreements with other licensees to give assistance in times of unusual demand.

(5) have a Department certified EMS training officer that is responsible for continuing education.

(6) have a current plan of operations, which shall include;

(a) a business plan demonstrating:

(i) ability to provide the service; and

(ii) fiscal plan.

(b) a roster of medical personnel which includes level of certification or licensure to ensure there is sufficient trained and certified staff that meets the requirements of R426-4-200 Staffing, and

(c) operational procedures.

(7) a description of how the licensee or applicant proposes to interface with other EMS agencies.

(8) all permitted vehicles shall be equipped to allow field EMS personnel to be able to:

(a) communicate with hospital emergency departments, dispatch centers, EMS providers, and law enforcement services; and

(b) communicate on radio frequencies assigned to the Department for EMS use by the Federal Communications Commission.

(9) have a current written agreement with a Department-certified off-line medical director or a medical director certified in the state where the service is based pursuant to R426-3-700.

(10) provide the Department with a copy of its certificate of insurance or if seeking application, provide proof of the ability to obtain insurance to respond to damages due to operation of a vehicle or air ambulance in the manner and following minimum amounts:

(a) have liability insurance in the amount of $300,000 for each individual claim and $500,000 for total claims for personal injury from any one occurrence; and

(b) liability insurance in the amount of $100,000 for property damage from any one occurrence.

(c) the licensee shall obtain the insurance from an insurance company authorized to write liability coverage in Utah or through a self-insurance program and shall:

(i) provide the Department with a copy of its certificate of insurance demonstrating compliance with this section; and

(ii) direct the insurance carrier or self-insurance program to notify the Department of all changes in insurance coverage within 60 days.

(11) not be disqualified for any of the following reasons:

(a) violation of Subsection 26-8a-504; or

(b) disciplinary action relating to an EMS license, permit, designation, or certification in this or any other state that adversely affect its service under its license.

(12) A paramedic tactical service must be a public safety agency or have a letter of recommendation from a county or city law enforcement agency within the paramedic tactical service's geographic service area.

 

R426-3-600. Application.

(1) An applicant desiring to be licensed or to renew its license for an air ambulance, ground ambulance, and paramedic services shall submit the applicable fees and application on Department-approved forms to the Department. As part of the application, the applicant shall submit documentation that it meets the requirements listed in R426-3-500 and the following:

(a) for an application for new service:

(i) a detailed description and detailed map of the exclusive geographical areas that will be served;

(ii) if the requested geographical service area is for less than all ground ambulance or paramedic services, the applicant shall include a written description and detailed map showing how the areas not included will receive ground ambulance or paramedic services;

(iii) if an applicant is responding to a public bid as described in 26-8a-405.2 the applicant shall include detailed maps and descriptions for all geographical areas served in accordance with 26-8a-405.2(2).

(iv) documentation showing that the applicant meets all local zoning and business licensing standards within the exclusive geographical service area that it will serve;

(v) a written description of how the applicant will communicate with dispatch centers, law enforcement agencies, on-line medical control, and patient transport destinations;

(b) for renewal applications:

(i) a written assessment of field performance from the applicant's off-line medical director; and

(ii) other information that the Department determines necessary for the processing of the application and the oversight of the licensed entity.

(2) In addition to the above, an applicant for air ambulance services must submit the following:

(a) certified articles of incorporation, if incorporated;

(b) a statement summarizing the training and experience of the applicant in the air transportation and care of patients;

(c) a copy of current Federal Aviation Administration (FAA) Air Carrier Operating Certificate authorizing FAR, Part 135, operations;

(d) a copy of the current certificates of insurance demonstrating coverage for medical malpractice;

(e) a statement detailing the level of care for which the air ambulance service wishes to be licensed, either advanced or specialized;

(f) air ambulance services must have an agreement to allow hospital emergency department physicians, nurses, and other personnel who participate in emergency medical services to fly on air ambulances;

(g) air ambulance service shall submit a description and location of each dedicated and back-up air ambulance(s) procured for use in the Air ambulance service, including the make, model, and year of manufacture, FAA-N number, insignia, name or monogram, or other distinguishing characteristics; and

(h) successful completion of a Department approved accreditation process; and

(i) for new air ambulance services licensed under R426-3-200 they must submit an application for accreditation by a Department approved accreditation process within one year of receiving a license under this rule; and

(j) air ambulance services licensed under R426-3-200 must achieve accreditation and maintain accreditation.

(3) A ground ambulance or paramedic service holding a license under 26-8a-404, including any political subdivision that is part of special district may respond to a request for proposal if it complies with 26-8a-405(2).

 

R426-3-700. Medical Control.

(1) All licensees must enter into a written agreement with a physician to serve as its off-line medical director to supervise the medical care or instructions provided by the field EMS personnel and dispatchers. The physician must be familiar with:

(a) the design and operation of the local prehospital EMS system; and

(b) local dispatch and communication systems and procedures.

(2) The off-line medical director shall:

(a) develop and implement patient care standards which include written standing orders and triage, treatment, and transport protocols;

(b) ensure the qualification of field EMS personnel involved in patient care through the provision of ongoing continuing medical education programs and appropriate review and evaluation;

(c) develop and implement an effective quality improvement program, including medical audit, review, and critique of patient care;

(d) annually review triage, treatment, and transport protocols and update them as necessary;

(e) suspend from patient care, pending Department review, a field EMS personnel who does not comply with local medical triage, treatment and transport protocols, or who violates any of the EMS rules, or who the medical director determines is providing emergency medical service in a careless or unsafe manner. The medical director must notify the Department within one business day of the suspension.

(f) attend meetings of the local EMS Council, if one exists, to participate in the coordination and operations of local EMS providers.

(g) licensed agencies shall notify the Department if an off-line medical director is replaced, within thirty days after the action.

(h) have current treatment protocols approved by the agency's off-line medical director for the existing service level for renewal or new treatment protocols if seeking an application.

(3) It is the responsibility of the air ambulance medical director to:

(a) authorize written protocols for the use by air medical attendants and review policies and procedures of the Air ambulance service.

(b) develop and review treatment protocols, assess field performance, and critique at least 10% of the Air ambulance service runs.

 

R426-3-800. Aid Agreements.

(1) All licensed ground ambulance provider shall have/maintain aid agreement(s) with other ground ambulance provider(s) to call upon them for assistance during times of unusual demand or standby events.

(2) Aid agreements shall be in writing, signed by both parties, and detail the:

(a) purpose of the agreement;

(b) type of assistance required;

(c) circumstances under which the assistance would be given; and

(d) duration of the agreement.

(3) The parties shall provide a copy of the aid agreement to the emergency medical dispatch centers that dispatch the licensees.

(4) If the ground ambulance licensee is unable or unwilling to provide ambulance standby service or special event coverage, the licensee shall allow a ground ambulance licensee through the use of aid agreements to provide all ground ambulance service for the standby or special event.

 

R426-3-900. Selection of a Provider by Public Bid.

(1) A political subdivision that desires to select a provider through a public bid process as provided in 26-8a-405.1, shall submit its draft request for proposal to the Department in accordance with 26-8a-405.2(2), together with a cover letter listing all contact information. The proposal shall include all the criteria listed in 26-8a-405.1 and 405.2.

(2) The Department shall, within 14 business days of receipt of a request for proposal from a political subdivision, review the request according to 26-8a-405.2(2); and

(a) approve the proposal by sending a letter of approval to the political subdivision;

(b) require the political subdivision to alter the request for proposal to meet statutory and rule requirements; or

(c) deny the proposal by sending a letter detailing the reasons for the denial and process for appeal.

 

R426-3-1000. Application Review and Award.

(1) Upon receipt of an appropriately completed application, for Air ambulance service, ground ambulance or paramedic service license and submission of license fees, the Department shall collect supporting documentation and review each application.

(2) After review and before issuing a license to a new service the Department shall directly inspect the air or ground vehicle(s), equipment, and required documentation.

(3) If, upon Department review, the application is complete and meets all the requirements, the Department shall:

(a) for a new license application, issue a notice of approved application as required by 26-8a-405 and 406;

(b) issue a renewal license to an applicant in accordance with 26-8a-413(1) and (2) or 26-8a-405.1(3), whichever is applicable.

(c) issue a four-year renewal license to a license selected by a political subdivision if the political subdivision certified to the Department that the licensee has met all of the specifications of the original bid and requirements of 26-8a-413(1) through 26-8a-313(3); or

(d) issue a second four-year renewal license to a licensee selected by a political subdivision if:

(i) the political subdivision certified to the Department that the licensee has met all of the specifications of the original bid and requirements of 26-8a(1) through (3); and

(ii) if the Department or the political subdivision has not received, prior to the expiration date, written notice from an approved applicant desiring to submit a bid for ambulance or paramedic services.

(4) Award of a new license or a renewal license is contingent upon the applicant's demonstration of compliance with all applicable statute and rules and a successful Department quality assurance review.

(5) A license may be issued for up to a four-year period unless revoked or suspended by the Department. The Department may alter the length of the license to standardize renewal cycles.

(6) Upon the request of the political subdivision and the agreement of all interested parties and the Department that the public interest would be served, the renewal license may be issued for a period of less than four years or a new request for the proposal process may be commenced at any time.

 

R426-3-1100. Criteria for Denial or Revocation of Licensure .

(1) The Department may deny an application for a license, a renewal of a license, or revoke, suspend or restrict a license without reviewing whether a license must be granted or renewed to meet public convenience and necessity for any of the following reasons:

(a) failure to meet substantial requirements as specified in the rules governing the service;

(b) failure to meet vehicle, equipment, staffing, or insurance requirements;

(c) failure to meet agreements covering training standards or testing standards;

(d) substantial violation of Subsection 26-8a-504(1);

(e) a history of disciplinary action relating to a license, permit, designation, or certification in this or any other state;

(f) a history of serious or substantial public complaints;

(g) a history of criminal activity by the licensee or its principals while licensed or designated as an EMS provider or while operating as an EMS service with permitted vehicles;

(h) falsification or misrepresentation of any information in the application or related documents;

(i) failure to pay the required licensing or permitting fees or other fees or failure to pay outstanding balances owed to the Department;

(j) financial insolvency;

(k) failure to submit records and other data to the Department as required by R426-7;

(l) a history of inappropriate billing practices, such as:

(i) charging a rate that exceeds the maximum rate allowed by rule;

(ii) charging for items or services for which a charge is not allowed by statute or rule; or

(iii) Medicare or Medicaid fraud.

(m) misuse of grant funds received under Section 26-8a-207; or

(n) violation of OSHA or other federal standards that it is required to meet in the provision of the EMS service.

(2) An applicant or licensee that has been denied, revoked, suspended or issued a restricted license may appeal by filing a written appeal within thirty calendar days of the receipt of the issuance of the Department's denial.

 

R426-3-1200. Change in Non-911 Service Level.

(1) A ground ambulance service licensee may apply to provide a higher level of non-911 ambulance service as referred to under 26-8a-102(14). The applicant shall submit:

(a) the applicable fees;

(b) an application on Department-approved forms to the Department.

(c) a copy of the new treatment protocols for the higher level of service approved by the off-line medical director;

(d) an updated plan of operations demonstrating the applicant's ability to provide the higher level of service; and

(e) a written assessment of the performance of the applicant's field performance by the applicant's off-line medical director.

(2) If the Department determines that the applicant has demonstrated the ability to provide the higher level of service, it shall issue a revised license reflecting the higher level of service without making a separate finding of public convenience and necessity.

 

R426-3-1300. Change of Owner.

A license and the vehicle permits terminate if the holder of a licensed service transfers ownership of the service to another party. As outlined in 26-8a-415, the new owner must submit, within ten business days of acquisition, applications and fees for a new license and vehicle permits.

 

R426-3-1400. Penalties.

As required by Subsection 63G-3-201(5): Any person that violates any provision of this rule may be assessed a civil money penalty as provided in Section 26-23-6 and/or suspension or revocation of license(s).

 

KEY: emergency medical services

Date of Enactment or Last Substantive Amendment: 2013

Authorizing, and Implemented or Interpreted Law: 26-8a

 

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