DAR File No. 37693
This rule was published in the July 1, 2013, issue (Vol. 2013, No. 13) of the Utah State Bulletin.
Health, Family Health and Preparedness, Emergency Medical Services
Rule R426-14
Ambulance Service and Paramedic Service Licensure
Notice of Proposed Rule
(Repeal)
DAR File No.: 37693
Filed: 06/04/2013 10:58:53 AM
RULE ANALYSIS
Purpose of the rule or reason for the change:
This repeal is in response to the Governor's mandate for rule review and simplification. This rule is repealed as part of a change to the sequence of numbering for Title R426 that allows for a new set of rules that begins with Rules R426-1 through R426-9.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:
This rule is repealed in its entirety.
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 repeal.
local governments:
No anticipated fiscal impact to local governments because there are no changes in the existing rule requirements that are imposed by this repeal.
small businesses:
No anticipated fiscal impact to small businesses because there are no changes in the existing rule requirements that are imposed by this repeal.
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 repeal.
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 repeal.
Comments by the department head on the fiscal impact the rule may have on businesses:
No impact on business.
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:
HealthFamily 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 [email protected]
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.
[R426-14. Ambulance Service and Paramedic Service Licensure.
R426-14-100. Authority and Purpose.
This rule is established under Title 26, Chapter 8a. It establishes standards for the licensure of ambulance and paramedic services.
R426-14-101. Requirement for Licensure.
A person or entity that provides or represents that it provides ambulance or paramedic services must first be licensed by the Department.
R426-14-200. Licensure Types.
The Department issues licenses for a type of service at a certain service level.
(1) The Department may issue ambulance licenses for the following types of service at the given levels:
(a) Basic;
(b) Intermediate;
(c) Intermediate Advanced; and
(d) Paramedic.
(2) The Department may issue ground ambulance inter-facility transfer licenses for the following types of service at the given levels:
(a) Basic;
(b) Intermediate;
(c) Intermediate Advanced; and
(d) Paramedic.
(3) The Department may issue paramedic, non-transport
licenses for the following types of service at the given response
configurations:
(a) Paramedic Rescue; and
(b) Paramedic Tactical Rescue.
R426-14-201. 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. It may
provide emergency medical services for its category of licensure
that corresponds to the certification levels in R426-12 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 medical facility when arranged by the transferring
physician for the particular patient.
R426-14-300. Minimum Licensure Requirements.
(1) A licensee must meet the following minimum
requirements:
(a) have sufficient ambulances, emergency response
vehicles, 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;
(b) have locations or staging areas for stationing its
vehicles;
(c) have a current written dispatch agreement with a
public safety answering point that answers and responds to 911 or
E911 calls, or with a local single access public safety answering
point that answers and responds to requests for emergency
assistance;
(d) have current written aid agreements with other
licensees to give assistance in times of unusual demand;
(e) have a Department certified EMS training
officer;
(f) have a current plan of operations, which shall
include:
(i) a business plan demonstrating its:
(A) ability to provide the service; and
(B) financial viability.
(ii) the number, training, and certification of
personnel;
(iii) operational procedures; and
(iv) a description of the how the licensee or applicant
proposes to interface with other EMS agencies;
(g) have sufficient trained and certified staff that meet
the requirements of R426-15 Licensed and Designated Provider
Operations;
(h) have a current written agreement with a
Department-certified off-line medical director;
(i) have current treatment protocols approved by the
agency's off-line medical director for the existing service
level or new treatment protocols if seeking approval under
26-8a-405;
(j) be able to pay its debts as they become due;
(k) provide the Department with a copy of its certificate
of insurance or if seeking application approval under 26-8a-405,
provide proof of the ability to obtain insurance to respond to
damages due to operation of a vehicle in the manner and minimum
amounts specified in R426-15-204. All licensees shall:
(i) obtain insurance from an insurance carrier authorized
to write liability coverage in Utah or through a self-insurance
program;
(ii) report any coverage change to the Department within
60 days after the change; and
(iii) direct the insurance carrier or self-insurance
program to notify the Department of all changes in insurance
coverage.
(l) not be disqualified for any of the following
reasons:
(i) violation of Subsection 26-8a-504; or
(ii) 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.
(2) A paramedic tactical rescue must be a public safety
agency or have a letter of recommendation form a county or city
law enforcement agency within the paramedic tactical rescue's
geographic service area.
R426-14-301. Application, Department Review, and
Issuance.
(1) An applicant desiring to be licensed or to renew its
license shall submit the applicable fees and an 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 R426-14-300 and the
following:
(a) a detailed description and detailed map of the
exclusive geographical area that it will serve;
(i) 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;
(ii) if an applicant is responding to a public bid as
described in 26-8a-405.2 the applicant shall include detailed
maps and descriptions of all geographical areas served in
accordance with 26-8a-405.2 (2).
(b) for an applicant for a new service, documentation
showing that the applicant meets all local zoning and business
licensing standards within the exclusive geographical service
area that it will serve;
(c) a written description of how the applicant will
communicate with dispatch centers, law enforcement agencies,
on-line medical control, and patient transport
destinations;
(d) for renewal applications, a written assessment of
field performance from the applicant's off-line medical
director; and
(e) other information that the Department determines
necessary for the processing of the application and the oversight
of the licensed entity.
(2) A ground ambulance or paramedic service holding a
license under 26-8a-404, including any political subdivision that
is part of a special district or unified fire authority holding
such a license, may respond to a request for proposal if it
complies with 26-8a-405(2).
(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);
(c) issue a license to an applicant selected by a
political subdivision in accordance with 26-8a-405.1(3);
(d) issue a four-year renewal license to a license
selected by a political subdivision if the political subdivision
certifies to the Department that the licensee has met all of the
specifications of the original bid and requirements of
26-8a-413(1) through (3); or
(e) issue a second four-year renewal license to a
licensee selected by a political subdivision if:
(i) the political subdivision certifies to the Department
that the licensee has met all of the specifications of the
original bid and requirements of 26-8a-413(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 statutes and rules and a successful
Department quality assurance review.
(5) A license may be issued for up to a four-year period.
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.
R426-14-302. 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.
R426-14-303. Application Denial.
(1) The Department may deny an application for a license
or a renewal of 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; and
(n) violation of OSHA or other federal standards that it
is required to meet in the provision of the EMS service.
(2) An applicant that has been denied a license may
appeal by filing a written appeal within thirty calendar days of
the issuance of the Department's denial.
R426-14-400. Change in Service Level.
(1) A ground ambulance service licensee may apply to
provide a higher level of non-911 ambulance or paramedic service.
The applicant shall submit:
(a) the applicable fees; and
(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.
R426-14-401. 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.
R426-14-500. Aid Agreements.
(1) A ground ambulance service must have in place aid
agreements with other ground ambulance services to call upon them
for assistance during times of unusual demand.
(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) A ground ambulance licensee must provide all
ambulance service, including standby services, for any special
event that requires ground ambulance service within its
geographic service area. If the ground ambulance licensee is
unable or unwilling to provide the special event coverage, the
licensee may arrange with a ground ambulance licensee through the
use of aid agreements to provide all ground ambulance service for
the special event.
R426-14-600. 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.
KEY: emergency medical services
Date of Enactment or Last Substantive Amendment: March 15,
2010
Notice of Continuation: July 28, 2009
Authorizing, and Implemented or Interpreted Law: 26-8a]
Additional Information
The Portable Document Format (PDF) version of the Bulletin is the official version. The PDF version of this issue is available at https://rules.utah.gov/publicat/bull-pdf/2013/b20130701.pdf. The HTML edition of the Bulletin is a convenience copy. Any discrepancy between the PDF version and HTML version is resolved in favor of the PDF version.
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For questions regarding the content or application of this rule, please contact Guy Dansie at the above address, by phone at 801-273-6671, by FAX at 801-273-4165, or by Internet E-mail at [email protected].