S.B. 180 Enrolled

EMERGENCY MEDICAL SERVICES
2003 GENERAL SESSION
STATE OF UTAH
Sponsor: Curtis S. Bramble
This act modifies the Health Code. The act modifies the Utah Emergency Medical
Services System Act. The act permits ambulance and paramedic license applicants who
have met the Department of Health's minimum requirements and standards to enter into
a competitive bid process to provide services to local governments for 911 ambulance and
paramedic calls. The act permits local governments in counties of the first and second
class to select a license applicant through an open procurement process. The act requires
a local government that elects to use the bid process to consider certain factors when
selecting a provider. The act requires the department to issue a license to the applicant
selected by a local government except in certain limited circumstances. The act makes
other technical and conforming amendments. This act takes effect January 1, 2004. This
act has a coordinating clause.
This act affects sections of Utah Code Annotated 1953 as follows:
AMENDS:
26-8a-404, as enacted by Chapter 141, Laws of Utah 1999
26-8a-405, as enacted by Chapter 141, Laws of Utah 1999
26-8a-406, as enacted by Chapter 141, Laws of Utah 1999
26-8a-411, as enacted by Chapter 141, Laws of Utah 1999
26-8a-413, as enacted by Chapter 141, Laws of Utah 1999
ENACTS:
26-8a-405.1, Utah Code Annotated 1953
26-8a-405.2, Utah Code Annotated 1953
Be it enacted by the Legislature of the state of Utah:
Section 1. Section 26-8a-404 is amended to read:
26-8a-404. Ground ambulance and paramedic licenses -- Application and
department review.

(1) Except as provided in Section 26-8a-413 , an applicant for a ground ambulance or
paramedic license shall apply to the department for a license only by:
(a) submitting a completed application;
(b) providing information in the format required by the department; and
(c) paying the required fees, including the cost of the hearing officer.
(2) The department [may] shall make rules establishing minimum qualifications and
requirements for:
(a) personnel;
(b) capital reserves;
(c) equipment;
(d) a business plan;
(e) operational procedures;
(f) [resource hospital and] medical direction agreements;
(g) management and control; and
(h) other matters that may be relevant to an applicant's ability to provide ground
ambulance or paramedic service.
(3) An application for a license to provide ground ambulance service or paramedic
service shall be for all ground ambulance services or paramedic services arising within the
geographic service area, except that an applicant may apply for a license for less than all ground
ambulance services or all paramedic services arising within an exclusive geographic area if it can
demonstrate how the remainder of that area will be served.
(4) (a) A ground ambulance service licensee may apply to the department for a license to
provide a higher level of service as defined by department rule if:
(i) the application for the license is limited to non-911 ambulance or paramedic services;
and
(ii) the application includes:
(A) a copy of the new treatment protocols for the higher level of service approved by the
off-line medical director;

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(B) an assessment of field performance by the applicant's off-line director; and
(C) an updated plan of operation demonstrating the ability of the applicant to provide the
higher level of service.
(b) If the department determines that the applicant has demonstrated the ability to
provide the higher level of service in accordance with Subsection (4)(a), the department shall
issue a revised license reflecting the higher level of service and the requirements of Section
26-8a-408 do not apply.
[(4)] (5) Upon receiving a completed application and the required fees, the department
shall review the application and determine whether the application meets the minimum
qualifications and requirements for licensure.
[(5)] (6) The department may deny an application if it finds that it contains any
materially false or misleading information, is incomplete, or if the application demonstrates that
the applicant fails to meet the minimum qualifications and requirements for licensure under
Subsection (2).
[(6)] (7) If the department denies an application, it shall notify the applicant in writing
setting forth the grounds for the denial. A denial may be appealed under Title 63, Chapter 46b,
Administrative Procedures Act.
Section 2. Section 26-8a-405 is amended to read:
26-8a-405. Ground ambulance and paramedic licenses -- Agency notice of
approval.
[If] (1) Beginning January 1, 2004, if the department determines that the application
meets the minimum requirements for licensure under Section 26-8a-404 , the department shall[:
(1)] issue a notice of [agency action to the applicant to commence an informal administrative
proceeding;] the approved application to the applicant.
[(2) provide notice of the application to all interested parties; and]
[(3) publish notice of the application, at the applicant's expense, once a week for four
consecutive weeks, in a newspaper of general circulation in the geographic service area that is the
subject of the application.]

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(2) A current license holder responding to a request for proposal under Section
26-8a-405.2 is considered an approved applicant for purposes of Section 26-8a-405.2 if the
current license holder, prior to responding to the request for proposal, submits the following to
the department:
(a) the information required by Subsection 26-8a-404 (4)(a)(ii); and
(b) if the license holder is a private entity, a financial statement, a pro forma budget and
necessary letters of credit demonstrating a financial ability to expand service to a new service
area; or
(c) if the license holder is a governmental entity, a letter from the governmental entity's
governing body demonstrating the governing body's willingness to financially support the
application.
Section 3. Section 26-8a-405.1 is enacted to read:
26-8a-405.1. Selection of provider by political subdivision.
(1) For purposes of this section and Section 26-8a-405.2 :
(a) "911 ambulance or paramedic services" means either 911 ambulance service, or 911
paramedic service, or both and:
(i) means a 911 call received by a designated dispatch center that receives 911 or E911
calls; and
(ii) does not mean a seven digit telephone call received directly by an ambulance
provider licensed under this chapter;
(b) "political subdivision" means:
(i) a city or town located in a county of the first or second class as defined in Section
17-50-501 ;
(ii) a county of the first or second class;
(iii) a special service district, created under Title 17A, Chapter 2, Part 13, Utah Special
Service District Act, within a county of the first or second class; or
(iv) areas coming together as described in Subsection (3)(b)(ii).
(2) (a) Only an applicant approved under Section 26-8a-405 may respond to a request for

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a proposal for 911 ambulance or paramedic services issued in accordance with Section
26-8a-405.2 by a political subdivision.
(b) A response to a request for proposal is subject to the maximum rates established by
the department under Section 26-8a-403 .
(c) A political subdivision may award a contract to an applicant for the provision of 911
ambulance or paramedic services:
(i) in accordance with Section 26-8a-405.2 ; and
(ii) subject to Subsection (3).
(3) (a) The department shall issue a license to an applicant selected by a political
subdivision under Subsection (2) unless the department finds that issuing a license to that
applicant would jeopardize the health, safety, and welfare of the citizens of the geographic
service area.
(b) A license issued under this Subsection (3):
(i) is for the exclusive geographic service area approved by the department in accordance
with Subsection 26-8a-405.2 (3);
(ii) is valid for four years;
(iii) is not subject to a request for license from another applicant under the provisions of
Sections 26-8a-406 through 26-8a-409 during the four-year term, unless the applicant's license is
revoked under Section 26-8a-504 ; and
(iv) is subject to supervision by the department under Sections 26-8a-503 and 26-8a-504 .
(4) The provisions of Sections 26-8a-406 through 26-8a-409 do not apply to a license
issued under this section.
Section 4. Section 26-8a-405.2 is enacted to read:
26-8a-405.2. Selection of provider -- Public bid -- Public convenience and necessity.
(1) (a) A political subdivision may contract with an applicant approved under Section
26-8a-404 to provide 911 ambulance or paramedic services for the geographic service area that is
approved by the department in accordance with Subsection (2), if the political subdivision
complies with the provisions of this section.

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(b) The provisions of this section and Section 26-8a-405.1 do not require a political
subdivision to issue a request for proposal for ambulance or paramedic services. If a political
subdivision does not contract with an applicant in accordance with this section, the provisions of
Sections 26-8a-406 through 26-8a-409 apply to the issuance of a license for ambulance or
paramedic services in the geographic service area that is within the boundaries of the political
subdivision.
(2) (a) The political subdivision shall submit the request for proposal and the exclusive
geographic service area to be included in the request for proposal to the department for approval
prior to issuing the request for proposal. The department shall approve the request for proposal
and the exclusive geographic service area:
(i) unless the geographic service area creates an orphaned area; and
(ii) in accordance with Subsections (2)(b) and (c).
(b) The exclusive geographic service area may:
(i) include the entire geographic service area that is within the political subdivision's
boundaries;
(ii) include islands within or adjacent to other peripheral areas not included in the
political subdivision that governs the geographic service area; or
(iii) exclude portions of the geographic service area within the political subdivision's
boundaries if another political subdivision or licensed provider agrees to include the excluded
area within their license.
(c) The proposed geographic service area for 911 ambulance or paramedic service must
demonstrate that non-911 ambulance or paramedic service will be provided in the geographic
service area, either by the current provider, the applicant, or some other method acceptable to the
department. The department may consider the effect of the proposed geographic service area on
the costs to the non-911 provider and that provider's ability to provide only non-911 services in
the proposed area.
(3) (a) (i) A political subdivision may select an applicant approved by the department
under Section 26-8a-404 to provide 911 ambulance or paramedic services by contract let to the

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lowest, responsive, and responsible bidder after publication of notice at least once a week for
three consecutive weeks in a newspaper of general circulation published in the county, or if there
is no such newspaper, then after posting such notice for at least 20 days in at least five public
places in the county.
(ii) The applicants who are approved under Section 26-8a-405 and who are selected
under Subsection (3)(a)(i) may be any other public entity or entities, any private person or entity,
or any combination thereof.
(b) A political subdivision may reject all of the bids.
(4) In seeking bids and awarding contracts under this section, a political subdivision:
(a) shall follow the provisions of Section 63-56-20;
(b) shall consider the public convenience and necessity factors listed in Subsections
26-8a-408 (2), (3), and (4);
(c) shall require the applicant responding to the bid to disclose how the applicant will
meet performance standards in the request for proposal;
(d) may not require or restrict an applicant to a certain method of meeting the
performance standards; and
(e) (i) shall require an applicant to submit the bid based on full cost accounting in
accordance with generally accepted accounting principals; and
(ii) if the applicant is a governmental entity, in addition to the requirements of
Subsection (4)(e)(i), in accordance with generally accepted government auditing standards and in
compliance with the State of Utah Legal Compliance Audit Guide.
Section 5. Section 26-8a-406 is amended to read:
26-8a-406. Ground ambulance and paramedic licenses -- Parties.
(1) When an applicant approved under Section 26-8a-404 seeks licensure under the
provisions of Sections 26-8a-406 through 26-8a-409 , the department shall:
(a) issue a notice of agency action to the applicant to commence an informal
administrative proceeding;
(b) provide notice of the application to all interested parties; and

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(c) publish notice of the application, at the applicant's expense, once a week for four
consecutive weeks, in a newspaper of general circulation in the geographic service area that is the
subject of the application.
[(1)] (2) An interested party has 30 days to object to an application.
[(2)] (3) If an interested party objects, the presiding officer must join the interested party
as an indispensable party to the proceeding.
[(3)] (4) The department may join the proceeding as a party to represent the public
interest.
[(4)] (5) Others who may be affected by the grant of a license to the applicant may join
the proceeding, if the presiding officer determines that they meet the requirement of legal
standing.
Section 6. Section 26-8a-411 is amended to read:
26-8a-411. Limitation on repetitive applications.
A person who has previously applied for a license under [this part] Sections 26-8a-406
through 26-8a-409 may not apply for a license for the same service that covers any exclusive
geographic service area that was the subject of the prior application unless:
(1) one year has passed from the date of the issuance of a final decision under Section
26-8a-407 ; or
(2) all interested parties and the department agree that a new application is in the public
interest.
Section 7. Section 26-8a-413 is amended to read:
26-8a-413. License renewals.
(1) A licensed provider desiring to renew its license must meet the renewal requirements
established by department rule.
(2) The department shall issue a renewal license for a ground ambulance provider or a
paramedic provider upon the licensee's application for a renewal and without a public hearing if
there has been [no]:
(a) no change in controlling interest in the ownership of the licensee as defined in

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Section 26-8a-415 ;
(b) no serious, substantiated public complaints filed with the department against the
licensee during the term of the previous license;
(c) no material or substantial change in the basis upon which the license was originally
granted;
(d) no reasoned objection from the committee or the department; and
(e) if the applicant was licensed under the provisions of Sections 26-8a-406 through
26-8a-409 , no conflicting license application.
(3) (a) (i) The provisions of this Subsection (3) apply to a provider licensed under the
provisions of Sections 26-8a-405.1 and 26-8a-405.2 .
(ii) A provider may renew its license if the provisions of Subsections (1), (2)(a) through
(d), and this Subsection (3) are met.
(b) (i) The department shall issue a renewal license to a provider upon the provider's
application for renewal for one additional four-year term if the political subdivision certifies to
the department that the provider has met all of the specifications of the original bid.
(ii) If the political subdivision does not certify to the department that the provider has
met all of the specifications of the original bid, the department may not issue a renewal license
and the political subdivision must enter into a public bid process under Sections 26-8a-405.1 and
26-8a-405.2 .
(c) (i) The department shall issue an additional renewal license to a provider who has
already been issued a one-time renewal license under the provisions of Subsection (3)(b)(i) if the
department and the political subdivision do not receive, prior to the expiration of the provider's
license, written notice from an approved applicant informing the political subdivision of the
approved applicant's desire to submit a bid for ambulance or paramedic service.
(ii) If the department and the political subdivision receive the notice in accordance with
Subsection (3)(c)(i), the department may not issue a renewal license and the political subdivision
must enter into a public bid process under Sections 26-8a-405.1 and 26-8a-405.2 .
[(3)] (4) The department shall issue a renewal license for an air ambulance provider upon

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the licensee's application for renewal and completion of the renewal requirements established by
department rule.
Section 8. Effective date.
This act takes effect on January 1, 2004.
Section 9. Coordination clause.
If this bill and S.B. 72, Amendments to Special Districts and Local Districts For
Expanded Fire Protection Services, both pass, it is the intent of the Legislature that the Office of
Legislative Research and General Counsel, in preparing the database for publication, shall:
(1) Amend Subsection 26-8a-405.1 (1)(b)(iii) to read as follows:
"(iii) the following districts or service areas located in a county of the first or second
class:
(A) a special service district created under Title 17A, Chapter 2, Part 13, Utah Special
Service District Act;
(B) a local district created after May 5, 2003 under Title 17B, Chapter 2, Local Districts,
for the purpose of providing fire protection, paramedic, and emergency services; and
(C) a county service area created after May 5, 2003, under Title 17A, Chapter 2, Part 4,
County Service Area, for the purpose of providing fire protection, paramedic, and emergency
services."
(2) Amend Subsection 26-8a-405.2 (1) by inserting Subsection (1)(c) to read as follows:
"(c) (i) For purposes of this Subsection (1)(c):
(A) "local district" and "county service area" are defined in Subsection
26-8a-405.1(1)(b)(iii);
(B) "participating municipality" means a city or town whose area is partly or entirely
included within a county service area or local district; and
(C) "participating county" means a county whose unincorporated area is partly or entirely
included within a county service area or local district.
(ii) A participating municipality or participating county may contract with a provider for
911 ambulance or paramedic service as provided in this section.

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(iii) If the participating municipality or participating county contracts with a provider for
911 ambulance or paramedic services under this section:
(A) the county service area or local district is not obligated to provide the ambulance or
paramedic services that are included in the contract between the participating municipality or the
participating county and the 911 ambulance or paramedic provider;
(B) the county service area and local district may impose taxes and obligations within the
county service area or local district in the same manner as if the participating municipality or
participating county were receiving all services offered by the local district or county service
area; and
(C) the participating municipality's and participating county's obligations to the local
district or county service area are not diminished."

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