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S.B. 214
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8 LONG TITLE
9 General Description:
10 This bill amends the Utah Emergency Medical Services System Act.
11 Highlighted Provisions:
12 This bill:
13 . creates definitions for:
14 . 911 ambulance services and non-911 ambulance services;
15 . a nonemergency medical condition; and
16 . nonemergency medical services;
17 . establishes a process by which an ambulance provider may apply for a nonexclusive
18 license for non-911 ambulance services within a geographic service area in which
19 the political subdivision is not providing non-911 ambulance services;
20 . requires an applicant for a nonexclusive license for non-911 ambulance services to
21 comply with certain provisions of the chapter, including the certificate of need
22 requirements;
23 . provides for supervision of the licensee and renewal of the license; and
24 . prohibits certain conduct related to solicitation of business.
25 Monies Appropriated in this Bill:
26 None
27 Other Special Clauses:
28 None
29 Utah Code Sections Affected:
30 AMENDS:
31 26-8a-102, as last amended by Chapter 305, Laws of Utah 2000
32 26-8a-401, as enacted by Chapter 141, Laws of Utah 1999
33 26-8a-402, as last amended by Chapter 1, Laws of Utah 2000
34 26-8a-404, as last amended by Chapter 213, Laws of Utah 2003
35 26-8a-405.1, as last amended by Chapter 60, Laws of Utah 2006
36 26-8a-405.2, as last amended by Chapters 25 and 205, Laws of Utah 2005
37 26-8a-413, as last amended by Chapter 213, Laws of Utah 2003
38 26-8a-502, as last amended by Chapter 1, Laws of Utah 2000
39 ENACTS:
40 26-8a-405.4, Utah Code Annotated 1953
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42 Be it enacted by the Legislature of the state of Utah:
43 Section 1. Section 26-8a-102 is amended to read:
44 26-8a-102. Definitions.
45 As used in this chapter:
46 (1) "911 ambulance services" means ground, air, or water transportation services
47 provided by an ambulance provider in response to:
48 (a) a request made through a designated dispatch center that receives 911 or E-911
49 calls; or
50 (b) an emergency medical condition.
51 [
52 (a) transports patients and is used to provide:
53 (i) emergency medical services; [
54 (ii) nonemergency medical services; and
55 (b) is required to obtain a permit under Section 26-8a-304 to operate in the state.
56 [
57 (a) transports and provides emergency medical [
58 medical services to patients; and
59 (b) is required to obtain a license under Part 4, Ambulance and Paramedic Providers.
60 [
61 created by Section 26-1-7 .
62 [
63 physician, registered nurse, physician's assistant, or individual certified under Section
64 26-8a-302 .
65 [
66 (a) a medical condition that manifests itself by symptoms of sufficient severity,
67 including severe pain, that a prudent layperson, who possesses an average knowledge of health
68 and medicine, could reasonably expect the absence of immediate medical attention to result in:
69 (i) placing the individual's health in serious jeopardy;
70 (ii) serious impairment to bodily functions; [
71 (iii) serious dysfunction of any bodily organ or part; or
72 (iv) a sudden onset or negative change in a person's medical condition; or
73 (b) a medical condition that in the opinion of a physician or his designee requires direct
74 medical observation during transport or may require the intervention of an individual certified
75 under Section 26-8a-302 during transport.
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77 (a) means an individual who provides emergency medical services to a patient and is
78 required to be certified under Section 26-8a-302 ; and
79 (b) includes a paramedic, medical director of a licensed emergency medical service
80 provider, emergency medical service instructor, and other categories established by the
81 committee.
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87 (8) "Emergency medical services" means medical services, transportation services, or
88 both rendered to a patient suffering from an emergency medical condition.
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90 (a) a licensed or designated emergency medical services provider that provides
91 emergency medical services within or in an area that abuts an exclusive geographic service area
92 that is the subject of an application submitted pursuant to Part 4, Ambulance and Paramedic
93 Providers;
94 (b) any municipality, county, or fire district that lies within or abuts a geographic
95 service area that is the subject of an application submitted pursuant to Part 4, Ambulance and
96 Paramedic Providers; or
97 (c) the department when acting in the interest of the public.
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99 emergency medical service provider.
100 (11) "Medical service provider" means:
101 (a) a licensed ambulance provider and paramedic provider;
102 (b) a facility or provider that is required to be designated under Section 26-8a-303 ; and
103 (c) emergency medical service personnel.
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105 vehicle that is:
106 (a) maintained and used for the transportation of emergency medical personnel,
107 medical service providers, equipment, and supplies to the scene of a medical emergency; and
108 (b) required to be permitted under Section 26-8a-304 .
109 (13) "Non-911 ambulance services":
110 (a) means ground, air, or water transportation services or standby services provided by
111 an ambulance provider in response to a request made to any person other than through a
112 designated dispatch center that receives 911 or E-911 calls; and
113 (b) includes:
114 (i) convalescent transports; and
115 (ii) interfacility transportation, when arranged by the patient, the patient's
116 representative, or a transferring physician or facility for a patient, from a:
117 (A) hospital;
118 (B) nursing facility;
119 (C) emergency patient receiving facility;
120 (D) mental health facility; or
121 (E) other medical facility.
122 (14) "Nonemergency medical condition" means:
123 (a) a medical condition that does not constitute an emergency medical condition but
124 that requires or may require assistance from a medical service provider; or
125 (b) a medical condition that in the opinion of a physician or the physician's designee
126 requires or may require transport by a licensed ambulance provider or intervention of an
127 individual certified under Section 26-8a-302 during transport.
128 (15) "Nonemergency medical services" means medical services, transportation
129 services, or both rendered to a patient with a nonemergency medical condition.
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131 (a) employs emergency medical service personnel; and
132 (b) is required to obtain a license under Part 4, Ambulance and Paramedic Providers.
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134 any of the criteria in Section 26-8a-305 .
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136 intervention.
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138 (a) organizes and coordinates the delivery of trauma care within defined geographic
139 areas from the time of injury through transport and rehabilitative care; and
140 (b) is inclusive of all prehospital providers, hospitals, and rehabilitative facilities in
141 delivering care for trauma patients, regardless of severity.
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143 or priority. For prehospital trauma victims, triage requires a determination of injury severity to
144 assess the appropriate level of care according to established patient care protocols.
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146 procedures that:
147 (a) direct the care of patients; and
148 (b) are adopted by the medical staff of an emergency patient receiving facility, trauma
149 center, or an emergency medical service provider.
150 Section 2. Section 26-8a-401 is amended to read:
151 26-8a-401. State regulation of emergency medical services market.
152 (1) To ensure emergency medical service quality and minimize unnecessary
153 duplication, the department shall regulate the emergency medical service market after October
154 1, 1999, by creating and operating a statewide system that:
155 (a) except as allowed by Section 26-8a-405.4 , consists of exclusive geographic service
156 areas as provided in Section 26-8a-402 ; and
157 (b) establishes maximum rates as provided in Section 26-8a-403 .
158 (2) (a) All licenses issued prior to July 1, 1996, shall expire as stated in the license.
159 (b) If no expiration date is stated on a license issued before July 1, 1996, the license
160 shall expire on October 1, 1999, unless:
161 (i) the license holder requests agency action before August 1, 1999; and
162 (ii) before October 1, 1999, the department:
163 (A) finds the license has been used as the basis for responding to requests for
164 ambulance or paramedic services during the past five years;
165 (B) identifies one or more specific geographic areas covered by the license in which the
166 license holder has actively and adequately responded as the primary provider to requests for
167 ambulance or paramedic services during the past five years; and
168 (C) determines that the continuation of a license in a specific geographic area identified
169 in Subsection (2)(b)(ii)(B) satisfies:
170 (I) the standards established pursuant to Subsection 26-8a-404 (2); and
171 (II) the requirement of public convenience and necessity.
172 (c) If the department finds that a license meets the requirements of Subsection (2)(b),
173 the department shall amend the license to reflect:
174 (i) the specific geographic area of the license; and
175 (ii) a four-year term extension.
176 (d) Before July 1, 1999, the department shall publish notice once a week for four
177 consecutive weeks of the expiration of licenses pursuant to Subsection (2)(b) in a newspaper of
178 general circulation in the state.
179 (e) Nothing in this Subsection (2) may be construed as restricting the authority of the
180 department to amend overlapping licenses pursuant to Section 26-8a-416 .
181 (3) After October 1, 1999, new licenses and license renewals shall be for a four-year
182 term.
183 Section 3. Section 26-8a-402 is amended to read:
184 26-8a-402. Exclusive geographic service areas.
185 (1) [
186 license issued under this part shall be for an exclusive geographic service area as described in
187 the license. Only [
188 request that originates within the provider's exclusive geographic service area, except as
189 provided in Subsection (5) and Section 26-8a-416 .
190 (2) Each paramedic provider license issued under this part shall be for an exclusive
191 geographic service area as described in the license. Only the licensed paramedic provider may
192 respond to a paramedic request that originates within the exclusive geographic service area,
193 except as provided in Subsection (6) and Section 26-8a-416 .
194 (3) Nothing in this section may be construed as either requiring or prohibiting that the
195 formation of boundaries in a given location be the same for a licensed paramedic provider as it
196 is for a licensed ambulance provider.
197 (4) (a) A licensed ground ambulance or paramedic provider may, as necessary, enter
198 into a mutual aid agreement to allow another licensed provider to give assistance in times of
199 unusual demand, as that term is defined by the committee in rule.
200 (b) A mutual aid agreement shall include a formal written plan detailing the type of
201 assistance and the circumstances under which it would be given.
202 (c) The parties to a mutual aid agreement shall submit a copy of the agreement to the
203 department.
204 (d) Notwithstanding this Subsection (4), a licensed provider may not subcontract with
205 another entity to provide services in the licensed provider's exclusive geographic service area.
206 (5) Notwithstanding Subsection (1), a licensed ground ambulance provider may
207 respond to an ambulance request that originates from the exclusive geographic area of another
208 provider:
209 (a) pursuant to a mutual aid agreement;
210 (b) to render assistance on a case-by-case basis to that provider; and
211 (c) as necessary to meet needs in time of disaster or other major emergency.
212 (6) Notwithstanding Subsection (2), a licensed paramedic provider may respond to a
213 paramedic request that originates from the exclusive geographic area of another provider:
214 (a) pursuant to a mutual aid agreement;
215 (b) to render assistance on a case-by-case basis to that provider; and
216 (c) as necessary to meet needs in time of disaster or other major emergency.
217 Section 4. Section 26-8a-404 is amended to read:
218 26-8a-404. Ground ambulance and paramedic licenses -- Application and
219 department review.
220 (1) Except as provided in Section 26-8a-413 , an applicant for a ground ambulance or
221 paramedic license shall apply to the department for a license only by:
222 (a) submitting a completed application;
223 (b) providing information in the format required by the department; and
224 (c) paying the required fees, including the cost of the hearing officer.
225 (2) The department shall make rules establishing minimum qualifications and
226 requirements for:
227 (a) personnel;
228 (b) capital reserves;
229 (c) equipment;
230 (d) a business plan;
231 (e) operational procedures;
232 (f) medical direction agreements;
233 (g) management and control; and
234 (h) other matters that may be relevant to an applicant's ability to provide ground
235 ambulance or paramedic service.
236 (3) An application for a license to provide ground ambulance service or paramedic
237 service shall be for all ground ambulance services or paramedic services arising within the
238 geographic service area, except that an applicant may apply for a license:
239 (a) for less than all ground ambulance services or all paramedic services arising within
240 an exclusive geographic area if it can demonstrate how the remainder of that area will be
241 served[
242 (b) for less than all ground ambulance services pursuant to Section 26-8a-405.4 if it
243 can demonstrate how the remainder of the area for which it seeks a license will be served.
244 (4) (a) A ground ambulance service licensee may apply to the department for a license
245 to provide a higher level of service as defined by department rule if:
246 (i) the application for the license is limited to non-911 ambulance or paramedic
247 services; and
248 (ii) the application includes:
249 (A) a copy of the new treatment protocols for the higher level of service approved by
250 the off-line medical director;
251 (B) an assessment of field performance by the applicant's off-line director; and
252 (C) an updated plan of operation demonstrating the ability of the applicant to provide
253 the higher level of service.
254 (b) If the department determines that the applicant has demonstrated the ability to
255 provide the higher level of service in accordance with Subsection (4)(a), the department shall
256 issue a revised license reflecting the higher level of service and the requirements of Section
257 26-8a-408 do not apply.
258 (5) Upon receiving a completed application and the required fees, the department shall
259 review the application and determine whether the application meets the minimum
260 qualifications and requirements for licensure.
261 (6) The department may deny an application if it finds that it contains any materially
262 false or misleading information, is incomplete, or if the application demonstrates that the
263 applicant fails to meet the minimum qualifications and requirements for licensure under
264 Subsection (2).
265 (7) If the department denies an application, it shall notify the applicant in writing
266 setting forth the grounds for the denial. A denial may be appealed under Title 63, Chapter 46b,
267 Administrative Procedures Act.
268 Section 5. Section 26-8a-405.1 is amended to read:
269 26-8a-405.1. Selection of 911 ambulance service provider by political subdivision.
270 (1) For purposes of this section and Sections 26-8a-405.2 and 26-8a-405.3 :
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278 (i) in the case of a municipality or county, the elected council, commission, or other
279 legislative body that is vested with the legislative power of the municipality;
280 (ii) in the case of a special service district, local service district, or county service area,
281 each elected council, commission, or other legislative body that is vested with the legislative
282 power of the municipalities or counties that are members of the district or service area; and
283 (iii) in the case of a special district for fire protection or interlocal entity, the board or
284 other body vested with the power to adopt, amend, and repeal rules, bylaws, policies, and
285 procedures for the regulation of its affairs and the conduct of its business.
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287 (i) a city or town located in a county of the first or second class as defined in Section
288 17-50-501 ;
289 (ii) a county of the first or second class;
290 (iii) the following districts or service areas located in a county of the first or second
291 class:
292 (A) a special service district created under Title 17A, Chapter 2, Part 13, Utah Special
293 Service District Act;
294 (B) a local district created under Title 17B, Chapter 2, Local Districts, for the purpose
295 of providing fire protection, paramedic, and emergency services; and
296 (C) a county service area created under Title 17A, Chapter 2, Part 4, County Service
297 Area Act, for the purpose of providing fire protection, paramedic, and emergency services; or
298 (iv) areas coming together as described in Subsection 26-8a-405.2 (2)(b)(ii);
299 (v) municipalities and counties joining together pursuant to Title 11, Chapter 13,
300 Interlocal Cooperation Act; or
301 (vi) a special district for fire protection as defined in Section 17A-2-1304 .
302 (2) (a) Only an applicant approved under Section 26-8a-405 may respond to a request
303 for a proposal for 911 ambulance or paramedic services issued in accordance with Section
304 26-8a-405.2 by a political subdivision.
305 (b) A response to a request for proposal is subject to the maximum rates established by
306 the department under Section 26-8a-403 .
307 (c) A political subdivision may award a contract to an applicant for the provision of
308 911 ambulance or paramedic services:
309 (i) in accordance with Section 26-8a-405.2 ; and
310 (ii) subject to Subsection (3).
311 (3) (a) The department shall issue a license to an applicant selected by a political
312 subdivision under Subsection (2) unless the department finds that issuing a license to that
313 applicant would jeopardize the health, safety, and welfare of the citizens of the geographic
314 service area.
315 (b) A license issued under this Subsection (3):
316 (i) is for the exclusive geographic service area approved by the department in
317 accordance with Subsection 26-8a-405.2 (2);
318 (ii) is valid for four years;
319 (iii) is not subject to a request for license from another applicant under the provisions
320 of Sections 26-8a-406 through 26-8a-409 during the four-year term, unless the applicant's
321 license is revoked under Section 26-8a-504 ; and
322 (iv) is subject to supervision by the department under Sections 26-8a-503 and
323 26-8a-504 .
324 (4) Except as provided in Subsection 26-8a-405.3 (4)(a), the provisions of Sections
325 26-8a-406 through 26-8a-409 do not apply to a license issued under this section.
326 Section 6. Section 26-8a-405.2 is amended to read:
327 26-8a-405.2. Selection of provider -- Request for competitive sealed proposal --
328 Public convenience and necessity.
329 (1) (a) A political subdivision may contract with an applicant approved under Section
330 26-8a-404 to provide 911 ambulance or paramedic services for the geographic service area that
331 is approved by the department in accordance with Subsection (2), if the political subdivision
332 complies with the provisions of this section and Section 26-8a-405.3 .
333 (b) The provisions of this section and Sections 26-8a-405.1 and 26-8a-405.3 do not
334 require a political subdivision to issue a request for proposal for ambulance or paramedic
335 services. If a political subdivision does not contract with an applicant in accordance with this
336 section and Section 26-8a-405.3 , the provisions of Sections 26-8a-406 through 26-8a-409 apply
337 to the issuance of a license for ambulance or paramedic services in the geographic service area
338 that is within the boundaries of the political subdivision.
339 (c) (i) For purposes of this Subsection (1)(c):
340 (A) "local district" and "county service area" are defined in Subsection
341 26-8a-405.1 (1)[
342 (B) "participating municipality" means a city or town whose area is partly or entirely
343 included within a county service area or local district; and
344 (C) "participating county" means a county whose unincorporated area is partly or
345 entirely included within a county service area or local district.
346 (ii) A participating municipality or participating county may contract with a provider
347 for 911 ambulance or paramedic service as provided in this section and Section 26-8a-405.3 .
348 (iii) If the participating municipality or participating county contracts with a provider
349 for 911 ambulance or paramedic services under this section and Section 26-8a-405.3 :
350 (A) the county service area or local district is not obligated to provide the ambulance or
351 paramedic services that are included in the contract between the participating municipality or
352 the participating county and the 911 ambulance or paramedic provider;
353 (B) the county service area and local district may impose taxes and obligations within
354 the county service area or local district in the same manner as if the participating municipality
355 or participating county were receiving all services offered by the local district or county service
356 area; and
357 (C) the participating municipality's and participating county's obligations to the local
358 district or county service area are not diminished.
359 (2) (a) The political subdivision shall submit the request for proposal and the exclusive
360 geographic service area to be included in the request for proposal to the department for
361 approval prior to issuing the request for proposal. The department shall approve the request for
362 proposal and the exclusive geographic service area:
363 (i) unless the geographic service area creates an orphaned area; and
364 (ii) in accordance with Subsections (2)(b) and (c).
365 (b) The exclusive geographic service area may:
366 (i) include the entire geographic service area that is within the political subdivision's
367 boundaries;
368 (ii) include islands within or adjacent to other peripheral areas not included in the
369 political subdivision that governs the geographic service area; or
370 (iii) exclude portions of the geographic service area within the political subdivision's
371 boundaries if another political subdivision or licensed provider agrees to include the excluded
372 area within their license.
373 (c) The proposed geographic service area for 911 ambulance or paramedic service must
374 demonstrate that non-911 ambulance or paramedic service will be provided in the geographic
375 service area, either by the current provider or providers as allowed in Section 26-8a-405.4 , the
376 applicant, or some other method acceptable to the department. The department may consider
377 the effect of the proposed geographic service area on the costs to the non-911 provider and that
378 provider's ability to provide only non-911 services in the proposed area.
379 Section 7. Section 26-8a-405.4 is enacted to read:
380 26-8a-405.4. Competition for non-911 ambulance services.
381 (1) In any geographic area where a political subdivision is not providing non-911
382 ambulance services through a governmental or quasi-governmental agency, the department
383 may issue more than one nonexclusive license to ambulance providers to provide non-911
384 ambulance services within that geographic area.
385 (2) Applicants for a license to provide non-911 ambulance services under Subsection
386 (1) shall comply with:
387 (a) the requirements of Section 26-8a-404 ; and
388 (b) all requirements to be a licensed ambulance provider.
389 (3) When issuing a license to provide non-911 ambulance services under Subsection
390 (1), the department shall follow the requirements and procedures for issuing a license as set
391 forth in Section 26-8a-404 and Sections 26-8a-406 through 26-8a-409 .
392 (4) A license issued to a non-911 ambulance service provider pursuant to this section:
393 (a) is a nonexclusive license;
394 (b) shall be for a period of four years;
395 (c) is subject to department supervision pursuant to Sections 26-8a-503 and 26-8a-504 ;
396 and
397 (d) may be renewed pursuant to Section 26-8a-413 .
398 (5) A non-911 ambulance service provider licensed to provide non-911 ambulance
399 services within a geographic area must provide non-911 ambulance services in response to a
400 request for such services originating from within that geographic area unless:
401 (a) another licensed non-911 ambulance service provider is responding to the request
402 for non-911 ambulance services; or
403 (b) the licensed non-911 ambulance service provider is not the only provider of
404 non-911 ambulance services within that geographic area and lacks sufficient resources to
405 respond to the request for non-911 ambulance services, provided that the non-911 ambulance
406 service provider arranges for another ambulance provider to respond to the request.
407 Section 8. Section 26-8a-413 is amended to read:
408 26-8a-413. License renewals.
409 (1) A licensed provider desiring to renew its license must meet the renewal
410 requirements established by department rule.
411 (2) The department shall issue a renewal license for a ground ambulance provider or a
412 paramedic provider upon the licensee's application for a renewal and without a public hearing
413 if there has been:
414 (a) no change in controlling interest in the ownership of the licensee as defined in
415 Section 26-8a-415 ;
416 (b) no serious, substantiated public complaints filed with the department against the
417 licensee during the term of the previous license;
418 (c) no material or substantial change in the basis upon which the license was originally
419 granted;
420 (d) no reasoned objection from the committee or the department; and
421 (e) if the applicant was licensed under the provisions of Sections 26-8a-406 through
422 26-8a-409 , no conflicting license application.
423 (3) (a) (i) The provisions of this Subsection (3) apply to a provider licensed under the
424 provisions of Sections 26-8a-405.1 [
425 (ii) A provider may renew its license if the provisions of Subsections (1), (2)(a)
426 through (d), and this Subsection (3) are met.
427 (b) (i) The department shall issue a renewal license to a provider upon the provider's
428 application for renewal for one additional four-year term if the political subdivision certifies to
429 the department that the provider has met all of the specifications of the original bid.
430 (ii) If the political subdivision does not certify to the department that the provider has
431 met all of the specifications of the original bid, the department may not issue a renewal license
432 and the political subdivision must enter into a public bid process under Sections 26-8a-405.1
433 and 26-8a-405.2 .
434 (c) (i) The department shall issue an additional renewal license to a provider who has
435 already been issued a one-time renewal license under the provisions of Subsection (3)(b)(i) if
436 the department and the political subdivision do not receive, prior to the expiration of the
437 provider's license, written notice from an approved applicant informing the political
438 subdivision of the approved applicant's desire to submit a bid for ambulance or paramedic
439 service.
440 (ii) If the department and the political subdivision receive the notice in accordance with
441 Subsection (3)(c)(i), the department may not issue a renewal license and the political
442 subdivision must enter into a public bid process under Sections 26-8a-405.1 and 26-8a-405.2 .
443 (4) The department shall issue a renewal license for an air ambulance provider upon
444 the licensee's application for renewal and completion of the renewal requirements established
445 by department rule.
446 Section 9. Section 26-8a-502 is amended to read:
447 26-8a-502. Illegal activity.
448 (1) Except as provided in Section 26-8a-308 , a person may not:
449 (a) practice or engage in the practice, represent himself to be practicing or engaging in
450 the practice, or attempt to practice or engage in the practice of any activity that requires a
451 license, certification, or designation under this chapter unless that person is so licensed,
452 certified, or designated; or
453 (b) offer an emergency medical service that requires a license, certificate, or
454 designation unless the person is so licensed, certified, or designated.
455 (2) A person may not advertise or hold himself out as one holding a license,
456 certification, or designation required under this chapter, unless that person holds the license,
457 certification, or designation.
458 (3) A person may not employ or permit any employee to perform any service for which
459 a license or certificate is required by this chapter, unless the person performing the service
460 possesses the required license or certificate.
461 (4) A person may not wear, display, sell, reproduce, or otherwise use any Utah
462 Emergency Medical Services insignia without authorization from the department.
463 (5) A person may not reproduce or otherwise use materials developed by the
464 department for certification or recertification testing or examination without authorization from
465 the department.
466 (6) A person may not willfully summon an ambulance or emergency response vehicle
467 or report that one is needed when such person knows that the ambulance or emergency
468 response vehicle is not needed.
469 (7) (a) An ambulance provider may not:
470 (i) solicit any person to use a seven-digit phone number to obtain transportation
471 services from an ambulance provider for an emergency medical condition; or
472 (ii) discourage any person from contacting a designated dispatch center that receives
473 911 or E-911 calls in order to obtain transportation services from an ambulance provider for an
474 emergency medical condition.
475 (b) The provisions of this section do not apply to transports of patients from one
476 hospital to another hospital for the treatment of an emergency medical condition.
477 [
Legislative Review Note
as of 1-25-07 6:37 AM