1     
BEHAVIORAL EMERGENCY SERVICES AMENDMENTS

2     
2021 GENERAL SESSION

3     
STATE OF UTAH

4     
Chief Sponsor: Daniel W. Thatcher

5     
House Sponsor: Jefferson S. Burton

6     

7     LONG TITLE
8     Committee Note:
9          The Government Operations Interim Committee recommended this bill.
10               Legislative Vote:     9 voting for     1 voting against     6 absent
11     General Description:
12          This bill enacts requirements and provisions relating to behavioral emergency services
13     technicians.
14     Highlighted Provisions:
15          This bill:
16          ▸     defines terms;
17          ▸     creates a new license for behavioral emergency services technicians and advanced
18     behavioral emergency services technicians;
19          ▸     requires the Utah Department of Health to administer the license, including setting
20     initial and ongoing licensure and training requirements;
21          ▸     enacts provisions relating to the new license for behavioral emergency services
22     technicians, including certain testimonial exceptions; and
23          ▸     makes technical and corresponding changes.
24     Money Appropriated in this Bill:
25          None
26     Other Special Clauses:
27          This bill provides a special effective date.
28     Utah Code Sections Affected:
29     AMENDS:
30          26-8a-102, as last amended by Laws of Utah 2019, Chapter 265
31          26-8a-103, as last amended by Laws of Utah 2017, Chapters 326 and 336
32          26-8a-206, as enacted by Laws of Utah 1999, Chapter 141
33          26-8a-302, as last amended by Laws of Utah 2017, Chapter 326
34          26-8a-307, as enacted by Laws of Utah 1999, Chapter 141
35          78B-5-901, as enacted by Laws of Utah 2018, Chapter 109
36          78B-5-902, as enacted by Laws of Utah 2018, Chapter 109
37     ENACTS:
38          78B-5-904, Utah Code Annotated 1953
39     

40     Be it enacted by the Legislature of the state of Utah:
41          Section 1. Section 26-8a-102 is amended to read:
42          26-8a-102. Definitions.
43          As used in this chapter:
44          (1) (a) "911 ambulance or paramedic services" means:
45          (i) either:
46          (A) 911 ambulance service;
47          (B) 911 paramedic service; or
48          (C) both 911 ambulance and paramedic service; and
49          (ii) a response to a 911 call received by a designated dispatch center that receives 911
50     or E911 calls.
51          (b) "911 ambulance or paramedic service" does not mean a seven or ten digit telephone
52     call received directly by an ambulance provider licensed under this chapter.
53          (2) "Ambulance" means a ground, air, or water vehicle that:
54          (a) transports patients and is used to provide emergency medical services; and
55          (b) is required to obtain a permit under Section 26-8a-304 to operate in the state.
56          (3) "Ambulance provider" means an emergency medical service provider that:
57          (a) transports and provides emergency medical care to patients; and
58          (b) is required to obtain a license under Part 4, Ambulance and Paramedic Providers.
59          (4) (a) "Behavioral emergency services" means delivering a behavioral health
60     intervention to a patient in an emergency context within a scope and in accordance with
61     guidelines established by the department.
62          (b) "Behavioral emergency services" does not include engaging in the:
63          (i) practice of mental health therapy as defined in Section 58-60-102;
64          (ii) practice of psychology as defined in Section 58-61-102;
65          (iii) practice of clinical social work as defined in Section 58-60-202;
66          (iv) practice of certified social work as defined in Section 58-60-202;
67          (v) practice of marriage and family therapy as defined in Section 58-60-302; or
68          (vi) practice of clinical mental health counseling as defined in Section 58-60-402; and
69          (vii) practice as a substance use disorder counselor as defined in Section 58-60-502.
70          [(4)] (5) "Committee" means the State Emergency Medical Services Committee
71     created by Section 26-1-7.
72          [(5)] (6) "Direct medical observation" means in-person observation of a patient by a
73     physician, registered nurse, physician's assistant, or individual licensed under Section
74     26-8a-302.
75          [(6)] (7) "Emergency medical condition" means:
76          (a) a medical condition that manifests itself by symptoms of sufficient severity,
77     including severe pain, that a prudent layperson, who possesses an average knowledge of health
78     and medicine, could reasonably expect the absence of immediate medical attention to result in:
79          (i) placing the individual's health in serious jeopardy;
80          (ii) serious impairment to bodily functions; or
81          (iii) serious dysfunction of any bodily organ or part; or
82          (b) a medical condition that in the opinion of a physician or his designee requires direct
83     medical observation during transport or may require the intervention of an individual licensed
84     under Section 26-8a-302 during transport.
85          [(7)] (8) "Emergency medical service personnel":
86          (a) means an individual who provides emergency medical services or behavioral
87     emergency services to a patient and is required to be licensed under Section 26-8a-302; and
88          (b) includes a paramedic, medical director of a licensed emergency medical service
89     provider, emergency medical service instructor, behavioral emergency services technician, and
90     other categories established by the committee.
91          [(8)] (9) "Emergency medical service providers" means:
92          (a) licensed ambulance providers and paramedic providers;
93          (b) a facility or provider that is required to be designated under Subsection
94     26-8a-303(1)(a); and
95          (c) emergency medical service personnel.
96          [(9)] (10) "Emergency medical services" means:
97          (a) medical services[,];
98          (b) transportation services[, or both rendered to a patient.];
99          (c) behavioral emergency services; or
100          (d) any combination of the services described in Subsections (10)(a) through (c).
101          [(10)] (11) "Emergency medical service vehicle" means a land, air, or water vehicle
102     that is:
103          (a) maintained and used for the transportation of emergency medical personnel,
104     equipment, and supplies to the scene of a medical emergency; and
105          (b) required to be permitted under Section 26-8a-304.
106          [(11)] (12) "Governing body":
107          (a) is as defined in Section 11-42-102; and
108          (b) for purposes of a "special service district" under Section 11-42-102, means a
109     special service district that has been delegated the authority to select a provider under this
110     chapter by the special service district's legislative body or administrative control board.
111          [(12)] (13) "Interested party" means:
112          (a) a licensed or designated emergency medical services provider that provides
113     emergency medical services within or in an area that abuts an exclusive geographic service area
114     that is the subject of an application submitted pursuant to Part 4, Ambulance and Paramedic
115     Providers;
116          (b) any municipality, county, or fire district that lies within or abuts a geographic
117     service area that is the subject of an application submitted pursuant to Part 4, Ambulance and
118     Paramedic Providers; or
119          (c) the department when acting in the interest of the public.
120          [(13)] (14) "Medical control" means a person who provides medical supervision to an
121     emergency medical service provider.
122          [(14)] (15) "Non-911 service" means transport of a patient that is not 911 transport
123     under Subsection (1).
124          [(15)] (16) "Nonemergency secured behavioral health transport" means an entity that:
125          (a) provides nonemergency secure transportation services for an individual who:
126          (i) is not required to be transported by an ambulance under Section 26-8a-305; and
127          (ii) requires behavioral health observation during transport between any of the
128     following facilities:
129          (A) a licensed acute care hospital;
130          (B) an emergency patient receiving facility;
131          (C) a licensed mental health facility; and
132          (D) the office of a licensed health care provider; and
133          (b) is required to be designated under Section 26-8a-303.
134          [(16)] (17) "Paramedic provider" means an entity that:
135          (a) employs emergency medical service personnel; and
136          (b) is required to obtain a license under Part 4, Ambulance and Paramedic Providers.
137          [(17)] (18) "Patient" means an individual who, as the result of illness [or], injury, or a
138     behavioral emergency condition, meets any of the criteria in Section 26-8a-305.
139          [(18)] (19) "Political subdivision" means:
140          (a) a city or town located in a county of the first or second class as defined in Section
141     17-50-501;
142          (b) a county of the first or second class;
143          (c) the following districts located in a county of the first or second class:
144          (i) a special service district created under Title 17D, Chapter 1, Special Service District
145     Act; or
146          (ii) a local district under Title 17B, Limited Purpose Local Government Entities - Local
147     Districts, for the purpose of providing fire protection, paramedic, and emergency services;
148          (d) areas coming together as described in Subsection 26-8a-405.2(2)(b)(ii);
149          (e) an interlocal entity under Title 11, Chapter 13, Interlocal Cooperation Act; or
150          (f) a special service district for fire protection service under Subsection 17D-1-201(9).
151          [(19)] (20) "Trauma" means an injury requiring immediate medical or surgical
152     intervention.
153          [(20)] (21) "Trauma system" means a single, statewide system that:
154          (a) organizes and coordinates the delivery of trauma care within defined geographic
155     areas from the time of injury through transport and rehabilitative care; and
156          (b) is inclusive of all prehospital providers, hospitals, and rehabilitative facilities in
157     delivering care for trauma patients, regardless of severity.
158          [(21)] (22) "Triage" means the sorting of patients in terms of disposition, destination,
159     or priority. For prehospital trauma victims, triage requires a determination of injury severity to
160     assess the appropriate level of care according to established patient care protocols.
161          [(22)] (23) "Triage, treatment, transportation, and transfer guidelines" means written
162     procedures that:
163          (a) direct the care of patients; and
164          (b) are adopted by the medical staff of an emergency patient receiving facility, trauma
165     center, or an emergency medical service provider.
166          Section 2. Section 26-8a-103 is amended to read:
167          26-8a-103. State Emergency Medical Services Committee -- Membership --
168     Expenses.
169          (1) The State Emergency Medical Services Committee created by Section 26-1-7 shall
170     be composed of the following [17] 19 members appointed by the governor, at least six of
171     whom shall reside in a county of the third, fourth, fifth, or sixth class:
172          (a) five physicians licensed under Title 58, Chapter 67, Utah Medical Practice Act, or
173     Title 58, Chapter 68, Utah Osteopathic Medical Practice Act, as follows:
174          (i) one surgeon who actively provides trauma care at a hospital;
175          (ii) one rural physician involved in emergency medical care;
176          (iii) two physicians who practice in the emergency department of a general acute
177     hospital; and
178          (iv) one pediatrician who practices in the emergency department or critical care unit of
179     a general acute hospital or a children's specialty hospital;
180          (b) two representatives from private ambulance providers;
181          (c) one representative from an ambulance provider that is neither privately owned nor
182     operated by a fire department;
183          (d) two chief officers from fire agencies operated by the following classes of licensed
184     or designated emergency medical services providers: municipality, county, and fire district,
185     provided that no class of medical services providers may have more than one representative
186     under this Subsection (1)(d);
187          (e) one director of a law enforcement agency that provides emergency medical
188     services;
189          (f) one hospital administrator;
190          (g) one emergency care nurse;
191          (h) one paramedic in active field practice;
192          (i) one emergency medical technician in active field practice;
193          (j) one licensed emergency medical dispatcher affiliated with an emergency medical
194     dispatch center; [and]
195          (k) one licensed mental health professional with experience as a first responder;
196          (l) one licensed behavioral emergency services technician; and
197          [(k)] (m) one consumer.
198          (2) (a) Except as provided in Subsection (2)(b), members shall be appointed to a
199     four-year term beginning July 1.
200          (b) Notwithstanding Subsection (2)(a), the governor:
201          (i) shall, at the time of appointment or reappointment, adjust the length of terms to
202     ensure that the terms of committee members are staggered so that approximately half of the
203     committee is appointed every two years;
204          (ii) may not reappoint a member for more than two consecutive terms; and
205          (iii) shall:
206          (A) initially appoint the second member under Subsection (1)(b) from a different
207     private provider than the private provider currently serving under Subsection (1)(b); and
208          (B) thereafter stagger each replacement of a member in Subsection (1)(b) so that the
209     member positions under Subsection (1)(b) are not held by representatives of the same private
210     provider.
211          (c) When a vacancy occurs in the membership for any reason, the replacement shall be
212     appointed by the governor for the unexpired term.
213          (3) (a) Each January, the committee shall organize and select one of its members as
214     chair and one member as vice chair. The committee may organize standing or ad hoc
215     subcommittees, which shall operate in accordance with guidelines established by the
216     committee.
217          (b) The chair shall convene a minimum of four meetings per year. The chair may call
218     special meetings. The chair shall call a meeting upon request of five or more members of the
219     committee.
220          (c) Nine members of the committee constitute a quorum for the transaction of business
221     and the action of a majority of the members present is the action of the committee.
222          (4) A member may not receive compensation or benefits for the member's service, but
223     may receive per diem and travel expenses in accordance with:
224          (a) Section 63A-3-106;
225          (b) Section 63A-3-107; and
226          (c) rules made by the Division of Finance pursuant to Sections 63A-3-106 and
227     63A-3-107.
228          (5) Administrative services for the committee shall be provided by the department.
229          Section 3. Section 26-8a-206 is amended to read:
230          26-8a-206. Personnel stress management program.
231          (1) The department shall develop and implement a statewide program to provide
232     support and counseling for personnel who have been exposed to one or more stressful incidents
233     in the course of providing emergency services.
234          (2) This program shall include:
235          (a) ongoing training for agencies providing emergency services and counseling
236     program volunteers; [and]
237          (b) critical incident stress debriefing for personnel at no cost to the emergency
238     provider[.]; and
239          (c) advising the department on training requirements for licensure as a behavioral
240     emergency services technician.
241          Section 4. Section 26-8a-302 is amended to read:
242          26-8a-302. Licensure of emergency medical service personnel.
243          (1) To promote the availability of comprehensive emergency medical services
244     throughout the state, the committee shall establish:
245          (a) initial and ongoing licensure and training requirements for emergency medical
246     service personnel in the following categories:
247          (i) paramedic;
248          (ii) medical director;
249          (iii) emergency medical service instructor; [and]
250          (iv) behavioral emergency services technician;
251          (v) advanced behavioral emergency services technician; and
252          [(iv)] (vi) other types of emergency medical personnel as the committee considers
253     necessary; and
254          (b) guidelines for giving credit for out-of-state training and experience.
255          (2) The department shall, based on the requirements established in Subsection (1):
256          (a) develop, conduct, and authorize training and testing for emergency medical service
257     personnel; and
258          (b) issue a license and license renewals to emergency medical service personnel.
259          (3) The department shall coordinate with the Department of Human Services
260     established in Section 62A-1-102, and local mental health authorities described in Section
261     17-43-301, to develop and authorize initial and ongoing licensure and training requirements for
262     licensure as a:
263          (a) behavioral emergency services technician; and
264          (b) advanced behavioral emergency services technician.
265          [(3)] (4) As provided in Section 26-8a-502, an individual issued a license under this
266     section may only provide emergency medical services to the extent allowed by the license.
267          [(4)] (5) An individual may not be issued or retain a license under this section unless
268     the individual obtains and retains background clearance under Section 26-8a-310.
269          Section 5. Section 26-8a-307 is amended to read:
270          26-8a-307. Patient destination.
271          (1) If an individual being transported by a ground or air ambulance is in a critical or
272     unstable medical condition, the ground or air ambulance shall transport the patient to the
273     trauma center or closest emergency patient receiving facility appropriate to adequately treat the
274     patient.
275          (2) If the patient's condition is not critical or unstable as determined by medical
276     control, the ground or air ambulance may transport the patient to the:
277          (a) hospital, emergency patient receiving facility, licensed mental health facility, or
278     other medical provider chosen by the patient and approved by medical control as appropriate
279     for the patient's condition and needs; or
280          (b) nearest hospital, emergency patient receiving facility, licensed mental health
281     facility, or other medical provider approved by medical control as appropriate for the patient's
282     condition and needs if the patient expresses no preference.
283          Section 6. Section 78B-5-901 is amended to read:
284     
Part 9. Public Safety Peer Counseling and Behavioral Emergency

285     
Services Technicians

286          78B-5-901. Public safety peer counseling and behavioral emergency services
287     technicians.
288          This part is known as "Public Safety Peer Counseling and Behavioral Emergency
289     Services Technicians."
290          Section 7. Section 78B-5-902 is amended to read:
291          78B-5-902. Definitions.
292          As used in this part:
293          (1) "Communication" means an oral statement, written statement, note, record, report,
294     or document made during, or arising out of, a meeting between a law enforcement officer,
295     firefighter, emergency medical service provider, or rescue provider and a peer support team
296     member.
297          (2) "Behavioral emergency services technician" means an individual who is licensed
298     under Section 26-8a-302 as:
299          (a) a behavioral emergency services technician; or
300          (b) an advanced behavioral emergency services technician.
301          [(2)] (3) "Emergency medical service provider or rescue unit peer support team
302     member" means a person who is:
303          (a) an emergency medical service provider as defined in Section 26-8a-102, a regular
304     or volunteer member of a rescue unit acting as an emergency responder as defined in Section
305     53-2a-502, or another person who has been trained in peer support skills; and
306          (b) designated by the chief executive of an emergency medical service agency or the
307     chief of a rescue unit as a member of an emergency medical service provider's peer support
308     team or as a member of a rescue unit's peer support team.
309          [(3)] (4) "Law enforcement or firefighter peer support team member" means a person
310     who is:
311          (a) a peace officer, law enforcement dispatcher, civilian employee, or volunteer
312     member of a law enforcement agency, a regular or volunteer member of a fire department, or
313     another person who has been trained in peer support skills; and
314          (b) designated by the commissioner of the Department of Public Safety, the executive
315     director of the Department of Corrections, a sheriff, a police chief, or a fire chief as a member
316     of a law enforcement agency's peer support team or a fire department's peer support team.
317          [(4)] (5) "Trained" means a person who has successfully completed a peer support
318     training program approved by the Peace Officer Standards and Training Division, the State Fire
319     Marshal's Office, or the Health Department, as applicable.
320          Section 8. Section 78B-5-904 is enacted to read:
321          78B-5-904. Exclusions for certain communications.
322          (1) In accordance with the Utah Rules of Evidence, a behavioral emergency services
323     technician may refuse to disclose communications made by an individual during the delivery of
324     behavioral emergency services as defined in Section 26-8a-102.
325          (2) Subsection (1) applies only to communications made during individual interactions
326     conducted by a behavioral emergency services technician who is:
327          (a) acting in the behavioral emergency services technician's capacity as an emergency
328     medical service provider; and
329          (b) functioning within the guidelines that are in effect for the behavioral emergency
330     services technician's emergency medical service agency or rescue unit.
331          (3) This section does not apply if:
332          (a) a behavioral emergency services technician was a witness or a party to the incident
333     that prompted the delivery of behavioral emergency services;
334          (b) information received by a behavioral emergency services technician is indicative of
335     actual or suspected child abuse, or actual or suspected child neglect;
336          (c) the individual receiving behavioral emergency services is a clear and immediate
337     danger to the individual's self or others; or
338          (d) communication to the behavioral emergency services technician evidence that the
339     individual who is receiving behavioral emergency services has committed a crime, plans to
340     commit a crime, or intends to conceal a crime.
341          Section 9. Effective date.
342          If approved by two-thirds of all the members elected to each house, this bill takes effect
343     upon approval by the governor, or the day following the constitutional time limit of Utah
344     Constitution, Article VII, Section 8, without the governor's signature, or in the case of a veto,
345     the date of veto override.