This document includes House Committee Amendments incorporated into the bill on Fri, Feb 11, 2022 at 11:25 AM by pflowers.
This document includes Senate Committee Amendments incorporated into the bill on Tue, Feb 22, 2022 at 1:34 PM by kpoll.
1     
GROUND AMBULANCE INTERFACILITY TRANSPORT

2     
LICENSING

3     
2022 GENERAL SESSION

4     
STATE OF UTAH

5     
Chief Sponsor: Ryan D. Wilcox

6     
Senate Sponsor: Curtis S. Bramble

7     

8     LONG TITLE
9     General Description:
10          This bill amends the Utah Emergency Medical Services System Act.
11     Highlighted Provisions:
12          This bill:
13          ▸     defines terms;
14          ▸     requires an applicant for ground ambulance or paramedic services to meet certain
15     requirements with respect to a geographic service area; and
16          ▸     repeals obsolete language regarding a transition to eliminate inconsistent licenses.
17     Money Appropriated in this Bill:
18          None
19     Other Special Clauses:
20          None
21     Utah Code Sections Affected:
22     AMENDS:
23          26-8a-102, as last amended by Laws of Utah 2021, Chapters 208, 237, and 265
24          26-8a-404, as last amended by Laws of Utah 2019, Chapter 390
25          26-8a-416, as enacted by Laws of Utah 1999, Chapter 141
26     

27     Be it enacted by the Legislature of the state of Utah:
28          Section 1. Section 26-8a-102 is amended to read:
29          26-8a-102. Definitions.
30          As used in this chapter:
31          (1) (a) "911 ambulance or paramedic services" means:
32          (i) either:
33          (A) 911 ambulance service;
34          (B) 911 paramedic service; or
35          (C) both 911 ambulance and paramedic service; and
36          (ii) a response to a 911 call received by a designated dispatch center that receives 911
37     or E911 calls.
38          (b) "911 ambulance or paramedic services" does not mean a seven or ten digit
39     telephone call received directly by an ambulance provider licensed under this chapter.
40          (2) "Ambulance" means a ground, air, or water vehicle that:
41          (a) transports patients and is used to provide emergency medical services; and
42          (b) is required to obtain a permit under Section 26-8a-304 to operate in the state.
43          (3) "Ambulance provider" means an emergency medical service provider that:
44          (a) transports and provides emergency medical care to patients; and
45          (b) is required to obtain a license under Part 4, Ambulance and Paramedic Providers.
46          (4) (a) "Behavioral emergency services" means delivering a behavioral health
47     intervention to a patient in an emergency context within a scope and in accordance with
48     guidelines established by the department.
49          (b) "Behavioral emergency services" does not include engaging in the:
50          (i) practice of mental health therapy as defined in Section 58-60-102;
51          (ii) practice of psychology as defined in Section 58-61-102;
52          (iii) practice of clinical social work as defined in Section 58-60-202;
53          (iv) practice of certified social work as defined in Section 58-60-202;
54          (v) practice of marriage and family therapy as defined in Section 58-60-302; or
55          (vi) practice of clinical mental health counseling as defined in Section 58-60-402; and
56          (vii) practice as a substance use disorder counselor as defined in Section 58-60-502.
57          (5) "Committee" means the State Emergency Medical Services Committee created by
58     Section 26-1-7.
59          (6) "Direct medical observation" means in-person observation of a patient by a
60     physician, registered nurse, physician's assistant, or individual licensed under Section
61     26-8a-302.
62          (7) "Emergency medical condition" means:
63          (a) a medical condition that manifests itself by symptoms of sufficient severity,
64     including severe pain, that a prudent layperson, who possesses an average knowledge of health
65     and medicine, could reasonably expect the absence of immediate medical attention to result in:
66          (i) placing the individual's health in serious jeopardy;
67          (ii) serious impairment to bodily functions; or
68          (iii) serious dysfunction of any bodily organ or part; or
69          (b) a medical condition that in the opinion of a physician or the physician's designee
70     requires direct medical observation during transport or may require the intervention of an
71     individual licensed under Section 26-8a-302 during transport.
72          (8) (a) "Emergency medical service personnel" means an individual who provides
73     emergency medical services or behavioral emergency services to a patient and is required to be
74     licensed or certified under Section 26-8a-302.
75          (b) "Emergency medical service personnel" includes a paramedic, medical director of a
76     licensed emergency medical service provider, emergency medical service instructor, behavioral
77     emergency services technician, other categories established by the committee, and a certified
78     emergency medical dispatcher.
79          (9) "Emergency medical service providers" means:
80          (a) licensed ambulance providers and paramedic providers;
81          (b) a facility or provider that is required to be designated under Subsection
82     26-8a-303(1)(a); and
83          (c) emergency medical service personnel.
84          (10) "Emergency medical services" means:
85          (a) medical services;
86          (b) transportation services;
87          (c) behavioral emergency services; or
88          (d) any combination of the services described in Subsections (10)(a) through (c).
89          (11) "Emergency medical service vehicle" means a land, air, or water vehicle that is:
90          (a) maintained and used for the transportation of emergency medical personnel,
91     equipment, and supplies to the scene of a medical emergency; and
92          (b) required to be permitted under Section 26-8a-304.
93          (12) "Governing body":
94          (a) means the same as that term is defined in Section 11-42-102; and
95          (b) for purposes of a "special service district" under Section 11-42-102, means a
96     special service district that has been delegated the authority to select a provider under this
97     chapter by the special service district's legislative body or administrative control board.
98          (13) "Interested party" means:
99          (a) a licensed or designated emergency medical services provider that provides
100     emergency medical services within or in an area that abuts an exclusive geographic service area
101     that is the subject of an application submitted pursuant to Part 4, Ambulance and Paramedic
102     Providers;
103          (b) any municipality, county, or fire district that lies within or abuts a geographic
104     service area that is the subject of an application submitted pursuant to Part 4, Ambulance and
105     Paramedic Providers; or
106          (c) the department when acting in the interest of the public.
107          (14) "Level of service" means the level at which an ambulance provider type of service
108     is licensed as:
109          (a) emergency medical technician;
110          (b) advanced emergency medical technician; or
111          (c) paramedic.
112          [(14)] (15) "Medical control" means a person who provides medical supervision to an
113     emergency medical service provider.
114          [(15)] (16) "Non-911 service" means transport of a patient that is not 911 transport
115     under Subsection (1).
116          [(16)] (17) "Nonemergency secured behavioral health transport" means an entity that:
117          (a) provides nonemergency secure transportation services for an individual who:
118          (i) is not required to be transported by an ambulance under Section 26-8a-305; and
119          (ii) requires behavioral health observation during transport between any of the
120     following facilities:
121          (A) a licensed acute care hospital;
122          (B) an emergency patient receiving facility;
123          (C) a licensed mental health facility; and
124          (D) the office of a licensed health care provider; and
125          (b) is required to be designated under Section 26-8a-303.
126          [(17)] (18) "Paramedic provider" means an entity that:
127          (a) employs emergency medical service personnel; and
128          (b) is required to obtain a license under Part 4, Ambulance and Paramedic Providers.
129          [(18)] (19) "Patient" means an individual who, as the result of illness, injury, or a
130     behavioral emergency condition, meets any of the criteria in Section 26-8a-305.
131          [(19)] (20) "Political subdivision" means:
132          (a) a city, town, or metro township;
133          (b) a county;
134          (c) a special service district created under Title 17D, Chapter 1, Special Service
135     District Act, for the purpose of providing fire protection services under Subsection
136     17D-1-201(9);
137          (d) a local district created under Title 17B, Limited Purpose Local Government Entities
138     - Local Districts, for the purpose of providing fire protection, paramedic, and emergency
139     services;
140          (e) areas coming together as described in Subsection 26-8a-405.2(2)(b)(ii); or
141          (f) an interlocal entity under Title 11, Chapter 13, Interlocal Cooperation Act.
142          [(20)] (21) "Trauma" means an injury requiring immediate medical or surgical
143     intervention.
144          [(21)] (22) "Trauma system" means a single, statewide system that:
145          (a) organizes and coordinates the delivery of trauma care within defined geographic
146     areas from the time of injury through transport and rehabilitative care; and
147          (b) is inclusive of all prehospital providers, hospitals, and rehabilitative facilities in
148     delivering care for trauma patients, regardless of severity.
149          [(22)] (23) "Triage" means the sorting of patients in terms of disposition, destination,
150     or priority. For prehospital trauma victims, triage requires a determination of injury severity to
151     assess the appropriate level of care according to established patient care protocols.
152          [(23)] (24) "Triage, treatment, transportation, and transfer guidelines" means written
153     procedures that:
154          (a) direct the care of patients; and
155          (b) are adopted by the medical staff of an emergency patient receiving facility, trauma
156     center, or an emergency medical service provider.
157          (25) "Type of service" means the category at which an ambulance provider is licensed
158     as:
159          (a) ground ambulance transport;
160          (b) ground ambulance interfacility transport; or
161          (c) both ground ambulance transport and ground ambulance interfacility transport.
162          Section 2. Section 26-8a-404 is amended to read:
163          26-8a-404. Ground ambulance and paramedic licenses -- Application and
164     department review.
165          (1) Except as provided in Section 26-8a-413, an applicant for a ground ambulance or
166     paramedic license shall apply to the department for a license only by:
167          (a) submitting a completed application;
168          (b) providing information in the format required by the department; and
169          (c) paying the required fees, including the cost of the hearing officer.
170          (2) The department shall make rules establishing minimum qualifications and
171     requirements for:
172          (a) personnel;
173          (b) capital reserves;
174          (c) equipment;
175          (d) a business plan;
176          (e) operational procedures;
177          (f) medical direction agreements;
178          (g) management and control; and
179          (h) other matters that may be relevant to an applicant's ability to provide ground
180     ambulance or paramedic service.
181          (3) An application for a license to provide ground ambulance service or paramedic
182     service shall be for all ground ambulance services or paramedic services arising within the
183     geographic service area, except that an applicant may apply for a license for less than all
184     ground ambulance services or all paramedic services arising within an exclusive geographic
185     area if it can demonstrate how the remainder of that area will be served.
186          (4) (a) A ground ambulance service licensee may apply to the department for a license
187     to provide a higher level of service as defined by department rule if the application includes:
188          (i) a copy of the new treatment protocols for the higher level of service approved by the
189     off-line medical director;
190          (ii) an assessment of field performance by the applicant's off-line director; and
191          (iii) an updated plan of operation demonstrating the ability of the applicant to provide
192     the higher level of service.
193          (b) If the department determines that the applicant has demonstrated the ability to
194     provide the higher level of service in accordance with Subsection (4)(a), the department shall
195     issue a revised license reflecting the higher level of service and the requirements of Section
196     26-8a-408 do not apply.
197          (c) A revised license issued under Subsection (4)(b):
198          (i) may only affect the level of service that the licensee may provide; and
199          (ii) may not affect any other terms, conditions, or limitations of the original license[;
200     and].
201          [(iii) may not impact the rights of other licensees.]
202          (5) Upon receiving a completed application and the required fees, the department shall
203     review the application and determine whether the application meets the minimum
204     qualifications and requirements for licensure.
205          (6) The department may deny an application if it finds that it contains any materially
206     false or misleading information, is incomplete, or if the application demonstrates that the
207     applicant fails to meet the minimum qualifications and requirements for licensure under
208     Subsection (2).
209          (7) If the department denies an application, it shall notify the applicant in writing
210     setting forth the grounds for the denial. A denial may be appealed under Title 63G, Chapter 4,
211     Administrative Procedures Act.
212          Section 3. Section 26-8a-416 is amended to read:
213          26-8a-416. Overlapping licenses.
214          [(1) By May 30, 2000, the department shall review all licenses in effect on October 2,
215     1999, to identify overlap, as defined in department rule, in the service areas of two or more
216     licensed providers.]
217          [(2) By June 30, 2000, the department shall notify all licensed providers affected by an
218     overlap. By September 30, 2000, the department shall schedule, by order, a deadline to resolve
219     each overlap, considering the effects on the licensed providers and the areas to be addressed.]
220          [(3) For each overlap, the department shall meet with the affected licensed providers
221     and provide 120 days for a negotiated resolution, consistent with the criteria in Section
222     26-8a-408.]
223          [(4) (a) If a resolution is reached under Subsection (2) that the department finds
224     satisfies the criteria in Section 26-8a-408, the department shall amend the licenses to reflect the
225     resolution consistent with Subsection (6).]
226          [(b) If a resolution is not reached under Subsection (2), the department or any of the
227     licensed providers involved in the matter may request the commencement of a formal
228     adjudicative proceeding to resolve the overlap.]
229          [(5) The department shall commence adjudicative proceedings for any overlap that is
230     not resolved by July 1, 2003.]
231          (1) As used in this section Ĥ→ [, "overlap"] :
231a          (a) "Overlap" ←Ĥ means two ground ambulance interfacility
232     transport providers that are licensed at the same level of service in all or part of a single
233     geographic service area.
233a          Ĥ→ (b) "Overlay" means two ground ambulance interfacility transport providers that
233b     are licensed at a different level of service in all or part of a single geographic service area. ←Ĥ
234          [(6)] (2) Notwithstanding the exclusive geographic service requirement of Section
235     26-8a-402, the department [may amend one or more licenses after a resolution is reached or an
236     adjudicative proceeding has been held to allow:] shall recognize overlap Ĥ→ and overlay ←Ĥ
236a     ground ambulance
237     interfacility transport licenses that existed on or before May 4, 2022.
238          [(a) a single licensed provider to serve all or part of the overlap area;]
239          [(b) more than one licensed provider to serve the overlap area;]
240          [(c) licensed providers to provide different types of service in the overlap area; or]
241          [(d) licenses that recognize service arrangements that existed on September 30, 1999.]
242          (3) The department may, without an adjudicative proceeding Ŝ→ but with at least 30 days
242a1     notice to providers in the same geographic service area ←Ŝ , amend an existing
242a     Ĥ→ overlay ←Ĥ ground
243     ambulance interfacility transport license Ŝ→ [that creates a new] solely to convert an overlay into
243a     an ←Ŝ overlap if the existing ground
244     ambulance interfacility transport Ŝ→ licensed ←Ŝ provider meets the requirements described in
244a     Subsection
245     26-8a-404(4).
245a          Ŝ→ (4) An amendment of a license under this section may not alter:
245b      (a) other terms of the original license, including the applicable geographic service area; or
245c      (b) the license of other providers that provide interfacility transport services in the geographic
245d     service area. ←Ŝ
246          [(7)] Ŝ→ [(4)] (5) ←Ŝ Notwithstanding Subsection [(6)] (2), any license for an overlap area
247     terminates upon:
248          (a) relinquishment by the provider; or
249          (b) revocation by the department.