HB-5454, As Passed House, December 11, 2014

SUBSTITUTE FOR

HOUSE BILL NO. 5454

     A bill to amend 1978 PA 368, entitled

"Public health code,"

by amending sections 20920 and 20921 (MCL 333.20920 and 333.20921),

as amended by 2004 PA 200, and by adding section 20921a; and to

repeal acts and parts of acts.

THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

     Sec. 20920. (1) A person shall not establish, operate, or

cause to be operated an ambulance operation unless the ambulance

operation is licensed under this section.

     (2) Upon proper application and payment of a $100.00 fee, the

department shall issue a license as an ambulance operation to a

person who meets the requirements of this part and the rules

promulgated under this part.

     (3) An applicant shall specify in the application each

ambulance to be operated.

     (4) An ambulance operation license shall specify the

ambulances licensed to be operated.

     (5) An ambulance operation license shall state the highest

level of life support the ambulance operation is licensed to

provide. An ambulance operation shall operate in accordance with

this part, rules promulgated under this part, and approved medical

control authority protocols and, except as provided in section

20921a(2), shall not provide life support at a level that exceeds

its license and available licensed personnel or violates approved

medical control authority protocols.

     (6) An ambulance operation license may be renewed annually

upon application to the department and payment of a $100.00 renewal

fee. Before issuing a renewal license, the department shall

determine that the ambulance operation is in compliance with this

part, the rules promulgated under this part, and medical control

authority protocols.

     (7) Beginning on July 22, 1997, an ambulance operation that

meets all of the following requirements may apply for an ambulance

operation upgrade license under subsection (8):

     (a) On or before July 22, 1997, holds an ambulance operation

license that designates the ambulance operation either as a

transporting basic life support service or as a transporting

limited advanced life support service.

     (b) Is a transporting basic life support service, that is able

to staff and equip 1 or more ambulances for the transport of

emergency patients at a life support level higher than basic life

support, or is a transporting limited advanced life support

service, that is able to staff and equip 1 or more ambulances for

the transport of emergency patients at the life support level of

advanced life support.

     (c) Is owned or operated by or under contract to a local unit

of government and providing first-line emergency medical response

to that local unit of government on or before July 22, 1997.

     (d) Will provide the services described in subdivision (b)

only to the local unit of government described in subdivision (c),

and only in response to a 911 call or other call for emergency

transport.

     (8) An ambulance operation meeting the requirements of

subsection (7) that applies for an ambulance operation upgrade

license shall include all of the following information in the

application provided by the department:

     (a) Verification of all of the requirements of subsection (7)

including, but not limited to, a description of the staffing and

equipment to be used in providing the higher level of life support

services.

     (b) If the applicant is a transporting basic life support

service, a plan of action to upgrade from providing basic life

support to providing limited advanced life support or advanced life

support to take place over a period of not more than 2 years. If

the applicant is a transporting limited advanced life support

service, a plan of action to upgrade from providing limited

advanced life support to providing advanced life support to take

place over a period of not more than 2 years.

     (c) The medical control authority protocols for the ambulance

operation upgrade license, along with a recommendation from the

medical control authority under which the ambulance operation

operates that the ambulance operation upgrade license be issued by

the department.

     (d) Other information required by the department.

     (9) The statewide emergency medical services coordination

committee shall review the information described in subsection

(8)(c) and make a recommendation to the department as to whether or

not an ambulance operation upgrade license should be granted to the

applicant.

     (10) Upon receipt of a completed application as required under

subsection (8), a positive recommendation under subsection (9), and

payment of a $100.00 fee, the department shall issue to the

applicant an ambulance operation upgrade license. Subject to

subsection (12), the license is valid for 2 years from the date of

issuance and is renewable for 1 additional 2-year period. An

application for renewal of an ambulance operation upgrade license

shall contain documentation of the progress made on the plan of

action described in subsection (8)(b). In addition, the medical

control authority under which the ambulance operation operates

shall annually file with the statewide emergency medical services

coordination committee a written report on the progress made by the

ambulance operation on the plan of action described in subsection

(8)(b), including, but not limited to, information on training,

equipment, and personnel.

     (11) If an ambulance operation is designated by its regular

license as providing basic life support services, then an ambulance

operation upgrade license issued under this section allows the

ambulance operation to provide limited advanced life support

services or advanced life support services when the ambulance

operation is able to staff and equip 1 or more ambulances to

provide services at the higher levels. If an ambulance operation is

designated by its regular license as providing limited advanced

life support services, then an ambulance operation upgrade license

issued under this section allows the ambulance operation to provide

advanced life support services when the ambulance operation is able

to staff and equip 1 or more ambulances to provide services at the

higher level. An ambulance operation shall not provide services

under an ambulance operation upgrade license unless the medical

control authority under which the ambulance operation operates has

adopted protocols for the ambulance operation upgrade license

regarding quality monitoring procedures, use and protection of

equipment, and patient care.

     (12) The department may revoke or fail to renew an ambulance

operation upgrade license for a violation of this part or a rule

promulgated under this part or for failure to comply with the plan

of action filed under subsection (8)(b). An ambulance operation

that obtains an ambulance operation upgrade license must annually

renew its regular license under subsections (2) to (6). An

ambulance operation's regular license is not affected by the

following:

     (a) The fact that the ambulance operation has obtained or

renewed an ambulance operation upgrade license.

     (b) The fact that an ambulance operation's ambulance operation

upgrade license is revoked or is not renewed under this subsection.

     (c) The fact that the ambulance operation's ambulance

operation upgrade license expires at the end of the second 2-year

period prescribed by subsection (10).

     (13) By July 22, 2000, the department shall file a written

report to the legislature. The department shall include all of the

following information in the report:

     (a) The number of ambulance operations that were qualified

under subsection (7) to apply for an ambulance operation upgrade

license under subsection (8) during the 3-year period.

     (b) The number of ambulance operations that in fact applied

for an ambulance operation upgrade license during the 3-year

period.

     (c) The number of ambulance operations that successfully

upgraded from being a transporting basic life support service to a

transporting limited advanced service or a transporting advanced

life support service or that successfully upgraded from being a

transporting limited advanced life support service to a

transporting advanced life support service under an ambulance

operation upgrade license.

     (d) The number of ambulance operations that failed to

successfully upgrade, as described in subdivision (c), under an

ambulance operation upgrade license, but that improved their

services during the 3-year period.

     (e) The number of ambulance operations that failed to

successfully upgrade, as described in subdivision (c), under an

ambulance operation upgrade license, and that showed no improvement

or a decline in their services.

     (f) The effect of the amendatory act that added this

subsection on the delivery of emergency medical services in this

state.

     Sec. 20921. (1) An ambulance operation shall do all of the

following:

     (a) Provide Except as provided in section 20921a, provide at

least 1 ambulance available for response to requests for emergency

assistance on a 24-hour-a-day, 7-day-a-week basis in accordance

with local medical control authority protocols.

     (b) Respond or ensure that a response is provided to each

request for emergency assistance originating from within the bounds

of its service area.

     (c) Operate under the direction of a medical control authority

or the medical control authorities with jurisdiction over the

ambulance operation.

     (d) Notify the department immediately of a change that would

alter the information contained on its application for an ambulance

operation license or renewal.

     (e) Subject to section 20920(7) to (12) and section 20921a,

provide life support consistent with its license and approved local

medical control authority protocols to each emergency patient

without prior inquiry into ability to pay or source of payment.

     (2) An ambulance operation shall not do 1 or more any of the

following:

     (a) Knowingly provide a person with false or misleading

information concerning the time at which an emergency response will

be initiated or the location from which the response is being

initiated.

     (b) Induce or seek to induce any person engaging an ambulance

to patronize a long-term care facility, mortuary, or hospital.

     (c) Advertise, or permit advertising of, within or on the

premises of the ambulance operation or within or on an ambulance,

the name or the services of an attorney, accident investigator,

nurse, physician, long-term care facility, mortuary, or hospital.

If 1 of those persons or facilities owns or operates an ambulance

operation, the person or facility may use its business name in the

name of the ambulance operation and may display the name of the

ambulance operation within or on the premises of the ambulance

operation or within or on an ambulance.

     (d) Advertise or disseminate information for the purpose of

obtaining contracts under a name other than the name of the person

holding an ambulance operation license or the trade or assumed name

of the ambulance operation.

     (e) If the ambulance operation is operating under an ambulance

operation upgrade license issued under section 20920(7) to (12),

advertise or otherwise hold itself out as a full-time transporting

limited advanced life support service or a full-time transporting

advanced life support service unless the ambulance operation

actually provides those services on a 24-hour-per-day, 7-day-a-week

basis.

     (3) Except as provided in subsection (4) and section 20921a,

an ambulance operation shall not operate, attend, or permit an

ambulance to be operated while transporting a patient unless the

ambulance is, at a minimum, staffed as follows:

     (a) If designated as providing basic life support, with at

least 1 emergency medical technician and 1 medical first responder.

     (b) If designated as providing limited advanced life support,

with at least 1 emergency medical technician specialist and 1

emergency medical technician.

     (c) If designated as providing advanced life support, with at

least 1 paramedic and 1 emergency medical technician.

     (4) An ambulance operation that is licensed to provide

advanced life support and has more than 1 ambulance licensed under

its operation may operate an ambulance licensed to provide basic

life support or limited advanced life support at a higher level of

life support if all of the following are met:

     (a) The ambulance operation has at least 1 ambulance under its

operation that is properly staffed and available to provide

advanced life support on a 24-hour-a-day, 7-day-a-week basis.

     (b) The licensed personnel required to operate at that higher

level of life support are available at the scene and in the

ambulance during the patient transport to provide life support to

that patient at that higher level.

     (c) The ambulance meets all equipment and communication

requirements to operate at that higher level of life support.

     (d) The ambulance operation that is unable to respond to a

request for emergency assistance immediately requests assistance

pursuant to protocols established by the local medical control

authority and approved by the department under this part.

     (5) Except as provided in subsection (6), an ambulance

operation shall ensure that an emergency medical technician, an

emergency medical technician specialist, or a paramedic is in the

patient compartment of an ambulance while transporting an emergency

patient.

     (6) Subsection (5) does not apply to the transportation of a

patient by an ambulance if the patient is accompanied in the

patient compartment of the ambulance by an appropriate licensed

health professional designated by a physician and after a

physician-patient relationship has been established as prescribed

in this part or the rules promulgated by the department under this

part.

     Sec. 20921a. (1) A limited or advanced ambulance operation

whose primary service area is in a county or micropolitan area with

a population of 10,000 or less and whose primary service area has a

population density of less than 7 people per square mile may have

an ambulance available for less than 24-hour-a-day, 7-day-a-week

availability in section 20921(1)(a) if both of the following

conditions are met:

     (a) The medical control authority under which the ambulance

operation operates authorizes the lesser availability.

     (b) The advanced ambulance operation has department–approved

local medical control authority protocols in place.

     (2) A basic ambulance operation whose primary service area is

in a county or micropolitan area with a population of 10,000 or

less and whose primary service area has a population density of

less than 7 people per square mile may operate at an increased

level of licensure when staffed with an EMT-specialist or EMT-

paramedic, if all of the following conditions are met:

     (a) The basic ambulance is equipped at the greater licensure

level.

     (b) The medical control authority under which the ambulance

operation operates authorizes the conditional increased level of

licensure.

     (c) The basic ambulance operation has department–approved

local medical control authority protocols in place.

     (3) As used in this section, "micropolitan area" means a

micropolitan statistical area as most recently delineated by the

United States office of management and budget.

     Enacting section 1. Section 20921a of the public health code,

1978 PA 368, MCL 333.20921a, is repealed effective January 1, 2018.