October 8, 2013, Introduced by Reps. Dianda, Pagel, Kivela, Switalski, Kelly, Driskell, Brinks, Yanez, Zemke, Lamonte, Dillon, Abed, Cochran, Durhal, Haugh, Cavanagh, Brunner, Smiley, Greimel, Lauwers, Kandrevas and Knezek and referred to the Committee on Health Policy.
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.
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 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 and subject to subsection (13),
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 Except as provided in
subsection (13), 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, part-time limited advanced life support, part-time
advanced life support, or a combination of those services 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 part-time advanced life support or 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
subsections (12)
and (13), 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 part-time limited advanced life
support
services, limited advanced life support
services, or part-
time advanced life support services, advanced life support
services, or a combination of those 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.
(13) An ambulance operation whose primary service area is not
in a county or micropolitan area with a population greater than
10,000 and whose primary service area has a population density of
less than 7 people per square mile may apply for a part-time
limited advanced life support services upgrade license, a part-time
advanced life support services upgrade license, or an upgrade
license for a combination of those services. The department may
issue a part-time limited advanced life support services upgrade
license or a part-time advanced life support services upgrade
license to an ambulance operation that meets the service area
requirement of this subsection and all of the equipment and
staffing requirements for a limited advanced life support services
upgrade license or an advanced life support services upgrade
license except the requirement for full-time availability of the
advanced or limited advanced life support services. A part-time
limited advanced life support services upgrade license or a part-
time advanced life support services upgrade license is valid for 2
years from the date of issue and may be renewed an unlimited number
of times. As used in this subsection, "micropolitan area" means a
micropolitan statistical area as most recently delineated by the
United States office of management and budget.
(14) As used in this section and section 20921 in relation to
advanced or limited advanced life support services, "part-time"
means on less than a 24-hour-a-day, 7-day-a-week basis.
Sec. 20921. (1) An ambulance operation shall do all of the
following:
(a) 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), (13), 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 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),
(13), 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), 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.
(d) If designated as providing part-time advanced life
support, with at least 1 paramedic and 1 emergency medical
technician while providing advanced life support services.
(e) If designated as providing part-time limited advanced life
support, with at least 1 emergency medical technician specialist
and 1 emergency medical technician while providing limited advanced
life support services.
(4) An ambulance operation that is licensed to provide part-
time advanced life support or 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. An
ambulance operation providing part-time advanced life support
services is exempt from the requirements of this subdivision.
(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.