KENTUCKY COMMUNITY AND TECHNICAL COLLEGE SYSTEM

Kentucky Board of Emergency Medical Services

(New Administrative Regulation)

 

      202 KAR 7:545. License classifications.

 

      RELATES TO: KRS 311A.030, 311A.190

      STATUTORY AUTHORITY: KRS 311A.020, 311A.025, 311A.030, 311A.190

      NECESSITY, FUNCTION, AND CONFORMITY: KRS 311A.020 requires the board to exercise all administrative functions in the regulation of the ambulance services and medical first response agencies. KRS 311A.030 requires the board to promulgate administrative regulations to establish requirements for various classes of ambulance and emergency medical service agencies. This administrative regulation establishes requirements for each class of ambulance service and medical first response agencies.

 

      Section 1. License Classifications. (1) License classifications for ambulance providers shall include:

      (a) A Class I ground ambulance agency operating at the Advanced Life Support (ALS), Basic Life Support (BLS), or Adult Critical Care Transport level to provide emergency and nonemergency care and transportation;

      (b) A Class II ground ambulance agency operating at the BLS level only to provide nonemergency care and transportation;

      (c) A Class III ground ambulance agency operating at the ALS level to provide critical care, specialty care, emergency or nonemergency care, and transportation between health care facilities. Based on the Certificate of Need and scope of care policy, a Class III ground ambulance agency shall be designated as one (1) of the following types:

      1. A Class III Adult Critical Care agency providing critical care transport services to patients ages twelve (12) and above;

      2. A Class III Pediatric Specialty Care agency providing specialty care transport services to patients under the age of twelve (12); or

      3. A Class III Neonatal Specialty Care agency providing specialty care transport services to patients less than twenty-nine (29) days of age;

      (d) A Class IV ground ambulance agency operating at the ALS or BLS level to provide emergency and nonemergency care and transportation for restricted locations, such as industrial sites or other sites that do not provide services outside the designated geographic service area;

      (e) A Class VI agency providing medical first response without patient transport at the BLS or ALS level.

      1. Each BLS First Response agency shall be licensed separately as a Class VI BLS agency unless a mutual aid agreement is executed with a licensed Class I ambulance agency that provides 911 response services for the geographic service area.

      2. A nonlicensed BLS First Response Agency may execute a mutual aid agreement with multiple nonlicensed BLS First Response Agencies that serve the same geographic service area.

      3. A mutual aid agreement shall automatically renew at the conclusion of a calendar year.

      4. A nonlicensed BLS First Response Agency or a Class I ALS agency may terminate a mutual aid agreement thirty (30) days after written notice is provided to the other party.

      5. A mutual aid agreement between a Class I ALS agency and a nonlicensed BLS First Response agency serving the same geographic area shall be updated as changes to the agreement occur and shall include provisions for:

      a. Medical direction;

      b. BLS protocols;

      c. Response protocol;

      d. Geographic service areas to be served;

      e. Circumstances causing dispatch of the nonlicensed BLS first response agency;

      f. Training;

      g. Quality assurance processes; and

      h. Liability Insurance if applicable.

      6. A nonlicensed BLS First Response agency shall not provide BLS care outside of the geographic service area of the Class I ALS agency.

      7. A nonlicensed BLS First Response agency unable to secure a written mutual aid agreement with a Class I ALS agency within its geographic service area, may operate within the jurisdiction as a nonlicensed BLS First Response agency if the agency has written correspondence from at least two (2) Class I 911 agencies denying the agency’s request to enter into a mutual aid agreement. The correspondence denying the mutual aid request shall be maintained on file at the agency.

      8. A license to provide BLS care shall not be issued solely through the execution of a mutual aid agreement between a Class I agency and a nonlicensed BLS First Response agency;

      (f) A Class VII rotor wing air ambulance service providing ALS emergency or nonemergency air transportation;

      (g) A fixed wing class VII service provides ALS or BLS emergency or nonemergency air transportation; and

      (h) A Class VIII agency providing BLS or ALS pre-hospital care above the first-aid level at special events, sports events, concerts, or large social gatherings.

      1. A Class VIII agency shall not transport patients beyond the grounds of an event and shall be bound by the geographic service area of its Certificate of Need.

      2. A Class VIII agency shall not transport patients independently to a hospital.

      3. If transport of a patient is required, a Class VIII agency shall contact 911 for transport by a Class I agency licensed for the geographic service area.

      (2) The KBEMS office shall license agencies in accordance with subsection (1 or i) of this section.

      (3) An agency shall obtain a license from the board within ninety (90) days of issuance of a Certificate of Need from the Cabinet for Health and Family Services.

      (4) An agency that does not receive a license within ninety (90) days of the issuance of its Certification of Need shall not be granted a license by the board.

      (5) An agency shall not hold more than one (1) license per level of classification in one (1) defined geographic service area unless each license was obtained prior to January 1, 2018.

 

      Section 2. Public Notice of Negative Action. The board office shall publish on the KBEMS Web site or similar publication of the board, the name of any licensed agency that is fined, placed on probationary status, placed on restricted status, suspended, or had a license revoked.

 

JIM DUKE, Chairperson

      APPROVED BY AGENCY: December 7, 2017

      FILED WITH LRC: December 13, 2017 at 2 p.m.

      PUBLIC HEARING AND PUBLIC COMMENT PERIOD: A public hearing on this administrative regulation shall be held on January 24, 2018 at 10:00 a.m. Eastern Standard Time at 118 James Court, Suite 50, Lexington, Kentucky 40505. Individuals interested in being heard at this hearing shall notify this agency in writing by 5 workdays prior to the hearing of their intent to attend. If no notification of intent to attend the hearing is received by that date, the hearing may be canceled. This hearing is open to the public. Any person who wishes to be heard will be given an opportunity to comment on the proposed administrative regulation. A transcript of the public hearing will not be made unless a written request for a transcript is made. If you do not wish to be heard at the public hearing, you may submit written comments on the proposed administrative regulation. Written comments shall be accepted through January 31, 2018. Send written notification of intent to be heard at the public hearing or written comments on the proposed administrative regulation to the contact person.

      CONTACT PERSON: Angela Evans; Legal Counsel, Kentucky Board of Emergency Medical Services; McBrayer, McGinnis, Leslie & Kirkland, PLLC, 201 East Main Street Suite 900, Lexington, Kentucky 40507, phone (859) 231-8780, fax (859) 231-1175, email aevans@mmlk.com.

 

REGULATORY IMPACT ANALYSIS AND TIERING STATEMENT

 

Contact Person: Angela Evans

      (1) Provide a brief summary of:

      (a) What this administrative regulation does: This administrative regulation establishes the different classes of ambulance agencies and the specific requirements for each class.

      (b) The necessity of this administrative regulation: This administrative regulation is necessary to differentiate the services each ambulance class can provide.

      (c) How this administrative regulation conforms to the content of the authorizing statutes: The board is authorized by statue to establish specific requirements for the different ambulance classes.

      (d) How this administrative regulation currently assists or will assist in the effective administration of the statutes: This administrative regulation informs potential applicants of the various ground ambulance classifications and the types within the classes, assisting potential applicants in determining which class is the most appropriate for them to apply.

      (2) If this is an amendment to an existing administrative regulation, provide a brief summary of:

      (a) How the amendment will change this existing administrative regulation: This is a new regulation.

      (b) The necessity of the amendment to this administrative regulation: This is a new regulation.

      (c) How the amendment conforms to the content of the authorizing statutes: The authorizing statute allows the board to establish specific requirements for each classification.

      (d) How the amendment will assist in the effective administration of the statutes: This is a new regulation.

      (3) List the type and number of individuals, businesses, organizations, or state and local governments affected by this administrative regulation: There are approximately 213 licensed agencies.

      (4) Provide an analysis of how the entities identified in question (3) will be impacted by either the implementation of this administrative regulation, if new, or by the change, if it is an amendment, including:

      (a) List the actions that each of the regulated entities identified in question (3) will have to take to comply with this administrative regulation or amendment: This amendment will not require any additional action by existing entities.

      (b) In complying with this administrative regulation or amendment, how much will it cost each of the entities identified in question (3): There is no cost to existing entities.

      (c) As a result of compliance, what benefits will accrue to the entities identified in question (3): The potential applicants will be educated on the various classes of ambulance services and be less likely to provide services beyond their classification which benefits the existing agencies.

      (5) Provide an estimate of how much it will cost the administrative body to implement this administrative regulation: None

      (a) Initially: None

      (b) On a continuing basis: None

      (6) What is the source of the funding to be used for the implementation and enforcement of this administrative regulation: Board funds.

      (7) Provide an assessment of whether an increase in fees or funding will be necessary to implement this administrative regulation, if new, or by the change if it is an amendment: No fee increase is necessary to implement this amendment.

      (8) State whether or not this administrative regulation established any fees or directly or indirectly increased any fees: This administrative regulation does not directly or indirectly increase any fees.

      (9) TIERING: Is tiering applied? Tiering was not applied as the regulation is applicable to all credential holders. This regulation does not distinguish between similarly situated individuals on the basis of any factor.

 

FISCAL NOTE ON STATE OR LOCAL GOVERNMENT

 

      1. What units, parts or divisions of state or local government (including cities, counties, fire departments, or school districts) will be impacted by this administrative regulation? Ambulance providers and first response agencies.

      2. Identify each state or federal statute or federal regulation that requires or authorizes the action taken by the administrative regulation: KRS 311A.020, 311A.025, 311A.030, 311A.190

      3. Estimate the effect of this administrative regulation on the expenditures and revenues of a state or local government agency (including cities, counties, fire departments, or school districts) for the first full year the administrative regulation is to be in effect.

      (a) How much revenue will this administrative regulation generate for the state or local government (including cities, counties, fire departments, or school districts) for the first year? No revenue will be generated by this administrative regulation.

      (b) How much revenue will this administrative regulation generate for the state or local government (including cities, counties, fire departments, or school districts) for subsequent years? No revenue will be generated by this administrative regulation.

      (c) How much will it cost to administer this program for the first year? None

      (d) How much will it cost to administer this program for subsequent years? None

      Note: If specific dollar estimates cannot be determined, provide a brief narrative to explain the fiscal impact of the administrative regulation.

      Revenues (+/-): None

      Expenditures (+/-): None

      Other Explanation: None