HB-5232, As Passed House, April 28, 2004
SUBSTITUTE FOR
HOUSE BILL NO. 5232
A bill to amend 1978 PA 368, entitled
"Public health code,"
by amending sections 20920, 20921, and 20923 (MCL 333.20920,
333.20921, and 333.20923), as amended by 2000 PA 375.
THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
1 Sec. 20920. (1) A person shall not establish, operate, or
2 cause to be operated an ambulance operation unless the ambulance
3 operation is licensed under this section.
4 (2) Upon proper application and payment of a $100.00 fee, the
5 department shall issue a license as an ambulance operation to a
6 person who meets the requirements of this part and the rules
7 promulgated under this part.
8 (3) An applicant shall specify in the application each
9 ambulance to be operated.
10 (4) An ambulance operation license shall specify the
1 ambulances licensed to be operated.
2 (5) An ambulance operation license shall state the highest
3 level of life support the ambulance operation is licensed to
4 provide. An ambulance operation shall operate in accordance with
5 this part, rules promulgated under this part, and approved
6 medical control authority protocols and shall not provide life
7 support at a level that exceeds its license or available licensed
8 personnel or violates approved medical control authority
9 protocols.
10 (6) An ambulance operation license may be renewed annually
11 upon application to the department and payment of a $100.00
12 renewal fee. Before issuing a renewal license, the department
13 shall determine that the ambulance operation is in compliance
14 with this part, the rules promulgated under this part, and
15 medical control authority protocols.
16 (7) Beginning on July 22, 1997, an ambulance operation that
17 meets all of the following requirements may apply for an
18 ambulance operation upgrade license under subsection (8):
19 (a) On or before July 22, 1997, holds an ambulance operation
20 license that designates the ambulance operation either as a
21 transporting basic life support service or as a transporting
22 limited advanced life support service.
23 (b) Is a transporting basic life support service, that is
24 able to staff and equip 1 or more ambulances for the transport of
25 emergency patients at a life support level higher than basic life
26 support, or is a transporting limited advanced life support
27 service, that is able to staff and equip 1 or more ambulances for
1 the transport of emergency patients at the life support level of
2 advanced life support.
3 (c) Is owned or operated by or under contract to a local unit
4 of government and providing first-line emergency medical response
5 to that local unit of government on or before July 22, 1997.
6 (d) Will provide the services described in subdivision (b)
7 only to the local unit of government described in
8 subdivision (c), and only in response to a 911 call or other call
9 for emergency transport.
10 (8) An ambulance operation meeting the requirements of
11 subsection (7) that applies for an ambulance operation upgrade
12 license shall include all of the following information in the
13 application provided by the department:
14 (a) Verification of all of the requirements of subsection (7)
15 including, but not limited to, a description of the staffing and
16 equipment to be used in providing the higher level of life
17 support services.
18 (b) If the applicant is a transporting basic life support
19 service, a plan of action to upgrade from providing basic life
20 support to providing limited advanced life support or advanced
21 life support to take place over a period of not more than 2
22 years. If the applicant is a transporting limited advanced life
23 support service, a plan of action to upgrade from providing
24 limited advanced life support to providing advanced life support
25 to take place over a period of not more than 2 years.
26 (c) The medical control authority protocols for the ambulance
27 operation upgrade license, along with a recommendation from the
1 medical control authority under which the ambulance operation
2 operates that the ambulance operation upgrade license be issued
3 by the department.
4 (d) Other information required by the department.
5 (9) The statewide emergency medical services coordination
6 committee shall review the information described in
7 subsection (8)(c) and make a recommendation to the department as
8 to whether or not an ambulance operation upgrade license should
9 be granted to the applicant.
10 (10) Upon receipt of a completed application as required
11 under subsection (8), a positive recommendation under
12 subsection (9), and payment of a $100.00 fee, the department
13 shall issue to the applicant an ambulance operation upgrade
14 license. Subject to subsection (12), the license is valid for 2
15 years from the date of issuance and is renewable for 1 additional
16 2-year period. An application for renewal of an ambulance
17 operation upgrade license shall contain documentation of the
18 progress made on the plan of action described in
19 subsection (8)(b). In addition, the medical control authority
20 under which the ambulance operation operates shall annually file
21 with the statewide emergency medical services coordination
22 committee a written report on the progress made by the ambulance
23 operation on the plan of action described in subsection (8)(b),
24 including, but not limited to, information on training,
25 equipment, and personnel.
26 (11) If an ambulance operation is designated by its regular
27 license as providing basic life support services, then an
1 ambulance operation upgrade license issued under this section
2 allows the ambulance operation to provide limited advanced life
3 support services or advanced life support services when the
4 ambulance operation is able to staff and equip 1 or more
5 ambulances to provide services at the higher levels. If an
6 ambulance operation is designated by its regular license as
7 providing limited advanced life support services, then an
8 ambulance operation upgrade license issued under this section
9 allows the ambulance operation to provide advanced life support
10 services when the ambulance operation is able to staff and equip
11 1 or more ambulances to provide services at the higher level. An
12 ambulance operation shall not provide services under an ambulance
13 operation upgrade license unless the medical control authority
14 under which the ambulance operation operates has adopted
15 protocols for the ambulance operation upgrade license regarding
16 quality monitoring procedures, use and protection of equipment,
17 and patient care.
18 (12) The department may revoke or fail to renew an ambulance
19 operation upgrade license for a violation of this part or a rule
20 promulgated under this part or for failure to comply with the
21 plan of action filed under subsection (8)(b). An ambulance
22 operation that obtains an ambulance operation upgrade license
23 must annually renew its regular license under subsections (2) to
24 (6). An ambulance operation's regular license is not affected by
25 the following:
26 (a) The fact that the ambulance operation has obtained or
27 renewed an ambulance operation upgrade license.
1 (b) The fact that an ambulance operation's ambulance
2 operation upgrade license is revoked or is not renewed under this
3 subsection.
4 (c) The fact that the ambulance operation's ambulance
5 operation upgrade license expires at the end of the second 2-year
6 period prescribed by subsection (10).
7 (13) By July 22, 2000, the department shall file a written
8 report to the legislature. The department shall include all of
9 the following information in the report:
10 (a) The number of ambulance operations that were qualified
11 under subsection (7) to apply for an ambulance operation upgrade
12 license under subsection (8) during the 3-year period.
13 (b) The number of ambulance operations that in fact applied
14 for an ambulance operation upgrade license during the 3-year
15 period.
16 (c) The number of ambulance operations that successfully
17 upgraded from being a transporting basic life support service to
18 a transporting limited advanced service or a transporting
19 advanced life support service or that successfully upgraded from
20 being a transporting limited advanced life support service to a
21 transporting advanced life support service under an ambulance
22 operation upgrade license.
23 (d) The number of ambulance operations that failed to
24 successfully upgrade, as described in subdivision (c), under an
25 ambulance operation upgrade license, but that improved their
26 services during the 3-year period.
27 (e) The number of ambulance operations that failed to
1 successfully upgrade, as described in subdivision (c), under an
2 ambulance operation upgrade license, and that showed no
3 improvement or a decline in their services.
4 (f) The effect of the amendatory act that added this
5 subsection on the delivery of emergency medical services in this
6 state.
7 Sec. 20921. (1) An ambulance operation shall do all of the
8 following:
9 (a) Provide at least 1 ambulance available for response to
10 requests for emergency assistance on a 24-hour-a-day, 7-day-a-
11 week basis in accordance with local medical control authority
12 protocols.
13 (b) Respond or ensure that a response is provided to each
14 request for emergency assistance originating from within the
15 bounds of its service area.
16 (c) Operate under the direction of a medical control
17 authority or the medical control authorities with jurisdiction
18 over the ambulance operation.
19 (d) Notify the department immediately of a change that would
20 alter the information contained on its application for an
21 ambulance operation license or renewal.
22 (e) Subject to section 20920(7) to (12), provide life support
23 consistent with its license and approved local medical control
24 authority protocols to each emergency patient without prior
25 inquiry into ability to pay or source of payment.
26 (2) An ambulance operation shall not do 1 or more of the
27 following:
1 (a) Knowingly provide a person with false or misleading
2 information concerning the time at which an emergency response
3 will be initiated or the location from which the response is
4 being initiated.
5 (b) Induce or seek to induce any person engaging an ambulance
6 to patronize a long-term care facility, mortuary, or hospital.
7 (c) Advertise, or permit advertising of, within or on the
8 premises of the ambulance operation or within or on an ambulance,
9 the name or the services of an attorney, accident investigator,
10 nurse, physician, long-term care facility, mortuary, or
11 hospital. If 1 of those persons or facilities owns or operates
12 an ambulance operation, the person or facility may use its
13 business name in the name of the ambulance operation and may
14 display the name of the ambulance operation within or on the
15 premises of the ambulance operation or within or on an
16 ambulance.
17 (d) Advertise or disseminate information for the purpose of
18 obtaining contracts under a name other than the name of the
19 person holding an ambulance operation license or the trade or
20 assumed name of the ambulance operation.
21 (e) If the ambulance operation is operating under an
22 ambulance operation upgrade license issued under section 20920(7)
23 to (12), advertise or otherwise hold itself out as a full-time
24 transporting limited advanced life support service or a full-time
25 transporting advanced life support service unless the ambulance
26 operation actually provides those services on a 24-hour-per-day,
27 7-day-a-week basis.
1 (3) An Except
as provided in subsection (4), an ambulance
2 operation shall not operate, attend, or permit an ambulance to be
3 operated while transporting a patient unless the ambulance is, at
4 a minimum, staffed as follows:
5 (a) If designated as providing basic life support, with at
6 least 1 emergency medical technician and 1 medical first
7 responder.
8 (b) If designated as providing limited advanced life support,
9 with at least 1 emergency medical technician specialist and 1
10 emergency medical technician.
11 (c) If designated as providing advanced life support, with at
12 least 1 paramedic and 1 emergency medical technician.
13 (4) An ambulance operation that is licensed to provide
14 advanced life support and has more than 1 ambulance licensed
15 under its operation may operate an ambulance licensed to provide
16 basic life support or limited advanced life support at a higher
17 level of life support if all of the following are met:
18 (a) The ambulance operation has at least 1 ambulance under
19 its operation that is properly staffed and available to provide
20 advanced life support on a 24-hour-a-day, 7-day-a-week basis.
21 (b) The licensed personnel required to operate at that higher
22 level of life support are available at the scene and in the
23 ambulance during the patient transport to provide life support to
24 that patient at that higher level.
25 (c) The ambulance is properly equipped to operate at that
26 higher level of life support.
27 (d) The ambulance operation that is unable to provide
1 advanced life support to an emergency patient as required under
2 this part shall immediately request mutual aid assistance from
3 the closest neighboring ambulance operation licensed to provide
4 advanced life support.
5 (5) (4) Except
as provided in subsection (5) (6), an
6 ambulance operation shall ensure that an emergency medical
7 technician, an emergency medical technician specialist, or a
8 paramedic is in the patient compartment of an ambulance while
9 transporting an emergency patient.
10 (6) (5) Subsection
(4) (5) does not apply to the
11 transportation of a patient by an ambulance if the patient is
12 accompanied in the patient compartment of the ambulance by an
13 appropriate licensed health professional designated by a
14 physician and after a physician-patient relationship has been
15 established as prescribed in this part or the rules promulgated
16 by the department under this part.
17 Sec. 20923. (1) Except as provided in section 20924(2), a
18 person shall not operate an ambulance unless the ambulance is
19 licensed under this section and is operated as part of a licensed
20 ambulance operation.
21 (2) Upon proper application and payment of a $25.00 fee, the
22 department shall issue an ambulance license, or annual renewal of
23 an ambulance license, to the ambulance operation. Receipt of the
24 application by the department serves as attestation to the
25 department by the ambulance operation that the ambulance being
26 licensed or renewed is in compliance with the minimum standards
27 required by the department. The inspection of an ambulance by
1 the department is not required as a basis for licensure renewal,
2 unless otherwise determined by the department.
3 (3) An ambulance operation shall submit an application and
4 fee to the department for each ambulance in service. Each
5 application shall include a certificate of insurance for the
6 ambulance in the amount and coverage required by the department.
7 (4) Upon purchase by an ambulance operation, an ambulance
8 shall meet all vehicle standards established by the department
9 under section 20910(e)(iv).
10 (5) Once licensed for service, an ambulance is not required
11 to meet subsequently modified state vehicle standards during its
12 use by the ambulance operation that obtained the license.
13 (6) Patient care equipment and safety equipment carried on an
14 ambulance shall meet the minimum requirements prescribed by the
15 department and the approved local medical control authority
16 protocols.
17 (7) An ambulance operation that maintains patient care
18 equipment and medications necessary to upgrade from providing
19 basic or limited advanced life support to providing advanced life
20 support in accordance with section 20921(4) shall secure the
21 necessary patient care equipment and medications in a way such
22 that the equipment or medications can only be used when the
23 appropriate licensed personnel are available.
24 (8) (7) An
ambulance shall be equipped with a
25 communications system utilizing frequencies and procedures
26 consistent with the statewide emergency medical services
27 communications system developed by the department.
1 (9) (8) An
ambulance license is not transferable to another
2 ambulance operation.