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Montana Administrative Register Notice 37-496 No. 24   12/24/2009    
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BEFORE THE DEPARTMENT OF PUBLIC

HEALTH AND HUMAN SERVICES OF THE

STATE OF MONTANA

 

In the matter of the adoption of New Rules I, II, and III, amendment of ARM 37.104.101, 37.104.105, 37.104.109, 37.104.203, 37.104.213, 37.104.218, and 37.104.316, and repeal of ARM 37.104.221 pertaining to emergency medical services (EMS)

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NOTICE OF PUBLIC HEARING ON PROPOSED ADOPTION, AMENDMENT, AND REPEAL

 

TO:  All Concerned Persons

 

            1.  On January 13, 2010, at 1:30 p.m., the Department of Public Health and Human Services will hold a public hearing in the auditorium of the Department of Public Health and Human Services Building, 111 North Sanders, Helena, Montana, to consider the proposed adoption, amendment, and repeal of the above-stated rules.

 

            2.  The Department of Public Health and Human Services will make reasonable accommodations for persons with disabilities who wish to participate in this rulemaking process or need an alternative accessible format of this notice.  If you require an accommodation, contact Department of Public Health and Human Services no later than 5:00 p.m. on January 4, 2010, to advise us of the nature of the accommodation that you need.  Please contact Rhonda Lesofski, Department of Public Health and Human Services, Office of Legal Affairs, P.O. Box 4210, Helena, Montana, 59604-4210; telephone (406) 444-4094; fax (406) 444-9744; or e-mail dphhslegal@mt.gov.

 

            3.  The rules as proposed to be adopted provide as follows:

 

            RULE I  PERSONNEL, EMT-INTERMEDIATE GROUND AMBULANCE SERVICE  (1)  An intermediate life support ground ambulance service must:

            (a)  meet the personnel requirements of a basic life support ground ambulance service as provided in ARM 37.104.316; and

            (b)  when transporting a patient at the intermediate life support level, ensure that one of the required personnel is an intermediate life support EMT.

 

AUTH:  50-6-323, MCA

IMP:  50-6-323, MCA

 

            RULE II  PERSONNEL, EMT-INTERMEDIATE LIFE SUPPORT AIR AMBULANCE SERVICE  (1)  In addition to the pilot, one immediate life support EMT is required.

 

AUTH:  50-6-323, MCA

IMP:  50-6-323, MCA

 

            RULE III  PERSONNEL, EMT-INTERMEDIATE LIFE SUPPORT NONTRANSPORTING UNIT  (1)  An intermediate life support nontransporting unit must:

            (a)  meet the personnel requirements of a basic life support nontransporting unit as provided in ARM 37.104.401; and

            (b)  when responding at the intermediate life support level, ensure that at least one advanced level EMT is on the call.

 

AUTH:  50-6-323, MCA

IMP:  50-6-323, MCA

 

            4.  The rules as proposed to be amended provide as follows, new matter underlined, deleted matter interlined:

 

            37.104.101  DEFINITIONS  The following definitions apply in subchapters 1 through 4:

            (1) through (5) remain the same.

            (6)  "Authorization for limited ALS" means the authorization for an ambulance service or nontransporting medical unit licensed at the basic life support level to provide limited advanced life support as provided in ARM 37.104.109.

            (7) through (20) remain the same.

            (21)  "First responder with an ambulance endorsement" means an individual licensed by the board as an EMT-F with ambulance endorsement (EMT-F3) as listed in ARM 24.156.2751.

            (22)  "Grandfathered advanced first aid" means a person:

            (a)  certified in American Red Cross emergency response;

            (b)  certified in cardiopulmonary resuscitation according to current American Heart Association standards; and

            (c)  who was continuously a member of a licensed emergency medical service and was certified in American Red Cross advanced first aid and emergency care from July 1, 1992 through December 31, 1992.

            (22)  "Intermediate life support service" means an ambulance service or nontransporting medical unit that has the capacity and is licensed by the department to provide care at the EMT-intermediate equivalent level 24 hours a day, seven days a week.

            (23) and (24) remain the same.

            (25)  "Online medical direction" means online medical direction as defined in ARM 24.156.2701.

            (26) remains the same but is renumbered (25).  

            (27) remains the same but is renumbered (29).

            (28) and (29) remain the same but are renumbered (26) and (27).

            (30) (28)  "Service medical director" means a person who meets the requirements of a service medical director as provided in ARM 24.156.2701 and provides offline medical director for an emergency medical service as defined in 50-6-302, MCA.

            (31)  "Service plan" means a written description of how an ambulance service or NTU service plans to provide response within its normal service area.

            (32) through (36) remain the same but are renumbered (30) through (34).

 

AUTH:  50-6-323, MCA

IMP:  50-6-323, MCA

 

            37.104.105  LICENSE TYPES AND LEVELS  (1)  A license will be issued for, and authorize performance of, emergency medical services of a specific type and at a basic, intermediate, or advanced life support level.

            (2)  Except as specifically provided in this chapter, an emergency medical service may be licensed at an intermediate or advanced life support level only if they can reasonably provide such service 24 hours a day, seven days a week.

 

AUTH:  50-6-323, MCA

IMP:  50-6-306, 50-6-323, MCA

 

            37.104.109  BASIC LIFE SUPPORT SERVICE LICENSING  (1)  An ambulance service or nontransporting medical unit (NTU) capable of providing service only at the basic life support level will be licensed at the basic life support level.

            (a)  An ambulance service or NTU that provides advanced life support but cannot reasonably provide it 24 hours per day, seven days per week due to limited personnel, will receive a basic life support license with authorization for limited ALS.

            (b) (2)  Ambulance services or NTUs shall request authorization for (1)(a) by submitting a service plan on forms provided by the department. requesting authorization for (1)(a) shall:

            (a)  request approval for each ALS level and endorsement the service plans to provide; and

            (b)  submit documentation of the level and endorsement(s) each emergency medical technician is authorized by the service medical director to provide.

 

AUTH:  50-6-323, MCA

IMP:  50-6-323, MCA

 

            37.104.203  EQUIPMENT  (1) remains the same.

            (2)  When a A transportation equipment kit or safety and extrication kit is required, it must be physically in each ground ambulance at all times and available to each air ambulance on every call.

            (3)  A safety and extrication kit must be physically in each ground ambulance at all times and available to each rotor wing air ambulance on every call.

            (3) remains the same but is renumbered (4).

 

AUTH:  50-6-323, MCA

IMP:  50-6-323, MCA

 

            37.104.213  PERSONNEL REQUIREMENTS  (1)  Each emergency medical service must meet the following personnel standards:

            (a)  All personnel functioning on the emergency medical service must have current certificates, licenses, proof of training, or evidence of legal authorization to function;.

            (b)  Emergency medical services personnel may use only that equipment and perform those skills for which they are trained, certified, or licensed and legally permitted to use;.

            (c)  When functioning under the conditions defined in ARM 24.156.2771, a licensed service may use EMTs licensed in another state to provide basic life support; and.

            (d) remains the same.

            (2)  All ambulances must have at least one of the required personnel as set forth in ARM 37.104.316, 37.104.319, 37.104.326, 37.104.329, 37.104.401, and 37.104.404 attending the patient, and, when providing care at an advanced life support level, the person certified licensed at the corresponding level must attend the patient.

 

AUTH:  50-6-323, MCA

IMP:  50-6-323, MCA

 

            37.104.218  MEDICAL CONTROL:  SERVICE MEDICAL DIRECTOR OFFLINE AND ONLINE MEDICAL DIRECTION  (1)  Each emergency medical service that provides service at the advanced life support level approved for a BLS license with authorization for limited ALS, or licensed at the intermediate life support or advanced life level shall have a service medical director.

            (2)  The requirements and responsibilities of the service medical director shall be as defined in ARM 24.156.2701 to provide offline medical direction as defined in 50-6-302, MCA.

            (3)  As provided in ARM 24.156.2701, a designated service medical director must be a physician or physician assistant who is responsible professionally and legally for overall medical care provided by a licensed ambulance service.  An emergency medical service defined under (1) must have a two-way communications system, approved by the department, which enables online medical direction.

 

AUTH:  50-6-323, MCA

IMP:  50-6-323, MCA

 

            37.104.316  PERSONNEL REQUIREMENTS:  BASIC LIFE SUPPORT GROUND AMBULANCE SERVICE  (1)  A Except as provided for in 50-6-322, MCA, a basic life support ground ambulance service must ensure that at least two of the following individuals are on board the ambulance when a patient is loaded or transported, with the proviso that having only two EMT-Fs with ambulance endorsements first responder ambulance personnel on a call is not allowed:

            (a)  a grandfathered person certified in advanced first aid a first responder ambulance EMT;

            (b) through (2) remain the same.

            (3)  Persons utilized as drivers of ambulances shall complete training equivalent to the emergency vehicle operation objectives in a board approved EMT-basic course.

 

AUTH:  50-6-323, MCA

IMP:  50-6-323, MCA

 

            5.  The department proposes to repeal the following rule:

 

            37.104.221  MEDICAL CONTROL:  ADVANCED LIFE SUPPORT, is found on page 37-25656 of the Administrative Rules of Montana.

 

AUTH:  50-6-323, MCA

IMP:  50-6-323, MCA

 

            6.  The Department of Public Health and Human Services (the department) is proposing the adoption of new Rules I, II, and III, the amendment of ARM 37.104.101, 37.104.105, 37.104.109, 37.104.203, 37.104.213, 37.104.218, and 37.104.316, and the repeal of ARM 37.104.221, pertaining to emergency medical services (EMS).  The proposed changes are reasonably necessary to implement changes made during the 2009 Montana Legislative Session, to clarify issues raised in a 2008 legislative performance audit, and to modify various rules which are outdated or confusing.

 

Rule I

 

This proposed new Rule I is reasonably necessary to clarify the personnel requirements for a service licensed an intermediate level service.  The proposed new rule allows the department to consistently evaluate applications for a service with/of an intermediate life support as well as to facilitate regulatory and enforcement activities by the department.

 

Rule II

 

This proposed new Rule II is reasonably necessary to clarify the personnel requirements for a service licensed an intermediate level service.  The proposed new rule allows the department to consistently evaluate applications for a service with/of an intermediate life support as well as to facilitate regulatory and enforcement activities by the department.  Consistent with personnel requirements specified in ARM 37.104.326 and 37.104.329, an air ambulance must be staffed with both a pilot and a licensed EMT and staffing by a single pilot/EMT would not be allowed.

 

Rule III

 

This proposed new Rule III is reasonably necessary to clarify the personnel requirements for a service licensed an intermediate level service.  The proposed new rule allows the department to consistently evaluate applications for a service with/of an intermediate life support as well as to facilitate regulatory and enforcement activities by the department. 

 

ARM 37.104.101

 

The proposed rule amendment to ARM 37.104.101(6) "authorization" for advance life support (ALS) has been interpreted as a separate level of service licensure and is confusing.  The proposed rule amendment is necessary to clarify that this is an authorization to provide limited ALS approved for services that are licensed at a basic life support level.

 

The proposed amendment to ARM 37.104.101(2) clarifies how the term "first responder ambulance" is commonly used in practice.  The department proposes the deletion of EMT-F3 as the Board of Medical Examiners has deleted that connotation in their rules and is no longer necessary in these rules.

 

The department proposes the deletion of ARM 37.104.101(22) "grandfathered advanced first aid" as it is an outdated definition and is no longer needed.  In conversion of EMS service licensing records to an electronic system over the last months, none of the providers were identified on service rosters.  While there are several references to intermediate life support in current rules, it is not clearly included in definitions like basic life support and advanced life support.  This proposed addition to rules clarifies what an intermediate life support service is and is necessary for the department to more clearly make decisions about whether or not to approve an application for an intermediate life support license. 

 

The department proposes the deletion of ARM 37.104.101(25) as House Bill 93 (HB 93) passed by the 2009 Montana Legislature deletes this definition from 50-6-101, MCA and is no longer necessary in the rules.

 

The department is proposing a new definition to ARM 37.104.101, "service medical director".  This proposed new definition clarifies that a service medical director must meet requirements for being an EMT medical director under rules promulgated by the Board of Medical Examiners and is necessary to enable the department to use the board's regulations as a basis for approving EMS service medical directors.  This also references the new definition of medical direction as passed by the 2009 Montana Legislature in HB 93.

 

The department proposes the deletion of ARM 37.104.101(31), "service plan".  With information collected in the new electronic EMS service licensing software, the need for a separate service plan to describe service operation is no longer necessary.

 

ARM 37.104.105

 

While intermediate life support is defined as a level of service in ARM 37.104.101, the term "intermediate" must also be added to ARM 37.104.105(1).  This is necessary in order to clarify that the department has authority to issue a license at this level.

 

The proposed amendment to ARM 37.104.105(2) by adding the word "intermediate" helps clarify that an intermediate service must be reasonably able to provide that level of care 24 hours a day, seven days a week in order for the department to issue such a license.  This is necessary in order to clarify the level of service licensure that the department may issue.

 

ARM 37.104.109

 

"Authorization for limited ALS" is clarified under proposed amendment to ARM 37.104.101(6).  The proposed amendment to ARM 37.104.109 clarifies information that needs to be submitted by services in the electronic service licensure software in order to receive this authorization for limited ALS and is necessary so that the department has authority to approve EMS service applications requesting such authorization.

 

Information previously collected in a written application for a service license is now effectively handled in the new electronic licensing software.  As such, the need for a written "service plan" is no longer necessary.

 

ARM 37.104.203

 

In a previous version of these rules, a table was used to specify what kits need to be on or available to each type of service.  This proposed amendment clarifies which services are required to have the transportation and the safety and extrication kits and is necessary so that the department has authority to regulate the inspection of these kits on EMS services.

 

ARM 37.104.213

 

ARM 24.156.2771 outlines how out-of-state EMTs may be authorized to provide either basic or advanced life support during declared emergencies.  Without the proposed amendment to ARM 37.104.213, EMTs authorized by the Board of Medical Examiners under ARM 24.156.2771 to provide advanced life support would not be able to provide advanced life support services while functioning on a licensed EMS service.

 

The proposed amendment to ARM 37.104.213(2) is necessary to correspond with language in EMT licensing statutes.

 

ARM 37.104.218

 

EMS services which provide advanced life support services must have an offline medical director.  The proposed amendment to ARM 37.104.218(1) is necessary to define the services that are licensed to provide ALS and therefore required to have a service medical director.

 

The proposed amendment to ARM 37.104.218(2) is necessary in order to reference a new definition for offline medical direction that was adopted by the 2009 Montana Legislature in HB 93.  The language for ARM 37.104.218(3) incorporated into 50-6-101, MCA by HB 93, definition for offline medical direction, therefore is duplicative and unnecessary in rule.  The proposed amendment to ARM 37.104.218(3) is necessary to allow the department to consider the approval of a variety of methods for a service to receive medical direction (e.g. radio, cell phone, satellite phone).

 

ARM 37.104.221

 

With the adoption of language in HB 93, definitions for medical control were deleted from statutes and are no longer necessary in ARM 37.104.221.  The department proposes to repeal ARM 37.104.221. 

 

            7.  Concerned persons may submit their data, views, or arguments either orally or in writing at the hearing.  Written data, views, or arguments may also be submitted to: Rhonda Lesofski, Department of Public Health and Human Services, Office of Legal Affairs, P.O. Box 4210, Helena, Montana, 59604-4210; fax (406) 444-9744; or e-mail dphhslegal@mt.gov, and must be received no later than 5:00 p.m., January 21, 2010.

 

8.  The Office of Legal Affairs, Department of Public Health and Human Services, has been designated to preside over and conduct this hearing.

 

9.  The department maintains a list of interested persons who wish to receive notices of rulemaking actions proposed by this agency.  Persons who wish to have their name added to the list shall make a written request that includes the name, e-mail, and mailing address of the person to receive notices and specifies for which program the person wishes to receive notices.  Notices will be sent by e-mail unless a mailing preference is noted in the request.  Such written request may be mailed or delivered to the contact person in 7 above or may be made by completing a request form at any rules hearing held by the department.

 

10.  An electronic copy of this Proposal Notice is available through the Secretary of State's web site at http://sos.mt.gov/ARM/Register.  The Secretary of State strives to make the electronic copy of the Notice conform to the official version of the Notice, as printed in the Montana Administrative Register, but advises all concerned persons that in the event of a discrepancy between the official printed text of the Notice and the electronic version of the Notice, only the official printed text will be considered.  In addition, although the Secretary of State works to keep its web site accessible at all times, concerned persons should be aware that the web site may be unavailable during some periods, due to system maintenance or technical problems.

 

11.  The bill sponsor contact requirements of 2-4-302, MCA, apply and have been fulfilled.  The primary bill sponsors were contacted by letter on May 21, 2009, sent postage prepaid via USPS, and by telephone and e-mail December 4, 2009.

 

 

 

 

/s/  Shannon McDonald                                /s/  Mary Dalton for                                       

Rule Reviewer                                               Anna Whiting Sorrell, Director

                                                                        Public Health and Human Services

           

Certified to the Secretary of State December 14, 2009.

 

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