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| Montana Administrative Register Notice 37-569 | No. 21 11/10/2011 | |
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BEFORE THE DEPARTMENT OF PUBLIC HEALTH AND HUMAN SERVICES OF THE STATE OF
TO: All Concerned Persons 1. On November 30, 2011 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 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 November 21, 2011, to advise us of the nature of the accommodation that you need. Please contact Kenneth Mordan, 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 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 (19)(c) remain the same. (20) "EMS incident" means an instance in which an ambulance service or nontransporting unit is requested to provide emergency medical services, including a mutual aid request, and for which: (a) a patient was assessed; (b) medical care was rendered; (c) a patient was transported; (d) a patient was pronounced dead at the scene; (e) a patient was transferred to another licensed service; (f) a patient was transferred from one medical facility to another; or (g) the person or persons for whom EMS was dispatched refused treatment, transport, or both. (20) through (24) remain the same but are renumbered (21) through (25). (26) "Patient care report" means an accurate and complete record of the response by an ambulance service or nontransporting unit to each EMS incident. (25) through (34) remain the same but are renumbered (27) through (36). AUTH: 50-6-323, MCA IMP: 50-6-323, MCA 37.104.212 RECORDS AND REPORTS (1) Each emergency medical service must maintain a (2) No later than January 1, 2012 ambulance services and nontransporting units must provide data as identified by the department in this rule. (3) Electronic data submitted to the department must be in the format prescribed by the National Emergency Medical Services Information System (NEMSIS). (a) For emergency medical services directly using the reporting system provided by the department, the data is considered submitted to the department as soon as it has been entered or updated in the department-provided system. (b) For emergency medical services using third-party software, the data is considered submitted to the department as soon as it has been uploaded or updated into the department-provided system. (4) The following NEMSIS demographic data elements for ambulance service or nontransporting unit licensing must be reported and updated no less than annually: D01_01 EMS Agency Number D01_02 EMS Agency Name D01_03 EMS Agency State D01_04 EMS Agency County D01_07 Level of Service D01_08 Organizational Type D01_09 Organization Status D01_10 Statistical Year D01_12 Total Service Size Area D01_13 Total Service Area Population D01_14 911 Call Volume per Year D01_15 EMS Dispatch Volume per Year D01_16 EMS Transport Volume per Year D01_17 EMS Patient Contact Volume per Year D01_19 EMS Agency Time Zone D01_21 National Provider Identifier D02_01 Agency Contact Last Name D02_02 Agency Contact Middle Name/Initial D02_03 Agency Contact First Name D02_04 Agency Contact Address D02_05 Agency Contact City D02_06 Agency Contact State D02_07 Agency Contact Zip Code D02_08 Agency Contact Telephone Number D02_09 Agency Contact Fax Number D02_10 Agency Contact Email Address D03_01 Agency Medical Director Last Name D03_02 Agency Medical Director Middle Name/Initial D03_03 Agency Medical Director First Name D03_04 Agency Medical Director Address D03_05 Agency Medical Director City D03_06 Agency Medical Director State D03_07 Agency Medical Director Zip Code D03_08 Agency Medical Director Telephone Number D03_09 Agency Medical Director Fax Number D03_11 Agency Medical Director Email Address D04_02 EMS Unit Call Sign D05_01 Station Name D05_02 Station Number D05_04 Station GPS D05_05 Station Address D05_06 Station City D05_07 Station State D05_08 Station Zip D05_09 Station Telephone Number D06_01 Unit/Vehicle Number D06_03 Vehicle Type D06_04 State Certification/Licensure Levels D06_07 Vehicle Model Year D06_08 Year Miles/Hours Accrued D06_09 Annual Vehicle Hours D06_10 Annual Vehicle Miles D07_01 Personnel's Agency ID Number D07_02 State/Licensure ID Number D07_05 Personnel's Level of Certification/Licensure for Agency D08_01 EMS Personnel's Last Name D08_02 EMS Personnel's Middle Name/Initial D08_03 EMS Personnel's First Name D08_04 EMS Personnel's Mailing Address D08_05 EMS Personnel's City of Residence D08_06 EMS Personnel's State D08_07 EMS Personnel's Zip Code D08_09 EMS Personnel's Home Telephone D08_10 EMS Personnel's Email Address D08_15 State EMS Certification Licensure Level D08_17 State EMS Current Certification Date (5) The following NEMSIS EMS data elements must be reported by ambulance services for each incident: E01_01 Patient Care Report Number E02_01 EMS Agency Number E02_04 Type of Service Requested E02_05 Primary Role of the Unit E02_06 Type of Dispatch Delay E02_07 Type of Response Delay E02_08 Type of Scene Delay E02_09 Type of Transport Delay E02_10 Type of Turn-Around Delay E02_12 E02_20 Response Mode to Scene E03_01 Complaint Reported by Dispatch E03_02 EMD Performed E05_02 PSAP Call Date/Time E05_04 Unit Notified by Dispatch Date/Time E05_06 Unit Arrived on Scene Date/Time E05_07 Arrived at Patient Date/Time E05_09 Unit Left Scene Date/Time E05_10 Patient Arrived at Destination Date/Time E05_11 Unit Back in Service Date/Time E05_13 Unit Back at Home Location Date/Time E06_08 Patient's Home Zip Code E06_11 Gender E06_12 Race E06_13 Ethnicity E06_14 Age E06_15 Age Units E07_01 Primary Method of Payment E07_34 CMS Service Level E07_35 Condition Code Number E08_05 Number of Patients at Scene E08_06 Mass Casualty Incident E08_07 Incident Location Type E08_15 Incident ZIP Code E09_01 Prior Aid E09_02 Prior Aid Performed by E09_03 Outcome of the Prior Aid E09_04 Possible Injury E09_11 Chief Complaint Anatomic Location E09_12 Chief Complaint Organ System E09_13 Primary Symptom E09_14 Other Associated Symptoms E09_15 Provider's Primary Impression E09_16 Provider's Secondary Impression E10_01 Cause of Injury E11_01 Cardiac Arrest E11_02 Cardiac Arrest Etiology E11_03 Resuscitation Attempted E12_01 Barriers to Patient Care E12_19 Alcohol/Drug Use Indicators E18_03 Medication Given E18_08 Medication Complication E19_03 Procedure E19_05 Number of Procedure Attempts E19_06 Procedure Successful E19_07 Procedure Complication E20_07 Destination Zip Code E20_10 Incident/Patient Disposition E20_14 Transport Mode from Scene E20_16 Reason for Choosing Destination E20_17 Type of Destination E22_01 Emergency Department Disposition E22_02 Hospital Disposition (6) Emergency medical services must provide patient care report data to the department at least quarterly based on a calendar year or on a schedule submitted to and approved by the department. (a) These quarterly data must be submitted to the department within 60 days of the end of the quarter as follows: (i) data for EMS responses occurring in January through March must be submitted by June 1; (ii) for responses in April through June by September 1; (iii) for responses in July through September by December 1; and (iv) for responses in October through December by March 1. (b) The data may be submitted more frequently than quarterly. (c) An emergency medical service with no EMS incidents during the quarter must report such to the department. (7) Ambulance services are not required to submit other NEMSIS data elements, but may do so. Nontransporting units are not required to submit NEMSIS data, but may do so. (8) Other software may be used to submit required data, but agencies must consult with the department before purchasing such software. (9) The department adopts and incorporates by reference the National Emergency Medical Services Information System (NEMSIS) Uniform Pre-Hospital Emergency Medical Services Dataset, Version 2.2.1, (5/04/2010) published by the National Highway Traffic Safety Administration (NHTSA). A copy may be obtained at http://www.nemsis.org/v2/downloads/datasetDictionaries.html or from the Department of Public Health and Human Services, Public Health and Safety Division, Emergency Medical Services and Trauma Systems Section, 1400 Broadway, P.O. Box 202951, Helena, MT 59620-2951. (a) If a completed patient care report cannot be left at the facility at the end of the patient transfer to the licensed hospital, an abbreviated patient encounter form containing information essential to continued patient care shall be provided until a patient care record can be left. (b) If an immediate response to another patient is required of an ambulance delivering a patient to a licensed hospital, a complete oral report on the patient being delivered will be given to the receiving facility until a patient encounter form or patient care record can be provided. AUTH: 50-6-323, MCA IMP: 50-6-323, MCA 4. The Department of Public Health and Human Services (the department) is proposing the amendment of ARM 37.104.101 and 37.104.212 pertaining to emergency medical services (EMS). These proposed rule amendments require ambulance services to report minimum, electronic data to a web-based department database. In order for the department to evaluate emergency medical care and to determine whether the emergency health care system is functioning as intended, collecting information about the characteristics, activities, and results of emergency medical services operations is essential. ARM 37.104.101 The department is proposing amendments to this rule in order to introduce new industry terms. The department is proposing a new definition to ARM 37.104.101, "EMS incident" in order to define what types of EMS calls need to be documented on a patient care report. The department is also proposing new definition, "patient care report." This definition is reasonably necessary to clarify that a patient record will be completed by each licensed EMS service on each EMS incident. It is also necessary as there currently is some confusion whether or not nontransporting units are required to complete a patient record. ARM 37.104.212 EMS services inconsistently interpret which calls require a completed patient care report. For example, some services complete patient care records for patient refusal calls and other services do not. The proposed amendment to ARM 37.104.212(1) is reasonably necessary to assure that all services consistently collect patient care records on the same types of calls. It is reasonably necessary to delete ARM 37.104.212(1)(a) through (1)(k) as they are too generic to be useful for data collection purposes, they are not compliant with the NEMSIS data standard, and they are better defined in these proposed rules which require collection of NEMSIS demographic and patient EMS sets. The new language for ARM 37.104.212(1)(a) is reasonably necessary to allow the department to assure that EMS services use written patient care records that meet current minimum data collection standards and medical record rules. The proposed new language in ARM 37.104.212(1)(b) and (c) clarify the procedure for documentation where there are multiple patient incidents or incidents in which multiple services respond. The proposed amendment to ARM 37.104.212(2) is reasonably necessary to require that all EMS services will collect data as defined in these proposed rules and to provide for an effective date. NEMSIS is the national standard for EMS data collection. ARM 37.104.212(3) is reasonably necessary to assure that all services collect data using the NEMSIS standard. Data collected using multiple definitions and standards would be useless for statewide data analysis and performance improvement. ARM 37.104.212(3)(a) is reasonably necessary in order to clarify that EMS services may collect data in the department-based software to be compliant with data collection requirements. ARM 37.104.212(3)(b) is reasonably necessary to clarify that EMS services using other third-party software must upload their data into the department-based software to be compliant with data collection requirements. ARM 37.104.212(4) specifies which NEMSIS demographic data set fields must be collected. These fields are primarily related to the EMS service licensing module of the department-based software and are necessary for administration and regulation of these service licenses. Additionally, ARM 37.104.212(4) is being proposed to ensure that licensing records are more up-to-date. In the previous, paper-based licensing process, most service license information was only updated once every two years upon relicensure. As such, much of the information the department maintained about licensed EMS services was very outdated and inaccurate. With the new electronic system, information can be easily updated by the EMS on a regular basis and in any case, no less than annually. Proposed amendment ARM 37.104.212(5) is a list of the minimum, national data elements described in the NEMSIS data dictionary. This rule requires ambulance services to report these minimum data elements on all incidents. No patient identifiers and only minimal service identifiers are included in the minimum data set. Services will only be able to access their own data for reports. Summary reports from other services and the EMS system will be produced by the department. As of 2011, 29 states are submitting data to the National EMS Database. It is the intent of the department to be one of 18 additional states seeking to submit state data in the next year. As in the state data system, the service data in the national database is nonidentifiable, except to the service. Like the department system, the national database allows the service to view detailed reports about their own service and only summary reports of other services reporting into the system. ARM 37.104.212(6), (a), (b), and (c) are necessary in order to establish a minimum schedule for data to be submitted into the department's data system. This rule also requires services that have no runs during the quarter to report such to the department so that compliance with these rules can be monitored. The department's data system accommodates entry of many more data elements than the minimum elements described above. ARM 37.104.212(7) clarifies that services may optionally enter additional data and, as such, have access to more complete demographic and statistical reports in the system. ARM 37.104.212(8) is reasonably necessary to assure that EMS services that choose to purchase or develop their own data systems will use software that is NEMSIS compliant and capable of uploading data into the department's data software. Without this requirement, services may invest considerable time and funds obtaining a system that is not compatible and would not allow them to meet the data collection requirements of these rules. ARM 37.104.212(10) is reasonably necessary to adopt the NEMSIS national data standard. This standard specifies data definitions, electronic format, and other standards which ensures that all services collect data the same way. ARM 37.104.212(2) and (3) have been renumbered to ARM 37.104.212(11) and (12), and are being updated to the more current terminology of the industry. The current rule language in ARM 37.104.212(4) is being deleted. This language has been replaced and clarified by several other sections of these proposed rules. ARM 37.104.212(5) is being renumbered to ARM 37.104.212(13). The department is proposing amendment to ARM 37.104.212(13) as it is necessary to resolve cases in which EMS leaves a patient at a hospital but does not also relay essential information about the patient that is necessary for continuity of care. The requirement for submission of a patient care report to the hospital has been changed from 48 hours to 24 hours. There are essential uses of EMS data in healthcare facilities and there have been numerous comments from field providers and hospitals that 24 hours is more than adequate for submission of this very important information. ARM 37.104.212(13)(a) is necessary as information that EMS has collected about a patient is essential to the ongoing care of the patient after they leave. In cases in which EMS cannot leave a patient care record at the hospital at the conclusion of the call, this rule requires services to leave an "encounter form." This form provides essential information about the patient to the hospital and helps assure continuity of care in the absence of a complete patient care record. ARM 37.104.212(13)(b) requires a service that may need to leave immediately due to backup of multiple calls still needs to provide at least a verbal report of this essential patient information before they leave the hospital. 5. 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: Kenneth Mordan, 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., December 8, 2011. 6. The Office of Legal Affairs, Department of Public Health and Human Services, has been designated to preside over and conduct this hearing. 7. 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 5 above or may be made by completing a request form at any rules hearing held by the department. 8. 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. 9. The bill sponsor contact requirements of 2-4-302, MCA do not apply. /s/ Shannon McDonald /s/ Anna Whiting Sorrell Rule Reviewer Anna Whiting Sorrell, Director Public Health and Human Services Certified to the Secretary of State October 31, 2011. |
A directory of state agencies is available online at http://www.mt.gov/govt/agencylisting.asp.
For questions about the organization of the ARM or this web site, contact sosarm@mt.gov.
