(a) Purpose: Acquiring, issuing, and maintaining an
EMS Providers License.
(b) EMS in Texas is a delegated practice, as written
in Occupations Code, §157.003.
(c) Application requirements for an Emergency Medical
Services (EMS) Provider License.
(1) An applicant for an initial EMS provider license
shall submit a completed application to the department on the required
official forms, following the department's written process.
(2) The nonrefundable application fee of $500 per provider
plus $180 for each EMS vehicle to be operated under the license shall
accompany the application.
(3) The department will process the EMS provider license
application as per §157.3 of this title (relating to Processing
EMS Provider Licenses and Applications for EMS Personnel Certification
and Licensure).
(4) An EMS provider holding a valid license or authorization
from another state; whose service area adjoins the State of Texas;
who has in place a written mutual aid agreement, with a licensed Texas
EMS provider, and who when requested to do so by a licensed Texas
EMS provider, responds into Texas for emergency mutual aid assistance,
may be exempt from holding a Texas EMS provider license, but will
be obligated to perform to the same medical standards of care required
of EMS providers licensed by their home state.
(5) A fixed-wing or rotor-wing air ambulance provider,
appropriately licensed by the state governments of New Mexico, Oklahoma,
Arkansas, Kansas, Colorado or Louisiana may apply for a reciprocal
issuance of a provider license, and the application would not require
staffing by Texas EMS certified or licensed personnel. A nonrefundable
administrative fee of $500 per provider in addition to a nonrefundable
fee of $180 for each EMS aircraft to be operated in Texas under the
reciprocal license shall accompany the application.
(6) An applicant for an EMS provider license that provides
emergency prehospital care is exempt from payment of department licensing
and authorization fees if the firm is staffed with at least 75% volunteer
personnel, has no more than five full-time staff or equivalent, and
the firm is recognized as a §501(c)(3) nonprofit corporation
by the Internal Revenue Service. An EMS provider who compensates a
physician to provide medical supervision may be exempt from the payment
of department licensing and authorization fees if all other requirements
for fee exemption are met.
(7) Required documents that shall accompany a license
application.
(A) Document verifying volunteer status, if applicable.
(B) Map and description of service area, a list of
counties and cities in which applicant proposes to provide primary
emergency service and a list of all station locations with address
and telephone and facsimile transmission numbers for each station.
(C) Declaration of organization type and profit status.
(D) Declaration of Provider Name.
(i) The legal name of the EMS provider cannot include
the name of the city, county or regional advisory council within or
in part, unless written approval is given by the individual city,
county or regional advisory council respectively.
(ii) The EMS provider operational name cannot include
the name of the city, county or regional advisory council within or
in part, unless written approval is given by the individual city,
county or regional advisory council respectively. A proposed provider
name is deemed to be deceptively similar to an established licensed
EMS provider if it meets the conditions listed in the Office of the
Secretary of State rule, 1 Texas Administrative Code, §79.39
(relating to Deceptively Similar Name).
(E) Declaration of Ownership.
(F) Declaration of the address for the main location
of the business, normal business hours and provide proof of ownership
or lease of such location.
(i) The normal business hours must be posted for public
viewing.
(ii) A service area map must be provided.
(iii) Only one EMS provider license will be issued
to each fixed address.
(iv) The applicant shall attest that no other license
EMS provider is at the provided business location or address.
(v) The emergency medical services provider must remain
in the same physical location for the period of licensure, unless
the department approves a change in location.
(G) Declaration of the administrator of record and
any subsequently filed declaration of a new administrator shall declare
the following, if the EMS provider is required to have an administrator
of record as per Health and Safety Code, §773.0571 or §773.05712.
(i) The administrator of record is not employed or
otherwise compensated by another private for-profit EMS provider.
(ii) The administrator of record meets the qualifications
required for an emergency medical technician certification or other
health care professional license with a direct relationship to EMS
and currently holds such certification or license issued by the State
of Texas.
(iii) The administrator of record has submitted to
a criminal history record check at the applicant's expense as directed
in §157.37 of this title (relating to Certification or Licensure
of Persons With Criminal Backgrounds).
(iv) The administrator of record has completed an initial
education course approved by the department regarding state and federal
laws and rules that affect EMS in the following areas:
(I) Health and Safety Code, Chapter 773 and 25 Texas
Administrative Code, Chapter 157;
(II) EMS dispatch processes;
(III) EMS billing processes;
(IV) Medical control accountability; and
(V) Quality improvement processes for EMS operations.
(v) The applicant will assure that its administrator
of record shall annually complete eight hours of continuing education
related to the Texas and federal laws and rules related to EMS.
(vi) An EMS provider that is directly operated by a
governmental entity, is exempt from this subparagraph, except for
declaration of administrator of record.
(vii) An EMS provider that held a license on September
1, 2013, and has an administrator of record who has at least eight
years of experience providing EMS, the administrator of record is
exempt from clauses (ii) and (iv) of this subparagraph.
(H) Copies of Doing Business Under Assumed Name Certificates
(DBA).
(I) Completed EMS Personnel Form.
(J) Staffing Plan that describes how the EMS provider
provides continuous coverage for the service area defined in documents
submitted with the EMS provider application. The EMS provider shall
have a staffing plan that addresses coverage of the service area or
shall have a formal system to manage communication when not providing
services after normal business hours.
(K) Completed EMS Vehicle Form.
(L) Declaration of an employed medical director and
a copy of the signed contract or agreement with a physician who is
currently licensed in the State of Texas, in good standing with the
Texas Medical Board, in compliance with Texas Medical Board rules,
22 Texas Administrative Code, Chapter 197, and in compliance with
Title 3 of the Texas Occupations Code.
(M) Completed Medical Director Information Form.
(N) Treatment and Transport Protocols and policies
addressing the care to be provided to adult, pediatric, and neonatal
patients, and as stated in Health and Safety Code §773.112(d),
must be approved and signed by the medical director.
(O) A list of equipment as required on the EMS Provider
initial and renewal application, with identifiable or legible serial
numbers, supplies and medications; approved and signed by the medical
director.
(P) The applicant shall attest that all required equipment
is permitted to be used by the EMS provider and provide proof of ownership
or hold a long-term lease for all equipment necessary for the safe
operation.
(Q) The applicant shall attest that each authorized
vehicle will have its own set of equipment required for each authorized
vehicle to operate at the level of the service for which the provider
is authorized.
(R) Description of how the EMS provider will conduct
quality assurance in coordination with the EMS provider medical director.
(S) The applicant shall provide an attestation or provide
documentation that it and/or its management staff will or continues
to participate in the local regional advisory council.
(T) Plan for how the provider will respond to disaster
incidents including mass casualty situations in coordination with
local and regional plans.
(U) Copies of written Mutual Aid and/or Inter-local
Agreements with EMS providers.
(V) Documentation as required for subscription or membership
program, if applicable.
(W) Certificate of Insurance, provided by the insurer,
identifying the department as the certificate holder and indicating
at least minimum motor vehicle liability coverage for each vehicle
to be operated and professional liability coverage. If applicant is
a government subdivision, submit evidence of financial responsibility
by self-insuring to the limit imposed by the tort claims provisions
of the Texas Civil Practice and Remedies Code.
(i) The applicant shall maintain motor vehicle liability
insurance as required under the Texas Transportation Code.
(ii) The applicant shall maintain professional liability
insurance coverage in the minimum amount of $500,000 per occurrence,
or as necessary per state law, with a company licensed or deemed eligible
by the Texas Department of Insurance to do business in Texas or acceptable
proof of self-insurance or captive insurance in order to secure payment
for any loss or damage resulting from any occurrence arising out of,
or caused by the care, or lack of care, of a patient.
(X) The applicant shall provide copies of vehicle titles,
vehicle lease agreements, copies of exempt registrations if applicant
is a government subdivision, or an affidavit identifying applicant
as the owner, lessee, or authorized operator for each vehicle to be
operated under the license.
(Y) The applicant shall provide documentation of the
following, showing that the applicant, including its management staff
possesses sufficient professional experience and qualifications related
to EMS:
(i) an attestation that its management staff have read
the Texas Emergency Healthcare Act and the department's EMS rules
in this chapter;
(ii) proof of one year experience or education provided
by a nationally recognized organization on emergency medical dispatch
processes;
(iii) proof of one year experience or education provided
by a nationally recognized organization concerning EMS billing processes;
(iv) proof of one year experience or education provided
by a nationally recognized organization on medical control accountability;
and
(v) proof of one year experience or education provided
by a nationally recognized organization on quality improvement processes
for EMS operations.
(Z) A copy of a letter of credit for the obtaining
or renewing of an EMS Providers license, issued by a federally insured
bank or savings institution:
(i) in the amount of $100,000 for the initial license
and for renewal of the license on the second anniversary of the date
the initial license is issued;
(ii) in the amount of $75,000 for renewal of the license
on the fourth anniversary of the date the initial license is issued;
(iii) in the amount of $50,000 for renewal of the license
on the sixth anniversary of the date the initial license is issued;
(iv) in the amount of $25,000 for renewal of the license
on the eighth anniversary of the date the initial license is issued;
(v) that shall include the names of all of the parties
involved in the transaction;
(vi) that shall include the names of the persons or
entity, who owns the EMS provider operation and to whom the bank is
issuing the letter of credit;
(vii) that shall include the name of the person or
entity, receiving the letter of credit; and
(viii) an EMS provider that is directly operated by
a governmental entity is exempt from this subsection.
(AA) A copy of the surety bond in the amount of $50,000
issued to and provided to the Health and Human Services Commission
by the applicant, participating in the medical assistance program
operated under Human Resources Code, Chapter 32, the Medicaid managed
care program operated under Government Code, Chapter 533, or the child
health plan program operated under Health and Safety Code, Chapter
62. An EMS provider that is directly operated by a governmental entity
is exempt from this subparagraph.
(BB) Documentation evidencing applicant or management
team has not been excluded from participation in the state Medicaid
program.
(CC) A copy of a governmental entity letter of approval
that shall:
(i) be from the governing body of the municipality
in which the applicant is located and is applying to provide EMS;
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