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TITLE 25HEALTH SERVICES
PART 1DEPARTMENT OF STATE HEALTH SERVICES
CHAPTER 157EMERGENCY MEDICAL CARE
SUBCHAPTER BEMERGENCY MEDICAL SERVICES PROVIDER LICENSES
RULE §157.11Requirements for an EMS Provider License

(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, 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;

Cont'd...

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