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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) 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.

  (2) A nonrefundable application fee of $500 per provider plus $180 for each EMS vehicle to be operated under the license shall accompany the application.

  (3) 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 in Texas.

  (4) A fixed-wing or rotor-wing air ambulance provider, appropriately licensed by the state governments of New Mexico, Oklahoma, Arkansas, or Louisiana may apply for reciprocal issuance of a provider license. 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.

  (5) 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 if 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.

  (6) 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.

    (E) Declaration of Ownership.

    (F) Declaration of Administrator of record and any subsequently filed declaration of a new administrator shall declare the following.

      (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 on state and federal laws and rules that affect EMS.

      (v) The applicant will assure that its administrator of record will complete the requirement of eight hours annual continuing education related to the state 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.

      (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.

    (G) Copies of Doing Business Under Assumed Name Certificates (DBA).

    (H) Completed EMS Personnel Form.

    (I) Staffing Plan that describes how the EMS provider will provide continuous coverage for the service area defined in documents submitted with the EMS provider application.

    (J) Completed EMS Vehicle Form.

    (K) 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, particularly regarding EMS as outlined in 22 Texas Administrative Code, Part 9, Texas Medical Board, Chapter 197, and in compliance with Title 3 of the Texas Occupations Code.

    (L) Completed Medical Director Information Form.

    (M) Treatment and Transport Protocols approved and signed by the medical director.

    (N) A listing of equipment, supplies and medications; approved and signed by the medical director.

    (O) Description of how the provider will conduct Quality Assurance.

    (P) Plan for how the provider will respond to disaster incidents including mass casualty situations.

    (Q) Copies of written Mutual Aid and/or Inter-local Agreements with EMS providers.

    (R) Documentation as required for subscription or membership program, if applicable.

    (S) 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, with a company licensed or deemed eligible by the Texas Department of Insurance to do business in Texas 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.

    (T) 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.

    (U) 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.

    (V) 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.

    (W) 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.

    (X) Documentation evidencing applicant or management team has not been excluded from participation in the state Medicaid program.

    (Y) 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;

      (ii) be from the commissioner's court of the county in which the applicant is located and is applying to provide EMS, if the applicant is not located in a municipality;

      (iii) include the attestation that the addition of another licensed EMS provider will not interfere with or adversely affect the provision of EMS by the licensed EMS providers operating in the municipality or county;

      (iv) include the attestation that the addition of another licensed EMS provider will remedy an existing provider shortage that cannot be resolved through the use of the licensed EMS providers operating in the municipality or county; and

      (v) include the attestation that the addition of another licensed EMS provider will not cause an oversupply of licensed EMS providers in the municipality or county.

  (7) Paragraph (6)(Y) of this subsection does not apply to renewal of an EMS provider license or a municipality, county, emergency services district, hospital, or EMS volunteer provider organization in this state that applies for an EMS provider license.

  (8) An EMS provider is prohibited from expanding operations to or stationing any EMS vehicles in a municipality or county other than the municipality or county from which the provider obtained the letter of approval under this subsection until after the second anniversary of the date the provider's initial license was issued, unless the expansion or stationing occurs in connection with:

    (A) a contract awarded by another municipality or county for the provision of EMS;

    (B) an emergency response made in connection with an existing mutual aid agreement; or

    (C) an activation of a statewide emergency or disaster response by the department.

  (9) Paragraph (8) of this subsection does not apply to renewal of an EMS provider license or a municipality, county, emergency services district, hospital, or EMS volunteer provider organization in this state that applies for an EMS provider license.

  (10) Paragraph (8) of this subsection does not apply to fixed or rotor wing EMS providers.

(c) EMS Provider License.

  (1) License.

    (A) Applicants who have submitted all required documents and who have met all the criteria for licensure will be issued a provider license to be effective for a period of two years from the date of issuance.

    (B) Licenses shall be issued in the name of the applicant.

    (C) License expiration dates may be adjusted by the department to create licensing periods less than two years for administrative purposes.

    (D) An application for an initial license or for the renewal of a license may be denied to a person or legal entity who owns or who has owned any portion of an EMS provider service or who operates/manages or who/which has operated/managed any portion of an EMS provider service which has been sanctioned by or which has a proposed disciplinary action/sanction pending against it by the department or any other local, state or federal agency.

    (E) The license will be issued in the form of a certificate which shall be prominently displayed in a public area of the provider's primary place of business.

    (F) An EMS Provider License issued by the department shall not be transferable to another person or entity.

  (2) Vehicle Authorizations.

    (A) The department will issue authorizations for each vehicle to be operated by the applicant which meets all criteria for approval as defined in subsection (d) of this section.

Cont'd...

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