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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) Candidates 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 EMS provider 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 Section 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.

    (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 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 Texas Medical Board Rules, particularly regarding Emergency Medical Services 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.

(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.

    (B) Vehicle Authorizations shall be issued for the following levels of service, and a provider may operate at a higher level of service based on appropriate staffing, equipment and medical direction for that level. Vehicle authorizations will include a level of care designation at one of the following levels:

      (i) Basic Life Support (BLS);

      (ii) BLS with Advanced Life Support (ALS) capability;

      (iii) BLS with Mobile Intensive Care Unit (MICU) capability;

      (iv) Advanced Life Support (ALS);

      (v) ALS with MICU capability;

      (vi) Mobile Intensive Care Unit (MICU);

      (vii) Air Medical:

        (I) Rotor wing; or

        (II) Fixed wing; and

      (viii) Specialized.

    (C) Change of Vehicle Authorization. To change an authorization to a different level the provider shall submit a request with appropriate documentation to the department verifying the provider's ability to perform at the requested level. A fee of $30 shall be required for each new authorization requested. The provider shall allow sufficient time for the department to verify the documentation and conduct necessary inspections before implementing service at the requested authorization level.

    (D) Vehicle Authorizations are not required to be specific to particular vehicles and may be interchangeably placed in other vehicles as necessary. The original Vehicle Authorization for the appropriate level of service shall be prominently displayed in the patient compartment of each vehicle:

    (E) Vehicle Authorizations are not transferable between providers.

    (F) A replacement of a lost or damaged license or authorization may be issued if requested with a nonrefundable fee of $10.

  (3) Declaration of Business Names and Administration.

    (A) The applicant shall submit a list of all business names under which the service is operated. If the applicant intends to operate the service under a name or names different from the name for which the license is issued, the applicant shall submit certified copies of assumed name certificates. The Department shall not issue licenses with an identical name.

    (B) A change in the name which the service is operated will require a new application and a prorated fee as determined by the department. A new provider number will be issued.

    (C) Name of Administrator must be declared. The applicant shall submit a notarized document declaring the full name of the chief administrator, his/her mailing address and telephone number to whom the department shall address all official communications in regard to the license.

(d) Vehicles.

  (1) All EMS vehicles must be adequately constructed, equipped, maintained and operated to render patient care, comfort and transportation safely and efficiently.

  (2) EMS vehicles must allow the proper and safe storage and use of all required equipment, supplies and medications and must allow all required procedures to be carried out in a safe and effective manner.

  (3) Unless otherwise approved by the department, EMS vehicles must meet the minimum ambulance vehicle body type, dimension and safety criteria as specified in the "Federal Specification for ambulances," KKK-A-1822, published by the U.S. General Services Administration.

  (4) All vehicles shall have an environmental system capable of heating or cooling, in accordance with the manufacturer specifications, within the patient compartment at all times when in service and which allows for protection of medication, according to manufacturer specifications, from extreme temperatures if it becomes environmentally necessary. The provider shall provide evidence of an operational policy which shall list the parenteral pharmaceuticals authorized by the medical director and which shall define the storage and/or FDA recommendations. Compliance with the policy shall be incorporated into the provider's Quality Assurance process and shall be documented on unit readiness reports.

  (5) When response-ready or in-service, EMS vehicles shall have operational two-way communication capable of contacting appropriate medical resources.

  (6) When response-ready or in-service, EMS vehicles shall be in compliance with all applicable federal, state and local requirements.

  (7) All EMS vehicles shall have the name of the provider and a current department issued EMS provider license number prominently displayed on both sides of the vehicle in at least 2 inch lettering. The license number should have the letters TX prior to the license number. This requirement does not apply to fixed wing aircraft.

(e) Substitution, replacement and additional vehicles.

  (1) The provider shall notify the department within five business days if the provider substitutes or replaces a vehicle. No fee is required for a vehicle substitution or replacement.

  (2) The provider shall notify the department if the provider adds a vehicle to the provider's operational fleet. A vehicle authorization request shall be submitted with a non-refundable vehicle fee prior to the vehicle being placed into service.

(f) Staffing Plan Required.

  (1) The applicant shall submit a completed EMS Personnel Form listing each response person assigned to staff EMS vehicles by name, certification level, and department issued certification/license identification number.

  (2) An EMS provider responsible for an emergency response area that is unable to provide continuous coverage within the declared service areas shall publish public notices in local media of its inability to provide continuous response capability and shall include the days and hours of its operation. The EMS provider shall notify all the public safety-answering points and all dispatch centers of the days and hours when unable to provide coverage. The EMS provider shall submit evidence that reasonable attempts to secure coverage from other EMS providers have been made.

(g) Minimum Staffing Required.

  (1) BLS--When response-ready or in-service, authorized EMS vehicles operating at the BLS level shall be staffed at a minimum with two emergency care attendants (ECAs).

  (2) BLS with ALS capability--When response-ready or in-service below ALS two ECAs. Full ALS status becomes active when staffed by at least an emergency medical technician (EMT)-Intermediate and at least an EMT.

  (3) BLS with MICU capability--When response-ready or in-service below MICU two ECAs. Full MICU status becomes active when staffed by at least a certified or licensed paramedic and at least an EMT.

  (4) ALS--When response-ready or in-service, authorized EMS vehicles operating at the ALS level shall be staffed at a minimum with one EMT Basic and one EMT-Intermediate.


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