Okla. Admin. Code § 310:641-2-3

Current through Vol. 42, No. 4, November 1, 2024

Section 310:641-2-3 - Certification or License required

(a) No person, company, governmental entity or trust authority shall operate, advertise, or hold themselves out as providing any type of emergency medical service agency without first obtaining a certification or license to operate from the Department. The Department shall have sole discretion to approve or deny an application based on the ability of the applicant to meet the requirements of the Act or this chapter of rules.

(b) Persons, companies and governmental entities that respond to requests for service off private or governmental property or premises are required to be certified or licensed by the Department. Entities that limit the interventions and activities of their staff members to first aid, CPR, and the use of an AED are not required to be a certified Emergency Medical Response Agency.

(1) Governmental entities not certified or licensed by the Department may be part of mutual aid and disaster plans.

(2) Governmental entities may transport patients of governmental entities off governmental property to appropriate facilities.

(3) Contractors for governmental entities that provide transport services shall be licensed by the Department.

(c) Persons, companies, and governmental entities which operate on their own premises, are exempt from certification and licensing requirement.

(d) An application for a certification or license shall be submitted on forms prescribed and provided by the Department. Ground ambulance, air ambulance, an emergency medical response agency, stretcher van and specialty care services shall each be considered a separate license.

(1) Specialty care licenses are statutorily limited to patient care and interventions above the Paramedic scope of practice.

(2) Specialty Care applicants will declare in the application the type or types of specialty care and patients that will be transported by the agency. The types of specialty care and patients may include, but not be limited to:

(A) adult, pediatric, infant, neonatal, or a combination of age types,

(B) cardiac care, respiratory, neurological, septicemia, or other single or multi-system complications or illnesses requiring specialized treatment during the transport of the patient.

(3) Ground ambulance services are required to meet the duty to act requirements as described in 63 O.S. § 1-2504.1.

(e) The application shall be signed under oath by the party or parties seeking to secure the license.

(f) The party or parties who sign the application shall be considered the owner or agent (licensee), and responsible for compliance to the Act and this chapter.

(g) All applications shall contain, but not be limited to the following:

(1) a statement of ownership which shall include the name, address, telephone number, occupation and/or other business activities of all owners or agents who shall be responsible for the service;

(A) If the owner is a partnership or corporation, a copy of incorporation documents and the name of all partner(s) or stockholder(s) with an ownership interest of five (5%) percent or more (principal), and the name and addresses of any other ambulance service in which any partner or stockholder holds an interest shall also be included.

(B) If the owner is an entity of government, governmental trust, trust authority, or non-profit corporation, the name of each board member, or the chief administrative officer and/or chief operation officer shall be included.

(C) A business plan which includes a financial disclosure statement showing evidence of the ability to sustain the operation for at least one (1) year.

(D) For purposes of unannounced inspections, the days and times the business office is open.

(2) Agencies that use emergency vehicles as defined in Title 47 O.S. Section 103 shall show proof of vehicle liability insurance, at least in the amount of one million dollars ($1,000,000.00) or to the amount provided for in "The Governmental Tort Claims Act", Title 51 O.S. Section 151 et seq. This insurance requirement shall remain in effect at all times while the service is licensed. Air ambulances are to maintain aircraft liability insurance as required within Federal regulation.

(3) Proof of professional liability insurance, at least in the amount of one million dollars ($1,000,000) or to the amount provided for in "The Governmental Tort Claims Act," Title 51 O.S. Section 151 et seq. This insurance requirement shall remain in effect at all times while the service is licensed;

(4) Proof of participation in a workers' compensation insurance program for employees who are subject to pertinent labor laws. This insurance requirement shall remain in effect at all times while the service is licensed;

(h) Ground Ambulance Services, Air Ambulances, Emergency Medical Response Agencies, and Specialty Care agencies shall have medical control as prescribed by the Act and these rules and submit with the application:

(1) a letter of agreement from the physician to provide medical direction and establish the protocols and the scope of practice provided at the service;

(2) the physicians primary practice address or home address if the physician does not have a practice and email address;

(3) For agencies providing care within the Intermediate, Advanced EMT, and Paramedic scope of practice, submit an Oklahoma Bureau of Narcotics and Dangerous Drugs (OBNDD) registrant certification or number;

(4) a current Oklahoma medical license; and

(5) a curriculum vitae,

(i) a copy of any contract(s) for vehicles, medical equipment, and/or personnel, if such exist;

(j) Ground Ambulance Services, Air Ambulances, Emergency Medical Response Agencies, and Specialty Care agencies shall submit a copy of patient care protocols and quality assurance plan or policy as required by the medical director and as prescribed by the Act and this chapter;

(1) The Department may require quality assurance documentation for review and shall protect the confidentiality of that information.

(2) The quality assurance documentation shall be maintained by the agency for three (3) years.

(3) The quality assurance policy shall include, but not be limited to:

(A) refusals,

(B) air ambulance utilization,

(C) airway management,

(D) cardiac arrest interventions,

(E) time sensitive medical and trauma cases,

(F) other selected patient care reports not specifically included, and

(G) how to provide internal and external feedback of findings determined through reviews. Documentation of the feedback will be maintained as part of the quality assurance documentation

(H) treatment protocols that expand beyond the published state protocols;

(k) Ground ambulance service and Pre-hospital emergency medical response agency applications are required to submit documentation that supports agency licensure from the governmental authority (ies) having jurisdiction over the proposed emergency response area. If the emergency response area encompasses multiple jurisdictions, a written endorsement shall be presented from each. The ground ambulance and prehospital emergency medical response agency application shall contain from each endorsement the following;

(1) a map and written description of the endorsed or approved response area,

(2) name(s) and title(s) of the person(s) providing approval,

(3) any expiration date,

(4) name of the service receiving the endorsement.

(5) Ground ambulance service supporting documentation will be consistent with the County EMS plan as required in 19 O.S. Section 1-1203.

(l) Pre-hospital emergency medical response agency applications shall include a letter of support or agreement from a licensed ambulance service within the proposed emergency medical response service area that includes:

(1) support of the application,

(2) support of the medical control physician choice, and

(3) plans or policies for supporting or participating in quality assurance activities.

(4) If an applicant is unable to provide a letter of support from a licensed ambulance service within their proposed response area, the applicant can request an exemption. The Department has the discretion to approve or deny the exemption request.

(m) Event standby emergency response agency applications will include the following restrictions and requirements:

(1) if the applicant is providing care to the public on public property, then letters of governmental support and documents verifying coordination with local ambulance services are required for that agency to have the authority to provide care at that setting.

(2) if the agency is providing care to the public in a business or establishment open to the public on private property, then letters of governmental support are not required.

(3) At all times, the standby event emergency medical response agency shall coordinate with other licensed and certified EMS agencies responsible for the event location when the event is within a licensed ambulance service area or approved area for prehospital emergency medical response agencies.

(n) All emergency medical response agencies are prohibited from transporting patients

(o) Stretcher Van service applications will include the following restrictions and requirements:

(1) Stretcher Vans are prohibited from carrying medications other than oxygen and those other medications which are passenger supplied and administered. The passenger must have a current physician prescription and/or order for the administration of oxygen. A copy of the order shall be maintained in agency files.

(2) Stretcher van applications will include a quality assurance process or policy that includes:

(A) The Department may require quality assurance documentation for review and shall protect the confidentiality of that information.

(B) The quality assurance documentation shall be maintained by the agency for three (3) years.

(C) Any passenger condition where the passenger entered the 911 system,

(D) If oxygen is continued, the physician order must be maintained with the trip report or passenger report;

(E) a review other selected passenger reports not specifically included, and

(F) process to provide internal and external feedback of findings determined through reviews. Documentation of the feedback will be maintained as part of the quality assurance documentation.

(p) Stretcher Van Services are to submit the following with their application:

(1) A map or narrative description which identifies the proposed service area;

(2) evidence that the proposed service area is an emergency medical service region, ambulance district, or county with a population in excess of five hundred thousand (500,000) people;

(q) Ground ambulance services will include a description of the proposed level of service in the proposed licensed service area, including:

(1) a map defining the whole licensed service area including location(s) of base station, substations, and posts;

(2) a description of the level of care to be provided;

(r) Ground Services, Air Ambulances, and prehospital emergency medical response agencies shall submit a communication policy addressing:

(1) receiving and dispatching emergency and non-emergency calls;

(2) ensuring compliance with State and local EMS communication plans.

(s) Specialty Care Services and Stretcher Van services shall submit communication policy addressing the screening process that ensures a request for service will meet the agency's capability, capacity, and licensure requirements. Documentation of the screening will be retained as part of the patient care report or call log.

(t) a response plan that includes:

(1) providing and receiving mutual aid with all surrounding, contiguous, or overlapping, licensed service areas,

(2) providing for and receiving disaster assistance in accordance with local and regional plans and command structures such as an incident command structure using national incident management support models.

(u) confidentiality policy ensuring confidentiality of all documents and communications regarding protected patient health information.

(v) For an initial or new ground ambulance service, air ambulance service, specialty care, and stretcher van service license application, shall be accompanied by a non-refundable fee of six hundred ($600.00) dollars plus twenty ($20.00) dollars for each vehicle, in excess of two (2) vehicles utilized for patient transport. An additional fee of one hundred fifty ($150.00) dollars shall be included for each ambulance substation in addition to the base station. An Emergency Medical Response Agency Application shall be accompanied by a non-refundable fee of fifty ($50.00) dollars.

(w) All applicants except air ambulance services are required to show documentation of compliance with any "Sole Source" Ordinance or Resolution. If an area of Oklahoma is being served by a licensed ambulance service, or services, and the area has adopted "sole source" resolutions or ordinances or an Emergency Services District as established pursuant to Article 10, Section 9 (c) of the Oklahoma Constitution, the Department shall require the approval of the community (ies) and/or the emergency medical services authority of that service area, before an additional ambulance service shall be licensed for that same service area.

(x) For all license applications, a business plan which includes a financial disclosure statement showing evidence of the ability to sustain the operation for at least one (1) year is required to be submitted with the application.

Okla. Admin. Code § 310:641-2-3

Adopted by Oklahoma Register, Volume 39, Issue 24, September 1, 2022, eff. 9/11/2022