2023 Colorado Revised Statutes › Title 25 - PUBLIC HEALTH AND ENVIRONMENT (§§ 25-1-101 — 25-59-106) › HOSPITALS (§§ 25-3-100.5 — 25-3.5-1401) › Article 3.5 - EMERGENCY MEDICAL AND TRAUMA SERVICES (§§ 25-3.5-101 — 25-3.5-1401) › Part 3 - TRANSPORTATION SUBSYSTEM (§§ 25-3.5-301 — 25-3.5-318) › Section 25-3.5-314 - Ambulance service - license required - exceptions - rules - local authorization to operate - penalties - liability insurance

(1)
State license required.
On and after July 1, 2024, and except as provided in subsection (2) of this section, a person shall not operate or maintain an ambulance service without a license issued by the department and without authorization to operate from the local licensing authority for the county or city and county in which the ambulance service operates or seeks to operate.
(2)
Exceptions.
Subsection (1) of this section does not apply to the following:
(a)
The exceptional emergency use of a privately or publicly owned vehicle, including search and rescue unit vehicles or aircraft not ordinarily used in the act of transporting patients;
(b)
A vehicle rendering services as an ambulance during a major catastrophe or emergency when ambulances with authorizations to operate in the county or city and county in which the major catastrophe or emergency occurred or is occurring are insufficient to render the ambulance services required;
(c)
An ambulance based outside of the state that is transporting a patient into the state;
(d)
A vehicle used or designed for the scheduled transportation of convalescent patients, individuals with disabilities, or individuals who would not be expected to require skilled treatment or care while in the vehicle; and
(e)
A vehicle used solely for the transportation of an intoxicated person, as defined in section
27-81-102 (11)
, who is not otherwise disabled or seriously injured and who would not be expected to require skilled treatment or care while in the vehicle.
(3)
Issuance of licenses.
(a)
Beginning July 1, 2024, the department shall issue an initial license to an ambulance service that, as of June 30, 2024, holds a valid license issued by a local jurisdiction.
(b)
An applicant for a license shall submit to the department, in the form and manner determined by the board by rule, evidence that the ambulance service that is the subject of the application, its employees, and any contractors that the ambulance service uses as staff are covered by general liability insurance. The board, by rule, shall determine the minimum amount of general liability insurance coverage required, which amount must not be less than the amount calculated in accordance with section
24-10-114 (1)(a) and (1)(b)
.
(4)
Violations - penalties.
(a)
A person that operates an ambulance service without a license issued pursuant to this part 3 commits a petty offense and shall be punished as provided in section
18-1.3-503
(1.5).
(b)
(I)
An owner or operator of an ambulance service or other person who violates this part 3 or a rule adopted pursuant to this part 3 or who operates without a valid license is subject to a civil penalty of:
(A)
Up to five hundred dollars per violation; or
(B)
For each day of a continuing violation, up to five hundred dollars per day.
(II)
The department shall assess and collect the civil penalties. Before collecting a civil penalty, the department shall provide the person alleged to have committed the violation with notice and an opportunity to be heard in accordance with article
4
of title
24
.
(III)
The department shall transmit all civil penalties collected to the state treasurer, who shall credit the money to the general fund.
(5)
County or city and county authorization to operate - rules.
(a)
(I)
An ambulance service seeking to operate on a regular basis, as defined by the board by rule, in a county or city and county shall file an intent to operate with the local licensing authority for the county or city and county in which the ambulance service intends to operate on forms provided by the department and containing such information as the department may require.
(II)
An ambulance service shall not operate in a county or a city and county unless the ambulance service has obtained authorization to operate from the county or the city and county.
(III)
A county or city and county may enact an ordinance or resolution governing the authorization to operate ambulance services within the county or city and county. The ordinance or resolution may:
(A)
Limit the number of ambulance services that will be authorized to operate within the county's or city and county's jurisdiction;
(B)
Determine and prescribe ambulance service areas within the county's or city and county's jurisdiction;
(C)
Authorize the local licensing authority to contract with ambulance services;
(D)
Authorize the local licensing authority to enter into memoranda of understanding, contracts, or other such agreements to impose obligations on ambulance services that are more stringent than the obligations imposed under this part 3 and rules adopted pursuant to this part 3; and
(E)
Establish other necessary requirements that are consistent with this part 3 or rules adopted pursuant to this part 3.
(b)
(I)
On and after July 1, 2024, a county or city and county that has not opted out of participating in the issuance of authorizations to operate pursuant to subsection (5)(b)(III) of this section shall not grant an ambulance service authorization to operate in the county or city and county without first verifying that the ambulance service has a valid license issued by the department.
(II)
Pursuant to section
25-3.5-317 (2)(a)
, the department has the sole responsibility to conduct vehicle inspections of ambulance services.
(III)
Before July 1, 2024, and before July 1 of any year thereafter, a county or city and county may opt out of participating in the issuance of authorizations to operate an ambulance service within the county or city and county by notifying the department in a form and manner determined by the department. If a county or city and county opts out of participating in the issuance of authorizations to operate an ambulance service, an ambulance service need only obtain a state license to operate in that county or city and county.
(c)
Except as provided in subsection (5)(d) of this section, a county or city and county shall not impose standards that are more or less stringent than the minimum standards that the board adopts by rule pursuant to section
25-3.5-315
.
(d)
Nothing in this part 3 prevents a county or city and county from imposing obligations that exceed the minimum standards that the board adopts by rule pursuant to section
25-3.5-315
through the use of memoranda of understanding, contracts, or other such agreements.
(e)
(I)
Upon a determination by a local licensing authority that a person has violated or failed to comply with this part 3, rules adopted pursuant to this part 3, or an ordinance, resolution, contract, or other agreement governing the ambulance service's authority to operate within the county or city and county, the local licensing authority may summarily suspend, for a period not to exceed ten days, the authorization to operate issued pursuant to this subsection (5).
(II)
A local licensing authority shall provide written notice to the ambulance service of a temporary suspension and shall hold a hearing on the matter no later than ten days after issuance of the temporary suspension. After the hearing, the local licensing authority may suspend or revoke the ambulance service's authorization to operate. At the end of any period of suspension, the person whose authorization to operate was suspended may apply for a new authorization to operate in the county or city and county in the same manner as the person applied for the initial authorization to operate.
(III)
If an ambulance service commits a second violation or failure to comply with this part 3, rules adopted pursuant to this part 3, or an ordinance, resolution, contract, or other agreement governing the ambulance service's authority to operate within the county or city and county, the local licensing authority may revoke the ambulance service's authorization to operate in the county or city and county.
(IV)
A local licensing authority that suspends or revokes an ambulance service's authorization to operate in the county or city and county shall notify the department of the suspension or revocation within thirty days after issuing the suspension or revocation and provide supporting documentation for the department's review of the possible effect that the suspension or revocation has on the ambulance service's state license.
Added by 2022 Ch. 291, § 4, eff. 6/1/2022.