Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 157 - EMERGENCY MEDICAL CARE › Subchapter B - EMERGENCY MEDICAL SERVICES PROVIDER LICENSES › Section 157.11 - Requirements for an EMS Provider License

Current through Reg. 49, No. 28; July 12, 2024
(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, and as stated in Health and Safety Code §
												773.112(d),
				  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;
(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.
(8) Paragraph (7)(CC) 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.
(9) 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.
(10) Paragraph (9) 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.
(11) Paragraph (9) of this subsection does
				  not apply to fixed or rotor wing EMS providers.