36-2232

36-2232. Director; powers and duties;
regulation of ambulance services; inspections; response time
compliance

A. The director shall adopt rules to regulate the operation of ambulances and
ambulance services in this state. Each rule shall identify all sections and subsections
of this chapter under which the rule was formulated. The rules shall provide for the
department to do the following:

1. Determine, fix, alter and regulate just, reasonable and sufficient rates and
charges for the provision of ambulances, including rates and charges for advanced life
support service, basic life support service, patient loaded mileage, standby waiting,
subscription service contracts and other contracts for services related to the provision
of ambulances. The director may establish a rate and charge structure as defined by
federal medicare guidelines for ambulance services. The director shall inform all
ambulance services of the procedures and methodology used to determine ambulance rates or
charges.

2. Regulate operating and response times of ambulances to meet the needs of the
public and to insure adequate service. The rules adopted by the director for
certificated ambulance service response times shall include uniform standards for urban,
suburban, rural and wilderness geographic areas within the certificate of necessity based
on, but not limited to, population density, geographic and medical considerations.

3. Determine, fix, alter and regulate bases of operation. The director may issue a
certificate of necessity to more than one ambulance service within any base of
operation. For the purposes of this paragraph, "base of operation" means a service area
granted under a certificate of necessity.

4. Issue, amend, transfer, suspend or revoke certificates of necessity under terms
and conditions consistent with this article.

5. Prescribe a uniform system of accounts to be used by ambulance services that
conforms to standard accounting forms and principles for the ambulance industry.

6. Require the filing of an annual financial report and other data. These rules
shall require an ambulance service to file the report with the department not later than
one hundred eighty days after the completion of its annual accounting period.

7. Regulate ambulance services in all matters affecting services to the public to
the end that the provisions of this article may be fully carried out.

8. Prescribe bonding requirements, if any, for ambulance services granted authority
to provide any type of subscription service.

9. Offer technical assistance to ambulance services to maximize a healthy and
viable business climate for the provision of ambulances.

10. Offer technical assistance to ambulance services in order to obtain or to amend
a certificate of necessity.

11. Inspect, at a maximum of twelve month intervals, each ambulance registered
pursuant to section 36-2212 to assure that the vehicle is operational and safe and that
all required medical equipment is operational. At the request of the provider, the
inspection may be performed by a facility approved by the director. If a provider
requests that the inspection be performed by a facility approved by the director, the
provider shall pay the cost of the inspection.

B. The director may require any ambulance service offering subscription service
contracts to obtain a bond in an amount determined by the director that is based on the
number of subscription service contract holders and to file the bond with the director
for the protection of all subscription service contract holders in this state who are
covered under that subscription contract.

C. An ambulance service shall:

1. Maintain, establish, add, move or delete suboperation stations within its base
of operation to assure that the ambulance service meets the established response times or
those approved by the director in a political subdivision contract.

2. Determine the operating hours of its suboperation stations to provide for
coverage of its base of operation.

3. Provide the department with a list of suboperation station locations.

4. Notify the department at least thirty days before the ambulance service makes a
change in the number or location of its suboperation stations.

D. At any time the director or the director's agents may:

1. Inquire into the operation of an ambulance service including a person operating
an ambulance that has not been issued a certificate of registration or a person who does
not have or is operating outside of a certificate of necessity.

2. Conduct on-site inspections of facilities, communications equipment, vehicles,
procedures, materials and equipment.

3. Review the qualifications of ambulance attendants.

E. If all ambulance services that have been granted authority to operate within the
same service area or that have overlapping certificates of necessity apply for uniform
rates and charges, the director may establish uniform rates and charges for the service
area.

F. In consultation with the medical director of emergency medical services, the
emergency medical services council and the medical direction commission, the director of
the department of health services shall establish protocols for ambulance services to
refer and advise a patient or transport a patient by the most appropriate means to the
most appropriate provider of medical services based on the patient's condition. The
protocols shall include triage and treatment protocols that allow all classes of
emergency medical technicians responding to a person who has accessed 911, or a similar
public dispatch number, for a condition that does not pose an immediate threat to life or
limb to:

1. Refer and advise a patient or transport a patient to the most appropriate health
care institution as defined by section 36-401 based on the patient's condition, taking
into consideration factors including patient choice, the patient's health care provider,
specialized health care facilities and local protocols.

2. Provide a list of alternative sites available to deliver care.

G. The director, when reviewing an ambulance service's response time compliance
with its certificate of necessity, shall consider in addition to other factors the effect
of hospital diversion, delayed emergency department admission and the number of
ambulances engaged in response or transport in the affected area.