HB 5446

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Full Text of HB5446
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	HB5446 - 104th General Assembly
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		HB5446 Enrolled		LRB104 17942 BAB 31379 b
1    AN ACT concerning regulation.
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
4    Section 5. The Emergency Medical Services (EMS) Systems
5Act is amended by changing Section 3.85 as follows:
6    (210 ILCS 50/3.85)
7    Sec. 3.85. Vehicle Service Providers.
8    (a) "Vehicle Service Provider" means an entity licensed by
9the Department to provide emergency or non-emergency medical
10services in compliance with this Act, the rules promulgated by
11the Department pursuant to this Act, and an operational plan
12approved by its EMS System(s), utilizing at least ambulances
13or specialized emergency medical service vehicles (SEMSV).
14        (1) "Ambulance" means any publicly or privately owned
15    on-road vehicle that is specifically designed, constructed
16    or modified and equipped, and is intended to be used for,
17    and is maintained or operated for the emergency
18    transportation of persons who are sick, injured, wounded
19    or otherwise incapacitated or helpless, or the
20    non-emergency medical transportation of persons who
21    require the presence of medical personnel to monitor the
22    individual's condition or medical apparatus being used on
23    such individuals.
		HB5446 Enrolled	- 2 -	LRB104 17942 BAB 31379 b
1        (2) "Specialized Emergency Medical Services Vehicle"
2    or "SEMSV" means a vehicle or conveyance, other than those
3    owned or operated by the federal government, that is
4    primarily intended for use in transporting the sick or
5    injured by means of air, water, or ground transportation,
6    that is not an ambulance as defined in this Act. The term
7    includes watercraft, aircraft and special purpose ground
8    transport vehicles or conveyances not intended for use on
9    public roads.
10        (3) An ambulance or SEMSV may also be designated as a
11    Limited Operation Vehicle or Special-Use Vehicle:
12            (A) "Limited Operation Vehicle" means a vehicle
13        which is licensed by the Department to provide basic,
14        intermediate or advanced life support emergency or
15        non-emergency medical services that are exclusively
16        limited to specific events or locales.
17            (B) "Special-Use Vehicle" means any publicly or
18        privately owned vehicle that is specifically designed,
19        constructed or modified and equipped, and is intended
20        to be used for, and is maintained or operated solely
21        for the emergency or non-emergency transportation of a
22        specific medical class or category of persons who are
23        sick, injured, wounded or otherwise incapacitated or
24        helpless (e.g. high-risk obstetrical patients,
25        neonatal patients).
26            (C) "Reserve Ambulance" means a vehicle that meets
		HB5446 Enrolled	- 3 -	LRB104 17942 BAB 31379 b
1        all criteria set forth in this Section and all
2        Department rules, except for the required inventory of
3        medical supplies and durable medical equipment, which
4        may be rapidly transferred from a fully functional
5        ambulance to a reserve ambulance without the use of
6        tools or special mechanical expertise.
7    (b) The Department shall have the authority and
8responsibility to:
9        (1) Require all Vehicle Service Providers, both
10    publicly and privately owned, to function within an EMS
11    System.
12        (2) Require a Vehicle Service Provider utilizing
13    ambulances to have a primary affiliation with an EMS
14    System within the EMS Region in which its Primary Service
15    Area is located, which is the geographic areas in which
16    the provider renders the majority of its emergency
17    responses. This requirement shall not apply to Vehicle
18    Service Providers which exclusively utilize Limited
19    Operation Vehicles.
20        (3) Establish licensing standards and requirements for
21    Vehicle Service Providers, through rules adopted pursuant
22    to this Act, including but not limited to:
23            (A) Vehicle design, specification, operation and
24        maintenance standards, including standards for the use
25        of reserve ambulances;
26            (B) Equipment requirements;
		HB5446 Enrolled	- 4 -	LRB104 17942 BAB 31379 b
1            (C) Staffing requirements; and
2            (D) License renewal at intervals determined by the
3        Department, which shall be not less than every 4
4        years.
5        The Department's standards and requirements with
6    respect to vehicle staffing for private, nonpublic local
7    government employers must allow for alternative staffing
8    models that include an EMR with a licensed EMT, EMT-I,
9    A-EMT, Paramedic, or PHRN, as appropriate, pursuant to the
10    approval of the EMS System Program Plan developed and
11    approved by the EMS Medical Director for an EMS System.
12    The EMS personnel licensed at the highest level shall
13    provide the initial assessment of the patient to determine
14    the level of care required for transport to the receiving
15    health care facility, and this assessment shall be
16    documented in the patient care report and documented with
17    online medical control. The EMS personnel licensed at or
18    above the level of care required by the specific patient
19    as directed by the EMS Medical Director shall be the
20    primary care provider en route to the destination facility
21    or patient's residence. The Department shall monitor the
22    implementation and performance of alternative staffing
23    models and may issue a notice of termination of an
24    alternative staffing model only upon evidence that an EMS
25    System Program Plan is not being adhered to. Adoption of
26    an alternative staffing model shall not result in a
		HB5446 Enrolled	- 5 -	LRB104 17942 BAB 31379 b
1    Vehicle Service Provider being prohibited or limited in
2    the utilization of its staff or equipment from providing
3    any of the services authorized by this Act or as otherwise
4    outlined in the approved EMS System Program Plan,
5    including, without limitation, the deployment of resources
6    to provide out-of-state disaster response. EMS System
7    Program Plans must address a process for out-of-state
8    disaster response deployments that must meet the
9    following:
10            (A) All deployments to provide out-of-state
11        disaster response must first be approved by the EMS
12        Medical Director and submitted to the Department.
13            (B) The submission must include the number of
14        units being deployed, vehicle identification numbers,
15        length of deployment, and names of personnel and their
16        licensure level.
17            (C) Ensure that all necessary in-state requests
18        for services will be covered during the duration of
19        the deployment.
20        An EMS System Program Plan for a Basic Life Support,
21    advanced life support, and critical care transport
22    utilizing an EMR and an EMT shall include the following:
23            (A) Alternative staffing models for a Basic Life
24        Support transport utilizing an EMR shall only be
25        utilized for interfacility Basic Life Support
26        transports as specified by the EMS System Program Plan
		HB5446 Enrolled	- 6 -	LRB104 17942 BAB 31379 b
1        as determined by the EMS System Medical Director.
2            (B) Protocols that shall include dispatch
3        procedures to properly screen and assess patients for
4        EMR-staffed transports.
5            (C) A requirement that a provider and EMS System
6        shall implement a quality assurance plan that shall
7        include for the initial waiver period the review of at
8        least 5% of total interfacility transports utilizing
9        an EMR with mechanisms outlined to audit dispatch
10        screening, reason for transport, patient diagnosis,
11        level of care, and the outcome of transports
12        performed. Quality assurance reports must be submitted
13        and reviewed by the provider and EMS System monthly
14        and made available to the Department upon request. The
15        percentage of transports reviewed under quality
16        assurance plans for renewal periods shall be
17        determined by the EMS Medical Director, however, it
18        shall not be less than 3%.
19            (D) The EMS System Medical Director shall develop
20        a minimum set of requirements for individuals based on
21        level of licensure that includes education, training,
22        and credentialing for all team members identified to
23        participate in an alternative staffing plan. The EMT,
24        Paramedic, PHRN, PHPA, PHAPRN, and critical care
25        transport staff shall have the minimum experience in
26        performance of pre-hospital and inter-hospital care,
		HB5446 Enrolled	- 7 -	LRB104 17942 BAB 31379 b
1        as determined by the EMS Medical Director in
2        accordance with the EMS System Program Plan, but at a
3        minimum of 6 months of prehospital experience or at
4        least 50 documented patient care interventions during
5        transport as the primary care provider and approved by
6        the Department.
7            (E) The licensed EMR must complete a defensive
8        driving course prior to participation in the
9        Department's alternative staffing model.
10            (F) The length of the EMS System Program Plan for a
11        Basic Life Support transport utilizing an EMR shall be
12        for one year, and must be renewed annually if proof of
13        the criteria being met is submitted, validated, and
14        approved by the EMS Medical Director for the EMS
15        System and the Department.
16            (G) Beginning July 1, 2023, the utilization of
17        EMRs for advanced life support transports and Tier III
18        Critical Care Transports shall be allowed for periods
19        not to exceed 3 years under a pilot program. The pilot
20        program shall not be implemented before Department
21        approval. Agencies requesting to utilize this staffing
22        model for the time period of the pilot program must
23        complete the following:
24                (i) Submit a waiver request to the Department
25            requesting to participate in the pilot program
26            with specific details of how quality assurance and
		HB5446 Enrolled	- 8 -	LRB104 17942 BAB 31379 b
1            improvement will be gathered, measured, reported
2            to the Department, and reviewed and utilized
3            internally by the participating agency.
4                (ii) Submit a signed approval letter from the
5            EMS System Medical Director approving
6            participation in the pilot program.
7                (iii) Submit updated EMS System plans,
8            additional education, and training of the EMR and
9            protocols related to the pilot program.
10                (iv) Submit agency policies and procedures
11            related to the pilot program.
12                (v) Submit the number of individuals currently
13            participating and committed to participating in
14            education programs to achieve a higher level of
15            licensure at the time of submission.
16                (vi) Submit an explanation of how the provider
17            will support individuals obtaining a higher level
18            of licensure and encourage a higher level of
19            licensure during the year of the alternative
20            staffing plan and specific examples of recruitment
21            and retention activities or initiatives.
22            Upon submission of a renewal application and
23        recruitment and retention plan, the provider shall
24        include additional data regarding current employment
25        numbers, attrition rates over the year, and activities
26        and initiatives over the previous year to address
		HB5446 Enrolled	- 9 -	LRB104 17942 BAB 31379 b
1        recruitment and retention.
2            The information required under this subparagraph
3        (G) shall be provided to and retained by the EMS System
4        upon initial application and renewal and shall be
5        provided to the Department upon request.
6        The Department must allow for an alternative rural
7    staffing model for those vehicle service providers that
8    serve a rural or semi-rural population of 10,000 or fewer
9    inhabitants and exclusively uses volunteers, paid-on-call,
10    or part-time employees, or a combination thereof. The 
11    changes made by this amendatory Act of the 104th General 
12    Assembly do not apply to employees covered by a collective 
13    bargaining agreement.
14        (4) License all Vehicle Service Providers that have
15    met the Department's requirements for licensure, unless
16    such Provider is owned or licensed by the federal
17    government. All Provider licenses issued by the Department
18    shall specify the level and type of each vehicle covered
19    by the license (BLS, ILS, ALS, ambulance, critical care
20    transport, SEMSV, limited operation vehicle, special use
21    vehicle, reserve ambulance).
22        (5) Annually inspect all licensed vehicles operated by
23    Vehicle Service Providers.
24        (6) Suspend, revoke, refuse to issue or refuse to
25    renew the license of any Vehicle Service Provider, or that
26    portion of a license pertaining to a specific vehicle
		HB5446 Enrolled	- 10 -	LRB104 17942 BAB 31379 b
1    operated by the Provider, after an opportunity for a
2    hearing, when findings show that the Provider or one or
3    more of its vehicles has failed to comply with the
4    standards and requirements of this Act or rules adopted by
5    the Department pursuant to this Act.
6        (7) Issue an Emergency Suspension Order for any
7    Provider or vehicle licensed under this Act, when the
8    Director or his designee has determined that an immediate
9    and serious danger to the public health, safety and
10    welfare exists. Suspension or revocation proceedings which
11    offer an opportunity for hearing shall be promptly
12    initiated after the Emergency Suspension Order has been
13    issued.
14        (8) Exempt any licensed vehicle from subsequent
15    vehicle design standards or specifications required by the
16    Department, as long as said vehicle is continuously in
17    compliance with the vehicle design standards and
18    specifications originally applicable to that vehicle, or
19    until said vehicle's title of ownership is transferred.
20        (9) Exempt any vehicle (except an SEMSV) which was
21    being used as an ambulance on or before December 15, 1980,
22    from vehicle design standards and specifications required
23    by the Department, until said vehicle's title of ownership
24    is transferred. Such vehicles shall not be exempt from all
25    other licensing standards and requirements prescribed by
26    the Department.
		HB5446 Enrolled	- 11 -	LRB104 17942 BAB 31379 b
1        (10) Prohibit any Vehicle Service Provider from
2    advertising, identifying its vehicles, or disseminating
3    information in a false or misleading manner concerning the
4    Provider's type and level of vehicles, location, primary
5    service area, response times, level of personnel,
6    licensure status or System participation.
7        (10.5) Prohibit any Vehicle Service Provider, whether
8    municipal, private, or hospital-owned, from advertising
9    itself as a critical care transport provider unless it
10    participates in a Department-approved EMS System critical
11    care transport plan.
12        (11) Charge each Vehicle Service Provider a fee per
13    transport vehicle, due annually at time of inspection. The
14    fee per transport vehicle shall be set by administrative
15    rule by the Department and shall not exceed 100 vehicles
16    per provider.
17        (12) Beginning July 1, 2023, as part of a pilot
18    program that shall not exceed a term of 3 years, an
19    ambulance may be upgraded to a higher level of care for
20    interfacility transports by an ambulance assistance
21    vehicle with appropriate equipment and licensed personnel
22    to intercept with the licensed ambulance at the sending
23    facility before departure. The pilot program shall not be
24    implemented before Department approval. To participate in
25    the pilot program, an agency must:
26            (A) Submit a waiver request to the Department with
		HB5446 Enrolled	- 12 -	LRB104 17942 BAB 31379 b
1        intercept vehicle vehicle identification numbers,
2        calls signs, equipment detail, and a robust quality
3        assurance plan that shall list, at minimum, detailed
4        reasons each intercept had to be completed, barriers
5        to initial dispatch of advanced life support services,
6        and how this benefited the patient.
7            (B) Report to the Department quarterly additional
8        data deemed meaningful by the providing agency along
9        with the data required under subparagraph (A) of this
10        paragraph (12).
11            (C) Obtain a signed letter of approval from the
12        EMS Medical Director allowing for participation in the
13        pilot program.
14            (D) Update EMS System plans and protocols from the
15        pilot program.
16            (E) Update policies and procedures from the
17        agencies participating in the pilot program.
18(Source: P.A. 102-623, eff. 8-27-21; 103-547, eff. 8-11-23.)
19    Section 99. Effective date. This Act takes effect upon
20becoming law.