6 Colo. Code Regs. § 1015-3-4-3

Current through Register Vol. 47, No. 11, June 10, 2024

Section 6 CCR 1015-3-4-3 - Department Issuance of Licenses and Ambulance Permits

3.1 On and after July 1, 2024, a person, entity, or agency shall not operate or maintain an ambulance or ambulance service without a license and vehicle permits issued by the Department and, if applicable, without authorization to operate from the governing body of a city-and-county or the Board of County Commissioners of the county or city-and-county in which the ambulance service operates or seeks to operate.

3.2 Department License Required

3.2.1 On and after July 1, 2024, and except as provided in Section 3.3 of these rules, a person, entity, or agency shall not operate or maintain an ambulance service, public or private, to transport a sick or injured person from any point within Colorado to any point within or outside Colorado unless that person, entity, or agency holds a valid license issued by the Department.

3.2.2 A person, entity, or agency that operates an ambulance service without a license issued by the Department commits a petty offense and shall be punished by fine or imprisonment as provided in Section 18-1.3-503 (1.5), C.R.S.

3.3 Exemptions from Licensure, Permit, and Authorization Requirements

3.3.1 Vehicles used for the transportation of persons injured at a mine when the personnel used on the vehicles are subject to the mandatory safety standards of the federal Mine Safety and Health Administration, or its successor agency.

3.3.2 Vehicles used to evacuate patients from areas inaccessible to a permitted ambulance. Vehicles used in this capacity may only transport patients to the closest practical point of access to a permitted ambulance or medical facility.

3.3.3 Vehicles rendering services as an ambulance during a major catastrophe or emergency when ambulances with an authorization to operate in the county and city-and-county in which the major catastrophe or emergency occurred or is occurring are insufficient to render the ambulance services required in the county or city-and-county.

3.3.4 An ambulance based outside of the state that is transporting a patient into the state.

3.3.5 Pursuant to Section 25-3.5-314(2)(d), C.R.S., vehicles used or designed for the scheduled transportation of convalescent patients, individuals with disabilities, or persons who would not be expected to require skilled treatment or care while in the vehicle.

3.3.6 Vehicles used solely for the transportation of intoxicated persons or persons incapacitated by alcohol as defined in Section 27-81-102(11), C.R.S., but who are not otherwise disabled or seriously injured and who would not be expected to require skilled treatment or care while in the vehicle.

3.3.7 The exceptional emergency use of a privately or publicly owned vehicle, including search and rescue unit vehicles, not ordinarily used in the act of transporting patients.

3.4 General Requirements for Department Licensure of Ambulance Services and Permitting of Ambulance Vehicles

3.4.1 If on June 30, 2024, an ambulance service has a valid license issued by a county or city-and-county for each ambulance used, the Department shall issue an initial state license to the ambulance service and initial state permits for each ambulance used that will remain valid for up to two (2) years.

3.4.2 For all ambulance services that do not have a valid license issued by a county or city-and-county on June 30, 2024, an owner or operator must file for and obtain an initial ambulance license and ambulance permits from the Department prior to beginning operations.

3.4.3 An ambulance service license or ambulance permit may not be assigned, sold or otherwise transferred.

3.4.4 Any vehicle that operates as an ambulance shall be permitted by the Department before it can be identified as an ambulance. Each ambulance shall:

A) Make its permit accessible upon request; and

B) Clearly display on the vehicle the name of the ambulance service as reported to the Department in the application.

3.5 State Licensing Process

3.5.1 To become licensed and maintain licensure by the Department, every ambulance service must comply with all applicable laws and regulations that are required to operate and maintain an ambulance service in Colorado, as well as all other applicable federal and state laws and regulations.

A) Section 14 of these rules will not go into effect until July 1, 2026.

3.5.2 To obtain an initial license or to renew an existing license, the owner or operator of an ambulance service ("applicant") shall submit to the Department:

A) A completed application form;

B) An application fee as set forth by the Department in Section 4 of these rules;

C) The names, addresses, telephone numbers, and e-mail contact information for the medical director[s] of the services;

D) A complete list of equipment carried on each permitted ambulance per medical protocols and policies;

E) Upon the Department's request, copies of the ambulance service's written policy and procedure manual, operational or medical protocols or guidelines, or other documentation the Department may deem necessary;

F) Proof of minimum vehicle insurance coverage as required by Section 10-4-619, C.R.S., and defined by Section 42-7-103 (2), C.R.S., with the Department identified as the certificate holder;

G) Proof of worker's compensation consistent with the Colorado Worker's Compensation Act, Title 8, Articles 40-47, C.R.S.;

H) Proof of general liability insurance coverage or a surety bond in an amount not less than the amount calculated in accordance with Sections 24-10-114(1)(a) and (1)(b), C.R.S.;

I) Compliance with all applicable requirements of Section 3.7 of these rules regarding permits;

J) Its articles of incorporation, articles of organization, partnership agreement, certificate of limited partnership, articles of association, statement of registration, operating agreement, or other document of similar import filed or recorded by or for an entity in the jurisdiction under the law of which the entity is formed, by which it is formed, or by which the entity obtains its status as an entity or the entity or any or all of its owners obtain the attribute of limited liability.

3.5.3 Upon receipt of all required application materials, the Department shall review the applicant's ability to provide ambulance services.

A) The Department may conduct an on-site licensing inspection or other appropriate review to determine whether the ambulance service and its ambulances and reserve ambulances conform with all applicable statutes and regulations.

B) The Department shall consider the information contained in the ambulance service's application and may request access to and consider other information concerning the ambulance service's operation, including without limitation, aspects related to patient care, such as:

1) The applicant's previous compliance history, if applicable;

2) The applicant's policies and procedures;

3) The applicant's quality assurance program and other quality assurance documentation as may be appropriate;

4) Credentials of patient care staff, including a list of each individual staff member's current certification and/or licensing credentials at the time the licensure application is submitted;

5) Interviews with staff; and

6) Other documents deemed appropriate by the Department.

3.5.4 The applicant shall provide, upon request, access to such individual patient records as the Department requires for the performance of its licensing and regulatory oversight responsibilities.

3.5.5 The applicant shall provide, upon request, access to or copies of reports and information required by the Department for the performance of its licensing and regulatory oversight responsibilities.

3.5.6 The Department shall not release to any unauthorized person any information defined as confidential under state law or the Health Insurance Portability and Accountability Act of 1996, codified at 42 U.S.C. Section 300gg, 42 U.S.C. 1320det seq., and 29 U.S.C. Section 1181, et seq.

3.5.7 An ambulance service license expires two (2) years from the Department's issuance of the license.

3.6 Fingerprint-based Background Check for License Applicant Owner or Operator

3.6.1 When submitting an application for an initial or renewal license, the owner or operator of an ambulance service shall submit with the license application a complete set of the owner's or operator's fingerprints to the Colorado Bureau of Investigation for the purpose of conducting a state and national fingerprint-based background check.

3.6.2 When a currently licensed ground ambulance service undergoes a change of ownership or change of operator, each prospective new owner or operator shall, within 10 (ten) days after a change in ownership or operator, submit along with the license application required in Section 3.5.2 of these rules, a complete set of the owner's or operator's fingerprints to the Colorado Bureau of Investigation for the purpose of conducting a state and national fingerprint-based background check.

3.6.3 Each owner or operator of an ambulance service is responsible for paying the fee established by the Colorado Bureau of Investigation for conducting the fingerprint-based background check to the Bureau.

3.7 Ambulance Permit Process

3.7.1 A licensed ambulance service shall not operate or maintain any vehicle it uses or intends to use as an ambulance or reserve ambulance, as defined in these rules, unless each such vehicle has been issued a valid permit by the Department.

3.7.2 For every ambulance that a licensed ambulance service uses or intends to use as an ambulance or reserve ambulance, the owner or operator of an ambulance service ("applicant") shall apply for a permit from the Department on a form specified by the Department. A permit application shall not be complete unless the applicant provides all requested information to the Department concerning the ambulance[s] and/or reserve ambulance[s] it seeks to permit, including but not limited to:

A) The vehicle identification number of the ambulance to be permitted;

B) Documented proof that all ambulance service ambulances are manufactured by a final stage or completed vehicle organization that has submitted all information to the National Highway Traffic Safety Administration (NHTSA) as required by 49 C.F.R. Part 566, 49 C.F.R. Part 567, and 49 C.F.R. Part 568;

C) Documented proof that all ambulance service ambulances are designed, built, and equipped in compliance with one of the nationally recognized ambulance standards, such as CAAS-GVS, Triple-K, or NFPA, and in accordance with applicable federal, state, and local regulations;

D) Documented proof that the ambulance is maintained and operating in good working order and has passed a mechanical safety inspection by a qualified mechanic pursuant to the service's preventative maintenance policy within, at minimum, the last twelve months;

E) Documented proof that the ambulance for which the permit is sought is authorized by the Colorado Department of Motor Vehicles as an emergency vehicle, pursuant to Section 42-4-108(5), C.R.S.;

F) The ambulance service policy that establishes the minimum equipment list for each ambulance that it seeks to permit; and

G) The applicable fee, as set forth in Section 4 of these rules.

3.7.3. Upon the issuance of a permit, the licensed ambulance service shall ensure the permit is located in the ambulance that is identified by the corresponding vehicle identification number and is available for inspection at all times.

3.7.4 An ambulance permit expires two (2) years from issuance of the permit.

3.7.5 A licensed ambulance service shall notify the Department within 30 days if the ambulance service sells, disposes of, or otherwise permanently removes a validly-permitted ambulance or reserve ambulance from operation as part of its inventory/fleet.

3.7.6 Any licensed ambulance service that buys, leases, or acquires possession of one (1) or more ambulances or reserve ambulances during its licensure period shall not operate or use any such ambulance for patient transport of any kind until the service has applied for and received a valid permit for each such ambulance from the Department, as set forth in Section 3.7.2 of these rules.

A) Temporary permits - The Department may issue a temporary permit to an ambulance service for its use of an ambulance or reserve ambulance under the following circumstances:

1) The ambulance service notifies the Department within seventy-two (72) hours of its unexpected and temporary use of another ambulance service's Colorado-permitted ambulance in order to provide coverage under unforeseen or unanticipated circumstances; or

2) The ambulance service requests the Department's permission to operate an ambulance that is not fully equipped as required by these rules but can establish to the Department's satisfaction that:

a) Receipt of the missing equipment is pending; and

b) The ambulance service's operation of the ambulance in the interim is safe for staff, patient care, and transportation.

B) When applying for a temporary permit, the ambulance service shall submit an application for a temporary permit on forms specified by the Department. Submission of this application requires the ambulance service to attest that the ambulance for which the temporary permit is sought complies with Section 3.7.2 of these rules.

C) The Department may conduct an on-site inspection or other appropriate review to determine whether the ambulance or reserve ambulance for which the ambulance service seeks a temporary permit conforms with all applicable statutes and regulations.

D) Once issued, a temporary permit will remain valid for up to one hundred eighty (180) calendar days with the following conditions:

1) The Department may renew a temporary permit once only for a period of up to ninety (90) calendar days;

2) The temporary permit is not otherwise renewable or transferable; and

3) The ambulance service shall ensure the temporary permit is located in the ambulance that is identified by the corresponding vehicle identification number, and is available for inspection at all times.

3.7.7 A person, entity, or agency that operates an ambulance without a permit issued by the Department is subject to a civil penalty of:

A) Up to five hundred dollars ($500) per violation; or

B) For each day of a continuing violation, up to five hundred dollars ($500) per day.

3.8 Provision of secure transportation services by licensed ground ambulances that operate and maintain a validly permitted ambulance in accordance with Section 25-3.5-314, C.R.S., and these rules may provide secure transportation services to an individual experiencing a behavioral health crisis.

3.9 A licensed ground ambulance service that provides community integrated health care services (CIHCS) in addition to medical transport services must also hold a valid CIHCS license from the Department pursuant to 6 C.C.R. 1011-3.

3.10 Provisional License

3.10.1 The Department may issue a provisional license to an applicant for an initial license to operate an ambulance service if:

A) The applicant is temporarily unable to conform to all the minimum standards required under Title 25, Article 3.5, Part 3, and these rules;

B) The operation of the applicant's ambulance service will not adversely affect patient care or the health, safety, and welfare of the public; and

C) The applicant ambulance service demonstrates it is making its best efforts to achieve compliance with all the applicable rules.

3.10.2 A provisional license issued by the Department shall be valid for a period not to exceed ninety (90) calendar days, except that the Department may issue a second provisional license for the same duration and shall charge the same fee set forth in Section 4 of these rules as for the first provisional license. The Department may not issue a third or subsequent provisional license to the applicant, and in no event shall a service be provisionally licensed for a period to exceed one hundred eighty (180) calendar days.

3.10.3 Pursuant to Section 16 of these rules, each service that is issued a provisional license from the Department must also, if applicable, obtain an authorization to operate from the local authorizing authority for each county or city-and-county in which the ambulance service intends to operate.

3.10.4 The applicant shall submit to the Department the applicable provisional fee(s) set forth in Section 4 of these rules.

3.11 License Renewal and Permit Renewal

3.11.1 To renew an existing ambulance service license, permit, or both, the licensee shall submit its application for renewal within ninety (90) calendar days preceding the expiration date, and no later than thirty (30) calendar days prior to the date of the ambulance license and/or permit expiration. At minimum, the licensee shall submit:

A) The applicable renewal application and fees, as set forth in Section 4 of these rules;

B) Documented proof that the ambulance is maintained and operating in good working order and has passed a mechanical safety inspection by a qualified mechanic pursuant to the service's preventative maintenance policy within, at minimum, the last twelve (12) months; and

C) Any further information as required by the Department.

3.11.2 A Department-issued ambulance license and/or permit is no longer valid upon the applicable expiration date. The ambulance service that has allowed its license and/or permit to expire shall not:

A) Hold itself out as a license and/or permit holder; and

B) Provide ambulance service or operate any ambulance for any reason, whether or not for compensation, until such time as the Department has issued a new or renewed license and/or permit.

3.11.3 When an ambulance service licensee submits an application to renew its license and/or permit, the Department may conduct an inspection of the ambulance service to assure its compliance with these rules.

3.11.4 Except as otherwise provided in Section 3.10 of these rules, the Department shall renew a license and/or permit when it is satisfied that the requirements of these rules have been met.

3.11.5 If the licensee has made a timely and sufficient application for renewal of the license and/or permit, the existing license and/or permit shall not expire until the Department has acted upon the renewal application.

3.12 Change of Ownership/Management

3.12.1 When a currently licensed ambulance service anticipates a change of ownership, the current licensee shall notify the Department within the specified time frame and the prospective new licensee shall submit an application for change of ownership along with the requisite fees as set forth in Section 4 of these rules, as applicable, and documentation within the same time frame. The time frame for submittal of such notification and documentation shall be at least sixty (60) calendar days before a change of ownership involving any ambulance service.

A) In case of exigent circumstances, an ambulance service may request a waiver of the sixty (60) calendar day requirement set forth above.

3.12.2 In general, the conversion of an ambulance service's legal structure, or the legal structure of an entity that has a direct or indirect ownership interest in the ambulance service is not a change of ownership unless the conversion also includes a transfer of at least fifty (50) percent of the licensed ambulance service's direct or indirect ownership interest to one (1) or more new owners.

A) However if, for example, the owner of an ambulance service enters into a lease arrangement or management agreement or other operational arrangement whereby the owner retains no authority or responsibility for the operation and management of the ambulance service, the action shall be considered a change of ownership that requires a new license.

3.12.3 Each applicant for a change of ownership shall provide information on change of ownership as requested by the Department, including, but not limited to the following:

A) The legal name of the entity and all other names used by it to provide health care services.

1) The applicant has a continuing duty to notify the Department of all name changes at least thirty (30) calendar days prior to the effective date of the change.

B) Contact information for the entity including mailing address, telephone and facsimile numbers, e-mail address, and website address, as applicable.

3.12.4 The existing licensee shall be responsible for correcting all rule violations and deficiencies in any current plan of correction before the change of ownership becomes effective. In the event that such corrections cannot be accomplished in the time frame specified, the prospective licensee shall be responsible for all uncorrected rule violations and deficiencies including any current plan of correction submitted by the previous licensee unless the prospective licensee submits a revised plan of correction, approved by the Department, before the change of ownership becomes effective.

3.12.5 If the Department issues a license to the new owner, the previous owner shall return its license to the Department within five (5) calendar days of the new owner's receipt of its license.

6 CCR 1015-3-4-3

37 CR 12, June 25, 2014, effective 5/21/2014

37 CR 12, June 25, 2014, effective 7/15/2014

37 CR 22, November 25, 2014, effective 12/15/2014

38 CR 24, December 25, 2015, effective 1/14/2016

40 CR 10, May 25, 2017, effective 7/1/2017

40 CR 20, October 25, 2017, effective 1/1/2018

40 CR 21, November 10, 2017, effective 1/1/2018

41 CR 23, December 10, 2018, effective 1/14/2019

43 CR 22, November 25, 2020, effective 1/1/2021

44 CR 23, December 10, 2021, effective 12/30/2021

45 CR 10, May 25, 2022, effective 6/14/2022

47 CR 02, January 25, 2024, effective 2/14/2024