W. Va. Code R. § 64-48-4

Current through Register Vol. XLI, No. 36, September 6, 2024

Section 64-48-4 - Agencies

4.1. The Commissioner shall evaluate EMS agencies according to this rule.

4.2. Responsibility. -- EMS agencies are responsible for ensuring that vehicles operated and maintained by the agency and personnel associated with the agency comply with this rule at all times.

4.3. License Required. -- A person or entity may not establish or operate and maintain or advertise any service or organization as an EMS agency without a valid OEMS license.

4.4. Display of License. -- The license shall be displayed publicly in the headquarters of the agency.

4.5. Licensed Service Types. -- EMS licenses shall be issued for one or more of the following services:

4.5.1. Rapid response -- basic life support;

4.5.2. Rapid response -- advanced life support;

4.5.3. Basic life support;

4.5.4. Advanced life support;

4.5.5. Critical care transport;

4.5.6. Rotary wing transport;

4.5.7. Fixed wing transport;

4.5.8. Specialized multi-patient medical transport. This type of service may not be licensed unless the EMS agency provides at least basic life support service; and

4.5.9. Fire Department Rapid Response. -- This applies only to fire departments certified by the West Virginia State Fire Commission.

4.5.9.a. A fire department rapid response service that charges a fee for its medical services or transports patients is subject to all licensure requirements and applicable standards of this rule, including the payment of fees.

4.5.9.b. A fire department rapid response service that does not charge a fee for its medical services or transport of patients shall obtain one of the following:

4.5.9.b.1. A license subject to all requirements and applicable standards of this rule, including full inspection and payment of fees; or

4.5.9.b.2. A license subject to requirements and applicable standards of this rule as outlined in subsection 4.9. of this rule.

4.5.9.c. A fire department rapid response service certified by the West Virginia State Fire Commission is not subject to licensure as described in this rule if it only provides basic life support services pursuant to an agreement with an EMS agency that addresses medical direction, training, quality assurance, and liability insurance.

4.6. Advertising. -- EMS agencies shall not advertise, in print, electronic, or other media for public consumption, any service for which they are not licensed. Aeromedical agencies may not solicit direct flight requests for service from the general public. Agencies may advertise for personnel or other community-oriented activities.

4.7. Application.

4.7.1. The EMS agency shall submit an application to OEMS for a license, in a format specified by the Commissioner, prior to agency inspection.

4.7.2. Any EMS agency seeking to make changes in the level of service, service area, station locations or number of vehicles shall submit an application in a format specified by the Commissioner, prior to making the change.

4.7.3. Management of an EMS agency includes those serving as Official Representative, Medical Director or Training Officer. Any changes to management require a revised application to be submitted within 10 days of the change.

4.8. Verification. -- The Commissioner may use any lawful investigatory means necessary to verify information contained in an application.

4.9. License Issuance. -- The Commissioner will determine whether an applicant should be issued a license based upon: the applicant's previous record of performance in the provision of a similar service; the resources available to the applicant for the provision of services; an objective measurement of the applicant's compliance with requirements and standards of this rule; and evidence of the applicant's current compliance with all state, local, and federal obligations, including, but not limited to, taxes and worker's compensation obligations.

4.10. Inspection. -- The Commissioner may inspect all places of operation of an EMS agency or proposed EMS agency, at any time, for compliance with this rule.

4.10.1. The inspection is in addition to other federal, state, or local inspections required by law.

4.10.2. The inspection will include all places of operations and all records of the EMS agency or proposed EMS agency.

4.10.3. The Commissioner may inspect, but not copy or maintain, records of a protected status.

4.10.4. Fire department rapid response agency inspection:

4.10.4.a. The official representative of the agency, as indicated on the application, shall verify the applicant's compliance with the requirements of this rule and sign and attest to compliance before a notary public.

4.10.4.b. The Commissioner may inspect all places of operation of an existing or proposed fire department rapid response service for compliance with this rule. The inspection is in addition to other federal, state, or local inspections required by law. The Commissioner may inspect, but not copy or maintain, records of a protected status.

4.10.4.c. Inspections will be conducted at no cost to the applicant.

4.11. Place of Operations. -- EMS agencies shall comply with the following requirements pertaining to all places of operations:

4.11.1. Storage. -- The EMS agency shall provide adequate and clean storage spaces in an enclosed area for equipment and supplies. These storage spaces must be constructed to permit thorough cleaning;

4.11.2. Supplies. -- The EMS agency shall maintain medical supplies required for all the classes of vehicles operated by the agency;

4.11.3. Sanitary Requirements. -- All areas used for storage of equipment and supplies must be kept neat, clean, and sanitary. Plastic bags or enclosed containers shall be provided for soiled supplies;

4.11.4. Living Quarters. -- If crews are required to work 24-hour or greater-length shifts, appropriate quarters shall be provided. These quarters shall meet standards established by W. Va. Code § 21-3-1, Safety and Welfare of Employees, and others established by the Commissioner; and

4.11.5. Medical Waste. -- All forms of medical waste must be stored and disposed of according to W. Va. Code § 20-5J-1, et seq. and Division of Health Legislative Rule, "Infectious Medical Waste," 64CSR56.

4.12. Operational Policies and Procedures. -- EMS agencies shall maintain current written operational policies and procedures which are subject to inspection by the Commissioner. Required policies and procedures include, but are not limited to, operation and maintenance of services; equipment and facilities management; health and safety practices for personnel; patient safety; a medication management plan compliant with federal and state requirements; infection control practices; anti-harassment; vehicle operations; and personnel management. Additional aeromedical agency requirements include: a contemporaneous flight following plan used in all phases of flight operations; a notification policy for requesting agencies and facilities which includes estimated time of arrival, any changes in time or flight status; a routinely drilled post accident/incident plan; a policy to reduce "helicopter shopping" including appropriate pre-flight screening and cooperation with other aeromedical providers; and a customer education program addressing patient preparation, landing zone management, and customer safety around the aircraft and equipment.

4.13. Records. -- EMS agencies are responsible for the preparation and maintenance of records. All records are subject to inspection by the Commissioner. Records must be stored in a manner as to provide reasonable safety from water and fire damage and from disclosure to persons other than those authorized by law. Secure storage must be provided for all medical records. EMS agencies shall comply with data collection and reporting requirements in subsection 3.2. of this rule. The EMS agency shall prepare and maintain for a period of not less than seven years the following records:

4.13.1. Personnel records documenting training, qualifications, and certifications for positions held; and

4.13.2. Records for each EMS vehicle including vehicle registration records, records of safety inspections, repair, and crash incident reports as specified by the Commissioner;

4.14. Insurance. -- Each EMS agency shall have in effect, maintain, and furnish proof of errors and omissions insurance as required by W. Va. Code § 16-4C-16, and current insurance policies for all EMS vehicles operated by the agency.

4.15. Non-Discrimination. -- EMS agencies shall maintain a written policy to prohibit the refusal of emergency response, treatment, and transportation of patients to the nearest appropriate facility on incidents with potentially critical illness or injury, regardless of the patient's age, gender, ethnicity, or ability to pay for services.

4.16. Public Access. -- An EMS agency shall provide a publicly listed telephone number to receive requests for service from the general public within its regular operating area.

4.16.1. The primary emergency number shall be 9-1-1.

4.16.2. Secondary telephone numbers may be provided for the provision of non-emergency services.

4.16.3. An EMS agency that, according to written policy, does not respond to calls from the general public and responds only to calls from a defined, closed population, such as the population of an institution, an industrial plant, facility, or a university, is not required to provide a publicly listed telephone number. These agencies shall provide a telephone number that is known to the defined population served and is answered during all periods when that population may require service.

4.17. Availability. -- EMS agencies shall ensure that service for which they are licensed is available to the public or population served within their regular operating area on a 24-hour continuous basis either by providing the service themselves or by written agreement with another licensed EMS agency.

4.18. Communications. -- Communication systems must comply with state and federal rules, regulations, policies, and protocols.

4.19. Performance Improvement. -- EMS agencies shall comply with the minimum performance improvement program established by the Commissioner.

4.20. Standards. -- In addition to the requirements set forth in this rule, the Commissioner will score the EMS agency or proposed EMS agency according to the standards contained in subsections 4.21. through 4.31. Certain standards, as determined by the Commissioner, may not apply to an EMS agency depending on the type of service provided or population served.

4.21. Level of Service. -- EMS agencies that have been licensed by the Commissioner are subject to a rating system based upon the following evaluations and point scores:

4.21.1. ALS staffed and equipped EMS vehicles are dispatched on all emergency requests for service, or; a tiered response is dispatched based on criteria from an OEMS recognized Emergency Medical Dispatch program: 15 points.

4.21.2. ALS services are available only on a part-time basis: 10 points.

4.21.3. BLS services only are available: five points.

4.22. Medical Accountability.

4.22.1. Offline Medical Direction.

4.22.1.a. The agency medical director(s) has a written contract with the EMS agency outlining duties and responsibilities and is actively involved with the agency through direct participation in activities, including, but not limited to, oversight of training, skills maintenance and recertification as established by OEMS and the MPCC; clinical performance evaluation, and the performance improvement process as evidenced by documented participation in quarterly, or more frequent, meetings with agency officials and personnel: 10 points; or

4.22.1.b. The medical director(s) has a written contract with the EMS agency outlining duties and responsibilities with minimal evidence of active involvement with the agency: five points.

4.22.2. Performance Improvement. -- The EMS agency demonstrates commitment to performance improvement as evidenced by activities substantially exceeding state minimum requirements described in subsection 4.19. of this rule: 15 points.

4.23. Rapid Response.

4.23.1. The EMS agency has a rapid response program which routinely places trained and equipped personnel on the scene of potential life-threatening emergencies prior to the arrival of an ambulance, in accordance with policies and guidelines established by OEMS: five points; or

4.23.2. The EMS agency has formalized rapid response capabilities provided irregularly or is not available in all parts of the service area: two points.

4.24. Public Education and Information.

4.24.1. The EMS agency has community presence which is documented through provision of public education and community service programs for the covered population. The EMS agency offers the activities quarterly, or more often and actively participates with outside organizations and groups: five points; or

4.24.2. The EMS agency provides limited or intermittent education or service programs within the community: one point.

4.25. Disaster Capability.

4.25.1. Disaster Plan. The EMS agency has a current, written all-hazards plan for disaster response which is integrated with adjacent providers and emergency management officials. The plan is compliant with current federal and state emergency planning and operational standards: five points.

4.25.2. Disaster Drills. The EMS agency conducts, or participates in, disaster drills with adjacent EMS agencies, other emergency response entities and county emergency management agencies at least annually: five points.

4.26. Mutual Aid.

4.26.1. The EMS agency maintains current written mutual aid agreements addressing all aspects of reciprocal service provision with all adjacent EMS agencies or operates under written mutual aid guidelines established by the Local System: five points.

4.26.2. The EMS agency has limited-scope mutual aid agreements or does not have them with all adjacent EMS agencies: one point.

4.27. Personnel.

4.27.1. Job Descriptions. -- The EMS agency maintains current written job descriptions for all positions within the agency: three points.

4.27.2. Recruitment. -- The EMS agency uses a formal, documented recruitment program to actively recruit new personnel: three points.

4.27.3. Personnel Screening. -- The EMS agency screens and selects applicants with a formal, documented, objective process: three points.

4.27.4. Orientation. -- The EMS agency uses a formal orientation process with documented completion of specific stated objectives. Documentation of completion is maintained in each personnel file: three points.

4.27.5. Retention. -- The EMS agency uses a formal, documented retention program to aid in retention of qualified personnel: three points.

4.28. Education and Training.

4.28.1. Personnel Education.

4.28.1.a. The EMS agency provides education for all personnel levels within the agency. Educational offerings exceed minimum recertification requirements and include at least one program leading to original certification: 15 points;

4.28.1.b. The EMS agency provides, in-house or makes available, training activities meeting all minimum recertification requirements for all personnel levels within the agency: 10 points; or

4.28.1.c. The EMS agency provides some in-house training activities meeting some recertification requirements for personnel: five points.

4.28.2. Training Officer's Program. The EMS agency participates fully in the state-approved training officers' program with a qualified designated agency training officer and offers in-house continuing education programs a minimum of two times per year: 10 points.

4.29. Financial. -- The following shall be prepared according to generally accepted accounting practices:

4.29.1. Budget. -- The EMS agency has an approved, written operating and capital expenditures budget which includes projected income and expenses, actual income and expenses, and an accounting of budget variances. Budget reports are provided quarterly, at a minimum, to the agency's governing body or ownership, management personnel and other significant stakeholders: five points.

4.29.2. Financial Stability. -- The EMS agency is financially viable as evidenced by:

4.29.1.a. A full financial audit or quarterly articulated financial statements provided by an independent accounting firm during the license period: 10 points;

4.29.1.b. A financial review conducted by an independent entity within the license period: five points; and

4.29.1.c. Interim articulated financial statements: two points.

4.29.3. Financial Responsibility. -- The EMS agency has formally designated individuals with financial responsibility. Individuals with financial responsibility shall be appropriately insured or bonded: five points.

4.30. Facilities and Equipment.

4.30.1. Facilities Maintenance Program. -- The EMS agency uses a documented, comprehensive program of routine inspection and preventive maintenance for all agency facilities: five points.

4.30.2. Vehicle Maintenance Program. -- The EMS agency uses a documented, comprehensive program of routine inspection and preventive maintenance performed by qualified personnel for all EMS vehicles: five points.

4.30.3. Medical Equipment. -- The EMS agency uses a documented, comprehensive program of routine inspection and preventive maintenance performed by qualified personnel for all medical equipment: five points.

4.31. Accountability and Stability.

4.31.1. Government Support and Recognition.

4.31.1.a. The responsible county commission statutory ambulance authority or other statutory entity charged with the responsibility for providing the service formally recognizes the agency as part of the Local System and provides sufficient resources to support agency operations: five points; or

4.31.1.b. The agency is formally recognized by the responsible county commission, statutory ambulance authority or other statutory entity charged with the responsibility for providing the service as part of the Local System but receives minimal support: two points.

4.31.2. Organization and Management:

4.31.2.a. The agency is formally and legally organized with clear lines of managerial authority and responsibility as evidenced by an agency charter or articles of incorporation, current written by-laws, current registration with the Secretary of State, current organizational charts, policies, etc.: five points.

4.31.2.b. Management Education -- EMS agency management personnel have documented education in emergency medical services management practices and procedures. Continuing education in management practice is required and participation of current management personnel is documented: five points.

4.32. The Commissioner may issue a license according to W. Va. Code § 16-4C-6a, provided the information contained in the application is complete and correct, and the applicant is determined eligible for licensure by the Commissioner in accordance with this rule.

4.33. The Commissioner will notify the EMS agency in writing of the findings of the inspection and, if the inspection is approved, issue an EMS agency license within 60 days of receipt of application and completion of agency and vehicle inspections.

4.34. An EMS agency license will include the following information:

4.34.1. The name and address of the EMS agency;

4.34.2. The name of the official representative of the EMS agency;

4.34.3. All levels of service for which the agency is licensed; and

4.34.4. The issue and expiration dates of the license.

4.35. The standards ratings and renewal periods are determined as follows:

4.35.1. "A" rating -- a score of 90 percent or higher of applicable points. A four-year license shall be issued.

4.35.2. "B" rating -- a score of between 80 percent and 89 percent of applicable points. A three- year license may be issued.

4.35.3. "C" rating -- a score of between 70 percent and 79 percent of applicable points. A two-year license may be issued.

4.35.4. "F" rating -- a score of less than 70 percent of applicable points. No license shall be issued.

4.35.5. "Provisional" rating -- a score of greater than 70 percent of applicable points earned by a new agency. Six- month license may be issued; and

4.35.6. Extension of license -- The Commissioner may extend, as necessary, an agency license for a period of not greater than six months from the date of expiration.

4.36. Review of Preliminary Agency Inspection Findings.

4.36.1. When a preliminary inspection report is completed, the OEMS inspector and the agency official representative will meet to discuss the findings. The agency official representative must either concur with the findings or present documentation or facts disputing any portion of the preliminary inspection report.

4.36.2. In the case of disputed findings the OEMS inspector may concur with the information provided and revise the findings appropriately, or refer the preliminary inspection report, along with all documentation presented by the official representative to the Director of OEMS for review.

4.36.2.a. The Director may either uphold the inspector's findings or modify the findings based on the facts presented.

4.36.2.b. The Director will communicate his or her action to the agency principal official within 10 days of receiving the preliminary inspection report and associated documentation.

4.37. Plan of Improvement.

4.37.1. An EMS agency may submit a plan of improvement to improve the rating upon receipt of a final license inspection report.

4.37.2. A plan of improvement will only be applicable to the standards section of a final license inspection report.

4.37.3. The agency has 10 working days from receipt of the final license inspection report to notify OEMS of intent to submit a plan of improvement.

4.37.4. The proposed plan of improvement will be submitted within 15 days of initial notification.

4.37.5. Plans of improvement must include:

4.37.5.a. Standards to be addressed;

4.37.5.b. Specific improvement strategies to be implemented;

4.37.5.c. The desired outcome of the proposed improvements; and

4.37.5.d. A proposed implementation period.

4.37.6. The Commissioner has 10 working days to approve or reject the plan.

4.37.7. The Commissioner must specify the areas of the plan he or she rejected.

4.37.8. In the event the plan is rejected, the agency may submit a revised plan within 10 working days of receipt of notice of the plan's rejection.

4.37.9. Once an improvement plan is approved, the agency will complete the proposed improvements within the agency's specified implementation period.

4.37.10. Upon completion of the improvement period, OEMS will re-inspect the specific standards proposed for improvement.

4.37.11. If, as a result of re-inspection, standards ratings improve, the Commissioner will issue a new license reflecting the change.

4.37.12. If, as a result of re-inspection, there is no improvement, the original license rating will stand without opportunity for further review until the next inspection period.

4.38. Alternative Licensing Method.

4.38.1. In lieu of the requirements set forth in this section, the Commissioner may recognize an agency evaluation by a nationally recognized EMS agency accrediting body as meeting state licensing requirements; Provided:That the nationally recognized EMS agency meets or exceeds state requirements, as determined by the Commissioner;

4.38.2. An OEMS inspector will accompany accreditation officials during the site visit to the EMS agency;

4.38.3. The accrediting body will provide a copy of the findings of the accreditation site visit directly to OEMS; and

4.38.4. Agencies seeking alternative licensing are subject to the fees set forth in subsection 4.39. of this rule.

4.39. Agency Fees. -- Non-refundable fees for agency license and vehicle permits are due upon receipt of the invoice. Fees are:

4.39.1. Original agency license application, $500.

4.39.2. Renewal fee for each agency licensing period, $300, except that no additional fee shall be charged to provisional licensees.

4.39.3. Yearly EMS vehicle permit, $200 per vehicle. Non-transporting vehicles are exempt from this fee.

4.39.4. Agency license modification, including revision based upon a plan of improvement, $100. A change of official representative, medical director, training officer, postal address, or other contact information is exempt from this fee.

4.39.5. Fees must be paid to the West Virginia Bureau for Public Health in a manner specified by the Commissioner.

W. Va. Code R. § 64-48-4