1. A. A commercial ambulance service wishing to provide neonatal ambulance services shall comply with the requirements of this chapter in addition to the other applicable requirements of this subtitle.
2. B. An ambulance service transporting neonates shall obtain a neonatal commercial ambulance service license.
3. C. An applicant for a neonatal commercial ambulance service license shall submit an application to SOCALR on the required form.

4. D. A completed application form shall be accompanied by documentation which states to SOCALR’s satisfaction that the commercial ambulance service has:

   1. (1) Retained two or more registered nurses who:

      1. (a) Meet the requirements of the Board of Nursing under COMAR 10.27.09.04 to provide nursing care to neonates during interfacility transport; and
      2. (b) Agree to assume responsibility for patient care during the transport process;

   2. (2) Retained one or more physicians who are board certified or are active candidates for board certification in neonatology who:

      1. (a) Possess current knowledge of the Maryland EMS System as required in COMAR 30.03.03.03B(4), as well as current knowledge of:

         1. (i) The effects of transport on the neonate; and
         2. (ii) The operation of neonatal transport equipment and ambulance communications equipment; and

      2. (b) Working with a neonatal or perinatal center, agree to:

         1. (i) Serve as medical director for the neonatal service;
         2. (ii) Provide medical direction to the commercial ambulance service's personnel-related neonatal care;
         3. (iii) Provide training as required in neonatal care; and
         4. (iv) Participate in a quality assurance program; and
   3. (3) If providing neonatal transport services in partnership with a hospital-based neonatal intensive care unit, a written MOU stating that all equipment and medications required to transport a neonate under this chapter will be readily available to the service.
5. E. A licensed neonatal commercial ambulance service shall immediately advise SOCALR of any change in the medical director named in §D(2) of this regulation.

6. F. A licensed neonatal commercial ambulance service may not transport a neonate from one hospital to another for a higher level of care unless the admitting hospital:

   1. (1) Is a perinatal center;
   2. (2) Is a neonatal center;
   3. (3) Before designation of perinatal centers by the EMS Board, has a certificate of need issued by the Maryland Health Resources Planning Commission for its neonatal intensive care unit or approval from Maryland Health Resources Planning Commission for a neonatal intensive care unit; or
   4. (4) Before the EMS Board has completed the process of entering into an agreement with an out-of-State hospital to serve as an out-of-State perinatal referral center, possesses all government approvals required to operate a neonatal intensive care unit under the laws of the jurisdiction in which it is located including, if required, a certificate of need and all necessary licenses.

7. G. Neonates.

   1. (1) Neonates being transferred to a neonatal intensive care unit (NICU) shall be transported by a neonatal licensed transport service, as described in Regulation .04 of this chapter.

   2. (2) Neonates being transferred to any acute care setting other than a NICU shall be transported by either:

      1. (a) A neonatal licensed transport service; or
      2. (b) A specialty care transport (SCT) service with an RN who has age-appropriate competencies and equipment.

8. H. Infants. Infants being transferred to any acute care setting shall be transported by:

   1. (1) A neonatal licensed transport service;
   2. (2) An SCT service with a staff who has age-appropriate competencies and equipment; or
   3. (3) An ALS unit that includes staff with age-appropriate competencies and equipment, only after a neonatal licensed transport or SCT service has reviewed the case and referred it to the ALS service.

9. I. Neonates or Infants being transported for convalescent care at a rehabilitation hospital or long-term facility shall be transported by:

   1. (1) A neonatal licensed transport service;
   2. (2) An SCT service with a staff who has age-appropriate competencies and equipment; or
   3. (3) An ALS unit that includes staff with age-appropriate competencies and equipment, only after a neonatal licensed transport or SCT service has reviewed the case and referred it to the ALS service.

Authority: Education Article, §13-515, Annotated Code of Maryland

Effective date: October 12, 1992 (19:20 Md. R. 1816)

Chapter recodified from COMAR 14.22.12 to COMAR 30.09.12, August, 1997

Regulations .01—.08, Enforcement, repealed effective January 10, 2000 (26:27 Md. R. 2017)

Regulations .01—.07, Neonatal Ambulance Service, adopted effective January 10, 2000 (26:27 Md. R. 2017)

Chapter revised effective September 1, 2014 (41:17 Md. R. 972)

Regulation .02 amended effective May 3, 2021 (48:9 Md. R. 361)

Regulation .03 amended effective May 3, 2021 (48:9 Md. R. 361)

Regulation .04A amended effective May 3, 2021 (48:9 Md. R. 361); October 16, 2023 (50:20 Md. R. 889)

Regulation .04C amended effective October 16, 2023 (50:20 Md. R. 889)

Regulation .05B amended effective May 3, 2021 (48:9 Md. R. 361)

Regulation .06 amended effective May 3, 2021 (48:9 Md. R. 361)