1. (a) License application process.

   1. (1) Initial applicants shall:

      1. (A) request an application form from the Texas Department of Health (department);
      2. (B) submit the completed, signed, and dated application and the nonrefundable license fee, if fee is applicable, as provided in subsection (c) of this section;
      3. (C) submit a notarized document which records the name of the business and a statement of disclosure of ownership;
      4. (D) submit names of all personnel and indicate whether they are paid or volunteer, their level of certification, and their individual identification number;

      5. (E) submit written or documented evidence of:

         1. (i) a staffing plan in compliance with subsection (d) of this section;

         2. (ii) treatment and transport protocols and/or standing orders for each level of care rendered which have been reviewed, dated, and signed within 12 months prior to the license period by:

            1. (I) the director or medical director of a basic life support provider (BLS);
            2. (II) the medical director of an advanced life support provider (ALS) or mobile intensive care provider (MICU); or
            3. (III) the medical director of a BLS service providing automatic external defibrillation (AED);
         3. (iii) a sample patient run report form; and

         4. (iv) a plan for the assessment of the quality of patient care delivered by EMS personnel and a mechanism by which this assessment is used to further improve upon the delivery of such care. This plan shall contain the following elements:

            1. (I) a description of the service area;
            2. (II) a delineation of the desired objectives for the plan;
            3. (III) identification of those factors which are necessary for the delivery of good patient care in the field;
            4. (IV) a description of the process by which those factors so identified can be monitored and evaluated either directly or indirectly;
            5. (V) a description of the process by which the information gained in monitoring and evaluating shall be assimilated and then used to improve upon the delivery of patient care;
            6. (VI) a description of the method by which the overall process of the plan can be evaluated with regard to its effectiveness in improving the delivery of patient care; and

            7. (VII) an evaluation of all aspects of medical and operational services provided, which shall include at a minimum:

               (-a-) medical protocols/standing orders;

               (-b-) operating procedures;

               (-c-) administrative procedures;

               (-d-) response data;

               (-e-) adherence to standards of care;

               (-f-) complaint management; and

               (-g-) proof of preventive and routine maintenance of vehicle(s) and equipment;

      6. (F) submit evidence of financial responsibility as in Texas Civil Statutes, Article 6675a-2a. If using standard liability coverage, a certificate of insurance shall be filed with the department;
      7. (G) submit a list of all vehicles including reserve vehicles with the vehicle identification number (VIN); and
      8. (H) submit a copy of a plan which is coordinated with the local emergency management director or coordinator and which specifically addresses prehospital response to multiple casualty, or catastrophic events.
   2. (2) Applicants who intend to operate at an advanced level either on a full-time or part-time basis shall submit a copy of the contract and/or letter of agreement with the medical director.
   3. (3) Applicants who are applying for a Basic Life Support (BLS) EMS provider license and who provide care at a level above BLS on a part-time basis when advanced level personnel are available shall be responsible for having the equipment and medical director necessary for the specific level of patient care delivered while in service at an advanced level in accordance with paragraph (2) of this subsection.
   4. (4) Applicants claiming volunteer status in accordance with subsection (c)(1)(A) of this section shall submit a letter of governmental sponsorship or recognition.
   5. (5) Applicants who receive and maintain certification from a national accrediting organization approved by the department shall be considered to have met the requirements of this section. They shall submit to the department a copy of the self-study for accreditation and a copy of the formal accreditation approval. Copies of any updates submitted to the accrediting organization as well as any correspondence from the organization affecting the provider's accreditation should also be submitted to the department.

2. (b) License renewal process. The renewal process shall be complete prior to the expiration of the current license.

   1. (1) The department shall notify the EMS provider before the expiration date of the provider license. If a provider does not receive notice of expiration from the department, it is the responsibility of the provider to notify the department and request a license renewal application. Failure to apply for renewal shall result in expiration of the license. Continuing to operate without a license may result in administrative penalties up to $250 a day, revocation of license or other sanctions as set out in §157.19 of this title (relating to Emergency Suspension, Suspension, Probation, Revocation of a License, and Administrative Penalty). A completed application shall be submitted at least 60 days before the expiration date of the current license.

   2. (2) The license renewal applicant shall submit:

      1. (A) the completed application and the nonrefundable license fee, if fee is applicable, as provided in subsection (c) of this section; and
      2. (B) evidence of compliance with requirements for a provider license as delineated in subsection (a)(1)(C)-(H) and (2)-(4) of this section.

   3. (3) Vehicle inspections for renewal of a license as described in subsection (e) of this section may be waived if the renewal applicant:

      1. (A) provides evidence of compliance with requirements in subsection (e) of this section; and
      2. (B) has not been found in violation of requirements of this section or §157.12 of this title (relating to Basic Life Support Level Requirements), §157.13 of this title (relating to Advanced Life Support Level Requirements), §157.14 of this title (relating to Mobile Intensive Care Level Requirements), §157.23 of this title (relating to Rotor-wing Air Ambulance Provider Licensure); or §157.24 of this title (relating to Fixed-wing Air Ambulance Provider Licensure) during scheduled or unscheduled spot inspections conducted by the department during the previous license period; or
      3. (C) has not been found in violation of the Health and Safety Code, Chapter 773, or rules promulgated thereunder during the previous license period.

3. (c) License fees.

   1. (1) Nonrefundable fees shall be $150 for each EMS patient transport vehicle, not including reserve vehicles; unless:

      1. (A) the applicant is exempt from fees because the applicant staffs or intends to staff with personnel of which 75% of the total are volunteers; and
      2. (B) the applicant has no more than five full-time staff or their equivalent to provide emergency prehospital care.

   2. (2) If a license is issued for less than a two-year period under subsection (h) of this section, the following nonrefundable fees per vehicle shall apply:

      1. (A) $150 if the license is valid for 13-24 months; or
      2. (B) $75 if the license is valid for less than 13 months.
   3. (3) A provider who has a check returned to the department for "insufficient funds" shall be subject to revocation of the EMS provider license and this may be used as grounds for nonrenewal of the EMS provider license.

4. (d) Provider license requirements.

   1. (1) Basic life support (BLS) staffing requirements.

      1. (A) A BLS provider shall staff BLS vehicle(s), when in service, with at least two emergency care attendants who have active status certification, 24 hours per day, seven days per week.
      2. (B) A BLS provider who does not provide service 24 hours per day, seven days per week, shall notify the department and publish notice of the hours of operation in the local media; and all advertising shall contain the hours of operation.
      3. (C) A BLS provider shall make available records or information as requested by the department to confirm the availability of certified EMS personnel to provide BLS level of care.

   2. (2) Advanced Life Support (ALS) staffing requirements.

      1. (A) An ALS provider shall staff ALS vehicle(s), when in service, with at least one EMT and one EMT-I who have active status certification, 24 hours per day, seven days per week.
      2. (B) If a BLS provider operates at the advanced level on a part-time basis and is operating in a rural service area, the BLS provider may petition the department to bypass §157.20(c) of this title (relating to Request for Variance from Minimum Standards). The provider shall demonstrate that a staffing deficit exists and that responding with an ECA and EMT-I in lieu of the EMT and EMT-I is in the best interest of the community. If granted the variance, evidence of upgrade attempts will be reviewed annually.
      3. (C) The provider shall make available records or information as requested by the department to confirm the availability of certified EMS personnel to provide ALS level of care.
      4. (D) An ALS provider is required to have a medical director.

   3. (3) Mobile intensive care unit (MICU) staffing requirements.

      1. (A) An MICU provider shall staff MICU vehicle(s), when in service, with at least one EMT and one EMT-P who have active status certification, 24 hours per day, seven days per week.
      2. (B) If a BLS provider operates at the MICU level on a part-time basis and is operating in a rural service area, the provider may petition the department to bypass §157.20(c) of this title. The provider shall demonstrate that a staffing deficit exists and that responding with an ECA and EMT-P in lieu of the EMT and EMT-P is in the best interest of the community. If granted the variance, evidence of upgrade attempts will be reviewed annually.
      3. (C) The provider shall make available records or information as requested by the department to confirm the availability of certified EMS personnel to provide MICU level of care.
      4. (D) An MICU provider is required to have a medical director.
   4. (4) Personnel provisional certification. If a provider chooses to recognize provisional certification as described in §157.41(m) of this title (relating to Certification), the individual may staff a vehicle within the parameters of provisional certification. If the provider has a medical director, the medical director's concurrence is also required.

5. (e) Vehicle inspection.

   1. (1) Before the issuance of a license to an initial applicant, the applicant's vehicle(s) shall be inspected by the department. Each vehicle shall have:

      1. (A) an air conditioner and heater in working order for the patient and passenger compartment;
      2. (B) emergency lights and siren in working order; and
      3. (C) the name of the service prominently displayed on the sides of the vehicle;
      4. (D) a current motor vehicle certificate of inspection prior to the department's inspection.

   2. (2) The inspection shall include:

      1. (A) visual and physical inspection of each vehicle and of the equipment on each vehicle for the purpose of determining compliance with the vehicle and equipment specifications as described in this section, §157.12 of this title, §157.13 of this title, §157.14 of this title, §157.23 of this title or §157.24 of this title; and

      2. (B) visual inspection of safety equipment as follows:

         1. (i) one fire extinguisher securely mounted and readily accessible;
         2. (ii) two "No Smoking" signs, one mounted in patient compartment and one in the cab;
         3. (iii) a minimum of three visible warning devices on the vehicle, i.e., reflective triangles, etc. which are safe and effective and visible for at least 500 feet; and
         4. (iv) one functional portable flashlight (excluding penlight).
6. (f) Failure of inspection. A vehicle shall fail the inspection if the requirements in subsection (e) of this section are not met and an EMS provider license shall not be issued. The department shall give the EMS provider a written report at the time of the inspection indicating the deficiencies.

7. (g) Provisional license.

   1. (1) If any part of the provider licensure process is incomplete, a provider may apply for a provisional license by signing a provisional licensure form and submitting a nonrefundable fee of $25. This fee is in addition to the fee in subsection (c) of this section. A 60-day provisional license will be issued if the department finds:

      1. (A) that the public interest and the community needs would be served;
      2. (B) staffing requirements are met;
      3. (C) vehicle specifications are met;
      4. (D) the required nonrefundable fee is received; and

      5. (E) the following equipment is present, clean and in working order and shall meet the size and physical needs of the patient:

         1. (i) rigid cervical immobilization devices of types that limit forward, backward, lateral movement or rotation of the head and cervical spine during movement of a patient;
         2. (ii) one portable suction unit with connecting tubing and suction tips (bulb syringes, syringes, or foot pump not acceptable);
         3. (iii) bag valve mask units which can be used with an external oxygen supply;
         4. (iv) nonmetallic oropharyngeal airways;
         5. (v) oxygen tubing and semi-open valveless, low, moderate, and high concentration, transparent oxygen delivery devices such as masks and cannulas;

         6. (vi) rigid, flexible, air, or vacuum extremity splints, in sufficient sizes for all extremities, of the type that limit movement of extremities during patient movement, and which may be, but are not limited to, any of the following types of splints:

            1. (I) padded aluminum, board, or cardboard splints;
            2. (II) inflatable or vacuum splints;
            3. (III) foam-type rapid splints;
            4. (IV) wire ladder splints or flexible metal splints;
            5. (V) commercial splints;

         7. (vii) long and short spine boards and straps to include:

            1. (I) one long six-foot board or commercial device; and
            2. (II) one short spine board or commercial device; or
            3. (III) commercial device which serves the purpose of both spine boards described in subclauses (I) and (II) of this clause;
         8. (viii) sphygmomanometers;
         9. (ix) stethoscope;
         10. (x) one multilevel stretcher capable of being secured to the vehicle and with two clean sheets and two clean blankets;
         11. (xi) dressing and bandaging materials; and
         12. (xii) two portable cylinders with a minimum capacity of 12 cubic feet in each cylinder with one regulator and piped-in medical grade oxygen in a cylinder with at least 107 cubic foot capacity in working order with current inspection stamps or equivalent.

   2. (2) A second 60-day provisional license may be issued if:

      1. (A) written documentation is submitted showing that equipment repair and/or part is back ordered; or
      2. (B) written documentation is submitted showing that equipment was ordered but not received;
      3. (C) a provisional licensure form is signed and submitted with a $25 nonrefundable fee.

8. (h) License periods. An initial applicant or a renewal applicant for an EMS provider license who meets the requirements of this section shall be issued a license valid for a period of two years, except that the department may issue an initial license for less than two years in order to conform expiration dates to existing schedules for a locality.

   1. (1) An initial license shall be valid upon the date of issuance.
   2. (2) A renewed license shall be valid on the day after the expiration of the previous license.
   3. (3) A copy of the provider license that is provided by the department shall be prominently displayed in the patient compartment.

9. (i) Expiration of license. A provider may not operate if there is a lapse in time between license expiration and licensure renewal without specific approval from the department. Approval shall be dependent upon:

   1. (1) documentation of circumstances beyond the control of the service; or
   2. (2) documentation of extenuating circumstances such as organizational restructuring; and
   3. (3) the impact the cessation of service would have on community.

10. (j) Levels of care.

    1. (1) Licenses may be issued by the department for the following levels of care to an applicant who meets the requirements of this section:

       1. (A) BLS;
       2. (B) BLS with ALS capability;
       3. (C) BLS with MICU capability;
       4. (D) ALS;
       5. (E) ALS with MICU capability; and/or
       6. (F) MICU.
    2. (2) Use of the pneumatic antishock garment may be utilized at the basic level only under medical direction/supervision.

11. (k) Advertisements.

    1. (1) A provider shall only advertise that level of care which can be provided in the service area 24 hours a day, seven days a week.
    2. (2) A provider shall not advertise as a volunteer provider unless at least 75% of all personnel are volunteer.
12. (l) Transfer of license. A license is not transferable from one EMS provider to another. Continuing to operate an EMS service as defined in subsection (m)(10) of this section is not considered a transfer of license.

13. (m) Responsibilities of the EMS provider. During the license period the provider's responsibility shall include:

    1. (1) notification of the department if a vehicle is added with submission of the nonrefundable prorated license fee, if applicable. The added vehicle shall be in compliance with §157.12 of this title, §157.13 of this title, §157.14 of this title, §157.23 of this title or §157.24 of this title;
    2. (2) notification of the department if a vehicle is substituted for 15 days or longer. No vehicle shall be substituted longer than 90 days;
    3. (3) notification of the department if a vehicle is replaced. A fee is not required;
    4. (4) completion of the annual run response summary or participation in the Texas Department of Health EMS/Trauma data collection system. After August 31, 1996, all providers shall submit run response/patient data to the department as required in §157.129 of this title (relating to State Trauma Registry);
    5. (5) assuring that copies of patient run reports are left at the receiving hospital;
    6. (6) written notification of the department within 30 days of a change in the provider name or ownership. If ownership changes, a new application and nonrefundable prorated fee is required for an EMS provider license even if the name of the service remains the same;
    7. (7) written notification of the department within 30 days when a partner is added or has left an unincorporated partnership. A new application and nonrefundable prorated fee is required for an EMS provider license even if the name of the service remains the same;
    8. (8) written notification of the department within 30 days if 10% or more of the financial interest changes hands. A new application and nonrefundable prorated fee is required for an EMS provider license even if the name of the service remains the same;
    9. (9) written notification of the department within 30 days if the officers of the corporation change. A new application is not required;
    10. (10) when a new application and nonrefundable fee is required, as in paragraphs (6), (7), (8), and (9) of this subsection, the involved parties shall have 90 days to operate while the application is being processed;
    11. (11) notification of the department within one working day of any change in medical director and written notification within 30 days of the change in medical director and submission of a copy of the contract and/or letter of agreement with the new medical director listing specific equipment and drugs to be carried;
    12. (12) notification of department within 48 hours of any permanent or long term change in level of service provided. A new application and nonrefundable prorated license fee, if applicable shall be submitted;
    13. (13) assuring that a vehicle, when response ready, is staffed and equipped in accordance with the Health and Safety Code, Chapter 773, and this section for each level of care provided;
    14. (14) maintaining confidentiality of medical records according to the Health and Safety Code, Chapter 773, Subchapter D, §§773.091-773.096;
    15. (15) submitting names of any employees who leave or any person who is hired within six months of personnel action;
    16. (16) maintaining compliance with all state motor vehicle laws and regulations; and
    17. (17) written notification of the department within 30 days of change in official business address.

Source Note:The provisions of this §157.11 adopted to be effective June 22, 1995, 20 TexReg 4238; amended to be effective December 29, 1995, 20 TexReg 10772.