# Education (GED)

## Title 13. University of Maryland -- General Provisions

### Subtitle 5. Emergency Medical Services

#### Section 13-501

(a) In this subtitle the following words have the meanings indicated.

(b) "Advisory Council" means the Advisory Council to the State Emergency Medical Services Board.

(c) "Board of Directors" means the Board of Directors of the Medical System Corporation.

(d) "Board of Regents" means the Board of Regents of the University System of Maryland.

(e) "Center" means the R Adams Cowley Shock Trauma Center.

(f) "EMS Board" means the State Emergency Medical Services Board.

(g) "Institute" means the Maryland Institute for Emergency Medical Services Systems.

(h) "Medical System Corporation" means the University of Maryland Medical System Corporation.

(i) "Study Center" means the Charles McC. Mathias, Jr. National Study Center for Trauma and Emergency Medical Systems.

(j) "University" means the University of Maryland, Baltimore Campus.

#### Section 13-502

It is hereby found and determined that:

(1) The State of Maryland has been a national pioneer in the development of emergency medical services;

(2) The Emergency Medical System has served the citizens of Maryland well for the past two decades by reducing morbidity and mortality for thousands of seriously ill patients;

(3) The success of Maryland's Emergency Medical System is due largely to the hard work and dedication of many individuals, particularly the thousands of career and volunteer firefighters, emergency medical technicians, and rescue squad personnel;

(4) The citizens of Maryland are fortunate to have highly trained career and volunteer firefighters, emergency medical technicians, and rescue squad personnel providing life-sustaining services in the field to ill and injured persons;

(5) The numbers of volunteer firefighters, emergency medical technicians, and rescue squad personnel have been declining but are an essential and integral part of the State's Emergency Medical System and it is important that their role is preserved;

(6) The Emergency Medical System is a large and complex entity involving numerous public and private interests and requiring close coordination to operate efficiently and in the best interests of all Marylanders;

(7) The R Adams Cowley Shock Trauma Center is the core element of the State's Emergency Medical System and shall continue to serve as the State's primary adult trauma clinical resource center;

(8) The Emergency Medical System could be further enhanced by establishing a governing body that is accountable for and vested with the responsibility and authority to ensure the effective and efficient operation of the System; and

(9) The Emergency Medical Services Field Operations of the Institute and the R Adams Cowley Shock Trauma Center shall remain an integral part of the overall Emergency Medical Services System.

#### Section 13-503

(a) There is a Maryland Institute for Emergency Medical Services Systems.

(b) The Institute is an independent agency located at the University of Maryland, Baltimore Campus.

(c) The Institute shall be governed by the State Emergency Medical Services Board.

(d) Funding for the Institute shall be from:

  (1) The surcharge imposed under Sec. 13-954 of the Transportation Article;

  (2) General funds; and

  (3) Funds from any other source.

#### Section 13-504

(a) In accordance with this subtitle, the Institute shall be the State administrative agency responsible for the coordination of all emergency medical services.

(b) The Institute includes the Emergency Medical Services Field Operations.

(c) The Institute shall have the staff and funds as provided in the State budget.

#### Section 13-505

(a)

  (1) The EMS Board consists of 11 members appointed by the Governor.

  (2) Of the 11 members:

    (i) One shall be the Secretary of Health or the Secretary's designee;

    (ii) One shall be a representative of the University of Maryland, Baltimore Campus, nominated by the Board of Regents;

    (iii) One shall be the chairperson of the Advisory Council;

    (iv) One shall be a physician knowledgeable in the delivery of emergency medical services;

    (v) One shall be a physician experienced in the clinical care of trauma patients;

    (vi) One shall be a nurse experienced in the clinical care of emergency patients;

    (vii) One shall be a career firefighter, emergency medical technician, or rescue squad person knowledgeable in the delivery of emergency medical services;

    (viii) One shall be a volunteer firefighter, emergency medical technician, or rescue squad person knowledgeable in the delivery of emergency medical services;

    (ix) One shall be a hospital administrator knowledgeable in the management and delivery of emergency medical services; and

    (x) Two shall be from the public at large, one of whom shall reside in a county with a population of less than 175,000.

(b)

  (1) Each appointed member shall have demonstrated interest or experience in the delivery of emergency medical services.

  (2) In appointing members to the EMS Board, the Governor shall take into consideration the five emergency medical service regions of the State to assure a geographic balance in the Board's membership.

  (3) In appointing members to the EMS Board, the Governor shall take into consideration persons:

    (i) Recommended by the Advisory Council; or

    (ii) Recommended by any statewide organization or association which is interested and involved in the delivery of emergency medical services.

  (4) The Governor may not appoint to the EMS Board more than two persons in total from:

    (i) The same health system;

    (ii) A health system and medical school that are affiliated; or

    (iii) Medical schools under the same governing board.

(c)

  (1) The term of an appointed member is 4 years.

  (2) At the end of a term, an appointed member continues to serve until a successor is appointed and qualifies.

  (3) A member who is appointed after a term has begun serves only for the rest of the term and until a successor is appointed and qualifies.

(d) Annually, from among the members of the EMS Board:

  (1) The Governor shall appoint a chairperson; and

  (2) The chairperson shall appoint a vice chairperson.

#### Section 13-506

(a) With the approval of the Governor, the EMS Board shall appoint an Executive Director.

(b) The Executive Director serves at the pleasure of the EMS Board. The Executive Director is entitled to the salary provided in the State budget.

(c) Under the direction of the EMS Board, the Executive Director shall:

  (1) Be the administrative head of the EMS Board;

  (2) Be the administrative head of the Institute; and

  (3) Perform any other duty or function that the EMS Board requires.

(d) Any foundation created by the EMS Board shall be subject to audit by the Office of Legislative Audits.

#### Section 13-507

(a)

  (1) A majority of the full authorized membership of the EMS Board is a quorum for the transaction of any business.

  (2) The EMS Board may adopt any rules or procedures necessary to ensure the orderly conduct of business.

(b) No formal action may be taken by the EMS Board without the approval of a majority of the full authorized membership of the EMS Board.

(c) The EMS Board shall meet at least six times a year, at the times and places that it determines.

(d) Each member of the EMS Board is entitled to reimbursement for expenses under the Standard State Travel Regulations as provided in the State budget.

#### Section 13-508

(a)

  (1) In addition to the powers set forth elsewhere in this subtitle, the EMS Board may:

    (i) Subject to the limitations set forth in Sec. 13-509 of this subtitle, adopt regulations to carry out the provisions of this subtitle;

    (ii) Create committees from among its members;

    (iii) Appoint advisory committees, which may include individuals and representatives of interested public or private organizations;

    (iv) Apply for and accept any funds, property, or services from any person or government agency;

    (v) Make agreements with a grantor or payor of funds, property, or services, including an agreement to make any study, plan, demonstration, or project;

    (vi) Except for confidential medical information, publish and give out any information that relates to the delivery of emergency medical services and is considered desirable in the public interest;

    (vii) Hold public hearings; and

    (viii) Set and charge reasonable fees to be paid by the applicants for the designation of trauma and specialty referral centers.

  (2)

    (i) The fees charged under paragraph (1)(viii) of this subsection shall be set in a manner that will produce funds sufficient to cover the actual documented direct costs of maintaining the designation program.

    (ii)

      (1) The EMS Board shall pay all fees collected under this subsection into the EMS Trauma and Specialty Referral Centers Designation Fund.

      (2) The Fund shall be used exclusively to cover the actual documented direct costs of designating EMS trauma and specialty referral centers.

      (3) The Fund is a continuing, nonlapsing fund, not subject to Sec. 7-302 of the State Finance and Procurement Article.

(b) In addition to the duties set forth elsewhere in this subtitle, the EMS Board shall:

  (1) Adopt regulations that relate to its meetings, minutes, and transactions;

  (2) Beginning with fiscal year 1996:

    (i) Prepare annually a budget proposal that includes the estimated income of the Institute and proposed expenses for its administration and operation; and

    (ii) Review and approve that portion of the proposed budgets derived from the Maryland Emergency Medical System Operations Fund for the:

      (1) Maryland Institute for Emergency Medical Services Systems;

      (2) R Adams Cowley Shock Trauma Center;

      (3) Maryland Fire and Rescue Institute; and

      (4) Aviation Division of the Special Operations Bureau, Department of State Police;

  (3) Periodically participate in or do analyses and studies that relate to emergency medical services;

  (4) On or before October 1 of each year, submit to the Governor and, subject to Sec. 2-1257 of the State Government Article, to the General Assembly an annual report on the operations and activities of the EMS Board and the Institute during the preceding fiscal year, including:

    (i) A report on the patients referred or transported to designated emergency medical facilities, including areawide trauma centers, the R Adams Cowley Shock Trauma Center, and specialty referral centers, in accordance with the emergency medical protocols adopted by the EMS Board; and

    (ii) Any fact, suggestion, or policy recommendation that the EMS Board considers necessary; and

  (5) Work with the Charles McC. Mathias, Jr. National Study Center for Trauma and Emergency Medical Systems to coordinate a plan for research and other academic activities related to emergency medical services issues.

(c) The provisions of subsection (b)(2) of this section may not be construed to affect the Governor's powers with respect to a request for an appropriation in the budget bill.

#### Section 13-509

(a) In addition to the duties set forth elsewhere in this subtitle, the EMS Board shall develop and adopt an Emergency Medical System plan to ensure effective coordination and evaluation of emergency medical services delivered in this State.

(b)

  (1) The Emergency Medical System plan shall include:

    (i) Criteria for the designation of trauma and specialty referral facilities, including all echelons of care;

    (ii) Criteria and guidelines for the delivery of emergency medical services including provisions to assure proper medical direction of emergency medical services;

    (iii) A plan designed to maintain and enhance the communications and transportation systems for emergency medical services;

    (iv) Provisions for the evaluation of emergency medical services personnel training programs;

    (v) Provisions for the establishment of public information and education programs designed to enhance the public's understanding of the Emergency Medical System;

    (vi) Criteria and methodologies to evaluate the System's effectiveness in delivering quality emergency medical services needed by the citizens of Maryland; and

    (vii) Provisions for the evaluation and monitoring of the Emergency Medical System plan to ensure compliance with this subtitle by all segments of the Emergency Medical System.

  (2) The EMS Board shall adopt regulations to implement the Emergency Medical System plan required under this section, subject to paragraph (3) of this subsection.

  (3) Prior to adopting regulations under this section, the EMS Board shall consult with and provide opportunity for comment from local jurisdictions, volunteer and career fire companies, emergency medical technicians, rescue squad personnel, and hospitals and consider:

    (i) The fiscal impact of the proposed regulations on local jurisdictions, volunteer and career fire companies, emergency medical technicians, rescue squad personnel, and hospitals; and

    (ii) The effect of the proposed regulations on the ability of local jurisdictions, volunteer and career fire companies, emergency medical technicians, rescue squad personnel, and hospitals to continue to deliver emergency medical services.

(c) The EMS Board shall consult with the Advisory Council in the development of the Emergency Medical System plan.

(d) The EMS Board may adopt regulations that assure that helicopters transporting patients between hospitals or to or from specialty centers notify the System's communication center in the State Emergency Medical Communications System.

(e) Each State agency and department shall cooperate with the EMS Board in implementing the State Emergency Medical System plan.

#### Section 13-510

In accordance with the Emergency Medical System plan and other relevant policies adopted by the EMS Board, the Executive Director shall:

(1) Coordinate a statewide system of emergency medical services;

(2) Coordinate the five emergency medical service regions in this State;

(3) Coordinate the planning and operation of emergency medical services with the federal, State, and county governments;

(4) Coordinate the training of all personnel in the Emergency Medical Services System and develop the necessary standards for their certification or licensure;

(5) Coordinate programs of research and education that relate to emergency medical services;

(6) Coordinate the development of centers for treating emergency injuries and illnesses;

(7) Coordinate the development of specialty referral centers for resuscitation, treatment, and rehabilitation of the critically ill and injured;

(8) Coordinate, with Jurisdictional Emergency Medical Services Operating Programs, the minimum equipment, supplies, and medications, including equipment, supplies, and medications needed for early childhood care, including neonatal care, to be available on emergency medical services vehicles;

(9) Work closely with the public and private agencies, health care institutions and universities involved with emergency medical services, the Emergency Medical Services Advisory Council, and the Medical Management Consultant Group;

(10) Administer State and federal funds for emergency medical services in this State;

(11) Work closely with the Maryland Fire and Rescue Institute, which is responsible for basic training for emergency medical technicians;

(12) Assure continued improvement of transportation for emergency, critically ill, and injured patients by supporting the goals of career and volunteer systems throughout this State; and

(13) Implement all programmatic, operational, and administrative components of the Institute.

#### Section 13-511

(a) There is a statewide Emergency Medical Services Advisory Council to advise and assist the EMS Board in performing its functions.

(b)

  (1) The Advisory Council consists of 31 members. The members shall be appointed by the Board from a list of three qualified nominees submitted to the Board by their respective organizations or associations represented on the Council. The appointments by the Board shall be subject to the approval of the Governor.

  (2) Of the 31 members:

    (i) One shall be a representative of the Maryland Chapter of the American College of Emergency Physicians;

    (ii) One shall be a representative of MedChi, The Maryland State Medical Society;

    (iii) One shall be a representative of the Maryland Hospital Association;

    (iv) One shall be a representative of the Maryland State Council of the Emergency Nurses Association;

    (v) One shall be a representative of the Maryland Fire and Rescue Institute;

    (vi) One shall be a representative of the Maryland State Firefighters Association;

    (vii) One shall be a representative of the Aviation Division of the Department of State Police;

    (viii) One shall be a representative of the Office of Traffic and Safety of the Maryland Department of Transportation;

    (ix) One shall be a representative from each of the five regional emergency medical services advisory councils;

    (x) One shall be a representative of the Maryland Trauma Center Network;

    (xi) One shall be a representative of a Maryland commercial ambulance service;

    (xii) One shall be a representative of the Board of Physicians;

    (xiii) One shall be a representative of the Maryland Chapter, American College of Surgeons;

    (xiv) One shall be a regional medical director;

    (xv) One shall be a representative of the Maryland Chapter (Chesapeake Bay), American Association of Critical Care Nurses;

    (xvi) One shall be a representative of the Professional Fire Fighters of Maryland;

    (xvii) One shall be a representative of the volunteer field providers;

    (xviii) One shall be a representative of the Maryland Metropolitan Fire Chiefs;

    (xix) One shall be a representative of the Emergency Number Systems Board;

    (xx) One shall be the Director of the R Adams Cowley Shock Trauma Center;

    (xxi) One shall be the Director of the National Study Center;

    (xxii) Three shall be members of the general public, one of whom shall reside in a county with a population of less than 175,000;

    (xxiii) One shall be a representative of the Committee on Pediatric Emergency Medicine of the American Academy of Pediatrics, Maryland Chapter;

    (xxiv) One shall be a representative of the Maryland Society of Anesthesiologists; and

    (xxv) One shall be a helicopter pilot.

(c) Each appointed member of the Council shall have demonstrated interest or experience in the delivery of emergency medical services.

(d) The members of the Advisory Council shall annually elect the chairperson of the Advisory Council, with the approval of the Governor. The Governor shall have 60 days to approve the elected chairperson. If the Governor has not acted within 60 days of being notified of the election of the chairperson, the elected chairperson shall be deemed approved.

(e) The Advisory Council shall:

  (1) Serve as a principal advisory body to the EMS Board on matters concerning finances, policies, guidelines, regulations, and procedures necessary for the efficient and effective operation of the statewide Emergency Medical Services System and the Institute;

  (2) Provide a means by which regional emergency medical services interests can be represented at a statewide level;

  (3) Assist in the development of goals for and facilitate the implementation of a comprehensive emergency medical services plan;

  (4) Provide assistance in the resolution of interregional and interstate emergency medical services system problems and concerns; and

  (5) Perform any other duties as may be requested by the EMS Board or the Governor.

(f) The staff for the Advisory Council will be provided by the Institute.

#### Section 13-512

(a) The power of the Board of Regents over plans, proposals, and projects of units in the University does not include the power to disapprove or modify any decision or determination that the EMS Board makes under authority specifically delegated by law to the EMS Board.

(b) The power of the Board of Regents to transfer by rule, regulation, or written directive, any staff, functions, or funds of units in the University does not apply to any staff, function, or funds of the EMS Board.

#### Section 13-513

(a) The Study Center's primary mission is research, with particular emphasis on establishing national policies related to prevention, treatment, acute care and rehabilitation, trauma and emergency medical care delivery systems, disaster epidemiology and management, injury surveillance, and data collection. It shall serve as the primary research center for the State Emergency Medical Services System.

(b) The Director of the Study Center shall work closely with the MIEMSS Director in the development of a research plan and the budget.

(c) The Director of the Study Center shall submit the budget and research plan to the EMS Board for review and comment.

(d) The Director of the Study Center shall advise and provide the opportunity for the EMS Board to comment prior to the adoption of any proposed change in the budget, mission, research plan, or other policies of the Study Center that would affect the ability of the Study Center to continue to fulfill its mission as the primary research center for the State Emergency Medical Services System.

(e) The Director of the Study Center shall submit to the EMS Board an annual report on the budget and research plan.

(f) Subject to the approval of the Governor, the President of the University of Maryland, Baltimore Campus shall appoint the Director of the Study Center. The Governor shall have 60 days to approve the appointment. If the Governor has not acted within 60 days of being notified of the appointed director, the appointed director shall be deemed approved.

(g) The University of Maryland, Baltimore Campus shall receive indirect cost recoveries as stipulated in grants received by the National Study Center.

(h) The University System of Maryland may not transfer funds for the Study Center to any other program or purpose.

#### Section 13-514

(a) The R Adams Cowley Shock Trauma Center is the primary adult clinical resource center for the State Emergency Medical Services Systems.

(b) The chief administrative officer of the Center is the Director who:

  (1) Shall be appointed by the Board of Directors of the Medical System Corporation, subject to the approval of the Governor or the passage of 60 days from the date of the appointment, whichever occurs first; and

  (2) May not hold concurrently the position of Executive Director of the Institute.

(c) The Director of the Center shall:

  (1) Report through the Medical System Corporation Chief Executive Officer to the Board of Directors;

  (2) Provide a monthly report to the Board of Directors and the EMS Board on the overall progress of programs;

  (3) Render reports to appropriate committees of the Board of Directors; and

  (4) Develop the budget and, after approval of the Medical System Corporation Chief Executive Officer, present the budget to the EMS Board for review and comment and through the appropriate committees of the Board of Directors for approval by the Board of Directors.

(d) The Director of the Center shall:

  (1) Advise and provide the opportunity for the EMS Board to comment prior to the adoption of any proposed change in the budget, services, mission, or other policies of the Center that would affect the ability of the Center to continue to fulfill its mission as the statewide primary adult clinical resource for emergency medical services; and

  (2) Submit to the EMS Board an annual report on the budget and on the operations of the Center.

#### Section 13-515

(a)

  (1) In this section the following words have the meanings indicated.

  (2)

    (i) "Ambulance" means any conveyance designed and constructed or modified and equipped to be used, maintained, or operated to transport individuals who are sick, injured, wounded, or otherwise incapacitated.

    (ii) "Ambulance" includes a conveyance designed and constructed or modified and equipped for aeromedical transport.

  (3)

    (i) "Ambulance service" means any individual, firm, partnership, corporation, association, or organization engaged in the business of transporting by ambulance individuals who are sick, injured, wounded, or otherwise incapacitated.

    (ii) "Ambulance service" does not include the transporting of individuals in an ambulance owned, operated, or under the jurisdiction of a unit of State government, a political subdivision of the State, or a volunteer fire company or volunteer rescue squad.

  (4) "Fund" means the Commercial Ambulance Service Fund.

  (5) "License" means a license issued by the Institute to operate an ambulance service in the State.

(b) Unless issued a license under this section, an individual, firm, partnership, corporation, association, or organization may not operate an ambulance service in the State.

(c)

  (1) The EMS Board, in consultation with representatives of the ambulance service industry in Maryland, shall adopt regulations necessary to establish a periodic licensing system for ambulance services in the State.

  (2) The regulations shall, at a minimum, require:

    (i) Each ambulance operated by the ambulance service to be equipped with adequate equipment and supplies to:

      (1) Care for the patients being transported; and

      (2) Communicate with the dispatcher;

    (ii)

      (1) At least one individual, in addition to the driver, in attendance during transport who is certified or licensed under Sec. 13-516 of this subtitle for the appropriate level for the care to be rendered; or

      (2) Personnel equivalent or superior to the requirements of item 1 of this subparagraph as demonstrated to the Institute including:

      (A) Licensed physicians;

      (B) Licensed nurses; or

      (C) Licensed respiratory therapists; and

    (iii) Each ambulance operated by the ambulance service be inspected:

      (1) For an ambulance intended for use on a roadway, once every 12 months by an inspection station licensed under Sec. 23-103 of the Transportation Article and be issued an inspection certificate by the inspection station; or

      (2) For any other type of ambulance, under all applicable State and federal inspection requirements for the type of ambulance.

(d) To qualify for an ambulance service license, an applicant shall:

  (1) Pay the Institute an application fee established under this section;

  (2) Maintain commercial general liability insurance for at least $1 million in coverage in an insurance policy issued by an insurer acceptable to the Maryland Insurance Commissioner to write such policies in the State;

  (3) Provide the Institute a certificate of insurance that at a minimum:

    (i) Indicates that the insurance required under this subsection is in effect when the application is submitted; and

    (ii) Lists the Institute as an additional party entitled to notification at least 10 days before any:

      (1) Nonrenewal or cancellation of a policy required by this subsection; or

      (2) Substantive change is made in the coverage or level of insurance under a policy required by this subsection; and

  (4) Meet the requirements of this section and all regulations under this section.

(e)

  (1) There is a Commercial Ambulance Service Fund within the Institute.

  (2)

    (i) The Institute shall set reasonable fees for the licensing and license renewal of ambulance services.

    (ii) The fees charged by the Institute shall be set in a manner that will produce funds sufficient to cover the actual direct and indirect costs of maintaining the licensing program under this section.

    (iii) The total reasonable cost of maintaining the licensing program may not be more than the revenues generated by the fees for the licensing and license renewal for ambulance services.

  (3)

    (i) The Institute shall pay all funds collected under this section to the Comptroller of the State.

    (ii) The Comptroller shall distribute the fees to the Fund.

  (4) The Fund shall be used to cover the actual documented direct and indirect costs of fulfilling the statutory and regulatory duties of the Institute as provided by the provisions of this section.

  (5) The Fund is a continuing, nonlapsing fund, not subject to Sec. 7-302 of the State Finance and Procurement Article.

  (6) Any unspent portions of the Fund may not be transferred or revert to the General Fund of the State, but shall remain in the Fund to be used for the purposes specified in this section.

  (7)

    (i) A designee of the Institute shall administer the Fund.

    (ii) Money in the Fund may be expended only for any lawful purpose authorized under the provisions of this section.

  (8) The Legislative Auditor shall audit the accounts and transactions of the Fund as provided in Sec. 2-1220 of the State Government Article.

(f) The Institute may inspect the operating base, equipment, supplies, and company procedures necessary to ensure compliance with the requirements of this section and all regulations adopted by the Institute under this section.

(g) Subject to the hearing provisions of subsection (h) of this section, the Institute may deny an application for an ambulance service license or suspend or revoke a license if the applicant or licensee violates any provision of this section or any regulation adopted by the Institute under this section.

(h) Before the Institute takes any final action under subsection (g) of this section, the Institute shall give the person against whom the action is contemplated an opportunity for a hearing under the provisions of Sec. 10-226 of the State Government Article.

(i) The Institute may waive the requirements of this section for any ambulance service:

  (1) Licensed in another state if the ambulance service provides adequate evidence that the ambulance service is licensed in the other state after meeting requirements that are at least as stringent as the licensing requirements of this State; or

  (2) That transports patients into this State only on an occasional basis as determined by the Institute.

(j) A person who violates any provision of this section or any regulation adopted by the Institute under this section is guilty of a misdemeanor and on conviction is subject to a fine not exceeding $1,000.

(k) This section preempts the authority of a county or municipal corporation to regulate any ambulance service with a base of operation located outside the county or municipal corporation that is licensed under this section.

#### Section 13-516

(a)

  (1) In this section the following words have the meanings indicated.

  (2) "Cardiac rescue technician" (CRT) means an individual who has:

    (i) Completed a cardiac rescue technician course approved by the EMS Board;

    (ii) Demonstrated competence in medical protocols within this State as determined by the EMS Board; and

    (iii) Been examined by the EMS Board and licensed as a CRT by the EMS Board.

  (3) "Certificate" means a certificate issued by the EMS Board to provide emergency medical services in the State, except where the context requires otherwise.

  (4) "Emergency medical dispatcher" (EMD) means an individual who has:

    (i) Completed an emergency medical dispatcher course approved by the EMS Board or its equivalent as determined by the EMS Board;

    (ii) Demonstrated competence in medical protocols as determined by the EMS Board; and

    (iii) Been examined by the EMS Board or has been recognized as an emergency medical dispatcher by an emergency medical dispatcher program approved by the EMS Board and licensed as an emergency medical dispatcher by the EMS Board.

  (5) "Emergency medical responder" means an individual who has:

    (i) Completed an emergency medical responder course approved by the EMS Board, or its equivalent as determined by the EMS Board;

    (ii) Demonstrated competence in medical protocols as determined by the EMS Board;

    (iii) Been examined by the EMS Board or by a basic life support education program approved by the EMS Board; and

    (iv) Been certified as an emergency medical responder by the EMS Board.

  (6) "Emergency medical services" means:

    (i) Medical services provided prehospital to prevent imminent death or aggravation of illness or injury whether or not transport to a hospital or appropriate facility occurs;

    (ii) Transport from the scene of a medical emergency to a hospital or appropriate facility whether or not medical services are provided;

    (iii) Medical interfacility transport services to an appropriate facility; or

    (iv) Medical interfacility critical care transport to an appropriate facility.

  (7) "Emergency medical services provider" means an individual licensed or certified by the EMS Board as:

    (i) A cardiac rescue technician;

    (ii) An emergency medical dispatcher;

    (iii) An emergency medical responder;

    (iv) An emergency medical technician; or

    (v) A paramedic.

  (8) "Emergency medical technician" (EMT) means an individual who has:

    (i) Completed an emergency medical technician course approved by the EMS Board;

    (ii) Demonstrated competence in medical protocols as determined by the EMS Board; and

    (iii) Been examined by the EMS Board or been examined and registered by the National Registry of Emergency Medical Technicians, Inc. as an emergency medical technician and certified as an EMT by the EMS Board.

  (9) "License" means a license issued by the EMS Board to provide emergency medical services in the State, unless the context requires otherwise.

  (10)

    (i) "Medical direction" means the written or oral instruction by a licensed physician to perform specified medical procedures or administer specified medications or intravenous solutions.

    (ii) "Medical direction" includes the activities of a licensed physician in the State serving as a medical director for an agency providing emergency medical services including quality assurance, planning, and education.

  (11) "National registry" means the nonproprietary, nongovernmental agency that provides standardized national testing and registration for emergency medical technicians based on national training standards.

  (12) "Paramedic" means an individual who has:

    (i) Completed a paramedic course approved by the EMS Board;

    (ii) Been examined and registered by the National Registry of Emergency Medical Technicians, Inc. as a paramedic;

    (iii) Demonstrated competence in medical protocols within this State as determined by the EMS Board; and

    (iv) Been licensed as a paramedic by the EMS Board.

  (13) "Provider review panel" means the 13-member panel appointed by the EMS Board in accordance with the provisions of subsection (e) of this section.

  (14) "Public safety personnel" means:

    (i) Any career or volunteer member of a fire, rescue or EMS department, company, squad or auxiliary;

    (ii) Any law enforcement officer; or

    (iii) The State Fire Marshal or a sworn member of the State Fire Marshal's office.

(b)

  (1) Except as otherwise provided in this section or Sec.Sec. 10-14A-03 and 10-14B-03 of the State Government Article, an individual may not provide emergency medical services in the State unless issued a license or certificate by the EMS Board under this section.

  (2) This section does not apply to:

    (i) An individual who:

      (1) Has completed an emergency medical services course or its equivalent as determined by the EMS Board;

      (2) Is authorized to provide emergency medical services by any state adjoining this State;

      (3) Is called on by a public safety agency providing emergency medical services to render emergency medical services in this State or to transport emergency patients from the adjoining state to a health care facility in this State;

      (4) Is providing emergency medical services within the scope of the license or certificate issued to the individual by the other state; and

      (5) Is not affiliated with an emergency medical service in this State or is not engaged in providing emergency medical services in this State on a regular basis;

    (ii) An individual who is enrolled in an emergency medical services provider training program that meets the standards set by the EMS Board in the course of that training;

    (iii) An individual who is not engaged in providing emergency medical services on a regular basis who provides emergency medical services at the scene of a medical emergency in rare instances;

    (iv) An individual who is a member of a volunteer fire or rescue company and solely engaged in driving the emergency vehicle;

    (v) An individual who assists an emergency medical services provider but does not directly provide emergency medical services;

    (vi) An individual who has American Red Cross first aid training or its equivalent and who provides services within the scope of that training, does not respond to emergency calls, and does not transport patients; or

    (vii) A law enforcement officer who:

      (1) Has successfully completed a course:

      (A) In first aid and CPR/AED approved by the American Red Cross, the National Safety Council, or another nationally recognized program;

      (B) That meets the requirements of the National Emergency Medical Services Education Standards and Instructional Guidelines for Emergency Medical Responders published by the U.S. Department of Transportation; or

      (C) Approved for law enforcement officers by the EMS Board;

      (2) Provides services within the scope of that training; and

      (3) Is not dispatched as an emergency medical services provider.

  (3) This subsection does not limit the right of an individual to practice a health occupation that the individual is authorized to practice under the Health Occupations Article.

  (4) A person who violates any provision of this subsection is guilty of a misdemeanor and on conviction is subject to a fine not exceeding $1,000 or imprisonment not exceeding 1 year or both.

(b-1)

  (1) In calculating an individual's years of experience in an occupation or profession, the EMS Board shall give credit to the individual for all relevant experience as an active service member.

  (2) The EMS Board shall credit any training and education provided by the uniformed services and completed by an active service member toward any training or education requirements for licensure or certification if the training or education is determined by the EMS Board to be:

    (i) Substantially equivalent to the training or education required by the EMS Board; and

    (ii) Not otherwise contrary to any other licensing requirement.

(c)

  (1) To apply for a license or certificate, an individual shall:

    (i) Submit an application on the form that the EMS Board requires; and

    (ii) Pay to the EMS Board any application fee set by the EMS Board under subsection (m) of this section.

  (2) The EMS Board may not:

    (i) Require as a condition for licensure or certification that an applicant:

      (1) Provide proof that the applicant is lawfully present in the United States, as allowed under 8 U.S.C. Sec. 1621; or

      (2) Have a Social Security number or Individual Taxpayer Identification Number; or

    (ii) Charge a licensing, certifying, testing, or retesting fee to any individual who is a member or employee of any governmental or volunteer fire, rescue, or emergency medical services company at the date of application.

  (3) The EMS Board shall provide for the term and renewal of licenses or certificates issued under this section.

(d)

  (1) The EMS Board may adopt rules, regulations, protocols, orders, and standards to carry out the provisions of this section.

  (2) Any regulations of the EMS Board relating to the practice of medicine shall be adopted jointly with the Board of Physicians.

  (3) Any regulations of the EMS Board relating to the practice of nursing shall be adopted in collaboration with the Board of Nursing.

(e)

  (1)

    (i) There is a provider review panel to the EMS Board.

    (ii) The provider review panel shall be appointed by the EMS Board.

  (2) The provider review panel consists of 13 members, 11 voting members appointed by the EMS Board and two nonvoting members.

  (3) Eight of the appointed members shall be licensed or certified emergency medical service providers who are actively providing emergency medical services at the time of their appointment. Three shall be members of a governmental fire, rescue, or emergency medical services company, three shall be members of a volunteer fire, rescue, or emergency medical services company, one shall be an employee of a commercial ambulance service, and one shall be an emergency medical dispatcher. In appointing the provider representatives of the provider review panel, the EMS Board shall give consideration to providing for reasonable representation from throughout the State.

  (4) One of the appointed members shall be a physician appointed by the Board of Physicians.

  (5) One of the appointed members shall be a medical director with emergency medical services experience.

  (6) One of the appointed members shall be a representative of the Medical and Chirurgical Faculty of the State of Maryland who has emergency medical services experience.

  (7) The Executive Director of the Institute and the State EMS Medical Director shall serve as nonvoting ex officio members.

  (8) The panel shall elect a chairman from among its members.

  (9) The EMS Board shall adopt regulations for the selection, appointment, and terms of the members of the panel, including providing for the staggering of terms.

  (10)

    (i) The provider review panel shall review patient care and other allegations of misconduct against emergency medical services providers and provide recommendations to the EMS Board for further action as necessary.

    (ii) The provider review panel shall perform any other duty or function that the EMS Board requires.

(f)

  (1) Subject to the rules, regulations, protocols, orders, and standards of the EMS Board and subject to medical direction, while providing emergency medical services:

    (i) A cardiac rescue technician, an emergency medical technician, or a paramedic may:

      (1) Perform specified medical procedures as authorized by the EMS Board;

      (2) Administer specified medications or intravenous solutions;

      (3) Offer an opioid overdose reversal drug approved by the federal Food and Drug Administration to an individual who received treatment for a nonfatal drug overdose or was evaluated by a crisis evaluation team; and

      (4) Provide emergency medical transport;

    (ii) An emergency medical dispatcher may:

      (1) Perform medical interrogation in order to determine the type and level of response required at the scene of a medical emergency; and

      (2) Provide prearrival instructions including instructions in cardiopulmonary resuscitation; and

    (iii) An emergency medical responder:

      (1) May perform specified medical procedures as defined by the EMS Board; and

      (2) May not be the primary emergency medical services provider during emergency medical transport.

  (2) Participation in emergency medical dispatch programs by jurisdictions is totally voluntary.

(g) Subject to the rules, regulations, protocols, orders, and standards of the EMS Board, a paramedic may administer:

  (1) Influenza and hepatitis B immunizations and tuberculosis skin testing, in a nonemergency environment, to public safety or ambulance service personnel within the jurisdiction of the paramedic, if the services are:

    (i) Authorized by a written agreement between the provider's jurisdictional EMS operational program medical director or ambulance service medical director and the county or city health department in whose jurisdiction the services are performed, which shall include provisions for documentation, referral and follow-up, and storage and inventory of medicine;

    (ii) Under the direction of the jurisdictional EMS operational program medical director or ambulance service medical director; and

    (iii) Approved by the Institute; and

  (2) Influenza and COVID-19 immunizations, if the immunizations are:

    (i)

      (1) Provided under the direction of the EMS operational program medical director, ambulance service medical director, or other qualified physician; and

      (2) Authorized by the Institute;

    (ii) Part of a population health outreach effort conducted by the appropriate local health department or a hospital or health system in the State; and

    (iii) Provided in accordance with a written agreement between the paramedic's EMS operational program or ambulance service and the county or city health department in the jurisdiction in which the services are performed or a hospital or health system in the State, which includes provisions for:

      (1) The administration of a vaccine to an individual at least 18 years old;

      (2) Storage and inventory of medication;

      (3) Distribution of appropriate Vaccine Information Statements;

      (4) Documentation of patient consent;

      (5) Recognition of adverse effects;

      (6) Referral and follow-up; and

      (7) Appropriate documentation of vaccine administration, including within the ImmuNet system.

(h)

  (1) Subject to the hearing provisions of subsection (i) of this section and as a result of any conduct of an emergency medical services provider or an applicant for a license or certificate under this section that is prohibited under the provisions of this section or any regulations adopted under this section, the EMS Board may:

    (i) Reprimand or place an emergency medical services provider on probation;

    (ii) Suspend or revoke the license or certificate of an emergency medical services provider;

    (iii) Deny a license or certificate to an applicant; or

    (iv) Refuse to renew an applicant's license or certificate.

  (2) On the application of an individual whose license or certificate has been suspended or revoked, the EMS Board may reinstate a suspended or revoked license or certificate.

  (3)

    (i) Unless the EMS Board agrees to accept the surrender of a license or certificate, a holder of a license or certificate may not surrender the license or certificate.

    (ii) A license or certificate may not lapse by operation of law while the holder of the license or certificate is under investigation or while charges are pending against the holder of the license or certificate.

  (4) The EMS Board may set conditions on its agreement with the holder of the license or certificate under investigation or against whom charges are pending to accept surrender of the license or certificate.

(i)

  (1) The EMS Board may take action under subsection (h) of this section only after:

    (i) A review and recommendation by the provider review panel; and

    (ii) The individual against whom the action is contemplated has had an opportunity for a hearing in accordance with the provisions of Title 10, Subtitle 2 of the State Government Article.

  (2) The EMS Board may not proceed with disciplinary cases concerning patient care except upon the affirmative recommendation of the provider review panel.

  (3) The individual may be represented at the hearing by counsel.

  (4) Any person aggrieved by a decision of the EMS Board may take any further appeal allowed under Title 10, Subtitle 2 of the State Government Article.

(j)

  (1) The EMS Board shall refer to the Board of Nursing any complaint about an emergency medical services provider who, in addition to being licensed or certified by the EMS Board, is licensed as a registered nurse or licensed practical nurse by the Board of Nursing.

  (2) The Board of Nursing may investigate and discipline a registered nurse or licensed practical nurse for a violation of this section and a violation of Title 8 of the Health Occupations Article.

  (3) The Board of Nursing shall conduct any hearing required by this section in accordance with Sec. 8-317 of the Health Occupations Article.

  (4) The EMS Board shall comply with any recommendation or order issued by the Board of Nursing regarding the issuance of a license or certificate by the EMS Board to an individual who is licensed as a registered nurse or licensed practical nurse.

(k)

  (1) The EMS Board may, over the signature of the chairman of the EMS Board, Executive Director of the Institute, chairman of the provider review panel, or State EMS Medical Director, issue subpoenas and administer oaths in connection with any investigation under this section and any hearings or proceedings before it.

  (2) If, without lawful excuse, a person disobeys a subpoena of the EMS Board or an order by the EMS Board to take an oath or to testify or answer a question, a court of competent jurisdiction may punish the person for contempt.

  (3) If, after due notice, the individual against whom an action is contemplated fails or refuses to appear, the EMS Board may hear and determine the matter.

  (4) If the entry is necessary to carry out a duty under this section, any duly authorized agent or investigator of the EMS Board may enter at any reasonable hour a place of business of a licensed or certified emergency medical services provider or public premises.

  (5) The EMS Board may issue a cease and desist order or obtain injunctive relief if a person provides emergency medical services without a license or certificate.

(l)

  (1) A person who violates any provision of this subsection is guilty of a misdemeanor and on conviction is subject to a fine not exceeding $1,000 or imprisonment not exceeding 1 year or both.

  (2) Unless licensed or certified to provide emergency medical services under this section, a person may not represent to the public that the person is authorized to provide emergency medical services in this State.

  (3) Unless licensed or certified to provide emergency medical services under this section, a person may not use the terms "cardiac rescue technician", "CRT", "emergency medical dispatcher", "EMD", "emergency medical responder", "emergency medical technician", "paramedic", or any other words, letters, or symbols with the intent to represent that the person is authorized to provide emergency medical services.

(m)

  (1) There is an EMS Board Provider Fund.

  (2) Except as provided in paragraph (3) of this subsection, the EMS Board may set reasonable fees for the initial issuance of licenses or certificates and its other services.

  (3)

    (i) The EMS Board may not charge an initial licensing fee, an initial certifying fee, a fee for the renewal of a license, a fee for the renewal of a certificate, a testing fee, or a retesting fee to an individual who is a member or employee of any governmental or volunteer fire or rescue company at the time of that individual's application.

    (ii) The EMS Board shall pay all fees collected under the provisions of this section to the Comptroller of the State.

    (iii) The Comptroller of the State shall distribute the fees to the EMS Board Provider Fund.

  (4) The EMS Board Provider Fund shall be used exclusively to fund the actual documented direct and indirect costs of fulfilling the statutory and regulatory duties of the EMS Board as provided by the provisions of this section.

  (5)

    (i) The EMS Board Provider Fund is a continuing, nonlapsing fund and is not subject to Sec. 7-302 of the State Finance and Procurement Article.

    (ii) Any unspent portion of the EMS Board Provider Fund may not be transferred or revert to the General Fund of the State but shall remain in the EMS Board Provider Fund to be used for the purposes specified in this section.

(n)

  (1) The EMS Board may delegate any portion of its authority under this section to the Executive Director of the Institute unless specifically precluded by statute.

  (2) Notice of any delegation of authority made under this section shall be published in the Maryland Register.

  (3) The EMS Board may not delegate its authority to promulgate and revise regulations, hear contested cases, or designate the provider review panel to the Executive Director of the Institute.

  (4) The EMS Board may delegate to the Office of Administrative Hearings the authority to hear contested cases and issue recommendations.

#### Section 13-517

(a)

  (1) In this section the following words have the meanings indicated.

  (2) "AED coordinator" means the individual designated by a registered entity to ensure compliance with the requirements of this section.

  (3) "Automated external defibrillator (AED)" means a medical heart monitor and defibrillator device that:

    (i) Is cleared for market by the U.S. Food and Drug Administration;

    (ii) Recognizes the presence or absence of ventricular fibrillation or rapid ventricular tachycardia;

    (iii) Determines, without intervention by an operator, whether defibrillation should be performed;

    (iv) On determining that defibrillation should be performed, automatically charges; and

    (v)

      (1) Requires operator intervention to deliver the electrical impulse; or

      (2) Automatically continues with delivery of electrical impulse.

  (4) "Certificate" means a certificate issued by the EMS Board to a registered entity.

  (5) "Entity" means an organization, a business, an association, an agency, a corporation, a firm, or a partnership in the State.

  (6) "Jurisdictional emergency medical services operational program" means the institution, agency, corporation, or other entity that has been approved by the EMS Board to provide oversight of emergency medical services for each of the local government and State and federal emergency medical services programs.

  (7) "Law enforcement agency" has the meaning stated in Sec. 2-101 of the Public Safety Article.

  (8) "Program" means the Public Access Automated External Defibrillator Program.

  (9) "Registered entity" means an entity that meets the requirements of the EMS Board for registering with the Program.

(b)

  (1) There is a Public Access Automated External Defibrillator Program.

  (2) The purpose of the Program is to:

    (i) Coordinate an effective statewide public access defibrillation program; and

    (ii) Implement the initiative to co-locate naloxone with automated external defibrillators placed in public buildings, as required under Sec. 13-518 of this subtitle.

  (3) The Program shall be administered by the EMS Board.

(c) The EMS Board may:

  (1) Adopt regulations for the administration of the Program;

  (2) Issue and renew certificates to entities that meet the requirements of this section;

  (3) Deny, suspend, revoke, or refuse to renew the certificate of a registered entity for failure to meet the requirements of this section;

  (4) Approve educational and training programs required under this section that:

    (i) Are conducted by any private or public entity; and

    (ii) May include courses from nationally recognized organizations such as the American Heart Association, the American Red Cross, and the National Safety Council; and

  (5) Delegate to the Institute any portion of its authority under this section.

(d)

  (1) Except as provided in paragraph (3) of this subsection, each entity that desires to make automated external defibrillation available shall possess a valid certificate from the EMS Board.

  (2) This subsection does not apply to:

    (i) A jurisdictional emergency medical services operational program;

    (ii) A licensed commercial ambulance service;

    (iii) A health care facility as defined in?Sec. 19-114 of the Health - General Article; or

    (iv) A place of business for health care practitioners who are licensed as dentists under Title 4 of the Health Occupations Article or as physicians under Title 14 of the Health Occupations Article and are authorized to use an AED in accordance with that license.

  (3) A law enforcement agency may not be required to obtain a certificate for an AED deployed in a patrol vehicle of the law enforcement agency.

(e)

  (1) Except as provided in paragraph (2) of this subsection, to qualify for and retain a certificate an entity shall:

    (i) Have a written plan for the use of an AED that includes a requirement that the entity notify the emergency medical services system through the use of the 911 universal emergency access number as soon as possible on the use of an AED;

    (ii) Have established AED maintenance, placement, operation, and reporting procedures as required by the EMS Board;

    (iii) Require the AED coordinator to maintain the functionality of each AED and all related equipment and supplies in accordance with the standards established by the device manufacturer and the U.S. Food and Drug Administration;

    (iv) Require the AED coordinator to promote awareness of the location and operation of the AED among potential or foreseeable AED operators in case of emergency; and

    (v) If the entity is a public building, meet any requirements established under Sec. 13-518 of this subtitle relating to the co-location of naloxone with each AED maintained by the entity.

  (2) For an entity that is a grocery store or restaurant, to qualify for and retain a certificate, the entity shall:

    (i) Register the name of the entity with the Program; and

    (ii) Maintain the functionality of each AED and all related equipment and supplies in accordance with the standards established by the device manufacturer and the U.S. Food and Drug Administration.

(f) In addition to the requirements established in this section, an entity other than a grocery store or restaurant that is subject to Sec. 21-330.3 of the Health - General Article shall ensure that the AED coordinator has successfully completed an educational training course and any refresher training courses as required by the EMS Board.

(g) A registered entity shall report the use of an AED to the Institute using the form provided by the Institute.

(h) An entity that desires to obtain or renew a certificate shall:

  (1) Submit an application on the form that the EMS Board requires; and

  (2) Meet the requirements under this section.

(i)

  (1) The EMS Board shall issue a new or a renewed certificate to an entity that meets the requirements of this section.

  (2) Each certificate shall include:

    (i) The type of certificate;

    (ii) The full name and address of the entity;

    (iii) A unique identification number; and

    (iv) The dates of issuance and expiration of the certificate.

  (3) A certificate is valid for 3 years.

(j) The EMS Board may issue a cease and desist order or obtain injunctive relief if an entity makes automated external defibrillation available in violation of this section.

(k)

  (1) In addition to any other immunities available under statutory or common law, a registered entity is not civilly liable for any act or omission in the provision of automated external defibrillation if the registered entity:

    (i) Has satisfied the requirements for making an AED available under this section; and

    (ii) Possesses a valid certificate at the time of the act or omission.

  (2) In addition to any other immunities available under statutory or common law, an individual is not civilly liable for any act or omission if:

    (i) The individual is acting in good faith while rendering automated external defibrillation to a person who is a victim or reasonably believed by the individual to be a victim of a sudden cardiac arrest;

    (ii) The assistance or aid is provided in a reasonably prudent manner; and

    (iii) The automated external defibrillation is provided without fee or other compensation.

  (3) The immunities in this subsection are not available if the conduct of the registered entity or an individual amounts to gross negligence, willful or wanton misconduct, or intentionally tortious conduct.

  (4) This subsection does not affect, and may not be construed as affecting, any immunities from civil or criminal liability or defenses established by any other provision of the Code or by common law to which a registered entity or an individual may be entitled.

(l)

  (1) A registered entity aggrieved by a decision of the Institute acting under the delegated authority of the EMS Board under this section shall be afforded an opportunity for a hearing before the EMS Board.

  (2) A registered entity aggrieved by a decision of the EMS Board under this section shall be afforded an opportunity for a hearing in accordance with Title 10, Subtitle 2 of the State Government Article.

#### Section 13-518

(a)

  (1) In this section the following words have the meanings indicated.

  (2) "Automated external defibrillator (AED)" has the meaning stated in Sec. 13-517 of this subtitle.

  (3) "Naloxone" means the medication approved by the federal Food and Drug Administration for community use for the reversal of a known or suspected opioid overdose.

  (4) "Public building" means:

    (i) A public mass transportation accommodation, such as a terminal or station, that is supported by public funds;

    (ii) An improvement of a public area used for gathering or amusement, including a public park or recreation center; or

    (iii) A facility that is supported by public funds and primarily used to provide secondary or higher education.

(b)

  (1) The EMS Board, in collaboration with the Maryland Department of Health, shall develop and implement an initiative under the Public Access Automated External Defibrillator Program to require that naloxone be co-located with each automated external defibrillator placed in a public building.

  (2) The initiative developed under paragraph (1) of this subsection shall ensure that up to two doses of naloxone are maintained in a location that:

    (i) Is visible and in close physical proximity to the automated external defibrillator; and

    (ii) Has a label that clearly indicates to the public the availability of naloxone.

  (3) The initiative developed under paragraph (1) of this subsection shall be funded using funds from the Opioid Restitution Fund appropriated through the State budget.

(c)

  (1) The owner or operator of a public building is not civilly liable for any act or omission in the provision and maintenance of naloxone under the initiative developed under subsection (b)(1) of this section if the owner or operator has satisfied any requirements established for providing and maintaining naloxone under the initiative.

  (2) An individual who administers naloxone made available under the initiative developed under paragraph (1) of this subsection in response to a known or suspected drug overdose shall have immunity from civil liability as provided in Sec. 5-603 of the Courts Article.

(d) The EMS Board and the Maryland Department of Health jointly shall adopt regulations that:

  (1) Establish guidelines for periodic inspections and maintenance of the naloxone placed in public buildings;

  (2) Assist the administrators of each public building in carrying out the provisions of this section; and

  (3) Establish initial prioritization of the public buildings eligible to receive funding under this section with a goal of co-location of naloxone with each automated external defibrillator located in a public building by October 1, 2027.

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Md. Code Ann., Educ. (as displayed at mgaleg.maryland.gov, October 16, 2026)