# COMAR Title 30 — Maryland Institute for Emergency Medical Services Systems (MIEMSS)

## Subtitle 03 — Ems Operational Programs

### Chapter 02 — Jurisdictional EMS Operational Programs

**Authority:** Education Article, §§13-509, 13-510, and 13-516, Annotated Code of Maryland

**Administrative History:** Effective date: December 15, 1999 (26:24 Md. R. 1859)

**Administrative History:** Regulation .02 amended effective January 15, 2005 (32:16 Md. R. 1866)

**Administrative History:** Regulation .02A amended effective December 19, 2005 (32:25 Md. R. 1945); October 8, 2007 (34:20 Md. R. 1742); January 13, 2011 (38:1 Md. R. 12)

**Administrative History:** Regulation .02B amended effective September 1, 2014 (41:17 Md. R. 971)

#### Regulation .01 Scope.

*COMAR 30.03.02.01*

A. Jurisdictional EMS operational programs shall be approved by the EMS Board under this chapter.

B. Commercial services shall be licensed under COMAR 30.09.

#### Regulation .02 Criteria for Approval as a Jurisdictional EMS Operational Program.

*COMAR 30.03.02.02*

A. To be eligible for approval an applicant:

  (1) May not be subject to licensure as a commercial service under Education Article, §13-515, Annotated Code of Maryland;

  (2) Shall retain an EMS operational program medical director whose qualifications and duties are consistent with the requirements of COMAR 30.03.03;

  (3) Shall have a written agreement with the EMS operational program medical director addressing:

    (a) The medical director's:

      (i) Duties,

      (ii) Authority, and

      (iii) Responsibilities; and

    (b) The jurisdictional EMS operational program's:

      (i) Duties,

      (ii) Authority, and

      (iii) Responsibilities; and

    (c) Other terms as the parties may agree upon;

  (4) Shall maintain a comprehensive quality assurance program consistent with the requirements of COMAR 30.03.04;

  (5) Shall meet the requirements of the Maryland Ambulance Information System under Public Safety Article, §8-103(b)(7), Annotated Code of Maryland, and COMAR 30.03.04.04;

  (6) Shall provide remedial education as necessary for affiliated EMS providers;

  (7) If also seeking approval as an emergency medical dispatch program shall utilize:

    (a) EMDs to provide medical:

      (i) Interrogation,

      (ii) Prioritization,

      (iii) Resource allocation,

      (iv) Resource management, and

      (v) Prearrival instructions; and

    (b) An emergency medical dispatch priority reference system approved by MIEMSS;

  (8) If also seeking approval as a specialty care transport program, meet the requirements of COMAR 30.09.14; and

  (9) Designate an EMS operational program quality assurance officer whose qualifications and duties are consistent with the requirements of COMAR 30.03.04.08.

  (10) Shall have an Infection Control Program consistent with the requirements of COMAR 30.03.09.

B. A jurisdictional EMS operational program may not provide interfacility specialty care transport from one hospital to another unless the ambulance used is at least an ALS ambulance, and either:

  (1) The jurisdictional EMS operational program is approved as a specialty care transport ambulance service; or

  (2) The following conditions are met:

    (a) A staffed and equipped specialty care transport ambulance is not available within a clinically reasonable time, as determined by the referring physician;

    (b) The sending facility provides health care personnel authorized by law to provide the level of care required by the patient during transport, which may include a nurse meeting the requirements of COMAR 10.27.09.04C(2); and

    (c) Required specialty equipment is available.

C. The EMS Board shall approve only jurisdictional EMS operational programs that are consistent with the goals and objectives of the EMS plan under Education Article, §13-509, Annotated Code of Maryland.

#### Regulation .03 Approval Process.

*COMAR 30.03.02.03*

A. An institution, government agency, corporation, or other entity responsible for EMS oversight may continue to function as a jurisdictional EMS operational program and shall be considered approved as of January 1, 1999, without submitting an application if it:

  (1) Was recognized by MIEMSS as a jurisdictional EMS operational program for purposes of EMS provider affiliation on December 31, 1998; and

  (2) Meets the requirements of this chapter for a jurisdictional EMS operational program on the effective date of this regulation.

B. An applicant for approval as a jurisdictional EMS operational program shall apply to MIEMSS.

C. MIEMSS may make an on-site review of an applicant as necessary to ensure the applicant meets the requirements of this chapter.

D. The EMS Board may:

  (1) Approve an application;

  (2) Provisionally approve an application for up to 18 months under Regulation .04 of this chapter; or

  (3) Deny an application under Regulation .05 of this chapter.

E. The EMS Board shall notify the applicant of the action taken on its application.

#### Regulation .04 Provisional Approval.

*COMAR 30.03.02.04*

A. An applicant granted provisional approval may file an appeal with the EMS Board under Regulation .08 of this chapter.

B. The EMS Board may require that a provisional jurisdictional EMS operational program:

  (1) Have a written work plan to rectify deficiencies; and

  (2) Demonstrate progress on the work plan throughout the provisional period.

C. At the end of the provisional period, the EMS Board may:

  (1) Grant full approval of the jurisdictional EMS operational program; or

  (2) Deny approval.

#### Regulation .05 Denial of Application for Approval.

*COMAR 30.03.02.05*

A. The EMS Board may deny an application for approval if it finds that the applicant is unable to meet the requirements of this chapter.

B. Notice of Denial.

  (1) The EMS Board shall issue a written notice of denial to an applicant that shall include the reasons for denial.

  (2) The notice of denial shall conform to the requirements of State Government Article, §10-207, Annotated Code of Maryland.

C. An applicant denied approval may file an appeal with the EMS Board under Regulation .08 of this chapter.

D. If an applicant does not file a timely appeal under Regulation .08 of this chapter, the EMS Board's decision is final.

E. If an application is denied the EMS Board may request that the applicant reapply under this chapter.

#### Regulation .06 Verification of Approval.

*COMAR 30.03.02.06*

MIEMSS shall verify that each jurisdictional EMS operational program approved under this chapter is in compliance with this chapter at 5-year intervals from the date of program approval.

#### Regulation .07 Compliance.

*COMAR 30.03.02.07*

A. The EMS Board may initiate an investigation of a jurisdictional EMS operational program upon information that the program has failed to comply with this chapter.

B. The EMS Board shall give written notice of the investigation to the jurisdictional EMS operational program.

C. The EMS Board may direct MIEMSS to make such on-site review as necessary as a part of its investigation.

D. If the EMS Board finds that a jurisdictional EMS operational program has materially failed to comply with this chapter, the EMS Board may:

  (1) Require corrective action;

  (2) Restrict available EMS Board funding for the jurisdictional EMS operational program; or

  (3) If the EMS Board finds that the jurisdictional EMS operational program is unable or unwilling to take the required corrective action within a reasonable time set by the EMS Board, take further action as necessary to ensure proper medical direction and oversight of EMS providers, including, but not limited to, revoking approval of the jurisdictional EMS operational program.

E. At the conclusion of the investigation, the EMS Board shall provide its findings and any proposed action in writing to the jurisdictional EMS operational program.

F. The report shall conform to the requirements of State Government Article, §10-207, Annotated Code of Maryland, and contain the reasons for the proposed EMS Board action.

G. Upon receipt of the report of the EMS Board's findings and proposed action, a jurisdictional EMS operational program may file an appeal with the EMS Board under Regulation .08 of this chapter.

H. If an applicant does not file a timely appeal under Regulation .08 of this chapter, the EMS Board's decision is final.

#### Regulation .08 Procedures for Appeals.

*COMAR 30.03.02.08*

A. An applicant or jurisdictional EMS operational program may appeal a disputed final decision by filing a notice of appeal to the EMS Board with the Executive Director of MIEMSS not later than 20 days from receipt of the EMS Board's decision.

B. The appeal shall state with specificity the reasons why the EMS Board should reconsider its decision.

C. An applicant or jurisdictional EMS operational program that files an appeal shall be granted a hearing before the EMS Board or, if the Board so elects and notifies the applicant or jurisdictional EMS operational program, the Office of Administrative Hearings.

D. An appeal hearing is governed by COMAR 28.02.01.

E. If the hearing is conducted by the Office of Administrative Hearings, COMAR 30.02.06.22 and .23 also apply.

F. An applicant or jurisdictional EMS operational program which has participated in a hearing under this regulation may seek judicial review of the EMS Board's final action under State Government Article, §10-222, Annotated Code of Maryland. The EMS Board shall be party to the proceeding.