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

## Subtitle 08 — Designation of Trauma and Specialty Referral Centers

### Chapter 15 — Freestanding Emergency Medical Facilities

**Authority:** Education Article, §13-509; Health-General Article, §19-120(o)(3); Annotated Code of Maryland

**Administrative History:** Effective date: May 5, 2008 (35:9 Md. R. 900)

**Administrative History:** Regulation .02A amended effective December 12, 2013 (40:24 Md. R. 2018)

**Administrative History:** Regulation .03 adopted effective July 31, 2017 (44:15 Md. R. 761)

#### Regulation .01 Definitions.

*COMAR 30.08.15.01*

A. In this chapter, the following term has the meaning indicated.

B. Term Defined. “Freestanding emergency medical facility” means a facility licensed by the Maryland Department of Health under Health-General Article, §19-3A-02, Annotated Code of Maryland.

#### Regulation .02 Freestanding Emergency Medical Facility.

*COMAR 30.08.15.02*

A. Freestanding Emergency Medical Facility. A freestanding emergency medical facility:

  (1) Shall be licensed under Health-General Article, §19-3A-02, Annotated Code of Maryland;

  (2) Shall comply with COMAR 10.07.08;

  (3) Shall abide by the protocols approved by the EMS Board for the transport by EMS of patients to freestanding emergency departments;

  (4) Shall abide by the Maryland Emergency Medical Services Interfacility Transfer Guidelines published by MIEMSS;

  (5) Shall participate in the County Hospital Alert Tracking System (CHATS) program;

  (6) Shall have radios and the ability to communicate with EMS and base stations;

  (7) Shall advise MIEMSS immediately of any change in status regarding the freestanding emergency department; and

  (8) Shall participate in data collection and quality management as required in COMAR 30.08.04.

B. MIEMSS shall designate a freestanding emergency medical facility that meets these requirements in accordance with COMAR 30.08.02.

C. Notwithstanding COMAR 30.08.02.06, MIEMSS may designate a freestanding emergency medical facility licensed by the Maryland Department of Health under Health-General Article, §19-3A-02, Annotated Code of Maryland, without conducting an on-site review.

#### Regulation .03 Determination of Adequacy and Appropriateness of Emergency Care Delivery Associated with Conversion of a Hospital to a Freestanding Medical Facility.

*COMAR 30.08.15.03*

A. The EMS Board shall consider the following factors in determining whether the conversion of a general hospital to a freestanding medical facility under COMAR 10.24.19.04C will maintain adequate and appropriate delivery of emergency care within the Statewide emergency medical services system:

  (1) The EMS resources in the jurisdictions affected by the proposed hospital conversion, including staffing, equipment, and units;

  (2) Any additional resources which will be provided by the hospital seeking to convert to augment the resources available in the affected jurisdiction.

  (3) The EMS call volume of affected jurisdictions by priority;

  (4) The projected number of patients who could require transport to a general acute hospital rather than the proposed freestanding medical facility for appropriate medical care;

  (5) EMS transport times in the jurisdictions affected by the proposed hospital conversion and the potential for extended transport and out-of-service times resulting from the proposed conversion to a freestanding medical facility, relative to the current pattern of transport times;

  (6) Commercial ambulance services availability and response times in the jurisdictions affected by the proposed hospital conversion;

  (7) The number of general hospitals likely to be affected by the proposed hospital conversion and the distance to the closest general hospital ED for appropriate patients if the hospital converts to a freestanding medical facility relative to current patterns of hospital use;

  (8) The expected additional ED visit volume and associated increases in admission and observation patient volumes for the general hospitals likely to be affected by the proposed hospital conversion;

  (9) Recent diversion utilization at the converting hospital and other general hospitals likely to be affected by the proposed hospital conversion and the potential impact of the proposed conversion on diversion utilization;

  (10) The size, scope, configuration, services, and staffing of the proposed project; and

  (11) Reasonable changes in the EMS system that are planned or can be made to maintain adequate and appropriate delivery of emergency care within the Statewide emergency medical services system if the hospital converts to a freestanding medical facility.

B. A general hospital seeking an exemption from a certificate of need to convert to a freestanding medical facility shall:

  (1) Notify MIEMSS in writing of its intent to seek an exemption at least 14 days prior to a public informational hearing required by the Maryland Health Care Commission;

  (2) Notify and seek input from EMS providers in jurisdictions affected by the proposed conversion at least 14 days prior to a public informational hearing required by the Maryland Health Care Commission, by publishing a physical address and email address on its website for receipt of comments;

  (3) Provide to MIEMSS the information required in COMAR 10.24.19C(8)(a),(b), (d), (e),(i), and (j) to MIEMSS within 7 days of the public informational hearing required by Maryland Health Care Commission regulations; and

  (4) Submit all notices and information required pursuant to COMAR 10.24.19.04(C) simultaneously to both the Maryland Health Care Commission and MIEMSS.

C. MIEMSS will continue to accept direct input from stakeholders for a period of 10 business days following the public informational hearing. MIEMSS will provide any direct input from stakeholders to the hospital proposing the conversion and allow the hospital 5 business days to respond.

D. The EMS Board will issue the determination concerning the proposed hospital conversion under §A of this regulation within 45 days of the required public informational hearing held by the hospital proposing the conversion, in consultation with the Maryland Health Care Commission.

E. MIEMSS will provide a copy of any determination issued by the EMS Board under this regulation to the Maryland Health Care Commission upon its issuance.