Chapter 04. Eligibility, Application, and License Renewal
Regulation .01 Scope.LinkCopy Citation
This chapter governs the eligibility, application, and renewal procedure for commercial ambulance service licenses.
Regulation .02 Requirements for a Commercial Ambulance Service License.LinkCopy Citation
To be eligible for a license, a commercial ambulance service shall:
A.
Own or operate at least one ambulance:
(1)
Which is licensed; or
(2)
For which a license has been applied under Regulation .04 of this chapter;
B.
Have ground ambulances mechanically inspected under Regulation .05D(4) of this chapter;
C.
Have all ambulances properly staffed and equipped;
D.
Comply with all applicable statutes and regulations governing the operation of a commercial ambulance service and commercial ambulances;
E.
Have proper insurance required by Regulation .06 of this chapter;
F.
Have reliable communications as required in COMAR 30.09.10.03 and .04;
G.
Submit the intended name of the service to SOCALR for approval;
H.
Apply for a license under Regulation .03 of this chapter; and
I.
Pay the required fees.
Regulation .03 Application for Commercial Ambulance Service License.LinkCopy Citation
A.
An applicant for a commercial ambulance service license shall submit a completed application to SOCALR on the required form.
B.
A completed application shall contain:
(1)
The commercial ambulance service's:
(a)
Name;
(b)
Principal physical business address;
(c)
Billing address;
(d)
Telephone number;
(e)
Facsimile number;
(f)
E-mail address;
(g)
Principal contact individual's name for official communications from MIEMSS;
(h)
Principal contact individual's name for daily operations;
(i)
Federal tax identification number; and
(j)
Entity type;
(2)
For a corporation, limited partnership, or a limited liability company:
(a)
A statement that the commercial ambulance service:
(i)
Is registered under the Corporations and Associations Article, Annotated Code of Maryland, in good standing;
(ii)
Has filed all required annual reports; and
(iii)
Has paid all required filing fees to the Maryland Department of Assessments and Taxation; and
(b)
The name of the resident agent on file with the Charter Division of the Maryland Department of Assessments and Taxation;
(3)
The principal place of business on file with or recognized by the:
(a)
Charter Division of the Maryland Department of Assessments and Taxation; or
(b)
Central Registration Unit of the Comptroller of the Treasury;
(4)
An agreement and representation that the commercial ambulance service:
(a)
Is qualified to do business in Maryland; and
(b)
Will take all necessary actions to remain qualified while licensed in Maryland;
(5)
For an air ambulance service:
(a)
If CAMTS accredited, a copy of the current CAMTS accreditation certificate; or
(b)
If CAMTS accreditation is pending:
(i)
A copy of the FAA operating certificate; and
(ii)
Proof of compliance with CAMTS standards;
(6)
All trade names under which the commercial ambulance service and any parent or subsidiary does or has ever done business;
(7)
The current Maryland Medical Assistance Program provider/vendor numbers issued by the Maryland Department of Health to the commercial ambulance service under its name or any of its trade names;
(8)
The CLIA (Clinical Laboratory Improvement Amendment) identification number, if issued;
(9)
The street address for each location the commercial ambulance service intends to operate including where:
(a)
Ambulances are parked or stored;
(b)
Records are kept;
(c)
Supplies are stored;
(d)
Ambulance crews are quartered; and
(e)
Ambulances are dispatched;
(10)
The following information about management personnel and owners:
(a)
Names;
(b)
Addresses;
(c)
Telephone numbers; and
(d)
Titles;
(11)
The following information about each employee who may provide patient care:
(a)
Name;
(b)
Type of health care certification or license and the identity of the issuer; and
(c)
Certification or license number;
(12)
A listing of all commercial ambulances to be operated by the service under the service license applied for with the information required for a commercial ambulance license in Regulation .05B(2) of this chapter;
(13)
A signed written statement under the penalties of perjury that:
(a)
There has been no attempt for the purpose of obtaining or attempting to obtain a license, to knowingly and willfully:
(i)
Falsify, conceal, or omit a material fact;
(ii)
Make any false, fictitious, incomplete, or fraudulent statements or representations; or
(iii)
Make or use any false writing, document, or entry knowing the same to contain any false, fictitious, or fraudulent statement; and
(b)
The signer is authorized by the commercial ambulance service identified on the application to sign the application form to execute the sworn statement;
(14)
The signatures of:
(a)
If a sole proprietorship, the owner;
(b)
If a partnership, all general partners;
(c)
If a corporation, a duly authorized corporate official accompanied by a certified corporate resolution authorizing the execution; or
(d)
If a limited liability company, an authorized individual; and
(15)
Any additional information which SOCALR may consider necessary.
C.
The applicant shall submit with the application the applicable fees required in Regulation .07 of this chapter together with the documents required in this subtitle.
D.
Before accepting any license for which it applied, the commercial ambulance service shall notify SOCALR of any changes to the information previously submitted on the application which occur before the license is granted, regarding:
(1)
The commercial ambulances;
(2)
Commercial ambulance service personnel; or
(3)
Any other material information in the application.
Regulation .04 Requirements for a Commercial Ambulance License.LinkCopy Citation
A.
To be eligible for a commercial ambulance license, an ambulance shall:
(1)
Be owned or operated by a licensed commercial ambulance service;
(2)
If a ground ambulance, be marked as follows:
(a)
The name of the licensed commercial ambulance service in letters at least 4 inches high,
(b)
For ambulances newly licensed or repainted after January 1, 2000, if other lettering is present naming a sponsoring or serviced facility, organization, or entity, the lettering of the licensed commercial ambulance service name prominently displayed in lettering at least the same size as the lettering in §A(2)(a) of this regulation, and
(c)
A unit designation number assigned by the commercial ambulance service in letters that are at least 3 inches high;
(3)
If an air ambulance, be marked with:
(a)
The name of the licensed commercial ambulance service in letters that are clearly visible, and
(b)
Any other markings required by the FAA; and
(4)
If a ground ambulance, be mechanically inspected as required under Regulation .05D(4) of this chapter;
(5)
Be properly equipped as required by COMAR 30.09.07 and 30.09.10—30.09.13;
(6)
Comply with all applicable statutes and regulations governing the operation of a commercial ambulance;
(7)
Be properly insured as required by Regulation .06 of this chapter; and
(8)
Have proper communication equipment as required in COMAR 30.09.10.04.
B.
Additional Lettering for Ground Ambulances.
(1)
If the ambulance is licensed as an ALS licensed commercial ambulance, the words “Advanced Life Support” may be displayed.
(2)
If the ambulance is licensed as a neonatal licensed commercial ambulance, the words “Neonatal Transport”, “Neonatal Ambulance”, or “Neonatal Intensive Care”, or similar words implying, in the judgement of SOCALR, that the ambulance is licensed as a neonatal commercial ambulance, may be displayed.
C.
The applicant shall submit a diagram of the markings intended to be displayed on the ambulance including:
(1)
Numbering;
(2)
Lettering; and
(3)
Symbols.
D.
The applicant shall submit an application as required under Regulation .05 of this chapter.
E.
The applicant shall pay the required fees.
Regulation .05 Application for Commercial Ambulance License.LinkCopy Citation
A.
An applicant for a commercial ambulance license shall submit a completed application to SOCALR on the required form.
B.
A completed application shall contain:
(1)
The following information about the commercial ambulance service:
(a)
Name,
(b)
Mailing address,
(c)
Phone number, and
(d)
Facsimile number;
(2)
The following information about the ambulance:
(a)
For ground ambulances:
(i)
The unit designation number assigned to each commercial ambulance by the commercial ambulance service for operational purposes,
(ii)
The license plate number,
(iii)
The state issuing the license plates,
(iv)
If the license plates are temporary, the issuance and expiration dates of the temporary license plates,
(v)
The vehicle identification number (VIN) issued by the chassis manufacturer,
(vi)
The year of manufacture of the ambulance chassis, and
(vii)
The color scheme, insignia, trademark, monogram, name, or other distinguishing characteristics used to designate the ambulance;
(b)
For air ambulances:
(i)
The unit designation number assigned to each air ambulance by the commercial ambulance service for operational purposes,
(ii)
The FAA registration number, and
(iii)
The make, model, and year of manufacture;
(3)
The signatures of:
(a)
If a sole proprietorship, the owner,
(b)
If a partnership, all general partners,
(c)
If a corporation, a duly authorized corporate official accompanied by a certified corporate resolution authorizing the execution, or
(d)
If a limited liability company, an authorized individual.
C.
The applicant shall pay the required fees.
D.
The applicant shall submit with the application the following documents for each ground ambulance to be licensed:
(1)
A copy of the motor vehicle registration certificate;
(2)
A copy of the “Application for Approval of Emergency Vehicles” approved by the Maryland Motor Vehicle Administration;
(3)
A certificate of motor vehicle liability insurance required under Regulation .06 of this chapter which lists the vehicle by the vehicle identification number (VIN) number; and
(4)
A copy of:
(a)
If the ambulance is 1 year old or older, the inspection certificate required by Education Article, §13-515(c)(2)(iii), Annotated Code of Maryland, together with a copy of the inspection report; or
(b)
If the ambulance is less than 1 year old, the certificate of origin issued by the vehicle manufacturer which includes:
(i)
Manufacturer's vehicle identification number (VIN),
(ii)
Manufacturer's name,
(iii)
General description of the body,
(iv)
Vehicle make,
(v)
Vehicle model, and
(vi)
Year manufactured.
E.
The applicant shall submit with the application the following documents for each air ambulance the service intends to operate in Maryland:
(1)
Proof of adequate insurance; and
(2)
A copy of the FAA air worthiness certification.
F.
Before the license is granted, the commercial ambulance service shall notify SOCALR of any changes to the information in the application which occur after the application is submitted.
Regulation .06 Insurance.LinkCopy Citation
A.
A commercial ambulance service or a commercial ambulance may not be licensed or operated in Maryland unless the commercial ambulance service maintains continuous insurance, issued by an insurer authorized by the Maryland Insurance Commissioner to write these policies in Maryland, of the following types and amounts:
(1)
Commercial general liability insurance coverage of not less than $1 million;
(2)
For ground ambulances, commercial motor vehicle liability insurance coverage of not less than the minimum required under Transportation Article, §17-103, Annotated Code of Maryland; and
(3)
Workers' compensation insurance in the amount required by law.
B.
The general liability insurance coverage required by §A(1) of this regulation shall provide for payment of damages as a result of:
(1)
Bodily injury to, or death of, individuals in accidents resulting from any cause for which the commercial ambulance service is liable; and
(2)
Property damage to or loss of the property of another, including personal property, resulting from any cause for which the commercial ambulance service is liable.
C.
The financial responsibility requirements for commercial motor vehicle liability coverage shall conform to all applicable laws including:
(1)
Transportation Article, Title 17, Annotated Code of Maryland;
(2)
Transportation Article, Title 18, Annotated Code of Maryland;
(3)
COMAR 11.18; and
(4)
Insurance Article, Title 19, Subtitle 5, Annotated Code of Maryland.
D.
The financial responsibility requirements for workers' compensation insurance shall comply with Labor and Employment Article, Title 9, Annotated Code of Maryland.
E.
A commercial ambulance service shall provide SOCALR, as a condition of licensure or continued licensure, a certificate of insurance that:
(1)
Verifies that the insurance required under this regulation is in effect at the time the application is submitted; and
(2)
Lists the State Office of Commercial Ambulance Licensing and Regulation, 653 West Pratt Street, Room 313, Baltimore, Maryland 21201-1536, as an additional party entitled to notification 10 days before any of the following relating to insurance required by this chapter occurs:
(a)
Nonrenewal,
(b)
Cancellation, or
(c)
Substantive change in the coverage or level of insurance.
F.
A certificate of insurance for motor vehicle insurance required under §E of this regulation shall identify all vehicles covered by the manufacturer's vehicle identification number (VIN).
G.
In addition to the notification requirements required by Insurance Article, §27-605, Annotated Code of Maryland, and this subtitle, a commercial ambulance service shall furnish to SOCALR, within 7 calendar days of receipt, copies of notification from an insurer of any of the following relating to insurance required by this chapter:
(1)
Nonrenewal;
(2)
Cancellation; or
(3)
Substantive change in the coverage or level of insurance.
H.
If the insurance coverage provided by an insurance company or a self-insurance fund is not adequate for the purposes required, MIEMSS may not issue a license.
Regulation .07 Fees.LinkCopy Citation
A.
Commercial Ambulance License Fees.
(1)
Ground ambulances.
(a)
Annual commercial ambulance ALS or BLS license fee as of July 1,1999 — $780
(b)
Semiannual commercial ambulance ALS or BLS license fee as of July 1, 1999 — $415
(c)
Specialty Care Transport Service License.
(i)
Annual commercial specialty care service license fee as of December 31, 2004 — $500.
(ii)
Semiannual commercial specialty care service license fee as of December 31, 2004 — $265.
(d)
Annual neonatal commercial ambulance license fee as of July 1, 1999 — $940
(e)
Semiannual neonatal commercial ambulance license fee as of July 1, 1999 — $500
(2)
Commercial Air Ambulance Service License.
(a)
Annual commercial air ambulance service license fee as of July 1, 2002 — $845.
(b)
Semiannual commercial air ambulance service license fee as of July 1, 2002 — $450.
(3)
Specialty Care Transport Service License.
(a)
Annual commercial specialty care service license fee as of December 31, 2004 — $500.
(b)
Semiannual commercial specialty care service license fee as of December 31, 2004 — $265.
B.
Miscellaneous Service Fees.
(1)
Ambulance license transfer — $50
(2)
Change in level of ambulance license — $50
(3)
Preliminary determination to prospective buyer — $100
(4)
Replacement of commercial ambulance vehicle license — $5
(5)
Replacement of commercial ambulance service license — $5
(6)
Replacement of ambulance licensing decal — $10
(7)
Service license application packet — $20.
(8)
Initial service license application review — $100.
C.
The licensing fee for adding a commercial ambulance vehicle during the fiscal year is:
(1)
One half of the semiannual fee rounded to the nearest $5 increment if the vehicle is added after April 1 and before June 30 of the current fiscal year;
(2)
Equal to the semiannual fee if the vehicle is added after January 1 and before March 31 of the current fiscal year;
(3)
Equal to the semiannual fee rounded to the nearest $5 increment if the vehicle is added after October 1 and before December 31 of the current fiscal year; or
(4)
Equal to the annual fee if the vehicle is added after July 1 and before September 30 of the current fiscal year.
D.
SOCALR shall make noninflationary adjustments to the fees listed in §§A and B of this regulation by means of the regulatory promulgation process which affords interested parties the opportunity to make both oral and written comments to SOCALR before the adoption of a new fee schedule. The fees established in §§A and B of this regulation may be adjusted by SOCALR, from time to time, notwithstanding the inflationary adjustment in §E of this regulation, in order to provide funds sufficient to cover the actual direct and indirect costs of maintaining the licensing program in accordance with Education Article, §13-515, Annotated Code of Maryland, and this subtitle.
E.
SOCALR may make inflationary adjustments to the fees listed in §§A and B of this regulation before the beginning of each fiscal year by applying the percent change in the consumer price index for the most recent complete calendar year to the annual licensing fee for the fiscal year ending rounded to the nearest $5 increment. This inflationary adjustment may be made by SOCALR without any additional consultation or amendment to the regulations. If the consumer price index ceases to be published, a comparable statistic on the purchasing power of the consumer dollar shall be adopted. If the base year (1982/84 = 100) or other base year used in computing the consumer price index is changed, the figures used in making the computation below shall be changed accordingly. The following formula shall be used in determining the annual inflationary adjustment to the fees:
F.
SOCALR may set semiannual licensing fees that are adjusted to cover the additional costs incurred for semiannual rather than annual processing of licenses and decals. The semiannual licensing fee shall be one half of the annual licensing fee plus 6 percent of the halved annual fee, the sum of which is rounded to the nearest $5 increment.
G.
Additional Fees.
(1)
SOCALR may set fees to recoup, on a cost basis, the cost of services and materials that are not covered by the licensing fees, provided to commercial ambulance services and other interested parties. These materials and services may include:
(a)
MAIS run reports;
(b)
Additional narratives;
(c)
Instruction booklets;
(d)
Triage tags;
(e)
Protocols;
(f)
Certification or license patches;
(g)
Reproduction of documents;
(h)
Production of statistical reports;
(i)
Copies of statutes and regulations; and
(j)
Bank service charges for checks returned for insufficient funds.
(2)
The price adjustments in §G(1) of this regulation may be made by SOCALR as necessary without any additional consultation or amendments to the regulations, if these fees are published in the fee schedule distributed in accordance with §H of this regulation.
H.
When the fee schedule is adjusted, SOCALR shall provide a copy of the new fee schedule to all commercial ambulance services that:
(1)
Are licensed by SOCALR at the time of issuance of any new or revised fee schedule; or
(2)
Apply for a license after the issuance of each new or revised fee schedule.
I.
All applicable fees listed in the fee schedule currently in effect shall be submitted to SOCALR with each application.
J.
A license fee may not be refunded, in whole or in part, to any commercial ambulance service whose service or vehicle license is suspended or revoked.
Regulation .08 Waivers.LinkCopy Citation
A.
SOCALR may waive any equipment requirements under COMAR 30.09 for any commercial ambulance service which is licensed by Maryland or applying for a license, which demonstrates to the satisfaction of SOCALR that the equipment offered by the commercial ambulance service is equivalent to or superior to the equipment required by this subtitle.
B.
Waiver of Personnel Requirements.
(1)
SOCALR may waive any personnel requirements under COMAR 30.09 for any commercial ambulance service which is licensed by Maryland or applying for a license, which demonstrates to the satisfaction of SOCALR that the personnel offered by the commercial ambulance service is equivalent to or superior to the personnel required by this subtitle, except the requirement for a licensed or certified driver for an ambulance, which may only be waived under §B(2) of this regulation.
(2)
SOCALR may waive the personnel requirements under COMAR 30.09 for a licensed or certified driver for any commercial ambulance service which is licensed by Maryland or applying for a license. The initial waiver shall be for 1 year, subject to renewal.
(3)
A commercial ambulance service seeking or maintaining a waiver of the requirement for a licensed or certified driver for an ambulance under COMAR 30.09 shall meet the following requirements:
(a)
Submit to SOCALR with the application and on a monthly basis:
(i)
The current number of unit hours staffed over a consecutive 7-day period during the most recent 30 days; and
(ii)
The name and address of each non-EMS individual designated by the commercial service to drive an ambulance;
(b)
Ensure that each non-EMS individual designated to drive an ambulance possesses a current and valid For-Hire Driver's license issued by the Public Service Commission prior to use of a non-EMS driver on an ambulance;
(c)
Provide to SOCALR a photocopy of a current and valid For-Hire Driver's license issued by the Public Service Commission for each non-EMS individual designated to drive an ambulance prior to use of a non-EMS drive on an ambulance;
(d)
Ensure that each non-EMS individual designated to drive an ambulance obtains an ePINS number prior to use of a non-EMS driver on an ambulance;
(e)
Provide the following training to each non-EMS individual it designates to drive an ambulance prior to use of a non-EMS driver on an ambulance:
(i)
COMAR 30.09.02.02 — Patient Rights;
(ii)
COMAR 30.09.07.03 — Operational Requirements;
(iii)
Bloodborne Pathogens (29 CFR 1910.1030 to include Personal Protective Equipment and Body Substance Isolation precautions);
(iv)
Lifting, moving, or positioning patients, to include stretcher and stair chair operations;
(v)
CPR certification training, including the use of an AED; and
(vi)
Driver's training program to include safe road operations, ambulance backing, and city driving;
(f)
Provide SOCALR with a copy of the training programs required for the non-EMS driver prior to use of a non-EMS driver on an ambulance;
(g)
Ensure that any ALS licensed ground ambulance that is staffed with a non-EMS driver is also staffed with at least two individuals who meet the following requirements:
(i)
A CRT or higher who is responsible for the patient as described in COMAR 30.09.07.02A(4)(b); and
(ii)
An EMT or higher; and
(h)
Ensure that any non-EMS individual designated to drive an ambulance:
(i)
Is not subject to a current suspension or revocation of EMS licensure or certification; and
(ii)
Has not been determined by SOCALR to be a threat to the health and safety of patients or the public.
C.
A commercial ambulance service seeking a waiver under this regulation shall apply in writing to SOCALR.
D.
A waiver is not valid unless issued in writing by SOCALR for a specific period of time.
E.
A commercial ambulance service granted a waiver under this subtitle shall reapply for the waiver 30 days before expiration of the waiver.
F.
A waiver may be summarily suspended if SOCALR finds the party to whom the waiver has been granted has:
(1)
Obtained or attempted to obtain a waiver by fraud or deceit;
(2)
Made a material omission or misrepresentation of fact on an application for a waiver;
(3)
Made a material omission or misrepresentation of fact in response to an inquiry or investigation by SOCALR;
(4)
Defaced, altered, removed, or obliterated any portion of or any official entry on a waiver issued by SOCALR;
(5)
Interfered with SOCALR in the performance of SOCALR's duties;
(6)
Failed to reapply for a waiver;
(7)
Violated any applicable federal, State, or local statute or regulation;
(8)
Failed to comply with the terms of the waiver; or
(9)
Continued to use a non-EMS driver that SOCALR has determined, in conjunction with the MIEMSS Office of Integrity, to be a threat to the health and safety of patients or the public.
G.
Failure to comply with the terms of a waiver granted under this regulation may be grounds for further action under COMAR 30.09.09.02.
Chapter annotations
Authority: Education Article, §§13-508 and 13-515, Annotated Code of Maryland
History: Effective date: October 12, 1992 (19:20 Md. R. 1816)
History: Chapter recodified from COMAR 14.22.04 to COMAR 30.09.04, August, 1997
History: Regulations .01—.02, Advertisement and Licensure Disclosure, repealed effective January 10, 2000 (26:27 Md. R. 2017)
History: Regulations .01—.07, Eligibility, Application, and License Renewal, adopted effective January 10, 2000 (26:27 Md. R. 2017)
History: Regulation .02 amended effective October 15, 2004 (31:20 Md. R. 1486)
History: Regulation .03B amended effective October 15, 2004 (31:20 Md. R. 1486)
History: Regulation .04A, B amended effective October 15, 2004 (31:20 Md. R. 1486)
History: Regulation .05 amended effective October 15, 2004 (31:20 Md. R. 1486)
History: Regulation .06A amended effective October 15, 2004 (31:20 Md. R. 1486)
History: Regulation .07 amended effective January 15, 2005 (31:26 Md. R. 1866)
History: Regulation .07A amended effective October 15, 2004 (31:20 Md. R. 1486)
History: Regulation .08 adopted effective May 14, 2001 (28:9 Md. R. 892)
History: Regulation .08 amended effective July 7, 2025 (52:13 Md. R. 657)
History: Regulation .08B, F amended as an emergency provision effective August 26, 2021 (48:20 Md. R. 850); amended permanently effective January 13, 2022 (49:1 Md. R. 16)
History: Regulation .08G adopted as an emergency provision effective August 26, 2021 (48:20 Md. R. 850); amended permanently effective January 13, 2022 (49:1 Md. R. 16)