BEFORE THE DEPARTMENT OF PUBLIC
HEALTH AND HUMAN SERVICES OF THE
STATE OF MONTANA
In the matter of the amendment of ARM 37.104.106 and 37.104.212 pertaining to updates to emergency medical service records and reports
NOTICE OF PUBLIC HEARING ON PROPOSED AMENDMENT
TO: All Concerned Persons
1. On July 26, 2018, at 10:00 a.m., the Department of Public Health and Human Services will hold a public hearing in Room 207 of the Department of Public Health and Human Services building, 111 North Sanders, Helena, Montana, to consider the proposed amendment of the above-stated rules.
2. The Department of Public Health and Human Services will make reasonable accommodations for persons with disabilities who wish to participate in this rulemaking process or need an alternative accessible format of this notice. If you require an accommodation, contact the Department of Public Health and Human Services no later than 5:00 p.m. on July 16, 2018, to advise us of the nature of the accommodation that you need. Please contact Todd Olson, Department of Public Health and Human Services, Office of Legal Affairs, P.O. Box 4210, Helena, Montana, 59604-4210; telephone (406) 444-9503; fax (406) 444-9744; or e-mail firstname.lastname@example.org.
3. The rules as proposed to be amended provide as follows, new matter underlined, deleted matter interlined:
37.104.106 LICENSE APPLICATION REQUIREMENTS (1) An application for a license to conduct an emergency medical service, including the renewal of a license, must be made on electronic forms specified by the department, accompanied by the license fee, and received by the department not less than 30 days prior to the commencement of a new emergency medical service or 15 days prior to the expiration of the license, in the case of an application for renewal.
(2) through (6) remain the same.
(7) The service license must be updated within 10 days when any information contained in the service license application changes.
(7) through (9) remain the same, but are renumbered (8) through (10).
(10) (11) In a catastrophe or major emergency when licensed ambulances are insufficient to render services required, nonlicensed non-licensed emergency medical services may be used.
AUTH: 50-6-323, MCA
IMP: 50-6-306, 50-6-313, 50-6-323, MCA
37.104.212 RECORDS AND REPORTS (1) remains the same.
(2) Ambulance services and
nontransporting non-transporting units must provide data as identified by the department in this rule.
(3) remains the same.
(4) The following NEMSIS demographic data elements for ambulance service or nontransporting unit licensing must be reported and updated no less than annually:
D01_01 EMS Agency Number
D01_02 EMS Agency Name
D01_03 EMS Agency State
D01_04 EMS Agency County
D01_07 Level of Service
D01_08 Organizational Type
D01_09 Organization Status
D01_10 Statistical Year
D01_12 Total Service Size Area
D01_13 Total Service Area Population
D01_14 911 Call Volume per Year
D01_15 EMS Dispatch Volume per Year
D01_16 EMS Transport Volume per Year
D01_17 EMS Patient Contact Volume per Year
D01_19 EMS Agency Time Zone
D01_21 National Provider Identifier
D02_01 Agency Contact Last Name
D02_02 Agency Contact Middle Name/Initial
D02_03 Agency Contact First Name
D02_04 Agency Contact Address
D02_05 Agency Contact City
D02_06 Agency Contact State
D02_07 Agency Contact Zip Code
D02_08 Agency Contact Telephone Number
D02_09 Agency Contact Fax Number
D02_10 Agency Contact Email Address
D03_01 Agency Medical Director Last Name
D03_02 Agency Medical Director Middle Name/Initial
D03_03 Agency Medical Director First Name
D03_04 Agency Medical Director Address
D03_05 Agency Medical Director City
D03_06 Agency Medical Director State
D03_07 Agency Medical Director Zip Code
D03_08 Agency Medical Director Telephone Number
D03_09 Agency Medical Director Fax Number
D03_11 Agency Medical Director Email Address
D04_02 EMS Unit Call Sign
D05_01 Station Name
D05_02 Station Number
D05_04 Station GPS
D05_05 Station Address
D05_06 Station City
D05_07 Station State
D05_08 Station Zip
D05_09 Station Telephone Number
D06_01 Unit/Vehicle Number
D06_03 Vehicle Type
D06_04 State Certification/Licensure Levels
D06_07 Vehicle Model Year
D06_08 Year Miles/Hours Accrued
D06_09 Annual Vehicle Hours
D06_10 Annual Vehicle Miles
D07_01 Personnel's Agency ID Number
D07_02 State/Licensure ID Number
D07_05 Personnel's Level of Certification/Licensure for Agency
D08_01 EMS Personnel's Last Name
D08_02 EMS Personnel's Middle Name/Initial
D08_03 EMS Personnel's First Name
D08_04 EMS Personnel's Mailing Address
D08_05 EMS Personnel's City of Residence
D08_06 EMS Personnel's State
D08_07 EMS Personnel's Zip Code
D08_09 EMS Personnel's Home Telephone
D08_10 EMS Personnel's Email Address
D08_15 State EMS Certification Licensure Level
D08_17 State EMS Current Certification Date
(5) The following NEMSIS EMS data elements must be reported by ambulance services for each incident:
E01_01 Patient Care Report Number
E02_01 EMS Agency Number
E02_04 Type of Service Requested
E02_05 Primary Role of the Unit
E02_06 Type of Dispatch Delay
E02_07 Type of Response Delay
E02_08 Type of Scene Delay
E02_09 Type of Transport Delay
E02_10 Type of Turn-Around Delay
E02_12 EMS Unit Call Sign (Radio Number)
E02_20 Response Mode to Scene
E03_01 Complaint Reported by Dispatch
E03_02 EMD Performed
E05_02 PSAP Call Date/Time
E05_04 Unit Notified by Dispatch Date/Time
E05_05 Unit En Route Date/Time
E05_06 Unit Arrived on Scene Date/Time
E05_07 Arrived at Patient Date/Time
E05_09 Unit Left Scene Date/Time
E05_10 Patient Arrived at Destination Date/Time
E05_11 Unit Back in Service Date/Time
E05_13 Unit Back at Home Location Date/Time
E06_08 Patient's Home Zip Code
E06_15 Age Units
E07_01 Primary Method of Payment
E07_34 CMS Service Level
E07_35 Condition Code Number
E08_05 Number of Patients at Scene
E08_06 Mass Casualty Incident
E08_07 Incident Location Type
E08_15 Incident ZIP Code
E09_01 Prior Aid
E09_02 Prior Aid Performed by
E09_03 Outcome of the Prior Aid
E09_04 Possible Injury
E09_11 Chief Complaint Anatomic Location
E09_12 Chief Complaint Organ System
E09_13 Primary Symptom
E09_14 Other Associated Symptoms
E09_15 Provider's Primary Impression
E09_16 Provider's Secondary Impression
E10_01 Cause of Injury
E11_01 Cardiac Arrest
E11_02 Cardiac Arrest Etiology
E11_03 Resuscitation Attempted
E12_01 Barriers to Patient Care
E12_19 Alcohol/Drug Use Indicators
E18_03 Medication Given
E18_08 Medication Complication
E19_05 Number of Procedure Attempts
E19_06 Procedure Successful
E19_07 Procedure Complication
E20_07 Destination Zip Code
E20_10 Incident/Patient Disposition
E20_14 Transport Mode from Scene
E20_16 Reason for Choosing Destination
E20_17 Type of Destination
E22_01 Emergency Department Disposition
E22_02 Hospital Disposition
(4) For ambulance services using NEMSIS version 3.4 software, the data elements designated as national requisite fields must be reported for each incident.
(6) remains the same, but is renumbered (5).
(7) (6) Ambulance services are not required to submit other NEMSIS data elements, but may do so. Nontransporting Non-transporting units are not required to submit NEMSIS data, but may do so.
(8) remains the same, but is renumbered (7).
(9) (8) The department adopts and incorporates by reference the National Emergency Medical Services Information System (NEMSIS) Uniform Pre-Hospital Emergency Medical Services Dataset, Version 2.2.1, (5/04/2010) 3.4 (7/13/2016) published by the National Highway Traffic Safety Administration (NHTSA). A copy may be obtained at http://www.nemsis.org/v2/downloads/datasetDictionaries.html https://nemsis.org/media/nemsis_v3/release-3.4.0/DataDictionary/PDFHTML/DEMEMS/NEMSISDataDictionary.pdf or from the Department of Public Health and Human Services, Public Health and Safety Division, Emergency Medical Services and Trauma Systems Section, 1400 Broadway, P.O. Box 202951, Helena, MT 59620-2951.
(10) through (12) remain the same, but are renumbered (9) through (11).
AUTH: 50-6-323, MCA
IMP: 50-6-323, MCA
4. STATEMENT OF REASONABLE NECESSITY
The Department of Public Health and Human Services (department) is proposing to amend ARM 37.104.106 and 37.104.212.
The department's EMS and Trauma Section has purchased new software to enable EMS services to apply for and update their service licenses and to complete electronic patient care records. ARM 37.104.212 requires EMS services to provide the department with minimum data (the data fields designated as national data elements of the National EMS Information System - NEMSIS data standard).
The department's current software is based upon an older NEMSIS 2.2.1 standard and current rule requires data be submitted in that format. The new software is based upon an updated NEMSIS 3.4 data standard. EMS services that have their own NEMSIS software but cannot meet the NEMSIS version 3.4 standards may be issued temporary waivers if their vendor is imminently upgrading to the NEMSIS 3.4 version or if there is a financial burden to the service that requires more time in order to be compliant with the version 3.4 standard.
The rules have also been revised for general clarity.
This rule requires an EMS service that is applying for a new license or renewing a license to complete an application on forms specified by the department and to submit the required information and fee 30 days before commencement of the service or expiration of the current license. The department proposes to amend (1) to clarify that the electronic forms specified by the department under the web-based OPHI eLicensing system will be required for license applications. Additionally, the department is proposing to decrease the 30-day requirement for receipt of a license renewal to 15 days. As the current licensing system is web-based, review of applications can be done faster than what was necessary to review paper forms.
The department proposes to amend (7) to require EMS services to update any changes, deletions, or additions to their license application within 10 business days. While this has been an assurance that EMS services have agreed to in the service license application for some time, putting this into rule will reinforce the significance of the department's need to know when EMS services managers, service medical directors, service addresses, and other license information has changed.
This administrative rule describes requirements for completion and submission of patient care records and other data to the department and hospitals. ARM 37.104.212(4) currently lists each NEMSIS national demographic data field and numerous license application data fields that must be reported to the department; (5) lists each patient care data field that must be reported.
The proposed rule amendments seek to remove the specific listing of each data field in rule and alternately require services submitting NEMSIS EMS data elements designated as "national fields" to the department. The NEMSIS data dictionary describes specifications for over 400 data elements and denotes certain fields as national data elements. Further, the department proposes to amend the NEMSIS data standard version adopted and incorporated by reference from the current version 2.2.1 to 3.4. Because NEMSIS 3.4 is more user-friendly, EMS services will likely spend less time meeting data reporting requirements than via the older 2.2.1 version software.
The proposed rule amendments will impose minimal fiscal impact as the new NEMSIS software has been purchased with grant funds and is being deployed to all services that wish to use it. The fiscal costs to EMS services that are required to submit data will also be minimal as we have a statewide license for the software and all EMS services are invited to use it at no cost.
It is possible that some services may choose to purchase their own software, but a majority are preparing to upgrade their software through the department. For EMS services that cannot expediently upgrade to the new standard, the department can approve waivers if their current software is being upgraded to version 3.4, or the service needs more time to budget to upgrade their software. Further, there may be a cost benefit to collecting electronic data as that more complete electronic patient care records may generate increased reimbursements because of increased accuracy in data entry and billing.
The proposed rulemaking is estimated to affect 120+ licensed ambulance services that are required to submit minimum data to the department.
5. Concerned persons may submit their data, views, or arguments either orally or in writing at the hearing. Written data, views, or arguments may also be submitted to: Todd Olson, Department of Public Health and Human Services, Office of Legal Affairs, P.O. Box 4210, Helena, Montana, 59604-4210; fax (406) 444-9744; or e-mail email@example.com, and must be received no later than 5:00 p.m., August 3, 2018.
6. The Office of Legal Affairs, Department of Public Health and Human Services, has been designated to preside over and conduct this hearing.
7. The department maintains a list of interested persons who wish to receive notices of rulemaking actions proposed by this agency. Persons who wish to have their name added to the list shall make a written request that includes the name, e-mail, and mailing address of the person to receive notices and specifies for which program the person wishes to receive notices. Notices will be sent by e-mail unless a mailing preference is noted in the request. Such written request may be mailed or delivered to the contact person in 5 above or may be made by completing a request form at any rules hearing held by the department.
8. The bill sponsor contact requirements of 2-4-302, MCA, do not apply.
9. With regard to the requirements of 2-4-111, MCA, the department has determined that the amendment of the above-referenced rules will not significantly and directly impact small businesses.
/s/ Shannon L. McDonald /s/ Sheila Hogan
Shannon L. McDonald Sheila Hogan, Director
Rule Reviewer Public Health and Human Services
Certified to the Secretary of State June 26, 2018.