Iowa Admin. Code r. 641-132.2 - Service program-authorization and renewal procedures and inspections
(1)
Requirements for initial service program authorization.
a. An entity that desires to provide
emergency medical care services in the out-of-hospital setting in this state
shall apply to the department for service program full authorization.
b. Information for initial authorization can
be found on the department's website or upon request.
c. Transport service-full authorization. An
entity seeking authorization as a transport service program shall apply for
full authorization at a minimum of the EMT level or the level of care that will
be provided by the service program or through a transport agreement for initial
911 or emergency calls 24 hours per day, seven days per week at the following
EMS service levels:
(1) EMT.
(2) AEMT.
(3) Paramedic.
d. Transport service-conditional service
level authorization. An entity seeking authorization as a transport service
that is capable of providing emergency medical care beyond the full
authorization level on an intermittent basis may apply for conditional service
level authorization at one or more of the following conditional service levels:
(1) AEMT.
(2) Paramedic.
e. Nontransport service-full authorization.
An entity seeking authorization as a nontransport service program shall apply
for full authorization at a minimum of the EMR level or at the level of care
that will be provided for initial 911 or emergency calls 24 hours per day,
seven days per week at the following EMS service levels:
(1) EMR.
(2) EMT.
(3) AEMT.
(4) Paramedic.
The nontransport service program shall have an executed written transport agreement ensuring simultaneous dispatch with an authorized transport service program for all 911 or emergency calls.
f. Nontransport service-conditional service
level authorization. An entity seeking authorization as a nontransport service
program that has an executed written transport agreement ensuring simultaneous
dispatch with an authorized transport service program for all 911 or emergency
calls and is capable of providing emergency medical care beyond the full
authorization level on an intermittent basis may apply for conditional service
level authorization at one or more of the following conditional service levels:
(1) EMT.
(2) AEMT.
(3) Paramedic.
g. Conditional service level authorization
requirements.
(1) A service program that has
been granted conditional service level authorization shall only advertise or
otherwise hold itself out to the public as an authorized service program at the
level of full authorization.
(2) A
service program authorized to operate at a conditional service level shall
operate at such level only when an emergency medical care provider certified at
the advanced certification level is listed on the service roster, physically
present and directly responsible for patient care.
h. Initial service program authorization is
valid for a period of one year from its effective date unless otherwise
specified on the certificate of authorization or unless sooner suspended or
revoked or surrendered.
i. An
applicant shall provide evidence of liability insurance coverage for the
service program and emergency medical care provider staff. Any change in
insurance status must be reported to the department no later than 30 days from
the change.
j. An applicant seeking
endorsement must submit a department-approved application.
(2)
Requirements for renewal of
service program authorization.
a. A
service program seeking renewal of current authorization shall submit all
required documentation to the department at least 90 days prior to the current
authorization expiration date.
b.
Transport service-full authorization. An entity seeking renewal authorization
as a transport service program shall apply for full authorization at a minimum
of the EMT level or the level of care that will be provided by the service
program or through a transport agreement for initial 911 or emergency calls 24
hours per day, seven days per week at the following EMS service levels:
(1) EMT.
(2) AEMT.
(3) Paramedic.
c. Transport service-conditional service
level authorization. An entity seeking renewal authorization as a transport
service that is capable of providing emergency medical care beyond the full
authorization level on an intermittent basis may apply for conditional service
level authorization at one or more of the following conditional service levels:
(1) AEMT.
(2) Paramedic.
d. Nontransport service-full authorization.
An entity seeking renewal authorization as a nontransport service program shall
apply for full authorization at a minimum of the EMR level or at the level of
care that will be provided for initial 911 or emergency calls 24 hours per day,
seven days per week at the following EMS service levels:
(1) EMR.
(2) EMT.
(3) AEMT.
(4) Paramedic.
e. Nontransport service-conditional service
level authorization. An entity seeking renewal authorization as a nontransport
service program that is capable of providing emergency medical care beyond the
full authorization level on an intermittent basis may apply for conditional
service level authorization at one or more of the following conditional service
levels:
(1) EMT.
(2) AEMT.
(3) Paramedic.
f. Air medical requirements.
(1) Staff fixed-wing ambulances, at a minimum
on each flight request, with the following staff while a patient is being
transported:
1. One health care clinician who
is certified or licensed in the state from which the aircraft launches and is
certified as an EMT or higher level; and
2. One FAA-certified commercial pilot who is
appropriately rated in the aircraft being used for the transport.
(2) Staff rotorcraft ambulances,
at a minimum on each flight request, with the following staff while a patient
is being transported:
1. Two health care
clinicians who are certified or licensed in the state from which the aircraft
launches, one of whom must at a minimum be certified as a paramedic;
and
2. One FAA-certified commercial
pilot who is appropriately rated in the aircraft being used for the
transport.
(3) Medical
crew members trained in the following areas:
1. Patient care limitations in
flight.
2. Altitude
physiology.
3. Appropriate
utilization of air medical services.
4. Air medical communication
systems.
5. Aircraft operations and
safety.
6. Emergency safety and
survival.
7. Prehospital scene
response and safety.
8. Crew
resource management.
9. Program
flight risk assessment procedures.
g. Conditional service level authorization
requirements.
(1) A service program that has
been granted conditional service level authorization shall only advertise or
otherwise hold itself out to the public as an authorized service program at the
level of full authorization.
(2) A
service program authorized to operate at a conditional service level shall
operate at such level only when an emergency medical care provider certified at
the advanced certification level is listed on the service roster, physically
present and directly responsible for patient care.
h. A service program that has submitted to
the department fewer than 100 data reports per year for each of the previous
two consecutive calendar years shall only be eligible for renewal of current
authorization as an affiliate. The department will provide technical assistance
in developing affiliations.
i. A
service program shall be fully operational upon the effective date specified on
the certificate of authorization and shall ensure compliance with Iowa Code
chapter 147A and these rules.
j. A
service program renewal authorization is valid for a period not to exceed three
years from its effective date unless otherwise specified on the certificate of
authorization or unless sooner revoked or suspended or
surrendered.
(3)
Reinstatement of service program authorization.
a. A service program whose full authorization
or conditional service level authorization has been revoked or suspended or
surrendered may apply to the department for reinstatement in accordance with
the terms and conditions of the order of revocation or suspension, unless the
order of revocation provides that the authorization is permanently
revoked.
b. If the authorization
was voluntarily surrendered, an initial application for reinstatement may not
be made until one year has elapsed from the date of the order or the date of
the voluntary surrender.
(4)
Out-of-state service
programs.
a. An emergency medical
service program authorized and based in another state shall provide the
department with verification of current state authorization upon request and
may provide emergency medical care to patients in Iowa.
b. A service program authorized and based in
another state shall meet all requirements of Iowa Code chapter 147A and these
rules and must be authorized by the department to respond to 911 requests in
Iowa to transport patients in Iowa to locations within Iowa.
(5)
Service program
inspections.
a. The department, at a
minimum, will complete an inspection of each base of operations, all associated
satellites, and all affiliate locations prior to initial authorization or
renewal of current full authorization or conditional service level to ensure
compliance with Iowa Code chapter 147A and these rules.
b. The department without prior notification
may make additional inspections at times, at places and under such
circumstances as it deems necessary to ensure compliance with Iowa Code chapter
147A and these rules.
c. Service
program inspection forms are available on the department's website.
d. A service program shall correct
deficiencies identified during a service program inspection within the time
period specified by the department on the inspection form. Failure to correct
identified deficiencies within the specified time period may result in
disciplinary action.
e. The
department may request additional information from or may inspect the records
of any service program or associated satellite or associated affiliate that is
currently authorized or that is seeking authorization to ensure continued
compliance or to verify the validity of any information presented on the
application for initial service program authorization or renewal of current
authorization.
f. The department
may inspect the patient care records of a service program to verify compliance
with Iowa Code chapter 147A and these rules.
g. No person shall interfere with the
inspection activities of the department or its agents pursuant to Iowa Code
section 135.36.
h. Interference with or failure to allow an
inspection by the department or its agents may be cause for disciplinary
action.
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
(1) Requirements for initial service program authorization.
a. An entity that desires to provide emergency medical care services in the out-of-hospital setting in this state shall apply to the department for service program full authorization and may apply for a conditional service level authorization if the entity can demonstrate advanced emergency medical care provider availability and medical director approval for conditional authorization at such level.
c. Transport service -full authorization . An entity seeking authorization as a transport service program shall apply for full authorization at a minimum of the EMT level or the level of care which will be provided by the service program or through a transport agreement for initial 911 or emergency calls 24 hours per day, seven days per week at the following EMS service levels:
(1) EMT.
(2) AEMT.
(3) Paramedic.
d. Transport service -conditional service level authorization . An entity seeking authorization as a transport service which is capable of providing emergency medical care beyond the full authorization level on an intermittent basis may apply for conditional service level authorization at one or more of the following conditional service levels:
(1) AEMT.
(2) Paramedic.
e. Nontransport service -full authorization . An entity seeking authorization as a nontransport service program shall apply for full authorization at a minimum of the EMR level or at the level of care which will be provided for initial 911 or emergency calls 24 hours per day, seven days per week . The nontransport service program shall have an executed written transport agreement ensuring simultaneous dispatch with an authorized transport service program for all 911 or emergency calls. The nontransport service shall apply for full authorization at the following EMS service levels:
(1) EMR.
(2) EMT.
(3) AEMT.
(4) Paramedic.
f. Nontransport service -conditional service level authorization . An entity seeking authorization as a nontransport service program that has an executed written transport agreement ensuring simultaneous dispatch with an authorized transport service program for all 911 or emergency calls and is capable of providing emergency medical care beyond the full authorization level on an intermittent basis may apply for conditional service level authorization at one or more of the following conditional service levels:
(1) EMT.
(2) AEMT.
(3) Paramedic.
g. Conditional service level authorization restrictions and requirements.
(1) A service program which has been granted conditional service level authorization shall only advertise or otherwise hold itself out to the public as an authorized service program at the level of full authorization .
(2) A service program authorized to operate at a conditional service level shall operate at such level only when an emergency medical care provider certified at the advanced certification level is listed on the service roster, physically present and directly responsible for patient care.
h. An applicant should expect a minimum of a 30-day time period for review of the application, completion of an inspection , and response by the department regarding authorization status.
i. Deficiencies that are identified during the application review and inspection process by the department shall be corrected prior to service program authorization.
j. An applicant may be authorized as a service program when the department is satisfied that the program proposed by the applicant and associated satellites or affiliates will be operated in compliance with Iowa Code chapter 147A and these rules.
k. An applicant for authorization as a service program shall be fully operational upon the effective date specified on the certificate of authorization and shall ensure compliance with Iowa Code chapter 147A and these rules.
l. Initial service program authorization shall be valid for a period of one year from its effective date unless otherwise specified on the certificate of authorization or unless sooner suspended or revoked or surrendered.
m. An applicant shall provide evidence of liability insurance coverage for the service program and emergency medical care provider staff. Any change in insurance status must be reported to the department no later than 30 days from the change.
n. An applicant seeking endorsement as a CCT must provide verification that the service program will be staffed by one or more paramedics with a critical care paramedic endorsement from the department or by other health care professionals when providing specialty care and transport.
(2) Requirements for renewal of service program authorization.
a. A service program seeking renewal of current authorization shall complete a process initiated by the department for renewal of the service program that includes the service program base of operations and all associated satellites and affiliates.
b. A service program seeking renewal of current authorization shall submit all required documentation to the department at least 90 days prior to the current authorization expiration date.
c. Transport service -full authorization . An entity seeking renewal authorization as a transport service program shall apply for full authorization at a minimum of the EMT level or the level of care which will be provided by the service program or through a transport agreement for initial 911 or emergency calls 24 hours per day, seven days per week at the following EMS service levels:
(1) EMT.
(2) AEMT.
(3) Paramedic.
d. Transport service -conditional service level authorization . An entity seeking renewal authorization as a transport service which is capable of providing emergency medical care beyond the full authorization level on an intermittent basis may apply for conditional service level authorization at one or more of the following conditional service levels:
(1) AEMT.
(2) Paramedic.
e. Nontransport service full authorization . An entity seeking renewal authorization as a nontransport service program shall apply for full authorization at a minimum of the EMR level or at the level of care which will be provided for initial 911 or emergency calls 24 hours per day, seven days per week at the following EMS service levels:
(1) EMR.
(2) EMT.
(3) AEMT.
(4) Paramedic.
f. Nontransport service -conditional service level authorization . An entity seeking renewal authorization as a nontransport service program which is capable of providing emergency medical care beyond the full authorization level on an intermittent basis may apply for conditional service level authorization at one or more of the following conditional service levels:
(1) EMT.
(2) AEMT.
(3) Paramedic.
g. Conditional service level authorization restrictions and requirements.
(1) A service program which has been granted conditional service level authorization shall only advertise or otherwise hold itself out to the public as an authorized service program at the level of full authorization .
(2) A service program authorized to operate at a conditional service level shall operate at such level only when an emergency medical care provider certified at the advanced certification level is listed on the service roster, physically present and directly responsible for patient care.
h. Effective January 1,2022, a service program which has submitted to the department fewer than 100 data reports per year for each of the previous two consecutive calendar years shall only be eligible for renewal of current authorization as an affiliate . The department will provide technical assistance in developing affiliations.
i. The department shall review the application and complete an inspection of the service program base of operations and all associated satellites and affiliates prior to renewal of current authorization.
j. A service program shall receive a renewal of authorization only when the department is satisfied that the service program and all associated satellites and affiliates will be operated in compliance with Iowa Code chapter 147A and these rules.
k. A service program shall be fully operational upon the effective date specified on the certificate of authorization and shall ensure compliance with Iowa Code chapter 147A and these rules.
l. A service program renewal authorization shall be valid for a period not to exceed three years from its effective date unless otherwise specified on the certificate of authorization or unless sooner revoked or suspended or surrendered.
m. A certificate of authorization shall be issued to the service program owner listed on the application.
n. A service program shall provide evidence of liability insurance coverage for the service program and emergency medical care provider staff. Any change in insurance status must be reported to the department no later than 30 days after the change.
o. An applicant seeking endorsement as a CCT must provide verification that the service program will be staffed by one or more paramedics with critical care paramedic endorsement by the department or other health care professionals when providing specialty care and transport.
(3) Reinstatement of service program authorization.
a. A service program whose full authorization or conditional service level authorization has been revoked or suspended or surrendered may apply to the department for reinstatement in accordance with the terms and conditions of the order of revocation or suspension, unless the order of revocation provides that the authorization is permanently revoked.
b. If the order of revocation or suspension did not establish terms and conditions upon which reinstatement might occur or if the authorization was voluntarily surrendered, an initial application for reinstatement may not be made until one year has elapsed from the date of the order or the date of the voluntary surrender
c. All proceedings for reinstatement shall be initiated by the service program , which shall file with the department an application for reinstatement of the authorization. Such application shall be docketed in the original case in which the authorization was revoked, suspended, or relinquished. All proceedings upon the application for reinstatement shall be subject to the same rules of procedure as other cases before the department .
d. An application for reinstatement shall be made in accordance with 132.2(1) and shall contain facts that will be sufficient to enable the department to determine that the basis for the revocation or suspension of the service program 's authorization no longer exists and that it will be in the public interest for the authorization to be reinstated. The burden of proof to establish such facts shall be on the service program .
e. An order denying or granting reinstatement shall be based upon a decision which incorporates findings of facts and conclusions of law. The order shall be published as provided for in this chapter
(4) Out-of-state service programs.
a. An emergency medical service program authorized and based in another state shall provide the department with verification of current state authorization upon request and may provide emergency medical care to patients in Iowa to:
(1) Transport from locations outside of Iowa to destinations within Iowa;
(2) Transport to or from locations outside of Iowa that require travel through Iowa;
(3) Transport from locations in Iowa to destinations outside of Iowa;
(4) Respond to a request for mutual aid.
b. A service program authorized and based in another state shall meet all requirements of Iowa Code chapter 147A and these rules and must be authorized by the department to respond to 911 requests in Iowa to transport patients in Iowa to locations within Iowa.
(5) Service program inspections.
a. The department at a minimum shall complete an inspection of each base of operations, all associated satellites, and all affiliate locations prior to initial authorization or renewal of current full authorization or conditional service level to ensure compliance with Iowa Code chapter 147A and these rules.
b. The department without prior notification may make additional inspections at times, at places and under such circumstances as it deems necessary to ensure compliance with Iowa Code chapter 147A and these rules.
d. Following a service program inspection , the department shall provide a copy of the completed inspection form and report to the service program .
e. A service program shall correct deficiencies identified during a service program inspection within the time period specified by the department on the inspection form. Failure to correct identified deficiencies within the specified time period may result in disciplinary action.
f. The department may request additional information from or may inspect the records of any service program or associated satellite or associated affiliate which is currently authorized or which is seeking authorization to ensure continued compliance or to verify the validity of any information presented on the application for initial service program authorization or renewal of current authorization.
g. The department may inspect the patient care records of a service program to verify compliance with Iowa Code chapter 147A and these rules.
h. No person shall interfere with the inspection activities of the department or its agents pursuant to Iowa Code section 135.36.
i. Interference with or failure to allow an inspection by the department or its agents may be cause for disciplinary action.