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

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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 [email protected].

 

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_11 Gender

E06_12 Race

E06_13 Ethnicity

E06_14 Age

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_03 Procedure

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. 

 

ARM 37.104.106

 

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.

 

ARM 37.104.212

 

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.

 

Fiscal Impact

 

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 protected], 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.