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Full Text of HB5446

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HB5446 - 104th General Assembly

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HB5446 Enrolled
LRB104 17942 BAB 31379 b
1

AN ACT concerning regulation.

2

Be it enacted by the People of the State of Illinois,
3
represented in the General Assembly:

4

Section 5.
The Emergency Medical Services (EMS) Systems
5
Act is amended by changing Section 3.85 as follows:

6

(210 ILCS 50/3.85)
7

Sec. 3.85.
Vehicle Service Providers.
8

(a) "Vehicle Service Provider" means an entity licensed by
9
the Department to provide emergency or non-emergency medical
10
services in compliance with this Act, the rules promulgated by
11
the Department pursuant to this Act, and an operational plan
12
approved by its EMS System(s), utilizing at least ambulances
13
or specialized emergency medical service vehicles (SEMSV).
14

(1) "Ambulance" means any publicly or privately owned
15

on-road vehicle that is specifically designed, constructed
16

or modified and equipped, and is intended to be used for,
17

and is maintained or operated for the emergency
18

transportation of persons who are sick, injured, wounded
19

or otherwise incapacitated or helpless, or the
20

non-emergency medical transportation of persons who
21

require the presence of medical personnel to monitor the
22

individual's condition or medical apparatus being used on
23

such individuals.

HB5446 Enrolled
- 2 -
LRB104 17942 BAB 31379 b
1

(2) "Specialized Emergency Medical Services Vehicle"
2

or "SEMSV" means a vehicle or conveyance, other than those
3

owned or operated by the federal government, that is
4

primarily intended for use in transporting the sick or
5

injured by means of air, water, or ground transportation,
6

that is not an ambulance as defined in this Act. The term
7

includes watercraft, aircraft and special purpose ground
8

transport vehicles or conveyances not intended for use on
9

public roads.
10

(3) An ambulance or SEMSV may also be designated as a
11

Limited Operation Vehicle or Special-Use Vehicle:
12

(A) "Limited Operation Vehicle" means a vehicle
13

which is licensed by the Department to provide basic,
14

intermediate or advanced life support emergency or
15

non-emergency medical services that are exclusively
16

limited to specific events or locales.
17

(B) "Special-Use Vehicle" means any publicly or
18

privately owned vehicle that is specifically designed,
19

constructed or modified and equipped, and is intended
20

to be used for, and is maintained or operated solely
21

for the emergency or non-emergency transportation of a
22

specific medical class or category of persons who are
23

sick, injured, wounded or otherwise incapacitated or
24

helpless (e.g. high-risk obstetrical patients,
25

neonatal patients).
26

(C) "Reserve Ambulance" means a vehicle that meets

HB5446 Enrolled
- 3 -
LRB104 17942 BAB 31379 b
1

all criteria set forth in this Section and all
2

Department rules, except for the required inventory of
3

medical supplies and durable medical equipment, which
4

may be rapidly transferred from a fully functional
5

ambulance to a reserve ambulance without the use of
6

tools or special mechanical expertise.
7

(b) The Department shall have the authority and
8
responsibility to:
9

(1) Require all Vehicle Service Providers, both
10

publicly and privately owned, to function within an EMS
11

System.
12

(2) Require a Vehicle Service Provider utilizing
13

ambulances to have a primary affiliation with an EMS
14

System within the EMS Region in which its Primary Service
15

Area is located, which is the geographic areas in which
16

the provider renders the majority of its emergency
17

responses. This requirement shall not apply to Vehicle
18

Service Providers which exclusively utilize Limited
19

Operation Vehicles.
20

(3) Establish licensing standards and requirements for
21

Vehicle Service Providers, through rules adopted pursuant
22

to this Act, including but not limited to:
23

(A) Vehicle design, specification, operation and
24

maintenance standards, including standards for the use
25

of reserve ambulances;
26

(B) Equipment requirements;

HB5446 Enrolled
- 4 -
LRB104 17942 BAB 31379 b
1

(C) Staffing requirements; and
2

(D) License renewal at intervals determined by the
3

Department, which shall be not less than every 4
4

years.
5

The Department's standards and requirements with
6

respect to vehicle staffing for private, nonpublic local
7

government employers must allow for alternative staffing
8

models that include an EMR with a licensed EMT, EMT-I,
9

A-EMT, Paramedic, or PHRN, as appropriate, pursuant to the
10

approval of the EMS System Program Plan developed and
11

approved by the EMS Medical Director for an EMS System.
12

The EMS personnel licensed at the highest level shall
13

provide the initial assessment of the patient to determine
14

the level of care required for transport to the receiving
15

health care facility, and this assessment shall be
16

documented in the patient care report and documented with
17

online medical control. The EMS personnel licensed at or
18

above the level of care required by the specific patient
19

as directed by the EMS Medical Director shall be the
20

primary care provider en route to the destination facility
21

or patient's residence. The Department shall monitor the
22

implementation and performance of alternative staffing
23

models and may issue a notice of termination of an
24

alternative staffing model only upon evidence that an EMS
25

System Program Plan is not being adhered to. Adoption of
26

an alternative staffing model shall not result in a

HB5446 Enrolled
- 5 -
LRB104 17942 BAB 31379 b
1

Vehicle Service Provider being prohibited or limited in
2

the utilization of its staff or equipment from providing
3

any of the services authorized by this Act or as otherwise
4

outlined in the approved EMS System Program Plan,
5

including, without limitation, the deployment of resources
6

to provide out-of-state disaster response. EMS System
7

Program Plans must address a process for out-of-state
8

disaster response deployments that must meet the
9

following:
10

(A) All deployments to provide out-of-state
11

disaster response must first be approved by the EMS
12

Medical Director and submitted to the Department.
13

(B) The submission must include the number of
14

units being deployed, vehicle identification numbers,
15

length of deployment, and names of personnel and their
16

licensure level.
17

(C) Ensure that all necessary in-state requests
18

for services will be covered during the duration of
19

the deployment.
20

An EMS System Program Plan for a Basic Life Support,
21

advanced life support, and critical care transport
22

utilizing an EMR and an EMT shall include the following:
23

(A) Alternative staffing models for a Basic Life
24

Support transport utilizing an EMR shall only be
25

utilized for interfacility Basic Life Support
26

transports as specified by the EMS System Program Plan

HB5446 Enrolled
- 6 -
LRB104 17942 BAB 31379 b
1

as determined by the EMS System Medical Director.
2

(B) Protocols that shall include dispatch
3

procedures to properly screen and assess patients for
4

EMR-staffed transports.
5

(C) A requirement that a provider and EMS System
6

shall implement a quality assurance plan that shall
7

include for the initial waiver period the review of at
8

least 5% of total interfacility transports utilizing
9

an EMR with mechanisms outlined to audit dispatch
10

screening, reason for transport, patient diagnosis,
11

level of care, and the outcome of transports
12

performed. Quality assurance reports must be submitted
13

and reviewed by the provider and EMS System monthly
14

and made available to the Department upon request. The
15

percentage of transports reviewed under quality
16

assurance plans for renewal periods shall be
17

determined by the EMS Medical Director, however, it
18

shall not be less than 3%.
19

(D) The EMS System Medical Director shall develop
20

a minimum set of requirements for individuals based on
21

level of licensure that includes education, training,
22

and credentialing for all team members identified to
23

participate in an alternative staffing plan. The EMT,
24

Paramedic, PHRN, PHPA, PHAPRN, and critical care
25

transport staff shall have the minimum experience in
26

performance of pre-hospital and inter-hospital care,

HB5446 Enrolled
- 7 -
LRB104 17942 BAB 31379 b
1

as determined by the EMS Medical Director in
2

accordance with the EMS System Program Plan, but at a
3

minimum of 6 months of prehospital experience or at
4

least 50 documented patient care interventions during
5

transport as the primary care provider and approved by
6

the Department.
7

(E) The licensed EMR must complete a defensive
8

driving course prior to participation in the
9

Department's alternative staffing model.
10

(F) The length of the EMS System Program Plan for a
11

Basic Life Support transport utilizing an EMR shall be
12

for one year, and must be renewed annually if proof of
13

the criteria being met is submitted, validated, and
14

approved by the EMS Medical Director for the EMS
15

System and the Department.
16

(G) Beginning July 1, 2023, the utilization of
17

EMRs for advanced life support transports and Tier III
18

Critical Care Transports shall be allowed for periods
19

not to exceed 3 years under a pilot program. The pilot
20

program shall not be implemented before Department
21

approval. Agencies requesting to utilize this staffing
22

model for the time period of the pilot program must
23

complete the following:
24

(i) Submit a waiver request to the Department
25

requesting to participate in the pilot program
26

with specific details of how quality assurance and

HB5446 Enrolled
- 8 -
LRB104 17942 BAB 31379 b
1

improvement will be gathered, measured, reported
2

to the Department, and reviewed and utilized
3

internally by the participating agency.
4

(ii) Submit a signed approval letter from the
5

EMS System Medical Director approving
6

participation in the pilot program.
7

(iii) Submit updated EMS System plans,
8

additional education, and training of the EMR and
9

protocols related to the pilot program.
10

(iv) Submit agency policies and procedures
11

related to the pilot program.
12

(v) Submit the number of individuals currently
13

participating and committed to participating in
14

education programs to achieve a higher level of
15

licensure at the time of submission.
16

(vi) Submit an explanation of how the provider
17

will support individuals obtaining a higher level
18

of licensure and encourage a higher level of
19

licensure during the year of the alternative
20

staffing plan and specific examples of recruitment
21

and retention activities or initiatives.
22

Upon submission of a renewal application and
23

recruitment and retention plan, the provider shall
24

include additional data regarding current employment
25

numbers, attrition rates over the year, and activities
26

and initiatives over the previous year to address

HB5446 Enrolled
- 9 -
LRB104 17942 BAB 31379 b
1

recruitment and retention.
2

The information required under this subparagraph
3

(G) shall be provided to and retained by the EMS System
4

upon initial application and renewal and shall be
5

provided to the Department upon request.
6

The Department must allow for an alternative rural
7

staffing model for those vehicle service providers that
8

serve a rural or semi-rural population of 10,000 or fewer
9

inhabitants and exclusively uses volunteers, paid-on-call,
10

or part-time employees,
or a combination thereof.
The
11

changes made by this amendatory Act of the 104th General
12

Assembly do not apply to employees covered by a collective
13

bargaining agreement.
14

(4) License all Vehicle Service Providers that have
15

met the Department's requirements for licensure, unless
16

such Provider is owned or licensed by the federal
17

government. All Provider licenses issued by the Department
18

shall specify the level and type of each vehicle covered
19

by the license (BLS, ILS, ALS, ambulance, critical care
20

transport, SEMSV, limited operation vehicle, special use
21

vehicle, reserve ambulance).
22

(5) Annually inspect all licensed vehicles operated by
23

Vehicle Service Providers.
24

(6) Suspend, revoke, refuse to issue or refuse to
25

renew the license of any Vehicle Service Provider, or that
26

portion of a license pertaining to a specific vehicle

HB5446 Enrolled
- 10 -
LRB104 17942 BAB 31379 b
1

operated by the Provider, after an opportunity for a
2

hearing, when findings show that the Provider or one or
3

more of its vehicles has failed to comply with the
4

standards and requirements of this Act or rules adopted by
5

the Department pursuant to this Act.
6

(7) Issue an Emergency Suspension Order for any
7

Provider or vehicle licensed under this Act, when the
8

Director or his designee has determined that an immediate
9

and serious danger to the public health, safety and
10

welfare exists. Suspension or revocation proceedings which
11

offer an opportunity for hearing shall be promptly
12

initiated after the Emergency Suspension Order has been
13

issued.
14

(8) Exempt any licensed vehicle from subsequent
15

vehicle design standards or specifications required by the
16

Department, as long as said vehicle is continuously in
17

compliance with the vehicle design standards and
18

specifications originally applicable to that vehicle, or
19

until said vehicle's title of ownership is transferred.
20

(9) Exempt any vehicle (except an SEMSV) which was
21

being used as an ambulance on or before December 15, 1980,
22

from vehicle design standards and specifications required
23

by the Department, until said vehicle's title of ownership
24

is transferred. Such vehicles shall not be exempt from all
25

other licensing standards and requirements prescribed by
26

the Department.

HB5446 Enrolled
- 11 -
LRB104 17942 BAB 31379 b
1

(10) Prohibit any Vehicle Service Provider from
2

advertising, identifying its vehicles, or disseminating
3

information in a false or misleading manner concerning the
4

Provider's type and level of vehicles, location, primary
5

service area, response times, level of personnel,
6

licensure status or System participation.
7

(10.5) Prohibit any Vehicle Service Provider, whether
8

municipal, private, or hospital-owned, from advertising
9

itself as a critical care transport provider unless it
10

participates in a Department-approved EMS System critical
11

care transport plan.
12

(11) Charge each Vehicle Service Provider a fee per
13

transport vehicle, due annually at time of inspection. The
14

fee per transport vehicle shall be set by administrative
15

rule by the Department and shall not exceed 100 vehicles
16

per provider.
17

(12) Beginning July 1, 2023, as part of a pilot
18

program that shall not exceed a term of 3 years, an
19

ambulance may be upgraded to a higher level of care for
20

interfacility transports by an ambulance assistance
21

vehicle with appropriate equipment and licensed personnel
22

to intercept with the licensed ambulance at the sending
23

facility before departure. The pilot program shall not be
24

implemented before Department approval. To participate in
25

the pilot program, an agency must:
26

(A) Submit a waiver request to the Department with

HB5446 Enrolled
- 12 -
LRB104 17942 BAB 31379 b
1

intercept vehicle vehicle identification numbers,
2

calls signs, equipment detail, and a robust quality
3

assurance plan that shall list, at minimum, detailed
4

reasons each intercept had to be completed, barriers
5

to initial dispatch of advanced life support services,
6

and how this benefited the patient.
7

(B) Report to the Department quarterly additional
8

data deemed meaningful by the providing agency along
9

with the data required under subparagraph (A) of this
10

paragraph (12).
11

(C) Obtain a signed letter of approval from the
12

EMS Medical Director allowing for participation in the
13

pilot program.
14

(D) Update EMS System plans and protocols from the
15

pilot program.
16

(E) Update policies and procedures from the
17

agencies participating in the pilot program.
18
(Source: P.A. 102-623, eff. 8-27-21; 103-547, eff. 8-11-23.)

19

Section 99.
Effective date.
This Act takes effect upon
20
becoming law.

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