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HB-5249, As Passed Senate, July 3, 2026
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SUBSTITUTE FOR
HOUSE BILL NO. 5249
A bill to amend 1978 PA 368, entitled
"Public health code,"
by amending section 20920 (MCL 333.20920), as amended by 2014 PA
413.
THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
Sec. 20920. (1) A person shall not establish, operate, or 1
cause to be operated an ambulance operation unless the ambulance 2
operation is licensed under this section. 3
(2) Upon proper application and payment of a $100.00 fee, the 4
department shall issue a license as an ambulance operation to a 5
person who meets the requirements of this part and the rules 6
promulgated under this part. 7
(3) An applicant shall specify in the application each 8
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ambulance to be operated. 1
(4) An ambulance operation license shall specify the 2
ambulances licensed to be operated. 3
(5) An ambulance operation license shall state the highest 4
level of life support the ambulance operation is licensed to 5
provide. An ambulance operation shall operate in accordance with 6
this part, rules promulgated under this part, and approved medical 7
control authority protocols and, except as provided in section 8
20921a(2), shall not provide life support at a level that exceeds 9
its license and available licensed personnel or violates approved 10
medical control authority protocols. 11
(6) An ambulance operation license may be renewed annually 12
upon application to the department and payment of a $100.00 renewal 13
fee. Before issuing a renewal license, the department shall 14
determine that the ambulance operation is in compliance with this 15
part, the rules promulgated under this part, and medical control 16
authority protocols. 17
(7) Beginning on July 22, 1997, an ambulance operation that 18
meets all of the following requirements may apply for an ambulance 19
operation upgrade license under subsection (8): 20
(a) On or before July 22, 1997, holds an ambulance operation 21
license that designates the ambulance operation either as a 22
transporting basic life support service or as a transporting 23
limited advanced life support service. 24
(b) Is a transporting basic life support service, that is able 25
to staff and equip 1 or more ambulances for the transport of 26
emergency patients at a life support level higher than basic life 27
support, or is a transporting limited advanced life support 28
service, that is able to staff and equip 1 or more ambulances for 29
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the transport of emergency patients at the life support level of 1
advanced life support. 2
(c) Is owned or operated by or under contract to a local 3
governmental unit of government and providing first-line emergency 4
medical response to that local governmental unit of government on 5
or before July 22, 1997. 6
(d) Will provide the services described in subdivision (b) 7
only to the local governmental unit of government described in 8
subdivision (c), and only in response to a 911 9-1-1 call or other 9
call for emergency transport. 10
(8) An ambulance operation meeting the requirements of 11
subsection (7) that applies for an ambulance operation upgrade 12
license shall include all of the following information in the 13
application provided by the department: 14
(a) Verification of all of the requirements of subsection (7) 15
including, but not limited to, a description of the staffing and 16
equipment to be used in providing the higher level of life support 17
services. 18
(b) If the applicant is a transporting basic life support 19
service, a plan of action to upgrade from providing basic life 20
support to providing limited advanced life support or advanced life 21
support to take place over a period of not more than 2 years. If 22
the applicant is a transporting limited advanced life support 23
service, a plan of action to upgrade from providing limited 24
advanced life support to providing advanced life support to take 25
place over a period of not more than 2 years. 26
(c) The medical control authority protocols for the ambulance 27
operation upgrade license, along with a recommendation from the 28
medical control authority under which the ambulance operation 29
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operates that the ambulance operation upgrade license be issued by 1
the department. 2
(d) Other information required by the department. 3
(9) The statewide emergency medical services coordination 4
committee shall review the information described in subsection 5
(8)(c) and make a recommendation to the department as to whether or 6
not an ambulance operation upgrade license should be granted to the 7
applicant. 8
(10) Upon receipt of a completed application as required under 9
subsection (8), a positive recommendation under subsection (9), and 10
payment of a $100.00 fee, the department shall issue to the 11
applicant an ambulance operation upgrade license. Subject to 12
subsection (12), the license is valid for 2 years from the date of 13
issuance and is renewable for 1 additional 2-year period. An 14
application for renewal of an ambulance operation upgrade license 15
shall must contain documentation of the progress made on the plan 16
of action described in subsection (8)(b). In addition, the medical 17
control authority under which the ambulance operation operates 18
shall annually file with the statewide emergency medical services 19
coordination committee a written report on the progress made by the 20
ambulance operation on the plan of action described in subsection 21
(8)(b), including, but not limited to, information on training, 22
equipment, and personnel. 23
(11) If an ambulance operation is designated by its regular 24
license as providing basic life support services, then an ambulance 25
operation upgrade license issued under this section allows the 26
ambulance operation to provide limited advanced life support 27
services or advanced life support services when the ambulance 28
operation is able to staff and equip 1 or more ambulances to 29
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provide services at the higher levels. If an ambulance operation is 1
designated by its regular license as providing limited advanced 2
life support services, then an ambulance operation upgrade license 3
issued under this section allows the ambulance operation to provide 4
advanced life support services when the ambulance operation is able 5
to staff and equip 1 or more ambulances to provide services at the 6
higher level. An ambulance operation shall not provide services 7
under an ambulance operation upgrade license unless the medical 8
control authority under which the ambulance operation operates has 9
adopted protocols for the ambulance operation upgrade license 10
regarding quality monitoring procedures, use and protection of 11
equipment, and patient care. 12
(12) The department may revoke or fail to renew an ambulance 13
operation upgrade license for a violation of this part or a rule 14
promulgated under this part or for failure to comply with the plan 15
of action filed under subsection (8)(b). An ambulance operation 16
that obtains an ambulance operation upgrade license must annually 17
renew its regular license under subsections (2) to (6). An 18
ambulance operation's regular license is not affected by the 19
following: 20
(a) The fact that the ambulance operation has obtained or 21
renewed an ambulance operation upgrade license. 22
(b) The fact that an ambulance operation's ambulance operation 23
upgrade license is revoked or is not renewed under this subsection. 24
(c) The fact that the ambulance operation's ambulance 25
operation upgrade license expires at the end of the second 2-year 26
period prescribed by subsection (10). 27
(13) Beginning 6 months after the effective date of the 28
amendatory act that added this subsection, an ambulance operation 29
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that meets all of the following requirements may apply for an 1
ambulance operation adaptive care license under subsection (14): 2
(a) Holds an ambulance operation license that designates the 3
ambulance operation as a transporting basic life support service. 4
(b) Was a transporting basic life support service on or before 5
October 1, 2022. 6
(c) Is a transporting basic life support service that is able 7
to staff and equip 1 or more ambulances for the transport of 8
emergency patients at a life support level higher than basic life 9
support. 10
(d) Is owned or operated by or under contract to a local 11
governmental unit and is designated by that local governmental unit 12
as the ambulance operation providing transporting service to that 13
local governmental unit. 14
(e) Will provide the services described in subdivision (c) 15
only to the local governmental unit described in subdivision (d), 16
and only in response to a 9-1-1 call or other call for emergency 17
transport. 18
(14) An ambulance operation meeting the requirements of 19
subsection (13) that applies for an ambulance operation adaptive 20
care license shall include all of the following information in the 21
application provided by the department: 22
(a) Verification of all of the requirements of subsection 23
(13), including, but not limited to, a description of the staffing 24
and equipment to be used in providing the higher level of life 25
support services. 26
(b) The medical control authority protocols for the ambulance 27
operation adaptive care license, along with a recommendation from 28
the medical control authority under which the ambulance operation 29
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operates that the ambulance operation adaptive care license be 1
issued by the department. 2
(c) Other information required by the department. 3
(15) The statewide emergency medical services coordination 4
committee shall review the information described in subsection (14) 5
and make a recommendation to the department as to whether or not an 6
ambulance operation adaptive care license should be granted to the 7
applicant. 8
(16) Upon receipt of a completed application as required under 9
subsection (14) and a positive recommendation under subsection 10
(15), the department shall issue to the applicant an ambulance 11
operation adaptive care license. Subject to subsection (18), the 12
ambulance operation adaptive care license is valid for 4 years from 13
the date of issuance. 14
(17) An ambulance operation adaptive care license issued under 15
this section allows the ambulance operation to provide limited 16
advanced life support services when the ambulance operation is able 17
to staff and equip 1 or more ambulances to provide services at the 18
limited advanced life support level. An ambulance operation shall 19
not provide services under an ambulance operation adaptive care 20
license unless the medical control authority under which the 21
ambulance operation operates has adopted protocols for the 22
ambulance operation adaptive care license regarding quality 23
monitoring procedures, use and protection of equipment, and patient 24
care. 25
(18) The department may revoke or fail to renew an ambulance 26
operation adaptive care license for a violation of this part or a 27
rule promulgated under this part. An ambulance operation that 28
obtains an ambulance operation adaptive care license must annually 29
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renew its regular license under subsections (2) to (6). An 1
ambulance operation's regular license is not affected by the 2
following: 3
(a) The fact that the ambulance operation has obtained or 4
renewed an ambulance operation adaptive care license. 5
(b) The fact that an ambulance operation's ambulance operation 6
adaptive care license is revoked or is not renewed under this 7
subsection. 8
(c) The fact that the ambulance operation's ambulance 9
operation adaptive care license expires as prescribed under 10
subsection (16). 11