46th legislature - STATE OF NEW MEXICO - first session, 2003

RELATING TO PUBLIC REGULATION; TRANSFERRING THE REGULATION OF AMBULANCE SERVICES FROM THE PUBLIC REGULATION COMMISSION TO THE DEPARTMENT OF HEALTH; AMENDING AND ENACTING SECTIONS OF THE NMSA 1978.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:

Section 1. Section 5-1-1 NMSA 1978 (being Laws 1967, Chapter 167, Section 1, as amended) is amended to read:

"5-1-1. POLITICAL SUBDIVISIONS--AMBULANCE SERVICE.--

A. A municipality or county may:

[A.] (1) provide ambulance service to transport sick or injured persons to a place of treatment in the absence of an established ambulance service only as authorized by the [state corporation commission] department of health;

[B.] (2) contract with other political subdivisions or with private ambulance services for the operation of its ambulance service;

[C.] (3) lease ambulances and other equipment necessary to the operation of its ambulance service;

[D.] (4) in the course of its operation of an ambulance service, proceed to the scene of a disaster beyond its subdivision boundaries when requested, providing no local established ambulance service is available or, if one exists, such local ambulance service deems [their] its capacity inadequate or insufficient for emergency transportation of the disaster victims; and

[E.] (5) transport sick or injured persons from the subdivision boundaries to any place of treatment.

[and

F.] B. No personal action shall be maintained in [any] a court of this state against [any] a member or officer of a political subdivision for [any] a tort or act done, or attempted to be done, when done by the authority of the political subdivision or in execution of its orders under this section. In all such cases, political subdivisions shall be responsible. [Any] A member or officer of the political subdivision may plead the provisions of this section in bar of such action whether it is now pending or hereafter commenced."

Section 2. Section 24-10B-3 NMSA 1978 (being Laws 1993, Chapter 161, Section 2) is amended to read:

"24-10B-3. DEFINITIONS.--As used in the Emergency Medical Services Act:

A. "academy" means a separately funded emergency medical services training program administered through the department of emergency medicine of the university of New Mexico school of medicine;

B. "advance directive" means a written instruction, such as a living will or durable power of attorney for health care, recognizable under state law and relating to the provision of health care when an individual is incapacitated;

C. "advanced life support" means advanced pre-hospital and interfacility care and treatment, including basic and intermediate life support, as prescribed by regulation, which may be performed only by an individual licensed as a paramedic by the bureau and operating under medical direction;

D. "air ambulance service" means [any] a governmental or private service that provides air transportation specifically designed to accommodate the medical needs of a person who is ill, injured or otherwise mentally or physically incapacitated and who requires in-flight medical supervision;

E. "approved emergency medical services training program" means an emergency medical services training program that is sponsored by a post-secondary educational institution, is accredited by the joint review committee on educational programs or active in the accreditation process, as verified by the chair of the joint review committee on educational programs, or is approved by the joint organization on education and participates in the joint organization on education;

F. "basic life support" means pre-hospital and interfacility care and treatment, as prescribed by regulation, [which] that can be performed by all licensed emergency medical technicians;

G. "bureau" means the primary care and emergency medical services bureau of the public health division of the department [of health];

H. "certified emergency medical services first responder" means a person who is certified by the bureau and who functions within the emergency medical services system to provide initial emergency aid, but not basic, intermediate or advanced life support, to a person in need of medical assistance;

I. "critical incident stress debriefing program" means a program of preventive education and crisis intervention intended to reduce the negative effects of critical stress on emergency responders;

J. "curricula" means programs of study, the minimum content of which has been developed by the joint organization on education, for the initial and mandatory refresher training of emergency medical technicians and certified emergency medical services first responders;

K. "department" means the department of health;

L. "emergency medical dispatcher" means a person who is trained and certified pursuant to Subsection [F] G of Section 24-10B-4 NMSA 1978 to receive calls for emergency medical assistance, provide pre-arrival medical instructions, dispatch emergency medical assistance and coordinate its response;

M. "emergency medical services" means the services rendered by emergency medical technicians, certified emergency medical services first responders or emergency medical dispatchers in response to an individual's need for immediate medical care to prevent loss of life or aggravation of physical or psychological illness or injury;

N. "emergency medical services system" means a coordinated system of health care delivery that includes community education and prevention programs, centralized access and emergency medical dispatch, trained first responders, medical-rescue services, ambulance services, hospital emergency departments and specialty care hospitals that respond to the needs of the acutely sick and injured;

O. "emergency medical technician" means a health care provider who has been licensed to practice by the bureau;

P. "intermediate life support" means certain advanced pre-hospital and interfacility care and treatment, including basic life support, as prescribed by regulation, [which] that may be performed only by an individual licensed by the bureau and operating under medical direction;

Q. "joint review committee" means the joint review committee on educational programs for the emergency medical technician-paramedic, a nonprofit organization incorporated in the state of Massachusetts;

R. "medical control" means supervision provided by or under the direction of physicians to providers by written protocol or direct communications;

S. "medical direction" means guidance or supervision provided by a physician to a provider or emergency medical services system and [which] that includes authority over and responsibility for emergency medical dispatch, direct patient care and transport of patients, arrangements for medical control and all other aspects of patient care delivered by a provider;

T. "medical-rescue service" means a provider that is part of the emergency medical services system, but not subject to the authority of the [state corporation commission] department under the Ambulance Standards Act, and [which] that may be dispatched to the scene of an emergency to provide rescue or medical care;

U. "physician" means a doctor of medicine or doctor of osteopathy who is licensed or otherwise authorized to practice medicine or osteopathic medicine in New Mexico;

V. "protocol" means a predetermined, written medical care plan and includes standing orders;

W. "provider" means a person or entity delivering emergency medical services;

X. "regional office" means a regional emergency medical services planning and development agency formally recognized and supported by the bureau;

Y. "secretary" means the secretary of health;

Z. "special skills" means a set of procedures or therapies that are beyond the usual scope of practice of a given level of life support and that have been approved by the medical direction committee for use by a specified provider; and

AA. "state emergency medical services medical director" means a physician employed by the bureau to provide overall medical direction to the statewide emergency medical services program, whose duties include serving as a liaison to the medical community and chairing the medical direction committee."

Section 3. Section 24-10B-4 NMSA 1978 (being Laws 1983, Chapter 190, Section 4, as amended) is amended to read:

"24-10B-4. BUREAU--DUTIES.--The bureau is designated as the lead agency for the emergency medical services system and shall establish and maintain a program for regional planning and development, improvement, expansion and direction of emergency medical services throughout the state, including:

A. design, development, implementation and coordination of communications systems to join the personnel, facilities and equipment of a given region or system that will allow for medical control of pre-hospital or interfacility care;

[B. provision of technical assistance to the public regulation commission for further development and implementation of standards for certification of ambulance services, vehicles and equipment;

C.] B. development of requirements for the collection of data and statistics to evaluate the availability, operation and quality of providers in the state;

[D.] C. adoption of [regulations] rules for medical direction of a provider or emergency medical services system upon the recommendation of the medical direction committee, including:

(1) development of model guidelines for medical direction of all components of an emergency medical services system;

(2) a process for notifying the bureau of the withdrawal of medical control by a physician from a provider; and

(3) specific requirements for medical direction of intermediate and advanced life support personnel and basic life support personnel with special skills approval;

[E.] D. maintenance of a list of approved emergency medical services training programs, the graduates of which shall be the only New Mexico emergency medical services students eligible to apply for emergency medical technician licensure or certified emergency medical services first responder certification;

[F.] E. approval of continuing education programs for emergency medical services personnel;

[G.] F. adoption of [regulations] rules pertaining to the training and certification of emergency medical dispatchers and their instructors;

[H.] G. adoption of [regulations] rules based upon the recommendations of the trauma advisory committee, for implementation and monitoring of a statewide, comprehensive trauma care system, including:

(1) minimum standards for designation or retention of designation as a trauma center or a participating trauma facility;

(2) pre-hospital care management guidelines for the triage and transportation of traumatized persons;

(3) establishment for interfacility transfer criteria and transfer agreements;

(4) standards for collection of data relating to trauma system operation, patient outcome and trauma prevention; and

(5) creation of a state trauma care plan;

[I.] H. adoption of [regulations] rules, based upon the recommendations of the air transport advisory committee, for the certification of air ambulance services;

[J.] I. adoption of [regulations] rules pertaining to authorization of providers to honor advance directives to withhold or terminate care in certain pre-hospital or interfacility circumstances, as guided by local medical protocols;

[K.] J. development of guidelines, with consultation from the state fire marshal, pertaining to the operation of medical-rescue services within the emergency medical services system;

[L.] K. operation of a critical incident stress debriefing program for emergency responders utilizing specifically trained volunteers who shall be considered public employees for the purposes of the Tort Claims Act when called upon to perform a debriefing; and

[M.] L. adoption of rules to establish a cardiac arrest targeted response program pursuant to the Cardiac Arrest Response Act, including registration of automated external defibrillator programs, maintenance of equipment, data collection, approval of automated external defibrillator training programs and a schedule of automated external defibrillator program registration fees."

Section 4. Section 24-10B-5 NMSA 1978 (being Laws 1983, Chapter 190, Section 5, as amended) is amended to read:

"24-10B-5. PERSONNEL LICENSURE REQUIRED.--

A. The department shall by regulation adopt and enforce licensure and certification requirements, including minimum standards for training, continuing education and disciplinary actions consistent with the Uniform Licensing Act, for all persons who provide emergency medical services within the state, irrespective of whether the services are remunerated. Such regulation shall include authorization for the bureau to issue at least annually an updated list of skills, techniques and medications approved for use at each level of life support. [When setting requirements for licensure of persons also subject to the Ambulance Standards Act, the bureau shall consult with the state corporation commission.]

B. In addition to the requirements specified in Subsection A of this section, the department may:

(1) prohibit the use of "emergency medical dispatcher", "emergency medical technician", "certified emergency medical services first responder", "paramedic" or similar terms connoting expertise in providing emergency medical services by any person not licensed or certified under the Emergency Medical Services Act;

(2) deny, suspend or revoke licensure or certification in accordance with the provisions of the Uniform Licensing Act; and

(3) establish a schedule of reasonable fees for application, examination, licensure or certification and regular renewal thereof."

Section 5. Section 27-5-4 NMSA 1978 (being Laws 1965, Chapter 234, Section 4, as amended by Laws 2001, Chapter 30, Section 1, Laws 2001, Chapter 272, Section 1 and also by Laws 2001, Chapter 280, Section 1) is amended to read:

"27-5-4. DEFINITIONS.--As used in the Indigent Hospital and County Health Care Act:

A. "ambulance provider" or "ambulance service" means a specialized carrier based within the state authorized [under] pursuant to provisions and subject to limitations as provided in individual carrier certificates issued by the [public regulation commission] department of health to transport persons alive, dead or dying en route by means of ambulance service. The rates and charges established by public regulation commission tariff shall govern as to allowable cost. Also included are air ambulance services approved by the board. The air ambulance service charges shall be filed and approved pursuant to Subsection D of Section 27-5-6 NMSA 1978 and Section 27-5-11 NMSA 1978;

B. "board" means a county indigent hospital and county health care board;

C. "indigent patient" means a person to whom an ambulance service, a hospital or a health care provider has provided medical care, ambulance transportation or health care services and who can normally support himself and his dependents on present income and liquid assets available to him but, taking into consideration this income and those assets and his requirement for other necessities of life for himself and his dependents, is unable to pay the cost of the ambulance transportation or medical care administered or both. If provided by resolution of a board, it shall not include [any] person whose annual income together with his spouse's annual income totals an amount that is fifty percent greater than the per capita personal income for New Mexico as shown for the most recent year available in the survey of current business published by the United States department of commerce. [Every] A board that has a balance remaining in the fund at the end of a given fiscal year shall consider and may adopt at the first meeting of the succeeding fiscal year a resolution increasing the standard for indigency. The term "indigent patient" includes a minor who has received ambulance transportation or medical care or both and whose parent or the person having custody of that minor would qualify as an indigent patient if transported by ambulance or admitted to a hospital for care or treated by a health care provider or all three;

D. "hospital" means a general or limited hospital licensed by the department of health, whether nonprofit or owned by a political subdivision, and may include by resolution of a board the following health facilities if licensed or, in the case of out-of-state hospitals, approved, by the department of health:

(l) for-profit hospitals;

(2) state-owned hospitals; or

(3) licensed out-of-state hospitals where treatment provided is necessary for the proper care of an indigent patient when that care is not available in an in-state hospital;

E. "cost" means all allowable ambulance transportation costs, medical care costs or costs of providing health care services, to the extent determined by resolution of a board, for an indigent patient. Allowable costs shall be determined in accordance with a uniform system of accounting and cost analysis as determined by regulation of a board, which includes cost of ancillary services but shall not include the cost of servicing long-term indebtedness of a hospital, health care provider or ambulance service;

F. "fund" means a county indigent hospital claims fund;

G. "medicaid eligible" means a person who is eligible for medical assistance from the department;

H. "county" means [any] a county, except a class A county, with a county hospital operated and maintained pursuant to a lease with a state educational institution named in Article 12, Section 11 of the constitution of New Mexico;

I. "department" means the human services department;

J. "sole community provider hospital" means:

(1) a hospital that is a sole community provider hospital under the provisions of the federal medicare guidelines established in 42 C.F.R. 412.92 pursuant to Title 18 of the federal Social Security Act; or

(2) an acute care general hospital licensed by the department of health that is qualified, pursuant to rules adopted by the state agency primarily responsible for the medicaid program, to receive distributions from the sole community provider fund;

K. "drug rehabilitation center" means an agency of local government, a state agency, a private nonprofit entity or combination thereof that operates drug abuse rehabilitation programs that meet the standards and requirements set by the department of health;

L. "alcohol rehabilitation center" means an agency of local government, a state agency, a private nonprofit entity or combination thereof that operates alcohol abuse rehabilitation programs that meet the standards set by the department of health;

M. "mental health center" means a not-for-profit center that provides outpatient mental health services that meet the standards set by the department of health;

N. "health care provider" means:

(1) a nursing home;

(2) an in-state home health agency;

(3) an in-state licensed hospice;

(4) a community-based health program operated by a political subdivision of the state or other nonprofit health organization that provides prenatal care delivered by New Mexico licensed, certified or registered health care practitioners;

(5) a community-based health program operated by a political subdivision of the state or other nonprofit health care organization that provides primary care delivered by New Mexico licensed, certified or registered health care practitioners;

(6) a drug rehabilitation center;

(7) an alcohol rehabilitation center;

(8) a mental health center; or

(9) a licensed medical doctor, osteopathic physician, dentist, optometrist or expanded practice nurse when providing services in a hospital or outpatient setting that are necessary for conditions that endanger the life of or threaten permanent disability to an indigent patient;

O. "health care services" means all treatment and services designed to promote improved health in the county indigent population, including primary care, prenatal care, dental care, provision of prescription drugs, preventive care or health outreach services, to the extent determined by resolution of the board;

P. "planning" means the development of a countywide or multicounty health plan to improve and fund health services in the county based on the county's needs assessment and inventory of existing services and resources and that demonstrates coordination between the county and state and local health planning efforts; and

Q. "commission" means the New Mexico health policy

commission."

Section 6. Section 65-6-2 NMSA 1978 (being Laws 1974, Chapter 82, Section 2, as amended) is amended to read:

"65-6-2. DEFINITIONS.--As used in the Ambulance Standards Act:

A. "ambulance" means a vehicle, including motor vehicles or watercraft, designed and used or intended to be used for the transportation of sick or injured persons;

B. "driver" means a person who, on a regular or irregular basis, either paid or voluntary, serves as the operator of an ambulance;

C. "attendant" means a person who, on a regular or irregular basis, either paid or voluntary, serves as an assistant to the driver in the operation of [the] an ambulance; and

[D. "commission" means the public regulation commission]

D. "department" means the department of health."

Section 7. Section 65-6-4 NMSA 1978 (being Laws 1974, Chapter 82, Section 4) is amended to read:

"65-6-4. [CORPORATION COMMISSION] DEPARTMENT--DUTIES.--

A. The [corporation commission in accordance with its responsibilities to regulate common carriers, shall, within one year of the effective date of this Act, hold public hearings as prescribed in Article 27 of Chapter 64 NMSA 1953 and] department shall adopt regulations:

[A.] (1) for the establishment of reasonable, flexible standards for ambulances, including but not limited to:

[(1)] (a) vehicle design;

[(2)] (b) health and safety equipment to be maintained and used in ambulances;

[(3)] (c) procedures for the operation of ambulances; and

[(4)] (d) at least annual inspection of [ambulances] ambulances; and

[B.] (2) for the licensure of all [ambulance] drivers and attendants, to include:

[(1) minumun] (a) minimum training requirements to include basic and advanced red cross and such other available training as the [commission] department finds reasonable and in the best interests of the public; and

[(2)] (b) a written and practical examination of competence limited to that material, information and training required of [ambulance] drivers and attendants, respectively, in the regulations adopted by the [corporation commission] department.

B. In establishing standards for ambulances, the [commission] department shall give serious consideration to the vehicle needs and limitations imposed by the topography and road and weather conditions of various localities. Further, the [commission] department shall take into consideration the resources of the various communities, institutions and sponsoring organizations providing ambulance service to the public."

Section 8. Section 65-6-5 NMSA 1978 (being Laws 1974, Chapter 82, Section 5) is amended to read:

"65-6-5. APPLICABILITY OF ACT.--Upon the effective date of the Ambulance Standards Act, all ambulances operating in New Mexico, except those excluded in Section [6] 65-6-6 NMSA 1978, shall be issued a three-year certificate of public convenience and necessity by the [state corporation commission] department."

Section 9. EFFECTIVE DATE.--The effective date of the provisions of this act is July 1, 2003.