1.1                          A bill for an act
  1.2             relating to health; creating an emergency medical 
  1.3             services regulatory board; providing for its 
  1.4             membership; transferring certain duties relating to 
  1.5             emergency medical services from the commissioner of 
  1.6             health to the board; amending Minnesota Statutes 1994, 
  1.7             sections 62N.381, subdivisions 2, 3, and 4; 144.801, 
  1.8             subdivisions 3 and 5; 144.802; 144.803; 144.804; 
  1.9             144.806; 144.807; 144.808; 144.809; 144.8091; 
  1.10            144.8093; 144.8095; 144C.01, subdivision 2; 144C.05, 
  1.11            subdivision 1; 144C.07; 144C.08; 144C.09, subdivision 
  1.12            2; and 144C.10; proposing coding for new law as 
  1.13            Minnesota Statutes, chapter 144D; repealing Minnesota 
  1.14            Statutes 1994, section 144.8097. 
  1.15  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.16                             ARTICLE 1
  1.17            EMERGENCY MEDICAL SERVICES REGULATORY BOARD
  1.18     Section 1.  [INTENT.] 
  1.19     The legislature intends that the transfer required by this 
  1.20  article not increase the level of funding for the functions 
  1.21  transferred. 
  1.22     Sec. 2.  [144D.01] [EMERGENCY MEDICAL SERVICES REGULATORY 
  1.23  BOARD.] 
  1.24     Subdivision 1.  [MEMBERSHIP.] (a) The emergency medical 
  1.25  services regulatory board consists of the following members: 
  1.26     (1) the commissioner of public safety or the commissioner's 
  1.27  designee; 
  1.28     (2) the commissioner of health or the commissioner's 
  1.29  designee; 
  1.30     (3) an emergency physician certified by the American board 
  2.1   of emergency physicians; 
  2.2      (4) a physician who is a medical director for a licensed 
  2.3   ambulance service and state certified emergency medical services 
  2.4   training institution; 
  2.5      (5) a representative of Minnesota hospitals; 
  2.6      (6) a representative of fire chiefs; 
  2.7      (7) a paramedic currently practicing full-time for a 
  2.8   licensed ambulance service; 
  2.9      (8) a representative of ambulance associations; 
  2.10     (9) a representative of sheriffs; 
  2.11     (10) a member of a local board of health to represent 
  2.12  community health services; 
  2.13     (11) three representatives of regional emergency medical 
  2.14  service programs, one of whom must be from the metropolitan 
  2.15  regional emergency medical services program; 
  2.16     (12) one emergency medical technician currently practicing 
  2.17  on an ambulance service; 
  2.18     (13) one registered nurse currently practicing in emergency 
  2.19  medical services; 
  2.20     (14) one state trooper, employed in a nonsupervisory role; 
  2.21     (15) one pediatrician, certified by the American board of 
  2.22  pediatrics, with experience in emergency medical services; and 
  2.23     (16) one public member. 
  2.24     (b) The governor shall appoint members under paragraph (a), 
  2.25  clauses (3) to (15).  Appointments under clauses (3) to (10), 
  2.26  (12), (13), and (15) are subject to advice and consent of the 
  2.27  senate.  In making appointments under clauses (3) to (10), (12), 
  2.28  (13), and (15), the governor shall consider recommendations of 
  2.29  the American college of emergency physicians, the Minnesota 
  2.30  chapter of the association of emergency medical services 
  2.31  physicians, the Minnesota hospital association, the Minnesota 
  2.32  state fire chiefs association, the Minnesota ambulance 
  2.33  association, the Minnesota state sheriff's association, the 
  2.34  association of Minnesota counties, the Minnesota emergency 
  2.35  medical services association, and the Minnesota nurses 
  2.36  association, respectively. 
  3.1      (c) No member appointed under paragraph (a), clauses (3) to 
  3.2   (16), may serve consecutive terms. 
  3.3      (d) At least seven members appointed under paragraph (a), 
  3.4   clauses (3) to (16), must reside outside of the seven-county 
  3.5   metropolitan area, as defined in section 473.121. 
  3.6      Subd. 2.  [EX OFFICIO MEMBERS.] The speaker of the house of 
  3.7   representatives and the committee on rules and administration of 
  3.8   the senate shall appoint one representative and one senator to 
  3.9   serve as ex officio, nonvoting members.  The state medical 
  3.10  director is also an ex officio, nonvoting member. 
  3.11     Subd. 3.  [CHAIR.] The lieutenant governor shall serve as 
  3.12  chair of the board, but may vote only when necessary to break a 
  3.13  tie. 
  3.14     Subd. 4.  [COMPENSATION; TERMS.] Membership terms, 
  3.15  compensation, and removal of members appointed under subdivision 
  3.16  1 are governed by section 15.0575. 
  3.17     Subd. 5.  [STAFF.] The board shall appoint an executive 
  3.18  director and a state medical director.  Both serve in the 
  3.19  unclassified service.  The executive director may appoint other 
  3.20  staff. 
  3.21     Sec. 3.  [TRANSFER.] 
  3.22     The powers and duties of the commissioner of health under 
  3.23  sections 62N.381, 144.801 to 144.8095, and chapter 144C are 
  3.24  transferred to the emergency medical services regulatory board 
  3.25  under section 15.039. 
  3.26     Sec. 4.  [EFFECTIVE DATE.] 
  3.27     Sections 1 to 3 are effective July 1, 1995. 
  3.28                             ARTICLE 2
  3.29                       CONFORMING AMENDMENTS
  3.30     Section 1.  Minnesota Statutes 1994, section 62N.381, 
  3.31  subdivision 2, is amended to read: 
  3.32     Subd. 2.  [RANGE OF RATES.] The reimbursement rate 
  3.33  negotiated for a contract period must not be more than 20 
  3.34  percent above or below the individual ambulance service's 
  3.35  current customary charges, plus the rate of growth allowed under 
  3.36  section 62J.04, subdivision 1.  If the network and ambulance 
  4.1   service cannot agree on a reimbursement rate, each party shall 
  4.2   submit their rate proposal along with supportive data to the 
  4.3   commissioner emergency medical services regulatory board. 
  4.4      Sec. 2.  Minnesota Statutes 1994, section 62N.381, 
  4.5   subdivision 3, is amended to read: 
  4.6      Subd. 3.  [DEVELOPMENT OF CRITERIA.] The commissioner 
  4.7   emergency medical services regulatory board, in consultation 
  4.8   with representatives of the Minnesota Ambulance Association, 
  4.9   regional emergency medical services programs, community 
  4.10  integrated service networks, and integrated service networks, 
  4.11  shall develop guidelines to use in reviewing rate proposals and 
  4.12  making a final reimbursement rate determination. 
  4.13     Sec. 3.  Minnesota Statutes 1994, section 62N.381, 
  4.14  subdivision 4, is amended to read: 
  4.15     Subd. 4.  [REVIEW OF RATE PROPOSALS.] The commissioner 
  4.16  emergency medical services regulatory board, using the 
  4.17  guidelines developed under subdivision 3, shall review the rate 
  4.18  proposals of the ambulance service and community integrated 
  4.19  service network or integrated service network and shall adopt 
  4.20  either the network's or the ambulance service's proposal.  
  4.21  The commissioner board shall require the network and ambulance 
  4.22  service to adhere to this reimbursement rate for the contract 
  4.23  period. 
  4.24     Sec. 4.  Minnesota Statutes 1994, section 144.801, 
  4.25  subdivision 3, is amended to read: 
  4.26     Subd. 3.  [COMMISSIONER BOARD.] "Commissioner" means the 
  4.27  commissioner of health of the state of Minnesota "Board" means 
  4.28  the emergency medical services regulatory board.  
  4.29     Sec. 5.  Minnesota Statutes 1994, section 144.801, 
  4.30  subdivision 5, is amended to read: 
  4.31     Subd. 5.  [LICENSE.] "License" means authority granted by 
  4.32  the commissioner board for the operation of an ambulance service 
  4.33  in the state of Minnesota.  
  4.34     Sec. 6.  Minnesota Statutes 1994, section 144.802, is 
  4.35  amended to read: 
  4.36     144.802 [LICENSING.] 
  5.1      Subdivision 1.  [LICENSES; CONTENTS, CHANGES, AND 
  5.2   TRANSFERS.] No natural person, partnership, association, 
  5.3   corporation or unit of government may operate an ambulance 
  5.4   service within this state unless it possesses a valid license to 
  5.5   do so issued by the commissioner board.  The license shall 
  5.6   specify the base of operations, primary service area, and the 
  5.7   type or types of ambulance service for which the licensee is 
  5.8   licensed.  The licensee shall obtain a new license if it wishes 
  5.9   to establish a new base of operation, or to expand its primary 
  5.10  service area, or to provide a new type or types of service.  A 
  5.11  license, or the ownership of a licensed ambulance service, may 
  5.12  be transferred only after the approval of the commissioner 
  5.13  board, based upon a finding that the proposed licensee or 
  5.14  proposed new owner of a licensed ambulance service meets or will 
  5.15  meet the requirements of section 144.804.  If the proposed 
  5.16  transfer would result in a change in or addition of a new base 
  5.17  of operations, expansion of the service's primary service area, 
  5.18  or provision of a new type or types of ambulance service, 
  5.19  the commissioner board shall require the prospective licensee or 
  5.20  owner to comply with subdivision 3.  The commissioner board may 
  5.21  approve the license or ownership transfer prior to completion of 
  5.22  the application process described in subdivision 3 upon 
  5.23  obtaining written assurances from the proposed licensee or 
  5.24  proposed new owner that no change in the service's base of 
  5.25  operations, expansion of the service's primary service area, or 
  5.26  provision of a new type or types of ambulance service will occur 
  5.27  during the processing of the application.  The cost of licenses 
  5.28  shall be in an amount prescribed by the commissioner board 
  5.29  pursuant to section 144.122.  Licenses shall expire and be 
  5.30  renewed as prescribed by the commissioner pursuant to section 
  5.31  144.122.  Fees collected shall be deposited to the trunk highway 
  5.32  fund. 
  5.33     Subd. 2.  [REQUIREMENTS FOR NEW LICENSES.] The commissioner 
  5.34  board shall not issue a license authorizing the operation of a 
  5.35  new ambulance service, provision of a new type or types of 
  5.36  ambulance service by an existing service, or establishment of a 
  6.1   new base of operation or an expanded primary service area for an 
  6.2   existing service unless the requirements of sections 144.801 to 
  6.3   144.807 are met.  
  6.4      Subd. 3.  [APPLICATIONS; NOTICE OF APPLICATION; 
  6.5   RECOMMENDATIONS.] (a) Each prospective licensee and each present 
  6.6   licensee wishing to offer a new type or types of ambulance 
  6.7   service, to establish a new base of operation, or to expand a 
  6.8   primary service area, shall make written application for a 
  6.9   license to the commissioner board on a form provided by the 
  6.10  commissioner board.  
  6.11     (b) For applications for the provision of ambulance 
  6.12  services in a service area located within a county, the 
  6.13  commissioner board shall promptly send notice of the completed 
  6.14  application to the county board and to each community health 
  6.15  board, governing body of a regional emergency medical services 
  6.16  system designated under section 144.8093, ambulance service, and 
  6.17  municipality in the area in which ambulance service would be 
  6.18  provided by the applicant.  The commissioner board shall publish 
  6.19  the notice, at the applicant's expense, in the State Register 
  6.20  and in a newspaper in the municipality in which the base of 
  6.21  operation will be located, or if no newspaper is published in 
  6.22  the municipality or if the service would be provided in more 
  6.23  than one municipality, in a newspaper published at the county 
  6.24  seat of the county in which the service would be provided.  
  6.25     (c) For applications for the provision of ambulance 
  6.26  services in a service area larger than a county, the 
  6.27  commissioner board shall promptly send notice of the completed 
  6.28  application to the municipality in which the service's base of 
  6.29  operation will be located and to each community health board, 
  6.30  county board, governing body of a regional emergency medical 
  6.31  services system designated under section 144.8093, and ambulance 
  6.32  service located within the counties in which any part of the 
  6.33  service area described by the applicant is located, and any 
  6.34  contiguous counties.  The commissioner board shall publish this 
  6.35  notice, at the applicant's expense, in the State Register.  
  6.36     (d) The commissioner board shall request that the chief 
  7.1   administrative law judge appoint an administrative law judge to 
  7.2   hold a public hearing in the municipality in which the service's 
  7.3   base of operation will be located.  The public hearing shall be 
  7.4   conducted as contested case hearing under chapter 14. 
  7.5      (e) Each municipality, county, community health board, 
  7.6   governing body of a regional emergency medical services system, 
  7.7   ambulance service, and other person wishing to make 
  7.8   recommendations concerning the disposition of the application 
  7.9   shall make written recommendations to the administrative law 
  7.10  judge within 30 days of the publication of notice of the 
  7.11  application in the State Register.  
  7.12     (f) The administrative law judge shall:  
  7.13     (1) hold a public hearing in the municipality in which the 
  7.14  service's base of operations is or will be located; 
  7.15     (2) provide notice of the public hearing in the newspaper 
  7.16  or newspapers in which notice was published under paragraph (b) 
  7.17  for two successive weeks at least ten days before the date of 
  7.18  the hearing; 
  7.19     (3) allow any interested person the opportunity to be 
  7.20  heard, to be represented by counsel, and to present oral and 
  7.21  written evidence at the public hearing; 
  7.22     (4) provide a transcript of the hearing at the expense of 
  7.23  any individual requesting it. 
  7.24     (g) The administrative law judge shall review and comment 
  7.25  upon the application and shall make written recommendations as 
  7.26  to its disposition to the commissioner board within 90 days of 
  7.27  receiving notice of the application.  In making the 
  7.28  recommendations, the administrative law judge shall consider and 
  7.29  make written comments as to whether the proposed service, change 
  7.30  in base of operations, or expansion in primary service area is 
  7.31  needed, based on consideration of the following factors:  
  7.32     (1) the relationship of the proposed service, change in 
  7.33  base of operations or expansion in primary service area to the 
  7.34  current community health plan as approved by the commissioner of 
  7.35  health under section 145A.12, subdivision 4; 
  7.36     (2) the recommendations or comments of the governing bodies 
  8.1   of the counties and municipalities in which the service would be 
  8.2   provided; 
  8.3      (3) the deleterious effects on the public health from 
  8.4   duplication, if any, of ambulance services that would result 
  8.5   from granting the license; 
  8.6      (4) the estimated effect of the proposed service, change in 
  8.7   base of operation or expansion in primary service area on the 
  8.8   public health; 
  8.9      (5) whether any benefit accruing to the public health would 
  8.10  outweigh the costs associated with the proposed service, change 
  8.11  in base of operations, or expansion in primary service area.  
  8.12     The administrative law judge shall recommend that the 
  8.13  commissioner board either grant or deny a license or recommend 
  8.14  that a modified license be granted.  The reasons for the 
  8.15  recommendation shall be set forth in detail.  The administrative 
  8.16  law judge shall make the recommendations and reasons available 
  8.17  to any individual requesting them.  
  8.18     Subd. 3a.  [LICENSURE OF AIR AMBULANCE SERVICES.] Except 
  8.19  for submission of a written application to the 
  8.20  commissioner board on a form provided by the commissioner board, 
  8.21  an application to provide air ambulance service shall be exempt 
  8.22  from the provisions of subdivisions 3 and 4.  
  8.23     A license issued pursuant to this subdivision need not 
  8.24  designate a primary service area.  
  8.25     No license shall be issued under this subdivision unless 
  8.26  the commissioner of health board determines that the applicant 
  8.27  complies with the requirements of applicable federal and state 
  8.28  statutes and rules governing aviation operations within the 
  8.29  state. 
  8.30     Subd. 3b.  [SUMMARY APPROVAL OF PRIMARY SERVICE AREAS.] 
  8.31  Except for submission of a written application to the 
  8.32  commissioner board on a form provided by the commissioner board, 
  8.33  an application to provide changes in a primary service area 
  8.34  shall be exempt from subdivisions 3, paragraphs (d) to (g); and 
  8.35  4, if: 
  8.36     (1) the application is for a change of primary service area 
  9.1   to improve coverage, to improve coordination with 911 emergency 
  9.2   dispatching, or to improve efficiency of operations; 
  9.3      (2) the application requests redefinition of contiguous or 
  9.4   overlapping primary service areas; 
  9.5      (3) the application shows approval from the ambulance 
  9.6   licensees whose primary service areas are directly affected by a 
  9.7   change in the applicant's primary service area; 
  9.8      (4) the application shows that the applicant requested 
  9.9   review and comment on the application, and has included those 
  9.10  comments received from:  all county boards in the areas of 
  9.11  coverage included in the application; all community health 
  9.12  boards in the areas of coverage included in the application; all 
  9.13  directors of 911 public safety answering point areas in the 
  9.14  areas of coverage included in the application; and all regional 
  9.15  emergency medical systems areas designated under section 
  9.16  144.8093 in the areas of coverage included in the application; 
  9.17  and 
  9.18     (5) the application shows consideration of the factors 
  9.19  listed in subdivision 3, paragraph (g). 
  9.20     Subd. 4.  [COMMISSIONER'S BOARD'S DECISION.] Within 30 days 
  9.21  after receiving the administrative law judge's report, the 
  9.22  commissioner board shall grant or deny a license to the 
  9.23  applicant.  In granting or denying a license, the commissioner 
  9.24  board shall consider the administrative law judge's report, the 
  9.25  evidence contained in the application, and any hearing record 
  9.26  and other applicable evidence.  The commissioner's board's 
  9.27  decision shall be based on a consideration of the factors 
  9.28  contained in subdivision 3, clause (g).  If the commissioner's 
  9.29  board's decision is different from the administrative law 
  9.30  judge's recommendations, the commissioner board shall set forth 
  9.31  in detail the reasons for differing from the recommendations.  
  9.32     Subd. 5.  [CONTESTED CASES.] The commissioner's board's 
  9.33  decision made under subdivision 3a or 4 shall be the final 
  9.34  administrative decision.  Any person aggrieved by the 
  9.35  commissioner's board's decision shall be entitled to judicial 
  9.36  review in the manner provided in sections 14.63 to 14.69.  
 10.1      Subd. 6.  [TEMPORARY LICENSE.] Notwithstanding other 
 10.2   provisions herein, the commissioner board may issue a temporary 
 10.3   license for instances in which a primary service area would be 
 10.4   deprived of ambulance service.  The temporary license shall 
 10.5   expire when an applicant has been issued a regular license under 
 10.6   this section.  The temporary license shall be valid no more than 
 10.7   six months from date of issuance.  A temporary licensee must 
 10.8   provide evidence that the licensee will meet the requirements of 
 10.9   section 144.804 and the rules adopted under this section.  
 10.10     Sec. 7.  Minnesota Statutes 1994, section 144.803, is 
 10.11  amended to read: 
 10.12     144.803 [LICENSING; SUSPENSION AND REVOCATION.] 
 10.13     The commissioner board may, after conducting a contested 
 10.14  case hearing upon reasonable notice, suspend or revoke, or 
 10.15  refuse to renew the license of a licensee upon finding that the 
 10.16  licensee has violated sections 144.801 to 144.808 or has ceased 
 10.17  to provide the service for which it is licensed. 
 10.18     Sec. 8.  Minnesota Statutes 1994, section 144.804, is 
 10.19  amended to read: 
 10.20     144.804 [STANDARDS.] 
 10.21     Subdivision 1.  [DRIVERS AND ATTENDANTS.] No publicly or 
 10.22  privately owned basic ambulance service shall be operated in the 
 10.23  state unless its drivers and attendants possess a current 
 10.24  emergency care course certificate authorized by rules adopted by 
 10.25  the commissioner of health board according to chapter 14.  Until 
 10.26  August 1, 1994, a licensee may substitute a person currently 
 10.27  certified by the American Red Cross in advanced first aid and 
 10.28  emergency care or a person who has successfully completed the 
 10.29  United States Department of Transportation first responder 
 10.30  curriculum, and who has also been trained to use basic life 
 10.31  support equipment as required by rules adopted by the 
 10.32  commissioner board under section 144.804, subdivision 3, for one 
 10.33  of the persons on a basic ambulance, provided that person will 
 10.34  function as the driver while transporting a patient.  The 
 10.35  commissioner board may grant a variance to allow a licensed 
 10.36  ambulance service to use attendants certified by the American 
 11.1   Red Cross in advanced first aid and emergency care in order to 
 11.2   ensure 24-hour emergency ambulance coverage.  The commissioner 
 11.3   shall study the roles and responsibilities of first responder 
 11.4   units and report the findings by January 1, 1991.  This study 
 11.5   shall address at a minimum:  
 11.6      (1) education and training; 
 11.7      (2) appropriate equipment and its use; 
 11.8      (3) medical direction and supervision; and 
 11.9      (4) supervisory and regulatory requirements. 
 11.10     Subd. 2.  [EQUIPMENT AND STAFF.] (a) Every ambulance 
 11.11  offering ambulance service shall be equipped as required by the 
 11.12  commissioner board and carry at least the minimal equipment 
 11.13  necessary for the type of service to be provided as determined 
 11.14  by standards adopted by the commissioner board pursuant to 
 11.15  subdivision 3. 
 11.16     (b) Each ambulance service shall offer service 24 hours per 
 11.17  day every day of the year, unless otherwise authorized by the 
 11.18  commissioner board.  
 11.19     (c) Each ambulance while transporting a patient shall be 
 11.20  staffed by at least a driver and an attendant, according to 
 11.21  subdivision 1.  An ambulance service may substitute for the 
 11.22  attendant a physician, osteopath, registered nurse, or 
 11.23  physician's assistant who is qualified by training to use 
 11.24  appropriate equipment in the ambulance.  Advanced life support 
 11.25  procedures including, but not limited to, intravenous fluid 
 11.26  administration, drug administration, endotracheal intubation, 
 11.27  cardioversion, defibrillation, and intravenous access may be 
 11.28  performed by the physician, osteopath, registered nurse, or 
 11.29  physician's assistant who has appropriate training and 
 11.30  authorization, and who provides all of the equipment and 
 11.31  supplies not normally carried on basic ambulances. 
 11.32     (d) An ambulance service shall not deny emergency ambulance 
 11.33  service to any person needing emergency ambulance service 
 11.34  because of inability to pay or due to source of payment for 
 11.35  services if this need develops within the licensee's primary 
 11.36  service area.  Transport for such a patient may be limited to 
 12.1   the closest appropriate emergency medical facility.  
 12.2      Subd. 3.  [TYPES OF SERVICES TO BE REGULATED.] The 
 12.3   commissioner board may adopt rules needed to carry out sections 
 12.4   144.801 to 144.8091, including the following types of ambulance 
 12.5   service: 
 12.6      (a) basic ambulance service that has appropriate personnel, 
 12.7   vehicles, and equipment, and is maintained according to rules 
 12.8   adopted by the commissioner board according to chapter 14, and 
 12.9   that provides a level of care so as to ensure that 
 12.10  life-threatening situations and potentially serious injuries can 
 12.11  be recognized, patients will be protected from additional 
 12.12  hazards, basic treatment to reduce the seriousness of emergency 
 12.13  situations will be administered and patients transported to an 
 12.14  appropriate medical facility for treatment; 
 12.15     (b) intermediate ambulance service that has appropriate 
 12.16  personnel, vehicles, and equipment, and is maintained according 
 12.17  to standards the commissioner board adopts according to chapter 
 12.18  14, and that provides basic ambulance service and intravenous 
 12.19  infusions or defibrillation or both.  Standards adopted by the 
 12.20  commissioner shall include, but not be limited to, equipment, 
 12.21  training, procedures, and medical control; 
 12.22     (c) advanced ambulance service that has appropriate 
 12.23  personnel, vehicles, and equipment, and is maintained according 
 12.24  to standards the commissioner board adopts according to chapter 
 12.25  14, and that provides basic ambulance service, and in addition, 
 12.26  advanced airway management, defibrillation, and administration 
 12.27  of intravenous fluids and pharmaceuticals.  Vehicles of advanced 
 12.28  ambulance service licensees not equipped or staffed at the 
 12.29  advanced ambulance service level shall not be identified to the 
 12.30  public as capable of providing advanced ambulance service. 
 12.31     (d) specialized ambulance service that provides basic, 
 12.32  intermediate, or advanced service as designated by the 
 12.33  commissioner board, and is restricted by the commissioner board 
 12.34  to (1) less than 24 hours of every day, (2) designated segments 
 12.35  of the population, or (3) certain types of medical conditions; 
 12.36  and 
 13.1      (e) air ambulance service, that includes fixed-wing and 
 13.2   helicopter, and is specialized ambulance service. 
 13.3      Until standards have been developed under clauses (b), (d), 
 13.4   and (e), the current provisions of Minnesota Rules shall govern 
 13.5   these services. 
 13.6      Subd. 5.  [LOCAL GOVERNMENT'S POWERS.] Local units of 
 13.7   government may, with the approval of the commissioner board, 
 13.8   establish standards for ambulance services which impose 
 13.9   additional requirements upon such services.  Local units of 
 13.10  government intending to impose additional requirements shall 
 13.11  consider whether any benefit accruing to the public health would 
 13.12  outweigh the costs associated with the additional requirements.  
 13.13  Local units of government which desire to impose such additional 
 13.14  requirements shall, prior to promulgation of relevant 
 13.15  ordinances, rules or regulations, furnish the commissioner board 
 13.16  with a copy of such proposed ordinances, rules or regulations, 
 13.17  along with information which affirmatively substantiates that 
 13.18  the proposed ordinances, rules or regulations:  will in no way 
 13.19  conflict with the relevant rules of the department of health; 
 13.20  will establish additional requirements tending to protect the 
 13.21  public health; will not diminish public access to ambulance 
 13.22  services of acceptable quality; and will not interfere with the 
 13.23  orderly development of regional systems of emergency medical 
 13.24  care.  The commissioner board shall base any decision to approve 
 13.25  or disapprove such standards upon whether or not the local unit 
 13.26  of government in question has affirmatively substantiated that 
 13.27  the proposed ordinances, rules or regulations meet these 
 13.28  criteria.  
 13.29     Subd. 6.  [RULES ON PRIMARY SERVICE AREAS.] The 
 13.30  commissioner board shall promulgate rules defining primary 
 13.31  service areas under section 144.801, subdivision 8, under which 
 13.32  the commissioner board shall designate each licensed ambulance 
 13.33  service as serving a primary service area or areas.  
 13.34     Subd. 7.  [DRIVERS OF AMBULANCES.] An ambulance service 
 13.35  vehicle shall be staffed by a driver possessing a current 
 13.36  Minnesota driver's license or equivalent and whose driving 
 14.1   privileges are not under suspension or revocation by any state.  
 14.2   If red lights and siren are used, the driver must also have 
 14.3   completed training approved by the commissioner board in 
 14.4   emergency driving techniques.  An ambulance transporting 
 14.5   patients must be staffed by at least two persons who are trained 
 14.6   according to subdivision 1, or section 144.809, one of whom may 
 14.7   be the driver.  A third person serving as driver shall be 
 14.8   trained according to this subdivision. 
 14.9      Sec. 9.  Minnesota Statutes 1994, section 144.806, is 
 14.10  amended to read: 
 14.11     144.806 [PENALTIES.] 
 14.12     Any person who violates a provision of sections 144.801 to 
 14.13  144.806 is guilty of a misdemeanor.  The commissioner board may 
 14.14  issue fines to assure compliance with sections 144.801 to 
 14.15  144.806 and rules adopted under those sections.  
 14.16  The commissioner board shall adopt rules to implement a schedule 
 14.17  of fines by January 1, 1991. 
 14.18     Sec. 10.  Minnesota Statutes 1994, section 144.807, is 
 14.19  amended to read: 
 14.20     144.807 [REPORTS.] 
 14.21     Subdivision 1.  [REPORTING OF INFORMATION.] Operators of 
 14.22  ambulance services licensed pursuant to sections 144.801 to 
 14.23  144.806 shall report information about ambulance service to the 
 14.24  commissioner board as the commissioner board may require.  The 
 14.25  reports shall be classified as "private data on individuals" 
 14.26  under the Minnesota government data practices act, chapter 13.  
 14.27     Subd. 2.  [FAILURE TO REPORT.] Failure to report all 
 14.28  information required by the commissioner board shall constitute 
 14.29  grounds for licensure revocation. 
 14.30     Sec. 11.  Minnesota Statutes 1994, section 144.808, is 
 14.31  amended to read: 
 14.32     144.808 [INSPECTIONS.] 
 14.33     The commissioner board may inspect ambulance services as 
 14.34  frequently as deemed necessary.  These inspections shall be for 
 14.35  the purpose of determining whether the ambulance and equipment 
 14.36  is clean and in proper working order and whether the operator is 
 15.1   in compliance with sections 144.801 to 144.804 and any rules 
 15.2   that the commissioner board adopts related to sections 144.801 
 15.3   to 144.804. 
 15.4      Sec. 12.  Minnesota Statutes 1994, section 144.809, is 
 15.5   amended to read: 
 15.6      144.809 [RENEWAL OF BASIC EMERGENCY CARE COURSE 
 15.7   CERTIFICATE; FEE.] 
 15.8      Subdivision 1.  [STANDARDS FOR RECERTIFICATION.] The 
 15.9   commissioner board shall adopt rules establishing minimum 
 15.10  standards for expiration and recertification of basic emergency 
 15.11  care course certificates.  These standards shall require:  
 15.12     (1) four years after initial certification, and every four 
 15.13  years thereafter, formal classroom training and successful 
 15.14  completion of a written test and practical examination, both of 
 15.15  which must be approved by the commissioner board; and 
 15.16     (2) two years after initial certification, and every four 
 15.17  years thereafter, in-service continuing education, including 
 15.18  knowledge and skill proficiency testing, all of which must be 
 15.19  conducted under the supervision of a medical director or medical 
 15.20  advisor and approved by the commissioner board.  
 15.21     Course requirements under clause (1) shall not exceed 24 
 15.22  hours.  Course requirements under clause (2) shall not exceed 36 
 15.23  hours, of which at least 12 hours may consist of course material 
 15.24  developed by the medical director or medical advisor.  
 15.25     Individuals may choose to complete, two years after initial 
 15.26  certification, and every two years thereafter, formal classroom 
 15.27  training and successful completion of a written test and 
 15.28  practical examination, both of which are approved by the 
 15.29  commissioner board, in lieu of completing requirements in 
 15.30  clauses (1) and (2).  
 15.31     Subd. 2.  [UPGRADING TO BASIC EMERGENCY CARE COURSE 
 15.32  CERTIFICATE.] By August 1, 1994, The commissioner board shall 
 15.33  adopt rules authorizing the equivalence of the following as 
 15.34  credit toward successful completion of the commissioner's 
 15.35  board's basic emergency care course:  
 15.36     (1) successful completion of the United States Department 
 16.1   of Transportation first responder curriculum; 
 16.2      (2) a minimum of two years of documented continuous service 
 16.3   as an ambulance driver, as authorized in section 144.804, 
 16.4   subdivision 7; 
 16.5      (3) documented clinical experience obtained through work or 
 16.6   volunteer activity as a first responder; and 
 16.7      (4) documented continuing education in emergency care.  
 16.8      Subd. 3.  [LIMITATION ON FEES.] No fee set by the 
 16.9   commissioner board for biennial renewal of a basic emergency 
 16.10  care course certificate by a volunteer member of an ambulance 
 16.11  service, fire department, or police department shall exceed $2.  
 16.12     Sec. 13.  Minnesota Statutes 1994, section 144.8091, is 
 16.13  amended to read: 
 16.14     144.8091 [REIMBURSEMENT TO NONPROFIT AMBULANCE SERVICES.] 
 16.15     Subdivision 1.  [REPAYMENT FOR VOLUNTEER TRAINING.] Any 
 16.16  political subdivision, or nonprofit hospital or nonprofit 
 16.17  corporation operating a licensed ambulance service shall be 
 16.18  reimbursed by the commissioner board for the necessary expense 
 16.19  of the initial training of a volunteer ambulance attendant upon 
 16.20  successful completion by the attendant of a basic emergency care 
 16.21  course, or a continuing education course for basic emergency 
 16.22  care, or both, which has been approved by the commissioner 
 16.23  board, pursuant to section 144.804.  Reimbursement may include 
 16.24  tuition, transportation, food, lodging, hourly payment for the 
 16.25  time spent in the training course, and other necessary 
 16.26  expenditures, except that in no instance shall a volunteer 
 16.27  ambulance attendant be reimbursed more than $450 for successful 
 16.28  completion of a basic course, and $225 for successful completion 
 16.29  of a continuing education course.  
 16.30     Subd. 2.  [VOLUNTEER ATTENDANT DEFINED.] For purposes of 
 16.31  this section, "volunteer ambulance attendant" means a person who 
 16.32  provides emergency medical services for a Minnesota licensed 
 16.33  ambulance service without the expectation of remuneration and 
 16.34  who does not depend in any way upon the provision of these 
 16.35  services for the person's livelihood.  An individual may be 
 16.36  considered a volunteer ambulance attendant even though that 
 17.1   individual receives an hourly stipend for each hour of actual 
 17.2   service provided, except for hours on standby alert, even though 
 17.3   this hourly stipend is regarded as taxable income for purposes 
 17.4   of state or federal law, provided that this hourly stipend does 
 17.5   not exceed $3,000 within one year of the final certification 
 17.6   examination.  Reimbursement will be paid under provisions of 
 17.7   this section when documentation is provided the department of 
 17.8   health board that the individual has served for one year from 
 17.9   the date of the final certification exam as an active member of 
 17.10  a Minnesota licensed ambulance service.  
 17.11     Sec. 14.  Minnesota Statutes 1994, section 144.8093, is 
 17.12  amended to read: 
 17.13     144.8093 [EMERGENCY MEDICAL SERVICES FUND.] 
 17.14     Subdivision 1.  [CITATION.] This section is the "Minnesota 
 17.15  emergency medical services system support act."  
 17.16     Subd. 2.  [ESTABLISHMENT AND PURPOSE.] In order to develop, 
 17.17  maintain, and improve regional emergency medical services 
 17.18  systems, the department of health emergency medical services 
 17.19  regulatory board shall establish an emergency medical services 
 17.20  system fund.  The fund shall be used for the general purposes of 
 17.21  promoting systematic, cost-effective delivery of emergency 
 17.22  medical care throughout the state; identifying common local, 
 17.23  regional, and state emergency medical system needs and providing 
 17.24  assistance in addressing those needs; providing discretionary 
 17.25  grants for emergency medical service projects with potential 
 17.26  regionwide significance; providing for public education about 
 17.27  emergency medical care; promoting the exchange of emergency 
 17.28  medical care information; ensuring the ongoing coordination of 
 17.29  regional emergency medical services systems; and establishing 
 17.30  and maintaining training standards to ensure consistent quality 
 17.31  of emergency medical services throughout the state.  
 17.32     Subd. 2a.  [DEFINITION.] For purposes of this section, 
 17.33  "board" means the emergency medical services regulatory board. 
 17.34     Subd. 3.  [USE AND RESTRICTIONS.] Designated regional 
 17.35  emergency medical services systems may use emergency medical 
 17.36  services system funds to support local and regional emergency 
 18.1   medical services as determined within the region, with 
 18.2   particular emphasis given to supporting and improving emergency 
 18.3   trauma and cardiac care and training.  No part of a region's 
 18.4   share of the fund may be used to directly subsidize any 
 18.5   ambulance service operations or rescue service operations or to 
 18.6   purchase any vehicles or parts of vehicles for an ambulance 
 18.7   service or a rescue service. 
 18.8      Subd. 4.  [DISTRIBUTION.] Money from the fund shall be 
 18.9   distributed according to this subdivision.  Ninety-three and 
 18.10  one-third percent of the fund shall be distributed annually on a 
 18.11  contract for services basis with each of the eight regional 
 18.12  emergency medical services systems designated by the 
 18.13  commissioner of health board.  The systems shall be governed by 
 18.14  a body consisting of appointed representatives from each of the 
 18.15  counties in that region and shall also include representatives 
 18.16  from emergency medical services organizations.  The commissioner 
 18.17  board shall contract with a regional entity only if the contract 
 18.18  proposal satisfactorily addresses proposed emergency medical 
 18.19  services activities in the following areas:  personnel training, 
 18.20  transportation coordination, public safety agency cooperation, 
 18.21  communications systems maintenance and development, public 
 18.22  involvement, health care facilities involvement, and system 
 18.23  management.  If each of the regional emergency medical services 
 18.24  systems submits a satisfactory contract proposal, then this part 
 18.25  of the fund shall be distributed evenly among the regions.  If 
 18.26  one or more of the regions does not contract for the full amount 
 18.27  of its even share or if its proposal is unsatisfactory, then the 
 18.28  commissioner board may reallocate the unused funds to the 
 18.29  remaining regions on a pro rata basis.  Six and two-thirds 
 18.30  percent of the fund shall be used by the commissioner to support 
 18.31  regionwide reporting systems and to provide other regional 
 18.32  administration and technical assistance.  
 18.33     Sec. 15.  Minnesota Statutes 1994, section 144.8095, is 
 18.34  amended to read: 
 18.35     144.8095 [FUNDING FOR THE EMERGENCY MEDICAL SERVICES 
 18.36  REGIONS.] 
 19.1      The commissioner of health emergency medical services 
 19.2   regulatory board shall distribute funds appropriated from the 
 19.3   general fund equally among the emergency medical service 
 19.4   regions.  Each regional board may use this money to reimburse 
 19.5   eligible emergency medical services personnel for continuing 
 19.6   education costs related to emergency care that are personally 
 19.7   incurred and are not reimbursed from other sources.  Eligible 
 19.8   emergency medical services personnel include, but are not 
 19.9   limited to, dispatchers, emergency room physicians, emergency 
 19.10  room nurses, first responders, emergency medical technicians, 
 19.11  and paramedics. 
 19.12     Sec. 16.  Minnesota Statutes 1994, section 144C.01, 
 19.13  subdivision 2, is amended to read: 
 19.14     Subd. 2.  [ADMINISTRATION.] (a) Unless paragraph (c) 
 19.15  applies, consistent with the responsibilities of the state board 
 19.16  of investment and the various ambulance services, the ambulance 
 19.17  service personnel longevity award and incentive program must be 
 19.18  administered by the commissioner of health emergency medical 
 19.19  services regulatory board.  The administrative responsibilities 
 19.20  of the commissioner of health board for the program relate 
 19.21  solely to the record keeping, award application, and award 
 19.22  payment functions.  The state board of investment is responsible 
 19.23  for the investment of the ambulance service personnel longevity 
 19.24  award and incentive trust.  The applicable ambulance service is 
 19.25  responsible for determining, consistent with this chapter, who 
 19.26  is a qualified ambulance service person, what constitutes a year 
 19.27  of credited ambulance service, what constitutes sufficient 
 19.28  documentation of a year of prior service, and for submission of 
 19.29  all necessary data to the commissioner of health board in a 
 19.30  manner consistent with this chapter.  Determinations of an 
 19.31  ambulance service are final. 
 19.32     (b) The commissioner of health board may administer the 
 19.33  commissioner's its assigned responsibilities regarding the 
 19.34  program directly or may retain a qualified governmental or 
 19.35  nongovernmental plan administrator under contract to administer 
 19.36  those responsibilities regarding the program.  A contract with a 
 20.1   qualified plan administrator must be the result of an open 
 20.2   competitive bidding process and must be reopened for competitive 
 20.3   bidding at least once during every five-year period after July 
 20.4   1, 1993. 
 20.5      (c) The commissioner of employee relations shall review the 
 20.6   options within state government for the most appropriate 
 20.7   administration of pension plans or similar arrangements for 
 20.8   emergency service personnel and recommend to the governor the 
 20.9   most appropriate future pension plan or nonpension plan 
 20.10  administrative arrangement for this chapter.  If the governor 
 20.11  concurs in the recommendation, the governor shall transfer the 
 20.12  future administrative responsibilities relating to this chapter 
 20.13  to that administrative agency. 
 20.14     Sec. 17.  Minnesota Statutes 1994, section 144C.05, 
 20.15  subdivision 1, is amended to read: 
 20.16     Subdivision 1.  [AWARD PAYMENTS.] (a) The commissioner of 
 20.17  health emergency medical services regulatory board or the 
 20.18  commissioner's board's designee under section 144C.01, 
 20.19  subdivision 2, shall pay ambulance service personnel longevity 
 20.20  awards to qualified ambulance service personnel determined to be 
 20.21  entitled to an award under section 144C.08 by the commissioner 
 20.22  board based on the submissions by the various ambulance services.
 20.23  Amounts necessary to pay the ambulance service personnel 
 20.24  longevity award are appropriated from the ambulance service 
 20.25  personnel longevity award and incentive trust account to the 
 20.26  commissioner of health board.  
 20.27     (b) If the state of Minnesota is unable to meet its 
 20.28  financial obligations as they become due, the commissioner of 
 20.29  health shall undertake all necessary steps to discontinue paying 
 20.30  ambulance service personnel longevity awards until the state of 
 20.31  Minnesota is again able to meet its financial obligations as 
 20.32  they become due. 
 20.33     Sec. 18.  Minnesota Statutes 1994, section 144C.07, is 
 20.34  amended to read: 
 20.35     144C.07 [CREDITING QUALIFIED AMBULANCE PERSONNEL SERVICE.] 
 20.36     Subdivision 1.  [SEPARATE RECORD KEEPING.] The commissioner 
 21.1   of health board or the commissioner's board's designee under 
 21.2   section 144C.01, subdivision 2, shall maintain a separate record 
 21.3   of potential award accumulations for each qualified ambulance 
 21.4   service person under subdivision 2. 
 21.5      Subd. 2.  [POTENTIAL ALLOCATIONS.] (a) On September 1, 
 21.6   annually, the commissioner of health board or the commissioner's 
 21.7   board's designee under section 144C.01, subdivision 2, shall 
 21.8   determine the amount of the allocation of the prior year's 
 21.9   accumulation to each qualified ambulance service person.  The 
 21.10  prior year's net investment gain or loss under paragraph (b) 
 21.11  must be allocated and that year's general fund appropriation, 
 21.12  plus any transfer from the suspense account under section 
 21.13  144C.03, subdivision 2, and after deduction of administrative 
 21.14  expenses, also must be allocated.  
 21.15     (b) The difference in the market value of the assets of the 
 21.16  ambulance service personnel longevity award and incentive trust 
 21.17  account as of the immediately previous June 30 and the June 30 
 21.18  occurring 12 months earlier must be reported on or before August 
 21.19  15 by the state board of investment.  The market value gain or 
 21.20  loss must be expressed as a percentage of the total potential 
 21.21  award accumulations as of the immediately previous June 30, and 
 21.22  that positive or negative percentage must be applied to increase 
 21.23  or decrease the recorded potential award accumulation of each 
 21.24  qualified ambulance service person. 
 21.25     (c) The appropriation for this purpose, after deduction of 
 21.26  administrative expenses, must be divided by the total number of 
 21.27  additional ambulance service personnel years of service 
 21.28  recognized since the last allocation or 1,000 years of service, 
 21.29  whichever is greater.  If the allocation is based on the 1,000 
 21.30  years of service, any allocation not made for a qualified 
 21.31  ambulance service person must be credited to the suspense 
 21.32  account under section 144C.03, subdivision 2.  A qualified 
 21.33  ambulance service person must be credited with a year of service 
 21.34  if the person is certified by the chief administrative officer 
 21.35  of the ambulance service as having rendered active ambulance 
 21.36  service during the 12 months ending as of the immediately 
 22.1   previous June 30.  If the person has rendered prior active 
 22.2   ambulance service, the person must be additionally credited with 
 22.3   one-fifth of a year of service for each year of active ambulance 
 22.4   service rendered before June 30, 1993, but not to exceed in any 
 22.5   year one additional year of service or to exceed in total five 
 22.6   years of prior service.  Prior active ambulance service means 
 22.7   employment by or the provision of service to a licensed 
 22.8   ambulance service before June 30, 1993, as determined by the 
 22.9   person's current ambulance service based on records provided by 
 22.10  the person that were contemporaneous to the service.  The prior 
 22.11  ambulance service must be reported on or before August 15 to the 
 22.12  commissioner of health board in an affidavit from the chief 
 22.13  administrative officer of the ambulance service. 
 22.14     Sec. 19.  Minnesota Statutes 1994, section 144C.08, is 
 22.15  amended to read: 
 22.16     144C.08 [AMBULANCE SERVICE PERSONNEL LONGEVITY AWARD.] 
 22.17     (a) A qualified ambulance service person who has terminated 
 22.18  active ambulance service, who has at least five years of 
 22.19  credited ambulance service, who is at least 50 years old, and 
 22.20  who is among the 400 persons with the greatest amount of 
 22.21  credited ambulance service applying for a longevity award during 
 22.22  that year, is entitled, upon application, to an ambulance 
 22.23  service personnel longevity award.  An applicant whose 
 22.24  application is not approved because of the limit on the number 
 22.25  of annual awards may apply in a subsequent year. 
 22.26     (b) If a qualified ambulance service person who meets the 
 22.27  age and service requirements specified in paragraph (a) dies 
 22.28  before applying for a longevity award, the estate of the 
 22.29  decedent is entitled, upon application, to the decedent's 
 22.30  ambulance service personnel longevity award, without reference 
 22.31  to the limit on the number of annual awards. 
 22.32     (c) An ambulance service personnel longevity award is the 
 22.33  total amount of the person's accumulations indicated in the 
 22.34  person's separate record under section 144C.07 as of the August 
 22.35  15 preceding the application.  The amount is payable only in a 
 22.36  lump sum. 
 23.1      (d) Applications for an ambulance service personnel 
 23.2   longevity award must be received by the commissioner of health 
 23.3   board or the commissioner's board's designee under section 
 23.4   144C.01, subdivision 2, by August 15, annually.  Ambulance 
 23.5   service personnel longevity awards are payable only as of the 
 23.6   last business day in October annually. 
 23.7      Sec. 20.  Minnesota Statutes 1994, section 144C.09, 
 23.8   subdivision 2, is amended to read: 
 23.9      Subd. 2.  [NONASSIGNABILITY.] No entitlement or claim of a 
 23.10  qualified ambulance service person or the person's beneficiary 
 23.11  to an ambulance service personnel longevity award is assignable, 
 23.12  or subject to garnishment, attachment, execution, levy, or legal 
 23.13  process of any kind, except as provided in section 518.58, 
 23.14  518.581, or 518.611.  The commissioner of health board may not 
 23.15  recognize any attempted transfer, assignment, or pledge of an 
 23.16  ambulance service personnel longevity award. 
 23.17     Sec. 21.  Minnesota Statutes 1994, section 144C.10, is 
 23.18  amended to read: 
 23.19     144C.10 [SCOPE OF ADMINISTRATIVE DUTIES.] 
 23.20     For purposes of administering the award and incentive 
 23.21  program, the commissioner of health board cannot hear appeals, 
 23.22  direct ambulance services to take any specific actions, 
 23.23  investigate or take action on individual complaints, or 
 23.24  otherwise act on information beyond that submitted by the 
 23.25  licensed ambulance services. 
 23.26     Sec. 22.  [REPEALER.] 
 23.27     Minnesota Statutes 1994, section 144.8097, is repealed. 
 23.28     Sec. 23.  [EFFECTIVE DATE.] 
 23.29     Sections 1 to 22 are effective July 1, 1995.