BILL ANALYSIS
C.S.H.B. 1604
By: Glaze
04-19-95
Committee Report (Substituted)
BACKGROUND
The Texas Department of Health (TDH) regulates the state's
emergency medical services (EMS) providers and has identified
several provisions in the EMS Act that are in need of updating.
Currently, EMS providers are required to secure a surety bond or
purchase and maintain contractual liability insurance before
creating and operating a subscription program. The purpose is to
insure that subscribers get their money back if the EMS provider
goes bankrupt, leaves the service area, loses its license or
otherwise discontinues service. It has since been learned that
there is no contractual liability insurance that will protect the
subscribers by reimbursing their money in cases of provider
default; this protection can be provided, however, with surety
bonds or self-insurance.
In 1991, the EMS Act was amended to allow for the licensing of EMS
providers (ambulance services or firms). Prior to that, the TDH
permitted individual vehicles only. References in the Act need to
be changed to be consistent with the concept of total provider
management, since the agency's responsibilities have extended
beyond regulation of ambulances, or vehicles.
All EMS courses are conducted by certified course coordinators.
Presently, the TDH's only option in sanctioning coordinators is to
suspend or revoke their certification. There are occasions when an
infraction cannot be overlooked, but is not severe enough to
warrant such serious action. The option of assessing an
administrative penalty would address this concern.
A provision requiring a hospital-based EMS provider to transport
patients to the hospital nearest the patient's location was enacted
in 1983. This section is in direct conflict with federal law that
states that an ambulance owned by a hospital is an extension of
that facility and to take a patient to another facility prior to
medical assessment would constitute patient dumping. More
importantly, the current provision specifies facility designation
without regard to patient needs and regional triage patterns based
on appropriateness of care.
PURPOSE
H.B. 1604 as substituted removes the existing requirement for EMS
providers to purchase and maintain contractual liability insurance
before operating a subscription program; updates terms by replacing
all references to EMS "vehicle" with "provider;" establishes fees
for certain applications; subjects course coordinators to
administrative penalties; replaces existing language relating to
administrative penalties with updated language; and repeals
specific provisions relating to transportation of patients, notice
of rule changes and refund of administrative penalties.
RULEMAKING AUTHORITY
It is the committee's opinion that this bill does not expressly
grant any additional rulemaking authority to a state officer,
department, agency, or institution.
SECTION BY SECTION ANALYSIS
SECTION 1. Amends Section 773.003(11), Health and Safety Code, by
adding the use of medical equipment to the existing definition of
"emergency medical services provider."
SECTION 2. Amends Section 773.011(c) and (d), Health and Safety
Code, by removing the requirement for an EMS provider to purchase
and maintain contractual liability insurance before creating and
operating a subscription program.
SECTION 3. Amends Section 773.042, Health and Safety Code, by
changing existing references from "vehicle" to "provider" and
adding "personnel" to the qualifications to be a basic life-support
EMS provider.
SECTION 4. Amends Section 773.043, Health and Safety Code, by
changing existing references from "vehicle" to "provider" and
adding "personnel" to the qualifications to be an advanced life-support EMS provider.
SECTION 5. Amends Section 773.044, Health and Safety Code, by
changing existing references from "vehicle" to "provider" and
adding "personnel" to the qualifications to be a mobile intensive-care provider.
SECTION 6. Amends Section 773.045, Health and Safety Code, by
changing existing references from "vehicle" to "provider" and
adding "personnel" to the qualifications to be a specialized EMS
provider.
SECTION 7. Amends Section 773.050(b)(c) and (d), Health and Safety
Code, as follows:
(b) Requires the Board to establish minimum standards in the
areas outlined in this section.
(c) Specifies that a $100 nonrefundable fee must accompany
each out-of-state application for certification; allows the
Board to establish criteria for
out-of-country EMS personnel
certification and specifies
that such applications must be
accompanied by a $150
nonrefundable fee.
(d) Modifies definitions in existing provision regarding rules
affecting advanced life- support or staffing.
SECTION 8. Amends Section 773.051, Health and Safety Code, by
removing reference to "staffing or equipping" standards and
changing "vehicle" to "provider."
SECTION 9. Amends Section 773.054, Health and Safety Code, by
amending Subsection (c) and adding Subsection (d) as follows:
(c) Adds a requirement for a $50 nonrefundable fee to be
submitted with certification applications from course
coordinators.
(d) Adds a provision specifying that applications for approval
of a course or training program must be submitted with a $25
nonrefundable fee for a basic course or
program or $50 for an advanced course or
program; prohibits the TDH from requiring
a fee for approval of a course or program
for which a course coordinator or
sponsoring agency is not compensated.
SECTION 10. Amends Section 773.055(a), Health and Safety Code, by
deleting the phrase "examination for certification of" from
existing provision relating to fees for personnel certification.
SECTION 11. Amends Section 773.056(b), Health and Safety Code, by
requiring the TDH to charge a $5 fee for replacement of lost or
stolen certificates.
SECTION 12. Amends Sections 773.057(b) and (c), Health and Safety
Code, as follows:
(b) Requires a nonrefundable fee not exceeding $150 for each
EMS vehicle to be determined by the Board and to be submitted
with each application. Deletes the language
setting a $2,000 fee for a fleet of EMS
vehicles.
(c) Clarifies that the TDH may delegate vehicle inspections to
local governments.
SECTION 13. Amends Section 773.0571, Health and Safety Code, by
modifying the section title and deleting reference to "conducting
an inspection."
SECTION 14. Amends Section 773.0572, Health and Safety Code, by
adding a declaration that a $25 nonrefundable fee must be submitted
with each application for a provisional license.
SECTION 15. Amends Section 773.0611(c), Health and Safety Code, by
adding the requirement that an EMS provider pay a $25 nonrefundable
fee if reinspection is necessary to determine compliance with
applicable laws and rules.
SECTION 16. Amends Section 773.065, Health and Safety Code, by
applying the TDH's existing administrative penalty authority to
course coordinators.
SECTION 17. Amends Section 773.066, Health and Safety Code, by
adding course coordinators to existing provisions regarding
administrative penalties.
SECTION 18. Amends Section 773.067, Health and Safety Code, as
follows:
(a) Requires course coordinators, as well as EMS providers,
within 30 days after an order of a penalty is final as
provided by Chapter 2001, Government Code, to pay the penalty
in full, pay the penalty and file a petition for judicial
review of all or parts of the charge, or file a petition for
judicial review without paying the penalty.
(b) Specifies conditions under which a person who declines to
pay the penalty and files for judicial review may stay
enforcement of the penalty or
request the court to do so.
(c) Permits the Commissioner of Health, within five days after
receiving a copy of an affidavit, to file a contest to the
affidavit with the court; requires the
court to hold a hearing on the facts
alleged in the affidavit as soon as
practicable and to stay the enforcement
of the penalty upon finding that the
alleged facts are true; declares that the
person who files the affidavit has the
burden of proving financial inability to
pay the penalty and to give a supersedeas
bond.
(d) Authorizes the commissioner to refer the matter to the
attorney general if the penalty is not paid and enforcement of
the penalty is not stayed.
(e) Clarifies that judicial review of the commissioner's order
is instituted by filing a petition under Subchapter G, Chapter
2001, Government Code and is under
the substantial evidence rule.
(f) Authorizes the court to uphold or reduce the penalty
amount and order the person to pay accordingly, or the court
shall order that no penalty is
owed, depending upon the
court's decision as to the
occurrence of the violation.
(g) Sets forth procedures under which the court shall act,
upon final judgment, relating to payment of the penalty, plus
interest, or release of the
supersedeas bond; deletes
existing language relating to
payment of administrative
penalties.
SECTION 19. Repeals Section 773.010, Health and Safety Code,
requiring a hospital-based EMS provider to transport certain
patients to the hospital nearest the patient's location; Section
773.053, Health and Safety Code, relating to notice of rule
changes, and Section 773.068, Health and Safety Code, relating to
refund of administrative penalties.
SECTION 20. Emergency clause. Effective immediately.
COMPARISON OF ORIGINAL TO SUBSTITUTE
The substitute for H.B. 1604 deletes Section 7(b)(8) of the
original bill, which required the Board to establish, by rule,
minimum standards for the scope of practice of emergency medical
service personnel. The substitute also amends the language in
Section 12 of the bill to permit the Board to set the amount of a
fee for vehicle licensure up to a maximum of $150, deleting the
language that set an exact fee of $150 in the statute.
SUMMARY OF COMMITTEE ACTION
H.B. 1604 was considered by the Public Health Committee in a public
hearing on April 19, 1995. The committee considered a complete
substitute for the bill. The substitute was adopted without
objection.
The bill was reported favorably as substituted, with the
recommendation that it do pass and be printed by a record vote of
8 AYES, 0 NAYS, 0 PNV, 1 ABSENT.