Yolo County Municipal Code Art. 3 Ambulance Permit Requirements

Except as provided in Section 4-6.1901, no person may furnish, operate, conduct, maintain, advertise or otherwise be engaged in, or profess to be engaged in business as an ambulance, air-ambulance, or medical transport vehicle within Yolo County unless he or she holds a valid permit issued by the LEMSA pursuant to this chapter.

A permit will be issued only when the permittee is in compliance with all applicable federal, state, and County codes and regulations, and LEMSA application, policies and procedures. Permittees, unless holding a contract with Yolo County to provide emergency medical service only, shall be approved by the county prior to beginning service.

Criminal action may be taken against an applicant who knowingly provides false information on the permit application. (§ 1, Ord. 1515, eff. December 19, 2019)

All EMS entities operating in the County shall be authorized by the LEMSA in accordance with the requirements of this chapter and any federal or state law or regulation governing EMS.

Authorization shall consist of provider authorization and, if indicated for the type of EMS entity, an ambulance provider permit.

Provider authorizations shall be issued in accordance with LEMSA provider authorization policy.

Ambulance service provider permits shall be issued in accordance with LEMSA ambulance service permit policy. (§ 1, Ord. 1515, eff. December 19, 2019)

(a) Any entity (either as an owner, agent or otherwise) who wishes to furnish, operate, conduct, maintain, or otherwise engage in, or offer, or profess to engage in providing ambulance service in the County shall have a valid ambulance service provider permit in accordance with the LEMSA system plan and EMS policies, procedures, and guidelines.

(b) Permit requirements shall apply to providers of air and ground ambulances, including BLS, ALS, IFT and CCT vehicles with the following exceptions:

(1) No permit is required of an ambulance service provider engaged in the transport of patients where the transport is initiated outside county boundaries for transport into the County.

(2) No permit is required of an ambulance service provider responding to a request from the EMS administrator or designee to calls arising from a declared multi-casualty incident (MCI) or declared disaster.

(3) No permit is required for specialized teams including, but not limited to: neonatal intensive care unit (NICU) and pediatric intensive care unit (PICU) teams that are permitted by another EMS agency and that pick up patients within the County for transportation to an acute care, tertiary, or quaternary care hospital located outside of the County, unless also responding to other services within the 9-1-1 system or inter-facility calls.

(c) Non-transport ALS. Any person, either as owner, agency, or otherwise, or any agency, who wishes to furnish, operate, conduct, maintain, or otherwise engage in, offer, or profess to engage in, or offer ALS non-transport services within the County, shall have a current valid non-transport ALS provider contract in accordance with the LEMSA's EMS system plan and EMS protocols, policies, and guidelines.

(d) An application for an initial ambulance Certificate of Operation shall be accompanied by payment of an application fee and an ambulance inspection fee. These fees are established by resolution of the Board of Supervisors, are listed in the Yolo County EMS Agency Fee Schedule and shall not exceed the reasonable cost of administering and enforcing this chapter. If the fees are not paid within thirty (30) days of permit issuance, the provider's permit will be considered suspended and the provider shall not provide the related service(s) within the County until the fees are paid in full. If the fees are not paid within ninety (90) days, the permit will be considered expired and a new application must be submitted to the LEMSA. Failed ambulance inspections will require a new inspection fee prior to the re-inspection of that ambulance. Exceptions to this section may be granted by the LEMSA. (§ 1, Ord. 1515, eff. December 19, 2019)

(a) Any EMS entity providing ambulance service, BLS, ALS, CCT or other EMS services requiring LEMSA authorization in the County, shall secure an ambulance service permit from the LEMSA specifying terms and conditions for the provision of EMS including, but not limited to, class of service to be provided, LEMSA approval for optional scope of practice, participation in LEMSA data and quality improvement activities and applicable performance standards as defined in LEMSA policies, procedures and guidelines.

(b) Provider authorizations shall not apply to cities or fire districts providing prehospital emergency medical services subject to and in accordance with Health and Safety Code section 1797.201. Such agencies providing services under section 1797.201 shall nonetheless be subject to LEMSA medical control and applicable performance standards as defined in LEMSA policies, procedures and guidelines. Compliance of City and Fire District prehospital emergency service providers with LEMSA medical control and applicable performance standards pursuant to LEMSA policies, procedures and guidelines shall not evidence or constitute an "agreement" with such City and Fire Districts for purposes of section 1797.201, and nothing in this chapter may be so construed. Nothing in this chapter is intended to affect or may be construed to affect in any way the rights and obligations of City and Fire District prehospital emergency service providers pursuant to section 1797.201. Nothing in this chapter is intended to affect or may be construed to affect the eligibility of City and Fire District prehospital emergency service providers to enter exclusive operating agreements under Health and Safety Code section 1797.224.

(c) Permit application.

(1) Applicants for an ambulance service permit or non-transporting ALS provider permit shall complete the LEMSA application process, which includes:

A. A LEMSA ambulance service provider permit application.

B. Provide a detailed description of company logo, color scheme used to designate the ambulance and attach a photo image.

C. A list of each ambulance including the following: make, model, year, mileage, VIN and license plate number.

D. Description of the company's program for vehicle maintenance.

E. Description of the company's vehicle radio/communication capabilities.

F. Copies of California Highway Patrol (CHP) inspection reports for each vehicle.

G. Portfolio of the company's experience and training in the transportation and care of patients.

H. List of employee's name and certification level with issued and expiration dates (EMT, paramedic, registered nurse, etc.).

I. Description of the company's training and orientation program for EMS personnel.

J. Applicants shall submit their planned work schedule for employees, including scheduled breaks and related staffing levels,

K. ePCR system description which is NEMSIS compliant.

L. A letter stating the willingness to share data with the LEMSA and participate in the Clinical Quality Improvement (CQI) process.

M. Current copy of the company's business license(s) and/or permits required by state law and regulations,

N. Recent financial statement (revenue, expenditures, balance sheet) stating total assets and liabilities.

O. Providing all transport and mileage billing rates.

P. Current insurance face sheet for: general liability for vehicle operation, comprehensive medical liability, workers compensation.

1. For general and comprehensive medical liability, the County shall be named as a co-insured. A valid certificate to self-insure from State of California Director of Industrial Relations is acceptable for workers compensation insurance. (§ 1, Ord. 1515, eff. December 19, 2019)

(a) Upon receipt of a completed application, the LEMSA shall conduct an inspection of the permit requester, including the applicant, any partner, officer, director, company and its ownership, to determine if there are any concerns related to the health, safety and welfare of the public. The inspection includes each vehicle, and its equipment and premises. A vehicle inspection fee is required per vehicle and the fee is approved by the board of supervisors. This required inspection shall be in addition to any other safety or motor vehicle inspections required or made under state, federal or local law.

(b) After the LEMSA has completed its inspection, it may issue the permit to be valid for a period of up to one year. The permit sticker must be placed on the window of the rear driver window of each permitted vehicle.

(c) Failed ambulance inspections will require a new inspection fee prior to the re-inspection of that ambulance. (§ 1, Ord. 1515, eff. December 19, 2019)

(a) Permits shall be renewed annually by the LEMSA upon application of the permittee if the LEMSA determines the permit holder has within the operating period of the expiring permit, acted in conformity with this chapter and the protocols and polices of the LEMSA.

(b) Applicants for permit renewal must be made at least thirty (30) days prior to the expiration date of the existing permit. The renewal fee must be included with the application for renewal. (§ 1, Ord. 1515, eff. December 19, 2019)

(a) The LEMSA may deny an ambulance services provider permit for any of the following reasons:

(1) Lack of approval by the LEMSA;

(2) Failure to provide a complete application or a determination by the LEMSA that the applicant fails to meet the requirements of this chapter;

(3) If the applicant has previously had an applicable permit or license revoked or the status is directly at issue, which affects the applicant's present ability to serve;

(4) If the applicant has a criminal or health record which reasonably indicates that the applicant would be unlikely to properly accept the responsibilities of operating a service;

(5) If there is reasonable cause to believe that the applicant will not provide emergency medical services or medical transport in a manner that will promote the health and general welfare of persons within the County who may need to utilize the applicant's proposed services;

(6) If the applicant does not have the required equipment for its units;

(7) If the applicant has not demonstrated, utilizing standard accounting practices and principles, sufficient financial stability or capitalization of a service to assure that the service will be run in an efficient and business-like manner for a period of at least one year or cannot meet the insurance requirements of Section 4-6.700 et seq.;

(8) If the applicant proposes to operate a service within a service area where another ambulance service or entity has been granted an exclusive operating area;

(9) Failure to comply with all applicable federal, state and county codes and regulations and LEMSA policies and procedures. (§ 1, Ord. 1515, eff. December 19, 2019)

The LEMSA may, and is authorized to, suspend or revoke any permit issued under this chapter for failure of a permittee to comply and to maintain compliance with, or for violation of the requirements of this chapter, or any other applicable laws or ordinances or regulations, or LEMSA policies, procedures, or protocols promulgated thereunder. (§ 1, Ord. 1515, eff. December 19, 2019)

(a) The LEMSA, as designated by the Board, may establish one or more exclusive operating areas (EOAs), as defined in Health & Safety Code section 1797.85, pursuant to a competitive process (a "competitive EOA"), provided the requirements of Health and Safety Code section 1797.224 are met.

(b) An EMS entity granted an EOA shall enter into an agreement with the County (an "EOA Agreement") setting forth the terms on which the EMS entity shall provide services within the EOA, including the level and type of ambulance services covered by the EOA Agreement.

(c) No EMS entity shall render any type or level of services considered exclusive within an EOA, unless the EMS entity has entered into an EOA Agreement with the County to provide such services.

(d) Nothing in this chapter or in any rule or regulation enacted by the County shall be construed as requiring the County to establish either a competitive or non-competitive EOA. (§ 1, Ord. 1515, eff. December 19, 2019)

A service permitted in accordance with this chapter must provide emergency care to and transport any emergency patient regardless of the patient's ability to pay. (§ 1, Ord. 1515, eff. December 19, 2019)

No permittee under this chapter shall cause or allow its units to respond to a location without receiving a specific request for that service. (§ 1, Ord. 1515, eff. December 19, 2019)

(a) Any private call requesting service for a life threatening emergency or a call requiring ALS level care where ALS care is timely, appropriate and available shall be immediately referred to the 9-1-1 emergency operators.

(b) If a BLS ambulance responds to a patient who appears to have a medical emergency, the crew shall call 9-1-1 and request a 9-1-1 response, and render appropriate care within their scope of practice until the ALS ambulance is on-scene.

(c) The permittee or their employees shall report any response to a non-emergency request for ambulance service that is responded to by a unit not permitted, staffed or equipped at the appropriate service level to the county EMS agency on an unusual occurrence form within ten (10) days of the incident. (§ 1, Ord. 1515, eff. December 19, 2019)

Whenever the LEMSA has reasonable cause to believe that any section of this chapter has been violated, he or she shall cause written notice to be served upon the person or persons responsible for the alleged violation. Such notice shall be sent to the person or persons' address of record and a copy to the employer of record. (§ 1, Ord. 1515, eff. December 19, 2019)

The notice shall specify:

(a) The section or sections of this chapter alleged to be violated;

(b) The facts alleged to constitute the violation; and

(c) An order to take corrective action within a specified time. (§ 1, Ord. 1515, eff. December 19, 2019)

Such an order becomes final unless, within ten (10) working days from the date of the notice, it is appealed in writing to the LEMSA. Upon receipt of an appeal, the LEMSA shall initiate the administrative appeal process.

Failure to comply with a Notice of Violation shall result in the issue being referred to the administrative appeal process by the LEMSA. (§ 1, Ord. 1515, eff. December 19, 2019)