Texas Administrative Code
Title 25 - HEALTH SERVICES
Part 1 - DEPARTMENT OF STATE HEALTH SERVICES
Chapter 157 - EMERGENCY MEDICAL CARE
Subchapter B - EMERGENCY MEDICAL SERVICES PROVIDER LICENSES
Section 157.11 - Requirements for an Emergency Medical Services (EMS) Provider License

Universal Citation: 25 TX Admin Code § 157.11

Current through Reg. 50, No. 13; March 28, 2025

(a) Purpose: Acquiring, issuing, and maintaining an EMS provider license.

(b) EMS in Texas is a delegated practice, as written in Texas Occupations Code § 157.003.

(c) Application requirements for an EMS provider license.

(1) An applicant for an initial EMS provider license must submit a completed application to the department on the required official forms, following the department's written process.

(2) The nonrefundable application fee of $500 per provider plus $180 for each EMS vehicle to be operated under the license must accompany the application.

(3) The department will process the EMS provider license application as per § 157.3 of this chapter (relating to Processing EMS Provider Licenses and Applications for EMS Personnel Certification and Licensure).

(4) An EMS provider holding a valid license or authorization from another state is exempt from holding a Texas EMS provider license if the provider:
(A) serves an area that adjoins the State of Texas;

(B) has a written mutual aid agreement with a licensed Texas EMS provider;

(C) is requested to do so by a licensed Texas EMS provider;

(D) responds into Texas for emergency mutual aid assistance; and

(E) is obligated to perform to the same medical standards of care required by the home state.

(5) A fixed-wing or rotor-wing air ambulance provider, appropriately licensed by the state governments of New Mexico, Oklahoma, Arkansas, Kansas, Colorado, or Louisiana, may apply for a reciprocal provider license. The application does not require staffing by Texas EMS certified or licensed personnel. A nonrefundable administrative fee of $500 per provider in addition to a nonrefundable fee of $180 for each EMS aircraft to be operated in Texas under the reciprocal license must accompany the application.

(6) An applicant for an EMS provider license that provides emergency prehospital care is exempt from paying department licensing and authorization fees if the provider is staffed with at least 75 percent volunteer personnel, has no more than five full-time staff or equivalent, and is recognized as a §501(c)(3) nonprofit corporation by the Internal Revenue Service. An EMS provider who compensates a physician to provide medical supervision will be exempt from paying department licensing and authorization fees if all other requirements for fee exemption are met.

(7) Required documents that must accompany a license application.
(A) Document verifying volunteer status, if applicable.

(B) Map and description of service area, a list of counties and cities in which applicant proposes to provide primary emergency service, and a list of all station locations with address and telephone and facsimile transmission numbers for each station.

(C) Declaration of organization type and profit status.

(D) Declaration of provider name.
(i) The legal name of the EMS provider cannot include the name of the city, county, or regional advisory council (RAC) within or in part, unless written approval is given by the individual city, county, or RAC respectively.

(ii) A proposed provider name is deemed to be the same name as an established licensed EMS provider if it meets the conditions listed in 1 Texas Administrative Code (TAC) §79.39 (relating to Same Defined) and therefore is not available if a comparison of the names reveals no differences.

(E) Declaration of ownership.

(F) Declaration of the address for the main location of the business, normal business hours, and proof of ownership or lease of the location.
(i) The normal business hours must be posted for public viewing.

(ii) A service area map must be provided.

(iii) Only one EMS provider license will be issued to each fixed address.

(iv) The applicant must attest no other licensed EMS provider is at the business location or address provided.

(v) The EMS provider must remain in the same physical location for the period of licensure, unless the department approves a change in location.

(G) A statement of an administrator of record under Texas Health and Safety Code § 773.0571 or § 773.05712.

(H) The administrator of record statement must declare they:
(i) are not employed or otherwise compensated by another private for-profit EMS provider;

(ii) meet the qualifications required for an emergency medical technician certification or other health care professional license with a direct relationship to EMS and currently hold such certification or license issued by the State of Texas;

(iii) have submitted to a criminal history record check at the applicant's expense as directed in § 157.37 of this chapter (relating to Certification or Licensure of Persons With Criminal Backgrounds);

(iv) have completed an initial education course approved by the department regarding state and federal laws and rules affecting EMS in the following areas:
(I) Texas Health and Safety Code Chapter 773 and 25 TAC Chapter 157;

(II) EMS dispatch processes;

(III) EMS billing processes;

(IV) Medical control accountability;

(V) Quality improvement processes for EMS operations; and

(v) have completed eight hours of continuing education related to the Texas and federal laws and rules related to EMS.

(I) If the EMS provider held a license on September 1, 2013, and has an administrator of record with at least eight years of experience providing EMS, then the administrator of record statement is exempt from subparagraph (H)(ii) and (iii) of this paragraph.

(J) EMS providers operated by a governmental entity are exempt from subparagraph (H) of this paragraph except for declaration of administrator of record.

(K) Copies of Doing Business Under Assumed Name Certificates (DBA).

(L) Completed EMS personnel form.

(M) Staffing Plan describing how the EMS provider provides continuous coverage for the service area defined in documents submitted with the EMS provider application. The EMS provider must have a staffing plan that addresses coverage of the service area or must have a formal system to manage communication when not providing services after normal business hours.

(N) Completed EMS vehicle form.

(O) Declaration of an employed medical director and a copy of the signed contract or agreement with a physician currently licensed in the State of Texas, in good standing with the Texas Medical Board and in compliance with Texas Medical Board rules, 22 TAC Chapter 197, and Texas Occupations Code Title 3.

(P) Completed medical director information form.

(Q) Treatment and transport protocols and policies addressing the care to be provided to adult, pediatric, and neonatal patients, and as stated in Texas Health and Safety Code § 773.112, must be approved and signed by the medical director.

(R) A list of equipment as required on the EMS provider initial and renewal application, with identifiable or legible serial numbers, supplies, and medications approved and signed by the medical director.

(S) Documentation that all required equipment is permitted to be used by the EMS provider and proof of ownership or long-term lease for all equipment necessary for the safe operation.

(T) Documentation that each authorized vehicle will have its own set of equipment required for such vehicles to operate at the level of the service for which the provider is authorized.

(U) Description of how the EMS provider will conduct quality assurance in coordination with the EMS provider medical director.

(V) Documentation that the applicant or the management staff will begin or continue to participate in the local RAC.

(W) Plan for how the provider will respond to disaster incidents, including mass casualty situations in coordination with local and regional plans.
(i) An EMS provider must have a plan for providing transport for a dialysis patient who places an emergency 9-1-1 telephone call during a declared disaster. An alternative mode of transport may be used to move the patient directly to and from an outpatient end stage renal disease facility if the patient's normal and alternative modes of transportation cannot be used during the disaster. The plan will include a communication plan with the receiving facility prior to the patient being transported to a receiving facility.

(ii) An EMS provider's plan under this subsection may prioritize providing transportation for a patient suffering from an acute emergency condition over transportation for a dialysis patient.
(I) A "disaster" has the meaning assigned by Texas Government Code § 418.004 and § 418.014.

(II) "End stage renal disease facility" has the meaning assigned by Texas Health and Safety Code § 251.001(7).

(X) Copies of written Mutual Aid or Inter-local Agreements with EMS providers.

(Y) Documentation as required for subscription or membership program, if applicable.

(Z) Certificate of Insurance, provided by the insurer, identifying the department as the certificate holder and indicating at least minimum motor vehicle liability coverage for each vehicle to be operated, and professional liability coverage. If applicant is a government subdivision, applicant must submit evidence of financial responsibility by self-insuring to the limit imposed by the tort claims provisions of the Texas Civil Practice and Remedies Code.
(i) The applicant must maintain motor vehicle liability insurance as required under the Texas Transportation Code.

(ii) The applicant must maintain professional liability insurance coverage in the minimum amount of $500,000 for each single occurrence for bodily injury or death and $100,000 for each single occurrence for injury to or destruction of property, as described in Texas Civil Practice and Remedies Code § 101.023(c), or as necessary per state law, with a company licensed or deemed eligible by the Texas Department of Insurance to do business in Texas. Alternatively, the applicant may provide acceptable proof of self-insurance or captive insurance in order to secure payment for any loss or damage resulting from any occurrence arising out of, or caused by the care, or lack of care, of a patient.

(iii) Liability of a unit of local government under this chapter is limited to money damages in a maximum amount of $100,000 for each person and $300,000 for each single occurrence for bodily injury or death and $100,000 for each single occurrence for injury to or destruction of property, as described in Texas Civil Practice and Remedies Code § 101.023(d).

(AA) Copies of vehicle titles, vehicle lease agreements, exempt registrations if applicant is a government subdivision, or an affidavit identifying applicant as the owner, lessee, or authorized operator for each vehicle to be operated under the license.

(BB) Documentation showing the applicant and management staff possess sufficient EMS professional experience and qualifications as follows:
(i) attestation that management staff have read the Texas Emergency Healthcare Act and the department's EMS rules in this chapter; and

(ii) proof of one year experience or education provided by a nationally recognized organization on:
(I) emergency medical dispatch processes;

(II) EMS billing processes;

(III) medical control accountability; and

(IV) quality improvement processes for EMS operations.

(CC) A copy of a letter of credit for obtaining or renewing an EMS provider license, issued by a federally insured bank or savings institution:
(i) in the amount of:
(I) $100,000 for the initial license and for renewal of the license on the second anniversary of the date the initial license is issued;

(II) $75,000 for renewal of the license on the fourth anniversary of the date the initial license is issued;

(III) $50,000 for renewal of the license on the sixth anniversary of the date the initial license is issued;

(IV) $25,000 for renewal of the license on the eighth anniversary of the date the initial license is issued;

(ii) that includes:
(I) the names of all the parties involved in the transaction;

(II) the name of the person or entity who owns the EMS provider operation and to whom the bank is issuing the letter of credit;

(III) the name of the person or entity receiving the letter of credit; and

(IV) an EMS provider directly operated by a governmental entity is exempt from this subsection.

(DD) A copy of the surety bond in the amount of $50,000 issued to and provided to the Health and Human Services Commission by the applicant participating in the medical assistance program operated under Texas Human Resources Code Chapter 32, the Medicaid Managed Care Program operated under Texas Government Code Chapter 540, or the child health plan program operated under Texas Health and Safety Code Chapter 62. An EMS provider directly operated by a governmental entity is exempt from this subparagraph.

(EE) Documentation showing applicant or management team has not been excluded from participation in the state Medicaid program.

(FF) A copy of a governmental entity letter of approval that must:
(i) be from the governing body of the municipality in which the applicant is located and is applying to provide EMS;

(ii) be from the commissioner's court of the county in which the applicant is located and is applying to provide EMS, if the applicant is not located in a municipality;

(iii) attest the addition of another licensed EMS provider will not interfere with or adversely affect the provision of EMS by the licensed EMS providers operating in the municipality or county;

(iv) attest, if applicable, the addition of another licensed EMS provider will remedy an existing provider shortage that cannot be resolved using the licensed EMS providers operating in the municipality or county; and

(v) attest the addition of another licensed EMS provider will not cause an oversupply of licensed EMS providers in the municipality or county.

(8) Paragraph (7)(FF) of this subsection does not apply to the renewal of an EMS provider license, or to a municipality, county, emergency services district, hospital, or EMS volunteer provider organization in this state that applies for an EMS provider license.

(9) An EMS provider is prohibited from expanding operations to or stationing any EMS vehicles in a municipality or county other than the municipality or county from which the provider obtained the letter of approval under this subsection until after the second anniversary of the date the provider's initial license was issued, unless the expansion or stationing occurs in connection with:
(A) a contract awarded by another municipality or county for the provision of EMS;

(B) an emergency response made in connection with an existing mutual aid agreement; or

(C) an activation of a statewide emergency or disaster response by the department.

(10) Paragraph (9) of this subsection does not apply to the renewal of an EMS provider license or to a municipality, county, emergency services district, hospital, or EMS volunteer provider organization in this state that applies for an EMS provider license.

(11) Paragraph (9) of this subsection does not apply to fixed or rotor wing EMS providers.

(d) EMS Provider License Issuance.

(1) License.
(A) Applicants who have submitted all required documents and who have met all the criteria for licensure will be issued a provider license effective for a period of two years from the date of issuance.

(B) Licenses must be issued in the name of the applicant.

(C) License expiration dates may be adjusted by the department to create licensing periods less than two years for administrative purposes.

(D) An application for an initial license or for the renewal of a license may be denied to a person or legal entity who owns or has owned any portion of an EMS provider service or who operates or manages or has operated or managed any portion of an EMS provider service that has been sanctioned by or that has a proposed disciplinary action or sanction pending against it by the department or any other local, state, or federal agency.

(E) The license will be issued in the form of a certificate that must be prominently displayed in a public area of the provider's primary place of business.

(F) An EMS provider license issued by the department is not transferable to another person or entity.

(2) Vehicle Authorization.
(A) The department issues an authorization for each vehicle operated by the applicant meeting all criteria for approval as defined in this subsection.

(B) A vehicle authorization is issued for the following levels of service. A provider may operate at a higher level of service based on appropriate staffing, equipment, and medical direction for that level. A vehicle authorization includes a level of care designation at one of the following levels:
(i) Basic Life Support (BLS);

(ii) BLS with Advanced Life Support (ALS) capability;

(iii) BLS with Mobile Intensive Care Unit (MICU) capability;

(iv) ALS;

(v) ALS with MICU capability;

(vi) MICU;

(vii) Air Medical:
(I) Rotor-wing; or

(II) Fixed-wing; and

(viii) Specialized.

(C) Change of Vehicle Authorization. To change an authorization to a different level, the provider must submit a request with appropriate documentation to the department verifying the provider's ability to perform at the requested level. A $30 fee is required for each new authorization requested. The provider must not operate a vehicle until authorized by the department.

(D) Vehicle Authorizations are not required to be specific to particular vehicles and may be interchangeably placed in other vehicles as necessary. The original Vehicle Authorization for the appropriate level of service must be prominently displayed in the patient compartment of each vehicle.

(E) Vehicle Authorizations are not transferable between providers.

(F) A replacement of a lost or damaged license or authorization may be issued, if requested, with a nonrefundable fee of $10.

(3) Declaration of Business Operational Name and Administration.
(A) The applicant must submit a list of all business operational names under which the service is operated. If the applicant intends to operate the service under a name or names different from that on the issued license, the applicant must submit certified copies of assumed name certificates.

(B) A change in the operational name in which the service is operated requires a new application and a prorated fee as determined by the department. The department will issue a new provider number.

(C) Name of Administrator of Record must be declared. The applicant must submit a notarized document declaring the full name, mailing address, email address, and telephone number of the chief administrator to whom the department addresses all official communications in regard to the license.

(e) Vehicle Requirements.

(1) All EMS vehicles must be adequately constructed, equipped, maintained, and operated to safely and efficiently render patient care, comfort, and transportation of adult, pediatric, and neonatal patients. A pediatric and neonatal equipment list must be based on endorsed pediatric equipment national standards within the approved equipment list required by the medical director.

(2) EMS vehicles must allow the proper and safe storage and use of required equipment, supplies, and medications and must allow required procedures to be carried out in a safe and effective manner.

(3) As approved by the department, EMS vehicles must meet a practical, efficient minimum national ambulance vehicle body type, dimension, and safety criteria standards.

(4) When in service, all vehicles must have an environmental system within the patient compartment capable of heating or cooling the patient and staff, in accordance with the manufacturer specifications and that allows for protection of medication, according to manufacturer specifications, from extreme temperatures.
(A) The provider must provide evidence of an operational policy that lists the parenteral pharmaceuticals authorized by the medical director.

(B) The provider must document and describe the storage of pharmaceuticals authorized by the medical director and stored in accordance with the manufacturer and U.S. Federal Drug Administration (FDA) recommendations.

(C) Compliance with the policy must be incorporated into the provider's Quality Assurance process and must be documented on unit readiness reports.

(5) EMS vehicles must have operational two-way communication capable of contacting appropriate medical resources and as outlined in the current Texas interoperability plan unless the vehicle is designated as being out of service with the form provided by the department.

(6) EMS vehicles must comply with all applicable federal, state, and local requirements unless the vehicle is designated out of service with the form provided by the department.

(7) All EMS vehicles must have the name of the provider and a current department-issued EMS provider license number prominently displayed on both sides of the vehicle in at least 2-inch lettering and in contrasting color. The license number must have the letters TX prior to the license number. This requirement does not apply to fixed or rotor wing aircraft.

(f) Substitution, Replacement, and Additional EMS Vehicles.

(1) The EMS provider must notify the department within five business days if the EMS provider substitutes or replaces a vehicle. No fee is required for a vehicle substitution or replacement.

(2) The EMS provider must notify the department if the EMS provider adds a vehicle to the provider's operational fleet prior to making the vehicle response ready. A vehicle authorization request must be submitted with a nonrefundable vehicle fee prior to the vehicle being placed into service.

(g) Staffing Plan Required.

(1) The applicant must submit a completed EMS Personnel Form listing each response person assigned to staff EMS vehicles by name, certification level, and department-issued certification or license identification number.

(2) An EMS provider responsible for an emergency response area unable to provide continuous coverage within the declared service areas must publish public notices in local media, to include social media, of its inability to provide continuous response capability and include the days and hours of its operation. The EMS provider must notify all public safety answering points and all dispatch centers of the days and hours when unable to provide coverage. The EMS provider must submit evidence that reasonable attempts to secure coverage from other EMS providers were made.

(3) The applicant must provide proof at license initiation and renewal that all licensed or certified personnel completed a jurisprudence examination approved by the department on state and federal laws and rules affecting EMS.

(h) Minimum Staffing Required.

(1) BLS--When response ready or in-service, authorized EMS vehicles operating at the BLS level must be staffed at a minimum with two emergency care attendants (ECAs) or higher certified or licensed staff.

(2) BLS with ALS capability--When response ready or in-service, authorized EMS vehicles operating below the ALS level must be staffed with two ECAs. Full ALS status becomes active when staffed by an advanced emergency medical technician (AEMT) and an emergency medical technician (EMT) or higher certified or licensed staff.

(3) BLS with MICU capability--When response ready or in-service, authorized EMS vehicles operating below the MICU level must be staffed with two ECAs. Full MICU status becomes active when staffed by a certified or licensed paramedic and an EMT or higher certified or licensed staff.

(4) ALS--When response ready or in-service, authorized EMS vehicles operating at the ALS level must be staffed with one AEMT and one EMT or higher certified or licensed staff.

(5) ALS with MICU capability--When response ready or in-service, authorized EMS vehicles operating below the MICU level must be staffed with one AEMT and one EMT. Full MICU status becomes active when staffed by a certified or licensed paramedic and an EMT or higher certified or licensed staff.

(6) MICU--When response ready or in-service, authorized EMS vehicles operating at the MICU level must be staffed at a minimum with one certified or licensed paramedic and one EMT or higher certified or licensed staff.

(7) Specialized--When response ready or in-service, EMS vehicles authorized to operate for a specialized purpose must be staffed with a minimum of two personnel appropriately licensed or certified as determined by the type and application of the specialized purpose and as approved by the medical director and the department.

(8) For air ambulance staffing requirements refer to § 157.12(f) of this subchapter (relating to Rotor-wing Air Ambulance Operations) or § 157.13(g) of this subchapter (relating to Fixed-wing Air Ambulance Operations).

(9) When response ready or in-service, authorized EMS vehicles may operate at a lower level than licensed by the department. When operating at the BLS level with an ALS MICU ambulance, the EMS provider must have an approved security plan for the ALS MICU medication as approved by the EMS provider medical director's protocol and policy.

(10) As justified by patient needs, providers may utilize appropriately certified or licensed medical personnel in addition to those required by the designation levels. In addition to the care rendered by the required staff, the provider must be accountable for care rendered by any additional personnel.

(i) Treatment and Transport Protocols Required. The protocols must include:

(1) written policies related to patient care and delegated standing orders for patient treatment and transport, approved and signed by the provider's medical director;

(2) an effective date;

(3) the use of non-EMS certified or licensed medical personnel who, in addition to the EMS staff, may provide patient care on behalf of the provider or in the provider's EMS vehicles;

(4) the use of all required, additional, or specialized medical equipment, supplies, and pharmaceuticals carried on each EMS vehicle in the provider's fleet;

(5) identified delegated procedures for each EMS certification or license level utilized by the provider;and

(6) the EMS medical director's approved protocols to be followed by on-duty EMS personnel within the EMS provider's geographical location, unless otherwise specified.

(j) EMS Equipment, Supplies, Medical Devices, Parenteral Solutions, and Pharmaceuticals.

(1) The EMS provider must submit a list, approved and signed by the medical director and fully supportive of and consistent with the treatment and transport protocols, of all medical equipment, supplies, medical devices, parenteral solutions, and pharmaceuticals to be carried. The list must specify the quantities of each item to be carried and the sizes and types of each item necessary to provide appropriate care for all age ranges appropriate to the needs of patients. The quantities listed must be appropriate to the provider's call volume, transport times, and restocking capabilities.

(2) All patient care equipment and medical devices must be operational, appropriately secured in the vehicle at the time of providing patient care, and response ready. Supplies must be clean and fully operational. All patient care powered equipment must have a manual mechanical feature, spare batteries, or an alternative power source.

(3) All solutions and pharmaceuticals must be up to date and be stored and maintained in accordance with the manufacturer's and U.S. FDA recommendations.

(4) The requirements for air ambulance equipment and supplies are listed in § 157.12(h) and § 157.13(h) of this subchapter.

(k) The following equipment must be present on each in-service EMS vehicle and on, or immediately available for, each response ready vehicle as required by the medical director's approved equipment list to include all state-required equipment. The equipment list must include equipment required for treatment and transport of adult, pediatric, and neonatal patients.

(1) Basic Life Support (BLS):
(A) equipment required to administer the BLS scope of practice and incorporate the knowledge, competencies, and basic skills of an EMT or ECA and additional skills as authorized by the EMS provider medical director; all BLS ambulances must be able to transport patients and perform the following treatments:
(i) airway, ventilation, oxygenation;

(ii) cardiovascular circulation;

(iii) immobilization;

(iv) medication administration - routes; and

(v) single and multi-system trauma patients;

(B) oropharyngeal airways;

(C) portable and vehicle mounted suction;

(D) bag valve mask units, oxygen capable;

(E) portable and vehicle mounted oxygen;

(F) oxygen delivery devices;

(G) dressing and bandaging materials;

(H) commercial tourniquet;

(I) rigid cervical immobilization devices;

(J) spinal immobilization devices;

(K) extremity splints;

(L) equipment to meet special patient needs;

(M) equipment for determining and monitoring patient vital signs, condition or response to treatment;

(N) pharmaceuticals, as required by the medical director protocols;

(O) an external cardiac defibrillator appropriate to the staffing level with two sets of adult and two sets of pediatric pads;

(P) a patient-transport device capable of being secured to the vehicle; the patient must be fully restrained per manufacturer recommendations; and

(Q) an epinephrine auto injector or similar device capable of treating anaphylaxis.

(2) Advanced Life Support (ALS):
(A) equipment required to administer the ALS scope of practice and incorporate the knowledge, competencies, and basic and advanced skills of an AEMT and additional skills as authorized by the EMS provider medical director; all ALS ambulances must be able to transport patients and perform the following treatments:
(i) airway, ventilation, oxygenation;

(ii) cardiovascular circulation;

(iii) immobilization;

(iv) medication administration - routes;

(v) intravenous (IV) initiation and maintenance of fluids; and

(vi) single and multi-system trauma patients;

(B) all required BLS equipment; and

(C) advanced airway equipment.

(3) Mobile Intensive Care Unit (MICU) :
(A) equipment required to administer the knowledge, competencies, and advanced skills of a paramedic, and additional skills as authorized by the EMS provider medical director; all MICU ambulances must be able to transport patients and perform the following treatments:
(i) airway, ventilation, oxygenation;

(ii) cardiovascular circulation;

(iii) immobilization;

(iv) medication administration - routes;

(v) IV initiation and maintenance of fluids;

(B) all required BLS and ALS equipment;

(C) transmitting 12-lead capability cardiac monitor-defibrillator; and

(D) pharmaceuticals as required by medical director protocols.

(4) BLS with ALS Capability:
(A) all required BLS equipment, even when in-service or response ready at the ALS level; and

(B) all required ALS equipment, when in-service or response ready at the ALS level.

(5) BLS with MICU Capability:
(A) all required BLS equipment, even when in-service or response ready at the MICU level; and

(B) all required MICU equipment, when in-service or response ready at the MICU level.

(6) ALS with MICU Capability:
(A) all required ALS equipment, even when in-service or response ready at the MICU level; and

(B) all MICU equipment, when in-service or response ready at the MICU level.

(7) Wave form capnography or carbon dioxide detection equipment must be used when performing or monitoring endotracheal intubation.

(8) In addition to medical supplies and equipment as defined in this subsection, EMS vehicles must also have:
(A) a complete and current copy of written or electronic formatted protocols approved and signed by the medical director, with a current and complete equipment, supply, and medication list available to the crew;

(B) operable emergency warning devices;

(C) personal protective equipment for the EMS vehicle staff, including at least:
(i) protective, non-porous gloves;

(ii) medical eye protection;

(iii) medical respiratory protection available per crew member, meeting National Institute for Occupational Safety and Health (NIOSH)-approved N95 or greater standards;

(iv) medical protective gowns or equivalent; and

(v) personal cleansing supplies;

(D) sharps container;

(E) biohazard bags;

(F) portable, battery-powered flashlight (not a pen-light);

(G) a mounted, currently inspected, 5-pound ABC fire extinguisher (not applicable to air ambulances);

(H) "No Smoking" signs posted in the patient compartment and cab of vehicle;

(I) a current emergency response guidebook, or an electronic version that is available to the crew (for hazardous materials); and

(J) 25 triage tags, or participation in the RAC triage plan.

(9) As justified by specific patient needs, and when qualified personnel are available, EMS providers may appropriately utilize equipment in addition to what is required by the authorization levels. Such equipment must be consistent with protocols and patient-specific orders and must correspond to personnel qualifications.

(l) National Accreditation. If a provider has been accredited through a national accrediting organization approved by the department and adheres to Texas staffing level requirements, the department may exempt the provider from portions of the license process. In addition to other licensing requirements, accredited providers must submit:

(1) an accreditation self-study;

(2) a copy of the formal accreditation certificate; and

(3) any correspondence or updates to or from the accrediting organization that impact the provider's status.

(m) Subscription or Membership Services. An EMS provider that operates or intends to operate a subscription or membership program for the provision of EMS within the provider's service area must meet all the requirements for an EMS provider license as established by, and rules adopted under, Texas Health and Safety Code Chapter 773. An EMS provider must obtain department approval prior to soliciting, advertising, or collecting subscription or membership fees. To obtain department approval for a subscription or membership program, the EMS provider must complete the following.

(1) Obtain written authorization from the highest elected official (county judge or mayor) of the political subdivision where subscriptions will be sold. Written authorization must be obtained from each county judge if subscriptions are to be sold in multiple counties.
(A) The county judge must provide written authorization if subscriptions are to be sold throughout a county.

(B) The mayor may provide written authorization if subscriptions are sold exclusively within the boundaries of an incorporated town or city.

(C) If an EMS provider is not the primary emergency provider in any area where they are going to sell a subscription plan, written notification must be provided to the participants receiving a subscription plan stating the EMS provider is not the primary emergency provider in that area. A copy of this documentation must be provided to the primary emergency provider and the department within 30 days before the beginning of any enrollment period.

(2) Submit a copy of the contract used to enroll participants.

(3) Maintain a current file of all advertising for the service and submit a copy of all advertising used to promote the subscription service within 30 days before the beginning of any enrollment period.

(4) Comply with all state and federal regulations regarding billing and reimbursement for participants in the subscription service.

(5) Provide evidence of financial responsibility by:
(A) obtaining a surety bond payable to the department in an amount equal to the funds to be subscribed. The surety bond must be on a department bond form and be issued by a company licensed by or eligible to do business in the State of Texas; or

(B) submitting satisfactory evidence of self-insurance in an amount equal to the funds to be subscribed if the provider is a function of a governmental entity.

(6) Not deny emergency medical services to non-subscribers or subscribers of non-current status.

(7) Be reviewed at least every year. The subscription program may be reviewed by the department at any time.

(8) Furnish a list after each enrollment period with the names, addresses, dates of enrollment of each subscriber, and subscription fee paid by each subscriber.

(9) Furnish the department beginning and ending dates of enrollment periods. Subscription service period must not exceed one year. Subscribers must not be charged more than a prorated fee for the remaining subscription service period.

(10) Furnish the department with the total amount of funds collected each year.

(11) Not offer membership nor accept members into the program who are Medicaid clients.

(n) Responsibilities of the EMS Provider. During the license period, the EMS provider's responsibilities must include:

(1) assuring all response ready and in-service vehicles are available 24 hours a day and seven days a week, maintained, operated, equipped, and staffed in accordance with the requirements of the provider's license, to include staffing, equipment, supplies, required insurance, and additional requirements per the current EMS provider's medical director-approved protocols and policies;

(2) developing, implementing, maintaining, and evaluating an effective, ongoing, system-wide, data-driven, interdisciplinary quality assessment and performance improvement program, that must be individualized to the provider and include:
(A) the standard of patient care as directed by medical director protocols and medical director input into the provider's policies and standard operating procedures;

(B) a complaint management system;

(C) monitoring the quality of patient care provided by the personnel and taking appropriate and immediate corrective action to ensure quality of care is maintained in accordance with the existing standards of care and the medical director signed, approved protocols; and

(D) an ongoing program that achieves measurable improvement in patient care outcomes and reduction of medical errors;

(3) providing an attestation or documentation its management staff will begin or continue to participate in the local RAC;

(4) when an air ambulance is initiated through any other method than the local 9-1-1 system, requiring the air service providing the air ambulance to notify the local 9-1-1 center or the appropriate local response of the location of the response at time of launch; this would not include interfacility transports or scheduled transports;

(5) ensuring all personnel are currently certified or licensed by the department;

(6) assuring all personnel, when on an in-service vehicle or when on the scene of an emergency, are prominently identified by the last name and the first initial of the first name, the certification or license level, and the EMS provider's name; a provider may utilize an alternative identification system in incident-specific situations that pose a potential for danger if the individuals are identified by name;

(7) assuring the confidentiality of patient information in compliance with federal and state laws;

(8) assuring Informed Treatment or Transport Refusal forms are signed by all persons refusing service, or documenting incidents when a signed Informed Treatment or Transport Refusal form cannot be obtained;

(9) assuring patient care reports are completed accurately and meet standards as outlined in 25 TAC Chapter 103;

(10) assuring patient care reports are provided to facilities receiving the patient:
(A) whenever operationally feasible, the report must be provided to the receiving facility at the time the patient is delivered, or a full written or computer-generated report delivered to the facility within 24 hours of the delivery of the patient;

(B) if in a response-pending status, an abbreviated documented report must be provided at the time the patient is delivered and a completed written or computer-generated report delivered to the facility within 24 hours of the delivery of the patient;

(C) the abbreviated report must document the patient's name and condition upon arrival at the scene; the prehospital care provided; the patient's condition during transport, including signs, symptoms, and responses to treatment during the transport; the call initiation time; dispatch time; scene arrival time; scene departure time; hospital arrival time; and the identification of the ambulance staff; and

(D) in lieu of subparagraph (C) of this paragraph, personnel may follow the RAC process for providing abbreviated documentation to the receiving facility;

(11) assuring all pharmaceuticals are stored according to conditions specified in the pharmaceutical storage policy approved by the EMS provider's medical director;

(12) assuring staff completes a readiness inspection as written by the EMS provider's policy;

(13) assuring there is a preventive maintenance plan for vehicles and equipment;

(14) assuring staff has reviewed policies and procedures as approved by the EMS provider and the EMS provider medical director;

(15) maintaining medical reports:
(A) a licensed EMS provider must maintain adequate medical reports of a patient for a minimum of seven years from the anniversary date of the date of last treatment by the EMS provider;

(B) if a patient was younger than 18 years of age when last treated by the provider, the medical reports of the patient must be maintained by the EMS provider until the patient reaches age 21 years or for seven years from the date of last treatment, whichever is longer;

(C) an EMS provider may destroy medical records that relate to any civil, criminal, or administrative proceeding only if the provider knows the proceeding has been finally resolved;

(D) EMS providers must retain medical records for a longer length of time when mandated by other federal or state statute or regulation;

(E) EMS providers may transfer ownership of records to another licensed EMS provider only if the EMS provider, in writing, assumes ownership of the records and maintains the records consistent with this chapter;

(F) destruction of medical records must be done in a manner that ensures continued confidentiality;

(G) at the time of initial licensing and at each license renewal, the EMS provider and medical director must attest or provide documentation to the department, a plan for going out of business, selling, or transferring the business to ensure the proper maintenance of medical records as outlined in subparagraph (E) of this paragraph; and

(H) the EMS provider must maintain all patient care records in the physical location that is the provider's primary place of business, unless the department approves an alternate location;

(16) assuring all requested patient records are made promptly available to the medical director, hospital, or department;

(17) assuring current protocols, equipment, supply and medication lists, and the correct original vehicle authorization at the appropriate level, are maintained on each response ready vehicle;

(18) monitoring and enforcing compliance with all policies and protocols;

(19) assuring provisions for the appropriate disposal of medical or biohazardous waste materials;

(20) assuring ongoing compliance with the terms of first responder agreements;

(21) assuring that all documents, reports, or information provided to the department and hospital are current, accurate, and complete;

(22) assuring compliance with all federal and state laws and regulations and all local ordinances, policies, and codes, at all times;

(23) assuring all response data required by the department are submitted in accordance with § 103.5 of this title (relating to Reporting Requirements for EMS Providers);

(24) assuring, whenever there is a change in the EMS provider's name or the service's operational assumed name, the printed name on the vehicles is changed accordingly within 30 days of the change;

(25) assuring the department is notified within 30 business days whenever:
(A) a vehicle is sold, substituted, or replaced;

(B) there is a change in the level of service;

(C) there is a change in the declared service area as written on an initial or renewal application;

(D) there is a change in the official business mailing address;

(E) there is a change in the physical location of the business or substations;

(F) there is a change in the physical location of patient report file storage, to assure the department has access to these records at all times; or

(G) there is a change of the administrator of record;

(26) assuring the department is notified within one business day when there is a change of the medical director;

(27) developing, implementing, and enforcing written operating policies and procedures required under this chapter or adopted by the licensee, assuring each employee (including volunteers) is provided a copy upon employment and whenever such policies or procedures are changed; a copy of the written operating policies and procedures must be made available to the department on request, and policies at a minimum must adequately address:
(A) personal protective equipment;

(B) immunizations available to staff;

(C) infection control procedures;

(D) management of possible exposure to communicable disease;

(E) emergency vehicle operation;

(F) contact information for the designated infection control officer for whom education based on U.S. Code Title 42, Chapter 6A, Subchapter XXIV, Part G, §300ff-136 has been documented;

(G) credentialing of new response personnel before being assigned primary care responsibilities, which must include at a minimum:
(i) a comprehensive orientation session of the services, policies, procedures, treatment and transport protocols, safety precautions, and the quality management process; and

(ii) an internship period in which all new personnel practice under the supervision of, and are evaluated by, another more experienced person;

(H) appropriate documentation of patient care;

(I) vehicle checks, equipment, and readiness inspections; and

(J) the security of medications, fluids, and controlled substances in compliance with local, state, and federal laws or rules;

(28) assuring manufacturers' operating instructions for all critical patient care electronic and technical equipment utilized by the provider are available for all response personnel;

(29) assuring the department is notified within five business days of a collision involving an in-service or response ready EMS vehicle that results in vehicle damage whenever:
(A) the vehicle is rendered disabled and inoperable at the scene of the occurrence; or

(B) there is a patient on board;

(30) assuring the department is notified within one business day of a collision involving an in-service or response ready EMS vehicle that results in vehicle damage whenever there is personal injury or death to any person;

(31) maintaining motor vehicle liability insurance as required under the Texas Transportation Code;

(32) ensuring continuous coverage for the service area defined in documents submitted with the EMS provider application;

(33) responding to requests for assistance from the highest elected official of a political subdivision or from the department during a declared emergency or mass casualty situation according to national, state, regional, or local plans, when authorized;

(34) providing written notice to the department, RAC, and Emergency Medical Task Force, if the EMS provider will make staff and equipment available during a declared emergency or mass casualty situation, for a state or national mission, when authorized;

(35) assuring all EMS personnel receive continuing education on the provider's anaphylaxis treatment protocols, and the provider must maintain education and training records to include date, time, and location of such education or training for all its EMS personnel;

(36) immediately notifying the department in writing when operations cease in any service area;

(37) assuring all patients transported by stretcher are in a department-authorized EMS vehicle; and

(38) developing or adopting and then implementing policies, procedures, and protocols necessary for its operations as an EMS provider, and enforcing all such policies, procedures, and protocols.

(o) License Renewal Process.

(1) The provider is responsible for requesting license renewal application information.

(2) EMS providers must submit a completed application, all other required documentation, and a nonrefundable license renewal fee, no later than 90 calendar days prior to the expiration date of the current license.
(A) If a complete renewal application is received by the department 90 or more calendar days prior to the expiration date of the current license, the applicant must submit a nonrefundable application fee of $400 per provider plus $180 for each EMS vehicle.

(B) If a complete renewal application is received by the department 60 or more days, but less than 90 calendar days, prior to the expiration date of the current license, the applicant must submit a nonrefundable application fee of $450 per provider plus $180 for each EMS vehicle.

(C) If a complete renewal application is received by the department less than 60 days prior to the expiration of the current license, the applicant must submit a nonrefundable application fee of $500 per provider plus $180 for each EMS vehicle.

(D) If the application for renewal is received by the department after the expiration date of the current license, that license expires on its expiration date. The EMS provider will be required to file a new initial application and follow the initial application process.

(E) An EMS provider may not operate after its license has expired.

(p) Provisional License. The department may issue an EMS provisional license if an urgent need exists in a service area when the department finds the applicant is in substantial compliance with the provisions of this section and if the public interest would be served. A provisional license is effective for no more than 30 days from the date of issuance.

(1) An EMS provider may apply for a provisional license by submitting a written request and a nonrefundable fee of $30.

(2) A provisional license issued by the department may be revoked at any time by the department, with written notice to the provider, when the department finds the provider is failing to provide appropriate service in accordance with this section or the provider is in violation of any of the requirements of this chapter.

(q) Advertisements.

(1) Any advertising by an EMS provider must not be misleading, false, or deceptive. When an EMS provider advertises in Texas or conducts business in Texas by regularly transporting patients from or within Texas, the provider is required to have a Texas EMS provider license.

(2) An EMS provider must not advertise levels of patient care that it cannot provide at all times. The provider must not use a name, logo, artwork, phrase, or language that could mislead the public to believe a higher level of care is being provided.

(3) An EMS provider that has more than five paid staff, but is composed of at least 75 percent volunteer EMS personnel, may advertise as a volunteer service.

(r) Surveys, Inspections, and Investigations.

(1) The department may conduct scheduled or unannounced on-site inspection or investigation of a provider's vehicles, offices, headquarters, and stations (hereinafter operations), at any reasonable time, including while services are being provided, to ensure compliance with Texas Health and Safety Code Chapter 773 and this chapter.

(2) An applicant or licensee, by applying for or holding a license, consents to entry and inspection or investigation of any of its operations by the department, as provided for by Texas Health and Safety Code Chapter 773 and this chapter.

(3) Department inspections or investigations to evaluate an EMS provider's compliance with the requirements of Texas Health and Safety Code Chapter 773 and this chapter, may include:
(A) initial, prelicensure, and change in status inspections for the issuance of a new license;

(B) routine inspection conducted at the department's discretion or prior to renewal;

(C) follow-up on-site inspection, conducted to evaluate implementation of a plan of correction for deficiencies cited during a department investigation or inspection;

(D) a complaint investigation, conducted in response to a report or complaint, as described in subsection (u) of this section, relating to complaint investigations; and

(E) an inspection to determine if a person, company, or organization is offering or providing EMS service without a license, or to determine if EMS vehicles are being staffed by persons who do not hold Texas EMS certification or license.

(4) The provider and medical director must cooperate with any department investigation or inspection, and must, consistent with applicable law, permit the department to examine the provider's grounds, buildings, books, records, and other documents and information maintained by or on behalf of the provider, that are necessary to evaluate compliance with applicable statutes, rules, plans of correction, and orders with which the EMS provider is required to comply. The EMS provider must permit the department, consistent with applicable law, to interview members of the governing authority, personnel, and patients.

(5) The EMS provider must, consistent with applicable law, permit the department to copy or reproduce, or must provide photocopies to the department of any requested records or documents. If it is necessary for the department to remove records or other information (other than photocopies) from the provider's premises, the department will provide the EMS provider's governing authority or designee with a written statement of this fact, describing the information being removed and when it is expected to be returned. The department will make a reasonable effort, consistent with the circumstances, to return the records the same day.

(6) The department holds an entrance conference with the EMS provider, governing authority, or designee before beginning the inspection or investigation, to explain, consistent with applicable law, the nature, scope, and estimated time schedule of the inspection or investigation.

(7) Except for a complaint investigation or a follow-up visit, an inspection includes an evaluation of compliance with Texas Health and Safety Code Chapter 773 and the rules of this chapter. During the inspection, the department representative, unless otherwise provided for by law, informs the EMS provider's governing authority or designee of the preliminary findings and gives the provider a reasonable opportunity to submit additional facts or other information to the department representative in response to those findings.

(8) When the inspection is complete, the department holds an exit conference with the provider, unless otherwise provided for by law, to inform the provider, to the extent permitted by law, of any preliminary findings of the inspection or investigation and gives the EMS provider the opportunity to provide additional information regarding the deficiencies cited. If no deficiencies are identified at the time of inspection, a statement indicating this fact may be left with the EMS provider's governing authority or designee. Such a statement does not constitute a department finding or certification the facility is in compliance.

(9) If deficiencies are cited, the department provides the EMS provider's administrator of record and medical director with a written deficiency report no more than 30 calendar days after the exit conference.
(A) The EMS provider's governing authority, designee, or person in charge at the time must sign an acknowledgement of the inspection and receipt of the written deficiency report and return it to the department. The signature does not indicate the EMS provider's agreement with, or admission to, the cited deficiencies unless the agreement or admission is explicitly stated.

(B) No later than 30 calendar days after the EMS provider's receipt of the deficiency report, the EMS provider must return a written plan of correction to the department for each deficiency, including time frames for implementation, together with any additional evidence of compliance the EMS provider may have, regarding any cited deficiency. The department determines if the written plan of correction and proposed time frames for implementation are acceptable. If the plan is not acceptable, the department notifies the provider in writing no later than 30 days after receipt and requests a modified plan. The EMS provider must modify and resubmit the plan of correction no later than 30 calendar days after the EMS provider's receipt of the request. The EMS provider must correct the identified deficiencies and submit documentation to the department verifying completion of the corrective action within the time frames set forth in the plan of correction accepted by the department, or as otherwise specified by the department. The provider will be deemed to have received the deficiency report or other department correspondence mailed under this subparagraph once the department receives delivery notification from the postal service.

(C) Regardless of the EMS provider's compliance with this subsection, the department's acceptance of the provider's plan of correction, or the provider's utilization of an informal compliance group review under paragraph (10) of this subsection, the department may, at any time, propose to take action as appropriate under § 157.16 of this subchapter (relating to Emergency Suspension, Suspension, Probation, Revocation, Denial of a Provider License or Administrative Penalties).

(10) The department inspector informs the provider's chief executive officer, designee, or person in charge at the time of the inspection, of the provider's right to an informal compliance group review. This review is available when there is disagreement with deficiencies cited by the inspector or investigator, which the provider was unable to resolve through submission of information to the inspector or additional information bearing on the deficiencies cited.

(11) The department refers issues and complaints relating to the conduct or actions by licensed professionals to the appropriate licensing boards.

(12) All initial applicants and the medical director must have an initial compliance survey by the department that evaluates all aspects of the applicant's proposed operations, including clinical care components and an inspection of all vehicles prior to the issuance of a license.

(13) At renewal, randomly, or in response to a complaint, the department may conduct an unannounced compliance survey that includes inspection of a provider's vehicles, operations, or records to ensure compliance with this title at any time, including nights or weekends.

(14) If a re-survey or inspection to ensure correction of a deficiency is conducted, the provider must pay a nonrefundable fee of $30 per vehicle needing a re-inspection.

(s) Specialty Care Transports. A Specialty Care Transport is defined as the interfacility transfer by a department-licensed EMS provider of a critically ill or injured patient requiring specialized interventions, monitoring, or staffing. To qualify to function as a Specialty Care Transport the following minimum criteria must be met.

(1) Qualifying Interventions:
(A) patients with one or more of the following IV infusions: vasopressors; vasoactive compounds; antiarrhythmics; fibrinolytics; tocolytics; blood; blood products; or any other parenteral pharmaceutical unique to the patient's special health care needs; and

(B) one or more of the following special monitors or procedures: mechanical ventilation; multiple monitors; cardiac balloon pump; external cardiac support (ventricular assist devices, etc.); and any other specialized device, vehicle, or procedure unique to the patient's health care needs.

(2) Equipment. All specialized equipment and supplies appropriate to the required interventions must be available at the time of the transport.

(3) Minimum Required Staffing.
(A) One currently certified EMT-Basic and one currently certified or licensed paramedic with the additional training as defined in paragraph (4) of this subsection; or

(B) a currently certified EMT-Basic and a currently certified or licensed paramedic accompanied by at least one of the following:
(i) a registered nurse with special knowledge of the patient's care needs;

(ii) a certified respiratory therapist;

(iii) a licensed physician; or

(iv) any other licensed health care professional designated by the transferring physician.

(4) Additional Required Education and Training for Certified or Licensed Paramedics:
(A) evidence of successful completion of post-paramedic education;

(B) training and periodic skills verification in management of patients on ventilators;

(C) training and periodic skills verification in 12 lead Electrocardiography (EKG) or other critical care monitoring devices;

(D) training and periodic skill verification in drug infusion pumps, and cardiac or other critical care medications; and

(E) training in any other specialized procedures or devices determined at the discretion of the EMS provider's medical director.

(t) For all initial applications and renewal applications, the department is authorized to collect subscription and convenience fees, in amounts determined by Texas Government Code Section 2054.252 (relating to State Electronic Internet Portal Project), to recover costs associated with the initial application and renewal application processing.

(u) Complaint Investigations.

(1) Upon request, all licensed EMS providers must make available for a patient or legal guardian a written statement, supplied by the department, identifying the department as the responsible agency for conducting EMS provider and EMS personnel complaint investigations. The statement must inform persons they may direct a complaint to the Department of State Health Services, EMS Compliance Unit, by phone, or by email. The statement must provide the most current contact information, including the appropriate department group, address, local and toll-free telephone number, and email address for filing a complaint.

(2) The department evaluates all complaints made against EMS providers or EMS personnel. Any complaint submitted to the department must be submitted by telephone, electronically, or in writing, using the department's current contact information for that purpose, as described in paragraph (1) of this subsection.

(3) The department documents, evaluates, and prioritizes complaints and information received, based on the seriousness of the alleged violation and the level of risk to patients, personnel, and the public.
(A) Allegations within the department's regulatory jurisdiction relating to emergency medical services are authorized for investigation under this chapter. Complaints received that are outside the department's jurisdiction may be referred to another appropriate agency for response.

(B) The investigation is conducted on-site, by telephone, and through written correspondence.

(4) The department conducts a prompt and thorough investigation of all reports or complaint allegations that may pose a threat of harm to the health and safety of patients or participants. Reports or complaints received by the department concerning alleged abuse, neglect, and exploitation will be addressed in accordance with Texas Human Resources Code Chapter 48 and Texas Family Code § 261.101.

(5) The department evaluates complaint allegations that do not pose a significant risk of harm to patients. Based on the nature and severity of the alleged incident, the department determines whether to investigate the complaint directly or to require the provider to conduct an internal investigation and submit its findings and supporting evidence to the department.
(A) The department reviews findings of an EMS provider's internal investigation and may perform an additional investigation by the department. The department may request a plan of correction be completed by the provider in accordance with subsection (r) of this section (relating to inspections and investigations), and a proposal to take action against the provider under § 157.16 of this subchapter.

(B) The EMS provider under investigation must provide department staff access to all documents, evidence, and individuals related to the alleged violation, including all evidence and documentation relating to any internal investigations.

(6) Once an internal EMS provider investigation or department investigation is complete, the department reviews the evidence from the investigation to evaluate whether the evidence substantiates the complaint and what corrective action, if any, is needed.

Disclaimer: These regulations may not be the most recent version. Texas may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.