Bill Text: NJ S2768 | 2022-2023 | Regular Session | Amended
Bill Title: Makes various changes concerning regulation of emergency medical services; establishes mobile integrated health program and new State Emergency Medical Services Medical Director in DOH.
Spectrum: Bipartisan Bill
Status: (Introduced - Dead) 2022-06-29 - Substituted by A4107 (2R) [S2768 Detail]
Download: New_Jersey-2022-S2768-Amended.html
[Second Reprint]
SENATE, No. 2768
STATE OF NEW JERSEY
220th LEGISLATURE
INTRODUCED MAY 26, 2022
Sponsored by:
Senator JOSEPH F. VITALE
District 19 (Middlesex)
Senator ROBERT W. SINGER
District 30 (Monmouth and Ocean)
SYNOPSIS
Makes various changes concerning regulation of emergency medical services; establishes mobile integrated health program and new State Emergency Medical Services Medical Director in DOH.
CURRENT VERSION OF TEXT
As reported by the Senate Budget and Appropriations Committee on June 27, 2022, with amendments.
An Act concerning emergency medical services 1and mobile integrated health1 and amending 1and supplementing1 P.L.1984, c.146.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. Section 1 of P.L.1984, c.146 (C.26:2K-7) is amended to read as follows:
1. As used in this act:
a. "Advanced life support" means an advanced level of [pre-hospital, inter-hospital, and] emergency [service] medical care, including specialty care transport, which includes basic life support functions[, cardiac monitoring, cardiac defibrillation, telemetered electrocardiography, administration of anti-arrhythmic agents, intravenous therapy, administration of specific medications, drugs and solutions, use of adjunctive ventilation devices, trauma care and other techniques and procedures authorized in writing by the commissioner] and procedures, medications, and equipment established by the National Highway Traffic Safety Administration's scope of practice for paramedics, and any other such procedures, medications, and equipment as set forth in 1[Section] section1 6 of P.L.1984, c.146 (C.26:2K-12);
b. "Board of Medical Examiners" means the State Board of Medical Examiners;
c. "Board of Nursing" means the New Jersey Board of Nursing;
d. "Commissioner" means the Commissioner of the 1[State]1 Department of Health;
e. "Department" means the 1[State]1 Department of Health;
f. "Emergency [service] department" means a program in a hospital staffed 24 hours a day by a licensed physician trained in emergency medicine;
g. ["Inter-hospital] "Specialty care transport" means [those emergency medical] services that are above basic life support services rendered [by mobile intensive care units] to [emergency] patients before and during transportation between [emergency treatment] licensed facilities, during retrieval from those facilities, and upon arrival within those facilities;
h. "Mobile intensive
care paramedic" means a person trained in advanced life support services
and [certified] licensed
by the commissioner to render advanced life support services as part of a
mobile intensive care unit or as otherwise provided in section 4 of
P.L.1984, c.146 (C.26:2K-10);
i. "Mobile intensive care unit" means a specialized emergency medical service [vehicle] unit that is staffed [by mobile intensive care paramedics or registered professional nurses trained in advanced life support nursing] in accordance with paragraph (2) of subsection a. of section 6 of P.L.1984, c.146 (C.26:2K-12) and operated for the provision of advanced life support services under the direction of an authorized hospital;
j. "Pre-hospital care" means those [emergency] medical services rendered by [mobile intensive care units to emergency patients] emergency medical services personnel before and during, or in lieu of, transportation to [emergency treatment] medical facilities, and upon arrival within those facilities.
k. "Volunteer paramedic unit" means an operational subunit within a mobile intensive care unit that is exclusively staffed by at least two volunteer paramedics with access to any vehicle, including a personal vehicle.
l. "Agency EMS medical director" means a physician licensed in this State who is certified in emergency medicine or emergency medical services, or both, and is responsible for the medical oversight of a hospital mobile intensive care program.
m. "Mobile integrated health" means 1[the provision of non-emergency]1 health care services 1[by a paramedic, registered nurse, advanced practice nurse, or physician assistant under a mobile intensive care program using] delivered with the approval of the Department of Health to patients outside of a hospital setting, using mobile resources, and employing team-based and1 patient-centered 1[, mobile resources in a prehospital]1 care 1[environment through an approved mobile intensive care hospital]1 .
(cf: P.L.2021, c.480, s.1)
2. Section 2 of P.L.1984, c.146 (C.26:2K-8) is amended to read as follows:
2. a. A mobile intensive care paramedic shall obtain [certification] licensure from the commissioner to [staff a mobile intensive care unit] provide advanced life support and shall make application therefor on forms prescribed by the commissioner.
b. The commissioner with the approval of the [board of medical examiners] State Board of Medical Examiners shall establish written standards which a mobile intensive care paramedic shall meet in order to obtain [certification] licensure. The commissioner shall act on a regular basis upon applications of candidates for [certification] licensure as a mobile intensive care paramedic. [The commissioner shall certify a candidate who provides satisfactory evidence of the successful completion of an educational program approved by the commissioner for the training of mobile intensive care paramedics and who passes an examination in the provision of advance life support services, which examination shall be conducted by the department at least twice a year.] The commissioner shall [certify] license a candidate 1[for] as1 a mobile intensive care paramedic [certification] who has equivalent military training or experience in any branch of the active duty or reserve component of the Armed Forces of the United States or the National Guard of any state if the commissioner determines that the candidate's military training and experience exceed or are equivalent to the certification standards established by the [commissioner] National Registry of Emergency Medical Technicians. The commissioner shall license a candidate 1[for] as1 a mobile intensive care paramedic who is registered as a paramedic with the National Registry of Emergency Medical Technicians.
c. The department shall maintain a register of all applicants for [certification] licensure hereunder, which register shall include but not be limited to:
(1) The name and residence of the applicant;
(2) The date of the application;
(3) Information as to whether the applicant was rejected or [certified] licensed and the date of that action.
The department shall annually compile a list of mobile intensive care paramedics. This list shall be available to the public.
(cf: P.L.2013, c.101, s.2)
3. Section 3 of P.L.1984, c.146 (C.26:2K-9) is amended to read as follows:
3. The commissioner after notice and hearing may revoke the [certification] license of a mobile intensive care paramedic for violation of any provision of this act or regulation promulgated hereunder.
(cf: P.L.1984, c.146, s.3)
4. Section 4 of P.L.1984, c.146 (C.26:2K-10) is amended to read as follows:
4. a. A mobile intensive care paramedic may perform advanced life support services, provided that the paramedic is following a standing order, or if the paramedic maintains direct voice communication with and is taking orders from a licensed physician or physician directed registered professional nurse, both of whom are affiliated with a mobile intensive care hospital which is approved by the commissioner to provide advanced life support services. [A telemetered electrocardiogram shall be monitored when deemed appropriate by the licensed physician or when required by written rules and regulations established by the mobile intensive care hospital and approved by the commissioner.]
b. (1) A mobile intensive care paramedic may deliver advanced life support services, or any other services within the approved scope of practice for mobile intensive care paramedics, in a pre-hospital setting, in a mobile integrated health care setting, health care specialty setting, or any other hospital-controlled setting, through an approved mobile intensive care hospital, as determined by the commissioner and as authorized by the agency EMS medical director. A mobile intensive care paramedic shall be permitted to provide advanced life support services when operating outside of a mobile intensive care unit in situations directly related to EMS first response or mobile integrated health as authorized by the mobile intensive care paramedic's agency EMS medical director. A single mobile intensive care paramedic shall not be acknowledged as a mobile intensive care unit.
(2) The authorized services provided under a mobile integrated health program shall be determined by the agency EMS medical director overseeing the program, and may include, but need not be limited to: providing paramedicine care, chronic disease management, preventive care, and post-discharge follow-up visits; or providing referrals and transportation assistance to appropriate care and services to patients requiring health care services who do not require hospital-based treatment.
c. Nothing in this section shall be construed to alter the scope of practice of any licensed health care professional under Title 45 of the Revised Statutes or the scope or authority of any agency, board, department, or other entity in this State that is responsible for licensing health care workers.
2d. The provisions of this section shall apply notwithstanding the provisions of section 12 of P.L.1984, c.146 (C.26:2K-18) and notwithstanding the provisions of any law to the contrary.2
(cf: P.L.2021, c.480, s.2)
5. Section 6 of P.L.1984, c.146 (C.26:2K-12) is amended to read as follows:
6. a. (1) Only a hospital exclusively authorized to develop and maintain advanced life support services in the municipality in which the trauma center is located pursuant to section 1 of P.L.2015, c.70 (C.26:2K-12.1), or a hospital authorized by the commissioner with an accredited emergency [service] department may develop and maintain a mobile intensive care unit, and provide advanced life support services utilizing licensed physicians, registered professional nurses trained in advanced life support nursing, and mobile intensive care paramedics.
(2) 2(a)2 A mobile intensive care unit, when in service, shall be staffed by a minimum of two persons, which two persons may be two mobile intensive care paramedics, two registered professional nurses trained in advanced life support nursing, 2or2 one mobile intensive care paramedic and one registered professional nurse trained in advanced life support nursing 2[, or one emergency medical technician and one mobile intensive care paramedic or registered professional nurse trained in advanced life support nursing]2. Any individual providing advanced life support as provided in this paragraph shall be authorized to render care within that individual's scope of practice based on the agency EMS medical director's determination of competency. 2[In the case of a mobile intensive care unit staffed by one emergency medical technician and one mobile intensive care paramedic or registered professional nurse trained in advanced life support nursing treating a patient in need of advanced life support services, the mobile intensive care paramedic or registered professional nurse trained in advanced life support nursing shall provide primary patient care. A mobile intensive care unit shall not be staffed by an emergency medical technician under this paragraph unless approved by the agency EMS medical director, based on the EMS medical director's determination of the competency of the mobile intensive care paramedic or registered professional nurse trained in advanced life support nursing and the emergency medical technician to work together to provide mobile intensive care services.]2
2(b) The Department of Health shall establish criteria for and a process by which a hospital may apply to the department for permission to operate a mobile intensive care unit that is staffed by one emergency medical technician and one mobile intensive care paramedic or registered professional nurse trained in advanced life support nursing, if the hospital is experiencing a staffing shortage.2
(3) Agency EMS medical directors shall have the authority to establish advanced life support protocols, within the scope of practice for advanced life support providers established by the commissioner, which protocols shall include, but shall not be limited to, protocols concerning medications, equipment, procedures, and clinical practice. Aspects of clinical practice that exceed the scope established by commissioner shall be submitted by an agency EMS medical director to the mobile intensive care advisory council for review and recommendation to the commissioner.
(4) A hospital with a mobile intensive care unit may authorize a board-certified or board-eligible emergency medicine physician, advanced practice nurse, or physician assistant, who has successfully completed an in-house practical competency-based 1[EMS] emergency medical services1 orientation and training guided by respective relevant professional standards and approved by the agency EMS medical director, and is employed by the hospital to deliver care within the approved scope of practice of the 1[board certified] board-certified1 or 1[board eligible] board-eligible1 emergency medicine physician, advanced practice nurse, or physician assistant in a 1[prehospital] pre-hospital1 setting or an interfacility setting, as determined by the agency EMS medical director.
b. A hospital authorized by the commissioner pursuant to subsection a. of this section shall provide mobile intensive care unit services on a seven-day-a-week basis.
c. The commissioner shall establish, in writing, criteria which a hospital shall meet in order to qualify for the authorization.
d. The commissioner may withdraw his authorization if the hospital or unit violates any provision of this act or rules or regulations promulgated pursuant thereto.
e. Nothing in this section shall be construed to alter the scope of practice of any licensed health care professional under Title 45 of the Revised Statutes or the scope or authority of any agency, board, department, or other entity in this State that is responsible for licensing health care workers.
(cf: P.L.1985, c.351, s.2)
6. Section 7 of P.L.1984, c.146 (C.26:2K-13) is amended to read as follows:
7. a. No person may advertise or disseminate information to the public that the person provides advanced life support services by a mobile intensive care unit unless the person is authorized to do so pursuant to section 6 of 1[this act] P.L.1984, c.146 (C.26:2K-12)1 .
b. No person may impersonate or refer to himself or herself as a mobile intensive care paramedic unless 1[he or she] the person1 is [certified] licensed or approved therefor, as appropriate.
(cf: P.L.1984, c.146, s.7)
7. Section 8 of P.L.1984, c.146 (C.26:2K-14) is amended to read as follows:
8. No emergency medical technician, mobile intensive care paramedic, licensed physician, hospital or its board of trustees, officers and members of the medical staff, [nurses] registered nurse, advanced practice nurse, physician assistant, or other employees of the hospital, first aid, [ambulance] 1[emergency medical service] ambulance1 or rescue squad, licensed emergency medical 1[service] services1 agency, or officers and members of a first aid, 1[emergency medical service] ambulance1 or rescue squad shall be liable for any civil damages as the result of an act or the omission of an act committed while in training for or in the rendering of basic and advanced life support services in good faith and in accordance with this act.
(cf: P.L.1984, c.146, s.8)
8. Section 10 of P.L.1984, c.146 (C.26:2K-16) is amended to read as follows:
10. 1[a] a.1 (1) The Commissioner of Health shall appoint a State Emergency Medical Services Medical Director to the Office of Emergency Medical Services 1in the Department of Health1 . The State Emergency Medical Services Medical Director shall be a licensed physician in this State and board certified in emergency medicine with leadership experience in the medical oversight of emergency medical services, specifically in advanced life support, basic life support, critical care transport, and emergency medical services dispatching. In selecting the State Emergency Medical Services Medical Director, the Commissioner of Health shall give preference to a candidate who is board certified in emergency medical services. The State Emergency Medical Services Medical Director shall not be permitted to be employed as an agency EMS medical director while serving as State Emergency Medical Services Medical Director.
(2) The State Emergency Medical Services Medical Director shall be coequal with the Director of Emergency Medical Services. The State Emergency Medical Services Medical Director shall have primary responsibility for the oversight, regulation, and discipline related to clinical issues pertaining to the provision of emergency medical services in New Jersey, and the Director of Emergency Medical Services shall have primary responsibility for the oversight of non-clinical issues related to the provision of emergency medical services in New Jersey. The State Emergency Medical Services Medical Director shall additionally be responsible for aiding the commissioner in promulgating rules and regulations establishing the scope of practice for providers of emergency medical services, including new standards for basic and advanced life support based on the National EMS Scope of Practice Model and the recommendations of the mobile intensive care advisory council.
b. The commissioner shall establish a State mobile intensive care advisory council, which shall: advise the department on all matters of [mobile intensive care services] advanced life support, the Emergency Medical Service Helicopter Response Program and emergency medical transportation; annually review advanced life support scope of practice; and provide recommendations directly to the commissioner for clinical updates. The council shall [select a chairman annually to chair the meetings and coordinate the activities of the advisory council] be chaired by the State Emergency Medical Services Medical Director. Within 60 days following the effective date of 1[this act] P.L. , c. (pending before the Legislature as this bill)1 , the council shall create new by-laws, and select a vice-chair from among its members. In the event that the State Emergency Medical Services Medical Director position is vacant, the vice-chair shall act as chair of the council until the State Emergency Medical Services Medical Director position is no longer vacant. The [chairman] chair shall appoint subcommittees to review and recommend policy on subjects including, but not limited to, advanced life support training programs, advanced life support patient care equipment, biomedical and telecommunications equipment and procedures, treatment protocols, and helicopter equipment and procedures, as well as other medical matters.
(cf: P.L.1986, c.106, s.5)
19. (New section) a. The Department of Health shall establish a mobile integrated health program. In establishing the mobile integrated health program, the Department of Health shall consider relevant standards and criteria developed or adopted by nationally recognized agencies or organizations, as well as recommendations of interested stakeholders, including, but not limited to, the State Trauma System Advisory Committee and the Mobile Intensive Care Advisory Council.
b. The Department of Health shall establish, in writing, criteria by which an entity may apply for and receive authorization from the department to participate in the mobile integrated health program, and criteria by which an entity may lose authorization to participate in the mobile integrated health program.
c. The Commissioner of Health shall adopt rules and regulations as are necessary to effectuate the provisions of this section, which rules and regulations shall be effective immediately upon filing with the Office of Administrative Law for a period not to exceed 18 months, and shall, thereafter, be amended, adopted, or readopted in accordance with the provisions of the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.)."1
1[9.] 10.1 Section 11 of P.L.1984, c.146 (C.26:2K-17) is amended to read as follows:
11. The commissioner shall promulgate such rules and regulations in accordance with the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.) as [he] the commissioner deems necessary to effectuate the purposes of this act, and the [board of medical examiners] State Board of Medical Examiners and the [board of nursing] New Jersey Board of Nursing shall promulgate such rules and regulations as they deem necessary to carry out their functions under this act.
(cf: P.L.1984, c.146, s.11)
1[10.] 11.1 This act shall take effect immediately.
