HB 1446: Health; transfer responsibility for oversight of emergency medical services from Department of Public Health to Georgia Emergency Medical Services and Trauma Council

The House Committee on Regulated Industries offers the following substitute to HB 1446:

A BILL TO BE ENTITLED

AN ACT

To amend Chapter 11 of Title 31 of the Official Code of Georgia Annotated, relating to emergency medical services, so as to transfer responsibility for the oversight of emergency medical services from the Department of Public Health to the Georgia Emergency Medical Services and Trauma Council; to transfer agreements, employees, and property to such council; to establish such council and provide for its membership, powers, and duties; to provide certain minimum requirements for such council in transacting business; to provide for the appointment of an executive director of such council; to provide for the establishment of emergency medical services regions; to transfer responsibility for designating and contracting with regional emergency medical services from the Board of Public Health to the Board of Community Health; to provide for rules and regulations; to provide for licensure of ambulance providers and emergency medical services personnel by the Georgia Emergency Medical Services and Trauma Council; to revise provisions relating to automated external defibrillators; to revise procedures for licensing and appeals related thereto; to transfer responsibility for designating and certifying stroke centers from the Department of Public Health to the Georgia Emergency Medical Services and Trauma Council; to transfer the Office of Cardiac Care and its employees to such council; to revise and provide for definitions; to provide for legislative findings; to update terminology and provide for conforming changes; to provide for construction; to amend various titles of the Official Code of Georgia Annotated, so as to make conforming changes; to provide for related matters; to provide for effective dates; to repeal conflicting laws; and for other purposes.

BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:

PART I

Emergency Medical Services Generally

SECTION 1-1.

Chapter 11 of Title 31 of the Official Code of Georgia Annotated, relating to emergency medical services, is amended by repealing Article 1, relating to general provisions, and enacting a new Article 1 to read as follows:

"ARTICLE 1

31-11-1.

(a) The General Assembly finds and determines that:

(1) The provision of emergency medical services is a matter of substantial importance to the people of this state;

(2) The cost and quality of emergency medical services are matters within the public interest;

(3) It is highly desirable for the state to participate in emergency medical systems communications programs established pursuant to Public Law 93-154, entitled the Emergency Medical Services Systems Act of 1973;

(4) The administration of an emergency medical systems communications program should be the responsibility of the Georgia Emergency Medical Services and Trauma Council, acting upon the recommendations of regional emergency medical services advisory councils which coordinate the program; all ambulance services shall be a part of this system even if this system is the 9-1-1 emergency telephone number;

(5) An emergency medical systems communications program in each emergency medical services region should be operated as economically and efficiently as possible to serve the public welfare and, to achieve this goal, should involve the designation of geographical territories to be serviced by participating ambulance providers and should involve an economic and efficient procedure to distribute emergency calls among participating ambulance providers serving the same emergency medical services region; and

(6) First responders should fall under the Georgia Emergency Medical Services and Trauma Council's rules and regulations governing ambulances and should transport only in life-threatening situations or by orders of a licensed physician or in situations where an ambulance provider cannot respond.

(b) The General Assembly therefore declares that, in the exercise of the sovereign powers of the state to safeguard and protect the public health and general well-being of its citizens, it is the public policy of this state to encourage, foster, and promote emergency medical systems communications programs and that such programs shall be accomplished in a manner that is coordinated, orderly, economical, and without unnecessary duplication of services and facilities.

31-11-2.

As used in this chapter, the term:

(1) 'Air ambulance' means any rotary-wing aircraft used or intended to be used for hire for transportation of a patient who may need medical attention during transport.

(2) 'Air ambulance services' means the for-hire provision of emergency care and transportation by means of an air ambulance for a patient to or from a place where medical or hospital care is furnished.

(3) 'Ambulance' means a motor vehicle that is specially constructed and equipped or an air ambulance and is intended to be used for the emergency transportation of patients, including dual purpose police patrol cars and funeral coaches or hearses which otherwise comply with the provisions of this chapter.

(4) 'Ambulance attendant' means an individual responsible for the care of patients being transported in an ambulance.

(5) 'Ambulance provider' means an agency or entity providing ambulance services which has been duly licensed under this chapter by a predecessor agency prior to January 1, 2028, or by the council on or after such date.

(6) 'Ambulance services' means the provision of:

(A) Emergency care and transportation on the public streets and highways of this state for a wounded, injured, sick, invalid, or incapacitated human being to or from a place where medical or hospital care is furnished;

(B) Any air ambulance services;

(C) Transportation services by an emergency organ transport vehicle on the public streets and highways of this state for the transport of necessary personnel, organs, tissue, or medical supplies to a time-critical organ transplant procedure; or

(D) Services specified in subparagraphs (A) and (B) of this paragraph.

(7) 'Board' means the Board of Community Health established pursuant to Code Section 31-2-3.

(8) 'Cardiac technician' means an individual who has been duly certified as such under this chapter by a predecessor agency prior to January 1, 2028, or by the council on or after such date.

(9) 'Composite board' means the Georgia Composite Medical Board established pursuant to Code Section 43-34-2.

(10) 'Council' means the Georgia Emergency Medical Services and Trauma Council established pursuant to Code Section 31-11-5.

(11) 'Department' means the Department of Community Health established pursuant to Code Section 31-2-4.

(12) 'Emergency medical services region' or 'EMS region' means any geographical district used as a basis for coordinating and administrating the EMSC Program and duly designated by a predecessor agency prior to January 1, 2028, or by the council on or after such date provided for pursuant to Code Section 31-11-9.

(13) 'Emergency medical services system' means a system which provides for the arrangement of personnel, facilities, and equipment for the effective and coordinated delivery in an appropriate geographical area of healthcare services under emergency conditions, occurring either as a result of the patient's condition or as a result of natural disasters or similar situations, and which is administered by a public or private nonprofit entity which has the authority and the resources to provide effective administration of the system.

(14) 'Emergency Medical Systems Communications Program' or 'EMSC Program' means any program established pursuant to Public Law 93-154, entitled the Emergency Medical Services Systems Act of 1973, which serves as a central communications system to coordinate the personnel, facilities, and equipment of an emergency medical services system and which:

(A) Utilizes emergency medical telephonic screening;

(B) Utilizes a publicized emergency telephone number; and

(C) Has direct communication connections and interconnections with the personnel, facilities, and equipment of an emergency medical services system.

(15) 'Emergency medical technician' means an individual who has been duly certified as such under this chapter by a predecessor agency prior to January 1, 2028, or by the council on or after such date.

(16) 'Emergency organ transport vehicle' means a motor vehicle that is intended to be used for the transport of necessary personnel, organs, tissue, or medical supplies to a time-critical organ transplant procedure.

(17) 'First responder' means any person or agency who provides on-site care until the arrival of an ambulance provider, including, but not limited to, those individuals who routinely respond to calls for assistance through an affiliation with law enforcement agencies, fire departments, and rescue agencies.

(18) 'Invalid car' means a motor vehicle not used for emergency purposes but used only to transport individuals who are convalescent, sick, or otherwise nonambulatory.

(19) 'License' means, when issued to an ambulance provider, that its facilities and operations comply with this chapter and any rules and regulations duly established by a predecessor agency prior to January 1, 2028, or by the council on or after such date.

(20) 'License officer' means a predecessor agency prior to January 1, 2028, or the council or its designee on or after such date.

(21) 'Paramedic' means an individual who has been duly certified as such under this chapter by a predecessor agency prior to January 1, 2028, or by the council on or after such date.

(22) 'Paramedic clinical preceptor' means a paramedic certified in this state with a minimum of two years of emergency medical services experience who meets the standard requirements for paramedic preceptor training as established by a predecessor agency prior to January 1, 2028, or by the council on or after such date.

(23) 'Patient' means an individual who is sick, injured, wounded, or otherwise incapacitated or helpless.

(24) 'Person' means any individual, firm, partnership, association, corporation, company, group of individuals acting together for a common purpose, or organization of any kind, including any governmental agency other than of the United States.

(25) 'Predecessor agency' means the Department of Public Health; provided, however, that such term shall mean the Georgia Composite Medical Board for the purposes of rules, regulations, policies, procedures, and administrative orders relating to the licensing of emergency medical services personnel under Article 2 of this chapter prior to January 1, 2002.

(26) 'Provisional license' means, when issued to an ambulance provider, a license issued on a conditional basis to allow a newly established ambulance provider a period of 30 days to demonstrate that its facilities and operations comply with this chapter and rules and regulations issued under this chapter by a predecessor agency prior to January 1, 2028, or by the council on or after such date.

(27) 'Regional emergency medical services advisory council' or 'REMSAC' means a public or private nonprofit local entity designated, pursuant to Code Section 31-11-10, to administer and coordinate the EMSC Program in an EMS region provided for pursuant to Code Section 31-11-9.

31-11-3.

Except as otherwise expressly provided, all powers, functions, duties, and obligations of the Department of Public Health under this chapter, as they exist on December 31, 2027, with the exception of subsections (a) and (b) of Code Section 31-11-10, relating to the designation of REMSACs, are transferred to the Georgia Emergency Medical Services and Trauma Council, effective January 1, 2028.

31-11-4.

(a) The Georgia Emergency Medical Services and Trauma Council shall succeed to all rules, regulations, policies, standards, programs, procedures, and administrative orders of a predecessor agency that are in effect on December 31, 2027, or scheduled to go into effect on or after January 1, 2028, and which relate to the functions transferred to the council pursuant to Code Section 31-11-3 and shall further succeed to any rights, privileges, entitlements, obligations, and duties of the Department of Public Health that are in effect on December 31, 2027, which relate to the functions transferred to the Georgia Emergency Medical Services and Trauma Council pursuant to Code Section 31-11-3. Such rules, regulations, policies, standards, programs, procedures, and administrative orders shall remain in effect until amended, repealed, superseded, or nullified by the Georgia Emergency Medical Services and Trauma Council by proper authority or as otherwise provided by law.

(b) Except as otherwise expressly provided, the rights, privileges, entitlements, obligations, and duties of parties to contracts, leases, agreements, and other transactions entered into prior to January 1, 2028, by the Department of Public Health which relate to the functions transferred to the Georgia Emergency Medical Services and Trauma Council pursuant to Code Section 31-11-3 shall continue to exist; and none of such rights, privileges, entitlements, obligations, and duties are impaired or diminished by reason of the transfer of the functions to the Georgia Emergency Medical Services and Trauma Council. In all such instances, the Georgia Emergency Medical Services and Trauma Council shall be substituted for the Department of Public Health, and the Georgia Emergency Medical Services and Trauma Council shall succeed to the rights, privileges, entitlements, obligations, and duties under such contracts, leases, agreements, and other transactions.

(c) All individuals employed by the Department of Public Health in capacities which relate to the functions transferred to the Georgia Emergency Medical Services and Trauma Council pursuant to Code Section 31-11-3 on December 31, 2027, including, but not limited to, the Office of Cardiac Care established pursuant to Code Section 31-11-132, shall, on January 1, 2028, become employees of the Georgia Emergency Medical Services and Trauma Council in similar capacities, as determined by the executive director appointed pursuant to Code Section 31-11-8.

(d) Notwithstanding any provision to the contrary in this chapter, any license, provisional license, certificate, permit, registration, or other authorization required under this chapter to engage in the practice of any profession or the provision of any service that was duly issued by a predecessor agency to any person prior to January 1, 2028, shall be valid until such license, provisional license, certificate, permit, registration, or other authorization expires, is revoked by the Georgia Emergency Medical Services and Trauma Council, is surrendered by the holder, or is otherwise terminated under this chapter.

(e) The Georgia Emergency Medical Services and Trauma Council shall receive custody of any state owned real property in the custody of the Department of Public Health on December 31, 2027, and which pertains to the functions transferred to the Georgia Emergency Medical Services and Trauma Council pursuant to Code Section 31-11-3.

31-11-5.

(a) There is established the Georgia Emergency Medical Services and Trauma Council, which shall be assigned to the department for administrative purposes only, as provided in Code Section 50-4-3.

(b) The council shall be composed of the following members:

(1) One member from each REMSAC, with preference given to the chairperson of each such REMSAC, to be appointed by the Governor;

(2) One member who is an employee or representative of a privately owned ambulance provider, to be appointed by the Governor;

(3) One member knowledgeable of the EMSC Program, to be appointed by the Governor;

(4) One member knowledgeable of the EMSC Program, to be appointed by the Speaker of the House of Representatives; and

(5) One member knowledgeable of the EMSC Program, to be appointed by the President of the Senate.

(c)(1) On or before August 1, 2027, the Governor, Speaker of the House of Representatives, and President of the Senate shall appoint the initial members of the council, in accordance with subsection (b) of this Code section. Each member of the council shall be appointed for a term of two years.

(2) Each member of the council shall serve until his or her successor is appointed and qualified. In the event of a vacancy in the council for any reason, such vacancy shall be filled for the remainder of the unexpired term in the same manner as the original appointment. Each member of the council shall be eligible to succeed himself or herself; provided, however, that no member shall serve more than two consecutive terms on the council.

(3) Members of the council may be removed from office under the same conditions for removal from office of members of professional licensing boards as provided in Code Section 43-1-17.

(d) At its first regular meeting, the council shall elect a chairperson and such other officers from among its membership as it deems necessary.

(e)(1) Each REMSAC shall promptly notify the council of any change in chairperson of such REMSAC.

(2) Upon request by the Governor, each REMSAC shall promptly notify the Governor of the name and contact information for the chairperson of such REMSAC.

(f) The council may, from time to time, designate advisory committees of such composition as the council may prescribe to assist and advise the council in carrying out its duties under this chapter. The members of any such advisory committee shall serve at the pleasure of the council.

(g) Members of the council shall serve without compensation but shall be allowed actual and necessary expenses in the performance of their duties. Members of the commission shall receive a daily expense allowance in the amount specified in subsection (b) of Code Section 45-7-21, as well as the mileage or transportation allowance authorized for state employees. The funds necessary for the reimbursement of expenses and allowances of any member of the council shall be paid from funds appropriated to or otherwise available to the department.

31-11-6.

(a) The council is vested with the following functions and powers:

(1) To provide rules of procedure for its internal management and control;

(2) To establish an internal code of conduct which shall contain member disclosure and conflict of interest policies;

(3) To enter into contracts or do such things as may be necessary and incidental to the administration of its authority pursuant to this chapter, including, but not limited to, employing professional, technical, and clerical personnel;

(4) To oversee the EMSC Program and the provision of emergency medical services within each EMS region, as provided under this chapter;

(5) To make all necessary modifications to the territorial zones within each EMS region and methods of distributing calls among ambulance providers participating in the EMSC Program, in accordance with the procedures set forth in Code Section 31-11-10;

(6) To prescribe reasonable health, sanitation, and safety standards for transporting patients in ambulances;

(7) To prescribe reasonable conditions under which ambulance attendants are required;

(8) To establish uniform minimum standards consistent with this chapter for the employment and training of first responders, emergency medical technicians, paramedics, paramedic clinical preceptors, ambulance attendants, cardiac technicians, and such other emergency medical service personnel as determined by the council, including qualifications, certifications, recertifications, decertifications, and probations for certified individuals and suspensions for noncertified individuals;

(9) To establish minimum curriculum requirements for schools operated by or for any employing agency for the specific purpose of training first responders, emergency medical technicians, paramedics, paramedic clinical preceptors, ambulance attendants, cardiac technicians, and such other emergency medical service personnel as determined by the council;

(10) To approve institutions and facilities for school operation by or for any employing agency for the specific purpose of training first responders, emergency medical technicians, paramedics, paramedic clinical preceptors, ambulance attendants, cardiac technicians, and such other emergency medical service personnel as determined by the council;

(11) To permit the emergency medical technician course to be offered at area hospitals and area vocational technical schools in conjunction with their emergency patient care and personnel training programs;

(12) To make or support studies on any aspect of the education and training or recruitment of first responders, emergency medical technicians, paramedics, paramedic clinical preceptors, ambulance attendants, cardiac technicians, and such other emergency medical service personnel as determined by the council;

(13) To make recommendations concerning any matter within its purview;

(14) To establish basic training requirements for first responders, emergency medical technicians, paramedics, paramedic clinical preceptors, ambulance attendants, cardiac technicians, and such other emergency medical service personnel as determined by the council;

(15) To certify any individual satisfactorily complying with the training program established in accordance with paragraph (13) of this subsection and the qualifications for employment under this chapter;

(16) To issue a certificate to any individual who has received training in another state as or who has received training by the United States government as a first responder, emergency medical technician, paramedic, paramedic clinical preceptor, ambulance attendant, cardiac technician, or such other emergency medical service personnel as determined by the council, when the council has determined that the training was at least equivalent to that required by the council for approved education and training programs in this state for such profession and when the individual has satisfactorily complied with all other requirements of this chapter;

(17) To accept donations, gifts, property, and other contributions and to use the same for carrying out the purposes of this chapter; and

(18) To promulgate rules and regulations as reasonably necessary to administer and implement the provisions of this chapter.

(b) Nothing in this Code section shall authorize the council to adopt and promulgate rules or regulations which prevent the continued use of dual purpose funeral coaches or hearses currently being used as ambulances if the vehicles otherwise conform in all respects to the requirements of Code Section 31-11-34 except for their size and shape.

31-11-7.

(a) The council shall transact business in the following manner:

(1) The council shall hold at least four regular meetings each year at the call of the chairperson or upon the written request of a majority of the members of the council;

(2) A majority of the members of the council shall constitute a quorum necessary for the transaction of business and shall be sufficient to do and perform any action permitted the council by this chapter. No vacancy on the council shall impair the right of a quorum to transact any and all business of the council; and

(3) The council shall adopt such rules for the transaction of its business as it shall desire.

(b) The council shall be subject to Chapter 14 of Title 50, relating to open meetings, and Article 4 of Chapter 18 of Title 50, relating to open records.

(c) The council shall make an annual report of its activities to the Governor and to the General Assembly and shall include in such report any recommendations for appropriate legislation. The council shall not be required to distribute copies of such report to the members of the General Assembly but shall notify the members of the availability of the report in the manner it deems to be most effective and efficient.

31-11-8.

(a) The council shall appoint an executive director and establish the executive director's duties and compensation. Such executive director shall serve at the pleasure of the council.

(b) The executive director may contract for such services and employ such other professional, technical, and clerical personnel as may be reasonably necessary to carry out the purposes of this chapter.

31-11-9.

On or after January 1, 2028, the council shall establish as a basis for coordinating and administering the EMSC Program one or more EMS regions composed of one or more counties. Each such EMS region shall, for purposes of coordinating and administering the EMSC Program, succeed to any health districts established by the Department of Public Health that are in effect on December 31, 2027, or scheduled to go into effect on or after January 1, 2028. Such health districts shall remain in effect until amended, superseded, or nullified by the council or as otherwise provided by law.

31-11-10.

(a)(1) Subject to paragraph (2) of this subsection, the board shall as soon as practicable designate and contract with a public or private nonprofit local entity to administer and coordinate the EMSC Program for each EMS region provided for pursuant to Code Section 31-11-9. Any such local entity designated or contracted with shall be known as a regional emergency medical services advisory council or REMSAC.

(2) Any public or private nonprofit local entity that is administering and coordinating the EMSC Program for a designated territory on January 1, 2028, or is scheduled to administer and coordinate the EMSC Program for a designated territory after such date, pursuant to a contract with, agreement with, or other designation by the Department of Public Health duly entered into or agreed to prior to January 1, 2028, shall serve out the remainder of the term of such contract, agreement, or designation; provided, however, that this shall not be construed to impair either party's rights, privileges, entitlements, or duties under any such contract, agreement, or designation. In all such instances, the Board of Community Health shall be substituted for the Board of Public Health; the board shall succeed to the rights, privileges, entitlements, and duties under any such contract, agreement, or designation; and, upon the expiration of such contract, agreement, or designation, the board shall designate and contract with a successor REMSAC in accordance with paragraph (1) of this subsection.

(3) In designating and contracting with a REMSAC pursuant to this subsection, the board shall take all steps necessary to ensure that each REMSAC conducts its business in accordance with Chapter 14 of Title 50, relating to open meetings, and Article 4 of Chapter 18 of Title 50, relating to open records.

(b) Each REMSAC shall be composed of between 25 to 50 members who are knowledgeable of the EMSC Program and meet such other requirements as the board may prescribe, one of whom shall serve as chairperson of such REMSAC.

(c) At such times as the council shall prescribe, each REMSAC shall recommend to the council or its designee the manner in which the EMSC Program is to be conducted. In making its recommendations, the REMSAC shall give priority to making the EMSC Program function as efficiently and economically as possible. (d)(1) Each ambulance provider in an EMS region shall have the opportunity to participate in the EMSC Program.

(2) Each REMSAC designated by the board pursuant to subsection (a) of this Code section shall request from each ambulance provider in its EMS region a written description of the territory in which it can respond to emergency calls. Each ambulance provider shall submit such written description to a REMSAC within ten days of any request by such REMSAC.

(3) Within ten days of receiving the written descriptions of territory provided by the ambulance providers in accordance with paragraph (2) of this subsection, each REMSAC shall recommend in writing to the council or its designee the territories within the EMS region to be serviced by each ambulance provider and the method for distributing emergency calls among the ambulance providers, based primarily on considerations of economy, efficiency, and benefit to the public welfare. The council or its designee shall approve or modify the territorial zones and method of distributing calls among ambulance providers participating in the EMSC Program in the EMS region based on such recommendations.

(e)(1) The council or its designee shall be empowered to conduct a hearing into the recommendations made by any REMSAC, and such hearing shall be conducted according to the procedures set forth in Code Section 31-11-15. The recommendations of any REMSAC shall not be modified unless the council or its designee finds, after a hearing, that the determination of such REMSAC is inconsistent with operation of the EMSC Program in an efficient and economical manner that benefits the public welfare. No hearing shall be required if the council adopts the recommendations of the REMSAC without modification. The final decision of the council or its designee shall be rendered as soon as possible and shall be final and conclusive concerning the operation of the EMSC Program. An appeal from such final decision shall be pursuant to Code Section 31-11-17.

(2) The REMSAC shall begin administering the EMSC Program in accordance with a final decision of the council or its designee immediately after issuance of the final decision by the council or its designee regarding the approval or modification of the recommendations made by the REMSAC, and the EMSC Program shall be operated in such manner pending the resolution of any appeals filed pursuant to Code Section 31-11-17, except as otherwise provided in such Code section.

(f) This Code section shall not apply to air ambulances, air ambulance services, or emergency organ transport vehicles.

31-11-11.

Records of each ambulance trip shall be made by the ambulance provider in such manner and on such forms as may be prescribed by the council through rules and regulations. Such records shall be available for inspection by the council at any time, and a summary of ambulance services shall be prepared on specific cases and furnished to the council upon request.

31-11-12.

(a) The driver of an ambulance on the public streets, highways, and private access roads of this state, when responding to an emergency call or while transporting a patient, shall be authorized to operate the ambulance as an emergency vehicle pursuant to Code Section 40-6-6.

(b) The driver of an emergency organ transport vehicle on the public streets, highways, and private access roads of this state, when transporting necessary personnel, organs, tissue, or medical supplies to a time-critical organ transplant procedure, shall be authorized to operate the emergency organ transport vehicle as an emergency vehicle pursuant to Code Section 40-6-6.

31-11-13.

(a) Any person, including an agent or employee, that is licensed to furnish ambulance services and in good faith renders emergency care to an individual who is a victim of an accident or emergency shall not be liable for any civil damages to such victim as a result of any act or omission by such person in rendering emergency care to such victim.

(b) A physician shall not be civilly liable for damages resulting from that physician's acting as medical adviser to an ambulance provider, pursuant to Code Section 31-11-50, if those damages are not a result of that physician's willful and wanton negligence.

(c) The immunity provided in this Code section shall apply only to those persons that perform the aforesaid emergency services for no remuneration.

31-11-14.

(a) The council and its duly authorized agents are authorized to enforce compliance with this chapter and rules and regulations promulgated under this chapter in the same manner as provided in Article 1 of Chapter 5 of this title and, in connection therewith during the reasonable business hours of the day, to enter upon and inspect in a reasonable manner the premises of an ambulance provider. All inspections under this Code section shall be in compliance with the provisions of Article 2 of Chapter 5 of this title.

(b) The council is authorized to enforce compliance with this chapter, including, but not limited to, compliance with the EMSC Program and the provision of emergency medical services within designated territories, by imposing fines in the same manner as provided in paragraph (6) of subsection (c) of Code Section 31-2-8; this enforcement action shall be a contested case under Chapter 13 of Title 50, the 'Georgia Administrative Procedure Act.'

31-11-15.

Hearings shall be required for any and all quasi-judicial actions and in any other proceeding required by this title or the Constitution of Georgia. All such hearings shall be conducted in accordance with Chapter 13 of Title 50, the 'Georgia Administrative Procedure Act.'

31-11-16.

All rules and regulations of the council shall be adopted after due notice to and hearing by persons and parties affected thereby; and such rules and regulations shall be maintained in a book kept for that purpose, orderly arranged and indexed and subject to inspection by the public during regular business hours. The council shall make copies thereof available for distribution to persons interested in or affected thereby. No rule or regulation shall become effective as law until 30 days after its adoption, except in cases of emergencies constituting an imminent threat to the public, in which event such rules or regulations shall become effective upon adoption; but, in all such cases, the council shall as a part thereof state the conditions found by it to justify such immediate effectiveness. Where deemed desirable by the council, hearing and notice in the same manner as provided in Code Section 31-11-15 may be conducted by it prior to adoption of any rule or regulation.

31-11-17.

(a) Any person or party to a proceeding who is aggrieved or adversely affected by a final order or action of the council, including, but not limited to, an order or action involving a dispute concerning the designation, application, or administration of an ambulance provider territory, may have review thereof by appeal to the superior court in the county in which the action arose. If an appeal concerns a final order or action involving the designation, application, or administration of an ambulance provider territory which includes portions of more than one county, such an appeal may be filed in the superior court of any such county.

(b) Appeal to the superior court shall be by petition which shall be filed in the clerk's office of such court within 30 days after the final order or action of the council. The petition shall set forth the names of the parties taking the appeal; the order, rule, regulation, or decision appealed from; and the reason it is claimed to be erroneous. The enforcement of the order or action appealed from shall not be stayed until and unless so ordered and directed by the superior court. A superior court may order a stay only if the court makes a finding that the public health, safety, and welfare will not be harmed by the issuance of the stay. Upon the filing of such petition, the petitioner shall serve on the council a copy thereof in a manner prescribed by law for the service of process, unless such service of process is waived. The review shall be conducted by the superior court without a jury and shall be confined to the record. In cases of alleged irregularities in procedure before the council, not shown in the record, proof thereon may be taken in the court. The superior court, upon request, shall hear oral argument and receive written briefs.

(c) The superior court shall not substitute its judgment for that of the council as to the weight of the evidence on questions of fact. The court may affirm the decision of the council or remand the case for further proceedings. The court may reverse or modify the decision if substantial rights of the appellant have been prejudiced because the administrative findings, inferences, conclusions, or decisions are:

(1) In violation of constitutional or statutory provisions;

(2) In excess of the statutory authority of the council;

(3) Made upon unlawful procedure;

(4) Affected by other error of law;

(5) Clearly erroneous in view of the reliable, probative, and substantial evidence on the whole record; or

(6) Arbitrary or capricious or characterized by abuse of discretion or clearly unwarranted exercise of discretion.

31-11-18.

Notwithstanding any provision to the contrary in this chapter, the council shall cooperate with and take all steps necessary to share information with, at such frequency and as required by, the Department of Public Health related to the Department of Public Health's performance of its duties under this title; provided, however, that any information released shall comply with the requirements of the federal Health Insurance Portability and Accountability Act of 1996, P.L. 104-191.

31-11-19.

Nothing in this chapter shall be construed as prohibiting or preventing a municipality from fixing, charging, or assessing any license fee or registration fee on any business or profession covered by this chapter or upon any related profession or any person engaged in any profession governed by this chapter or collecting any fee so imposed or from establishing additional regulations regarding ambulance services.

31-11-20.

This chapter shall not apply to:

(1) An ambulance or any provision of ambulance services operated by an agency of the United States government;

(2) A vehicle or aircraft operated by an individual who is not licensed to furnish ambulance services when rendering assistance temporarily in the case of a major catastrophe or emergency because the ambulance providers of the state are insufficient or unable to meet the demands thereof;

(3) An ambulance which is operated from a location outside of the state in order to transport patients from without the state's limits to locations within the state; or

(4) An invalid car or the operator thereof, except as provided in subsection (b) of Code Section 31-11-30.

31-11-21.

Medical directors of ambulance providers, first responders, or neonatal services are authorized to contract with licensed pharmacies to furnish dangerous drugs and controlled substances for the vehicles of their particular services. Such dangerous drugs and controlled substances shall be furnished, secured, and stored in the manner provided for in Code Section 26-4-116."

PART II

Licenses

SECTION 2-1.

Said chapter is further amended in Article 2, relating to licenses, by revising Code Section 31-11-30, relating to license requirement, as follows:

"31-11-30.

(a) No person shall operate as an ambulance service provider in this state without having a valid license or provisional license issued by the license officer pursuant to this chapter.

(b) No person shall make use of the word 'ambulance' to describe any ground or air transportation or facility or service associated therewith which such person provides or to otherwise hold oneself out to be an ambulance service provider unless such person has a valid license or provisional license issued pursuant to the provisions of this chapter or is exempt from licensing under this chapter and is not the operator of an invalid car.

(c) Any person who violates the provisions of this Code section shall be guilty of a misdemeanor."

SECTION 2-2.

Said chapter is further amended in said article by revising paragraphs (1) and (7) of Code Section 31-11-31, relating to application for license, as follows: "(1) The name and address of the owner of the ambulance service provider or proposed ambulance service provider;"

"(7) The location and description of the place or places from which the ambulance service provider is intended to operate."

SECTION 2-3.

Said chapter is further amended in said article by revising Code Section 31-11-31.2, relating to ambulance service provider matching payment, segregated account, appropriations from segregated account, audits, and rules and regulations, as follows: "(a) As used in this Code section, the term:

(1) 'Ambulance service' means an entity licensed by the Department of Public Health pursuant to this chapter.

(2) 'Board' means the Board of Community Health.

(3) 'Department' means the Department of Community Health.

(4) 'Provider matching payment' 'provider matching payment' means a payment assessed by the board pursuant to this Code section on providers which operate an ambulance service provider.

(b)(1) The board shall be authorized to establish and assess, by board rule, one or more provider matching payments on a subclass of ambulance services providers, as defined by the board; provided, however, that, if any such provider matching payment is established and assessed, the provider matching payment shall comply with the requirements of 42 C.F.R. 433.68. Any provider matching payment assessed pursuant to this Code section shall not exceed the amount necessary to obtain federal financial participation allowable under Title XIX of the federal Social Security Act.

(2) The board shall be authorized to discontinue any provider matching payment assessed pursuant to this Code section. The board shall cease to impose any such provider matching payment if:

(A) The provider matching payments are not eligible for federal matching funds under Title XIX of the federal Social Security Act; or

(B) The department, as a direct result of the enactment of this Code section, reduces or supplants Medicaid payment rates to ambulance providers as such rates are in effect on June 30, 2021, or reduces or supplants the provider matching payment rate adjustment factors utilized in developing the state Fiscal Year 2021 capitated rates for Medicaid managed care organizations.

(c)(1) Any provider matching payments assessed pursuant to this Code section shall be deposited into a segregated account within the Indigent Care Trust Fund created pursuant to Code Section 31-8-152 and used solely for the purpose of obtaining federal financial participation for medical assistance payments to providers on behalf of Medicaid recipients pursuant to Article 7 of Chapter 4 of Title 49. Any funds deposited into such segregated account pursuant to this Code section shall be subject to appropriation by the General Assembly.

(2) The department shall be authorized to impose a penalty of up to 6 percent on the amount of any owed provider matching payments for any ambulance service provider that fails to pay a provider matching payment within the time required by the department for each month, or fraction thereof, that such provider matching payment is overdue. If a required provider matching payment has not been received by the department in accordance with department timelines, the department shall withhold an amount equal to the provider matching payment and penalty owed from any medical assistance payment due such ambulance service provider under the Medicaid program. Any provider matching payment assessed pursuant to this Code section shall constitute a debt due the state and may be collected by civil action and the filing of tax liens in addition to such methods provided for in this Code section. Any penalty that accrues pursuant to this subsection shall be credited to the applicable segregated account. (d)(1) Notwithstanding any other provision of Chapter 8 of this title, the General Assembly is authorized to appropriate as state funds to the department for use in any fiscal year all revenues dedicated and deposited into one or more segregated accounts. Such appropriations shall be authorized to be made for the sole purpose of obtaining federal financial participation for medical assistance payments to providers on behalf of Medicaid recipients pursuant to Article 7 of Chapter 4 of Title 49. Any appropriation from a segregated account for any purpose other than such medical assistance payments shall be void.

(2) Revenues appropriated to the department pursuant to this Code section shall be used to match federal funds that are available for the purpose for which such funds have been appropriated.

(3) Appropriations from a segregated account to the department shall not lapse to the general fund at the end of the fiscal year.

(e) The department shall have the authority to inspect and copy the records of an ambulance service provider for purposes of auditing the calculation of the provider matching payment. All information obtained by the department pursuant to this Code section shall be confidential and shall not constitute a public record.

(f) The board shall be authorized to establish rules and regulations to assess and collect any such provider matching payments, including, but not limited to, payment frequency and schedules, required information to be submitted, and record retention."

SECTION 2-4.

Said chapter is further amended in said article by revising subsections (c) and (d) of Code Section 31-11-32, relating to duties of license officer, as follows: "(c) The license officer shall issue provisional licenses for 30 days for the purpose specified in paragraph (19) of Code Section 31-11-2 to allow a newly established ambulance provider a period of 30 days to demonstrate that its facilities and operations comply with this chapter and any rules and regulations issued under this chapter by a predecessor agency prior to January 1, 2028, or by the council on or after such date.

(d) Before issuing a license to a government or governmental agency for a new ambulance service provider, the license officer shall establish that, due to inadequate private service, the public's convenience and necessity require the proposed ambulance service provider."

SECTION 2-5.

Said chapter is further amended in said article by revising subsection (b) of Code Section 31-11-35, relating to renewal of license and change of ownership of ambulance service, as follows:

"(b) Change of ownership of an ambulance service provider shall require a new application and a new license issued in conformance with the requirements of this article as upon original licensing."

SECTION 2-6.

Said chapter is further amended in said article by revising Code Section 31-11-36, relating to suspension or revocation of license and appeal to superior court, as follows:

"31-11-36.

(a) Any license issued under this article may be suspended or revoked for a failure of a licensee to comply and to maintain compliance with this article or rules and regulations issued under this article, but only after an opportunity for a hearing as provided in Article 1 of Chapter 5 of this title Code Section 31-11-15.

(b) Any person who has exhausted all administrative remedies available within the department and who is substantially aggrieved by a final order or final action of the license officer is entitled to judicial review in the manner provided by Article 1 of Chapter 5 of this title and, notwithstanding Code Section 31-5-3, shall be entitled to an appeal to superior court as provided in subsection (c) of this Code section Code Section 31-11-17.

(c) Appeal to the superior court shall be by petition which shall be filed in the clerk's office of such court within 30 days after the final order or action of the department; the petition shall set forth the names of the parties taking the appeal, the order, rule, regulation, or decision appealed from, and the reason it is claimed to be erroneous. The enforcement of the order or action appealed from shall be automatically stayed upon the filing of such petition unless the commissioner of public health in his final order certifies that his decision if stayed will harm the public health and safety, in which case a reviewing court may order a stay only if the court makes a finding that the public health and safety will not be harmed by the issuance of the stay. Upon the filing of such petition, the petitioner shall serve on the commissioner a copy thereof in the manner prescribed by law for the service of process, unless such service of process is waived. The appeal shall be an appeal de novo to the superior court and the appealing party shall have a right to a jury trial and all rights provided under Chapter 11 of Title 9, the 'Georgia Civil Practice Act.' The superior court shall render a decision approving, setting aside, or modifying the order or action appealed from."

PART III

Personnel

SECTION 3-1.

Said chapter is further amended in Article 3, relating to personnel, by revising paragraph (3) of Code Section 31-11-49, relating to definitions, as follows: "(3) 'Emergency medical services personnel' means all individuals duly licensed by the department under this article by a predecessor agency prior to January 1, 2028, or by the council on or after such date."

SECTION 3-2.

Said chapter is further amended in said article by revising Code Section 31-11-50, relating to medical adviser, as follows:

"31-11-50.

(a) To enhance the provision of emergency medical care, each ambulance service provider shall be required to have a medical adviser. The adviser shall be a physician licensed to practice medicine in this state and subject to approval by the medical consultant of the Emergency Health Section of the Department of Public Health council. Ambulance services providers unable to obtain a medical adviser, due to unavailability or refusal of physicians to act as medical advisers, may request the district health director or his or her designee to act as assistance from the council in identifying an individual to act as a medical adviser until the services of a physician are available.

(b) The duties of the medical adviser shall be to provide medical direction and training for the ambulance service provider personnel in conformance with acceptable emergency medical practices and procedures.

(c) This Code section shall not apply to any ambulance service provider which solely provides transportation for necessary personnel, organs, tissue, or medical supplies to a time-critical organ transplant procedure by emergency organ transport vehicles or any county having a population under 12,000 according to the United States decennial census of 1970 2020 or any such future census."

SECTION 3-3.

Said chapter is further amended in said article by revising Code Section 31-11-51, relating to licensing of emergency medical services personnel, rules and regulations, use of conviction data in licensing decisions, and retention of fingerprints, as follows:

"31-11-51.

(a) As used in this Code section, the term 'conviction data' means a record of a finding or verdict of guilty or plea of guilty or plea of nolo contendere with regard to any crime, regardless of whether an appeal of the conviction has been sought.

(b) Except as otherwise provided for in this chapter, the board council shall, by rule or regulation, authorize the department to establish procedures and standards for the licensing of emergency medical services personnel. The department council shall succeed to all rules and regulations, policies, standards, programs, procedures, and administrative orders of the composite board which were in effect on December 31, 2001, and which relate to the functions transferred to the department by this chapter. Such rules, regulations, policies, procedures, and administrative orders shall remain in effect until amended, repealed, superseded, or nullified by proper authority or as otherwise provided by law a predecessor agency, in accordance with Code Section 31-11-4.

(c) In reviewing applicants for initial licensure of emergency medical services personnel, the department council shall be authorized pursuant to this Code section to obtain conviction data with respect to such applicants for the purposes of determining the suitability of the applicant for licensure.

(d) The department council shall, by rule or regulation, consistent with the requirements of this subsection, establish a procedure for requesting a fingerprint based criminal history records check from the center and the Federal Bureau of Investigation. Fingerprints shall be in such form and of such quality as prescribed by the center and under standards adopted by the Federal Bureau of Investigation. Fees may be charged as necessary to cover the cost of the records search. An applicant may request that a criminal history records check be conducted by a state or local law enforcement agency or by a private vendor approved by the department council. Fees for criminal history records checks shall be paid by the applicant to the entity processing the request at the time such request is made. The state or local law enforcement agency or private vendor shall remit payment to the center in such amount as required by the center for conducting a criminal history records check. The department council shall accept a criminal history records check whether such request is made through a state or local law enforcement agency or through a private vendor approved by the department council. Upon receipt of an authorized request, the center shall promptly cause such criminal records search to be conducted. The center shall notify the department council in writing of any finding of disqualifying information, including, but not limited to, any conviction data regarding the fingerprint records check, or if there is no such finding.

(e) An applicant with conviction data which indicates a conviction of a felony more than five but less than ten years prior to application shall not be disqualified for licensure, provided that such applicant has:

(1) Successfully completed a training program duly approved by a predecessor agency prior to January 1, 2028, or by the department council on or after such date and sponsored by the Department of Corrections pursuant to Code Section 42-5-57; and

(2) Met all other requirements as set forth in this chapter.

(f) Conviction data received by the department council or a any state or local law enforcement agency shall be privileged and shall not be a public record or disclosed to any person. Conviction data shall be maintained by the department council and the any state or local law enforcement agency pursuant to laws regarding such records and the rules and regulations of the center and the Federal Bureau of Investigation. Penalties for the unauthorized release or disclosure of conviction data shall be as prescribed by law or rule or regulation of the center or Federal Bureau of Investigation.

(g) The center, the department council, or any law enforcement agency, or the employees of any such entities, shall neither be responsible for the accuracy of information provided pursuant to this Code section nor be liable for defamation, invasion of privacy, negligence, or any other claim relating to or arising from the dissemination of information pursuant to this Code section.

(h) If the department council is participating in the program described in subparagraph (a)(1)(F) of Code Section 35-3-33, the Georgia Bureau of Investigation and the Federal Bureau of Investigation shall be authorized to retain fingerprints obtained pursuant to this Code section for such program, and the department council shall notify the individual whose fingerprints were taken of the parameters of such retention."

SECTION 3-4.

Said chapter is further amended in said article by revising Code Section 31-11-52, relating to certification of paramedics and cardiac technicians and provisional practice by military medical personnel, as follows:

"31-11-52.

(a) As used in this Code section, the term 'military medical personnel' means an individual who has, within 12 months of seeking certification pursuant to this Code section, served as a medic in the United States Army, medical technician in the United States Air Force, or corpsman in the United States Navy or Coast Guard and who was discharged or released from such service under conditions other than dishonorable.

(b) The department council shall establish procedures and standards for certifying and recertifying first responders, emergency medical technicians, paramedics, and cardiac technicians. An applicant for initial certification as a paramedic or a cardiac technician shall:

(1) Submit a completed application on a form to be prescribed by the department council, which shall include evidence that the applicant is 18 years of age or older and is of good moral character;

(2) Submit from the department council a notarized statement that the applicant has completed a training course approved by the department council;

(3) Submit to the department council a fee as set forth in the regulations of the department council; and

(4) Meet such other requirements as are set forth in the rules and regulations of the department council.

(b)(c) The department council shall also adopt procedures and standards for its approval of paramedic training courses and cardiac technician training courses for first responders, emergency medical technicians, paramedics, and cardiac technicians. The department council shall adopt such regulations after consultation with appropriate public and private agencies and organizations concerned with medical education and the practice of medicine. Procedures and standards adopted by the department council shall be consistent with the purposes and provisions of this chapter.

(c)(d) An applicant convicted of a felony more than five but less than ten years prior to application shall not be disqualified for certification, provided that such applicant has:

(1) Successfully completed a training program approved by the department council and sponsored by the Department of Corrections pursuant to Code Section 42-5-57; and

(2) Met all other requirements as set forth in this chapter.

(d)(e) The department council, in collaboration with the Department of Veterans Service, shall establish a program through which military medical personnel may provisionally operate within their scope of practice and training for a period of 12 months without meeting the requirements provided for in paragraphs (2) and (4) of subsection (a) (b) of this Code section. The program established pursuant to this subsection shall not conflict with or supplant Code Section 38-3-71 or Georgia's status as a member of the EMS Interstate Compact.

(e) As used in this Code section, the term 'military medical personnel' means an individual who has, within 12 months of seeking certification pursuant to this Code section, served as a medic in the United States Army, medical technician in the United States Air Force, or corpsman in the United States Navy or Coast Guard and who was discharged or released from such service under conditions other than dishonorable.

(f) Any rules, regulations, policies, standards, programs, procedures, or administrative orders issued by the council under this Code section shall succeed to the rules, regulations, policies, standards, programs, procedures, or administrative orders of a predecessor agency, in accordance with Code Section 31-11-4."

SECTION 3-5.

Said chapter is further amended in said article by revising Code Section 31-11-53, relating to services which may be rendered by certified emergency medical technicians and trainees and provisional practice by military medical personnel, as follows:

"31-11-53.

(a) As used in this Code section, the term 'military medical personnel' means an individual who has, within 12 months of seeking certification pursuant to this Code section, served as a medic in the United States Army, medical technician in the United States Air Force, or corpsman in the United States Navy or Coast Guard and who was discharged or released from such service under conditions other than dishonorable.

(b) Emergency Upon certification by the department, emergency medical technicians may do any of the following:

(1) Render first-aid and resuscitation services as taught in the United States Department of Transportation basic training courses for emergency medical technicians or an equivalent course approved by the department council;

(2) Upon the order of a duly licensed physician, administer approved intravenous solutions and opioid antagonists; and

(3) Upon the order of a duly licensed physician during a public health emergency, as defined in Code Section 31-12-1.1, administer vaccines.

(b)(c) While in training preparatory to becoming certified, emergency medical technician trainees may perform any of the functions specified in this Code section under the direct supervision of a duly licensed physician or a registered nurse. (c)(d) The department council, in collaboration with the Department of Veterans Service, shall establish a program through which military medical personnel may provisionally operate within their scope of practice and training without additional training, experience, or examination for a period of up to 12 months. During such 12 month period, such individual may apply for certification at the appropriate level. The program established pursuant to this subsection shall not conflict with or supplant Code Section 38-3-71 or Georgia's status as a member of the EMS Interstate Compact.

(d) As used in this Code section, the term 'military medical personnel' means an individual who has, within 12 months of seeking certification pursuant to this Code section, served as a medic in the United States Army, medical technician in the United States Air Force, or corpsman in the United States Navy or Coast Guard and who was discharged or released from such service under conditions other than dishonorable.

(e) Any rules, regulations, policies, standards, programs, procedures, or administrative orders issued by the council under this Code section shall succeed to the rules, regulations, policies, standards, programs, procedures, or administrative orders of a predecessor agency, in accordance with Code Section 31-11-4."

SECTION 3-6.

Said chapter is further amended in said article by revising Code Section 31-11-53.1, relating to automated external defibrillator program, establishment, regulations, and liability, as follows:

"31-11-53.1.

(a) As used in this Code section, the term:

(1) 'Agencies' means every state department, agency, division, board, bureau, commission, or entity, including without limitation the Board of Regents of the University System of Georgia.

(1)(2) 'Automated external defibrillator' means a defibrillator which:

(A) Is capable of cardiac rhythm analysis;

(B) Will charge and be capable of being activated to deliver a countershock after electrically detecting the presence of certain cardiac dysrhythmias; and

(C) Is capable of continuous recording of the cardiac dysrhythmia at the scene with a mechanism for transfer and storage or for printing for review subsequent to use. (2)(3) 'Defibrillation' means to terminate ventricular fibrillation.

(3) 'First responder' means any person or agency who provides on-site care until the arrival of a duly licensed ambulance service. This shall include, but not be limited to, persons who routinely respond to calls for assistance through an affiliation with law enforcement agencies, fire suppression agencies, rescue agencies, and others.

(4) 'Person' means any firm, partnership, association, corporation, or other private entity, including without limitation any private postsecondary school, college, or university in this state.

(5) 'Public safety answering point' shall have the same meaning as set forth in Code Section 46-5-122.

(b) It is the intent of the General Assembly that an automated external defibrillator may be used by any person for the purpose of saving the life of another person an individual in cardiac arrest. In order to ensure public health and safety:

(1) It is recommended that all persons who have access to or use an automated external defibrillator obtain appropriate training as set forth in the rules and regulations of the Department of Public Health from the American Red Cross, the American Heart Association, or another nationally recognized training. It is further recommended that such training include at a minimum the successful completion of:

(A) A nationally recognized health care provider/professional healthcare provider or professional rescuer level cardiopulmonary resuscitation course; and

(B) A department established or approved nationally recognized course which includes demonstrated proficiency in the use of an automated external defibrillator;

(2) All persons and agencies possessing and maintaining an automated external defibrillator shall notify the appropriate emergency medical services system public safety answering point of the existence and location of the automated external defibrillator prior to said defibrillator being placed in use;. The council is authorized to promulgate rules and regulations to implement this provision; and

(3) All persons who use an automated external defibrillator shall activate the emergency medical services system as soon as reasonably possible by calling 9-1-1 or the appropriate emergency telephone number upon use of the automated external defibrillator; and

(4) Within a reasonable period of time, all persons who use an automated external defibrillator shall make available a printed or electronically stored report to the licensed emergency medical services provider which transports the patient.

(c) With the exception of communications officers under Code Section 35-8-23, who shall complete training as set forth in such Code section, all All persons who provide instruction to others in the use of the automated external defibrillator shall have completed an a nationally recognized instructor course established or approved by the department.

(d) The department shall establish an automated external defibrillator program for use by emergency medical technicians. Such program shall be subject to the direct supervision of a medical adviser approved under Code Section 31-11-50. No emergency medical technician shall be authorized to use an automated external defibrillator to defibrillate a person unless that defibrillator is a properly maintained automated external defibrillator and that emergency medical technician:

(1) Submits to and has approved by the department an application for such use, and in considering that application the department may obtain and use the recommendation of the local coordinating entity for the health district in which the applicant will use such defibrillator;

(2) Successfully completes an automated external defibrillator training program established or approved by the department;

(3) Is subject to protocols requiring that both the emergency physician who receives a patient defibrillated by that emergency medical technician and the medical adviser for the defibrillator program review the department required prehospital care report and any other documentation of the defibrillation of any person by that emergency medical technician and send a written report of such review to the district EMS medical director of the health district in which the defibrillation occurred; and

(4) Obtains a passing score on an annual automated external defibrillator proficiency exam given in connection with that program.

(e) It shall not be necessary for a licensed emergency medical service, licensed neonatal transport service, or other services licensed by the department which provide care administered by cardiac technicians or paramedics to obtain department approval for the use of an automated external defibrillator on licensed vehicles.

(f) Any emergency medical technician who violates the provisions of this Code section shall be subject to having revoked by the department that person's authority to use an automated external defibrillator. Such a violation shall also be grounds for any entity which issues a license or certificate authorizing such emergency medical technician to perform emergency medical services to take disciplinary action against such person, including but not limited to suspension or revocation of that license or certificate. Such a violation shall also be grounds for the employer of such emergency medical technician to impose any sanction available thereto, including but not limited to dismissal. (g)(d) Any first responder who gratuitously and in good faith renders emergency care or treatment by the use of or provision of an automated external defibrillator, without objection of the injured victim or victims thereof, shall not be held liable for any civil damages as a result of such care or treatment or as a result of any act or failure to act in providing or arranging further medical treatment where the person first responder acts without gross negligence or intent to harm or as an ordinary reasonably prudent person would have acted under the same or similar circumstances, even if such individual does so without benefit of the appropriate training. This provision includes paid persons individuals who extend care or treatment without expectation of remuneration from the patient or victim for receiving the defibrillation care or treatment.

(e) Any rules, regulations, policies, standards, programs, procedures, or administrative orders issued by the council under this Code section shall succeed to the rules, regulations, policies, standards, programs, procedures, or administrative orders of a predecessor agency, in accordance with Code Section 31-11-4."

SECTION 3-7.

Said chapter is further amended in said article by revising subsection (a) of Code Section 31-11-54, relating to services which may be rendered by paramedics and paramedic trainees, as follows:

"(a) Paramedics Upon certification by the department, paramedics may perform any service that a cardiac technician is permitted to perform. In addition, upon the order of a duly licensed physician and subject to the conditions set forth in paragraph (2) of subsection (a) of Code Section 31-11-55, paramedics may perform any other procedures which they have been both trained and certified to perform, including, but not limited to:

(1) Administration of parenteral injections of diuretics, anticonvulsants, hypertonic glucose, antihistamines, bronchodilators, emetics, narcotic antagonists, and others, and administration of opioid antagonists;

(2) Cardioversion; and

(3) Endotracheal suction."

SECTION 3-8.

Said chapter is further amended in said article by revising subsection (a) of Code Section 31-11-55, relating to services which may be rendered by certified cardiac technicians and trainees, as follows:

"(a) Cardiac Upon certification by the department, cardiac technicians may do any of the following:

(1) Render first-aid and resuscitation services;

(2) Upon the order of a duly licensed physician and as recommended by the Georgia Emergency Medical Services Advisory Council and duly approved by the department a predecessor agency prior to January 1, 2028, or by the council on or after such date:

(A) Perform cardiopulmonary resuscitation and defibrillation in a hemodynamically unstable patient;

(B) Administer approved intravenous solutions;

(C) Administer parenteral injections of antiarrhythmic agents, vagolytic agents, chronotropic agents, alkalizing agents, analgesic agents, and vasopressor agents or administer opioid antagonists;

(D) Perform pulmonary ventilation by esophageal airway and endotracheal intubation; and

(E) Upon the order of a duly licensed physician during a public health emergency, as defined in Code Section 31-12-1.1, administer vaccines."

SECTION 3-9.

Said chapter is further amended in said article by revising subsections (a) and (b) of Code Section 31-11-55.1, relating to administration of opioid antagonists by first responders and issuance by pharmacies, as follows:

"(a) As used in this Code section, the term:

(1) 'First responder' means any person or agency who provides on-site care until the arrival of a duly licensed ambulance service. This shall include, but not be limited to, persons who routinely respond to calls for assistance through an affiliation with law enforcement agencies, fire departments, and rescue agencies.

(2)(1) 'Opioid antagonist' means any drug that binds to opioid receptors and blocks or inhibits the effects of opioids acting on those receptors and that is approved by the federal Food and Drug Administration for the treatment of an opioid related overdose. (3)(2) 'Opioid related overdose' means an acute condition, including, but not limited to, extreme physical illness, decreased level of consciousness, respiratory depression, coma, mania, or death, resulting from the consumption or use of an opioid or another substance with which an opioid was combined or that a layperson would reasonably believe to be resulting from the consumption or use of an opioid or another substance with which an opioid was combined.

(b) An opioid antagonist may be administered or provided by any first responder for the purpose of saving the life of a person an individual experiencing an opioid related 1000 overdose. In order to ensure public health and safety:

1001 (1) All first responders who have access to or maintain an opioid antagonist shall obtain 1002 appropriate training as set forth in the any rules and regulations of the Department of 1003 Public Health duly established under this chapter; 1004 (2) All law enforcement agencies, fire departments, rescue agencies, and other similar 1005 entities shall notify the appropriate emergency medical services system of the possession 1006 and maintenance of opioid antagonists by its personnel; and 1007 (3) Within a reasonable period of time, all first responders who administer or provide an 1008 opioid antagonist shall make available a printed or electronically stored report to the 1009 licensed ambulance service ambulance provider which transports the patient." 1010 SECTION 3-10.

1011 Said chapter is further amended in said article by revising subsections (c) and (d) of Code 1012 Section 31-11-55.2, relating to administration of hydrocortisone sodium succinate and 1013 training, and adding a new subsection to read as follows: 1014 "(c) In order to ensure public health and safety:

1015 (1) All emergency medical services personnel shall obtain appropriate training on 1016 congenital adrenal hyperplasia, and all paramedics shall obtain appropriate training 1017 regarding administration of hydrocortisone sodium succinate as set forth in the rules and 1018 regulations of the Department of Public Health council; and 1019 (2) Within a reasonable period of time, all paramedics who administer hydrocortisone 1020 sodium succinate shall make available a printed or electronically stored report to the 1021 licensed ambulance service ambulance provider which transports the patient. 1022 (d) The immunity provided in Code Section 31-11-8 31-11-13 shall apply to any 1023 paramedic who in good faith renders emergency care pursuant to this Code section. 1024 (e) Any rules, regulations, policies, standards, programs, procedures, or administrative 1025 orders issued by the council under this Code section shall succeed to the rules, regulations, 1026 policies, standards, programs, procedures, or administrative orders of a predecessor agency, 1027 in accordance with Code Section 31-11-4."

1028 SECTION 3-11.

1029 Said chapter is further amended in said article by revising Code Section 31-11-56, relating 1030 to revocation of certificates issued to emergency medical technicians, as follows: 1031 "31-11-56.

1032 Certificates issued to emergency medical technicians pursuant to this chapter may be 1033 revoked by the council for good cause, as set forth in the in accordance with any rules and 1034 regulations, by the department duly established under this chapter, after notice to the 1035 certificate holder of the charges and an opportunity for hearing. Such proceedings shall be 1036 conducted in accordance with Chapter 13 of Title 50, the 'Georgia Administrative 1037 Procedure Act.', in accordance with the procedures set forth in Code Section 31-11-15." 1038 SECTION 3-12.

1039 Said chapter is further amended in said article by revising Code Section 31-11-57, relating 1040 to revocation of certificates issued to paramedics and cardiac technicians, as follows: 1041 "31-11-57.

1042 Certificates issued to paramedics and cardiac technicians pursuant to this chapter may be 1043 revoked for good cause by the department council in accordance with established any rules 1044 and regulations duly established under this chapter, after notice to the certificate holder of 1045 the charges and an opportunity for hearing. Such proceedings shall be conducted in 1046 accordance with Chapter 13 of Title 50, the 'Georgia Administrative Procedure Act.', in 1047 accordance with the procedures set forth in Code Section 31-11-15. The department 1048 council shall have the authority to conduct investigations and subpoena any documents 1049 relating to the fitness of paramedics and cardiac technicians. Such documents may be used 1050 in any hearing conducted by the department council." 1051 SECTION 3-13.

1052 Said chapter is further amended in said article by revising Code Section 31-11-58, relating 1053 to recertification of emergency medical technicians and continuing education requirements, 1054 as follows:

1055 "31-11-58.

1056 (a) The department council shall be authorized to require emergency medical technicians 1057 seeking recertification under this chapter to complete department council approved 1058 continuing education. The department council shall be authorized to approve courses, 1059 including, but not limited to, courses offered by the department council, the number of 1060 hours required, and the category in which these hours should be earned. 1061 (b) The department council shall be authorized to waive the continuing education 1062 requirement in cases of hardship, disability, illness, or under such other circumstances as 1063 the department council deems appropriate. 1064 (c) The department council shall be authorized to promulgate rules and regulations to 1065 implement and ensure compliance with the requirements of this Code section. 1066 (d) This Code section shall apply to each certification and recertification cycle which 1067 begins after the 1992-1993 renewal January 1, 2028." 1068 SECTION 3-14.

1069 Said chapter is further amended in said article by revising Code Section 31-11-58.1, relating 1070 to recertification of paramedics and cardiac technicians and continuing education 1071 requirements, as follows:

1072 "31-11-58.1.

1073 (a) The department council shall be authorized to require paramedics and cardiac 1074 technicians seeking recertification under this chapter to complete department council 1075 approved continuing education of not less than 40 hours biennially. The department 1076 council shall be authorized to approve courses, including but not limited to courses offered 1077 by the department council, the number of hours required, and the category in which these 1078 hours should be earned.

1079 (b) The department council shall be authorized to waive the continuing education 1080 requirement in cases of hardship, disability, illness, or under such other circumstances as 1081 the department council deems appropriate. 1082 (c) The department council shall be authorized to promulgate rules and regulations to 1083 implement and ensure compliance with the requirements of this Code section. 1084 (d) This Code section shall apply to each certification and recertification cycle which 1085 begins after the renewal deadline in 2000 January 1, 2028." 1086 SECTION 3-15.

1087 Said chapter is further amended in said article by revising Code Section 31-11-60, relating 1088 to obtaining and administering drugs by certified employees of counties or municipalities, 1089 as follows:

1090 "31-11-60.

1091 (a) Any emergency medical technician, paramedic, or cardiac technician who is certified 1092 under this article and who works for a county or municipal police department, fire 1093 department, or rescue unit is authorized to obtain any substance which such person 1094 technician or paramedic is authorized to administer by virtue of his such certification. Any 1095 such unit to which the emergency medical technician, paramedic, or cardiac technician is 1096 attached must be duly licensed by the department as a medical first responder unit by a 1097 predecessor agency prior to January 1, 2028, or by the council on or after such date. Such 1098 unit may then obtain from a hospital pharmacy those legend drugs listed and legally 1099 permitted to be used by paramedics, emergency medical technicians, paramedics, or 1100 cardiac technicians. The first responder unit shall have a signed agreement with the 1101 hospital in order for the hospital to furnish such drugs, and a copy of this agreement must 1102 be filed with the Georgia Drugs and Narcotics Agency. The requirements for 1103 administering, controlling, and storing these drugs shall be the same as the requirements 1104 for a standard ward inventory in a hospital.

1105 (b) Any substance obtained under subsection (a) of this Code section shall be used only 1106 in connection with the emergency medical technician's, paramedic's, or cardiac technician's 1107 employment with the county or municipality, as such, and only while on duty as an 1108 emergency medical technician, paramedic, or cardiac technician. 1109 (c) It shall not be necessary for an emergency medical technician, paramedic, or cardiac 1110 technician to be assigned to a licensed an ambulance service provider in order to obtain any 1111 substance under subsection (a) of this Code section."

1112 SECTION 3-16.

1113 Said chapter is further amended in said article by revising Code Section 31-11-60.1, relating 1114 to program for physician control over emergency medical services to nonhospital patients, 1115 as follows:

1116 "31-11-60.1.

1117 (a) As used in this Code section, the term:

1118 (1) 'Ambulance provider medical director' 'Ambulance service medical director' means 1119 a physician licensed to practice in this state and subject to the approval of the local 1120 coordinating entity and the department REMSAC and the council who has agreed, in 1121 writing, to provide medical direction to a specific ambulance service ambulance provider. 1122 (2) 'Base station facility' means any facility responsible for providing direct physician 1123 control of emergency medical services.

1124 (3) 'District emergency medical services medical director' means a person an individual 1125 who is:

1126 (A) A physician licensed to practice medicine in this state; 1127 (B) Familiar with the design and operation of prehospital emergency services systems; 1128 (C) Experienced in the prehospital emergency care of acutely ill or injured patients; 1129 and

1130 (D) Experienced in the administrative processes affecting regional and state prehospital 1131 emergency medical services systems.

1132 (4) 'Emergency medical services personnel' means any emergency medical technician, 1133 paramedic, cardiac technician, or designated first responder who is certified under this 1134 article.

1135 (b) The department council and the district emergency medical services medical directors 1136 shall develop and implement a program to ensure appropriate physician control over the 1137 rendering of emergency medical services by emergency medical services personnel to 1138 patients who are not in a hospital, which program shall succeed to any program developed 1139 and implemented by a predecessor agency and the district emergency medical services 1140 medical directors prior to January 1, 2028. Such program shall include but not be limited 1141 to the following:

1142 (1) Medical protocols regarding permissible and appropriate emergency medical services 1143 which may be rendered by emergency medical services personnel to a patient not in a 1144 hospital;

1145 (2) Communication protocols regarding which medical situations require direct voice 1146 communication between emergency medical services personnel and a physician or a 1147 nurse or a paramedic or a physician assistant in direct communication with a physician 1148 prior to those emergency medical services personnel's rendering specified emergency 1149 medical services to a patient not in a hospital;

1150 (3) Record-keeping and accountability requirements for emergency medical services 1151 personnel and base station facility personnel in order to monitor compliance with this 1152 subsection; and

1153 (4) Base station facility standards.

1154 (c) The ambulance service provider medical director shall serve as the medical authority 1155 for the ambulance service provider, performing liaison activities with the medical 1156 community, medical facilities, and governmental agencies. The ambulance service 1157 provider medical director shall be responsible for the provision of medical direction and 1158 training for the emergency medical services personnel providing ambulance service 1159 services for the ambulance provider for which he or she is responsible in conformance with 1160 acceptable emergency medical practices and procedures. These responsibilities shall 1161 include the duties set forth in the department's council's rules and regulations for the 1162 provision of ambulance services.

1163 (d) The district emergency medical services medical director shall not override those 1164 policies or protocols of the ambulance service provider medical director if that ambulance 1165 service provider medical director is documenting compliance with the department's 1166 council's rules and regulations for the provision of ambulance services. 1167 (e) Every base station facility shall comply with the policies, protocols, requirements, and 1168 standards provided for in subsection (b) of this Code section. 1169 (f) All emergency medical services personnel shall comply with appropriate policies, 1170 protocols, requirements, and standards of the ambulance service provider medical director 1171 for that service or the policies, protocols, requirements, and standards provided for in 1172 subsection (b) of this Code section.

1173 (g) Conduct which would otherwise constitute a violation of subsection (f) of this Code 1174 section shall not be such a violation if such conduct was carried out by any emergency 1175 medical services personnel pursuant to an order from a physician, the ambulance service 1176 provider medical director for such person personnel, or the protocol of that ambulance 1177 service provider as approved by the ambulance service provider medical director for such 1178 person personnel.

1179 (h) Violation by any base station facility of subsection (e) of this Code section may be 1180 grounds for the removal of that base station facility's designation by the department 1181 council.

1182 (i) Enforcement of subsections (g) and (h) of this Code section by the council shall 1183 commence no earlier than 12 months after July 1, 1989 January 1, 2028." 1184 SECTION 3-17.

1185 Said chapter is further amended in said article by revising subsections (a) and (b) of Code 1186 Section 31-11-60.2, relating to testing for illegal drug usage and requirements, as follows: 1187 "(a) All persons licensed or certified based upon successful completion of training set forth 1188 in paragraph (1) of subsection (e) of Code Section 31-11-51 or paragraph (1) of 1189 subsection (c) (d) of Code Section 31-11-52 shall be subject to random testing for evidence 1190 of use of illegal drugs. Such testing shall occur at least biannually for the first two years 1191 of licensure or certification. Such testing shall be noninvasive and may be conducted at 1192 any time during the calendar year, and the cost of all such testing shall be borne by the 1193 employer. If the drug test shows the presence of drugs in the employee's system, the results 1194 of the test will be confirmed with an alternative method by using the same urine sample. 1195 (b) The department council shall adopt rules and regulations to establish for purposes of 1196 testing and retesting for illegal drugs:

1197 (1) Which illegal drugs will be the subject of testing;

1198 (2) Methods for ensuring minimal privacy intrusions during collection of body fluid 1199 specimens for such testing;

1200 (3) Methods for ensuring proper storage, transportation, and handling of such specimens 1201 in order to maintain the integrity of the testing process; 1202 (4) Which persons should be entitled to the results of such tests and which methods 1203 should be used for ensuring that only authorized persons are given access to such results; 1204 (5) A list of laboratories qualified to conduct established drug tests; and 1205 (6) Procedures through which emergency medical services personnel, paramedics, or 1206 cardiac technicians, prior to the collection of body fluid specimens for such testing, may 1207 provide information to their employers regarding use of any drug pursuant to a medical 1208 prescription or, as otherwise authorized by law, any substance which could affect the 1209 results of such test."

1210 PART IV

1211 Emergency Services

1212 SECTION 4-1.

1213 Said chapter is further amended in Article 4, relating to emergency services, by revising 1214 paragraph (2) of Code Section 31-11-81, relating to definitions, as follows: 1215 "(2) 'Emergency medical provider' means any provider of emergency medical 1216 transportation duly licensed or permitted by the Department of Public Health a 1217 predecessor agency prior to January 1, 2028, or by the council on or after such date, any 1218 hospital licensed or permitted by the Department of Community Health department, any 1219 hospital based service, or any physician licensed by the Georgia Composite Medical 1220 Board composite board who provides emergency services." 1221 SECTION 4-2.

1222 Said chapter is further amended in said article by revising subsection (b) of Code 1223 Section 31-11-82, relating to evaluation of emergency condition required, stabilization of 1224 patient, and prospective authorization by insurer, as follows: 1225 "(b) If in the opinion of the attending physician or licensed ambulance service ambulance 1226 provider personnel acting under the medical direction of an ambulance service provider 1227 medical director, as defined in Code Section 31-11-60.1, the evaluation provided under 1228 subsection (a) of this Code section warrants, he or she may initiate appropriate intervention 1229 to stabilize the condition of the patient without seeking or receiving prospective 1230 authorization by an insurer, a health maintenance organization, or a private health benefit 1231 plan. No insurer, health maintenance organization, or private health benefit plan may 1232 subsequently deny payment for an evaluation, diagnostic testing, or treatment provided as 1233 part of such intervention for an emergency condition."

1234 PART V

1235 Georgia Trauma Care Network Commission

1236 SECTION 5-1.

1237 Said chapter is further amended in Article 5, relating to Georgia Trauma Care Network 1238 Commission, by revising paragraphs (1) and (3) of Code Section 31-11-100, relating to 1239 definitions, as follows:

1240 "(1) 'Burn trauma center' means a facility that has been designated by the Department of 1241 Public Health council as a burn center and that admits at least 300 patients annually with 1242 the burn specific principal diagnosis codes as published by the International 1243 Classification of Diseases."

1244 "(3) 'Trauma center' means a facility designated by the Department of Public Health 1245 council as a Level I, II, III, or IV or burn trauma center. However, a burn trauma center 1246 shall not be considered or treated as a trauma center for purposes of certificate of need 1247 requirements under state law or regulations, including exceptions to need and adverse 1248 impact standards allowed by the department council for trauma centers or for purposes 1249 of identifying safety net hospitals."

1250 SECTION 5-2.

1251 Said chapter is further amended in said article by revising paragraphs (6), (7), and (10) of 1252 subsection (a) of Code Section 31-11-102, relating to duties and responsibilities, as follows: 1253 "(6) To reserve and disburse additional moneys to increase the number of participants in 1254 the Georgia trauma system. These funds shall be disbursed through an application 1255 process to cover partial start-up costs for nondesignated acute care facilities to enter the 1256 system as Level II, III, or IV trauma centers. The application process developed by the 1257 commission for start-up costs shall include, but is not limited to, the following: 1258 (A) Criteria assuring that the trauma fund is a payor of last resort; 1259 (B) Criteria assuring that all other resources for start-up costs must be exhausted before 1260 the trauma funds are allocated;

1261 (C) Criteria assuring that the distribution of trauma funds will result in the applicant's 1262 achieving a trauma designation as defined by the commission within the time frame 1263 specified on the application;

1264 (D) Criteria assuring and verifying that the Department of Public Health council has 1265 determined that there is a need for an additional trauma center with the designation that 1266 the applicant is seeking; and

1267 (E) Criteria assuring that no more than 15 percent of the total annual distribution from 1268 the trauma fund total shall be distributed for new trauma center development; 1269 (7)(A) To develop, implement, administer, and maintain a system to compensate 1270 members of the emergency medical service transportation community for readiness and 1271 uncompensated trauma care.

1272 (B) The compensation for the cost of readiness shall be through an application process 1273 adopted by the commission. The application process developed by the commission for 1274 readiness costs shall include, but is not limited to, the following: 1275 (i) Criteria assuring that the trauma fund is a payor of last resort; 1276 (ii) Criteria assuring that all other resources for readiness costs must be exhausted 1277 before the trauma funds are allocated;

1278 (iii) Criteria assuring that the distribution of trauma funds will result in the applicant's 1279 achieving certification as defined by the commission within the time frame specified 1280 on the application; and

1281 (iv) Criteria assuring and verifying that the Department of Public Health council has 1282 determined that there is a need for additional emergency medical services with the 1283 certification that the applicant is seeking."

1284 "(10) To coordinate its activities with the Department of Public Health council;" 1285 PART VI

1286 System of Certified Stroke Centers

1287 SECTION 6-1.

1288 Said chapter is further amended in Article 6, relating to system of certified stroke centers, by 1289 repealing in its entirety Code Section 31-11-111, relating to "department" defined, and 1290 designating said Code section as reserved.

1291 SECTION 6-2.

1292 Said chapter is further amended in said article by revising Code Section 31-11-112, relating 1293 to identification of stroke centers, as follows:

1294 "31-11-112.

1295 (a) The department council shall identify hospitals that meet the criteria set forth in this 1296 article as comprehensive, primary, or remote treatment stroke centers. In addition, the 1297 department council shall be authorized to establish one or more additional levels of stroke 1298 centers, in consultation with the Georgia Coverdell Acute Stroke Registry, as necessary 1299 based on advancements in medicine and patient care.

1300 (b) A hospital shall apply to the department council for such identification and shall 1301 demonstrate to the satisfaction of the department council that the hospital meets the 1302 applicable criteria set forth in or established in accordance with Code Section 31-11-113. 1303 (c) The department council shall identify as many hospitals as stroke centers as apply for 1304 the identification, provided that each applicant meets the applicable criteria set forth in 1305 Code Section 31-11-113 or established by the department council. 1306 (d) The department council may suspend or revoke a hospital's identification as a stroke 1307 center, after notice and hearing, if the department council determines that the hospital is not 1308 in compliance with the requirements of this article."

1309 SECTION 6-3.

1310 Said chapter is further amended in said article by revising Code Section 31-11-113, relating 1311 to certification, application process, and inspections, as follows: 1312 "31-11-113.

1313 (a) A hospital identified as a comprehensive or primary stroke center shall be certified as 1314 such by a national health care healthcare accreditation body recognized by the department 1315 council. Any hospital wishing to receive official identification under this subsection shall 1316 submit a written application to the department council, providing adequate documentation 1317 of the hospital's valid certification as a comprehensive or primary stroke center by any such 1318 national health care healthcare accreditation body. 1319 (b) Remote treatment stroke centers shall be certified and identified by the department 1320 council either by certification as an acute stroke-ready hospital by a national health care 1321 healthcare accreditation body recognized by the department council or through an 1322 application process to be determined by the department council. Said application process 1323 shall contain, at minimum, the following requirements:

1324 (1) Remote treatment stroke center certifications and identifications by the department 1325 council are limited to those hospitals that utilize current and acceptable telemedicine 1326 protocols relative to acute stroke treatment as defined by the department council; 1327 (2) Upon receipt of complete and proper application for certification as a remote 1328 treatment stroke center, the department council shall schedule and conduct an inspection 1329 of the applicant's facility no later than 90 days after receipt of application; and 1330 (3) Any hospital, upon certification by the department council as a remote treatment 1331 stroke center, shall automatically be identified as a remote treatment stroke center and 1332 shall be added to the list of such hospitals maintained pursuant to subsection (a) of Code 1333 Section 31-11-115.

1334 (c) Any additional levels of stroke centers established by the department council pursuant 1335 to subsection (a) of Code Section 31-11-112 shall be certified by the department council 1336 in accordance with any criteria and guidelines established by the department council in 1337 rules and regulations.

1338 (d) Comprehensive and primary stroke centers are encouraged to coordinate, through 1339 agreement, with remote treatment stroke centers throughout the state to provide appropriate 1340 access to care for acute stroke patients. The coordinating stroke care agreements shall be 1341 in writing and include at minimum:

1342 (1) Transfer agreements for the transport and acceptance of all stroke patients seen by 1343 the remote treatment stroke center for stroke treatment therapies which the remote 1344 treatment stroke center is not capable of providing; and 1345 (2) Communication criteria and protocols with the remote treatment stroke centers." 1346 SECTION 6-4.

1347 Said chapter is further amended in said article by revising Code Section 31-11-114, relating 1348 to grants and reports, as follows:

1349 "31-11-114.

1350 (a) In order to encourage and ensure the establishment of stroke centers throughout the 1351 state, the department council shall award grants, subject to appropriations from the General 1352 Assembly, to hospitals that seek identification as remote treatment stroke centers and 1353 demonstrate a need for financial assistance to develop the necessary infrastructure, 1354 including personnel and equipment, in order to satisfy the criteria for identification as a 1355 remote treatment stroke center pursuant to subsection (b) of Code Section 31-11-113. 1356 (b) A hospital seeking identification as a remote treatment stroke center pursuant to this 1357 article may apply to the department council for a grant, in a manner and on a form required 1358 by the department council, and provide such information as the department council deems 1359 necessary to determine if the hospital is eligible for the grant. 1360 (c) The department council may provide grants to as many hospitals as it deems 1361 appropriate, subject to appropriations, taking into consideration adequate geographic 1362 diversity with respect to locations.

1363 (d) The department council shall annually prepare and submit to the Governor, the 1364 President of the Senate, the Speaker of the House of Representatives, and the chairpersons 1365 of the House Committee on Health and Human Services and the Senate Health and Human 1366 Services Committee for distribution to its committee members a report indicating the total 1367 number of hospitals that have applied for grants pursuant to this Code section, the number 1368 of applicants that have been determined by the department council to be eligible for such 1369 grants, the total number of grants to be awarded, the name and address of each grantee 1370 hospital, the amount of the award to each grantee, and the amount of each award to be 1371 disbursed to the grantee."

1372 SECTION 6-5.

1373 Said chapter is further amended in said article by revising Code Section 31-11-115, relating 1374 to distribution of list of stroke centers, development of assessment tool, and protocols for 1375 emergency medical service providers, as follows:

1376 "31-11-115.

1377 (a) Beginning June 1, 2009 January 1, 2028, and each year thereafter, the department 1378 council shall send a list of comprehensive, primary, remote treatment, and other level 1379 stroke centers identified pursuant to Code Section 31-11-113 to the medical director of 1380 each licensed emergency medical services provider in this state, shall maintain a copy of 1381 the list in the office designated with the department to oversee emergency medical services, 1382 and shall coordinate with the department to post a list of comprehensive, primary, remote 1383 treatment, and other level stroke centers on the department's website. 1384 (b) The department council shall adopt or develop a sample stroke triage assessment tool. 1385 The department council shall coordinate with the department to post this sample 1386 assessment tool on its department's website and distribute a copy of the sample assessment 1387 tool to each licensed emergency medical services provider no later than December 31, 2008 1388 as soon as practicable. Each licensed emergency medical services provider shall use a 1389 stroke triage assessment tool that is substantially similar to the sample stroke triage 1390 assessment tool provided by the department council. 1391 (c) The office designated within the department to oversee emergency medical services 1392 council shall establish protocols related to the assessment, treatment, triage, and transport 1393 of stroke patients, including transport to the appropriate level stroke centers, by licensed 1394 emergency medical services providers in this state.

1395 (d) Any assessment tools or protocols of the council shall succeed to the assessment tools 1396 or protocols of a predecessor agency, in accordance with Code Section 31-11-4." 1397 SECTION 6-6.

1398 Said chapter is further amended in said article by revising Code Section 31-11-116, relating 1399 to annual reports, as follows:

1400 "31-11-116.

1401 (a) In order to assure that the patients are receiving the appropriate level of care and 1402 treatment at each level of stroke center in the state, each hospital identified as a stroke 1403 center shall annually report information, as specified by the department council in its rules 1404 and regulations, to the department council. 1405 (b) The department council shall collect the information reported pursuant to 1406 subsection (a) of this Code section and shall coordinate with the department to post such 1407 information in the form of a report card annually on the department's website and present 1408 such report to the Office of Health Strategy and Coordination. The results of this report 1409 card may be used by the department council to conduct training with the identified facilities 1410 regarding best practices in the treatment of stroke.

1411 (c) In no way shall this article be construed to require disclosure of any confidential 1412 information or other data in violation of the federal Health Insurance Portability and 1413 Accountability Act of 1996, P.L. 104-191."

1414 SECTION 6-7.

1415 Said chapter is further amended in said article by revising Code Section 31-11-118, relating 1416 to advertising, as follows:

1417 "31-11-118.

1418 A hospital may not advertise to the public, by way of any medium whatsoever, that it is 1419 identified by the state as a comprehensive, primary, remote treatment, or other level stroke 1420 center unless the hospital has been identified as such by the department council pursuant 1421 to this article."

1422 SECTION 6-8.

1423 Said chapter is further amended in said article by revising Code Section 31-11-119, relating 1424 to rules and regulations, as follows:

1425 "31-11-119.

1426 The department council shall be authorized to promulgate rules and regulations to carry out 1427 the purposes of this article. Such rules and regulations shall succeed to the rules and 1428 regulations of a predecessor agency, in accordance with Code Section 31-11-4." 1429 PART VII

1430 Emergency Cardiac Care Centers

1431 SECTION 7-1.

1432 Said chapter is further amended in Article 7, relating to emergency cardiac care centers, by 1433 revising Code Section 31-11-132, relating to Office of Cardiac Care and level designations 1434 and requirements, as follows:

1435 "31-11-132.

1436 (a) There shall be established the Office of Cardiac Care within the Department of Public 1437 Health council. The office shall administer the designation process provided for in this 1438 article, including, but not limited to, data collection, analysis and reporting, and site visits. 1439 (b) The office shall designate hospitals that meet the criteria set forth in this article as 1440 emergency cardiac care centers. Each emergency cardiac care center shall be further 1441 designated as Level I, Level II, or Level III by the office. The criteria for each level 1442 designation shall be established by the office and shall include, at a minimum, the 1443 following:

1444 (1) Level I shall have:

1445 (A) Cardiac catheterization and angioplasty facilities available 24 hours, seven days 1446 per week, 365 days per year;

1447 (B) On-site cardiothoracic surgery capability available 24 hours, seven days per 1448 week, 365 days per year;

1449 (C) Established protocols for therapeutic hypothermia for out-of-hospital cardiac arrest 1450 patients;

1451 (D) The ability to implant percutaneous left ventricular assist devices for support of 1452 hemodynamically unstable patients experiencing out-of-hospital cardiac arrest or heart 1453 attack;

1454 (E) Neurologic protocols to measure functional status at hospital discharge; and 1455 (F) The ability to implant automatic implantable cardioverter defibrillators; 1456 (2) Level II shall have:

1457 (A) Cardiac catheterization and angioplasty facilities available 24 hours, seven days 1458 per week, 365 days per year, but no on-site cardiothoracic surgery capability; 1459 (B) Established protocols for therapeutic hypothermia for out-of-hospital cardiac arrest 1460 patients;

1461 (C) Neurologic protocols to measure functional status at hospital discharge; and 1462 (D) A written transfer plan with one or more Level I emergency cardiac care centers 1463 for patients who need left ventricular assist devices or cardiothoracic surgery; 1464 (3) Level III shall have:

1465 (A) Established protocols for therapeutic hypothermia for out-of-hospital cardiac arrest 1466 patients; and

1467 (B) A written plan for systematic transfer to a Level I or Level II facility; and 1468 (4) The department council shall be authorized to establish one or more additional levels 1469 of cardiac care centers as necessary based upon advancements in medicine and patient 1470 care."

1471 PART VIII

1472 Conforming Changes

1473 SECTION 8-1.

1474 Chapter 10 of Title 16 of the Official Code of Georgia Annotated, relating to offenses against 1475 public administration, is amending by revising Code Section 16-10-29, relating to request for 1476 ambulance service when not reasonably needed, as follows: 1477 "16-10-29.

1478 (a) It shall be unlawful for any person to transmit in any manner a request for ambulance 1479 service services to any person, firm, or corporation furnishing ambulance service services, 1480 public or private, knowing at the time of making the request for ambulance service services 1481 that there exists no reasonable need for such ambulance service services. 1482 (b) Any person who violates subsection (a) of this Code section shall be guilty of a 1483 misdemeanor."

1484 SECTION 8-2.

1485 Chapter 11 of Title 16 of the Official Code of Georgia Annotated, relating to offenses against 1486 public order and safety, is amending by revising subsection (a) of Code Section 16-11-42, 1487 relating to refusal to relinquish telephone party line in case of emergency, false request on 1488 party line as to emergency, and warning printed in telephone books, as follows: 1489 "(a) A person is guilty of a misdemeanor when he or she fails to relinquish a telephone 1490 party line consisting of subscriber line telephone circuit with two or more main telephone 1491 stations connected therewith, each having a distinctive ring or telephone number, after he 1492 such person has been requested to do so to permit another to place a call in an emergency, 1493 in which property or human life is in jeopardy and the prompt summoning of aid is 1494 essential, to a fire or police department or for medical aid or ambulance service services, 1495 if the party line at the time of the request is not being used for any such other emergency 1496 call. Any person who shall request the use of the party line by falsely stating that the same 1497 is needed for any of such purposes, knowing the statement to be false, is guilty of a 1498 misdemeanor."

1499 SECTION 8-3.

1500 Chapter 8 of Title 40 of the Official Code of Georgia Annotated, relating to equipment and 1501 inspection of motor vehicles, is amending by revising subsection (a) of Code 1502 Section 40-8-92, relating to designation of emergency vehicles, flashing or revolving lights, 1503 permits, fee, and use of flashing or revolving green lights on public property, as follows: 1504 "(a) The commissioner of public safety shall be authorized to designate certain motor 1505 vehicles as emergency vehicles. The commissioner of public safety shall so designate each 1506 vehicle by issuing to such vehicle a permit to operate flashing or revolving emergency 1507 lights of the appropriate color. Such permit shall be valid for five years from the date of 1508 issuance. Any and all officially marked law enforcement vehicles as specified in Code 1509 Section 40-8-91 shall not be required to have a permit for the use of a blue light. Any and 1510 all fire department vehicles which are distinctly marked on each side shall not be required 1511 to have a permit for the use of a red light. Any and all motor vehicles which are operated 1512 for ambulance services as ambulance providers, as defined in Code Section 31-11-2, under 1513 a valid license from the Emergency Health Section of the Department of Public Health 1514 shall not be required to have a permit for the use of a red light." 1515 SECTION 8-4.

1516 The Official Code of Georgia Annotated is amended by replacing "ambulance service" with 1517 "ambulance provider", "licensed ambulance services" with "ambulance providers", "a duly 1518 licensed ambulance service" with "an ambulance provider", and "a licensed ambulance 1519 service" with "an ambulance provider" wherever the terms or phrases occur in: 1520 (1) Code Section 24-9-921, relating to identification of medical bills and expert witness 1521 unnecessary;

1522 (2) Code Section 26-4-5, relating to definitions relative to pharmacists and pharmacies; 1523 (3) Code Section 26-4-116.2, relating to licensed health practitioners authorized to 1524 prescribe opioid antagonists, pharmacists authorized to fill prescriptions, and immunity 1525 from liability;

1526 (4) Code Section 33-20A-9, relating to emergency services requirements and restrictive 1527 formulary requirements;

1528 (5) Code Section 33-30-24, relating to health benefit plans providing incentives to use 1529 services of preferred providers and minimum requirements; 1530 (6) Code Section 37-3-101, relating to transportation of patients generally relative to 1531 examination and treatment of mental illness;

1532 (7) Code Section 37-7-101, relating to transportation of patients generally relative to 1533 hospitalization and treatment of alcoholics, drug dependent individuals, and drug abusers; 1534 and

1535 (8) Code Section 40-2-86.1, relating to license plates promoting or supporting certain 1536 agencies, funds, or nonprofit corporations or issued to qualified motor vehicles or owners 1537 with proceeds deposited in the general fund.

1538 SECTION 8-5.

1539 The Official Code of Georgia Annotated is amended by replacing "air ambulance service" 1540 with "air ambulance services" and "Air ambulance service" with "Air ambulance services" 1541 wherever the terms occur in:

1542 (1) Code Section 33-1-21, relating to certain subscription agreements for prepaid air 1543 ambulance service not contract of insurance and definitions; 1544 (2) Code Section 31-11-33, relating to insurance coverage requirements; 1545 (3) Code Section 33-24-47.1, relating to notice prior to cancellation or nonrenewal of 1546 individual or group accident and sickness policy;

1547 (4) Code Section 33-29-1, relating to "accident and sickness policy" defined and 1548 applicability of chapter;

1549 (5) Code Section 33-29A-31, relating to relating to definitions relative to individual 1550 accident and sickness insurance; and

1551 (6) Code Section 43-25-8, relating to promulgation of rules and regulations by Safety Fire 1552 Commissioner.

1553 PART IX

1554 Effective Date and Repealer

1555 SECTION 9-1.

1556 (a) This Act shall become effective on January 1, 2028, except as provided otherwise in 1557 subsection (b) of this section.

1558 (b) Code Section 31-11-5 of this Act shall become effective on July 1, 2027. 1559 SECTION 9-2.

1560 All laws and parts of laws in conflict with this Act are repealed.