Presentation on theme: "Code of Maryland Regulations Title 30"— Presentation transcript:
1 Code of Maryland Regulations Title 30 This presentation was developed to give the provider an understanding of what regulations are, where they are located for EMS services and providers and how they inapt the day to day operations of EMS in the State of Maryland.Several case studies will be used to demonstrate the impact of State Regulations on emergency Services in Maryland.Maryland Institute for Emergency Medical Services Systems
2 ObjectivesFollowing the completion of this presentation the participant will be able to:Locate and reference the Code of Maryland Regulations (COMAR), Title 30Describe the impact of Title 30 on the daily operations of emergency servicesRecognize the Provider Review Process (PRP)Recognize the role of Quality Review as outlined in Title 30Review each objective with the participants.Locate and Reference…Gives you a source to gather information for yourself when questions arise.Describe the impact…The overview will cover all sections of the State regulations that apply to EMS.Recognize the PRP…Recognize the role of QA...
3 Why Regulate? Why Regulate? In its infancy MIEMSS established guidelines based on an informal process.The result was inconsistency, and the lack of coordination often caused confusion among providers.There were no formal policies or procedures.No one likes regulations!So why do you need them?Regulations are in place to provide consistency. Without a formal process hospitals could for example simply declare themselves a trauma center or a base station regardless of capability.Regulations are not meant to force the public to respond in a particular manner but to protect the public from_____.There is a standard process to for developing regulations.
4 Maryland RegulationsRegulations are the generally applicable rules under which a state agency operates.The legislature must authorize an agency to promulgate regulations.The agency then must follow detailed rules in drafting and enacting the regulations.To develop regulations an agency must have:Legal approvalReview by representation of the states Attorney General OfficeThe process for developing regulations..MIEMSS uses consensus building to develop regulations.Once consensus (or close to consensus) has been obtained the draft is take to the EMS Board for approval.Regulations developed by MIEMSS have State impact.
5 What is COMAR?The Regulations of all Maryland Agencies are collected in the Code of Maryland Regulations known as “COMAR”.
6 COMAR DescriptionCOMAR is divided into “Titles”. Each title is numbered and generally represents the rules for a separate state agency.Examples:MIEMSS -Title 30Department of Health -Title 10
7 COMAR DescriptionTitles are then broken down into “Subtitles” or “Chapters”.Examples from MIEMSS Title 30:Subtitle 02: Emergency Medical Services ProvidersChapter 03: Scope of Practice and Duties
8 COMAR DescriptionThe information in each chapter defines the regulations relating to that title.The chapter is written in outline format (much like the Maryland Medical Protocols) for ease of reference.Each Subtitle contains a list of definitions for terms used in the chapter.
9 Where Can I Locate a Copy? A copy is located in the reference section of each public library.COMAR can also be located on-line at
10 Who Does it Impact? TITLE 30 effects: ...“any EMS service or provider whooperates in theState of Maryland”...
11 Operational Impact Day-to-day influence of Title 30 Licensure / Certification / CredentialScope of Practice and DutiesProhibited ConductDisciplinary ProceduresOperational SuspensionsHearingsSummary Suspension of License or Certification
12 Maryland Title 30 Overview Subtitle 01: GeneralSubtitle 02: Emergency Medical Services ProvidersSubtitle 03: EMS Operational ProgramsSubtitle 04: Emergency Medical Services Education Programs and CoursesSubtitle 06: Automated External Defibrillation Program
13 Maryland Title 30 Subtitle 07: Emergency Medical Communications System Subtitle 08: Designation of Trauma and Specialty Referral CentersSubtitle 09: Commercial Ambulances ServicesSubtitle 05 will cover EMS Regional Councils tentatively beginning July 1, 2002.
14 Explains “Incorporation by Reference” Subtitle 01 GeneralExplains “Incorporation by Reference”The mechanism for including the Maryland Medical Protocols into COMAR.Designates the MIEMSS “Open Meeting” policy.Outlines the process for the access and/or correction of public records.Governs the procedures for obtaining a declaratory ruling from the EMS Board.
15 Subtitle 02 Emergency Medical Services Providers Defines the Licensure and Certification ProcessIncluding:Establishing fees for testingRequirements for providersReciprocityExamination and reexaminationIssuance of a license or certificateRenewal, surrender and/or reinstatement of a license or certificateCriteria for denial of a license or certificate
16 Subtitle 02 Emergency Medical Services Providers Chapter 3 of this subtitle establishes the “Scope of Practice” (based on the Maryland Medical Protocols) and duties for all levels of EMS providers including:Emergency Medical DispatchersFirst RespondersThe chapter also contains the requirement that an EMS provider must function under an EMS Operational Program.A jurisdiction has authority for..In Maryland each county plus the City of Baltimore and City of Annapolis is considered a jurisdiction.
17 Subtitle 02 Emergency Medical Services Providers Chapter 4 defines “Prohibited Conduct”Outlines the actions that can be taken as a result of prohibited conductReprimand or probationSuspend or revoke a license or certificateDeny a license or certificateRefuse to renew a license or certificateRefer to newsletter article and possibly provide for a handout as part of this class.
18 Subtitle 02 Emergency Medical Services Providers Chapter 05 specifies the disciplinary procedures including:Investigation of incident reportsReview by the Provider Review PanelAction by the EMS BoardCase resolution conferenceHearingsEMS Board actionHow does MIEMSS use the disciplinary process.All information in the Provider Review Process and medical review is considered confidential.EXAMPLES
19 Subtitle 02 Emergency Medical Services Providers Chapter 5 continued:Designates the composition of the Provider Review PanelEstablishes the process for summary suspension of a license or certificationProvides confidentiality and admissibility of proceedings, records, and files used throughout the provider review process.
20 Subtitle 02 Emergency Medical Services Providers Chapter 6:Contains the procedures for administrative hearings regarding:LicensureCertificationDisciplinary action of an EMS provider
21 Subtitle 02 Emergency Medical Services Providers Chapter 7:Governs summary procedures for suspending an EMS providers license or certificate based on the protection of public health, safety or welfare.
22 Subtitle 03 EMS Operational Programs Defines the criteria for approval of an EMS Operational ProgramEstablishes the policy for Medical Direction including the appointment of the EMS Medical Directors.Provides the guidelines for quality assurance, protocol development and designation of Base stations.Describe an EMS Operational:Currently only a county or a commercial ambulance services can be recognizes as an EMS operational program. There are 23 operational programs in Maryland, plus the City of Baltimore and the City of Annapolis.MIEMSS also recognizes several Federal installations as well. Examples include:Fort MeadeAberdeen Proving GroundNational Security Agency
23 Subtitle 03 EMS Operational Programs Quality Assurance (QA)Each EMS Operational Program must have:A written QA plan approved by the medical directorA medical Review CommitteeIt is important to have defined duties.The EMS Jurisdictional Medical Director is responsible for all care provided within the jurisdiction
24 Quality Assurance Quality assurance plan components Data review Identification and analysis of trendsPositiveNegativeIdentification of protocol violationsRemediation for patient care issues at the jurisdictional level.What is defined as a State issue?What is defined as a County issue?Jurisdictions are not always able to resolve an issue locally.We don’t want the problem moving to another county.MRC
25 Quality Assurance Quality assurance plan requirements Notify MIEMSS within 30 days of incidents that may have resulted in patient harm, require disciplinary actions from MIEMSS, or require a change in state protocol.Review written and oral allegations that an EMS provider failed to act in accordance with applicable law or protocol.
26 Medical Review Committee Medical Review Committee (MRC) responsibilities:Every operational program must designate a MRC.The committee is selected by the operational program and its medical director.It shall be the duty of the MRC with the participation of the medical director to carry out the quality assurance plan.How should the committee be developed?Bring in the experts. Who are they?What are the roles and responsibilities?Confidentiality
27 Medical Review Committee Medical Review Committee (MRC) responsibilities:The MRC is subject to the confidentiality and immunity provisions as provided by COMAR.Each member must sign a confidentiality agreement.
28 Subtitle 03 EMS Operational Programs Protocol development is also covered under this subtitle.Chapter 05 section .02 defines the composition of the Protocol Review Committee.This section also established the process for protocol development and approval including:Pilot ProtocolsResearch ProtocolsOptional ProtocolsEmergency Protocols
29 Subtitle 03 EMS Operational Programs Chapter 06 governs the approval and operation of an EMS Base Station.Specific requirements are outlined for:Approval and renewalSpecialty centers and consultation centersOut-of-state centersDenial or rescission of approvalAppeal process
30 Subtitle 04 Emergency Medical Services Education Programs and Courses Governs the Educational Programs for:Emergency Medical DispatchersBasic Life Support ProvidersAdvanced Life Support Providers
31 Subtitle 04 Emergency Medical Services Education Programs and Courses Governs the Educational Programs for:Emergency Medical DispatchersBasic Life Support ProvidersAdvanced Life Support ProvidersRequirements for continuing education programs are also contained within this subtitle.
32 Subtitle 06 Automated External Defibrillation Program Establishes the criteria for the authorization of “Public Access” AED ProgramsSpecific requirements for PAD programs include:Medical directionProtocolsQuality assurance and maintenanceTraining
33 Subtitle 07 Emergency Medical Services Communications System Establishes the systemfor helicoptercommunicationto SYSCOM.
34 Subtitle 08 Designation of Trauma and Specialty Referral Centers Provides the criteria for the designation of trauma and specialty referral centers.In addition it outlines the following standards for the trauma and specialty referral centersData Collection and Quality ManagementDesignation and verification criteriaDisciplinary Action for subtitle violation
35 Subtitle 08 Designation of Trauma and Specialty Referral Centers This subtitle establishes the standards for the following:Trauma CentersBurn CentersSpecialty Referral CentersPediatric Trauma CentersEye Trauma CentersPerinatal and Neonatal Referral Centers
36 Subtitle 09 Commercial Ambulance Services This subtitle provides the standards for Commercial Ambulance Services in the State of Maryland.Licensing process is definedOperational requirements are establishedEligibility, application and renewal procedures are includedRecord keeping and MIEMSS record submission are outlined
37 Subtitle 09 Commercial Ambulance Services Commercial Ambulance Services continuedChapter 09 governs the enforcement of commercial ambulance statutes and regulations.A standard commercial ambulance service equipment list (for ALS and BLS) is located in Chapters 10 & 11.The last chapter of the commercial ambulance service subtitle governs the operation of neonatal ambulance services.
38 Maryland Title 30 Maryland Information System Each operational program shall provideto MIEMSS on a monthlybasis a report of patientencounters.
39 Maryland Title 30 How do we get to compliance? Education CommunicationsCooperationConsensus
40 SummaryCOMAR provides the framework for the Maryland EMS System.
41 More InformationIf you need additional information please contact the MIEMSS, Office of the Assistant Attorney GeneralMonty Magee (410)Sarah Sette (410)