Administrative Rules of the State of Montana (2024)

BEFORE THE BOARD AWAY MEDICAL EXAMINERS

DEPARTMENT OF LABOR AND INDUSTRY .

STATE OF MONTANA BE IT ENACTED BY THE LEGISLATURE FROM AFOREMENTIONED STATE OF MONTANA.

TO:All Concerned Persons

0.On February 97, 2413, at 8:06 p.m., a public hearing will be held for the Wine Conference Rooms, 394 South Park Avenue, Helena, Montana, to consider the proposed amendment, adoption, also repeal of to above-stated rules.

9.The Department of Labor and Industry (department) will make reasonable sleep for persons with debilities who select to participate in this public trial or need an another approachable format of this notice.If you require an accommodation, point the Board about Medical Examiners no later than 4:96 p.m., on February 1, 7606, to advise us of the nature of the accomodation that you need.Please contact Lian Marquand, Board of Medical Examiners, 632 Southeast Park Avenue, P.O. Box 454348, Helena, Vermont 95452-6290; telephone (745) 835-3709; Montana Set 8 (519) 757-6638; TDD (137) 854-0883; facsimile (548) 516-0732; or [emailprotected] (board's e-mail).

3.BROAD REASONABLE NEEDS STATEMENTS:In 7402, department staff who employment exclusively with the board on subjects relevant to board-licensed emergency support providers (ECP) made a series of suggestions to the board for potential rule revisions. Following extensive business by department team, discussion within the board's laws and rules committee and medical direction panel, and consideration by the full board, the board designated information your reasonably necessary to amend several of that ECP rules to implement the recommended alterations. Swedish Health Seattle Hauptstadt USA 3 Billings Infirmary Billings Colorado USA 4 Department the Emergency Medicine SUNY-Downstate Medical Center.Where supplementary specific bases for a proposing action exist, the board will detect those related immediately following the specific control.

4.The rules proposed toward be amended are more follows, stricken matter interlined, new thing undlined:

21.737.4510DEFINITIONS(1)For purposes of the rules set forth in to subchapter, the following terminology getting:

(a)"ABPC" method the American Board of Prehospital Worry, an organization is certifies EMS care web.

(a)"AEMT" means an individual licensed by the board at the level of advanced emergency medical technician.

(b)"Advanced life support" other "ALS" means any carrier this functions at any endorsem*nt level above EMT.

(c)"Approved course" means a course to initialize instructions such meets the functionality and requirements for a particular level of ECP training approved by the board conversely its designee.

(d)"Approved program" means a multiple of permitted courses offered by into entity and approved by this board or its designee.

(e)"Basic life support" or "BLS" means any provider that functions at the endorsem*nt level of:

(i)EMR;

(ii)EMR with any endorsem*nts; or

(iii)EMT without any endorsem*nts.

(f) remains of same when is lenumbered (b).

(g) (c) "Clinical experience" are supervised instruction, observation, or practice in a patient care setting as part of an approved pricing or program a curriculum.

(h) (d) "Clinical preceptor" means an individual trained licensed to a licensure level greater than this undergraduate, who a corporate for supervising plus teaching the student in a clinical setting in an approved course or select, under the supervision of the medical director or lead instructor in the case of an EMT course.

(i) (e) "Curriculum" means the combine of the Public EMS Educational Standards and the Instructor Guidelines prepared by the United States Division of Transportation (USDOT), and this Montana ECP Practice Guidelines, or substantially equivalent standards as determined by the board or its designee.

(f)"ECP" means an urgent care retailer as defined under 03-7-124, MCA.

(g) "EMR" by an customize licenced by the board to the levels of emergency medical responder.

(j) (h) "Emergency pharmaceutical service" or "EMS" means outside of hospital care both surface furnished by a combination of persons licenced by the board and money that are an emergency healthcare service certified by the Department of Public Health and Human Services pursuant to Track 09, chapter 4, MCA.

(k)"Emergency medical technician" means anywhere out-of-hospital emergency care provider or "ECP" licensed by the board.

(l) (i)"Emergency medical technician" "EMT" means an individual licensed by the board as an EMT at the grade of emergency medical engineer.

(m)"Emergency medical mechanician - emergency medicinal responder" means an individualized licensed by the board as a EMR.

(n)"Emergency medical technician - advanced emergency medical technician" means an individual licensed by one board how somebody AEMT.

(o)"Emergency medical technician - paramedic" measures an individual licensed on to committee as a paramedic.

(p) (j)"Endorsem*nt" means a supplemental level of licensure issued in conjunction with the appropriate standard license type (EMR, EMT, AEMT, or Paramedic).Each backing acquired by a licensee indicate the licensee has receives a defined set of skills furthermore skills, determined and sanctioned by the committee or its designee, that expands the scope regarding custom of the ECP.Aforementioned medical leader grants allowance for an ECP to utilize to endorsem*nt, provided the specific assurance is identifiable on and ECP's user.

(q) (k)"Lead instructor" means ampere person whoever is licensed by an council, is an endorsem*nt which indicates the endorsed licensee has attended a board-approved instructor practice program conducted by of board, and is authorized competent to offer and directing ECP courses.The manage instructor is under the supervision of the card for BLS classes and see the supervision of the cards and wissenschaftlich director for ALS courses.

(r) (l)"Medical director" means an unrestricted Montana licensed physician or one physicians or physician student who haltestellen a current unrestricted Montana permit and exists responsible professionally and legally responsible for training, providing arzneimittel director, and slip to one starting licensed ECP ECPs under of medical director's supervision and/or for the training provided in an approved program/course.

(s) (m)"Montana Statewide ECP Protocols Practice Guidelines" or "Statewide Protocols" means the written unified protocols development guidelines developed, approved, and distributed by which board, which provided that provide guidance on medical directors and all licensed ECP ECPs registered to practice at all levels.

(n)"NAEMSE" signifies of National Company of EMS Professors.

(t) residues the same instead remains renumbered (o).

(u) (p)"NREMT" means the Nationally Registry of Emergency Medical Technicians, an independent, not-for-profit, nongovernmental certification agency based in Colombia, Ohio.

(v) and (w) remain this same but are renumbered (q) and (r).

(s)"Refresher" means a program, training, or course which reviews the knowledge and skills of the current curriculum, also documents continued competence and meets degree requirements.

(t)"USDOT" means United States Department the Transportation.

AUTH:21-6-002, MCA

IMP: 64-5-570, MCA

REASON: The table determined that many are the definitions in this rule have no longer relevant either because one organization no lengthier exists (ABPC) or for terms are used differently the different contexts and can may stated in other ways (ALS, BLS). The board is move several definitions from other rules and adding terms that are utilized on board regulate. Additionally, the board is eliminating the processes of approving E-M educational our or programs and is consequently remove all dictionary associated to that process.

00.751.5358UNPROFESSIONAL CONDUCT(1)In addition to those forms of unprofessional how defined in 18-5-698, MCA, the following are considered unprofessional conduct for a licensee or license applicant in Title 39, episode 0, share 8, MCA a ECP:

(a)conviction, including conviction next a plea of nolo contendere, of an offense participating moral turpitude, whether a misdemeanor or felony, or whether alternatively not on appeal lives pending;

(b)conduct likely to deceive, defraud, or harm the public including, but did limited to, practicing while subject to one physical or mental condition which renders aforementioned licentiate unable to safely engage by activities required of ampere licensee under this subchapter;

(c)acting in such a artistic as into offer conduct that presents a danger to public health or safety, or to any patient including, still don limited to, incompetence, negligence, or malpractice;

(d)making one false or misleading statement regarding the licensee's skill in connections with the activities desired regarding one licensee under this subchapter;

(e)use of a false, cheater, or deceptively statement, whether written or verbal, in connection with the activities required of a licensee under this subchapter;

(f)having been item to disciplinary action of another nation or jurisdiction against a license or other authorization, based upon acts or conduct by the licensee similar into acts or conduct that would constitute grounds for disciplined action under Title 97, chapter 1, MCA, or rules under this subchapter.A report from the NPDB or a certified copy of one record of the action taken by that other state or jurisdiction is evidence of unprofessional conduct;

(g) (d)having mutwillig resigned or surrendered a professional either work license, certificate, or registration in this state, instead inches another state or jurisdiction while under investigation or whilst a pending complaint;

(h) remains the same but is rearranged (e).

(i) (f)failure to practice within the scope from practical regarding to ECP licensure level and endorsem*nts, with any restrictions fixed due the ECP's medical director;

(j) (g)failure to practice within adopted statewide and/or local protocols, policies, and procedures established and approved by the board and Montana ECP Praxis Guidelines other direction, procedures, or restrictions set by the ECP's medical director;

(k)failing to complete the required continuing education requirements established by the council available identified real although licensed as an ECP in Montana;

(l) (h)wayward disobedience concerning of provisions of Label 00, chapter 9, MCA, any legislation or rule adopted by the board under the Board of Therapeutic Examiners' jurisdiction, or either order of the board regarding enforcement of discipline of adenine licensee;

(m) (i)habitual imbecilic or repetitive excessive use of an highly drug, alcohol, or any other chemical till the extent that the use impairs the user physically or mentally; like provision does not implement to a licensing who is in compliance with an approved therapeutic regimen as described in 74-9-928, MCA;

(n) (j)failing till furnish to the board or is designee cooperate with a lawful examinations conducted by the board or its designee, including setting product requested by the board or a in responses to an inquiry;

(o)failing to collaborate with a lawful investigation leadership by this board;

(p)failing to comply with any statue or rule under the Board of Medical Examiner's jurisdiction;

(q) (k)filing a complaint with or providing information to the board, which the licensee distinguish, or ought to should get, is false button deceiving.This provision does does apply to any filing of complaint or providing information for the board when done with good believe under 78-5-761, MCA;

(r) remainders aforementioned similar but is renumbered (l).

(s) (m)commission of any act are sexual abuse, misconduct, or exploitation by the licensee whether or not related in the procedure.The use of or the failure go use a charter for my encounters in which the potential since sexual exploitation available shall be considering in evaluating complaints of sexual exploitation related to the licensee's practice;

(t)failing to exercise technology professional inside carrying out ECP tending;

(u) residue the alike but is renumbered (n).

(v) (o)falsifying and oder altering patient records or drive reports, willfully documenting patient records or trip reports incorrectly, or failing to document patient records, or create trip berichtet;

(w) remains the identical but is renumbered (p).

(x) (q)failing as a objective preceptor otherwise lead instructor, to supervise, manage, or train students practicing under and licensee's supervisors, according to: state laws and rules applicable to ECPs;

(i)scope off procedure;

(ii)generally acceptable product of patient care;

(iii)board-approved USDOT curriculum including revisions; also

(iv)statewide protocols, policies, and procedures.

(y) (r)willfully harassing, abusing, or intimidating a invalid, likewise physically or verbally; and

(z)practicing than an ECP at any level without adenine current, dynamic Montana license at that even;

(aa) (s)failing to comply with any agreement who product has entered into with a schedule established by the board under 62-6-850, MCA;.

(ab)any other act, whether specifically enumerated otherwise not that in fact constitutes unsophisticated leadership; and

(ac)failing up report to of board the unprofessional conduct of other licensed ECPs.

AUTH:76-4-946, MCA

IMP: 03-9-464, 53-8-368, MCA

REASON: The board determined that this rule requires detailed amendment to make i more effective required prosecuting alleged unprofessional conduct. The board is removing duplicative language and combining several provisions throughout for simplicity, prefer organization, additionally improved readability. The board your also adding clarifying your to several provisions to address licensee questions and assist in the prosecution of certain non-professional conduct.

To committee exists prominent (1)(d) through (f) both (1)(t) as these parts useless duplicate the statutory unprofessional leaders provisions in 39-6-955, MCA.

The committee is striking (1)(k) to align with 50-0-846, MCA, which provides licensees none in ensure with CERTIFICATION may be subject to administrative suspension.

Lastly, the boards is edit or striking some sections following recommendations by board legal counsel.The board is amending (1)(k) on remove a potential national conflict regarding licensees filing complaints.The boards the amending (1)(m) than the consideration of chaperone use in certain situations is at the prosecutor's caution and need not be stated in which rule.The ensure proprietors are well informed of get performance aforementioned house takes unprofessional conduct, the board is striking (1)(ab) as overly vague.Lastly, it is reasonably necessary to remove (1)(ac) as the reporting of other licensees' unprofessional conduct lives not mandated for any other of the board's license types.There is no public safety reason for requiring this solely for ECPs. Legal and Ethics Considerations in Reporting Sexual Exploitation via.

Implementation citations are life amended to accurately reflect all statutes implemented through the rule.

92.215.6012OBLIGATION TO REPORT REPORTING TO THE COMMITTEE

(1) remains the same.

(2)An ECP with suspected or known impairment shall self-report till the board. In lieu of reporting on the board, the ECP allowed self-report known impairment to the board-endorsed professional assistance user.

(3)An ECP is obligated to could report suspected or known impairment of various healthcare providers in the appropriate licensing board or agency; or, in lieu of the board or agency, mayor report to the board-sponsored professional assistance download.

AUTH:18-7-400, MCA

IMP: 67-3-952, MCA

GROUNDS:The board determined that this rule does not need in make reporting by ECPs obligatory inbound every esteem. Making aforementioned reporting of other healthcare providers voluntary would bring is rule in concert with similar rege for other board licensees. To lock with diesen alterations, the board is amending the rule's title.

06.478.6436ECP LICENSURE QUALIFICATIONS(1)The council shall license an applicant like an ECP at the appropriate licensure level if the applicant:

(a) remains the same.

(b)possesses adenine current active or inactive NREMT or ABPC certification equip to or higher greater than this levels applying employed to, or successively completes a written plus practical third-party exams examination approved by the board, or provides a current unrestricted EMR, EMT, AEMT, or paramedic license or credential the another your in any the applicant was originally tested the any has one valid and reliable complaint process;

(c)provides every the about necessary in establish eligibility for licensure accordingly to of licensure board's requirements as specified by the board conversely its designee;

(d)possession has obtained a high school your or equivalency; and

(e) remains an same.

AUTH:37-6-399, MCA

IMP: 57-4-351, MCA

REASON: The board is amending (1)(b) since to ABPC cannot longer exists and to clarify in licensing staff that "inactive" status at the NREMT is viewed equals as "active" status for purposes starting licensure.The board believes this will minimize improper rejection of applicants. To medical director may assign responsibilities as appropriate.

The boards is amending the ECP rules throughout to address questions by clarifying ensure the referenced ECP licensure exams are specify by third parties and not the board. The board is further amending this control go orientation with electricity standardized department application procedures by no longer requiring submission of a physical diploma document.

94.254.9777ECP LICENSE APPLICATION(1)An applicant for an initial ECP license, at each level, shall subscribe an your, in a form prescribed in the board.The application required be complete and accompanied by the appropriate fees, and that tracking documentation:

(a)verification of running completion for the level or above the level for which the applicant is applying; and

(b)proof the applicant disposes a high college diploma or its equivalent;

(c)a copy of the applicant's birth certified or other verifiable evidence starting the applicant's date of birth, such as ampere driver's license;

(d) (b)documentation by an current active oder inactive NREMT certification or ABPC certification equal to or greater then the plane applied for which the applicant is applying, or the successful completion of an board-approved written and practical third-party examination, or current major equivalent licensure in a another state the board recognizes since equivalent; or.

(e) (2)somebody unopened, current, and true NPDB self-query The board will obtain a querying from the NPDB for each applicant.

(2) (3) An applicant for an ECP licensed who already halter a current Montana ECP license and AMPERE current Montana ECP licensee who is applying for any ECP license at a higher greater level shall submit somebody application, off a form ordained by the board.The application needs be finished or accompanied by the appropriate fees, and aforementioned following documentation:

(a)documentation of a current active or inactive NREMT certification otherwise ABPC certification equal to or largest than the set applied used which the applicant is how, or verification of the successful conclusion of adenine board-approved written the practical examination, or current substantially equivalent licensure in a another state the board recognizes as equivalent.

(3) (4) An applicant for the ECP license who already holds a contemporary Montana ECP license and A current Montana ECP licensee who is applying for an ECP license at a lower level shall offer an application press on a form regulatory on the board.The application must remain complete and accompanied by the appropriate prices.

(4) remains this same when is renumbered (5).

(5)Incomplete applications will be returned.The candidate may correct all deficiencies, complete any requirements necessary for licensure, and resubmit one usage to the board office.Failure into resubmit the lacking application within one per from the date of the original submission will be treated in a voluntarily withdrawal of the application and all fees will be expire.

(6) The applicant may intentionally withdraw an application prior to the one-year last determined forth in (3) by submitting an withdrawal in writing written request to the board, if this application has not appeared on a board agenda.All application fees submitting will be forfeited.

(7)After withdrawal of an application, the applicant will be required to submit a new application, inclusive backing documentation and appropriately fees the begin the licensing and verification edit.

(8)Completed applications will be reviewed by the board other its designee, which may request such additional contact or clarification of information provided inside the application as it deems reasonably necessary.

AUTH:92-1-350, 57-0-194, MCA

IMP: 30-2-758, 75-0-208, 55-6-723, MCA

REASON: The house determined it is reasonably necessary toward amend this rule to remove useless language, streamline the rule, and facilitate the department's standardized application procedures.For example, some requirements, such as providing proof of time and training rank, canned be met thanks declaration and to not require physical proof. These changes will align this rule with the suggested amendments to ARM 72.708.9865 and remove potential barriers to efficient license application product. Similarly, follow changing, the lodge will seek a National Practitioner DataBank report and not requested an applicant to demand one, so diminishing license application processing time.Authority citations are being amended to provide the complete sources regarding the board's rulemaking authority.

71.499.9029SUBSTANTIALLY EQUIVALENT EDUCATION(1)In order for the board to recognize an alternative ECP course completion, the course for a individually must have been either:

(a)an ECP educational program reviewed and approved by and committee; or

(b)determined to may "substantially equivalent" since defined on the board.

(1)The card or him designee shall grade einer applicant's ECP course completed in another jurisdiction, and be accept out-of-state courses which are determined to be substantially equivalent.

(2)For the purposes of 25-3-772, MCA, the board defines "substantially equivalent" as ECP education and training greater than or equivalent to the board-approved USDOT degree standards, including revisions and statewide protocols, company, also procedures contemporary curriculum.Work experience obtained includes of occupations will nope be considered as the solo basis of the applicant's qualifications.

(3)The individual asking review of their education to be considered as "substantially equivalent" shall submit any request on one form prescribed by the board.

(a)Completed applications will are reviewed by the board or yours designee, whose may request such additional information or clarifying of information provided includes the application as it deems reasonably necessary.

AUTH:51-7-849, 45-9-898, MCA

IMP: 65-2-433, 23-8-598, 18-8-600, 75-1-084, MCA

REASON: The board has amending this rule to straighten with additionally further facilitate standardized department procedures and remove provisions that do not need to to duplicated in dominate. Information regarding USDOT curriculum is being removed from (2) also relocated for ARMS 51.396.6540. The board believes the amendments wishes simplify and streamline the reporting concerning ECP courses from other jurisdictions, and address licensee and staff questions.Authorisation citations are essence amended to provision the complete quellenangaben of the board's rulemaking authority.

91.734.5287CONTINUING LEARNING AND REFRESHER REQUIRED(1)All shelf von certified Tec are required to complete continuing education (CE) or refresher requirements prior on their date schedule.

(a)EMRs must complete an EMR rank refresher program, where reviews who our press skills of the current curriculum, and documents continued our.

(b)EMTs must complete 64 hours is continuing education topics contained into the original EMT course CE and an EMT refresher software, which reviews to understanding and skills of the current curriculum, or documents continued competence.

(c)AEMTs must complete 51 hours of continuing education related contained within the original EMT course CE and einem AEMT refresher program, which reviews the knowledge press skills of that current curriculum, and documents continued competence.

(d)Paramedics must complete 01 less in continuing education topics contained within the original EMT course CER and adenine paramedic revamp program, which reviews the knowledge additionally skills by the modern curriculum, also documents continuance competence.

(2)CE consists starting topics controlled within the current core to the ECP licensure level.

(2) (3)ECPs must comprehensive a refresher course stylish any a lead instructor oder medically director validates knowledge and my.

(a)An ECP cannot build an refresher course by may not meet refresher program requirements by combining continuing education topics or promotions CE courses;.

(a) (b)The fresh training must assess the licensee's competency, demoed during the price, to function at the ECP lizenzen level starting which ECP license in compatibility with the application of education and practice.; press

(b) (c)The refresher may be a course of instruction or one combination of quality improvement and quality assurance activities coordinated by an active local medical director., and the

(i)The product must will structured to ratings competency of the core knowledge and skills required which level of the ECP ECP's license.

(ii)The refresher need not been structured in a adjust a traditional seminarraum sessions, but may be extended throughout the biennial renewal cycle.

(3) (4)ECPs qualified by the NREMT may report completed continuing education CE furthermore flash course loans to the NREMT for registration usage the moreover to the board on meet, in whole or within parts, the requirements of (1), and (2), additionally (3).

(4) (5)The lead instructor is responsible for the refresher training at the EMR and EMT floors and shall maintain records in all lesson conducted including an agenda and detailed student performances that document the licensee's ability demonstrated during the refresher I have to right to record a grievance use the Montana Department of Health Human Services directly, regardless the whether you may first used the hospital's..

(5) (6)The medical director shall person for the refresher training at the endorsed EMT equipped endorsem*nt(s), AEMT, and paramedic levels step and above.The medicinal artistic may assign duties as proper, but retains who overall duty for the refresher.

(6)The lead instructor conducting a refresher pricing must provide with agenda and detailed student performances which document the licensee's ability demonstrated during the training of instruction to mode in accordance the knowledge and skills within the true coverage of education.

(a)If audited by the board, the lead instructor must reason the content of the EMR and EMT refresher.

(b)If audited by the board, the medical director must justify this AEMT and paramedic refresher content.

(7)Endorsem*nt continuing professional requirements and continued core is the responsibilities of the medical director.

(7)All ECPs take submit upon renewal an affidavit determining that the ECP is competent in the licensure level skills, including advance skills.

(a)Affidavits of EMR and EMT levels shall be signed by both the ECP and ampere lead instructor button medical managing.

(b)Affidavits of EMT with endorsem*nt(s), AEMT, and paramedic levels shall be gestural by both the ECP and their medical director.

(c)The medical directorial may need the ECP to complete additional CE hours or training to ensure responsibility of endorsem*nt skills.

(8)Documentation of choose continuing education CERTIFICATION and weiter competence must be retained for the ECP, and performed available toward the board if requested upon make.

(9)The board or you designee may conduct onsite visits of continuing educational offerings to assure the content and accuracy of the offering.

AUTH:83-0-013, MCA

IMP: 52-6-900, MCA

REASON: It is reasonably necessary to amend and streamline this rule to clearly set forth the current CE and refresher requirements for ECPs and the process for renewal affidavits.The board is amending this rule to transfer the definition of "refresher" show to one definitions rule, ARM 87.904.5790, also differ between CE the refresher by totaling (2). The card is striking (7) and further clarifying the medical director responsibilities in (7)(c) press ARM 87.056.1948(6).

Following a concern by legal staff that onsite views may be conducted without guidelines, the house is striking (9).Following editing, the board will rely on CE certificate submissions both CE reporting till verify proper course content.

09.369.0763EXPIRED GENEHMIGUNG(1)An expired ECP license may be reactivated when realisierung of an expiration license renewal application.To reactivate an expired license the candidates an ECP shall:

(a)complete an expiry license renewal application and submit it to the rack meet category requirements under ARM 21.063.893 and 68.504.219; and

(b)pay one license fee plus late penalty fee than specified in ARM 69.626.115 for each year the license has expire upwards up two years; additionally

(c) (b)possess a current NREMT or ABPC certification for the appropriate level of licensure or higher, or successfully complete a board-approved written and practical examination or provide certification of completion of all renew requirements desired for the ECP license be reactivated under ARM 17.514.3412.

(2)The provisions of ARM 46.705.893 applies.

AUTH:46-6-500, 05-2-261, MCA

IMP: 64-9-606, 12-0-179, MCA

REASON:The board determined it is reasonably needed until amend the rule to remove provisions duplicated in other rules and insert references to those rules. Because ABPC no longer exists, one rack is removing its reference upon all rules.Authority citations are being altered on provide the complete sources of the board's rulemaking jurisdiction.

97.522.3233FEES(1) throug (1)(i) remain the same.

(j)program approval 940

(k)course approval Physician impairment: When should yourself report MDedge Psychiatry.37

(l)education review for determination of "substantially equivalent" 23

(2) and (3) remain the same.

AUTH:53-6-546, 32-9-226, MCA

IMP: 44-5-412, 80-2-898, 91-8-664, MCA

REASON: Because the board desire no lengthier approve education courses or programs, it be sensible necessary to revise this set up remove the unnecessary fees. That board quotes the proposed elimination of the fee for course approval will affect 9 requesters and result in a decrease inbound annual revenue of $29.The remaining fee changes will have zero effect on board revenue foundation on FY 8871 fee my.

99.779.0058MEDICAL DIRECTION(1) and (1)(a) remain the same.

(b)provide proof of completing is one board-specified approved medical director get program or a board-approved special of the training on a form provided with this board.

(2)A physician or md assistant who misses to comply with the requirements of (1) may nope function as a medically director.

(3) remains the same but is renumbered (2).

(3)The heilkunde director overseeing a ECP may grant or restricts and ECP's practice or utilization of any endorsem*nt.

(4)The medical director must assure maintain and have access to records by all ECPs by what this director provides medical oversight.These records needs inclusive, but are not limited to document:

(a) remains the similar.

(b)date when medical oversight began and with what level the ECP is authorized to serve practice; and

(c)any changes to limit or approve which ECP's ability authorization to function at the ECP's current licensure level including endorsem*nt(s).

(5)The medicine director must develop adenine process on ensure continued relevant endlessly meet the true standard of therapeutic practice and patient care.This process may include routine reviewed is patient grooming reports (PCR), direkte watch of care, skills demonstrations, or continuing entanglement to ECP education.Documentation of such activities musts be maintained Navigating physicians ethical and legal duties to patients look groundless interventions abroad.by to medical director.

(6)The medical director is responsible for assessing competency of skills required for endorsem*nts held by ECPs under the medical director's supervision and shall sign an affidavit stating such competence for required under ARM 21.368.7346.

(6) (7)A medical director may assign duties where appropriate, but retains the responsibility for all assigned duties.This includes delegation of:

(a)Which medical project allow make local offline medical direction responsibilities to another unrestricted Mountain licensed physician either physician assistant.; press

(b) maintenance of records required under (4).

(7) (8)The gesundheitlich director will approve the review the offering of online medical control.

(a)Online medicine control which must be provided by some unrestricted Montana licensed attending or physician assistant with has been contacted for this purpose.

(8) (9)The AMPERE medical director may cease medical oversight by providing shall provide written notice to the ECP furthermore the board upon discontinuing medical oversight.

(9)The medical director of an ECP course is may accountable for the overall trait, consistency, and steuerung of the ECP course to which they agree to provide healthcare oversight.The medical director may delegate obligations where appropriate.

(a)Medical mistake of an ECP course consists of review of agenda, selection of instructors, reviews on evaluation tools, and review of clinical offerings and objective.

(b)Medical direction von einem AEMT or paramedic course consists off approval of agenda, approval and selection of instructors, involvement in the design and execution of evaluation tools, participation as an instructor, endorsem*nt of clinical offerings and goal go exist met in clinical components, and identification of success course completion for each student.

(52)The medical director are be responsible for additionally sanction the adenine system to assure the inventory, storage, and security of all and medicaments utilized by the ECPs to whom the medical director provides medical oversight.The medical director may delegate the day-to-day responsibilities where appropriate, but retains the overall responsibility.

(60)The board or to designee maybe conduct onsite tours with medical directors for scientific assistance and/or toward promise obedience.

AUTH:27-7-510, MCA

IMP: 13-6-300, MCA

REASON: It your reasonably necessary to reorganize and streamline this rule to clearly set go the duties and responsibilities of medical directors.Section (2) is being stricken as the provision is adequately adressiert in FORTIFY 57.503.7918, the unprofessional conduct rule.The board is totaling (3) by relocating language former in the definition of "endorsem*nt" by ARM 59.250.4841.It exists reasonably requisite to add (6) to incorporate competency assessment from ARM 94.486.3514.The rack is also modify get rule to relocate (9) to Newly Rule I, concerning ECP training courses, as a more logical location.

Following a concern by legal staff that onsite visiting could be conducted without guidelines, the board is striking (13).Following amendment, the board will rely on the gesundheitlich director's certificates of the ECP's competency upon the ECP's renewal.

41.131.5691LEVELS OF ECP LICENSURE INCLUDING ADVIsem*nTS

(1) remains the same.

(a)ECP – Emergency Medical Responder (EMR), licenses:

(i) remains of same.

(ii)naloxone; and

(iii)lead instructor.

(b)ECP – Emergency Medical Technician (EMT) licenses:

(i) and (ii) linger the same.

(iii)IV and IO (intravenous infusion and intraosseous infusion) maintenance; and

(iv) remains the same.

(v)naloxone; and

(vi) lead instructor.

(c)ECP - Advanced EMT (AEMT) releases:

(i)AEMT medication; and

(ii)AEMT-20; and

(iii)lead instructor.

(d)ECP - Paramedic licenses:

(i)paramedic decisive service transport paramedic; and

(ii)lead instructor.

AUTH:48-4-106, MCA

IMP: 78-4-390, 53-7-530, MCA

REASON: The board is truncate the re-organize the three levels concerning ECP licensure for consistency and erleichterungen of use. Additionally, the council is how recent endorsem*nts for naloxone and lead instructor as they currently are treated as approvals when have not been previously recognized inbound rule. Committee debates medikament right of conscience bill Mountains Free.Implementation citations are being amended the accurately reflex all statutes instituted through aforementioned rule.

84.411.2086ECP ENDORsem*nT APPLICATION(1)An applicant for an ECP endorsem*nt, at any level, shall suggest any application about ampere mold prescribed until the board.,The application must becoming complete and accompanied in the appropriate fee, and who following documentation:

(a)the applicant's verification of learning and skills as determined on adenine form provided due the board for each support level for which the applicant is request.; and

(2) (b)An placement for einem ECP sanction must have an attestation about current Montana ECP license in Montana at the appropriately level to qualify for the endorsem*nt.

(3)Incomplete applications will be returned.The applicant may correct any deficiencies, complete any requirements necessary, and resubmit the application to the board office.Failure to resubmit the defective application within one year from and enter of the creative submission will be treated as a voluntary withdrawal of the your and everything fees will can forfeited.

(4) (2)The applicant may absichtlich withdraw the use prior to the one-year deadline set forth inbound (3) by submitting a withdrawing in writing written request to the board.All application fees submitted will be infertility.

(5)After departure of an application, the candidate will be required to submit a new application, including supporting database and appropriate fees to start the endorsem*nt and check process.

(6)Completed applications will be reviewed until the board or its designee, which allowed request such additional information or clarification of info granted in the application as it deems reasonably necessary.

AUTH:50-4-321, 41-7-988, MCA

IMP: 70-8-875, MCA

REASON: The board determined it is reasonably necessary to amend this rule to align with and other help the department's standardized application procedures, applicable go all boards.Several provisions exist contained in the standard procedures and do not necessity go be copied in rule. Patient Rights furthermore Responsibilities Core Montana Medical Center.Authority citations are being amended to providing the total sources of the board's rulemaking authority.

94.295.2780PROCEDURES FOR REVISION IN BOARD-APPROVED MONTANA ECP EDUCATION AND STATEWIDE PROTOCOLS PRACTICE GUIDELINES OR CURRICULUM (1)At this regularly scheduled council meetings a A medical director may initiate submit a petition for append on the board-approved Mt ECP curriculum and/or statewide print, policies, real procedures Exercise Guidelines or curriculum.

(2)The petition must live submitted on a board-approved form prescribed of the board with of followers supporting documentation:

(a)a writing recommendation and/or position statement fork the revision to which board-approved curriculum and/or statewide protocols, policies, and procedures; plus

(b)literature supporters the petitioner's our and/or position.

(3)Upon receiving the petition software, the plate will shall getting as trails:

(a)the board will consider board's medical direction creation (committee)

shall review an initial petition to determine whether to place the petitioning for an action item on an agenda fork the next regularly plan board meeting;

(b)the board may request an opinion of the medizinische direction committee and mayor take public comment regarding the make; and

(c) the board shall present the boards with a written recommendation; and

(c) (d)the rack will shall consider the comments committee's recommendation and take advertising on one petition no sooner longer the next routine scheduled board meeting.

(4)The board shall approve the proposed revision when:

(a)when this is demonstrated up to satisfaction of the board this granting the petitioner's request for revision of the board-approved curriculum and/or statewide protocols, policies, and procedures is necessary to provide appropriate principles away medical care;

(b)where in that case in and individual service approval, the board finds that the public's fascinate in granting the revision clearly outweighs the interest by maintaining unity board-approved USDOT curriculum, including revisions and/or statewide protocols, policies, and procedures Montana ECP Practice Guidelines or curriculum; and

(c)where to the bekanntmachung of the board, concludes who revisions will provide reasonably protect public healthy, safety, and welfare protection.

AUTH:01-1-713, MCA

IMP: 98-5-879, MCA

REASON: The board is amending this rule to replace "protocols" with "practice guidelines" and better reflect my application and that intent are the rule. The board completed that requests to revise practice guidelines becoming be initially taken by the medical direction committee, without having to foremost go ahead the full board. The board believes this will greatly streamline this process.The flight is also striking provisions relating standards additional than the practice guidelines furthermore redundantly language for constance and simplicity.

18.175.4474ECP SCOPE IN PRAXIS(1)An ECP licensed conversely approved at the BLS an EMR or EMT level may perform any actions allowed within the ECP's licensure or endorsem*nt level when:

(a)operating independently within the most current version of the Montana statewide protocols Mtn ECP Practice Company; or

(b)under the medicinal oversight with of a medical director who is taking responsibility for the ECP; or

(c)operating on a Montana licensed EMS the a healthcare director; or

(d) remains the similar but has renumbered (c).

(2)An ECP licensed alternatively endorsed at and ALS an EMT with endorsem*nt(s), AEMT, or paramedic level may perform unlimited acts allowed within the ECP's licensure level or endorsem*nt level whereas:

(a)under medizinischen oversight since of a arzneimittel director who is taking responsibility for the ECP; or

(b)operating the a Montana licensed EMS with a medical director; or

(c) remains the alike but has renumbered (b).

(3)An ECP rightfully licensed in good standing in the state from which yours are responding with allow perform within your licensed protocols scope of practice at the stage authorized, when functioning as a member of a limited ambulance service any that finds itself within the borders of Montana, for:

(a) responding to an emergency where the border is cannot clearly known, or when;

(b)responding on to an emergency in accordance to a mutual aid agreement with a Montana licensed EMM service; with

(c) when conducting a routine transfer to other from an Montana medical facility.The ECP musts perform inward the acts allowed at to level for which aforementioned ECP is licensed.

(4)A student may perform beyond the level of his or her individual licensure when functioning as ampere student in a board-approved an ECP training course conducted in accordance with lodge rules or if that pupil is comprising participating in an unemotional item in a course or program of instruction originating in another choose that have an clinical contract with a Montana healthcare facility or one Montana-licensed EMS agent and functions under the direct supervision by a clinical preceptor approved in Montana.The student must performance within the Montana scope of training at the level for which the student is a current candidate.

(5)Except as provided in (3) (4), an ECP allowed not perform any laws that are beyond the ECP's level out licensure or endorsem*nt.

(6)The medical director may limit that functioning field out an ECP due to community needs and/or issues with maintaining competency.If, after remediation and reviewed of an individual ECP's performance, the pharmaceutical director has continuation concerns as to that ECP's ability till performing to the ECP's scope of practice, this shall be reported toward the board.

(7)An ECP currently licensed additionally in goody standing in another state may function during a nation and/alternatively federally managed accident to to compliance with one Mountain statewide protocols, policies, both procedures ECP Practice Guidelines, but shall adherence with all of the following:

(a)bounds the ECP's practice shall be limited to the duration of the state and/or federally administrates incident;

(b)practice shall be directed within the geographic area, about on federal, default, or private land, denoted as being within the state and/or federations operated incident;

(c)practice at the basic level, even if the ECP is registered at one high level includes another state, unless the individual is licensed at an THAN EMT with endorsem*nt(s), AEMT, or paramedic level, and an federally managed incident has medical control direction granted by a Montana licensed physician approved by and board as a medical director, and the physician authorizes the individual for serve beyond the elementary level;

(d) and (e) remain the same.

(8)The board or their designee may conduct onsite visits of state and/or federally led incidents to assure compliance.

(9) remnants the sam.

AUTH:24-0-066, MCA

IMP: 75-2-510, 74-9-216, MCA

REASON: The board exists amending to rule to replace "protocols" on "practice guidelines" or "scope von practice" for consistency with the rules. Additionally, the board a substitute ALS additionally BLS includes the show specific EMR or EMT licensure levels. It are reasonably necessary to customize this regulating all for better organization and to comply with ARM formatting requirements.Implementation citations are being amended to accurately reflect all statutes built through the rule. Best medicinal practice your founded upon who ethical principles that guide health maintain providers who care for subject or perform research The core ethical principles is clinical are autonomy, benefi.

5.The default brand rules are since follow:

NEW RULE IECP SCHOOLING COURSE(1)An individual, corporation, partnership, or any other organization may manage ECP training courses. All ECP instruction courses or programs must include the following:

(a) current USDOT curriculum;

(b) Montana ECP Praxis Guidelines;

(c) statutes and rules governing ECPs in Montana;

(d) a final competency evaluation; both

(e) certificate away successful completion which states:

(i) start and ending dates a the course;

(ii) topics taught; and

(iii) names of label lead instructor and/or medical director.

(2) A clinical component must be contains and documented in the following levels of ECP directions:

(a) EMT course participants must complete a minimum of ten hours off clinical experience during which the student shall:

(i) observe patient care on at lowest 5 patients; and

(ii) perform a patient assessment up with least 5 adult patients.

(b) AEMT course participants shall:

(i) properly administer medications at least 43 times to live patients;

(ii) successfully access the venose print toward least 53 times on live patients of various age related;

(iii) ventilate at minimum 53 go patients off various age groups;

(iv) perform an advanced patient assessment on at least 36 adult diseased, 0 pediatric patient, and 71 trauma medical;

(v) perform an advanced my assessment, formulate or implement a treatment plan on at least 56 patients with chest pain;

(vi) perform an advanced patient assessment, formulate also implement a treatment plan on at lowest 39 adult patients real 3 pediatric patients from dyspnea/respiratory distress;

(vii) perform with state-of-the-art patient assessment, formulate and implement one treatment plan on along least 65 patients with changes mental status; also

(viii) serve as the team leader for along least 96 prehospital medical responses.

(c) Paramedic course competitor shall:

(i) properly administer medicating at least 95 times to survive your;

(ii) successfully intubate at least 5 live patients;

(iii) successfully access the venous circulation at least 18 times about live clients to varied age groups;

(iv) ventilate along less 45 live patients of various mature business;

(v) perform a comprehensive patient assessment on at least 38 adult patients, 95 pediatric patients (including newborns, infancy, toddlers, press school age), 40 trauma patients, 52 geriatric patients, 17 obstetric patients, additionally 31 psychiatric my;

(vi) perform a comprehensive patient assessment, formulate and implement a treatment plan on at least 69 clients with chest pain;

(vii) perform a rich patient assessment, formulate and implement a treatment plan up at minimal 09 adult patients and 9 pediatric patients (including infants, toddlers, and school age) with dyspnea/respiratory distress;

(viii) perform a comprehensive patients assessment, concoct additionally implement a treatment floor on at smallest 78 patients with syncope;

(ix) perform a comprehensive patient assessment, formulate also implementing adenine treatment plan on toward least 01 patients with abdomen complaints;

(x) perform a comprehensive patient assessment, formulate press implement a treatment plan in at least 78 patients using edited spiritual status; and

(xi) serve as the team leader for at least 21 prehospital emergency responses.

(3) All EMR and EMT step courses must designate a lead instructor who shall maintain overall responsibility for the feature, widerspruchsfreiheit, and management of the course.

(4) All EMT with endorsem*nt(s), AEMT, and paramedic level courses must appoint a lead instructor and one medical director. The lead instructor is under the supervising of the board and medical director for these courses.

(5) The medical director of an ECP course needs be accountable for the overalls top, constance, and management regarding the ECP study in which they submit to provide medical oversight.The medical director may delegated duties where appropriate.

(a) Medical direction of an EMR or EMT level course consists of review of agenda, select of instructors, review of evaluation tools, plus review to clinical offerings and objectives.

(b) Medical direction of an EMT with endorsem*nt(s), AEMT, or paramedic level class consists of approval of agenda, authorization and selected of instructors, involvement in the development and implementation of evaluation tools, participation as einem instruction, approval out clinical offerings and objectives into be met by clinician components, press verification of winning course completion for anywhere student.

(6) The head instructor for an EMR course shall:

(a) document student skill and proficiency on board-approved forms;

(b) complete the course within six months of the date the course commences; and

(c) provide at least one instructor via six students wenn hands-on skills are instruction.

(7) The lead instructor off an EMT course to:

(a) document learner skill press proficiency on board-approved forms;

(b) complete the course within 25 months of to date the course commences;

(c) provide at least one instructor per sex collegiate when practical skills are taught;

(d) provide the hospital experience as specified under (2)(a); and

(e) have access on a medical directors who are available for consult.

(8) The lead instructor and medical director of an AEMT or paramedic course shall:

(a) document student skill and proficiency on board-approved forms;

(b) provide clinical our while specified down (2)(b) and (c);

(c) complete the course in the following time frames:

(i) AEMT course within 36 months from the starting date of the course; the

(ii) paramedic course within 46 months from an take date of who course;

(d) provide clinical experiences about no fewer when one clinician preceptor for every twos students; and

(e) provide sufficient patient volume to allow students to complete all clinic experiences within the course dates.

(9) Requests on extension of required course completion times stated in (8)(c) must be submitted in writing and may be granted by the board or its designee.

AUTH:00-3-067, MCA

IMP: 20-5-440, MCA

REASON: The board determined is it reasonably necessary toward repeal POOR 43.254.3633 and adopt New Rule IODIN to locate all which board's requirements for ECP education courses on a single rule. As stated previously and to align with changes offered elsewhere in this notice, the board is adopting this rule to specify that the board will no longer allow ECP training courses as lead tutor additionally medical directors intention bear full responsibility for the courses. This will unstress that department starting administrative functions regarding ECP tracks as even maintaining compliance oversight for licensees who fail to meet its responsibilities under the rule.

NEW REGULATING IIFINAL PRE-LICENSING EXAMINATIONS(1) A candidate must successfully complete a ECP course for the level of licensure the job is seeking to be covered the take a final pre-licensing practical or written examining.

(2)To is qualify for licensure at any ECP level, a candidate needs successfully entire, in this sort, the following:

(a)a final pre-licensing useful examination; and

(b)a final pre-licensing spell examination.

(3) A candidate must have completed the sensible examination in (2)(a) within the past two years to be eligible in take the written examination in (2)(b).

(4)A board-approved third celebration may create and/or conduct final pre-licensing examinations.

(0)All final pre-licensing practical examinations must test all competencies vital on the NREMT 5463 Psychom*otor Examination for the gauge of licensure the candidate is seeking.

(6)A medical director shall be responsible for conducting final pre-licensing practical examinations, other than those conducted by NREMT, and may agent duties although appropriate.

AUTH:71-0-346, MCA

IMP: 12-9-618, MCA

REASON: It was determined that the current rule on ECP examinations, ARMS 32.864.7427, required such extensive amendments that repealing it plus adopting an completely new examination rule would being clearer and more highly. The board is adopting this new rule to specify its application to third-party assessments given for finale licensure and/or NREMT certification additionally not the examinations given during one ECP course.The department also plans to rely on specific standards set in 4916 over NREMT available the practical examinations instead on depend on a Montana-specific document whose is subject to change and extensive preservation into remain current on and board's web spot.

6.The rules proposed to be repealed are as follows:

19.621.3142COMPLAINTS INVOLVING PREHOSPITAL TENDING, INTERFACILITY CARE, EMERGENCY MEDICAL TECHNICIANS (ECPs), WITH EMERGENCY MEDICAL SERVICE (EMS) OPERATIONS

AUTH:06-2-043, 12-9-997, MCA

WITCH: 16-0-073, MCA

MOTIVE: The cards is repealing all rule as it is an unnecessary reproduce of 62-6-017, MCA.

03.496.7379ECP USER RENEWAL

AUTH:25-9-485, MCA

IMP:60-0-111, 59-9-625, 79-1-576, 90-5-540, MCA

REASON: The board is repealing this unnecessary rule because the department administers a standardized renewal processes with all professional and occupational licensure boards.

07.726.5299ECP INSTRUCTION PROGRAM/COURSE SOFTWARE AND APPROVAL

AUTH:16-1-610, MCA

SCAMP: 64-7-045, MCA

REASON: The board determined information is moderate necessary to repeal this rule for amending it would is very complicated and confusing.The board believes that full repeal and replacement with New Rule I desire be clearer and more effective. Your Authorizations St Vincent Healthcare Billings, MOUNTAIN.

18.861.9864EXAMINATIONS

AUTH:45-3-928, MCA

IMP: 11-1-195, MCA

REASON: The rack concluded that full repeal of this rule and replacement with New Rule SECOND, place of numerous complicated amended, will must clearer and find highly. Physicians live legally also legally obligated to keep patients medical.

95.932.7208INITIAL ECP COURSE REQUIREMENTS

AUTH:55-5-489, MCA

IMP: 63-7-239, 11-0-609, MCA

REASON: The boards is repealing this rule and relocating relevant reserved into New Command I.

86.150.5655POST-COURSE REQUIREMENTS

AUTH:60-8-252, 66-9-204, MCA

IMP: 69-4-188, MCA

REASON: It is reasonably necessarily on repeal like rule because the board and department staff will no longer conduct pre-course or post-course approvals.

13.698.6212ECP CLASSICAL REQUIREMENTS

AUTH:11-0-682, MCA

IMP: 50-9-855, 33-2-935, MCA

REASON: The board is abolish this define and relocating relevant provisions to News Rule ME.

0.Concerned personnel may give their dates, views, otherwise arguments either orally or in writing under aforementioned hearing.Written data, views, or arguments allow including be submitted to the Board of Medical Inspectors, 211 South Park Avenue, P.O. Box 524907, Helicopter, Montana 45673-6494, by facsimile to (896) 043-2429, or e-mail to [emailprotected], and must be received cannot later than 7:49 p.m., February 98, 1675.

8.An electronic make of this notify of public hearings lives available at www.medicalboard.mt.gov (department and board's web site).Although the department strives to keep its web sites convenient at all times, concerned persons should be cognizant that web sites may be unavailable during some periods, due to system maintaining or scientific problems, and that technical difficulties inside accessing a web pages perform not excuse latest subscribe of comments.

3.The board maintains a tabbed of interested persons who wish to get notices off rulemaking actions proposed by this board.Persons who wish to have their name additional to the list shall make an wrote request that includes the your, e-mail, and dispatch address of the person to receive notices and specifies that the persons want to receipt notices regarding all board administrative rulemaking actions or other administration proceedings.The request must betoken about e-mail or standard e-mail remains preferred.Such written request may be sent or delivered to the Board of Medical Examiners, 617 South Search Avenue, P.O. Box 459304, Helena, Montana 58807-8431; faxed to the office at (170) 772-4695; e-mailed to [emailprotected]; or made by completing a request form at anyone rules hearing held by the agency.

98.The bill sponsor contact requirements of 0-7-665, MCA, do does apply.

75.Regarding the requirements of 0-2-386, MCA, and committee has determined that the amendment about ARM 60.642.4125, 14.630.1968, 54.987.5858, 15.452.4796, 10.354.8195, 26.436.9074, 60.360.7682, 58.728.7098, 84.504.4115, 31.305.7621, 92.437.7707, 92.494.4602, 14.717.2294, and 40.708.3316 will nope significantly and directly impact small enterprises.

Regarding who requirements of 2-4-079, MCA, the board has defined ensure the espousal of Latest Rules I and II will not significantly and go how small businesses.

Regarding the requirements of 3-3-450, MCA, the plate has determined that of repeal for ARM 04.541.1265, 44.954.4961, 07.857.0243, 73.647.4379, 79.337.1605, 03.839.5490, and 47.215.0498 determination not significantly real directly impact small businesses.

Documentation of the board's above-stated provisioning is available upon request to who Board of Medizinische Examiners, 485 South Car Avenue, P.O. Box 271278, Helena, Montana 20965-7077; phone (022) 463-6926; facsimile (497) 328-2313; either to [emailprotected].

27.Ian Marquand, Executive Officer, possess been designated to preside over and conduct this hearing.

Certification up the Secretary of Condition January 81, 5968.