Salt Lake City — Utah counties and incorporated municipalities must issue a public request for proposal and hold an open meeting to select 911 ambulance and non-emergency interfacility transport providers under Senate Bill 215, which took effect May 7, the Utah Bureau of Emergency Medical Services told local officials in a May webinar.

The requirement applies to both emergency 911 transport—where a dispatched EMS agency provides emergency medical care and transport to a hospital—and interfacility transport, or IFT, which is the transfer of a patient without an emergency medical condition from one licensed facility to another, Kate Carlson, program manager at the Utah Bureau of Emergency Medical Services, said. “We’re going to talk a little bit today about Senate Bill 215,” Carlson said.

The nut graf: The law removes the old, ambiguous “needs and necessities” licensing category and places responsibility for selecting both 911 and interfacility transport providers with counties and municipalities. Local governments must publish an RFP, review respondents against locally adopted cost, quality and access goals, choose providers in an open public meeting at least three months before an agency’s license expires, and provide a signed letter of support to the Bureau when a selected agency applies for state licensure.

Under the state code Carlson cited, localities must review three elements when making selections: cost (the financial cost to provide EMS and patient charges), quality (the expected clinical level of service such as EMT, advanced EMT or paramedic), and access (the expected availability of EMS to individuals within the jurisdiction). Carlson recommended publishing an RFP about six months before an existing license expires to allow time for proposals and public review, and said the bureau maintains a public license lookup for agencies and expiration dates.

How it works in practice: a county or city may provide 911 services itself or contract with an external EMS agency. If different providers cover 911 and IFT in the same area, the jurisdiction must offer the incumbent 911 provider a right to provide IFTs when an IFT license is up for renewal; the incumbent may accept or decline, Carlson said. Where needed, jurisdictions must also select and contract a designated backup IFT provider through the same RFP and public-selection process so a backup ambulance is available during high demand or when crews are on other calls.

The bureau will not conduct or adjudicate local RFP appeals; Carlson said appeals and disputes remain at the county or municipal level. The bureau’s role is to license EMS agencies, verify that a public RFP and public meeting occurred before issuing or renewing an IFT or 911 license, accept the jurisdiction’s signed letter of support submitted with an agency’s licensure application, and, on a case-by-case basis during the transition, grant limited extensions to existing licenses when jurisdictions request relief.

Carlson encouraged local officials to inventory licensed EMS agencies in their areas, confirm each agency’s license expiration (licenses are typically issued for a four-year term, she said), and coordinate across municipalities and special service districts so multiple expirations do not force repeated reviews. She advised jurisdictions that the selection meeting must occur no fewer than three months before an existing license expires, and recommended publishing the RFP about six months before expiration to give respondents time to assemble required materials.

Questions from participants during the webinar covered whether special service districts must follow the same process (yes; SSDs receive authority from a county and selections must be authorized by the county or an incorporated municipality), whether the requirement covers transfers involving nursing homes and mental-health receiving facilities (yes; IFTs include transfers arranged by a transferring physician from hospitals, nursing facilities, mental-health facilities or other licensed medical facilities), and whether the bureau can help identify incumbent IFT providers (the bureau maintains an online lookup and offered to assist jurisdictions that remain uncertain).

Carlson concluded by offering bureau staff assistance and a template for cost, quality and access goals. “The sooner you do this, probably the better,” she said, noting the bureau is tracking license expirations and has granted extensions during the transition. Contact information for the Utah Bureau of Emergency Medical Services was provided to webinar registrants for follow-up.

For jurisdictions: plan a public RFP process that defines the scope and qualifications you require, record and publish your cost/quality/access goals, hold the required public selection meeting at least three months before a license expires, and deliver a signed letter of support to the bureau as part of any selected agency’s licensure application.

— Reporting by Kate Carlson and Molly Wheeler; for more information contact the Utah Bureau of Emergency Medical Services.