§ 46-92. Certificate of public convenience and necessity (COPCN).

(a)

Application. An application for any COPCN required by state law or regulation for the operation of any advanced life support service or ATS operator, shall be filed with the division on such forms as the division may require, together with such fee as the county council by resolution may establish. All applications shall be signed by the duly authorized chief administrative officer of the applicant.

(b)

Applications for a nontransport COPCN shall include:

(1)

The names and addresses of all principals of the proposed provider, including the chief administrative officer, EMS manager and fire chief, if applicable;

(2)

The trade or other name, if any, under which the applicant does business and proposes to do business;

(3)

The boundaries the applicant proposes to serve for each of the following categories: i) primary service area; and ii) closest unit emergency medical response service area for each fire station of the applicant to include a map in a format deemed acceptable by the division.

(4)

The level and nature of the services proposed, in specific detail;

(5)

A description of all vehicles and equipment the applicant proposes to use to supply the service, including make, model, year of manufacture, vehicle identification number, vehicle type, current state license number (if applicable) and a listing if all medical equipment to be utilized in the provision of emergency medical services under the certificate;

(6)

Proof that the applicant has employed an adequate number of state-certified and credentialed personnel, and possesses all required federal or state licenses and permits;

(7)

A notarized statement that the applicant agrees to utilize the services of the county medical director for the duration of the certificate;

(8)

A notarized statement by the applicant that it shall provide a closest unit emergency medical response to each emergency medical condition within its service area;

(9)

Proposed EMD plan;

(10)

Proof that the applicant is in compliance with all applicable federal, state and local requirements, protocols, policies and directives;

(11)

A summary of the training and experience of the applicant in the provision of nontransport advanced life support services;

(12)

The address of the intended headquarters and any substations, and the address to which the public may have access in person during normal business hours;

(13)

The applicant has furnished evidence of adequate insurance coverage for claims arising out of injury to or death of persons and damage to the property of others resulting from any cause for which the owner of such business or service would be liable. The applicant must provide insurance in such sums and under such terms as required by the Florida Department of Health, Bureau of EMS. In lieu of such insurance, the applicant may furnish a certificate of self-insurance evidencing that the applicant has established an adequate self-insurance plan to cover such risks and that the plan has been approved by the department of insurance; and

(14)

Such other information as the county council, county manager, or their designee may deem necessary and relevant.

(c)

Applications for an ambulance COPCN shall include:

(1)

The names and addresses of all principals of the proposed provider, including the chief administrative officer, EMS manager and fire chief, if applicable;

(2)

The trade or other name, if any, under which the applicant does business and proposes to do business;

(3)

The boundaries of the territory to be served;

(4)

The level and nature of the services proposed, in specific detail;

(5)

A description of all vehicles and equipment the applicant proposes to use to supply the service, including make, model, year of manufacture, vehicle identification number, vehicle type, current state license number (if applicable) and a listing if all medical equipment to be utilized in the provision of emergency medical services under the certificate;

(6)

Proof that the applicant has employed an adequate number of state-certified and credentialed personnel, and possesses all required federal or state licenses and permits;

(7)

A notarized statement that the applicant agrees to utilize the services of the county medical director for the duration of the certificate;

(8)

Proposed EMD plan;

(9)

Proof that the applicant is in compliance with all applicable federal, state and local requirements, protocols, policies and directives;

(10)

A summary of the training and experience of the applicant in the provision of ambulance services;

(11)

The address of the intended headquarters and any substations, and the address to which the public may have access in person during normal business hours;

(12)

The applicant has furnished evidence of adequate insurance coverage for claims arising out of injury to or death of persons and damage to the property of others resulting from any cause for which the owner of such business or service would be liable. The applicant must provide insurance in such sums and under such terms as required by the Florida Department of Health, Bureau of EMS. In lieu of such insurance, the applicant may furnish a certificate of self-insurance evidencing that the applicant has established an adequate self-insurance plan to cover such risks and that the plan has been approved by the department of insurance;

(13)

A proposed detailed budget, and if public funds will be needed for operation;

(14)

A written analysis and evaluation of the activity level of the proposed service, including an evaluation of the unit hour utilization (UHU) of ambulances to be operated under the terms of the COPCN;

(15)

A schedule of the applicant's intended rates, if any, and the length of time they will remain in effect. Any changes to the rate structure will require prior approval by the county council; and

(16)

Such other information as the county council or county manager, or their designee may deem necessary and relevant.

(d)

Applications for an alternative transport service COPCN shall include:

(1)

The names and addresses of all principals of the proposed operator, including the chief administrative officer;

(2)

The trade or other name, if any, under which the applicant does business and proposes to do business;

(3)

The boundaries of the territory to be served;

(4)

A description of all vehicles and equipment the applicant proposes to use to supply the service, including make, model, year of manufacture, vehicle identification number, vehicle type and a listing if all equipment to be utilized in the provision of ATS services under the certificate;

(5)

A notarized statement that the applicant agrees to comply with the clinical guidelines for ATS services promulgated by the county medical director for the duration of the certificate;

(6)

Proof that the applicant is in compliance with all applicable federal, state, and local requirements, protocols, policies and directives;

(7)

A summary of the experience of the applicant in the provision of ATS services;

(8)

The address of the intended headquarters and any substations, and the address to which the public may have access in person during normal business hours;

(9)

The applicant has furnished evidence of adequate insurance coverage for claims arising out of injury to or death of persons and damage to the property of others resulting from any cause for which the owner of such business or service would be liable. The applicant must provide insurance in such sums and under such terms as required by the Florida Department of Health, Bureau of EMS. In lieu of such insurance, the applicant may furnish a certificate of self-insurance evidencing that the applicant has established an adequate self-insurance plan to cover such risks and that the plan has been approved by the department of insurance;

(10)

A proposed detailed budget, if public funds will be needed for operation;

(11)

A schedule of the applicant's intended rates, if any, and the length of time they will remain in effect. Any changes to the rate structure will require prior approval by the county council; and

(12)

Such other information as the county council or county manager, or their designee may deem necessary and relevant.

(e)

Fees. Applications for new COPCNs shall require a nonrefundable application fee of $1,500.00, or one-half of the total cost of evaluating the COPCN application, whichever is greater, to cover the cost of processing the application. This provision shall not apply to an application for a COPCN from existing providers which is necessary to become compliant with the changes to this article.

(f)

Notice. The county council, at a regularly scheduled meeting within 60 days after receipt of an application deemed to be complete by the division, shall set a public hearing date for the application and authorize notice thereof, which shall be published in a newspaper of general paid circulation in the county at least 21 days prior to the date of the hearing.

(g)

Medical director review. Within ten days of receipt of an application deemed to be complete by the division under this article, a complete copy thereof shall be forwarded by the division to the medical director for review and recommendations. The medical director shall prepare a written report within 30 days of his receipt of the application, unless an extension of time is agreed to by all interested parties or is granted by the county council for good cause.

(h)

Municipal review. Within ten days of receipt of an application deemed to be complete by the division under this article, a complete copy thereof shall be forwarded by the division to the chief administrative officer of each municipality where the service is to be provided for the municipality's review and recommendation. The municipality may submit its recommendation to the county council in writing or in person at the public hearing.

(i)

Provider review. Within ten days of receipt of an application deemed to be complete by the division under this article, a complete copy thereof shall be forwarded by the division to the principal of record of each provider or operator within the proposed service area for the provider's or operator's review and comment. The provider may submit its comments to the county council in writing or in person at the public hearing.

(j)

Standards. Before taking action on an application under this article, the county council shall consider, where applicable, the following criteria:

(1)

The extent to which the applicant, and all proposed equipment and personnel, conform to the standards of F.S. ch. 401, any amendments thereto, and any rules promulgated thereunder;

(2)

The extent to which the applicant and all proposed equipment and personnel conform to this article, any amendments thereto, and any rules, resolutions or policies adopted thereunder;

(3)

The extent to which the proposed services are needed to improve the overall capability of the emergency medical services within the county;

(4)

The effect of the proposed services on the quality and cost of any existing provider or operator;

(5)

The effect of the proposed services on the overall cost of medical transportation or rescue services within the county;

(6)

The financial ability of the applicant to provide and maintain the proposed services at the levels of performance proposed;

(7)

The effect of the proposed services on existing hospitals and other health care facilities;

(8)

The recommendations of the county's medical director;

(9)

The recommendations of any affected municipality;

(10)

The recommendations of any effected provider or operator;

(11)

The experience and training of the applicant and its personnel, and the quality of its proposed equipment and vehicles;

(12)

The past performance of the applicant in this or other jurisdictions;

(13)

The ability of the applicant to comply with all applicable laws, ordinances, rules and regulations of federal, state and local governments, including, closest unit emergency medical response; and

(14)

The applicant's rate schedule, if any, and the length of time such schedule is to remain in effect.

(k)

Disposition of the application. At the close of the public hearing on the application, the county council shall approve, approve with conditions, or deny such application. Approval of the application shall result in the issuance of a COPCN which shall include the conditions upon which the COPCN was approved. The terms of the COPCN shall incorporate the boundaries of the service area and be conditioned on the representations set forth in the application. The COPCN shall be issued within 21 calendar days after the close of the public hearing.

(l)

Suspension or revocation. The county council may suspend or revoke any certificate granted under this article for good cause, after a hearing upon reasonable notice to the holder of the certificate, and to any affected municipality. Good cause shall be deemed to include, but not be limited to one or more of the following circumstances:

(1)

The certificate holder has failed or refused to provide full and satisfactory service to the area covered by the certificate;

(2)

The certificate holder or any principal of the certificate holder fails to comply with the reporting requirements under the terms of the COPCN issuance;

(3)

The certificate holder or any principal of the certificate holder fails to comply with the terms or conditions of the COPCN, or any requirement of this article, including the standards and policies implemented by the medical director or the division;

(4)

The certificate holder or any principal of the certificate holder has been convicted of or entered a plea of no contest to a felony or other offense involving moral turpitude;

(5)

False statements of material fact in the application, or the intentional omission of material facts from the application;

(6)

Failure to correct any deficiencies in the operations permitted by the certificate, following reasonable notice of such deficiencies;

(7)

Failure to comply with any applicable federal, state or local laws, ordinances, regulations, resolutions or policies;

(8)

The certificate holder or any principal of the certificate holder has been found guilty of negligence in the operation of his service by any court of competent jurisdiction;

(9)

Any material change in the ownership, management or operations of the certificate holder; or

(10)

Failure to provide EMD services or utilize the services of the medical director.

(m)

Rights and duties granted by certification.

(1)

Each COPCN issued in accordance with this article will expire automatically two years after the date of issuance. The requirements for renewal of any COPCN issued under this part are the same as the requirements in effect at the time of renewal for an original COPCN. The division will prepare an abbreviated renewal application from which shall assure that the applicant meets the requirements of this article for a COPCN and include, at a minimum:

a.

The organization's name;

b.

The name, telephone number, email address and signature of the provider's chief administrative officer;

c.

The name, telephone number, email address and signature of the provider's EMS manager;

d.

A copy of the provider's current license issued by the department of health; and

e.

Any change in required information provided on the application for the currently approved COPCN of the applicant.

(2)

The certificate shall not be transferable or assignable, either voluntarily or by operation of law, without the prior written approval of the county council, upon a finding of conformance with all requirements of this article.

(3)

The holder of a COPCN, regardless of date of issuance, shall:

a.

Provide continuous and uninterrupted services in the manner and for those areas authorized by the certificate;

b.

Provide services authorized by the certificate to adjacent areas or routes, when requested to do so by a public safety agency or EMS provider;

c.

Keep such records as may be required by the federal or state government, or by the county council, pursuant to any rules and regulations adopted by resolution under this article, and furnish or make such records available to the county manager or designee for inspection at reasonable times and places;

d.

Operate in conformance with all federal, state or local laws or ordinances, and all rules and regulations, resolutions or policies thereunder, and any conditions or limitations imposed by the county council upon issuance of the certificate;

e.

File an application for renewal of its certificate, or a notice of its intent not to seek renewal of its certificate, at least 120 days prior to its expiration;

f.

Maintain liability insurance in such amounts and with such coverages as the county council may require upon issuance of the certificate;

g.

In the case of a nontransport or ambulance certificate holder, utilize emergency medical dispatch, or enter into an agreement with an agency to provide said service, authorized by the medical director;

h.

In the case of a nontransport certificate holder, establish, implement and maintain run cards which achieve closest unit emergency medical response in the manner and for those areas authorized by the certificate. The director shall have the authority to review these run cards periodically to determine that closest unit emergency response is being functionally achieved. Upon determination that closest unit emergency medical response is not being functionally achieved, the director shall notify the certificate holder(s) of the failure and consult with the applicable agency fire chief(s) to change the run card(s) to achieve functional closest unit emergency medical response. The director shall have the final authority to resolve each run card discrepancy to achieve functional closest unit emergency response. The applicable certificate holder shall direct the agency's dispatch center to change the run card(s) in the manner and within the time period determined by the director; and

i.

In the case of a nontransport certificate holder, maintain closest unit emergency medical response at all times without charge, unless authorized by resolution of the council in accordance with section 46-93. Under no circumstances may a certificate holder withhold or condition closest unit emergency medical response.

(4)

The county council may modify the terms and conditions of any certificates issued hereunder, at any time, after a public hearing upon reasonable notice to all interested persons.

(n)

Status of any current COPCN. Any valid COPCN in force on the effective date of this article shall remain in full force and effect until its current expiration date unless the COPCN is suspended or revoked by the county council. Provision of services under a valid COPCN shall conform to this article, regardless of date of issuance. A closest unit response service area established by interlocal agreement between a certificate holder and other local government in effect on or before August 1, 2009 is incorporated by reference and made a part of the certificate holder's COPCN in effect on said date until the expiration of the interlocal agreement or COPCN, whichever occurs first. Any renewal of a valid COPCN shall comply with the application requirements in section 46-92.

(o)

Interfacility transfers and nonemergency transportation services.

(1)

Legislative findings. The county council makes the following determinations pertaining to the provision of interfacility transfers and nonemergency medical transportation services:

a.

The provision of effective medical transportation services is essential to the health and well-being of all citizens of the county, and the establishment of a comprehensive county-wide emergency and nonemergency response program for both medical transport and nontransport services supports county and community health systems by further enhancing the total delivery system of emergency medical services and reducing injuries for all persons;

b.

The county cannot effectively monitor, review, or otherwise evaluate the quality and effectiveness of interfacility transfers and nonemergency medical transportation services to ensure compliance with the requirements and intent of this article when the county is not providing such services or a provider offers such services outside the context of an emergency medical response;

c.

Revenue received by the county for interfacility transfers and nonemergency medical transportation services constitutes significant income necessary to support the county's provision of emergency medical services and other supplemental programs the county council deems necessary and proper;

d.

To ensure that the county maintains the necessary capacity, quality and availability of county resources to provide competent and adequate emergency medical response services to the public, the county must, as a general rule, serve as the sole provider of interfacility transfers and nonemergency medical transport services.

(2)

Interfacility transfers or nonemergency medical transportation services. Unless this section is amended by ordinance, the county council, except as may be permitted pursuant to subsection (3) herein, will neither consider, nor issue a COPCN authorizing any person, firm, corporation, or association owning or acting as agent for the owner of any business or service, other than the county and its departments and agencies, to engage in or otherwise provide interfacility transfers or other medical transportation services not provided as part of an emergency medical response, the provision and conduct of such services being reserved solely to the county and those departments, agencies, and contractors assigned by the county to provide such services.

(3)

Temporary COPCN for interfacility transfers or nonemergency medical transportation services. Regardless of the requirements of this section, the emergency medical administration director for the county or his/her designee may, on a case-by-case basis, issue a temporary and conditional COPCN specially permitting certain interfacility transfers or medical transports unrelated to an emergency medical response from facilities and locations within the county if the following criteria are met:

a.

The county is unable or unavailable to perform the requested interfacility transfer or medical transportation services due to the need for specialized services during transport or other mitigating factors warranting the use of a medical transportation service provider other than the county: and

b.

The medical transportation service provider has been issued a current and valid license pursuant to F.S. § 401.25, to provide the type of medical transportation services needed, whether such services are statutorily classified as basic life support services or advanced life support services; and

c.

The medical transportation service provider demonstrates that it carries adequate insurance or self-insurance coverage as required by F.S. § 401.25; and

d.

The medical transportation service provider produces such other information as the county medical director, or his/her designee deems necessary or relevant; and

e.

The medical transportation service provider:

1.

Is, for the purposes of the requested transfer or transport, providing services for or on behalf of any official, officer, commission, board, authority, council, committee, or department of the executive branch of the state government; or

2.

Has performed no more than 12 such transfers or transports within the 12-month period preceding the proposed date of transport or transfer.

A COPCN issued pursuant to this subsection shall: (i) be temporary in nature; (ii) apply only to the interfacility transfer or nonemergency medical transportation service for which the application or request was made; and (iii) expire immediately after completion of the interfacility transfer or nonemergency medical transportation service for which such COPCN was approved. The emergency medical administration director or his/her designee shall maintain records of temporary COPCNs issued pursuant to this section and is authorized to issue any such COPCN or confirmation thereof to the medical transportation service provider in writing, which COPCN or confirmation may be delivered via courier service, U.S. Mail, facsimile, email, or other commonly accepted method of delivery.

(Ord. No. 2003-14, § III, 8-21-03; Ord. No. 2009-26, § V, 11-5-09; Ord. No. 2011-20, § II, 7-21-11; Ord. No. 2012-22, § II, 12-20-12)