Title of Regulation: 12VAC5-31. Virginia Emergency Medical Services Regulations (amending 12VAC5-31-1401; repealing 12VAC5-31-1465).

Statutory Authority: §§ 32.1-12, 32.1-111.4, and 32.1-111.5 of the Code of Virginia.

Public Hearing Information: No public hearings are scheduled.

Public Comment Deadline: February 12, 2014.

Effective Date: March 1, 2014.

Agency Contact: Michael Berg, Regulatory and Compliance Manager, Department of Health, 1041 Technology Park Drive, Glen Allen, VA 23059-4500, telephone (804) 888-9131, or email michael.berg@vdh.virginia.gov.

Basis: Section 32.1-12 of the Code of Virginia authorizes the State Board of Health to promulgate regulations to carry out the provisions of Title 32.1 of the Code of Virginia. Section 32.1-111.4 of the Code of Virginia directs the board to establish requirements regarding emergency medical services (EMS). Section 32.1-111.5 of the Code of Virginia requires the board to establish the qualifications required for certification of emergency medical services providers, including those qualifications necessary for authorization to follow Do Not Resuscitate Orders pursuant to § 54.1-2987.1 of the Code of Virginia, and the procedures and the qualifications required for the recertification of EMS providers.

Purpose: This regulatory action will help to strengthen the EMS system, and thereby protect the health, safety, and welfare of citizens, by improving the efficiency of the EMS provider recertification process through the removal of certain unnecessary and burdensome regulatory requirements. There is unanimous consensus by the EMS system that the current method and process used to recertify EMS providers needs to be changed. The EMS system is in agreement that the recertification of EMS credentials should be based solely on completion of continuing education hours and should not require a written examination or examination waiver by the provider's EMS agency operational medical director (OMD) to complete the process. Current review of available data reveals greater than 90% of all recertification testing is being waived.

These changes will not adversely affect the health, safety, and welfare of the citizens of the Commonwealth because the ability to provide patient care as an EMS provider is governed by regulations that require authorization by the agency OMD and affiliation with an EMS agency.

Rationale for Using Fast-Track Process: Changes to the regulations are not expected to be controversial as the various stakeholders groups and the EMS community requested this change to simplify the existing recertification process. These changes will mirror the recertification processes of other allied health professions.

Substance: The changes to the regulation allow a certified EMS provider to gain recertification through continuing education only, removes any retesting requirement (written or practical) at the state level, and removes the requirement for the OMD to sign any paperwork to "waive" any test administered by the state. This does not preclude the ability of the individual OMD to implement any local requirements he believes necessary to evaluate the ability of the EMS providers that provide patient care under his authority.

Issues: The primary advantage of this regulatory action is that it removes burdensome and unnecessary regulatory requirements as well as aligns with other allied health care recertification practices in the Commonwealth. This regulatory action poses no disadvantages to either the public or the Commonwealth.

Department of Planning and Budget's Economic Impact Analysis:

Summary of the Proposed Amendments to Regulation. Pursuant to Chapters 72 and 331 of the 2013 Acts of Assembly, the proposed regulations no longer require Emergency Services (EMS) providers to take a written examination for recertification.

Result of Analysis. The benefits likely exceed the costs for all proposed changes.

Estimated Economic Impact. Pursuant to Chapters 72 and 331 of the 2013 Acts of Assembly, the proposed regulations no longer require EMS providers to take a written examination for recertification. Under the current regulations, EMS providers are required to take a written examination for recertification. However, the written examination requirement may be waived by the relevant operational medical director. According to the Virginia Department of Health (VDH), more than 90% of all recertification testing is currently being waived. With the proposed changes, recertification of EMS credentials will be based solely on completion of continuing education hours currently required.

The proposed changes will primarily affect EMS providers. EMS providers who are currently obtaining waivers will not have to seek waivers and the ones currently taking the exam will not have to take it under the proposed regulations. VDH estimates that during the five-month period from August to December 2013, approximately 2,137 providers will be required to take the test. Of these, approximately 1,991 will obtain waivers and about 145 will actually take the test. The proposed regulations will benefit the affected providers as they will no longer incur time and travel costs to take the exam or obtain a waiver. The test is administered by VDH free of charge. Thus, VDH is also expected to realize cost savings from reduced administrative workload, reduced postage costs, and reduced printing costs.

Businesses and Entities Affected. There are approximately 37,000 EMS providers in the Commonwealth. These providers work for approximately 684 agencies that are volunteer, commercial, and municipal entities.

Localities Particularly Affected. The proposed regulations apply throughout the Commonwealth.

Projected Impact on Employment. Proposed elimination of the recertification exam is expected to provide time savings to the providers as well as to VDH due to their reduced work load. Thus, a potential increase in supply of EMS providers and a potential decrease in demand for VDH administrative staff time may be expected.

Effects on the Use and Value of Private Property. The proposed regulations are not expected to have a significant effect on the value of private property.

Small Businesses: Costs and Other Effects. Some of the commercial agencies employing EMS providers may be small businesses. However, the proposed regulations do not have a direct impact on these agencies.

Small Businesses: Alternative Method that Minimizes Adverse Impact. The proposed regulations are not anticipated to have a direct impact on commercial agencies that may be small businesses.

Real Estate Development Costs. No effect on real estate development costs is expected.

Legal Mandate. The Department of Planning and Budget (DPB) has analyzed the economic impact of this proposed regulation in accordance with § 2.2-4007.04 of the Administrative Process Act and Executive Order Number 14 (10). Section 2.2-4007.04 requires that such economic impact analyses include, but need not be limited to, a determination of the public benefit, the projected number of businesses or other entities to whom the regulation would apply, the identity of any localities and types of businesses or other entities particularly affected, the projected number of persons and employment positions to be affected, the projected costs to affected businesses or entities to implement or comply with the regulation, and the impact on the use and value of private property. Further, if the proposed regulation has an adverse effect on small businesses, § 2.2-4007.04 requires that such economic impact analyses include (i) an identification and estimate of the number of small businesses subject to the regulation; (ii) the projected reporting, recordkeeping, and other administrative costs required for small businesses to comply with the regulation, including the type of professional skills necessary for preparing required reports and other documents; (iii) a statement of the probable effect of the regulation on affected small businesses; and (iv) a description of any less intrusive or less costly alternative methods of achieving the purpose of the regulation. The analysis presented above represents DPB's best estimate of these economic impacts.

Agency's Response to Economic Impact Analysis: The Virginia Department of Health has reviewed the economic impact analysis and concurs with the results.

Summary:

In accordance with Chapters 72 and 331 of the 2013 Acts of Assembly, the amendments remove the requirement for emergency medical services (EMS) providers to take a written examination or obtain a waiver from testing from the relevant operational medical director to recertify their EMS certifications.

12VAC5-31-1401. General recertification requirements.

A. An EMS provider must complete the requirements for recertification and the requesting recertification must complete the continuing education hour requirements, as identified in 12VAC5-31-1403, for the level at which the EMS provider is requesting to be recertified. The Office of EMS must receive the required documentation of the EMS provider's completion of continuing education within the issued certification period for the provider to maintain a current certification.

B. An EMS provider requesting recertification must complete the continuing education (CE) hour requirements for the level to be recertified.

C. An EMS provider requesting recertification must pass the written state certification examination.

1. An EMS provider affiliated with an EMS agency may be granted an exam waiver from the state written certification examination by the OMD of the EMS agency, provided:

a. The EMS provider meets the recertification requirements including those established by the OMD; and

b. The EMS provider must submit a completed Virginia EMS Certification Application with the exam waiver approval signed by the EMS agency OMD, which must be received by the Office of EMS within 30 days following the expiration of his certification.

(1) If the Virginia EMS Certification Application form is received by the Office of EMS after the EMS provider's certification expiration date, the EMS provider may not practice at the expired certification level until a valid certification is received from the Office of EMS.

(2) If the Virginia EMS Certification Application form is received by the Office of EMS more than 30 days after the EMS provider's certification expiration date, his certification will be in reentry and he will be required to test pursuant to 12VAC5-31-1407.

2. B. An EMS provider under legal recognition pursuant to 12VAC5-31-1393 must pass recertify by passing a Virginia written and practical EMS certification examination and is not eligible for examination waiver.

12VAC5-31-1465. Recertification examination requirement. (Repealed.)

A. Individuals who are eligible to recertify and hold current certifications are required to successfully complete the state written examination process based upon the following:

1. All individuals who are not affiliated with a licensed EMS agency must take the state written examination to recertify.

2. Individuals affiliated with a licensed EMS agency may be granted an exam waiver from the state written recertification examination by the operational medical director (OMD) of the EMS agency, provided:

a. A completed Virginia EMS Certification Application signed by the OMD and the individual is submitted to the Office of EMS documenting the exam waiver or a format approved by the Office of EMS.

b. A Virginia EMS Certification Application form submitted as an exam waiver must be received by the Office of EMS no later than 30 days following the expiration of the individual's certification at the level being waived.

(1) Virginia EMS Certification Application forms received by the Office of EMS during the 30 days after the individual's certification expiration date will be considered valid for recertification purposes. However, during this period following expiration, the individual may not practice at the expired certification level.

(2) Virginia EMS Certification Application forms received by the Office of EMS more than 30 days after the individual's certification expiration date will be considered as invalid and the individual will be deemed in reentry status and required to test to regain current certification.

B. Candidates in current provider status required or choosing to take the state recertification examination must demonstrate eligibility as evidenced by presentation of a valid recertification eligibility notice letter from the Office of EMS.