(A) Purpose. The best interests of the citizens of Wake County are served by franchising non-emergency ambulance service, convalescent ambulance services, and specialty care transport services to assure adequate and continuing ambulance service and to preserve, protect, and promote the public health, safety and welfare. (See also G.S. § 153A-240(a))
(B) Franchise required. No person may furnish, operate, conduct, maintain, advertise or otherwise engage in or profess to be engaged in the provision of non-emergency ambulance service, convalescent ambulance service, or specialty care transport service within the geographic boundaries of Wake County unless the person has been either granted a franchise to do so by the Board pursuant to this chapter or exempted from a franchise pursuant to this chapter.
(C) (1) No franchise shall be required for the provision of emergency ambulance service within Wake County. The provision of emergency advanced life support ambulance service is the sole responsibility of the Wake County EMS System. Therefore, no franchise shall be required for operation of ambulances by:
(a) Employees of Wake County EMS;
(b) A contract EMS agency as defined in this chapter; or
(c) An entity rendering assistance to the system at the request of the Director during a major emergency or when system resources are insufficient resources to meet the needs of the community for EMS or non-emergency ambulance service.
(2) No franchise shall be required for the provision of ambulance transportation by a specialty care transport program operated by a hospital that is physically located within the geographic limits of Wake County.
(3) The county may limit the number of ambulance franchises awarded consistent with the needs of the community. The county expressly reserves the right to amend, suspend, or revoke a franchise for any reason.
(D) Application for franchise. Application for a franchise to provide non-emergency ambulance services, convalescent ambulance services or specialty care transport services in Wake County shall be made upon forms prepared or prescribed by the Department and shall contain:
(1) The name and address of the applicant, who shall be the owner of the entity and any ambulances to be operated under the franchise. If the owner is a corporation, a certified copy of the articles of incorporation must be attached.
(2) The address of the location in Wake County where the applicant will maintain a business office for transaction of business, including payment of bills.
(3) The trade names under which the applicant does business, with a certified copy of an assumed name certificate or articles of incorporation stating such name.
(4) Training, credentials and experience of the applicant, its agents and employees related to operation of non-emergency ambulance services and patients care.
(5) A description of each ambulance owned or operated by the applicant, including chassis manufacturer, ambulance maker, year of manufacture, vehicle identification number, and NCOEMS permit number, if already permitted. A franchise may not be granted to applicant who owns/leases no ambulance vehicles.
(6) An inventory of all equipment that will be carried aboard each ambulance. This equipment may not exceed the scope of practice of an EMT-Basic except when franchised by the Board of County Commissioners of another county to provide services in excess of the EMT-Basic scope of practice.
(7) The location and description of places of business in Wake County where the applicant intends to locate ambulances.
(8) A description of the applicant’s capability to provide non-emergency ambulance services on a 24-hour per day, seven-day per week basis.
(9) An official criminal record of the applicant if a sole proprietorship, of any partners if the applicant is a partnership, or any officers, directors, or managers of the applicant if a corporation or other business entity.
(10) A statement that the applicant will not discriminate as to any person with regard to race, color, creed, national origin, or gender.
(11) An audited financial statement, in such form and detail as the county may require.
(12) A certificate of insurance currently in force, issued by an insurance company licensed to provide insurance in the State of North Carolina evidencing the following insurance coverage:
(a) Vehicle insurance. For every ambulance owned or operated by the applicant providing for the payment of damages in the sum of $1,000,000 for injury to or death of individuals in accidents resulting from any cause for which the owner of said vehicle would be liability on account of liability imposed on him/her by law, regardless of whether the ambulance was being driven by the owner, his/her agent, or any other person, and in the sum of $1,000,000 for the loss of or damage to the property of another, including personal property.
(b) General comprehensive liability insurance. A certificate of insurance currently in force and effect, issued by an insurance company licensed to provide insurance in the State of North Carolina, providing for the payment of damages in the sum of $3,000,000 for general (non-vehicular) liability including medical malpractice.
(13) A notarized statement certifying that the applicant is not debarred from receiving Medicare or Medicaid programs, nor currently the subject of debarment proceedings, and is and will remain in compliance with this chapter, OEMS rules and all applicable state and federal statutes and regulations.
(14) A non-refundable application fee, to defray the costs associated with processing the application, conducting investigations, providing such public notice as may be required by law, and ongoing oversight.
(E) Departmental review. Upon receipt of a complete application for a franchise, the Department will:
(1) Review the application for completeness and compliance with this chapter;
(2) Cause such investigation to be made as the Department deems necessary;
(3) Determine whether the applicant meets the requirements for the award of a franchise under this chapter;
(4) Make a recommendation to the Board of County Commissioners on whether to grant the application for franchise; and
(5) Schedule a public hearing before the Board after providing all required public notices.
(F) Board action. The Board may grant a franchise upon finding the following fact:
(1) The public will be served by granting the applicant a franchise, consistent with the policy set forth in § 111.01 of this chapter;
(2) The application is accurate, complete and correct;
(3) The applicant has produced adequate evidence of its ability to provide adequate and responsible non-emergency or convalescent ambulance service, and evidence that no owner, operator, agent or employee has been debarred from the Medicare or Medicaid program, or any other public benefit program of the United States or any other state; and
(4) The applicant holds all necessary licenses and permits from OEMS or will be fully qualified to obtain all necessary licenses and permits upon the award of the franchise.
(G) Conditions of franchises granted by the Board.
(1) A franchise issued by the county shall be valid for the term specified by the Board, not to exceed five years.
(2) A franchise may be extended for additional term of the same number of years for which it was initially granted upon written application, submission of a renewal fee, and certification that the applicant has been continuously in compliance with all county and OEMS requirements and retains all necessary licenses and permits from OEMS.
(3) No franchise may be sold, assigned, or transferred to or in any way vest in any person other than the applicant to whom the franchise is granted.
(4) The applicant must maintain continuous insurance coverage in the amounts specified in division (D) above and submit new insurance certificates when coverage is changed or renewed.
(5) Any change of ownership of a franchised ambulance service, including the acquisition of more than 10% of the common stock of any corporation by an individual not named as an owner in the original application, shall be considered a material change necessitating a new franchise application and issuance of a new franchise.
(H) Administrative requirements for franchised ambulance providers. Each franchised ambulance provider must:
(1) Affiliate with the Wake County EMS system.
(2) Submit data to the PreMIS system, CIS, and the Department, as required by OEMS or the Department.
(3) Permit representatives of the Department to inspect vehicles, facilities, personnel, and records at times and in locations specified by the Department.
(4) Employ, contract, or otherwise obtain the services of a medical director, as required by OEMS rules. The county’s Medical Director shall not serve as the medical director for any franchised ambulance service.
(5) Immediately transfer to the appropriate 9-1-1 center any call which reasonably appears to require emergency medical services or advanced life support services, including but not limited to Medical Priority Dispatch System classifications of CHARLIE, DELTA, or ECHO.
(6) Submit a plan for delivery of the following services to the Department, not later than June 30 of each year:
(a) Medical direction of the franchised service and the development and enforcement of medical protocols consistent with OEMS rules and Wake County EMS System protocols.
(b) Receiving calls and dispatching ambulances, including the criteria for screening calls, identifying calls not appropriate for their franchised level of response, and referring those calls to the appropriate 9-1-1 center.
(c) Continuing education for every level of EMS personnel provided by the franchisee.
(d) Employee background checks to assure that personnel employed in the delivery of franchised ambulance services have acceptable criminal and driving records.
(e) Radio communications between ambulances, dispatch points and hospitals, as described in OEMS rules. Cellular telephone or other common carrier services may only be used as secondary communications for non-emergency ambulance service providers. The franchise shall provide county with a copy of the license(s) issued by the Federal Communications Commission authorized the use of license frequencies.
(f) Telephone communications, including at least one land-line telephone which shall provide 24-hour per day access to ambulance dispatch service.
(g) Participation in the franchised ambulance rotation program operated by the Department for those patients who access the 9-1-1 system, are assessed by EMS system personnel, and are determined to require ambulance transportation but not to require the services of an emergency ambulance. The Director shall promulgate standards for the franchised ambulance rotation program. A franchised ambulance service operated by a hospital system for the sole purposes of moving patients to and from its facilities is not required to participate in the franchised ambulance rotation program; however the non-participating sendee will not be permitted to pick up patients within Wake County from any but its own facilities.
(h) Assuring that vehicles, personnel, equipment, and operating procedures are in compliance with applicable OEMS rules and statutes.
(I) Operating requirements for non-emergency ambulance services.
(1) Franchisees shall maintain all licenses and permits required by OEMS, and shall at all times be in compliance with OEMS rules.
(2) Except when providing emergency services to the EMS system during a period of major emergency, as directed by the Director, or in other situations where the life or health of a patient so require, non-emergency ambulance providers shall not operate ambulances vehicles using emergency warning equipment (red lights and sirens) in Wake County.
(3) In any circumstances where emergency warning lights and sirens are used by a non-emergency ambulance provider (except a specialty care transport provider) without prior authorization by the Director, the manager or owner of the franchise shall file a report with the Director disclosing the date, time, location, and justification for use of emergency warning equipment. Inappropriate use of emergency warning equipment by non-emergency ambulance providers may constitute grounds for sanctions or revocation of the franchise. This requirement does not apply to ambulance transports originating outside of Wake County.
(4) The Director may promulgate operational performance standards for non- emergency and convalescent ambulance services, which apply to all franchisees.
(5) Upon the Director’s declaration of major emergency, the Director may restrict or suspend non-emergency and convalescent ambulance operations in order to make ambulances available to the system. The Director shall promulgate and publish major emergency procedures, which will include reasonable compensation to nonemergency and convalescent ambulance services for such services provided to the county.
(6) Franchisees must make its records, premises and equipment available for inspection by the Director during normal business hours after reasonable notice to the franchisee, in order to insure compliance with this chapter and any franchise granted hereunder. Franchisee must permit the Director to inspect any ambulance and interview the personnel assigned thereto at any time and without prior notice except while the ambulance is actually transporting a patient.
(7) Reporting requirements.
(a) Annually, at least 45 days prior to the anniversary date of the issuance of the franchise, the franchisee shall report to the county in writing and under oath its compliance with this chapter, OEMS rules, and applicable state statutes during the previous year.
(b) Monthly, franchisees must submit to the Director a report that details the following information concerning the prior month of operation:
1. Number of requests for ambulance transportation;
2. Number of patients transported;
3. For requests for service scheduled in advance, the percentage of on-time arrivals and the average delay for those calls for the ambulance did not arrive on time;
4. For requests for service not scheduled in advance (either immediate or as soon as possible), the 90th percentile interval between the time of the requests and the arrival of the ambulance at the curb side of the building for which the request was made;
5. Written details of any critical vehicle failure (failure of a vehicle after dispatch to a request for service or while transporting a patient;
6. Written details of any vehicle collision after dispatch to a request for service or while transporting a patient; and
7. Number of calls to the service deemed to be emergent and referred to a 9-1-1 center for disposition.
(Ord. passed 8-3-2015)