Ambulance Certification Regulations.

Milwaukee Code of Ordinances § 75-15

in effect

75-15. Ambulance Certification Regulations. 1. DEFINITIONS. In this section: a. "Advanced life support" (“ALS”) means advanced life support as defined in s. DHS 110.04(1r), Wis. Adm. Code. b. “Agreement” means the ambulance service standards agreement identified in sub. 2-b-2. c. “Ambulance” means a certified emergency vehicle used to transport sick, disabled or injured individuals as defined in s. DHS 110.04(4), Wis. Adm. Code and s. 340.01(3)(i), Wis. Stats. d. “Ambulance rate” means the base fee for ambulance conveyance which cannot be exceeded by certified providers on city authorized dispatch. e. “Basic life support” (“BLS”) means basic life support as defined in s. 256.15(1)(d), Wis. Stats. f. "Board” means the ambulance service board. g. “Certified provider” means a provider from the private sector that applied for and obtained a certificate to supply care within the Milwaukee emergency medical services system as a certified provider within a defined service area. h. "Committee" means the committee designated by the common council as responsible for ambulance service regulations. i. “Emergency medical care” means medical care to sick, disabled, or injured individuals at the scene of an emergency, during transport to a hospital, while in the hospital emergency department until responsibility for care is assumed by the regular hospital staff, or during transfer of a patient between health care facilities, which is based on state-approved patient care protocols, as defined in s. DHS 110.04(21), Wis. Adm. Code. j. “Emergency medical services” (EMS) means those services which are required as a result of an unforeseen attack of illness or an injury. These include rescue, ambulance, hospital emergency departments, communications and public education services. k. “EMT” means emergency medical technician as defined in s. DHS 110.04(27), Wis. Adm. Code. L. “Fire department” means the city of Milwaukee fire department. m. “Incident” means each event that causes MFD dispatch, through its usual procedures to refer a request for ambulance transport service to a certified provider, by telephone or other electronic means. n. “Limited certified provider” means a provider from the private sector that holds a certificate to supply care within the Milwaukee emergency medical services system as a certified provider without a defined primary service area and which can respond to incidents as assigned or dispatched. o. “Milwaukee emergency medical services system” means a system composed of fire department personnel and equipment, and private sector personnel and equipment, for the purpose of providing advanced life support and basic life support responses, treatment and conveyances within city limits. p. “Milwaukee fire department dispatch” (“MFD dispatch”) means the dispatch center operated by the department of emergency communications at any location for receiving and dispatching all calls for emergency medical assistance. q. “Non-transporting EMS provider” means an emergency medical service provider that provides emergency medical care with staff licensed as EMS practitioners to sick, disabled or injured individuals, but that does not transport patients as prescribed in s. DHS 110.04(47), Wis. Adm. Code. r. “Paramedic” means an EMS provider licensed in the state of Wisconsin as a paramedic as defined in s. DHS 110.04(51m), Wis. Adm. Code and s. 256.01(14), Wis.Stats. s. “Primary service area” means the geographical area in which an ambulance service provider is designated to provide first-in EMS under contract with a local government, as defined in s. DHS 110.04(60), Wis. Adm. Code. “Primary service area” does not include an area a provider services through mutual aid or back-up arrangements. t. “Private sector” means any person, firm, partnership or corporation within the city providing ambulance services on a fee-for-service basis. u. “Service area” means a geographically-defined area within the city assigned in accordance with sub. 13. v. “Special event plan” means a written document in a format approved by the Milwaukee county office of emergency management - emergency medical services, specifically addressing all of the items listed in s. DHS 110.44, Wis. Adm. Code. 2. AMBULANCE SERVICE BOARD. a. Establishment. An 11-member ambulance service board is established consisting of: a-1. A member of the public safety and health committee appointed by the president of the common council. a-2. City health commissioner or designee. a-3. Public member appointed by the mayor and confirmed by the common council. This member shall serve a term coterminous with that of the mayor. The mayor shall make his or her appointment within 60 days after commencement of a new common council-mayoral term or within 60 days after a vacancy in the board occurs, whichever is later. a-4. Homeland security director or designee. a-5. Milwaukee fire department medical director. This member shall not participate in disciplinary matters. a-6. Representatives of the 5 hospital systems of Advocate Aurora, Ascension, Children’s Hospital, Froedtert and the Medical College of Wisconsin, and Veterans Health Administration. A hospital representative shall not be a current medical director of a provider. a-7. Designee of the Milwaukee county office of emergency operations emergency medical services division by action of the committee, who shall not be a current medical director of a provider. b. Duties. b-1. The board shall advise the committee on all matters pertaining to issuance, renewal, suspension, revocation and reinstatement of certified, limited and non-transporting provider certificates, and shall, consistent with sub. 13, assist in the development and modification of service plans. b-2. The board, with the assistance of the city attorney, the chief of the fire department and the certified providers shall oversee development and implementation of the agreement between the city and the certified providers, for specifying appropriate rules, regulations, procedures and service standards as required for the safe operation of the Milwaukee emergency medical services system. c. The city clerk’s office shall staff the board. 3. CERTIFICATION. No one from the private sector shall within the city act as a certified, limited or non-transporting provider within the Milwaukee emergency medical services system without first having obtained a certificate as provided under this section. This section applies only to private sector providers supplying care that originates within the city of Milwaukee, or that integrates into the city of Milwaukee emergency medical services system. 4. APPLICATION FOR CERTIFI-CATION AS CERTIFIED PROVIDER AND SERVICE AREA. a. Applications for certificates as a certified provider, a limited certified provider, or a non-transporting provider under this section shall be filed with the fire department on forms approved by the committee. The board and the committee are authorized to require sufficient information to determine the qualifications of the applicant to engage in the business of providing basic life support and advanced life support ambulance conveyances to the Milwaukee emergency medical services system. The application signed in proper form shall be presented to the common council for referral to the committee for its recommendation. b. Each applicant shall furnish his or her name, date of birth, address, employer’s name and address, a statement as to whether the applicant has been convicted of any crime, misdemeanor or violation of any municipal ordinance other than traffic violations, and any other information required by the committee, subject to s. 111.335, Wis. Stats. All applicants for certificates as certified providers shall be exempt from the fingerprinting requirement provided in s. 85-21-1. c. The fire department shall promulgate an appropriate initial or renewal application form to all providers by not later than September 1 of each year. All applications for initial or renewal certification shall be filed not later than September 30, to be eligible for certification for the next service period. 5. FEES. An applicant filing an initial application for a certificate as a certified provider or an application for renewal shall pay the fee required in ch. 60. 6. INVESTIGATION. Upon receipt of the application for a certificate as a certified provider, the matter shall be referred to the chief of police, who shall cause an investigation of the applicant’s moral character to be made for the protection of the public health, welfare and safety. As part of the investigation, the chief of police shall report to the health department all convictions, other than traffic violations, of the applicant, together with any other information in the possession of the police department as to the business conduct and moral character of the applicant. 7. HEARING. a. Upon referral of an application for certification as a certified provider from the common council to the committee, the committee shall schedule a hearing thereon. Prior to the hearing, the committee shall submit the application to the board for its consideration and advice. b. The applicant shall receive notice of the hearing not less than 10 days prior to the hearing. At the hearing, the applicant may be represented by counsel, present witnesses and cross-examine any adverse witnesses under oath, and receive a transcript of the hearing at the applicant's expense. c. At the conclusion of the hearing, a recommendation shall be made by the committee to the common council. Any member of the committee who votes to deny an application shall state the basis for the vote on the record. 8. CERTIFICATE ISSUANCE. The health department shall issue to each person qualifying under this section a certificate as a certified provider on which there shall be the person’s true first name, surname and middle initial, the number of the certificate, and the period of time for which the certificate is valid. The certificate shall be in such form so to avoid alteration. The certificate shall be maintained by the provider and be exhibited to any person requesting to see it. Furthermore, the health department shall assign to each qualified person a series of numbers, which shall be used to identify the provider’s ambulances. These numbers shall be placed on the front doors of the ambulances and shall be at least 5 inches high and in a color to contrast with the background on which it is placed. 9. APPROVAL OR DENIAL OF CERTIFICATE. a. The committee may recommend the denial of any application for certification as a certified provider for any of the following reasons: a-1. The applicant is not of good character. a-2. The applicant has violated any of the required or prohibited practices set forth in this section. a-3. The applicant's previous certificate has been revoked for any reason whatsoever. a-4. The applicant's inability to substantially understand the required business regulations provided by this section. a-5. The qualifications of the applicant, when compared with the qualifications of applicants receiving a recommendation of approval, is deficient in any material respect. a-6. The applicant's failure in the past or refusal in the future to act in accordance with this section or with the terms of the agreement. a-7. The applicant's physical location for operations is not within the city limits. b. The common council may upon receipt of the recommendations of the committee for approval or denial of applications for certification as certified providers, grant the number of certificates which, in its discretion and judgment, the public welfare, safety and interest require. Thereafter, a list of those providers granted certification as certified providers by the common council shall be provided to the board for designation of service area assignments in a manner consistent with sub. 13. 10. INSPECTION. No ambulance shall be granted a permit to operate under the terms of this section until it has been inspected and found to be in a thoroughly safe condition for the transportation of the sick and injured. The inspection shall be made by the Wisconsin department of transportation, division of state patrol, which shall determine that the ambulance complies with all the requirements set forth in ch. Trans 309, Wis. Adm. Code. Verification of the inspection shall be provided to the board at the annual certification hearing. 11. FINANCIAL RESPONSIBILITY. a. Insurance Requirement. A certified, limited, or non-transporting provider shall furnish the city with a certificate of insurance, issued by a company authorized to do business in the state of Wisconsin, confirming that the certified provider has been issued a current policy insuring the provider against loss or damage that may result to any person or property, the policy of insurance to be in the limits of $1,000,000 for any one person injured or killed, $3,000,000 for all persons injured or killed in case of one accident resulting in bodily injury or death of more than one person, and $3,000,000 for injury or destruction to the property of others in the case of accident. The policy shall guarantee payment of any final judgment rendered against the provider within the limits provided in this paragraph irrespective of the financial responsibility or any act of omission of the certified provider. The city of Milwaukee shall be named as an additional insured. b. Cancellation. All certificates shall be executed by an insurance company licensed to do business in the state of Wisconsin. All certificates shall be approved as to form and execution by the city attorney before they are accepted by the fire department, and shall contain a provision or endorsement by which the insurance carrier shall be required to notify the fire department by registered mail or personal service of the cancellation of the insurance policy. Notice of cancellation shall be received by the fire department at least 30 days prior to the effective date of cancellation. If at any time the policy of insurance is cancelled by the issuing company, or the authority of the issuing company to do business in the state of Wisconsin is revoked, the fire chief shall require the certified provider to replace the policy with another policy satisfactory to the chief, and in default thereof the certified provider’s certificate issued under this section may be suspended until proof of valid policy is presented by a certified provider. Suspension shall be at the discretion of the board and effectuated by vote of the common council. c. Transporting and non-transporting private sector providers furnishing care for specials events or private facilities shall assume the same financial responsibility as private providers participating in the 911-based EMS system. d. Exceptions. Private sector providers who are not participating within the city emergency medical services system, and who are providing transport services that terminate, but do not originate, within the city of Milwaukee, need not file the insurance required herein. This exception also applies to private sector providers providing emergency medical care within the city of Milwaukee as a form of mutual aid or back-up. 12. REQUIREMENTS. All certified providers shall adhere to the following general conditions and specifications concerning Milwaukee emergency medical service systems incidents: a. Seek reimbursement from those requesting service from the Milwaukee emergency medical services system or any third-party payer, and provide the most economical service in accordance with accepted medical practice. The city will not be responsible for collection or payment of any charge for services rendered by reason of its having dispatched the service relative to this section, with the exception of services provided to those individuals pursuant to sub. 18. b. Not pursue beyond a reasonable limit compensation for conveyance where a conveyed party has demonstrated an inability to pay the service charge. c. Charge an ambulance rate, which is approved by the common council. The approval of the ambulance rate may be taken in conjunction with the common council’s approval of the ambulance service plan, in accordance with the ambulance rate provisions of sub. 14. d. Charge fees for equipment and procedures other than the rates established under par. c. The fees shall be determined by the fire department and approved by the common council. The fire department shall review the fees on an annual basis, with any necessary adjustments being submitted to the common council for approval in conjunction with approval of the ambulance rate under par. c. e. Utilize the incident command system for all special events, mass casualty incidents, and major incidents. f. Maintain an annual subscription to and utilize the fire department approved secure EMS electronic incident surveillance system for all special events which may require the provider to be dispatched by the public safety access point operated by the city. 13. SERVICE AREAS. a. Criteria. In establishing and re-establishing the number and geographical boundaries of the service areas, the common council shall endeavor to provide effective ambulance service within the Milwaukee emergency medical services system. The common council shall take into consideration all the information obtained through the certification process, including the service capacities of each prospective provider and the previous performances, if any, of each certified provider. b. Assignment of Service Areas. b-1. Service Plan Development. Following common council certification of one or more providers from the private sector as certified providers, the fire department shall propose a service plan and transmit it to the board which shall develop a proposed service plan to be utilized during the next service period. In developing the service plan, the fire department and board shall take into consideration all the information obtained through the certification process, including the service capacities of each certified provider and the previous performances, if any, by each certified provider. The plan shall include the number of service areas, the geographical size and boundaries of each service area, and a designation of a certified provider for assignment to each service area. The number of service areas shall be determined by the best interests of the Milwaukee emergency medical services system. The geographical size and boundaries of each service area shall be determined by the service capabilities and past performance of each certified provider to be assigned to a service area. Each certified provider designated for service area assignment shall, within 15 days of announcement by the board of its proposed service plan, file a written response of its acceptance or objection to the plan. Each certified provider accepting the plan shall also file with the board a properly executed agreement. The board shall thereafter submit the plan to the committee for its review and recommendation to the common council. Upon approval by the common council of any service plan for the next scheduled service period, the plan shall be implemented by the Milwaukee emergency medical services system for that period, subject to subd. 2. b-2. Duration. Service plans shall be approved by the common council annually commencing on January 1, 2008. Notwithstanding such approval, the board shall recommend modifications of the size of the service areas and assignments of certified providers to service areas during the pendency of any service period, and the common council, with the recommendation of the board, shall modify any service plan during the pendency of any service period, if it is determined that one or more certified providers are not meeting the requirements of the agreement. The board shall also review the service plan and geographical size and boundaries of each service area on an annual basis, to determine if the certified providers are complying with requirements of the agreement and if service area adjustments are necessary. The board shall provide the common council with the board’s reasons for recommending or not recommending any changes in the service plan or service areas subsequent to the board’s annual review. c. Subcontracting of Service Areas. To ensure the equitable and effective distribution of EMS services, a certified provider may subcontract with a provider with limited certification to provide supplemental services within the certified provider’s area. The conditions of subcontracting agreements shall be presented to the fire department for approval and integration in the CAD system to minimize system disruption and inappropriate dispatching of resources. d. Revocation of Service Area. In addition to any revocation under the agreement or sub. 19, the board shall revoke the assignment of any service area for any certified provider no longer certified. 14. DETERMINING RATES BILLED BY PRIVATE SECTOR PROVIDERS. a. The fire department annually shall review and report to the common council by April 1 with respect to the ambulance conveyance rate established under par. c and recommend, if appropriate, an adjustment in the conveyance rate. b. Upon request, the legislative reference bureau shall provide the fire department with information from health-related cost indexes, including the medical care component of the Chicago-Naperville-Elgin, IL-IN-WI and the Minneapolis-St. Paul-Bloomington, MN-WI consumer price index issued by the U.S. bureau of labor statistics. c. The rate charged for conveyance by private providers, or when the fire department provides BLS transports with an ALS apparatus due to turn-back or other extenuating circumstances, shall be as follows: c-1. For patients who are residents of the city of Milwaukee, for basic life support, $778.92 and, for basic life support-lights-and-sirens response, $778.92. When patients require treatment without transport, a $249.47 basic life support non-transport fee shall apply. c-2. For patients who are not residents of the city of Milwaukee, for basic life support, $901.03 and, for basic life support-lights-and-sirens response, $901.03. When patients require treatment without transport, a $358.94 basic life support non-transport fee shall apply. c-3. In addition to the charges provided in subds. c-1 and 2, a charge of $21.20 per mile shall be assessed for mileage, mileage to be defined as the distance traveled with the patient in the ambulance from the point of patient origin to destination. d. In those instances where a certified provider has a contract with any insurer or health maintenance organization with respect to establishment of fees for ambulance services for persons insured through the organization, the fees established in the contract shall take precedence over those in par. c and sub. 15, and the certified provider shall charge only those fees established in the contract. 15. BASIC LIFE SUPPORT ANCILLARY CHARGES BILLED BY PRIVATE SECTOR PROVIDERS. Pursuant to sub. 12-d, certified providers are authorized to charge the following: a. Ancillary charges. a-1. Airway supplies: $28.49. a-2. Ventilation and CPR supplies: $417.55. a-3. Bandaging and Trauma Treatment supplies: $24.26. a-4. Personal Protection Equipment supplies: $36.84 a-5. Obstetrics and Child Delivery supplies: $258.11. a-6. Splinting and Immobilization supplies: $523.12. a-7. Oxygen Therapy and supplies: $112.24. a-8. BLS supplies (COVID decontam- ination or other routine supplies) $36.84. a-9. CPAP Mask supplies: $59.84. b. Drug charges. Drugs allowed by the state of Wisconsin emergency medical technician basic scope of practice and approved by the Milwaukee county council on emergency medical services, shall be charged at the same rates established under sub. 17. 16. CHARGES FOR ADVANCED LIFE SUPPORT PATIENT SERVICES DELIVERED BY PRIVATE PROVIDERS. Whenever a certified provider performs an advanced life support conveyance under the agreement, the certified provider is authorized to charge the same rates as established for the fire department, pursuant to sub. 17-a and b. When performing an advanced life support, certified providers are authorized to charge the same ancillary charges established for the fire department under sub. 17-c and d. These charges shall in no way be construed so as to circumvent the role of the fire department as the designated responder to advanced life support service calls. 17. CHARGES FOR PATIENT SERVICES DELIVERED BY THE FIRE DEPARTMENT. The fire department shall bill for and collect all revenues generated from advanced life support conveyances and service provisions using fee schedules that have been adopted by the common council. The rate charged for conveyance and services delivered by fire department paramedic fleet shall be as follows: a. For advanced life support for patients who are residents of Milwaukee county: a-1. Paramedic non-invasive service or treatment without conveyance: $299.19. a-2. Paramedic invasive service or treatment without conveyance: $299.19. a-3. Paramedic service with transport Level ALS-1: $926.17. a-4. Paramedic service with transport Level ALS-2: $1018.57. b. For advanced life support for patients who are not residents of Milwaukee county: b-1. Paramedic non-invasive service or treatment without conveyance: $421.29. b-2. Paramedic invasive service or treatment without conveyance: $421.29. b-3. Paramedic service with transport Level ALS-1: $1043.87. b-4. Paramedic service with transport Level ALS-2: $1201.16. c. Advanced life support ancillary charges: c-1. ALS supplies: $105.64. c-2. Intubation supplies: $194.37. c-3. I.V. and supplies: $79.88. c-4. Defibrillation supplies: $237.60. c-5. EKG and supplies: $204.60. c-6. Oxygen and supplies: $112.24. d. Drugs included in the Milwaukee county office of emergency management, emergency medical services program adopted by the Milwaukee county association of fire chiefs and the intergovernmental cooperation council of Milwaukee county: d-1. Items approved in Drugs, Group 1: Acetaminophen (1000 mg tablet & 160 mg/5 mL Liquid), Albuterol (2.5mg)/Ipratropium (0.5mg)/3 mL (.83%), Amioderone HCI (150mg), Aspirin (chewable 81 mg), Atropine Sulfate (0.3 mg), Calcium Gluconate (10 ml), Dextrose 10% (D10), Dextrose 5% (D5), Duoneb, IV-D5W, Glucose (oral gel 15 g), IV-Sodium Normal Saline (bags & capped), Ondansetron Tabs, Ondansetron IV/IO, shall be charged a rate of $42.93. d-2. Items approved in Drugs, Group 2: Diphenhydramine 50 mg, Dopamine, EPL 1 mg/10 mL IV, EPI 1 mg/cc IV, Lidocaine Drip 1 gm/25 mL, Lidocaine HCI (2%) 50 mg, Sodium Bicarbonate (50 CC), shall be charged a rate of $49.42. d-3. Items approved in Drugs, Group 3: Fentanyl, Ketamine (Pediatric) Infusion, Ketorolac 30 mg/1 mL, Midazolam HCI 1 mg, Nitroglycerine Spray 0.4 mg IV, Norepinephrine 4 mg/4mL, shall be charged a rate of $63.73. e. Other items shall be charged at the following rates: e-1. Adenosine: $119.67. e-2. Glucagon, up to 1 mg: $119.67. e-3. Dexamethasone 20mg/5mL: $78.05. e-4. E-Z IO: $160.01. e-5. Patient ID & Tracking: $4.18. e-6. Hydroxocobalamin (Cyano-kit): $1201.90. e-7. CPAP mask supplies: $59.84. e-8. Airway Supplies: $28.49 e-9. Ventilation and CPR Supplies: $417.55. e-10. Bandaging and Trauma Supplies: $24.26. e-11. Personal Protective Supplies: $36.84. e-12. Obstetrics and Child Delivery Supplies: $258.11. e-13. Splinting and Immobilization Supplies: $523.12. f. For lift assistance, access and conveyance of bariatric patients: f-1. When the fire department provides basic life support transport, with an ALS apparatus, for a bariatric patient, the department is authorized to charge the rate specified in subd. a-3 or b-3 as appropriate. f-2. When the fire department Heavy Urban Rescue Team is required to alter a structure, the department is authorized to charge a supplemental charge of $631.56 to cover the costs of supplemental materials and equipment. f-3. When the fire department is dispatched to assist a licensed provider at the request of a commercial property or a skilled nursing facility to perform a lift assist for a patient not requiring transport, the department is authorized to charge the rate outlined in sub. 14-c-1 or 14-c-2 as appropriate to the facility or firm. g. When the fire department provides advanced life support services to a cardiac arrest patient who is not resuscitated in the field, the department is authorized to charge the rate specified in subd. a-4 or b-4, as appropriate. h. In addition to the charges provided in pars. a to e, a mileage charge indicated in sub. 14-c-3 shall be assessed for the distance traveled with the patient in the ambulance from the point of patient origin to destination. 18. CONVEYANCE OF POLICE PRISONERS AND THOSE IN PROTECTIVE CUSTODY. Certified providers under contract with the city for payment for conveyance of police prisoners for medical treatment, those incapacitated persons in protective custody and those in need of emergency detention, in situations where the person conveyed is unable to pay for conveyance shall be paid a rate equal to 60% of the conveyance rate and mileage charge in sub. 14 and 60% of the services fees charged in sub. 15. Charges for services rendered by the fire department under this subsection shall be paid a rate equal to 60% of all patient services delivered by the department pursuant to sub. 17. 19. VIOLATIONS. a. Suspension and Revocation. The common council may, subsequent to a hearing conducted by the committee, suspend, revoke, deny, not renew or place other limitations on a certificate issued under this section for any reasonable cause which shall be in the best interests and good order of the city, including, but not limited to, the following findings: a-1. Conviction of a violation of this section. a-2. Where the committee, on hearing of evidence, determines that the certified provider has been violating any of the provisions of this section even though the certified provider may not have been convicted in a court for this violation. a-3. Conviction of a criminal statute or city ordinance involving moral turpitude. a-4. Violation of a city ordinance where the violation is connected with or a part of carrying on the business for which the certificate is issued. a-5. Failure to obtain any permit required under the ordinances of the city or laws of the state of Wisconsin, or employing persons not authorized to do any specific work as required under the ordinances of the city, or the laws of the state of Wisconsin. a-6. Failure to comply with any of the provisions of the agreement. a-7. In the case of a limited provider or a non-transporting EMS provider, where the committee, on hearing evidence, determines the provider has failed to follow a special event plan, any standard set forth by DHS, or any of the other requirements in this ordinance or has substantially underperformed in its responsibility to provide care or transport, the common council may suspend, revoke, deny, not renew, or place limitations or restrictions on the certificate issued under this section on the provider’s ability to supply care within the Milwaukee emergency medical services system as a service provider which shall be appropriate under the circumstances. b. Hearing. b-1. Whenever the committee has scheduled a hearing for determining whether to recommend suspension, revocation or limitation of a certified provider's certificate, the certified provider shall receive written notice of the hearing not less than 10 days prior to the hearing. The notice shall specify the nature of the complaint against the certified provider. b-2. The certified provider may attend the hearing and be represented by counsel, may present witnesses and confront and cross- examine any adverse witnesses under oath, and may obtain a transcript of the hearing at the certified provider's own expense. b-3. At the conclusion of the hearing, the committee shall make its recommendation to the common council. If the recommendation is to suspend, revoke or limit a certified provider’s certificate, each member of the committee voting in favor of the action shall state the basis therefore on the record. b-4. The certified provider shall be provided with written notice of any recommendation of the committee. If the recommendation is to suspend, revoke or limit the certified provider’s certificate, the provider may, within 10 days of the notice, appeal the recommendation by filing written notice with the city clerk. If notice of appeal is filed, a copy of the transcript of the hearing shall be provided to each common council member at least 3 days prior to the common council vote on whether to accept or reject the recommendation of the committee. c. Penalty. Anyone who acts as a certified provider without having obtained a certificate to do so, or who violates any other part of this section, shall upon conviction be subject to a forfeiture of not less than $25,000, and in default of payment, be committed to the county jail or house of correction for a period of time not to exceed 10 days. Each day in which any person shall operate as a certified provider without having obtained a certificate, or after revocation of the same, shall constitute a separate offense. 20. ANNUAL REPORT. The fire chief shall present an annual status report to the common council on all fire department advanced life support billing activities, including descriptions of the amounts invoiced, collected and outstanding, no later than June 30 commencing June 30, 2008. 21. HIGH UTILIZERS. City of Milwaukee residents, identified through the quality control process of the fire department, private provider, or a healthcare partner, whose usage of the EMS system exceeds 5 calls in a 12-month period shall be enrolled in a program to assess the needs of the individual and identify ways to monitor and improve the individual’s personal health in an effort to reduce the individual’s utilization of the EMS system. Evaluation and intervention may include members of medical direction, the applicable hospital systems represented in sub. 2-a-6 or recognized independent clinics, and the personal physician, primary care provider or appropriate specialist of the indicated patient, with discussions and plans to be held in private to protect the individual’s privacy. The fire department may utilize resources within its mobile integrated health system and the health department to facilitate positive outcomes for these patients. 22. COMMUNITY HEALTHCARE ACCESS PROGRAM (CHAP) REFERRAL. The fire department shall, upon identifying that a patient lacks health insurance, refer the patient to the health department’s CHAP administrator, transmitting the necessary information for the referral through a secure electronic medium, for the purpose of identifying an appropriate health insurance plan, and reducing the financial burden of the residents of the city of Milwaukee. 23. HEALTH INFORMATION EXCHANGE (HIE) CONTRIBUTION. The health department, in its operation of clinics, and the fire department, in its operation of an EMS system, shall contribute appropriate patient information to the state of Wisconsin health information exchange for the purpose enabling access to the patient’s longitudinal care record, promoting positive health outcomes through prevention, and providing patient records to supplemental clinicians, providers and healthcare systems in accordance with the centers for medicare and medicaid services (CMS) interoperability and patient access final rule (CMS-9115-F). Patients may opt out of contributing their information at the site of care in accordance with HIE policies. 24. SPECIAL EVENT PLANS. a. Any provider providing services for a special event shall submit a written plan approved by Milwaukee county office of emergency management - emergency medical services containing, at a minimum, the items described in s. DHS 110.44, Wis. Adm. Code. b. In the event a 911 caller requests EMS from an approved special event during the scheduled dates and times, the approved special event provider, and not the assigned service area provider, shall be dispatched. If the special event provider’s ambulance is not available or not on the scene, a response commensurate with the caller’s request shall be dispatched by the provider assigned to the service area. c. The plan for an event with total projected attendance exceeding 5,000 people shall include a mass casualty plan approved by the fire department and sufficiently address the items listed in s. DHS 110.44(20r), Wis. Adm. Code. d. A provider providing service for a special event shall have an approved plan to integrate its service into the 911 dispatch service of the city of Milwaukee. e. Unless specifically waived, all BLS and ALS service provided at a special event shall be in accordance with Milwaukee county office of emergency management emergency medical services standards of care. f. A provider shall not charge more than the city-approved rates for any emergency medical care provided to an attendee at a special event within the city that falls within the Milwaukee county office of emergency management emergency medical services standards of care. g. A special event plan for a multiday event, or a sporting event, shall not exceed 90 calendar days or the normal season for a given single sport, whichever is greater. A blanket plan covering multiple sports, separate events or geographic locations substantially removed from each other shall not be considered. h. A limited or non-transporting certified provider not providing a 911-based response system shall pay to the fire department a fee of $200 to review and approve each special event plan. The fee shall also cover temporary modifications to the computer-aided dispatch system for routing calls and notifying appropriate agencies as noted in s. DHS 110.44(15) and (16), Wis. Adm. Code. i. Class AA, A, and B events as defined in s. serviced by 105-55.5, non-transporting or limited certification providers shall incur fees from the department of emergency communication for routing calls and integrating the provider into the city’s incident command system in compliance with s. DHS 110.44(15), Wis. Adm. Code, and providing emergency incident support to appropriate agencies as noted in S. DHS 110.44(15) and (16), Wis. Adm. Code. j. In the event of a mass casualty incident, the provider shall immediately notify the fire department via dispatch and shall fold into the incident command system under the department, should circumstances dictate. k. Any provider not receiving approval from the fire department shall be considered as not having met the requirements of s. DHS 110.44(10), (14), (17) and (20), Wis. Adm. Code. 25. TARGET HAZARDS. A private provider furnishing non-911-based services for skilled care medical facilities shall complete the limited certification process set forth in sub. 4. 26. ADVERTISING. a. A provider shall submit all forms of proposed advertising, for clinical care or transport, to the general public to the fire chief for review prior to the advertising being disseminated in any form. The review is for the purpose of ensuring that the communication has no adverse impact upon the substantial interests of the EMS system. If the fire chief makes an adverse finding, he or she shall immediately advise the provider and work with the provider to develop an unobjectionable alternative. b. All of a provider’s advertising and marketing materials directed to the general public for clinical care or transport shall state: “In case of emergency, call 911.” If the provider places a telephone number on the exterior of an ambulance, the words, “In case of emergency, call 911” shall also appear. 27. DISPUTE RESOLUTION FOR PRIVATE PROVIDER AGREEMENT. In the event a certified provider and the fire department are unable to resolve a dispute regarding an alleged breach of the terms of the agreement, the common council shall, subsequent to a hearing conducted by the committee on hearing the evidence, make a determination and issue any remedies allowed under the agreement. The determination shall be considered a final, appealable determination.

Source: City of Milwaukee Legislative Reference Bureau, Milwaukee City Charter and Code of Ordinances (city.milwaukee.gov master PDFs)URL: https://city.milwaukee.gov/ImageLibrary/Groups/ccClerk/Ordinances/Volume-1/CH75.pdf#page=5Fetched: 10/26/2026