C.R.S. § 25-3.5-101 Short title
25-3.5-101. Short title. This article shall be known and may be cited as the "Colorado Emergency Medical and Trauma Services Act".
Emergency Medical and Trauma Services
C.R.S. tit. 25, art. 3.5
in effectC.R.S. § 25-3.5-102 Legislative declaration
25-3.5-102. Legislative declaration. (1) The general assembly hereby declares that it is in the public interest to provide available, coordinated, and quality emergency medical and trauma services to the people of this state. It is the intent of the general assembly in enacting this article to establish an emergency medical and trauma services system, consisting of at least treatment, transportation, communication, and documentation subsystems, designed to prevent premature mortality and to reduce the morbidity that arises from critical injuries, exposure to poisonous substances, and illnesses.
(2) To effect this end, the general assembly finds it necessary that the department of public health and environment assist, when requested by local government entities, in planning and implementing any one of such subsystems so that it meets local and regional needs and requirements and that the department coordinate local systems so that they interface with an overall state system providing maximally effective emergency medical and trauma systems.
(3) The general assembly further finds that the provision of adequate emergency medical and trauma services on highways in all areas of the state is a matter of statewide concern and requires state financial assistance and support.
(4) The general assembly also finds that:
(a) Colorado's emergency medical services system not only provides individuals who are ill or injured emergency medical and trauma care twenty-four hours per day and three hundred sixty-five days per year, but also serves as a critical safety net for many Coloradans who might not have immediate access to other health-care services;
(b) As highlighted by the COVID-19 pandemic, Colorado's emergency medical services system augments community health, preventative health, and public health programs throughout the state;
(c) Despite the essential nature of the emergency medical services system and the assumption held by members of the public that, once a 911 call is placed, an ambulance will quickly arrive, emergency medical services are not a required service in Colorado;
(d) While emergency medical services are generally available throughout the state, some Coloradans no longer have access to a Colorado-based emergency medical services system, and other Colorado communities are at risk of losing their emergency medical services;
(e) The instability and unsustainability of emergency medical services in some parts of the state puts lives at risk;
(f) Ground ambulance service is the only component of Colorado's emergency medical system that is not subject to statewide standardization and regulation, which statewide standardization and regulation would provide medical and operational benefits and consumer protections;
(g) The lack of statewide standardization and regulation for ground ambulance services inhibits consumer protections and investigations and adjudication of consumer complaints because the department lacks authority to investigate and adjudicate any complaints related to ground ambulances; and
(h) To ensure sustainability of, and equitable access to, emergency medical services in Colorado, a comprehensive assessment of the emergency medical services system, along with recommendations for modernizing and sustaining the emergency medical services system, should be performed.
C.R.S. § 25-3.5-103 Definitions
25-3.5-103. Definitions. As used in this article 3.5, unless the context otherwise requires:
(1) "Air ambulance" means a fixed-wing or rotor-wing aircraft that is equipped to provide air transportation and is specifically designed to accommodate the medical needs of individuals who are ill, injured, or otherwise mentally or physically incapacitated and who require in-flight medical supervision.
(1.3) "Air ambulance service" means any public or private entity that uses an air ambulance to transport patients to a medical facility.
(1.5) "Ambulance" means any privately or publicly owned ground vehicle:
(a) Especially constructed or modified and equipped, intended to be used, and maintained or operated by an ambulance service for the transportation, upon the streets and highways in this state, of individuals who are sick, injured, or otherwise incapacitated or helpless; and
(b) That is required to be licensed pursuant to part 3 of this article.
(2) (Deleted by amendment, L. 2005, p. 1330, § 1, effective July 1, 2005.)
(3) "Ambulance service" means the furnishing, operating, conducting, maintaining, advertising, or otherwise engaging in or professing to be engaged in the transportation of patients by ambulance. Taken in context, it also means the person so engaged or professing to be so engaged. The person so engaged and the vehicles used for the emergency transportation of persons injured at a mine are excluded from this definition when the personnel utilized in the operation of said vehicles are subject to the mandatory safety standards of the federal mine safety and health administration, or its successor agency.
(3.1) "Authorization to operate" or "authorized to operate" means a local licensing authority's approval of or act of approving an ambulance service to operate within the jurisdiction of the local licensing authority.
(3.3) "Behavioral health" has the same meaning as set forth in section 27-50-101 (1).
(3.5) "Board" means the state board of health created pursuant to section 25-1-103.
(4) "Board of county commissioners" includes the governing body of any city and county.
(4.3) "Community integrated health-care service" means the provision of certain out-of-hospital medical services, as determined by rule, that a community paramedic may provide.
(4.5) "Community paramedic" means an emergency medical service provider who obtains an endorsement in community paramedicine pursuant to section 25-3.5-206.
(5) "Department" means the department of public health and environment.
(6) "Director" means the executive director of the department of public health and environment.
(7) "Emergency" means any actual or self-perceived event which threatens life, limb, or well-being of an individual in such a manner that a need for immediate medical care is created.
(7.5) "Emergency medical practice advisory council" or "advisory council" means the emergency medical practice advisory council created in section 25-3.5-206.
tor of the department of public health and environment.
(7) "Emergency" means any actual or self-perceived event which threatens life, limb, or well-being of an individual in such a manner that a need for immediate medical care is created.
(7.5) "Emergency medical practice advisory council" or "advisory council" means the emergency medical practice advisory council created in section 25-3.5-206.
(8) "Emergency medical service provider" means an individual who holds a valid emergency medical service provider certificate or license issued by the department as provided in this article 3.5.
(8.1) [Editor's note: This version of subsection (8.1) is effective until July 1, 2026.] "Emergency medical services facility" means a licensed or certified facility that provides emergency medical services, including but not limited to hospitals, hospital units as defined in section 25-3-101, freestanding emergency departments as defined in section 25-1.5-114, psychiatric hospitals, community clinics, community mental health centers, and acute treatment units.
(8.1) [Editor's note: This version of subsection (8.1) is effective July 1, 2026.] "Emergency medical services facility" means a licensed or certified facility that provides emergency medical services, including but not limited to hospitals, hospital units as defined in section 25-3-101, freestanding emergency departments as defined in section 25-1.5-114, critical access hospitals as defined in section 25-1.5-114.5, psychiatric hospitals, community clinics, community mental health centers, and acute treatment units.
(8.3) "EMS agency patient care database" means the department's database containing records required to be submitted in accordance with section 25-3.5-501.
(8.4) "EMS system sustainability task force" or "task force" means the EMS system sustainability task force created in section 25-3.5-108 (1)(a).
(8.5) "Health information organization network" means an organization that oversees and governs the exchange of health-related information among organizations according to nationally recognized standards.
(8.6) "Justifiable medical emergency" means an underlying medical, traumatic, or psychiatric condition posing an immediate safety risk to the individual, emergency medical service provider, or public. Excited delirium, any subsequent term for excited delirium, or any acute psychiatric diagnosis not recognized in the most recent edition of the diagnostic and statistical manual of mental disorders is not a justifiable medical emergency.
(8.7) "Local licensing authority" means the governing body of a city and county or the board of county commissioners in a county in the state.
(8.8) "Medical direction" includes, but is not limited to, the following:
(a) Approval of the medical components of treatment protocols and appropriate prearrival instructions;
(b) Routine review of program performance and maintenance of active involvement in quality improvement activities, including access to dispatch tapes as necessary for the evaluation of procedures;
(c) Authority to recommend appropriate changes to protocols for the improvement of patient care; and
(d) Provision of oversight for the ongoing education, training, and quality assurance for providers of emergency care.
(9) "Patient" means any individual who is sick, injured, or otherwise incapacitated or helpless.
(10) "Permit" means the authorization issued by the department with respect to an ambulance used or to be used to provide ambulance service in the state.
(10.3) "Prehospital setting" means one of the following settings in which an emergency medical service provider performs patient care, which care is subject to medical direction by a medical director:
(a) At the site of an emergency;
(b) During emergency transport; or
uthorization issued by the department with respect to an ambulance used or to be used to provide ambulance service in the state.
(10.3) "Prehospital setting" means one of the following settings in which an emergency medical service provider performs patient care, which care is subject to medical direction by a medical director:
(a) At the site of an emergency;
(b) During emergency transport; or
(c) During interfacility transport.
(10.6) "Refresher course program" means a program establishing a course of instruction designed to keep emergency medical service providers abreast of developments or new techniques in their profession, which course includes an examination administered at any time during or following the course to facilitate continuing evaluation of emergency medical service providers.
(10.8) "Registered emergency medical responder" means an individual who has successfully completed the training and examination requirements for emergency medical responders, who provides assistance to the injured or ill until more highly trained and qualified personnel arrive, and who is registered with the department pursuant to part 11 of this article.
(11) "Rescue unit" means any organized group chartered by this state as a corporation not for profit or otherwise existing as a nonprofit organization whose purpose is the search for and the rescue of lost or injured persons and includes, but is not limited to, such groups as search and rescue, mountain rescue, ski patrols (either volunteer or professional), law enforcement posses, civil defense units, or other organizations of governmental designation responsible for search and rescue.
(11.4) (a) "Secure transportation" or "secure transportation services" means urgent transportation services provided to individuals experiencing a behavioral health crisis.
(b) Secure transportation includes:
(I) For an individual being transported pursuant to section 27-65-104 or 27-65-106 (1), transportation from the community to a facility designated by the commissioner of the behavioral health administration in the department of human services for treatment and evaluation pursuant to article 65 of title 27;
(II) For an individual in need of services pursuant to articles 81 and 82 of title 27, transportation from any location to an approved treatment facility, as described in section 27-81-106, or a walk-in crisis center that is operating as part of the behavioral health crisis response system;
(III) For an individual who is receiving transportation across levels of care or to a higher level of care, transportation between any of the following types of facilities:
(A) An emergency medical services facility;
(B) A facility designated by the commissioner of the behavioral health administration in the department of human services for treatment and evaluation pursuant to article 65 of title 27;
(C) An approved treatment facility, as described in section 27-81-106;
(D) A walk-in crisis center that is operating as part of the behavioral health crisis response system; or
(E) A behavioral health entity licensed pursuant to section 25-27.6-106 with a current twenty-four-hour endorsement.
on in the department of human services for treatment and evaluation pursuant to article 65 of title 27;
(C) An approved treatment facility, as described in section 27-81-106;
(D) A walk-in crisis center that is operating as part of the behavioral health crisis response system; or
(E) A behavioral health entity licensed pursuant to section 25-27.6-106 with a current twenty-four-hour endorsement.
(c) "Secure transportation" does not include urgent transportation services provided by law enforcement or personnel employed by or contracted with a law enforcement agency to individuals experiencing a behavioral health crisis; except that any member of a co-responder team who is not law enforcement or personnel employed by or contracted with a law enforcement agency and who holds a valid license for secure transportation by the county in which the secure transportation originates, in a vehicle with a valid permit issued by the county in which the secure transportation originates, and which meets the minimum requirements for secure transportation established by rule pursuant to section 25-3.5-311 may provide urgent secure transportation services.
(11.5) "Service agency" means a fixed-base or mobile prehospital provider of emergency medical services that employs emergency medical service providers to render medical care to patients.
(12) "Volunteer emergency medical service provider" means an emergency medical service provider who does not receive direct remuneration for the performance of emergency medical services.
C.R.S. § 25-3.5-104 Emergency medical and trauma services advisory council - creation - duties
25-3.5-104. Emergency medical and trauma services advisory council - creation - duties. (1) (a) There is hereby created, in the department of public health and environment, a state emergency medical and trauma services advisory council, referred to in this article as the "council", to be composed of thirty-two members, of whom twenty-five shall be appointed by the governor no later than January 1, 2001, and at least one of whom shall be from each of the regional emergency medical and trauma advisory council planning areas established in section 25-3.5-704. The other seven members shall be ex officio, nonvoting members. Not more than thirteen of the appointed members of the council shall be members of the same political party. A majority of the members shall constitute a quorum. The membership of the council shall reflect, as equally as possible, representation of urban and rural members.
(b) The appointed members of the council shall be from the following categories:
(I) A fire chief of a service that provides prehospital care in an urban area;
(II) A fire chief of a service that provides prehospital care in a rural area;
(III) An administrative representative of an urban trauma center;
(IV) An administrative representative of a rural trauma center;
(V) A licensed physician who is a prehospital medical director;
(VI) A board-certified physician certified in pediatrics or a pediatric subspecialty;
(VII) A board-certified emergency physician;
(VIII) A flight nurse of an emergency medical service air team or unit;
(IX) An officer or crew member of a volunteer organization who provides prehospital care;
(X) An officer or employee of a public provider of prehospital care;
(XI) An officer or employee of a private provider of prehospital care;
(XII) A representative of a government provider of prehospital care;
(XIII) Three county commissioners or council members from a city and county, two of whom shall represent rural counties and one of whom shall represent an urban county or city and county;
(XIV) A board-certified surgeon providing trauma care at a level I trauma center;
(XV) A board-certified surgeon providing trauma care at a level II trauma center;
(XVI) A board-certified surgeon providing trauma care at a level III trauma center;
(XVII) A board-certified neurosurgeon involved in providing trauma care at a level I or II trauma center;
(XVIII) A trauma nurse coordinator;
(XIX) A registered nurse involved in rural emergency medical and trauma services care;
(XX) A regional council chair;
(XXI) A county emergency manager; and
(XXII) Two representatives of the general public, one from a rural area and one from an urban area.
(c) Ex officio, nonvoting members of the council shall include members from the following categories:
(I) A representative of the state coroners' association, as selected by the association;
(II) The director of the state board for community colleges and occupational education or the director's designee;
(III) The manager of the telecommunication services of the Colorado information technology services in the department of personnel, general support services, or the manager's designee;
(IV) The executive director of the department of public health and environment or the director's designee;
(V) The director of the office of transportation safety in the department of transportation or the director's designee;
(VI) A representative from the state sheriffs' association; and
(VII) A representative from the Colorado state patrol.
neral support services, or the manager's designee;
(IV) The executive director of the department of public health and environment or the director's designee;
(V) The director of the office of transportation safety in the department of transportation or the director's designee;
(VI) A representative from the state sheriffs' association; and
(VII) A representative from the Colorado state patrol.
(2) Members of the council shall serve for terms of three years each; except that, of the members first appointed, eight shall be appointed for terms of one year, nine shall be appointed for terms of two years, and eight shall be appointed for terms of three years. Members of the council shall be reimbursed for actual and necessary expenses incurred in the actual performance of their duties. All vouchers for expenditures shall be subject to approval by the director. A vacancy shall be filled by appointment by the governor for the remainder of the unexpired term. Any appointed member who has two consecutive unexcused absences from meetings of the council shall be deemed to have vacated the membership, and the governor shall fill such vacancy as provided in this subsection (2).
(3) The council shall meet at least quarterly at the call of the chairperson or at the request of any seven members. At the first meeting after the appointment of new members, the members shall elect a chairperson who shall serve for a term of one year.
(4) The council shall:
(a) Advise the department on all matters relating to emergency medical and trauma services programs;
(b) Make recommendations concerning the development and implementation of statewide emergency medical and trauma services;
(c) Identify and make recommendations concerning statewide emergency medical and trauma service needs;
(d) Review and approve new rules and modifications to rules existing prior to July 1, 2000, prior to the adoption of such rules or modifications by the state board of health;
(e) Review and make recommendations concerning guidelines and standards for the delivery of emergency medical and trauma services, including:
(I) Establishing a list of minimum equipment requirements for ambulance vehicles operated by an ambulance service licensed in this state and making recommendations on the process used by counties in the licensure of ambulance services;
(II) Developing curricula for the training of emergency medical personnel;
(III) Making recommendations on the verification process used by the department to determine facility eligibility to receive trauma center designation; and
(IV) Making recommendations regarding the process used by the department to identify accrediting organizations for air ambulance licensing;
(f) Seek advice and counsel, up to and including the establishment of special ad hoc committees with other individuals, groups, organizations, or associations, when in the judgment of the council such is advisable to obtain necessary expertise for the purpose of meeting the council's responsibilities under this article. The council is authorized to establish special committees for the functions described in this paragraph (f).
(g) Review and make recommendations to the department regarding the amount, allocation, and expenditure of funds for the development, implementation, and maintenance of the statewide emergency medical and trauma system.
C.R.S. § 25-3.5-104.3 State trauma advisory council - duties
25-3.5-104.3. State trauma advisory council - duties. (Repealed)
C.R.S. § 25-3.5-104.5 Joint advisory council - duties
25-3.5-104.5. Joint advisory council - duties. (Repealed)
C.R.S. § 25-3.5-105 Rules and regulations
25-3.5-105. Rules and regulations. All rules and regulations adopted pursuant to the provisions of this article shall be adopted in accordance with the provisions of article 4 of title 24, C.R.S.
C.R.S. § 25-3.5-106 Local standards - uninterrupted service - repeal
25-3.5-106. Local standards - uninterrupted service - repeal. (Repealed)
C.R.S. § 25-3.5-107 Religious exception
25-3.5-107. Religious exception. Nothing in this article or the rules and regulations adopted pursuant to this article shall be construed to authorize any medical treatment or transportation to any hospital or other emergency care center of an adult who objects thereto on religious grounds and signs a written waiver to that effect.
C.R.S. § 25-3.5-108 EMS system sustainability task force - created - powers and duties - membership - reports - repeal
25-3.5-108. EMS system sustainability task force - created - powers and duties - membership - reports - repeal. (1) (a) The EMS system sustainability task force is created in the department.
(b) The task force consists of the following twenty voting members:
(I) The following two legislative members:
(A) One member of the senate, appointed by the president of the senate; and
(B) One member of the house of representatives, appointed by the speaker of the house of representatives;
(II) The following eight members appointed by the director of the department:
(A) Four individuals representing emergency medical services agencies and representing a mix of fire-department-based ambulance services, hospital-based ambulance services, critical care transport ambulance services, private ambulance services, frontier counties, rural counties, metropolitan counties, volunteer services, and air ambulance services;
(B) One individual who is a board-certified emergency medical services physician;
(C) Two individuals who are certified or licensed emergency medical service providers, one of whom is a licensed or certified paramedic and the other of whom is a licensed or certified emergency medical technician; and
(D) One individual representing a community integrated health-care service agency, as defined in section 25-3.5-1301 (1), that is licensed pursuant to part 13 of this article 3.5;
(III) One member of a statewide group representing emergency medical service providers, as designated by the group;
(IV) The chair of the council created in section 25-3.5-104 (1)(a) or the chair's designee;
(V) One member of a statewide group representing fire chiefs, as designated by the group;
(VI) One member of a statewide group representing professional firefighters, as designated by the group;
(VII) One member of a statewide group representing emergency medical service provider educators, as designated by the group;
(VIII) One member of a statewide group representing special districts, as designated by the group;
(IX) Two members of a statewide group representing counties, as designated by the group;
(X) One member of a statewide group representing municipalities, as designated by the group; and
(XI) One member of a statewide group representing hospitals, as designated by the group.
(c) The director, or the director's designee, serves as an ex officio, nonvoting member of the task force.
(d) Each legislative member of the task force appointed pursuant to subsection (1)(b)(I) of this section:
(I) Is entitled to compensation in accordance with section 2-2-326;
(II) Must have a party affiliation or nonaffiliation distinct from the other legislative member appointed to the task force; and
(III) Serves until the appointment of a successor legislative member, upon termination of the legislative member's term of office in the general assembly, or upon completion of the task force's work, whichever occurs first.
(e) The membership of the task force must represent both rural and metropolitan areas of the state as equally as possible.
(f) Appointing or designating authorities must appoint or designate members of the task force on or before August 1, 2022.
pon termination of the legislative member's term of office in the general assembly, or upon completion of the task force's work, whichever occurs first.
(e) The membership of the task force must represent both rural and metropolitan areas of the state as equally as possible.
(f) Appointing or designating authorities must appoint or designate members of the task force on or before August 1, 2022.
(g) Members appointed pursuant to subsections (1)(b)(II) to (1)(b)(XI) of this section serve for the duration of the task force. An appointing or designating authority shall fill any vacancy for the remainder of the duration of the task force. Members appointed or designated serve at the pleasure of the appointing or designating authority and continue to serve until a successor is appointed or designated. Each nonlegislative member of the task force serves without compensation but is entitled to receive reimbursement for actual and necessary expenses incurred in the performance of duties as a member of the task force.
(2) (a) The legislative members of the task force shall convene the first meeting of the task force no later than September 30, 2022. At the first meeting of the task force, the voting members of the task force shall select one of the legislative members to serve as chair of the task force and the other legislative member to serve as vice-chair of the task force. The legislative members shall alternate between chair and vice-chair each year thereafter for the duration of the task force.
(b) The task force shall meet at least four times each year and at such other times as a majority of the voting members of the task force deem necessary. The chair and vice-chair may designate subcommittees of the task force, which subcommittees may include both task force members and nonmembers, and establish organizational and procedural rules as are necessary for the work of the task force.
(c) The task force may hear presentations from and seek the advice of other individuals, associations, or other organizations when, in the judgment of the task force, it would be helpful to obtain outside expertise to help the task force meet its obligations under this section.
(3) The task force shall make recommendations for statutory, rule, and policy changes required to preserve, promote, and expand consumer access to quality life-preserving emergency medical care and services. To develop the recommendations, the task force's work must reflect at least the following phases of tasks:
(a) Phase one, which includes:
(I) Providing input on the regulatory structure for ambulance service oversight, including input regarding the mechanism by which the department and local jurisdictions will share accountability for ambulance service oversight; and
(II) Overseeing the completion of an environmental scan that will generate a report on the state of emergency medical services in the state, which report is referred to in this subsection (3) as the "state report";
(b) Phase two, which includes:
(I) Reviewing data from the state report; and
(II) Collaborating with stakeholders to formulate recommendations that address inequity or disparity in access to emergency medical services in the state;
(c) Phase three, which, based on the task force's review of the state report, includes collaborating with stakeholders to formulate recommendations addressing emergency medical services workforce recruiting and retention needs in the state;
(d) Phase four, which, based on the task force's review of the state report, includes collaborating with stakeholders to formulate recommendations addressing the financial sustainability of the state's emergency medical services system; and
udes collaborating with stakeholders to formulate recommendations addressing emergency medical services workforce recruiting and retention needs in the state;
(d) Phase four, which, based on the task force's review of the state report, includes collaborating with stakeholders to formulate recommendations addressing the financial sustainability of the state's emergency medical services system; and
(e) Phase five, which includes reviewing the implementation status of prior task force recommendations and making recommendations for the long-term sustainability of the emergency medical services system.
(4) The task force shall submit findings and recommendations to the general assembly and the department based on the following schedule:
(a) On or before September 1, 2023, the task force shall submit a report summarizing its phase one findings and recommendations regarding the state of emergency medical services in the state;
(b) On or before September 1, 2024, the task force shall submit a report summarizing its phase two findings and recommendations regarding equitable access to emergency medical services;
(c) On or before September 1, 2025, the task force shall submit a report summarizing its phase three findings and recommendations regarding workforce recruiting and retention considerations;
(d) On or before September 1, 2026, the task force shall submit a report summarizing its phase four findings and recommendations regarding financial sustainability of the state's emergency medical services system; and
(e) On or before January 1, 2027, the task force shall submit a final report summarizing its phase five findings and recommendations regarding implementation of previous recommendations and its recommendations regarding long-term sustainability of the emergency medical services system.
(5) This section is repealed, effective September 1, 2027.
C.R.S. § 25-3.5-201 Training programs
25-3.5-201. Training programs. (1) The department shall design and establish specialized curricula for personnel who respond routinely to emergencies. The board of county commissioners may select from the various curricula available those courses meeting the minimum requirements established by said board.
(2) The department shall distribute the curricula and teaching aids to training institutions and hospitals upon request from a recognized training group or hospital. If a county is unable to arrange for necessary training programs, the department shall arrange a training program within the immediate vicinity of the agency requesting the program. The department shall issue emergency medical service provider certificates or licenses in accordance with section 25-3.5-203 (1) and may issue certificates of successful course completion to those individuals who successfully complete other emergency medical services training programs of the department. The programs may provide for the training of emergency medical dispatchers, emergency medical services instructors, emergency medical services coordinators, and other personnel who provide emergency medical services. The receipt of the certificate of course completion is not deemed state licensure, approval, or a determination of competency.
(3) The department shall consider including in the department's training curriculum for personnel who respond routinely to emergencies the training curriculum concerning interactions with persons with disabilities recommended by the commission on improving first responder interactions with persons with disabilities pursuant to section 24-31-1004.
C.R.S. § 25-3.5-202 Personnel - basic requirements
25-3.5-202. Personnel - basic requirements. Emergency medical service providers employed or utilized in connection with an ambulance service shall meet the qualifications established by the board by rule in order to be certified or licensed. For ambulance drivers, the minimum requirements include the possession of a valid driver's license and other requirements established by the board by rule under section 25-3.5-315. For any person responsible for providing direct emergency medical care and treatment to patients transported in an ambulance, the minimum requirement is possession of an emergency medical service provider certificate or license issued by the department. In the case of an emergency in an ambulance service area where no person possessing the qualifications required by this section is present or available to respond to a call for the emergency transportation of patients by ambulance, any person may operate the ambulance to transport any sick, injured, or otherwise incapacitated or helpless person in order to stabilize the medical condition of the person pending the availability of medical care.
C.R.S. § 25-3.5-203 Emergency medical service providers - licensure - renewal of license - duties of department - rules - record checks - definitions
25-3.5-203. Emergency medical service providers - licensure - renewal of license - duties of department - rules - record checks - definitions.
(1) (a) Repealed.
(a.5) The executive director or chief medical officer shall regulate the acts emergency medical service providers are authorized to perform subject to the medical direction of a licensed physician. The executive director or chief medical officer, after considering the advice and recommendations of the advisory council, shall adopt and revise rules, as necessary, regarding the regulation of emergency medical service providers and their duties and functions.
(b) The department shall certify and license emergency medical service providers. The board shall adopt rules for the certification and licensure of emergency medical service providers. The rules must include the following:
(I) A statement that a certificate or license is valid for a period of three years after the date of issuance;
(II) A statement that the certificate or license is renewable at its expiration upon the certificate holder's or licensee's satisfactory completion of the training requirements established pursuant to subsection (2) of this section;
(III) Provisions governing the use of results of national and state criminal history record checks by the department to determine the action to take on a certification or license application pursuant to subsection (4) of this section. Notwithstanding section 24-5-101, provisions governing the use of criminal history record check results must allow the department to consider whether the applicant has been convicted of a felony or misdemeanor involving moral turpitude and the pertinent circumstances connected with the conviction and to make a determination whether the conviction disqualifies the applicant from certification or licensure.
(IV) Disciplinary sanctions, which must include provisions for the denial, revocation, and suspension of certificates and licenses and the suspension and probation of certificate holders and licensees;
(V) An appeals process pursuant to sections 24-4-104 and 24-4-105 that is applicable to department decisions in connection with certifications and licenses and sanctions;
(VI) Pursuant to subsection (1)(b.5) of this section, rules regarding the conversion of an emergency medical service provider's valid certification to a license upon the emergency medical service provider's demonstration to the satisfaction of the department that the emergency medical service provider has completed a four-year bachelor's degree program from an accredited college or university in a field related to the health sciences or an equivalent field, as determined by the board by rule; and
(VII) A statement that an emergency medical service provider may practice in a clinical setting, as defined in section 25-3.5-207 (1)(a), subject to the requirements of section 25-3.5-207 and rules adopted by the board.
(b.5) (I) On or after January 1, 2021, an individual in this state who holds a valid emergency medical service provider certificate issued by the department may apply for a license issued by the department pursuant to this section. The department may issue a license to a certificate holder who has completed a four-year bachelor's degree program from an accredited college or university in a field related to the health sciences or an equivalent field, as determined by the board by rule.
(II) The conversion of an emergency medical service provider's certification to licensure pursuant to this subsection (1)(b.5) does not:
(A) Affect any prior discipline, limitation, or condition imposed by the department on an emergency medical service provider;
(B) Limit the department's authority over any certificate holder; or
(C) Affect any pending investigation or administrative proceeding.
II) The conversion of an emergency medical service provider's certification to licensure pursuant to this subsection (1)(b.5) does not:
(A) Affect any prior discipline, limitation, or condition imposed by the department on an emergency medical service provider;
(B) Limit the department's authority over any certificate holder; or
(C) Affect any pending investigation or administrative proceeding.
(c) (I) The department may issue a provisional certification or license to an applicant for certification or licensure as an emergency medical service provider who requests issuance of a provisional certification or license and who pays any fee authorized under rules adopted by the board. A provisional certification or license is valid for not more than ninety days.
(II) The department shall not issue a provisional certification or license unless the applicant satisfies the requirements for certification or licensure in accordance with this section and rules adopted by the board under this subsection (1). If the department finds that an emergency medical service provider who has received a provisional certification or license has violated any requirements for certification or licensure, the department may impose disciplinary sanctions under subsection (1)(b)(IV) of this section.
(III) The department may issue a provisional certification or license to an applicant whose fingerprint-based criminal history record check has not yet been completed. The department shall require the applicant to submit to a name-based judicial record check prior to issuing a provisional certification or license.
(IV) The board shall adopt rules as necessary to implement this subsection (1)(c), including rules establishing a fee for provisional certification or licensure. The department shall deposit any fee collected for a provisional certification or license in the emergency medical services account created in section 25-3.5-603.
(d) (I) The department shall exempt certified or licensed emergency medical service providers who have been called to federally funded active duty for more than one hundred twenty days to serve in a war, emergency, or contingency from the payment of certification or license fees and from continuing education or professional competency requirements of this article 3.5 for a renewal date during the service or the six months after the completion of service.
(II) Upon presentation of satisfactory evidence by an applicant for certification or license renewal, the department may accept continuing medical education, training, or service completed by an individual as a member of the armed forces or reserves of the United States, the National Guard of any state, the military reserves of any state, or the naval militia of any state toward the qualifications to renew the individual's certification or license.
(III) (A) A veteran, active military service member, or member of the National Guard and reserves separating from an active duty tour or the spouse of a veteran or member may apply for certification or licensure under this article 3.5 while stationed or residing within this state. The veteran, member, or spouse is exempt from the initial certification or licensure requirements in this article 3.5, except for those in subsection (4) of this section, if the veteran, member, or spouse holds a current, valid, and unrestricted certification from the National Registry of Emergency Medical Technicians (NREMT) at or above the level of state certification being sought.
(B) The department shall expedite the processing of a certification or license application submitted by a veteran, active military service member, or member of the National Guard and reserves separating from an active duty tour or the spouse of a veteran or member.
(IV) The board shall promulgate rules to implement this subsection (1)(d), including the criteria and evidence for acceptable continuing medical education and training or service.
ng of a certification or license application submitted by a veteran, active military service member, or member of the National Guard and reserves separating from an active duty tour or the spouse of a veteran or member.
(IV) The board shall promulgate rules to implement this subsection (1)(d), including the criteria and evidence for acceptable continuing medical education and training or service.
(2) (a) The council shall advise the department and the board in establishing the training requirements for certificate or license renewal, which training requirements must include a classroom component requiring at least thirty-six and not more than fifty classroom hours.
(b) With the exception of using the term "excited delirium" in the teaching of the history of the term, a person or entity conducting a training program for emergency medical service providers shall not include any training on or reference to the term "excited delirium" in any training program. Nothing in this section prohibits the instruction of emergency medical service courses that include the safe and effective medical interaction with individuals exhibiting an altered mental state, including symptomatology of a state of agitation, excitability, paranoia, extreme aggression, physical violence, and apparent immunity from pain.
(c) For purposes of subsection (2)(b) of this section, "excited delirium" means a term used to describe a person's state of agitation, excitability, paranoia, extreme aggression, physical violence, and apparent immunity to pain that is not listed in the most recent version of the Diagnostic and Statistical Manual of Mental Disorders. "Excited delirium" also includes excited delirium syndrome, hyperactive delirium, agitated delirium, and exhaustive mania.
(3) Repealed.
(4) (a) The department shall require a certification or licensure applicant to submit to a federal bureau of investigation fingerprint-based national criminal history record check from the Colorado bureau of investigation to investigate the applicant for an emergency medical service provider certificate or license. The department may acquire a name-based judicial record check for a certificate or license applicant.
(b) Each emergency medical service provider certification or licensure applicant required under this subsection (4) to submit to a federal bureau of investigation fingerprint-based national criminal history record check shall obtain a complete set of fingerprints taken by a local law enforcement agency, another entity designated by the department, or any third party approved by the Colorado bureau of investigation. If an approved third party takes the applicant's fingerprints, the fingerprints may be electronically captured using Colorado bureau of investigation-approved livescan equipment. Third-party vendors shall not keep the applicant's information for more than thirty days unless requested to do so by the applicant. The approved third party or government entity shall transmit the fingerprints to the Colorado bureau of investigation, which shall in turn forward them to the federal bureau of investigation for a national criminal history record check. The department or other authorized government entity is the authorized agency to receive and disseminate information regarding the result of a national criminal history record check. Each entity handling the national criminal history record check shall comply with Pub.L. 92-544, as amended. Each government entity acting as the authorized recipient of the result of a national criminal history record check shall forward the result of the initial national criminal history record check and any subsequent notification of activity on the record to the department to determine the individual's eligibility for initial certification or licensure or certification or licensure renewal.
(c) to (e) (Deleted by amendment, L. 2019.)
e authorized recipient of the result of a national criminal history record check shall forward the result of the initial national criminal history record check and any subsequent notification of activity on the record to the department to determine the individual's eligibility for initial certification or licensure or certification or licensure renewal.
(c) to (e) (Deleted by amendment, L. 2019.)
(f) If an applicant for certification or licensure renewal has lived in Colorado for:
(I) More than three years at the time of certification or licensure renewal and submitted to a federal bureau of investigation fingerprint-based national criminal history record check at the time of initial certification or licensure or at the time of a previous renewal of certification or licensure, the applicant is not required to submit to a subsequent fingerprint-based criminal history record check; or
(II) Three years or less at the time of certification or licensure renewal and submitted to a federal bureau of investigation fingerprint-based national criminal history record check at the time of initial certification or licensure or a previous renewal of certification or licensure, the applicant shall submit to another federal bureau of investigation fingerprint-based national criminal history record check from the Colorado bureau of investigation; except that the department may acquire a state name-based judicial record check for an applicant.
(g) When the results of a fingerprint-based criminal history record check of a person performed pursuant to this subsection (4) reveal a record of arrest without a disposition, the department, government entity, or private, not-for-profit, or for-profit organization that required the fingerprint-based criminal history record check shall require that person to submit to a name-based judicial record check, as defined in section 22-2-119.3 (6)(d).
(4.5) (a) As used in this subsection (4.5), unless the context otherwise requires:
(I) "Cat" means a small, domesticated feline animal that is kept as a pet. "Cat" does not include a nondomesticated wild animal.
(II) "Dog" means any canine animal owned for domestic, companionship, service, therapeutic, or assistance purposes.
(III) "Emergency medical service provider" means an emergency medical service provider that is certified or licensed by the department of public health and environment, created under section 25-1-102.
(IV) "Employer" means an entity or organization that employs or enlists the services of an emergency medical service provider, regardless of whether the provider is paid or is a volunteer. The employer may be a public, private, for-profit, or nonprofit organization or entity; or a special district.
(V) "Preveterinary emergency care" means the immediate medical stabilization of a dog or cat by an emergency medical service provider, in an emergency to which the emergency medical service provider is responding, through means including oxygen, fluids, medications, or bandaging, with the intent of enabling the dog or cat to be treated by a veterinarian. "Preveterinary emergency care" does not include care provided in response to an emergency call made solely for the purpose of tending to an injured dog or cat, unless a person's life could be in danger attempting to save the life of a dog or cat.
(b) Notwithstanding any other provision of law, an emergency medical service provider may provide preveterinary emergency care to dogs and cats to the extent the provider has received commensurate training and is authorized by the employer to provide the care. Requirements governing the circumstances under which emergency medical service providers may provide preveterinary emergency care to dogs and cats may be specified in the employer's policies governing the provision of care.
r may provide preveterinary emergency care to dogs and cats to the extent the provider has received commensurate training and is authorized by the employer to provide the care. Requirements governing the circumstances under which emergency medical service providers may provide preveterinary emergency care to dogs and cats may be specified in the employer's policies governing the provision of care.
(c) Notwithstanding any other provision of law, nothing in this subsection (4.5) imposes upon an emergency medical service provider any obligation to provide care to a dog or cat, or to provide care to a dog or cat before a person.
(5) Repealed.
C.R.S. § 25-3.5-203.5 Community paramedic endorsement - rules
25-3.5-203.5. Community paramedic endorsement - rules. (1) On or before January 1, 2018, the board shall adopt rules in accordance with article 4 of title 24, C.R.S., for community paramedics including standards for:
(a) The department's issuance of an endorsement in community paramedicine to an emergency medical service provider;
(b) Verifying an emergency medical service provider's competency to be endorsed as a community paramedic. The standards must include a requirement that the emergency medical service provider has obtained from an accredited paramedic training center or an accredited college or university a certificate of completion for a course in community paramedicine with competency verified by a passing score on an examination offered nationally and recognized in Colorado for certifying competency to serve as a community paramedic.
(c) Continuing competency to maintain a community paramedic endorsement.
(2) Rules adopted under this section supersede any rules of the Colorado medical board regarding the matters set forth in this part 2.
C.R.S. § 25-3.5-204 Emergency medical services for children
25-3.5-204. Emergency medical services for children. (1) The department is authorized to establish a program to improve the quality of emergency care to pediatric patients throughout the state, including a component to address public awareness of pediatric emergencies and injury prevention.
(2) The department is authorized to receive contributions, grants, donations, or funds from any public or private entity to be expended for the program authorized pursuant to this section.
C.R.S. § 25-3.5-205 Emergency medical service providers - investigation - discipline
25-3.5-205. Emergency medical service providers - investigation - discipline. (1) (a) The department may administer oaths, take affirmations of witnesses, and issue subpoenas to compel the attendance of witnesses and the production of all relevant records and documents to investigate alleged misconduct by certified or licensed emergency medical service providers.
(b) Upon failure of a witness to comply with a subpoena, the department may apply to a district court for an order requiring the person to appear before the department or an administrative law judge, to produce the relevant records or documents, or to give testimony or evidence touching the matter under investigation or in question. When seeking an order, the department shall apply to the district court of the county in which the subpoenaed person resides or conducts business. The court may punish such failure as a contempt of court.
(2) An emergency medical service provider, the medical supervisor of an emergency medical service provider in a clinical setting, as those terms are defined in section 25-3.5-207 (1), the employer of an emergency medical service provider, a medical director, and a physician providing medical direction of an emergency medical service provider shall report to the department any misconduct that is known or reasonably believed by the person to have occurred.
(3) A person acting as a witness or consultant to the department, a witness testifying, and a person or employer who reports misconduct to the department under this section shall be immune from liability in any civil action brought for acts occurring while testifying, producing evidence, or reporting misconduct under this section if such individual or employer was acting in good faith and with a reasonable belief of the facts. A person or employer participating in good faith in an investigation or an administrative proceeding pursuant to this section shall be immune from any civil or criminal liability that may result from such participation.
(4) All records, documents, testimony, or evidence obtained under this section shall remain confidential except to the extent necessary to support the administrative action taken by the department, to refer the matter to another regulatory agency, or to refer the matter to a law enforcement agency for criminal prosecution.
(5) For the purposes of this section:
(a) "Medical director" means a physician who provides medical direction to certified or licensed emergency medical service providers consistent with the rules adopted by the director or chief medical officer, as applicable, under section 25-3.5-206.
(b) "Misconduct" means an activity meeting the good cause for disciplinary sanctions standard, as defined by the board.
C.R.S. § 25-3.5-206 Emergency medical practice advisory council - creation - powers and duties - emergency medical service provider scope of practice - definitions - rules
25-3.5-206. Emergency medical practice advisory council - creation - powers and duties - emergency medical service provider scope of practice - definitions - rules. (1) There is created in the department, under the direction of the director of the department, the emergency medical practice advisory council, referred to in this part 2 as the "advisory council". The advisory council is responsible for advising the department regarding the appropriate scope of practice for emergency medical service providers certified or licensed under section 25-3.5-203. The advisory council is a type 2 entity, as defined in section 24-1-105.
(2) (a) The advisory council consists of the following thirteen members:
(I) Eight voting members appointed by the governor as follows:
(A) Two physicians licensed in good standing in Colorado who are actively serving as emergency medical service medical directors and are practicing in rural or frontier counties;
(B) Two physicians licensed in good standing in Colorado who are actively serving as emergency medical service medical directors and are practicing in urban counties;
(C) One physician licensed in good standing in Colorado who is actively serving as an emergency medical service medical director in any area of the state;
(D) One emergency medical service provider certified or licensed at an advanced life support level who is actively involved in the provision of emergency medical services;
(E) One emergency medical service provider certified or licensed at a basic life support level who is actively involved in the provision of emergency medical services; and
(F) One emergency medical service provider certified or licensed at any level who is actively involved in the provision of emergency medical services;
(II) One voting member who, as of July 1, 2010, is a member of the state emergency medical and trauma services advisory council, appointed by the executive director of the department;
(III) Two nonvoting ex officio members appointed by the executive director of the department.
(IV) One voting member who is a clinical psychiatrist licensed in good standing in Colorado, recommended by a statewide association of psychiatrists, and appointed by the governor; and
(V) One voting member who is an anesthesiologist licensed in good standing in Colorado, recommended by a statewide association of anesthesiologists, and appointed by the governor.
(b) Members of the advisory council shall serve four-year terms; except that, of the members initially appointed to the advisory council by the governor, four members shall serve three-year terms. A vacancy on the advisory council shall be filled by appointment by the appointing authority for that vacant position for the remainder of the unexpired term. Members serve at the pleasure of the appointing authority and continue in office until the member's successor is appointed.
(c) Members of the advisory council shall serve without compensation but shall be reimbursed from the emergency medical services account, created in section 25-3.5-603, for their actual and necessary travel expenses incurred in the performance of their duties under this article.
(d) The advisory council shall elect a chair and vice-chair from its members.
(e) The advisory council shall meet at least quarterly and more frequently as necessary to fulfill its obligations.
(f) The department shall provide staff support to the advisory council.
(g) As used in this subsection (2), "licensed in good standing" means that the physician holds a current, valid license to practice medicine in Colorado that is not subject to any restrictions.
(3) The advisory council shall provide general technical expertise on matters related to the provision of patient care by emergency medical service providers and shall advise or make recommendations to the department in the following areas:
"licensed in good standing" means that the physician holds a current, valid license to practice medicine in Colorado that is not subject to any restrictions.
(3) The advisory council shall provide general technical expertise on matters related to the provision of patient care by emergency medical service providers and shall advise or make recommendations to the department in the following areas:
(a) The acts and medications that emergency medical service providers at each level of certification or licensure are authorized to perform or administer under the direction of a physician medical director. The advisory council shall submit a report to the house of representatives health and insurance committee and the senate health and human services committee, or any successor committees, any time the advisory council advises or recommends authorizing the administration of any new chemical restraint, as defined in section 26-20-102 (2). The report must include the advisory council's reasoning for such advisement or recommendation.
(b) Requests for waivers to the scope of practice rules adopted pursuant to this section and section 25-3.5-203 (1)(a.5);
(c) Modifications to emergency medical service provider certification or licensure levels and capabilities; and
(d) Criteria for physicians to serve as emergency medical service medical directors.
(4) (a) The director or, if the director is not a physician, the chief medical officer shall adopt rules in accordance with article 4 of title 24 concerning the scope of practice of emergency medical service providers. The rules must include the following:
(I) Allowable acts for each level of emergency medical service provider certification or licensure and the medications that a certificate holder or licensee at each level of emergency medical service provider certification or licensure can administer;
(II) Defining the physician medical direction required for appropriate oversight of an emergency medical service provider by an emergency medical services medical director;
(III) Criteria for requests to waive the scope of practice rules in a prehospital setting and the conditions for the waivers;
(IV) Minimum standards for physicians to be emergency medical services medical directors; and
(V) (A) Standards for the issuance by the department of a critical care endorsement for emergency medical service providers. An emergency medical service provider with a critical care endorsement is authorized to perform the tasks and procedures specified by rule. The endorsement is valid as long as the emergency medical service provider maintains certification or licensure by the department.
(B) The director or, if the director is not a physician, the chief medical officer, shall adopt rules implementing this subparagraph (V) by August 1, 2014.
(a.5) (I) The director or, if the director is not a physician, the chief medical officer shall adopt rules in accordance with article 4 of title 24 concerning the scope of practice of a community paramedic. An emergency medical service provider's endorsement as a community paramedic, issued pursuant to the rules adopted under section 25-3.5-203.5, is valid for as long as the emergency medical service provider maintains the emergency medical service provider's certification or licensure by the department.
(II) The rules must establish the tasks and procedures that an emergency medical service provider with a community paramedic endorsement is authorized to perform in addition to an emergency medical service provider's scope of practice, including:
(A) An initial assessment of the patient and any subsequent assessments, as needed;
(B) Medical interventions;
(C) Care coordination;
(D) Resource navigation;
(E) Patient education;
(F) Inventory, compliance, and administration of medications; and
(G) Gathering of laboratory and diagnostic data.
to perform in addition to an emergency medical service provider's scope of practice, including:
(A) An initial assessment of the patient and any subsequent assessments, as needed;
(B) Medical interventions;
(C) Care coordination;
(D) Resource navigation;
(E) Patient education;
(F) Inventory, compliance, and administration of medications; and
(G) Gathering of laboratory and diagnostic data.
(b) Rules adopted pursuant to this subsection (4) supersede any rules of the Colorado medical board regarding the matters set forth in this subsection (4).
(5) As used in this section:
(a) "Interfacility transport" has the meaning set forth in section 25-3.5-207 (1)(c).
(b) Repealed.
(c) "Scope of practice" has the meaning set forth in section 25-3.5-207 (1)(f).
C.R.S. § 25-3.5-207 Ability of certified or licensed emergency medical service providers to work in clinical settings - restrictions - definitions - rules
25-3.5-207. Ability of certified or licensed emergency medical service providers to work in clinical settings - restrictions - definitions - rules. (1) As used in this section, unless the context otherwise requires:
(a) "Clinical setting" means a health facility licensed or certified by the department pursuant to section 25-1.5-103 (1)(a).
(b) "In-scope tasks and procedures" means tasks and procedures performed by an emergency medical service provider within the emergency medical service provider's scope of practice.
(c) "Interfacility transport" means the movement of a patient from one licensed health-care facility to another licensed health-care facility.
(d) "Medical supervision" means the oversight, guidance, and instructions that a medical supervisor provides to an emergency medical service provider.
(e) "Medical supervisor" means a Colorado-licensed physician, physician assistant, advanced practice registered nurse, registered nurse, or certified midwife.
(f) "Scope of practice" means the tasks, medications, and procedures that an emergency medical service provider is authorized to perform or administer in accordance with sections 25-3.5-203 and 25-3.5-206 and rules promulgated pursuant to those sections.
(2) In accordance with the limitations contained in this article 3.5, an emergency medical service provider may work in a clinical setting subject to the following conditions:
(a) The emergency medical service provider may perform only tasks and procedures that are within the emergency medical service provider's applicable scope of practice;
(b) The emergency medical service provider shall perform in-scope tasks and procedures pursuant to orders or instructions from, and under the medical supervision of, a medical supervisor;
(c) Medical supervision must be provided by a medical supervisor who is immediately available and physically present at the clinical setting where the care is being delivered to provide oversight, guidance, or instruction to the emergency medical service provider during the emergency medical service provider's performance of in-scope tasks and procedures;
(d) The medical supervisor of the emergency medical service provider must be licensed in good standing; and
(e) Each clinical setting at which an emergency medical service provider performs in-scope tasks and procedures pursuant to this section shall, in collaboration with its medical staff, establish operating policies and procedures that ensure that emergency medical service providers perform tasks and procedures and administer medications within their scope of practice.
(3) Nothing in this section alters the authority of a physician or registered nurse in a clinical setting to delegate acts, including the administration of medications, that are outside of an emergency medical service provider's scope of practice pursuant to section 12-240-107 or 12-255-131, as appropriate.
(4) The board may promulgate rules as necessary to implement this section.
C.R.S. § 25-3.5-208 Emergency medical service providers' peer health assistance program - fund - rules
25-3.5-208. Emergency medical service providers' peer health assistance program - fund - rules. (1) As a condition of initial certification or licensure and certification or licensure renewal, every applicant shall pay to the department, at the time of application, two dollars and fifty-five cents. This amount may be adjusted on January 1, 2021, and annually thereafter by the board to reflect:
(a) Changes in the United States department of labor, bureau of labor statistics, consumer price index for Denver-Aurora-Lakewood, or its successor index; and
(b) Overall utilization of the program.
(2) The fee imposed pursuant to subsection (1) of this section is to support designated providers the department selects to provide assistance to emergency medical service providers needing help in dealing with physical, emotional, or psychological conditions that may be detrimental to their ability to provide emergency medical services.
(3) The department shall deposit the fees collected pursuant to this section in the emergency medical services peer assistance fund, referred to in this section as the "fund", which is hereby created in the state treasury. Money in the fund is not subject to annual appropriation by the general assembly. The state treasurer shall credit all interest and income derived from the deposit and investment of money in the fund to the fund. The department may seek, accept, and expend gifts, grants, or donations from private or public sources for the purposes of this section.
(4) The department shall select one or more peer health assistance programs as designated providers. To be eligible for designation by the department, a peer health assistance program must:
(a) Provide for the education of emergency medical service providers with respect to the recognition and prevention of physical, emotional, and psychological conditions and provide for intervention when necessary or under circumstances that the department may establish by rule;
(b) Offer assistance to an emergency medical service provider in identifying physical, emotional, or psychological conditions;
(c) Evaluate the extent of physical, emotional, or psychological conditions and refer the emergency medical service provider for appropriate treatment;
(d) Monitor the status of an emergency medical service provider who has been referred for treatment;
(e) Provide counseling and support for the emergency medical service provider and for the family of any emergency medical service provider referred for treatment;
(f) Agree to receive referrals from the department; and
(g) Agree to make services available to all certified and licensed emergency medical service providers.
(5) The department may select an entity to administer the emergency medical service providers peer health assistance program. The administering entity must be a nonprofit private foundation that is qualified under section 501 (c)(3) of the federal "Internal Revenue Code of 1986", as amended, and is dedicated to providing support for charitable, benevolent, educational, and scientific purposes that are related to medicine, medical education, medical research and science, and other medical charitable purposes.
(6) The administering entity shall:
(a) Distribute the money collected from the department, less expenses, to an approved designated provider, as directed by the department;
(b) Provide an annual accounting to the department of all amounts collected, expenses incurred, and amounts disbursed; and
to medicine, medical education, medical research and science, and other medical charitable purposes.
(6) The administering entity shall:
(a) Distribute the money collected from the department, less expenses, to an approved designated provider, as directed by the department;
(b) Provide an annual accounting to the department of all amounts collected, expenses incurred, and amounts disbursed; and
(c) Post a surety performance bond in an amount specified by the department to secure performance under the requirements of this section. The administering entity may recover the actual administrative costs incurred in performing its duties under this section in an amount not to exceed ten percent of the total amount collected.
(7) (a) Any certificate holder or licensee who does not have access to an employee assistance program may apply to the department for participation in a qualified peer health assistance program. In order to be eligible for participation, a certificate holder or licensee shall:
(I) Acknowledge the existence or the potential existence of a physical, psychological, or emotional condition; excessive alcohol or drug use; or a substance use disorder, as defined in section 27-81-102;
(II) After a full explanation of the operation and requirements of the peer health assistance program, agree to voluntarily participate in the program and agree in writing to participate in the program of the peer health assistance organization designated by the department.
(b) (I) Any certificate holder or licensee may self-refer to the qualified peer health assistance program selected by the department. If a certificate holder or licensee who self-refers in accordance with this subsection (7)(b) has access to an employee assistance program, the certificate holder or licensee shall cover the cost of the program.
(II) A certificate holder or licensee who self-refers and is accepted into a qualified peer health assistance program shall affirm that, to the best of their knowledge, information, and belief, they know of no instance in which they have violated this article 3.5 or the rules of the board, except in instances affected by the certificate holder's or licensee's physical, psychological, or emotional condition.
(8) All documents, records, or reports generated in the provision of services to a certificate holder or licensee who is attending a qualified peer health assistance program are confidential and not subject to subpoena and shall not be used as evidence in any proceeding other than disciplinary action by the department. The documents, records, and reports are not public records for purposes of section 24-72-203.
(9) Notwithstanding the provisions of this section, the department may summarily suspend the certification of any certificate holder or the license of any licensee who is referred to a peer health assistance program by the department and who fails to attend or to complete the program. If a certificate holder or licensee objects to the suspension, the certificate holder or licensee may submit a written request to the department for the formal hearing on the suspension within two days after receiving notice of the suspension and the department shall grant the request. In the hearing, the certificate holder or licensee shall have the burden of proving that the certificate holder's certification or licensee's license should not be suspended. The hearing shall be conducted in accordance with section 24-4-105.
the department for the formal hearing on the suspension within two days after receiving notice of the suspension and the department shall grant the request. In the hearing, the certificate holder or licensee shall have the burden of proving that the certificate holder's certification or licensee's license should not be suspended. The hearing shall be conducted in accordance with section 24-4-105.
(10) Nothing in this section creates any liability on the department or the state of Colorado for the actions of the department in making grants to peer assistance programs, and no civil action may be brought or maintained against the department or the state for an injury alleged to have been the result of the activities of any state-funded peer assistance program or the result of an act or omission of an emergency medical service provider participating in or referred by a state-funded peer assistance program. However, the state remains liable under the "Colorado Governmental Immunity Act", article 10 of title 24, if an injury alleged to have been the result of an act or omission of an emergency medical service provider participating in or referred by a state-funded peer assistance program occurred while the emergency medical service provider was performing duties as an employee of the state.
(11) The department may promulgate rules necessary to implement this section.
C.R.S. § 25-3.5-209 Use of ketamine in prehospital setting when peace officer is present - definition
25-3.5-209. Use of ketamine in prehospital setting when peace officer is present - definition. (1) (a) When a peace officer is present at the scene of an emergency, an emergency medical service provider authorized to administer ketamine in a prehospital setting shall only administer ketamine if the provider has:
(I) Weighed the individual to ensure accurate dosage. If the emergency medical service provider is unable to weigh the individual, the emergency medical service provider shall, prior to the administration of ketamine:
(A) Estimate the individual's weight, and at least two personnel who are trained in weight assessments must agree with the weight assessment; and
(B) Attempt to obtain a verbal order from the emergency medical service provider's medical director or their designee, unless there is a verifiable reason the emergency medical service provider cannot obtain a verbal order.
(II) Training in the administration of ketamine, including training to ensure appropriate dosage based on the weight of the individual;
(III) Training in advanced airway support techniques;
(IV) Equipment available to manage respiratory depression; and
(V) Equipment available to immediately monitor the vital signs of the individual receiving ketamine and the ability to respond to any adverse reactions.
(b) The medical director of an agency that has a waiver to administer ketamine shall develop any necessary training for emergency medical service providers pursuant to this subsection (1).
(2) An emergency medical service provider who administers ketamine shall:
(a) Provide urgent transport to the individual receiving ketamine; and
(b) Record any complications arising out of such administration, including but not limited to apnea, laryngospasm, hypoxia, hypertension, hypotension, seizure, and cardiac arrest.
(3) Absent a justifiable medical emergency, an emergency medical service provider shall not administer ketamine in a prehospital setting to subdue, sedate, or chemically incapacitate an individual for alleged or suspected criminal, delinquent, or suspicious conduct.
(4) If an emergency medical service provider does not comply with the provisions of this section, such noncompliance is considered misconduct, as defined in section 25-3.5-205 (5)(b).
C.R.S. § 25-3.5-210 Report on statewide use of ketamine
25-3.5-210. Report on statewide use of ketamine. Beginning January 1, 2022, and each January 1 thereafter, the department shall submit a report on the statewide use of ketamine by emergency medical service providers and any complications that arise out of such use to the house of representatives judiciary committee, the house of representatives public and behavioral health and human services committee, the senate health and human services committee, and the senate judiciary committee, or their successor committees. The department shall make the report publicly available on the department's website.
C.R.S. § 25-3.5-301 Number of individuals needed for ambulance operation - exception
25-3.5-301. Number of individuals needed for ambulance operation - exception. (1) and (2) Repealed.
(3) No patient shall be transported in an ambulance in this state after January 1, 1978, unless there are two or more individuals, including the driver, present and authorized to operate said ambulance except under unusual conditions when only one authorized person is available.
(4) (Deleted by amendment, L. 2002, p. 696, § 1, effective May 29, 2002.)
(5) and (6) Repealed.
C.R.S. § 25-3.5-302 Issuance of licenses and permits - term - requirements - repeal
25-3.5-302. Issuance of licenses and permits - term - requirements - repeal. (Repealed)
C.R.S. § 25-3.5-303 Vehicular liability insurance required - repeal
25-3.5-303. Vehicular liability insurance required - repeal. (Repealed)
C.R.S. § 25-3.5-304 Suspension - revocation - hearings - repeal
25-3.5-304. Suspension - revocation - hearings - repeal. (Repealed)
C.R.S. § 25-3.5-305 Alleged negligence
25-3.5-305. Alleged negligence. (1) In any legal action filed against a person who has been issued a license pursuant to this part 3 in which it is alleged that the plaintiff's injury, illness, or incapacity was exacerbated or that he was otherwise injured by the negligence of the licensee, an act of negligence shall not be presumed based on the fact of the allegation.
(2) In the event a judgment is entered against a person issued a license pursuant to this part 3, the person shall, within thirty days after the judgment is entered, file a copy of the findings of fact, conclusions of law, and order in the case with the department, and the department shall take note of the judgment for purposes of investigation and appropriate action to determine if the person committed a violation of this part 3. Any and all complaints received directly by the department are subject to review.
C.R.S. § 25-3.5-306 Violation - penalty
25-3.5-306. Violation - penalty. Any person who violates any provision of this part 3 commits a petty offense and shall be punished as provided in section 18-1.3-503.
C.R.S. § 25-3.5-307 Licensure of fixed-wing and rotor-wing air ambulances - cash fund created - rules
25-3.5-307. Licensure of fixed-wing and rotor-wing air ambulances - cash fund created - rules. (1) (a) Except as provided in paragraph (b) of this subsection (1), prior to beginning air ambulance operations in this state, an air ambulance service must be licensed by the department. Except as otherwise provided in paragraph (d) of this subsection (1), compliance with rules promulgated by the board or successful completion of an accreditation process through an accrediting organization approved by the department as having standards equivalent to or exceeding the standards established in rules of the board is required for full licensure and renewal of such license by the department for an air ambulance service.
(b) (I) Upon a showing of exigent circumstances, as defined by the board, the department may authorize an unlicensed air ambulance service to provide a particular transport.
(II) The department may recognize the license issued by another jurisdiction for an air ambulance service that makes a limited number of flights per calendar year into or out of Colorado, and the department shall impose an annual fee upon an air ambulance service whose license is so recognized. The department may rescind such recognition, without refunding or prorating the fee, if rescission is necessary to protect public health and safety.
(b.5) The board shall allow the department to grant a waiver of a rule adopted by the board if the applicant for the waiver satisfactorily demonstrates:
(I) (A) The waiver will not adversely affect the health and safety of patients; and
(B) In the particular situation, the requirement serves no beneficial public purpose; or
(II) Circumstances indicate that the public benefit of waiving the requirement outweighs the public benefit to be gained by strictly adhering to the requirement.
(c) In addition to its rule-making authority granted under section 25-3.5-307.5, the board shall promulgate rules specifying minimum licensure requirements and standards for air ambulance services necessary to ensure public health and safety, including governing the issuance of initial and renewal licenses, conditional licenses, provisional licenses, and other necessary licenses; establishing reasonable fees for licensure and for on-site inspections, investigations, changes of ownership, and other activities related to licensure; defining exigent circumstances for purposes of the exception in subparagraph (I) of paragraph (b) of this subsection (1); and specifying the procedure and grounds for the suspension, revocation, or denial of a license. The rules must include the process used to investigate complaints against an air ambulance service and procedures for data collection and reporting to the department by an air ambulance service; except that complaints that are related to the requirements of an accrediting organization approved by the department in accordance with paragraph (a) of this subsection (1) may be referred to the organization for investigation if the department determines that referral is appropriate. The department shall consider the results of such investigations in making licensure decisions concerning air ambulance services.
laints that are related to the requirements of an accrediting organization approved by the department in accordance with paragraph (a) of this subsection (1) may be referred to the organization for investigation if the department determines that referral is appropriate. The department shall consider the results of such investigations in making licensure decisions concerning air ambulance services.
(d) The department may issue a provisional license to an applicant for an initial license to operate an air ambulance service if the applicant is temporarily unable to conform to all the minimum standards required under this article and rules of the board; except that a license shall not be issued to an applicant if the operation of the applicant's air ambulance service will adversely affect patient care or the health, safety, and welfare of the public. As a condition of obtaining a provisional license, the applicant must demonstrate to the department that the applicant is making its best efforts to achieve compliance with applicable standards. The department may issue the applicant a second provisional license for the same duration and shall charge the same fee as for the first provisional license, but the department shall not issue a third or subsequent provisional license to the applicant.
(2) (a) The board shall establish the amount of the licensure fee to reflect the direct and indirect costs incurred by the department in implementing such licensure. The department shall transmit all fees collected pursuant to this section to the state treasurer who shall credit the same to the fixed-wing and rotary-wing ambulances cash fund, which fund is hereby created in the state treasury.
(b) Any interest derived from the deposit and investment of moneys in the fixed-wing and rotary-wing ambulances cash fund shall be credited to such fund. Any unexpended or unencumbered moneys remaining in such fund at the end of any fiscal year shall remain in the fund and shall not revert or be transferred to the general fund or any other fund of the state. Moneys in such fund shall be subject to annual appropriation by the general assembly to the department for the costs incurred by the department in implementing this section.
C.R.S. § 25-3.5-307.5 Standards for air ambulance services - rules - civil penalties - disciplinary actions
25-3.5-307.5. Standards for air ambulance services - rules - civil penalties - disciplinary actions. (1) The board shall promulgate rules in accordance with section 24-4-103, C.R.S., to establish minimum standards for an air ambulance service. The rules must include minimum requirements or standards for:
(a) Approval of an accrediting organization;
(b) Recognizing another jurisdiction's license, including a restriction on the number of allowable flights per year in Colorado under that license, a fee for such recognition, and a process to rescind the recognition upon a showing of good cause;
(c) Malpractice and liability insurance for injuries to persons, in amounts determined by the board, and workers' compensation coverage as required by Colorado law;
(d) Medical crew qualifications and training;
(e) Qualifications, training, and roles and responsibilities for a medical director for an air ambulance service;
(f) Communication equipment, reporting capabilities, patient safety, and crew safety and staffing;
(g) Medical equipment in an air ambulance;
(h) Data collection and submission, including reporting requirements as determined by the department;
(i) Maintaining program quality; and
(j) Management of patient and medical staff safety with regard to clinical staffing and shift time.
(2) Rules promulgated by the board must not include activities preempted by the federal aviation administration or 49 U.S.C. sec. 41713.
(3) Civil penalties. An air ambulance operator, service, or provider or other person who violates this section, section 25-3.5-307, or a rule of the board promulgated pursuant to this part 3 or who operates without a current and valid license is subject to a civil penalty of up to five thousand dollars per violation or for each day of a continuing violation. The department shall assess and collect these penalties. Before collecting a penalty, the department shall provide the alleged violator with notice and the opportunity for a hearing in accordance with the "State Administrative Procedure Act", article 4 of title 24, C.R.S., and all applicable rules of the board. The department shall transmit all penalties collected pursuant to this section to the state treasurer, who shall credit them to the general fund.
(4) Disciplinary actions. For violation of any provision of this section, section 25-3.5-307, or a rule of the board promulgated pursuant to this part 3 or for operating without a license, the department may take any one or more of the following actions:
(a) Deny, suspend, or revoke a license issued pursuant to this part 3;
(b) Impose a civil penalty as provided in subsection (3) of this section;
(c) Issue a cease-and-desist order if the department has determined that a violation has occurred and immediate enforcement is deemed necessary. The cease-and-desist order must set forth the provisions alleged to have been violated, the facts alleged to have constituted the violation, and the requirement that all violations cease forthwith.
(d) Summarily suspend a license issued pursuant to this part 3 in accordance with article 4 of title 24, C.R.S.
(5) Repealed.
C.R.S. § 25-3.5-308 Rules - repeal
25-3.5-308. Rules - repeal. (Repealed)
C.R.S. § 25-3.5-309 Secure transportation - license required - fees - exceptions
25-3.5-309. Secure transportation - license required - fees - exceptions. (1) (a) After January 1, 2023, an entity shall not provide public or private secure transportation services, as defined in section 25-3.5-103 (11.4), in this state unless that entity holds a valid license issued by the board of county commissioners of the county in which the secure transportation service is based; except that entities described in subsection (2) of this section may provide secure transportation services.
(b) Licenses, permits, and renewals issued pursuant to this section and section 25-3.5-310 require a fee in an amount to be determined by the board of county commissioners of the county in which the secure transportation service is based to reflect the direct and indirect costs incurred by the county in implementing licenses for secure transportation.
(2) Ambulance agencies, transportation services provided by the state department of human services, emergency service patrols established pursuant to section 27-81-115, and law enforcement may provide secure transportation services to an individual in need of urgent behavioral health care.
(3) An ambulance agency is eligible to receive reimbursement pursuant to section 25.5-5-328 and is exempt from additional licensing requirements if the agency meets the requirements for secure transportation as established by rule pursuant to section 25-3.5-311.
(4) Each vehicle operated by a secure transportation licensee must be issued a separate permit by the board of county commissioners of the county in which the secure transportation service is based upon positive review pursuant to section 25-3.5-310.
C.R.S. § 25-3.5-310 Secure transportation - issuance of licenses and permits - term - requirements
25-3.5-310. Secure transportation - issuance of licenses and permits - term - requirements. (1) (a) After receipt of an original application for a license to provide public or private secure transportation services, the board of county commissioners of the county in which the secure transportation service is based shall review the application, the applicant's record, and the applicant's equipment, as well as the applicant's training and operating procedures. In order to be approved for a license, the applicant must provide evidence that the applicant's equipment and training and operating procedures meet or exceed the minimum requirements established by the state board of health pursuant to section 25-3.5-311. The board of county commissioners of any county may impose, by resolution, additional requirements for secure transportation that is based in that county.
(b) If an applicant is approved pursuant to subsection (1)(a) of this section, the board of county commissioners of the county in which the secure transportation service is based shall issue a license, valid for three years, to the applicant to provide secure transportation services. The board of county commissioners of the county in which the secure transportation service is based shall also issue a permit, valid for twelve months after the date of issuance, for each vehicle used by the licensee if the vehicles and equipment meet or exceed the minimum requirements established by the state board of health pursuant to section 25-3.5-311.
(2) Any license or permit issued pursuant to this section, unless revoked by the board of county commissioners of the county in which the secure transportation service is based, may be renewed by filing an application, as applicable for an original license or permit. Applications for permit renewal must be filed annually, but not less than thirty days before the date the permit expires.
(3) A licensee or permit holder shall not sell, assign, or otherwise transfer a license or permit issued pursuant to this section.
C.R.S. § 25-3.5-311 Secure transportation - rules
25-3.5-311. Secure transportation - rules. (1) On or before July 1, 2022, the state board of health shall adopt rules establishing the minimum requirements for secure transportation services licensing, including but not limited to:
(a) Staffing requirements for vehicles;
(b) Staff training requirements, including verbal de-escalation and trauma-informed care, as well as cultural competencies related to supporting persons with physical or cognitive disabilities;
(c) Operating procedures, including circumstances when individual physical restraint is allowed;
(d) Quality improvement and the process used to investigate complaints against a licensee;
(e) Data collection and reporting on utilization to the department by a licensee;
(f) Minimum clinical and medical standards and procedures;
(g) The circumstances under which an individual may be transported; and
(h) Criteria for pickup and drop-off.
C.R.S. § 25-3.5-312 Funding
25-3.5-312. Funding. The department is authorized to seek, accept, and expend gifts, grants, and donations from public or private sources for the purpose of facilitating the rule-making process set forth in section 25-3.5-311.
C.R.S. § 25-3.5-313 Reporting
25-3.5-313. Reporting. The department shall annually make publicly available the data collected from secure transportation providers.
C.R.S. § 25-3.5-314 Ambulance service - license required - exceptions - rules - local authorization to operate - penalties - liability insurance
25-3.5-314. Ambulance service - license required - exceptions - rules - local authorization to operate - penalties - liability insurance. (1) State license required. On and after July 1, 2024, and except as provided in subsection (2) of this section, a person shall not operate or maintain an ambulance service without a license issued by the department and without authorization to operate from the local licensing authority for the county or city and county in which the ambulance service operates or seeks to operate.
(2) Exceptions. Subsection (1) of this section does not apply to the following:
(a) The exceptional emergency use of a privately or publicly owned vehicle, including search and rescue unit vehicles or aircraft not ordinarily used in the act of transporting patients;
(b) A vehicle rendering services as an ambulance during a major catastrophe or emergency when ambulances with authorizations to operate in the county or city and county in which the major catastrophe or emergency occurred or is occurring are insufficient to render the ambulance services required;
(c) An ambulance based outside of the state that is transporting a patient into the state;
(d) A vehicle used or designed for the scheduled transportation of convalescent patients, individuals with disabilities, or individuals who would not be expected to require skilled treatment or care while in the vehicle; and
(e) A vehicle used solely for the transportation of an intoxicated person, as defined in section 27-81-102 (11), who is not otherwise disabled or seriously injured and who would not be expected to require skilled treatment or care while in the vehicle.
(3) Issuance of licenses. (a) Beginning July 1, 2024, the department shall issue an initial license to an ambulance service that, as of June 30, 2024, holds a valid license issued by a local jurisdiction.
(b) An applicant for a license shall submit to the department, in the form and manner determined by the board by rule, evidence that the ambulance service that is the subject of the application, its employees, and any contractors that the ambulance service uses as staff are covered by general liability insurance. The board, by rule, shall determine the minimum amount of general liability insurance coverage required, which amount must not be less than the amount calculated in accordance with section 24-10-114 (1)(a) and (1)(b).
(4) Violations - penalties. (a) A person that operates an ambulance service without a license issued pursuant to this part 3 commits a petty offense and shall be punished as provided in section 18-1.3-503 (1.5).
(b) (I) An owner or operator of an ambulance service or other person who violates this part 3 or a rule adopted pursuant to this part 3 or who operates without a valid license is subject to a civil penalty of:
(A) Up to five hundred dollars per violation; or
(B) For each day of a continuing violation, up to five hundred dollars per day.
(II) The department shall assess and collect the civil penalties. Before collecting a civil penalty, the department shall provide the person alleged to have committed the violation with notice and an opportunity to be heard in accordance with article 4 of title 24.
(III) The department shall transmit all civil penalties collected to the state treasurer, who shall credit the money to the general fund.
The department shall assess and collect the civil penalties. Before collecting a civil penalty, the department shall provide the person alleged to have committed the violation with notice and an opportunity to be heard in accordance with article 4 of title 24.
(III) The department shall transmit all civil penalties collected to the state treasurer, who shall credit the money to the general fund.
(5) County or city and county authorization to operate - rules. (a) (I) An ambulance service seeking to operate on a regular basis, as defined by the board by rule, in a county or city and county shall file an intent to operate with the local licensing authority for the county or city and county in which the ambulance service intends to operate on forms provided by the department and containing such information as the department may require.
(II) An ambulance service shall not operate in a county or a city and county unless the ambulance service has obtained authorization to operate from the county or the city and county.
(III) A county or city and county may enact an ordinance or resolution governing the authorization to operate ambulance services within the county or city and county. The ordinance or resolution may:
(A) Limit the number of ambulance services that will be authorized to operate within the county's or city and county's jurisdiction;
(B) Determine and prescribe ambulance service areas within the county's or city and county's jurisdiction;
(C) Authorize the local licensing authority to contract with ambulance services;
(D) Authorize the local licensing authority to enter into memoranda of understanding, contracts, or other such agreements to impose obligations on ambulance services that are more stringent than the obligations imposed under this part 3 and rules adopted pursuant to this part 3; and
(E) Establish other necessary requirements that are consistent with this part 3 or rules adopted pursuant to this part 3.
(b) (I) On and after July 1, 2024, a county or city and county that has not opted out of participating in the issuance of authorizations to operate pursuant to subsection (5)(b)(III) of this section shall not grant an ambulance service authorization to operate in the county or city and county without first verifying that the ambulance service has a valid license issued by the department.
(II) Pursuant to section 25-3.5-317 (2)(a), the department has the sole responsibility to conduct vehicle inspections of ambulance services.
(III) Before July 1, 2024, and before July 1 of any year thereafter, a county or city and county may opt out of participating in the issuance of authorizations to operate an ambulance service within the county or city and county by notifying the department in a form and manner determined by the department. If a county or city and county opts out of participating in the issuance of authorizations to operate an ambulance service, an ambulance service need only obtain a state license to operate in that county or city and county.
(c) Except as provided in subsection (5)(d) of this section, a county or city and county shall not impose standards that are more or less stringent than the minimum standards that the board adopts by rule pursuant to section 25-3.5-315.
(d) Nothing in this part 3 prevents a county or city and county from imposing obligations that exceed the minimum standards that the board adopts by rule pursuant to section 25-3.5-315 through the use of memoranda of understanding, contracts, or other such agreements.
standards that are more or less stringent than the minimum standards that the board adopts by rule pursuant to section 25-3.5-315.
(d) Nothing in this part 3 prevents a county or city and county from imposing obligations that exceed the minimum standards that the board adopts by rule pursuant to section 25-3.5-315 through the use of memoranda of understanding, contracts, or other such agreements.
(e) (I) Upon a determination by a local licensing authority that a person has violated or failed to comply with this part 3, rules adopted pursuant to this part 3, or an ordinance, resolution, contract, or other agreement governing the ambulance service's authority to operate within the county or city and county, the local licensing authority may summarily suspend, for a period not to exceed ten days, the authorization to operate issued pursuant to this subsection (5).
(II) A local licensing authority shall provide written notice to the ambulance service of a temporary suspension and shall hold a hearing on the matter no later than ten days after issuance of the temporary suspension. After the hearing, the local licensing authority may suspend or revoke the ambulance service's authorization to operate. At the end of any period of suspension, the person whose authorization to operate was suspended may apply for a new authorization to operate in the county or city and county in the same manner as the person applied for the initial authorization to operate.
(III) If an ambulance service commits a second violation or failure to comply with this part 3, rules adopted pursuant to this part 3, or an ordinance, resolution, contract, or other agreement governing the ambulance service's authority to operate within the county or city and county, the local licensing authority may revoke the ambulance service's authorization to operate in the county or city and county.
(IV) A local licensing authority that suspends or revokes an ambulance service's authorization to operate in the county or city and county shall notify the department of the suspension or revocation within thirty days after issuing the suspension or revocation and provide supporting documentation for the department's review of the possible effect that the suspension or revocation has on the ambulance service's state license.
C.R.S. § 25-3.5-315 Minimum standards for ambulance services - rules
25-3.5-315. Minimum standards for ambulance services - rules. (1) On or before January 1, 2024, the board shall adopt rules establishing minimum standards for the operation of an ambulance service within the state. The rules must address the following:
(a) Minimum equipment to be carried on an ambulance;
(b) Staffing requirements for ambulances;
(c) Medical oversight and quality assurance of ambulance services;
(d) The issuance of licenses;
(e) The process used to investigate complaints against an ambulance service;
(f) Data collection and reporting to the department by an ambulance service;
(g) Inspection of ambulance services by the department or the department's designated representative;
(h) Minimum education, training, and experience standards for the administrator of an ambulance service;
(i) The amount of general liability insurance coverage that an ambulance service shall maintain in accordance with section 25-3.5-314 (3)(b) and the manner in which an ambulance service shall demonstrate proof of insurance to the department. The board may establish by rule that an ambulance service may obtain a surety bond in lieu of liability insurance coverage.
(j) Qualifications, training, and roles and responsibilities for a medical director of an ambulance service;
(k) Communication equipment, reporting capabilities, patient safety, and safety and staffing of crew members;
(l) Management of patient safety with regard to minimum clinical staffing;
(m) Administrative and operational standards for governance, patient records and record retention, personnel, and policies and procedures;
(n) Mandatory incident reporting to the department, including specifying the acts or events that trigger mandatory reporting;
(o) Fees for ambulance service applications and licenses, if deemed necessary to cover the department's direct and indirect costs in implementing and administering this part 3;
(p) Requirements for motor vehicle liability insurance, as required by section 10-4-619;
(q) Vehicle standards to ensure minimum safety standards;
(r) Criteria for waivers to the rules; and
(s) Any other rules as necessary to implement this part 3.
C.R.S. § 25-3.5-316 Ambulance services cash fund - created
25-3.5-316. Ambulance services cash fund - created. (1) There is hereby created the ambulance services cash fund, referred to in this section as the "fund". The department shall transmit any fees collected pursuant to this part 3 to the state treasurer, who shall credit the fees to the fund. The fund consists of the credited fees and any money that the general assembly may transfer or appropriate to the fund.
(2) The money in the fund is subject to annual appropriation by the general assembly to the department for the department's direct and indirect costs in implementing and administering this part 3.
(3) The state treasurer shall credit all interest and income derived from the deposit and investment of money in the fund to the fund. Any unencumbered or unexpended money in the fund at the end of a state fiscal year remains in the fund and is not transferred to the general fund or any other fund.
C.R.S. § 25-3.5-317 License - application - inspection - criminal history record check - issuance - investigation
25-3.5-317. License - application - inspection - criminal history record check - issuance - investigation. (1) An ambulance service license expires after two years. The department shall determine the form and manner of initial and renewal license applications.
(2) (a) To ensure the health, safety, and welfare of ambulance service patients, the department shall inspect an ambulance service, including all vehicles used in providing the ambulance service, in accordance with this part 3 and board rules adopted by the board pursuant to this part 3 and as the department deems necessary. If the department finds one or more violations as a result of an inspection, the ambulance service shall submit to the department in writing, in the form and manner determined by the department, a plan detailing the measures that the ambulance service will take to correct the violations found.
(b) The department shall keep confidential all medical records and personally identifying information obtained during an inspection of an ambulance service.
(3) (a) (I) When submitting an application for a license pursuant to this section, or within ten days after a change in owner or operator of an ambulance service, each owner or operator of an ambulance service shall submit a complete set of the owner's or operator's fingerprints to the Colorado bureau of investigation for the purpose of conducting a state and national fingerprint-based criminal history record check. The Colorado bureau of investigation shall forward the fingerprints to the federal bureau of investigation for the purpose of conducting fingerprint-based criminal history record checks.
(II) Each owner or operator of an ambulance service is responsible for paying the fee established by the Colorado bureau of investigation for conducting the fingerprint-based criminal history record check to the bureau.
(b) The department may deny a license or renewal of a license if the results of a criminal history record check of an owner or operator demonstrate that the owner or operator has been convicted of a felony or a misdemeanor involving conduct that the department determines could pose a risk to the health, safety, or welfare of ambulance service patients.
(c) (I) If an ambulance service applying for an initial license is temporarily unable to satisfy all of the requirements for licensure, the department may issue a provisional license to the ambulance service; except that the department shall not issue a provisional license to an ambulance service if operation of the ambulance service will adversely affect the health, safety, or welfare of the ambulance service's patients.
(II) The department may require an ambulance service applying for a provisional license to demonstrate to the department's satisfaction that the ambulance service is taking sufficient steps to satisfy all of the requirements for full licensure. A provisional license is valid for ninety days and may be renewed one time at the department's discretion.
(4) (a) In investigating alleged violations of this part 3 or rules adopted pursuant to this part 3, the department may administer oaths to, or take affirmations of, witnesses, and issue subpoenas to compel the attendance of witnesses and the production of all relevant records and documents.
A provisional license is valid for ninety days and may be renewed one time at the department's discretion.
(4) (a) In investigating alleged violations of this part 3 or rules adopted pursuant to this part 3, the department may administer oaths to, or take affirmations of, witnesses, and issue subpoenas to compel the attendance of witnesses and the production of all relevant records and documents.
(b) Upon the failure of a witness to comply with a subpoena, the department may apply to a district court for an order requiring the person to appear before the department or an administrative law judge, to produce the relevant records or documents, or to give testimony or evidence related to the matter under investigation. When applying for a district court order, the department shall apply to the district court of the county in which the subpoenaed person resides or conducts business. The court may punish a failure to comply with a subpoena issued by the department as a contempt of court.
(5) A person acting as a witness or consultant to the department, a witness testifying, or a person, including an employer, that reports misconduct to the department under this section is immune from liability in any civil action brought for acts occurring while testifying, producing evidence, or reporting misconduct under this section if the person was acting in good faith and with a reasonable belief of the facts testified to, produced as part of evidence, or reported.
(6) All records, documents, testimony, or evidence obtained pursuant to this section remains confidential except to the extent necessary to support the administrative action taken by the department, to refer the matter to another local government, state, or federal agency with regulatory authority, or to refer the matter to a law enforcement agency for criminal prosecution.
C.R.S. § 25-3.5-318 License denial, suspension, revocation, or refusal to renew
25-3.5-318. License denial, suspension, revocation, or refusal to renew. (1) In denying a license application, the department shall issue its denial in accordance with article 4 of title 24.
(2) (a) The department may suspend, revoke, or refuse to renew the license of an ambulance service that is out of compliance with the requirements of this part 3 or rules adopted pursuant to this part 3. Except as provided in subsection (2)(b) of this section, before taking final action to suspend or revoke a license, the department shall conduct a hearing on the matter in accordance with article 4 of title 24.
(b) The department may summarily suspend a license before a hearing in accordance with section 24-4-104 (4)(a).
(3) After conducting a hearing pursuant to subsection (2)(a) of this section and in accordance with article 4 of title 24, the department may revoke or refuse to renew an ambulance service license if an owner or operator of the ambulance service has been convicted of a felony or misdemeanor involving conduct that the department determines could pose a risk to the health, safety, or welfare of the ambulance service's patients.
(4) (a) The department may impose intermediate restrictions or conditions on an ambulance service, which restrictions or conditions may require the ambulance service to:
(I) Retain a consultant to address corrective measures;
(II) Be monitored by the department for a specific period;
(III) Provide additional training to its employees, contractors, owners, or operators;
(IV) Comply with a directed written plan to correct the violation in accordance with procedures established pursuant to section 25-27.5-108 (2)(b); or
(V) Pay a civil penalty of up to five hundred dollars per violation.
(b) (I) With respect to any civil penalties that the department assesses against an ambulance service pursuant to subsection (4)(a)(V) of this section, the department, after providing the ambulance service with notice and an opportunity for a hearing pursuant to section 24-4-105, shall transmit any penalties collected from the ambulance service to the state treasurer, who shall credit the money to the general fund.
(II) Upon request of the ambulance service assessed civil penalties pursuant to this subsection (4), the department shall grant a stay of payment of the civil penalties until final disposition of the intermediate restrictions or conditions imposed on the ambulance service pursuant to this subsection (4).
C.R.S. § 25-3.5-401 Responsibility for coordination
25-3.5-401. Responsibility for coordination. (1) The telecommunications subsystem shall be used to maintain effective interface with the other components of the system, which shall include but not be limited to the following:
(a) To dispatch the ambulance;
(b) To maintain contact while en route to the scene of the emergency;
(c) To provide for triage at the scene of the emergency;
(d) To provide for treatment while en route to the primary emergency care center;
(e) To arrange for transfer to advanced emergency care centers.
(2) (a) The department of personnel, in consultation with the office of information technology created in the office of the governor, shall coordinate the telecommunications subsystem with the existing state telecommunications network to the extent possible.
(b) Repealed.
C.R.S. § 25-3.5-402 Local government participation
25-3.5-402. Local government participation. The department of personnel shall consult with local government entities to ensure that provision is made for their entry into the statewide telecommunications subsystem and that their present resources are being fully utilized.
C.R.S. § 25-3.5-403 Poison information center - state funding
25-3.5-403. Poison information center - state funding. (Repealed)
C.R.S. § 25-3.5-501 Records - ambulance services to report - access to patient information
25-3.5-501. Records - ambulance services to report - access to patient information. (1) Each ambulance service shall prepare and transmit copies of uniform and standardized records, as specified by regulation adopted by the department, concerning the transportation and treatment of patients in order to evaluate the performance of the emergency medical services system and to plan systematically for improvements in said system at all levels.
(2) The record forms adopted by the department may distinguish between rural ambulance service and urban ambulance service and between mobile intensive care units and basic ambulance service.
(3) The department shall make individualized patient information from its EMS agency patient care database available to health information organization networks for uses allowed under the federal "Health Insurance Portability and Accountability Act of 1996", as amended, Pub.L. 104-191. The department shall contract with health information organization networks regarding accessing patient information and limiting the use of information to purposes allowed under the "Health Insurance Portability and Accountability Act of 1996", as amended.
C.R.S. § 25-3.5-502 Forms and reports - repeal
25-3.5-502. Forms and reports - repeal. (Repealed)
C.R.S. § 25-3.5-601 Legislative declaration
25-3.5-601. Legislative declaration. (1) The general assembly recognizes that an efficient and reliable statewide emergency medical and trauma network would serve not only to promote the health, safety, and welfare of Colorado residents, but would also, by increasing safety throughout the state, indirectly serve to facilitate tourism and economic development in the state.
(2) The general assembly also finds that accident victims are often transported over state highways and that an improved response to accidents through an efficient and reliable statewide emergency medical and trauma network impacts both directly and indirectly on the maintenance and supervision of the public highways of this state.
(3) Therefore, it is the purpose of this part 6 to enhance emergency medical and trauma services statewide by financially assisting local emergency medical and trauma service providers who operate or wish to operate in the counties in their efforts to improve the quality and effectiveness of local emergency medical and trauma services, including emergency medical and trauma equipment and communications, and by supporting the overall coordination of such efforts by the department.
C.R.S. § 25-3.5-602 Definitions
25-3.5-602. Definitions. As used in this part 6, unless the context otherwise requires:
(1) "Council" means the state emergency medical and trauma services advisory council created in section 25-3.5-104.
(2) "Department" means the department of public health and environment.
(3) "EMTS" means emergency medical and trauma services.
(4) "Local emergency medical and trauma service providers" includes, but is not limited to, local governing boards, training centers, hospitals, special districts, and other private and public service providers that have as their purpose the provision of emergency medical and trauma services.
C.R.S. § 25-3.5-603 Emergency medical services account - creation - allocation of funds
25-3.5-603. Emergency medical services account - creation - allocation of funds. (1) (a) There is hereby created a special account within the highway users tax fund established under section 43-4-201, to be known as the emergency medical services account, which consists of all money transferred into the account in accordance with section 42-3-304 (21), fees collected under section 25-3.5-203 for provisional certifications or licenses of emergency medical service providers, and fees collected under section 25-3.5-1103 for provisional registration of emergency medical responders.
(b) All moneys in and state FTE funded by the emergency medical services account shall be subject to annual appropriation by the general assembly.
(c) At the end of any fiscal year, all unexpended and unencumbered moneys in the emergency medical services account shall remain therein and shall not be credited or transferred to the general fund or any other fund. Any interest earned on the investment or deposit of moneys in the account shall also remain in the account and shall not be credited to the general fund.
(2) (Deleted by amendment, L. 2005, p. 280, § 13, effective August 8, 2005.)
(3) The general assembly shall appropriate money in the emergency medical services account:
(a) (I) To the department for distribution as grants to local emergency medical and trauma service providers pursuant to the emergency medical and trauma services (EMTS) grant program set forth in section 25-3.5-604.
(II) Of the amount appropriated under subparagraph (I) of this paragraph (a) for grants:
(A) One hundred thousand dollars shall remain in the account for unexpected emergencies that arise after the deadline for grant applications has passed. The department and the council shall promulgate any rules necessary to define the expenditures of such emergency funds.
(B) The department shall award a minimum of one hundred fifty thousand dollars to offset the training costs of emergency medical service providers, emergency medical dispatchers, emergency medical services instructors, emergency medical services coordinators, and other personnel who provide emergency medical services. Of said one hundred fifty thousand dollars, no less than eighty percent shall be used in the training of emergency medical service providers.
(b) (I) To the department for distribution for each Colorado county within a RETAC no less than fifteen thousand dollars and seventy-five thousand dollars to each RETAC, in accordance with section 25-3.5-605 for planning and, to the extent possible, coordination of emergency medical and trauma services in the county and between counties when such coordination would provide for better service geographically. In the event that a RETAC is composed of less than five counties as of July 1, 2002, the council shall recommend that for each Colorado county within such RETAC, the RETAC shall receive fifteen thousand dollars in accordance with section 25-3.5-605 for planning and, to the extent possible, coordination of emergency medical and trauma services in the county and between counties when such coordination would provide for better service geographically. Any RETAC may apply for additional moneys and may receive such moneys if the request is approved by the council, so long as the moneys are used in accordance with section 25-3.5-605 for planning and, to the extent possible, coordination of emergency medical and trauma services in the county and between counties when such coordination would provide for better service geographically.
(II) A county may request to the council that the county's representative fifteen thousand dollars be divided between two different RETACs pursuant to section 25-3.5-704 (2)(c)(IV)(B).
25-3.5-605 for planning and, to the extent possible, coordination of emergency medical and trauma services in the county and between counties when such coordination would provide for better service geographically.
(II) A county may request to the council that the county's representative fifteen thousand dollars be divided between two different RETACs pursuant to section 25-3.5-704 (2)(c)(IV)(B).
(c) To the direct and indirect costs of planning, developing, implementing, maintaining, and improving the statewide emergency medical and trauma services system. These costs include:
(I) Providing technical assistance and support to local governments, local emergency medical and trauma service providers, and RETACs operating a statewide data collection system, coordinating local and state programs, providing assistance in selection and purchasing of medical and communication equipment, administering the EMTS grant program, establishing and maintaining scope of practice for certified or licensed emergency medical service providers, and administering a registration program for emergency medical responders; and
(II) The costs of the department of revenue in collecting the additional motor vehicle registration fee pursuant to section 42-3-304 (21), C.R.S.
C.R.S. § 25-3.5-604 EMTS grant program - EMS account - role of council and department - rules - awards
25-3.5-604. EMTS grant program - EMS account - role of council and department - rules - awards. (1) (a) The council shall make recommendations to the department concerning the application for and distribution of moneys from the EMS account for the development, maintenance, and improvement of emergency medical and trauma services in Colorado and for the establishment of priorities for emergency medical and trauma services grants.
(b) Any rules that relate to the distribution of grants shall provide that awards shall be made on the basis of a substantiated need and that priority shall be given to those applicants that have underdeveloped or aged emergency medical and trauma services equipment or systems.
(c) The department, upon recommendations from the council, shall allocate moneys pursuant to section 25-3.5-603.
(2) (a) Applications for grants shall be made to the department commencing January, 2001, and each January thereafter, except as otherwise provided in section 25-3.5-603 (3).
(b) The department shall review each application and make awards in accordance with the rules promulgated pursuant to subsection (1) of this section.
(c) Grants awarded under this section shall require local matching funds, unless such requirement is waived by the council upon demonstration that local sources of matching funds are not available.
(3) Grants shall be awarded July 1 of each year.
(4) The council shall review the adequacy of funding for each RETAC for the period beginning July 1, 2002. The review shall be completed by December 31, 2005. The council may recommend any necessary changes to the department as a result of the review conducted pursuant to this subsection (4).
C.R.S. § 25-3.5-605 Improvement of county emergency medical and trauma services - eligibility for county funding - manner of distributing funds
25-3.5-605. Improvement of county emergency medical and trauma services - eligibility for county funding - manner of distributing funds. (1) Moneys in the emergency medical services account shall be apportioned pursuant to subsection (2.5) of this section.
(2) In order to qualify for money under this section, a county must:
(a) Comply with all provisions of part 3 of this article 3.5 regarding the authorization to operate ambulance services in the county;
(b) Require all licensed ambulance services to utilize the statewide emergency medical and trauma services uniform prehospital care reporting system operated by the department;
(c) Repealed.
(d) Ensure that all money received under this section is expended on developing and updating the emergency medical and trauma services plan and other emergency medical and trauma services needs of the county such as:
(I) Training and certification or licensure of emergency medical service providers;
(II) Assisting local emergency medical and trauma providers in applying for grants under section 25-3.5-604;
(III) Improving the emergency medical and trauma services system on a county wide or regional basis and implementing the county emergency medical and trauma services plan.
(e) Repealed.
(2.5) (a) On or before October 1, 2003, and on or before October 1 each year thereafter, each RETAC shall submit to the council an annual financial report that details the expenditure of moneys received. Such report shall be in a format specified by the council and the department. In instances where the council finds such report inadequate, the RETAC shall resubmit the report to the council by December 1 of the same year.
(b) On or before July 1, 2003, and on or before July 1 each odd-numbered year thereafter, each RETAC shall submit to the council a biennial plan that details the RETAC's EMTS plan and any revisions pursuant to section 25-3.5-704 (2)(c)(I)(B). If the RETAC includes a county that has been divided geographically pursuant to section 25-3.5-704 (2)(c)(IV), the plan shall include an evaluation of such division. Such plan shall be in a format specified by the council and the department. In instances where the council finds such plan inadequate, the RETAC shall resubmit the plan to the council by September 14 of the same year.
(c) On or before October 15, 2003, and on or before October 15 each odd-numbered year thereafter, the council shall submit to the department a plan for all RETACs in the state. On or before November 1, 2003, and on or before November 1 each odd-numbered year thereafter, the department, in consultation with the council, shall approve a plan for all RETACs in the state.
(3) Funds distributed to counties and RETACs pursuant to this section shall be used in planning the improvement of existing county emergency medical and trauma service programs and shall not be used to supplant moneys already allocated by the county for emergency medical and trauma services.
(4) (a) Failure to comply with the requirements of subsection (2) of this section shall render a county ineligible to receive moneys from the emergency medical services account until the following January.
(b) At the end of any fiscal year, moneys which are not distributed to a county shall remain in the emergency medical services account until the following January.
C.R.S. § 25-3.5-606 Annual report
25-3.5-606. Annual report. No later than January 1, 1991, and prior to November 1 of each year thereafter, the department, in cooperation with the council, shall submit a report to the health, environment, welfare, and institutions committees and the joint budget committee of the general assembly on the moneys credited to the emergency medical services account and on the expenditure of such moneys during the preceding fiscal year. Such report shall contain a listing of the grant recipients, proposed projects, and a statement of the short-term and long-term planning goals of the department and the council to further implement the provisions of this part 6.
C.R.S. § 25-3.5-607 Repeal of part
25-3.5-607. Repeal of part. (Repealed)
C.R.S. § 25-3.5-701 Short title
25-3.5-701. Short title. This part 7 shall be known and may be cited as the "Statewide Trauma Care System Act".
C.R.S. § 25-3.5-702 Legislative declaration
25-3.5-702. Legislative declaration. (1) The general assembly hereby finds and declares that trauma is the greatest single cause of death and disability in Colorado for persons under the age of forty-five years and that trauma care is a unique type of emergency medical service.
(2) The general assembly further finds that a trauma system task force made up of various emergency health and trauma care entities submitted a report to the general assembly in 1993 indicating a compelling need to develop and implement a statewide trauma care system in order to assure that appropriate resources are available to trauma victims from the point of injury through rehabilitative care. In addition, a statewide system is essential to provide Colorado residents and visitors with a greater probability of surviving a life-threatening injury and to reduce trauma-related morbidity and mortality in this state.
(3) The general assembly, therefore, declares that it is necessary to enact legislation directing the board of health to adopt rules that govern the implementation and oversight of the trauma care system. The general assembly further declares that to ensure the availability and coordination of resources necessary to provide essential care, it is necessary to enact legislation that directs the department of public health and environment to collaborate with existing agencies and organizations, including governing bodies for counties and cities and counties, in implementing and monitoring a statewide trauma care system.
C.R.S. § 25-3.5-703 Definitions
25-3.5-703. Definitions. As used in this article, unless the context otherwise requires:
(1) (Deleted by amendment, L. 2000, p. 537, § 16, effective July 1, 2000.)
(2) "Board" means the state board of health.
(3) Repealed.
(3.5) "Council" means the state emergency medical and trauma services advisory council created by section 25-3.5-104.
(4) "Designation" means the process undertaken by the department to assign a status to a health-care facility based on the level of trauma services the facility is capable of and committed to providing to injured persons. Facilities may be designated at one of the following levels:
(a) Nondesignated, which is for facilities that do not meet the criteria required for level I to V facilities, but that receive and are accountable for injured persons, which accountability includes having a transfer agreement to transfer persons to level I to V facilities as determined by rules promulgated by the board;
(a.5) Level V, which is for basic trauma care in rural areas, including resuscitation, stabilization, and arrangement for the transfer of all patients with potentially life- or limb-threatening injuries, consistent with triage and transport protocols as recommended by the council and adopted by the board. Level V facilities shall transfer patients within their own region or to a higher level facility in another region, as described in paragraphs (c), (d), and (e) of this subsection (4).
(b) Level IV, which is for basic trauma care, including resuscitation, stabilization, and arrangement for appropriate transfer of persons requiring a higher level of care based upon patient criticality and triage practices within each facility, which are consistent with triage criteria and transport protocols as recommended by the council and adopted by the board. These facilities must transfer appropriate patients to a higher level facility within their own region or to a higher level facility in another region, as described in paragraphs (d) and (e) of this subsection (4).
(c) Level III, which is for general trauma care, including resuscitation, stabilization, and assessment of injured persons, and either the provision of care for the injured person or arrangement for appropriate transfer based upon patient criticality and triage practices within each facility, which are consistent with triage criteria and transport protocols as recommended by the council and adopted by the board. The facilities must transfer appropriate patients to a higher level facility within its own region or to a higher level facility in another region, as described in paragraphs (d) and (e) of this subsection (4).
(d) Level II, which is for major trauma care based upon patient criticality and triage practices within each facility, which are consistent with triage criteria and transport protocols as recommended by the council and adopted by the board. This type of facility may serve as a resource for lower level facilities when a level I facility, as described in paragraph (e) of this subsection (4), is not available within its region, but it is not a facility required to conduct research or provide comprehensive services through subspecialty units such as, but not limited to, burn units, spinal cord injury centers, eye trauma centers, and reimplantation centers.
(e) Level I, which is for comprehensive trauma care, including the acute management of the most severely injured patients, which is a facility that may serve as the ultimate resource for lower level facilities or as the key resource facility for a trauma area and which is a facility that provides education in trauma-related areas for health-care professionals and performs trauma research;
enters.
(e) Level I, which is for comprehensive trauma care, including the acute management of the most severely injured patients, which is a facility that may serve as the ultimate resource for lower level facilities or as the key resource facility for a trauma area and which is a facility that provides education in trauma-related areas for health-care professionals and performs trauma research;
(f) Regional pediatric trauma center, which is a facility that provides comprehensive pediatric trauma care, including acute management of the most severely injured pediatric trauma patients, and is a facility that may serve as an ultimate resource for lower level facilities on pediatric trauma care, and which is a facility that performs pediatric trauma research and provides pediatric trauma education for health-care professionals. No facility shall be deemed a regional pediatric trauma center unless the facility predominately serves children and is a facility where at least eighty-five percent of hospital admissions are for individuals who are under eighteen years of age. A separate administrative unit within a general hospital or hospital system shall not be deemed a regional pediatric trauma center.
(5) (Deleted by amendment, L. 2000, p. 537, § 16, effective July 1, 2000.)
(6) "Interfacility transfer" means the movement of a trauma victim from one facility to another.
(6.5) "Key resource facility" means a level I or level II certified trauma facility that provides consultation and technical assistance to a RETAC, as such term is defined in subsection (6.8) of this section, regarding education, quality, training, communication, and other trauma issues described in this part 7 that relate to the development of the statewide trauma care system.
(6.8) "Regional emergency medical and trauma services advisory council" or "RETAC" means the representative body appointed by the governing bodies of counties or cities and counties for the purpose of providing recommendations concerning regional area emergency medical and trauma service plans for such counties or cities and counties.
(7) Repealed.
(8) "Statewide trauma registry" means a statewide database of information concerning injured persons and licensed facilities receiving injured persons, which information is used to evaluate and improve the quality of patient management and care and the quality of trauma education, research, and injury prevention programs. The database integrates medical and trauma systems information related to patient diagnosis and provision of care. Such information includes epidemiologic and demographic information.
(9) "Trauma" means an injury or wound to a living person caused by the application of an external force or by violence. Trauma includes any serious life-threatening or limb-threatening situations.
(10) "Trauma care system" means an organized approach to providing quality and coordinated care to trauma victims throughout the state on a twenty-four-hour per day basis by transporting a trauma victim to the appropriate trauma designated facility.
(11) "Trauma transport protocols" means written standards adopted by the board that address the use of appropriate resources to move trauma victims from one level of care to another on a continuum of care.
(12) "Triage" means the assessment and classification of an injured person in order to determine the severity of trauma injury and to prioritize care for the injured person.
(13) "Verification process" means a procedure to evaluate a facility's compliance with trauma care standards established by the board and to make recommendations to the department concerning the designation of a facility.
C.R.S. § 25-3.5-704 Statewide emergency medical and trauma care system - development and implementation - duties of department - rules
25-3.5-704. Statewide emergency medical and trauma care system - development and implementation - duties of department - rules. (1) The department shall develop, implement, and monitor a statewide emergency medical and trauma care system in accordance with the provisions of this part 7 and with rules adopted by the board. Pursuant to section 24-50-504 (2), the department may contract with any public or private entity in performing any of its duties concerning education, the statewide trauma registry, and the verification process as set forth in this part 7.
(2) The board shall adopt rules for the statewide emergency medical and trauma care system, including but not limited to the following:
(a) Minimum services in rendering patient care. These rules ensure the appropriate access through designated centers to the following minimum services:
(I) Prehospital care;
(II) Hospital care;
(III) Rehabilitative care;
(IV) Injury prevention;
(V) Disaster medical care;
(VI) Education and research; and
(VII) Trauma communications.
(b) Transport protocols. The board shall set forth trauma transport protocols in these rules, which include but are not limited to a requirement that a facility that receives an injured person provide the appropriate available care, which may include stabilizing an injured person before transferring that person to the appropriate facility based on the person's injury. These rules ensure that when the most appropriate trauma facility for an injured person is not easily accessible in an area, that person will be transferred as soon as medically feasible to the nearest appropriate facility, which may be in or out of the state. These rules shall conform with applicable federal law governing the transfer of patients.
(c) Regional emergency medical and trauma advisory councils - plans established - process. (I) These rules provide for the implementation of regional emergency medical and trauma system plans that describe methods for providing the appropriate service and care to persons who are ill or injured in areas included under a regional emergency medical and trauma system plan. In these rules, the board shall specify that:
(A) The governing body of each county or city and county throughout the state shall establish a regional emergency medical and trauma advisory council (RETAC) with the governing body of four or more other counties, or with the governing body of a city and county, to form a multicounty RETAC. The number of members on a RETAC shall be defined by the participating counties. Membership shall reflect, as equally as possible, representation between hospital and prehospital providers and from each participating county and city and county. There shall be at least one member from each participating county and city and county in the RETAC. Each county within a RETAC shall be located in reasonable geographic proximity to the other counties and city and counties within the same RETAC. In establishing a RETAC, the governing body shall obtain input from health-care facilities and providers within the area to be served by the RETAC. If the governing body for a county or city and county fails to establish a RETAC by July 1, 2002, two counties with a combined population of at least seven hundred fifty thousand residents may apply to the council for establishment of a RETAC of fewer than four counties. The council shall conduct a hearing with all counties that may be affected by the establishment of a RETAC with fewer than four counties before deciding whether to grant such application. The decision on such an application shall be completed within sixty days after the date of application. For all other counties that do not qualify as a two-county RETAC and that have not established a RETAC by July 1, 2002, the council shall designate an established RETAC to serve as the county's or city and county's RETAC.
ewer than four counties before deciding whether to grant such application. The decision on such an application shall be completed within sixty days after the date of application. For all other counties that do not qualify as a two-county RETAC and that have not established a RETAC by July 1, 2002, the council shall designate an established RETAC to serve as the county's or city and county's RETAC.
(B) No later than July 1, 2003, each RETAC with approval from the governing bodies for a multicounty RETAC shall submit a regional emergency medical and trauma system plan to the council for approval by the department. If the governing body for a county or city and county fails to submit a plan, if a county or city and county is not included in a multicounty plan, or, if a multicounty plan is not approved pursuant to a procedure established by the board for approving plans, the department shall design a plan for the county, city and county, or multicounty area.
(II) In addition to any issues the board requires to be addressed, every regional emergency medical and trauma system plan shall address the following issues:
(A) The provision of minimum services and care at the most appropriate facilities in response to the following factors: Facility-established triage and transport plans; interfacility transfer agreements; geographical barriers; population density; emergency medical services and trauma care resources; and accessibility to designated facilities;
(B) The level of commitment of counties and city and counties under a regional emergency medical and trauma system plan to cooperate in the development and implementation of a statewide communications system and the statewide emergency medical and trauma care system;
(C) The methods for ensuring facility and county or city and county adherence to the regional emergency medical and trauma system plan, compliance with board rules and procedures, and commitment to the continuing quality improvement system described in paragraph (h) of this subsection (2);
(D) A description of public information, education, and prevention programs to be provided for the area;
(E) A description of the functions that will be contracted services; and
(F) The identification of regional emergency medical and trauma system needs through the use of a needs assessment instrument developed by the department; except that the use of such instrument shall be subject to approval by the counties and city and counties included in a RETAC.
(III) The board shall specify in regional emergency medical and trauma system plan rules the time frames for approving regional emergency medical and trauma system plans and for resubmitting plans, as well as the number of times the plans may be resubmitted by a governing body before the department designs a plan for a multicounty area. The department shall provide technical assistance to any RETAC for preparation, implementation, and modification, as necessary, of regional emergency medical and trauma system plans.
(IV) (A) A county may request that the county be included in two separate RETACs because of geographical concerns. The council shall review and approve any request that a county be divided prior to inclusion within two separate RETACs if the county demonstrates such a division will not adversely impact the emergency medical and trauma needs for the county, that such a division is beneficial to both RETACs, and that such division does not create a RETAC with fewer than five contiguous counties, except for RETACs that contain two counties with a combined population of at least seven hundred fifty thousand residents pursuant to sub-subparagraph (A) of subparagraph (I) of this paragraph (c).
(B) A county that is included in two separate RETACs may request that the council allocate any portion of the fifteen thousand dollars received by a RETAC, pursuant to section 25-3.5-603, between the two separate RETACs.
hat contain two counties with a combined population of at least seven hundred fifty thousand residents pursuant to sub-subparagraph (A) of subparagraph (I) of this paragraph (c).
(B) A county that is included in two separate RETACs may request that the council allocate any portion of the fifteen thousand dollars received by a RETAC, pursuant to section 25-3.5-603, between the two separate RETACs.
(d) Designation of facilities. The designation rules shall provide that every facility in this state required to be licensed in accordance with article 3 of this title and that receives ambulance patients shall participate in the statewide emergency medical and trauma care system. Each such facility shall submit an application to the department requesting designation as a specific level trauma facility or requesting nondesignation status. A facility that is given nondesignated status shall not represent that it is a designated facility, as prohibited in section 25-3.5-707. The board shall include provisions for the following:
(I) The criteria to be applied for designating and periodically reviewing facilities based on level of care capability providing trauma care. In establishing such criteria, the board shall take into consideration recognized national standards including, but not limited to, standards on trauma resources for optimal care of the injured patient adopted by the American college of surgeons' committee and the guidelines for trauma care systems adopted by the American college of emergency physicians.
(II) A verification process;
(III) The length of a designation period;
(IV) The process for evaluating, reviewing, and designating facilities, including an ongoing periodic review process for designated facilities, which process shall take into account the national standards referenced in subparagraph (I) of this paragraph (d). Each facility shall be subject to review in accordance with rules adopted pursuant to this paragraph (d). In the event a certified facility seeks to be designated at a different level or seeks nondesignation status, the facility shall comply with the board's procedures for initial designation.
(V) Disciplinary sanctions, which shall be limited to the revocation of a designation, temporary suspension while the facility takes remedial steps to correct the cause of the discipline, redesignation, or assignment of nondesignation status to a facility;
(VI) A designation fee established in accordance with section 25-3.5-705; and
(VII) An appeals process concerning department decisions in connection with evaluations, reviews, designations, and sanctions.
(e) Communications system. (I) The communications system rules shall require that a regional emergency medical and trauma system plan ensure citizen access to emergency medical and trauma services through the 911 telephone system or its local equivalent and that the plan include adequate provisions for:
(A) Public safety dispatch to ambulance service and for efficient communication from ambulance to ambulance and from ambulance to a designated facility;
(B) Efficient communications among the trauma facilities and between trauma facilities and other medical care facilities;
(C) Efficient communications among service agencies to coordinate prehospital, day-to-day, and disaster activities; and
(D) Efficient communications among counties and RETACs to coordinate prehospital, day-to-day, and disaster activities.
(II) In addition, the board shall require that a regional emergency medical and trauma system plan identify the key resource facilities for the area. The key resource facilities shall assist the RETAC in resolving trauma care issues that arise in the area and in coordinating patient destination and interfacility transfer policies to assure that patients are transferred to the appropriate facility for treatment in or outside of the area.
e that a regional emergency medical and trauma system plan identify the key resource facilities for the area. The key resource facilities shall assist the RETAC in resolving trauma care issues that arise in the area and in coordinating patient destination and interfacility transfer policies to assure that patients are transferred to the appropriate facility for treatment in or outside of the area.
(f) Statewide trauma registry. (I) The registry rules shall require the department to establish and oversee the operation of a statewide trauma registry. The rules shall allow for the provision of technical assistance and training to designated facilities within the various trauma areas in connection with requirements to collect, compile, and maintain information for the statewide central registry. Each licensed facility, clinic, or prehospital provider that provides any service or care to or for persons with trauma injury in this state shall collect the information described in this subparagraph (I) about any such person who is admitted to a hospital as an inpatient or transferred from one facility to another or who dies from trauma injury. The facility, clinic, or prehospital provider shall submit the following information to the registry:
(A) Admission and readmission information;
(B) Number of trauma deaths;
(C) Number and types of transfers to and from the facility or the provider; and
(D) Injury cause, type, and severity.
(II) In addition to the information described in subparagraph (I) of this paragraph (f), facilities designated as level I, II, or III shall provide such additional information as may be required by board rules.
(III) The registry rules shall include provisions concerning access to information in the registry that does not identify patients or physicians. Any data maintained in the registry that identifies patients or physicians shall be strictly confidential and shall not be admissible in any civil or criminal proceeding.
(g) Public information, education, and injury prevention. The department and county, district, and municipal public health agencies may operate injury prevention programs, but the public information, education, and injury prevention rules shall require the department and county, district, and municipal public health agencies to consult with the state and regional emergency medical and trauma advisory councils in developing and implementing area and state-based injury prevention and public information and education programs including, but not limited to, a pediatric injury prevention and public awareness component. In addition, the rules shall require that regional emergency medical and trauma system plans include a description of public information and education programs to be provided for the area.
(h) (I) Continuing quality improvement system (CQI). These rules require the department to oversee a continuing quality improvement system for the statewide emergency medical and trauma care system. The board shall specify the methods and periods for assessing the quality of regional emergency medical and trauma systems and the statewide emergency medical and trauma care system. These rules must include the following requirements:
(A) That RETACs assess periodically the quality of their respective regional emergency medical and trauma system plans and that the state assess periodically the quality of the statewide emergency medical and trauma care system to determine whether positive results under regional emergency medical and trauma system plans and the statewide emergency medical and trauma care system can be demonstrated;
(B) That all facilities comply with the trauma registry rules;
e regional emergency medical and trauma system plans and that the state assess periodically the quality of the statewide emergency medical and trauma care system to determine whether positive results under regional emergency medical and trauma system plans and the statewide emergency medical and trauma care system can be demonstrated;
(B) That all facilities comply with the trauma registry rules;
(C) That reports concerning regional emergency medical and trauma system plans include results for the emergency medical and trauma area, identification of problems under the regional emergency medical and trauma system plan, and recommendations for resolving problems under the plan. In preparing these reports, the RETACs shall obtain input from facilities, counties included under the regional emergency medical and trauma system plan, and service agencies.
(D) That the names of patients or information that identifies individual patients shall be kept confidential and shall not be publicly disclosed without the patient's consent;
(E) That the department be allowed access to prehospital, hospital, and coroner records of emergency medical and trauma patients to assess the continuing quality improvement system for the area and state-based injury prevention and public information and education programs pursuant to subsection (2)(g) of this section. All information provided to the department shall be confidential pursuant to this subsection (2)(h). To the greatest extent possible, patient-identifying information shall not be gathered. If patient-identifying information is necessary, the department shall keep such information strictly confidential, and such information may only be released outside of the department upon written authorization of the patient. The department shall prepare an annual report that includes an evaluation of the statewide emergency medical and trauma services system. Such report shall be distributed to all designated trauma centers, ambulance services, and service agencies.
(F) That nothing in this subsection (2)(h)(I) prohibits the department from providing information to health information organization networks from its EMS agency patient care database including access to individualized patient information in accordance with section 25-3.5-501 (3).
(II) Data or information related to the identification of individual patient's, provider's, or facility's care outcomes collected as a result of the continuing quality improvement system and records or reports collected or compiled as a result of the continuing quality improvement system are confidential and are exempt from the open records law in part 2 of article 72 of title 24. Data, information, records, or reports are not subject to subpoena or discovery and are not admissible in any civil action, except pursuant to a court order that provides for the protection of sensitive information about interested parties. Nothing in this subsection (2)(h)(II):
(A) Precludes the patient or the patient's representative from obtaining the patient's medical records as provided in section 25-1-801;
(B) Shall be construed to allow access to confidential professional review committee records or reviews conducted under part 2 of article 30 of title 12; or
(C) Prohibits the department from providing information to health information organization networks from its EMS agency patient care database including individualized patient information in accordance with section 25-3.5-501 (3).
(III) That reports concerning regional emergency medical and trauma system plans include results for the emergency medical and trauma area, identification of problems under the regional emergency medical and trauma system plan, and recommendations for resolving problems under the plan. In preparing these reports, the RETACs shall obtain input from facilities, counties included under the regional emergency medical and trauma system plan, and service agencies.
rauma system plans include results for the emergency medical and trauma area, identification of problems under the regional emergency medical and trauma system plan, and recommendations for resolving problems under the plan. In preparing these reports, the RETACs shall obtain input from facilities, counties included under the regional emergency medical and trauma system plan, and service agencies.
(i) Trauma care for pediatric patients. The trauma care for pediatric patient rules shall provide for the improvement of the quality of care for pediatric patients.
(3) The board shall adopt rules that take into consideration recognized national standards for emergency medical and trauma care systems, such as the standards on trauma resources for optimal care of the injured patient adopted by the American college of surgeons' committee on trauma and the guidelines for emergency medical and trauma care systems adopted by the American college of emergency physicians and the American academy of pediatrics.
(4) The board shall adopt and the department shall use only cost-efficient administrative procedures and forms for the statewide emergency medical and trauma care system.
(5) In adopting its rules, the board shall consult with and seek advice from the council, as defined in section 25-3.5-703 (3.5), where appropriate, and from any other appropriate agency. In addition, the board shall obtain input from appropriate health-care agencies, institutions, facilities, and providers at the national, state, and local levels and from counties and city and counties.
C.R.S. § 25-3.5-705 Creation of fee - creation of trauma system cash fund
25-3.5-705. Creation of fee - creation of trauma system cash fund. (1) The board is authorized, by rule, to establish a schedule of fees based on the direct and indirect costs incurred in designating facilities. In addition, the department is authorized to collect the appropriate fee on the schedule. The board may adjust fees in amounts necessary to cover such costs. The fees collected pursuant to this section shall be deposited in the trauma system cash fund created by subsection (2) of this section.
(2) There is hereby created in the state treasury a statewide trauma care system cash fund. All moneys in the fund shall be subject to appropriation by the general assembly for allocation to the department to administer the trauma system. Any moneys in the fund not appropriated shall remain in the fund and shall not be transferred or revert to the general fund at the end of any fiscal year. All interest derived from the deposit and investment of moneys in the fund shall remain in the fund.
C.R.S. § 25-3.5-706 Immunity from liability
25-3.5-706. Immunity from liability. The department, the board, the council as defined in section 25-3.5-703 (3.5), a RETAC as defined in section 25-3.5-703 (6.8), the emergency medical practice advisory council created in section 25-3.5-206, key resource facilities, any other public or private entity acting on behalf of or under contract with the department, and counties and cities and counties shall be immune from civil and criminal liability and from regulatory sanction for acting in compliance with the provisions of this part 7. Nothing in this section shall be construed as providing any immunity to such entities or any other person in connection with the provision of medical treatment, care, or services that are governed by the medical malpractice statutes, article 64 of title 13, C.R.S.
C.R.S. § 25-3.5-707 False representation as trauma facility - penalty
25-3.5-707. False representation as trauma facility - penalty. (1) No facility, or agent or employee of a facility, shall represent that the facility functions as a level I, II, III, IV, or V trauma facility unless the facility possesses a valid certificate of designation issued pursuant to section 25-3.5-704 (2)(d). In addition, no facility, provider, or person shall violate any rule adopted by the board.
(2) Any facility, provider, or person who violates the provisions of subsection (1) of this section is subject to a civil penalty, which the board shall establish by rule, but which shall not exceed five hundred dollars. The penalty shall be assessed and collected by the department. Before a fee is collected, a facility, provider, or person shall be provided an opportunity for review of the assessed penalty. The procedures for review shall be in accordance with the "State Administrative Procedure Act", article 4 of title 24, C.R.S., and board rules. Any penalty collected pursuant to this section shall be transmitted to the state treasurer, who shall credit the same to the statewide trauma care system cash fund created in section 25-3.5-705.
C.R.S. § 25-3.5-708 Financing for statewide trauma system
25-3.5-708. Financing for statewide trauma system. (1) The implementation of the statewide trauma system shall be subject to the availability of:
(a) Federal transportation highway safety seed moneys that the department of transportation transfers to the department of public health and environment pursuant to an intergovernmental agreement between the two agencies;
(b) Moneys from the emergency medical services account within the highway users tax fund that are unexpended portions of state administrative funds that may be allocated pursuant to section 25-3.5-603 (2)(c). Nothing in this paragraph (b) shall be construed to authorize moneys that may be allocated pursuant to section 25-3.5-603 (2)(a)(I) or (2)(b) to be used for the financing of the administration of the statewide trauma system.
(c) Moneys from the statewide trauma care system cash fund created in section 25-3.5-705.
(2) In addition to any funds available pursuant to subsection (1) of this section, the executive director of the department of public health and environment is hereby authorized to accept any grants, donations, gifts, or contributions from any other private or public entity for the purpose of implementing this part 7.
C.R.S. § 25-3.5-709 Annual report
25-3.5-709. Annual report. No later than January 1, 1999, and prior to November 1 of each year thereafter, the department, in cooperation with the council, as defined in section 25-3.5-703 (3.5), shall submit a report to the health, environment, welfare, and institutions committees and the joint budget committee of the general assembly on the quality of the statewide emergency medical and trauma care system. Such report shall include an evaluation of each component of the statewide emergency medical and trauma care system and any recommendation for legislation concerning the statewide emergency medical and trauma care system or any component thereof.
C.R.S. § 25-3.5-801 Short title
25-3.5-801. Short title. This part 8 shall be known and may be cited as the "Tobacco Education, Prevention, and Cessation Act".
C.R.S. § 25-3.5-802 Legislative declaration
25-3.5-802. Legislative declaration. (1) The general assembly hereby finds that:
(a) The use of all types of tobacco products, including smokeless tobacco, results in a high incidence of addiction, disease, illness, and death;
(b) Persons who begin using and become addicted to tobacco products in their youth often face a lifetime of struggle and recurring illness in coping with and attempting to overcome addiction to tobacco products;
(c) Experimentation with tobacco products by youth is often a first step toward more serious drug experimentation and creates a greater likelihood that the youth who experiment with tobacco will at some point be addicted to even more harmful substances;
(d) Implementation of aggressive tobacco and substance abuse prevention, education, and cessation programs for school-age children is necessary to assist young people in avoiding and ending tobacco use;
(e) School districts, schools, and other entities that provide tobacco and substance abuse prevention, education, and cessation programs for school-age children should reach out to parents and encourage them to participate, either as students or role models, in implementing said programs.
(2) The general assembly finds that persons with behavioral or mental health disorders are more likely to abuse tobacco products than any other segment of society. The general assembly further finds that the unusually heavy pattern of tobacco abuse engaged in by persons with behavioral or mental health disorders requires special treatment strategies that are not provided by other alcohol, drug, or tobacco abuse programs or substance use disorder treatment programs. It is therefore the general assembly's intent that the programs funded pursuant to this part 8 include comprehensive programs to prevent and treat tobacco addiction among persons with behavioral or mental health disorders.
(3) The general assembly also finds that:
(a) Each year, thousands of people in this state die from diseases that have been clinically proven to be caused by or directly related to tobacco use;
(b) Once a person starts using tobacco, he or she usually becomes addicted to the nicotine contained in the tobacco, which makes it terribly difficult for the person to quit using tobacco even when the person is aware of the significant health risks that accompany tobacco use;
(c) Studies show that a child is at a substantially greater risk of starting to use tobacco if the child's parents or older siblings use tobacco. Therefore, reducing tobacco use by adults may significantly reduce the risk that children will begin using tobacco.
(d) Annual direct medical costs from tobacco use in Colorado currently exceed one billion dollars;
(e) Comprehensive tobacco education, prevention, and cessation programs may result in millions of dollars in savings to the state and individual residents of the state for generations.
C.R.S. § 25-3.5-803 Definitions
25-3.5-803. Definitions. As used in this part 8, unless the context otherwise requires:
(1) "Division" means the division within the department of public health and environment responsible for prevention services.
(2) "Entity" means any local government, county, district, or municipal public health agency, political subdivision of the state, county department of human or social services, state agency, state institution of higher education that offers a teacher education program, school, school district, or board of cooperative services or any private nonprofit or not-for-profit community-based organization. "Entity" also means a for-profit organization that applies for a grant for the sole purpose of providing a statewide public information campaign concerning tobacco use prevention and cessation.
(3) "Master settlement agreement" means the master settlement agreement, the smokeless tobacco master settlement agreement, and the consent decree approved and entered by the court in the case denominated State of Colorado, ex rel. Gale A. Norton, Attorney General v. R.J. Reynolds Tobacco Co.; American Tobacco Co., Inc.; Brown &Williamson Tobacco Corp.; Liggett & Myers, Inc.; Lorillard Tobacco Co., Inc.; Philip Morris, Inc.; United States Tobacco Co.; B.A.T. Industries, P.L.C.; The Council For Tobacco Research--U.S.A., Inc.; and Tobacco Institute, Inc., Case No. 97 CV 3432, in the district court for the city and county of Denver.
(4) "Program" means the tobacco education, prevention, and cessation grant program created in section 25-3.5-804.
(5) "State board" means the state board of health created in section 25-1-103.
C.R.S. § 25-3.5-804 Tobacco education, prevention, and cessation programs - review committee - grants - reimbursement for expenses
25-3.5-804. Tobacco education, prevention, and cessation programs - review committee - grants - reimbursement for expenses. (1) There is hereby created the tobacco education, prevention, and cessation grant program to provide funding for community-based and statewide tobacco education programs designed to reduce initiation of tobacco use by children and youth, promote cessation of tobacco use among youth and adults, and reduce exposure to secondhand smoke. Any such tobacco programs may be presented in combination with other substance abuse programs. The program shall be administered by the division within the department and coordinated with efforts pursuant to article 7 of title 44. The state board shall award grants to selected entities from money appropriated to the department from the tobacco education programs fund created in section 24-22-117.
(2) The state board shall adopt rules that specify, but are not necessarily limited to, the following:
(a) The procedures and timelines by which an entity may apply for program grants;
(b) Grant application contents;
(c) Criteria for selecting those entities that shall receive grants and determining the amount and duration of said grants;
(d) Reporting requirements for entities that receive grants pursuant to this part 8.
(3) (a) The division shall review the applications received pursuant to this part 8 and make recommendations to the state board regarding those entities that may receive grants and the amounts of said grants. On and after October 1, 2005, the review committee shall review the applications received pursuant to this part 8 and submit to the state board and the director of the department recommended grant recipients, grant amounts, and the duration of each grant. Within thirty days after receiving the review committee's recommendations, the director shall submit his or her recommendations to the state board. The review committee's recommendations regarding grantees of the Tony Grampsas youth services program, section 26-6.8-102, pursuant to section 25-3.5-805 (5) shall be submitted to the state board and the Tony Grampsas youth services board. Within thirty days after receiving the review committee's recommendations, the Tony Grampsas youth services board shall submit its recommendations to the state board. The state board has the final authority to approve the grants under this part 8. If the state board disapproves a recommendation for a grant recipient, the review committee may submit a replacement recommendation within thirty days. In reviewing grant applications for programs to provide tobacco education, prevention, and cessation programs for persons with behavioral or mental health disorders, the division or the review committee shall consult with the programs for public psychiatry at the university of Colorado health sciences center, the national alliance on mental illness, the mental health association of Colorado, and the department of human services.
for programs to provide tobacco education, prevention, and cessation programs for persons with behavioral or mental health disorders, the division or the review committee shall consult with the programs for public psychiatry at the university of Colorado health sciences center, the national alliance on mental illness, the mental health association of Colorado, and the department of human services.
(b) The state board shall award grants to the selected entities, specifying the amount and duration of the award. No grant awarded pursuant to this part 8 shall exceed three years without renewal. Of the amount awarded each year pursuant to the provisions of this part 8, the state board shall award at least one-third of the amount to entities that provide tobacco education, prevention, and cessation programs, solely or in combination with substance abuse programs, to school-age children.
(4) In implementing the program, the division shall survey the need for trained teachers, health professionals, and others involved in providing tobacco education, prevention, and cessation programs. To the extent the division determines there is a need, the division may provide technical training and assistance to entities that receive program grants pursuant to this part 8.
(5) (a) There is hereby created the tobacco education, prevention, and cessation grant program review committee, referred to in this part 8 as the "review committee". The review committee is established in the division. The review committee is responsible for ensuring that program priorities are established consistent with the Colorado tobacco prevention and control strategic plan, overseeing program strategies and activities, and ensuring that the program grants are in compliance with section 25-3.5-805.
(b) The review committee shall consist of the following sixteen members:
(I) The director of the department or the director's designee;
(II) Five members who shall be appointed by the director of the department, one of whom shall include the director of the tobacco education, prevention, and cessation program within the division and four of whom shall be staff of the program with expertise in tobacco prevention among youth, reducing exposure to secondhand smoke, tobacco cessation, or public education;
(III) Eight members who shall be appointed by the state board as follows:
(A) One member who is a member of the state board;
(B) One member who is a representative of a local public health agency;
(C) One member who is a representative of a statewide association representing physicians;
(D) One member who is a representative of an association representing family physicians;
(E) One member who is a representative of the Colorado department of education;
(F) One member who is a representative of the university of Colorado health sciences center who has expertise in evaluation;
(G) One member who represents a sociodemographic disadvantaged population in Colorado; and
(H) One member who is a representative of a statewide nonprofit organization with a demonstrated expertise in and commitment to tobacco control;
(IV) The president of the senate shall appoint one member of the senate;
(V) The speaker of the house of representatives shall appoint one member of the house of representatives.
o represents a sociodemographic disadvantaged population in Colorado; and
(H) One member who is a representative of a statewide nonprofit organization with a demonstrated expertise in and commitment to tobacco control;
(IV) The president of the senate shall appoint one member of the senate;
(V) The speaker of the house of representatives shall appoint one member of the house of representatives.
(c) (I) Except as provided in subparagraph (II) of this paragraph (c), members of the review committee shall serve three-year terms; except that of the members initially appointed to the review committee, five members appointed by the state board shall serve two-year terms. Members of the review committee appointed pursuant to subparagraph (III) of paragraph (b) of this subsection (5) shall not serve more than two consecutive terms.
(II) The terms of the members appointed by the speaker of the house of representatives and the president of the senate and who are serving on March 22, 2007, shall be extended to and expire on or shall terminate on the convening date of the first regular session of the sixty-seventh general assembly. As soon as practicable after such convening date, the speaker and the president shall appoint or reappoint members in the same manner as provided in subparagraphs (IV) and (V) of paragraph (b) of this subsection (5). Thereafter, the terms of members appointed or reappointed by the speaker and the president shall expire on the convening date of the first regular session of each general assembly, and all subsequent appointments and reappointments by the speaker and the president shall be made as soon as practicable after such convening date. The person making the original appointment or reappointment shall fill any vacancy by appointment for the remainder of an unexpired term. Members shall serve at the pleasure of the appointing authority and shall continue in office until the member's successor is appointed.
(d) The composition of the review committee shall reflect, to the extent practical, Colorado's ethnic, racial, and geographic diversity.
(e) Except as otherwise provided in section 2-2-326, members of the review committee shall be reimbursed from money deposited in the tobacco education programs fund created in section 24-22-117 for their actual and necessary expenses incurred in the performance of their duties pursuant to this part 8.
(f) The review committee shall elect from its membership a chair and a vice-chair of the committee.
(g) The division shall provide staff support to the review committee.
(h) If a member of the review committee has an immediate personal, private, or financial interest in any matter pending before the review committee, the member shall disclose the fact and shall not vote upon such matter.
C.R.S. § 25-3.5-805 Tobacco education, prevention, and cessation programs - requirements
25-3.5-805. Tobacco education, prevention, and cessation programs - requirements. (1) An entity that applies for a grant pursuant to the provisions of this part 8 shall in the application demonstrate that the tobacco education, prevention, or cessation program provides at least one of the following:
(a) Education designed for school-age children that, at a minimum, addresses tobacco use prevention and cessation strategies and the dangers of tobacco use; or
(b) Education programs, including but not limited to school, work site, mass media, and health-care setting programs, designed to prevent or reduce the use of all types of tobacco products or help reduce exposure to secondhand smoke; or
(c) Counseling regarding the use of all types of tobacco products; or
(d) Programs that address prevention and cessation of the abuse of various types of drugs, with an emphasis on prevention and cessation of tobacco use; or
(e) (Deleted by amendment, L. 2005, p. 935, § 25, effective June 2, 2005.)
(f) Tobacco use and substance abuse prevention and cessation services addressed to specific population groups such as adolescents and pregnant women and provided within specific ethnic and low-income communities; or
(g) Training of teachers, health professionals, and others in the field of tobacco use and prevention; or
(h) Tobacco addiction prevention and treatment strategies that are designed specifically for persons with behavioral or mental health disorders; or
(i) Activities to prevent the sale or furnishing by other means of cigarettes or tobacco products to minors; or
(j) Programs that are designed to eliminate health disparities among segments of the population that have higher than average tobacco burdens.
(1.5) Notwithstanding the requirements of subsection (1) of this section, an entity may apply for a grant for the purpose of evaluating the entire statewide program or individual components of the program.
(2) If the entity applying for a grant pursuant to the provisions of this part 8 is a school district or board of cooperative services, in addition to the information specified in subsection (1) of this section, the entity shall demonstrate in the application that the tobacco education, prevention, and cessation program to be operated with moneys received from the grant is a program that has not been previously provided by the school district or board of cooperative services. The entity shall also demonstrate that the program is specifically designed to appeal to and address the concerns of the age group to which the program will be presented.
(3) In adopting criteria for awarding grants, the state board shall adopt such criteria as will ensure that the implementation of a comprehensive program is consistent with the Colorado tobacco prevention and control strategic plan, that tobacco education, prevention, and cessation programs are available throughout the state, and that the programs are available to serve persons of all ages.
(4) At least fifteen percent of the moneys annually awarded to grantees pursuant to this section shall be for the purposes of providing funding to eliminate health disparities among minority populations and high-risk populations that have higher-than-average tobacco burdens.
(5) Up to fifteen percent of the moneys annually awarded pursuant to this section shall be allocated to grantees of the Tony Grampsas youth services program, section 26-6.8-102, C.R.S., for proven tobacco prevention and cessation programs.
(6) The majority of moneys annually awarded to grantees that qualify pursuant to subsections (1), (2), and (5) of this section shall be for evidence-based programs and programs that prevent and reduce tobacco use among youth and young adults.
C.R.S. § 25-3.5-806 Tobacco education, prevention, and cessation programs - reporting requirements
25-3.5-806. Tobacco education, prevention, and cessation programs - reporting requirements. (1) In adopting rules specifying the reporting requirements for entities that receive grants pursuant to this part 8, the state board shall ensure that such reports, at a minimum, include:
(a) An evaluation of the implementation of the program, including but not limited to the number of persons served and the services provided;
(b) The results achieved by the program, specifying the goals of the program and the criteria used in measuring attainment of the goals;
(c) An explanation of how the results achieved by the program contribute to the achievement of the program goals as stated in section 25-3.5-802.
(2) The division shall compile the annual reports received from entities pursuant to this section.
(3) (a) The division shall annually review the reports received from entities receiving grants pursuant to this part 8 and shall make recommendations to the state board concerning whether the amount received by an entity should be continued, reduced, or increased. The division may also recommend that the grant for an entity be immediately terminated or not renewed if the tobacco education, prevention, and cessation program funded by the grant does not demonstrate a sufficient level of success, as determined by the division.
(b) The division may contract with one or more public or private entities to review and compile the reports received pursuant to this section and prepare the recommendations pursuant to paragraph (a) of this subsection (3).
C.R.S. § 25-3.5-807 Tobacco program fund - created
25-3.5-807. Tobacco program fund - created. (Repealed)
C.R.S. § 25-3.5-807.5 Transfer of balance of tobacco program fund - repeal
25-3.5-807.5. Transfer of balance of tobacco program fund - repeal. (Repealed)
C.R.S. § 25-3.5-808 Administration - limitation
25-3.5-808. Administration - limitation. The prevention services division of the department may receive up to five percent of the moneys annually appropriated by the general assembly from the tobacco education programs fund created in section 24-22-117, C.R.S., for the actual costs incurred in administering the program, including the hiring of sufficient staff within the division to effectively administer the program and reimbursement of review committee members pursuant to section 25-3.5-804 (5).
C.R.S. § 25-3.5-809 Tobacco education, prevention, and cessation programs - funding
25-3.5-809. Tobacco education, prevention, and cessation programs - funding. The programs under this part 8 shall be funded by moneys annually appropriated by the general assembly to the department from the tobacco education programs fund created in section 24-22-117, C.R.S.
C.R.S. § 25-3.5-810 Nicotine products education, prevention, and cessation programs
25-3.5-810. Nicotine products education, prevention, and cessation programs. The education, prevention, and cessation programs that are funded with money transferred to the tobacco education programs fund in accordance with section 24-22-118 (2) may also apply to nicotine products.
C.R.S. § 25-3.5-901 Short title
25-3.5-901. Short title. This part 9 shall be known and may be cited as the "Carol J. Shanaberger Act".
C.R.S. § 25-3.5-902 Legislative declaration
25-3.5-902. Legislative declaration. The general assembly hereby finds and declares that the implementation of quality management functions to evaluate and improve prehospital emergency medical service patient care is essential to the operation of emergency medical services organizations. For this purpose, it is necessary that the collection of information by prehospital medical directors and emergency medical services organizations be reasonably unfettered so that a complete and thorough evaluation and improvement of the quality of patient care can be accomplished. To this end, quality management information relating to the evaluation or improvement of the quality of prehospital emergency medical services is confidential, subject to section 25-3.5-904 (3), and persons performing quality management functions are granted qualified immunity as specified in section 25-3.5-904 (4). It is the intent of the general assembly that nothing in this section revise, amend, or alter part 2 of article 30 or article 240 of title 12.
C.R.S. § 25-3.5-903 Definitions
25-3.5-903. Definitions. As used in this part 9, unless the context otherwise requires:
(1) "Emergency medical services organization" means:
(a) Local emergency medical and trauma service providers, as defined in section 25-3.5-602 (4), excluding a health-care facility licensed or certified by the department pursuant to section 25-1.5-103 (1)(a) that has a quality management program pursuant to section 25-3-109;
(b) Regional emergency medical and trauma services advisory councils, as defined in section 25-3.5-703 (6.8) and established under section 25-3.5-704 (2)(c); and
(c) Public safety answering points, as defined in section 29-11-101 (23), performing emergency medical dispatch.
(2) "Prehospital medical director" or "medical director" means a licensed physician who supervises certified or licensed emergency medical service providers who provide prehospital care.
(3) "Quality management assessment" means a review and assessment of the performance of prehospital care provided by emergency medical service providers operating under a medical director.
(4) (a) "Quality management program" means a program established under this part 9 that is designed to perform quality management assessments for the purpose of improving patient care and includes:
(I) Quality assurance and risk management activities;
(II) Peer review of emergency medical service providers; and
(III) Other quality management functions.
(b) "Quality management program" does not include review or assessment of the licensing, use, or maintenance of vehicles used by an emergency medical services organization.
C.R.S. § 25-3.5-904 Quality management programs - creation - assessments - confidentiality of information - exceptions - immunity for good faith participants
25-3.5-904. Quality management programs - creation - assessments - confidentiality of information - exceptions - immunity for good faith participants. (1) Each emergency medical services organization that institutes a quality management program to conduct quality management assessments shall include in that program at least the following components:
(a) Periodic review of treatment protocols, compliance with treatment protocols, and prehospital emergency medical care provided to patients;
(b) Peer review of emergency medical service providers, including review of their qualifications and competence and quality and appropriateness of patient care;
(c) The collection of data if required pursuant to section 25-3.5-704 (2)(h)(II);
(d) A general description of the types of cases, problems, or risks to be reviewed and the process used for identifying potential risks;
(e) Identification of the personnel or committees responsible for coordinating quality management activities and the means of reporting within the quality management program;
(f) A description of the method for systematically reporting information to the organization's medical director;
(g) A description of the method for investigating and analyzing causes of individual problems and patterns of problems;
(h) A description of possible corrective actions to address the problems, including education, prevention, and minimizing potential problems or risks; and
(i) A description of the method for following up in a timely manner on corrective action to determine the effectiveness of the action.
(2) (a) Except as provided in subsection (2)(b) or (3) of this section, information required to be collected and maintained, including information from the prehospital care reporting system that identifies an individual, and records, reports, and other information obtained and maintained in accordance with a quality management program established pursuant to this section are confidential and shall not be released except to the department in cases of an alleged violation of board rules pertaining to emergency medical service provider certification or licensure or except in accordance with section 25-3.5-205 (4).
(b) (I) An emergency medical services organization or prehospital medical director may share quality management records related to peer review of an emergency medical service provider with another emergency medical services organization or a licensed or certified health-care facility that has a quality management program under this section or section 25-3-109, as applicable, without violating the confidentiality requirements of paragraph (a) of this subsection (2) and without waiving the privilege specified in subsection (3) of this section, if the emergency medical service provider seeks to subject himself or herself to, or is currently subject to, the authority of the emergency medical services organization or health-care facility.
(II) A health-care facility licensed or certified by the department pursuant to section 25-1.5-103 (1)(a) that has a quality management program pursuant to section 25-3-109 may share quality management records related to peer review of an emergency medical service provider with an emergency medical services organization or prehospital medical director if the emergency medical service provider seeks to subject himself or herself to, or is currently subject to, the authority of the emergency medical services organization or prehospital medical director without violating the confidentiality requirements of this subsection (2) and section 25-3-109 (3) and without waiving the privilege specified in subsection (3) of this section and section 25-3-109 (4).
e emergency medical service provider seeks to subject himself or herself to, or is currently subject to, the authority of the emergency medical services organization or prehospital medical director without violating the confidentiality requirements of this subsection (2) and section 25-3-109 (3) and without waiving the privilege specified in subsection (3) of this section and section 25-3-109 (4).
(c) The confidentiality of information provided for in this section is not impaired or otherwise adversely affected solely because the prehospital medical director or emergency medical services organization submits the information to a nongovernmental entity to conduct studies that evaluate, develop, and analyze information about emergency medical care operations, practices, or any other function of emergency medical care organizations. The records, reports, and other information collected or developed by a nongovernmental entity remain protected as provided in paragraph (a) of this subsection (2). In order to adequately protect the confidentiality of the information, the findings, conclusions, or recommendations contained in the studies conducted by a nongovernmental entity are not deemed to establish a standard of care for emergency medical care organizations.
(3) (a) The records, reports, and other information described in subsection (2) of this section are not subject to subpoena and are not discoverable or admissible as evidence in any civil or administrative proceeding. A person who participates in the reporting, collection, evaluation, or use of quality management information with regard to a specific circumstance shall not testify about his or her participation in any civil or administrative proceeding.
(b) This subsection (3) does not apply to:
(I) Any civil or administrative proceeding, inspection, or investigation as otherwise provided by law by the department or other appropriate regulatory agency having jurisdiction for disciplinary or licensing sanctions;
(II) A person giving testimony concerning facts of which he or she has personal knowledge acquired independently of the quality management program or function;
(III) The availability, as provided by law or the rules of civil procedure, of factual information relating solely to the individual in interest in a civil suit by the person, next friend, or legal representative, but factual information does not include opinions or evaluations performed as a part of the quality management program;
(IV) A person giving testimony concerning an act or omission that he or she observed or in which he or she participated, notwithstanding any participation by him or her in the quality management program;
(V) A person giving testimony concerning facts he or she had recorded in a medical record relating solely to the individual in interest in a civil suit.
(4) A person, acting in good faith, within the scope and functions of a quality management program, and without violating any applicable laws, who participates in the reporting, collection, evaluation, or use of quality management information or performs other functions as part of a quality management program with regard to a specific circumstance is immune from liability in any civil action based on his or her participation in the quality management program brought by an emergency medical service provider or person to whom the quality management information pertains. This immunity does not apply to any negligent or intentional act or omission in the provision of care.
(5) Nothing in this section:
(a) Affects or prevents the voluntary release of any quality management record or information by a prehospital medical director or emergency medical services organization; except that no patient-identifying information may be released without the patient's consent;
(b) Limits any statutory or common-law privilege, confidentiality, or immunity; or
provision of care.
(5) Nothing in this section:
(a) Affects or prevents the voluntary release of any quality management record or information by a prehospital medical director or emergency medical services organization; except that no patient-identifying information may be released without the patient's consent;
(b) Limits any statutory or common-law privilege, confidentiality, or immunity; or
(c) Affects a person's ability to access his or her medical records as provided in section 25-1-801 or the right of any family member or other person to obtain medical record information upon the consent of the patient or his or her authorized representative.
C.R.S. § 25-3.5-1001 Legislative declaration
25-3.5-1001. Legislative declaration. (1) The general assembly hereby finds and declares that:
(a) Many substance abuse, public health, education, regulatory, and law enforcement professionals are concerned about the impact that the legalization of retail marijuana will have on children, youth, and adults in the state;
(b) Many of these professionals believe that the legalization of retail marijuana may result in:
(I) An increase in the abuse of marijuana by adults and youth;
(II) A greater need for early intervention services due to increased use of marijuana by youth and adults;
(III) A belief among children and youth that the risks associated with marijuana use are low;
(IV) Health impacts in connection with exposure to secondhand smoke;
(V) An increase in the instances of impaired driving and the associated increase in crashes;
(VI) New health concerns regarding pregnant or nursing women who use marijuana or who are exposed to secondhand smoke from marijuana; and
(VII) Other potential concerns that have not yet been identified.
(c) Mass-reach health communications strategies have been found to be effective in reducing tobacco and alcohol use among adults and youth, in increasing the use of cessation services, and in limiting tobacco and alcohol initiation by youth; and
(d) There is substantial evidence that mass media campaigns and community coalitions are effective in preventing marijuana use.
(2) The general assembly further finds and declares that to protect and improve the health of the citizens of the state, it is a prudent use of state resources to require the Colorado department of public health and environment to implement a campaign to increase the awareness of and education about the impacts of marijuana use.
C.R.S. § 25-3.5-1002 Definitions
25-3.5-1002. Definitions. As used in this part 10, unless the context otherwise requires:
(1) "Division" means the division within the department of public health and environment responsible for prevention services.
(2) "Retail marijuana" means marijuana that is legal for adults to purchase and use pursuant to section 16 of article XVIII of the state constitution.
C.R.S. § 25-3.5-1003 Eighteen-month public awareness and education campaign - legalization of marijuana - repeal
25-3.5-1003. Eighteen-month public awareness and education campaign - legalization of marijuana - repeal. (Repealed)
C.R.S. § 25-3.5-1004 Ongoing prevention and education campaign - training - marijuana
25-3.5-1004. Ongoing prevention and education campaign - training - marijuana. (1) Subject to available appropriations, beginning in the 2014-15 state fiscal year, the division shall develop, implement, and evaluate an ongoing statewide prevention and education campaign to address the long-term marijuana education needs in the state. In the prevention and education messaging, the division shall provide information to:
(a) The general public regarding the law surrounding the legal use of retail marijuana;
(b) People in the retail marijuana industry regarding restricting youth access to retail marijuana;
(c) Retail marijuana users and other relevant populations identified as high-risk regarding the potential risks associated with the use of marijuana; and
(d) The general public regarding the dangers associated with the over-consumption of marijuana-infused products.
(2) In furtherance of the goals of the ongoing marijuana prevention and education campaign, the division may use television messaging, radio broadcasts, print media, digital strategies, or any other form of messaging deemed necessary and appropriate by the division to reach the target audiences of the campaign.
(3) In furtherance of the goals of the ongoing marijuana prevention and education campaign, the department of public health and environment shall provide at least five regional training sessions during the 2014-15 fiscal year for community partners to implement youth health development strategies.
C.R.S. § 25-3.5-1005 Website - primary state resource for information
25-3.5-1005. Website - primary state resource for information. (1) In furtherance of the goals of the eighteen-month public awareness and education campaign created in section 25-3.5-1003, as it existed prior to its repeal in 2016, and the ongoing prevention and education campaign created in section 25-3.5-1004, the division shall create a website that will serve as the state portal for the most accurate and timely information regarding the health effects of marijuana use and the laws regarding marijuana use. The division shall ensure that the website links to the information made available by local governments that have passed additional restrictions on the use of retail marijuana and links to the website of every state agency that contains relevant information regarding retail marijuana, including any youth prevention campaign managed by a state agency.
(2) The division shall implement a marketing campaign to generate public awareness of the website as the primary state resource for information regarding the legalization and use of retail marijuana in the state.
C.R.S. § 25-3.5-1006 Align marijuana messaging - integration of information across state agencies
25-3.5-1006. Align marijuana messaging - integration of information across state agencies. (1) The division shall integrate information from each state agency involved in providing retail marijuana information, including the department of human services, the department of transportation, the department of revenue, the department of law, the department of public safety, and the department of education, to align the messaging, branding, and education provided by each agency for the eighteen-month public education and awareness campaign required pursuant to section 25-3.5-1003, as it existed prior to its repeal in 2016, the ongoing prevention and education campaign required pursuant to section 25-3.5-1004, and the website required pursuant to section 25-3.5-1005.
(2) The division shall provide data, training, educational materials, and resources on effective prevention strategies to local community coalitions and programs addressing marijuana prevention.
C.R.S. § 25-3.5-1007 Evaluation of marijuana campaigns
25-3.5-1007. Evaluation of marijuana campaigns. (1) The department shall contract with a respected evaluation partner to develop and implement a three-year evaluation plan assessing the reach and impact of the eighteen-month public education and awareness campaign required pursuant to section 25-3.5-1003, as it existed prior to its repeal in 2016, and the ongoing prevention and education campaign required pursuant to section 25-3.5-1004. The evaluation must also assess the department's success in educating the citizens of the state regarding the legal parameters of the use of retail marijuana and preventing negative health impacts from the legalization of retail marijuana.
(2) (Deleted by amendment, L. 2017.)
C.R.S. § 25-3.5-1101 Legislative declaration
25-3.5-1101. Legislative declaration. (1) The general assembly hereby finds that:
(a) The department has responsibility for oversight of the emergency medical and trauma services system and the certification or licensure of emergency medical service providers. Emergency medical service providers are certified or licensed by the department to provide treatment and transport to the sick and injured.
(b) Emergency medical responders are the part of the emergency medical and trauma services system who answer emergency calls, provide effective and immediate care to ill and injured patients, prepare the scene for the arrival of the ambulance and emergency medical service providers, and provide assistance to emergency medical service providers as directed;
(c) Most emergency medical responders perform their duties in an ethical and professional manner;
(d) It is in the interests of the citizens of this state that a voluntary process exists whereby individuals may register their training and status as an emergency medical responder with the state; and
(e) It is in the public interest to place the voluntary registration of emergency medical responders within the state department that has statutory responsibility for the statewide emergency medical and trauma services system.
(2) Therefore, it is the intent of the general assembly to:
(a) Transfer the oversight of emergency medical responders, formerly known as first responders, from the department of public safety to the department of public health and environment; and
(b) Fund the oversight of the voluntary registration program through the highway users tax fund established in section 42-3-304 (21), C.R.S., in order to avoid cost-prohibitive registration fees.
C.R.S. § 25-3.5-1102 Definitions
25-3.5-1102. Definitions. As used in this part 11:
(1) "Emergency medical responder" means an individual who has successfully completed the training and examination requirements for emergency medical responders and who provides assistance to the injured or ill until more highly trained and qualified personnel arrive.
(2) "Physician" means a person licensed pursuant to article 240 of title 12, in good standing, who authorizes and directs, through protocols and standing orders, the performance of students-in-training enrolled in department-recognized emergency medical responder education programs.
(3) "Registered emergency medical responder" means an individual who has successfully completed the training and examination requirements for emergency medical responders, who provides assistance to the injured or ill until more highly trained and qualified personnel arrive, and who is registered with the department pursuant to this part 11.
C.R.S. § 25-3.5-1103 Registration - rules - funds
25-3.5-1103. Registration - rules - funds. (1) On and after July 1, 2017, the department shall administer a voluntary registration program for emergency medical responders. A person shall not hold himself or herself out as a registered emergency medical responder, providing care or services as identified in national guidelines for emergency medical response as approved by the department, unless the person meets the requirements set forth in this part 11; except that a person may function as a good samaritan pursuant to section 13-21-116, C.R.S.
(2) The board shall adopt rules for the administration of the emergency medical responder registration program, which rules shall include, at a minimum, the following:
(a) Requirements for emergency medical responder registration, which include certification of the applicant through a nationally recognized emergency responder certification organization approved by the department;
(b) The period of time for which the registration as an emergency medical responder is valid;
(c) Registration renewal requirements;
(d) Training requirements for new and renewing registrants;
(e) Provisions governing national and state criminal history record checks for new and renewing registrants and the use of the results of the checks by the department to determine the action to take on a registration application. Notwithstanding section 24-5-101, C.R.S., these provisions must allow the department to consider whether the applicant has been convicted of a felony or misdemeanor involving moral turpitude and the pertinent circumstances connected with the conviction and to make a determination whether any such conviction disqualifies the applicant from registration.
(f) Disciplinary sanctions, which may include provisions for the denial, revocation, probation, and suspension, including summary suspension, of registration and of education program recognition; and
(g) An appeal process consistent with sections 24-4-104 and 24-4-105, C.R.S., that is applicable to department decisions in connection with sanctions.
(3) Rules promulgated by the department of public safety remain in effect until superceded by rules duly adopted pursuant to this part 11.
(4) (a) The department may issue a provisional registration to an applicant for registration as an emergency medical responder who requests issuance of a provisional registration and who pays a fee authorized under rules adopted by the board. A provisional registration is valid for not more than ninety days.
(b) The department may not issue a provisional registration unless the applicant satisfies the requirements for registration established in rules of the board. If the department finds that an emergency medical responder who has received a provisional registration has violated any requirements for registration, the department may revoke the provisional registration and prohibit the registration of the emergency medical responder.
(c) The department may issue a provisional registration to an applicant whose fingerprint-based criminal history record check has not yet been completed. The department shall require the applicant to submit to a name-based judicial record check prior to issuing a provisional registration.
ent may revoke the provisional registration and prohibit the registration of the emergency medical responder.
(c) The department may issue a provisional registration to an applicant whose fingerprint-based criminal history record check has not yet been completed. The department shall require the applicant to submit to a name-based judicial record check prior to issuing a provisional registration.
(d) The board shall adopt rules as necessary to implement this subsection (4), including rules establishing a fee to be charged to applicants seeking a provisional registration. The department shall deposit any fee collected for a provisional registration in the emergency medical services account created in section 25-3.5-603.
(5) (a) The department shall acquire a fingerprint-based criminal history record check from the Colorado bureau of investigation to investigate the holder of or applicant for an emergency medical responder registration. The department may acquire a name-based judicial record check for a registrant or an applicant. Notwithstanding subsection (5)(b) of this section, if a person submitted to a fingerprint-based criminal history record check at the time of initial registration or registration renewal, the person is not required to submit to a subsequent fingerprint-based criminal history record check.
(b) If, at the time of application for registry or for renewal, an individual has lived in the state for three years or less, the department shall require the applicant to submit to a federal bureau of investigation fingerprint-based national criminal history record check; except that the department may acquire a national name-based judicial record check for an applicant. The department is the authorized agency to receive and disseminate information regarding the result of any national criminal history record check.
(c) When the results of a fingerprint-based criminal history record check of a person performed pursuant to this subsection (5) reveal a record of arrest without a disposition, the department shall require that person to submit to a name-based judicial record check, as defined in section 22-2-119.3 (6)(d).
C.R.S. § 25-3.5-1104 Training programs - rules
25-3.5-1104. Training programs - rules. (1) The board shall adopt rules regarding the recognition by the department of education programs that provide initial training and continued competency education for emergency medical responders.
(2) The receipt of a certificate or other document of course completion issued by an education program or national certification organization is not deemed state licensure, approval, or registration.
C.R.S. § 25-3.5-1105 Investigation and discipline
25-3.5-1105. Investigation and discipline. (1) The department may administer oaths, take affirmations of witnesses, and issue subpoenas to compel the attendance of witnesses and the production of all relevant records and documents to investigate alleged misconduct by registered emergency medical responders.
(2) Upon failure of a witness to comply with a subpoena, the department may apply to a district court for an order requiring the person to appear before the department or an administrative law judge, to produce the relevant records or documents, or to give testimony or evidence touching the matter under investigation or in question. When seeking an order, the department shall apply to the district court of the county in which the subpoenaed person resides or conducts business. The court may punish such failure as a contempt of court.
(3) A registered emergency medical responder, the employer of a registered emergency medical responder, or a physician shall report to the department any misconduct by a registered emergency medical responder that is known or reasonably believed by the person to have occurred.
(4) A person acting as a witness or consultant to the department, a witness testifying, and a person or employer who reports misconduct to the department under this section is immune from liability in any civil action brought for acts occurring while testifying, producing evidence, or reporting misconduct under this section if the individual or employer was acting in good faith and with a reasonable belief of the facts. A person or employer participating in good faith in an investigation or an administrative proceeding pursuant to this section is immune from any civil or criminal liability that may result from such participation.
(5) Records, documents, testimony, or evidence obtained under this section are confidential except to the extent necessary to support the administrative action taken by the department, to refer the matter to another regulatory agency, or to refer the matter to a law enforcement agency for criminal prosecution.
C.R.S. § 25-3.5-1201 Short title
25-3.5-1201. Short title. The short title of this part 12 is the "Community Assistance Referral and Education Services (CARES) Program Act".
C.R.S. § 25-3.5-1202 Definitions
25-3.5-1202. Definitions. As used in this part 12, unless the context otherwise requires:
(1) "Authorized entity" means:
(a) A licensed ambulance service;
(b) A fire department of a town, city, or city and county;
(c) A fire protection district, ambulance district, health assurance district, health service district, or metropolitan district or a special district authority; or
(d) A health-care business entity, including a licensed or certified health-care facility that is subject to regulation under article 3 of this title.
(2) "Medical direction" means the supervision over and direction of individuals who perform acts on behalf of a CARES program by a physician or advanced practice registered nurse who is licensed in Colorado and in good standing and who is identified as being responsible for assuring the competency of those individuals in the performance of acts on behalf of the CARES program.
(3) "Program" or "CARES program" means a community assistance referral and education services program established in accordance with this part 12.
C.R.S. § 25-3.5-1203 Community assistance referral and education services programs - authorization - scope
25-3.5-1203. Community assistance referral and education services programs - authorization - scope. (1) To improve the health of residents within its jurisdiction, prevent illness and injury, or reduce the incidence of 911 calls and hospital emergency department visits made for the purpose of obtaining nonemergency, nonurgent medical care or services, an authorized entity may establish a community assistance referral and education services program to provide community outreach and health education to residents within the authorized entity's jurisdiction.
(2) (a) On or after July 1, 2018, an authorized entity that operates or plans to operate a CARES program in Colorado shall notify the department of its CARES program in the form and manner required by the department.
(b) The department shall maintain a list of all authorized entities that operate a CARES program and make the list accessible to the public.
(c) An authorized entity operating a CARES program shall not assert that it is licensed or certified by the department.
(3) Subject to medical direction, an authorized entity operating a program may, within the scope of practice of its practitioners:
(a) Provide the following services:
(I) Health education and information available on relevant services; and
(II) Referrals for and information concerning low-cost medication programs and alternative resources to the 911 system;
(b) To provide services in accordance with paragraph (a) of this subsection (3) and to ensure nonduplication of the services, collaborate with appropriate community resources, including:
(I) Health-care facilities licensed or issued a certificate of compliance pursuant to section 25-1.5-103 or subject to regulation by the department pursuant to article 1 or 3 of this title;
(II) Primary care providers;
(III) Other health-care professionals; or
(IV) Social services agencies.
(4) (a) An authorized entity operating a CARES program shall not provide services that would require a license or certification pursuant to part 13 of this article or article 3 or 3.5 of this title.
(b) In the form and manner prescribed by the department and before referring a service or provider to a recipient of a CARES program service, an authorized entity operating a CARES program shall disclose, at a minimum, in writing, the following information to the recipient:
(I) Any relationship that the CARES program has with an individual or entity to which it refers a recipient of CARES program service; and
(II) Whether the authorized entity directs, controls, schedules, or trains any provider to which it refers a recipient of CARES program services.
(5) The department may investigate an authorized entity as it deems necessary to ensure:
(a) The protection of the health, safety, and welfare of a recipient of CARES program services; and
(b) That the authorized entity is not providing services through its CARES program that require a license or certification pursuant to part 13 of this article or article 3 or 3.5 of this title.
(6) A person working directly or indirectly for a CARES program, whether as an employee or a contractor, may only provide services consistent with the requirements of subsection (3) of this section; except that nothing in this section prohibits a licensed, certified, or registered health-care or mental health provider or certified or licensed emergency medical service provider from acting or providing services within the provider's scope of practice if necessary to respond to an emergent situation.
(7) Repealed.
C.R.S. § 25-3.5-1204 Reports
25-3.5-1204. Reports. (1) (a) If an authorized entity develops a program under this article, the authorized entity shall report to the department, in the form and manner determined by the department, on the progress of the program on or before December 31 in the year following the year in which the program commenced and on or before December 31 of each subsequent year in which the program continues to operate.
(b) An authorized entity's report must include:
(I) The number of residents who have used program services and the types of program services used;
(II) A measurement of any reduction in the use of the 911 system for nonemergency, nonurgent medical assistance by residents within the authorized entity's jurisdiction; and
(III) A measurement of any reduction in visits to the emergency department in a hospital for nonemergency, nonurgent medical assistance by residents within the authorized entity's jurisdiction.
(c) An authorized entity's report pursuant to this section must not include any personally identifiable information concerning a program client or prospective client.
(2) On or before March 31 of each year, the department shall compile annual reports received from authorized entities in the previous year into a single report and post the report on its website.
C.R.S. § 25-3.5-1301 Definitions
25-3.5-1301. Definitions. As used in this part 13, unless the context otherwise requires:
(1) "Community integrated health-care service agency" or "agency" means a sole proprietorship, partnership, corporation, nonprofit entity, special district, governmental unit or agency, or licensed or certified health-care facility that is subject to regulation under article 1.5 or 3 of this title that manages and offers, directly or by contract, community integrated health-care services.
(2) "Manager" or "administrator" means any person who controls and supervises or offers or attempts to control and supervise the day-to-day operations of a community integrated health-care service agency.
(3) "Medical direction" means the supervision over and direction of individuals who perform acts on behalf of an agency by a physician or advanced practice registered nurse who is licensed in Colorado, is in good standing, and is identified as being responsible for assuring the competency of those individuals in the performance of acts on behalf of the agency; except that, if the agency hires or contracts with a community paramedic, only a licensed physician in good standing may provide medical direction.
(4) "Owner" means an officer, director, general partner, limited partner, or other person having a financial or equity interest of twenty-five percent or greater.
C.R.S. § 25-3.5-1302 Community integrated health-care service agency license required - rules - civil and criminal penalties - liability insurance
25-3.5-1302. Community integrated health-care service agency license required - rules - civil and criminal penalties - liability insurance. (1) On or after July 1, 2018, a person shall not operate or maintain a community integrated health-care service agency unless the person has submitted to the department a completed application for licensure as a community integrated health-care service agency. On or after December 31, 2018, a person shall not operate or maintain an agency without a community integrated health-care service agency license issued by the department.
(2) (a) A person who violates subsection (1) of this section:
(I) Is guilty of a misdemeanor and, upon conviction thereof, shall be punished by a fine of not less than fifty dollars nor more than five hundred dollars; and
(II) May be subject to a civil penalty assessed by the department, after conducting a hearing in accordance with section 24-4-105, C.R.S., of up to ten thousand dollars for each violation of this section. The department shall transmit all fines collected pursuant to this subparagraph (II) to the state treasurer, who shall credit the moneys to the general fund.
(b) An owner, manager, or administrator of an agency is subject to the penalties in this subsection (2) for any violation of subsection (1) of this section.
(3) A license applicant shall submit to the department, in the manner determined by the board by rule, proof that the agency and any staff that it employs or contracts is covered by general liability insurance in an amount determined by the board by rule, but not less than the amount calculated in accordance with section 24-10-114 (1)(a)(I) and (1)(b), C.R.S.
C.R.S. § 25-3.5-1303 Minimum standards for community integrated health-care service agencies - adult protective services data system check - rules
25-3.5-1303. Minimum standards for community integrated health-care service agencies - adult protective services data system check - rules. (1) In addition to the services that the board, by rule, authorizes a community integrated health-care service agency to perform, an agency may perform any of the services that may be provided through a CARES program pursuant to section 25-3.5-1203 (3) and the tasks and procedures that a community paramedic is authorized to perform within his or her scope of practice in accordance with section 25-3.5-206 and rules promulgated pursuant to that section. On or before January 1, 2018, the board shall promulgate rules providing minimum standards for the operation of an agency within the state. The rules must include the following:
(a) A requirement that the agency have medical direction;
(b) Inspection of agencies by the department or the department's designated representative;
(c) Minimum educational, training, and experience standards for the administrator and staff of an agency, including a requirement that the administrator and staff be of good moral character;
(d) (I) Fees for agency applications and licensure based on the department's direct and indirect costs in implementing this part 13. The department shall transmit the fees to the state treasurer, who shall credit the fees to the community integrated health care service agencies cash fund created in section 25-3.5-1304.
(II) The department shall collect fees from any entity that applies to operate a community integrated health-care service agency, including an agency wholly owned and operated by a governmental unit or agency. The department shall transmit the fees to the state treasurer who shall credit the fees to the community integrated health care service agencies cash fund created in section 25-3.5-1304.
(e) The amount of general liability insurance coverage that an agency shall maintain and the manner in which an agency shall demonstrate proof of insurance to the department. The board may establish by rule that an agency may obtain a surety bond in lieu of liability insurance coverage.
(f) Establishing occurrence reporting requirements pursuant to section 25-1-124;
(g) Requirements for retaining records, including the time that agencies must maintain records for inspection by the department; and
(h) A requirement that agencies report to the department on an annual basis.
(2) On and after January 1, 2019, prior to employment, a community integrated health-care service agency shall submit the name of a person who will be providing direct care, as defined in section 26-3.1-101 (3.5), to an at-risk adult, as defined in section 26-3.1-101 (1.5), as well as any other required identifying information, to the department of human services for a check of the Colorado adult protective services data system, pursuant to section 26-3.1-111, to determine if the person is substantiated in a case of mistreatment of an at-risk adult.
C.R.S. § 25-3.5-1304 Community integrated health care service agencies cash fund - created
25-3.5-1304. Community integrated health care service agencies cash fund - created. There is created the community integrated health care service agencies cash fund, referred to in this section as the "fund". The department shall transmit fees collected pursuant to this part 13 to the state treasurer for deposit in the fund. The money in the fund is subject to annual appropriation by the general assembly to the department for the department's direct and indirect costs in implementing and administering this part 13. Any unencumbered or unexpended money in the fund at the end of a fiscal year remains in the fund and shall not be credited or transferred to the general fund or any other fund.
C.R.S. § 25-3.5-1305 License - application - inspection - record check - issuance
25-3.5-1305. License - application - inspection - record check - issuance. (1) A community integrated health-care service agency license expires after one year. The department shall determine the form and manner of initial and renewal license applications.
(2) (a) The department shall inspect an agency as it deems necessary to ensure the health, safety, and welfare of agency consumers. An agency shall submit in writing, in a form and manner prescribed by the department, a plan detailing the measures that the agency will take to correct any violations found by the department as a result of an inspection.
(b) The department shall keep all medical records and personally identifying information obtained during an inspection of an agency confidential. All records and information obtained by the department through an inspection are exempt from disclosure pursuant to sections 24-72-204, C.R.S., and 25-1-124.
(3) (a) (I) With the submission of an application for a license pursuant to this section, each owner, manager, and administrator of an agency applying for an initial or renewal license shall submit a complete set of his or her fingerprints to the Colorado bureau of investigation for the purpose of conducting a state and national fingerprint-based criminal history record check utilizing the records of the Colorado bureau of investigation and the federal bureau of investigation. The Colorado bureau of investigation shall forward the results of a criminal history record check to the department.
(II) Each owner, manager, or administrator of an agency is responsible for paying the fee established by the Colorado bureau of investigation for conducting the fingerprint-based criminal history record check to the bureau.
(III) The department may acquire a name-based judicial record check for an owner, manager, or administrator.
(IV) When the results of a fingerprint-based criminal history record check of a person performed pursuant to this subsection (3) reveal a record of arrest without a disposition, the department shall require that person to submit to a name-based judicial record check, as defined in section 22-2-119.3 (6)(d).
(b) The department may deny a license or renewal of a license if the results of a record check of an owner, manager, or administrator demonstrates that the owner, manager, or administrator has been convicted of a felony or a misdemeanor involving conduct that the department determines could pose a risk to the health, safety, or welfare of community integrated health-care service consumers.
(c) If an agency applying for an initial license is temporarily unable to satisfy all of the requirements for licensure, the department may issue a provisional license to the agency; except that the department shall not issue a provisional license to an agency if operation of the agency will adversely affect the health, safety, or welfare of the agency's consumers. The department may require an agency applying for a provisional license to demonstrate to the department's satisfaction that the agency is taking sufficient steps to satisfy all of the requirements for full licensure. A provisional license is valid for ninety days and may be renewed one time at the department's discretion.
C.R.S. § 25-3.5-1306 License denial - suspension - revocation
25-3.5-1306. License denial - suspension - revocation. (1) Upon denial of an application for an initial license, the department shall notify the applicant in writing of the denial by mailing a notice to the applicant at the address shown on the application. If an applicant, within sixty days after receiving the notice of denial, petitions the department to set a date and place for a hearing, the department shall grant the applicant a hearing to review the denial in accordance with article 4 of title 24, C.R.S.
(2) The department may suspend, revoke, or refuse to renew the license of a community integrated health-care service agency that is out of compliance with the requirements of this part 13 or rules promulgated pursuant to this part 13. Before taking final action to suspend, revoke, or refuse to renew a license, the department shall conduct a hearing on the matter in accordance with article 4 of title 24, C.R.S. The department may implement a summary suspension before a hearing in accordance with section 24-4-104 (4)(a), C.R.S.
(3) After conducting a hearing on the matter in accordance with article 4 of title 24, C.R.S., the department may revoke or refuse to renew an agency license where the owner, manager, or administrator of the agency has been convicted of a felony or misdemeanor involving conduct that the department determines could pose a risk to the health, safety, or welfare of the agency's consumers.
(4) The department may impose intermediate restrictions or conditions on an agency that may require the agency to:
(a) Retain a consultant to address corrective measures;
(b) Be monitored by the department for a specific period;
(c) Provide additional training to its employees, owners, managers, or administrators;
(d) Comply with a directed written plan to correct the violation, in accordance with the procedures established under section 25-27.5-108 (2)(b); or
(e) Pay a civil penalty of up to ten thousand dollars per violation. The department, after providing the agency with the opportunity for a hearing in accordance with section 24-4-105, C.R.S., on any penalties assessed, shall transmit all penalties collected pursuant to this paragraph (e) to the state treasurer, who shall credit the money to the general fund. The agency may request, and the department shall grant, a stay in payment of a civil penalty until final disposition of the restriction or condition.
C.R.S. § 25-3.5-1307 Repeal of part - review of functions
25-3.5-1307. Repeal of part - review of functions. This part 13 is repealed, effective September 1, 2025. Before the repeal, the department's functions under this part 13 shall be reviewed as provided for in section 24-34-104, C.R.S.
C.R.S. § 25-3.5-1401 Stop the bleed school control kits - report - definitions - repeal
25-3.5-1401. Stop the bleed school control kits - report - definitions - repeal. (1) The department shall distribute stop the bleed control kits to each school that chooses to administer stop the bleed training.
(2) For each of the 2023-24, 2024-25, and 2025-26 state fiscal years, the general assembly shall appropriate one hundred fifty thousand dollars to the department for the purpose of purchasing and distributing stop the bleed control kits to high schools, middle schools, and elementary schools. Any unexpended money remaining at the end of the 2023-24 and 2024-25 state fiscal years from this appropriation:
(a) Does not revert to the general fund or any other fund;
(b) May be used by the department in the 2024-25 and 2025-26 state fiscal years without further appropriation; and
(c) Must not be used for any other purpose other than the purpose set forth in this section.
(2.5) The department shall provide each school with its allotment of bleed control kits after a school has held a stop the bleed training.
(3) The department shall distribute bleed control kits according to the following:
(a) Schools with a population of over one thousand students that opt in receive ten bleed control kits;
(b) Schools with a population between five hundred and one thousand students that opt in receive five bleed control kits; and
(c) Schools with a population of less than five hundred students that opt in receive three bleed control kits.
(4) On or before July 1, 2024, and on or before July 1 each year thereafter through July 1, 2026, the department shall collaborate with the American college of surgeons' committee on trauma to submit a report to the health and human services committee of the senate and the public and behavioral health and human services committee of the house of representatives, or any successor committees, and to the governor on the distribution of stop the bleed control kits. At a minimum, the report must include:
(a) The total number of schools that opted in to receive stop the bleed control kits;
(b) The total number of people in schools who have been trained in stop the bleed;
(c) The total number of stop the bleed control kits that have been sent to schools; and
(d) The total cost of distributing the stop the bleed control kits.
(5) Any contract or agreement that the department enters into in furtherance of this section is exempt from the requirements of the "Procurement Code", articles 101 to 112 of title 24.
(6) As used in this section:
(a) "Bleed control" means actions that control bleeding from a person who has suffered a traumatic injury.
(b) "Bleed control kit" means a first aid response kit developed by stop the bleed that contains:
(I) One tourniquet endorsed by the United States department of defense committee on tactical combat casualty care;
(II) One compression bandage;
(III) One bleeding control bandage;
(IV) Protective gloves;
(V) One marker; and
(VI) One pair of scissors.
(c) "School" means a public school, school district, board of cooperative services, charter school, or institute charter school.
(d) "Stop the bleed" means the American college of surgeons' stop the bleed program that is administered by the American college of surgeons' committee on trauma.
(7) This section is repealed, effective July 1, 2026.
Source: Open US Law by Vaquill AI (CC BY 4.0)URL: https://leg.colorado.gov/sites/default/files/images/olls/crs2024-title-25.docxFetched: 10/6/2026