Title 202 | Chapter 007 | Regulation 545REG


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KENTUCKY BOARD OF EMERGENCY MEDICAL SERVICES
(Amended at ARRS Committee)

202 KAR 7:545.License classifications.

Section 1.

Definitions.

(1)

 

(a)

"911 scene response" means a response:

1.(a)

Resulting from a 911 call or other call to a dispatch center or public safety answering point for assistance;

2.(b)

Where an ambulance provider is dispatched to, responds to, provides an assessment to, provides care to, or transports a person reporting a medical condition or injury; and

3.(c)

Where transportation of the patient will terminate in an emergency room or other location for immediate assessment or treatment.

(b)(d)

"911 scene response" shall not include a response to a call in whichwhere a patient is receiving care at a hospital.

(2)

"Agency" means an individual or private or public organization, except the United States government, seeking or holding a license from the board to provide emergency medical services pursuant tounder KRS Chapter 311A and 202 KAR Chapter 7.

(3)

"ALS first response" means 911 scene response to provide ALS emergency care or treatment to an ill or injured person by emergency medical services personnel.

(4)

"BLS first response" means 911 scene response to provide BLS emergency care or treatment to an ill or injured person by emergency medical services personnel.

(5)

"Medical first response" means 911 scene response to provide ALS or BLS emergency care or treatment to an ill or injured person by emergency medical services personnel before the arrival of an ambulance.

(6)

"Mobile integrated healthcare" or "MIH" is defined by KRS 311A.010(18).

(7)

"Nonemergency" means any scheduled, non-scheduled, or interfacility medically necessary ambulance transportation that is not a 911 scene response.

Section 2.

License Classifications.

(1)

Beginning on January 1, 2026, licenseIn accordance with KRS 311A.030(1), license classifications for ambulance providers, mobile integrated healthcare programs, and medical first response agencies shall include:

(a)

A Class I ground ambulance providers, which shall be classified as:agency operating at the Advanced Life Support (ALS), Basic Life Support (BLS), or Adult Critical Care Transport level to provide emergency and nonemergency care and transportation.

1.

Class Ia – (911 Services) – A ground ambulance provider operating at the ALS or BLS level, or both, thatand which shall provide 911 scene response and may provide emergency, nonemergency, or interfacility care and transportation; or

2.

Class Ib – (CON-Exempt City and County Services) – A ground ambulance provider operating pursuant to KRS 216B.020(8) at the ALS or BLS level, or both;.

(b)

A Class II ground ambulance providers, which shall be classified as:agency operating at the BLS level only to provide nonemergency care and transportation.

1.

Class IIa – (Non-911 Services) – A ground ambulance provider operating at the ALS or BLS level, or both, to provide interfacility care and nonemergency care and transportation; or

2.

Class IIb – (CON-Exempt Hospital Services) – A ground ambulance provider operating pursuant to KRS 216B.020(7) at the ALS or BLS level, or both;.

(c)

A Class III ground ambulance providers, which, based on the provider's Certificate of Need and scope of care policy, shall be classified as one (1) or more of the following:agency operating at the ALS level to provide critical care, specialty care, emergency or nonemergency care, and transportation between health care facilities. Based on the Certificate of Need and scope of care policy, a Class III ground ambulance agency shall be designated as one (1) or more of the following types:

1.

Class IIIa – (Adult Critical Care Services) – A ground ambulance provider operating at the ALS level as an adult critical care agency providing critical care interfacility transport services to patients ages twelve (12) and above;

2.

Class IIIb – (Pediatric Specialty Care Services) – A ground ambulance provider operating at the ALS level as a pediatric specialty care agency providing critical care interfacility and specialty care transport services to patients under the age of twenty-one (21); or

3.

Class IIIc – (Neonatal Specialty Care Services) – A ground ambulance provider operating at the ALS level as a neonatal specialty care agency providing critical care interfacility and specialty care transport services to patients less than twenty-nine (29) days of age;.

1.

A Class III Adult Critical Care agency providing critical care transport services to patients ages twelve (12) and above;

2.

A Class III Pediatric Specialty Care agency providing specialty care transport services to patients under the age of twenty-one (21); or

3.

A Class III Neonatal Specialty Care agency providing specialty care transport services to patients less than twenty-nine (29) days of age.

(d)

A Class IV – (Restricted Location Services) – A ground ambulance provideragency operating at the ALS or BLS level to provide emergency and nonemergency care with or withoutand transportation for restricted locations, such as industrial sites or other sites that do not provide services outside the designated geographic service area;.

(e)

Class V – (Mobile Integrated Health Care Programs) – A mobile integrated health care program operating at the ALS and BLS level;.

(f)(e)

A Class VI – (Medical First Response Agencies) – An agency providing medical first response without patient transport at the ALS or BLSBLS or ALS level;.

1.

Each ALS first response agency shall be licensed separately as a Class VI ALS agency.

2.

Each BLS first responseFirst Response agency shall be licensed separately as a Class VI BLS agency unless a memorandum of understandingmutual aid agreement is executed with a licensed Class I ambulance agency that provides 911 response services for the geographic service area.

3.2.

A licensed Class I agencynonlicensed BLS First Response Agency may execute a memorandum of understandingmutual aid agreement with multiple nonlicensed BLS first response agenciesFirst Response Agencies that serve the same geographic service area.

4.3.

A memorandum of understandingmutual aid agreement shall automatically renew at the conclusion of a calendar year.

5.4.

A nonlicensed BLS first response agencyFirst Response Agency or a Class I ALS agency may terminate a memorandum of understandingmutual aid agreement thirty (30) days after written notice is provided to the other party.

6.5.

A memorandum of understandingmutual aid agreement between a Class I ALS agency and a nonlicensed BLS first responseFirst Response agency serving the same geographic area shall be updated as changes to the agreement occur and shall include provisions for:

a.

Medical direction;

b.

BLS protocols consistent with the current scope of practice;

c.

Response protocol;

d.

Geographic service areas to be served;

e.

Circumstances causing dispatch of the nonlicensed BLS first response agency;

f.

Training;

g.

Quality assurance processes; and

h.

Liability insurance,Insurance if applicable.

7.6.

A nonlicensed BLS first responseFirst Response agency shall not provide BLS care outside of itsthe geographic service area unless responding through an executed mutual aid agreement.of the Class I ALS agency.

8.7.

A nonlicensed BLS first responseFirst Response agency unable to secure a written memorandum of understandingmutual aid agreement with a Class I ALS agency within its geographic service area, may operate within the jurisdiction as a nonlicensed BLS first responseFirst Response agency if:

a.

Thethe agency has written correspondence from at least one (1) Class I 911 agency within its geographic service area denying the nonlicensed BLS first response agency's request to enter into a memorandum of understandingmutual aid agreement; and

b.

The agency maintains:.

(i)

The correspondence denying the memorandum of understanding request on file at the agency;mutual aid request shall be maintained on file at the agency.

(ii)

Board-approved medical direction;

(iii)

Board-approved BLS first response agency protocols; and

(iv)

Written policies addressing each of the issues listed in subsection (1)(f)6.c. through h.subsections (1)(f)(6)(c) through (h) of this section.

9.8.

A license to provide BLS care shall not be issued solely through the execution of a memorandum of understandingmutual aid agreement between a Class I agency and a nonlicensed BLS first responseFirst Response agency;

(g)(f)

A Class VII – (Air Ambulance Services) – A rotor or fixed wing air ambulance service providing ALS and BLS 911 scene response or emergency, interfacility, or nonemergency care and air transportation;

(g)

A fixed wing class VII service provides ALS or BLS emergency or nonemergency air transportation; and

(h)

A Class VIII – (Event Medicine Providers) – An agency utilizing emergency medical services personnel to provide ALS or BLS careproviding BLS or ALS pre-hospital care above the first-aid level at special events, sports events, concerts, or other large social gatherings;.

1.

A Class VIII agency shall be licensed separately as a Class VIII ALS or BLS agency.A Class VIII agency shall not transport patients beyond the grounds of an event and shall be bound by the geographic service area of its Certificate of Need.

2.

A Class VIII agency shall not transport patients independently to a hospital.

3.

If transport of a patient is required, a Class VIII agency shall contact 911 for transport by a Class I agency licensed for the geographic service area.

4.

Upon request, a Class VIII agency shall make available to any Class I agency within its geographic service area its protocols, treatment capabilities, and updated contact information;.

(i)

Class IX – (State Special Response Agencies) – An agency providing emergency and nonemergency care as part of a state-sponsored specialty team, such as Kentucky Urban Search and Rescue or other state special response agency, and that provides services and conducts trainings throughout the Commonwealth.

1.

A Class IX agency shall be licensed separately as a Class IX ALS or BLS agency.

2.

A Class IX agency shall not transport patients independently to a hospital.

3.

If transport of a patient is required, a Class IX agencyshall contact 911 for transport by a Class I agency licensed for the geographic service area; and.

(j)

Class X – (Nonemergency Out-of-State Reciprocity License) – An out-of-state agency providing nonemergency response and that is licensed by and in good standing with another state EMS regulatory body and holds a Certificate of Need to operate a Class III agency in Kentucky.

1.

An out-of-state agency shall be eligible for a reciprocal Kentucky license if the agency:

a.

Provides only nonemergency response;

b.

Is licensed by and in good standing with another state EMS regulatory body; and

c.

Holds a Certificate of Need to operate a Class III agency in Kentucky.

2.

An out-of-state agency may apply for a Class X license by submitting a valid agency license from another state to the KBEMS office.

3.

A Class X agency shall be exempt from all administrative regulations promulgated by the board except 202 KAR 7:030, 202 KAR 7:501, and 202 KAR 7:540.

4.

A Class X agency shall satisfy all requirements for maintaining its license issued by another state EMS regulatory body, including but not limited to all staffing, equipment, medical director, and inspection requirements of the state of original licensure.

5.

A Class X license shall not require an initial or annual inspection by the KBEMS office, but a Class X agency shall be subject to random inspections by the KBEMS office.

6.

If a Class X agency fails to maintain its license issued by another state EMS regulatory body, the agency shall be deemed to have surrendered its Class X license.

7.

If a Class X agency's license issued by another state EMS regulatory body is revoked, suspended, lapses, or placed on probationary status, the agency shall notify the KBEMS office within five (5) days of such action.

(2)

The KBEMS office shall license agencies in accordance with subsection (1) of this section.

(3)

An agency shall apply for license from the board within ninety (90) days of issuance of a Certificate of Need from the Cabinet for Health and Family Services.

(4)

An agency that does not apply for a license within ninety (90) days of the issuance of its Certification of Need shall not be granted a license by the board.

(5)

An agency shall request a final inspection for licensure from the board, in writing, within 180 days after applying for a license from the board.

(6)

An agency that does not request a final inspection for licensure from the board, in writing, within 180 days after applying for a license from the board shall not be granted a license by the board.

(7)

An agency shall not hold more than one (1) license per level of classification in one (1) defined geographic service area unless each license was obtained prior to January 1, 2018.

Section 3.Section 2.

Public Notice of Negative Action. The board office shall publish on the KBEMS websiteWeb site or similar publication of the board, the name of any licensed agency that is fined, placed on probationary status, placed on restricted status, suspended, or had a license revoked.

FILED WITH LRC: September 9, 2025 at 1 p.m.
CONTACT PERSON: John K. Wood, Counsel for the Kentucky Board of Emergency Medical Services, 163 East Main Street, Suite 200, Lexington, Kentucky 40507, phone (859) 225-4714, email administrativeregulations@wgmfirm.com.

7-Year Expiration: 8/25/2029

Last Updated: 9/24/2025


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