Title 202 | Chapter 007 | Regulation 545REG
PROPOSED
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KENTUCKY BOARD OF EMERGENCY MEDICAL SERVICES
(Amendment)
202 KAR 7:545.License classifications.
Section 1.
Definitions.(1)
"911 scene response" means a response:(a)
Resulting from a 911 call or other call to a dispatch center or public safety answering point for assistance;(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(c)
Where transportation of the patient will terminate in an emergency room or other location for immediate assessment or treatment.(d)
"911 scene response" shall not include response to a call where 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 under 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, license(a)
1.
Class Ia – (911 Services) – A ground ambulance provider operating at the ALS or BLS level, or both, and which shall provide 911 scene response and may provide emergency, nonemergency, or interfacility care and transportation; or2.
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)
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; or2.
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)
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); or3.
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.
2.
3.
(d)
(e)
Class V – (Mobile Integrated Health Care Programs) – A mobile integrated health care program operating at the ALS and BLS level.(f)(e)
1.
Each ALS first response agency shall be licensed separately as a Class VI ALS agency.2.
Each BLS first response3.2.
A licensed Class I agency4.3.
A memorandum of understanding5.4.
A nonlicensed BLS first response agency6.5.
A memorandum of understandinga.
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; andh.
Liability insurance,7.6.
A nonlicensed BLS first response8.7.
A nonlicensed BLS first responsea.
Theb.
The agency maintains:(i)
The correspondence denying the memorandum of understanding request 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 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 understanding(g)(f)
(g)
(h)
1.
A Class VIII agency shall be licensed separately as a Class VIII ALS or BLS agency.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 agency shall contact 911 for transport by a Class I agency licensed for the geographic service area.(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 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; andc.
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)
(4)
(5)
(6)
(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 websiteJOHN R. HOLDER, Chair
APPROVED BY AGENCY: April 30, 2025
FILED WITH LRC: May 21, 2025 at 2:36 p.m.
PUBLIC HEARING AND COMMENT PERIOD: A public hearing on this administrative regulation shall be held on August 22, 2025, at 1:00 p.m. ET at the Kentucky Board of Emergency Medical Services, 500 Mero Street, 5th Floor 5SE32, Frankfort, Kentucky 40601. Individuals interested in being heard at this hearing shall notify this agency in writing by five (5) workdays prior to the hearing of their intent to attend. If no notification of intent to attend the hearing is received by that date, the hearing may be canceled. This hearing is open to the public. Any person who wishes to be heard will be given an opportunity to comment on the proposed administrative regulation. A transcript of the public hearing will not be made unless a written request for a transcript is made. If you do not wish to be heard at the public hearing, you may submit written comments on the proposed administrative regulation. Written comments shall be accepted through August 31, 2025. Send written notification of intent to be heard at the public hearing or written comments on the proposed administrative regulation to the contact person.
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.
REGULATORY IMPACT ANALYSIS AND TIERING STATEMENT
Contact Person:
John K. Wood
(1) Provide a brief summary of:
(a) What this administrative regulation does:
KRS 311A.030 requires the board to promulgate administrative regulations establishing the license classifications of ambulance services, mobile integrated healthcare programs, and medical first response providers. This administrative regulation establishes the classes of ambulance services, mobile integrated healthcare programs, and medical first response providers.
(b) The necessity of this administrative regulation:
House Bill 57 (2024 Regular Session) amended KRS 311A.030 to permit the Board to classify ambulance services, mobile integrated healthcare programs, and medical first response providers. This administrative regulation is necessary to update the classifications of agencies, as authorized by HB 57.
(c) How this administrative regulation conforms to the content of the authorizing statutes:
This administrative regulation conforms to the content of KRS 311A.030 by establishing the license classifications of ambulance services, mobile integrated healthcare programs, and medical first response providers.
(d) How this administrative regulation currently assists or will assist in the effective administration of the statutes:
KRS 311A.030 requires the board to promulgate administrative regulations establishing the license classifications of ambulance services, mobile integrated healthcare programs, and medical first response providers. This administrative regulation will assist in the effective administration of KRS 311A.030 by classifying EMS agencies.
(2) If this is an amendment to an existing administrative regulation, provide a brief summary of:
(a) How the amendment will change this existing administrative regulation:
This amendment establishes new classes of EMS agencies and modifies existing classes. Specifically, this amendment: Separates Class I agencies into two classes: Class Ia and Class Ib. Class Ia services will be required to provide 911 scene response, which is defined in this amendment, and will be permitted to provide other emergency, nonemergency, or interfacility care and transportation. Class Ib services will be the Certificate of Need-exempt city and county services operating pursuant to KRS 216B.020(8). Separates Class II services into two classes: Class IIa and Class IIb. Class IIa services will be permitted to provide interfacility and nonemergency care at the ALS or BLS level, or both. Class IIb services will be the Certificate of Need-exempt hospital services operating pursuant to KRS 216B.020(7). Clarifies that the three types of Class III agencies must operate at the ALS level and may provide interfacility care and transportation. Establishes a class of license for mobile integrated health care programs. Clarifies that Class VI medical first response agencies may operate without a license if they have a memorandum of understanding with the Class I agency that services their geographic service area. If such agencies cannot secure a memorandum of understanding, they must maintain board-approved medical direction and protocols. Clarifies that Class VII air ambulance services may provide both ALS and BLS 911 scene response and emergency, interfacility, or nonemergency care and air transportation. Clarifies that Class VIII event medicine providers are those agencies that utilize EMS personnel to provide ALS or BLS care at special events, sports events, concerts, or other large social gatherings. Upon request, Class VIII event medicine providers must make their protocol, treatment capabilities, and contact information available to any Class I agency in their geographic service area. Creates a new class of license, Class IX, for state special response agencies. Those agencies may provide emergency and nonemergency care as part of a state-sponsored specialty team, such as Kentucky Urban Search and Rescue. Class IX agencies must be licensed at either the ALS or BLS level and may not transport patients independently to a hospital. Creates a new class of license, Class X, for out-of-state nonemergency agencies holding a Certificate of Need to operate a Class III agency in Kentucky. Clarifies the requirement to timely apply for a license after obtaining a Certificate of Need. Agencies will be required to submit an initial license application to the Board within 90 days after being issued a CON. Changes the requirement to request a final inspection after obtaining a Certificate of Need. Agencies will be required to request a final inspection within one (1) year after submitting a completed initial license application. Under the current version of this administrative regulation, agencies must request a final inspection within 180 days after applying for a license from the Board. Grants agencies an automatic 180-day extension to the deadline to request a final inspection upon written request. No additional extensions of time are available. In accordance with House Bill 305 (2025 Regular Session), deletes deadlines to apply for a license and request a final inspection after receiving a Certificate of Need.
(b) The necessity of the amendment to this administrative regulation:
This amendment is necessary to update the license classifications of ambulance services, mobile integrated healthcare programs, and medical first response providers. Before House Bill 57 (2024 Regular Session) became law, the classifications of EMS agencies were established by KRS 311A.030.
(c) How the amendment conforms to the content of the authorizing statutes:
This amendment conforms to the content of KRS 311A.030 by establishing the license classifications of ambulance services, mobile integrated healthcare programs, and medical first response providers.
(d) How the amendment will assist in the effective administration of the statutes:
Before House Bill 57 (2024 Regular Session) became law, the classifications of EMS agencies were established by KRS 311A.030. The current version of this administrative regulation mirrors those previous statutory classifications. House Bill 57 amended KRS 311A.030 to grant the Board the authority to classify ambulance services, mobile integrated healthcare programs, and medical first response providers. This amendment will assist in the effective administration of KRS 311A.030 by updating the license classifications of ambulance services, mobile integrated healthcare programs, and medical first response providers.
(3) List the type and number of individuals, businesses, organizations, or state and local governments affected by this administrative regulation:
This administrative regulation will affect all ambulance services, mobile integrated healthcare programs, and medical first response providers.
(4) Provide an analysis of how the entities identified in question (3) will be impacted by either the implementation of this administrative regulation, if new, or by the change, if it is an amendment, including:
(a) List the actions that each of the regulated entities identified in question (3) will have to take to comply with this administrative regulation or amendment:
Ambulance service, mobile integrated healthcare program, or medical first response provider will be required to operate within the scope of their defined license classification. Agencies currently licensed as a Class I, for example, will be reclassified as a Class I A or Class I B agency.
(b) In complying with this administrative regulation or amendment, how much will it cost each of the entities identified in question (3):
There will be no cost to any entity identified in question (3), other than the costs of operating within the scope of the agency’s license classification.
(c) As a result of compliance, what benefits will accrue to the entities identified in question (3):
Ambulance service, mobile integrated healthcare program, or medical first response providers will benefit from the clarifications to each type of EMS agency license class provided in this amendment.
(5) Provide an estimate of how much it will cost the administrative body to implement this administrative regulation:
(a) Initially:
Other than administrative costs, there will be no costs to the Board in implementing this administrative regulation.
(b) On a continuing basis:
Other than administrative costs, there will be no costs to the Board in implementing this administrative regulation.
(6) What is the source of the funding to be used for the implementation and enforcement of this administrative regulation:
The Kentucky Board of Emergency Medical Services is a state agency that receives its annual budget from the state government.
(7) Provide an assessment of whether an increase in fees or funding will be necessary to implement this administrative regulation, if new, or by the change if it is an amendment:
No increase in fees or funding will be necessary to implement this amendment.
(8) State whether or not this administrative regulation establishes any fees or directly or indirectly increases any fees:
This regulation does not establish any fees.
(9) TIERING: Is tiering applied?
Tiering is not applied to this administrative regulation because the amendment applies to all ambulance services, mobile integrated healthcare programs, and medical first response providers.
FISCAL IMPACT STATEMENT
(1) Identify each state statute, federal statute, or federal regulation that requires or authorizes the action taken by the administrative regulation:
KRS 311A.030 requires the board to promulgate administrative regulations establishing the license classifications of ambulance services, mobile integrated healthcare programs, and medical first response providers.
(2) State whether this administrative regulation is expressly authorized by an act of the General Assembly, and if so, identify the act:
This administrative regulation is expressly authorized by House Bill 57 (2024 Regular Session), 2024 Ky. Acts ch. 94, sec. 1.
(3)(a) Identify the promulgating agency and any other affected state units, parts, or divisions:
This amendment is promulgated by the Kentucky Board of Emergency Medical Services.
(b) Estimate the following for each affected state unit, part, or division identified in (3)(a):
1. Expenditures:
For the first year:
None
For subsequent years:
None
2. Revenues:
For the first year:
None
For subsequent years:
None
3. Cost Savings:
For the first year:
None
For subsequent years:
None
(4)(a) Identify affected local entities (for example: cities, counties, fire departments, school districts):
All cities and counties.
(b) Estimate the following for each affected local entity identified in (4)(a):
1. Expenditures:
For the first year:
None
For subsequent years:
None
2. Revenues:
For the first year:
None
For subsequent years:
None
3. Cost Savings:
For the first year:
None
For subsequent years:
None
(5)(a) Identify any affected regulated entities not listed in (3)(a) or (4)(a):
All emergency medical services, first response agencies, and mobile integrated health care programs.
(b) Estimate the following for each regulated entity identified in (5)(a):
1. Expenditures:
For the first year:
None
For subsequent years:
None
2. Revenues:
For the first year:
None
For subsequent years:
None
3. Cost Savings:
For the first year:
None
For subsequent years:
None
(6) Provide a narrative to explain the following for each entity identified in (3)(a), (4)(a), and (5)(a)
(a) Fiscal impact of this administrative regulation:
No fiscal impact is anticipated as a result of this administrative regulation, other than the existing costs of operating within the entity’s license classification.
(b) Methodology and resources used to reach this conclusion:
This amendment does not increase any fees and is not otherwise expected to have a fiscal impact.
(7) Explain, as it relates to the entities identified in (3)(a), (4)(a), and (5)(a):
(a) Whether this administrative regulation will have a "major economic impact", as defined by KRS 13A.010(13):
This administrative regulation will not have a major economic impact.
(b) The methodology and resources used to reach this conclusion:
This amendment does not increase any fees and is not otherwise expected to have a fiscal impact.
KENTUCKY BOARD OF EMERGENCY MEDICAL SERVICES
(Amendment)
202 KAR 7:545.License classifications.
Section 1.
Definitions.(1)
"911 scene response" means a response:(a)
Resulting from a 911 call or other call to a dispatch center or public safety answering point for assistance;(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(c)
Where transportation of the patient will terminate in an emergency room or other location for immediate assessment or treatment.(d)
"911 scene response" shall not include response to a call where 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 under 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, license classifications for ambulance providers, mobile integrated healthcare programs, and medical first response agencies shall include:(a)
Class I ground ambulance providers, which shall be classified as:1.
Class Ia – (911 Services) – A ground ambulance provider operating at the ALS or BLS level, or both, and which shall provide 911 scene response and may provide emergency, nonemergency, or interfacility care and transportation; or2.
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)
Class II ground ambulance providers, which shall be classified as: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; or2.
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)
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: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); or3.
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.(d)
Class IV – (Restricted Location Services) – A ground ambulance provider operating at the ALS or BLS level to provide emergency and nonemergency care with or without 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)
Class VI – (Medical First Response Agencies) – An agency providing medical first response without patient transport at the ALS or BLS level.1.
Each ALS first response agency shall be licensed separately as a Class VI ALS agency.2.
Each BLS first response agency shall be licensed separately as a Class VI BLS agency unless a memorandum of understanding is executed with a licensed Class I agency that provides services for the geographic service area.3.
A licensed Class I agency may execute a memorandum of understanding with multiple nonlicensed BLS first response agencies that serve the same geographic service area.4.
A memorandum of understanding shall automatically renew at the conclusion of a calendar year.5.
A nonlicensed BLS first response agency or a Class I agency may terminate a memorandum of understanding thirty (30) days after written notice is provided to the other party.6.
A memorandum of understanding between a Class I agency and a nonlicensed BLS first 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; andh.
Liability insurance, if applicable.7.
A nonlicensed BLS first response agency shall not provide BLS care outside of its geographic service area unless responding through an executed mutual aid agreement.8.
A nonlicensed BLS first response agency unable to secure a written memorandum of understanding with a Class I agency within its geographic service area may operate within the jurisdiction as a nonlicensed BLS first response agency if:a.
The agency has written correspondence from at least one (1) Class I agency within its geographic service area denying the nonlicensed BLS first response agency's request to enter into a memorandum of understanding; andb.
The agency maintains:(i)
The correspondence denying the memorandum of understanding request 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 subsections (1)(f)(6)(c) through (h) of this section.9.
A license to provide BLS care shall not be issued solely through the execution of a memorandum of understanding between a Class I agency and a nonlicensed BLS first response agency;(g)
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;(h)
Class VIII – (Event Medicine Providers) – An agency utilizing emergency medical services personnel to provide ALS or BLS care 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.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 agency shall contact 911 for transport by a Class I agency licensed for the geographic service area.(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 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; andc.
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 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.
Public Notice of Negative Action. The board office shall publish on the KBEMS website 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.JOHN R. HOLDER, Chair
APPROVED BY AGENCY: April 30, 2025
FILED WITH LRC: May 21, 2025 at 2:36 p.m.
PUBLIC HEARING AND COMMENT PERIOD: A public hearing on this administrative regulation shall be held on August 22, 2025, at 1:00 p.m. ET at the Kentucky Board of Emergency Medical Services, 500 Mero Street, 5th Floor 5SE32, Frankfort, Kentucky 40601. Individuals interested in being heard at this hearing shall notify this agency in writing by five (5) workdays prior to the hearing of their intent to attend. If no notification of intent to attend the hearing is received by that date, the hearing may be canceled. This hearing is open to the public. Any person who wishes to be heard will be given an opportunity to comment on the proposed administrative regulation. A transcript of the public hearing will not be made unless a written request for a transcript is made. If you do not wish to be heard at the public hearing, you may submit written comments on the proposed administrative regulation. Written comments shall be accepted through August 31, 2025. Send written notification of intent to be heard at the public hearing or written comments on the proposed administrative regulation to the contact person.
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.
REGULATORY IMPACT ANALYSIS AND TIERING STATEMENT
Contact Person:
John K. Wood
(1) Provide a brief summary of:
(a) What this administrative regulation does:
KRS 311A.030 requires the board to promulgate administrative regulations establishing the license classifications of ambulance services, mobile integrated healthcare programs, and medical first response providers. This administrative regulation establishes the classes of ambulance services, mobile integrated healthcare programs, and medical first response providers.
(b) The necessity of this administrative regulation:
House Bill 57 (2024 Regular Session) amended KRS 311A.030 to permit the Board to classify ambulance services, mobile integrated healthcare programs, and medical first response providers. This administrative regulation is necessary to update the classifications of agencies, as authorized by HB 57.
(c) How this administrative regulation conforms to the content of the authorizing statutes:
This administrative regulation conforms to the content of KRS 311A.030 by establishing the license classifications of ambulance services, mobile integrated healthcare programs, and medical first response providers.
(d) How this administrative regulation currently assists or will assist in the effective administration of the statutes:
KRS 311A.030 requires the board to promulgate administrative regulations establishing the license classifications of ambulance services, mobile integrated healthcare programs, and medical first response providers. This administrative regulation will assist in the effective administration of KRS 311A.030 by classifying EMS agencies.
(2) If this is an amendment to an existing administrative regulation, provide a brief summary of:
(a) How the amendment will change this existing administrative regulation:
This amendment establishes new classes of EMS agencies and modifies existing classes. Specifically, this amendment: Separates Class I agencies into two classes: Class Ia and Class Ib. Class Ia services will be required to provide 911 scene response, which is defined in this amendment, and will be permitted to provide other emergency, nonemergency, or interfacility care and transportation. Class Ib services will be the Certificate of Need-exempt city and county services operating pursuant to KRS 216B.020(8). Separates Class II services into two classes: Class IIa and Class IIb. Class IIa services will be permitted to provide interfacility and nonemergency care at the ALS or BLS level, or both. Class IIb services will be the Certificate of Need-exempt hospital services operating pursuant to KRS 216B.020(7). Clarifies that the three types of Class III agencies must operate at the ALS level and may provide interfacility care and transportation. Establishes a class of license for mobile integrated health care programs. Clarifies that Class VI medical first response agencies may operate without a license if they have a memorandum of understanding with the Class I agency that services their geographic service area. If such agencies cannot secure a memorandum of understanding, they must maintain board-approved medical direction and protocols. Clarifies that Class VII air ambulance services may provide both ALS and BLS 911 scene response and emergency, interfacility, or nonemergency care and air transportation. Clarifies that Class VIII event medicine providers are those agencies that utilize EMS personnel to provide ALS or BLS care at special events, sports events, concerts, or other large social gatherings. Upon request, Class VIII event medicine providers must make their protocol, treatment capabilities, and contact information available to any Class I agency in their geographic service area. Creates a new class of license, Class IX, for state special response agencies. Those agencies may provide emergency and nonemergency care as part of a state-sponsored specialty team, such as Kentucky Urban Search and Rescue. Class IX agencies must be licensed at either the ALS or BLS level and may not transport patients independently to a hospital. Creates a new class of license, Class X, for out-of-state nonemergency agencies holding a Certificate of Need to operate a Class III agency in Kentucky. Clarifies the requirement to timely apply for a license after obtaining a Certificate of Need. Agencies will be required to submit an initial license application to the Board within 90 days after being issued a CON. Changes the requirement to request a final inspection after obtaining a Certificate of Need. Agencies will be required to request a final inspection within one (1) year after submitting a completed initial license application. Under the current version of this administrative regulation, agencies must request a final inspection within 180 days after applying for a license from the Board. Grants agencies an automatic 180-day extension to the deadline to request a final inspection upon written request. No additional extensions of time are available. In accordance with House Bill 305 (2025 Regular Session), deletes deadlines to apply for a license and request a final inspection after receiving a Certificate of Need.
(b) The necessity of the amendment to this administrative regulation:
This amendment is necessary to update the license classifications of ambulance services, mobile integrated healthcare programs, and medical first response providers. Before House Bill 57 (2024 Regular Session) became law, the classifications of EMS agencies were established by KRS 311A.030.
(c) How the amendment conforms to the content of the authorizing statutes:
This amendment conforms to the content of KRS 311A.030 by establishing the license classifications of ambulance services, mobile integrated healthcare programs, and medical first response providers.
(d) How the amendment will assist in the effective administration of the statutes:
Before House Bill 57 (2024 Regular Session) became law, the classifications of EMS agencies were established by KRS 311A.030. The current version of this administrative regulation mirrors those previous statutory classifications. House Bill 57 amended KRS 311A.030 to grant the Board the authority to classify ambulance services, mobile integrated healthcare programs, and medical first response providers. This amendment will assist in the effective administration of KRS 311A.030 by updating the license classifications of ambulance services, mobile integrated healthcare programs, and medical first response providers.
(3) List the type and number of individuals, businesses, organizations, or state and local governments affected by this administrative regulation:
This administrative regulation will affect all ambulance services, mobile integrated healthcare programs, and medical first response providers.
(4) Provide an analysis of how the entities identified in question (3) will be impacted by either the implementation of this administrative regulation, if new, or by the change, if it is an amendment, including:
(a) List the actions that each of the regulated entities identified in question (3) will have to take to comply with this administrative regulation or amendment:
Ambulance service, mobile integrated healthcare program, or medical first response provider will be required to operate within the scope of their defined license classification. Agencies currently licensed as a Class I, for example, will be reclassified as a Class I A or Class I B agency.
(b) In complying with this administrative regulation or amendment, how much will it cost each of the entities identified in question (3):
There will be no cost to any entity identified in question (3), other than the costs of operating within the scope of the agency’s license classification.
(c) As a result of compliance, what benefits will accrue to the entities identified in question (3):
Ambulance service, mobile integrated healthcare program, or medical first response providers will benefit from the clarifications to each type of EMS agency license class provided in this amendment.
(5) Provide an estimate of how much it will cost the administrative body to implement this administrative regulation:
(a) Initially:
Other than administrative costs, there will be no costs to the Board in implementing this administrative regulation.
(b) On a continuing basis:
Other than administrative costs, there will be no costs to the Board in implementing this administrative regulation.
(6) What is the source of the funding to be used for the implementation and enforcement of this administrative regulation:
The Kentucky Board of Emergency Medical Services is a state agency that receives its annual budget from the state government.
(7) Provide an assessment of whether an increase in fees or funding will be necessary to implement this administrative regulation, if new, or by the change if it is an amendment:
No increase in fees or funding will be necessary to implement this amendment.
(8) State whether or not this administrative regulation establishes any fees or directly or indirectly increases any fees:
This regulation does not establish any fees.
(9) TIERING: Is tiering applied?
Tiering is not applied to this administrative regulation because the amendment applies to all ambulance services, mobile integrated healthcare programs, and medical first response providers.
FISCAL IMPACT STATEMENT
(1) Identify each state statute, federal statute, or federal regulation that requires or authorizes the action taken by the administrative regulation:
KRS 311A.030 requires the board to promulgate administrative regulations establishing the license classifications of ambulance services, mobile integrated healthcare programs, and medical first response providers.
(2) State whether this administrative regulation is expressly authorized by an act of the General Assembly, and if so, identify the act:
This administrative regulation is expressly authorized by House Bill 57 (2024 Regular Session), 2024 Ky. Acts ch. 94, sec. 1.
(3)(a) Identify the promulgating agency and any other affected state units, parts, or divisions:
This amendment is promulgated by the Kentucky Board of Emergency Medical Services.
(b) Estimate the following for each affected state unit, part, or division identified in (3)(a):
1. Expenditures:
For the first year:
None
For subsequent years:
None
2. Revenues:
For the first year:
None
For subsequent years:
None
3. Cost Savings:
For the first year:
None
For subsequent years:
None
(4)(a) Identify affected local entities (for example: cities, counties, fire departments, school districts):
All cities and counties.
(b) Estimate the following for each affected local entity identified in (4)(a):
1. Expenditures:
For the first year:
None
For subsequent years:
None
2. Revenues:
For the first year:
None
For subsequent years:
None
3. Cost Savings:
For the first year:
None
For subsequent years:
None
(5)(a) Identify any affected regulated entities not listed in (3)(a) or (4)(a):
All emergency medical services, first response agencies, and mobile integrated health care programs.
(b) Estimate the following for each regulated entity identified in (5)(a):
1. Expenditures:
For the first year:
None
For subsequent years:
None
2. Revenues:
For the first year:
None
For subsequent years:
None
3. Cost Savings:
For the first year:
None
For subsequent years:
None
(6) Provide a narrative to explain the following for each entity identified in (3)(a), (4)(a), and (5)(a)
(a) Fiscal impact of this administrative regulation:
No fiscal impact is anticipated as a result of this administrative regulation, other than the existing costs of operating within the entity’s license classification.
(b) Methodology and resources used to reach this conclusion:
This amendment does not increase any fees and is not otherwise expected to have a fiscal impact.
(7) Explain, as it relates to the entities identified in (3)(a), (4)(a), and (5)(a):
(a) Whether this administrative regulation will have a "major economic impact", as defined by KRS 13A.010(13):
This administrative regulation will not have a major economic impact.
(b) The methodology and resources used to reach this conclusion:
This amendment does not increase any fees and is not otherwise expected to have a fiscal impact.