25 TAC §§500.501, 500.503, 500.505, 500.507, 500.509, 500.511, 500.513, 500.515, 500.517, 500.519, 500.521, 500.523, 500.525, 500.527
The Center for Rural Health Initiatives (center) proposes
new §§500.501, 500.503, 500.505, 500.507, 500.509, 500.511, 500.513,
500.515, 500.517, 500.519, 500.521, 500.523, 500.525, 500.527 concerning a
state grant program to match funds committed by qualified rural communities
to cover training of Emergency Medical Services (EMS) providers.
These rules are proposed to implement the Medicare Rural Hospital Flexibility
Program, under 42 United States Code §1395i-4. The Center received federal
funds to develop and implement the Critical Access Hospital Program in the
State of Texas, of which emergency services are a critical component. The
federal program specifically includes EMS as one of the stakeholders in the
Critical Access Hospital program; in the State of Texas, EMS representatives
have been involved in the program development. In order to assist Critical
Access Hospitals and the rural communities in their efforts to maintain EMS
services, the availability of trained, qualified EMS personnel was reported
as a major concern. This program will allow these entities to "grow their
own" EMS professionals and retain them in their rural communities, thus helping
to ensure the availability of EMS services in those communities.
The sections are needed to accomplish the following: define terms; provide
the center's philosophy in making the grants; discuss the sources and allocation
of funds; establish who is eligible to receive the grants; provide the requirements
for receiving the grants; establish the procedures for grant announcements;
establish the procedures for grant applications; describe the competitive
review process; and outline the selection criteria for awarding grants.
The center's proposed definition for a rural county is one that has a population
in the most recent decennial United States census of 50,000 or less, or with
respect to a county that has a population of more than 50,000 and contains
a geographic area that is not delineated as urbanized by the federal census
bureau, that part of the county that is not delineated as urbanized.
The center would like comments on its proposal to award grants to communities
to help cover the costs of training EMS professionals. The center would also
like comments on the funding amounts proposed in the rules. The center would
like comments on the selection criteria. The center would like comments on
whether the preferred criteria should be required or if there are additional
criteria that should be preferred.
Regional Advisory Councils are not eligible for this program as they do
not qualify as a political subdivision, nor are they able to provide for the
community service requirement, which is a requirement for accepting program
funds. Volunteer Emergency Medical Service groups who meet the qualifications
in §500.505 would be eligible. Also, this fund is meant only to train
Emergency Medical Technicians, Emergency Medical Technician-Intermediate and
Emergency Medical Technician-Paramedic, not to assist existing Emergency Medical
Service professionals in maintaining their required Continuing Medical Education
hours. First responder personnel would be eligible, so long as they are supported
by an eligible community and the candidate's training results in at least
an Emergency Medical Technician certificate. Emergency Care Attendant training
would not be sufficient for the purposes of this program.
Robt. J. "Sam" Tessen, MS, has also determined that for the first five
years that the rules will be in effect, there will be an effect on state government,
the center, to administer the grant program. The cost each year is estimated
to be $2000.00. Because local governments will qualify for grants, it is estimated
that there will be a positive impact on local governments in an amount equal
to the amount of grants that local governments receive. Political subdivisions
of the state or non-profit entities governed by council members, commissioners,
or a board of trustees are eligible to receive these grants, therefore some
portion of the funds appropriated may be granted to political subdivisions
of the state or non-profit entities which own or provide emergency medical
services in rural counties. Because non-profit entities will also qualify
for grants, it is not possible to determine the exact dollar amount that will
go to local governments.
Robt. J. "Sam" Tessen, MS, has also determined that for the first five
years the sections are in effect, the public benefit anticipated is an increase
in the number of EMS professionals to be vital links in the health care safety
net by providing funds to train individuals that have been selected by and
to serve in their local communities; however, grantees must match the funds
received from the center and may have nominal administrative costs in applying
for the grants. There is no anticipated cost to small businesses or micro-businesses
since they are not eligible for these funds. There will be no anticipated
impact on local employment.
Comments on the proposal may be submitted to Robt. J. "Sam" Tessen, MS,
Executive Director, Center for Rural Health Initiatives, P.O. Drawer 1708,
Austin, Texas, 78767-1708, (512) 479-8891. Comments will be accepted for 30
days following the date of publication of this proposal in the
Texas Register
.
The new sections are proposed under the Health and Safety Code, §106.021(j)
which provides the center with the authority to adopt rules to implement chapter
106.
The new sections affect the Health and Safety Code, §106.025.
§500.501.Purpose.
(a)
Purpose. This subchapter establishes rules for the allocation
of grant funds to qualified communities through the Rural Emergency Medical
Services (EMS) Scholarship Incentive Program. State grants match funds committed
by rural communities to cover training for EMS providers. EMS plays a critical
role in ensuring access to health care services in rural areas. The professionals
that provide these services and the training they receive correlates directly
with the quality of the emergency medical services available in any given
area. The goal is to partner with rural communities to ensure that they receive
the same level of emergency medical services that their urban counterparts
rely on and also to help in the retention of trainees by identifying candidates
from within the local community.
(b)
Funding. This subchapter describes the criteria and procedures
to be used by the Center for Rural Health Initiatives (center) in determining
the applicant's eligible for funding and the funding allocation method.
(c)
Administration. The center shall allocate funds to eligible
applicants based on the procedures specified in this subchapter.
§500.503.Definitions.
The following words and terms, when used in this subchapter, shall
have the following meanings, unless the context clearly indicates otherwise.
(1)
Applicant--A community that is requesting assistance through
the Rural EMS Scholarship Incentive Program.
(2)
Candidate--An individual who a community has selected
to receive the training eligible through the Rural EMS Scholarship Incentive
Program.
(3)
Center--The Center for Rural Health Initiatives.
(4)
Contracting community--An applicant that is contracted
to receive funds through the Rural EMS Scholarship Incentive Program.
(5)
Director--Executive Director of the Center for Rural
Health Initiatives or his or her designee.
(6)
Emergency medical services (EMS)--Services used to
respond to an individual's perceived need for immediate medical care and to
prevent death or aggravation of physiological or psychological illness or
injury.
(7)
EMT--An emergency medical technician meeting any of
the following training or certification levels:
(A)
Emergency medical technician (EMT-Basic)--An individual
who is certified by the Texas Department of Health as minimally proficient
to perform emergency prehospital or interfacility care that is necessary for
basic life support and that includes the control of hemorrhaging and cardiopulmonary
resuscitation.
(B)
Emergency medical technician-intermediate (EMT-I)--An individual
who is certified by the Texas Department of Health as minimally proficient
in performing skills required to provide emergency prehospital or interfacility
care by initiating under medical supervision certain procedures, including
intravenous therapy and endotracheal or esophageal intubation or both.
(C)
Emergency medical technician-paramedic (EMT-P)--An individual
who is certified by the Texas Department of Health as minimally proficient
to provide emergency prehospital or interfacility care by providing advanced
life support that includes initiation under medical supervision of certain
procedures, including intravenous therapy, endotracheal or esophageal intubation
or both, electrical cardiac defibrillation or cardioversion, and drug therapy.
(8)
Executive committee--The Executive Committee
of the Center for Rural Health Initiatives.
(9)
Rural county--A county that has a population in the
most recent decennial United States census of 50,000 or less, or with respect
to a county that has a population of more than 50,000 and contains a geographic
area that is not delineated as urbanized by the federal census bureau, that
part of the county that is not delineated as urbanized.
(10)
Training--Costs associated with an EMT training program,
including tuition, fees, books, supplies and travel. Training must be for
the purpose of upgrading a candidate's EMT-I or EMT-P certification or for
a candidate to obtain the level of EMT-Basic.
§500.505.Eligibility Criteria for a Rural EMS Scholarship Incentive Program Applicant.
To be eligible to participate in this program, an applicant must:
(1)
be located in a rural county;
(2)
exist in perpetuity as a political subdivision of
the state or a non-profit entity governed by council members, commissioners,
or a board of trustees that:
(A)
is responsible to and serves the community in which it
is located;
(B)
is legally authorized to raise funds and/or accept grants
and financial gifts from citizens, scholarship funds, or private foundations;
(C)
assures a commitment from the community of at least $2,000
or an amount equal to that granted by the center, whichever is less, in contributions
toward EMT training;
(D)
assures that applicant contributions will include no federal
or state funds; and
(E)
assures the availability of an emergency medical services
position for a candidate;
(3)
apply for state matching funds available through
this program; and
(4)
contract with a candidate to complete the training
program and to provide emergency medical services in the community for at
least one year following disbursement of the state funds and to reimburse
the center and the community for all funds if the candidate breaches the contract.
§500.507.Candidate Eligibility Criteria.
(a)
To qualify for funding from this program for EMT-Basic
training, a candidate must:
(1)
be at least 18 years of age; and
(2)
have a high school diploma or GED certificate.
(b)
To qualify for funding from this program for EMT-I or EMT-P
training, a candidate must:
(1)
hold a current license as an EMT (for EMT-I training) or
EMT-I (for EMT-P training) from the State of Texas;
(2)
have contracted with the applicant (that has made
a financial commitment of at least the minimum contribution level) to provide
emergency medical services in the community for at least one year;
(3)
have never defaulted on nor currently owe a refund
on any state, federal, or local student financial aid;
(4)
have authorized a credit check and background check,
the results of which are satisfactory to the applicant; and
(5)
have never been convicted of a felony.
§500.509.Procedures to Apply for Funds.
(a)
Application cycle. The center shall publish an annual notice
of availability of funds in the
Texas Register
.
(b)
Issuing office. A Request for Application (RFA) shall be
issued by the center. Potential applicants may request a copy of the RFA from
the center.
(c)
Purpose. The RFA shall provide the applicant with information
and forms necessary to apply for funding.
(d)
Application submission.
(1)
The center must receive the application by the due date
specified in the RFA.
(2)
Applicants must submit an original and two copies
of the application to the center.
(3)
The application must be on the forms and in the format
prescribed by the center.
(4)
The center shall return late or incomplete applications
with an explanation. Otherwise, all applications shall be considered for funding.
§500.511.Application Requirements.
Applications must contain the following information:
(1)
a description of the applicant which at a minimum shall
include:
(A)
the applicant's full name and address;
(B)
the name, title, mailing address, physical address, and
telephone number of a contact person;
(C)
the applicant's status as a political subdivision of the
state or nonprofit entity (including a certified copy of the organization's
nonprofit charter, if applicable) and ability to comply with §500.505(2)(B)
of this title (relating to Eligibility Criteria for a Rural EMS Scholarship
Incentive Program Applicant);
(D)
the name of the person responsible for the candidate's
progress and employment; and
(E)
the name of the person authorized to execute contracts
on behalf of the applicant; and
(2)
a description of the candidate which at a minimum
shall include:
(A)
the candidate's full name and address; and
(B)
the candidate's qualifications (including education level
and/or certification held).
§500.513.Evaluation of Application.
(a)
The executive committee delegates to the director the necessary
powers, duties and functions to administer this program.
(b)
The center shall review each complete application to determine
program eligibility, to prioritize community need among applicants, and to
make recommendations for funding.
(c)
An application which contains false information, shall
be denied consideration for the duration of the application period.
(d)
The center may renegotiate the amount of matching funds
to be awarded to any applicant.
(e)
The center may limit award amounts based on the availability
of funds.
(f)
The director of the center may waive provisions of this
subchapter if necessary to address unusual or exceptional applicant or candidate
eligibility issues.
§500.515.Contract Award.
(a)
After a review of staff recommendations, the director shall
announce the applicants selected for funding.
(b)
Applicants will be notified in writing of the approval
or denial of the application.
(c)
Any applicant who is denied funds under this program may
file a written request for an administrative review of the denial. The request
shall be mailed to the center within ten working days of the postmarked date
of the center's letter of denial. Upon receipt of the request, the director
shall conduct an administrative review, resulting in a final decision. The
center will mail a written notice of the decision either upholding or overruling
the denial to the applicant.
(d)
Contract awards shall not exceed $2,000 per applicant unless
the center has determined that the application demonstrates exceptional financial
need.
§500.517.Methodology for Prioritizing Neediest Communities.
The center will prioritize the applicants found eligible for participation
in the program to assure that the neediest communities are provided grants.
The prioritization process will quantify indicators of need (not listed in
any assigned priority order) which may include, but are not limited to, the
following:
(1)
communities needing basic and intermediate emergency medical
services personnel;
(2)
highest level of service currently available in the
county;
(3)
volunteer EMS staffing level;
(4)
average EMS call volume by category of county;
(5)
designation by the United States Department of Health
and Human Services as a medically underserved area (MUA);
(6)
communities located in a frontier area as defined
by the Federal Census Bureau;
(7)
number of hospitals and EMS providers in the county;
(8)
distance to the nearest level III, II and I trauma
centers;
(9)
average EMS transportation distance;
(10)
county mortality rate for unintentional injury;
(11)
county mortality rate for motor vehicle injury;
(12)
county mortality rate for stroke;
(13)
county mortality rate for heart disease; and
(14)
county population over 64 years of age.
§500.519.Contribution Procedures.
The center may provide up to $2,000 in matching funds per candidate
to the neediest communities as determined under §500.517 of this title
(relating to Methodology For Prioritizing Neediest Communities).
§500.521.Contract.
(a)
The center will execute a written contract with each selected
applicant concerning use of the state matching funds allocated under this
program. The contract shall provide that:
(1)
the applicant has obtained a credit check, background check,
verification of education level achieved and verification of any current EMS
certification held by the candidate;
(2)
the applicant has executed a contract with an eligible
candidate containing at least the following provisions:
(A)
the candidate shall engage in emergency medical services
in the contracting community for at least one year following disbursement
of the state funds; and
(B)
during the one-year service obligation, the candidate shall
not discriminate among patients seeking care based on their ability to pay
or whether payment will be made though Medicaid or Medicare.
(b)
The contracting community will provide proof of program
completion (candidate's EMS certification) upon completion of the candidate's
training.
§500.523.Funding Allocation Procedure.
A state warrant for the prescribed disbursement will be released to
a contracting community representative following execution of the required
contract.
§500.525.Breach of Contract
(a)
Binding contract. A contract executed under this subchapter
between the center and the contracting community is a binding contract.
(b)
A contracting community shall notify the center in writing
within thirty days of any change in its status or that of the candidate.
(c)
The center may find that the contracting community has
breached the contract if they have failed to:
(1)
provide the full amount of funding specified in the contract;
or
(2)
fulfill any other conditions specified in the contract.
(d)
If the center finds that the contracting community has
breached the contract, the center may require the following:
(1)
cancellation of the candidate's service obligation to the
contracting community;
(2)
reimbursement by the contracting community to the
center of state matching funds; and
(3)
forfeiture of the opportunity to participate in the
program in the future.
(e)
If the center finds that a candidate has breached his or
her contract with a contracting community, the candidate will not be eligible
to participate in the program in the future.
§500.527.Reporting and Monitoring.
(a)
The contracting community shall provide semi-annual reports
reflecting the candidate's total training costs to date and progress during
and after training.
(b)
The candidate shall provide the center with their employment
location, one year after their commitment to the community has been completed.
This agency hereby certifies that the proposal has been reviewed
by legal counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of
the Secretary of State, on March 24, 2000.
TRD-200002117
Robt. J. "Sam" Tessen
Executive Director
Center for Rural Health Incentives
Earliest possible date of adoption: May 7, 2000
For further information, please call: (512) 479-8891