1.1.................... moves to amend H.F. No. 4738, the third engrossment, as follows:
1.2Page 30, after line 14, insert:


1.6    Section 1. Minnesota Statutes 2022, section 144E.001, subdivision 3a, is amended to read:
1.7    Subd. 3a. Ambulance service personnel. "Ambulance service personnel" means
1.8individuals who are authorized by a licensed ambulance service to provide emergency care
1.9for the ambulance service and are:
1.10(1) EMTs, AEMTs, or paramedics;
1.11(2) Minnesota registered nurses who are: (i) EMTs, are currently practicing nursing, and
1.12have passed a paramedic practical skills test, as approved by the board and administered by
1.13an educational program approved by the board been approved by the ambulance service
1.14medical director; (ii) on the roster of an ambulance service on or before January 1, 2000;
1.15or (iii) after petitioning the board, deemed by the board to have training and skills equivalent
1.16to an EMT, as determined on a case-by-case basis; or (iv) certified as a certified flight
1.17registered nurse or certified emergency nurse; or
1.18(3) Minnesota licensed physician assistants who are: (i) EMTs, are currently practicing
1.19as physician assistants, and have passed a paramedic practical skills test, as approved by
1.20the board and administered by an educational program approved by the board been approved
1.21by the ambulance service medical director; (ii) on the roster of an ambulance service on or
1.22before January 1, 2000; or (iii) after petitioning the board, deemed by the board to have
1.23training and skills equivalent to an EMT, as determined on a case-by-case basis.

2.1    Sec. 2. Minnesota Statutes 2023 Supplement, section 144E.101, subdivision 6, is amended
2.2to read:
2.3    Subd. 6. Basic life support. (a) Except as provided in paragraph (f) subdivision 6a, a
2.4basic life-support ambulance shall be staffed by at least two EMTs, one of whom must
2.5accompany the patient and provide a level of care so as to ensure that:
2.6(1) one individual who is:
2.7(i) certified as an EMT;
2.8(ii) a Minnesota registered nurse who meets the qualification requirements in section
2.9144E.001, subdivision 3a, clause (2); or
2.10(iii) a Minnesota licensed physician assistant who meets the qualification requirements
2.11in section 144E.001, subdivision 3a, clause (3); and
2.12(2) one individual to drive the ambulance who:
2.13(i) either meets one of the qualification requirements in clause (1) or is a registered
2.14emergency medical responder driver; and
2.15(ii) satisfies the requirements in subdivision 10.
2.16(b) An individual who meets one of the qualification requirements in paragraph (a),
2.17clause (1), must accompany the patient and provide a level of care so as to ensure that:
2.18    (1) life-threatening situations and potentially serious injuries are recognized;
2.19    (2) patients are protected from additional hazards;
2.20    (3) basic treatment to reduce the seriousness of emergency situations is administered;
2.21and
2.22    (4) patients are transported to an appropriate medical facility for treatment.
2.23    (b) (c) A basic life-support service shall provide basic airway management.
2.24    (c) (d) A basic life-support service shall provide automatic defibrillation.
2.25(d) (e) A basic life-support service shall administer opiate antagonists consistent with
2.26protocols established by the service's medical director.
2.27    (e) (f) A basic life-support service licensee's medical director may authorize ambulance
2.28service personnel to perform intravenous infusion and use equipment that is within the
2.29licensure level of the ambulance service. Ambulance service personnel must be properly
3.1trained. Documentation of authorization for use, guidelines for use, continuing education,
3.2and skill verification must be maintained in the licensee's files.
3.3    (f) For emergency ambulance calls and interfacility transfers, an ambulance service may
3.4staff its basic life-support ambulances with one EMT, who must accompany the patient,
3.5and one registered emergency medical responder driver. For purposes of this paragraph,
3.6"ambulance service" means either an ambulance service whose primary service area is
3.7mainly located outside the metropolitan counties listed in section 473.121, subdivision 4,
3.8and outside the cities of Duluth, Mankato, Moorhead, Rochester, and St. Cloud; or an
3.9ambulance service based in a community with a population of less than 2,500.

3.10    Sec. 3. Minnesota Statutes 2022, section 144E.101, is amended by adding a subdivision
3.11to read:
3.12    Subd. 6a. Variance; staffing of basic life-support ambulance. (a) Upon application
3.13from an ambulance service that includes evidence demonstrating hardship, the board may
3.14grant a variance from the staff requirements in subdivision 6, paragraph (a), and may
3.15authorize a basic life-support ambulance to be staffed, for all emergency calls and interfacility
3.16transfers, with one individual who meets the qualification requirements in paragraph (b) to
3.17drive the ambulance and one individual who meets one of the qualification requirements in
3.18subdivision 6, paragraph (a), clause (1), and who must accompany the patient. The variance
3.19applies to basic life-support ambulances until the ambulance service renews its license.
3.20When the variance expires, the ambulance service may apply for a new variance under this
3.21subdivision.
3.22(b) In order to drive an ambulance under a variance granted under this subdivision, an
3.23individual must:
3.24(1) hold a valid driver's license from any state;
3.25(2) have attended an emergency vehicle driving course approved by the ambulance
3.26service;
3.27(3) have completed a course on cardiopulmonary resuscitation approved by the ambulance
3.28service; and
3.29(4) register with the board according to a process established by the board.
3.30(c) If an individual serving as a driver under this subdivision commits or has a record
3.31of committing an act listed in section 144E.27, subdivision 5, paragraph (a), the board may
3.32temporarily suspend or prohibit the individual from driving an ambulance or place conditions
4.1on the individual's ability to drive an ambulance using the procedures and authority in
4.2section 144E.27, subdivisions 5 and 6.

4.3    Sec. 4. Minnesota Statutes 2023 Supplement, section 144E.101, subdivision 7, as amended
4.4by Laws 2024, chapter 85, section 32, is amended to read:
4.5    Subd. 7. Advanced life support. (a) Except as provided in paragraphs (f) and (g), an
4.6advanced life-support ambulance shall be staffed by at least:
4.7    (1) one EMT or one AEMT and one paramedic;
4.8    (2) one EMT or one AEMT and one registered nurse who: (i) is an EMT or an AEMT,
4.9is currently practicing nursing, and has passed a paramedic practical skills test approved by
4.10the board and administered by an education program has been approved by the ambulance
4.11service medical director; or (ii) is certified as a certified flight registered nurse or certified
4.12emergency nurse; or
4.13    (3) one EMT or one AEMT and one physician assistant who is an EMT or an AEMT,
4.14is currently practicing as a physician assistant, and has passed a paramedic practical skills
4.15test approved by the board and administered by an education program has been approved
4.16by the ambulance service medical director.
4.17    (b) An advanced life-support service shall provide basic life support, as specified under
4.18subdivision 6, paragraph (a) (b), advanced airway management, manual defibrillation,
4.19administration of intravenous fluids and pharmaceuticals, and administration of opiate
4.20antagonists.
4.21    (c) In addition to providing advanced life support, an advanced life-support service may
4.22staff additional ambulances to provide basic life support according to subdivision 6 and
4.23section 144E.103, subdivision 1.
4.24    (d) An ambulance service providing advanced life support shall have a written agreement
4.25with its medical director to ensure medical control for patient care 24 hours a day, seven
4.26days a week. The terms of the agreement shall include a written policy on the administration
4.27of medical control for the service. The policy shall address the following issues:
4.28    (1) two-way communication for physician direction of ambulance service personnel;
4.29    (2) patient triage, treatment, and transport;
4.30    (3) use of standing orders; and
4.31    (4) the means by which medical control will be provided 24 hours a day.
5.1    The agreement shall be signed by the licensee's medical director and the licensee or the
5.2licensee's designee and maintained in the files of the licensee.
5.3    (e) When an ambulance service provides advanced life support, the authority of a
5.4paramedic, Minnesota registered nurse-EMT, or Minnesota registered physician
5.5assistant-EMT to determine the delivery of patient care prevails over the authority of an
5.6EMT.
5.7    (f) Upon application from an ambulance service that includes evidence demonstrating
5.8hardship, the board may grant a variance from the staff requirements in paragraph (a), clause
5.9(1), and may authorize an advanced life-support ambulance to be staffed by a registered
5.10emergency medical responder driver with a paramedic for all emergency calls and interfacility
5.11transfers. The variance shall apply to advanced life-support ambulance services until the
5.12ambulance service renews its license. When the variance expires, an ambulance service
5.13may apply for a new variance under this paragraph. This paragraph applies only to an
5.14ambulance service whose primary service area is mainly located outside the metropolitan
5.15counties listed in section 473.121, subdivision 4, and outside the cities of Duluth, Mankato,
5.16Moorhead, Rochester, and St. Cloud, or an ambulance service based in a community with
5.17a population of less than 1,000 persons.
5.18    (g) After an initial emergency ambulance call, each subsequent emergency ambulance
5.19response, until the initial ambulance is again available, and interfacility transfers, may be
5.20staffed by one registered emergency medical responder driver and an EMT or paramedic.
5.21This paragraph applies only to an ambulance service whose primary service area is mainly
5.22located outside the metropolitan counties listed in section 473.121, subdivision 4, and outside
5.23the cities of Duluth, Mankato, Moorhead, Rochester, and St. Cloud, or an ambulance service
5.24based in a community with a population of less than 1,000 persons.
5.25    (h) An individual who staffs an advanced life-support ambulance as a driver must also
5.26meet the requirements in subdivision 10.

5.27    Sec. 5. Minnesota Statutes 2022, section 144E.27, subdivision 3, is amended to read:
5.28    Subd. 3. Renewal. (a) The board may renew the registration of an emergency medical
5.29responder who:
5.30(1) successfully completes a board-approved refresher course; and
5.31(2) successfully completes a course in cardiopulmonary resuscitation approved by the
5.32board or by the licensee's medical director. This course may be a component of a
5.33board-approved refresher course; and
6.1(2) (3) submits a completed renewal application to the board before the registration
6.2expiration date.
6.3(b) The board may renew the lapsed registration of an emergency medical responder
6.4who:
6.5(1) successfully completes a board-approved refresher course; and
6.6(2) successfully completes a course in cardiopulmonary resuscitation approved by the
6.7board or by the licensee's medical director. This course may be a component of a
6.8board-approved refresher course; and
6.9(2) (3) submits a completed renewal application to the board within 12 48 months after
6.10the registration expiration date.

6.11    Sec. 6. Minnesota Statutes 2022, section 144E.27, subdivision 5, is amended to read:
6.12    Subd. 5. Denial, suspension, revocation; emergency medical responders and
6.13drivers. (a) This subdivision applies to individuals seeking registration or registered as an
6.14emergency medical responder and to individuals seeking registration or registered as a driver
6.15of a basic life-support ambulance under section 144E.101, subdivision 6a. The board may
6.16deny, suspend, revoke, place conditions on, or refuse to renew the registration of an individual
6.17who the board determines:
6.18(1) violates sections 144E.001 to 144E.33 or the rules adopted under those sections, an
6.19agreement for corrective action, or an order that the board issued or is otherwise empowered
6.20to enforce;
6.21(2) misrepresents or falsifies information on an application form for registration;
6.22(3) is convicted or pleads guilty or nolo contendere to any felony; any gross misdemeanor
6.23relating to assault, sexual misconduct, theft, or the illegal use of drugs or alcohol; or any
6.24misdemeanor relating to assault, sexual misconduct, theft, or the illegal use of drugs or
6.25alcohol;
6.26(4) is actually or potentially unable to provide emergency medical services or drive an
6.27ambulance with reasonable skill and safety to patients by reason of illness, use of alcohol,
6.28drugs, chemicals, or any other material, or as a result of any mental or physical condition;
6.29(5) engages in unethical conduct, including, but not limited to, conduct likely to deceive,
6.30defraud, or harm the public, or demonstrating a willful or careless disregard for the health,
6.31welfare, or safety of the public;
6.32(6) maltreats or abandons a patient;
7.1(7) violates any state or federal controlled substance law;
7.2(8) engages in unprofessional conduct or any other conduct which has the potential for
7.3causing harm to the public, including any departure from or failure to conform to the
7.4minimum standards of acceptable and prevailing practice without actual injury having to
7.5be established;
7.6(9) for emergency medical responders, provides emergency medical services under
7.7lapsed or nonrenewed credentials;
7.8(10) is subject to a denial, corrective, disciplinary, or other similar action in another
7.9jurisdiction or by another regulatory authority;
7.10(11) engages in conduct with a patient that is sexual or may reasonably be interpreted
7.11by the patient as sexual, or in any verbal behavior that is seductive or sexually demeaning
7.12to a patient; or
7.13(12) makes a false statement or knowingly provides false information to the board, or
7.14fails to cooperate with an investigation of the board as required by section 144E.30.
7.15(b) Before taking action under paragraph (a), the board shall give notice to an individual
7.16of the right to a contested case hearing under chapter 14. If an individual requests a contested
7.17case hearing within 30 days after receiving notice, the board shall initiate a contested case
7.18hearing according to chapter 14.
7.19(c) The administrative law judge shall issue a report and recommendation within 30
7.20days after closing the contested case hearing record. The board shall issue a final order
7.21within 30 days after receipt of the administrative law judge's report.
7.22(d) After six months from the board's decision to deny, revoke, place conditions on, or
7.23refuse renewal of an individual's registration for disciplinary action, the individual shall
7.24have the opportunity to apply to the board for reinstatement.

7.25    Sec. 7. Minnesota Statutes 2022, section 144E.27, subdivision 6, is amended to read:
7.26    Subd. 6. Temporary suspension; emergency medical responders and drivers. (a)
7.27This subdivision applies to emergency medical responders registered under this section and
7.28to individuals registered as drivers of basic life-support ambulances under section 144E.101,
7.29subdivision 6a. In addition to any other remedy provided by law, the board may temporarily
7.30suspend the registration of an individual after conducting a preliminary inquiry to determine
7.31whether the board believes that the individual has violated a statute or rule that the board
8.1is empowered to enforce and determining that the continued provision of service by the
8.2individual would create an imminent risk to public health or harm to others.
8.3(b) A temporary suspension order prohibiting an individual from providing emergency
8.4medical care or from driving a basic life-support ambulance shall give notice of the right
8.5to a preliminary hearing according to paragraph (d) and shall state the reasons for the entry
8.6of the temporary suspension order.
8.7(c) Service of a temporary suspension order is effective when the order is served on the
8.8individual personally or by certified mail, which is complete upon receipt, refusal, or return
8.9for nondelivery to the most recent address provided to the board for the individual.
8.10(d) At the time the board issues a temporary suspension order, the board shall schedule
8.11a hearing, to be held before a group of its members designated by the board, that shall begin
8.12within 60 days after issuance of the temporary suspension order or within 15 working days
8.13of the date of the board's receipt of a request for a hearing from the individual, whichever
8.14is sooner. The hearing shall be on the sole issue of whether there is a reasonable basis to
8.15continue, modify, or lift the temporary suspension. A hearing under this paragraph is not
8.16subject to chapter 14.
8.17(e) Evidence presented by the board or the individual may be in the form of an affidavit.
8.18The individual or the individual's designee may appear for oral argument.
8.19(f) Within five working days of the hearing, the board shall issue its order and, if the
8.20suspension is continued, notify the individual of the right to a contested case hearing under
8.21chapter 14.
8.22(g) If an individual requests a contested case hearing within 30 days after receiving
8.23notice under paragraph (f), the board shall initiate a contested case hearing according to
8.24chapter 14. The administrative law judge shall issue a report and recommendation within
8.2530 days after the closing of the contested case hearing record. The board shall issue a final
8.26order within 30 days after receipt of the administrative law judge's report.

8.27    Sec. 8. Minnesota Statutes 2022, section 144E.28, subdivision 3, is amended to read:
8.28    Subd. 3. Reciprocity. The board may certify an individual who possesses a current
8.29National Registry of Emergency Medical Technicians registration certification from another
8.30jurisdiction if the individual submits a board-approved application form. The board
8.31certification classification shall be the same as the National Registry's classification.
8.32Certification shall be for the duration of the applicant's registration certification period in
8.33another jurisdiction, not to exceed two years.

9.1    Sec. 9. Minnesota Statutes 2022, section 144E.28, subdivision 8, is amended to read:
9.2    Subd. 8. Reinstatement. (a) Within four years of a certification expiration date, a person
9.3whose certification has expired under subdivision 7, paragraph (d), may have the certification
9.4reinstated upon submission of:
9.5(1) evidence to the board of training equivalent to the continuing education requirements
9.6of subdivision 7 or, for community paramedics, evidence to the board of training equivalent
9.7to the continuing education requirements of subdivision 9, paragraph (c); and
9.8(2) a board-approved application form.
9.9(b) If more than four years have passed since a certificate expiration date, an applicant
9.10must complete the initial certification process required under subdivision 1.
9.11(c) Beginning July 1, 2024, through December 31, 2025, and notwithstanding paragraph
9.12(b), a person whose certification as an EMT, AEMT, paramedic, or community paramedic
9.13expired more than four years ago but less than ten years ago may have the certification
9.14reinstated upon submission of:
9.15(1) evidence to the board of the training required under paragraph (a), clause (1). This
9.16training must have been completed within the 24 months prior to the date of the application
9.17for reinstatement;
9.18(2) a board-approved application form; and
9.19(3) a recommendation from an ambulance service medical director.
9.20This paragraph expires December 31, 2025.

9.21    Sec. 10. Minnesota Statutes 2022, section 144E.285, subdivision 1, is amended to read:
9.22    Subdivision 1. Approval required. (a) All education programs for an EMR, EMT,
9.23AEMT, or paramedic must be approved by the board.
9.24(b) To be approved by the board, an education program must:
9.25(1) submit an application prescribed by the board that includes:
9.26(i) type and length of course to be offered;
9.27(ii) names, addresses, and qualifications of the program medical director, program
9.28education coordinator, and instructors;
9.29(iii) names and addresses of clinical sites, including a contact person and telephone
9.30number;
10.1(iv) (iii) admission criteria for students; and
10.2(v) (iv) materials and equipment to be used;
10.3(2) for each course, implement the most current version of the United States Department
10.4of Transportation EMS Education Standards, or its equivalent as determined by the board
10.5applicable to EMR, EMT, AEMT, or paramedic education;
10.6(3) have a program medical director and a program coordinator;
10.7(4) utilize instructors who meet the requirements of section 144E.283 for teaching at
10.8least 50 percent of the course content. The remaining 50 percent of the course may be taught
10.9by guest lecturers approved by the education program coordinator or medical director;
10.10(5) have at least one instructor for every ten students at the practical skill stations;
10.11(6) maintain a written agreement with a licensed hospital or licensed ambulance service
10.12designating a clinical training site;
10.13(7) (5) retain documentation of program approval by the board, course outline, and
10.14student information;
10.15(8) (6) notify the board of the starting date of a course prior to the beginning of a course;
10.16and
10.17(9) (7) submit the appropriate fee as required under section 144E.29; and.
10.18(10) maintain a minimum average yearly pass rate as set by the board on an annual basis.
10.19The pass rate will be determined by the percent of candidates who pass the exam on the
10.20first attempt. An education program not meeting this yearly standard shall be placed on
10.21probation and shall be on a performance improvement plan approved by the board until
10.22meeting the pass rate standard. While on probation, the education program may continue
10.23providing classes if meeting the terms of the performance improvement plan as determined
10.24by the board. If an education program having probation status fails to meet the pass rate
10.25standard after two years in which an EMT initial course has been taught, the board may
10.26take disciplinary action under subdivision 5.

10.27    Sec. 11. Minnesota Statutes 2022, section 144E.285, is amended by adding a subdivision
10.28to read:
10.29    Subd. 1a. EMR education program requirements. The National EMS Education
10.30Standards established by the National Highway Traffic Safety Administration of the United
10.31States Department of Transportation specify the minimum requirements for knowledge and
10.32skills for emergency medical responders. An education program applying for approval to
11.1teach EMRs must comply with the requirements under subdivision 1, paragraph (b). A
11.2medical director of an emergency medical responder group may establish additional
11.3knowledge and skill requirements for EMRs.

11.4    Sec. 12. Minnesota Statutes 2022, section 144E.285, is amended by adding a subdivision
11.5to read:
11.6    Subd. 1b. EMT education program requirements. In addition to the requirements
11.7under subdivision 1, paragraph (b), an education program applying for approval to teach
11.8EMTs must:
11.9(1) include in the application prescribed by the board the names and addresses of clinical
11.10sites, including a contact person and telephone number;
11.11(2) maintain a written agreement with at least one clinical training site that is of a type
11.12recognized by the National EMS Education Standards established by the National Highway
11.13Traffic Safety Administration; and
11.14(3) maintain a minimum average yearly pass rate as set by the board. An education
11.15program not meeting this standard must be placed on probation and must comply with a
11.16performance improvement plan approved by the board until the program meets the pass
11.17rate standard. While on probation, the education program may continue to provide classes
11.18if the program meets the terms of the performance improvement plan, as determined by the
11.19board. If an education program that is on probation status fails to meet the pass rate standard
11.20after two years in which an EMT initial course has been taught, the board may take
11.21disciplinary action under subdivision 5.

11.22    Sec. 13. Minnesota Statutes 2022, section 144E.285, subdivision 2, is amended to read:
11.23    Subd. 2. AEMT and paramedic education program requirements. (a) In addition to
11.24the requirements under subdivision 1, paragraph (b), an education program applying for
11.25approval to teach AEMTs and paramedics must:
11.26(1) be administered by an educational institution accredited by the Commission of
11.27Accreditation of Allied Health Education Programs (CAAHEP).;
11.28(2) include in the application prescribed by the board the names and addresses of clinical
11.29sites, including a contact person and telephone number; and
11.30(3) maintain a written agreement with a licensed hospital or licensed ambulance service
11.31designating a clinical training site.
12.1(b) An AEMT and paramedic education program that is administered by an educational
12.2institution not accredited by CAAHEP, but that is in the process of completing the
12.3accreditation process, may be granted provisional approval by the board upon verification
12.4of submission of its self-study report and the appropriate review fee to CAAHEP.
12.5(c) An educational institution that discontinues its participation in the accreditation
12.6process must notify the board immediately and provisional approval shall be withdrawn.
12.7(d) This subdivision does not apply to a paramedic education program when the program
12.8is operated by an advanced life-support ambulance service licensed by the Emergency
12.9Medical Services Regulatory Board under this chapter, and the ambulance service meets
12.10the following criteria:
12.11(1) covers a rural primary service area that does not contain a hospital within the primary
12.12service area or contains a hospital within the primary service area that has been designated
12.13as a critical access hospital under section 144.1483, clause (9);
12.14(2) has tax-exempt status in accordance with the Internal Revenue Code, section
12.15501(c)(3);
12.16(3) received approval before 1991 from the commissioner of health to operate a paramedic
12.17education program;
12.18(4) operates an AEMT and paramedic education program exclusively to train paramedics
12.19for the local ambulance service; and
12.20(5) limits enrollment in the AEMT and paramedic program to five candidates per
12.21biennium.

12.22    Sec. 14. Minnesota Statutes 2022, section 144E.285, subdivision 4, is amended to read:
12.23    Subd. 4. Reapproval. An education program shall apply to the board for reapproval at
12.24least three months 30 days prior to the expiration date of its approval and must:
12.25(1) submit an application prescribed by the board specifying any changes from the
12.26information provided for prior approval and any other information requested by the board
12.27to clarify incomplete or ambiguous information presented in the application; and
12.28(2) comply with the requirements under subdivision 1, paragraph (b), clauses (2) to (10).
12.29(7);
12.30(3) be subject to a site visit by the board;
13.1(4) for education programs that teach EMRs, comply with the requirements in subdivision
13.21a;
13.3(5) for education programs that teach EMTs, comply with the requirements in subdivision
13.41b; and
13.5(6) for education programs that teach AEMTs and paramedics, comply with the
13.6requirements in subdivision 2 and maintain accreditation with CAAHEP.

13.7    Sec. 15. REPEALER.
13.8Minnesota Statutes 2022, section 144E.27, subdivisions 1 and 1a, are repealed."
13.9Amend the title accordingly