The Florida Senate
BILL ANALYSIS AND FISCAL IMPACT STATEMENT
(This document is based on the provisions contained in the legislation as of the latest date listed below.)
Prepared By: The Professional Staff of the Committee on Health Policy
BILL: SB 502
INTRODUCER: Senator Rodriguez
SUBJECT: Certificates of Public Convenience and Necessity
DATE: December 1, 2021
ANALYST STAFF DIRECTOR REFERENCE ACTION
1. Smith Brown HP Pre-meeting
2. CA
3. RC
I. Summary:
SB 502 requires a county that has a population exceeding one million to issue a certificate of
public convenience and necessity to any applicant that has been operating in Florida for 10 years
and has a certificate of public convenience and necessity from at least three other Florida
counties. This requirement would not apply to a county operating under a home rule charter.
The bill has no fiscal impact on state revenues or state expenditures.
The bill provides an effective date of July 1, 2022.
II. Present Situation:
Basic and Advanced Life Support Services
Part III of ch. 401, F.S., consisting of ss. 401.2101-401.465, F.S., provides for the regulation of
emergency medical services by the Department of Health (DOH). The DOH website reflects that
its Emergency Medical Services Section is responsible for the licensure and oversight of over
60,000 emergency medical technicians and paramedics, 270+ advanced and basic life support
agencies, and over 4,500 EMS vehicles.
1
The DOH licenses three types of emergency medical
services: air ambulance,
2
basic life support, and advanced life support services.
A basic life support service is an emergency medical service that uses only basic life support
techniques.
3
In contrast, an advanced life support service is an emergency medical transport or
1
Florida Department of Health, Emergency Medical Services System, available at http://www.floridahealth.gov/licensing-
and-regulation/ems-system/index.html (last visited Nov. 24, 2021).
2
Sections 401.23(3)-(4) and 401.251, F.S.
3
Section 401.23(8), F.S.
REVISED: BILL: SB 502 Page 2
non-transport service that uses advanced life support techniques.
4
Similarly, an emergency
medical technician (EMT) is certified to perform basic life support,
5
but a paramedic is certified
to perform basic and advanced life support.
6
“Basic life support” is the assessment or treatment through the use of techniques described in the
EMT-Basic National Standard Curriculum or the National EMS Education Standards of the
United States Department of Transportation and approved by the DOH. The term includes the
administration of oxygen and other techniques that have been approved by the DOH.
7
When
transporting a person who is sick, injured, wounded, incapacitated, or helpless, each basic life
support ambulance must be occupied by at least two persons:
One patient attendant who is a certified EMT, certified paramedic, or licensed physician; and
One ambulance driver who meets the requirements of s. 401.281, F.S.
8
“Advanced life support” is the assessment or treatment through the use of techniques such as
endotracheal intubation, the administration of drugs or intravenous fluids, telemetry, cardiac
monitoring, cardiac defibrillation, and other techniques described in the EMT-Paramedic
National Standard Curriculum or the National EMS Education Standards, pursuant to DOH
rules.
9
When transporting a person who is sick, injured, wounded, incapacitated, or helpless,
each advanced life support ambulance must be occupied by at least two persons:
One certified paramedic or licensed physician; and
One certified EMT, certified paramedic, or licensed physician who also meets the
requirements of s. 401.281, F.S., for drivers.
10
The person occupying the advanced life support ambulance with the highest medical
certifications is in charge of patient care.
11
Section 401.25, F.S., provides requirements for licensure as basic and advanced life support
services. Every licensee must possess a valid permit for each vehicle in use.
12
Certificate of Public Convenience and Necessity Requirement
Section 401.25(2)(d), F.S., requires an applicant for licensure to obtain a certificate of public
convenience and necessity from each county in which the applicant will operate. In issuing the
certificate of public convenience and necessity, the governing body of each county must consider
the recommendations of municipalities within its jurisdiction.
DOH Rule 64J-1.001, Florida Administrative Code, defines a “certificate of public convenience
and necessity” as “a written statement or document, issued by the governing board of a county,
granting permission for an applicant or licensee to provide services authorized by a license
4
Section 401.23(2), F.S.
5
Section 401.23(11), F.S.
6
Section 401.23(17), F.S.
7
Section 401.23(7), F.S.
8
Section 401.25(7)(a), F.S.
9
Section 401.23(1), F.S.
10
Section 401.25(7)(b), F.S.
11
Id.
12
Section 401.26, F.S. BILL: SB 502 Page 3
issued under ch. 401, part III, F.S., for the benefit of the population of that county or the benefit
of the population of some geographic area of that county. No certificate of public need from one
county may interfere with the prerogatives asserted by another county regarding certificate of
public need.”
An applicant that is an active first responder agency is exempt from the certificate of public
necessity requirement for licensure if it meets all of the following requirements:
13
Is a faith-based, not-for-profit charitable corporation registered under ch. 617, F.S., which
has been responding to medical emergencies in this state for at least 10 consecutive years.
Is not a parent, subsidiary, or affiliate of, or related to, any for-profit entity.
Provides basic life support services or advanced life support services solely through at least
50 unpaid licensed emergency medical technician or paramedic volunteers.
Is not operating for pecuniary profit or financial gain.
Does not distribute to or inure to the benefit of its directors, members, or officers any part of
its assets or income.
Does not receive any government funding. However, the volunteer ambulance service may
receive funding from specialty license plate proceeds.
Has never had a license denied, revoked, or suspended.
Provides services free of charge.
As part of its application for licensure, provides to the DOH a management plan that includes
a training program, dispatch protocols, a complaint management system, an accident or
injury handling system, a quality assurance program, and proof of adequate insurance
coverage to meet state or county insurance requirements, whichever requirements are greater.
Provides a disclaimer on all written materials that the volunteer ambulance service is not
associated with the state’s 911 system.
The exemption above may be granted to no more than four counties.
14
Insurance Requirement
Section 401.25(2)(c), F.S., requires an applicant for licensure as a basic life support service or an
advanced life support service to furnish evidence of adequate insurance coverage for claims
arising out of injury to or death of persons and damage to the property of others resulting from
any cause that the owner of such service would be liable. In lieu of such insurance, the applicant
may furnish a certificate of self-insurance evidencing that the applicant has established an
adequate self-insurance plan to cover such risks and that the plan has been approved by the
Office of Insurance Regulation of the Financial Services Commission.
DOH Rule 64J-1.002, Florida Administrative Code, requires each non-government-operated
ground ambulance vehicle to be insured for the sum of at least $100,000 for injuries to or death
of any one person arising out of any one accident; the sum of at least $300,000 for injuries to or
death of more than one person in any one accident; and for the sum of at least $50,000 for
damage to property arising from any one accident. The rule requires government-operated
13
Section 401.25(2)(d), F.S
14
Id. BILL: SB 502 Page 4
service vehicles to be insured for the sum of at least $100,000 for any claim or judgment and the
sum of $200,000 total for all claims or judgments arising out of the same occurrence.
Some counties and municipal governments throughout the state have minimum insurance limits
within their ordinances that exceed those required by the DOH rule.
III. Effect of Proposed Changes:
Section 1 of the bill amends s. 401.25, F.S., to require a county that has a population exceeding
one million to issue a certificate of public convenience and necessity to any applicant that has
been operating in Florida for 10 years and has a certificate of public convenience and necessity
from at least three other Florida counties. This requirement would not apply to a county
operating under a home rule charter adopted pursuant to s. 10, s. 11, or s. 24, Art. VIII of the
State Constitution of 1885, as preserved by paragraph 6(e), Art. VIII of the State Constitution of
1968.
Section 2 of the bill provides an effective date of July 1, 2022.
IV. Constitutional Issues:
A. Municipality/County Mandates Restrictions:
None.
B. Public Records/Open Meetings Issues:
None.
C. Trust Funds Restrictions:
None.
D. State Tax or Fee Increases:
None.
E. Other Constitutional Issues:
None.
V. Fiscal Impact Statement:
A. Tax/Fee Issues:
None.
B. Private Sector Impact:
None. BILL: SB 502 Page 5
C. Government Sector Impact:
None.
VI. Technical Deficiencies:
None.
VII. Related Issues:
None.
VIII. Statutes Affected:
This bill substantially amends section 401.25 of the Florida Statutes.
IX. Additional Information:
A. Committee Substitute – Statement of Changes:
(Summarizing differences between the Committee Substitute and the prior version of the bill.)
None.
B. Amendments:
None.
This Senate Bill Analysis does not reflect the intent or official position of the bill’s introducer or the Florida Senate.