Bill > A1018

Introduced Session

This bill revises the requirements for the licensure and operation of mobile intensive care units and personnel operating on those units. The bill identifies several new categories of licensure with regard to prehospital care: advanced paramedics; paramedic assistants; mobile intensive care nurses; specialty care transport nurses; paramedic support units; and mobile integrated care units. The bill additionally revises the requirements for paramedic licensure and for licensure of mobile intensive care units. Under the bill, mobile intensive care programs operated by a hospital may provide, in addition to advanced life support services through a mobile intensive care unit, mobile integrated health care and specialty care transport services. Mobile integrated health care is the provision of non-emergent health care services by an advanced paramedic or registered nurse using patient-centered, mobile resources, including alternative treatment modalities in response to non-emergent 9-1-1 calls; providing community paramedicine care, chronic disease management, preventative care, and post-discharge follow-up visits; and providing referrals and transportation assistance to patients who do not require hospital-based treatment. Specialty care transport is the inter-facility transportation of a patient in need of care that exceeds the scope of practice for a basic life support unit, which would ordinarily provide transportation services. The bill authorizes a mobile intensive care unit to be operated by a paramedic operating with another paramedic, a mobile intensive care nurse, or an advanced paramedic, or by an advanced paramedic and a paramedic assistant, which, under the bill, is a professional licensed to provide intermediate life support. Specialty care transport units would be staffed by a specialty care transport nurse and at least one other professional certified as an emergency medical technician (EMT). The bill additionally authorizes paramedic support units, which would be staffed by at least one advanced paramedic and used to provide both mobile integrated health care and support to mobile intensive care units responding to an emergency call. Units may hold multiple licenses at one time, provided that they meet the qualification requirements for each type of license held. The bill will not revise the current requirements for a hospital to be authorized to develop and provide a mobile intensive care program or the primary response areas in which hospitals are authorized to provide services. The bill establishes in, but not of, the Department of Health, the Advanced Life Support (ALS) Oversight Board. The ALS Oversight Board will be responsible for: (1) establishing and maintaining written standards for the licensure of paramedics, advanced paramedics, and paramedic assistants; (2) establishing education or equivalency standards for advanced paramedics and standards for the approval of advanced paramedic training programs; (3) establishing and maintaining written standards for the acknowledgement of mobile intensive care nurses and specialty care transport nurses; (4) establishing the scope of practice and medical protocols for paramedic assistants and paramedics; (5) approving medical protocols for advanced paramedics; (6) establishing equivalency standards for approval of out-of-State health care professionals, including paramedics, other emergency medical services personnel, members of the military, and federal law enforcement officers to train and practice in the State; (7) providing advice to the Commissioner of Health concerning the promulgation of regulations and on other aspects concerning advanced life support, mobile integrated health care, specialty care transport, and other aspects of prehospital care; and (8) such other duties as are expressly provided under the bill. The membership of the board will comprise the agency directors and agency medical directors of mobile intensive care programs authorized to operate in the State, as well as two paramedics, one mobile intensive care nurse, and one specialty care transport unit nurse. Agency medical directors are board-certified emergency physicians who provide medical oversight for a hospital mobile intensive care program, while agency operational directors are paramedics, or nurses holding a valid EMT certification, who are responsible for oversight and administration of the program's mobile intensive care units, mobile integrated care units, and specialty care transport units. Each mobile intensive care program is required to have both an agency director and an agency medical director. The chair of the board, who will be appointed by the Commissioner of Health and will serve at the commissioner's pleasure, is required to be a licensed physician who is board certified in emergency medicine or emergency medical services. In general, the scope of practice and protocols authorized for a given paramedic, advanced paramedic, paramedic assistant, mobile intensive care nurse, specialty care transport nurse, mobile intensive care unit, paramedic support unit, mobile integrated care unit, or specialty care transport unit will be authorized by that professional's or unit's agency medical director, consistent with standards established by the ALS Oversight Board and subject to board approval. However, the ALS Oversight Board will have exclusive authority to determine the scope of practice for advanced paramedics. Advanced paramedics will be required, at a minimum, to hold a bachelor's degree in paramedicine; however, until bachelor's degree programs in paramedicine become available in New Jersey, the ALS Oversight Board will have the authority to establish the minimum education, training, and experience requirements for licensure. The board will continue to have the authority to establish these requirements even after an accredited paramedicine degree program becomes available in the State and the degree becomes a minimum requirement for advanced paramedic licensure. The bill repeals sections 1 through 14 of P.L.1984, c.146 (C.26:2K-7 et seq.), which set forth the current licensing and operational requirements for mobile intensive care units, and P.L.1985, c.351 (C.26:2K-21 et seq.), which established the now obsolete EMT-intermediate pilot program. It is the sponsor's belief that this bill will foster an enhanced and more dynamic system of prehospital care in the State through the use of a diversified licensing structure, community-based mobile integrated health care designed to prevent unnecessary hospital utilization, and additional types of mobile care units, including mobile integrated care units and paramedic support units. It is the sponsor's hope that this new system of prehospital care will increase access to care by improving paramedic distribution and allowing faster response times, improve the efficiency and effectiveness of the State emergency medical services system, and that this reformed system of prehospital care may lead to other innovative healthcare solutions that may become available and prudent as the healthcare care delivery system evolves.

Committee Categories

Nancy Muñoz (R)*, 

Introduced, Referred to Assembly Health Committee (on 01/09/2024)

Official Document