Health: emergency services; ambulance operation adaptive care license; create, the official text

Act No. 90

Public Acts of 2026

Approved by the Governor

July 21, 2026

Filed with the Secretary of State

July 27, 2026

EFFECTIVE
DATE: July 27, 2026

state of michigan

103rd Legislature

Regular session of 2026

Introduced by Reps. Prestin, Frisbie, Bohnak, Markkanen,
Cavitt, Borton, Rigas, St. Germaine, Beson, Roth, Tisdel, Schmaltz, Bierlein,
Thompson, Breen, Woolford, Weiss, DeBoyer, Wozniak, Harris, Mentzer, Fairbairn,
Alexander, Kuhn, Linting, Kunse, B. Carter, Martus, BeGole, Wortz, VanderWall,
Scott and Brixie

ENROLLED HOUSE BILL No. 5249

AN ACT to amend 1978 PA 368,
entitled “An act to protect and promote the public health; to codify, revise,
consolidate, classify, and add to the laws relating to public health; to
provide for the prevention and control of diseases and disabilities; to provide
for the classification, administration, regulation, financing, and maintenance
of personal, environmental, and other health services and activities; to create
or continue, and prescribe the powers and duties of, departments, boards,
commissions, councils, committees, task forces, and other agencies; to
prescribe the powers and duties of governmental entities and officials; to
regulate occupations, facilities, and agencies affecting the public health; to
regulate health maintenance organizations and certain third party
administrators and insurers; to provide for the imposition of a regulatory fee;
to provide for the levy of taxes against certain health facilities or agencies;
to promote the efficient and economical delivery of health care services, to
provide for the appropriate utilization of health care facilities and services,
and to provide for the closure of hospitals or consolidation of hospitals or
services; to provide for the collection and use of data and information; to
provide for the transfer of property; to provide certain immunity from
liability; to regulate and prohibit the sale and offering for sale of drug
paraphernalia under certain circumstances; to provide for the implementation of
federal law; to provide for penalties and remedies; to provide for sanctions
for violations of this act and local ordinances; to provide for an
appropriation and supplements; to repeal certain acts and parts of acts; to
repeal certain parts of this act; and to repeal certain parts of this act on
specific dates,” by amending section 20920 (MCL 333.20920), as amended by
2014 PA 413.

The People of the State of
Michigan enact:

Sec.
20920. (1) A person shall not establish, operate, or cause to be operated an
ambulance operation unless the ambulance operation is licensed under this
section.

(2) Upon proper application and payment of a $100.00 fee, the
department shall issue a license as an ambulance operation to a person who
meets the requirements of this part and the rules promulgated under this part.

(3) An applicant shall specify in the application each
ambulance to be operated.

(4) An ambulance operation license shall specify the
ambulances licensed to be operated.

(5) An ambulance operation license shall state the highest
level of life support the ambulance operation is licensed to provide. An
ambulance operation shall operate in accordance with this part, rules
promulgated under this part, and approved medical control authority protocols
and, except as provided in section 20921a(2), shall not provide life support at
a level that exceeds its license and available licensed personnel or violates
approved medical control authority protocols.

(6) An ambulance operation license may be renewed annually
upon application to the department and payment of a $100.00 renewal fee. Before
issuing a renewal license, the department shall determine that the ambulance
operation is in compliance with this part, the rules promulgated under this
part, and medical control authority protocols.

(7) Beginning on July 22, 1997, an ambulance operation that
meets all of the following requirements may apply for an ambulance operation
upgrade license under subsection (8):

(a) On or before July 22, 1997, holds an ambulance operation
license that designates the ambulance operation either as a transporting basic
life support service or as a transporting limited advanced life support
service.

(b) Is a transporting basic life support service, that is
able to staff and equip 1 or more ambulances for the transport of emergency
patients at a life support level higher than basic life support, or is a
transporting limited advanced life support service, that is able to staff and
equip 1 or more ambulances for the transport of emergency patients at the life
support level of advanced life support.

(c) Is owned or operated by or under contract to a local
governmental unit and providing first-line emergency medical response to that
local governmental
unit on or before July 22, 1997.

(d) Will provide the services described in subdivision (b)
only to the local governmental unit described in subdivision (c), and only in
response to a 9-1-1 call or other call for emergency transport.

(8) An ambulance operation meeting the requirements of
subsection (7) that applies for an ambulance operation upgrade license shall
include all of the following information in the application provided by the
department:

(a) Verification of all of the requirements of subsection (7)
including, but not limited to, a description of the staffing and equipment to
be used in providing the higher level of life support services.

(b) If the applicant is a transporting basic life support
service, a plan of action to upgrade from providing basic life support to
providing limited advanced life support or advanced life support to take place
over a period of not more than 2 years. If the applicant is a transporting
limited advanced life support service, a plan of action to upgrade from
providing limited advanced life support to providing advanced life support to
take place over a period of not more than 2 years.

(c) The medical control authority protocols for the ambulance
operation upgrade license, along with a recommendation from the medical control
authority under which the ambulance operation operates that the ambulance
operation upgrade license be issued by the department.

(d) Other information required by the department.

(9) The statewide emergency medical services coordination
committee shall review the information described in subsection (8)(c) and make
a recommendation to the department as to whether or not an ambulance operation
upgrade license should be granted to the applicant.

(10) Upon receipt of a completed application as required
under subsection (8), a positive recommendation under subsection (9), and
payment of a $100.00 fee, the department shall issue to the applicant an
ambulance operation upgrade license. Subject to subsection (12), the license is
valid for 2 years from the date of issuance and is renewable for 1 additional
2-year period. An application for renewal of an ambulance operation upgrade
license must contain documentation of the progress made on the plan of action
described in subsection (8)(b). In addition, the medical control authority
under which the ambulance operation operates shall annually file with the
statewide emergency medical services coordination committee a written report on
the progress made by the ambulance operation on the plan of action described in
subsection (8)(b), including, but not limited to, information on training,
equipment, and personnel.

(11) If an ambulance operation is designated by its regular
license as providing basic life support services, then an ambulance operation
upgrade license issued under this section allows the ambulance operation to
provide limited advanced life support services or advanced life support
services when the ambulance operation is able to staff and equip 1 or more
ambulances to provide services at the higher levels. If an ambulance operation
is designated by its regular license as providing limited advanced life support
services, then an ambulance operation upgrade license issued under this section
allows the ambulance operation to provide advanced life support services when
the ambulance operation is able to staff and equip 1 or more ambulances to
provide services at the higher level. An ambulance operation shall not provide
services under an ambulance operation upgrade license unless the medical
control authority under which the ambulance operation operates has adopted
protocols for the ambulance operation upgrade license regarding quality
monitoring procedures, use and protection of equipment, and patient care.

(12) The department may revoke or fail to renew an ambulance
operation upgrade license for a violation of this part or a rule promulgated
under this part or for failure to comply with the plan of action filed under
subsection (8)(b). An ambulance operation that obtains an ambulance operation
upgrade license must annually renew its regular license under subsections (2)
to (6). An ambulance operation’s regular license is not affected by the
following:

(a) The fact that the ambulance operation has obtained or
renewed an ambulance operation upgrade license.

(b) The fact that an ambulance operation’s ambulance
operation upgrade license is revoked or is not renewed under this subsection.

(c) The fact that the ambulance operation’s ambulance
operation upgrade license expires at the end of the second 2-year period
prescribed by subsection (10).

(13)
Beginning 6 months after the effective date of the amendatory act that added
this subsection, an ambulance operation that meets all of the following
requirements may apply for an ambulance operation adaptive care license under
subsection (14):

(a)
Holds an ambulance operation license that designates the ambulance operation as
a transporting basic life support service.

(b)
Was a transporting basic life support service on or before October 1, 2022.

(c)
Is a transporting basic life support service that is able to staff and equip 1
or more ambulances for the transport of emergency patients at a life support
level higher than basic life support.

(d)
Is owned or operated by or under contract to a local
governmental unit and is designated by that local governmental unit as the
ambulance operation providing transporting service to that local governmental
unit.

(e)
Will provide the services described in subdivision (c) only to the local
governmental unit described in subdivision (d), and only in response to a 9-1-1
call or other call for emergency transport.

(14)
An ambulance operation meeting the requirements of subsection (13) that applies
for an ambulance operation adaptive care license shall include all of the
following information in the application provided by the department:

(a)
Verification of all of the requirements of subsection (13), including, but not
limited to, a description of the staffing and equipment to be used in providing
the higher level of life support services.

(b)
The medical control authority protocols for the ambulance operation adaptive
care license, along with a recommendation from the medical control authority
under which the ambulance operation operates that the ambulance operation
adaptive care license be issued by the department.

(c)
Other information required by the department.

(15)
The statewide emergency medical services coordination committee shall review
the information described in subsection (14) and make a recommendation to the
department as to whether or not an ambulance operation adaptive care license
should be granted to the applicant.

(16)
Upon receipt of a completed application as required under subsection (14) and a
positive recommendation under subsection (15), the department shall issue to
the applicant an ambulance operation adaptive care license. Subject to
subsection (18), the ambulance operation adaptive care license is valid for 4
years from the date of issuance.

(17)
An ambulance operation adaptive care license issued under this section allows
the ambulance operation to provide limited advanced life support services when
the ambulance operation is able to staff and equip 1 or more ambulances to
provide services at the limited advanced life support level. An ambulance
operation shall not provide services under an ambulance operation adaptive care
license unless the medical control authority under which the ambulance
operation operates has adopted protocols for the ambulance operation adaptive
care license regarding quality monitoring procedures, use and protection of
equipment, and patient care.

(18)
The department may revoke or fail to renew an ambulance operation adaptive care
license for a violation of this part or a rule promulgated under this part. An
ambulance operation that obtains an ambulance operation adaptive care license
must annually renew its regular license under subsections (2) to (6). An
ambulance operation’s regular license is not affected by the following:

(a)
The fact that the ambulance operation has obtained or renewed an ambulance
operation adaptive care license.

(b)
The fact that an ambulance operation’s ambulance operation adaptive care
license is revoked or is not renewed under this subsection.

(c)
The fact that the ambulance operation’s ambulance operation adaptive care
license expires as prescribed under subsection (16).

This act is ordered to take
immediate effect.

Clerk of the House of
Representatives

Secretary of the Senate

Approved___________________________________________

____________________________________________________

Governor