Chapter 256

256.205(4) (4) Affiliation. A community paramedic may provide services under sub. (6) only if he or she is a volunteer for or an employee of a community emergency medical services provider, as defined in s. 256.215 (1) (a), or if he or she is an employee of or under contract with a hospital, clinic, or physician.

256.205(5) (5) Requirements.

256.205(5)(a) (a) A community paramedic shall follow any protocols and supervisory standards established by the department or by a medical director.

256.205(5)(b) (b) A community paramedic is subject to certification, disciplinary, complaint, and other regulatory requirements that apply to emergency medical services practitioners under s. 256.15.

256.205(6) (6) Services provided. Notwithstanding the actions authorized for emergency services under s. 256.15 (6n), a community paramedic may provide services for which he or she is trained under a training program approved by the department under sub. (3), that are not duplicative of services already being provided to a patient, and that are approved by the hospital, clinic, or physician for which the community paramedic is an employee or contractor or are incorporated in the patient care protocols under s. 256.215 (2) (b).

256.205 History History: 2017 a. 66.

256.21 256.21 Community emergency medical services practitioners.

256.21(1) (1) Definition. In this section, “community emergency medical services practitioner” means an individual who has obtained an approval issued under sub. (2).

256.21(2) (2) Departmental approval. No person may use the title “community emergency medical services practitioner” unless he or she obtains an approval from the department issued under this section to provide services as a community emergency medical services practitioner. To be eligible for an approval by the department as a community emergency medical services practitioner, an individual shall meet all of the following criteria:

256.21(2)(a) (a) The individual is licensed as an emergency medical services practitioner of any level, that license is not suspended or revoked, and the individual is not the subject of an action under s. 256.15 (11).

256.21(2)(b) (b) The individual has the equivalent of 2 years of service as an emergency medical services practitioner at any level.

256.21(2)(c) (c) The individual successfully completes a training program that has been approved by the department under sub. (3).

256.21(2)(d) (d) The individual submits an application for the approval on a form specified by the department.

256.21(2)(e) (e) The individual satisfies any other requirements established by the department.

256.21(3) (3) Training program. The department shall, after consulting the board, approve training programs for community emergency medical services practitioners that include clinical experience, that provide flexibility in addressing local service needs, and that meet any other criteria established by the department.

256.21(4) (4) Affiliation. A community emergency medical services practitioner may provide services under sub. (6) only if he or she is a volunteer for or an employee of a community emergency medical services provider, as defined in s. 256.215 (1) (a), or if he or she is an employee of or under contract with a hospital, clinic, or physician.

256.21(5) (5) Requirements.

256.21(5)(a) (a) A community emergency medical services practitioner shall follow any protocols and supervisory standards established by the department or by a medical director.

256.21(5)(b) (b) A community emergency medical services practitioner is subject to certification, disciplinary, complaint, and other regulatory requirements that apply to emergency medical services practitioners under s. 256.15.

256.21(6) (6) Services provided. Notwithstanding the actions authorized for emergency services under s. 256.15 (6n), a community emergency medical services practitioner may provide services for which he or she is trained under a training program approved by the department under sub. (3), that are not duplicative of services already being provided to a patient, and that are approved by the hospital, clinic, or physician for which the community emergency medical services practitioner is an employee or contractor or are incorporated in the patient care protocols under s. 256.215 (2) (b).

256.21 History History: 2017 a. 66.

256.215 256.215 Providers of community emergency medical services.

256.215(1) (1) Definitions. In this section:

256.215(1)(a) (a) “Community emergency medical services provider” means an emergency medical services provider that has approval from the department for its personnel to provide community emergency medical services under sub. (2).

256.215(1)(b) (b) “Community emergency medical services practitioner” has the meaning given under s. 256.21 (1).

256.215(1)(c) (c) “Community paramedic” has the meaning given under s. 256.205 (1).

256.215(1)(d) (d) “Emergency medical services provider” means an emergency medical services program under s. 256.12 that provides services as a nontransporting emergency medical services practitioner provider or an ambulance service provider licensed under s. 256.15 (5).

256.215(2) (2) Approval. No emergency medical services provider may advertise as providing community emergency medical services or may advertise having community paramedics or community emergency medical services practitioners unless the emergency medical services provider has approval from the department under this subsection. To be eligible for approval to provide community emergency medical services, an emergency medical services provider shall satisfy all of the following criteria:

256.215(2)(a) (a) The emergency medical services provider is licensed by the department at any emergency medical services level.

256.215(2)(b) (b) The emergency medical services provider establishes, submits to the department, and maintains patient care protocols corresponding to the appropriate service level to be used by a community paramedic or a community emergency medical services practitioner. The emergency medical services provider may include in a patient care protocol only those services that do not require a license, certificate, or other credential under subch. II, III, IV, or VII of ch. 448 or subch. I of ch. 457 or ch. 441, 446, 447, 449, 450, 451, 455, or 459 to provide.

256.215(2)(c) (c) The emergency medical services provider agrees to provide to the department a list identifying each community paramedic and community emergency medical services practitioner providing community emergency medical services as a volunteer or employee of that emergency medical services provider. If the emergency medical services provider is approved under this subsection as a community emergency medical services provider, the emergency medical services provider shall provide and update its list of community paramedics and community emergency medical services practitioners.

256.215(2)(d) (d) The emergency medical services provider meets other requirements as specified by the department.

256.215 History History: 2017 a. 66; 2023 a. 55.

256.23 256.23 Ambulance service provider fee.

256.23(1) (1) In this section:

256.23(1)(a) (a) “Eligible ambulance service provider” means any privately owned ambulance service provider. “Eligible ambulance service provider” does not include any ambulance service provider that is owned by any municipality or group of municipalities regardless of whether or not the ambulance service provider is organized as a nonprofit corporation.

256.23(1)(b) (b) “Emergency ambulance transport” means all of the following:

256.23(1)(b)1. 1. Each ground emergency ambulance transport that requires the delivery of life support services, including basic life support or advanced life support, by an emergency medical responder or emergency medical services practitioner at any practice level.

256.23(1)(b)2. 2. Any other ambulance transport that is designated by the department to be subject to the fee under sub. (2).

256.23(2) (2) For the privilege of doing business in this state, there is imposed on each eligible ambulance service provider a fee that is equal to a uniform percentage, as determined under sub. (3), of the eligible ambulance service provider’s net patient revenues from emergency ambulance transports. Except as provided in sub. (4), each eligible ambulance service provider shall pay the fee under this subsection in a manner determined by the department acting in collaboration with the Professional Ambulance Association of Wisconsin, or its successor organization, no more frequently than quarterly. An eligible ambulance service provider cannot increase rates it charges for its services because of the imposition of the fee under this subsection.

256.23(3) (3) The department shall establish the uniform percentage of the eligible ambulance service provider’s net patient revenues so that the total amount of fees collected from an eligible ambulance service provider under sub. (2) in a state fiscal year is an amount not less than one quarter of 1 percent lower than the maximum limit for a provider fee under 42 CFR 433.68 (f) but does not exceed the maximum limit.

256.23(4) (4) The department may allow an eligible ambulance service provider that is unable to make a payment of the fee by the date specified under sub. (2) to make a delayed payment.

256.23(5) (5) In accordance with s. 20.940, the department shall submit to the federal department of health and human services a request for any state plan amendment, waiver or other approval that is required to implement this section and s. 49.45 (3) (em). If federal approval is required, the department may not implement the collection of the fee under sub. (2) until it receives approval from the federal government to obtain federal matching funds.

256.23(6) (6) In each fiscal year, the secretary of administration shall transfer from the ambulance service provider trust fund under s. 25.776 to the appropriation under s. 20.435 (4) (jw) an amount equal to the annual costs of administering the ambulance assessment as specified under this section and making supplemental reimbursements to ambulance service providers under s. 49.45 (3) (em).

256.23 History History: 2021 a. 228; 2023 a. 30.

256.25 256.25 Statewide trauma care system.

256.25(1g) (1g) In this section, “performance improvement” means a method of evaluating and improving processes of trauma patient care that emphasizes a multidisciplinary approach to problem solving.

256.25(1r) (1r) The department shall develop and implement a statewide trauma care system. The department shall seek the advice of the statewide trauma advisory council under s. 15.197 (25) in developing and implementing the system, and, as part of the system, shall develop regional trauma advisory councils.

256.25(2) (2) The department shall promulgate rules to develop and implement the system. The rules shall include a method by which to classify all hospitals as to their respective emergency care capabilities. The classification rule shall be based on standards developed by the American College of Surgeons. Within 180 days after promulgation of the classification rule, and every 3 years thereafter, each hospital shall certify to the department the classification level of trauma care services that is provided by the hospital, based on the rule. The department may require a hospital to document the basis for its certification. The department may not direct a hospital to establish a certain level of certification. Confidential injury data that is collected under this subsection shall be used for confidential review relating to performance improvements in the trauma care system, and may be used for no other purpose.

256.25(3) (3) Except as provided in sub. (4), all information and documents provided by a hospital under sub. (2) and all information and documents procured by or furnished to the department, the statewide trauma advisory council, or regional trauma advisory councils with respect to performance improvement activities, certifications by hospitals under sub. (2), and documentation of the bases for hospitals’ certifications under sub. (2) are immune from discovery under ch. 804, confidential, and privileged and may not be used or admitted into evidence in a civil action. With respect to a communication made by a staff member of the department or by an individual serving on the statewide trauma advisory council or a regional trauma advisory council, and to a finding or recommendation made under this section by the department, the statewide trauma advisory council, or a regional trauma advisory council, all of the following apply:

256.25(3)(a) (a) The staff member or individual may not be examined in an action for civil damages with respect to the communication, finding, or recommendation.

256.25(3)(b) (b) The staff member or individual has immunity from civil liability, with respect to the communication, finding, or recommendation, for any of the following:

256.25(3)(b)1. 1. An action taken or omitted by the staff member or individual in an official capacity.

256.25(3)(b)2. 2. A statement made in good faith by the staff member or individual in an official capacity.

256.25(4) (4) Subsection (3) does not apply to the release of information and documents specified in sub. (3) created apart from a performance improvement activity or apart from a certification by a hospital under sub. (2) that are maintained by or for a hospital, the department, the statewide trauma advisory council, or a regional trauma advisory council for the particular purpose of diagnosing, treating, or documenting care provided to a particular patient or for another purpose, upon a showing by clear and convincing evidence that the information or documents are otherwise unavailable.

256.25(5) (5) This section does not apply to s. 146.38.

256.25 History History: 1997 a. 154; 1999 a. 9; 2001 a. 16, 109; 2005 a. 315; 2007 a. 130 s. 150; Stats. 2007 s. 256.25.

256.25 Cross-reference Cross-reference: See also ch. DHS 118, Wis. adm. code.

256.30 256.30 Refusal or delay of emergency service.

256.30(1) (1) In this section “hospital providing emergency services” means a hospital which the department has identified as providing some category of emergency service.

256.30(2) (2) No hospital providing emergency services may refuse emergency treatment to any sick or injured person.

256.30(3) (3) No hospital providing emergency services may delay emergency treatment to a sick or injured person until credit checks, financial information forms or promissory notes have been initiated, completed or signed if, in the opinion of one of the following, who is an employee, agent or staff member of the hospital, the delay is likely to cause increased medical complications, permanent disability or death:

256.30(3)(a) (a) A physician, registered nurse, or paramedic.

256.30(3)(b) (b) A licensed practical nurse under the specific direction of a physician or registered nurse.

256.30(3)(c) (c) A physician assistant or any other person under the specific direction of a physician.

256.30(3m) (3m) Hospitals shall establish written procedures to be followed by emergency services personnel in carrying out sub. (3).

256.30(4) (4) No hospital may be expected to provide emergency services beyond its capabilities as identified by the department.

256.30(5) (5) Each hospital providing emergency services shall create a plan for referrals of emergency patients when the hospital cannot provide treatment for such patients.

256.30(6) (6) The department shall identify the emergency services capabilities of all hospitals in this state and shall prepare a list of such services. The list shall be updated annually.

256.30(7) (7) A hospital which violates this section may be fined not more than $1,000 for each offense.

256.30 History History: 1977 c. 361; 1983 a. 273 s. 8; 1989 a. 102; 1993 a. 105; 2007 a. 130 s. 43; Stats. 2007 s. 256.30; 2017 a. 12.

256.35 256.35 Statewide emergency services number.

256.35(1) (1) Definitions. In this section:

256.35(1)(a) (a) “Automatic location identification” means a system which has the ability to automatically identify the address of the telephone being used by the caller and to provide a display at the central location of a sophisticated system.

256.35(1)(b) (b) “Automatic number identification” means a system which has the ability to automatically identify the caller’s telephone number and to provide a display at the central location of a sophisticated system.

256.35(1)(c) (c) “Basic system” means a telecommunications system which automatically connects a person dialing the digits “911” to a public safety answering point.

256.35(1)(cm) (cm) “Commercial mobile radio service provider” has the meaning given in s. 196.01 (2g).

256.35(1)(d) (d) “Department” means the department of military affairs.

256.35(1)(e) (e) “Direct dispatch method” means a telecommunications system providing for the dispatch of an appropriate emergency service vehicle upon receipt of a telephone request for such service.

256.35(1)(em) (em) “Emergency number system” means any basic system, sophisticated system, or Next Generation 911, as defined in sub. (3s) (a) 3., regardless of technology platform.

256.35(1)(es) (es) “Originating service provider” means an entity that provides a service that may be used to generate a request for emergency assistance and that may connect to an emergency number system.

256.35(1)(f) (f) “Public agency” means any municipality as defined in s. 345.05 (1) (c) or any state agency which provides or is authorized by statute to provide fire fighting, law enforcement, ambulance, medical or other emergency services.

256.35(1)(g) (g) “Public safety agency” means a functional division of a public agency which provides fire fighting, law enforcement, medical or other emergency services.

256.35(1)(gm) (gm) “Public safety answering point” means a facility to which a call on an emergency number system is initially routed for response, and on which a public agency directly dispatches the appropriate emergency service provider, relays a message to the appropriate emergency service provider or transfers the call to the appropriate emergency services provider.

256.35(1)(h) (h) “Relay method” means a telecommunications system whereby a request for emergency services is received and relayed to a provider of emergency services by telephone.

256.35(1)(i) (i) “Sophisticated system” means a basic system with automatic location identification and automatic number identification.

256.35(1)(k) (k) “Transfer method” means a telecommunications system which receives telephone requests for emergency services and transfers such requests directly to an appropriate public safety agency or other provider of emergency services.

256.35(2) (2) Emergency phone system.

256.35(2)(a) (a) Every public agency may establish and maintain within its respective jurisdiction a basic or sophisticated system under this section. Such a system shall be in a central location.