Service Licensing Requirements

The EMS & Trauma Systems Section is responsible for the licensing of all EMS agencies in the state including ground transport (ambulances), non-transport, and air medical. For emergency care provider (ECP) licensing (EMR, EMT, AEMT, Paramedic) please visit the Montana Board of Medical Examiners website.

Agencies can be licensed at either the basic life support (BLS) level or advanced life support (ALS) level depending on the level of care they wish to provide.

• BLS level: providers can practice at the EMR and EMT level (without endorsements)
• ALS level: providers can practice at the EMT with endorsement, AEMT, and Paramedic level and medical director oversight is required.
• For agencies that are unable to staff ALS level providers 100% of the time a BLS license with authorization for limited ALS may be granted.

Montana does not offer any special waivers or application process for seasonal wildland fire agencies. They must complete the full application process.

For a full list of statue and rules please review 50-6 MCA and ARM 37.104.5

List of licensed Montana EMS Agencies (PDF)/(Excel) - Last Updated 7/3/24

All agencies wishing to provide emergency medical services in Montana must first obtain an agency license. To get started with the licensing process p lease contact Nick Burkland, EMS Licensing Specialist at nicholas.burkland@mt.gov. Initial licensure involves three parts:

1. Initial licensure application completed through the OPHI e-Licensing Portal. This must be completed within 30 business days of initiating the application and at least 30 days prior to the commencement of operations. Please review the OPHI e-License User Guide. Licensure applications must include the following documents:
   • Montana Mutual Aid Frequency Permit for the frequencies required in Table 2 of the EMS Rule Appendix
   • A written sanitation policy in compliance with ARM 37.104.507(3) and the Infectious Waste Management Act
   • A written maintenance policy requiring preventative maintenance of ambulances and emergency medical equipment.
   • Proof of current single occurrence malpractice insurance and liability insurance coverage.
   • For all non-transport agencies : a copy of your dispatch/transport agreement with a transporting EMS agency.
   • For all air medical agencies : documentation of a 14 CFR Part 135 “Air Carrier Certificate”
   • For all rotor wing agencies : an attestation form that that the operations comply with 14 CFR Part 135 Subpart L and related circulars.
   • Medical director assurances form if operating at the ALS level.
2. An in-person inspection verifying the presence of all applicable supplies and compliance with all applicable rules.
3. Payment of a $35 fee by check, money order, or credit card

Certain non-transporting agencies may be exempt from licensing requirements:

ARM 37.104.513 (2) A law enforcement agency, fire department, search and rescue unit, ski patrol, or mine rescue unit which does not hold itself out as a provider of emergency medical care to the public and does not routinely offer to provide services to the general public beyond the boundaries of a single recreational site, work site, school, or other facility shall not be considered a non-transporting medical unit solely because members of the unit provide medical care at the scene of a medical emergency to which they were dispatched for other purposes.

If you are unsure if this applies to you or not, please contact the EMS office for further information.

Renewals are required on a two-year cycle with applications due on December 16 th and payment due by Dece mber 31 st on the year of expiration. Renewals also involve a three part process:

1. Renewal application completed in the OPHI e-Licensing Portal. Please review the OPHI e-License User Guide. Renewal applications must include the following documents:
   • Montana Mutual Aid Frequency Permit for the frequencies required in Table 2 of the EMS Rule Appendix
   • A written sanitation policy in compliance with ARM 37.104.507(3) and the Infectious Waste Management Act
   • A written maintenance policy requiring preventative maintenance of ambulances and emergency medical equipment.
   • Proof of current single occurrence malpractice insurance and liability insurance coverage.
   • Proof of current accreditation without variance if requesting a waiver of inspection (see below).
   • For all non-transport agencies: a copy of your dispatch/transport agreement with a transporting EMS agency.
   • For all air medical agencies : documentation of a 14 CFR Part 135 “Air Carrier Certificate”
   • For all rotor wing agencies s: an attestation form that that the operations comply with 14 CFR Part 135 Subpart L and related circulars.
   • Medical director assurances form if operating at the ALS level.
2. An inspection verifying the presence of required equipment and compliance with applicable rules. This will be scheduled by the inspector in the 12 months prior to your expiration date.
3. Payment of a $35 fee by check, money order, or credit card.

For agencies that have current accreditation, inspection requirements may be waived:

ARM 37.104.510 (9) An ambulance service renewing its service license at the same level of service that holds valid and current accreditation without variance or limitations from an accrediting body is exempt from vehicle, equipment, and operation inspections. The ambulance service must still request, pay for, and display state-issued permits for each ambulance.

Deficiencies are noted during biannual and spot inspection visits.

Minor deficiencies have little potential to affect the safety of the crew, patient, or pubic and will be noted during the inspection. A permit will be issued for the vehicle or service in question and the service manager has 180 days to provide proof to the department that the deficiency has been corrected.

Major deficiencies have high potential of affecting the safety of the crew, patient, and public. If a major defect is noted, a permit will not be issued until the deficiency has been corrected.

The department has the ability to investigate any complaint regarding:

• the type and condition of equipment and procedures used by an emergency medical service to provide care at the scene during prehospital or Interfacility transportation or in other out-of-hospital care settings
• the condition of any vehicle or aircraft used as an ambulance
• general performance by an emergency medical service
• the results of any investigation conducted by the Board of Medical Examiners concerning patient care by an emergency care provider who was, at the time of the complaint, providing care through the emergency medical service that is the subject of a complaint under investigation by the department.

Complaints can be filed with the Department of Labor’s Screening Panel here: How to File a Complaint

For further information on enforcement and penalties please review:

• 50-6-313 MCA - Inspections
• 50-6-314 MCA - Authority of department to compel and take testimony
• 50-6-316 MCA - Criminal and civil penalties
• 50-6-323 MCA - Powers and duties of department
• 50-6-326 MCA - Injunction to require compliance
• 50-6-327 MCA - Administrative enforcement

All facilities in the United States that perform laboratory testing on human specimens for health assessment or the diagnosis, prevention, or treatment of disease are regulated under the Clinical Laboratory Improvement Amendments of 1988 (CLIA). For most ambulance services, the only test regulated by CLIA is blood glucose testing which is approved for a CLIA waiver. If you are performing other tests such as PTT, or using iSTATs you may not be eligible for a waiver, please refer to the CLIA website for more information (see Waived Test List). If your service is part of a hospital or larger healthcare system, it may not be eligible for a waiver as it may be considered an extension of the hospital lab. Please refer to the CLIA website, your administration, or contact Michelle Griffin, Montana CLIA Program Manager, 406-558-9502, michelle.griffin@mt.gov

How to get a CLIA Certificate of Waiver:

You can enroll in the CLIA program by completing an application (Form CMS-116) available on the CMS CLIA website or from your local State Agency. Send your completed application to the address of the local State Agency for the State in which your laboratory or testing site is located. For Montana this is:

For more information, please see the How to Obtain a CLIA Certificate of Waiver brochure. For questions, please email CMS LAB Excellence at LabExcellence@cms.hhs.gov.

Once you submit an application, you will be sent a bill for the fee. This fee is generally mailed to a different location than you sent your application so please check carefully to make sure it is sent to the correct location.

Refer to 50-6-325 MCA for waiver of licensing requirements.