STEMI Critical Care System Plan Requirements and Determination Process.

22 CCR 100146.03

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23 segments

22 CCR 100146.03

§ 100146.03. STEMI Critical Care System Plan Requirements and Determination Process.

(a)

Plan Submission to EMSA. Prior to the implementation of a new STEMI critical care system, the local EMS agency (LEMSA) shall complete the Initial STEMI Critical Care System Plan Template (Rev. 11/2025), incorporated by reference, and submit to the Emergency Medical Services Authority (EMSA) for approval, as set forth below.

(b)

Determination and Notification Process. Following the submission of a STEMI critical care system plan, EMSA shall review the plan for completeness and compliance with the requirements of Division 2.5 of the Health and Safety Code, this subchapter, and the Initial STEMI Critical Care System Plan Template (Rev. 11/2025), incorporated by reference. EMSA shall:

(1)

Acknowledgement. Within thirty (30) days of receiving the plan submission, provide written notification to the LEMSA to acknowledge receipt of the STEMI critical care system plan and state whether the STEMI critical care system plan is:

(A)

Complete, meaning it contains all information required by the Initial STEMI Critical Care System Plan Template (Rev. 11/2025); or

(B)

Incomplete. If the STEMI critical care system plan submission is incomplete, EMSA's notification shall identify the deficiencies.

(2)

Determination. Within sixty (60) days of receiving the plan, EMSA shall provide written notification to the LEMSA that its STEMI critical care system plan is:

(A)

Approved, or

(B)

Denied. If the plan is denied, the notice shall specify the reasons for denial, including identification of the plan's failure to meet applicable statutory or regulatory requirements.

(c)

LEMSA Response to a Denial. If EMSA denies a STEMI critical care system plan, the LEMSA shall have six (6) months from the date of the notification of the denial to:

(1)

Submit a revised STEMI critical care system plan which conforms to the requirements of Division 2.5 of the Health and Safety Code and this subchapter, or

(2)

Appeal the decision to the Commission on EMS (the Commission). A proceeding before the Commission to hear an appeal of a STEMI critical care system plan shall be conducted in accordance with the provisions of Section 100000.01 of this division.

(d)

Implementation of an Approved Plan. If a STEMI critical care system plan is approved by EMSA or following a successful appeal to the Commission, the LEMSA shall begin implementation of the STEMI critical care system plan within six (6) months of the date of the plan approval.

(e)

Rescinding Approval. A LEMSA's failure to implement its STEMI critical care system in accordance with the approved STEMI critical care system plan may result in EMSA rescinding approval of the STEMI critical care system plan.

(1)

For purposes of this section, “failure to implement” means a failure to execute the STEMI critical care system plan in a manner consistent with the approved plan, including deviations that affect the structure, function, or effectiveness of the STEMI care system. In determining whether a failure to implement has occurred, EMSA shall consider factors including but not limited to:

(A)

The extent to which the STEMI care system deviates from the approved plan;

(B)

The impact of the deviation on patient care, system operations, or access to care;

(C)

The duration and frequency of the deviation; and

(D)

Whether the LEMSA has taken corrective action to address identified deficiencies.

(2)

EMSA will consider any information, including but not limited to that received in connection with a subsequent STEMI system status plan, site visits, complaints, or pending litigation indicating that the LEMSA has failed to implement the STEMI care system in accordance with the approved STEMI critical care system plan. If EMSA determines that the STEMI care system has not been implemented in accordance with the approved plan, EMSA may rescind approval of the STEMI care system plan following written notice to the LEMSA. Any rescission shall be subject to a right of appeal in accordance with Section 1797.105 of the Health and Safety Code and the provisions of Section 100000.01 of this Division.

(f)

STEMI Critical Care System Plan Updates. As part of its annual EMS plan update the LEMSA shall include a STEMI critical care system plan update, as set forth in section 100146.04 of this article.

(g)

Plan Modifications. The LEMSA shall submit any significant changes to the STEMI critical care system plan to EMSA for approval, prior to implementation of the change(s), utilizing the Annual STEMI Critical Care System Plan Update Template (Rev. 11/2025), incorporated by reference. Significant changes include, but are not limited to closures of a general acute care hospital's (GACH's) PCI services, changes to a GACH's PCI verification or designation status, and changes to LEMSA STEMI or cardiac care destination policies. In instances where a delay in approval would adversely impact the current level of STEMI critical care, the LEMSA may implement the changes after electronic notification to EMSA. Within thirty (30) days of implementation, the LEMSA shall submit an amended Annual STEMI Critical Care System Plan Update Template reflecting all changes to EMSA for approval.

(h)

Public Notice Requirement. The LEMSA shall share the approved STEMI critical care system plan on their website, as part of its approved local EMS plan.

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