Section 170.200 - Licensure of Ambulance and EFR Services(A) No person shall establish, operate or maintain an ambulance or EFR service without a valid license or in violation of the terms of a valid license. All services shall be licensed as provided in 105 CMR 170.000. Any person who proposes to establish or operate a service shall apply for and obtain from the Department a license before initiating service.(B) Ambulance services may be licensed at the BLS, ALS, or critical care service level, and EFR services may be licensed at the EMS first response, BLS or ALS level. Licensure as an ambulance service at a particular level of service includes licensure to provide ambulance or EFR service at the same or lower level of service.(C) Ambulance and EFR service licenses shall identify and reflect the number of EMS vehicles to be operated, the classification of each certified EMS vehicle to be operated and maintained, and the level of service at each place of business. No service shall operate at a level of service above that for which it is licensed.(D) To be eligible for licensure at the critical care services level, the applicant must document the following:(1) Current licensure from the Department as an ambulance service at the ALS-Paramedic level;(2) Current written affiliation agreement between a hospital and the applicant, meeting the requirements of 105 CMR 170.300, under which the hospital shall provide oversight of the delivery of critical care services and designate a medical director to have authority over the clinical and patient care aspects of critical care services; and(3) Current accreditation, in good standing, from the CAMTS, its successor(s), or an accreditation program the Department approves as substantially equivalent to CAMTS.Amended by Mass Register Issue 1486, eff. 1/6/2023.