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Regular Session, 2010
SENATE BILL NO. 523
BY SENATOR CHEEK
HEALTH CARE. Provides for the First Responder Financial Stabilization and Enhancement
Act. (gov sig) (2/3 - CA6s30.1(B))
AN ACT1
To enact Subpart E of Part VII of Chapter 5 of Title 40 of the Louisiana Revised Statutes,2
to be comprised of R.S. 40:1236.21 through 1236.31, relative to emergency medical3
services; to provide for the creation of the statewide ambulance service district; to4
provide for the purpose and object of the district; to provide for a board of5
commissioners; to provide for powers and duties of the board of commissioners; to6
provide for domicile of the district; to provide for rules and regulations; to provide7
for the authority to incur debt and issue general bonds; to provide for legislative8
findings; and to provide for related matters.9
Be it enacted by the Legislature of Louisiana:10
Section 1. Subpart E of Part VII of Chapter 5 of Title 40 of the Louisiana Revised11
Statutes, comprised of R.S. 40:1236.21 through 1236.31 is hereby enacted to read as follows:12
SUBPART E. FIRST RESPONDER FINANCIAL13
STABILIZATION AND ENHANCEMENT14
§1236.21. Legislative findings15
The legislature hereby finds and declares the following:16
(1) Emergency medical services constitute an invaluable part of the17 SB NO. 523
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healthcare delivery system of Louisiana and are an essential element of1
Louisiana's emergency preparedness system.2
(2) Emergency medical services will be a key element in any healthcare3
reform initiative.4
(3) Emergency medical services are a key component of any economic5
development program as they are essential to recruiting and retaining industry.6
(4) The cost of funding the Medicaid program and healthcare for the7
poor and uninsured in the state must be carefully managed in a manner which8
recognizes the challenges associated with appropriate reimbursement for9
services under the program.10
(5) Emergency medical service providers want to assure that emergency11
medical services are available to all residents of Louisiana.12
(6) It is in the best interest of the state that there exist sufficient resources13
to assure the availability of emergency ambulance services to the citizens of14
Louisiana and the creation of a statewide ambulance service district will help15
to ensure this goal.16
(7) The Louisiana Ambulance Alliance and the Department of Health17
and Hospitals are interested in exploring the use of local revenues to enhance18
the delivery of emergency ambulance services through the use of certified public19
expenditures, intergovernmental transfers or other financing mechanisms that20
are in accordance with the applicable state and federal regulations.21
§1236.22. Short title22
This Subpart shall be known and may be cited as the "First Responder23
Financial Stabilization and Enhancement Act".24
§1236.23. Statewide ambulance service district; creation25
In order to provide for sufficient resources to assure the availability of26
emergency ambulance services to the population of Louisiana, the legislature27
does hereby establish a statewide ambulance service district. The boundaries28
of the district shall be coterminous with the boundaries of the state. The29 SB NO. 523
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ambulance service district thus created shall constitute a body corporate in law1
with all powers of a corporation, shall have perpetual existence, shall have the2
power and right to contract obligations, to sue and be sued, and to do and3
perform any and all acts in its corporate capacity and its corporate name4
necessary and proper for the carrying out of the objects and purposes for which5
the ambulance service district was created. It shall have the power and6
authority to acquire any and all necessary equipment and buildings for the7
purpose of performing the objects for which it is formed and shall own all sites8
and physical facilities which are acquired either by donation, purchase,9
exchange, and otherwise in full ownership.10
§1236.24. Object and purpose of the district11
The object and purpose of the ambulance service district and the12
governing body created under the provisions of this Subpart shall be to enhance13
reimbursement and financial stability of ambulance providers. The14
Department of Health and Hospitals may submit waivers or state plan15
amendments to the Centers for Medicare and Medicaid Services in order to16
secure federal financial participation in relation to any such payments or17
reimbursement. Payments shall be made only in accordance with an approved18
waiver or state plan amendment. The department and the statewide ambulance19
district may enter into an agreement, in accordance with state and federal law,20
to develop funding methodologies in a way that is consistent with the legislative21
intent set forth herein. The methodology shall be created with the intent to22
maximize, to the fullest extent possible, the return to the providers located23
within the jurisdiction of the local governing body which subsidized the delivery24
of services. Any licensed provider of ambulance services shall be eligible to25
participate in the district. Participation is on a strictly voluntary basis.26
§1236.25. Ambulance service district commission; qualifications, appointment,27
vacancies, removal and compensation of members28
A. The ambulance service district created under this Subpart shall be29 SB NO. 523
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governed by the Ambulance Service District Commission, hereafter referred to1
as the "commission". The commission shall be composed of one member from2
each congressional district, appointed by the governor, subject to confirmation3
by the Senate, from a list of names submitted by the Louisiana Ambulance4
Alliance. The nomination list submitted to the governor shall include at least5
three nominees from each congressional district. Members of the commission6
shall be citizens and qualified electors of this state. Initially, three members of7
the commission shall be appointed for a two-year term, and the remaining8
members for four-year terms. Thereafter, all members shall be appointed for9
four years. Any vacancy on the board caused by death, resignation, removal or10
disability of a member shall be filled for the unexpired term by appointment by11
the governor from the congressional district where the vacancy occurred.12
B. Any member of the commission whose term expires shall continue to13
serve on the commission until such time that a successor is appointed.14
C. Any member of the commission may be removed from office for15
cause and his appointment rescinded by a two-thirds vote of the membership16
of the governing authority.17
D. The commission annually shall elect one of its members chairman,18
and one vice-chairman. The meetings shall be held at the domicile of the19
district established by the commission. At least four regular meetings shall be20
held annually. Special meetings may be held at such times and places as shall21
be specified, by call of the chairman or by a simple majority of the commission.22
E. A majority of the members shall constitute a quorum of the board for23
all purposes and functions of the board.24
F. Each member of the board shall receive a certificate or commission25
from the governor and before beginning his term of office shall file with the26
secretary of state a written oath or affirmation of faithful discharge of his27
official duties.28
G. The members of the commission and all employees of the corporation29 SB NO. 523
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shall be subject to the Code of Governmental Ethics. They shall be considered1
public employees as defined by R.S. 42:1102(18) and the corporation shall be2
considered an agency as defined by R.S. 42:1102(2) for purposes of the Code of3
Governmental Ethics only. All meetings of the board shall be open and subject4
to the provisions of R.S. 42:4.1 et seq. A record of all proceedings at regular and5
special meetings of the board shall be kept and shall be open to public6
inspection, except as otherwise provided by this Title or in R.S. 42:6.1.7
H. No member of the board shall receive a per diem or shall be8
reimbursed for expenses incurred when attending a meeting of the board or any9
of its committees or for the time spent on behalf of the board on official10
business.11
§1236.26. Powers and duties of the commission12
In addition to the duties defined elsewhere, the commission shall have the13
duty and authority:14
(1) To represent the public interest in facilitating ambulance care in the15
state.16
(2) To pursue grant funds to advance first responder services.17
(3) To enter into cooperative agreements with other public and private18
entities.19
(4) To assist ambulance providers in obtaining lowest possible cost for20
equipment and supplies through group purchasing.21
(5) To appoint a director of the ambulance service district and to22
perform such other duties as may now or hereafter be required by law.23
(6) To appoint the necessary standing and special committees which may24
be necessary to carry out the purposes of this Subpart.25
(7) To establish rates of pay for the use of facilities provided by the26
district.27
(8) To enter into contractual arrangements with recognized and duly28
constituted ambulance providers which are primarily engaged in the operation29 SB NO. 523
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of ambulance related functions in order to enhance Medicaid funding and1
reimbursement, and for related matters.2
(9) To designate a bank to act as agent for depositing funds.3
(10) To designate rules and regulations for safekeeping of the funds4
acquired, collected, or loaned by or to the district, and to provide for regular5
audits of the accounts of the district.6
§1236.27. Procedure for organizing the ambulance service district7
A. At the same time as the governor appoints the initial members of the8
commission, the governor shall designate a time and place for the first meeting9
of the commission. The first meeting shall take place within sixty days from the10
date of the initial appointments. At the first meeting of the commission, the11
commission shall proceed to organize by electing a chairman and a vice-12
chairman.13
B. It shall be the duty of the chairman to preside over the meetings of the14
commission and to perform such other duties as are usually required of the15
chairman of a corporate board. It shall be the duty of the vice-chairman to act16
in the absence of the chairman and in case of the disability of the chairman.17
§1236.28. Domicile; service of process18
A. The domicile of the district shall be fixed by the commission and may19
be changed at the pleasure of the commission. All books and records of the20
district shall be kept at the domicile.21
B. Service of process shall be made upon the director, and in his22
absence, upon the chairman of the commission, and in his absence or their23
absence, then upon the vice-chairman of the commission.24
§1236.29. District as a political subdivision; power to incur debt and issue25
general bonds26
The ambulance service district is hereby declared to be a political27
subdivision of the state. For carrying out the purposes of the ambulance service28
district as provided in this Subpart, the district, under the provisions of the29 SB NO. 523
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Louisiana Constitution of 1974, shall have the power to incur debt and issue1
general obligation bonds or revenue.2
§1236.30. Federal and state aid3
The ambulance service district created hereunder shall have full power4
to do such things and enter into any contracts and agreements with any state or5
federal agency or instrumentality as may be necessary to procure aids and6
grants to assist such districts in carrying out the purpose for which they are7
created.8
§1236.31. Rules and regulations9
The commission shall have the power, and it shall be its duty, to adopt10
rules and regulations, in accordance with the Administrative Procedure Act, for11
the proper disbursement of funds to participating providers. Such rules and12
regulations shall be submitted to the Senate and House committees on health13
and welfare and such committees shall have jurisdiction for purposes of the14
Administrative Procedure Act.15
Section 2. This Act shall become effective upon signature by the governor or, if not16
signed by the governor, upon expiration of the time for bills to become law without signature17
by the governor, as provided by Article III, Section 18 of the Constitution of Louisiana. If18
vetoed by the governor and subsequently approved by the legislature, this Act shall become19
effective on the day following such approval.20
The original instrument was prepared by Greg Waddell. The following
digest, which does not constitute a part of the legislative instrument, was
prepared by Nancy Vicknair.
DIGEST
Cheek (SB 523)
Proposed law provides for legislative findings.
Proposed law creates a statewide ambulance service district, hereinafter referred to as the
"district", whose boundaries are be coterminous with the boundaries of the state.
Proposed law provides that the ambulance service district thus created shall constitute a body
corporate in law with all powers of a corporation, shall have perpetual existence, shall have
the power and right to contract obligations, to sue and be sued, and to do and perform any
and all acts in its corporate capacity and its corporate name necessary and proper for the
carrying out of the objects and purposes for which the ambulance service district was SB NO. 523
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created.
Proposed law provides that the district shall have the power and authority to acquire any and
all necessary equipment and buildings for the purpose of performing the objects for which
it is formed, and shall own all sites and physical facilities which are acquired either by
donation, purchase, exchange, and otherwise in full ownership.
Proposed law provides that the object and purpose of the ambulance service district and the
governing body shall be to enhance reimbursement and financial stability of ambulance
providers.
Proposed law provides that DHH may submit waivers or state plan amendments to the
Centers for Medicare and Medicaid Services in order to secure federal financial participation
in relation to any such payments or reimbursement.
Proposed law provides that payments shall be made only in accordance with an approved
waiver or state plan amendment.
Proposed law provides that DHH and the statewide ambulance district may enter into an
agreement, in accordance with state and federal law, to develop funding methodologies in
a way that is consistent with the legislative intent set forth in proposed law.
Proposed law provides that the methodology shall be created with the intent to maximize,
to the fullest extent possible, the return to the providers located within the jurisdiction of the
local governing body which subsidized the delivery of services.
Proposed law provides that any licensed provider of ambulance services shall be eligible to
participate in the district and that participation is on a strictly voluntary basis.
Proposed law provides that the ambulance service district shall be governed by Ambulance
Service District Commission, hereafter referred to as the commission, and that the
commission shall be composed of one member from each congressional district appointed
by the governor from a list of names submitted by the Louisiana Ambulance Alliance.
Proposed law provides that, initially, three members of the commission shall be appointed
for a two-year term, and the remaining members for four-year terms and thereafter, all
members shall be appointed for four years.
Proposed law provides that any member of the commission whose term expires shall
continue to serve on the commission until such time that a successor is appointed.
Proposed law provides that any member of the commission may be removed from office for
cause and his appointment rescinded by a two-thirds vote of the membership of the
governing authority.
Proposed law provides that the commission annually shall elect one of its members
chairman, and one vice-chairman and meetings shall be held at the domicile of the district
established by the commission.
Proposed law provides that a majority of the members shall constitute a quorum of the board
for all purposes and functions of the board.
Proposed law provides that each member of the board shall receive a certificate or
commission from the governor and before beginning his term of office shall file with the
secretary of state a written oath or affirmation of faithful discharge of his official duties.
Proposed law provides that the members of the commission and all employees of the
corporation shall be subject to the Code of Governmental Ethics and shall be considered SB NO. 523
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions.
public employees and the corporation shall be considered an agency.
Proposed law provides that no member of the board shall receive a per diem or shall be
reimbursed for expenses incurred when attending a meeting of the board or any of its
committees or for the time spent on behalf of the board on official business.
Proposed law provides for the following powers and duties of the commission:
(1) To represent the public interest in facilitating ambulance care in the state.
(2) To pursue grant funds to advance first responder services.
(3) To enter into cooperative agreements with other public and private entities.
(4) To assist ambulance providers in obtaining lowest possible cost for equipment and
supplies through group purchasing.
(5) To appoint a director of the ambulance service district and to perform such other
duties as may now or hereafter be required by law.
(6) To appoint the necessary standing and special committees which may be necessary
to carry out the purposes of this Subpart.
(7) To establish rates of pay for the use of facilities provided by the district.
(8) To enter into contractual arrangements with recognized and duly constituted
ambulance providers which are primarily engaged in the operation of ambulance
related functions in order to enhance Medicaid funding and reimbursement and for
related matters.
(9) To designate a bank to act as agent for depositing funds.
(10) To designate rules and regulations for safekeeping of the funds acquired, collected,
or loaned by or to the district, and to provide for regular audits of the accounts of the
district.
Proposed law provides that the governor shall designate a time and place for the first
meeting of the commission and such meeting shall take place within 60 days from the date
of the initial appointments.
Proposed law provides for the duties of the chairman and the vice-chairman.
Proposed law provides that the domicile of the district shall be fixed by the commission and
may be changed at the pleasure of the commission and that the domicile shall be within the
district, and books and records shall be kept at the domicile.
Proposed law provides that service of process shall be made upon the director, and in his
absence, upon the chairman of the commission, and in his absence or their absence, then
upon the vice-chairman of the commission.
Proposed law provides that the ambulance service district is hereby declared to be a political
subdivision of the state and for carrying out the purposes of the ambulance service district,
the district, under the provisions of the Louisiana Constitution of 1974, shall have the power
to incur debt and issue general obligation bonds or revenue.
Proposed law provides that the ambulance service districts created hereunder shall have full
power to do such things and enter into any contracts and agreements with any state or federal
agency or instrumentality as may be necessary to procure aids and grants to assist such SB NO. 523
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districts in carrying out the purpose for which they are created.
Proposed law provides that the commission shall have the power, and it shall be its duty, to
adopt rules and regulations, in accordance with the APA, for the proper disbursement of
funds to participating providers. Such rules and regulations shall be submitted to the Senate
and House committees on health and welfare and such committees shall have jurisdiction
for purposes of the APA.
Effective upon signature of the governor or lapse of time for gubernatorial action.
(Adds R.S. 40:1236.21 - 1236.31)
Summary of Amendments Adopted by Senate
Committee Amendments Proposed by Senate Committee on Health and Welfare to
the original bill.
1. Provides for an additional legislative finding.
2. Changes the method by which the statewide ambulance district and state
develop the applicable funding mechanisms.
Senate Floor Amendments to engrossed bill.
1. Makes technical changes.