Missouri 2023 Regular Session

Missouri Senate Bill SB24 Compare Versions

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Old	New	Differences
1	1
2	2	EXPLANATION-Matter enclosed in bold-faced brackets [thus] in this bill is not enacted
3	3	and is intended to be omitted in the law.
4	4	FIRST REGULAR SESSION
5	5	[TRULY AGREED TO AND FINALLY PASSED ]
6	6	HOUSE COMMITTEE SUBSTITUTE FOR
7	7	SENATE SUBSTITUTE FOR
8	8	SENATE BILL NO. 24
9	9	102ND GENERAL ASSEMBLY
10	10	2023
11	11	1080H.08T
12	12	AN ACT
13	13	To repeal sections 67.145, 70.631, 105.500, 135.327, 135.331, 135.333, 170.310, 190.091,
14	14	190.100, 190.103, 190.134, 190.142, 190.147, 190.255, 190.327, 190.460, 192.2405,
15	15	195.206, 197.020, 208.1032, 285.040, 287.067, 287.245, 287.715, 320.336, 320.400,
16	16	321.225, 321.620, 537.037, 595.209, 650.320, 650.330, 650.335, and 650.340, RSMo,
17	17	and section 192.530 as truly agreed to and finally passed by senate substitute for house
18	18	bill no. 402, one hundred second general assembly, first regular session, and to enact
19	19	in lieu thereof thirty-seven new sections relating to vulnerable persons.
20	20
21	21	Be it enacted by the General Assembly of the State of Missouri, as follows:
22	22	Section A. Sections 67.145, 70.631, 105.500, 135.327, 1
23	23	135.331, 135.333, 170.310, 190.091, 190.100, 190.103, 190.134, 2
24	24	190.142, 190.147, 190.255, 190.327, 190.460, 192 .2405, 195.206, 3
25	25	197.020, 208.1032, 285.040, 287.067, 287.245, 287.715, 320.336, 4
26	26	320.400, 321.225, 321.620, 537.037, 595.209, 650.320, 650.330, 5
27	27	650.335, and 650.340, RSMo, and section 192.530 as truly agreed 6
28	28	to and finally passed by senate substitute for ho use bill no. 7
29	29	402, one hundred second general assembly, first regular 8
30	30	session, are repealed and thirty -seven new sections enacted in 9
31	31	lieu thereof, to be known as sections 67.145, 70.631, 105.500, 10
32	32	135.327, 135.331, 135.333, 161.244, 170.310, 190.091, 190.100 , 11
33	33	190.103, 190.142, 190.147, 190.255, 190.327, 190.460, 190.1010, 12
34	34	192.2405, 195.206, 197.020, 208.1032, 285.040, 287.067, 13 HCS SS SB 24 2
35	35	287.245, 287.715, 320.336, 320.400, 321.225, 321.620, 537.037, 14
36	36	579.088, 595.209, 650.320, 650.330, 650.335, 650.340, and 1, to 15
37	37	read as follows:16
38	38	67.145. 1. No political subdivision of this state 1
39	39	shall prohibit any first responder from engaging in any 2
40	40	political activity while off duty and not in uniform, being 3
41	41	a candidate for elected or appointed public office, or 4
42	42	holding such office unless such political activity or 5
43	43	candidacy is otherwise prohibited by state or federal law. 6
44	44	2. As used in this section, "first responder" means 7
45	45	any person trained and authorized by law or rule to render 8
46	46	emergency medical assistance or trea tment. Such persons may 9
47	47	include, but shall not be limited to, emergency first 10
48	48	responders, telecommunicator first responders, police 11
49	49	officers, sheriffs, deputy sheriffs, firefighters, 12
50	50	[ambulance attendants and attendant drivers, ] emergency 13
51	51	medical technicians, [mobile emergency medical technicians, 14
52	52	emergency medical technician -paramedics,] registered nurses, 15
53	53	or physicians. 16
54	54	70.631. 1. Each political subdivision may, by 1
55	55	majority vote of its governing body, elect to cover 2
56	56	[emergency telecommunicators ] telecommunicator first 3
57	57	responders, jailors, and emergency medical service personnel 4
58	58	as public safety personnel members of the system. The clerk 5
59	59	or secretary of the political subdivision shall certify an 6
60	60	election concerning the co verage of [emergency 7
61	61	telecommunicators] telecommunicator first responders , 8
62	62	jailors, and emergency medical service personnel as public 9
63	63	safety personnel members of the system to the board within 10
64	64	ten days after such vote. The date in which the political 11
65	65	subdivision's election becomes effective shall be the first 12
66	66	day of the calendar month specified by such governing body, 13 HCS SS SB 24 3
67	67	the first day of the calendar month next following receipt 14
68	68	by the board of the certification of the election, or the 15
69	69	effective date of the political subdivision's becoming an 16
70	70	employer, whichever is the latest date. Such election shall 17
71	71	not be changed after the effective date. If the election is 18
72	72	made, the coverage provisions shall be applicable to all 19
73	73	past and future employment wi th the employer by present and 20
74	74	future employees. If a political subdivision makes no 21
75	75	election under this section, no [emergency] telecommunicator 22
76	76	first responder, jailor, or emergency medical service 23
77	77	personnel of the political subdivision shall be con sidered 24
78	78	public safety personnel for purposes determining a minimum 25
79	79	service retirement age as defined in section 70.600. 26
80	80	2. If an employer elects to cover [emergency 27
81	81	telecommunicators] telecommunicator first responders , 28
82	82	jailors, and emergency medi cal service personnel as public 29
83	83	safety personnel members of the system, the employer's 30
84	84	contributions shall be correspondingly changed effective the 31
85	85	same date as the effective date of the political 32
86	86	subdivision's election. 33
87	87	3. The limitation on incr eases in an employer's 34
88	88	contributions provided by subsection 6 of section 70.730 35
89	89	shall not apply to any contribution increase resulting from 36
90	90	an employer making an election under the provisions of this 37
91	91	section. 38
92	92	105.500. For purposes of sections 105.500 to 105.598, 1
93	93	unless the context otherwise requires, the following words 2
94	94	and phrases mean: 3
95	95	(1) "Bargaining unit", a unit of public employees at 4
96	96	any plant or installation or in a craft or in a function of 5
97	97	a public body that establ ishes a clear and identifiable 6
98	98	community of interest among the public employees concerned; 7 HCS SS SB 24 4
99	99	(2) "Board", the state board of mediation established 8
100	100	under section 295.030; 9
101	101	(3) "Department", the department of labor and 10
102	102	industrial relations establ ished under section 286.010; 11
103	103	(4) "Exclusive bargaining representative", an 12
104	104	organization that has been designated or selected, as 13
105	105	provided in section 105.575, by a majority of the public 14
106	106	employees in a bargaining unit as the representative of such 15
107	107	public employees in such unit for purposes of collective 16
108	108	bargaining; 17
109	109	(5) "Labor organization", any organization, agency, or 18
110	110	public employee representation committee or plan, in which 19
111	111	public employees participate and that exists for the 20
112	112	purpose, in whole or in part, of dealing with a public body 21
113	113	or public bodies concerning collective bargaining, 22
114	114	grievances, labor disputes, wages, rates of pay, hours of 23
115	115	employment, or conditions of work; 24
116	116	(6) "Public body", the state of Missouri, or any 25
117	117	officer, agency, department, bureau, division, board or 26
118	118	commission of the state, or any other political subdivision 27
119	119	or special district of or within the state. Public body 28
120	120	shall not include the department of corrections; 29
121	121	(7) "Public employee", any person employed by a public 30
122	122	body; 31
123	123	(8) "Public safety labor organization", a labor 32
124	124	organization wholly or primarily representing persons 33
125	125	trained or authorized by law or rule to render emergency 34
126	126	medical assistance or treatment, including, but not l imited 35
127	127	to, firefighters, [ambulance attendants, attendant drivers, ] 36
128	128	emergency medical technicians, [emergency medical technician 37
129	129	paramedics,] dispatchers, registered nurses and physicians, 38
130	130	and persons who are vested with the power of arrest for 39 HCS SS SB 24 5
131	131	criminal code violations including, but not limited to, 40
132	132	police officers, sheriffs, and deputy sheriffs. 41
133	133	135.327. 1. Any person residing in this state who 1
134	134	legally adopts a special needs child on or after January 1, 2
135	135	1988, and before January 1, 2000, shall be eligible to 3
136	136	receive a tax credit of up to ten thousand dollars for 4
137	137	nonrecurring adoption expenses for each child adopted that 5
138	138	may be applied to taxes due under chapter 143. Any business 6
139	139	entity providing funds to an employee to enabl e that 7
140	140	employee to legally adopt a special needs child shall be 8
141	141	eligible to receive a tax credit of up to ten thousand 9
142	142	dollars for nonrecurring adoption expenses for each child 10
143	143	adopted that may be applied to taxes due under such business 11
144	144	entity's state tax liability, except that only one ten 12
145	145	thousand dollar credit is available for each special needs 13
146	146	child that is adopted. 14
147	147	2. Any person residing in this state who proceeds in 15
148	148	good faith with the adoption of a special needs child on or 16
149	149	after January 1, 2000, and before January 1, 2022, shall be 17
150	150	eligible to receive a tax credit of up to ten thousand 18
151	151	dollars for nonrecurring adoption expenses for each child 19
152	152	that may be applied to taxes due under chapter 143; 20
153	153	provided, however, that beginning on March 29, 2013, the tax 21
154	154	credits shall only be allocated for the adoption of special 22
155	155	needs children who are residents or wards of residents of 23
156	156	this state at the time the adoption is initiated. Any 24
157	157	business entity providing funds to an employee to enab le 25
158	158	that employee to proceed in good faith with the adoption of 26
159	159	a special needs child shall be eligible to receive a tax 27
160	160	credit of up to ten thousand dollars for nonrecurring 28
161	161	adoption expenses for each child that may be applied to 29
162	162	taxes due under such business entity's state tax liability, 30 HCS SS SB 24 6
163	163	except that only one ten thousand dollar credit is available 31
164	164	for each special needs child that is adopted. 32
165	165	3. Any person residing in this state who proceeds in 33
166	166	good faith with the adoption of a child on or af ter January 34
167	167	1, 2022, regardless of whether such child is a special needs 35
168	168	child, shall be eligible to receive a tax credit of up to 36
169	169	ten thousand dollars for nonrecurring adoption expenses for 37
170	170	each child that may be applied to taxes due under chapter 38
171	171	143. The tax credit shall be allowed regardless of whether 39
172	172	the child adopted is a resident or ward of a resident of 40
173	173	this state at the time the adoption is initiated; however, 41
174	174	for all fiscal years ending on or before June 30, 2024, 42
175	175	priority shall be give n to applications to claim the tax 43
176	176	credit for special needs children who are residents or wards 44
177	177	of residents of this state at the time the adoption is 45
178	178	initiated. Any business entity providing funds to an 46
179	179	employee to enable that employee to proceed in good faith 47
180	180	with the adoption of a child shall be eligible to receive a 48
181	181	tax credit of up to ten thousand dollars for nonrecurring 49
182	182	adoption expenses for each child that may be applied to 50
183	183	taxes due under such business entity's state tax liability; 51
184	184	except that, only one credit, up to ten thousand dollars, 52
185	185	shall be available for each child who is adopted. 53
186	186	4. Individuals and business entities may claim a tax 54
187	187	credit for their total nonrecurring adoption expenses in 55
188	188	each year that the expenses are inc urred. A claim for fifty 56
189	189	percent of the credit shall be allowed when the child is 57
190	190	placed in the home. A claim for the remaining fifty percent 58
191	191	shall be allowed when the adoption is final. The total of 59
192	192	these tax credits shall not exceed the maximum li mit of ten 60
193	193	thousand dollars per child. For all tax years beginning on 61
194	194	or after January 1, 2024, the total of these tax credits 62 HCS SS SB 24 7
195	195	allowed per child shall be adjusted annually for increases 63
196	196	in cost-of-living, if any, as of the preceding July over the 64
197	197	level of July of the immediately preceding year of the 65
198	198	Consumer Price Index for All Urban Consumers. The 66
199	199	cumulative amount of tax credits which may be claimed by 67
200	200	taxpayers claiming the credit for nonrecurring adoption 68
201	201	expenses in any one fiscal year prio r to July 1, 2004, shall 69
202	202	not exceed two million dollars. The cumulative amount of 70
203	203	tax credits that may be claimed by taxpayers claiming the 71
204	204	credit for nonrecurring adoption expenses shall not be more 72
205	205	than two million dollars but may be increased by 73
206	206	appropriation in any fiscal year beginning on or after July 74
207	207	1, 2004, and ending on or before June 30, 2021. The 75
208	208	cumulative amount of tax credits that may be claimed by 76
209	209	taxpayers claiming the credit for nonrecurring adoption 77
210	210	expenses shall not exceed si x million dollars in any fiscal 78
211	211	year beginning on or after July 1, 2021 , and ending on or 79
212	212	before June 30, 2024. For all fiscal years beginning on or 80
213	213	after July 1, 2024, there shall be no limit imposed on the 81
214	214	cumulative amount of tax credits that may b e claimed by 82
215	215	taxpayers claiming the credit for nonrecurring adoption 83
216	216	expenses. For all fiscal years beginning on or after July 84
217	217	1, 2006, applications to claim the adoption tax credit shall 85
218	218	be filed between July first and April fifteenth of each 86
219	219	fiscal year. 87
220	220	5. Notwithstanding any provision of law to the 88
221	221	contrary, any individual or business entity may assign, 89
222	222	transfer or sell tax credits allowed in this section. Any 90
223	223	sale of tax credits claimed pursuant to this section shall 91
224	224	be at a discount rate of seventy-five percent or greater of 92
225	225	the amount sold. 93 HCS SS SB 24 8
226	226	135.331. No credit shall be allowable for the adoption 1
227	227	of any child who has attained the age of eighteen, unless it 2
228	228	has been determined that the child has a medical condition 3
229	229	or [handicap] disability that would limit the child's 4
230	230	ability to live independently of the adoptive parents. 5
231	231	135.333. 1. (1) For tax years beginning on or before 1
232	232	December 31, 2023, any amount of tax credit which exceeds 2
233	233	the tax due or which is applied for and otherwise eligible 3
234	234	for issuance but not issued shall not be refunded but may be 4
235	235	carried over to any subsequent [taxable] tax year, not to 5
236	236	exceed a total of five years for which a tax credit may be 6
237	237	taken for each child ado pted. 7
238	238	(2) For all tax years beginning on or after January 1, 8
239	239	2024, any amount of tax credit that is issued and which 9
240	240	exceeds the tax due shall be refunded to the taxpayer; 10
241	241	however, any tax credits carried forward from tax years 11
242	242	beginning on or before December 31, 2023, shall not be 12
243	243	refundable. 13
244	244	2. Tax credits that are assigned, transferred or sold 14
245	245	as allowed in section 135.327 may be assigned, transferred 15
246	246	or sold in their entirety notwithstanding the taxpayer's tax 16
247	247	due. 17
248	248	161.244. 1. As used in this section, the following 1
249	249	terms mean: 2
250	250	(1) "Early childhood education services", programming 3
251	251	or services intended to effect positive developmental 4
252	252	changes in children prior to their entry into kindergarten; 5
253	253	(2) "Private entity", an entity that meets the 6
254	254	definition of a licensed child care provider as defined in 7
255	255	section 210.201, license exempt as described in section 8
256	256	210.211, or that is unlicensed but is contracted with the 9
257	257	department of elementary and secondary education. 10 HCS SS SB 24 9
258	258	2. Subject to appropriation, the department of 11
259	259	elementary and secondary education shall provide grants 12
260	260	directly to private entities for the provision of early 13
261	261	childhood education services. The standards prescribed in 14
262	262	section 161.213 shall be applicable to all private entities 15
263	263	that receive such grant moneys. 16
264	264	170.310. 1. For school year 2017 -18 and each school 1
265	265	year thereafter, upon graduation from high school, pupils in 2
266	266	public schools and charter schools shall hav e received 3
267	267	thirty minutes of cardiopulmonary resuscitation instruction 4
268	268	and training in the proper performance of the Heimlich 5
269	269	maneuver or other first aid for choking given any time 6
270	270	during a pupil's four years of high school. 7
271	271	2. Beginning in school year 2017-18, any public school 8
272	272	or charter school serving grades nine through twelve shall 9
273	273	provide enrolled students instruction in cardiopulmonary 10
274	274	resuscitation. Students with disabilities may participate 11
275	275	to the extent appropriate as determined by the provisions of 12
276	276	the Individuals with Disabilities Education Act or Section 13
277	277	504 of the Rehabilitation Act. Instruction shall be included 14
278	278	in the district's existing health or physical education 15
279	279	curriculum. Instruction shall be based on a program 16
280	280	established by the American Heart Association or the 17
281	281	American Red Cross, or through a nationally recognized 18
282	282	program based on the most current national evidence -based 19
283	283	emergency cardiovascular care guidelines, and psychomotor 20
284	284	skills development shall be inco rporated into the 21
285	285	instruction. For purposes of this section, "psychomotor 22
286	286	skills" means the use of hands -on practicing and skills 23
287	287	testing to support cognitive learning. 24
288	288	3. The teacher of the cardiopulmonary resuscitation 25
289	289	course or unit shall not be required to be a certified 26 HCS SS SB 24 10
290	290	trainer of cardiopulmonary resuscitation if the instruction 27
291	291	is not designed to result in certification of students. 28
292	292	Instruction that is designed to result in certification 29
293	293	being earned shall be required to be taught by a n authorized 30
294	294	cardiopulmonary instructor. Schools may develop agreements 31
295	295	with any local chapter of a voluntary organization of first 32
296	296	responders to provide the required hands -on practice and 33
297	297	skills testing. For purposes of this subsection, "first 34
298	298	responders" shall include telecommunicator first responders 35
299	299	as defined in section 650.320. 36
300	300	4. The department of elementary and secondary 37
301	301	education may promulgate rules to implement this section. 38
302	302	Any rule or portion of a rule, as that term is defined in 39
303	303	section 536.010, that is created under the authority 40
304	304	delegated in this section shall become effective only if it 41
305	305	complies with and is subject to all of the provisions of 42
306	306	chapter 536 and, if applicable, section 536.028. This 43
307	307	section and chapter 536 are nonseverable and if any of the 44
308	308	powers vested with the general assembly pursuant to chapter 45
309	309	536 to review, to delay the effective date, or to disapprove 46
310	310	and annul a rule are subsequently held unconstitutional, 47
311	311	then the grant of rulemaking authority and any rule proposed 48
312	312	or adopted after August 28, 2012, shall be invalid and void. 49
313	313	190.091. 1. As used in this section, the following 1
314	314	terms mean: 2
315	315	(1) "Bioterrorism", the intentional use of any 3
316	316	microorganism, virus, infectious substance, or biological 4
317	317	product that may be engineered as a result of biotechnology 5
318	318	or any naturally occurring or bioengineered component of any 6
319	319	microorganism, virus, infectious substance, or biological 7
320	320	product to cause death, disease, or other biolo gical 8
321	321	malfunction in a human, an animal, a plant, or any other 9 HCS SS SB 24 11
322	322	living organism to influence the conduct of government or to 10
323	323	intimidate or coerce a civilian population; 11
324	324	(2) "Department", the Missouri department of health 12
325	325	and senior services; 13
326	326	(3) "Director", the director of the department of 14
327	327	health and senior services; 15
328	328	(4) "Disaster locations", any geographical location 16
329	329	where a bioterrorism attack, terrorist attack, catastrophic 17
330	330	or natural disaster, or emergency occurs; 18
331	331	(5) "First responders", state and local law 19
332	332	enforcement personnel, telecommunicator first responders, 20
333	333	fire department personnel, and emergency medical personnel 21
334	334	who will be deployed to bioterrorism attacks, terrorist 22
335	335	attacks, catastrophic or natural disasters, and emergencies; 23
336	336	(6) "Missouri state highway patrol telecommunicator", 24
337	337	any authorized Missouri state highway patrol communications 25
338	338	division personnel whose primary responsibility includes 26
339	339	directly responding to emergency communications and who me et 27
340	340	the training requirements pursuant to section 650.340 . 28
341	341	2. The department shall offer a vaccination program 29
342	342	for first responders and Missouri state highway patrol 30
343	343	telecommunicators who may be exposed to infectious diseases 31
344	344	when deployed to disa ster locations as a result of a 32
345	345	bioterrorism event or a suspected bioterrorism event. The 33
346	346	vaccinations shall include, but are not limited to, 34
347	347	smallpox, anthrax, and other vaccinations when recommended 35
348	348	by the federal Centers for Disease Control and Pre vention's 36
349	349	Advisory Committee on Immunization Practices. 37
350	350	3. Participation in the vaccination program shall be 38
351	351	voluntary by the first responders and Missouri state highway 39
352	352	patrol telecommunicators , except for first responders or 40
353	353	Missouri state highway patrol telecommunicators who, as 41 HCS SS SB 24 12
354	354	determined by their employer, cannot safely perform 42
355	355	emergency responsibilities when responding to a bioterrorism 43
356	356	event or suspected bioterrorism event without being 44
357	357	vaccinated. The recommendations of the Centers fo r Disease 45
358	358	Control and Prevention's Advisory Committee on Immunization 46
359	359	Practices shall be followed when providing appropriate 47
360	360	screening for contraindications to vaccination for first 48
361	361	responders and Missouri state highway patrol 49
362	362	telecommunicators. A first responder and Missouri state 50
363	363	highway patrol telecommunicator shall be exempt from 51
364	364	vaccinations when a written statement from a licensed 52
365	365	physician is presented to their employer indicating that a 53
366	366	vaccine is medically contraindicated for such person. 54
367	367	4. If a shortage of the vaccines referred to in 55
368	368	subsection 2 of this section exists following a bioterrorism 56
369	369	event or suspected bioterrorism event, the director, in 57
370	370	consultation with the governor and the federal Centers for 58
371	371	Disease Control and P revention, shall give priority for such 59
372	372	vaccinations to persons exposed to the disease and to first 60
373	373	responders or Missouri state highway patrol 61
374	374	telecommunicators who are deployed to the disaster location. 62
375	375	5. The department shall notify first respo nders and 63
376	376	Missouri state highway patrol telecommunicators concerning 64
377	377	the availability of the vaccination program described in 65
378	378	subsection 2 of this section and shall provide education to 66
379	379	such first responders , [and] their employers, and Missouri 67
380	380	state highway patrol telecommunicators concerning the 68
381	381	vaccinations offered and the associated diseases. 69
382	382	6. The department may contract for the administration 70
383	383	of the vaccination program described in subsection 2 of this 71
384	384	section with health care providers , including but not 72 HCS SS SB 24 13
385	385	limited to local public health agencies, hospitals, 73
386	386	federally qualified health centers, and physicians. 74
387	387	7. The provisions of this section shall become 75
388	388	effective upon receipt of federal funding or federal grants 76
389	389	which designate that the funding is required to implement 77
390	390	vaccinations for first responders and Missouri state highway 78
391	391	patrol telecommunicators in accordance with the 79
392	392	recommendations of the federal Centers for Disease Control 80
393	393	and Prevention's Advisory Committee on Im munization 81
394	394	Practices. Upon receipt of such funding, the department 82
395	395	shall make available the vaccines to first responders and 83
396	396	Missouri state highway patrol telecommunicators as provided 84
397	397	in this section. 85
398	398	190.100. As used in sections 190.001 to 190.245 and 1
399	399	section 190.257, the following words and terms mean: 2
400	400	(1) "Advanced emergency medical technician" or "AEMT", 3
401	401	a person who has successfully completed a course of 4
402	402	instruction in certain aspects of advanced life support care 5
403	403	as prescribed by the department and is licensed by the 6
404	404	department in accordance with sections 190.001 to 190.245 7
405	405	and rules and regulations adopted by the department pursuant 8
406	406	to sections 190.001 to 190.245; 9
407	407	(2) "Advanced life support (ALS)", an advan ced level 10
408	408	of care as provided to the adult and pediatric patient such 11
409	409	as defined by national curricula, and any modifications to 12
410	410	that curricula specified in rules adopted by the department 13
411	411	pursuant to sections 190.001 to 190.245; 14
412	412	(3) "Ambulance", any privately or publicly owned 15
413	413	vehicle or craft that is specially designed, constructed or 16
414	414	modified, staffed or equipped for, and is intended or used, 17
415	415	maintained or operated for the transportation of persons who 18
416	416	are sick, injured, wounded or otherwis e incapacitated or 19 HCS SS SB 24 14
417	417	helpless, or who require the presence of medical equipment 20
418	418	being used on such individuals, but the term does not 21
419	419	include any motor vehicle specially designed, constructed or 22
420	420	converted for the regular transportation of persons who are 23
421	421	disabled, handicapped, normally using a wheelchair, or 24
422	422	otherwise not acutely ill, or emergency vehicles used within 25
423	423	airports; 26
424	424	(4) "Ambulance service", a person or entity that 27
425	425	provides emergency or nonemergency ambulance transportation 28
426	426	and services, or both, in compliance with sections 190.001 29
427	427	to 190.245, and the rules promulgated by the department 30
428	428	pursuant to sections 190.001 to 190.245; 31
429	429	(5) "Ambulance service area", a specific geographic 32
430	430	area in which an ambulance service has been auth orized to 33
431	431	operate; 34
432	432	(6) "Basic life support (BLS)", a basic level of care, 35
433	433	as provided to the adult and pediatric patient as defined by 36
434	434	national curricula, and any modifications to that curricula 37
435	435	specified in rules adopted by the department pursua nt to 38
436	436	sections 190.001 to 190.245; 39
437	437	(7) "Council", the state advisory council on emergency 40
438	438	medical services; 41
439	439	(8) "Department", the department of health and senior 42
440	440	services, state of Missouri; 43
441	441	(9) "Director", the director of the departme nt of 44
442	442	health and senior services or the director's duly authorized 45
443	443	representative; 46
444	444	(10) "Dispatch agency", any person or organization 47
445	445	that receives requests for emergency medical services from 48
446	446	the public, by telephone or other means, and is respo nsible 49
447	447	for dispatching emergency medical services; 50 HCS SS SB 24 15
448	448	(11) "Emergency", the sudden and, at the time, 51
449	449	unexpected onset of a health condition that manifests itself 52
450	450	by symptoms of sufficient severity that would lead a prudent 53
451	451	layperson, possessing an a verage knowledge of health and 54
452	452	medicine, to believe that the absence of immediate medical 55
453	453	care could result in: 56
454	454	(a) Placing the person's health, or with respect to a 57
455	455	pregnant woman, the health of the woman or her unborn child, 58
456	456	in significant jeopardy; 59
457	457	(b) Serious impairment to a bodily function; 60
458	458	(c) Serious dysfunction of any bodily organ or part; 61
459	459	(d) Inadequately controlled pain; 62
460	460	(12) "Emergency medical dispatcher", a person who 63
461	461	receives emergency calls from the public an d has 64
462	462	successfully completed an emergency medical dispatcher 65
463	463	course[, meeting or exceeding the national curriculum of the 66
464	464	United States Department of Transportation and any 67
465	465	modifications to such curricula specified by the department 68
466	466	through rules adopted pursuant to sections 190.001 to 69
467	467	190.245] and any ongoing training requirements under section 70
468	468	650.340; 71
469	469	(13) "Emergency medical responder", a person who has 72
470	470	successfully completed an emergency first response course 73
471	471	meeting or exceeding the nati onal curriculum of the U.S. 74
472	472	Department of Transportation and any modifications to such 75
473	473	curricula specified by the department through rules adopted 76
474	474	under sections 190.001 to 190.245 and who provides emergency 77
475	475	medical care through employment by or in ass ociation with an 78
476	476	emergency medical response agency; 79
477	477	(14) "Emergency medical response agency", any person 80
478	478	that regularly provides a level of care that includes first 81 HCS SS SB 24 16
479	479	response, basic life support or advanced life support, 82
480	480	exclusive of patient trans portation; 83
481	481	(15) "Emergency medical services for children (EMS -C) 84
482	482	system", the arrangement of personnel, facilities and 85
483	483	equipment for effective and coordinated delivery of 86
484	484	pediatric emergency medical services required in prevention 87
485	485	and management of incidents which occur as a result of a 88
486	486	medical emergency or of an injury event, natural disaster or 89
487	487	similar situation; 90
488	488	(16) "Emergency medical services (EMS) system", the 91
489	489	arrangement of personnel, facilities and equipment for the 92
490	490	effective and coordinated delivery of emergency medical 93
491	491	services required in prevention and management of incidents 94
492	492	occurring as a result of an illness, injury, natural 95
493	493	disaster or similar situation; 96
494	494	(17) "Emergency medical technician", a person licensed 97
495	495	in emergency medical care in accordance with standards 98
496	496	prescribed by sections 190.001 to 190.245, and by rules 99
497	497	adopted by the department pursuant to sections 190.001 to 100
498	498	190.245; 101
499	499	(18) ["Emergency medical technician -basic" or "EMT-B", 102
500	500	a person who has successfully completed a course of 103
501	501	instruction in basic life support as prescribed by the 104
502	502	department and is licensed by the department in accordance 105
503	503	with standards prescribed by sections 190.001 to 190.245 and 106
504	504	rules adopted by the department pursuant t o sections 190.001 107
505	505	to 190.245; 108
506	506	(19)] "Emergency medical technician -community 109
507	507	paramedic", "community paramedic", or "EMT -CP", a person who 110
508	508	is certified as an emergency medical technician -paramedic 111
509	509	and is certified by the department in accordance w ith 112
510	510	standards prescribed in section 190.098; 113 HCS SS SB 24 17
511	511	[(20) "Emergency medical technician -paramedic" or "EMT- 114
512	512	P", a person who has successfully completed a course of 115
513	513	instruction in advanced life support care as prescribed by 116
514	514	the department and is licensed by the department in 117
515	515	accordance with sections 190.001 to 190.245 and rules 118
516	516	adopted by the department pursuant to sections 190.001 to 119
517	517	190.245; 120
518	518	(21)] (19) "Emergency services", health care items and 121
519	519	services furnished or required to screen and stab ilize an 122
520	520	emergency which may include, but shall not be limited to, 123
521	521	health care services that are provided in a licensed 124
522	522	hospital's emergency facility by an appropriate provider or 125
523	523	by an ambulance service or emergency medical response agency; 126
524	524	[(22)] (20) "Health care facility", a hospital, 127
525	525	nursing home, physician's office or other fixed location at 128
526	526	which medical and health care services are performed; 129
527	527	[(23)] (21) "Hospital", an establishment as defined in 130
528	528	the hospital licensing law, subsec tion 2 of section 197.020, 131
529	529	or a hospital operated by the state; 132
530	530	[(24)] (22) "Medical control", supervision provided by 133
531	531	or under the direction of physicians, or their designated 134
532	532	registered nurse, including both online medical control, 135
533	533	instructions by radio, telephone, or other means of direct 136
534	534	communications, and offline medical control through 137
535	535	supervision by treatment protocols, case review, training, 138
536	536	and standing orders for treatment; 139
537	537	[(25)] (23) "Medical direction", medical guidance and 140
538	538	supervision provided by a physician to an emergency services 141
539	539	provider or emergency medical services system; 142
540	540	[(26)] (24) "Medical director", a physician licensed 143
541	541	pursuant to chapter 334 designated by the ambulance service , 144
542	542	dispatch agency, or emergency medical response agency and 145 HCS SS SB 24 18
543	543	who meets criteria specified by the department by rules 146
544	544	pursuant to sections 190.001 to 190.245; 147
545	545	[(27)] (25) "Memorandum of understanding", an 148
546	546	agreement between an emergency medical response agency or 149
547	547	dispatch agency and an ambulance service or services within 150
548	548	whose territory the agency operates, in order to coordinate 151
549	549	emergency medical services; 152
550	550	(26) "Paramedic", a person who has successfully 153
551	551	completed a course of instruction in advanced life support 154
552	552	care as prescribed by the department and is licensed by the 155
553	553	department in accordance with sections 190.001 to 190.245 156
554	554	and rules adopted by the department pursuant to sections 157
555	555	190.001 to 190.245; 158
556	556	[(28)] (27) "Patient", an individual who is sick, 159
557	557	injured, wounded, diseased, or otherwise incapacitated or 160
558	558	helpless, or dead, excluding deceased individuals being 161
559	559	transported from or between private or public institutions, 162
560	560	homes or cemeteries, and individuals declared dead prior to 163
561	561	the time an ambulance is called for assistance; 164
562	562	[(29)] (28) "Person", as used in these definitions and 165
563	563	elsewhere in sections 190.001 to 190.245, any individual, 166
564	564	firm, partnership, copartnership, joint venture, 167
565	565	association, cooperative organization, corporation, 168
566	566	municipal or private, and whether organized for profit or 169
567	567	not, state, county, political subdivision, state department, 170
568	568	commission, board, bureau or fraternal organization, estate, 171
569	569	public trust, business or common law trust, receiver, 172
570	570	assignee for the benefi t of creditors, trustee or trustee in 173
571	571	bankruptcy, or any other service user or provider; 174
572	572	[(30)] (29) "Physician", a person licensed as a 175
573	573	physician pursuant to chapter 334; 176 HCS SS SB 24 19
574	574	[(31)] (30) "Political subdivision", any municipality, 177
575	575	city, county, city not within a county, ambulance district 178
576	576	or fire protection district located in this state which 179
577	577	provides or has authority to provide ambulance service; 180
578	578	[(32)] (31) "Professional organization", any organized 181
579	579	group or association with an ongoin g interest regarding 182
580	580	emergency medical services. Such groups and associations 183
581	581	could include those representing volunteers, labor, 184
582	582	management, firefighters, [EMT-B's] EMTs, nurses, [EMT-P's] 185
583	583	paramedics, physicians, communications specialists and 186
584	584	instructors. Organizations could also represent the 187
585	585	interests of ground ambulance services, air ambulance 188
586	586	services, fire service organizations, law enforcement, 189
587	587	hospitals, trauma centers, communication centers, pediatric 190
588	588	services, labor unions and poison c ontrol services; 191
589	589	[(33)] (32) "Proof of financial responsibility", proof 192
590	590	of ability to respond to damages for liability, on account 193
591	591	of accidents occurring subsequent to the effective date of 194
592	592	such proof, arising out of the ownership, maintenance or use 195
593	593	of a motor vehicle in the financial amount set in rules 196
594	594	promulgated by the department, but in no event less than the 197
595	595	statutory minimum required for motor vehicles. Proof of 198
596	596	financial responsibility shall be used as proof of self - 199
597	597	insurance; 200
598	598	[(34)] (33) "Protocol", a predetermined, written 201
599	599	medical care guideline, which may include standing orders; 202
600	600	[(35)] (34) "Regional EMS advisory committee", a 203
601	601	committee formed within an emergency medical services (EMS) 204
602	602	region to advise ambulance ser vices, the state advisory 205
603	603	council on EMS and the department; 206
604	604	[(36)] (35) "Specialty care transportation", the 207
605	605	transportation of a patient requiring the services of an 208 HCS SS SB 24 20
606	606	emergency medical technician -paramedic who has received 209
607	607	additional training bey ond the training prescribed by the 210
608	608	department. Specialty care transportation services shall be 211
609	609	defined in writing in the appropriate local protocols for 212
610	610	ground and air ambulance services and approved by the local 213
611	611	physician medical director. The protocols shall be 214
612	612	maintained by the local ambulance service and shall define 215
613	613	the additional training required of the emergency medical 216
614	614	technician-paramedic; 217
615	615	[(37)] (36) "Stabilize", with respect to an emergency, 218
616	616	the provision of such medical treatmen t as may be necessary 219
617	617	to attempt to assure within reasonable medical probability 220
618	618	that no material deterioration of an individual's medical 221
619	619	condition is likely to result from or occur during ambulance 222
620	620	transportation unless the likely benefits of such 223
621	621	transportation outweigh the risks; 224
622	622	[(38)] (37) "State advisory council on emergency 225
623	623	medical services", a committee formed to advise the 226
624	624	department on policy affecting emergency medical service 227
625	625	throughout the state; 228
626	626	[(39)] (38) "State EMS medical directors advisory 229
627	627	committee", a subcommittee of the state advisory council on 230
628	628	emergency medical services formed to advise the state 231
629	629	advisory council on emergency medical services and the 232
630	630	department on medical issues; 233
631	631	[(40)] (39) "STEMI" or "ST-elevation myocardial 234
632	632	infarction", a type of heart attack in which impaired blood 235
633	633	flow to the patient's heart muscle is evidenced by ST - 236
634	634	segment elevation in electrocardiogram analysis, and as 237
635	635	further defined in rules promulgated by the department und er 238
636	636	sections 190.001 to 190.250; 239 HCS SS SB 24 21
637	637	[(41)] (40) "STEMI care", includes education and 240
638	638	prevention, emergency transport, triage, and acute care and 241
639	639	rehabilitative services for STEMI that requires immediate 242
640	640	medical or surgical intervention or treatment; 243
641	641	[(42)] (41) "STEMI center", a hospital that is 244
642	642	currently designated as such by the department to care for 245
643	643	patients with ST-segment elevation myocardial infarctions; 246
644	644	[(43)] (42) "Stroke", a condition of impaired blood 247
645	645	flow to a patient's brai n as defined by the department; 248
646	646	[(44)] (43) "Stroke care", includes emergency 249
647	647	transport, triage, and acute intervention and other acute 250
648	648	care services for stroke that potentially require immediate 251
649	649	medical or surgical intervention or treatment, and may 252
650	650	include education, primary prevention, acute intervention, 253
651	651	acute and subacute management, prevention of complications, 254
652	652	secondary stroke prevention, and rehabilitative services; 255
653	653	[(45)] (44) "Stroke center", a hospital that is 256
654	654	currently designated as such by the department; 257
655	655	[(46)] (45) "Time-critical diagnosis", trauma care, 258
656	656	stroke care, and STEMI care occurring either outside of a 259
657	657	hospital or in a center designated under section 190.241; 260
658	658	[(47)] (46) "Time-critical diagnosis adviso ry 261
659	659	committee", a committee formed under section 190.257 to 262
660	660	advise the department on policies impacting trauma, stroke, 263
661	661	and STEMI center designations; regulations on trauma care, 264
662	662	stroke care, and STEMI care; and the transport of trauma, 265
663	663	stroke, and STEMI patients; 266
664	664	[(48)] (47) "Trauma", an injury to human tissues and 267
665	665	organs resulting from the transfer of energy from the 268
666	666	environment; 269
667	667	[(49)] (48) "Trauma care" includes injury prevention, 270
668	668	triage, acute care and rehabilitative services for maj or 271 HCS SS SB 24 22
669	669	single system or multisystem injuries that potentially 272
670	670	require immediate medical or surgical intervention or 273
671	671	treatment; 274
672	672	[(50)] (49) "Trauma center", a hospital that is 275
673	673	currently designated as such by the department. 276
674	674	190.103. 1. One physician with expertise in emergency 1
675	675	medical services from each of the EMS regions shall be 2
676	676	elected by that region's EMS medical directors to serve as a 3
677	677	regional EMS medical director. The regional EMS medical 4
678	678	directors shall constitute the state EMS medical director's 5
679	679	advisory committee and shall advise the department and their 6
680	680	region's ambulance services on matters relating to medical 7
681	681	control and medical direction in accordance with sections 8
682	682	190.001 to 190.245 and rules adopted by the d epartment 9
683	683	pursuant to sections 190.001 to 190.245. The regional EMS 10
684	684	medical director shall serve a term of four years. The 11
685	685	southwest, northwest, and Kansas City regional EMS medical 12
686	686	directors shall be elected to an initial two -year term. The 13
687	687	central, east central, and southeast regional EMS medical 14
688	688	directors shall be elected to an initial four -year term. 15
689	689	All subsequent terms following the initial terms shall be 16
690	690	four years. The state EMS medical director shall be the 17
691	691	chair of the state EMS medi cal director's advisory 18
692	692	committee, and shall be elected by the members of the 19
693	693	regional EMS medical director's advisory committee, shall 20
694	694	serve a term of four years, and shall seek to coordinate EMS 21
695	695	services between the EMS regions, promote educational 22
696	696	efforts for agency medical directors, represent Missouri EMS 23
697	697	nationally in the role of the state EMS medical director, 24
698	698	and seek to incorporate the EMS system into the health care 25
699	699	system serving Missouri. 26 HCS SS SB 24 23
700	700	2. A medical director is required for all a mbulance 27
701	701	services and emergency medical response agencies that 28
702	702	provide: advanced life support services; basic life support 29
703	703	services utilizing medications or providing assistance with 30
704	704	patients' medications; or basic life support services 31
705	705	performing invasive procedures including invasive airway 32
706	706	procedures. The medical director shall provide medical 33
707	707	direction to these services and agencies in these instances. 34
708	708	3. The medical director, in cooperation with the 35
709	709	ambulance service or emergency medica l response agency 36
710	710	administrator, shall have the responsibility and the 37
711	711	authority to ensure that the personnel working under their 38
712	712	supervision are able to provide care meeting established 39
713	713	standards of care with consideration for state and national 40
714	714	standards as well as local area needs and resources. The 41
715	715	medical director, in cooperation with the ambulance service 42
716	716	or emergency medical response agency administrator, shall 43
717	717	establish and develop triage, treatment and transport 44
718	718	protocols, which may inclu de authorization for standing 45
719	719	orders. Emergency medical technicians shall only perform 46
720	720	those medical procedures as directed by treatment protocols 47
721	721	approved by the local medical director or when authorized 48
722	722	through direct communication with online medic al control. 49
723	723	4. All ambulance services and emergency medical 50
724	724	response agencies that are required to have a medical 51
725	725	director shall establish an agreement between the service or 52
726	726	agency and their medical director. The agreement will 53
727	727	include the roles, responsibilities and authority of the 54
728	728	medical director beyond what is granted in accordance with 55
729	729	sections 190.001 to 190.245 and rules adopted by the 56
730	730	department pursuant to sections 190.001 to 190.245. The 57
731	731	agreement shall also include grievance pro cedures regarding 58 HCS SS SB 24 24
732	732	the emergency medical response agency or ambulance service, 59
733	733	personnel and the medical director. 60
734	734	5. Regional EMS medical directors and the state EMS 61
735	735	medical director elected as provided under subsection 1 of 62
736	736	this section shall be considered public officials for 63
737	737	purposes of sovereign immunity, official immunity, and the 64
738	738	Missouri public duty doctrine defenses. 65
739	739	6. The state EMS medical director's advisory committee 66
740	740	shall be considered a peer review committee under section 67
741	741	537.035. 68
742	742	7. Regional EMS medical directors may act to provide 69
743	743	online telecommunication medical direction to AEMTs, [EMT- 70
744	744	Bs, EMT-Ps] EMTs, paramedics, and community paramedics and 71
745	745	provide offline medical direction per standardized 72
746	746	treatment, triage, and transport protocols when EMS 73
747	747	personnel, including AEMTs, [EMT-Bs, EMT-Ps] EMTs, 74
748	748	paramedics, and community paramedics, are providing care to 75
749	749	special needs patients or at the request of a local EMS 76
750	750	agency or medical director. 77
751	751	8. When developing treatment protocols for special 78
752	752	needs patients, regional EMS medical directors may 79
753	753	promulgate such protocols on a regional basis across 80
754	754	multiple political subdivisions' jurisdictional boundaries, 81
755	755	and such protocols may be used by multiple agencies 82
756	756	including, but not limited to, ambulance services, emergency 83
757	757	response agencies, and public health departments. Treatment 84
758	758	protocols shall include steps to ensure the receiving 85
759	759	hospital is informed of the pending arrival of the special 86
760	760	needs patient, the condition of the patient, and the 87
761	761	treatment instituted. 88
762	762	9. Multiple EMS agencies including, but not limited 89
763	763	to, ambulance services, emergency response agencies, and 90 HCS SS SB 24 25
764	764	public health departments shall take necessary steps to 91
765	765	follow the regional EMS protocols established as provided 92
766	766	under subsection 8 of this section in cases of mass casualty 93
767	767	or state-declared disaster incidents. 94
768	768	10. When regional EMS medical directors develop and 95
769	769	implement treatment protocols for patients or provide online 96
770	770	medical direction for patients, such activity shall not be 97
771	771	construed as having usurped local medical direction 98
772	772	authority in any manner. 99
773	773	11. The state EMS medical directors advisory committee 100
774	774	shall review and make recommendations regarding all pro posed 101
775	775	community and regional time -critical diagnosis plans. 102
776	776	12. Notwithstanding any other provision of law to the 103
777	777	contrary, when regional EMS medical directors are providing 104
778	778	either online telecommunication medical direction to AEMTs, 105
779	779	[EMT-Bs, EMT-Ps] EMTs, paramedics, and community paramedics, 106
780	780	or offline medical direction per standardized EMS treatment, 107
781	781	triage, and transport protocols for patients, those medical 108
782	782	directions or treatment protocols may include the 109
783	783	administration of the patient's own prescription medications. 110
784	784	190.142. 1. (1) For applications submitted before 1
785	785	the recognition of EMS personnel licensure interstate 2
786	786	compact under sections 190.900 to 190.939 takes effect, the 3
787	787	department shall, within a reasonable time after receipt of 4
788	788	an application, cause such investigation as it deems 5
789	789	necessary to be made of the applicant for an emergency 6
790	790	medical technician's license. 7
791	791	(2) For applications submitted after the recognition 8
792	792	of EMS personnel licensure inter state compact under sections 9
793	793	190.900 to 190.939 takes effect, an applicant for initial 10
794	794	licensure as an emergency medical technician in this state 11
795	795	shall submit to a background check by the Missouri state 12 HCS SS SB 24 26
796	796	highway patrol and the Federal Bureau of Investig ation 13
797	797	through a process approved by the department of health and 14
798	798	senior services. Such processes may include the use of 15
799	799	vendors or systems administered by the Missouri state 16
800	800	highway patrol. The department may share the results of 17
801	801	such a criminal background check with any emergency services 18
802	802	licensing agency in any member state, as that term is 19
803	803	defined under section 190.900, in recognition of the EMS 20
804	804	personnel licensure interstate compact. The department 21
805	805	shall not issue a license until the departm ent receives the 22
806	806	results of an applicant's criminal background check from the 23
807	807	Missouri state highway patrol and the Federal Bureau of 24
808	808	Investigation, but, notwithstanding this subsection, the 25
809	809	department may issue a temporary license as provided under 26
810	810	section 190.143. Any fees due for a criminal background 27
811	811	check shall be paid by the applicant. 28
812	812	(3) The director may authorize investigations into 29
813	813	criminal records in other states for any applicant. 30
814	814	2. The department shall issue a license to al l levels 31
815	815	of emergency medical technicians, for a period of five 32
816	816	years, if the applicant meets the requirements established 33
817	817	pursuant to sections 190.001 to 190.245 and the rules 34
818	818	adopted by the department pursuant to sections 190.001 to 35
819	819	190.245. The department may promulgate rules relating to 36
820	820	the requirements for an emergency medical technician 37
821	821	including but not limited to: 38
822	822	(1) Age requirements; 39
823	823	(2) Emergency medical technician and paramedic 40
824	824	education and training requirements based on re spective 41
825	825	National Emergency Medical Services Education Standards and 42
826	826	any modification to such curricula specified by the 43 HCS SS SB 24 27
827	827	department through rules adopted pursuant to sections 44
828	828	190.001 to 190.245; 45
829	829	(3) Paramedic accreditation requirements. Paramedic 46
830	830	training programs shall be accredited [by the Commission on 47
831	831	Accreditation of Allied Health Education Programs (CAAHEP) 48
832	832	or hold a CAAHEP letter of review ] as required by the 49
833	833	National Registry of Emergency Medical Technicians ; 50
834	834	(4) Initial licensure testing requirements. Initial 51
835	835	[EMT-P] paramedic licensure testing shall be through the 52
836	836	national registry of EMTs; 53
837	837	(5) Continuing education and relicensure requirements; 54
838	838	and 55
839	839	(6) Ability to speak, read and write the English 56
840	840	language. 57
841	841	3. Application for all levels of emergency medical 58
842	842	technician license shall be made upon such forms as 59
843	843	prescribed by the department in rules adopted pursuant to 60
844	844	sections 190.001 to 190.245. The application form shall 61
845	845	contain such information as the department deems necessary 62
846	846	to make a determination as to whether the emergency medical 63
847	847	technician meets all the requirements of sections 190.001 to 64
848	848	190.245 and rules promulgated pursuant to sections 190.001 65
849	849	to 190.245. 66
850	850	4. All levels of emergency medical technicians may 67
851	851	perform only that patient care which is: 68
852	852	(1) Consistent with the training, education and 69
853	853	experience of the particular emergency medical technician; 70
854	854	and 71
855	855	(2) Ordered by a physician or set forth in protocols 72
856	856	approved by the medical director. 73
857	857	5. No person shall hold themselves out as an emergency 74
858	858	medical technician or provide the services of an emergency 75 HCS SS SB 24 28
859	859	medical technician unless such person is licensed by the 76
860	860	department. 77
861	861	6. Any rule or portion of a rule, a s that term is 78
862	862	defined in section 536.010, that is created under the 79
863	863	authority delegated in this section shall become effective 80
864	864	only if it complies with and is subject to all of the 81
865	865	provisions of chapter 536 and, if applicable, section 82
866	866	536.028. This section and chapter 536 are nonseverable and 83
867	867	if any of the powers vested with the general assembly 84
868	868	pursuant to chapter 536 to review, to delay the effective 85
869	869	date, or to disapprove and annul a rule are subsequently 86
870	870	held unconstitutional, then the grant of rulemaking 87
871	871	authority and any rule proposed or adopted after August 28, 88
872	872	2002, shall be invalid and void. 89
873	873	190.147. 1. [An emergency medical technician 1
874	874	paramedic (EMT-P)] A paramedic may make a good faith 2
875	875	determination that such be havioral health patients who 3
876	876	present a likelihood of serious harm to themselves or 4
877	877	others, as the term "likelihood of serious harm" is defined 5
878	878	under section 632.005, or who are significantly 6
879	879	incapacitated by alcohol or drugs shall be placed into a 7
880	880	temporary hold for the sole purpose of transport to the 8
881	881	nearest appropriate facility; provided that, such 9
882	882	determination shall be made in cooperation with at least one 10
883	883	other [EMT-P] paramedic or other health care professional 11
884	884	involved in the transport. Once in a temporary hold, the 12
885	885	patient shall be treated with humane care in a manner that 13
886	886	preserves human dignity, consistent with applicable federal 14
887	887	regulations and nationally recognized guidelines regarding 15
888	888	the appropriate use of temporary holds and res traints in 16
889	889	medical transport. Prior to making such a determination: 17 HCS SS SB 24 29
890	890	(1) The [EMT-P] paramedic shall have completed a 18
891	891	standard crisis intervention training course as endorsed and 19
892	892	developed by the state EMS medical director's advisory 20
893	893	committee; 21
894	894	(2) The [EMT-P] paramedic shall have been authorized 22
895	895	by his or her ground or air ambulance service's 23
896	896	administration and medical director under subsection 3 of 24
897	897	section 190.103; and 25
898	898	(3) The [EMT-P's] paramedic ground or air ambulance 26
899	899	service has developed and adopted standardized triage, 27
900	900	treatment, and transport protocols under subsection 3 of 28
901	901	section 190.103, which address the challenge of treating and 29
902	902	transporting such patients. Provided: 30
903	903	(a) That such protocols shall be reviewed an d approved 31
904	904	by the state EMS medical director's advisory committee; and 32
905	905	(b) That such protocols shall direct the [EMT-P] 33
906	906	paramedic regarding the proper use of patient restraint and 34
907	907	coordination with area law enforcement; and 35
908	908	(c) Patient restraint protocols shall be based upon 36
909	909	current applicable national guidelines. 37
910	910	2. In any instance in which a good faith determination 38
911	911	for a temporary hold of a patient has been made, such hold 39
912	912	shall be made in a clinically appropriate and adequately 40
913	913	justified manner, and shall be documented and attested to in 41
914	914	writing. The writing shall be retained by the ambulance 42
915	915	service and included as part of the patient's medical file. 43
916	916	3. [EMT-Ps] Paramedics who have made a good faith 44
917	917	decision for a temporary hold of a patient as authorized by 45
918	918	this section shall no longer have to rely on the common law 46
919	919	doctrine of implied consent and therefore shall not be 47
920	920	civilly liable for a good faith determination made in 48
921	921	accordance with this section and shall not have waived any 49 HCS SS SB 24 30
922	922	sovereign immunity defense, official immunity defense, or 50
923	923	Missouri public duty doctrine defense if employed at the 51
924	924	time of the good faith determination by a government 52
925	925	employer. 53
926	926	4. Any ground or air ambulance service that adopts the 54
927	927	authority and protocols provided for by this section shall 55
928	928	have a memorandum of understanding with applicable local law 56
929	929	enforcement agencies in order to achieve a collaborative and 57
930	930	coordinated response to patients displaying symptoms of 58
931	931	either a likelihood of serious harm to themselves or others 59
932	932	or significant incapacitation by alcohol or drugs, which 60
933	933	require a crisis intervention response. The memorandum of 61
934	934	understanding shall include, but not be limited to, the 62
935	935	following: 63
936	936	(1) Administrative oversight, including coordination 64
937	937	between ambulance services and law enforcement agencies; 65
938	938	(2) Patient restraint techniques and coordination of 66
939	939	agency responses to situations in which patient restraint 67
940	940	may be required; 68
941	941	(3) Field interaction between paramedics and law 69
942	942	enforcement, including patient destination and 70
943	943	transportation; and 71
944	944	(4) Coordination of program quality assurance. 72
945	945	5. The physical restraint of a patient by an emergency 73
946	946	medical technician under the authority of this section shall 74
947	947	be permitted only in order to provide for the safety of 75
948	948	bystanders, the patient, or emergency personnel due to an 76
949	949	imminent or immediate danger, or upon approval by local 77
950	950	medical control through direct communications. Restraint 78
951	951	shall also be permitted through cooperation with on -scene 79
952	952	law enforcement officers. All incidents involving patient 80 HCS SS SB 24 31
953	953	restraint used under the authority of this section shall be 81
954	954	reviewed by the ambulance service physician medical director. 82
955	955	190.255. 1. Any qualified first responder may obtain 1
956	956	and administer naloxone , or any other drug or device 2
957	957	approved by the United States Food and Drug Administration, 3
958	958	that blocks the effects of an opioid overdose and is 4
959	959	administered in a manner ap proved by the United States Food 5
960	960	and Drug Administration to a person suffering from an 6
961	961	apparent narcotic or opiate -related overdose in order to 7
962	962	revive the person. 8
963	963	2. Any licensed drug distributor or pharmacy in 9
964	964	Missouri may sell naloxone , or any other drug or device 10
965	965	approved by the United States Food and Drug Administration, 11
966	966	that blocks the effects of an opioid overdose and is 12
967	967	administered in a manner approved by the United States Food 13
968	968	and Drug Administration to qualified first responder 14
969	969	agencies to allow the agency to stock naloxone for the 15
970	970	administration of such drug to persons suffering from an 16
971	971	apparent narcotic or opiate overdose in order to revive the 17
972	972	person. 18
973	973	3. For the purposes of this section, "qualified first 19
974	974	responder" shall mean any [state and local law enforcement 20
975	975	agency staff,] fire department personnel, fire district 21
976	976	personnel, or licensed emergency medical technician who is 22
977	977	acting under the directives and established protocols of a 23
978	978	medical director of a local license d ground ambulance 24
979	979	service licensed under section 190.109 , or any state or 25
980	980	local law enforcement agency staff member, who comes in 26
981	981	contact with a person suffering from an apparent narcotic or 27
982	982	opiate-related overdose and who has received training in 28
983	983	recognizing and responding to a narcotic or opiate overdose 29
984	984	and the administration of naloxone to a person suffering 30 HCS SS SB 24 32
985	985	from an apparent narcotic or opiate -related overdose. 31
986	986	"Qualified first responder agencies" shall mean any state or 32
987	987	local law enforcement agency, fire department, or ambulance 33
988	988	service that provides documented training to its staff 34
989	989	related to the administration of naloxone in an apparent 35
990	990	narcotic or opiate overdose situation. 36
991	991	4. A qualified first responder shall only administer 37
992	992	naloxone by such means as the qualified first responder has 38
993	993	received training for the administration of naloxone. 39
994	994	190.327. 1. Immediately upon the decision by the 1
995	995	commission to utilize a portion of the emergency telephone 2
996	996	tax for central dispatching and an affirmative vote of the 3
997	997	telephone tax, the commission shall appoint the initial 4
998	998	members of a board which shall administer the funds and 5
999	999	oversee the provision of central dispatching for emergency 6
1000	1000	services in the county and in munic ipalities and other 7
1001	1001	political subdivisions which have contracted for such 8
1002	1002	service. Beginning with the general election in 1992, all 9
1003	1003	board members shall be elected according to this section and 10
1004	1004	other applicable laws of this state. At the time of the 11
1005	1005	appointment of the initial members of the board, the 12
1006	1006	commission shall relinquish to the board and no longer 13
1007	1007	exercise the duties prescribed in this chapter with regard 14
1008	1008	to the provision of emergency telephone service and in 15
1009	1009	chapter 321, with regard to th e provision of central 16
1010	1010	dispatching service, and such duties shall be exercised by 17
1011	1011	the board. 18
1012	1012	2. Elections for board members may be held on general 19
1013	1013	municipal election day, as defined in subsection 3 of 20
1014	1014	section 115.121, after approval by a simple m ajority of the 21
1015	1015	county commission. 22 HCS SS SB 24 33
1016	1016	3. For the purpose of providing the services described 23
1017	1017	in this section, the board shall have the following powers, 24
1018	1018	authority and privileges: 25
1019	1019	(1) To have and use a corporate seal; 26
1020	1020	(2) To sue and be sued, and be a party to suits, 27
1021	1021	actions and proceedings; 28
1022	1022	(3) To enter into contracts, franchises and agreements 29
1023	1023	with any person, partnership, association or corporation, 30
1024	1024	public or private, affecting the affairs of the board; 31
1025	1025	(4) To acquire, construct, purchase, maintain, dispose 32
1026	1026	of and encumber real and personal property, including leases 33
1027	1027	and easements; 34
1028	1028	(5) To have the management, control and supervision of 35
1029	1029	all the business affairs of the board and the construction, 36
1030	1030	installation, operati on and maintenance of any improvements; 37
1031	1031	(6) To hire and retain agents and employees and to 38
1032	1032	provide for their compensation including health and pension 39
1033	1033	benefits; 40
1034	1034	(7) To adopt and amend bylaws and any other rules and 41
1035	1035	regulations; 42
1036	1036	(8) To fix, charge and collect the taxes and fees 43
1037	1037	authorized by law for the purpose of implementing and 44
1038	1038	operating the services described in this section; 45
1039	1039	(9) To pay all expenses connected with the first 46
1040	1040	election and all subsequent elections; and 47
1041	1041	(10) To have and exercise all rights and powers 48
1042	1042	necessary or incidental to or implied from the specific 49
1043	1043	powers granted in this subsection. Such specific powers 50
1044	1044	shall not be considered as a limitation upon any power 51
1045	1045	necessary or appropriate to carry out the purposes and 52
1046	1046	intent of sections 190.300 to 190.329. 53 HCS SS SB 24 34
1047	1047	4. (1) Notwithstanding the provisions of subsections 54
1048	1048	1 and 2 of this section to the contrary, the county 55
1049	1049	commission may elect to appoint the members of the board to 56
1050	1050	administer the funds and oversee the provision of central 57
1051	1051	dispatching for emergency services in the counties, 58
1052	1052	municipalities, and other political subdivisions which have 59
1053	1053	contracted for such service upon the request of the 60
1054	1054	municipalities and other political subdivisions. Upon 61
1055	1055	appointment of the initial members of the board, the 62
1056	1056	commission shall relinquish all powers and duties to the 63
1057	1057	board and no longer exercise the duties prescribed in this 64
1058	1058	chapter with regard to the provision of central dispatching 65
1059	1059	service and such duti es shall be exercised by the board. 66
1060	1060	(2) The board shall consist of seven members appointed 67
1061	1061	without regard to political affiliation. The members shall 68
1062	1062	include: 69
1063	1063	(a) Five members who shall serve for so long as they 70
1064	1064	remain in their respective c ounty or municipal positions as 71
1065	1065	follows: 72
1066	1066	a. The county sheriff, or his or her designee; 73
1067	1067	b. The heads of the municipal police department who 74
1068	1068	have contracted for central dispatching service in the two 75
1069	1069	largest municipalities wholly contained wi thin the county, 76
1070	1070	or their designees; or 77
1071	1071	c. The heads of the municipal fire departments or fire 78
1072	1072	divisions who have contracted for central dispatching 79
1073	1073	service in the two largest municipalities wholly contained 80
1074	1074	within the county, or their designees; 81
1075	1075	(b) Two members who shall serve two -year terms 82
1076	1076	appointed from among the following: 83 HCS SS SB 24 35
1077	1077	a. The head of any of the county's fire protection 84
1078	1078	districts who have contracted for central dispatching 85
1079	1079	service, or his or her designee; 86
1080	1080	b. The head of any of the county's ambulance districts 87
1081	1081	who have contracted for central dispatching service, or his 88
1082	1082	or her designee; 89
1083	1083	c. The head of any of the municipal police departments 90
1084	1084	located in the county who have contracted for central 91
1085	1085	dispatching service, or his or her designee, excluding those 92
1086	1086	mentioned in subparagraph b. of paragraph (a) of this 93
1087	1087	subdivision; and 94
1088	1088	d. The head of any of the municipal fire departments 95
1089	1089	in the county who have contracted for central dispatching 96
1090	1090	service, or his or he r designee, excluding those mentioned 97
1091	1091	in subparagraph c. of paragraph (a) of this subdivision. 98
1092	1092	(3) Upon the appointment of the board under this 99
1093	1093	subsection, the board shall have the powers provided in 100
1094	1094	subsection 3 of this section and the commission shall 101
1095	1095	relinquish all powers and duties relating to the provision 102
1096	1096	of central dispatching service under this chapter to the 103
1097	1097	board. 104
1098	1098	[5.An emergency services board originally organized 105
1099	1099	under section 190.325 operating within a county with a 106
1100	1100	charter form of government and with more than two hundred 107
1101	1101	thousand but fewer than three hundred fifty thousand 108
1102	1102	inhabitant s shall not have a sales tax for emergency 109
1103	1103	services or for providing central dispatching for emergency 110
1104	1104	services greater than one -quarter of one percent. If on 111
1105	1105	July 9, 2019, such tax is greater than one -quarter of one 112
1106	1106	percent, the board shall lower the tax rate. ] 113
1107	1107	190.460. 1. As used in this section, the following 1
1108	1108	terms mean: 2 HCS SS SB 24 36
1109	1109	(1) "Board", the Missouri 911 service board 3
1110	1110	established under section 650.325; 4
1111	1111	(2) "Consumer", a person who purchases prepaid 5
1112	1112	wireless telecommunications service in a retail transaction; 6
1113	1113	(3) "Department", the department of revenue; 7
1114	1114	(4) "Prepaid wireless service provider", a provider 8
1115	1115	that provides prepaid wireless service to an end user; 9
1116	1116	(5) "Prepaid wireless telecommunications service", a 10
1117	1117	wireless telecommunications service that allows a caller to 11
1118	1118	dial 911 to access the 911 system and which service shall be 12
1119	1119	paid for in advance and is sold in predetermined units or 13
1120	1120	dollars of which the number declines with use in a known 14
1121	1121	amount; 15
1122	1122	(6) "Retail transaction", the purchase of prepaid 16
1123	1123	wireless telecommunications service from a seller for any 17
1124	1124	purpose other than re sale. The purchase of more than one 18
1125	1125	item that provides prepaid wireless telecommunication 19
1126	1126	service, when such items are sold separately, constitutes 20
1127	1127	more than one retail transaction; 21
1128	1128	(7) "Seller", a person who sells prepaid wireless 22
1129	1129	telecommunications service to another person; 23
1130	1130	(8) "Wireless telecommunications service", commercial 24
1131	1131	mobile radio service as defined by 47 CFR 20.3, as amended. 25
1132	1132	2. (1) Beginning January 1, 2019, there is hereby 26
1133	1133	imposed a prepaid wireless emergency telepho ne service 27
1134	1134	charge on each retail transaction. The amount of such 28
1135	1135	charge shall be equal to three percent of the amount of each 29
1136	1136	retail transaction. The first fifteen dollars of each 30
1137	1137	retail transaction shall not be subject to the service 31
1138	1138	charge. 32
1139	1139	(2) When prepaid wireless telecommunications service 33
1140	1140	is sold with one or more products or services for a single, 34 HCS SS SB 24 37
1141	1141	nonitemized price, the prepaid wireless emergency telephone 35
1142	1142	service charge set forth in subdivision (1) of this 36
1143	1143	subsection shall apply to t he entire nonitemized price 37
1144	1144	unless the seller elects to apply such service charge in the 38
1145	1145	following way: 39
1146	1146	(a) If the amount of the prepaid wireless 40
1147	1147	telecommunications service is disclosed to the consumer as a 41
1148	1148	dollar amount, three percent of such do llar amount; or 42
1149	1149	(b) If the seller can identify the portion of the 43
1150	1150	price that is attributable to the prepaid wireless 44
1151	1151	telecommunications service by reasonable and verifiable 45
1152	1152	standards from the seller's books and records that are kept 46
1153	1153	in the regular course of business for other purposes 47
1154	1154	including, but not limited to, nontax purposes, three 48
1155	1155	percent of such portion; 49
1156	1156	The first fifteen dollars of each transaction under this 50
1157	1157	subdivision shall not be subject to the service charge. 51
1158	1158	(3) The prepaid wireless emergency telephone service 52
1159	1159	charge shall be collected by the seller from the consumer 53
1160	1160	with respect to each retail transaction occurring in this 54
1161	1161	state. The amount of the prepaid wireless emergency 55
1162	1162	telephone service charge shall be either sepa rately stated 56
1163	1163	on an invoice, receipt, or other similar document that is 57
1164	1164	provided to the consumer by the seller or otherwise 58
1165	1165	disclosed to the consumer. 59
1166	1166	(4) For purposes of this subsection, a retail 60
1167	1167	transaction that is effected in person by a consu mer at a 61
1168	1168	business location of the seller shall be treated as 62
1169	1169	occurring in this state if that business location is in this 63
1170	1170	state, and any other retail transaction shall be treated as 64 HCS SS SB 24 38
1171	1171	occurring in this state if the retail transaction is treated 65
1172	1172	as occurring under chapter 144. 66
1173	1173	(5) The prepaid wireless emergency telephone service 67
1174	1174	charge is the liability of the consumer and not of the 68
1175	1175	seller or of any provider; except that, the seller shall be 69
1176	1176	liable to remit all charges that the seller collects or is 70
1177	1177	deemed to collect. 71
1178	1178	(6) The amount of the prepaid wireless emergency 72
1179	1179	telephone service charge that is collected by a seller from 73
1180	1180	a consumer, if such amount is separately stated on an 74
1181	1181	invoice, receipt, or other similar document provided to the 75
1182	1182	consumer by the seller, shall not be included in the base 76
1183	1183	for measuring any tax, fee, surcharge, or other charge that 77
1184	1184	is imposed by this state, any political subdivision of this 78
1185	1185	state, or any intergovernmental agency. 79
1186	1186	3. (1) Prepaid wireless eme rgency telephone service 80
1187	1187	charges collected by sellers shall be remitted to the 81
1188	1188	department at the times and in the manner provided by state 82
1189	1189	law with respect to sales and use taxes. The department 83
1190	1190	shall establish registration and payment procedures that 84
1191	1191	substantially coincide with the registration and payment 85
1192	1192	procedures that apply under state law. On or after the 86
1193	1193	effective date of the service charge imposed under the 87
1194	1194	provisions of this section, the director of the department 88
1195	1195	of revenue shall perfor m all functions incident to the 89
1196	1196	administration, collection, enforcement, and operation of 90
1197	1197	the service charge, and the director shall collect, in 91
1198	1198	addition to the sales tax for the state of Missouri, all 92
1199	1199	additional service charges imposed in this section . All 93
1200	1200	service charges imposed under this section together with all 94
1201	1201	taxes imposed under the sales tax law of the state of 95
1202	1202	Missouri shall be collected together and reported upon such 96 HCS SS SB 24 39
1203	1203	forms and under such administrative rules and regulations as 97
1204	1204	may be prescribed by the director. All applicable 98
1205	1205	provisions contained in sections 144.010 to 144.525 99
1206	1206	governing the state sales tax and section 32.057 shall apply 100
1207	1207	to the collection of any service charges imposed under this 101
1208	1208	section except as modified. 102
1209	1209	(2) Beginning on January 1, 2019, and ending on 103
1210	1210	January 31, 2019, when a consumer purchases prepaid wireless 104
1211	1211	telecommunications service in a retail transaction from a 105
1212	1212	seller under this section, the seller shall be allowed to 106
1213	1213	retain one hundred percent of the prepaid wireless emergency 107
1214	1214	telephone service charges that are collected by the seller 108
1215	1215	from the consumer. Beginning on February 1, 2019, a seller 109
1216	1216	shall be permitted to deduct and retain three percent of 110
1217	1217	prepaid wireless emergency telephone service charges that 111
1218	1218	are collected by the seller from consumers. 112
1219	1219	(3) The department shall establish procedures by which 113
1220	1220	a seller of prepaid wireless telecommunications service may 114
1221	1221	document that a sale is not a retail transaction, which 115
1222	1222	procedures shall substantially coincide with the procedures 116
1223	1223	for documenting sale for resale transactions for sales and 117
1224	1224	use purposes under state law. 118
1225	1225	(4) The department shall deposit all remitted prepaid 119
1226	1226	wireless emergency telephone service charges into the 120
1227	1227	general revenue fund for the department's use until eight 121
1228	1228	hundred thousand one hundred fifty dollars is collected to 122
1229	1229	reimburse its direct costs of administering the collection 123
1230	1230	and remittance of prepaid wireless emergency telephone 124
1231	1231	service charges. From then onward, the department shall 125
1232	1232	deposit all remitted prepaid wireless emergency telephone 126
1233	1233	service charges into the Missouri 911 service trust fund 127
1234	1234	created under section 190.420 within thirty days of receipt 128 HCS SS SB 24 40
1235	1235	for use by the board. After the initial eight hundred 129
1236	1236	thousand one hundred fifty dollars is collected, the 130
1237	1237	department may deduct an amount not to exceed one percent of 131
1238	1238	collected charges to be retained by the department to 132
1239	1239	reimburse its direct costs of administering the collection 133
1240	1240	and remittance of prepaid wireless emergency telephone 134
1241	1241	service charges. 135
1242	1242	(5) The board shall set a rate between twenty -five and 136
1243	1243	one hundred percent of the prepaid wireless emergency 137
1244	1244	telephone service charges deposited in the Missouri 911 138
1245	1245	service trust fund collec ted in counties without a charter 139
1246	1246	form of government, less the deductions authorized in 140
1247	1247	subdivision (4) of this subsection, that shall be remitted 141
1248	1248	to such counties in direct proportion to the amount of 142
1249	1249	charges collected in each county. The board shall set a 143
1250	1250	rate between sixty-five and one hundred percent of the 144
1251	1251	prepaid wireless emergency telephone service charges 145
1252	1252	deposited in the Missouri 911 service trust fund collected 146
1253	1253	in counties with a charter form of government and any city 147
1254	1254	not within a county, less the deductions authorized in 148
1255	1255	subdivision (4) of this subsection, that shall be remitted 149
1256	1256	to each such county or city not within a county in direct 150
1257	1257	proportion to the amount of charges collected in each such 151
1258	1258	county or city not within a county. If a county has an 152
1259	1259	elected emergency services board, the Missouri 911 service 153
1260	1260	board shall remit the funds to the elected emergency 154
1261	1261	services board, except for an emergency services board 155
1262	1262	originally organized under section 190.325 operating within 156
1263	1263	a county with a charter form of government and with more 157
1264	1264	than two hundred thousand but fewer than three hundred fifty 158
1265	1265	thousand inhabitants, in which case the funds shall be 159
1266	1266	remitted to the county's general fund for the purpose of 160 HCS SS SB 24 41
1267	1267	public safety infrastructure. The initial percentage rate 161
1268	1268	set by the board for counties with and without a charter 162
1269	1269	form of government and any city not within a county shall be 163
1270	1270	set by June thirtieth of each applicable year and may be 164
1271	1271	adjusted annually for the first three years, an d thereafter 165
1272	1272	the rate may be adjusted every three years; however, at no 166
1273	1273	point shall the board set rates that fall below twenty -five 167
1274	1274	percent for counties without a charter form of government 168
1275	1275	and sixty-five percent for counties with a charter form of 169
1276	1276	government and any city not within a county. 170
1277	1277	(6) Any amounts received by a county or city under 171
1278	1278	subdivision (5) of this subsection shall be used only for 172
1279	1279	purposes authorized in sections 190.305, 190.325, and 173
1280	1280	190.335. Any amounts received by any cou nty with a charter 174
1281	1281	form of government and with more than six hundred thousand 175
1282	1282	but fewer than seven hundred thousand inhabitants under this 176
1283	1283	section may be used for emergency service notification 177
1284	1284	systems. 178
1285	1285	4. (1) A seller that is not a provider sha ll be 179
1286	1286	entitled to the immunity and liability protections under 180
1287	1287	section 190.455, notwithstanding any requirement in state 181
1288	1288	law regarding compliance with Federal Communications 182
1289	1289	Commission Order 05-116. 183
1290	1290	(2) A provider shall be entitled to the immunit y and 184
1291	1291	liability protections under section 190.455. 185
1292	1292	(3) In addition to the protection from liability 186
1293	1293	provided in subdivisions (1) and (2) of this subsection, 187
1294	1294	each provider and seller and its officers, employees, 188
1295	1295	assigns, agents, vendors, or anyone acting on behalf of such 189
1296	1296	persons shall be entitled to the further protection from 190
1297	1297	liability, if any, that is provided to providers and sellers 191 HCS SS SB 24 42
1298	1298	of wireless telecommunications service that is not prepaid 192
1299	1299	wireless telecommunications service under section 190.455. 193
1300	1300	5. The prepaid wireless emergency telephone service 194
1301	1301	charge imposed by this section shall be in addition to any 195
1302	1302	other tax, fee, surcharge, or other charge imposed by this 196
1303	1303	state, any political subdivision of this state, or any 197
1304	1304	intergovernmental agency for 911 funding purposes. 198
1305	1305	6. The provisions of this section shall become 199
1306	1306	effective unless the governing body of a county or city 200
1307	1307	adopts an ordinance, order, rule, resolution, or regulation 201
1308	1308	by at least a two-thirds vote prohibiting th e charge 202
1309	1309	established under this section from becoming effective in 203
1310	1310	the county or city at least forty -five days prior to the 204
1311	1311	effective date of this section. If the governing body does 205
1312	1312	adopt such ordinance, order, rule, resolution, or regulation 206
1313	1313	by at least a two-thirds vote, the charge shall not be 207
1314	1314	collected and the county or city shall not be allowed to 208
1315	1315	obtain funds from the Missouri 911 service trust fund that 209
1316	1316	are remitted to the fund under the charge established under 210
1317	1317	this section. The Missouri 911 service board shall, by 211
1318	1318	September 1, 2018, notify all counties and cities of the 212
1319	1319	implementation of the charge established under this section, 213
1320	1320	and the procedures set forth under this subsection for 214
1321	1321	prohibiting the charge from becoming effective. 215
1322	1322	7. Any county or city which prohibited the prepaid 216
1323	1323	wireless emergency telephone service charge pursuant to the 217
1324	1324	provisions of subsection 6 of this section may take a vote 218
1325	1325	of the governing body, and notify the department of revenue 219
1326	1326	of the result of such vote[, by November 15, 2019, ] to 220
1327	1327	impose such charge [effective January 1, 2020 ]. A vote of 221
1328	1328	at least two-thirds of the governing body is required in 222
1329	1329	order to impose such charge. The department shall notify 223 HCS SS SB 24 43
1330	1330	the board of notices received by [December 1, 2019] within 224
1331	1331	sixty days of receiving such notice . 225
1332	1332	190.1010. 1. As used in this section, the following 1
1333	1333	terms shall mean: 2
1334	1334	(1) "Employee", a first responder employed by an 3
1335	1335	employer; 4
1336	1336	(2) "Employer", the state, a unit of local government, 5
1337	1337	or a public hospital or ambulance service that employs first 6
1338	1338	responders; 7
1339	1339	(3) "First responder", a 911 dispatcher, paramedic, 8
1340	1340	emergency medical technician, or a volunteer or full -time 9
1341	1341	paid firefighter; 10
1342	1342	(4) "Peer support advisor", a person approved by the 11
1343	1343	employer who voluntarily provides confidential support and 12
1344	1344	assistance to employees experiencing personal or 13
1345	1345	professional problems. An employer shall provide peer 14
1346	1346	support advisors with an appropriate level of training i n 15
1347	1347	counseling to provide emotional and moral support; 16
1348	1348	(5) "Peer support counseling program", a program 17
1349	1349	established by an employer to train employees to serve as 18
1350	1350	peer support advisors in order to conduct peer support 19
1351	1351	counseling sessions; 20
1352	1352	(6) "Peer support counseling session", communication 21
1353	1353	with a peer support advisor designated by an employer. A 22
1354	1354	peer support counseling session is accomplished primarily 23
1355	1355	through listening, assessing, assisting with problem 24
1356	1356	solving, making referrals to a pro fessional when necessary, 25
1357	1357	and conducting follow -up as needed; 26
1358	1358	(7) "Record", any record kept by a therapist or by an 27
1359	1359	agency in the course of providing behavioral health care to 28
1360	1360	a first responder concerning the first responder and the 29
1361	1361	services provided. "Record" includes the personal notes of 30 HCS SS SB 24 44
1362	1362	the therapist or agency, as well as all records maintained 31
1363	1363	by a court that have been created in connection with, in 32
1364	1364	preparation for, or as a result of the filing of any 33
1365	1365	petition. "Record" does not include information that has 34
1366	1366	been de-identified in accordance with the federal Health 35
1367	1367	Insurance Portability and Accountability Act (HIPAA) and 36
1368	1368	does not include a reference to the receipt of behavioral 37
1369	1369	health care noted during a patient history and physical or 38
1370	1370	other summary of care. 39
1371	1371	2. (1) Any communication made by an employee or peer 40
1372	1372	support advisor in a peer support counseling session, as 41
1373	1373	well as any oral or written information conveyed in the peer 42
1374	1374	support counseling session, shall be confidential and shall 43
1375	1375	not be disclosed by any person participating in the peer 44
1376	1376	support counseling session or released to any person or 45
1377	1377	entity. Any communication relating to a peer support 46
1378	1378	counseling session made confidential under this section that 47
1379	1379	is made between peer support advisors and the supervisors or 48
1380	1380	staff of a peer support counseling program, or between the 49
1381	1381	supervisor and staff of a peer support counseling program, 50
1382	1382	shall be confidential and shall not be disclosed. The 51
1383	1383	provisions of this section shal l not be construed to 52
1384	1384	prohibit any communications between counselors who conduct 53
1385	1385	peer support counseling sessions or any communications 54
1386	1386	between counselors and the supervisors or staff of a peer 55
1387	1387	support counseling program. 56
1388	1388	(2) Any communication de scribed in subdivision (1) of 57
1389	1389	this subsection may be subject to a subpoena for good cause 58
1390	1390	shown. 59
1391	1391	(3) The provisions of this subsection shall not apply 60
1392	1392	to the following: 61 HCS SS SB 24 45
1393	1393	(a) Any threat of suicide or homicide made by a 62
1394	1394	participant in a peer s upport counseling session or any 63
1395	1395	information conveyed in a peer support counseling session 64
1396	1396	related to a threat of suicide or homicide; 65
1397	1397	(b) Any information mandated by law or agency policy 66
1398	1398	to be reported, including, but not limited to, domestic 67
1399	1399	violence, child abuse or neglect, or elder abuse or neglect; 68
1400	1400	(c) Any admission of criminal conduct; or 69
1401	1401	(d) Any admission or act of refusal to perform duties 70
1402	1402	to protect others or the employee. 71
1403	1403	(4) All communications, notes, records, and rep orts 72
1404	1404	arising out of a peer support counseling session shall not 73
1405	1405	be considered public records subject to disclosure under 74
1406	1406	chapter 610. 75
1407	1407	(5) A department or organization that establishes a 76
1408	1408	peer support counseling program shall develop a policy or 77
1409	1409	rule that imposes disciplinary measures against a peer 78
1410	1410	support advisor who violates the confidentiality of the peer 79
1411	1411	support counseling program by sharing information learned in 80
1412	1412	a peer support counseling session with personnel who are not 81
1413	1413	supervisors or staff of the peer support counseling program 82
1414	1414	unless otherwise exempted under the provisions of this 83
1415	1415	subsection. 84
1416	1416	3. Any employer that creates a peer support counseling 85
1417	1417	program shall be subject to the provisions of this section. 86
1418	1418	An employer shall ensure that peer support advisors receive 87
1419	1419	appropriate training in counseling to conduct peer support 88
1420	1420	counseling sessions. An employer may refer any person to a 89
1421	1421	peer support advisor within the employer's organization or, 90
1422	1422	if those services are not avail able with the employer, to 91
1423	1423	another peer support counseling program that is available 92
1424	1424	and approved by the employer. Notwithstanding any other 93 HCS SS SB 24 46
1425	1425	provision of law to the contrary, an employer shall not 94
1426	1426	mandate that any employee participate in a peer suppor t 95
1427	1427	counseling program. 96
1428	1428	[192.530. 1. As used in this section, the 1
1429	1429	following terms mean: 2
1430	1430	(1) "Department", the department of health 3
1431	1431	and senior services; 4
1432	1432	(2) "Health care provider", the same 5
1433	1433	meaning given to the term in sec tion 376.1350; 6
1434	1434	(3) "Voluntary nonopioid directive form", 7
1435	1435	a form that may be used by a patient to deny or 8
1436	1436	refuse the administration or prescription of a 9
1437	1437	controlled substance containing an opioid by a 10
1438	1438	health care provider. 11
1439	1439	2. In consultation with the board of 12
1440	1440	registration for the healing arts and the board 13
1441	1441	of pharmacy, the department shall develop and 14
1442	1442	publish a uniform voluntary nonopioid directive 15
1443	1443	form. 16
1444	1444	3. The voluntary nonopioid directive form 17
1445	1445	developed by the department shall ind icate to 18
1446	1446	all prescribing health care providers that the 19
1447	1447	named patient shall not be offered, prescribed, 20
1448	1448	supplied with, or otherwise administered a 21
1449	1449	controlled substance containing an opioid. 22
1450	1450	4. The voluntary nonopioid directive form 23
1451	1451	shall be posted in a downloadable format on the 24
1452	1452	department's publicly accessible website. 25
1453	1453	5. (1) A patient may execute and file a 26
1454	1454	voluntary nonopioid directive form with a health 27
1455	1455	care provider. Each health care provider shall 28
1456	1456	sign and date the form in the p resence of the 29
1457	1457	patient as evidence of acceptance and shall 30
1458	1458	provide a signed copy of the form to the patient. 31
1459	1459	(2) The patient executing and filing a 32
1460	1460	voluntary nonopioid directive form with a health 33
1461	1461	care provider shall sign and date the form in 34
1462	1462	the presence of the health care provider or a 35
1463	1463	designee of the health care provider. In the 36
1464	1464	case of a patient who is unable to execute and 37
1465	1465	file a voluntary nonopioid directive form, the 38
1466	1466	patient may designate a duly authorized guardian 39
1467	1467	or health care proxy to execute and file the 40
1468	1468	form in accordance with subdivision (1) of this 41
1469	1469	subsection. 42
1470	1470	(3) A patient may revoke the voluntary 43
1471	1471	nonopioid directive form for any reason and may 44
1472	1472	do so by written or oral means. 45
1473	1473	6. The department shall promulgate 46
1474	1474	regulations for the implementation of the 47
1475	1475	voluntary nonopioid directive form that shall 48
1476	1476	include, but not be limited to: 49
1477	1477	(1) A standard method for the recording 50
1478	1478	and transmission of the voluntary nonopioid 51 HCS SS SB 24 47
1479	1479	directive form, which shall include veri fication 52
1480	1480	by the patient's health care provider and shall 53
1481	1481	comply with the written consent requirements of 54
1482	1482	the Public Health Service Act, 42 U.S.C. Section 55
1483	1483	290dd-2(b), and 42 CFR Part 2, relating to 56
1484	1484	confidentiality of alcohol and drug abuse 57
1485	1485	patient records, provided that the voluntary 58
1486	1486	nonopioid directive form shall also provide the 59
1487	1487	basic procedures necessary to revoke the 60
1488	1488	voluntary nonopioid directive form; 61
1489	1489	(2) Procedures to record the voluntary 62
1490	1490	nonopioid directive form in the patient's 63
1491	1491	medical record or, if available, the patient's 64
1492	1492	interoperable electronic medical record; 65
1493	1493	(3) Requirements and procedures for a 66
1494	1494	patient to appoint a duly authorized guardian or 67
1495	1495	health care proxy to override a previously filed 68
1496	1496	voluntary nonopioid directi ve form and 69
1497	1497	circumstances under which an attending health 70
1498	1498	care provider may override a previously filed 71
1499	1499	voluntary nonopioid directive form based on 72
1500	1500	documented medical judgment, which shall be 73
1501	1501	recorded in the patient's medical record; 74
1502	1502	(4) Procedures to ensure that any 75
1503	1503	recording, sharing, or distributing of data 76
1504	1504	relative to the voluntary nonopioid directive 77
1505	1505	form complies with all federal and state 78
1506	1506	confidentiality laws; and 79
1507	1507	(5) Appropriate exemptions for health care 80
1508	1508	providers and emergenc y medical personnel to 81
1509	1509	prescribe or administer a controlled substance 82
1510	1510	containing an opioid when, in their professional 83
1511	1511	medical judgment, a controlled substance 84
1512	1512	containing an opioid is necessary, or the 85
1513	1513	provider and medical personnel are acting in 86
1514	1514	good faith. 87
1515	1515	The department shall develop and publish 88
1516	1516	guidelines on its publicly accessible website 89
1517	1517	that shall address, at a minimum, the content of 90
1518	1518	the regulations promulgated under this 91
1519	1519	subsection. Any rule or portion of a rule, as 92
1520	1520	that term is defined in section 536.010, that is 93
1521	1521	created under the authority delegated in this 94
1522	1522	section shall become effective only if it 95
1523	1523	complies with and is subject to all of the 96
1524	1524	provisions of chapter 536 and, if applicable, 97
1525	1525	section 536.028. This section and chapter 53 6 98
1526	1526	are nonseverable and if any of the powers vested 99
1527	1527	with the general assembly pursuant to chapter 100
1528	1528	536 to review, to delay the effective date, or 101
1529	1529	to disapprove and annul a rule are subsequently 102
1530	1530	held unconstitutional, then the grant of 103
1531	1531	rulemaking authority and any rule proposed or 104
1532	1532	adopted after August 28, 2023, shall be invalid 105
1533	1533	and void. 106
1534	1534	7. A written prescription that is 107
1535	1535	presented at an outpatient pharmacy or a 108 HCS SS SB 24 48
1536	1536	prescription that is electronically transmitted 109
1537	1537	to an outpatient pharmacy is presum ed to be 110
1538	1538	valid for the purposes of this section, and a 111
1539	1539	pharmacist in an outpatient setting shall not be 112
1540	1540	held in violation of this section for dispensing 113
1541	1541	a controlled substance in contradiction to a 114
1542	1542	voluntary nonopioid directive form, except upon 115
1543	1543	evidence that the pharmacist acted knowingly 116
1544	1544	against the voluntary nonopioid directive form. 117
1545	1545	8. (1) A health care provider or an 118
1546	1546	employee of a health care provider acting in 119
1547	1547	good faith shall not be subject to criminal or 120
1548	1548	civil liability and shall no t be considered to 121
1549	1549	have engaged in unprofessional conduct for 122
1550	1550	failing to offer or administer a prescription or 123
1551	1551	medication order for a controlled substance 124
1552	1552	containing an opioid under the voluntary 125
1553	1553	nonopioid directive form. 126
1554	1554	(2) A person acting as a representative or 127
1555	1555	an agent pursuant to a health care proxy shall 128
1556	1556	not be subject to criminal or civil liability 129
1557	1557	for making a decision under subdivision (3) of 130
1558	1558	subsection 6 of this section in good faith. 131
1559	1559	(3) Notwithstanding any other provision of 132
1560	1560	law, a professional licensing board, at its 133
1561	1561	discretion, may limit, condition, or suspend the 134
1562	1562	license of, or assess fines against, a health 135
1563	1563	care provider who recklessly or negligently 136
1564	1564	fails to comply with a patient's voluntary 137
1565	1565	nonopioid directive for m.] 138
1566	1566	192.2405. 1. The following persons shall be required 1
1567	1567	to immediately report or cause a report to be made to the 2
1568	1568	department under sections 192.2400 to 192.2470: 3
1569	1569	(1) Any person having reasonable cause to suspect that 4
1570	1570	an eligible adult presents a likelihood of suffering serious 5
1571	1571	physical harm, or bullying as defined in subdivision (2) of 6
1572	1572	section 192.2400, and is in need of protective services; and 7
1573	1573	(2) Any adult day care worker, chiropractor, Christian 8
1574	1574	Science practitioner, coroner, dentist, embalmer, employee 9
1575	1575	of the departments of social services, mental health, or 10
1576	1576	health and senior services, employee of a local area agency 11
1577	1577	on aging or an organized area agency on aging program, 12
1578	1578	emergency medical technician, firefight er, first responder, 13
1579	1579	funeral director, home health agency, home health agency 14
1580	1580	employee, hospital and clinic personnel engaged in the care 15 HCS SS SB 24 49
1581	1581	or treatment of others, in -home services owner or provider, 16
1582	1582	in-home services operator or employee, law enforcement 17
1583	1583	officer, long-term care facility administrator or employee, 18
1584	1584	medical examiner, medical resident or intern, mental health 19
1585	1585	professional, minister, nurse, nurse practitioner, 20
1586	1586	optometrist, other health practitioner, peace officer, 21
1587	1587	pharmacist, physical the rapist, physician, physician's 22
1588	1588	assistant, podiatrist, probation or parole officer, 23
1589	1589	psychologist, social worker, or other person with the 24
1590	1590	responsibility for the care of an eligible adult who has 25
1591	1591	reasonable cause to suspect that the eligible adult has be en 26
1592	1592	subjected to abuse or neglect or observes the eligible adult 27
1593	1593	being subjected to conditions or circumstances which would 28
1594	1594	reasonably result in abuse or neglect. Notwithstanding any 29
1595	1595	other provision of this section, a duly ordained minister, 30
1596	1596	clergy, religious worker, or Christian Science practitioner 31
1597	1597	while functioning in his or her ministerial capacity shall 32
1598	1598	not be required to report concerning a privileged 33
1599	1599	communication made to him or her in his or her professional 34
1600	1600	capacity. 35
1601	1601	2. Any other person who becomes aware of circumstances 36
1602	1602	that may reasonably be expected to be the result of, or 37
1603	1603	result in, abuse or neglect of an eligible adult may report 38
1604	1604	to the department. 39
1605	1605	3. The penalty for failing to report as required under 40
1606	1606	subdivision (2) of subsection 1 of this section is provided 41
1607	1607	under section 565.188. 42
1608	1608	4. As used in this section, "first responder" means 43
1609	1609	any person trained and authorized by law or rule to render 44
1610	1610	emergency medical assistance or treatment. Such persons may 45
1611	1611	include, but shall not be limited to, emergency first 46
1612	1612	responders, police officers, sheriffs, deputy sheriffs, 47 HCS SS SB 24 50
1613	1613	firefighters, or emergency medical technicians [, or 48
1614	1614	emergency medical technician -paramedics]. 49
1615	1615	195.206. 1. As used in this section, the following 1
1616	1616	terms shall mean: 2
1617	1617	(1) "Addiction mitigation medication", naltrexone 3
1618	1618	hydrochloride that is administered in a manner approved by 4
1619	1619	the United States Food and Drug Administration or any 5
1620	1620	accepted medical practice method of administering; 6
1621	1621	(2) "Opioid antagonist", naloxone hydrochloride , or 7
1622	1622	any other drug or device approved by the United States Food 8
1623	1623	and Drug Administration, that blocks the effects of an 9
1624	1624	opioid overdose [that] and is administered in a manner 10
1625	1625	approved by the United States Food and Drug Administration 11
1626	1626	or any accepted medical practice method of administering; 12
1627	1627	(3) "Opioid-related drug overdose", a condition 13
1628	1628	including, but not limited to, extreme physical illness, 14
1629	1629	decreased level of consciousness, respiratory de pression, 15
1630	1630	coma, or death resulting from the consumption or use of an 16
1631	1631	opioid or other substance with which an opioid was combined 17
1632	1632	or a condition that a layperson would reasonably believe to 18
1633	1633	be an opioid-related drug overdose that requires medical 19
1634	1634	assistance. 20
1635	1635	2. Notwithstanding any other law or regulation to the 21
1636	1636	contrary: 22
1637	1637	(1) The director of the department of health and 23
1638	1638	senior services, if a licensed physician, may issue a 24
1639	1639	statewide standing order for an opioid antagonist or an 25
1640	1640	addiction mitigation medication; 26
1641	1641	(2) In the alternative, the department may employ or 27
1642	1642	contract with a licensed physician who may issue a statewide 28
1643	1643	standing order for an opioid antagonist or an addiction 29 HCS SS SB 24 51
1644	1644	mitigation medication with the express written consent of 30
1645	1645	the department director. 31
1646	1646	3. Notwithstanding any other law or regulation to the 32
1647	1647	contrary, any licensed pharmacist in Missouri may sell and 33
1648	1648	dispense an opioid antagonist or an addiction mitigation 34
1649	1649	medication under physician protocol or under a statewide 35
1650	1650	standing order issued under subsection 2 of this section. 36
1651	1651	4. A licensed pharmacist who, acting in good faith and 37
1652	1652	with reasonable care, sells or dispenses an opioid 38
1653	1653	antagonist or an addiction mitigation medication and an 39
1654	1654	appropriate device to administer the drug, and the protocol 40
1655	1655	physician, shall not be subject to any criminal or civil 41
1656	1656	liability or any professional disciplinary action for 42
1657	1657	prescribing or dispensing the opioid antagonist or an 43
1658	1658	addiction mitigation medication or any outc ome resulting 44
1659	1659	from the administration of the opioid antagonist or an 45
1660	1660	addiction mitigation medication. A physician issuing a 46
1661	1661	statewide standing order under subsection 2 of this section 47
1662	1662	shall not be subject to any criminal or civil liability or 48
1663	1663	any professional disciplinary action for issuing the 49
1664	1664	standing order or for any outcome related to the order or 50
1665	1665	the administration of the opioid antagonist or an addiction 51
1666	1666	mitigation medication. 52
1667	1667	5. Notwithstanding any other law or regulation to the 53
1668	1668	contrary, it shall be permissible for any person to possess 54
1669	1669	an opioid antagonist or an addiction mitigation medication. 55
1670	1670	6. Any person who administers an opioid antagonist to 56
1671	1671	another person shall, immediately after administering the 57
1672	1672	drug, contact emerge ncy personnel. Any person who, acting 58
1673	1673	in good faith and with reasonable care, administers an 59
1674	1674	opioid antagonist to another person whom the person believes 60
1675	1675	to be suffering an opioid -related drug overdose shall be 61 HCS SS SB 24 52
1676	1676	immune from criminal prosecution, discip linary actions from 62
1677	1677	his or her professional licensing board, and civil liability 63
1678	1678	due to the administration of the opioid antagonist. 64
1679	1679	197.020. 1. "Governmental unit" means any county, 1
1680	1680	municipality or other political subdivision or an y 2
1681	1681	department, division, board or other agency of any of the 3
1682	1682	foregoing. 4
1683	1683	2. "Hospital" means a place devoted primarily to the 5
1684	1684	maintenance and operation of facilities for the diagnosis, 6
1685	1685	treatment or care for not less than twenty -four consecutive 7
1686	1686	hours in any week of three or more nonrelated individuals 8
1687	1687	suffering from illness, disease, injury, deformity or other 9
1688	1688	abnormal physical conditions; or a place devoted primarily 10
1689	1689	to provide for not less than twenty -four consecutive hours 11
1690	1690	in any week medical or nursing care for three or more 12
1691	1691	nonrelated individuals. The term "hospital" shall include a 13
1692	1692	facility designated as a rural emergency hospital by the 14
1693	1693	Centers for Medicare and Medicaid Services. The term 15
1694	1694	"hospital" does not include convalescent, nu rsing, shelter 16
1695	1695	or boarding homes as defined in chapter 198. 17
1696	1696	3. "Person" means any individual, firm, partnership, 18
1697	1697	corporation, company or association and the legal successors 19
1698	1698	thereof. 20
1699	1699	208.1032. 1. The department of social servi ces shall 1
1700	1700	be authorized to design and implement in consultation and 2
1701	1701	coordination with eligible providers as described in 3
1702	1702	subsection 2 of this section an intergovernmental transfer 4
1703	1703	program relating to ground emergency medical transport 5
1704	1704	services, including those services provided at the emergency 6
1705	1705	medical responder, emergency medical technician (EMT), 7
1706	1706	advanced EMT, [EMT intermediate,] or paramedic levels in the 8
1707	1707	prestabilization and preparation for transport, in order to 9 HCS SS SB 24 53
1708	1708	increase capitation payments fo r the purpose of increasing 10
1709	1709	reimbursement to eligible providers. 11
1710	1710	2. A provider shall be eligible for increased 12
1711	1711	reimbursement under this section only if the provider meets 13
1712	1712	the following conditions in an applicable state fiscal year: 14
1713	1713	(1) Provides ground emergency medical transportation 15
1714	1714	services to MO HealthNet participants; 16
1715	1715	(2) Is enrolled as a MO HealthNet provider for the 17
1716	1716	period being claimed; and 18
1717	1717	(3) Is owned, operated, or contracted by the state or 19
1718	1718	a political subdivision. 20
1719	1719	3. (1) To the extent intergovernmental transfers are 21
1720	1720	voluntarily made by and accepted from an eligible provider 22
1721	1721	described in subsection 2 of this section or a governmental 23
1722	1722	entity affiliated with an eligible provider, the department 24
1723	1723	of social services shall make increased capitation payments 25
1724	1724	to applicable MO HealthNet eligible providers for covered 26
1725	1725	ground emergency medical transportation services. 27
1726	1726	(2) The increased capitation payments made under this 28
1727	1727	section shall be in amounts at least act uarially equivalent 29
1728	1728	to the supplemental fee -for-service payments and up to 30
1729	1729	equivalent of commercial reimbursement rates available for 31
1730	1730	eligible providers to the extent permissible under federal 32
1731	1731	law. 33
1732	1732	(3) Except as provided in subsection 6 of this 34
1733	1733	section, all funds associated with intergovernmental 35
1734	1734	transfers made and accepted under this section shall be used 36
1735	1735	to fund additional payments to eligible providers. 37
1736	1736	(4) MO HealthNet managed care plans and coordinated 38
1737	1737	care organizations shall pay o ne hundred percent of any 39
1738	1738	amount of increased capitation payments made under this 40
1739	1739	section to eligible providers for providing and making 41 HCS SS SB 24 54
1740	1740	available ground emergency medical transportation and 42
1741	1741	prestabilization services pursuant to a contract or other 43
1742	1742	arrangement with a MO HealthNet managed care plan or 44
1743	1743	coordinated care organization. 45
1744	1744	4. The intergovernmental transfer program developed 46
1745	1745	under this section shall be implemented on the date federal 47
1746	1746	approval is obtained, and only to the extent 48
1747	1747	intergovernmental transfers from the eligible provider, or 49
1748	1748	the governmental entity with which it is affiliated, are 50
1749	1749	provided for this purpose. The department of social 51
1750	1750	services shall implement the intergovernmental transfer 52
1751	1751	program and increased capitation p ayments under this section 53
1752	1752	on a retroactive basis as permitted by federal law. 54
1753	1753	5. Participation in the intergovernmental transfers 55
1754	1754	under this section is voluntary on the part of the 56
1755	1755	transferring entities for purposes of all applicable federal 57
1756	1756	laws. 58
1757	1757	6. As a condition of participation under this section, 59
1758	1758	each eligible provider as described in subsection 2 of this 60
1759	1759	section or the governmental entity affiliated with an 61
1760	1760	eligible provider shall agree to reimburse the department of 62
1761	1761	social services for any costs associated with implementing 63
1762	1762	this section. Intergovernmental transfers described in this 64
1763	1763	section are subject to an administration fee of up to twenty 65
1764	1764	percent of the nonfederal share paid to the department of 66
1765	1765	social services and shall be allowed to count as a cost of 67
1766	1766	providing the services not to exceed one hundred twenty 68
1767	1767	percent of the total amount. 69
1768	1768	7. As a condition of participation under this section, 70
1769	1769	MO HealthNet managed care plans, coordinated care 71
1770	1770	organizations, eligible providers as described in subsection 72
1771	1771	2 of this section, and governmental entities affiliated with 73 HCS SS SB 24 55
1772	1772	eligible providers shall agree to comply with any requests 74
1773	1773	for information or similar data requirements imposed by the 75
1774	1774	department of social services for purposes of obtaining 76
1775	1775	supporting documentation necessary to claim federal funds or 77
1776	1776	to obtain federal approvals. 78
1777	1777	8. This section shall be implemented only if and to 79
1778	1778	the extent federal financial participation is available and 80
1779	1779	is not otherwise jeopa rdized, and any necessary federal 81
1780	1780	approvals have been obtained. 82
1781	1781	9. To the extent that the director of the department 83
1782	1782	of social services determines that the payments made under 84
1783	1783	this section do not comply with federal Medicaid 85
1784	1784	requirements, the dir ector retains the discretion to return 86
1785	1785	or not accept an intergovernmental transfer, and may adjust 87
1786	1786	payments under this section as necessary to comply with 88
1787	1787	federal Medicaid requirements. 89
1788	1788	285.040. 1. As used in this section, "public s afety 1
1789	1789	employee" shall mean a person trained or authorized by law 2
1790	1790	or rule to render emergency medical assistance or treatment, 3
1791	1791	including, but not limited to, firefighters, [ambulance 4
1792	1792	attendants and attendant drivers, ] emergency medical 5
1793	1793	technicians, [emergency medical technician paramedics, ] 6
1794	1794	dispatchers, registered nurses, physicians, and sheriffs and 7
1795	1795	deputy sheriffs. 8
1796	1796	2. No public safety employee of a city not within a 9
1797	1797	county who is hired prior to September 1, 2023, shall be 10
1798	1798	subject to a residency requirement of retaining a primary 11
1799	1799	residence in a city not within a county but may be required 12
1800	1800	to maintain a primary residence located within a one -hour 13
1801	1801	response time. 14
1802	1802	3. Public safety employees of a city not within a 15
1803	1803	county who are hired aft er August 31, 2023, may be subject 16 HCS SS SB 24 56
1804	1804	to a residency rule no more restrictive than a requirement 17
1805	1805	of retaining a primary residence in a city not within a 18
1806	1806	county for a total of seven years and of then allowing the 19
1807	1807	public safety employee to maintain a primar y residence 20
1808	1808	outside the city not within a county so long as the primary 21
1809	1809	residence is located within a one -hour response time. 22
1810	1810	287.067. 1. In this chapter the term "occupational 1
1811	1811	disease" is hereby defined to mean, unless a different 2
1812	1812	meaning is clearly indicated by the context, an identifiable 3
1813	1813	disease arising with or without human fault out of and in 4
1814	1814	the course of the employment. Ordinary diseases of life to 5
1815	1815	which the general public is exposed outside of the 6
1816	1816	employment shall not be compensable, except where the 7
1817	1817	diseases follow as an incident of an occupational disease as 8
1818	1818	defined in this section. The disease need not to have been 9
1819	1819	foreseen or expected but after its contraction it must 10
1820	1820	appear to have had its origin in a risk con nected with the 11
1821	1821	employment and to have flowed from that source as a rational 12
1822	1822	consequence. 13
1823	1823	2. An injury or death by occupational disease is 14
1824	1824	compensable only if the occupational exposure was the 15
1825	1825	prevailing factor in causing both the resulting medic al 16
1826	1826	condition and disability. The "prevailing factor" is 17
1827	1827	defined to be the primary factor, in relation to any other 18
1828	1828	factor, causing both the resulting medical condition and 19
1829	1829	disability. Ordinary, gradual deterioration, or progressive 20
1830	1830	degeneration of the body caused by aging or by the normal 21
1831	1831	activities of day-to-day living shall not be compensable. 22
1832	1832	3. An injury due to repetitive motion is recognized as 23
1833	1833	an occupational disease for purposes of this chapter. An 24
1834	1834	occupational disease due to repetit ive motion is compensable 25
1835	1835	only if the occupational exposure was the prevailing factor 26 HCS SS SB 24 57
1836	1836	in causing both the resulting medical condition and 27
1837	1837	disability. The "prevailing factor" is defined to be the 28
1838	1838	primary factor, in relation to any other factor, causing 29
1839	1839	both the resulting medical condition and disability. 30
1840	1840	Ordinary, gradual deterioration, or progressive degeneration 31
1841	1841	of the body caused by aging or by the normal activities of 32
1842	1842	day-to-day living shall not be compensable. 33
1843	1843	4. "Loss of hearing due to industrial noise" is 34
1844	1844	recognized as an occupational disease for purposes of this 35
1845	1845	chapter and is hereby defined to be a loss of hearing in one 36
1846	1846	or both ears due to prolonged exposure to harmful noise in 37
1847	1847	employment. "Harmful noise" means sound capable of 38
1848	1848	producing occupational deafness. 39
1849	1849	5. "Radiation disability" is recognized as an 40
1850	1850	occupational disease for purposes of this chapter and is 41
1851	1851	hereby defined to be that disability due to radioactive 42
1852	1852	properties or substances or to Roentgen rays (X -rays) or 43
1853	1853	exposure to ionizing radiation caused by any process 44
1854	1854	involving the use of or direct contact with radium or 45
1855	1855	radioactive properties or substances or the use of or direct 46
1856	1856	exposure to Roentgen rays (X -rays) or ionizing radiation. 47
1857	1857	6. Disease of the lungs or respiratory tract, 48
1858	1858	hypotension, hypertension, or disease of the heart or 49
1859	1859	cardiovascular system, including carcinoma, may be 50
1860	1860	recognized as occupational diseases for the purposes of this 51
1861	1861	chapter and are defined to be disability due to exposure to 52
1862	1862	smoke, gases, carcinogens, inadequate oxygen, of paid 53
1863	1863	firefighters of a paid fire department or paid police 54
1864	1864	officers of a paid police department certified under chapter 55
1865	1865	590 if a direct causal relationship is established, or 56
1866	1866	psychological stress of firefighters of a paid fire 57
1867	1867	department or paid peace officers of a police department who 58 HCS SS SB 24 58
1868	1868	are certified under chapter 590 if a direct causal 59
1869	1869	relationship is established. 60
1870	1870	7. Any employee who is exposed to and contracts any 61
1871	1871	contagious or communicabl e disease arising out of and in the 62
1872	1872	course of his or her employment shall be eligible for 63
1873	1873	benefits under this chapter as an occupational disease. 64
1874	1874	8. With regard to occupational disease due to 65
1875	1875	repetitive motion, if the exposure to the repetitive mo tion 66
1876	1876	which is found to be the cause of the injury is for a period 67
1877	1877	of less than three months and the evidence demonstrates that 68
1878	1878	the exposure to the repetitive motion with the immediate 69
1879	1879	prior employer was the prevailing factor in causing the 70
1880	1880	injury, the prior employer shall be liable for such 71
1881	1881	occupational disease. 72
1882	1882	9. (1) (a) Posttraumatic stress disorder (PTSD), as 73
1883	1883	described in the Diagnostic and Statistical Manual of Mental 74
1884	1884	Health Disorders, Fifth Edition, published by the American 75
1885	1885	Psychiatric Association, (DSM -5) is recognized as a 76
1886	1886	compensable occupational disease for purposes of this 77
1887	1887	chapter when diagnosed in a first responder, as that term is 78
1888	1888	defined under section 67.145. 79
1889	1889	(b) Benefits payable to a first responder under this 80
1890	1890	section shall not require a physical injury to the first 81
1891	1891	responder and are not subject to any preexisting PTSD. 82
1892	1892	(c) Benefits payable to a first responder under this 83
1893	1893	section are compensable only if demonstrated by clear and 84
1894	1894	convincing evidence that PTSD has resulted from the course 85
1895	1895	and scope of employment, and the first responder is examined 86
1896	1896	and diagnosed with PTSD by an authorized treating physician, 87
1897	1897	due to the first responder experiencing one of the following 88
1898	1898	qualifying events: 89
1899	1899	a. Seeing for oneself a deceased minor; 90 HCS SS SB 24 59
1900	1900	b. Witnessing directly the death of a minor; 91
1901	1901	c. Witnessing directly the injury to a minor who 92
1902	1902	subsequently died prior to or upon arrival at a hospital 93
1903	1903	emergency department, participating in the physical 94
1904	1904	treatment of, or manually transporting, an injured minor who 95
1905	1905	subsequently died prior to or upon arrival at a hospital 96
1906	1906	emergency department; 97
1907	1907	d. Seeing for oneself a person who has suffered 98
1908	1908	serious physical injury of a nature that shocks the 99
1909	1909	conscience; 100
1910	1910	e. Witnessing directly a death, including suicide, due 101
1911	1911	to serious physical injury; or homicide, including murder, 102
1912	1912	mass killings, manslaughter, self -defense, misadventure, and 103
1913	1913	negligence; 104
1914	1914	f. Witnessing directly an injury that results in 105
1915	1915	death, if the person suffered serious physical injury that 106
1916	1916	shocks the conscience; 107
1917	1917	g. Participating in the physical treatment of an 108
1918	1918	injury, including attempted suicide, or manually 109
1919	1919	transporting an injured person who suffered serious physical 110
1920	1920	injury, if the injured person subsequently died prior to or 111
1921	1921	upon arrival at a hospital emergency department; or, 112
1922	1922	h. Involvement in an event that caused or may have 113
1923	1923	caused serious injury or harm to the first responder or had 114
1924	1924	the potential to cause the death of th e first responder, 115
1925	1925	whether accidental or by an intentional act of another 116
1926	1926	individual. 117
1927	1927	(2) The time for notice of injury or death in cases of 118
1928	1928	compensable PTSD under this section is measured from 119
1929	1929	exposure to one of the qualifying stressors listed i n the 120
1930	1930	DSM-5 criteria, or the diagnosis of the disorder, whichever 121
1931	1931	is later. Any claim for compensation for such injury shall 122 HCS SS SB 24 60
1932	1932	be properly noticed within fifty -two weeks after the 123
1933	1933	qualifying exposure, or the diagnosis of the disorder, 124
1934	1934	whichever is later. 125
1935	1935	287.245. 1. As used in this section, the following 1
1936	1936	terms shall mean: 2
1937	1937	(1) "Association", volunteer fire protection 3
1938	1938	associations as defined in section 320.300; 4
1939	1939	(2) "State fire marshal", the state fire marshal 5
1940	1940	selected under the provisions of sections 320.200 to 320.270; 6
1941	1941	(3) "Volunteer firefighter", the same meaning as in 7
1942	1942	section 287.243; 8
1943	1943	(4) "Voluntary [firefighter cancer] critical illness 9
1944	1944	benefits pool" or "pool", the same meaning as in section 10
1945	1945	320.400. 11
1946	1946	2. (1) Any association may apply to the state fire 12
1947	1947	marshal for a grant for the purpose of funding such 13
1948	1948	association's costs related to workers' compensation 14
1949	1949	insurance premiums for volunteer firefighters. 15
1950	1950	(2) Any voluntary [firefighter cancer] critical 16
1951	1951	illness benefits pool may apply to the state fire marshal 17
1952	1952	for a grant for the [purpose of establishing a ] voluntary 18
1953	1953	[firefighter cancer] critical illness benefits pool. [This 19
1954	1954	subdivision shall expire June 30, 2023. ] 20
1955	1955	3. Subject to appropriations, the state fire marshal 21
1956	1956	may disburse grants to any applying volunteer fire 22
1957	1957	protection association subject to the following schedule: 23
1958	1958	(1) Associations which had zero to five volunteer 24
1959	1959	firefighters receive workers' compensation benefits fr om 25
1960	1960	claims arising out of and in the course of the prevention or 26
1961	1961	control of fire or the underwater recovery of drowning 27
1962	1962	victims in the preceding calendar year shall be eligible for 28
1963	1963	two thousand dollars in grant money; 29 HCS SS SB 24 61
1964	1964	(2) Associations which had si x to ten volunteer 30
1965	1965	firefighters receive workers' compensation benefits from 31
1966	1966	claims arising out of and in the course of the prevention or 32
1967	1967	control of fire or the underwater recovery of drowning 33
1968	1968	victims in the preceding calendar year shall be eligible for 34
1969	1969	one thousand five hundred dollars in grant money; 35
1970	1970	(3) Associations which had eleven to fifteen volunteer 36
1971	1971	firefighters receive workers' compensation benefits from 37
1972	1972	claims arising out of and in the course of the prevention or 38
1973	1973	control of fire or the underwater recovery of drowning 39
1974	1974	victims in the preceding calendar year shall be eligible for 40
1975	1975	one thousand dollars in grant money; 41
1976	1976	(4) Associations which had sixteen to twenty volunteer 42
1977	1977	firefighters receive workers' compensation benefits from 43
1978	1978	claims arising out of and in the course of the prevention or 44
1979	1979	control of fire or the underwater recovery of drowning 45
1980	1980	victims in the preceding calendar year shall be eligible for 46
1981	1981	five hundred dollars in grant money. 47
1982	1982	4. Grant money disbursed under this section shall only 48
1983	1983	be used for the purpose of paying for the workers' 49
1984	1984	compensation insurance premiums of volunteer firefighters or 50
1985	1985	[establishing] for the benefit of a voluntary [firefighter 51
1986	1986	cancer] critical illness benefits pool. 52
1987	1987	287.715. 1. For the purpose of providing for revenue 1
1988	1988	for the second injury fund, every authorized self -insurer, 2
1989	1989	and every workers' compensation policyholder insured 3
1990	1990	pursuant to the provisions of this chapter, shall be liable 4
1991	1991	for payment of an annual sur charge in accordance with the 5
1992	1992	provisions of this section. The annual surcharge imposed 6
1993	1993	under this section shall apply to all workers' compensation 7
1994	1994	insurance policies and self -insurance coverages which are 8
1995	1995	written or renewed on or after April 26, 1988, including the 9 HCS SS SB 24 62
1996	1996	state of Missouri, including any of its departments, 10
1997	1997	divisions, agencies, commissions, and boards or any 11
1998	1998	political subdivisions of the state who self -insure or hold 12
1999	1999	themselves out to be any part self -insured. Notwithstanding 13
2000	2000	any law to the contrary, the surcharge imposed pursuant to 14
2001	2001	this section shall not apply to any reinsurance or 15
2002	2002	retrocessional transaction. 16
2003	2003	2. Beginning October 31, 2005, and each year 17
2004	2004	thereafter, the director of the division of workers' 18
2005	2005	compensation shall e stimate the amount of benefits payable 19
2006	2006	from the second injury fund during the following calendar 20
2007	2007	year and shall calculate the total amount of the annual 21
2008	2008	surcharge to be imposed during the following calendar year 22
2009	2009	upon all workers' compensation policyhol ders and authorized 23
2010	2010	self-insurers. The amount of the annual surcharge 24
2011	2011	percentage to be imposed upon each policyholder and self - 25
2012	2012	insured for the following calendar year commencing with the 26
2013	2013	calendar year beginning on January 1, 2006, shall be set at 27
2014	2014	and calculated against a percentage, not to exceed three 28
2015	2015	percent, of the policyholder's or self -insured's workers' 29
2016	2016	compensation net deposits, net premiums, or net assessments 30
2017	2017	for the previous policy year, rounded up to the nearest one - 31
2018	2018	half of a percentage point, that shall generate, as nearly 32
2019	2019	as possible, one hundred ten percent of the moneys to be 33
2020	2020	paid from the second injury fund in the following calendar 34
2021	2021	year, less any moneys contained in the fund at the end of 35
2022	2022	the previous calendar year. All policyholders and self- 36
2023	2023	insurers shall be notified by the division of workers' 37
2024	2024	compensation within ten calendar days of the determination 38
2025	2025	of the surcharge percent to be imposed for, and paid in, the 39
2026	2026	following calendar year. The net premium equivalent for 40
2027	2027	individual self-insured employers shall be based on average 41 HCS SS SB 24 63
2028	2028	rate classifications calculated by the department of 42
2029	2029	commerce and insurance as taken from premium rates filed by 43
2030	2030	the twenty insurance companies providing the greatest volume 44
2031	2031	of workers' compensa tion insurance coverage in this state. 45
2032	2032	For employers qualified to self -insure their liability 46
2033	2033	pursuant to this chapter, the rates filed by such group of 47
2034	2034	employers in accordance with subsection 4 of section 287.280 48
2035	2035	shall be the net premium equivalent. Any group of political 49
2036	2036	subdivisions of this state qualified to self -insure their 50
2037	2037	liability pursuant to this chapter as authorized by section 51
2038	2038	537.620 may choose either the average rate classification 52
2039	2039	method or the filed rate method, provided that the m ethod 53
2040	2040	used may only be changed once without receiving the consent 54
2041	2041	of the director of the division of workers' compensation. 55
2042	2042	The director may advance funds from the workers' 56
2043	2043	compensation fund to the second injury fund if surcharge 57
2044	2044	collections prove to be insufficient. Any funds advanced 58
2045	2045	from the workers' compensation fund to the second injury 59
2046	2046	fund must be reimbursed by the second injury fund no later 60
2047	2047	than December thirty -first of the year following the 61
2048	2048	advance. The surcharge shall be collected fr om 62
2049	2049	policyholders by each insurer at the same time and in the 63
2050	2050	same manner that the premium is collected, but no insurer or 64
2051	2051	its agent shall be entitled to any portion of the surcharge 65
2052	2052	as a fee or commission for its collection. The surcharge is 66
2053	2053	not subject to any taxes, licenses or fees. 67
2054	2054	3. All surcharge amounts imposed by this section shall 68
2055	2055	be deposited to the credit of the second injury fund. 69
2056	2056	4. Such surcharge amounts shall be paid quarterly by 70
2057	2057	insurers and self-insurers, and insurers sha ll pay the 71
2058	2058	amounts not later than the thirtieth day of the month 72
2059	2059	following the end of the quarter in which the amount is 73 HCS SS SB 24 64
2060	2060	received from policyholders. If the director of the 74
2061	2061	division of workers' compensation fails to calculate the 75
2062	2062	surcharge by the thi rty-first day of October of any year for 76
2063	2063	the following year, any increase in the surcharge ultimately 77
2064	2064	set by the director shall not be effective for any calendar 78
2065	2065	quarter beginning less than sixty days from the date the 79
2066	2066	director makes such determination . 80
2067	2067	5. If a policyholder or self -insured fails to make 81
2068	2068	payment of the surcharge or an insurer fails to make timely 82
2069	2069	transfer to the division of surcharges actually collected 83
2070	2070	from policyholders, as required by this section, a penalty 84
2071	2071	of one-half of one percent of the surcharge unpaid, or 85
2072	2072	untransferred, shall be assessed against the liable 86
2073	2073	policyholder, self-insured or insurer. Penalties assessed 87
2074	2074	under this subsection shall be collected in a civil action 88
2075	2075	by a summary proceeding brought by the dire ctor of the 89
2076	2076	division of workers' compensation. 90
2077	2077	6. Notwithstanding subsection 2 of this section to the 91
2078	2078	contrary, the director of the division of workers' 92
2079	2079	compensation shall collect a supplemental surcharge not to 93
2080	2080	exceed [three] one percent for calendar years 2014 to [2022] 94
2081	2081	2026 of the policyholder's or self -insured's workers' 95
2082	2082	compensation net deposits, net premiums, or net assessments 96
2083	2083	for the previous policy year, rounded up to the nearest [one- 97
2084	2084	half] one-quarter of a percentage point. [For calendar year 98
2085	2085	2023, the director of the division of workers' compensation 99
2086	2086	shall collect a supplemental surcharge not to exceed two and 100
2087	2087	one-half percent of the policyholder's or self -insured's 101
2088	2088	workers' compensation net deposits, net premiums, or net 102
2089	2089	assessments for the previous policy year, rounded up to the 103
2090	2090	nearest one-half of a percentage point. ] All policyholders 104
2091	2091	and self-insurers shall be notified by the division of the 105 HCS SS SB 24 65
2092	2092	supplemental surcharge percentage to be imposed for such 106
2093	2093	period of time as par t of the notice provided in subsection 107
2094	2094	2 of this section. The provisions of this subsection shall 108
2095	2095	expire on December 31, [2023] 2026. 109
2096	2096	7. Funds collected under the provisions of this 110
2097	2097	chapter shall be the sole funding source of the second 111
2098	2098	injury fund. 112
2099	2099	320.336. 1. No public or private employer shall 1
2100	2100	terminate an employee for joining any fire department or 2
2101	2101	fire protection district, including but not limited to any 3
2102	2102	municipal, volunteer, rural, or subscription fire department 4
2103	2103	or organization or any volunteer fire protection 5
2104	2104	association, as a volunteer firefighter, or the Missouri -1 6
2105	2105	Disaster Medical Assistance Team, Missouri Task Force One, 7
2106	2106	or Urban Search and Rescue Team, or being activated to a 8
2107	2107	national disaster response by the Federal Emergency 9
2108	2108	Management Agency (FEMA). 10
2109	2109	2. No public or private employer shall terminate an 11
2110	2110	employee who is a volunteer firefighter, a member of 12
2111	2111	Missouri-1 Disaster Medical Assistance Team, Missouri Task 13
2112	2112	Force One, or Urban Search and Re scue Team because the 14
2113	2113	employee, when acting as a volunteer firefighter, or as a 15
2114	2114	member of Missouri-1 Disaster Medical Assistance Team, 16
2115	2115	Missouri Task Force One, Urban Search and Rescue Team, or 17
2116	2116	FEMA is absent from or late to his or her employment in 18
2117	2117	order to respond to an emergency before the time the 19
2118	2118	employee is to report to his or her place of employment. 20
2119	2119	3. An employer may charge against the employee's 21
2120	2120	regular pay any employment time lost by an employee who is a 22
2121	2121	volunteer firefighter, or a m ember of Missouri-1 Disaster 23
2122	2122	Medical Assistance Team, Missouri Task Force One, Urban 24
2123	2123	Search and Rescue Team, or FEMA because of the employee's 25 HCS SS SB 24 66
2124	2124	response to an emergency in the course of performing his or 26
2125	2125	her duties as a volunteer firefighter, or a membe r of 27
2126	2126	Missouri-1 Disaster Medical Assistance Team, Missouri Task 28
2127	2127	Force One, Urban Search and Rescue Team, or FEMA. 29
2128	2128	4. In the case of an employee who is a volunteer 30
2129	2129	firefighter, or a member of Missouri -1 Disaster Medical 31
2130	2130	Assistance Team, Missouri T ask Force One, Urban Search and 32
2131	2131	Rescue Team, or FEMA and who loses time from his or her 33
2132	2132	employment in order to respond to an emergency in the course 34
2133	2133	of performing his or her duties as a volunteer firefighter, 35
2134	2134	or a member of Missouri -1 Disaster Medical Assistance Team, 36
2135	2135	Missouri Task Force One, Urban Search and Rescue Team, or 37
2136	2136	FEMA, the employer has the right to request the employee to 38
2137	2137	provide the employer with a written statement from the 39
2138	2138	supervisor or acting supervisor of the volunteer fire 40
2139	2139	department or the commander of Missouri -1 Disaster Medical 41
2140	2140	Assistance Team or the FEMA supervisor stating that the 42
2141	2141	employee responded to an emergency and stating the time and 43
2142	2142	date of the emergency. 44
2143	2143	5. An employee who is a volunteer firefighter, or a 45
2144	2144	member of Missouri-1 Disaster Medical Assistance Team, 46
2145	2145	Missouri Task Force One, Urban Search and Rescue Team, or 47
2146	2146	FEMA and who may be absent from or late to his or her 48
2147	2147	employment in order to respond to an emergency in the course 49
2148	2148	of performing his or her du ties as a volunteer firefighter, 50
2149	2149	or a member of Missouri -1 Disaster Medical Assistance Team, 51
2150	2150	Missouri Task Force One, Urban Search and Rescue Team, or 52
2151	2151	FEMA shall make a reasonable effort to notify his or her 53
2152	2152	employer that he or she may be absent or lat e. 54
2153	2153	6. Any member of Missouri Task Force One shall be 55
2154	2154	entitled to the initial employment rights, reemployment 56
2155	2155	rights, retention in employment rights, promotion rights, 57 HCS SS SB 24 67
2156	2156	and discrimination protections provided by Title 38 of the 58
2157	2157	United States Code, the Revised Statutes of Missouri, and 59
2158	2158	all amendments thereto. The attorney general shall enforce 60
2159	2159	the rights and protections contained in this subsection for 61
2160	2160	members of Missouri Task Force One. 62
2161	2161	320.400. 1. For purposes of this secti on, the 1
2162	2162	following terms mean: 2
2163	2163	(1) "Covered individual", a [firefighter] first 3
2164	2164	responder who: 4
2165	2165	(a) Is a paid employee or is a volunteer [firefighter 5
2166	2166	as defined in section 320.333 ]; 6
2167	2167	(b) Has been assigned to at least five years of 7
2168	2168	hazardous duty as a [firefighter] paid employee or volunteer ; 8
2169	2169	(c) Was exposed to [an agent classified by the 9
2170	2170	International Agency for Research on Cancer, or its 10
2171	2171	successor organization, as a group 1 or 2A carcinogen, or 11
2172	2172	classified as a cancer -causing agent by the American Cancer 12
2173	2173	Society, the American Association for Cancer Research, the 13
2174	2174	Agency for Health Care Policy and Research, the American 14
2175	2175	Society for Clinical Oncology, the National Institute for 15
2176	2176	Occupational Safety and Health, or the United States 16
2177	2177	National Cancer Institute ] or diagnosed with a critical 17
2178	2178	illness type; 18
2179	2179	(d) Was last assigned to hazardous duty [as a 19
2180	2180	firefighter] within the previous fifteen years; and 20
2181	2181	(e) In the case of a diagnosis of cancer, is not 21
2182	2182	seventy years of age or older at the time of the diagnosis 22
2183	2183	of cancer; 23
2184	2184	(2) "Critical illness", one of the following: 24
2185	2185	(a) In the case of a cancer claim, exposure to an 25
2186	2186	agent classified by the International Agency for Research on 26
2187	2187	Cancer, or its successor organization , as a group 1 or 2A 27 HCS SS SB 24 68
2188	2188	carcinogen, or classified as a cancer -causing agent by the 28
2189	2189	American Cancer Society, the American Association for Cancer 29
2190	2190	Research, the Agency for Healthcare Research and Quality, 30
2191	2191	the American Society of Clinical Oncology, the Nation al 31
2192	2192	Institute for Occupational Safety and Health, or the United 32
2193	2193	States National Cancer Institute; 33
2194	2194	(b) In the case of a posttraumatic stress injury 34
2195	2195	claim, such an injury that is diagnosed by a psychiatrist 35
2196	2196	licensed pursuant to chapter 334 or a psyc hologist licensed 36
2197	2197	pursuant to chapter 337 and established by a preponderance 37
2198	2198	of the evidence to have been caused by the employment 38
2199	2199	conditions of the first responder; 39
2200	2200	(3) "Dependent", the same meaning as in section 40
2201	2201	287.240; 41
2202	2202	[(3)] (4) "Emergency medical technician -basic", the 42
2203	2203	same meaning as in section 190.100; 43
2204	2204	(5) "Emergency medical technician -paramedic", the same 44
2205	2205	meaning as in section 190.100; 45
2206	2206	(6) "Employer", any political subdivision of the state; 46
2207	2207	[(4)] (7) "First responder", a firefighter, emergency 47
2208	2208	medical technician-basic or emergency medical technician - 48
2209	2209	paramedic, or telecommunicator; 49
2210	2210	(8) "Posttraumatic stress injury", any psychological 50
2211	2211	or behavioral health injury suffered by and through the 51
2212	2212	employment of an individual due to exposure to stressful and 52
2213	2213	life-threatening situations and rigors of the employment, 53
2214	2214	excluding any posttraumatic stress injuries that may arise 54
2215	2215	solely as a result of a legitimate personnel action by an 55
2216	2216	employer such as a transfer, prom otion, demotion, or 56
2217	2217	termination; 57
2218	2218	(9) "Telecommunicator", the same meaning as in section 58
2219	2219	650.320; 59 HCS SS SB 24 69
2220	2220	(10) "Voluntary [firefighter cancer] critical illness 60
2221	2221	benefits pool" or "pool", an entity described in section 61
2222	2222	537.620 that is established for the purposes of this section ; 62
2223	2223	(11) "Volunteer", a volunteer firefighter, as defined 63
2224	2224	in section 320.333; volunteer emergency medical technician - 64
2225	2225	basic; volunteer emergency medical technician -paramedic; or 65
2226	2226	volunteer telecommunicator . 66
2227	2227	2. (1) Three or more employers may create a 67
2228	2228	[voluntary firefighter cancer benefits ] pool for the purpose 68
2229	2229	of this section. Notwithstanding the provisions of sections 69
2230	2230	537.620 to 537.650 to the contrary, a pool created pursuant 70
2231	2231	to this section may allow covered i ndividuals to join the 71
2232	2232	pool. An employer or covered individual may make 72
2233	2233	contributions into the [voluntary firefighter cancer 73
2234	2234	benefits] pool established for the purpose of this section. 74
2235	2235	Any professional organization formed for the purpose, in 75
2236	2236	whole or in part, of representing or providing resources for 76
2237	2237	any covered individual may make contributions to the pool on 77
2238	2238	behalf of any covered individual without the professional 78
2239	2239	organization itself joining the pool. The contribution 79
2240	2240	levels and award levels shall be set by the board of 80
2241	2241	trustees of the pool. 81
2242	2242	(2) For a covered individual or an employer that 82
2243	2243	chooses to make contributions into the [voluntary 83
2244	2244	firefighter cancer benefits ] pool, the pool shall provide 84
2245	2245	the minimum benefits specified by the board of trustees of 85
2246	2246	the pool to covered individuals, based on the award level of 86
2247	2247	the [cancer] critical illness at the time of diagnosis, 87
2248	2248	after the employer or covered individual becomes a 88
2249	2249	participant. 89
2250	2250	(3) Benefit levels for cancer shall be established by 90
2251	2251	the board of trustees of the pool based on the category and 91 HCS SS SB 24 70
2252	2252	stage of the cancer. Benefit levels for a posttraumatic 92
2253	2253	stress injury shall be established by the board of trustees 93
2254	2254	of the pool. Awards of benefits may be made to the same 94
2255	2255	individual for both cancer and posttraumatic stress injury 95
2256	2256	provided the qualifications for both awards are met. 96
2257	2257	(4) In addition to [an] a cancer award pursuant to 97
2258	2258	subdivision (3) of this subsection: 98
2259	2259	(a) A payment may be made from the pool to a cove red 99
2260	2260	individual for the actual award, up to twenty -five thousand 100
2261	2261	dollars, for rehabilitative or vocational training 101
2262	2262	employment services and educational training relating to the 102
2263	2263	cancer diagnosis; 103
2264	2264	(b) A payment may be made to covered individual of u p 104
2265	2265	to ten thousand dollars if the covered individual incurs 105
2266	2266	cosmetic disfigurement costs resulting from cancer. 106
2267	2267	(5) If the cancer is diagnosed as terminal cancer, the 107
2268	2268	covered individual may receive a lump -sum payment of twenty - 108
2269	2269	five thousand dollar s as an accelerated payment toward the 109
2270	2270	benefits due based on the benefit levels established 110
2271	2271	pursuant to subdivision (3) of this subsection. 111
2272	2272	(6) The covered individual may receive additional 112
2273	2273	awards if the cancer increases in award level, but the 113
2274	2274	amount of any benefit paid earlier for the same cancer may 114
2275	2275	be subtracted from the new award. 115
2276	2276	(7) If a covered individual dies while owed benefits 116
2277	2277	pursuant to this section, the benefits shall be paid to the 117
2278	2278	dependent or domestic partner, if any, at the time of 118
2279	2279	death. If there is no dependent or domestic partner, the 119
2280	2280	obligation of the pool to pay benefits shall cease. 120
2281	2281	(8) If a covered individual returns to the same 121
2282	2282	position of employment after a cancer diagnosis, the covered 122 HCS SS SB 24 71
2283	2283	individual may receive benefits in this section for any 123
2284	2284	subsequent new type of covered cancer diagnosis. 124
2285	2285	(9) The cancer benefits payable pursuant to this 125
2286	2286	section shall be reduced by twenty -five percent if a covered 126
2287	2287	individual used a tobacco product within the fi ve years 127
2288	2288	immediately preceding the cancer diagnosis. 128
2289	2289	(10) A cancer claim for benefits from the pool shall 129
2290	2290	be filed no later than two years after the diagnosis of the 130
2291	2291	cancer. The claim for each type of cancer needs to be filed 131
2292	2292	only once to allow the pool to increase the award level 132
2293	2293	pursuant to subdivision (3) of this subsection. 133
2294	2294	(11) A payment may be made from the pool to a covered 134
2295	2295	individual for the actual award, up to ten thousand dollars, 135
2296	2296	for seeking treatment with a psychiatrist licen sed pursuant 136
2297	2297	to chapter 334 or a psychologist licensed pursuant to 137
2298	2298	chapter 337 and any subsequent courses of treatment 138
2299	2299	recommended by such licensed individuals. If a covered 139
2300	2300	individual returns to the same position of employment after 140
2301	2301	a posttraumatic stress injury diagnosis, the covered 141
2302	2302	individual may receive benefits in this section for the 142
2303	2303	continued treatment of such injury or any subsequently 143
2304	2304	covered posttraumatic stress injury diagnosis. 144
2305	2305	(12) For purposes of all other employment policies a nd 145
2306	2306	benefits that are not workers' compensation benefits payable 146
2307	2307	under chapter 287, health insurance, and any benefits paid 147
2308	2308	pursuant to chapter 208, a covered individual's [cancer] 148
2309	2309	critical illness diagnosis shall be treated as an on -the-job 149
2310	2310	injury or illness. 150
2311	2311	3. The board of trustees of [the pool] a pool created 151
2312	2312	pursuant to this section may: 152
2313	2313	(1) Create a program description to further define or 153
2314	2314	modify the benefits of this section; 154 HCS SS SB 24 72
2315	2315	(2) Modify the contribution rates, benefit levels, 155
2316	2316	including the maximum amount, consistent with subdivision 156
2317	2317	(1) of this subsection, and structure of the benefits based 157
2318	2318	on actuarial recommendations and with input from a committee 158
2319	2319	of the pool; and 159
2320	2320	(3) Set a maximum amount of benefits that may be pa id 160
2321	2321	to a covered individual for each [cancer] critical illness 161
2322	2322	diagnosis. 162
2323	2323	4. The board of trustees of the pool shall be 163
2324	2324	considered a public governmental body and shall be subject 164
2325	2325	to all of the provisions of chapter 610. 165
2326	2326	5. A pool may accept or apply for any grants or 166
2327	2327	donations from any private or public source. 167
2328	2328	6. (1) Any pool may apply to the state fire marshal 168
2329	2329	for a grant for the [purpose of establishing a voluntary 169
2330	2330	firefighter cancer benefits ] pool. The state fire marshal 170
2331	2331	shall disburse grants to the pool upon receipt of the 171
2332	2332	application. 172
2333	2333	(2) The state fire marshal may grant money disbursed 173
2334	2334	under section 287.245 to be used for the purpose of setting 174
2335	2335	up a pool. 175
2336	2336	[(3)This subsection shall expire on June 30, 2023. ] 176
2337	2337	7. (1) This [subsection] section shall not affect any 177
2338	2338	determination as to whether a covered individual's [cancer] 178
2339	2339	critical illness arose out of and in the course of 179
2340	2340	employment and is a compensable injury pursuant to chapter 180
2341	2341	287. Receipt of benefits from [the] a pool under this 181
2342	2342	section shall not be considered competent evidence or proof 182
2343	2343	by itself of a compensable injury under chapter 287. 183
2344	2344	(2) Should it be determined that a covered 184
2345	2345	individual's [cancer] critical illness arose out of and in 185
2346	2346	the course of employment and is a compensable injury under 186 HCS SS SB 24 73
2347	2347	chapter 287, the compensation and death benefit provided 187
2348	2348	under chapter 287 shall be reduced one hundred percent by 188
2349	2349	any benefits received from the pool under this section. 189
2350	2350	(3) The employer in any claim made pursuant to chapter 190
2351	2351	287 shall be subrogated to the right of the employee or to 191
2352	2352	the dependent or domestic partner to receive benefits from 192
2353	2353	[the] a pool and such employer may recover any amounts which 193
2354	2354	such employee or the dependent or domestic partner would 194
2355	2355	have been entitled to recover from [the] a pool under this 195
2356	2356	section. Any receipt of benefits from the pool under this 196
2357	2357	section shall be treated as an advance payment by the 197
2358	2358	employer, on account of any future installments of benefi ts 198
2359	2359	payable pursuant to chapter 287. 199
2360	2360	321.225. 1. A fire protection district may, in 1
2361	2361	addition to its other powers and duties, provide emergency 2
2362	2362	ambulance service within its district if a majority of the 3
2363	2363	voters voting thereon approve a proposition to furnish such 4
2364	2364	service and to levy a tax not to exceed thirty cents on the 5
2365	2365	one hundred dollars assessed valuation to be used 6
2366	2366	exclusively to supply funds for the operation of an 7
2367	2367	emergency ambulance service. The district shall exercise 8
2368	2368	the same powers and duties in operating an emergency 9
2369	2369	ambulance service as it does in operating its fire 10
2370	2370	protection service. 11
2371	2371	2. The proposition to furnish emergency ambulance 12
2372	2372	service may be submitted by the board of directors at any 13
2373	2373	municipal general, primary or general election or at any 14
2374	2374	election of the members of the board. 15
2375	2375	3. The question shall be submitted in substantially 16
2376	2376	the following form: 17
2377	2377	Shall the board of directors of ______ Fire 18
2378	2378	Protection District be authorized to provide 19 HCS SS SB 24 74
2379	2379	emergency ambulance service within the district 20
2380	2380	and be authorized to levy a tax not to exceed 21
2381	2381	thirty cents on the one hundred dollars assessed 22
2382	2382	valuation to provide funds for such service? 23
2383	2383	4. If a majority of the voters casting votes thereon 24
2384	2384	be in favor of emergency ambulance service and the levy, the 25
2385	2385	district shall forthwith commence such service. 26
2386	2386	5. As used in this section "emergency" means a 27
2387	2387	situation resulting from a sudden or unforeseen situation or 28
2388	2388	occurrence that requires immediate action to save life or 29
2389	2389	prevent suffering or disability. 30
2390	2390	6. In addition to all other taxes authorized on or 31
2391	2391	before September 1, 1990, the board of directors of any fire 32
2392	2392	protection district may, if a majority of the voters of the 33
2393	2393	district voting thereon approve, levy an additional tax of 34
2394	2394	not more than forty cents per one hundred dollars of 35
2395	2395	assessed valuation to be used for the support of the 36
2396	2396	ambulance service or partial or complete support of [an 37
2397	2397	emergency medical technician defibrillator progra m or 38
2398	2398	partial or complete support of an emergency medical 39
2399	2399	technician] a paramedic first responder program. The 40
2400	2400	proposition to levy the tax authorized by this subsection 41
2401	2401	may be submitted by the board of directors at the next 42
2402	2402	annual election of the memb ers of the board or at any 43
2403	2403	regular municipal or school election conducted by the county 44
2404	2404	clerk or board of election commissioners in such district or 45
2405	2405	at a special election called for the purpose, or upon 46
2406	2406	petition of five hundred registered voters of the district. 47
2407	2407	A separate ballot containing the question shall read as 48
2408	2408	follows: 49 HCS SS SB 24 75
2409	2409	If a majority of the qualified voters casting votes thereon 62
2410	2410	be in favor of the question, the board of directors shall 63
2411	2411	accordingly levy a tax in accordance with th e provisions of 64
2412	2412	this subsection, but if a majority of voters casting votes 65
2413	2413	thereon do not vote in favor of the levy authorized by this 66
2414	2414	subsection, any levy previously authorized shall remain in 67
2415	2415	effect. 68
2416	2416	321.620. 1. Fire protection districts in first class 1
2417	2417	counties may, in addition to their other powers and duties, 2
2418	2418	provide ambulance service within their district if a 3
2419	2419	majority of the voters voting thereon approve a proposition 4
2420	2420	to furnish such service and to levy a tax not to exce ed 5
2421	2421	thirty cents on the one hundred dollars assessed valuation 6
2422	2422	to be used exclusively to supply funds for the operation of 7
2423	2423	an emergency ambulance service. The district shall exercise 8
2424	2424	the same powers and duties in operating an ambulance service 9
2425	2425	as it does in operating its fire protection service. As 10
2426	2426	used in this section "emergency" means a situation resulting 11
2427	2427	from a sudden or unforeseen situation or occurrence that 12
2428	2428	50
2429	2429	51
2430	2430	52
2431	2431	53
2432	2432	54
2433	2433	55
2434	2434	56
2435	2435	57
2436	2436	Shall the board of directors of the ______ Fire
2437	2437	Protection District be authorized to levy an
2438	2438	additional tax of not more than forty cents per one
2439	2439	hundred dollars assessed valuation to provide funds
2440	2440	for the support of an ambulance service or partial or
2441	2441	complete support of an emergency medical technician
2442	2442	defibrillator program or partial or complete support
2443	2443	of an emergency medical technician paramedic first
2444	2444	responder program?
2445	2445
2446	2446	58 □ FOR THE PROPOSITION
2447	2447	59 □ AGAINST THE PROPOSITION
2448	2448	60
2449	2449	61
2450	2450	(Place an X in the square opposite the one for which
2451	2451	you wish to vote.)
2452	2452	HCS SS SB 24 76
2453	2453	requires immediate action to save life or prevent suffering 13
2454	2454	or disability. 14
2455	2455	2. The proposition to furnish ambulance service may be 15
2456	2456	submitted by the board of directors at any municipal 16
2457	2457	general, primary or general election or at any election of 17
2458	2458	the members of the board or upon petition by five hundred 18
2459	2459	voters of such district. 19
2460	2460	3. The question shall be submitted in substantially 20
2461	2461	the following form: 21
2462	2462	Shall the board of directors of ______ Fire 22
2463	2463	Protection District be authorized to provide 23
2464	2464	ambulance service within the district and be 24
2465	2465	authorized to levy a tax not to exceed t hirty 25
2466	2466	cents on the one hundred dollars assessed 26
2467	2467	valuation to provide funds for such service? 27
2468	2468	4. If a majority of the voters casting votes thereon 28
2469	2469	be in favor of ambulance service and the levy, the district 29
2470	2470	shall forthwith commence such service. 30
2471	2471	5. In addition to all other taxes authorized on or 31
2472	2472	before September 1, 1990, the board of directors of any fire 32
2473	2473	protection district may, if a majority of the voters of the 33
2474	2474	district voting thereon approve, levy an additional tax of 34
2475	2475	not more than forty cents per one hundred dollars of 35
2476	2476	assessed valuation to be used for the support of the 36
2477	2477	ambulance service, or partial or complete support of [an 37
2478	2478	emergency medical technician defibrillator program or 38
2479	2479	partial or complete support of an emergency medical 39
2480	2480	technician] a paramedic first responder program. The 40
2481	2481	proposition to levy the tax authorized by this subsection 41
2482	2482	may be submitted by the board of directors at the next 42
2483	2483	annual election of the members of the board or at any 43
2484	2484	regular municipal or school e lection conducted by the county 44 HCS SS SB 24 77
2485	2485	clerk or board of election commissioners in such district or 45
2486	2486	at a special election called for the purpose, or upon 46
2487	2487	petition of five hundred registered voters of the district. 47
2488	2488	A separate ballot containing the question sh all read as 48
2489	2489	follows: 49
2490	2490	If a majority of the qualified voters casting votes thereon 62
2491	2491	be in favor of the question, the board of directors shall 63
2492	2492	accordingly levy a tax in accordance w ith the provisions of 64
2493	2493	this subsection, but if a majority of voters casting votes 65
2494	2494	thereon do not vote in favor of the levy authorized by this 66
2495	2495	subsection, any levy previously authorized shall remain in 67
2496	2496	effect. 68
2497	2497	537.037. 1. Any physician or surgeon, registered 1
2498	2498	professional nurse or licensed practical nurse licensed to 2
2499	2499	practice in this state under the provisions of chapter 334 3
2500	2500	or 335, or licensed to practice under the equivalent laws of 4
2501	2501	any other state and any person licensed as [a mobile] an 5
2502	2502	emergency medical technician under the provisions of chapter 6
2503	2503	190, may: 7
2504	2504	50
2505	2505	51
2506	2506	52
2507	2507	53
2508	2508	54
2509	2509	55
2510	2510	56
2511	2511	57
2512	2512	Shall the board of directors of the ______ Fire
2513	2513	Protection District be authorized to levy an
2514	2514	additional tax of not more than forty cents per one
2515	2515	hundred dollars assessed valuation to provide funds
2516	2516	for the support of an ambulance service or partial or
2517	2517	complete support of an emergency medical technician
2518	2518	defibrillator program or partial or complete support
2519	2519	of an emergency medical technician paramedic first
2520	2520	responder program?
2521	2521
2522	2522	58 □ FOR THE PROPOSITION
2523	2523	59 □ AGAINST THE PROPOSITION
2524	2524	60
2525	2525	61
2526	2526	(Place an X in the square opposite the one for which
2527	2527	you wish to vote).
2528	2528	HCS SS SB 24 78
2529	2529	(1) In good faith render emergency care or assistance, 8
2530	2530	without compensation, at the scene of an emergency or 9
2531	2531	accident, and shall not be liable for any civil damage s for 10
2532	2532	acts or omissions other than damages occasioned by gross 11
2533	2533	negligence or by willful or wanton acts or omissions by such 12
2534	2534	person in rendering such emergency care; 13
2535	2535	(2) In good faith render emergency care or assistance, 14
2536	2536	without compensation, to a ny minor involved in an accident, 15
2537	2537	or in competitive sports, or other emergency at the scene of 16
2538	2538	an accident, without first obtaining the consent of the 17
2539	2539	parent or guardian of the minor, and shall not be liable for 18
2540	2540	any civil damages other than damages occ asioned by gross 19
2541	2541	negligence or by willful or wanton acts or omissions by such 20
2542	2542	person in rendering the emergency care. 21
2543	2543	2. Any other person who has been trained to provide 22
2544	2544	first aid in a standard recognized training program may, 23
2545	2545	without compensation, render emergency care or assistance to 24
2546	2546	the level for which he or she has been trained, at the scene 25
2547	2547	of an emergency or accident, and shall not be liable for 26
2548	2548	civil damages for acts or omissions other than damages 27
2549	2549	occasioned by gross negligence or by willful or wanton acts 28
2550	2550	or omissions by such person in rendering such emergency care. 29
2551	2551	3. Any mental health professional, as defined in 30
2552	2552	section 632.005, or qualified counselor, as defined in 31
2553	2553	section 631.005, or any practicing medical, osteopathic, o r 32
2554	2554	chiropractic physician, or certified nurse practitioner, or 33
2555	2555	physicians' assistant may in good faith render suicide 34
2556	2556	prevention interventions at the scene of a threatened 35
2557	2557	suicide and shall not be liable for any civil damages for 36
2558	2558	acts or omissions othe r than damages occasioned by gross 37
2559	2559	negligence or by willful or wanton acts or omissions by such 38
2560	2560	person in rendering such suicide prevention interventions. 39 HCS SS SB 24 79
2561	2561	4. Any other person may, without compensation, render 40
2562	2562	suicide prevention interventions at th e scene of a 41
2563	2563	threatened suicide and shall not be liable for civil damages 42
2564	2564	for acts or omissions other than damages occasioned by gross 43
2565	2565	negligence or by willful or wanton acts or omissions by such 44
2566	2566	person in rendering such suicide prevention intervention s. 45
2567	2567	579.088. Notwithstanding any other provision of this 1
2568	2568	chapter or chapter 195 to the contrary, it shall not be 2
2569	2569	unlawful to manufacture, possess, sell, deliver, or use any 3
2570	2570	device, equipment, or other material for the purpose of 4
2571	2571	analyzing controlled substances to detect the presence of 5
2572	2572	fentanyl or any synthetic controlled substance fentanyl 6
2573	2573	analogue. 7
2574	2574	595.209. 1. The following rights shall automatically 1
2575	2575	be afforded to victims of dangerous felonies, as defined in 2
2576	2576	section 556.061, victims of murder in the first degree, as 3
2577	2577	defined in section 565.020, victims of voluntary 4
2578	2578	manslaughter, as defined in section 565.023, victims of any 5
2579	2579	offense under chapter 566, victims of an attempt to commit 6
2580	2580	one of the preceding cr imes, as defined in section 562.012, 7
2581	2581	and victims of domestic assault, as defined in sections 8
2582	2582	565.072 to 565.076; and, upon written request, the following 9
2583	2583	rights shall be afforded to victims of all other crimes and 10
2584	2584	witnesses of crimes: 11
2585	2585	(1) For victims, the right to be present at all 12
2586	2586	criminal justice proceedings at which the defendant has such 13
2587	2587	right, including juvenile proceedings where the offense 14
2588	2588	would have been a felony if committed by an adult, even if 15
2589	2589	the victim is called to testify or may be called to testify 16
2590	2590	as a witness in the case; 17
2591	2591	(2) For victims, the right to information about the 18
2592	2592	crime, as provided for in subdivision (5) of this subsection; 19 HCS SS SB 24 80
2593	2593	(3) For victims and witnesses, to be informed, in a 20
2594	2594	timely manner, by the prosec utor's office of the filing of 21
2595	2595	charges, preliminary hearing dates, trial dates, 22
2596	2596	continuances and the final disposition of the case. Final 23
2597	2597	disposition information shall be provided within five days; 24
2598	2598	(4) For victims, the right to confer with and to be 25
2599	2599	informed by the prosecutor regarding bail hearings, guilty 26
2600	2600	pleas, pleas under chapter 552 or its successors, hearings, 27
2601	2601	sentencing and probation revocation hearings and the right 28
2602	2602	to be heard at such hearings, including juvenile 29
2603	2603	proceedings, unless in the determination of the court the 30
2604	2604	interests of justice require otherwise; 31
2605	2605	(5) The right to be informed by local law enforcement 32
2606	2606	agencies, the appropriate juvenile authorities or the 33
2607	2607	custodial authority of the following: 34
2608	2608	(a) The status of any case concerning a crime against 35
2609	2609	the victim, including juvenile offenses; 36
2610	2610	(b) The right to be informed by local law enforcement 37
2611	2611	agencies or the appropriate juvenile authorities of the 38
2612	2612	availability of victim compensation assistance, assistance 39
2613	2613	in obtaining documentation of the victim's losses, 40
2614	2614	including, but not limited to and subject to existing law 41
2615	2615	concerning protected information or closed records, access 42
2616	2616	to copies of complete, unaltered, unedited investigation 43
2617	2617	reports of motor vehicle, pedestrian, and other similar 44
2618	2618	accidents upon request to the appropriate law enforcement 45
2619	2619	agency by the victim or the victim's representative, and 46
2620	2620	emergency crisis intervention services available in the 47
2621	2621	community; 48
2622	2622	(c) Any release of such person on bond or for any 49
2623	2623	other reason; 50 HCS SS SB 24 81
2624	2624	(d) Within twenty-four hours, any escape by such 51
2625	2625	person from a municipal detention facility, county jail, a 52
2626	2626	correctional facility operated by the department of 53
2627	2627	corrections, mental health facility, or the division of 54
2628	2628	youth services or any agency thereof, and any subsequent 55
2629	2629	recapture of such person; 56
2630	2630	(6) For victims, the right to be informed by 57
2631	2631	appropriate juvenile authorities of probation revocation 58
2632	2632	hearings initiated by the juvenile authority and the right 59
2633	2633	to be heard at such hearings or to offer a written 60
2634	2634	statement, video or audio tape, counsel or a representative 61
2635	2635	designated by the victim in lieu of a personal appearance, 62
2636	2636	the right to be informed by the board of probation and 63
2637	2637	parole of probation revocati on hearings initiated by the 64
2638	2638	board and of parole hearings, the right to be present at 65
2639	2639	each and every phase of parole hearings, the right to be 66
2640	2640	heard at probation revocation and parole hearings or to 67
2641	2641	offer a written statement, video or audio tape, couns el or a 68
2642	2642	representative designated by the victim in lieu of a 69
2643	2643	personal appearance, and the right to have, upon written 70
2644	2644	request of the victim, a partition set up in the probation 71
2645	2645	or parole hearing room in such a way that the victim is 72
2646	2646	shielded from the view of the probationer or parolee, and 73
2647	2647	the right to be informed by the custodial mental health 74
2648	2648	facility or agency thereof of any hearings for the release 75
2649	2649	of a person committed pursuant to the provisions of chapter 76
2650	2650	552, the right to be present at such hearings, the right to 77
2651	2651	be heard at such hearings or to offer a written statement, 78
2652	2652	video or audio tape, counsel or a representative designated 79
2653	2653	by the victim in lieu of personal appearance; 80
2654	2654	(7) For victims and witnesses, upon their written 81
2655	2655	request, the right to be informed by the appropriate 82 HCS SS SB 24 82
2656	2656	custodial authority, including any municipal detention 83
2657	2657	facility, juvenile detention facility, county jail, 84
2658	2658	correctional facility operated by the department of 85
2659	2659	corrections, mental health facility, division of youth 86
2660	2660	services or agency thereof if the offense would have been a 87
2661	2661	felony if committed by an adult, postconviction or 88
2662	2662	commitment pursuant to the provisions of chapter 552 of the 89
2663	2663	following: 90
2664	2664	(a) The projected date of such person's release from 91
2665	2665	confinement; 92
2666	2666	(b) Any release of such person on bond; 93
2667	2667	(c) Any release of such person on furlough, work 94
2668	2668	release, trial release, electronic monitoring program, or to 95
2669	2669	a community correctional facility or program or release for 96
2670	2670	any other reason, in advance of such release; 97
2671	2671	(d) Any scheduled parole or release hearings, 98
2672	2672	including hearings under section 217.362, regarding such 99
2673	2673	person and any changes in the scheduling of such hearings. 100
2674	2674	No such hearing shall be conducted without thirty days' 101
2675	2675	advance notice; 102
2676	2676	(e) Within twenty-four hours, any escape by such 103
2677	2677	person from a municipal detention facility, county jail, a 104
2678	2678	correctional facility operated by the department of 105
2679	2679	corrections, mental health facility, or the division of 106
2680	2680	youth services or any agency thereof, and any subsequent 107
2681	2681	recapture of such person; 108
2682	2682	(f) Any decision by a parole board, by a juvenile 109
2683	2683	releasing authority or by a circuit court presiding over 110
2684	2684	releases pursuant to the provisions of chapter 552, or by a 111
2685	2685	circuit court presiding over releases under section 217.362, 112
2686	2686	to release such person or any decision by the governor to 113
2687	2687	commute the sentence of such person or pardon such person; 114 HCS SS SB 24 83
2688	2688	(g) Notification within thirty days of the death of 115
2689	2689	such person; 116
2690	2690	(8) For witnesses who have been summoned by the 117
2691	2691	prosecuting attorney and for victims, to be notified by the 118
2692	2692	prosecuting attorney in a timely manner when a court 119
2693	2693	proceeding will not go on as scheduled; 120
2694	2694	(9) For victims and witnesses, the right to reasonable 121
2695	2695	protection from the defendant or any person acting on behalf 122
2696	2696	of the defendant from harm and threats of harm arising out 123
2697	2697	of their cooperation with law enforcement and prosecution 124
2698	2698	efforts; 125
2699	2699	(10) For victims and witnesses, on charged cases or 126
2700	2700	submitted cases where no charge decision has yet been made, 127
2701	2701	to be informed by the prosecuting attorney of the status of 128
2702	2702	the case and of the availability of victim compensation 129
2703	2703	assistance and of financial assistance and emergency and 130
2704	2704	crisis intervention servic es available within the community 131
2705	2705	and information relative to applying for such assistance or 132
2706	2706	services, and of any final decision by the prosecuting 133
2707	2707	attorney not to file charges; 134
2708	2708	(11) For victims, to be informed by the prosecuting 135
2709	2709	attorney of the right to restitution which shall be 136
2710	2710	enforceable in the same manner as any other cause of action 137
2711	2711	as otherwise provided by law; 138
2712	2712	(12) For victims and witnesses, to be informed by the 139
2713	2713	court and the prosecuting attorney of procedures to be 140
2714	2714	followed in order to apply for and receive any witness fee 141
2715	2715	to which they are entitled; 142
2716	2716	(13) When a victim's property is no longer needed for 143
2717	2717	evidentiary reasons or needs to be retained pending an 144
2718	2718	appeal, the prosecuting attorney or any law enforcement 145
2719	2719	agency having possession of the property shall, upon request 146 HCS SS SB 24 84
2720	2720	of the victim, return such property to the victim within 147
2721	2721	five working days unless the property is contraband or 148
2722	2722	subject to forfeiture proceedings, or provide written 149
2723	2723	explanation of the reason why such property shall not be 150
2724	2724	returned; 151
2725	2725	(14) An employer may not discharge or discipline any 152
2726	2726	witness, victim or member of a victim's immediate family for 153
2727	2727	honoring a subpoena to testify in a criminal proceeding, 154
2728	2728	attending a criminal proceeding, or f or participating in the 155
2729	2729	preparation of a criminal proceeding, or require any 156
2730	2730	witness, victim, or member of a victim's immediate family to 157
2731	2731	use vacation time, personal time, or sick leave for honoring 158
2732	2732	a subpoena to testify in a criminal proceeding, atten ding a 159
2733	2733	criminal proceeding, or participating in the preparation of 160
2734	2734	a criminal proceeding; 161
2735	2735	(15) For victims, to be provided with creditor 162
2736	2736	intercession services by the prosecuting attorney if the 163
2737	2737	victim is unable, as a result of the crime, temporar ily to 164
2738	2738	meet financial obligations; 165
2739	2739	(16) For victims and witnesses, the right to speedy 166
2740	2740	disposition of their cases, and for victims, the right to 167
2741	2741	speedy appellate review of their cases, provided that 168
2742	2742	nothing in this subdivision shall prevent the d efendant from 169
2743	2743	having sufficient time to prepare such defendant's defense. 170
2744	2744	The attorney general shall provide victims, upon their 171
2745	2745	written request, case status information throughout the 172
2746	2746	appellate process of their cases. The provisions of this 173
2747	2747	subdivision shall apply only to proceedings involving the 174
2748	2748	particular case to which the person is a victim or witness; 175
2749	2749	(17) For victims and witnesses, to be provided by the 176
2750	2750	court, a secure waiting area during court proceedings and to 177
2751	2751	receive notification of the date, time and location of any 178 HCS SS SB 24 85
2752	2752	hearing conducted by the court for reconsideration of any 179
2753	2753	sentence imposed, modification of such sentence or recall 180
2754	2754	and release of any defendant from incarceration; 181
2755	2755	(18) For victims, the right to receive upon request 182
2756	2756	from the department of corrections a photograph taken of the 183
2757	2757	defendant prior to release from incarceration. 184
2758	2758	2. The provisions of subsection 1 of this section 185
2759	2759	shall not be construed to imply any victim who is 186
2760	2760	incarcerated by the department of corrections or any local 187
2761	2761	law enforcement agency has a right to be released to attend 188
2762	2762	any hearing or that the department of corrections or the 189
2763	2763	local law enforcement agency has any duty to transport such 190
2764	2764	incarcerated victim to any hearing. 191
2765	2765	3. Those persons entitled to notice of events pursuant 192
2766	2766	to the provisions of subsection 1 of this section shall 193
2767	2767	provide the appropriate person or agency with their current 194
2768	2768	addresses, electronic mail addresses, and telephone numbers 195
2769	2769	or the addresses, electronic mail addresses, or telephone 196
2770	2770	numbers at which they wish notification to be given. 197
2771	2771	4. Notification by the appropriate person or agency 198
2772	2772	utilizing the statewide automated crime victim notification 199
2773	2773	system as established in section 650.310 shall co nstitute 200
2774	2774	compliance with the victim notification requirement of this 201
2775	2775	section. If notification utilizing the statewide automated 202
2776	2776	crime victim notification system cannot be used, then 203
2777	2777	written notification shall be sent by certified mail or 204
2778	2778	electronic mail to the most current address or electronic 205
2779	2779	mail address provided by the victim. 206
2780	2780	5. Victims' rights as established in Section 32 of 207
2781	2781	Article I of the Missouri Constitution or the laws of this 208
2782	2782	state pertaining to the rights of victims of crime sha ll be 209
2783	2783	granted and enforced regardless of the desires of a 210 HCS SS SB 24 86
2784	2784	defendant and no privileges of confidentiality shall exist 211
2785	2785	in favor of the defendant to exclude victims or prevent 212
2786	2786	their full participation in each and every phase of parole 213
2787	2787	hearings or probation revocation hearings. The rights of 214
2788	2788	the victims granted in this section are absolute and the 215
2789	2789	policy of this state is that the victim's rights are 216
2790	2790	paramount to the defendant's rights. The victim has an 217
2791	2791	absolute right to be present at any hearing in which the 218
2792	2792	defendant is present before a probation and parole hearing 219
2793	2793	officer. 220
2794	2794	650.320. For the purposes of sections 650.320 to 1
2795	2795	650.340, the following terms mean: 2
2796	2796	(1) "Ambulance service", the same meaning given to the 3
2797	2797	term in section 190.100; 4
2798	2798	(2) "Board", the Missouri 911 service board 5
2799	2799	established in section 650.325; 6
2800	2800	(3) "Dispatch agency", the same meaning given to the 7
2801	2801	term in section 190.100; 8
2802	2802	(4) "Medical director", the same meaning given to the 9
2803	2803	term in section 190.100; 10
2804	2804	(5) "Memorandum of understanding", the same meaning 11
2805	2805	given to the term in section 190.100; 12
2806	2806	[(2)] (6) "Public safety answering point", the 13
2807	2807	location at which 911 calls are answered; 14
2808	2808	[(3)] (7) "Telecommunicator first responder", any 15
2809	2809	person employed as an emergency [telephone worker,] call 16
2810	2810	taker or public safety dispatcher whose duties include 17
2811	2811	receiving, processing or transmitting public safety 18
2812	2812	information received through a 911 public safety answering 19
2813	2813	point. 20
2814	2814	650.330. 1. The board shall consist of fifteen 1
2815	2815	members, one of which shall be chosen from the department of 2 HCS SS SB 24 87
2816	2816	public safety, and the other members shall be selected as 3
2817	2817	follows: 4
2818	2818	(1) One member chosen to represent an association 5
2819	2819	domiciled in this state whose primary interest relates to 6
2820	2820	municipalities; 7
2821	2821	(2) One member chosen to represent the Missouri 911 8
2822	2822	Directors Association; 9
2823	2823	(3) One member chosen to represent emergency medical 10
2824	2824	services and physicians; 11
2825	2825	(4) One member chosen to represent an association with 12
2826	2826	a chapter domiciled in this state whose primary interest 13
2827	2827	relates to a national emergency number; 14
2828	2828	(5) One member chosen to represent an association 15
2829	2829	whose primary interest relates to issues pertaining to fire 16
2830	2830	chiefs; 17
2831	2831	(6) One member chosen to represent an association with 18
2832	2832	a chapter domiciled in this state whose primary interest 19
2833	2833	relates to issues pertaining to public safety communications 20
2834	2834	officers; 21
2835	2835	(7) One member chosen to represent an association 22
2836	2836	whose primary interest relates to issues pertaining to 23
2837	2837	police chiefs; 24
2838	2838	(8) One member chosen to represent an association 25
2839	2839	domiciled in this state whose primary interest relates to 26
2840	2840	issues pertaining to sheriffs; 27
2841	2841	(9) One member chosen to represent co unties of the 28
2842	2842	second, third, and fourth classification; 29
2843	2843	(10) One member chosen to represent counties of the 30
2844	2844	first classification, counties with a charter form of 31
2845	2845	government, and cities not within a county; 32
2846	2846	(11) One member chosen to represent telecommunications 33
2847	2847	service providers; 34 HCS SS SB 24 88
2848	2848	(12) One member chosen to represent wireless 35
2849	2849	telecommunications service providers; 36
2850	2850	(13) One member chosen to represent voice over 37
2851	2851	internet protocol service providers; and 38
2852	2852	(14) One member chosen to represent the governor's 39
2853	2853	council on disability established under section 37.735. 40
2854	2854	2. Each of the members of the board shall be appointed 41
2855	2855	by the governor with the advice and consent of the senate 42
2856	2856	for a term of four years. Members of the committee may 43
2857	2857	serve multiple terms. No corporation or its affiliate shall 44
2858	2858	have more than one officer, employee, assign, agent, or 45
2859	2859	other representative serving as a member of the board. 46
2860	2860	Notwithstanding subsection 1 of this section to the 47
2861	2861	contrary, all members appointed as of August 28, 2017, shall 48
2862	2862	continue to serve the remainder of their terms. 49
2863	2863	3. The board shall meet at least quarterly at a place 50
2864	2864	and time specified by the chairperson of the board and it 51
2865	2865	shall keep and maintain records of such meetings , as well as 52
2866	2866	the other activities of the board. Members shall not be 53
2867	2867	compensated but shall receive actual and necessary expenses 54
2868	2868	for attending meetings of the board. 55
2869	2869	4. The board shall: 56
2870	2870	(1) Organize and adopt standards governing the board's 57
2871	2871	formal and informal procedures; 58
2872	2872	(2) Provide recommendations for primary answering 59
2873	2873	points and secondary answering points on technical and 60
2874	2874	operational standards for 911 services; 61
2875	2875	(3) Provide recommendations to public agencies 62
2876	2876	concerning model systems to be considered in preparing a 911 63
2877	2877	service plan; 64
2878	2878	(4) Provide requested mediation services to political 65
2879	2879	subdivisions involved in jurisdictional disputes regarding 66 HCS SS SB 24 89
2880	2880	the provision of 911 services, except that the board shall 67
2881	2881	not supersede decision-making authority of local political 68
2882	2882	subdivisions in regard to 911 services; 69
2883	2883	(5) Provide assistance to the governor and the general 70
2884	2884	assembly regarding 911 services; 71
2885	2885	(6) Review existing and proposed legislation and make 72
2886	2886	recommendations as to changes that would improve such 73
2887	2887	legislation; 74
2888	2888	(7) Aid and assist in the timely collection and 75
2889	2889	dissemination of information relating to the use of a 76
2890	2890	universal emergency telephone number; 77
2891	2891	(8) Perform other duties as necessary to promote 78
2892	2892	successful development, implementation and operation of 911 79
2893	2893	systems across the state, including monitoring federal and 80
2894	2894	industry standards being developed for next -generation 911 81
2895	2895	systems; 82
2896	2896	(9) Designate a state 911 coordinator who shall be 83
2897	2897	responsible for overseeing statewide 911 operations and 84
2898	2898	ensuring compliance with federal grants for 911 funding; 85
2899	2899	(10) Elect the chair from its membership; 86
2900	2900	(11) Apply for and receive grants from federal, 87
2901	2901	private, and other sources; 88
2902	2902	(12) Report to the governor and the general assembly 89
2903	2903	at least every three years on the status of 911 services 90
2904	2904	statewide, as well as specific efforts to improve 91
2905	2905	efficiency, cost-effectiveness, and levels of service; 92
2906	2906	(13) Conduct and review an annual survey of public 93
2907	2907	safety answering points in Missouri to evaluate potential 94
2908	2908	for improved services, coordination, and feasibility of 95
2909	2909	consolidation; 96
2910	2910	(14) Make and execute contracts or any other 97
2911	2911	instruments and agreements necessary or convenient for the 98 HCS SS SB 24 90
2912	2912	exercise of its powers and functions, including for the 99
2913	2913	development and implementation of an emergency services 100
2914	2914	internet protocol network that can be shared by all public 101
2915	2915	safety agencies; 102
2916	2916	(15) Develop a plan and timeline of target dates for 103
2917	2917	the testing, implementation, and operation of a next - 104
2918	2918	generation 911 system throughout Missouri. The next- 105
2919	2919	generation 911 system shall allow for the processing of 106
2920	2920	electronic messages including, but not limited to, 107
2921	2921	electronic messages containing text, images, vid eo, or data; 108
2922	2922	(16) Administer and authorize grants and loans under 109
2923	2923	section 650.335 to those counties and any home rule city 110
2924	2924	with more than fifteen thousand but fewer than seventeen 111
2925	2925	thousand inhabitants and partially located in any county of 112
2926	2926	the third classification without a township form of 113
2927	2927	government and with more than thirty -seven thousand but 114
2928	2928	fewer than forty-one thousand inhabitants that can 115
2929	2929	demonstrate a financial commitment to improving 911 services 116
2930	2930	by providing at least a fifty percent match and demonstrate 117
2931	2931	the ability to operate and maintain ongoing 911 services. 118
2932	2932	The purpose of grants and loans from the 911 service trust 119
2933	2933	fund shall include: 120
2934	2934	(a) Implementation of 911 services in counties of the 121
2935	2935	state where services do not exis t or to improve existing 911 122
2936	2936	systems; 123
2937	2937	(b) Promotion of consolidation where appropriate; 124
2938	2938	(c) Mapping and addressing all county locations; 125
2939	2939	(d) Ensuring primary access and texting abilities to 126
2940	2940	911 services for disabled residents; 127
2941	2941	(e) Implementation of initial emergency medical 128
2942	2942	dispatch services, including prearrival medical instructions 129 HCS SS SB 24 91
2943	2943	in counties where those services are not offered as of July 130
2944	2944	1, 2019; and 131
2945	2945	(f) Development and implementation of an emergency 132
2946	2946	services internet protocol network that can be shared by all 133
2947	2947	public safety agencies; 134
2948	2948	(17) Develop an application process including 135
2949	2949	reporting and accountability requirements, withholding a 136
2950	2950	portion of the grant until completion of a project, and 137
2951	2951	other measures to ensure funds are used in accordance with 138
2952	2952	the law and purpose of the grant, and conduct audits as 139
2953	2953	deemed necessary; 140
2954	2954	(18) Set the percentage rate of the prepaid wireless 141
2955	2955	emergency telephone service charges to be remitted to a 142
2956	2956	county or city as prov ided under subdivision (5) of 143
2957	2957	subsection 3 of section 190.460; 144
2958	2958	(19) Retain in its records proposed county plans 145
2959	2959	developed under subsection 11 of section 190.455 and notify 146
2960	2960	the department of revenue that the county has filed a plan 147
2961	2961	that is ready for implementation; 148
2962	2962	(20) Notify any communications service provider, as 149
2963	2963	defined in section 190.400, that has voluntarily submitted 150
2964	2964	its contact information when any update is made to the 151
2965	2965	centralized database established under section 190.475 as a 152
2966	2966	result of a county or city establishing or modifying a tax 153
2967	2967	or monthly fee no less than ninety days prior to the 154
2968	2968	effective date of the establishment or modification of the 155
2969	2969	tax or monthly fee; 156
2970	2970	(21) Establish criteria for consolidation 157
2971	2971	prioritization of public safety answering points; 158
2972	2972	(22) In coordination with existing public safety 159
2973	2973	answering points, by December 31, 2018, designate no more 160
2974	2974	than eleven regional 911 coordination centers which shall 161 HCS SS SB 24 92
2975	2975	coordinate statewide interoperability among pu blic safety 162
2976	2976	answering points within their region through the use of a 163
2977	2977	statewide 911 emergency services network; [and] 164
2978	2978	(23) Establish an annual budget, retain records of all 165
2979	2979	revenue and expenditures made, retain minutes of all 166
2980	2980	meetings and subcomm ittees, post records, minutes, and 167
2981	2981	reports on the board's webpage on the department of public 168
2982	2982	safety website; and 169
2983	2983	(24) Promote and educate the public about the critical 170
2984	2984	role of telecommunicator first responders in protecting the 171
2985	2985	public and ensuring public safety. 172
2986	2986	5. The department of public safety shall provide staff 173
2987	2987	assistance to the board as necessary in order for the board 174
2988	2988	to perform its duties pursuant to sections 650.320 to 175
2989	2989	650.340. The board shall have the authority to hire 176
2990	2990	consultants to administer the provisions of sections 650.320 177
2991	2991	to 650.340. 178
2992	2992	6. The board shall promulgate rules and regulations 179
2993	2993	that are reasonable and necessary to implement and 180
2994	2994	administer the provisions of sections 190.455, 190.460, 181
2995	2995	190.465, 190.470, 19 0.475, and sections 650.320 to 650.340. 182
2996	2996	Any rule or portion of a rule, as that term is defined in 183
2997	2997	section 536.010, shall become effective only if it has been 184
2998	2998	promulgated pursuant to the provisions of chapter 536. This 185
2999	2999	section and chapter 536 are nons everable and if any of the 186
3000	3000	powers vested with the general assembly pursuant to chapter 187
3001	3001	536 to review, to delay the effective date or to disapprove 188
3002	3002	and annul a rule are subsequently held unconstitutional, 189
3003	3003	then the grant of rulemaking authority and any r ule proposed 190
3004	3004	or adopted after August 28, 2017, shall be invalid and void. 191
3005	3005	650.335. 1. (1) Any county or any home rule city 1
3006	3006	with more than fifteen thousand but fewer than seventeen 2 HCS SS SB 24 93
3007	3007	thousand inhabitants and partially located in any c ounty of 3
3008	3008	the third classification without a township form of 4
3009	3009	government and with more than thirty -seven thousand but 5
3010	3010	fewer than forty-one thousand inhabitants, or a regional 6
3011	3011	planning commission as defined in section 70.515 that 7
3012	3012	provides emergency tele phone service to multiple counties, 8
3013	3013	when the prepaid wireless emergency telephone service charge 9
3014	3014	is collected in the county or city, may submit an 10
3015	3015	application for loan funds or other financial assistance to 11
3016	3016	the board for the purpose of financing all or a portion of 12
3017	3017	the costs incurred in implementing a 911 communications 13
3018	3018	service project. If a county has an elected emergency 14
3019	3019	services board, the elected emergency service board shall be 15
3020	3020	eligible for loan funds or other financial assistance under 16
3021	3021	this section. 17
3022	3022	(2) The application shall be accompanied by a 18
3023	3023	technical assistance report. The application and the 19
3024	3024	technical assistance report shall be in such form and 20
3025	3025	contain such information, financial or otherwise, as 21
3026	3026	prescribed by the board. 22
3027	3027	(3) This section shall not preclude any applicant or 23
3028	3028	borrower from joining in a cooperative project with any 24
3029	3029	other political subdivision or with any state or federal 25
3030	3030	agency or entity in a 911 communications service project, 26
3031	3031	provided that all other req uirements of this section have 27
3032	3032	been met. 28
3033	3033	2. Applications may be approved for loans only in 29
3034	3034	those instances where the applicant has furnished the board 30
3035	3035	information satisfactory to assure that the project cost 31
3036	3036	will be recovered during the repayment period of the loan. 32
3037	3037	In no case shall a loan be made to an applicant unless the 33
3038	3038	approval of the governing body of the applicant to the loan 34 HCS SS SB 24 94
3039	3039	agreement is obtained and a written certification of such 35
3040	3040	approval is provided, where applicable. Repayment periods 36
3041	3041	are to be determined by the board. 37
3042	3042	3. The board shall approve or disapprove all 38
3043	3043	applications for loans which are sent by certified or 39
3044	3044	registered mail or hand delivered and received by the board 40
3045	3045	upon a schedule as determined by the board. 41
3046	3046	4. Each applicant to whom a loan has been made under 42
3047	3047	this section shall repay such loan, with interest. The rate 43
3048	3048	of interest shall be the rate required by the board. The 44
3049	3049	number, amounts, and timing of the payments shall be as 45
3050	3050	determined by the bo ard. 46
3051	3051	5. Any applicant who receives a loan under this 47
3052	3052	section shall annually budget an amount which is at least 48
3053	3053	sufficient to make the payments required under this section. 49
3054	3054	6. Repayment of principal and interest on loans shall 50
3055	3055	be credited to the Missouri 911 service trust fund 51
3056	3056	established under section 190.420. 52
3057	3057	7. If a loan recipient fails to remit a payment to the 53
3058	3058	board in accordance with this section within sixty days of 54
3059	3059	the due date of such payment, the board shall notify the 55
3060	3060	director of the department of revenue to deduct such payment 56
3061	3061	amount from first, the prepaid wireless emergency telephone 57
3062	3062	service charge remitted to the county or city under section 58
3063	3063	190.460; and if insufficient to affect repayment of the 59
3064	3064	loan, next, the regular apportionment of local sales tax 60
3065	3065	distributions to that county or city. Such amount shall 61
3066	3066	then immediately be deposited in the Missouri 911 service 62
3067	3067	trust fund and credited to the loan recipient. 63
3068	3068	8. All applicants having received loans under t his 64
3069	3069	section shall remit the payments required by subsection 4 of 65
3070	3070	this section to the board or such other entity as may be 66 HCS SS SB 24 95
3071	3071	directed by the board. The board or such other entity shall 67
3072	3072	immediately deposit such payments in the Missouri 911 68
3073	3073	service trust fund. 69
3074	3074	9. Loans made under this section shall be used only 70
3075	3075	for the purposes specified in an approved application or 71
3076	3076	loan agreement. In the event the board determines that loan 72
3077	3077	funds have been expended for purposes other than those 73
3078	3078	specified in an approved application or loan agreement or 74
3079	3079	any event of default of the loan agreement occurs without 75
3080	3080	resolution, the board shall take appropriate actions to 76
3081	3081	obtain the return of the full amount of the loan and all 77
3082	3082	moneys duly owed or other available re medies. 78
3083	3083	10. Upon failure of a borrower to remit repayment to 79
3084	3084	the board within sixty days of the date a payment is due, 80
3085	3085	the board may initiate collection or other appropriate 81
3086	3086	action through the provisions outlined in subsection 7 of 82
3087	3087	this section, if applicable. 83
3088	3088	11. If the borrower is an entity not covered under the 84
3089	3089	collection procedures established in this section, the 85
3090	3090	board, with the advice and consent of the attorney general, 86
3091	3091	may initiate collection procedures or other appropriate 87
3092	3092	action pursuant to applicable law. 88
3093	3093	12. The board may, at its discretion, audit the 89
3094	3094	expenditure of any loan, grant, or expenditure made or the 90
3095	3095	computation of any payments made. 91
3096	3096	13. The board shall not approve any application made 92
3097	3097	under this section if the applicant has failed to return the 93
3098	3098	board's annual survey of public safety answering points as 94
3099	3099	required by the board under section 650.330. 95
3100	3100	650.340. 1. The provisions of this section may be 1
3101	3101	cited and shall be known as the "9 11 Training and Standards 2
3102	3102	Act". 3 HCS SS SB 24 96
3103	3103	2. Initial training requirements for 4
3104	3104	[telecommunicators] telecommunicator first responders who 5
3105	3105	answer 911 calls that come to public safety answering points 6
3106	3106	shall be as follows: 7
3107	3107	(1) Police telecommunicator first responder, 16 hours; 8
3108	3108	(2) Fire telecommunicator first responder, 16 hours; 9
3109	3109	(3) Emergency medical services telecommunicator first 10
3110	3110	responder, 16 hours; 11
3111	3111	(4) Joint communication center telecommunicator first 12
3112	3112	responder, 40 hours. 13
3113	3113	3. All persons employed as a telecommunicator first 14
3114	3114	responder in this state shall be required to complete 15
3115	3115	ongoing training so long as such person engages in the 16
3116	3116	occupation as a telecommunicator first responder. Such 17
3117	3117	persons shall complete at least twenty -four hours of ongoing 18
3118	3118	training every three years by such persons or organizations 19
3119	3119	as provided in subsection 6 of this section. 20
3120	3120	4. Any person employed as a telecommunicator on August 21
3121	3121	28, 1999, shall not be required to complete the training 22
3122	3122	requirement as provided in subsection 2 of this section. 23
3123	3123	Any person hired as a telecommunicator or a telecommunicator 24
3124	3124	first responder after August 28, 1999, shall complete the 25
3125	3125	training requirements as provided in subsection 2 of this 26
3126	3126	section within twelve m onths of the date such person is 27
3127	3127	employed as a telecommunicator or telecommunicator first 28
3128	3128	responder. 29
3129	3129	5. The training requirements as provided in subsection 30
3130	3130	2 of this section shall be waived for any person who 31
3131	3131	furnishes proof to the committee that such person has 32
3132	3132	completed training in another state which is at least as 33
3133	3133	stringent as the training requirements of subsection 2 of 34
3134	3134	this section. 35 HCS SS SB 24 97
3135	3135	6. The board shall determine by administrative rule 36
3136	3136	the persons or organizations authorized to condu ct the 37
3137	3137	training as required by subsection 2 of this section. 38
3138	3138	7. [This section shall not apply to an emergency 39
3139	3139	medical dispatcher or agency as defined in section 190.100, 40
3140	3140	or a person trained by an entity accredited or certified 41
3141	3141	under section 190.131, or a person who provides prearrival 42
3142	3142	medical instructions who works for an agency which meets the 43
3143	3143	requirements set forth in section 190.134. ] The board shall 44
3144	3144	be responsible for the approval of training courses for 45
3145	3145	emergency medical dispatchers. The board shall develop 46
3146	3146	necessary rules and regulations in collaboration with the 47
3147	3147	state EMS medical director's advisory committee, as 48
3148	3148	described in section 190.103, which may provide 49
3149	3149	recommendations relating to the medical aspects of 50
3150	3150	prearrival medical in structions. 51
3151	3151	8. A dispatch agency is required to have a memorandum 52
3152	3152	of understanding with all ambulance services that it 53
3153	3153	dispatches. If a dispatch agency provides prearrival 54
3154	3154	medical instructions, it is required to have a medical 55
3155	3155	director whose duties include the maintenance of standards 56
3156	3156	and approval of protocols or guidelines. 57
3157	3157	Section 1. The department of health and senior 1
3158	3158	services shall include on its website an advance health care 2
3159	3159	directive form and directions for completi ng such form as 3
3160	3160	described in section 459.015. The department shall include 4
3161	3161	a listing of possible uses for an advance health care 5
3162	3162	directive, including to limit pain control to nonopioid 6
3163	3163	measures. 7
3164	3164	[190.134. A dispatch agency is requi red to 1
3165	3165	have a memorandum of understanding with all 2
3166	3166	ambulance services that it dispatches. If a 3
3167	3167	dispatch agency provides prearrival medical 4
3168	3168	instructions, it is required to have a medical 5 HCS SS SB 24 98
3169	3169	director, whose duties include the maintenance 6
3170	3170	of standards and protocol approval.] 7
3171	3171	