EXPLANATION-Matter enclosed in bold-faced brackets [thus] in this bill is not enacted
and is intended to be omitted in the law.
FIRST REGULAR SESSION
[TRULY AGREED TO AND FINALLY PASSED ]
HOUSE COMMITTEE SUBSTITUTE FOR
SENATE SUBSTITUTE FOR
SENATE BILL NO. 24
102ND GENERAL ASSEMBLY
2023
1080H.08T
AN ACT
To repeal sections 67.145, 70.631, 105.500, 135.327, 135.331, 135.333, 170.310, 190.091,
190.100, 190.103, 190.134, 190.142, 190.147, 190.255, 190.327, 190.460, 192.2405,
195.206, 197.020, 208.1032, 285.040, 287.067, 287.245, 287.715, 320.336, 320.400,
321.225, 321.620, 537.037, 595.209, 650.320, 650.330, 650.335, and 650.340, RSMo,
and section 192.530 as truly agreed to and finally passed by senate substitute for house
bill no. 402, one hundred second general assembly, first regular session, and to enact
in lieu thereof thirty-seven new sections relating to vulnerable persons.
Be it enacted by the General Assembly of the State of Missouri, as follows:
Section A. Sections 67.145, 70.631, 105.500, 135.327, 1
135.331, 135.333, 170.310, 190.091, 190.100, 190.103, 190.134, 2
190.142, 190.147, 190.255, 190.327, 190.460, 192 .2405, 195.206, 3
197.020, 208.1032, 285.040, 287.067, 287.245, 287.715, 320.336, 4
320.400, 321.225, 321.620, 537.037, 595.209, 650.320, 650.330, 5
650.335, and 650.340, RSMo, and section 192.530 as truly agreed 6
to and finally passed by senate substitute for ho use bill no. 7
402, one hundred second general assembly, first regular 8
session, are repealed and thirty -seven new sections enacted in 9
lieu thereof, to be known as sections 67.145, 70.631, 105.500, 10
135.327, 135.331, 135.333, 161.244, 170.310, 190.091, 190.100 , 11
190.103, 190.142, 190.147, 190.255, 190.327, 190.460, 190.1010, 12
192.2405, 195.206, 197.020, 208.1032, 285.040, 287.067, 13 HCS SS SB 24 2
287.245, 287.715, 320.336, 320.400, 321.225, 321.620, 537.037, 14
579.088, 595.209, 650.320, 650.330, 650.335, 650.340, and 1, to 15
read as follows:16
67.145. 1. No political subdivision of this state 1
shall prohibit any first responder from engaging in any 2
political activity while off duty and not in uniform, being 3
a candidate for elected or appointed public office, or 4
holding such office unless such political activity or 5
candidacy is otherwise prohibited by state or federal law. 6
2. As used in this section, "first responder" means 7
any person trained and authorized by law or rule to render 8
emergency medical assistance or trea tment. Such persons may 9
include, but shall not be limited to, emergency first 10
responders, telecommunicator first responders, police 11
officers, sheriffs, deputy sheriffs, firefighters, 12
[ambulance attendants and attendant drivers, ] emergency 13
medical technicians, [mobile emergency medical technicians, 14
emergency medical technician -paramedics,] registered nurses, 15
or physicians. 16
70.631. 1. Each political subdivision may, by 1
majority vote of its governing body, elect to cover 2
[emergency telecommunicators ] telecommunicator first 3
responders, jailors, and emergency medical service personnel 4
as public safety personnel members of the system. The clerk 5
or secretary of the political subdivision shall certify an 6
election concerning the co verage of [emergency 7
telecommunicators] telecommunicator first responders , 8
jailors, and emergency medical service personnel as public 9
safety personnel members of the system to the board within 10
ten days after such vote. The date in which the political 11
subdivision's election becomes effective shall be the first 12
day of the calendar month specified by such governing body, 13 HCS SS SB 24 3
the first day of the calendar month next following receipt 14
by the board of the certification of the election, or the 15
effective date of the political subdivision's becoming an 16
employer, whichever is the latest date. Such election shall 17
not be changed after the effective date. If the election is 18
made, the coverage provisions shall be applicable to all 19
past and future employment wi th the employer by present and 20
future employees. If a political subdivision makes no 21
election under this section, no [emergency] telecommunicator 22
first responder, jailor, or emergency medical service 23
personnel of the political subdivision shall be con sidered 24
public safety personnel for purposes determining a minimum 25
service retirement age as defined in section 70.600. 26
2. If an employer elects to cover [emergency 27
telecommunicators] telecommunicator first responders , 28
jailors, and emergency medi cal service personnel as public 29
safety personnel members of the system, the employer's 30
contributions shall be correspondingly changed effective the 31
same date as the effective date of the political 32
subdivision's election. 33
3. The limitation on incr eases in an employer's 34
contributions provided by subsection 6 of section 70.730 35
shall not apply to any contribution increase resulting from 36
an employer making an election under the provisions of this 37
section. 38
105.500. For purposes of sections 105.500 to 105.598, 1
unless the context otherwise requires, the following words 2
and phrases mean: 3
(1) "Bargaining unit", a unit of public employees at 4
any plant or installation or in a craft or in a function of 5
a public body that establ ishes a clear and identifiable 6
community of interest among the public employees concerned; 7 HCS SS SB 24 4
(2) "Board", the state board of mediation established 8
under section 295.030; 9
(3) "Department", the department of labor and 10
industrial relations establ ished under section 286.010; 11
(4) "Exclusive bargaining representative", an 12
organization that has been designated or selected, as 13
provided in section 105.575, by a majority of the public 14
employees in a bargaining unit as the representative of such 15
public employees in such unit for purposes of collective 16
bargaining; 17
(5) "Labor organization", any organization, agency, or 18
public employee representation committee or plan, in which 19
public employees participate and that exists for the 20
purpose, in whole or in part, of dealing with a public body 21
or public bodies concerning collective bargaining, 22
grievances, labor disputes, wages, rates of pay, hours of 23
employment, or conditions of work; 24
(6) "Public body", the state of Missouri, or any 25
officer, agency, department, bureau, division, board or 26
commission of the state, or any other political subdivision 27
or special district of or within the state. Public body 28
shall not include the department of corrections; 29
(7) "Public employee", any person employed by a public 30
body; 31
(8) "Public safety labor organization", a labor 32
organization wholly or primarily representing persons 33
trained or authorized by law or rule to render emergency 34
medical assistance or treatment, including, but not l imited 35
to, firefighters, [ambulance attendants, attendant drivers, ] 36
emergency medical technicians, [emergency medical technician 37
paramedics,] dispatchers, registered nurses and physicians, 38
and persons who are vested with the power of arrest for 39 HCS SS SB 24 5
criminal code violations including, but not limited to, 40
police officers, sheriffs, and deputy sheriffs. 41
135.327. 1. Any person residing in this state who 1
legally adopts a special needs child on or after January 1, 2
1988, and before January 1, 2000, shall be eligible to 3
receive a tax credit of up to ten thousand dollars for 4
nonrecurring adoption expenses for each child adopted that 5
may be applied to taxes due under chapter 143. Any business 6
entity providing funds to an employee to enabl e that 7
employee to legally adopt a special needs child shall be 8
eligible to receive a tax credit of up to ten thousand 9
dollars for nonrecurring adoption expenses for each child 10
adopted that may be applied to taxes due under such business 11
entity's state tax liability, except that only one ten 12
thousand dollar credit is available for each special needs 13
child that is adopted. 14
2. Any person residing in this state who proceeds in 15
good faith with the adoption of a special needs child on or 16
after January 1, 2000, and before January 1, 2022, shall be 17
eligible to receive a tax credit of up to ten thousand 18
dollars for nonrecurring adoption expenses for each child 19
that may be applied to taxes due under chapter 143; 20
provided, however, that beginning on March 29, 2013, the tax 21
credits shall only be allocated for the adoption of special 22
needs children who are residents or wards of residents of 23
this state at the time the adoption is initiated. Any 24
business entity providing funds to an employee to enab le 25
that employee to proceed in good faith with the adoption of 26
a special needs child shall be eligible to receive a tax 27
credit of up to ten thousand dollars for nonrecurring 28
adoption expenses for each child that may be applied to 29
taxes due under such business entity's state tax liability, 30 HCS SS SB 24 6
except that only one ten thousand dollar credit is available 31
for each special needs child that is adopted. 32
3. Any person residing in this state who proceeds in 33
good faith with the adoption of a child on or af ter January 34
1, 2022, regardless of whether such child is a special needs 35
child, shall be eligible to receive a tax credit of up to 36
ten thousand dollars for nonrecurring adoption expenses for 37
each child that may be applied to taxes due under chapter 38
143. The tax credit shall be allowed regardless of whether 39
the child adopted is a resident or ward of a resident of 40
this state at the time the adoption is initiated; however, 41
for all fiscal years ending on or before June 30, 2024, 42
priority shall be give n to applications to claim the tax 43
credit for special needs children who are residents or wards 44
of residents of this state at the time the adoption is 45
initiated. Any business entity providing funds to an 46
employee to enable that employee to proceed in good faith 47
with the adoption of a child shall be eligible to receive a 48
tax credit of up to ten thousand dollars for nonrecurring 49
adoption expenses for each child that may be applied to 50
taxes due under such business entity's state tax liability; 51
except that, only one credit, up to ten thousand dollars, 52
shall be available for each child who is adopted. 53
4. Individuals and business entities may claim a tax 54
credit for their total nonrecurring adoption expenses in 55
each year that the expenses are inc urred. A claim for fifty 56
percent of the credit shall be allowed when the child is 57
placed in the home. A claim for the remaining fifty percent 58
shall be allowed when the adoption is final. The total of 59
these tax credits shall not exceed the maximum li mit of ten 60
thousand dollars per child. For all tax years beginning on 61
or after January 1, 2024, the total of these tax credits 62 HCS SS SB 24 7
allowed per child shall be adjusted annually for increases 63
in cost-of-living, if any, as of the preceding July over the 64
level of July of the immediately preceding year of the 65
Consumer Price Index for All Urban Consumers. The 66
cumulative amount of tax credits which may be claimed by 67
taxpayers claiming the credit for nonrecurring adoption 68
expenses in any one fiscal year prio r to July 1, 2004, shall 69
not exceed two million dollars. The cumulative amount of 70
tax credits that may be claimed by taxpayers claiming the 71
credit for nonrecurring adoption expenses shall not be more 72
than two million dollars but may be increased by 73
appropriation in any fiscal year beginning on or after July 74
1, 2004, and ending on or before June 30, 2021. The 75
cumulative amount of tax credits that may be claimed by 76
taxpayers claiming the credit for nonrecurring adoption 77
expenses shall not exceed si x million dollars in any fiscal 78
year beginning on or after July 1, 2021 , and ending on or 79
before June 30, 2024. For all fiscal years beginning on or 80
after July 1, 2024, there shall be no limit imposed on the 81
cumulative amount of tax credits that may b e claimed by 82
taxpayers claiming the credit for nonrecurring adoption 83
expenses. For all fiscal years beginning on or after July 84
1, 2006, applications to claim the adoption tax credit shall 85
be filed between July first and April fifteenth of each 86
fiscal year. 87
5. Notwithstanding any provision of law to the 88
contrary, any individual or business entity may assign, 89
transfer or sell tax credits allowed in this section. Any 90
sale of tax credits claimed pursuant to this section shall 91
be at a discount rate of seventy-five percent or greater of 92
the amount sold. 93 HCS SS SB 24 8
135.331. No credit shall be allowable for the adoption 1
of any child who has attained the age of eighteen, unless it 2
has been determined that the child has a medical condition 3
or [handicap] disability that would limit the child's 4
ability to live independently of the adoptive parents. 5
135.333. 1. (1) For tax years beginning on or before 1
December 31, 2023, any amount of tax credit which exceeds 2
the tax due or which is applied for and otherwise eligible 3
for issuance but not issued shall not be refunded but may be 4
carried over to any subsequent [taxable] tax year, not to 5
exceed a total of five years for which a tax credit may be 6
taken for each child ado pted. 7
(2) For all tax years beginning on or after January 1, 8
2024, any amount of tax credit that is issued and which 9
exceeds the tax due shall be refunded to the taxpayer; 10
however, any tax credits carried forward from tax years 11
beginning on or before December 31, 2023, shall not be 12
refundable. 13
2. Tax credits that are assigned, transferred or sold 14
as allowed in section 135.327 may be assigned, transferred 15
or sold in their entirety notwithstanding the taxpayer's tax 16
due. 17
161.244. 1. As used in this section, the following 1
terms mean: 2
(1) "Early childhood education services", programming 3
or services intended to effect positive developmental 4
changes in children prior to their entry into kindergarten; 5
(2) "Private entity", an entity that meets the 6
definition of a licensed child care provider as defined in 7
section 210.201, license exempt as described in section 8
210.211, or that is unlicensed but is contracted with the 9
department of elementary and secondary education. 10 HCS SS SB 24 9
2. Subject to appropriation, the department of 11
elementary and secondary education shall provide grants 12
directly to private entities for the provision of early 13
childhood education services. The standards prescribed in 14
section 161.213 shall be applicable to all private entities 15
that receive such grant moneys. 16
170.310. 1. For school year 2017 -18 and each school 1
year thereafter, upon graduation from high school, pupils in 2
public schools and charter schools shall hav e received 3
thirty minutes of cardiopulmonary resuscitation instruction 4
and training in the proper performance of the Heimlich 5
maneuver or other first aid for choking given any time 6
during a pupil's four years of high school. 7
2. Beginning in school year 2017-18, any public school 8
or charter school serving grades nine through twelve shall 9
provide enrolled students instruction in cardiopulmonary 10
resuscitation. Students with disabilities may participate 11
to the extent appropriate as determined by the provisions of 12
the Individuals with Disabilities Education Act or Section 13
504 of the Rehabilitation Act. Instruction shall be included 14
in the district's existing health or physical education 15
curriculum. Instruction shall be based on a program 16
established by the American Heart Association or the 17
American Red Cross, or through a nationally recognized 18
program based on the most current national evidence -based 19
emergency cardiovascular care guidelines, and psychomotor 20
skills development shall be inco rporated into the 21
instruction. For purposes of this section, "psychomotor 22
skills" means the use of hands -on practicing and skills 23
testing to support cognitive learning. 24
3. The teacher of the cardiopulmonary resuscitation 25
course or unit shall not be required to be a certified 26 HCS SS SB 24 10
trainer of cardiopulmonary resuscitation if the instruction 27
is not designed to result in certification of students. 28
Instruction that is designed to result in certification 29
being earned shall be required to be taught by a n authorized 30
cardiopulmonary instructor. Schools may develop agreements 31
with any local chapter of a voluntary organization of first 32
responders to provide the required hands -on practice and 33
skills testing. For purposes of this subsection, "first 34
responders" shall include telecommunicator first responders 35
as defined in section 650.320. 36
4. The department of elementary and secondary 37
education may promulgate rules to implement this section. 38
Any rule or portion of a rule, as that term is defined in 39
section 536.010, that is created under the authority 40
delegated in this section shall become effective only if it 41
complies with and is subject to all of the provisions of 42
chapter 536 and, if applicable, section 536.028. This 43
section and chapter 536 are nonseverable and if any of the 44
powers vested with the general assembly pursuant to chapter 45
536 to review, to delay the effective date, or to disapprove 46
and annul a rule are subsequently held unconstitutional, 47
then the grant of rulemaking authority and any rule proposed 48
or adopted after August 28, 2012, shall be invalid and void. 49
190.091. 1. As used in this section, the following 1
terms mean: 2
(1) "Bioterrorism", the intentional use of any 3
microorganism, virus, infectious substance, or biological 4
product that may be engineered as a result of biotechnology 5
or any naturally occurring or bioengineered component of any 6
microorganism, virus, infectious substance, or biological 7
product to cause death, disease, or other biolo gical 8
malfunction in a human, an animal, a plant, or any other 9 HCS SS SB 24 11
living organism to influence the conduct of government or to 10
intimidate or coerce a civilian population; 11
(2) "Department", the Missouri department of health 12
and senior services; 13
(3) "Director", the director of the department of 14
health and senior services; 15
(4) "Disaster locations", any geographical location 16
where a bioterrorism attack, terrorist attack, catastrophic 17
or natural disaster, or emergency occurs; 18
(5) "First responders", state and local law 19
enforcement personnel, telecommunicator first responders, 20
fire department personnel, and emergency medical personnel 21
who will be deployed to bioterrorism attacks, terrorist 22
attacks, catastrophic or natural disasters, and emergencies; 23
(6) "Missouri state highway patrol telecommunicator", 24
any authorized Missouri state highway patrol communications 25
division personnel whose primary responsibility includes 26
directly responding to emergency communications and who me et 27
the training requirements pursuant to section 650.340 . 28
2. The department shall offer a vaccination program 29
for first responders and Missouri state highway patrol 30
telecommunicators who may be exposed to infectious diseases 31
when deployed to disa ster locations as a result of a 32
bioterrorism event or a suspected bioterrorism event. The 33
vaccinations shall include, but are not limited to, 34
smallpox, anthrax, and other vaccinations when recommended 35
by the federal Centers for Disease Control and Pre vention's 36
Advisory Committee on Immunization Practices. 37
3. Participation in the vaccination program shall be 38
voluntary by the first responders and Missouri state highway 39
patrol telecommunicators , except for first responders or 40
Missouri state highway patrol telecommunicators who, as 41 HCS SS SB 24 12
determined by their employer, cannot safely perform 42
emergency responsibilities when responding to a bioterrorism 43
event or suspected bioterrorism event without being 44
vaccinated. The recommendations of the Centers fo r Disease 45
Control and Prevention's Advisory Committee on Immunization 46
Practices shall be followed when providing appropriate 47
screening for contraindications to vaccination for first 48
responders and Missouri state highway patrol 49
telecommunicators. A first responder and Missouri state 50
highway patrol telecommunicator shall be exempt from 51
vaccinations when a written statement from a licensed 52
physician is presented to their employer indicating that a 53
vaccine is medically contraindicated for such person. 54
4. If a shortage of the vaccines referred to in 55
subsection 2 of this section exists following a bioterrorism 56
event or suspected bioterrorism event, the director, in 57
consultation with the governor and the federal Centers for 58
Disease Control and P revention, shall give priority for such 59
vaccinations to persons exposed to the disease and to first 60
responders or Missouri state highway patrol 61
telecommunicators who are deployed to the disaster location. 62
5. The department shall notify first respo nders and 63
Missouri state highway patrol telecommunicators concerning 64
the availability of the vaccination program described in 65
subsection 2 of this section and shall provide education to 66
such first responders , [and] their employers, and Missouri 67
state highway patrol telecommunicators concerning the 68
vaccinations offered and the associated diseases. 69
6. The department may contract for the administration 70
of the vaccination program described in subsection 2 of this 71
section with health care providers , including but not 72 HCS SS SB 24 13
limited to local public health agencies, hospitals, 73
federally qualified health centers, and physicians. 74
7. The provisions of this section shall become 75
effective upon receipt of federal funding or federal grants 76
which designate that the funding is required to implement 77
vaccinations for first responders and Missouri state highway 78
patrol telecommunicators in accordance with the 79
recommendations of the federal Centers for Disease Control 80
and Prevention's Advisory Committee on Im munization 81
Practices. Upon receipt of such funding, the department 82
shall make available the vaccines to first responders and 83
Missouri state highway patrol telecommunicators as provided 84
in this section. 85
190.100. As used in sections 190.001 to 190.245 and 1
section 190.257, the following words and terms mean: 2
(1) "Advanced emergency medical technician" or "AEMT", 3
a person who has successfully completed a course of 4
instruction in certain aspects of advanced life support care 5
as prescribed by the department and is licensed by the 6
department in accordance with sections 190.001 to 190.245 7
and rules and regulations adopted by the department pursuant 8
to sections 190.001 to 190.245; 9
(2) "Advanced life support (ALS)", an advan ced level 10
of care as provided to the adult and pediatric patient such 11
as defined by national curricula, and any modifications to 12
that curricula specified in rules adopted by the department 13
pursuant to sections 190.001 to 190.245; 14
(3) "Ambulance", any privately or publicly owned 15
vehicle or craft that is specially designed, constructed or 16
modified, staffed or equipped for, and is intended or used, 17
maintained or operated for the transportation of persons who 18
are sick, injured, wounded or otherwis e incapacitated or 19 HCS SS SB 24 14
helpless, or who require the presence of medical equipment 20
being used on such individuals, but the term does not 21
include any motor vehicle specially designed, constructed or 22
converted for the regular transportation of persons who are 23
disabled, handicapped, normally using a wheelchair, or 24
otherwise not acutely ill, or emergency vehicles used within 25
airports; 26
(4) "Ambulance service", a person or entity that 27
provides emergency or nonemergency ambulance transportation 28
and services, or both, in compliance with sections 190.001 29
to 190.245, and the rules promulgated by the department 30
pursuant to sections 190.001 to 190.245; 31
(5) "Ambulance service area", a specific geographic 32
area in which an ambulance service has been auth orized to 33
operate; 34
(6) "Basic life support (BLS)", a basic level of care, 35
as provided to the adult and pediatric patient as defined by 36
national curricula, and any modifications to that curricula 37
specified in rules adopted by the department pursua nt to 38
sections 190.001 to 190.245; 39
(7) "Council", the state advisory council on emergency 40
medical services; 41
(8) "Department", the department of health and senior 42
services, state of Missouri; 43
(9) "Director", the director of the departme nt of 44
health and senior services or the director's duly authorized 45
representative; 46
(10) "Dispatch agency", any person or organization 47
that receives requests for emergency medical services from 48
the public, by telephone or other means, and is respo nsible 49
for dispatching emergency medical services; 50 HCS SS SB 24 15
(11) "Emergency", the sudden and, at the time, 51
unexpected onset of a health condition that manifests itself 52
by symptoms of sufficient severity that would lead a prudent 53
layperson, possessing an a verage knowledge of health and 54
medicine, to believe that the absence of immediate medical 55
care could result in: 56
(a) Placing the person's health, or with respect to a 57
pregnant woman, the health of the woman or her unborn child, 58
in significant jeopardy; 59
(b) Serious impairment to a bodily function; 60
(c) Serious dysfunction of any bodily organ or part; 61
(d) Inadequately controlled pain; 62
(12) "Emergency medical dispatcher", a person who 63
receives emergency calls from the public an d has 64
successfully completed an emergency medical dispatcher 65
course[, meeting or exceeding the national curriculum of the 66
United States Department of Transportation and any 67
modifications to such curricula specified by the department 68
through rules adopted pursuant to sections 190.001 to 69
190.245] and any ongoing training requirements under section 70
650.340; 71
(13) "Emergency medical responder", a person who has 72
successfully completed an emergency first response course 73
meeting or exceeding the nati onal curriculum of the U.S. 74
Department of Transportation and any modifications to such 75
curricula specified by the department through rules adopted 76
under sections 190.001 to 190.245 and who provides emergency 77
medical care through employment by or in ass ociation with an 78
emergency medical response agency; 79
(14) "Emergency medical response agency", any person 80
that regularly provides a level of care that includes first 81 HCS SS SB 24 16
response, basic life support or advanced life support, 82
exclusive of patient trans portation; 83
(15) "Emergency medical services for children (EMS -C) 84
system", the arrangement of personnel, facilities and 85
equipment for effective and coordinated delivery of 86
pediatric emergency medical services required in prevention 87
and management of incidents which occur as a result of a 88
medical emergency or of an injury event, natural disaster or 89
similar situation; 90
(16) "Emergency medical services (EMS) system", the 91
arrangement of personnel, facilities and equipment for the 92
effective and coordinated delivery of emergency medical 93
services required in prevention and management of incidents 94
occurring as a result of an illness, injury, natural 95
disaster or similar situation; 96
(17) "Emergency medical technician", a person licensed 97
in emergency medical care in accordance with standards 98
prescribed by sections 190.001 to 190.245, and by rules 99
adopted by the department pursuant to sections 190.001 to 100
190.245; 101
(18) ["Emergency medical technician -basic" or "EMT-B", 102
a person who has successfully completed a course of 103
instruction in basic life support as prescribed by the 104
department and is licensed by the department in accordance 105
with standards prescribed by sections 190.001 to 190.245 and 106
rules adopted by the department pursuant t o sections 190.001 107
to 190.245; 108
(19)] "Emergency medical technician -community 109
paramedic", "community paramedic", or "EMT -CP", a person who 110
is certified as an emergency medical technician -paramedic 111
and is certified by the department in accordance w ith 112
standards prescribed in section 190.098; 113 HCS SS SB 24 17
[(20) "Emergency medical technician -paramedic" or "EMT- 114
P", a person who has successfully completed a course of 115
instruction in advanced life support care as prescribed by 116
the department and is licensed by the department in 117
accordance with sections 190.001 to 190.245 and rules 118
adopted by the department pursuant to sections 190.001 to 119
190.245; 120
(21)] (19) "Emergency services", health care items and 121
services furnished or required to screen and stab ilize an 122
emergency which may include, but shall not be limited to, 123
health care services that are provided in a licensed 124
hospital's emergency facility by an appropriate provider or 125
by an ambulance service or emergency medical response agency; 126
[(22)] (20) "Health care facility", a hospital, 127
nursing home, physician's office or other fixed location at 128
which medical and health care services are performed; 129
[(23)] (21) "Hospital", an establishment as defined in 130
the hospital licensing law, subsec tion 2 of section 197.020, 131
or a hospital operated by the state; 132
[(24)] (22) "Medical control", supervision provided by 133
or under the direction of physicians, or their designated 134
registered nurse, including both online medical control, 135
instructions by radio, telephone, or other means of direct 136
communications, and offline medical control through 137
supervision by treatment protocols, case review, training, 138
and standing orders for treatment; 139
[(25)] (23) "Medical direction", medical guidance and 140
supervision provided by a physician to an emergency services 141
provider or emergency medical services system; 142
[(26)] (24) "Medical director", a physician licensed 143
pursuant to chapter 334 designated by the ambulance service , 144
dispatch agency, or emergency medical response agency and 145 HCS SS SB 24 18
who meets criteria specified by the department by rules 146
pursuant to sections 190.001 to 190.245; 147
[(27)] (25) "Memorandum of understanding", an 148
agreement between an emergency medical response agency or 149
dispatch agency and an ambulance service or services within 150
whose territory the agency operates, in order to coordinate 151
emergency medical services; 152
(26) "Paramedic", a person who has successfully 153
completed a course of instruction in advanced life support 154
care as prescribed by the department and is licensed by the 155
department in accordance with sections 190.001 to 190.245 156
and rules adopted by the department pursuant to sections 157
190.001 to 190.245; 158
[(28)] (27) "Patient", an individual who is sick, 159
injured, wounded, diseased, or otherwise incapacitated or 160
helpless, or dead, excluding deceased individuals being 161
transported from or between private or public institutions, 162
homes or cemeteries, and individuals declared dead prior to 163
the time an ambulance is called for assistance; 164
[(29)] (28) "Person", as used in these definitions and 165
elsewhere in sections 190.001 to 190.245, any individual, 166
firm, partnership, copartnership, joint venture, 167
association, cooperative organization, corporation, 168
municipal or private, and whether organized for profit or 169
not, state, county, political subdivision, state department, 170
commission, board, bureau or fraternal organization, estate, 171
public trust, business or common law trust, receiver, 172
assignee for the benefi t of creditors, trustee or trustee in 173
bankruptcy, or any other service user or provider; 174
[(30)] (29) "Physician", a person licensed as a 175
physician pursuant to chapter 334; 176 HCS SS SB 24 19
[(31)] (30) "Political subdivision", any municipality, 177
city, county, city not within a county, ambulance district 178
or fire protection district located in this state which 179
provides or has authority to provide ambulance service; 180
[(32)] (31) "Professional organization", any organized 181
group or association with an ongoin g interest regarding 182
emergency medical services. Such groups and associations 183
could include those representing volunteers, labor, 184
management, firefighters, [EMT-B's] EMTs, nurses, [EMT-P's] 185
paramedics, physicians, communications specialists and 186
instructors. Organizations could also represent the 187
interests of ground ambulance services, air ambulance 188
services, fire service organizations, law enforcement, 189
hospitals, trauma centers, communication centers, pediatric 190
services, labor unions and poison c ontrol services; 191
[(33)] (32) "Proof of financial responsibility", proof 192
of ability to respond to damages for liability, on account 193
of accidents occurring subsequent to the effective date of 194
such proof, arising out of the ownership, maintenance or use 195
of a motor vehicle in the financial amount set in rules 196
promulgated by the department, but in no event less than the 197
statutory minimum required for motor vehicles. Proof of 198
financial responsibility shall be used as proof of self - 199
insurance; 200
[(34)] (33) "Protocol", a predetermined, written 201
medical care guideline, which may include standing orders; 202
[(35)] (34) "Regional EMS advisory committee", a 203
committee formed within an emergency medical services (EMS) 204
region to advise ambulance ser vices, the state advisory 205
council on EMS and the department; 206
[(36)] (35) "Specialty care transportation", the 207
transportation of a patient requiring the services of an 208 HCS SS SB 24 20
emergency medical technician -paramedic who has received 209
additional training bey ond the training prescribed by the 210
department. Specialty care transportation services shall be 211
defined in writing in the appropriate local protocols for 212
ground and air ambulance services and approved by the local 213
physician medical director. The protocols shall be 214
maintained by the local ambulance service and shall define 215
the additional training required of the emergency medical 216
technician-paramedic; 217
[(37)] (36) "Stabilize", with respect to an emergency, 218
the provision of such medical treatmen t as may be necessary 219
to attempt to assure within reasonable medical probability 220
that no material deterioration of an individual's medical 221
condition is likely to result from or occur during ambulance 222
transportation unless the likely benefits of such 223
transportation outweigh the risks; 224
[(38)] (37) "State advisory council on emergency 225
medical services", a committee formed to advise the 226
department on policy affecting emergency medical service 227
throughout the state; 228
[(39)] (38) "State EMS medical directors advisory 229
committee", a subcommittee of the state advisory council on 230
emergency medical services formed to advise the state 231
advisory council on emergency medical services and the 232
department on medical issues; 233
[(40)] (39) "STEMI" or "ST-elevation myocardial 234
infarction", a type of heart attack in which impaired blood 235
flow to the patient's heart muscle is evidenced by ST - 236
segment elevation in electrocardiogram analysis, and as 237
further defined in rules promulgated by the department und er 238
sections 190.001 to 190.250; 239 HCS SS SB 24 21
[(41)] (40) "STEMI care", includes education and 240
prevention, emergency transport, triage, and acute care and 241
rehabilitative services for STEMI that requires immediate 242
medical or surgical intervention or treatment; 243
[(42)] (41) "STEMI center", a hospital that is 244
currently designated as such by the department to care for 245
patients with ST-segment elevation myocardial infarctions; 246
[(43)] (42) "Stroke", a condition of impaired blood 247
flow to a patient's brai n as defined by the department; 248
[(44)] (43) "Stroke care", includes emergency 249
transport, triage, and acute intervention and other acute 250
care services for stroke that potentially require immediate 251
medical or surgical intervention or treatment, and may 252
include education, primary prevention, acute intervention, 253
acute and subacute management, prevention of complications, 254
secondary stroke prevention, and rehabilitative services; 255
[(45)] (44) "Stroke center", a hospital that is 256
currently designated as such by the department; 257
[(46)] (45) "Time-critical diagnosis", trauma care, 258
stroke care, and STEMI care occurring either outside of a 259
hospital or in a center designated under section 190.241; 260
[(47)] (46) "Time-critical diagnosis adviso ry 261
committee", a committee formed under section 190.257 to 262
advise the department on policies impacting trauma, stroke, 263
and STEMI center designations; regulations on trauma care, 264
stroke care, and STEMI care; and the transport of trauma, 265
stroke, and STEMI patients; 266
[(48)] (47) "Trauma", an injury to human tissues and 267
organs resulting from the transfer of energy from the 268
environment; 269
[(49)] (48) "Trauma care" includes injury prevention, 270
triage, acute care and rehabilitative services for maj or 271 HCS SS SB 24 22
single system or multisystem injuries that potentially 272
require immediate medical or surgical intervention or 273
treatment; 274
[(50)] (49) "Trauma center", a hospital that is 275
currently designated as such by the department. 276
190.103. 1. One physician with expertise in emergency 1
medical services from each of the EMS regions shall be 2
elected by that region's EMS medical directors to serve as a 3
regional EMS medical director. The regional EMS medical 4
directors shall constitute the state EMS medical director's 5
advisory committee and shall advise the department and their 6
region's ambulance services on matters relating to medical 7
control and medical direction in accordance with sections 8
190.001 to 190.245 and rules adopted by the d epartment 9
pursuant to sections 190.001 to 190.245. The regional EMS 10
medical director shall serve a term of four years. The 11
southwest, northwest, and Kansas City regional EMS medical 12
directors shall be elected to an initial two -year term. The 13
central, east central, and southeast regional EMS medical 14
directors shall be elected to an initial four -year term. 15
All subsequent terms following the initial terms shall be 16
four years. The state EMS medical director shall be the 17
chair of the state EMS medi cal director's advisory 18
committee, and shall be elected by the members of the 19
regional EMS medical director's advisory committee, shall 20
serve a term of four years, and shall seek to coordinate EMS 21
services between the EMS regions, promote educational 22
efforts for agency medical directors, represent Missouri EMS 23
nationally in the role of the state EMS medical director, 24
and seek to incorporate the EMS system into the health care 25
system serving Missouri. 26 HCS SS SB 24 23
2. A medical director is required for all a mbulance 27
services and emergency medical response agencies that 28
provide: advanced life support services; basic life support 29
services utilizing medications or providing assistance with 30
patients' medications; or basic life support services 31
performing invasive procedures including invasive airway 32
procedures. The medical director shall provide medical 33
direction to these services and agencies in these instances. 34
3. The medical director, in cooperation with the 35
ambulance service or emergency medica l response agency 36
administrator, shall have the responsibility and the 37
authority to ensure that the personnel working under their 38
supervision are able to provide care meeting established 39
standards of care with consideration for state and national 40
standards as well as local area needs and resources. The 41
medical director, in cooperation with the ambulance service 42
or emergency medical response agency administrator, shall 43
establish and develop triage, treatment and transport 44
protocols, which may inclu de authorization for standing 45
orders. Emergency medical technicians shall only perform 46
those medical procedures as directed by treatment protocols 47
approved by the local medical director or when authorized 48
through direct communication with online medic al control. 49
4. All ambulance services and emergency medical 50
response agencies that are required to have a medical 51
director shall establish an agreement between the service or 52
agency and their medical director. The agreement will 53
include the roles, responsibilities and authority of the 54
medical director beyond what is granted in accordance with 55
sections 190.001 to 190.245 and rules adopted by the 56
department pursuant to sections 190.001 to 190.245. The 57
agreement shall also include grievance pro cedures regarding 58 HCS SS SB 24 24
the emergency medical response agency or ambulance service, 59
personnel and the medical director. 60
5. Regional EMS medical directors and the state EMS 61
medical director elected as provided under subsection 1 of 62
this section shall be considered public officials for 63
purposes of sovereign immunity, official immunity, and the 64
Missouri public duty doctrine defenses. 65
6. The state EMS medical director's advisory committee 66
shall be considered a peer review committee under section 67
537.035. 68
7. Regional EMS medical directors may act to provide 69
online telecommunication medical direction to AEMTs, [EMT- 70
Bs, EMT-Ps] EMTs, paramedics, and community paramedics and 71
provide offline medical direction per standardized 72
treatment, triage, and transport protocols when EMS 73
personnel, including AEMTs, [EMT-Bs, EMT-Ps] EMTs, 74
paramedics, and community paramedics, are providing care to 75
special needs patients or at the request of a local EMS 76
agency or medical director. 77
8. When developing treatment protocols for special 78
needs patients, regional EMS medical directors may 79
promulgate such protocols on a regional basis across 80
multiple political subdivisions' jurisdictional boundaries, 81
and such protocols may be used by multiple agencies 82
including, but not limited to, ambulance services, emergency 83
response agencies, and public health departments. Treatment 84
protocols shall include steps to ensure the receiving 85
hospital is informed of the pending arrival of the special 86
needs patient, the condition of the patient, and the 87
treatment instituted. 88
9. Multiple EMS agencies including, but not limited 89
to, ambulance services, emergency response agencies, and 90 HCS SS SB 24 25
public health departments shall take necessary steps to 91
follow the regional EMS protocols established as provided 92
under subsection 8 of this section in cases of mass casualty 93
or state-declared disaster incidents. 94
10. When regional EMS medical directors develop and 95
implement treatment protocols for patients or provide online 96
medical direction for patients, such activity shall not be 97
construed as having usurped local medical direction 98
authority in any manner. 99
11. The state EMS medical directors advisory committee 100
shall review and make recommendations regarding all pro posed 101
community and regional time -critical diagnosis plans. 102
12. Notwithstanding any other provision of law to the 103
contrary, when regional EMS medical directors are providing 104
either online telecommunication medical direction to AEMTs, 105
[EMT-Bs, EMT-Ps] EMTs, paramedics, and community paramedics, 106
or offline medical direction per standardized EMS treatment, 107
triage, and transport protocols for patients, those medical 108
directions or treatment protocols may include the 109
administration of the patient's own prescription medications. 110
190.142. 1. (1) For applications submitted before 1
the recognition of EMS personnel licensure interstate 2
compact under sections 190.900 to 190.939 takes effect, the 3
department shall, within a reasonable time after receipt of 4
an application, cause such investigation as it deems 5
necessary to be made of the applicant for an emergency 6
medical technician's license. 7
(2) For applications submitted after the recognition 8
of EMS personnel licensure inter state compact under sections 9
190.900 to 190.939 takes effect, an applicant for initial 10
licensure as an emergency medical technician in this state 11
shall submit to a background check by the Missouri state 12 HCS SS SB 24 26
highway patrol and the Federal Bureau of Investig ation 13
through a process approved by the department of health and 14
senior services. Such processes may include the use of 15
vendors or systems administered by the Missouri state 16
highway patrol. The department may share the results of 17
such a criminal background check with any emergency services 18
licensing agency in any member state, as that term is 19
defined under section 190.900, in recognition of the EMS 20
personnel licensure interstate compact. The department 21
shall not issue a license until the departm ent receives the 22
results of an applicant's criminal background check from the 23
Missouri state highway patrol and the Federal Bureau of 24
Investigation, but, notwithstanding this subsection, the 25
department may issue a temporary license as provided under 26
section 190.143. Any fees due for a criminal background 27
check shall be paid by the applicant. 28
(3) The director may authorize investigations into 29
criminal records in other states for any applicant. 30
2. The department shall issue a license to al l levels 31
of emergency medical technicians, for a period of five 32
years, if the applicant meets the requirements established 33
pursuant to sections 190.001 to 190.245 and the rules 34
adopted by the department pursuant to sections 190.001 to 35
190.245. The department may promulgate rules relating to 36
the requirements for an emergency medical technician 37
including but not limited to: 38
(1) Age requirements; 39
(2) Emergency medical technician and paramedic 40
education and training requirements based on re spective 41
National Emergency Medical Services Education Standards and 42
any modification to such curricula specified by the 43 HCS SS SB 24 27
department through rules adopted pursuant to sections 44
190.001 to 190.245; 45
(3) Paramedic accreditation requirements. Paramedic 46
training programs shall be accredited [by the Commission on 47
Accreditation of Allied Health Education Programs (CAAHEP) 48
or hold a CAAHEP letter of review ] as required by the 49
National Registry of Emergency Medical Technicians ; 50
(4) Initial licensure testing requirements. Initial 51
[EMT-P] paramedic licensure testing shall be through the 52
national registry of EMTs; 53
(5) Continuing education and relicensure requirements; 54
and 55
(6) Ability to speak, read and write the English 56
language. 57
3. Application for all levels of emergency medical 58
technician license shall be made upon such forms as 59
prescribed by the department in rules adopted pursuant to 60
sections 190.001 to 190.245. The application form shall 61
contain such information as the department deems necessary 62
to make a determination as to whether the emergency medical 63
technician meets all the requirements of sections 190.001 to 64
190.245 and rules promulgated pursuant to sections 190.001 65
to 190.245. 66
4. All levels of emergency medical technicians may 67
perform only that patient care which is: 68
(1) Consistent with the training, education and 69
experience of the particular emergency medical technician; 70
and 71
(2) Ordered by a physician or set forth in protocols 72
approved by the medical director. 73
5. No person shall hold themselves out as an emergency 74
medical technician or provide the services of an emergency 75 HCS SS SB 24 28
medical technician unless such person is licensed by the 76
department. 77
6. Any rule or portion of a rule, a s that term is 78
defined in section 536.010, that is created under the 79
authority delegated in this section shall become effective 80
only if it complies with and is subject to all of the 81
provisions of chapter 536 and, if applicable, section 82
536.028. This section and chapter 536 are nonseverable and 83
if any of the powers vested with the general assembly 84
pursuant to chapter 536 to review, to delay the effective 85
date, or to disapprove and annul a rule are subsequently 86
held unconstitutional, then the grant of rulemaking 87
authority and any rule proposed or adopted after August 28, 88
2002, shall be invalid and void. 89
190.147. 1. [An emergency medical technician 1
paramedic (EMT-P)] A paramedic may make a good faith 2
determination that such be havioral health patients who 3
present a likelihood of serious harm to themselves or 4
others, as the term "likelihood of serious harm" is defined 5
under section 632.005, or who are significantly 6
incapacitated by alcohol or drugs shall be placed into a 7
temporary hold for the sole purpose of transport to the 8
nearest appropriate facility; provided that, such 9
determination shall be made in cooperation with at least one 10
other [EMT-P] paramedic or other health care professional 11
involved in the transport. Once in a temporary hold, the 12
patient shall be treated with humane care in a manner that 13
preserves human dignity, consistent with applicable federal 14
regulations and nationally recognized guidelines regarding 15
the appropriate use of temporary holds and res traints in 16
medical transport. Prior to making such a determination: 17 HCS SS SB 24 29
(1) The [EMT-P] paramedic shall have completed a 18
standard crisis intervention training course as endorsed and 19
developed by the state EMS medical director's advisory 20
committee; 21
(2) The [EMT-P] paramedic shall have been authorized 22
by his or her ground or air ambulance service's 23
administration and medical director under subsection 3 of 24
section 190.103; and 25
(3) The [EMT-P's] paramedic ground or air ambulance 26
service has developed and adopted standardized triage, 27
treatment, and transport protocols under subsection 3 of 28
section 190.103, which address the challenge of treating and 29
transporting such patients. Provided: 30
(a) That such protocols shall be reviewed an d approved 31
by the state EMS medical director's advisory committee; and 32
(b) That such protocols shall direct the [EMT-P] 33
paramedic regarding the proper use of patient restraint and 34
coordination with area law enforcement; and 35
(c) Patient restraint protocols shall be based upon 36
current applicable national guidelines. 37
2. In any instance in which a good faith determination 38
for a temporary hold of a patient has been made, such hold 39
shall be made in a clinically appropriate and adequately 40
justified manner, and shall be documented and attested to in 41
writing. The writing shall be retained by the ambulance 42
service and included as part of the patient's medical file. 43
3. [EMT-Ps] Paramedics who have made a good faith 44
decision for a temporary hold of a patient as authorized by 45
this section shall no longer have to rely on the common law 46
doctrine of implied consent and therefore shall not be 47
civilly liable for a good faith determination made in 48
accordance with this section and shall not have waived any 49 HCS SS SB 24 30
sovereign immunity defense, official immunity defense, or 50
Missouri public duty doctrine defense if employed at the 51
time of the good faith determination by a government 52
employer. 53
4. Any ground or air ambulance service that adopts the 54
authority and protocols provided for by this section shall 55
have a memorandum of understanding with applicable local law 56
enforcement agencies in order to achieve a collaborative and 57
coordinated response to patients displaying symptoms of 58
either a likelihood of serious harm to themselves or others 59
or significant incapacitation by alcohol or drugs, which 60
require a crisis intervention response. The memorandum of 61
understanding shall include, but not be limited to, the 62
following: 63
(1) Administrative oversight, including coordination 64
between ambulance services and law enforcement agencies; 65
(2) Patient restraint techniques and coordination of 66
agency responses to situations in which patient restraint 67
may be required; 68
(3) Field interaction between paramedics and law 69
enforcement, including patient destination and 70
transportation; and 71
(4) Coordination of program quality assurance. 72
5. The physical restraint of a patient by an emergency 73
medical technician under the authority of this section shall 74
be permitted only in order to provide for the safety of 75
bystanders, the patient, or emergency personnel due to an 76
imminent or immediate danger, or upon approval by local 77
medical control through direct communications. Restraint 78
shall also be permitted through cooperation with on -scene 79
law enforcement officers. All incidents involving patient 80 HCS SS SB 24 31
restraint used under the authority of this section shall be 81
reviewed by the ambulance service physician medical director. 82
190.255. 1. Any qualified first responder may obtain 1
and administer naloxone , or any other drug or device 2
approved by the United States Food and Drug Administration, 3
that blocks the effects of an opioid overdose and is 4
administered in a manner ap proved by the United States Food 5
and Drug Administration to a person suffering from an 6
apparent narcotic or opiate -related overdose in order to 7
revive the person. 8
2. Any licensed drug distributor or pharmacy in 9
Missouri may sell naloxone , or any other drug or device 10
approved by the United States Food and Drug Administration, 11
that blocks the effects of an opioid overdose and is 12
administered in a manner approved by the United States Food 13
and Drug Administration to qualified first responder 14
agencies to allow the agency to stock naloxone for the 15
administration of such drug to persons suffering from an 16
apparent narcotic or opiate overdose in order to revive the 17
person. 18
3. For the purposes of this section, "qualified first 19
responder" shall mean any [state and local law enforcement 20
agency staff,] fire department personnel, fire district 21
personnel, or licensed emergency medical technician who is 22
acting under the directives and established protocols of a 23
medical director of a local license d ground ambulance 24
service licensed under section 190.109 , or any state or 25
local law enforcement agency staff member, who comes in 26
contact with a person suffering from an apparent narcotic or 27
opiate-related overdose and who has received training in 28
recognizing and responding to a narcotic or opiate overdose 29
and the administration of naloxone to a person suffering 30 HCS SS SB 24 32
from an apparent narcotic or opiate -related overdose. 31
"Qualified first responder agencies" shall mean any state or 32
local law enforcement agency, fire department, or ambulance 33
service that provides documented training to its staff 34
related to the administration of naloxone in an apparent 35
narcotic or opiate overdose situation. 36
4. A qualified first responder shall only administer 37
naloxone by such means as the qualified first responder has 38
received training for the administration of naloxone. 39
190.327. 1. Immediately upon the decision by the 1
commission to utilize a portion of the emergency telephone 2
tax for central dispatching and an affirmative vote of the 3
telephone tax, the commission shall appoint the initial 4
members of a board which shall administer the funds and 5
oversee the provision of central dispatching for emergency 6
services in the county and in munic ipalities and other 7
political subdivisions which have contracted for such 8
service. Beginning with the general election in 1992, all 9
board members shall be elected according to this section and 10
other applicable laws of this state. At the time of the 11
appointment of the initial members of the board, the 12
commission shall relinquish to the board and no longer 13
exercise the duties prescribed in this chapter with regard 14
to the provision of emergency telephone service and in 15
chapter 321, with regard to th e provision of central 16
dispatching service, and such duties shall be exercised by 17
the board. 18
2. Elections for board members may be held on general 19
municipal election day, as defined in subsection 3 of 20
section 115.121, after approval by a simple m ajority of the 21
county commission. 22 HCS SS SB 24 33
3. For the purpose of providing the services described 23
in this section, the board shall have the following powers, 24
authority and privileges: 25
(1) To have and use a corporate seal; 26
(2) To sue and be sued, and be a party to suits, 27
actions and proceedings; 28
(3) To enter into contracts, franchises and agreements 29
with any person, partnership, association or corporation, 30
public or private, affecting the affairs of the board; 31
(4) To acquire, construct, purchase, maintain, dispose 32
of and encumber real and personal property, including leases 33
and easements; 34
(5) To have the management, control and supervision of 35
all the business affairs of the board and the construction, 36
installation, operati on and maintenance of any improvements; 37
(6) To hire and retain agents and employees and to 38
provide for their compensation including health and pension 39
benefits; 40
(7) To adopt and amend bylaws and any other rules and 41
regulations; 42
(8) To fix, charge and collect the taxes and fees 43
authorized by law for the purpose of implementing and 44
operating the services described in this section; 45
(9) To pay all expenses connected with the first 46
election and all subsequent elections; and 47
(10) To have and exercise all rights and powers 48
necessary or incidental to or implied from the specific 49
powers granted in this subsection. Such specific powers 50
shall not be considered as a limitation upon any power 51
necessary or appropriate to carry out the purposes and 52
intent of sections 190.300 to 190.329. 53 HCS SS SB 24 34
4. (1) Notwithstanding the provisions of subsections 54
1 and 2 of this section to the contrary, the county 55
commission may elect to appoint the members of the board to 56
administer the funds and oversee the provision of central 57
dispatching for emergency services in the counties, 58
municipalities, and other political subdivisions which have 59
contracted for such service upon the request of the 60
municipalities and other political subdivisions. Upon 61
appointment of the initial members of the board, the 62
commission shall relinquish all powers and duties to the 63
board and no longer exercise the duties prescribed in this 64
chapter with regard to the provision of central dispatching 65
service and such duti es shall be exercised by the board. 66
(2) The board shall consist of seven members appointed 67
without regard to political affiliation. The members shall 68
include: 69
(a) Five members who shall serve for so long as they 70
remain in their respective c ounty or municipal positions as 71
follows: 72
a. The county sheriff, or his or her designee; 73
b. The heads of the municipal police department who 74
have contracted for central dispatching service in the two 75
largest municipalities wholly contained wi thin the county, 76
or their designees; or 77
c. The heads of the municipal fire departments or fire 78
divisions who have contracted for central dispatching 79
service in the two largest municipalities wholly contained 80
within the county, or their designees; 81
(b) Two members who shall serve two -year terms 82
appointed from among the following: 83 HCS SS SB 24 35
a. The head of any of the county's fire protection 84
districts who have contracted for central dispatching 85
service, or his or her designee; 86
b. The head of any of the county's ambulance districts 87
who have contracted for central dispatching service, or his 88
or her designee; 89
c. The head of any of the municipal police departments 90
located in the county who have contracted for central 91
dispatching service, or his or her designee, excluding those 92
mentioned in subparagraph b. of paragraph (a) of this 93
subdivision; and 94
d. The head of any of the municipal fire departments 95
in the county who have contracted for central dispatching 96
service, or his or he r designee, excluding those mentioned 97
in subparagraph c. of paragraph (a) of this subdivision. 98
(3) Upon the appointment of the board under this 99
subsection, the board shall have the powers provided in 100
subsection 3 of this section and the commission shall 101
relinquish all powers and duties relating to the provision 102
of central dispatching service under this chapter to the 103
board. 104
[5.An emergency services board originally organized 105
under section 190.325 operating within a county with a 106
charter form of government and with more than two hundred 107
thousand but fewer than three hundred fifty thousand 108
inhabitant s shall not have a sales tax for emergency 109
services or for providing central dispatching for emergency 110
services greater than one -quarter of one percent. If on 111
July 9, 2019, such tax is greater than one -quarter of one 112
percent, the board shall lower the tax rate. ] 113
190.460. 1. As used in this section, the following 1
terms mean: 2 HCS SS SB 24 36
(1) "Board", the Missouri 911 service board 3
established under section 650.325; 4
(2) "Consumer", a person who purchases prepaid 5
wireless telecommunications service in a retail transaction; 6
(3) "Department", the department of revenue; 7
(4) "Prepaid wireless service provider", a provider 8
that provides prepaid wireless service to an end user; 9
(5) "Prepaid wireless telecommunications service", a 10
wireless telecommunications service that allows a caller to 11
dial 911 to access the 911 system and which service shall be 12
paid for in advance and is sold in predetermined units or 13
dollars of which the number declines with use in a known 14
amount; 15
(6) "Retail transaction", the purchase of prepaid 16
wireless telecommunications service from a seller for any 17
purpose other than re sale. The purchase of more than one 18
item that provides prepaid wireless telecommunication 19
service, when such items are sold separately, constitutes 20
more than one retail transaction; 21
(7) "Seller", a person who sells prepaid wireless 22
telecommunications service to another person; 23
(8) "Wireless telecommunications service", commercial 24
mobile radio service as defined by 47 CFR 20.3, as amended. 25
2. (1) Beginning January 1, 2019, there is hereby 26
imposed a prepaid wireless emergency telepho ne service 27
charge on each retail transaction. The amount of such 28
charge shall be equal to three percent of the amount of each 29
retail transaction. The first fifteen dollars of each 30
retail transaction shall not be subject to the service 31
charge. 32
(2) When prepaid wireless telecommunications service 33
is sold with one or more products or services for a single, 34 HCS SS SB 24 37
nonitemized price, the prepaid wireless emergency telephone 35
service charge set forth in subdivision (1) of this 36
subsection shall apply to t he entire nonitemized price 37
unless the seller elects to apply such service charge in the 38
following way: 39
(a) If the amount of the prepaid wireless 40
telecommunications service is disclosed to the consumer as a 41
dollar amount, three percent of such do llar amount; or 42
(b) If the seller can identify the portion of the 43
price that is attributable to the prepaid wireless 44
telecommunications service by reasonable and verifiable 45
standards from the seller's books and records that are kept 46
in the regular course of business for other purposes 47
including, but not limited to, nontax purposes, three 48
percent of such portion; 49
The first fifteen dollars of each transaction under this 50
subdivision shall not be subject to the service charge. 51
(3) The prepaid wireless emergency telephone service 52
charge shall be collected by the seller from the consumer 53
with respect to each retail transaction occurring in this 54
state. The amount of the prepaid wireless emergency 55
telephone service charge shall be either sepa rately stated 56
on an invoice, receipt, or other similar document that is 57
provided to the consumer by the seller or otherwise 58
disclosed to the consumer. 59
(4) For purposes of this subsection, a retail 60
transaction that is effected in person by a consu mer at a 61
business location of the seller shall be treated as 62
occurring in this state if that business location is in this 63
state, and any other retail transaction shall be treated as 64 HCS SS SB 24 38
occurring in this state if the retail transaction is treated 65
as occurring under chapter 144. 66
(5) The prepaid wireless emergency telephone service 67
charge is the liability of the consumer and not of the 68
seller or of any provider; except that, the seller shall be 69
liable to remit all charges that the seller collects or is 70
deemed to collect. 71
(6) The amount of the prepaid wireless emergency 72
telephone service charge that is collected by a seller from 73
a consumer, if such amount is separately stated on an 74
invoice, receipt, or other similar document provided to the 75
consumer by the seller, shall not be included in the base 76
for measuring any tax, fee, surcharge, or other charge that 77
is imposed by this state, any political subdivision of this 78
state, or any intergovernmental agency. 79
3. (1) Prepaid wireless eme rgency telephone service 80
charges collected by sellers shall be remitted to the 81
department at the times and in the manner provided by state 82
law with respect to sales and use taxes. The department 83
shall establish registration and payment procedures that 84
substantially coincide with the registration and payment 85
procedures that apply under state law. On or after the 86
effective date of the service charge imposed under the 87
provisions of this section, the director of the department 88
of revenue shall perfor m all functions incident to the 89
administration, collection, enforcement, and operation of 90
the service charge, and the director shall collect, in 91
addition to the sales tax for the state of Missouri, all 92
additional service charges imposed in this section . All 93
service charges imposed under this section together with all 94
taxes imposed under the sales tax law of the state of 95
Missouri shall be collected together and reported upon such 96 HCS SS SB 24 39
forms and under such administrative rules and regulations as 97
may be prescribed by the director. All applicable 98
provisions contained in sections 144.010 to 144.525 99
governing the state sales tax and section 32.057 shall apply 100
to the collection of any service charges imposed under this 101
section except as modified. 102
(2) Beginning on January 1, 2019, and ending on 103
January 31, 2019, when a consumer purchases prepaid wireless 104
telecommunications service in a retail transaction from a 105
seller under this section, the seller shall be allowed to 106
retain one hundred percent of the prepaid wireless emergency 107
telephone service charges that are collected by the seller 108
from the consumer. Beginning on February 1, 2019, a seller 109
shall be permitted to deduct and retain three percent of 110
prepaid wireless emergency telephone service charges that 111
are collected by the seller from consumers. 112
(3) The department shall establish procedures by which 113
a seller of prepaid wireless telecommunications service may 114
document that a sale is not a retail transaction, which 115
procedures shall substantially coincide with the procedures 116
for documenting sale for resale transactions for sales and 117
use purposes under state law. 118
(4) The department shall deposit all remitted prepaid 119
wireless emergency telephone service charges into the 120
general revenue fund for the department's use until eight 121
hundred thousand one hundred fifty dollars is collected to 122
reimburse its direct costs of administering the collection 123
and remittance of prepaid wireless emergency telephone 124
service charges. From then onward, the department shall 125
deposit all remitted prepaid wireless emergency telephone 126
service charges into the Missouri 911 service trust fund 127
created under section 190.420 within thirty days of receipt 128 HCS SS SB 24 40
for use by the board. After the initial eight hundred 129
thousand one hundred fifty dollars is collected, the 130
department may deduct an amount not to exceed one percent of 131
collected charges to be retained by the department to 132
reimburse its direct costs of administering the collection 133
and remittance of prepaid wireless emergency telephone 134
service charges. 135
(5) The board shall set a rate between twenty -five and 136
one hundred percent of the prepaid wireless emergency 137
telephone service charges deposited in the Missouri 911 138
service trust fund collec ted in counties without a charter 139
form of government, less the deductions authorized in 140
subdivision (4) of this subsection, that shall be remitted 141
to such counties in direct proportion to the amount of 142
charges collected in each county. The board shall set a 143
rate between sixty-five and one hundred percent of the 144
prepaid wireless emergency telephone service charges 145
deposited in the Missouri 911 service trust fund collected 146
in counties with a charter form of government and any city 147
not within a county, less the deductions authorized in 148
subdivision (4) of this subsection, that shall be remitted 149
to each such county or city not within a county in direct 150
proportion to the amount of charges collected in each such 151
county or city not within a county. If a county has an 152
elected emergency services board, the Missouri 911 service 153
board shall remit the funds to the elected emergency 154
services board, except for an emergency services board 155
originally organized under section 190.325 operating within 156
a county with a charter form of government and with more 157
than two hundred thousand but fewer than three hundred fifty 158
thousand inhabitants, in which case the funds shall be 159
remitted to the county's general fund for the purpose of 160 HCS SS SB 24 41
public safety infrastructure. The initial percentage rate 161
set by the board for counties with and without a charter 162
form of government and any city not within a county shall be 163
set by June thirtieth of each applicable year and may be 164
adjusted annually for the first three years, an d thereafter 165
the rate may be adjusted every three years; however, at no 166
point shall the board set rates that fall below twenty -five 167
percent for counties without a charter form of government 168
and sixty-five percent for counties with a charter form of 169
government and any city not within a county. 170
(6) Any amounts received by a county or city under 171
subdivision (5) of this subsection shall be used only for 172
purposes authorized in sections 190.305, 190.325, and 173
190.335. Any amounts received by any cou nty with a charter 174
form of government and with more than six hundred thousand 175
but fewer than seven hundred thousand inhabitants under this 176
section may be used for emergency service notification 177
systems. 178
4. (1) A seller that is not a provider sha ll be 179
entitled to the immunity and liability protections under 180
section 190.455, notwithstanding any requirement in state 181
law regarding compliance with Federal Communications 182
Commission Order 05-116. 183
(2) A provider shall be entitled to the immunit y and 184
liability protections under section 190.455. 185
(3) In addition to the protection from liability 186
provided in subdivisions (1) and (2) of this subsection, 187
each provider and seller and its officers, employees, 188
assigns, agents, vendors, or anyone acting on behalf of such 189
persons shall be entitled to the further protection from 190
liability, if any, that is provided to providers and sellers 191 HCS SS SB 24 42
of wireless telecommunications service that is not prepaid 192
wireless telecommunications service under section 190.455. 193
5. The prepaid wireless emergency telephone service 194
charge imposed by this section shall be in addition to any 195
other tax, fee, surcharge, or other charge imposed by this 196
state, any political subdivision of this state, or any 197
intergovernmental agency for 911 funding purposes. 198
6. The provisions of this section shall become 199
effective unless the governing body of a county or city 200
adopts an ordinance, order, rule, resolution, or regulation 201
by at least a two-thirds vote prohibiting th e charge 202
established under this section from becoming effective in 203
the county or city at least forty -five days prior to the 204
effective date of this section. If the governing body does 205
adopt such ordinance, order, rule, resolution, or regulation 206
by at least a two-thirds vote, the charge shall not be 207
collected and the county or city shall not be allowed to 208
obtain funds from the Missouri 911 service trust fund that 209
are remitted to the fund under the charge established under 210
this section. The Missouri 911 service board shall, by 211
September 1, 2018, notify all counties and cities of the 212
implementation of the charge established under this section, 213
and the procedures set forth under this subsection for 214
prohibiting the charge from becoming effective. 215
7. Any county or city which prohibited the prepaid 216
wireless emergency telephone service charge pursuant to the 217
provisions of subsection 6 of this section may take a vote 218
of the governing body, and notify the department of revenue 219
of the result of such vote[, by November 15, 2019, ] to 220
impose such charge [effective January 1, 2020 ]. A vote of 221
at least two-thirds of the governing body is required in 222
order to impose such charge. The department shall notify 223 HCS SS SB 24 43
the board of notices received by [December 1, 2019] within 224
sixty days of receiving such notice . 225
190.1010. 1. As used in this section, the following 1
terms shall mean: 2
(1) "Employee", a first responder employed by an 3
employer; 4
(2) "Employer", the state, a unit of local government, 5
or a public hospital or ambulance service that employs first 6
responders; 7
(3) "First responder", a 911 dispatcher, paramedic, 8
emergency medical technician, or a volunteer or full -time 9
paid firefighter; 10
(4) "Peer support advisor", a person approved by the 11
employer who voluntarily provides confidential support and 12
assistance to employees experiencing personal or 13
professional problems. An employer shall provide peer 14
support advisors with an appropriate level of training i n 15
counseling to provide emotional and moral support; 16
(5) "Peer support counseling program", a program 17
established by an employer to train employees to serve as 18
peer support advisors in order to conduct peer support 19
counseling sessions; 20
(6) "Peer support counseling session", communication 21
with a peer support advisor designated by an employer. A 22
peer support counseling session is accomplished primarily 23
through listening, assessing, assisting with problem 24
solving, making referrals to a pro fessional when necessary, 25
and conducting follow -up as needed; 26
(7) "Record", any record kept by a therapist or by an 27
agency in the course of providing behavioral health care to 28
a first responder concerning the first responder and the 29
services provided. "Record" includes the personal notes of 30 HCS SS SB 24 44
the therapist or agency, as well as all records maintained 31
by a court that have been created in connection with, in 32
preparation for, or as a result of the filing of any 33
petition. "Record" does not include information that has 34
been de-identified in accordance with the federal Health 35
Insurance Portability and Accountability Act (HIPAA) and 36
does not include a reference to the receipt of behavioral 37
health care noted during a patient history and physical or 38
other summary of care. 39
2. (1) Any communication made by an employee or peer 40
support advisor in a peer support counseling session, as 41
well as any oral or written information conveyed in the peer 42
support counseling session, shall be confidential and shall 43
not be disclosed by any person participating in the peer 44
support counseling session or released to any person or 45
entity. Any communication relating to a peer support 46
counseling session made confidential under this section that 47
is made between peer support advisors and the supervisors or 48
staff of a peer support counseling program, or between the 49
supervisor and staff of a peer support counseling program, 50
shall be confidential and shall not be disclosed. The 51
provisions of this section shal l not be construed to 52
prohibit any communications between counselors who conduct 53
peer support counseling sessions or any communications 54
between counselors and the supervisors or staff of a peer 55
support counseling program. 56
(2) Any communication de scribed in subdivision (1) of 57
this subsection may be subject to a subpoena for good cause 58
shown. 59
(3) The provisions of this subsection shall not apply 60
to the following: 61 HCS SS SB 24 45
(a) Any threat of suicide or homicide made by a 62
participant in a peer s upport counseling session or any 63
information conveyed in a peer support counseling session 64
related to a threat of suicide or homicide; 65
(b) Any information mandated by law or agency policy 66
to be reported, including, but not limited to, domestic 67
violence, child abuse or neglect, or elder abuse or neglect; 68
(c) Any admission of criminal conduct; or 69
(d) Any admission or act of refusal to perform duties 70
to protect others or the employee. 71
(4) All communications, notes, records, and rep orts 72
arising out of a peer support counseling session shall not 73
be considered public records subject to disclosure under 74
chapter 610. 75
(5) A department or organization that establishes a 76
peer support counseling program shall develop a policy or 77
rule that imposes disciplinary measures against a peer 78
support advisor who violates the confidentiality of the peer 79
support counseling program by sharing information learned in 80
a peer support counseling session with personnel who are not 81
supervisors or staff of the peer support counseling program 82
unless otherwise exempted under the provisions of this 83
subsection. 84
3. Any employer that creates a peer support counseling 85
program shall be subject to the provisions of this section. 86
An employer shall ensure that peer support advisors receive 87
appropriate training in counseling to conduct peer support 88
counseling sessions. An employer may refer any person to a 89
peer support advisor within the employer's organization or, 90
if those services are not avail able with the employer, to 91
another peer support counseling program that is available 92
and approved by the employer. Notwithstanding any other 93 HCS SS SB 24 46
provision of law to the contrary, an employer shall not 94
mandate that any employee participate in a peer suppor t 95
counseling program. 96
[192.530. 1. As used in this section, the 1
following terms mean: 2
(1) "Department", the department of health 3
and senior services; 4
(2) "Health care provider", the same 5
meaning given to the term in sec tion 376.1350; 6
(3) "Voluntary nonopioid directive form", 7
a form that may be used by a patient to deny or 8
refuse the administration or prescription of a 9
controlled substance containing an opioid by a 10
health care provider. 11
2. In consultation with the board of 12
registration for the healing arts and the board 13
of pharmacy, the department shall develop and 14
publish a uniform voluntary nonopioid directive 15
form. 16
3. The voluntary nonopioid directive form 17
developed by the department shall ind icate to 18
all prescribing health care providers that the 19
named patient shall not be offered, prescribed, 20
supplied with, or otherwise administered a 21
controlled substance containing an opioid. 22
4. The voluntary nonopioid directive form 23
shall be posted in a downloadable format on the 24
department's publicly accessible website. 25
5. (1) A patient may execute and file a 26
voluntary nonopioid directive form with a health 27
care provider. Each health care provider shall 28
sign and date the form in the p resence of the 29
patient as evidence of acceptance and shall 30
provide a signed copy of the form to the patient. 31
(2) The patient executing and filing a 32
voluntary nonopioid directive form with a health 33
care provider shall sign and date the form in 34
the presence of the health care provider or a 35
designee of the health care provider. In the 36
case of a patient who is unable to execute and 37
file a voluntary nonopioid directive form, the 38
patient may designate a duly authorized guardian 39
or health care proxy to execute and file the 40
form in accordance with subdivision (1) of this 41
subsection. 42
(3) A patient may revoke the voluntary 43
nonopioid directive form for any reason and may 44
do so by written or oral means. 45
6. The department shall promulgate 46
regulations for the implementation of the 47
voluntary nonopioid directive form that shall 48
include, but not be limited to: 49
(1) A standard method for the recording 50
and transmission of the voluntary nonopioid 51 HCS SS SB 24 47
directive form, which shall include veri fication 52
by the patient's health care provider and shall 53
comply with the written consent requirements of 54
the Public Health Service Act, 42 U.S.C. Section 55
290dd-2(b), and 42 CFR Part 2, relating to 56
confidentiality of alcohol and drug abuse 57
patient records, provided that the voluntary 58
nonopioid directive form shall also provide the 59
basic procedures necessary to revoke the 60
voluntary nonopioid directive form; 61
(2) Procedures to record the voluntary 62
nonopioid directive form in the patient's 63
medical record or, if available, the patient's 64
interoperable electronic medical record; 65
(3) Requirements and procedures for a 66
patient to appoint a duly authorized guardian or 67
health care proxy to override a previously filed 68
voluntary nonopioid directi ve form and 69
circumstances under which an attending health 70
care provider may override a previously filed 71
voluntary nonopioid directive form based on 72
documented medical judgment, which shall be 73
recorded in the patient's medical record; 74
(4) Procedures to ensure that any 75
recording, sharing, or distributing of data 76
relative to the voluntary nonopioid directive 77
form complies with all federal and state 78
confidentiality laws; and 79
(5) Appropriate exemptions for health care 80
providers and emergenc y medical personnel to 81
prescribe or administer a controlled substance 82
containing an opioid when, in their professional 83
medical judgment, a controlled substance 84
containing an opioid is necessary, or the 85
provider and medical personnel are acting in 86
good faith. 87
The department shall develop and publish 88
guidelines on its publicly accessible website 89
that shall address, at a minimum, the content of 90
the regulations promulgated under this 91
subsection. Any rule or portion of a rule, as 92
that term is defined in section 536.010, that is 93
created under the authority delegated in this 94
section shall become effective only if it 95
complies with and is subject to all of the 96
provisions of chapter 536 and, if applicable, 97
section 536.028. This section and chapter 53 6 98
are nonseverable and if any of the powers vested 99
with the general assembly pursuant to chapter 100
536 to review, to delay the effective date, or 101
to disapprove and annul a rule are subsequently 102
held unconstitutional, then the grant of 103
rulemaking authority and any rule proposed or 104
adopted after August 28, 2023, shall be invalid 105
and void. 106
7. A written prescription that is 107
presented at an outpatient pharmacy or a 108 HCS SS SB 24 48
prescription that is electronically transmitted 109
to an outpatient pharmacy is presum ed to be 110
valid for the purposes of this section, and a 111
pharmacist in an outpatient setting shall not be 112
held in violation of this section for dispensing 113
a controlled substance in contradiction to a 114
voluntary nonopioid directive form, except upon 115
evidence that the pharmacist acted knowingly 116
against the voluntary nonopioid directive form. 117
8. (1) A health care provider or an 118
employee of a health care provider acting in 119
good faith shall not be subject to criminal or 120
civil liability and shall no t be considered to 121
have engaged in unprofessional conduct for 122
failing to offer or administer a prescription or 123
medication order for a controlled substance 124
containing an opioid under the voluntary 125
nonopioid directive form. 126
(2) A person acting as a representative or 127
an agent pursuant to a health care proxy shall 128
not be subject to criminal or civil liability 129
for making a decision under subdivision (3) of 130
subsection 6 of this section in good faith. 131
(3) Notwithstanding any other provision of 132
law, a professional licensing board, at its 133
discretion, may limit, condition, or suspend the 134
license of, or assess fines against, a health 135
care provider who recklessly or negligently 136
fails to comply with a patient's voluntary 137
nonopioid directive for m.] 138
192.2405. 1. The following persons shall be required 1
to immediately report or cause a report to be made to the 2
department under sections 192.2400 to 192.2470: 3
(1) Any person having reasonable cause to suspect that 4
an eligible adult presents a likelihood of suffering serious 5
physical harm, or bullying as defined in subdivision (2) of 6
section 192.2400, and is in need of protective services; and 7
(2) Any adult day care worker, chiropractor, Christian 8
Science practitioner, coroner, dentist, embalmer, employee 9
of the departments of social services, mental health, or 10
health and senior services, employee of a local area agency 11
on aging or an organized area agency on aging program, 12
emergency medical technician, firefight er, first responder, 13
funeral director, home health agency, home health agency 14
employee, hospital and clinic personnel engaged in the care 15 HCS SS SB 24 49
or treatment of others, in -home services owner or provider, 16
in-home services operator or employee, law enforcement 17
officer, long-term care facility administrator or employee, 18
medical examiner, medical resident or intern, mental health 19
professional, minister, nurse, nurse practitioner, 20
optometrist, other health practitioner, peace officer, 21
pharmacist, physical the rapist, physician, physician's 22
assistant, podiatrist, probation or parole officer, 23
psychologist, social worker, or other person with the 24
responsibility for the care of an eligible adult who has 25
reasonable cause to suspect that the eligible adult has be en 26
subjected to abuse or neglect or observes the eligible adult 27
being subjected to conditions or circumstances which would 28
reasonably result in abuse or neglect. Notwithstanding any 29
other provision of this section, a duly ordained minister, 30
clergy, religious worker, or Christian Science practitioner 31
while functioning in his or her ministerial capacity shall 32
not be required to report concerning a privileged 33
communication made to him or her in his or her professional 34
capacity. 35
2. Any other person who becomes aware of circumstances 36
that may reasonably be expected to be the result of, or 37
result in, abuse or neglect of an eligible adult may report 38
to the department. 39
3. The penalty for failing to report as required under 40
subdivision (2) of subsection 1 of this section is provided 41
under section 565.188. 42
4. As used in this section, "first responder" means 43
any person trained and authorized by law or rule to render 44
emergency medical assistance or treatment. Such persons may 45
include, but shall not be limited to, emergency first 46
responders, police officers, sheriffs, deputy sheriffs, 47 HCS SS SB 24 50
firefighters, or emergency medical technicians [, or 48
emergency medical technician -paramedics]. 49
195.206. 1. As used in this section, the following 1
terms shall mean: 2
(1) "Addiction mitigation medication", naltrexone 3
hydrochloride that is administered in a manner approved by 4
the United States Food and Drug Administration or any 5
accepted medical practice method of administering; 6
(2) "Opioid antagonist", naloxone hydrochloride , or 7
any other drug or device approved by the United States Food 8
and Drug Administration, that blocks the effects of an 9
opioid overdose [that] and is administered in a manner 10
approved by the United States Food and Drug Administration 11
or any accepted medical practice method of administering; 12
(3) "Opioid-related drug overdose", a condition 13
including, but not limited to, extreme physical illness, 14
decreased level of consciousness, respiratory de pression, 15
coma, or death resulting from the consumption or use of an 16
opioid or other substance with which an opioid was combined 17
or a condition that a layperson would reasonably believe to 18
be an opioid-related drug overdose that requires medical 19
assistance. 20
2. Notwithstanding any other law or regulation to the 21
contrary: 22
(1) The director of the department of health and 23
senior services, if a licensed physician, may issue a 24
statewide standing order for an opioid antagonist or an 25
addiction mitigation medication; 26
(2) In the alternative, the department may employ or 27
contract with a licensed physician who may issue a statewide 28
standing order for an opioid antagonist or an addiction 29 HCS SS SB 24 51
mitigation medication with the express written consent of 30
the department director. 31
3. Notwithstanding any other law or regulation to the 32
contrary, any licensed pharmacist in Missouri may sell and 33
dispense an opioid antagonist or an addiction mitigation 34
medication under physician protocol or under a statewide 35
standing order issued under subsection 2 of this section. 36
4. A licensed pharmacist who, acting in good faith and 37
with reasonable care, sells or dispenses an opioid 38
antagonist or an addiction mitigation medication and an 39
appropriate device to administer the drug, and the protocol 40
physician, shall not be subject to any criminal or civil 41
liability or any professional disciplinary action for 42
prescribing or dispensing the opioid antagonist or an 43
addiction mitigation medication or any outc ome resulting 44
from the administration of the opioid antagonist or an 45
addiction mitigation medication. A physician issuing a 46
statewide standing order under subsection 2 of this section 47
shall not be subject to any criminal or civil liability or 48
any professional disciplinary action for issuing the 49
standing order or for any outcome related to the order or 50
the administration of the opioid antagonist or an addiction 51
mitigation medication. 52
5. Notwithstanding any other law or regulation to the 53
contrary, it shall be permissible for any person to possess 54
an opioid antagonist or an addiction mitigation medication. 55
6. Any person who administers an opioid antagonist to 56
another person shall, immediately after administering the 57
drug, contact emerge ncy personnel. Any person who, acting 58
in good faith and with reasonable care, administers an 59
opioid antagonist to another person whom the person believes 60
to be suffering an opioid -related drug overdose shall be 61 HCS SS SB 24 52
immune from criminal prosecution, discip linary actions from 62
his or her professional licensing board, and civil liability 63
due to the administration of the opioid antagonist. 64
197.020. 1. "Governmental unit" means any county, 1
municipality or other political subdivision or an y 2
department, division, board or other agency of any of the 3
foregoing. 4
2. "Hospital" means a place devoted primarily to the 5
maintenance and operation of facilities for the diagnosis, 6
treatment or care for not less than twenty -four consecutive 7
hours in any week of three or more nonrelated individuals 8
suffering from illness, disease, injury, deformity or other 9
abnormal physical conditions; or a place devoted primarily 10
to provide for not less than twenty -four consecutive hours 11
in any week medical or nursing care for three or more 12
nonrelated individuals. The term "hospital" shall include a 13
facility designated as a rural emergency hospital by the 14
Centers for Medicare and Medicaid Services. The term 15
"hospital" does not include convalescent, nu rsing, shelter 16
or boarding homes as defined in chapter 198. 17
3. "Person" means any individual, firm, partnership, 18
corporation, company or association and the legal successors 19
thereof. 20
208.1032. 1. The department of social servi ces shall 1
be authorized to design and implement in consultation and 2
coordination with eligible providers as described in 3
subsection 2 of this section an intergovernmental transfer 4
program relating to ground emergency medical transport 5
services, including those services provided at the emergency 6
medical responder, emergency medical technician (EMT), 7
advanced EMT, [EMT intermediate,] or paramedic levels in the 8
prestabilization and preparation for transport, in order to 9 HCS SS SB 24 53
increase capitation payments fo r the purpose of increasing 10
reimbursement to eligible providers. 11
2. A provider shall be eligible for increased 12
reimbursement under this section only if the provider meets 13
the following conditions in an applicable state fiscal year: 14
(1) Provides ground emergency medical transportation 15
services to MO HealthNet participants; 16
(2) Is enrolled as a MO HealthNet provider for the 17
period being claimed; and 18
(3) Is owned, operated, or contracted by the state or 19
a political subdivision. 20
3. (1) To the extent intergovernmental transfers are 21
voluntarily made by and accepted from an eligible provider 22
described in subsection 2 of this section or a governmental 23
entity affiliated with an eligible provider, the department 24
of social services shall make increased capitation payments 25
to applicable MO HealthNet eligible providers for covered 26
ground emergency medical transportation services. 27
(2) The increased capitation payments made under this 28
section shall be in amounts at least act uarially equivalent 29
to the supplemental fee -for-service payments and up to 30
equivalent of commercial reimbursement rates available for 31
eligible providers to the extent permissible under federal 32
law. 33
(3) Except as provided in subsection 6 of this 34
section, all funds associated with intergovernmental 35
transfers made and accepted under this section shall be used 36
to fund additional payments to eligible providers. 37
(4) MO HealthNet managed care plans and coordinated 38
care organizations shall pay o ne hundred percent of any 39
amount of increased capitation payments made under this 40
section to eligible providers for providing and making 41 HCS SS SB 24 54
available ground emergency medical transportation and 42
prestabilization services pursuant to a contract or other 43
arrangement with a MO HealthNet managed care plan or 44
coordinated care organization. 45
4. The intergovernmental transfer program developed 46
under this section shall be implemented on the date federal 47
approval is obtained, and only to the extent 48
intergovernmental transfers from the eligible provider, or 49
the governmental entity with which it is affiliated, are 50
provided for this purpose. The department of social 51
services shall implement the intergovernmental transfer 52
program and increased capitation p ayments under this section 53
on a retroactive basis as permitted by federal law. 54
5. Participation in the intergovernmental transfers 55
under this section is voluntary on the part of the 56
transferring entities for purposes of all applicable federal 57
laws. 58
6. As a condition of participation under this section, 59
each eligible provider as described in subsection 2 of this 60
section or the governmental entity affiliated with an 61
eligible provider shall agree to reimburse the department of 62
social services for any costs associated with implementing 63
this section. Intergovernmental transfers described in this 64
section are subject to an administration fee of up to twenty 65
percent of the nonfederal share paid to the department of 66
social services and shall be allowed to count as a cost of 67
providing the services not to exceed one hundred twenty 68
percent of the total amount. 69
7. As a condition of participation under this section, 70
MO HealthNet managed care plans, coordinated care 71
organizations, eligible providers as described in subsection 72
2 of this section, and governmental entities affiliated with 73 HCS SS SB 24 55
eligible providers shall agree to comply with any requests 74
for information or similar data requirements imposed by the 75
department of social services for purposes of obtaining 76
supporting documentation necessary to claim federal funds or 77
to obtain federal approvals. 78
8. This section shall be implemented only if and to 79
the extent federal financial participation is available and 80
is not otherwise jeopa rdized, and any necessary federal 81
approvals have been obtained. 82
9. To the extent that the director of the department 83
of social services determines that the payments made under 84
this section do not comply with federal Medicaid 85
requirements, the dir ector retains the discretion to return 86
or not accept an intergovernmental transfer, and may adjust 87
payments under this section as necessary to comply with 88
federal Medicaid requirements. 89
285.040. 1. As used in this section, "public s afety 1
employee" shall mean a person trained or authorized by law 2
or rule to render emergency medical assistance or treatment, 3
including, but not limited to, firefighters, [ambulance 4
attendants and attendant drivers, ] emergency medical 5
technicians, [emergency medical technician paramedics, ] 6
dispatchers, registered nurses, physicians, and sheriffs and 7
deputy sheriffs. 8
2. No public safety employee of a city not within a 9
county who is hired prior to September 1, 2023, shall be 10
subject to a residency requirement of retaining a primary 11
residence in a city not within a county but may be required 12
to maintain a primary residence located within a one -hour 13
response time. 14
3. Public safety employees of a city not within a 15
county who are hired aft er August 31, 2023, may be subject 16 HCS SS SB 24 56
to a residency rule no more restrictive than a requirement 17
of retaining a primary residence in a city not within a 18
county for a total of seven years and of then allowing the 19
public safety employee to maintain a primar y residence 20
outside the city not within a county so long as the primary 21
residence is located within a one -hour response time. 22
287.067. 1. In this chapter the term "occupational 1
disease" is hereby defined to mean, unless a different 2
meaning is clearly indicated by the context, an identifiable 3
disease arising with or without human fault out of and in 4
the course of the employment. Ordinary diseases of life to 5
which the general public is exposed outside of the 6
employment shall not be compensable, except where the 7
diseases follow as an incident of an occupational disease as 8
defined in this section. The disease need not to have been 9
foreseen or expected but after its contraction it must 10
appear to have had its origin in a risk con nected with the 11
employment and to have flowed from that source as a rational 12
consequence. 13
2. An injury or death by occupational disease is 14
compensable only if the occupational exposure was the 15
prevailing factor in causing both the resulting medic al 16
condition and disability. The "prevailing factor" is 17
defined to be the primary factor, in relation to any other 18
factor, causing both the resulting medical condition and 19
disability. Ordinary, gradual deterioration, or progressive 20
degeneration of the body caused by aging or by the normal 21
activities of day-to-day living shall not be compensable. 22
3. An injury due to repetitive motion is recognized as 23
an occupational disease for purposes of this chapter. An 24
occupational disease due to repetit ive motion is compensable 25
only if the occupational exposure was the prevailing factor 26 HCS SS SB 24 57
in causing both the resulting medical condition and 27
disability. The "prevailing factor" is defined to be the 28
primary factor, in relation to any other factor, causing 29
both the resulting medical condition and disability. 30
Ordinary, gradual deterioration, or progressive degeneration 31
of the body caused by aging or by the normal activities of 32
day-to-day living shall not be compensable. 33
4. "Loss of hearing due to industrial noise" is 34
recognized as an occupational disease for purposes of this 35
chapter and is hereby defined to be a loss of hearing in one 36
or both ears due to prolonged exposure to harmful noise in 37
employment. "Harmful noise" means sound capable of 38
producing occupational deafness. 39
5. "Radiation disability" is recognized as an 40
occupational disease for purposes of this chapter and is 41
hereby defined to be that disability due to radioactive 42
properties or substances or to Roentgen rays (X -rays) or 43
exposure to ionizing radiation caused by any process 44
involving the use of or direct contact with radium or 45
radioactive properties or substances or the use of or direct 46
exposure to Roentgen rays (X -rays) or ionizing radiation. 47
6. Disease of the lungs or respiratory tract, 48
hypotension, hypertension, or disease of the heart or 49
cardiovascular system, including carcinoma, may be 50
recognized as occupational diseases for the purposes of this 51
chapter and are defined to be disability due to exposure to 52
smoke, gases, carcinogens, inadequate oxygen, of paid 53
firefighters of a paid fire department or paid police 54
officers of a paid police department certified under chapter 55
590 if a direct causal relationship is established, or 56
psychological stress of firefighters of a paid fire 57
department or paid peace officers of a police department who 58 HCS SS SB 24 58
are certified under chapter 590 if a direct causal 59
relationship is established. 60
7. Any employee who is exposed to and contracts any 61
contagious or communicabl e disease arising out of and in the 62
course of his or her employment shall be eligible for 63
benefits under this chapter as an occupational disease. 64
8. With regard to occupational disease due to 65
repetitive motion, if the exposure to the repetitive mo tion 66
which is found to be the cause of the injury is for a period 67
of less than three months and the evidence demonstrates that 68
the exposure to the repetitive motion with the immediate 69
prior employer was the prevailing factor in causing the 70
injury, the prior employer shall be liable for such 71
occupational disease. 72
9. (1) (a) Posttraumatic stress disorder (PTSD), as 73
described in the Diagnostic and Statistical Manual of Mental 74
Health Disorders, Fifth Edition, published by the American 75
Psychiatric Association, (DSM -5) is recognized as a 76
compensable occupational disease for purposes of this 77
chapter when diagnosed in a first responder, as that term is 78
defined under section 67.145. 79
(b) Benefits payable to a first responder under this 80
section shall not require a physical injury to the first 81
responder and are not subject to any preexisting PTSD. 82
(c) Benefits payable to a first responder under this 83
section are compensable only if demonstrated by clear and 84
convincing evidence that PTSD has resulted from the course 85
and scope of employment, and the first responder is examined 86
and diagnosed with PTSD by an authorized treating physician, 87
due to the first responder experiencing one of the following 88
qualifying events: 89
a. Seeing for oneself a deceased minor; 90 HCS SS SB 24 59
b. Witnessing directly the death of a minor; 91
c. Witnessing directly the injury to a minor who 92
subsequently died prior to or upon arrival at a hospital 93
emergency department, participating in the physical 94
treatment of, or manually transporting, an injured minor who 95
subsequently died prior to or upon arrival at a hospital 96
emergency department; 97
d. Seeing for oneself a person who has suffered 98
serious physical injury of a nature that shocks the 99
conscience; 100
e. Witnessing directly a death, including suicide, due 101
to serious physical injury; or homicide, including murder, 102
mass killings, manslaughter, self -defense, misadventure, and 103
negligence; 104
f. Witnessing directly an injury that results in 105
death, if the person suffered serious physical injury that 106
shocks the conscience; 107
g. Participating in the physical treatment of an 108
injury, including attempted suicide, or manually 109
transporting an injured person who suffered serious physical 110
injury, if the injured person subsequently died prior to or 111
upon arrival at a hospital emergency department; or, 112
h. Involvement in an event that caused or may have 113
caused serious injury or harm to the first responder or had 114
the potential to cause the death of th e first responder, 115
whether accidental or by an intentional act of another 116
individual. 117
(2) The time for notice of injury or death in cases of 118
compensable PTSD under this section is measured from 119
exposure to one of the qualifying stressors listed i n the 120
DSM-5 criteria, or the diagnosis of the disorder, whichever 121
is later. Any claim for compensation for such injury shall 122 HCS SS SB 24 60
be properly noticed within fifty -two weeks after the 123
qualifying exposure, or the diagnosis of the disorder, 124
whichever is later. 125
287.245. 1. As used in this section, the following 1
terms shall mean: 2
(1) "Association", volunteer fire protection 3
associations as defined in section 320.300; 4
(2) "State fire marshal", the state fire marshal 5
selected under the provisions of sections 320.200 to 320.270; 6
(3) "Volunteer firefighter", the same meaning as in 7
section 287.243; 8
(4) "Voluntary [firefighter cancer] critical illness 9
benefits pool" or "pool", the same meaning as in section 10
320.400. 11
2. (1) Any association may apply to the state fire 12
marshal for a grant for the purpose of funding such 13
association's costs related to workers' compensation 14
insurance premiums for volunteer firefighters. 15
(2) Any voluntary [firefighter cancer] critical 16
illness benefits pool may apply to the state fire marshal 17
for a grant for the [purpose of establishing a ] voluntary 18
[firefighter cancer] critical illness benefits pool. [This 19
subdivision shall expire June 30, 2023. ] 20
3. Subject to appropriations, the state fire marshal 21
may disburse grants to any applying volunteer fire 22
protection association subject to the following schedule: 23
(1) Associations which had zero to five volunteer 24
firefighters receive workers' compensation benefits fr om 25
claims arising out of and in the course of the prevention or 26
control of fire or the underwater recovery of drowning 27
victims in the preceding calendar year shall be eligible for 28
two thousand dollars in grant money; 29 HCS SS SB 24 61
(2) Associations which had si x to ten volunteer 30
firefighters receive workers' compensation benefits from 31
claims arising out of and in the course of the prevention or 32
control of fire or the underwater recovery of drowning 33
victims in the preceding calendar year shall be eligible for 34
one thousand five hundred dollars in grant money; 35
(3) Associations which had eleven to fifteen volunteer 36
firefighters receive workers' compensation benefits from 37
claims arising out of and in the course of the prevention or 38
control of fire or the underwater recovery of drowning 39
victims in the preceding calendar year shall be eligible for 40
one thousand dollars in grant money; 41
(4) Associations which had sixteen to twenty volunteer 42
firefighters receive workers' compensation benefits from 43
claims arising out of and in the course of the prevention or 44
control of fire or the underwater recovery of drowning 45
victims in the preceding calendar year shall be eligible for 46
five hundred dollars in grant money. 47
4. Grant money disbursed under this section shall only 48
be used for the purpose of paying for the workers' 49
compensation insurance premiums of volunteer firefighters or 50
[establishing] for the benefit of a voluntary [firefighter 51
cancer] critical illness benefits pool. 52
287.715. 1. For the purpose of providing for revenue 1
for the second injury fund, every authorized self -insurer, 2
and every workers' compensation policyholder insured 3
pursuant to the provisions of this chapter, shall be liable 4
for payment of an annual sur charge in accordance with the 5
provisions of this section. The annual surcharge imposed 6
under this section shall apply to all workers' compensation 7
insurance policies and self -insurance coverages which are 8
written or renewed on or after April 26, 1988, including the 9 HCS SS SB 24 62
state of Missouri, including any of its departments, 10
divisions, agencies, commissions, and boards or any 11
political subdivisions of the state who self -insure or hold 12
themselves out to be any part self -insured. Notwithstanding 13
any law to the contrary, the surcharge imposed pursuant to 14
this section shall not apply to any reinsurance or 15
retrocessional transaction. 16
2. Beginning October 31, 2005, and each year 17
thereafter, the director of the division of workers' 18
compensation shall e stimate the amount of benefits payable 19
from the second injury fund during the following calendar 20
year and shall calculate the total amount of the annual 21
surcharge to be imposed during the following calendar year 22
upon all workers' compensation policyhol ders and authorized 23
self-insurers. The amount of the annual surcharge 24
percentage to be imposed upon each policyholder and self - 25
insured for the following calendar year commencing with the 26
calendar year beginning on January 1, 2006, shall be set at 27
and calculated against a percentage, not to exceed three 28
percent, of the policyholder's or self -insured's workers' 29
compensation net deposits, net premiums, or net assessments 30
for the previous policy year, rounded up to the nearest one - 31
half of a percentage point, that shall generate, as nearly 32
as possible, one hundred ten percent of the moneys to be 33
paid from the second injury fund in the following calendar 34
year, less any moneys contained in the fund at the end of 35
the previous calendar year. All policyholders and self- 36
insurers shall be notified by the division of workers' 37
compensation within ten calendar days of the determination 38
of the surcharge percent to be imposed for, and paid in, the 39
following calendar year. The net premium equivalent for 40
individual self-insured employers shall be based on average 41 HCS SS SB 24 63
rate classifications calculated by the department of 42
commerce and insurance as taken from premium rates filed by 43
the twenty insurance companies providing the greatest volume 44
of workers' compensa tion insurance coverage in this state. 45
For employers qualified to self -insure their liability 46
pursuant to this chapter, the rates filed by such group of 47
employers in accordance with subsection 4 of section 287.280 48
shall be the net premium equivalent. Any group of political 49
subdivisions of this state qualified to self -insure their 50
liability pursuant to this chapter as authorized by section 51
537.620 may choose either the average rate classification 52
method or the filed rate method, provided that the m ethod 53
used may only be changed once without receiving the consent 54
of the director of the division of workers' compensation. 55
The director may advance funds from the workers' 56
compensation fund to the second injury fund if surcharge 57
collections prove to be insufficient. Any funds advanced 58
from the workers' compensation fund to the second injury 59
fund must be reimbursed by the second injury fund no later 60
than December thirty -first of the year following the 61
advance. The surcharge shall be collected fr om 62
policyholders by each insurer at the same time and in the 63
same manner that the premium is collected, but no insurer or 64
its agent shall be entitled to any portion of the surcharge 65
as a fee or commission for its collection. The surcharge is 66
not subject to any taxes, licenses or fees. 67
3. All surcharge amounts imposed by this section shall 68
be deposited to the credit of the second injury fund. 69
4. Such surcharge amounts shall be paid quarterly by 70
insurers and self-insurers, and insurers sha ll pay the 71
amounts not later than the thirtieth day of the month 72
following the end of the quarter in which the amount is 73 HCS SS SB 24 64
received from policyholders. If the director of the 74
division of workers' compensation fails to calculate the 75
surcharge by the thi rty-first day of October of any year for 76
the following year, any increase in the surcharge ultimately 77
set by the director shall not be effective for any calendar 78
quarter beginning less than sixty days from the date the 79
director makes such determination . 80
5. If a policyholder or self -insured fails to make 81
payment of the surcharge or an insurer fails to make timely 82
transfer to the division of surcharges actually collected 83
from policyholders, as required by this section, a penalty 84
of one-half of one percent of the surcharge unpaid, or 85
untransferred, shall be assessed against the liable 86
policyholder, self-insured or insurer. Penalties assessed 87
under this subsection shall be collected in a civil action 88
by a summary proceeding brought by the dire ctor of the 89
division of workers' compensation. 90
6. Notwithstanding subsection 2 of this section to the 91
contrary, the director of the division of workers' 92
compensation shall collect a supplemental surcharge not to 93
exceed [three] one percent for calendar years 2014 to [2022] 94
2026 of the policyholder's or self -insured's workers' 95
compensation net deposits, net premiums, or net assessments 96
for the previous policy year, rounded up to the nearest [one- 97
half] one-quarter of a percentage point. [For calendar year 98
2023, the director of the division of workers' compensation 99
shall collect a supplemental surcharge not to exceed two and 100
one-half percent of the policyholder's or self -insured's 101
workers' compensation net deposits, net premiums, or net 102
assessments for the previous policy year, rounded up to the 103
nearest one-half of a percentage point. ] All policyholders 104
and self-insurers shall be notified by the division of the 105 HCS SS SB 24 65
supplemental surcharge percentage to be imposed for such 106
period of time as par t of the notice provided in subsection 107
2 of this section. The provisions of this subsection shall 108
expire on December 31, [2023] 2026. 109
7. Funds collected under the provisions of this 110
chapter shall be the sole funding source of the second 111
injury fund. 112
320.336. 1. No public or private employer shall 1
terminate an employee for joining any fire department or 2
fire protection district, including but not limited to any 3
municipal, volunteer, rural, or subscription fire department 4
or organization or any volunteer fire protection 5
association, as a volunteer firefighter, or the Missouri -1 6
Disaster Medical Assistance Team, Missouri Task Force One, 7
or Urban Search and Rescue Team, or being activated to a 8
national disaster response by the Federal Emergency 9
Management Agency (FEMA). 10
2. No public or private employer shall terminate an 11
employee who is a volunteer firefighter, a member of 12
Missouri-1 Disaster Medical Assistance Team, Missouri Task 13
Force One, or Urban Search and Re scue Team because the 14
employee, when acting as a volunteer firefighter, or as a 15
member of Missouri-1 Disaster Medical Assistance Team, 16
Missouri Task Force One, Urban Search and Rescue Team, or 17
FEMA is absent from or late to his or her employment in 18
order to respond to an emergency before the time the 19
employee is to report to his or her place of employment. 20
3. An employer may charge against the employee's 21
regular pay any employment time lost by an employee who is a 22
volunteer firefighter, or a m ember of Missouri-1 Disaster 23
Medical Assistance Team, Missouri Task Force One, Urban 24
Search and Rescue Team, or FEMA because of the employee's 25 HCS SS SB 24 66
response to an emergency in the course of performing his or 26
her duties as a volunteer firefighter, or a membe r of 27
Missouri-1 Disaster Medical Assistance Team, Missouri Task 28
Force One, Urban Search and Rescue Team, or FEMA. 29
4. In the case of an employee who is a volunteer 30
firefighter, or a member of Missouri -1 Disaster Medical 31
Assistance Team, Missouri T ask Force One, Urban Search and 32
Rescue Team, or FEMA and who loses time from his or her 33
employment in order to respond to an emergency in the course 34
of performing his or her duties as a volunteer firefighter, 35
or a member of Missouri -1 Disaster Medical Assistance Team, 36
Missouri Task Force One, Urban Search and Rescue Team, or 37
FEMA, the employer has the right to request the employee to 38
provide the employer with a written statement from the 39
supervisor or acting supervisor of the volunteer fire 40
department or the commander of Missouri -1 Disaster Medical 41
Assistance Team or the FEMA supervisor stating that the 42
employee responded to an emergency and stating the time and 43
date of the emergency. 44
5. An employee who is a volunteer firefighter, or a 45
member of Missouri-1 Disaster Medical Assistance Team, 46
Missouri Task Force One, Urban Search and Rescue Team, or 47
FEMA and who may be absent from or late to his or her 48
employment in order to respond to an emergency in the course 49
of performing his or her du ties as a volunteer firefighter, 50
or a member of Missouri -1 Disaster Medical Assistance Team, 51
Missouri Task Force One, Urban Search and Rescue Team, or 52
FEMA shall make a reasonable effort to notify his or her 53
employer that he or she may be absent or lat e. 54
6. Any member of Missouri Task Force One shall be 55
entitled to the initial employment rights, reemployment 56
rights, retention in employment rights, promotion rights, 57 HCS SS SB 24 67
and discrimination protections provided by Title 38 of the 58
United States Code, the Revised Statutes of Missouri, and 59
all amendments thereto. The attorney general shall enforce 60
the rights and protections contained in this subsection for 61
members of Missouri Task Force One. 62
320.400. 1. For purposes of this secti on, the 1
following terms mean: 2
(1) "Covered individual", a [firefighter] first 3
responder who: 4
(a) Is a paid employee or is a volunteer [firefighter 5
as defined in section 320.333 ]; 6
(b) Has been assigned to at least five years of 7
hazardous duty as a [firefighter] paid employee or volunteer ; 8
(c) Was exposed to [an agent classified by the 9
International Agency for Research on Cancer, or its 10
successor organization, as a group 1 or 2A carcinogen, or 11
classified as a cancer -causing agent by the American Cancer 12
Society, the American Association for Cancer Research, the 13
Agency for Health Care Policy and Research, the American 14
Society for Clinical Oncology, the National Institute for 15
Occupational Safety and Health, or the United States 16
National Cancer Institute ] or diagnosed with a critical 17
illness type; 18
(d) Was last assigned to hazardous duty [as a 19
firefighter] within the previous fifteen years; and 20
(e) In the case of a diagnosis of cancer, is not 21
seventy years of age or older at the time of the diagnosis 22
of cancer; 23
(2) "Critical illness", one of the following: 24
(a) In the case of a cancer claim, exposure to an 25
agent classified by the International Agency for Research on 26
Cancer, or its successor organization , as a group 1 or 2A 27 HCS SS SB 24 68
carcinogen, or classified as a cancer -causing agent by the 28
American Cancer Society, the American Association for Cancer 29
Research, the Agency for Healthcare Research and Quality, 30
the American Society of Clinical Oncology, the Nation al 31
Institute for Occupational Safety and Health, or the United 32
States National Cancer Institute; 33
(b) In the case of a posttraumatic stress injury 34
claim, such an injury that is diagnosed by a psychiatrist 35
licensed pursuant to chapter 334 or a psyc hologist licensed 36
pursuant to chapter 337 and established by a preponderance 37
of the evidence to have been caused by the employment 38
conditions of the first responder; 39
(3) "Dependent", the same meaning as in section 40
287.240; 41
[(3)] (4) "Emergency medical technician -basic", the 42
same meaning as in section 190.100; 43
(5) "Emergency medical technician -paramedic", the same 44
meaning as in section 190.100; 45
(6) "Employer", any political subdivision of the state; 46
[(4)] (7) "First responder", a firefighter, emergency 47
medical technician-basic or emergency medical technician - 48
paramedic, or telecommunicator; 49
(8) "Posttraumatic stress injury", any psychological 50
or behavioral health injury suffered by and through the 51
employment of an individual due to exposure to stressful and 52
life-threatening situations and rigors of the employment, 53
excluding any posttraumatic stress injuries that may arise 54
solely as a result of a legitimate personnel action by an 55
employer such as a transfer, prom otion, demotion, or 56
termination; 57
(9) "Telecommunicator", the same meaning as in section 58
650.320; 59 HCS SS SB 24 69
(10) "Voluntary [firefighter cancer] critical illness 60
benefits pool" or "pool", an entity described in section 61
537.620 that is established for the purposes of this section ; 62
(11) "Volunteer", a volunteer firefighter, as defined 63
in section 320.333; volunteer emergency medical technician - 64
basic; volunteer emergency medical technician -paramedic; or 65
volunteer telecommunicator . 66
2. (1) Three or more employers may create a 67
[voluntary firefighter cancer benefits ] pool for the purpose 68
of this section. Notwithstanding the provisions of sections 69
537.620 to 537.650 to the contrary, a pool created pursuant 70
to this section may allow covered i ndividuals to join the 71
pool. An employer or covered individual may make 72
contributions into the [voluntary firefighter cancer 73
benefits] pool established for the purpose of this section. 74
Any professional organization formed for the purpose, in 75
whole or in part, of representing or providing resources for 76
any covered individual may make contributions to the pool on 77
behalf of any covered individual without the professional 78
organization itself joining the pool. The contribution 79
levels and award levels shall be set by the board of 80
trustees of the pool. 81
(2) For a covered individual or an employer that 82
chooses to make contributions into the [voluntary 83
firefighter cancer benefits ] pool, the pool shall provide 84
the minimum benefits specified by the board of trustees of 85
the pool to covered individuals, based on the award level of 86
the [cancer] critical illness at the time of diagnosis, 87
after the employer or covered individual becomes a 88
participant. 89
(3) Benefit levels for cancer shall be established by 90
the board of trustees of the pool based on the category and 91 HCS SS SB 24 70
stage of the cancer. Benefit levels for a posttraumatic 92
stress injury shall be established by the board of trustees 93
of the pool. Awards of benefits may be made to the same 94
individual for both cancer and posttraumatic stress injury 95
provided the qualifications for both awards are met. 96
(4) In addition to [an] a cancer award pursuant to 97
subdivision (3) of this subsection: 98
(a) A payment may be made from the pool to a cove red 99
individual for the actual award, up to twenty -five thousand 100
dollars, for rehabilitative or vocational training 101
employment services and educational training relating to the 102
cancer diagnosis; 103
(b) A payment may be made to covered individual of u p 104
to ten thousand dollars if the covered individual incurs 105
cosmetic disfigurement costs resulting from cancer. 106
(5) If the cancer is diagnosed as terminal cancer, the 107
covered individual may receive a lump -sum payment of twenty - 108
five thousand dollar s as an accelerated payment toward the 109
benefits due based on the benefit levels established 110
pursuant to subdivision (3) of this subsection. 111
(6) The covered individual may receive additional 112
awards if the cancer increases in award level, but the 113
amount of any benefit paid earlier for the same cancer may 114
be subtracted from the new award. 115
(7) If a covered individual dies while owed benefits 116
pursuant to this section, the benefits shall be paid to the 117
dependent or domestic partner, if any, at the time of 118
death. If there is no dependent or domestic partner, the 119
obligation of the pool to pay benefits shall cease. 120
(8) If a covered individual returns to the same 121
position of employment after a cancer diagnosis, the covered 122 HCS SS SB 24 71
individual may receive benefits in this section for any 123
subsequent new type of covered cancer diagnosis. 124
(9) The cancer benefits payable pursuant to this 125
section shall be reduced by twenty -five percent if a covered 126
individual used a tobacco product within the fi ve years 127
immediately preceding the cancer diagnosis. 128
(10) A cancer claim for benefits from the pool shall 129
be filed no later than two years after the diagnosis of the 130
cancer. The claim for each type of cancer needs to be filed 131
only once to allow the pool to increase the award level 132
pursuant to subdivision (3) of this subsection. 133
(11) A payment may be made from the pool to a covered 134
individual for the actual award, up to ten thousand dollars, 135
for seeking treatment with a psychiatrist licen sed pursuant 136
to chapter 334 or a psychologist licensed pursuant to 137
chapter 337 and any subsequent courses of treatment 138
recommended by such licensed individuals. If a covered 139
individual returns to the same position of employment after 140
a posttraumatic stress injury diagnosis, the covered 141
individual may receive benefits in this section for the 142
continued treatment of such injury or any subsequently 143
covered posttraumatic stress injury diagnosis. 144
(12) For purposes of all other employment policies a nd 145
benefits that are not workers' compensation benefits payable 146
under chapter 287, health insurance, and any benefits paid 147
pursuant to chapter 208, a covered individual's [cancer] 148
critical illness diagnosis shall be treated as an on -the-job 149
injury or illness. 150
3. The board of trustees of [the pool] a pool created 151
pursuant to this section may: 152
(1) Create a program description to further define or 153
modify the benefits of this section; 154 HCS SS SB 24 72
(2) Modify the contribution rates, benefit levels, 155
including the maximum amount, consistent with subdivision 156
(1) of this subsection, and structure of the benefits based 157
on actuarial recommendations and with input from a committee 158
of the pool; and 159
(3) Set a maximum amount of benefits that may be pa id 160
to a covered individual for each [cancer] critical illness 161
diagnosis. 162
4. The board of trustees of the pool shall be 163
considered a public governmental body and shall be subject 164
to all of the provisions of chapter 610. 165
5. A pool may accept or apply for any grants or 166
donations from any private or public source. 167
6. (1) Any pool may apply to the state fire marshal 168
for a grant for the [purpose of establishing a voluntary 169
firefighter cancer benefits ] pool. The state fire marshal 170
shall disburse grants to the pool upon receipt of the 171
application. 172
(2) The state fire marshal may grant money disbursed 173
under section 287.245 to be used for the purpose of setting 174
up a pool. 175
[(3)This subsection shall expire on June 30, 2023. ] 176
7. (1) This [subsection] section shall not affect any 177
determination as to whether a covered individual's [cancer] 178
critical illness arose out of and in the course of 179
employment and is a compensable injury pursuant to chapter 180
287. Receipt of benefits from [the] a pool under this 181
section shall not be considered competent evidence or proof 182
by itself of a compensable injury under chapter 287. 183
(2) Should it be determined that a covered 184
individual's [cancer] critical illness arose out of and in 185
the course of employment and is a compensable injury under 186 HCS SS SB 24 73
chapter 287, the compensation and death benefit provided 187
under chapter 287 shall be reduced one hundred percent by 188
any benefits received from the pool under this section. 189
(3) The employer in any claim made pursuant to chapter 190
287 shall be subrogated to the right of the employee or to 191
the dependent or domestic partner to receive benefits from 192
[the] a pool and such employer may recover any amounts which 193
such employee or the dependent or domestic partner would 194
have been entitled to recover from [the] a pool under this 195
section. Any receipt of benefits from the pool under this 196
section shall be treated as an advance payment by the 197
employer, on account of any future installments of benefi ts 198
payable pursuant to chapter 287. 199
321.225. 1. A fire protection district may, in 1
addition to its other powers and duties, provide emergency 2
ambulance service within its district if a majority of the 3
voters voting thereon approve a proposition to furnish such 4
service and to levy a tax not to exceed thirty cents on the 5
one hundred dollars assessed valuation to be used 6
exclusively to supply funds for the operation of an 7
emergency ambulance service. The district shall exercise 8
the same powers and duties in operating an emergency 9
ambulance service as it does in operating its fire 10
protection service. 11
2. The proposition to furnish emergency ambulance 12
service may be submitted by the board of directors at any 13
municipal general, primary or general election or at any 14
election of the members of the board. 15
3. The question shall be submitted in substantially 16
the following form: 17
Shall the board of directors of ______ Fire 18
Protection District be authorized to provide 19 HCS SS SB 24 74
emergency ambulance service within the district 20
and be authorized to levy a tax not to exceed 21
thirty cents on the one hundred dollars assessed 22
valuation to provide funds for such service? 23
4. If a majority of the voters casting votes thereon 24
be in favor of emergency ambulance service and the levy, the 25
district shall forthwith commence such service. 26
5. As used in this section "emergency" means a 27
situation resulting from a sudden or unforeseen situation or 28
occurrence that requires immediate action to save life or 29
prevent suffering or disability. 30
6. In addition to all other taxes authorized on or 31
before September 1, 1990, the board of directors of any fire 32
protection district may, if a majority of the voters of the 33
district voting thereon approve, levy an additional tax of 34
not more than forty cents per one hundred dollars of 35
assessed valuation to be used for the support of the 36
ambulance service or partial or complete support of [an 37
emergency medical technician defibrillator progra m or 38
partial or complete support of an emergency medical 39
technician] a paramedic first responder program. The 40
proposition to levy the tax authorized by this subsection 41
may be submitted by the board of directors at the next 42
annual election of the memb ers of the board or at any 43
regular municipal or school election conducted by the county 44
clerk or board of election commissioners in such district or 45
at a special election called for the purpose, or upon 46
petition of five hundred registered voters of the district. 47
A separate ballot containing the question shall read as 48
follows: 49 HCS SS SB 24 75
If a majority of the qualified voters casting votes thereon 62
be in favor of the question, the board of directors shall 63
accordingly levy a tax in accordance with th e provisions of 64
this subsection, but if a majority of voters casting votes 65
thereon do not vote in favor of the levy authorized by this 66
subsection, any levy previously authorized shall remain in 67
effect. 68
321.620. 1. Fire protection districts in first class 1
counties may, in addition to their other powers and duties, 2
provide ambulance service within their district if a 3
majority of the voters voting thereon approve a proposition 4
to furnish such service and to levy a tax not to exce ed 5
thirty cents on the one hundred dollars assessed valuation 6
to be used exclusively to supply funds for the operation of 7
an emergency ambulance service. The district shall exercise 8
the same powers and duties in operating an ambulance service 9
as it does in operating its fire protection service. As 10
used in this section "emergency" means a situation resulting 11
from a sudden or unforeseen situation or occurrence that 12
50
51
52
53
54
55
56
57
Shall the board of directors of the ______ Fire
Protection District be authorized to levy an
additional tax of not more than forty cents per one
hundred dollars assessed valuation to provide funds
for the support of an ambulance service or partial or
complete support of an emergency medical technician
defibrillator program or partial or complete support
of an emergency medical technician paramedic first
responder program?
58 â–¡ FOR THE PROPOSITION
59 â–¡ AGAINST THE PROPOSITION
60
61
(Place an X in the square opposite the one for which
you wish to vote.)
HCS SS SB 24 76
requires immediate action to save life or prevent suffering 13
or disability. 14
2. The proposition to furnish ambulance service may be 15
submitted by the board of directors at any municipal 16
general, primary or general election or at any election of 17
the members of the board or upon petition by five hundred 18
voters of such district. 19
3. The question shall be submitted in substantially 20
the following form: 21
Shall the board of directors of ______ Fire 22
Protection District be authorized to provide 23
ambulance service within the district and be 24
authorized to levy a tax not to exceed t hirty 25
cents on the one hundred dollars assessed 26
valuation to provide funds for such service? 27
4. If a majority of the voters casting votes thereon 28
be in favor of ambulance service and the levy, the district 29
shall forthwith commence such service. 30
5. In addition to all other taxes authorized on or 31
before September 1, 1990, the board of directors of any fire 32
protection district may, if a majority of the voters of the 33
district voting thereon approve, levy an additional tax of 34
not more than forty cents per one hundred dollars of 35
assessed valuation to be used for the support of the 36
ambulance service, or partial or complete support of [an 37
emergency medical technician defibrillator program or 38
partial or complete support of an emergency medical 39
technician] a paramedic first responder program. The 40
proposition to levy the tax authorized by this subsection 41
may be submitted by the board of directors at the next 42
annual election of the members of the board or at any 43
regular municipal or school e lection conducted by the county 44 HCS SS SB 24 77
clerk or board of election commissioners in such district or 45
at a special election called for the purpose, or upon 46
petition of five hundred registered voters of the district. 47
A separate ballot containing the question sh all read as 48
follows: 49
If a majority of the qualified voters casting votes thereon 62
be in favor of the question, the board of directors shall 63
accordingly levy a tax in accordance w ith the provisions of 64
this subsection, but if a majority of voters casting votes 65
thereon do not vote in favor of the levy authorized by this 66
subsection, any levy previously authorized shall remain in 67
effect. 68
537.037. 1. Any physician or surgeon, registered 1
professional nurse or licensed practical nurse licensed to 2
practice in this state under the provisions of chapter 334 3
or 335, or licensed to practice under the equivalent laws of 4
any other state and any person licensed as [a mobile] an 5
emergency medical technician under the provisions of chapter 6
190, may: 7
50
51
52
53
54
55
56
57
Shall the board of directors of the ______ Fire
Protection District be authorized to levy an
additional tax of not more than forty cents per one
hundred dollars assessed valuation to provide funds
for the support of an ambulance service or partial or
complete support of an emergency medical technician
defibrillator program or partial or complete support
of an emergency medical technician paramedic first
responder program?
58 â–¡ FOR THE PROPOSITION
59 â–¡ AGAINST THE PROPOSITION
60
61
(Place an X in the square opposite the one for which
you wish to vote).
HCS SS SB 24 78
(1) In good faith render emergency care or assistance, 8
without compensation, at the scene of an emergency or 9
accident, and shall not be liable for any civil damage s for 10
acts or omissions other than damages occasioned by gross 11
negligence or by willful or wanton acts or omissions by such 12
person in rendering such emergency care; 13
(2) In good faith render emergency care or assistance, 14
without compensation, to a ny minor involved in an accident, 15
or in competitive sports, or other emergency at the scene of 16
an accident, without first obtaining the consent of the 17
parent or guardian of the minor, and shall not be liable for 18
any civil damages other than damages occ asioned by gross 19
negligence or by willful or wanton acts or omissions by such 20
person in rendering the emergency care. 21
2. Any other person who has been trained to provide 22
first aid in a standard recognized training program may, 23
without compensation, render emergency care or assistance to 24
the level for which he or she has been trained, at the scene 25
of an emergency or accident, and shall not be liable for 26
civil damages for acts or omissions other than damages 27
occasioned by gross negligence or by willful or wanton acts 28
or omissions by such person in rendering such emergency care. 29
3. Any mental health professional, as defined in 30
section 632.005, or qualified counselor, as defined in 31
section 631.005, or any practicing medical, osteopathic, o r 32
chiropractic physician, or certified nurse practitioner, or 33
physicians' assistant may in good faith render suicide 34
prevention interventions at the scene of a threatened 35
suicide and shall not be liable for any civil damages for 36
acts or omissions othe r than damages occasioned by gross 37
negligence or by willful or wanton acts or omissions by such 38
person in rendering such suicide prevention interventions. 39 HCS SS SB 24 79
4. Any other person may, without compensation, render 40
suicide prevention interventions at th e scene of a 41
threatened suicide and shall not be liable for civil damages 42
for acts or omissions other than damages occasioned by gross 43
negligence or by willful or wanton acts or omissions by such 44
person in rendering such suicide prevention intervention s. 45
579.088. Notwithstanding any other provision of this 1
chapter or chapter 195 to the contrary, it shall not be 2
unlawful to manufacture, possess, sell, deliver, or use any 3
device, equipment, or other material for the purpose of 4
analyzing controlled substances to detect the presence of 5
fentanyl or any synthetic controlled substance fentanyl 6
analogue. 7
595.209. 1. The following rights shall automatically 1
be afforded to victims of dangerous felonies, as defined in 2
section 556.061, victims of murder in the first degree, as 3
defined in section 565.020, victims of voluntary 4
manslaughter, as defined in section 565.023, victims of any 5
offense under chapter 566, victims of an attempt to commit 6
one of the preceding cr imes, as defined in section 562.012, 7
and victims of domestic assault, as defined in sections 8
565.072 to 565.076; and, upon written request, the following 9
rights shall be afforded to victims of all other crimes and 10
witnesses of crimes: 11
(1) For victims, the right to be present at all 12
criminal justice proceedings at which the defendant has such 13
right, including juvenile proceedings where the offense 14
would have been a felony if committed by an adult, even if 15
the victim is called to testify or may be called to testify 16
as a witness in the case; 17
(2) For victims, the right to information about the 18
crime, as provided for in subdivision (5) of this subsection; 19 HCS SS SB 24 80
(3) For victims and witnesses, to be informed, in a 20
timely manner, by the prosec utor's office of the filing of 21
charges, preliminary hearing dates, trial dates, 22
continuances and the final disposition of the case. Final 23
disposition information shall be provided within five days; 24
(4) For victims, the right to confer with and to be 25
informed by the prosecutor regarding bail hearings, guilty 26
pleas, pleas under chapter 552 or its successors, hearings, 27
sentencing and probation revocation hearings and the right 28
to be heard at such hearings, including juvenile 29
proceedings, unless in the determination of the court the 30
interests of justice require otherwise; 31
(5) The right to be informed by local law enforcement 32
agencies, the appropriate juvenile authorities or the 33
custodial authority of the following: 34
(a) The status of any case concerning a crime against 35
the victim, including juvenile offenses; 36
(b) The right to be informed by local law enforcement 37
agencies or the appropriate juvenile authorities of the 38
availability of victim compensation assistance, assistance 39
in obtaining documentation of the victim's losses, 40
including, but not limited to and subject to existing law 41
concerning protected information or closed records, access 42
to copies of complete, unaltered, unedited investigation 43
reports of motor vehicle, pedestrian, and other similar 44
accidents upon request to the appropriate law enforcement 45
agency by the victim or the victim's representative, and 46
emergency crisis intervention services available in the 47
community; 48
(c) Any release of such person on bond or for any 49
other reason; 50 HCS SS SB 24 81
(d) Within twenty-four hours, any escape by such 51
person from a municipal detention facility, county jail, a 52
correctional facility operated by the department of 53
corrections, mental health facility, or the division of 54
youth services or any agency thereof, and any subsequent 55
recapture of such person; 56
(6) For victims, the right to be informed by 57
appropriate juvenile authorities of probation revocation 58
hearings initiated by the juvenile authority and the right 59
to be heard at such hearings or to offer a written 60
statement, video or audio tape, counsel or a representative 61
designated by the victim in lieu of a personal appearance, 62
the right to be informed by the board of probation and 63
parole of probation revocati on hearings initiated by the 64
board and of parole hearings, the right to be present at 65
each and every phase of parole hearings, the right to be 66
heard at probation revocation and parole hearings or to 67
offer a written statement, video or audio tape, couns el or a 68
representative designated by the victim in lieu of a 69
personal appearance, and the right to have, upon written 70
request of the victim, a partition set up in the probation 71
or parole hearing room in such a way that the victim is 72
shielded from the view of the probationer or parolee, and 73
the right to be informed by the custodial mental health 74
facility or agency thereof of any hearings for the release 75
of a person committed pursuant to the provisions of chapter 76
552, the right to be present at such hearings, the right to 77
be heard at such hearings or to offer a written statement, 78
video or audio tape, counsel or a representative designated 79
by the victim in lieu of personal appearance; 80
(7) For victims and witnesses, upon their written 81
request, the right to be informed by the appropriate 82 HCS SS SB 24 82
custodial authority, including any municipal detention 83
facility, juvenile detention facility, county jail, 84
correctional facility operated by the department of 85
corrections, mental health facility, division of youth 86
services or agency thereof if the offense would have been a 87
felony if committed by an adult, postconviction or 88
commitment pursuant to the provisions of chapter 552 of the 89
following: 90
(a) The projected date of such person's release from 91
confinement; 92
(b) Any release of such person on bond; 93
(c) Any release of such person on furlough, work 94
release, trial release, electronic monitoring program, or to 95
a community correctional facility or program or release for 96
any other reason, in advance of such release; 97
(d) Any scheduled parole or release hearings, 98
including hearings under section 217.362, regarding such 99
person and any changes in the scheduling of such hearings. 100
No such hearing shall be conducted without thirty days' 101
advance notice; 102
(e) Within twenty-four hours, any escape by such 103
person from a municipal detention facility, county jail, a 104
correctional facility operated by the department of 105
corrections, mental health facility, or the division of 106
youth services or any agency thereof, and any subsequent 107
recapture of such person; 108
(f) Any decision by a parole board, by a juvenile 109
releasing authority or by a circuit court presiding over 110
releases pursuant to the provisions of chapter 552, or by a 111
circuit court presiding over releases under section 217.362, 112
to release such person or any decision by the governor to 113
commute the sentence of such person or pardon such person; 114 HCS SS SB 24 83
(g) Notification within thirty days of the death of 115
such person; 116
(8) For witnesses who have been summoned by the 117
prosecuting attorney and for victims, to be notified by the 118
prosecuting attorney in a timely manner when a court 119
proceeding will not go on as scheduled; 120
(9) For victims and witnesses, the right to reasonable 121
protection from the defendant or any person acting on behalf 122
of the defendant from harm and threats of harm arising out 123
of their cooperation with law enforcement and prosecution 124
efforts; 125
(10) For victims and witnesses, on charged cases or 126
submitted cases where no charge decision has yet been made, 127
to be informed by the prosecuting attorney of the status of 128
the case and of the availability of victim compensation 129
assistance and of financial assistance and emergency and 130
crisis intervention servic es available within the community 131
and information relative to applying for such assistance or 132
services, and of any final decision by the prosecuting 133
attorney not to file charges; 134
(11) For victims, to be informed by the prosecuting 135
attorney of the right to restitution which shall be 136
enforceable in the same manner as any other cause of action 137
as otherwise provided by law; 138
(12) For victims and witnesses, to be informed by the 139
court and the prosecuting attorney of procedures to be 140
followed in order to apply for and receive any witness fee 141
to which they are entitled; 142
(13) When a victim's property is no longer needed for 143
evidentiary reasons or needs to be retained pending an 144
appeal, the prosecuting attorney or any law enforcement 145
agency having possession of the property shall, upon request 146 HCS SS SB 24 84
of the victim, return such property to the victim within 147
five working days unless the property is contraband or 148
subject to forfeiture proceedings, or provide written 149
explanation of the reason why such property shall not be 150
returned; 151
(14) An employer may not discharge or discipline any 152
witness, victim or member of a victim's immediate family for 153
honoring a subpoena to testify in a criminal proceeding, 154
attending a criminal proceeding, or f or participating in the 155
preparation of a criminal proceeding, or require any 156
witness, victim, or member of a victim's immediate family to 157
use vacation time, personal time, or sick leave for honoring 158
a subpoena to testify in a criminal proceeding, atten ding a 159
criminal proceeding, or participating in the preparation of 160
a criminal proceeding; 161
(15) For victims, to be provided with creditor 162
intercession services by the prosecuting attorney if the 163
victim is unable, as a result of the crime, temporar ily to 164
meet financial obligations; 165
(16) For victims and witnesses, the right to speedy 166
disposition of their cases, and for victims, the right to 167
speedy appellate review of their cases, provided that 168
nothing in this subdivision shall prevent the d efendant from 169
having sufficient time to prepare such defendant's defense. 170
The attorney general shall provide victims, upon their 171
written request, case status information throughout the 172
appellate process of their cases. The provisions of this 173
subdivision shall apply only to proceedings involving the 174
particular case to which the person is a victim or witness; 175
(17) For victims and witnesses, to be provided by the 176
court, a secure waiting area during court proceedings and to 177
receive notification of the date, time and location of any 178 HCS SS SB 24 85
hearing conducted by the court for reconsideration of any 179
sentence imposed, modification of such sentence or recall 180
and release of any defendant from incarceration; 181
(18) For victims, the right to receive upon request 182
from the department of corrections a photograph taken of the 183
defendant prior to release from incarceration. 184
2. The provisions of subsection 1 of this section 185
shall not be construed to imply any victim who is 186
incarcerated by the department of corrections or any local 187
law enforcement agency has a right to be released to attend 188
any hearing or that the department of corrections or the 189
local law enforcement agency has any duty to transport such 190
incarcerated victim to any hearing. 191
3. Those persons entitled to notice of events pursuant 192
to the provisions of subsection 1 of this section shall 193
provide the appropriate person or agency with their current 194
addresses, electronic mail addresses, and telephone numbers 195
or the addresses, electronic mail addresses, or telephone 196
numbers at which they wish notification to be given. 197
4. Notification by the appropriate person or agency 198
utilizing the statewide automated crime victim notification 199
system as established in section 650.310 shall co nstitute 200
compliance with the victim notification requirement of this 201
section. If notification utilizing the statewide automated 202
crime victim notification system cannot be used, then 203
written notification shall be sent by certified mail or 204
electronic mail to the most current address or electronic 205
mail address provided by the victim. 206
5. Victims' rights as established in Section 32 of 207
Article I of the Missouri Constitution or the laws of this 208
state pertaining to the rights of victims of crime sha ll be 209
granted and enforced regardless of the desires of a 210 HCS SS SB 24 86
defendant and no privileges of confidentiality shall exist 211
in favor of the defendant to exclude victims or prevent 212
their full participation in each and every phase of parole 213
hearings or probation revocation hearings. The rights of 214
the victims granted in this section are absolute and the 215
policy of this state is that the victim's rights are 216
paramount to the defendant's rights. The victim has an 217
absolute right to be present at any hearing in which the 218
defendant is present before a probation and parole hearing 219
officer. 220
650.320. For the purposes of sections 650.320 to 1
650.340, the following terms mean: 2
(1) "Ambulance service", the same meaning given to the 3
term in section 190.100; 4
(2) "Board", the Missouri 911 service board 5
established in section 650.325; 6
(3) "Dispatch agency", the same meaning given to the 7
term in section 190.100; 8
(4) "Medical director", the same meaning given to the 9
term in section 190.100; 10
(5) "Memorandum of understanding", the same meaning 11
given to the term in section 190.100; 12
[(2)] (6) "Public safety answering point", the 13
location at which 911 calls are answered; 14
[(3)] (7) "Telecommunicator first responder", any 15
person employed as an emergency [telephone worker,] call 16
taker or public safety dispatcher whose duties include 17
receiving, processing or transmitting public safety 18
information received through a 911 public safety answering 19
point. 20
650.330. 1. The board shall consist of fifteen 1
members, one of which shall be chosen from the department of 2 HCS SS SB 24 87
public safety, and the other members shall be selected as 3
follows: 4
(1) One member chosen to represent an association 5
domiciled in this state whose primary interest relates to 6
municipalities; 7
(2) One member chosen to represent the Missouri 911 8
Directors Association; 9
(3) One member chosen to represent emergency medical 10
services and physicians; 11
(4) One member chosen to represent an association with 12
a chapter domiciled in this state whose primary interest 13
relates to a national emergency number; 14
(5) One member chosen to represent an association 15
whose primary interest relates to issues pertaining to fire 16
chiefs; 17
(6) One member chosen to represent an association with 18
a chapter domiciled in this state whose primary interest 19
relates to issues pertaining to public safety communications 20
officers; 21
(7) One member chosen to represent an association 22
whose primary interest relates to issues pertaining to 23
police chiefs; 24
(8) One member chosen to represent an association 25
domiciled in this state whose primary interest relates to 26
issues pertaining to sheriffs; 27
(9) One member chosen to represent co unties of the 28
second, third, and fourth classification; 29
(10) One member chosen to represent counties of the 30
first classification, counties with a charter form of 31
government, and cities not within a county; 32
(11) One member chosen to represent telecommunications 33
service providers; 34 HCS SS SB 24 88
(12) One member chosen to represent wireless 35
telecommunications service providers; 36
(13) One member chosen to represent voice over 37
internet protocol service providers; and 38
(14) One member chosen to represent the governor's 39
council on disability established under section 37.735. 40
2. Each of the members of the board shall be appointed 41
by the governor with the advice and consent of the senate 42
for a term of four years. Members of the committee may 43
serve multiple terms. No corporation or its affiliate shall 44
have more than one officer, employee, assign, agent, or 45
other representative serving as a member of the board. 46
Notwithstanding subsection 1 of this section to the 47
contrary, all members appointed as of August 28, 2017, shall 48
continue to serve the remainder of their terms. 49
3. The board shall meet at least quarterly at a place 50
and time specified by the chairperson of the board and it 51
shall keep and maintain records of such meetings , as well as 52
the other activities of the board. Members shall not be 53
compensated but shall receive actual and necessary expenses 54
for attending meetings of the board. 55
4. The board shall: 56
(1) Organize and adopt standards governing the board's 57
formal and informal procedures; 58
(2) Provide recommendations for primary answering 59
points and secondary answering points on technical and 60
operational standards for 911 services; 61
(3) Provide recommendations to public agencies 62
concerning model systems to be considered in preparing a 911 63
service plan; 64
(4) Provide requested mediation services to political 65
subdivisions involved in jurisdictional disputes regarding 66 HCS SS SB 24 89
the provision of 911 services, except that the board shall 67
not supersede decision-making authority of local political 68
subdivisions in regard to 911 services; 69
(5) Provide assistance to the governor and the general 70
assembly regarding 911 services; 71
(6) Review existing and proposed legislation and make 72
recommendations as to changes that would improve such 73
legislation; 74
(7) Aid and assist in the timely collection and 75
dissemination of information relating to the use of a 76
universal emergency telephone number; 77
(8) Perform other duties as necessary to promote 78
successful development, implementation and operation of 911 79
systems across the state, including monitoring federal and 80
industry standards being developed for next -generation 911 81
systems; 82
(9) Designate a state 911 coordinator who shall be 83
responsible for overseeing statewide 911 operations and 84
ensuring compliance with federal grants for 911 funding; 85
(10) Elect the chair from its membership; 86
(11) Apply for and receive grants from federal, 87
private, and other sources; 88
(12) Report to the governor and the general assembly 89
at least every three years on the status of 911 services 90
statewide, as well as specific efforts to improve 91
efficiency, cost-effectiveness, and levels of service; 92
(13) Conduct and review an annual survey of public 93
safety answering points in Missouri to evaluate potential 94
for improved services, coordination, and feasibility of 95
consolidation; 96
(14) Make and execute contracts or any other 97
instruments and agreements necessary or convenient for the 98 HCS SS SB 24 90
exercise of its powers and functions, including for the 99
development and implementation of an emergency services 100
internet protocol network that can be shared by all public 101
safety agencies; 102
(15) Develop a plan and timeline of target dates for 103
the testing, implementation, and operation of a next - 104
generation 911 system throughout Missouri. The next- 105
generation 911 system shall allow for the processing of 106
electronic messages including, but not limited to, 107
electronic messages containing text, images, vid eo, or data; 108
(16) Administer and authorize grants and loans under 109
section 650.335 to those counties and any home rule city 110
with more than fifteen thousand but fewer than seventeen 111
thousand inhabitants and partially located in any county of 112
the third classification without a township form of 113
government and with more than thirty -seven thousand but 114
fewer than forty-one thousand inhabitants that can 115
demonstrate a financial commitment to improving 911 services 116
by providing at least a fifty percent match and demonstrate 117
the ability to operate and maintain ongoing 911 services. 118
The purpose of grants and loans from the 911 service trust 119
fund shall include: 120
(a) Implementation of 911 services in counties of the 121
state where services do not exis t or to improve existing 911 122
systems; 123
(b) Promotion of consolidation where appropriate; 124
(c) Mapping and addressing all county locations; 125
(d) Ensuring primary access and texting abilities to 126
911 services for disabled residents; 127
(e) Implementation of initial emergency medical 128
dispatch services, including prearrival medical instructions 129 HCS SS SB 24 91
in counties where those services are not offered as of July 130
1, 2019; and 131
(f) Development and implementation of an emergency 132
services internet protocol network that can be shared by all 133
public safety agencies; 134
(17) Develop an application process including 135
reporting and accountability requirements, withholding a 136
portion of the grant until completion of a project, and 137
other measures to ensure funds are used in accordance with 138
the law and purpose of the grant, and conduct audits as 139
deemed necessary; 140
(18) Set the percentage rate of the prepaid wireless 141
emergency telephone service charges to be remitted to a 142
county or city as prov ided under subdivision (5) of 143
subsection 3 of section 190.460; 144
(19) Retain in its records proposed county plans 145
developed under subsection 11 of section 190.455 and notify 146
the department of revenue that the county has filed a plan 147
that is ready for implementation; 148
(20) Notify any communications service provider, as 149
defined in section 190.400, that has voluntarily submitted 150
its contact information when any update is made to the 151
centralized database established under section 190.475 as a 152
result of a county or city establishing or modifying a tax 153
or monthly fee no less than ninety days prior to the 154
effective date of the establishment or modification of the 155
tax or monthly fee; 156
(21) Establish criteria for consolidation 157
prioritization of public safety answering points; 158
(22) In coordination with existing public safety 159
answering points, by December 31, 2018, designate no more 160
than eleven regional 911 coordination centers which shall 161 HCS SS SB 24 92
coordinate statewide interoperability among pu blic safety 162
answering points within their region through the use of a 163
statewide 911 emergency services network; [and] 164
(23) Establish an annual budget, retain records of all 165
revenue and expenditures made, retain minutes of all 166
meetings and subcomm ittees, post records, minutes, and 167
reports on the board's webpage on the department of public 168
safety website; and 169
(24) Promote and educate the public about the critical 170
role of telecommunicator first responders in protecting the 171
public and ensuring public safety. 172
5. The department of public safety shall provide staff 173
assistance to the board as necessary in order for the board 174
to perform its duties pursuant to sections 650.320 to 175
650.340. The board shall have the authority to hire 176
consultants to administer the provisions of sections 650.320 177
to 650.340. 178
6. The board shall promulgate rules and regulations 179
that are reasonable and necessary to implement and 180
administer the provisions of sections 190.455, 190.460, 181
190.465, 190.470, 19 0.475, and sections 650.320 to 650.340. 182
Any rule or portion of a rule, as that term is defined in 183
section 536.010, shall become effective only if it has been 184
promulgated pursuant to the provisions of chapter 536. This 185
section and chapter 536 are nons everable and if any of the 186
powers vested with the general assembly pursuant to chapter 187
536 to review, to delay the effective date or to disapprove 188
and annul a rule are subsequently held unconstitutional, 189
then the grant of rulemaking authority and any r ule proposed 190
or adopted after August 28, 2017, shall be invalid and void. 191
650.335. 1. (1) Any county or any home rule city 1
with more than fifteen thousand but fewer than seventeen 2 HCS SS SB 24 93
thousand inhabitants and partially located in any c ounty of 3
the third classification without a township form of 4
government and with more than thirty -seven thousand but 5
fewer than forty-one thousand inhabitants, or a regional 6
planning commission as defined in section 70.515 that 7
provides emergency tele phone service to multiple counties, 8
when the prepaid wireless emergency telephone service charge 9
is collected in the county or city, may submit an 10
application for loan funds or other financial assistance to 11
the board for the purpose of financing all or a portion of 12
the costs incurred in implementing a 911 communications 13
service project. If a county has an elected emergency 14
services board, the elected emergency service board shall be 15
eligible for loan funds or other financial assistance under 16
this section. 17
(2) The application shall be accompanied by a 18
technical assistance report. The application and the 19
technical assistance report shall be in such form and 20
contain such information, financial or otherwise, as 21
prescribed by the board. 22
(3) This section shall not preclude any applicant or 23
borrower from joining in a cooperative project with any 24
other political subdivision or with any state or federal 25
agency or entity in a 911 communications service project, 26
provided that all other req uirements of this section have 27
been met. 28
2. Applications may be approved for loans only in 29
those instances where the applicant has furnished the board 30
information satisfactory to assure that the project cost 31
will be recovered during the repayment period of the loan. 32
In no case shall a loan be made to an applicant unless the 33
approval of the governing body of the applicant to the loan 34 HCS SS SB 24 94
agreement is obtained and a written certification of such 35
approval is provided, where applicable. Repayment periods 36
are to be determined by the board. 37
3. The board shall approve or disapprove all 38
applications for loans which are sent by certified or 39
registered mail or hand delivered and received by the board 40
upon a schedule as determined by the board. 41
4. Each applicant to whom a loan has been made under 42
this section shall repay such loan, with interest. The rate 43
of interest shall be the rate required by the board. The 44
number, amounts, and timing of the payments shall be as 45
determined by the bo ard. 46
5. Any applicant who receives a loan under this 47
section shall annually budget an amount which is at least 48
sufficient to make the payments required under this section. 49
6. Repayment of principal and interest on loans shall 50
be credited to the Missouri 911 service trust fund 51
established under section 190.420. 52
7. If a loan recipient fails to remit a payment to the 53
board in accordance with this section within sixty days of 54
the due date of such payment, the board shall notify the 55
director of the department of revenue to deduct such payment 56
amount from first, the prepaid wireless emergency telephone 57
service charge remitted to the county or city under section 58
190.460; and if insufficient to affect repayment of the 59
loan, next, the regular apportionment of local sales tax 60
distributions to that county or city. Such amount shall 61
then immediately be deposited in the Missouri 911 service 62
trust fund and credited to the loan recipient. 63
8. All applicants having received loans under t his 64
section shall remit the payments required by subsection 4 of 65
this section to the board or such other entity as may be 66 HCS SS SB 24 95
directed by the board. The board or such other entity shall 67
immediately deposit such payments in the Missouri 911 68
service trust fund. 69
9. Loans made under this section shall be used only 70
for the purposes specified in an approved application or 71
loan agreement. In the event the board determines that loan 72
funds have been expended for purposes other than those 73
specified in an approved application or loan agreement or 74
any event of default of the loan agreement occurs without 75
resolution, the board shall take appropriate actions to 76
obtain the return of the full amount of the loan and all 77
moneys duly owed or other available re medies. 78
10. Upon failure of a borrower to remit repayment to 79
the board within sixty days of the date a payment is due, 80
the board may initiate collection or other appropriate 81
action through the provisions outlined in subsection 7 of 82
this section, if applicable. 83
11. If the borrower is an entity not covered under the 84
collection procedures established in this section, the 85
board, with the advice and consent of the attorney general, 86
may initiate collection procedures or other appropriate 87
action pursuant to applicable law. 88
12. The board may, at its discretion, audit the 89
expenditure of any loan, grant, or expenditure made or the 90
computation of any payments made. 91
13. The board shall not approve any application made 92
under this section if the applicant has failed to return the 93
board's annual survey of public safety answering points as 94
required by the board under section 650.330. 95
650.340. 1. The provisions of this section may be 1
cited and shall be known as the "9 11 Training and Standards 2
Act". 3 HCS SS SB 24 96
2. Initial training requirements for 4
[telecommunicators] telecommunicator first responders who 5
answer 911 calls that come to public safety answering points 6
shall be as follows: 7
(1) Police telecommunicator first responder, 16 hours; 8
(2) Fire telecommunicator first responder, 16 hours; 9
(3) Emergency medical services telecommunicator first 10
responder, 16 hours; 11
(4) Joint communication center telecommunicator first 12
responder, 40 hours. 13
3. All persons employed as a telecommunicator first 14
responder in this state shall be required to complete 15
ongoing training so long as such person engages in the 16
occupation as a telecommunicator first responder. Such 17
persons shall complete at least twenty -four hours of ongoing 18
training every three years by such persons or organizations 19
as provided in subsection 6 of this section. 20
4. Any person employed as a telecommunicator on August 21
28, 1999, shall not be required to complete the training 22
requirement as provided in subsection 2 of this section. 23
Any person hired as a telecommunicator or a telecommunicator 24
first responder after August 28, 1999, shall complete the 25
training requirements as provided in subsection 2 of this 26
section within twelve m onths of the date such person is 27
employed as a telecommunicator or telecommunicator first 28
responder. 29
5. The training requirements as provided in subsection 30
2 of this section shall be waived for any person who 31
furnishes proof to the committee that such person has 32
completed training in another state which is at least as 33
stringent as the training requirements of subsection 2 of 34
this section. 35 HCS SS SB 24 97
6. The board shall determine by administrative rule 36
the persons or organizations authorized to condu ct the 37
training as required by subsection 2 of this section. 38
7. [This section shall not apply to an emergency 39
medical dispatcher or agency as defined in section 190.100, 40
or a person trained by an entity accredited or certified 41
under section 190.131, or a person who provides prearrival 42
medical instructions who works for an agency which meets the 43
requirements set forth in section 190.134. ] The board shall 44
be responsible for the approval of training courses for 45
emergency medical dispatchers. The board shall develop 46
necessary rules and regulations in collaboration with the 47
state EMS medical director's advisory committee, as 48
described in section 190.103, which may provide 49
recommendations relating to the medical aspects of 50
prearrival medical in structions. 51
8. A dispatch agency is required to have a memorandum 52
of understanding with all ambulance services that it 53
dispatches. If a dispatch agency provides prearrival 54
medical instructions, it is required to have a medical 55
director whose duties include the maintenance of standards 56
and approval of protocols or guidelines. 57
Section 1. The department of health and senior 1
services shall include on its website an advance health care 2
directive form and directions for completi ng such form as 3
described in section 459.015. The department shall include 4
a listing of possible uses for an advance health care 5
directive, including to limit pain control to nonopioid 6
measures. 7
[190.134. A dispatch agency is requi red to 1
have a memorandum of understanding with all 2
ambulance services that it dispatches. If a 3
dispatch agency provides prearrival medical 4
instructions, it is required to have a medical 5 HCS SS SB 24 98
director, whose duties include the maintenance 6
of standards and protocol approval.] 7
