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Missouri Senate Bill SB1382

Missouri 2024 Regular Session

Missouri Senate Bill SB1382 Compare Versions

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1-5374S.02C
2- 1
3-SENATE COMMITTEE SUBSTITUTE
4-FOR
1+
2+EXPLANATION-Matter enclosed in bold-faced brackets [thus] in this bill is not enacted
3+and is intended to be omitted in the law.
4+SECOND REGULAR SESSION
55 SENATE BILL NO. 1382
6+102ND GENERAL ASSEMBLY
7+INTRODUCED BY SENATOR WASHINGTON.
8+5374S.01I KRISTINA MARTIN, Secretary
69 AN ACT
7-To repeal sections 190.053, 190.098, 190.101, and
8-190.109, RSMo, and to enact in lieu thereof seven new
9-sections relating to emergency medical services.
10+To repeal section 190.098, RSMo, and to enact in lieu thereof one new section relating to
11+community paramedics.
1012
1113 Be it enacted by the General Assembly of the State of Missouri, as follows:
12- Section A. Sections 190.053, 190.098, 190.101, and
13-190.109, RSMo, are repealed and seven new sections enacted in
14-lieu thereof, to be known as sections 190.053, 190.076, 190.098,
15-190.101, 190.109, 190.112, and 190.166, to read as follows:
16- 190.053. 1. All members of the board of directors of
17-an ambulance district first elected on or after January 1,
18-2008, shall attend and complete an educational seminar or
19-conference or other suitable training on the role and duties
20-of a board member of an a mbulance district. The training
21-required under this section shall be offered by a statewide
22-association organized for the benefit of ambulance districts
23-or be approved by the state advisory council on emergency
24-medical services. Such training shall i nclude, at a minimum:
25- (1) Information relating to the roles and duties of an
26-ambulance district director;
27- (2) A review of all state statutes and regulations
28-relevant to ambulance districts;
29- (3) State ethics laws;
30- (4) State sunshine laws, chapter 610;
31- (5) Financial and fiduciary responsibility;
32- (6) State laws relating to the setting of tax rates;
33-and
34- (7) State laws relating to revenue limitations.
35- 2
36- 2. [If any ambulance district board member fails to
37-attend a training session within twelve months after taking
38-office, the board member shall not be compensated for
39-attendance at meetings thereafter until the board member has
40-completed such training session. If any ambulance district
41-board member fails to att end a training session within
42-twelve months of taking office regardless of whether the
43-board member received an attendance fee for a training
44-session, the board member shall be ineligible to run for
45-reelection for another term of office until the board member
46-satisfies the training requirement of this section; however,
47-this requirement shall only apply to board members elected
48-after August 28, 2022 ] All members of the board of directors
49-of an ambulance district shall complete three hours of
50-continuing education for each term of office. The
51-continuing education shall be offered by a statewide
52-association organized for the benefit of ambulance districts
53-or be approved by the state advisory council on emergency
54-medical services.
55- 3. Any ambulance district board member who fails to
56-complete the initial training and continuing education
57-requirements on or before the anniversary date of his or her
58-election or appointment shall immediately be disqualified
59-from office and his or her position sh all be vacant without
60-further process or declaration. The vacancy shall be filled
61-in the manner provided for pursuant to section 190.052 .
62- 190.076. Each ambulance district shall arrange for an
63-audit of the records and accounts of the di strict at least
64-every three years by a certified public accountant or firm
65-of certified public accountants. The audit shall be made
66-available to the public on the district's website or
67-otherwise freely available by other electronic means.
68- 3
69- 190.098. 1. In order for a person to be eligible for
70-certification by the department as a community paramedic, an
71-individual shall:
72- (1) Be currently [certified] licensed as a paramedic;
73- (2) Successfully complete or have successfully
74-completed a community paramedic certification program from a
75-college, university, or educational institution that has
76-been approved by the department or accredited by a national
77-accreditation organization approved by the department; and
78- (3) Complete an application form approved by the
79-department.
80- 2. [A community paramedic shall practice in accordance
81-with protocols and supervisory standards established by the
82-medical director. A community paramedic shall provide
83-services of a health care p lan if the plan has been
84-developed by the patient's physician or by an advanced
85-practice registered nurse through a collaborative practice
86-arrangement with a physician or a physician assistant
87-through a collaborative practice arrangement with a
88-physician and there is no duplication of services to the
89-patient from another provider.
90- 3. Any ambulance service shall enter into a written
91-contract to provide community paramedic services in another
92-ambulance service area, as that term is defined in se ction
93-190.100. The contract that is agreed upon may be for an
94-indefinite period of time, as long as it includes at least a
95-sixty-day cancellation notice by either ambulance service. ]
96-As used in this section, the term "community paramedic
97-services" shall mean services provided by any entity that
98-employs licensed paramedics who are certified by the
99-department as community paramedics for services that are:
100- 4
101- (1) Provided in a nonemergent setting that is
102-independent of an emergency telephone servic e, 911 system,
103-or emergency summons;
104- (2) Consistent with the training and education
105-requirements described in subdivision (2) of subsection 1 of
106-this section, the scope of skill and practice for community
107-paramedics, and the supervisory standard approved by the
108-entity's medical director; and
109- (3) Reflected and documented in the entity's medical
110-director-approved patient care plans or protocols in
111-accordance with the provisions of section 190.142.
112- 3. (1) Any ambulance service that se eks to provide
113-community paramedic services outside of the ambulance
114-service's service area:
115- (a) Shall have a memorandum of understanding (MOU)
116-regarding the provision of such services with the ambulance
117-service in that service area if that ambul ance service is
118-already providing community paramedic services; or
119- (b) Shall not be required to have an MOU with the
120-ambulance service in that service area if that ambulance
121-service is not already providing community paramedic
122-services, provided that the ambulance service seeking to
123-provide such services shall provide notification to the
124-other ambulance service of the community paramedic services
125-to be provided.
126- (2) Any emergency medical response agency (EMRA) that
127-seeks to provide commu nity paramedic services within its
128-designated response service area may do so if the ground
129-ambulance service area within which the EMRA operates does
130-not already provide such services. If the ground ambulance
131-service does provide community paramedic services, then the
132-ground ambulance service may enter into an MOU with the EMRA
133-in order to coordinate programs and avoid service
134- 5
135-duplication. If the EMRA provides community paramedic
136-services in the ground ambulance service's service area
137-prior to the provision of such services by the ground
138-ambulance service, then the EMRA and the ground ambulance
139-service shall enter into an MOU for the coordination of
140-services.
141- (3) Any community paramedic program shall notify the
142-appropriate local ambulan ce service when providing services
143-within the service area of an ambulance service.
144- (4) The department shall promulgate rules and
145-regulations for the purpose of recognizing which community
146-paramedic services entities have met the standards necessa ry
147-to provide community paramedic services, including, but not
148-limited to, physician medical oversight, training, patient
149-record retention, formal relationships with primary care
150-services as needed, and quality improvement policies.
151-Community paramedic services entities shall be certified by
152-the department, allowing such entities to provide community
153-paramedic services for a period of five years.
154- 4. A community paramedic is subject to the provisions
155-of sections 190.001 to 190.245 and rules pr omulgated under
156-sections 190.001 to 190.245.
157- 5. No person shall hold himself or herself out as a
158-community paramedic or provide the services of a community
159-paramedic unless such person is certified by the department.
160- 6. The medical director shall approve the
161-implementation of the community paramedic program.
162- 7. Any rule or portion of a rule, as that term is
163-defined in section 536.010, that is created under the
164-authority delegated in this section shall become effective
165-only if it complies with and is subject to all of the
166-provisions of chapter 536 and, if applicable, section
167-536.028. This section and chapter 536 are nonseverable and
168- 6
169-if any of the powers vested with the general assembly
170-pursuant to chapter 536 to review, to delay the effective
171-date, or to disapprove and annul a rule are subsequently
172-held unconstitutional, then the grant of rulemaking
173-authority and any rule proposed or adopted after August 28,
174-2013, shall be invalid and void.
175- 190.101. 1. There is hereby established a "State
176-Advisory Council on Emergency Medical Services" which shall
177-consist of [sixteen] no more than twenty-three members[, one
178-of which shall be a resident of a city not within a
179-county]. The members of the council shall be ap pointed [by
180-the governor with the advice and consent of the senate ]
181-pursuant to subsection 2 of this subsection and shall serve
182-terms of four years. The [governor shall designate one of
183-the members as chairperson ] council members shall annually
184-select a chairperson, along with other officers as the
185-council deems necessary . The chairperson may appoint
186-subcommittees that include noncouncil members.
187- 2. Council members shall be appointed as follows:
188- (1) The director of the department of hea lth and
189-senior services shall make appointments to the council from
190-the recommendations provided by the following:
191- (a) The statewide professional association
192-representing ambulance service managers;
193- (b) The statewide professional association
194-representing EMT's and paramedics;
195- (c) The statewide professional association
196-representing ambulance districts;
197- (d) The statewide professional association
198-representing fire chiefs;
199- (e) The statewide professional association
200-representing fire protection districts;
201- 7
202- (f) The statewide professional association
203-representing firefighters;
204- (g) The statewide professional association
205-representing emergency nurses;
206- (h) The statewide professional association
207-representing the air ambulance industry;
208- (i) The statewide professional association
209-representing emergency medicine physicians;
210- (j) The statewide association representing hospitals;
211-and
212- (k) The statewide association representing pediatric
213-emergency professionals;
214- (2) The director of health and senior services shall
215-appoint a member to the council with a background in mobile
216-integrated healthcare -community paramedicine (MIH -CP);
217- (3) Each regional EMS advisory committee shall appoint
218-one member; and
219- (4) The time-critical diagnosis advisory committee
220-established under section 190.257 shall appoint one member.
221- 3. The state EMS medical directors advisory committee
222-and the regional EMS advisory committees will be recognized
223-as subcommittees of the state advisory council on emergency
224-medical services.
225- [3.] 4. The council shall have geographical
226-representation and representation from appropriate areas of
227-expertise in emergency medical services including
228-volunteers, professi onal organizations involved in emergency
229-medical services, EMT's, paramedics, nurses, firefighters,
230-physicians, ambulance service administrators, hospital
231-administrators and other health care providers concerned
232-with emergency medical services. [The regional EMS advisory
233-committees shall serve as a resource for the identification
234- 8
235-of potential members of the state advisory council on
236-emergency medical services.
237- 4.] 5. The state EMS medical director, as described
238-under section 190.103, shall se rve as an ex officio member
239-of the council.
240- [5.] 6. The members of the council and subcommittees
241-shall serve without compensation except that members of the
242-council shall, subject to appropriations, be reimbursed for
243-reasonable travel expenses an d meeting expenses related to
244-the functions of the council.
245- [6.] 7. The purpose of the council is to make
246-recommendations to the governor, the general assembly, and
247-the department on policies, plans, procedures and proposed
248-regulations on how to improve the statewide emergency
249-medical services system. The council shall advise the
250-governor, the general assembly, and the department on all
251-aspects of the emergency medical services system.
252- [7.] 8. (1) There is hereby established a standing
253-subcommittee of the council to monitor the implementation of
254-the recognition of the EMS personnel licensure interstate
255-compact under sections 190.900 to 190.939, the interstate
256-commission for EMS personnel practice, and the involvement
257-of the state of Missouri. The subcommittee shall meet at
258-least biannually and receive reports from the Missouri
259-delegate to the interstate commission for EMS personnel
260-practice. The subcommittee shall consist of at least seven
261-members appointed by the chair of the council, to include at
262-least two members as recommended by the Missouri state
263-council of firefighters and one member as recommended by the
264-Missouri Association of Fire Chiefs. The subcommittee may
265-submit reports and recommendations to the council, the
266-department of health and senior services, the general
267-assembly, and the governor regarding the participation of
268- 9
269-Missouri with the recognition of the EMS personnel licensure
270-interstate compact.
271- (2) The subcommittee shall formally request a public
272-hearing for any rule proposed by the interstate commission
273-for EMS personnel practice in accordance with subsection 7
274-of section 190.930. The hearing request shall include the
275-request that the hearing be presented live through the
276-internet. The Missouri delegate to the interstate
277-commission for EMS personnel practice shall be responsible
278-for ensuring that all hearings, notices of, and related
279-rulemaking communications as required by the compact be
280-communicated to the council and emergency medica l services
281-personnel under the provisions of subsections 4, 5, 6, and 8
282-of section 190.930.
283- (3) The department of health and senior services shall
284-not establish or increase fees for Missouri emergency
285-medical services personnel licensure in accor dance with this
286-chapter for the purpose of creating the funds necessary for
287-payment of an annual assessment under subdivision (3) of
288-subsection 5 of section 190.924.
289- [8.] 9. The council shall consult with the time -
290-critical diagnosis advisory comm ittee, as described under
291-section 190.257, regarding time -critical diagnosis.
292- 190.109. 1. The department shall, within a reasonable
293-time after receipt of an application, cause such
294-investigation as the department deems necessary to be made
295-of the applicant for a ground ambulance license.
296- 2. Any person that owned and operated a licensed
297-ambulance on December 31, 1997, shall receive an ambulance
298-service license from the department, unless suspended,
299-revoked or terminated, for th at ambulance service area which
300-was, on December 31, 1997, described and filed with the
301-department as the primary service area for its licensed
302- 10
303-ambulances on August 28, 1998, provided that the person
304-makes application and adheres to the rules and regul ations
305-promulgated by the department pursuant to sections 190.001
306-to 190.245.
307- 3. The department shall issue a new ground ambulance
308-service license to an ambulance service that is not
309-currently licensed by the department, or is currently
310-licensed by the department and is seeking to expand its
311-ambulance service area, except as provided in subsection 4
312-of this section, to be valid for a period of five years,
313-unless suspended, revoked or terminated, when the director
314-finds that the applicant meet s the requirements of ambulance
315-service licensure established pursuant to sections 190.100
316-to 190.245 and the rules adopted by the department pursuant
317-to sections 190.001 to 190.245. In order to be considered
318-for a new ambulance service license, an am bulance service
319-shall submit to the department a letter of endorsement from
320-each ambulance district or fire protection district that is
321-authorized to provide ambulance service, or from each
322-municipality not within an ambulance district or fire
323-protection district that is authorized to provide ambulance
324-service, in which the ambulance service proposes to
325-operate. If an ambulance service proposes to operate in
326-unincorporated portions of a county not within an ambulance
327-district or fire protection di strict that is authorized to
328-provide ambulance service, in order to be considered for a
329-new ambulance service license, the ambulance service shall
330-submit to the department a letter of endorsement from the
331-county. Any letter of endorsement required pur suant to this
332-section shall verify that the political subdivision has
333-conducted a public hearing regarding the endorsement and
334-that the governing body of the political subdivision has
335-adopted a resolution approving the endorsement. The letter
336- 11
337-of endorsement shall affirmatively state that the proposed
338-ambulance service:
339- (1) Will provide a benefit to public health that
340-outweighs the associated costs;
341- (2) Will maintain or enhance the public's access to
342-ambulance services;
343- (3) Will maintain or improve the public health and
344-promote the continued development of the regional emergency
345-medical service system;
346- (4) Has demonstrated the appropriate expertise in the
347-operation of ambulance services; and
348- (5) Has demonstrated the f inancial resources necessary
349-for the operation of the proposed ambulance service.
350- 4. A contract between a political subdivision and a
351-licensed ambulance service for the provision of ambulance
352-services for that political subdivision shall expand,
353-without further action by the department, the ambulance
354-service area of the licensed ambulance service to include
355-the jurisdictional boundaries of the political subdivision.
356-The termination of the aforementioned contract shall result
357-in a reduction of the licensed ambulance service's ambulance
358-service area by removing the geographic area of the
359-political subdivision from its ambulance service area,
360-except that licensed ambulance service providers may provide
361-ambulance services as are needed at and around the state
362-fair grounds for protection of attendees at the state fair.
363- 5. The department shall renew a ground ambulance
364-service license if the applicant meets the requirements
365-established pursuant to sections 190.001 to 190.245, and the
366-rules adopted by the department pursuant to sections 190.001
367-to 190.245.
368- 12
369- 6. The department shall promulgate rules relating to
370-the requirements for a ground ambulance service license
371-including, but not limited to:
372- (1) Vehicle design, specificati on, operation and
373-maintenance standards;
374- (2) Equipment requirements;
375- (3) Staffing requirements;
376- (4) Five-year license renewal;
377- (5) Records and forms;
378- (6) Medical control plans;
379- (7) Medical director qualifications;
380- (8) Standards for medical communications;
381- (9) Memorandums of understanding with emergency
382-medical response agencies that provide advanced life support;
383- (10) Quality improvement committees; [and]
384- (11) Response time, patient care and tran sportation
385-standards;
386- (12) Participation with regional emergency medical
387-services advisory committees; and
388- (13) Ambulance service administrator qualifications .
389- 7. Application for a ground ambulance service license
390-shall be made upon su ch forms as prescribed by the
391-department in rules adopted pursuant to sections 190.001 to
392-190.245. The application form shall contain such
393-information as the department deems necessary to make a
394-determination as to whether the ground ambulance service
395-meets all the requirements of sections 190.001 to 190.245
396-and rules promulgated pursuant to sections 190.001 to
397-190.245.
398- 190.112. 1. Each ambulance service licensed under
399-this chapter shall identify to the department the individual
400-serving as the ambulance service administrator who is
401-responsible for the operations and staffing of the ambulance
402- 13
403-service. The ambulance service administrator shall be
404-required to have achieved basic training of at least forty
405-hours regarding the ope rations of an ambulance service and
406-two hours of annual continuing education. The training
407-required under this section shall be offered by a statewide
408-association organized for the benefit of ambulance districts
409-or be approved by the state advisory co uncil on emergency
410-medical services and shall include the following:
411- (1) Basic principles of accounting and economics;
412- (2) State and federal laws applicable to ambulance
413-services;
414- (3) Regulatory requirements applicable to ambulance
415-services;
416- (4) Human resources management and laws;
417- (5) Grant writing, contracts, and fundraising;
418- (6) State sunshine laws in chapter 610, as well as
419-applicable ethics requirements; and
420- (7) Volunteer and community involvement.
421- 2. Ambulance service administrators serving in this
422-capacity as of August 28, 2024, shall have until January 1,
423-2026, to demonstrate compliance with the provisions of this
424-section.
425- 190.166. 1. In addition to the provisions of section
426-190.165, the department of health and senior services may
427-refuse to issue, deny renewal of, or suspend a license
428-required pursuant to section 190.109, or take other
429-corrective actions as described in this section, based on
430-the following considerations:
431- (1) The license holder is determined to be financially
432-insolvent;
433- (2) The ambulance service has inadequate personnel to
434-operate the ambulance service to provide for basic emergency
435-operations, determined by the ability to staff a minimum of
436- 14
437-one ambulance unit twenty -four hours per day, seven days per
438-week, with at least two licensed emergency medical
439-technicians and a reasonable plan and schedule for the
440-services of a second ambulance;
441- (3) The ambulance service requires an inordinate
442-amount of mutual aid from neighboring services, such as more
443-than ten percent of the total runs in the service area in
444-any given month, or than would be considered prudent and
445-thus cannot provide an appropriate level of emergency
446-response for the ser vice area as would be considered prudent
447-by the typical ground ambulance services operator;
448- (4) The principal manager, board members, or other
449-executives are determined to be criminally liable for
450-actions related to the license or service provided ;
451- (5) The license holder or principal manager, board
452-members, or other executives are determined by the Centers
453-for Medicare and Medicaid Services to be ineligible for
454-participation in Medicare;
455- (6) The license holder or principal manager, b oard
456-members, or other executives are determined by the MO
457-HealthNet division to be ineligible for participation in MO
458-HealthNet;
459- (7) The ambulance service administrator has failed to
460-meet the required qualifications or failed to complete the
461-training required pursuant to section 190.112; and
462- (8) Three or more board members have failed to
463-complete required training pursuant to section 190.053 if
464-the ambulance service is an ambulance district.
465- 2. If the department makes a determinati on of
466-insolvency or insufficiency of operations of a license
467-holder under subsection 1 of this section, then the
468-department may require the license holder to submit a
469- 15
470-corrective plan within fifteen days and require
471-implementation of the corrective pla n within thirty days.
472- 3. The department shall be required to provide notice
473-of any determination by the department of insolvency or
474-insufficiency of operations of a license holder to other
475-license holders operating in the license holder's vicinity ,
476-members of the general assembly who represent the license
477-holder's service area, the governing officials of any county
478-or municipal entity in the license holder's service area,
479-the appropriate regional emergency medical services advisory
480-committee, and the state advisory council on emergency
481-medical services.
482- 4. The department shall immediately engage with other
483-license holders in the area to determine the extent to which
484-ground ambulance service may be provided to the affected
485-service area during the time in which the license holder is
486-unable to provide adequate services, including any long -term
487-service arrangements. The nature of the agreement between
488-the license holder and other license holders providing
489-services to the affected area may include an agreement to
490-provide services, a joint powers agreement, formal
491-consideration, or some payment for services rendered.
492- 5. Any license holder who provides assistance in the
493-service area of another license holder whose license has
494-been suspended under this section shall have the right to
495-seek reasonable compensation from the license holder whose
496-license to operate has been suspended for all calls, stand -
497-by time, and responses to medical emergencies during such
498-time as the license remains suspended. The reasonable
499-compensation shall not be limited to those expenses incurred
500-in actual responses, but may also include reasonable
501-expenses to maintain ambulance service, including, but not
502-limited to, the daily operation costs of mai ntaining the
503- 16
504-service, personnel wages and benefits, equipment purchases
505-and maintenance, and other costs incurred in the operation
506-of a ground ambulance service. The license holder providing
507-assistance shall be entitled to an award of costs and
508-reasonable attorney fees in any action to enforce the
509-provisions of this subsection.
14+ Section A. Section 190.098, RSMo, is repealed and one new 1
15+section enacted in lieu thereof, to be known as section 190.098, 2
16+to read as follows:3
17+ 190.098. 1. In order for a person to be eligible for 1
18+certification by the department as a community paramedic, an 2
19+individual shall: 3
20+ (1) Be currently [certified] licensed as a paramedic; 4
21+ (2) Successfully complete or have successfully 5
22+completed a community paramedic certification program from a 6
23+college, university, or educational institution that has 7
24+been approved by the department or accredited by a national 8
25+accreditation organization approved by the department; and 9
26+ (3) Complete an application form approved by the 10
27+department. 11
28+ 2. [A community paramedic shall practice in accordance 12
29+with protocols and supervisory standards established by the 13
30+medical director. A community paramedic shall provide 14
31+services of a health care plan if the plan has been 15
32+developed by the patient's physician or by an advanced 16
33+practice registered nurse through a collaborative practice 17
34+arrangement with a physician or a physician assistant 18 SB 1382 2
35+through a collaborative practice arrangement with a 19
36+physician and there is no duplication of services to the 20
37+patient from another provider. 21
38+ 3. Any ambulance service shall enter into a written 22
39+contract to provide community paramedic services in another 23
40+ambulance service area, as that term is defined in section 24
41+190.100. The contract that is agreed upon may be for an 25
42+indefinite period of time, as long as it includes at least a 26
43+sixty-day cancellation notice by either ambulance service. ] 27
44+As used in this section, the term "community paramedic 28
45+services" shall mean services pr ovided by any entity that 29
46+employs licensed paramedics who are certified by the 30
47+department as community paramedics for services that are: 31
48+ (1) Provided in a nonemergent setting that is 32
49+independent of an emergency telephone service, 911 system, 33
50+or emergency summons; 34
51+ (2) Consistent with the training and education 35
52+requirements described in subdivision (2) of subsection 1 of 36
53+this section, the scope of skill and practice for community 37
54+paramedics, and the supervisory standard approved by the 38
55+entity's medical director; and 39
56+ (3) Reflected and documented in the entity's medical 40
57+director-approved patient care plans or protocols in 41
58+accordance with the provisions of section 190.142. 42
59+ 3. (1) Any ambulance service that seeks to provide 43
60+community paramedic services outside of the ambulance 44
61+service's service area: 45
62+ (a) Shall have a memorandum of understanding (MOU) 46
63+regarding the provision of such services with the ambulance 47
64+service in that service area if that ambulance service is 48
65+already providing community paramedic services; or 49 SB 1382 3
66+ (b) Shall not be required to have an MOU with the 50
67+ambulance service in that service area if that ambulance 51
68+service is not already providing community paramedic 52
69+services, provided that the ambulance s ervice seeking to 53
70+provide such services shall provide notification to the 54
71+other ambulance service of the community paramedic services 55
72+to be provided. 56
73+ (2) Any emergency medical response agency (EMRA) that 57
74+seeks to provide community paramedic servi ces within its 58
75+designated response service area may do so if the ground 59
76+ambulance service area within which the EMRA operates does 60
77+not already provide such services. If the ground ambulance 61
78+service does provide community paramedic services, then the 62
79+ground ambulance service may enter into an MOU with the EMRA 63
80+in order to coordinate programs and avoid service 64
81+duplication. If the EMRA provides community paramedic 65
82+services in the ground ambulance service's service area 66
83+prior to the provision of such services by the ground 67
84+ambulance service, then the EMRA and the ground ambulance 68
85+service shall enter into an MOU for the coordination of 69
86+services. 70
87+ (3) Any community paramedic program shall notify the 71
88+appropriate local ambulance service when prov iding services 72
89+within the service area of an ambulance service. 73
90+ (4) The department shall promulgate rules and 74
91+regulations for the purpose of recognizing which community 75
92+paramedic services entities have met the standards necessary 76
93+to provide community paramedic services, including, but not 77
94+limited to, physician medical oversight, training, patient 78
95+record retention, formal relationships with primary care 79
96+services as needed, and quality improvement policies. 80
97+Community paramedic services entities shall be certified by 81 SB 1382 4
98+the department, allowing such entities to provide community 82
99+paramedic services for a period of five years. 83
100+ 4. A community paramedic is subject to the provisions 84
101+of sections 190.001 to 190.245 and rules promulgated under 85
102+sections 190.001 to 190.245. 86
103+ 5. No person shall hold himself or herself out as a 87
104+community paramedic or provide the services of a community 88
105+paramedic unless such person is certified by the department. 89
106+ 6. The medical director shall approve the 90
107+implementation of the community paramedic program. 91
108+ 7. Any rule or portion of a rule, as that term is 92
109+defined in section 536.010, that is created under the 93
110+authority delegated in this section shall become effective 94
111+only if it complies with and is su bject to all of the 95
112+provisions of chapter 536 and, if applicable, section 96
113+536.028. This section and chapter 536 are nonseverable and 97
114+if any of the powers vested with the general assembly 98
115+pursuant to chapter 536 to review, to delay the effective 99
116+date, or to disapprove and annul a rule are subsequently 100
117+held unconstitutional, then the grant of rulemaking 101
118+authority and any rule proposed or adopted after August 28, 102
119+2013, shall be invalid and void. 103
120+