COMMITTEE ON LEGISLATIVE RESEARCH
OVERSIGHT DIVISION
FISCAL NOTE
L.R. No.:1803H.01I Bill No.:HB 640 Subject:Ambulances and Ambulance Districts; Emergencies; Boards, Commissions,
Committees, and Councils
Type:Original Date:January 9, 2025Bill Summary:This proposal modifies provisions relating to emergency medical services.
FISCAL SUMMARY
ESTIMATED NET EFFECT ON GENERAL REVENUE FUNDFUND AFFECTEDFY 2026FY 2027FY 2028Total Estimated Net
Effect on General
Revenue $0$0$0
ESTIMATED NET EFFECT ON OTHER STATE FUNDSFUND AFFECTEDFY 2026FY 2027FY 2028Total Estimated Net
Effect on Other State
Funds $0$0$0
Numbers within parentheses: () indicate costs or losses. L.R. No. 1803H.01I
Bill No. HB 640
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ESTIMATED NET EFFECT ON FEDERAL FUNDSFUND AFFECTEDFY 2026FY 2027FY 2028Total Estimated Net
Effect on All Federal
Funds $0$0$0
ESTIMATED NET EFFECT ON FULL TIME EQUIVALENT (FTE)FUND AFFECTEDFY 2026FY 2027FY 2028Total Estimated Net
Effect on FTE 000
☐ Estimated Net Effect (expenditures or reduced revenues) expected to exceed $250,000 in any
of the three fiscal years after implementation of the act or at full implementation of the act.
☐ Estimated Net Effect (savings or increased revenues) expected to exceed $250,000 in any of
the three fiscal years after implementation of the act or at full implementation of the act.
ESTIMATED NET EFFECT ON LOCAL FUNDSFUND AFFECTEDFY 2026FY 2027FY 2028Local Government$0$0$0 L.R. No. 1803H.01I
Bill No. HB 640
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FISCAL ANALYSIS
ASSUMPTION
§§ 190.053, 190.076, 190.109, 190.112 and 190.166 - Emergency medical services
Officials from the Department of Health and Senior Services (DHSS) state the proposed
legislation modifies provisions relating to emergency medical services. Sections 190.109.6(12)
and 190.109.6(13) require DHSS, Bureau of Emergency Medical Services (BEMS) to
promulgate rules related to the requirements for a ground ambulance service license including
“participation with regional emergency medical services advisory committees” and “ambulance
service administrator qualifications.”
Section 190.166.3 of the proposed legislation requires the department to “provide notice of any
determination by the department of insolvency or insufficiency of operations of a license holder
to other license holders operating in the license holder's vicinity, members of the general
assembly who represent the license holder's service area, the governing officials of any county or
municipal entity in the license holder's service area, the appropriate regional emergency medical
services advisory committee, and the state advisory council on emergency medical services.”
The BEMS has the ability to mail or email a notice to all entities required by this section.
Section 190.166.4 of the proposed legislation requires the department to “immediately engage
with other license holders in the area to determine the extent to which ground ambulance service
may be provided to the affected service area during the time in which the license holder is unable
to provide adequate services, including any long-term service arrangements.”
It is assumed that the Department can absorb the costs of this bill with current resources.
However, if the workload significantly increased or other legislation was enacted, additional
resources would be requested through the appropriation process.
Oversight does not have any information to the contrary. Therefore, Oversight assumes DHSS
will be able to perform any additional duties required by this proposal with current staff and
resources and will reflect no fiscal impact to DHSS for fiscal note purposes.
Officials from the Department of Public Safety – Division of Fire Safety, the Department of
Social Services and the City of Kansas City assume the proposal will have no fiscal impact on
their respective organizations. Oversight does not have any information to the contrary.
Therefore, Oversight will reflect a zero impact in the fiscal note for these agencies. L.R. No. 1803H.01I
Bill No. HB 640
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Rule Promulgation
Officials from the Joint Committee on Administrative Rules assume this proposal is not
anticipated to cause a fiscal impact beyond its current appropriation.
Officials from the Office of the Secretary of State (SOS) note many bills considered by the
General Assembly include provisions allowing or requiring agencies to submit rules and
regulations to implement the act. The SOS is provided with core funding to handle a certain
amount of normal activity resulting from each year's legislative session. The fiscal impact for
this fiscal note to the SOS for Administrative Rules is less than $5,000. The SOS recognizes that
this is a small amount and does not expect that additional funding would be required to meet
these costs. However, the SOS also recognizes that many such bills may be passed by the
General Assembly in a given year and that collectively the costs may be in excess of what the
office can sustain with its core budget. Therefore, the SOS reserves the right to request funding
for the cost of supporting administrative rules requirements should the need arise based on a
review of the finally approved bills signed by the governor.
Oversight only reflects the responses received from state agencies and political subdivisions;
however, other cities, county officials, fire protection districts and ambulance districts were
requested to respond to this proposed legislation but did not. A listing of political subdivisions
included in the Missouri Legislative Information System (MOLIS) database is available upon
request.
FISCAL IMPACT – State GovernmentFY 2026
(10 Mo.)
FY 2027FY 2028$0$0$0FISCAL IMPACT – Local GovernmentFY 2026
(10 Mo.)
FY 2027FY 2028$0$0$0
FISCAL IMPACT – Small Business
No direct fiscal impact to small businesses would be expected as a result of this proposal.
FISCAL DESCRIPTION
The proposed legislation appears to have no direct fiscal impact. L.R. No. 1803H.01I
Bill No. HB 640
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This legislation is not federally mandated, would not duplicate any other program and would not
require additional capital improvements or rental space.
SOURCES OF INFORMATION
Department of Health and Senior Services
Department of Public Safety – Division of Fire Safety
Department of Social Services
Joint Committee on Administrative Rules
Office of the Secretary of State
City of Kansas City
Julie MorffJessica HarrisDirectorAssistant DirectorJanuary 9, 2025January 9, 2025