| 1 | 1 | | FIRSTREGULARSESSION |
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| 2 | 2 | | HOUSEBILLNO.640 |
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| 3 | 3 | | 103RDGENERALASSEMBLY |
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| 4 | 4 | | INTRODUCEDBYREPRESENTATIVEPERKINS. |
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| 5 | 5 | | 1803H.01I DANARADEMANMILLER,ChiefClerk |
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| 6 | 6 | | ANACT |
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| 7 | 7 | | Torepealsections190.053and190.109,RSMo,andtoenactinlieuthereoffivenewsections |
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| 8 | 8 | | relatingtoemergencymedicalservices. |
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| 9 | 9 | | BeitenactedbytheGeneralAssemblyofthestateofMissouri,asfollows: |
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| 10 | 10 | | SectionA.Sections190.053and190.109,RSMo,arerepealedandfivenewsections |
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| 11 | 11 | | 2enactedinlieuthereof,tobeknownassections190.053,190.076,190.109,190.112,and |
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| 12 | 12 | | 3190.166,toreadasfollows: |
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| 13 | 13 | | 190.053.1.Allmembersoftheboardofdirectorsofanambulancedistrictfirst |
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| 14 | 14 | | 2electedonorafterJanuary1,2008,shallattendandcompleteaneducationalseminaror |
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| 15 | 15 | | 3conferenceorothersuitabletrainingontheroleanddutiesofaboardmemberofan |
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| 16 | 16 | | 4ambulancedistrict.Thetrainingrequiredunderthissectionshallbeofferedbyastatewide |
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| 17 | 17 | | 5associationorganizedforthebenefitofambulancedistrictsorbeapprovedbythestate |
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| 18 | 18 | | 6advisorycouncilonemergencymedicalservices.Suchtrainingshallinclude,ataminimum: |
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| 19 | 19 | | 7 (1)Informationrelatingtotherolesanddutiesofanambulancedistrictdirector; |
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| 20 | 20 | | 8 (2)Areviewofallstatestatutesandregulationsrelevanttoambulancedistricts; |
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| 21 | 21 | | 9 (3)Stateethicslaws; |
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| 22 | 22 | | 10 (4)Statesunshinelaws,chapter610; |
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| 23 | 23 | | 11 (5)Financialandfiduciaryresponsibility; |
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| 24 | 24 | | 12 (6)Statelawsrelatingtothesettingoftaxrates;and |
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| 25 | 25 | | 13 (7)Statelawsrelatingtorevenuelimitations. |
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| 26 | 26 | | 14 2.[Ifanyambulancedistrictboardmemberfailstoattendatrainingsessionwithin |
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| 27 | 27 | | 15twelvemonthsaftertakingoffice,theboardmembershallnotbecompensatedforattendance |
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| 28 | 28 | | 16atmeetingsthereafteruntiltheboardmemberhascompletedsuchtrainingsession.Ifany |
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| 29 | 29 | | EXPLANATION—Matterenclosedinbold-facedbrackets[thus] intheabovebillisnotenactedandis |
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| 30 | 30 | | intendedtobeomittedfromthelaw.Matterinbold-facetypeintheabovebillisproposedlanguage. 17ambulancedistrictboardmemberfailstoattendatrainingsessionwithintwelvemonthsof |
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| 31 | 31 | | 18takingofficeregardlessofwhethertheboardmemberreceivedanattendancefeefora |
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| 32 | 32 | | 19trainingsession,theboardmembershallbeineligibletorunforreelectionforanothertermof |
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| 33 | 33 | | 20officeuntiltheboardmembersatisfiesthetrainingrequirementofthissection;however,this |
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| 34 | 34 | | 21requirementshallonlyapplytoboardmemberselectedafterAugust28,2022] Allmembers |
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| 35 | 35 | | 22oftheboardofdirectorsofanambulancedistrictshallcompletethreehoursof |
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| 36 | 36 | | 23continuingeducationforeachtermofoffice.Thecontinuingeducationshallbeoffered |
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| 37 | 37 | | 24byastatewideassociationorganizedforthebenefitofambulancedistrictsorbe |
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| 38 | 38 | | 25approvedbythestateadvisorycouncilonemergencymedicalservices. |
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| 39 | 39 | | 26 3.Anyambulancedistrictboardmemberwhofailstocompletetheinitial |
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| 40 | 40 | | 27trainingandcontinuingeducationrequirementsonorbeforetheanniversarydateofhis |
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| 41 | 41 | | 28orherelectionorappointmentshallimmediatelybedisqualifiedfromofficeandhisor |
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| 42 | 42 | | 29herpositionshallbevacantwithoutfurtherprocessordeclaration.Thevacancyshall |
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| 43 | 43 | | 30befilledinthemannerprovidedforpursuanttosection190.052. |
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| 44 | 44 | | 190.076.Eachambulancedistrictshallarrangeforanauditoftherecordsand |
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| 45 | 45 | | 2accountsofthedistrictatleasteverythreeyearsbyacertifiedpublicaccountantorfirm |
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| 46 | 46 | | 3ofcertifiedpublicaccountants.Theauditshallbemadeavailabletothepubliconthe |
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| 47 | 47 | | 4district'swebsiteorotherwisefreelyavailablebyotherelectronicmeans. |
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| 48 | 48 | | 190.109.1.Thedepartmentshall,withinareasonabletimeafterreceiptofan |
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| 49 | 49 | | 2application,causesuchinvestigationasthedepartmentdeemsnecessarytobemadeofthe |
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| 50 | 50 | | 3applicantforagroundambulancelicense. |
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| 51 | 51 | | 4 2.AnypersonthatownedandoperatedalicensedambulanceonDecember31,1997, |
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| 52 | 52 | | 5shallreceiveanambulanceservicelicensefromthedepartment,unlesssuspended,revokedor |
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| 53 | 53 | | 6terminated,forthatambulanceserviceareawhichwas,onDecember31,1997,describedand |
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| 54 | 54 | | 7filedwiththedepartmentastheprimaryserviceareaforitslicensedambulancesonAugust |
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| 55 | 55 | | 828,1998,providedthatthepersonmakesapplicationandadherestotherulesandregulations |
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| 56 | 56 | | 9promulgatedbythedepartmentpursuanttosections190.001to190.245. |
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| 57 | 57 | | 10 3.Thedepartmentshallissueanewgroundambulanceservicelicensetoan |
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| 58 | 58 | | 11ambulanceservicethatisnotcurrentlylicensedbythedepartment,oriscurrentlylicensedby |
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| 59 | 59 | | 12thedepartmentandisseekingtoexpanditsambulanceservicearea,exceptasprovidedin |
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| 60 | 60 | | 13subsection4ofthissection,tobevalidforaperiodoffiveyears,unlesssuspended,revoked |
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| 61 | 61 | | 14orterminated,whenthedirectorfindsthattheapplicantmeetstherequirementsofambulance |
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| 62 | 62 | | 15servicelicensureestablishedpursuanttosections190.100to190.245andtherulesadoptedby |
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| 63 | 63 | | 16thedepartmentpursuanttosections190.001to190.245.Inordertobeconsideredforanew |
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| 64 | 64 | | 17ambulanceservicelicense,anambulanceserviceshallsubmittothedepartmentaletterof |
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| 65 | 65 | | 18endorsementfromeachambulancedistrictorfireprotectiondistrictthatisauthorizedto |
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| 66 | 66 | | 19provideambulanceservice,orfromeachmunicipalitynotwithinanambulancedistrictorfire |
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| 67 | 67 | | HB640 2 20protectiondistrictthatisauthorizedtoprovideambulanceservice,inwhichtheambulance |
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| 68 | 68 | | 21serviceproposestooperate.Ifanambulanceserviceproposestooperateinunincorporated |
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| 69 | 69 | | 22portionsofacountynotwithinanambulancedistrictorfireprotectiondistrictthatis |
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| 70 | 70 | | 23authorizedtoprovideambulanceservice,inordertobeconsideredforanewambulance |
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| 71 | 71 | | 24servicelicense,theambulanceserviceshallsubmittothedepartmentaletterofendorsement |
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| 72 | 72 | | 25fromthecounty.Anyletterofendorsementrequiredpursuanttothissectionshallverifythat |
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| 73 | 73 | | 26thepoliticalsubdivisionhasconductedapublichearingregardingtheendorsementandthat |
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| 74 | 74 | | 27thegoverningbodyofthepoliticalsubdivisionhasadoptedaresolutionapprovingthe |
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| 75 | 75 | | 28endorsement.Theletterofendorsementshallaffirmativelystatethattheproposedambulance |
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| 76 | 76 | | 29service: |
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| 77 | 77 | | 30 (1)Willprovideabenefittopublichealththatoutweighstheassociatedcosts; |
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| 78 | 78 | | 31 (2)Willmaintainorenhancethepublic'saccesstoambulanceservices; |
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| 79 | 79 | | 32 (3)Willmaintainorimprovethepublichealthandpromotethecontinued |
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| 80 | 80 | | 33developmentoftheregionalemergencymedicalservicesystem; |
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| 81 | 81 | | 34 (4)Hasdemonstratedtheappropriateexpertiseintheoperationofambulance |
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| 82 | 82 | | 35services;and |
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| 83 | 83 | | 36 (5)Hasdemonstratedthefinancialresourcesnecessaryfortheoperationofthe |
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| 84 | 84 | | 37proposedambulanceservice. |
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| 85 | 85 | | 38 4.Acontractbetweenapoliticalsubdivisionandalicensedambulanceserviceforthe |
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| 86 | 86 | | 39provisionofambulanceservicesforthatpoliticalsubdivisionshallexpand,withoutfurther |
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| 87 | 87 | | 40actionbythedepartment,theambulanceserviceareaofthelicensedambulanceserviceto |
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| 88 | 88 | | 41includethejurisdictionalboundariesofthepoliticalsubdivision.Theterminationofthe |
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| 89 | 89 | | 42aforementionedcontractshallresultinareductionofthelicensedambulanceservice's |
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| 90 | 90 | | 43ambulanceserviceareabyremovingthegeographicareaofthepoliticalsubdivisionfromits |
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| 91 | 91 | | 44ambulanceservicearea,exceptthatlicensedambulanceserviceprovidersmayprovide |
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| 92 | 92 | | 45ambulanceservicesasareneededatandaroundthestatefairgroundsforprotectionof |
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| 93 | 93 | | 46attendeesatthestatefair. |
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| 94 | 94 | | 47 5.Thedepartmentshallrenewagroundambulanceservicelicenseiftheapplicant |
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| 95 | 95 | | 48meetstherequirementsestablishedpursuanttosections190.001to190.245,andtherules |
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| 96 | 96 | | 49adoptedbythedepartmentpursuanttosections190.001to190.245. |
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| 97 | 97 | | 50 6.Thedepartmentshallpromulgaterulesrelatingtotherequirementsforaground |
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| 98 | 98 | | 51ambulanceservicelicenseincluding,butnotlimitedto: |
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| 99 | 99 | | 52 (1)Vehicledesign,specification,operationandmaintenancestandards; |
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| 100 | 100 | | 53 (2)Equipmentrequirements; |
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| 101 | 101 | | 54 (3)Staffingrequirements; |
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| 102 | 102 | | 55 (4)Five-yearlicenserenewal; |
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| 103 | 103 | | 56 (5)Recordsandforms; |
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| 104 | 104 | | HB640 3 57 (6)Medicalcontrolplans; |
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| 105 | 105 | | 58 (7)Medicaldirectorqualifications; |
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| 106 | 106 | | 59 (8)Standardsformedicalcommunications; |
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| 107 | 107 | | 60 (9)Memorandumsofunderstandingwithemergencymedicalresponseagenciesthat |
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| 108 | 108 | | 61provideadvancedlifesupport; |
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| 109 | 109 | | 62 (10)Qualityimprovementcommittees;[and] |
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| 110 | 110 | | 63 (11)Responsetime,patientcareandtransportationstandards; |
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| 111 | 111 | | 64 (12)Participationwithregionalemergencymedicalservicesadvisory |
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| 112 | 112 | | 65committees;and |
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| 113 | 113 | | 66 (13)Ambulanceserviceadministratorqualifications. |
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| 114 | 114 | | 67 7.Applicationforagroundambulanceservicelicenseshallbemadeuponsuchforms |
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| 115 | 115 | | 68asprescribedbythedepartmentinrulesadoptedpursuanttosections190.001to190.245. |
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| 116 | 116 | | 69Theapplicationformshallcontainsuchinformationasthedepartmentdeemsnecessaryto |
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| 117 | 117 | | 70makeadeterminationastowhetherthegroundambulanceservicemeetsalltherequirements |
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| 118 | 118 | | 71ofsections190.001to190.245andrulespromulgatedpursuanttosections190.001to |
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| 119 | 119 | | 72190.245. |
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| 120 | 120 | | 190.112.1.Eachambulanceservicelicensedunderthischaptershallidentifyto |
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| 121 | 121 | | 2thedepartmenttheindividualservingastheambulanceserviceadministratorwhois |
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| 122 | 122 | | 3responsiblefortheoperationsandstaffingoftheambulanceservice.Theambulance |
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| 123 | 123 | | 4serviceadministratorshallberequiredtohaveachievedbasictrainingofatleastforty |
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| 124 | 124 | | 5hoursregardingtheoperationsofanambulanceserviceandtwohoursofannual |
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| 125 | 125 | | 6continuingeducation.Thetrainingrequiredunderthissectionshallbeofferedbya |
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| 126 | 126 | | 7statewideassociationorganizedforthebenefitofambulancedistrictsorbeapprovedby |
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| 127 | 127 | | 8thestateadvisorycouncilonemergencymedicalservicesandshallincludethe |
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| 128 | 128 | | 9following: |
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| 129 | 129 | | 10 (1)Basicprinciplesofaccountingandeconomics; |
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| 130 | 130 | | 11 (2)Stateandfederallawsapplicabletoambulanceservices; |
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| 131 | 131 | | 12 (3)Regulatoryrequirementsapplicabletoambulanceservices; |
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| 132 | 132 | | 13 (4)Humanresourcesmanagementandlaws; |
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| 133 | 133 | | 14 (5)Grantwriting,contracts,andfundraising; |
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| 134 | 134 | | 15 (6)Statesunshinelawsinchapter610,aswellasapplicableethicsrequirements; |
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| 135 | 135 | | 16and |
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| 136 | 136 | | 17 (7)Volunteerandcommunityinvolvement. |
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| 137 | 137 | | 18 2.AmbulanceserviceadministratorsservinginthiscapacityasofAugust28, |
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| 138 | 138 | | 192025,shallhaveuntilJanuary1,2026,todemonstratecompliancewiththeprovisionsof |
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| 139 | 139 | | 20thissection. |
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| 140 | 140 | | HB640 4 190.166.1.Inadditiontotheprovisionsofsection190.165,thedepartmentof |
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| 141 | 141 | | 2healthandseniorservicesmayrefusetoissue,denyrenewalof,orsuspendalicense |
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| 142 | 142 | | 3requiredpursuanttosection190.109,ortakeothercorrectiveactionsasdescribedin |
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| 143 | 143 | | 4thissection,basedonthefollowingconsiderations: |
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| 144 | 144 | | 5 (1)Thelicenseholderisdeterminedtobefinanciallyinsolvent; |
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| 145 | 145 | | 6 (2)Theambulanceservicehasinadequatepersonneltooperatetheambulance |
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| 146 | 146 | | 7servicetoprovideforbasicemergencyoperations,determinedbytheabilitytostaffa |
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| 147 | 147 | | 8minimumofoneambulanceunittwenty-fourhoursperday,sevendaysperweek,with |
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| 148 | 148 | | 9atleasttwolicensedemergencymedicaltechniciansandareasonableplanandschedule |
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| 149 | 149 | | 10fortheservicesofasecondambulance; |
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| 150 | 150 | | 11 (3)Theambulanceservicerequiresaninordinateamountofmutualaidfrom |
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| 151 | 151 | | 12neighboringservices,suchasmorethantenpercentofthetotalrunsintheservicearea |
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| 152 | 152 | | 13inanygivenmonth,orthanwouldbeconsideredprudentandthuscannotprovidean |
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| 153 | 153 | | 14appropriatelevelofemergencyresponsefortheserviceareaaswouldbeconsidered |
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| 154 | 154 | | 15prudentbythetypicalgroundambulanceservicesoperator; |
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| 155 | 155 | | 16 (4)Theprincipalmanager,boardmembers,orotherexecutivesaredetermined |
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| 156 | 156 | | 17tobecriminallyliableforactionsrelatedtothelicenseorserviceprovided; |
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| 157 | 157 | | 18 (5)Thelicenseholderorprincipalmanager,boardmembers,orotherexecutives |
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| 158 | 158 | | 19aredeterminedbytheCentersforMedicareandMedicaidServicestobeineligiblefor |
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| 159 | 159 | | 20participationinMedicare; |
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| 160 | 160 | | 21 (6)Thelicenseholderorprincipalmanager,boardmembers,orotherexecutives |
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| 161 | 161 | | 22aredeterminedbytheMOHealthNetdivisiontobeineligibleforparticipationinMO |
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| 162 | 162 | | 23HealthNet; |
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| 163 | 163 | | 24 (7)Theambulanceserviceadministratorhasfailedtomeettherequired |
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| 164 | 164 | | 25qualificationsorfailedtocompletethetrainingrequiredpursuanttosection190.112; |
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| 165 | 165 | | 26and |
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| 166 | 166 | | 27 (8)Threeormoreboardmembershavefailedtocompleterequiredtraining |
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| 167 | 167 | | 28pursuanttosection190.053iftheambulanceserviceisanambulancedistrict. |
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| 168 | 168 | | 29 2.Ifthedepartmentmakesadeterminationofinsolvencyorinsufficiencyof |
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| 169 | 169 | | 30operationsofalicenseholderundersubsection1ofthissection,thenthedepartment |
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| 170 | 170 | | 31mayrequirethelicenseholdertosubmitacorrectiveplanwithinfifteendaysand |
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| 171 | 171 | | 32requireimplementationofthecorrectiveplanwithinthirtydays. |
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| 172 | 172 | | 33 3.Thedepartmentshallberequiredtoprovidenoticeofanydeterminationby |
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| 173 | 173 | | 34thedepartmentofinsolvencyorinsufficiencyofoperationsofalicenseholdertoother |
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| 174 | 174 | | 35licenseholdersoperatinginthelicenseholder'svicinity,membersofthegeneral |
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| 175 | 175 | | 36assemblywhorepresentthelicenseholder'sservicearea,thegoverningofficialsofany |
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| 176 | 176 | | 37countyormunicipalentityinthelicenseholder'sservicearea,theappropriateregional |
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| 177 | 177 | | HB640 5 38emergencymedicalservicesadvisorycommittee,andthestateadvisorycouncilon |
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| 178 | 178 | | 39emergencymedicalservices. |
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| 179 | 179 | | 40 4.Thedepartmentshallimmediatelyengagewithotherlicenseholdersinthe |
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| 180 | 180 | | 41areatodeterminetheextenttowhichgroundambulanceservicemaybeprovidedtothe |
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| 181 | 181 | | 42affectedserviceareaduringthetimeinwhichthelicenseholderisunabletoprovide |
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| 182 | 182 | | 43adequateservices,includinganylong-termservicearrangements.Thenatureofthe |
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| 183 | 183 | | 44agreementbetweenthelicenseholderandotherlicenseholdersprovidingservicestothe |
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| 184 | 184 | | 45affectedareamayincludeanagreementtoprovideservices,ajointpowersagreement, |
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| 185 | 185 | | 46formalconsideration,orsomepaymentforservicesrendered. |
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| 186 | 186 | | 47 5.Anylicenseholderwhoprovidesassistanceintheserviceareaofanother |
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| 187 | 187 | | 48licenseholderwhoselicensehasbeensuspendedunderthissectionshallhavetheright |
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| 188 | 188 | | 49toseekreasonablecompensationfromthelicenseholderwhoselicensetooperatehas |
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| 189 | 189 | | 50beensuspendedforallcalls,stand-bytime,andresponsestomedicalemergencies |
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| 190 | 190 | | 51duringsuchtimeasthelicenseremainssuspended.Thereasonablecompensationshall |
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| 191 | 191 | | 52notbelimitedtothoseexpensesincurredinactualresponses,butmayalsoinclude |
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| 192 | 192 | | 53reasonableexpensestomaintainambulanceservice,including,butnotlimitedto,the |
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| 193 | 193 | | 54dailyoperationcostsofmaintainingtheservice,personnelwagesandbenefits, |
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| 194 | 194 | | 55equipmentpurchasesandmaintenance,andothercostsincurredintheoperationofa |
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| 195 | 195 | | 56groundambulanceservice.Thelicenseholderprovidingassistanceshallbeentitledto |
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| 196 | 196 | | 57anawardofcostsandreasonableattorney'sfeesinanyactiontoenforcetheprovisions |
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| 197 | 197 | | 58ofthissubsection. |
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| 198 | 198 | | âś” |
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| 199 | 199 | | HB640 6 |
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