FIRSTREGULARSESSION
HOUSEBILLNO.640
103RDGENERALASSEMBLY
INTRODUCEDBYREPRESENTATIVEPERKINS.
1803H.01I DANARADEMANMILLER,ChiefClerk
ANACT
Torepealsections190.053and190.109,RSMo,andtoenactinlieuthereoffivenewsections
relatingtoemergencymedicalservices.
BeitenactedbytheGeneralAssemblyofthestateofMissouri,asfollows:
SectionA.Sections190.053and190.109,RSMo,arerepealedandfivenewsections
2enactedinlieuthereof,tobeknownassections190.053,190.076,190.109,190.112,and
3190.166,toreadasfollows:
190.053.1.Allmembersoftheboardofdirectorsofanambulancedistrictfirst
2electedonorafterJanuary1,2008,shallattendandcompleteaneducationalseminaror
3conferenceorothersuitabletrainingontheroleanddutiesofaboardmemberofan
4ambulancedistrict.Thetrainingrequiredunderthissectionshallbeofferedbyastatewide
5associationorganizedforthebenefitofambulancedistrictsorbeapprovedbythestate
6advisorycouncilonemergencymedicalservices.Suchtrainingshallinclude,ataminimum:
7 (1)Informationrelatingtotherolesanddutiesofanambulancedistrictdirector;
8 (2)Areviewofallstatestatutesandregulationsrelevanttoambulancedistricts;
9 (3)Stateethicslaws;
10 (4)Statesunshinelaws,chapter610;
11 (5)Financialandfiduciaryresponsibility;
12 (6)Statelawsrelatingtothesettingoftaxrates;and
13 (7)Statelawsrelatingtorevenuelimitations.
14 2.[Ifanyambulancedistrictboardmemberfailstoattendatrainingsessionwithin
15twelvemonthsaftertakingoffice,theboardmembershallnotbecompensatedforattendance
16atmeetingsthereafteruntiltheboardmemberhascompletedsuchtrainingsession.Ifany
EXPLANATION—Matterenclosedinbold-facedbrackets[thus] intheabovebillisnotenactedandis
intendedtobeomittedfromthelaw.Matterinbold-facetypeintheabovebillisproposedlanguage. 17ambulancedistrictboardmemberfailstoattendatrainingsessionwithintwelvemonthsof
18takingofficeregardlessofwhethertheboardmemberreceivedanattendancefeefora
19trainingsession,theboardmembershallbeineligibletorunforreelectionforanothertermof
20officeuntiltheboardmembersatisfiesthetrainingrequirementofthissection;however,this
21requirementshallonlyapplytoboardmemberselectedafterAugust28,2022] Allmembers
22oftheboardofdirectorsofanambulancedistrictshallcompletethreehoursof
23continuingeducationforeachtermofoffice.Thecontinuingeducationshallbeoffered
24byastatewideassociationorganizedforthebenefitofambulancedistrictsorbe
25approvedbythestateadvisorycouncilonemergencymedicalservices.
26 3.Anyambulancedistrictboardmemberwhofailstocompletetheinitial
27trainingandcontinuingeducationrequirementsonorbeforetheanniversarydateofhis
28orherelectionorappointmentshallimmediatelybedisqualifiedfromofficeandhisor
29herpositionshallbevacantwithoutfurtherprocessordeclaration.Thevacancyshall
30befilledinthemannerprovidedforpursuanttosection190.052.
190.076.Eachambulancedistrictshallarrangeforanauditoftherecordsand
2accountsofthedistrictatleasteverythreeyearsbyacertifiedpublicaccountantorfirm
3ofcertifiedpublicaccountants.Theauditshallbemadeavailabletothepubliconthe
4district'swebsiteorotherwisefreelyavailablebyotherelectronicmeans.
190.109.1.Thedepartmentshall,withinareasonabletimeafterreceiptofan
2application,causesuchinvestigationasthedepartmentdeemsnecessarytobemadeofthe
3applicantforagroundambulancelicense.
4 2.AnypersonthatownedandoperatedalicensedambulanceonDecember31,1997,
5shallreceiveanambulanceservicelicensefromthedepartment,unlesssuspended,revokedor
6terminated,forthatambulanceserviceareawhichwas,onDecember31,1997,describedand
7filedwiththedepartmentastheprimaryserviceareaforitslicensedambulancesonAugust
828,1998,providedthatthepersonmakesapplicationandadherestotherulesandregulations
9promulgatedbythedepartmentpursuanttosections190.001to190.245.
10 3.Thedepartmentshallissueanewgroundambulanceservicelicensetoan
11ambulanceservicethatisnotcurrentlylicensedbythedepartment,oriscurrentlylicensedby
12thedepartmentandisseekingtoexpanditsambulanceservicearea,exceptasprovidedin
13subsection4ofthissection,tobevalidforaperiodoffiveyears,unlesssuspended,revoked
14orterminated,whenthedirectorfindsthattheapplicantmeetstherequirementsofambulance
15servicelicensureestablishedpursuanttosections190.100to190.245andtherulesadoptedby
16thedepartmentpursuanttosections190.001to190.245.Inordertobeconsideredforanew
17ambulanceservicelicense,anambulanceserviceshallsubmittothedepartmentaletterof
18endorsementfromeachambulancedistrictorfireprotectiondistrictthatisauthorizedto
19provideambulanceservice,orfromeachmunicipalitynotwithinanambulancedistrictorfire
HB640 2 20protectiondistrictthatisauthorizedtoprovideambulanceservice,inwhichtheambulance
21serviceproposestooperate.Ifanambulanceserviceproposestooperateinunincorporated
22portionsofacountynotwithinanambulancedistrictorfireprotectiondistrictthatis
23authorizedtoprovideambulanceservice,inordertobeconsideredforanewambulance
24servicelicense,theambulanceserviceshallsubmittothedepartmentaletterofendorsement
25fromthecounty.Anyletterofendorsementrequiredpursuanttothissectionshallverifythat
26thepoliticalsubdivisionhasconductedapublichearingregardingtheendorsementandthat
27thegoverningbodyofthepoliticalsubdivisionhasadoptedaresolutionapprovingthe
28endorsement.Theletterofendorsementshallaffirmativelystatethattheproposedambulance
29service:
30 (1)Willprovideabenefittopublichealththatoutweighstheassociatedcosts;
31 (2)Willmaintainorenhancethepublic'saccesstoambulanceservices;
32 (3)Willmaintainorimprovethepublichealthandpromotethecontinued
33developmentoftheregionalemergencymedicalservicesystem;
34 (4)Hasdemonstratedtheappropriateexpertiseintheoperationofambulance
35services;and
36 (5)Hasdemonstratedthefinancialresourcesnecessaryfortheoperationofthe
37proposedambulanceservice.
38 4.Acontractbetweenapoliticalsubdivisionandalicensedambulanceserviceforthe
39provisionofambulanceservicesforthatpoliticalsubdivisionshallexpand,withoutfurther
40actionbythedepartment,theambulanceserviceareaofthelicensedambulanceserviceto
41includethejurisdictionalboundariesofthepoliticalsubdivision.Theterminationofthe
42aforementionedcontractshallresultinareductionofthelicensedambulanceservice's
43ambulanceserviceareabyremovingthegeographicareaofthepoliticalsubdivisionfromits
44ambulanceservicearea,exceptthatlicensedambulanceserviceprovidersmayprovide
45ambulanceservicesasareneededatandaroundthestatefairgroundsforprotectionof
46attendeesatthestatefair.
47 5.Thedepartmentshallrenewagroundambulanceservicelicenseiftheapplicant
48meetstherequirementsestablishedpursuanttosections190.001to190.245,andtherules
49adoptedbythedepartmentpursuanttosections190.001to190.245.
50 6.Thedepartmentshallpromulgaterulesrelatingtotherequirementsforaground
51ambulanceservicelicenseincluding,butnotlimitedto:
52 (1)Vehicledesign,specification,operationandmaintenancestandards;
53 (2)Equipmentrequirements;
54 (3)Staffingrequirements;
55 (4)Five-yearlicenserenewal;
56 (5)Recordsandforms;
HB640 3 57 (6)Medicalcontrolplans;
58 (7)Medicaldirectorqualifications;
59 (8)Standardsformedicalcommunications;
60 (9)Memorandumsofunderstandingwithemergencymedicalresponseagenciesthat
61provideadvancedlifesupport;
62 (10)Qualityimprovementcommittees;[and]
63 (11)Responsetime,patientcareandtransportationstandards;
64 (12)Participationwithregionalemergencymedicalservicesadvisory
65committees;and
66 (13)Ambulanceserviceadministratorqualifications.
67 7.Applicationforagroundambulanceservicelicenseshallbemadeuponsuchforms
68asprescribedbythedepartmentinrulesadoptedpursuanttosections190.001to190.245.
69Theapplicationformshallcontainsuchinformationasthedepartmentdeemsnecessaryto
70makeadeterminationastowhetherthegroundambulanceservicemeetsalltherequirements
71ofsections190.001to190.245andrulespromulgatedpursuanttosections190.001to
72190.245.
190.112.1.Eachambulanceservicelicensedunderthischaptershallidentifyto
2thedepartmenttheindividualservingastheambulanceserviceadministratorwhois
3responsiblefortheoperationsandstaffingoftheambulanceservice.Theambulance
4serviceadministratorshallberequiredtohaveachievedbasictrainingofatleastforty
5hoursregardingtheoperationsofanambulanceserviceandtwohoursofannual
6continuingeducation.Thetrainingrequiredunderthissectionshallbeofferedbya
7statewideassociationorganizedforthebenefitofambulancedistrictsorbeapprovedby
8thestateadvisorycouncilonemergencymedicalservicesandshallincludethe
9following:
10 (1)Basicprinciplesofaccountingandeconomics;
11 (2)Stateandfederallawsapplicabletoambulanceservices;
12 (3)Regulatoryrequirementsapplicabletoambulanceservices;
13 (4)Humanresourcesmanagementandlaws;
14 (5)Grantwriting,contracts,andfundraising;
15 (6)Statesunshinelawsinchapter610,aswellasapplicableethicsrequirements;
16and
17 (7)Volunteerandcommunityinvolvement.
18 2.AmbulanceserviceadministratorsservinginthiscapacityasofAugust28,
192025,shallhaveuntilJanuary1,2026,todemonstratecompliancewiththeprovisionsof
20thissection.
HB640 4 190.166.1.Inadditiontotheprovisionsofsection190.165,thedepartmentof
2healthandseniorservicesmayrefusetoissue,denyrenewalof,orsuspendalicense
3requiredpursuanttosection190.109,ortakeothercorrectiveactionsasdescribedin
4thissection,basedonthefollowingconsiderations:
5 (1)Thelicenseholderisdeterminedtobefinanciallyinsolvent;
6 (2)Theambulanceservicehasinadequatepersonneltooperatetheambulance
7servicetoprovideforbasicemergencyoperations,determinedbytheabilitytostaffa
8minimumofoneambulanceunittwenty-fourhoursperday,sevendaysperweek,with
9atleasttwolicensedemergencymedicaltechniciansandareasonableplanandschedule
10fortheservicesofasecondambulance;
11 (3)Theambulanceservicerequiresaninordinateamountofmutualaidfrom
12neighboringservices,suchasmorethantenpercentofthetotalrunsintheservicearea
13inanygivenmonth,orthanwouldbeconsideredprudentandthuscannotprovidean
14appropriatelevelofemergencyresponsefortheserviceareaaswouldbeconsidered
15prudentbythetypicalgroundambulanceservicesoperator;
16 (4)Theprincipalmanager,boardmembers,orotherexecutivesaredetermined
17tobecriminallyliableforactionsrelatedtothelicenseorserviceprovided;
18 (5)Thelicenseholderorprincipalmanager,boardmembers,orotherexecutives
19aredeterminedbytheCentersforMedicareandMedicaidServicestobeineligiblefor
20participationinMedicare;
21 (6)Thelicenseholderorprincipalmanager,boardmembers,orotherexecutives
22aredeterminedbytheMOHealthNetdivisiontobeineligibleforparticipationinMO
23HealthNet;
24 (7)Theambulanceserviceadministratorhasfailedtomeettherequired
25qualificationsorfailedtocompletethetrainingrequiredpursuanttosection190.112;
26and
27 (8)Threeormoreboardmembershavefailedtocompleterequiredtraining
28pursuanttosection190.053iftheambulanceserviceisanambulancedistrict.
29 2.Ifthedepartmentmakesadeterminationofinsolvencyorinsufficiencyof
30operationsofalicenseholderundersubsection1ofthissection,thenthedepartment
31mayrequirethelicenseholdertosubmitacorrectiveplanwithinfifteendaysand
32requireimplementationofthecorrectiveplanwithinthirtydays.
33 3.Thedepartmentshallberequiredtoprovidenoticeofanydeterminationby
34thedepartmentofinsolvencyorinsufficiencyofoperationsofalicenseholdertoother
35licenseholdersoperatinginthelicenseholder'svicinity,membersofthegeneral
36assemblywhorepresentthelicenseholder'sservicearea,thegoverningofficialsofany
37countyormunicipalentityinthelicenseholder'sservicearea,theappropriateregional
HB640 5 38emergencymedicalservicesadvisorycommittee,andthestateadvisorycouncilon
39emergencymedicalservices.
40 4.Thedepartmentshallimmediatelyengagewithotherlicenseholdersinthe
41areatodeterminetheextenttowhichgroundambulanceservicemaybeprovidedtothe
42affectedserviceareaduringthetimeinwhichthelicenseholderisunabletoprovide
43adequateservices,includinganylong-termservicearrangements.Thenatureofthe
44agreementbetweenthelicenseholderandotherlicenseholdersprovidingservicestothe
45affectedareamayincludeanagreementtoprovideservices,ajointpowersagreement,
46formalconsideration,orsomepaymentforservicesrendered.
47 5.Anylicenseholderwhoprovidesassistanceintheserviceareaofanother
48licenseholderwhoselicensehasbeensuspendedunderthissectionshallhavetheright
49toseekreasonablecompensationfromthelicenseholderwhoselicensetooperatehas
50beensuspendedforallcalls,stand-bytime,andresponsestomedicalemergencies
51duringsuchtimeasthelicenseremainssuspended.Thereasonablecompensationshall
52notbelimitedtothoseexpensesincurredinactualresponses,butmayalsoinclude
53reasonableexpensestomaintainambulanceservice,including,butnotlimitedto,the
54dailyoperationcostsofmaintainingtheservice,personnelwagesandbenefits,
55equipmentpurchasesandmaintenance,andothercostsincurredintheoperationofa
56groundambulanceservice.Thelicenseholderprovidingassistanceshallbeentitledto
57anawardofcostsandreasonableattorney'sfeesinanyactiontoenforcetheprovisions
58ofthissubsection.
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