FIRSTREGULARSESSION HOUSEBILLNO.724 103RDGENERALASSEMBLY INTRODUCEDBYREPRESENTATIVEPETERS. 1844H.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 27trainingorcontinuingeducationrequirementsonorbeforetheanniversarydateofthe 28member'selectionorappointmentasrequiredunderthissectionshallimmediatelybe 29disqualifiedfromoffice.Uponsuchdisqualification,themember'spositionshallbe 30deemedvacantwithoutfurtherprocessordeclaration.Thevacancyshallbefilledinthe 31mannerprovidedforinsection190.052. 190.076.Inadditiontotheannualauditrequiredundersection190.075,each 2ambulancedistrictshall,atleastonceeverythreeyears,arrangeforacertifiedpublic 3accountantorafirmofcertifiedpublicaccountantstoaudittherecordsandaccountsof 4thedistrict.Theauditshallbemadefreelyavailabletothepubliconthedistrict's 5websiteorbyotherelectronicmeans. 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 HB724 2 18endorsementfromeachambulancedistrictorfireprotectiondistrictthatisauthorizedto 19provideambulanceservice,orfromeachmunicipalitynotwithinanambulancedistrictorfire 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; HB724 3 55 (4)Five-yearlicenserenewal; 56 (5)Recordsandforms; 57 (6)Medicalcontrolplans; 58 (7)Medicaldirectorqualifications; 59 (8)Standardsformedicalcommunications; 60 (9)Memorandumsofunderstandingwithemergencymedicalresponseagenciesthat 61provideadvancedlifesupport; 62 (10)Qualityimprovementcommittees;[and] 63 (11)Responsetime,patientcareandtransportationstandards; 64 (12)ParticipationwithregionalEMSadvisorycommittees;and 65 (13)Ambulanceserviceadministratorqualifications. 66 7.Applicationforagroundambulanceservicelicenseshallbemadeuponsuchforms 67asprescribedbythedepartmentinrulesadoptedpursuanttosections190.001to190.245. 68Theapplicationformshallcontainsuchinformationasthedepartmentdeemsnecessaryto 69makeadeterminationastowhetherthegroundambulanceservicemeetsalltherequirements 70ofsections190.001to190.245andrulespromulgatedpursuanttosections190.001to 71190.245. 190.112.1.Eachambulanceservicelicensedundersections190.001to190.245 2shallidentifytothedepartmentanindividualastheambulanceserviceadministrator, 3whoshallberesponsiblefortheoperationsandstaffingoftheambulanceservice. 4 2.Anyindividualidentifiedastheambulanceserviceadministratorunder 5subsection1ofthissectionshallberequiredtohaveachievedbasictrainingofatleast 6fortyhoursregardingtheoperationsofanambulanceserviceandtocompletetwohours 7ofannualcontinuingeducationtomaintaintheindividual'sstatusastheambulance 8serviceadministrator. 9 3.Thetrainingrequiredunderthissectionshallbeofferedbyastatewide 10associationorganizedforthebenefitofambulancedistrictsorbeapprovedbythestate 11advisorycouncilonemergencymedicalservices.Suchtrainingshallinclude 12informationon: 13 (1)Basicprinciplesofaccountingandeconomics; 14 (2)Stateandfederallawsapplicabletoambulanceservices; 15 (3)Regulatoryrequirementsapplicabletoambulanceservices; 16 (4)Humanresourcesmanagementandlaws; 17 (5)Grantwriting,contracts,andfundraising; 18 (6)Thestatesunshinelawrequirementsunderchapter610andstateethicslaws; 19and 20 (7)Volunteerandcommunityinvolvement. HB724 4 21 4.AnyindividualservingasanambulanceserviceadministratorasofAugust 2228,2025,shallhaveuntilJanuary1,2027,tomeetthetrainingrequirementsofthis 23section. 190.166.1.Inadditiontothegroundsfordisciplinaryactiondescribedin 2section190.165,thedepartmentmayrefusetoissue,denyrenewalof,orsuspenda 3licenserequiredundersection190.109,ortakeothercorrectiveactionsasdescribedin 4thissection,basedonanyofthefollowingconsiderations: 5 (1)Thelicenseholderisdeterminedtobefinanciallyinsolvent; 6 (2)Theambulanceservicehasinadequatepersonneltooperatetheambulance 7servicetoprovidebasicemergencyoperations.Theambulanceserviceshallnotbe 8deemedtohavesuchinadequatepersonnelaslongastheambulanceservicehasthe 9abilitytostaffaminimumofoneambulanceunittwenty-fourhourseachday,seven 10dayseachweek,withatleasttwolicensedemergencymedicaltechnicians,andhasa 11reasonableplanandschedulefortheservicesofasecondambulanceunit; 12 (3)Theambulanceservicerequiresaninordinateamountofmutualaidfrom 13neighboringservices,suchasmorethantenpercentofthetotalrunsinthejurisdiction 14inanygivenmonthormorethanwouldbeconsideredprudent,andthuscannotprovide 15anappropriatelevelofemergencyresponsefortheserviceareathatwouldbe 16consideredprudentbythetypicaloperatorofemergencyambulanceservices; 17 (4)Theprincipalmanageroraboardmemberorexecutiveoftheambulance 18serviceisdeterminedtobecriminallyliableforactionsrelatedtothelicenseorservice 19provided; 20 (5)Thelicenseholderorprincipalmanageroraboardmemberorother 21executiveoftheambulanceserviceisdeterminedbytheCentersforMedicareand 22MedicaidServicestobeineligibleforparticipationinMedicare; 23 (6)Thelicenseholderorprincipalmanageroraboardmemberorother 24executiveoftheambulanceserviceisdeterminedbytheMOHealthNetdivisiontobe 25ineligibleforparticipationintheMOHealthNetprogram; 26 (7)Theambulanceserviceadministratorhasfailedtomeettherequired 27qualificationsorfailedtocompletethetrainingrequiredinsection190.112;or 28 (8)Iftheambulanceserviceisanambulancedistrict,threeormoreboard 29membershavefailedtocompletethetrainingrequiredinsection190.053. 30 2.Ifthedepartmentdeterminesanambulanceserviceisfinanciallyinsolventor 31itsoperationsareinsufficientasdescribedinsubsection1ofthissection,thedepartment 32mayrequirethelicenseholdertosubmitacorrectiveactionplanwithinfifteendaysand 33requireimplementationofsuchcorrectiveactionplanwithinthirtydays. HB724 5 34 3.Thedepartmentshallprovidenoticeofanydeterminationofinsolvencyor 35insufficiencyofoperationsofalicenseholderbythedepartmentto: 36 (1)Otherlicenseholdersoperatinginthelicenseholder'svicinity; 37 (2)Membersofthegeneralassemblywhorepresentallorpartofthelicense 38holder'sservicearea; 39 (3)Thegoverningofficialsofanycountyormunicipalentityinthelicense 40holder'sservicearea; 41 (4)TheappropriateregionalEMSadvisorycommittee;and 42 (5)Thestateadvisorycouncilonemergencymedicalservices. 43 4.Upontakinganycorrectiveactionunderthissection,thedepartmentshall 44immediatelyengagewithotherlicenseholdersintheaffectedareatodeterminethe 45extenttowhichgroundambulanceservicemaybeprovidedtotheaffectedservicearea 46duringthetimeinwhichtheprovisionaloraffectedlicenseholderisunabletoprovide 47adequateservices,includinganylong-termservicearrangements.Theholderofa 48provisionalorsuspendedlicensemayenterintoanagreementwithotherlicenseholders 49toprovideservicestotheaffectedarea.Suchagreementmaybeintheformofan 50agreementtoprovideservices,ajointpowersagreement,formalconsideration,or 51paymentforservicesrendered. 52 5.Anyambulanceserviceoperatorwhoprovidesassistanceintheserviceareaof 53anotherambulanceserviceoperatorwhoselicensetooperatehasbeensuspendedunder 54thissectionshallhavetherighttoseekreasonablecompensationfromtheambulance 55serviceoperatorwhoselicensetooperatehasbeensuspendedunderthissectionforall 56calls,stand-bytime,andresponsestomedicalemergenciesduringsuchtimethelicense 57remainssuspended.Thereasonablecompensationshallnotbelimitedtoonlythose 58expensesincurredinactualresponsesbutmayincludereasonableexpensestomaintain 59theambulanceserviceincluding,butnotlimitedto,thedailyoperationalcostsof 60maintainingtheservice,personnelwagesandbenefits,equipmentpurchasesand 61maintenance,andothercostsincurredintheoperationofanambulanceservice.The 62ambulanceserviceoperatorprovidingassistanceshallbeentitledtoanawardofcosts 63andreasonableattorney'sfeesinanyactiontoenforcetheprovisionsofthissection. ✔ HB724 6