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.
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