COMMITTEE ON LEGISLATIVE RESEARCH
OVERSIGHT DIVISION
FISCAL NOTE
L.R. No.:0565S.02P Bill No.:Perfected SS for SB 7 Subject:Emergencies; Ambulances and Ambulance Districts; Department of Health and
Senior Services; Health Care; Health Care Professionals; Boards, Commissions,
Committees, and Councils
Type:Original Date:February 6, 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. 0565S.02P
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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. 0565S.02P
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FISCAL ANALYSIS
ASSUMPTION
Oversight was unable to receive some of the agency responses in a timely manner due to the
short fiscal note request time. Oversight has presented this fiscal note on the best current
information that we have or on prior year information regarding a similar bill. Upon the receipt
of agency responses, Oversight will review to determine if an updated fiscal note should be
prepared and seek the necessary approval to publish a new fiscal note.
§§ 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 Section 190.053.2
of the proposed legislation requires ambulance district board members to complete three hours of
continuing education training for each term of office. Training shall be offered by a statewide
association or program approved by the State Advisory Council on Emergency Medical Services.
This will require the Department of Health and Senior Services (DHSS), Division of Regulation
and Licensure’s (DRL) Bureau of Emergency Medical Services (BEMS) to verify ambulance
district board member training records through the licensure application review process and
during inspections.
The proposed legislation modifies provisions relating to emergency medical services. Sections
190.109.6(12) and 190.109.6(13) require the Department of Health and Senior Services, 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 190.112 requires licensed ambulance services to identify an individual to DHSS who
will serve as the ambulance service administrator responsible for ambulance service operations
and staffing. Additionally, the identified administrator is required to complete 40 initial training
hours and two hours of continuing education annually related to the operations of an ambulance
service. Training shall be offered by a statewide association or program approved by the State
Advisory Council on Emergency Medical Services. Individuals serving as an ambulance service
administrator as of August 28, 2025, will have until January 1, 2026, to demonstrate compliance
with these provisions. This will require BEMS to verify training records through the licensure
application review process for the individual administrator and the ambulance service, as well as
during inspections of the ambulance service.
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 L.R. No. 0565S.02P
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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.
In response to a previous version, officials from the Department of Public Safety – Division of
Fire Safety, the Department of Social Services and the City of Kansas City assumed the
proposal would 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.
Senate Amendment 1 - § 537.038 - Modifies the immunity from liability for care or assistance
rendered in emergency
In response to similar legislation from the current session (SB 521), officials from the Attorney
General’s Office and the Office of the State Courts Administrator each assumed the proposal
would 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 for this section.
Senate Amendment 3 – § 197.135 - Specialty hospital forensic examinations of victims of sexual
offenses
Officials from the Department of Health and Senior Services state Section 197.135.7 of the
proposed legislation exempts specialty hospitals from Sections 192.2520 and 197.135, RSMo,
which set forth the mandatory forensic exams and evidence collection for sexual assaults and
being part of the Sexual Assault Network tele-reporting. Specialty hospitals would be exempt
only if they have a policy to transfer those patients to an acute care hospital with an Emergency
Department. The Division of Regulation and Licensure’s (DRL) Section for Health Standards
and Licensure (HSL) is responsible for conducting inspections of hospitals. Should the proposed
legislation become law, HSL would make review of this policy part of the inspection protocol. L.R. No. 0565S.02P
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Adding this component to inspection protocol would be within the normal ebb and flow of work
scope.
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.
Responses regarding the proposed legislation as a whole
Officials from the Department of Social Services assume the proposal will have no fiscal
impact on their organization. Oversight does not have any information to the contrary.
Therefore, Oversight will reflect a zero impact in the fiscal note for this agency.
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.
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.
In response to a previous version, officials from the Office of the Secretary of State (SOS)
noted 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. L.R. No. 0565S.02P
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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.
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
Attorney General’s Office
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
Office of the State Courts Administrator
City of Kansas City
Julie MorffJessica HarrisDirectorAssistant DirectorFebruary 6, 2025February 6, 2025