HS/HCS/SCS/SB 486 and SB 422 - This act contains several provisions pertaining to emergency services.

RURAL FIRE DEPARTMENTS - Clarifies that the Commissioner of Administration may distribute surplus or unneeded supplies or property to rural fire departments (Section 34.140).

CITY LAW ENFORCEMENT SALES TAX - Authorizes cities located within a county which has enacted a countywide sales tax for law enforcement to impose an additional sales tax for the same purpose upon voter approval (Section 67.582).

JEFFERSON COUNTY FIRE PROTECTION DISTRICT - Authorizes a fire protection district located in Jefferson County which serves an area that is annexed to continue to provide services. The city will pay the fire protection district an amount equal to what the fire protection district would have collected from the property levy (Section 72.419).

KANSAS CITY CAPITAL IMPROVEMENTS SALES TAX - Authorizes Kansas City to resubmit a capital improvements sales tax proposal prior to twelve months from the date of the last submitted proposal (Section 94.577).

This portion of the act has an emergency clause and is contained in TAT version of CCS/SCS/HB 80 (2001) and SS/SCS/HCS/HB 780 (2001).

TAX INCREMENT FINANCING (TIF) PROJECTS - Requires any district providing emergency services to a redevelopment project established after August 28, 2001, to be reimbursed 50% of the district's tax increment (Section 99.847).

BOARD OF DIRECTORS OF AMBULANCE DISTRICTS - Requires candidates for the board of directors of an ambulance district to be a resident of the district for 2 years before the election and be twenty-four years old. Current law requires that a candidate be a resident of the district for one year and be twenty-one years old (Section 190.050).

Allows the six-member board to be increased to seven with one board member elected district-wide. This provision also authorizes the decrease in the board membership from six to five or three members upon voter approval (Section 190.051).

Clarifies the procedure for a recall election of a member of the board of directors of a fire district.

This portion of the act is similar to SCS/SB 486 (2001).

AUTOMATED EXTERNAL DEFIBRILLATOR - Requires the person or entity to develop and maintain training for intended users (Section 190.092).

Removes the requirement that a mobile emergency medical technician be present when transporting a patient in an ambulance (Section 190.094).

EMERGENCY MEDICAL SERVICES SYSTEM - Expands definitions to include "proof of financial responsibility" required by the owner of a motor vehicle (Section 190.100).

GROUND AMBULANCE - Requires each ground ambulance be staffed with at least two licensed individuals except for service provided in Cass, Bates, Johnson, Henry and St. Clair Counties.

Exempts an ambulance service or vehicle from being treated as a common contract carrier under the jurisdiction of Missouri Division of Motor Carrier and Railroad Safety. Current law refers to jurisdiction under the Missouri Public Service Commission (Section 190.105).

Requires that the letter of endorsement from an ambulance district state that such ambulance services:

(1) Will provide a benefit to public health; (2) Will maintain or enhance public access to ambulance service; (3) Maintain or improve public health; (4) Demonstrate expertise in the operation of the ambulance service; and (5) Demonstrate financial resources necessary to operate the proposed ambulance service.

Authorizes a nonprofit, public benefit corporation that owned and operated a licensed ambulance service on December 31, 1997 that converts to a profit corporation subsequent to December 31, 2000 to receive an ambulance service license (Section 190.109).

Authorizes the granting of a temporary ambulance service license to the Firefighter's Association of Missouri in order to provide services at the Missouri State Fair (Section 190.111).

AMBULANCE SERVICE LICENSE - Allows for proof of financial responsibility be provided prior to issuance of a license (Section 190.120).

Removes the provisions of law that require the Department of Health to promulgate rules pertaining to the transportation of patients in a vehicle other than an ambulance (Section 190.142).

TEMPORARY EMERGENCY MEDICAL TECHNICIAN LICENSE - Authorizes the Department of Health to issue a temporary emergency medical technician license to qualified individuals (Section 190.143).

LICENSURE BY THE DEPARTMENT OF HEALTH - Technical corrections to clarify which sections pertain to the licensing authority of the Department of Health (Section 190.160).

Expands behavior that may be considered for the refusal of a license by the Department of Health to include: refusal to cooperate, harmful or dangerous conduct or gross negligence. Prohibits the relicensure of individuals whose license has been revoked twice within a ten-year period (Section 190.165).

Requires that if no contested case has been filed against a licensee, the agency will submit a copy of the settlement agreement signed by all parties within 15 days after signature to the Administrative Hearing Commission. Any person directly harmed by the specific conduct for which the discipline is sought for the licensee may write to the Administrative Hearing Commission (Section 190.172).

Requires that a patient care report be completed for each ambulance run and remarks will be entered on the form by the emergency medical technician, registered nurse or physician (Section 190.175).

Requires a written or electronic patient care document be completed and given to the ambulance service personnel by the health care facility when a patient is transferred to a different health care facility (Section 190.175).

Authorizes the Department of Health to promulgate rules pertaining to the enforcement of these sections (Section 190.185).

Requires any person or entity supervising an emergency medical technician-basic, emergency medical technician-paramedic, registered nurse or physician to cooperate with the Department of Health. Requires any employer employing individuals licensed by the Department of Health to notify the department within 72 hours if any charges are filed against such licensee (Section 190.196).

All investigations of allegations of violations of the licensing provisions will be investigated within six months of receipt of allegation (Section 190.248).

STRETCHER VAN SERVICES - Regulates stretcher van services. A stretcher van service is a person or agency that provides transportation to passengers who are confined to stretchers and whose conditions are not likely to need medical attention during transportation (Section 190.525).

This act:

(1) Requires any person, owner, or agent to be licensed by the Department of Health if the person or entity advertises, operates, maintains, engages, or proposes to engage in the transport of persons confined to stretchers. The Department can issue such licenses for a period of 5 years;

(2) Allows political subdivisions who are authorized to provide ambulance service to adopt ordinances and regulations governing the use of stretcher vans as long as those regulations are as strict as the minimum state standards. Ordinances and regulations in effect prior to August 28, 2001, may continue to be enforced by any political subdivision;

(3) Allows the governing body in St. Louis County to set standards for all stretcher van services. Any service in the county must be licensed by the state. The county may not prohibit a licensed service from operating in the county as long as the service meets county standards;

(4) Requires stretcher vans to operate with a 2-person crew;

(5) Requires stretcher van operators to immediately contact the appropriate ground ambulance service if a passenger's medical condition deteriorates;

(6) Prohibits services from transporting persons currently admitted to a hospital or persons being transported to a hospital for admission or emergency treatment;

(7) Requires the Department to establish regulations requiring adequate insurance, vehicle maintenance and specifications, passenger safety, and service records and reports;

(8) Requires the Department to establish the application forms for stretcher van service licenses in order to ensure compliance with rules;

(9) Requires services to notify the Department upon the sale or transfer of any service license. The department must inspect the new service to verify compliance with licensure standards (Section 190.528).

Allows the Department to refuse to issue or deny renewal of a stretcher van license for failure to comply with the law or any regulation promulgated by the department. Guidelines for disciplinary action and relicensure are established. The Department may cause a complaint to be filed with the Administrative Hearing Commission against a licensee for noncompliance with regulations. Procedures are established for the notification of the applicant that a license has been refused and for the applicant to file a complaint with the Administrative Hearing Commission. An individual whose license has been revoked must wait one year to apply for relicensure (Section 190.531).

The Department may notify any other state in which a person is licensed of a suspended or revoked license in this state (Section 190.531).

Protects any person or organization from civil damage when in good faith the person provides information to the department regarding stretcher van regulations.

Allows the Department to suspend a license if the department finds that there is an imminent threat to public health. The Department must file a complaint with the Administrative Hearing Commission upon the suspension.

Procedures are established for the suspension and appeal of such suspension. The Attorney General has concurrent jurisdiction with all prosecuting attorneys to prosecute persons in violation of these laws and regulations. Injunctive proceedings may be instituted against persons in violation. Persons violating these laws are guilty of a Class B misdemeanor. Each day that any violation continues constitutes a separate offense, but the court may stay the cumulative penalties (Section 190.534).

AUTOMATED EXTERNAL DEFIBRILLATOR ADVISORY COMMITTEE - This portion of the act establishes the Automated External Defibrillator Advisory Committee. The Committee is required to advise the Department of Health, Office of Administration, and the General Assembly on placing automated external defibrillators (AEDs) in public buildings, particularly public buildings owned by the state of Missouri or housing state employees, with special consideration given to state office buildings which are accessible to the public.

The committee is required to issue an initial report to the Department of Health, Office of Administration, and the Governor's Office no later than June 1, 2002, and a final report no later than December 31, 2002. The issues the report should address include cost projections, training personnel in the use of AEDs and in cardiopulmonary resuscitation, and the criteria used to place AEDs in public buildings.

Provisions pertaining to the composition of the committee, selection of the chair, reimbursement of expenses, and the adoption of written by-laws are contained in the act. The Department of Health is required to provide technical and administrative support services required by the committee. The Office of Administration is required to provide technical support to the Committee.

The Advisory Committee will terminate on June 1, 2003 (Section 191.938).

This portion of the act is similar to HB 749 (2001).

MISSOURI HEALTH FACILITIES REVIEW LAW - This act will be known as the "Missouri Health Facilities Review Law" and states the purpose of the Office of Health Facilities Review. Revised definitions are provided (Sections 197.370 - 197.374).

The Missouri Health Facilities Review Committee is established, consisting of seven members and the Director of the Division of Health Standards and Licensure and the Division of Aging. The Committee must meet at least twice per year. Existing members will complete their terms (Section 197.376). The duties of the Committee are provided, including the review and approval or disapproval of all applications for review certification (Section 197.378).

The procedures for application submission are outlined. A letter of intent should be submitted 30 days before filing an application and a fee must accompany the application. Applicants have the right to appeal the Committee's decision (Section 197.380 - 197.382).

Any person proposing a new institutional health service, first-time service, the addition of newly licensed beds, or renovations over a certain amount must obtain a non-transferable review certification. Certification will also be granted to those demonstrating a need for a competitive alternative in concentrated markets. If costs exceed 10% of the approved amount, the Committee must consent to the increase. Applicants must submit periodic reports and the Committee may revoke certification in certain situations. A review certification may be forfeited for failure to spend 20% of the total approved cost within 12 months. State agencies may not license, certify, or provide funds without a person or facility first obtaining review certification, if required to do so (Section 197.384).

An application for review certification will not be required for previously certified facilities which are run by the state, facilities operated for the purpose of treating AIDS patients, and other nonreviewable projects (Section 197.386).

Review certification will not be issued until January 1, 2003 for additional ICF, RCF I or II, or SNF beds unless they are exempt from review certification requirements, or for hospital beds which are reallocated to nursing care beds (Section 197.388).

The Department of Health must determine existing need for additional beds by county. Occupancy within a county must exceed 90% for at least 4 consecutive quarters and the Department may make other considerations, as well (Section 197.390).

The procedure for increasing licensed bed capacity in a RCF I or II or a SNF is outlined. The facility must perform certain duties and certify certain procedures in order to increase. This section takes the language of the repealed Section 197.318.8(1), RSMo (Section 197.392).

Any person paid to support or oppose a project must register with the Committee. Persons regulated by Chapters 197 or 198, RSMo, are prohibited from soliciting Committee members while an application is pending (Section 197.394).

Reimbursement for new institutional health service project costs over 10% of the initial estimate will not be paid for the first 3 years that a facility receives payment for services through Medicaid. A review certification must be granted before payment for excess project costs will be made. The Committee must submit an annual report to the Governor and General Assembly regarding approved, disapproved, or pending projects. The Committee is given rule authority to enforce these sections (Section 197.396 - 197.398).

Portions of this act are substantially similar to SS/HB 949 (2001)and SB 235 (2001).

STATE EMERGENCY MANAGEMENT AGENCY - This act extends the certificate for the collection of fees for the State Emergency Management Agency from companies that use and store hazardous chemicals. The current date for ending the fees is ten years from August 28, 1992. This act will make the ending date twenty years from August 28, 1992 (Section 292.606).

This portion of the act is similar to provisions contained in TAT CCS/SS/SCS/HB 453 (2001).

DONATED FIRE PROTECTION EQUIPMENT - Currently, immunity relating to donated fire equipment is limited to "used personal protection equipment" and "fire protection clothing". This act allows immunity for any donated fire equipment used to suppress a fire, provided:

(1) The State Fire Marshal approves the equipment; (2) Any donated motor vehicle passes inspection; (3) The receiving agency demonstrates the equipment works properly; and (4) Donor agencies inform receiving agencies in writing of any defects (Section 320.091).

This portion of the act is similar to SB 197 (2001).

FIRE PROTECTION DISTRICT BOARD OF DIRECTORS - Requires candidates for the board of directors to be twenty-four years old. Current law requires the candidates to be twenty-five years old (Section 321.130).

Authorizes fire protection district board of directors located in St. Louis, Jackson, or St. Charles Counties to receive an additional fee for attending a meeting, not to exceed more than four such meetings in any calendar month (Section 321.190).

ANNEXATION - Requires any city, not located in St. Louis County or already having a fire district, which annexes an area within an existing fire district to reimburse the existing district for the portion of outstanding indebtedness (Section 321.300).

FIRE PROTECTION DISTRICT BOARD OF DIRECTORS RECALL ELECTION - This act requires that a fire district board member commit some act of misconduct, malfeasance or nonfeasance relating to official board duties, or that the board member be convicted of any felony or any Class A or B misdemeanor, before a registered voter from that district may initiate recall proceedings (Sections 321.701 and 321.703).

This portion of the act is similar to SCS/SB 486 (2001).

NOT-FOR-PROFIT CORPORATION LAW - Expands the definition of "public benefit corporation" to include the Kansas City ambulance service (Section 355.066).
JULIA SOMMER GRUS

HA 1 - REMOVES THE WORDS "OR FIRE PROTECTION" TO DESCRIBE SERVICES THAT MAY BE FUNDED BY A VOTER APPROVED SALES TAX.

REMOVES SUBSECTION 8 OF SECTION 190.109 WHICH AUTHORIZES A NONPROFIT, PUBLIC BENEFIT CORPORATION THAT OWNED AND OPERATED A LICENSED AMBULANCE SERVICE ON DECEMBER 31, 1997 THAT CONVERTS TO A PROFIT CORPORATION SUBSEQUENT TO DECEMBER 31, 2000 TO RECEIVE AN AMBULANCE SERVICE LICENSE (Section 190.109).

REMOVES THE REFERENCE TO THE KANSAS CITY AMBULANCE SERVICE FROM THE DEFINITION OF "PUBLIC BENEFIT CORPORATION" (SECTION 355.066).

HA 2 - REMOVES THE WORDS "UNITS OF SERVICE" IN THE DEFINITION OF "FIRST-TIME SERVICE" AND REPLACES IT WITH THE WORDS, "NEW MACHINES OR NEW ROOMS USED FOR THE LISTED SERVICES" PERTAINING TO THE MISSOURI HEALTH FACILITIES REVIEW LAW.

ALLOWS FOR THE REPLACEMENT COST OF LISTED MACHINES OR ROOMS UNLESS THE REPLACEMENT EXCEEDS THE THRESHOLD LIMITS.

EXPANDS THE DEFINITION OF HEALTH CARE FACILITIES TO INCLUDE ANY RESIDENTIAL CARE FACILITY I OR RESIDENTIAL CARE FACILITY II OPERATED BY A RELIGIOUS ORGANIZATION QUALIFIED PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. SUCH FACILITY MUST NOT REQUIRE THE EXPENDITURE OF PUBLIC FUNDS AND A TOTAL LICENSED BED CAPACITY OF ONE HUNDRED BEDS OR LESS.

CLARIFIES THAT THE EXPENDITURE FOR NON-SUBSTANTIVE PROJECTS AND THE "TOTAL PROJECT COSTS" WILL INCLUDE "CAPITAL EXPENDITURE, INCLUDING LEASE COSTS".

EXPANDS THE DEFINITION OF TOTAL PROJECT COST TO INCLUDE THE "ACQUISITION, NEWLY CONSTRUCTED OR ACQUIRED" BUILDINGS.

REQUIRES THE HEALTH FACILITIES REVIEW COMMITTEE WHEN REVIEWING AN APPLICATION TO ISSUE IN WRITING "ITS FINDING OF FACT, CONCLUSIONS OF LAW".

REMOVES THE PROVISIONS THAT REQUIRE A DEMONSTRATION OF A LEVEL OF UNCOMPENSATED CARE EQUAL TO 5% OF NET OPERATING REVENUE FOR THE THREE FISCAL YEARS PRECEDING THE YEAR IN WHICH AN APPLICATION IS FILED BEFORE A RENOVATION, REPLACEMENT OR EXPANSION IN EXCESS OF $10M MAY APPROVED.

A REVIEW CERTIFICATION IS NOT REQUIRED IF A FACILITY CEASES OPERATION.

INSERTS SECTION 197.399 WHICH CLARIFIES THE DEFINITION OF HEALTH CARE FACILITIES.

HA 3 - REVISES THE TRAINING AND CERTIFICATION REQUIREMENTS FOR PEACE OFFICERS, CERTIFIED RESERVE OFFICERS AND RESERVE OFFICERS. THIS AMENDMENT IS SIMILAR TO SB 351 (2001).

HA 4 - INSERTS A SECTION 1 WHICH STATES IT WILL BE CONTRARY TO PUBLIC POLICY TO WITHHOLD MEDICAID REIMBURSEMENT TO A MEDICAID ELIGIBLE SKILLED NURSING FACILITY.

HA 5 - INSERTS "INCLUDING THE LICENSED PHYSICIAN WHO REVIEWS AND APPROVES THE CLINICAL PROTOCOL" WHEN REFERRING TO THE AUTOMATED EXTERNAL DEFIBRILLATOR.

HA 7 - INSERTS SECTION 292.602 WHICH EXPANDS MISSOURI EMERGENCY RESPONSE COMMISSION TO INCLUDE THE CITY OF ST. JOSEPH (BUCHANAN COUNTY)

HA 8 - INSERTS SECTION 190.072 WHICH AUTHORIZES CONTIGUOUS AMBULANCE DISTRICTS TO PROVIDE SERVICES TO TERRITORY LOCATED IN ONE DISTRICT THAT IS ANNEXED AND SERVED BY THE CONTIGUOUS DISTRICT.

HA 10 - INSERTS SECTION 58.451 WHICH REQUIRES THE CORONER OR MEDICAL EXAMINER TO MAKE CERTAIN INFORMATION ABOUT AN INVESTIGATED DEATH PUBLIC.

HA 11 - INSERTS SECTION 1 WHICH REQUIRES THE DENIAL OR ACCEPTANCE OF AN APPLICATION FOR PAYMENT OF MEDICAL SERVICES WITHIN FIFTEEN DAYS BY THE DIVISION OF FAMILY SERVICES.

HA 12 - INSERTS SECTION 190.109 WHICH AUTHORIZES A NONPROFIT, PUBLIC BENEFIT CORPORATION THAT OWNED AND OPERATED A LICENSED AMBULANCE SERVICE ON DECEMBER 31, 1997 THAT CONVERTS TO A PROFIT CORPORATION SUBSEQUENT TO DECEMBER 31, 2000 TO RECEIVE AN AMBULANCE SERVICE LICENSE (Section 190.109).