SCS/HS#2/HCS/HB 1186 - This act makes various changes to the creation, operation and delivery of emergency services and is known as the "Comprehensive Emergency Medical Services System Act."

The act makes the following changes to the ambulance district law:

(1) The assessed valuation of the area to be included in a petition for an ambulance district is raised from $2.5 million to $10 million (Section 190.015);

(2) No geographic area shall pay a tax to more than one ambulance district. Provisions are detailed regarding the elimination of any double tax (Section 190.042);

(3) Ambulance boards should engage in educational programs (Section 190.055); and

(4) Multicounty districts may no longer be divided into separate ambulance districts (Section 190.973 deleted).

This act creates a State Council on Emergency Medical Services to make recommendations to the Governor and the General Assembly (Section 190.101). This council replaces the Advisory Council of the same name, and assumes the same responsibilities, except that the new council is appointed by the Director of Health instead of the Governor and does not require advice and consent of the Senate.

DOH will divide the state into designated Emergency Medical Services (EMS) regions and appoint a committee in each region to develop policies, standards, and protocols to improve EMS in the region (Section 190.102). The Director will also appoint one physician, with expertise in EMS, to serve as the regional EMS medical director to advise the Department. In addition, each ambulance service in the region would have to appoint a local physician to be their medical director. The local medical director has the responsibility to ensure that the personnel are meeting the standards of the DOH (Section 190.103).

The DOH is authorized to establish a program to improve the quality of emergency care for pediatric patients throughout the state and to implement a comprehensive pediatric emergency medical services system. DOH is authorized to receive contributions, grants, donations or funds for this program (Section 190.104).

This act requires DOH to license ambulance services for 3 year periods and allows the DOH authority to suspend, revoke or refuse to renew licensure of a ground (Section 190.108) or air ambulance (Section 190.107) service if such service does not meet established standards.

If any new or existing service areas overlap, the ambulance services will develop a plan for the coordination of emergency and nonemergency services which the department shall approve. The plans shall include mutual aid, tiered response, 911 and other dispatching procedures and call referral procedures. The development of an approved plan shall be a condition of licensure. If no agreement is reached by December 31, 1997, then the Department shall develop a nonoverlapping service areas after holding public hearings (Section 109.113).

Any new ground ambulance service voted in after April 1, 1996 must receive a license from the Department if such ambulance services meets the necessary standards determined by the Department. The Department may not change the areas of any ground ambulance service voted on by the people (Section 190.113).

The act also authorizes the Department to provide training for ambulance services; requires the Department to license emergency medical response agencies that provide advanced life support or early defibrillation services and sets new standards for the licensing of ambulance technicians (Sections 190.131, 190.133 and 190.142).

Any action taken by the DOH pursuant to chapter 190, RSMo, may be appealed to the AHC (Section 190.171).

The DOH is to develop and administer a uniform data collection system on all ambulance runs and injured patients for the purpose reviewing patient care outcome, peer review, injury prevention and research purposes. The Department may require health care providers o provide additional data for regional medical peer review for regional quality improvement activities (Section 190.175).

Section 190.181 states that no liability shall attach unless a particular act constitutes "gross negligence or willful and wanton misconduct" (Section 190.181).

The DOH in cooperation with the local and regional EMS systems may provide public and professional information and education programs related to emergency medical services systems including trauma systems and emergency medical care and treatment (Section 190.200).

The act provides that insurance carriers and managed care plans shall pay benefits directly to the provider of emergency services in accordance with the provisions of section 376.427, RSMo. Insurance companies and managed care plans shall not prohibit or discourage the use of the 911 system when emergency services are needed and shall not require prior authorization or retrospectively deny payment for a plan enrollee's use of emergency services (Section 190.205).

The DOH shall designate a hospital as an adult, pediatric or adult/pediatric trauma center when a hospital, upon proper application has been found by the Department to meet the applicable level of trauma center criteria. The DOH shall conduct on-site review of every trauma center in the state. A trauma center's designation shall be revoked if the center fails two consecutive on-site reviews (Section 190.241).

Under this act, severely injured patients shall be transported to the nearest medical facility or facility of the patient's choice. The transportation of a severely injured patient shall be governed by principles of timely and medically appropriate care and consideration of reimbursement mechanisms shall not supersede those principles. Patients who are not severely injured shall be transported to and cared for at the hospital of their choice so long as such ambulance service in not in violation of local protocols (Section 190.243).

After August 28, 1996, ambulance districts may contract out to a private company to provide ambulance service if a majority of the voters of the political subdivision authorize such a proposal at a public election. The provision of this section shall not apply to contracts executed prior to August 28, 1996, or to the renewal or modification of such contracts (Section 1).
RONALD J. LEONE