SB 415 - This bill substantially revises the law governing organizations providing emergency medical services and the delivery of those services.

The State Advisory Council on Emergency Medical Services is created within the Department of Health. The fifteen members are appointed by the Governor with advise and consent of the Senate. Members are appointed for four years and are reimbursed for reasonable expenses. Members must be selected so as to be geographically representative and representative of the various professions involved in the delivery of emergency services. The Council shall make recommendations to the Department, the Governor and the General Assembly on issues related to emergency services.

The Department shall designate emergency medical services regions by rule. The Director will appoint personnel to at least six regional emergency medical services committees. Appointments will be made from recommendations provided from professional organizations. Committee members serve for four years and are reimbursed for reasonable expenses.

Expert in emergency medical services shall select a physician to serve as a regional medical director. The directors of the regions constitute the state emergency medical services medical director's advisory committee to advise the Department and their region's ambulance service. Each ambulance service and emergency medical response agency that provides advanced life support services shall have a medical director, who, in cooperation with the service or agency administrator, shall ensure proper standards of care are being met. Each agency and their medical director will develop an agreement concerning their respective roles, as well as grievance procedures.

The Department is authorized to establish a program to improve the quality of pediatric emergency care and to receive contributions or funds from any private entity. The funds shall transfer to the Director of Revenue to the credit of general revenue to be expended after appropriation for the pediatric emergency medical services program.

Ambulances in the air are included in the requirement that owners and operators engaged in the transportation of patients hold a currently valid license for an ambulance service. The ground ambulance must be under the immediate supervision and direction of a person holding a valid emergency medical technician license. Each ambulance service is responsible for assuring that any driver is competent in emergency vehicle operations. No ambulance service license is required if the service or employee is rendering assistance at the request of a licensed service in the case of an emergency or major catastrophe.

Political subdivisions authorized to provide ambulance service may adopt ordinances which exceed state standards. Municipalities or counties located within an ambulance district shall not adopt regulations related to ambulance services, and shall not operate an ambulance service if the ambulance district has made such practice unlawful, unless the ambulance service was established prior to August 28, 1997. A person acting as a owner, agent or otherwise, holding a valid ambulance service license shall not violate the laws of any political subdivision by failing to obtain a franchise, contract or mutual aid agreement. Any person who fails to comply with such laws is guilty of a Class B misdemeanor, and is subject to suspension or revocation of its license by the Department. The Director shall establish a process to resolve ground service area boundaries. Providers shall not discriminate in the treatment or transportation of patients, including based on ability to pay.

Any ambulance service may enter into mutual aid contracts for emergency services, as long as they include a minimum sixty- day cancellation notice by either party. Any ambulance service may provide assistance to another service that requests it in case of natural disasters and unforeseen events. Mutual aid contracts may be agreed to between ambulances services in this state and a neighboring state.

The Department shall license any air ambulance service, ground ambulance service, emergency medical response agency which provides advanced life support, and emergency medical technicians. Ambulance services shall have a lien upon any claims of any person it treats or transports for the cost of services, except as to any person coming under the provisions of Chapter 287, RSMo. Written notice of the lien must be sent by registered mail to the person or entity alleged to be liable and to the insurance carrier, if known. The lien may be enforced against the payor if not honored within one year from payment.

The Department shall certify training entities for first responders, emergency medical dispatchers, emergency technicians- basic and -paramedic, and shall promulgate rules relating to minimum requirements. Periodic reviews of the training entity will be conducted.

Dispatch agencies are required to have a memorandum of understanding with all ambulance services that it dispatches. A dispatch agency must have a medical director if it provides pre- arrival medical instructions. Emergency medical technicians must receive medical direction or be authorized to operate under protocols while performing advanced life support services.

Licenses and renewal applications may be denied, as well as suspended or revoked, by the Director, for failure to comply with provisions of law. Grounds for taking disciplinary action are listed. Aggrieved parties may appeal to the Administrative Hearing Commission within thirty days.

A uniform data collection system will be developed and administered by the Department on all ambulance runs and injured patients, and may require health care providers to supply certain additional data for regional medical peer review. Information generated by peer review activity or for the purpose of complying with a Department request will be protected from discovery or disclosure.

Any person who fails to comply with the provisions of these sections is guilty of a Class B misdemeanor and if convicted, shall be sentenced to a fine or imprisonment, or both. The prosecuting attorney will file charges in the circuit court, and may appoint the attorney for the ambulance district to be special prosecuting attorney. The Department shall adopt rules and standards, with consideration of the recommendations of the state advisory council on emergency medical services.

The expiration date of the licenses of ground ambulance vehicles and air ambulance aircraft that have or are qualified to have a valid license on the effective date of this act is extended to August 28, 1998. All such services shall have one year after this act is effective to comply with its rules. No employer shall knowingly employ or permit any employee to provide services without the required certification, and will cooperate with the Department's monitoring of those employed as first responder or emergency medical dispatcher.

The Department may provide public and professional information and education programs with the local and regional emergency medical services systems and agencies.

Insurance carriers and managed care plans must pay benefits directly or ambulance services or emergency medical response agencies. The carriers shall not prohibit use of services when needed, and shall not require preauthorization. The carriers shall pay for services provided pursuant to the Patient Transfer Act.

The Department will designate a hospital as an adult, pediatric or adult/pediatric trauma center after written application of the hospital and site review, if the necessary criteria is met. The Department will conduct on-site reviews of trauma centers every three years, and may conduct reviews more often if it has reasonable cause to suspect noncompliance. The designation of a trauma center that fails two consecutive on-site reviews shall be revoked. No hospital may hold itself out as a adult, pediatric or adult/pediatric trauma center unless so designated by the Department.

Severely injured patients must be transported to a trauma center. If such transport would be prolonged, a severely injured patient may be stabilized at the nearest appropriate facility prior to transport to the trauma center. Consideration of reimbursement mechanisms shall not supersede principles of medically appropriate care regarding the transport of severely injured patients. Patients who are not severely injured shall be transported to the hospital of their choice so long as the ambulance service is not in violation of local protocols.
TOM MORTON