HS HB 390 -- AMBULANCE SERVICE (Hoppe)

This Comprehensive Emergency Medical Services System Act:

(1)  Authorizes, upon voter approval, the creation of ambulance
districts in counties with populations less than 400,000 at the
time the ambulance district is created;

(2)  Establishes the State Advisory Council on Emergency Medical
Services (EMS) to advise the Governor and General Assembly on
matters related to improving all aspects of emergency medical
services;

(3)  Establishes the State EMS Medical Directors Advisory
Committee and no less than 6 Regional EMS Advisory Committees as
subcommittees of the State Advisory Council on EMS;

(4)  Requires the Department of Health to establish EMS regions
and committees;

(5)  Requires the department with the help of the council to
adopt state-of-the-art EMS rules and regulations for the state;

(6)  Requires the selection by EMS physicians of one physician
from each EMS region to serve as a regional physician medical
director;

(7)  Authorizes the department to establish a pediatric EMS
system;

(8)  Requires an agreement on ambulance service between an
ambulance district and either a municipality or county.  The
agreement is not required if the municipality-or county-operated
ambulance service was in operation before August 28, 1997;

(9)  Requires that after August 28, 1997, any contract between
an ambulance district or board and a private company receive
approval by the voters;

(10)  Allows political subdivisions authorized to provide
ambulance services to adopt rules and regulations exceeding
state standards related to providing, selecting, or contracting
for ambulance service;

(11)  Requires the director to regulate and settle disputes on
issues regarding service areas in order to assure ambulance
service throughout the state.  The director may not modify the
jurisdictional boundaries of any existing ambulance district,
fire protection district, or municipal ambulance service
established before August 28, 1997;

(12)  Allows cooperation and coordination between ambulance
services during an emergency or major catastrophe;

(13)  Requires the department to license and regulate air
ambulance services, ground ambulance services, and emergency
medical response agencies;

(14)  Requires the department to certify and regulate
institutions that train EMS personnel;

(15)  Requires a dispatch agency to have a dispatch agreement
with ambulance services;

(16)  Requires the department to license and regulate all levels
of emergency medical technicians for a period not to exceed 5
years;

(17)  Allows the department to place on probation or deny a
license to any emergency medical technician for non compliance
with department regulations, incompetency, or negligence.  The
licensee may appeal to the Administrative Hearing Commission;

(18)  Requires the department to collect data on all ambulance
runs and injured patients for use by the department;

(19)  Gives air and ground ambulances until August 28, 1998, to
comply with new EMS rules and regulations promulgated by the
department;

(20)  Requires ambulance services to employ only technicians
licensed by the department;

(21)  Allows the department and EMS regions to provide public
training and professional education training, related to
emergency care;

(22)  Requires insurance carriers and managed care plans to pay
benefits directly to ambulance service;

(23)  Prohibits insurance carriers and managed care plans from
prohibiting or discouraging the use of 911 systems when
emergency service is needed;

(24)  Requires the department to designate a hospital as an
adult, pediatric, or adult/pediatric trauma center;

(25)  Requires severely injured patients to be transported to a
trauma center or nearest appropriate facility for
stabilization.  Patients who are not severely injured will be
transported to a hospital of choice;

(26)  Allows ambulance services to secure a lien on property and
insurance benefits for services provided;

(27)  Requires ambulance services to provide emergency service
regardless of race, sex, age, color, religion, sexual
preference, national origin, ancestry, handicap, medical
condition, or ability to pay;

(28)  Gives the medical director in cooperation with the
ambulance service administrator the responsibility and the
authority to ensure that technicians provide adequate care to
patients.  An agreement on roles, responsibility, authority, and
grievance procedure between the medical director, emergency
personnel,  and the ambulance service is required;

(29)  Defines the following:  ambulance service, ambulance
service area, emergency medical response agency, dispatch
agency, emergency medical technician, medical director,
ambulance service, and emergency; and

(30)  Makes a violation of any of the above provisions of this
bill a class B misdemeanor.

This bill also establishes a 911 Service Oversight Committee
within the Department of Public Safety.

FISCAL NOTE:  Estimated Net Cost to General Revenue Fund of
$63,760 for FY 1998, $78,279 for FY 1999, and $80,635 for FY
2000.

HB 390 -- AMBULANCE SERVICE

SPONSOR:  Hoppe

COMMITTEE ACTION:  Voted "do pass" by the Committee on Local
Government and Related Matters by a vote of 15 to 2.

This Comprehensive Emergency Medical Services System Act:

(1)  Authorizes, upon voter approval, the creation of ambulance
districts in counties with populations less than 400,000 at the
time the ambulance district is created;

(2)  Establishes the State Advisory Council on Emergency Medical
Services (EMS) to advise the Governor and General Assembly on
matters related to improving all aspects of emergency medical
services;

(3)  Establishes the State EMS Medical Directors Advisory
Committee and the Regional EMS Advisory Committee as
subcommittees of the State Advisory Council on EMS;

(4)  Requires the Department of Health to establish EMS regions
and committees;

(5)  Requires the department with the help of the council to
adopt state of the art EMS rules and regulations for the state;

(6)  Requires the department to appoint one physician from each
EMS region to serve as a regional physician medical director;

(7)  Authorizes the department to establish a pediatric EMS
system;

(8)  Requires an agreement on ambulance service between an
ambulance district and either a municipality or county.  The
agreement is not required if the municipality or county operated
ambulance district was in operation before April 1, 1997;

(9)  Allows political subdivisions authorized to provide
ambulance services to adopt rules and regulations exceeding
state standards;

(10)  Allows ambulance services in existence before April 1,
1997, to maintain their ambulance service areas unless changed
by the director or by legislation.  The director is required to
regulate and settle disputes on issues regarding service areas;

(11)  Allows cooperation and coordination between ambulance
services during an emergency or major catastrophe;

(12)  Requires the department to license and regulate air
ambulance services, ground ambulance services, and emergency
medical response agencies;

(13)  Requires the department to certify and regulate
institutions that train EMS personnel;

(14)  Requires a dispatch agency to have a dispatch agreement
between ambulance services;

(15)  Requires the department to license and regulate all levels
of emergency medical technicians for a period not to exceed 5
years;

(16)  Allows the department to place on probation or deny a
license to any medical technician for non-compliance with
department regulations, incompetency, or negligence.  The
licensee may appeal to the administrative hearing committee;

(17)  Requires the department to collect data on all ambulance
runs and injured patients for use by the department;

(18)  Allows air and ground ambulances until August 28, 1998, to
comply with new EMS rules and regulations promulgated by the
department;

(19)  Requires ambulance services to employ only technicians
licensed by the department;

(20)  Allows the department and EMS regions to provide public
training and professional education training related to
emergency care;

(21)  Requires insurance carriers and managed care plans to pay
benefits directly to ambulance service;

(22)  Prohibits insurance carriers and managed care plans from
prohibiting or discouraging the use of 911 systems when
emergency service is needed;

(23)  Requires the department to designate a hospital as an
adult, pediatric, or adult/pediatric trauma center.  The
department is required to regulate designated trauma centers;

(24)  Requires severely injured patients to be transported to a
trauma center or nearest appropriate facility for
stabilization.  Patients who are not severely injured will be
transported to a hospital of choice;

(25)  Allows ambulance services to secure a lien on property and
insurance benefits for services provided;

(26)  Requires ambulance services to provide service regardless
of race, sex, age, color, religion, sexual preference, national
origin, ancestry, handicap, medical condition, or ability to pay;

(27)  Gives the medical director in cooperation with the
ambulance service administrator the responsibility and the
authority to ensure that technicians provide adequate care to
patients.  An agreement on roles, responsibility, authority, and
grievance procedure between the medical director and the
ambulance service is required;

(28)  Defines the following:  ambulance service, ambulance
service area, emergency medical response agency, dispatch
agency, emergency medical technician, medical director,
ambulance service, and emergency; and

(29)  Makes a violation of any provision of this bill a class B
misdemeanor.

FISCAL NOTE:  Estimated Cost to General Revenue Fund is $50,800
for FY 1998, $62,789 for FY 1999, and $64,673 for FY 2000.

PROPONENTS:  Supporters say that current statutes controlling
ambulance service is 25 years old and terms are no longer used.
This bill contains recommendations made by the State Advisory
Council.  The role of the medical director is clarified and
better quality medical care will be provided.  Medical training
would be improved under this bill.  This bill is a compromise
between many individuals and has taken over two years of work.

Testifying for the bill were Representative Hoppe; Dr. Bill
Jermyn; Chesterfield Fire Protection District; Governor's
Advisory Committee on EMS; Central Jackson County Fire
Protection District; Missouri Emergency Medical Services
Association; Cox Health Systems of Springfield; Missouri
Ambulance Association; Fort Osage Fire District; Missouri
Department of Health; Mehlville Fire Protection District; West
County EMS and Fire Protection District; Eureka Fire Protection
District; Creve Coeur Fire Protection District; Missouri Fire
Service Alliance; American College of Emergency Medicine;
Metropolitan Ambulance Service Trust; Life Flight Eagle Air
Ambulance; Fire Fighters Association of Missouri; Ambulance
District Association of Missouri; SEMO EMS Network; East Central
Emergency Service Planning Committee; and Kansas City.

OPPONENTS:  Those who oppose the bill say that many dispatchers
will no longer be certified.  The bill will create confusion for
dispatchers who answer fire, law enforcement, and ambulance
calls.  Additional fees must be paid under this bill, which many
rural ambulance services will not be able to pay.
Confidentiality of patient records will be a problem.  This bill
would also allow political subdivisions to alter current
ambulance service boundaries.  The bill would also encourage
contracts between ambulance services and health maintenance
organizations.

Testifying against the bill were Macon County Enhanced 911;
Missouri Chapter of National Emergency Number Association;
Alliance Blue Cross Blue Shield; Abbott Ambulance; University
Hospital of Columbia; Missouri Association of Trial Attorneys;
and Missouri Managed Care Association.

Steve Bauer, Research Analyst

HB 390 -- Ambulance Service

Sponsor:  Hoppe

This Comprehensive Emergency Medical Services System Act:

(1)  Authorizes, upon voter approval, the creation of ambulance
districts in counties with populations less than 400,000 at the
time the ambulance district is created;

(2)  Establishes the State Advisory Council on Emergency Medical
Services (EMS) to advise the Governor and General Assembly on
matters related to improving all aspects of emergency medical
services;

(3)  Establishes the State EMS Medical Directors Advisory
Committee and the Regional EMS Advisory Committee as
subcommittees of the State Advisory Council on EMS;

(4)  Requires the Department of Health to establish EMS regions
and committees;

(5)  Requires the department with the help of the council to
adopt state of the art EMS rules and regulations for the state;

(6)  Requires the department to appoint one physician from each
EMS region to serve as a regional physician medical director;

(7)  Authorizes the department to establish a pediatric EMS
system;

(8)  Requires an agreement on ambulance service between an
ambulance district and either a municipality or county.  The
agreement is not required if the municipality or county operated
ambulance district was in operation before April 1, 1997;

(9)  Allows political subdivisions authorized to provide
ambulance services to adopt rules and regulations exceeding
state standards;

(10)  All ambulance services in existence before April 1, 1997,
may maintain their ambulance service areas unless changed by the
director or by legislation.  The director is required to
regulate and settle disputes on issues regarding service areas;

(11)  Allows cooperation and coordination between ambulance
services during an emergency or major catastrophe;

(12)  Requires the department to license and regulate air
ambulance services, ground ambulance services, and emergency
medical response agencies;

(13)  Requires the department to certify and regulate
institutions that train EMS personnel;

(14)  Requires a dispatch agency to have a dispatch agreement
between ambulance services;

(15)  Requires the department to license and regulate all levels
of emergency medical technicians for a period not to exceed 5
years;

(16)  Allows the department to place on probation or deny a
license to any medical technician for non-compliance with
department regulations, incompetency, or negligence.  The
licensee may appeal to the administrative hearing committee;

(17)  Requires the department to collect data on all ambulance
runs and injured patients for use by the department;

(18)  Allows air and ground ambulances until August 28, 1998, to
comply with new EMS rules and regulations promulgated by the
department;

(19)  Requires ambulance services to employ only technicians
licensed by the department;

(20)  Allows the department and EMS regions to provide public
training and professional education training, related to
emergency care;

(21)  Requires insurance carriers and managed care plans to pay
benefits directly to ambulance service;

(22)  Prohibits insurance carriers and managed care plans from
prohibiting or discouraging the use of 911 systems when
emergency service is needed;

(23)  Requires the department to designate a hospital as an
adult, pediatric, or adult/pediatric trauma center.  The
department is required to regulate designated trauma centers;

(24)  Requires severely injured patients to be transported to a
trauma center or nearest appropriate facility for
stabilization.  Patients who are not severely injured will be
transported to a hospital of choice;

(25)  Allows ambulance services to secure a lien on property and
insurance benefits for services provided;

(26)  Requires ambulance services to provide service regardless
of race, sex, age, color, religion, sexual preference, national
origin, ancestry, handicap, medical condition, or ability to pay;

(27)  Gives the medical director in cooperation with the
ambulance service administrator the responsibility and the
authority to ensure that technicians provide adequate care to
patients.  An agreement on roles, responsibility, authority, and
grievance procedure between the medical director and the
ambulance service is required;

(28)  Defines the following:  ambulance service, ambulance
service area, emergency medical response agency, dispatch
agency, emergency medical technician, medical director,
ambulance service, and emergency; and

(29)  Makes a violation of any provision of this bill a class B
misdemeanor.