HCS/SCS/SB 625 - This act is to be known as the "Comprehensive Emergency Medical Services Act." The act:

(1) Authorizes continued operation of ambulance districts in counties with population of less than 400,000 which were operating before August, 1998;

(2) Prevents double taxation by ground ambulance services;

(3) Requires ambulance districts which plan to contract out for service after August 1, 1998, to hold public hearings. Such contract may not be implemented for 30 days;

(4) Allows for a property tax to fund ambulance district pension programs;

(5) Establishes the State Advisory Council on Emergency Medical Services (EMS) to advise the Governor, General Assembly, and Department of Health on matters related to improving all aspects of emergency medical service;

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

(7) Requires the selection of one physician from each EMS region to serve as regional EMS medical director;

(8) Authorizes the Department of Health to establish a pediatric EMS system;

(9) Requires all ambulance services to operate in accordance with state regulations;

(10) Allows political subdivisions to promulgate rules and regulations related to ambulance services. Rules promulgated by political subdivisions may not be below state standards;

(11) Requires political subdivisions not operating or regulating an ambulance service as of August 28, 1998, to receive voter approval in order to operate an ambulance service within their jurisdictional boundaries, except when a private ambulance service has been utilized and terminates services;

(12) Prohibits municipalities and counties located within an ambulance district from promulgating ordinances or regulations related to ambulance services, unless the service was established and in operation before August 28, 1998;

(13) Prohibits municipalities and counties located within an ambulance district from operating an ambulance service without a franchise in an ambulance district that has ordinances prohibiting such service, unless the service was established and in operation before August 28, 1998;

(14) Allows the Director of the Department of Health to resolve issues regarding ground ambulance service area boundaries in order to assure ambulance service coverage throughout the state. This authority does not allow the Director to modify the jurisdictional boundaries of any existing service operating before August 28, 1998;

(15) Allows any municipal ambulance service to enter into contracts providing mutual aid services. Ambulances services are allowed to provide assistance during major emergencies or catastrophes;

(16) Allows mutual aid contracts between ambulance services in the states neighboring Missouri;

(17) Requires the Department to license and regulate air ambulance services, ground ambulances services, and emergency medical response agencies;

(18) Requires the Department to certify the various levels of technicians and regulate and accredit institutions that train EMS personnel;

(19) Requires a memorandum of understanding between a dispatch agency and all ambulance services that it dispatches;

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

(21) Gives air and ground ambulances until August 28, 1999, to comply with new EMS rules and regulations promulgated by the Department;

(22) Requires ambulance services to employ technicians licensed by the Department;

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

(24) Requires insurance carriers and managed care plans to pay benefits directly to ambulance services;

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

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

(27) Requires certain health care coverage of emergency services, subject to applicable copayments and deductibles;

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

(29) 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;

(30) Includes in the definition of health care professionals subject to current law governing health care peer review committees the following persons: emergency medical dispatcher, first responder, emergency medical technician- paramedic, and emergency medical technician-basic;

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

(32) Makes a violation of any of the provisions of this act a Class B misdemeanor and subject to licensure action by the Department; and

(33) Any fire protection district which provides emergency ambulance service pursuant to Section 321.225, RSMo, may provide primary ambulance service if a majority of the voters of the district approve the proposition to replace the emergency ambulance service with primary ambulance service within the district.

As part of the ballot, voters would have to approve using the existing tax levy for emergency ambulance service and a fee for nonemergency ambulance service. Primary ambulance service is defined in Section 321.227 of the act. The provisions of this act are also contained in CCS/HS/SB 743.
TOM MORTON