SB 0625 - Fiscal Note

Fiscal Note - SB 0625 - Revises provisions regarding emergency services

COMMITTEE ON LEGISLATIVE RESEARCH

OVERSIGHT DIVISION

FISCAL NOTE

L.R. NO. 1889-07

BILL NO. HCS for SCS for SB 625

SUBJECT: Ambulances: Health Department

TYPE: Original

DATE: April 29, 1998

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FISCAL SUMMARY

ESTIMATED NET EFFECT ON STATE FUNDS
FUND AFFECTED	FY 1999	FY 2000	FY 2001
General Revenue	$82,900	$82,900	$82,900
Total Estimated Net Effect on All State Funds	$82,900	$82,900	$82,900

ESTIMATED NET EFFECT ON FEDERAL FUNDS
FUND AFFECTED	FY 1999	FY 2000	FY 2001
None
Total Estimated Net Effect on All Federal Funds	$0	$0	$0

ESTIMATED NET EFFECT ON LOCAL FUNDS
FUND AFFECTED	FY 1999	FY 2000	FY 2001
Local Government	$0	$0	$0

Numbers within parentheses: ( ) indicate costs or losses

This fiscal note contains 6 pages.

FISCAL ANALYSIS

ASSUMPTION

Officials from the Department of Economic Development - Division of Professional Registration, the Office of Prosecution Services, the Missouri Consolidated Health Care Plan, the Department of Public Safety - Missouri State Highway Patrol, the Department of Conservation, the Office of State Treasurer, the Office of Administration, the Department of Transportation, the Department of Mental Health, and the Office of Secretary of State assume this proposal would not fiscally impact their agencies.

Department of Health (DOH) officials state the present staff assigned to DOH -Bureau of Emergency Medical Services (EMS) is adequate to meet the certification, designation and licensure requirements of the proposal. DOH states that state revenues would increase due to increases in existing licensure fees (ambulance service licensure fees based on the number of ambulance vehicles operated by the ambulance service and EMT licensure fees) and the addition of one new licensure fee (emergency medical response agency licensure fees). DOH projects ambulance service licensure fees at $50 per vehicle operated by the ambulance service per year of licensure (the present ambulance vehicle licensure fee of $20 per vehicle per year was established in statute in 1975 and has not been increased since). DOH also projects the EMT licensure fee at $10 per licensee per year of licensure (the present ambulance personnel licensure fee of $1 per year of licensure was also established by statute in 1975 and has not been increased since). In addition, DOH also projects emergency medical response agency licensure at $50 per year of licensure as a set fee per year since these agencies will not be using a set number of vehicles and will not be transporting patients. DOH estimates 333 (non Political Subdivision (PSD) exempt) of the 1,000 total ambulance vehicles (operated by 250 ambulance services) times $50 per vehicle per year would equal $16,650 annually. DOH also estimates 6,000 (non PSD exempt) of the 12,000 total EMTs times $10 per year would equal $60,000 annually. In addition, DOH estimates 125 (non PSD exempt) of the 250 total emergency medical response agencies times $50 per year would equal $6,250 annually. Therefore, DOH estimates the total state revenue would equal $82,900 annually to the General Revenue Fund.

Officials from the Department of Insurance (INS) anticipate that current appropriations and staff would be able to absorb the additional duties for this proposal. However, INS states that if additional proposals are approved during the legislative session, INS may need to request an increase in appropriations due to the combined effect of multiple proposals.

Officials from the Ste. Genevieve County Memorial Hospital, the Newton County Ambulance District, the St. Charles County Ambulance District, the Vallee Ambulance District, the Mid-Mo Ambulance District, the Stoddard County Ambulance District, and the Taney County Ambulance District did not respond to our fiscal impact request.

FISCAL IMPACT - State Government	FY 1999	FY 2000	FY 2001
	(10 Mo.)
GENERAL REVENUE FUND
Income - Department of Health
License fees	$82,900	$82,900	$82,900
ESTIMATED NET EFFECT ON
GENERAL REVENUE FUND	$82,900	$82,900	$82,900
FISCAL IMPACT - Local Government	FY 1999	FY 2000	FY 2001
	(10 Mo.)
	$0	$0	$0
FISCAL IMPACT - Small Business

Small businesses would be expected to be fiscally impacted to the extent that they would incur additional licensing costs due to the requirements of this proposal.

DESCRIPTION

This Comprehensive Emergency Medical Services System Act would:

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

(2) Prevent double taxation by ground ambulance services;

(3) Require 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) Allow for a property tax to fund ambulance district pension programs;

(5) Establish 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) Establish 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) Require the selection of one physician from each EMS region to serve as regional EMS medical director;

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

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

(10) Allow political subdivisions to promulgate rules and regulations related to ambulance DESCRIPTION (continued)

services. Rules promulgated by political subdivisions may not be below state standards;

(11) Require 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 service;

(12) Prohibit 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) Prohibit 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) Allow the Director of Health to resolve issues regarding ground ambulance service area boundaries in order to assure ambulance service coverage throughout the state. This authority

would not allow the director to modify the jurisdictional boundaries of any existing service operating before August 28, 1998;

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

(16) Allow mutual aid contracts with ambulance services in the states neighboring Missouri;

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

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

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

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

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

(22) Require ambulance services to employ technicians licensed by the department;

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

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

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

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

(27) Require certain health care coverage of emergency services, subject to applicable

copayments and deductibles;

DESCRIPTION (continued)

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

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

(30) Include 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) Define the following: ambulance, ambulance service, ambulance service area, emergency medical response agency, dispatch agency, emergency medical technician, medical director,

emergency, and emergency service; and

(32) Make a violation of any of the provisions of this proposal a class B misdemeanor and subject to licensure action by the department.

This proposal would also authorize, upon voter approval, any fire protection district that provides emergency ambulance service to provide primary ambulance service. If approved by the voters,

the existing tax used to operate emergency ambulance service and a voter approved fee may be used to operate the primary ambulance service.

This legislation is not federally mandated, would not duplicate any other program and would not require additional capital improvements or rental space. It would increase total state revenues.

SOURCES OF INFORMATION

Department of Health

Department of Economic Development

Division of Professional Development

Office of Prosecution Services

Office of Secretary of State

Missouri Consolidated Health Care Plan

Department of Public Safety

Missouri State Highway Patrol

Department of Conservation

Office of State Treasurer

Office of Administration

Department of Transportation

Department of Insurance

Department of Mental Health

SOURCES OF INFORMATION (continued)

NOT RESPONDING: Ste. Genevieve County Memorial Hospital, Newton County Ambulance District, St. Charles County Ambulance District, Vallee Ambulance District, Mid-Mo Ambulance District, Stoddard County Ambulance District, Taney County Ambulance District

Jeanne Jarrett, CPA

Director

April 29, 1998