SB 0587 - Fiscal Note

Fiscal Note - SB 0587 - Major revision of laws relating to emergency medical services

COMMITTEE ON LEGISLATIVE RESEARCH

OVERSIGHT DIVISION

FISCAL NOTE

L.R. NO. 2342-02

BILL NO. SB 587

SUBJECT: Ambulances and Ambulance Districts; Emergencies

TYPE: #Revised

DATE: April 1, 1998

#Revised due to change in policy by Oversight Subcommittee on March 30, 1998, regarding Article X, Section 21.

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FISCAL SUMMARY

ESTIMATED NET EFFECT ON STATE FUNDS
FUND AFFECTED	FY 1999	FY 2000	FY 2001
General Revenue	$68,525 to $122,124	$41,843 to $107,846	$37,902 to $105,606
Insurance Dedicated	$14,450 to $28,900	$0	$0
Total Estimated Net Effect on All State Funds	$82,975 to $151,024	$41,843 to $107,846	$37,902 to $105,606

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	(less than $182,500)	(less than $182,500)	(less than $182,500)

Numbers within parentheses: ( ) indicate costs or losses

This fiscal note contains 6 pages.

FISCAL ANALYSIS

ASSUMPTION

Officials from the Missouri Consolidated Health Care Plan, the Department of Conservation, the Department of Transportation, the Office of Attorney General, the Department of Mental Health, the Department of Public Safety - Division of Fire Safety, the Department of Revenue, and the Office of State Courts Administrator assume this proposal would not fiscally impact their agencies.

The Department of Insurance (INS) states that approximately 259 health insurers and 30 HMOs have policies filed with INS. Each insurer may submit one or two policy form amendments (one for individual and one for group or one filing for both) to comply with the requirements of this proposal. Form filings are to be accompanied with a $50 filing fee. Based on the estimated range of new policy filings, $14,450 to $28,900 in new revenue would be generated for the Insurance Dedicated Fund in the first fiscal year only. INS further states that the passage of more than one similar proposal could require the INS to request increased appropriations to cover cumulative administrative costs.

Officials from the Department of Health (DOH) state that present staff assigned to the Bureau of Emergency Medical Services (Bureau) is adequate to meet the certification, designation, and licensure requirements of the proposal. However, DOH states that new expenses related to the six regional Emergency Medical Service committees and the one state Emergency Medical Service Medical Directors Advisory committee. In addition, DOH states that state revenue would be generated by certification, designation, and licensure fees. DOH assumes 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 services 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 fees of $20 per vehicle per year was established in statute in 1975 and has not been increased since). DOH further projects the EMT licensure fee of $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 projects emergency medical response agency licensure at $50 per year of licensure as a set fee per year since these agencies would not be using a set number of vehicles and would not be transporting patients. The following revenue is expected to be generated by the new fees:

ASSUMPTION (continued)

1,000 ambulance vehicles x $50 $ 50,000

12,000 EMT's x $10 120,000

250 agencies x $50 12,500

Total $182,500

DOH assumes that the establishment of six EMS regional committees would require additional meeting expenses in the amount of $68,400 (6 regional committees x 4 meetings per year x 15 members per region x $170 per meeting +$300 room rental per meeting). DOH also assumes the establishment of one state medical directors' advisory committee will require additional meeting expenses in the amount of $4,080 (6 medical directors x 4 meetings per year x $170 per meeting). Total committee meeting expenses would be $72,480 annually.

DOH further assumes that if the department chooses to implement a pediatric EMS program referred to in section 190.104 then the Bureau would need to hire an additional Health Facilities Nursing Consultant ($41,488). Equipment ($3,730) would include office equipment and furniture for one FTE. Expenses ($12,165) would include travel expenses, rental expense, and office and communication expenses for one FTE.

Oversight has not included any rental expense as the employee would be located in current facilities if DOH decides to implement a pediatric EMS program. In addition, Oversight has ranged the costs of the additional employee.

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.

Oversight assumes the maximum costs to local governments would be $182,500 annually.

FISCAL IMPACT - State Government	FY 1999	FY 2000	FY 2001
	(10 Mo.)
GENERAL REVENUE FUND
Income - Department of Health
Licensure fees	$182,500	$182,500	$182,500
Costs - Department of Health
Personal services (1 FTE)	$0 to	$0 to	$0 to
	($35,423)	($43,588)	($44,678)
Fringe benefits	$0 to	$0 to	$0 to
	($9,929)	($12,218)	($12,523)
Expense and equipment	($60,376 to	($74,654 to	($76,894 to
	$68,623)	$84,851)	$87,397)
Total Costs - Department of Health	($60,376 to	($74,654 to	($76,894 to
	$113,975)	$140,657)	$144,598)
ESTIMATED NET EFFECT ON
GENERAL REVENUE FUND	$68,525 to	$41,843 to	$37,902 to
	$122,124	$107,846	$105,606
INSURANCE DEDICATED FUND
Income - Department of Insurance
Filings fees	$14,450 to $28,900	$0	$0
ESTIMATED NET EFFECT ON
INSURANCE DEDICATED FUND	$14,450 TO $28,900	$0	$0
FISCAL IMPACT - Local Government	FY 1999	FY 2000	FY 2001
	(10 Mo.)
LOCAL GOVERNMENTS
Costs - Local Governments
Licensure and operating costs	(less than	(less than	(less than
	$182,500)	$182,500)	$182,500)
ESTIMATED NET EFFECT ON
LOCAL GOVERNMENTS	(less than	(less than	(less than
	$182,500)	$182,500)	$182,500)

FISCAL IMPACT - Small Business

No direct fiscal impact to small businesses would be expected as a result of this proposal.

DESCRIPTION

This proposal would revise the statutes governing organizations providing emergency medical services and the delivery of those services. The " State Advisory Council on Emergency Medical Services" is created with the Department of Health. The fifteen members would be appointed by the Governor with the advice and consent of the Senate. Members would be appointed for four years and would be reimbursed for reasonable expenses. The Council would make DESCRIPTION (continued)

recommendations to the Department of Health, the Governor, and the General Assembly on issues related to emergency services. The Department would designate emergency medical

services regions by rule. The director would appoint personnel to at least six regional emergency medical services committees. The Department would select one physician from each EMS region to be the regional medical director. The directors of the regions would constitute the State Emergency Medical Services Medical Director's Advisory Committee to advise the Department and their regions' ambulance services.

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 would be transferred to the Director of Revenue and placed to the credit of the General Revenue Fund. Funds may be expended after appropriation for the pediatric emergency medical services program.

This legislation is not federally mandated, would not duplicate any other program and would not require additional capital improvements or rental space. It would affect Total State Revenues.

SOURCES OF INFORMATION

Missouri Consolidated Health Care Plan

Department of Conservation

Department of Transportation

Office of Attorney General

Department of Mental Health

Department of Public Safety

Division of Fire Safety

Department of Revenue

Office of State Courts Administrator

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 1, 1998