COMMITTEE ON LEGISLATIVE RESEARCH
OVERSIGHT DIVISION
FISCAL NOTE
L.R. No.: 3922-03
Bill No.: SB 1107
Subject: Ambulances and Ambulance Districts; Emergencies; Health Care Professionals; Health Dept. Licenses - Misc.; Medical Procedures and Personnel; Motor Carriers
Type: Original
Date: February 18, 2002
FISCAL SUMMARY
| FUND AFFECTED | FY 2003 | FY 2004 | FY 2005 |
| Total Estimated
Net Effect on All State Funds |
$0 | $0 | $0 |
| FUND AFFECTED | FY 2003 | FY 2004 | FY 2005 |
| Total Estimated
Net Effect on All Federal Funds |
$0 | $0 | $0 |
| FUND AFFECTED | FY 2003 | FY 2004 | FY 2005 |
| Local Government | $0 | $0 | $0 |
Numbers within parentheses: ( ) indicate costs or losses.
This fiscal note contains 5 pages.
ASSUMPTION
Officials from the Office of the Secretary of State (SOS) state this bill revises requirements and regulations for ambulances, emergency services and personnel. The Department of Health and Senior Services will promulgate rules to implement this bill. Based on experience with other divisions, the rules, regulations and forms issued by the Department of Health and Senior Services could require as many as 56 pages in the Code of State Regulations. For any given rule, roughly one-half again as many pages are published in the Missouri Register as are published in the Code because cost statements, fiscal notes and notices are not published in the Code. The estimated cost of a page in the Missouri Register is $23.00. The estimated cost of a page in the Code of State Regulations is $27.00. The actual costs could be more or less than the numbers given. The fiscal impact of this legislation in future years is unknown and depends upon the frequency and length of rules filed, amended, rescinded and withdrawn. The SOS estimates the cost of this legislation to be $3,444 [(56 pp x $27) + (84 pp x $23)].
Oversight assumes the SOS could absorb the costs of printing and distributing regulations related to this proposal. If multiple bills pass which require the printing and distribution of regulations at substantial costs, the SOS could request funding through the appropriation process. Any decisions to raise fees to defray costs would likely be made in subsequent fiscal years.
Officials from the Department of Revenue, Department of Public Safety - Division of Fire Safety, Office of State Courts Administrator, Office of Administration (COA) - Division of Facilities Management and Department of Insurance assume the proposed legislation will not fiscally impact their organizations.
Officials from the Office of Prosecution Services assume any costs associated with the proposed legislation could be absorbed within existing resources.
Officials from the COA - Administrative Hearing Commission anticipates that this legislation will not significantly alter its caseload. However, if other similar bills also pass, there will be a fiscal impact. If there are more cases, or more complex cases, there could be a fiscal impact.
Officials from the COA - Division of Budget and Planning (BAP) stated the proposed legislation should not result in additional costs or savings to the BAP.
ASSUMPTION (continued)
Officials from the Department of Health and Senior Services (DOH) stated this legislation would not be expected to significantly impact the operations of the DOH. If the proposal were to substantially impact the DOH programs, then the DOH would request funding through the legislative process.
Officials from the Department of Social Services - Division of Medial Services (DMS) stated the DMS does not anticipate a material fiscal impact from this legislation assuming that the Department of Health and Senior Services will continue to use the same standard of staffing levels of expertise that they require today. The NEMT program uses stretcher vans to transport Medicaid recipients when appropriate. The NEMT program is administered by a broker. The current contract with the broker is for one year with three optional one year renewals.
Officials from the Department of Economic Development (DED) did not respond to our request for a statement of fiscal impact. However, in response to similar legislation introduced this session, the DED officials assumed the proposed legislation would not fiscally impact their agency.
Officials from the Office of Attorney General, St. Louis County Clerk, Mid-MO Ambulance District, Osage County Ambulance District, Callaway County Ambulance District and St. Charles County Ambulance District did not respond to our request for a statement of fiscal impact.
| FISCAL IMPACT - State Government | FY 2003
(10 Mo.) |
FY 2004 | FY 2005 |
| $0 | $0 | $0 |
| FISCAL IMPACT - Local Government | FY 2003
(10 Mo.) |
FY 2004 | FY 2005 |
| $0 | $0 | $0 |
FISCAL IMPACT - Small Business
The proposed legislation may have a negative fiscal impact to small stretcher van businesses because they will be required to have a two-staff person crew. The net effect is unknown.
DESCRIPTION
This act revises the requirements to be a candidate for Ambulance District Director (Section 190.050). Procedures for changes in the number of directors in a district and the recall of directors are
created(Sections 190.051 to 190.054). Any person or entity that owns an automated external defibrillator used outside of a health care facility must have a physician review all protocols (Section 190.092). The definition of "first responder" is deleted (Section 190.092).
With certain exceptions, each ground ambulance must be staffed by two licensed emergency medical technicians(Section 190.105). Owners of a ground or air ambulance service must notify the Department of Health and Senior Services within 30 days of the sale of the service and the Department shall conduct an inspection of the service to ensure compliance with licensure standards(Sections 190.105 and 190.108). Application requirements for an ambulance license are revised (Sections 190.109 and 190.120).
Provided the person meets other current requirements for a temporary license, a person not currently licensed as an Emergency Medical Technician in Missouri may be issued a 90-day temporary license (Section 190.143). Additional causes for discipline of an ambulance license are created. Any individual whose license has been revoked twice in ten years shall not be eligible for a new license (Section 190.165).
Any settlement agreement in a contested case against a licensee must be submitted to the administrative hearing commission for its approval. Any person directly harmed by the actions of a licensee may submit an impact statement to the Commission (Section 190.172).
A patient care document must be given to ambulance personnel by a health care facility for any transfer of the patient to a different facility (Section 190.175).
Requirements regarding the reporting of certain felonies by licensees to the Department are created (Section 190.196).
The act creates procedures for the issuance and discipline of a new license category for stretcher van services to transport persons in a supine position who do not require medical monitoring or treatment other than self-administered oxygen. (Sections 190.525 to 190.537). Any person who violates the provisions of Sections 190.525 to 190.527 shall be guilty of a Class B misdemeanor. The Attorney General and the local prosecuting attorney shall have concurrent jurisdiction to prosecute violations of Sections 190.525 to 190.537 and the Attorney General shall have injunctive power (Section 190.534).
DESCRIPTION (continued)
Section 190.044, RSMo, has been deleted. This section relieved a taxpayer of the obligation to pay property taxes for ground ambulance service to both an ambulance district and a fire protection district unless certain conditions were met.
This legislation is not federally mandated, would not duplicate any other program and would not require additional capital improvements or rental space.
SOURCES OF INFORMATION
Office of the Secretary of State
Department of Revenue
Department of Insurance
Department of Public Safety - Division of Fire Safety
Office of Prosecution Services
Office of Administration -
Administrative Hearing Commission
Division of Facilities Management
Division of Budget and Planning
Office of State Courts Administrator
Department of Health and Senior Services
NOT RESPONDING: Office of Attorney General, Department of Economic Development, St. Louis County Clerk, Mid-MO Ambulance District, Osage County Ambulance District, Callaway County Ambulance District and St. Charles County Ambulance District.
Mickey Wilson, CPA
Acting Director
February 18, 2002