SB 975 — Modifies provisions relating to ambulance districts

SS SB 975 9 (2) The names of the districts to be consolidated, accompanied by a list of all real property owned and financial assets currently held by the district, all outstanding bonds or debts of each of saidsuch districts, and the current tax levies imposed by each of saidsuch districts;

(3) The name of the district whichthat shall be responsible for maintaining ambulance service during the consolidation, including continuing operations, administration, and governance of the consolidated district, provided that there shall be a presumption that the district with the largest CCS HCS SS SB 975 10 operating budget in the preceding fiscal year shall assume such responsibility;

and (5) A proposed timetimeline line for consolidation, which shall not exceed one hundred eighty days, provided that such timetimeline line shall be subject to modification by the board of the consolidated district for good cause.

Upon the filing of a petition, or a resolution, and a consolidation plan with the county clerk from each of the ambulance districts proposed to be consolidated, the county clerk shall present the petition or resolution and a consolidation plan to the commissioners of the county commission [having jurisdiction who shall thereupon order the submission of the question to the voters of the districts.

SS SB 975 10 6.

If the county commission having jurisdiction finds that the question to consolidate the districts received a CCS HCS SS SB 975 11 majority of the votes cast, the commission shall make and enter its order declaring that the proposition passed.

All assets and obligations of the existing ambulance districts shall become assets and obligations of the SS SB 975 11 consolidated district], who shall record such documents in the records of the county.

In addition, publication of such notice of intent shall be made in a newspaper of general circulation CCS HCS SS SB 975 12 in every county in which the proposed consolidated ambulance district shall be located, with publication to be made once per week for two consecutive weeks.

A public hearing shall be held jointly by all ambulance districts seeking to consolidate at a location within the boundaries of the proposed consolidated ambulance district, provided that such hearing shall be no more than tenthirty days after the date of the second publication.

You are hereby notified that a petition/resolution has been filed for the consolidation of the above named ambulance districts into one consolidated ambulance district to be known as the _____ Ambulance District.

SS SB 975 12 A public hearing will be held on ______ (date) at ________ (time) at the following location:

Any such objection must be signed by a number of voters residing in the proposed consolidated district that is not less than CCS HCS SS SB 975 13 five percent of the votes cast for governor in the district in the most recent gubernatorial election.

If no objections are filed with the county clerk within thirty days after the public hearing, then within forty-fiveforty- five days following the date of the public hearing, the county commission shall order the districts consolidated pursuant to the terms of the consolidation plan and shall further appoint as directors those individuals identified in the consolidation plan.

If saidsuch objections are signed by an appropriate number of voters, the county commission of each county in which the proposed consolidated district is to be located shall thereupon order the submission of the question to the voters of the districts.

SS SB 975 13 Shall the existing ______ ambulance districts be consolidated into one ambulance district to be known as the _________ Ambulance District, with such consolidated district authorized to levy a property tax not to exceed the annual rate of ______ cents on the hundred dollars assessed valuation or a sales tax in an amount not to exceed ______ percent, or a combination of both? CCS HCS SS SB 975 14 If the county commission having jurisdiction finds that the question to consolidate the districts received a majority of the votes cast, the commission shall make and enter its order declaring that the proposition passed.

Without a vote of the residents of the consolidated district as provided in this section, no consolidated ambulance district shall be permitted to impose a property tax greater than the lowest of any existing property tax rate of the districts to be consolidated, nor shall the consolidated ambulance district be permitted to SS SB 975 14 impose any sales tax greater than the lowest of any existing sales tax rate of the districts to be consolidated.

Upon written certification by the board of directors of the consolidated district to the prior district that the consolidated district has obtained the necessary licenses and permits to operate an ambulance service and all directors of such consolidated district have completed the training required by section 190.053, the existing ambulance districts shall cease to exist and the consolidated district CCS HCS SS SB 975 15 shall assume all of the powers and duties exercised by those districts.

190.098.

1.

As used in this section, the term "community paramedic services" means services that are:

(1) Provided by any entity that:

(a) Employs licensed paramedics who are certified as community paramedics by the department;

and (b) Has received an endorsement by the department as a community paramedic service entity;

(2) Provided in a nonemergent setting, independent of a 911 system or emergency summons;

(3) Consistent with the training and education, as well as within the scope of skill and practice, of the personnel and with the supervisory standard approved by the medical director;

and (4) Reflected and documented in the entity's patient care plans or protocols approved by the medical director in accordance with section 190.142.

2.

In order for a person to be eligible for certification by the department as a community paramedic, an individual shall:

SS SB 975 15 (1) Be currently [certified] licensed as a paramedic;

(2) Successfully complete or have successfully completed a community paramedic certification program from a college, university, or educational institution that has been approved by the department or accredited by a national accreditation organization approved by the department;

and (3) Complete an application form approved by the department.

[2.] 3.

A community paramedic shall practice in accordance with protocols and supervisory standards established by the medical director[.

A community paramedic shall provide services of a health care plan if the plan has been developed by the patient's physician or by an advanced practice registered nurse through a collaborative practice arrangement with a physician or a physician assistant through a collaborative practice arrangement with a physician and there is no duplication of services to the patient from another provider] in collaboration with the ambulance service or emergency medical response agency administrator.

Patient care plans that are developed by the patient's physician, advanced practice nurse practitioner, or physician assistant shall be implemented through a collaboration with the medical director and emergency response agency or ambulance service.

[3.] 4.

(1) Any ambulance service [shall enter into a written contract to provide community paramedic services in another ambulance service area, as that term is defined in section 190.100.

The contract that is agreed upon may be for an indefinite period of time, as long as it includes at least a sixty-day cancellation notice by either ambulance service] that seeks to provide community paramedic services outside of its ambulance service area, as described in SS SB 975 16 subdivision (5) of section 190.100 and section 190.109, and administered by the department, and in the service area of another ambulance service that currently provides community paramedic services shall be required to have a memorandum of understanding with that ambulance service regarding the provision of such community paramedic services.

An ambulance service that provides community paramedic services may provide community paramedic services without a memorandum of understanding in the ambulance service area of an ambulance service that is not providing community paramedic services, but the ambulance service providing community paramedic services shall provide notification, within ninety days, to the ambulance service with emergency service responsibilities in the service area of the general community paramedic activities being performed.

(2) An ambulance service that provides community paramedic services and that has executed formal contracts or agreements with health care institutions, hospitals, health clinics, or insurance companies for the provision of community paramedic services shall be permitted to honor those agreements.

(3) For sustained services provided outside the county of the ambulance services' primary 911 response territory where another licensed ambulance service also offers community paramedic services, the community paramedic program shall coordinate with the local ambulance service.

(4) Any emergency medical response agency seeking to provide community paramedic services within its designated response service area may do so if the ground ambulance service covering the area within which the emergency medical response agency is located does not provide community paramedic services.

If such ground ambulance service does SS SB 975 17 provide community paramedic services, the ground ambulance service may establish, at its sole discretion, a memorandum of understanding with the emergency medical response agency planning to offer community paramedic services in order to coordinate programs and avoid service duplication.

If an emergency medical response agency is providing community paramedic services in a service area before the ground ambulance service in that service area begins offering community paramedic services, the emergency medical response agency and the ground ambulance service shall establish a memorandum of understanding for the coordination of services.

(5) A community paramedic program shall notify the appropriate local ambulance service when providing services within the service area of an ambulance service.

(6) The department shall establish regulations for the purpose of recognizing community paramedic service entities that have met the standards necessary to provide community paramedic services, including physician medical oversight, training, patient record keeping, formal relationships with primary care services where necessary, and quality improvement policies.

The department shall issue an endorsement to any community paramedic service entity that meets such standards that allow the entity to provide community paramedic services for a period of five years.

[4.] 5.

A community paramedic is subject to the provisions of sections 190.001 to 190.245 and rules promulgated under sections 190.001 to 190.245.

[5.] 6.

No person shall hold himself or herself out as a community paramedic or provide the services of a community paramedic unless such person is certified by the department.

[6.] 7.

The medical director shall approve the implementation of the community paramedic program.

SS SB 975 18 [7.] 8.

Any rule or portion of a rule, as that term is defined in section 536.010, that is created under the authority delegated in this section shall become effective only if it complies with and is subject to all of the provisions of chapter 536 and, if applicable, section 536.028.

This section and chapter 536 are nonseverable and if any of the powers vested with the general assembly pursuant to chapter 536 to review, to delay the effective date, or to disapprove and annul a rule are subsequently held unconstitutional, then the grant of rulemaking authority and any rule proposed or adopted after August 28, 2013, shall be invalid and void.

190.165.

1.

The department may refuse to issue or deny renewal of any endorsement, certificate, permit or license required pursuant to sections [190.100] 190.098 to 190.245 for failure to comply with the provisions of sections [190.100] 190.098 to 190.245 or any lawful regulations promulgated by the department to implement its provisions as described in subsection 2 of this section.

The department shall notify the applicant in writing of the reasons for the refusal and shall advise the applicant of his or her right to file a complaint with the administrative hearing commission as provided by chapter 621.

2.

The department may cause a complaint to be filed with the administrative hearing commission as provided by chapter 621 against any holder of any endorsement, certificate, permit or license required by sections [190.100] 190.098 to 190.245 or any person who has failed to renew or has surrendered his or her certificate, permit or license for failure to comply with the provisions of sections [190.100] 190.098 to 190.245 or any lawful regulations promulgated by the department to implement such SS SB 975 19 sections.

Those regulations shall be limited to the following:

(1) Use or unlawful possession of any controlled substance, as defined in chapter 195, or alcoholic beverage to an extent that such use impairs a person's ability to perform the work of any activity licensed or regulated by sections [190.100] 190.098 to 190.245;

(2) Being finally adjudicated and found guilty, or having entered a plea of guilty or nolo contendere, in a criminal prosecution under the laws of any state or of the United States, for any offense reasonably related to the qualifications, functions or duties of any activity licensed or regulated pursuant to sections [190.100] 190.098 to 190.245, for any offense an essential element of which is fraud, dishonesty or an act of violence, or for any offense involving moral turpitude, whether or not sentence is imposed;

(3) Use of fraud, deception, misrepresentation or bribery in securing any endorsement, certificate, permit or license issued pursuant to sections [190.100] 190.098 to 190.245 or in obtaining permission to take any examination given or required pursuant to sections [190.100] 190.098 to 190.245;

(4) Obtaining or attempting to obtain any fee, charge, tuition or other compensation by fraud, deception or misrepresentation;

(5) Incompetency, misconduct, gross negligence, fraud, misrepresentation or dishonesty in the performance of the functions or duties of any activity licensed or regulated by sections [190.100] 190.098 to 190.245;

(6) Violation of, or assisting or enabling any person to violate, any provision of sections [190.100] 190.098 to SS SB 975 20 190.245, or of any lawful rule or regulation adopted by the department pursuant to sections [190.100] 190.098 to 190.245;

(7) Impersonation of any person holding [a] an endorsement, certificate, permit or license or allowing any person to use his or her endorsement, certificate, permit, license or diploma from any school;

(8) Disciplinary action against the holder of a license or other right to practice any activity regulated by sections [190.100] 190.098 to 190.245 granted by another state, territory, federal agency or country upon grounds for which revocation or suspension is authorized in this state;

(9) For an individual being finally adjudged insane or incompetent by a court of competent jurisdiction;

(10) Assisting or enabling any person to practice or offer to practice any activity licensed or regulated by sections [190.100] 190.098 to 190.245 who is not licensed and currently eligible to practice pursuant to sections [190.100] 190.098 to 190.245;

(11) Issuance of [a] an endorsement, certificate, permit or license based upon a material mistake of fact;

(12) Violation of any professional trust, confidence, or legally protected privacy rights of a patient by means of an unauthorized or unlawful disclosure;

(13) Use of any advertisement or solicitation which is false, misleading or deceptive to the general public or persons to whom the advertisement or solicitation is primarily directed;

(14) Violation of the drug laws or rules and regulations of this state, any other state or the federal government;

(15) Refusal of any applicant or licensee to respond to reasonable department of health and senior services' SS SB 975 21 requests for necessary information to process an application or to determine license status or license eligibility;

(16) Any conduct or practice which is or might be harmful or dangerous to the mental or physical health or safety of a patient or the public;

(17) Repeated acts of negligence or recklessness in the performance of the functions or duties of any activity licensed or regulated by sections [190.100] 190.098 to 190.245.

3.

If the department conducts investigations, the department, prior to interviewing a licensee who is the subject of the investigation, shall explain to the licensee that he or she has the right to:

(1) Consult legal counsel or have legal counsel present;

(2) Have anyone present whom he or she deems to be necessary or desirable;

and (3) Refuse to answer any question or refuse to provide or sign any written statement.

The assertion of any right listed in this subsection shall not be deemed by the department to be a failure to cooperate with any department investigation.

4.

After the filing of such complaint, the proceedings shall be conducted in accordance with the provisions of chapter 621.

Upon a finding by the administrative hearing commission that the grounds, provided in subsection 2 of this section, for disciplinary action are met, the department may, singly or in combination, censure or place the person named in the complaint on probation on such terms and conditions as the department deems appropriate for a period not to exceed five years, or may suspend, for a SS SB 975 22 period not to exceed three years, or revoke the license, certificate endorsement, or permit.

Notwithstanding any provision of law to the contrary, the department shall be authorized to impose a suspension or revocation as a disciplinary action only if it first files the requisite complaint with the administrative hearing commission.

The administrative hearing commission shall hear all relevant evidence on remediation activities of the licensee and shall make a recommendation to the department of health and senior services as to licensure disposition based on such evidence.

5.

An individual whose license has been revoked shall wait one year from the date of revocation to apply for relicensure.

Relicensure shall be at the discretion of the department after compliance with all the requirements of sections [190.100] 190.098 to 190.245 relative to the licensing of an applicant for the first time.

Any individual whose license has been revoked twice within a ten- year period shall not be eligible for relicensure.

6.

The department may notify the proper licensing authority of any other state in which the person whose license was suspended or revoked was also licensed of the suspension or revocation.

7.

Any person, organization, association or corporation who reports or provides information to the department pursuant to the provisions of sections [190.100] 190.098 to 190.245 and who does so in good faith shall not be subject to an action for civil damages as a result thereof.

8.

The department of health and senior services may suspend any endorsement, certificate, permit or license required pursuant to sections [190.100] 190.098 to 190.245 simultaneously with the filing of the complaint with the SS SB 975 23 administrative hearing commission as set forth in subsection 2 of this section, if the department finds that there is an imminent threat to the public health.

The notice of suspension shall include the basis of the suspension and notice of the right to appeal such suspension.

The licensee may appeal the decision to suspend the license, certificate endorsement, or permit to the department.

The appeal shall be filed within ten days from the date of the filing of the complaint.

A hearing shall be conducted by the department within ten days from the date the appeal is filed.

The suspension shall continue in effect until the conclusion of the proceedings, including review thereof, unless sooner withdrawn by the department, dissolved by a court of competent jurisdiction or stayed by the administrative hearing commission.

For SS SB 975 24 purposes of this section, the term "first responder" shall have the same meaning as first responder in section 190.1010.

All peace officers and first responders shall be required to meet with a program service provider once every three to five years for a mental health check-in, or aparticipate departmentin establisheda department-established behavioral health or mental health program that meets the requirements of subsection 1 of this section which shall satisfy this requirement.

The program service provider shall send a notification to the peace officer's commanding officer, or first responder's commanding officer, or first responder's CCS HCS SS SB 975 16 director or supervisor that he or she completed such check-in.check- in.

The fund shall be a dedicated fund and moneys in the fund shall be used solely by the department of public safety for the purposes of providing services for SS SB 975 25 peace officers and first responders to assist in coping with stress and potential psychological trauma resulting from a response to a critical incident or emotionally difficult event pursuant to subsection 1 of this section.

The director of public safety may prescribe rules and regulations necessary to carry out the provisions of this CCS HCS SS SB 975 17 section.