Missouri Statute | Act | Code |Public Health And Welfare| US Code - US Statute

Sections 190.001 to 190.245 shall be known and may be cited as
the "Comprehensive Emergency Medical Services Systems Act". (L. 1998 S.B.
743)

1. An ambulance district may be created, incorporated and
managed as provided in sections 190.001 to 190.090 and may exercise the
powers herein granted or necessarily implied. The territory contained
within the corporate limits of a proposed ambulance district shall not be
required to be contiguous. Any territory which is noncontiguous within a
proposed district must be located so that at least a portion of the
territory lies within five miles of any other portion of the territory
contained within the proposed ambulance district. Notwithstanding the
provisions of subsection 2 of section 190.015, an ambulance district may
include municipalities or territory not in municipalities or both or
territory in one or more counties; except, that the provisions of
sections 190.001 to 190.090 are not effective in counties having a
population of more than four hundred thousand inhabitants at the time the
ambulance district is formed. The territory contained within the
corporate limits of an existing ambulance district shall not be
incorporated in another ambulance district. Ambulance districts created
and still operating before August 1, 1998, in counties of less than four
hundred thousand population are authorized to continue operation subject
to sections 190.001 to 190.090 if the population of the county within the
ambulance district exceeds four hundred thousand after August 1, 1998.

2. When an ambulance district is organized it shall be a body corporate
and a political subdivision of the state and shall be known as
"............... Ambulance District", and in that name may sue and be
sued, levy and collect taxes within the limitations of sections 190.001
to 190.090 and the constitution and issue bonds as provided in sections
190.001 to 190.090. (L. 1971 S.B. 108 § 1, A.L. 1998 S.B. 743, A.L. 2005
H.B. 58 merged with S.B. 210)

1. Whenever the creation of an ambulance district is desired, a
number of voters residing in the proposed district equal to ten percent
of the vote cast for governor in the proposed district in the next
preceding gubernatorial election may file with the county clerk in which
the territory or the greater part thereof is situated a petition
requesting the creation thereof. In case the proposed district is
situated in two or more counties, the petition shall be filed in the
office of the county clerk of the county in which the greater part of the
area is situated, and the commissioners of the county commission of the
county shall set the petition for public hearing. The petition shall set
forth:

(1) A description of the territory to be embraced in the proposed
district;

(2) The names of the municipalities located within the area;

(3) The name of the proposed district;

(4) The population of the district which shall not be less than two
thousand inhabitants;

(5) The assessed valuation of the area, which shall not be less than ten
million dollars; and

(6) A request that the question be submitted to the voters residing
within the limits of the proposed ambulance district whether they will
establish an ambulance district pursuant to the provisions of sections
190.001 to 190.090 to be known as "............. Ambulance District" for
the purpose of establishing and maintaining an ambulance service.

2. In any county with a charter form of government and with more than one
million inhabitants, fire protection districts created under chapter 321,
RSMo, may choose to create an ambulance district with boundaries
congruent with each participating fire protection district's existing
boundaries provided no ambulance district already exists in whole or part
of any district being proposed and the dominant provider of ambulance
services within the proposed district as of September 1, 2005, ceases to
offer or provide ambulance services, and the board of each participating
district, by a majority vote, approves the formation of such a district
and participating fire protection districts are contiguous. Upon approval
by the fire protection district boards, subsection 1 of this section
shall be followed for formation of the ambulance district. Services
provided by a district under this subsection shall only include emergency
ambulance services as defined in section 321.225, RSMo. (L. 1971 S.B. 108
§ 2, A.L. 1978 H.B. 971, A.L. 1998 S.B. 743, A.L. 2005 H.B. 58 merged
with S.B. 210)

(1977) Held, failure to include description of area to be included in
district and failure to hold hearing within statutory time did not
invalidate formation of district. See also dissents. State at Information
of Fleming v. Zimmerschied (Mo.), 559 S.W.2d 178.

1. Upon the filing of the petition with the county clerk, he
shall present it to the commissioners of the county commission who shall
thereupon set the petition for hearing within not less than thirty nor
more than forty days after the filing.

2. Notice shall be given by the commissioner of the county commission of
the time and place where the hearing will be held, by publication on
three separate days in one or more newspapers having a general
circulation within the territory proposed to be incorporated as an
ambulance district, the first of which publications shall be not less
than twenty days prior to the date set for the hearing and if there is no
such newspaper, then notice shall be posted in ten of the most public
places in the territory, not less than twenty days prior to the date set
for the hearing. This notice shall include a description of the territory
as set out in the petition, names of municipalities located therein and
the name of the proposed district and the question of creating an
ambulance district.

3. The costs of printing and publication or posting of notices of public
hearing thereon shall be paid in advance by the petitioners, and, if a
district is organized under the provisions of sections 190.005 to
190.085, they shall be reimbursed out of the funds received by the
district from taxation or other sources. (L. 1971 S.B. 108 § 3)

Effective 6-15-71

If two or more petitions covering in part the same territory are
filed prior to the public hearing upon the petition which is first filed,
the petitions shall be consolidated for public hearing, and hearing
thereon may be continued to permit the giving of notice of any subsequent
petitions. At the public hearing upon the petitions, the petitioners in
the petition first filed may move to amend the petition to include any
part of the territory described in the subsequent petitions, either as
originally filed or as amended. Any such motion shall be allowed by the
commissioners of the county commission. The public hearing shall proceed
upon the first petition as originally filed or as so amended, and further
proceedings upon any other petitions subsequently filed shall be stayed
and held in abeyance until the termination of all proceedings upon the
first petition, or any petition may be dismissed or withdrawn upon motion
of the petitioners therein by their representatives. (L. 1971 S.B. 108 §
4)

Effective 6-15-71

If the territory, petition and proceedings meet the requirements
of sections 190.005 to 190.085, the county commissioners shall make a
finding determining the sufficiency of the petition and that the
territory meets the requirements of sections 190.005 to 190.085 and order
the submission of the question. (L. 1971 S.B. 108 § 5, A.L. 1978 H.B.
971, A.L. 1986 H.B. 898, et al.)

Each notice shall state briefly the purpose of the election,
setting forth the proposition to be voted upon and a description of the
territory. The notice shall further state that any district upon its
establishment shall have the powers, objects and purposes provided by
sections 190.005 to 190.085, and shall have the power to levy a property
tax not to exceed thirty cents on the one hundred dollars valuation. (L.
1971 S.B. 108 § 6, A.L. 1978 H.B. 971, A.L. 1984 H.B. 924)

(1977) Held, failure to include description of area to be included in
district and failure to hold hearing within statutory time did not
invalidate formation of district. See also dissents. State at Information
of Fleming v. Zimmerschied (Mo.), 559 S.W.2d 178.

The question shall be submitted in substantially the following
form:

Shall there be organized in the counties of ........, state of Missouri,
an ambulance district for the establishment and operation of an ambulance
service to be located within the boundaries of said proposed district and
having the power to impose a property tax not to exceed the annual rate
of thirty cents on the hundred dollars assessed valuation without voter
approval, and such additional tax as may be approved hereafter by vote
thereon, to be known as "........ Ambulance District" as prayed for by
petition filed with the county clerk of ........ County, Missouri, on the
...... day of ......, 20....? (L. 1971 S.B. 108 § 7, A.L. 1978 H.B. 971,
A.L. 1984 H.B. 924)

1. Notwithstanding any other provision of law, an additional tax
of not to exceed three cents per one hundred dollars of assessed
valuation may be levied and collected by any ambulance district upon
approval by the voters of the district, but all the funds derived from
such tax shall be used solely for the purpose of providing a central
dispatching service for such ambulance district.

2. The funds from the tax shall be kept separate and apart from all other
funds of the ambulance district and shall be paid out only on order of
the governing body of the ambulance district. (L. 1986 H.B. 898, et al. §
2)

Subject to the provisions of chapter 137, RSMo, in addition to
the tax rate increase allowed pursuant to subdivision (3) of subsection 5
of section 137.073, RSMo, if an ambulance district voluntarily decreases
its tax rate duly authorized pursuant to section 190.040 or 190.041 in
any tax year, such ambulance district may in any subsequent tax year
increase such tax rate, without voter approval, to the rate previously
authorized pursuant to section 190.040 or 190.041. (L. 1994 H.B. 1490,
A.L. 1998 S.B. 743)

The results of the submission of the question shall be entered
upon the records of the commission and a certified copy thereof shall be
filed with the county clerk of each other county in which the proposed
district lies, who shall cause the same to be spread upon the records of
the county commission. If the order shows that the question to organize
the district received a majority of the votes cast, the order shall
declare the district organized. (L. 1971 S.B. 108 § 8, A.L. 1978 H.B. 971)

1. After the ambulance district has been declared organized, the
declaring county commission, except in counties of the second class
having more than one hundred five thousand inhabitants located adjacent
to a county of the first class having a charter form of government which
has a population of over nine hundred thousand inhabitants, shall divide
the district into six election districts as equal in population as
possible, and shall by lot number the districts from one to six
inclusive. The county commission shall cause an election to be held in
the ambulance district within ninety days after the order establishing
the ambulance district to elect ambulance district directors. Each voter
shall vote for one director from the ambulance election district in which
the voter resides. The directors elected from districts one and four
shall serve for a term of one year, the directors elected from districts
two and five shall serve for a term of two years, and the directors from
districts three and six shall serve for a term of three years;
thereafter, the terms of all directors shall be three years. All
directors shall serve the term to which they were elected or appointed,
and until their successors are elected and qualified, except in cases of
resignation or disqualification. The county commission shall reapportion
the ambulance districts within sixty days after the population of the
county is reported to the governor for each decennial census of the
United States. Notwithstanding any other provision of law, if the number
of candidates for the office of director is no greater than the number of
directors to be elected, no election shall be held, and the candidates
shall assume the responsibilities of their offices at the same time and
in the same manner as if they have been elected.

2. In all counties of the second class having more than one hundred five
thousand inhabitants located adjacent to a county of the first class
having a charter form of government which has a population of over nine
hundred thousand inhabitants, the voters shall vote for six directors
elected at large from within the district for a term of three years.
Those directors holding office in any district in such a county on August
13, 1976, shall continue to hold office until the expiration of their
terms, and their successors shall be elected from the district at large
for a term of three years. In any district formed in such counties after
August 13, 1976, the governing body of the county shall cause an election
to be held in that district within ninety days after the order
establishing the ambulance district to elect ambulance district
directors. Each voter shall vote for six directors. The two candidates
receiving the highest number of votes at such election shall be elected
for a term of three years, the two candidates receiving the third and
fourth highest number of votes shall be elected for a term of two years,
the two candidates receiving the fifth and sixth highest number of votes
shall be elected for a term of one year; thereafter, the term of all
directors shall be three years.

3. A candidate for director of the ambulance district shall, at the time
of filing, be a citizen of the United States, a qualified voter of the
election district as provided in subsection 1 of this section, a resident
of the district for two years next preceding the election, and shall be
at least twenty-four years of age. In an established district which is
located within the jurisdiction of more than one election authority, the
candidate shall file his or her declaration of candidacy with the
secretary of the board. In all other districts, a candidate shall file a
declaration of candidacy with the county clerk of the county in which he
or she resides. A candidate shall file a statement under oath that he or
she possesses the required qualifications. No candidate's name shall be
printed on any official ballot unless the candidate has filed a written
declaration of candidacy pursuant to subsection 5 of section 115.127,
RSMo. If the time between the county commission's call for a special
election and the date of the election is not sufficient to allow
compliance with subsection 5 of section 115.127, RSMo, the county
commission shall, at the time it calls the special election, set the
closing date for filing declarations of candidacy. (L. 1971 S.B. 108 § 9,
A.L. 1976 S.B. 562, A.L. 1978 H.B. 971, A.L. 1986 H.B. 898, et al., A.L.
1988 H.B. 933, et al., A.L. 1991 S.B. 34, A.L. 2002 S.B. 1107)

1. Notwithstanding the provisions of sections 190.050 and
190.052 to the contrary, upon a motion by the board of directors in
districts where there are six-member boards, and upon approval by the
voters in the district, the number of directors may be increased to seven
with one board member running district wide, or decreased to five or
three board members. The ballot to be used for the approval of the voters
to increase or decrease the number of members on the board of directors
of the ambulance district shall be substantially in the following form:

Shall the number of members of the board of directors of the
.............. (Insert name of district) Ambulance District be (increased
to seven members/decreased to five members/decreased to three members)?

[ ] YES [ ] NO

2. If a majority of the voters voting on a proposition to increase the
number of board members to seven vote in favor of the proposition, then
at the next election of board members after the voters vote to increase
the number of directors, the voters shall select one person to serve in
addition to the existing six directors as the member who shall run
district wide.

3. If a majority of the voters voting on a proposition to decrease the
number of board members vote in favor of the proposition, then the county
clerk shall redraw the district into the resulting number of subdistricts
with equal population bases and hold elections by subdistricts pursuant
to section 190.050. Thereafter, members of the board shall be elected to
serve terms of three years and until their successors are duly elected
and qualified.

4. Members of the board of directors in office on the date of an election
pursuant to this section to increase or decrease the number of members of
the board of directors shall serve the term to which they were elected or
appointed and until their successors are elected and qualified. (L. 2002
S.B. 1107)

Any member of the board of directors who moves his residence
from the district from which he was elected, shall be disqualified as a
member of the board. If one or two vacancies occur in the membership of
the board as a result of death, resignation, or disqualification, the
remaining members shall appoint one or two qualified persons, as provided
in section 190.050, to fill the vacancies until the next annual election
of the members of the board. Such appointment shall be made with the
consent of a majority of the remaining members of the board. If the board
is unable to agree in filling a vacancy within sixty days or if there are
more than two vacancies at any one time, the county commission, upon
notice from the board of failure to agree in filling the vacancies, shall
within ten days fill them by appointment of qualified persons, as
provided in section 190.050, and shall notify the persons in writing of
their appointment. The persons appointed shall serve for the unexpired
term. (L. 1977 H.B. 278, A.L. 1986 H.B. 898, et al.)

1. The board of directors of a district shall possess and
exercise all of its legislative and executive powers. Within thirty days
after the election of the initial directors, the board shall meet. The
time and place of the first meeting of the board shall be designated by
the county commission. At its first meeting and after each election of
new board members the board shall elect a chairman from its members and
select a secretary, treasurer and such officers or employees as it deems
expedient or necessary for the accomplishment of its corporate
objectives. The secretary and treasurer need not be members of the board.
At the meeting the board, by ordinance, shall define the first and
subsequent fiscal years of the district, and shall adopt a corporate seal
and bylaws, which shall determine the times for the annual election of
officers and of other regular and special meetings of the board and shall
contain the rules for the transaction of other business of the district
and for amending the bylaws.

2. Each board member of any district shall devote such time to the duties
of the office as the faithful discharge thereof may require, including
educational programs provided by the state and each board member may be
reimbursed for actual expenditures in the performance of his or her
duties on behalf of the district.

3. The secretary and treasurer, if members of the board of directors, may
each receive additional compensation for the performance of their duties
as secretary or treasurer as the board shall deem reasonable and
necessary; provided that, such additional compensation shall not exceed
one thousand dollars per year.

4. Each board member may receive an attendance fee not to exceed one
hundred dollars for attending each regularly or specially called board
meeting. Such member shall not be paid for attending more than two
meetings in any calendar month, except that in a county of the first
classification having a charter form of government, such member shall not
be paid for attending more than four such meetings in any calendar month.
In addition, the chairman of the board may receive fifty dollars for
attending each regularly or specially called board meeting, but such
chairman shall not be paid the additional fee for attending more than two
meetings in any calendar month.

5. The compensation authorized by subsections 3 and 4 of this section
shall only apply:

(1) If such compensation is approved by the board of such district; and

(2) To any elected term of any board member beginning after August 28,
2000. (L. 1971 S.B. 108 § 10, A.L. 1986 H.B. 898, et al., A.L. 1998 S.B.
743, A.L. 2000 H.B. 1284)

1. An ambulance district shall have the following governmental
powers, and all other powers incidental, necessary, convenient or
desirable to carry out and effectuate the express powers:

(1) To establish and maintain an ambulance service within its corporate
limits, and to acquire for, develop, expand, extend and improve such
service;

(2) To acquire land in fee simple, rights in land and easements upon,
over or across land and leasehold interests in land and tangible and
intangible personal property used or useful for the location,
establishment, maintenance, development, expansion, extension or
improvement of an ambulance service. The acquisition may be by
dedication, purchase, gift, agreement, lease, use or adverse possession;

(3) To operate, maintain and manage the ambulance service, and to make
and enter into contracts for the use, operation or management of and to
provide rules and regulations for the operation, management or use of the
ambulance service;

(4) To fix, charge and collect reasonable fees and compensation for the
use of the ambulance service according to the rules and regulations
prescribed by the board from time to time;

(5) To borrow money and to issue bonds, notes, certificates, or other
evidences of indebtedness for the purpose of accomplishing any of its
corporate purposes, subject to compliance with any condition or
limitation set forth in sections 190.001 to 190.090 or otherwise provided
by the Constitution of the state of Missouri;

(6) To employ or enter into contracts for the employment of any person,
firm, or corporation, and for professional services, necessary or
desirable for the accomplishment of the objects of the district or the
proper administration, management, protection or control of its property;

(7) To maintain the ambulance service for the benefit of the inhabitants
of the area comprising the district regardless of race, creed or color,
and to adopt such reasonable rules and regulations as may be necessary to
render the highest quality of emergency medical care; to exclude from the
use of the ambulance service all persons who willfully disregard any of
the rules and regulations so established; to extend the privileges and
use of the ambulance service to persons residing outside the area of the
district upon such terms and conditions as the board of directors
prescribes by its rules and regulations;

(8) To provide for health, accident, disability and pension benefits for
the salaried members of its organized ambulance district and such other
benefits for the members' spouses and minor children, through either, or
both, a contributory or noncontributory plan. The type and amount of such
benefits shall be determined by the board of directors of the ambulance
district within the level of available revenue of the pension program and
other available revenue of the district. If an employee contributory plan
is adopted, then at least one voting member of the board of trustees
shall be a member of the ambulance district elected by the contributing
members. The board of trustees shall not be the same as the board of
directors;

(9) To purchase insurance indemnifying the district and its employees,
officers, volunteers and directors against liability in rendering
services incidental to the furnishing of ambulance services. Purchase of
insurance pursuant to this section is not intended to waive sovereign
immunity, official immunity or the Missouri public duty doctrine
defenses; and

(10) To provide for life insurance, accident, sickness, health,
disability, annuity, length of service, pension, retirement and other
employee-type fringe benefits, subject to the provisions of section
70.615, RSMo, for the volunteer members of any organized ambulance
district and such other benefits for their spouses and eligible
unemancipated children, either through a contributory or noncontributory
plan, or both. For purposes of this section, "eligible unemancipated
child" means a natural or adopted child of an insured, or a stepchild of
an insured who is domiciled with the insured, who is less than
twenty-three years of age, who is not married, not employed on a
full-time basis, not maintaining a separate residence except for
full-time students in an accredited school or institution of higher
learning, and who is dependent on parents or guardians for at least fifty
percent of his or her support. The type and amount of such benefits shall
be determined by the board of directors of the ambulance district within
available revenues of the district, including the pension program of the
district. The provision and receipt of such benefits shall not make the
recipient an employee of the district. Directors who are also volunteer
members may receive such benefits while serving as a director of the
district.

2. The use of any ambulance service of a district shall be subject to the
reasonable regulation and control of the district and upon such
reasonable terms and conditions as shall be established by its board of
directors.

3. A regulatory ordinance of a district adopted pursuant to any provision
of this section may provide for a suspension or revocation of any rights
or privileges within the control of the district for a violation of any
regulatory ordinance.

4. Nothing in this section or in other provisions of sections 190.001 to
190.245 shall be construed to authorize the district or board to
establish or enforce any regulation or rule in respect to the operation
or maintenance of the ambulance service within its jurisdiction which is
in conflict with any federal or state law or regulation applicable to the
same subject matter.

5. After August 28, 1998, the board of directors of an ambulance district
that proposes to contract for the total management and operation of the
ambulance service, when that ambulance district has not previously
contracted out for said service, shall hold a public hearing within a
thirty-day period and shall make a finding that the proposed contract to
manage and operate the ambulance service will:

(1) Provide benefits to the public health that outweigh the associated
costs;

(2) Maintain or enhance public access to ambulance service;

(3) Maintain or improve the public health and promote the continued
development of the regional emergency medical services system.

6. (1) Upon a satisfactory finding following the public hearing in
subsection 5 of this section and after a sixty-day period, the ambulance
district may enter into the proposed contract, however said contract
shall not be implemented for at least thirty days.

(2) The provisions of subsection 5 of this section shall not apply to
contracts which were executed prior to August 28, 1998, or to the renewal
or modification of such contracts or to the signing of a new contract
with an ambulance service provider for services that were previously
contracted out. (L. 1971 S.B. 108 § 11, A.L. 1986 H.B. 898, et al., A.L.
1993 H.B. 177, A.L. 1998 S.B. 743, A.L. 1999 S.B. 436)

1. For the purpose of purchasing any property or equipment
necessary or incidental to the operation of an ambulance service, the
board of directors may borrow money and issue bonds for the payment
thereof in the manner provided herein. The question of the loan shall be
decided by the submission of the question ordered by the board of
directors of the district.

2. The question shall be submitted in substantially the following form:

Shall the ..... ambulance district borrow money in the amount of .....
dollars for the purpose of ..... and issue bonds for the payment thereof?

3. If the constitutionally required percentage of the votes cast are for
the loan, the board shall, subject to the restrictions of subsection 4,
be vested with the power to borrow money in the name of the district, to
the amount and for the purposes specified on the ballot, and issue the
bonds of the district for the payment thereof.

4. The loans authorized by this section shall not be contracted for a
period longer than twenty years, and the entire amount of the loan shall
at no time exceed, including the existing indebtedness of the district,
in the aggregate, ten percent of the value of taxable tangible property
therein, as shown by the last completed assessment for state and county
purposes, the rate of interest to be agreed upon by the parties, but in
no case to exceed the highest legal rate allowed by contract; when
effected, it shall be the duty of the directors to provide for the
collection of an annual tax sufficient to pay the interest on the
indebtedness as it falls due, and also to constitute a sinking fund for
the payment of the principal thereof within the time the principal
becomes due. (L. 1971 S.B. 108 § 12, A.L. 1978 H.B. 971, A.L. 1990 H.B.
1621)

1. A petition for annexation of land to an ambulance district
shall be signed by not less than ten percent or fifty voters, whichever
is fewer, residing within the territory therein described proposed for
annexation and shall be filed with the county clerk of the county in
which the district or the greater portion thereof is situated, and shall
be addressed to the commissioners of the county commission. A hearing
shall be held thereon as nearly as possible as in the case of a formation
petition. If upon the hearing the commissioners of the county commission
find that the petition is in compliance with the provisions of sections
190.005 to 190.085, they shall order the question to be submitted to the
voters within the territory and within the district.

2. The question shall be submitted in substantially the following form:

Shall ..... (description of territory) be annexed to the ..... ambulance
district?

3. If a majority of the votes cast on the question in the district and in
the territory described in the petition, respectively, are in favor of
the annexation, the commissioners of the county commission shall by order
declare the territory annexed and shall describe the altered boundaries
of the district. (L. 1971 S.B. 108 § 13, A.L. 1978 H.B. 971)

To levy and collect taxes as herein provided, the board shall
fix a rate of levy, not to exceed ten cents on the one hundred dollars
valuation of the taxable tangible property within the district as shown
by the last completed assessment, the revenues from which shall be
deposited in a special fund and used only for the pension program of the
district, by submitting the following question to the voters at the
municipal general, or a state primary or general election in such
district or at any election at which a member of the board of directors
is to be elected:

Shall the board of directors of ................. Ambulance District be
authorized to levy an annual tax rate of ........... cents per one
hundred dollars valuation, the revenues from which shall be deposited in
a special fund and used only for the pension program of the district?

If a majority of the qualified voters casting votes thereon be in favor
of the question, the board of directors shall accordingly levy a tax in
accordance with the provisions of this section, but if a majority of the
voters casting votes thereon do not vote in favor of the levy authorized
by this subsection, any levy previously authorized shall remain in
effect. (L. 1998 S.B. 743)

The board shall provide for the proper and safe keeping of its
permanent records and for the recording of the corporate action of the
district. Such books and records shall be made available for inspection
by any member of the board upon request by the board member. It shall
keep a true and accurate account of its receipts and an annual audit
shall be made of its books, records and accounts. All officers and
employees authorized to receive or retain the custody of money or to sign
vouchers, checks, warrants or evidences of indebtedness binding upon the
district shall furnish surety bond for the faithful performance of their
duties and the faithful accounting for all moneys that may come into
their hands in an amount to be fixed and in a form to be approved by the
board. (L. 1971 S.B. 108 § 14, A.L. 1986 H.B. 898, et al.)

Any person desiring to donate property for the benefit of an
ambulance district established pursuant to the provisions of sections
190.005 to 190.085 may vest title to the property so donated in the board
of directors created pursuant to the provisions of sections 190.005 to
190.085, and the board of directors shall hold and control the property
so received and accepted according to the terms of the deed, gift, devise
or bequest of the property, and shall be a trustee of the property, and
shall take title to all property it may acquire in the name of the
district and shall control the property for the purposes provided in
sections 190.005 to 190.085. (L. 1971 S.B. 108 § 15)

Effective 6-15-71

In any ambulance district created under the provisions of
sections 190.005 to 190.085, which is not operating an ambulance service
and in which the voters of said district have on three separate occasions
refused to approve a bond issue to secure the necessary property and
equipment to operate the service, the board of the district shall submit
to the voters the proposition of the dissolution of the district. If a
majority of the voters approve the dissolution, the district shall be
dissolved and any tax money in the treasury shall be rebated to the
original taxpayer on a pro rata basis. (L. 1971 S.B. 108 § 17)

Effective 6-15-71

The boundaries of any ambulance district established pursuant to
chapter 190, which is located in a noncharter county of the first
classification with a population of less than one hundred thousand which
adjoins any county of the first classification with a charter form of
government with a population of nine hundred thousand or more
inhabitants, if such ambulance district serves any portion of a city
which is located in both such counties, may be expanded so as to include
the entire city within the ambulance district, but the boundaries of the
district shall not be expanded beyond the city limits of such city. Such
change in the boundaries of the district shall be accomplished only if
seventy-five percent of the owners of any territory or tract of land
within that part of the city which is not within the ambulance district
file with the board a petition in writing praying that such real property
be included within the district. The petition shall describe the property
to be included in the district and shall describe the property owned by
the petitioners and shall be deemed to give assent of the petitioners to
the inclusion in the district of the property described in the petition;
and such petition shall be in substantially the form set forth in section
321.495, RSMo, dealing with referendums and verified in like manner. (L.
1993 S.B. 256 § 1)

Effective 5-19-93

1. Two or more organized ambulance districts may consolidate
into one ambulance district by following the procedures set forth in this
section.

2. If the consolidation of existing ambulance districts is desired, a
number of voters residing in an existing ambulance district equal to ten
percent of the vote cast for governor in the existing district in the
next preceding gubernatorial election may file with the county clerk in
which the territory or greater part of the proposed consolidated district
is situated a petition requesting the consolidation of two or more
existing ambulance districts.

3. The petition shall be in the following form:

We, the undersigned voters of the ..... ambulance district do hereby
petition that ..... existing ambulance districts be consolidated into one
consolidated ambulance district.

4. An alternative procedure of consolidation may be followed, if the
board of directors of the existing ambulance districts pass a resolution
in the following form:

Be it resolved by the board of directors of the ambulance district that
the ..... ambulance districts be consolidated into one consolidated
ambulance district.

5. Upon the filing of a petition, or a resolution, with the county clerk
from each of the ambulance districts proposed to be consolidated, the
county clerk shall present the petition or resolution to the
commissioners of the county commission having jurisdiction who shall
thereupon order the submission of the question to the voters of the
districts. The filing of each of the petitions in the ambulance districts
shall have occurred within a continuous twelve-month period.

6. The notice shall set forth the names of the existing ambulance
districts to be included in the consolidated district.

7. The question shall be submitted in substantially the following form:

Shall the existing ..... ambulance districts be consolidated into one
ambulance district?

8. 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.

9. Within thirty days after the district has been declared consolidated,
the county commission shall divide the district into six election
districts and shall order an election to be held and conducted as
provided in section 190.050 for the election of directors.

10. Within thirty days after the election of the initial board of
directors of the district, the directors shall meet and the time and
place of the first meeting of the board shall be designated by the county
commission. At the first meeting the newly elected board of directors
shall choose a name for the consolidated district and shall notify the
clerk of the county commission of each county within which the
consolidated district is located of the name of the consolidated district.

11. On the thirtieth day following the election of the board of
directors, the existing ambulance districts shall cease to exist and the
consolidated district shall assume all of the powers and duties exercised
by those districts. All assets and obligations of the existing ambulance
districts shall become assets and obligations of the consolidated
district. (L. 1975 H.B. 642, A.L. 1978 H.B. 971, A.L. 2005 H.B. 58 merged
with S.B. 210)

1. As used in this section, the following terms mean:

(1) "Bioterrorism", the intentional use of any microorganism, virus,
infectious substance, or biological product that may be engineered as a
result of biotechnology or any naturally occurring or bioengineered
component of any microorganism, virus, infectious substance, or
biological product to cause death, disease, or other biological
malfunction in a human, an animal, a plant, or any other living organism
to influence the conduct of government or to intimidate or coerce a
civilian population;

(2) "Department", the Missouri department of health and senior services;

(3) "Director", the director of the department of health and senior
services;

(4) "Disaster locations", any geographical location where a bioterrorism
attack, terrorist attack, catastrophic or natural disaster, or emergency
occurs;

(5) "First responders", state and local law enforcement personnel, fire
department personnel, and emergency medical personnel who will be
deployed to bioterrorism attacks, terrorist attacks, catastrophic or
natural disasters, and emergencies.

2. The department shall offer a vaccination program for first responders
who may be exposed to infectious diseases when deployed to disaster
locations as a result of a bioterrorism event or a suspected bioterrorism
event. The vaccinations shall include, but are not limited to, smallpox,
anthrax, and other vaccinations when recommended by the federal Centers
for Disease Control and Prevention's Advisory Committee on Immunization
Practices.

3. Participation in the vaccination program shall be voluntary by the
first responders, except for first responders who, as determined by their
employer, cannot safely perform emergency responsibilities when
responding to a bioterrorism event or suspected bioterrorism event
without being vaccinated. The recommendations of the Centers for Disease
Control and Prevention's Advisory Committee on Immunization Practices
shall be followed when providing appropriate screening for
contraindications to vaccination for first responders. A first responder
shall be exempt from vaccinations when a written statement from a
licensed physician is presented to their employer indicating that a
vaccine is medically contraindicated for such person.

4. If a shortage of the vaccines referred to in subsection 2 of this
section exists following a bioterrorism event or suspected bioterrorism
event, the director, in consultation with the governor and the federal
Centers for Disease Control and Prevention, shall give priority for such
vaccinations to persons exposed to the disease and to first responders
who are deployed to the disaster location.

5. The department shall notify first responders concerning the
availability of the vaccination program described in subsection 2 of this
section and shall provide education to such first responders and their
employers concerning the vaccinations offered and the associated diseases.

6. The department may contract for the administration of the vaccination
program described in subsection 2 of this section with health care
providers, including but not limited to local public health agencies,
hospitals, federally qualified health centers, and physicians.

*7. The provisions of this section shall become effective upon receipt of
federal funding or federal grants which designate that the funding is
required to implement vaccinations for first responders in accordance
with the recommendations of the federal Centers for Disease Control and
Prevention's Advisory Committee on Immunization Practices. Upon receipt
of such funding, the department shall make available the vaccines to
first responders as provided in this section. (L. 2005 H.B. 413)

Effective 6-30-05 (H.B. 413 § B, 2005)

*Contingent effective date

1. A person or entity who acquires an automated external
defibrillator shall ensure that:

(1) Expected defibrillator users receive training by the American Red
Cross or American Heart Association in cardiopulmonary resuscitation and
the use of automated external defibrillators, or an equivalent nationally
recognized course in defibrillator use and cardiopulmonary resuscitation;

(2) The defibrillator is maintained and tested according to the
manufacturer's operational guidelines;

(3) Any person who renders emergency care or treatment on a person in
cardiac arrest by using an automated external defibrillator activates the
emergency medical services system as soon as possible; and

(4) Any person or entity that owns an automated external defibrillator
that is for use outside of a health care facility shall have a physician
review and approve the clinical protocol for the use of the
defibrillator, review and advise regarding the training and skill
maintenance of the intended users of the defibrillator and assure proper
review of all situations when the defibrillator is used to render
emergency care.

2. Any person or entity who acquires an automated external defibrillator
shall notify the emergency communications district or the ambulance
dispatch center of the primary provider of emergency medical services
where the automated external defibrillator is to be located.

3. Any person who has had appropriate training, including a course in
cardiopulmonary resuscitation, has demonstrated a proficiency in the use
of an automated external defibrillator, and who gratuitously and in good
faith renders emergency care when medically appropriate by use of or
provision of an automated external defibrillator, without objection of
the injured victim or victims thereof, shall not be held liable for any
civil damages as a result of such care or treatment, where the person
acts as an ordinarily reasonable, prudent person would have acted under
the same or similar circumstances. The person or entity who provides
appropriate training to the person using an automated external
defibrillator, the person or entity responsible for the site where the
automated external defibrillator is located, and the licensed physician
who reviews and approves the clinical protocol shall likewise not be held
liable for civil damages resulting from the use of an automated external
defibrillator, provided that all other requirements of this section have
been met. Nothing in this section shall affect any claims brought
pursuant to chapter 537 or 538, RSMo.

4. The provisions of this section shall apply in all counties within the
state and any city not within a county. (L. 1998 H.B. 1668 § 190.375,
A.L. 2002 S.B. 1107, A.L. 2004 H.B. 1195)

As used in sections 190.001 to 190.245, the following words and
terms mean:

(1) "Advanced life support (ALS)", an advanced level of care as provided
to the adult and pediatric patient such as defined by national curricula,
and any modifications to that curricula specified in rules adopted by the
department pursuant to sections 190.001 to 190.245;

(2) "Ambulance", any privately or publicly owned vehicle or craft that is
specially designed, constructed or modified, staffed or equipped for, and
is intended or used, maintained or operated for the transportation of
persons who are sick, injured, wounded or otherwise incapacitated or
helpless, or who require the presence of medical equipment being used on
such individuals, but the term does not include any motor vehicle
specially designed, constructed or converted for the regular
transportation of persons who are disabled, handicapped, normally using a
wheelchair, or otherwise not acutely ill, or emergency vehicles used
within airports;

(3) "Ambulance service", a person or entity that provides emergency or
nonemergency ambulance transportation and services, or both, in
compliance with sections 190.001 to 190.245, and the rules promulgated by
the department pursuant to sections 190.001 to 190.245;

(4) "Ambulance service area", a specific geographic area in which an
ambulance service has been authorized to operate;

(5) "Basic life support (BLS)", a basic level of care, as provided to the
adult and pediatric patient as defined by national curricula, and any
modifications to that curricula specified in rules adopted by the
department pursuant to sections 190.001 to 190.245;

(6) "Council", the state advisory council on emergency medical services;

(7) "Department", the department of health and senior services, state of
Missouri;

(8) "Director", the director of the department of health and senior
services or the director's duly authorized representative;

(9) "Dispatch agency", any person or organization that receives requests
for emergency medical services from the public, by telephone or other
means, and is responsible for dispatching emergency medical services;

(10) "Emergency", the sudden and, at the time, unexpected onset of a
health condition that manifests itself by symptoms of sufficient severity
that would lead a prudent layperson, possessing an average knowledge of
health and medicine, to believe that the absence of immediate medical
care could result in:

(a) Placing the person's health, or with respect to a pregnant woman, the
health of the woman or her unborn child, in significant jeopardy;

(b) Serious impairment to a bodily function;

(c) Serious dysfunction of any bodily organ or part;

(d) Inadequately controlled pain;

(11) "Emergency medical dispatcher", a person who receives emergency
calls from the public and has successfully completed an emergency medical
dispatcher course, meeting or exceeding the national curriculum of the
United States Department of Transportation and any modifications to such
curricula specified by the department through rules adopted pursuant to
sections 190.001 to 190.245;

(12) "Emergency medical response agency", any person that regularly
provides a level of care that includes first response, basic life support
or advanced life support, exclusive of patient transportation;

(13) "Emergency medical services for children (EMS-C) system", the
arrangement of personnel, facilities and equipment for effective and
coordinated delivery of pediatric emergency medical services required in
prevention and management of incidents which occur as a result of a
medical emergency or of an injury event, natural disaster or similar
situation;

(14) "Emergency medical services (EMS) system", the arrangement of
personnel, facilities and equipment for the effective and coordinated
delivery of emergency medical services required in prevention and
management of incidents occurring as a result of an illness, injury,
natural disaster or similar situation;

(15) "Emergency medical technician", a person licensed in emergency
medical care in accordance with standards prescribed by sections 190.001
to 190.245, and by rules adopted by the department pursuant to sections
190.001 to 190.245;

(16) "Emergency medical technician-basic" or "EMT-B", a person who has
successfully completed a course of instruction in basic life support as
prescribed by the department and is licensed by the department in
accordance with standards prescribed by sections 190.001 to 190.245 and
rules adopted by the department pursuant to sections 190.001 to 190.245;

(17) "Emergency medical technician-intermediate" or "EMT-I", a person who
has successfully completed a course of instruction in certain aspects of
advanced life support care as prescribed by the department and is
licensed by the department in accordance with sections 190.001 to 190.245
and rules and regulations adopted by the department pursuant to sections
190.001 to 190.245;

(18) "Emergency medical technician-paramedic" or "EMT-P", a person who
has successfully completed a course of instruction in advanced life
support care as prescribed by the department and is licensed by the
department in accordance with sections 190.001 to 190.245 and rules
adopted by the department pursuant to sections 190.001 to 190.245;

(19) "Emergency services", health care items and services furnished or
required to screen and stabilize an emergency which may include, but
shall not be limited to, health care services that are provided in a
licensed hospital's emergency facility by an appropriate provider or by
an ambulance service or emergency medical response agency;

(20) "First responder", a person who has successfully completed an
emergency first response course meeting or exceeding the national
curriculum of the United States Department of Transportation and any
modifications to such curricula specified by the department through rules
adopted pursuant to sections 190.001 to 190.245 and who provides
emergency medical care through employment by or in association with an
emergency medical response agency;

(21) "Health care facility", a hospital, nursing home, physician's office
or other fixed location at which medical and health care services are
performed;

(22) "Hospital", an establishment as defined in the hospital licensing
law, subsection 2 of section 197.020, RSMo, or a hospital operated by the
state;

(23) "Medical control", supervision provided by or under the direction of
physicians to providers by written or verbal communications;

(24) "Medical direction", medical guidance and supervision provided by a
physician to an emergency services provider or emergency medical services
system;

(25) "Medical director", a physician licensed pursuant to chapter 334,
RSMo, designated by the ambulance service or emergency medical response
agency and who meets criteria specified by the department by rules
pursuant to sections 190.001 to 190.245;

(26) "Memorandum of understanding", an agreement between an emergency
medical response agency or dispatch agency and an ambulance service or
services within whose territory the agency operates, in order to
coordinate emergency medical services;

(27) "Patient", an individual who is sick, injured, wounded, diseased, or
otherwise incapacitated or helpless, or dead, excluding deceased
individuals being transported from or between private or public
institutions, homes or cemeteries, and individuals declared dead prior to
the time an ambulance is called for assistance;

(28) "Person", as used in these definitions and elsewhere in sections
190.001 to 190.245, any individual, firm, partnership, copartnership,
joint venture, association, cooperative organization, corporation,
municipal or private, and whether organized for profit or not, state,
county, political subdivision, state department, commission, board,
bureau or fraternal organization, estate, public trust, business or
common law trust, receiver, assignee for the benefit of creditors,
trustee or trustee in bankruptcy, or any other service user or provider;

(29) "Physician", a person licensed as a physician pursuant to chapter
334, RSMo;

(30) "Political subdivision", any municipality, city, county, city not
within a county, ambulance district or fire protection district located
in this state which provides or has authority to provide ambulance
service;

(31) "Professional organization", any organized group or association with
an ongoing interest regarding emergency medical services. Such groups and
associations could include those representing volunteers, labor,
management, firefighters, EMT-B's, nurses, EMT-P's, physicians,
communications specialists and instructors. Organizations could also
represent the interests of ground ambulance services, air ambulance
services, fire service organizations, law enforcement, hospitals, trauma
centers, communication centers, pediatric services, labor unions and
poison control services;

(32) "Proof of financial responsibility", proof of ability to respond to
damages for liability, on account of accidents occurring subsequent to
the effective date of such proof, arising out of the ownership,
maintenance or use of a motor vehicle in the financial amount set in
rules promulgated by the department, but in no event less than the
statutory minimum required for motor vehicles. Proof of financial
responsibility shall be used as proof of self-insurance;

(33) "Protocol", a predetermined, written medical care guideline, which
may include standing orders;

(34) "Regional EMS advisory committee", a committee formed within an
emergency medical services (EMS) region to advise ambulance services, the
state advisory council on EMS and the department;

(35) "Specialty care transportation", the transportation of a patient
requiring the services of an emergency medical technician-paramedic who
has received additional training beyond the training prescribed by the
department. Specialty care transportation services shall be defined in
writing in the appropriate local protocols for ground and air ambulance
services and approved by the local physician medical director. The
protocols shall be maintained by the local ambulance service and shall
define the additional training required of the emergency medical
technician-paramedic;

(36) "Stabilize", with respect to an emergency, the provision of such
medical treatment as may be necessary to attempt to assure within
reasonable medical probability that no material deterioration of an
individual's medical condition is likely to result from or occur during
ambulance transportation unless the likely benefits of such
transportation outweigh the risks;

(37) "State advisory council on emergency medical services", a committee
formed to advise the department on policy affecting emergency medical
service throughout the state;

(38) "State EMS medical directors advisory committee", a subcommittee of
the state advisory council on emergency medical services formed to advise
the state advisory council on emergency medical services and the
department on medical issues;

(39) "Trauma", an injury to human tissues and organs resulting from the
transfer of energy from the environment;

(40) "Trauma care" includes injury prevention, triage, acute care and
rehabilitative services for major single system or multisystem injuries
that potentially require immediate medical or surgical intervention or
treatment;

(41) "Trauma center", a hospital that is currently designated as such by
the department. (L. 1973 S.B. 57 § 1, A.L. 1987 S.B. 31 § 29, A.L. 1989
S.B. 337, A.L. 1998 S.B. 743, A.L. 2002 S.B. 1107, A.L. 2003 S.B. 68)

1. There is hereby established a "State Advisory Council on
Emergency Medical Services" which shall consist of sixteen members, one
of which shall be a resident of a city not within a county. The members
of the council shall be appointed by the governor with the advice and
consent of the senate and shall serve terms of four years. The governor
shall designate one of the members as chairperson. The chairperson may
appoint subcommittees that include noncouncil members.

2. The state EMS medical directors advisory committee and the regional
EMS advisory committees will be recognized as subcommittees of the state
advisory council on emergency medical services.

3. The council shall have geographical representation and representation
from appropriate areas of expertise in emergency medical services
including volunteers, professional organizations involved in emergency
medical services, EMT's, paramedics, nurses, firefighters, physicians,
ambulance service administrators, hospital administrators and other
health care providers concerned with emergency medical services. The
regional EMS advisory committees shall serve as a resource for the
identification of potential members of the state advisory council on
emergency medical services.

4. The members of the council and subcommittees shall serve without
compensation except that members of the council shall, subject to
appropriations, be reimbursed for reasonable travel expenses and meeting
expenses related to the functions of the council.

5. The purpose of the council is to make recommendations to the governor,
the general assembly, and the department on policies, plans, procedures
and proposed regulations on how to improve the statewide emergency
medical services system. The council shall advise the governor, the
general assembly, and the department on all aspects of the emergency
medical services system. (L. 1998 S.B. 743, A.L. 2002 H.B. 1953 merged
with S.B. 1107)

1. The department shall designate through regulation EMS regions
and committees. The purpose of the regional EMS advisory committees is to
advise and make recommendations to the region and the department on:

(1) Coordination of emergency resources in the region;

(2) Improvement of public and professional education;

(3) Cooperative research endeavors;

(4) Development of standards, protocols and policies; and

(5) Voluntary multiagency quality improvement committee and process.

2. The members of the committees shall serve without compensation except
that the department of health and senior services shall budget for
reasonable travel expenses and meeting expenses related to the functions
of the committees.

3. The director will appoint personnel to no less than six regional EMS
committees from recommendations provided by recognized professional
organizations. Appointments will be for four years with individuals
serving until reappointed or replaced. (L. 1998 S.B. 743)

1. One physician with expertise in emergency medical services
from each of the EMS regions shall be elected by that region's EMS
medical directors to serve as a regional EMS medical director. The
regional EMS medical directors shall constitute the state EMS medical
director's advisory committee and shall advise the department and their
region's ambulance services on matters relating to medical control and
medical direction in accordance with sections 190.001 to 190.245 and
rules adopted by the department pursuant to sections 190.001 to 190.245.

2. A medical director is required for all ambulance services and
emergency medical response agencies that provide: advanced life support
services; basic life support services utilizing medications or providing
assistance with patients' medications; or basic life support services
performing invasive procedures including invasive airway procedures. The
medical director shall provide medical direction to these services and
agencies in these instances.

3. The medical director, in cooperation with the ambulance service or
emergency medical response agency administrator, shall have the
responsibility and the authority to ensure that the personnel working
under their supervision are able to provide care meeting established
standards of care with consideration for state and national standards as
well as local area needs and resources. The medical director, in
cooperation with the ambulance service or emergency medical response
agency administrator, shall establish and develop triage, treatment and
transport protocols, which may include authorization for standing orders.

4. All ambulance services and emergency medical response agencies that
are required to have a medical director shall establish an agreement
between the service or agency and their medical director. The agreement
will include the roles, responsibilities and authority of the medical
director beyond what is granted in accordance with sections 190.001 to
190.245 and rules adopted by the department pursuant to sections 190.001
to 190.245. The agreement shall also include grievance procedures
regarding the emergency medical response agency or ambulance service,
personnel and the medical director. (L. 1998 S.B. 743)

1. The department is authorized to establish a program to
improve the quality of emergency care for pediatric patients throughout
the state and to implement a comprehensive pediatric emergency medical
services system in accordance with standards prescribed by sections
190.001 to 190.245 and rules adopted by the department pursuant to
sections 190.001 to 190.245.

2. The department is authorized to receive contributions, grants,
donations or funds from any private entity to be expended for the program
authorized pursuant to this section. (L. 1998 S.B. 743)

1. No person, either as owner, agent or otherwise, shall
furnish, operate, conduct, maintain, advertise, or otherwise be engaged
in or profess to be engaged in the business or service of the
transportation of patients by ambulance in the air, upon the streets,
alleys, or any public way or place of the state of Missouri unless such
person holds a currently valid license from the department for an
ambulance service issued pursuant to the provisions of sections 190.001
to 190.245.

2. No ground ambulance shall be operated for ambulance purposes, and no
individual shall drive, attend or permit it to be operated for such
purposes in the state of Missouri unless the ground ambulance is under
the immediate supervision and direction of a person who is holding a
currently valid Missouri license as an emergency medical technician.
Nothing in this section shall be construed to mean that a duly registered
nurse or a duly licensed physician be required to hold an emergency
medical technician's license. Each ambulance service is responsible for
assuring that any person driving its ambulance is competent in emergency
vehicle operations and has a safe driving record. Each ground ambulance
shall be staffed with at least two licensed individuals when transporting
a patient, except as provided in section 190.094.

3. No license shall be required for an ambulance service, or for the
attendant of an ambulance, which:

(1) Is rendering assistance in the case of an emergency, major
catastrophe or any other unforeseen event or series of events which
jeopardizes the ability of the local ambulance service to promptly
respond to emergencies; or

(2) Is operated from a location or headquarters outside of Missouri in
order to transport patients who are picked up beyond the limits of
Missouri to locations within or outside of Missouri, but no such outside
ambulance shall be used to pick up patients within Missouri for
transportation to locations within Missouri, except as provided in
subdivision (1) of this subsection.

4. The issuance of a license pursuant to the provisions of sections
190.001 to 190.245 shall not be construed so as to authorize any person
to provide ambulance services or to operate any ambulances without a
franchise in any city not within a county or in a political subdivision
in any county with a population of over nine hundred thousand
inhabitants, or a franchise, contract or mutual-aid agreement in any
other political subdivision which has enacted an ordinance making it
unlawful to do so.

5. Sections 190.001 to 190.245 shall not preclude the adoption of any
law, ordinance or regulation not in conflict with such sections by any
city not within a county, or at least as strict as such sections by any
county, municipality or political subdivision except that no such
regulations or ordinances shall be adopted by a political subdivision in
a county with a population of over nine hundred thousand inhabitants
except by the county's governing body.

6. In a county with a population of over nine hundred thousand
inhabitants, the governing body of the county shall set the standards for
all ambulance services which shall comply with subsection 5 of this
section. All such ambulance services must be licensed by the department.
The governing body of such county shall not prohibit a licensed ambulance
service from operating in the county, as long as the ambulance service
meets county standards.

7. An ambulance service or vehicle when operated for the purpose of
transporting persons who are sick, injured, or otherwise incapacitated
shall not be treated as a common or contract carrier under the
jurisdiction of the Missouri division of motor carrier and railroad
safety.

8. Sections 190.001 to 190.245 shall not apply to, nor be construed to
include, any motor vehicle used by an employer for the transportation of
such employer's employees whose illness or injury occurs on private
property, and not on a public highway or property, nor to any person
operating such a motor vehicle.

9. A political subdivision that is authorized to operate a licensed
ambulance service may establish, operate, maintain and manage its
ambulance service, and select and contract with a licensed ambulance
service. Any political subdivision may contract with a licensed ambulance
service.

10. Except as provided in subsections 5 and 6, nothing in section 67.300,
RSMo, or subsection 2 of section 190.109, shall be construed to authorize
any municipality or county which is located within an ambulance district
or a fire protection district that is authorized to provide ambulance
service to promulgate laws, ordinances or regulations related to the
provision of ambulance services. This provision shall not apply to any
municipality or county which operates an ambulance service established
prior to August 28, 1998.

11. Nothing in section 67.300, RSMo, or subsection 2 of section 190.109
shall be construed to authorize any municipality or county which is
located within an ambulance district or a fire protection district that
is authorized to provide ambulance service to operate an ambulance
service without a franchise in an ambulance district or a fire protection
district that is authorized to provide ambulance service which has
enacted an ordinance making it unlawful to do so. This provision shall
not apply to any municipality or county which operates an ambulance
service established prior to August 28, 1998.

12. No provider of ambulance service within the state of Missouri which
is licensed by the department to provide such service shall discriminate
regarding treatment or transportation of emergency patients on the basis
of race, sex, age, color, religion, sexual preference, national origin,
ancestry, handicap, medical condition or ability to pay.

13. No provision of this section, other than subsections 5, 6, 10 and 11
of this section, is intended to limit or supersede the powers given to
ambulance districts pursuant to this chapter or to fire protection
districts pursuant to chapter 321, RSMo, or to counties, cities, towns
and villages pursuant to chapter 67, RSMo.

14. Upon the sale or transfer of any ground ambulance service ownership,
the owner of such service shall notify the department of the change in
ownership within thirty days of such sale or transfer. After receipt of
such notice, the department shall conduct an inspection of the ambulance
service to verify compliance with the licensure standards of sections
190.001 to 190.245. (L. 1973 S.B. 57 § 2, A.L. 1998 S.B. 743, A.L. 2002
S.B. 1107)

CROSS REFERENCE:

Commercial driver's licensing law not applicable to emergency vehicles,
RSMo 302.775

(1987) This section requires one license per ambulance, not per business.
Fenton Ambulance Service, Inc. v. Ritchie, 729 S.W.2d 493 (Mo.App.).

1. Any municipally operated ambulance service, ambulance
district, fire protection district that provides ambulance service or any
other ambulance service may enter into contracts providing for mutual aid
services provided by such ambulance service. The contracts that are
agreed upon may provide for compensation from the parties and other terms
that are agreeable to the parties and may be for an indefinite period as
long as they include a minimum of a sixty-day cancellation notice by
either party.

2. Any municipally operated ambulance service, ambulance district, fire
protection district that provides ambulance service or any other
ambulance service may provide assistance to any other ambulance service
in the state that requests it, at the time of an emergency, major
catastrophe or any other unforeseen event or series of events which
jeopardizes the ability of the local ambulance service to promptly
respond to emergencies.

3. When responding on mutual aid or emergency aid requests, the ambulance
service shall be subject to all provisions of law as if it were providing
service within its own jurisdiction.

4. Mutual-aid contracts may be agreed to between ambulance services in
the states neighboring Missouri and ambulance services in the state of
Missouri in the exact same manner as contracts between ambulance services
within the state of Missouri. (L. 1998 S.B. 743)

1. The department shall, within a reasonable time after receipt
of an application, cause such investigation as the department deems
necessary to be made of the applicant for an air ambulance license.

2. The department shall have the authority and responsibility to license
an air ambulance service in accordance with sections 190.001 to 190.245,
and in accordance with rules adopted by the department pursuant to
sections 190.001 to 190.245. The department may promulgate rules relating
to the requirements for an air ambulance license including, but not
limited to:

(1) Medical control plans;

(2) Medical director qualifications;

(3) Air medical staff qualifications;

(4) Response and operations standards to assure that the health and
safety needs of the public are met;

(5) Standards for air medical communications;

(6) Criteria for compliance with licensure requirements;

(7) Records and forms;

(8) Equipment requirements;

(9) Five-year license renewal;

(10) Quality improvement committees; and

(11) Response time, patient care and transportation standards.

3. Application for an air ambulance service license shall be made upon
such forms as prescribed by the department in rules adopted pursuant to
sections 190.001 to 190.245. The application form shall contain such
information as the department deems necessary to make a determination as
to whether the air ambulance service meets all the requirements of
sections 190.001 to 190.245 and rules promulgated pursuant to sections
190.001 to 190.245.

4. Upon the sale or transfer of any air ambulance service ownership, the
owner of such service shall notify the department of the change in
ownership within thirty days of such sale or transfer. After receipt of
such notice, the department shall conduct an inspection of the ambulance
service to verify compliance with the licensure standards of sections
190.001 to 190.245. (L. 1998 S.B. 743, A.L. 2002 S.B. 1107)

1. The department shall, within a reasonable time after receipt
of an application, cause such investigation as the department deems
necessary to be made of the applicant for a ground ambulance license.

2. Any person that owned and operated a licensed ambulance on December
31, 1997, shall receive an ambulance service license from the department,
unless suspended, revoked or terminated, for that ambulance service area
which was, on December 31, 1997, described and filed with the department
as the primary service area for its licensed ambulances on August 28,
1998, provided that the person makes application and adheres to the rules
and regulations promulgated by the department pursuant to sections
190.001 to 190.245.

3. The department shall issue a new ground ambulance service license to
an ambulance service that is not currently licensed by the department, or
is currently licensed by the department and is seeking to expand its
ambulance service area, except as provided in subsection 4 of this
section, to be valid for a period of five years, unless suspended,
revoked or terminated, when the director finds that the applicant meets
the requirements of ambulance service licensure established pursuant to
sections 190.100 to 190.245 and the rules adopted by the department
pursuant to sections 190.001 to 190.245. In order to be considered for a
new ambulance service license, an ambulance service shall submit to the
department a letter of endorsement from each ambulance district or fire
protection district that is authorized to provide ambulance service, or
from each municipality not within an ambulance district or fire
protection district that is authorized to provide ambulance service, in
which the ambulance service proposes to operate. If an ambulance service
proposes to operate in unincorporated portions of a county not within an
ambulance district or fire protection district that is authorized to
provide ambulance service, in order to be considered for a new ambulance
service license, the ambulance service shall submit to the department a
letter of endorsement from the county. Any letter of endorsement required
pursuant to this section shall verify that the political subdivision has
conducted a public hearing regarding the endorsement and that the
governing body of the political subdivision has adopted a resolution
approving the endorsement. The letter of endorsement shall affirmatively
state that the proposed ambulance service:

(1) Will provide a benefit to public health that outweighs the associated
costs;

(2) Will maintain or enhance the public's access to ambulance services;

(3) Will maintain or improve the public health and promote the continued
development of the regional emergency medical service system;

(4) Has demonstrated the appropriate expertise in the operation of
ambulance services; and

(5) Has demonstrated the financial resources necessary for the operation
of the proposed ambulance service.

4. A contract between a political subdivision and a licensed ambulance
service for the provision of ambulance services for that political
subdivision shall expand, without further action by the department, the
ambulance service area of the licensed ambulance service to include the
jurisdictional boundaries of the political subdivision. The termination
of the aforementioned contract shall result in a reduction of the
licensed ambulance service's ambulance service area by removing the
geographic area of the political subdivision from its ambulance service
area, except that licensed ambulance service providers may provide
ambulance services as are needed at and around the state fair grounds for
protection of attendees at the state fair.

5. The department shall renew a ground ambulance service license if the
applicant meets the requirements established pursuant to sections 190.001
to 190.245, and the rules adopted by the department pursuant to sections
190.001 to 190.245.

6. The department shall promulgate rules relating to the requirements for
a ground ambulance service license including, but not limited to:

(1) Vehicle design, specification, operation and maintenance standards;

(2) Equipment requirements;

(3) Staffing requirements;

(4) Five-year license renewal;

(5) Records and forms;

(6) Medical control plans;

(7) Medical director qualifications;

(8) Standards for medical communications;

(9) Memorandums of understanding with emergency medical response agencies
that provide advanced life support;

(10) Quality improvement committees; and

(11) Response time, patient care and transportation standards.

7. Application for a ground ambulance service license shall be made upon
such forms as prescribed by the department in rules adopted pursuant to
sections 190.001 to 190.245. The application form shall contain such
information as the department deems necessary to make a determination as
to whether the ground ambulance service meets all the requirements of
sections 190.001 to 190.245 and rules promulgated pursuant to sections
190.001 to 190.245. (L. 1998 S.B. 743, A.L. 2001 S.B. 619, A.L. 2002 S.B.
1107)

1. No ambulance service license shall be issued pursuant to
sections 190.001 to 190.245, nor shall such license be valid after
issuance, nor shall any ambulance be operated in Missouri unless there is
at all times in force and effect insurance coverage or proof of financial
responsibility with adequate reserves maintained for each and every
ambulance owned or operated by or for the applicant or licensee to
provide for the payment of damages in an amount as prescribed in
regulation:

(1) For injury to or death of individuals in accidents resulting from any
cause for which the owner of such vehicle would be liable on account of
liability imposed on him or her by law, regardless of whether the
ambulance was being driven by the owner or the owner's agent; and

(2) For the loss of or damage to the property of another, including
personal property, under like circumstances.

2. The insurance policy or proof of financial responsibility shall be
submitted by all licensees required to provide such insurance pursuant to
sections 190.001 to 190.245. The insurance policy, or proof of the
existence of financial responsibility, shall be submitted to the
director, in such form as the director may specify, for the director's
approval prior to the issuance of each ambulance service license.

3. Every insurance policy or proof of financial responsibility document
required by the provisions of this section shall contain proof of a
provision for a continuing liability thereunder to the full amount
thereof, notwithstanding any recovery thereon; that the liability of the
insurer shall not be affected by the insolvency or the bankruptcy of the
assured; and that until the policy is revoked the insurance company or
self-insured licensee or entity will not be relieved from liability on
account of nonpayment of premium, failure to renew license at the end of
the year, or any act or omission of the named assured. Such policy of
insurance or self-insurance shall be further conditioned for the payment
of any judgments up to the limits of such policy, recovered against any
person other than the owner, the owner's agent or employee, who may
operate the same with the consent of the owner.

4. Every insurance policy or self-insured licensee or entity as required
by the provisions of this section shall extend for the period to be
covered by the license applied for and the insurer shall be obligated to
give not less than thirty days' written notice to the director and to the
insured before any cancellation or termination thereof earlier than its
expiration date, and the cancellation or other termination of any such
policy shall automatically revoke and terminate the licenses issued for
the ambulance service covered by such policy unless covered by another
insurance policy in compliance with sections 190.001 to 190.245. (L. 1973
S.B. 57 § 5, A.L. 1980 H.B. 1595, A.L. 1998 S.B. 743, A.L. 2002 S.B. 1107)

(1979) Insurance coverage is required for accidents resulting from
negligent operation of the ambulance, not negligent or maladroit
administration of emergency care. Bailey v. City of St. Louis (A.), 578
S.W.2d 279.

1. The department shall accredit or certify training entities
for first responders, emergency medical dispatchers, emergency medical
technicians-basic, emergency medical technicians-intermediate, and
emergency medical technicians-paramedic, for a period of five years, if
the applicant meets the requirements established pursuant to sections
190.001 to 190.245.

2. Such rules promulgated by the department shall set forth the minimum
requirements for entrance criteria, training program curricula,
instructors, facilities, equipment, medical oversight, record keeping,
and reporting.

3. Application for training entity accreditation or certification shall
be made upon such forms as prescribed by the department in rules adopted
pursuant to sections 190.001 to 190.245. The application form shall
contain such information as the department deems reasonably necessary to
make a determination as to whether the training entity meets all
requirements of sections 190.001 to 190.245 and rules promulgated
pursuant to sections 190.001 to 190.245.

4. Upon receipt of such application for training entity accreditation or
certification, the department shall determine whether the training
entity, its instructors, facilities, equipment, curricula and medical
oversight meet the requirements of sections 190.001 to 190.245 and rules
promulgated pursuant to sections 190.001 to 190.245.

5. Upon finding these requirements satisfied, the department shall issue
a training entity accreditation or certification in accordance with rules
promulgated by the department pursuant to sections 190.001 to 190.245.

6. Subsequent to the issuance of a training entity accreditation or
certification, the department shall cause a periodic review of the
training entity to assure continued compliance with the requirements of
sections 190.001 to 190.245 and all rules promulgated pursuant to
sections 190.001 to 190.245.

7. No person or entity shall hold itself out or provide training required
by this section without accreditation or certification by the department.
(L. 1998 S.B. 743, A.L. 2002 S.B. 1107)

1. The department shall, within a reasonable time after receipt
of an application, cause such investigation as the department deems
necessary to be made of the applicant for an emergency medical response
agency license.

2. The department shall issue a license to any emergency medical response
agency which provides advanced life support if the applicant meets the
requirements established pursuant to sections 190.001 to 190.245, and the
rules adopted by the department pursuant to sections 190.001 to 190.245.
The department may promulgate rules relating to the requirements for an
emergency medical response agency including, but not limited to:

(1) A licensure period of five years;

(2) Medical direction;

(3) Records and forms; and

(4) Memorandum of understanding with local ambulance services.

3. Application for an emergency medical response agency license shall be
made upon such forms as prescribed by the department in rules adopted
pursuant to sections 190.001 to 190.245. The application form shall
contain such information as the department deems necessary to make a
determination as to whether the emergency medical response agency meets
all the requirements of sections 190.001 to 190.245 and rules promulgated
pursuant to sections 190.001 to 190.245.

4. No person or entity shall hold itself out as an emergency medical
response agency that provides advanced life support or provide the
services of an emergency medical response agency that provides advanced
life support unless such person or entity is licensed by the department.

5. Only emergency medical response agencies, fire departments, and fire
protection districts may provide certain ALS services with the services
of EMT-Is.

6. Emergency medical response agencies functioning with the services of
EMT-Is must work in collaboration with an ambulance service providing
advanced life support with personnel trained to the emergency medical
technician-paramedic level. (L. 1998 S.B. 743, A.L. 2002 S.B. 1107, A.L.
2004 H.B. 1195)

A dispatch agency is required to have a memorandum of
understanding with all ambulance services that it dispatches. If a
dispatch agency provides prearrival medical instructions, it is required
to have a medical director, whose duties include the maintenance of
standards and protocol approval. (L. 1998 S.B. 743)

1. The department shall, within a reasonable time after receipt
of an application, cause such investigation as it deems necessary to be
made of the applicant for an emergency medical technician's license. The
director may authorize investigations into criminal records in other
states for any applicant.

2. The department shall issue a license to all levels of emergency
medical technicians, for a period of five years, if the applicant meets
the requirements established pursuant to sections 190.001 to 190.245 and
the rules adopted by the department pursuant to sections 190.001 to
190.245. The department may promulgate rules relating to the requirements
for an emergency medical technician including but not limited to:

(1) Age requirements;

(2) Education and training requirements based on respective national
curricula of the United States Department of Transportation and any
modification to such curricula specified by the department through rules
adopted pursuant to sections 190.001 to 190.245;

(3) Initial licensure testing requirements;

(4) Continuing education and relicensure requirements; and

(5) Ability to speak, read and write the English language.

3. Application for all levels of emergency medical technician license
shall be made upon such forms as prescribed by the department in rules
adopted pursuant to sections 190.001 to 190.245. The application form
shall contain such information as the department deems necessary to make
a determination as to whether the emergency medical technician meets all
the requirements of sections 190.001 to 190.245 and rules promulgated
pursuant to sections 190.001 to 190.245.

4. All levels of emergency medical technicians may perform only that
patient care which is:

(1) Consistent with the training, education and experience of the
particular emergency medical technician; and

(2) Ordered by a physician or set forth in protocols approved by the
medical director.

5. No person shall hold themselves out as an emergency medical technician
or provide the services of an emergency medical technician unless such
person is licensed by the department.

6. Any rule or portion of a rule, as that term is defined in section
536.010, RSMo, 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, RSMo, and, if applicable, section
536.028, RSMo. This section and chapter 536, RSMo, are nonseverable and
if any of the powers vested with the general assembly pursuant to chapter
536, RSMo, 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,
2002, shall be invalid and void. (L. 1998 S.B. 743, A.L. 1999 H.B. 343,
A.L. 2002 S.B. 1107)

1. Notwithstanding any other provisions of law, the department
may grant a ninety-day temporary emergency medical technician license to
all levels of emergency medical technicians who meet the following:

(1) Can demonstrate that they have, or will have, employment requiring an
emergency medical technician license;

(2) Are not currently licensed as an emergency medical technician in
Missouri or have been licensed as an emergency medical technician in
Missouri and fingerprints need to be submitted to the Federal Bureau of
Investigation to verify the existence or absence of a criminal history,
or they are currently licensed and the license will expire before a
verification can be completed of the existence or absence of a criminal
history;

(3) Have submitted a complete application upon such forms as prescribed
by the department in rules adopted pursuant to sections 190.001 to
190.245;

(4) Have not been disciplined pursuant to sections 190.001 to 190.245 and
rules promulgated pursuant to sections 190.001 to 190.245;

(5) Meet all the requirements of rules promulgated pursuant to sections
190.001 to 190.245.

2. A temporary emergency medical technician license shall only authorize
the license to practice while under the immediate supervision of a
licensed emergency medical technician-basic, emergency medical
technician-paramedic, registered nurse or physician who is currently
licensed, without restrictions, to practice in Missouri.

3. A temporary emergency medical technician license shall automatically
expire either ninety days from the date of issuance or upon the issuance
of a five-year emergency medical technician license. (L. 2001 S.B. 619,
A.L. 2002 S.B. 1107)

Any licensee allowing a license to lapse may within two years of
the lapse request that their license be returned to active status by
notifying the department in advance of such intention, and submit a
complete application upon such forms as prescribed by the department in
rules adopted pursuant to sections 190.001 to 190.245. If the licensee
meets all the requirements for relicensure, the department shall issue a
new emergency medical technician license to the licensee. (L. 2002 S.B.
1107 § 190.145)

The renewal of any license shall require conformance with
sections 190.001 to 190.245 and sections 190.525 to 190.537, and rules
adopted by the department pursuant to sections 190.001 to 190.245 and
sections 190.525 to 190.537. (L. 1973 S.B. 57 § 13, A.L. 1998 S.B. 743,
A.L. 2002 S.B. 1107)

1. The department may refuse to issue or deny renewal of any
certificate, permit or license required pursuant to sections 190.100 to
190.245 for failure to comply with the provisions of sections 190.100 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, RSMo.

2. The department may cause a complaint to be filed with the
administrative hearing commission as provided by chapter 621, RSMo,
against any holder of any certificate, permit or license required by
sections 190.100 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 to 190.245 or any lawful
regulations promulgated by the department to implement such sections.
Those regulations shall be limited to the following:

(1) Use or unlawful possession of any controlled substance, as defined in
chapter 195, RSMo, 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 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 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
certificate, permit or license issued pursuant to sections 190.100 to
190.245 or in obtaining permission to take any examination given or
required pursuant to sections 190.100 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 to 190.245;

(6) Violation of, or assisting or enabling any person to violate, any
provision of sections 190.100 to 190.245, or of any lawful rule or
regulation adopted by the department pursuant to sections 190.100 to
190.245;

(7) Impersonation of any person holding a certificate, permit or license
or allowing any person to use his or her 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 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 to 190.245 who is
not licensed and currently eligible to practice pursuant to sections
190.100 to 190.245;

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

(12) Violation of any professional trust or confidence;

(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 cooperate with the
department of health and senior services during any investigation;

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

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

3. After the filing of such complaint, the proceedings shall be conducted
in accordance with the provisions of chapter 621, RSMo. 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 period not to exceed three years, or revoke the
license, certificate or permit.

4. 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 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.

5. 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.

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

7. The department of health and senior services may suspend any
certificate, permit or license required pursuant to sections 190.100 to
190.245 simultaneously with the filing of the complaint with the
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 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. (L. 1973 S.B. 57 § 14, A.L. 1978
S.B. 661, A.L. 1998 S.B. 743, A.L. 2002 S.B. 1107)

Any person aggrieved by an official action of the department of
health and senior services affecting the licensed status of a person
pursuant to the provisions of sections 190.001 to 190.245 and sections
190.525 to 190.537, including the refusal to grant, the grant, the
revocation, the suspension, or the failure to renew a license, may seek a
determination thereon by the administrative hearing commission pursuant
to the provisions of section 621.045, RSMo, and it shall not be a
condition to such determination that the person aggrieved seek a
reconsideration, a rehearing, or exhaust any other procedure within the
department of health and senior services or the department of social
services. (L. 1978 S.B. 661, A.L. 1998 S.B. 743, A.L. 2002 S.B. 1107)

(1993) Competing ambulance service lacks standing to contest action of
department before administrative hearing commission, because for purposes
of statute, "aggrieved person" does not include competing ambulance
service that is economically affected by an action of department of
health granting an ambulance license to another ambulance service. Gold
Cross Ambulance, Inc. v. Missouri Dept. of Health, 866 S.W.2d 473 (Mo.
App. W.D.).

Notwithstanding the provisions of subdivision (3) of subsection
3 of section 621.045, RSMo, to the contrary, if no contested case has
been filed against the licensee, the agency shall submit a copy of the
settlement agreement signed by all of the parties within fifteen days
after signature to the administrative hearing commission for
determination that the facts agreed to by the parties to the settlement
constitute grounds for denying or disciplining the license of the
licensee. Any person who is directly harmed by the specific conduct for
which the discipline is sought may submit a written impact statement to
the administrative hearing commission for consideration in connection
with the commission's review of the settlement agreement. (L. 2002 S.B.
1107)

1. Each ambulance service licensee or emergency medical response
agency licensee shall maintain accurate records, which contain
information concerning the care and, if applicable, the transportation of
each patient.

2. Records will be retained by the ambulance service licensees and
emergency medical response agency licensees for five years, readily
available for inspection by the department, notwithstanding transfer,
sale or discontinuance of the ambulance services or business.

3. A patient care report, approved by the department, shall be completed
for each ambulance run on which are entered pertinent remarks by the
emergency medical technician, registered nurse or physician and such
other items as specified by rules promulgated by the department.

4. A written or electronic patient care document shall be completed and
given to the ambulance service personnel by the health care facility when
a patient is transferred between health care facilities. Such patient
care record shall contain such information pertinent to the continued
care of the patient as well as the health and safety of the ambulance
service personnel during the transport. Nothing in this section shall be
construed as to limit the reporting requirements established in federal
law relating to the transfer of patients between health care facilities.

5. Such records shall be available for inspection by the department at
any reasonable time during business hours. (L. 1973 S.B. 57 § 16, A.L.
1998 S.B. 743, A.L. 2002 S.B. 1107)

1. The department shall develop and administer a uniform data
collection system on all ambulance runs and injured patients, pursuant to
rules promulgated by the department for the purpose of injury etiology,
patient care outcome, injury prevention and research purposes. The
department shall not require disclosure by hospitals of data elements
pursuant to this section unless those data elements are required by a
federal agency or were submitted to the department as of January 1, 1998,
pursuant to:

(1) Departmental regulation of trauma centers; or

(2) The Missouri head and spinal cord injury registry established by
sections 192.735 to 192.745, RSMo; or

(3) Abstracts of inpatient hospital data; or

(4) If such data elements are requested by a lawful subpoena or subpoena
duces tecum.

2. All information and documents in any civil action, otherwise
discoverable, may be obtained from any person or entity providing
information pursuant to the provisions of sections 190.001 to 190.245.
(L. 1998 S.B. 743)

1. Any person violating, or failing to comply with, the
provisions of sections 190.001 to 190.245 is guilty of a class B
misdemeanor.

2. Each day that any violation of, or failure to comply with, sections
190.001 to 190.245 is committed or permitted to continue shall constitute
a separate and distinct offense and shall be punishable as such
hereunder; but the court may, in appropriate cases, stay the cumulation
of penalties.

3. The attorney general of Missouri shall have concurrent jurisdiction
with any and all prosecuting attorneys to prosecute persons in violation
of sections 190.001 to 190.245, and the attorney general or prosecuting
attorney may institute injunctive proceedings against any person
operating in violation of sections 190.001 to 190.245.

4. The prosecuting attorney for the county in which the violation of a
political subdivision's law, ordinance or regulation relating to the
provision of ambulance services occurs may prosecute such violations in
the circuit court of that county. The legal officer or attorney for the
political subdivision may be appointed by the prosecuting attorney as
special assistant prosecuting attorney for the prosecution of any such
violation.

5. A person, acting as owner, agent or otherwise, who holds a valid
license for an ambulance service, shall not, incident to such person's
business or service of transporting patients, violate any applicable law,
ordinance or regulation of any political subdivision by providing
ambulance services or operating any ambulances without a franchise,
contract or mutual-aid agreement in such political subdivision, or by
violating any such franchise, contract or mutual-aid agreement by any
political subdivision which has enacted ordinances making it unlawful to
do so. If the department receives official written notification by a
political subdivision that an ambulance service has been adjudicated and
found to be in violation of any applicable law or ordinance, such
ambulance service shall be subject to licensure action by the department.

6. No provision of this section is intended to limit or supersede a
political subdivision's right to enforce any law, ordinance, regulation,
franchise, contract or mutual-aid agreement.

7. The provisions of subsections 4, 5 and 6 of this section shall not
apply to a city not within a county and any county with a population of
over nine hundred thousand inhabitants and any licensed ambulance service
when operating in a city not within a county. (L. 1973 S.B. 57 § 17, A.L.
1998 S.B. 743)

The department shall adopt, amend, promulgate, and enforce such
rules, regulations and standards with respect to the provisions of this
chapter as may be designed to further the accomplishment of the purpose
of this law in promoting state-of-the-art emergency medical services in
the interest of public health, safety and welfare. When promulgating such
rules and regulations, the department shall consider the recommendations
of the state advisory council on emergency medical services. Any rule or
portion of a rule promulgated pursuant to the authority of sections
190.001 to 190.245 or sections 190.525 to 190.537 shall become effective
only if it complies with and is subject to all of the provisions of
chapter 536, RSMo, and, if applicable, section 536.028, RSMo. This
section and chapter 536, RSMo, are nonseverable and if any of the powers
vested with the general assembly pursuant to chapter 536, RSMo, 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, 2002, shall
be invalid and void. (L. 1973 S.B. 57 § 18, A.L. 1989 S.B. 337, A.L. 1993
S.B. 52, A.L. 1995 S.B. 3, A.L. 1998 S.B. 743, A.L. 2002 S.B. 1107)

1. All ambulance vehicles or aircraft that have or are qualified
to have a valid license issued by the department on the day that sections
190.001 to 190.245 take effect will have their ambulance vehicle or
aircraft license expiration date extended to a date that is one year
after the effective date of sections 190.001 to 190.245.

2. All ambulance services shall have until August 28, 1999, to comply
with the provisions of sections 190.001 to 190.245 and rules developed
pursuant to sections 190.001 to 190.245. Pursuant to sections 190.001 to
190.245 the department may adjust the initial period of licensure, from
one year to five years, of any ambulance service licensed pursuant to
sections 190.001 to 190.245, to equalize the number of licenses that may
be renewed during each year of any five-year licensure period. (L. 1973
S.B. 57 § 19, A.L. 1998 S.B. 743)

1. No employer shall knowingly employ or permit any employee to
perform any services for which a license, certificate or other
authorization is required by sections 190.001 to 190.245, or by rules
adopted pursuant to sections 190.001 to 190.245, unless and until the
person so employed possesses all licenses, certificates or authorizations
that are required.

2. Any person or entity that employs or supervises a person's activities
as a first responder, emergency medical dispatcher, emergency medical
technician-basic, emergency medical technician-paramedic, registered
nurse or physician shall cooperate with the department's efforts to
monitor and enforce compliance by those individuals subject to the
requirements of sections 190.001 to 190.245.

3. Any person or entity who employs individuals licensed by the
department pursuant to sections 190.001 to 190.245 shall report to the
department within seventy-two hours of their having knowledge of any
charges filed against a licensee in their employ for possible criminal
action involving the following felony offenses:

(1) Child abuse or sexual abuse of a child;

(2) Crimes of violence; or

(3) Rape or sexual abuse.

4. Any licensee who has charges filed against him or her for the felony
offenses in subsection 3 of this section shall report such an occurrence
to the department within seventy-two hours of the charges being filed.

5. The department will monitor these reports for possible licensure
action authorized pursuant to section 190.165. (L. 1998 S.B. 743, A.L.
2002 S.B. 1107)

The department of health and senior services in cooperation with
local and regional EMS systems and agencies may provide public and
professional information and education programs related to emergency
medical services systems including trauma systems and emergency medical
care and treatment. The department of health and senior services may also
provide public information and education programs for informing residents
of and visitors to the state of the availability and proper use of
emergency medical services, of the value and nature of programs to
involve citizens in the administering of prehospital emergency care,
including cardiopulmonary resuscitation, and of the availability of
training programs in emergency care for members of the general public.
(L. 1998 S.B. 743)

1. Health carriers and managed care plans shall pay benefits
directly to ambulance services or emergency medical response agencies.

2. Health carriers and managed care plans shall not prohibit or
discourage the use of the 911 system when emergency services are needed
as defined in section 190.100.

3. If a request for emergency services is made to an ambulance service
which is not the 911 provider or the recognized emergency provider in
areas not covered by 911 ambulance services, then the 911 provider or the
recognized emergency provider shall be notified immediately by the
ambulance service receiving the request. (L. 1998 S.B. 743)

1. The department shall designate a hospital as an adult,
pediatric or adult and pediatric trauma center when a hospital, upon
proper application submitted by the hospital and site review, has been
found by the department to meet the applicable level of trauma center
criteria for designation in accordance with rules adopted by the
department.

2. The department of health and senior services shall, not less than once
every five years, conduct an on-site review of every trauma center
through appropriate department personnel or a qualified contractor. No
person shall be a qualified contractor for purposes of this subsection
who has a substantial conflict of interest in the operation of any trauma
center under review. The department may deny, place on probation, suspend
or revoke a trauma center designation in any case in which it has
reasonable cause to believe that there has been a substantial failure to
comply with the provisions of this chapter or any rules or regulations
promulgated pursuant to this chapter. If the department of health and
senior services has reasonable cause to believe that a hospital is not in
compliance with such provisions or regulations, it may conduct additional
announced or unannounced site reviews of the hospital to verify
compliance. If a trauma center fails two consecutive on-site reviews
because of substantial noncompliance with standards prescribed by
sections 190.001 to 190.245 or rules adopted by the department pursuant
to sections 190.001 to 190.245, its trauma center designation shall be
revoked.

3. The department of health and senior services may establish appropriate
fees to offset the costs of trauma center reviews.

4. No hospital shall hold itself out to the public as an adult, pediatric
or adult and pediatric trauma center unless it is designated as such by
the department of health and senior services.

5. Any person aggrieved by an action of the department of health and
senior services affecting the trauma center designation pursuant to this
chapter, including the revocation, the suspension, or the granting of,
refusal to grant, or failure to renew a designation, may seek a
determination thereon by the administrative hearing commission pursuant
to the provisions of chapter 536, RSMo. It shall not be a condition to
such determination that the person aggrieved seek a reconsideration, a
rehearing, or exhaust any other procedure within the department. (L. 1987
S.B. 31 & 29 § 4, A.L. 1998 S.B. 743)

1. Severely injured patients shall be transported to a trauma
center. A physician or registered nurse authorized by a physician who has
established verbal communication with ambulance personnel shall instruct
the ambulance personnel to transport a severely injured patient to the
closest hospital or designated trauma center, as determined according to
estimated transport time whether by ground ambulance or air ambulance, in
accordance with transport protocol approved by the medical director and
the department of health and senior services, even when the hospital is
located outside of the ambulance service's primary service area. When
initial transport from the scene of injury to a trauma center would be
prolonged, the severely injured patient may be transported to the nearest
appropriate facility for stabilization prior to transport to a trauma
center.

2. Transport of the severely injured patient shall be governed by
principles of timely and medically appropriate care; consideration of
reimbursement mechanisms shall not supersede those principles.

3. Patients who are not severely injured shall be transported to and
cared for at the hospital of their choice so long as such ambulance
service is not in violation of local protocols. (L. 1987 S.B. 31 & 29 §
5, A.L. 1998 S.B. 743)

The department shall require hospitals, as defined by chapter
197, RSMo, designated as trauma centers to provide for a peer review
system, approved by the department, for trauma cases pursuant to the
provisions of section 537.035, RSMo. For purposes of sections 190.241 to
190.245, the department of health and senior services shall have the same
powers and authority of a health care licensing board pursuant to
subsection 6 of section 537.035, RSMo. Failure of a hospital to provide
all medical records necessary for the department to implement provisions
of sections 190.241 to 190.245 shall result in the revocation of the
hospital's designation as a trauma center. Any medical records obtained
by the department or peer review committees shall be used only for
purposes of implementing the provisions of sections 190.241 to 190.245
and the names of hospitals, physicians and patients shall not be released
by the department or members of review committees. (L. 1987 S.B. 31 & 29
§ 6, A.L. 1998 S.B. 743)

1. As used in this section, the following terms shall mean:

(1) "Eligible person, firm, organization or other entity", an ambulance
service or emergency medical response agency, a certified first
responder, emergency medical technical-basic or emergency medical
technician-paramedic who is employed by, or an enrolled member, person,
firm, organization or entity designated by, rule of the department of
health and senior services in consultation with other appropriate
agencies. All such eligible persons, firms, organizations or other
entities shall be subject to the rules promulgated by the director of the
department of health and senior services;

(2) "Emergency health care provider":

(a) A physician licensed pursuant to chapter 334, RSMo, with knowledge
and experience in the delivery of emergency care; or

(b) A hospital licensed pursuant to chapter 197, RSMo, that provides
emergency care.

2. Possession and use of epinephrine auto-injector devices shall be
limited as follows:

(1) No person shall use an epinephrine auto-injector device unless such
person has successfully completed a training course in the use of
epinephrine auto-injector devices approved by the director of the
department of health and senior services. Nothing in this section shall
prohibit the use of an epinephrine auto-injector device:

(a) By a health care professional licensed or certified by this state who
is acting within the scope of his or her practice; or

(b) By a person acting pursuant to a lawful prescription;

(2) Every person, firm, organization and entity authorized to possess and
use epinephrine auto-injector devices pursuant to this section shall use,
maintain and dispose of such devices in accordance with the rules of the
department;

(3) Every use of an epinephrine auto-injector device pursuant to this
section shall immediately be reported to the emergency health care
provider.

3. (1) Use of an epinephrine auto-injector device pursuant to this
section shall be considered first aid or emergency treatment for the
purpose of any law relating to liability.

(2) Purchase, acquisition, possession or use of an epinephrine
auto-injector device pursuant to this section shall not constitute the
unlawful practice of medicine or the unlawful practice of a profession.

(3) Any person otherwise authorized to sell or provide an epinephrine
auto-injector device may sell or provide it to a person authorized to
possess it pursuant to this section.

4. Any person, firm, organization or entity that violates the provisions
of this section is guilty of a class B misdemeanor. (L. 2002 S.B. 1107)

1. All investigations conducted in response to allegations of
violations of sections 190.001 to 190.245 shall be completed within six
months of receipt of the allegation.

2. In the course of an investigation the department shall have access to
all records directly related to the alleged violations from persons or
entities licensed pursuant to this chapter or chapter 197 or 198, RSMo.

3. Any department investigations that involve other administrative or law
enforcement agencies shall be completed within six months of notification
and final determination by such administrative or law enforcement
agencies. (L. 2002 S.B. 1107)

1. As used in this section, the following terms mean:

(1) "Claim", a claim of a patient for:

(a) Damages from a tort-feasor; or

(b) Benefits from an insurance carrier;

(2) "Insurance carrier", any person, firm, corporation, association or
aggregation of persons conducting an insurance business pursuant to
chapter 375, 376, 377, 378, 379, 380, 381, or 383, RSMo;

(3) "Patient", any person to whom an ambulance service delivers
treatment, care, or transportation for sickness or injury caused by a
tort-feasor from whom such person seeks damages or any insurance carrier
which has insured such tort-feasor.

2. Ambulance services shall have the same rights granted to hospitals in
sections 430.230 to 430.250, RSMo.

3. If the liens of such ambulance services or hospitals exceed fifty
percent of the amount due the patient, every ambulance service or
hospital giving notice of its lien, as aforesaid, shall share in up to
fifty percent of the net proceeds due the patient, in the proportion that
each claim bears to the total amount of all other liens of ambulance
services or hospitals. "Net proceeds", as used in this section, means the
amount remaining after the payment of contractual attorney fees, if any,
and other expenses of recovery.

4. In administering the lien of the ambulance service, the insurance
carrier may pay the amount due secured by the lien of the ambulance
service directly, if the claimant authorizes it and does not challenge
the amount of the customary charges or that the treatment provided was
for injuries caused by the tort-feasor.

5. Any ambulance service electing to receive benefits hereunder releases
the claimant from further liability on the cost of the services and
treatment provided to that point in time. (L. 2002 S.B. 1107 § 1)

As used in sections 190.290 to 190.296, the following terms
shall mean:

(1) "Emergency telephone service", a telephone system utilizing a single
three digit number, "911", for reporting police, fire, medical, or other
emergency situations;

(2) "Emergency services board" or "board", those persons appointed or
elected pursuant to section 190.292;

(3) "Person", any individual, firm, partnership, copartnership, joint
venture, association, cooperative organization, corporation, municipal or
private, and whether organized for profit or not, state, county,
political subdivision, state department, commission, board, bureau, or
fraternal organization, estate, trust, business, or common law trust,
receiver, assignee for the benefit of creditors, trustee or trustee in
bankruptcy, or any other service user;

(4) "Public agency", any city, county, city not within a county,
municipal corporation, public district or public authority located in
whole or in part within this state which provides or has authority to
provide fire fighting, law enforcement, ambulance, emergency medical, or
other emergency services. (L. 2004 S.B. 1329 § 190.342)

1. In lieu of the tax levy authorized under section 190.305 for
emergency telephone services, the county commission of any county may
impose a county sales tax for the provision of central dispatching of
fire protection, including law enforcement agencies, emergency ambulance
service or any other emergency services, including emergency telephone
services, which shall be collectively referred to herein as "emergency
services", and which may also include the purchase and maintenance of
communications and emergency equipment, including the operational costs
associated therein, in accordance with the provisions of this section.

2. Such county commission may, by a majority vote of its members, submit
to the voters of the county, at a public election, a proposal to
authorize the county commission to impose a tax under the provisions of
this section. If the residents of the county present a petition signed by
a number of residents equal to ten percent of those in the county who
voted in the most recent gubernatorial election, then the commission
shall submit such a proposal to the voters of the county.

3. The ballot of submission shall be in substantially the following form:

Shall the county of ................... (insert name of county) impose a
county sales tax of ............ (insert rate of percent) percent for the
purpose of providing central dispatching of fire protection, emergency
ambulance service, including emergency telephone services, and other
emergency services?

[ ] YES [ ] NO

If a majority of the votes cast on the proposal by the qualified voters
voting thereon are in favor of the proposal, then the ordinance shall be
in effect as provided herein. If a majority of the votes cast by the
qualified voters voting are opposed to the proposal, then the county
commission shall have no power to impose the tax authorized by this
section unless and until the county commission shall again have submitted
another proposal to authorize the county commission to impose the tax
under the provisions of this section, and such proposal is approved by a
majority of the qualified voters voting thereon.

4. The sales tax may be imposed at a rate not to exceed one percent on
the receipts from the sale at retail of all tangible personal property or
taxable services at retail within any county adopting such tax, if such
property and services are subject to taxation by the state of Missouri
under the provisions of sections 144.010 to 144.525, RSMo. The sales tax
shall not be collected prior to thirty-six months before operation of the
central dispatching of emergency services.

5. Except as modified in this section, all provisions of sections 32.085
and 32.087, RSMo, shall apply to the tax imposed under this section.

6. Any tax imposed pursuant to section 190.305 shall terminate at the end
of the tax year in which the tax imposed pursuant to this section for
emergency services is certified by the board to be fully operational. Any
revenues collected from the tax authorized under section 190.305 shall be
credited for the purposes for which they were intended.

7. At least once each calendar year, the board, as established by
subsection 11 of this section, shall establish a tax rate, not to exceed
the amount authorized, that together with any surplus revenues carried
forward will produce sufficient revenues to fund the expenditures
authorized by sections 190.290 to 190.296. Amounts collected in excess of
that necessary within a given year shall be carried forward to subsequent
years. The board shall make its determination of such tax rate each year
no later than September first and shall fix the new rate which shall be
collected as provided in sections 190.290 to 190.296. Immediately upon
making its determination and fixing the rate, the board shall publish in
its minutes the new rate, and it shall notify every retailer by mail of
the new rate.

8. Immediately upon the affirmative vote of voters of such a county on
the ballot proposal to establish a county sales tax pursuant to the
provisions of this section, the county commission shall appoint the
initial members of a board to administer the funds and oversee the
provision of emergency services in the county. Beginning with the general
election in 1994, all board members shall be elected according to this
section and other applicable laws of this state. At the time of the
appointment of the initial members of the board, the commission shall
relinquish and no longer exercise the duties prescribed in this chapter
with regard to the provision of emergency services and such duties shall
be exercised by the board.

9. The initial board shall consist of seven members appointed without
regard to political affiliation, three of whom shall be selected from,
and who shall represent, the fire protection districts, ambulance
districts, sheriff's department, municipalities, and any other emergency
services. Four of the members of the board shall not be selected from or
represent the fire protection districts, ambulance districts, sheriff's
department, municipalities, or any other emergency services. Any
individual serving on the board on August 28, 2004, may continue to serve
and seek reelection or reappointment to the board, notwithstanding any
provisions of this subsection. This initial board shall serve until its
successor board is duly elected and installed in office. The commission
shall ensure geographic representation of the county by appointing no
more than four members from each district of the county commission.

10. Beginning in 1994, three members shall be elected from each district
of the county commission and one member shall be elected at large. The
members of the board shall annually elect, from among their number, the
chairman of the board. Of those first elected, four members from
districts of the county commission shall be elected for terms of two
years and two members from districts of the county commission and the
member at large shall be elected for terms of four years. In 1996, and
thereafter, all terms of office shall be four years. The election of the
board members shall be conducted at the first municipal election held in
a calendar year.

11. When the board is organized, it shall be a body corporate and a
political subdivision of the state and shall be known as the
"............ Emergency Services Board".

12. This section shall only apply to any county of the third
classification without a township form of government and with more than
twenty-four thousand five hundred but less than twenty-four thousand six
hundred inhabitants. (L. 2004 S.B. 1329 § 190.344, A.L. 2005 H.B. 58)

1. The powers and duties of the emergency services board shall
include, but not be limited to:

(1) Planning a 911 system and dispatching system;

(2) Coordinating and supervising the implementation, upgrading or
maintenance of the system, including the establishment of equipment
specifications and coding systems;

(3) Receiving money from any county sales tax authorized to be levied
pursuant to section 190.292 and authorizing disbursements from such
moneys collected;

(4) Hiring any staff necessary for the implementation, upgrade or
operation of the system;

(5) Acquiring land in fee simple, rights in land and easements upon,
over, or across land and leasehold interests in land and tangible and
intangible personal property used or useful for the location,
establishment, maintenance, development, expansion, extension, or
improvement of the central dispatching of emergency services. The
acquisition may be by dedication, purchase, gift, agreement, lease, use,
or adverse possession;

(6) Borrowing money and issuing bonds, notes, certificates, or other
evidences of indebtedness for the purpose of accomplishing any of its
corporate purposes, subject to compliance with any condition or
limitation set forth in sections 190.290 to 190.296 or otherwise provided
by the Constitution of Missouri;

(7) Suing and being sued, and to be party to suits, actions, and
proceedings;

(8) Having and using a corporate seal;

(9) Entering into contracts, franchises, and agreements with any person,
partnership, association, or corporation, public or private, affecting
the affairs of the board;

(10) Having the management, control, and supervision of all the business
affairs of the board and the construction, installation, operation, and
maintenance of any improvements;

(11) Hiring and retaining agents and employees and providing for their
compensation, including health and pension benefits;

(12) Adopting and amending bylaws and any other rules and regulations;

(13) Paying all expenses connected with the first election and all
subsequent elections;

(14) Having and exercising all rights and powers necessary or incidental
to or implied from the specific powers granted in this section. Such
specific powers shall not be considered as a limitation upon any power
necessary or appropriate to carry out the purposes and intent of sections
190.290 to 190.296;

(15) Maintaining central dispatching of emergency services for the
benefit of the inhabitants of the area comprising the district regardless
of race, creed, or color, and to adopt such reasonable rules and
regulations as may be necessary to render the highest quality of the
central dispatching of emergency services; excluding from the use of the
central dispatching of emergency services all persons who willfully
disregard any of the rules and regulations so established; extending the
privileges and use of the central dispatching of emergency services to
persons residing outside the area of the district upon such terms and
conditions as the board prescribes by its rules and regulations;

(16) Purchasing insurance indemnifying the district and its employees,
officers, volunteers, and directors against liability in rendering
services incidental to the furnishing of central dispatching of emergency
services. Purchase of insurance pursuant to this section is not intended
to waive sovereign immunity, official immunity, or the Missouri public
duty doctrine defenses.

2. The administrative control and management of the moneys from any
county sales tax authorized to be levied pursuant to section 190.292 and
the administrative control and management of the central dispatching of
emergency services shall rest solely with the board, and the board shall
employ all necessary personnel, affix their compensation and provide
suitable quarters and equipment for the operation of the central
dispatching of emergency services from the funds available for this
purpose.

3. The board may contract to provide services relating in whole or in
part to central dispatching of emergency services and for such purpose
may expend the tax funds or other funds.

4. The board shall elect a vice chairman, treasurer, secretary and such
other officers as it deems necessary. Before taking office, the treasurer
shall furnish a surety bond in an amount to be determined and in a form
to be approved by the board for the faithful performance of the
treasurer's duties and faithful accounting of all moneys that may come
into the treasurer's hands. The treasurer shall enter into the surety
bond with a surety company authorized to do business in Missouri, and the
cost of such bond shall be paid by the board of directors.

5. The board may accept any gift of property or money for the use and
benefit of the central dispatching of emergency services, and the board
is authorized to sell or exchange any such property which it believes
would be to the benefit of the service so long as the proceeds are used
exclusively for central dispatching of emergency services. The board
shall have exclusive control of all gifts, property or money it may
accept; of all interest of other proceeds which may accrue from the
investment of such gifts or money or from the sale of such property; of
all tax revenues collected by the county on behalf of the central
dispatching of emergency services; and of all other funds granted,
appropriated or loaned to it by the federal government, the state or its
political subdivisions so long as such resources are used solely to
benefit the central dispatching of emergency services.

6. Any board member may, following notice and an opportunity to be heard,
be removed from any office by a majority vote of the other members of the
board for any of the following reasons:

(1) Failure to attend five consecutive meetings, without good cause;

(2) Conduct prejudicial to the good order and efficient operation of the
central dispatching of emergency services; or

(3) Neglect of duty.

7. The chairperson of the board shall preside at such removal hearing,
unless the chairperson is the person sought to be removed, in which case
the hearing shall be presided over by another member elected by a
majority vote of the other board members. All interested parties may
present testimony and arguments at such hearing, and the witnesses shall
be sworn in by oath or affirmation before testifying. Any interested
party may, at his or her own expense, record the proceedings.

8. Vacancies on the board occasioned by removals, resignations or
otherwise shall be filled by the remaining members of the board. The
appointee or appointees shall act until the next election at which a
director or directors are elected to serve the remainder of the unexpired
term.

9. Individual board members shall not be eligible for employment by the
board within twelve months of termination of service as a member of the
board.

10. No person shall be employed by the board who is related within the
fourth degree by blood or by marriage to any member of the board.

11. Any rule or portion of a rule, as that term is defined in section
536.010, RSMo, that is created under the authority delegated in sections
190.300 to 190.341* shall become effective only if it complies with and
is subject to all of the provisions of chapter 536, RSMo, and, if
applicable, section 536.028, RSMo. This section and chapter 536, RSMo,
are nonseverable and if any of the powers vested with the general
assembly pursuant to chapter 536, RSMo, 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, 2004, shall be invalid and void.

12. This section shall only apply to any county of the third
classification without a township form of government and with more than
twenty-four thousand five hundred but less than twenty-four thousand six
hundred inhabitants. (L. 2004 S.B. 1329 § 190.346)

*Section 190.341 does not exist.

1. For the purpose of purchasing any property or equipment
necessary or incidental to the operation of central dispatching of
emergency services, the board may borrow money and issue bonds for the
payment thereof in the manner provided herein. The question of the loan
shall be decided by the submission of the question to the eligible voters
of the county at the first municipal election held in a calendar year.

2. The question shall be submitted in substantially the following form:

Shall the ........... emergency services board borrow money in the amount
of ............ dollars for the purpose of ........ and issue bonds for
the payment thereof?

3. If the constitutionally required percentage of the votes cast are for
the loan, the board shall, subject to the restrictions of subsection 4 of
this section, be vested with the power to borrow money in the name of the
board, to the amount and for the purposes specified on the ballot, and
issue the bonds of the board for the payment thereof.

4. The loans authorized by this section shall not be contracted for a
period longer than twenty years, and the entire amount of the loan shall
at no time exceed, including the existing indebtedness of the board, in
the aggregate, ten percent of the value of taxable tangible property
therein, as shown by the last completed assessment for state and county
purposes, the rate of interest to be agreed upon by the parties, but in
no case to exceed the highest legal rate allowed by contract; when
effected, it shall be the duty of the directors to direct a portion of
the tax collected pursuant to section 190.292 in an amount sufficient to
pay the interest on the indebtedness as it falls due, and also to
constitute a sinking fund for the payment of the principal thereof within
the time the principal becomes due.

5. This section shall only apply to any county of the third
classification without a township form of government and with more than
twenty-four thousand five hundred but less than twenty-four thousand six
hundred inhabitants. (L. 2004 S.B. 1329 § 190.348)

As used in sections 190.300 to 190.320, the following terms and
phrases mean:

(1) "Emergency telephone service", a telephone system utilizing a single
three digit number "911" for reporting police, fire, medical or other
emergency situations;

(2) "Emergency telephone tax", a tax to finance the operation of
emergency telephone service;

(3) "Exchange access facilities", all facilities provided by the service
supplier for local telephone exchange access to a service user;

(4) "Governing body", the legislative body for a city, county or city not
within a county;

(5) "Person", any individual, firm, partnership, copartnership, joint
venture, association, cooperative organization, corporation, municipal or
private, and whether organized for profit or not, state, county,
political subdivision, state department, commission, board, bureau or
fraternal organization, estate, trust, business or common law trust,
receiver, assignee for the benefit of creditors, trustee or trustee in
bankruptcy, or any other service user;

(6) "Public agency", any city, county, city not within a county,
municipal corporation, public district or public authority located in
whole or in part within this state which provides or has authority to
provide fire fighting, law enforcement, ambulance, emergency medical, or
other emergency services;

(7) "Service supplier", any person providing exchange telephone services
to any service user in this state;

(8) "Service user", any person, other than a person providing pay
telephone service pursuant to the provisions of section 392.520, RSMo,
not otherwise exempt from taxation, who is provided exchange telephone
service in this state;

(9) "Tariff rate", the rate or rates billed by a service supplier to a
service user as stated in the service supplier's tariffs, approved by the
Missouri public service commission which represent the service supplier's
recurring charges for exchange access facilities or their equivalent,
exclusive of all taxes, fees, licenses or similar charges whatsoever. (L.
1981 H.B. 437 § 1, A.L. 1993 S.B. 160)

CROSS REFERENCE: Advisory committee for 911 service oversight, created,
members, terms, qualifications, powers and duties, staffed by department
of public safety, RSMo 650.325, 650.330

1. In addition to its other powers for the protection of the
public health, a governing body may provide for the operation of an
emergency telephone service and may pay for it by levying an emergency
telephone tax for such service in those portions of the governing body's
jurisdiction for which emergency telephone service has been contracted.
The governing body may do such other acts as are expedient for the
protection and preservation of the public health and are necessary for
the operation of the emergency telephone system. The governing body is
hereby authorized to levy the tax in an amount not to exceed fifteen
percent of the tariff local service rate, as defined in section 190.300,
or seventy-five cents per access line per month, whichever is greater,
except as provided in sections 190.325 to 190.329, in those portions of
the governing body's jurisdiction for which emergency telephone service
has been contracted. In any county of the third classification with a
population of at least thirty-two thousand but not greater than forty
thousand that borders a county of the first classification, a governing
body of a third or fourth class city may, with the consent of the county
commission, contract for service with a public agency to provide services
within the public agency's jurisdiction when such city is located wholly
within the jurisdiction of the public agency. Consent shall be
demonstrated by the county commission authorizing an election within the
public agency's jurisdiction pursuant to section 190.320. Any contract
between governing bodies and public agencies in existence on August 28,
1996, that meets such criteria prior to August 28, 1996, shall be
recognized if the county commission authorized the election for emergency
telephone service and a vote was held as provided in section 190.320. The
governing body shall provide for a board pursuant to sections 190.327 and
190.328.

2. The tax shall be utilized to pay for the operation of emergency
telephone service and the operational costs associated with the answering
and dispatching of emergency calls as deemed appropriate by the governing
body, and may be levied at any time subsequent to execution of a contract
with the provider of such service at the discretion of the governing
body, but collection of such tax shall not begin prior to twenty-seven
months before operation of the emergency telephone service and dispatch
center.

3. Such tax shall be levied only upon the tariff rate. No tax shall be
imposed upon more than one hundred exchange access facilities or their
equivalent per person per location.

4. Every billed service user is liable for the tax until it has been paid
to the service supplier.

5. The duty to collect the tax from a service user shall commence at such
time as specified by the governing body in accordance with the provisions
of sections 190.300 to 190.320. The tax required to be collected by the
service supplier shall be added to and may be stated separately in the
billings to the service user.

6. Nothing in this section imposes any obligation upon a service supplier
to take any legal action to enforce the collection of the tax imposed by
this section. The service supplier shall provide the governing body with
a list of amounts uncollected along with the names and addresses of the
service users refusing to pay the tax imposed by this section, if any.

7. The tax imposed by this section shall be collected insofar as
practicable at the same time as, and along with, the charges for the
tariff rate in accordance with the regular billing practice of the
service supplier. The tariff rates determined by or stated on the billing
of the service supplier are presumed to be correct if such charges were
made in accordance with the service supplier's business practices. The
presumption may be rebutted by evidence which establishes that an
incorrect tariff rate was charged. (L. 1981 H.B. 437 § 2, A.L. 1986 H.B.
1268, A.L. 1990 H.B. 951, A.L. 1993 H.B. 910 merged with S.B. 157 & 29,
A.L. 1994 S.B. 700, A.L. 1996 H.B. 1097, A.L. 1997 H.B. 249)

No provision in this chapter shall be construed to require any
municipality within any county of the third classification without a
township form of government and with more than fifty-four thousand two
hundred but less than fifty-four thousand three hundred inhabitants that
has established an emergency telephone service to dissolve the service in
the event that the county in which the municipality is located
establishes an emergency telephone service and moves to a higher county
classification. (L. 2004 H.B. 795, et al.)

1. No public agency or public safety agency, nor any officer,
agent or employee of any public agency, shall be liable for any civil
damages as a result of any act or omission except willful and wanton
misconduct or gross negligence, in connection with developing, adopting,
operating or implementing any plan or system required by sections 190.300
to 190.340.

2. No person who gives emergency instructions through a system
established pursuant to sections 190.300 to 190.340 to persons rendering
services in an emergency at another location, nor any persons following
such instructions in rendering such services, shall be liable for any
civil damages as a result of issuing or following the instructions,
unless issuing or following the instructions constitutes willful and
wanton misconduct, or gross negligence. (L. 1990 H.B. 951, A.L. 1999 H.B.
268 merged with S.B. 436)

(2005) Section supercedes the common law official immunity doctrine for
certain individuals and agencies and provides qualified immunity allowing
civil liability only where gross negligence can be established. State ex
rel. Golden v. Crawford, 165 S.W.3d 147 (Mo.banc).

1. In any county that has established an emergency telephone
service pursuant to sections 190.300 to 190.320, it shall be unlawful for
any person to misuse the emergency telephone service. For the purposes of
this section, "emergency" means any incident involving danger to life or
property that calls for an emergency response dispatch of police, fire,
EMS or other public safety organization, "misuse the emergency telephone
service", includes, but is not limited to, repeatedly calling the "911"
for nonemergency situations causing operators or equipment to be in use
when emergency situations may need such operators or equipment and
"repeatedly" means three or more times within a one-month period.

2. Any violation of this section is a class B misdemeanor. (L. 1996 H.B.
1304, A.L. 1997 H.B. 95 merged with S.B. 133)

1. Any county may establish an "Emergency Telephone Service 911
Board", referred to in this section as the "board". The powers and duties
of the board may be defined by order or ordinance of the county. Such
powers shall include, but not be limited to:

(1) Planning a 911 system;

(2) Coordinating and supervising the implementation, upgrading, or
maintenance of the system, including the establishment of equipment
specifications and coding systems;

(3) Receiving moneys from any emergency telephone service tax levy
authorized by the governing body of the county pursuant to section
190.305, and authorizing disbursements from such moneys collected;

(4) Hiring any staff necessary for the implementation or upgrade of the
system.

2. Members of the board shall be appointed by the governing body of the
county, and shall be known as the board of directors of the emergency
service telephone 911 board. The governing body shall appoint eleven
persons to the board. At least six of such members shall represent public
safety agencies. At least nine of the board members shall be residents of
the county described in subsection 1 of this section or a county
adjoining such county. All board members shall be appointed to serve for
a term of three years, except that of the first board appointed, five
members shall be appointed for one-year terms, three members for two-year
terms and three members for three-year terms. Board members may be
reappointed. The members of the board shall not receive compensation for
their services, but may be reimbursed for their actual and necessary
expenses.

3. The administrative control and management of the county emergency
telephone 911 service shall rest solely with the board, and the board
shall employ all necessary personnel, fix their compensation, and provide
suitable quarters and equipment for the operation of the facility from
funds made available for this purpose. Employees of the board shall be
eligible for membership in the Missouri local government employees'
retirement system pursuant to sections 70.600 to 70.755, RSMo.

4. The board may contract to provide services relating in whole or in
part to emergency telephone 911 service and for such purpose may expend
the tax funds or other funds.

5. The board shall elect a chairman, vice chairman, treasurer, and such
other officers as it deems necessary for its membership. Before taking
office, the treasurer shall furnish a surety bond, in an amount to be
determined and in a form to be approved by the board, for the faithful
performance of the treasurer's duties and faithful accounting of all
moneys that may come into the treasurer's hands. The treasurer shall
enter into the surety bond with a surety company authorized to do
business in Missouri, and the cost of such bond shall be paid by the
board.

6. The board shall set rules for establishment and operation of the
emergency 911 system, and shall do all other things necessary to carry
out the purposes of sections 190.300 to 190.320.

7. The board may contract with any not-for-profit corporation including
any corporation which is incorporated for the purpose of implementing the
provisions of sections 190.300 to 190.320.

8. The board may accept any gift of property or money for the use and
benefit of the emergency telephone 911 service in the county, and the
board is authorized to sell or exchange any such property which the board
believes would be to the benefit of the service so long as the proceeds
are used exclusively for emergency telephone services. The board shall
have exclusive control of all gifts, property or money the board may
accept; of all interest or other proceeds which may accrue from the
investment of such gifts or money or from the sale of such property; of
all tax revenues collected by the county on behalf of the emergency
telephone 911 services; and of all other funds granted, appropriated, or
loaned to the board by the federal government, the state, or its
political subdivisions so long as these resources are used solely to
benefit the emergency telephone service in the county.

9. Any board member may, following notice and an opportunity to be heard,
be removed from office by a majority vote of the other members of the
board for any of the following grounds:

(1) Failure to attend five consecutive meetings, without good cause;

(2) Conduct prejudicial to the good order and efficient operation of the
emergency telephone service; or

(3) Neglect of duty.

10. The chairman of the board shall preside at such removal hearing,
unless the chairman is the person sought to be removed, in which case the
hearing shall be presided over by another member elected by the majority
vote of the other board members. All interested parties may present
testimony and arguments at such hearing, and the witnesses shall be sworn
by oath or affirmation before testifying. Any interested party may, at
his or her own expense, record the proceedings.

11. Vacancies on the board occasioned by removals, resignations or
otherwise shall be reported by the board chairman to the governing body
of the county and shall be filled in like manner as original
appointments; except that, if the vacancy occurs during an unexpired
term, the appointment shall be for only the unexpired portion of that
term.

12. Individual board members shall not be eligible for employment by the
board within twelve months of termination of service as a member of the
board.

13. No person shall be employed by the board who is related within the
fourth degree of* consanguinity or affinity to any member of the board.
(L. 1995 H.B. 452, et al., A.L. 1996 H.B. 766, A.L. 1997 H.B. 816)

*Word "of" does not appear in original rolls.

1. The tax imposed by sections 190.300 to 190.320 and the
amounts required to be collected are due quarterly. The amount of tax
collected in one calendar quarter by the service supplier shall be
remitted to the governing body no later than sixty days after the close
of a calendar quarter. On or before the sixtieth day of each calendar
quarter following, a return for the preceding quarter shall be filed with
the governing body in such form as the governing body and service
supplier shall agree. The service supplier will include the list of any
service user refusing to pay the tax imposed by sections 190.300 to
190.320 with each return filing. The service supplier required to file
the return shall deliver the return, together with a remittance of the
amount of the tax collected under the provisions of sections 190.300 to
190.320. The records shall be maintained for a period of one year from
the time the tax is collected.

2. From every remittance to the governing body made on or before the date
when the same becomes due, the service supplier required to remit the
same shall be entitled to deduct and retain, as a collection fee, an
amount equal to two percent thereof.

3. At least once each calendar year, the governing body shall establish a
tax rate, not to exceed the amount authorized, that together with any
surplus revenues carried forward will produce sufficient revenues to fund
the expenditures authorized by sections 190.300 to 190.320. Amounts
collected in excess of that necessary within a given year shall be
carried forward to subsequent years. The governing body shall make its
determination of such tax rate each year no later than September first
and shall fix the new rate which shall be collected as provided in
sections 190.300 to 190.320. Immediately upon making its determination
and fixing the rate, the governing body shall publish in its minutes the
new rate, and it shall notify by mail every service supplier registered
with it of the new rate. The governing body may require an audit of the
service supplier's books and records concerning the collection and
remittance of the tax authorized by sections 190.300 to 190.320. (L. 1981
H.B. 437 § 3, A.L. 1990 H.B. 951)

Effective 6-12-90

Any governing body imposing the tax authorized herein may
contract directly with the provider of the emergency telephone service or
may contract and cooperate with any public agency or with other states or
their political subdivisions or with any association or corporation for
the administration of emergency telephone service as provided by law. (L.
1981 H.B. 437 § 4, A.L. 1986 H.B. 1268)

Before any governing body may establish emergency telephone
service and impose an emergency telephone tax under the provisions of
sections 190.300 to 190.320, it shall submit a proposal to its voters for
the approval of such service and such tax. The ballot of submission shall
contain, but need not be limited to, the following language:

May the (City, County) of . . . . . . . establish an emergency telephone
service and impose a telephone tax to finance such service?

Yes

No

The initial tax imposed shall be . . . . . . . (Here the governing body
in 25 words or less shall describe the tax per telephone per year or any
other wording which will give the voter an approximation of what the tax
will cost the taxpayer.) If a majority of the votes cast on the proposal
by the qualified voters voting thereon are in favor of the proposal, then
the governing body may establish the service and impose the tax allowed
by the provisions of sections 190.300 to 190.320. If a majority of the
votes cast on the proposal by the qualified voters voting thereon are
opposed to the proposal, then the governing body submitting the proposal
shall not be allowed to implement the provisions of sections 190.300 to
190.320 until it has again submitted such proposal to its qualified
voters and a majority of the votes cast are in favor of the proposal. (L.
1981 H.B. 437 § 5)

1. In any county of the first classification without a charter
form of government with a population of at least one hundred fifty
thousand inhabitants but less than two hundred thousand inhabitants, the
county commission may use all or a part of the moneys derived from the
emergency telephone tax authorized pursuant to section 190.305 for
central dispatching of fire protection, emergency ambulance service or
any other emergency services, which may include the purchase and
maintenance of communications and emergency equipment. In the event such
commission chooses to use the tax provided in that section for such
services, the provisions of sections 190.300 to 190.320 shall apply
except as provided in this section.

2. The tax shall not exceed a percentage of the base tariff rate and such
percentage shall not exceed an amount equal to a maximum rate of one
dollar thirty cents per line per month, the provisions of section 190.305
to the contrary notwithstanding. The tax imposed by this section and the
amounts required to be collected are due monthly. The amount of tax
collected in one calendar month by the service supplier shall be remitted
to the governing body no later than one month after the close of a
calendar month. On or before the last day of each calendar month, a
return for the preceding month shall be filed with the governing body in
such form as the governing body and service supplier shall agree. The
service supplier shall include the list of any service user refusing to
pay the tax imposed by this section with each return filing. The service
supplier required to file the return shall deliver the return, together
with a remittance of the amount of the tax collected. The records shall
be maintained for a period of one year from the time the tax is
collected. From every remittance to the governing body made on or before
the date when the same becomes due, the service supplier required to
remit the same shall be entitled to deduct and retain, as a collection
fee, an amount equal to two percent thereof.

3. Nothing in this section shall be construed to require any municipality
or other political subdivision to join the central dispatching system
established pursuant to this section. The governing body of any
municipality or other political subdivision may contract with the board
established pursuant to section 190.327 for such services or portion of
such services, or for the purchase and maintenance of communication and
emergency equipment. (L. 1990 H.B. 951 § 1 subsec. 1, A.L. 1993 H.B. 910)

1. Immediately upon the decision by the commission to utilize a
portion of the emergency telephone tax for central dispatching and an
affirmative vote of the telephone tax, the commission shall appoint the
initial members of a board which shall administer the funds and oversee
the provision of central dispatching for emergency services in the county
and in municipalities and other political subdivisions which have
contracted for such service. Beginning with the general election in 1992,
all board members shall be elected according to this section and other
applicable laws of this state. At the time of the appointment of the
initial members of the board, the commission shall relinquish to the
board and no longer exercise the duties prescribed in this chapter with
regard to the provision of emergency telephone service and in chapter
321, RSMo, with regard to the provision of central dispatching service,
and such duties shall be exercised by the board.

2. Elections for board members may be held on general municipal election
day, as defined in subsection 3 of section 115.121, RSMo, after approval
by a simple majority of the county commission.

3. For the purpose of providing the services described in this section,
the board shall have the following powers, authority and privileges:

(1) To have and use a corporate seal;

(2) To sue and be sued, and be a party to suits, actions and proceedings;

(3) To enter into contracts, franchises and agreements with any person,
partnership, association or corporation, public or private, affecting the
affairs of the board;

(4) To acquire, construct, purchase, maintain, dispose of and encumber
real and personal property, including leases and easements;

(5) To have the management, control and supervision of all the business
affairs of the board and the construction, installation, operation and
maintenance of any improvements;

(6) To hire and retain agents and employees and to provide for their
compensation including health and pension benefits;

(7) To adopt and amend bylaws and any other rules and regulations;

(8) To fix, charge and collect the taxes and fees authorized by law for
the purpose of implementing and operating the services described in this
section;

(9) To pay all expenses connected with the first election and all
subsequent elections; and

(10) To have and exercise all rights and powers necessary or incidental
to or implied from the specific powers granted in this subsection. Such
specific powers shall not be considered as a limitation upon any power
necessary or appropriate to carry out the purposes and intent of sections
190.300 to 190.329. (L. 1990 H.B. 951 § 1 subsec. 2, A.L. 1995 H.B. 452,
et al., A.L. 1996 S.B. 532)

1. Beginning in 1997, within the area from which voters and the
commission have approved the provision of central dispatching for
emergency services by a public agency for an area containing third or
fourth class cities in counties of the third classification with a
population of at least thirty-two thousand but no greater than forty
thousand that border a county of the first classification but do not
border the Mississippi River, the initial board shall consist of two
members from each township within such area and one at-large member who
shall serve as the initial chairperson of such board.

2. Within the area from which voters and the commission have approved the
provision of central dispatching for emergency services by a public
agency for an area containing third or fourth class cities in counties of
the third classification with a population of at least thirty-two
thousand but no greater than forty thousand that border a county of the
first classification, voters shall elect a board to administer funds and
oversee the provision of central dispatching for emergency services. Such
board shall consist of two members elected from each of the townships
within such area and one member elected at large who shall serve as the
chairperson of the board.

3. Of those initially elected to the board as provided in this section,
four from the townships shall be elected to a term of two years, and four
from the townships and the at-large member shall be elected to a term of
four years. Upon the expiration of these initial terms, all members shall
thereafter be elected to terms of four years. (L. 1997 H.B. 249)

1. Except in areas from which voters and the commission have
approved the provision of central dispatching for emergency services by a
public agency for an area containing third or fourth class cities located
in counties of the third classification with a population of at least
thirty-two thousand but no greater than forty thousand that border a
county of the first classification but do not border the Mississippi
River, the initial board shall consist of seven members appointed without
regard for political party who shall be selected from and shall represent
the fire protection districts, ambulance districts, sheriff's department,
municipalities, any other emergency services and the general public. This
initial board shall serve until its successor board is duly elected and
installed in office. The commission shall ensure geographic
representation of the county by appointing no more than four members from
any one commission district of the county.

2. Beginning in 1992, three members shall be elected from each commission
district and one member shall be elected at large, with such at-large
member to be a voting member and chairman of the board. Of those first
elected, four members from commission districts shall be elected for
terms of two years and two members from commission districts and the
member at large shall be elected for terms of four years. In 1994, and
thereafter, all terms of office shall be for four years, except as
provided in subsection 3 of this section. Any vacancy on the board shall
be filled in the same manner as the initial appointment was made. Four
members shall constitute a quorum.

3. Upon approval by the county commission for the election of board
members to be held on general municipal election day, pursuant to
subsection 2 of section 190.327, the terms of those board members then
holding office shall be reduced by seven months. After a board member's
term has been reduced, all following terms for that position shall be for
four years. (L. 1990 H.B. 951 § 1 subsecs. 3, 4, A.L. 1995 H.B. 452, et
al., A.L. 1996 S.B. 532, A.L. 1997 H.B. 249)

1. In lieu of the tax levy authorized under section 190.305 for
emergency telephone services, the county commission of any county may
impose a county sales tax for the provision of central dispatching of
fire protection, including law enforcement agencies, emergency ambulance
service or any other emergency services, including emergency telephone
services, which shall be collectively referred to herein as "emergency
services", and which may also include the purchase and maintenance of
communications and emergency equipment, including the operational costs
associated therein, in accordance with the provisions of this section.

2. Such county commission may, by a majority vote of its members, submit
to the voters of the county, at a public election, a proposal to
authorize the county commission to impose a tax under the provisions of
this section. If the residents of the county present a petition signed by
a number of residents equal to ten percent of those in the county who
voted in the most recent gubernatorial election, then the commission
shall submit such a proposal to the voters of the county.

3. The ballot of submission shall be in substantially the following form:

Shall the county of ............................... (insert name of
county) impose a county sales tax of ............ (insert rate of
percent) percent for the purpose of providing central dispatching of fire
protection, emergency ambulance service, including emergency telephone
services, and other emergency services?

[ ] YES [ ] NO

If a majority of the votes cast on the proposal by the qualified voters
voting thereon are in favor of the proposal, then the ordinance shall be
in effect as provided herein. If a majority of the votes cast by the
qualified voters voting are opposed to the proposal, then the county
commission shall have no power to impose the tax authorized by this
section unless and until the county commission shall again have submitted
another proposal to authorize the county commission to impose the tax
under the provisions of this section, and such proposal is approved by a
majority of the qualified voters voting thereon.

4. The sales tax may be imposed at a rate not to exceed one percent on
the receipts from the sale at retail of all tangible personal property or
taxable services at retail within any county adopting such tax, if such
property and services are subject to taxation by the state of Missouri
under the provisions of sections 144.010 to 144.525, RSMo. The sales tax
shall not be collected prior to thirty-six months before operation of the
central dispatching of emergency services.

5. Except as modified in this section, all provisions of sections 32.085
and 32.087, RSMo, shall apply to the tax imposed under this section.

6. Any tax imposed pursuant to section 190.305 shall terminate at the end
of the tax year in which the tax imposed pursuant to this section for
emergency services is certified by the board to be fully operational. Any
revenues collected from the tax authorized under section 190.305 shall be
credited for the purposes for which they were intended.

7. At least once each calendar year, the governing body shall establish a
tax rate, not to exceed the amount authorized, that together with any
surplus revenues carried forward will produce sufficient revenues to fund
the expenditures authorized by this act. Amounts collected in excess of
that necessary within a given year shall be carried forward to subsequent
years. The governing body shall make its determination of such tax rate
each year no later than September first and shall fix the new rate which
shall be collected as provided in this act. Immediately upon making its
determination and fixing the rate, the governing body shall publish in
its minutes the new rate, and it shall notify every retailer by mail of
the new rate.

8. Immediately upon the affirmative vote of voters of such a county on
the ballot proposal to establish a county sales tax pursuant to the
provisions of this section, the county commission shall appoint the
initial members of a board to administer the funds and oversee the
provision of emergency services in the county. Beginning with the general
election in 1994, all board members shall be elected according to this
section and other applicable laws of this state. At the time of the
appointment of the initial members of the board, the commission shall
relinquish and no longer exercise the duties prescribed in this chapter
with regard to the provision of emergency services and such duties shall
be exercised by the board.

9. The initial board shall consist of seven members appointed without
regard to political affiliation, who shall be selected from, and who
shall represent, the fire protection districts, ambulance districts,
sheriff's department, municipalities, any other emergency services and
the general public. This initial board shall serve until its successor
board is duly elected and installed in office. The commission shall
ensure geographic representation of the county by appointing no more than
four members from each district of the county commission.

10. Beginning in 1994, three members shall be elected from each district
of the county commission and one member shall be elected at large, such
member to be the chairman of the board. Of those first elected, four
members from districts of the county commission shall be elected for
terms of two years and two members from districts of the county
commission and the member at large shall be elected for terms of four
years. In 1996, and thereafter, all terms of office shall be four years.

11. Notwithstanding the provisions of subsections 8 to 10 of this section
to the contrary, in any county of the first classification with more than
two hundred forty thousand three hundred but fewer than two hundred forty
thousand four hundred inhabitants, any emergency telephone service 911
board appointed by the county under section 190.309 which is in existence
on the date the voters approve a sales tax under this section shall
continue to exist and shall have the powers set forth under section
190.339. (L. 1993 S.B. 157 & 29 § 1, A.L. 1996 H.B. 1460, A.L. 2005 H.B.
58)

1. The sales tax established by a county according to the
provisions of section 190.335 shall be permanent and revenues from it
shall be disbursed only for the purposes for which it was collected. Upon
receipt of a petition signed by a number of voters in the county equal to
ten percent of the number of voters in the county who voted in the most
recent gubernatorial election requesting the submission of the question
of continuation or termination, the county commission in any county which
has adopted the sales tax as a means of paying for emergency services in
lieu of financing such services through taxes as provided in section
190.305, shall submit to the voters of the county the question to
continue or to terminate the sales tax.

2. The question shall be submitted in the following form:

Shall the county of ............ (insert name of county) continue to
impose a county sales tax of ............ (insert rate of percent)
percent for the purpose of providing central dispatching of fire
protection, emergency ambulance, or emergency telephone, services?

YES NO

3. If a majority of those voting on the question vote "YES" for
continuation, the sales tax shall be continued unless and until
terminated by a vote of the qualified voters voting thereon; if a
majority of those voting on the question vote "NO" for the termination of
the sales tax, the county commission shall declare the sales tax
terminated effective the first day of the second calendar quarter
following notification to the director of revenue that the tax has been
repealed and shall discharge any board appointed pursuant to section
190.335. Any order adopted by the board shall be void and of no effect
from and after the termination of the sales tax.

4. If the majority of the voters vote "NO" pursuant to subsection 3 of
this section, the emergency services shall be deemed to have been
terminated. Such emergency services may be reestablished in the county
pursuant to the provisions of section 190.305. (L. 1993 S.B. 157 & 29 § 2)

1. The powers and duties of the emergency services board shall
include, but not be limited to:

(1) Planning a 911 system and dispatching system;

(2) Coordinating and supervising the implementation, upgrading or
maintenance of the system, including the establishment of equipment
specifications and coding systems;

(3) Receiving money from any county sales tax authorized to be levied
pursuant to section 190.335 and authorizing disbursements from such
moneys collected;

(4) Hiring any staff necessary for the implementation, upgrade or
operation of the system.

2. The administrative control and management of the moneys from any
county sales tax authorized to be levied pursuant to section 190.335 and
the administrative control and management of the central dispatching of
emergency services shall rest solely with the board, and the board shall
employ all necessary personnel, affix their compensation and provide
suitable quarters and equipment for the operation of the central
dispatching of emergency services from the funds available for this
purpose.

3. The board may contract to provide services relating in whole or in
part to central dispatching of emergency services and for such purpose
may expend the tax funds or other funds.

4. The board shall elect a vice chairman, treasurer, secretary and such
other officers as it deems necessary. Before taking office, the treasurer
shall furnish a surety bond in an amount to be determined and in a form
to be approved by the board for the faithful performance of the
treasurer's duties and faithful accounting of all moneys that may come
into the treasurer's hands. The treasurer shall enter into the surety
bond with a surety company authorized to do business in Missouri, and the
cost of such bond shall be paid by the board of directors.

5. The board may accept any gift of property or money for the use and
benefit of the central dispatching of emergency services, and the board
is authorized to sell or exchange any such property which it believes
would be to the benefit of the service so long as the proceeds are used
exclusively for central dispatching of emergency services. The board
shall have exclusive control of all gifts, property or money it may
accept; of all interest of other proceeds which may accrue from the
investment of such gifts or money or from the sale of such property; of
all tax revenues collected by the county on behalf of the central
dispatching of emergency services; and of all other funds granted,
appropriated or loaned to it by the federal government, the state or its
political subdivisions so long as such resources are used solely to
benefit the central dispatching of emergency services.

6. Any board member may, following notice and an opportunity to be heard,
be removed from any office by a majority vote of the other members of the
board for any of the following reasons:

(1) Failure to attend five consecutive meetings, without good cause;

(2) Conduct prejudicial to the good order and efficient operation of the
central dispatching of emergency services; or

(3) Neglect of duty.

7. The chairperson of the board shall preside at such removal hearing,
unless the chairperson is the person sought to be removed, in which case
the hearing shall be presided over by another member elected by a
majority vote of the other board members. All interested parties may
present testimony and arguments at such hearing, and the witnesses shall
be sworn in by oath or affirmation before testifying. Any interested
party may, at his or her own expense, record the proceedings.

8. Vacancies on the board occasioned by removals, resignations or
otherwise, shall be filled by the remaining members of the board. The
appointee or appointees shall act until the next election at which a
director or directors are elected to serve the remainder of the unexpired
term.

9. Individual board members shall not be eligible for employment by the
board within twelve months of termination of service as a member of the
board.

10. No person shall be employed by the board who is related within the
fourth degree by blood or by marriage to any member of the board. (L.
1996 H.B. 1460)

1. It shall be the duty of the chairperson to preside at all
board meetings, to act as official head of the emergency services board
and to execute all contracts required to be executed by the board. In the
absence and disability of the chairperson, the vice chairperson shall
assume the duties of the chairperson.

2. The secretary shall keep the official records of the meetings of the
board, shall attest all official documents with the seal of the board,
shall, when called upon, make reports pertaining to the business of the
secretary's office, attend the board meetings and perform such other
duties as may be imposed upon the secretary by the provisions of sections
190.335 to 190.342 and the rules of the board.

3. The treasurer shall be the custodian of the funds of the board and pay
money out of the treasury only upon valid checks or drafts drawn on the
treasury.

4. The board may, from time to time, provide for additional rules and
regulations concerning the duties of its officers. (L. 1996 H.B. 1460)

1. The "Advisory Committee on Poison Control" is hereby created
within the department of health and senior services.

2. The committee shall consist of nine members, as follows:

(1) The director of the department of health and senior services or his
designee;

(2) One health care professional with demonstrated ability and experience
in the area of poison from each of the seven federally designated
emergency medical services areas in this state. Such members shall be
appointed by the governing body of each area, or, in cases where no
governing body has been formed, by the director of the department of
health and senior services, and shall serve terms of four years; and

(3) The director of the Missouri poison information center established
pursuant to section 190.353.

3. The committee shall meet within ten days after September 28, 1985, and
organize by selecting a chairman and vice chairman. A majority of the
members shall constitute a quorum.

4. The members of the committee shall serve without compensation, but
shall be reimbursed for actual and necessary expenses incurred in the
performance of their official duties. (L. 1985 H.B. 435 § 1)

1. The advisory committee on poison control shall:

(1) Provide for the establishment of a "Missouri Regional Poison
Information Center" capable of providing the services described in
subsection 3 of this section based on the best demonstrated ability to
perform such services as evidenced by past performance of such services
and by current certification as a regional poison control center by the
American Association of Poison Control Centers;

(2) Provide for the establishment of a "Missouri Poison Control Network"
to consist of poison prevention and treatment centers throughout the
state of Missouri, representing all federally designated emergency
medical services areas;

(3) Establish policies for data collection at poison treatment centers
and procedures for the medical treatment of victims of poisoning and
overdose;

(4) Develop a systematic plan for the statewide education of the general
public and health care professionals on the control and proper use of
poisonous substances and the treatment of poison victims;

(5) Cooperate with the Missouri poison information center in systems
evaluation and in review of morbidity and mortality rates among poison
victims; and

(6) Fund educational programs at area poison treatment centers for the
general public and for health care professionals.

2. The committee shall submit an annual report to the presiding officers
of each house of the general assembly and the department of health and
senior services concerning the administration of the Missouri poison
control network, and shall cooperate with the department of health and
senior services for the purpose of providing data for health planning.

3. The Missouri poison information center shall provide:

(1) A twenty-four hour toll-free telephone referral and information
service for the general public and health care professionals, supervised
by a physician who is board-certified in the field of clinical toxicology
and staffed by licensed professionals who are certified as information
specialists or whose certification is pending, according to the
requirements of the American Association of Poison Control Centers;

(2) Design and coordination of appropriate public and professional
education services in the area of poison treatment and prevention;

(3) Plans for cooperation between the Missouri poison control network and
health and emergency service agencies and associations involved in poison
control activities;

(4) Program evaluation and systematic data collection on poison exposures
in cooperation with the department of health and senior services; and

(5) Coordination of poison control, treatment, and education activities
of poison prevention and treatment centers. (L. 1985 H.B. 435 § 2)

The advisory committee on poison control may contract for
services from such private persons, agencies, and corporations as are
necessary to fully effectuate the purposes of sections 190.350 to
190.355, and shall fully utilize existing institutions and services for
the control and treatment of poisons. (L. 1985 H.B. 435 § 3)

As used in sections 190.400 to 190.440, the following words and
terms shall mean:

(1) "911", the primary emergency telephone number within the wireless
system;

(2) "Board", the wireless service provider enhanced 911 advisory board;

(3) "Public safety agency", a functional division of a public agency
which provides fire fighting, police, medical or other emergency
services. For the purpose of providing wireless service to users of 911
emergency services, as expressly provided in this section, the department
of public safety and state highway patrol shall be considered a public
safety agency;

(4) "Public safety answering point", the location at which 911 calls are
initially answered;

(5) "Wireless service provider", a provider of commercial mobile service
pursuant to Section 332(d) of the Federal Telecommunications Act of 1996
(47 U.S.C. Section 151 et seq). (L. 1998 S.B. 743)

Effective 7-2-98

1. There is hereby created in the department of public safety
the "Wireless Service Provider Enhanced 911 Advisory Board", consisting
of eight members as follows:

(1) The director of the department of public safety or the director's
designee who shall hold a position of authority in such department of at
least a division director;

(2) The chairperson of the public service commission or the chairperson's
designee; except that such designee shall be a commissioner of the public
service commission or hold a position of authority in the commission of
at least a division director;

(3) Three representatives and one alternate from the wireless service
providers, elected by a majority vote of wireless service providers
licensed to provide service in this state; and

(4) Three representatives from public safety answering point
organizations, elected by the members of the state chapter of the
associated public safety communications officials and the state chapter
of the National Emergency Numbering Association.

2. Immediately after the board is established the initial term of
membership for a member elected pursuant to subdivision (3) of subsection
1 of this section shall be one year and all subsequent terms for members
so elected shall be two years. The membership term for a member elected
pursuant to subdivision (4) of subsection 1 of this section shall
initially and subsequently be two years. Each member shall serve no more
than two successive terms unless the member is on the board pursuant to
subdivision (1) or (2) of subsection 1 of this section. Members of the
board shall serve without compensation, however, the members may receive
reimbursement of actual and necessary expenses. Any vacancies on the
board shall be filled in the manner provided for in this subsection.

3. The board shall do the following:

(1) Elect from its membership a chair and other such officers as the
board deems necessary for the conduct of its business;

(2) Meet at least one time per year for the purpose of discussing the
implementation of Federal Communications Commission order 94-102;

(3) Advise the office of administration regarding implementation of
Federal Communications Commission order 94-102; and

(4) Provide any requested mediation service to a political subdivision
which is involved in a jurisdictional dispute regarding the providing of
wireless 911 services. The board shall not supersede decision-making
authority of any political subdivision in regard to 911 services.

4. The director of the department of public safety shall provide and
coordinate staff and equipment services to the board to facilitate the
board's duties. (L. 1998 S.B. 743)

Effective 7-2-98

1. There is hereby established in the state treasury a fund to
be known as the "Wireless Service Provider Enhanced 911 Service Fund".
All fees collected pursuant to sections 190.400 to 190.440 by wireless
service providers shall be remitted to the director of the department of
revenue. The director shall remit such payments to the state treasurer.

2. The state treasurer shall deposit such payments into the wireless
service provider enhanced 911 service fund. Moneys in the fund shall be
used for the purpose of reimbursing expenditures actually incurred in the
implementation and operation of the wireless service provider enhanced
911 system.

3. Any unexpended balance in the fund shall be exempt from the provisions
of section 33.080, RSMo, relating to the transfer of unexpended balances
to the general revenue fund, and shall remain in the fund. Any interest
earned on the moneys in the fund shall be deposited into the fund. (L.
1998 S.B. 743)

Effective 7-2-98

1. The commissioner of the office of administration is
authorized to establish a fee, if approved by the voters pursuant to
section 190.440, not to exceed fifty cents per wireless telephone number
per month to be collected by wireless service providers from wireless
service customers.

2. The office of administration shall promulgate rules and regulations to
administer the provisions of sections 190.400 to 190.440. Any rule or
portion of a rule, as that term is defined in section 536.010, RSMo, that
is promulgated pursuant to the authority delegated in sections 190.400 to
190.440 shall become effective only if it has been promulgated pursuant
to the provisions of chapter 536, RSMo. All rulemaking authority
delegated prior to July 2, 1998, is of no force and effect and repealed;
however, nothing in this section shall be interpreted to repeal or affect
the validity of any rule filed or adopted prior to July 2, 1998, if it
fully complied with the provisions of chapter 536, RSMo. This section and
chapter 536, RSMo, are nonseverable and if any of the powers vested with
the general assembly pursuant to chapter 536, RSMo, 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 July 2, 1998, shall be invalid and void.

3. The office of administration is authorized to administer the fund and
to distribute the moneys in the wireless service provider enhanced 911
service fund for approved expenditures as follows:

(1) For the reimbursement of actual expenditures for implementation of
wireless enhanced 911 service by wireless service providers in
implementing Federal Communications Commission order 94-102; and

(2) To subsidize and assist the public safety answering points based on a
formula established by the office of administration, which may include,
but is not limited to the following:

(a) The volume of wireless 911 calls received by each public safety
answering point;

(b) The population of the public safety answering point jurisdiction;

(c) The number of wireless telephones in a public safety answering point
jurisdiction by zip code; and

(d) Any other criteria found to be valid by the office of administration
provided that of the total amount of the funds used to subsidize and
assist the public safety answering points, at least ten percent of said
funds shall be distributed equally among all said public safety answering
points providing said services under said section;

(3) For the reimbursement of actual expenditures for equipment for
implementation of wireless enhanced 911 service by public safety
answering points to the extent that funds are available, provided that
ten percent of funds distributed to public safety answering points shall
be distributed in equal amounts to each public safety answering point
participating in enhanced 911 service;

(4) Notwithstanding any other provision of the law, no proprietary
information submitted pursuant to this section shall be subject to
subpoena or otherwise released to any person other than to the submitting
wireless service provider, without the express permission of said
wireless service provider. General information collected pursuant to this
section shall only be released or published in aggregate amounts which do
not identify or allow identification of numbers of subscribers or
revenues attributable to an individual wireless service provider.

4. Wireless service providers are entitled to retain one percent of the
surcharge money they collect for administrative costs associated with
billing and collection of the surcharge.

5. No more than five percent of the moneys in the fund, subject to
appropriation by the general assembly, shall be retained by the office of
administration for reimbursement of the costs of overseeing the fund and
for the actual and necessary expenses of the board.

6. The office of administration shall review the distribution formula
once every year and may adjust the amount of the fee within the limits of
this section, as determined necessary.

7. The provisions of sections 190.307 and 190.308 shall be applicable to
programs and services authorized by sections 190.400 to 190.440.

8. Notwithstanding any other provision of the law, in no event shall any
wireless service provider, its officers, employees, assigns or agents, be
liable for any form of civil damages or criminal liability which directly
or indirectly result from, or is caused by, an act or omission in the
development, design, installation, operation, maintenance, performance or
provision of 911 service or other emergency wireless two- and three-
digit wireless numbers, unless said acts or omissions constitute gross
negligence, recklessness or intentional misconduct. Nor shall any
wireless service provider, its officers, employees, assigns, or agents be
liable for any form of civil damages or criminal liability which directly
or indirectly result from, or is caused by, the release of subscriber
information to any governmental entity as required under the provisions
of this act* unless the release constitutes gross negligence,
recklessness or intentional misconduct. (L. 1998 S.B. 743)

Effective 7-2-98

*"This act" (S.B. 743, 1998) contained numerous sections. Consult
Disposition of Sections table for a definitive listing.

1. The office of administration shall not be authorized to
establish a fee pursuant to the authority granted in section 190.430
unless a ballot measure is submitted and approved by the voters of this
state. The ballot measure shall be submitted by the secretary of state
for approval or rejection at the general election held and conducted on
the Tuesday immediately following the first Monday in November, 1998, or
at a special election to be called by the governor on the ballot measure.
If the measure is rejected at such general or special election, the
measure may be resubmitted at each subsequent general election, or may be
resubmitted at any subsequent special election called by the governor on
the ballot measure, until such measure is approved.

2. The ballot of the submission shall contain, but is not limited to, the
following language:

Shall the Missouri Office of Administration be authorized to establish a
fee of up to fifty cents per month to be charged every wireless telephone
number for the purpose of funding wireless enhanced 911 service?

[ ] YES [ ] NO

If you are in favor of the question, place an "X" in the box opposite
"Yes". If you are opposed to the question, place an* "X" in the box
opposite "No".

3. If a majority of the votes cast on the ballot measure by the qualified
voters voting thereon are in favor of such measure, then the office of
administration shall be authorized to establish a fee pursuant to section
190.430, and the fee shall be effective on January 1, 1999, or the first
day of the month occurring at least thirty days after the approval of the
ballot measure. If a majority of the votes cast on the ballot measure by
the qualified voters voting thereon are opposed to the measure, then the
office of administration shall have no power to establish the fee unless
and until the measure is approved. (L. 1998 S.B. 743)

Effective 7-2-98

*Word "and" appears in original rolls.

Resubmitted to voters 8-06-02, defeated.

1. Notwithstanding any other provision of law to the contrary, a
temporary license may be issued for no more than a twelve-month period by
the appropriate licensing board to any otherwise qualified health care
professional licensed and in good standing in another state and who meets
such other requirements as the licensing board may prescribe by rule and
regulation, if the health care professional:

(1) Is acting pursuant to federal military orders under Title X for
active duty personnel or Title XXXII for national guard members; and

(2) Is enrolled in an accredited training program for trauma treatment
and disaster response in a hospital in this state; or

(3) If the health care professional is acting pursuant to the governor's
declaration of an emergency as defined in section 44.010, RSMo, such
temporary licensure shall be issued pursuant to this subdivision for a
two-week period and, upon license verification, may be reissued every two
weeks thereafter.

2. Licensure information and confirmation of health care professionals
acting pursuant to this section may be obtained by any available means,
including electronic mail.

3. For purposes of this section, the term "health care professional"
shall have the same meaning as such term is defined in section 383.130,
RSMo. (L. 1999 H.B. 343 § 6, A.L. 2001 H.B. 431, A.L. 2002 S.B. 712
merged with S.B. 714)

As used in sections 190.525 to 190.537, the following terms mean:

(1) "Department", the department of health and senior services;

(2) "Director", the director of the department of health and senior
services or the director's duly authorized representative;

(3) "Passenger", an individual needing transportation in a supine
position who does not require medical monitoring, observation, aid, care
or treatment during transportation, with the exception of
self-administered oxygen as ordered by a physician during transportation;

(4) "Patient", an individual who is sick, injured, wounded, diseased, or
otherwise incapacitated or helpless, and who may require medical
monitoring, medical observation, aid, care or treatment during
transportation, with the exception of self-administered oxygen as ordered
by a physician;

(5) "Person", any individual, firm, partnership, copartnership, joint
venture, association, cooperative organization, corporation, municipal or
private, and whether organized for profit or not, state, county,
political subdivision, state department, commission, board, bureau or
fraternal organization, estate, public trust, business or common law
trust, receiver, assignee for the benefit of creditors, trustee or
trustee in bankruptcy, or any other service user or provider;

(6) "Stretcher van", any vehicle other than an ambulance designed and
equipped to transport passengers in a supine position. No such vehicle
shall be used to provide medical services;

(7) "Stretcher van service", any person or agency that provides stretcher
van transportation to passengers who are confined to stretchers and whose
conditions are such that they do not need and are not likely to need
medical attention during transportation. (L. 2002 S.B. 1107)

1. No person, either as owner, agent or otherwise, shall
furnish, operate, conduct, maintain, advertise, or otherwise be engaged
in or profess to be engaged in the business or service of the
transportation of passengers by stretcher van upon the streets, alleys,
or any public way or place of the state of Missouri unless such person
holds a currently valid license from the department for a stretcher van
service issued pursuant to the provisions of sections 190.525 to 190.537
notwithstanding any provisions of chapter 390 or 622, RSMo, to the
contrary.

2. Subsection 1 of this section shall not preclude any political
subdivision that is authorized to operate a licensed ambulance service
from adopting any law, ordinance or regulation governing the operation of
stretcher vans that is at least as strict as the minimum state standards,
and no such regulations or ordinances shall prohibit stretcher van
services that were legally picking up passengers within a political
subdivision prior to January 1, 2002, from continuing to operate within
that political subdivision and no political subdivision which did not
regulate or prohibit stretcher van services as of January 1, 2002, shall
implement unreasonable regulations or ordinances to prevent the
establishment and operation of such services.

3. In any county with a charter form of government and with more than one
million inhabitants, the governing body of the county shall set
reasonable standards for all stretcher van services which shall comply
with subsection 2 of this section. All such stretcher van services must
be licensed by the department. The governing body of such county shall
not prohibit a licensed stretcher van service from operating in the
county, as long as the stretcher van service meets county standards.

4. Nothing shall preclude the enforcement of any laws, ordinances or
regulations of any political subdivision authorized to operate a licensed
ambulance service that were in effect prior to August 28, 2001.

5. Stretcher van services may transport passengers.

6. A stretcher van shall be staffed by at least two individuals when
transporting passengers.

7. The crew of the stretcher van is required to immediately contact the
appropriate ground ambulance service if a passenger's condition
deteriorates.

8. Stretcher van services shall not transport patients, persons currently
admitted to a hospital or persons being transported to a hospital for
admission or emergency treatment.

9. The department of health and senior services shall promulgate
regulations, including but not limited to adequate insurance, on-board
equipment, vehicle staffing, vehicle maintenance, vehicle specifications,
vehicle communications, passenger safety and records and reports.

10. The department of health and senior services shall issue service
licenses for a period of no more than five years for each service meeting
the established rules.

11. Application for a stretcher van license shall be made upon such forms
as prescribed by the department in rules adopted pursuant to sections
190.525 to 190.537. The application form shall contain such information
as the department deems necessary to make a determination as to whether
the stretcher van agency meets all the requirements of sections 190.525
to 190.537 and rules promulgated pursuant to sections 190.525 to 190.537.
The department shall conduct an inspection of the stretcher van service
to verify compliance with the licensure standards of sections 190.525 to
190.537.

12. Upon the sale or transfer of any stretcher van service ownership, the
owner of the stretcher van service shall notify the department of the
change in ownership within thirty days prior to the sale or transfer. The
department shall conduct an inspection of the stretcher van service to
verify compliance with the licensure standards of sections 190.525 to
190.537.

13. Ambulance services licensed pursuant to this chapter or any rules
promulgated by the department of health and senior services pursuant to
this chapter may provide stretcher van and wheelchair transportation
services pursuant to sections 190.525 to 190.537.

14. Any rule or portion of a rule, as that term is defined in section
536.010, RSMo, 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, RSMo, and, if applicable, section
536.028, RSMo. This section and chapter 536, RSMo, are nonseverable and
if any of the powers vested with the general assembly pursuant to chapter
536, RSMo, 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,
2002, shall be invalid and void. (L. 2002 S.B. 1107)

1. The department may refuse to issue or deny renewal of any
license required pursuant to sections 190.525 to 190.537 for failure to
comply with the provisions of sections 190.525 to 190.537 or any lawful
regulations promulgated by the department to implement the provisions of
sections 190.525 to 190.537. 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, RSMo.

2. The department may cause a complaint to be filed with the
administrative hearing commission as provided by chapter 621, RSMo,
against any holder of any license required by sections 190.525 to 190.537
or any person who has failed to renew or has surrendered his or her
license for failure to comply with the provisions of sections 190.525 to
190.537 or any lawful regulations promulgated by the department to
implement such sections. Those regulations shall be limited to the
following:

(1) Use or unlawful possession of any controlled substance, as defined in
chapter 195, RSMo, 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 190.525 to 190.537;

(2) Being finally adjudicated and found guilty, or having entered a plea
of guilty or nolo contendere, in a criminal prosecution pursuant to 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 190.525 to 190.537, 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
certificate, permit or license issued pursuant to sections 190.525 to
190.537 or in obtaining permission to take any examination given or
required pursuant to sections 190.537 to 190.540;

(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 190.525 to 190.537;

(6) Violation of, or assisting or enabling any person to violate, any
provision of sections 190.525 to 190.537, or of any lawful rule or
regulation adopted by the department pursuant to sections 190.525 to
190.537;

(7) Impersonation of any person holding a license or allowing any person
to use his or her license;

(8) Disciplinary action against the holder of a license or other right to
practice any activity regulated by sections 190.525 to 190.537 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) Issuance of a license based upon a material mistake of fact;

(11) Violation of any professional trust or confidence;

(12) 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;

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

(14) Refusal of any applicant or licensee to cooperate with the
department of health and senior services during any investigation;

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

(16) Repeated negligence in the performance of the functions or duties of
any activity licensed by this chapter.

3. After the filing of such complaint, the proceedings shall be conducted
in accordance with the provisions of chapter 621, RSMo. Upon a finding by
the administrative hearing commission that the grounds, as 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 period not to exceed three years, or revoke the
license.

4. 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 190.525 to 190.537 relative to the licensing of
an applicant for the first time.

5. 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.

6. Any person, organization, association or corporation who reports or
provides information to the department pursuant to the provisions of
sections 190.525 to 190.537 and who does so in good faith and without
negligence shall not be subject to an action for civil damages as a
result thereof.

7. The department of health and senior services may suspend any license
required pursuant to sections 190.525 to 190.537 simultaneously with the
filing of the complaint with the 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 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. (L. 2002 S.B. 1107)

1. Any person violating, or failing to comply with, the
provisions of sections 190.525 to 190.537 is guilty of a class B
misdemeanor.

2. Each day that any violation of, or failure to comply with, sections
190.525 to 190.537 is committed or permitted to continue shall constitute
a separate and distinct offense, and shall be punishable as a separate
offense pursuant to this section; but the court may, in appropriate
cases, stay the cumulation of penalties.

3. The attorney general shall have concurrent jurisdiction with any and
all prosecuting attorneys to prosecute persons in violation of sections
190.525 to 190.537, and the attorney general or prosecuting attorney may
institute injunctive proceedings against any person operating in
violation of sections 190.525 to 190.537. (L. 2002 S.B. 1107)

Any rule or portion of a rule, as that term is defined in
section 536.010, RSMo, that is created pursuant to the authority of
sections 190.525 to 190.537 shall become effective only if it complies
with and is subject to all of the provisions of chapter 536, RSMo, and,
if applicable, section 536.028, RSMo. This section and chapter 536, RSMo,
are nonseverable and if any of the powers vested with the general
assembly pursuant to chapter 536, RSMo, 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, 2002, shall be invalid and void. (L.
2002 S.B. 1107)

1. The department of health and senior services shall by rule
establish a schedule of fees to be paid by applicants for specific
licensure or accreditation under sections 190.001 to 190.250 and sections
190.525 to 190.537; except that, such fee shall not be imposed for
specific licensure or accreditation of persons employed by volunteer
ambulance services. Any rule or portion of a rule, as that term is
defined in section 536.010, RSMo, 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, RSMo, and, if
applicable, section 536.028, RSMo. This section and chapter 536, RSMo,
are nonseverable and if any of the powers vested with the general
assembly pursuant to chapter 536, RSMo, 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, 2005, shall be invalid and void.

2. All fees imposed under this section shall be collected by the
department and deposited in the Missouri public health services fund
established in section 192.900, RSMo. Moneys in the fund deposited under
this section shall be used upon appropriation by the general assembly for
the purpose of implementing the provisions of sections 190.001 to 190.250
and sections 190.525 to 190.537. Notwithstanding the provisions of
section 33.080, RSMo, moneys deposited to the credit of the fund under
this section shall not revert to the credit of general revenue at the end
of the biennium. (L. 2005 S.B. 177)

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