CCS/HS/SB 743 - This act makes various changes to laws relating to emergency response agencies by combining the major provisions of SB 743, HCS/SCS/SB 625 and SCS/SB 628.

SB 743 amended sections 44.010 through 44.130 relating to the State Emergency Management Agency (SEMA).

Revisions are made to the definition section that change the terminology regarding civil disasters and civil defense. Such areas are now referred to as emergencies and related emergency management functions.

SEMA is named as the Governor's official designee to act in the event of a natural or man-made disaster. The Adjutant General will act as the executive head of SEMA. The agency's authority is now described as assisting in coordination of activities related to emergency functions through coordination of response, recovery, planning and mitigation. SEMA is additionally named as the state coordinator for the National Flood Insurance Program.

The Governor's general powers in this area are: (1) to execute orders and rules related to emergencies; (2) to direct the cooperation of the various areas of the state in the performance of emergency functions; (3) to enter into mutual aid agreements with other states and various areas of this state; (4) to delegate the governor's authority; (5) to cooperate with federal officials; and (6) to create committees of volunteers and agencies to deal with emergency matters.

Broad powers are granted to the Governor to respond to emergencies declared by the Governor or General Assembly. Upon such declaration, the Governor shall have control over all necessary property and services within the state. The Governor is also authorized to suspend rules and agency operations as necessary to properly react to the emergency.

The Missouri Disaster Fund is reauthorized to expend funds during a state emergency for delineated items. Significant changes to the line items include allowing expenditures for the duration of response and recovery, and repairing and restoring all public infrastructure. Previously authorized expenditures for restoring means of communication have been removed. Any expenditure in excess of $1,000 must have the Governor's prior authorization.

Political subdivisions are required to establish local emergency response organizations and coordinators. Local organizations are required to enforce the regulations of the Governor and are prohibited from engaging in political activity. Subject to the Governor's approval, political subdivisions may also enter into mutual aid agreements.

Other changes allow SEMA to utilize volunteers and remove references to response in the event of enemy attack.

HCS/SCS/SB 625 contained sections 190.001 to 190.245, which is to be known as the "Comprehensive Emergency Medical Services Act." The act:

(1) Authorizes continued operation of ambulance districts in counties with population of less than 400,000 which were operating before August, 1998. New ambulance districts can be formed in districts with an assessed valuation of ten million dollars or more;

(2) Prevents double taxation by ground ambulance services in third class counties unless approved by the affected voters;

(3) Requires ambulance districts which plan to contract out for service after August 1, 1998, to hold public hearings. Such contract may not be implemented for 30 days;

(4) Allows for a ten cent property tax to fund ambulance district pension programs;

(5) Establishes the State Advisory Council on Emergency Medical Services (EMS) to advise the Governor, General Assembly, and Department of Health on matters related to improving all aspects of emergency medical service;

(6) Establishes the State EMS Medical Directors Advisory Committee and no less than 6 Regional EMS Committees as subcommittees of the State Advisory Council on EMS;

(7) Requires the selection of one physician from each EMS region to serve as regional EMS medical director;

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

(9) Requires ground ambulances to be operated under the immediate supervision of a licensed emergency medical technician;

(10) Allows political subdivisions to require franchises to operate ambulance services. Allows political subdivisions, other than St. Louis City and St. Louis County, to require contracts or mutual aid agreements to operate ambulance services. Regulations promulgated by most political subdivisions may not be below state standards. The governing body of St. Louis County is the only entity within that county that may set standards for operation of ambulance services, and such standards must be at least as strict as state standards;

(11) Requires political subdivisions not operating or regulating an ambulance service as of August 28, 1998, to receive voter approval in order to operate an ambulance service within their jurisdictional boundaries. Any political subdivision may contract with a licensed ambulance service;

(12) Prohibits municipalities and counties located within an ambulance district from promulgating ordinances or regulations related to ambulance services, unless the service was established and in operation before August 28, 1998;

(13) Prohibits municipalities and counties located within an ambulance district from operating an ambulance service without a franchise in an ambulance district that has ordinances prohibiting such service, unless the service was established and in operation before August 28, 1998;

(14) Allows the Director of the Department of Health to resolve issues regarding ground ambulance service area boundaries in order to assure ambulance service coverage throughout the state. This authority does not allow the Director to modify the jurisdictional boundaries of any existing service operating before August 28, 1998;

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

(16) Allows mutual aid contracts between ambulance services in the states neighboring Missouri;

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

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

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

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

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

(22) Requires ambulance services to employ technicians licensed by the Department;

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

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

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

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

(27) Requires certain health care coverage of emergency services, subject to applicable copayments and deductibles;

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

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

(30) Defines the following: ambulance, ambulance service, ambulance service area, emergency medical response agency, dispatch agency, emergency medical technician, medical director, emergency, and emergency service; and

(31) Makes a violation of any of the provisions of this act a Class B misdemeanor and subject to licensure action by the Department.

SCS/SB 628 contains sections 190.400 to 190.440 pertaining to Enhanced 911 (E911) telecommunications service provided by wireless (cellular) service providers.

The act establishes the Wireless Service Provider Enhanced 911 Advisory Board. The Board shall consist of eight persons: the Director of the Department of Public safety or his designee, the Chairman of the Public Service Commission or his designee, three representatives of wireless telecommunications service providers selected by majority vote of licensed wireless telecommunications service providers and three representatives of Public Safety Answering Point (PSAP) organizations elected by the members of the state chapter of Associated Public Safety Communications Officials and the state chapter of the National Emergency Numbering Association. The Board shall address implementation of Federal Communications Commission (FCC) Order 94-102 regarding implementation of E911 service, advise the Office of Administration on implementation of that Order and provide mediation, upon request, for jurisdictional disputes among political subdivisions providing wireless (cellular) 911 service.

The act establishes the Wireless Service Provider enhanced 911 Service Fund. Fees collected pursuant to the act by wireless service providers shall be credited to the fund. Wireless providers may keep one percent of the fee for collection costs.

The act authorizes the Office of Administration to establish a fee, if approved by voters, of fifty cents per month upon every wireless telephone number in the state. The Office shall distribute the funds to wireless service providers and PSAPs to implement and operate the Enhanced 911 system. Funds shall be provided, if available, to PSAPs for equipment and 10% of those funds to PSAPs shall be distributed in equal amounts to each PSAP participating in enhanced 911 service.

Proprietary information submitted by wireless providers under this act shall not be released without permission from the provider. General information may only be released in an aggregated form.

Wireless providers shall not be civilly or criminally liable for any act related to providing E911 service unless the act constitutes gross negligence, recklessness or intentional misconduct.

A ballot measure shall be placed before the voters of the state for approval of a fee of up to fifty cents per month upon all wireless telephone numbers in the state. The issue shall be submitted upon the November 1998 general election ballot or at a special election called for that purpose by the Governor. If approved by voters, the fee shall take effect January 1, 1999 or on the first day of the first month beginning at least thirty days after the approval of the ballot issue. JOAN GUMMELS/DENISE GARNIER