This Fiscal Note is not an official copy and should not be quoted or cited.
Fiscal Note - SB 0917 - Emergency Services
L.R. NO. 3435-01
BILL NO. SB 917
SUBJECT: Ambulance; Health; Department of Health; Medical Procedures
TYPE: Original
DATE: March 6, 1996
FISCAL SUMMARY
ESTIMATED NET EFFECT ON STATE FUNDS
FUND AFFECTED FY 1997 FY 1998 FY 1999
General Revenue ($30,000 to ($30,000 to ($30,000 to
$130,000) $130,000) ($130,000)
Total Estimated
Net Effect on All ($30,000 to ($30,000 to ($30,000 to
State Funds $130,000) $130,000) $130,000)
ESTIMATED NET EFFECT ON FEDERAL FUNDS
FUND AFFECTED FY 1997 FY 1998 FY 1999
None
Total Estimated
Net Effect on All
Federal Funds $0 $0 $0
ESTIMATED NET EFFECT ON LOCAL FUNDS
FUND AFFECTED FY 1997 FY 1998 FY 1999
Local Government Unknown Unknown Unknown
FISCAL ANALYSIS
ASSUMPTION
Officials from the Department of Mental Health, the Office of Attorney
General, the Office of Administration, the Office of State Court
Administrator, the Department of Insurance, and the Office of State Treasurer
assume this proposal would not fiscally impact their agencies.
Department of Health (DOH) officials assume this proposal would require the
establishment of four Emergency Medical Service regional committees. DOH
estimates additional meeting expenses of $30,000 annually (4 regions x 4
meetings x 15 members x $125).
Officials from the Department of Revenue (DOR) assumes DOR would be required
to collect the taxes if an ambulance district were to vote and approve a
sales tax rate. DOR assumes the costs for this proposal represent the costs
for collecting the sales tax which may be imposed by ambulance districts that
are not necessarily coterminous with city county boundaries, if imposed in
many areas of the state. DOR assumes that when and if an ambulance district
implements a sales tax, DOR would need one Programmer Analyst II ($29,460)
and overtime funding of $38,219 in the Information Systems Division. This
FTE and overtime would be needed to develop a new sales tax system. DOR
states the Programmer Analyst and overtime request would be needed before the
following FTE due to design of the new system. Two Tax Audit Analyst I's
($16,164) would be required to handle correspondence and telephone calls,
assist the ambulance districts in imposition and repeal of the sales tax,
adjust the rates on an annual basis, handle protests, and refund requests.
DOR states the actual number of FTE would be dependent upon the number of
ambulance districts imposing the sales tax and the level of DOR involvement
in the collection and administration of the sales taxes. One Examiner Clerk
($15,072) would be requested for the purpose of handling rejected title
applications due to applicants for title not knowing whether they reside in
an ambulance district and not including the proper amount of tax with the
title application. Expenses would include office supplies, rental space,
renovation expense, and communication expense ($21,721). Equipment would
include office furniture and personal computers ($18,679)
Oversight assumes that no additional rental space would be needed and
additional renovation expense would be handled through the budget process.
Oversight further assumes that DOR administrative costs cannot be estimated
with any degree of accuracy at this time, however they would not be expected
to exceed $100,000 annually.
Officials from Mehlville Fire Protection District, LeMay Fire Protection
District, Phelps County Regional Medical Center, Raytown Fire Protection
District, Barton County Memorial Hospital, Cass Medical Center, Cooper County
Memorial Hospital, Excelsior Springs Medical Center, Lincoln County Memorial
Hospital, Pemiscot Memorial Hospital, Ray County Memorial Hospital, Samaritan
Memorial Hospital, Ste. Genevieve County Memorial Hospital, Newton County
Ambulance District, St. Charles County Ambulance District, Vallee Ambulance
District, Mid-Mo Ambulance District, Stoddard County Ambulance District, and
the Missouri Association of Counties did not respond to our fiscal impact
request.
FISCAL IMPACT - State Government FY 1997 FY 1998 FY 1999
(10 Mo.)
GENERAL REVENUE FUND
Costs - Department of Health
Expense and equipment ($30,000) ($30,000) ($30,000)
Total Costs to Department of Health ($30,000) ($30,000) ($30,000)
Costs - Department of Revenue
Administrative Costs ($0 to ($0 to ($0 to
$100,000) $100,000) $100,000)
ESTIMATED NET EFFECT ON ($30,000 to ($30,000 to ($30,000 to
GENERAL REVENUE FUND $130,000) $130,000) $130,000)
FISCAL IMPACT - Local Government FY 1997 FY 1998 FY 1999
(10 Mo.)
Ambulance Districts Unknown Unknown Unknown
*There could be income to local ambulance districts if voters approve a sales
tax.
This proposal would be known as the "Comprehensive Emergency Medical Services
(EMS) Act". The proposal would make minor changes to the ambulance district
law (Sections 190.005-190.090), and major changes to the ambulance service
personnel and treatment (Sections 190.093-190.190) and the trauma centers
(Sections 190.235-190-237) sections of the law. This proposal would change
current law by licensing ambulance services rather than ambulances
themselves. This proposal would create a State Council on Emergency Medical
Services to make recommendations to the Governor and the General Assembly.
This council replaces the Advisory Council of the same name, and assumes the
same responsibilities, with these changes:
(1) The new council is appointed by the Director of Health instead of the
Governor and does not include advice and consent of the Senate;
(2) The new council would be responsible for designating and approving
trauma centers. This responsibility now rests with the Director of the
Department of Health (DOH). DOH will divide the state up into designated
regions and appoint a committee in each region to develop policies,
standards, and protocols to improve EMS in the region. The Director also
appoints a physician, with expertise in EMS, to serve as the regional EMS
medical director to advise the Department. In addition, each ambulance
service in the region would have to appoint a local physician to be their
medical director. The local medical director would have the responsibility
to ensure that the personnel are meeting the standards of the DOH. This
proposal would eliminate in statute the specific listing of requirements for
EMS personnel and the listing of services they can provide, and replaces it
with general language, with the specific listing of requirements for EMS
personnel and the listing of the services specifics to be filled in through
rules and regulations. Also, currently when ambulance services are faced
with a severely injured patient, they are supposed to take the patient to the
nearest hospital or trauma center. Under this proposal, the ambulance
service would take the patient to a trauma center, unless the center is too
far as to risk patient harm or death. If this is the case, they can
transport to another facility that is closer until the patient is stabilized,
upon which time they must transport to the trauma center. This proposal
contains a provision that allows any political subdivision to levy a sales
tax to support an ambulance service upon a vote of the people in the
subdivision. As it stands now, county commissions can put a measure on the
ballot to raise the sales tax to provide for 911 services. This proposal
would require a petition to be signed by 10% of those in the subdivision that
voted in the last gubernatorial election. The proposal would also make the
following changes to the ambulance district law:
(1) The assessed valuation of the area to be included in a petition for an
ambulance district is raised from $2,500,000 to$10,000,000;
(2) Ambulance boards should engage in educational programs;
(3) Multicounty districts would no longer be divided into separate ambulance
districts.
This legislation is not federally mandated, would not duplicate any other
program and would not require additional capital improvements or rental
space.
SOURCES OF INFORMATION
Department of Mental Health
Office of Attorney General
Office of Administration
Office of State Court Administrator
Office of State Treasurer
Department of Insurance
Department of Health
Department of Revenue
NOT RESPONDING: Mehlville Fire Protection District, LeMay Fire Protection
District, Phelps County Regional Medical Center, Raytown Fire Protection
District, Barton County Memorial Hospital, Cass Medical Center, Cooper County
Memorial Hospital, Excelsior Springs Medical Center, Lincoln County Memorial
Hospital, Pemiscot Memorial Hospital, Ray County Memorial Hospital, Samaritan
Memorial Hospital, Ste. Genevieve County Memorial Hospital, Newton County
Ambulance District, St. Charles County Ambulance District, Vallee Ambulance
District, Mid-Mo Ambulance District, Stoddard County Ambulance District, and
the Missouri Association of Counties