HOUSE BILL NO. 1979 103RD GENERAL ASSEMBLY
INTRODUCED BY REPRESENTATIVE COOK.
4829H.02I JOSEPH ENGLER, Chief Clerk
AN ACT To repeal section 190.098, RSMo, and to enact in lieu thereof one new section relating to community paramedic services.
Be it enacted by the General Assembly of the state of Missouri, as follows:
Section A. Section 190.098, RSMo, is repealed and one new section enacted in lieu 2 thereof, to be known as section 190.098, to read as follows: 190.098. 1. As used in this section, the term "community paramedic services" 2 means services that are: 3 (1) Provided by any entity that: 4 (a) Employs licensed paramedics who are certified as community paramedics by 5 the department; and 6 (b) Has received an endorsement by the department as a community paramedic 7 service entity; 8 (2) Provided in a nonemergent setting, independent of a 911 system or 9 emergency summons; 10 (3) Consistent with the training and education, as well as within the scope of skill 11 and practice, of the personnel and with the supervisory standard approved by the 12 medical director; and 13 (4) Reflected and documented in the entity's patient care plans or protocols 14 approved by the medical director in accordance with section 190.142. 15 2. In order for a person to be eligible for certification by the department as a 16 community paramedic, an individual shall: 17 (1) Be currently [certified] licensed as a paramedic;
EXPLANATION — Matter enclosed in bold-faced brackets [thus] in the above bill is not enacted and is intended to be omitted from the law. Matter in bold-face type in the above bill is proposed language. HB 1979 2
18 (2) Successfully complete or have successfully completed a community paramedic 19 certification program from a college, university, or educational institution that has been 20 approved by the department or accredited by a national accreditation organization approved 21 by the department; and 22 (3) Complete an application form approved by the department. 23 [2.] 3. A community paramedic shall practice in accordance with protocols and 24 supervisory standards established by the medical director in collaboration with the 25 ambulance service administrator. [A community paramedic shall provide services of a 26 health care plan if the plan has been developed by the patient's physician or by an advanced 27 practice registered nurse through a collaborative practice arrangement with a physician or a 28 physician assistant through a collaborative practice arrangement with a physician and there is 29 no duplication of services to the patient from another provider] Patient care plans that are 30 developed by the patient's physician, advanced practice registered nurse, or physician 31 assistant shall be implemented through a collaboration with the medical director and 32 emergency medical response agency. 33 [3. Any ambulance service shall enter into a written contract to provide community 34 paramedic services in another ambulance service area, as that term is defined in section 35 190.100. The contract that is agreed upon may be for an indefinite period of time, as long as 36 it includes at least a sixty-day cancellation notice by either ambulance service] 4. (1) (a) 37 Any ambulance service that seeks to provide community paramedic services outside of 38 its ambulance service area, as described in section 190.105 and administered by the 39 department, and in the service area of another ambulance service that currently 40 provides community paramedic services shall be required to have a memorandum of 41 understanding with that ambulance service regarding the provision of such community 42 paramedic services. An ambulance service that provides community paramedic services 43 may provide community paramedic services without a memorandum of understanding 44 in the ambulance service area of an ambulance service that is not providing community 45 paramedic services, but the ambulance service providing community paramedic 46 services shall provide notification to the ambulance service with emergency service 47 responsibilities in the service area of the general community paramedic activities being 48 performed. 49 (b) An ambulance service that provides sustained community paramedic 50 services in an area outside the county of the ambulance service's primary 911 response 51 territory and where another ambulance service also offers community paramedic 52 services shall coordinate its community paramedic services with the local ambulance 53 service offering community paramedic services in that area. HB 1979 3
54 (c) Nothing in this subdivision shall prevent an ambulance service that provides 55 community paramedic services from honoring any formal contract or agreement with a 56 health care institution, hospital licensed under chapter 197, health clinic, or insurance 57 company for the provision of community paramedic services. 58 (2) Any emergency medical response agency seeking to provide community 59 paramedic services within its designated response service area may do so if the ground 60 ambulance service covering the area within which the emergency medical response 61 agency is located does not provide community paramedic services. If such ground 62 ambulance service does provide community paramedic services, the ground ambulance 63 service may establish, at its sole discretion, a memorandum of understanding with the 64 emergency medical response agency planning to offer community paramedic services in 65 order to coordinate programs and avoid service duplication. If an emergency medical 66 response agency is providing community paramedic services in a service area before the 67 ground ambulance service in that service area begins offering community paramedic 68 services, the emergency medical response agency and the ground ambulance service 69 shall establish a memorandum of understanding for the coordination of services. 70 (3) A community paramedic program shall notify the appropriate local 71 ambulance service when providing services within the service area of an ambulance 72 service. 73 (4) The department shall establish regulations for the purpose of recognizing 74 community paramedic service entities that have met the standards necessary to provide 75 community paramedic services, including physician medical oversight, training, patient 76 recordkeeping, formal relationships with primary care services where necessary, and 77 quality improvement policies. The department shall issue an endorsement to any 78 community paramedic service entity that meets such standards that allows the entity to 79 provide community paramedic services for a period of five years. 80 [4.] 5. A community paramedic is subject to the provisions of sections 190.001 to 81 190.245 and rules promulgated under sections 190.001 to 190.245. 82 [5.] 6. No person shall hold himself or herself out as a community paramedic or 83 provide the services of a community paramedic unless such person is certified by the 84 department. 85 [6.] 7. The medical director shall approve the implementation of the community 86 paramedic program. 87 [7.] 8. Any rule or portion of a rule, as that term is defined in section 536.010, that is 88 created under the authority delegated in this section shall become effective only if it complies 89 with and is subject to all of the provisions of chapter 536 and, if applicable, section 536.028. 90 This section and chapter 536 are nonseverable and if any of the powers vested with the HB 1979 4
91 general assembly pursuant to chapter 536 to review, to delay the effective date, or to 92 disapprove and annul a rule are subsequently held unconstitutional, then the grant of 93 rulemaking authority and any rule proposed or adopted after August 28, 2013, shall be invalid 94 and void. ✔
Statutes affected: