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EXPLANATION-Matter enclosed in bold-faced brackets [thus] in this bill is not enacted
and is intended to be omitted in the law.
SECOND REGULAR SESSION
SENATE BILL NO. 964
103RD GENERAL ASSEMBLY
INTRODUCED BY SENATOR WASHINGTON.
4283S.02I KRISTINA MARTIN, Secretary
AN ACT
To repeal section 190.098, RSMo, and to enact in lieu thereof one new section relating to
community paramedics.
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Section A. Section 190.098, RSMo, is repealed and one new 1
section enacted in lieu thereof, to be known as section 190.098, 2
to read as follows:3
190.098. 1. As used in this section, the term 1
"community paramedic services" means services that are: 2
(1) Provided by any entity that: 3
(a) Employs licensed paramedics who are certified as 4
community paramedics by the department; and 5
(b) Has received an endorsement by the department as a 6
community paramedic service entity; 7
(2) Provided in a nonemergent setting, independent of 8
a 911 system or emergency summons; 9
(3) Consistent with the training and education, as 10
well as within the scope of skill and practice, of the 11
personnel and with the supervisory standard approved by the 12
medical director; and 13
(4) Reflected and documented in the entity's patient 14
care plans or protocols approved by the medical director in 15
accordance with section 190.142. 16
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2. In order for a person to be eligible for 17
certification by the department as a community paramedic, an 18
individual shall: 19
(1) Be currently [certified] licensed as a paramedic; 20
(2) Successfully complete or have successfully 21
completed a community paramedic certification program from a 22
college, university, or educational institution that has 23
been approved by the department or accredited by a national 24
accreditation organization approved by the department; and 25
(3) Complete an application form approved by the 26
department. 27
[2.] 3. A community paramedic shall practice in 28
accordance with protocols and supervisory standards 29
established by the medical director[. A community paramedic 30
shall provide services of a health care plan if the plan has 31
been developed by the patient's physician or by an advanced 32
practice registered nurse through a collaborative practice 33
arrangement with a physician or a physician assistant 34
through a collaborative practice arrangement with a 35
physician and there is no duplication of services to the 36
patient from another provider] in collaboration with the 37
ambulance service administrator. Patient care plans that 38
are developed by the patient's physician, advanced practice 39
nurse practitioner, or physician assistant shall be 40
implemented through a collaboration with the medical 41
director and agency. 42
[3.] 4. (1) Any ambulance service [shall enter into a 43
written contract to provide community paramedic services in 44
another ambulance service area, as that term is defined in 45
section 190.100. The contract that is agreed upon may be 46
for an indefinite period of time, as long as it includes at 47
least a sixty-day cancellation notice by either ambulance 48
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service] that seeks to provide community paramedic services 49
outside of its ambulance service area, as described in 50
section 190.105 and administered by the department, and in 51
the service area of another ambulance service that currently 52
provides community paramedic services shall be required to 53
have a memorandum of understanding with that ambulance 54
service regarding the provision of such community paramedic 55
services. An ambulance service that provides community 56
paramedic services may provide community paramedic services 57
without a memorandum of understanding in the ambulance 58
service area of an ambulance service that is not providing 59
community paramedic services, but the ambulance service 60
providing community paramedic services shall provide 61
notification to the ambulance service with emergency service 62
responsibilities in the service area of the general 63
community paramedic activities being performed. 64
(2) An ambulance service that provides community 65
paramedic services and that has executed formal contracts or 66
agreements with health care institutions, hospitals, health 67
clinics, or insurance companies for the provision of 68
community paramedic services shall be permitted to honor 69
those agreements. 70
(3) For sustained services provided outside the county 71
of the ambulance services' primary 911 response territory 72
where another licensed ambulance service also offers 73
community paramedic services, the community paramedic 74
program shall coordinate with the local ambulance service. 75
(4) Any emergency medical response agency seeking to 76
provide community paramedic services within its designated 77
response service area may do so if the ground ambulance 78
service covering the area within which the emergency medical 79
response agency is located does not provide community 80
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paramedic services. If such ground ambulance service does 81
provide community paramedic services, the ground ambulance 82
service may establish, at its sole discretion, a memorandum 83
of understanding with the emergency medical response agency 84
planning to offer community paramedic services in order to 85
coordinate programs and avoid service duplication. If an 86
emergency medical response agency is providing community 87
paramedic services in a service area before the ground 88
ambulance service in that service area begins offering 89
community paramedic services, the emergency medical response 90
agency and the ground ambulance service shall establish a 91
memorandum of understanding for the coordination of services. 92
(5) A community paramedic program shall notify the 93
appropriate local ambulance service when providing services 94
within the service area of an ambulance service. 95
(6) The department shall establish regulations for the 96
purpose of recognizing community paramedic service entities 97
that have met the standards necessary to provide community 98
paramedic services, including physician medical oversight, 99
training, patient record keeping, formal relationships with 100
primary care services where necessary, and quality 101
improvement policies. The department shall issue an 102
endorsement to any community paramedic service entity that 103
meets such standards that allow the entity to provide 104
community paramedic services for a period of five years. 105
[4.] 5. A community paramedic is subject to the 106
provisions of sections 190.001 to 190.245 and rules 107
promulgated under sections 190.001 to 190.245. 108
[5.] 6. No person shall hold himself or herself out as 109
a community paramedic or provide the services of a community 110
paramedic unless such person is certified by the department. 111
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[6.] 7. The medical director shall approve the 112
implementation of the community paramedic program. 113
[7.] 8. Any rule or portion of a rule, as that term is 114
defined in section 536.010, that is created under the 115
authority delegated in this section shall become effective 116
only if it complies with and is subject to all of the 117
provisions of chapter 536 and, if applicable, section 118
536.028. This section and chapter 536 are nonseverable and 119
if any of the powers vested with the general assembly 120
pursuant to chapter 536 to review, to delay the effective 121
date, or to disapprove and annul a rule are subsequently 122
held unconstitutional, then the grant of rulemaking 123
authority and any rule proposed or adopted after August 28, 124
2013, shall be invalid and void. 125
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