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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
[TRULY AGREED TO AND FINALLY PASSED]
CONFERENCE COMMITTEE SUBSTITUTE FOR
HOUSE COMMITTEE SUBSTITUTE FOR
SENATE SUBSTITUTE FOR
SENATE BILL NO. 975
103RD GENERAL ASSEMBLY
2026
5215S.11T
AN ACT
To repeal sections 190.050, 190.051, 190.052, 190.070, 190.090, and 590.192, RSMo, and to enact
in lieu thereof seven new sections relating to ambulance districts.
Be it enacted by the General Assembly of the State of Missouri, as follows:
Section A. Sections 190.050, 190.051, 190.052, 190.070, 1
190.090, and 590.192, RSMo, are repealed and seven new sections 2
enacted in lieu thereof, to be known as sections 190.050, 3
190.051, 190.052, 190.070, 190.089, 190.090, and 590.192, to 4
read as follows:5
190.050. 1. After the ambulance district has been 1
declared organized, the declaring county commission[, except 2
in counties of the second class having more than one hundred 3
five thousand inhabitants located adjacent to a county of 4
the first class having a charter form of government which 5
has a population of over nine hundred thousand inhabitants,] 6
shall divide the district into six election districts as 7
equal in population as possible[, and] or provide for the 8
election of six directors elected at large from within the 9
district. 10
(1) If the county commission divides the district into 11
election districts, the commission shall by lot number the 12
CCS HCS SS SB 975 2
districts from one to six inclusive. The county commission 13
shall cause an election to be held in the ambulance district 14
[within ninety days] on the next regularly scheduled 15
election date after the order establishing the ambulance 16
district to elect ambulance district directors. Each voter 17
shall vote for one director from the ambulance election 18
district in which the voter resides. The directors elected 19
from districts one and four shall serve for a term of one 20
year, the directors elected from districts two and five 21
shall serve for a term of two years, and the directors from 22
districts three and six shall serve for a term of three 23
years; thereafter, the terms of all directors shall be three 24
years. All directors shall serve the term to which they 25
were elected or appointed, and until their successors are 26
elected and qualified, except in cases of resignation or 27
disqualification. The county commission shall reapportion 28
the ambulance districts within sixty days after the 29
population of the county is reported to the governor for 30
each decennial census of the United States. Notwithstanding 31
any other provision of law, if the number of candidates for 32
the office of director is no greater than the number of 33
directors to be elected, no election shall be held, and the 34
candidates shall assume the responsibilities of their 35
offices at the same time and in the same manner as if they 36
have been elected. 37
[2. In all counties of the second class having more 38
than one hundred five thousand inhabitants located adjacent 39
to a county of the first class having a charter form of 40
government which has a population of over nine hundred 41
thousand inhabitants,] (2) If the county commission 42
provides for an at-large board of directors, it shall order 43
an election be held on the next regularly scheduled election 44
CCS HCS SS SB 975 3
date and the voters shall vote for six directors elected at 45
large from within the district for a term of three years. 46
[Those directors holding office in any district in such a 47
county on August 13, 1976, shall continue to hold office 48
until the expiration of their terms, and their successors 49
shall be elected from the district at large for a term of 50
three years. In any district formed in such counties after 51
August 13, 1976, the governing body of the county shall 52
cause an election to be held in that district within ninety 53
days after the order establishing the ambulance district to 54
elect ambulance district directors. Each voter shall vote 55
for six directors.] The two candidates receiving the 56
highest number of votes at such election shall be elected 57
for a term of three years, the two candidates receiving the 58
third and fourth highest number of votes shall be elected 59
for a term of two years, the two candidates receiving the 60
fifth and sixth highest number of votes shall be elected for 61
a term of one year; thereafter, the term of all directors 62
shall be three years. A director holding office as of 63
August 28, 2026, shall continue as an at-large director for 64
the remainder of such director's existing term. 65
[3.] 2. A candidate for director of the ambulance 66
district shall, at the time of filing, be a citizen of the 67
United States, [a qualified voter of the election district 68
as provided in subsection 1 of this section,] a resident of 69
the district for two years next preceding the election, and 70
shall be at least twenty-four years of age. In an 71
established district which is located within the 72
jurisdiction of more than one election authority, the 73
candidate shall file his or her declaration of candidacy 74
with the secretary of the board. In all other districts, a 75
candidate shall file a declaration of candidacy with the 76
CCS HCS SS SB 975 4
county clerk of the county in which he or she resides. A 77
candidate shall file a statement under oath that he or she 78
possesses the required qualifications. No candidate's name 79
shall be printed on any official ballot unless the candidate 80
has filed a written declaration of candidacy pursuant to 81
subsection 5 of section 115.127. If the time between the 82
county commission's call for a special election and the date 83
of the election is not sufficient to allow compliance with 84
subsection 5 of section 115.127, the county commission 85
shall, at the time it calls the special election, set the 86
closing date for filing declarations of candidacy. 87
3. An ambulance district may, following a public 88
hearing subject to the provisions of chapter 610, by an 89
ordinance adopted by an affirmative vote of two-thirds of 90
the members of the board of directors, abolish the 91
boundaries of any existing election subdistricts if the 92
board is unable to find a qualified candidate to fill the 93
director position of each such subdistrict. Such ordinance 94
may eliminate the subdistricts entirely and provide for the 95
election of directors at large. A copy of the ordinance 96
shall be filed with the county clerk. Upon the abolition of 97
such election subdistricts, all current directors shall 98
serve as directors at large for the remainder of their 99
existing terms. 100
4. Any ambulance district may, by an ordinance adopted 101
by an affirmative vote of two-thirds of the members of the 102
board of directors, establish election subdistricts. Each 103
election subdistrict shall consist of contiguous territory 104
and shall be as compact and nearly equal in population as 105
practicable. The boundaries of such subdistricts shall be 106
established by the county commission. Each board member 107
shall be a resident of the election subdistrict that he or 108
CCS HCS SS SB 975 5
she represents at the time of election and shall remain a 109
resident of such subdistrict for the duration of the 110
member's term. 111
5. Notwithstanding any other provision of law to the 112
contrary, if the number of candidates for the office of 113
director is no greater than the number of directors to be 114
elected, no election shall be held, and the candidates shall 115
assume the responsibilities of their offices at the same 116
time and in the same manner as if they were elected. 117
190.051. 1. Notwithstanding the provisions of 1
sections 190.050 and 190.052 to the contrary, upon a 2
[motion] resolution adopted by the board of directors in 3
districts where there are six-member boards, and upon 4
approval by the voters in the district, the number of 5
directors may be increased to seven [with one board member 6
running district wide,] or decreased to five or three board 7
members. The resolution shall state the names of the 8
existing directors who will fill the positions on the board 9
if such measure is approved by the voters, as well as any 10
vacancies to be filled by subsequent election, and shall 11
state the dates on which those terms shall conclude. 12
2. The ballot to be used for the approval of the 13
voters to increase or decrease the number of members on the 14
board of directors of the ambulance district shall be 15
substantially in the following form: 16
17
18
19
20
21
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)?
22 □ YES □ NO
CCS HCS SS SB 975 6
[2.] 3. If a majority of the voters voting on a 23
proposition to increase the number of board members [to 24
seven] vote in favor of the proposition, then at the next 25
election of board members after the voters vote to increase 26
the number of directors, the voters shall select [one person 27
to serve in addition to the existing six directors as the 28
member who shall run district wide] additional persons to 29
fill any such vacancies. 30
[3.] 4. If a majority of the voters voting on a 31
proposition to decrease the number of board members vote in 32
favor of the proposition, then the county clerk shall redraw 33
the district into the resulting number of subdistricts with 34
equal population bases and hold elections by subdistricts 35
pursuant to section 190.050. Thereafter, members of the 36
board shall be elected to serve terms of three years and 37
until their successors are duly elected and qualified. 38
[4. Members of the board of directors in office on the 39
date of an election pursuant to this section to increase or 40
decrease the number of members of the board of directors 41
shall serve the term to which they were elected or appointed 42
and until their successors are elected and qualified.] 43
190.052. Any member of the board of directors who 1
moves residency from the district [from which the member was 2
elected] shall be disqualified as a member of the board. If 3
one or two vacancies occur in the membership of the board as 4
a result of death, resignation, or disqualification, the 5
remaining members shall appoint one or two qualified 6
persons, as provided in section 190.050, to fill the 7
vacancies until the end of the unexpired term. Such 8
appointment shall be made with the consent of a majority of 9
the remaining members of the board. If the board is unable 10
to agree in filling a vacancy [within sixty days or if there 11
CCS HCS SS SB 975 7
are more than two vacancies at any one time], the county 12
commission, upon [notice from the board of failure to agree 13
in filling the vacancies] the written request of a majority 14
of the remaining board members or the ambulance service 15
administrator, as described in section 190.112, shall within 16
[ten] thirty calendar days fill them by appointment of 17
qualified persons, as provided in section 190.050, and shall 18
notify the persons in writing of their appointment. The 19
persons appointed shall serve for the unexpired term. 20
190.070. 1. A petition for annexation of land to an 1
ambulance district shall be signed by not less than ten 2
percent or fifty voters, whichever is fewer, residing within 3
the territory therein described proposed for annexation and 4
shall be filed with the county clerk of the county in which 5
the district or the greater portion thereof is situated, and 6
shall be addressed to the commissioners of the county 7
commission. A hearing shall be held thereon [as nearly as 8
possible as in the case of a formation petition] within 9
thirty days of the filing of such petition. If upon the 10
hearing the commissioners of the county commission find that 11
the petition is in compliance with the provisions of 12
sections 190.005 to 190.085, they shall order the question 13
to be submitted to the voters within the territory and 14
within the district. 15
2. The question shall be submitted in substantially 16
the following form to all of the voters in the existing 17
ambulance district and the area proposed to be annexed: 18
Shall ______ (description of territory) be 19
annexed to the ______ ambulance district, and a 20
tax imposed within such annexed area equal to 21
the existing rate of the _____ ambulance 22
district? 23
CCS HCS SS SB 975 8
3. If a majority of the votes cast on the question [in 24
the district and in the territory described in the petition, 25
respectively,] are in favor of the annexation, the 26
commissioners of the county commission shall, within thirty 27
days of the certification of the election results, by order 28
declare the territory annexed and shall describe the altered 29
boundaries of the district. A copy of the same shall be 30
filed with the county clerk. 31
190.089. Upon voter approval of an ambulance district 1
consolidation at an election, the department shall 2
prioritize and expedite any activities necessary to 3
facilitate the consolidation. 4
190.090. 1. Two or more organized ambulance districts 1
may consolidate into one ambulance district by following the 2
procedures set forth in this section. 3
2. If the consolidation of existing ambulance 4
districts is desired, a number of voters residing in an 5
existing ambulance district equal to ten percent of the vote 6
cast for governor in the existing district in the next 7
preceding gubernatorial election may file with the county 8
clerk in which the territory or greater part of the proposed 9
consolidated district is situated a petition requesting the 10
consolidation of two or more existing ambulance districts. 11
3. The petition shall be in the following form: 12
We, the undersigned voters of the ______ 13
ambulance district do hereby petition that 14
______ existing ambulance districts be 15
consolidated into one consolidated ambulance 16
district to be known as the _____ Ambulance 17
District, subject to the attached consolidation 18
plan. 19
CCS HCS SS SB 975 9
4. An alternative procedure of consolidation may be 20
followed, if the board of directors of the existing 21
ambulance districts pass a resolution in the following form: 22
Be it resolved by the board of directors of the 23
ambulance district that the ______ ambulance 24
districts be consolidated into one consolidated 25
ambulance district to be known as the _____ 26
Ambulance District, subject to the attached 27
consolidation plan. 28
5. Every petition or resolution shall be accompanied 29
by a consolidation plan outlining the process for the 30
proposed consolidation. At a minimum, the consolidation 31
plan shall include the following: 32
(1) The name of the proposed consolidated district, a 33
legal description of the boundaries of such consolidated 34
district, and the proposed tax levy to be imposed by the 35
consolidated district. In the event that the proposed plan 36
is for the consolidation into an existing district, the 37
consolidation plan shall clearly state that the existing 38
district shall continue as the legal entity into which the 39
other districts are consolidated; 40
(2) The names of the districts to be consolidated, 41
accompanied by a list of all real property owned and 42
financial assets currently held by the district, all 43
outstanding bonds or debts of each of such districts, and 44
the current tax levies imposed by each of such districts; 45
(3) The name of the district that shall be responsible 46
for maintaining ambulance service during the consolidation, 47
including continuing operations, administration, and 48
governance of the consolidated district, provided that there 49
shall be a presumption that the district with the largest 50
CCS HCS SS SB 975 10
operating budget in the preceding fiscal year shall assume 51
such responsibility; 52
(4) The proposed number of board members and specific 53
individuals who will serve as the initial directors, 54
provided that such directors shall be chosen from among the 55
existing board members of the districts to be consolidated 56
such that there is at least one director from each of the 57
districts to be consolidated; and 58
(5) A proposed timeline for consolidation, which shall 59
not exceed one hundred eighty days, provided that such 60
timeline shall be subject to modification by the board of 61
the consolidated district for good cause. 62
6. Upon the filing of a petition, or a resolution, and 63
a consolidation plan with the county clerk from each of the 64
ambulance districts proposed to be consolidated, the county 65
clerk shall present the petition or resolution and a 66
consolidation plan to the commissioners of the county 67
commission [having jurisdiction who shall thereupon order 68
the submission of the question to the voters of the 69
districts. The filing of each of the petitions in the 70
ambulance districts shall have occurred within a continuous 71
twelve-month period. 72
6. The notice shall set forth the names of the 73
existing ambulance districts to be included in the 74
consolidated district. 75
7. The question shall be submitted in substantially 76
the following form: 77
Shall the existing ______ ambulance districts be 78
consolidated into one ambulance district? 79
8. If the county commission having jurisdiction finds 80
that the question to consolidate the districts received a 81
CCS HCS SS SB 975 11
majority of the votes cast, the commission shall make and 82
enter its order declaring that the proposition passed. 83
9. Within thirty days after the district has been 84
declared consolidated, the county commission shall divide 85
the district into six election districts and shall order an 86
election to be held and conducted as provided in section 87
190.050 for the election of directors. 88
10. Within thirty days after the election of the 89
initial board of directors of the district, the directors 90
shall meet and the time and place of the first meeting of 91
the board shall be designated by the county commission. At 92
the first meeting the newly elected board of directors shall 93
choose a name for the consolidated district and shall notify 94
the clerk of the county commission of each county within 95
which the consolidated district is located of the name of 96
the consolidated district. 97
11. On the thirtieth day following the election of 98
the board of directors, the existing ambulance districts 99
shall cease to exist and the consolidated district shall 100
assume all of the powers and duties exercised by those 101
districts. All assets and obligations of the existing 102
ambulance districts shall become assets and obligations of 103
the consolidated district], who shall record such documents 104
in the records of the county. A petition or resolution for 105
a proposed consolidation shall be received from all 106
ambulance districts within the same calendar year or shall 107
be considered null and void. 108
7. Each of the ambulance districts seeking to 109
consolidate shall post the notice of the intent to 110
consolidate in the same manner as district public meetings 111
are posted. In addition, publication of such notice of 112
intent shall be made in a newspaper of general circulation 113
CCS HCS SS SB 975 12
in every county in which the proposed consolidated ambulance 114
district shall be located, with publication to be made once 115
per week for two consecutive weeks. A public hearing shall 116
be held jointly by all ambulance districts seeking to 117
consolidate at a location within the boundaries of the 118
proposed consolidated ambulance district, provided that such 119
hearing shall be no more than thirty days after the date of 120
the second publication. The notice of intent shall be in 121
substantially the following form: 122
123
124
125
NOTICE OF THE FILING OF A PETITION/RESOLUTION
FOR CONSOLIDATION OF THE ______ AMBULANCE
DISTRICTS
126
127
128
129
130
131
132
133
134
135
To all voters, residents, and interested
persons within the boundaries of the above
described ambulance districts: You are hereby
notified that a petition/resolution has been
filed for the consolidation of the above named
ambulance districts into one consolidated
ambulance district to be known as the _____
Ambulance District. A proposed consolidation
plan is available for inspection at the office
of the County Clerk of _____ County.
136
137
138
139
140
141
A public hearing will be held on ______ (date)
at ________ (time) at the following location:
________. The purpose of this public hearing
shall be to explain the reasons for the
consolidation and answer questions from the
public.
142
143
144
145
146
147
148
Objections to this consolidation may be filed
with the County Clerk of _____ County,
provided such objections are filed in writing
not less than thirty days after the public
hearing. Any such objection must be signed by
a number of voters residing in the proposed
consolidated district that is not less than
CCS HCS SS SB 975 13
8. If no objections are filed with the county clerk 152
within thirty days after the public hearing, within forty- 153
five days following the date of the public hearing, the 154
county commission shall order the districts consolidated 155
pursuant to the terms of the consolidation plan and shall 156
further appoint as directors those individuals identified in 157
the consolidation plan. The county commission shall further 158
set a date, time, and location for the first meeting of the 159
directors of the newly consolidated district. 160
9. Upon receipt of any objections filed, the county 161
clerk shall verify that such objections are signed by the 162
necessary number of voters of the district. If such 163
objections are signed by an appropriate number of voters, 164
the county commission of each county in which the proposed 165
consolidated district is to be located shall thereupon order 166
the submission of the question to the voters of the 167
districts. The question shall be submitted in substantially 168
the following form: 169
149
150
151
five percent of the votes cast for governor in
the district in the most recent gubernatorial
election.
170
171
172
173
174
175
176
177
178
Shall the existing ______ ambulance districts
be consolidated into one ambulance district to
be known as the _________ Ambulance District,
with such consolidated district authorized to
levy a property tax not to exceed the annual
rate of ______ cents on the hundred dollars
assessed valuation or a sales tax in an amount
not to exceed ______ percent, or a combination
of both?
CCS HCS SS SB 975 14
If the county commission having jurisdiction finds that the 179
question to consolidate the districts received a majority of 180
the votes cast, the commission shall make and enter its 181
order declaring that the proposition passed. The county 182
commission shall further order the districts consolidated 183
pursuant to the terms of the consolidation plan and shall 184
further appoint as directors those individuals identified in 185
the consolidation plan. The county commission shall further 186
set a date, time, and location for the first meeting of the 187
directors of the newly consolidated district. 188
10. Notwithstanding any other provision of law to the 189
contrary, the consolidated district may impose an initial 190
tax levy up to the highest tax levy of the consolidating 191
districts, provided such tax levy is specifically set forth 192
in the ballot language submitted to and approved by the 193
voters of the consolidating district. 194
11. Without a vote of the residents of the 195
consolidated district as provided in this section, no 196
consolidated ambulance district shall be permitted to impose 197
a property tax greater than the lowest of any existing 198
property tax rate of the districts to be consolidated, nor 199
shall the consolidated ambulance district be permitted to 200
impose any sales tax greater than the lowest of any existing 201
sales tax rate of the districts to be consolidated. 202
12. Upon written certification by the board of 203
directors of the consolidated district to the prior district 204
that the consolidated district has obtained the necessary 205
licenses and permits to operate an ambulance service and all 206
directors of such consolidated district have completed the 207
training required by section 190.053, the existing ambulance 208
districts shall cease to exist and the consolidated district 209
CCS HCS SS SB 975 15
shall assume all of the powers and duties exercised by those 210
districts. All assets and obligations of the existing 211
ambulance districts shall become assets and obligations of 212
the consolidated district. 213
590.192. 1. There is hereby established the "Critical 1
Incident Stress Management Program" within the department of 2
public safety. The program shall provide services for peace 3
officers and first responders to assist in coping with 4
stress and potential psychological trauma resulting from a 5
response to a critical incident or emotionally difficult 6
event. Such services may include consultation, risk 7
assessment, education, intervention, and other crisis 8
intervention services provided by the department to peace 9
officers and first responders affected by a critical 10
incident. For purposes of this section, a "critical 11
incident" shall mean any event outside the usual realm of 12
human experience that is markedly distressing or evokes 13
reactions of intense fear, helplessness, or horror and 14
involves the perceived threat to a person's physical 15
integrity or the physical integrity of someone else. For 16
purposes of this section, the term "first responder" shall 17
have the same meaning as first responder in section 190.1010. 18
2. All peace officers and first responders shall be 19
required to meet with a program service provider once every 20
three to five years for a mental health check-in, or 21
participate in a department-established behavioral health or 22
mental health program that meets the requirements of 23
subsection 1 of this section which shall satisfy this 24
requirement. The program service provider shall send a 25
notification to the peace officer's commanding officer, or 26
first responder's commanding officer, or first responder's 27
CCS HCS SS SB 975 16
director or supervisor that he or she completed such check- 28
in. 29
3. Any information disclosed by a peace officer or 30
first responder shall be privileged and shall not be used as 31
evidence in criminal, administrative, or civil proceedings 32
against the peace officer or first responder unless: 33
(1) A program representative reasonably believes the 34
disclosure is necessary to prevent harm to a person who 35
received services or to prevent harm to another person; 36
(2) The person who received the services provides 37
written consent to the disclosure; or 38
(3) The person receiving services discloses 39
information that is required to be reported under mandatory 40
reporting laws. 41
4. (1) There is hereby created in the state treasury 42
the "988 Public Safety Fund", which shall consist of moneys 43
appropriated by the general assembly. The state treasurer 44
shall be custodian of the fund. In accordance with sections 45
30.170 and 30.180, the state treasurer may approve 46
disbursements. The fund shall be a dedicated fund and 47
moneys in the fund shall be used solely by the department of 48
public safety for the purposes of providing services for 49
peace officers and first responders to assist in coping with 50
stress and potential psychological trauma resulting from a 51
response to a critical incident or emotionally difficult 52
event pursuant to subsection 1 of this section. Such 53
services may include consultation, risk assessment, 54
education, intervention, and other crisis intervention 55
services provided by the department to peace officers or 56
first responders affected by a critical incident. The 57
director of public safety may prescribe rules and 58
regulations necessary to carry out the provisions of this 59
CCS HCS SS SB 975 17
section. Any rule or portion of a rule, as that term is 60
defined in section 536.010, that is created under the 61
authority delegated in this section shall become effective 62
only if it complies with and is subject to all of the 63
provisions of chapter 536 and, if applicable, section 64
536.028. This section and chapter 536 are nonseverable and 65
if any of the powers vested with the general assembly 66
pursuant to chapter 536 to review, to delay the effective 67
date, or to disapprove and annul a rule are subsequently 68
held unconstitutional, then the grant of rulemaking 69
authority and any rule proposed or adopted after August 28, 70
2021, shall be invalid and void. 71
(2) Notwithstanding the provisions of section 33.080 72
to the contrary, any moneys remaining in the fund at the end 73
of the biennium shall not revert to the credit of the 74
general revenue fund. 75
(3) The state treasurer shall invest moneys in the 76
fund in the same manner as other funds are invested. Any 77
interest and moneys earned on such investments shall be 78
credited to the fund. 79