Legislative Update for Missouri EMS

Update on current issues (5/15/16):

Session is over for 2016.

Patient Safety & Quality Act of 2005 - How to choose a PSO - Here is a brochure from AHRQ (part of federal government) on how to measure a PSO and decide.   

Federal EMS Legislation

Federal Controlled Substance Act - Both Congressman Graves & Luetkemeyer have now co-signed the bill in Congress (along with Congressman Long).

Funding for CP - Article that Kenneth McKenzie, Oregon County Ambulance District, found: http://www.ems-financial.com/blog/get-paid-for-community-paramedicine-65.php

DEA Bill - HR 4365 now has 3 Missouri members of congress as co-sponsors. The bill is up to 63 co-sponsors and now has a House hearing set. A senate version is almost done. This is moving forward.

Veterans Bill - HR 1818 had a hearing in the House.  It passed and is now headed for a floor vote in the US Congress.

Veteran Emergency Medical Technician Support Act Passes the U.S. House of Representatives 

On May 12, the U.S. House of Representatives passed H.R. 1818, the Veterans EMT Support Act, by a vote of 415 to 1. The legislation assists military medic veterans to efficiently transition their military medical training into the civilian workforce and addresses the shortage of emergency medical technicians in states.

This has been a key legislative priority of the National Association of Emergency Medical Technicians (NAEMT), as well as other national and state EMS organizations. H.R. 1818 directs the Department of Health and Human Services to establish a demonstration program for states with a shortage of emergency medical technicians to develop a streamlined transition program for trained military medics to meet state EMT licensure requirements.

NAEMT is grateful to Reps. Adam Kinzinger (R-IL) and Lois Capps (D-CA) for their bipartisan introduction of the bill. They have remained committed to its passage and have been unwavering in their support.

Rep. Kinzinger remarked, "I'm proud to see H.R. 1818 pass the House with such strong bipartisan support. The Veteran EMT Support Act is a common sense bill that helps veterans transition into civilian careers, improve public health, and ensure communities have first responders to answer challenging emergency calls like opioid overdoses. Thank you to Congresswoman Lois Capps for her strong support and advocacy of this bill. I look forward to the Senate taking up this important legislation and the several others that were passed this week to help combat the thousands of opioid overdose deaths each year."

"The Veterans EMT Support Act is an important step forward to help veterans in their transition back to civilian life, while improving emergency care in our communities," said Rep. Lois Capps. "These heroes have proven their skills on the battlefield. It is only right that we break down any artificial barriers that delay or prevent them from serving our communities here at home."

"The bill's passage is a direct result of advocacy efforts by thousands of EMS professionals and other supporters of military-to-civilian transition programs," NAEMT President Conrad "Chuck" Kearns said. "We applaud all who contributed to the bill's passage by visiting their representatives, by sending emails and letters requesting congressional support, or by walking the halls of our nation's Capitol during EMS On The Hill Day on April 20. Our efforts provided the momentum to achieve today's victory, and honors the bravery and sacrifice of our military veterans."

Learn more about NAEMT's legislative priorities and EMS advocacy at naemt.org/advocacy.

Key Legislative Bills for Missouri EMS

These issues (except for the budget topics) are part of legislation that has passed the Missouri General Assembly and is now on the Governor's desk for his consideration. The budget items are already approved and final.

$45 increase to base rate of Medicaid emergency calls - This occurred through the state budget and will occur due to the FRA creating the leverage for additional federal funds leading to the $45 increase effective July 1, 2016.  Credit to the Mo Ambulance Assoc lobbyists.

Medicaid Payments - $1.6 million was put into the state budget to start providing Medicaid payments for treatment no transport.  A task force is starting work on this now. This is starting a new idea and will take some changes by Mo Medicaid. Credit to BJC folks and their lobbyist.

GEMT - Another Medicaid supplemental funding program. Credit to Mo Fire Chiefs and the FSA lobbyist.

FRA - Regular legislative renewal of the whole state FRA program for 2 years. This is about $13 million/ year that goes to the ambulance FRA program. Credit Mo Hosp Assoc, Mo Nursing Home Assoc, Mo Pharmacy Assoc, Mo Amb Assoc, FSA.

Narcan - Allows any pharmacist to provide Narcan to family and friends to try and make Narcan available into the areas where it might be available where ODs occur.  Credit to Rep. Lynch.

CPR for high school grads - Requires each student completing high school to have 30 minutes of CPR instruction. This gives EMS an opportunity to help local high schools to successfully fulfill this requirement. Credit to AHA.

Military / Paramedic testing - Requires initial paramedic license to use either National Registry or a test developed and administered by DHSS.  This should clarify that Veterans must take NR test to fulfill paramedic licensure requirements. Credit to Rep. Dave Hinson.

TCD - Makes revisions to the TCD law so that hospitals with national accreditation can be recognized instead of the duplicate effort by DHSS doing accreditation of Stroke centers and makes changes to the data collection process of TCD data.  Credit to Mo Hosp Assoc.

DHSS can not set CE requirements for doctors - Only the Board of Health can do this. This is a response to the current DHSS TCD regulations.  Credit the Mo Hosp Assoc.

Helio Pad Safety - Credit to Helio folks in MO and the Mo Hosp Assoc.

Mandatory Reporting of Elder Abuse by EMS - Some clean-up to make it very clear that EMS personnel are mandatory reporters of Elder Abuse.  Credit to the DHSS & Rep. Hinson.

Background Checks by Ambulance Districts - The current state law allows for almost all local governments to conduct fingerprint checks as part of background checks, but not Ambulance Districts.  Credit to Marion County Amb Dist & Rep. Shumake.

Psych - Provides liability protection for EMS in dealing with Psych patients, same as doctors and police; requires hospitals to notify EMS when transferring patients who may be violent and allows ED doctors to place psych patients under a formal legal hold during the transfer to a psych facility.  Credit to Drs. Reich & Gustafson, Frank Foster & Alan Holtcamp along with the Mo Amb Assoc lobbyist.

EMS Discipline issues by DHSS - Clean-up and adjustments as worked out by DHSS & SAC 3 years ago.  Credit to Mo Amb Assoc.

EMS Regional Council - Some clean-up language.  Credit to Mo Amb Assoc.

Volunteer FF Workers Comp - Legislation that provides a serious benefit for volunteer fire departments was passed

Stoddard County 911 - Allows for the creation of 9-1-1 district for Stoddard County

Liberty / NKC - Allows for public safety sales tax option to assist with funding

Topics of impact to EMS that did not pass this year.........

9-1-1 - Failed in an ugly Senate floor action.  Sen. Schmitt required that SL County be carved out of the bill or he would filibuster. With that done Sen. Schaaf suddenly required that Platte and Buchanan Counties (his entire district) be carved out. This was a huge surprise as days before he had stated his support for the bill. This led to Sen. Emery asking for 3 new amendments (which were worked out and adopted). During the Wed. debate of over an hour clearly the bill was in trouble. It was laid over until Thursday and brought back up for another 45 minutes during which Sen. Schaaf reaffirmed that his area must be carved out despite the requests by many public officials in his area (in fact we can find only one public official in his area that want to be carved out). This lead to a breakdown of commitments by other senators and soon Sen. Curls from KCMO required Jackson County be carved out and then Sen. Weiland required Jefferson County be carved out. Then Sen. Brown began a filibuster with the bill due to the fact that since much of the state (5 big counties) had been carved out, the legislation would not work. While seriously damaged the bill would have still accomplished a lot and some repairs could be made in 2017, we would still have preferred to pass the bill but Sen. Brown indicated he would not leave the floor until the bill was set aside for the year. Ugly, and for those parts of the state needing help with 9-1-1, a shame. We are now the only state in the nation to have not fixed this issue for 12 years and running.

CIT - This issue went through a hearing in the Senate and had no opposition, but in its first year did not advance.  Will be pushed in 2017 with leadership of Drs. Reich & Gustafson

TIF reform - This issue has been around for several years, creates some tricky politics but is passable. Many Ambulance and Fire districts have taken severe losses related to TIF programs.  This legislative approach would shift more power related to the TIF programs to the Ambulance & Fire District boards.  Leadership has been Mo Amb Assoc.

Retirement / LAGERS for ambulance district personnel - This legislation just did not have enough energy to advance. The legislation would allow ambulance districts to consider setting LAGERS retirement at the same level that firefighters presently have.  Leadership was LAGERS Board and Rep. Dave Hinson.

LODD - This was year 3 for this legislation. It passed the House and had a good hearing in the Senate but died. The House sponsor was blackballed by leadership due to an unrelated matter meaning that the legislation he sponsored was dead.  Topic well positioned for next year.

Fund Protection for amb district - This has been around for several years. This would require that ambulance districts take the same protections of district funds as required by law of other local government entities. Leadership has been Rep. Love.

Special Needs - Late in the session some legislation was developed to allow regional medical directors to prepare template protocols to assist local medical directors to standardize the approach to these patients.  Leadership has been Rep. Hubrecht.

Interstate Compact - Was passed by the House but late in the session. There are now 7 states that have passed it (need 10 for the compact to go active). We expect another 3-5 states to pass it in 2017. In Missouri, Interstate Compacts for Nurses and Physical Therapists have passed the General Assembly this year and are on the Governor's desk. Expect a renewed effort in 2017.