Missouri Code of State Regulations › Title 19 - DEPARTMENT OF HEALTH AND SENIOR SERVICES › Division 30 - Division of Regulation and Licensure › Chapter 40 - Comprehensive Emergency Medical Services Systems Regulations › Section 19 CSR 30-40.810 - Ground Ambulance Transport of Patients to Locations That Are Not Hospitals

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This rule establishes training and transport
				  requirements for ground ambulances to transport patients to Missouri Department
				  of Mental Health designated behavioral health crisis centers and other
				  locations for those patients who do not require transport to a hospital and
				  whose health needs can be met by behavioral health crisis centers or these
				  other locations where patients are transported.
EMERGENCY STATEMENT: This emergency rule establishes
				  training and transport requirements for ground ambulances to transport patients
				  to Missouri Department of Mental Health designated behavioral health crisis
				  centers and other locations for those patients who do not require transport to
				  a hospital and whose health needs can be met by behavioral health crisis
				  centers or other locations where patients are transported. The Missouri
				  Department of Mental Health filed
				  9 CSR
				  30-7.010 on November 2, 2022, which created
				  regulations for behavioral health crisis centers. Regulation
				  9 CSR
				  30-7.010 became effective on June 30, 2023. The
				  purpose of these behavioral health crisis centers is to interrupt and/or
				  ameliorate a behavioral health crisis experience with the goal of symptom
				  reduction, observation, stabilization, and restoration to a previous level of
				  functioning for the individuals being served. Currently, there are eighteen
				  (18) behavioral health crisis centers located throughout Missouri with six (6)
				  planned expansion locations. These behavioral health crisis centers provide an
				  alternative location for emergency medical services "EMS" and law enforcement
				  to transport individuals experiencing a behavioral health crisis who do not
				  require hospitalization/a level of medical care that only hospitals can
				  provide. By transporting these individuals to behavioral health crisis centers,
				  these patients can receive individualized services to stabilize their immediate
				  crisis, which may include linking the individual to additional treatment
				  services, for further evaluation and/or to behavioral health services. EMS and
				  hospitals in Missouri are extremely busy and understaffed in many areas of
				  Missouri. This rule encourages EMS to consider alternative transport to
				  behavioral health crisis centers and other locations to provide more
				  individualized services for individuals seeking assistance by EMS who do not
				  require a hospital level of care and who can benefit from these individualized
				  services to meet their immediate crisis needs and a linkage to other services
				  for long-term treatment. This rule also provides a framework for EMS to follow
				  when considering transport to behavioral health crisis centers, so that EMS can
				  get reimbursed for transport to behavioral health crisis centers by Medicaid in
				  the future. This emergency rule is necessary to protect a compelling
				  governmental interest to reduce the repetitive calls to EMS that strain the
				  emergency system from individuals who do not necessarily require a hospital
				  level of care, but who require individualized services that behavioral health
				  crisis centers and other locations can better meet the individuals' immediate
				  and long-term needs and promote the individuals' health and well-being. As a
				  result, the Department of Health and Senior Services finds a compelling
				  governmental interest, which requires this emergency action. A proposed rule,
				  which covers the same material, is published in this issue of the Missouri
				  Register. The scope of this emergency rule is limited to the circumstances
				  creating the emergency and complies with the protections extended in the
				  Missouri and United States Constitutions. The Department of Health and Senior
				  Services believes this emergency rule is fair to all interested persons and
				  parties under the circumstances. This emergency rule was filed February 26,
				  2024, becomes effective March 11, 2024, and expires September 06,
				  2024.
(1) As used in this
				rule, the following terms and phrases shall mean:
(A) Advanced emergency medical technician
				(also known as Emergency Medical Technician-Intermediate) - the midlevel of
				licensure of licensed emergency medical services' personnel who meet the
				requirements of 19 CSR
				30-40.342(5);
(B) Advanced life support shall mean an
				advanced level of care as provided to the adult and pediatric patient when a
				patient is in a more critical condition and a paramedic is required to assist
				in the treatment of the patient during transport by an ambulance;
(C) Basic life support shall mean a basic
				level of care, as provided to the adult and pediatric patient where only
				emergency medical technicians are on ambulances during transport;
(D) BHCC shall mean Behavioral Health Crisis
				Centers designated by the Missouri Department of Mental Health;
(E) Department shall mean the Missouri
				Department of Health and Senior Services;
(F) Emergency Medical Technician means the
				lowest level of licensure of licensed emergency medical services' personnel who
				meet the requirements in
				19 CSR
				30-40.342(2);
(G) Ground ambulance services shall mean
				ambulance services licensed under
				19 CSR
				30-40.309;
(H) Hospital shall mean the definition of
				hospital in section 197.020, RSMo or a hospital
				operated by the state of Missouri;
(I) Medical director shall mean the medical
				director of an ambulance service as required by
				19 CSR
				30-40.303; and
(J) Paramedic means the highest level of
				licensure of licensed emergency medical services' personnel who meet the
				requirements in 19 CSR
				30-40.342(4).