190.166.  License sanction, when — corrective plan — department duties. — 1.  In addition to the provisions of section 190.165, the department of health and senior services may refuse to issue, deny renewal of, or suspend a license required pursuant to section 190.109, or take other corrective actions as described in this section, based on the following considerations:

  (1)  The license holder is determined to be financially insolvent;

  (2)  The ambulance service has inadequate personnel to operate the ambulance service to provide basic emergency operations.  The ambulance service shall not be deemed to have such inadequate personnel as long as the ambulance service staffs to meet the needs of its emergency call volume.  Smaller ambulance services shall have the ability to staff a minimum of one ambulance unit twenty-four hours each day, seven days each week, with at least two licensed emergency medical technicians, and have a reasonable plan and schedule for the services of a second ambulance unit;

  (3)  The ambulance service requires an inordinate amount of mutual aid from neighboring services, such as more than ten percent of the total runs in the service area in any given month, or than would be considered prudent and thus cannot provide an appropriate level of emergency response for the service area as would be considered prudent by the typical ground ambulance services operator;

  (4)  The principal manager, board members, or other executives are determined to be criminally liable for actions related to the license or service provided;

  (5)  The license holder or principal manager, board members, or other executives are determined by the Centers for Medicare and Medicaid Services to be ineligible for participation in Medicare;

  (6)  The license holder or principal manager, board members, or other executives are determined by the MO HealthNet division to be ineligible for participation in MO HealthNet;

  (7)  The ambulance service administrator has failed to meet the required qualifications or failed to complete the training required pursuant to section 190.112; and

  (8)  Three or more board members have failed to complete required training pursuant to section 190.053 if the ambulance service is an ambulance district.

  2.  If the department makes a determination of insolvency or insufficiency of operations of a license holder under subsection 1 of this section, then the department may require the license holder to submit a corrective plan within fifteen days and require implementation of the corrective plan within thirty days.

  3.  The department shall be required to provide notice of any determination by the department of insolvency or insufficiency of operations of a license holder to other license holders operating in the license holder's vicinity, members of the general assembly who represent the license holder's service area, the governing officials of any county or municipal entity in the license holder's service area, the appropriate regional emergency medical services advisory committee, and the state advisory council on emergency medical services.

  4.  The department shall immediately engage with other license holders in the area to determine the extent to which ground ambulance service may be provided to the affected service area during the time in which the license holder is unable to provide adequate services, including any long-term service arrangements.  The nature of the agreement between the license holder and other license holders providing services to the affected area may include an agreement to provide services, a joint powers agreement, formal consideration, or some payment for services rendered.

  5.  Any license holder who provides assistance in the service area of another license holder whose license has been suspended under this section shall have the right to seek reasonable compensation from the license holder whose license to operate has been suspended for all calls, stand-by time, and responses to medical emergencies during such time as the license remains suspended.  The reasonable compensation shall not be limited to those expenses incurred in actual responses, but may also include reasonable expenses to maintain ambulance service, including, but not limited to, the daily operation costs of maintaining the service, personnel wages and benefits, equipment purchases and maintenance, and other costs incurred in the operation of a ground ambulance service.  The license holder providing assistance shall be entitled to an award of costs and reasonable attorney fees in any action to enforce the provisions of this subsection.