COMMITTEE ON LEGISLATIVE RESEARCH
OVERSIGHT DIVISION
FISCAL NOTE
L.R. No.:3928H.01I Bill No.:HB 1630 Subject:Physicians; Department of Health and Senior Services; Health Care Professionals Type:Original Date:February 7, 2022Bill Summary:This proposal establishes a grant program for primary care physicians
working and residing in rural counties.
FISCAL SUMMARY
ESTIMATED NET EFFECT ON GENERAL REVENUE FUNDFUND AFFECTEDFY 2023FY 2024FY 2025
General Revenue*
More than or Less
than ($375,917)
More than or Less
than ($379,522)
More than or less than
($380,283)
Total Estimated Net
Effect on General
Revenue
More than or Less
than ($375,917)
More than or Less
than ($379,522)
More than or less
than ($380,283)
*Program is subject to appropriation. Oversight used a similar program - the Federal State Loan
Repayment Program (SLRP) already in DHSS to estimate the number of grantees (30) receiving
the $10,000 annual award (actual count could vary substantially).
ESTIMATED NET EFFECT ON OTHER STATE FUNDSFUND AFFECTEDFY 2023FY 2024FY 2025Rural Primary Care
Physician Grant
Program Fund*$0$0$0
Total Estimated Net
Effect on Other State
Funds $0$0$0
*Oversight assumes Transfers-In and expenditures (grants) would net to zero.
Numbers within parentheses: () indicate costs or losses. L.R. No. 3928H.01I
Bill No. HB 1630
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February 7, 2022
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ESTIMATED NET EFFECT ON FEDERAL FUNDSFUND AFFECTEDFY 2023FY 2024FY 2025Total Estimated Net
Effect on All Federal
Funds $0$0$0
ESTIMATED NET EFFECT ON FULL TIME EQUIVALENT (FTE)FUND AFFECTEDFY 2023FY 2024FY 2025General Revenue0 or 1 FTE0 or 1 FTE0 or 1 FTETotal Estimated Net
Effect on FTE0 or 1 FTE0 or 1 FTE0 or 1 FTE
☒ Estimated Net Effect (expenditures or reduced revenues) expected to exceed $250,000 in any
of the three fiscal years after implementation of the act or at full implementation of the act.
☐ Estimated Net Effect (savings or increased revenues) expected to exceed $250,000 in any of
the three fiscal years after implementation of the act or at full implementation of the act.
ESTIMATED NET EFFECT ON LOCAL FUNDSFUND AFFECTEDFY 2023FY 2024FY 2025Local Government$0$0$0 L.R. No. 3928H.01I
Bill No. HB 1630
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February 7, 2022
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FISCAL ANALYSIS
ASSUMPTION
§191.620 – Grant program for primary care physicians working and residing in rural areas
Officials from the Department of Health and Senior Services (DHSS) state the proposed
legislation would create a new grant program for rural primary care physicians. The legislation
also creates a new fund “Rural Primary Care Physician Grant Program Fund” which shall consist
of the moneys appropriated for the new grant program. Section 191.620.2 of the proposed
legislation provides that grants will be made “on the basis of available funds.” The DHSS does
not have an estimate for the funding that would appropriated to the program for the purpose of
providing grant funds to rural primary care physicians. DHSS assumes that all funds
appropriated to the Rural Primary Care Physician Grant Program Fund will be transferred from
General Revenue.
DHSS assumes that funding will be appropriated. The minimum staffing DHSS estimates that
will be needed to administer the new grant program is one (1) FTE. The FTE will be required to
implement and manage the program and to develop grant agreements as required by the
legislation. The position would be classified as a Public Health Program Specialist, with an
estimated salary of $44,235 based on the average annual salary of the position in the Division of
Community and Public Health as of January 2021. Staffing level needs will increase depending
on the amount appropriated for grants.
Oversight assumes the DHSS will not need additional space for one new FTE and will remove
rental costs from the estimated costs provided by the DHSS. However, if multiple proposals pass
this session which result in the DHSS needing additional rental space, the DHSS can request
additional funding through the appropriations process.
Oversight notes there are currently (based on 2020 census) 82 counties in Missouri with less
than 35,000 in population.
Oversight notes this program, if enacted, is very similar to the federal State Loan Repayment
Program (SLRP) already in the DHSS. According to the DHSS 2023 budget request, the Health
Professional State Loan Repayment Program (SLRP) provides educational loan repayment to
practicing medical, dental, health, and mental health professionals in exchange for service in
Missouri areas with a shortage of health professionals. The SLRP grant requires one dollar of
state funds for each dollar of federal funds. Awards for the SLRP were 18 in FY 2019; 25 in FY
2020; 26 in FY 2021; and are projected by be 30 for each FY 2022, 23 and 24. For fiscal note
purposes, Oversight will utilize the projected number of applicants (30) for this program for an
annual cost for grants of $300,000 (30 x $10,000). L.R. No. 3928H.01I
Bill No. HB 1630
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February 7, 2022
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Officials from the Department of Commerce and Insurance, the Department of Revenue and
the Office of the State Treasurer each assume the proposal will have no fiscal impact on their
respective organizations. Oversight does not have any information to the contrary. Therefore,
Oversight will reflect a zero impact in the fiscal note for these agencies.
Rule Promulgation
Officials from the Joint Committee on Administrative Rules assume this proposal is not
anticipated to cause a fiscal impact beyond its current appropriation.
Officials from the Office of the Secretary of State (SOS) note many bills considered by the
General Assembly include provisions allowing or requiring agencies to submit rules and
regulations to implement the act. The SOS is provided with core funding to handle a certain
amount of normal activity resulting from each year's legislative session. The fiscal impact for
this fiscal note to the SOS for Administrative Rules is less than $5,000. The SOS recognizes that
this is a small amount and does not expect that additional funding would be required to meet
these costs. However, the SOS also recognizes that many such bills may be passed by the
General Assembly in a given year and that collectively the costs may be in excess of what the
office can sustain with its core budget. Therefore, the SOS reserves the right to request funding
for the cost of supporting administrative rules requirements should the need arise based on a
review of the finally approved bills signed by the governor. L.R. No. 3928H.01I
Bill No. HB 1630
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FISCAL IMPACT – State GovernmentFY 2023
(10 Mo.)
FY 2024FY 2025GENERAL REVENUE FUNDTransfer-out – to the Rural Primary
Care Physician Grant Program Fund
(§191.620)
More than or
Less than
($300,000)
More than or
Less than
($300,000)
More than or
Less than
($300,000)
Costs – DHSS (§191.620) Personal services ($36,863) ($44,677) ($45,124) Fringe benefits ($23,876) ($28,812) ($28,975) Equipment and expense ($15,178) ($6,033) ($6,184) Grants$0 or
(Unknown)
$0 or
(Unknown)
$0 or
(Unknown)
Total Costs - DHSS$0 or
(Unknown
greater than
$75,917)
$0 or
(Unknown
greater than
$79,522)
$0 or
(Unknown
greater than
$80,283)
FTE Change DHSS0 or 1 FTE0 or 1 FTE0 or 1 FTEESTIMATED NET EFFECT ON
THE GENERAL REVENUE FUND
More than or
Less than
($375,917)
More than or
less than
($379,522)
More than or
Less than
($380,283)
Estimated Net FTE Change on the
General Revenue Fund0 or 1 FTE0 or 1 FTE0 or 1 FTE
FISCAL IMPACT – State Government
(continued)
FY 2023
(10 Mo.)
FY 2024FY 2025 L.R. No. 3928H.01I
Bill No. HB 1630
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February 7, 2022
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RURAL PRIMARY CARE
PHYSICIAN GRANT PROGRAM
FUND
Transfer – in – from the General
Revenue Fund (§191.620)
More than or
Less than
($300,000)
More than or
Less than
($300,000)
More than or
Less than
($300,000)
Expense – DHSS – Grants (§191.620)More than or
Less than
($300,000)
More than or
Less than
($300,000)
More than or
Less than
($300,000)
ESTIMATED NET EFFECT ON
THE RURAL PRIMARY CARE
PHYSICIAN GRANT PROGRAM
FUND $0$0$0
FISCAL IMPACT – Local GovernmentFY 2023
(10 Mo.)
FY 2024FY 2025$0$0$0
FISCAL IMPACT – Small Business
This may have a direct positive fiscal impact on small business physicians’ offices in rural areas.
(§191.620)
FISCAL DESCRIPTION
This bill mandates that the Department of Health and Senior Services (DHSS) shall, subject to
appropriations, establish a rural primary care physician grant program that provides incentives
for physicians to practice and reside in rural counties, defined as counties with fewer than 35,000
inhabitants. The Department shall post eligibility criteria, contents of the grant application, and
procedures and time lines by which physicians may apply for grants to enter into a grant
agreement with DHSS. Provisions of grant agreements include that the physician must practice
and reside in the rural county for a period of five years and a statement of damages to which the
state is entitled should the physician breach the grant agreement. L.R. No. 3928H.01I
Bill No. HB 1630
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February 7, 2022
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This bill establishes the "Rural Primary Care Physician Grant Program Fund". Moneys in the
Fund shall be used solely for awarding grants and administering the grant program.
This legislation is not federally mandated, would not duplicate any other program and would not
require additional capital improvements or rental space.
SOURCES OF INFORMATION
Department of Commerce and Insurance
Department of Health and Senior Services
Department of Revenue
Office of the Secretary of State
Office of the State Treasurer
Joint Committee on Administrative Rules
Julie MorffRoss StropeDirectorAssistant DirectorFebruary 7, 2022February 7, 2022