COMMITTEE ON LEGISLATIVE RESEARCH
OVERSIGHT DIVISION
FISCAL NOTE
L.R. No.:3723H.01I Bill No.:HB 1640 Subject:Workers Compensation; Labor and Management; Employees - Employers; Health
Care; Emergencies; Insurance - General
Type:Original Date:March 25, 2022Bill Summary:This proposal modifies provisions relating to workers' compensation.
FISCAL SUMMARY
ESTIMATED NET EFFECT ON GENERAL REVENUE FUNDFUND AFFECTEDFY 2023FY 2024FY 2025General Revenue*$0 to (Unknown)$0 to (Unknown)$0 to (Unknown)Total Estimated Net
Effect on General
Revenue$0 to (Unknown)$0 to (Unknown)$0 to (Unknown)
*Budget Requests for FY2023 reflects there are 1,398 FTE State Troopers in Missouri. If only
6.5% of those request PTSD treatment, and each deemed a valid case, the State of Missouri
would have minimal expenses of $105,560 (91*$1,160 – lower estimate for treatment) to
$429,884 (91*$4,724).
ESTIMATED NET EFFECT ON OTHER STATE FUNDSFUND AFFECTEDFY 2023FY 2024FY 2025Total Estimated Net
Effect on Other State
Funds $0$0$0
Numbers within parentheses: () indicate costs or losses. L.R. No. 3723H.01I
Bill No. HB 1640
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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 2025Total Estimated Net
Effect on FTE 000
☒ 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 Political
Subdivisions*
$0 to (Unknown)$0 to (Unknown)$0 to (Unknown)Local Government$0 to (Unknown)$0 to (Unknown)$0 to (Unknown)
* Using the lower spectrum of those first responders affected with PTSD (6.5%), the potential
cost for the local governments could range from $1,885,000 (1,625*$1,160) to $7,676,500
(1,625*$4,724) to the local political subdivisions. L.R. No. 3723H.01I
Bill No. HB 1640
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FISCAL ANALYSIS
ASSUMPTION
Officials from the Department of Labor and Industrial Relations (DOLIR) assume the
proposal would not have a direct fiscal impact on their organization.
Oversight notes that in response to the similar proposal, HB 1249 (2021), DOLIR further
elaborated on this proposal and determined that a change in coverage will not cost DOLIR/DWC
more money to administer. Additionally, since the vast majority of “first responders” are public
employees (not small business employees), this legislation should not have a significant impact
on private businesses (regardless of whether the premiums for public employers may or may not
rise).
Officials from the Office of Administration – Budget & Planning assume these changes could
potentially increase workers comp payouts, which could have a negative impact to state funds
due to increased expenditures.
Officials from the Office of Administration (OA) assume the legislation, specifically Section
287.067.9, creates a provision that PTSD is recognized as an occupational disease for first
responders. This change will affect the proof requirements to establish the injury of occupational
disease for first responders, and the costs to the state are unknown. The amount of cost increase,
if any, cannot be estimated as it would depend on the facts and circumstances of each case and
judicial interpretation of the changes.
Oversight notes, for illustrative purpose of this note, but excluding any proposals with data
including 2020 thru 2022 due to the COVID-19, South Carolina (SC) passed a similar bill, S429
(2016). The SC General Assembly noted the “this bill would have an expenditure impact on the
general fund, but an estimate could not be determined as the costs will depend upon the number
of workers' compensation claims filed in a given year.” This bill is not expected to impact federal
funds or other funds.” (Source:
https://www.masc.sc/Pages/programs/solutions/insurance/RiskLetter/Fall%202021/First-
Responder-PTSD-Assistance.aspx)
Additionally, “this bill would have a local expenditure impact on municipal and county
governments of $1,950,000 to $5,475,000 in FY 2015-16 based on estimates from the Municipal
Association and counties on increased premium costs and incurred claims expenses.” (Source:
https://www.scstatehouse.gov/sess121_2015-2016/prever/429_20150430.ht).
Oversight notes that the South Carolina General Assembly appropriated $500,000 annually to
the Workers Compensation Fund, since the passage of similar PTSD legislation S326 in 2016, to L.R. No. 3723H.01I
Bill No. HB 1640
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pay for PTSD claims for first responders. (Source: https://www.scstatehouse.gov/sess123_2019-
2020/appropriations2019/tap1b.htm
Oversight notes that the Ohio General Assembly, while passing HB 308 concerning First
Responder PTSD legislation, estimated that it is possible the bill might in future years affect the
state and political subdivisions’ costs and liabilities related to PTSD compensation and benefits.
The General Assembly also noted that it will need to transfer $500,000 into a special fund
maintained by OMB Office to take care of such a claims.
(Source: https://www.legislature.ohio.gov/download?key=15338&format=pdf;
Oversight also notes that Florida Department on Financial Services stated, in regards to fiscal
analysis of similar proposal (2018 House Bill 227 First Responders PTSD), that this proposal
would have likely significant negative impact to the state and local political subdivisions.
However, the amount is indeterminate depending on variation of number of claims meeting the
requirements of the proposal.
(Source: http://gencourt.state.nh.us/SofS_Archives/2018/house/SB553H.pdf).
Oversight notes that the officials from OA stated there could be a potential direct impact on
State agencies but the amount of cost increase, if any, cannot be estimated.
Oversight does not have any information to the contrary. Therefore, Oversight will range the
impact from zero impact (no future claims of PTSD) to a negative Unknown (employees will be
filing PTSD claims and meet the requirement of the proposal) in the fiscal note.
$250,000 threshold of negative impact to the General Revenue
Oversight notes the Budget Request 2023 shows there are 1,393 State Troopers in Missouri. If
only 6.5% (please see the explanation for the percentage below) of those request PTSD
treatment, and each deemed as a valid case, the State of Missouri would have minimal expense
of $105,560 (91*$1160 – lower estimate for treatment) to $429,884 (91*$4724).
Oversight notes that the above estimates are based on lowest possible percentage of such cases
filed within the first responders sub-group, therefore, the expense could reach greater amount of
expense in the future years.
Officials from the Department of Mental Health & Department of Health and Senior
Services both defer to the OA for the potential fiscal impact of this proposal.
Officials from the Office of Administration – Administrative Hearing Commission, the
Department of Commerce and Insurance, the Department of Economic Development, the
Department of Elementary and Secondary Education, the Department of Higher Education
and Workforce Development, the Department of Natural Resources, the Department of
Corrections, the Department of Public Safety – (Director’s
Office Capital Police, Fire Safety, State Emergency Management Agency, Missouri L.R. No. 3723H.01I
Bill No. HB 1640
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National Guard & Veterans Commission), the Department of Social Services, the Missouri
Department of Agriculture Missouri Department of Conservation, the Missouri
Department of Transportation – Patrol Employees’ Retirement System, the Petroleum
Storage Tank Insurance Fund, and the Office of the State Public Defender each assume the
proposal will not have a direct fiscal impact on their respective organizations. Officials from the
above organizations assume the proposal will have no fiscal impact on their organization.
Oversight does not have any information to the contrary. Therefore, Oversight will reflect a
zero impact in the fiscal note for these agencies.
Officials from the Missouri Department of Transportation (MoDOT) assume the proposal
will not have a direct fiscal impact on their organization.
Officials from the Department of Public Safety – Missouri Highway Patrol defer to Missouri
Department of Transportation for the potential fiscal impact of this proposal.
Officials from the City of Kansas City assume this legislation would have a negative fiscal
impact on Kansas City by increasing the number of workers compensation claims made against
the City.
Officials from the City of Springfield assume the proposal would have a direct fiscal impact on
their organization and the City of Springfield estimates a negative fiscal impact of $500,000 per
year from this bill based on estimated increased claims.
Oversight notes that for purpose of this note “first responders” defined in RSMo 67.145.2 as
“emergency first responders, police officers, sheriffs, deputy sheriffs, firefighters, ambulance
attendants and attendant drivers, emergency medical technicians, mobile emergency medical
technicians, emergency medical technician-paramedics, registered nurses, or physicians.”
Oversight notes that according to the U.S National Library of Medicine – National Institute of
Health, the rates of PTSD among firefighters appear elevated, with point prevalence estimates
ranging from 6.5% to 30%. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5825264/
Oversight estimates there to be around 25,000 fire fighters, police officers, EMTs and
Paramedics in the State of Missouri according the Bureau of Labor Statistics 2020.
Oversight notes that if only 6.5 % of the above group are diagnosed with PTSD it would
represent 1,625 first responders with PTSD.
A study by Rand Company found that the annual cost ranges from about $1,160 to $4,724 per
person (though this data is from 2008, Tanielian says there is little reason to think that these
numbers would have changed significantly). https://www.marketwatch.com/story/what-ptsd-
costs-families-2014-04-04
Additionally, the total annual cost for health care for a veteran who had PTSD was estimated to
be $11,342, which was more than double the annual VA health care cost of a veteran without L.R. No. 3723H.01I
Bill No. HB 1640
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PTSD; 73.1% of health care costs for veterans who had PTSD was for non-mental health
services (Watkins et al., 2011). https://www.ncbi.nlm.nih.gov/books/NBK224872/
Oversight notes that above estimated amount indicates the total price is a partially mental health
and partially non-mental health services. The actual cost for only mental health service is as
follows:
Total PTSD expense per person $ 11,342 -Non-mental health services (73.1%) $ 8,291 =Mental health services cost only $ 3,051
Oversight notes that for purpose of this fiscal note the Oversight will estimate the cost using the
Rand study.
Oversight notes that using the lower spectrum of those affected with PTSD (6.5%), within the
first responder sub group (firefighters) could potentially require additional cost ranging from
$1,885,000 (1,625*$1,160) to $7,676,500 (1,625*$4,724) to the local political subdivisions.
Oversight notes the City of Kansas City and City of Springfield both assume the proposal will
have a direct fiscal impact on their organization. Oversight does not have any information to the
contrary. Therefore, Oversight will reflect a range the impact from $0 (no cases of PTSD are
diagnosed) to a negative unknown (the employees are diagnosed with PTSD) in the fiscal note.
Officials from the City of Hughesville, the Phelps County Sheriff Department, and the
Crawford County 911 Board each assume the proposal would not have a direct fiscal impact
on their respective organization.
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) notes 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. 3723H.01I
Bill No. HB 1640
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Oversight only reflects the responses received from state agencies and political subdivisions;
however, other political subdivisions were requested to respond to this proposed legislation but
did not. A listing of political subdivisions included in the Missouri Legislative Information
System (MOLIS) database is available upon request.
FISCAL IMPACT –
State Government
FY 2023
(10 Mo.)
FY 2024FY 2025GENERAL
REVENUE FUND
Cost - payments to
treat PTSD cases$0 to (Unknown)$0 to (Unknown)$0 to (Unknown)
NET ESTIMATED
EFFECT ON THE
GENERAL
REVENUE FUND
$0 to (Unknown)$0 to (Unknown)$0 to (Unknown)
FISCAL IMPACT –
Local Government
FY 2023
(10 Mo.)
FY 2024FY 2025LOCAL
POLITICAL
SUBDIVISION
Cost – payments to
treat PTSD cases $0 to (Unknown)$0 to (Unknown)$0 to (Unknown)
NET ESTIMATED
EFFECT ON
LOCAL
POLITICAL
SUBDIVISION$0 to (Unknown)$0 to (Unknown)$0 to (Unknown)
FISCAL IMPACT – Small Business
This proposal would not fiscally impact small businesses. L.R. No. 3723H.01I
Bill No. HB 1640
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FISCAL DESCRIPTION
This bill recognizes Posttraumatic Stress Disorder (PTSD) as an occupational disease, under
Chapter 287, RSMo dealing with Workers Compensation, when diagnosed in specified first
responders.
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 Labor and Industrial Relations
Office of Administration – Budget & Planning
Office of Administration
Office of Administration – Administrative Hearing Commission
Department of Commerce and Insurance
Department of Economic Development
Department of Elementary and Secondary Education
Higher Education and Workforce Development
Department of Natural Resources
Department of Corrections
Department of Revenue
Department of Public Safety –
Missouri Department of Agriculture
Missouri Department of Conservation
Missouri Department of Transportation – Patrol Employees’ Retirement System Petroleum
Storage Tank Insurance Fund
Office of the State Public Defender
Department of Mental Health
Department of Health and Senior Services
Missouri Department of Transportation
Office of the Secretary of State
Joint Committee on Administrative Rules
City of Kansas City
City of Springfield
City of Hughesville
Phelps County Sheriff Department
Crawford County 911 Board L.R. No. 3723H.01I
Bill No. HB 1640
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Julie MorffRoss StropeDirectorAssistant DirectorMarch 25, 2022March 25, 2022