COMMITTEE ON LEGISLATIVE RESEARCH
OVERSIGHT DIVISION
FISCAL NOTE
L.R. No.:4497H.01I Bill No.:HB 2004 Subject:Physicians; Professional Registration and Licensing Type:Original Date:March 22, 2022Bill Summary:This proposal establishes Missouri as a member of the Interstate Medical
Licensure Compact.
FISCAL SUMMARY
ESTIMATED NET EFFECT ON GENERAL REVENUE FUNDFUND AFFECTEDFY 2023FY 2024FY 2025Total Estimated Net
Effect on General
Revenue $0$0$0
ESTIMATED NET EFFECT ON OTHER STATE FUNDSFUND AFFECTEDFY 2023FY 2024FY 2025Board of Registration
for the Healing Arts
Fund (0634)
$0 or
(Could be less than
$615,020)
$0 or
(Could be less than
$696,932)
$0 or
(Could be less than
$707,887)
Total Estimated Net
Effect on Other State
Funds
$0 or
(Could be less than
$615,020)
$0 or
(Could be less than
$696,932)
$0 or
(Could be less than
$707,887)
Numbers within parentheses: () indicate costs or losses. L.R. No. 4497H.01I
Bill No. HB 2004
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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 2025Board of Registration
for the Healing Arts
Fund (0634)
Up to 9 FTEUp to 9 FTEUp to 9 FTETotal Estimated Net
Effect on FTE
Up to 9 FTEUp to 9 FTEUp to 9 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
FISCAL ANALYSIS L.R. No. 4497H.01I
Bill No. HB 2004
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ASSUMPTION
Section 334.290 Interstate Medical Licensure Compact
Officials from the Department of Commerce and Insurance (DCI) state that this legislative
language establishes Missouri as a member of the Interstate Medical Licensure Compact.
DCI assumes the following:
Licensee/Revenue
225 State of principal licensure applications (Board Estimate)
$300 License Fee
$75 Renewal Fee
175 Applications for letters of qualification (Board Estimate)
$75 Fee (one time)
225 State of principal licensure applicants and 175 applications for letter of qualification.
fees will be adjusted accordingly
In summary, DCI assumes a revenue of $80,625 ($225 applicants x $300 fee + 175 applicants for
letters of qualification x $75 onetime fee) in FY 2023, $19,350 in FY 2024 and $19,875 in FY
2025 to the Board of Registration for the Healing Arts Fund (0634) as a result of the changes in
this proposal.
The following board-specific expenses are being calculated to determine the additional
appropriation needed by the division to support the board and to assist in calculating the
anticipated license and renewal fees.
Staffing
2 Legal Counsel ($69,677/annually) needed to assist with implementation of the program
by assisting with any rules that are deemed necessary, responding to legal questions
pertaining to the qualifications for licensure, compact and investigations. Prepare
documents for disqualified applicants who appeal the Board’s decision and serve as legal
advisors to the Board and its staff.
1 Paralegal ($40,050/annually) to assist legal counsel with the duties listed above. L.R. No. 4497H.01I
Bill No. HB 2004
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1 Customer Service Supervisor ($38,300/annually) to oversee the implementation of the
compact licensure process and serve as a liaison to the Board, board staff and IMLCC.
4 Customer Service Representative ($30,700/annually) needed to provide technical support,
process applications for licensure, and respond to inquiries related to the licensure law
and/or rules and regulations.
1 Non Commissioned Investigator ($46,000/annually) needed to conduct investigations and
inspections, serve notices, and gather information required by the board.
Complaints and Investigations
It is estimated the board will receive approximately 7 complaints. The division does not
anticipate receiving any complaints until FY 2024. It is estimated 30% of the complaints filed
will require field investigations with 50% requiring overnight travel. One car is needed to
conduct investigations and will need to be eventually replaced based upon usage. Therefore, the
vehicle cost is considered an ongoing expense and appropriation need.
Interstate Commission Annual Fee
The board anticipates a cost of $10,000 annually from each member state to cover the cost of the
operations of the Interstate Commission and its staff.
In summary, DCI assumes a cost of $695,645 in FY 2023, $716,282 in FY 2024 and $727,762 in
FY 2025 to provide for the implementation of the changes in this proposal.
Oversight assumes DCI is provided with core funding to handle a certain amount of activity
each year. Oversight assumes DCI could absorb some of the FTE costs related to this proposal.
Therefore, Oversight will reflect the cost and the FTE as “up to” the estimate provided by DCI to
the Professional Registration Fee Fund (0689).
Oversight will also reflect a possibility that not enough other states join the Compact - $0 impact
to Missouri until that threshold is reached.
Oversight notes that the balance in the Board of Registration for the Healing Arts Fund (0634)
was $9,582,993 as of February 2022.
Officials from the Department of Health and Senior Services, the Department of Mental
Health and the Department of Social Services 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. L.R. No. 4497H.01I
Bill No. HB 2004
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FISCAL IMPACT – State GovernmentFY 2023
(10 Mo.)
FY 2024FY 2025BOARD OF REGISTRATION FOR
THE HEALING ARTS FUND (0634)
Revenue – DCI -§334.290
interstate medical licensure compact
$0 or $80,625$0 or $19,350$0 or $19,875Cost – DCI - §334.290$0 or ….$0 or….$0 or….. Personal Service(Up to
$322,087)
(Up to
$394,234)
(Up to
$402,119)
Fringe Benefits(Up to
$218,941)
(Up to
$265,320)
(Up to
$267,963)
Equipment and Expense(Up to
$141,341)
(Up to
$43,370)
(Up to
$44,238)
Other Fund Cost(Up to
$13,276)
(Up to
$13,358)
(Up to
$13,442)
Total Cost – DCIUp to
($695,645)
(Up to
$716,282)
(Up to
$727,762)
FTE Change – DCIUp to 9 FTEUp to 9 FTEUp to 9 FTEESTIMATED NET EFFECT ON
BOARD OF REGISTRATION FOR
THE HEALING ARTS FUND (0634)
$0 or (Could
be less than
$615,020)
$0 or
(Could be less
than $696,932)
$0 or
(Could be less
than $707,887)
Estimated Net FTE Change to the
Board of Registration for the Healing
Arts Fund (0634)
Up to 9 FTEUp to 9 FTEUp to 9 FTEFISCAL IMPACT – Local GovernmentFY 2023
(10 Mo.)
FY 2024FY 2025$0$0$0
FISCAL IMPACT – Small Business
A fiscal impact to small businesses who employ physicians with an expedited license could be
expected as a result of this proposal. L.R. No. 4497H.01I
Bill No. HB 2004
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FISCAL DESCRIPTION
This bill adopts the "Interstate Medical Licensure Compact". The Compact allows a physician
who meets the eligibility requirements to receive an expedited license. The state must perform a
criminal background check on an applicant and the state cannot require any additional
verification beyond primary-source verification of medical education or results of medical or
licensing examinations.
A physician may renew his or her expedited license as a member of the Compact.
The Compact establishes a confidential database of all physicians who have been granted an
expedited license or who have applied for an expedited license, for the purpose of allowing
member states to report disciplinary or investigatory information.
Member states may participate in joint investigations of physicians with other member states,
and any disciplinary action taken by one member state may subject the physician to discipline
with other member states. If a physician's license is revoked, surrendered, or relinquished in one
state, it shall automatically be placed on the same status in the other member states.
The Compact establishes the "Interstate Medical Licensure Compact Commission" to act as a
corporate and joint agency of the member states and to oversee and maintain administration of
the Compact. The Compact outlines procedures for any member state who fails to perform its
obligations of the Compact.
The Compact will only be effective once seven states have enacted legislation to join the
Compact.
The Compact outlines the procedure to withdraw from the Compact. The Compact supersedes all
other laws that conflict with provisions of the Compact.
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 Mental Health
Department of Social Services L.R. No. 4497H.01I
Bill No. HB 2004
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Julie MorffRoss StropeDirectorAssistant DirectorMarch 22, 2022March 22, 2022