COMMITTEE ON LEGISLATIVE RESEARCH
OVERSIGHT DIVISION
FISCAL NOTE
L.R. No.:4042H.01I Bill No.:HB 2096 Subject:Physical Therapists; Professional Registration and Licensing Type:Original Date:January 18, 2022Bill Summary:This proposal modifies provisions relating to physical therapists.
FISCAL SUMMARY
ESTIMATED NET EFFECT ON GENERAL REVENUE FUNDFUND AFFECTEDFY 2023FY 2024FY 2025General Revenue
Fund ($59,052)($34,631)($35,220)
Total Estimated
Net Effect on
General Revenue($59,052)($34,631)($35,220)
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. 4042H.01I
Bill No. HB 2096
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ESTIMATED NET EFFECT ON FEDERAL FUNDSFUND AFFECTEDFY 2023FY 2024FY 2025Federal Funds*Total Estimated Net
Effect on All Federal
Funds $0$0$0
* Revenues and Expenses Net to $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 Government$0$0$0 L.R. No. 4042H.01I
Bill No. HB 2096
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FISCAL ANALYSIS
ASSUMPTION
In response to a similar proposal from this year (HB 1555), officials from the Department of
Social Services (DSS) assumed this legislation revises Chapter 334, RSMo, by changing two
sections that would allow physical therapists to treat patients without a prescription or referral
from an approved health care provider.
This legislation is almost identical to HB 367 (0770-01) from the 2021 session. Since this
legislation revises Chapter 334, RSMo, and since there is no specific exemption for physical
therapists that contract with the Health Maintenance Organizations (HMOs) that contact with the
state to provide health benefits to MO HealthNet managed Care members, it is assumed this will
apply to them.
The HMOs that contract with the state have current policies and procedures that outline
treatment guidelines for members for physical therapy services. This legislation revises current
language to remove the requirement for a prescription or referral from an approved healthcare
provider provided the physical therapist has a doctorate of physical therapy degree or has five
years of clinical practice as a physical therapist. In addition, this legislation revises language that
states consultation with an approved health care provider is not required if the course of physical
therapy services or treatment is completed within ten visits or twenty-one business days.
Providers enrolled with MO HealthNet must be licensed by the state in which they practice. In
order to receive reimbursement for services provided to a MO HealthNet participant, providers
must also be enrolled with the state as a MO HealthNet provider. Physical therapy services must
be prescribed by a primary care provider and is only a covered benefit for children. Additionally,
any service included in the Individualized Education Program (IEP) developed through the
public school is covered through Fee-For-Service.
Medicaid’s requirement for medical necessity of physical therapy services would be impacted if
the need for prescription and referral by a primary care provider (or specialist) were removed. By
removing this connection to the primary care/specialist provider, utilization for these services
will inevitably increase over time due to provider induced demand, potential for over treatment
(due to lack of utilization controls), and difficulty in enforcement. In addition, utilization
increases may be expected based on the use of in-office ancillary. Without the need for a script
or other utilization control, utilization increases may be anticipated as clinicians have the ability
to bill up to ten visits before they must seek further consult, and without an enforcement process,
it is assumed this type of behavior will increase. L.R. No. 4042H.01I
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It is assumed that the Managed Care capitation rates would increase at least $100,000 based on
this legislation. For FY23 and FY24, a 3.7% medical inflation rate was used. DSS estimates the
actuarial cost to evaluate this program change to the Managed Care capitation rates to be no
more than $50,000.
FY23: Total - $150,000 (GR - $59,052; Federal - $90,948)
FY24: Total - $101,700 (GR - $34,631; Federal - $67,069)
FY25: Total - $103,429 (GR - $35,220; Federal - $68,209)
Officials from the Department of Commerce and Insurance, the Department of Health and
Senior Services, the Missouri Consolidated Health Care Plan, the Department of
Transportation, the Department of Public SafetyMissouri Highway Patrol the City of
Springfield, Kansas City, the City of O’Fallon, and the St. Louis Budget Division
assume the proposal will have no fiscal impact on their respective organizations.
In response to a similar proposal from this year (HB 1555), officials from the Office of
Administration - Administrative Hearing Commission and the Missouri Department of
Conservation each assumed the proposal will have no fiscal impact on their organizations.
Oversight notes that the above mentioned agencies have stated the proposal would not have a
direct fiscal impact on their organization. Oversight does not have any information to the
contrary. Therefore, Oversight will reflect a zero impact on the fiscal note for these agencies.
Oversight only reflects the responses received from state agencies and political subdivisions;
however, counties were requested to respond to this proposed legislation but did not. A general
listing of political subdivisions included in Oversight’s database is available upon request. L.R. No. 4042H.01I
Bill No. HB 2096
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FISCAL IMPACT – State GovernmentFY 2023
(10 Mo.)
FY 2024FY 2025GENERAL REVENUE FUNDCost - DSS Increase in Managed Care Capitation
Rates (state portion)
($34,052)($34,631)($35,220) Actuarial Study (state portion)($25,000)$0$0
ESTIMATED NET EFFECT TO
THE GENERAL REVENUE FUND($59,052)($34,631)($35,220)
FEDERAL FUNDSRevenue - DSS Increase in Managed Care Capitation
Rates
$65,948$67,069$68,209 Actuarial Study$25,000$0$0Cost - DSS Increase in Managed Care Capitation
Rates (federal portion)
($65,948)($66,965)($68,371) Actuarial Study (federal portion)($25,000)$0$0
ESTIMATED NET EFFECT TO
FEDERAL FUNDS$0$0$0
FISCAL IMPACT – Local GovernmentFY 2023
(10 Mo.)
FY 2024FY 2025$0$0$0
FISCAL IMPACT – Small Business
Small business physical therapists could be impacted by this proposal.
FISCAL DESCRIPTION L.R. No. 4042H.01I
Bill No. HB 2096
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This bill allows physical therapist to evaluate and initiate treatment on a patient without a
prescription or referral from an approved health care provider.
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 Social Services
Missouri Consolidated Health Care Plan
Missouri Department of Conservation
Department of Transportation
Department of Public Safety - Missouri Highway Patrol
Kansas City
City of O’Fallon
City of Springfield
St. Louis Budget Division
Julie MorffRoss StropeDirectorAssistant DirectorJanuary 18, 2022January 18, 2022