COMMITTEE ON LEGISLATIVE RESEARCH
OVERSIGHT DIVISION
FISCAL NOTE
L.R. No.:0039H.03P Bill No.:Perfected HCS for HB Nos. 115 & 99 Subject:Physical Therapists; Professional Registration and Licensing Type:Original Date:February 9, 2023Bill Summary:This proposal modifies provisions relating to the scope of practice for
physical therapists.
FISCAL SUMMARY
ESTIMATED NET EFFECT ON GENERAL REVENUE FUNDFUND AFFECTEDFY 2024FY 2025FY 2026General Revenue
Fund
($58,995)($35,831)($37,766)
Total Estimated
Net Effect on
General Revenue($58,995)($35,831)($37,766)
ESTIMATED NET EFFECT ON OTHER STATE FUNDSFUND AFFECTEDFY 2024FY 2025FY 2026Total Estimated Net
Effect on Other State
Funds $0$0$0
Numbers within parentheses: () indicate costs or losses. L.R. No. 0039H.03P
Bill No. Perfected HCS for HB Nos. 115 & 99
Page 2 of
February 9, 2023
KC:LR:OD
ESTIMATED NET EFFECT ON FEDERAL FUNDSFUND AFFECTEDFY 2024FY 2025FY 2026Federal Funds*Total Estimated Net
Effect on All Federal
Funds $0$0$0
* Revenues and Expenses of about $70,000 per year Net to $0.
ESTIMATED NET EFFECT ON FULL TIME EQUIVALENT (FTE)FUND AFFECTEDFY 2024FY 2025FY 2026Total 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 2024FY 2025FY 2026Local Government$0$0$0 L.R. No. 0039H.03P
Bill No. Perfected HCS for HB Nos. 115 & 99
Page 3 of
February 9, 2023
KC:LR:OD
FISCAL ANALYSIS
ASSUMPTION
Officials from the Department of Social Services (DSS) assume his legislation revises Chapter
334, RSMo, by adding three sections that would allow physical therapists to treat patients
without a prescription or referral from an approved health care provider. 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 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.
It is assumed that the Managed Care capitation rates would increase at least $100,000 based on
this legislation. For FY25 and FY26, a 5.4% medical inflation rate was used. DSS estimates the L.R. No. 0039H.03P
Bill No. Perfected HCS for HB Nos. 115 & 99
Page 4 of
February 9, 2023
KC:LR:OD
actuarial cost to evaluate this program change to the Managed Care capitation rates to be no
more than $50,000.
FY24: Total - $150,000 (GR - $58,995; Federal - $91,005)
FY25: Total - $105,400 (GR - $35,831; Federal - $69,569)
FY26: Total - $111,092 (GR - $37,766; Federal - $73,326)
Oversight does not have any information to the contrary. Therefore, Oversight will reflect the
cost estimate provided by DSS in the fiscal note.
Officials from the Department of Commerce and Insurance, the Department of Health and
Senior Services, the Missouri Consolidated Health Care Plan and the Department of
Transportation each assume the proposal will have no fiscal impact on their respective
organizations.
In response to a previous version, officials from the Office of Administration - Administrative
Hearing Commission, the Missouri Department of Conservation, the City of O’Fallon, the
St. Louis Budget Division, the City of Springfield and Kansas City each assumed the proposal
will have no fiscal impact on their respective 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.
Officials from the Department of Public Safety - Missouri Highway Patrol defer to the
Missouri Department of Transportation for the potential fiscal impact of this proposal.
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 listing of
political subdivisions included in the Missouri Legislative Information (MOLIS) database is
available upon request.
House Amendment 1 – Oversight notes that none of the agencies impacted by the bill expects
this amendment to change their responses to the House Committee Substitute. L.R. No. 0039H.03P
Bill No. Perfected HCS for HB Nos. 115 & 99
Page 5 of
February 9, 2023
KC:LR:OD
FISCAL IMPACT – State GovernmentFY 2024
(10 Mo.)
FY 2025FY 2026GENERAL REVENUE FUNDCost – DSS Increase in Managed Care Capitation
Rates (state portion)
($33,995)($35,831)($37,766) Actuarial Study (state portion)($25,000)$0$0ESTIMATED NET EFFECT TO
THE GENERAL REVENUE FUND($58,995)($35,831)($37,766)
FEDERAL FUNDSRevenue - DSS Increase in Managed Care Capitation
Rates
$66,005$69,569$73,326 Actuarial Study$25,000$0$0Cost - DSS Increase in Managed Care Capitation
Rates (federal portion)
($66,005)($69,569)($73,326) Actuarial Study (federal portion)($25,000)$0$0
ESTIMATED NET EFFECT TO
FEDERAL FUNDS$0$0$0
FISCAL IMPACT – Local GovernmentFY 2024
(10 Mo.)
FY 2025FY 2026$0$0$0
FISCAL IMPACT – Small Business
Small business physical therapists could be impacted by this proposal. L.R. No. 0039H.03P
Bill No. Perfected HCS for HB Nos. 115 & 99
Page 6 of
February 9, 2023
KC:LR:OD
FISCAL DESCRIPTION
This bill changes the laws regarding physical therapists so that physical therapists no longer need
a prescription or referral from a doctor in order to evaluate and initiate treatment on a patient, as
long as the physical therapist has a Doctorate of Physical Therapy Degree or has five years of
clinical practice as a physical therapist. However, the bill does require a physical therapist to
refer to an approved health care provider any patient whose condition is beyond the physical
therapist's scope of practice, or any patient who does not demonstrate measurable or functional
improvement after 10 visits or 30 days, whichever occurs first.
The physical therapist must also consult with an approved health care provider before continuing
therapy if after 10 visits or 30 days, whichever occurs first, the patient has demonstrated
measurable or functional improvement from the physical therapy and the physical therapist
believes that continuation of physical therapy is necessary. Continued physical therapy must be
in accordance with any direction of the health care provider. The physical therapist must notify
the health care provider of continuing physical therapy every 30 days. The bill removes a
provision that allows the State Board of Registration for the Healing Arts to file a complaint
against a physical therapist who provides physical therapy without a prescription.
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
O’Fallon
Springfield
St. Louis Budget Division
Julie MorffRoss StropeDirectorAssistant DirectorFebruary 9, 2023