COMMITTEE ON LEGISLATIVE RESEARCH
OVERSIGHT DIVISION
FISCAL NOTE
L.R. No.:0039S.05F Bill No.:SS for HCS for HB Nos. 115 & 99 Subject:Health Care Professionals; Physical Therapists; Physicians; Professional
Registration and Licensing; Health Care; Nurses; Mental Health; Health Care;
Drugs and Controlled Substances; Pharmacy
Type:Original Date:April 5, 2023Bill Summary:This proposal modifies provisions relating to licensing of health care
professionals.
FISCAL SUMMARY
ESTIMATED NET EFFECT ON GENERAL REVENUE FUNDFUND AFFECTEDFY 2024FY 2025FY 2026
General 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 2026Committee of
Professional
Counselors Fund$0 or ($3,000-$6,000)$0 or ($3,000-$6,000)$0 or ($3,000-$6,000)
Total Estimated Net
Effect on Other State
Funds$0 or ($3,000-$6,000)$0 or ($3,000-$6,000)$0 or ($3,000-$6,000)
Numbers within parentheses: () indicate costs or losses. L.R. No. 0039S.05F
Bill No. SS for HCS for HB Nos. 115 & 99
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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. 0039S.05F
Bill No. SS for HCS for HB Nos. 115 & 99
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FISCAL ANALYSIS
ASSUMPTION
Sections 195.070, 335.016 - 335.175 - APRN Provisions
In response to a similar proposal from this year (HB 330), officials from the Department of
Commerce and Insurance, the Department of Health and Senior Services and the
Department of Social Services each assumed 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.
Oversight contacted DCI officials and learned there are currently 14,673 registered APRNs in
Missouri. APRNs are required to pay a one-time fee of $150 for recognition of their APRN
status. DCI officials state this proposal does not change the fee structure or requirements related
to APRNs. The proposal instead changes the current APRN recognition model to a licensure
model.
Sections 334.100, 334.506 and 334.613
In response to a previous version, officials from the Department of Social Services (DSS)
assumed 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. L.R. No. 0039S.05F
Bill No. SS for HCS for HB Nos. 115 & 99
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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
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.
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.
Sections 337.510 - 337.550 – Counseling Interstate Compact L.R. No. 0039S.05F
Bill No. SS for HCS for HB Nos. 115 & 99
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In response to a similar proposal from this year (SB 70), officials from the Department of
Commerce and Insurance (DCI) stated it is uncertain if the compact would be enacted in
FY24, FY25 or FY26. Once the compact is enacted the Division would have the following fiscal
impact: $3,000 to $6,000 estimated annual fees to participate in the compact.
Oversight does not have any information to the contrary. Therefore, Oversight will reflect the
estimated fiscal impact as a range of $0 (the compact is not enacted) to $3,000 - $6,000 (the
compact is enacted) to the Committee of Professional Counselors Fund (0672).
Sections 338.010 - 338.012 – Administration of Medication
In response to a similar proposal from this year (SB 41), officials from the Department of
Commerce and Insurance assumed the proposal will have no fiscal impact on their
organization.
In response to a similar proposal from this year (SB 41), officials from Department of Health
and Senior Services assumed the proposal will have no fiscal impact on their organization.
Oversight notes that the above mentioned agencies have stated the proposal would not have a
direct fiscal impact on their organizations. Oversight does not have any information to the
contrary. Therefore, Oversight will reflect a zero impact on the fiscal note for these sections.
Bill as a whole:
Officials from the Office of Administration - Administrative Hearing Commission and the
Department of Public Safety - Missouri Highway Patrol 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 L.R. No. 0039S.05F
Bill No. SS for HCS for HB Nos. 115 & 99
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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.
FISCAL IMPACT – State GovernmentFY 2024
(10 Mo.)
FY 2025FY 2026GENERAL REVENUE FUNDCost – DSS §334.100 p.4-5 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 §334.100 p.4-5 Increase in Managed Care Capitation
Rates$66,005$69,569$73,326
Actuarial Study$25,000$0$0Cost - DSS §334.100 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 L.R. No. 0039S.05F
Bill No. SS for HCS for HB Nos. 115 & 99
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FISCAL IMPACT – State Government
(continued)
FY 2024
(10 Mo.)
FY 2025FY 2026COMMITTEE OF
PROFESSIONAL COUNSELORS
FUND (0672)
Cost – DCI p.3
Counseling Interstate Compact fees
(§§337.510-337.550)
$0 or ($3,000-
$6,000)
$0 or ($3,000-
$6,000)
$0 or ($3,000-
$6,000)
ESTIMATED NET EFFECT TO
THE COMMITTEE OF
PROFESSIONAL COUNSELORS
FUND (0672)
$0 or ($3,000-
$6,000)
$0 or ($3,000-
$6,000)
$0 or ($3,000-
$6,000)
FISCAL IMPACT – Local GovernmentFY 2024
(10 Mo.)
FY 2025FY 2026$0$0$0
FISCAL IMPACT – Small Business
Small business physical therapists, pharmacists and Licensed Professional Counselors could
have a direct fiscal impact as a result of this proposal.
FISCAL DESCRIPTION
This proposal modifies provisions relating to licensing of health care professionals.
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 L.R. No. 0039S.05F
Bill No. SS for HCS for HB Nos. 115 & 99
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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 DirectorApril 5, 2023April 5, 2023