COMMITTEE ON LEGISLATIVE RESEARCH
OVERSIGHT DIVISION
FISCAL NOTE
L.R. No.:0039S.05T Bill No.:Truly Agreed To and Finally Passed 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:May 31, 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.05T
Bill No. Truly Agreed To and Finally Passed 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.05T
Bill No. Truly Agreed To and Finally Passed SS for HCS for HB Nos. 115 & 99
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FISCAL ANALYSIS
ASSUMPTION
Sections 195.070, 335.016 - 335.175 - APRN Provisions
Officials from the Department of Commerce and Insurance (DCI) state it is estimated that to
fully investigate and prosecute complaints, the board may need additional resources. An
unknown cost of up to $100,000 from the Board of Nursing Fund may be necessary, depending
on the number of cases and legal expenses that occur.
Oversight assumes because the potential for litigation is speculative that the Department of
Commerce and Insurance will not incur significant cost related to this proposal. If a fiscal impact
were to result, the DCI may request additional funding through the appropriation process.
(Oversight notes that the State Board of Nursing Fund (0635) had a balance of $11,442,483 as
of April 30, 2023.)
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
Officials from the Department of Social Services (DSS) assume this 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. L.R. No. 0039S.05T
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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
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.
Sections 337.510 - 337.550 – Counseling Interstate Compact
Officials from the Department of Commerce and Insurance (DCI) state 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).
Bill as a whole: L.R. No. 0039S.05T
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Officials from the Office of Administration - Administrative Hearing Commission, the
Department of Health and Senior Services, the Department of Public Safety - Missouri
Highway PatrolMissouri Department of Conservation, the Missouri Department of
Transportation, the Missouri Consolidated Health Care Plan, Kansas City and the City of
Springfield 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
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 L.R. No. 0039S.05T
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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$0ESTIMATED NET EFFECT TO
FEDERAL FUNDS$0$0$0
COMMITTEE 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. L.R. No. 0039S.05T
Bill No. Truly Agreed To and Finally Passed SS for HCS for HB Nos. 115 & 99
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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
Office of Administration - Administrative Hearing Commission
Department of Commerce and Insurance
Department of Health and Senior Services
Department of Social Services
Department of Public Safety - Missouri Highway Patrol
Missouri Consolidated Health Care Plan
Missouri Department of Conservation
Department of Transportation
Joint Committee on Administrative Rules
Office of the Secretary of State
Kansas City
City of Springfield
Julie MorffRoss StropeDirectorAssistant DirectorMay 31, 2023May 31, 2023