COMMITTEE ON LEGISLATIVE RESEARCH
OVERSIGHT DIVISION
FISCAL NOTE
L.R. No.:0337H.01I Bill No.:HB 336 Subject:Health, Public; Employees - Employers; Liability Type:Original Date:February 22, 2023Bill Summary:This proposal creates provisions relating to employer liability for injuries
from required immunizations.
FISCAL SUMMARY
ESTIMATED NET EFFECT ON GENERAL REVENUE FUNDFUND AFFECTEDFY 2024FY 2025FY 2026General Revenue*$0 or (Unknown)$0 or (Unknown)$0 or (Unknown)Total Estimated Net
Effect on General
Revenue$0 or (Unknown)$0 or (Unknown)$0 or (Unknown)
*Oversight assumes funding of potential injury claims required by immunizations from federal
vaccine mandates are unknown and could exceed $250,000 annually.
ESTIMATED NET EFFECT ON OTHER STATE FUNDSFUND AFFECTEDFY 2024FY 2025FY 2026
Legal Expense Fund*$0$0$0
Other State Funds$0 or (Unknown)$0 or (Unknown)$0 or (Unknown)Total Estimated Net
Effect on Other State
Funds$0 or (Unknown)$0 or (Unknown)$0 or (Unknown)
*Oversight assumes net effect on the Legal Expense Fund will be $0.
Numbers within parentheses: () indicate costs or losses. L.R. No. 0337H.01I
Bill No. HB 336
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ESTIMATED NET EFFECT ON FEDERAL FUNDSFUND AFFECTEDFY 2024FY 2025FY 2026All Federal Funds*$0 or (Unknown)$0 or (Unknown)$0 or (Unknown)Total Estimated Net
Effect on All Federal
Funds$0 or (Unknown)$0 or (Unknown)$0 or (Unknown)
*The potential “(Unknown)” fiscal impact to various state agencies could be quite substantial,
depending upon decisions by the courts and actions taken by the federal government.
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 Political
Subdivisions$0 or (Unknown)$0 or (Unknown)$0 or (Unknown)Local Government$0 or (Unknown)$0 or (Unknown)
$0 or (Unknown) L.R. No. 0337H.01I
Bill No. HB 336
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FISCAL ANALYSIS
ASSUMPTION
§537.1405 – Required Immunization Liability Act
Officials from the Department of Mental Health (DMH) state this proposal creates provisions
relating to employer liability for injuries from required immunizations. Section 537.1405 states
this section shall be known as the “Required Immunization Liability Act.” CMS expects all
facilities’ staff to have received vaccination unless exempted as required by law. Facility staff
vaccination rates under 100% constitute non-compliance (CMS guidance QSO-23-02-ALL).
CMS rule currently allows for exemption in certain circumstances. However, in the event that
CMS removes exemption option for vaccination, this may put some DMH facilities and agencies
at odds with federal requirements for licensure and/or CMS funding. Fiscal impact unknown.
Officials from the Department of Revenue defer to the Office of Administration for the
potential fiscal impact of this proposal.
Officials from the Office of Administration assume this proposal has the potential to increase
costs to the state Legal Expense Fund (LEF) for actions alleging violation by a state employee in
connection with their official duties on behalf of the state. The amount of the potential costs
resulting from this proposal cannot be reasonably estimated as this language creates new legal
standards, subject to judicial interpretation, and there is no readily available information that
could assist in forming a rational basis for estimating costs. In addition, the number of potential
claims, the severity of those claims, and the ultimate costs associated with any settlement or
judgment resulting from those claims cannot be forecasted with any degree of assurance to their
accuracy.
The state self-assumes its own liability under the state LEF, Section 105.711 RSMo. It is a self-
funding mechanism whereby funds are made available for the payment of any claim or judgment
rendered against the state in regard to the waivers of sovereign immunity or against employees
and specified individuals. Investigation, defense, negotiation or settlement of such claims is
provided by the Office of the Attorney General. Payment is made by the Commissioner of
Administration with the approval of the Attorney General.
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. 0337H.01I
Bill No. HB 336
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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.
Oversight assumes the SOS could absorb the costs of printing and distributing regulations
related to this proposal. If multiple bills pass which require the printing and distribution of
regulations at substantial costs, the SOS could request funding through the appropriation process.
Officials from the University of Missouri System (UM) assume the proposal would create a
new potential source of liability for the UM, however it is not possible to identify a significant
fiscal impact at this time.
Officials from the City of Kansas City assume a negative impact from this proposal in an
indeterminate amount by increasing the City’s exposure to liability.
In response to similar legislation from 2022, Perfected HB 1692, officials from the Dent County
Health Department (DCHD) stated should such a liability be incurred, DCHD would expect
costs to cover said liability. In addition, this legislation would further reduce DCHD's ability to
mitigate the impact of COVID-19, increasing personnel costs and reducing DCHD ability to
deliver services.
In response to similar legislation from 2022, Perfected HB 1692, officials from the St. Louis
County Health Department assumed an unknown impact from this proposal.
Officials from the St. Joseph Police Department state there could potentially be a fiscal impact
if the city/department were to require employees to receive immunizations and someone was
injured from that.
Officials from the Kansas City Employees’ Retirement System, the Kansas City
Supplemental Retirement PlanKansas City Firefighter’s Pension System each
assume a negative impact on the City of Kansas City in an indeterminate amount by increasing
the City’s exposure to liability.
Officials from the University of Central Missouri
the uncertainty of application from this proposal.
Officials from the Missouri Western State University
the amount of the litigation, if any, is unknown.
Officials from the Northwest Missouri State University state the financial impact would be
dependent on the extent of the employees’ injury or damage from the required immunization.
The University assumes an impact of $20,000.
Officials from the Camden County Auditor’s Office assume a negative fiscal impact from this
proposal. L.R. No. 0337H.01I
Bill No. HB 336
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Officials from the Little Blue Valley Sewer District
their organization. Oversight notes the district did not state whether the impact was positive or
negative.
Oversight notes the United States Supreme court ruled that vaccine mandates could only be
required for health care entities receiving federal Medicare and Medicaid funds. Oversight notes
the number of potential claims, the severity of those claims, and the ultimate costs associated
with any settlement or judgment resulting from those claims cannot be accurately forecasted.
Therefore, Oversight will reflect a negative impact of $0 to unknown that could exceed $250,000
in General Revenue, other State Funds, Colleges and Universities for various agencies. Oversight
will also reflect the same impact for local political subdivisions, as there could be increased
liability for potential legal fees and additional insurance coverage needed that will need to be
acquired by these local political subdivisions. Oversight assumes that the net fiscal impact on the
Legal Expense Fund (LEF) will be $0. Transfers in from the General Revenue Fund, Federal
Funds and from other State Funds will offset increased payments from the LEF to successful
plaintiffs.
Officials from the Public Schools and Education Employee Retirement Systems
(PSRS/PEERS) assumes no substantial fiscal or operational impact from this proposal.
PSRS/PEERS provide retirement benefits to more than 130,000 active members and nearly
103,000 retired Missouri public school teachers, school employees, and their families. The total
invested assets of both PSRS and PEERS were $53.5 billion as of June 30, 2022, making the
combined entity larger than all other public retirement plans in the state combined, and the 46th
largest institutional investor in the United States.
Officials from the Attorney General’s Office, the Office of Administration - Administrative
Hearing Commission, the Office of Administration - Budget and PlanningDepartment
of Labor and Industrial Relations, the Department of Commerce and Insurance, the
Department of Economic DevelopmentDepartment of Elementary and Secondary
Education, the Department of Higher Education and Workforce Development, the
Department of Health and Senior Services, the Department of Natural Resources, the
Department of Corrections, the Department of Public Safety’s Division of Alcohol and
Tobacco Control, Capitol Police, Fire Safety, Office of the Director, Missouri Gaming
Commission, Missouri National Guard and the Missouri Highway Patrol, the State
Emergency Management Agency, the Missouri Veterans Commission, the Department of
Social Services, the Missouri Department of Agriculture, the Missouri Department of
Conservation, the Missouri Ethics Commission, the Missouri Department of
Transportation, the MoDOT & Patrol Employees’ Retirement System, the Petroleum
Storage Tank Insurance Fund, the Office of the State Public Defender, the Office of the
GovernorOffice of the State Auditor, the Missouri House of Representatives, the Joint
Committee on Administrative Rules, the Joint Committee on EducationJoint
Committee on Public Employee Retirement, Legislative Research, the Oversight Division,
the Missouri SenateMissouri Lottery, the Missouri Consolidated Health Care Plan, the L.R. No. 0337H.01I
Bill No. HB 336
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Missouri Higher Education Loan Authority, the Missouri Office of Prosecution Services,
the Missouri State Employee's Retirement System, the Office of the Lieutenant Governor
the Office of the State Courts Administrator and the State Tax Commission 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.
Officials from the City of Claycomo, the City of O’Fallon, the City of Springfield, the
Jackson County Board of ElectionsPlatte County Board of Elections, the St. Louis City
Board of Elections, the St. Louis County Board of Elections, the Newton County Health
Department, the Lincoln County Assessor’s Office, the Christian County Auditor’s Office,
the Clay County Auditor’s Office, the Phelps County Sheriff’s OfficeKansas City
Police Department, the St. Louis County Police Department, the Hannibal Rural Fire
Protection District, the Cole Camp Ambulance District, the Nodaway County Ambulance
District, the County Employees Retirement FundKansas City Police Retirement
System, the Kansas City Civilian Police Employees’ Retirement, the Kansas City Public
School Retirement System, the Public Education Employees’ Retirement System, the
Sheriff’s Retirement System, the Blackwater Reorganized Common Sewer District, the
Lexington Water/WastewaterMorgan County PWSD #2, the St. Charles County
PWSD #2, the Wayne County PWSD #2, the Metropolitan St. Louis Sewer District
South River Drainage District, St. Charles Community College and the Hancock Street
Light District 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.
In response to similar legislation from 2022, Perfected HB 1692, officials from the Office of the
State Treasurer, the City of Hughesville, the City of Urich, the St. Charles County Board of
Elections, the Kansas City Health Department, the Gasconade County Assessor’s Office
Greene County, the Springfield Police DepartmentCarroll County 911 Board, the
Crawford County 911 Board, the Eastern Clay Ambulance District, the McDonald County
911 Board, the Lake West Ambulance DistrictRock Community FPD Retirement Plan,
the Spanish Lake FPD Retirement Plan, the St. Louis City Firefighter’s Retirement Plan,
the Metro St. Louis Sewer District Employees Pension Plan, the St. Joseph Policemen’s
Pension Fund, the Howard County C-PWSD #1, the Vernon County PWSD #7, the
Hermann Area Hospital District, the Hughesville Water/Wastewater District, the St. Louis-
Jefferson Solid Waste Management District, and the Missouri State University
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 only reflects the responses received from state agencies and political subdivisions;
however, other cities, counties, local election authorities, county health departments, recorder of
deeds offices, nursing homes, assessors, county auditors, circuit clerks, collectors, county
prosecutors, treasurers, public administrators, local law enforcement, fire protection districts, L.R. No. 0337H.01I
Bill No. HB 336
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ambulance districts, retirement agencies, schools, colleges, utility departments, hospitals and
electric companies and coops were requested to respond to this proposed legislation but did not.
A listing of political subdivisions included in the Missouri Legislative Information System
database is available upon request.
FISCAL IMPACT – State GovernmentFY 2024
(10 Mo.)
FY 2025FY 2026GENERAL REVENUE FUNDCosts – State Agencies – (§537.1405)
Potential funding to pay claims related
to injuries from required immunizations
from federal vaccine mandates (p.5)
$0 or
(Unknown)
$0 or
(Unknown)
$0 or
(Unknown)
ESTIMATED NET EFFECT ON
THE GENERAL REVENUE FUND
$0 or
(Unknown)
$0 or
(Unknown)
$0 or
(Unknown)
OTHER STATE FUNDSCosts – State Agencies – (§537.1405)
Potential funding to pay claims related
to injuries from required immunizations
from federal vaccine mandates (p.5)
$0 or
(Unknown)
$0 or
(Unknown)
$0 or
(Unknown)
ESTIMATED NET EFFECT ON
OTHER STATE FUNDS
$0 or
(Unknown)
$0 or
(Unknown)
$0 or
(Unknown)
FEDERAL FUNDSCosts – State Agencies – (§537.1405)
Potential funding to pay claims related
to injuries from required immunizations
from federal vaccine mandates (p.5)
$0 or
(Unknown)
$0 or
(Unknown)
$0 or
(Unknown)
ESTIMATED NET EFFECT ON
FEDERAL STATE FUNDS
$0 or
(Unknown)
$0 or
(Unknown)
$0 or
(Unknown) L.R. No. 0337H.01I
Bill No. HB 336
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FISCAL IMPACT – State GovernmentFY 2024
(10 Mo.)
FY 2025FY 2026LEGAL EXPENSE FUND (LEF)Income – State Agencies – (§537.1405)
Transfers-in to pay claims related to
injuries from required immunizations
from federal vaccine mandates
$0 or
(Unknown)
$0 or
(Unknown)
$0 or
(Unknown)
Costs – (§537.1405)
Potential claims related to injuries from
required immunizations from federal
vaccine mandates (p.3)
$0 or
(Unknown)
$0 or
(Unknown)
$0 or
(Unknown)
ESTIMATED NET EFFECT ON
THE LEGAL EXPENSE FUND$0$0$0
FISCAL IMPACT – Local GovernmentFY 2024
(10 Mo.)
FY 2025FY 2026LOCAL POLITICAL
SUBDIVISIONS
Costs – State Agencies – (§537.1405)
Potential legal expenses and additional
insurance coverage need relating to
injury claims from required
immunizations from federal vaccine
mandates (p.5)
$0 or
(Unknown)
$0 or
(Unknown)
$0 or
(Unknown)
ESTIMATED NET EFFECT ON
THE LOCAL POLITICAL
SUBDIVISIONS
$0 or
(Unknown)
$0 or
(Unknown)
$0 or
(Unknown)
FISCAL IMPACT – Small Business
There could be an increase in costs to small businesses because these injuries would be taken
outside of the workers compensation system. (§537.1405)
FISCAL DESCRIPTION
This bill establishes the "Required Immunization Liability Act", which states that an employer
that requires its employees to receive an immunization as a condition of employment shall be L.R. No. 0337H.01I
Bill No. HB 336
Page 9 of
February 22, 2023
NM:LR:OD
liable for damages or injury resulting from the required immunization. In addition, an employer
can purchase insurance to cover and protect the employer and its employees from liability.
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 Health and Senior Services
Department of Mental Health
Department of Labor and Industrial Relations
Missouri Veterans Commission
Office of Administration
Office of the Secretary of State
University of Missouri System
City of Kansas City
Dent County Health Department
St. Louis County Health Department
Kansas City Employees’ Retirement System
Kansas City Supplemental Retirement Plan
Kansas City Firefighter’s Pension System
Kansas City Public School Retirement System
University of Central Missouri
Attorney General’s Office
Office of Administration
Department of Commerce and Insurance
Department of Economic Development
Department of Elementary and Secondary Education
Department of Higher Education and Workforce Development
Department of Natural Resources
Department of Corrections
Department of Revenue
Department of Public Safety
Department of Social Services
Missouri Department of Agriculture
Missouri Department of Conservation
Missouri Ethics Commission
Missouri Department of Transportation
MoDOT & Patrol Employees’ Retirement System
Petroleum Storage Tank Insurance Fund
Office of the State Public Defender
Office of the Governor
Office of the State Auditor
Office of the State Treasurer L.R. No. 0337H.01I
Bill No. HB 336
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Missouri House of Representatives
Office of the Lieutenant Governor
Joint Committee on Administrative Rules
Joint Committee on Education
Joint Committee on Public Employee Retirement
Legislative Research
Oversight Division
Missouri Senate
Missouri Lottery
Missouri Consolidated Health Care Plan
Missouri Higher Education Loan Authority
Missouri Office of Prosecution Services
Missouri State Employee's Retirement System
Office of the State Courts Administrator
State Tax Commission
City of Claycomo
City of Hughesville
City of O’Fallon
City of Springfield
City of Urich
Jackson County Board of Elections
Platte County Board of Elections
St. Charles County Board of Elections
St. Louis City Board of Elections
St. Louis County Board of Elections
Kansas City Health Department
Newton County Health Department
Mississippi County Recorder of Deeds
Gasconade County Assessor’s Office
Lincoln County Assessor’s Office
Camden County Auditor’s Office
Christian County Auditor’s Office
Clay County Auditor’s Office
Greene County
Phelps County Sheriff’s Office
St. Joseph Police Department
Kansas City Police Department
Springfield Police Department
St. Louis County Police Department
Cole Camp Ambulance District
Carroll County 911 Board
Crawford County 911 Board
Eastern Clay Ambulance District
McDonald County 911 Board L.R. No. 0337H.01I
Bill No. HB 336
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Nodaway County Ambulance District
County Employees Retirement Fund
Kansas City Police Retirement System
Lake West Ambulance District
Rock Community FPD Retirement Plan
Spanish Lake FPD Retirement Plan
St. Louis City Firefighter’s Retirement Plan
Metro St. Louis Sewer District Employees Pension Plan
Sheriff’s Retirement System
St. Joseph Policemen’s Pension Fund
Hughesville Water/Wastewater District
Metropolitan St. Louis Sewer District
South River Drainage District
St. Louis-Jefferson Solid Waste Management District
Missouri State University
St. Charles Community College
Hancock Street Light District
Howard County C-PWSD #1
Morgan County PWSD #2
St. Charles County PWSD #2
Vernon County PWSD #7
Hermann Area Hospital District
Hannibal Rural Fire Protection District
Kansas City Public School Retirement System
Public Education Employees’ Retirement System
Kansas City Civilian Police Employees’ Retirement
Blackwater Reorganized Common Sewer District
Lexington Water/Wastewater
Little Blue Valley Sewer District
Wayne County PWSD #2
Missouri Western State University
Northwest Missouri State University
Julie MorffRoss StropeDirectorAssistant DirectorFebruary 22, 2023February 22, 2023